Value of nomogram based on preoperative ultrasound and inflammatory indexes in predicting axillary high nodal burden in early breast cancer / 中华超声影像学杂志

Objective:To explore the values of ultrasound, pathology combined with inflammatory indicators in predicting high nodal burden (HNB) in patients with early breast cancer and to construct a nomogram to provide reference for individualized diagnosis and treatment.Methods:The ultrasonographic, pathological features and preoperative inflammatory indicators of 378 female patients diagnosed with early breast cancer confirmed by pathology in the South Hospital of the Sixth People′s Hospital Affiliated to Shanghai Jiaotong University from January 2014 to July 2022 were retrospectively analyzed. They were randomly divided into training set ( n=302) and test set ( n=76) in a ratio of 8∶2, and the baseline data of the two groups were compared. The optimal cutoff values of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and lymphocyte to monocyte ratio (LMR) were obtained by ROC curve. In the training set, with axillary high lymph node load (≥3 metastatic lymph nodes) as the dependent variable, independent influencing factors of HNB were identified by univariate and multivariate Logistic regression analyses, and the nomogram was established. The test set data were used to verify the model. The discrimination, calibration and clinical applicability of the model were assessed by the area under the ROC curve (AUC), C-index, the calibration curve, Brier score and the decision curve analysis, respectively. Results:There were no significant differences in all variables between the training set and the test set (all P>0.05). ROC curve analysis results showed that AUCs of NLR, PLR and LMR were 0.578, 0.547 and 0.516, respectively, and the optimal cut-off values were 2.184, 150 and 3.042, respectively. Univariate Logistic regression analysis showed that age, pathological type, histological grade, Ki-67, lymphovascular invasion, NLR, PLR, ultrasonic characteristics (maximum diameter of primary tumor, shape, long/short diameter of lymph node, cortical thickness, cortical and medullary boundary, lymph node hilum, lymph node blood flow pattern) were correlated with HNB of early breast cancer (all P<0.05). Multivariate Logistic regression analysis showed that ultrasonic characteristics (maximum diameter of primary tumor >2 cm, effacement of lymph node hilum, non-lymphatic portal blood flow), lymphovascular invasion, Ki-67>14% and NLR>2.184 were independent risk factors for HNB in early breast cancer ( OR=7.258, 8.784, 6.120, 8.031, 3.394 and 3.767, respectively; all P<0.05) and were used to construct the nomogram model. The AUC of the training set was 0.914 (95% CI=0.878-0.949), C-index was 0.914; The AUC of the test set was 0.871 (95% CI=0.769-0.973), C-index was 0.871, indicating good discrimination. Calibration curve and Brier score were 0.090, indicating high calibration degree of the model. The clinical decision curve indicated good clinical benefit. Conclusions:The nomogram based on ultrasonic characteristics (maximum diameter of primary tumor, lymph node hilum, lymph node blood flow pattern), lymphovascular invasion, Ki-67 and NLR can effectively predict the risk of HNB in patients with early breast cancer, and provide a reference for precision diagnosis and treatment to avoid excessive or insufficient treatment.

Analysis of color doppler flow imaging diagnosis of benign and malignant of superficial substantial tumors / 中国医师杂志

Objective To explore the value of Color Doppler Flow Imaging in diagnosis of superfi-cial substantial tumors.Methods Retrospective analysis of 742 cases of superficial substantial masses ( all confirmed by operation and pathology) of Patients'ultrasonography , and summarized its features of benign and malignant, and made a comparison.Results Of the 742 patients, ultrasound detection rate of 100%, including 12 cases of malignant lesions, ultrasound diagnosis of 12 malignant cases, the accuracy rate of 100%;730 cases of benign lesions, ultrasound diagnosis of 711 cases of benign, qualitative accuracy rate 97.4%.Conclusions Color Doppler Flow Imaging has an important value in the diagnosis of benign and malignant of superficial substantial tumors.

Establishing myocardial infarction animal models by the median sternotomyversus the left intercostal thoracotomy / 中国组织工程研究

BACKGROUND:Studies addressing coronary heart disease are largely dependent on the establishment of myocardial infarction animal models. It is very important that exploring a safe method with easy operation, less damage, long time survival and high survival rate for myocardial infarction animal model OBJECTIVE:To compare the pros and cons of two kinds of thoracotomy anterior descending coronary artery ligation to do myocardial infarction animal model. METHODS: Thirty healthy male New Zealand white rabbits were randomly divided into three groups: control, median sternotomy incision, and left sternal incision. The anterior descending coronary artery was ligated after thoracotomy. The operation time, amount of intraoperative bleeding, postoperative food intake, and recovery time of eating were monitored during the surgery and within 24 hours after the surgery. And myocardial enzyme indexes were also monitored within 24 hours after the surgery. Rabbits were detected with ultrasonic echocardiogram at 4 weeks. RESULTS AND CONCLUSION:Different levels of ST segment elevation appeared in median sternotomy and left sternal incision groups by echocardiogram. The success rate of modeling was 70% in median sternotomy incision group, and 80% in left sternal incision group. Within 24 hours post-surgery, the myocardial enzyme indexes in the two groups were significantly increased compared with before surgery (P < 0.05). At 4 weeks, the left ventricular ejection fraction and the left ventricular shortening fraction were significantly decreased when compared to before surgery (P< 0.05). The operation time was shorter, the amount of bleeding was less, the time of eating recovery was less and the amount of eating was much in median sternotomy group than in left sternal incision, with significant differences between he two groups (P < 0.05). The median sternotomy incision for the ligation of anterior descending coronary artery is better than the left sternal incision to establish myocardial infarction models.

