7 cm in diameter)of the breast were treated in our hospital by lumpectomy via a periareolar incision.The length of the incision was less than half of the perimeter of the areola.For multiple fibroadenomas,circumareolar incision(not longer than half of the nipple-areolar perimeter)was made in different quadrants according to the position of the main tumor,so that the multiple benign tumors could be integrally removed through the approach between the hypodermic fat and glands via radial incisions.Similarly,giant benign tumors were treated through the same approach,cut into pieces,and then removed.Results Totally 165 tumors were removed from the 46 patients with multiple fibroadenomas.In the resected masses,19 were from one patient,who had bilateral multiple breast tumors.The 2 patients with giant breast fibroadenoma were also cured by lumpectomy,the diameter of the largest tumor in the two was 8 cm,while the circumareolar incisions were shorter than 3.5 cm.No nipple necrosis occurred after the operation in our series.Follow-up was achieved in all of the patients for 1 month to 2 years(mean,14.4 months),during which,11 cases showed no incision scar,26 had non-notable scars,9 cases developed observable incision scars,and 2 cases had apparent scars owing to their susceptibility to scar.Conclusions Lumpectomy via minor circumareolar incision is convenient and effective for multiple or giant benign fibroadenoma of the breast with good cosmetic outcomes.

Objective To investigate the effects of Huoxue yiqi runchang decoction in the treatment of chronic intractable constipation in colonic dynamics.Methods 68 cases patients of chronic obstinate functional constipation from October 2013 to June 2016 in linhai traditional chinese medicine hospital were selected and randomly divided into two groups,34 cases in each group,two groups received reasonable diet and lifestyle guidance and general treatment, and the control group received oral mosapride,and the experiment group received more with Huoxue yiqi runchang decoction.Levels of serum MTL and SP,the score of line Wexner constipation and GIQLI,colon motility examination,and clinical efficacy were compared.Results Compared with before treatment,levels of serum MTL and SP in two groups were increased (P<0.05),score of Wexner constipation decreased (P<0.05),and score of GIQLI increased (P<0.05),and transmission time of RCTT,LCTT and RSTT decreased (P<0.05).Compared with the control group,levels of serum MTL and SP in the experiment group were higher,score of Wexner constipation were lower (P<0.05),score of GIQLI were higher(P<0.05), and transmission time of RCTT,LCTT and RSTT was lower ( P <0.05 ) , and the clinical efficacy was higher ( P <0.05 ) .Conclusion Huoxue yiqi runchang decoction can improve clinical symptoms in patients with chronic constipation, and enhance the gastrointestinal motility,and improve the clinical efficacy.

Objective To develop a fluorescence signal activatable multifunctional molecular probe with theranostics function through combining ultrasmall gold nanorods(UGNRs) with fluorescein,and to evaluate its therapeutic effect on photothermal therapy (PTT) in breast cancer cells.Methods The UGNRs were synthesized by the one-pot seedless method,then the functionalized modification of UGNRs were conducted using cysteamine.Finally,the activatable ultrasmall gold nanorods (AUGNRs) were synthesized by amide condensation of —NH2 of cysteamine and —COOH of carboxylated fluorescein CyS.The cell uptake ability and GSH-mediated imaging ability of AUGNRs were studied using breast cancer 4T1 cells.4T1 cells co-cultured with AUGNRs were irradiated with 808 nm excitation light,and the PTT effects were assessed by MTT colorimetric staining and calcein-AM/PI staining.Results The AUGNRs were synthesized successfully,which could be uptaken by 4T1 cells quickly and efficiently,and could achieve intracellular glutathione (GSH) triggered fluorescence recovery.No obvious cytotoxicity of AUGNRs to 4T1 cells was observed in the co-cultivation.Moreover,obvious PTT effects could be induced by 808 nm laser,which could effectively kill 4T1 cancer cells.Conclusion The fluorescence signals of AUGNRs can be induced by intracellular GSH,and tumor cell destruction can be achieved by 808 laser-excitated PTT effects.

