Radiotherapy after breast conserving surgery for breast cancer is an important part of comprehensive therapy,and breast conserving surgery combined with radiotherapy for early stage breast cancer has been widely recognized.Modern radiotherapy techniques including three-dimensional conformal radiation therapy (3D-CRT) and intensity modulated radiation therapy (IMRT) have obtained reasonable application in breast conserving therapy.Radiation reaction and cosmetic result are important factors to evaluate radiotherapy after breast conserving surgery.Radiation reactions and cosmetic results of different radiotheraies are different and each has its own characteristics.

Pregnancy associated breast cancer (PABC) has many special characteristics,such as the clinical manifestation,pathology,diagnosis,treatment and prognosis.Due to the delay of diagnosis,the survival rate is low and the prognosis is poor.Early diagnosis and comprehensive individualized treatment with operation,radiotherapy and chemotherapy are needed to improve the prognosis of patients and prolong the survival period.

This paper analyzes the characteristics of the follow-up quality survey and evaluation of medical graduate students in China.It raises that the follow-up quality survey of graduate students in medical schools should be institutionalized,standardized and normalized; the survey and evaluation should be conducted through close cooperation with the relevant departments and training units; comparative studies on graduates of different years should be conducted; and the indicator system and survey content should value the characteristics of times,training units and subjects; Finally,specific technical issues such as when and to whom the evaluation and survey should be conducted,survey arrangements,evaluation methods,the diversity of participants and determination of results are discussed and suggestions are put forward.

Objective To explore the related factors influencing the condensate infection level in order to provide a reference for ventilator pipe care and reducing condensate infections.Methods A total of 80 patients using ventilator in ICU of the First Hospital of Liaoning Medical University was chosen as the research object,and the related factors influencing the condensate infection using correlation and regression analysis method were explored,and the regression model was estabhshed as well.Results Condensate infection were correlated with pipe length (r=0.837,P＜0.01),temperature difference between ward and gas in the pipe (r=0.875,P＜0.01),exhaled gas humidity (r=0.793,P＜0.01) and ventilation (r=0.932,P＜0.01),but the pipe length could not enter the regression equation (t=-0.09,P＞0.05),and the regression equation was y=-168.08 +9.96x1 (temperature difference) +0.33x2 (exhaled gas humidity) +20.98x3 (ventilation).Conclusions Pipe length,temperature difference between ward and gas in the pipe,exhaled gas humidity and ventilation were the influencing factors,and medical personnel can control the infection of condensate considering the influencing factors.

0.05).Side effects of group D were greater than other groups(? 2, P

Objective To evaluate the level situation of clinical doctors graduating from mil-itary medical university within a certain period, understand their career development, and explore and analyze the problems and deficiencies in doctoral education and training to provide reference for deep-ening the reform of clinical disciplines doctoral education. Methods Stratified random samples of 9 Hospitals were selected and the established evaluation index system of clinical discipline quality tracking and investigation questionnaire was used to evaluate doctoral quality. Evaluation was surveyed by self rating and other rating combination. Quality evaluation system contains 4 first level indicators such as the military and political quality, clinical, teaching and research level, the development po-tential as well as 15 second-level indexes. The scores of self-assessment and other evaluation were compared by Pearson rank correlation analysis. The corresponding indicator scores of different doctorate types were compared using the test of variance and the subject research and published papers were analyzed by χ2 inspection. Results The comprehensive score of graduated doctors is excellent, with self-evaluation score (92.72±7.06) and other evaluation score (93.61±8.05). Correlation coefficient is 0.33(P=0.04); The academic doctors have done better in publishing papers(χ2=5.97, P=0.01) and undertaking subject research(χ2=6.08, P=0.00), but poorer in clinical work compared with the doctors of professional degree. The assessed groups are inadequate in publishing high level papers and in un-dertaking research projects and doctors of different degree types have different cognition of the ele-ments of improving the quality. Conclusions Cultivating the doctors' clinical ability and innovation ability are the cores of deepening the reform of clinical doctoral education. We should focus on inno-vation ability , value the cultivation of the clinical professional doctoral degree and explore various joint evaluation systems to attain the goal of enhancing the education quality of doctors.

Objective To investigate the clinical outcome of post-traumatic tibial osteomyelitis treated by induced membrane technique combined with the antibiotic cement-coated locking plate.Methods A restrospective case series analysis was made on 71 cases of post-traumatic tibial osteomyelitis treated by induced membrane technique from September 2014 to September 2014.There were 55 males and 16 females, aged 18-60 years(mean, 37.4 years).Mean length of bone defect following debridement was 4.5 cm(range, 4-11 cm).Antibiotic cement-coated locking plates were used to provide the stability of the bone defects after one-stage debridement.Bone grafting and exchanging the plates with ntramedullary nails were done during the second-stage surgery.Parameters were monitored dynamically after operation to evaluate infection recurrence and bone healing, including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), clinical features(sinus formation, redness and swelling, warmth and pain) and X-ray films of the involved limbs.Results All patients were followed up for 13-25 months (mean, 19.5 months).There was no sign of recurring infection and CRP and ESR were normal in all cases after the first stage surgery.However, four cases (6%) had recurrent infection with sinus exudates and their CRP and ESR were abnormal after the second stage surgery, and further treatments were carried out on these patients.Follow-up showed bony union in all patients within mean 5.5 months (range, 4-6 months).Conclusion Induced membrane technique with antibiotic cement-coated locking plates for treatment of post-traumatic tibial osteomyelitis can shorten bone healing time and decrease infection recurrent rate without obvious impact on osteogenic activity.

