Objective To explore the preoperative misdiagnosis in the breast cancer and the methods to improve the diagnostic accordance rate. Methods The preoperative diagnosis and results of 358 cases with breast cancer has been analysized retrospectively in the recent ten years. Results Total Cases with present diagnostic technique diagnosed befor operation was 176 only;the accordance rate was less than 50%.With aspiration biopsy and molybdenum palladium roentgenograph,the rate was 25%(79 cases).The actual preoperative accordance rate was less than 10%(32 cases).It is said approximately 90% cases were postoperatively diagnosed. Conclusion The present excision biopsy not only has made many patients lost the chance of chemotherapy preoperation, but also interferenced the application of new therapic methods in the clinical practice.Infrared spectroscopy and ultrasonography have been commonly used in the clinical practice.With the low diagnostic accordance rate,they were applied only for screening.With simplity and high diagnostic accor dance rate,aspiration biopsy and molybdenum pall adium roentgenograph should be enrolled extensively in the clinical practice. The puncture and specimen fixing technique also should be improved.

Objective To find an effective operational approach that can mostly reduce heat and other injury to Calot's triangle when separating and anatomizing it at LC operation.Method We abandoned traditional hot separating method by electric coagulation hook which can cause hot injury easily and cold separating method simply by elastic separating plier which can cause errhysis and illegibility of operational field.We applied sucting and scraping cold separating method mainly by suction apparatus which can keep operational field clear and avoid hot injury.Result 52 cases with different cholecyst disease (including cholecystolithiasis,cholecyst polyp,acute cholecystitis with edema and acute cholecystitis with partly gangrene) were adopted by this method and achieved satisfacted effect.Conclusion Sucting and scraping cold separating method are easily operated and can mostly keep separated tube skeletonized.It can avoid hot and other injury in operation,keep operational field clear by less errhysis.To acute cholecystitis with edema it has more advantage and are worth to adopting.

Shanghanlun contains the theory of stagnation,though which is concealed among the treating system.This theory is great important to clinical practice.When we have a whole understanding to the theory of stagnation,it is easy to analyze the obstruction-removing therapy.Though this principle hasn't clearly definition,it is connected closely with other regular treating methods.Based on it,the dissertation analyzes all kinds of obstruction-removing therapy in Shanghanlun.That will be very helpful for readers to understand this theory and its significance in clinical practice.

Objective To establish the determination method of baicalin in the children's YifeiPingchuan mixture by RP-HPLC.Methods A Kromasil C18 column was used with methanol-(0.4％)phosphoric acid-triethylamine (45 ∶ 55 ∶ 2 drops) as mobile phase with a column temperature of 28 ℃.The flow rate was 1.0 ml/min.The detection wavelength was set at 277 nm.Results The linear range of baicalin was 0.040～1.000 μg (r=0.9999) with a average recovery of 99.82 and RSD of 1.01％.Conclusion The method for quantification of baicalin was sensitive,accurate,and convenient,which can also be used as one of basis of quality standard for Yifei-Pingchuan mixture.

Objectives Pancreatic ischemia is a pathogeny of acute pancreatitis(AP), and systemic blood rheologic changes have close relationship with AP. The aim of this study was to investigate the potential role of the systemic blood rheologic and pancreatic hemodynamic changes in rats with AP, and to reveal their relationship. Methods Acute edematous pancreatitis(AEP, n =20) and acute necrotizing pancreatits(ANP, n =20) models were induced by injection of sodium taurocholate into the pancreatic duct of rats, another 10 normal rats were used as control group. The pancreatic blood flow(PBF) was measured by Doppler ultrasound before and after the operation. At 12 h after the induction of AP, 10 rats in each group were sacrificed, the blood rheologic indexes were detected, and the pathological study of pancreas was performed. The survival rate in 3 days of the rest 10 rats in AEP and ANP group was also observed. Results Compared with the control group, only the hemagglatination index increased in AEP group and all the blood rheologic indexes increased in ANP group distinctly with the elevation of blood viscosity curve. The velocity of PBF was decreased in AEP and ANP groups, reducing to 79% and 30% of theirs levels before the induction of AP. Compared with the control group, the pathological scores of pancreatic edema, inflammation, hemorrhage and necrosis of AEP rats significantly increased, and compared with AEP group, these four indexes increased significantly in ANP rats. The survival rate in 3 days of AEP group was 90%, but that of ANP group was 0. Conclusions Systemic blood rheologic and pancreatic hemodynamic changes happen synchronously in rats with AP. The injury of pancreatic microcirculation due to ischemia is one of the initial pathogeneses of AP. The change of blood rheology is not a contributing factor causing AP, it could aggravate pancreatic ischemia and accelerate the pancreatic injury after onset.

