Calculation of the Paternity Index for the Alleged Father Related to the Child's Mother / 法医学杂志

OBJECTIVES@#To derive the paternity index (PI) calculation formula of the alleged father (AF) when the AF is a relative (parent/child, siblings, grandparent/grandchild, uncle/nephew, first cousins) of the child's biological mother.@*METHODS@#For the case when the AF is related to the child's biological mother, the existence of the relationship in the numerator and denominator hypothesis of PI was considered. The genotype frequency of the AF was calculated by using the frequency formula in which the mother's genotype was considered, while the random male in the denominator was substituted as another relative of the mother's same rank. The PI calculation formula was derived to eliminate the effect of the relationship between AF and the child's biological mother.@*RESULTS@#When the AF and the biological mother have first, second and tertiary kinship, a more conservative PI was obtained from the PI calculation formula derived in this study compared with the PI calculation method which did not consider kinship.@*CONCLUSIONS@#The calculation method provided in this study can eliminate the effect of the relation of the AF and mother on the PI in incest cases, to obtain more accurate and conservative identification conclusions.

Retrospective analysis of clinical features and prognosis of breast encapsulated papillary carcinoma based on SEER database / 国际外科学杂志

Objective:To analyze the clinicopathological features, survival and related prognostic factors of encapsulated papillary carcinoma (EPC) of breast.Methods:Data on EPC and invasive ductal carcinoma (IDC) of the breast from January 2010 to December 2015 were searched and screened using the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was used to adjust for baseline confounding between the EPC and IDC groups. The Kaplan-Meier method was used to calculate cumulative survival curves for overall survival (OS) and breast cancer-specific survival (BCSS). Prognostic value of these factors were assessed by univariate Log-rank test and multivariate Cox regression analysis.Results:In this study, 184 524 patients with IDC and 175 patients with EPC were included. Compared with patients with IDC, patients with EPC over 60 years old had a higher proportion, a lower rate of lymph node metastasis, and a higher proportion of estrogen receptor positive, progesterone receptor positive and human epidermal growth factor receptor 2 negative ( P<0.05). After PSM adjustment, OS of patients with EPC was worse than that of IDC, and BCSS was better than that of IDC ( P<0.05). Univariate and multivariate analysis showed that age, surgical approach and N stage were associated with poorer OS, while surgery approach, T stage, N stage and molecular typing were associated with worse BCSS ( P<0.05). Conclusions:Compared with IDC, EPC of breast has better BCSS and lower lymph node metastasis rate. There is a certain correlation between tumor stage and molecular type and prognosis of EPC.

Data Mining Study on Prescription Patterns of Different Dosage Forms of Chinese Herbal Medicines for Treating and Improving Immune-Inflammatory Indices in Patients with Rheumatoid Arthritis / 中国结合医学杂志

OBJECTIVE@#To explore the prescription patterns of different dosage forms of Chinese herbal medicines (CHMs) for the treatment of rheumatoid arthritis (RA) and their effects on immune-inflammatory indices.@*METHODS@#Clinical data were collected from patients with RA in 4 hospitals (3 Class A comprehensive hospitals and 1 Class B comprehensive hospital) in Anhui Province, China, from August 2012 to June 2018 via the electronic medical record gathering system. Following extraction of prescription information, each prescribed herb was quantified and standardized according to the knowledge base to establish a database of RA treatment formulae. The medical records were divided into the granules group and decoction pieces group. Core herbs and their combination patterns were obtained from the two groups of cases using Liquorice software. Changes in immune-inflammatory and hepatic and renal function indices were compared between the two groups using SPSS 23.0 software. The Aprior module of SPSS Clementine 11.1 software was applied to analyse the correlation between CHMs and improvement in indices. Finally, the ORACLE 10 g tool was used to evaluate the random walk model of the immune-inflammatory indices between the two groups.@*RESULTS@#(1) We retrospectively analysed 35,898 prescriptions for 6,829 patients with RA who received CHM treatment. There were 3,816 patients in the granules group and 3,013 in the decoction pieces group. (2) The core herbs were Pi (Spleen)-strengthening and dampness-resolving drugs, blood-activating and stasis-resolving drugs, wind/dampness-dispelling drugs and heat-clearing and detoxifying drugs. (3) Both dosage forms could improve immune-inflammatory indices in RA patients, with similar efficacy and no influence on hepatic or renal function. (4) Herba Siegesbeckiae and Oldenlandia had a stronger association with immune-inflammatory indices in the two groups. (5) The immune-inflammatory indices showed obvious improvement after treatment with granules and decoction pieces of CHMs, and there were long range correlations between the comprehensive evaluation indices and interventions.@*CONCLUSIONS@#The principal CHM treatment methods for RA in four hospitals in Anhui Province are strengthening Pi and resolving dampness, activating blood and resolving stasis, dispelling wind/dampness and clearing heat. Granules and decoction pieces of CHMs have similar efficacy in improving immune-inflammatory indices in RA patients and could be used as treatment options for RA.

