Objective To establish a preoperative evaluation system for breast reconstruction,and to simplify the selection of surgical methods for breast reconstruction in a standard way.Methods We investigated respectively 192 successful cases that underwent breast reconstruction from July 2003 to July 2009.The factors influencing selection of methods for breast reconstruction were studied.The results presented in more than 50 ％ were collected.Results A special table of the preoperative evaluation system for breast reconstruction was established by analyzing statistical results. Conclusions The selection of methods for breast reconstruction is simplified according to this preoperative evaluation system.

Diabetes mellitus increases the risk of breast cancer and affects the prognosis of breast cancer patients. Metformin, an anti-diabetic drug, decreases blood glucose level and has a role in suppressing various cancers. In addition, metformin has a unique in-hibitory effect on breast cancer, i.e., it can inhibit breast cancer cells in vivo and in vitro. Moreover, metformin exerts its anti-tumor ef-fect on epidermal growth factor receptor 2 (HER-2) positive and monoclonal antibody trastuzumab-resistant breast cancer cell lines, breast cancer stem cells, and triple negative breast cancer cells. Metformin can reduce the risk of the breast cancer in patients with dia-betes, lower histologic grade, and increase expression of estrogen and progesterone receptors. Furthermore, metformin has certain effect on neo-adjuvant chemotherapy for breast cancer. This review aims to clarify the mechanism of metformin in restraining breast cancer based on basic and clinical study results.

Conventional diagnostic methods used for pathologic nipple discharge (PND) include color ultrasound, mammary mo-lybdenum target X-ray radiography (mammography), nipple cytologic smears, and ductography. Diagnosis of PND through inspection yields indirect signs and has low positive rate. Fiberoptic ductoscopy (FDS) allows direct visualization of intra-ductal lesions, evaluates etiology of PND, and accurately locates intraductal lesions through wire marking. FDS is a valuable test for the early diagnosis of breast cancer and can help identify appropriate location for surgical excision. Interventional treatment for ductal ectasia and inflamma-tion is also efficient. Our study discusses FDS as a novel diagnosis and treatment method for PND patients.

Objective To compare contrast-enhanced ultrasonography (CEUS), contrast-enhanced CT (CECT) and combined detection of two methods in the diagnosis of small renal masses, and differential diagnosis of different types of small renal masses by CEUS. Methods In 95 cases of small renal masses, there were 79 patients with small renal cell carcinoma and 16 patients with benign tumor. The diagnostic results of the three methods were compared based on the pathological results, which were used as thegold standardfor the diagnostic efficacy. The ROC curve was drawn, and the area under the curve (AUC) was compared. The characteristics of the two groups were analyzed and compared by Q-Lab software in CEUS. The angiographic parameters included arrival time (AT), time to peak (TTP) and peak intensity (PI). CEUS patterns for several pathologic types of renal tumors with larger sample sizes were compared. The characteristic manifestations of small renal masses under CEUS were analyzed. Results The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and AUC of CEUS were 87.37%, 93.67%, 56.25%, 91.36%, 64.29%and 0.750, the values for CECT were 88.42%, 93.67%, 62.50%, 92.50%, 66.67%and 0.775, and the values for combined detection of two methods were 95.79%, 98.73%, 81.25%, 96.30%, 92.86%and 0.869 respectively. The sensitivities of the three methods were high, but the specificities were the same. The combined detection showed better diagnostic efficacy than that of single diagnostic method. The AT and TTP of CEUS were earlier in small renal carcinoma group than those of benign nephrotic group, and PI was higher than that of benign nephrotic group (P<0.05). There were significant differences in the contrasts ofcontrast enhancement methods between clear cell carcinoma, papillary cell carcinoma, chromophobe cell carcinoma, and angiomyolipoma (P<0.01). There was little difference in contrast enhancement between the other types of carcinoma. False envelope can be observed by CEUS.'Cystic area'of the detection rate was increased significantly by CEUS than that of conventional ultrasound. Conclusion Combined detection of CEUS and CECT can improve the diagnostic accuracy of small renal tumors. CEUS has great clinical value in the differential diagnosis of small renal masses, which is worthy of clinical promoting.

