Objective To investigate the expression of calpain small subunit 1 (Capn4) in breast cancer and its clinical significance. Methods The cancer tissues and the paraffin-embeded specimens of the corresponding adjacent normal tissues from 12 patients with breast cancer between May 2015 and July 2015 in Shanghai General Hospital were collected. The expression of Capn4 was detected by using immunohistochemistry. The paraffin-embeded specimens of cancer tissues from 70 breast cancer patients in Shanghai General Hospital between January 2009 and September 2011 were also collected. And the expression of Capn4 was detected. The correlation between Capn4 expression level and TNM stage, pathological grade, molecular markers as well as the prognosis of breast cancer was also analyzed. Results The expression of Capn4 in breast cancer tissues was higher than that in the corresponding adjacent normal tissues. The expression level of Capn4 was correlated with TNM stage (P = 0.002), T stage (P = 0.004), N stage (P = 0.004), M stage (P = 0.025), estrogen receptor (ER) status (χ 2 = 4.787, P = 0.029) and survival status (χ 2 = 5.826, P = 0.016). Kaplan-Meier survival analysis revealed that the median survival time in the higher expression of Capn4 group 90 months was shorter than that in the lower expression of Capn4 group (not reaching the median survival time), and there were statistical differences (χ 2 = 4.351, P = 0.037). Conclusions The expression of Capn4 in breast cancer tissues is upregulated. The expression difference is correlated with TNM stage, pathological grade, ER status and the prognosis of breast cancer, suggesting that it may become a new target and molecular marker for breast cancer treatment.

Carotid artery vulnerable plaque is prone to rupture and thrombosis,which is closely related to the occurrence of stroke.The detection of carotid plaque vulnerability is particularly important for early risk assessment of cerebrovascular disease.Carotid ultrasound is noninvasive,less expensive and with high reproducibility,therefore has become the important method for detecting the vulnerability of carotid artery plaque.The progresses of ultrasound technique for detection of carotid vulnerable plaque in recent years were reviewed in this article.

Objective To evaluate the evidence and recommendations of the relevant clinical practice guidelines for the prevention and treatment of stroke published in the last five years. Methods The stroke and guideline-related key words and free words domestic computer retrieval platforms(China biomedical literature database,CNKI,and Yimaitong etc.),as well as foreign platforms(PubMed,NGC,GIN,etc.) were retrieved.The retrieval time limit ranged from January 2012 to May 2017.Appraisal of Guidelines for Research and Evaluation Ⅱ(AGREE Ⅱ)was used to assess the quality of the guidelines. Results A total of 9 490 documents were retrieved preliminarily and finally 16 articles were included. The average scoring rates of the 16 guidelines in the 6 fields of AGREE Ⅱ,including the scope and purpose,participants,rigor of the formulation,clarity of expression,applicability,and independence of the editors were 66.3%, 27.4%,23.0%,53.9%,18.8%,and 0%,respectively.The different guidelines all recommend that internal endarterectomy or carotid balloon dilatation and carotid artery stenting are used to extracranial carotid stenosis,while the treatment of vertebral artery stenting is recommended for extracranial vertebral artery stenosis.However,the intravascular interventional therapy is not recommended for intracranial arterial stenosis.The perioperative period of ischemic stroke intravascular intervention need to pay attention to the application of anti-platelet aggregation,anticoagulation,blood pressure,blood glucose,blood lipid management,and postoperative monitoring. For postoperative stent restenosis,especially after vertebral artery stenting,the guidelines recommend using drug-eluting stents,however,the dosage of heparin in intraoperative anticoagulation is still controversial.The intracranial aneurysm guidelines are more recommended for interventional therapy.The cerebral hemorrhage in different regions is recommended for different surgical procedures. Conclusions The guidelines in this field can reflect the key problems in clinical practice and keep up with the international concept.However,the quality of the methodology of the guidelines development needs to be improved. Some of them need to be updated and the recommendations should refer more evidence of the Chinese population.

Objective To investigate distribution of carotid plaques,degree of stenosis and risk factors of unstable plaques in patients with acute ischemic stroke.Methods Totally 909 patients with acute ischemic stroke (AIS group) confirmed with head MRI were enrolled,while 885 patients without stroke in the same period hospitalization were selected as controls (control group).The distribution of carotid plaques and the degree of stenosis were compared between the 2 groups.Patients in AIS group were divided into stenosis rate ≥50％ subgroup and ＜50％ subgroup according to the degree of carotid artery stenosis,and the detectable rate of stable plaques and unstable plaques were compared between the 2 groups.Clinical data of patients with unstable plaques and non-unstable plaques in AIS group were compared.Logistic regression models were established with parameters with significantly differences among those features.Results The detectable rates of multiple plaques and unstable plaques of carotid artery and the degree of stenosis in AIS group were statistically higher than those in control group (all P＜0.001).The detectable rate of unstable plaque in carotid artery stenosis rate ≥50％ group was statistically higher than that in stenosis rate ＜50％ group (P＜0.001).Age,male,diabetes,dyslipidemia,smoking and drinking were significantly risk factors (all P＜0.05).Age,diabetes,dyslipidemia and smoking were independent risk factors (all P＜0.05).Conclusion Carotid unstable plaque and stenosis are closely related to the occurrence of AIS.Age,diabetes,dyslipidemia and smoking are independent risk factors for carotid artery plaque.

