Objective To explore the usefulness of enhanced patient education in increasing the patients' knowledge and awareness of peripherally inserted central catheter (PICC) protection.Methods Totally 200 patients with PICC in Neijiang First People's Hospital from June 2009 to June 2012 were divided into control group (odd numbers,conventional patient education,n =100) and observation group (even numbers,enhanced patient education,n =100) according to their admission numbers.The patients' knowledge and awareness of PICC protection were analyzed after treatment,and the incidences of adverse events and catheter indwelling time were also compared between these two groups.Results Compared with the control group,the observation group had significantly higher PICC protection knowledge rate (91％ vs.78％,P =0.001),awarehess rate (95％ vs.80％,P=0.011),lower incidence of adverse events (1％ vs.5％,P =0.034),and longer PICC indwelling time [(125.8 ± 10.6) d vs.(106.7 ±8.2) d,P =0.026].Conclusion Enhanced patient education can effectively enhance the patients' knowledge and awareness of PICC protection.

Objective To observe the effect and mechanism of Ligustrazine ( LIG ) on the Airway smooth muscle( ASM) of isolated guinea pigs. Methods The normal guinea pig bronchus were made into tra-chea spiral,and randomly divided into LIG group, LIG+Propranolol group, LIG+Atropine, LIG+Nifedipine group,LIG+Glibenclamide group and the control group. The effect of different concentrations of LIG on the ASM was respectively observed in the resting tension and the high tension caused by histamine,and the ASM re-laxation rate were compared between each groups. Results (1)It had diastolic function for LIG on the isolated guinea pigs ASM in the resting tension and the high tension caused by histamine. (2)In the resting tension,com-pared with the group LIG,the diastolic function was antagonism by the concentration of LIG 10-7 ~10-6. 5 mol/L in the group LIG+Propranolo (P<0. 05). The diastolic function had no significant difference by the concentra-tion of LIG 10 -7.5 ~10 -3 mol/L in the group LIG+atropine and LIG+Glibenclamide(P>0. 05). The diastolic function was improved remarkably by the concentration of LIG 10 -6 ~10 -4 mol/L,in the group LIG+Nifedip-ine (P<0. 05). (3)In the high tension caused by histamine,compared with the group LIG,the diastolic function was antagonism obviously by the concentration of LIG 10 -6. 5 ~ 10 -5 mol/L in group LIG+Propranolol ( P<0. 05);The diastolic function had no significant difference by the concentration of LIG 10 -8 ~10 -3 mol/L in group LIG+atropine,and LIG+Glibenclamide (P>0. 05);The diastolic function was improved remarkably by the concentration of LIG 10 -6.5 ~10 -5 mol/L in group LIG+Nifedipine (P<0. 05). Conclusion It has dias-tolic function for LIG on the isolated guinea pigs ASM in the resting tension and the high tension caused by his-tamine. The effect and mechanism may be related with the competitive exciting beta 2 receptor and the inhibitor of Ca2+ internal flow. It provides a theoretical basis for the clinical application of LIG in treating asthma.

Objective To investigate the protective effect and mechanism of recombinant hirudin on avulsed flap and to explore the application of recombinant hirudin in clinical treating avulsed flap.Methods 108 Sprague-Dawley rats were randomly divided into three groups:local injecting recombinant hirudin (group A),local injecting low molecular heparin (group B),and local injecting physiological saline (group C).The far ends were sutured after forming dorsal avulsed flap with local freeing.The levels of P-selectin and VEGF were detected,and the inflammatory cell aggregation and formation of microthrombus were observed in pathological section.On 14th postsurgery day the survival rate of flap was calculated.Results The content of P-selectin in group A was lower than that of groups B and C,with a statistical difference (P＜0.05).The content of VEFG in group A was higher than that of groups B and C,with a statistical difference (P＜0.05).On 14th postsurgery day,group A was higher than that in groups B (P＜0.05)and C (P＜0.01) in the survival rate of flap.Conclusions Locally injected recombinant hirudin can actively suppress the production of P-selectin,reduce accumulation of inflammatory cells,prevent information of microthrombus,improve ischemia and anoxia of avulsed flaps,decrease injuries of endotheliocyte,enhance the expression of VEGF,and stimulate hyperplasia of neogenesis capillaries that elevate survival rate of avulsed flaps.

Several key issues in the diagnosis of osteoporosis were discussed. The definition of osteoporosis and some concepts in bone fracture risk evaluation were explained, so as the methods to avoid the common misunderstandings in clinical practice. Finally, the parameters used in determination of bone metabolism and bone mass were listed, and their application and limitation were analyzed. It may help the clinicians to make correct choice of these parameters.

Currently the most effective treatment strategy for breast cancer is standardized multi-discipline comprehensive treatment. However, there are no effective models that can accurately predict prognosis, so that no guidance of individualized treatment has yet been set up, resulting in a proportion of patients with low risk who received chemotherapy with little benefit. With the development of genomics, several gene sets have been demonstrated to be helpful in predicting of breast cancer prognosis and grading the patients' benefit from chemotherapy, thus avoid overtreatment. 21-gene Oncotype Dx was reported as one of them and has been demonstrated to be effective and accurate in various clinical studies. This paper summarizes researches on 21-gene Oncotype Dx in breast cancer.

