ObjectiveTo identify the status of quality of life in breast cancer patients and explore the impact of environmental factors on quality of life in breast cancer patients receiving chemotherapy. MethodsTotally 201 primary breast cancer patients undergoing chemotherapy after surgery were investigated.Self-developed demographic and clinical character investigation questionnaire,WHO Disability Assessment Schedule Ⅱ(WHODAS Ⅱ),and environmental factors in International Classification of Functioning Disability and Health(ICF)core sets for breast cancer patients were adopted to collect relevant data. ResultsBreast cancer patients had different levels of difficulties on each domain of WHODAS Ⅱ.Multiple stepwise regression analysis demonstrated that“material and emotional support and interrelationship with friends”, “social security service,system and policies” and“social norms,practices and ideologies” were factors influencing quality of life of breast cancer patients. ConclusionsIn addition to the strengthen of rehabilitation exercise training,nurses should advocate more services from society through policy making,prompt public awareness and scientific cognition,as well as construct effective nursing interventions to help enlarge social support resources and improve social support level.

Objective To investigate the influence of fast track surgery on stress and inflammatory re-sponse in breast cancer patients treated with modified radical mastectomy .Methods Ninety nine patients with breast cancer undergoing modified radical mastectomy were allocated randomly to fast track surgery group (46cases)and general group(53cases).The concentrations of serum PRA,Ang-Ⅱ,ALD,cortisol,IL-6,IL-8,TNF-αof each group were measured before operation ,12 hour,24hour and 48hour after operation by radioim-munoassay method.Operation time,operative blood loss and hospitalization days were analyzed between the two groups,simultaneously ,the incidence of subcutaneous hydrops ,flap necrosis and upper limb edema were also de-tected.Results The concentration of serum PRA ,Ang-Ⅱ,ALD,cortisol,IL-6,IL-8 and TNF-αwere no significantly differences in two groups before operation and at 48 hours after surgery(P>0.05).The concentra-tions of serum PRA,Ang-Ⅱ,ALD,cortisol,IL-6,IL-8 and TNF-αof FTS group were significantly different between the preoperative and different time points (P<0.05).The concentration of serum PRA,Ang-Ⅱ,ALD, cortisol,IL-6,IL-8 and TNF-αof FTS group were lower than that of control group at the same time point ( P<0.05).The operative time was(158.32 ±22.47)mins in FTS group and(161.32 ±22.37)mins in control group,respectively,and there were no significant statistical differences (P>0.05).The intraoperative blood loss in the FTS group(156.98 ±17.09)ml was not significantly less than that in the control group (158.57 ±16.92) ml(P=0.644).Hospitalization days were 8.37 ±1.89 and 10.37 ±2.05 in the FTS and the control group re-spectively ,with significant difference .The incidence of upper limb edema ,subcutaneous hydrops ,flap necrosis in FTS group were not less than control group .Conclusion Fast track surgery could attenuate stress and inflamma-tory response during ,and it is safe and effective in modified radical mastectomy .

Objective The aim of study is to explore the TORCH infection status on the pre-pregnancy women and analyze the relationship with pregnancy outcome in Hongkou District,Shanghai,and provide the reference for the eugenic and superi-or nurture.Methods Enzyme linked immunosorbent assay (ELISA)was used to detect the specificity antibodies to Toxo-plasma (TOX),Rubelavirus (RUV),Cytomegalovirus (CMV)IgG and IgM in sera of the 3 500 pre-pregnant women in Hongkou District,Shanghai.Chi-square test was used for comparative analysis of the different rates.Results The positive rate of TOX-IgG,TOX-IgM,RV-IgG,CMV-IgG and CMV-IgM in pregnancy women from Hongkou district were 1.37%, 0.34%,89.7%,96.2% and 0.60% respectively.The total positive rate of TOX and (or)CMV IgM was 0.94%.According to age group,the results showed that TORCH infections with three pathogens associated with the pre-pregnancy women’s age,and the difference was statistically significant (χ2=102.9,P<0.01).The abnormal pregnancy rate of TORCH infec-tion-positive pregnancy women (25.0%,3/12)was higher than that of TORCH-negative pregnancy women (6.62%,27/408),and the difference was statistically significant (χ2 =4.43,P=0.04).Conclusion The infection opportunity of TORCH in pregnant women in Shanghai Hongkou district was obviously existent and the TORCH infection status could effect on pregnancy outcome.TORCH testing has important practical significance as a routine examination of the pre-preg-nancy healthy service.

