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Objective:The aim of the study is analyze the recurrence, metastasis and prognosis of early breast cancer patients and evaluate the long-term safety of tracer sentinel lymph node biopsy (SLNB) using indocyanine green (ICG) and methylene blue (MB) in early breast cancer.Methods:A total of 394 breast cancer patients were enrolled from January 1, 2014 to December 31, 2014 in Affiliated Hospital of Chengde Medical University. The baseline data and clinical characteristics of 222 patients who met the inclusion criteria were analyzed.Results:The median follow-up time of 222 patients was 57 months. The detection rate of sentinel lymph nodes (SLNs) using ICG or MB alone was 96.4% and 84.7% ( P=0.02); the number of SLNs detected was 740 and 604 ( P<0.001); the positive SLN detection rates were 100% and 91% ( P=0.014), and the positive SLNs were 221 and 195 ( P<0.001). The local recurrence rates were 0.7% in patients without axillary lymph node dissection (ALND) and 1.4% ( P=0.57) in patients with ALND, and the distant metastasis rates were 5.3% and 15.7% ( P=0.01), respectively. The 5-year overall survival (OS) was 4.7% and 91.7% ( P=0.421), and the disease-free survival (DFS) was 90.5% and 85.9% ( P=0.285). The OS and DFS of the 222 patients were 100%, 96.8%, 94.1% and 100%, 96.4% and 89.2% respectively at 1, 3 and 5 years after operation. Multivariate COX regression model showed that age ≤50 years old, triple negative molecular classification and primary tumor >2 cm were independent risk factors for prognosis, and HR were 3.254, 7.321 and 3.507, respectively (all P<0.05). Conclusions:Sentinel lymph node biopsy with indocyanine green combined with methylene blue is a safe and reliable method for axillary staging of breast cancer. The COX regression models showed that patients with younger age, three-negative molecular type and larger primary tumor were more likely to have adverse events.
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To implement the task of health anti-poverty campaign,the medical alliance of northwest Guangxi hospitals made full use of its synergy strengths to achieve remarkable progress in constructing a telemedicine cooperation network, nurturing medical discipline of primary hospitals in the alliance, promoting regional medical resources sharing, and improving the humanities connection mechanism.To further develop health anti-poverty via medical alliances,relevant institutions are recommended to probe into such problems as telemedicine compensation mechanism,precision-based disciplinary support,breakdown of resource sharing barriers and profit distribution mechanisms.
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Objective To investigate the prevalence of urine abnormalities for school children in Chengdu city and to evaluate the significance of urinary screening.Methods During January to December 2013,morning urine of 6 615 students were collected and screened by urine reagent paper.Two weeks later,the repeated screening was conducted in the children whose urine samples were positive for the first screening.Urine samples with positive testing results for twice were submitted to urine routine tests at local hospital,and the children with the urine positive results were defined as urine abnormalities.The children with urine abnormalities were transferred to a tertiary hospital and given treatment and follow-up.Results There were 6 615 cases receiving urine screening,including 2 624 cases (39.67 ％) of the grade I,and 3 991 cases(60.33％) at junior middle school.During the first screening,323 cases (4.83％) children had urinary occult blood positive,43 cases (0.65％) had urinary protein,20 cases (0.30％) had occult blood positive and proteinuria,and 103 cases (1.56％) had white cells in urine.During the second urine screening,62 cases (0.94％) had occult blood positive,6 cases (0.09％) had urinary protein,2 cases (0.03％) had proteinuria and occult blood positive,46 cases (0.70％) had white cells in urine.The incidence of urine abnormalities with occult blood positive,proteinuria,occult blood positive and proteinuria,and white cells in urine of children at junior middle school [1.38％ (55/3 991 cases),0.13％ (5/3 991 cases),0.05％ (2/3 991 cases),0.70％ (28/3 991 cases)] were significantly higher than those of children at primary school [0.27％ (7/2 624 cases),0.04％ (1/2 624 cases),0 (0/ 2 624 cases),0.69％ (18/2 624 cases)],and all the differences were statisticallysignificant (x2 =64.16,168.53,178.09,98.16,all P ＜ 0.05).In children transferred to a tertiary hospital for treatment,there were 4 cases with IgA nephropathy,1 case with minor glomerular abnormalities,and 12 cases with urinary tract infection.Conclusion Urinary screening is an effective way to find out kidney disease and urinary tract infection in children.Follow-ups should be strengthened.
