Objective: To explore and compare the clinical and pathologic features of breast cancer between the young women (< 40 years old) and the elder women (≥ 40 years old), and to evaluate the overall survival. Methods: There were 1393patients with breast cancer hospitalized in Department of Surgical Oncology, Sir Run Run Shaw Hospital, Medical College, Zhejiang University between August 1996 and April 2011. After exclusion of 15patients whose information of age was missed, 1378patients (194young and 1184elder patients) were included in this retrospective study. breast cancer patients who received treatment in Sir Run Run Shaw Hospital were retrospectively analyzed. The clinicopathological features and the survival were compared between the young and the elder patients. All patients were followed-up, and 218 were lost. The prognostic factors for all patients and young patients were analyzed, respectively. Results: The molecular subtypes, T stage, N stage and the rate of breast-conserving radical surgery were significantly different between the young and the elder patients (P < 0.05), but the positive rates of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER2) and the stages of M and TNM were not significantly different (P > 0.05). The proportion of Luminal B was higher in the young patients than that in the elder patients. The median survial time was not significantly different between the young and the elder patients (58.2 vs 45.8 months, P > 0.05). The univariate analysis revealed that PR-negative and lymph node and distant metastases were associated with lower five-year survival rate in young patients (P < 0.05). The multivariate analysis revealed that lymph node and distant metastases were independent prognostic factors in young patients (P < 0.05). Conclusion: Young patients with breast cancer have more poor prognostic factors than the elders, such as later stages of tumor size and lymph node, more proportion of type Luminal B, and higher rate of breast-conserving radical surgery, but the overall survival between the young and the elder patients had no significant difference.

AIM: To discuss the effect of Smart Plug canalicular plug on aqueous-deficient dryeye.
METHODS:Forty-eight cases of aqueous-deficient dry eye patients in our hospital from May 2012 to April 2013 were selected for the study. After treated by Smart Plug canalicular plug, postoperative clinical efficacy, foundation Schirmer I test ( SIt) , tear film break-up time ( BUT ) , corneal fluorescein staining ( FL ) changes were observed.
RESULTS: Forty-eight patients were cured, 31 cases were markedly effective(65%), effective 14 cases (29%), invalid in 3 cases (6%), the total effective rate was 94%. Before treatment, SⅠt, BUT, and FL was ( 3. 49±1. 24 ) mm/5min, ( 3. 15±1. 07 ) s, and ( 2. 52±0. 11 ) points, respectively. After treatment, SIt, BUT, FL were significantly improved compared with before treatment, the difference was statistically significant (P<0. 05). One patient had postoperative foreign body sensation, 8h after shedding emboli; One patient granulation tissue after surgery 8mo, canalicular plug off. The remaining cases had no inferior lacrimal duct infection or granuloma.
CONCLUSION: Smart Plug canalicular plug is an effective treatment for aqueous-deficient dry eye, can effectively relieve symptoms, worthy of promotion.

Objective To systematically evaluate the application of problem-based learning (PBL)in the teaching process of health management major in China.Methods Databases including CNKI (1979 to December the 2015),VIP (1989 to December the 2015),Wanfang (1982 to December the 2015) and PubMed were systematically retrieved.Any literature about PBL of health management major was included.Seffdeveloped data extraction form was used for collecting the information.Data were input and analyzed using Excel 2007.Results 15 papers were included in the analysis.The first author mainly came from the northeast region of China (7).Most (10) papers did not get the funding support.No paper was published in the journals contained in the Guide to the Core Journals of China.6 papers of experimental studies compared the performance difference of students of the PBL and lecture-based learning (LBL),which was statistically significant.Conclusion PBL is superior to the LBL.However,due to the large difference in the quality of literature,more studies were needed to determine the effect of PBL.Moreover,we should pay attention to the combination of PBL and LBL.

