Objective To study the histopathological features, diagnosis criteria, the relationship of surgery pattern and prognosis of phyllode tumor of breast. Methods To analyze the histopathological features and clinical outcome of different surgery patterns in 203 patients with phyllode tumor of breast by Chi square test, Cluster, Focater, Logistic and Cox multivariate regression according to the request of SPSS 10. 0. Results 203 patients with phyllode tumor of breast were divided into three groups, i.e. benign 133 cases, borderline 42 cases and malignant 28 cases. Local recurrences in three groups were 28, 19 and 18, respectively. The patients died from tumor were 0, 2 and 16, and circulatory metastases were 0, 1 and 10, respectively. Five-year survival were 100 %,92. 0% and 33. 3% in the three groups of 131 patients by a 5 years' follow-up survey. Conclusions Tumor necrosis has important value in the diagnosis of phyllode tumor. Nature of tumor margin, cellular pleomorphism, frequency of mitoses and tumor necrosis were statistically appropriate composition in histological diagnosis of phyllode tumor. Wide local excision is preferred for the benign and borderline phyllode tumor, while simple mastectomy is indicated for recurred borderline and malignant, but tylectomy should be abolished in the treatment of phyllode tumor. Correlation of histotypes of phyllode tumor with local recurrence and tumor death was statistically significant at a level of P＜0. 001; correlation of infiltrative growth of the tumor with local recurrence was statistically significant at a level of P＜0. 001. Tumor necrosis and mitotic activity were independent prognostic factors.

Objective To investigate the effects of the double J tube in treating drug -crystalline upper uri-nary tract obstruction.Methods There were 12 cases of drug -crystalline urinary tract obstruction,which were diag-nosed by CT for urinary tract obstruction.With the help of cystoscope,we retrograde placed the double -J tube in all the 12 patients who with persistently elevated serum creatinine in the next day of admission.Results Nine patients were successfully placed double J stent and serum creatinine of the patients decreased to normal rapidly.There were 2 patients with failed implantation and were with persistently elevated serum creatinine.1 patient with unilateral urina-ry tract obstruction was treated with conservative treatment and eventually cured.Conclusion Patients with drug -induced renal injury should have a routine bilateral ureteral CT scan,once they are clearly diagnosed as drug crystal upper urinary tract obstruction in them,timely placement of bilateral double J tube with the help of cystoscope,which was a simple and effective treatments.

Objective To investigate the effects of sensory cueing (SC) on unilateral spatial neglect after stroke.Methods Five stroke survivors with unilateral spatial neglect underwent a tailored sensory cueing treatment (wearing a sensory cueing device 3 hours a day, 5 days a week for 2 weeks) in addition to their conventional rehabilitation.Two weeks before and one day before the treatment, and then one day, two weeks and 4 weeks after the treatment, all five patients were assessed using the Hong Kong edition of the behavioral inattention test (BIT-C).Results No significant changes were identified in the average BIT-C ratings at the two time point before the intervention.However, the average score had increased significantly only one day after the start of the intervention, with further significant improvement at each of the succeeding 2 week intervals.The greatest improvement was in finishing cancellation tasks, and the most severely affected patient showed the greatest improvement.Conclusion Sensory cueing treatment may be useful and feasible in reducing unilateral spatial neglect for stroke survivors.However, randomized and controlled trials with larger samples are needed to further verify its effects.

Objective To explore the effect of Yes-associated protein 1 (YAP1) and potential mechanism on erlotinib ( ER) resistance in lung adenocarcinoma.Methods In PC-9 cells and acquired ER resistant PC-9 ( PC-9/ER) cells, the expression changes in YAP1 gene were measured by quantitative real-time PCR( RT-qPCR) and Western blot.Indirect immunofluorescence was adopted to observe the location of YAP1.PC-9/ER cells were treated with the verteporfin ( VP, YAP1 inhibitor) for 24 h and 48 h, respectively.Expression changes in mRNA and proteins of YAP1, AKT and p-AKT were detected in the presence or absence of VP.The effect of VP was analyzed by drug resistance index using Cell Counting Kit 8(CCK-8) assay.Results The resistance index of PC-9/ER cells was (99.80 ±25.81).Compared with PC-9 cells, the expression levels of YAP1 mRNA and protein were increased in PC-9/ER.The inhibitory efficiency of VP was (50.96 ±5.86)%, and the levels of AKT and p-AKT proteins were down-regulated by the inhibition of YAP1 simultaneously.The half maximal inhibitory concentration (IC50) of PC-9/ER decreased from (11.10 ±2.72) to (1.47 ± 0.32)μmol/L (P =0.024).Resistance index was reduced to one eighth of the original.Conclusion These results indicate that the YAP1 mediates ER resistance in lung adenocarcinoma.Suppression of YAP1 can reduce the resistance through PI3K/AKT signaling pathway.Therefore, YAP1 may be a potential target for lung cancer gene therapy.

