ObjectiveTo identify the status of quality of life in breast cancer patients and explore the impact of environmental factors on quality of life in breast cancer patients receiving chemotherapy. MethodsTotally 201 primary breast cancer patients undergoing chemotherapy after surgery were investigated.Self-developed demographic and clinical character investigation questionnaire,WHO Disability Assessment Schedule Ⅱ(WHODAS Ⅱ),and environmental factors in International Classification of Functioning Disability and Health(ICF)core sets for breast cancer patients were adopted to collect relevant data. ResultsBreast cancer patients had different levels of difficulties on each domain of WHODAS Ⅱ.Multiple stepwise regression analysis demonstrated that“material and emotional support and interrelationship with friends”, “social security service,system and policies” and“social norms,practices and ideologies” were factors influencing quality of life of breast cancer patients. ConclusionsIn addition to the strengthen of rehabilitation exercise training,nurses should advocate more services from society through policy making,prompt public awareness and scientific cognition,as well as construct effective nursing interventions to help enlarge social support resources and improve social support level.

Objective The aim of study is to explore the TORCH infection status on the pre-pregnancy women and analyze the relationship with pregnancy outcome in Hongkou District,Shanghai,and provide the reference for the eugenic and superi-or nurture.Methods Enzyme linked immunosorbent assay (ELISA)was used to detect the specificity antibodies to Toxo-plasma (TOX),Rubelavirus (RUV),Cytomegalovirus (CMV)IgG and IgM in sera of the 3 500 pre-pregnant women in Hongkou District,Shanghai.Chi-square test was used for comparative analysis of the different rates.Results The positive rate of TOX-IgG,TOX-IgM,RV-IgG,CMV-IgG and CMV-IgM in pregnancy women from Hongkou district were 1.37%, 0.34%,89.7%,96.2% and 0.60% respectively.The total positive rate of TOX and (or)CMV IgM was 0.94%.According to age group,the results showed that TORCH infections with three pathogens associated with the pre-pregnancy women’s age,and the difference was statistically significant (χ2=102.9,P<0.01).The abnormal pregnancy rate of TORCH infec-tion-positive pregnancy women (25.0%,3/12)was higher than that of TORCH-negative pregnancy women (6.62%,27/408),and the difference was statistically significant (χ2 =4.43,P=0.04).Conclusion The infection opportunity of TORCH in pregnant women in Shanghai Hongkou district was obviously existent and the TORCH infection status could effect on pregnancy outcome.TORCH testing has important practical significance as a routine examination of the pre-preg-nancy healthy service.

Objective To investigate the influence of fast track surgery on stress and inflammatory re-sponse in breast cancer patients treated with modified radical mastectomy .Methods Ninety nine patients with breast cancer undergoing modified radical mastectomy were allocated randomly to fast track surgery group (46cases)and general group(53cases).The concentrations of serum PRA,Ang-Ⅱ,ALD,cortisol,IL-6,IL-8,TNF-αof each group were measured before operation ,12 hour,24hour and 48hour after operation by radioim-munoassay method.Operation time,operative blood loss and hospitalization days were analyzed between the two groups,simultaneously ,the incidence of subcutaneous hydrops ,flap necrosis and upper limb edema were also de-tected.Results The concentration of serum PRA ,Ang-Ⅱ,ALD,cortisol,IL-6,IL-8 and TNF-αwere no significantly differences in two groups before operation and at 48 hours after surgery(P>0.05).The concentra-tions of serum PRA,Ang-Ⅱ,ALD,cortisol,IL-6,IL-8 and TNF-αof FTS group were significantly different between the preoperative and different time points (P<0.05).The concentration of serum PRA,Ang-Ⅱ,ALD, cortisol,IL-6,IL-8 and TNF-αof FTS group were lower than that of control group at the same time point ( P<0.05).The operative time was(158.32 ±22.47)mins in FTS group and(161.32 ±22.37)mins in control group,respectively,and there were no significant statistical differences (P>0.05).The intraoperative blood loss in the FTS group(156.98 ±17.09)ml was not significantly less than that in the control group (158.57 ±16.92) ml(P=0.644).Hospitalization days were 8.37 ±1.89 and 10.37 ±2.05 in the FTS and the control group re-spectively ,with significant difference .The incidence of upper limb edema ,subcutaneous hydrops ,flap necrosis in FTS group were not less than control group .Conclusion Fast track surgery could attenuate stress and inflamma-tory response during ,and it is safe and effective in modified radical mastectomy .

