目的:调查三甲综合性医院住院医师抑郁现状并分析其影响因素,为提高临床住院医师生活质量及工作效率提供依据.方法:选择三甲综合性医院临床各科室住院医97例为研究对象,调查其性别、年龄、文化程度、婚姻状况等基线资料,采用抑郁自评量表(SDS)对其基线资料进行分析,并采用logistics回归分析住院医师抑郁状态发生的影响因素.结果:97例住院医师SDS评分为(48.99± 9.78)分显著高于人群常模(41.85±10.57)分(t=3.212,P＜0.05),其中抑郁的发生率(35.05％)显著高于正常人群(16.07％)与护士人群(22.55％) (x2=9.437,4.124;P＜0.05);多因素分析显示,未取得执业医师证书(OR=2.241,P＜0.05)、不喜欢医生职业(OR=3.722,P＜0.05)及对工作不满意(OR=7.713,P＜0.05)是住院医师发生抑郁的危险因素.结论:三甲住院医师的抑郁发生率处于较高水平,未取得执业医师证书、不喜欢医生职业、对工作不满意是住院医师发生抑郁的危险因素.

目的:探究三甲综合医院住院医师职业倦怠的发生现状及其影响因素,为预防三甲综合医院住院医师发生职业倦怠提供依据.方法:选择三甲综合医院各临床住院医师218名为研究对象,采用问卷调查住院医师性别、年龄、文化程度、职务、婚姻状况、职称、工作时间、编制及身体健康情况等基线资料及职业倦怠程度,采用logistics回归分析住院医师职业倦怠的影响因素.结果:218例三甲住院医师中119例人(54.59％)发生职业倦怠,其中轻度倦怠者60人(27.52％),中度倦怠者49人(22.48％),重度倦怠者10人(4.59％);身体健康状况一般、差(OR=1.547,5.342;P＜0.05)是住院医师发生职业倦怠的危险因素,职称为初级、中级、副高及以上(OR=0.893,0.827,0.736;P＜0.05)是住院医师发生职业倦怠的保护因素.结论:三甲住院医师职业倦怠发生的现状不容乐观,无编制、身体健康状况一般、差是住院医师发生职业倦怠的危险因素,职称为初级、中级、副高及以上是住院医师发生职业倦怠的保护因素.

Objective To analyze the quality of life and efficacy of elderly breast cancer patients treated with breast -conserving surgery .Methods In the 180 early breast cancer patients ,56 cases received breast-conserving surgery ,63 cases re-ceived standard radical mastectomy and 61 cases received modified radical mastectomy .Results Hospitalization time,operative time and blood loss in breast-conserving surgery group were better than those of the radical surgery group ( standard radical sur-gery group +modified radical mastectomy group ) (P<0.0001);No significant differences were identified among the 3 groups in survival rate,distant metastasis and recurrence rate (P>0.05);psychological factors,physical factors,mental factors and social support factors in breast-conserving surgery group were significantly superior to those of the radical surgery group (P<0.05);Compared with radical surgery group ,breast appearance and cosmetic results had significant differences in breast -conserving sur-gery group (P<0.05).Conclusion For early stage breast cancer patients ,breast-conservative surgery has good efficacy .Strict tumorectomy and auxiliary dissection followed by post-operative adjuvant chemotherapy and radiotherapy is very important .

Objective To observe the clinical efficacy of auricular plaster therapy on insomnia patients with breast cancer. Methods Ninety hospitalized insomnia patients with breast cancer in general surgery from June 2011 to May 2014 were divided into observation group (n=45) and control group (n=45). Patients in control group received conventional treatment and nursing and those in observation group received auricular plaster therapy besides conventional treatment and nursing. The clinical efficiency of each group after treatment was compared. Results Insomnia of patients in observation group was improved greatly when compared that in control group (P<0.01). Conclusion Auricular plaster therapy is effective for improving the sleep quality of the breast cancer patients with insomnia.

