Increases in diagnostic frequency of breast ductal carcinoma in situ(DCIS) have followed the introduction of mammographic screening in past years.It is very important to distinguish the clinical syndrome of DCIS.The management of surgery for DCIS includes mastectomy,lumpectomy plus radiotherapy and lumpectomy alone; axillary lymph node dissection(ALND) in DCIS has not been recommended and sentinel lymph node biopsy(SLNB) is still controversial; adjuvant radiotherapy for ipsilateral whole breast and endocrine treatment can reduce local recurrence,prevent second primary breast tumor,preclude regional and distant metastasis.But whatever we take towards the DCIS above,there is little disturbance to DCIS' s inherent prognosis.Doctors must pay enough attention to this point.

Objective To investigate the efficacies of conventional and modified laparoscopic gastric bypass in the treatment of type 2 diabetes mellitus.Methods The clinical data of 30 patients with type 2 diabetes mellitus who were admitted to the Xijing Hospital of the Fourth Military Medical University from January 2012 to October 2012 were prospectively analyzed.All the 30 patients were randomly divided into the conventional group (15 patients) and the modified group (15 patients) according to the random number table.Patients in the 2 groups received conventional and modified laparoscopic gastric bypass,respectively.The operation time,blood loss,anal exhaust time,duration of postoperative hospital stay,incidence of severe complications,postoperative 3-month body mass index (BMI),fasting plasma glucose (FPG),fasting serum insulin (Fins),fasting serum C-peptide (FC-P) and glycosylated hemoglobin (HbAlc) of the 2 groups were compared.The measurement data were analyzed using the t test,and the count data were analyzed using the Fisher exact probability.Results The operation time of the conventional group and the modified group were (141 ± 22)minutes and (113 ± 26)minutes,with significant difference between the 2 groups (t =3.184,P ＜ 0.05).The volume of intraoperative blood loss,anal exhaust time,duration of postoperative hospital stay,postoperative 3-month BMI,FPG,Fins,FC-P and HbAlc were (65 ±29)ml,(2.5 ±1.2)days,(7.5 ±2.1)days,(27 ±4)kg/m2,(6.7 ±1.5)mmol/L,(18 ± 8) mU/L,(2.0 ± 0.6) μg/L and 5.8％ ± 1.5 ％ in the conventional group,and (57 ± 25) ml,(2.1 ± 1.0) days,(7.1 ± 1.9) days,(28 ± 4) kg/m2,(6.4 ± 2.0) mmol/L,(17 ± 6) mU/L,(1.9 ± 0.6) μg/L and 6.1％ ± 1.4％ in the modified group,with no significant difference between the 2 groups (t =0.809,0.992,0.545,0.485,0.463,0.523,0.130,0.572,P ＞ 0.05).The levels of preoperative BMI,FPG,Fins,FC-P and HbAle of the conventional group were (31 ± 4) kg/m2,(11.3 ± 2.3) mmol/L,(13 ± 4) mU/L,(1.4 ± 0.5) μg/L and 8.6％ ± 1.0％,which were significantly different from those at 3 months after operation (t =2.304,6.615,3.109,2.920,5.997,P ＜ 0.05).The levels of preoperative BMI,FPG,Fins,FC-P and HbAlc of the modified group were (31 ±4)kg/m2,(11.9±2.4)mmol/L,(12±5)mU/L,(1.4 ±0.6) μg/L and 8.9％±0.9％,which were significant different from those at 3 months after operation (t =2.165,6.711,2.616,2.478,6.571,P ＜0.05).Conclusion The safety and short-term efficacy of modified laparoscopic gastric bypass are comparable to those of the conventional laparoscopic gastric bypass,but the operation time of the modified method is significantly shorter.

