Inflammatory breast carcinoma (IBC) is a particularly local advanced breast cancer,which has characters of high invasion,high metastasis and high human mortality.Because of high malignancy and rapid development,extensive body metastasis often happens in early stage and the prognosis is very poor.Currently,the therapy strategy of operation,chemotherapy combined with radiotherapy is used to treat IBC.However,the effect is always very limited.Now,the advances in researches of molecular biology and cancer immunology bring hope.Some recent progresses of therapy in IBC are reviewed in the article.

The price adjustment in medical service system is a quite complex systematic engineering,this paper proposed the implement steps for the price adjustment in medical care system and correlative information technological support in Nanjing Jinling Hospital in details.The application results showed that the steps for the price adjustment in medical service system could insure the adjustment process steadyand effective,and it could also make the new price list software system and the whole information system run stably and reliably.

BACKGROUND: Family factor is the main reason for children's psychological and behavioral problems. Seen from the view of systemic family theory, in any circumstances, children's behavioral problems reflect various interpersonal systemic networks among society, school, family, relatives and friends and the relationship of complicated interactions among individuals.Family therapy is an important way to cure children's behavioral problems.OBJECTIVE: To observe whether systemic family rehabilitation is adequate for intervening in children's behavioral problems.DESIGN: Cluster sampling; Contrast observationSETTING: Department of Psychiatry, Kunming Medical College.PARTICIPANTS: A total of 276 students in grade four from Mingtong primary school of Kunming City were selected along with their parents from May 2004 to March 2005. A survey was conducted on students and their parents according to the principle of cluster sampling.METHODS: Self-rating family dynamics scale was used to investigate the characteristics of family dynamics of 276 students in grade four. Achenbach child behavior checklist for parents was adopted to investigate the situation of their children' s behaviors. 57 cases of children with behavioral problems were detected out, and took the families in which the whole family members voluntarily participated in the intervention as interventional group and the families in which any one of the family members did not want to participate in the intervention as abnormal control group. The students and their parents in interventional group were treated with 4-month systemic therapy. 4 months later, resent the above rating scales.MAIN OUTCOME MEASURES: Comparison of family dynamics and children's behaviors between interventional group and abnormal control group before and after intervention.RESULTS: After intervention, changes of family dynamics and children's behaviors in interventional group had taken place, which had statistical difference. The changes as follows: family atmosphere changed from "depressive and hostile" to "harmonious, pleasant, equal and exoteric"; the degree of individuation of family members changed from low level to high; disease concept changed from "regarding the patients as helpless victims" to "regarding them as helpful doers", which realize "softening of disease concept". The total scores of Achenbach child behavior checklist for parents decreased [The scores of questionnaire for fathers before and after intervention were (42.20±22.58) and (28.95±21.90) respectively, and scores of questionnaire for mothers before and after intervention were (50.95±14.60) and (36.40-±15.36) respectively, P ＜ 0.05]. There was no significant difference between the changes of children's behaviors assessed by fathers and mothers in abnormal control group [The scores of questionnaire for fathers before and after intervention were (38.32±17.30) and (37.57±16.45) respectively, and scores of questionnaire for mothers before and after intervention were (45.54±16.02) and (40.14±17.95) respectively, P ＞ 0.05].CONCLUSION: Using the idea and technique of systemic family therapy ,it is feasible and effective to intervene in children's behavioral problems by family therapy.

Objective To investigate the effects of Huaier Granule combined with TAC chemotherapy on immunologic function and prognosis in triple negative breast cancer patients after operation.Methods Ninty-two cases of Ⅰ-ⅢA stage triple negative breast cancer patients entered the study.They were randomly divided into control group and research group.Only TAC chemotherapy was affected in control group of 42 cases, while Huaier Granule combined with TAC chemotherapy was applied in research group of 50 cases.And we gave Huaier Granule to patients in the first day of chemotherapy.The changes of T cell subset, NK cell were detected in the patients respectively in the first day before therapy and after therapy.The five-year disease-free survival rate and overall survival rate were also observed in two groups.Results Compared with control group, the changes of T cell subset, NK cell had no significant differences in research group in the first day before therapy(P ＞0.05).In the first day after therapy, the level of CD4 + (38.16 ± 5.71) ％ in control group was significantly lower than that (44.67 ± 6.47) ％ in research group(P ＜ 0.05).However, the percentage of CD8 + T cells (28.68 ± 4.06) ％ in control group was markedly higher than that (22.85 ± 3.22) ％ in research group (P ＜ 0.05).The level of NK cell (15.75 ± 3.47) ％ in control group was obviously lower than that (19.46 ± 4.22) ％ in research group(P ＜ 0.05).The five-year disease-free survival rate is 28.6％ in control group, however the five-year disease-free survival rate is 42.0％ in research group, there were significant differences between two groups(P ＜ 0.05).Furthermore, the five-year overall survival rate in research group was obviously higher than that in control group(P ＜ 0.01).Conclusions Huaier Granule combined with TAC chemotherapy not only enhances immune function but also improves prognosis and quality of life in triple negative breast cancer patients after operation.It provides a positive exploration for anti-cancer research by integration of traditional and western medicine.

