Objective To investigate the effects and underlying mechanisms of a spray prepared from exosomes derived from M2 macrophages induced by interleukin-4 （IL-4） and tantalum particles （Ta） on the healing of pressure ulcers. Methods Bone marrow-derived macrophages were polarized into M2 macrophages using IL-4 or Ta, and exosomes （Exo-IL-4/Exo-Ta） were extracted. The regulatory effects of Exo-IL-4/Exo-Ta on M1 macrophage phenotypes and fibroblast matrix secretion were evaluated in vitro. Proteomic analysis was conducted to explore the biological processes and regulatory networks associated with Exo-Ta. A rat pressure ulcer model was used to assess the effects of Exo-IL-4/Exo-Ta spray on wound healing rate, inflammatory cell infiltration, and collagen deposition. Results In vitro, Exo-IL-4/Exo-Ta induced the polarization of M1 macrophages to M2 macrophages, reduced the secretion of pro-inflammatory factors, and promoted the expression of anti-inflammatory substances. Additionally, Exo-IL-4/Exo-Ta enhanced the production of collagen and fibronectin in fibroblasts. Proteomic analysis revealed that Exo-Ta primarily participated in biological processes such as energy metabolism and macromolecule biosynthesis. In vivo, Exo-IL-4/Exo-Ta spray accelerated wound healing, reduced inflammatory infiltration, and improved tissue remodeling in the rat pressure ulcer model. Conclusion Exosome sprays derived from M2 macrophages could accelerate pressure ulcer healing by modulating inflammation and promoting tissue regeneration, which demonstrated excellent clinical application potential.

Objectives:To examine the clinicopathological characteristics and the influencing factors of the residual tumor of patients with Breast Image Report and Data System (BI-RADS) grade 3 lesions diagnosed with malignancy after minimally invasive excision.Methods:In this retrospective case-control study, clinicopathological data of 69 cases, which had been evaluated as BI-RADS 3 lesions by ultrasound (4 151 cases) diagnosed with breast cancer by minimally invasive excision pathology, were analyzed between May 2012 and June 2016 at the Department of Breast Surgery of the Second Hospital of Shandong University and Linyi People′s Hospital. All patients were female, aged (43.4±8.2) years (range: 22 to 70 years). Based on residual tumor after minimally invasive excision, patients were classified into two subgroups: tumor residual group ( n=39) and non-tumor residual group ( n=30). The clinicopathological features between the two groups were compared. The differences in clinicopathological characteristics were compared in different groups using the χ 2 test and the t test. Potential variables identified in the univariate analysis and other relevant variables will be analyzed multivarially using Logistic regression models. The Kaplan-Meier method was applied for survival analysis and survival curves. Results:The breast cancer detection rate of ultrasound BI-RADS 3 lesions was 1.66% (69/4 151), and their maximum diameter of the masses was (1.27±0.45) cm (range: 0.5 to 2.3 cm). Among them, the maximum diameter were ≤1 cm in 28 cases and >1 cm in 41 cases. Histopathological results showed carcinoma in situ in 24 cases and invasive carcinoma in 41 cases, positive expression of the estrogen receptor in 47 cases, positive expression of the progesterone receptor in 43 cases, Ki-67 proliferation index elevated in 26 cases. Axillary metastasis positive rate was 10.1% (7/69). Residual tumor after minimally invasive surgery was found in 39 cases (56.5%). Univariate analysis showed that the tumour residual group showed a significantly increased rate of positive expression of the estrogen receptor (91.9%(34/37) vs. 61.9%(13/21), χ2=7.838, P=0.012). In multivariate analysis, the only variable found to significantly affect the residual tumor was the positive expression of the estrogen receptor ( OR=16.852, 95% CI: 1.819 to 156.130, P=0.013). The 5-year disease-free survival rate of breast cancer patients with breast ultrasound BI-RADS 3 lesions was 97.1% and the overall survival rate was 98.6%. Conclusions:BI-RADS 3 lesions diagnosed by ultrasound undergoing ultrasound-guided minimally invasive excision have a certain risk of detected malignancy, approximately 1.66%. Patients with positive expression of the estrogen receptor are more likely to develop residual tumor. A secondary operation should be considered to ensure that no tumor residues remain in the cavity.