Objective To investigate the value of urine L-type fatty acid-binding protein (uL-FABP) and uric neutrophil gelatinase-associated lipocalin (uNGAL), and predict the value of poor outcomes (injury progression,dialysis,or death within 7 days ) in critically ill patients with early acute kidney injury (AKI) at time of nephropathy consultation. Methods One hundred and twenty-five patients with evidence of the AKIN criteria stage1 AKI were enrolled in this study. At time of nephropathy consultation , urinary samples were collected. The levels of uL-FABP and uNGAL were measured. Each marker was assessed for its predictive value using an area under the receiver operator characteristic curves (ROC-AUC) to predict AKI prognosis. Results Twenty-eight patients developed poor outcome. It was 0.81 in ROC-AUC in uL-FABP , in,which it could be improved to 0.83 when combined with APACHEⅡscore (0.75 in ROC-AUC). The ROC-AUC of uNGAL was 0.66, in which it could not impove its predictive power significantly when combined with APACHEⅡscore. Conclusion Among critically ill patients with early AKI , uL-FABP provided an independent and prognostic power when combined with APACHEⅡscore and the level of uL-FABP at time of nephropathy consultation helps to predict clinical outcome in critically ill patients with early AKI.

A sensitive, rapid and accurate liquid chromatography-tandem mass spectrometric (LC-MS/MS) method with pre-column derivatization was developed for the simultaneous determination of erdosteine and its thiol-containing active metabolite in human plasma. Paracetamol and captopril were chosen as the internal standard of erdosteine and its active metabolite, respectively. Aliquots of 100 microL plasma sample were derivatized by 2-bromine-3'-methoxy acetophenone, then separated on an Agilent XDB-C18 (50 mm x 4.6 mm ID, 1.8 microm) column using 0.1% formic acid methanol--0.1% formic acid 5 mmol x L(-1) ammonium acetate as mobile phase, in a gradient mode. Detection of erdosteine and its active metabolite were achieved by ESI MS/MS in the positive ion mode. The linear calibration curves for erdosteine and its active metabolite were obtained in the concentration ranges of 5-3 000 ng x mL(-1) and 5-10 000 ng x mL(-1), respectively. The lower limit of quantification of erdosteine and its active metabolite were both 5.00 ng x mL(-1). The pharmacokinetic results of erdosteine and its thiol-containing active metabolite showed that the area under curve (AUC) of the thiol-containing active metabolite was 6.2 times of that of erdosteine after a single oral dose of 600 mg erdosteine tables in 32 healthy volunteers, The mean residence time (MRT) of the thiol-containing active metabolite was (7.51 +/- 0.788) h, which provided a pharmacokinetic basis for the rational dosage regimen.

