Objective:To investigate the malignant potential of histopathological class B3 and B5a lesions by ultrasound-guided core needle biopsy (CNB).Methods:Retrospective analysis of the histopathological results of 712 breast lesions that successively underwent CNB process and surgical resection in the Shanghai General Hospital from January 2018 to December 2022, of which 47 lesions were reported as class B3 and 70 lesions as class B5a.Results:CNB identified 47 category B3 lesions, comprising 19 cases of atypical ductal hyperplasia, 17 papillary lesions, 8 phyllodes tumors, and 3 complex sclerosing lesions. Of these cases, surgical pathology was in full agreement with CNB pathology in 27 instances, indicating a concordance rate of 57.4% (27/47) and an inconsistency rate of 42.6% (20/47). Out of the 20 inconsistent cases, 70.0% (14/20) were upgraded based on the findings from the surgical pathology.Specifically, 4 cases of atypical ductal hyperplasia and 2 cases of intraductal papilloma were upgraded to invasive breast cancer (B5b) after surgery. Among the 4 cases with puncture pathology indicating atypical ductal hyperplasia and one complex sclerosing lesion, these five lesions were upgraded to ductal carcinoma in situ (B5a) after surgery. Two puncture pathologies were diagnosed as atypical ductal hyperplasia, and these were upgraded to ductal carcinoma in situ with microinvasion (B5b) after surgery. One puncture pathology indicated a borderline phyllodes tumor, and this was upgraded to malignant phyllodes tumor (B5b) after surgery. And 30.0% (6/20) resulted in downgrade after surgery, specifically 4 cases of atypical ductal hyperplasia, which were downgraded to breast adenopathy (B2). Of these, 1 puncture pathology was identified as atypical ductal hyperplasia and one as a borderline phyllodes tumor, which were both downgraded to fibroadenoma (B2). Seventy lesions were diagnosed as B5a lesions by CNB pathology, with 28 of them showing complete concurrence with the surgical pathology, a concordance rate of 40.0% (28/70), and an inconsistency rate of 60.0% (42/70). Of the 42 cases with discrepancies, all 42 were upgraded, yielding an upgrading rate of 100% (42/42). Of these, 21 were upgraded to ductal carcinoma in situ with microinvasion (B5b) and 21 to invasive breast cancer (B5b).Conclusions:Lesions with CNB pathology in categories B3 and B5a have a high rate of postoperative escalation. B3 and B5a lesions should be treated with considerable care, especially atypical ductal hyperplasia, which should be surgically resected, and CNB examination should be performed twice if necessary.

Objective:To compare the prosthesis locations and postoperative hip functions between supercapsular percutaneously-assisted total hip (SuperPATH) approach and traditional posterolateral approach (PLA) in total hip arthroplasty.Methods:A retrospective analysis was conducted of the 107 patients who had undergone unilateral total hip arthroplasty at Department of Orthopedic Surgery, The First Affiliated Hospital to Soochow University from August 2016 to February 2019. They were divided into 2 groups according to their surgical approaches. In the SuperPATH group of 54 cases, there were 20 males and 34 females with an age of (64.3±9.1) years; in the PLA group of 53 cases, there were 20 males and 33 females with an age of (62.2±10.6) years. The 2 groups were compared in terms of abduction angle, ratio of abduction angle to safety zone, anteversion angle, ratio of anteversion angle to safety zone, retroversion angle, incidence of retroversion, and differences in eccentricity and lower limb length on the first day after operation, and Harris hip scores at 1 week, 3 months and the last follow-up postoperatively. Their complications were also recorded as well.Results:There were no statistically significant differences in the preoperative general data between the 2 groups, showing comparability ( P>0.05). The postoperative imaging data were complete for the 107 patients who had been followed up satisfactorily for 14 to 36 months (average, 25 months). The SuperPATH group had significantly larger retroversion angle (13.6°±9.6°) and incidence of retroversion (18.5%, 10/54), significantly smaller difference in eccentricity [0.26 (0.13,0.49) cm], and significantly higher Harris hip score [(74.8±7.8) points] at one week after surgery than those in the PLA group [3.0°±1.0°; 5.7%, 3/53; 0.38 (0.13,0.70) cm; (72.0±6.7) points] ( P<0.05). There were no statistically significant differences between the 2 groups in abduction angle, ratio of abduction angle to safety zone, anteversion angle, ratio of anteversion angle to safety zone, difference in lower limb length, or Harris hip scores at 3 months or the last follow-up postoperatively (all P>0.05). Follow-ups in both groups observed no more than one case of dislocation which responded to manual reduction. Conclusion:The minimally invasive SuperPATH approach may obtain better femoral eccentricity and higher early hip function scores than the traditional posterolateral approach, but may lead to a higher incidence of retroversion after prosthesis placement.

