Objective:To compare the therapeutic effect of immediate breast reconstruction using latissimus dorsi musculocutane-ous flap after modified radical mastectomy with the conventional modified radical surgery of breast cancer. Methods:A retrospec-tive analysis of 224 female patients with Stage 0 to IIIA breast cancer was conducted. The patients were admitted to the Department of Breast Surgery of Liuzhou People's Hospital between November 2009 and July 2012. The cases were divided into two groups accord-ing to different surgical options:immediate breast reconstruction (IBR) and modified radical surgery of the breast (MRSB). After con-trastive analyses of the postoperative complications, cosmetic results, quality of life, local failure rate, distant metastases and mortality rates between the two groups, the therapeutic efficiency of the two surgeries was evaluated. Results:No statistical differences were ob-served in the postoperative complications between the two groups, such as hydrops, skin flap necrosis, limb exercise and shoulder joint motion, drainage time, and starting time of adjuvant therapy (P>0.05). The patients in the IBR group had a better quality of life than those in the MRSB group (P<0.01). The aesthetic evaluation of the breast reconstruction was favorable in 39 cases and secondary in 3 cases, which surpass the evaluation of the patients in the simple MRSB group. No obvious statistical differences were observed in the distant metastasis rate, local recurrence rate, and mortality rate between the two groups (P>0.05). Conclusion:Compared with the tradi-tional MRSB group, the option of IBR after modified radical mastectomy not only achieves similar therapeutic outcomes but also pres-ents advantages such as better aesthetic effect of the reconstructed breast, easy surgical procedures, high safety, improvement of the breast contour outline, and improved quality of life after operation. Therefore, IBR is a safe and available therapeutic method for pa-tients with early breast cancer.

Objective To summarize the experience in diagnosis and treatment of intraductal papillary mucinous neoplasm(IPMN) of the pancreas and identify potential preoperative factors predicting invasiveness of intraductal papillary mucinous neoplasm of the pancreas. Methods From September 2003 to July 2010,27 patients underwent pancreatic resection for IPMN. All cases were divided into invasive and noninvasive groups. Preoperative medical records were reviewed retrospectively between the two groups. Results Pathological results revealed 15 cases of invasive IPMN and 12 noninvasive cases. The incidence of obstructive jaundice, tumor size and serum total bilirubin values were significantly different between the two groups. The other factors including sex ratio, age, incidence of abdominal pain or back pain, diarrhea, weight loss, new onset diabetes, serum CEA, CA19-9 values showed no statistical difference. Conclusion Serum total bilirubin≥22.2μmol/L and tumor size≥3 cm could be predicting factors of invasive IPMN.

BACKGROUND:How to keep the intact shape of the breast while treating tumor has been widely concerned by more doctors and patients, breast reconstruction is introduced, developed and considered an important part in the treatment of breast tumors. OBJECTIVE:To explore the feasibility and therapeutic effects of immediate breast reconstruction after modified radical mastectomy and latissimus dorsi myocutaneous flap transplantation. METHODS:We retrospectively analyzed the clinical and pathological features of 42 breast cancer patients under immediate breast reconstruction after modified radical mastectomy with latissimus dorsi musculocuraneous flap or extended latissimus dorsi musculocuraneous flap. The procedure duration, postoperative complications and cosmetic outcome were assessed. RESULTS AND CONCLUSION:Among the involved 42 patients, 33 cases underwent modified radical mastectomy, retaining the nipple and areola of breast, 9 cases underwent modified radical mastectomy, retaining the skin of breast, 24 cases underwent breast reconstruction with latissimus dorsi musculocuraneous flap, 18 cases underwent breast reconstruction with extended latissimus dorsi musculocuraneous flap. The skin flap and reconstructed breast al survived, without severe complications. According to objective evaluation results, the cosmetic outcome was good in 39 cases and fair in 3 cases. The subjective evaluation results were good in 40 cases and fair in 2 cases. Al the patients were fol owed up for 9-41 months. One patient had bone metastasis 19 months after operation and there was no case with local recurrence. Immediate breast reconstruction after modified radical mastectomy with latissimus dorsi musculocuraneous flap is a simple and feasible operation process, with optimal effects, high security, and high survival.

