Objective To investigate the clinical efficacy of neoadjuvant chemotherapy regimens of TA or AC in the treatment of locally advanced triple negative breast cancer. Methods Data of 99 women with stageⅡ/ Ⅲ locally advanced triple negative breast cancer treated in the Centre Hospital of Cangzhou from Jan. 2006 to Dec. 2011 were retrospectively analyzed. These patients were divided into two groups based on the regimen of the neoadjuvant chemotherapy. Fifty-two cases were received TA regimen(Docetaxel 75 mg/ m2 and pirarubicin 50 mg/ m2 )and 47 cases were received AC( pirarubicin 50 mg/ m2 ,cyclophosphamide 600 mg/ m2 ). IV drip infusion was administered in both groups for 4 cycles before surgery,with 3 weeks for each cycle. The efficacy after treatment,the 2 year recurrence rate and overall survival rate after operation were compared between the two groups. Results The response rates in TA group were 88. 46% ,higher than that of AC group(57. 45% ),and the difference was statistically significant(χ2 = 12. 260,P < 0. 001). Furthermore,the rate of pathological grade 4 and 5 in TA group were 42. 3%(22 / 52)was superior to AC group(23. 4%(11 / 47);P = 0. 046). The 2-year recurrence rate and survival rate in TA group were 23. 08%(12 / 52)and 84. 62% ,as same as that in AC group ((27. 66%(13 / 47)and 80. 85% ;χ2 = 0. 400;P = 0. 53). Conclusion TA and AC are both effective in terms of females with stage Ⅱ/ Ⅲ locally advanced triple negative breast cancer treat with neoadjuvant chemotherapy. Moreover,TA is superior to AC. However,there is no statistical difference of 2-years recurrence rate and survival rate between two groups.

Objective To investigate the effect of gastrointestinal Roux-en-Y gastric bypass surgery on blood sugar and insulin function of patients with type-2 diabetes mellitus.Methods Twenty-seven cases of gastric cancer patients with type-2 diabetes and undergone Roux-en-Y bypass the gastrointestinal treatment in the centre hospital of Cangzhou were selected as our subject.Body mass index (BMI),Glycosylated hemoglobin (HBA1c),Fasting and glucose (FPG),fasting insulin (FINS),Fasting C-peptide (FCP) levels were measured.Glucose (2 hPG),insulin (2 hINS) and C-peptide (2 hCP) levels were detected after 2 h for oral use 75 g glucose.Homeostasis model was applied to assess insulin resistance index (HOMA-IR).Results No significant change was seen in terms of BMI between before and after surgery.Compared to before surgery,the levels of FPG((7.58 ±0.84) mmol/L),2 hPG((10.43 ± 1.88) mmol/L),HbA1c((7.56 ± 1.15)％) and HOMA-IR(4.55 ±0.76) were lower in patients at 3 months after surgery ((9.93 ± 1.57) mtmol/L,(13.89± 2.13) mtmol/L,(9.88 ± 1.66) ％,(4.55 ± 0.76),respectively,P ＜ 0.05 or P ＜ 0.01).FPG ((6.56± 0.80) mmol/L),2 hPG ((8.57 ± 1.32) mmol/L),HbA1 c ((6.37 ± 1.24) ％),HOMA-IR (4.03 ± 0.45)of patients after 6 months were lower than that of before surgery and 3 months after surgery (P ＜ 0.05 or P＜0.01).However,the levels of FINS ((13.67 ± 1.96) mU/L),FCP((2.62 ±0.87) μg/L),2 hINS((49.91± 5.14) mU/L) and 2 hCP ((6.28 ± 1.65) μg/L) were higher in patients with 3 months after surgery compared to that of before surgery ((11.08 ± 1.69) mU/L,(1.78 ± 0.61) μg/L,(36.05 ± 4.03) mU/L,(4.28 ± 1.48) μg/L,P ＜ 0.01).Meanwhile those indices after 6 months (FINS:(15.88 ± 2.05) mU/L,FCP:(3.30 ±0.68) μg/L,2 hINS:(67.40 ±5.68) mU/L,2 hCP:(9.39 ± 1.52) μg/L) were higher than that of before surgery and 3 months after surgery(P ＜ 0.01).Conclusion Roux-en-Y gastrointestinal bypass can effectively reduce blood sugar level and improve the situation of Pancreatic Beta-cell function of gastric cancer patients with type-2 diabetes.

