Objective To evaluate the diagnosis, treatment and prognosis of occult breast cancer(OBC). Methods Clinical data of 12 OBC cases from June 1995 to June 2006 were retrospectively analyzed.Results There were 12 female; the mean age was 52.7 years(39～66). Tumor of all cases was in one of breasts, left(10 cases) or right(2 cases), 4 cases in pro- menostasis, 8 cases in post-menopause, and inci-dence of OBC in all kinds of breast cancer was 0.5% (12/2385). All cases were found because of lump in axillary fossa, the biopsy of 10 showed cases were lymph node adenocarcinoma metastatic, the fine needle aspiration of 2 cases were lymph node adenocarcinoma metastatic. Three cases were positive in the determi-nation of estrogen receptor of lymph node adenocareinoma metastatic. Two cases, suspecting breast cancer,could be found fine calcification in the examination of breast X-ray molybdenum target in 10 cases. Buhra-sound in 11 cases and near infrared ray scan in 10 cases did not detect cancer in breast; chest X-ray and Bultrasound in 10 cases and CT and all over the body bone scan in 5 cases did not found any cancer besides breast. Ten cases used modified radical mastectomy for breast cancer, one case radical mastectomy for breast cancer, one palliative operation. Pathological diagnosis of 9 cases after operation found breast primary le-sion, 6 cases were infiltrated duct cancer, 3 eases were intraductal cancer. All cases received radiotherapy and chemotherapy. Three cases which were positive in the determination of estrogen receptor of lymph node adenocarcinoma metastatic received TAM. Followed-up was made from 3 to 10 years, 11 cases were not found recurrence or metastses, and 5 cases had been living over 5 years. Conclusions OBC is one of rare special breast cancers. The powerful infiltrating capability leads to lump in axillary fessa in prophase and dis-rant metastses. The biopsy and fine needle aspiration would be used for diagnosis. Modified radical mastecto-my for breast cancer is the usual therapy method.

Objective To analyze the learning curve of microendoscopic lumbar discectomy (MED) and summarize the operative experience. Methods From July 2010 to March 2012, the first 100 patients with single level lumbar disc herniation managed with MED were divided into chronological groups (A, B, C and D), 30 patients in group A, B, C and 10 patients in group D. The comparsons were conducted in terms of operative time , estimated blood loss , number of cases with transition from MED to open surgey or for reoperation , rate of complications and postoperative efficacy. Results The mean operative time and the mean estimated blood loss in each group was valuated respectively. In group A , the operative time and estimated blood loss were significantly decreased as compared with those in group B, C and D respectively (P < 0.05), but those in group B were not significantly different from those in group C and D (P > 0.05). There were 6 complications in group A, 1 complication in group B and C respectively and no complication in group D. The leg pain visual analogue scale and Oswestry disability index at the first month and the twelfth month postoperatively were all improved respectively as compared with those preoperatively (P < 0.01). Conclusion The learning curve of microendoscopic lumbar discectomy generally may reach the plateau when about 30 cases are operated on. The key procedure to pass over the learning curve includes puncture and location , flavectomy , anatomy mark identification, and precaution of damage in dural sac.

The complement system is a part of the innate immune system, playing an important role in protecting hosts from pathogens.Many researches showed that complements were strongly associated with a wide spectrum of glomerulonephritis, such as IgA nephropathy, membranous nephropathy, post infectious glomerulonephritis, membranoproliferative glomerulonephritis, C 3 nephropathy, focal segmental glomerulosclerosis, lupus nephritis, and ANCA induced renal vasculitis.Various factors may induce abnormal activation or dysregulation of the local or systemic complement system, resulting in further kidney injury.Selective blocking of the complement cascades could protect the kidney.Further investigations are needed to fully understand the mechanism of complement, and targeting complement could be considered a novel therapeutic method in refractory renal diseases.