Objective To evaluate different tigecycline susceptibility testing methods for A.baumannii.Methods Thirty carbapenem resistant A.baumannii (CRAB) and 30 carbapenem sensitive A.baumannii (CSAB) isolates were randomly collected from 30 hospitals during January to December in 2010 in China retrospectively.MIC and inhibitory zone diameters for tigecyclinc were determined by the susceptibility testing methods such as broth microdilution (BMD),agar dilution,E test,MIC Test Strip (MTS),Vitek2.Data were analyzed by comparing the results from each method to those produced by the reference BMD method.The effects of two different susceptibility test media (M-H and ISO-Sensitest Agar) on the MIC of tigecycline were also analyzed.Results For CSAB isolates,the MIC50/MIC90 of BMD,agar dilution,E test,MTS and Vitek2 were as follows:0.125/0.25 mg/L,0.125/0.25 mg/L,0.5/1 mg/L,0.125/0.25 mg/L and 0.5/0.5 mg/L.Compared with BMD method,the categorical agreement rates (CA) of each method were ≥90％,and produced no very major errors (VME) by Food and Drug Administration (FDA)/ European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints.For CRAB isolates,the MIC50/MIC90 of BMD,agar dilution,E test,MTS and Vitek2 were as follows:2/4 mg/L,4/4 mg/L,4/4 mg/L,1/2 mg/L and 2/4 mg/L.Compared with BMD method,MTS produced 3.3％ (1/30)/6.7％ (2/30) VME(FDA/EUCAST breakpoints),and no method CA was ≥90％.The CA between disk diffusion and BMD results were higher by using the criteria of Jones than FDA breakpoints,but only 66.7％ (20/30) were observed in CRAB isolates,and produced no VME.The MIC of tigecycline determined using M-H agar were usually higher than those using ISO-sensitest Agar.Conclusions Agar dilution,E test,Vitek 2 and disk diffusion appear not to be a suitable method for routine susceptibility testing of tigecycline for CRAB strains.Tigecycline intermediate or resistant results determined by these methods require confirmation by BMD,and MTS results also need to be interpreted with caution.

Objective To evaluate the clinical significance of plasma ionized calcium (ICa) and total calcium (TCa) measurement in diagnosis of tumor-associated hypercalcemia. Methods The heparin lithium anticoagulated plasma were collected and measured with ion selective electrode (ISE) and orthocresolphthalein complexone (OCPC) method for ICa and TCa in 77 patients with malignant tumor (tumor group) and 44 healthy controls (control group). Meanwhile,plasma albumin and pH value were measured to correct TCa (cTCa) and ICa(nICa). The results were analyzed. Results The levels of cTCa,ICa and nICa in tumor group were significantly higher than those in control group(P＜ 0.01 ) ,but there was no significant difference of TCa between two groups (P ＞ 0.05 ). cTCa ＞ 2.70 mmol/L, nICa ＞ 1.35 mmol/L as the hypercalcemia eritical value, the positive rate of nICa and cTCa were 18.18% (14/77) and 6.49% (5/77)respectively,the difference was significant (P = 0.023). Conclusion Determination of ICa may be more clinical meaningful than TCa for tumor-associated hypercalcemia.

Objective To evaluate the interstital MR lymphography using positive lymphotropic contrast agent for differentiation of metastatic lymph nodes from inflammatory lymph nodes hyperplasm.Methods Eighteen New Zealand white rabbits weighted at 2.0-2.5 kg were used.Inflammatory hyperplastic popliteal lymph node model was established in 9 rabbits by injection of complete freund adjuvant into the interdigitial skin of the dorsal aspect of one hind leg,and tumor-bearing popliteal lymph node model was established in another 9 rabbits by injection of VX~2 tumor cell suspension.The popliteal lymph nodes of another hind leg of all 18 rabbits were assigned to the normal contral group.In each group,every rabbit underwent MR lymphography examination before and after the inoculation.Volumes of 0.2 ml of Gd[DTPA-bis(2-aminoethoxy)ethane]polymeric contrast agent(Gd-poly-DTPA-EOEA)injection were injected subcutaneously into the dorsal feet of both hind legs of two groups of rabbits.T_1-weighted 3D gradient-echo images were obtained,and source images were used to reconstruct images of MIP before and after the administration of agent.The maximum short-axis diameter(MSAD)of each popliteal lymph node was measured on the enhanced 3D MIP images,and the signal-to-noise ratio(SNR)measurement was performed in the largest popliteal node of each rabbit at each time point in delayed scan.Independentsamples t test was used to compare the sizes of popliteal nodes in MSADs between inflammatorily hyperplastic and tumor-bearing nodes after the inoculation,and the values of SNRs of popliteal nodes at each time point between inflammatorily hyperplastic,tumor-bearing and normal popliteal lymph nodes.Imaging results of the popliteal nodes were analyzed and correlated with pathological findings.Results All of the rabbits were successfully inoculated except of the 2 rabbits in tumor-bearing nodal group.The size in MSAD of 13 inflammatorily hyperplastic and 11 tumor-bearing nodes was(1.32±0.14)and(1.33±0.12)cm,respectively.There was no significant statistical difference between the sizes of the two groups(t=0.186,P＞0.05).At the time of 5,15,30,60,90,120 minutes after the injection of the agent,the value of SNR of 9 inflammatorily hyperplastic and 9 contralateral normal nodes was 17.31±0.37 and 17.19±0.29,27.42±0.50 and 27.39±0.48,38.44±0.47 and 38.19±0.27,37.10±0.09 and 36.97±0.10,36.32±0.61 and 36.20±0.80,34.60±0.44 and 34.71±0.32,respectively.There was no significant statistical difference between the values of the two groups(t=0.78,0.14,1.43,1.00,0.36,-0.62,respectively,P＞0.05).The value of SNR of seven tumor-bearing and seven contralateral normal nodes was 6.00±0.22 and 17.21±0.28,7.87±0.16 and 27.17±0.23,8.14±0.24 and 38.16±0.19,8.09±0.28 and 36.94±0.30,7.59±0.20 and 35.96±0.72,7.50±0.14 and 34.81±0.27,respectively.There was significant statistical difference between the values of the two groups(t=-84.00,-182.72,-261.27,-186.48,-100.22,-239.00,respectively,P＜0.01).At each time point,inflammatorily hyperplastic nodes had significantly higher values of SNRs compared to tumor-bearing nodes(t=83.97,174.07,158.49,152.71,96.06,154.57,respectively,P＜0.01).A complete or part signal filling defect occurred in the tumor-bearing lymph node on the MR lymphographic images.Conclusions The internal anatomy and function of the lymph nodes were effectively visualized by interstitial MR lymphography with positive lymphotropic contrast agent,which provide a sensitively diagnostic way for the differentiation of benign lymph nodes from malignant ones.

