Objective To evaluate diagnostic value of the combined examination of ultrasound , contrast-enhanced CT and physical examination in axillary lymph node status in breast cancer .Methods 316 cases of breast cancer were studied from Jan .2012 to Dec.2013.The axillary lymph nodes were divided into negative group, suspicious negative group , suspicious positive group and positive group by physical examination , axillary ultrasound , and contrast-enhanced breast CT imaging .ROC curve was used to evaluate diagnostic value and the sensitivity,specificity,and accuracy were analyzed .Results The evaluation model presented the AUC of 0.859. The accuracy, sensitivity, specificity, positive and negative predictive value was 91.3%, 93.8%, 92.5%, 94.0%and 90.9%in negative group and positive group .Conclusion This evaluation method can accurately predict the axillary lymph node status and may be instructive to clinical operation mode selection .

Objective To investigate the extent of axillary lymph node dissection which can not only ef-fectively evaluate the axillary status but also reduce the complications to the minimum in early stage breast can-cer. Methods 331 patients with early breast cancer surgically treated from Jan. 2011 to Dec. 2013 were retro-spectively analyzed. Their preoperative axillary state was evaluated. They undertook sentinel lymph node biopsy (SLNB) by pure methylene blue dye method and frozen section examination during surgery. According to the ex-tent of axillary lymph nodes dissection, patients were divided into SLNB group (98 cases) and intercostobrachial nerve level lymph node dissection (ILND) group (233 cases). The pros and cons of the operation were compared. Results The sentinel lymph nodes (SLN) labeled by methylene blue were located under the intercostobrachial nerve level. The average number of SLN and intercostobrachial nerve level lymph nodes were 5.64+1.68 and 13.34+3.61 respectively. The detection rate and the false negative rate of SLNB was 97.42% and 2.58% respec-tively. The medium follow-up was 27.5 months. There was no significant difference in postoperative complications including upper limb paresthesia, swelling or limitation of shoulder activity between the two groups. Conclusion ILND is an effective and suitable surgical method in early breast cancer patients with failed intraoperative SLN labeling or with one SLN metastasis.

Objective Less than a decade ago, ER-positive and PgR-positive diagnostic criteria decrease from 10%to 1%. Up to 20%of current immunohistochemical determinations of ER and PgR worldwide may be inaccu-rate. It is necessary to study patients whose tumors are between luminal A (LABC) and triple-negative (TNBC) breast cancer. Methods Survival analysis grouping by the level of positive hormone receptor, CK5/6 and EGFR, and en-docrine therapy was carried out in 206 patients whose tumors were junction zone between LABC and TNBC. Re-sults There were no significant differences between the low-positive (1%-9%) HR group and positive HR (10%-19%) group in overall survival (OS) and disease-free survival (DFS). There was an apparent difference between the nor-mal-like group and basal-like group in OS and DFS, and between the patients with and without endocrine therapy. There were significant differences between death and tumor progression for EGFR and CK5/6, chemotherapy, and endocrine therapy. Conclusions We conclude that EGFR and CK5/6 are better prognostic indicators than the lev-el of positive HR in patients whose tumors are junction zone at the junction zone between LABC and TNBC. En-docrine therapy can be highly beneficial to these patients regardless of the positive HR level.

