Nco-adjuvant endocrine therapy has provided opened new alternatives for locally advanced breast cancer, especially for patient groups such as the elderly, those who are not suited for chemotherapy, and those whose response may not be optimal. The latest generation of endocrine therapy for breast cancer,aromatase inhibitors, has proved superior to tamoxifen in terms of toxicity and efficacy in the adjuvant setting.Compared with neo-adjuvant chemotherapy, the appropriate patients to receive nco-adjuvant endocrine therapy can achieve similar short-term benefit. However, because of fewer long-term follow up results, the overall prognosis is not clear.

Objective: To analyze the efficiency and differences of China Community Health Service, to analyze the shares of eastern-middle-western regional differences and the difference within each region in the total efficiency difference. Methods: The super efficiency DEA model and decomposition of Gini coefficient by Subgroups are used to analyze the provincial data in China from 2008 to 2011. Results: The eastern-central-western regional difference is the major cause of the efficiency differences in China Community Health Service. In the meantime, the shares of the difference within each region in the total efficiency difference are also non-negligible. Conclusion: To narrow the efficiency differences among eastern, central and western areas; improve the inter-regional flow of community health service resources; improve the support and supervision on the backward regions; make regional policies to coordinate the internal resources of community health services and strengthen the assessment mechanism using efficiency as the indicator.

Transcatheter closure as an alternative to medical surgery has become a preferred therapeutic method to atrial septal defect (ASD).However,thrombopoiesis after occluder implantation has been reported comprehensively and causes a series of serious complications such as cerebral embolism、myocardial infarction,pulmonary embolism and so on.Reasons of device thrombopoiesis are closely associated with atrial fibrillation,persistent atrial septal aneurysm,occluder type,activated coagulation system and occluder endothelialization process.This paper summarizes correlation factors of occluder thrombopoiesis and current related prevention proposal after transcatheter closure of ASD,and provides theoretical and experimental foundation for prevenition of device thrombopoiesis after occluder implantation of ASD.

New technologies and ideas are constantly emerging recently. With the arrival of the era of minimally invasive surgery, most of the colorectal cancer surgeries can be conducted through minimally invasive techniques. In this study, we discuss the status, characteristics, controversy, and consensus of minimally invasive techniques in colorectal cancer surgery.

The restriction factors in organizing the high-level and substantiality international cooper-ation were analyzed in this paper from investments, managements, evaluation, intellectual property right pro-tection and independent innovation in previous titular, unequal and injured international cooperations. The effctive principles were suggested to promote the international cooperation level in china, such as insisting the reasonable investments, standardized managemet, equal status and mutual benefis.

Objective To investigate the significance of human cyomeg Movirus(HCMV)pp65 IgG antibody avidity index(AI)for the clinical diagnosis of HCMV primary infection through the experimental model of HCMV primaly infection in BALB/c mice.Methods 6～8 weeks,female,specific-pathogen-free BALB/c mice were divided into 5 groups.6 mice in each group. And he mice were injected with 2×106 PFU/m1,2×105 PFU/mi,2×104 PFU/ml,2×103 PFU/ml and 2×102 PFU/ml of HCMV intraperitoneally respectively. Another 6 mice were injected intraperitoneally with the maximum dose of HCMV kept at 56℃ for 30 min as inactivated virus group.And HF negative control group was established at same time. All the mice ere sacrificed to obtain brain and lung tissues for the following experiments after 1 montll.(1)Tissue samples obtained from mice were inoculated in human embryo fibroblasts(HF)monolayers after routine treatment for virus isolation.HCMV specific eytopathie effect(CPE) was observed bv inverted phase-contrast microscopy.HCMV UL83 DNA in the ultures as tested by PCR and pp65 antigen was detected by indirect immunofluorescence.(2)Extracted mRNA from tissue samples and HCMV pp67 mRNA were analyzed by reverse transcriptase PCR(RT-PcR).(3)Immunoglobulin M(IgM)antibody and immunoglobulin G(1gG)antibody avidity Was investigated for their usefulness in distinguishing primary genital HCMV infections rom nonprimary infections with ELISA kit using truncated pp65 protein.ResultsHCMV can be isolated in the tissues from the mice injected with 2×106 PFU/ml and 2×105 PFU/m1.RT- PCR and ELISA showed positive results in the same groups.The infective rates were 100%.The analysis of the low doses groups,inactivated group and HF negative ontrol group all showed negative results.Conclusions BALB/c mice can be infected with HCMV and appeared as primary infection after1 month.Determination of HCMV pp65 IgM and HCMV p065 IgG-AI by ELISA incorporated with virus isolation and RT-PCR are helpful for distinguishing primary infections from nonpfimary infections.The detection of HCMV p65 IgM and HCMV pp65 IgG-AI by ELISA utilizing recombinant protein pp5 as antigens can be used for preliminary screening.

