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Objective To find the correlation between phosphatidylinositol kinase-3 catalytic subunit A gene(PIK3CA)mutation and pathological features as well as clinical prognosis of breast cancer.Methods The patho-logical data of 181 patients diagnosed with invasive breast cancer from January 2018 to January 2020 were collected.The estrogen receptor(ER),progestogen receptor(PR),human epidermal growth factor receptor-2(HER2),Ki67 were examined by immuno-histochemistry(IHC).Mutation of exon 9 and exon 20 of PIK3CA were examined by quantitative real-time PCR(qPCR).Results Among 181 cases of invasive breast cancer,70 cases had PIK3CA mutation with 31 cases(44.28%)showed exon 9 mutations and 39 cases(55.71%)showed exon 20 mutations.The difference between PIK3CA mutation and their distribution in molecular typing of breast cancer was statistically significant(P＜0.05).The expression of PIK3CA mutation in breast cancer with different Ki67 expression was sig-nificantly different(P＜0.05).There were 34 cases(48.57%)showed PIK3CA mutations in the HR+/HER2 group and 36 cases(51.43%)of non HR+/HER2 group mutations.There was a statistically significant difference in the distribution of PIK3CA mutations between 2 groups(P＜0.05).The death rate of PIK3CA mutation cases was higher than that of PIK3CA wild type cases(P＜0.05).Conclusions PIK3CA mutation is associated with molecular typ-ing,Ki67 increment index and prognosis of breast cancer.Detection of PIK3CA mutation provides potential support to the development of precise treatment of breast cancer patients.

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Objective To study the expression of thyroid hormone receptor binding protein 4(TRIP4)and DNA damage inducing transcription factor 4(DDIT4)in glioma tissue and their relationship with clinical pathological characteristics and prognosis.Methods 94 glioma patients admitted to the First Hospital of Hebei Medical University from February 2018 to February 2019 were selected as the research subjects.The expression of TRIP4,DDIT4 proteins in tissues were detected by immunohistochemistry.The relationship between the expression of TRIP4,DDIT4 proteins in glioma tissues and clinical pathological characteristics were compared.The differences in survival prognosis of glioma patients with different levels of TRIP4,DDIT4 protein expression were analyzed by Kaplan-Meier survival curve.Univariate and multivariate COX regression analysis was conducted to analyze the factors affecting the survival prognosis of glioma patients.Results The positive rates of TRIP4(68.09%),DDIT4(65.96%)proteins in glioma tissues were higher than those in adjacent tissues(13.83%,10.64%),with statistically significant differences(χ2=57.212,60.866,all P<0.05).There was a significant positive correlation between TRIP4 and DDIT4 protein expression in glioma tissues(r=0.722,P<0.05).The positive rates of TRIP4(83.64%vs 46.15%,80.00%vs 51.28%)and DDIT4(80.00%vs 46.15%,76.36%vs 51.28%)proteins in glioma tissues with tumor diameter≥3cm,WHO grade Ⅲ were significantly higher than those in tissues with tumor diameter＜3cm,WHO grade Ⅰ～Ⅱ(χ2=6.393～14.754,P<0.05).The 3-year overall survival rates of the TRIP4 positive and negative expression groups were 37.50%(24/64)and 66.67%(20/30),respectively.The 3-year cumulative survival of the TRIP4 positive expression group was significantly lower than that in the TRIP4 negative expression group(Log-rank χ2=5.949,P=0.015).The 3-year overall survival rate of DDIT4 positive and negative expression group was 37.10%(23/62)and 70.00%(21/30),respectively.The 3-year cumulative survival of the DDIT4 positive expression group was significantly lower than that in the DDIT4 negative expression group(Log-rank χ2=7.642,P=0.006).Tumor diameter≥3cm(HR=1.614,P=0.000),WHO grade Ⅲ(HR=1.790,P=0.000),positive TRIP4(HR=1.665,P=0.000)and positive DDIT4(HR=1.476,P=0.000)were independent risk factors affecting the survival prognosis of glioma patients.Conclusion The expression of TRIP4 and DDIT4 protein in glioma tissue was increased.Both of them were related to tumor diameter and WHO grade,and are potential tumor markers for survival prognosis of glioma.

