Objective To explore the indications, superiority and surgical technique of periareolar approach in the management of benign breast diseases. Methods 132 patients with benign breast disease (91 cases of Fibroadenoma, 12 cases of limited gland hyperplasia, 8 cases of cyst, 2 cases of benign phyllodes tumor and 6 cases of male gynecomastia) underwent operation through areolar incision. Results All patients were followed up for 1-10 months. 107 cases were satisfied with their treatment,19 cases were not quite satisfied with the relatively long incision, and 6 cases were not satisfied with the front incision. The one-month-later reexamination showed that 117 cases feel good and 15 cases had partial numbness of the nipple (15/132, 11.36%). All but two patients wound healing delayed because of local hematoma (2/132, 1.52%). Neither necrosis nor infection was found. Conclusions With the advantages of fewer complications and cosmetic effect, periareolar approach can be applied in management of various benign breast diseases. Factors such as indications, anatomical layer, postoperative molding, appropriate drainage, pressure dressing should be taken into consideration for the success of operation.

A combination product is a new model of the medical product that incorporates at least two of the regulated component categories of device, drug, or biological product into one product. It has become a new hot point within the development of devices and drugs, and has brought about a new opportunity for device and drug industries and a new challenge for administration too. In the paper, the properties of combination products are summed up and the impact on device and drug industries are discussed.
Biological Products ; Device Approval ; Drug Industry ; instrumentation ; Drug-Eluting Stents ; Equipment and Supplies

Objective To study effects of multimodal analgesia on postoperative delirium (POD)in elder patients with hip fracture.Methods One hundred and eight elder patients with hip fractures were gathered in a prospective study.Fifty-nine cases were included in the group of multimodal analgesia (25 males,34 females),with an average age of 72.91±5.42 years,and 35 were treated with hip replacements,the other 24 were internal fixations.Forty-nine cases were in the group of conventional analgesia (22 males,27 females),with an average age of 72.14±4.93 years,29 were treated with hip replacements,20 were internal fixations.Assessments of delirium were based on confusion assessment method.Local infiltrated anesthesia,patient control intravenous analgesia,and intravenous nonsteroid anti-inflammatory drug were applied in the group of multimodal analgesia.For the other group,morphine would be given only when patient complained pain or there was POD.Postoperatively,visual analogue scale (VAS),onset of delirium,other correlative data were recorded by an independent researcher.All patients underwent POD were managed with intensive pain management,and then reevaluated.Results VAS in multimodal analgesia group [Day1:2.10±1.43(resting),4.74±1.45 (active) and Day 3:1.01±0.92 (resting),3.31±1.36 (active)] were significandy lower than that in the other group [Day1:4.67±1.33 (resting),7.44±1.59 (active)and Day 3:2.24±1.39 (resting),5.06±1.46 (active)].PODs were detected in 15 (30.6％) in group of conventional analgesia; while in group of multimodal analgesia,there were 7 (11.9％).All POD were given intensive pain managements by injection of 10 mg morphine and achieved relief of deliriums.Conclusion Postoperative multimodal analgesia may reduce the incidence of POD.First aid of intensive pain management may help to control POD.

