Intraoperative frozen pathology is critical when a breast tumor is not diagnosed before surgery. However, frozen tumor tissues always present various microscopic morphologies, leading to a high misdiagnose rate from frozen section examination. Thus, we aimed to identify breast tumors using bioimpedance spectroscopy (BIS), a technology that measures the tissues' impedance. We collected and measured 976 specimens from breast patients during surgery, including 581 breast cancers, 190 benign tumors, and 205 normal mammary gland tissues. After measurement, Cole-Cole curves were generated by a bioimpedance analyzer and parameters R-0/R-infinity, f(c), and alpha were calculated from the curve. The Cole-Cole curves showed a trend to differentiate mammary gland, benign tumors, and cancer. However, there were some curves overlapped with other groups, showing that it is not an ideal model. Subsequent univariate analysis of R-0/R-infinity, f(c), and alpha showed significant differences between benign tumor and cancer. However, receiver operating characteristic (ROC) analysis indicated the diagnostic value of f(c) and R-0/R-infinity were not superior to frozen sections (area under curve [AUC]= 0.836 and 0.849, respectively), and a was useless in diagnosis (AUC= 0.596). After further research, we found a scatter diagram that showed a synergistic effect of the R-0/R-infinity, and f(c), in discriminating cancer from benign tumors. Thus, we used multivariate analysis, which revealed that these two parameters were independent predictors, to combine them. A simplified equation, RF' = 0: 2f (c) + 3: 6R(0)/R-infinity, based on multivariate analysis was developed. The ROC curve for RF' showed an AUC= 0.939, and the sensitivity and specificity were 82.62% and 95.79%, respectively. To match a clinical setting, the diagnostic criteria were set at 6.91 and 12.9 for negative and positive diagnosis, respectively. In conclusion, RF' derived from BIS can discriminate benign tumor and cancers, and integrated criteria were developed for diagnosis.
We aimed to report surgical outcomes in female urethral diverticula and to investigate the risk factors for diverticula recurrence. A total of 66 patients underwent urethral diverticulectomies from January 2009 to October 2015 at out institution. Patient and diverticula characteristics were collected. Mean follow-up was 28.8 months (range 4-85 months). Recurrence was defined as requiring a repeat diverticulectomy. Mean age was 44.9 years. Mean duration of symptoms was 28.1 months. Seven cases had previous urethral surgeries. Mean diverticula size was 2.8 cm. Main clinical symptoms included dribbling (n = 41), vaginal mass (n = 41), dysuria (n = 33), frequency/urgency (n = 29), infection (n = 24), stress urinary incontinence (SUI) (n = 20) and dyspareunia (n = 8). 10 cases had proximal diverticula, 10 cases had multiple diverticula, and 35 cases had horseshoe/circumferential diverticula. Postoperatively, the recurrence rate was 19.7 %. Preoperative SUI disappeared in 14 cases, and de novo SUI was developed in six cases. One case developed urethral stricture, and no cases reported urinary fistula. Among 60 cases with pathological results, neoplastic change was seen in one case (1.7 %). Besides, atypical hyperplasia (n = 2) and metaplasia (n = 3) were observed. Univariate analysis suggested that age, duration, follow-up, diverticula size and diverticula shape were not associated with surgical outcomes. Patients with multiple diverticula (p = 0.032), proximal diverticula (p = 0.042) and those with previous urethral procedures (p = 0.004) were at risk of recurrent diverticula confirmed by multivariate logistic regression analysis. The surgical outcomes of urethral diverticulectomies were acceptable. Multiple diverticula, proximal diverticula and previous urethral surgery were three independent risk factors for recurrent diverticula.