目的:总结乳腺癌术后早期患者中医辨证的常见分型规律并初步观察预后因子的表达情况.方法:调查乳腺癌行手术治疗患者174例术后早期的中医证候分布状况,观察其预后因子水平,包括肿瘤(TNM)分期、ER、PR、Her-2、p53、VEGF的表达,分析常见证型乳腺癌预后因子的差异,推断常见证型的预后.结果:气血两虚型、痰瘀毒热型、肝郁脾虚型是最常见的3个证型,其中TNM分期,ER、PR、053表达无显著性差异(P＞0.05);气血两虚型的Her-2、VEGF阳性率最低(P＜0.05);痰瘀毒热型的Her-2、VEGF阳性率最高(P＜0.05).结论:乳腺癌术后早期中医证候以本虚标实、虚实夹杂为主,不同中医证型的乳腺癌患者的预后因子存在一定差异.

本文从安全化、归属化、时效化、便利化、声望化5个途径论述了有形化在医院服务场景中的实际运用。认为服务场景帮助形成顾客的经历,影响服务满意度,甚至会成为影响顾客是否会重复购买该服务的决定因素。

AIM: To investigate the expression of GATA3 in human breast carcinoma and its clinical significance.METHODS: The expression level of GATA3 in breast cancer tissues from 124 patients was detected by the method of immunohistochemistry and the relationships between GATA3 expression and other clinicopathological factors were analyzed.RESULTS: Low expression of GATA3 in breast cancer tissues was associated with estrogen receptor(ER) / progesterone receptor(PR) negative,high histological tumor grade,p53 mutation and vascular invasion(P < 0.05),but not with age,tumor size,human epidermal growth factor receptor 2(HER-2) expression and lymph node metastasis(P > 0.05).In all breast cancer tissues,the positive expression rate of GATA3 was 56.4%.The positive expression rate of GATA3 in luminal breast cancer is 68.4%,higher than that in non-luminal breast cancer(32.6%,P < 0.05).In all breast cancer tissues,the expression of GATA3 in middle recurrence risk group was higher than that in high recurrence risk group(P < 0.05).CONCLUSION: GATA3 expression in breast cancer is related to differentiation and biological characteristics of the tumor,which can be a factor for evaluation of the treatment and prognosis.

<正>患者女,47岁,2012年4月18日因"体检发现双乳多发肿物6年余"入院。其6年余前无意中触及左乳内上方一光滑、活动包块,于当地医院行乳腺B超检查提示为"双乳多发实性占位,考虑纤维腺瘤可能性大",遂对病情未予重视及治疗,近期复查超声提示肿物较前增大并增多,方来我院求治。既往患者曾分别于1993年、1997年、2003年因左乳触及肿物在外院行手术治疗,外院病理均提示为"乳腺纤维腺瘤"。入院体检:双乳外观不对称,

<正>平滑肌肉瘤是一种常见的肿瘤,多见于子宫及胃肠,有时也见于腹膜后、肠系膜、大网膜及皮下组织。而原发性乳腺平滑肌肉瘤罕见,尤其是原发于男性者。笔者在临床工作中遇见1例,现结合文献复习报告如下。1临床资料患者,男性,65岁,因"触及右乳肿物4月余,伴疼痛2月余"于2012年4月25日收入本院。患者4月前因右乳瘙痒不适触及右乳乳头旁一突起,无明显压痛,无伴皮

<正>患者女,41岁,因"发现左乳肿块半月余"于2010年8月16日入院。查体:左乳12点钟距乳头1cm处可及一大小约1cm×1cm包块,质偏硬,表面欠光滑,活动度差,无明显压痛。外院B超及我院钼靶检查均提示乳腺癌可能。患者于2010年8月17行左乳

<正>患者,女,73岁,因左乳腺癌术后5年,出现右乳肿物4年于2011年2月11日入院。体格检查:右乳见多个溃烂点及破溃口,最大的破溃口大小约6 cm×4 cm,各破溃口流出大量恶臭,褐色脓血样液体,触诊可及巨大实性肿块,占据外上2/3腺体,活动度差。CT提示"右侧乳腺癌,可能轻度侵犯胸壁肌肉";取肿物活检病理回报为乳腺癌。

