Objective To establish the athrmic inouse model of breast cancer in normal position and imitated metastatic breast cancer. Methods Breast cancer cells MDA-MB-231-luc carrying luciferase gene was injected into the athymie mice.The optieal imaging in vivo system was used to observe the establislament of the model. Reseults The breast tumor emerged after we planted the MDA-MB-231-lue cells in the mammary gland fatpads,the volume and photon of the tumor increased during the second weekto the fifth week.After injection by the tail vein,the tumors mainly located in the lungs While after infusion in the left alrtrium.the tumolrs metastate to all over the body. Conclusions We succeeded in the establishment of the athymic mice model of breast cancer.in situ and imitated metastatic breast cancer by iniection into the vena caudalis and the left alttrium.The optical imaging in vivo system could distinctly show the formation of the tumors.

Objective To evaluate immediate breast reconstruction with extended latissimus dorsi flap after mastectomy for patients of breast cancer. Methods One hundred and sixty-two women with breast cancer underwent surgery from Jan, 2000 to Dec, 2007. Masteetomy was carried out including traditional modified mastectomy in 32 cases, skin sparing mastectomy in 51 cases and nipple-areolar sparing mastectomy in 79 cases. Immediate breast reconstruction was performed with latissimus dorsi flap and surrounding fat tissue. Results Operation was successful in 161 cases. The morphology of reconstructed breasts was excellent in 91.93% cases as evaluated by patients themselves. After operation 6 cases had partial nipple necrosis, 5 cases had rhacoma of the chest, but cured conservatively. Eleven cases had seroma on the back, among them 8 cases cured by puncture and drainage. Two cases cured by erasion of the pseudomembrane and 1 case cured by exairesis of the fibrous capsule. Three cases had limited skin necrosis around the incision. One case had necrosis on part of the donor side, cured by reoperation. One case had implant necrosis necessitating removal of the implant. The patients were followed up for 7～90 months, and the 23 cases were free of tumor recurrence before they lost to follow-up. Among those followed-up cases there were bone metastasis in 2 cases, lung metastasis in 1 case and supra clavicular lymph node metastasis in one. No local recurrence was found. Conclusions Immediate breast reconstruction with extended latissimus dorsi flap after masteetomy is safe and effective, especially suitable for small and medium size breasts.

OBJECTIVETo evaluate the technique and significance of the sentinel lymph node (SLN) biopsy using different methods in patients with breast cancer.

METHODSSeventy-one female patients with node-negative breast cancer diagnosed by fine needle biopsy or frozen section underwent lymphatic mapping. They were divided into 4 groups: methylene blue, isosulfan blue, (99m)technetium-labelled sulfur colloid, combined vital blue dye and radiocolloid. The number of each group was 24, 29, 8 and 10 respectively. The SLN was identified and removed, followed by a definitive cancer operation, including a complete axillary node dissection. Pathological examination of the SLN was made with HE and immunohistochemical staining. Pathologic characteristics of SLN and other axillary nodes were analyzed.

RESULTSAmong the 71 patients, 60 were (84.5%) confirmed by SLN biopsy. The positive rates were 75.0% (18/24) for methylene blue group and 86.2% (25/29) for isosulfan blue group, respectively. Seven positive cases were detected by (99m)technetium-labelled sulfur colloid and all the positive cases by combined vital blue dye and radiocolloid. The total sensitivity was 83.3% and the sensitivity for each group was 70.0%, 90.0%, 100% and 100%, respectively. The total false negative rate was 16.7% and the false negative rate for each group was 30.0%, 10.0%, 0 and 0, respectively. The total accuracy rate was 93.3% and the accuracy rate for each group was 83.3%, 96.0%, 100% and 100%, respectively. The time of finding the SLN was 29, 22, 7, 6 min respectively.

CONCLUSIONSSLN biopsy is technically possible in patients with breast cancer. Most of SLNs can probably reflect the histological characteristics of the axillary lymph nodes. Combination of vital blue dye and isotope makes mapping exact and satisfactory and it may be the best choice among the four methods.

