Objective To investigate the possibility and accuracy of idenfication of the sentinel lymph node(SLN) in breast cancer(BC) by using methylene blue intra operatively.Methods 4～6ml methylene blue dye was injected around the breast mass intra operatively. 5～10 minutes after injection,the operation for BC was performed. All blue stained lymph nodes found during operation were considered as SLN, and removed for pathological examination. All patients had axillary lymphadenectomy(ALDN),and the acquired nonsentinel lymph nodes(NSLN)from them were also examined. Results The SLN were identified in 45 of 50 patients(90.0%).There were all 117 SLNs in this series. Of 117 SLNs,111 were located in stage I lymph nodes in axilla(95.0%),and 6 SLNs in stage II(5.0%). Of the 5 cases of the unidentified SLN,the primary tumor was located in the inferior quadrant in 4 cases,and in the uper quadrant in 1 case (P0.05). Histologic status of the SLNs accurately predicted axillary nodes status with an accuracy rate of 91.0%. 4 cases or SLN examination were negative while their NSLN were positive with false negative rate 8.9%. Conclusions This technique can identify SLN accurately;the histology of SLN can predict axillary status correctly. Sentinel lymph node has correlation with the location of the primary tumor but has no correlation with the size of the tumor or breast operation before.

Objective To evaluate the prevalence and the predictors of clopidogrel therapy after DES implantation,and to determine the impact of discontinuation of clopidogrel therapy on the occurrence of late stent thrombosis(ST)and very late stent thrombosis.Methods Between July 2003 and June 2005,2 930 consecutive patients treated with PCI and DES implantation in Anzhen hospital were involved in the study,and among them,13 patients died within 3 dys after PCI.A total of 2 704 patients out of the 2 917 patients were followed up successfully for at least 2 years,or mortality.All of the clinical,angiographic and intervention treatment character were recorded.ST was adjudicated by the definition of ARC Dublin.Patients were grouped by the duration of clopidogrel therapy to 4 groups(group 1,12 months).The duration of clopidogrel therapy and the predictors of the premature discontinuation of clopidogrel were evaluated,and the rate of late ST(1 month to 12 months)and very late ST(after 12 months)in the 4 groups were analysised.Results There were 82(3.0%)patients in group 1,333(12.3%)patients in group 2,1 590(58.8%)patients in group 3,and 699(25.9%)patients in group 4.In contrast with group 4,the mean level of total cholesterol were higher,mean LVEF value were lower,more patients were diabetes,less patients were STEMI,and the mean number of DES implantation was less in group 1-3.In group 1 and group 2,most of the discontinuation of clopidogrel therapy(95.1%,85.9% respectively)were directed by patients themselves;and in group 3,71.1% of the patients discortinued clopidogrel therapy on the doctor's order.There was no significant differences among the 3 groups on discontinuation of clopidogrel for bleeding or other operations.By Cox regression,diabetes(OR=1.542,95% CI=1.184-2.008,P=0.001)and number and DES implantation(OR=0.790,95% CI=0.709-0.880,P

Objective To understand antimicrobial resistance and therapeutic efficacy of imipenem/cilastatin and meropenem for treatment of multidrug-resistant Pseudomonas aeruginosa (MDRPA)from patients with mechanical ventilation.Methods From January 2010 to December 2015,78 patients with mechanical ventilation and isolated MDRPA from sputum cultures were selected and divided into imipenem/cilastatin (n=44)and meropenem(n=34) treatment groups,basic condition,time of emergence of drug resistance,and therapeutic efficacy of antimicrobial agents between two groups were compared.Results The basic data of two groups were comparable,before treat-ment by imipenem/cilastatin and meropenem,resistance rates of Pseudomonas aeruginosa (P .aeruginosa )to quinolones,ceftazidime,piperacillin,and amikacin were not significantly different (all P >0.05).After patients received antimicrobial agents for 6 days,difference in antimicrobial resistance between imipenem /cilastatin and meropenem treatment groups were not significantly different (22.73% vs 8.82%,P >0.05).On the 8th,10th,and 12th day of treatment,resistance rates of imipenem treatment group were 40.91%,77.27%,and 97.73%, respectively,which were all higher than meropenem treatment group (17.65%,32.35%,44.12%,respectively,all P <0.05).After the treatment with different antimicrobial agents,the average time for the emergence of resistance in imipenem/cilastatin and meropenem treatment group were 9.0 days and 13.5 days respectively.Therapeutic efficacy between two groups was not significantly different (64.71% vs 74.19%,P =0.41).Conclusion Compared with meropenem,imipenem/cilastatin shows higher risk for the emergence of drug resistance during therapy of P . aeruginosa infection in patients with mechanical ventilation,there is no significant difference in therapeutic efficacy between two groups of patients after 7 days of treatment.