Objective To explore the clinical effect of patients of oral and maxillofacial space infection treated with improved closed negative pressure drainage combined with hyperbaric oxygen, and the possibility of using this method to decrease the hospital expenses. Methods 156 patients with oral and maxillofacial space infection were divided into control group, closed negative pressure drainage group and improved closed negative pressure drainage combined with hyperbaric oxygen group by random number table. 52 patients in each group. The granulation tissue growth time, the healing of wound, clinical effect of the 8thday, hospitalization days, wound healing time, antibiotic cost, average cost in hospital were recorded after treatment. Results The average wound healing time of patients in improved closed negative pressure drainage combined with hyperbaric oxygen group was(6.06 ± 0.23)days, while the granulation tissue growth time was(16.13 ± 2.89)days, both of them were much shorter than the control group[(15.46 ± 4.68)days and(28.60 ± 3.50)days respectively],as well as the closed negative pressure drainage group [(7.43 ± 0.75) days and (22.67 ± 4.34) days respectively], and the differences were statistically significant which the F values equaled to 6.213 and 8.451, P values all less than 0.05. The total healing rate of patients in closed negative pressure drainage group and improved closed negative pressure drainage combined with hyperbaric oxygen group were both 100.00%(52/52), the difference was statistically significant compared with control group (χ2=6.89, P<0.05). The average hospitalization days of the patients in the closed negative pressure drainage group and improved closed negative pressure drainage combined with hyperbaric oxygen group were (8.20 ± 1.49) days and (7.45 ± 0.42)days, the antibiotic cost were(5 068.34 ± 1 074.68)RMB and (5 001.00 ± 456.00) RMB, the average total cost were (9 457.43 ± 647.23)RMB and (9 249.00 ± 367.00)RMB, all these indexes were much lower that which in control group[(18.40 ± 5.89)days,(21 000.43 ± 2 036.48) RMB and (31 000.66 ± 2 711.36) RMB], and the differences were statistically significant, F values equaled to 15.221, 29.434 and 81.220 each, P values were all less than 0.01. Conclusions Improved closed negative pressure drainage combined with hyperbaric oxygen method could improve the clinical effect of patients with oral and maxillofacial space infection, speed up the granulation tissue, shorten the in-hospital time as well as reduce the medical cost.

OBJECTIVETo evaluate diffusion tensor tractography (DTT) of white matter in prognosis of acute lacunar infarctions.

METHODSTwenty-eight patients of pyramidal tract strokes at the acute phase (<3 days) with a marked motor defect were examined. Lesions were identified on diffusion weighted imaging and isotropic imaging of DTI, and infarctions and the tract were shown on the DTT images simultaneously. The anatomic location and pattern of the lesions were visualized on DTT, with regard of the corticospinal tract (CST), all patients were divided into three clinical subgroups: in Group 1 infarction lesions were close to CST, in Group 2 CST was partial involved, in Group 3 lesions centered in the pyramidal tract. Subsequently, they were compared with the National Institutes of Health Stroke Scale (NIHSS) scores at acute phase (<3 days), early chronic phase (8 approximately 14 days), and outcome(30 approximately 60 days).

RESULTNIHSS scores of Group 1(12/28) were not different with those of Group 2 (11/28) at the acute phase (U=-1.430, P>0.05), and NIHSS scores in Group 2 were significantly lower than those of Group 3(5/28) (U= -2.676, P <0.01). In the outcome, NIHSS scores of Group 1 were significantly lower than those of Group 2 (U= -2.501, P<0.05), NIHSS scores of Group 2 were significantly lower than those of Group 3 (U= -2.948, P<0.01). Among these three groups,Group 1 all had good recovery, Group 2 also had good recovery but sometimes with some mild motor disfunction, and Group 3 always had marked defect and minor improvement. Both rADC value and rFA value were induced in the acute lacunar infarctions.

CONCLUSIONDTT is helpful in prognestic valuation of acute lacunar infarction by providing visualized stereo localization of CST and infarction lesions.

Brain ; pathology ; Brain Infarction ; diagnosis ; pathology ; Diffusion Magnetic Resonance Imaging ; methods ; Female ; Humans ; Imaging, Three-Dimensional ; methods ; Male ; Middle Aged ; Nerve Fibers, Myelinated ; pathology ; Prognosis