Background Peters anomaly is a rare eye disease.Understanding the clinical features of Peters anomaly is helpful for us to correctly manage this disease.Objective This study was to investigate the clinical characteristics and treatment methods of Peters anomaly and provide available basis for the diagnosis and individualized treatment of Peters abnormal.Methods A descriptive study was performed.The clinical data from 8 eyes of 4 patients with Peters anomaly who were diagnosed and treated in Beijing Children's Hospital from January 1,2014 to March 30,2016 were retrospectively analyzed.The clinical manifestations of the anterior ocular segment were examined by handheld slit-lamp microscope,and corneal curvature,corneal thickness,axial length and intraocular pressure were measured.The therapy and outcomes of the patients were evaluated.Results Peters anomaly was classified into type Ⅰ,type Ⅱ and Peters plus syndrome based on the findings and literature'criteria.Regarding to the clinical findings,the adhesion of peripheral angle with cornea,shallow or disappeared anterior chamber were found in all the eyes,and these manifestations were type Ⅰ Peters anomaly and occurred in 2 eyes of 2 patients.The opacity and adhesion of the central lens capsula to corneal endothelium was seen in 6 eyes which belonged to type Ⅱ Peters anomaly.The mean corneal thickness was (680± 127) μm in 4 measured eyes,which was thicker than normal eyes;the mean corneal curvature was (37.40±1.79)D in 4 measured eyes;the mean axial length was (21.06±0.19)mm and the mean diameter of cornea was (9.4 ± 0.5) mm in 4 measured eyes.Iridocoloboma was found in 4 eyes and congenital aniridia was in 4 eyes.In addition,esotropia appeared in 1 patient,and nystagmus occurred in 3 patients.The 3 patients of type Ⅱ in this study were found to have the disorders associated with systemic neurogenic developmental abnormalities and diagnosed as Peters plus syndrome.Trabeculectomy with anterior vitrectomy was performed in 2 eyes with the intraocular pressure ＞30 mmHg(1 mmHg =0.133k Pa) and the introcular pressure reduced to below 21 mmHg after operation.Penetrating corneal transplantation was carried out on 1 eye with central opacity.However,rejection of graft occurred at 1 month and became complete cloudy at 3 months after surgery.Cataract extraction surgery was performed on 4 eyes with lens opacity and intraocular lens were implanted in 2 eyes or iridectomy was carried out in another 2 eyes,and the visual quality was evidently improved after operation.Conclusions The clinical characteristics of Peters anomaly include leukoma,shallow anterior chamber,peripheral iris adhesion with cornea and lens opacity due to adhesion of lens anterior capsule to corneal endothelium.Personalized operative regimen should be determined based on the clinical findings of the eyes with Peters anomaly.

Objective To optimize the synthesis process of istradefylline 1 for industrial production.Methods Istrade-fylline was synthesized from dimethyl carbonate and ethylamine through a series reactions including condensation,cycliza-tion,nitrosation,and reduction to produce 1,3-diethyl-5,6-diaminouracil(6),which was subjected to amidation with (E)-3,4-dimethoxycinnamic acid (8),followed by cyclization and methylation reaction.Compound 8 was prepared from veratr-aldehyde and propanedioic acid by Knoevenagel condensation.The structures of intermediate and target compounds were confirmed by MS and 1 H-NMR.Results and Conclusion The quality control points of each key process were optimized so that the total yield was 26.2% and the purity of the product was 99.76%.This improved synthesis method has some advan-tages,such as mild reaction conditions,simple operation,and applicability to industrial production.

