Objective：To investigate the intertumoral heterogeneity of multifocal/multicentric breast cancer（MMBC）and its impact on treatment decision.Methods：We retrospectively collected information of 65 cases of patients with multifocal multicentric breast cancer，which included estrogen receptor（ER），progesterone receptor（PR），human epidermal growth factor receptor 2（HER2）and Ki67，and assessed the heterogeneity among the lesions.Molecular phenotype was determined by immunohistochemistry.We also compared the  Intertumoral heterogeneity of molecular type and analyzed its effect on treatment decisions.Results：A total of 65 patients with MMBC were included.Intertumoral heterogeneity in tumor type and grade were detected in 6 of 65 patients（9.2%）and 5 of 65 patients（8.5%）respectively.Intertumoral heterogeneity in ER，PR，HER2，Ki67，molecular type were detected in 5（7.7%），5（7.7%），2（3.1%），6（9.2%）and 10（15.4%）individually.Molecular type of additional lesions in 8 patients（12.3%）can influence the choice of treatment decisions.Conclusion：We conclude that intertumoral heterogeneity of multifocal/multicentric breast cancer was existed in histology and molecular type.Immunohistochemistry tests carried out in all lesions to determine molecular type is necessary for the full treatment of multifocal/multicentric breast cancer.

Objective：To explore the diagnosis and treatment of nonpuerperal mastitis.Methods：The clinical data of 48 patients diagnosed as nonpuerperal mastitis in our hospital in recent two years were retrospectively analyzed.Results：Among 48 cases of nonpuerperal mastitis，36 in 48 cases（75%）showed solid mass，10 cases（20.8%）showed mass combined with abscess，And 2 cases（4.2%） showed bilateral breast inflammation.In 36 cases showing solid mass，29 cases received oral Xihuang capsule treatment and 23 cases had the curative or effctive result，so  effective rate was  79.5%（18/29），the other 7 cases got operation treatment and recovered except that one cace had postoperative incisional infection with abscess； in 10 cases showing mass combined with abscess，7 cases got abscess drainage and 3 cases received abscess suction with gentamicin infusion.All cases got cured for abscess，afterward 9 cases were administrated with oral xihuang capsule and 6 cases got effecetive or cured with the effective rate was 66.7%.For 2 cases showing bilateral mass，they received twosided mammectomy or twosided segment exicion separately.Totally 15（31.3%）cases received  mass excision and the total effetive rate of oral xihuang capsule was 76.3%（29/38）.Conclusion：Surgery treatment is considered as the main radical treatment choice and  oral Xihuang capsule deserves more attention as a very important treatment.

Objective：To study the clinical curative effect and the immune function influence of mammotome minimally invasive surgery on 1cm benign breast diseases.Methods：200 patients with 1cm benign breast lumps divided into observation group and control group according to the random number method，100 cases in each group.Control group were treated with traditional open surgery，observation group were takenmammotome minimally invasive surgery.Patients with intraoperative situation，immune function，complications following surgery，cosmetic effect and evaluation of surgery patients psychological satisfaction were observed.Results：Observation group with operation time，intraoperative blood loss，length of scar，postoperative healing time were significantly less than the control group[（18.33±1.23）min，（4.43±1.21）ml，（2.98±0.22）mm，（4.52±0.84）d VS（29.25±3.23）min，（13.56±2.44）ml，（24.54±2.58）mm，（6.87±1.52）d]（P<0.05）.After surgery，observation group of CD4+，CD8+，CD4+/CD8+ immune function index was significantly lower than the control group[（38.57±3.61）%，（28.21±2.52）%，（1.49±0.46）VS（39.98±4.53）%，（28.25±2.53）%，（1.86±0.51）]（P<0.05）.Cosmetic effect was excellent in observation group patients was significantly more than the control group [70.00%（70/100）VS 36.00%（36/100）]（P<0.05）.Patients psychological satisfaction was high in the observation group was significantly more than the control group [75.00%（75/100）VS 43.00%（43/100）]（P<0.05）.Local infection，local hematoma in the observation group，the incidence of breast deformity was significantly lower than the control group [0，9%（9/100），0 VS 11.00%（11/100），26.00%（26/100），9.00%（9/100）].Conclusion：Patients with 1cm benign breast lumps using mammotome minimally invasive surgery，operation time，intraoperative blood loss，length of scar，postoperative healing time is less，the  immunefunction of patients with to the impact of  small，low complication rates and better cosmetic effect，and the higher psychological satisfaction.

