Purpose To investigate clinicopathological features,diagnosis and differential diagnosis of tubular carcinoma of the breast.Methods Morphological observation and immunohistochemistry were applied in 29 cases of tubular carcinoma of the breast, and the literatures were also reviewed.Results The tumors were composed of open tubules, infiltrating haphazardly in the cellular desmoplastic stroma. The neoplastic tubules were enclosed by a single layer of epithelial cells with insignificant atypia or rare mitoses.The tumors were often associated with lobular neoplasm, columnar cell lesion, ductal atypical hyperplasia or carcinoma in situ. Immunostaining displayed that myoepithelial cells were absent or incomplete.Conclusions Tubular carcinoma of the breast is a peculiar subtype of breast carcinoma with good prognoses, which is easily confused with microglandular adenosis, radial sclerosing lesions,or low grade invasive ductal carcinoma.Immunohistochemistry is useful for the differential diagnosis.

Objective To analyze the problem existing in the process of health records informatization con-struction and explore solution on the basis of situation of health record informatization in Yanta district of Xi'an city. And to provide bases for acceleration of residents'health records informatization construction in Xi'an.Methods Send 10 investigators to study and investigate the hospital information management system of 10 full-time public universities in Yanta district.Results There were a total of 25 711 faculties in 10 full-time public universities and 19 809 facul-ties had established electronic files,the filing rate was 77.04% A.On the whole,it seemed that the teaching staff in the filing rate(78.91%)was higher than that of the retired workers filing rate(73.78%),the two groups had statisti-cally significant difference(χ2 =88.164,P <0.05)B.Conclusion Xi'an Yanta district university faculty of electron-ic health records has exceeded the national average level,but there are still many problems need to be improved.We should strengthen government investment,the establishment of the region's unified information management standards, increase publicity and education efforts,and actively create the region's resource information sharing platform.

Objective To explore clinic effect and advantages of the free arm lateral neurocutaneous flap in repairing cutaneous defects of opisthenar.Methods Between July,2012 and December,2013,12 patients with skin and soft tissue defects in opisthenar caused by trauma factor,accident,machine injury,hot crush injury etc were treated with free arm lateral neurocutaneous flap at our institution.Vessels both in recipient and donor site were detect-ed by color Doppler ultrasound preoperatively.Relative cutaneous nervers were reserved in the flap during selective operation.The flap size resected range from 6 cm × 4 cm to 10 cm × 6 cm.The posterior cutaneous nerve of the forearm were included in the flap to restore sensory sesation after transection.The wound in the donor site was closed in in-tradermal suture primarily.Postoperative algesia,touch,temperature sensation,Weber test of flap were tested and reco-rded.The critia of follow-up in this study were donor site morbidity,abnormal sensations,functional outcomes and sat-isfaction.Results The success rate was 100 percent in the series cases.The average length of follow up was 35 months (range,24 to 41 months).The wound in recipient area healed primarily and flaps showed no pigmentation but fine overall appearance,texture,and elasticity.The functional recovery of protective sensation was S3+ in 4 cases,S3 in 6,S2 in 2.Patients with liner scar in donor site were higly satisfied with the flaps for the sake of no significant joint functional outcomes.In terms of sensory sesation,the excellent and good rate of flap reached to 83 percent.Conclusion The free arm lateral flap represented a constant vascular anatomy,rich blood supply.Easy dissection,pliable texture,skin colour close to dorsum of hand and the possibility to be innervated through the posterior cutaneous nerve of the arm acceptable donor side morbidity provide a good option for the reconstruction of cutaneous defects of opisthena.

Objective To investigate the inhibitory effects of arsenic trioxide on salivary duct carcinoma cell colony and to explore a new approach to treat salivary duct carcinoma .Methods Human salivary duct carci-noma cancer cells were established .The effects of different concentrations (0.5、1、2、4μmol/L)and time(48,96 H) of arsenic trioxid on salivary duct carcinoma cell colony and the changes of the cell colony were observed with MTT assay and microscopic cell analysis .Results Human salivary duct carcinoma were significantly inhibited by Different concentrations of arsenic trioxide at different times points , and the relationship between the doses and time points are dependent ,cell atypia disappearing apoptosis appears apoptotic bodies .Conclusion Arsenic tri-oxide can significantly inhibit proliferation ,induce differentiation and promote apoptosis in the salivary duct carci-noma cells .

