With the development of breast cancer treatment mode and the changing attitudes of patients, re-construction of the breast after mastectomy plays an important role in the interdisciplinary treatment concept of breast cancer. Because of the large area and the less variation of vessels pedicle of latissimus dorsi, it is considered to be an al-ternative flap for breast reconstruction. The latissimus dorsi flap can be used widely in breast reconstruction. Besides the implant-assisted latissimus dorsi (LDI) and autologous latissimus dorsi (ALD) flap breast reconstructions, the modified latissimus dorsi flap could be selected for various mastectomy. Compared with implant-assisted breast reconstruction, the latissimus dorsi flap can model a better mammary contour and receive better cosmetic outcomes on post-reconstruc-tion radiation. Compared with the transverse rectus abdominis myocutaneous (TRAM) flap, the latissimus dorsi flap has smaller scars and more rapid recovery. The improvement in postoperative donor area suturing techniques and auxiliary drug application greatly reduced the incidence of seroma. The Endoscopic technology avoids the donor scar. In clinical practice, statistical evaluation of aesthetic outcomes was impossible as an advantage in operation selection. This article summarized the control of complications and the further discussion of controversy.

Objective To study the clinical effect of parecoxib sodium for injection combined with psychological intervention on postoperative analgesia in the patients with thyroid cancer. Methods 100 patients with thyroid cancer Hangzhou tumor hospitalfrom July 2015 to April 2017 were randomly divided into two groups, the experimental group and the control group. The control group were given parecoxib sodium for injection, and the experimental group were received parecoxib sodium for injection combined with psychological intervention. Three days after treatment, the average amount of parecoxib sodium for injection and SAS, SDS score in the two groups were compared. Results The average dosage of parecoxib sodium for injection in the experimental group was (45.6±9.7) mg, and (67.9±9.5) mg in the control group. In the control group, SAS was (45.88± 7.56)points before treatment and (50.42±7.91) points after treatment, SAS was (45.94±7.32)points before treatment and (40.81 ± 6.61) points after treatment. SDS in the control group before treatment was (45.53±8.62) points and (50.29±7.24) points after treatment. In the experimental group, SDS before treatment was (45.41±7.18) points and (40.36±6.15) after treatment. The differences of all the data were statistically significant in the two gorups(P<0.01). Conclusion Postoperative psychological intervention can effectively enhance the analgesic effect of parecoxib sodium for injection, reduce the dosage and also improve the psychological score. This treatment is worthy of clinical promotion.

Objective To investigate influence of Ang-(1-7) on the inducible nitric oxide synthase (iNOS) activity and gene expression following focal cerebral ischemia/reperfusion in rats. Methods Cerebral ischemia/reperfusion injury was induced by intraluminal thread occlusion of middle cerebral artery in the adult male Sprague-Dawley (SD) rats. Ang-(1-7) or artificial cerebrospinal fluid (aCSF) was continuous administrated by implanted Alzet osmotic minipumps into lateral cerebral ventricle after reperfusion. Experimental animals were divided into sham-operated group ( sham operation + aCSF), aCSF treatment group(MCAO+aCSF)and ang-(1-7)treatment groups(MCAO+Ang-(1-7))at low(1 pmol·0.5 μl-1·h-1),medium (100 pmol·0.5 μl-1·h-1)or hith(10 nmol·0.5 μl-1·h-1)dose levels.The activity of iNOS in ischemic tissues were measured by iNOS detection kits. Reverse transcription( RT)-PCR was used to determine messenger RNA (mRNA) of the iNOS in ischemic tissues. Results The cerebral ischemic lesion resulted in a significant increase of iNOS expression compared with sham operation group. The high-dose Ang-(1-7) markedly enhanced (iNOS) activity ( 160. 83 vs 116. 75 U/mg, F = 19. 22,P＜0.01; 151.87 vs 113.07 U/mg, F=63.52,P＜0. 01) and gene expression(0.43 vs 0.38, F=21.83,P ＜ 0. 01; 0. 40 vs 0. 35, F = 19.49, P ＜ 0. 01 ) compared with aCSF treatment group at 24 hours and 48hours after reperfusion, whereas medium and low-dose Ang-( 1-7 ) didn't stimulate iNOS activation.Conclusions The obtained results suggest that high-dose Ang-(1-7) upregulate iNOS expression following ischemic stroke.Moreover,overdose Ang-(1-7)(10 nmol·0.5 μl-1·h-1)may have Ang Ⅱ-like effects in iNOS expression increase.

