Objective To study the clinical effect of plastic operation treated to vice- mammary gland located armpit ,s forepart. Methods Two hundred patients of vice- mammary gland separately were carried on the armpit plastic operation (study group)and the pure vice- mammary gland excision operation (control group),and compared the curative effects between two groups. Results Two groups is not obvi-ous difference in the surgery time,the hemorrhage quantity,the margin heal and so on (P > 0.05 ),In the out-ward appearance of armpit after the operation,plastic operation demonstrates the good effect. Two sets were in surgical operation time,the hemorrhage quantity and slice a people match to wait the aspect to all had no obvious difference more ( P > 0.05),but after operation the external appearance armpit plastic surgery dis-plays good result ( P < 0.05). Conclusion Armpit department reshaping technique treatment for the vice-mammary gland effect is good,is worth promoting. Vice- mammary glands result is good,deserving the expansion. The armpit plastic surgery cures the vice- mammary glands in forepart in armpit at cut off the disease cooking stove to have to make up the result concurrently at the same time,design reasonable,operation simple,deserve expansion.

Objective To investigate the factors influencing the outcomes of patients with ALI/ARDS.Method Data of 63 patients with ALI/ARDS in ICU,Cancer Hospital,Chinese Academy of Medical Science,from January 2005 to December 2006,were retrospectively analyzed.Patients were divided into survivor group(n=39)and non-survivor group(n=24)according to different outcomes,and equally,patients were classified in the rcspect of different causes as pulmonary origin and extra-pulmonary origin.Results The incidence of ALI/ARDS was 5.2%(63/1201)in ICU.The univariate analysis showed that the differences in the length of mechanical ventilation(P=0.028),blood creatinine level(P=0.031),oxygenation index(P=0.023),between survivor group and non-survivor group.In addition,the differences in acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)scores and sequential organ failure assessment(SOFA)on the admission day were significant between survival group and non-survival group(P<0.001,respectively).Logistic regression analysis showed that APACHE Ⅱ scores was the only independent predictor of the mortality in patients with ALI/ARDS(P=0.015,OR:3.809,95%CI:1.295～11.203).There was no significant difference in one-year survival between pul-monary origin cause of ALI/ARDS group and exwa-pulmonary origin cause of ALI/ARDS group(63.9% vs.55.4%).There was significant difference in one-year survival between ARDS and ALI group(44.9% vs.88.9%,P<0.05).Conclusions APACHE Ⅱscores on the admission day of patients is the only independent predictor of the mortality in patients with ALI/ARDS,whereas the underlying cause of ALI/ARDS does not matter to the survival of patients.

Objective To discuss the efficacy of fiberoptic ductoscopy(FDS)in the treatment of mammary duct diseases with nipple discharge.Methods Fiberoptic ductoscopy was utilized for diagnosing and treating exudative lesions in the mammary duct in 72 cases(80 sides).After the lesion was detected under ductoscope,repeated irrigation using normal saline was performed until the flocculent discharge disappeared.Intraductal drug administration(dexamethasone 5 mg and gentamycin 40 000 U)was given during the retreat of ductoscope.Results There were 57 sides of galactophoritis and 23 sides of mammary duct ectasia.A complete recovery was achieved in 65 sides(nipple discharge disappeared completely and no relapse occurred in 6 months),in which a follow-up for 1～2 years showed no recurrence.A remarkable improvement was obtained in 15 sides(nipple discharge significantly reduced,or progressively decreased within 6 months,or underwear wetted occasionally).Conclusions Fiberoptic ductoscopy in the treatment of mammary duct lesions with abnormal nipple discharge is effective.