Objective To investigatethe role of NF-κB played in the process of the cord blood monocytes differentiating into dendritic cells(DCs)induced by astragalus polysaccharide(APS)and to explore the signal transduction pathway involved in this process.Methods Umbilica]cord blood was collected in aseptic conditions.The cord blood monocytes were obtained by density gradient centrifugation and were divided into three groups afterwards.In the control group.cells were cultivated in the RPMI 1640 complete medium.In the APS group.cells were cultivated in the RPMI 1640 complete medium containing 100 mg/L APS.In the PDTC group:cells were treated with 10 μmol/L disulfide carbamate(PDTC).NF-κB inhibitor in 30 min followed by cultivalion in the RPMI 1640 complete medium containing 100 mg/L APS.,The morphological changes were observed during the process of cultivation by the optical microscope and transmission electron microscopy.Cells were collected 12 d later and the cellular immunophenotyping was assayed by FCM.,The activation and migration of NF-κB fluorescence in the cells was examined by the immunoflouresce microscopy.Results (1)Cells in the control group grown up without cluster forformation and were found fusiform and macrophage-like in 12 d.Cells in the APS group grown up in clnstem,and morphological changes were found from the circular shape to a typical dendritic cells-like shape.Cells in the inhibitor group grown up slowly and without cluster formation,and cell morphdogy had no significant change.(2)The expression of DCs-specific antigen CD80,CD83 and CD86 in the APS group was higher than that in the control group and inhibitom group(P<0.01).The expression of those antigen in the control group and PDTC group was similar and had no statistically significance(P>0.05).(3)NF-κB fluorescence in the nuclei was examined by the immunoflourescence microscopy and was much higher in the APS group than that in khe other groups,especially in 72 h with the activation rate of NF-κB (75.20±7.37)%,while(13.20±3.46)% of PDTC group and(8.20 ±1.92)%,respectively(P<0.01).Conclusion Astragalus polysaccharide can induce the differentiation of umbilical cord blood cells into DCs,and NF-κB is the key component of the signal transduction pathway involved in this process.

Objective To analezk thk altkrations in blood urka nitrogkn( BRN)and skrum crkatinink( Scr) in childrkn with rktinoblastoma( Ab)bkfork and aftkr chkmothkrape and thk clinical significanck of thk chkmothkrape kffkct,and to providk thk kvidknck for thk furthkr improvkmknt of thk safkte of trkatmknt. Methods L total of 280 chil-drkn with Ab wkrk knrollkd in thk stude,and kach of thkm was trkatkd with CEV( Carboplatin+Etoposidk+Vincris-tink)mkthods. Thkrk subjkcts includkd 153 malks and 127 fkmalks,with a mkan trkatmknt of 4. 5 ceclks(rangk 2 to 12 ceclks)and a mkan agk of 21. 5 months(rangk 1 to 84 months). Lmong thkm,149 casks wkrk diagnoskd clinicalle,131 casks wkrk diagnoskd pathologicalle. Eight casks wkrk in thk kxtraocular stagk,3 casks wkrk in glaucoma and 269 casks in intraocular pkriod(101 casks of singlk keks and 168 casks of doublk keks). BRN and Scr wkrk dktkctkd bkfork thk first coursk of chkmothkrape and aftkr thk last coursk of chkmothkrape. ResuIts BRN and Scr valuks wkrk analezkd bk-fork and aftkr chkmothkrape. BRN was 3. 05 mmol╱F bkfork chkmothkrape and 3. 46 mmol╱F aftkr chkmothkrape in thk group agkd from 4 months to lkss than 12 months(73 casks),thk valuks of BRN aftkr chkmothkrape was highkr than that bkfork chkmothkrape,and onle in this group thk changk was statisticalle diffkrknt(t﹦ -2. 829,P﹦0. 006),but all BRN valuks in this group wkrk not bkeond thk highkst rkfkrknck valuk(1. 70 mmol╱F-7. 10 mmol╱F). Bkfork initial chkmothkrape,149 patiknts( 53. 2﹪)had Scr bklow thk rkfkrknck rangk( malk:30 -104 μmol╱F,fkmalk:30 -84 μmol╱F),and 20 casks(7. 0﹪)had thk BRN bklow thk rkfkrknck valuk. In 2 casks,BRN(7. 25 mmol╱F and 7. 34 mmol╱F, rkspkctivkle)bkfork thk initial chkmothkrape was slightle highkr than thk normal valuk,but thk valuk was normal(5. 01 mmol╱F and 4. 98 mmol╱F,rkspkctivkle)aftkr thk last chkmothkrape. In onk cask,thk BRN(5. 62 mmol╱F)was normal bkfork thk initial chkmothkrape,but it was klkvatkd(7. 33 mmol╱F)aftkr thk last chkmothkrape. In anothkr onk cask,thk BRN was normal bkfork and aftkr chkmothkrape,but thk valuk aftkr chkmothkrape was 4. 69 timks highkr than that bk-fork chkmothkrape. ConcIusions Aknal function of Ab childrkn bkfork trkatmknt is normal. Skvkn pkrcknt of thksk patiknts havk BRN undkr thk BRN rkfkrknck rangk,and 53. 2﹪ of thksk patiknts havk Scr undkr thk Scr rkfkrknck rangk. It suggkstkd that thk rkfkrknck valuks of BRN and Scr nkkd to bk adjustkd. BRN of infant Ab mae incrkask signifi-cantle aftkr chkmothkrape,but it doks not mkkt thk currknt diagnostic critkria of mild nkphrotoxicite. Still,thk karle rknal damagk nkkds to bk notickd.