Objective To explore the effects of Irbesartan on the plasma concentrations of lysophosphatidic acid(LPA), endothelin-1(ET-1),serum concentration of nitric oxcide (NO) in the patients with acute cerebral infarction(CI).Methods All of the 53 patients were randomly assigned to Irbesartan therapy group(n=25) treated with Irbesartan 150 mg/d and Aspirin 100 mg/d and conventional therapy group(n=28) treated with Aspirin 100 mg/d.Both groups were treated for 14 days and the other measures of symptomatic therepy were the same. And another 23 patients without cerebrovascular diseases and 7 health volunteers were taken as control group.The venous blood samples were taken for measureing the levels of LPA,ET-1,NO while the scorces of neurological deficit (NDS)were evaluated before and after treatment. Results (1)Before treatment the levels of LPA,ET-1 in CI group were significantly higher and the level of NO was significantly lower than that in control group (all P

Objective To investigate the clinical and imageological features of pituitrin-induced delayed encephalopathy. Methods Clinical data of 8 patients with delayed encephalopathy caused by pituitrin were analyzed retrospectively. Results All of the 8 patients presented diffent degree neuropsychic symptoms at 4～12 d after stop using the pituitrin. The extrapyramidal and psychiatric symptoms of the cases were found,such as hypermyotonia(8 cases),hypokinesia(6 cases),extremity buffeting(3 cases),emotional and behavior disorder(6 cases). The 8 cases with EEG examination showed:there were gently to midrange widespread dysfunction in 4 cases,severe widespread dysfunction in 1 case. The levels of serum Na+ in 5 cases were decrease slightly. The 8 cases with brain MRI examination showed that the abnormal signals were mainly located in lentiform nucleus and head of caudate nucleus with long T1 and T2-weighted images,and including thalamus or midbrain abnormalities signal in 1 case,respectively. Conclusions The manifestations of pituitrin-induced delayed encephalopathy are extrapyramidal symptoms and cerebral disorders. The characteristics of brain MRI are abnormal signals in lentiform nucleus and head of caudate nucleus with long T1 and T2-weighted images. The supposed pathogenesis may be nerve necrosis induced by Charcot's artery spasm and hyponatremia.

According to teaching outline and clinical training characteristic of psychophy-laxis speciality(including Psychiatry and Medicopsychology),we explored how to strengthen the clinical thinking ability and clinical skill training for clinical medicine students based on cultiva-tion of elementary knowledge and theory,and we also established a set of more appropriate item system of clinical skills assessment so as to improve the practice quality in psychiatry and medical psychology departments.

Objective To improve the recognition of rapid eye movement(REM) sleep behavior disorder(RBD) as an early marker for ?-synucleinopathies.Methods By studying a typical case of RBD followed with multiple system atrophy-P,the clinical features,pathogenesis and its correlation with ?-synucleinopathies of RBD were elucidated.Results This case manifested a serial of paroxysmal increased activities of the limbs and behavioral disturbances during his REM sleep,and parkinsonism features appeared 9 years later.His cranial MRI showed the abnormal long T1 and T2 signals at bilateral centrum ovale,corona radiate and basal ganglia area of the cerebral hemisphere.Conclusions RBD is clinically characterized with paroxysmal behavioral disorder in the REM sleep,the changes of the brain stem,striatum and cortical perfusion are attributed to the RBD pathogenesis.Closely linked to a-synucleinopathies,RBD may be clinical harbinger of those disorders.

Objective To explore the changes of rennin-angiotensin system in rats with focal brain ischemia-reperfusion injury and the effects of intervention and neuroprotective mechanisms with Irbsartan. Methods The male SD rats were randomly assigned to sham operated group, ischemia-reperfusion (IR) group and Irbsartan pretreatment group. The focal IR model was made by suture occlusion of right middle cerebral artery (MCAO). At 24 h and 72 h following onset of MCAO with reperfusion,the neurologic impairment function scores and the infarction volume were evaluated, the mRNA expression of angiotensinⅡ type 1 receptor (AT1R) and angiotensinⅡ type 2 receptor(AT2R)were detected by RT-PCR, and AngⅡ levels and Renin activity were examined by radioimmuno-assay. Results (1) Pretreatment with Irbsartan could significantly improve neurological outcome and reduced infarction size. (2) In bilateral cerebral cortex, hypothalamus, brain stem and peripheral blood leucocyte, the mRNA expressions of the AT1R and AT2R were significantly increased after either 24 h or 72 h of MCAO with reperfusion (all P

Objective To study the effect of Irbesartan on the level of serum high-sensitivity C-reactive protein(hs-CRP) in the patients with acute cerebral infarction(ACI).Methods 60 patients with ACI were randomly assigned to Irbesartan therapy group(n=30) treated with Irbesartan 150 mg/d combined Aspirin 100 mg/d and conventional therapy group(n=30) treated with Aspirin 100 mg/d.Both groups were treated for 14 consecutive days and the other measures of symptomatic therapy were same.And another 30 patients without cerebrovascular diseases were selected as control group.The levels of serum hs-CRP were measured and the scores of neurological deficit(NDS) were evaluated before and after treatment.Results(1) Before treatment the levels of serum hs-CRP of ACI patients in both therapy groups were significantly higher than that in control group(all P