To study the drug-drug interaction of morinidazole and warfarin and its application, a sensitive and rapid liquid chromatography-tandem mass spectrometric (LC-MS/MS) method was developed for the determination of R-warfarin/S-warfarin in human plasma. In a random, two-period crossover study, 12 healthy volunteers received a single oral dose of 5 mg racemic warfarin in the absence and presence of morinidazole. Blood samples were collected according to a pre-designed time schedule. R-warfarin, S-warfarin and methyclothiazide were extracted with ethylether : methylenechloride (3 : 2), then separated on a Astec Chirobiotic V (150 mm x 4.6 mm ID, 5 microm) column using 5 mmol x L(-1) ammonium acetate (pH 4.0) - acetonitrile as mobile phase at a flow-rate of 1.5 mL x min(-1). The mobile phase was splitted and 0.5 mL x min(-1) was introduced into MS. A tandem mass spectrometer equipped with electrospray ionization source was used as detector and operated in the negative ion mode. Quantification was performed using multiple reaction monitoring (MRM). The resolution of warfarin enantiomers is 1.56. The linear calibration curves for R-warfarin and S-warfarin both were obtained in the concentration range of 5 - 1 000 ng x mL(-1). Intra- and inter-day relative standard deviation (RSD) for R-warfarin and S-warfarin over the entire concentration range across three validation runs was both less than 10%, and relative error (RE) ranged from -4.9% to 0.7%, separately. The method herein described is effective and convenient, and suitable for the study of metabolic interaction between morinidazole and warfarin. The results showed that coadministration of warfarin with morinidazole did not affect the pharmacokinetics of either R-warfarin or S-warfarin.

Objective To discuss the ability of nursing major undergraduate students in disaster response in order to construct undergraduate's disaster response ability evaluation system.Methods Delphi method was used to draw the evaluation system framework on the basis of consulting literature material and analyzing theories.35 related experts attended it.The choice was evaluated according to the 5 classification Likert evaluation method.Results Consensus was reached after two rounds inst.Questionnaire recovery rate was 100％.Construct undergraduate's disaster response ability evaluation system with 3 first-level indexes,12 second-level indexes,37 third-level indexes.Conclusions The undergraduate's disaster response ability evaluation system based on Delphi experts method is reliable.It can provide reference for the nursing major undergraduate student's disaster response training and research.

Objective To evaluate the role of prostaglandin E2 (EP) receptors in H9c2 cardiomyocyte hypertrophy induced by prostaglandin E2 (PGE2).Methods Primary cultured H9c2 cardiomyocytes were seeded in culture flasks (3 ml/flask) or in 24-well plate (1 ml/hole) or 6-well plate (2 ml/hole) with density of 4 × 104/ml.The cells were randomly divided into 4 groups (n=24 each): control group (group C),PGE2 group,AH6809 (EP1 and EP2 receptor antagonist) group (group A) and GW627368X (EP4 receptor antagonist) group (group G).The cells were continuously cultured for 48 h.PGE2 (final concentration 1 μmol/L) was added to the culture medium in PGE2 group.PGE2 (final concentration 1 μmol/L) and A H6809 (final concentration 10 μmol/L) were added to the culture medium in group A.PGE2 (final concentration 1 μmol/L) and GW627368X (final concentration 10 μmol/L) were added to the culture medium.The cells were then cultured for 48 h in groups PGE2,A and G.Then the cell morphology was observed by using fluorescent microscope.The cell diameter was measured by using the Image J medical image analysis system.Total protein content in the cells was measured with BCA method.The expression of atrial natriuretic peptide (ANP) mRNA and brain natriuretic peptide (BNP) mRNA in the cytoplasm was determined using RT-PCR.Results Compared with group C,the total protein in the cells and cell diameter were significantly increased,and the expression of ANP mRNA and BNP mRNA in the cytoplasm was up-regulated in groups PGE2,A and G (P ＜ 0.05).Compared with group PGE2,the total protein in the cells and cell diameter were significantly decreased,and the expression of ANP mRNA and BNP mRNA in the cytoplasm was downregulated in group G (P ＜ 0.05),and no significant change was found in the parameters mentioned above in group A (P ＞ 0.05).Conclusion EP4 receptor mediates H9c2 cardiomyocyte hypertrophy induced by PGE2 and the effect is not related to EP1 and EP2.