Study on critical quality attributes of Qingjin Huatan Decoction based on serum pharmacochemistry / 中国中药杂志

Qingjin Huatan Decoction is a classic prescription with the effects of clearing heat, moistening lung, resolving phlegm, and relieving cough. In order to explore the critical quality attributes of Qingjin Huatan Decoction, we identified the blood components of Qingjin Huatan Decoction by ultra-performance liquid chromatography quadrupole time of flight mass spectrometry(UPLC-Q-TOF-MS) under the following conditions, chromatographic column: Acquity UPLC BEH C_(18) column(2.1 mm×100 mm, 1.7 μm); mobile phase: 0.1% formic acid acetonitrile(A)-0.1% formic acid in water(B); gradient elution; flow rate: 0.2 mL·min~(-1); column temperature: 30 ℃; injection volume: 5 μL. The electrospray ionization(ESI) source was used to collect data in both positive and negative ion modes under the following conditions, capillary voltage: 3 kV for the positive ion mode and 2 kV for the negative ion mode; ion source temperature: 110 ℃; cone voltage: 30 V; cone gas flow rate: 50 L·h~(-1); nitrogen degassing temperature: 350 ℃; degassing volume flow rate: 800 L·h~(-1); scanning range: m/z 50-2 000. In this experiment, a total of 66 related components of Qingjin Huatan Decoction were identified, including 22 prototype components and 44 metabolites. The results of this study preliminarily revealed the pharmacodynamic material basis of Qingjin Huatan Decoction in vivo, which has provided an experimental basis for the determination of quality markers of Qingjin Huatan Decoction and the development of new drugs.

Application value of artificial intelligence model based on deep learning in Breast Ultrasound Imaging Reporting and Data System: breast nodules classification / 肿瘤研究与临床

Objective:To explore the application value of artificial intelligence (AI) model based on deep learning in breast nodules classification of Breast Imaging Reporting and Data System of ultrasound (BI-RADS-US).Methods:The ultrasound images of 2 426 breast nodules from 1 558 female patients with breast diseases at Beijing Tongren Hospital, Capital Medical University between December 2006 and December 2019 were collected . The image data sets were divided into training (63%), verification (7%), and test (30%) subsets for the construction of AI model. The diagnostic efficiencies of AI model, doctors' arbitration results and doctors' diagnosis with or without AI model assistance were analyzed by using receiver operating characteristic (ROC) curve. The Cohen weighted Kappa statistic was used to compare the consistency of BI-RADS-US classification among 5 ultrasound doctors' diagnosis with or without AI model assistance. And the changes of BI-RADS-US classification were analyzed before and after each doctor adopted AI model assistance.Results:The differences in diagnostic efficiencies of AI model, doctors' arbitration results and doctors' diagnosis with or without AI model assistance were statistically significant (all P > 0.05). The consistency among 5 ultrasound doctors was improved due to AI model assistance and Kappa value was increased from 0.433 (category 3), 0.600 (category 4a), 0.614 (category 4b), 0.570 (category 4c) and 0.495 (category 5) to 0.812, 0.704, 0.823, 0.690 and 0.509 (all P < 0.05), respectively. The upgrade and downgrade of BI-RADS-US classification occurred in 5 doctors after the classification of AI model assistance. Downgrade from category 4 to 3 in benign nodules of 56.6% (47/76) and upgrade from category 4 to 5 in malignant nodules of 69.4% (34/49) were mostly observed. Conclusions:AI-assisted BI-RADS-US classification can effectively improve the consistency of classification among the doctors without reducing the diagnostic efficiency. AI model shows clinical values in reducing unnecessary biopsy of partial benign lesions and increasing diagnostic accuracy of partial malignant lesions through the adjustment of breast nodule classification.

