As a kind of breast cancer surgery choice,the nipple-sparing mastectomy (NSM)saves the patients′nipple-areola complex (NAC)which has significant meaning for patients′cosmetic results and posto-peration reconstruction.However,the clinical application of NSMis still in controversial.Some hot topics about oncological safety of NSM have appeared in recent years,such as the screening criterion of the enrolled patients,the situation of NAC involvement and the complications after NSM and handing methods.

Objective To investigate the expression of protease-activated receptors (PARs) in colon mucosal tissue of patients with diarrhea-predominant irritable bowel syndrome (D-IBS). Methods Colon mucosa tissues were obtained from 28 D-IBS patients and 18 normal controls by colonoscopy.The expression of PARs was detected using Western blotting and real-time PCR. Data were analysed by SPSS 18. 0 softwave, and comparisons between groups were done using Mann-Whitney U test.Results There was no difference in expression of PAR1 between D-IBS patients and normal controls (P=0. 300). The expressions of PAR2 and PAR4 were higher in D-IBS patients than those in normal controls (0.99±0.67 vs 0.63±0.38, P=0.038 and 0.37±0. 14 vs 0.25±0. 11, P=0.013,respectively). The results of real-time PCR were in accordance with those of Western blotting.Conclusion The increased expressions of PAR2 and PAR4 in colon mucosa of D-IBS patients indicate that these two PAR receptors may be involved in the process of D-IBS.

Objective To investigate the clinical value of the test injection at popliteal arteries on 64-slice CTA in lower extremity peripheral arterial occlusive disease (PAOD). Methods Twenty-eight patients with PAOD referred for 64-slice CTA were enrolled consecutively in the study. Test injection was performed at bilateral popliteal arteries (the level of knee joints) and the clinic value of the peak value and the time to peak was analyzed. The relationship between the time to peak and the peak value was evaluated with Pearson test. The time to peak was used for programming of the CT angiographic acquisitions with fast scanning mode. The quality of visualization of each arterial segment was determined independently by two radiologists. Results Fifty-four (96%, 54/56) time-attenuation curves were obtained in 28 patients. The wide interindividual variation in the peak value and the time to peak was observed in 52 curves of 26 patients with range of 60-178 HU,21-46 s and an average of (135±28) HU,(31±6) s, respectively. The difference in the peak value and the time to peak between bilateral popliteal arteries was also observed with range of 10-80 HU and an average of (32±18) HU in 19 patients,with range of 1-12 s and an average of (5±3) s in 21 patients. There was negative relationship between the peak value and the time to peak (r=-0.526, P<0.01). The CTA images were of good (598 segments) or medium quality (12 segments) in 99% segments (610/616). Conclusions The test injection at popliteal arteries was useful for 64-slice CTA in the patients with PAOD, as it could accurately specify the delay time of CT angiographic acquisitions.

To observe the effect of Helicobacter pylori(H.priori) on cell gap junction ultrastructure of gastric epithelial cells,and to explore carcinogenic mechanism of H.priori from the changes of cell gap junction,BGC-823 cells were co-cultured with different H.prlori strains for 24 h and 48 h.The cell gap junction ultrastructure was observed under transmission electron microscope with sample preparation of fixation and embedding in situ.In 70 patients with gastric eancer(GC),H.priori was detected by rapid urease test,basic fuchsin stain and 14C-urea breath test.The CagA gene of H.prlori was determined by PCR and the cell gap junction ultrastructure was observed under transmission electron microscope.More cell gap junctions and junction complexes of BGC-823 cells were found in control group without H.priori.Groups with H.priori had less number of cell gap junctions,less number of junctions/unit perimeter,shorter length of junctions/unit perimeter,and bigger width of the intercellular space,comparing to control groups without H.priori(P＜ 0.001 or P＜ 0.005).The number of cell junctions and the number of junctions/unit perimeter in the groups co-cultured with NCTC J99,GC 01 and NCTC 11639(CagA+) were less than that in the groups co-cultured with NCTC 12908(CagA-)(P ＜0.001 or P＜0.05),and the length of junctions/unit perimeter in the groups co-cultured with NCTC J99 and GC 01 was shorter than that in the groups co-cultured with NCTC 12908 (P＜ 0.001).In patients with GC,the number of cell junctions,the number of junctions/unit perimeter and the length of junctions/unit perimeter in group H.priori infection were all less than those in group without H.prior/infection(P ＜0.001),and that in CagA+ H.prlori group were less than that in CagA- H.prlori group,but its smallest width of the intercellular space was longer than that in CagA- H.prlori group.The above results showed that the changes of cell gap junction of gastric epithelial cells were associated with H.prlori infection especially CagA+ H.prlori infection.