Biopsy, Needle ; Breast Neoplasms ; pathology ; Female ; Humans ; Lymph Nodes ; pathology ; Lymphocytes, Tumor-Infiltrating ; Sentinel Lymph Node Biopsy

Objective To construct an oncolytic adenovirus CNHK600-IL24, and to observe the in vivo effects of CNHK600-IL24 in treating breast cancer. Methods The IL-24 gene was cloned into adenovirus shuttle vector SG502-△CR2, and CNHK600-IL24 was obtained by cotransfection of SG502-INSIL24 and pPE3 plasmids and subsequent recombination in 293 cells. Based on the establishment of the athymic mice model of breast cancer in situ and imitated metastatic breast cancer by injection in the vena caudalis and the left artrium, we administered the virus by the tail vein. We used the optical imaging in vivo system to monitor the effects. Results The oncolytic adenovirus CNHK600-IL24 was correctly constructed and confirmed by restriction DNA sequence analysis and PCR. The titer of CNHK600-IL24 reached 1.9 ×1010pfu/ml. Establishing athymic mice model of breast cancer in situ, the volume and photon number of the tumors in the control group was significantly larger than those of the CNHK600-IL24 group( P ＜0. 05). The tumor had conspicuous necrosis after the treatment of CNHK600-IL24. There was noticeable apoptosis of the tumor cells. Immunohistochemistry showed the expression of IL-24 and the Hexon protein in the tumor cells.In athymic mice model of imitated metastatic breast cancer by infusion into the vena caudalis, most of the mice in the control group died before 38 days, the mice of the CNHK600-IL24 group survived significantly longer(P ＜0. 05 ). Using athymic mice model of imitated metastatic breast cancer by infusion in the left artrium, the optical imaging in vivo system showed obvious difference between the control group and the CNHK600-IL24 group. Conclusions The high-titer oncolytic adenovirus CNHK600-IL24 was successfully constructed and purified. The oncolytic adenovirus had obvious antitumor effect on breast cancer.

Purpose　To introduce our experience about the skin-sparing mastectomy and immediate breast reconstruction using transverse rectus abdominis myocutaneous flap(TRAM).　Methods　For early stage breast cancer,we preserved the breast skin,performed the subcutaneous glandular excision and axillary dissection,immediately reconstructed the breast using TRAM flap.　Results　9 patients were treated by skin-sparing mastectomy and immediate TRAM breast reconstruction.The morphology of reconstructed breasts was excellent.　Conclusions　The skin-sparing mastectomy and immediate TRAM breast reconstruction is safe and effective for treating early stage breast cancer.The incision is relative small and more aesthestic.

BACKGROUND: Appropriate direction and angle of traction for the vertebral artery type cervical spondylosis(CSA)make significant effect.Selective angiography is recognized as"gold standard"to diagnose the vascular disease.Although magnetic resonance angiography as a non-invasive examination,there exist shortcomings such as a longer time checking,vulnerable to man-made factors,a certain aggressive feature.OBJECTIVE: Through the use of color Doppler flow imaging(CDFI)and transcranial Doppler sonography(TCD)adding the test of turning neck,to analyze the change of blood current parameter before and after the tractions from different directions and angles.METHODS: 240 cases suffering CSA were selected and divided into groups according to anatomy angle of lesion parts(upper cervical segments,lower cervical segments,mixed type)and traction mode,angel(anteversion sitting position 1°-10°,11°-20°,21°-30° groups,posterior extension sitting position 1°-10°,11°-20°,21°-30° groups,neutral position sitting position group).Local massage served as control group.The indexes of vertebral artery of neck part including inner diameter(D)of narrowest location,peak systolic velocity and average velocity of blood were measured by CDFI adding the test of turning neck.The indexes of left vertebral artery,right vertebral artery and basiiar artery including peak velocity(Vp)of period of contraction and mean velocity(Vm)of blood were measured by TCD adding the test of turning neck.RESULTS AND CONCLUSION: ①We determined vertebral artery type of cervical spondylosis on the base of anatomic site. On the basis of diseased region,we divided cervical syndrome into 3 types.They were superior part(C1-C3),inferior part (C4-C6) and commixture.it offers clinical guidance for traction therapy from spondylous morphous and mechanics.② We determined the gbest angle of traction.The therapeutic efficacy in posterior extension sitting position occupying 11-20～was better in upper hind neck;the therapeutic efficacy in anteversion sitting position occupying 11-20° was better in inferior neck; the therapeutic efficacy in anteversion sitting position occupying 1-10° was better in neutral position sitting position.③ We knew that CDFI and TCD are the convenient,non-invasive,safe and reduplicative methods to guide traction therapy in vertebral artery type of cervical spondylosis.

Objective:To observate the changing trend of flow of in-situ bilateral internal mammary artery as grafts during perioperative period in patients undergoing coronary artery bypass grafting(CABG), and to compare the parameters of flow between LIMA and RIMA.Methods:A total of 57 patients , 50 males and 7 femails, mean aged(57.8±10.1) years, underwent bilateral IMA CABG in our hospital from August 2016 to January 2019. Transthoracic ultrasound of IMA examination was performed before CABG. The blood flow, the PI(pulsation index) and other parameters were measured and recorded by intraoperative TTFM.Results:There was no significant difference of the average diameter and PI between LIMA and RIMA, but the preoperative flow of RIMA is higher( P=0.026) in our study. There was no significant difference of the average flow and PI between LIMA and RIMA recorded by TTFM( P>0.05), but the higher diastolic flow(DF) in LIMA grafts( P=0.022) compared with RIMA grafts may be associated with the different target sites( P<0.05). Compared with the preoperative flow and PI of IMA, the intraoperative flow and PI of both LIMA and RIMA grafts were better( P<0.001). Conclusion:Compared with the preoperative flow of IMA, both flow of LIMA and RIMA are better. In spite of the targets exist difference , there are no significant difference of the average flow and PI between LIMA graft and RIMA graft recorded by TTFM.