Objective To explore the efficacy of cold packs combined with ice compress in treatment of pain after erbium fractional photothermal therapy on acne scars. Methods Eighty cases which were confirmed to the criteria were randomized into two groups:treatment group and control group. The treatment group (n=40) treated with cold packs combined with cold icy compress immediately after the surgery for 30~40 mins. The control group (n=40) was given icy compress therapy immediately after the surgery for 30~40 mins. The therapy continued for three days after the surgery on the two groups. The self-feeling symptom and pain relieving time were compared between the two groups. Result The time for pain relief in the wounds and the time for scabbing were both significantly shorter than those in the control group (P<0.01). Conclusion The cold packs combined with ice compress therapy can relieve the pains effectively and it can shorten the recovery time after fractional photothermal therapy.

Objective To explore the influence of body position intervention combined with lying position logo on the compliance of patients after vitrectomy needing to keep lying position. Methods A total of 100 patients, who were hospitalized in ophthalmology ward from January to June 2013,received vitrectomy combined with gas or silicone oil filled were involved. All the patients were divided into intervention group (60 cases) and control group (40 cases) according to the order of admission. Patients in control group received routine nursing after retinal vitreous operation, guiding the proper way to keep lying position, putting a sponge pillow, shaping凹, under patients′heads. And some pertinence measures were applied in intervention group on this basis. Results The percentage of the patients who could keep the special position complying with doctor's orders at 72 h and 1 week after the operation were 95.0%(57/60),91.7%(55/60) in intervention group, which were greater than those in control group 80.0%(32/40),75.0%(30/40), and there were significant differences,χ2=4.090,4.003,P<0.05.The mastery of the body position, and the satisfaction of the nursing care were 96.7%(58/60), 98.3%(59/60) in intervention group, which were better than those in control group 77.5%(31/40), 85.0%(34/40),and there were significant differences, χ2=7.154, 4.666,P <0.05. Conclusions Developing a reasonable nursing plan depending on the body position intervention and relevant nursing measures can help the patients comply with doctor's orders effectively, improve comfort,and extend the time to keep the special position,so as to improve postoperative recovery and ensure the success of the operation.

Objective To explore the sensitivity and specificity of colposcopy directed biopsy (CDB) and the value of loop electrosurgical excision procedure (LEEP) for the diagnosis and treatment of microinvasive cervical cancer (MCC). Methods One hundred and thirty five patients with MCC were diagnosed with LEEP in Obstetrics and Gynecology Hospital, Fudan University from April 2008 to November 2010, and were retrospectively analyzed on CDB diagnoses and following treatment after LEEP. According to patient′s desire for preservation of fertility and cone margin status, following strategies after LEEP included follow-up, second LEEP, hysterectomy, modified radical hysterectomy and radical hysterectomy. Single and multiple factors related to residual lesions after LEEP were analysed with Pearson Chi-square test and logistic regression model, respectively. Results CDB diagnosed MCC with a sensitivity of 4.4%(6/135), specificity of 100.0%(4 680/4 680), and false negative rate of 95.6%(129/135). Among the 135 patients, 29 did not receive further treatment in our hospital and lost contact. One hundred and six patients had secondary treatment or follow-up in our hospital, 4 of among which were closely followed up;one hundred and two received further treatment, which included 6 cases with second LEEP (3 received extrafascial hysterectomy after repeat LEEP), 59 cases hysterectomy, 14 cases modified radical hysterectomy and 26 cases radical hysterectomy. For factors related to residual lesions after LEEP, single factor analysis showed that the ratio of residual lesion in patients aged 27-39, 40-49 and 50-65 years were respectively 19.0%(11/58), 15.4%(10/65) and 5/12 (χ2=4.505, P=0.105). Residual lesions occurred in 24.7%(23/93) of patients with positive LEEP margins, which was more than that 7.1%(3/42) of patients with negative LEEP margins (χ2=5.756, P=0.016). The ratio of residual lesions in patients with positive endocervical, ectocervical and deep stromal margins were respectively 29.6%(8/27), 17.1%(7/41)and 30.6%(11/36;χ2=2.275, P=0.321). Residual lesions in patients with or without lymph vascular space invasion (LVSI) were 2/7 and 18.8%(24/128), respectively (χ2=0.412, P=0.521). The ratio of residual lesions in patients with invasion depth of<1 mm was 17.1%(7/41), 1-<3 mm was 19.0%(16/84), and 3-5 mm was 3/10, with no significant difference among three groups (χ2=0.870, P=0.647). Logistic regression analysis showed positive cone margin (OR=5.069, P=0.014) and age (OR=1.080, P=0.024) were the independent risk factors of residual lesions after LEEP conization. Conclusions CDB alone is not adequate for the diagnosis of MCC. For young patients who desire to preserve fertility with a negative cone margin, close follow-up is acceptable. Cone margin status and age are two independent risk factors for residual lesions after LEEP.

