Objective:To explore the optimal dose of atrovastatin treating acute coronary syndrome (ACS) .Methods:A total of 86 ACS patients were randomly and equally divided into atorvastatin large dose group (40 mg/d) and rou-tine dose group (20 mg/d ) . Blood lipid levels , blood lipid standard-reaching rate , serum levels of adiponectin (APN) and high sensitive C reactive protein (hsCRP) were compared between two groups before and after treat-ment .All patients were followed up for six months after discharge ,and incidence rates of cardiovascular events and adverse reactions were compared between two groups .Results:Compared with routine dose group ,the levels of TC and LDL-C significantly reduced on 3 months after treatment ,in large dose group (P<0.01 ,<0.05 respectively);the standard-reaching rates of TC and LDL-C [TC:(23.3% vs .44.2% ) ,LDL-C:(37.2% vs .60.5% ) ,P<0.05 all];level of APN [ (8.47 ± 1.73) mg/L vs .(12.96 ± 2.15) mg/L] significantly rose ,level of CRP [ (6.23 ± 1.26) mg/L vs .(4.07 ± 1.54) mg/L] significantly reduced ,P<0.01all;incidence rate of adverse cardiovascular e-vents (23.3% vs .7.0% , P= 0.035) significantly reduced ,but there was no significant difference in incidence rate of adverse reactions between two groups ,P=0.213.Conclusion:Atorvastatin therapy can effectively reduce in-cidence rate of cardiovascular events in ACS patients ,and the dose 40mg/d is optimal dose .

The current complex medical environment has a negative influence on doctors and also hinders the further development of healthcare industry in China.By analyzing the problems of medical social workers in doctors' social support system,this paper proposes the roles medical social workers should play in constructing a new social support system of doctors.

Objective To investigate how to improve test quality by monitoring and analyzing 15 clinical laboratory quality indicators from the National Health and Family Planning Commission .Methods Data were collected from clinical laboratory department of the First Affiliated Hospital of Kunming Medical University between January 2011 and August 2015.15 quality indicators were analyzed retrospectively , including the error rate of specimen type , the coefficient variation unqualified rate of internal quality control test, the reporting rate of critical value , et al.Results The monitoring results of quality indicators basically satisfied the quality goals , except that the median of turn around time in pre-analytical phase was not established, routine internal quality control was not conducted in some laboratory tests in analytical phase and the reporting rate and reporting timely rate of critical value should be further improved in post -analytical phase .Conclusion Medical laboratory quality system can be continuously improved by means of setting up the quality goals of 15 quality indicators referring to sub-specialty and laboratory tests , as well as automated monitoring, statistics and analysis in LIS.

Objective To compare the influence of hemodialysis (HD) and peritoneal dialysis (PD) on early outcome of patients underwent kidney transplantation from donation after cardiac death (DCD).Methods Patients admitted in the First People's Hospital of Foshan with DCD kidney transplant from January 1st,2011 to June 30th,2016 were analyzed retrospectively.Recipients were grouped into HD group (n=61) and PD group (n=28) according to their pre-transplant dialysis modality.Their short-term outcomes after DCD kidney transplant were compared,including recovery of renal function,short-term complications and laboratory data.Results Patients had longer dialysis duration and lower hemoglobin,serum albumin and phosphorus in PD group than those in HD group (all P ＜ 0.05),but no significant difference shown in age,gender,body mass index,primary disease,blood pressure,and hepatitis B infection (all P ＞ 0.05).HD patients with 6.00(4.00,11.00) d recovery time of renal function,18.00(17.00,21.50) d hospital time,had 24.59％ the delayed graft function (DGF),3.28％ acute rejection and 16.39％ infection during hospitalization.While for PD patients the recovery time of renal function was 4.00(3.75,7.00) d;hospital time was 19.00(15.00,21.75) d;the incidence rate of DGF was 14.29％;acute rejection was 3.57％;and infection during hospitalization reached 17.86％.Above indexes were not significantly different between HD and PD groups (all P ＞0.05).Repeated measure ments showed that,compared with those before transplant surgery,after 1 month,3 months and 6 months HD and PD groups had decreased creatinine and phosphorus,and increased hemoglobinserum albumin and calcium;Serum albumin and calcium were different between the two groups (P ＜ 0.001,P=0.040),whereas creatinine,hemoglobin and phosphorus did not show difference (all P ＜ 0.05).After transplantation the trends of creatinine,hemoglobin,calcium and phosphorus were not different between the two groups (P values were 0.295,0.310,0.501 and 0.063,respectively).Conclusions No significant difference of the recovery regarding renal function,anemia,nutrition status and mineral metabolites was found between pre-transplant HD and PD modality in patients who underwent DCD kidney transplantations.

