Objective:To assesss the effectiveness of dapoxetine in the treatment of premature ejaculation.Methods:Both English and Chinese studies involving men with prematrue ejaculation who were treated with dapoxetine from the Cochrane Library,MEDLINE,EMBASE and CNKI,CBM,VIP between 1979 and 2009.were included in the randomized controlled trials(RCTs) and the data processed by RevMan.Results:Five RCTs involving 4433 patients were included in the Meta analysis,of which 3 were of grade A and 2 were of grade B according to the quality evaluation of methodology.Intravaginal ejaculatory latency time(IELT),patient-reported global impression of change(PGI),satisfaction with sexual intercourse(SWSI),perceived control over ejaculation(PCOE),personal distress related to ejaculation(PDRE) were used for assessment.Meta analysis based on included studies of patients having been treated with dapoxetine for 9-24 weeks showed that:(1) the difference of the patients' IELT between treatment group and control group was statistically significan [P

10.3969/j.issn.2095-4344.2013.25.024

Objective To study blood supply by the internal mammary artery(IMA)for hepatic carcinoma and evaluate the efficacy and safety of transcatheter arterial chemoembolization(TACE)via IMA. Methods 86 cases of hepatic cancer(HCC)fed by the IMA underwent TACE of the IMA.All of the patients had previously undergone several TACE for HCC.16 patients had undertaken percutaneous microwave coagulation therapy in addition to TAE.4 patients had a history of surgery for upper abdomen.Plain and enhanced CT and MRI scannings were performed before operation.Internal mammary arteriography was carried out during the interventional procedure to clarify the feeding range and then the superselected catheterization of the feeding branch was done with TACE.The IMA angiographic features,tumor location,clinical observation, laboratory tests,imageology were evaluated,and finally were correlated with the angiographic findings of the IMA.Results All lesions were massive type and located at the ventral aspect and subcapsular region of the liver:57 cases in segment 4,5,8,and 29 cases in segment 5,7,8.Recurrent HCCs were supplied by the right IMA in 80 cases,from the left IMA in 5 cases and with the bilateral IMA in 1 case.Lipiodol-TACE of the IMA for HCC can be performed without skin complications in cases of subselective catheterization.Conclusion Tumors located ventrally and superficially in the liver may recruit blood supply through IMA collaterals,often occurring in massive type of HCC after several times of TACE.TACE of IMA is safe and has become technically feasible in almost all patients,although cutaneous damage should be cautious during the interventional procedure.(J Intervent Radiol,2007,16:816-819)

Objective To evaluate the efficacy and safety of the interventional techniques for emergent treatment of iatrogenic renal injuries.Methods Nine patients with iatrogenic renal vascular injuries were treated with superselective renal arterial embolization.The causes of renal injury included post-renal biopsy in 5 patients,endovascular interventional procedure-related in 2,post-renal surgery in 1,and post-percutaneous nephrostomy in 1 patient.The patients presented clinically with hemodynamical unstability with blood loss shock in 7 patienrs,severe flank pain in 7,and hematuria in 8 patients.Perirenal hematoma was confirmed in 8 patients by CT and ultrasonography.The embolization materials used were microcoils in 7 and standard stainless steel coils in 2 patients,associated with polyvinyl alcohol particles(PVA)in 5,and gelfoam panicles in 2 cases.Results Renal angiogram revealed intra-renal arteriovenous fistula in 6 cases,intrarenal pseudoaneurysm in 2 cases,and the contrast media extravasation in 1 patient.The technical success of the arterial embolization was achieved in all 9 cases within a single session.All angiographies documented complete obliteration of the abnormal vessels together with all major intrarenal arterial branches maintaining patent.Seven patients with hemodynamically compromise experienced immediate relief of their blood loss related symptoms,and another 7 with severe flank pain got relief progressively.Hematuria ceased in 8 patients within 2-14 days after the embolization and impairment of renal function occurred after the procedure in 5 cases,including transient aggrevation(n=3)and developed new renal dysfunction(n=2).Two of these patients required hemodialysis.Perirenal hematoma were gradually absorbed on ultrasonography during 2-4 months after the procedures.Follow-up time ranged from 6-78 months(mean,38 months),4 patients died of other primary diseases of renal and multi-organ failures.Five patients are still alive without further intervention,and suffering no more of rebleeding and deterioration of renal function.Conclusions Transcatheter selective renal arterial embolization is safe and effective in the treatment of iatrogenic renal vascular injuries,resulting in permanent cessation of bleeding.(J Intervent Radiol,2007,16:807-810)

