Objective To study the clinical,pathological features and treatment of metastatic breast cancer with triple negative breast cancer(TNBC) and its relationship with disease free survival.Methods One hundred and fifty-eight cases of TNBC patients who were treated in the First Affiliated Hospital of Zhengzhou University and the Chinese Medicine Hospital of Changge from January 2004 to January 2009 were selected as the research objects.All patients received operation and radiotherapy,the relationship between the clinical characteristics,pathological features and treatment with 5,3 year survival rate,and the recurrence and metastasis of patient were analyzed.Results In clinical stage Ⅲ period,the 3 years survival rate was 46.51％ (20/43),5years survival rate was 37.21％ (16/43),all significantly lower than in the phase Ⅰ and Ⅱ (91.53％ (54/59) and 76.27 ％ (45/59);87.50％ (49/56) and 71.43 ％ (40/56)),and the differences were statistically significant (x2=25.306,15.787,19.348,11.592;P＜0.001).With lymph node metastasis,the 3 years survival rate was 66.00％ (33/50),5 years survival rate was 50.00％ (25/50),significantly lower than that without lymph node metastasis(83.33％ (90/108),70.37％ (76/108)),the difference was statistically significant (x2=5.954,6.150;P＜0.05).In pathological grade Ⅲ,the 3 years survival rate was 65.67％(44/67),5 years survival rate was 43.28％ (29/67),significantly lower than that of grade Ⅰ (92.86％ (26/28),85.71％ (24/28)) and grade Ⅱ (84.13％ (53/63),76.19％ (48/63)),the difference was statistically significant(x2=7.527,14.414,5.839,14.560;P＜0.05).The 3 year survival rate of radiotherapy group was significantly higher than that in non radiotherapy group,the difference was statistically significant (81.58％ (31/38) vs.57.69％ (15/26);x2=4.357,P＜0.05).Patients with metastatic sites were lung,liver,brain,bone and supraclavicular lymph nodes,the median survival time after the transfer all more than 2 years.Conclusion TNBC is a special type of breast cancer that is difficult to treat,no consensus has been reached on the clinical treatment plan.Breast conserving surgery also has certain application value,radiotherapy only can increase the 3 year survival rate.The clinical stage and pathological grade are the influence factors of prognosis.

BACKGROUND:In the treatment of tibial plateau fractures, because of the variety of fracture, the complexity of anatomical changes, X-ray films or three-dimensional CT scan limited by two-dimensional plane, increases the difficulty in preoperative plan and surgical treatment. The application of three-dimensional (3D) printing technology has attracted attention in the department of orthopedics. OBJECTIVE:To explore the auxiliary role of 3D printing technique in preoperative plan and treatment for tibial plateau fractures. METHODS:Thirty patients with tibial plateau comminuted fractures were enroled in this study and divided into two groups: experimental and control groups, with 15 patients in each group. In the experimental group, patients underwent 3D CT scan, which was stored in DICOM format, and processed by Mimics software. Data were converted into STL format, entered 3D printer, and a 1:1 entity size of the fracture model was made, in accordance with repair plan of 3D fracture model. Operation time and intraoperative blood loss were compared between the two groups. At 12 months after treatment, their outcomes were assessed using Rasmussen evaluation criteria. RESULTS AND CONCLUSION: The 3D printing fracture models of 1:1 ratio identified fracture type and made a repair program before surgery in the experimental group. Operation time and intraoperative blood loss were significantly less in the experimental group than in the control group (P < 0.05). After surgery, patients were folowed up for 12 to 18 months. The healing time was 3-5 months, averagely 4.3 months. At 12 months after treatment, the Rasmussen evaluation criteria results showed that the excelent and good rate was significantly higher in the experimental group than in the control group (P < 0.05). These results suggest that the fracture model of 3D can help to make the operation plan. The treatment of tibial plateau fractures is more precise, personalized and visual.

Objective To investigate the feasibility and safety*with the low dose fentanyl for valve replacement fast track cardiac anesthesia. Methods 40 cases with cardiac valve replacement were divided into two groups,group Ⅰ :20 cases with fast track anesthesia,group Ⅱ :20 cases with large dose fentanyl anesthesia. The blood presure, HR, SpO2, CVP,Temperature, airway pressure were observed at different time points. The postoperative extubation time,ICU stay,hospital stay,postoperative pulmonary complications were recorded. Results The fentanyl(μg/kg) of group Ⅰ (23. 25 ± 1.32) was less than that of group Ⅱ ( 35.75 ± 6. 84) ( P < 0. 05 ); Extubation time (hours), ICU stay ( hours),length of stay (days) were ( 7.92 ± 3. 16), (25. 12 ± 7.50), ( 28.50 ± 8. 94 ) in group Ⅰ , and that were (13.70±5.63) ,(37.53 ±13. 19) ,(38.00 ± 12. 90) in group Ⅱ. The group Ⅰ were shorter than the group Ⅱ ,P<0. 05; There were four cases of lung infection in group Ⅱ, no one in group Ⅰ ( P < 0. 05 ); There were significant differences between the two groups. There were no significant differences in the remaining observations. Conclusion The low dose fentanyl anesthesia for fast track anesthesia in heart valve replacement surgery was reliable and safe;It could help to reduce postoperative extubation time, ICU stay time and hospital stay time and reduce postoperative pulmonary complications and hospital costs.

