Objective To evaluate the results of prosthesis augmentation,relieve suffering patient experience,improve shape and touch of breast.Methods According to design,in dual-plane mammaplasty transaxillary approach with endoscopic assistance,we used soft-tissue expansion before prosthesis,saline volume in expander was the same as prosthesis size at beginning; adjusting expander volume and position,then determined prosthesis size according to expander volume lastly.after intraoperative sustained expansion for 30 to 60 minutes twice prosthes volume,replace expander with prosthesis.Results This method was applied in 120 patients,showing that pain significantly reduced after expansive without use of analgesia pump; complications included that 3 patients appeared seroma and absorbed soon; 2 patients had poor prosthese location,which was adjusted in reoperation; one capsular contracture was repaired later.After 6-months to 2-years follow-up,the results showed that breast was nature and dynamic; satisfactory rate reached to 95 ％.Conclusions In augmentation mammaplastic operation,pre-adoption of an expander can make it easy to adjust the location of prosthesis,to avoid being injured and to determine prosthesis volume by expander injection of saline volume,especially for patient with different size of both breasts.

OBJECTIVE: To investigate the effects of different concentrations of curcumin on secretion of adiponectin (APN) and interleukin-6 (IL-6) in human adipose tissues cultivated in vitro. METHODS: Seven male patients with kidney stones were admitted. Abdominal subcutaneous adipose tissue and perirenal adipose tissue were collected from the operating-patients, and were cultivated with different concentrations of curcumin (10 and 100 microg/ml) in vitro. The contents of APN and IL-6 in the culture medium of adipose tissue cells were measured by enzyme-linked immunosorbent assay (ELISA) after they were cultured for 6 and 24 hours. RESULTS: Compared with the blank control group, the content of APN in the adipose tissue culture medium was increased by 100 microg/ml curcumin (P<0.05) after 6-hour culture, and the content of IL-6 was significantly decreased by 100 microg/ml curcumin after 6- and 24-hour culture (P<0.05). CONCLUSION: 100 microg/ml curcumin can increase APN secretion and decrease IL-6 secretion in human adipose tissues cultivated in vitro.

Objective To elucidate whether taking Ⅱ b/Ⅲ a receptor antagonist instead of oral antiplatelet drugs during perioperative in patients with drug-eluting stent implantation undergoing non-cardiac surgery would play a preventive role of stent thrombosis,without increasing surgical bleeding.Methods Six patients aged 60 -75 years old with drug-eluting stent implantation within 1 year taking dual antiplatelet drugs without any chest pain,and whose heart function classification for two (NYHA) were enrolled.They underwent surgical treatment due to ineffective conservative treatment of surgical disease,5 days before surgery intravenous infusion tirofiban 0.1 μg/( kg · min) micro pumps continuously instead of oral dual antiplatelet drugs,2 hours before surgery stop tirofiban and re-application of tirofiban 0.1 μg/( kg · rain) after surgery in the intensive care unit,and replacing tirofiban with oral dual antiplatelet as soon as possible according to the situation.Analyze cardiovascular events,especially stent thrombosis events and seriously bleeding,tirofiban adverse drug events during perioperative.Results Six patients have no perioperative malignant ischemic ventricular arrhythmia,angina,myocardial infarction,sudden cardiac death,no massive bleeding and adverse drug reactions.Conclusion Substitution of oral dual antiplatelet drugs for Ⅱ b/Ⅲ a receptor antagonists to prevent stent thrombosis treatment during perioperative in patients with drug-eluting stent implantation undergoing non=cardiac surgery may be feasible and safe,but needs to be further confirmed through large sample of randomly controlled trials.

Objective:To evaluate the safety and efficacy of antiplatelet therapy of ticagrelor on patients suffering from acute ST segment elevation myocardial infarction undergoing primary percutaneous coronary in-tervention. Methods:In the study, 96 patients suffering from acute ST segment elevation myocardial infarction onset within 12 h undergoing primary percutaneous coronary intervention from May to October in 2013 were randomly divided into ticagrelor group (n=48) and clopidogrel group (n=48) by using the method of random number table. Ticagrelor and clopidogrel antiplatelet treatment were used before and after operation. Their baseline data, coronary artery disease characteristics, platelet count, adenosine diphosphate(ADP)-induced platelet inhibition rate by thrombelastograph after 5 days of treatment, the major adverse cardiovascular events of the follow up for 6 months and bleeding complications were observed and compared in the two groups. Re-sults:The differences between the two groups of patients with their baseline data, the features of coronary ar-tery lesions, platelet count before and after 5 days of treatment had no statistical significance (P>0. 05). ADP induced platelet inhibition rate [(80. 2 ± 10. 7)%] after 5 days of treatment in ticagrelor group was sig-nificantly higher than that in clopidogrel group [(75. 3 ± 12. 1)%, P<0. 05]. The two groups of patients were followed up for 6 months, 8 cases of major adverse cardiovascular events occurred in clopidogrel group, 2 ca-ses of major adverse cardiovascular events occurred in ticagrelor group, and there was significant difference between the two groups (P<0. 05). The two groups (7 cases of 48 patients in ticagrelor group vs. 3 cases of 48 patients in clopidogrel group ) had no statistically significant difference in bleeding complications ( P>0. 05). Conclusion: Antiplatelet therapy of ticagrelor on patients suffering from acute ST segment elevation myocardial infarction undergoing emergency PCI has good efficacy and safety.

