Objective To study the clinical and imaging features of patients with bone metastases from breast cancer and identify the factors related to the incidence of bone metastases. Methods Three hundred and thirty-four patients with breast cancer were recruited into this study. Whole-body 99Tcm-methylene disphosphonate (MDP) bone scan, clinical staging, pathological, immunohistochemical and serological test results were analyzed retrospectively. χ2 test was used for statistical analysis. Results The incidence rate of bone metastases for patients with and without lymph node metastases was 71% (152/214) and 22. 5% (27/120), respectively (χ2 =72.80, P =0.000). The incidence rate of bone metastases from infiltrated non-specified and specified breast cancer was 69% (203/294) and 41.7% (5/12), respectively (χ2 =3. 97, P=0.046). Alkaline phosphatase (ALP) was elevated in 28.5% (51/179) and 14.9%(11/74) of patients with and without bone metastases, respectively (χ2 = 5. 25, P = 0.022 ). Carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 15-3, CA125, CA19-9 increased in 68.7% ( 123/179) and 27.0% (20/74) of patients with and without bone metastases, respectively (χ2 = 37. 03, P =0. 000). Conclusions The incidence of bone metastases from breast cancer is correlated to pathological types of primary tumor and lymph node metastases. Bone metastases occurs more frequently in patients with infiltrated, non-specified, primary cancer and with lymph node metastases. Serum ALP, CEA, CA15-3,CA125, CA19-9 might be the tumor makers for early diagnosis of bone metastases from breast cancer.

Objective The aim of the study was to investigate the epidemic situation,clinical symptom,diagnosis and epidemiological characteristics of human Fasciola gigantica infection in Dali,Yunnan province.It will also provide a scientific basis for fasciolosis control and prevention.Methods Epidemic data were collected and patient's clinical signs and symptoms were studied.Serum soluble antigen of Fasciola gigantica of patients and part of family members and health people in the same village was detected using enzyme-linked immunosorbent assay (ELISA) and the eggs of Fasciola gigantica in stool were observed under microscope.Sequencing and PCR amplification of Fasciola gigantica eggs had been done.Sequencing results were analyzed using basic local alignment search tool (BLAST) program of the U.S.National Center for Biotechnology Information (NCBI) and the similarity of the two in the sequence of nucleic acid was compared.Furthermore,patients were experimentally given orally therapeutic doses of Triclabendazole 10 mg·kg-1·d-1 daily for 2 days,and kept in the hospital for observation for one week.Moreover,host and vector were investigated in the surrounding ditches of Dali prefecture and Limnaea peregra snail samples were collected.All the snails were squashed by glass sheet in order to detect the cercarie.Cow dung and sheep manure was collected in the Limnaea peregra distribution environment,and the eggs in the feces were checked by microscope after washing and precipitation.Results All the 26 patients had a continued hyperpyrexia with distinct alimentary system symptoms of nausea,vomiting,stomachache,abdominal distension as well as hepatomegaly,sensitive to percussion,different levels of liver damage detected by CT.All the patients had an eaten history of raw Herba Houttuyniae and other aquatic plants,and the course of the disease was similar,with the same epidemiological characteristics.ELISA detection was used in the 26 patients,family members and other healthy population,the results of all the 26 patients were positive(100.0％,26/26) ; the positive rates of the 57 family members and other health people of the same village were 31.6％ (18/57) and 17.1％ (6/35),respectively.The results of sequencing and BLAST program showed that the pathogen was Fasciola gigantica with the similarity between 99％-100％.PCR amplification also confirmed that the eggs were Fasciola gigantica eggs with an approximately 1000 bp band on agarose gel.After treatment with Triclabendazole,body temperature of the patients dropped to normal and symptoms improved markedly.Moreover,329 Limnaea peregra snails were collected including 5 ones with redia and one-tailed cercariae which were preliminary identified as the larva of Fasciola gigantica.There were also eggs of Fasciola gigantica detected in one stool of cattle and one of goat.Conclusions Eating raw food is the leading cause of the onset of the disease.Triclabendazole is the drug of choice to treat Fasciolasis.Health education should be strengthened by government and disease prevention and control departments in order to make the local residents to understand the potential hazard of eating raw aquatic vegetable and drinking unboiled water,which is the key to prevent the occurrence of the disease.

