There are two main lymphatic drainage routes of the breast: a superficial system and a deep system, and only the deep one can drain into the internal mammary lymph node (IMLN) which receive about 25%of the lymph of the breast. As one of the important nodal sites of lymphatic spread of breast, IMLN is important for neoplasm staging and it will guide adjuvant radiotherapy. However, there still lack an effective and feasible minimally invasive diagnosis technology of IMLN, leading to inaccurate staging and over/under-treatment. The“modified injection technique” broke through the bottle-neck of the low internal mammary visualization rate with traditional injection technique, and made the internal mammary sentinel lymph node biopsy possible to be a min-imally invasive assessment for IMLN status, and further guided internal mammary radiotherapy (IM-RT). Patients with IMLN positive should accept IM-RT, with IMLN negative can avoid IM-RT. With the unceasing progress in studies on internal mammary lymph drainage area, patients may obtain the individualized diagnosis and treat-ment. The review summarizes current knowledge on the anatomy and physiology of the lymphatic system of the breast to translate this into implications for clinical practice of IM-SLNB.

Objective To explore the treatment and clinical outcomes of unstable combined fractures of pelvis and acetabulum.Methods From January 2013 through December 2014,21 unstable pelvic fractures associated with acetabular fractures received surgical treatment at our department.They were 18 men and 3 women,aged from 21 to 55 years (average,43.2 years).By the Tile classification for pelvic fractures,12 cases were type B and 9 type C.By the Letourel-Judet classification for acetabular fractures,11 cases were transverse fractures,5 both-column fractures,3 posterior column + posterior wall fractures,and 2 anterior column fractures.The intervals between injury and surgery averaged 6.5 days (from 4 to 15 days).Results The 21 cases were followed up for 6 to 18 months (average,9 months).According to the Matta's criteria for pelvic reduction,5 cases were excellent,12 good,and 4 fair,giving an excellent to good rate of 81.0％.According to the Matta's criteria for acetabular reduction,5 cases were excellent,11 good,and 5 poor,giving an excellent to good rate of 76.2％.The pelvic fractures healed after 12 to 18 weeks (average,14.5 weeks);the acetabular fractures healed after 12 to 22 weeks (average,15.5 weeks).According to the Majeed's functional evaluation at the last follow-ups,10 cases were excellent,8 good and 3 fair,giving an excellent to good rate of 85.7％.According to the Merle d'Aubigné-postel evaluation,8 cases were excellent,9 good,and 4 fair,giving an excellent to good rate of 81.0％.Three patients had nerve injury which was almost completely recovered 4 to 6 months after operation.Two cases had wound infection which was controlled after debridement for twice.No other complications like ectopic ossification,avascular necrosis of the femoral head,iatrogenic vascular or nerve lesion was observed during the follow-ups.Conclusion Precise diagnosis,rational plan,careful surgery,effective reduction,rigid fixation and active rehabilitation are keys to fine outcomes in the treatment of unstable pelvic fractures associated with acetabular fractures.

AIM:To establish the quality control standard of Compound Glucomannan Weight-reducing Tablet. METHODS:Material and tablets went through ultrasonic cleaning by 60% alcohol and then hydrolyzed to glucose and mannose with 2.0 mol/L sulfuric acid,derivatized with PMP,separated by RP-HPLC using a stage gradient elution,and wavelength was at 250 nm. The monosaccharide were studied under the help of internal standard; while the glucomannan content in Konjac refined powder and tablets was determined. RESULTS:Linearities of glucose and mannose were good (r=0.994 3,0.999 8) in the range of 0.05-0.5 mmol/L.The average recoveries of this method were 100.67% and 98.34%,RSD were 2.74% and 3.22%(n=5) respectively. Ratio of glucose to mannose in glucomannan was 2 ∶3,glucomannan content in Konjac refined powder was 88.2%,glucomannan content in tablet was 354 mg/p. dissolution used for glucomannan conformed to homogeneity. CONCLUSION:The established quality standard is simple,feasible and reproducible,and can be used for quality control of Compound Glucomannan Weight-reducing Tablet.

