The research findings published by National Surgical Adjuvant Breast and Bowel Project have continued to change the clinical practice of early-stage breast cancer over the past decade.Sentinel lymph node biopsy has become the new surgical operation standard.The aromatase inhibitor adjuvant endocrine therapy cycle has been extended from 5 years to 10 years, which benefits the patients with high risk and reactivity.Chemotherapy combined with trastuzumab has become the standard adjuvant therapy strategy of human epidermal growth factor receptor-2-positive invasive breast cancer.In addition, the research progress is also related to the optimization of the fields including the postoperative adjuvant chemotherapy and neoadjuvant chemotherapy.

Objective To investigate the clinical application of Morse Fall Scale by primary nurses.Methods Morse Fall Scale was used to assess the falling risk in 21,378 patients by the primary nurses.The application of the Morse Fall Scale, choices of right time for assessment and the occurrence of falls in patients with risks of falling were evaluated by a self-designed questionnaire.Results Among 21,378 patients, 222 patients were at risk of falling.In terms of the items like the history of falls,more than one diagnosis,intravenous injection,the accuracy of assessment was above 91.6%.In terms of the items like aided walking,gait,cognitive state,the assessment accuracy is below 86.0%.The accuracy of assessment timing selection in the situations like admission,the score by Morse fall scale over 24at admission and the accuracy in choosing right time for assessment was was above 90.2% after transferring to other deparments and falling.The accuracy in choosing the right time for fall assessment was below 67.9% under such conditions as apostasies,and oral administration of drugs probably leading to fall. Conclusions It is acceptable that the primary nurses use the Morse fall scale to assess patients with risky falls and for the right choice of assessment.Attention should be paid to strengthen the nurses training to improve the accuracy of the scale,to make sure to choose right time for the assessment so as to prevent the falls of patients to the greatest extent.

OBJECTIVE: To study the mechanism and clinical significance of specific immunotherapy (SIT) on the expression changes of GM-CSF and IL-5 in the tissue samples of recurrent nasal polyps. METHOD: Perennial allergic rhinitis patients with recurrent nasal polyps were randomly divided into 2 groups. The experimental group of 19 patients was treated by SIT and standardized treatment (glucocorticoid nasal spray) , and the control group of 17 patients was only treated by standardized treatment (glucocorticoid nasal spray). We measured the expression levels of GM-CSF and IL-5 in the tissue samples of the nasal polyps by ELISA, and compared the results obtained before treatment with expression levels detected at 6 months and 1 year after the treatment. RESULT: The expression of GM-CSF and IL-5 in the recurrent nasal polyps reduced significantly (P < 0.05) in both groups after 6 months and 1 year post-treatment compared with pre-treatment, and the expression of GM-CSF and IL-5 in the experimental group was much lower than that of the control group. CONCLUSION SIT decreases the expression of GM-CSF and IL-5 and reduces the inflammatory reaction in the tissue samples of recurrent nasal polyps.
Enzyme-Linked Immunosorbent Assay ; Granulocyte-Macrophage Colony-Stimulating Factor ; metabolism ; Humans ; Immunotherapy ; Inflammation ; drug therapy ; Interleukin-5 ; metabolism ; Nasal Mucosa ; pathology ; Nasal Polyps ; drug therapy ; metabolism ; Rhinitis, Allergic, Perennial ; drug therapy ; metabolism

OBJECTIVE To observe the efficacy of specific immunotherapy (SIT) with Alutard and NHD in children with allergic rhinitis due to different level of skin prick test (SPT) with dermatophagoides farinae (DF) and dermatophagoides pteronyssinus (DP). METHODS A total of 178 children with persistent allergic rhinitis were included in this study. Their age ranged from 6 to 12 years. They were divided into 3 groups according to level of SPT. Group 1: The level of skin index (SI) of DF is greater than that of DP, Group 2: The level of SI of DF is equal to that of DP and Group 3: The level of SI of DF is less than that of DP. The children in each group were randomly divided into 2 subgroups: Alutard group and NHD group. The children were given SIT with Alutard or NHD for one year. Symptom and medication scores were recorded and analyzed. RESULTS After receiving therapy for 3 months and 6 months, symptom and medication scores of the Group 1 and 2 in the NHD group were lower than those in the Alutard group (P<0.05); Symptoms and medication scores of the Group 3 in the Alutard group were lower than those in the NHD group (P<0.05). After receiving therapy for 9 and 12 months, the symptom and medication scores of the NHD and Alutard group in all the three groups showed no statistical difference (P>0.05). CONCLUSION The efficacy of SIT with Alutard and NHD is different in children with allergic rhinitis with different levels of SPT due to DF and DP after 3 and 6 months, but is similar after 9 and 12 months. SIT with Alutard and NHD is effective in treating children with allergic rhinitis.