Objective To study the epidemiology and genotypes of extended-spectrum beta-lactamases (ESBL)-producing Escherichia coli (EC) and Klebsiella pneumoniae (KP) that caused community-onset bloodstream infections (COBSI) in 9 county hospitals of Zhejiang Province.Methods This is a multi-center, prospective, observational study.The cases and isolates with COBSI caused by EC and KP were consecutively collected from 9 county hospitals in Zhejiang Province between 1st March 2014 and 30th April 2015.The double disk diffusion method was used to confirm the production of ESBL.The ESBL genotypes were determined by polymerase chain reaction(PCR) amplification and sequence analysis.Multi-locus Sequence Typing (MLST) was used to analyze the homology of ESBL-producing isolates.Minimal inhibitory concentration (MIC) of frequently used drugs for ESBL-producing isolates was determined by in-vitro antimicrobial susceptibility tests.Results During the study period, a total of 172 cases with COBSI were collected and 171 cases were eligible, among which 126 were caused by EC and 45 were caused by KP.The overall prevalence of ESBL was 34.5% (59/171),and the prevalence of ESBL-EC and-KP was 41.3% (52/126) and 15.6% (7/45), respectively.CTX-M-type ESBL accounted for 96.6% (57/59) of all the ESBLs-producing isolates, and the most common type was CTX-M-14 (27.1%, 16/59), followed by CTX-M-55 (22%, 13/59).MLST analyses revealed significant genetic diversity among ESBL-EC and-KP.The most prevalent ST of ESBL-EC was ST131 (23.1%).In addition to carbapenems, cefoperazone/sulbactam, piperacillin/tazobactam, moxalactam, amikacin and fosfomycin also showed good in-vitro activity against ESBL-EC and-KP.Conclusions The prevalence of ESBL in EC and KP is high in 9 county hospitals of Zhejiang Province, and the most common genotypes are CTX-M-14 and CTX-M-55.The detection rate of ESBL in EC is higher than in KP.It could be considered adequate empirical therapy according to the results of antimicrobial susceptibility tests.Carbapenems, cefoperazone/sulbactam, piperacillin/tazobactam, moxalactam, amikacin and fosfomycin have good in-vitro activity against ESBL-EC and-KP.

The First Affiliated Hospital of Nanjing Medical University has adopted a strategy of brand development in the process of continuing medical education.Given the different recipients,the First Affiliated Hospital of Nanjing Medical University has established four types of brand-based education modes,namely Jinling high-level forum of clinical medicine,hospital management school,management salon,and clinical case discussion in English.The influence and competitiveness of the brand of hospital continuing education should be elevated through the following methods:adhering to the brand development orientation-to fulfill the public responsibility and cultivate medical talents; establishing appraisal mechanism of continuing medical education; transforming thinking of management department; relying on new media propaganda and expanding domestic and international communication.

Objective To analyze the policy support of rural doctors for the essential medicine system,and explore the main influence factors and mechanism affecting the support degree.Methods 621 rural doctors from five cities in Shandong province were subject to a stratified random sampling for a quantitative questionnaire,to build a hypothesis model of policy support of rural doctors,which is verified using factor analysis and path analysis.Results 59.1% of rural doctors support the essential drugs policy.It was found that the essential medicine factor,the factor to influence the practitioner,and the supporting policy factor had a direct impact on policy support of rural doctors,with the effect of 0.305, 0.1 59 and 0.135 respectively;Essential medicine factor and the supporting policy factor indirectly influence the policy support of rural doctors through the factor to influence practitioners,with the effect of 0.065 and 0.032 respectively.Conclusion The essential medicine system needs to emphasize such rationality as the quality,list and pricing of essential medicines;it is imperative for the government to better oversee the purchase and supply of essential drugs,to cater to the interests of rural doctors,to encourage the enforcement of the system,and promote the development of village clinics.

Objective To investigate psychology state of AIDS-phobia population. Methods 50 AIDS-pho-bia patients and 50 healthy controls were enrolled and tested with SCL-90,EPQ, LES and social support scale. Results Scores of SCL-90 in AIDS-phobia patients are significantly more than those in controls. Scores of anxiety, depres-sion,compulsion,dread and somatization in AIDS-phobia patients are significantly more than those in controls. Scores of negative life event scale in AIDS-phobia patients are significantly more than those in controls. Scores of positive life event scale in AIDS-phobia patients are significandy less than those in controls. Scores of social support scale in AIDS-phobia patients are significantly less than those in controls. Conclusions Anxiety, depression, compulsion, dread and somatization are primary clinical manifestation of AiDS-phobia. Personal character,negative life event and lack of social support might be nosogenesis correlated with AIDS-phobia.