AIM: To explore transdifferentiation potential of Sca-1 + cells from murine fetal liver. METHODS: 2?10 3 of Sca-1 + cells from male murine fetal liver were transfused into female mouse irradiated lethally with ? ray from 60 Co source (10 Gy) via tail vein. Two months later, FISH and immunohistochemistry were used to detect the situation for transdifferentiating of the donor cells (male cells) in tissues of female recipient mouse. RESULTS: The renal tubular epitheliocyte-like and neurocyte-like cells with Y chromosome were found on the sections of renal and brain tissues from female recipient mice. These cells have phenotype characteristics of RCA+/CD - 45 F - 4/80 and NueN +/CD -45 F - 4/80, respectively. CONCLUSION: The evidence is provided for Sca-1 + cells from murine fetal liver to transdifferentiate into both renal and brain tissue cells.

Objective To evaluate the clinical value of serum amyloid protein(SAA),C-reactive protein (CPR)and SAA/CRP ratio in early diagnosis of influenza A in children. Method SAA,CRP,SAA/CRP ratio and serum white blood cell(WBC)count were measured in 417 children. One hundred and thirty-nine children were diagnosed with Influenza A and were enrolled in the influenza A group ,and the other 278 healthy children were enrolled in the control group from April 2016 to June 2016. The values of the screened biomarkers for diagno-sis of influenza A were assessed by ROC curve analysis. Results Levels of SAA,CRP and SAA/CRP ratio in the influenza A group were significantly higher than those in the control group(P<0.001,respectively). The areas un-der the ROC curve of SAA and SAA/CRP ratio for the diagnosis of influenza A were higher than 0.7(P<0.001). The optimal cut-off values of SAA and SAA/CRP ratio for the diagnosis of Influenza A were 10.500 mg/L and 6.165,respectively. The corresponding sensitivities of the optimal cut-off values for the diagnosis of influenza A were 85.5% and 55.4%,respectively,and the corresponding specificities were 96.8% and 91.4%,respectively. Conclusion Measurement of SAA and SAA/CRP ratio are valuable biomarkers for clinical in early diagnosis of in-fluenza A and SAA has a better diagnostic performance than CRP.

Objective:To compare and analyze the changes and the influencing factors of out of pocket(OOP) expenditure before and after the new medical reform.Methods:2000-2015 time series data was used to compare the changes of OOP in different years.The cross-section data was applied to compare the OOP of China and other countries.The principle component analysis method was used to research the contribution rates of different factors for the OOP ratio changes.Result:According to the vertical comparison,it found that the OPP ratio showed steady decreasing trend.The horizontal comparison found that there were great gap for OOP ratios of China and other countries.The per capita GDP,under five mortality and proportion over 65 years were significant factors for OOP.Conclusion:The OOP ratio still needed to be devreased,which needed to promote the economic growth,implement medical insurance system,improve the public health input and decrease the health economic burden for residents.

Objective To discuss the pathological morphological features of the macrofollicular variant of papillary thyroid carcinoma ( MFPTC ) .Methods Clinical data of 2 cases of MFPTC were reviewed .The his-topathological and immunohistochemical features were analyzed .Relevant literatures were reviewed .Results The histological characters of MFPTC mainly included its multiple macrofolliculus , plenty of colloid and atypical nuclear morphology.Immunohistochemistry stain showed cytokeratin-19, Galectin-3 and HBME-1 expressed simultaneously. Conclusions MFPTC is a thyroid papillary carcinoma with unique histological characters .It should be differen-tially diagnosed from some benign lesions such as nodular goiter and follicular adenoma .Immunohistochemical stain of cytokeratin-19, Galection-3 and HBME-1 may be very helpful in the diagnosis and differential diagnosis .

Objective To observe the effect of Montelukast (MTL)on the airway smooth muscle(ASM)iso-lated from asthmatic guinea pigs.Methods The bronchus of asthmatic guinea pigs were made into trachea spiral. These bronchus were divided into 6 groups:MTL group,MTL +Nifedipine group,MTL +Glibenclamide,MTL +Prop-ranolol group,MTL +Atropine group and control group.The effect of different concentrations of MTL on the ASMin the resting tension was observed and the ASMrelaxation pigs were compared among the groups.Results MTL in 1 0 -7.5 -1 0 -3.0 mol/L had diastolic effect on the asthmatic guinea pigs ASM[(0.31 ±0.1 2)% -(99.61 ±0.40)%],and compared with the control group,there were significant differences[0 -(1 2.77 ±0.33)%,all P <0.05].In the resting tension of asthmatic guinea pig ASM[(1 1 .48 ±1 .63)% -(94.03 ±1 .87)%],the diastolic function was remarkably improved at 1 0 -6.0 -1 0 -3.5 mol/L of MTL in MTL +Nifedipine group,and the differences among the groups had statis-tical significance (all P <0.05).The diastolic function was antagonism at 1 0 -7.5 -1 0 -6.5 mol/L of MTL in MTL +Pro-pranolol group [(0.1 6 ±0.07)% -(2.73 ±0.84)%]and the differences among the groups had statistical signifi-cance (all P <0.05).The diastolic function had no significant difference between 1 0 -8.0 -1 0 -3.0 mol/L of MTL in MTL +Atropine group and MTL +Glibenclamide group (all P >0.05).Conclusions It has diastolic function for MTL on the isolated asthmatic guinea pigs ASMin the resting tension.The effect may be related with inhibitor of Ca2 + inter-nal flow and the competitive exciting β2 receptor.