Objective To investigate the correlation between preoperative anxiety and emergence agitation(EA)in children after sevoflurane anesthesia.Methods A total of 120 children who were going to receive an elective surgery were recruited in this study.The preoperative anxiety in these children was measured through the Modified Yale Preoperative Anxiety Scale(mYPAS)at the following time:during the preoperative interview(T1),waiting period in surgery waiting room(T2),after the children entered the operating room(T3)and at the beginning of sevoflurane inhalation induction(T4).The emergence agitation(EA)scores were obtained by using the Pediatric Anesthesia Emergence Delirium(PAED) Scale after the surgery.Results After adjusting for the effect of age,it was found that the anxiety scores at T1 and T2 had no significant correlation with EA,while those in T3 and T4 showed a statistically significant correlation with EA.The level of anxiety at the beginning of induction showed a strong positive correlation with EA,and the correlation coefficient was 0.708(P<0.01).Conclusion The preoperative anxiety in the operating room and at the beginning of induction of anesthesia is correlated with EA in children receiving sevoflurane anesthesia.

Objective To retrospectively analyze the incidence of bleeding during transbronchial needle aspiration (TBNA) procedures, so as to provide evidence for prevention and treatment of the condition. Methods TBNA procedures were performed in 178 patients with enlarged mediastinal and/or hilar lymph nodes, who were treated in the People's Hospital of Linyi. A total of 248 lymph node sites were punctured, including 100 for the groups of pretracheal and post-superior vena cava lymph nodes (4R), 10 for the groups of left paratracheal (aorta-pulmonary artery windows) lymph nodes (4L), 13 for the groups of pre-carinal lymph nodes (7),90 for the groups of sub-carinal lymph nodes (7), 12 for the groups of sub-subcarinal lymph nodes (7), 12 for the groups of right lung hilar lymph nodes (11R), and 11 for the groups of left lung hilar lymph nodes (11L).TBNA procedures were performed according to WANG's TBNA positioning and punctured method. The sites and incidence rates of bleeding sites during the procedures were analyzed. Results The highest incidence rate of bleeding (20%) was found during TBNA procedures in the sub-carinal lymph node groups (7), and the lowest incidence rate was found (2%) in the pretracheal and post-superior vena cava lymph node groups (4R).The incidence rates of bleeding were significantly different between different puncture sites as demonstrated by chi-square test (χ2=17.035,P=0.009). Conclusion Pretracheal and post-superior vena cava lymph nodes (4R) and sub-carinal lymph nodes (7) are the most common TBNA puncture position in the airway. TBNA procedure at sub-carinal lymph nodes (7) has the highest risk of bleeding. The massive bleeding during TBNA procedures can be avoided by prior enhanced CT and/or endobronchial ultrasound (EBUS)-TBNA of the lung.

Low grade inflammation has recently emerged as a common underlying cause of many chronic diseases. Heart disease, type 2 diabetes, Alzheimer's disease and many types of cancer have all been associated with chronic inflammation. Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Insulin resistance is a key component in the development of diabetes mellitus which is caused by inflammation, and throughout the whole process of diabetes. In recent years, research on traditional Chinese medicine treatment of diabetes has got lots of achievements, and makes a further analysis about insulin resistance of diabetic, while has profound significance in the treatment of diabetes in the future. Insulin resistance can be improved with Chinese herb medicine using compound, single herbal drug and its extracts. This review focuses on the pathogenesis of inflammation and insulin resistance, and the effects of Chinese herb medicine on insulin resistance in diabetes.