Objective:To compare the nutritional status between alcoholic cirrhosis and viral cirrhosis,and to provide reference information for the nutritional support strategy.Methods:95 alcoholic cirrhosis and 260 viral cirrhosis patients were involved in the study.The patients were reviewed with NRS 2002 and SGA within 48 hours after admission.The general information and liver function parameters including gender,age,BMI,Child-Pugh score,ALB,PA and Hb were recorded.Results:The NRS 2002 nutritional risk rate of alcoholic cirrhosis and viral cirrhosis patients was 76.80％ and 65.00％,respectively.The SGA malnutrition rate of alcoholic cirrhosis and viral cirrhosis patients was 67.40％ and 61.90％,respectively.There was statistically significant difference between the two groups in gender,Child-Pugh A rate,ALB,PA,Hb and NRS 2002,while there was no significant difference in age,Child-Pugh B rate,Child-Pugh C rate,BMI and SGA.Conclusion:Nutritional dysfunction exists in both of the two types of liver cirrhosis.The nutritional risk rate and the anemia rate in alcoholic cirrhosis patients are significantly worse than those in viral cirrhosis patients.

Objective To explore the effect of iliac artery to deep femoral artery angioplasty on the improvement of postoperative lower limb ischemic symptoms and recovery in patients with lower limb arteriosclerosis obliterans(LEASO).Methods One hundred and four LEASO patients in Dongzhimen Hospital of Beijing University of Chinese Medicine from December 2013 to July 2016 were involved in the study and they were divided into control group and observation group according to the treatment program,each group 52 cases.The control group was treated with conservative treatment,and the observation group was treated with iliac artery to deep femoral artery angioplasty.After treatment,the limb ischemic injury degree Rutherford classification and clinical efficacy of the two groups were compared,all patients were followed up for 6 months to compare the survival quality score before and 6-month after treatment.Results (1) Rutherford classification: after treatment,Rutherford classification in the observation group was significantly higher than that of the control group,the result was statistically significant (Z=2.160,P=0.031);(2) Clinical efficacy: the total effective rate in the observation group (94.23% (49/52)) was higher than that of the control group (76.92% (40/52)),the difference was statistically significant (χ2=6.310,P=0.012);(3) Life quality: before treatment,there was no significant difference between the two groups in terms of the quality of life score ((55.01±6.32) points vs.(54.89±6.14) points,t=0.098,P=0.922),but 6 months after treatment,the score of the observation group became higher than that of the control group ((69.63±7.51) points vs.(63.15±6.98) points,t=4.558,P=0.000).Conclusion The treatment of LEASO using iliac artery to deep femoral artery angioplasty can effectively improve patient''s lower limb ischemic symptoms and life quality.

