Objective To study the value of pre-operative chemotherapy combined with breast conservation surgery for the treatment of middle-advanced breast cancer.Methods The clinical efficacy and outcomes of breast conservation therapy in 100 patients with middle-advanced breast cancer received pre-operative chemotherapy were analyzed.Restuls Total efficacy, stadge decrease rate and breast conservation rate were 64%, 53% and 42% respectively. 31 patients received breast conservation therapy and there was no recurrence in following 3 years.Conclusion Breast conservation therapy after pre-operative chemotherapy in patients with middle-advanced breast cancer is safe and it can significantly improve the life quality of patients.

Ikaros is a transcriptional factor playing an essential role in lymphoid lineage development and differentiation. Ikaros gene deletions occur in some acute lymphoblastic leukemia (ALL) patients, and the most common type of abnormality is overexpression of dominant negative isoforms 6 (Ik6). Deletion of Ikaros gene has an independent association with a very poor outcome in B-cell-progenitor ALL. A new subtype of ALL characterized by the deletion of Ikaros and poor outcome has been identified by researchers, and named BCR/ABL1 like ALL.We can conclude that Ikaros may play an important role in the diagnosis and treatment of pediatric ALL.

This paper analyse psychologysis problem of patient and their family member from one case with passive euthanasia. and elaborate own idea about Social worth of euthanasia.

Heart failure is one common critical cardiovascular disease in children.Angiotensin convening enzyme inhibitors plays an important role in the treatment of pediatric heart failure.In this paper,the pharmacological mechanism,pharmacokinetics,clinical studis and application of angiotensin converting enzyme inhibitors in the treatment of pediatric heart failure were concerned.

In order to improve the performance of the photorefraction device,shorten the detection time and improve the accuracy of measuring,the theory of a new kind of double-cranny eccentric photorefraction device is described.Some features and key point of technology are emphatically pointed out.A method is put forward to determine the ocular diopter by image processing.

Objective To systematically review the changes in the intensity of postoperative pain under ketamine anesthesia in children.Methods We searched the Cochrane Library,PubMed,OVID,EMBASE,and Chinese Biomedical Database for prospective randomized controlled trials involving the changes in the intensity of postoperative pain under ketamine anesthesia in children.The quality of the studies was evaluated by the method recommended by Cochrane Collaboration.Evaluation indexes included pain score and analgesic consumption during 6 h after operation,pain score and analgesic consumption during 6-24 h after operation,duration of sensory block (caudal block),side effects during 24 h after operation (postoperative nausea and vomiting and psycho-mimetic manifestations).Meta-analysis was conducted using the Cochrane Collaboration's RevMan 5.0 software.Results Fifteen prospective randomized controlled trials involving 955 patients were included in our Meta-analysis.The patients were divided into 2 groups:control group ( n =455) and ketamine group ( n =500).The pain score and analgesic consumption during 6 h after operation were significantly decreased after general anesthesia with ketamine.The pain score during 6-24 h after operation and analgesic consumption during 6 h after operation were significantly decreased after local anesthesia with ketamine.The duration of sensory block was prolonged and the analgesic consumption during 6 h after operation was significantly reduced after caudal block with ketamine.There was no significant difference in the incidence of postoperative nausea and vomiting and psycho-mimetic manifestations between the two groups.Conclusion The intensity of pain and analgesic requirement during 6 h after operation are significantly reduced under ketamine anesthesia in children.

ObjectiveThe aim of this study was to establish women previously undergoing cesarean section again puerperal ways.Methods170 pregnant women who had previously undergone 1 or 2 cesarean section were studied. ResultsAmong the 170 cases, 93 cases were trial of labor. The success was 81 cases, the success rate was 87%. One patient with preuterine scar ruptured. There was no maternal death. When the repeat cesarean group was compared with the trial of labor group, in the blood loss and after delivery febrile morbidity were significantly higher in women with repeat cesarean (P＜0.05). The Apgar score of newborns was no difference (P＞0.05). ConelusionWe should control the indications for cesarean section. A trial of labor after previous cesarean is safe, less damage and can be rceommended in the majority of cases. All eligible women would allowed to deliver vaginally after previous cesarean.

