Objective:To analyze the breast cancer-related parameters and the ultrasonic features of positive axillary lymph nodes,to discuss the risk factors for axillary lymphnode metastatic burden,and to provide basis for preoperative evaluation of breast cancer patients.Methods:The ultrasonic and clinicopathological data of 574 breast cancer patients with axillary lymph node metastasis confirmed by surgery and pathology were retrospectively analyzed.According to the status of axillary lymphnode metastasis,the patients were divided into low nodal burden(LNB)group(n=283)and high nodal burden(HNB)group(n=291).The affected side,tumor quadrant,distance to skin,maximum diameter,internal echogenicity,shape,margin,calcification,blood supply,posterior echo,lymphnode long diameter,lymphnode short diameter,lymphnode aspect ratio,number of suspicious metastases,intranodal blood supply,lymphnode hilum morphology,age,pathological type,histological grade,molecular subtype,and the expressions of estrogen receptor(ER),progesterone receptor(PR),Ki-67,human epidermal growth factor receptor 2(HER2),and P53 were compared between two groups.Logistic regression was used to analyze the risk factors for axillary lymph node metastatic burden in the breast cancer patients;receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to evaluate the predictive value.Results:The univariate analysis results showed that there were statistically significant differences in tumor quadrant,distance to skin,molecular subtype,HER2 positive expression,lymphnode long diameter,lymph node short diameter,lymph node aspect ratio,number of suspicious metastases,and lymphnode hilum morphology between two groups(P<0.05).The multivariate Logistic regression analysis results showed that tumor located in the upper outer quadrant(OR=0.648,P=0.021),distance to skin<5 mm(OR=0.283,P=0.016),Luminal A(OR=1.564,P=0.044),lymphnode long diameter≥20 mm(OR=2.050,P<0.01),lymphnode short diameter≥8.6 mm(OR=2.430,P<0.01),lymph node aspect ratio<2(OR=1.585,P<0.01),and indistinct lymphnode hilum structure(OR=2.092,P<0.01)were the independent risk factors for axillary lymphnode metastatic burden.The ROC curve analysis results showed that compared with the ultrasonic features of positive axillary lymph nodes,the AUC of the combination of breast cancer-related parameters and ultrasonic features of positive axillary lymphnodes was larger(Z=2.72,P=0.006 5),and it had higher predictive value for axillary lymphnode metastatic burden.Conclusion:The tumor quadrant,distance to skin,molecular subtype,lymphnode long diameter,lymph node short diameter,lymphnode aspect ratio,and lymphnode hilum structure are the independent risk factors for axillary lymphnode metastatic burden,and they have certain predictive value for axillary lymphnode metastatic burden.

Objective:To investigate the clinical effect of free flap transfer with anastomosis of anterior interosseous artery and accompanying veins as the recipient vessels in reconstruction of forearm defects.Methods:A retrospective study was conducted on 5 patients who received free flaps transfers with anastomoses of anterior interosseous artery and accompanying veins in reconstruction of forearm defects with exposed bone and tendon in the Department of Orthopaedics of the First Affiliated Hospital of Anhui Medical University between July 2022 and November 2023. All patients were males, aged 31 to 54 years old with an average age of 41.8 years old. Two patients had defects of dorsal ulnar forearm, 2 of distal forearm and 1 of radial palmar forearm. The defected areas after debridement sized 11.0 cm×4.5 cm-20.0 cm×6.0 cm. Free anterolateral thigh perforator flaps (ALTPF), sized 13.0 cm×6.0 cm-22.0 cm×7.0 cm, were used in 4 patients to reconstruct the forearm defects. A free superficial circumflex iliac artery perforator flap was used in 1 patient with the flap sized at 12.0 cm×5.5 cm. All donor sites were directly sutured. Scheduled postoperative follow up was carried out to evaluate the blood supply to the flaps, texture, appearance, fracture healing and the function of the affected limb, as well as the flap sensation according to the criteria for sensory function of British Medical Research Council (BMRC).Results:All 5 patients had received 4 to 16 (mean 8.8) months of follow-up. All flaps survived completely without necrosis or infection. All flaps were good in colour and texture. The blood supply to hands was good, without a symptoms of coldness and fear of cold of hand. At the final follow-up review, sensation of flaps was assessed according to the criteria for sensory function of BMRC and the sensation of the flaps had recovered to S 2~S 3+. The appearance of flaps was good. Conclusion:Free flap with the anterior interosseous artery and accompanying veins as the recipient vessels in the treatment of forearm defects can achieve satisfactory clinical effect, however, further clinical studies are required.