The gene-expression changes related with precancerous lesion of gastric cancer (PLGC) are surveyed. Not only the regulative effect of traditional Chinese medicine (TCM) on oncogene, antioncogene and anti-apoptosis gene that are related with PLGC is analyzed, but also current research state is presented. It's showed that TCM has effects of therapy and inversion on PLGC. These effects are related with the inhibition to related oncogene expression, the regulation and activation to the deletion of antioncogene, the inhibition to the high-expression of mutant gene-protein about antioncogene, and the regulative function to anti-apoptosis gene.
Animals ; Apoptosis ; genetics ; Gene Expression ; Humans ; Medicine, Chinese Traditional ; Oncogenes ; Precancerous Conditions ; genetics ; Stomach Neoplasms

Purpose: To construct an index system to evaluate the competencies of nurses in enhanced recovery after surgery (ERAS) programs and provide a scientific foundation for their training and assessment. Methods: Utilizing a literature review and semi-structured interviews, a preliminary indicator system was constructed. Based on the preliminary indicator system, a Delphi questionnaire was developed and utilized to achieve consensus among experts in two rounds of Delphi studies. The indicators were selected based on a mean importance score greater than 4 and a coefficient of variation less than .25. The weights of the indicators were calculated using the Analytic Hierarchy Process. Results: The study developed a system that evaluates the competencies of nurses involved in ERAS programs, offering a reference for their training and evaluation. The final index system includes 7 primary indicators, 20 secondary indicators, and 66 tertiary indicators. The primary indicators consist of competencies in the following components: 1) Direct clinical practice (20 items); 2) Expert coaching and guidance (9 items); 3) Consultation (6 items); 4) Research (7 items); 5) Leadership (11 items); 6) Collaboration (8 items); and 7) Ethical decision-making (5 items). Conclusion The developed competency evaluation index system is reliable and can serve as a foundation for the selection, training, and assessment of ERAS nurses.

Purpose: To construct an index system to evaluate the competencies of nurses in enhanced recovery after surgery (ERAS) programs and provide a scientific foundation for their training and assessment. Methods: Utilizing a literature review and semi-structured interviews, a preliminary indicator system was constructed. Based on the preliminary indicator system, a Delphi questionnaire was developed and utilized to achieve consensus among experts in two rounds of Delphi studies. The indicators were selected based on a mean importance score greater than 4 and a coefficient of variation less than .25. The weights of the indicators were calculated using the Analytic Hierarchy Process. Results: The study developed a system that evaluates the competencies of nurses involved in ERAS programs, offering a reference for their training and evaluation. The final index system includes 7 primary indicators, 20 secondary indicators, and 66 tertiary indicators. The primary indicators consist of competencies in the following components: 1) Direct clinical practice (20 items); 2) Expert coaching and guidance (9 items); 3) Consultation (6 items); 4) Research (7 items); 5) Leadership (11 items); 6) Collaboration (8 items); and 7) Ethical decision-making (5 items). Conclusion The developed competency evaluation index system is reliable and can serve as a foundation for the selection, training, and assessment of ERAS nurses.

Purpose: To construct an index system to evaluate the competencies of nurses in enhanced recovery after surgery (ERAS) programs and provide a scientific foundation for their training and assessment. Methods: Utilizing a literature review and semi-structured interviews, a preliminary indicator system was constructed. Based on the preliminary indicator system, a Delphi questionnaire was developed and utilized to achieve consensus among experts in two rounds of Delphi studies. The indicators were selected based on a mean importance score greater than 4 and a coefficient of variation less than .25. The weights of the indicators were calculated using the Analytic Hierarchy Process. Results: The study developed a system that evaluates the competencies of nurses involved in ERAS programs, offering a reference for their training and evaluation. The final index system includes 7 primary indicators, 20 secondary indicators, and 66 tertiary indicators. The primary indicators consist of competencies in the following components: 1) Direct clinical practice (20 items); 2) Expert coaching and guidance (9 items); 3) Consultation (6 items); 4) Research (7 items); 5) Leadership (11 items); 6) Collaboration (8 items); and 7) Ethical decision-making (5 items). Conclusion The developed competency evaluation index system is reliable and can serve as a foundation for the selection, training, and assessment of ERAS nurses.

This article reports a case with the chief complaint of “hepatosplenomegaly to be investigated” and a confirmed diagnosis of Niemann-Pick disease type B after various tests， and a literature review was conducted to summarize the heterogeneous manifestations of liver involvement in type B Niemann-Pick disease， in order to improve the clinical management of difficult and rare liver diseases.