Human epidermal growth factor receptor 2 (HER-2/neu) is an important prognostic predictor and the key predictor of anti-HER-2 therapy of breast cancer. Accurate testing of HER-2 status for breast cancer patients is important in clinical practice. As of this writing, the American Society of Clinical Oncology and the College of American Pathologists recommend three methods for HER-2 detection, namely, immunohistochemistry, fluorescence in situ hybridization, and bright-field in situ hybridization. The abovementioned methods have their own advantages and disadvantages. New methods, such as multiplex ligation-dependent probe amplification, quantitative reverse transcription polymerase chain reaction, and RNA in situ hybridization, are currently applied to detect HER-2 status. New technologies not only make up for the shortcomings of routine methods but also have unique benefits that can meet the demands for HER-2 testing of some breast cancer patients. Thus, these methods are promising for clinical applications and can improve clinical diagnosis and treatment. The characteristics, advantages, and drawbacks of these technologies are introduced and reviewed in this paper.

Objective To compare the diagnostic reliability of AO classification and Evans-Jensen classifications in X ray film and three-dimensional CT reconstruction images intertochanteric fractures, and explore advantage of the three-di?mensional CT. Methods A retrospective study was performed to evaluate 54 patients with intertochanteric fractures. Three orthopaedic surgeons were asked to make assessment of fracture classifications using X ray film and the three-dimen?sional CT images. Agreement test was performed to evaluate interobserver and intraobserver reliability for fracture classifica?tion. Results When X ray film was used, mean Kappa values of interobserver reliability for AO and Evans-Jensen classifi?cations between three surgeons were 0.597 and 0.571, that was medium consistency. While using three-dimensional CT to AO classification, lower Kappa value was 0.411, medium consistency. Evans-Jensen classification, Kappa value was 0.704, highly consistency. Each surgeon respectively using X ray film and three-dimensional CT, the mean Kappa values of AO and Evans-Jensen classification were 0.464, medium consistency and 0.191 (0.160-0.233), weak consistency. Conclusion Both classifications based on X ray film show moderate consistency, using three-dimensional CT does not improve the consis?tency of AO classification. The three-dimensional CT is not applicable in Evans-Jensen classification.

Objective To explore the effect of low constant direct current (LCDC) in the medullary cavity on repairing of rabbit radial defect as to evaluate its clinical value. Methods DBX was put into the segmental osteoperiosteum defect of rabbit bilateral radius. The rabbits were divided into 2 groups: group A (subject group) with the defects stimulated by LCDC and group B (control group) with the defects left untreated. In week 2,5 and 9, 4 animals from each group were put into death, and the radius was taken for study using photograph, electron microscope, histological & morphologic technique, and the contents of the Calcium (Ca) and ALP were determined. Results Compared with group B, the healing of group A was better. The contents of Ca and ALP increased obviously in week 2 (P

Objective To investigate the most sensitive methods for diagnosing spontaneous internal carotid artery dissection (sICAD) and spontaneous vertebral artery dissection (sVAD) respectively,for the sake of earlier and more accurate diagnosis.Methods Consecutive patients with sICAD and sVAD who visited the Department of Neurology and Radiology,Huashan Hospital Affiliated to Fudan University during 2008-2013 were retrospectively reviewed and the sensitivity of CT angiography (CTA),magnetic resonance T1-weighted fat-suppressed images (MR T1-FS) and digital subtraction angiography (DSA) for the diagnosis of sICAD and sVAD was compared.Results Eighty patients (62 male,18 female; mean age (45.7 ± 11.9) years) were included in the study.There were 99 arterial dissections in total,45 cases of sICAD,52 cases of sVAD and 2 cases of spontaneous middle cerebral artery dissections.The sensitivity of CTA,DSA and MR T1-FS for diagnosing sICAD was 97.5％ (39/40),90.0％ (36/40) and 69.6％ (16/23) respectively,while for sVAD was 89.8％ (44/49),84.6％ (44/52) and 100.0％ (27/27) respectively.Conclusions sICAD and sVAD have significant differences in many aspects including diagnostic strategies.CTA and MR T1-FS seem to be the most sensitive methods for the diagnosis of sICAD and sVAD respectively.Although DSA has been considered as the gold standard for the diagnosis of artery dissection,this imaging technique does not allow analysis of artery wall thickness,thus also has limitations.It is likely that the diagnostic sensitivity will be improved by combining CTA and MR T1-FS.

