The metastases status of internal mammary lymph node(IMLN) is an independent prognostic factor for breast cancer and it also is an important reference for neoplasm staging.The patients with IMLN metastases consistently have worse outcomes.The overall risk of IMLN metastases is 18 ％-33 ％.Metastases exclusively situated in the IMLN,without concurrent axillary metastases,occur in 2 ％-11％ of patients.Factors related to IMLN metastases include the status of axillary node,the age of patients,the localization and characteristics of primary tumor.Recently,with the development of sentinel lymph node biopsy(SLNB), internal mammary-SLNB may access the status of IMLN with a minimal risk. Internal mammary-SLNB procedure can improve the system for nodal staging of breast cancer,and it will contribute to the individualized treatment for breast cancer patients.

Objective To study the expression of macrophage inflammatory protein-1α(MIP-1α),inter-feron gamma inducible protein 10(IP -10)and angiopoietin -1 (Ang -1)in primary acute myelogenous leukemia (AML),and clarify their clinical significance.Methods ELISA was used to detect the expressions of MIP -1α,IP-10 and Ang -1 in serum samples from 54 AML patients(observation group),and twenty volunteers(normal control group).Results The expression levels of MIP -1α,IP -10 and Ang -1 in the observation group[(198.813 ± 53.923)pg/mL,(2.332 ±0.745)ng/mL,(1.593 ±0.447)ng/mL]were significantly higher than the normal control group[(153.309 ±44.475)pg/mL,(1.569 ±0.485)ng/mL,(0.838 ±0.333)ng/mL](t =3.369,5.133,6.856, all P <0.05).Subgroup analysis,during the groups of better -risk,intermediate -risk and poor -risk,the contents of MIP -1αwere (141.524 ±27.510)pg/mL,(196.370 ±31.966)pg/mL,(269.892 ±54.795)pg/mL;the contents of IP -10 were (2.085 ±0.332)ng/mL,(2.307 ±0.696)ng/mL,(2.685 ±0.348)ng/mL;the contents of Ang -1 were (1.248 ±0.454)ng/mL,(1.599 ±0.386)ng/mL,(1.951 ±0.359)ng/mL.The levels of MIP -1αand Ang -1 in the better -risk group were significantly lower than those in the intermediate -risk group and poor -risk group (q =6.100,11.438,3.603,5.742,all P <0.05).While the levels of IP -10 had no closely correlation with NCCN risk status(q =1.225,2.643,2.016,all P >0.05).There were remarkable correlation between the serum expression levels of MIP -1αand Ang -1 (r =0.324,P <0.05).Conclusion There are differences of serum MIP -1α, IP -10 and Ang -1 in the different NCCN prognosis groups,which reflect they may have certain guiding significance in the choice of clinical treatment and the prognosis for newly diagnosed AML.

Objective The patients with non-syndromic deafness in Shanxi Province were retrospectively an_alyzed for the common deafness gene mutations and frequency of mutations carrying rate ,to understand the molecu_lar pathogenesis of deafness in Shanxi area .Methods Genomic DNAs of 800 patients of non -syndromic deafness within Shanxi were obtained from peripheral blood .Genes GJB2 ,GJB3 ,SLC26A4 and mitochondrial 12SrRNA 1494 and 1555 loci were sequenced after polymerase chain reaction (PCR) amplification and compared with the NCBI website for the analysis of the formation of mutations .ResuIts Among 800 patients ,353 cases (44 .13% ) showed detected deafness related mutations and the genetic etiology was found for 294 patients (36 .75% ) .Among them , 153 cases (19 .13% ) carried double allele mutations in the GJB2 gene .The most frequent mutation of GJB2 gene was 235delC ,and the carrying rate was 13 .5% (216/1 600) .The double mutant allele of SLC26A4 gene was detec_ted in 123 cases (15 .38% ) ,and the most common mutation was IVS7-2A>G ,identified in 7 .44% (119/1 600) of patients .Homogenic mitochondrial 12S rRNA 1494C> T mutation in one patient and 1555A> G mutation in 15 patients were detected .GJB3 gene c .538C > T heterozygous mutation was found in two patients .Altogether , 36 .75% (294/800) of patients with deafness were caused by gene mutations .ConcIusionThe data containing GJB2 gene and SLC26A4 gene carrying rate are consistent with the published data of non-syndromic deafness in the Northwest region of China ,but the carrying rate of mitochondrial gene mutations is lower than the average level of China .Our data show that the gene mutations contribute to 36 .75% of etiology in patients with deafness .This study reflects the importance of deafness related genes screening in Shanxi area for early diagnosis and genetic con_sultation .

