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.

Prostate cancer is one of the leading causes of cancer-related deaths in adult males, and its morbidity and mortality keep growing year after year. However, the pathogenesis is not understood clearly yet. The development of prostate cancer is a synergistic, multi-gene process. MicroRNA (miRNA), as small ribonucleic acid molecules and a class of non-coding small RNAs, controls the expression of several genes and plays an important role in cell proliferation, differentiation, and apoptosis. In recent years, emerging evidence shows that the miRNAs are significantly abnormally expressed in prostate cancer and that they can target multiple signaling pathways involved in the occurrence and progression of prostate cancer, which has important value in the diagnosis, treatment, and prognosis of prostate cancer. In this paper, the origin, formation, and biological properties of miRNAs, as well as their potential application in the diagnosis and treatment of prostate cancer, were reviewed with the aim of providing an in-depth understanding of prostate cancer from the perspective of molecular biology and new thinking for clinical diagnosis and treatment.

Objective:To investigate the ultrasonographic features and evolution of thyroid shrinking nodules in order to improve the differential diagnosis and management strategy and avoid unnecessary biopsy.Methods:A total of 245 patients with old bleeding of benign thyroid nodules diagnosed via fine needle aspiration cytology (FNAC) from May 2015 to July 2020 in the southern part of the Shanghai General Hospital Affiliated to the Medical College of Shanghai Jiaotong University, including 263 nodules. The sonographic parameters such as size, shape, aspect ratio, echo, edge, boundary, periphery, halo, calcification, posterior echo enhancement and posterior acoustic attenuation of nodules were analyzed retrospectively, and the ultrasonic appearances of nodules were classified; 41 nodules from 40 patients, who did ultrasound examinations more than twice and had both complete ultrasonographic data, were compared and then classified in order to explore the evolution rules of the nodules.Results:Two hundred and sixty-three thyroid shrinking nodules in 245 cases were classified into 4 types: "cystic wall shrinkage sign" type(71.48%, 188/263), "carcinoma-like" type (22.05%, 58/263), "inflammation-like" type(3.04%, 8/263) and "undefined atypical solid nodules" type(3.42%, 9/263). Of the 41 consecutive follow-up nodules, 37 cases showed obvious cystic wall shrinkage sign, and 7 of them developed into "carcinoma-like" type and 6 cases into "inflammation-like" type.Conclusions:The ultrasonographic appearance of thyroid shrinking nodules is a dynamic process, which can be divided into 4 types: "cystic wall shrinkage sign" , "carcinoma-like" , "inflammation-like" and "undefined atypical solid nodules" types. The "cystic wall shrinkage sign" type is typical and common. The "cystic wall shrinkage sign" type can develope into the "carcinoma-like" type or the "inflammation-like" type.

Objective:To evaluate the qualitative diagnosis of contrast enhanced ultrasound (CEUS) in different sizes′ benign and malignant breast nodules (BNs) of BI-RADS 4.Methods:A total of 506 BNs in 467 patients from Shanghai General Hospital between October 2017 and May 2019 classified as BI-RADS 4 were divided into large size group (>20 mm, n=198) and small size group (≤20 mm, n=308) according to their largest diameter lines. The CEUS characteristics of benign and malignant BNs in two groups were analyzed by Chi-square test. The CEUS characteristics of BNs were assigned scores for diagnosis of benign and malignant BNs with different sizes, the diagnostic efficacy of these scores was evaluated by ROC curve. Results:There were statistic differences in the degree, size change of the enhanced lesions, enhancement time of lesions compared with surrounding tissues, radial enhancement or not, homogeneity of enhancement, with or without penetrating of perfusion between benign and malignant BNs in both groups (all P<0.001). In small size group, with the critical value of 2.5 points, area under curve(AUC) of ROC curve was 0.793, and the sensitivity, specificity, accuracy of CEUS was 82.67%, 60.22% and 69.48%, respectively. In large size group, with the critical value of 3.5 points, AUC of ROC curve was 0.901, and the sensitivity, specificity, accuracy of CEUS was 85.42%, 80.00% and 82.65%, respectively. Conclusions:CEUS has great significance in qualitative diagnosis of benign and malignant in BI-RADS 4 BNs with different sizes. The biopsy could be avoided in BNs greater than 20 mm, while biopsy is still needed in BNs less than or equal to 20 mm.

