Breast conserving surgery has become the first choice for the treatment of early breast cancer.However,the safety margin is still one of the important issues for surgeons in the implementation of breast conserving surgery.Because variety of clinical factors have some effects on the safety margin,at present,no consensus on safe margin of breast conserving surgery is reached,and the controversy still goes on.

Objective To study the relevance between blood loss, widespread brain contusion injury and consumptive coagulopathy. Methods One hundred and fifty-three cases with severe brain injury was studied about their coagulation data. Analyzed the relationship between blood loss group according to ≥3000 ml and ＜ 3000 ml and coagulation features, the relationship between widespread brain contusion injury and disorder of coagulation;according to whether with brain contusion injury,kinds of bloods transplant and prognosis were asseseed;according to whether with widespread brain contusion injury in ≥ 3000 ml blood loss group,kinds of bloods transplant and prognosis were assessed. Results Compared with ＜ 3000 ml blood loss patients, ≥ 3000 ml patients' blood coagulation changed obviously, with PT prolonging, Fbg and Plt decreasing, the differences were statistically significant (P ＜ 0.05). Compared with no extensive brain contusion injury patients, in extensive brain contusion injury patients, APTT, PT, TT prolonged, Fbg and Plt decreased,and the difference was statistically significant (P ＜0.05). Extensive brain contusion injury patients with blood loss compared with those without such loss, needed more blood transfusion volume,larger amount of input of fresh frozen plasma Plt volume,the former survival rate was lower [68.29%(28/41)vs. 96.43%(108/112)], the difference between them was statistically significant (P＜ 0.05 ). In 41 patients who had brain widespread contusion ,the cases with extensive blood loss ( ≥ 3000 ml) were compared with those ＜ 3000 ml, and the differences in blood transfusion treatment, fresh frozen plasma, Plt volume,survival rate were statistically significant (P ＜ 0.05). Conclusion When blood loss ≥ 3000 ml after trauma,patients show various degrees of coagulopathy,and when accompanied with extensive brain tissue injury,coagulation disorders are more obvious, and the prognosis is even worse.

A nuclear accident likely leads to the leakage of radiocesium to a large degree,which could poses threatens to the environment and human heahh.Hence,it is very important to remove radiocesium ion from the environment and human body in the aftermath of a nuclear accident.In this review,the new progress of radiocesium ion removal in a nuclear emergency is discussed.The main technique to reduce soil pollution is to remove and purify topsoil.The methods of purification include leaching method,electrokinetic process and soil immobilization.The technique to remove radiocesium from water is mainly via adsorption.Common adsorbents include crown ether,calix ether,ammonium molybdophosphate and Prussian blue.Radiocesium removal from human body is mainly via oral administration of Prussian blue at fractioned doses in a timely manner but spents a relatively long response time,possibly accompanied with some severe side effects,like hypopotassemia and physical damage of digestive tract.Therefore,new techniques are still in need of development to remove radiocesium ion from human body more effectively.

Background:Studies have shown that GEF-H1 can activate Rho protein, and is closely associated with tumorigenesis,tumor progression,infiltration,migration. Aims:To construct human pEGFP-GEF-H1 vector and stably transfect into colon cancer HCT116 cells,and determine the expression of GEF-H1. Methods:The gene sequence was designed according to the Online primers synthesis software for constructing recombinant plasmid pEGFP-GEF-H1. HCT116 cells were transfected with plasmid pEGFP-GEF-H1,empty plasmid,respectively,and HCT116 cells without transfection were served as blank control group. Expression of green fluorescence protein was observed under fluorescence microscope. mRNA and protein expressions of GEF-H1 were determined by RT-PCR and Western blotting,respectively. Results:Human pEGFP-GEF-H1 vector was successfully constructed and identified by sequence analysis. After transfection with pEGFP-GEF-H1,green fluorescence could be observed in HCT116 cells,and the mRNA and protein expressions of GEF-H1 were higher than those in empty plasmid group and blank control group. Conclusions:Recombinant plasmid pEGFP-GEF-H1 is successfully constructed in vitro,and transfection into HCT116 cells leads to high expression of GEF-H1, thereby can provide experimental materials needed for further study on correlation between colon cancer and GEF-H1.

Objective To study the clinical features,diagnosis and treatment of polycystic liver disease (PLD)complicated with portal hypertension (PHT).Methods The clinical data of one patient with PLD and PHT was retrospectively analyzed,and relevant literature was reviewed.Results The patient presented fatigue,dyspepsia, abdominal distension and lower limb edema.Laboratory examination showed mild liver dysfunction(Alkaline phospha-tase 291.2U/L,gamma glutamyl transpeptidase 168.1U/L,59.9g/L,total protein,albumin 32.2g/L,21.0μmol /L, total bilirubin,direct bilirubin 11.5μmol /L).Abdominal ultrasound (US)and computerized tomography (CT) showed multiple noncommunicating cysts of varying size in both liver and kidney.Antioxidant supplements and diuretic were introduced,and the therapy was approved to be effective.Conclusion The case in this report illustrates that PLD could occasionally present with PHT.Physician should be alert to prevent misdiagnosis.

OBJECTIVEThis study aims to construct a long-term, osteogenesis-targeting HU-308 drug delivery implant by the layer-by-layer electrostatic self-assembly (LBL) technique, and observe the features of its delayed release in vitro.

METHODSA heparin (Hep) and chitosan (Chi) multilayer was coated on pure titanium using the LBL technique, and the titanium implants were dipped into the solution to load HU-308. The amount of loaded drug and release rates were measured using a UV-Vis spectrophotometer. The relationships between the loading efficiency, release time, and multilayer films were evaluated. The morphology of all the multilayers was characterized by scanning electron microscopy (SEM) and atomic force microscopy (AFM).