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Heterotopic pancreas is usually defined as a presence of pancreatic tissue without any anatomical or vascular continuity,and is one of the congenital and rare diseases.The clinical manifestations are easily confused with other gastrointestinal diseases,and conventional endoscopic examination cannot provide a clear preoperative diagnosis,therefore heterotopic pancreas is often misdiagnosed.It is very important to distinguish heterotopic pancreas and other digestive diseases.In this article,the clinical characteristics,differential diagnosis and treatment method of one patient with heterotopic pancreas who was admitted to the Affiliated Hospital of Chengde Medical College in March 2014 were analyzed.
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Objective To prepared the docetaxel nano liposome (L-DOC) for the therapy of liver cancer HepG2 cells in vitro and in vivo. Methods The film-ultrasonic dispersion method was used to prepare the L-DOC.The diameter and Zeta potential of L-DOC were determined by Nanosizer and the encapsulation efficiency was further measured.CCK-8 method was used to determine the cell viability of HepG2 cell after treating with various concentration of DOC and L-DOC respectively and the cell death type was detected by Flow cytometer.Next, we have studied the relative tumor volume change of tumor-bearing mice and the toxicity in vivo.Results The average diameter of L-DOC was 104 nm and the Zeta potential was about -35.1 mV.The Zeta potential of L-DOC was almost unchanged after standing for 96 hours.The encapsulation efficiency of L-DOC was ( 71.2 ±1.6 )%.The CCK-8 results showed that the cell viability was decreased after treating with various concentration of DOC and L-DOC, but the inhibition effect of L-DOC was better than that of DOC after treating with the same dose, especially for 20μg/mL.It was found that the cell death was induced by apoptosis.The in vivo study results showed that 6mg/kg L-DOC could inhibit the tumor volume better than that of same dose of DOC.In addition, 6mg/kg L-DOC and DOC didn’ t induce in vivo toxicity.Conclusion The L-DOC is prepared by film-ultrasonic dispersion method which has small diameter, great biocompatibility.And it could inhibit the HepG2 cells in vitro and in vivo, especially for no in vivo toxicity.
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Objective To understand the clinical characteristics and correlative factors of ANCA-associated systemic vasculitis with interstitial lung disease.Methods Seventy-five AASV patients in Shanghai Renji Hospital from January 2010 to June 2013 were selected.The clinical data of those cases with interstitial lung disease were analyzed retrospectively and logistic regression model was applied to analyze the correlative factors.Results Of the 75 AASV patients,52％ were male,48％ were female,and the average age was (56±19) years.Forty-four cases were defined as interstitial lung disease.Among patients with interstitial lung dis-ease,31 (70％) cases were chronic onset,32(72％) cases had pulmonary infection and 8 (18％) cases died.The main chnical manifestations were dry cough,shortness of breath after labour and fever,the proportion was 68％,36％ and 50％ respectively.Irregular linear shadow was the main imagine changes,the rate was 55％.Pulmonary function changes varied in degrees with diffusion capacity reduction.Multivariate logistic regres-sion analysis showed that those who were older than 60 years (OR=3.44,95％CI:1.05-11.28),positive for MPO-ANCA (OR=3.7,95％CI:1.10-12.65) and Birmingham vasculitis activitv score higher than15 (OR=3.67,95％CI:1.21-11.15) were more likely to have interstitial lung disease.Conclusion Interstitial lung disease is one of the common pulmonary damages of ANCA-associated systemic vasculitis and it will lead to death because of respiratory failure or secondary pulmonary infection.Those who are elders,with positive MPO-ANCA,and with active disease are at high risk for interstitial lung disease among AASV patients.The results of this study sugest that clinicians should pay more attention to patients with these high risk factors.
