Purpose To investigate the clinicopathologic features and prognostic factors of apocrine carcinoma ( AC) of breast. Meth-od Clinical data of 70 ACs and 283 invasive carcinomas, not otherwise specified were collected. Differences between the prognostic outcomes of the two groups were compared, and the relationship between clinicopathological characteristics and prognosis was also ana-lyzed. Results The mean age of the patients with AC (56. 17 ± 12. 41 years) was older than those with invasive carcinoma not other-wise specified (52. 77 ± 11. 07 years) (P=0. 039). The patients with AC had a lower frequency of axillary nodal metastasis, a lower frequency of ER and PR positivity comparing to invasive carcinoma not otherwise specified ( P<0. 05 ) . No significant differences in the overall survival (P=0. 221) and disease-free survival (P=0. 378) periods of the two groups were observed. Kaplan-Meier surviv-al analysis showed tumor size, lymph node metastasis, pathological stage, lymph node tissue infiltration were related with prognosis of patients with AC ( P<0. 05 ) . In multivariate analysis, lymph node metastasis was associated with a worse prognosis ( P<0. 05 ) . Conclusions Although AC and invasive carcinoma not otherwise specified have different clinicopathologic characteristics, the prog-noses of patients with these diseases are similar. Lymph node metastasis could be used as an independent factor for predicting the prog-nosis of patients with AC, early diagnosis and early treatment is the key to improve its prognosis.

This paper presented the thinking of security problems of the pulse pressure transducer which was widely used in TCM field. And we suggest that the selection of the pulse sensor should be flexible, the pressure should be comply with the security value of the body's tolerance range, and pulse instrument operator should pay attention to the accuracy and safety, so that the pulse instrument will be more humane, scientific and security-oriented.

Objective To investigate prenatal ultrasound diagnosis of clubfoot and its clinical value.Methods Three thousands pregants ranging gestational age from 12 through 40 weeks were checked using Ascuson Sequoia 512 equipment.The diagnosis of clubfoot was made prospectively at the time of the scan by the following criteria: the ball of foot had to be visible in the same plane as the longitudinal section of bones of the lower leg,unchanging with fetal activity and reproducible for several images.All prenatal ultrasonographic dignoses of clubfoot were proved by autopsy or newborn physical examination.Results A total of 17 cases clubfoot fetuses were prenatal diagnosed by ultrasonography.Fourteen of 17 clubfoot fetuses had associated with complex abnormalities,three of them were isolated clubfoot.Fourteen of 17 cases with clubfoot prenatal diagnosed by ultrasound were proved by autopsy.Another three cases with clubfoot were proved by newborn physical examination,two of them were false positive diagnosis.Conclusions Prenatal diagnosis of clubfoot is reliable by ultrasound.It is helpful in diagnosis with other structural abnormalities associated with clubfoot.It can also provide direction for clinical obstetrical management.

Objective To investigate prenatal ultrasound diagnosis of radial ray abnormalities and its clinical value. Methods All the fetus that entered usual prenatal ultrasound diagnosis were scanned each limb using a systematic continuous sequence approach (SCSA) with Acuson Sequoia 512 and GE Logiq 400 equipments. All the artificial aborted fetal radius malformation also had ultrasound examination in a simulating intrauterine estate and /or X-ray examination. Results Correctly diagnosis was made in 13 cases fetal radial ray abnormalities by prenatal ultrasonography following SCSA through the scaning course. All the fetal radial ray abnormalities had radius absence(only one skeleton in the forearm) or radius dysplasia and characteristic radial club hand. Ray abnormalities can be classifyied into three types on ultrasonography: type Ⅰ, radius absence; type Ⅱ,radius part absence; type Ⅲ,radius dysplasia.Conclusions Mastering characteristic radial club hand and SCSA are the keys to diagnose fetal radial ray abnormalities by prenatal ultrasonography.

0.05). It seems valid to use this nutritive yeast as a vehicle for iron supplementation. Further studies are discussed.

135 children, aged 18-36 months, were selected from two nurseries and divided into 3 groups. To children in group A, Fe-enriched yeast fortified "Bao Bao Le" formula powder (40+5g per capita per day) was given instead of soybean milk and soybean curd in the ordinary nursery diet. Unfortified "Bao Bao Le" was given to group B as another test food. Children in group C, serving as control, were given ordinary nursery diet. This experiment lasted for three months. Dietary survey, Hb, FEP, SF, serum uric acid concentration, vitamin B2 and C loading tests (4 h) , and anthropometric measurements were determined before and after the experiment.No statistically significant differences were observed in nutrient intake, vitamin loading tests and serum uric acid (seeking for nuclecic acid metabolite) in each group before and after the experiment. At the end of the experiment, changes of Hb, FEP, SF concentration and FEP/Hb indicated that iron status of children in group A was much better than that in groups B and C, with no significant differences between the latter groups. Weight gain and height increment of children in group C were much less than those in groups A and B, with no significant differences between the latter groups too. Therefore we conclude that the improvement of iron status in group A is due to the effect of Fe-enriched yeast contained in the fortified "Bao Bao Le" formula powder.

