BACKGROUND: During plasty of breast, innervation in nipple and areola of breast should be comprehended particularly in order to avoid sensory and motor disorder induced by nerve injury. OBJECTIVE: To observe the courser and distribution of nerve in nipple and areola of breast and provide anatomic data for plasty of breast. DESIGN: Single sampling study. SETTING: Department of Human Anatomy, Medical College of Qingdao University; Department of Pathology, Affiliated Hospital of Medical College of Qingdao University. PARTICIPANTS: The experiment was carried out in the Department of Human Anatomy, Medical College of Qingdao University and Department of Pathology, Affiliated Hospital of Medical College of Qingdao University from September 1999 to April 2001. Sixteen breasts of 8 adult female corpses aged 20-40 years and 10 breasts (5 right and 5 left) of 10 adult females with cancer of the breast aged 43-58 years were selected in this study. All patients or relations were consent. METHODS: ① Breast samples of 16 adult female corpses were scanned layers by layers with stereo anatomic micro scope to chase courser and distribution of nerve in subcutaneous fascia of mammary cancer. ② Ten fresh breast sam pies were frozen, cut into sections and stained with haematine-eosin. The typical transects were selected to observe dis tributed density of nerve fiber in 4 quadrants at various layers with stereology. MAIN OUTCOME MEASURES: ① Innervation in nipple and areola of breast,, ② numbers of nerve fiber of the same sample in various transects. RESULTS: ① Nerve which was distributed in nipple and areola of breast was derived from the lateral cutaneous branch and anterior cutaneous branch of the 3rd, 4th and 5th intercostal nerves and deep branch of mammary cancer. ② The lat eral cutaneous branch of the 4th intercostal nerves went into nipple and areola of breast with the directions like 4 o'clock in the left and 8 o'clock in the right, and nerves dominated nipple were derived from the lateral cutaneous branch of the 4th intercostal nerves. ③ Numbers of nerve fiber in extra-inferior quadrant of nipple and areola of breast were more than those in intra-superior, intra-inferior and extra-superior quadrants (8.06±0.18, 4.63±0.14, 4.43±0.16, 2.13±0.11, P ＜ 0.01). ④ Density of innervation in nipple and areola of breast was decreased centripetally. CONCLUSION: Operation of chest, especially plasty of breast, had better not damage lateral cutaneous branch and ante rior cutaneous branch of the 3rd, 4th and 5th intercostal nerves. Extraordinarily, the lateral cutaneous branch of the 4th inter costal nerves and nerve in extra-inferior quadrant of nipple and areola of breast should be protected carefully in order to avoid sensory disorder.

Objective To investigate the pathogenesis of cerebral watershed infarction (CWI) through analyzing the appearance examined by Color duplex Imaging(CDI) and transcranial doppler (TCD).Methods One hundred and forty-two patients with CWI diagnosed by magnetic resonance imaging(MRI) were enrolled in the study group and 150 patients with acute cerebral infarction were enrolled in the control group.The results of CDI and TCD were retrospectively analyzed of the two groups.The vascular stenosis,plaque detection rate,plaque characteration,plaque scores,the cause of low blood volume,intracranial collateral circulation were compared between the two groups to investigate the pathogenesis of CWI.Results Among the 142 cases in the study group,there were 72 cases of severe stenosis and occlusion,21 cases of moderate stenosis,31 cases of mild stenosis and 18 cases without stenosis and there were 19 cases of severe stenosis and occlusion,41 cases of moderate stenosis,23 cases of mild stenosis and 67 cases without stenosis among the 150 cases in the control group.There were significant differences in the two groups (x2 =66.583,P =0.000).There were significant differences on the plaque detection rate between the two groups (80.99％ (115/142) vs 49.33％ (74/150),x2 =32.010,P =0.000).There were significant differences on the scores of plaque between the study group and the control group ((11.47 ± 3.78) points vs (6.57 ± 3.53) points,t =4.019,P =0.001).There were significant differences on the defined cause of low blood volume between the study group and the control group (54.93％ (78/142) vs 11.33％ (17/150),x2 =63.164,P =0.000).There were 50 patients had collateral circulation in the study group and 38 cases in the control group,there were no significant differences between the two groups (35.31％ (50/142) vs 25.33％ (38/150),x2 =3.381,P =0.066).Conclusion Angiostegnosis,microemboli from the unstable atherosclerosis plaque,lower perfusion on the basis of hypovolemia are all the pathogenesis of CWI.CDI combine with TCD can provide more information in vascular evaluation and treatment.