Adult ; Diagnosis, Differential ; Endometriosis ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; pathology ; Lumbar Vertebrae ; pathology ; Magnetic Resonance Imaging ; Spinal Canal ; pathology ; surgery ; Spinal Diseases ; pathology ; surgery

Background: Early diagnosis and staging of liver fibrosis are important for the prognosis and evaluating the survival of patients.Aims: To systematically assess the diagnostic value of transient elastography (TE) for staging of liver fibrosis in patients with chronic liver disease.Methods: PubMed,Embase,Cochrane Library,CNKI,Wanfang and VIP from Jan.2001 to Dec.2015 were retrieved to collect the articles with staging of liver fibrosis in patients with chronic liver disease by TE.Data extraction was conducted.Article quality was evaluated by quality assessment of diagnostic accuracy studies 2 (QUADAS2).Meta-analysis was conducted by Stata 12.0 software.Results: Twenty articles involving 5 748 patients were included.Meta-analysis showed that the combined sensitivity,specificity and AUC of TE for diagnosing significant fibrosis (≥F2) were 0.78 (95％ CI: 0.73-0.82),0.85 (95％ CI: 0.80-0.88) and 0.88 (95％ CI: 0.85-0.91),respectively.The combined sensitivity,specificity and AUC for advanced fibrosis (≥F3) were 0.89 (95％ CI: 0.86-0.91),0.88 (95％ CI: 0.85-0.91) and 0.94 (95％ CI: 0.92-0.96),respectively.The combined sensitivity,specificity and AUC for cirrhosis (F4) were 0.91 (95％ CI: 0.86-0.95),0.89 (95％ CI: 0.87-0.92) and 0.95 (95％ CI: 0.93-0.97),respectively.Conclusions: TE technique has a good diagnostic value in assessing significant fibrosis,advanced fibrosis and cirrhosis in patients with chronic liver disease,especially for advanced fibrosis and cirrhosis.

Objective To observe the formation of the biofilm in endotracheal tubes,the characteris-tics of etiology, drug resistance and relationship between the biofilm and ventilator-associated pneumonia ( VAP) . Methods A total of 60 cases of ventilated children patients whose mechanical ventilation time were≥48 h in the ICU from September 2010 to September 2012,according to the mechanical ventilation time,all cases were divided into 2 to 6 d group,7 to 14 d group and ≥15 d group. The incidence of VAP, biofilm structure under the electron microscope,etiology culture positive rate of the lower airway secretions and bio-film,etiological characteristics and drug resistance were prospectively studied. Results ( 1 ) A total of 19 cases occurred VAP in 60 cases of mechanical ventilation,the incidence of VAP was 31. 7%. (2) Observed by electron microscope,biofilm had formed in the endotracheal tube inner wall in early period of mechanical ventilation. With prolonged mechanical ventilation,biofilm structure had improved,as well as VAP incidence rate from 9. 1%(2 to 6 d group ) increased to 44. 4%(7 to 14 d group) and 88. 9%(≥15 d group). (3) A large number of pathogenic bacteria colonized in the biofilm. Gram-negative bacilli were dominate and drug resistance was high. (4) With prolonged mechanical ventilation,the cultured pathogens from the lower airway secretions and biofilm converged. Conclusion Biofilm could form in the endotracheal tube with mechanical ventilation patients,and is associated with the occurrence of VAP and refractory infections.

Objective To explore clinical characteristic of metal-on-metal hip joint prosthesis with large heads(ASRTMXL).Methods Total hip arthroplasty(THA)with ASRTMXL was performed in 14 patients including two with ankylosing spondylitis combined with hip amalgamation,three with avascular necrosis,two with secondary osteoarthritis and seven with femoral neck fractures.Based on shortterm follow-up results,we analyzed its design characteristic and clinical properties.Results All patients walked with crotches one week after operation and began weight bearing without support six weeks later.An improvement was seen on the average range of motion of the hip including anteflexion,retroextension,internal rotation,external rotation,adduction and abduction.The mean Harris score was increased from precperative 30 points(13-50 points)to postoperative 90 points(75-100 points),with statistical difference.Postoperative X-ray showed right positions of the prostheses,normal abduction angle and anteversion angle,without complications cccurred.Condusion Short-term follow-up results show that metal-on-metal hip joint prosthesis with large heads has advantages of lower wearing,large range of motion,few dislocation and small deformation of acetabular cup.

OBJECTIVETo explore the correlation of the gene polymorphisms of Toll-like receptor 2 ( TLR2) and TLR4 with the susceptibility and recurrence of condyloma acuminatum (CA).

