As a result of accuracy of staging and decreased patient morbidity,sentinel lymph node biopsy for breast cancer was quickly accepted into clinical practice.Many controversies remain in the methods and indications of sentinel lymph node biopsy.In this article,we attempt to highlight the clinical studies regarding the biopsy techniques,pathologic evaluation,indication for lymphatic mapping and eliminating axillary lymph dissection by sentinel lymph node biopsy.It is demonstrated that radioisotope and blue dye techniques are complementary.Preoperative lymphoscintigraphy is most useful for detecting an internal mammary SLN,but the practicability of internal mammary SLN biopsy is still in the investigative stage.As for intraoperative diagnosis of sentinel lymph node,imprint cytology is a quick,economic and tissue-preserving method,but not very effective in the identification of micrometastasis;axillary lymph node dissection is preferable for patients with micrometastasis.Sentinel lymph node biopsy is indicated for ductal carcinoma in situ,with prophylactic mastectomy,breast cancer patients with previous reduction mammoplasty and breast implants.Currently,NSABP B32,Z0010 and Z0011,large,prospective randomized trials are in progress to evaluate unresolved issues of SLN biopsy.Although data from these trials is not available,SLN biopsy has been widely adopted in the clinic.Consistency of technique as well as case selection has attained great significance.

Objective To analyze retrospectively the results of closed reduction and static transarticular fixation with unilateral external fixators in the treatment of severely comminuted distal radius fractures caused by high-energy injuries. Methods From June 2000 to June 2003, 20 patients with 24 severely comminuted distal radius fractures were treated with closed reduction and static transarticular fixation with unilateral external fixator. The injuries involved 16 males and 4 females, the age of the patients was from 15 to 48 years (average 33.4 years). All fractures were classified as Frykman's type Ⅷ or AO type C3. The operative technique consisted of reduction of the fractures by manipulation or assisted with the external fixator, then fixed them statically. The mean duration of the union was 7.4 weeks (ranged from 6-8 weeks). After the fixator removal, the patients were encouraged to proceed for the rehabilitations, such as the elbow flexion-extension, radial abduction, ulnar adduction, and the pronation as well as the supination of the forearm. Results All patients were available at the final follow-up, the mean duration was 16 months (range, 6-42 months). At the last examination, the radiological manifestations revealed excellent in 21 fractures (17 patients) and good in 3 (3 patients) according to the Sarmiento scoring system (modified by Stewart); and the functional results displaied excellent in 16 (13 patients), good in 6 (5 patients) and fair in 2 (2 patients) according to Gartland-Werley functional assessment system. There were only 2 cases of superficial pin site infection cured with oral antibiotics and local care with mild disinfectants. 7 obvious defect of mataphysis occurred in 5 patients, but the fractures united simultaneously without any additional treatment. And there was no any complication, such as pin tract infection, fixator loosening, iatrogenic fracture and injury of the superficial radial nerve. Conclusion The technique of closed reduction by manipulations or external fixators combined with static transarticular fixation plus unilateral external fixators is an effective method for the treatment of severely comminuted distal radius fracture caused by high-energy injuries, such as falling from the height. It is unnecessary to apply supplementary bone grafts to promote bone healing. The complications can be avoided by selecting the right sites for the insertion of the pins, which is beneficial for the hand to mobilize earlier after operation.

Objective To retrospectively analyze the results of closed reduction and static trans-articular fixation with unilateral external fixators in the treatment of unstable distal radius fractures.Methods From June 2000 to March 2005,45 patients with 50 unstable distal radius fractures were treated with closed reduction and static transarticular fixation by unilateral external fixators.Their average age was 44.8 years(15 to 78 years).All the fractures were classified with AO-scheme.There were five A3-fractures,four B3-fractures,three C1-fractures,nine C2-fractures and 29 C3-fractures in 24 cases.Follow-ups lasted from 8 to 48 months(averaging 20 months).Results The time of bone healing was 6 to 8 weeks(averaging 7.6 weeks).At the latest follow-up,the radiological outcomes were excellent in 42 fractures(39 patients)and good in eight fractures(six patients)according to the Sarmiento rating system modified by Ste wart et al.The functional results included 37 excellent cases(34 patients),nine good ones(eight patients)and four fair ones(three patients)according to the Gartland-Werley assessment.There were only four cases of superficial pin site infection settled with oral antibiotics and mild disinfectants.Conclusions Closed reduction by manipulation and static transarticular fixation with unilateral external fixators is an effective method to treat severely comminuted distal radius fractures caused by high-energy injury.Radial nerve injury and iatrogenic fracture of the 2nd metacarpal bone can be avoided,pin tract infection and pin loosening can be decreased,and early postoperative mobilization of hand can be facilitated by insertion of external pins at appropriate sites.It is unnecessary to apply supplementary bone grafting to promote bone healing.

