Objective To study the safety and effect of ultrasound guided minimally invasive rotary cutting for treatment of benign breast lesions. Methods A single-center, prospective, randomized, controlled study method was used, 84 patients with breast benign lesions were randomly divided into observation group and control group, 42 patients in each group. Patients in the observation group were treated with ultrasound guided minimally invasive rotary cutting, patients in control group were treated with traditional surgery. The intraoperative and postoperative related indicators were compared between two groups. Results The intraoperative blood loss, length of incision, operation time in breast benign unilateral single and unilateral and bilateral lesions in the observation group were significantly less than those in the control group, with statistically significant difference (P<0.01) . The healing time, postoperative pain score, complications in breast benign unilateral single and unilateral and bilateral lesions in observation group were less than those in the control group, with statistically significant difference (P<0.01) . And the postoperative satisfaction, and the excellent rate of beauty in breast benign unilateral single、unilateral and bilateral lesions were better than control group, with statistically significant difference (P<0.01) . There was no breast deformation in observation group after treatment, and there were 3 patients of breast deformation in the control group has 3 patients, accounting for 7.14%. Conclusion Ultrasound guided minimally invasive rotary cutting is significantly superior to the traditional treatment in security and effectiveness for treatment of breast benign lesions in one single and unilateral multiple and bilateral lesions.

Objective To study the relation between coagulation-fibrinolysis and metastasis, hormone receptor and TNM stage of breast cancer. Methods The plasm levels of six coagulation-fibrinolysis indexes of 30 breast cancer patients were tested, which included activated partial thromboplastin time(APTT), fibrinogen(FIB), D-dimer(D-Di), tissue type plasminogen activator (t-PA)and plasminogen activator inhibitor-1(PAI-1). Statistic analysis of the relation between the changes of these indexes and metastasis, hormone receptor and breast cancer cell proliferation was performed. Results There were statistically significant differences between the malignant and benign breast disease in FiB(3.05±0.44)g/L vs(3.39±0.52)g/L(P＜0.05),D-Di(0.27±0.06)μg/ml vs(0.36±0.16)μg/ml(P＜0.05) and PAI-1(26.14±3.30)ng/ml vs(34.59±3.68)ng/ml (P＜0.01). The levels of plasma FIB (3.70±0.47)g/L and PAI-1 (37.36±2.71)ng/ml in metastasis group were higher than those in the non-metastasis group (P＜0.01). Significantly higher levels of PAI-1(36.40±3.57)ng/ml(P＜0.05)in expression of Ki67≥30% in the patients with lymph node involvement were seen. Conclusion Coagulation-fibrinolysis indexes were related to the proliferation, invasion, metastasis and clinical stage of breast cancer and it can serve as an important marker for predicting breast cancer's biological behavior and prognosis.

Eight-year program education is the heated topic in the field of medical education across the country.The system of eight-year program education can be discussed as a system,from the view of system philosophy.We analyzed beth internal relationships and external relationships connected to the system,so as to look upon the eight-year program education in its entirety.And then we discussed about the problems of epistemology and methodology on that basis.

Objective To study the lung protection of ambroxol in general thoracic surgery perioperation for the elderly.Methods Totally 130 hospitalized patients aged (65.1±4.3) years in our hospital during general thoracic surgery were randomly divided into two groups:ambroxol intervention(2 mg/kg,intravenous drip,once/d) and control groups (n=65 for each).The incidenceof pulmonary complications,changes of blood gas analysis before and after surgery and time of hospitalization were compared between the groups.Results The incidence of pulmonary complications was significantly lower in ambroxol intervention group than in control group (9.23％ vs.24.62％,P＜0.05).Blood gas analysis results before and after surgery were improved in ambroxol intervention group[PaO2:(61.32±8.65) mm Hg,(95.07±13.62)mm Hg; PaCO2:(44.15±5.52)mm Hg,(37.28±4.06)mm Hg] as compared with control group[PaO2:(62.11 ± 8.83) mm Hg,(80.37±10.46)mm Hg; PaCO2:(44.39±5.17) mm Hg,(40.73±4.51)mm Hg] (t=3.61,3.75,both P＜0.05).The time of hospitalization was shorter in ambroxol intervention group than in control group [(12.14±0.29) d vs.(15.85±0.62)d,t=3.41,P=0.036].Conclusions Perioperative use of ambroxol in general thoracic surgery in the elderly is worthy of clinical application because of reduction of pulmonary complications and shortness of hospital stay.

Objective To evaluate the efficacy and toxicity of navebine(NVB) given by continuous infusion plus cisplatin combination therapy in the treatment of advanced breast cancer.Methods 60 patients with advanced breast cancer were enrolled in this study.The type of his to pathologyis invasive ductal carcinoma.19 patients had no previous chemotherapy but 21 cases received chemotherapy containing ADM.26 patients had ≥2 metasta-ticsites.All the patients received vinorelbine according to the following doses chedule:10mg bolus followed by 10mg by continuous infusion over 24 hours every 5 days every 3 weeks.Results 60 patients were evaluable for response.A total of 131 cycles were administered.The lverall response rate was 41.6%(3 patients achieved a complete response and 22 patients achieved a partial response).The median over all survival was 35 weeks and the median duration of response was 19 weeks.The dose limiting toxicity was marrow-suppression.Neutropenia was in 43% patients(31% was grade Ⅲ and Ⅳ).Thrombo-cytopenia and anemia were mild.Conclusion A highe rsponse is obtained in advanced breast cancer treated by continuous intravenous NVB infusion with tolerable toxicity and deserve further revaluation.

