In the last decade, the rate of clinicopathologic autopsies has dropped markedly whereas the rate of forensic pathologic autopsies performed as a result of medical disputes has risen by a big margin. In view of this, the authors analyze the causes and put forward appropriate measures. First of all, it is imperative for relevant departments of medical administration to attach importance to the issue and to strengthen legal system building. Next, it is important to pay attention to the development of the specialty of pathology and the cultivation of pathology personnel, improve the conditions for autopsies and bring the initiative of pathologists into full play. Thirdly, it is necessary to reinforce the spread of knowledge and education and be patient in making matters clear to the relatives of the dead.

Objective To study the method and effect of superomedial pedicled mammaplasty based on Würinger's horizontal septum.Methods During August 2014 to August 2015,25 cases of cromastia were treated with septum-based mammaplasties with a superomedial pedicled and vertical incision.Based on the preoperation design,the superomedial pedicle was deepithelialized with preservation of the dermis and the subdermal plexus.The pedicle was dissected as described,the excess tissue was removed with the prepectoral fascia preserved.After remodeling the shape of mammary gland,the incision was sutured.Results There was no hematoma,no fat liquefaction and no partial or complete NAC necrosis.The pre and postoperative NAC sensibilities were comparable in all the patients.The patients were followed up for 6 to 12 months,and all the patients were satisfied with the therapeutic effect and expressed acceptance to the scar.Conclusions The breast reduction based on wellvascularized septum and superomedial pedicle is safe with minor scar,even in large breasts.This technique demonstrates ease of pedicle shaping and breast remodeling.The satisfied effect could be obtained for patients with severe ptosis of breasts just after operations and in future.

Objective To introduce a modified surgical technique for repairing palate fistulae.Methods Based on the clinical categories of palate fistulae,local mucosal flap was designed,if possible,to reduce the area of the fistulae and reshape the fistulae.Then the thin tongue flap with anterior pedicle was designed for repairing the palate fistulae,without much limitation of tongue movement and excessive tension of tongue flap pedicle short lingual frenulum correction was performed firstly to release the motion of tongue,if necessary.The donor site was closed directly.Three weeks later division of the tongue flap,as well as detailed appearance correction of tongue,was carried out at the same time.Results 12 cases were treated,and followed up for 6-12 months.For all the cases,the defect of fistulae was totally repaired,while aesthetics appearance of tongue was satisfactory,and no interference with speech with the use of tongue as donor site.Oral hygiene and mastication were unimpaired.No patient described disability of sensory or gustatory postoperatively.Conclusions Tongue flap has sufficient blood supply,while impairment of donor site is minimal.The planning and procedure of surgery are relatively simple.It is an ideal flap in treatment of palate fistulae.

Objective To explore a therapeutic method for repairing the avulsion injury of total hand skin. Methods Bilateral chest navel flaps with nerves were used to repair the avulsion injury of total hand skin. Two nerves of the right lateral flap were anastomosed with the first and third common palmar digital nerves respectively; two nerves of the left lateral flap were anastomosed with the dorsum manus of ulnar nerve and cutaneous branch of radial nerve respectively. Results Postoperative follow up of 12 to 15 months showed that two cases were successful. The injured hands regained thalposis and thigmesthesia; the ulnar hand had sensitive thigmesthesia when touching a table; and the grasping function of the hand recovered partially. Conclusion Bilateral chest navel flaps with nerves are recommendable to all kinds of hospitals for repairing the avulsion injury of total hand skin.

Objective To study the method and effect of deep inferior epigastric perforator flap(DIEP)in repairing the large defects of lower limbs.Methods Eight cases,from July 2009 to November 2011,including 3 cases of plantar skin defects with bone exposure after foot injuries,three cases of plate exposure after tibia fracture surgery and 2 cases of heel repeated ulceration after skin graft,were repaired by deep inferior epigastric perforator flap.Results All deep inferior epigastric perforator flaps survived with good functions,except 1 case whose distal with poor blood supply and the flap survived after treatmenting,three cases of flap bloated with good appearances after second operation.Conclusion DIEP is a proper option for repair of large defects of lower limbs.It has the advantages of abundant blood supply,large flap area,abdomen can suturing without abdominal complications.

Purpose To investigate the expression of DLC1 and its relationship with Ki-67 in cancerous and non-cancerous tissues of the breast.Methods In situ hybridization and immunohistochemiscal EnVision method were used to detect the expression of DLC1 mRNA and protein and Ki-67 in 52 invasive breast ductal carcinomas and 42 non-cancerous mammary tissues, including 22 mammary fibroadenomas and 20 paracancerous tissues.Results The positive rates of DLC1 mRNA and protein expression in the breast carcinomas (50% and 57.7%) was significantly lower than that in the non-cancerous mammary tissues (90.5% and 92.9%) (χ~2=17.518 and 10.729,P＜0.01).The expression of DLC1-mRNA was positively related to DLC1protein (r_s=0.379,P＜0.01). The positive rate of Ki-67 expression was 61.5% in the breast carcinomas, but no expression was observed in the all non-cancerous tissues (χ~2=39.186,P＜0.01).Correlation analysis showed that DLC1 expression was negatively correlated with Ki-67 expression (r_s=-0.507,P＜0.01).Conclusions Lower or no expression of DLC1 mRNA and protein may play an important role in the pathogenesis and progression in breast carcinoma. DLC1 may inhibit the proliferation of the breast carcinoma cells,which indicates that it may act as a new molecular marker of breast carcinoma.Combining detection of DLC1 and Ki-67 may be useful parameters for evaluating the biological behaviors of breast carcinoma.

