Objective To analyze the manifestation,reason,the processing method of the steel wire implantation with the sereotactic mammography to improve the accuracy of the preoperative positioning.Methods Seventy-nine cases which got the stereotactic steel wire implantation.In 96 lesions, 13 had steel wire displacement.Among them,5 cases got steel wire displacement during the sereotactic process,5 cases got steel wire displacement after the stereotactic process,2 cases got steel wire displacement during the operation,one case did not show the calcification on the postoperative radiography.Results The steel wire displacement occurred in 5 cases during the stereotactic process came from the patients and doctors respectively and the repositioning was needed.The steel wire displacement after the stereoscopic positioning was attributed to the overdose injection of local anesthesia,which led to the mismatch between the depth of Z axis of the mammary gland and the actual depth the computer given,the incorrect method for needle placement,and,neglecting whether the steel wire have got the lesion anchored when pulling out the needle set of steel wire hood,besides,these three kinds of instances above were all exaggerated by the accordion effect.For the displacement within 2 cm,the lesion can be excised toward the pathological change direction according to the position that steel wire prompted and re-place the second steel wire,putting the J-shaped steel wire into the needle hood and taking it out of the body.After repositioning,2 cases had the steel wire prolapse during operation,which resulted from the over-lifting of the steel wire.After placing the steel wire, the radiologist should give an accurate description on the depth and direction to the surgeon and the notch should be taken for incision from the steel wire head end which is proximate to skin.The postoperative specimen from one case had no calcification,which might be related to the condition that the calcification was located in the gland body,which got destruction from the surgical electrical electrotome.The excisionscope should be extended and the short term reexamination is recommended to make sure the complete excision of the calcification.Conclusion It is the gold standard method that implanting the steel wire with the stereotactic mammography to guide the surgical dissecting technique to diagnose non-palpable breast lesion(NPBL).Thorough understanding of the displacement manifestation of implanting steel wire with stereotactic technique and the treatment methods will be helpful in the surgical dissecting guidance.

Objective To explore the effect of cutaneous never anastomosis on sensory recovery in repairing wide spreadly soft tissue defects in dorsal hand with free anterolateral femoral flap. Methods The cases with wide spreadly soft tissue defects in dorsal hand repaired with free anterolateral femoral flap from January 2006 to December 2012 were divided into 2 groups. The control group including 15 consecutive patients from January 2006 to January 2009, whose sensation was reconstructed in routine way. Other 15 consecutive patients from Febnary 2009 to December 2012 were as research group, whose sensation was reconstructed with the suture of cutaneous nevers of anterolateral femoral flaps and forearm. All the patients were followed up for 12~24 months. Results All the free flaps survived in both groups. There were 4 cases good of sensory recovery in the control group, and it was 11 in the research group. No ulceration happened. Conclusion Cutaneous never anastomosis may result in satisfactory sensory function in the patients with wide spreadly soft tissue descts in dorsal hand repaired with free anterolateral femoral flap.

Objective To investigate the effect of nicotinamide mononucleotide (NMN) on insulin secretion and gene expressions of pancreatic and duodenal homeobox 1 ( PDX-1 ) and forkhead box-containing protein O-1 ( FoxO1 ),which were important transcription factors for insulin secretion.Methods Insulin secretion level in RIN-m5f cells was detected by rat insulin ELISA detection kit.The mRNA expression levels of PDX-1 and FoxO1 in RIN-m5f cells were analyzed by real-time PCR.The protein expression of PDX-1 was measured by Western blot.Results Insulin secretion levels in RIN-m5f cells treated with repaglinide ( 10 nmol/L) plus NMN ( 100 μnol/L) was significantly higher than those in the blank control,the DMSO control group,and the NMN (50μmol/L) treated group (P ＜0.05 ).The mRNA expression levels of PDX-1 in RIN-m5f cells treated with NMN ( 10,50 and 100 μmol/L) for 36 h were significantly higher than those in the control group (P ＜0.05,P ＜ 0.01,and P ＜ 0.001,respectively).There was marked differences in the mRNA expression levels of PDX-1 among different concentrations of NMN (P ＜0.001 ),but no significant differences in the mRNA expression level of FoxO1 ( P ＞ 0.05).No significant difference was found in the protein expression levels of PDX-1 in RIN-m5f cells treated by NMN (50,100,and 200 μmol/L) for 36 or 48 h compared with the control group (P ＞ 0.05).Conclusion NMN can stimulate insulin secretion and upregulate the mRNA expression of PDX-1 in RIN-m5f cells.

