Multifocality and multicentric breast cancer (MMBC) has been attached remarkable importance.The diagnosis of MMBC is of great importance for breast cancer individualized management,particularly regarding the choice of surgical method.A discovery of MMBC may be verified decisions to perform a wider excision which will avoid the appearance of positive margins.As for the results of conservative surgery developed by MMBC,however,contradictory conclusions exist in the related documents.No general common has been reached.MMBC may also alter the solution of the axillary basin.

As a pattern of manifestation of cerebral small vessel disease,cerebral microinfarct(CMI) is a very common neuropathological change in old people. It is significantly correlated w ith cognitive decline and dementia. This article review s the meuropathology, neuroimaging and clinical significance of CMI.

Objective To study on antibacterial effect of active ingredient of se-enriched Macleya cordata.Methods Penicillin sodium and saline as control, detected the average inhibition zone diameter of se-enriched Macleya cordata group ( containing 0.96 mg/mL sanguinarine) on 9 common bacteria with disc agar diffusion method;20% methanol and saline as control, se-enriched Macleya cordata group which the average inhibition zone diameter was minimum, without se-enriched Macleya cordata group and penicillin sodium were diluted with 20% methanol, made concentration of 0.48, 0.24,0.12,0.06, 0.03 mg/mL.minimal inhibitory concentration ( MIC) of each treatment group was determined by agar dilution method, evaluated antibacterial effect of se-enriched Macleaya cordata group.Results se-enriched Macleya cordata group could improve antibacterial effect significantly, the average inhibition zone of 100 μg/mL sodium selenite treatment group was minimum(Φ15.33 mm);MIC of se-enriched Macleya cordata group on E.coli O1 , E.coli P22 , E.Dublin reduced from 0.96 to 0.24 mg/mL;MIC of S.typhimurium and S.suipare were 0.12 mg/mL;MIC of S.aureus and S.suis were 0.06 mg/mL; MIC of E.Dublin and L.murrayi were less than 0.03 mg/mL.Conclusion Se-enriched Macleya cordata improves the antibacterial effect signififcantly, and it lays the theoretical foundation for development and utilization of se-enriched Macleya cordata for future.

Objective To analysis newborn stage and long-term physiological and neuropsychological development in children born after assisted reproductive technology(ART),and to evaluate the safety of ART.Methods Eighty-four 6-month-old to 6-year-old children born after ART performed from January 1st,2006 to June 30th,2011 in Reproduction Center of Fuzhou General Hospital were taken as ART group; and 84 matched children born after spontaneous conception were as control group.The physiological and neuropsychological states of these children in their newborn stage and 6-month-old to 6-year-old duration were compared with Chi-square or t test.Results There was no statistical difference in childbearing age of mothers,the prevalence of gestational diabetes mellitus and hypcrtensive disorder complicating pregnancy,delivery mode,living environment,parents' education level,newborn birth length,birth weight,the rate of premature birth,low birth weight,asphyxia and hospitalized to neonatal intensive care unit between two groups (P＞0.05).In ART group,the incidence of growth retardation and abnormal social life skills was 6.0 ％ (5/84) and 1.2 ％ (1/84),and no statistical difference were found comparing with control guoup [4.8％(4/84) and 1.2％(1/84),x2 =0.12 and 0.00,P＞0.05],neither the developmental quotient (95.9±6.1 vs 94.8±5.1,t=1.25,P=0.21).Twins had higher rates of preterm birth [41.8％ (33/79) vs 10.1％(9/89),x2 =22.37,OR=6.38,95％CI:2.81-14.50,P=0.00],low birth weight [51.9％(41/79) vs 6.7％(6/89),x2=42.35,OR=14.93,95％ CI:5.84-38.16,P=0.00],asphyxia [10.1 ％ (8/79) vs 1.1 ％(1/89),x2 =6.69,OR=9.92,95％ CI:1.21～81.15,P=0.01],hospitalized to neonatal intensive care unit [36.7 ％ (29/79) vs 14.6 ％ (13/89),x2 =10.90,OR =3.39,95％CI:1.61-7.14,P=0.00] and growth retardation [11.4％(9/79) vs 0.0％(0/89),x2=10.71,RR=0.11,P=0.00] than singleton.Conclusions ART has no negative effects on children's physical and neuropsychological development.It could increase the incidence of twins,so that it might increase the incidences of preterm labor and low birth weight,which might affect the long-term physical and neuropsychological development of the offspring.