Objective To observe the therapeutic efficacy of all-trans retinoic acid(ATRA) combined with arsenic trioxide(As2O3) on acute promyelocytic leukemia(APL).Methods 9 patients of APL underwent ATRA with As2O3 therapy.The patients in combination group were treated with ATRA 25mg/(m2?d) and As2O3 10mg intravenously for 3 to 4 hours per day until complete remission(CR) or for 50 days.According to the white blood cell(WBC) counts,anthracycline and cytosine arabinoside(Ara-C) were added on third day.Results 6 newly-diagnosed and 2 relapse patients of the combination group were CR after first treat.The medium time to CR was 30.12?4.89 days.Conclusion ATRA + As2O3 with anthracycline regiment is superior to either regiment given alone to patients with APL.It is an efficient therapeutic approach to APL patients using a combination of ATRA with As2O3.

This paper analysed the rhinoscope's clinical value in microsurgical treatment of intracranial aneurysms. Application of the rhinoscope in 87 patients, only 2 patients had ruptured during operation. However, 11 cases had ruptured in 94 cases without using rhinoscope, P < 0.05, they had a significant difference. By DSA follow-up review, 82 cases of used rhinoscope only 2 cases had remained the aneurysm neck, but 9 cases had the aneurysm neck in 77 cases which had not used the rhinoscope in the microsurgical treatment, P < 0.05, they also had significant difference. The application of rhinoscope in microsurgical treatment of intracranial aneurysms intraoperative, can reduce the risk of the intraoperative aneurysm rupture. It can achieve better clinical effect.
Adult ; Aged ; Endoscopy ; Female ; Humans ; Intracranial Aneurysm ; surgery ; Male ; Microsurgery ; Middle Aged ; Nose ; surgery ; Treatment Outcome

Background and purpose: When patients have positive sentinel lymph node (SLN), axillary lymph node dissection (ALND) is usually performed, but most of them have no metastasis in the non-sentinel lymph node (nSLN). It is of great significance to predict metastasis of nSLN precisely. The aim of the study was to establish a nomogram for the intraoperative prediction of nSLN metastasis in breast cancer patients using one-step nucleic acid amplification (OSNA) techniques and to direct the subsequent therapy for breast cancer effectively. Methods: Of 552 breast cancer patients who underwent SLN biopsy in the 2010 OSNA clinical trial, 103 with SLN metastasis treated with ALND were assessed to establish a nomogram for intraoperative prediction of nSLN based on the molecular diagnosis. A validation cohort of 61 patients who met the similar criteria in the 2015 OSNA clinical trial subsequently validated it. Results: Primary tumor size, total tumor load, the number of positive SLNs and negative SLNs were associated with the presence of nSLN metastasis based on the multivariable logistic regression results, and a nomogram was established with these variables. Its area under the ROC curve was 0.814 for the predictive model and it was 0.842 in the re-validation cohort. The tumor size assessed by the postoperative histological examination was replaced by the size evaluated by the imaging examination, and the area under the ROC curve was 0.838. There was no statistically significant difference in the accuracy compared with the former validation data (P=0.7406). Conclusion: The predictive nomogram based on the molecular diagnosis can predict the nSLN metastases intra/post-operatively. It appears to be obviously superior to other predictive models and may help to guide the axillary management and to make decisions about radiation target region.

Objective To prospectively investigate the optimal setting for sentinel lymph node biopsy (SLNB) in patients with breast cancer by comparing the effects of different preparation methods and injection sites of 99Tcm-SC in sentinel lymph node (SLN) mapping and detection.Methods Two batches of 99Tcm-SC were prepared by boiling for 3 min (radiotracer 1) and 5 min (radiotracer 2),respectively.Radioactive chemical purity (RCP) and size of colloid particles were measured at 10 min,1 h,2 h and 4 h after the preparation.One hundred and forty-seven patients with breast cancer were involved and randomly divided into 3 groups.Group A consisted of 40 patients with periareolar injection of radiotracer 1,group B of 40 patients with periareolar injection of radiotracer 2,and group C of 67 patients with peritumoral injection of radiotracer 2.Lymphatic mapping was performed for all patients using SPECT/CT preoperatively and blue dye was subdermally injected over the tumor.The detection rate of the axillary and internal mammary SLN was recorded.One-way analysis of variance,independent two-sample t and x2 tests were used to analyze the data.Results There was no significant difference of RCP between the two radiotracers at 10 min,1 h,2 h and 4 h after preparation (t =-0.267,-0.794,0.826 and-0.977,all P＞0.05).Compared with radiotracer 1,the percentage of particles smaller than 100 nm in radiotracer 2 reduced significantly ((73.72±2.36) ％ vs (65.25±3.56)％,t=6.436,P＜0.05) and the mean effective particle size was significantly larger ((45.27±6.42) nm vs (75.59t7.04) nm,t=7.315,P＜0.05).In groups A,B and C,the detection rate of the internal mammary SLN was 70.0％ (28/40),47.5％ (19/40) and 17.9％ (12/67),respectively,with significant difference (x2=29.525,P＜0.05).In groups A,B and C,the detection rate of the axillary SLN was 100％ (40/40),95.0％ (38/40) and 97.0％ (65/67),respectively,without significant difference (x2 =2.686,P＞ 0.05).Conclusion For SLNB of patients with breast cancer,the axillary and internal mammary SLN could be better detected by SPECT/CT lymphatic mapping using radiotracer prepared with a shorter boiling time,via periareolar injection,and combined with subdermal injection of blue dye.