Objective To observe the clinical efficacy of minimally invasive percutaneous K-wire crossover fixation treating scaphoid fractures under C-arm.Methods From March 2011 to May 2014,20 patients with fresh scaphoid fractures had postoperative regular outpatient follow-up.Evaluation indicators included Cooney wrist scoring system,X-ray assessment of fracture healing,questionnaire survey of patient's subjective satisfaction at the final follow-up.Results All patients were followed up for 4 to 18 months,the mean follow-up time being 10 months.Postoperative X-ray showed all cases achieved bony union within 8 to 12 weeks,an average of 9.2 weeks.The questionaire resuits of patient's subjective satisfaction showed that general feeling of treatment in 2 cases,relatively satisfied in 2 cases,greatly satisfied in remaining 16 patients at the final follow-up.According to the postoperative Cooney wrist score,excellent in 8 cases,good in 10 cases,fair in 2 cases,the overall satisfactory rate was 90.2％.There were not pin tract infection,nonunion,malunion,avascular necrosis of scaphoid and other complications.2 cases showed that wrist pain during weight-bearing activities and weather getting cold,minor limitations of wrist function and degree of activity,grip strength slightly worse than the contralateral.Conclusions Minimally invasive percutaneous K-wire crossover fixation under C-arm combined with postoperative plaster external fixation properly can attain good clinical results in the treating of scaphoid fractures and worthy of further promotion.

Objective The onset and progression of lung cancer correlate closely to individual genetic background .This study evaluated the correlation between the onset risk of lung cancer and short tandem repeat (STR) polymorphisms in order to find a new pathway for investigating the pathogenesis of lung cancer . Methods Using PCR and electrophoresis on 15 STR loci , we studied the gene and genotype frequencies of peripheral vein blood specimens from 120 lung cancer patients and 156 healthy individuals in Nan-jing area.According to the differences in the allele distribution of the 15 STR loci, we evaluated the susceptive and/or resistant factors relevant to lung cancer . Results There were statistically significant differences between the lung cancer patients and healthy controls at alleles 10, 15.2, and 16 of the loci CSF1PO, D19S433, and D3S1358 (P<0.05, OR>1), as well as at alleles 14 and 14.2 of the loci CSF1PO and D19S433 (P<0.05, OR<1). Conclusion It is possible that alleles 10, 15.2 and 16 of the loci CSF1PO, D19S433, and D3S1358 are susceptive factors and alleles 14 and 14.2 of the loci CSF1PO and D19S433 are resistant factors relevant to lung cancer .

Objective To evaluate changes of regional cerebral metabolism by proton MR spectroscopy (~1H-MRS) in patients with minimal hepatic encephalopathy (MHE) and to correlate these changes with the neuropsychological test. Methods Fifty-four patients with cirrhosis including nine patients with hepatic encephalopathy (HE),23 patients with MHE,22 patients without HE and 13 controls underwent neuropsychological tests and ~1H-MRS scanning. The volumes of interest included occipital gray matter and left parietal white matter regions. Ratio of spectral peak areas of N-acetylaspartate (NAA),choline (Cho),myo-inositol (mI),and glutamine/glutamate (Glx) relative to creatine (Cr) were acquired. Statistical analysis was conducted using independent t test and one-way analysis of variance. The results of different groups were compared by using the nonparametric Mann-Whitney U test with Bonferroni correction. Correlations among the ~1H-MRS ratios, the grade of HE, neuropsychological test and ammonia data were calculated with Spearman correlation test. Results The ratios of NAA/Cr,Cho/Cr,mI/Cr,Glx/Cr of the occipital gray matter and left parietal white matter regions in patients with cirrhosis are 1.55±0.12,0.48±0.10,0.42±0.14,2.52±0.48 and 1.73±0.17,0.75±0.16,0.42±0.16,2.75±0.59respectively,and they are 1.53±0.10,0.48±0.09,0.51±0.11,2.20±0.39 and 1.69±0.15,0.82±0.14,0.53±0.12,2.40±0.40 in patients without HE,1.58±0.13,0.48±0.08,0.38±0.13,2.62±0.39 and 1.78±0.18,0.74±0.14,0.38±0.15,2.84±0.58 in patients with MHE,1.54±0.12,0.50±0.13,0.29±0.07,3.04±0.31 and 1.70±0.19,0.62±0.16,0.29±0.07,3.37±0.38 inpatients with HE.Compared with controls, decreased mI/Cr and Cho/Cr ratios and elevated Glx/Cr ratios were found in patients with cirrhosis (t=3.196,9.394,-6.527,P＜0.01,occipital gray matter. t=5.592,9.717,-6.681,P＜0.01,left parietal white matter＝ and in subgroup of patients without HE, with MHE and HE (F=5.097,25.896,20.204,P＜0.01,occipital gray matter.F=16.435,28.660,21.283,P＜0.01,left parietal white matter).Significant difference in these metabolic alterations was also found among the different groups of cirrhosis especially the ratios of Glx/Cr in occipital gray matter and left parietal white matter (P＜0.0084).The ratios of mI/Cr also significantly altered between patients without HE and with MHE (P＜0.0084).There was a significant negative correlation between the ratios of Cho/Cr,mI/Cr and the grade of HE (P＜0.01＝ and a significant positive correlation between the ratios of Glx/Cr and the grade of HE (r=0.709,P＜0.01,occipital gray matter; r=0.720,P＜0.01,left parietal white matter＝.NCT-A and DST of controls is (49±8) s and 39±6.They are (134±37),(83±26),(64±22) second and 15±2,25±9,35±8 in patients with HE,MHE and without HE respectively.The metabolic alterations of Cho/Cr,mI/Cr,Glx/Cr correlated significantly with neurepsychological tests in all subjects (P＜0.01＝.There was a significant positive and a negative correlation between the ratios of Glx/Cr and the data of NCT-A and DST respectively (r=0.570,-0.642,occipital gray matter; r=0.541,-0.632,left parietal white matter).The metabolic alterations of Glx/Cr had no correlation with ammonia data as well as other metabolic alterations.Conclusions ~1H-MRS study shows cerebral metabolic alterations of gray and white matter in patients with cirrhosis,especially the reduction in mI/Cr ratio and increase in Glx/Cr ratio. These changes correlate well with the neuropsychological tests and may be useful in predicting the presence of MHE.

