Objective:To analyze the effect and safety of levonorgestrel-releasing intrauterine system(LNG-IUS) for the premenopausal patients with breast cancer who took tamoxifen as adjuvant therapy.Methods:From June 2014 to June 2016, 84 patients with breast cancer who met the inclusion criteria in the First People′s Hospital of Xiaoshan District were randomly divided into two groups according to the digital table.The treatment group (39 cases) underwent LNG-IUS insertion, while the control group (45 cases) received no LNG-IUS insertion.The general condition of patients before the use of tamoxifen and LNG-IUS was evaluated.Transvaginal ultrasound was used to measure the thickness of endometrium, hysteroscope was used for pathological examination of endometrium and the measurement of ER/PR expression, and blood lipid level was also detected.All above was done before the treatment of tamoxifen and LNG-IUS, 1 year after treatment and 2 years after treatment.Results:Before the therapy, there were no statistically significant differences between the two groups in general condition and uterine cavity condition(all P>0.05). After 1 year, the incidences of endometrial polyp, endometrial hyperplasia/secretion, benign lesion and endometrial atrophy in the treatment group were 2.6%, 5.1%, 15.4%, 76.9%, respectively, which in the control group were 6.7%, 20.0%, 17.8%, 55.6%, respectively.the differences between the two groups were statistically significant(χ 2=4.06, 4.22, all P<0.05). After 2 years, the incidences of endometrial polyp, endometrial hyperplasia/secretion, benign lesion and endometrial atrophy in the treatment group were 0.0%, 2.6%, 84.6%, respectively, which in the control group were 11.1%, 15.6%, 60.0%, respectively, the differences between the two groups were statistically significant(χ 2=4.608, 4.092, 6.203, all P<0.05). Conclusion:LNG-IUS can prevent the benign endometrial lesions of breast cancer patients caused by tamoxifen therapy after surgery, and can decrease the incidence of endometrial polyp and endometrial hyperplasia/secretion, while increase the incidence of endometrial atrophy, without increasing the recurrence risk of breast cancer.

Objective To observe the effect of Dexmedetomidine (DEX)on induction peri-od of hemodynamics in patients undergoing general anesthesia combined with epidural block.Meth-ods A total of 40 hysterectomy patients in optional period (ASA Ⅰ~Ⅱ)were randomly divided into Dexmedetomidine group(Group D)and Propofol group(P group).Group D received continuous epidural anesthesia with infusion of DEX 0.5 μg /(kg·h)and endotracheal intubation was applied after general anesthesia.Group P was given the same therapy with group D except dexmedetomi-dine.HR,SBP,DBP and MAP of the hemodynamic index were recorded at the time of entering the operation room(T1),after the determination of epidural plane(T2),pre-intubation(T3),intu-bation(T4),immediately after trachea intubation(T4),and the beginning of operation(T4).Results The difference was not statistically significant in the index between the two groups at T1 .HR of group D was lower than that in group P at all-time points(P <0.05).SBP,DBP and MAP of group D were higher than group P at T2,T3 and T4(P <0.05).SBP,DBP,MAP of group D were lower than group P at T5 and T6(P <0.05).SBP、DBP and MAP in group D at T2、T3 and T4 were higher than that in the group P (P <0.05).Conclusion Dexmedetomidine can offer a stable hemo-dynamics in the patients with general anesthesia combined with epidural block.

Objective To observe the effect of Dexmedetomidine (DEX)on induction peri-od of hemodynamics in patients undergoing general anesthesia combined with epidural block.Meth-ods A total of 40 hysterectomy patients in optional period (ASA Ⅰ~Ⅱ)were randomly divided into Dexmedetomidine group(Group D)and Propofol group(P group).Group D received continuous epidural anesthesia with infusion of DEX 0.5 μg /(kg·h)and endotracheal intubation was applied after general anesthesia.Group P was given the same therapy with group D except dexmedetomi-dine.HR,SBP,DBP and MAP of the hemodynamic index were recorded at the time of entering the operation room(T1),after the determination of epidural plane(T2),pre-intubation(T3),intu-bation(T4),immediately after trachea intubation(T4),and the beginning of operation(T4).Results The difference was not statistically significant in the index between the two groups at T1 .HR of group D was lower than that in group P at all-time points(P <0.05).SBP,DBP and MAP of group D were higher than group P at T2,T3 and T4(P <0.05).SBP,DBP,MAP of group D were lower than group P at T5 and T6(P <0.05).SBP、DBP and MAP in group D at T2、T3 and T4 were higher than that in the group P (P <0.05).Conclusion Dexmedetomidine can offer a stable hemo-dynamics in the patients with general anesthesia combined with epidural block.