BACKGROUND: The observation of vascular endothelial growth factor gene expression of cerebrovascular diseases and ultrastructure of cells may be helpful to understand angiogenesis and its relative cellular factors involved in the pathogenesis at cellular and molecular levels. OBJECTIVE: To investigate the method of culture of human cerebral cap illary endothelial cell by separation of capillary fragment in vitro, and to ob serve vascular endothelial growth factor gene expression and ultrastructure of cells. DESIGN: A randomized controlled research on technique and method. SETTING: The neurosurgery department of a general hospital of a military area command of Chinese PLA and the neurosurgery department of a college hospital. PARTICIPANTS: Eighteen patients with arteriovenous malformation of brain(Spetzler Ⅱ-Ⅲ grade), as confirmed by aortocranial angiography before operation, in the Department of Neurosurgery, General Hospital of Shenyang Military Area Command of Chinese PLA were included. The material was obtained from fresh integrated specimen of arteriovenous malfor mation of brain with surrounding fresh brain tissues during the opera tion. Capillary endothelial cell was separated by homogenate, filtration and enzymatic digestion techniques. Cells grew well in culture flask and were divided into 4 groups(hypoxia state for 2, 4, 8 hours groups and control group). Each group contained four flasks.METHODS: Simulation of anoxia condition: volume faction 0.95 N2 and volume fraction 0.05 CO2. Expression of factor Ⅷ related antigen in cells was detected by immunohistochemistry. mRNA expression of vascular endothelial growth factor on endothelial in every group was observed by RT-PCR, protein content of vascular endothelial growth factor in supernatant detected by enzyme-linked immunoadsordent assay, and cellular ultrastructural change observed by transmission electron microscopy.MAIN OUTCOME MEASURES: mRNA expression of vascular endothelial growth factor on endothelial cell and protein content of vascular endothelial growth factor in supernatant in control group and every hypoxia groups; cellular ultrastructural changes.RESULTS: Under phase contrast microscope, cultured living cells had mono-layer pebble-like typical character. More than 90% of were factor Ⅷrelated antigen(FⅧ-RA) staining positive. mRNA and protein expression of vascular endothelial growth factor in hypoxia 4 hours group was 0.98 ±0. 19,( 180. 77 ± 20. 15) ng/L, which was significantly higher than in control group [0, (26. 20 ± 6.33) ng/L, P ＜ 0.01 ]. Eight hours later, expression decreased [(0. 35 ±0.07), (31.68 ±8.34) ng/L]; swollen mitochondrion, dilated endoplasmic reticulum, and lysosome vesiculation were found.CONCLUSION: Humane cerebral capillary endothelial cell can be cultured by separation of capillary fragment, which is easy to operate and the cellular purity is reliable. In the early stage of ischemia and hypoxia, expression of vascular endothelial growth factor is not enough to maintain cellular ultrastructure integrity. Cells may be injured along with the prolong of hypoxia.Zhao MG, Tang T, Gao YZ, Pu PY, Wei XZ. Culture of human cerebral capillary endothelial by separation of capillary fragment and the observation of vascular endothelial growth factor gene expression and cell ultrastructure. Zhongguo Linchuang Kangfu 2005; 9(21):211-3 (China) [www. zglckf. com]