Objectives:To examine the clinicopathological characteristics and the influencing factors of the residual tumor of patients with Breast Image Report and Data System (BI-RADS) grade 3 lesions diagnosed with malignancy after minimally invasive excision.Methods:In this retrospective case-control study, clinicopathological data of 69 cases, which had been evaluated as BI-RADS 3 lesions by ultrasound (4 151 cases) diagnosed with breast cancer by minimally invasive excision pathology, were analyzed between May 2012 and June 2016 at the Department of Breast Surgery of the Second Hospital of Shandong University and Linyi People′s Hospital. All patients were female, aged (43.4±8.2) years (range: 22 to 70 years). Based on residual tumor after minimally invasive excision, patients were classified into two subgroups: tumor residual group ( n=39) and non-tumor residual group ( n=30). The clinicopathological features between the two groups were compared. The differences in clinicopathological characteristics were compared in different groups using the χ 2 test and the t test. Potential variables identified in the univariate analysis and other relevant variables will be analyzed multivarially using Logistic regression models. The Kaplan-Meier method was applied for survival analysis and survival curves. Results:The breast cancer detection rate of ultrasound BI-RADS 3 lesions was 1.66% (69/4 151), and their maximum diameter of the masses was (1.27±0.45) cm (range: 0.5 to 2.3 cm). Among them, the maximum diameter were ≤1 cm in 28 cases and >1 cm in 41 cases. Histopathological results showed carcinoma in situ in 24 cases and invasive carcinoma in 41 cases, positive expression of the estrogen receptor in 47 cases, positive expression of the progesterone receptor in 43 cases, Ki-67 proliferation index elevated in 26 cases. Axillary metastasis positive rate was 10.1% (7/69). Residual tumor after minimally invasive surgery was found in 39 cases (56.5%). Univariate analysis showed that the tumour residual group showed a significantly increased rate of positive expression of the estrogen receptor (91.9%(34/37) vs. 61.9%(13/21), χ2=7.838, P=0.012). In multivariate analysis, the only variable found to significantly affect the residual tumor was the positive expression of the estrogen receptor ( OR=16.852, 95% CI: 1.819 to 156.130, P=0.013). The 5-year disease-free survival rate of breast cancer patients with breast ultrasound BI-RADS 3 lesions was 97.1% and the overall survival rate was 98.6%. Conclusions:BI-RADS 3 lesions diagnosed by ultrasound undergoing ultrasound-guided minimally invasive excision have a certain risk of detected malignancy, approximately 1.66%. Patients with positive expression of the estrogen receptor are more likely to develop residual tumor. A secondary operation should be considered to ensure that no tumor residues remain in the cavity.

Objective: To investigate the current basic situation of the staff of ultrasound departments in Shanghai′s medical institutions, for providing references in making management policy of these professionals. Methods: Questionnaire surveys on human resource and service ability were made to all the ultrasound departments of medical institutions in Shanghai in December 2013 and November 2018 respectively. Data of the two surveys were compared and analyzed, and were descriptively analyzed by mean and percentage. Results: The number of ultrasound professionals per 10 000 people in Shanghai was 1.04 in 2018. Tertiary hospitals had advantages in the number of the professionals, and the proportion of professional qualification, age, education background and professional title of the professionals. Compared to those data in 2013, the number of ultrasound professionals had increased 31.8% in 2018. The proportion of medical practitioners with medical imaging specialty was 95.6%(2 063/2 158), and had increased by 4.7 percent. The medical services workload of ultrasound was 19.82 million person-time, and had increased 45.8%. Conclusions Development of ultrasound departments was rapid, but the development of professionals was unbalanced with the development of medical services. It is suggested to strengthen training of ultrasound professionals and improve the system of hierarchical medical system.

