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.

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.

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.

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.

OBJECTIVETo investigate the blood supply of the pedicle fat grafts with the third lumbar segmental artery and its clinical effects on reoperation for lumbar disc herniation.

METHODSTwelve sides of 6 adult cadaver examples were contributed to investigate the courser of lumbar segmental vessels and the distribution of hypodermic capillary net of the dorsal branch of the third lumbar segmental artery. From January 2000 to January 2007,49 patients needed reoperation to treat lumbar disc herniation,including 26 males and 23 females with an average age of 55.6 years (ranged from 39 to 70 years). Duration between two operations ranged from 8 months to 15 years with an average of 6.9 years. Reoperative reasons included recurrent lumbar disc protrusion(30 cases)postoperative epidural scar formation (17 cases), postoperative epidural cyst formation (2 cases). Of them,9 patients underwent posterior lumbar interbody fusion at the second operation. The pedicle fat grafts with the third lumbar segmental artery were covered on the sites of the laminectomy in these patients. After negative pressure drainage tube were pulled out, 2 ml Chitsan were injected to the sites of the laminectomy and around epidural nerve root through epidural catheter. VAS score and the Oswestry Disability Index (ODI) were used to assess clinical outcomes before and after operation.

RESULTSThe courser of third lumbar segmental vessels were invariant at the lateral face of the lumbar vertebral body. The dorsal branch of the third lumbar segmental artery penetrated thoracolumbar fascia and formed rich hypodermic capillary net in the region. All patients were followed up from 5 to 8 years with an average of 5.6 years. VAS score of low back pain and leg pain decreased respectively from preoperative 7.6 +/- 1.2, 8.9 +/- 0.9 to 3.6 +/- 0.5, 3.0 +/- 0.4 at final follow-up (P < 0.01); and ODI score decreased from preoperative 44.1 +/- 6.2 to 13.9 +/- 3.6 at final follow-up (P < 0.01). According to ODI score to evaluate the clinical outcomes, 29 cases got excellent results, 11 good, 7 fair, 2 poor.

CONCLUSIONThe pedicle fat grafts with the third lumbar segmental artery and Chitsan can reduce epidural scar formation and prevent peridural fibrosis and adhesion and improve clinical effects of reoperation for lumbar disc herniation.

Adipose Tissue ; pathology ; Adult ; Aged ; Arteries ; pathology ; physiopathology ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; pathology ; physiopathology ; surgery ; Lumbar Vertebrae ; blood supply ; pathology ; surgery ; Male ; Middle Aged ; Reoperation ; Transplantation ; Treatment Outcome