Objective To explore the metabolic characteristic of prostate cancer (PCa) in central gland with magnetic resonance (MR) spectroscopic, and evaluate the value of MRS in the differential diagnosis of benign prostatic hyperplasia nodus. Methods MR images were performed in 38 cases with prostate disease by 3.0T MR, 11 cases with PCa in central gland and 27 cases with benign prostatic hyperplasia nodus. All the cases were scanned by routine, then by the combined MRS. MRS findings were reviewed in 27 cases with benign prostatic hyperplasia (BPH) and 11 cases with PCa (3 in central gland origin, 8 with large tumor invading both peripheral zone and central gland). (Cho+Cr)/Cit ratios of PCa and BPH were retrospectively measured, (Cho+Cr)/Cit of PCa voxels were compared with that of BPH voxels. Results Significantly higher choline levels and lower citrate levels were observed in central gland of PCa compared with BPH. In the glandular BPH region, the amount of Cit was high; while in the stromal region, the Cit and Cho level was much lower. The average (Cho+Cre)/Cit values of PCa and BHP were 1.94±1.43 and 0. 83±0. 28 respectively, the difference in ratio between both was statistically significant (P＜0. 01). Conclusions The combined use of MRI and MR spectroscopy is propitious for differentiating prostate cancer in central gland and benign prostatic hyperplasia nodus and for increasing the diagnostic accuracy of prostate cancer.

Objective To investigate the expression of hypoxia inducible factor 1α (HIF-1α) and glucose transporter 1 (GLUT1) in lung adenocarcinoma and its correlation with tumor metastasis. Methods SP immunohistochemistry was used to detect GLUT1 and HIF-1α protein expression in 125 lung adenocarcinoma, including 41 cases without metastasis, 38 cases with lymphatic metastasis and 46 cases with brain metastasis. The correlation of GLUT1 and HIF-1α in lung adenocarcinoma metastasis was analyzed by using x 2 test and Pearson correlation analysis. Results Most lung adenocarcinoma were histologically heterogeneous, which contained more than one adenocarcinoma type. 73.2 % (30/41) cases were acinar predominant adenocarcinoma in lung adenocarcinoma without metastasis; 53.6 % (15/38) cases were acinar predominant adenocarcinoma and 26.3 % (10/38) cases were solid predominant adenocarcinoma in lung adenocarcinoma with lymphatic metastasis; 47.8 % (22/46) cases were papillary predominant adenocarcinoma and 34.8 % (16/46) cases were solid predominant adenocarcinoma in lung adenocarcinoma with brain metastases. The expression level of GLUT1 and HIF-1α in lung adenocarcinoma with lymphatic metastasis group was higher than that of the group without tumor metastasis (P< 0.05); the expression of GLUT1 and HIF-1α were positively correlated (r=0.407, P=0.000). Conclusions Papillary adenocarcinoma is the most histological type in lung adenocarcinoma with brain metastasis, suggesting that papillary adenocarcinoma is more prone to brain metastasis. The expression of GLUT1 and HIF-1α play an important role in lymph node metastasis and brain metastasis of lung adenocarcinoma.

Objective To observe the efficacy and prognosis of recombinant human brain natriuretic peptide ( rhBNP) and conventional treatment in acute myocardial infarction patients undergoing percutaneous coronary intervention therapy complicated by acute of left heart failure. Methods Retrospective analysis of 229 cases of hospitalized patients with acute myocardial infarction undergoing percutaneous coronary intervention therapy in 24 hours after admission, complicating with acute left ventricular failure in Shenyang Military General Hospital from June 2012 to January 2014 were enrolled and devided into: the conventional heart failure therapy group (the control group, n=122) and the rhBNP plus conventional treatment group ( the treatment group, n =107 ) , according to the patient's economic conditions and wishes. Observed improvement in heart failure symptoms before and after treatment during hospitalization and follow-up and also the 30 days and 12 months mortality. Results After 72 hrs of treatment of heart failure, both groups had decrease in heart rates, systolic blood pressure and NT-proBNP levels as compared to pre-treatment levels ( all P ﹤ 0. 05 ) . The NT-proBNP levels and heart rate of the treatment group decreased more significantly compared to the control group (both P﹤0. 05). Compared with the control group, rhBNP which to be used 72 hrs, can improve the cardiac function of AMI patients with the ratio of KillipⅡ-Ⅲ(72. 9%vs. 54. 9%, P=0. 005). There was no significant differences between two groups in in-hospital mortality and early follow-up period ( 30 days ) ( P ﹥0. 05 ) . After 12 months of follow-up, the mortality of the treatment group was lower than the control group ( 6. 5% vs. 13. 9%, P = 0. 068 ) . Through logistic regression analysis, the value of NT-proBNP and whether patients were treated with rhBNP on the basis of the routine drug were independent influencing factors for mortality of 12 months. Conclusions Additional to standard conventional therapy for acute left heart failure in patients with acute myocardial infarction undergoing PCI, rhBNP can lower the 12 months mortality and improve prognosis.