Objective To prepare the quantum dots(QDs) (CdTe-MPA)-loaded polymer(lactic-coglycolic acid,PLGA) microbubbles(MBQDs@PLGA) as dual-modality imaging agent for both fluorescent and ultrasonic imaging ability.Methods The MBQDs@PLGA were generated by the double emulsion technique,then filling in C3F8 after freeze-drying.Confocal laser scanning microscope(CLSM) and transmission electron microscope(TEM) were used to confirm the load of quantum dots in the MBs.Fluorospectro photometer spectra of the MBQDs@PLGA were analyzed to demonstrate the fluorescent imaging ability and determine the encapsulation efficiency by using the regression equation.Imaging experiments was applied to validate the fluorescent and ultrasonic imaging ability of the MBQDs@PLGA both by imaging of the model in vitro and by imaging of ovarian tumor blood vessels of tumor-bearing nude mouse in vivo.Results At excitation 272 nm the MBQDs@PLGA peak of the emission spectrum was 549 nm,and the encapsulation efficiency was 54％.The average diameter of MBQDs@PLGA was (1.7 ±0.2)μm,CLSM and TEM results confirmed the QDs-loaded in MBQDs-PLGA.The imaging results of MBQDs@PLGA showed a dual-modality imaging ability both fluorescent and ultrasonic imaging.Conclusions MBQDs@PLGA present fluorescence-ultrasound dual mode imaging performance by the QDs embedding in polymer microbubbles,and explore a new development train of thought of multi-mode imaging agent.

Objective To explore the feasibility of virtual touch tissue quantification(VTQ) technique in noninvasive assessment of transjugular intrahepatic portosystemic stent shunt (TIPSS).Methods Twenty-four patients were enrolled in this study.Shear wave velocity(SWV) of the liver and spleen were obtained by VTQ technique on one day before TIPSS insertion and one week after TIPSS placement,and the portal vein pressure was measured while placing the TIPSS.The correlation between SWV of the liver and spleen and portal venous pressure were analysed.In addition,fourteen patients were followed up for one month after TIPSS placement.Results There was significant difference in portal vein pressure pre [(27.82 ± 4.07) mm Hg] and post [(16.26-± 3.10) mm Hg] TIPSS insertion.The SWV of the liver in patients pre and post TIPSS measured (2.43 ± 0.37)m/s and (2.40 ± 0.34)m/s,respectively.The SWV of the spleen in patients pre and post TIPSS were (3.49 ± 0.40)m/s and (3.08 ± 0.39)m/s,respectively,there was significant difference (P =0.000).However,SWV of the liver pre and post TIPSS placement was no significant difference(P =0.130).And as well as the patients which were followed up for one month after TIPSS placement.A significant,direct,linear correlation(r =0.602,P =0.000) was found between SWV of the spleen and portal vein pressure,but liver SWV was not correlated with the portal venous pressure.Conclusions SWV of the spleen measured by VTQ technique has a significant correlation with portal vein pressure.Hence,the spleen SWV based on VTQ technique can be used as a non-invasive method for quantitatively in monitoring the portal vein pressure as the function of the TIPSS.However,evidence to support a similar role for liver stiffness is lacking.

Objective To evaluate the performance of virtual touch tissue quantification (VTQ)technique in noninvasive assessment of esophageal varices (EV) in patients with hepatitis B cirrhosis.Methods One hundred and thirty-five patients were enrolled in this study.Liver shear wave velocity (LSWV) and spleen shear wave velocity (SSWV) were obtained by VTQ technique,and the detection of EV was performed by upper endoscopy per patient.The severity of EV was staged on a G1-G3 scale.Liver function was also tested.ResultsThe mean value of LSWV in patients with cirrhosis was (2.48±0.50)m/s,LSWV was not correlated with the stage of EV.The mean value of SSWV was (3.25 ± 0.44) m/s,a significant,direct,linear correlation ( r =0.66,P＜0.001 ) was found between SSWV and the stage of EV.The cut-off value of SSWV for predicting the presence of EV was 3.16 m/s and the area under ROC curve was 0.83,with the sensitivity and specificity of 0.83 and 0.80,respectively.The cut-off value of SSWV for predicting severe EV was 3.39m/s and the area under ROC curve was 0.84,with the sensitivity and specificity of 0.83 and 0.77,respectively.ConclusionsIn cirrhotic patients infected with hepatitis B virus,SSWV measured by VTQ technique can be used as a noninvasive method for determining the presence and the severity of EV,however evidence to support a similar role for LSWV is lacking.

