There are two main lymphatic drainage routes of the breast: a superficial system and a deep system, and only the deep one can drain into the internal mammary lymph node (IMLN) which receive about 25%of the lymph of the breast. As one of the important nodal sites of lymphatic spread of breast, IMLN is important for neoplasm staging and it will guide adjuvant radiotherapy. However, there still lack an effective and feasible minimally invasive diagnosis technology of IMLN, leading to inaccurate staging and over/under-treatment. The“modified injection technique” broke through the bottle-neck of the low internal mammary visualization rate with traditional injection technique, and made the internal mammary sentinel lymph node biopsy possible to be a min-imally invasive assessment for IMLN status, and further guided internal mammary radiotherapy (IM-RT). Patients with IMLN positive should accept IM-RT, with IMLN negative can avoid IM-RT. With the unceasing progress in studies on internal mammary lymph drainage area, patients may obtain the individualized diagnosis and treat-ment. The review summarizes current knowledge on the anatomy and physiology of the lymphatic system of the breast to translate this into implications for clinical practice of IM-SLNB.

Objective To observe the protective effect of Chinese traditional medicine Ginkgo Biloba extract on rat brain with cerebral ischemia/reperfusion.Methods Compared with ischemia/reperfusion group, Ginkgo Biloba extract-treated group was observed the change of ischemia and edema volume and NAA and lactate in by DWI and ~1H-MRS examination after cerebral ischemia /reperfusion 1 h,3 h,6 h. Results A significant reductions in infarct volume were found in the Ginkgo Biloba extract-treated group compared with the control group after cerebral ischemia 60 min/reperfusion 1 h,3 h,6 h. Ginkgo Biloba extract could decrease the concentration of Lac/(PCr+Cr) and prevent the decline of the concentration of NAA /(PCr+Cr) after cerebral ischemia/reperfusion, it had significantly difference compared with the control group(all P

Aim To observe the neuroprotective effect of platelet activating factor receptor antagonist Kadsurenone on rat brain with cerebral ischemia/reperfusion.Methods Animal model was established through middle cerebral artery occlusion(MCAO).we studied the changes of infarct volume,NAA and Lactate in Kadsurenone-treated group with DWI and()~1H-MRS examination after cerebral ischemia 60 min and reperfusion 1,3,6 h.Results Significant reductions in infarct volume were found in the Kadsurenone-treated group as well as in the Ginkgolides-treated group compared with the control group.And Kadsurenone decreased the concentration of lactate and prevented the decline of the concentration of NAA after cerebral ischemia/reperfusion.Conclusion As platelet-activating factor receptor antagonists,both Kadsurenone and Ginkgolides show remarkable neuroprotective effect.And MRI offers exact neuroimaging information for studying the neuroprotective meachnism of Chinese traditional medicine after cerebral ischemia and reperfusion.

Objective To investigate the status quos of helicobacter pylori infection in people of the area bordering Yunnan,Guizhou and Guangxi so as to provide the basis for the prevention of diseases caused by helico-bacter pylori infection. Methods There were 29547 people including 6644 civil servants,1484 medical staff,5839 factory workers,5542 teachers,10038 students,who took physical examination from January,2012 to Decem-ber,2015 in the Affiliated Hospital of Youjiang Medical University for Nationalities. According to the principle of stratified sampling,3363 people were selected at random from the above groups. Among them there were 756 civil servants,215 medical staff,689 factory workers,654 teachers,1049 students. And there were 1515 Zhuang people, 897 Han people,234 Miao people,282 Yao people ,147 Gelao ,134 Buyi,154 people from other ethnics. Their ages ranged from 7 to 65. ELISA reagent method was adopted to detect helicobacter pylori infection. The relationship between ethnicity,gender,age,occupation,region and infection rate was analyzed. Results The total positive rate of helicobacter pylori was 47.2%in this region. As for different ethnic groups,the positive rate of Zhuang people was as high as 52.7%,and that of Kelao people was the lowest ,only 31.3%. Women′s infection rate was 41.5%,while that of the male was 52.4%. In terms of different age groups,people aged from 50 to 59 got an infection rate as high as 55.3%,while the age group under 18 had the lowest rate,only 19.6%. In the aspect of different professions,civil servants had the highest positive rate 57.9%. Students had the lowest rate 35.9%. Regional distribution analysis showed that Baise had the highest infection rate(51.4%),while Qian xi nan had the lowest rate of 33.9%. There was statistical difference in helicobacter pylori infection between different ethnic groups,genders,ages,occupations and regions(P<0.05). Conclusion The infection of helicobacter pylori in people of the area bordering Yunnan, Guizhou and Guangxi are related to ethnicity,gender,age,occupation and region.

