Objective To review the recent studies about sentinel lymph node biopsy in breast cancer. Methods The literatures in recent years on the history, concept, technique and clinical application of sentinel lymph node biopsy were reviewed and summarized.Results There was no unified method for sentinel lymph node biopsy. There was a wide range of detection rate and false negative rate.Conclusion Prospective multi center random clinical trials will help to evaluate the clinical application of sentinel lymph node biopsy.

Objective To investigate the therapeutic effect of Shenmai injection(SMI)on neonatal hypoxic-ischemic encephalopathy(HIE)and it's possible mechanism.Methods 45 neonates with HIE were randomly divided into the SMI treatment group and routine treatment group.At the basic of routine treatment,the SMI treatment group was treated with 10 ml SMI added into 10% GS 30~50 ml via injecting into veins once a day for 7~10 d.The levels of serum S-100?,NSE were measured at 1 d,3 d,6 d after treatment.The development quotients(DQ)was evaluated at 3-month-old infants.Results Compared with routine treatment group,symptoms of nervous system in SMI treatment group were recovered obviously faster,the hospitalization time was shorter(all P

BACKGROUND: Nowadays, it is reported that vessel structural abnormity is the main morphological basis of vertigo due to vertebrobasilar arterial insufficiency abroad, but the report of vascular structural abnormality in vertebrobasilar arterial insufficiency is rare at home.OBJECTIVE: To observe the manifestation and clinical significance of vessel structural abnormity tested by digital substraction angiography (DSA)in patients with vertigo induced by vertebrobasilar arterial insufficiency.DESIGN: Case analysis.SETTING: Department of Neurology, Wuxi Second Hospital (Wuxi Municipal Second People's Hospital) Affiliated to Nanjing Medical University and Department of Neurology, Huaihua Hospital Affiliated to Nanhua University.PARTICIPANTS: A total of 57 patients, who were diagnosed as having episodic vertigo with or without nausea or vomiting, and hospitalized in the Department of Neurology, Huaihua Hospital Affiliated to Nanhua University from August 2003 to May 2004 and Wuxi Second Hospital (Wuxi Municipal Second People's Hospital) Affiliated to Nanjing Medical University between October 2004 and May 2005, were enrolled.METHODS: Fifty-seven patients with vertigo induced by vertebrobasilar arterial insufficiency hospitalized in the recent two years were treated with digital subtraction radiography in aortic arch and aortocranial angiography:Applying retrograde angiography of femoral artery puncture, Optiray nonionic contrast agent with syringe pattern to perform aortic arch angiography. Digital subtraction machine displayed bilateral carotid artery, vertebral artery, ranged from carotid artery to siphon of carotid artery from multiple angles. Measurement and evaluation were conducted by 2 doctors from department of neurology.MAIN OUTCOME MEASURES: Type, distribution and proportion of vesselstructural abnormity of aortic arch, carotid artery and vertebrobasilar system.RESULTS: Of the 57 patients, 1 patient was dropped out, because the left vertebral artery (LVA) could not be entered. A large area cerebral infarction was occurred in another patients during aortic arch angiography was performed, and the operation was stopped. Totally 55 patients were involved in the result analysis. It was found that 71%(39/55) of patients had vessel structural abnormity in cervical part and intracalvarium, 11%(6/55)of patients with simple anterior circulation lesion, 60% (33/55) of patients with posterior circulation lesion, of which 9 cases (16%) with compound lesion of anterior circulation abnormity. Two or above vessels in 24 cases (24/55,44%) were involved. Vertebral artery complicated with other angiostegnosis was the most common, and there was no vessel structural abnormity in other 16 cases (16/55,29%).CONCLUSION: Various types of vessel structural abnormity are the main etiological factors of vertigo induced by vertebrobasilar arterial insufficiency. Gold standard of diagnosing vertigo due to vertebrobasilar arterial insufficiency is DSA.

Objective:To observe the clinical effect of acupuncture combined with tuina manipulation for thoracic facet joint disorder. Methods:A total of 93 eligible cases were randomly allocated into an observation group and a control group. Patients in the observation group (n=46) were treated with acupuncture combined with tuina manipulation, whereas patients in the control group (n=47) were treated with tuina manipulation alone. The treatment was done once a day, for a total of 3 times. Therapeutic efficacies were then evaluated according to scores on signs and symptoms.
Results:After treatment, there were intra-group statistically significant differences in scores of eight signs and symptoms (all P<0.01); and the between-group differences were statistically significant in scores of eight signs and symptoms (all P<0.05). After three times of treatment, the recovery rate in the observation group was 54.4%, versus 25.4% in the control group, showing a statistical significance (P<0.05).
Conclusion:Acupuncture combined with tuina manipulation can obtain better effects than tuina manipulation alone for thoracic facet joint disorder and is therefore worth further clinical application.

