Neoadjuvant or preoperative chemotherapy (NAC) is the use of chemotherapy to treat a cancerous tumor before surgery. With this chemotherapy, the pathologic complete response and survival rate could be extensive improved, and it make possible to perform breast-conserving surgery successfully. The evaluating methods of response to NAC in breast cancer has been discussed widely,this review presents the evaluation methods of response to NAC for patients with breast cancer.

Objective To explore the relationship between mean platelet volume(MPV),blood fibrinogen(Fg)level and carotid atherosclerosis in patients with cerebral infarction.Methods 50 patients with cerebral infarction were selected as the research objects,and divided into the carotid atherosclerosis group and without carotid atherosclerosis group depending on whether carotid atherosclerosis,each group 25 cases.The MPV and plasma Fg of the two groups were detected and compared.Results The levels of MPV and blood fibrinogen in the carotid atherosclerosis group[(12.99±1.45)fl,(4.59±1.05)g/L]were higher than those without carotid atherosclerosis group[(11.01±1.21)fl,(3.05±0.51)g/L](t=4.212,-0.387,P=0.000,0.001).Conclusion The relationship between MPV,Fg levels and carotid atherosclerosis in patients with cerebral infarction is close.

Objective To investigate the complication and its treatment method of the percutaneous nephrolithotomy(PCNL).Methods The clinical data of 137 patients with PCNL,were retrospectively analyzed statistical analysis of complications.Results In 137 cases of PCNL,83 cases were male,54 cases were female; 103 cases of kidney stones,ureteral calculi in 34 cases,including 24 cases of ureteral calculi with renal calculi.All patients were cured,no patients died;complications occurred in 9 cases,in which the puncture failure in 1 case,renal hemorrhage in 5 cases,postoperative arteriovenous fistula in 1 case,infection in 2 cases.Conclusion PCNL is minimally invasive,effective,but still had more serious complications.We should strengthen the prevention and cure measures.

Alpha-fetoprotein (AFP) was first discovered over 50 years ago, and is currently applied clinically in diagnosis, effects evaluation and relapse judgement of tumors especially for the primary hepatocellular carcinomas.And as an effective tumor marker, AFP test has become one of the essential items in physical examination.However, its clinical application is not limited to primary hepatocellular carcinomas,and its great application value has been proved in many benign diseases and other tumors (non-hepatic carcinomas).

The incidence of gastroesophageal junction cancers is rapidly increasing, the Year' s upwards rate being more than 5％ ～ 10％. Siewert in 1987 proposed a definition for adenocarcinoma of the esophagogastric junction (AEG), as a adenocarcinoma within 5 cm of the gastroesophageal junction (GEJ), and divided AEG in to three types. The majority of patients with AEG in Asian countries have type Ⅱ and Ⅲ cancers, and no obvious differences have been reported in 5-year survival rates between patients with different types of AEG. In contrast, in western countries, the distribution of each type of AEG is nearly equal,patients with AEG type Ⅰ cancer have the best prognosis, whereas the overall survival of patients with type Ⅲ cancer is the worst. Now people presume that the AEG is a special type of carcinoma which is not same as carcinoma of esophagus and stomach. The surgical routes and operative methods and the extent of lymph node dissection of AEG are still not completely clear, and AEG lacks also a independent TNM system for itself. We will summarize the actuality of diagnosis and therapy of AEG.

Objective To summarize the endoscopic characteristics of Primary Gastrointestinal Malignant Lymphoma (PGIML) and increase the diagnostic accuracy of this method to aid the clinical treatment.Methods The clinical data of 67cases with PGIML from 2004 to 2009 were studied retrospectively.ResultsPGIML lacked specific clinical symptoms.The main clinical symptoms were abdominal pain, melena and abdominal mass.In our study, most PGIML(37/67,55.8％)were detected in stomach.Nodular appearance of mucosal surface was the most common endoscopic finding.The positive rate of endoscopic biopsy for the diagnosis of PGIML was 68.7 ％ (46/67 biopsy cases).All cases had Non-Hogkin Lymphoma (NHL).The most common immunophenotype was B-cell majority (50/67).Thirty cases had MALT.ConclusionIt is hard to diagnose PGIML at early stage,combination of various diagnosis tests should be considered to solve this problem.The effectiveness of surgery on PGIML should be further confirmed by prospective randomized clinical trials.