Objective To explore the correlation of fatigue with health-promoting lifestyle in the udnergraduate students, so as to provide scientific evidence for the intervention. Methods A cross-section trial was carried out in the undergraduate students from a medical university in Guangzhou. By a self-designed questionnaire, the incidence of fatigue in the undergraduate students was figured out after data processing and statistical analysis. Results A total of 6 100 questionnaires were released, and 5 843 were responded, with a respondent rate being 95.79%. The number of effective questionnaires arrived 5 676. The results showed that the prevalence of fatigue among undergraduate students was 49.6%. The female had a higher risk than the male ( 51.6% vs 45.8%, P<0.01). The prevalence of fatigue in grade 1-3 students was 49.4%, 48.1% and 52.1% , respectively, the difference being insignificant among the three grades (P>0.05). The students with poor level of health-promoting lifestyle had a higher risk of suffering from fatigue (OR=6.647, 95%CI: 4.913-8.993). Conclusion Fatigue is prevalent among the undergraduate students. The incidence of fatigue can be reduced by increasing the level of self-actualization, physical exercise and pressure management.

Objective To investigate the genotype distribution of microsatellite locus CAI among Candida albicans ( C.albicans ) strains and to evaluate its relationship with the epidemic of vulvovaginal candidiasis ( VVC) in Guizhou region .Methods Ninety independent C.albicans strains isolated from pa-tients with VVC in Guizhou were investigated based on single-strand conformation polymorphisms ( SSCP ) and GeneScan analysis .The genotypes of C.albicans strains were identified by microsatellite locus CAI pol-ymorphism analysis .The gene polymorphism and the cluster of C.albicans strains were analyzed by using software SPSS 19.0.A logistic regression model was used to analyze the relationship between genotype distri -bution of CAI microsatellite among C.albicans strains and VVC infection .Results Twenty-seven distinct CAI genotypes with various patterns were identified from 90 C.albicans strains by GeneScan analysis .Clus-ter analysis showed that the C.albicans strains were classified into three clusters ( ClusterⅠto Cluster Ⅲ) . Three predominant genotypes including 30-45, 32-46 and 30-46 and other 7 highly similar genotypes be-longed to clusterⅡthat accounted for 70.0%(63 strains) in all strains.The odds ratio for the predominant genotypes associated with VVC infection was 4.3.Conclusion The predominant distribution of genotypes was observed among the isolated C.albicans strains.The predominant genotypes of C.albicans were highly associated with the occurrence of VVC .