AIM:To investigate the perfusion parameters using dynamic contrast-enhanced magnetic resonance imaging ( DCE-MRI) in rectal cancer patients so as to explore its potential value in estimating the microvascular condition including perfusion and permeability .METHODS:The data of 38 rectal cancer patients examined with DCE-MRI was ret-rospectively analyzed .The perfusion parameters of carcinoma and normal rectal wall in each case were calculated , inclu-ding volume transfer constant (Ktrans), rate constant of back flux (Kep), extravascular extracellular space fractional volume (Ve) and initial area under curve (iAUC).The mean values of tumor and normal rectal wall , mucinous and nonmucinous carcinoma, poorly and moderately-to-well differentiated carcinoma , case with or without lymph node metastasis were com-pared.RESULTS:All the parameters of rectal cancer were higher than normal rectal wall (P<0.01).No significant difference was found between poorly and moderately-to-well differentiated carcinoma in terms of K trans, Kep and Ve, neither was the case with or without lymph node metastasis .The cases with lymph node metastasis had lower iAUC than those with-out (P<0.05).CONCLUSION:Quantitative perfusion DCE-MRI answered the microvascular perfusion and permeability change of rectal cancer compared with normal rectal wall , besides it could be used to distinguish between mucinous and nonmucinous carcinoma , which demonstrated its value in the evaluation of rectal cancer .However , it should not be recom-mended to predict the degrees of tumor cell differentiation and lymph node metastasis just according to the perfusion param -eters.

Objective To detect the expression of Raf kinase inhibitor protein (RKIP) and NF-κB in renal tissue of diabetic kidney disease (DKD) rats model,and to investigate the effect of rituximab (RTX) on the expression of RKIP in the renal tissue of DKD rats. Methods SD rats were randomly divided into normal group (N),DKD model group (M) and RTX treatment group (D).Blood glucose and 24-hour urine protein of rats were determined in three groups.RKIP protein and NF-κB protein were determined by immunohistochemistry staining. RKIP protein expression was detected by Western blotting. Results Compared with N group,blood glucose,24-hour urine protein and NF-κB expression in M group increased significantly (all P＜ 0.01),the expression of RKIP in M group decreased significantly (P＜0.05).Compared with M group,the expression of RKIP increased significantly in D group (P＜0.05),and 24-hour urine protein and NF-κB expression decreased in D group (all P＜0.05).NF-κB protein expression was negatively correlated with RKIP expression in M group. Conclusions The NF-κB pathway regulated by RKIP plays an important role in the development and pathogenesis of diabetic nephropathy.Rituximab may have a role in treatment of DKD.

Objective To assess the treatment of splenic artery aneurysms (SAA) and prognosis.Methods Clinical data of 18 SAA patients treated in our hospital from 1999 to 2011 were retrospectively analyzed. Results There were 18 patients diagnosed as SAA,including 7 males and 11 females.The average age was 53.8 ± 7.3 years.8 patients were asymptomatic found by routine physical examination,7 patients complained upper left abdominal pain,3 cases suffered from aneurysm rupture. Diagnosis was established by three-dimensional computed tomography angiography (3DCTA) in 14,Digital subtraction angiography (DSA) in 3 and magnetic resonance angiography (MRA) in 1 patient.Three patients with ruptured splenic artery aneurysm underwent emergent operations,11 patients underwent elective surgery or interventional therapy.Surgical procedures included aneurysmectomy and splenectomy in 4 patients,distal pancreatectomy in 5 cases; aneurysmectomy and splenic artery ligation in one patient; and aneurysmectomy with splenectomy and colon resection in 1 case.Interventional embolization by coils of the splenic aneurysm in 3 patients.The remaining 4 being asymptomatic and with tumor diameter less than 2 cm were put on a close follow-up.There was no perioperative mortality.Two were lost to follow-up.16 cases were followed-up for averaging 3.2 years. 1 patient died of cerebral hemorrhage after four years. Conclusions Splenic artery aneurysms was a rare disease and with usually occult symptoms,but rupture can leads to abdominal apoplexy.Open surgery and minimally invasive endovascular treatment is effective and offers a good prognosis.