Objective To study the short-term outcome of transforaminal posterolateral endoscopic discectomy and radiofrequency annuloplasty in patients with discogenic low back pain. Methods A total of 25 patients with discogenic low back pain,who were diagnosed by provocative discography,received transforaminal posterolateral endoscopic discectomy and radiofrequency annuloplasty in our hospital. The VAS scores determined before and 6 months after the operation were compared in the patients. Their MacNab scores were also evaluated at 6 months postoperation. Results After the surgery,2 patients who had ruptured intervertebral discs (L5-S1) developed sunburn syndrome,and then was relieved by pulsed electrical stimulation for one week. The patients were followed up for 6-10 months,during which no other postoperative complications occurred. The mean VAS score of this series decreased significantly after the treatment,and kept being reduced in 6 months [preoperation:6.24?0.97,1,3,6 months after the operation:0(0~2); Kruskal-Wallis rank-sum test,H=61.680,P=0.000]. Four patients showed lower limbs pain before the treatment and were relieved after the surgery. The evaluation of MacNab score showed excellent in 11 pateints,good in 12,and fair in 2,suggesting an effective rate of 92.0%(23/25). Conclusions Transforaminal posterolateral endoscopic discectomy plus radiofrequency annuloplasty is effective for discogenic low back pain in a short term.

Purpose:To clarify the different expression patterns of the cyclins and P21 between the normal breast epithelium cells and breast cancer cells of different degrees of malignancy.Methods:Using Western Blot, we detected the protein expression of cyclin D1, E, and p21 in the normal breast epithelium cells AG11132A, ER positive MCF 7 breast cancer cells and ER negative MDA MB 231 breast cancer cells.Results:(1) P21 protein was highly expressed and cyclin E lowly expressed in the normal breast epithelium cells. Compared with the normal breast epithelium cells, Cyclin E were highly expressed in breast cancer cells of MCF 7 and MDA MB 231 cells. Abnormal low molecular weight cyclin E was co expressed with normal cyclin E in both MCF 7 and MDA MB 231 breast cancer cells, but not in normal breast epithelium cells AG11132A. (2) In breast cancer cells, compared with the ER positive MCF 7 cells the ER negative MDA MB 231 cells expressed a high level of cyclin E protein but low p21.Conclusions:(1) There are many forms of differences both quantitive and qualitative between normal cells and cancer cells, as well as between relatively low degree and high degree invasive malignant cancer cells. (2) Cyclin E and P21 may be potential indicators that reflect the malignancy of breast cancer cells, but they should be analyzed as a whole in order to get more accurate prognostic information. [

ObjectiveTo introduce the design of the instrument for percutaneous posterolateral foraminoplasty and analyze long-term outcomes of percutaneous foraminoplasty and transforaminal endoscopic discectomy in the treatment of non-contained lumbar disc herniation.MethodsFifty-six patients with noncontained lumbar disc herniation confirmed by symptom,physical sign and concordant imaging underwent percutaneous foraminoplasty and transforaminal endoscopic discectomy,including 7 cases of L3-4,30 of L4-5 and 19 of L5S1.The visual analogue scales(VAS) of pre- and post-operative low back pain and sciatica were compared,and the Macnab scores were also evaluated.ResultsAll of the procedures were performed successfully,with mean operation time of 60 min(range,40-120 min),and a mean blood loss of 30 ml (range,20-50 ml).The follow-up time was more than 36 months.Postoperative VAS of low back pain and sciatica were significantly decreased compared with preoperative VAS (P＜0.01).There were 44 cases of excellent,10of good,and 2 of fair according to Macnab score system,with total successful rate (excellent and good) up to 96.4％.Only 5 cases with L5S1 disc herniation were found complicated with sun-burn syndrome,which were relieved by pulsed electro-stimulant therapy for 1 week.ConclusionPercutaneous foraminoplasty and transforaminal endoscopic discectomy is an effective and safe minimally invasive treatment alternative for non-contained lumbar disc herniation.

Objectives To investigate the risk factors of acute renal injury (acute kidney injury) in patients with acute left heart failure.Methods Clinical data of 188 patients with acute left heart failure who were admitted to our hospital were retrospectively analyzed.Logistic regression analysis was used to assess the risk factors for AKI.Results Among 188 patients with acute left heart failure,incidence of acute kidney injury was 33.51％.Univariate and Multivariable logistic regression analyses showed that the independent predictors of acute kidney injury were lower baseline eGFR (OR=4.294,P ＜ 0.001) and anemia (OR=3.573,P=0.006).Conclusions The incidence of acute left heart failure complicated with AKI was high.Basic state of renal function and anemia were the independent risk factors for AKI.