Clinical observation on Tongdu Tiaoqi acupuncture combined with warming acupuncture for postoperative urinary retention / 中国针灸

OBJECTIVE@#To compare the therapeutic effect of Tongdu Tiaoqi acupuncture (acupuncture for unblocking governor vessel and regulating qi ) combined with warming acupuncture, Tongdu Tiaoqi acupuncture, abdominal moxibustion and oral tamsulosin hydrochloride sustained release capsule on postoperative urinary retention.@*METHODS@#A total of 120 patients with postoperative urinary retention were randomized into an acupuncture-moxibustion group, an acupuncture group, a moxibustion group and a medication group, 30 cases in each group. Tongdu Tiaoqi acupuncture combined with warming acupuncture were applied in the acupuncture-moxibustion group. Tongdu Tiaoqi acupuncture was applied at Baihui (GV 20), Shuigou (CV 26) etc. in the acupuncture group. Moxibustion was applied at Qihai (CV 6), Guanyuan (CV 4), Shuidao (ST 28) and Sanyinjiao (SP 6) in the moxibustion group. Tamsulosin hydrochloride sustained release capsule was given orally in the medication group. The treatment was once a day, and 5-day treatment was required in each group. Before and after treatment, the residual urine volume of bladder, the visual analogue scale (VAS) score and the time of first urethral catheter removal were observed, and the clinical efficacy was compared in the 4 groups.@*RESULTS@#After treatment, the residual urine volume of bladder was decreased compared before treatment in the 4 groups (P<0.05), and that in the acupuncture-moxibustion group was less than the other 3 groups (P<0.05). After treatment, the VAS scores were decreased compared before treatment in the acupuncture-moxibustion group, the acupuncture group and the moxibustion group (P<0.05), and those in the 3 groups were lower than the medication group (P<0.05). The time of first urethral catheter removal in the acupuncture-moxibustion group was earlier than the other 3 groups (P<0.05). The total effective rate was 93.3% (28/30) in the acupuncture-moxibustion group, which was superior to 63.3% (19/30) in the acupuncture group, 60.0% (18/30) in the moxibustion group and 66.7% (20/30) in the medication group (P<0.05).@*CONCLUSION@#The therapeutic effect of Tongdu Tiaoqi acupuncture combined with warming acupuncture on postoperative urinary retention is superior to simple acupuncture, abdominal moxibustion and tamsulosin hydrochloride sustained release capsule.

Application of VR and AR integrated teaching system in stomatology general medical education of clinical medicine students / 中华医学教育探索杂志

Objective:To investigate the application and effect of the virtual reality (VR) combined with the augmented reality (AR) integrated teaching system in stomatology general medical education of clinical medicine students.Methods:A total of 160 undergraduates from the five-year clinical medicine Batch 2015 of Naval Medical University were randomly divided into VR+AR group and traditional group, with 80 students in each group. A comparative analysis was made on the previous and teaching achievements of the two groups of students, and a questionnaire survey was conducted after the completion of the class. Epidata 3.0 was used to input questionnaire data, and SPSS 23.0 software was used to carry out t test, chi-square test and Fisher precision test. Results:There was no statistical difference in written test scores between the VR+AR group and the traditional group [(52.65±3.76) vs. (51.90±3.46), P=0.516], but the VR+AR group was significantly higher than the traditional group in case analysis scores [(35.85±2.56) vs. (31.40±2.96), P < 0.001] and overall performance [(88.50±4.95) vs. (83.30±4.86), P= 0.002]. The questionnaire survey results showed that the scores of "teaching mode" [(92.30±6.90) vs. (85.20±7.30), P<0.001], "teaching method" [(91.70±5.90) vs. (86.00±6.70), P=0.012] and "teaching improvement" [(90.70± 8.70) vs. (82.30±8.40), P<0.001] in VR + AR group were significantly higher than those in the traditional teaching group. Conclusion:The VR combined with AR integrated teaching system can significantly improve teaching performance and teaching quality, and is convenient for teaching demonstrations and simulation operations in small oral spaces, and is especially suitable for oral general medical education for clinical medicine.