Objective To evaluate the effects of different positions on cerebral blood flow in patients undergoing laparoscopic surgery.Methods Thirty patients of both sexes,aged 23-64 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective laparoscopic surgery,were included.Patients' position was changed using a random number table after induction of anesthesia.Patients were placed in the supine position and tilted 15° head-up or 15° head-down,and the parameters of the middle cerebral artery were monitored using the transcranial Doppler ultrasound.After admission to the operating room (baseline),after induction of anesthesia and before pneumoperitoneum,in the supine position,at head-up tilt and at head-down tilt,the mean blood flow velocity,pulsatility index,resistance index,mean arterial blood pressure (MAP) and heart rate were recorded.Results Compared with the baseline in the supine position,the MAP and bilateral mean blood flow velocity were significantly decreased at head-up tilt,and the MAP and bilateral pulsatility and resistance indices were significantly increased at head-down tilt (P＜0.05).Conclusion During laparoscopic surgery,head-up tilt can lead to a decrease in cerebral blood flow,and head-down tilt exerts no effect on cerebral blood flow.

Objective To determine whether the antiserum produced by immunizing mice with conotoxin GI coupled with bovine serum albumin (BSA) could neutralize GI conotoxin.Methods The GI-BSA was prepared by glutaraldehyde-coupled method,and the mice were immunized with the GI-BSA to produce antiserum.The antibody neutralization assay was used to test the detoxication of the antiserum.Results The SDS-PAGE protein electrophoresis showed that the coupling reaction of GI hapten with BSA was successful.The two distinct protein bands of GI-BSA were more than 120×103.Each mouse was immunized four times with 99 μg every two weeks.After the fourth immunization,the serum neutralization titer was more than 1:64 000.After the intraperitoneal injection of the mixture of 100 or 200 μl of the antiserum and different doses of GI,75% of the mice survived in the group with 100 μl of the antiserum and 1× LD50 GI(16.3 μg/kg).The same percentage of mice also survived in the group of with 200 μl of serum and 25.8 μg/kg of GI.Conclusion The antiserum produced by immunizing mice with GI-BSA exhibits significant detoxication activity to conotoxin GI.

ObjectiveTo determine endometrial thickness, endometrial volumeand, endometrial and subendometrial blood flows, by using transvaginal two-dimensional (2D) and three-dimensional (3D) ultrasound examination and to compare the value of all the parameters in the prediction of endometrial receptivity during in vitro fertilization-embryo transfer (IVF-ET) cycles.MethodsOne hundred and twenty patients undergoing IVF cycles were recruited for this study. Transvaginal 2D and 3D ultrasound examination was performed to determine endometrial thickness, endometrial volume, pulsatility index (PI), resisitance index (RI) , systolic/diastolic ratio (S/D) of endometrial, subendometrial blood flows , vascularization index (VI), flow index (FI) and vascularization flow index (VFI) of endometrial and subendometrial regions by experienced sonographers on the day of human chorionic gonadotropin (HCG) injection. Statistical comparison was carried out by Mann-Whitney test. The receiver operator characteristic (ROC) curve analysis was applied and the area under the curve (AUC) was calculated. Statistic analyses were performed using SPSS 13.0. The two-tailed value of was considered statistically significant.ResultsThere were no significant differences between the pregnant group and non-pregnant group in endometrial thickness, endometrial volume (P>0.05). Patients in the pregnant group had lower PI, RI and S/D of endometrial and subendometrial blood flows than those in the non-pregnant group (Z=-3.811,-3.097,-2.071, P=0.001, 0.001, 0.038), with statisticalsignificant difference. Patients in the pregnant group had higher VI, FI and VFI of endometrial and subendometrial regions than those in the non-pregnant group (Z=-1.970,-2.698,-1.981, P=0.490, 0.007, 0.048;Z=-2.098,-2.090,-2.115,P=0.036, 0.037, 0.034), with statistical significant difference. ConclusionsEndometrial and subendometria blood flows measured by transvaginal 2D and 3D ultrasound can be as a reliable indicator to assess endometrial receptivity and predict the pregnancy outcome. Among all the endometrial and subendometrial blood flow parameters, VI of endometrial and subendometrial are better predicators.