Objective To explore the effect of the posterior condylar offset (PCO) on clinical results after total knee arthroplasty (TKA) using a high-flex posterior-stabilized (PS) fixed-bearing prosthesis.Methods Clinical and radiographic materials of 107 consecutive female patients (107 knees),who had undergone primary TKAs for end-stage osteoarthritis was prospectively analyzed.All operations were performed by using the same operative technique.Based on the corrected PCO change,all cases were divided into two groups:66 knees in which the corrected PCO change ≥0 mm (aged 48-73 years,with an average of 61.4 years) and 41 knees in which the corrected PCO change ＜ 0 mm (aged 52-75 years,with an average of 62.2 years).One-year postoperatively,clinical and radiographic variables from the two groups were compared by independent t-test.The associations between the corrected PCO changes and the improvements of clinical variables in all patients were analyzed by Pearson linear correlation.Results The corrected PCO change was 2.49±1.71 mm in the PCO change ≥0 mm group and-1.28±1.41 mm in the PCO change ＜ 0 mm group.One-year postoperatively,the Knee Society scores,the Western Ontario and McMaster Universities Osteoarthritis Index,non-weight-bearing active and passive range of knee flexion,flexion contracture,and their improvements had no statistical differences between the two groups.The corrected PCO change was not significantly correlated with the improvement of any clinical variable.While the PCO change ≥0 mm group (130.40°± 11.63°) demonstrated greater flexion than the PCO change ＜ 0 mm group (123.80°±13.12°) during active weight-bearing one year after TKA,which was significantly different between the two groups (t=2.11,P=0.0401).Conclusion Restoration of PCO plays an important role in the optimization of active knee flexion during weight-bearing conditions after posterior-stabilized TKA,while it had no benefit to non-weight-bearing knee flexion and any other clinical result.

Objective To investigate ACEI ( benazepril ) and tranilast exert renoprotective properties in diabetic nephropathy( DN) through the inhibition of thioredoxin( Trx) . Methods Forty male SD rats were randomly divided into normal control group,model control group,tranilast group and benazepril group (n=10 each).Normal control group was fed with normal diet. Other groups were fed with high-glucose high-fat diet to make DN models. Rats in model control, tranilast, and benazepril groups were fed with normal diet,400 mg??kg-1??d-1 tranilast plus normal diet,and 10 mg??kg-1??d-1 benazepril plus normal diet,respectively,via oral gavage for 12 weeks.The 24-hour proteinuria,blood glucose(BG),blood urea nitrogen (BUN),serum creatinine ( Scr) and renal pathology changes were detected. Expression of Trx was measured by Western-blot. Results The 24 h urine protein, BG, BUN, Scr, kidney/body weight, and glomerular sclerosis index were significantly decreased in tranilast group and benazepril group,as compaired with model control group ( P<0.05) ,but there was no statistical difference between the two drug groups (P>0.05).Both tranilast and benazepril can reduce renal pathological changes,and can increase the expression of Trx of DN rats, but benazepril had a more significant effect on increasing Trx expression. Conclusion Both tranilast and benazepril have renoprotective function in DN, and benazepril is more effective than tranilast in delaying the progression of diabetic nephropathy by increasing Trx expression and decreasomg oxidative stress.

Objective To investigate the expression of apoptotic protease cysteinyl aspartate specific proteinase (caspase-3) in cortex neurons of rats with sepsis.Methods Models of rats with sepsis were established by the cecal ligation and puncture (CLP).Totally 70 cases of 30-day-old male Wistar rats were randomly divided into CLP group (n =50) and control group (n =20).In CLP group,CLP was performed in the rats.Neurobehavioral score was measured in 5 rats at 6,12,24 and 48 h after CLP surgery,respectively.Then,they were killed and their brains were removed.The immunohistochemical staining and Western blot were used to detect the apoptotic protein caspase-3 expression in cortex of rats.Control group did not undergo CLP,and the other treatment was the same as CLP group.Results Neurobehavioral scores at 12,24 and 48 h after CLP surgery were significantly lower than that in the control group(t =3.651,3.773,7.155,all P ＜ 0.05),and the scores were gradually decreased,overall situation of rats was getting worse along with the time.Caspase-3 protein expressed only in trace amounts in rat cerebral cortex in the control group by immunofluorescence analysis,however,its expression was significantly increased at 12 h after CLP surgery.Western blot test showed that caspase-3 protein expression in rat cerebral cortex at 6,12 and 24 h after CLP surgery was significantly higher than those in control group (all P ＜ 0.05).Its expression began to increase at 6 h after CLP surgery,and reached the peak at 12 h,then decreased at 48 h.Conclusion The neurobehavioral scores decreases and the expression of apeptosis protease caspase-3 increases in cortex of rats with sepsis brain injury.