With the widespread adoption of screening mammography, the incidence of ductal carcinoma in situ (DCIS) has been dramatically increased. The spectrum of local treatment advances from mastectomy to breast conservation surgery plus whole breast irradiation (WBI), and hypofractionated WBI or accelerated partial breast irradiation. Although the efficacy of WBI on reducing local recurrence is clear, such benefit in the low-risk DCIS is still controversial. Further studies are required to establish a more precise local recurrence risk stratification system for better tailoring local treatment in patients with DCIS. In this review, the latest advances and controversies in surgery, radiation therapy and local recurrence risk stratification system for patients with DCIS were summarized.

Objective To explore the imaging features and its correlation with pathological findings of giant cell tumor of the ten-don sheath (GCTTS).Methods The clinical data,radiographic images and pathological characteristics of sixteen cases of GCTTS confirmed by pathology were retrospectively reviewed.Plain CT,pre and post-contrast MR were performed in all patients.HE stai-ning was used to investigate the histological characteristics of GCTTS,and immunohistochemistry was employed to detect the ex-pression of CD68.Results There were nine cases of local type GCTTS and seven cases of diffuse type GCTTS in our present study. Nine cases were located in the knee joint,four cases in the foot,and three cases in the hand.Compared with normal skeletal muscle signals,lesions showed isointensity or low intensity on T1 WI and inhomogeneous low intensity on T2 WI.Three cases caused adja-cent bone destruction,one case lead to adjacent bone absorption,and no abnormality was found in other twelve cases.Six cases were injected Gd-DTPA for enhanced scan,in which four cases showed significantly heterogeneous enhancement,one case mild heteroge-neous enhancement,and one case no heterogeneous enhancement.Pathology examination results revealed that GCTTS parenchyma cells were mainly formed by histocyte-like monocytes,and scattered multinuclear giant cells.GCTTS mesenchyme was rich in gelat-inous fiber and hemosiderin pigmentation.Conclusion MR has a significant advantage in detecting specific hemosiderin pigmentation and determining lesions area of GCTTS.Combination of MR with pathology results may improve the diagnosis accuracy.

Objective:To understand the relationship between psychiatric nurses' communication ability, personality characteristics and conflict management patterns, and to provide a basis for training psychiatric nurses' conflict management ability courses.Methods:A convenient sampling method was used to investigate and investigate 208 nurses in the first-line clinical hospitals of a third-class psychiatric hospital, used the nurses′ clinical communication ability scale, the nurse′s interpersonal conflict management morphology scale, and the simplified version of the Chinese Big Five Personality Questionnaire.Results:Integration dimension (18.67±2.58) points, concession dimension (12.93±2.43) points, escape dimension (14.05±2.02) points, dominance dimension (14.49±3.06) points, and integration dimension and gender ( t value was -2.57, P=0.01)), education ( F value was 3.76, P=0.02), technical title ( F value was 3.03, P=0.02), position ( t value was 2.08, P=0.03), whether to participate in nurse-patient communication training ( t value was 2.54, P=0.02). Nurses with pleasant personality could better deal with interpersonal conflict ( r=0.361, P<0.01), and the nurse′s personality had a direct effect on the form of interpersonal conflict ( P=0.036, 95% CI 0.107-0.422), the nurse′s communication ability plays a part of indirect effect ( P=0.031, 95% CI 0.001-0.063). Conclusion:The form of interpersonal conflict management of psychiatric nurses was closely related to communication ability and personality characteristics. Nursing managers could carry out targeted training to improve the conflict management ability of nursing staff.

Purpose To explore the methods of selectively visualizing hepatic portal vein by using three-dimensional fast imaging employing steady state acquisition combined with in-flow inversion recovery labeling pulse at 3.0 Tesla. Materials and Methods Ten healthy volunteers were examined under different TI (1200, 1400, 1600, 1800 ms), and the vessel-to-liver contrast ratio of the main portal vein, right portal vein, and left portal vein were measured. Results Non-contrast-enhanced MRA images of portal vein were obtained successfully in all ten volunteers. The signal intensity of peripheral portal branches gradually increased when TI increased from 1200 ms to 1600 ms, and the highest vessel-to-liver contrast ratio occurred when TI was 1400 ms. Conclusion Non-contrast enhanced magnetic resonance angiography of the hepatic portal vein can be successfully achieved at 3.0T high field MRI. A fixed TI of 1400 ms is preferable.