Objective:To prepare a discharge readiness scale suitable for patients with enterostomy and to test the reliability and validity, so as to provide an effective measurement tool for the assessment of discharge readiness of patients.Methods:On the basis of the existing Chinese version of the discharge readiness scale, items related to enterostomy nursing problems were added to form the scale entry pool, and a draft of the scale was formed by expert consultation. 132 patients with preventive enterostomy admitted to the Affiliated Hospital of Qingdao University were pre-investigated with the original scale to test the reliability and validity.Results:The discharge readiness scale of enterostomy patients contained 18 items. The content validity of the scale was 0.969, and the content validity of each item was 0.824 - 1.000. Four common factors were extracted from the scale, and the cumulative variance contribution rate was 79.503%. Cronbach alpha coefficient of the total scale was 0.923, and each dimension was 0.806 - 0.947.Conclusions:The discharge readiness scale of patients with enterostomy has good reliability and validity, which can be used as an evaluation tool for patients at discharge.

Objective: To explore the effects of delayed umbilical cord clamping on full-term newborns and maternal outcomes. Methods: From January 2017 to April 2018, 287 normal full-term newborns delivered by vagina in the First People's Hospital of Xiaoshan District were selected in the research, and randomly divided into the control group (141 cases) and observation group (146 cases) according to the order of entering the delivery room.The control group was ligated the umbilical cord 15-20 s after delivery, while the observation group was ligated the umbilical cord 60 s after delivery.The level of hemoglobin, hematocrit, the incidence of anemia, polycythemia, hyperbilirubinemia and phototherapy time of full-term newborns were compared between the two groups 3 days after birth.The third stage of labor, the amount of postpartum hemorrhage and the incidence of postpartum hemorrhage were compared between the two groups. Results: The hemoglobin[(181.49±16.84) g/L] and hematocrit (0.545±0.055) in the observation group were significantly higher than those in the control group[(175.90±17.49 )g/L, (0.515±0.062)] at the third day after birth (t=2.748, 3.409, all P<0.05). The incidence of neonatal anemia in the observation group was 0.68% (1/146), which was significantly lower than that in the control group [4.96% (7/141)], and the difference was statistically significant (χ²=4.848, P<0.05). The incidence rates of neonatal polycythemia, hyperbilirubinemia and phototherapy time in the observation group were 2.05% (3/146), 24.66% (36/146), (65.50 ±14.63)h, respectively, which in the control group were 0.17% (1/141), 22.70% (32/141) and (62.09±14.40)h, respectively, there were no statistically significant differences between the two groups (χ²=0.945, 0.153, t=0.953, all P>0.05). The third stage of labor time, postpartum hemorrhage volume, incidence of postpartum hemorrhage in the observation group were (5.97 ±4.17)min, (239.04±69.15)mL, 2.05% (3/146), respectively, which in the control group were (5.84±3.62)min, (227.73±56.99)mL, 0.71% (1/141), respectively, there were no statistically significant differences between the two groups (t=0.281, 1.504, χ²=0.945, all P>0.05). Conclusion Delayed umbilical cord clamping can increase the level of hemoglobin and hematocrit in newborns, reduce the incidence of anemia in newborns, and without increasing postpartum hemorrhage.

Objective To explore the effect of social support and coping style on posttraumatic growth of ostomy patients. Methods A total of 237 patients with ostomy from Affiliated Hospital of Qingdao University were investigated using General questionnaire, Perceived Social Support Scale, Medical Coping Modes Questionnaire and Posttraumatic Growth Inventory by cross-sectional survey method from September 2017 to March 2018. The path of social support and coping style on post-traumatic growth was established by correlation analysis and structural equation model. Results The total score of posttraumatic growth in patients with ostomy was (66.76±12.20) points, which was at the upper-middle level. Correlation analysis showed that posttraumatic growth was positively correlated with comprehension of social support (r=0.551, P<0.01), positively correlated with face style (r=0.580, P<0.01), negatively correlated with avoidance style and resignation style (r=-0.334, P<0.01;r=-0.449, P<0.01). Structural equation model showed social support had directly positive effect on posttraumatic growth, path coefficient were 0.44. Face style, avoidance style, and resignation style had a partial mediating effect between social support and posttraumatic growth, and mediation effects account for 20.01％, 5.21％, 9.25％of the total effect, respectively. Conclusions The posttraumatic growth level of patients with ostomy needs to be improved. Medical staff should strengthen social support for patients and guide patients to adopt the positive coping styles, reduce the avoidance and resignation coping styles, and promote patients to get more posttraumatic growth, furthermore, improve their social adaptability and quality of life.