Objective To investigate the various occasions of invasive mechanical ventilation in patients with acute left heart failure. Methods Thirty-two patients with acute severe left heart failure were divided into two groups:17 patients were treated with non-invasive mechanical ventilation (non-invasive mechanical ventilation group) and 15 patients were treated with invasive mechanical ventilation (invasive mechanical ventilation group). The respiratory rate (RR), arterial oxy-gen partial pressure p(O2), heart rate (HR) and mean arterial pressure (MAP) were observed after treatment for 0.5 h,1 h and 3 h in two groups of patients. The in-hospital mortality was compared between two groups. Results Ten patients of non-in-vasive mechanical ventilation group were in remission after 0.5 h, 7 cases without remission switched to endotracheal intuba-tion for invasive mechanical. And 3 of them were in remission in 0.5~1 h, 4 of them dead. Fourteen patients in invasive me-chanical ventilation group were in remission after 0.5 h, one case was in remission after 0.5~1 h and no dead in this group. There were more patients in remission after 0.5 h in invasive mechanical ventilation group than those of non-invasive me-chanical ventilation group (P=0.041). There were no significant differences in the number of patients in clinical remission af-ter 0.5~1 h and mortality between two groups. The values of RR and HR were decreased with the increasing treatment time in two groups. The values of p(O2) and MAP were increased with the increasing treatment time in two groups. There was a sig-nificantly lower RR at 0.5 h and 1 h in invasive mechanical ventilation group than that of non-invasive mechanical ventila-tion group (P ＜ 0.05). The values of p(O2) and MAP were significantly higher at 0.5 h in invasive mechanical ventilation group than those of non-invasive mechanical ventilation group (P＜0.05). The levels of HR at 0.5 h and 3 h were significant-ly lower in invasive mechanical ventilation group than those of non-invasive mechanical ventilation group ( P＜0.05). Con-clusion Invasive mechanical ventilation should be used as soon as possible if non-invasive mechanical ventilation can not alleviate the symptoms in patients more than 0.5 hours.

Aim To evaluate the mucosal-protective effects of carboxymethylpachyman( CMP) on Fluorou-racil(5-Fu)-induced mice intestinal mucositis and ex-plore its mechanisms. Methods ICR mice were as-signed randomly to four groups:normal group( n=8;re-ceiving pure water orally for 14 d) ,CMP group( n=8;200 mg·kg-1 CMP for 14 d orally),5-Fu group(n=8;25 mg·kg-1 5-Fu for 7 d,intraperitoneally( i. p. ) , and CMP+5-Fu group( n=8;200 mg·kg-1 CMP for 14 d orally and 25 mg·kg-1 5-Fu for 7 d,i. p. ). At day 14the mice were sacrificed. The intestinal propel-ling rate and the colon length were measured. ROS, GSH and IL-1βcontents,and CAT,GSH-Px activities in homogenate supernatant of PPs were measured by kits for observing the effects of CMP on mice lipid peroxida-tion and intestinal mucosal inflammatory induced by 5-Fu. Colon tissues were used for hematoxylin and eosin ( HE ) staining for the determination of the effect of CMP on mice colon histopathology, immunohistochem-istry for the protein levels of NF-κB and p-p38 . Results CMP significantly extended colon lengths,accelerate the intestinal propelling rates, reduced colonic mucosa epithelium goblet cell loss, inflammatory cells infiltra-tion,and crypt depth shallow induced by 5-Fu. CMP obviously reduced ROS and IL-1β contents, and pre-vented reductions in homogenate supernatant of PPs GSH content, CATand GSH-Px activities by 5-Fu ad-ministration,and also reduced the expression of NF-κB and p-p38 in colon tissues. However, CMP alone had no effect on the colon of normal mice. Conclusion The current study demonstrates that CMP may have sig-nificant protective effects against 5-Fu-induced intesti-nal mucositis. Its mechanism may be related to enhan-cing the antioxidant activity,anti-inflammatory and an-ti-apoptotic effects.