Objective To analyze the reasons of the emergency patients forgoing the invasive rescue therapy and to put forward the corresponding strategy.Methods According to whether the patients accepted the invasive rescue therapy or not,2 673 patients in resuscitation room of Peking Union Medical College Hospital were divided into rescue group (group R) and do not rescue group (group DNR).There were 2 147 cases in group R and 526 case in group DNR.The rescue consent form or do not rescue consent form was required to sign by patient self,patient' s family member or relatives.The patient' s basic information,underlying disease,payment of medical expenses,personnel who signed the consent form,treatment and prognosis in both groups were investigated.Results There was no significant gender deference in both groups (x2 =1.86,P =0.173).The mean age of patients in group DNR was much higher than that in group R (69.5 ±-12.5 vs.58.6 ± 19.2 years,F =28.92,P =0.000).The proportion of patients outside Beijing in group DNR was higher than that of group R (51.90％ vs.44.01％,x2 =10.59,P =0.001).The ratios of chronic heart failure,chronic respiratory failure,chronic hepatic encephalopathy,chronic renal failure,malignant tumor in group DNR were significantly higher than that of group R (8.17％ vs.3.03％,8.17％ vs.2.61％,3.80％ vs.1.16％,5.32％ vs.1.44％,11.98％ vs.2.28％,all P=0.000).The proportion of patients without insurance in group DNR was higher than that of group R (52.09％ vs.41.08％,x2 =20.87,P =0.000).Except the ratio of patients self signing the consent form in group DNR was higher than that of group R (3.04％ vs.0.42％,x2 =64.40,P =0.000),there were no significant deference in other people who signed the consent form such as patient's offspring,spouse,parents,siblings and others.Univariate and multivariate logistic regression analyses showed older age,non Beijing patients,chronic underlying diseases,without insurance and patients self signing the consent form were the major risk factors on refusing the invasive rescue therapy.The mortality rate of group DNR was much higher than that of group R (19.39％ vs.7.68％,x2=64.40,P=0.000).Conclusions Most of patients who refused to accept invasive rescue therapy were elderly people or in condition of end stage of chronic disease.The doctors and nurses in emergency department should continue to take care of these patients and make use of noninvasive methods to treat them or relieve their pain.

Objective To investigate the gene expression of vascular endothelial growth factor(VEGF) and ultrastructural changes in cultured endothelial cells from human cerebral microvessels under hypoxic conditions.Methods Human cerebral microvessels were isolated from freshly obtained specimens of normal brain adherent to resected cerebral arteriovenous malformations.The expression of factor Ⅷ-relative antigen(FⅧ-RA) in cultured cells was observed with immunocytochemistry.The level of VEGFmRNA in cells and released VEGF protein in cell supernatant were determined by RT-PCR analysis and ELISA respectively when they were exposed to hypoxic conditions(95% N_2,5% CO_2;two hours,four hours,eight hours) or maintained in basal condition.Ultrastructural changes in cells were also observed by electron microscopy.Results In inverted microscope the cultured cells showed contact inhibition and a rounded cobblestone appearance.More than 90% of them were stained strongly with antibodies against FⅧ-RA.Significant VEGF mRNA and protein accumulated when these cells were exposed to hypoxia for 4 hours.However,their VEGF expression was down-regulated after hypoxia for 8 hours and a number of vesicles and swollen mitochondria were present in the cytoplasm.Conclusion The level of VEGF expression may havesignificant relationship with ultrastructural changes in human cerebral endothelial cells under hypoxic conditions.