Objective To observe the influence of diabetes educationon the treatment compliance and quality of life (QOL) of diabetics and to find out the influencing factors of diabetics' QOL. Methods This study applied the questionnaire of compliance and the SF-36 to make an investigation on diabetics. Ninety diabetics who participated in the course of diabetes education during the period from October 2008 to March 2009, and 205 diabetics who were seen in the first affiliated hospital of China Medical Universitybut never participated in the course of diabetes education during the period from September to October of 2008. By comparing the data with control group and using self-paired comparison, the influence of diabetes education on the treatment compliance and the QOL of diabetics was studied. The factors influencing the QOL of each dimension were analyzed by means of single or multiple regressions. Results The treatment compliance of patients was improved with the number of times that these patients participated diabetes education was increased (P<0.05). The treatment compliance of the patients in hospital who had not participated in diabetes education was improved temporarily. However, 2 weeks after these patients were discharged the treatment compliance of these patients had began to decline. The treatment compliance would be declined if patients discontinued participating education for a long time. After 24 weeks intevention, the total score of compliance of intervention group (42.44±4.10) was higher than control group (35.60±3.90), and also higher than the intervention group before intervention (34.56 ± 4.34) (all P<0.01). The scores of 5 dimensions were significantly different (P<0.05 or 0.01). Of 8 dimensions of intervention group, the scores of vitality, social functioning, role-emotional and mental health were all increased after intervention, with significant differences except for role-emotional (P<0.05). The mental health index of patients with long-term health education was increased to a certain degree. Conclusion Long-term health education plays an active role in treatment. Insisting on taking part in health education regularly can improve the quantity of mental health.

Objective To observe the near future curative effect and toxicity of the combination of weekly dose of cisplatin in the treatment of elderly patients with esophageal cancer intensity-modulated radiotherapy observa-tion.Methods 60 patients with locally advanced esophageal cancer patients aged by method randomly were divided into synchronous chemotherapy group( CRT group) and 30 cases of radiotherapy alone group( RT group) 30 cases,the two groups using 6MV-X ray intensity modulated radiotherapy,radiotherapy dose:DT 60 Gy/30/6 week.The CRT treated group was given cisplatin 20-25mg/m2 in the radiotherapy of second day,1 times per week,a total of 6 times. Results Radiotherapy and chemotherapy, radiotherapy group recent effective rate were 80.0% and 63.3%, the difference was statistically significant(χ2 =5.934,P<0.05),P< 0.05).The main toxicity was myelosuppres-sion,radiation esophagitis,basically I and II,no statistically significant difference between the two groups(P>0.05). Conclusion Intensity modulated radiotherapy combined with weekly dose of cisplatin in the treatment of elderly patients with esophageal cancer significant short-term effect,less adverse reactions,patient tolerance is good,which is worth the clinical promotion.

Objective To investigate the value of clinical characteristics in diagnosis of vocal fold paralysis (VFP) and arytenoid dislocation .Methods Eighty - eight patients of VFP and 27 patients of arytenoid dislocation were studied , by comparing the causes , laryngeal morphologic characteristics and laryngeal electromyography (LEMG) .Results The causes of 88 VFP patients included surgery (45 cases) ,neck trauma(2 cases) ,idiopathic causes(16 cases) ,infection(16 cases) ,and tumor invasion - related(9 cases) .Of the 27 arytenoid dislocation pa‐tients ,24 had a history of endotracheal intubation and the others had a history of gastric tube insertion .The vocal folds were mostly fixed at the paramedian position ,followed by the abducent position and the median position .No significant differences were found in laryngeal morphologic characteristics between the two groups ,including vocal fold shape , glottis vertical symmetry , mucosal waves , supraglottic compensation , glottis closure and arytenoid movement .The LEMG of VFP patients appeared as denervation patterns ,reinnervation potentials ,or electrical si‐lence ;the recruitment patterns appeared as mix or simple patterns ;the evoked potentials were absent .Of the VFP patients ,54 cases(61 .36% % )were found synkinesis of involved posterior cricoarytenoid and two of them also in ‐volved thyroatenoid .The patients with synkinesis had lower percentage of vocal fold bowing and higher percentage of glottic vertical asymmetry compared to the ones without synkinesis .Of the VFP patients whose cause was surgery or neck trauma ,the median - position fixed vocal folds were mostly observed in the patients with duration of less than 1 month or with synkinesis .Of the 27 arytenoid dislocation patients ,20(74 .07% )showed normal LEMG pat‐terns and 7(25 .93% )showed apparent LEMG abnormality on the affected side .Conclusion The causes of vocal fold paralysis and arytenoid dislocation are different .Laryngeal morphologic characteristics have limitations in distinguis‐hing vocal fold paralysis from arytenoid dislocation .The shape and position of involved vocal folds of the VFP pa‐tients are correlated with duration ,nerve regeneration and synkinesis .