ObjectiveTo investigate the effect and medical cost of different revascularization strategies for acute myocardial infarction (AMI) patients with multi-vessel disease (MVD).Methods A prospective randomized controlled trial (RCT) was conducted. From January 2009 to June 2012, patients with AMI and MVD undergoing primary percutaneous coronary intervention (PCI) were enrolled. They were randomly assigned to group A [staged PCI for non-infarction related artery (non-IRA) within 7-10 days after AMI] and group B (subsequent PCI for non-IRA recommended only for those with evidence of ischemia). All of patients were given optimized medical therapy according to clinical guideline, and they were followed up for 24 months at regular intervals. Major adverse cardiovascular events(MACE) including recurrence of myocardial infarction and death due to cardiac ailments were recorded. Meanwhile, re-hospitalization from cardiac causes, recurrence of angina, heart failure, and re-PCI, number of stents, total hospital stay days, and total medical expenditure were recorded.Results A total of 428 patients accomplished the 24-month follow up. All the patients underwgennt PCI for non-IRA in group A (215 patients), while 62 patients in group B (213 patients) undergone PCI for myocardial ischemia, and 51 patients received non-IRA treatment. There was no significant difference in MACE incidence between group A and group B [8.4% (18/215) vs. 10.8% (23/213),χ2= 0.727,P = 0.394]. The difference of death rate due to cardiac causes (5.1% vs. 6.6%), recurrence of myocardial infarction (4.2% vs. 6.6%), and heart failure (4.2% vs. 7.0%) were not significantly different between groups A and B (allP> 0.05). The rate of recurrence of angina (14.4 % vs. 32.9%), re-hospitalization from cardiac causes (14.4% vs. 33.8%), and re-treatment of implanting stents (12.6% vs. 29.1%) were significantly lower in group A than group B (allP< 0.01), and the rate of revascularization was significantly higher in group A than group B (10.7% vs. 5.2%,P< 0.05). The total number of stents (610 vs. 366), mean number of stents per patient (2.83±0.91 vs. 1.72±0.91,t = 12.725,P = 0.000), and total cost per patient (kRMB: 63.7±12.6 vs. 51.5±12.3,t = 10.107,P = 0.000) in group A were significantly higher than those in group B. Total hospital stay days in group A was significantly less than group B (days: 8.21±2.45 vs. 9.89±3.23, t = 6.071,P = 0.000). Because non-IRA-vascular reconstruction rate was low in group B, the rate of usingβ-blocker and anti-anginal agents during the 24-month follow up in group B was significantly higher than group A [59.2% (126/213) vs. 47.0% (101/215),χ2= 6.371,P = 0.012; 56.3% (112/213) vs. 17.6% (36/215),χ2 = 64.704,P = 0.000]. Conclusions In patients with AMI and MVD undergone emergency PCI, staged PCI within 7-10 days for non-IRA cannot decrease the incidence of myocardial infarction and death due to cardiac causes, recurrence of angina and rehospitalization for cardiac causes was diminished, and it may increase the number of stents and medical cost significantly.

Objective To explore the clinical effect that the free twin-flap with the first dorsal (bottom) metatarsa artery repair the defects of distal in adjacent two fingers.Methods The twin-flap from the big toe and the second toe based on a single vascular pedicle of the firstl dorsal (bottom) metatarsa artery was designed in this article.From November 2010 to June 2013,this twin-flap was transferred in 9 patients.In order to solve the problems:the shortage of arterial span,the bone and (or)tendon exposed in the donor site,the thickness skin graft resurfaced in the donor site was not easy to survive,the bare vascular pedicle and the donor site were covered with artificial dermis for 3 weeks.After 3 weeks,cutting skin bridge and removing the thin of artificial dermis,the donor site was resurfaced by thickness skin graft.Results All cases were followed up for 4 to 12 months.All transfering flaps and the thickness skin graft were survival.The colours and texture of the flaps matched the recipient site.2-point discrimination ranged from 8 to 12 mm.Finger flexion and extension was satisfactory.The appearance of the donor site was well-stacked.No case had successive ulces,pain and car.Conclusion The twin-flap from the big toe and the second toe based on a single vascular pedicle of the first dorsal (bottom) metatarsal artery combined with artificial dermis to repair the defects of distal in adjacent two fingers.For one side,this operation can solve he shortage of arterial span and repair the defects of distal in adjacent two fingers at the same time.For another,it can provid a easy method for deal with the donor site and raise the survial rate of the thickness skin graft.Besides,it also is easy and safe,clinical effect is satisfaction.

Purpose To investigate the diameter change of dorsal root ganglion (DRG) in lumbar disc herniation using three-dimensional MR neurography. Materials and Methods Sixty-ifve patients with lumbar disc herniation and 30 healthy volunteers were selected. Bilateral DRG diameter was measured using MR three-dimensional constructive interference steady state (3D-CISS) sequence at the level of L3-S1 in the control group and at the level of herniation disc in patient group including central and lateral subgroups. The relationship between the sagittal index and DRG diameter at the level of herniation disc was analyzed. Results In the control group, the DRG diameters increased from the level of L3 to S1. The DRG diameters of the central subgroup were bigger than those of the control group (t=-2.485--2.253, P<0.05). The DRG diameters of the lateral subgroup were bigger on the diseased side than the contralateral side (t=1.956-2.432, P<0.05). The DRG diameters of the contralateral side in lateral subgroup were slightly bigger than those of control group without statistical signiifcance (t=-1.248--0.981, P>0.05). The sagittal index was not correlated with DRG diameter. Conclusion 3D-CISS sequence clearly demonstrates morphological changes of lumbosacral nerve root and measures its diameter.

