The distant metastases is the major cause of death in patients with breast cancer.Metastasis of tumor cells is defined to be a series process including tumor cells shedding from the primary lesion,intruding and circulating in blood vessels,implantation into distant organs and developing into metastasis lesion,only complete the series process can eventually form a distant metastasis.Micrometastasis reters to exist in lymph nodes,peripheral blood and bone marrow,yet conventional testing method usually does not reveal it,the presence of tumor cells in blood called circulating tumor cells,and the tumor cells in bone marrow called disseminated tumor cells.In order to predict and prevent tumor spreading and acquire therapeutic strategy,many attempts are being made to detect small numbers of tumor cells that have shed from the primary lesions.This article presents the techniques used for disseminated tumor cells detection,clinical relevance and biological questions for the recent a few years.

Objective To investigate the risk factors for ischemic stroke in patients of Aba Tibetan and Qiang Autonomous Prefecture. Methods From March 2012 to March 2014,314 consecutive patients with ischemic stroke admitted to the Department of Neurology,Aba Tibetan and Qiang Autonomous Prefecture People′s Hospital,Sichuan Province were enrolled respectively. All patients were Tibetans. They were divided into either an observation group (n = 105)or a control group (n = 209)according to whether they had high-altitude polycythemia or not. The observation group was the patients with high-altitude polycythemia complicated with ischemic stroke,and the control group was the patients with ischemic stroke without high-altitude polycythemia. The risk factors for onset of stroke in both groups were compared,and the single factor indices with statistical significance were analyzed by multiple logistic regression analysis. Results There were significant differences in hypercholesteremia,history of heavy smoking,and family history of stroke between the observation group and the control group (χ2 values were 6. 489,8. 107,and 11. 206,respectively;P values were 0. 011,0. 004,and 0. 001,respectively). There were no significantly difference in other stroke risk factors between the 2 groups (all P > 0. 05). Multiple logistic regression analysis showed that hypercholesteremia,history of heavy smoking,and family history of stroke were the independent risk factors for high-altitude polycythemia complicated with ischemic stroke (hypercholester-emia:OR,4 . 799 ,95 % CI 1 . 266 - 3 . 148 ,P = 0 . 028;history of heavy smoking:OR,4 . 539 , 95 % CI 1. 061 -4. 182,P =0. 033;family history of stroke:OR,3. 549,95% CI 1. 279 -5. 377,P =0. 008). Conclusions Hypercholesteremia,history of heavy smoking,and family history of stroke,are the independent risk factors for ischemic stroke. The prevention of stroke in the local area should be targeted at the geograph-ical and population characteristics.

Patients on Porcelain-fused-to-metal restorations of vital teeth are increasingly year by year, this article mainly discusses the psychological characteristics of adult on porcelain-fused-to-metal restorations of vital teeth on the view of medical ethics.It is helpful to lighten patients’burden and complete treatment successfully by improving the qualities of dentists and giving patients psychological guidance.

Objective　To study the therapeutic effect of hepatic artery and portal vein dual perfusion chemotherapy (AVPC) combined with intratumoral injection of lipiodol-ethanol (ITILE) for unresectable primary hepatic carcinoma (PHC). Methods　138 pathologically proved and unresectable PHC cases were divided into two groups: Group A (80 cases), treated with AVPC through hypodermic implanted drug delivery pumps. Group B (58 cases), treated with AVPC plus ITILE. Results　　The secondary resection rate was 2.5% in group A, while 　 12.1% in group B, (P<0.05); The 0.5, 1, 2 years survival rate in group A was 56.3% 45.0% and 21.2%, in group B 81.0% 61.2% and 39.6% respectively. there were significent difference between two groups in 0.5,1,2 years survival rate respectively (P<0.05); the complication occurrence rate was found no significant difference between two groups (P>0.05). Conclusions　The therapeutic effect of AVPC plus ITILE for unresectable PHC is much better than that of AVPC alone.