Objective To report the clinical effect of free transplanting for soft tissue defects pedieled with high site cutaneous branches of the transverse branch of lateral cirumflex femoral artery.Methods Cu- taneous branches of the descending branch of lateral circumflex femoral artery were found small or abscent in 7 patients.The anterolateral femoral skin flap was pedicled with high site cutaneous branches of the transverse branch to repair the soft tissue defects of the arm,hand,leg and foot,rather than with the descending ones. The size of the flap ranged from 15 cm?6 cm to 28 cm?13 cm,with part muscle valve,iliotibal tract and lat- eral femoral cutaneous nerve.The fractures were performed with internal or external fixation.Results All of the anterolateral femoral skin flap survived well postoperatively in the 7 cases and had good appearance and sensation at one stage.The function of the repaired extremities recovered well.Conclusion The anterolat- eral femoral skin flap pedicled with high site cutaneous branches of the transuvrse branch of lateral circumflex femoral artery has many advantages of good blood supply and large size.The flap was secluding,and can be taken with some muscle and lateral femoral cutaneous nerve.When cutaneous branches of the descending branch of lateral circumflex femoral artery is small or abscent,the anterolateral femoral skin flap with high site cutaneous branches of the transverse branch of lateral circumflex femoral artery is an optimal alternative.

BACKGROUND:Tissue factor (TF) is the initiation factor of the extrinsic coagulation pathway, and plays a critical role in the process of thrombosis. This study aimed to investigate the expression of TF and to explore their clinical effect on the pulmonary artery after acute pulmonary thromboembolism. METHODS:Thirty-four Japanese white rabbits (Level II animals) supplied by Tianjin Medical University were randomly assigned into:group A, specimens of the pulmonary artery taken 3 hours after pulmonary embolism (n=8); group B, specimens of the pulmonary artery taken 8 hours after pulmonary embolism (n=8); group C, specimens of the pulmonary artery taken 24 hours after pulmonary embolism (n=8); and control group, pseudo-operations performed without injection of autologous blood clots (n=10). The animal model of pulmonary thrombo-embolism was established by injection of autologous blood clots into the jugular vein through a 5F catheter, and was confirmed by digital subtraction angiography. The mRNA expression of TF in different parts of the pulmonary artery was accessed by RT-PCR. Theq test was used if there was a significant difference in a given continuous variable among the three groups assessed by ANOVA. The experiment equipment was supplied by the State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, the Chinese Academy of Medical Sciences and Peking Union Medical College. RESULTS:The TF expression in the specimen adjacent to emboli was stable at 3, 8 or 24 hours after embolism. The mRNA expression of TF at 3 and 8 hours after embolism was lower in the specimens taken from the distal end of the morbid pulmonary artery than those adjacent to emboli. While at 24 hours after embolism, there were similar mRNA levels in specimens either adjacent or distal to emboli. CONCLUSION:The high level of TF expression in pulmonary artery tissue adjacent to emboli could lead to locally increased coagulation activity, indicating the necessity of initiating anti-coagulation treatment as soon as possible after acute pulmonary embolism.

Objective - （ ） To evaluate the effect of job rotation on pain in wrist work related musculoskeletal disorders WMSDs （ ）Methods of physical therapists PTs . A total of 100 PTs from nine medical institutions were selected as the research subjects ， using judgment sampling method and they were divided into control group and intervention group by stratified random sampling ， method with 50 person in each group. The individuals in control group perform routine works. People in the intervention group were rotated between posts or added mobile shift replacements in daily work for 30 minutes. The duration of intervention was ， ， （ ） once a day five days a week for ten weeks. Visual Analogue Scale VAS score and pain duration were used as the evaluation ， indexes of intervention effect. The changes of indexes before intervention five weeks and ten weeks after intervention were Results ， compared between the two groups. Before intervention there was no significant difference in the VAS score and pain （ P ） duration between the control group and the intervention group all >0.05 . There was no significant difference in VAS score （ P ） and pain duration among the control group at three time points after intervention all >0.05 . The VAS score of PTs in the （P ）， intervention group at ten weeks was lower than that in the control group at the same time point <0.05 and it was lower than （ P ） that before intervention and at five weeks of intervention in the same group all <0.05 . The pain duration of PTs in the （ P ）， intervention group was lower than that in the control group at five and ten weeks after intervention all <0.05 and was lower （ P ） Conclusion ， than that before intervention at the same group all <0.05 . Rotating schedule can relieve WMSDs of PTs and the effect of intervention for ten weeks is more effective than that of intervention for five weeks.