Objective To explore the difference of social support,self-esteem and marital quality between urban and rural areas and discuss the impact on each other.Methods Chinese marital quality questionnaire,selfesteem scale (SES) and social support rating scale were used to test 386 urban and rural married residents.Results ①The results of descriptive statistics showed that marriage quality,social support and self-esteem of urban and rural residents were (318.46±37.41),(42.44±5.84) and (30.65 ± 3.95) respectively.②There was no significant difference among social support,self-esteem and marital quality in different gender(t =0.41,-0.16,0.03,P＞ 0.05),but had significant difference between urban and rural areas(t=2.83,3.91,5.24,P＜0.01).There were significant differences between social support and marital quality in different age structures(t=5.22,3.85,P＜0.05).There were significant differences between social support and self-esteem in different educational level (t =3.48,4.16,P＜0.01).③Social support,subjective support,objective support and marital quality had positive correlation (r=0.114～0.394,P＜0.05).The degree and character compatibility,communication between couples,resolve conflicts are positively related to support (r=0.308～ 0.476,P＜0.01).④Stepwise multiple regression analysis and structural equation modeling analysis showed that self-esteem played partial intermediary role between social support and marital quality(37.7％),which could explain 26.8％ of marital quality.The social suptort and self-esteem could better predict marital quality.Conclusion The higher social support and self-esteem are,the higher marital quality is.Social support can directly affect the marital quality and indirectly affect marital quality through self-esteem.

Objective To explore the distinguishing method and threshold of optimum pulse pressures on Cun pulse and Chi pulse to solve the problem how to exert pressure upon Three Regions Pulse Detecting Instrument.Methods Totally 55 subjects meeting the inclusion criteria were collected.The data of optimum pulse pressures on Cun Guan Chi of the same hand of the same tested person were collected respectively and the comparative analysis on the data was carried out.Results In normal subjects,the attenuation degree of optimum pulse pressures on Guan pulse compared with Cun pulse was 0.189?0.053,and the attenuation degree of optimum pulse pressures on Chi pulse in comparison with Guan pulse was 0.226?0.044.Conclusion Through calculating the attenuation degree of optimum pulse pressures reasonably,the identified threshold of Cun and Chi pulses can be judged from the threshold of Fu-superficial,Zhong-medium,and Chen-deep of Guan pulse.

Objective To explore the problems and solving countermeasures in application of nursing vertical management,and provide references for nursing post management reform.Methods Through purposive sampling method,nursing administers,clinical nurses,heads of clinical departments and performance directors from five hospitals were interviewed by semi-structured interview method.Data were analyzed using 7-step Colaizzi's phenomenological analysis method.Results Four themes were formed about the problems in application of nursing vertical management,including:affecting department management and doctor-nurse collaboration,insufficient scientificity and fairness of performance evaluation,significant issues regarding post setting of senior nurses,competence and sense of belonging of temporarily deployed nurses.Four themes were formed about the solving countermeasures in application of nursing vertical management,including:improving participation of clinical departments in nursing management,making performance system to public and asking advices of nurses,providing career development for senior nurses,and conducting standardized training and establishing reserve nurses tank.Conclusion The main problems in application of nursing vertical management consisted of affecting department management and doctor-nurse collaboration,insufficient scientificity and fairness of performance evaluation,post setting of senior nurses,and competence and sense of belonging of temporarily deployed nurses.We suggested to better apply nursing vertical management by improving participation of clinical department in nursing management,making performance system to public and asking advices of nurses,providing career development for senior nurses,and conducting standardized training and establishing reserve nurses tank.

Synchronous multiple primary carcinomas refers to 2 or more than 2 kinds of different primary malignant tumors develop synchronously or in 6 months.The incidence of synchronous multiple primary carcinoma is low.A patient with esophageal basaloid squamous cell carcinoma (BSCC) and gastric adenocarcinoma was admitted to the First People's Hospital of Lianyungang in October 2011.The main symptom of this patient was dysphagia,and multiple lesions were found in esophagus,cardia and stomach fundus by gastroscopy respectively.On computed tomography image,eminence lesion in esophageal midpiece and wall thickening from esophagus-cardia to stomach fundus were displayed and were both enhanced slightly by enhancement scanning.The esophageal and cardia tumors were resected via left thoracic approach,and postoperative pathological examination revealed esophageal BSCC and moderately differentiated adenocarcinoma of cardia respectively.Comedo necrosis and red basal membrane material were seen under light microscope.The expressions of cytokeratin 5/6 and P63 were positive,the expression of cytokeratin L was weak positive and the expressions of synaptophysin,chromogranin A and CD117 were negative.The patient suffered from pleural effusion and multiple liver metastases after 4 months follow-up and died of liver metastases in May 2012.Multiple primary carcinomas including esophageal BSCC and gastric adenocarcinoma are rarely seen in clinical practice.Their diagnosis and differential diagnosis mainly depend on histological morphology and immunohistochemical method.Surgical resection combined with postoperative radiotherapy and chemotherapy is selectable,but the prognosis is poor.