Objective To observe the implementation of prevention and control measures for water quality improvement in drinking water type of fluorosis and arsenic poisoning areas,to investigate the operating condition of fluoride-safe water supply projects,and to comprehensively evaluate the project's quality and its effectiveness on water quality improvement.Methods According to the Shanxi Province Drinking Water-Borne Fluorosis and Arsenic Poisoning Fluoride-Safe Water Supply Projects Monitoring Programme,in October 2012-June 2013,45 counties in the province were selected to monitor fluorosis and arsenic poisoning.The running condition of fluoridesafe water supply projects was investigated.One factory water sample was collected to determine the water fluoride (arsenic) concentration.Meanwhile,3 tap water samples were collected to determine the water fluoride (arsenic)concentration in each village,using the Standards for Drinking Water Quality (GB/T 5750.5-2006).Results Totally 1 804 fluoride-safe water supply projects had been surveyed,and 1 673 were in normal condition,accounting for 92.7％.The number of projects supplying fluoride-safe water was 1 328,accounting for 73.6％,benefiting a population of 2.636 779 million people.A total of 2 277 villages were investigated,and 1 826 villages had fluoride-safe water,accounting for 80.2％ of the investigated villagcs.One hundred and forty-five arsenic-safe water supply projects in drinking water type of arsenic poisoning areas were investigated,and 138 were in normal condition,accounting for 95.2％.One hundred and forty-three arsenic-safe water supply projects were qualified,accounting for 98.6％,benefiting a population of 295 240 people.One hundred and fifty-nine villages in drinking water-borne arsenic poisoning areas were investigated,and 156 villages were qualified in water arsenic,accounting for 98.1％ of the investigated villages.Conclusions The qualified rate of fluoride-safe water supply projects is relatively low in drinking water type of fluorosis areas.It has not yet reached the national standard and the management of fluoride-safe water supply projects should be strengthened.The effect of arsenic-safe water supply projects on prevention of drinking water type of arsenic poisoning is significant.

BACKGROUND: To prepare a novel biological material that can be implanted into the lesion of bone tuberculosis, keep sustained release of anti-tuberculosis drugs around bone tuberculosis tissues for a long time, and enhance the effect on bone repair has become a hot spot for clinical studies on bone tuberculosis.OBJECTIVE: To prepare the adipose-derived mesenchymal stem cells (ADMSCs)/sustained-release rifampin-loaded microsphere complex, and to preliminarily study its effects in a rabbit model of spinal tuberculosis.METHODS: Rifampin-chitosan-calcium alginate sustained-release microspheres were synthesized, and co-cultured with ADMSCs to prepare an anti-tuberculosis composite for bone tissue engineering. Forty New Zealand rabbits were used to make lumbar L6 tuberculosis models. Thereafter, rat models were randomly divided into four groups and given rifampin by gavage in rifampin group, ADMSCs by paravertebral injection+rifampin by gavage in stem cell group, rifampin by gavage+implantation of the anti-tuberculosis composite material in experimental group, and no treatment in control group.The duration time of rifampin administration was 8 weeks. The anti-tuberculosis effect of the composite material was evaluated by X-ray and CT scanning observation.RESULTS AND CONCLUSION: In the control group, obvious damage to lumbar vertebrae L5 and L6 was apparent; inflammatory granulation tissues formed; and the intervertebral space was narrowed. In addition, two rabbits in the control group showed obvious kyphotic deformity and five showed pasoas major swelling with low-density dark region in the psoas muscle. In the rifampin group, there were five rabbits with moderate damage of the lumbar vertebrae L5 and L6,and two rabbits with pasoas major swelling. In the stem cell group, there were two rabbits with moderate damage of the lumbar vertebrae L5 and L6, three rabbits with mild damage of the upper part of the lumbar vertebra L6, and three rabbits with pasoas major swelling. In the experimental group, only four rabbits suffered from mild damage of the upper part of the lumbar vertebra L6 but with no changes in the intervertebral space between the L5 and L6, and without pasoas major swelling. These results indicate that the composite material of ADMSCs combined with sustained-release rifampin-loaded microspheres can inhibit mycobacterial growth effectively, and reduce vertebral bone destruction,thereby giving some therapeutic actions for the animal models with spinal tuberculosis.

