Objective To systematically evaluate the effectiveness and safety of axillary lymph node dissection for breast cancer patients with negative sentinel node biopsy.Methods Literatures in CNKI,PubMed,EMBASE and CBMwere searched from their establishment to December 1,2013.Accord-ing to the inclusion and exclusion criteria,trials of axillary lymph node dissection and sentinel node biopsy for breast cancer were strictly screened and extracted for quality assessment and result analysis.Meta-anal-ysis was conducted by using Revman 5.1 software.Results A total of 10 studies involving 7731 patients were eligible for the final analysis.Because of the large differences in research type,measurement indica-tor,follow-up period and statistical index,subgroup analysis was adopted.Meta-analysis was applied for homogeneous researches and the remaining studies were analyzed with qualitative descriptive analysis.The results showed no significant differences in disease-free survival,overall survival,local recurrence rate,and distant metastasis rate in different follow-up periods.Conclusion For breast cancer patients with single invasive lesion,axillary lymph node dissection is not necessary.More high-quality random control trials and long-term follow-up are required to confirm the conclusions of this systematic review.

10.3969/j.issn.2095-4344.2013.26.009

Objective To optimize the preparation condition of Ginkgolides drop pill. Methods The technique of preparation drop pill were optimized by orthogonal test. Results The optimized technique to prepare Ginkgolides drop pills:PEG4000∶PEG6000=1∶1,the temperature for the aqueous mixture was 85 ℃,the temperature for cool aqueous was 5 ℃,active ingredients∶excipient was 1∶3. Conclusion good quality of Ginkgolides drop pill can produced.

Objective To investigate the antibiotic resistance of extended-spectrum β-lactamases (ESBLs)-producing bacteria,and the risk factors for patients with hospital-acquired lower respiratory tract infections caused by these bacteria.Methods The clinical data of 80 cases of hospital-acquired lower respiratory tract infections caused by ESBLs + bacteria in the People's Hospital of Qingtian in Zhejiang Province from July 2008 to December 2011 were collected; and 160 cases of nosocomial infection caused by ESBLs- bacteria were randomly selected as controls.Univariate analysis and multivariate logistic regression were used to analyze the risk factors for ESBLs + bacteria infection.The resistance of sixteen antibiotics was detected by K-B method.Results Univariate analysis revealed that the risk factors for nosocomial lower respirator tract infection caused by ESBLs+ bacteria were hospitalization ≥ 10 d,readmission to hospital,oxygen inhalation,invasive operations,using antacid ＞ 7 d,using glucocorticoids ＞ 7 d,using immunosuppressant ＞ 7 d,using third-generation cephalosporins,using fluoroquinolone antibacterials,and the combined use of antibiotics≥3 d.Multivariate logistic regression analysis identified five independent risk faetors:oxygen inhalation (OR =8.613,95％ CI:1.870-39.659),invasive operations (OR =5.900,95％CI:1.885-18.467),using third-generation cephalosporins (OR =7.465,95％ CI:2.364-23.578),using fluoroquinolone antibacterials (OR =4.481,95％ CI:1.197-16.781) and combined use of antibiotics≥3 d (OR =5.346,95％ CI:1.717-16.643).ESBLs + Escherichia coli and Klebsiella pneumoniae strains were sensitive to imipenem,meropenem,cefoperazone /sulbactam and piperacillin/tazobactam (with the resistance rates lower than 30.00％),but were highly resistant to most β-lactam,aminoglycoside,fluoroquinolone and sulfonamide antibacterials.Conclusion ESBLs + isolates were highly resistant to most antibacterials,and hospital-acquired lower respiratory tract infections with ESBLs+ bacteria are mainly related with invasive operations and the use of antibiotics.