Objective:To explore the effect of self strengthening management education on selfmanagement ability of breast cancer patients undergoing peripherally inserted central venous catheterization（PICC）chemotherapy.Methods:130 patients with breast cancer who received PICC chemotherapy were selected.They were randomly divided into intensive group and control group with 65 cases in each group.The intensive group was given selfreinforcement management education intervention，while the control group was only given general nursing and guidance.The PICC selfmanagement ability of the two groups before and after intervention was observed（CPPSM）scale score，PICC retention time，and complication rate during tube operation.Results:Before intervention，there was no significant difference in daily life management，maintenance compliance management，sports management，information acquisition，daily catheter observation，abnormal handling，catheter management confidence and CPPSM score between the intensive group and the control group（P>0.05）.Exercise management，information acquisition，routine catheter observation，exception handling，catheter management confidence and CPPSM scores were significantly higher than those in the control group（P<0.05），the average tube time of  the intensive group was longer than that in the control group（P<0.05），and the complication rate in the intensive group was 1.59%，significantly lower than that in the control group（11.48%）（P<0.05）.Conclusion:Self strengthening management education can improve the selfmanagement score of breast cancer patients with PICC chemotherapy and reduce the complication rate.

Objective:To study the feasibility and safety analysis of intercostal brachial nerve preservation in modified radical mastectomy for breast cancer.Methods:The data of sixty patients with modified radical mastectomy were retrospectively analyzed.Thirtyfour patients who underwent intraoperative intercostobrachial nerve preservation were set as the study group.Twentysix patients who did not had intercostal brachial nerve preservation during the operation were set as the control group.The situation of operation and hospitalization，the quantitative score of sensory dysfunctions，the location of postoperative sensory changes，quality of life score（QOL），complications and recurrence rate of one year followup for cancer patients were compared between the two groups.Results:The operation time of the experimental group（110.45±27.53）min，intraoperative blood loss（115.76±23.13）ml，lymph node dissection（12.65±2.77）and control group was（102.37±26.15）min，（108.55±21.49）ml and （11.78±2.52），respectively（P>0.05）.The length of hospital stays in the experimental group[（7.49±1.32）d] was significantly lower than that in the control group[（8.42±1.45）d]（P<0.05）.The quantitative scores of sensory dysfunctions in the experimental group at 1 month，3 months，and 6 months were（2.04±0.71），（2.87±0.84），and（3.25±1.06），respectively，which were significantly higher than those in the control group[（1.63±0.54），（2.12±0.72） and （2.56±0.93），respectively]（P<0.05）.The sensory change rates of the axilla，anterior，posterior，medial and lateral sides of the experimental group were 14.71%，5.88%，11.76%，8.82%，and 2.94%，respectively，which were significantly lower than those of the control group[34.62%，26.92%，23.08%，30.77%，15.38%]（P<0.05）.The total score of QOL in the experimental group（41.35±6.84）was significantly higher than that in the control group（32.45±5.67）（P<0.05）.The incidence of complications in the experimental group was 14.71%，which was not significantly different from the complication rate in the control group（11.54%）（P>0.05）.The recurrence rate of the experimental group was 8.82% with one year，and the recurrence rate of the control group was 7.69%.The difference was not statistically significant（P>0.05）.Conclusion:Retaining the intercostal brachial nerve during modified radical mastectomy for breast cancer can effectively improve postoperative sensory function，and has no significant effect on the surgical outcome and complications.It has high feasibility and safety，and can be based on the degree of tumor progression to flexible use.