Objective To research the location in cerebral circulations of recurrent stroke.Methods We included patients with acute cerebral infarction from the Department of Neurology of People's Hospital of Peking University within three years.We followed up the patients by telephone and electronic medical record to determine whether they belong to recurrent group or not.We recorded the clinical and image variables of recurrent group.We classified the recurrent group by whether the loci of recurrent stroke is in the same circulation.We determined the independent risk factors of the same circulation loci by Cox regression.Results There are 106 cases of recurrent stroke.Within 5 years,46.2％ of the cases had recurrent loci in the same circulation as first stroke loci.53.8％ of the cases had recurrent loci in the different circulation from first stroke loci.According to logistic regression,whether the recurrent loci was in the same circulation was not related to age,sex,hypertension,diabetes mellitus,smoking,but related to the survival time.The shorter the survival time was the more ratio of same circulation loci happened.The longer the survival time was the more ratio of different circulation loci happened.37％ of cases with recurrent strokes happened in the first year occupied the most cases in the 5 years.Conclusions With the long time study of the location of recurrent stroke,we get the conclusion that the longer the survival time is the more ratio of different circulation stroke happen.So we emphasize the importance of medicine for the stroke in long time.At the same time we conclude the rationality of endovascular treatments within 1 year from first stroke because recurrent loci is more often in the same circulation in 1 year.

Objective To construct anti-IL-4R murine anti-human single-chain variable fragment (scFvs) antibodies through BL21 (DE3) prokaryotic expression system. Methods The anti-IL-4R scFv sequence was optimizated on the basis of previous findings. The optimized scFv sequence was analyzed. The recombinant plasmid pET-32a-scFv was constructed. The recombinant plasmid was detected through enzyme identification, and was turned into BL21 (DE3) prokaryotic expression bacteria to express the pET-32a-scFv recombinant protein in E.coli BL21 (DE3). The purification and renaturation were researched, and SDS-PAGE analysis was studied. The molecular weight of ScFv against IL-4R was analyzed by SDS-PAGE. The expression of the fusion protein was detected by Western-blot assay. Results The length of fusion gene scFv-MLT sequence was 761 bp. The molecular weight of the recombinant expression of proteins of anti-IL-4R single antibody was approximately 45 ku. The recombinant proteins showed high specificity with anti-6 × His-tag antibody. Conclusion This experiment successfully constructs pET-32a-scFv prokaryotic expression system of recombinant protein with high immune reactivity, which provides the basis for further study of anti-IL-4R single chain antibody as drug target.

Objective To evaluate the safety and efficacy of the temporary bedside cardiac pacing in controlling torsades de points (TdP) in patients with acquired long QT syndrome (LQTS). Methods Twelve patients with acquired LQTS were enrolled from April 2003 to August 2007 consecutively and their clinical data were analyzed. Bedside cardiac pacing was adopted when other methods couldn't terminate the repeated TdP. Results Twelve patients successfully experienced the temporary bedside cardiac pacing via femoral venous. The average time spent in bedside cardiac pacing was about (10.5±2.4) min. After cardiac pacing the interval of QT and QTc were shortened [ (0.42±0.03 ) svs (0.52±0.06) s, P < 0.05; (0.43± 0.04 ) s vs (0.53±0.05 ) s, P <0.05 ]. The TdP occurred (4.6±1.2 ) times per day before cardiac pacing and it didn't reoccur any more after bedside cardiac pacing. The average time for cardiac pacing was(3.8±1.4) d. When the patients were discharged, the interval of QT and QTe were (0.41±0.02) s and (0.42±0.05) s respectively, there were significant differences compared with that before cardiac pacing(P< 0.05). During 1 year follow-up, the patients didn't experience TdP any more, and the interval of QT and QTe were (0.41± 0.06) s and (0.42±0.05) s respectively. Conclusion The immediate bedside cardiac pacing is a safe and effective way to control the repeated TdP.