Objective To detect the incidence and monality of the pediatric sepsis/severe sepsis,and to investigate the risk factors for poor prognosis in these patients.Methods From Jan.1 to Dec.31,2008,all pediatric patients admitted to PICU in Beijing Children's Hospital were prospectively surveyed.Both Chinese pediatric critical care scoring system and American guidelines for PICU admission and discharge were applied for screening subjects.The diagnosis criteria of pediatric sepsis/severe sepsis were made according to the definition determined on the International Pediatric Sepsis Consensus Conference held in the United States in early 2002.The qualified subjects were surveyed by questionnaire until discharge.After three months,the subjects were followed up by telephone.Results In a total of 742 children were screened.545 cases were critically ill,143 cases (26.2%) developed sepsis,and 104 cases (19.1%) deteriorated into a state af severe sepsis.Hospital mortality of severe sepsis was 21.2%,and that of sepsis was 0.7%.At the end of three months after discharged from hospital,mortality of severe sepsis was 30.8%.and that of sepsis was 1.4%.Patients under 3-year-old accounted for 72.5%.Pneumonia was the most common primary disease.The respiratory dysfunctions in severe sepsis cases were most common organ dysfunction (73.1%) . In surviving patients with severe sepsis,the PICU stay was significantly longer than that in deceased patients,and the PICU costs and average per capita costs were higher than the critically ill patients.Muhiple stepwise logistic regression analysis showed that pediatric critical illness score (PCIS score),capillary refilling Lime,respiratory dysfunction and hypoalbuminemia were the risk factors for death.Conclusions Sepsis/severe sepsis are common in the PICU,which have high mortality,high hospital charges.Infants and young children were the most commonly affected.Pneumoma was the most common primary disease.PCIS score.capillary filling time,respiratory dysfunction and hypoalbuminemia were the risk factors for death.

Long-term failure in choice of materials for artificial esophagus (AE) and in treating incidence of postoperative com-plications of esophageal cancer has resulted in lack of ideal AE regeneration. As one of the innate elements forming the human body, carbon possesses high tissue affinity. Artificial esophagus as the induced stent of esophageal regeneration is the best choice for replac-ing esophageal defects and for reintroducing oral feeding after cancer radical resection.

Objective To evaluate the role of extracelluar signal-regulated kinase (ERK)-cyclic AMP response element binding protein (CREB) signaling pathway in the spinal cord in naloxone-induced withdrawal response in morphine-dependent rats.Methods Fifty male adult SD rats,aged 2 months,weighing 200-250 g,in which intrathecal catheters were successfully implanted without complications,were randomly divided into 5 groups (n =10 each):group control (group C); group morphine dependence (group MD); group morphine withdrawal (group MW); group U0126 (ERK signaling pathway blocker); group dimethyl sulfoxide (DMSO,solvent for U0126).Morphine dependence was induced by increasing doses of subcutaneous morphine for 6 days.The initial dose of morphine was 10 mg/kg twice a day and was increased by 10 mg/kg twice every other day until 50 mg/kg on 6th day in groups MD,MW,U0126 and DMSO.Morphine withdrawal response was induced by intraperitoneal naloxone 4 mg/kg at 4 h after last morphine administration in groups MW,U0126 and DMSO.U0126 150μg (in DMSO 10 μl) and DMSO 10 μl were administered intrathecally at 30 min before naloxone administration in groups U0126 and DMSO respectively.Morphine withdrawal response (0=no withdrawal response,3 =severe response)and touch evoked agitation (0 =no agitation,2 =severe agitation) were observed and scored during 1 h after naloxone administration.The animals were then sacrificed and the spinal cord was removed for determination of the expression of phosphorylated ERK (p-ERK) and phosphorylated CREB (p-CREB) by immuno-histochemistry and Western blot.Results Morphine withdrawal significantly up-regulated the p-ERK and p-CREB expression in group MW compared with group C ( P ＜ 0.05).Withdrawal response score and touch evoked agitation score were significantly increased in groups MW,U0126 and DMSO as compared with group MD ( P ＜ 0.05).U0126 pretreatment significantly attenuated naloxone-induced increase in withdrawal response score and touch evoked agitation score and down-regulated p-ERK and p-CREB expression in group U0126 as compared with group MW ( P ＜ 0.05).Conclusion ERK-CREB signaling pathway in the spinal cord is involved in morphine withdrawal response in morphine-dependent rats.

ObjectiveTo study the effects of dl-3n-butylphthalide on study and memory abilities and hippocampus expression of MMP-9 in rat model of radiation injuries of brain.MethodsWistar rats were divided into radiation group radiated by linear accelerator and control group.Morris water test were taken to study the learning and memory ability of rats in each group before irradiation and 120 d after irradiation.ResultsMorris water maze test results showed that:in the academic test,compared with model group,high-dose butylphthalide group and low dose butylphthalide group had significantly shorter escape latency( (79.61 ± 7.17 )s,(43.64 ± 4.72)s,(42.15 ±4.19 ) s) and decreased number of errors ( 36.43 ± 6.59,14.58 ± 4.22,13.66 ± 3.91 ) (P ＜ 0.01 ).In the memory test,compared with model group,high-dose butylphthalide group and low dose butylphthalide group had significantly longer the former platform quadrant time respectively (30.09 ± 3.68 ) s,( 31.25 ± 3.17 ) s vs ( 17.57 ±4.29) s and faster swimming speed respectively (P ＜ 0.01 ).ConclusionButylphthalide can significantly reduce hippocampal neurons expression of MMP-9,which indicates that butylphthalide has curative effect on radiation brain injuries by regulating the expression of MMD-9.