[Abstract]? Objective? To investigate the current situation of negative leadership behavior in hospital nursing management, analyze the relationship and influence between negative leadership behavior and nurses' sense of professional mission and patients' satisfaction, and provide theoretical basis for reducing negative leadership behavior in nursing management and improving nurses' sense of professional mission and nursing quality. Methods? From January 2017 to July 2018, 260 clinical nurses from three hospitals in Hangzhou were selected by convenience sampling method. General Information Questionnaire, Negative Leadership Scale, Professional Mission Questionnaire and Nursing Job Satisfaction Scale were used in the questionnaire survey. The negative leadership behavior in hospital nursing management and its influence on nurses' sense of professional mission and patients' satisfaction were analyzed. A total of 271 questionnaires were distributed to the nursing staff and 260 valid questionnaires were retrieved. Results? Among the 260 nurses surveyed, 22.69% encountered autocratic and selfish leadership, 30.77% encountered unfaithful leadership, 55.00% experienced constructive leadership, and the total average score of items in Negative Leadership Scale was (1.58±0.76). Autocratic and selfish leadership behavior was negatively correlated with nurses' sense of professional mission and nursing quality (P＜ 0.01), unfaithful leadership behavior was negatively correlated with nurses' sense of professional mission and nursing quality (P＜ 0.01), and constructive leadership behavior was positively correlated with nurses' sense of professional mission and nursing quality (P＜0.01). Conclusions? There are some arbitrary, selfish and unfaithful negative leadership behaviors in hospital management, which have a negative impact on nurses' sense of professional mission and patients' satisfaction. Effective measures should be taken to intervene.

OBJECTIVE To explore the effects of irbesartan（Irb）combined with 5-fluorouracil（5-FU）on the proliferation and extracellular signal-regulated kinase （ERK）/peroxidase proliferator-activated receptor γ（PPARγ）signaling pathway of Lewis lung cancer cells. METHODS Lewis lung cancer cells from mice were divided into normal control （NC）group，Irb low-dose （LD）group（1×10－3 mmol/L），Irb high-dose （HD）group（1×10－1 mmol/L），5-FU group （10 μmol/L），Irb LD+ 5-FU group （Irb 1×10－3 mmol/L+5-FU 10 μmol/L）and Irb HD+ 5-FU group （Irb 1×10－1 mmol/L+5-FU 10 μmol/L）. MTT method was used to measure the activity of cell proliferation in each group. Plate colony formation experiment was used to determine the number of cell colonies formed in each group ；Western blot method was used to detect the expression levels of proliferating cell nuclear antigen （PCNA），p53，ERK1/2，p-ERK1/2 and PPAR γ protein in each group. RESULTS Compared with the NC group ，the cell proliferation activity ，the number of colonies formed and the protein levels of PCNA ，p-ERK1/2，and PPARγ were significantly reduced in the other five groups ，and the protein level of p 53 was significantly increased （P＜0.05）；the protein expression of ERK1/2 had no significant difference （P＞0.05）. The changes of above indexes in Irb LD+ 5-FU group and Irb HD+ 5-FU group were more significant than Irb LD group ，Irb HD group and 5-FU group （P＜0.05）. CONCLUSIONS Irb combined with 5-FU can inhibit the proliferation of Lewis lung cancer cell ，and the effect is better than that of the two alone. The mechanism may be related to the inhibition of ERK/PPARγ signal pathway.