Objective To assess the efficiency and safety of mycophenolate mofetil (MMF) in patients with multiple sclerosis (MS) and neuromyelitis optica (NMO). Methods Twenty-seven patients with MS or NMO were selected, and the patients were divided into 2 groups:MMF group (MMF combined with glucocorticoid treatment group, 10 cases) and glucocorticoid group (only glucocorticoid treatment group, 17 cases). There were 5 cases with MS and 5 cases with NMO in MMF group. There were 13 cases with MS and 4 cases with NMO in glucocorticoid group. The therapeutic efficacy 6 months after treatment, expanded disability status scale (EDSS) before treatment and 6 months after treatment, and annualized relapse rate (ARR) were compared; and the safety was observed. Results There was no statistical difference in efficacy rate 6 months after treatment between MMF group and glucocorticoid group: 9/10 vs. 11/17, P>0.05. The EDSS scores 6 months after treatment in MMF group and glucocorticoid group were significantly lower than those before treatment: (2.41 ± 2.05) scores vs. (3.40 ± 2.05) scores and (1.17 ± 0.92) scores vs. (2.38 ± 1.28) scores, and there were statistical differences (P<0.05), particularly for the patients with MS. The ARR 6 months after treatment in MMF group was significantly lower than that before treatment: 0 time/year vs. 0.75 times/year, and there was statistical difference (P<0.05). The difference of ARR before and after treatment in MMF group was significantly higher than that in glucocorticoid group: 0.75 times/year vs.- 0.46 times/year, and there was statistical difference (P<0.01), particularly for the patients with MS. Only 1 female patient had myalgia when taking higher dosage of MMF, and the symptom tended to relieve after the dosage was reduced. Conclusions MMF is effective in the treatment of MS and NMO. MS can improve the neurological function and reduce the recurrence of the disease;and the safety is high.

Objective To investigate the relative motion between the femoral component and the tibial insert through the technology of fluoroscopy and digital model.Methods Sixteen female patients (16 knees) with knee osteoarthritis were performed TKA (GENESIS Ⅱ) from July 2007 to June 2008.The mean age was 66.4 years (range from 56 to 76 years).All patients were followed up 48 months to 60 months,with the mean of 56±3 months.The postoperative clinical function was evaluated by Knee Society Score (KSS).To match the digital model to the imaging data of fluoroscopy using 2D-3D automatic registration technology and reconstruct motion of the knee after TKA.The movement of contact position between femoral medial and lateral condyle and tibial insert and tibial internal rotation during flexion were measured.The contact time and range between femoral cam and tibial post were analyzed.Results The cases were statistically improved in KSS postoperatively,knee score was 93±5 and function score 88±13.The range of movement for femoral medial condyle was 8.5±2.5 mm,and the lateral condyle was 9.5±4.8 mm,the range of tibial internal rotation was 2.5°±8.4°.The contact of cam and post was observed after 30°-40° flexion of the knee,and the range was 8.0±1.8 mm.The greater tilting angle of the tibial plateau was,the later contact between cam and post happened.Conclusion The kinematics of tibiofemoral joint after TKA is different from the kinematics of normal knee.With knee flexion within 10°-30°,femoral medial condyle moves forward.When flexion is greater than 40°,medial and lateral condyle begins rollback.The time of contact of cam and post is relative to tibial prosthesis slope.

Objective To evaluate the value of angled insonation technique in obtaining the volumes of the fetal palate and in three-dimensional post-processing.Methods Five hundred and sixty-six cases of 20~28 weeks fetuses with normal face were confirmed by systemic ultrasound examinations and post-natal examination.The volumes in the standard midsagittal plane and angled midsagittal plane were obtained,then post-processed these data by 4D-View software.The same technology was used for volume data acquisition and processing to 1 case of cleft lip and palate fetal.Results In 566 fetuses,two groups of volume data were successfully acquired in 458 cases (standard midsagittal plane group) and 411 cases (angled midsagittal plane group).Fetal primary palate in the standard group and the angled group can be both well visualized(100%).Axial plane of hard palate can not be reconstructed in the standard group.Only 36% of the fetal hard palate's coronal plane and transoral oblique coronal plane can be reconstructed.The visualization rate of soft palate was 87% in the standard group,which was slightly higher than the angled group (82%).The visualization rate of hard palate's axial plane,coronal plane and transoral oblique coronal plane was 100% respectively in the angled group.Cleft alveolar process involving the secondary palate can be clearly visualized in 1 case of cleft lip and palate fetus.Conclusions By using the angled insonation technique,which is based on clearly visualizing secondary palate to obtain volumes,using three-dimensional post-processing technique can obtain the conventional three orthogonal planes and any other section of the whole palate.By using it we can assess the integrity of fetal palate,diagnose cleft lip with or without cleft palate and classify the cleft palate,even make prenatal diagnosis of the isolated cleft palate possible.