Objective To investigate the prevalence and endoscopic detection rate of proximal serrated polyps and to screen the risk factors. Methods The data of 9010 colonoscopies performed by 22 endoscopists between September 2016 and September 2017 were reviewed. The adenoma detection rate (ADR) and proximal serrated polyp detection rate (PSDR) were calculated, and the correlation between ADR and PSDR was estimated by Pearson correlation coefficients. Multivariate logistic regression was used to analyze PSDR among endoscopists. Results For all subjects, the mean ADR was 30. 07％ ( ranged from 20. 00％ to 40. 78％) and mean PSDR was 4. 70％ ( ranged from 1. 52％ to 9. 28％) . PSDR of males was 1. 38 times of that of females ( OR=1. 38, 95％CI:1. 13-1. 69, P<0. 01) . For 3560 cases ( 39. 51％) of 50 years and older subjects, the mean ADR was 45. 01％ ( 28. 99％-57. 78％) and mean PSDR was 6. 08％(2. 07％-10. 56％). PSDR was moderately correlated with ADR (r=0. 48, P=0. 02). PSDR of males was 1. 36 times of that of females (OR=1. 36, 95％CI: 1. 04-1. 80, P=0. 03). Endoscopist was a significant risk factor for detection of proximal serrated polyps ( P<0. 01) . Compared with endoscopist with the highest PSDR, odds ratio of other endoscopists ranged from 0. 16 (95％CI:0. 06-0. 40, P<0. 01) to 0. 83 (95％CI:0. 53-1. 32, P=0. 44) . Conclusion Proximal serrated polyps are more common in males, who are over 50 years old. The PSDR is highly variable and dependent on endoscopists. It is possible that a certain proportion of proximal serrated polyps are missed during colonoscopy.

Objective: To investigate the effect of axillary lymph node status in evaluating the prognosis of patients with local recurrence after breast-conserving surgery. Methods: The clinical data of 72 patients with local-regional recurrence who had undergone breast-conserving therapy in Tianjin Cancer Hospital from February 2001 to December 2009 were collected and retrospectively analyzed. These patients were divided into axillary lymph node positive group (23 cases) and negative group (49 cases), according to their axillary lymph node status. Results: Among 72 patients, 21 cases were local recurrence, 35 cases were regional recurrence, and 16 cases were local-regional recurrence. In the axillary lymph node positive group, 7 cases were local recurrence, 10 cases were regional recurrence, 6 cases were local-regional recurrence. In the axillary lymph node negative group, 14 cases were local recurrence, 25 cases were regional recurrence, 10 cases were local-regional recurrence. There was no significant difference between these two groups (P=0.807). Moreover, no significant differences of the age, recurrent site, estrogen receptor (ER) and/or progesterone receptor (PR) status, human epidermal growth factor receptor 2 (HER-2) status, disease-free period, local and systemic therapeutic effect, non-distant metastasis survival between these two groups were observed (P>0.05). However, the overall survival of axillary lymph node positive group after recurrence was significantly lower than that of negative group (P=0.014). Cox multivariate analysis showed that recurrent site is an independent prognostic factor of disease-free survival of patients with regional recurrence after breast-conserving surgery (OR=2.050, P=0.002). The axillary lymph node status and recurrent site were independent prognostic factors of overall survival of these patients (OR=3.469, P=0.003; OR=3.676, P<0.001). Conclusions Axillary lymph node status is an independent factor of overall survival of patients with regional recurrence after breast-conserving surgery, but it is marginally related with their non-distant metastasis survival.

Objective: To explore the oncological safety of immediate breast reconstruction after nipple-areola complex(NAC) sparing mastectomy(NSM+ IBR) in patients with early stage breast cancer, and to analyze the prognostic factors of NSM+ IBR. Methods: From January 2004 to December 2015, the clinical data of 118 cases of stage Ⅰ-ⅡA breast cancer who had undergone NSM+ IBR in Tianjin Tumor Hospital were collected, comparing with 75 cases of Ⅰ-ⅡA breast cancer patients who had undergone immediate breast reconstruction after modified radical mastectomy (MRM+ IBR) at the same period. In addition to the prognosis of these two groups, the prognostic factors were also retrospectively analyzed. Results: The median follow-up were 53 months in the NSM+ IBR group and 51 months in the MRM+ IBR group, respectively. In the NSM+ IBR group, local recurrence, distant metastasis, death and NAC necrosis occurred in 4, 6, 9 and 4 cases during 3 years after operation, respectively. The local recurrence rate (LRR) was 3.4%, 3-year disease-free survival (DFS) rate was 91.5%, and the overall survival (OS) rate was 92.4%. In the MRM+ IBR group, local recurrence, distant metastasis, and death occurred in 1, 4, and 3 cases during 3 years after operation, respectively. The LRR was 1.3%, 3-year DFS was 93.3%, whereas the OS rate was 96.0%. No statistical difference was noted between the two groups (all P>0.05). That HER-2 positive and molecular type correlated with the 3-year DFS (P<0.05) independently and molecular type correlated with OS (P<0.05) independently in the NSM+ IBR group. Conclusions NSM does not impair patients′ prognosis and could ensure oncological safety of patients with early stage breast cancer. IBR could improve female patients′ figure and ensure the quality of life. HER-2 status and molecular type are the independent prognostic factors of the 3-year DFS. Molecular type is the independent prognosis factor of OS.