Objective To investigate the association of serum adiponectin and tumor necrosis factor alpha (TNF-α) with endothelial damages in metabolic syndrome (MS) patients. Methods One-hundred and five patients diagnosed as MS were recruited as cases and 37 subjects without characteristics of MS were recruited as controls. The cases were divided into two groups according to the level of serum von Willebrand factor (vWF) :normal endo-thelial functional MS group (57 patients) and abnormal endothelial functional MS group (48 patients). Serum adi-ponectin concentration was measured by enzyme-linked immanosorbont assay (ELISA). Serum TNF-α concentration was measured by radioimmunoassay (RIA). Results The concentration of serum adiponectin in normal subjects (10.5 mg/L [SD:3.2]) was significantly higher than both that of normal endothelial functional MS group (7.9 mg/L [SD :2.2]) and abnormal endothelial functional MS group (6.5 μg/L [SD :2.5]) (P < 0.05). The concen-tration of serum TNF-α in normal subjects(0.17 μg/L [SD :0.04]) were significantly lower than that of normal en-dothelial functional MS group (0.19 μg/L [SD:0.05]) and abnormal endothelial functional MS group (0.23 ng/mi [SD: 0.06]) (P< 0.05). The level of serum adiponectin were negatively correlated with TNF-α(r=- 0.555, P < 0.01). Logistic regression analysis results showed that high level of TNF-α was a risk factor of endo-thelial damages (OR = 20.649, P = 0.035), whereas high level of serum adiponectin protected against endothelial damages (OR = 0.340,P=0.006). Conclusions Low level of serum adiponectin and high level of serum TNF-α may correlate with endothelial damages in MS patients.

OBJECTIVE:To compare the incidence of cerebral events in patients with ischemic cerebrovascular disease compli-cating with cerebral microbleeds(CMBs)at the last stage of antiplatelet agent use. METHODS:140 patients with ischemic cerebro-vascular disease were selected from Beijing Anzhen Hospital Affilicated to Capital Medical University during Jan. 2013-Jan. 2014, and then divided into CMBs group and non-CMBs group according to whether complicated with CMBs,with 70 cases in each group. After followed up for 1 year(regular use of aspirin 100 mg/d and/or clopidogrel 75 mg/d),the incidence of recurrent cere-bral infarction and cerebral bleeding and mortality were compared. RESUTLS:The incidence of recurrent cerebral infarction was 12.9% in CMBs group and 8.6% in non-CMBs group,without statistical significance(P=0.412);the incidence of cerebral bleed-ing was 10.0% in CMBs group and 1.4% in non-CMBs group,with statistical significance(P=0.029);the mortality of cerebro-vascular event at the last stage was 5.7% in CMBs group and 4.3% in non-CMBs group,without statistical significance (P=0.698). CONCLUSIONS:The risk of cerebral bleeding increase in patients with ischemic cerebrovascular disease complicating with CMBs after the application of antiplatelet agent. For patients with ischemic cerebrovascular disease complicating with CMBs,the application of antiplatelet agent should be based on the complete judgment and weighing of benefit and bleeding risk.

ObjectiveTo report the clinical results of applying free second toe hemiarthrosis to repair finger hemiarthrosis injury,and discussed the countermeasures of relative problems.MethodsFrom June 2005 to January 2010, thirteen fingers of 13 patients with traumatic finger joint injury had repaired by using vascularized second toe hemiarthrosis graft.ResultsAll 13 grafted fingers survived,and all wounds were primary healing.The time of follow-up was between 1.5 and 4.5 years,average of 3.2 years.All grafted joints were healed and the remaining joints were normal in morphology and structure,except for 1 patient subluxation with dorsal slightly convex.No degenerative changes happened to the grafted joints.No pain and no joint instability phenomenon.Nonunion and re-fracture phenomenon did not appear.The average extension of joint motion was 0°.The average flexion was 80°.Healing of the foot donate areas were satisfactory,and did not affect walking function.Using TAM assessment method of the hand joint function,the excellent rate was 90％.ConclusionThe way of using free second toe hemiarthrosis to repair finger hemiarthrosis injury could achieve satisfactory clinical efficacy.To completed set-up of transplanted joint structure and function units,a delicate surgery were improved to be important factors of the surgical treatment.