Objective:LTo explore the relationship between the ultrasound findings of breast cancer and the expression of CerbB2，vascular endothelial growth factor（VEGF）and nm23 and their clinical significance.Methods:A total of 102 patients with breast lesions were enrolled.87 patients were diagnosed with breast cancer by pathological examination.All patients underwent contrastenhanced color Doppler ultrasonography，and immunohistochemistry was used to detect the expression levels of CerbB2，VEGF and nm23 in tumor tissues.The ultrasound characteristics of each patient were evaluated and compared to the expression of CerbB2，VEGF and nm23.Results:Ultrasound examination showed that the tumor had calcification，burr signs，vascular abnormalities and lymphatic metastasis，etc.These symptoms were associated with high expression of CerbB2，VEGF，and nm23（P<0.05），whereas calcification was not associated with high expression of these biomarkers（P>0.05）.For patients with high expression of CerbB2 and VEGF，the timeintensity peak（TTP）curve is shorter and the peak intensity（PI）is higher.In contrast，patients with high expression of NM23 had significantly longer TTP and lower PI（P<0.05）.Conclusion

:The ultrasound characteristics of breast cancer are related to the expression of CerbB2，VEGF and nm23.Predictive expression of CerbB2，VEGF and nm23 based on ultrasound characteristics of patients.Then adjuvant evaluation of therapeutic effect and prognosis of breast cancer.

Objective:To analyze the clinical and radiological data of microcalcificationrelated breast cancer in fullfield digital mammography，explore the risk factors and in order to improve the diagnosis and treatment of suspicious microcifications.Methods:Clinical data and radiological characteristics were analyzed retrospectively in 447 cases of breast lesions，whose pathology were confirmed by operation.The clinical and imaging data were analyzed to compare their differences in benign and malignant lesionsResults:A total of 93 cases of breast cancer were detected（20.8%），52 cases were intraductal carcinoma（11.6%），12 cases were invasivel carcinoma（4.7%），29 cases were intraductal carcinoma with infiltration（6.5%）.A total of 354 cases were benign lesion（79.2%），297 cases were hyperadenosis（66.4%），37 cases were fibroadenoma（8.3%），10 cases were intraductal papilloma（2.2%），4 cases were duct ectasia（0.9%），4 cases were interstitial chronic inflammation（0.9%），2 cases were sclerosing adenopathy（0.4%）.There were significant differences in microcalcifications between benign and malignant breast lesions according to position、distribution、shape、density、range and BIRADS（P<0.05），larger differences were shown in distribution、shape and BIRADS（P<0.05）.Conclusion:The distribution（grouped and linear/segmental）、shape（fine pleomorphic and finelinear/finelinear branch）and BIRADS（4 and 5 category）of the microcalcification are the important factors affecting pathological results，aggressive multimodality therapy is warranted to improve prognosis.

Objective:To investigate the expression of androgen receptor（AR）in triplenegative breast cancer and its prognostic significance.Methods:We collected the clinical data of 133 female patients with triplenegative breast cancer.The expression of AR in breast cancer tissues was detected by immunohistochemical staining.We analyzed the relationship of AR expression with the other clinicopathological characteristics and survival.Results:The positive rate of AR expression was 28.6%（38/133）.AR expression were significantly related to elder age（≥50years old），menopause，lower Ki67 index and negative CK5/6（P<0.05）.There was no significant relationship between AR expression and menarche age，BMI，diabetes，family history of malignant tumor，histological grade，lymph node status，vascular invasion，TNM stage and EGFR（P>0.05）.KaplanMeier curves identified that AR expression was positively correlated with overall survival（P<0.05）.No significant relationship was found in diseasefree survival.Conclusion:AR expression were significantly related to some of the clinicopathological characteristics and overall survival，which indicates that it may be a new prognosis factor and therapeutic target.

