Objective To explore the clinical significance of occult breast lesions biopsy,determine the operating methods of ultrasound-guided precisie resection of occult breast lesions,improve early diagnosis rate of breast cancer.Methods Forty-eight occult breast lesions of 44 patients were reviewed by localization-needle and skin markers method under ultrasound-guided,and the lesions were removed surgically according to the fixed steps.Results It was confirmed that all the impalpable mammary masses were exactly excised without localization-needle fracture or prolapse through postoperative pathological diagnosis.Breast appearance had no change after the operation.No nipple-areola necrosis occurred.The pathology results showed 4 cases of invasive ductal carcinoma (Ⅰ stage),the incidence rate being 8.3％,and 15 cases of atypical hyperplasia,the incidence rate being 31.3％.The other types were benign disease such as adenosis,intraductal papilloma,fibroadenoma and mammary duct ectasia.Conclusions Ultrasound-guided precise resection of occult breast lesions is a safe and effective diagnosis and treatment method,which needs some surgical skills.It has positive significance in improving breast cancer early diagnosis rate,reducing medical costs and decreasing breast biopsies complications.

Objective To investigate the protection of the parathyroid in thyroid cancer operation,reduce the postoperative complications of hypoparathyroidism.Methods Selected 107 cases of thyroid cancer patients from Mar.2013 to Fed.2014 who were underwent thyroid total excision + Ⅵ lymphadenectomy.Identified and preserve in situ of parathyroid according to the typical appearance.Identified the parathyroid on the surface of thyroid and Ⅵ lymph node specimen carefully.Sented a part of the suspected tissue to intraoperative frozen section examination,transplant residual tissue to stemocleidomastoid muscle after confirmed.According to postoperative pathological diagnosis,determined the specimen of thyroid and Ⅵ lymph node with or without removed parathyroid.Monitored serum calcium and symptomatic treatment for 1 to 3 days after operation.Results Error cut rate of parathyroid was 11.4％.In vitro parathyroid autograft rate was 54.4％.Hypocalcemia occurred in 32.7％.Symptomatic hypocalcemia occurred in 16.8％.Permanent hypocalcemia did not happen.Conclusions In thyroid cancer operation,accurate identification of parathyroid is the precondition of preservation in situ and self transplantation,is the effective methods to reduce error removal and decrease postoperative hypocalcemia.

Objective To investigate the technology learning curve of thyroid cancer intraoperative nerve monitoring aiming to reduce the recurrent laryngeal nerve injury complication.Methods Eighty-two cases of thyroid cancer accepted thyroid cancer radical mastectomy or combined radical operation,dissected 147 recurrent laryngeal nerve,used intraoperative nerve monitoring technology,monitored recurrent laryngeal nerve function with four steps method.The recurrent laryngeal nerve injury can be diagnosed when the intraoperative signal decay rate was more than 50％.The damage point and reason can be judged.Results The recurrent laryngeal nerve search time was 0.5 to 2 minutes.The recurrent laryngeal nerve damage rate was 2.7％.Recurrent laryngeal nerve damage cases were all diagnosed during the operation.Recurrent laryngeal nerve damage points were all located in the throat or approaching into the throat.The damage reasons were pull,tumor adhesion,thermal damage and clamp.The technology learning curve of thyroid cancer intraoperative nerve monitoring formatted through search time and injury cases of each group according to the time sequence.Recurrent laryngeal nerve search time and injury cases were obviously downtrend.Conclusions The technology learning curve of thyroid cancer intraoperative nerve monitoring existed.It can be used to protect recurrent laryngeal nerve.