Neurodevelopmental disorders(NDDs)are chronic developmental brain disorders that can affect cognition,motor,social adaptation,behavior and so on due to multiple genetic or acquired causes.Natural polysaccharides are synthesized by living organisms,located in the cell wall,inside and between cells,and outside the cells,and are essential components of life activities.Previous studies have found that natural polysaccharides play an important role in neurological diseases,which mainly ameliorate the behavioral abnormalities and clinical symptoms caused by anti-oxidative stress,anti-neuronal apoptosis,anti-neuroinflammation,anti-excitatory amino acid toxicity,and regulation of the brain-gut axis.This review summarizes the intervention role of 17 bioactive polysaccharides from plants and fungi in neurological diseases,aiming to provide new ideas for the research and treatment of NDDs.

Objective:To evaluate the effectiveness of esketamine during perioperative anesthesia for acute and chronic pain after cesarean section.Methods:One hundred and fifty patients scheduled for elective cesarean section under spinal anesthesia were randomly assigned into 2 equal groups ( n=75) using a random number table: esketamine group (group E) and control group (group C). Subarachnoid block was administered with 9-11 mg of hyperbaric bupivacaine with 0.33% glucose concentration. After the delivery of the fetus, 0.15 mg/kg (1 mg/ml) esketamine was pumped intravenously for 30 min in the group E, while the same dosage of normal saline was administered in the group C. Furthermore, patients received an intravenous patient controlled intravenous analgesia (PCIA) pump after surgery (100 μg sufentanil + 1.25 mg/kg esketamine + 8 mg ondansetron for the group E, 100 μg sufentanil + 8 mg ondansetron for the group C). Heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were recorded in the initial time of esketamine administration, and 5, 15 min, and 30 min after administration. The pain Numerical Rating Scale (NRS) score at rest and during coughing were recorded at 2, 6, 12, 24 h and 48 h after surgery. The first analgesic time and cumulative sufentanil consumption were recorded at 0-12 h, 12-24 h, 24-48 h, 0-24 h and 0-48 h after surgery. Moreover, we recorded the incidence of chronic pain at 3 and 6 months after surgery. Results:There were no significant differences in HR, SBP and DBP between the two groups immediately after administration of esketamine and 5, 15 min and 30 min after administration (all P>0.05). At rest or during coughing, the pain NRS score were significantly lower at 2, 6 h, and 12 h postoperatively in group E compared to group C (all P<0.05). The time to first analgesia in group E was significantly longer than the group C [(176.8±18.3)min vs (148.5±16.9)min, P<0.05]. The cumulative sufentanil consumption was significantly lower in group E during 0-12 h, 12-24 h, 0-24 h and 0-48 h postoperatively than in group C (all P<0.05), but there was no statistical significance between the two groups at 24-48 h ( P>0.05). There were no significant difference between the two groups in the incidence of chronic pain at 3 months and 6 months after surgery ( all P>0.05). The incidence of chronic pain in group E was lower than that in group C at 3 months [13.4%(9/67) vs 18.8%(13/69), P=0.392] and 6 months [10.7%(6/56) vs 16.1%(10/62), P=0.391], but the difference was not statistically significant. Conclusions:Perioperative administration of esketamine provided superior short-term analgesia after cesarean section and did not increase the psychotomimetic adverse event rate. However, the development of chronic pain was not restrained.

Ion trap performances are investigated based on digital ion trap technique with different collision gases at different pressures. Collision gases of helium (4 amu), nitrogen (28 amu) and argon (40 amu) with various pressures are adopted in ion excitation and dissociation stages to investigate the ion trap performances, including mass resolution, signal intensity, tandem mass spectrometric analysis ability and low-mass cut off (LMCO) effect. It is found that when heavy gas of argon is used, energy can be efficiently transferred and LMCO effect is decreased with higher ion capture and dissociation efficiencies but with low mass resolution. Higher mass resolution is realized with helium as collision gas. Furthermore, at the same gas pressure, heavy gas is beneficial to abundant fragment ions and structural information of precursor ion.

