Current situation and prospect of breast-conserving surgery using oncoplastic surgery technique in breast cancer / 中华内分泌外科杂志

Breast cancer is the most common malignant tumor in the population, and the incidence of young breast cancer patients is gradually increasing. With the increasing requirements of patients for cosmetic effect after tumor resection, the traditional breast conserving surgery can no longer meet the treatment needs of patients. Breast-conserving plastic surgery for breast cancer has been proved to be safe in oncology, but there are still many deficiencies. Therefore, it is very important for surgeons and patients to develop unified and repeatable standard guidelines for breast-conserving plastic surgery of breast cancer.

Factors affecting dyslipidemia among residents in Haining City / 预防医学

Objective@#To investigate the prevalence and risk factors of dyslipidemia among residents in Haining City, Zhejiang Province, so as to provide into the management of dyslipidemia.@*Methods@#Totally 1 953 residents at ages of 15 to 69 years were recruited using a multi-stage stratified cluster sampling method in 5 townships (streets) of Hainan City. Subjects' demographic features, smoking status, alcohol consumption, family history of diseases and development of chronic diseases were collected. The height, body weight, waist circumstance and blood pressure were measured, and the fasting blood glucose, serum uric acid and blood lipid levels were determined. The prevalence of dyslipidemia was analyzed and standardized by the 7th population census data. The factors affecting dyslipidemia were identified using a multivariable logistic regression model.@*Results@#Totally 1 893 valid questionnaires were recovered. The respondents included 949 males (50.13%) and 944 females (49.87%), and had a mean age of (47.90±14.34) years. A total of 513 participants were detected with dyslipidemia, and the prevalence and standardized prevalence of dyslipidemia were 27.10% and 27.01%, respectively. The prevalence of hypertriglyceridemia, hypercholesterolemia, hyperlipoproteinemia and hypolipoproteinemia was 16.53%, 3.22%, 1.74% and 15.27%, respectively. Multivariate logistic regression analysis showed that male (OR=1.571, 95%CI: 1.268-1.947), family history of stroke (OR=1.645, 95%CI: 1.192-2.270), hyperuricemia (OR=1.809, 95%CI: 1.370-2.388), central obesity (OR=1.423, 95%CI: 1.066-1.900), obesity (OR=1.736, 95%CI: 1.335-2.257), underweight (OR=0.171, 95%CI: 0.049-0.593) significantly correlated with dyslipidemia.@*Conclusions@#The prevalence of dyslipidemia is lower than the national level among residents at ages of 15 to 69 years in Haining City, and hypertriglyceridemia and hypolipoproteinemia are predominant types of dyslipidemia. Male, obesity, family history of stroke and hyperuricemia are risk factors of dyslipidemia.

Transphyseal anterior cruciate ligament reconstruction in skeletally immature pubescent adolescents / 中华骨科杂志

Objective:To evaluate the safety and clinical efficacy of transphyseal anterior cruciate ligament (ACL) reconstruction with hamstring autograft in skeletally immature pubescent adolescents.Methods:Retrospectively reviewed 10 skeletally immature pubescent patients (10 knees) who underwent transphyseal ACL reconstruction with hamstring autograft between May 2015 and May 2020 in our center. Out of the 10 patients, 6 were males aged 14.2±1.4 years (range, 13-15 years) with bone age 13-15 years, 4 were females aged 12.4±1.2 years (range, 11-13 years) with bone age 11-13 years. The average duration from injury to surgery was 8.3±5.3 months (range, 3-48 months). Before operation, left hand and wrist plain film were done to assess bone age. Before operation and at follow up, physical examination, KT-1000 measurements and functional outcome instruments (the Lysholm score, and the Tegner score) were done. Radiographs were performed for angular deformity and leg-length measurements. The surgery was conducted via arthroscopically assisted transphyseal reconstruction of the ACL with use of an autogenous quadrupled hamstring tendon graft and fixation devices that did not cross the physes. A protective knee brace was used for 1 month postoperatively. Comparison of Lysholm score and Tegner score before and after surgery was performed using t test. Results:Arthroscopy confirmed ACL rupture in 10 knees. Concurrent meniscal surgery was performed in 3 knees. The follow-up duration was 3.2±2.3 years (range 2-5 years), one of 10 patients had ligament reinjury 1 year after surgery with positive anterior drawer test and Lachman test. As for the remaining 9 patients, the mean Lysholm knee score improved from preoperative 76.1±8.2 to 95.8 ±3.5, and the mean Tegner score improved from preoperative 4.3±0.9 to 8.3±0.6, both of the two outcomes had statistically significant difference ( t=6.43, P=0.024; t=4.41, P=0.033). One patients was weakly positive for anterior drawer test and Lachman test, with KT-1000 side difference >3 mm, the remaining eight were negative for anterior drawer test and Lachman test, and KT-1000 side difference was mean 1.7±0.7 mm. All patients had no more than 5° restriction in knee range of motion compared with the healthy side. The full-length X-ray of the standing lower limbs showed no length and angle deformity in both lower limbs. Conclusion:Transphyseal ACL reconstruction with autogenous quadrupled hamstring graft in treating skeletally immature pubescent patients (bone age over 13 years in male and 11 years in female) yields satisfied functional outcomes without growth disturbance.

