Objective To investigate the surgical treatment of occult breast cancer.Methods The clinical data of 11 cases of occult breast cancer were analyzed retrospectively.Results In 11 female cases aged between 44and 70 years old,2 cases were accompanied with supraclavicular node metastasis.Axillary node enlargement was presented as the first sign,which was located in left side in 4 cases and right side in 7 cases.3 cases underwent axillary lymph lode desection,2 cases accepted axillary node excision and other 2 cases with supraclavicular node enlargement only underwent excisional biopsy.All patients received radiochemotherapy and endocrine therapy.All cases were followed-up from 8 months to 9 years and 6 months,during which 3 cases died,with the 5 years survival rate of 54.5%(6/11).Conclusion Combined treatment is suitable to occult breast cancer.Modified radical mastectomy or breast conserving surgery should be conducted,but axillary lymph node desection may be conducted when the diagnosis is established.

Objective To explore the value of fiberoptic ductoseopy in diagnosis and treatment of nipple discharge diseases.Methods From March 2007 to March 2008,91 patients with nipple discharge were admitted in our hospital.These patients were diagnosed and treated using flberoptic ductoscope FVY-780,and their documents were retrospectively analyzed.Results All the 91 cases were successfully diagnosed and treated with fiberoptic ductoscopy.54 cases(59.3%) were diagnosed as protrusion lesions,19 of whom experinced multiple protrusion,and 5 cases(5.5%) of early breast carcinoma were confirmed by postoperative pathology.37 patients(40.7%) diagnosed as non-protrusion lesions were treated by irrigation therapy,some of whom improved or cured.Conclusions Fiberoptic ductoseopy is the first choice of examination for nipple discharge,and it has important clinical values in choosing procedures for it can show precisely the cause and lesion site.Surgery can thereby be avoided for non-protrusion lesions.Locating the site of lesions in mammary ducts guided by fiberoptic duetoscopy may make operations more accurate and minimally invasive.

Objective To investigate the clinical characteristics and prognosis in the patients with type 2 diabetes mellitus and invasive pulmonary aspergillosis(IPA) for better management of the disease .Methods Clinical data of 9 cases of type 2 diabetes associated with IPA treated in Qingdao Municipal Hospital from January 2008 to December 2013 were analyzed retrospectively . Results The diagnosis of IPA was proven in 5 and probable in 4 of the 9 patients .The main clinical manifestations were fever , cough and expectoration .The findings of CT scan mainly showed pulmonary nodules along the bronchovascular bundle and cavity signs .Bronchoscopy showed congestion ,edema ,and erosion of bronchial mucosa covered with yellow‐white or brown pus ,partially or completely blocking the lumen .Antifungal treatment was effective for 4 patients .The other five patients died . Conclusions Type 2 diabetes mellitus is a risk factor for developing invasive pulmonary aspergillosis .Early diagnosis and proper treatment are critical for improved prognosis .

Objective To evaluate ultrasound combined with thri-operators and the blood-oxygen functional image (TOBOFI) technology in diagnosis of breast cancer in young women. Methods 221 breast tumor patients under 45 years old were selected to analyze their TOBOFI and ultrasonographic characteristics respectively. Based on pathological result, the two diagnostic methods were compared to determine the accurate rate. Results Of all the 221 patients, 82 (37.1%) were malignant and 139 benign. The sensitivity of TOBOFI and ultrasonography was 90.24% and 83.57% respectively, while the accurate rate of the two was 89.14% and 84 62% respectively. Accurate rate was improved to 93.90 % (77/82) if the two were combined. Conclusion TOBOFI has unique clinical value in diagnosing breast cancer in young women, especially in combination with ultrasound.

The content of optical isomerism is the difficult point of organic chemistry teaching, and so case-based learning (CBL), theoretical-experimental integration teaching method and micro class teaching methods are tried to be used in classroom teaching according to the actual teaching situations. For CBL teaching method, the course is guided by the step of introduction-question-discussion and summary-exten-sions; For theoretical-experimental integration teaching method, combined with the theory class, the two experiments including the determination of optical rotation and organic molecular model are set for the opti-cal isomer content, to enhance the students' understanding of theoretical knowledge through the hands-on operation;For micro class teaching method, the key and difficult points of this chapter are dug out and about 10 minutes of video are recorded by using common video software before class, which are introduced in the classroom or provided to students after class for repeated watching, to deepen the students' understanding of the concept and phenomenon of optical isomers. In brief, it is important to combine various teaching method to improve the classroom instructing effectively and stimulate the students' interest in organic chemistry.