OBJECTIVE: To discuss the quality of reporting in randomized controlled trials (RCTs) of Chinese herbal medicine (CHM), and to provide suggestions for improving the reporting of future clinical studies in this therapeutic area. METHODS: A search of the Cochrane Library was conducted to identify RCTs of CHM. A revised CONSORT checklist designed for CHM clinical studies was implemented. The revised CONSORT checklist contained 63 items, including the following new items added specifically for CHM: (1) "syndrome of disease" based on Chinese medicine theories; (2) rationale of CHM formula; (3) formula composition; (4) preparation form of CHM; (5) quality control of CHM. RESULTS: The overall reporting quality of the RCTs as assessed with the revised CONSORT checklist varied between 19% and 44%, with a median score of 32% (standard deviation 8%). CONCLUSION: The overall quality of reporting of RCTs of CHM evaluated with a revised CONSORT checklist was poor, reflecting the need for improvements in reporting future clinical trials in this area. RECOMMENDATIONS: To improve the quality of reporting of RCTs of CHM, we recommend adopting a revised CONSORT checklist that includes items specific to CHM. We also recommend that editors of CHM journals require authors to use a structured approach to presenting their trials as a condition of publication.

Objective: To evaluate the anti- herpes simplex virus type 1 (HSV-1) activity of KPC-rg1, a water extract from Cinnamomum cassia, and explore its potential function of broad-spectrum antivirus effect. Methods: In vitro, the changes of morphology of Vero cells were assessed and viral loads were detected after cells were infected with HSV-1 alone and HSV-1 pre-treated with KPC-rg1 respectively. The corneal lesions of mouse and tree shrew corneal infection model were evaluated after they were infected with HSV-1 alone and HSV-1 pre-treated with KPC-rg1 respectively. The antiviral activity of KPC-rg1 against 9 viruses were measured by CPE and GFP reduction assays. Results: The virus replication of HSV-1 infected cells was moderately inhibited by KPC-rg1 in a dose range of 0.0001-1.0 mg/ml, while the cells were completely protected when they were infected with HSV-1 pre-treated with KPC-rg1 (0.001-1.0 mg/ml). The corneal lesions of animals were improved in both mouse and tree shrews models infected with HSV-1 after the treatment of KPC-rg1, while animals were completely protected from infection when HSV-1 pre-treated with KPC-rg1. KPC-rg1 had a potential anti-virus effect on the enveloped viruses such as HSV-1, HCMV, RSV alone and HIV-1. Conclusions KPC-rg1 is a collosol (Tyndall effect) which would immediately form a stable super-nanoparticle structure of KPC-rg1/virus when encounter virus, and thus the virus coated by KPC-rg1 lost its ability of infection. KPC-rg1 can reduce the suffering by newly or latent virus infection because its encapsulation of virus and inhibition of further infection. Our study added additional proofs of the anti-viral property of the water extract from Cinnamomum cassia, and provided a further basis to develop KPC-rg1 as a drug which could be potentially applied in clinic to treat HSV-1 infection.

OBJECTIVETo study the clinicopathologic features and diagnosis of metastatic carcinoma to the spleen (MCS).

METHODSFour patients (1 man and 3 women, mean age 43.5 years) with MCS were analyzed clinicopathologically.

RESULTSThe four MCS patients accounted for 1.3% of 308 patients having spleen biopsy from 1959 to 1999. Their chief presentations were pain and mass in the left upper quadrant of the abdomen. The mass was located in the upper pole of the spleen (1 patient), the lower pole of the spleen (2), or the lower pole and hilum of the spleen (1). Macroscopically, all of the lesions were nodular. Histologic type of these MCSs included acinar cell carcinoma of the pancreas (2 patients), transverse colon adenocarcinoma (1), and hepatic cell carcinoma (1). Clinically, 1 patient was diagnosed as having MCS and 3 were misdiagnosed. According to Chinese literature, the clinicopathologic features of MCS were as follows: (1) 66.7% of the patients with MCS were aged 30 approximately 60 years, with a mean of 51.2 years. (2) 76.3% of the patients presented with pain in the left upper quadrant of the abdomen and 63.2% with splenomegaly and splenic masses. (3) Macroscopically, nodular lesions accounted for 68.4%. (4) Microscopically, 84.2% of the lesions were adenocarcinomas and 70.3% originated from carcinomas of the colon, liver, ovary and pancreas. (5) B-mode ultrasonography and/or CT showed occupying lesions or masses in the spleen in 76.7%, and MCS in 11.8%. (6) Clinically, 73.7% of the patients were misdiagnosed.

CONCLUSIONSMCS is uncommon but its clinical misdiagnosis rate is high. Image examination is of value in clinical diagnosis. Cooperation of clinicians and pathologists may enhance the diagnostic level of MCS.