OBJECTIVE ToinvestigatethepossibleprotectiveeffectofTripterygiumwilfordiipolyg-lycoside (TWP ) on experi mental diabetic nephropathy (D N ) rats and its possible mechanis m. METHODS Thediabeticmodelwasinducedbyasingleintraperitonealinjectionofstreptozotocin (STZ)65 mg·kg -1 .Three weeks after modeling,TWP 4.5,9.0 and 1 8.0 mg·kg -1 was ig given to rats,once daily,for 8 consecutive weeks.During the experiment,the changes of body mass,hair, mental health of rats were observed.Two days before the end of the experi ment,the rats were placed into metabolic cages to collect 24 h urine in order to detect 24 h urinary albu min excretion rate (UAER). The rats were given TWP for 8 weeks and anesthetized with 1 0%chloral hydrate.The blood was collect-ed fro m the heart and centrifuged,seru m creatinine and urine creatinine were measured,and creatinine clearance (Clcr)was calculated.Blood urea nitrogen (BUN)and the serum catalase (CAT)activity were tested by optical method while the level of seru m superoxide oxygen anion(O2÷)was tested by col-orimetry.The level of malondialdehyde(MDA)was determined by thiobarbituric acid condensation,and glutathione peroxidase (GSH-Px)activity was tested by colorimetry.The right kidney was HE stained to observepathologicalchanges.RESULTS Comparedwithnormalcontrolgroup,theratsinmodel control group developed polydipsia,polyuria,polyphagia,body mass loss,unresponsiveness,brown hair,pale tail and apathy clammy.Besides,blood glucose,BUN and 24 h UAER were significantly higher (P<0.01 ),but Clcr was lower (P<0.01 ).The activity of serum CAT and GSH-Px in renal tissue was significantly lower(P<0.01 ),while the level of serum O2÷ and MDA in the renal tissue was significantly higher(P<0.01 ).Compared with model control group,TWP 9.0 and 18.0 mg·kg -1 could improve the general condition of rats.BUN and 24 h UAER were obviously reduced(P<0.01 ),Clcr and serum CAT were increased obviously(P<0.01 ),the level of MDA and O2÷ were reduced obviously(P<0.01 ),and GSH-Px level was increased(P<0.01 ).TWP 9.0 and 18.0 mg·kg -1 could significantly im-prove the renal histopathological changes of rats.TWP 4.5 mg·kg -1 had no significant effect on the aboveindicators.CONCLUSION TWPhasprotectiveeffectontherenalfunctionofexperimentalDN rats.The mechanis m may be related to inhibition of the oxidative stress and enhance ment of the body antioxidant capacity.

The department of radiology, as one of the public platforms for standardized residency training, is very crucial to the training of high level clinicians and essential to improve quality of medical care. According to the present situation and existing problems of standardized residency training for the non-imaging professional residents in the department of radiology in China, combining with our practice, this article primarily explores the improvement of the rules and regulations, the specific arrangement of the rotation, daily and graduation examination forms, and training quality supervision, etc. We hope to improve the training quality of the non-imaging professional residents' rotation in the department of radiology and explore more suitable and effective medical educative strategies.