Deep learning applied to two-dimensional color Doppler flow imaging ultrasound images significantly improves diagnostic performance in the classification of breast masses: a multicenter study / 中华医学杂志(英文版)

BACKGROUND@#The current deep learning diagnosis of breast masses is mainly reflected by the diagnosis of benign and malignant lesions. In China, breast masses are divided into four categories according to the treatment method: inflammatory masses, adenosis, benign tumors, and malignant tumors. These categorizations are important for guiding clinical treatment. In this study, we aimed to develop a convolutional neural network (CNN) for classification of these four breast mass types using ultrasound (US) images.@*METHODS@#Taking breast biopsy or pathological examinations as the reference standard, CNNs were used to establish models for the four-way classification of 3623 breast cancer patients from 13 centers. The patients were randomly divided into training and test groups (n = 1810 vs. n = 1813). Separate models were created for two-dimensional (2D) images only, 2D and color Doppler flow imaging (2D-CDFI), and 2D-CDFI and pulsed wave Doppler (2D-CDFI-PW) images. The performance of these three models was compared using sensitivity, specificity, area under receiver operating characteristic curve (AUC), positive (PPV) and negative predictive values (NPV), positive (LR+) and negative likelihood ratios (LR-), and the performance of the 2D model was further compared between masses of different sizes with above statistical indicators, between images from different hospitals with AUC, and with the performance of 37 radiologists.@*RESULTS@#The accuracies of the 2D, 2D-CDFI, and 2D-CDFI-PW models on the test set were 87.9%, 89.2%, and 88.7%, respectively. The AUCs for classification of benign tumors, malignant tumors, inflammatory masses, and adenosis were 0.90, 0.91, 0.90, and 0.89, respectively (95% confidence intervals [CIs], 0.87-0.91, 0.89-0.92, 0.87-0.91, and 0.86-0.90). The 2D-CDFI model showed better accuracy (89.2%) on the test set than the 2D (87.9%) and 2D-CDFI-PW (88.7%) models. The 2D model showed accuracy of 81.7% on breast masses ≤1 cm and 82.3% on breast masses >1 cm; there was a significant difference between the two groups (P < 0.001). The accuracy of the CNN classifications for the test set (89.2%) was significantly higher than that of all the radiologists (30%).@*CONCLUSIONS@#The CNN may have high accuracy for classification of US images of breast masses and perform significantly better than human radiologists.@*TRIAL REGISTRATION@#Chictr.org, ChiCTR1900021375; http://www.chictr.org.cn/showproj.aspx?proj=33139.

Nomogram for predicting axillary lymph node pathological response in node-positive breast cancer patients after neoadjuvant chemotherapy / 中华医学杂志(英文版)

BACKGROUND@#Pathological complete response (pCR) of axillary lymph nodes (ALNs) is frequently achieved in patients with clinically node-positive breast cancer after neoadjuvant chemotherapy (NAC), and ALN status is an important prognostic factor for breast cancer patients. This study aims to develop a new predictive clinical model to assess the ALN pCR rate after NAC.@*METHODS@#This was a retrospective series of 467 patients who had biopsy-proven positive ALNs at diagnosis and underwent ALN dissection from 2007 to 2014 at the National Cancer Center/Cancer Hospital of the Chinese Academy of Medical Sciences. We analyzed the clinicopathologic features of the patients and developed a nomogram to predict the probability of ALN pCR. A multivariable logistic regression stepwise model was used to construct a nomogram to predict ALN pCR in node-positive patients. The adjusted area under the receiver operating characteristic curve (AUC) was calculated to quantify the ability to rank patients by risk. Internal validation was performed using the 50/50 hold-out validation method. The nomogram was externally validated with prospective cohorts of 167 patients from 2016 to 2018 at the Cancer Hospital of the Chinese Academy of Medical Sciences and 114 patients from 2018 to 2020 at Beijing Tiantan Hospital.@*RESULTS@#In this retrospective study, 115 (24.6%) patients achieved ALN pCR after NAC. Multivariate analysis showed that clinical tumor stage (Odds ratio [OR]: 0.321, 95% confidence interval [CI]: 0.121-0.856; P = 0.023); primary tumor response (OR: 0.189; 95% CI: 0.123-0.292; P < 0.001), and estrogen receptor status (OR: 0.530, 95% CI: 0.304-0.925; P = 0.025) were independent predictors of ALN pCR. The nomogram was constructed based on the result of multivariate analysis. In the internal validation of performance of nomogram, the AUCs for the training and test sets were 0.719 and 0.753, respectively. The nomogram was validated in external cohorts with AUCs of 0.720, which demonstrated good discriminatory power in these data sets.@*CONCLUSION@#We developed a nomogram to predict the likelihood of axillary pCR in node-positive breast cancer patients after NAC. The predictive model performed well in multicenter prospective external validation. This practical tool could provide information to surgeons regarding whether to perform additional ALN dissection after NAC.@*TRIAL REGISTRATION@#ChiCTR.org.cn, ChiCTR1800014968.