The value of color Doppler ultrasonography in the differential diagnosis of benign and malignant testicular tumors in children / 中华超声影像学杂志

Objective To investigate the value of color Doppler ultrasonography in the differential diagnosis of benign and malignant testicular tumors in children. Methods The sonographic findings of 63 children pathologically confirmed testicular tumors were retrospectively analyzed.All children were divided into benign group and malignant group according to pathologic diagnosis. The tumor size,shape,border, echo texture,calcification and color blood flow were compared between two groups. Logistic regression analysis was employed to predict sonographic features of benign and malignant testicular tumors.Receiver operating curve (ROC) was employed to assess the diagnostic performance of sonographic features. Results Among the 63 cases of pediatric testicular tumors,42 cases were histologically confirmed as benign testicular tumors (66.7% ),and the rest 21 cases were malignant testicular tumors (33.3% ). The maximum diameter of tumor in benign tumors was significantly smaller than that in malignant tumors[(1.75 ± 0.75) cm vs (2.90 ± 1.22)cm,P =0.000].In the sonographic features,malignant testicular tumors were more likely to present with solid masses,and benign testicular tumors were more likely to be cystic or cystic-solid ( P =0.024).Calcification was more common in benign tumors than that in malignant tumors ( P =0.000).Compared with benign tumors,malignant tumors had increased blood flow on color Doppler images ( P =0.000).Logistic regression analysis indicated that flow grade was the independent prognostic factors for malignant tumor. By using Alder grade of 2 or above as threshold,the sensitivity,specificity and accuracy were 95.2%,78.6% and 84.1%,respectively. Conclusions The sonographic features vary between benign and malignant testicular tumors. Blood flow is the independent factors for predicting malignant tumor. Color Doppler ultrasonography is an important method for differential diagnosis of testicular tumors in children.

Ultrasound evaluation of leuprorelin therapeutic efficacy in girls with central precocious puberty / 中华超声影像学杂志

Objective To investigate the value of ultrasound in assessing leuprorelin treatment response of girls with central precocious puberty . Methods Forty girls with central precocious puberty scheduled for leuprorelin treatment were enrolled . Ultrasound examination as well as the serum hormone level test of luteinizing hormone ( LH) and follicle stimulating hormone ( FSH) were performed prior to the treatment ,after 3 and 9 months of treatment . The correlation between uterine volume ,ovarian volume and hormone levels were analyzed . Results After 3 and 9 months of leuprorelin treatment ,both the volumes of uterus and ovary and the levels of LH and FSH were significant reduced ( all P < 0 .05) . After 3 months of leuprorelin treatment ,the reduction rate in ovarian volume was positively correlated with the reduction rate of LH and FSH ( r = 0 .335 , P = 0 .034 ; r = 0 .334 , P = 0 .035) . No correlation was found between the reduction rate of uterine volume and hormone level changes ( r = 0 .110 , P = 0 .501 ; r = 0 .257 , P =0 .109) . After 9 months of treatment ,the ovarian volume reduction rate was positively correlated with the reduction rate of LH and FSH ( r = 0 .327 , P = 0 .039 ; r = 0 .356 , P = 0 .024) ,and the uterine volume reduction rate was positively correlated with the reduction rate of LH and FSH ( r = 0 .439 , P = 0 .005 ;r =0 .433 , P = 0 .005 ) . Conclusions Leuprorelin could effectively inhibit hormone release and gonadal development in girls with central precocious puberty . Ultrasound examination , as a noninvasive and convenient method ,could dynamically monitor the volume changes of uterus and ovary ,thus reflect the development of gonadal development directly and the changes of hormone level indirectly . It could be used as a routine outpatient follow-up method after central precocious medicine treatment .