Objective To evaluate the in vivo antibacterial effect of cefathiamidinein against mouse septicemia.Methods Experimental model of mouse septicemia was established by intraperitoneally injection with 0.5 mL minimum lethal dose (MLD) bacteria.The 0.2 mL different concentrations of drugs were injected through caudal vein.Cefathiamidine,cefazolin and ampicillin adopted two methods of dose regimen,which are single-dose and two-dose;while,both ceftriaxone and levofloxacin adopted single-dose.The survival time of the infected mouse was monitored for 1-7 d.The 50％,95％ effective doses(ED50,ED95) were determined by the Bi-level integrated system synthesis (BLISS) method.The antibacterial activities between cefiazine and control drugs were compared.In vivo protection experiments were carned out on 3 standard strains and 7 pathogenic strains isolated through single dose.Results The cefathiamidine had good antibacterial activity in vivo against Streptococcus pneumonia and Enterococcus faecalis.The ED50 of single-dose was between 1.43-1.71 mg · kg-1,which was significantly superior to cefazolin and was similar to levofloxacin.According to the results of two -dose regimen,the ED50 values of cefathiamidine against Sreptococcus pneumonia,Staphylococcus aureus and Haemophilus influenza significantly declined,which were between 0.78-14.78 mg · kg-1.However,with regard to Enterococcus faecalis,the ED50 value of two-dose increased compared to that of single-dose,which could be related to the fact that low plasma concentration affected protective effects in vivo.Conclusion Cefathiamidine had a better antibacteria effect in vivo against gram-positive bacteria,especially Streptococcus pneumonia and Enterococcus faecalis.Through the comparison between single-dose and two-dose,it is more reasonable to adopt two-dose or multiple-dose of cefathiamidine with regard to most strains.

Intestine,the body's largest digestive and immune organ,always affects the occurrence and development of cardiovascular disease process.Especially the trimethylamine N-oxide as one of the metabolic derivatives produced by intestinal microbiota,can increase the risk of atherosclerosis and promote cardiovascular diseases such as chronic heart failure.Therefore,changing the level of trimethylamine N-oxide in the circulation by taking different measures to intervene the structure,composition and metabolic activity of intestinal flora can affect the occurrence and development of the disease.Thus,the intestinal flora is recognized as a new target for the treatment of cardiovascular diseases.

Objective To report a new approach,endoscopic transoral approach for the resection of jugular foramen schwannoma.Methods Nine patients with jugular foramen schwannoma ( three males and six females,ranging in age from 15 to 61 years old ) were treated by direct surgery via a pure endoscopic transoral approach to the jugular foramen. Eight patients complained of hypoglossal nerve palsy with hemiatrophy of the tongue; six cases complained of vagus nerve palsy. Three cases complained of glossopharyngeal nerve palsy,one case complained of facial nerve palsy and hearing loss.Results The nerves in this area were preserved and radical intracapsular removal of the tumor was performed via endoscopic transoral approach in the nine cases.Tumor removal,as assessed by intraoperative endoscopic inspection,postoperative magnetic resonance imaging and clinical evaluation,revealed all tumors were completely removed.One patient suffered from temporary swallowing difficulties and temporary right vagus palsy Ⅰ day after surgery.There were no others intraoperative and postoperative complications.All patients were followed up for 4 -29 months,no recurrences were occured in all these patients and the muscle bulk,motor and the pre-postoperative swallowing fuction,the vagus palsy,the facial nerve palsy and hearing loss had improved in these patients.Conclusion The endoscopic transoral approach and intracapsular removal of the tumor provided for successful minimally invasive surgery in the jugular foramen schwannomas.