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Objective:To explore the factors that affect the participation of elderly care nurses in home-based elderly care services, in order to provide reference for the targeted improvement of human problems in home-based elderly care services.Methods:The phenomenological research method of qualitative research was used to conduct semi-structured in-depth interviews, on-site recordings and transcripts with 14 nurses in the geriatrics department of Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical College from September to October, 2021. The collected data were analyzed and the theme was refined by using the 7-step analysis method of Colaizzi phenomenology.Results:Through sorting and analysis, four themes and six sub themes were extracted as follows: language behavior factors including environmental discomfort and differences in living habits, freedom was limited; psychological and emotional factors including high psychological pressure and loneliness, not respected; career development factors; social security factors including the definition of work scope is unclear, the division of responsibility for the accident was unclear and the protection of relevant rights and interests was insufficient.Conclusions:The intention of elderly care nurses to participate in home-based elderly care services is affected by many factors. These factors need to be accurately identified and targeted support measures should be taken to improve their enthusiasm to participate in home-based elderly care services and improve the human problems in home-based elderly care services.

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Objective:To construct a Question Prompt List of information needs for patients with interstitial lung disease, providing a tool for patients with interstitial lung disease to actively obtain disease-related information.Methods:A literature study was conducted based on the three core needs (ERG) theory framework of existence,relatedness and growth. A purposive sampling method was used to select 15 patients with interstitial lung disease from Drum Tower Hospital, Medical School of Nanjing University from December 2021 to January 2022 for descriptive research. Based on literature research and qualitative research, the initial items of the Question Prompt List were determined through expert inquiry, and the items were extracted, discussed, and adjusted, and finalized the list of information needs and prompts for patients with interstitial lung disease.Results:The 19 experts participated in the consultation, with a positive coefficient of 100.0% and 94.7% for two rounds of consultation, an authoritative coefficient of 0.91 and 0.92, and the Kendall coordination coefficient of 0.31 and 0.23, respectively. Finally, a list of interstitial lung disease patients′ question prompts containing 4 primary indicators and 34 secondary indicators was formed.Conclusions:Based on the ERG theory, the research method for the Question Prompt List of information needs for patients with interstitial lung disease is scientific and reliable, and can be used in clinical practice to help patients inquire and obtain the necessary information.

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@#To investigate the current status of milk and dairy product intake of primary and middle school students in Guangzhou and to explore the influencing factors, to provide the basis for promoting the consumption of milk and dairy products for students.@*Methods@#Questionnaire survey was conducted among 7 948 students selected from 3 primary schools and 3 middle schools in Guangzhou. The contents included general information, average amount of the intake of milk and dairy products (including pure milk, yoghurt, milk powder, cheese and other dairy products). Using χ2 test and multivariate Logistic regression to analyze the influencing factors of students’ milk and dairy product intake.@*Results@#About 76.12% of all participants reported milk and dairy products intake<7 times/week, 78.88% reported milk and dairy products intake<300 g/d and the median of milk and dairy products was 178.57 g/d. In the multiple Logistic regression model, girls and high school students were more likely to consume milk and dairy products insufficiently, with the OR of 1.42 (95%CI=1.26-1.60), 1.86 (95%CI=1.51-2.28) respectively. The students with father’s education level being college degree or above (OR= 0.75, 95%CI=0.59-0.94), mother’s education level being high school or above (high school:OR=0.75, 95%CI=0.61-0.93, college degree or above:OR=0.58, 95%CI=0.46-0.72) and annual household income ≥200 000 (OR=0.77,95%CI=0.64-0.92) were more likely to consume sufficient milk and dairy products.@*Conclusion@#Consumption of milk and dairy products among primary and middle school students in Guangzhou was high but not meet the recommended amount,should be strengthened. Health and nutritional education for students and their parents,especially girls and senior students,should be strengthened to promote the milk and dairy products consumption.

