Background and purpose:Tamoxifen is the main endocrine therapy of premenopausal breast cancer with positive hormone receptors but numerous patients have developed advanced refractory breast cancer due to drug resistance.Our study investigated the role of combining oophorectomy and exemestane in the treatment of advanced refractory breast cancer.Methods:Oophorectomy was carried out in all patients.Exemestane was administered orally (25 mg/d) one week after the operation.The median time of progression (TTP),the median survival time as well as the survival rate were calculated using the Kaplan-Meier methods.Results:Seventeen patients ranging between the ages of 26 and 44 years (median:36 years) were treated resulting in an overall response rate of 64.70%,TTP was 8 months and the median survival time was 31 months.The survival rates for 1 year,3 years and 5 years were 88.24%,64.71%,29.41%,respectively.No grade Ⅲ and Ⅳ side effects appeared.Conclusion:Oophorectomy when combined with exemestane showed antitumor activity for advanced refractory premenopausal breast cancer through positive hormone receptor and it is also well-tolerated.

AIM: To study the inhibitory effects of domestic leuprolide acetate microsphere (LE-ms) on the growth of explanted endometrium in the rat models of EMT and its possible mechanisms. METHODS: The 60 rats models of EMT were induced surgically by the Jones method. Then the animals were treated with LE (20 ?g? -1?d -1,28 d,sc) , enanton(20 ?g? -1?d -1,sc) and domestic LE-ms (2, 20, and 200 ?g㎏ -1?d -1,sc), respectively; another 30 rats were divided into sham group(N.S, 1 ml?kg -1?d -1,21 d,sc), EMT+ LE group(100 ?g?kg -1?d -1,21 d,sc)and EMT group(N.S, 1 ml?kg -1?d -1,21 d,sc). At the same time, estrous cycle was monitored daily by examination of vaginal cytologic smears. After 3 weeks, blood was drawn and the serum estradiol concentration was assayed. The volume of endometrial implant was assessed. Lateral uterus, bilateral ovary, thymus and spleen were weighed. The NK cell cytotoxicity in the spleen was evaluated with lactate dehydrogenase (LDH) release assay. RESULTS: Implants in control group continued to grow, while those in groups treated with the drugs showed remarkable atrophy. The inhibitory rates were 87.2%, 78.3%, 57.3%, 89.0% and 94.7%, respectively. The regular estrous cycle of the model rats was abolished and serum estradiol reduced (P0.05); and the NK cells activity was enhanced(P

Aim To study the effect of leuprorelin acetate microspheres (LE ms) on endometriosis in rats, and compare the efficacy of material drug (LE), domestic and imported LE ms (enanton). Methods Endometriosis was induced by endometrial implant in rats. Then the animals were treated with LE (20 ?g?kg -1 ?d -1 ? 28 d ,sc), enanton(20 ?g?kg -1 ?d -1 ,sc)and domestic LE ms ( 2,20,200 ?g?kg -1 ?d -1 ,sc). Results Implants in control group continued to grow, while those in groups treated with drugs shrinked significantly, and domestic LE ms could produce dose dependent inhibitory effect on the growth of endometrial implant in rats. Conclusion The domestic LE ms at the single dose of 20 ?g?kg -1 ?d -1 has the same effectiveness as enanton and routine injection with the same does of LE for 28 days.

Objective To analyze the visual acuity and refractive status of kindergarten children and primary and middle school students in Xinhong Community of Shanghai from 2015 to 2018, and to provide basis and reference for the prevention and control of students^' myopia. Methods The data of 3 904 person-times of complete visual acuity and refraction records from 2015 to 2018 was derived from the ^"Shanghai Residents^' Eye Health Information Service System^". Results From 2015-2018, the total detection rate of poor vision of kindergarten children and primary and middle school students was 60.86%, and the detection rate of poor vision in kindergarten, primary school and middle school was 29.90%，62.63% and 87.26% respectively，showing an increasing trend with the education stage (χ²=727.206，P<0. 05). The detection rate of poor vision in boys was 57.31%, and that of girls was 64.29% (χ²=19.949, P<0.05). According to the classification of the degree of visual impairment, the peak stage of mild poor vision was in grade one to three of primary school, the peak stage of moderate poor vision was in grade four and five of primary school, the peak stage of severe poor vision was in middle school, and the highest peak of poor vision in second grade of middle school, accounting for about 70.85%. The total detection rate of poor vision with glasses reached 18.21%. The total detection rate of myopia in refractive state was 54.79%, and the detection rate of myopia in kindergarten, primary school and middle school were 16.27%,56.61% and 88.28% respectively, showing an increasing trend with the education stage (χ²=1099.978, P<0.05). In terms of growth rate, the increase in myopia in the first grade of primary school was the largest. Conclusion The myopia rate of primary and secondary school students was higher than that of kindergarten children, and showed an increasing trend with the education stage. The critical period of myopia prevention and control should be advanced to the kindergarten stage.