AIM:To investigate the effect of hepatic oval cells (HOCs) on the protein expression of TGF-?/Smad signaling pathway in the liver tissue of hepatic fibrosis rats.METHODS:The SD rat models of liver fibrosis were made by treating with carbon tetrachloride and combined factors.The HOCs was isolated from the model rats.HOCs suspension (0.5 mL at a density of 1 ? 1012cells/L) were transplanted via portal vein into the hepatic fibrosis rats at 8th week and observed continuously for 30 days.Meanwhile,WuLing capsules were used for positive control.The blood samples were collected through trail vein at 8th day,15th day,23th day and 30th day after transplantation of HOCs.The levels of aspartate aminotransferase (AST) and alamine aminotransferase (ALT) in serum were determined by enzyme method.The morphological changes of hepatic tissues were observed under microscope with HE and Musson staining.The protein levels of collagen type I (Col-Ⅰ),extracellular-signal regulated protein kinase (ERK),phosphory-lation extracellular regulatedprotein kinases (p-ERK),TGF-? receptor type Ⅰ (T?RⅠ),TGF-? receptor type Ⅱ (T?RⅡ),mothers against decapentaplegic homolog 2 /3 (Smad 2 /3) and mothers against decapentaplegic homolog (Smad 7) were assessed in liver tissues by Western blotting.RESULTS:In HOCs and WuLing capsules treated groups,the levels of ALT and AST decreased significantly at 15th day,23th day and 30th day after the transplantation of HOC.The damage degree of hepatic fiber hyperplasia of the liver histological structure reduced notably.The expression levels of Col-Ⅰ,ERK,p-ERK,T?RⅠ and T?RⅡ in liver tissues of hepatic fibrosis rats were down-regulated obviously while the expression of Smad 7 increased significantly.CONCLUSION:The implantation of HOCs prevents the progress of liver fibrosis in rats.The mechanism of action is to inhibit the protein expression of p-ERK,T?RⅠ,T?R Ⅱ for TGF-?/Smad signaling pathway of liver tissue.

Objective:To evaluate the security of recombinant human brain natriuretic peptide (rhBNP)in the treatment of acute decompensated heart failure (ADHF ), and to provide the basis for its application.Methods:Both foreign language databases including PubMed,The Cochrane Library (Issue 1,2015),EMBase and Chinese databases involving CNKI,VIP and Wanfang Data were searched.Two reviewers independently extracted the data,and assessed the quality;then the Meta-analysis was performed by using RevMan 5.1 software and Stata 12.0 software.Results:A total of 35 randomized controlled trials (RCTs)involving 12 143 patients were included. The results of Meta-analysis showed that compared with control group the 1-month mortality (RR=1.01,95%CI:0.85-1.21,P =0.88),3-month mortality (RR=0.89,95%CI:0.63-1.27,P =0.53)and 6-month mortality (RR = 0.97, 95% CI: 0.87 - 1.08,P = 0.59 )in rhBNP group had no statistical differences;no statistical difference was found in the incidence of side effects (RR=1.01,95%CI:0.71-1.43,P =0.97).The incidence of hypotension in rhBNP group was significantly higher than that in control group (RR= 1.42,95%CI:0.99 -2.03,P =0.06).Conclusion:Compared with dobutamine,vasodilator drugs and placebo,rhBNP doesn’t change the mortality and incidence of adverse reactions of the patients with ADHF,but increases the risk of hypotension.Clinical application of rhBNP should be reasonable and its effectiveness should be exerted sufficiently,meanwhile,as much as possible to avoid hypotension,etc.

Objective To explore the difference between laparoscopic transabdominal preperitoneal hernia repair (TAPP) and open preperitoneal hernia repair for the treatment of inguinal hernia under local anesthesia.Methods A total of 64 cases with inguinal hernia underwent hernia repair in Beijing Daxing District Hospital of Capital Medical University from January 2014 to January 2015 were retrospectively analyzed.Thirty-four cases in test group were applied with TAPP and used D(9 * 13) mesh to repair for inguinal hernia,and 30 cases in traditional group with open preperitoneal hernia repair which used D10 mesh to repair for inguinal hernia.Results All operations were successfully completed.There was statistically significant difference in operation time(P =0.000),postoperative activity time(P =0.000),postoperative hospitalization time (P =0.003) and pass flatus time (P =0.000) between these two groups.There was no statistically significant difference in wound seroma(P =0.216),hematoma (P =1.000),analgesics (P =0.090) and recurrence rate of the first year (P =1.000).Conclusions Both TAPP and tension free repair of inguinal hernia under regional anesthesia are safe and effective methods for the treatment of inguinal hernia,which has its advantages.Surgeon should choose the suitable procedure according to patient's condition reasonably.

Objective To study the feasibility of laparoscopic cholecystectomy in low pneumoperitoneum pres sure and the effct of low pressure pneumoperitoneum on liver enzymes.Methods A total of 128 cases of laparoscopic gallbladder resection for gallbladder stones or chronic acalculous cholecystitis patients came from outpatient of Department of Two General Surgery of Daxing Hospital Affiliated to Capital Medical University from Jan.2010 to Apr.2015.Patients with odd hospital numbers were divided into the conventional pressure group (group A:12-14 mmHg,n =64).Patients with even numbers were divided into the low pressure group (group B:8-10 mmHg,n =64).The venous blood was respectively collected at the first day and second day preoperatively to determine and compare the contents of alanine aminotransferase (ALT) and aspartate aminotransferase(AST) in two groups.The mean and standard deviation of the above indexes and operation time of two group patients are compared.Results All patients were successfully completed surgery.The average operation time of group A was (65 ± 6.5) minutes,and group B was (61 ± 8.2) minutes,and there was no significant difference between the two groups (t =2.212,P =0.976).Compared with the A group,the B group had less effect on the aminotransferase,the data of the two groups were significantly different (P ＜ 0.05).Conclusion Laparoscopic gallbladder resection underwent the low pneumoperitoneal pressure (8-10 mmHg) is safe and feasible,doesnt extend the operation time,and helps to reduce the effect of pneumoperitoneum pressure on transaminase,which is much important for patients with abnormal aminotransferase preoperative.