Objective To describe the manifestations of the inferior phrenic arteries(IPA)supply to the pulmonary hemorrhagic lesions and to evaluate the safety and efficacy of transcatheter arterial embolization(TAE)of the IPA.Methods The clinical data and imaging findings of eighteen patients with the additional blood supply to the pulmonary hemorrhagic lesions from the IPA were evaluated retrospectively.The causes of the bleeding were lung malignancies in 9,bronchiectasis in 7,and chronic inflammation in 2 patients.TAE supplementally was performed in patients with IPA supply to the pulmonary lesions,using polyvinyl alcohol particles,gelatin sponge particles,and microcoils.Results Selective arteriogram demonstrates an enlarged IPA,with numerous branches and hypervascularity in all 18 cases, with tumor staining in 9,the contrast material extravasation in 6,and non-specific staining in 2 cases.In addition,IPA-to-pulmonary shunting was found in 9 cases.All the lesions supplying by IPA were adjacent to the pleurae,including adjacent to the diaphragmatic pleura in 11,the mediastinal pleura in 5,and the lateral pleura of the lower lobe in 2 cases.Technical success of IPA embolization was achieved in the 18 cases.Embolization of other nonbronchial systemic arteries(the internal thoracic artery in 7 and intercostal artery in 3)was performed at the same session.All bleeding ceased immediately after supplemental IPA embolization.Follow-up time ranged from 8 months to 4 years.Mild recurrent hemoptysis occurred in 3 patients at 1,2,6 months respectively,after the embolization.These patients were responsive to conservative management.Recurrent bleeding did not occur in 15 patients during the follow-up. Conclusion The pulmonary hemorrhagic lesions,especially adjacent to the diaphragmatic and mediastinal pleurae,can be supplied by IPA,and may result in clinical failure following BAE.Supplemental TAE of IPA is a safe and effective adjunct to BAE in the management of bronchial bleeding supplied by IPA.

Breast cancer is the leading cause of malignancy-related mortality in women worldwide. The more accurate prediction of lymph node metastasis and evaluation of personalized prognosis of breast cancer patients could provide evidence and reference for individualized comprehensive treatment and clinical decision-making. Nomogram is statistical calculation model developed to generate individualized prediction of a certain clinical event through the factors associated with it. Currently breast cancer related nomogram models is most commonly used in the prediction of non-sentinel lymph node status in patients with sentinel lymph node-positive breast cancer, sentinel lymph node metastasis in clinical node-negative breast cancer and prognosis evaluation of breast cancer. This article reviewed the recent advances in breast cancer related nomograms according to the above mentioned three aspects, and evaluated respectively the predictive factors, accuracy, characteristics and clinical application potential.

BACKGROUND:Intertrochanteric fracture can obtain good curative effects after active effective internal fixation in early stage.
OBJECTIVE:To compare dynamic hip screw+trochanter stabilizing plate and Gamma nail fixation for treatment of Evans type IIIB and type IV intertrochanteric fracture.
METHODS:A total of 67 patients with Evans type IIIB and type IV intertrochanteric fracture, including 28 cases undergoing dynamic hip screw+trochanter stabilizing plate and 39 cases undergoing Gamma nail, were selected from Chongming Branch, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from February 2009 to November 2012. Al patients received antibiotics and functional exercises after treatment. Time of therapy, intraoperative bleeding amount, fracture healing time and Harris Hip Score were retrospectively analyzed in patients of both groups.
RESULTS AND CONCLUSION:Al patients were fol owed up for 6-45 months, averagely 21 months. (1) One patient affected infection in the dynamic hip screw+trochanter stabilizing plate group. He was healed after fixation removal half a year after drug exchange. One obese patient experienced injury again during out-of-bed activity at 3 weeks after treatment in the Gamma nail group. Fracture appeared at distal end of lock pin, and healed after replaced by Gamma nail. Trochanteric stabilizing plate was unstable in four patients of the Gamma nail group. They affected severe pneumonia after over 6 weeks of lying in bed, and healed after treatment in the medical department (2) Coxa vara appeared in two cases of the dynamic hip screw+trochanter stabilizing plate group, and three cases in the Gamma nail group. Fracture healing was achieved in al patients. (3) The time of therapy was longer, and intraoperative bleeding amount was significantly more in the dynamic hip screw+trochanter stabilizing plate group compared with the Gamma nail group (P<0.05). No significant difference in healing time and Harris Hip Score was detected between the two groups (P>0.05). Dynamic hip screw+trochanter stabilizing plate and Gamma nail are effective methods for treatment of Evans type IIIB and type IV intertrochanteric fracture. To choose a suitable fixator, we should aggregately analyze fracture stability, healing state and the degree of osteoporosis.