Objective To evaluate the clinical application of superselective renal artery embolization in the treatment of iatrogenic renal hemorrhage. Methods The iatrogenic renal hemorrhage in fifteen patients was first demonstrated by renal arterigraphy to diagnose the rupture site and degree of injury. And then they were treated by percutaneous catheterized superselective renal arterial embolization through guidance of guide wire. Results In all 15 patients, the occlusive ruption of bleeding arteries and disappearance of extravasation staining were found after the superselective catheterized renal arterial embolization. Clinically, the bloody urine turned clear without macroscopic hematuria during 1-3 days in all patients after the procedure. Conclusions Superseclective renal arterial embolization treatment signified a less invasion, less complications, good hemostatic efficacy, and maximal preservation of renal tissue and function for iatrogenic renal hemorrhage. The treatment is worthy to be recommended.

Objective To evaluate the feasibility and efficacy of laparoscopic repair of vesicovaginal fistula (VVF) with omentum shift.Methods Sixteen VVF patients were reviewed retrospectively from July 2007 to July 2011,aged from 34 to 72 years with a mean age of 48 years.The history of leakage of urine ranged from 1 month to 30 years,of which 15 cases due to uterine operation complication and 1 case due to IUD perforation.All cases were single fistula,with the fistula diameter ＜ 1 cm in 13 cases and ＞ 1 cm in 3 cases.Fourteen cases of fistulas were in the vaginal wall,and 2 cases were in the cervix.Surgical techniques were transabdominal laparoscopic local displacement of the great omentum and conventional layered suture repair of vesicovaginal fistula.Results All surgeries were successful.The operation time was 120 -175 min,with an average of 150 min.The blood loss was 50 -300 ml,with an average of 120 ml.The postoperative hospital stay was 6 to 10 d,with an average of 8.5 d.The catheter indwelling time was 14 to 21 d,with an average of 17 d.During the period of follow-up for 3 to 45 months with an average of 23months,14 cases cured,1 case improved and 1 case failed.No major complications such as intestinal injury occurred.Conclusions Laparoscopic repair of VVF with great omentum shift has the characteristics of less damage,less pain and positive effect.The key points of the surgery are local filling of great omentum and delicate layered suture.

Objective To analyze the clinical data and TUBB4A mutation of hypomyelination with atrophy of the basal ganglia and cerebellum (HABC)in a family,thus to provide accurate genetic counseling and prenatal diagno-sis for this family with HABC,and also to provide clinical experience for the diagnosis of HABC in China.Methods The clinical data of the proband and her family members were collected at the Department of Pediatrics,Peking Univer-sity First Hospital,December 201 4,including medical history,physical signs,and brain MRI,biochemical tests and metabolic disease screening.The associated gene of hereditary leukoencephalopathy was screened for the proband and her family members were screened by targeting -high -throughput sequencing technology,and then the genetic varia-tions were verified by Sanger sequencing.With those detection methods,the gene mutation was confirmed,and then ge-netic features were analyzed.Results Clinical features were as follows:nystagmus as the first symptom,and motor and mental retardation,dystonia and ataxia followed.Brain MRI indicated hypomyelination of white matter and atrophy of the basal ganglia and cerebellum.The clinical diagnosis of HABC was established based on the clinical features and brain MRI features above.Genetics features showed that one novel TUBB4A c.974G >T heterozygous missense muta-tion was found from the proband,which caused an amino acid change from the Trp into Leu (p.Trp325Leu).Both of her parents with normal phenotype were of wild -type in this site.Conclusions The proband from this family was diagnosed clinically based on her clinical data.One novel TUBB4Ac.974G > T (p.Trp325Leu)was founded in this study.Therefore,the spectrum of TUBB4A mutation will be expanded.In addition,this study elucidated clinical and genetic characteristics in this family with HABC,which may lay a solid foundation for the accurate genetic counseling and prenatal diagnosis.This study reported the first case of HABC caused by TUBB4A mutation in China.