Objective To evaluate the polyethersulfone(PES)hollow fiber membrane automatic plasma collector and its efficiency for separating plasma.Methods The plasma was collected by using the automated plasma collector with an innovating PES hollow fiber membrane plasma separator incorporated into a plasmapheresis device,using single needle.The concentration of total plasma protein was determined by Bio Rad method.Results 1)The sieving coefficients were over 95% during the plasma collection, and were stable.2)As the hematocrit (Hct) increased, the plasma collection rate decreased, but the plasma separation efficiency increased.At constant Hct of 0.45,the plasma filtration rate was 23.6ml/min,and the plasma separation efficiency was 52%.It took 20min to collect 200mL plasma.3)The maximum hemolysis rate after several circulation of collection was below 2.5%.Conclusion The plasma collection was satisfactorily performed, and the yield of plasma protein components was nearly the same as the plasma in whole blood.The PES membrane collector had a comparatively high efficiency of plasma separation.

AIM: PSP94 has been shown promise as a potential prostate cancer marker and it was reported that PSP94 can inhibit the growth of prostate cancer cell in vitro and in vivo. This study aimed to construct recombinant human PSP94 expression vector. METHODS:The PSP94 cDNA was obtained from normal prostate tissue, and recombinant plasmid pUC19-PSP94 was constructed. The target gene was identified and sequenced. Then the PSP94 gene was inserted to the secretory expression vector. RESULTS:The gene sequence of PSP94 was identified. The recombinant vector was constructed. The secreted PSP94 was isolated and identified by Western blot. CONCLUSION:The recombinated PSP94 could expressed PSP94 successfully.

Objective:To evaluate the optimized efficacy of single-injection thoracic paravertebral block (TPVB) with multiple adjuvant drugs combined with general anesthesia for modified radical mastectomy (MRM) for breast cancer.Methods:Sixty American Society of Anesthesiologists physical statusⅠ or Ⅱ patients, aged 20-60 yr, with body mass index<30 kg/m 2, scheduled for elective primary modified radical mastectomy for breast cancer under general anesthesia, were divided into 2 groups ( n=30 each) using a random number table method: single-injection TPVB with multiple adjuvants group (group PV-SI) and continuous infusion via TPVB group (group PV-CI). In group PV-SI, single-injection TPVB was performed with 0.25% ropivacaine 25 ml, dexamethasone 3 mg, buprenorphine 120 μg, and adrenaline 2.5 μg/ml, and general anesthesia was performed after induction of anesthesia.In group PV-CI, the mixture of 0.25% ropivacaine 25 ml and epinephrine 2.5 μg/ml was injected after induction of anesthesia, and then 0.125% ropivacaine 8 ml/h was continuously infused via TPVB until 48 h after operation.At the end of operation, a patient-controlled intravenous analgesic pump was connected and programmed to deliver a bolus dose of morphine 2 mg with a lockout interval of 10 min and no loading dose and background infusion.The duration of postoperative analgesia, total consumption of morphine within 48 h after operation, occurrence of nausea and vomiting, and patient′s recommendation and satisfaction were recorded. Results:There was no significant difference in the duration of postoperative analgesia, total consumption of morphine within 48 h after operation, incidence of nausea and vomiting, and rates of patient′s recommendation and satisfaction between PV-SI group and PV-CI group ( P>0.05). Conclusion:Single-injection TPVB with multiple adjuvants combined with general anesthesia can be used as an optimized strategy to improve the postoperative analgesia in the patients undergoing MRM for breast cancer.

Objective To assess the value of dual-source computed tomography angiography (DSCTA)in detecting intracranial aneurysms by comparing with conventional and three-dimensional DSA.Methods In this study,95 patients with subarachnoid hemorrhage(SAH)underwent both DSCTA and DSA examination.The detection rate,size,and ratio of the neck to the dome(N/D ratio)of the aneurysrns were evaluated.Statistical analysis was performed using a paired sample Student's t-test for the comparisons of the value of N/D and 2 Related Samples test for long axis.Results A total of 67 aneurysms in 63 patients at DSA and 64 aneurysms in 60 patients at DSCTA were detected,respectively;whereas no aneurysm was detected in 32 patients at DSA.Compared with DSA,the overall sensitivity.specificity,positive predictive value,and negative predictive value of DSCTA on a per-aneurysm basis were 94.2%,100.0%,100.0%,and 91.4%,respectively.For the aneurysms larger than 3 mm,the sensitivity and specificity of DSCTA in detecting intracranial aneurysms were equal to those of DSA:For aneurysms smaller than 3 mm,however,the sensitivity and specificity of DSCTA is 80.0% and 100.0%.The N/D ratio for DSA and DSC:TA was 0.46±0.14 and 0.51±0.18.respectively,and the median of long axis was 4.9 mm and 4.8 mm.respectively.There was no significant difierence in the N/D ratio(t=3.20;P＞0.05)and the long axis(Z=-1.309;P＞0.05)between DSA and DSCT.Condusions Compared with conventional and three-dimensional digital subtraction angiography,DSCTA has high sensitivity and specificity in the detection of intracranial aneurysms,especially for detection of snlall aneurysnm(＜3 mm).It can be used as a routine screening technique.