Objective To clarify the mechanism of Yifeiqinghua granules on tumor angiogenesis and tumor inhibition by observing its influence on the expression of vascular endothelial growth factor (VEGF) and its receptor KDR in Lewis lung cancer mice. Methods Eighty C57BL/6 inbred mice subcutaneously planted with Lewis tumor cell suspension 0.2 mL were randomly divided into 8 groups:blank group, control group, low-, medium- and high-dose of Yifeiqinghua granules groups, Gefitinib group, Gefitinib plus medium-dose of Yifeiqinghua granules group and CTX group, 10 mice in each group. Drugs were administrated from the second day. CTX group was administered on third day and seventh day, other groups were administered for 14 days. The mice were killed to take the tumor on the 15th days. VEGF and KDR expression in tumor tissue was measured by Western Blot. Results Compared with the blank group, the expression of VEGF was significantly decreased in the low- and medium-dose of Yifeiqinghua granules groups (P<0.01). Gefitinib group’s VEGF value was lower than the blank group (P<0.05). Compared with the blank group, the expression of VEGF was significantly decreased in the high-dose of Yifeiqinghua granular group, Gefitinib plus medium-dose of Yifeiqinghua granules group and CTX group (P<0.001). Compared with the blank group, the expression of KDR was significantly decreased in the low-, medium- and high-dose of Yifeiqinghua granules groups, Gefitinib group and CTX group (P<0.05). Conclusions The possible mechanism of Yifeiqinghua granules in treating non-small cell lung cancer is reducing the expression of VEGF and KDR, thus play an inhibitory effect.

The continuing education system at the Peking University Health Science Center for vis-iting scholars (Research program for young and middle-aged doctors) is a relatively advanced and compre-hensive medical continuing education system in China, among which, the tutorial system is a good method to guide the visiting scholars of continuing education. On this basis we conducted scholars learning effect questionnaire survey and combined with the feedback results, discussed the advantages and disadvantages of the current educational system of visiting scholars in China, and put forward some concrete suggestions on the development of the continuing education in China.

OBJECTIVE:To observe clinical efficacy and safety of salmeterol fluticasone combined with tiotropium bromide in the treatment of COPD via different inhalation devices.METHODS:Eighty COPD patients were selected from our hospital during Jan.2014 to Jan.2015,and then divided into trial group and control group according to random number table,with 40 cases in each group.Both groups were given Salmeterol fluticasone inhalant 500 μg,bid+Tiotropium bromide inhalant 18 μg,qd.Control group was given medicine via inhalation device coming with medicine,while trial group was given medicine via gas compression type ultrasonic spray inhalator.Both groups were treated for 1 year.Blood concentration of medicine 0.5 h after medication,mMRC score and COPD acsessment test (CAT) score 3,6,9 months after treatment,the times of acute exacerbation during treatment,FEV1％ before and af ter treatment were all observed in 2 groups.The occurrence of ADR was recorded.RESULTS:Four cases withdrew from trial group and 1 case from control group.After medication,there was no statistical significance in blood concentration of fluticasone,salmeterol and tiotropium bromide between 2 groups (P＞0.05).0.5 h after medication,mMRC score of trial group was slightly lower than that of control group,without statistical significance (P＞0.05);CAT score of it was significantly lower than that of control group,with statistical significance (P＜0.05).The times of acute exacerbation in trial group during treatment was significantly less than control group,with statistical significance (P＜0.05).The decrease of FEV1％ in trial group was slightly lower than control group,without statistical significance (P＞0.05).The incidence of ADR in trial group was significantly lower than control group,with statistical significance (P＜0.05).CONCLUSIONS:For COPD patients,salmeterol fluticasone combined with tiotropium bromide via gas compression type ultrasonic spray inhalator is better than inhalation device coming with medicine in clinical efficacy and safety.