Objective To study the etiology of severe acute pancreatitis (SAP) in Tibetan population at high altitude area.Methods Data of patients with acute pancreatitis (AP) from January 2013 to January 2016 were retrospectively collected.Tibetan and Han patients were selected.According to AP diagnosis criteria, the patients were divided into SAP and non-severe acute pancreatitis (NSAP).Chi square test and multiple Logistic regression analysis were used for data analysis.Results There were 53 Tibetan SAP patients, 98 Tibetan NSAP patients, and 47 Han SAP patients.The results of etiology analysis indicated that the ratios of biliary diseases caused pancreatitis in Tibetan SAP patients, Tibetan NSAP patients and Han SAP patients were 5.7% (3/53), 51.0% (50/98) and 6.4% (3/47), respectively;those alcohol caused pancreatitis were 39.6% (21/53), 10.2% (10/98) and 34.0% (16/47), respectively;those hyperlipidemia caused pancreatitis were 39.6% (21/53), 9.2% (9/98) and 40.4% (19/47), respectively;those drug caused pancreatitis were 1.9% (1/53), 2.0% (2/98) and 2.1% (1/47), respectively;those infection caused pancreatitis were 1.9%(1/53), 6.1%(6/98) and 2.1%(1/47), respectively;those trauma caused pancreatitis were 1.9%(1/53), 5.1%(5/98) and 2.1%(1/47), respectively;those other reasons were 3.8% (2/53), 13.3% (13/98) and 4.3% (2/47), respectively;and those unexplained pancreatitis were 5.7% (3/53), 3.1% (3/98) and 8.5% (4/47), respectively.The ratio of biliary diseases caused pancreatitis in Tibetan SAP patients was lower than that of Tibetan NSAP patients (5.7%, 3/53 vs 51.0%, 50/98), however the ratios of alcohol and hyperlipidemia higher than those of Tibetan NSAP patients (39.6%, 21/53 vs 10.2%, 10/98;39.6%,21/53 vs 9.2%, 9/98), and the differences were statistically significant (x2=31.069, 18.246 and 20.019, all P<0.01).Biliary disease was the independent etiology of NSAP in Tibetan (odd ratios (OR)=20.668, 95% confidence interval (CI) 5.072 to 59.427, P<0.01), but alcohol (OR=16.007, 95%CI 3.700 to 45.654) and hyperlipidemia disease (OR=11.590, 95%CI 2.581 to 33.859) were the independent etiologies of SAP (both P<0.01).There was no statistically significant difference in etiology of SAP between Tibetan and Han (P>0.05).Conclusion The etiology of SAP in high altitude Tibetan people is different from that of NSAP, however there is no difference in etiology of SAP between Tibetan and Han in the same area.

Objective To study and evaluate the therapeutic safety and effect of frequency-doubled-double-pulse laser(FREDDY)lithotripsy for treating upper urinary calculi combined with acute renal failure.Methods The clinical data of 32 cases treated by frequency-doubled-double-pulse laser(FREDDY)lithotripsy were retrospectively analyzed.Results After the operation the serum BUN and Cr levels in the patients got close or returned to normal and the free rate of the stones was up to 90.6%(29/32).Conclusions The ureteroscopic frequency-doubled-double-pulse laser(FREDDY)lithotripsy has the advantage of safety,high efficiency and less trauma for treating the upper urinary tract obstruction combined with acute renal failure.It can also deal with the bilateral ureteral stones at one time.It can be the first choice when the condition is proper.

As an exposing part of the human body,facial surface is easy to be injured in our daily lives.With the increase of living standards,the patients have an ever more urgent require for aesthetic treatment for the medical and plastic surgical treatment for the exposing parts of body,especially for the facial surface.But we found in the clinical work some aesthetic treatment were not satisfying,and some patients even needed a second restitution.We have analyzed the reasons for this phenomenon and proposed some corresponding solving methods.

This article mainly discusses the psychological characteristics of patients in orthodontic practice on the view of medical ethics. To achieve good relationship and cooperation between doctors and patients, be helpful to lighten patients' burden and to complete treatment successfully by strengthening the ethical education on orthodontic doctors and right education on patients and giving psychological guidance.