Strategy and effects of the areo-medical evacuation team in Mali to prevent and control COVID-19 pneumonia epidemic / 上海预防医学

This article summarizes the strategy and effects of preventing and controlling the epidemic in the evacuation support of the aero medical evacuation team of the 7th peacekeeping medical contingent of China to Mali， to actively respond to the coronavirus disease-19 （COVID-19 ）epidemic based on existing medical conditions and further provide scientific evidence for guaranteeing military medical service in public health emergencies.

Construction of SNP-STR Multiplex Amplification System with Genetic Markers and Its Forensic Application / 法医学杂志

Objective To select and develop a SNP-STR multiplex amplification system with genetic markers compatible with current STR databases. To understand its genetic polymorphisms in Sichuan Han population and its application value in DNA mixture analysis. Methods Based on the STR genetic markers in commercial kits, SNPs adjacent to these STR markers were selected to be SNP-STR genetic markers. A SNP-STR multiplex amplification system with genetic markers based on allele-specific amplification was constructed using allele-specific amplification primers. The genetic polymorphism of the system in the Sichuan Han population was investigated and the efficiency of systems with different numbers of loci to detect the two individual DNA mixture samples was evaluated. Results An allele-specific multiplex amplification system constituted of 13 SNP-STR genetic markers was selected and constructed. In Sichuan Han population, the heterozygosity of each locus ranged from 0.76 to 0.88, and the combined discrimination power reached 0.999 999 999 999 999 968. In the analysis of the two individual DNA mixture samples： for single-locus amplification, the genotype of the minor components can still be detected when the mixture ratio reaches 1 000∶1; for multiple loci multiplex amplification, the maximum mixture ratio can reach 500∶1. As the number of loci in the system increased, the detection efficiency of the minor components in the DNA mixture decreased. Conclusion SNP-STR genetic markers have a higher polymorphism than STR. The multiplex amplification system made of SNP-STR genetic markers has a better analysis efficiency for mixed samples than traditional STR multiplex amplification system.

Research progress on teaching performance appraisal management of clinical teachers in teaching hospitals / 中华医学教育探索杂志

This paper summarizes the current research on teaching performance appraisal management of teaching hospitals at home and abroad, analyzes existing problems in teaching performance appraisal at present, and puts forward that teaching performance appraisal should be included in hospital performance appraisal. The principle of "informatization and anonymity" should be adopted to evaluate the teaching quality of clinical teachers, so that clinical teachers can participate in teaching performance appraisal management, and the indicators and weights of teaching performance appraisal can be determined scientifically and reasonably.

Change and significance of optic nerve sheath pulsatile dynamics in normal-tension glaucoma / 中华实验眼科杂志

Objective:To analyze the value and difference of the optic nerve sheath pulse dynamic deformation index (DI) in normal-tension glaucoma (NTG) and high-pressure primary open angle glaucoma (POAG).Methods:A cross-sectional study was conducted to collect clinical data at the Eye Center of Beijing Tongren Hospital from June 2016 to March 2017, 32 patients with NTG and 35 patients with high-pressure POAG were sampled.For all subjects, their basic information, body mass index (BMI), mean arterial blood pressure (MAP), 24 hours intraocular pressure, and ophthalmologic examinations required for diagnosis were recorded.All subjects underwent transorbital ultrasonography and for each 15 seconds of consecutive ultrasound images were taken.The dynamic post-processing technique was used to calculate the DI.The difference in DI between the two groups and the correlation of DI with other variables were analyzed.The study protocol was approved by the Ethics Committee of Beijing Tongren Hospital.Written informed consent was obtained from all subjects prior to their entering the study cohort and receiving the transorbital ultrasound examination.Results:The median level of DI in the NTG group was 0.51 (0.48, 0.54), which was higher than that in the high-pressure POAG group (0.23[0.20, 0.25]), exhibiting a significant difference ( Z=-7.01, P<0.01). The mean BMI in the NTG group was lower than that in the high-pressure POAG group([21.29±4.64]kg/m 2vs. [23.53±3.40]kg/m 2), the mean MAP in the NTG group was lower than that in the high-pressure POAG group([91.44±14.30]mmHg vs. [104.05±13.96] mmHg), the differences between the two groups were statistically significant ( t=-2.30, P<0.05; t=-3.65, P<0.01). There was no statistical association between the two groups of DI and age, MAP, BMI, mean intraocular pressure and maximum intraocular pressure (all at P>0.05). Conclusions:The DI of the NTG patient is higher than that of the POAG patient, which indicates that the optic nerve sheath subarachnoid pressure and optic nerve sheath stiffness in NTG patients are lower than those in POAG patients.Therefore, the DI is a potential indicator of non-invasive intracranial pressure and translaminar cribrosa pressure difference detection in ophthalmology.