Objective Three-dimensional(3D) automated ultrasonic volume measurement is becoming favorable in clinical application and turns to be an important direction .The article was to evaluate the consistency of two-dimensional (2D) and three-di-mensional ultrasonography in the diameter measurement of single follicle . Methods 438 single folliculars were respectively meas-ured by the same sonographer in 2D and 3D ultrasonic measurement.2D diameter, 3D mean diameter and 3D virtual ball diameter of every single follicle were recorded , and Bland-Altman method were used to evaluate the consistency of the results by these two meth-ods. Results In the consistency analysis on the diameter measurement of single follicle by 2D and 3D mean diameter measurment methods, d equaled -1.06 mm, and 95% LoA range covered the range of -4.82 mm to 2.70 mm.95% CI of 95% LoA range,-5.21 mm to 3.08 mm, was beyond the settings of clinical acceptable error limit range , -3.56 mm to 1.44 mm, showing poor consis-tency.Likewise, in the research of the consistency in the measurement of 2D diameter and 3D virtual ball diameter in the diameter measurement of single follicle , d equaled -0.07 mm , and 95%LoA range covered the range of -3.11 mm to 2.98 mm.95%CI of 95%LoA range, -3.43 mm to 3.29 mm, was beyond the settings of clinical acceptable error limit range , -2.57 mm to 2.43 mm, showing poor consistency . Conclusion 2D and 3D ultrasound measurements in the diameter measurement of single follicle are not consistent.However, considering the objectivity and accuracy of the results , 3D ultrasonography still has an advantage over 2D ultra-sonography , which can provide more acurate aid for assisted reproductive technology .

Objective:To explore the factors influencing patient safety behavior of nursing students during clinical practice.Methods:A cross-sectional study was used, in which a total of 214 participants completed the online survey related to the undergraduate nursing students ′ clinical teaching satisfaction scale, safety attitude questionnaire and nurse safety behavior questionnaire. Results:The mean scores of clinical teaching satisfaction, safety attitude and nurse safety behavior were (3.83±0.81), (3.70±0.65) and (3.93±0.79) respectively. There were positive correlations between clinical teaching satisfaction, safety attitude with the nurse safety behavior ( r=0.82, 0.75, P<0.01). The results also showed that the same shifts with their clinical instructors, clinical teaching satisfaction and safety attitude could affect safety behavior of nursing students ( F=67.81, R2=0.753, ΔR2= 0.742, P=0.00), which accounted for 74.20% of total variation. Conclusions:The same shift arrangement for both clinical instructors and nursing students, enhancement of the demonstration and guidance from clinical instructors, as well as strengthening the cultivating patient safety attitude would be beneficial to promoting the safety behavior of nursing students during clinical practice.

Objective To perform a systematic review and meta-analysis of the predictive abilities of CHADS2 and CHA2DS2-VASc in stroke and thromboembolism risk stratification of atrial fibrillation (AF) patients. Methods We searched PubMed and EMBASE for Eng-lish-language literature on comparisons of the diagnostic performance between CHADS2 and CHA2DS2-VASc in predicting stroke, or sys-temic embolism, in AF. We then assessed the quality of the included studies and pooled the C-statistics and 95%confidence intervals (95%CI). Results Eight studies were included. It was unsuitable to perform a direct meta-analysis because of high heterogeneity. When analyzed as a continuous variable, the C-statistic ranged from 0.60 to 0.80 (median 0.683) for CHADS2 and 0.64-0.79 (median 0.673) for CHA2DS2-VASc. When analyzed as a continuous variable in anticoagulation patients, the subgroup analysis showed that the pooled C-statistic (95%CI) was 0.660 (0.655-0.665) for CHADS2 and 0.667 (0.651-0.683) for CHA2DS2-VASc (no significant difference). For non-anticoagulation patients, the pooled C-statistic (95%CI) was 0.685 (0.666-0.705) for CHADS2 and 0.675 (0.656-0.694) for CHA2DS2-VASc (no significant differ-ence). The average ratio of endpoint events in the low-risk group of CHA2DS2-VASc was less than CHADS2 (0.41%vs. 0.94%, P＜0.05). The average proportion of the moderate-risk group of CHA2DS2-VASc was lower than CHADS2 (11.12%vs. 30.75%, P＜0.05). Conclu-sions The C-statistic suggests a similar clinical utility of the CHADS2 and CHA2DS2-VASc scores in predicting stroke and thromboem-bolism, but CHA2DS2-VASc has the important advantage of identifying extremely low-risk patients with atrial fibrillation, as well as classi-fying a lower proportion of patients as moderate risk.