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Objective To investigate the mRNA expression of IKB kinase (IKK-α) and interferon-α (IFN-α) in the peripheral blood leukocytes of patients with systemic lupus erythematosus (SLE), and to explore the role of IKK-α in the production of IFN-α in SLE patients. Methods SYBR green dye I based real-time quantitative PCR was used to detect the mRNA expression levels of IKK-α and IFN-α in the peripheral blood leucocytes of SLE patients and healthy controls. Serum levels of IFN-α were measured with ELISA method. Results IKK-α mRNA expression levels in SLE patients were significantly higher than those of normal controls (P<0.05). IKK-α mRNA expression levels in SLE patients with active disease were significantly higher than patients with stable disease (P<0.01). IFN-α mRNA expression level in SLE patients was significantly lower than that of the normal controls (P<0.01). IFN-α mRNA expression levels in SLE patients with active disease were significantly higher than patients with stable disease (P<0.01). Serum levels of IFN-α in SLE patients with active disease was significantly higher than that of the normal controls and patients with stable disease (P<0.05). The anti-dsDNA antibody correlated positively, and complement C3 correlated negatively with serum concentration of IFN-α. IKK-α mRNA expression levels in SLE patients correlated positively with serum concentration of IFN-α. Conclusion IKK-α correlates positively with serum concentration of IFN-α. The IFN-α level is significantly correlated with disease activity, This suggests that IKK-α may play an important role in the pathogenesis of SLE.
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Objective To study the incidence of osteopenia in patients with initial systemic lupus erythematosus(SLE). Investigate the levels of the vitamin D (VitD) endocrine system in peripheral blood of SLE patients and its relation to bone mineral density (BMD). Analyse the relationship between the estrogen receptor (ER) and BMD and evaluate the role of ER in the pathogenesis osteopenia. Methods Serum levels of 25-OH VitD_3 and 1,25-(OH)_2 VitD_3 were detected by enzyme linked immunosorbent assay. The gene expression levels of VitD receptor (VDR) and ER were determined by real-time PCR. BMD measurements in the lumbar spine (L1-L4) and left proximal femur (femoral neck) were performed using dual X-ray absorptiometry before treatment. Results The initial SLE patients had significantly lower BMD values, and higher frequency of bone loss at both sites of measurement compared with normal controls (P < 0. 05). The levels of 25-OH VitD_3 and 1,25-(OH)_2 VitD3 were lower in the initial SLE patients than normal controls(P<0.01 both). There is no difference in the levels of 25-OH VitD_3 and 1,25-(OH)_2 VitD_3 between the osteopenia SLE group and the normal BMD SLE group (P > 0. 05, P > 0. 05). There are no correlations between the Vitd and BMD in initial SLE patients (P>0.05 both). The expressions of VDR gene were significantly increased in the initial SLE patients compared with the normal controls(P<0.01). There was no difference in VDR gene expression between osteopenia SLE group and normal BMD SLE group (P>0.05). The VDR gene expression does not correlate with the bone mass (P>0.05). The levels of ER-β gene expression are higher in the initial SLE group than the normal controls (P<0.01).Conclusions The incipient SLE patients may have lower BMD than expected. SLE patients present abnormal VitD endocrine system and higher ER-β mRNA expression than those in normal controls, but these weren't concerned with osteopenia.
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Objective To evaluate the application value of hip joint traction device in treating serious developmental dysplasia of the hip. Methods From April 2006 to October 2008, 6 cases Crowe Ⅳ hip dysplasia and 1 case dysplasia of acetabulum in coxa vara underwent arthroplasty. There were 2 males and 5 females with an average age of 30 years (range, 12-45). All patients were admitted to the hospital for the distraction, which was 1.0-2.0 cm on the first day and 1 mm/d thereafter, until slowly pulling femur head to the real acetabulum. Changing to the skin distraction with 3 kg, arthroplasty was performed after pin sites healing. Results Seven femur heads of 5 cases and two greater trochanters of 1 case were pulled into the real acetabulum, average distraction length was 4.45 cm, and average time was 43 d, no nerve injury and infection of pin sites. Soft tissue release and femur shortening were not required in arthroplasty. One case accelerated pulling speed to 1.25 mm/d when left femur head was distracted to 6.0 cm, so that the partial left deep peroneal nerve injury happened after 12 h. Ending distraction, bilateral THA was undergone by stages and femur shortening 3 cm in operation, nerve injury restored after half year. All patients were followed up for average 2.5 years (range, 1.5-3.0). In all patients, two limb lengths were equal, middle gluteal muscle myodynamia improved about 1-2 grades. The mean Harris hip score improved from 56.2 to 92.2 one year after operation. Conclusion The hip joint traction device could pulled femoral head to the real acetabulum rotating center, as a result, femur shortening and soft tissue release were not required while performing arthroplasty, and through which wound and operative time were decreased, middle gluteal muscle function was improved. However, we should strictly pulled the femur head at 1 mm/d to avoid nerve injury.