Epidemiological analysis of cytogenetic abnormalities in patients with newly-diagnosed multiple myeloma: a multi-center retrospective study / 中华血液学杂志

Objective@#To analyze the frequency and composition of risk-related cytogenetic abnormalities (CAs) in patients with newly-diagnosed multiple myeloma (NDMM) .@*Methods@#The frequency and composition of risk-related CAs from a cohort of 1 015 Chinese patients with NDMM were determined by interphase fluorescence in situ hybridization (iFISH) , individually or in combination.@*Results@#Of the cohort of 1 015 Chinese patients with NDMM, the frequencies of IgH arrangement, del (13q) /13q14, 1q gain and del (17p) were 54.0%, 46.4%, 46.1% (35.8% and 12. 7% for 3 or more than 3 copies) and 9.9%, respectively. Among 454 patients who had the baseline information for all risk-related CAs [except t (14;20) , which was not covered by the FISH panels performed routinely at all five centers], the frequencies of t (4;14) , t (11;14) or t (14;20) were 14.1%, 11.2% and 4.8%, respectively; of them, 44.3% patients carried 2 or more CAs (28.0%, 13.4% and 2.9% for 2, 3 or ≥4 CAs) ; 83.3%, 95.0% or 68.6% patients with 1q gain, del (17p) or IgH rearrangement had 1 or more additional CA (s) , with del (13q) /13q14 as the most frequently accompanied CA; 57.7% patients carried at least 1 HRCA; the incidences of double-hit (DH) MM (DHMM) (=2 HRCAs) and triple-hit (TH) (THMM) (≥3 HRCAs) were 14.3% and 2.9%, respectively.@*Conclusions@#Our results provided an up-to-date profile of CAs in Chinese NDMM patients, which revealed that approximately 58% patients might carry at least 1 HRCA, and 17% could experience so-called DHMM or THMM who presumably had the worst outcome.

Application value of artificial intelligence-assisted diagnosis model in ultrasound diagnosis of breast nodules / 肿瘤研究与临床

Objective@#To explore the application value of the convolutional neural network (CNN)-based artificial intelligence-assisted diagnosis model in the ultrasound differentiation diagnosis of benign and malignant breast nodules.@*Methods@#A total of 7 334 ultrasound images from 1 351 patients with breast nodules including 807 benign cases and 544 malignant cases were retrieved by using the CNN-based artificial intelligence-assisted diagnosis model from Beijing Tongren Hospital of Capital Medical University ultrasound images database between December 2006 and July 2017. The study included training subset (6 162 images), verification subset (555 images), and test subset (617 images), which were performed in the artificial intelligence-assisted diagnosis model. The outcome results of test subset in diagnosis model were compared with the pathological results. The sensitivity, specificity and accuracy of the artificial intelligence-assisted diagnosis model were calculated.@*Results@#After the test of 617 images, the model diagnostic results could be automatically output with a rectangular frame indicating the nodule position, benign and malignant diagnosis, benign and malignant probability values. The diagnosis time was approximately 4 seconds for each nodule. The sensitivity, specificity and accuracy of the diagnostic model in differentiating benign and malignant breast nodules were 84.1%, 95.0% and 91.2% , respectively.@*Conclusion@#The CNN-based artificial intelligence-assisted diagnosis model has satisfactory results in the differentiation diagnosis of the benign breast nodules and the malignant ones, which indicating the promising application prospect.

Application value of artificial intelligence-assisted diagnosis model in ultrasound diagnosis of breast nodules / 肿瘤研究与临床