Objective To evaluate the diffuse characteristics of two types of botulinum toxin type A (BOTOX and CBTX A) in the forehead and the effect of intradermal (ID) and subcutanous (SC) infections on their diffusion.Methods Healthy volunteers (n =20) were recruited to receive a 0.05 ml (2 U) injection of botulinum toxin type A at four forehead sites [both sides of medial forehead (SC) and temporal forehead (ID)],one side for BOTOX and another for CBTX-A.On day 14,the Minors' iodine starch test was performed and photographs were taken for calculating the area and dimensions of anhydrotic area.Results The areas of anhidrosis ID were significantly greater with CBTX-A (180±15) mm2 than that of BOTOX (144±14) mm2.The same conditions occurred in vertical dimensions (14.4±1.1) mm vs.(15.8±1.0) mm and horizontal dimensions (10.8±0.6) mm vs.(12.5±0.7) mm.There was significant variation between the both for diffuseness in the two anhidrotic halos observed after ID injection (P＜0.05).The areas of anhidrosis by SC were significantly greater with CBTX-A (207±17) mm2 than that in BOTOX (183±18) mm2.The mean horizontal dimension was greater with CBTX-A by SC (13.2±0.6) mm than that of BOTOX by SC (12.2±0.7) mm,but not statistically significant (P =0.06).The mean horizontal dimension in BOTOX was significantly greater with SC than that with ID (P＜0.05).There was no statistically significant difference between SC and ID administration of CBTX-A.Conclusions BOTOX diffuses less than CBTX-A.ID injection technique may result in less diffusion than SC.

Objective To explore the diagnosis and treatment of phyllodes tumor of the breast. Methods Clinical data from 30 patients with phyllodes tumor confirmed surgically and pathologically were analyzed retrospectively. Results Of the 30 cases of phyllodes tumor, there were 16 cases of benign tumor, 9 cases of borderline tumor and 5 cases of malignant tumor according to the standard histological criteria. Local mass excision, total mastectomy, modified radical mastectomy and tumor mass excision were performed in 8, 8 and 13 patients, and 1 patient, respectively. A follow up of 20 cases for 1-24 years found 1 death, but all the others survived. Four patients out of the 20 patients underwent total mastectomy or modified radical mastectomy due to tumor recurrence. Conclusion The preoperative diagnosis of phyllodes tumor is difficult. Intraoperative frozen section examination of the suspicious lesions should be conducted. Multiple slices of the specimen should be performed. Surgical options are closely associated with the prognosis. Wide local excision or total mastectomy is recommended in surgical options.

Objective To assess the value of rigid wall and outer coarse signs in 64-slice CT for pre-operation stages of colorectal carcinoma. Methods One hundred and twenty-three colorectal carcinoma patients underwent 64-slice CT;then rigid wall and out coarse signs were evaluated respectively. The tumors were grouped according to the postoperative pathologic infiltrative depth. Two signs of the neighboring infiltrative depth groups were compared and analyzed, so as the relativity between two signs and tumor infiltrative depth. Results Among all 123 patients, 7 were Tis, 6 were T1, 14 were T2a, 16 were T2b, 75 were T3 (including 22 infiltrate to chorion and 53 infiltrate through chorion) and 5 were T4. According to the pathologic infiltrative depth, the patients were grouped into GroupⅠ: Tis+T1;GroupⅡ: T2a;Group Ⅲ: T2b;Group Ⅳ: T3a;Group Ⅴ: T3b+T4. Significant difference of the incidence of rigid wall was found between GroupⅠand Ⅱ (P=0.013), while of outer coarse between Group Ⅱ and Ⅲ (P=0.004). Coefficient correlation of rigid wall, outer coarse and the infiltrative depth of the tumor were detected (r=0.673, r=0.528, respectively, both P＜0.001), also between the two signs (r=0.725, P＜0.001). To predict the tumor of and above T1 with rigid wall and tumor of and above T3a with outer coarse, the sensitivity, specificity and accuracy was 92.30% and 79.31%, 89.09% and 69.44%, 89.43% and 76.42%, respectively. Conclusion The sign of rigid wall is valuable to distinguish the pathological changes in the tumor of and above T1, while outer coarse is better to distinguish the pathological changes of and above T2a, but not good at distinguishing tumors of T2b and T3 or above. Rigid wall and outer coarse are both in positive correlation with the infiltrative depth of the tumor, and each has different values. Combination of the two signs may be helpful to raise the accuracy for pre-operation staging of colorectal carcinoma.