METHODSUsing Snapshot, we detected the gene polymorphisms of TLR2 597(T/C), 1350(T/C), 15607(A/G), and 2258(G/A) and TLR4 896(A/G) and 1196(C/T) in the peripheral blood of 140 CA patients and 105 HPV-negative controls. We made comparisons between the CA patients and controls as well as between the cases of recurrent CA and those of non-recurrence at 6 months after treatment.

RESULTSThere were 72, 48, and 20 cases of genotype TT, TC, and CC of TLR2 597 (T/C), respectively, in the CA patients, as compared with 71, 31, and 3 cases in the controls. The gene frequency of mutant C was 31. 43% in the patients, significantly higher than 17.62% in the controls (χ2 = 12.04, P < 0.01), and it was 38.68% in the recurrent cases, remarkably higher than 27.01% in the non-recurrent cases (χ2 = 4.16, P < 0.05). There were 74, 49, and 17 cases of genotype TT, TC, and CC of TLR2 1350( T/C), respectively, in the CA patients, as compared with 73, 29, and 3 cases in the controls. The gene frequency of mutant C was 29. 64% in the patients, significantly higher than 16. 67% in the controls (χ2 =11.05, P < 0.01), and it was 36.79% in the recurrent cases, markedly higher than 25. 29% in the non-recurrent cases (χ2 = 4.18, P < 0.05). There were 44, 66, and 30 cases of genotype AA, AG, and GG of TLR2 15607(A/G), respectively, in the CA patients, as compared with 26, 58, and 21 cases in the controls. There was no significant difference in the gene frequencies of mutant G between the two groups (χ2 = 0.33, P > 0.05). No mutant genes of TLR2 2508 (G/A) or TLR4 896(A/G) and 1196(C/ T) were detected in either the CA patients or the controls. Linkage disequilibrium analysis showed a tight linkage between TLR2 597 (T/C) and 1350(T/C) (D' = 1, r2 = 0.93).

CONCLUSIONTLR2 597(T/C) is tightly linked to 1350(T/C), which is correlated with both the susceptibility and the recurrence of condyloma acuminatum.

Aged ; Case-Control Studies ; Condylomata Acuminata ; genetics ; Gene Frequency ; Genetic Linkage ; Genetic Predisposition to Disease ; Genotype ; Humans ; Polymorphism, Genetic ; Recurrence ; Toll-Like Receptor 2 ; genetics ; Toll-Like Receptor 4 ; genetics

Objective To assess the potential clinical signiifcance of myocardial composite index (MCI) in the evaluation of left ventricular myocardial function in breast cancer patients with postoperative chemotherapy by speckle tracking echocardiography (STE). Methods A total of 33 consecutive breast cancer patients with postoperative chemotherapy were prospectively enrolled in Shanghai East Hospital, Tongji University, from February 2012 to February 2013. Thirty-six female healthy volunteers were enrolled as the controls. Routine echocardiographic parameters [left ventricular end diastolic volume (EDV), end systolic volume (ESV), interventricular septum thickness at diastole (IVSTd), left ventricular posterior wall thickness (PWTd) and left ventricular ejection fraction (LVEF)] were obtained. EDV and ESV were corrected for body surface area, and then end diastolic volume index (EDVI) and end-systolic volume index (ESVI) were calculated. STE-derived parameters [left ventricular global longitudinal strain (GLS), global radial strain (GRS), left ventricular twist (LVtw) and myocardial composite index (MCI)] were evaluated. All above data were obtained after 5 anthracycline-based chemotherapeutic cycles and compared with baseline measurements in controls respectively. Receiver operating characteristic (ROC) curves were constructed to determine optimal sensitivity and specificity of continuous variables for the prediction of future cardiotoxicity. Results (1)Changes in EDV, ESV, IVSTd, PWTd and LVEF showed no significant decreases compared with baseline and controls (F=1.35, 2.04, 1.28, 2.34, 2.16, P > 0.05 for all), while the changes in ESVI and EDVI showed statistically decreases (F=4.73, 6.86, P < 0.05 for all);(2)The changes in EDVI and ESVI showed signiifcant decreases compared with baseline (t=6.10, 5.13, P<0.05 for all) and controls (t=5.26, 4.24, P<0.05 respectively);(3)The change in GRS showed no statistical signiifcance compared with baseline and controls (F=1.23, P>0.05), while change in GLS, LVtw and MCI showed statistical significances compared with baseline and controls (F=4.29, 5.02, 12.35, P<0.05 for all);(4)The changes in GLS, LVtw and MCI showed signiifcant decreases compared with baseline (t=5.33, 13.94, P<0.05 respectively) and controls (t=4.97, 4.46, 7.18, P<0.05 all);(5)The area under receiver operating characteristics curve (AUC) of MCI was 0.894, and its optimal cut-off value was-265.7 (%×degree) with sensitivity of 82.6%and specificity of 78.7%. Conclusion MCI based on STE, combining myocardial strain and cardiac twist, may be an accurate predictor in identifying potential cardiotoxicity in postoperative chemotherapeutic survivors with breast cancer.