Objective To explore the application value of the convolutional neural network (CNN)-based artificial intelligence-assisted diagnosis model in the ultrasound differentiation diagnosis of benign and malignant breast nodules. Methods A total of 7334 ultrasound images from 1351 patients with breast nodules including 807 benign cases and 544 malignant cases were retrieved by using the CNN-based artificial intelligence-assisted diagnosis model from Beijing Tongren Hospital of Capital Medical University ultrasound images database between December 2006 and July 2017. The study included training subset (6162 images), verification subset (555 images), and test subset (617 images), which were performed in the artificial intelligence-assisted diagnosis model. The outcome results of test subset in diagnosis model were compared with the pathological results. The sensitivity, specificity and accuracy of the artificial intelligence-assisted diagnosis model were calculated. Results After the test of 617 images, the model diagnostic results could be automatically output with a rectangular frame indicating the nodule position, benign and malignant diagnosis, benign and malignant probability values. The diagnosis time was approximately 4 seconds for each nodule. The sensitivity, specificity and accuracy of the diagnostic model in differentiating benign and malignant breast nodules were 84.1％, 95.0％ and 91.2％ , respectively. Conclusion The CNN-based artificial intelligence-assisted diagnosis model has satisfactory results in the differentiation diagnosis of the benign breast nodules and the malignant ones, which indicating the promising application prospect.

Effect of breast conserving surgery on neurotensin and its receptor 1 in patients with breast cancer / 国际外科学杂志

Objective To investigate the effect of breast conserving surgery on neurotensin (NTS) and its receptor 1(NTR1) in patients with breast cancer.Methods From May 2012 to May 2015,200 patients with breast cancer,aged 44.7 years(range,32-56 years),were treated at Tiantan Hospital,Capital Medical University.All patients were divided into control group (n =100) and observation group (n =100).The patients in the control group were treated with radical operation and the patients in the observation group were treated with breastconserving surgery.The positive rate of NTS and NTR1 before and 1 week after operation,WHOQOL-100 (It includes four aspects:physiological state,psychological state,environmental condition and social function) 1 d before surgery,3 months and 6 months after surgery,and the incidence of postoperative complications 1 week after surgery were compared between the two groups.Measurement data with normal distribution were described as mean± standard deviation (Mean ± SD) and analyzed by the t test.Count data were analyzed by chi-square test.Results The positive rate of NTS (17.00％) in the observation group was significantly lower than that in the control group (36.00％) (t =9.267,P =0.002),The positive rate of NTR1 (19.00％) was significantly lower than that in the control group (33.00％) (t =5.094,P =0.024).The physiological status,psychological state,environmental condition and social function of 3 months after surgery of the observation group were (62.57 ± 5.73),(63.48 ±5.91),(68.73 ±6.32),(64.06 ±5.94) scores,respectively,and the control group were (53.47 ±5.38),(55.62 ±5.54),(60.38 ±6.14),(55.86 ±5.66) scores,respectively,showing statistically significant differences between the two groups (P ＜ 0.05).The physiological status,psychological state,environmental condition and social function of 6 months after surgery were (73.74 ±t 6.19),(76.27 ± 6.32),(78.85 ±6.77),(73.53 ±6.58) scores in the observation group,and (64.18 ±5.67),(67.38 ±6.02),(69.64 ± 6.43),(63.28 ± 6.17) scores in the control group,showing statistically significant differences between the two groups (P ＜ 0.05).The incidence of postoperative complications in the observation group (6.00％) was significantly lower than that in the control group (18.00％) (P ＜ 0.05).Conclusion Breast conserving surgery can reduce the expression level of NTS and NTR1 in breast cancer patients,It is related to reducing the incidence of postoperative complications and improving the quality of life of patients.

Evaluation for laryngopharynx of normal adult with high frequency ultrasound / 中国耳鼻咽喉头颈外科

OBJECTIVE Attempt to visualize the hypopharyngeal anatomy and related structures in normal adults with ultrasound. METHODS Sonographic features of laryngopharynx were confirmed by comparable tissue sections of 6 corpses at the same level. Then, the laryngopharynx of 30 men and 30 women were examined by ult rasound and thei r sonographic images were evaluated. RESULTS In male or female volunteers, perfect visualization pattern was obtained in all (100％) pyriform sinuses, 60％ or 93.3％ postcricoid areas,66.7％ or 93.3％ posterior pharyngeal walls, 96.7％ or 100％ thyroid cartilages, 63.3％ or 93.3％ arytenoid cartilages, 70％ or 93.3％ vocal cords,and 83.3％ or 96.7％ ventricular bands. CONCLUSION The ultrasonic visualization of laryngopharynx and its related structures are satisfactory in healthy adult women. For adult men, the pyriform sinus and thyroid cartilage can be best identified while the identification of vocal cords and ventricular bands is less satisfactory. However, postcricoid region, pharyngeal posterior wall, and arytenoid cartilage are the most difficult to detect.