Objective To observe the lung protective effect of Tongfu Xiefei method (TFXF) in rats with sepsis, and to discuss its possible mechanism.Methods Forty-two Sprague-Dawley (SD) rats were randomly divided into blank control group (n = 6), model group (n = 18) and TFXF group (n = 18). Sepsis model was reproduced by cecal ligation and puncture (CLP) in rats of model group and TFXF group. After the reproduction of sepsis model, rats in TFXF group received Tongfu Xiefei granules 0.01 mL/g by gavge, while those in model group were given equal dose of normal saline by the same way. The rats in blank control group received no treatment. At 3, 6, 12 hours after CLP, abdominal aorta blood was collected for blood gas analysis and inferior vena cava blood was collected for determination of the concentrations of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). Bronchoalveolar lavage fluid (BALF) was collected for measurement of concentrations of total protein (TP), total phospholipid (TPL), and desaturated phosphatidyl choline (DSPC). The ratio of wet/dry lung weight ratio (W/D) was measured, and malondialdehyde (MDA) and myeloperoxidase (MPO) in lung tissues were determined. The pathologic changes in their lungs were observed with light microscopy.Results Compared with those in blank control group, the levels of pH value, arterial oxygen partial pressure (PaO2), HCO3-, base excess (BE) were lowered, and partial pressure of carbon dioxide of arterial blood (PaCO2) was increased in model group. The serum concentrations of TNF-α and IL-6 were gradually increased after the reproduction of sepsis model. Compared with those in blank control group, the levels of TP, TPL, and DSPC/TPL in model group were decreased, while the levels of W/D, MDA and MPO were increased. Compared with those in model group, pH value was elevated in TFXF group at 3 hours (7.27±0.04 vs. 7.18±0.07,P < 0.05). PaO2 (mmHg, 1 mmHg = 0.133 kPa) was improved at 3, 6, 12 hours (3 hours: 128.00±16.05 vs. 106.78±10.73, 6 hours: 98.46±15.97 vs. 72.80±16.33, 12 hours: 90.70±9.31 vs. 74.28±12.19, allP < 0.05). The serum concentrations of TNF-α (ng/L) in TFXF group were significantly lower than those in model group at 12 hours (508.20±94.08 vs. 756.60±138.77,P < 0.05), and the serum concentrations of IL-6 (ng/L) in TFXF group were significantly lower than those in model group at 6 hours and 12 hours (6 hours: 687.80±35.00 vs. 849.40±148.28, 12 hours: 728.80±214.41 vs. 917.00±245.96, bothP < 0.05). Compared with those of model group, the levels of TP (g/L) in BALF in TFXF group were significantly decreased at 12 hours (1.01±0.23 vs. 1.60±0.47,P < 0.05), and the levels of TPL (mg/L) in TFXF group were significantly increased at 12 hours (86.40±11.33 vs. 62.40±16.33,P < 0.05). The levels of DSPC/TPL in TFXF group were significantly higher than those in model group at 6 hours and 12 hours (6 hours: 0.58±0.13 vs. 0.38±0.10, 12 hours: 0.45±0.13 vs. 0.24±0.07, bothP < 0.05). The levels of W/D in TFXF group were significantly higher than those in model group at 3 hours (3.84±0.25 vs. 2.99±0.50,P < 0.01), but lower than those in model group at 12 hours (3.21±0.53 vs. 4.89±1.14,P < 0.05). The levels of MDA (nmol/mg) in TFXF group were significantly lower than those in model group at 6 hours and 12 hours (6 hours: 4.04±2.58 vs. 8.89±2.61, 12 hours: 11.31±3.60 vs. 20.60±8.10, bothP < 0.05), while the levels of MPO (U/g) in TFXF group were lower than those in model group at 12 hours (4.79±0.66 vs. 7.22±1.76,P < 0.05). Compared with model group, the lungs in TFXF group showed less morphological changes under light microscopy, such as pulmonary edema, congestion, effusion and fibrosis.Conclusions The method of Tongfu Xiefei may improve hypoxemia and metabolic acidosis, alleviate lung edema and ameliorate pulmonary pathological changes in rat sepsis model. Tongfu Xiefei method shows a protective effect in sepsis by the way of reducing peroxidative damage, inhibiting the release of proinflammatory factors and abating degradation of lung surfactant.