Objective To investigate the safety of the laparoscopic pancreaticoduodenectomy (LPD) in 70 years of age or older patients.Methods The retrospective cohort study was conducted.The clinicopathological data of 40 patients (age ≥70 years old) who underwent pancreaticoduodenectomy in the West China Hospital of Sichuan University between January 2012 and December 2016 were collected.Twenty patients undergoing LPD were allocated into the LPD group,and 20 receiving open pancreaticoduodenectomy (OPD) who were selected by random number table during the same period were allocated into the OPD group.Observation indicators included:(1) intraoperative situations;(2) postoperative situations;(3) follow-up situation.Follow-up using outpatient examination and telephone interview was performed to detect the patients' survival after discharge and tumor recurrence and metastasis up to March 2017.Measurement data with normal distribution was represented as x±s,and comparison between groups were evaluated with the t test.Measurement data with skewed distribution were described as median (range) and comparison between groups was analyzed using the nonparametric test.Comparison of count data was analyzed using the chi-square test.Comparison of ranked data was analyzed by non parametric test.Results (1) Intraoperative situations:1 patient in the LPD group was converted to open surgery,with a conversive rate of 5.0％ (1/20).Operative time and volume of intraoperative blood loss were (463 ± 10) minutes,210.5 mL (152.5-300.0 mL) in the LPD group and (332± 25) minutes,420.0 mL (350.1-493.8 mL) in the OPD group,showing statistically significant differences between the 2 groups (t =5.48,Z =-3.98,P＜0.05).Cases with intraoperative blood transfusion and pylorus preservation were respectively 4,14 in the LPD group and 6,10 in the OPD group,showing no statistically significant difference between the 2 groups (x2=0.53,1.67,P＞0.05).The results of intraoperative rapid frozen pathological examination showed negative margin of the 40 patients.(2) Postoperative situations:cases in ICU,cases with postoperative analgesia,time for out-of-bed activity,time to anal exsufflation and time for intake were 17,7,(2.2±0.7)days,(4.2± 0.9)days,(4.8±0.7)days in the LPD group and 6,15,(3.6±0.8)days,(5.7±0.9)days,(7.1 ± 2.7)days in the OPD group,showing statistically significant differences between the 2 groups (x2 =12.34,6.47,t=-6.18,-6.55,-3.65,P＜0.05).Pancreatic fistula,delayed gastric emptying (Grade B),postoperative bleeding (Grade B),biliary fistula,pulmonary infection,intestinal obstruction,wound infection,reoperation and major complication were respectively detected in 2,3,1,1,3,1,0,2,3 patients of the LPD group and 2,4,1,1,4,1,2,3,4 in patients of the OPD group,showing no statistically significant difference between the 2 groups (x2 =0.00,0.17,0.00,0.00,0.17,0.00,2.11,0.23,0.17,P＞0.05).Results of postoperative pathological examination showed that duodenal adenocarcinoma,ampullary carcinoma,lower bile duct carcinoma,pancreatic ductal adenocarcinoma and pancreatic cystic tumor were respectively detected in 8,2,5,3,2 patients of the LPD group and 10,2,4,2,2 patients of the OPD group,showing no statistically significant difference between the 2 groups (x2 =0.53,P＞0.05).Duration of postoperative hospital stay in the LPD and OPD groups were (19± 13) days and (15±7) days,respectively,showing no statistically significant difference between the 2 groups (t =1.28,P＞ 0.05).Results of postoperative oncology showed that tumor diameter,number of lymph node dissected,number of positive lymph nodes,cases with negative margin,cases in T1N0M0,T2N0M0,T3N0M0,T3N1M0,T4N0M0,T4N1M0 of TNM staging were respectively (2.4±0.7)cm,15.4±2.3,2,20,2,7,8,2,1,0 in the LPD group and (2.8±0.9)cm,14.4±2.5,3,20,1,8,5,2,3,1 in the OPD group,with no statistically significant difference between the 2 groups (t =-1.64,1.32,x2 =0.23,0.00,Z =-0.69,P＞ 0.05).(3) Follow-up situation:1 patient died respectively in both groups within the postoperative 30 days.Thirty-eight patients were followed up for 1-26 months,with a median time of 14 months.During follow-up,2 patients had tumor recurrence and 1 died of myocardial infarction in the LPD group;3 had tumor recurrence and 1 died of tumor recurrence in the OPD group.Conclusion LPD in 70 years of age or older patients is not only safe and feasible,but also significantly reduce volume of intraoperative blood loss and demand of analgesia,as well as quickly resume normal diet and activities.

Described gambro hemodialysis reverse osmosis water treatment system can not supply water due to PC PLC failure, the reasons of failure were analysed, troubleshooting methods and procedures were introduced.
Maintenance ; Renal Dialysis ; instrumentation

Objective To investigate the effect of long-term walking exercise on the health status of low-labor-intensity population under long-term walking exercise.Methods A total of 100 volunteer teachers from universities in Beijing were enrolled.After physical examination,they were randomly divided into control group and observation group.The observation group regularly carried out corresponding encouragingactivities and recorded the daily number of steps.The corresponding indexes were measured again after 450 days.Results 45.24％ participants in the observation group got more than 75％ participation rate.The lower the participation rate,the lower the average daily steps (P ＜ 0.05).The fasting blood glucose,systolic blood pressure,LDL and total cholesterol were lower than other groups in the group participation rate ＜25％ (P ＜0,05).The body mass index,systolic blood pressure,fasting blood glucose,total cholesterol,ratio diabetes and hypertension in low activities group (＜ 7 500 steps/day) were lower than those in other groups (P ＜ 0.05).Conclusions Walking exercise can achieve good long-term persistence with constant feedback.For those who are older and whose initial indicators are higher,participation rate and exercise volume are more likely to be better under the guidance of encouragement.Persisting long-term walking exercise can help reduce blood pressure and blood lipids.