Objective To explore the changes of the serum matrix metalloproteinase 9(MMP-9) in coronary artery bypass grafting(CABG) under cardiopulmonary bypass (CPB) and the correlations between the serum MMP-9 and tumor necrosis factor alpha (TNF-α),interleukin 8 (IL-8).Methods Twenty-two patients who subjected to CABG were selected.Artery blood samples were collected at the following time points:before intubation (T0),15 min after initiation of CPB (T1),the end of operation (T2),2 h after operation (T3) and 6 h after operation(T4).The serum MMP-9,TNF-α and IL-8 levels were detected by ELISA and analyzed.Results The serum MMP-9 levels at T1,T2,T3 and T4 were (102.82 ± 19.03),( 428.80 ± 32.91 ),( 305.64 ± 29.75 ),( 157.78 ± 22.18 ) μg/L,respectively,which were significantly higher than that at To [ (38.67 ± 10.15 ) μ g/L] (P ＜ 0.05 ).The serum MMP-9 level gradually increased during CPB and reached the peak at T2,and then decreased.The serum TNF- α and IL-8 levels had the same change as MMP-9,the peak levels at T2 were (287.06 ±24.58),(143.12 ± 16.36) ng/L,respectively.The serum MMP-9 level had positive correlation with TNF- α and IL-8 levels ( r =0.69,0.54,P ＜ 0.05 ).Conclusions CPB can lead to the increased release of MMP-9,TNF-α and IL-8.TNF-α and IL-8 may induce the activation and release of MMP-9.The serum MMP-9 can contribute to the general inflammatory reaction of CPB.

Objective To evaluate the effect and safety ofotoscopic myringoplasty and microscopic myringoplasty.Methods PubMed,CNKI,VIP database and Wanfang database were searched to identify citations mentioned otoscopic myringoplasty or microscopic myringoplasty.In addition,manual collection of clinical study of related reviews and its references were also conducted.Inclusion criteria of the ordinance made Meta analysis.Results A total of 15 clinical studies with 915 patients (otoscopic group was in 691patients and microscope group was in 224 patients) was identified.According to Q test,there was no heterogeneity between 2 groups (I2 =0),all computed by fixed effects model.Meta analysis demonstrated that there was no significant difference between 2 groups on the type of perforation (OR =1.00,95％ CI:0.70-1.42,P =0.13).Both curable rate and enhance of air conduction had no significant difference between 2groups (OR =0.97,95％ CI:0.72-1.29,P=0.97;OR =1.14,95％ CI:0.68-1.91,P=0.96).The curable rate in otoscopic group was 0.92 (95％ CI:0.90-0.94),and the complication rate was 0.030 (95％ CI:0.009-0.051).Conclusions The available clinical evidence shows that there is no significant difference between otoscopic myringoplasty and microscopic myringoplasty.However,otoscopic myringoplasty should be recommended to perform in clinical practice because of the feasible and convenient procedure.

Objective To study the effects of different postoperative analgesia on the postoperative stress and cellular immune function in patients undergoing total hysterectomy.Methods Seventy-five patients undergoing total hysterectomy were divided into three groups by table of random digit with 25 cases each:morphine patient controlled epidural analgesia (PCEA) group (group A),tramadol PCEA group (group B) and butorphanol tartrate preemptive analgesia combined with tramadol PCEA group (group C).Peripheral venous blood samples were taken before anesthesia,the end of operation,1 and 3 d after operation for the serum levels of cortisol,norepinephrine (NE),epinephrine (E) and T-lymphocyte subsets (CD4+,CD8+).Results The serum levels of cortisol at the end of operation and 1,3 d after operation in group A and B had significant difference compared with those before anesthesia (P ＜ 0.05),the serum level of cortisol at 1d after operation in group C had significant difference compared with that before anesthesia (P ＜ 0.05).Compared with those before anesthesia,in the 3 groups,there were significant differences in the serum levels of E at the end of operation and 1 d after operation and the serum levels of NE at the end of operation and 1,3 d after operation (P ＜0.05).Compared with the same time of group A and B,there were significant differences in the serum levels of cortisol and E at 1 d after operation and the serum levels of NE at 1,3 d after operation in group C (P ＜ 0.05).CD4+,CD4+/CD8+ at the end of operation and 1,3 d after operation in 3 groups were significantly lower than those before anesthesia (group A:0.266 ±0.034,0.226 ±0.029,0.256 ±0.031 vs.0.313 ±0.030 and 1.3 ±0.3,1.0 ±0.1,1.1 ±0.2 vs.1.5 ±0.2,group B:0.271 ±0.031,0.242 ± 0.027,0.261 ± 0.030 vs.0.311 ± 0.034 and 1.3 ± 0.2,1.1 ± 0.1,1.2 ± 0.1 vs.1.5 ± 0.1,group C:0.282 ±0.036,0.276 ±0.030,0.290 ±0.028 vs.0.314 ±0.032 and 1.4 ±0.2,1.3 ±0.1,1.4 ±0.1 vs.1.5 ± 0.2,P ＜ 0.05).There were significant difference in CD4+ and CD4+/CD8+ 1,3 d after operation of group C than those of group A and B (P＜ 0.05).There was no significant difference in CD8+ among the 3 groups (P＞0.05).Conclusion Butorphanol tartrate preemptive analgesia combined with tramadol PCEA may reduce postoperative stress response and immune depress,compared with only morphine or tramadol PCEA.

Objective:To discusse some questions and solve method on microecological in the market at present,to uppraised the form and pharmacologic effect.Methods:To gather the directions related to content for clinical often to used preparations.Results:It hasn't unitary standard and expression on every microecological,the effect is close related to the form. The importance of pharmacologic effect is health care and regalating.Conclusion:It must have a quality standard and expression on microecological.