Objective: To evaluate the diagnostic efficiency in differential diagnosis for breast sentinel lymph nodes, and to analyze the imaging characteristics of involved breast sentinel lymph node in lymphatic contrast enhanced ultrasound. Methods: Sixty-one patients suspected with breast cancer from May 2017 to March 2019 in Shanghai General Hospital, Shanghai Jiao Tong University were included in the study. Ultrasound contrast agent was injected subcutaneously, and axillary lymph nodes were displayed under contrast enhanced ultrasound mode. The longitudinal diameter (anteroposterior diameter), transverse diameter, longitudinal/transverse ratio and the distance from skin surface were measured. Five types were concluded according to the imaging characteristics in lymphatic contrast enhanced ultrasound: typeⅠ, uniform enhancement; type Ⅱ, ring-shape enhancement; type Ⅲ, ununiform enhancement; type Ⅳ, regional filling defect; type Ⅴ, total filling defect. Sentinel lymph nodes were guided by wire guides and verified in pathology after excision in the operation. Results: The detection rate of sentinel lymph nodes was 95.08% (58/61). Seventy-seven lymph nodes, including 21 involved nodes and 56 uninvolved nodes were detected by lymphatic contrast enhanced ultrasound in 58 patients. The longitudinal diameters and transverse diameters of involved lymph nodes were larger than those of uninvolved ones (P=0.001, 0.003). When type Ⅳ(regional filling defect) and type Ⅴ(total filling defect) were classified as involved, the sensitivity, specificity, positive-predictive value, negative-predictive value, accuracy and the area under ROC curve of predicting sentinel lymph node metastases were 85.71%, 96.43%, 90.00%, 94.70%, 93.51% and 0.911, respectively. Conclusions Lymphatic contrast enhanced ultrasound reaches a high diagnostic efficiency in qualitative analysis of breast sentinel lymph nodes. Regional filling defect and total filling defect are the imaging characteristics of involved sentinel lymph nodes in lymphatic contrast enhanced ultrasound.

Objective To explore the treatment of locally advanced pancreatic cancer(LAPC)by Nanoknife,and the demonstrations on contrast enhanced ultrasonography(CEUS)after the procedures. Methods Four patients were enrolled.Each of them was percutaneously inserted 3-5 Nanoknife electrodes to ablate the lesions with 2-3 sessions under the guidance of ultrasound.After the procedures,CEUS, contrast enhanced CT,contrast enhanced MRI or computed tomography angiography (CTA) were performed to assess the efficacy.Results All patients uneventfully were able to tolerate the high-voltage Nanoknife procedures.However,the endurable pain or discomfort in abdomen was complained.For one patient with obstructive jaundice and mild liver dysfunction,pancreatic amylase in serum increased slightly at the first day after treatment.Furthermore,C response protein in serum elevated,and biliary tract infection happened at the third day.Moreover,thromboses in portal and splenic vein were found at the seventh day.The survival time for all cases were 3-8 months.According to the findings of CEUS,a well-defined no contrast enhancement was detected at ablative zone for all the patients within one week.Yet, contrast enhancement was sporadically detected at the periphery in 3 patients 1-2 months late.Meanwhile, on contrast enhanced CT or MRI,an area of absent enhancement was also depicted at the ablation zone with heterogeneously decreased enhancement at periphery of the lesion.Base on CTA findings,local stenosis of splenic vein and superior mesenteric vein with varices of collateral vascularity were found in one patient at the fiftieth day,and superior mesenteric vein obstruction accompanied by varices of collateral vascularity was also found in another patient at the seventieth day.Conclusions For patients with LAPC,Nanoknife treatment is a safe and convenient procedure that can be percutaneously completed under the guidance of ultrasound.Along with enhanced CT,MRI or CTA,CEUS is a promising way to evaluate the efficacy of this procedure.

Objective To establish an HPLC quantitative method for the content determination of baicalin in Kangdeling capsule .Methods The chromatography column was Agilent Tc-C18-WR (4 .6 mm × 250 mm ,5μm) ,and the column temper-ature was 30 ℃ .The mobile phase consisted of acetonitrile and 0 .5‰ phosphoric acid (26 ∶ 74 ) .The flow rate was 1 .0 ml/min ,and the detection wavelength was 265 nm .Results The retention time of baicalin was about 16 min .The calibra-tion equation was Y=22 114 .67 X -112 836 .7(r=0998 8)with good linearity in the range of 5 .410-108 .2 μg/ml for baicalin . The average recovery was 98 .78% while RSD were 0 .74% .Conclusion This method is simple ,time-saving and accurate which could be used to routine analysis of baicalin in Kangdeling capsule .