BACKGROUND: Currently, acid etching and bonding technology have been widely used in clinical stomatology. Data have indicated that the main content of inorganic elements (calcium and phosphorus) has a certain difference between the dental enamel and dentin of the young and adult permanent teeth. OBJECTIVE:To measure the content of main inorganic elements, calcium and phosphorus, in the dental enamel and dentin from young and adult permanent teeth with spectrophotometry and ethylene diamine tetraacetie acid titration method. METHODS:Each 20 adult and young permanent teethin vitrowere selected. Plaster stone and water was mixed; when it was nearly dried, the teeth were verticaly cast in the mixture and the tooth surface was exposed. The models were cut into the slices using syj-200 precision cutting machine, and then the slices were put into nitric acid and dissolved through heater to prepare standard solution. At last, the concentrations of calcium and phosphorus in the hard tissue of both young and adult permanent teeth were measured with spectrophotometric method and titration method. RESULTS AND CONCLUSION:The content of calcium and phosphorus and calcium/phosphorus ratio in the hard tissue of young permanent teeth were less than those of adult permanent teeth (P < 0.05), reflecting that the organic matter content was more than that in adult permanent teeth, but their mineralized degree was inferior to that of adult permanent teeth (P < 0.05). These findings indicate that the young permanent teeth are more acid proof than the adult permanent teeth; therefore, the acid etching time can be properly prolonged for young permanent teeth in clinical treatment, in order to achieve better effects.

Objective To evaluate the safety and efficacy of treating bifurcation lessions with jailed-balloon technique in simple strategy. Methods Ninety patients with bifurcation lessions (Duke D or F type) who received the side branch protection technique with simple strategy were involved in a single center retrospective analysis. Patients were randomly divided into jailed-balloon protection group (n=48) and jailed guidewire group (n=42). The process operating, procedural success of percutaneous coronary intervention (PCI) and percutaneous transluminal coronary angioplasty (PTCA), complications and the results of follow-up were investigated. Results The clinical baseline date and the bifurcation lesions were not significant different between jailed-balloon group and jailed guidewire group (P>0.05). The procedural success rate of PCI was 100%in jailed-balloon group and 97.6%in jailed guidewire group, no significance difference user between two groups (P>0.05). The perioperative complications (the rate of no reflow) was lower in jailed-balloon group than those of jailed guidewire group (1.0%vs. 19.0%, P<0.05). The procedural success rate of PTCA were lower in jailed-balloon group than that of jailed guidewire group (4.2%vs. 23.8%, P<0.01). The total operation time [(56.40±11.71) s vs. (72.60±10.62) s],exposing time [(9.86±1.82) s vs.(12.24±2.32)s] or amount of used contrast agent [(90.54±15.26) mL vs. (118.16±18.64) mL] were significantly lower in jailed-balloon group compared with those of jailed guidewire group (P<0.05). At the 12-month follow-up, the MACE was lower in the jailed-balloon group than that of jailed guidewire group (16.7%vs. 38.1%, P<0.05). The restenotic rate (2.1%vs. 4.8%, P>0.05) and the maximum restenotic level (19.24%vs. 21.46%,P>0.05) in the main branch were not significant different between jailed-balloon group and jailed guidewire group. But the maximum restenotic level in the opening of side branch was lower in jailed-balloon group than that of jailed guidewire group (51.2% vs. 72.46%, P < 0.01). Conclusion The jailed-balloon technique reduces the operation complications, exposure time and amount of contrast agent, and also saves surgical consumables. The procedure of branch with simple strategy is safe and effective in treatment of bifurcation lesions.

