Objective To evaluate the diagnostic value of preoperative assessment of the status of sentinel lymph node（SLN）in breast cancer using contrast-enhanced ultrasonography combined with fine needle aspiration cytology（CEUSFNAC）.Methods 122 consenting patients with early breast cancer admitted in our hospital were prospectively recruited in this study.Before the surgery，SLN was assessed using contrast-enhanced ultrasound combined with fine needle aspiration cytology.Determination and characterization of SLN by simple dye method or combined isotope method were performed.The findings of CEUS-FNAC were recorded and compared with the final pathological diagnosis.Results The cases of SLN metastasis group and metastasis-free group detected by pathological diagnosis were 28 and 94 respectively.CEUS-FNAC detected 20 cases of SLN metastasis，and 103 cases did not metastasize.The detection rate，sensitivity，specificity，positive predictive value and negative predictive value of CEUS-FNAC for evaluating the status of sentinel lymph node were 100%，71.43%，100%，93.44%，100%，92.16%,respectively，with statistically significant（P=0.000，Kappa=0.794）.Conclusion The cytopathological results obtained by preoperative contrast-enhanced ultrasonography combined with fine needle aspiration of SLN were consistent with the pathological results of postoperative SLN，indicating that the CEUS-FNAC can be used for the assessment of sentinel lymph node status in preoperative breast cancer.

Objective To investigate the mechanism of aquaporin 4（AQP4）in the development of breast cancer.Methods The expression of aquaporin 4 in the T47D and MCF-7 cell lines of breast cancer cells was downregulated by siRNA interference，and the effect of this down regulation on the invasion and metastasis of breast cancer cells was detected.Results Decreased expression of AQP4 inhibits invasion and metastasis of breast cancer cells.Conclusion The expression level of AQP4 is correlated with the development of breast cancer，and it can further develop into a new target.

Objective Meta-analysis was conducted to investigate the effect of methylene blue on the number of lymph node harvest in pathological specimens of gastrointestinal malignant tumors.Methods We electronically searched PubMed，EmBase，Cochrane Library，CBM，CNKI and Wanfang database for collecting the relevant studies about the detection of methylene blue and lymph nodes in gastrointestinal malignancies（from inception to December 2018）.Two researchers screened of the literatures according to the inclusion and exclusion criteria，and further extracted the data and evaluated the quality.RevMan 5.3 software was used for this analysis.Results A total of 21 articles（containing 22 independent data），including 1140 patients in the traditional mode group and 1098 patients in the methylene blue staining group，were included in the metaanalysis.The results of the analysis showed that the use of methylene blue tracer in gastrointestinal tumor specimens significantly increased the number of lymph node harvest（P<0.001）compared with conventional manual harvest of lymph nodes.Subgroup analysis suggested that the number of lymph nodes detected during the increase in methylene blue was not associated with cancer types and whether patients received neoadjuvant chemotherapy（P<0.001，respectively）.Conclusion Methylene blue staining can significantly increase the average number of lymph node harvest in tissue samples from patients with gastrointestinal malignancies，and exhibits potential clinical application value.

Objective To summarize the experience of gunsight closure technique in loop stoma reversal.Methods This retrospective trial enrolled 22 patients who underwent gunsight stoma closure.The main techniques were as followings：The skin was sewn continuously 0.2cm away from the edge of the stoma to close the stoma.After intestinal anastomosis，the intestine was incorporated into the abdominal cavity and the fascial closure was achieved en masse continuously with PDS II.The subcutaneous adipose tissue was sutured by circular absorbable suture and leaving a residual hole of 1cm in the center.Grasped the skin and pulled it toward the center of the wound to mark four points and triangles of 0，3，6，and 9 o’clock.Resected the four triangles and placed a circumferential absorbable subcuticular suture in the wound edge，leaving a small residual hole of 0.5cm in the center of the wound，leaving a drainage strip in the hole.Interrupted sutured the wound.Results The median blood loss was 20ml（10～40ml），median operative time was 70min（60～90min），median postoperative hospital stay was 6.5 days（5～8 days）.There was only one patient（4.5%）with surgical site infection on the second day postoperatively.The median healing time was 17 days（14～22 days）.The median cosmetic score according to the visual analog scale（0 being the lowest and 10 the highest grade in cosmetic scar perception of the patient）was 9（6～10）with a median followup of 14 months（10～21 months）.Conclusion Gunsight closure might be a relatively safe and feasible technique for stoma reversal，and might lower the wound tension，shorter wound healing time and postoperative hospital stay with satisfied cosmetic results，without prolonged operative time and increased postoperative pain.