Objective To explore metabolic characteristics of and risk factors for newly diagnosed type 2 diabetes mellitus(T2DM) combined with non-alcoholic fatty liver disease (NAFLD).Methods One hundred and forty-two cases of newly diagnosed T2DM were divided into two groups according to whether they have comorbid NAFLD:group A (without NAFLD,n =79) and group B (combined with NAFLD,n =63).Data collected included body height,body weight,blood pressure,fasting plasma glucose (FPG),blood lipid,serum uric acid (UA),HbA1c and fasting insulin,body mass index and insulin resistance index with homeostasis model(HOMA-IR) were calculated to compare the clinical and biochemical parameters between groups A and B.Results (1) The difference of age and blood pressure between groups A and B were not statistical different (P ＞ 0.05).Compared with group A,BMI ((26.79 ± 1.93) kg/m2 vs (24.61 ± 2.46) kg/m2,t =5.76),FINS((15.49±2.44) mU/L vs (13.20±2.17) mU/L),t =5.91),HOMA-IR((6.74± 1.32) vs (5.65 ±1.10),t =5.37),glycerin trimyristate (TG) ((2.94 ± 0.65) mmol/L vs (1.74 ± 0.46) mmol/L),t =12.86),low density lipoprotein cholesterin (LDL-C) ((3.46 ±0.73) mmol/L vs (2.78 ±0.86) mmol/L,t =5.07) and UA((342.41 ±71.49) mmol/L vs (312.98 ±66.24) mmol/L,t =2.54) were significantly higherand hight density lipoprotein cholesterin (HDL-C) ((0.99 ± 0.17) mmol/L vs (1.21 ± 0.29) mmol/L,t =5.33) was significantly lower in group B (P ＜ 0.05).(2) Using whether to combined with NAFLD as dependent variable,and BMI,FINS,HOMA-IR,TG,LDL-C,HDL-C and UA as independent variable,logistics regression analysis showed that BMI,HOMA-IR and TG were risk factors for NAFLD(OR =2.838,19.241,and 2.019 respectively,P ＜ 0.05).Conclusion Newly diagnosed type 2 diabetes mellitus combined with NAFLD have more obvious dyslipidemia and insulin resistance.Obesity,insulin resistance,hyper-triglyceridemia are risk factors for newly diagnosed type 2 diabetes mellitus combined with NAFLD.

Based on clinical research and information-sharing system, this article was aimed to study both the syndrome distribution and Chinese medicine composition of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in the COPD base of our hospital using the complex networks. The analysis was made on the common rules of syndrome distribution and features of key Chinese medicine compositions in the diagnosis and treatment of AECOPD. The clinical research and information-sharing system was used on the AECOPD data study (3000 hospital electronic medical records from August 2012 to January 2015). Data was processed by ETL software. The database was constructed. And the complex networks were used in the data mining. The results showed that the distribution of AECOPD common syndromes was heat-phlegm obstructing lung of 41.94%, phlegm-turbid obstructing lung of 22.97%, phlegm-damp obstructing lung of 10.30%,qi-yin deficiency of 6.31%, phlegm-stasis obstructing lung of 5.72%, lung-kidneyqi-deficiency of 4.01%, lung-spleenqi-deficiency of 1.15%, and phlegm obstructing orifices of 1.15%. Chinese medicine compositions were obviously divided into two large groups, which were the core Chinese medicine group and the associated Chinese medicine group. The research results illustrated that the clinical research and information-sharing system had good analysis and classification effects, which not only analyzing the medication laws of senior Chinese medicine experts and single disease treatment by a hospital, but also using in the large data analysis (data collection of single or multiple diseases on Chinese medicine clinical research nationally). It provided a good scientific research platform for Chinese medicine.

Objective To observe the post-systolic shortening (PSS) during isovolumic relaxation phase and its clinical significance in regional myocardium in chronic heart failure (CHF) patients.MethodsLeft ventricular regional myocardium movement in 60 CHF patients (CHF group) and 30 healthy volunteers (control group) were assessed with tissue velocity imaging (TVI). QLAB software was used to measure the systolic peak velocity (V_s), regional systolic time (T_s), post-systolic shortening velocity (V_(pss)) and post-systolic shortening time (T_(pss)) at the basal and middle levels of left ventricle. Results In CHF patients, the rate of isovolumic relaxation phase PSS was 34.44% both in basal and mid segments, the rate of pathological PSS was 29.44% and 29.72%, respectively. The rate of isovolumic relaxation phase PSS in control group was 26.11% and 20.56%, respectively; none pathological PPS occured. Compared with the physiological PSS of control group, the pathological PSS of CHF group had a higher peak velocity and a longer time (P<0.05). Conclusion The pathological PSS of CHF patients has high peak velocity and long duration, which may be one of the causes leading to the asynchronous movement of left ventricle in CHF.

