Objective: To investigate the value of left ventricular global longitudinal strain( LVGLS) in predicting early chemotherapy related cardiotoxicity in breast cancer patients after chemotherapy． Methods : Eighty-six breast cancer patients were enrolled in this study and received 6 cycles of doxorubicin + cyclophosphamide．Conventional echocardiography parameters were measured before chemotherapy ( T0 ) ，immediately after chemotherapy ( T1 ) ，6 months(T2) and 12 months after chemotherapy ( T3 ) ． LVGLS was obtained by 2D speck tracing imaging (2DSTI) ，and the relative change of LVGLS( △LVGLS) was calculated at T1．With the occurrence of cardiotoxicity as the clinical outcome，receiver operating characteristic ( ROC) curve was plotted．The parameters were analyzed at T1 to evaluate the value of △LVGLS in predicting cardiotoxicity. Results: ① Although the change in LVEF was not different between T0 and T1 (P ＞0. 05) ，LVEF decreased significantly at T2 and T3 (P ＜0. 05) . ② Compared with T0，LVGLS decreased at T1，which was further damaged at T2 and T3 (P＜0. 05) . ③ Seven patients (8. 1% ) developed chemotherapy-related cardiotoxicity．LVGLS and △LVGLS were correlated with cardiotoxicity at T1 stage ，and △LVGLS was more significant ( r = 0. 64，P ＜0. 001 ) . ROC curve analysis showed that a △LVGLS ＞12% at T1 predicted cardiotoxicity，with sensitivity of 92. 2% ，specificity of 76% ，and area under the curve was 0. 88. Conclusion The LVGLS decreased earlier than LVEF in breast cancer patients after doxorubicin treatment. △LVGLS ＞12% is a good predictor of cardiotoxicity in patients with breast cancer.

Abstract This prospective observational study included 361 benign and malignant breast nodules from 258 women who had underwent breast grayscale ultrasound and had been confirmed pathologically. A total of 396 image features of lesion areas in ultrasonic images were extracted. The radiomic signature was developed using least absolute shrinkage and selection operator algorithms after feature selection using the minimum redundancy maximum relevance method. Receiver operating characteristic curve(ROC)and calibration curve were used to test the performance of the model. The area under the ROC curve(AUC), accuracy, sensitivity, specificity, Youden index for the training cohort were 0.84,0.761,0.840,0.715,0.603. And the AUC, accuracy, sensitivity, specificity, Youden index for the validation cohort were 0.84,0.716, 0.823, 0.654, 0.536. The diagnostic results of data from the radiomics model were basically consistent with the actual situation. Radiomics based on grayscale ultrasound performs well in the differentiation of malignant from benign breast nodules which effectively avoids the subjective diagnosis, and has good clinical application value.

Tuberculous meningitis is the most common and serious type of central nervous system tuberculosis, with high mortality and disability rate, which has attracted extensive attention of global public health. The high mortality rate and disability rate of tuberculosis meningitis may be related to its lack of specific clinical and imaging characteristics, insufficient attention from clinicians, lack of early sensitive and specific diagnostic testing techniques, delay in treatment, and restricted penetration of anti-TB drugs into the blood-brain barrier or/and MDR-TB, etc. This article reviews the disease burden of TBM, chemotherapy drugs and regimens, anti-inflammatory agents, aspirin, interventional and surgical treatment to provide reference for clinical management of this disease.

Objective:To explore the effects of stepwise acute pain management on acute pain and post-traumatic stress disorder (PTSD) in children with burns.Methods:From November 2018 to December 2019, 196 children with burns who were admitted to West China Hospital of Sichuan University and met the inclusion criteria were enrolled in the prospective randomized controlled study. The children were divided into traditional pain management group (97 children, 51 males and 46 females, aged 1 to 6 years) and stepwise pain management group (96 children, 55 males and 41 females, aged 1 to 6 years) according to the random number table. Children in traditional pain management group were treated with traditional acute pain care, while the children in stepwise pain management group were treated with stepped acute pain management (moderate pain was treated with oral administration of acetaminophen sustained-release dry suspension at the dose of 10 to 15 mg/kg once every 4 to 6 hours, and severe pain was treated with morphine intravenous injection at the dose of 0.1 to 0.2 mg/kg once every 4 hours) on the basis of traditional acute pain care after admission. The COMFORT behavior scale was applied to compare the resting pain levels of children in the two groups within post injury day (PID) 3 (1, 9, and 17 o'clock each day). The adverse reactions of children in the stepwise pain management group during the treatment period were recorded. The occurrence of PTSD within one month after injury was evaluated in both groups by the revised PTSD scale. Data were statistically analyzed with independent sample t test, Bonferroni correction, analysis of variance for repeated measurement, chi-square test, Wilcoxon rank sum test, and Fisher's exact probability test. Results:The pain scores of children in stepwise pain management group were significantly lower than traditional pain management group at 1, 9, and 17 o'clock on PID 1, 1, 9, and 17 o'clock on PID 2, and 1, 9, and 17 o'clock on PID 3 ( t=2.71, 3.44, 4.05, 4.18, 4.08, 4.19, 4.25, 3.69, 3.71, P<0.05 or P<0.01). The pain scores of children in both groups showed a decreasing trend over time. Of the 96 children in stepwise pain management group, 84 children were treated with oral administration of acetaminophen sustained-release dry suspension, and 12 children were treated with morphine intravenous injection. No adverse reaction occurred during the treatment period. The incidence of PTSD of children in stepwise pain management group within 1 month after injury was 3.12% (3/96), which was significantly lower than 14.43% (14/97) in traditional pain management group, P<0.05. Conclusions:The stepped acute pain management can relieve the acute pain and reduce the incidence of PTSD in children with burns.