Construction of Rat Extracellular Signal-regulated Kinase 1 Gene 3' Untranslated Regions Dual-luciferase Reporter Plasmids and Effect of rno-miR-15b-5p on Its Activitiy / 中国康复理论与实践

@#Objective To construct dual-luciferase reporter plasmids containing the wild type and mutant rat extracellular signal-regulat-ed kinase 1 (ERK1) gene 3' untranslated regions (UTR) which were used to detect rno-miR-15b-5p's putative target gene. Methods The rat ERK1 gene 3' UTR fragment was amplified by polymerase chain reaction (PCR) from PC12 cell cDNA and cloned into pmiR-RB-ReportTM vector. The mutant rat ERK1 gene 3' UTR fragment was obtained by overlap PCR and inserted into pmiR-RB-ReportTM vector. Successful wild type and mutant recombinant plasmids were confirmed by DNA sequencing. PC12 cells were co-transfected with rno-miR-15b-5p mim-ic and pmiR-ERK13' UTR or pmiR-ERK1-mut 3' UTR and then analyzed by dual-luciferase reporter assay system. The achieved mutation sequence of the target site TGCTGCT was mutated to CGAACGT and GTACACG, respectively. Results The wild-type reporter vector pmiR-ERK13' UTR and the mutant reporter vector pmiR-ERK1-mut 3' UTR were successfully constructed. The rno-miR-15b-5p mimic de-creased the activity of pmiR-ERK13' UTR plasmid (P<0.001) but did not decrease the activity of pmiR-ERK1-mut 3' UTR plasmid. Conclu-sion The recombinant pmiR-ERK13' UTR and pmiR-ERK1-mut 3' UTR plasmids were constructed successfully, and luciferase activities demonstrated that the 3' UTR of ERK1 gene might be a potential target of rno-miR-15b-5p.

Practices and experiences of training high-competence specialists in the hospital / 中华医院管理杂志

High-competence specialists are elites among health professionals.By means of the authoritative training system,the hospital took such measures as,strengthened management,rotary training without fixed posts,and cross training.Efforts of 8 years have helped the hospital to establish a high-competence specialists team,a good academic atmosphere,and enhanced capacity of disciplines. Key experiences of the hospital in this process include well-identified objectives,well-designed training programs, strict supervision of training process, and establishment of long-term management mechanism.

Lumbar spine superior-level facet joint violations: percutaneous versus open pedicle screw insertion using intraoperative 3-dimensional computer-assisted navigation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Percutaneous pedicle screw use has a high rate of cranial facet joint violations (FVs) because of the facet joint being indirectly visualized. Computer-assisted navigation shows the anatomic structures clearly, and may help to lower the rate of FVs during pedicle screw insertion. This study used computed tomography (CT) to evaluate and compare the incidence of FVs between percutaneous and open surgeries employing computer-assisted navigation for the implantation of pedicle screw instrumentation during lumbar fusions.</p><p><b>METHODS</b>A prospective study, including 142 patients having lumbar and lumbosacral fusion, was conducted between January 2013 and April 2014. All patients had bilateral posterior pedicle screw-rod instrumentation (top-loading screws) implanted by the same group of surgeons; intraoperative 3-dimensional computer navigation was used during the procedures. All patients underwent CT examinations within 6 months postoperation. The CT scans were independently reviewed by three reviewers blinded to the technique used.</p><p><b>RESULTS</b>The cohort comprised 68 percutaneous and 74 open cases (136 and 148 superior-level pedicle screw placements, respectively). Overall, superior-level FVs occurred in 20 patients (20/142, 14.1%), involving 27 top screws (27/284, 9.5%). The percutaneous technique (7.4% of patients, 3.7% of top screws) had a significantly lower violation rate than the open procedure (20.3% of patients, 14.9% of top screws). The open group also had significantly more serious violations than did the percutaneous group. Both groups had a higher violation rate when the cranial fixation involved the L5. A 1-level open procedure had a higher violation rate than did the 2- and 3-level surgeries.</p><p><b>CONCLUSIONS</b>With computer-assisted navigation, the placement of top-loading percutaneous screws carries a lower risk of adjacent-FVs than does the open technique; when FVs occur, they tend to be less serious. Performing a single-level open lumbar fusion, or the fusion of the L5-S1 segment, requires caution to avoid cranial adjacent FVs.</p>

Clinic effect analysis of improved V-shaped osteotomy to correct thoraco lumbar kyphosis / 中国现代医生