Objective To investigate the injury and disruption of anterior sacroiliac ligament (ASIL) and sacrotuberous/sacrospinous ligament complex(STL/SSL),as well as the displacement of pubic symphysis (PS) and sacroiliac joint (SIJ),associated with anterior-posterior compression (APC) of Young-Burgess type Ⅱ.Methods Test models of APC of Young-Burgess type Ⅱ were created in 10 fresh human pelvic cadaveric specimens which were randomized into 2 equal groups (n =5).The fight hemipelvis in one group was fixed to a table (the limited group) while that in the other was not (the unlimited group).At the disruption point of ASIL during external rotation of the hemipelvis,displacement of PS,separation distance between the anterior parts of the sacroiliac joint,and injury and disruption of STL/SSL were recorded.When STL/SSL was gradually made to breakdown and fracture with continuous external rotation of the hemipelvis,bony changes and injuries to the posterior pelvic ligaments were observed and recorded.Results At the failure point of ASIL,the mean displacement of PS was 23.8 ± 2.8 mm and that of SIJ was 10.9 ± 4.4 mm,showing no significant difference between the limited and unlimited groups (P ＞ 0.05);the mean external rotation angle was 40.1°± 9.8° and the mean torsion was 646.7 ± 131.5 N,showing significant differences between the limited and unlimited groups (P ＜ 0.05).At the disruption point of ASIL,obvious injuries or disruption of STL/SSL were not observed in the unlimited group but observed in the limited group.With extreme external rotation,obvious disruption of STL/SSL was not found in the unlimited group but observed in the limited group.When ASIL and STL/SSL were all fractured,the mean displacement of PS was 41.8 mm and that of SIJ was 16.8 mm in the limited group.Conclusions Since APC injury can lead to 2 situations,limited or unlimited hemipelvis,external rotation injuries to the ligaments differ in the 2 different situations.When ASIL fails,the displacement of PS will fluctuate greatly.

Background and purpose:Whether axillary sentinel lymph node biopsy (ASLNB) could replace axillary lymph node dissection (ALND) in patients who converted after neoadjuvant chemotherapy (NAC) from cN+ to ycN0 is still contentious, and the previous study only evaluated the pathological status of ALN without internal mammary lymph node (IMLN) condition. This study is to evaluate roles of ASLNB and internal mammary sentinel lymph node biopsy (IM-SLNB) in breast cancer patients after NAC.Methods:From Jan. 2012 to Dec. 2014, 60 breast cancer cT1-4N0-3M0patients who were scheduled for neoadjuvant chemotherapy (NAC) and agreed to accept surgery after NAC from our department were enrolled into the retrospective study. Patients with cN0 before NAC and ycN0 after NAC underwent ASLNB (group A). Patients with cN+ received NAC and ycN0 after NAC (group B) were treated with ASLNB and ALND. Only patients whose clinical nodal status remained positive (ycN+) after NAC underwent ALND without ASLNB (group C). All the patients received radiotracer injection and patients in group A and group B received blue dye injection additionally. Meanwhile, IM-SLNB would be performed for all patients with IM-SLN visualization.Results:The number of patients enrolled in group A, group B and group C was 6, 45 and 9 cases respectively. The accuracy rate of ASLNB in group A was 100% (6/6). Only one patient was axillary sentinel lymph node (ASLN) positive performed ALND. With combination of blue dye and radiolabeled colloid, the accuracy rate of ASLNB in group B was 100% (48/48) and the false negative rate (FNR) was 17.9% (5/28). The FNR in patients with 1, 2 and>2 SLNs examined was 27.3% (3/11), 20.0% (2/10) and 0% (0/7). All of the ALNs were positive in group C. The visualization rate of IM-SLN was 63.3% (38/60). The detection rate of IM-SLNB was 97.4% (37/38) and the metastasis rate was 8.1% (3/37). The incidence of complications was 5.3% (2/38).Conclusion:ASLNB can be performed either before or after preoperative chemotherapy for patients with cN0 disease. Among women with cN+ converted to ycN0 who had 3 or more SLNs examined, the FNR could return to be less than 10%. Those patients whose nodes are still ycN+ should perform ALND. IM-SLNB should be performed routinely in all breast cancer patients after NAC, for it might help to make clear of the nodal staging and the pathological status of IM-SLN and provide the accurate indication of radiation to the internal mammary area in case of under-stage and under-/over-treatment, expecting to develop the deifnition of pathological complete response (pCR).