Objective:To investigate the clinicopathological characteristics and the meaning of staging evaluation by the prognostic staging system of breast cancer with different molecular types.Methods:Clinicopathologic data of 236 breast cancer cases，which confirmed by surgical treatment.2018.According to the 2017 CACA guidelines of breast cancer diagnosis and treatment distinguished different molecular subtypes，and compared clinicopathological characteristics of different molecular subtypes.The study reappraised the anatomic staging and prognostic staging according to the AJCC staging criteria for breast cancer，and compared the changing characteristics of prognostic staging in different anatomical stages of each molecular subtype.Results:The study found different subtypes show statistical significant differences in histological grading、 Ki67 level、lymph node metastasis、anatomical stage and prognosis stage（P＜0.05），but not in tumor size（P＞0.05）.Compared with anatomical stage，the prognosis stage changed，and there were statistical significant among subtypes（P＜0.05）.The changing characteristics of prognostic staging in different anatomical stages of each molecular subtype is significant（P＜0.05）.Conclusion:There is heterogeneity among different molecular subtypes.Compared with anatomical stage，the changing characteristics of prognostic staging is vary from molecular subtype.Molecular typing combined with prognostic staging maybe provided an important basis for accurated individualized treatment of breast cancer.

Objective:To explore a reasonable surgical treatment for Oddi sphincter relaxation complicated with recurrent choledocholithiasis.Methods:342 patients with choledocholithiasis complicated with Oddi sphincter relaxation disease（all underwent several biliary operations，including cholecystectomy） to receive surgical treatment in cholangiopancreatic surgery were selected as research object.According to the surgical treatment in different ways，these patients were divided into three groups：bile duct transection + RouxenY anastomosis（group Ⅰ，281 cases），holedocholithotomy and T tube drainage by laparotomy or endoscopy（group Ⅱ，40 cases），ERCP operation（group Ⅲ，21 cases），compared with three groups of different surgical methods of treatment.Results:The calculi recurrence rate and the incidence of cholangitis in Ⅰ group were significantly lower than that in Ⅱ group and Ⅲ group（P<0.05），and the average recurrence time was significantly later than that of Ⅱ group and Ⅲ group（P<0.05），while there was no significant difference between Ⅱ group and Ⅲ group about the calculi recurrence rate，recurrence of cholangitis rate and average time（P>0.05）.The total effective rates of cholangioenterostomy was significantly higher than that of choledocholithotomy and ERCP（P<0.05），while there was no significant difference between the total effective rate of choledocholithotomy and ERCP（P>0.05）.Conclusion:Transection of bile duct and bile duct RouxenY anastomosis is an effective surgical treatment for Oddi sphincter relaxation combined with recurrent bile duct stones.

Objective:To study the effect of the high acetabular position on stress of femoral prosthesis.Methods:In Mimics 17.0 and Geomagic 2012，the patient’s hip CT image was fitted to the NUBES surface.In CERO 4.0，the threedimensional solid model of prosthesis was designed according to the revision system.The above models was imported into hypermesh and assembled according to the length of the proximal femoral components，model A（75mm），model B（85mm），model C（95mm），model D（105mm）.In Abaqus6.14，the distal femur was constrained as the boundary condition，and a single foot standing load was loaded to calculate the maximum Mises stress of the femur prosthesis and the shear stress of the coronal plane（XZ plane）.Results:There was no statistically significant difference between the maximum Mises stress distribution of model B and model A（P>0.05）.Compared with the model B，the compressive stress significantly increased at Ⅴarea in the model C（P<0.05）.In model D，the tensile stress inⅠarea and the compressive stress inⅤarea were significantly larger than that in model C（P<0.05）.In model A，shear stress mainly appeared in Ⅶ area，the shear stress was significantly greater thanⅠand Ⅲ areas（P<0.05）.In the model C and D，The maximum shear stress change of femoral prosthesis in Ⅲ and Ⅴareas，there were significant statistically differences compared with model A（P<0.05）.Conclusion:High placement technique in total hip arthroplasty may not only lead to the increase of tensile stress and compressive stress at the distal femoral prosthesis，but also increased the femoral prosthesis bone contact interface shear stress.We should pay attention to the length，diameter，coating and other factors of the femoral prosthesis that affect the stability of the prosthesis.