Objective To explore clinic effect analysis of improved V-shaped osteotomy to correct thoracolumbar kyphosis. Methods A total of 64 patients with thoracolumbar kyphosis were divided into two groups, traditional group and improved group, the traditional surgery group of 30 patients underwent the traditional V-shaped osteotomy, includ-ing 20 males and 10 females with an age range of 45 to 68 years. Improved surgery group of 34 patients underwent the improved V-shaped osteotomy, including 22 males and 12 females with an age range of 53 to 65 years. Perioperative complications and Cobb angle of kyphosis were compared between two groups. Results The improved group and tradi-tional group in correction Cobb of kyphosis had no obvious difference(P>0.05), the incidence of postoperative gastroin-testinal complications in improved group was obviously lower than traditional group with statistical difference(P<0.05). Conclusion The improved V-shaped osteotomy surgery can correct thoracolumbar kyphosis with cobb angle< 80o and the gastrointestinal complications and vascular events can be significantly reduced.

Primary hepatolithiasis complicating cholangiocarcinoma / 中华普通外科杂志

Objective To summarize the clinical features,diagnosis,treatment and prognosis of hepatolithiasis complicating cholangiocarcinoma. Methods From June 1958 to March 2011,709 cases of hepatolithiasis were admitted to Department of General Surgery,Peking University Third Hospital.The cases concomitant with cholangiocarcinoma were reviewed. Results 20 of 709 (2.8％ ) hepatolithiasis cases developed cholangiocarcinoma.17 cases (85％,17/20) were followed-up for 2 years (0 - 15 years).The hepatolithiasis course before the malignant diagnosis was 15 ± 1 1 years (3 -38 years).14 cases had frequent episodes of cholangitis,15 cases had liver cirrhosis.Preoperative diagnosis was established by CT,MRCP,B-ultrasound and tumor markers in 55％ (11/20) cases.4 cases underwent radical resection,7 received palliative resection,9 cases received conservative treatment.In radical resection,one lost to follow-up,one survived one year,two for 5 years.In palliative resection,2 lost to follow-up,two survived one year,one survived 3 years, one for 5 years. None in conservative group survived more than one year.Conclusions Cholangiocarcinoma developed from hepatolithiasis with a long history,frequent cholangitis,liver cirrhosis,especially in cases with imige showing thickness of bile duct or mass and rising tumor markers (CA19-9,CA125,CEA).The cases undergoing radical resection may have a favorable prognosis.

The value of region Ⅵ lymph nodes in the surgical treatment of papillary thyroid carcinoma / 肿瘤研究与临床

Objective To evaluate the value of region Ⅵ lymph nodes in surgical treatment of cN0 papillary thyroid carcinoma(PTC). Methods 98 cases of PTC with cN0 which received functional lymph nodes dissection were collected. We analyzed the results of pathologic examination by region Ⅵ lymph nodes distinguished from lateral neck lymph nodes(Ⅱ～Ⅴ) retrospectively. Results In 98 cases, the rate of region Ⅵ lymph nodes metastasis was 20.4 %(20 cases); the rate of region Ⅱ～Ⅴ lymph nodes metastasis was 13 cases(13.3 %). In cases with region Ⅵ lymph nodes metastasis, the rate of Ⅱ～Ⅴ lymph nodes metastasis was 45.0 %(9/20). Meanwhile in cases without region Ⅵ lymph nodes metastasis, the rate of Ⅱ～Ⅴ lymph nodes metastasis was 5.1 % (4/78, P

Total flavonoid extracted from Sophara japonica buds with assistant of laccase from endophytic Fusarium sp. C-8 / 中草药

Objective To study the application of extracellular laccase from endophytic fungi to total flavonoid extraction. Methods The extracellular laccase vitality of an endophytic Fusarium sp.C-8 from Artemisa annua reached 36.1 U/mL when the fungus was cultivated in revised PDA medium with initial pH 7.0 at 20℃ on a rotary shaker incubator for 6 d. The crude laccase from the cultural medium was applied for extraction of flavonoid from the buds of Sophara japonica. The optimization on the ratio of dry buds to crude enzyme liquid,temperature,time,and pH value was carried out during the process of laccase-assistant treatment. Results After incubation with 40∶1 of crude enzyme (pH 7.0) at 20℃ to dry buds for 1 h,the extraction rate of total flavonoids was 11.4 %,a more increase of 28.7 % than that in regular extraction process. Conclusion The results present a practical method of laccase-assistant extraction process on total flavones in S. japonica buds.