Objcctive To investigate the predictive value of the 40 Hz auditory steady-state response (ASSR) in patients with the malignant process of middle cerebral artery territory infarction.Methods The40 Hz ASSR and brainstem auditory evoked potential (BAEP) were performed within 72 hours after patients with middle cerebral artery terrtory infarction admitted in the neuro-intensive care unite (NICU).At the same time,the National Institutes of Health Stroke Scale (NIHSS) scores were assessed.Multivariable logistic regression analysis was used to deterrmine the influencing factors of the malignant process.The relevant indicators of the malignant process were analyzed by the receiver operating characteristic(ROC) curve in order to clear the predictive value of 40 Hz ASSR in the malignant process of middle cerebral artery territory infarction.Results A total of 104 patients with supratentorial middle cerebral artery territory infarction were included.They were divided into the malignant process group (n=59) or the non-malignant process group (n=45).There were significant differences in the baseline NIHSS scores (17.25 ± 7.23 vs.20.40 ± 8.09; t =- 2.055,P =0.043),infarct volume (105.85 ± 73.37 mm3 us.179.15 ± 144.38 mm3; t =-3.011,P =0.004),leukocyte count ([ 10.26 ±3.14] × 109/L vs.[ 13.45 ±5.42] × 109/L; t =-3.336,P =0.001),40 Hz ASSR (Z =-3.237,P =0.001),and short-latency somatosensory evoked potentials (Z =-3.130,P =0.002) grade between the malignant process group and the non-malignant process group.Multivariate logistic regression analysis showed that the40 Hz ASSR (odds ratio [OR] 3.347,95％ confidence interval [CI] 1.630 -6.872; P=0.014),infarct volume (OR 1.006,95％ CI 1.001 - 1.012,P=0.003),and leukocyte count (OR 1.277,95％ CI 1.074 - 1.402; P =0.001) were the independent predictors in patients with the malignant process of middle cerebral artery territory infarction.When the 40 Hz ASSR was grade 3,the sensitivity and specificity of predicting malignant process were 39.5％ and 94.4％.Conclusions The 40 Hz ASSR has an important predictive value in patients with the malignant process of middle cerebral artery territory infarction.

Objective To evaluate the relationship between the perfusion mode of neovascularization of carotid plaque in CEUS and the ischemic stroke in transient ischemic attack (TIA) patient.Methods A total of 73 TIA patients according to the inclusive criteria were enrolled.All the patients underwent routine carotid ultrasonic examination.And 61 patients with plaque thicker than 2.5 mm in carotid bifurcation underwent CEUS and follow-up for at least 18 months.All the patients were divided into recurrent and non-recurrent groups.Logistic regression analysis were performed to detect the risk factors for incurrence of ischemic stroke or recurrence of TIA in 18 months.Results There were statistical differences between 2 groups in hypertension,diabetes,hyperlipemia,smoking history,family history of stroke,medication compliance,two-dimensional ultrasound and CEUS characteristics (all P＜0.05).Multivariate Logistic regression analysis showed that all the factors correlated with the recurrency,from big to small order were the CEUS characteristics of carotid plaque,hypertension,medication compliance,diabetes,two-dimensional ultrasound characteristics of carotid plaque.Conclusion CEUS could evaluate the perfusion mode of neovascularization in carotid plaques.For TIA patients,CEUS could predict the incurrence of ischemic stroke or recurrence of TIA,which can guide TIA patients targeted prophylaxis of them.

Objective To discuss the design of pedicled thoracodorsal artery perforator flap (TDAP flap),and to evaluate the aesthetic results and donor-site complications for immediate partial breast reconstruction (IPBR) after breast conserving surgery (BCS) for breast cancer patients.Method Clinical data of 13 breast cancer cases treated with BCS + IPBR using TDAP flap from November 2004 to November 2010 were retrospectively analyzed.Perforators were identified with Doppler preoperatively in all patients.Results All perforators originated within a median distance of 8.0 cm ( range,7.5 to 9.5 cm) from axillary plica at the posterior line of axilla.Median area of the flaps was 6.0 × 8.0 cm ( range,5.0 × 7.0 cm to 8.0 × 10.0 cm).One flap was muscle-sparing,while a small muscle strip was left embedding the perforators in other twelve flaps to increase the reliability of the vascular pedicle.Postoperatively patients were followedup from 4 to 71 months.Median follow-up time was 41 months.Flap necrosis and seroma in the donor-site were not found in all patients.Aesthetic results were graded as excellent or good in 9 patients,fair in 3,and poor in one.Conclusions TDAP flap is a good choice for IPBR after BCS for breast cancer patients whether lesions in outer quadrants or inner quadrants,especially for those patients with excisional biopsy.Preoperative mini-Doppler is helpful for determining the precise location of the main perforators,and decreasing the risk of vessels injury.