With the development of breast cancer treatment mode and the changing attitudes of patients, re-construction of the breast after mastectomy plays an important role in the interdisciplinary treatment concept of breast cancer. Because of the large area and the less variation of vessels pedicle of latissimus dorsi, it is considered to be an al-ternative flap for breast reconstruction. The latissimus dorsi flap can be used widely in breast reconstruction. Besides the implant-assisted latissimus dorsi (LDI) and autologous latissimus dorsi (ALD) flap breast reconstructions, the modified latissimus dorsi flap could be selected for various mastectomy. Compared with implant-assisted breast reconstruction, the latissimus dorsi flap can model a better mammary contour and receive better cosmetic outcomes on post-reconstruc-tion radiation. Compared with the transverse rectus abdominis myocutaneous (TRAM) flap, the latissimus dorsi flap has smaller scars and more rapid recovery. The improvement in postoperative donor area suturing techniques and auxiliary drug application greatly reduced the incidence of seroma. The Endoscopic technology avoids the donor scar. In clinical practice, statistical evaluation of aesthetic outcomes was impossible as an advantage in operation selection. This article summarized the control of complications and the further discussion of controversy.

Objective To study the clinical effect of parecoxib sodium for injection combined with psychological intervention on postoperative analgesia in the patients with thyroid cancer. Methods 100 patients with thyroid cancer Hangzhou tumor hospitalfrom July 2015 to April 2017 were randomly divided into two groups, the experimental group and the control group. The control group were given parecoxib sodium for injection, and the experimental group were received parecoxib sodium for injection combined with psychological intervention. Three days after treatment, the average amount of parecoxib sodium for injection and SAS, SDS score in the two groups were compared. Results The average dosage of parecoxib sodium for injection in the experimental group was (45.6±9.7) mg, and (67.9±9.5) mg in the control group. In the control group, SAS was (45.88± 7.56)points before treatment and (50.42±7.91) points after treatment, SAS was (45.94±7.32)points before treatment and (40.81 ± 6.61) points after treatment. SDS in the control group before treatment was (45.53±8.62) points and (50.29±7.24) points after treatment. In the experimental group, SDS before treatment was (45.41±7.18) points and (40.36±6.15) after treatment. The differences of all the data were statistically significant in the two gorups(P<0.01). Conclusion Postoperative psychological intervention can effectively enhance the analgesic effect of parecoxib sodium for injection, reduce the dosage and also improve the psychological score. This treatment is worthy of clinical promotion.

Objective To investigate influence of Ang-(1-7) on the inducible nitric oxide synthase (iNOS) activity and gene expression following focal cerebral ischemia/reperfusion in rats. Methods Cerebral ischemia/reperfusion injury was induced by intraluminal thread occlusion of middle cerebral artery in the adult male Sprague-Dawley (SD) rats. Ang-(1-7) or artificial cerebrospinal fluid (aCSF) was continuous administrated by implanted Alzet osmotic minipumps into lateral cerebral ventricle after reperfusion. Experimental animals were divided into sham-operated group ( sham operation + aCSF), aCSF treatment group(MCAO+aCSF)and ang-(1-7)treatment groups(MCAO+Ang-(1-7))at low(1 pmol·0.5 μl-1·h-1),medium (100 pmol·0.5 μl-1·h-1)or hith(10 nmol·0.5 μl-1·h-1)dose levels.The activity of iNOS in ischemic tissues were measured by iNOS detection kits. Reverse transcription( RT)-PCR was used to determine messenger RNA (mRNA) of the iNOS in ischemic tissues. Results The cerebral ischemic lesion resulted in a significant increase of iNOS expression compared with sham operation group. The high-dose Ang-(1-7) markedly enhanced (iNOS) activity ( 160. 83 vs 116. 75 U/mg, F = 19. 22,P＜0.01; 151.87 vs 113.07 U/mg, F=63.52,P＜0. 01) and gene expression(0.43 vs 0.38, F=21.83,P ＜ 0. 01; 0. 40 vs 0. 35, F = 19.49, P ＜ 0. 01 ) compared with aCSF treatment group at 24 hours and 48hours after reperfusion, whereas medium and low-dose Ang-( 1-7 ) didn't stimulate iNOS activation.Conclusions The obtained results suggest that high-dose Ang-(1-7) upregulate iNOS expression following ischemic stroke.Moreover,overdose Ang-(1-7)(10 nmol·0.5 μl-1·h-1)may have Ang Ⅱ-like effects in iNOS expression increase.

According to teaching outline and clinical training characteristic of psychophy-laxis speciality(including Psychiatry and Medicopsychology),we explored how to strengthen the clinical thinking ability and clinical skill training for clinical medicine students based on cultiva-tion of elementary knowledge and theory,and we also established a set of more appropriate item system of clinical skills assessment so as to improve the practice quality in psychiatry and medical psychology departments.