OBJECTIVETo investigate the effects of Tpo and/or IL-11 gene modified stromal cells on the expansion of CD(34)(+) hematopoietic stem/progenitor cells in cord blood.

METHODSRetroviral vectors containing Tpo or IL-11 gene were constructed and used to transfect the stromal cell line HFCL. Tpo and/or IL-11 mRNA was assayed by Northern blot. Non-modified stromal cells were used, CD(34)(+) hematopoietic stem/progenitor cells from cord blood were expanded on gene-modified stromal cells for 7 days. The phenotype of CD(34)(+)CD(38)(-) primitive progenitors was detected by flow cytometry.

RESULTSHFCL expressed Tpo and/or IL-11 mRNA after transfected by the retroviral vectors. The percentages of CD(34)(+)CD(38)(-) primitive progenitors in the cultures of Tpo, IL-11 and Tpo + IL-11 modified HFCL were (1.8 +/- 0.24)%, (1.62 +/- 0.23)%, and (2.45 +/- 0.28)%, respectively, which were higher than that in the control [(0.8 +/- 0.23)%].

CONCLUSIONThe stromal cells modified by Tpo and/or IL-11 gene were able to enhance ex vivo expansion of CD(34)(+) and CD(34)(+)CD(38)(-) hematopoietic stem/progenitor cells from cord blood.

ADP-ribosyl Cyclase ; analysis ; ADP-ribosyl Cyclase 1 ; Antigens, CD ; analysis ; Antigens, CD34 ; analysis ; Fetal Blood ; cytology ; Hematopoietic Stem Cells ; physiology ; Humans ; Infant, Newborn ; Interleukin-11 ; genetics ; Membrane Glycoproteins ; Stromal Cells ; physiology ; Thrombopoietin ; genetics

OBJECTIVETo explore the clinical characteristics and risk factors of refracture in patients suffering from osteoporosis-related fractures as well as effective interventions.

METHODSFrom January 2006 to January 2008, both out-patients and in-patients in our hospital who were over 50 years old and suffered from osteoporosis-related fractures were selected for this research. They were divided into fracture group and refracture group. The refracture rate was followed up for 2 years, during which 11 patients developed refracture, thus were included in the refracture group. Therefore, 273 patients, 225 first-fracture cases, aged (67.7+/-8.5) years, and 48 refracture cases, aged (72.7+/-9.5) years, were included in this study. General data including age and sex, fracture types, femoral neck bone mineral density (BMD) T-scores tested by dual-energy X-rays absorptiometry (DEXA), Charlson index, time-frame between two fractures as well as mobility skill assessment were collected and analyzed by single-factor and multivariate statistical methods.

RESULTSFemales accounted for 70.2% of the fracture group and 77.1% of the refracture group. The most common refracture type was vertebral fracture for the first time and femoral neck fracture for the second time during the follow-up. The second fracture happened 3.7 years after the first one on average. The refracture rate was 2.12% within one year, and 4.66% within two years. Risk factors for a second fracture in osteoporotic fracture patients included age (larger than 75 years, HR equal to 1.23, 95%CI 1.18-1.29; larger than 85 years, HR equal to 1.68, 95% CI 1.60-1.76), female sex (HR equal to 1.36, 95%CI 1.32-1.40), prior vertebral fractures (HR equal to 1.62, 95%CI 1.01-2.07), prior hip fractures (HR equal to 1.27, 95%CI 0.89-2.42), BMD T-score less than -3.5 (HR equal to 1.38, 95%CI 1.17-1.72) and weakened motor skills (HR equal to 1.27, 95%CI 1.09-1.40).

CONCLUSIONSThe risks of second fracture among patients with initial brittle fracture are substantial. There is adequate time between the first and second fractures for interventions to reduce the risks of refracture, especially for the old women with a vertebral or hip fracture. Medication, motor functional rehabilitation and fall-down prevention training are helpful.