Objective To approach the significance of procalcitonin(PCT)in judgment of the degree of severity in patients with acute pancreatitis(AP). Methods A prospective method was conducted in the study. Ninety-eight patients with AP admitted from April 2013 to December 2013 in the First Affiliated Hospital of Zhengzhou University were enrolled. They were divided into mild AP(MAP,48 cases)and severe AP(SAP,50 cases)groups, biliary AP(58 cases)and non biliary AP(40 cases)groups,and biliary SAP and biliary MAP groups,non biliary SAP and non biliary MAP groups. The venous blood levels of PCT on the first day and second day after admission were assayed for all the patients,and the correlations between PCT levels on the two time points respectively and each of the following items were calculated:Ranson score,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,CT grade,number of organ dysfunction,intensive care unit(ICU)time of stay and total time of hospitalization. Results On the second day after admission,the PCT levels in groups different in etiology and groups different in severity were all elevated and higher than those on the first day,the level in SAP group being significantly higher than that of MAP group〔3.723(2.538,9.023)vs. 0.282(0.166,1.348),P<0.01〕,the level in biliary AP group being higher than that in non biliary AP group〔2.567(1.483,8.412)vs. 2.391(1.262,7.453),P>0.05〕,the level in biliary SAP group being higher than that in biliary MAP group〔4.023(3.273,10.015)vs. 0.305 (0.244,1.413),P<0.01〕,and the level in non biliary SAP group being higher than that in non biliary MAP group〔3.624(2.454,8.993)vs. 0.256(0.144,1.137),P<0.01〕. The correlations between PCT levels on the first day and second day after admission and each of the following items were respectively as follows:the correlations with Ranson score〔relative risk (RR1)=0.643,P1=0.001,95% confidence interval(95%CI1):0.435-1.596;RR2=0.762, P2=0.001,95%CI2:0.692-1.541〕,APACHE Ⅱ score(RR1=0.543,P1=0.009,95%CI1:0.842-1.512;RR2=0.672,P2=0.001,95%CI2:0.747-1.234)and CT grade(RR1=0.231,P1=0.048,95%CI1:0.596-1.412;RR2=0.256,P2=0.032,95%CI2:0.702-1.324)were all positive;the higher the number of organ dysfunction,the higher the level of PCT(RR1=0.321,P1=0.023,95%CI1:0.763-2.588;RR2=0.389,P1=0.020,95%CI2:0.683-1.742);the level of PCT had relatively favorable correlation with ICU time of stay(RR1=0.423,P1=0.019,95%CI1:0.779-1.459;RR2=0.453,P2=0.010,95%CI2:0.684-1.853),but there was no correlation between the level and the total time of hospitalization(RR1=0.004,P1=0.067,95%CI1:0.864-2.071;RR2=0.009,P2=0.078,95%CI2:0.645-1.376). Conclusion The level of PCT can be used in judgment of the degree of severity of the patients with AP,not only it can be applied in patients biliary in origin,but also can be used in patients non biliary in origin.

To evaluate the clinical effects of Shengmai Injection in treating coronary heart disease (CHD) based on correct syndrome differentiation and incorrect syndrome differentiation.

To analyze the relationships among syndrome, therapeutic method and Chinese herbal medicine in patients with coronary artery disease (CAD).

Objective To evaluate the incidence and to investigate risk factors of supraventricular arrhythmia (SVAs) in postoperative cancer patients in intensive care unit ( ICU ). Methods Data of 570 patients consecutively admitted to oncologic surgical ICU of Cancer Hospital of Chinese Academy of Medical Sciences from Nov. 2008 to Oct. 2009 were retrospectively collected. Univariate and multivariate logistic analysis were conducted for potential factors that influenced SAVs. Results Thirteen patients with a history of atrial fibrillation (AF) were excluded and 557 patients were eligible for the study. SVAs occurred in 72 patients ( 12. 93% ). Multivariate analysis showed four independent predictors of SVAs including age ( OR = 1. 066,95%CI: 1. 034 - 1. 099,P ＜0. 001 ) ,a history of coronary heart diseases ( OR = 2. 644,95% CI: 1. 459 - 4. 790,P ＜ 0. 05), sepsis ( OR = 2. 374,95% CI: 1. 098 - 5. 135, P ＜ 0. 05 ) and intra-thoracic procedure ( OR =2. 322,95 % CI: 1.061 - 5.084, P ＜ 0. 05 ) . ICU length of stay, severity ( APACHE Ⅱ scores in SVAs patients) were significantly greater in patients who were not affected by SVAs ( ICU stay: [2 ( 1 ～ 77 )]vs [3 ( 1 ～ 40 )]days,P ＜ 0. 001; APACHE Ⅱ score: [9 (0 ～ 37 )] vs [11 (3 ～ 38 )], P = 0. 001 ). Nine cases died in SVAs patients ( 12. 5% ) and 19 died in the non-SVAs patients (3.9%), with significant difference between the two groups( x2 = 9. 673, P = 0. 002). Conclusion In oncologic surgical ICU, the incidence of SVAs is high. Age,history of coronary heart diseases, sepsis and intra-thoracic procedure were independent rsik factors of SVAs. SVAs prolong ICU length of stay. SVAs is a marker of critical illness severity.