OBJECTIVE:To optimize the extraction technology of Tibetan medicine Pedicularis kansuensis and compare con-tent of verbascoside and isoverbascoside differences in P. kansuensis from various habitats. METHODS:Using verbascoside and iso-verbascoside and dry paste yield as comprehensive evaluation indexes,single factor test and orthogonal test were used to investigate the extraction solvent,solvent dosage,extraction time and times to optimize extraction technology,and the verification test was conducted. Contents of the 2 constituents verbascoside and isoverbascoside in P. kansuensis from Gansu,Qinghai and Sichuan were compared. RESULTS:The optimal extraction technology was as follows as 8-fold 50% ethanol,extraction for 3 times,90 min each time. The verification results showed that the average contents of verbascoside and isoverbascoside were 3.49%(RSD=1.28%,n=3),1.26%(RSD=1.32%,n=3),and average dry paste yields were 37.99%(RSD=1.97%,n=3). The contents of verbascoside and isoverbascoside in P. kansuensis from Qinghai were relatively higher. CONCLUSIONS:Optimized extraction tech-nology is reasonable,stable,feasible;the contents of index constituents in P. kansuensis from different habitats have certain differ-ences. The study can provide scientific evidence for the development and utilization of extraction,and the in-depth study of quality evaluation for medicinal material.

Objective To explore the association of estrogen receptor β expression with different stages and molecular subtypes of invasive breast cancer.Methods The clinicopathologic data of 446 invasive breast cancer cases was retrospectively analyzed.ERβ expression was evaluated by types and stages.Results Of all 446 invasive breast cancer cases,328 (73.5％) were ERβ positive.The ERβ positive rate was 77.9％ (240/308) and 63.8％ (88/138) in ERα + group and ERα-group,respectively.The ERβ expression in breast cancer was positively correlated with ERα (P ＜ 0.01) while it had no correlation with PR,histological grade,HER-2 and Ki-67 (P ＞ 0.05).ERβ expression was not significantly different among different age,tumor size and axillary lymph node groups(all P ＞ 0.05).A total of 418 invasive breast cancer cases were recruited for pathologic stage and NPI analysis,including 168 cases at stage Ⅰ,152 cases at stage Ⅱ and 98 cases at stage Ⅲ.ERβ expression was not significantly different among different stages of breast cancer(P =0.743).Analyzed in these 418 cases,NPI was ＜ 3.4 in 126 cases,3.4-5.4 in 207 cases and ＞ 5.4 in 85 cases.ERβ expression was not significantly different among different NPI group (P =0.644).The ERβ positive rate in Luminal A subtype,Luminal B1 subtype,Luminal B2 subtype,HER-2 subtype and TN subtype was 75.6％ (88/118),75.9％ (110/145),85.2％ (46/54),68.4％ (39/57) and 62.5％ (45/72) respectively.ERβ expression was significantly different between Luminal subtype and non-Luminal subtype (P =0.007).Conclusions ERβ was not differentially expressed among different breast cancer stages and NPI groups.ERβ was differentially expressed in different breast cancer molecular subtypes.

Objective:To study the effects of ascorbic acid on BMP-2 mRNA expression of osteoblast cell sheets.Methods:Rat os-teoblasts were primaryly cultured and identified;osteoblast cell sheets were built by physical scraping method in vitro;the osteoblast cell sheets were cultured with 1 5,50 and 85 mg/L ascorbic acid for 1 and 2 weeks respectively,and the expression of BMP-2 mRNA of the cell sheets was detected by RT-qPCR.Results:The obtained cells were conformed to be osteoblasts.The osteoblast cell sheets could be rolled into tube in vitro.The expression of BMP-2 mRNA of osteoblast cell sheets in experiment group,whether in week one or week two was higher than that in control group,50 mg/L group showed the highest expression(first week P <0.05;second week P>0.05);the expression of any group in week two was higher than that in week one(P <0.05).Conclusion:Ascorbic acid may pro-mote the expression of BMP-2 mRNA in osteoblast cell sheets.