Objective To investigate pediatric infective endocarditis(IE) risk factors and the feature of pathogen.Methods We conducted a retrospective study of 46 cases who were diagnosed as IE from January 2000 to June 2007.Sixteen variables such as sex,primary disease,infectious site,complication,culture result and therapeutic measure were selected for logistic regression analysis.Results Forty-six IE patients accounted for 0.78‰ of all the hospitalized patients during the same period.Of 46 cases,40 had heart diseases.The incidence rate of left-sided endocarditis was higher than that of right-sided endocarditis.Twenty-four had positive blood culture result,one patient had positive culture from vegetation sample.The total positive culture rate was 54%.Gram-positive bacteria were found in 15 cases,and the most common organisms were α-hemolytic streptococcus.Gram-negative bacteria were in 7 cases and fungus infection was present in 3 cases.After antiboitic treatment,40 were cured,6 died.In the logistic regression model,the variables significantly associated with death included negative blood culture (OR=25.127,95%CI=1.110-363.236),hematological system disease (OR=28.620,95%CI=2.261-354.448) and multiple organ failure (OR=19.843,95%CI=0.786-221.754).Conclusion Streptococcus viridans is the most common pathogen in pediatric IE in our hospital.Higher incidence in the left heart than that in the right heart is found.Negative blood culture,hematological system disease and MOF are the risk factors in IE patients.

Objective To investigate the influence of PBL combined with CBS education on reporting cognition and reporting intention of adverse events.Methods Using convenience sampling method,66 registered nurses working for over 6 months were extracted as the study object.The training group was set up and the training files were established,PBL combined with CBS mode were implemented for 6 months from March to August 2013,once a month,2 hours per time.Training cases were designed and written,teaching staff was organized to carry out the training,problems were raised in class and discussed on site.Training staff looked up relevant data,collected information,organized another focused discussion and summarized the results.The Adverse Event Reporting Cognitive Questionnaire and Adverse Nursing Event Reporting Intention Questionnaire were adopted to evaluate reporting cognition and reporting intention before and after the training.Results After the implementation of PBL combined with CBS education,cognition of nurses for adverse events scored (7.23±1.20),higher than that before the intervention,(6.48±1.49),t=3.17,P ＜ 0.01.The numbers of nurses to report adverse events such as potential vulnerabilities and not doing any harm were 42 and 45 before the intervention,while 53 and 56 after the intervention.Conclusions Using PBL combined with CBS model to implement educational interventions can improve reporting cognition and report intention on nursing adverse events of nurses.

Objective:To investigate the compatibility stability of muscular amino acids and peptides and nucleosides for injection in different infusions to provide basis for clinical application .Methods: The compatibility stability of muscular amino acids and pep-tides and nucleosides for injection respectively in 0.9%sodium chloride injection , 5% glucose injection , 10%glucose injection and glucose and sodium chloride injection was studied , and the indices included the appearance , pH value , number of insoluble particles and contents of hypoxanthine and polypeptides .Results:All the solutions were transparent .The pH value and the contents of hypoxan-thine and polypeptides showed no significant changes .When muscular amino acids and peptides and nucleosides for injection was mixed with 10%glucose injection , the number of insoluble particles (≥10 μm) was the smallest , which met the requirement in Chi-nese pharmacopoeia (2015 edition,volume Ⅳ).When it was mixed with 0.9% sodium chloride injection, 5% glucose injection and glucose and sodium chloride injection , the number of insoluble particles (≥10 μm) was beyond the limits .The number of insoluble particles (≥25 μm) in all the solutions met the requirement .Conclusion: The most suitable solvent for muscular amino acids and peptides and nucleosides for injection is 10%glucose injection .