BACKGROUND:Gastrodin has anti-inflammatory effects and is mainly used in clinical practice for the treatment of ischemic stroke,and its mechanism of action is still unclear. OBJECTIVE:To explore the mechanism of gastrodin intervention on inflammatory injury in ischemic stroke rats. METHODS:Fifty Sprague-Dawley rats were divided into sham-operated group,model group,positive control group,high-dose gastrodin group and low-dose gastrodin group by the randomized numerical method,with 10 rats in each group.Ischemic stroke models were established by the middle cerebral artery occlusion method in all groups of rats except for the sham operation group.Administration in each group started on the 3rd day after surgery,and the rats in the positive control group were intraperitoneally injected with edaravone injection(6 mg/kg),the rats in the high-and low-dose gastrodin groups were intraperitoneally injected with 50 and 10 mg/kg gastrodin injection respectively,and the rats in the sham-operated and model groups were intraperitoneally injected with the equal volume of physiological saline.After 14 days of continuous treatment in each group,the pathological changes in rat brain tissue were observed,and the positive expression of NLRP3 inflammasome and the expression of inflammatory response-related proteins and their mRNAs were detected. RESULTS AND CONCLUSION:Compared with the sham-operated group,the volume of cerebral infarction became larger in the model group;the structure of brain tissue was loose,irregular cavities could be observed,and the number of neurons was reduced and irregularly arranged;the positive expression of NLRP3 inflammasome increased(P<0.01);and the protein and mRNA expression levels of Toll-like receptor 4,myeloid differentiation factor 88,apoptosis-associated speck-like protein containing a caspase-recruitment domain,Caspase-1,and interleukin-1β increased(P<0.01).Compared with the model group,the volume of cerebral infarction became smaller in the high-and low-dose gastrodin groups;the neurons were regularly arranged,increased in number,and uniformly distributed;the positive expression of NLRP3 inflammasome was decreased(P<0.05);the protein and mRNA expression levels of Toll-like receptor 4,myeloid differentiation factor 88,apoptosis-associated speck-like protein containing a caspase-recruitment domain,Caspase-1,and interleukin-1β were decreased in the high-dose gastrodin group(P<0.01);Toll-like receptor 4 protein expression showed no significant changes in the low-dose gastrodin group,and the protein and mRNA expression of the other inflammatory response-associated factors decreased(P<0.05,P<0.01).To conclude,gastrodin attenuates inflammatory injury in ischemic stroke rats,and its mechanism of action may be related to the inhibition of inflammatory response-associate factor expression.

OBJECTIVETo assess the optimal configuration of double-screw fixation for subtalar arthrodesis using finite element analysis.

METHODSThree-dimensional finite element double-screw models of subtalar arthrodesis were reconstructed using Mimics 13.0, Geomagic 10.0 and solid works software based on the 3-D images of the volunteer's right foot. The external and internal rotation torques of 4 N·m were applied, and the micromotion at the bone-to-bone interface were measured to evaluate the initial stability of subtalar arthrodesis.

RESULTSA neck screw plus an anterolateral dome screw was the most stable model. The peak micromotion at the fusion site of this fixation configuration were 41.67mnplus;0.49 and 42.64mnplus;0.75 µm in response to the respectively. A neck screw plus a posteromedial dome screw was the least stable model, with peak micromotion at the bone-to-bone interface of 61.76mnplus;1.00 and 62.32mnplus;0.90 µm, respectively.

CONCLUSIONA neck screw plus an anterolateral dome screw is the best fixation configuration while a neck screw plus a posteromedial screw provides the least stability of subtalar arthrodesis. Three-dimensional finite element models allow effective preoperative planning of the screw number and placement.

Adult ; Ankle ; diagnostic imaging ; Arthrodesis ; methods ; Bone Screws ; Finite Element Analysis ; Humans ; Imaging, Three-Dimensional ; Internal Fixators ; Models, Anatomic ; Software ; Subtalar Joint ; surgery ; Tomography, X-Ray Computed

Objective:To explore the establishment of a surgical complication monitoring mode based on data on the medical record homepage, and analyze its impact on the trend of changes in surgical complication incidence.Methods:A monitoring mode of surgical complication was developed based on the " structure-process-results" framework by using surgical complication rates derived from performance appraisal for a tertiary general hospital in Guangzhou. The number of surgical complications and the number of discharged surgical patients was collected from the hospital from January 2019 to June 2022 through the home page collection system for performance appraisal of national tertiary public hospitals. Descriptive analysis was used to analyze the incidence of surgical complications, and Joinpoint regression was used to analyze the trend of changes in the incidence of surgical complications. Monthly percentage change ( MPC) and average monthly percentage change ( AMPC) were calculated. Results:Since the hospital began implementing the surgical complication monitoring mode in May 2021, the incidence of surgical complications had decreased from 2.55% in June 2021 to 0.82% in June 2022, with an MPC of -5.58% ( P=0.024), which was better than the changes from January 2019 to May 2021 ( MPC=0.18%, P=0.755). Conclusions:The surgical complication monitoring mode constructed by the hospital can effectively reduce the incidence of surgical complications, providing reference for optimizing hospital′s medical quality management process and decision-making mode.