Objective To study the benchmark dose (BMD) of fluoride concentration in saliva,and to evaluate the significance of saliva fluoride on control and prevention of endemic fluorosis.Methods In September 2014,middle school students in endemic fluorosis areas and non-endemic fluorosis areas in North China Petoleum were selected as objects.The contents of fluoride in water,urine and saliva were determined.The correlation of fluoride content in water,urine fluoride and fluoride concentration in saliva was analyzed.According to the levels of the saliva fluoride concentration,the children were divided into 11 groups,＜ 1.00,1.00-,2.00-,3.00-,4.00-,5.00-,6.00-,7.00-,8.00-,9.00-and ≥ 10.00 mg/L.The prevalence of dental fluorosis and defected dental fluorosis were investigated and the saliva fluoride concentration was calculated by Banch-Mark Dose Software.Results Compared with non endemic areas,the fluoride contents in water,urine and saliva [(2.13 ± 0.13),(1.29 ±0.73),(4.01 ± 3.61) mg/L] were higher than that in endemic areas [(0.67 ± 0.13),(0.38 ± 0.08),(0.75 ± 0.12) mg/L,t =158.730,24.780,18.114,all P ＜ 0.01].The fluoride concentration in saliva was positively correlated with the fluoride content in water and urine in endemic areas (r =0.626,0.945,all P ＜ 0.01).The (BMDs and benchmark dose lower bound (BMDLs) were 0.91,0.54,3.72,3.32 mg/L respectively,calculated by Banch-Mark Dose Software.With the increase of fluoride concentration in saliva,the prevalence of dental fluorosis and defect dental fluorosis had increased too,especially when the fluoride content in saliva was more than 4 mg/L.There were significant doseresponse relationships between the urine fluoride and the prevalence of dental fluorosis and defected dental fluorosis.Conclusion The fluoride concentration in saliva could be used as one of the evaluation indexes of fluorosis,and the BMD of saliva fluoride concentration in endemic fluorosis areas is suggested as 0.91 mg/L.

Objective To summarize the methods and experience of surgical treatment of abdominal aortic aneurysm.Methods The clinical data of 12 patients with abdominal aortic aneurysm treated in our hospital from August 2010 to December 2014 were analyzed retrospectively.All patients were diagnosed by B ultrasound,CT,MRI and DSA,and the surgical treatment plan was established.Open surgical resection and artificial vascular graft were performed in 8 cases and endovascular repairing other 4 cases.Festlts All the operations were performed successfully with no perioperative mortality.One case of type Ⅱ internal leakage and 1 case of pulmonary infection were observed.Conclusions The importance attached to perioperative treatment and strict selection of indications and treatment can increase the safety of the surgical performance of abdominal aortic aneurysm.

ObjectiveTo assess long-term effect of two different types of arterial reanastomoses for kidney transplantation [an end-to-side anastomoses (ESA) of renal artery to external iliac artery and an endto-end anastomoses (EEA) of renal artery to internal iliac artery] by comparing conventional ultrasound and contrast-enhanced ultrasonography(CEUS) after five years of renal transplantation.MethodsSixty patients underwent kidney transplatation were included and divided into EEA group or ESA group based on the type of anastomoses. Data of renal blood flow perfusion,hemodynamic parameters,and renal anatomical structure were collected and analyzed in each groups using CEUS,color Doppler flow imaging(CDFI) and B-mode ultrasound.ResultsThe patients of the two arterial reanastomoses had no significantly difference in B-mode ultrasound and CDFI. The ESA patients had a slightly better perfusion than the EEA ones in parameters of CEUS.Conclusions Transplant tissue perfusion imaging was performed by CEUS. The perfusion of ESA grafts was slightly better than that of EEA.