The increasing need for ideal body shape makes more and more patients choose to receive different types of breast reconstruction surgery after mastectomy. Right now, it is a key problem for the multidisciplinary treatment to find an optimal sequence of comprehensive treatment from which those patients can receive the maximum benefits and a good balance between ideal body shape and satisfactory antitumor outcomes. This paper reviews the latest research advances in the effect of postoperative radiotherapy on breast shape after breast reconstruction, the sequential relationship between the replacement of the temporary tissue expander with the permanent breast prosthesis and postoperative radiotherapy, breast construction surgery, and radiotherapy techniques. To provide a basis for clinical practice, this paper proposes a flow chart for decision?making in reconstruction surgery and adjuvant treatment based on the current literature and clinical data.

As a milestone in the development of personalized comprehensive treatment for breast cancer, molecular subtype classification quantitatively characterizes breast cancer as heterogeneous diseases rather than a single disease in terms of onset risk, natural course, and treatment response. The significance of molecular subtype classification has been widely confirmed in prediction of the efficacy of systemic treatment and prognosis of systemic metastases and risk of death. However, the association between molecular subtype and local?regional recurrence ( LRR) risk as well as the impact of molecular subtype classification on radiotherapy strategy still needs more attention. This review discusses the association between molecular subtype and LRR risk as well as the significance of molecular subtype classification in guiding radiotherapy strategy.

With the widespread adoption of screening mammography, the incidence of ductal carcinoma in situ (DCIS) has been dramatically increased. The spectrum of local treatment advances from mastectomy to breast conservation surgery plus whole breast irradiation (WBI), and hypofractionated WBI or accelerated partial breast irradiation. Although the efficacy of WBI on reducing local recurrence is clear, such benefit in the low-risk DCIS is still controversial. Further studies are required to establish a more precise local recurrence risk stratification system for better tailoring local treatment in patients with DCIS. In this review, the latest advances and controversies in surgery, radiation therapy and local recurrence risk stratification system for patients with DCIS were summarized.

AIM and METHODS:To investigate the effect of L-arginine -nitric oxide pathway on patients with essential hypertension via hemodynamics and neuroendocrinology. 24 essential hypertension patients were randomly divided into two groups, group I was given L-Arg, and groups Ⅱ was given normal saline as control. Blood pressure, heart rate, heart funtion, nitric oxide, angiotensinⅡ, endothelin, thromboxane A 2 and prostacyline were measure in all patients. RESULTS: In group Ⅰ arterial pressure decreased, heart rate increased, cardial output, systolic volume and eject fraction increased, total peripheral resistance decreased. NO and PGI 2 levels were inceased. But at 80 min , with NO concentration decreased, SBP,DBP were increased, TPR, FT and AngⅡ were also increased. While HR, CO, SV and EF were decreased. However TXA 2 and PGI 2 showed not much change. CONCLUSION: Exogenous L-arginine produced a vasodilatory effect by increasing NO production ,caused the change of other hemodynamic function . It also indirectly changed plasma ET, AngⅡlevels by negative feed-back and suppressed the accumulation of platelet.

Objective To explore the role of spinal monocyte chemoattractant protein?1 ( MCP?1) ?extracellular signal?regulated protein kinase ( ERK)?kinesin superfamily motor protein 17 ( KIF17)∕N?methyl?D?aspartate receptor subunit 2B ( NR2B) signaling pathway in the maintenance of type 2 diabetic neuropathic pain (DNP) in rats. Methods Type 2 diabetes mellitus was induced by a high?fat and high?sucrose diet and intraperitoneal streptozotocin ( STZ) 35 mg∕kg, and confirmed by fasting blood glucose level≥16?7 mmol∕L 3 days later in male Sprague?Dawley rats aged 6 weeks. Type 2 DNP was confirmed when the mechanical paw withdrawal threshold ( MWT ) and thermal paw withdrawl latency ( TWL ) measured on day 14 after STZ administration decreased to< 80% of the baseline value. The rats with type 2 DNP were randomly divided into 4 groups ( n=36 each) using a random number table: type 2 DNP group (group DNP), type 2 DNP +MCP?1 neutralizing antibody group (group DM), type 2 DNP +ERK inhibi?tor group (group DE) and type 2 DNP + dimethyl sulfoxide group ( group DD). In DM, DE and DD groups, 0?1 ng∕μl MCP?1 neutralizing antibody 10 μl, 0?5 μg∕μl U0126 10 μl and 5 % dimethyl sulfoxide 10 μl were injected intrathecally, respectively, once a day for 14 consecutive days starting from 14 days after administration of STZ. Another 36 normal rats fed a common forage diet were adopted as con?trol group ( group C) . MWT and TWL were measured before STZ injection and at 1, 3, 7 and 14 days after STZ injection ( T0-4 ) . Nine rats were sacrificed after measurement of pain thresholds at T1-4 , and the lumbar segments ( L4-6 ) of the spinal cord were removed for determination of the expression of phosphoryla?ted ERK (p?ERK), KIF17 and phosphorylated NR2B (p?NR2B) by Western blot. Results Compared with group C, the MWT was significantly decreased, the TWL was shortened, and the expression of p?ERK, KIF17 and p?NR2B was up?regulated at T1-4 in DNP, DM, DE and DD groups. Compared with group DNP, the MWT at T3-4 in group DM and at T2-4 in group DE was significantly increased, the TWL at T3-4 in group DM and at T2-4 in group DE was prolonged, and the expression of p?ERK, KIF17 and p?NR2B was down?regulated at T2-4 in DM and DE groups, and no significant changes were found in the pa?rameters mentioned above in group DD. Conclusion Spinal MCP?1?ERK?KIF17∕NR2B signaling pathway is involved in the maintenance of type 2 DNP in rats.