Objective To investigate psychology state of AIDS-phobia population. Methods 50 AIDS-pho-bia patients and 50 healthy controls were enrolled and tested with SCL-90,EPQ, LES and social support scale. Results Scores of SCL-90 in AIDS-phobia patients are significantly more than those in controls. Scores of anxiety, depres-sion,compulsion,dread and somatization in AIDS-phobia patients are significantly more than those in controls. Scores of negative life event scale in AIDS-phobia patients are significantly more than those in controls. Scores of positive life event scale in AIDS-phobia patients are significandy less than those in controls. Scores of social support scale in AIDS-phobia patients are significantly less than those in controls. Conclusions Anxiety, depression, compulsion, dread and somatization are primary clinical manifestation of AiDS-phobia. Personal character,negative life event and lack of social support might be nosogenesis correlated with AIDS-phobia.

Objective To explore the MRI findings of Wernicke encephalopathy so that to improve the knowledge of this disease.Methods MRI data of Wernicke encephalopathy in 7 cases were retrospectively analyzed.Results Symmetrical abnormal signal intensity was appeared in bilateral thalamus and the area around the third cerebral ventricle in 6 cases,in the area around aqueduct and pontine in 7 cases and in mammillary body,hypothalamus,fornix and the four cerebal ventricles in 2 cases.Above mentioned lesions showed long T1 and long T2 signal intensity and high signal intensity on fluid-attenuated inversion recovery(FLAIR),and high signal intensity on DWI in 2 cases.The lesions were enhanced in 2 cases and small vessels were radial enhancement around lateral ventricle in 1 case after administration of Gd-DTPA.Conclusion Wernicke encephalopathy has definite MR imaging findings,which is of important value in clinical diagnosis and treatment.

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Objective To study the epidemiology and genotypes of extended-spectrum beta-lactamases (ESBL)-producing Escherichia coli (EC) and Klebsiella pneumoniae (KP) that caused community-onset bloodstream infections (COBSI) in 9 county hospitals of Zhejiang Province.Methods This is a multi-center, prospective, observational study.The cases and isolates with COBSI caused by EC and KP were consecutively collected from 9 county hospitals in Zhejiang Province between 1st March 2014 and 30th April 2015.The double disk diffusion method was used to confirm the production of ESBL.The ESBL genotypes were determined by polymerase chain reaction(PCR) amplification and sequence analysis.Multi-locus Sequence Typing (MLST) was used to analyze the homology of ESBL-producing isolates.Minimal inhibitory concentration (MIC) of frequently used drugs for ESBL-producing isolates was determined by in-vitro antimicrobial susceptibility tests.Results During the study period, a total of 172 cases with COBSI were collected and 171 cases were eligible, among which 126 were caused by EC and 45 were caused by KP.The overall prevalence of ESBL was 34.5% (59/171),and the prevalence of ESBL-EC and-KP was 41.3% (52/126) and 15.6% (7/45), respectively.CTX-M-type ESBL accounted for 96.6% (57/59) of all the ESBLs-producing isolates, and the most common type was CTX-M-14 (27.1%, 16/59), followed by CTX-M-55 (22%, 13/59).MLST analyses revealed significant genetic diversity among ESBL-EC and-KP.The most prevalent ST of ESBL-EC was ST131 (23.1%).In addition to carbapenems, cefoperazone/sulbactam, piperacillin/tazobactam, moxalactam, amikacin and fosfomycin also showed good in-vitro activity against ESBL-EC and-KP.Conclusions The prevalence of ESBL in EC and KP is high in 9 county hospitals of Zhejiang Province, and the most common genotypes are CTX-M-14 and CTX-M-55.The detection rate of ESBL in EC is higher than in KP.It could be considered adequate empirical therapy according to the results of antimicrobial susceptibility tests.Carbapenems, cefoperazone/sulbactam, piperacillin/tazobactam, moxalactam, amikacin and fosfomycin have good in-vitro activity against ESBL-EC and-KP.