BACKGROUND:The output of computed tomography (CT) is Digital Imaging and Communications in Medicine (DICOM), whereas the input of three-dimensional (3D) printing is an object Standard Template Library model represented by a triangular mesh. The process of data handing and forrmat conversion are keys to the combination of these two techniques. OBJECTIVE:To explore how to convert CT data into a stereoscopic 3D model efficiently. METHODS:The DICOM in Medicine format data of the patients with femoral fractures were edited and produced by Mimics. We made a 3D model by adjusting the parameters of the 3D printer slicing software, and discussed the significance of 3D model in medical field, especially orthopedics. RESULTS AND CONCLUSION:Mimics software is the bridge to connect two-dimensional CT scan images and 3D images, to create a 3D model by editing the data of DICOM which comes from the CT scanner, with a 3D printing technology. The 3D Model can help doctors for routine clinical diagnosis and treatment, to improve the communication between doctors and patients and the quality of clinical medical teaching. 3D printing also makes medicine more personalized, remote, minimally invasive, and promote the development of medicine to the direction of digital medicine.

BACKGROUND:As a noticeable tissue engineering material of polyhy droxyalka noates family, poly (3-hydroxybutyrate-co-4-hydroxybutyrate)(P3HB4HB) exhibitsgood biocompatibility, adhesion and mechanicalproperties, presenting aextensive application future in tissue-engineered research.
OBJECTIVE:To investigate the biocompat ibilityin vitroand ectopic osteogenic differentiationin vivoof P3HB4HB and human bone marrow mesenchymal stem cels.
METHODS:Passage 5human bone marrow mesenchymal stem cels transplanted ontothe three-dimensional P3HB4HB scaffoldwereincubated with osteogenic induction medium (test group)or with no osteogenic induction(control group), respectively. After 5-day incubation, thecelgrowth was assessed by acridine orange staining and scanning electron microscopy; after14-day incubation, both kinds of cel-scaffold composites were subcutaneously implanted into the nude mice. At 16 weeks after implantation, the cel-scaffold composites were removed to observeectopic osteogenic differentiationin vivousing hematoxylin-eosin staining, von Kossa staining and colagen type I immunohistochemical staining.
RESULTS AND CONCLUSION:Acridine orange staining showed that cels adhered wel on the surface of the scaffold;under thescanning electron microscope, induced celsgrew wel on the P3HB4HB scaffold and produced abundant extracelular matrixes. In addition, at 16 weeks after implantation, there were osteoidtissues in the test group, positive for von Kossa staining as wel as colagen type I immunohistochemical staining;furthermore, hematoxylin-eosin staining showednumerous osteoblasts and bone lacunas. In contrast, no bone tissues appeared in the control group. To conclude, P3HB4HB is a suitable material for bone tissue engineering.

BACKGROUND:Autologous tissue-engineered bone marrow mesenchymal stem cel s (BMSCs) transplantation is one of the most common methods of treating early osteonecrosis of femoral head, but now there is stil no any special-purpose grafter available in the market. Such surgical transplantation is a laborious, time-consuming and tedious process, which goes against its clinical promotion. OBJECTIVE:To develop a supporting, efficient, special-purpose grafter, to solve the difficulty in stem cel s transplantation during core decompression of femoral head. METHODS:CAD software was used to perform solid modeling for this special-purpose grafter and print them by three-dimensional (3D) fast printing technology. The performance of this special-purpose grafter was tested by femoral head core decompression combined with BMSCs transplantation. It was compared with traditional surgical instrument in terms of duration of operation, intraoperative blood loss, visual analogue scale (VAS) of stem cel/biological fiber col agen complex omission amount and doctor’s satisfaction score. RESULTS AND CONCLUSION:(1) A kind of special-purpose grafter was developed by 3D printing technology rapidly. (2) Compared with the control group, duration of operation, intraoperative blood loss, VAS scores and doctor’s satisfaction scores were significantly improved in the trial group (P<0.05). (3) CAD software combined with 3D printing technology is a highly efficient means for front-line clinicians to perform independent development. The research and development of this special-purpose grafter provides a perfect solution to the laborious, time-consuming and tedious process of cel/biological col agen fiber transplantation.

Objective:To observe the clinical effect of extracorporeal shock wave treatment in the treatment of functional disorders after a palm crush injury.Methods:Forty patients who had experienced a hand crush injury more than 3 months previously were randomly divided into a control group and a combination group, each of 20. Both groups were given routine joint mobilization, ultrasound treatment, muscle strength training and occupational therapy every day in ten day units for 2 months. The combination group also received extracorporeal shock wave therapy three times a week for the two months. Before the experiment and after one and two months of treatment, both groups′ upper limb functioning was evaluted using the DASH score, grip strength and hand flexibility in the 9-hole wood board test.Results:After 2 months of treatment, significant improvement was observed in all of the measurements with both groups. The average scores of the combination group on all three tests were by then significantly better than the control group′s averages.Conclusions:Adding extracorporeal shock wave therapy to routine rehabilitation can improve the rough and fine functioning of a crushed hand.

The poor stability of the ligustilide (LIG) makes its quantitation in Angelica sinensis (AS) difficult. This study establishes a chemical conversion method for the determination of ligustilide content in AS and proposes a national pharmacopoeia standard. Mechanical agitation and sonication of a powdered AS extract in a methanol/cyprolamine mixture facilitated the stabilization and transformation of ligustilide. Using an external reference HPLC-DAD method, the cyclopropyl-ligustilide (LIGc) content in the mixture could be determined. The content of ligustilide was greater than 1.0% based on 144 AS specimens including 68 obtained from the originally planted areas of Qinghai and Gansu Province; 55 specimens were obtained from Minxian and Weiyuan County medicine markets, and 21 specimens for which the storage period reached or exceeded 1.5 years. According to the Hong Kong Chinese materis medica standards, the content of ligustilide in AS should not be lower than 0.6%. The developed method could also be applied to the quality control of other Chinese medicinal materials (such as Ligusticum chuanxiong) or Chinese patent medicines in which ligustilide is the main component.