Objective To investigate the feasibility，safety and efficacy of laparoscopic D3 lymph node dissection for sigmoid cancer with preservation of superior rectal artery.Methods Laparoscopic D3 lymph node dissection of superior rectal artery was performed in 25 cases and direct dissection of inferior mesenteric artery without preservation of superior rectal artery in 20 cases at the same time.The clinicopathological data，operative time，intestinal function recovery and postoperative complications were compared between the two groups.Results The operative time in SRA group and non-SRA group was（202.2±46.50）min and（147.5±37.3）min，and the recovery time of intestinal function was（2.1±1.1）days and（3.1 ±1.3）days，The hospitalization time was（8.1±0.9）days and（11.5±1.1）days，there were significant difference between the two groups（P<0.05）.The intraoperative bleeding volume in the SRA-sparing group and the non-SRA-sparing group was（65.3 ±10.2）ml and（59.2±9.9）ml，The number of lymph node dissectionwas（14.4±3.5）and（15.3±4.2），and the incidence of postoperative complications was 8%（2/25）and 15%（3/20），there were no significant difference between the two groups（P＞0.05）.Conclusions The laparoscopic D3 lymph node dissection  with preservation of superior rectal artery for sigmoid cancer is safe and feasible，the patients can recover early，and without increasing complication incidence，Thus  has great clinical value.

Objective To investigate the influence of conventional and modified LIFT on clinical efficacy for short-term and anal function of patients with complex anal fistula.Methods 94 patients with complex anal fistula were chosen in the period from January 2016 to January 2018 in our hospital and randomly divided into two groups including control group（47 patients）with conventional LIFT operation and modified group（47 patients）with modified LIFT operation;and the surgery-related clinical indicators，clinical efficacy for short-term，pain VAS score after operation，Wexner score of anal incontinence before and after surgery，anal and rectal pressure before and after surgery and complications incidence after surgery of both groups were compared.Results There was no significant difference in the surgery-related clinical indicators between 2 groups （P>0.05）.The clinical efficacy for short-term of control group and modified group were separately 76.60%，93.62%.The clinical efficacy for shortterm of modified group were significant better than control group（P<0.05）.There was no significant difference in the pain VAS score after operation and Wexner score of anal incontinence after surgery between 2 groups （P>0.05）.There was no significant difference in the anal and rectal pressure before and after surgery between 2 groups （P>0.05）.The incidence of intermuscular incision dehiscence infection and sphincter fistula of control group were separately 25.53%，14.89%.The incidence of intermuscular incision dehiscence infection and sphincter fistula of modified group were 14.89%，4.26%.The incidence of intermuscular incision dehiscence infection and sphincter fistula of modified group were significant lower than control group（P<0.05）.Conclusion Compared with conventional LIFT，modified LIFT in the treatment of patients with complex anal fistula can efficiently improve the overall clinical effect，promote the healing process of lesions，reduce the postoperative complications risk and not affect anal function.

Objective To compare the therapeutic effect of transforminal lumbar interbody fusion（TLIF）with posterior lumbar interbody fusion（PLIF）in treatment of lumbar spondylolisthesis.Methods From March 2010 to March 2014，a total of 62 patients suffering from lumbar spondylolisthesis were divided into 2 groups.36 patients in group underwent TLIF.26 patients in group underwent PLIF.Posterolateral fixation with pedicle screw and decompression，interbody fusion through TLIF or PLIF technical combined with cage for distraction reduction.The application of statistics analysis of the indicators compared between the two groups，including operating time，blood loss and volume of drainage after operation.VAS，ODI evaluating standards were applied to evaluate the therapeutic effect.The intervertebral height and bone fusion were observed by X ray.Results All patients underwent surgery safely without severe complications occurred.2 cases occurred dural tear and 1 of nerve root injury in PLIF group.There was no significant difference in general materials and operation time between TLIF group[（134.17±27.40）min] and PLIF group[（130.38±30.00）min] （P>0.05）.The blood during operation，volume of drainage after operation of TLIF group were significantly less than PLIF（P<0.05）.The average following up time was 20 months（12～48 months）in TLIF group and 18 months（9～42 months）in PLIF group.Compared with preoperative parameters，the scores of VAS and ODI decreased significantly after surgery and at the final followup in both groups（P<0.05）.But there was no significantly difference between TLIF and PLIF in VAS and ODI score（P>0.05）.It occurred cage dislocation with no nerve symptom in PLIF group in 1 cases.1 case of fat liquefaction of incision injure happened in TLIF group.At the followup after 6.5 months postoperatively，the fusion is 94.4% in TLIF and 92.3% in PLIF，and no broken screw.Conclusion TLIF and PLIF technical both have a good clinical results in the treatment of lumbar spondylolisthesis which can achieve stable and effective decompression.With a less invasive and a less rate of nerve injury compared with PLIF，TLIF procedure can be performed easily and better protection the structure with less complications.

Objective To explore the clinical application of percutaneous minimally invasive plate osteotomy（MIPPO）combined with locking compression plate（LCP）internal fixation in patients with limb fracture trauma and its impact on life quality.Methods A total of 128 patients with limb fracture trauma admitted to our hospital from August 2016 to April 2018 were randomly divided into two groups and given LCP internal fixation treatment to the control group，while the study group combined with MIPPO technology on the basis of LCP internal fixation treatment.The quality of life and self-care ability of the two groups before and after surgery were observed and compared，and the complications，surgical related conditions and comprehensive functional rehabilitation levels of the two groups were compared.Results The quality of life of the study group was significantly higher than that of the control group（P＜0.05）.The rehabilitation level of self-care ability，comprehensive function and operation related conditions of the study group were significantly better than those of the control group（P＜0.05），and the incidence of complications of the study group was significantly lower than that of the control group（P＜0.05）.Conclusion MIPPO technology combined with LCP internal fixation of fracture in the limbs trauma patients in clinical application had a good curative effect，not only can improve the quality of life of patients with self-care ability and life level，also can promote the comprehensive function in patients with rehabilitation speed，reduce the surgical complications.