Objective To discuss the accuracy and objectivity of student standardized patients (SSP) in objective structured clinical examination(OSCE). Methods On March 30 and 31, 2013, 168 seven-year program medical students of class 2006 and 2007 took part in OSCE. Differences in as-sessment results between SPP and those given by professional doctors at 3 SP sites(angina pectoris SSP station, acute cholecystitis SSP station, depression SSP station) were analyzed. Each site had 4 items for assessment, with a total score of 100. Scores were given in strict accordance with a set of unified scoring rules. Counting data were presented as x±s. Data were verified using t test. P<0.05 was considered statis-tically considerable. Results At angina pectoris station, respective scores of SSP and professional physi-cians were 85.2±7.1 and 85.5±6.6, P=0.688. At acute cholecystitis station, respective score of SSP and professional physicians were 89.1±5.2 and 88.2±6.2, P=0.150. At depression station, respec-tive score of SSP and professional physicians were 79.8±7.5 and 78.2±7.0, P=0.078. Conclusion There is no statistical difference between scores given by SSP and those given by the physicians in OSCE. This proves that SSP who received standardized training delivers fair and accurate results in OSCE , and therefore is recommended for future application.

AIM: To observe the short-term curative effect of Suxiao Jiuxin Pill on coronary heart disease (CHD) and angina pectoris. METHODS: 187 patients were divided into two groups at random:the treatment group with 105 cases and the control group with 82 cases. The treatment group was given Suxiao Jiuxin Pill 6 pills tid and the control group was given Compound Danshen Dripping Pill 6 pills tid orally. The treating period was 2 weeks. Before and after treatment angina pectoris was observed and electrocardiogram was determined. RESULTS: Suxiao Jiuxin Pill could significantly alleviate syndrome of CHD in patients, lessen electrocardiogram and decrease dosage of nitroglycerin. The total effective rate on angina pectoris and the effective rate in improving electrocardiogram was higher in treatment group than that in control group (P

Cochlear Implantation ; HIV Infections ; Humans

ObjectiveTo discuss dosimetric characteristics of an intensity-modulated radiotherapy (IMRT) technique for treating the chest wall and regional nodes as an integrated volume after modified radical mastectomy ( MRM ),and observe acute side-effects following irradiation.Methods From June 2009 to August 2010,75 patients were randomly enrolled.Of these,41 had left-sided breast cancer.Each eligible patient had a planning CT in treatment position,on which the chest wall,supraclavicular,and infraclavicular nodes,+/-internal mammary region,were contoured as an integrated volume.A muhi-beam IMRT plan was designed with the target either as a whole or two segments divided at below the clavicle head.A dose of 50 Gy in 25 fractions was prescribed to cover at least 90％ of the PTV.Internal mammary region was included in 31 cases.Dose volume histograms were used to evaluate the IMRT plans.The acute side effects were followed up regularly during and after irradiation.The independent two-sample t-test was used to compare the dosimetric parameters between integrated and segmented plans.ResultsPlanning design was completed for all patients,including 55 integrated and 20 segmented plans,with median number of beams of 8.The conformity index and homogeneity index was 1.43 ± 0.15 and 0.14 ± 0.02,respectively.Patients with internal mammary region included in PTV had higher homogeneity index PT.The percent volume of PTV receiving ＞ 110％ prescription dose was ＜ 5％.None of the dose constraints to normal structures was violated.There were statistically significant differences in the means of dosimetric parameters of PTV,such as Dmax,DmeanV107％,and V110％,between integrated and segmented plans (t=2.19 -2.53,P=0.013-0.031 ).≥ grade 2 radiation dermatitis was identified in 3 2 patients ( grade 2 in 2 2 patients,grade 3 in 10 patients ),mostly occurred within 1 - 2 weeks after treatment.The sites of moist desquamation were anterior axillary fold (27/37) and chest wall (10/37).Only 2 patients developed grade 2 radiation pneumonitis.Conclusions The IMRT technique applied after MRM with integrated locoregional target volume is dosimetrically feasible,and the treatment was proved to be well-tolerated by most patients.