Objective:To investigate the efficacy of dual plate fixation in the treatment of proximal humeral fracture with comminuted calcar.Methods:From July 2018 to April 2020, 25 patients (7 males and 18 females) were treated operatively for proximal humeral fractures with calcar comminution using anterior plate and lateral Philos plate. The data of patients who were followed up for more than 12 months was retrospectively analyzed. The mean age was 58.3 years (range 33-79 years). There were 13 right sides (all principal sides) and 12 left sides (all non-principal sides). The causes of injuries included: falling on flat ground (12 cases), traffic accidents (11 cases) and falling from height (2 cases). According to Neer classification, there were 7 cases of two-part fractures, 16 cases of three-part fractures and 2 cases of four-part fractures. A number of parameters including patient demographics, mechanism of injury, operative time, time to union, the range of shoulder motion, visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley shoulder joint score, neck-shaft angle and the complications were recorded.Results:All of 25 patients were operated and followed up for 24.7 months (range 14 to 36 months). The operation time was 124.3 min (75-185 min), and the blood loss was 178.4 ml (100-350 ml). All patients had healed fractures at the last follow-up, and the neck-shaft angle was 132.88°±8.11° immediately after surgery, and 132.68°±8.36° at the last follow-up. All 25 patients healed completely in 4.7 months (range 3-5 months). Range of shoulder joint motion were forward flexion 161.20°±13.01° (range 140°-180°), external rotation 37.60°±7.65° (range 20°-45°), and internal rotation T 4-L 4 levels. VAS score was 0.36±0.81 points (range 0-3 points), while ASES score was 87.32±8.78 points (range 57.7-100 points) and Constant-Murley score was 89.40±8.37 points (range 60 to 100 points). Overall satisfaction score (Constant-Murley score) was excellent in 23 cases, and good in 2 cases. No obvious complications occurred. Conclusion:The combination of anterior plate and lateral Philos plate in the treatment of proximal humerus fractures with comminuted calcar can achieve stable fixation and satisfactory postoperative results.

Objective:To investigate the operation efficacy of anterior radius head fracture combined with lateral ligament complex injury.Methods:The patients with radial head fracture admitted from September 2017 to August 2021 were retrospectively analyzed, 51 males and 54 females, average age of 38.84±13.63 years (range of 16-70 years). Based on the radial head fractures of Mason classification of type II, the cases involving the anterior radius head fracture were divided into three subtypes according to the number of fracture blocks and the type of displacement: type A (53 cases): one part of the anterior radius head collapse fracture; type B (50 cases): two or more parts of the anterior radial head collapse fracture; type C (2 cases): anterior radius head dissociated and displaced fracture. All fractures were treated with open reduction and internal fixation. Among them, the lateral ligament complex of type B were elongated due to the injury but the continuity existed. Therefore, the lateral ligament complex in 21 cases were not repaired in the early period (unrepaired group); in recent years, 29 cases repaired the lateral ligament complex (repair group). The postoperative efficacy was evaluated by elbow range of motion, table-top relocation test, Mayo score, and Broberg Morrey score. the patients were evaluated at final follow-up, except table-top relocation test was recorded according to the actual completion time.Results:All operations were successfully completed. The mean follow-up was 14.08±1.52 months (range of 12-18 months). Type A: the flexion and extension range was 115.70°±6.35°; the completion time of the table-top relocation test was 75.68±11.90 days; the Mayo score was 93.72±2.40 point, and the Broberg Morrey score was 92.89±2.28 point. Type B: lateral ligament repair group (repaired group) 29 cases and unrepaired lateral ligament group (unrepaired group) 21 cases. The flexion and extension range of elbow in repaired group was 112.1°±4.4°, which was better than that in unrepaired group 105.8°±3.7° ( t=5.31, P<0.001). The completion time of table-top relocation test was 77.72±6.51 days in repaired group and 104.29±18.45 days in unrepaired group ( t=6.32, P<0.001). The Mayo score of the repaired group was 90.21±5.88 points and that of the unrepaired group was 87.14±5.26 points ( t=1.90, P=0.063), and there was no significant difference between the two groups. Broberg Morrey score of 90.93±6.43 points in the repaired group was better than 86.95±6.37 points in the unrepaired group ( t=2.17, P=0.035). Type C for 2 patients, the flexion and extension range of elbow were 107°and 106°; the completion time of table-top relocation test were 82 days and 98 days; the Mayo scores were 91 point and 87 point; Broberg Morrey scores were 93 point and 85 point. There was a patient developed myositis ossificans in unrepair group of tybe B. Conclusion:The elbow joint is stable when one part of the anterior radius head collapse fracture; there is a degree of instability in the elbow when two or more parts of the anterior radial head collapse fractures suggest to repair the lateral ligament complex. The elbow joint is extremely unstable when anterior radius head dissociated and displaced fractures, the lateral ligament complex should be repaired in time.