Objective To assess the clinical threatment results of pilon fractures managed with arthroscopyassisted minimally invasive percutaneous plate osteosynthesis (MIPPO).Methods 33 patients with pilon fractures were classified into 3 groups according to the Ruedi-Allgower classification:type Ⅰ in 26 cases,type Ⅱ in 5 cases,type Ⅲ in 2 cases,including 29 males and 4 females,aged 22 to 51 years,mean 31.5 years of age.All patients were treated with arthroscopy-assisted MIPPO with the postoperative follow-up time of 12 to 84 months.Results The clinical surgery efficacy according to Mazur's criterion was evaluated as excellent in 22 cases,good in 8 cases,fair in 3 cases.The excellent and good rate was 90.9％.Conclusion Arthroscopy-assisted MIPPO surgical treatment is an effective method for Pilon fractures with the advantages of good healing,minimal trauma and less complications,it is worthy of clinical application.

To investigate the relationship between proliferative capacity of salivary gland cells in contiguous acini of parotid tumors and recurrent neoplasma, DNA contents of 30 fresh specimens of parotid were studied by using cytometry in tumors, normal and shallow or deep lobe acini of the masses. The results showed that the DI was 1.369, S % 16.95, PI 26.18 in malignant tumors;DI was 1.171, S % 12.41, PI 15.54 in recurrent pleomorphic adenoma; DI was 1.141, S % 12.74, PI 13.07 in pleomorphic adenoma, DI was 0.999, S % 5.10, PI 8.00 in normal acini. Analysis of variance showed there was a significant difference (P＜0.01). The average DNA contents of shallow on deep lobe of contiguous tumors was 1.08 in DI, 10. 65 in S %, 13.49 in PI in malignant tumor, 1.06 in DI, 8.96 in S % and 9.85 in PI in pleomorphic adenoma, which were all higher than in normal acini (P＞0.05). It was concluded that the levels of DI and S % of parotid tumor and its contiguous acini are related to degree of malignancy or recurrent condition of the tumors, suggesting contiguous acini of parotid tumors had the strong capacity of proliferation,which might play an important role in recurrent or malignant change of the parotid tumors.

To investigate the relationship between proliferative capacity of salivary gland cells in contiguous acini of parotid tumors and recurrent neoplasma, DNA contents of 30 fresh specimens of parotid were studied by using cytometry in tumors, normal and shallow or deep lobe acini of the masses. The results showed that the DI was 1.369, S % 16.95, PI 26.18 in malignant tumors;DI was 1.171, S % 12.41, PI 15.54 in recurrent pleomorphic adenoma; DI was 1.141, S % 12.74, PI 13.07 in pleomorphic adenoma, DI was 0.999, S % 5.10, PI 8.00 in normal acini. Analysis of variance showed there was a significant difference (P＜0.01). The average DNA contents of shallow on deep lobe of contiguous tumors was 1.08 in DI, 10. 65 in S %, 13.49 in PI in malignant tumor, 1.06 in DI, 8.96 in S % and 9.85 in PI in pleomorphic adenoma, which were all higher than in normal acini (P＞0.05). It was concluded that the levels of DI and S % of parotid tumor and its contiguous acini are related to degree of malignancy or recurrent condition of the tumors, suggesting contiguous acini of parotid tumors had the strong capacity of proliferation,which might play an important role in recurrent or malignant change of the parotid tumors.