Objective The aim of this study was to evaluate the feasibility,safety and efficacy of peratrial device closure of ventricular septal defect (VSD) through a right parasternal approach.Methods Between May 2011 and July 2012,47 patients (peratrial group),aged 7 months to 37 years,underwent peratrial device closure of VSD through a right parasternal approach.According to the same inclusion criteria,47 patients who underwent perventricular device closure of VSD were randomly chosen as the control group (perventricular group).In the peratrial group,a 1.5 to 2.0 cm parasternal incision was made in the right fourth or third intercostal space.The pericardium was incised and cradled.Two parallel pursestring sutures were placed at the right atrium near the atrioventricular groove.After puncture,a specially designed hollow probe was inserted into the right atrium.The probe was passed through the tricuspid valve into the right ventricle.Under transesophageal echocardiographic guidance,the tip of the probe was adjusted to point to or cross the defect.A flexible guidewire was rapidly inserted into the left ventricle through the channel of the probe to establish a delivery pathway,and the delivery sheath was introduced through the defect over the wire.Then the device was deployed to close the defect.Results Successful implantation of the device was achieved in both groups of patients (100％).In the peratrial group,the entrance and the exit diameter of the VSD were (7.4 ±4.1) mm (range,2.0 to 20.0 mm) and (3.4 ± 1.2)mm (range,2.0 to 7.0 mm),respectively.The mean device size was (6.3 ± 1.5)mm (range,4.0 to 12.0 mm).The mean intracardiac manipulation time is longer in the peratrial group [(15 ± 13) min] than in the perventricular group[(8 ± 5)min],P ＜ 0.01.But the procedure time is shorter in the peratrial group[(56 ± 24) min] than in the perventricular group [(72 ± 16) min],P ＜ 0.01.During the follow-up period of 1 to 12 months,no device-related complications were found.Conclusion The peratrial device closure of VSD is feasible,safe,and efficacious.It has the advantages of less invasiveness,better cosmetic results,and a shorter procedure time.

Objective To investigate whether cerebral microbleeds (CMBs) can predict hematoma expansion in hypertensive cerebral hemorrhage bleeding.Methods One hundred and forty-four patients with hypertensive cerebral hemorrhage bleeding in 6 hours after the onset of symptom were included.Gradient echo pulse sequence-T2 WI (GRE-T2 WI) and computed tomography (CT) were performed to detect the size of hematoma in half an hour after hospital admission.Based on the performance of GRE-T2 WI,patients were divided into microbleeds group and no microbleeds group.CT was performed 24 and 72 hours later to check whether hematoma was enlarged,the ratio of hematoma enlargement and the increased hematoma volume were compared between 2 groups.Results A variable number of CMBs were found in 74 cases by GRE-T2WI on admission.The hematoma volume was increased in 12.5％ (18/144) of patients by CT 24 hours later,and in 13.9％ (20/144) by CT 72 hours later.The ratio of CMBs in microbleeds group was higher than no microbleeds group significantly (70.0％ (14/20) vs 48.4％ (60/124),x2 =4.221,P ＜0.01).Besides,the ratio of the patients with the increased hematoma volume in microbleeds group was significantly higher than no microbleeds group(17.6％ (13/74) vs 10.0％ (7/70),x2 =3.172,P ＜ 0.05).Logistic multiple regression showed that CMBs was the only risk factor which could enter regression equation (OR=2.213,95％CI 1.320-2.972,P＜0.01).Conclusion CMBs patients with hypertensive cerebral hemorrhage bleeding in GRE-T2WI can predict the high risk of hematoma expansion.