Objective To evaluate long-term efficacy and safety of Topiramate in patients with various types of epilepsy.Methods 115 patients with epilepsy were underwent open-label experience with Topiramate as monotherapy or add-on therapy. The efficacy was assessed after 6 months. The rates of seizure-free and Topiramate retention were estimated after 1 and 2 years, and side effect were also evaluated during open-label treatment period.Results (1) After 6 months, total effective rate was 83.9% in monotherapy group and 66.1% in add-on therapy group. Topiramate was proved to be effective on various types of epilepsy, but there were not significant differences in seizure-free rate and total effective rate between the different types. (2) The optimal dosage was ( 105.72?48.28) mg/d in children and ( 176.26?62.81) mg/d in adults. (3) The seizure-free rate was 40.0% at 1 year and 28.7% at 2 years, and retention rate was 67.8% at 1 year and 46.1% at 2 years. (4) Side effects were observed in 34 patients (29.6%), including mild to moderate events related to central nervous system, anorexia and weight decrease.Conclusion Topiramate is a widespread antiepileptic drug with high efficacy and safety for long-term administration.

Objective To investigate the effects of Topiramate(TPM) on activity of SOD and concentration of MDA in blood serum and the changes of the nerve function scores after cerebral ischemia/perfusion in rats. Methods Male Sprague-Dawley rats were randomly divided into ischemia/perfusion group, TPM group and sham-operation group. Rat models of transient focal cerebral ischemia were made by 2 h occlusion of right middle cerebral artery occlusion and reperfusion for 24 h.Rats in TPM group were injected TPM(8 mg/ml,80 mg/kg)in the beginning of the artery occlusion and the reperfusion. The rats were sacrificed after they were evaluated by the nerve function deficiency scores. The activity of SOD and concentration of MDA in blood serum were measured.Results The activity of SOD and concentration of MDA in blood serum in ischemia/perfusion group were (157.72?19.04)U/ml and (7.45?0.84 )nmol/ml, those in TPM group were ( 171.25?15.72)U/ml and (( 6.10?0.98) nmol/ml,those in sham-operation group were (179.74?7.95)U/ml and (5.90?0.72 )nmol/ml. Compaired with sham-operation and TPM groups, the activity of SOD in ischemia/perfusion group was significantly lower, the concentration of MDA was obviously higher (all P

Objective To investigate the neuroprotective effects of Topiramate (TPM) on rat brain with ischemia-reperfusion damage and its mechanisms.Methods The 30 male SD rats were randomly assigned to sham operated group, ischemia-reperfusion group and TPM treated group.The cerebral ischamia and reperfusion model was made by suture occlusion of right middle cerebral artery(MCAO).Rats in TPM treated group were intraperitoneally injected TPM (80 mg/kg) twice. At 24 h following onset of MCAO,the nerve function score was evaluated with Neurological Grading Scale. The infarction volume was measured with TTC staining. The contents of glutamate (Glu) and gamma-aminobutyric acid (GABA) of cerebral cortex were tested by the high performance liquid chromatography with fluorescent detection. GABAA receptors were observed by immunohistochemistry.Results (1) Compared with the ischemia-reperfusion group, the Neurological Grading Scale of TPM treated group was significantly higher(P

Objective To explore the effects of Irbesartan on the plasma concentrations of lysophosphatidic acid(LPA), endothelin-1(ET-1),serum concentration of nitric oxcide (NO) in the patients with acute cerebral infarction(CI).Methods All of the 53 patients were randomly assigned to Irbesartan therapy group(n=25) treated with Irbesartan 150 mg/d and Aspirin 100 mg/d and conventional therapy group(n=28) treated with Aspirin 100 mg/d.Both groups were treated for 14 days and the other measures of symptomatic therepy were the same. And another 23 patients without cerebrovascular diseases and 7 health volunteers were taken as control group.The venous blood samples were taken for measureing the levels of LPA,ET-1,NO while the scorces of neurological deficit (NDS)were evaluated before and after treatment. Results (1)Before treatment the levels of LPA,ET-1 in CI group were significantly higher and the level of NO was significantly lower than that in control group (all P

Objective To improve the recognition of rapid eye movement(REM) sleep behavior disorder(RBD) as an early marker for ?-synucleinopathies.Methods By studying a typical case of RBD followed with multiple system atrophy-P,the clinical features,pathogenesis and its correlation with ?-synucleinopathies of RBD were elucidated.Results This case manifested a serial of paroxysmal increased activities of the limbs and behavioral disturbances during his REM sleep,and parkinsonism features appeared 9 years later.His cranial MRI showed the abnormal long T1 and T2 signals at bilateral centrum ovale,corona radiate and basal ganglia area of the cerebral hemisphere.Conclusions RBD is clinically characterized with paroxysmal behavioral disorder in the REM sleep,the changes of the brain stem,striatum and cortical perfusion are attributed to the RBD pathogenesis.Closely linked to a-synucleinopathies,RBD may be clinical harbinger of those disorders.