Objective:To evaluate the effects of Sander Ⅱ appliance in the orthodontic treatment of adolescent ClassⅡmalocclusion. Methods:15 cases (6 male and 9 female)of adolescent ClassⅡ malocclusion with mandibular retrution were treated with Sander Ⅱappliance.Pre-treatment and post-treatment Lateral cephalogram measurements were traced and analyzed in terms of 28 indicators. SPSS 19.0 software package was used for paired t test.Results:After treatment,15 patients achieved remarkable improvement in the maxillofacial profile and normal overjet of teeth.The cephalometric analysis showed that ANB,OJ,H°and U1-E decreased(P <0. 05),SNB,B-OLP,Pg-OLP(mm),Ii-OLP,Ms-OLP(mm),Mi-OLP(mm),N-Me,ANS-Me,S-Go,Go-Gn,N'-Pg'/FH,Cm-Sn-Ls and Pg-Pg'increased(P <0.05).There was no significant change in SN-MP,SN-OL and Y-axis before and after treatment. Conclusion:Sander Ⅱ appliance is effective in the treatment of adolescent early Class Ⅱmalocclusion.

Objective:To invest the risk factors associated with delayed hemorrhage after pancreaticoduodenectomy occurred.Methods:A retrospective analysis was performed from January 2012 to June 2015 Shengjing hospital 511 cases of patients who accepted pancreaticoduodenectomy.Results:The incidence of PD postoperative delayed hemorrhage was 8.81％ (45/511).Univariate analysis shows:Preoperative bilirubin levels,pancreatic fistula,biliary fistula,postoperative abdominal infection are all the meaningful related factors(P＜0.05).With the application of multivariate logistic regression analysis,pancreatic fistula (OR=2.158) and abdominal infection (OR=3.051) were independent risk factors for postoperative delayed hemorrhages (P＜0.05).Conclusion:Dealing with the postoperative complications of PD like pancreatic fistula,abdominal infection and others,early detection and rapid diagnosis and correct treatment can effectively reduce the incidence of delayed hemorrhage.

Objective To compare the effects of intensive blood pressure (BP) lowering and guideline-recommended standard BP lowering on the early reperfusion and prognosis after intravenous thrombolysis in patients with acute ischemic stroke. Methods This is a randomised controlled trial consisting of 118 consecutive patients who came from Department of Neurology, Nanjing First Hospital from July 2012 to April 2016, accepting intravenous recombinant tissue plasminogen activator thrombolysis with the systolic blood pressure (SBP) being 150-185 mmHg(1 mmHg=0.133 kPa). The patients with ischemic stroke were diagnosed by multi-mode MRI and confirmed to have ischemic penumbra. The SBP of patients randomly assigned to intensive BP lowering group and guideline BP lowering group was maintained in 140-150 mmHg or below 180 mmHg respectively for 72 h and all patients needed to reexamine multi-mode MRI at 24 h. The primary endpoints were the neurologic function at early stage, modified Rankin Scale (mRS) score and the mortality at 90 d;the secondary endpoints were the volume of infarction and hypoperfusion area, the rate of reperfusion, hemorrhagic transformation (HT) and syptomatic intracerebral hemorrhage (sICH). Results Forty-nine cases in intensive BP lowering group and 56 cases in guideline BP lowering group acquired the available images. The volume of infarction was increased both in these two groups, and there was no statistically significant difference in the increased values ((13.21±9.51) cm3 vs (12.95±9.68) cm3). There were no statistically significant differences in the volume of hypoperfusion, reperfusion rate, neurologic function at early stage, the mRS scores and mortality at 90 d, the incidence of sICH except the rate of HT (9.4%, 5/53 vs 23.1%, 15/65, χ2=3.860, P=0.049) between the two groups.Conclusion Early intensive BP-lowering treatment has no adverse effects on the transformation of ischemic penumbra and prognosis after intravenous thrombolysis in patients with acute ischemic stroke and may decrease the the rate of HT in some degree.