Objective:To compare the surgical procedures and postoperative effects of PFNA and DHS in the treatment of intertrochanteric fracture in elderly patients.Methods:The clinical data of 30 elderly patients with intertrochanteric fracture treated in our department from March 2013 to March 2017 were retrospectively analyzed.15 cases were treated with PFNA internal fixation and 15 cases with DHS internal fixation.The average length of operation,the amount of bleeding during operation,the time of hospitalization and the difference of postoperative functional recovery were compared between the two surgical procedures.Results:The intraoperative bleeding of the DHS group was more than that of the PFNA group,and the difference was statistically significant (P＜0.05).There was no significant difference in length of operation,time of hospitalization or postoperative hip function between the two groups.Conclusions:DHS is similar in clinical efficacy to PFNA in the treatment of intertrochanteric fracture in elderly patients,especially for intertrochanteric fractures with simple fracture types and intact lateral wall of the femur.DHS has the advantages of anatomical reduction and simple operation,which is worthy of clinical promotion.

Background Vascular anomalies are common and multidisciplinary involved diseases. The greatest impediment to their treatment in the past was their confusing terminology and clinical heterogeneities. This hospital-based retrospective study assessed some clinical characteristics, diagnosis, therapies and outcomes of patients with vascular anomalies in southeast China.Methods A total of 592 vascular anomalies patients (patients with intracranial tissues or viscera involved were excluded), admitted to the First Affiliated Hospital of Sun Yat-sen University from January 2006 to September 2009, were enrolled in the study. Data for clinical characteristics, diagnosis, therapies and outcomes were collected and analyzed.Results Of the 592 patients, the male:female ratios in the vascular tumor group (n=187) and the vascular malformation group (n=405) were 1∶1.49 and 1∶1.06 respectively, with no significant difference between them. The mean onset age of the vascular tumor group was significantly younger than that of the vascular malformation group (P ＜0.001). The head and neck were the most commonly (31.4％) involved areas in vascular anomalies. A total of 23.8％ of the patients with vascular anomalies had definite symptoms caused by the vascular lesions. In the vascular tumor group, 94.1％ of them were infantile hemangiomas. Venous malformation was the most common (41.0％) subtype of vascular malformations.Surgical therapy was undertaken in 94.2％ of the patients with vascular anomalies. Of the 519 patients available for the 16-58 month follow-up, 322 patients (62.0％) were cured, 108 patients (20.8％) were markedly improved, 57 patients (11.0％) were partially improved, and 32 patients (6.2％) were uncured.Conclusions Vascular anomalies are clinically heterogeneous. While the outcome is generally favorable, further effort should be made to determine the appropriate terminology and management.

Objective To observe the correlation of plasma amino-terminal pro-A-,B-and C-type natriuretic peptide(NT-proANP,NT-proBNP and NT-proCNP)levels with New York Heart Association (NYHA)functional class and echocardiographic derived parameters of cardiac function in heart failure patients.Methods Data of NYHA grade,echocardiographic derived parameters of cardiac function,plasma levels of NT-proANP,NT-proBNP and NT-proCNP(measured by enzyme immunoassay method)were obtained in 112 heart failure patients and 44 normal control Subiects.The correlation analysis was made between NT-proANP,NT-proBNP,NT-proCNP and NYHA functional class,left atrium diameter(LAD),left ventricular end-diastolic diameter(LVEDD) and left ventricular ejection fraction(LVEF),respectively.Results The plasma concentrations of NT-proANP,NT-proBNP and NT-proCNP in heart failure patients were significantly higher than in control group(all P＜0.05).Correiation analysis revealed a strong correlation between NT-proANP and NT-proBNP(r=0.790,P=0.000)and a weak correlation between NT-proCNP and NT-proBNP(r=0.278,P=0.003)as well as between NT-proCNP and NT proANP(r=0.236,P=0.012)in heart failure patients.Univariant analysis showed that NT-proANP and NT-proBNP were positively correlated to LAD,LVEDD and negatively correlated to LVEF(all P＜0.05)while there was no significant correlation between NT-proCNP and echocardiographic derived parameters of cardiac function in heart failure patients.Multivariate stepwise regression analysis including age,gender,NYHA classification,LAD,LVEDD and LVEF revealed that NYHA classification,LVEF,LAD and age were independent predictors of NT-proANP;while NYHA classification,LVEF and age were independent predictors of NT-proBNP while there Was no association among these factors and NT-proCNP.Conclusion In heart failure patients,the plasma concentration of NT-proANP,NT-proBNP and NT-proCNP were significantly increased and NT-proANP,NT-proBNP but not NT-proCNP were significantly correlated to NYHA classification and echocardiographic derived parameters of cardiac function.