Objective Lungs from non-heart-beating donors for transplantation require protection against warm ischemic damage.This study investigated the preservative effect of Ventilation with cooled carbon monoxide during warm ischemia in non-heart-beating donor rat lungs.Method 18 rats were divided into a CO group (n =6),which received ventilation with low-dose carbon monoxide at normal temperature during a 4-hour warm ischemic period; a Control group (n =6),which received no ventilation at normal temperature; a cooling CO group (n =6),which received ventilation with cooled carbon monoxide.PaO2,Myeloperoxidase (MPO) activity,Bronchoalveolar lavage (BAL) neutrophil count and the wet-to-dry (W/D) lung weight ratio were recorded in every group.Quantitative real-time RT-PCR was used to analysis the expression of IL-1β and caspase 3 mRNA in graft lung tissures.Result Endobronchial temperatures and lung surface temperatures in the Cooling CO group were lower than those in the corresponding Control group and CO group (P＜ 0.01).Lower wet/dry lung weight ratio,MPO activity,BAL neutrophil count,expression of IL-1β and caspase 3 mRNA in graft lung tissures were seen in the Cooling group compared with the Control group and CO group (P＜0.05).Conclusion Ventilation with cooled carbon monoxise can decrease lung temperature and improve the protecting effect on non-heart-beating donor rat lungs againt worm ischemic injury by inhibiting the expression of proimflammatory factor IL-1β and apoptosis-associated gene caspase 3.

ObjectiveBronchogenic carcinoma involving the carina or tracheobronchial angle still presents a challenge due to specific problems related to surgical technique and airway management.Aim of this paper is to examine complications and long-term survival of our personal series and those reported in literature.MethodsBetween 1985 and 2010,48 patients underwent carinal resection:a right tracheal sleeve pneumoneetomy was performed in 47 patients and a left tracheal sleeve pneumonectomy in 1 patient.The anastomosis was performed with aid of high-frequency jet ventilation or introfield tube ventilation.ResultsOverall morbidity and mortality rate was 25％ and 6.3％ respectively,and there was no death in operation.5-yearsurvival rate of patients with squamous and adenocarcinoma was 27.3％ and 12.5％,respectively,P =0.04.The overall 5-year survival rate was 24.3％.Patients without nodal involvement had a significantly better prognosis than N1 and N2 patients (5-year survival:52％,13％ and 0,respectively).Multivariate analysis showed that nodal status was the only independent prognostic factor( P =0.006 ).ConclusionWith careful selection of patients and meticulous surgical technique,Tracheal sleeve pneumonectomy for bronchogenic carcinoma can be accomplished with acceptable mortality and morbidity,proriding good long-term results.

Objective To evaluate the complications and prognostic factors of lung transplantation performed in a single center.Methods A rettospective analysis of demographic and outcome data of lung transplantation was performed.Survival analyses were performed using Kaplan-Meier estimation.Results Between January 2003 and April 2011,42 lung transplant procedures were performed.Overall survival rate at 1,3,and 5 years were 89％,59％ and 38％,respectively.1,3,and 5 years survival in patients with COPD was 83％,66％ and 45％,respectively,which were better than other primary end stage lung diseases ( 78％,17％ and 17％,respectively,P =0.013).Postoperative complications included pulmonary bacterium infection in 8 patients (20％),fungal infection in 12 (30％),and airway complications in4 (9.5％).35％ of patients had at least 1 episode of acute rejections within the first year,and 22.5％ of patients had BOS.2 patients underwent single lung retransplantation.Conclusion In this single center study,patients with COPD may have a good long-term survival.The most common postoperative complications were pulmonary infection and airway complication.

Child ; China ; Humans ; Living Donors ; Lung Injury ; therapy ; Lung Transplantation ; methods ; Male

BACKGROUNDTo investigate immunoexpression of P14ARF protein in non-small cell lung cancer (NSCLC) and to evaluate the prognostic significance.

METHODSThirty-nine tumor specimens were immunohistochemically examined with FL-132 antibody against P14ARF protein.

RESULTSP14 nuclei immunoexpression was found in 25 tumor specimens (64.1%). The patients in stage I and II had a much higher P14 expression rate than the patients in stage III and IV [78.0%(18/23) vs 43.8%(7/16) P =0.043]. The P14 expression rate in patients with and without metastasis was 78.3%(18/23) and 43.8%(7/16) respectively (P=0.043). The mean survival time of patients without P14-immunopositive staining was significantly shorter than that of patients with P14-immunopositive staining (17 months vs 45 months, P=0.023 5).

CONCLUSIONSPatients with the expression of P14ARF protein have a better prognosis. Detection of P14ARF protein in lung cancer tissues may be helpful to predict the prognosis of NSCLC.