Objective Purpose Making a multi-perspective analysis of the drug sensitivity result of 46 patients with ureteral calculus and concomitant urinary infection so as to offer valuable medication instruction.Methods Respectively analyzing clinical information of patients diagnosed with ureteral calculus in our hospital from January，2016 to December，2017，and selecting out 46 cases from all 402 cases with ureteral calculus.To compare the populations of the microbial community，drug sensitivity，anti-bacterial effects and effectiveness of cephalosporins in order to confirm the more rational choice of drugs.Results It had been showed that E.coli was the major bacterial of both genders and 25（54%）samples were positive; while men had a relatively lower percentage of E.coli to all bacteria compared to women，but no statistical significance（RR=0.68，95% CI：0.344～1.185，P＞0.05）.Enterubacterium had a high resistance rate for single betalactam antibiotics while significantly improved sensitivity and decreased resistance were acquired when combined with Betalactamase inhibitors（sulbactam/tazobactam）（OR=0.058，95% CI：0.022～0.151，P<0.05）.According to drug sensitivity results（sensitive、intermediary、resistant）of 7 different cephalosporins，it had notable distinction.So Cefoxitin and Cefoperazone combined with sulbactam as the major antibiotics for empirical medication were screen out as the ideal antibacterial drugs.Conclusion We recommend Cefoxitin or Cefoperazone combined with sulbactam as the first choice，Ceftazidime and Cefepime as the second choice，meanwhile decreasing the application of Ciprofloxacin and Levofloxacin.

Objective To evaluate the prognostic value of histone deacetylase 9（HDAC9） expression in malignant tumor.Methods Databases including PubMed，EMbase，The Cochrane Library，CNKI and WanFang Data were searched to collect case-control studies about the prognostic value of HDAC9 expression in malignant tumor from inception to Jan 2019.Literatures were screened and data was extracted.Then meta-analysis was performed by using RevMan 5.3 software.Results Finally，a total of 8 case-control studies were included.The results of meta-analysis showed that the high expression of HDAC9 was not associated with gender（OR=0.87，95％CI =0.22～3.40，P=0.84），TNM staging（OR=0.55，95％CI =0.20～1.52，P=0.25）and progressionfree survival（HR = 1.10，95％CI =0.97～1.26，P=0.14）.But the high expression of HDAC9 was significantly associated with lymph node metastasis（OR=2.25，95％CI =1.18～4.29，P=0.01），overall survival（HR=2.51，95％CI =1.11～5.66，P=0.03）and eventfree survival（HR=10.61，95％CI =1.26～86.90，P=0.03）.Conclusion HDAC9 high expression is a risk factor for poor prognosis in cancer patients and may be used as a predictive maker for poor prognosis in malignant tumor.

Objective To investigate the curative effect of spiral suture of longitudinal trapezoidal flap in preventing the tightness of the pedicle and the atrophy and collapse of the nipple after ureteropaplasty.Methods A retrospective analysis was performed on the clinical data，incidence of postoperative dermal papillary atrophy and collapse，and outcomes of 15 elderly patients who underwent total cystectomy and total bladder combined with partial ureterectomy in general surgery department of zhengzhou university affiliated cancer hospital from January 2013 to December 2016.Among the 15 cases with longitudinal trapezoidal flap spiral suture，12 cases had good ureteral length and blood supply.Due to the insufficient length of ureter in 3 cases，it was difficult to form the same side of ureter on both sides，and the dermal papilla of ureter was formed on both sides respectively.Results One of the 18 nipples collapsed，with an incidence of 5.56%.One papillary root infection resulted in ureteral flap root fistula，with an incidence of 5.56%.One nipple showed distal ureteral necrosis，with an incidence of 5.56%.The comprehensive incidence of complications was 16.7% and all the patients had no problems of skin flap necrosis and nonunion，skin flap pedicle tightness，nipple atrophy and collapse，etc.Conclusion The longitudinal trapezoidal flap spiral suture can effectively prevent the tightness of the pedicle and the atrophy and collapse of the nipple after ureteropaplasty.

Anterior pelvic ring fracture is a more common kind of fracture.With the development of orthopaedic fixation technology，there are many fixation methods.Because of the particularity of its anatomic morphology and the complexity of the injury mechanism，there are individualized differences in its treatment plan.However，for any fixation method，it is necessary to consider the fracture location，type，infection degree and systemic status，so as to formulate the most appropriate fixation method.The most common surgical methods for anterior pelvic ring fractures are summarized below.