Objective To evaluate the effect of dexmedetomidine on the quality of intraoperative wake-up test in the patients undergoing balloon occlusion test of the internal carotid artery.Methods Forty-two patients of either sex with intracranial aneurysm,aged 57-78 yr,weighing 53-86 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective balloon occlusion test of the internal carotid artery under general anesthesia,were assigned into 2 groups (n =21 each) using a random number table:propofol conbined with remifentanil group (group PR) and dexmedetomidine combined with propofol and remifentanil group (group DPR).In group DPR,dexmedetomidine was intravenously infused over 15 min in a loading dose of 0.5 μg · kg-1 before induction of anesthesia,followed by an infusion of 0.3 μg · kg-1 · h-1 throughout surgery.Propofol and remifentanil were given by target-controlled infusion (TCI) after infusion of the loading dose.The patients were mechanically ventilated after placement of the laryngeal mask airway.Maintenance of anesthesia was as follows:propofol and remifentanil were given by TCI with the target plasma concentrations of 0.5-1.0 μg/ml and 1-3 ng/ml,respectively,in group DPR;propofol and remifentanil were given by TCI with the target plasma concentrations of 3-5 μg/ml and 3-6 ng/ml,respectively,in group PR.Bispectral index (BIS) value was maintained at 40-60.Before wakeup test,propofol infusion was stopped and the target plasma concentration of remifentanil was decreased to 0.5 ng/ml in two groups,and the infusion rate of dexmedetomidine was decreased to 0.1 pg · kg-1 · h-1 in group DPR.The wake-up time was recorded and the wake-up quality was assessed.After admission to the operating room (T0,baseline),at 10 min before wake-up test (T1),immediately after patients were wakened (T2),at 10 min after patients were wakened (T3) and at the end of wake-up test (T4),the mean blood pressure (MAP),heart rate,respiratory rate (RR),SpO2 and BIS values were recorded.The development of intraoperative awareness,emergence time,postoperative agitation,nausea and vomiting,regurgitation and aspiration and severe pain was recorded.Results MAP,heart rate,SpO2 and RR were all within the normal range during wake-up period in two groups.Compared with the baseline at To,MAP was significantly decreased at Ti,3,4 in group PR,and BIS value was decreased at T1-4 in DPR and PR groups (P＜0.05).Compared with group PR,MAP was significantly increased at T1.3,BIS value was decreased at T24,the wake-up time was shortened,Ramsay sedation score and wake-up quality were increased,the emergence time was shortened,and the incidence of agitation was deceased (P＜0.05),and no significant change was found in verbal rating scale scores assessed after extubation in group DPR (P ＞ 0.05).No cardiovascular events,respiratory depression,intraoperative awareness,postoperative nausea and voniting,regurgitation and aspiration or severe pain was found in two groups.Conclusion Dexmedetomidine can raise the quality of intraoperative wake-up test in the patients undergoing balloon occlusion test of the internal carotid artery.

Objective To evaluate thri-operators and the blood-oxygen functional image technology in di-agnosing breast cancer. Methods One hundred and forty-six patients were admitted to hospital for operation due to one hundred and fifty-three suspicious lesions detected in their breasts. These lesions were detected by physical examination, thri-operators and the blood-oxygen functional image, mammography uhrasonography. The sensitivity and specificity of each diagnostic method were obtained and the radiolagie-pathologic correlation was meanwhile calculated. Results Sixty one(41.8%)breast lesions were diagnosed as malignancy. The sensitivity, specificity, accuracy,positive prognostic value and negative prognostic value of ultras onography were 80. 33% ,89. 41%,85.61% ,84.48% and 86.36%. Such data of mammography were 57.89% ,80. 36% ,69.03% ,75.00% and 65. 22%. And those of thri-operators and the blood-oxygen functional image technology were 91.80% ,83.53%, 86.99% ,80.00% and 94.67%. Conclusions Thri-operators and the blood-oxygen functional image technology is superior to uhrasonography and mammography in diagnosing breast lesions with its sensitivity accuracy and neg-ative prognostic value, while specificity and positive prognostic value were between them, have greater value in screeninging and the diagnosing breast cancer.

ObjectiveTo investigate the expression of miR-155 in whole blood of patients with breast cancer and explore the possibility of miR-155 in whole blood as a marker of beast cancer. Methods65 cases (breast cancer:47 cases, non-breast cancer:18 cases) in Thyroid and Breast Surgery Department of No.1 People's Hospital of Huai'an from Dec 2010 to Apr 2011 were enrolled according to the selected criteria.Two milliliters anticoagulant blood were sampled to isolate total RNA.The expression level of miR-155 in whole blood was measured by real-time quantitative polymerase chain reaction (real-time qPCR)analysis.The relationship between the expression level of miR-155 in whole blood and the clinical pathological fearutres was analyzed.ResultsThe expression level of miR-155 in breast cancer patients was up-regulated compared with that in non-breast cancer patients(P ＜ 0.05).The expression level of miR-155 in patients with positive lymph nodes was up-regulated compared with that in patients with negative lymph nodes( P ＜ 0.05).The expression level of miR-155 in stage Ⅲ breast cancer was up-regulated compared with that in stage Ⅰ & Ⅱ breast cancer( P ＜ 0.05 ).The expression level of miR-155 in patients with positive ER and PR was down-regulated compared with that in patients with negative ER and PR breast cancer.Conclusion The study demonstrates that the expression of miR-155 in whole blood is related to clinical pathological features of patients with breast cancer and can be used as a potential marker of breast cancer.

OBJECTIVE: This study was performed to evaluate the accuracy and reliability of a newly designed method to achieve mandibular dental model superimposition, using voxel-based cone-beam computed tomography (CBCT) registration. METHODS: Fourteen dry cadaveric mandibles and six teeth extracted from patients with severe periodontitis were used to establish 14 orthodontic tooth-movement models. The protocol consisted of two steps: in the first step, voxel-based CBCT mandible superimposition was performed; the reference comprised the external portion of the symphysis, extending to the first molar. The laser-scanned dental model image was then integrated with the CBCT image to achieve mandibular dental model superimposition. The entire process required approximately 10 minutes. Six landmarks were assigned to the teeth to measure tooth displacement, using tooth displacement on the superimposed laser-scanned mandibles as the reference standard. Accuracy was evaluated by comparing differences in tooth displacement based on the method and the reference standard. Two observers performed superimposition to evaluate reliability. RESULTS: For three-dimensional tooth displacements, the differences between the method and the reference standard were not significant in the molar, premolar, or incisor groups (p > 0.05). The intraclass correlation coefficients for the inter- and intra-observer reliabilities of all measurements were > 0.92. CONCLUSIONS Our method of mandibular dental model superimposition based on voxel registration is accurate, reliable, and can be performed within a reasonable period of time in vitro, demonstrating a potential for use in orthodontic patients.