Objective To explore the adeno-associated virus (AAV)gene transduction and cellular endocytosis mediated by ultrasound combined with microbubbles in two types of cells.Methods HeLa and NIH/3T3 cells were infected by rAAV2-EGFP at a concentration gradient to get the optimal concentrations for enhancement.At these concentrations,HeLa and NIH/3T3 cells were infected by rAAV2-EGFP mediated by ultrasound combined with microbubbles.The gene transduction efficiency were observed and measured by fluorescence microscopy and flow cytometry at 48 h after treatment.The cell viability was tested by CCK-8.The number and distribution of cellular clathrin-coated endocytic pits were observed by confocal fluorescence microscopy and transmission electron microscopy on 45 min after treatment.Results The optimal concentrations for HeLa and NIH/3T3 cells were 2000 v.g./cell and 10000 v.g./cell.Ultrasound combined with microbubbles significantly enhanced the transduction efficiency of rAAV2-EGFP (P <0.01) without significant cell viability decrease (P > 0.05 ).Confocal fluorescence microscopy and transmission electron microscopy demonstrated that clathrin-coated endocytic pits were more obviously increased in ultrasound combined with microbubbles mediated AAV transduction group than AAV transduction group. Conclusions Ultrasound combined with microbubbles can efficiently enhance the gene transduction of AAV,whose cellular transportation depends on cellular endocytosis,in two types of cells.Stimulating cellular endocytosis might be one of the mechanisms of enhanced cellular transportation of AAV mediated by ultrasound combined with microbubbles.

Objective To explore the difference of the contrast-enhanced ultrasound (CEUS) image and quantitative parameters between two different contrast agents Fluorocarbon and SonoVue. Methods The tumor model of colorectal carcinoma in nude mice was established by injecting CT26 cells into the subcutaneous space in hepatic area of 15 nude mice. CEUS was performed with Fluorocarbon and SonoVue on the 14th day after establishment. SonoLiver software was used to analyze the dynamic image quantitatively. The difference of the CEUS image and quantitative parameters between the two contrast agents was analyzed. Results Compared with normal liver parenchyma around the tumor, the tumor ultrasound contrast performance was fast forward and rewind with low enhancement. There was no signiifcant difference between the two kinds of microbubbles not only for CEUS image but also for quantitative parameters [maximum intensity (Imax):49.53%±24.38%vs 45.04%±17.03%, rise time (RT):11.68 s±3.07 s vs 13.76 s±2.92 s, time to peak (TTP):12.76 s±4.12 s vs 15.26 s±3.74 s, T1/2:50.57 s±28.32 s vs 48.75 s±9.85 s, Imax/TTP(V1):4.48±2.82 vs 3.18±1.49, (Imax-INT60)/(60-TTP)(V2):0.67±0.34 vs 0.60±0.20, AUC1:3032.78%±1343.12%vs 3258.77%±1369.84%, AUC2:11647.38%±6183.10%vs 10439.04%±4604.65%, AUC:14680.17%±7469.85%vs 13697.81%±5831.99%, Rate of AUC1:264.25±146.93 vs 222.24±92.16, Rate of AUC2:241.67±119.97 vs 231.97±100.34, all P>0.05). No mouse was dead during the CEUS examination. Conclusion Fluorocarbon had similar CEUS imaging effect and quantitative information compared with SonoVue.

Objective To evaluate the clinical value of ultrasonography guided percutaneous core needle biopsy in pancreatic lesions. Methods Thirty-four patients with 36 pancreatic lesions in Shanghai First People′s Hospital Afifliated to Shanghai Jiao Tong University from February 2012 to November 2013 underwent conventional ultrasound-guided percutaneous core needle biopsy using automatic gun and 18-gauge biopsy needles. The site, size, internal and surrounding vascularity, the sampling number of the lesions, and whether the specimens′ quality was satisfied were recorded. Then specimens were sent for pathological examination, and all above observations were compared with the ifnal diagnosis. Results The number of lesions with 2, 3 and 4 samplings was 32, 2 and 2, respectively. The average number of sampling was 2.2 (mean, 2.17;standard deviation, 0.51) and the acquisition rate of satisifed specimens was 89%(32/36). The pathological results of biopsy were malignant in 31 of 36 lesions including 27 cases of ductal adenocarcinoma, 2 cases of lymphoma, 1 case of small cell neuroendocrine carcinoma and 1 case of uterine leiomyosarcoma metastasis. The other 5 lesions were non-malignant including 3 cases of benign lesion, 1 cases of atypical hyperplasia and 1 cases of granulation tissue. The 36 lesions were ifnally diagnosed as 34 cases of pancreatic malignancy, 2 cases of non-malignant neoplasm. The sensitivity, speciifcity, accuracy, positive predictive value and negative predictive value of ultrasonography guided percutaneous core needle biopsy in pancreatic lesions were 91%(31/34), 100%(2/2), 92%(33/36), 100%(31/31) and 40%(2/5), respectively. Youden index was 0.91. Two patients had mild upper abdominal pain and 1 patient had transient elevated serum amylase. No pancreatitis, pancreatic fistula, peritonitis, bleeding or dispersion of malignant cells along the penetrating channel or other serious complications occurred. Conclusion Ultrasonography guided percutaneous core needle biopsy is a simple, rapid, safe and effective diagnostic method in pancreatic lesions with high clinical value.