Objective To address the clinical features of the overlap of polymyositis (PM) and primary biliary cirrhosis (PBC),as well as its similarities to and differences from PBC/nPM patients.Methods Medical charts of 10 cases of PBC/PM inpatients admitted to Peking Union Medical College Hospital (PUMCH) from October 1989 to October 2009 were systemically reviewed.Two hundred and twenty-three cases were included as controls from the database of PBC patients in PUMCH at the same period by the statistic methods of t test,x2 test or Fisher exact test.Results ① Ten (2.67%) PBC patients had concurrent PM.② Male/Female ratio in PBC/PM group was 3/7 and the age at diagnosis was (54±8) years.No significant differences between the two groupsin these data (P＞0.05).③ Clinical features and laboratory findings of PBC/PM included: cardiomyopathy in 4 cases,respiratory muscle involvement in 2 cases,level A of Child-Pugh classification in 9 cases,level C in 1 case,positive antinuclear antibody in 10 cases,positive anti-mitochondrial antibody in 10 cases,positive M2 subtype in 7 cases,elevated erythrocyte sedimentation rate(ESR)in 9 cases.④ The significant difference between the two groups was ESR (P=0.047).Conclusion The concurrence of PBC and PM is not rare,and the inflammation of PBC/PM is likely more prominent than PBC/nPM.

Objective To assess the effect of ursedeoxycholic acid (UDCA) withdrawal in primary biliary cirrhosis (PBC). Methods Twenty seven patients who were biochemically normalized for more than 6 months were derided to two groups. Group A discontinued UDCA, Group B received UDCA 13-15 mg'kg·-1·d-1.The two groups were well matched in age, sex, and disease duration. The patient# were followed-up for 12 months. Results Two patients withdrawal the therapy because of imcompliance. Therefore, there were 12 patients in Group A, 13 patients in Group B for analysis. Two patients (17%) showed disease progression in group A in 3 months and 12 months during follow-up respectively, which were indicated by the doubling of serum bilirubin concentrations above normal limits, and none in group B. Disease relapse rate was 92% and 15%, respectively, and the difference was significant (P<0.05). Alkaline phosphates (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and γ-glutamy-hranspeptidase (GGT) deteriorated significantly, but serum bilirubin level remained unchanged. All other laboratory tests values remained unchanged. Conclusion long-term UDCA therapy is recommended in PBC patients, even though they achieve biochemical normalization.

Objective To investigate the association of fluctuation of anticardiolipin antibody (ACA) levels and clinical manifestations in patients with systemic lupus erythematosus (SLE). Methods Anticar-diolipin antibodies were measured sequentially by commercial enzyme-linked immunosorbent assay (ELISA) in 85 SLE patients. Patients were classified into two groups: group A was persistently positive for ACA, group B was transiently positive for ACA, and the clinical features of the two groups were compared. Results There were 37 patients (44%) in group A, and 48 (57%) patients in group B. 41% patients had occurred thromboeytopenia in group A, 19% patients in group B, the difference was significant (P<0.05); platelet accounts were (24±6)×109/L in group A,and (46±10)×109/L in group B, the difference was significant (P< 0.05), too. 11% patients experienced thrombosis in group A, and none in group B, the difference was significant (P<0.05). 19% in group A and 4% in group B had occurred valvular diseases, the difference was significant (P<0.05.). The prevalence of lupus anticoagulant was 32% in group A, 13% in group B and the difference was significant (P<0.05). There was no significant difference between the two groups in Raynaud's phenomenon, pulmonary hypertension, and lupus nephritis (P0.05). Conclusion Fluctuations of anticardio-lipin antibodies are asso-ciated with thrombosis, thrombocytopenia vascular disease and lupus anticoagulant however, there is no lack of association with other clinical manifestations in SLE patients.