Preliminary study of 3D ultrasound in visualization of levator hiatus in intrapartum women / 中华超声影像学杂志

Objective To visualize the pelvic floor structures by translabial three‐dimensional(3D) ultrasonography performed during labor and immediately after delivery, and to observe the morphological changes of levator hiatus in intrapartum women. Methods Totally 62 nulliparous women with singleton pregnancy and cephalic presentation in labor ward underwent intrapartum translabial 3D ultrasound examination before cervical dilatation, at 10 cm dilatation and immediately after delivery. Volume datasets were obtained at rest, biometric measurements and observation of the morphological changes of levator hiatus in different stages were determined in the axial plane. Comparative analyses of parameters in three stages were carried out. Results Translabial 3D ultrasound demonstrated the pelvic floor structures of intrapartum women well. All biometric measurements of the hiatus before cervical dilatation were the smallest and became the largest at 10 cm dilatation, showed statistically significant differences. The measurements after delivery got smaller immediately but still significantly larger than those before cervical dilatation ( P <0 0.01). Conclusions Translabial 3D ultrasound examination of the pelvic floor during labor and within the first 2h after delivery is feasible. It seems to be an effective tool to visualize pelvic floor structures in intrapartum women. Hiatal enlargement may be a common consequence of vaginal childbirth.

A preliminary application of levator-urethra gap in evaluating levtor avulsion in postpartum women / 中华超声影像学杂志

Objective To study the change of levator urethra gap(LUG) in postpartum female using pelvic floor three-dimensional ultrasonography.Methods Totally 80 postpartum women and 30 nulliparas were examined by three-dimensional pelvic floor ultrasonography.The images were obtained at maximal pelvic floor muscle contraction,and then the morphology of puborectalis muscle on tomographic ultrasound imaging were observed and the right LUG and left LUG were measured.Results The puborectalis was intact in all nulliparas and 69 postpartum women.The puborectalis avulsion was find in 11 postpartum women.The LUG of postpartum group was greater than that of nullipara group (P ＜0.05).In postpartum group,the LUG of puborectalis avulsion was greater than that of intact puborectalis(P ＜0.05).There was no difference between the right LUG and left LUG in nullipara group and in the postpartum women with intact puborectalis (P ＞ 0.05).ConcIusions LUG is a good imaging parameter to evaluate the levator avulsion in postpartum women.

Ultrasound imaging of pelvic floor in postpartum women—the movement of three compartments / 中华超声影像学杂志

Objective To dynamically observe and evaluate the position and movement of pelvic floor organs in vaginal delivery primipara with translabial two-dimensional(2D) ultrasound,and to provide the imaging basis for the effects of pregnancy and vaginal delivery on the pelvic floor support structures.Methods Translabial 2D ultrasound was performed on 52 vaginal delivery postpartum women (postpartum group) and 43 normal women as control group to observe the position and movement of pelvic floor organs at rest,on pelvic muscle contraction and during maximum Valsalva maneuver.Results The location of urethrovesical junction and cervix were significantly lower in postpartum group compared with the control group at three stages.The movement of urethrovesical junction and cervix in vertical direction was greater in postpartum group than control group during maximum Valsalva maneuver,while was smaller on pelvic floor contraction.Conclusions Translabial 2D ultrasound could dynamically observe and evaluate the position and movement of pelvic floor organs.Pregnancy and vaginal delivery produce certain effect on pelvic floor support structures,which manifest as weak,defective and dysfunction.The impact was more obvious in anterior and middle compartments.

Value of translabial ultrasonography in the diagnosis of female anterior pelvic floor dysfunction / 中华超声影像学杂志

Objective To evaluate the diagnostic value of translabial two-dimensional (2D) ultrasound for female anterior pelvic floor dysfunction,and to discuss the ultrasound appearance of anterior pelvic floor dysfunction.Methods Translabial 2D ultrasound was performed on 63 patients who were diagnosed or suspected with anterior pelvic floor dysfunction using pelvic organ prolapse quantitation system,the position and mobility of bladder neck,the retrovesical angle and urethral rotation were measured during maximum Valsalva maneuver.Different types of anterior pelvic floor dysfunction diseases were diagnosed according to the ultrasound findings.Results Translabial 2D ultrasound diagnose different types of anterior pelvic floor dysfunction diseases based on the position and mobility of bladder neck,retrovesical angle and urethral rotation,including 15 cases bladder neck hypermobility,9 cases funneling of the bladder neck and 37 cases cystocele.Conclusions Translabial 2D ultrasound could provide useful information of anterior pelvic floor and is of great value in the diagnosis of female anterior pelvic floor dysfunction.