Objective To evaluate the diagnostic efficacy of Kwak and ACR( 2017 ) thyroid imaging reporting and data systems ( T I‐RADS ) for thyroid nodules . Methods Cases of thyroid nodule who underwent surgery from January 2015 to M arch 2018 in 15 hospitals in Sichuan province were collected and the ultrasonographic features of thyroid nodules were retrospectively analyzed by trained senior ultrasound physicians using Kwak and ACR T I‐RADS classification methods . Totally ,12 712 thyroid nodules were observed ,7 023 thyroid nodules in 7 023 cases with complete ultrasound and surgical and pathological data were eventually enrolled in the study . T hyroid nodules with solid ,hypoechoic or very hypoechoic ,tall/wide ratio ≥ 1 , margin ill‐defined and microcalcification were classified as malignant signs of ultrasound . M alignant percentage was calculated and diagnostic tests were performed . Results ① T here was a statistical difference between the benign and malignant nodules in the two types of T I‐RADS classification ( P＜0 .01) . ② T he area under ROC curve of Kwak and ACR in the diagnosis of malignant nodules were 0 .89 and 0 .84 ,respectively . T he Youden index of Kwak and ACR were 0 .66 and 0 .57 ,respectively . ③Taking Kwak T I4B and ACR T R4 as critical points for malignancy ,the sensitivity ,specificity ,positive predictive value and negative predictive value of Kwak T I 4B were 75 .0% ,90 .9% ,83 .2% ,and 85 .9% , respectively . T he accuracy of Kwak T I4B was 84 .9% ; T he sensitivity ,specificity ,positive predictive value and negative predictive value of ACR T R4 were 88 .2% ,68 .9% ,62 .9% ,and 90 .8% ,respectively . T he accuracy of ACR T R4 was 76 .2% . T he Kappa value of Kwak TI4B and ACR T R4 was 0 .52 . T he χ2 value of Kwak T I4B and ACR T R4 was 2 174 .6 ( P ＜ 0 .01 ) . Conclusions T he diagnostic values of two T I‐RADS classification methods for thyroid malignant nodules are high . T he overall efficiency of Kwak T I‐RADS classification method is better than that of ACR TI‐RADS classification method .

Objective To assess the toxicity of anthracyclinc to left ventricle function in patients withbreast cancer,and to compare the clinical values between two-dimensional speckle tracking echocardiography (2D-STE) and 3D-STE.Methods 50 patients with breast cancer who had received surgical treatment and epirubicinbased chemotherapy were recruited to study groups.All the patients had undergone up to 6 cycles of chemotherapy.Different stages wcre identified according to accumulated doses of epirubicin reaching 0 mg/m2,120 mg/m2,240 mg/m2 and 360 mg/m2.2D-STE and 3D-STE parameters were measured before chemotherapy and after different stage of chemotherapy.The receiver operating characteristics curves (ROC) of parameters (2D-GLS,3D-GLS,3D-GCS,3DGAS) were graphed to evaluate the specificity and sensitivity of detecting dysfunction of the left ventricles.25 healthy volunteers were recruited to a control group.Results As compared with the control group and the baselines,2D-GLS and 3D-GCS was significantly declined (P ＜ 0.05),3D-GAS and 3D-GLS were significantly lowered after interim period and later period (P ＜ 0.05),while 3D-GRS was not changed significantly during the whole chemotherapy period.The ROC curves revealed the sensitivity of 2D-GLS,3D-GCS,3D-GLS and 3D-GAS for assessing dysfunction of the left ventricles was 60.7％,65.3％,62.7％,and 80.7％,while the specificity was 50.0％,54.0％,64.0％,and 82.0％,respectively.Conclusions As compared with 2D-STE,3D-STE can detect the dysfunction of left ventricles earlier and more accurately.Furthermore,the specificity and sensitivity of 3D-GAS are the highest among all parameters in detecting the early dysfunction of left ventricles.