Objective:To investigate the effect of percutaneous vertebroplasty（PVP）with selfcuring calcium phosphate cement（CPC）on pain and quality of life in elderly patients with painful osteoporotic lumbar fractures（OVCF）.Methods:127 cases of elderly patients with painful thoracolumbar OVCF were randomly divided into two groups：group A（n=65）was treated with CPC and PVP system，group B（n=62）was treated with polymethyl methacrylate（PMMA）and PVP system.The postoperative complications were compared.The Oswestry Disability Index（ODI），pain Visual Analogue Scale（VAS），Qualitative Quality of Life Assessment 41（QUALEFFO41）scores were evaluated before and after surgery，the vertebral morphology was determined and compared.Results:At 3 days，1 month，3 months，6 months and 12 months' final followup，the VAS scores of both groups were significantly lower than before surgery（P<0.05），but there was no significant difference between group A and group B（P>0.05）.ODI and QUALEFFO41 scores at 1 month，6 months and final followup in the two groups were significantly lower than before surgery（P<0.05），the scores of group A were lower than group B at 6 months the final followup（P<0.05）.The anterior height of compressed vertebral body in both groups was significantly increased after surgery，and the Cobb angle of kyphosis was significantly decreased（P<0.05），but there was no significant difference between the two groups（P>0.05）.There was no significant difference in the leakage rate of bone cement between the two groups（P>0.05）.The fracture rate in the adjacent vertebral body in group A was 1.54%，significantly lower than 9.68% in group B（P<0.05）.Conclusion:PVP filling with CPC can effectively relieve the pain symptoms of elderly patients with painful thoracolumbar OVCF，improve vertebral body deformity，promote functional rehabilitation and improve their quality of life.

With the improvement of survival rate and the significant extension of survival time of patients with breast cancer，more and more patients are entering the stage of chronic disease management.For patients with breast cancer，they will inevitably face many new problems in the longterm survival process，such as the occurrence of concomitant diseases，treatments of side effects of drugs and quality of life needed to be improved and so on.“LiangQuan” management of breast cancer refers to the whole process and allround management，which is highly compatible with the strategic plan of“healthy China”.The implementation of the management of “LiangQuan” is helpful for breast cancer specialists to manage breast cancer more comprehensively and rationally，thus improving the survival period and quality of life of patients.

The evaluation of sentinel lymph node metastasis has important guiding significance for the treatment of axillary lymph nodes in breast cancer patients.At present，although the dual isotope with blue dye method，which also has dominant position in breast cancer treatment，is the highest detection method for sentinel lymph node biopsy（SLNB），due to some insurmountable problems，there are new SLNB methods for clinical application，such as contrast enhanced ultrasound，nearinfrared fluorescent method（indocyanine green ICG），carbon nanoparticle suspension，superparamagnetic iron oxide（SPIO）and so on.These new methods and technologies make SLNB diversified，nucleusfree，and less invasive，and the detection rate，sensitivity，and specificity are comparable to traditional methods.In particular，the ultrainnovative method of preoperative evaluation of SLN using fineneedle aspiration cytology（qualitative）guided by contrastenhanced ultrasound（positioning）can advance the traditional intraoperative SLN assessment to preoperative，so that the clinical stage of breast cancer Practice is more rational.In addition，the evaluation of Internal mammary lymph node in breast cancer also contributes to a more comprehensive clinical stage.This article also reviews the new perspectives on the detection of internal mammary lymph nodes and the improvement of detection techniques.

Chronic mastitis is a benign inflammatory condition of the breast with unknown etiology，which can be easily misdiagnosed as carcinoma.Timely diagnosis and treatment are critical to improve the prognosis.As one of the main treatment，surgical intervention at the right time can have a positive therapeutic effect.Therefore，this article will emphasize on surgical treatment as well as the appropriate timing to provide help for dealing with this disease.

Congenital breast anomalies mainly include polythelia，nipples inversion，accessory breasts，gynecomastia，hypertrophic abnormalities of the breast，tubular breasts，Poland syndrome and other breast deficiencies，dysplasia and displacement.Breast dysplasia may exist alone，but sometimes it coexists with other congenital syndromes，especially tending to affect the urinary system and limb girdles.Breast，as the second sex characteristic of women，is an important manifestation of female beauty.However，congenital breast deformity not only brings  psychological burden to patients，but causes a series of complications，which seriously threaten the physical and mental health of patients.