Aim:To investigate the clinical application of Mammotome minimally invasive techniques for breast mass under ultrasonoscopy.The indicatins of minimally invasive Mammotome were saminarized.Methods: Mammotome minimally invasive biopsy 292 cases of breast mass ultrasound explored before operation,a total of 1 055 masses.Results: All masses were reseeted completely,the pathology showed: 686 breast fibroadenoma,253 breast adenosis,64 breast cystic disease,39 papilloma,12 breast cancer,1 dysplasia.Postoperative hematoma happened in 1 case,no infection,skin ulcer and other complications.The patients were followed up after operation 3 months and 6 months,and 98% patients were satisfied the operation.Conclusion:Mammotome minimally invasive techniques can be used as the best method to remove benign breast mass ultrasound explored,and as a way of sub-clinical breast cancer biopsies.

乳腺癌是女性最常见的恶性肿瘤,一些乳腺癌可伴有不同程度的鳞状上皮化生,但真正的乳腺原发性鳞状细胞癌却十分罕见.笔者在临床工作中遇到l例,现结合文献复习,对该肿瘤的组织学发生,临床病理特征及诊断,鉴别诊断和治疗作一报道.

<正>近年女性乳腺癌的发病率有年轻化趋势,一般认为35岁以下年轻乳腺癌在生物学行为、病理类型和预后上不同于其他年龄组病人。本例15岁基底细胞样乳腺癌(Basal-like型)女性乳腺癌患者,患病年龄之小在国内罕见,现结合文献对年轻乳腺癌患者的生物学特征及综合治疗作一报道。

QI Kun is a well-known foreign scientists in China in the Qing Dynasty,who refer to Plain Questions,Lingshu,found ancient and modern famous doctor of the theory,written in the surgical famous book surgical Dacheng,the book in detail,"ulcer of the clock",and Combin wiht "Bagang" in treating ulcer,attach importance to the meridian and acupuncture dialectical therapy,the ulcer has become pus were promoted to do incision and drainage surgery,which reached the highest level before the Qing.And the book has made tremendous contributions to TCM Surgery.

Objective: To evaluate the clinical use of ultrasound-guided Mammotome minimally invasive peeling of benign breast mass. Methods: Between March 2007 and September 2007, 38 patients (57 confirmed benign breast masses) underwent ultrasound-guided Mammotome minimally invasive peeling of the lesions. Results: All of breast masses were resected safely and completely. Each mass was resected through 9 peelings on average over a mean of 18 minutes. The masses measured (1.4±0.6) cm long, and the length of incision was only 0.4 to 0.5 cm. One case (1/57, 1.75%) was found with mild ecchymosis. No other complications occurred. Conclusion: Ultrasound-guided Mammotome minimally invasive peeling for benign breast mass appears to be a procedure that warrants widespread use, because of its simplicity, accuracy, safety, and minimally invasiveness.

Objective To evaluate the effect and mechanism of non-steroidal anti-flammatory drags(NSAIDs) on the colon cancer cell growth by using S-nitrosoglutathione(GSNO) which can produce nitric oxide.(Methods) Apoptosis of 3 colon cell lines were evaluated by cell growth curve and flow cytometry,the PGE_2 levels in cell culture supernatants were determined by competitive enzyme immunoassay method,and the(protein) expression of COX-1 and COX-2 were analyzed by Western blot.Results The production level of PGE_2 was increased with CSNO treated concentration and time.Using 500μmol/L CSNO treatment for 48h,the expression level of COX-1 and COX-2 protein increased.NASIDs can block the production of PGE_2 but had no effect on the inhibition of cell growth induced by GSNO.Conclusions GSNO can increase PGE_2(production) and induce COX-1 and COX-2 protein expression in a dose-and time-dependent manner.Higher concentrations of GSNO also can inhibite cell growth and induced apoptosis in all 3 cell lines.NSAIDs can block production of PEG2 but NSAIDs are no effect on cell growth.