Objective To investigate relationship between IL-6, IL-8 and Helicobacter pylori in patients with gastric cancer.Methods 264 cases patients with gastric cancer and gastritis were selected, and divided into control group, precancerous lesion group and gastric cancer group according to the tissue biopsy, then each group were divided into positive group and negative group according to 12 C test.IL-6 and IL-8 in serum and gastric juice were detected by ELISA, while in gastric mucosa by double antibody sandwich method.Results Compared with control group, IL-6 and IL-8 in serum, gastric juiceand gastric mucosa were higher ( P<0.05 ) .Compared with precancerous lesion group, IL-6 and IL-8 in serum, gastric juice and gastric mucosa were higher(P<0.05).Compared with Hp negative group, IL-6 and IL-8 in serum, gastric juice and gastric mucosa were higher(P<0.05). Compared with gastric cancer group, Hp eradication rate of precancerous lesion group and control group was higher, respectively ( P<0.05 ) . Conclusion IL-6 and IL-8 in gastric cancer patients’ serum, gastric juice and gastric mucosa increased, which is higher in Hp positive group.The levels of IL-6, IL-8 maybe the key mechanism of the formation of gastric cancer, which has important sense of assessment and diagnosis of gastric cancer.

Objective To substantiate the relationship between connective tissue diseases and lung bullae. Method In 10 years, 70 patients with lung bullae were admitted to internal medicine inpatient wards of Peking Union Medical College Hospital, among which 12 connective tissue diseases were diagnosed. Two cases were excluded because their lung bullae was secondary. Results Six cases were Sj?觟gren′s syndrome (SS), two cases were vasculitis [one Takayasu disease and one was polyarteritis nodosa (PAN)], one was rheumatoid arthritis (RA) and one was undifferentiated connective tissue disease (UCTD). Symptoms of respiratory system were present in the patients with pulmonary interstitial fibrosis (five cases) and pulmonary amyloidosis (one case). Pulmonary function tests showed restrictive ventilatory dysfunction and obstriction of small airway (two cases), diffusion dysfunction (one case), restrictive ventilatory dysfunction (one case). A trans-bronchial lung biopsy specimen showed thickening of alveolar septa, chronic inflammation, proliferation of fiberous connective tissue and inflammatory cell infiltration. Conclusion Connective tissue diseases may result in lung bullae because they cause narrow of small airways.It is definitive in the relationship between SS and lung bullae, but further study needs to be done to clarify the relationship between other connective tissue diseases and lung bullae.

