Objective To probe the effect of perioperative therapeutic regime on breast reconstruction after surgery in breast cancer patients.Methods We retrospectively reviewed the clinical data of 145 consecutive breast cancer patients with 162 reconstructions.Results 127 of 145 patients got an excellent or good appearance (87.6％),and 42 cases had complications occurring in 162 operations (25.9％).After a median follow-up of 38.4 months,recurrences were found in 9 patients,3 cases died,and the disease free survival rate was 93.1％.Multivariate analysis showed that radiation therapy,without nipple-sparing and one-stage prosthesis implant were independent risk factors for negative postoperative aesthetic outcome;Delayed reconstruction and implant reconstruction were found to be protective factors for the postoperative complications.Conclusions Although the survival rate appears to be scarcely affected,different treatment modalities in reconstruction strategy bring different clinical results and outcomes.The perioperative decision-making of reconstruction strategy should be based on oncological safety,postoperative complications,aesthetic outcomes and subsequent therapies.

Objective To study the lymphatic microvessel density of keloid and correlation of invasive growth.Methods Invasive part,proliferative part and peripheral normal skin of keloid patients (n=10) were collected by surgical excision,and normal skin of keloid and non-keloid patients as control.Lymphatic vessel density of different parts of keloid and normal skin were investigated by immunohistochemical staining using the lymphatic endothelium specific marker D2-40.Results There were no significant differences between lymphatic microvessel density of peripheral normal skin of keloid (12.563 ±1.803) n/mm2 and normal skin of non-keloid patients (11.071 ± 2.645) n/mm2 (t=1.389,P＞0.05); Lymphatic microvessel density of invasive part of keloid (27.315 ± 7.430) n/mm2 was significantly higher than those of proliferative part of keloid (17.375± 6.221) n/mm2 and normal skin (12.563±1.803) n/mm2 (x2 =16.8,P＜0.01); there were significant differences between proliferative parts of keloid and normal skin (t=2.276,P＜0.05).Conclusions Lymphatic microvessel density increase in the invasive part of keloid may have a certain relationship with invasive growth.

Objective To evaluate the therapeutic effect of long-pulsed Nd:YAG 1064 laser on hyperplastic scars by using a rabbit ear model.Methods Five female and five male New Zealand long-ear white rabbits weighting 2.0-2.5 kg were used in this experiment.Four square full-thickness skin wounds sized 1.5 cm x1.5 cm were created on the ventral surface of each ear to develop a model of hyperplastic scar.Finally,a total of 74 hyperplastic scars developed on the 80 wounds,and the scars on the left and right ears served as the control (unirradiated) and treatment (irradiated with long-pulsed 1064 nm Nd:YAG laser) group,respectively.After 30 days of irradiation,the color and texture of scars were observed and the scar thickness was measured by color Doppler ultrasonogTaphy.Then,the scars were harvested followed by the analysis of density of fibroblasts and microvessels as well as the changes in collagen fibers in scars by HE staining,CD31 staining and Masson staining,respectively.Results A decrease was observed in the color,hardness and thickness of scars in the irradiated ears compared with the unirradiated ears.The average thickness of scars,microvessel density and fibroblast density in scars were significantly lower in the treatment group than in the control group(2.137vs.3.089 am,t=5.72,P<0.01;38.333/mm2vs.68.056/mm2,t=4.93,P<0.01;166.940/mm2vs.355.000/mm2,t=13.36.P<0.01).Masson staining revealed a disorganized arrangement of collagen fibers in the control group but a sparse and regular alignment in the treatment group.Conclusion Long-pulsed 1064 nm Nd:YAG laser may promote the shrinkage and suppress the hyperplasia of scars.

Objective To improve lower eyelid blepharoplasty by using myocutaneous flap and lateral one-third skin flap.Methods A total of 37 patients were recruited in this study and received lower eyelid blepharoplasty.Incision was made at the lower palpebral margin,and the extension of incision was hided into the outer canthus rhytids.Myocutaneous flap was made first followed by the preparation of skin flap at the lateral one-third of the lower eyelid.Results All the patients experienced a quick recovery from the surgery.The excess skin at the lateral canthus was completely removed,the incision was sutured under moderate tension,and the eyelid skin was flattened.No lid-retraction or lower eyelid ectropion was observed in the 6-to 12-month postoperative follow-up.The lateral incision sear was hidden and the operation outcome was satisfactory.Conclusions The lower eyelid blepharoplasty with myocutaneous flap and lateral one-third skin flap may lead to a satisfactory outcome with the formation of natural outer canthus angle and make the patients younger.

ObjectiveTo search for the optimum external masking time and tonal models for patients with tinnitus.MethodsTwenty-seven patients with cochlear tinnitus were selected respectively from three different out-patients departments and divided into three groups. Nine patients in every group were treated with different masking parameters according to factorial design which had three masking noises, i.e. narrow band noise (NBN), wide band noise (WBN), speech noise (SN),and three masking time ranges, i.e. 15,30,45 minutes. The results before and after treatment were compared and analysed with analysis of variance (ANOVA). ResultsThe treatment effect when masking for 15 minutes was worse than that for 30,45 minutes, but there was no difference between 30 and 45 minutes. The NBN had the best effect when tinnitus signal was single, the WBN was effective for tinnitus with multiple sounds. ConclusionNBN or WBN masking for 30 minutes showed better therapeutic effect.