Background: Plantar plate tears could be the reason of forefoot pain, affecting foot function. Magnetic resonance imaging (MRI) and ultrasound (US) were commonly used for the diagnosis of plantar plate tears. The decision of whether to use MRI or US carried some controversy. Our study aimed to find out the diagnostic accuracy of MRI versus US for plantar plate tears. Methods: The database of the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, and relative orthopedic meetings until May 2016 were searched. Studies involved in the diagnostic detection of MRI or ultrasound for plantar plate tears with surgical criteria as the reference test were included. Data was analyzed by meta-analysis. We compared sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and summary receiver operating characteristic (sROC) plot of both MRI and US. Results: Seven studies involving 246 plantar plate tears were included. The MRI showed more diagnostic accuracy than US for the detection of plantar plate tears. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of MRI were 95%, 54%, 2.08, and 0.08, respectively, while the same values for US were 93%, 33%, 1.20, and 0.35, respectively. And the sROC showed more superior diagnostic accuracy than the US. Conclusion: The current result suggests that MRI has better accuracy than US for detection of plantar plate tears.
Background: The incidence of cryptococcal meningitis (CM) and tuberculous meningitis (TBM) have gradually increased in recent years. These two types of meningitis are easily misdiagnosed which leads to a poor prognosis. In this study we compared differences of clinical features and prognostic factors in non-HIV adults with CM and TBM. Methods: We retrospectively reviewed the medical records of CM and TBM patients from January 2008 to December 2015 in our university hospital in China. The data included demographic characteristics, laboratory results, imaging findings, clinical outcomes. Results: A total of 126 CM and 105 TBM patients were included. CM patients were more likely to present with headache, abnormal vision and hearing, and they might be less prone to fever and cough than TBM patients (P < 0.05). Higher percentage of CM patients presented with cerebral ischemia/infarction and demyelination in brain MRI than TBM patients (P < 0.05). CM patients had lower counts of WBC in CSF, lower total protein in CSF and serum CD4/CD8 ratio than TBM patients (P < 0.05). After three months of treatment, CM group have worse outcome than TBM group (P < 0.05). Multivariate analysis showed that age more than 60y (OR = 4.981, 95% CI: 1. 955-12.692, P = 0.001), altered mentation (OR = 5.054, 95% CI: 1.592-16.046, P = 0.006), CD4/CD8 ratios < 1 (OR = 8. 782, 95% CI: 2.436-31.661, P = 0.001) and CSF CrAg >= 1: 1024 (OR = 4.853, 95% CI: 1.377-17.098, P = 0.014) were independent risk factors for poor prognosis for CM patients. For TBM patients, hydrocephalus (OR = 7.290, 95% CI: 1. 630-32.606, P = 0.009) and no less than three underlying diseases (OR = 6.899, 95% CI: 1.766-26.949, P = 0.005) were independent risk factors, headache was a protective factor of prognosis. Conclusions: Our study provided some helpful clues in the differential diagnosis of non-HIV patients with CM or TBM and identified some risk factors for the poor prognosis of these two meningitis which could help to improve the treatment outcome. Further studies are worth to be done.
Background: Visceral leishmaniasis (VL) is a life-threatening parasitic infection transmitted by phlebotomine sandflies. We undertook this study to analyze the clinical features of pediatric VL in a population of Chinese children. Methods: A retrospective study was performed with pediatric patients (<= 14 years) diagnosed with VL based on bone marrow biopsy, serology and diagnosis based on clinical manifestation and the improvement after the experimental drug when negative bone marrow and serology results were shown in West China Second Hospital, between January 2001 and December 2015. Results: A total of 43 patients were determined as having a VL infection (ranging from 4 months to 12 years with a slight male preponderance). Sixty-seven percent were less than 5 years of age and 74% of patients resided in endemic regions. The average time to diagnosis from the onset of symptoms was 37.5 days (ranging from 5 days to 6 months). The main clinical manifestations were fever (98%), splenomegaly (98%), hepatomegaly (74%), pancytopenia (72%), pallor (33%), cough (33%) and lymphadenopathy (33%). Hepatic dysfunction was also found in 24 patients (68%). All patients were treated with meglumine antimonite; only 1 child was treated with liposomal amphotericin B after resistance to meglumine antimonite was discovered. Patients were clinically cured except for 1 patient, who died from hemorrhagic shock because of refusal of standard treatment. Conclusions: Although there were no specific clinical manifestations of pediatric VL, a characterization of the overall symptoms may lead to an improved awareness of VL by clinicians and prompt early diagnosis and treatments. Presently, pentavalent antimony remains the first-line drug and there is low resistance in China.