Objective To evaluate the feasibility,safety and efficacy of perventricular device closure of supracristal or intracristal ventricular septal defects (VSD) using a minimally invasive technique through a parasternal approach.Methods 49 patients,aged 4 months to 53 years [median 4.8 years],were enrolled in this study.A 1.5 to 3 cm parasternal incision was made in the left second or third intercostal space.The pericardium was incised and cradled without entering the pleural space.Two parallel pursestring sutures were placed at the right ventricular outflow tract.After puncture,the specially designed delivery sheath loaded with the device was inserted into the right ventricle.Under transesophageal echocardiographic guidance,the sheath was advanced through the defect into the left ventricle.Then the device was deployed to close the defect.Results Successful implantation of the device was achieved in 47 patients (96％),including 26 in intracristal group and 21 in supracristal group.The concentric,eccentric,and muscular occluders were used in 17,28 and 2 patients,respectively.The mean diameter of VSD was (4.4 ± 1.7)mm in the intracristal group and (2.7 ± 0.9) mm in the supracristal group.The mean device size was (7.0 ± 2.3) mm and (4.8 ± 1.1)mm in the intralcristal and supracristal group,respectively.The mean intracardiac manipulation time was (17 ± 16) min.During the follow-up period of 3 to 24 months,no device-related complications were found.Conclusion The perventricular device closure of small-sized supracristal or under medium-sized intracristal VSD is feasible,safe,and efficacious through a left parasternal approach.

Objective This study is to evaluate the advantages between percutaneous and peratrial device closure of secundum atrial septal defects(ASD) under single transesophageal echocardiographic (TEE) guidance.Methods From December 2010 to December 2012,53 patients with the ASD of≤25 mm in diameter underwent percutaneous device closure under simple TEE guidance(the percutaneous group).The device was implanted through the femoral vascular access.Fifty patients with similar age and similar-sized ASD to the percutaneous group,were selected from 350 consecutive patients who underwent peratrial device closure of ASD and assigned to the peratrial group.The ASDs were occluded through a right minithoracotomy approach.The success rate,intracardiac manipulation time,procedural time,postoperative stay and the follow-up results were recorded.Results When the maximum diameter of ASD was ＜ 20 mm,the success rate of both groups was 100％.When the ASD diameter was 20 mm but 25 mm,the success rate was 84％ in the percutaneous group and 100％ in the peratrial group.Three patients failed in the percutaneous group with the ASD diameter of 20 mm and the aortic rim of 3 mm.They were successfully converted to peratrial device closure.The average intrcardiac manipulation time was(20±7) minutes in the percutaneous group and (5 ± 6) minutes in the peratrial group(P ＜ 0.05).The average procedure time was(24 ± 7) minutes in the percutaneous group and (39 ± 6) minutes in the peratrial group(P ＜ 0.05).The postoperative hospital stay was (3.0 ± 0.8) days in the percutaneous group and(4.7 ± 1.5) days in the peratrial group(P ＜ 0.05).Conclusion The percutaneous device closure of ASD under simple TEE guidance is feasible,safe,and efficacious in patients with the ASD diameter of ≤25 mm.It has the advantages of less trauma,less procedural time,shorter hospital stay and better cosmetic results.However,when the ASD diameter was 20 mm and the aortic rim was 3 mm,the peratrial approach may be a better choice.

Osteoporosis (OP) is a systemic bone metabolism disease characterized by a systemic impairment of bone mass ,strength ,and microarchitecture ,which will be result in increasing the propensity of fragility fractures .In recent years , OP becomes a worldwide health problem and a hotspot in medical research due to its increasing incidence .Anti-resorptive drugs inhibit osteoclast differentiation and maturation in order to reduce bone resorption ;Bone-anabolic drugs promote the bone for-mation function of osteoblast and reconstruct bone tissue ;Bone mineralization-acceleration drugs are the basic material for pre-vention and treatment of osteoporosis ,including calcium and vitamin D ;Strontium ranelate is the representative drug of un-coupling agents .In this paper ,the current progress of osteoporosis treatments were reviewed including these proposed drugs .

As a progressive and chronic intractable disease, chronic pancreatitis (CP) is generally manifested as early chronic pain, and then exocrine and endocrine insufficiency, and various complications in clinical course. The complex clinical manifestations lead to the controversies over treatment strategies at present, involving a multidisciplinary treatment (MDT) approach. It can enable different professional medical experts to discuss the diagnosis and treatment for patients together during a specific period (online or offline), which is an effective mode for diagnosing and treating complex diseases nowadays. MDT for CP usually begins with lifestyle intervention and drug therapy, and then goes with endoscopic interventions and surgical resection, or their combination. This article reviewed the current status on MDT approaches for CP and shared the MDT experience from Changhai Hospital in order to improve the management of CP course.