Purpose:To determine the efficacy and toxicity of gemcitabine plus cisplatin in anthracyclin- and taxane-pretreated patients with advanced breast cancer. Methods:Chemo-resistance was defined as no response while rece iving first-line and/or second-line chemotherapy. Patients with advanced and c hemo-resistant breast cancer, which was confirmed histologically, received gemc itabine 1,000 mg/m 2 on d1, 8 and cisplatin 25 mg/m 2 on d1-3, every 3 weeks.2 cycles were delivered at least. Results:30 female patients were enrolled in this trial. All pat ients were evaluable for response and toxicity. The median age was 46 years (ran ge, 34-58 years). After 2-4 (median, 3) cycles of chemotherapy, overall object ive response was 50.0%, with 5 CRs (Complete response 16.7%) and 10 PRs (Partial response 33.3%). Stable disease was seen in 13 patients (43.3%), and disease pr ogression in 2 patiens (6.7%). Toxicities included myelosuppression and gastroin testinal reaction mainly. Grade Ⅲ-Ⅳ toxicites developed in 50% patients. Ther e were no treat-related deaths. The median follow-up time was 12.5 (range: 2- 48) months. Median overall survival was 14 months, and median time to progressio n was 10 months. Conclusions:These data indicate that the combination of gemcita bine and cisplatin is an effective treatment for heavily pretreated breast cance r patients with manageable toxicity.

Epilepsy is the common neurological disease, and antiepileptic drugs are the main means for the treatment of epilepsy. However, there is no conclusion on the timing of drug withdrawal in patients with epilepsy. In recent years, some large-scale prospective studies have provided some guidance on anti-epileptic drugs withdrawal. This article focused on the factors affecting the prognosis and timing of drug withdrawal, hoping to further the understanding of anti-epileptic drugs withdrawal and instruct clinical practise.

Objective To explore the alterations of resting-state neural networks in females with migraine at attack stage in low-and high-frequency ranges compared to healthy controls. Methods Resting-state magnetoencephalography data from 20 females with migraine ( migraine group ) and 20 age-and gender-matched healthy controls ( control group ) were collected to compute the neural network parameters through graph theory analysis.Independent samples t test was used to compare the difference of the network parameters between the two groups.The Pearson coefficient was used to assess the relationship between the abnormal network parameters and clinical manifestations of migraine.Results Compared with control group, females in migraine group at attack stage showed increased functional connectivity in the 0.1 -1 Hz, 4 -8 Hz, 12 -30 Hz, 30 -80 Hz band; increased shortest path length in the 80-250 Hz band; increased clustering coefficient and degree in the 0.1 -1 Hz band;decreased clustering coefficient and degree in the 4 -8 Hz, 12 -30 Hz band ( P<0.05 -0.01 ) .The functional connectivity of females with migraine at attack stage was positively correlated with number of years with migraine in the 12-30 Hz ( r=0.56, P=0.01 ) .Conclusion These results indicate that inherent neural networks are significantly impaired in low-and high-frequency ranges in females with migraine at attack stage and may contribute to the clinical manifestations of this disorder.

Objective To compare the biomechanical properties of non-locking compression plate (DCP) and locking compression plate (LCP) in the internal fixation of humeral shaft fracture by means of finite element analysis.Methods Three-dimensional finite element models were constructed to simulate DCP and LCP internal fixation of humeral transverse fracture.The DCP and LCP groups were compared in terms of peak stress on the humeral fracture fragments (MPa),peak stress on the screws (MPa),and overall displacement peak value (mm) under 4 basic loads (bending,shear,torsion and compression).The biomechanical stability was analyzed after fracture fixation.Results The stress tended to concentrate at the connection sites of plate and screws and distributed evenly on DCP.The stress distributed in a gradient manner at the multiple screw holes and tended to concentrated on the central screws on LCP.Under the bending,shear and torsion loadings,the peak stresses on the fracture fragments and screws in the DCP fixation were larger than in the LCP fixation.However,under the compression loading,the peak stresses on the fracture fragments and screws in the DCP fixation were smaller than in the LCP fixation.DCP and LCP had similar trends in displacement.Under the bending,shear and torsion loadings,the overall displacement peak values in LCP fixation were smaller.However,under the compression loading,the overall displacement peak values in DCP fixation were smaller.Conclusions DCP and LCP have similar biomechanical properties to resist bending,shear,torsion and compression.Due to the gradient distribution of stress among the screw holes,LCP is more suitable for patients with comminuted fracture or osteoporosis.Stress distribution is more even in DCP.Surgeons should consider the advantages of both DCP and LCP to achieve better stability.