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Objective To evaluate the clinical significance of plasma ionized calcium (ICa) and total calcium (TCa) measurement in diagnosis of tumor-associated hypercalcemia. Methods The heparin lithium anticoagulated plasma were collected and measured with ion selective electrode (ISE) and orthocresolphthalein complexone (OCPC) method for ICa and TCa in 77 patients with malignant tumor (tumor group) and 44 healthy controls (control group). Meanwhile,plasma albumin and pH value were measured to correct TCa (cTCa) and ICa(nICa). The results were analyzed. Results The levels of cTCa,ICa and nICa in tumor group were significantly higher than those in control group(P＜ 0.01 ) ,but there was no significant difference of TCa between two groups (P ＞ 0.05 ). cTCa ＞ 2.70 mmol/L, nICa ＞ 1.35 mmol/L as the hypercalcemia eritical value, the positive rate of nICa and cTCa were 18.18% (14/77) and 6.49% (5/77)respectively,the difference was significant (P = 0.023). Conclusion Determination of ICa may be more clinical meaningful than TCa for tumor-associated hypercalcemia.

Objective To evaluate the interstital MR lymphography using positive lymphotropic contrast agent for differentiation of metastatic lymph nodes from inflammatory lymph nodes hyperplasm.Methods Eighteen New Zealand white rabbits weighted at 2.0-2.5 kg were used.Inflammatory hyperplastic popliteal lymph node model was established in 9 rabbits by injection of complete freund adjuvant into the interdigitial skin of the dorsal aspect of one hind leg,and tumor-bearing popliteal lymph node model was established in another 9 rabbits by injection of VX~2 tumor cell suspension.The popliteal lymph nodes of another hind leg of all 18 rabbits were assigned to the normal contral group.In each group,every rabbit underwent MR lymphography examination before and after the inoculation.Volumes of 0.2 ml of Gd[DTPA-bis(2-aminoethoxy)ethane]polymeric contrast agent(Gd-poly-DTPA-EOEA)injection were injected subcutaneously into the dorsal feet of both hind legs of two groups of rabbits.T_1-weighted 3D gradient-echo images were obtained,and source images were used to reconstruct images of MIP before and after the administration of agent.The maximum short-axis diameter(MSAD)of each popliteal lymph node was measured on the enhanced 3D MIP images,and the signal-to-noise ratio(SNR)measurement was performed in the largest popliteal node of each rabbit at each time point in delayed scan.Independentsamples t test was used to compare the sizes of popliteal nodes in MSADs between inflammatorily hyperplastic and tumor-bearing nodes after the inoculation,and the values of SNRs of popliteal nodes at each time point between inflammatorily hyperplastic,tumor-bearing and normal popliteal lymph nodes.Imaging results of the popliteal nodes were analyzed and correlated with pathological findings.Results All of the rabbits were successfully inoculated except of the 2 rabbits in tumor-bearing nodal group.The size in MSAD of 13 inflammatorily hyperplastic and 11 tumor-bearing nodes was(1.32±0.14)and(1.33±0.12)cm,respectively.There was no significant statistical difference between the sizes of the two groups(t=0.186,P＞0.05).At the time of 5,15,30,60,90,120 minutes after the injection of the agent,the value of SNR of 9 inflammatorily hyperplastic and 9 contralateral normal nodes was 17.31±0.37 and 17.19±0.29,27.42±0.50 and 27.39±0.48,38.44±0.47 and 38.19±0.27,37.10±0.09 and 36.97±0.10,36.32±0.61 and 36.20±0.80,34.60±0.44 and 34.71±0.32,respectively.There was no significant statistical difference between the values of the two groups(t=0.78,0.14,1.43,1.00,0.36,-0.62,respectively,P＞0.05).The value of SNR of seven tumor-bearing and seven contralateral normal nodes was 6.00±0.22 and 17.21±0.28,7.87±0.16 and 27.17±0.23,8.14±0.24 and 38.16±0.19,8.09±0.28 and 36.94±0.30,7.59±0.20 and 35.96±0.72,7.50±0.14 and 34.81±0.27,respectively.There was significant statistical difference between the values of the two groups(t=-84.00,-182.72,-261.27,-186.48,-100.22,-239.00,respectively,P＜0.01).At each time point,inflammatorily hyperplastic nodes had significantly higher values of SNRs compared to tumor-bearing nodes(t=83.97,174.07,158.49,152.71,96.06,154.57,respectively,P＜0.01).A complete or part signal filling defect occurred in the tumor-bearing lymph node on the MR lymphographic images.Conclusions The internal anatomy and function of the lymph nodes were effectively visualized by interstitial MR lymphography with positive lymphotropic contrast agent,which provide a sensitively diagnostic way for the differentiation of benign lymph nodes from malignant ones.