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@#Objective To investigate the effect of scalp acupuncture on cerebral blood flow and gross motor function in children with spastic cerebral palsy. Methods From January to November, 2016, 79 children with spastic cerebral palsy were randomly divided into con-ventional group (n=40) and scalp acupuncture group (n=39). Both groups received conventional rehabilitation treatment, and the scalp acu-puncture group was given scalp acupuncture in addition, for five months. The systolic blood flow velocity (Vs), mean flow velocity of cere-bral artery (Vm) and vascular resistance index (RI) of anterior cerebral artery (ACA), middle cerebral artery (MCA) and posterior cerebral artery (PCA) before and after treatment were assessed with color transcranial Doppler ultrasound (TCD). The clinical effect was evaluated with the Gross Motor Function Classification System (GMFCS). Results Five cases dropped out during the follow-up, three cases in the con-ventional group and two cases in the scalp acupuncture group. There was no significant difference in all the indexes between two groups be-fore treatment (P>0.05). After treatment, the Vs and Vm of ACA, MCA and PCA improved (t>2.051, P<0.05), no improvement was found in the RI of ACA, MCA and PCA in the conventional group (t<1.1631, P>0.05), and they decreased in the scalp acupuncture group (t>2.659, P<0.05). After treatment, the Vs and Vm of ACA, MCA and PCA were higher in the scalp acupuncture group than in the conventional group (t>2.098, P<0.05), the RI of ACA was lower in the scalp acupuncture group than in the conventional group (t=2.375, P<0.05), and no signifi-cant difference was found in the RI of MCA and PCA between two groups (t<1.637, P>0.05). The total effective rate was higher in the scalp acupuncture group than in the conventional group (χ2=6.887, P<0.05). Conclusion Scalp acupuncture facilitates to increase the cerebral blood flow, decrease the vascular resistance, and improve gross motor function in children with spastic cerebral palsy.

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<p><b>OBJECTIVE</b>To evaluate the sensitivity and specificity of immunohistochemical (IHC) staining of DNA mismatch repair (MMR) protein for the screening of microsatellite instability (MSI) colorectal cancer (CRC).</p><p><b>METHODS</b>A total of 255 CRC cases were studied, including 140 cases of routine paraffin-embedded tissue samples and 115 cases constructed on tissue microarray. Expressions of 4 MMR proteins including MHL1, MSH2, MSH6 and PMS2 were investigated by IHC. Negative protein expression was defined as complete absence of nuclear staining within tumor cells in the presence of positively labeled internal non-neoplastic cells. Focal staining was defined as the presence of staining in < 5% of the tumor cells. CRCs showing negative staining for any MMR proteins were interpreted as MMR deficient tumors. PCR-genescan MSI analysis was performed in each case by a five marker panel including Bat26, Bat25, NR-21, NR-24 and MONO-27.</p><p><b>RESULTS</b>Among the 140 CRCs with routine formalin-fixed paraffin embedded tissue sections, concordance rate between IHC and PCR-genescan was 98.6% (138/140), the sensitivity and specificity of IHC in detecting MSI tumors were 94.9% (37/39) and 100.0% (101/101), respectively. The 2 disconcordant cases showed focal staining in at least one of the MMR proteins but were confirmed to be MSI-H CRCs by PCR-genescan assay. On tissue microarray, 91.3% (105/115) of the cases had informative results. The concordance rate between IHC and PCR-genescan was 100.0% (105/105). Both the specificity and sensitivity of IHC in detecting MSI tumors on available tissue microarray samples were 100.0%. Ten cases were inclusive due to the presence of negative stains of MMR proteins in both the tumor and internal control cells.</p><p><b>CONCLUSIONS</b>Detection of 4 MMR proteins expression by IHC is reliable for identifying MSI CRCs and is recommended for routine practice. Tumors with focal MMR protein staining are highly suspected for the presence of MSI-H and PCR-genescan based MSI analysis should be performed to confirm.</p>