BACKGROUND:Psychological disorder and behavior disorders can affect the development of behavior and personality in children.OBJECTIVE:To investigate the behavior disorders and the personality in children with tic disorders (TD).DESIGN:A comparative investigation between TD children and the healthy controls.SETTING:It was conducted at the Department of Pediatrics,Daqing Oil Felid General Hospital in Heilongjiang ProvincePARTICIPANTS:Totally 110 outpatients including 92 males and 18females, diagnosed as TD at the Department of Pediatrics, Daqing Oil Felid General Hospital,were selected (TD group) from February 2003 to December 2004.According to the clinical manifestations,they were divided into transient tic disorder group (46 cases),chronic motor/vocal tic disorder group (34 cases) and Tourette Syndrom (TS) group(30 cases).All the patients were newly diagnosed without any medication and intracranial organic diseases. Meanwhile,30 children with normal physical examination findings, between the ages of 7 and 14,24 males and 6 females, were selected as controls. Informed consents were obtained from guardians of all the participants.used to measure the children's social skills and behaviors (It contains a 113-item behavior problems scale. According to the children's ages,the items were classified into 9 factors,including somatic complains,poor social skills,compulsions,undisciplined,hyperactivity,Asperger syndrome,immaturity,hostility and aggressiveness.The scores of referring items constitute the total score of each factor).Comparison of these scores between patients and healthy controls is helpful to determine if a factor in affected children is abnormal. The closer the relationship between the patients and the controls is, the less behavioral problems Personality Questionnaire (EPQ) was adopted in this study to evaluate the personality in the patients compared to healthy controls.{There were four major dimensions of personality including introversion/extraversion,neuroticism,psychoticism and validity questionnaire (construct validity).When the validity score was over 70,it represented that the EPQ was invalid.An over-61.5 neuroticism score represented an apparent neuroticism tendency. Once the neuroticism score and introversion/extraversion score were over 56.7,mental instability or instable tendency could be suspected. When introversion/extraversion score was over 56.7and the neuroticism (extraversion) score was less than 43.3,it represented a sanguine personality or such tendency. When both of the neuroticism score and introversion/extraversion score were less than43.3 (introversion),it revealed a phlegmatic personality or such tendency. And when the introversion/extraversion score was less than43.3 with neuroticism score over 56.7,it represented a melancholic personality or such tendency.}MAIN OUTCOME MEASURES:Comparison of Achenbach's CBCLand EPQ between patients and healthy controls .RESULTS:Totally 110 TD patients and 30 healthy children completed the control group (t=3.12-8.60, P ＜ 0.01).The hyperactivity score in the transient tic group was significantly higher than that in the control group (t=2.01, P ＜ 0.05). In the chronic motor tic disorder group and the TS group,the scores of depression/anxiety,poor social skills,compulsions,social withdrawal,hyperactivity and aggression were all higher than those in the control group(t=2.11-7.65, P ＜ 0.05-0.01).In all of these three TD groups, score factors relating to social functions,such as movements, social skills and school life were apparently lower than those in the control group (t= 1.97-7.31, P ＜ 0.05-0.01).(t=2.76-4.32, P ＜ 0.05-0.01), while the score of validity questionnaire was lower than that in control group (t=3.49-6.38, P ＜ 0.05).CONCLUSION:It reveals that TD patients have many behavioral problems,personality defects and poor social skills. Of all the TD groups,the transient tic group has a higher occurrence rate of disease and only one abnormal factor, hyperactivity. While,the chronic motor tic disorder group and the TS group have more abnormal behavioral factors.

Objective To study the therapeutic effect of the complex mixture of luteolin and rutin ( MLR) on 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridin ( MPTP) induced Parkinson’ s disease ( PD) mouse model. Methods Seventy-two C57BL/6 mice were divided into six groups randomly ( n=12 in each group): the normal control , model control , madopar (50 mg·kg-1) group, MLR at low (140 mg·kg-1), middle (280 mg·kg-1) and high (560 mg·kg-1) dose groups. PD mouse models were established by intraperitoneal injection of MPTP ( 30 mg · kg-1 ) . Pole test and traction performance were recorded to access the body coordinate capability and strength. The tyrosine hydroxylase (TH), dopamine transport protein ( DAT) , and glial fibrillary acidic protein ( GFAP ) positive cells were detected by immunohistochemical method. Dopamine ( DA ) , dihydroxyphenylacetic acid ( DOPAC ) , homovanilic acid ( HVA ) , 5-hydroxytryptamine ( 5-HT ) and 5-hydroxyindoleacetic acid (5-HIAA) in striatum were quantified by HPLC-ECD. Results MLR significantly ameliorated mouse motor coordination ability (P<0. 01 or P<0. 05). MLR at 280 and 560 mg·kg-1 could increase TH-positive neurons by 69. 00%and 77. 95% compared with the normal control group (P<0. 01) and DAT-positive neurons by 68. 53% and 70. 40% compared with the normal control group(P<0. 05), and decrease GFAP-postive astrocyte reactivity. The treatment with MLR at three doses attenuated the monoamine neurotransmitter disorder. Conclusion MLR markedly improves MPTP caused movement coordinate ability injury in mice and exerts therapeutic action on PD by regulating neurotransmitters in brain, inhibiting the inflammatory reaction and alleviating the neuron injury.