Age Factors ; Aged ; Aged, 80 and over ; Bone Density ; Female ; Humans ; Male ; Middle Aged ; Motor Skills ; Multivariate Analysis ; Osteoporotic Fractures ; etiology ; Risk Factors

Objective To explore the clinical value of indocyanine green (ICG) fluorescence navigation combined with carbon nanoparticles (CNP) in sentinel lymph node biopsy (SLNB) for patients with early breast cancer. Methods A total of 294 early breast cancer patients with axillary node negative in Department of Breast Surgery, Foshan Hospital Affiliated to Sun Yat-Sen University from June 2013 to April 2016 were retrospectively analyzed. Of the patients, 149 cases underwent SLNB with ICG combined with CNP (combination group), while 145 cases underwent SLNB with methylene blue alone (MB group). If the intraoperative pathology results of sentinel lymph nodes (SLNs) were negative, axillary lymph node dissection (ALND) was avoided. The SLNs detection rate, detection number, metastatic SLNs detection rate in SLNB were compared between two groups. The influence of age and body mass index (BMI) on SLNs detection rate was also analyzed. Results In the combination group, subcutaneous lymphatic channels were successfully visualized in 145 patients, and the detection rate was 97.3％(145/149). The fluorescence of SLNs was successfully detected in 143 patients, and the detection rate was 95.9％(143/149). The detection rate of SLNs was higher in the combination group than that of methylene dye alone group (97.9％vs. 91.0％,χ2=6.902,P<0.05). The average number of detected SLNs was higher in the combination group than that of methylene dye alone group (4.5±1.6 vs. 3.2±1.5,t=4.476,P<0.05). Fifty-eight metastatic SLNs were found in 715 SLNs in the combination group (8.1％), and 26 in 544 SLNs in MB group (4.7％). The detection rate was significantly higher in the combination group than that of methylene dye alone group (χ2=13.714,P<0.01). Age and BMI showed no influence on the detection rate and accuracy of SLNB in two groups (P>0.05). Conclusion The combined tracing of ICG fluorescence and carbon nanoparticles for SLNB has showed a better stability and operability in patients with early breast cancer, which is recommended to be a new SLNB method.

Objective To investigate the effective treatments of combined injury with craniocerebral firearm wound in dogs immersed by seawater under maritime environment. Methods Models of combined injury with craniocerebral firearm wound, including craniocerebral gunshot wound,open chest injury, open abdominal injury, open trauma of extremities and burn injury, were established in 60 healthy adult mongrel dogs. Animal models after being wounded were immersed by the seawater for 30 min, and then, they were equally randomized into conventional treatment group and comprehensive treatment group; 30 dogs in the conventional treatment group were given routine treatment and the other 30 dogs in the comprehensive treatment group were given lukewarm glucose liquid, β-aescin, naloxone hydrochloride, levofloxacin and re-warming treatments besides the conventional treatment. Transcranial Doppler ultrasound, blood gas analysis, measurement of plasma osmotic pressure and intracranial pressure (ICP) monitoring were performed on the dogs of the 2 groups; and the treatment efficacy of the 2groups were compared. Results Low incidence rate of brain vasospasm was noted and TCD indicated that blood flow speed approached normal in the comprehensive treatment group 3 h after the treatment.The plasma osmotic pressure and the indicators of metabolic acidosis reached normal levels in the comprehensive treatment group 12 h after the treatment. The ICP significantly decreased in the comprehensive treatment group 24 h after the treatment. Survival rate in the comprehensive treatment group (70%) was significantly higher as compared with that in the conventional treatment group (53%)7 d after the treatment (P＜0.05). All the indexes in the comprehensive treatment group were better than those in the conventional treatment group (P＜0.05) Conclusion Early infusion of lukewarm hypotonic solution can significantly reduce the osmotic pressure, correct the electrolyte balance, help the re-warming and prolong the survival rate. Naloxone possesses protective effect on brain. The β-aescine sodium can diminish viscosity, slow down brain edema progress, obviously reduce ICP and improve brain tissue oxygen metabolism. In a word, comprehensive treatment in effective in treating combined injury with craniocerebral firearm wound.