Objective To observe the protective effect of Chinese traditional medicine Ginkgo Biloba extract on rat brain with cerebral ischemia/reperfusion.Methods Compared with ischemia/reperfusion group, Ginkgo Biloba extract-treated group was observed the change of ischemia and edema volume and NAA and lactate in by DWI and ~1H-MRS examination after cerebral ischemia /reperfusion 1 h,3 h,6 h. Results A significant reductions in infarct volume were found in the Ginkgo Biloba extract-treated group compared with the control group after cerebral ischemia 60 min/reperfusion 1 h,3 h,6 h. Ginkgo Biloba extract could decrease the concentration of Lac/(PCr+Cr) and prevent the decline of the concentration of NAA /(PCr+Cr) after cerebral ischemia/reperfusion, it had significantly difference compared with the control group(all P

Objective To explore the relationship between the amount of CD3+ T cells in gastric cardia carcinoma(GCC)samples and the clinical pathological index of GCC.Methods Immunohistochemical Elivision method was used to detect CD3+T cells in 42 cases of GCC samples,18 cases of paraneoplastic tissue and 12 cases of normal cardiac mucosa tissue.The relationship between CD3+ T cell and the clinical pathological index was analysed.Results(1)The order of the mean number of CD3+ T cells from high to low was paraneoplastic tissue,GCC and normal mucosa(P0.05).(3)The mean number of CD3+ T cells was negatively correlated with the depth of carcinoma invasion and the lymphatic metastisis(P

OBJECTIVETo evaluate the clinical effects of percutaneous pedicle screw fixation(PPSF) combined with percutaneous vertebroplasty(PVP) for the treatment of osteoporotic thoracolumbar fractures.

METHODSThe clinical data of 94 patients with osteoporotic thoracolumbar fractures treated from January 2014 to December 2015 were retrospectively analyzed. There were 31 males and 63 females, aged from 65 to 70 years old with an average of 67.2 years. Fracture level was T₁₁ on 15 cases, T₁₂ on 32 cases, L₁ on 29 cases and L₂ on 18 cases. The patients were divided into two groups according to different therapeutic methods. Percutaneous pedicle screw fixation combined with percutaneous vertebroplasty were applied in 43 patients(group A) and percutaneous vertebroplasty was applied to 51 patients(group B). Operation time, intraoperative blood loss, bone cement volume, postoperative in-bed time were recorded; preoperatively, 3 d, 1 year after the operation, the ratios of anterior border heights, sagittal Cobb angles, visual analogue scale(VAS) scores were compared between two groups. The condition of postoperative complication in two groups was analyzed.

RESULTSAll the patients were followed up for 12 to 24 months with an average of 18.5 months. Operation time of group A [(96.2±28.7) min] was longer than that of group B [(31.8±10.6) min]. Intraoperative blood loss of group A[(62.2±25.5) ml] was more than that of group B [(25.4±10.9) ml]. Bone cement volume of group A [(5.5±0.5) ml] was larger than that of group B [(4.9±1.1) ml]. Postoperative in-bed time of group A[(5.1±1.8) d] was longer than that of group B[(1.8±0.7) d]. There were significant differences in operation time, intraoperative blood loss, bone cement volume, postoperative in-bed time between two groups(<0.05). Three days, 12 months after the operation, the ratios of anterior border heights and Cobb angles in two groups were significantly improved. At final follow-up, the ratio of anterior border height and Cobb angle of group A[(85.6±3.5)%, (11.9±5.3)°] were better than of group B[(84.2±4.5)%, (15.3±3.4)°](<0.05). Three cases in group B had re-collapse of cemented vertebral bodies. Postoperative at 3 d, 1 year, VAS score of all patients had significantly decreased(<0.05), and there was no significant difference between two groups(>0.05).

CONCLUSIONSCompared to simple PVP, PPSF combined with PVP in treating osteoporotic thoracolumbar fracture can obtain stronger vertebral strength and stiffness, furthermore to improve vertebral reduced effect, keeping vertebral heights, and preventing vertebral re-collapse.

Aged ; Female ; Fracture Fixation, Internal ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Osteoporotic Fractures ; surgery ; Pedicle Screws ; Retrospective Studies ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; injuries ; surgery ; Treatment Outcome ; Vertebroplasty