d infrastructure quality.Conclusions Raising responsiveness for special medical services will be conducive for improving the quality of non-medical services for these inpatients when they are in the hospital.

An analysis is made on major issues and difficulties in the application of the performance appraisal system structure,appraisal model and appraisal outcomes.It was discovered that the performance appraisal system,if used in clinical medical technology departments in the hospital,should focus on the system itself,the appraisal process and re-improvement of the system.These three factors are key to determining whether the system is effective and efficient,and key to transforming the system into departmental and hospital performance,even into overall enhancement of hospital performance in general.

Pregnancy associated breast cancer(PABC) is a special kind of breast cancer,it is difficult to diagnose at early stage since the mammary epithelial cells are actively proliferative.Whether pregnancy will affect the biological behavior of breast cancer and how the treatment strategy for the patients with PABC impact on the outcome in terms of side effects,response,etc,those factors have to be taken into special consideration.The standard management of PABC still remain controversial.This article summarized the studies on PABC and discusses the advances in the management of the disease.

Background and purpose:Cyclooxysenase-2(COX-2)was first researched in colon caner,and extensively studied in breast cancer.However it was rarely reported in lymph node negative breast cancer.This study assessed the effect of expression of COX-2 in the prognosis of lymph node negative breast cancer and its use as information of COX-2 status to perfect the prognostic mathematic model.Methods:The expression of COX-2 protein was detected by IHC in 119 cases of lymph node negative breast cancer,the survival data was analyzed.Results:Elevated expression of COX-2 was associated with unfavorable distant disease-free survival(74% vs 93.86%).In subgroups by the simple prognostic model PI=size+HER2-2.5?age-CT-0.55?(ER?ET),the 5-year DFS were decreased with subgroups of low-risk,mid-risk and high-risk and the rate of elevated expression of COX-2 was increased with higher risk subgroups.Furthermore,in mid-risk group,the elevated expression of COX-2 was still able to predict poorer prognosis.Conclusion:The information of expression of COX-2 can be used to perfect the simple prognostic mathematic model,thus it would be more effective for treatment of breast cancer with auxiliary lymph nodes metastases.

With the development of breast-conserving surgery,the problem of local relapse after conservation therapy became a hot spot for discussion.There was much research done on the influential factors of recurrence after conservation therapy,however,there is little research on the strategy for salvage of relapse.This review summarizes the recent research on the diagnosis,treatment and prognosis of local recurrence of breast cancer after conservation therapy.

Studying prognostic factors of breast cancer is a traditional subject. With new advances in detection methods applied and new prognostic factors, the clinical course and the biological behavior of breast cancer have been well understood, thus the treatment can be more rational. At present, the majority of prognostic factors related to molecular biology still need to be investigated. And although some of them have broad prospects, they are not available for routine examination currently. In this article, we reviewed some prognostic factors of breast cancer, which have been confirmed or may have potential in practical application.

Purpose: To analyze the clinical and pathological factors in post-operative breast cancer patients with bone metastasis, and, identify risk factors predicting the skeletal metastasis. Methods: We evaluated data from 3 796 patients who were surgically treated from January 1981 to December 2000. Those patients were divided into groups according to different first events. Then we assessed data of 116 cases of bone metastasis as first event, and comparing with visceral metastasis and lymph node or soft tissue metastasis cases. Results: In our group there were 116 cases with bone metastasis as first event, about 3. 1%; bone metastasis correlated with young age, large tumor, clinical palpable axillary nodes, pathological positive nodes, stage II/HI disease and non-specific invasvie breast carcinoma. Multivariate logistic regression found that large tumor, clinical palpable axillary nodes related with bone metastasis in pre-operative data. In post-operative data, large tumor, pathological positive nodes and non-specific invasive breast carcinoma correlated with bone metastasis. Hormone receptor status and HER2 expression did not predict the bone metastasis. All cases received standard local and adjuvant systemic treatment. Among patients who had as their first event a local recurrence or a recurrence in soft tissue or lymph node or local and systemic metastasis, there were more specific invasive carcinomas than those in bone metastasis group. Occurrence of bone metastasis and visceral metastasis had similar time distribution, however, local recurrence and/or node, soft tissue metastasis occurred earlier than skeletal metastasis. Conclusions: Pre-operative bone scintigraphy was indicated in those with young age, T2/T3 tumor, and clinical palpable nodes. Breast cancer patients at high risk for bone metastasis were T2/T3 tumor, non-specific invasive breast carcinoma and with 4 or more involved axillary lymph nodes. It might be important to study the effect of bisphosphonates in the adjuvant settings.

Purpose: Comprehensively assess the role of prognostic and predictive factors and set up a mathematical model to evaluate prognosis and to help the decision of adjuvant therapy. Methods: All prognostic indicator and therapeutic modalities have been performed, mutivariate survival analyses was done by Cox regression. The split-group method was used to construct the mathematical model for prognosis. Results: In multivariate analysis, the factors including age, tumor size, overexpression of Her-2, the interaction between ER status and endocrine therapy (ER ET), and chemotherapy can independently predict prognosis. Finally, the mathematical model acquired is PS = Size + Her2 -2. 5 x age - CT -0. 55 x ( ET x ER). Conclusions: According to PI of individuals, the different risks of failure can been distinguished.

Angiogensis plays an important role in tumor growth and metastasis,and anti-angiogenic therapy is a promising treatment of cancer. We review the proceedings on angiogensis and breast cancer ,and the progress in the field of anti-angiogenic therapy for breast cancer.

Background and purpose:Duffy blood group(DBG)system contains genotype system and phenotype system.DBG phenotype system is embodied by the protein carrying blood group antigens on the surface of red blood cells.Epidemiological evidence has shown that different races had definitely different DBG phenotype disuribution and there is a variation of morbidity and mortality of breast cancer among different race populations.Therefore,this study was to investigate whether DBG phenotype affects breast cancer occurrence and malignancy.Methods:We investigated DBG phenotypes of 253 female cases with breast diseases who were consecutively hospitalized in the Shanghai Cancer Hospital and analysis was done on its relationship with clinical pathological diagnosis.DBG phenotypes were examined by indirect antiglobulin-test with anti-Fya and anti-Fyb reagents,and were classified into Fya+Fyb-,Fya-Fyb+,Fya+Fyb+,Fya-Fyb-according agglutination.Results:Neither DBG phenotypes distribution difference existed in breast disease patients nor in breast cancer patients as observed in the general Chinese Han population.Fya-Fyb-and Fya-Fyb+ demonstrated more susceptibility to breast cancer than Fya+Fyb-and Fya+Fyb+,but there was no statistical significant difference.Fya-group(57.14%)had more malignant incidence than that of Fya+ group(39.02%),but there was also no statistical significance(P=0.28).No significant differences have been observed in ER,PR,Her-2 status and P53,PCNA,PS2,nm23,P450 status between every DBG phenotypes,nor in tumor grades in various DBG phenotypes.More patients were involved in axillary lymph nodes metastasis in Fya-than that in Fya+ group and reached statistical significance(100% and 39.13% respectively,P