Objective To investigate the expression and their clinical significance of P?- glycoprotein (P?- gp), glutathione?- S?- transferase?- ?(GST?- ?)and DNA topoisomerase Ⅱ(TopoⅡ)in breast cancer. Methods The expressions of P?- gp, GST?- ? and TopoⅡ were detected in 60 cases of untreated primary breast cancer by using immunohistochemical S?- P method. Results The positive expression rates of P?- gp, GST?- ? and TopoⅡ in breast cancer were 37.1 %, 66.7 % and 55.0 % respectively. The expression of P?- gp and TopoⅡ had positive correlation with degree of differentiation(P

Objective: To evaluate the clinical efficacy of total arthroscopic anterior talofibular ligament repair for chron-ic lateral instability of ankle joint. Methods: Data of 70 patients with chronic lateral mechanical instability of ankle joint treated by anterior talofibular ligament repair under full scope from September 2016 to October 2017 were retrospectively analyzed. There were 48 males and 22 females, aging from 18 to 49 years old (average, 32.3±3.4 years). Arthroscopic exploration, synovial mem-brane cleaning, extraction of lateral malleolus free body or microfracture were used in the operation, and the anterior talofibular lig-ament was repaired with knottless anchors to restore ankle stability. After the operation, plaster support was used for fixation, and relevant rehabilitation plans were conducted. X-ray films of the front drawer stress position of the ankle joint was taken preopera-tively and during follow-up, and the talus advancing distance was measured preoperatively and during follow-up. Ankle function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot function score, and pain was evaluat-ed by visual analogue scale (VAS). Results: Seventy patients were followed up for 8-18 months, with an average of 11.5 months. The incisions of all patients were healed in one stage without internal plant rejection reaction. The plaster was fixed for 2 weeks af-ter operation, followed by rehabilitation training 2 weeks later, non-confrontational physical exercise 3 months later and confronta-tional physical exercise 6 months later. Within one year after operation, 58 patients could meet the needs of daily life and exercise. Seven basketball and football fans complained of ankle joint soreness and discomfort after strenuous exercise, and the symptoms were relieved after treatment. The symptoms of foot and ankle instability were not significantly improved in 5 patients. Stress X-ray showed that the talus advancing distance was improved from 11.70±1.05 mm before operation to 3.25±1.09 mm at the latest follow-up, and the difference was statistically significant (t=32.15, P< 0.0001). VAS decreased from 5.70±2.90 before operation to 2.05±0.52 at the latest follow-up (t=11.75, P< 0.0001). AOFAS increased from 54.50±7.40 before operation to 87.80±5.60 at the latest follow-up (t=34.04, P< 0.0001). There was excellent in 53 cases, good in 8 cases, fair in 5 cases, poor in 4 cases, thus the excellent and good rate was 87.14% (61/70). One of the patients suffered from joint pain in ankle metatarsal flexion half a year later, and MRI reexamination found that the anchor had entered the joint cavity, whose symptom was relieved after the anchor was cleared by arthroscopy at the later stage. Conclusion The treatment of lateral chronic instability of ankle joint with arthroscopic non-knot anchor nail repair of anterior talofibular ligament can effectively restore the stability of ankle joint and the movement ability of pa-tients. The operation has advantages of definite curative effect, minimally invasive, fast recovery and easy acceptance by patients.

Objective To study the value of postmortem imaging on the diagnosis of intestinal perforation.Method Postmortem imaging(PMCT and PMCTA)data of 2 intestinal perforation deaths(and 4 controlled cases)were reviewed retrospectively.Diagnosing capacities of intestinal perforation by postmortem imaging method were further investigated.Results PMCT is sensitive in detecting the free air and liquid induced by intestinal perforation.PMCT can sometimes detect the gravity-dependent purulent secretions in the abdominopelvic cavity.PMCTA can visualize the extravasation of contrast agent from the perforation,which can be used to locate the accurate perforation region.Conclusion Postmortem imaging method(PMCT and PMCTA)is an important tool for the diagnosis of intestinal perforation,which can not only be used as a forensic diagnosis method,but is also useful to locate the perforation site before an forensic autopsy.

[Objective] To explore the correlation between the 5-factor modified frailty index (mFI-5) and acute kidney injury (AKI) after laparoscopic radical nephrectomy in elderly patients with renal cancer, so as to provide reference for the prevention and treatment of postoperative AKI. [Methods] A retrospective analysis was conducted on the clinical data of 214 elderly patients (≥60 years) who underwent laparoscopic radical nephrectomy at our hospital during Dec.2018 and Dec.2021.Patients were divided into frail group (n=75, mFI-5≥2) and non-frail group (n=139, mFI-5<2). The incidence of AKI and sub items of mFI-5 were compared between the two groups.According to the occurrence of AKI, patients were divided into AKI group (n=77) and non-AKI group (n=137). Univariate and multivariate logistic analyses were conducted to identify risk factors of AKI.Receiver operating characteristic (ROC) curves were plotted to test the effectiveness of mFI-5 in predicting AKI. [Results] The incidence of AKI was significantly higher in the frail group than in the non-frail group (64.00% vs. 20.86%, P<0.05). Univariate analysis showed that the incidence of AKI was related to gender, diabetes, hypertension, nonfunctional independent status, weakness and split kidney glomerular filtration rate (GFR). Multivariate logistic regression analysis showed that male (OR=2.454, 95%CI: 1.193—5.047), complicated weakness (OR=6.580, 95%CI: 3.380—12.811), and low split kidney GFR (OR=0.945, 95%CI: 0.911—0.980) were independent risk factors of AKI (P<0.05). The area under the ROC curve of AKI predicted by mFI-5 was 0.711. [Conclusion] Preoperative mFI-5 score is an effective predictor of AKI in elderly patients undergoing laparoscopic radical nephrectomy.As patients with frailty have a higher risk of AKI, preoperative evaluation and monitoring should be strengthened and timely intervention should be taken to improve the prognosis.