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.

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.

Conductive education is an education system aiming at helping the handicapped people improve the impaired and abnormal function through education. This article started from the current status of conductive education in clinical rehabilitation and analyzed the causes for imbalance between supply and demand of conductive education professionals. Meanwhile strengthening and ex-panding the coverage and strength of general conductive education was proposed and bringing con-ductive education into the compulsory course of rehabilitation therapy major was recommended. Finally, training conductive educational professionals with high-quality was regarded as the most fundamental measure to solve these problems.

Objective: To evaluate the effectiveness of the Demin Circle in on-site first-aid training among fishermen, so as to provide insights into improving the on-site first-aid knowledge and skills among fishermen. Methods : Deep-sea male fishermen were sampled from Putuo District of Zhoushan City, Zhejiang Province and randomly assigned to the intervention and control groups. Participants in the control group received training pertaining to conventional first-aid knowledge, while participants in the intervention group were given the Deming Circle. The knowledge, awareness and skills of on-site first-aid, and satisfaction with the first-aid training were evaluated among fishermen before and after the training using questionnaire surveys and on-site first-aid skill operations. Results: A total of 327 questionnaires were allocated, and 273 valid questionnaires were recovered, with an effective recovery rate of 83.49%. There were 132 respondents in the control group and 141 in the intervention group, and there were no significant differences between the two groups in terms of age or educational level ( P>0.05 ). The increase of the score of on-site first-aid knowledge, proportion of active learning of on-site first-aid knowledge, proportion of active elimination of potential dangers and proportion of active implementation of on-site first-aid, and seizing the skills of cardiopulmonary resuscitation, trauma first-aid, airway foreign body disposal and calling the police were all higher in the intervention group than in the control group ( P<0.05 ). Following training, the score of satisfaction with the training was significantly higher in the intervention group than in the control group [( 9.13±0.49 ) vs. ( 7.08±0.72 ) points, P<0.05 ], and the score of willingness to continue the enrollment in the Deming Circle was significantly greater in the intervention group than in the control group [( 65.13±3.11 ) vs. ( 43.62±3.79 ) points, P<0.05 ]. Conclusion Deming Circle is superior to conventional first-aid training for improving the effectiveness of on-site first-aid training among fishermen.

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.

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.

The Auditory Apperception Measurement Model (AAMM) is often used to test the ability of people's auditory learning. Through learning auditory signals,the testees' apperception abilities are tested under different process of learning. In this paper,the AAMM is built,and the design and realization of the software is introduced.

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 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.