The application of robotic nephrectomy, work bench surgery with robotic kidney autotransplantation in nephron-sparing surgery of complex renal tumors / 中华泌尿外科杂志

Objective To investigate the safety and feasibility of robotic nephrectomy,work bench surgery with robotic kidney autotransplantation in the treatment of complex renal tumors.Methods The clinical data of 5 patients with renal tumors admitted from January 2018 to July 2018 were analyzed retrospectively.There were 4 males and 1 females.The median age was 49 years old,ranging 32-66 years.The median body mass index was 25.6 kg/m2,ranging 21.1-27.8 kg/m2.Serum creatinine level was 87.2 μmol/L,ranging 78.0-88.9μmol/L before bench surgery.5 patients had multiple bilateral renal tumors and had undergone laparoscopic or robotic partial nephrectomy on the contralateral kidney.For bench surgery kidney,4 cases were on the left side and 1 case was on the right side.Each kidney has more than 2 separate tumors,combined with complete endophytic tumors,tumors larger than 7 cm in diameter or hilar tumors.5 patients were all performed robotic nephrectomy,work bench partial nephrectomy with robotic kidney autotransplantation under general anesthesia.The patient was first in a lateral decubitus position for robotic nephrectomy,and the kidney was removed through a median 6 cm periumbilical incision.After kidney removal,kidney tumors were resected and kidney was reconstructed on a hypothermic working table.Then the kidney was packed in a plastic bag,filling with ice slush.The corresponding parts of the plastic bag were cut to expose the renal artery and vein.Finally,the patient was moved to lithotomy position with Trendelenburg tilt of 20°,and the autologous kidney wrapped in the plastic bag was placed through the previous periumbilical incision into the abdominal cavity for robotic kidney autotransplantation.The renal artery and vein were anastomosed end-to-side with the right external iliac artery and vein.The ureter and bladder were anastomosed.Autologous kidneys were placed in abdominal cavity in 4 cases,and placed in right iliac fossa with retroperitonealization in 1 case.Ice slush on the surface of the autologous kidney did not completely melt before the blood supply was restored during the operation,and the autologous kidney immediately urinated after the blood supply was restored.Results All surgeries were performed successfully without conversion to open surgeries.The total operation time was 460 min,ranging (415-645 min),the time of robotic nephrectomy was 120 min,ranging (74-300 min),the time of robotic kidney autotransphntation was 135 min,ranging(103-163 min),the warm ischemia time was 3 min,ranging (1.5-6.0 min),the cold ischemia time was 182 min,ranging(135-210 min),the rewarming time was 50 min,ranging(45-55 min),the estimated blood loss during operation was 100 ml,ranging(50-300 ml),and the hospital stay was 6 d,ranging(5-9 d).The number of resected tumors was 4,ranging(2-6).The pathology reveals clear cell carcinoma in 3 cases and chromophobe cell carcinoma in 2 cases.The surgical margins were all negative.The serum creatinine levels were 111.1 μmol/L (87-217.6 μ mol/L) and 106.1 μmol/L (87.1-172 μmol/L) on the 7th and 30th day after operation,respectively.One month after operation,CT showed that the function and morphology of the autologous kidneys were fine.No recurrence or metastasis was found in 5 patients during a median follow-up of 7 months,ranging (5.4-11.7 mon).Conclusions For patients with complex renal tumors who cannot undergo in situ partial nephrectomy,robotic nephrectomy,work bench surgery with robotic kidney autotransplantation can completely remove the tumors,maximize the preservation of renal function and minimize the trauma of patients,making the ultimate means of nephron-sparing surgery for patients with complex renal tumors more minimally invasive and safe.

Preparation of antibody against mouse UPF1 and the expression of UPF1 in adipose cell differentiation / 基础医学与临床

Objective To prepare polyclonal antibodies against mouse UPF1 protein and to investigate the expression of UPF1 protein during adipocyte differentiation. Methods UPF1 protein expression vector was constructed to prepare and purify rabbit UPF1 antibody. The differentation of 3T3-L1 cells was induced and the expression of UPF1 was detected by CoIP. Results 1)High specific mUPF1 polyclonal antibody was prepared and the titer of this anti-body reached 640 000;2)The expression of UPF1 protein did not change during adipogenesis;3)In the process of adipocyte differentiation,interaction of UPF1 and UPF2 was increased. Conclusions 1)The polyclonal antibodies prepared by using 550 amino acids at the C terminal of mUPF1 protein could effectively recognize intact mUPF1 pro-tein;2)The interaction of UPF1 protein with UPF2 protein during adipocyte differentiation is enhanced.