Objective To evaluate the value of extended latissimus dorsi flap (ELDF) in immediate breast reconstruction in patients with breast cancer after modified radical mastectomy.Methods Thirty-six patients with breast cancer who accepted modified radical mastectomy and 12 patients with breast cancer who accepted immediate breast reconstruction after modified radical mastectomy from January 2008 to June 2009 were included.The complications,cosmetical results and quality of life of these patients were compared.The shape of breast reconstruction was also evaluated.Results All of 12 patients succeeded in proceeding immediate breast reconstruction with ELDF.The evaluation of shape of breast reconstruction was good in 6 cases,secondary in 4 cases,and bad in 2 cases,which was beyond that in patients of radical operation group (P0.05).The patients in breast reconstruction group had a better quality of life compared with the patients in radical operation group (P

Objective To analysis the application value and the existing problems of sentinel lymph node biopsy in breast cancer surgery.Methods Pathological findings were retrospectively analysised in 100 female cases of breast cancer,who were diagnosed with early breast cancer and used blue dye in sentinel lymph node biopsy.Results Among 100 cases,92 cases were found SLNS,that the detected rate was 92％.Detected 217 sentinel lymph node,every case has 1 to 6 node,with the average of 2.4.Nintg-two cases were performed ALND.Among them,the SLNS negative detected 58 cases of ALN feminine,SLNS negative ALN detected positive 4 cases,30 cases of SLNS positive ALN positive detected.All of the patients did not appear allergic reaction.SLNB false positive rate of O,the false negative rate was 11.8％,sensitivity 88.3％,specific degree of 100％,the diagnostic coincidence rate was 95.7％.Conclusions Compared with the conventional axillary lymph node dissection,the sentinel lymph node biopsy has obvious advantages in early breast cancer surgery.For the cases of sentinel lymph node negative,there was no necessary to do the axillary lymph node dissection.

Objective To study comparatively the changes in epi th elial growth factor (EGF) and its receptor (EGFR) in injured intestine induced b y neutron and ?-ray irradiation in mice and their significance. Method s 350 male BALB/C mice were irradiated with neutron and ?-rays, and t hey were sacrificed at 6 and 12 hours and 1, 2, 3, 4, 5, 7, 10, 14, 21 and 28 da ys, respectively, after irradiation. Immunohistochemical method was employed to assess EGF and EGFR in the intestinal tissue of the mice. Results After the neutron radiation with 2.5Gy dosage, the expressions of EGF and E GFR in the cytoplasm of mucosa epithelial cells and crypt cells were obviously u p-regulated within 1 day, decreased after 1~2 days, increased again on 3~7 days , reached the peak value at the 5th day, and returned to normal values in 14 day s. Whereas EGF and EGFR were increased at 6 hours and progressively decreased fr om 12 hours up to 4 days after 4.0 and 5.5Gy neutron and 12Gy g-ray radiation . They were increased progressively within 3 days, reaching peak value on the 3r d day, and returned to normal values 5 days after 5.5Gy g-ray irradiation. Conclusions The expressions of endogenous EGF and EGFR showed diffe rent regularities after neutron and g-ray radiation, and they were involved in the pathologic courses of radiation damage and recovery of the intestine.

Delphian lymph node is a part of Ⅵlymph node.According to the latest research ,the metasta-sis rate in papillary thyroid carcinoma ( PTC) is up to nearly 20%.Meanwhile ,the Ⅵlymph node is usually con-sidered as the sentinel lymph node of PTC metastasis .Most scholars believe that .Delphian lymph nodes may have certain clinical significance in the development process of PTC .This article aims to summarize the research pro-gress in clinical relations between the Delphian node and papillary thyroid carcinoma .

Incised wounds were made in rabbits, and some of the wounds were dressed with chitosan, and others with gauze. After bleeding stopped, hemoglobin in dressings was measured to determine the hemostaic effect. Wounds were redressed, and healing process was studied histologically. The results showed that less Hb was detected in chitosandressing than in gauze. On day 9 after wounding, the content of granulation tissue and collagen formation in the chitosan dressed wounds was more than that in Vaseline gauze dressed group. It suggests that chitosan dressing is effective in hemostasis for incised wounds and may be helpful in wound healing process.

Objective To study the effect of 17-β estradiol on Collagen Ⅰ,lysyl oxidase like 1 (LOXL1),fibrinectin( FN )after stretch in the pelvic function dysfunction(PFD) patients vaginal wall fibroblasts cultured in vitro,and the effect in PFD pathogenesis.Methods Twelve patients with pelvic function dysfunction who under surgery in the second Hospital,Hebei Medical University from October 2009 to September 2010 were collected vaginal wall organization in this study.Use of tissue and collagenase digestion method for primary culture in the vaginal wall fibroblasts.After stretch with different concentrations of 17-β estradiol cultured fibroblasts.Total mRNA was extracted from fibroblasts and gene expression of Col Ⅰ,LOXL1,FN were measured.Results After stretch,the expression of Col Ⅰ ( 1.1872 ± 0.0733 vs 1.5035 ±0.0733,t =-4.815,P ＜0.01),LOXLI(0.7724 ±0.1873 vs 1.0855 ±0.0805,t =-5.111,P ＜0.01 ) were significant higher than before( P ＜0.01 ),the expression of FN (0.4290 ±0.1168 vs 0.4215±0.0830) was not significantly different ( P ＞0.05).The expression of all factor Col [ (3.0809 ±0.1862),LOXLI ( 1.5863 ±0.3241 ),FN( 1.1418 ± 1.0030) in high drug concentrations of 17-β estradiol were increased significant compared with controlled groups( P ＜ 0.01 ).Conclusions 17-β estradiol increased synthesis of extracellular matrix components from cultured vaginal wall fibroblasts of patient with pelvic floor dysfunction after stretch.Stretch and estrogen may play an important role in PFD pathogenesis.