[Objective] To study effect of cholecystokinin-A recaptor antagonist on experimental pancreas regeneration model. [Methods] 24 rats were divided into 3 groups, as sham operation Px(-), using CCK-RA antagonist with pancreastectomy Px+CCK-RA, pancreastectomy without using CCK-RA antagonist Px by random method.After 5 days, we detected the samples wet weight of parabiliary segment from the duodenum and cell proliferation index by microscope observation using bromodeoxyuridine (BrdU) labeling,cell proliferation index(LI) and the plasma CCK concentrations were measured. [Results] 24 rats were detected, wet weight of parabiliary segment from the duodenum in Px(-) group is (86.98±3.51) mg, Px+CCK-RA group (92.46±6.67) mg, Px group (210.72±7.39) mg,compared each group have revealed significant difference (F=772.9, P ＜0.01). In Px(-) group, the LI in acinar cells was approximately 1%, but in Px and Px+CCK-RA group are about 10% and 5%; Plasma CCK concentration of each group is Px(-) group (28.22±2.45) pg/mL, Px+CCK-RA group (53.62±4.49) pg/mL and Px group (62.85± 4.33)pg/mL by radioimmunoassay, the results diseovered significant difference (F=171.8, P ＜0.01). [Conclusions] Endogenous CCK is one of the essential factors for pancreatic regeneration; secretion of them is promoted by partial pancreatectomy. But its effect are inhibited by CCK-RA, the molecular mechanism by CCK secretion is promoted remains to be elucidated.

目的 探讨半乳糖受体介导的增殖细胞核抗原(PCNA)反义核酸(ASODN)对肝癌Bel-7402细胞增殖的靶向抑制作用.方法选择来源于3个不同系统的肿瘤细胞:肝癌Bel-7402细胞、肺腺癌GLC-82细胞、慢性髓系白血病K562细胞,将半乳糖-聚乙烯亚胺(Gal-PEI)与PCNA反义核酸结合形成交联复合物Gal-PEI-ASODN,台盼兰拒染计数法观察不同浓度Gal-PEI-ASODN对这3种细胞增殖的影响;流式细胞仪检测3种细胞对羧基荧光素(FAM)标记的Gal-PEI-ASODN的摄取率及细胞内平均荧光强度;相差/荧光显微镜观察FAM标记的Gal-PEI-ASODN及ASODN进入3种不同细胞的情况.结果浓度从10 μmol/L到40 μmol/L的ASODN作用于Bel-7402细胞48 h后,可抑制其增殖,IC50为29.3 μmol/L.浓度从0.05 μmol/L到0.25 μmol/L的ASODN作用于Bel-7402细胞48 h后,均未显著抑制其增殖;相同浓度的Gal-PEI-ASODN作用于3种不同细胞48 h后,对GLC-82细胞、K562细胞的增殖未产生显著抑制作用,而Bel-7402细胞的增殖却受到明显抑制.对于Bel-7402细胞,Gal-PEI-ASODN的IC50为0.06 μmol/L,与单纯ASODN组相比,增敏倍数为488倍.FAM标记的Gal-PEI-ASODN或ASODN与不同细胞孵育0.5 h到2.0 h内,Gal-PEI-ASODN-Bel-7402细胞组所有时间点的细胞荧光摄取率、胞内平均荧光强度均显著高于ASODN-Bel-7402细胞组、Gal-PEI-ASODN-GLC-82细胞组和Gal-PEI-ASODN-K562细胞组.FAM标记的Gal-PEI-ASODN或ASODN与Bel-7402、GLC-82、K562细胞作用1 h后,Gal-PEI-ASODN-Bel-7402组的细胞荧光摄取率较高(反义核酸大量分布于细胞的胞浆内),其他各组细胞荧光摄取率较低.结论半乳糖受体介导的PCNA反义核酸能被肝癌Bel-7402细胞高效地摄取,抑制Bel-7402细胞的增殖,增强反义核酸的作用效果,具有靶向性。