Objective To investigate the effect of β-lactam antibiotics on the false positive rate of the serum Aspergillus galactomannan (GM) assay in patients with lung diseases.Methods We selectively recruited 77 lung disease patients who did not meet the diagnostic criteria of invasive pulmonary Aspergillosis (IPA) and received different β-lactam antibiotics,while 41 patients without IPA who did not receive any antibiotic treatment were recruited as the control group.Serum samples for GM detection were collected from all participants.The rate of false-positive Aspergillus galactomannan was compared between the two groups.Results False-positive serum results were found in patients who received piperacillin-tazobactam (30.8％ or 8/26) and cefoperazone sulbactamand (27.8％ or 5/18).The rate of false-positive Aspergillus galactomannan in patients who receive β-lactam antibiotics were significantly higher than that in the control group (24.7％ or 19/77vs.7.3％ or 3/41,x2 =5.315,P=0.025).Taking false-positive serum Aspergillus galactomannan as the dependent variable and β-lactam antibiotic treatment as the independent variable,univariate logistic regression analysis showed that the rate of false-positive Aspergillus galactomannan in patients who received β-lactam antibiotics were 4.149 times more than that in the control group (OR=4.149,P=0.030).Conclusions The administration of β-lactam antibiotics may increase the occurrence of false-positive serum Aspergillus galactomannan,and physicians should be aware of this possible interference.

This study was aimed to design the distal radial anatomic splint which was more in line with the human anatomy and treatment characteristics using the computer design software 3D-MAX. According to ergonomic design principles, the forearm and wrist plaster splint were selected from volunteer models. Then, data of the plaster was measured and input into the computer for the design of the three-dimensional model of distal radial anatomic splint with 3D-MAX software. Finally, the blueprint was drawn for the factory to make the distal radial anatomic splint. The results showed that the distal radial anatomic splint was more in line with human anatomy, which did not require shaping in clinical using. It did not affect the biomechanical properties. And the patients never complain the squeez-ing discomfort of the splint. It was concluded that the three-dimensional model of the distal radial anatomic splint, which designed with 3D-MAX software, provided key parameters of the important part of the distal radial anatomic splint. Therefore, the produced splint was more in accordance with the human anatomy and the clinic treatment re-quirements. It avoided the loss of biomechanical properties after shaping, which was more convenient and effective in the clinical using. Its clinical promotion has a broad prospect.

Objective To evaluate the impact of the recombined plasmid vector with enhanced green fluorescent protein (EGFP) encoding soluble tumor necrosis factor related apoptesis inducing ligand (pIRES-EGFP-sTRAIL) on proliferation and apoptosis of human hepatocellular carcinoma cell line HepG2, and investi-gate the feasibility and efficiency of the transfection of pIRES- EGFP- sTRAIL into HepG2 by ultrasound micro-bubble contrast agent. Methods pIRES-EGFP-sTRAIL was constructed and transfected into HepG2 cells by using different types of mediated methods: microbubble echocontrast agent combining appropriate dose of ultra-sound irradiation, liposome method, microbubble echocontrast agent only or blank medium treatment. Transfec-tion efficiency was evaluated by EGFP-expressed cell count; proliferation-lnhibiting rate and the apoptosis rate of HepG2 cells were determined by MTT method and flow cytometry analysis; changes of cell morphology were examined by microscopy with Hoechst33258 dyeing; expression of caspase-8 and caspase-3 was detected by Western blot. Results Ultrasound microbubbh enhanced pIKES-EGFP-sTRAIL uptake by HepG2 cells, and the transfection efficiency was significantly higher in ultrasound microlmbble group than that in other groups( P<0.05 ) ; pIRES- EGFP- sTBAIL effectively inhibited HepG2 cell proliferation and induced cell apoptosis by triggering caspase cascade. Both the inhibiting rate and apoptosis rate were significantly higher in ultrasound microbubble group than those in other groups(P<0.05). Conclusion pIRES-EGFP-sTRAIL expresses ef-fectively in HepG2 cells, sTRAIL has a potential role on the inhibiting proliferation and inducing apoptosis of HepG2 cells by triggering caspase cascade, and this role can be enhanced by the administration of low-intensity ultrasound and microbubble echecontrast agent.