Objective: To detect the viscoelasticity of carotid artery in healthy volunteers using ultrasonic shear wave dispersion (SWD) technique, and explore the feasibility and influencing factors for SWD parameters. Methods: Forty-five healthy volunteers were recruited and divided into elder group (≥50 years old) and younger group (<50 years old) according to the age. The carotid arteries were examined by SWD at systole, axial elastic modulus (SWE_R) and viscous index (SWD_R) were obtained. The pulse wave velocity (PWV), a carotid artery circumferential elastic parameter was obtained and considered as the reference indicator. The difference of SWE_R, SWD_R and PWV were compared between two groups; and the correlation between them were analyzed by Pearson analysis, respectively. Results: ①Compared with the younger group, the carotid PWV increased, while SWE_R and SWD_R decreased in the elder group(all P<0.05). ②In all subjects, SWE_R was negatively correlated with PWV (r=-0.256, P<0.05). In the elder group, SWE_R was negatively correlated with systolic blood pressure (r=-0.357, P<0.05), and SWD_R was negatively correlated with PWV (r=-0.393, P<0.05). In the younger group, SWD_R was positively correlated with systolic blood pressure (r=0.366, P<0.05). Conclusions Compared with the elder group, the carotid viscoelasticity was higher in young people, and it is correlated with PWV. SWD can evaluate carotid viscoelasticity, and contribute to better understanding of its tissue characteristics.

Objective To detect the viscoelasticity of carotid artery in healthy volunteers using ultrasonic shear wave dispersion ( SWD ) technique ,and explore the feasibility and influencing factors for SWD parameters . Methods Forty‐five healthy volunteers were recruited and divided into elder group ( ≥50 years old) and younger group ( ＜50 years old) according to the age . T he carotid arteries were examined by SWD at systole ,axial elastic modulus ( SWER ) and viscous index ( SWDR ) were obtained . T he pulse wave velocity ( PWV ) ,a carotid artery circumferential elastic parameter was obtained and considered as the reference indicator . T he difference of SWE R ,SWDR and PWV were compared between two groups ; and the correlation between them were analyzed by Pearson analysis ,respectively . Results ① Compared with the younger group ,the carotid PWV increased ,w hile SWE R and SWDR decreased in the elder group ( all P ＜0 .05) . ②In all subjects ,SWER was negatively correlated with PWV ( r ＝ －0 .256 , P ＜ 0 .05 ) . In the elder group ,SWER was negatively correlated with systolic blood pressure ( r ＝ －0 .357 , P ＜ 0 .05 ) ,and SWDR was negatively correlated with PWV ( r ＝ －0 .393 , P ＜0 .05 ) . In the younger group ,SWDR was positively correlated with systolic blood pressure ( r ＝0 .366 , P ＜0 .05) . Conclusions Compared with the elder group ,the carotid viscoelasticity was higher in young people ,and it is correlated with PWV . SWD can evaluate carotid viscoelasticity ,and contribute to better understanding of its tissue characteristics .

Objective To explore the value of transvaginal three-dimensional power Doppler ultrasound in evaluation of endometrial receptivity in patients with intrauterine adhesions.Methods Totally 43 patients with intrauterine adhesions confirmed by hysteroscopy were enrolled in this study.According to the hysteroscopy,the patients were divided into mild adhesion group (n=17),moderate adhesion group (n=18) and severe adhesion group (n=8).All the patients were examined with transvaginal three-dimensional power Doppler ultrasonography on the day of ovulation.Endometrial thickness (ED),endometrial volume (EV),endometrial vascular index (VI),endometrial flow index (FI) and endometrial vascular flow index (VFI) were compared among three groups.Results There was significant difference in EV among three groups (P＜0.001).ED,VI and VFI were significantly different between the mild and severe adhesion groups,as well as between moderate and severe adhesion groups (all P＜0.05).Conclusion Transvaginal three-dimensional power Doppler ultrasound provides a safe and noninvasive approach to assess endometrial receptivity of patients with intrauterine adhesions.EV has good predictive value on endometrial receptivity.

Objective To understand the cognition of patients with anxiety disorder and their inner experience and disease,and provide reference and basis for making more perfect health education. Methods A group of 38 patients with hospitalized anxiety were interviewed by collective focus interview. The interview was conducted by using the team skill training model to create a pleasant atmosphere. Results Five subjects of periods were identified, including the denial period of disease, the period of inner pain,the period of worrying about side effects of drugs,and the expectation period of disease cure. Conclusions The lack of awareness of disease and the desire for disease-related knowledge are very urgent. Through this study, we understand the psychological characteristics and needs of some patients with anxiety, and explore a set of patients who are suitable for anxiety of the mission model to provide some reference.