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Objective]Summarizing the thinking and experience for pediatric diseases of Zhi Yu QiaoKe. [Method]Analyse and induce the contents of“Clear-headed of Pediatric”, which was written by Zhi Yu QiaoKe ,elaborating his characteristics in treating pediatric diseases features.[Results]Zhi Yu QiaoKe amended the treatments and academic point of views, which were not conformed to the medical principles and practice proved to be errors, proposed“the differentiation of infantile convulsion of error theory”,“not hungry theory”; he considered that clinical cure, then pathogenesis diagnosis was accurate;medication must be care of primordial qi and spleen and stomach;in addition, we still should also focus on nursing and adhere to the taboo. [Conclusion]The Clear-headed Pediatric with precise arguments and appropriate classification reflects the author ’s advanced medical theory and excellent medication principle of dialectical thinking, rigorous medication principle and exquisite nursing technique, the clinical diagnosis and treatment rules and characteristics of a certain reference value for the modern clinical, worthy of promotion.

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OBJECTIVE:To explore the observation and nursing points of hemorrhage in intravenous thrombolysis after using alteplase. METHODS:128 patients underwent alteplase intravenous thrombolysis were selected as the research object. The occur-rence of hemorrhage in each part were observed within 48 hours after medication and nursed timely. RESULTS:128 patients re-ceived intravenous thrombolysis. 48 h later,26 patients suffered from hemorrhage complications (20.3%). Among them,there were 6 cases of nose bleeding (4.7%),8 cases of subcutaneous congestion (6.3%),6 cases of gingival bleeding (4.7%) and 6 cases of gastrointestinal bleeding(4.7%). There was no significant difference in the incidence of complications among those groups (P>0.05). The time of nose bleeding was (3.2 ± 1.3) h,the time of subcutaneous congestion (3.5 ± 1.2)h,the time of gingival bleeding(1.5±0.7)h,and the time of gastrointestinal bleeding(4.1±1.8)h. The time of gingival bleeding was earlier than that of other groups,with statistically significant difference(P0.05). CONCLUSIONS:In alteplase intravenous thrombolysis,nurses should closely monitor hemorrhage and complications, especially the complication of gingival bleeding. Find out the complications timely and nurse it as early as possible.

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<p><b>OBJECTIVE</b>To investigate the association of mesorectal invasion depth before neoadjuvant radiochemotherapy with pathological outcome and to provide evidence for individualized treatment in T3 rectal cancer.</p><p><b>METHODS</b>Retrospective analysis was performed on the clinical records of 73 consecutive rectal cancer patients treated with neoadjuvant radiochemotherapy and radical surgery in the Shanghai Cancer Center from January 2010 to December 2012. All the patients underwent high-resolution MRI and the depth of mesorectal invasion, lymph node status, tumor length, and mesorectal fascia status were evaluated. The category T3 was subdivided according to the measurement of the maximal tumor invasion beyond the outer border of the muscularis propria: T3a(<5 mm), T3b(5-10 mm) and T3c(>10 mm). The association of mesorectal invasion depth,other MRI and clinical features with short-term efficacy was analyzed,especially with pathological complete response(pCR).</p><p><b>RESULTS</b>T3a, T3b and T3c accounted for 19.2%, 64.4% and 16.4% in 73 rectal cancer patients who underwent high resolution MRI, respectively. There were 42.9% of T3a patients achieved pathological complete response,significantly higher than those of T3b(14.9%)and T3c(0%) (P=0.017).</p><p><b>CONCLUSIONS</b>T3a rectal cancer patients are more likely to achieve pCR than those of T3b and T3c after neoadjuvant radiochemotherapy. The maximal tumor invasion beyond the outer border of the muscularis propria less than 5 mm may act as a predictive factor and guide the follow-up treatment of T3 rectal cancer.</p>