Objective To observe the effect and safety of supplying sodium chloride in the treatment of patients with severe heart failure.Methods Consecutive 51 hospitalized patients with severe heart failure and cardiac edema were included in this study.Normal diet (6 g NaCl/d) was supplied to all patients.On the basis of controlling fluid intake and treating related etiological factors as well as standard medications including furosemide for severe heart failure,patients with mild hyponatremia (serum sodium level 130- 134 mmol/L) ate additional salted vegetables,patients with moderate hyponatremia (serum sodium level 125 - 129 mmol/L) and severe hyponatremia (serum sodium level ＜ 125 mmol/L) ate additioual salted vegetables and were received additionally intravenous 3％ NaCl hypertonic saline infusion ( 10 ml/h) until reaching normal serum sodium level.Results On admission,37.25％ ( 19/51 ) patients had hyponatremia.During the first two weeks hospitalization period,88.24％ (45/51) patients were treated with intravenous diuretics and total incidence of hyponatremia was 64.71％ (33/51),mild hyponatremia was 50.98％ (26/51),middle and severe hypouatremia was 13.73％ (7/51) ; among them,hyponatremia lasted less than 3 d in 57.58％ (19/33) patients and ≥3 d in 42.42％ ( 14/33 ) patients.Heart failure exacerbation and hypernatremia were not observed in patients receiving additional sodium chloride therapy.Hospitalization time was similar among patients with different blood natrium levels [ average ( 16 ± 12) d ].Fifty out of 51 (98％) patients discharged from the hospital with improved heart failure symptoms and signs.Conclusion Supplying additional sodium chloride could rapid correct hyponatremia in heart failure patients with or without intravenous diuretics therapy which might contribute to a favorable prognosis in hospitalized heart failure patients.

Objective To summarize the clinical features of extraorbital inflammatory myofibroblastic tumor (IMT) of the head and neck.Methods Fourteen cases of extraorbital IMT treated in recent 20 years were analyzed retrospectively.Results Of the 14 patients,9 cases with limited lesion in maxilla (n =5),mandible (n =2) or neck (n =2) underwent local resection,and no recurrences were found after 1.5 to 20.0 years; 3 cases diagnosed as maxillary IMT involved in orbit,hard palate or pterygopalatine fossa received conservative therapy (prednisone,prednisone plus radiotherapy or prednisone plus chemotherapy),and no disease progression was found after 6,9 or 2 years respectively; and 1 case diagnosed as maxillary IMT involved in orbit and pterygopalatine fossa was confirmed with cervical metastases after two operations and died of brain invasion within 17 months.One patient with localized lesion around the common carotid artery was treated with prednisone and had no disease progression with a 2-year follow-up.Conelusions Extraorbital IMT of the head and neck is a rare clinical entity.Pathology examination is required for final diagnosis.Corticosteroid administration may be a choice of treatments,and radical resection should be taken selectively for limited lesions.