OBJECTIVE:To provide references for the controlling of reimbursement of medicare drug expenditure in urban employees in China.METHODS:Referenced experiences were summed up from classified drug reimbursement acts in other countries and areas stated in the literature review.RESULTS&CONCLUSION:It is a common international policy to clas?sify drugs by quality and adopt different reimbursement ratio;most of the countries and areas would exclude the reimburse?ments of over-the-counter drugs;the purpose of classified drug payment and reimbursement was to increase the users'payment thereby to lessen the burden of the authorities on the expenditure of social medicare drugs;concerning the controlling of drug expenditure,measures only taken from the aspects of price setting,ratio of reimbursement and quantity of drug con?sumption can that be effective;analysis about advantages and disadvantages should be considered in the making of the re?forming policies about establishing pharmaceutical reference prices and setting up prescription fee and etc.

Objective:To investigate the role of transcription factor SP1 decoy oligodeoxynucleotides(ODN) on expression of ? Gal in SV-40-PED cells.Methods:Immortalized porcine aortic endothelial cells of the PED line were cultured and transfected with ?1,3galactosyltransferase(?1,3GT) specific decoy ODN.Cells transfected with mismatch ODN was used as negative controls.Twenty-six hours later the cells were collected.The expression of ? Gal was determined with fluorescence microscope and Western blot.The expression of ?1,3GT mRNA was examined by RT-PCR.Results:Fluorescence microscopy observed the decreased fluorescence of ? Gal after decoy ODN transfection.Western blot showed that the average absorbance of the PED cells transfected with decoy ODNs was(48.2?0.9).It is 52.6% of the mock group(P0.05).Conclusion:?1,3GT gene reduce actually occurs following transfection of decoy ODN.Porcine endothelial cells can be the targets of decoy ODN.

Objective To study the correlations between DLN and clinical pathological factors and provide clinical data for assessing the operation scopes and prognostic evaluations aims at further clarify its clinical values.Methods The research aimed at the 69 cases who undertook first-time surgery and confirmed thyroid papillary carcinoma by intraoperative frozen pathology from 2013 to 2014 in Wannan Medical college affiliated Yijishan Hospital.The groups was divided by whether the DLN had been detected and metastasized.And we made chi-square test or t test by using SPSS 22.0 to analysis between the clinical and pathological factors.Results The groups was divided by whether DLN had been metastasized from the detected cases and the results shown that there was no relationship with gender,age,tumor size,Hashimoto's thyroiditis and the number of COLN (which not including DLN).For multifocal cases (21.05％ vs 57.14％,P =0.047);for vascular infiltration,the positive cases of (10.53％ vs 71.43％,P＜0.001);for the metastasized rate of COLN,the positive cases of (65.79％ vs 14.29％,P =0.011);for the metastasized number of COLN,[(0.84 ± 1.48) vs (3.86 ± 3.08),P ＜ 0.001].All the data above illustrated that the two groups are statistically correlative in mulifocality,vascular infiltration,the metastasized rate of COLN and for the metastasized number of COLN.17.39％ of PTC cases can be detected by CD34 and D2-40.According to the presence of vascular infiltration,it can be divided into two groups,We contrast analyzed of the number of TCLN (include DLN),metastasized number of TCLN and the metastasized rate of TCLN.The results shown that the number of TCLN had no statistical differences,but significant in metastasized number of TCLN [(0.74 ± 1.83) vs (4.50 ± 2.20),P ＜ 0.001) and the metastasized rate of TCLN (29.82％ vs 100.00％,P ＜ 0.01)].Conclusions The DLN positive patients are more likely to have distant lymph node metastasized.If DLN positive,total thyroidectomy and bilateral central compartment neck dissection (CCND) has been necessary.Lateral selective neck node dissection (LSND) can be underwent after evaluating carefully combining with the history and preoperative images.CD34 and D2-40 could be the detection indexes of vascular infiltration for PTC.For the cases with vascular infiltration,it has a higher proportion to have the metastasized number and metastasized rate of TCLN and higher possibility of distant metastasis.So we should expand the scope of operation moderately and strengthen postoperative follow-up according to the history and preoperative images so as to reduce postoperative recurrence,distant metastasis rate and improve the living quality of patients.

Objectives To analyze the incidence of cranial nerve injury in patients after receiving carotid endarterectomy ( CEA) in a single-center and to investigate its correlation with surgical experiences. Methods The clinical data of patients underwent CEA at Beijing Xuanwu Hospital, Capital Medical University from January. 2001 to December 2013 were analyzed retrospectively. Cranial nerve injury was assessed at day 7 after procedure according to the clinical symptoms,and they were followed up at 1,3,6, and 12 months. The incidence of permanent cranial nerve injury was evaluated. The incidences of permanent cranial nerve injury were further analyzed at two time periods ( from January 2001 to September 2011 and from October 2011 to December 2013 ) . Results ( 1 ) A total of 598 consecutive patients treated with CEA were enrolled,and 15 (2. 5%) of them had cranial nerve injury,including 2 (0. 3%) facial nerve injury,7 (1. 2%) hypoglossal nerve injury,and 6 (1. 0%) vagus nerve injury. Only 1 case (0. 2%) did not recover completely at 6 months after procedure. ( 2 ) The patients with cranial nerve injury were 10 (3. 2%,10/308) and 5 (1. 7%,5/290) respectively from January 2001 to September 2011 and from October 2011 to December 2013). There was no significant difference (P < 0. 05). Conclusion The incidence of cranial nerve injury was low after CEA,and most patients could recover completely. The increased surgical experiences did not show the reduction of cranial nerve injury rate evidently after CEA.