Objective To analyze the clinical effect of pedicle screw fixation in the treatment of multi-segmental lumbar fracture and dislocation under the guidance of visualization technique. Methods A total of 21 patients with multi-segmental lumbar fracture and dislocation were selected from November 2012 to November 2013. Before the screw implantation, the structure of bilateral pedicle was observed through Mimics software and the implantation parameters were measured. The position of pedicle screws by postoperative CT scan, operation time, and the satisfaction of the patients were assessed. The percentages of anterior vertebral height and Cobb′s angle were measured before operation, 2 weeks and 8 months after operation. Results All patients were satisfied with informed consent score and the way of pedicle screw and the selection of plant were more reasonable. With better screw position, shorter operative time and less blood loss and adverse reactions, pedicle screw fixation achieved good effect. Conclusion With high security and considerable clinical value, pedicle screw fixation in the treatment of multi-segmental lumbar fracture and dislocation under the guidance of visualization technique has exact and good effecct.

After a description of the background and ideas to introduce the third party testing in information system construction of Sichuan grass-root medical and health institutions and the specific working contents of third party testing team, the problems to which importance should be attached in information system construction were analyzed with suggestions put forward for their solution .

Objective To investigate the effects of therapeutic hypothermia (TH) on myocardial Ca2+/calmodulin-dependent protein kinase Ⅱ (CaMK Ⅱ) and cell autophagy after cardiopulmonary resuscitation (CPR) in swine.Methods Twenty healthy male domestic swine weighing 33-40 kg were randomly (random number) divided into 3 groups:sham group (n=4),CPR group (n=8) and TH group (n=8).Sham animals only underwent general preparation without experiencing cardiac arrest and resuscitation.The animal model was established by 8 min of electrically induced ventricular fibrillation and then 5 min CPR in the CPR and TH groups.Successful resuscitation was regarded as an organized rhythm with a mean arterial pressure of greater than 50 mmHg for 5 min or more.After successful resuscitation,body temperature was decreased to 33 ℃ by a cooling blanket and then maintained until 24 h post-resuscitation,and followed by a rewarming at a rate of 1 ℃/h for 5 h in the TH group.A normal temperature was maintained by the blanket throughout the experiment in the sham and CPR groups.At 6,12,24 and 30 h after resuscitation,the values of stroke volume (SV) and global ejection fraction (GEF) were measured by PiCCO,and meanwhile the serum concentrations of cardiac troponin Ⅰ (cTnI) were measured by ELISA assay and the serum activities of creatine kinase-MB (CK-MB) were evaluated by an automatic biochemical analyzer.At 30 h after resuscitation,the animals were sacrificed and left ventricular myocardium was obtained for the determination ofCaMK Ⅱ,microtubule-associated protein light chain 3 Ⅱ (LC3 Ⅱ) and p62 expressions by Western blot.The variables were compared with One way analysis of variance and then the Bonferroni test among the three groups.Results Compared with the sham group,myocardial dysfunction and injury after resuscitation were observed in the CPR and TH groups,which were indicated by decreased SV and GEF and also increased cTnI concentration and CK-MB activity in serum (all P＜0.05).Compared with the CPR group,the values of SV and GEF were significantly increased at 6 h after resuscitation,and serum cTnI concentration and CK-MB activity were significantly decreased starting 12 h after resuscitation in the TH group [SV (mL):25.0±6.9 vs 31.9±3.3 at 6 h,26.7±5.1 vs 34.6±3.7 at 12 h,28.8±3.3 vs 35.7±3.2 at 24 h,29.2±5.2 vs 36.7±3.3 at 30 h;GEF (％):17.1±2.7 vs 19.9±1.8 at 6 h,18.7±1.9 vs 21.6±1.8 at 12 h,19.3±2.3 vs 23.0±2.4 at 24 h,21.0±1.7 vs 23.7±1.7 at 30 h;cTnI (pg/mL):564±51 vs 466±56 at 12 h,534±38 vs 427±60 at 24 h,476±55 vs 375±46 at 30 h;CK-MB (U/L):803±164 vs 652±76 at 12 h,693±96 vs 557±54 at 24 h,633±91 vs 480±77 at 30 h,all P＜0.05].Tissue detection indicated that the expression of CaMK Ⅱ and LC3 Ⅱ were increased while the expression of p62 was decreased in post-resuscitation myocardium in the CPR and TH groups compared with the sham group (all P＜0.05).However,the expression of CaMK Ⅱ and LC3 Ⅱ were decreased and the expression of p62 was increased in postresuscitation myocardium in the TH group compared to the CPR group (CaMK Ⅱ:0.73±0.06 vs 0.58±0.05;LC3 Ⅱ:0.69±0.09 vs 0.50±0.07;p62:0.40±0.07 vs 0.68±0.14,all P＜0.05).Conclusion The mechanism of TH alleviating post-resuscitation myocardial dysfunction and injury may be related to the inhibition of CaMK Ⅱ expression and cell autophagy.