Postoperative sensory dysfunction of breast cancer is a common complication after breast cancer surgery,which is main-ly manifested in numbness,pain and hypothyroidism,etc.This article introduced the common sensory impairments and related factors,as well as the evaluation and treatment of sensory dysfunction after breast cancer surgery.

Most of clinicians'researches are investigator-initiated clinical trial.There is a great difficulty in not knowing what to choose.Clinicians can think about the etiology and incidence, treatment effect evaluation, diagnostic methods and prognosis prediction.Clinicians can also find topics from clinical practice, from clinical guidelines, from literature and from different perspectives.If there is no high quality level of research evidence, it can be used as a research topic.

Carotid artery stenting has emerged as a therapeutic alternative to carotid artery endarterectomy for stroke prevention in patients with carotid artery stenosis.Preoperative assessment of peri-interventional complications is an important part to make a treatment strategy.However,no such assessment is available in China now.We tried to make a review of the risk models for predicting peri-interventional complications of carotid artery stenting.

Objective To investigate the value of adenosine triphosphate(ATP)bioluminescence assay for assessing object surface contamination degree in intensive care unit(ICU).Methods 30 groups of high frequency contact object(including ventilator panel,bedside table and computer keyboard)in ICU from January to December 2016 were enrolled for the study. Each object was sampled and evaluated before and after disinfection,and their surface was divided into two areas,whose sur-face contamination degree was evaluated by ATP bioluminescence assay and bacterial culture method that were classified as ATP group and control group.The fluorescence detection value and colony number were compared between two groups be-fore and after disinfection.The correlation between the fluorescence detection value and colony number was analyzed by Pearson correlation in the same sample,and the Kappa consistency test was used for the qualification rates of two detections. Results ①The fluorescence detection value and colony number of ventilator panel,bedside table and computer keyboard af-ter disinfection in two groups were significantly lower than that before disinfection(t=8.107~26.393,all P<0.05).②Pearson analysis result showed that both before and after disinfection,the fluorescence detection value had no significant cor-relation with colony number of ventilator panel,bedside table and computer keyboard(r=0.199~0.338,all P>0.05).③There were no significant differences in the qualification rate between two groups of ventilator panel,bedside table and com-puter keyboard before and after disinfection(χ2=0.000~1.404,all P>0.05).The qualification rate before the disinfection of ATP group and control group were 0 and 8.9%,and that after disinfection were 86.7% and 91.1%,whose Kappa consis-tency test result showed that the Kappa value was 0.776(95%CI:0.575~0.978)>0.75,so the consistency was quite sat-isfied.Conclusion ATP bioluminescence assay could be used as a rapid and handy preliminary screening to assist bacterial culture method to evaluate the object surface contamination in ICU,and the result was satisfactory and it would be worthy of clinical application.

A two-sided market perspective was employed to depict public hospital as a platform,including cross-group network externality,demand complementarities and price discrimination.Knowledge worker framework was employed to depict features of physicians.The paper argued that the public hospital could support autonomy and achievement attributes.The development of organization platform indicates that public hospital should invest more resources in technician exclusively associated to platform,encourage physicians to use platform efficiently,establish a various organizational ecology,and entrust physicians greater governance.

Post-stroke cognitive impairment (PSCI) is a cognitive impairment syndrome that occurs after stroke.The pathogenesis is unknown.Studies have shown that the occurrence and development of PSCI is associated with cerebral small vascular disease (CSVD).The imaging findings mainly include white matter hyperintensities,lacune,cortical or subcortical microinfarction,microbleeds,brain atrophy and enlarged perivascular space.This article reviews the correlation between PSCI and CSCD.

BDDH (borderline developmental dysplasia of the hip) or BHD (borderline hip dysplasia) is a disease with more controversies in the following aspects, including definition, diagnosis and interventions. The proportion of radiographic BDDH is 3.5 times that of developmental dysplasia of the hip (DDH) in the asymptomatic general population, and can exceed 40% in specific cohorts including female collegiate athletes. Up till now, researchers have not reached a consensus on its definition. The diagnosis depends largely on personal history, physical examinations and radiographic examination. The interventions, including non-operative approaches, hip arthroscopy and periacetabular osteotomy, are used. Inappropriate treatment may exacerbate symptoms and accelerate hip joint degeneration. Recent studies on BDDH with regard to its definition, diagnosis and interventions were reviewed. Lateral centre-edge angle (LCEA) measured on AP pelvis was crucial but not enough in defining BDDH, for it only reflects lateral coverage of the hip while anterior and posterior coverage may vary dramatically. Given that hips with an LCEA less than 20 degrees associated with developing osteoarthritis, we recommended that LCEA between 20 to 25 degrees be used as the radiographic criterion in the primary screening. Further evaluation of symptoms and physical examinations should be follow to identify hip instability and/or impingement. Periacetabular osteotomy must be indicated for hips with predominant instability and it can be performed with or without hip arthroscopy which is aimed to address labral lesion or cam deformity on the femoral side. Hip arthroscopy is indicated for hip with predominant impingement symptoms. However, there is no consensus on the outcomes of the two procedures currently. Further studies are still required to confirm long-term results. Thus, it is imperative to choose the right indications for each procedure.

Adjacent segment disease (ASDis) is a kind of mid- or long-term complication after lumbar spinal fusion. Although natural degenerative factors and patients' characteristics play a major role in the development of ASDis, iatrogenic related factors, especially surgical related factors, are also important factors affecting ASDis. The research shows that injury of posterior ligament complex, insufficient recovery of the disc height and lumbar alignment, and violation of the implant on adjacent segments will accelerate ASDis. Therefore, attention should be paid to the protection of the posterior lumbar structure, suitable reconstruction of the disc height and alignment of the lumbar spine, and avoiding the violation of the implant on adjacent segments. In addition, the quality of clinical research on ASDis has gradually improved in recent years, but there are still many problems, including small sample size, short follow-up time, low evidence level, and poor clinical values. To solve these problems, randomized controlled trial (RCT) should be conducted to evaluate the impact of specific factors on ASDis in order to obtain high level evidence. On the other hand, real world studies (RWS) should also be conducted, focusing on the actual problems encountered in clinical practice, through the real medical environment and medical process, to obtain the results with guidance and value for clinical problems.