Objective To investigate the availability and strategy of breast reconstruction for patients with caesarotomy scar using pedicled TRAM flap.Methods From January 2007 to May 2011,12 cases of breast reconstruction with caesarotomy scar were carried out with pedicled TRAM flaps.All the patients that were classified as the class Ⅱ that was 0.5 or less by score were operated on by using the inverted trapezoid incision,of which the upper edge was 2 or 3 cm down to the umbilicus.Double pedicles were adopted for the patient with the longest vertical scar; single pedicle of the breast contralateral side and the muscle sheath of the breast ipsilateral side were harvested for the rest of the patients.A synthetic mesh was used for the enforcement of the muscle and sheath defect.Results No flap necrosis or abdominal complications were observed.With the follow-up from 3 months to 4 years and 4 months,the overall satisfactory rate was 100 ％.Conclusions The strict patient selection and the operating strategy are the keys to the successful breast reconstruction for patients with caesarotomy scar using pedicled TRAM flap.

Objective To analyze the current status of exercise and exercise self-efficacy (ESE) and its influencing factors in middle-aged and elderly patients with high blood pressure, and to provide a basis for the intervention of patients with hypertension in the community. Methods The stratified random sampling method was used to select 546 patients with hypertension who had received hypertension management for one year in the community. The general condition, exercise condition, and ESE scores were collected using survey questionnaires. Chi-square test was applied to analyze the difference of exercise efficacy score among different characteristic objects, and analysis of regression method was applied to analyze the influencing factors of exercise self-efficacy. Results A total of 546 people were surveyed in this study, of which 67.03% of hypertension patients participated in exercise. The main exercise program was walking healthily (87.43%). A total of 262 people (47.99%) had strong performance on ESE score, while 284 people (52.01%) had weak self-efficacy. The univariate unconditional logistic regression analysis found that there were significant differences in the distribution of educational level, family monthly income, years of hypertension, whether they received the guidance from family doctors, whether they exercised and whether they warmed up before exercise (P<0.05). The multivariate unconditional logistic regression analysis showed that educational level of junior high school and low average monthly household income were the risk factors affecting exercise efficacy, and the guidance of family doctors, exercise, and hypertension less than 5 years were the protective factors affecting exercise efficacy. Conclusion The exercise self-efficacy of middle-aged and elderly patients with hypertension in this community is at a medium level, and family doctors should carry out targeted interventions based on influencing factors to improve exercise self-management ability.

Objective To discuss the effect of milking in different times on very low birth weight premature infants .Methods Totals of 78 very low birth weight premature infants were chosen and divided into the no asphyxia group A(Apgar score 7-10), mild asphyxia group B(Apgar score 4-6.9), sever asphyxiation group C(Apgar score 0-3.9) according to the Apgar score.Then every group was randomly divided into the subgroups:13 neonates for group A1, group A2, group B1, group B2, group C1 and group C2.Group A1, group B1 and group C1 added early trace formula into enteral feeding in 24 hours until converted to full-intestinal absorption, while group A2 , group B2 and group C2 were given the same nutrition after 24 hours.Changes of indicators of infants were observed in all groups .Results The weight gain , excrement , time to regain body bass, PPN time, FEN time and hospitalization day was respectively (17.5 ±6.6) g/d,(3.2 ±1.2) times/d, (4.7 ±2.6)d, (9.2 ±4.1)d, (20.4 ±7.1)d ,(25.6 ±4.8)d in group A1, and(11.4 ±5.3)g/d, (1.9 ± 1.7)times/d, (6.2 ±3.1) d,(13.1 ±3.7) d,(25.1 ±7.9) d and(29.7 ±5.3) d in group A2, and the differences were statistically significant ( t =7.045,5.379,6.001,5.891,5.913,7.704, respectively;P <0.05).The weight gain, excrement, time to regain body bass, PPN time, FEN time and hospitalization day was respectively (10.0 ±3.5) g/d,(1.4 ±0.8) times/d,(7.9 ±3.7) d, (15.6 ±5.2) d, (27.7 ±6.8) d, (32.8 ±8.2)d in group B1, and(10.6 ±2.8)g/d,(1.3 ±1.1)times/d,(8.1 ±3.1)d,(14.8 ±6.1)d, (28.1 ±5.4)d,(36.4 ±8.7)d in group B2, and the differences were not statistically significant (t=1.964, 1.157,2.131,1.467,2.003,1.980, respectively;P>0.05).The weight gain, excrement, time to regain body bass, PPN time, FEN time and hospitalization day was respectively (4.4 ±1.8) g/d,(0.0 ±0.3) times /d, (13.4 ±4.8)d, (19.2 ±7.7)d, (36.1 ±9.5)d,(43.5 ±10.2)d in group C1, and (7.4 ±3.4)g/d,(1.1 ± 0.9)times/d,(10.6 ±3.1) d,(17.0 ±6.9) d,(30.2 ±7.5) d and(39.9 ±9.1) d in group C2, and the differences were statistically significant ( t =5.549,6.000,5.836,5.907,8.114,7.908, respectively;P <0.05).There was statistically significant difference of gastrointestinal functional damage between group A 1 and A2(χ2 =8.496,P<0.05).There was no statistically significant difference of gastrointestinal functional damage between group B1 and B2 (χ2 =2.001,P>0.05).There was statistically significant difference of gastrointestinal functional damage between group C1 and C2 (χ2 =13.457,P <0.01).Conclusions Presence of asphyxia hazard is one of the most important standards of starting breastfeeding in 24 hours for very low birth weight premature infants , and Apgar score can be used as one of the references for start milking for premature infants .