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Objective To study mathematical model and to perform computer simulation for an important subsystem in the bioregenerative life support system(BLSS),i.e.,light-algae bioreactor(LABR)forcontinuously cultivating green microalgae andsignificantly maintaining life support function of BLSS.MethodsBased on the theories of system dynamics and stoichiometry,the mathematical model and simulation model of LABR were respectively established with experimental data,and then computer experiments were conducted to simulate dynamic responses of LABR under different parameters as well as their combinations.Results It was shown that the kinetic model of LABR was valid for its real-life counterpart by a series of verification tests.It could reliably and beneficially provede technical and methodologcal helps for further investigations of LABR,such as theoretical analysis,design,control and optimization,and so on.Conclusion With computer experiments based on mathematical model and simulation model,it decreases much more in time and money consumption for investigations than with real experiment.This method can also be extended to use in other subsystems studies of BLSS.
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Objective ① To investigate the level of the vitamin D endocrine system in peripheral relationships with bone mineral density (BMD) and the disease activity respectively. Methods The level of the 25-hydroxylate vitamin D3 (25OHD3) and 1,25-dihydroxyvitamin D3 [1,25(OH)D3] in plasma from 43 SLE patients and 44 normal controls were detected by enzyme linked immunosorbent assay. Vitamin D receptor (VDR) gene expression was determinied by real-time PCR in peripheral blood. BMD measurements in the lumbar spine (L1-4) and left proximal femur (femoral neck) were performed using dual X-ray absorptiometry before treatment. The relationship between the vitamin D endocrine system and the bone mass were studied. We also discussed the relationship between the vitamin D endocrine system and the disease activity. Results The levels of 25OHD3 and 1,25 (OH)2D3 were lower in the initial SLE patients than normal controls (P<0.01, P<0.01). The expressions of VDR gene were significantly increased in initial SLE compared with normal controls (P<0.01). The initial SLE patients had significantly lower BMD values, and higher frequency of osteopenia (35%) at both sites of measurement compared with matched healthy controls (P<0.01). The initial SLE patients were divided into two groups by BMD, abnormal group and normal group. There were no differences in 25OHD3, 1,25 (OH)D3 and VDR gene expression (P0.05). There was no correlation between the vitamin D endocrine system and BMD in initial SLE patients. There was no correlation between the vitamin D endocrine system and the disease activity either. Conclusion Vitamin D endocrine system may play an important role in SLE, but the level of VDR gene is not correlated with BMD and disease activity.
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Objective To evaluate the efficacy and safety profile of a recombinant human tumor necrosis factor receptor: Fc fusion protein in ankylosing spondylitis (AS). Methods This was a multicenter,randomized, double-blind, placebo-controlled trial in the first 6 weeks and then followed by an open-labeled trial in the next 6 weeks. One hundred and forty-three patients of active AS were randomly assigned to receive 25 mg twice-weekly subcutaneous injections of rhTNFR:Fc or placebo for 6 weeks. The primary endpoint was proportion of ASAS20 responders at week 6. The secondary endpoints were the proportion of subjects achieving a BASDAI 20%, BASDAI 50% and BASDAI 70% improvement at week 6. Other secondary endpoints, related to reducing signs and symptoms of AS and improving range of motion and physical function, were evaluated.Results Treatment with rhTNFR:Fc resulted in significant improvement. At 6 weeks, 68% of the 71 patients in the rhTNFR: Fc group had a treatment response, as compared with 28% of those in the placebo group(P＜0.01). Improvements over base-line values for other measures of disease activity were significantly greater in the rhTNFR:Fc group, rhTNFR:Fc was well tolerated, The most frequently treatment related adverse event was injection site reaction. Conclusion rhTNFR:Fc has demonstrated consistent evidence of efficacy and is well tolerated in the treatment of active AS.