Objective To observe the analgesia effect of combination of continuous femoral nerve block and oral analgesics after total knee arthroplasty and the impact on early rehabilitation of knee.Methods Sixty patients scheduled for unilateral total knee arthroplasty were randomly divided into two groups.One group was the multimodal analgesia group (group M)and the other was patient controlled intravenous analgesia group (PCIA)(group Ⅰ),30 patients in each group.In group M, patients were given celecoxib (200 mg,bid)and oxycodone (10 mg,bid)two days before operation, then received continuous femoral nerve block followed by oral acetaminophen (100 mg,tid)and oxyc-odone (20 mg,bid)three days after operation.In group I,patients took no medicine before operation and only received PCIA after operation.The two groups were compared with postoperative visual ana-logue scale(VAS)scores at 6,12,24,48 h at rest,during active training and continuous passive movement,range of motion of the knee joint during active training and continuous passive movement, the first time of ambulation,length of hospital stay,range of motion of the knee joint at hospital dis-charge and the incidence of complications.Intravenous dezocine 5 mg was given when VAS score was higher than 5,which was recorded.Results Compared with group Ⅰ,the VAS scores at rest,during active and continuous passive movement at postoperative 6,12,24,48 and 72 h in group M were de-creased significantly (P <0.05).The range of motion of the knee joint during active training and con-tinuous passive movement at postoperative 24,48 and 72 h in group M was increased significantly(P<0.05).The first time of ambulation(2.5±0.8)d and length of hospital stay(9.1±2.3)d in group M were shorter significantly than the first time of ambulation (3.3 ±0.7)d and length of hospital stay (10.8±2.0)d in group I (P <0.05 ).The range of motion of the knee joint(95.6 ± 1 7.2)°in group M at hospital discharge was greater significantly than the range of motion of the knee joint (82.5± 1 5.2 )° in group I (P < 0.05 ).The incidence of nausea and vomiting (3.3%),uroschesis (6.7%)in group M was lower significantly than the incidence of nausea and vomiting (30.0%), uroschesis (26.7%)(P < 0.05 ).Additional use dezocine (3.3%)was lower significantly than additional use dezocine (40.0%)(P <0.05).Conclusion Compared to patient controlled intravenous analgesia,combination of continuous femoral nerve block and oral analgesics can effectively alleviate postoperative pain in patients undergoing total knee arthroplasty,which is beneficial to early postop-erative knee function recovery.

Objective To explore the effect of intrahepatic injection of liposome-mediated VEGF plasmid on ischemia-reper-fusion liver injury and its mechanism. Methods Rabbits were randomly divided into normal group, ischemia-reperfusion group and recombinant VEGF therapy group( liposome-mediated transfer of VEGF plasmid into liver via portal vein 20 min before ischemia of liver). The model of liver ischemia-reperfusion injury was established. Liver function and the activity of SOD.XO in blood were determined at the 0,2nd,6th,12th,and 24th h after operation. RT-PCR technique was applied to detect the expression level of Fas mRNA in liver tissues of every group,and flow cytometry was used to measure cell apoptosis rate at the 6th h after operation. At the 24th h after operation,all rabbits were killed and liver tissues of ischemia were taken to make pathological sections for observing the morphology and microstructure under the light microscopy and electron microscopy. ResuJts The level of ALT in recombinant VEGF therapy group was markedly reduced as compared with ischemia-reperfusion group at the 6th,12th,and 24th h after operation( P<0. 05). The activity of SOD in recombinant VEGF therapy group was significantly higher than in ischemia-reperfusion group at the 6th, 12th,and 24th h after operation. The activity of XO in recombinant VEGF therapy group was significantly lower than that in ischemia-reperfusion group at the 6th,12th,and 24th h after operation(P< 0. 05 or P<0. 01). In addition,there was significant difference in the expression of Fas mRNA and cell apoptosis rate between recombinant VEGF therapy group and ischemia-reperfusion group(P<0. 01). The injury of hepatocytes in recombinant VEGF therapy group was significantly alleviated as compared with that in ischemia-reperfusion group under the light microscopy and e-lectron microscopy. Conclusion Liposome-mediated transfer of VEGF plasmid into liver before ischemia of liver can obviously protect hepatocytes by increasing anti-oxidative ability, decreasing the expression of Fas mRNA, and finally inhibiting hepato-cyte apoptosis.