Objective To study the expression of the fused proteasome activator REGγ(11S regulator complex gamma subunit) using gene recombination technology and to further study the interaction between REGγ and casein kinase-2 interacting protein-1(CKIP-1)in vitro.Methods Firstly, the full length cDNA fragment of REGγ was amplified through PCR using the plasmid pCMV-Myc-REGγ as template and subcloned into the prokaryotic expression vector pGEX-4T-2 before being transformed into E.coli BL21 cells. The protein expression was induced by isopropyl-β-D-thiogalactoside(IPTG) .Secondly, the protein expression was monitored by SDS-PAGE and Western blotting after ultrasonication. Finally, the GST Pull-down assay was performed to investigate the interaction between REGγ and CKIP-1 in vitro.Results The prokaryotic expression construct pGEX-4T-2-REGγ was generated successfully and confirmed by DNA sequencing. Expression analysis showed that the GST-REGγ protein was easily expressed and isolated mainly in the lysate supernatant after sonication and centrifugation. The GST Pull-down assay revealed the strong mutual interaction between REGγ and CKIP-1 in vitro.Conclusion The proteasome activator REGγ could interact with the negative regulator of osteoblastogenesis CKIP-1 in vitro and the current study has shed light on further investigations of their physiological relevance.

Objective To investigate the effects and mechanisms of anal electrical stimulation (AES) with long pulses on anal sphincter pressure (ASP) in conscious dogs.Methods Nine healthy female hound dogs were used for the study,composed of 4 randomized sessions including AES with vari- ous stimulation parameters,20-min sustained AES to assess anal sphincter fatigue,atropine or phentolamine were used to block corresponding receptor.ASP was measured with manometry and the contractile area under the contraction curve.AES was performed via a pair of ring electrodes attached to the manometric catheter.The stimulation parameters in all sessions but the first session included a frequency of 20 ppm,width of 200 ms and amplitude of 3 mA.Results ASP was 55.7?6.0 at baseline and increased by 37% to 76.4?6.5 during AES (P

Objective To explore the relevance between sequence variation of human papillomavirus (HPV)16 subtypes E2 gene or long control region (LCR) and cervical lesions.Methods Fifty specimens from HPV16 infected people in Chengdu were collected,including cervical exfoliated cells from 38 HPV carriers,papilloma tissues from 8 cases of genital warts,2 with cervical intraepithelial neoplasia (CIN) Ⅱ and 2 with CIN Ⅲ in this study.Polymerase chain reaction was used to amplify E2 gene and LCR,then an evolutionary tree was constructed.Results In all the 50 specimens,there were 12 mutation sites in E2 gene,among which,C→A existed in one specimen of genital warts,and ≥2 mutation sites existed in all the other 48 specimens.There were 28 mutation sites of LCR sequence of all the specimens.Ten specimens were chosen to construct evolutionary tree and were sequenced.The data showed that 8 specimens were Asian variants,E2 gene mutation existed in all the specimens while the LCR 7867 G→A only existed in the four CIN.Conclusion LCR 7867G→A is a correlative mutation site of cervical lesions in Chengdu.

Acute blood loss anemia is the most common surgical complication of total knee arthroplasty. Currently, alloge?neic transfusion has been the major method of managing postoperative anemia. Although allogeneic transfusion can correct anae?mic condition temporarily, it can lead to severe complications, such as postoperative infection, prolongation of physical recovery, increased length of hospital stay, and increased mortality. Perioperative blood management can effectively reduce blood loss and transfusion rate. These strategies mainly focus on three parts:therapy for anemia and autologous blood donation before operation;application of a tourniquet, antifibrinolytic drugs, topical hemostatic agents and acute normovolemic hemodilution during opera?tion; selection of reinfusion systems, restrictive transfusion thresholds, drainage and knee position after operation. Perioperative blood management should run throughout the perioperative period, which mainly aims at reducing blood loss and blood transfu?sion, improving prognosis, promoting the postoperative recovery and lowering the medical cost. Depending on the actual situations of patients, surgeons should combine different major characteristics of each strategy and weigh the pros and cons to make effective and reasonable individualized treatment plan.