Objective:To summarize the experience and technical difficulties of complete thoracoscopic lobectomy(segmental) in the treatment of congenital pulmonary airway malformation in children.Methods:The clinical data, surgical videos and follow-up results of 38 children suffering from congenital pulmonary airway malformation and underwent complete thoracoscopic lobectomy in Children′s Hospital of Fudan University Xiamen Branch from January 2017 to December 2019 were retrospectively analyzed.A statistical comparisons of operative time, intraoperative blood loss, postoperative pain (the first time of getting out of bed), incision length and postoperative pulmonary complications were made between 28 children who underwent the total thoracoscopic lobectomy and 21 children who accepted open surgical lobectomy before January 2017 in Children′s Hospital of Fudan University Xiamen Branch.Results:Thirty-eight children with congenital pulmonary airway malformation were successfully operated by complete thoracoscopy.There were 28 lobectomies, 6 segmental lobectomies and 4 wedge lobectomies.Postoperative follow-up was conducted for more than 3 months, and no serious surgical complications occurred.Chest radiograph of 2 children with the right lower lobectomy at 48 hours after surgery had the elevation of the right diaphragm (2-3 intercostal), and it returned to normal 3 months after surgery.The CT review of 1 child with pulmonary wedge resection 1 month after surgery displayed a little residual lesion.Thoracoscopic lobectomy was significantly different from open surgery in terms of incision length[(2.0±0.5) cm vs. (10.0±0.5) cm], postoperative pain (the first time of getting out of bed)[(24.0±2.0) h vs. (48.0±1.5) h] and pulmonary complications (0 vs. 5 cases). The operative time of single lung ventilation was remarkably different from that of double lung ventilation in thoracoscopic lobectomy[(96.0±6.0) min vs. (118.0±7.0) min, t=106.501, P<0.001]. Compared with thoracoscopic lobectomy, thoracoscopic pulmonary segmentectomy has a long time and a large amount of blood loss. Conclusions:Complete thoracoscopic lobectomy (segmental) is the first choice for the treatment of congenital pulmonary airway malformation in children, with clear operative field, little trauma, less postoperative pain, quick recovery and fewer respiratory complications.Single-lung ventilation is beneficial for surgical completion.

Objective:To explore the patterns and causes of occupational exposure to infectious diseases (OEID) among frontline medical staffs (FMS) in coronavirus disease 2019 (COVID-19) isolation wards (CIW), and the particularity of post-OEID management and the measures to prevent OEID.Methods:A total of 1 061 FMS of Wuhan Huoshenshan Hospital from February 4 to March 21, 2020 were enrolled. The OEID of FMS was investigated and analyzed from the perspectives of FMS physical and psychological conditions, protective equipment, infection-control related regulations and procedures, local air quality, exposure patterns, and the particularity of emergency treatment after exposure.Results:The incidence of OEID among FMS was 2.0%(21/1 061). The nurses and doctors accounted for 95.2%(20/21) and 4.8%(1/21), respectively. The incidences in 17 general wards and two intensive care units (ICU) were 71.4%(15/21) and 28.6%(6/21), respectively. Nearly 90.5%(19/21) and 9.5%(2/21) of the OEID events occurred in contaminated area and potential contaminated area, respectively. About 23.8%(5/21) of the OEID events were air exposure of oral-nasal skin, mucosa and respiratory tract, which was secondary to uncontrollable vomiting, and 76.2%(16/21) were pricking injuries. The inducement factors involved poor quality and inappropriate wearing of some goggles, atomization of the inside of goggles leading to blurring vision, chest distress and decreased sense of touch and operational flexibility related to level-3 protection equipment, poor air quality, FMS physical and psychological conditions, etc. Under the direction of "the Procedures for Handling OEID" , all incidents are properly handled and no FMS was infected by 2019 novel coronavirus and blood-borne pathogens. No new OEID event was found after the strict implement of set of preventive measures.Conclusions:The OEID among FMS in CIW is attributed to multiple causes. The optimized process that takes into account the specificity of OEID management for both COVID-19 and blood-borne infectious diseases can effectively prevent potential post-exposure infections. And reasonable precautions can fully reduce the risk of OEID of FMS in CIW.