On the model of isoprenaline (ISO)-perinjured rat heart, the protctive effect of ischemic preconditioning (IPC) on ischemia reperfusion (I/R) damage was observed.It was found that compared with alone I/R group,IPC ameliorated I/R-induced reduced reduction of coronary blood flow (CBF) (8. 8 + 0. 6 vs 6. 6 + 0. 4mL/min,P

Objective To determine the ESBLs of Klebsiella pneumoniae and ESBL typing by molecular genetic procedures. Methods MIC test and ESBLs confirmation test were taken by agar dilution method in 80 strains of Klebsiella pneumoniae isolated in Beijing area from July 1999 to December 1999. To the 20 ESBLs positive conjugates isoelectric focusing was given. And nucleotide sequencing was analysed to conjugate strain CK23. Results 28 (35%) of the 80 strains of Klebsiella pneumoniae produced ESBLs. In the 28 strains, 20 were successfully done with conjugation of resistant plasmid. Isoelectric focusing results revealed that 13 (65%) of the 20 strains produced an ESBLs protein with a pI of 8.8 with or without additional pI 7.6 and pI 5.4. These ? lactamases were all inhibited by clavulanite acid. The strains with pI=8.8 protein were highly resistant to cefotaxime and ceftriaxone but were susceptible or intermediate to ceftazidime. We picked CK23 strain out from 13 conjugates for gene cloning by the primers designed for bla CTX M and nucleotide sequencing. The results showed that the ESBLs gene in CK23 was CTX M, highly similar to CTX M 3 but had 3 amino acids, which were Glu39Gly, Leu122Pro, Asp278His. Conclusions 28 (35%) of the 80 strains of Klebsiella pneumoniae produced ESBLs. Resistant plasmid successfully conjugated in 20 of the 28 ESBLs producing strains. 13 of the 20 (65%) conjugates pruduced a pI =8.8 ESBLs,which was CTX M ESBLs,with only 3 amino acids different from CTX M 3. This paper indicated that a type of CTX M ESBLs existed in Klebsiella pneumoniae in Beijing, which specifically confers resistance to cefotaxime.

Objective To study the adverse effect of mercury on the tibial nerves of rats. Methods Seventy SD rats (35 females, 35 males, weighed 160-200 g) were randomly divided into 4 groups. 40 rats in group 1 were used to test the acute toxicity of HgCl2, 10 rats in group 2 were given HgCl2 by gavage at 17 mg/kg(1/4 LD50) daily, in group 3 the dose was 8.5 mg/kg(1/8 LD50), 10 rats in group 4 were treated with 0.9% saline 2 ml by gavage daily, the experimental duration was (20?4) days. When the model had been developed, all the male rats were killed and the female rats in group 2 and 3 were given the chelator(DMPS) by intraperitoneal injection at 28 mg/kg for 2 periods of treatment, then were killed and the tibial nerves were examined with the electronic microscope. Results The oral LD50 of HgCl2 was 68.1 mg/kg. Seven rats in group 2 (7/10) were poisoned and two of them got pain manifestation. Six rats in group 3(6/10) were poisoned. Myelinoclasis and the changed axons were found in the tibial nerves of poisoned rats and it was more serious in the rats with pain. The chelator(DMPS) did not relieve the change. Conclusion Sub-acute poisoning of HgCl2 can induce degeneration of tibial nerves in SD rats .

Objective To investigate the effect of HgCl2 and drugs on the expression of calcitonin gene related peptide(CGRP) in the spinal cord and dorsal root ganglion(DRG).Methods Forty male SD rats(180-220 g) were randomly divided into 7 groups,5 in each treated group,10 in the control.Group A(high HgCl2),B(high HgCl2 +DMPS),C(high HgCl2+DMPS+ carbamzepine) were administrated with HgCl2 at the dose of 17 mg/kg(1/4 LD50),group D(low HgCl2),E(low HgCl2+DMPS),F(low HgCl2+NS) at the dose of 8.5 mg/kg(1/8 LD50),by gavage,once a day,the control group treated with normal saline(NS) in the same way.The sub-acute mercury poisoning models were developed within 18-22 days.Then five rats of control group and group A and D were killed and group B and E were treated with the chelator(DMPS) by intraperitoneal injection at the dose of 28 mg/kg for 2 periods.Group C was given DMPS+ carbamzepine and group F was given NS only.The carbamzepine was used at the dose of 16.82 mg/kg by gavage daily for 14 days.The spinal cord(L5-6) and the DRG of L5 and L6 were collected after the treatment finished.The immunohistochemistry SABC way was used to detect CGRP.Results The CGRP level in spinal cord and DRG of the rats exposed to HgCl2 increased significantly compared with the control group(P