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Objective To investigate the ability of immune response of cotransfection of rat breast cancer cells with MIP-1αand B7-1 .Methods Tumor growth was observed every day after the SHZ-88 breast cancer cells were inoculated in the rats .The tumor-bearing rats were randomly divided into control group ,MIP-1αgroup ,B7-1 group and combination group ,which were injected with corresponding transgenic cells .The change of tumor volume in 1~4 weeks and the survival time were observed and compared .The peripheral blood was collected .CD4+ ,CD8+ percentage and CD4+ /CD8+ ratio and the levels of IL-2 and IFN-γof the peripheral blood were detected and compared .Results The tumorigenic rate were 100% ,20% ,30% and 0% after the SD rats were inoculated with SHZ-88 ,SHZ-88/MIP-1α,SHZ-88/B7-1 and SHZ-88/MIP-1α+B7-1 cells for 10 days .After the transgenic therapy ,the tumor volume of the combination group in 1~4 weeks were significantly smaller than the other groups .The survival time of the combina-tion group was significantly longer than the other groups .The CD4+ ,CD8+ percentage and CD4+ /CD8+ ratio and the levels of IL-2 and IFN-γof peripheral blood in the combination group were significantly higher than the other groups .The differences above were all statistically significant (P<0 .05) .Conclusion Cotransfection of MIP-1αand B7-1 could induce immune response in breast cancer rats and play anti-cancer effects .

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Objective In the previous study completed in Korea, early three-dimensional conformal radiotherapy concurrent with chemotherapy in rectal cancer after radical surgery demonstrated a better prognosis compared with late radiotherapy. However, with the report of MOSAIC trial, the adjuvant chemotherapy regimen had transferred from 5-Fu alone to combined 5-Fu and Oxaliplatin. We need more evidence to clarify the best radiotherapy timing during the whole period of adjuvant therapy . Methods Patients who met the following criteria were accrued in this study: 18-70 years old, lower anterior resection,pathologically proven rectal adenocarcinoma, stage T3-4 and/or N+, no evidence of distant metastases and KPS≥70. Three dimensional conformal Radiotherapy was started at the fourth week after surgery, which included 45 Gy whole pelvic radiation following by 6-10 Gy tumor bed boost. Oxaliplatin of 50 mg/m2 weekly and Xeloda 625 mg/m2 twice a day, every week from d1-5 were used concurrent with radiotherapy.Toxicity was evaluated and graded by common toxicity critera version 3. 0. The study was designed as Simon two-phase design, in the first phase, a total of 15 patients were accrued, and if more than or equal to 9 patients had grade 3 toxicity, we had 85% power to confirm the toxicity caused by early radiotherapy more than 50%. Otherwise, another 15 patients of the second phase were accrued, we would have 85% power to confirm the high toxicity of more than 50% if 18 out of 30 patients had grade 3 toxicity. Results From July 2008 to December 2008, 15 patients were treated with early radiotherapy concurrent with combined chemotherapy, Grade 3 gastrointestinal toxicity occurred in 12 patients and Grade 3 hematologic toxicity occurred in 2 patients. According to Simon design, we had 85% power to confirm the toxicity caused by early radiotherapy more than 50%. Conclusions For locally advanced rectal cancer patients, whole pelvic radiotherapy concurrent with oxaliplatin and xeloda had severe toxicities. Further studies are needed to decrease toxieities.

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Objective To study the relationship of interleukin-18 (IL-18)gene-137G/C polymorphisms in the promoter region with cerebral infarction(CI) and the effect of integrin gene polymorphisms on plasma lipid and lipoprotein levels. Methods Polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP) were used for the detection of integrin genotypes in 190 patients with CI and 210 healthy controls. The plasma lipid and lipoprotein levels were measured by routine method. Results The distributions of IL-18 gene -137G/C polymorphism was significantly different between CI group and control group(P ＜0. 05＝ ,The relative risk suffered from CI of C allele was 1.624 times of the G allele (OR = 1.624,95% CI: 1.134 ～ 2.324), The level of plasma lipid C allele carriers was significantly higher than no carriers(P ＜0.05＝. Conclusion IL-18 gene-137G/C polymorphism was associated with CI, C allele may be genetic susceptibility gene for CI.