Objective To explore the effect of three-in-one nursing including the music therapy , massage and non-nutritional sucking on the prevention of feeding intolerance in very low birth weight infant . Methods One hundred and twenty very low birth weight infants from January 2010 to January 2013 were chosen and randomly divided into the control group and the intervention group , each with 60 cases.All patients received the homogeneous parenteral nutrition and a little formula through enteral feeding , and at the same time the control group received the massage and non-nutritional sucking , and the intervention group received the three-in-one nursing .The feeding effect was compared between two groups .Results The time of recovery of birth weight , the weight gain every day , and the time of parenteral nutrition and reaching enough enteral feeding, the length of time were respectively (2.9 ±2.1)d, (17.8 ±7.9)g and (7.7 ±3.1) d,(17.4 ±6.3)d, (19.6 ±5.9)d in the intervention group, and were better than those of the control group , and the differences were statistically significant (t=7.685, 9.001, 7.061,11.047,17.438,14.225, respectively;P<0.05).The incidence rate of feeding intolerance was 6.67% in the intervention group , and was 20.00% in the control group, and the difference was statistically significant (χ2 =12.005,P<0.01).Conclusions Three-in-one nursing can improve the early enteral feeding in very low birth weight infant , and improve the function of the routine massage and non-nutritional sucking , and reduce the incidence rate of feeding intolerance .

Objective To investigate the effect of standardized extended care on the patients after endoscopic sinus surgery .Methods Eighty cases after endoscopic sinus surgery , from January 2012 to January 2013 , were randomly divided into treatment group and control group , with 40 cases each .The control group was taken the usual care and discharge guidance , and the treatment group was given the standardized extended care . Results The effective rate of the treatment group and the control group were 97.5% and 85.0%.There was significant difference between groups (χ2 =2.23,P <0.05).2 cases in the treatment group occurred nasal adhesions, with a complication rate of 5.0%.In the control group, 6 cases occurred nasal adhesions;1 case occurred maxillary sinus stenosis; 1 case occurred orbital hemorrhage , with a complication rate of 20.0%. There was significant difference between groups (χ2 =3.45,P =0.561).Conclusions The standardized extended care can significantly improve patient treatment efficiency and reduce complications .It is worthy of clinical application .

Objective To explore the clinical efficacy of full-time nursing intervention on the treatment of sinusitis and nasal polyps through endoscopic .Methods One hundred and ten patients with sinusitis and nasal polyps from October 2009 to June 2012 in our hospital were chosen and divided into the control group and the observation group according to the random number table , each with 55 cases.All patients were all given the endoscopic surgery , and the control group received the routine nursing , and the observation group received the full-time nursing intervention before and after the operation on the basis of the traditional nursing .The clinical efficacy was observed in two groups , and the incidence rate of postoperative complication was compared between two groups, and the psychological state of patients was analyzed by self-rating anxiety scale ( SAS) and self-rating depression scale ( SDS ) .Results The total effective rate was 96 .4% ( 53/55 ) in the observation group, and was higher than 83.6%(46/55) in the control group, and the difference was statistically significant (χ2 =11.23,P<0.05).The incidence rate of complication was 5.5%in the observation group, and was lower than 14.5%in the control group, and the difference was statistically significant (P<0.05).The score of SAS in the observation group was (41.7 ±4.23) after intervention, and was better than (63.8 ±3.75) before intervention, and the score of SDS was (40.6 ±4.10) after intervention, and was better than (62.5 ±3.99) before intervention;the score of SAS in the control group was (55.8 ±3.92) after intervention, and was better than (64.1 ±4.04) before intervention, and the score of SDS was (56.2 ±4.11) after intervention, and was better than (62.8 ±4.13) before intervention.The scores of SAS and SDS after intervention were respectively (41.7 ±4.23), (40.6 ±4.10) in the observation group, and were better than (55.8 ±3.92), (56.2 ±4.11) in the control group, and the differences were statistically significant ( t =10.70,11.49, respectively;P <0.05 ) .Conclusions Full-time nursing intervention can significantly improve the clinical efficacy of endoscopic treatment of sinusitis and nasal polyps , and reduce the occurrence of complication , and relieve the anxiety and depression of patients , and is worthy of clinical promotion .