Objective To explore the diagnostic value of thin image and multiplanar reconstruction (MPR) for preoperative T staging on different regions and various pathological staging of colorectal cancer. Methods A total of 163 colorectal cancer patients underwent 64-slice CT examination, then cross section image with thickness of 5 mm (5 mm interval) and 0.5 mm (0.4 mm interval) were reconstructed. The lesions were evaluated and T staged with 5 mm, 0.5 mm and MPR image, respectively. Patients were divided according to the region of lesions: groupⅠ: the anterior wall of lower rectal or near dentate line; groupⅡ: the posterior or lateral wall of lower rectal; group Ⅲ: upper middle rectal or clone. Patients in group Ⅲ were divided into 4 subgroups according to postoperative pathological staging: group A: Tis and T1; group B: T2 (B1: T2a; B2: T2b); group C: T3; group D: T4. The accurate diagnostic rates of different regions, different imaging techniques and different pathological staging were analyzed compared with postoperative pathological results. Results CT accurate T staging diagnostic rate for group Ⅰ, Ⅱ, Ⅲ was 44.44%, 61.54% and 66.67% respectively with 5 mm; 51.85%, 61.54% and 69.92% respectively with 0.5 mm; 51.85%, 76.92% and 78.86% with MPR. There was significant difference of CT accurate diagnostic rates only between group Ⅰ and group Ⅲ (5 mm P=0.031, MPR P=0.004). MRP was better then 5 mm and 0.5 mm only in group Ⅲ (P=0.008, P=0.019). The sensibility of diagnostic T staging of A, B, C and D subgroup in group Ⅲ was as follows: 53.85%, 30.00%(B1: 57.14%, B2: 6.25%), 84.00% and 60.00% with 5 mm; 76.92%, 33.33%(B1: 76.92%, B2: 18.75%),84.00% and 60.00% with 0.5 mm; 92.31%, 53.33%(B1: 78.57%, B2: 31.25%), 86.67% and 80.00% with MPR. CT accurate T staging diagnostic rate of subgroup B2 was significantly lower than those of other groups, and most of the errors were over valuated. Conclusion CT has good sensitivity, specificity and accuracy for diagnostic T staging for early colorectal cancer. MPR can raise the accurate diagnostic rate of upper middle rectal and colon tumor. CT diagnostic value for T staging of lesions at the anterior wall of lower rectal or near dentate line tumor is limited, and the primary cause is over diagnosis of T2b lesions.

Objective To investigate the effect of hypercapnia on cerebral oxygen metabolism under propofol anesthesia during one-lung ventilation (OLV) in patients.Methods Forty ASA physical status [or Ⅱ patients,aged 53-63 yr,scheduled for elective lobectomy performed via video-assisted thoracoscope,were enrolled in the study.Anesthesia was induced with iv injection of midazolam,fentanyl and vecuronium and target-controlled infusion of propofol and maintained with target-controlled infusion of propofol and intermittent iv boluses of fentanyl and vecuronium.BIS value was maintained at 40-60 during surgery.At 15 min of OLV,hypercapnia was performed and PaCO2 was maintained at 50-55 mm Hg lasting for 15 min,and then respiratory rate was adjusted to maintain PaCO2 at 40-45 mm Hg.Immediately before OLV (T0),at 15 min of OLV and hypercapnia (T1,2),and at 15 min after the end of hypercapnia (T3),arterial and jugular bulb venous blood samples were obtained for determination of arterial partial pressure of oxygen (PaO2),arterial oxygen saturation (SaO2),jugular bulb venous oxygen partial pressure (PjO2) and hemoglobin saturation (SjO2).The arterial to venous oxygen content difference (Da-jO2) and cerebral extraction rate of oxygen (CERO2) were calculated.Results SaO2 and PaO2 at T1-3,SjO2 and PjO2 at T1 and T3 and Da-jO2 at T2 were significantly lower and CERO2 at T1 and T3 was higher than those at T0 (P ＜ 0.05).SjO2 and PjO2 were significantly increased and Da-jO2 and CERO2 were significantly decreased at T2(P ＜0.05) and no significant changes were found in the parameters of cerebral oxygen metabolism at T3 as compared with those at T1 (P ＞ 0.05).Conclusion Hypercapnia can improve cerebral oxygen metabolism under propofol anesthesia during OLV in patients.