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OBJECTIVE To investigate the postoperative morbility of deep fungal infections and the source and composition of the pathogenic fungi.METHODS Clinical data of 816 patients with post-operative deep fungal infections from Jul 2006 to Jun 2008 were reviewed and analyzed retrospectively.RESULTS The detectable rate of post-operative deep fungal infections was 24.82%,among which Candida albicans was the most common(65.69%),followed by C.tropicalis(10.57%);the rate of broad-spectrum antibiotic application in peri-operation was 96.45%;the infection site in the descending order was cardio-thorax,gastrointestinal tract,urinary tract,female reproductive system,blood and skeleton.CONCLUSIONS Operative trauma is an important factor that causes deep fungal infections in hospital,and is closely related to broad-spectrum antibiotic application.Positive prevention,timely diagnosis and effective treatment should be highly emphasized when dealing with post-operative deep fungal infections.

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Objective: To observe the effects of manganese( Ⅲ ) meso-tetrakis (N, N'-diethylimidazolium-2-yl) porphyrin (MnTDM) in treatment of early Parkinson's disease(PD) mouse model induced by subcutaneous injection of 1-methyl-4-phenyl1, 2, 3, 6-tetrahydropyridine(MPTP) and to discuss its possible mechanism. Methods:Forty male C57BL/6 mice were evenly randomized into 4 groups: MPTP model group(subcutaneous injection of 25 mg/kg MPTP for 3 days), MnTDM+ MPTP group (15 mg/kg MnTDM was subcutaneously injected 1 h before MPTP injection), MnTDM control group, and normal saline group. Performance of animals in the pole and swimming test was observed 3 days after the last injection. Levels of dopamine (DA) and its metabolites(3,4-dihydroxyphenylacetic acid [DOPAC] and homovanillic acid [HVA]) in the striatum of animals were measured by high-performance liquid chromatography with an electrochemical detector(HPLC-ECD). Thiobarbituric acid (TBA) method was used to examine the levels of malondialdehyde(MDA). Results: Acute injection of MPTP could be used for establishment of PD model. The striatal levels of DA, DOPAC and HVA in MPTP group were significantly lower(P＜0.01)and the striatal level of MDA was significantly higher(P＜0.05) than those of the control group. MPTP had no obvious effect on the behavioral performance of the animals in a short term. MnTDM could partly inhibit the above effects of MPTP. Compared with MPTP group, MnTDM+ MPTP group had significantly higher DA, DOPAC, and HVA levels and significantly lower MDA level(all P＜0.05). There was no significant difference in the behavioral indices of animals between the 4 groups. Conclusion:MnTDM can inhibit lipid peroxidation and promote DA production; it has preventive and therapeutic effects on MPTP induced PD.

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OBJECTIVE:To study the rationality of multiple-unit containers of oral drugs.METHODS:The condition of whether the oral western medicines currently used in our hospital were packaged in single-dose container or not were inves?tigated;the information on packaging and distribution of multiple-unit containers was analyzed as well.RESULT:Of the460kinds of oral western medicines investigated,220were in single-dose containers,and138were in multiple-unit containers,of the multiple-unit containers87involved problems in packaging.CONCLUSION:It is suggested that single-dose container should be used and the multiple-unit containers should be improved reasonably.

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The authors hold that factors affecting the quality of hospital network data include ideologies of relevant personnel, state of the administrative organization, quality of the staff, standardization level of data, level of the software used, interdepartmental cooperation, feedback of test data, and mechanism of supervisory control. Only by taking corresponding measures can the quality of network data be constantly improved.