Objective To study the roles of serum tumor necrosis factor-α (TNF-α),sTNFR-Ⅰ and sT-NFR-Ⅱ in asthmatic children.Methods The levels of serum TNF-α,sTNFR-Ⅰ and sTNFR-Ⅱ in 60 asthmatic children,including 30 cases of acute exacerbation group and 30 cases of clinical paracmasia group,and 22 cases of healthy children (control group) were detected by ELISA.Results (1) The level of serum TNF-α in acute exacerbation group was (98.87 ± 16.25) ng/L,it is significantly higher than the clinical paracmasia group (62.19 ± 15.85) ng/L and control group (44.25 ± 10.44) ng/L (F =94.78,P ＜ 0.05).The level of serum sTNFR-Ⅰ and sTNFR-Ⅱ in acute exacerbation group were (11.14 ±2.04) μg/L and (11.81 ±2.14) μg/L respectively,they were significantly higher than their own clinical remission group (8.91 ± 1.63) μg/L and (9.36 ± 1.72) μg/L,also significantly higher than the control group (5.03 ± 1.18) μg/L and (5.21 ±1.23) μg/L,(F =83.03 and 87.62,all P ＜ 0.05).The levels of TNF-α,sTNFR-Ⅰ and sTNFR-Ⅱ in clinical paracmasia group were significantly higher than that in control group (P ＜ 0.05).(2) The levels of sTNFR-Ⅰ and sTNFR-Ⅱ in asthmatic children,both acute exacerbation and clinical paracmasia,were positively correlated (r=0.908,P ＜ 0.05 and r =0.737,P ＜ 0.05).Conclusion The level of TNF-α maybe indicate the inflammatory severity of asthma,and the changes of serum sTNFR-Ⅰ and sTNFR-Ⅱ were closely related with asthmatic airway inflammation.

Objective Fluctuation of glucose levels is more likely to cause oxidative stress which contributes to the development of insulin resistance through activating c-Jun N-terminal kinase (JNK).Such antio xidants as vitamin C or vitamin E do not appear very helpful.Radix Astragali (RA) is an herbal medicine with antioxidative ability.The study was to explore whether RA would lower the risk of insulin resistance in diabetic rats.Methods Diabetic rats received RA,insulin or both RA and insulin after diabetes were induced in male Wistar rats.Serum levels of interleukin 6 (IL-6) and tumor necrosis factor α (TNFα),advanced glycation endproducts(AGEs) levels in kidney,the expression of insulin receptor (IR),insulin receptor substrate 1 (IRS-1),p38 mitogen-activated protein kinase (MAPK),p-p38 MAPK,p-JNK,p-IRS-1 Ser307,and p-IRS-1 Tyr612 in skeletal muscles were determined.Results Compared to diabetic rats treated with insulin,the diabetic rats treated with both insulin and RA demonstrated significantly lower levels of IL-6,TNF-α and AGEs (P ＜ 0.05),significantly lower activation of p-p38 MAPK and JNK (P ＜0.05),significantly higher expressions of IRS-1 (P ＜0.05),p-IRS-1 Tyr612,and significantly lower expression of p-IRS-1 Ser307 (P ＜ 0.05).Conclusions RA can lower the risk of insulin resistance through fighting oxidative stress in diabetic rats.

Objective To explore the relationship between the level of tumor necrosis factor related apoptosis inducing ligand(TRAIL) and death receptor 5(DR5) and atherosclerosis(AS).Methods Eighty-three patients were divided into two groups: Sixty-one in the coronary artery disease(CAD) group and 22 in normal coronary artery group.Plasma soluble TRAIL(sTRAIL) and soluble DR5(sDR5) levels from these people were assayed by ELISA.The level of TRAIL and DR5 protein expression in coronary arteries were detected by immunohistochemisty statining.Results Plasma sTRAIL and sDR5 significantly increased in the CAD group(P