Objective:To understand the current situation of human resources in the hemodialysis centers of different levels of hospitals in Beijing, and to provide reference data for themedical institutions at all levels to adjust the related human resources programs.Methods:Based on the self-designed questionnaire, the basic situation of 123 hemodialysis centers and the allocation of human resources of doctors, nurses and engineers in medical institutions of Beijing were investigated and analyzed.Results:Each nurse in hemodialysis center was responsible for (4.98± 0.74) hemodialysis patients at the same time in each treatment shift. The specialized nurses accounted for 23.32% of the total registered nurses. The ratio of engineers to dialysis machines was 1∶25.76. The proportion of doctors, nurses and engineers with intermediate professional titles or above was 82.47%, 33.08% and 29.81% respectively. The proportion of doctors with graduate education or above was 51.13%. The proportion of nurses and engineers with bachelor degree or above was 56.12% and 51.56% respectively. The differences in the professional titles and the highest academic qualifications of the employees (doctors, nurses and engineers) between tertiary hospitals and non-tertiary hospitals were statistically significant ( P < 0.05). Conclusion:The number of personnel in Beijing hemodialysis centers is basically in a similar proportion, but there are some differences between the hemodialysis centers of tertiary hospitals and those of non-tertiary hospitals in terms of age composition, working years, professional titles and educational background. It is necessary to optimize the allocation of human resources in hemodialysis centers of different levels of hospitals, further strengthen the training of professional talents and the cooperation of multidisciplinary teams, to promote the sustainable development of medical service quality.

Objective To study Medpor combined with autogenous outer table of calvarial in management of deformities secondary to orbitozygomatic fracture.Methods In the reconstruction of the orbitozygomatic fracture,we firstly did the operation of osteotomies to reset reliable internal fixation,then Medpor combined with autogenous outer table of calvarial was used to repair wall and in correction of depressed orbitozygomatic region.Results From January 2007 to December 2010,13 cases of deformities secondary to orbitozygomatic fracture were repaired.The enlarged orbital volume was reduced,enophthalmos and facial asymmetry were corrected or improved.Facial deformity was significantly improved and no complications occurred.Conclusions Medpor combined with autogenous outer table of calvarial is benefit to most of secondary deformities to orbitozygomatic fracture.It is an effective solution to the orbital content shift and double vision problem,and it also can reduce the autologous damage and foreign body rejection.

Objective This trial was to observe the effect of Ulinastatin on coagulation functions in patients during operation period,and to investigate the protective mechanisms of Ulinastatin.Methods Forty patients were randomly divided into Ulinastatin group (Group U,n =20) and control group (Group C,n =20).Group U was infused intravenously ulinastatin 4000 U/kg (diluted with saline to 30 ml,20min losers) after anesthesia and before cutting skin,while Group C received the same volume of normal saline.All patients were phlebotomized 1 ml peripheral blood before administered (T0) and after 1 hour (T1),respectively.Coagulation activation time (SonACT),clot rate (CR) and platelet function (PF)were detected by sonoclot coagulation analyzer and platelet function analyzer.Results Compared with group C (controlled group),SonACT of Group U was prolonged significantly at T1 (P ＜ 0.05),and PF were increased at T1 (P ＜ 0.05) ; Compared with T0,SonACT and PF were increased at T1,respectively (P ＜ 0.01).Conclusions Ulinastatin can improve perioperative coagulation function and platelet function.It may reduce intraoperative micro-thrombosis syndrome and postoperative deep vein thrombosis.

ObjectiveTo observe the efficacy of maintenance hormonal treatment after response to chemotherapy in advanced breast cancer. Methods8 patients with advanced breast cancer were treated with chemotherapy,maintenance hormonal therapy were given after response to chemotherapy.The efficacy was evaluated every 2 cycles of chemotherapy and 2 months of endocrine therapy according to RECIST standard.Results8 patients received chemotherapy for 2-8 cycles (median 4 cycles). All patients got PR, the duration of chemotherapy was 1-6 months (median 2 months), the time to failure of chemotherapy was 4 months. Until the last follow-up day (31th December 2010), the time to progression was 6-86 months (median 13.5 months).Survival was 6-86 months(median 21.5 months).Seven patients quit the chemotherapy due to severe side effects of hematologic toxicity,fatigue or nausea vomiting.One patient died because of allergy to paclitaxol.Conclusion Maintenance hormonal treatment after patients with metastatic breast cancer response to chemotherapy may prolong the duration of effective therapy and improve the QOL.

Objective To study the degradation of hepatitis C virus(HCV) genome before and after methylene blue photochemistry(MB-P) treatment of the plasma.Methods MB was added to HCV positive plasma to a final concentration of 1.0?mol/L.The plasma was then exposed to 30000 Lux fluorescence.Plasma samples were then collected at different times of exposure.Real-time PCR was used to quantitatively study the course of the HCV-RNA degradation.The whole genome was screened for integrity by RT-PCR with 8 pairs of specific primers which targeted sequential overlapping sections of HCV genome.Results Results of real-time PCR showed that the copy number of HCV-RNA was continuously decreasing during MB-P treatment.RT-PCR results showed that the reactivity of different sections of the HCV genome to MB-P was significantly different and indicated that the 5' end and 3' end were more stable. Conclusion MB-P treatment could degrade HCV RNA with various sensitivities to different sections of the genome.RNA degradation may play an important role in plasma virus inactivation.Detection of HCV genomic RNA might be clinically useful to monitor the process and efficiency of virus inactivation.