[Evaluation of menopause and treatment choice of breast cancer patients before endocrine therapy].

Aromatase inhibitors (AIs) directly applies to postmenopausal breast cancer patients. Patients underwent bilateral ovariectomy or ≥60 years were acknowledged as postmenopausal.Alternatively, for <60 years breast cancer patients, sex hormone detection to evaluate menopause is recommended by National Comprehensive Cancer Network (NCCN) guideline, textbooks, and AIs clinical trials.However, series of clinical trial found that, a broad overlap region of follicle stimulating hormone and estradiol appeared between premenopausal and postmenopausal patients, which unable to determine the menopause even with sensitivity promotion of detection equipment or manners.We have abandon this detection in clinical treatment, and decision making was only according to the relapse risk and disease status. We recommend bilateral ovariectomy resection accompanied with AIs for breast cancer patients with high recurrence risk (e.g. T3-4 or LNM≥4) or patients with advanced metastatic disease.However, patients with low or moderate recurrence risk can be treated with tamoxifen.

[Diagnosis and treatment of osteoblastic metastasis in patients with breast cancer].

Osteoblastic metastasis of breast cancer is relatively rare, but there are cases of misdiagnosis and mistreatment in clinical treatment. They can only be diagnosed by X ray or CT bone scan and must be identified from bone repair after effective treatment in patients with osteolytic or mixed bone metastases. Bone metastasis is often seen in the disease-free condition of breast cancer, and very few can occur in stage Ⅳ lesions prior to surgery. Based on the analysis of clinical phenomena, we questioned the evaluation criteria of the therapeutic effect on bone metastasis of breast cancer created by the World Health Organization and the MD Anderson Cancer Center and concluded the formation mechanism of bone metastasis. For patients with simple osteoblastic bone metastasis, we broke through the recommendations of the National Comprehensive Cancer Network guideline and advocated the concept of "noninterference" . Patients with positive hormone receptor can be treated with traditional endocrine therapy. Hormone receptor negative and/or human epidermal growth factor receptor 2 positive patients can be observed first, followed by chemotherapy and/or targeted therapy when there is osteolytic bone metastasis or visceral metastasis. Furthermore, bisphosphonates are not required since osteoblastic bone metastasis is generally not associated with the risk of bone related events. The active treatment of primary lesion should be taken into account in stage Ⅳ patient before operation.

Effects of feeding sodium stearoyl-2-lactylate diets to lactating sows on performance, digestibility of nutrients, composition, and fat globule size in milk.

The objective of this study was to determine the effects of feeding sodium stearoyl-2-lactylate (SSL) as a new feeding emulsifier diet with and without soybean oil (SO) on the milk fat globule (MFG) size, milk composition, digestibility of nutrients, and performance in lactating sows. Sixty sows (Large White × Landrace) were randomly assigned to 1 of 4 treatments according to a 2 × 2 factorial arrangement of treatments. Each treatment had 15 replicates composed of 1 sow. The factors included 1) the fat level (0% vs. 3% SO) and 2) the emulsifier content (0% vs. 0.1% SSL). Treatments included 1) Control (without SO and SSL), 2) SO (3% SO without SSL), 3) SSL (0.1% SSL without SO), and 4) SO + SSL (3% SO and 0.1% SSL). During the suckling period, sows in the SO + SSL group lost less back fat thickness ( < 0.05) compared to other groups; sows fed 3% SO diets consumed less feed ( < 0.05) compared to sows fed diets without SO, but there were no significant effects ( > 0.05) of dietary fat and its interaction with a dietary emulsifier on energy intake and the weaning-estrus interval. The digestibility of ether extract in the SO + SSL group was greater than in the SO group ( < 0.05). Moreover, greater digestibility of CP, Ca, and P in the SO+SSL group was observed compared to that of other groups ( < 0.05). Feeding the SO + SSL diet improved the concentrations of milk fat, protein, and total solids on d 11 of lactation compared to other diets ( < 0.05). Also, an interaction between supplemental SSL and SO was observed for the milk fat and total solids concentrations. The average diameter of MFG on d 11 of lactation was significantly decreased by the addition of 0.1% SSL compared to a diet with no SSL supplementation ( < 0.05). No significant differences among the dietary treatments were observed in cholesterol, triglyceride, high-density lipoprotein cholesterol, or low-density lipoprotein cholesterol in sows' plasma ( > 0.05). In conclusion, feeding a 0.1% SSL diet to lactating sows may decrease the average diameter of MFG and improve the digestibility of nutrients and composition of milk.

Professional behaviour of medical school graduates: an analysis.

Recent graduates (1989-1990) of a traditional school of Chinese medicine were assessed by observers using a 10-item scale for professional behaviour in the non-cognitive realm. Overall, 10.7% of the graduates had low ratings on this scale. Of those who scored in the top two quartiles on this scale, 71.4% reported that 'Professional ethics' was the key determinant of their professional behaviour, whereas legal concerns were the prime motivator for only 3.6% of the top scorers. It was also found that students' scores in the medical ethics course correlated with their professional behaviour score to a statistically significant degree.