Objective: The aim of the current study is to compare the short-term clinical outcomes between Billroth-I reconstruction using an overlap method and delta-shaped anastomosis in totally laparoscopic distal gastrectomy (TLDG). Method: A retrospective cohort study was performed. The following inclusion criteria were applied: (1) Preoperative gastroscopy and CT confirmed that the tumor is located in the antrum of the stomach, and the biopsy suggested adenocarcinoma; (2) Chest, abdomen and pelvis enhanced CT showed no evidence of distant metastasis; (3) Preoperative gastric reconstruction CT or endoscopic ultrasonography suggested that the clinical stage of the tumor is stage I-III. (4) During the operation, the tumor position was confirmed to be located in the antrum of the stomach by nanocarbon injection or gastroscope; (5) Complete laparoscopic radical gastrectomy for distal gastrectomy, and the gastrointestinal reconstruction was performed by delta-shaped anastomosis or overlap anastomosis. And the following exclusion criteria were applied: (1) History of gastric surgery; (2) Patients who cannot tolerate laparoscopic surgery because of comorbidities. Finally, data on 43 consecutive patients who underwent TLDG with Billroth-I reconstruction between January 2016 and November 2018 in Peking Union Medical College Hospital were retrospectively reviewed. Patients were divided into those who underwent Billroth-I reconstruction using an overlap method (n=20) or using delta-shaped anastomosis (n=23). The demographic and clinical characteristics and perioperative data of the two groups were analyzed. Measurement data that conformed to the normal distribution were expressed as the mean ± s, and differences between groups were compared using Student′s t-test; comparisons between the counting data groups were performed using the χ² test or the continuously corrected χ² test. Results: The demographic and clinical characteristics were similar between the delta-shaped group and the overlap group (P>0.05). There was no significant difference between groups regarding operation time [(185.9±22.8) minutes vs. (184.0±25.8) minutes, t=0.260, P=0.796], blood loss [(50.9±36.0) ml vs. (47.0±30.8) ml, t=0.375, P=0.709], number of stapler reloads used for anastomosis (5.1±0.3 vs. 5.2±0.6, t=-0.465, P=0.651), time to flatus [(3.3±0.9) days vs. (3.6±0.9) days, t=-1.067, P=0.292) and postoperative hospitalization [(8.8±3.1) days vs. (10.4±3.8) days,t=-1.494, P=0.143]. As for the delta-shaped group and the overlap group, the anastomotic leakage rate was 4.3% (1/23) and 0 (χ²=0.000, P=1.000), respectively. The incidence of anastomotic bleeding was 4.3% (1/23) and 5.0% (1/20) (χ²=0.000, P=1.000), while the incidence of intra-abdominal hemorrhage was 4.3% (1/23) and 0 (χ²=0.000, P=1.000). The incidence of gastric emptying disorders was 4.3% (1/23) and 30.0% (6/20), respectively (χ²=3.454, P=0.063). All complications were cured after conservative treatment or symptomatic treatment. Conclusion The overlap method for Billroth-I reconstruction is safe and feasible.