ObjectiveTo evaluate and improve the quality of autoantibodies testing in China.Methods 102 laboratories participated voluntarily in the survey of the quality of autoantibodies testing in October 2009 and received a total of 15 samples from Japan MBL company including 5 different assays:antinuclear antibody ( ANA),anti-double strain DNA (dsDNA) antibody,anti-extractable nuclear antigen (ENA) antibody,anti-mitochondrial antibody ( AMA),anti-smooth muscle antibody ( ASMA ) and anti-cyclic citrollinated peptide (CCP) antibodies.There were 3 samples for each assay.The samples were detected by routine methods.The results were reported with qualitive results (for all),titer (for ANA,antidsDNA antibody and AMA/ASMA),patterns (for ANA) and methods.At the same time,MBL company also distributed the samples to the laborotories in the other areas,Greece,Italy,Japan,Korea,Portugue and China Taiwan,respectively.The results from the other areas were analyzed by MBL company.The results from China were analyzed in our laborotories.The distribution of samples and analysis of testing results was double-blinded.Descriptive analysis were performed with Excel.Only descriptive analysis of the qualitiveresult,positive rate (laboratories that all three results were right/laboratories that took part in the relevant autoantibody detection) were done,and quantity results were set as reference.Results According to the standard results from the analysis of MBL company the rate of satisfied results of ANA,anti-dsDNA antibody,AMA,ASMA,anti-ENA antibody and anti-CCP were 80.8％ ( 80/99 ),81.2％ ( 78/96 ),86.3％ (44/51),76.3％ (29/38),95.9％ (93/97) and 93.1％ (67/72),respectively.The accuracy rate of the titer for ANA was low and related results of sample 901 and 902 were 12.7％ (11/79) and 7.6％ (6/79),respectively.Also a considerable discrepancy was found in the results of anti-CCP among different laboratories using different commercial kits.The ranges of sample 921 and 923 were 10.0-419.0 U/ml and 15.3-418.5 U/ml,respectively.Conclusions The accuracy rates of the rate of satisfied results among ANA,anti-dsDNA antibody,AMA,and ASMA were lower than 90％,however,it's satisfed that the rate is higher than 90％ in anti-ENA antibody and anti-CCP.Internal quality control of ANA titer,AMA and ASMA,and external quality assurance of anti-CCP should be improved.

Objective To investigate clinical features of cutaneous sarcoidosis. Methods A retrospective analysis was carried out based on the clinic data of 35 patients with cutaneous sarcoidosis who were hospitalized in Peking Union Medical College Hospital during 1980-2009. They were divided into two groups, the group without systemic involvement (skin group )and the group with systemic involvement ( systemic group). Results ( 1 ) The ratio of men and women with cutaneous sarcoidosis was 1: 3. 38, and the average incident age was (47. 5 ± 10. 0) years old. The average incident age of skin group and systemic group were (41.8 ± 12.5 ) years old and ( 50. 5 ± 7. 1 ) years old, respectively. (2) The most common skin manifestation was subcutaneous nodule, followed by maculopapule and erythema nodosa. The most common involved sites were limbs. (3) The common involved systems extra-skin included the lung, joints and lymph nodes. The involvement rate of lung in cutaneous sarcoidosis of our present data was lower than those of foreign reports. However, the involvement rates of joints, lymph nodes, kidney, muscles and nervous system showed higher in our data. (4) The incidences of fatigue and weight loss in systemic group were higher than those in skin group ( P ＜ 0. 05 ). The indexes of erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor in systemic group were higher than those in skin group ( P ＜ 0. 05 ). More patients in systemic group were treated with corticosteroid than that in skin group ( 95.7% vs 66.7%, P ＜ 0. 05 ).Conclusions Subcutaneous nodules are the most common and the involvement rate of lung is lower in cutaneous sarcoidosis of our present data. Compared to the patients without systemic involvement, the average incident age of systemic ones is older, the indexes of inflammation markers and the usage of corticosteroid are higher.

Objective To explore the differentially expressed genes in peripheral blood mononuclear cells of patients with primary biliary cirrhosis and compare it with healthy controls.Methods Peripheral blood mononuclear cells were isolated from 9 primary biliary cirrhosis patients and 9 age and sex matched healthy controls.Total RNA was extracted from peripheral blood mononuclear cells and analyzed by human genome oligonucleotide microarrays (22K).The differences of gene expression and signaling pathway of patients and healthy controls were compared.Results Seventy-nine genes differentially expressed in primary biliary cirrhosis were identified by microarray analysis,in which 21 were up-regulated and 58 were downregulated.The genes were further categorized into 27 signaling pathways,in which 6 pathways were involved in immune regulation and apoptosis:natural killer cell mediated cytotoxicity pathway,toll-like receptor signaling pathway,antigen processing and presentation pathway,cytokine-cytokine receptor interaction pathway,T cell receptor signaling pathway and apoptosis pathway.Conclusion This study has identified that some genes are different in transcription expression in the primary biliary cirrhosis patients.It may provide new clues for the pathogenesis and biomarker studies.