Objective To summarize the distribution of departments,conditions of diagnosis and treatment of the syphilis patients in the general hospitals,and thus to improve the level of diagnosis and treatment.Methods A retrospective analysis of epidemiology and clinical data of 282 cases with syphilis in recent 5 years were conducted. Results The ratio of male to female was about 1:1.9.Female showed a high incidence in the 21 -50 years old,aver-age (41.68 ±0.96)years old,but for male in the 41 -70 years old,average (53.25 ±1.59)years old.The cases combined with other infectious diseases accounted to 22.0 % (62/282).The cases from the department of obstetrics and gynecology were the most (106 cases),followed by surgery (86 cases)and internal medicine (49 cases).Only 23 cases showed the clinical manifestations of syphilis in the 79 cases,which must be treated.The test rate of TRUST was only 39.0% (110/282).Furthermore,it was very low for the rate of treatment and standard treatment. Conclusion Syphilis is the most in department of obstetrics and gynecology in general hospital,and it is also com-mon in the surgery and internal medicine.The most prominent problems are that the non-special doctors had weak awareness for definite diagnosis of syphilis,and the low rate of treatment and standard treatment.

Objective: To evaluate the predictive value for baseline levels of high sensitivity C-reactive protein (hs-CRP) in morbidity of pulmonary embolism (PE). Methods: We conducted a prospective cohort study of 101510 subjects in Kailuan Group by regular physical examination from 2006-07 to 2007-10, and 94314 subjects were enrolled by relevant criteria including 75252 male and 19062 female. The baseline levels of hs-CRP were divided by quartile levels as①hs-CRP<0.3l mg/L,n=25592,②hs-CRP (0.3l-0.77) mg/L,n=21746,③hs-CRP (0.78-1.9) mg/L,n=23504 and④hs-CRP≥2.0 mg/L,n=23472. The subjects were followed-up for (81.5 ± 4.76) months, the morbidity of PE was collected and the predictive value of baseline levels of hs-CRP for PE occurrence was evaluate by multivariable Cox proportional hazard regression analysis. Results: The total PE morbidity was 0.15%, the female subjects were similar with male subjects,P>0.05. As the increased baseline level of hs-CRP, PE occurrence was elevated accordingly,P<0.05. Multivariable Cox proportional hazard regression analysis presented that with adjusted age, gender, smoking, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), triglyceride (TG), fasting blood glucose (FBG), neutrophile granulocyte (NEU), white blood cells (WBC) and heart rate (HR), the subjects in the highest quartile group had 2.84 times higher risk for PE occurrence than the subjects in the lowest quartile group. With the elevated baseline level of hs-CRP, the subjects’ mean age, BMI, SBP, FBG and NEU levels increased accordingly, allP<0.05; while DBP, TG and HR were similar between quartile③ and quartile④ groups, allP>0.05. WBC counts had the increasing trend in quartile①,②,③ groups and had the decreasing trend in quartile④ group, while it was similar between quartile③ and quartile④ groups,P>0.05. Conclusion: Baseline hs-CRP level may predict the risk of PE morbidity; the increased hs-CRP level could be used as one of the predictors for PE occurrence.

Objective To evaluate the correlation of Omentin-1, the high sensitivity C-reactive protein (hsCRP) and coronary heart disease (CHD). Methods Sixty-eight patients with CHD were divided into the unstable angina pectoris (UAP) group (n=36), stable angina pectoris (SAP) group (n=32). And 30 normal subjects without CHD diagnosed by coronary arteriography (CAG) were served as the control group. The serum level of Omentin-1 was measured by enzyme linked immu-nosorbent assay (ELISA) and the serum level of hsCRP was measured by turbidmetric immunoassay. Results The serum level of Omentin-1 was significantly lower, but the serum level of hsCRP was significantly higher in CHD group than that of control group (P<0.05). The serum level of hsCRP was significantly lower in SAP group than that of UAP group (P<0.05). There was no significant difference in serum level of Omentin-1 between groups (P>0.05). The serum level of Omentin-1 was significantly lower in patients with single, double and three-vessel lesion group than that of control group, but the serum level of hsCRP was significantly higher in CHD group than that of control group (P<0.05). There were no significant differ-ence in serum levels of Omentin-1 and hs-CRP between single, double and three-vessel lesion groups (P>0.05). The se-rum level of Omentin-1 was negatively correlated with serum level of hsCRP (P<0.01). Conclusion The serum level of Omentin-1 and hsCRP may correlate with CHD, but which may not reflect the severity of artery stenosis.