Objective To explore etiological factors, clinical characteristic and diagnosis of acute recurrent pancreatitis (ARP). Methods Clinical data of 68 patients with ARP from Jan. 2003 to Dec. 2009 were reviewed retrospectively. Results Among 532 acute pancreatitis (AP) cases, 68 were diagnosed as ARP ( 12.8% ). The majority of ARP patients were male, amounting 76.5% of the total. The average age of ARP patients was 45.6 years. Cholelithiasis, hyperlipemia and alcohol were the most frequent factors causing ARP. Among the 68 ARP cases, 58 cases were mild (85.3%) and 10 cases were severe ( 14. 7% ). 54 cases underwent surgery or endoscopic treatment (79.4%) while 14 cases underwent non-operative treatment (20.6%). As a result, 66 cases were cured or improved and 2 cases with severe ARP died. Conclusion The key to reduce recurrent rate of ARP is to find out the causes of recurrence and then treat the diseases accordingly.

Objective To investigate the distribution of biliary bacteriology and their sensitivity to antibiotics in patients with biliary tract infection in Jinshan area in recent 3 years.Methods Bile specimens collected from 367 patients with cholelithiasis between June 2006 and June 2009 were cultured and tested for drug sensitivity to aerobic bacteria.The results were statistically analyzed.Results One hundred and fifty-six bacterial strains were found in 142 (38.7%) bile specimens including gram negative strains (97,62.2%),gram positive strains (51,32.7% ),and fungal strains (8,5.1%).Enterococcus (17.9%) was major pathogen and follwed by Escherichia coli (12.8%),staphylococcus (11.5%),Klebsiella pneumoniae (8.3%),Pseudomonas aeruginosa (7.7%).Whereas the mixed infection was found in 26 (18.3%) specimens.The positive rate of bacterial infection was 53.1% in patients over 60 years of age (X2=8.36,P<0.01 ) and 47.1% in patients with acute biliary infection(X2=4.68,P<0.05).The drug susceptibility revealed that gram negative strains had low resistance to Meropenem (7.5 %),and followed by Imipenem (8.8 %),Cefoperazone +Sulbactam (19.7%),Amikacin (21.9%) and Tazobactam+Piperacillin (TZP,25.3%),but they were highly resistant to Ampicillin,Quinolones and some third generation of Cephalosporins (>50% ).In gram positive strains,none was resistant to Vancomycin,11.3% to fosfomycin and 11.6% to chloromycetin.They were highly resistant to Penicillins,Ampicillin and Cefazollin (>40%).ConclusionsEnterococcus,Escherichia coli,Sstaphylococcus and Klebsiella pneumoniae are commonly seen pathogens in biliary tract infection in Jinshan area.Use of Sulperazone or TZP plus Amikacin and metronidazole is recommended.Imipenem and Vancomycins may be second choice in treatment of severe biliary infection and refractory infection.

Objective To optimize the formulation of a new kind of ultrasound contrast agents carrying the sensitizer of hematoporphyrin(HP)with[Poly(lactic-co-glycolic acid),PLGA]for material.Methods The technique of double emulsion was applied to produce HP loaded PLGA ultrasound microbubbles,which was optimized through orthogonal test using encapsulation efficiency for the detected index.Then morphology and distribution of HP-PLGA microbubbles were observed through light microscope and scaning electron microscope.The size,Zeta potential and the properties of releasing behavior and ultrasound imaging in vitro of Hp-PLGA contrast agents were detected.Results The optimization parameters were picked out as 10 mg/ml for concentration of HP,40 mg for PLGA,and 1/5 for volume ratio of water inside to dichloromethane.The optimized HP-PLGA contrast agents were spheric with the mean size of 602.3 nm,and Zeta potentiaI of-(17.1±1.6)mV.The drug loading and encapsulation efficiency of HP-PLGA were(2.15±0.15)%and(63.5±2.6)%,respectively.And the releasing behavior of HP-PLGA contrast agents in vitro was that after an obvious release of about 35.1%in former 24 h,there were 86.5%HP-PLGA released within 14 days.The ultrasound imaging of HP-PLGA could be enhanced obviously in vitro.Conclusions The self-made HP-PLGA ultrasound microbubble might be a useful tool for delivering sensitizer and thus provide a novel strategy for sonodynamic therapy on tumor.