Objective To measure the longitudinal elastic modulus in patients with acute ischemic stroke by shear wave elasotography(SWE),and to study its feasibility and related factors.Methods There were 1 79 cases with acute ischemic stroke (AIS)including 103 cases with large artery atherosclerosis and 76 cases with lacunar infarction classified according to the TOAST classification.There were 168 age and sex-matched cases as control group.Pulse wave velocity (PWV ) of bilateral carotid was measured by radiofrequency ultrasound.The 20 areas of superficial walls of bilateral carotid artery were analyzed by SWE,and the average values of longitudinal average elastic modulus (MEmean ),the maximum elastic modulus (MEmax )and minimum elastic modulus (MEmin )were calculated.The independent factors of MEmean were analyzed using multiple linear regression analysis.Results ①Compared with control group, PWV in patients with AIS was increased (P <0.05).②The MEmax and MEmean of carotid artery in patients with AIS were more than those in the control group (P <0.05).③Age,systolic blood pressure,PWV and low-density lipoprotein cholesterol(LDL-C)were positively related to MEmean (r =0.221 ,0.1 74,0.776 and 0.1 73,respectively,P <0.05 ),and were independent factors for MEmean .Conclusions SWE can evaluated the arterial stiffness using longitudinal elastic modulus of carotid.Age,systolic blood pressure,PWV and LDL were independent factors for longitudinal elastic modulus.

Objective To investigate the effect of nursing ward rounds with doctors on cognition disease of primary caretakers of asthmatic children . Methods According to the admission sequence, 82 asthmatic patients and their primary caretakers were set as the control group, 76 asthmatic patients and their primary caretakers were set as the observation group. The control group adopted the traditional method of separating ward rounds between doctors and nurses. The observation group used the method of nursing ward rounds with doctors. Then their differences were compared in terms of cognition of disease and medical compliance of these two groups′primary caretakers. Result The observation group was significantly better than the control group in terms of the cognition of disease and medical compliance (P<0.01). Conclusions The method of nursing ward rounds with doctors can improve the cognition of disease and medical compliance of the asthmatic patients′ primary caretakers. It can effectively monitor and manage the asthmatic patients and control the disease recurrence. As effective ward rounds, it is worth in clinical application.

Objective To explore the relation between single umbilical artery with other malformations and pregnancy outcome,and to provide evidence for pregnancy counseling and diagnosis.Methods The outcomes of 92 fetuses with single umbilical artery diagnosed and delivered in Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University from September 2007 to July 2009 were followed up and retrospectively analyzed with Chi-square test.Results Among 25 292 pregnant women,92 cases were finally diagnosed as single umbilical artery giving the incidence of 0.36％,among which 57.6％ (53/92) of newborns survived without malformations,15.2％(14/92) survived with malformations and 27.2％ (25/92) died during perinatal period.There were 36 fetuses (39.1％,36/92) with single umbilical artery complicated with other malformations,among which 29 had single malformation (80.6 ％ ),and seven ( 19.4 ％ ) had multiple malformations.The incidence of heart defects was the highest among the complicated malformations,and then followed by central nervous system,digestive system,motor system and urinary system.Thirty-three fetuses with single umbilical artery accepted karyotype analysis.Chromosome abnormality was diagnosed in three subjects (9.1％,3/33).Twenty-three fetus (25.0％,23/92) associated with small for gestational age,and among which 18 fetuses (78.3％,18/23) died with a higher mortality than that (4.0％,24/597) of small for gestational age patients without single umbilical artery (x2=181.71,P＜0.01).Conclusions Single umbilical artery is likely to be complicated with congenital anomalies.After single umbilical artery was diagnosed by routine ultrasound,fetal ultrasonography,echocardiography and amniocentesis for karyotype analysis is suggested.Fetal growth restriction is an important indicator of fetal adverse outcomes.

Objective To study the correlation between quantitative parameters of contrast-enhanced ultrasonography(CEUS)and microvessel density(MVD)in hepatocellular carcinoma(HCC),and to investigate the value of CEUS in noninvasively assessing HCC angiogenesis.Methods The patients with 28 HCCs confirmed by pathology were examined by CEUS.A new type quantification software SW-UCS was used to delineate time-intensity curve(TIC)and to obtain quantitative parameters of HCC and hepatic parenchyma in region of interest.The quantitative parameters were compared with MVD,which was counted by immunohistochemistry method using CD34 antibody,and the correlation between them was studied.Results The TICs of HCC showed typical contrast-enhancement pattern of"fast-in and fast-out"comparing with normal hepatic parenchyma.There were significant differences between HCC and hepatic parenchyma in slope of rise time(a3),time to initial peak(TTP),peak intensity(PI),increased signal intensity(ISI)and acceleration time(ACT)(P＜0.05).MVD in HCC(49.36±12.57)was higher than that in hepatic parenchyma(32.46±11.78,P=0.000).For HCC,the PI,ISI and area under curve were positively correlated with MVD,while the slope of decrease to half of peak(a2)was negatively correlated with MVD (P＜0.05).Conclusions The quantitative parameters of CEUS in HCC were correlated with MVD,CEUS can evaluate the angiogenesis of HCC in vivo noninvasively.