Adenocarcinoma of the esophagogastric junction is a special type of tumor,not only in the special location,but also in the biological characteristics and clinical manifestations are unique.Surgery is the main treatment,but surgery alone sometimes result in poor prognosis,as a new direction of cancer treatment,Molecular targeting therapy is playing an increasingly important role.Some molecular targets such as vascular endothelial growth factor,hepatocyte growth factor receptor,epidermal growth factor receptor,fibroblast growth factor receptor 2,human epidermal growth factor receptor-2 in the treatment of esophageal gastric adenocarcinoma show a broad prospect.This review summarizes the current status and progress of molecular targeted therapy of adenocarcinoma of esophagogastric junction.

Objective To explore human cytomegalovirus UL97 mutations related to ganciclovir resistance in hematopoietic stem cell transplant (HSCT) recipients.Methods A total of 43 patients,including 24 males and 19 females,with an average age of 21 years old,who had HCMV DNAemia for more than two weeks after HSCT between 2008 and 2010 in Peking University People's Hospital,were included in this prospective study.UL97 GCV resistance mutations were investigated in 49 plasma specimens collected from those patients.GCV resistance mutations such as UL97 M460V/I,H520Q,A591V,A594V,L595S/F,and C603W,were analyzed by modified PCR-RFLP methods.UL97 mutations related to GCV resistance were assayed by the method of PCR-direct sequencing (PCR-DS).An amplified refractory mutation system real-time PCR (ARMS RT-PCR) was developed for the detection of UL97 A594V mutation.Results Eight known UL97 ganciclovir resistance mutations were not detected by PCR-RFLP and PCR-DS.Four new UL97 mutations like UL97 R494P,T502A,N558D,and G561S,were detected by PCR-DS.The ARMS RT-PCR for detecting of UL97 A594V was established successfully.The lower limit of detection of the method was at least 7.5 × 102 copies/ml combined with the use of nucleic acid extraction reagent.UL97 A594V resistance mutation was identified by the method of ARMS RT-PCR in two HSCT recipients.The rate of UL97 A594V mutation was 4.7％ (2/43) in HSCT recipients.Conclusion The ARMS RT-PCR assay represented a sensitive method for the identification of UL97 A594V mutation.

Ten adult rabbits (7 and ♀3; body weights 1.5～2 kg) were selected for thee present study. A solution of 2～10％ HRP (RZ=2.9) was injected into the subserosa of the caecum in seven rabbits and a solution of 5～10％ HRP into the deep peroneal nerve of Tsusanli (足三里) region in the other three. The uptake and retrograds transmission of HRP in the afferent fibres of both the somatic and visceral nerves were traced to the spinal ganglia. The range of segments where the neurons from which these two afferent fibres originate overlap each other. The results are a follows:1. Labelled sensory neurons from the region of the caecum where HRP was injected are observed in the spinal ganglia C_8～S_3 with a higher concentration in T_(11)～L_2.2. Labelled neurons from the region of Tsusanli are found in the spinal ganglia L_1～S_3 with a higher concentration in L_6～S_2.3. The ranges of distribution of labelled neurons from the two groups of afferent fibres overlap in the segments L_1～S_3.4. Most of the labelled cells are small and medium in size and the Iabelled cells are found more concentrated in the lumbosacral segments.