RESULTSThe results showed that the Hep/Chi self-assembly multilayer was gradually fabricated on the titanium surface. HU-308 was successfully loaded on the titanium implants. The amount of loaded drug increased with the amount of multilayer films, except in the T20 group. In vitro drug release study showed that drug release was more difficult in the system with thicker films, and large amounts of multilayer films decreased the release speed. Both SEM and AFM measurements showed typical LBL deposition of Hep and Chi.

CONCLUSIONThe HU-308 drug delivery implant is successfully fabricated via LBL technology. It could provide sustained release of HU-308 over 30 d. This type of implant may provide a new possi- bility of promoting implant-bone osseointegration for osteoporotic patients.

Objective To evaluate the effect of dexmedetomidine on the quality of recovery from sevoflurane-based anesthesia in the patients undergoing abdominal surgery.Methods Eighty patients of both sexes, aged 30-64 yr, weighing 45-80 kg, with American Society of Anesthesiologists physical status Ⅰ or Ⅱ , scheduled for elective abdominal surgery, were randomly assigned into 2 groups (n =40 each) using a random number table: control group (group C) and dexmedetomidine group (group D).After routine induction of anesthesia, all the patients were tracheally intubated, and mechanically ventilated.Anesthesia was maintained with sevoflurane inhalation and intermittent iv boluses of sufentanil and cisatracurium besylate, and bispectral index values were maintained at 45-60.After induction of anesthesia, dexmedetomidine was infused in a dose of 1 μg/kg over 15 min, followed by a continuous infusion of 0.6 μg · kg-1 · h-1 until 30 min before the end of surgery in group D.Group C received normal saline instead.Heart rate (HR) and mean arterial pressure (MAP) were recorded at the end of surgery, and at 1 min before and after extubation.The emergence time, extubation time, and occurrence of bucking during extubation, and nausea and vomiting, respiratory depression, and agitation during recovery from anesthesia were recorded.Results Compared with group C, MAP and HR were significantly decreased at 1 min before and after extubation, the emergence time and extubation time were shortened, the incidence of bucking, nausea and vomiting, and agitation was decreased, and no significant change was found in the incidence of respiratory depression in group D.Conclusion Dexmedetomidine infused in a dose of 1 μg/kg after routine induction of anesthesia, followed by a continuous infusion of 0.6 μg · kg-1 · h-1 until 30 min before the end of surgery, can significantly increase the quality of recovery from sevoflurane-based anesthesia in the patients undergoing abdominal surgery.

Objective To evaluate the clinical efficiency and seeurity of SilverHawk directional atherectomy device in treating arteriosclerosis obliterans of lower extremity.Methods Seyen patients with lower extremity ischemia were treated with SilverHawk directional atherectomy.The lesions length varied from 1.8 to 14.5 cm.Clinical symptoms(Fontaine classification)included 4 cases of grade Ⅱ b,1 case of grade Ⅲ,2 cases of grade Ⅳ.The ABI varied from 0.28 to 0.65.Patency was evaluated with color duplex sonography or CTA besides clinical examination during follow-up.Results Seven occlusive lesions were recanalizated successfully.The technical success(residual stenosis<30%)rate was 100%. Clinical symptoms were obviously improved or disappeared.The ABI varied from 0.82 to 1.18(P=0.002),and Fontaine classification included 6 cases of Ⅰ:1 case of Ⅱ a.Patency rate was 100%and the ABI varied from 0.75 to 1.14(P=0.938).Fontaine classifications keep consistent l-6 nonths after operation.Conclusion SilverHawk drectional atherectomy Was a safe and effective way for treatment of lower arteriosclerosis obliteran.

Objective To evaluate a minimally invasive procedure for intertrochanteric fracture treatment in elderly patients. Methods Total 46 elderly patients with intertrochanteric fracture were treated with a minimally invasive procedure from September 2008 to February 2010. The fractures were fixed with multiple K-wires combined with skeletal traction through supracondyle of femur. All procedures were undertaken under local anesthesia. Results All the patients were followed up for 8.8-months in average, and 42 patients recovered with independent walking, and the good rates was 91.3%, without severe complications in this group. Conclusions Minimally invasive procedure including fixation with multiple K-wires combined with traction through femoral supracondyle, is a safe and effective treatment for intertrochanteric fracture in elderly patients, avoiding high risks of intra-and post-operative complications.

ObjectiveTo investigate the efifcacy of alarm treatment in a sample of China monosymptomatic nocturnal enuresis (MNE) children and adolescents with smaller than expected bladder capacity (EBC) for age.Methods Fifteen MNE pa-tients with a smaller than age-expected BC and without nocturia were included. All the patients were treated with enuretic alarm and water restriction 2 hours before sleep. All patients were followed up monthly. A success criterion was deifned as “14 con-secutive dry nights” after successive 2-3 months treatment. A relapse criterion was deifned as “more than two wet nights every two weeks” after therapy discontinuation. The relapsed patients were treated with enuretic alarm and followed up again.Results The patients consisted of 9 boys and 6 girls. The mean age was 9.76±4.24 years (6-15 years). Thirteen patients were successfully cured after three months treatment. Two patients discontinued the treatment and received the treatment of desmopressin. Five patients relapsed and received the enuresis alarm treatment again. Four patients had never relapsed, and one failed. The cure rate was 80%.Conclusions The enuretic alarm device is effective on MNE patients with a smaller than age-expected BC and without nocturia.