Objective To investigate the distribution of femoro-popliteal artery chronic totally occlusions (CTO) and to analyze the influence of different risk factors on the distribution of lesions. Methods A total of 47 patients with CTA and DSA proved femoro-popliteal artery CTO, who were admitted to the Affiliated Beijing Shijitan Hospital of Capital Medical University during the period from January 2013 and May 2015, were enrolled in this study. In order to make a clear description about the distribution characteristics of the lesions, the superficial femoral artery was averagely divided into three segments (F1-F3), and the popliteal artery was also divided into three segments (P1-P3) according to the bony landmarks. Based on the CTA images (including 3D reconstruction images) and DSA images, the distribution of CTO lesions was determined. The factors that might influence the distribution of CTO lesions were collected, and the results were analyzed using multivariable logistic regression analysis. Results A total of 59 femoro-popliteal artery CTO lesions detected in 47 patients were included in this study. The average length of lesion segment was (12.91 ± 10.13) cm. According to the 6-section division method of femoro-popliteal artery, the lesions involved F1 (n=23), F2(n=34), F3(n=48), P1(n=18), P2(n=6) as well as P3(n=5) segments. Multivariable logistic regression analysis reveals that F1 segment was most prone to be affected by CTO lesions in patients with hypertension (RR=3.21) and in patients who had cigarette smoking habit (RR=1.76). In male patients, P1segment was more easil y involved by CTO lesions (RR=1.98). In patients with diabetes mellitus, the RR value was gradually increased from the proximal to the distal end of the blood vessel, indicating that the lesion was more likely to involve distal vessels. Conclusion The distributions of femoro-popliteal artery CTO lesions have certain characteristics, which are closely associated with femoro-popliteal artery hemodynamics and atherosclerosis risk factors.

Objective To observe the influence of hepatic oval cell (HOC) on the expression ERK and P38MAPK signaling pathway protein in liver tissue of murine experimental hepatofibrosis (HF).Method SD rats were fed with 10% ethanol and food with high-fat and low-protein, and were injected subcutaneously with carbontetrachloride once every four days for 8 weeks to establish hepatic fibrosis. HOGs were isolated from male HF rats by collagenase porfusion of the liver. HF rats at 8th week were transplanted with 0. 5 ml HOC suspension medium at a density of 1 × 109 cell /ml via portal vein, and the rats were sacrificed at 8th, 15th, 30th day respectively. Histopathologic changes of liver tissues were observed by HE and Masson. The expression of ERK and P38MAPK signaling pathway protein were determined by Western blotting. Result Hepatofibrosis was reversed and the degree of hyperplasia fibrilcollagen in hepatic fibrosis rats decreased significantly by HOC transplantion. HOC down-regulated the protein expression of Ras, ERK,p-ERK, c-fos, c-jun, STAT3, ALB, FGF-3, PCNA ( F = 91.88,36.28,54.66,93.07,64.76,58.49,52.63,20.45 ,27.03, all P ＜ 0.05 ), up-regulated the protein expression level of HNF-α1, PDGF-Rβ significantly in liver tissues(F = 18.63,25.99,P ＜0.05). Conclusions HOC improves the degree of hepatofibrosis through inhibiting hyperplasia of collagen fibril in liver tissue of hepatofibrosis rats. With the presence of HOC the expression of c-fos,c-jun,STAT3,5 was not activated by p-P38MAPK. The expression of c-kit and HNF-1α increased and that liver tissue injury alleviated, and hepatofibrosis was improved.

The quality and safety of traditional Chinese medicines directly affect the development of the entire Chinese medicine industry. Establishing and improving traceability systems for Chinese medicine quality will play a decisive role in improving the quality of Chinese medicine. The traceability system of Chinese herbal medicines as an important part of the quality traceability system of traditional Chinese medicine overcomes the inability of existing technologies to achieve traceability, control, and queryability of information on the whole process of planting Chinese medicinal materials. The recording, inquiry and traceability of important information to track and supervise the whole process of cultivation of Chinese herbal medicines is an effective measure to realize the availability, retrievability and accountability of Chinese medicines, and to strengthen quality safety management and risk control throughout the entire process.