Objective: To explore the security and the radical and clinical value of thoracoscopic-laparoscopic esophagectomy with two-field lymph node dissection for middle esophageal cancer through comparison with open esophagectomy. Methods: A total of 410 stage II to stage III esophageal cancer patients who underwent two-field lymph node dissection with two different methods (thora-colaparoscopic esophagectomy and open esophagectomy) from January 2009 to July 2013 in Uninon Hospital, Fujian Medical Universi-ty, were analyzed retrospectively. General pathological parameters, operative procedures, and short-term outcomes were collected and compared between the two groups (TLG and OG). Results: No significant differences were found regarding general pathological pa-rameters, such as gender, age, etc. Significant differences between thoracolaparoscopic and open two-field lymph node dissection esoph-agectomy were observed in terms of esophagectomy intraoperative blood loss [(206 ± 138) mL vs. (240±111) mL] and the mean num-ber of dissected lymph node per person [(26.6±8.6)/per vs. (21.7±9.2)/per]. Overall postoperative morbidity rate in OG was 35.2%, and its difference from that of TEG (25.8%) is statistically significant (P<0.05). Regarding single complications, such as pulmonary infec-tion and arrhythmia, OG showed evidently superior results (P<0.05). Meanwhile, anastomotic stricture and hoarseness rate are higher in TEG (P<0.05), and the difference was statistically significant as well. Conclusion: Thoracolaparoscopic two-field esophagectomy is technically feasible and safe and can achieve radical tumor resection.

Objective The plasma levels of fibrinogen degradation products (FDP),D-dimer(DD) and fibrinogen (Fg) in patients with rheumatoid arthritis (RA) were tested and the relationship between the upregulated coagulation system and disease activity were explored.Methods Patients were divided into the active group and the remission group and 50 patients were included in each group.Hematological variables,including FDP,DD,Fg,and disease activity parameters including erythrocyte sedimentation rate (ESR),C-reactive protein (CRP) levels and rheumatoid factor (RF) titer were measured.Two-sample t-test,linear correlation test and Chi-square test were nsed for data analysis by SPSS 11.0 software.Results Age and sex were comparable in the two groups (P＞0.05).The FDP,DD and Fg were significantly higher in patients with active disease [(12.0±8.2) μg/ml, (3.1±3.1) μg/ml, (4.6±1.4) g,/L] than those in patients with remission [(2.1±1.1) μg/ml, (0.4±0.4) μg/ml, (3.0±0.6) g/L,all P＜0.01 ].There was no difference in gender distribution in FDP and DD (P＞0.05).However,Fg was significantly higher in men than that in women (P＜0.05).FDP showed a significantly positive correlation with DAS28 (r=0.48,P＜0.01) and ESR(r=0.28,P＜0.05).DD correlated positively and significantly with ESR and DAS28 (r=0.69,0.52,all P＜0.01).Fg was significantly positively correlated with DAS28,CRP and ESR (r=0.57,0.64,0.68,all P＜0.01).FDP,DD and Fg were not correlated with RF (r=-0.07,0.06,-0.01,all P＞0.05).Conclusion FDP and DD correlate well with disease activity and may be important disease activity parameters for RA.The rank of sensitivity of FDP,CRP,DD,ESR,Fg and RF for disease activity assessment of RA presents in a declined manner.

Objective: To investigate a new method for improving the therapeutic effect on malignant glioma. Methods: A new type of killer cells, named GS-LAK, was induced by means of costimulating the peripheral ginsenoside(GS) and interleukin-2 (IL-2). Comparing with control group-LAK cells, cytotoxicity of GS-LAK cells against malignant glioma cells(BT325) was examined with MTI method. Results: It showed that GS-LAK cells exhibited some advantages over LAKcells in proliferation, cytotoxicity, as well as the utilizing of IL-2. Conclusion: The application of GS-LAK cells mightopen a new prospect to clinical therapeutic approach to malignant glioma.