Objective To analyze the clinical characteristics of Duchenne/ Becker muscular dystrophy (DMD/BMD)with the initial presentation of transaminase elevation,in order to improve the clinician's understanding of this disease,and reduce misdiagnosis and missed diagnosis. To investigate the relationship between the elevation of transami-nase and the early stage of DMD/ BMD,and to provide the strategy for early diagnosis. Methods Twenty - four pa-tients admitted to the hospital with elevated serum transaminase as the initial presentation from January 2012 to Decem-ber 2014,who were diagnosed as DMD/ BMD by genetic testing or muscle biopsy,were enrolled. Their clinical data and laboratory examinations were retrospectively analyzed,including clinical features,diagnostic steps,serum muscle en-zymes,genetic analysis,electromyography and muscle pathological changes. Results The 24 patients were all male without family history of DMD/ BMD prior to birth. The average visiting age was (3. 4 ± 1. 2)years (ranging from 0. 8 to 6. 1 years),and 87. 5％ (21 / 24 cases)of cases were preschool children aged 2 - 6 years. Hypertransaminasemia was found in 21 cases (87. 5％)during the kindergarten physical examination,1 case during pre - operative investigation and 2 cases during respiratory infection. Due to its insidious onset,the time interval between incidental finding of elevated transaminase and definitive diagnosis was between 0. 6 and 20. 4 months. Among them,16 cases (66. 7％)had obvious pseudohypertrophy of calf muscles,and 18 cases (81. 8％)showed different degrees of movement disorder,such as unable to jump,easy to fall,and difficulty in climbing stairs. In addition,18. 2％ cases (4 / 22 cases)had a delay in language development. The serum alanine aminotransferase and aspartate aminotransferase levels were 120. 3 - 761. 7 U/ L and 83. 3 - 675. 5 U/ L,respectively. Serum creatine kinase (CK)was found to be markedly elevated (ranging from 3940 to 27510 U/ L)in all patients. Electromyography showed myogenic damage in 13 / 23 cases (56. 5％). DMD gene deletions were found in 18 cases (75. 0％),and duplications in 4 cases (16. 7％). The muscle biopsy performed in 2 cases (8. 3％)multiplex ligation - dependent probe amplification (MLPA)- negative cases showed evidence of dystrophic features on routine histology. Immunohistochemistry showed absent dystrophin staining in all 2 MLPA - nega-tive cases. Conclusion The clinical manifestation of DMD/ BMD is not typical in the early stage,so it is easy to be neglected or misdiagnosed. Elevated ALT and AST are important clues in the early diagnosis of DMD/ BMD. Children with elevated transaminase,in the absence of other signs and symptoms of hepatic injury,may have occult muscular di-sease,most frequently DMD/ BMD. A thorough physical examination and history taking as well as the measurement of serum CK are helpful in the differential diagnosis. Genetic testing or muscle biopsy should be done early for correct diagnosis of DMD/ BMD.

Ductal carcinoma in situ (DCIS) is a precursor of invasive ductal breast cancer,and up to 40％ of these lesions will progress to invasive disease if untreated.The micro-environment,genetic aberrations,signal pathways and epigenetics play important roles during the infiltration and transformation of DCIS.Further studies of the infiltration and transformation of DCIS will promote the accurate assessment and prognosis prediction of the patients with DCIS,for finding a comprehensive evaluation standard and the balance between the over and low treatment.

To observe the effects of basic fibroblast growth factor (bFGF) on human adenoid cystic carcinoma ACC-2 cell line proliferation and ERK, cyclin D1/p21waf/ciplsignaling pathways, human adenoid cystic carcinoma cells (ACC-2) were cultured and the influence of bFGF of different concentrations on cell proliferation was determined by MTT. Protein was detected by im muno-precipitation and ERK activity by using ERK agent kit. P-ERK1/2 and down-stream cyclin D1, p21waf/ciplexpression were detected by Western blotting and the interfering role of mitogen pro- tein-activated kinase (MEK) suppressor U0126 in the afore-mentioned indicators was examined. MTr demonstrated ACC-2 cell proliferation was substantially enhanced by bFGF, immuo-precipitation displayed ERK activity was up-regulated by bFGF, and immuno-imprinting also showed p-ERK1/2, cyclin D1 expression was greatly enhanced and p21waf/ciplexpression was inhibited by bFGE U0126 suppressed the effect of bFGE It is concluded that bFGF can promote the proliferation of human adenoid cystic carcinoma ACC-2 cells, and its pathways are associated with the up-regulated activity and expression of p-ERK1/2, inhibited p21waf/cipl expression and enhanced cyclin DI expression.