Objective: To establish real-time qPCR method to analyze each HLA-C allele expression level of individual.Methods:Database including exon 2&3 sequences of HLA class Ⅰalleles was built ,HLA-C allelic specific primers were designed and the real-time quantitative PCR method for analyzing HLA-C allele expression level was built .The allelic specificity of these primers were confirmed in database and 835 normal peripheral blood samples of Han population .The mRNA level of each HLA-C allele from 20 pairs of liver tumor tissues and non-tumor tissues was analyzed by the qPCR method we built .Results:20 pairs of allelic specific primers were designed to distinguish the two HLA-C alleles of each individual with frequency over 0.96%in 835 cases of Han population.Among 55%of the liver cancer tissues ,the expression levels of the two HLA-C alleles from the same tumor tissue changes differently compared to that of the relevant non-tumor tissue.Conclusion:This study provides method for HLA-C allele expression level analysis of Han population and each HLA-C allele expression level is inconsistent of liver cancer tissue .

Objective To explore the value of three-dimensional speckle tracking imaging (3D-STI)in early dectection of left ventricular myocardial dysfunction in patients with breast cancer after receiving Anthracycline.Methods A group of 63 breast cancer postoperative patients were recruited and received a six-cycle epirubicin-based chemotherapy.Electrocardiogram,conventional echocardiography and 3D-STI parameters were measured before chemotherapy and during 24-48 hours after the cumulative dose of 120 mg/m2 ,240 mg/m2 and 360 mg/m2 .The receiver operating characteristics (ROC ) curves of 3D-STl parameters,such as global area strain(GAS),global longitudinal strain(GLS),global circumferential strain (GCS),and global radial strain(GRS)were drawn to determine optimal sensitivity and specificity.Twenty-one healthy female volunteers served as control subjects.Results Compared with before chemotherapy and control subjects,GAS and GLS were significantly reduced at the cumulative dose of 240 mg/m2 ,360 mg/m2 (P <0.05).The area under ROC of GAS was 0.974,and its optimal cut-off value was -3 1 .5%,with a specificity of 87.1 % and a sensitivity of 92.9%.Moreover,correlation analysis showed GAS was significantly associated with cumulative doxorubicin dose(r = -0.834,P < 0.01 ).Conclusions During chemotherapy,GAS can detect minor LV myocardial dysfunction associated with cardiotoxicity of anthracycline.3D-STI is useful in early dectection of left ventricular myocardial dysfunction in patients with breast cancer after receiving anthracycline.

Objective To observe heart functions of the patient with cancer receiving combined chemotherapy of paclitaxel plus cisplatin through troponin test and speckle tracking echocardiography. Methods 43 patients who had been scheduled to receive combined chemotherapy of paclitaxel plus cisplatin were recruited in the study. Ser-um cTnT and cTnI levels were measured before chemotherapy,after the first cycle of chemotherapy,middle cycle of chemotherapy and after the last cycle of chemotherapy. In all patients, the lobal longitudinal systolic strain( GSL) and strain rate(GSRs)of the LV as well as peak early-diastolic strain rate (GSRe) and peak late-diastolic strain rate ( GSRa) were measured by two-dimensional speckle tracking echocardiography at every stage. Results The patients' serum cTnT and cTnI level after chemotherapy were increased gradually(P<0.01). After the last stage of chemotherapy the GSL and GSRs decreased significantly, having made significance in statistics ( P <0.01 ) . Compared with those before chemotherapy, the patients' GSRe and GSRa in the early stage of chemotherapy had no significant difference (P>0. 05), but compared to those of the middle and last stage of chemotherapy, significant difference (P<0.01) existed. Conclusion Paclitaxel plus cisplatin induce certain subclinical myocardial injury to patient's heart. Cardiac troponin level and speckle tracking echocardiography have important value in the obser-vation of heart functions of the patients with cancer receiving chemotherapy.

Objective To analysis of the thyroid hormone test results of Abbott Architect ci16200 automatic biochemical-im-mune analyzer (Abbott system) and Roche Cobas e601 automated immunoassay analyzer (Roche system) .Methods The thyroid hormone(including T4 ,FT4 ,T3 ,FT3 ,TSH ) levels of 93 cases of serum samples were respectively detected by Abbott system (CMIA) and Roche system (ECLIA) ,and the results were analyzed .Results The thyroid hormone test results of the two systems had a good correlation ,and the coefficients of T4 ,FT4 ,T3 ,FT3 ,and TSH were 0 .960 ,0 .962 ,0 .976 ,0 .900 ,and 0 .999(P<0 .01) . However ,there were significant difference of the detection results of the two systems(P<0 .05) .Conclusion The thyroid hormone test results of Abbott system and Roche system are not comparable .