Progress in the metacarpophalangealgeal joint implantation has drawn increasing attention to its role in treatment of chronic arthritis of the hand. This paper summarizes the biomechanic research and devolvement of the prosthesis, preoperative evaluation and plan for metacarpophalangealgeal joint implantation and the clinical results of different designs of the MCP prosthetic joint in the past decade. With improvement of prosthesis designs and operative technology, the MCP implantation will play a better role in clinical treatment of chronic arthritis of the hand, such as relief of pain, rectification of abnormality and functional recovery of the hand.

Objective To analyze risk factors for the perioperative heart failure following hip fracture surgery in the aged patients.Methods The present study included 186 elderly patients(≥ 65 years)who had received hip fracture surgery from August 2009 to Janurary 2014 in our department.Their clinical data were analyzed to define risk factors for perioperative heart failure.Results Factors significantly affecting the perioperative heart failure included age,gender,hypertension,time from injury to operation,general health before injury,pain score,perioperative blood transfusion,perioperative human serum albumin transfusion,fluid infusion during operation,perioperative balance between daily fluid intake and output,perioperative temperature changing and heart diseases.A multivariate Logistic regression analysis revealed that the independent risk factors for perioperative heart failure included general health before injury (OR =21.967,P=0.000),perioperative balance between daily fluid intake and output (OR =19.349,P =0.005),heart diseases (OR =6.009,P =0.006).Conclusions In aged patients undergoing hip fracture repair operations the independent risk factors for perioperative heart failure include general health before injury,perioperative balance between daily fluid intake and output,heart diseases.Perioperative risk assessment and prevention are the keys of better prognosis.

Objective To understand the cue-induced craving, physiological reactions to heroin-related cues, and to explore the factors that impact the cue-induced craving. Methods 369 abstinent heroin addicts were exposed to videotapes of heroin using and simulacrum after the self relaxation. The craving, abstinent symp-toms were measured before and after cue exposures. The physiological reactions were measured by multi-biofeed-back instrument before, during, and after cue exposure. BIS-Ⅱ questionnaire was used to collect information about their impulsive characteristic. Results After cue exposure, the self-reports scores of craving (t=11.24, P< 0.01), physiological index including heart rate((76.6±11.3) beats/min, F=19.23), skin conduct ((7.48± 4.25)μs, F=53.99), pupil size (t=11.73) had significant change in heroin addicts (P<0.01). Logistic regres-sion results showed that the scores of BIS-Ⅱ were related to cue-reduced craving (P=0.001,95% CI: 1.015～1. 065). Conclusions Exposure to drug-related cues can induces craving and physiological reactions in long term abstinence heroin addicts. High impulsive characteristic is a risk factor to induce drug-related craving. The inter-vention strategies should consider the impulsive characteristic and make a comprehensive intervention program to prevent relapse.

Objective To investigate the regulation of CCL22/CCR4 signaling on CD4 + CD25 + regulatory T cells (Tregs) and immune escape in hepatocellular carcinoma (HCC).Methods CCL22,interleukin-2 (IL-2),transforming growth factor-β (TGF-β),and interleukin-10 (IL-10) levels in tumor tissue of 30 HCC patients were determined by ELISA.Tumor infiltrating lymphocytes were isolated and assayed by flow cytometry to evaluate the change of CD4 + CD25 + Tregs in tumor tissue,and CCR4 in CD4 + CD25 +Tregs were detected.Results The CCL22 level in tumor tissue was obviously increased.The level of CCL22 in tumor tissue was (920.1-± 180.1)ng/L,which was significantly higher than that in non-tumor tissue [(227.2 ± 108.6) ng/L; P ＜ 0.05].The tumor infiltrating CD4 + CD25 + Tregs was obviously increased,reaching approximately to (13.3 ±4.0)％,and the CCR4 expression in CD4+ CD25 + Tregs increased to (8.8 ± 3.0) ％.Along with progression in clinical TNM staging,the levels of CD4 + CD25 + Tregs and CD4 + CD25 + CCR4 + Tregs in tumor tissue increased,and were correlated with the CCL22 level.IL-2 level in tumor tissue was decreased,but TGF-β and IL-10 levels were increased.HCC tissue can secrete a large amount of CCL22 that could recruit CD4 + CD25 + Tregs to tumor tissue by activating CCL22/CCR4 signaling.CD4 + CD25 + Tregs played an important role in the immune escape of HCC by releasing plenty of TGF-β and IL-10 and inhibiting IL-2 secretion.Conclusion This study validates CCL22/CCR4 as therapeutic targets in immunotherapy for HCC.

Objective To evaluate surgical resection combined with RFA and TACE for multiple hepatocellular carcinoma.Methods Between 2010 and 2013, 27 multiple hepatocellular carcinoma cases were treated with surgical resection combined with RFA and TACE.The clinical data and postoperative complications were observed.Results Left lateral lobectomy was performed in 4 patients, left hemihepatectomy was performed in 8 patients, right liver resection was performed in 3 patients, irregular right liver resection was performed in 12 patients.The operation time was (223 ± 77) min, The intraoperative bleeding was (435 ± 144) ml.There were not postoperative severe complications, such as hepatic hematoma, liver abscess, intraabdominal hemorrhage, liver failure.Unresected focus uderwent complete necrosis or liquefaction in the RFA regions as shown by CT scanning after 1 month in 24 patients.Postoperative, TACE was performed regularly in all the patients.Lipiodol deposition on the margin of RFA regions was found in 3 patients.After a year, new foci were found in 9 cases.Patients were followed-up from 8-39 months.The median survival time after operation was 26.3 months.The survival rates were 92％, 60％, 15％, respectively after 1, 2, 3 year.Conclusions For patients with multiple hepatocellular carcinoma, surgical resection combined with RFA and TACE was safe and effective.