Objective To clarify the expression of leptin and leptin receptor in normal brain tissues and gliomas and investigate the effect of exogenous leptin on the proliferation,migration and invasion of human glioma U251 cell line.Methods Immunohistochemical staining was used to detect the expression of leptin and leptin receptor in 50 cases of different grades of glioma tissues and 20 cases of normal brain tissues.The effects of exogenous leptin on proliferation,migration and invasion of U251 cells were detected by MTT assay,cell scratch assay and Transwell invasion assay.Results (1) The positive expression rates of leptin and leptin receptors in glioma tissues were 50.0％ and 92.0％,respectively.(2)Proliferation activity:leptin concentrations of 0 ng/ml,10 ng/ml,and 50 ng/ml had no significant difference in the proliferation of U251 cells (absorbance:0.263±0.015,0.273±0.017 and 0.277±0.006,respectively),and the leptin concentration of 100 ng/ml had a significant effect on the proliferation of U251 cells (absorbance:0.315±0.005,P＜0.05).(3)Migration ability:the migration rate of U251 cells treated with different concentrations of leptin increased significantly with the passage of time,and the migration rate was most significant at the concentration of 100 ng/ml ((93.313±3.080) ％),and the difference was statistically significant (P＜0.05).(4)Invasive ability:with the increase of leptin concentration and the prolongation of the action time,the invasive ability of U251 cells was enhanced.When leptin was used at a concentration of 100 ng/ml,the number of penetrating cells were the biggest(135±2).Conclusion Leptin and leptin receptors are involved in the occurrence of gliomas;and exogenous leptin promotes the proliferation of U251 cells and has time and dose dependability on the migration and invasion of U251 cells.

Objective To investigate the teaching effects of flipped class model on the Surgery Intensive Care Unit (SICU) nurses' ability of autonomic learning. Methods From July to December 2015, a total of 38 nurses who worked in SICU of Zhejiang Cancer Hospital were selected as the research objects by convenience sampling method. The nurses were trained in postoperative pain management knowledge by flipped class model, and were evaluated before and after the training by rating scale of self-directed learning competence for nurses. Results The total score of rating scale of self-directed learning competence for nurses, self motivation belief, task analysis, self monitoring and regulation, self evaluation were (128.26±18.69), (54.50±7.65), (22.05±3.66), (37.57±5.82) and (14.13±2.67) after the training, which all improved than (108.89±15.71), (47.18±6.61), (18.03±3.33), (31.37±5.24) and (12.32±2.14) respectively before training. The differences were statistically significant (t=-4.889, -4.460, -5.013, -4.883, -3.266; P<0.05). Conclusions Flipped class teaching model improves nurses' autonomous learning ability comprehensively and provide a new teaching mode for nurses' training.

OBJECTIVETo evaluate the value of D2+ lymph node dissection for patients with distal advanced gastric cancer.

METHODSClinicopathological data of 305 cases with distal advanced gastric cancer receiving D2+(n=68) or D2(n=237) lymph node dissection in the Tianjin Cancer Hospital from January 2003 to December 2007 were analyzed retrospectively. The overall 5-year survival rate between the 2 groups.

RESULTSThe median survival was 36 months and the 5-year overall survival rate was 40.3% in all patients. The 5-year overall survival rates in the D2+ and D2 groups were 50.4% and 37.4% respectively, and the difference was statistically significant(P=0.049). In multivariate prognostic analysis however, the extent of lymph node dissection was not identified as an independent prognostic factor(P=0.174). Subgroup analysis showed that 5-year survival rate of D2+ group was significantly higher as compared to D2 group for the following subgroups: maximum diameter of tumor larger than 4 cm(43.9% vs. 27.0%), Borrmann type III(-IIII((55.5% vs. 30.1%), poorly differentiated and undifferentiated tumor (49.8% vs. 37.0%), T4 stage (47.8% vs. 31.0%), N2 stage (53.3% vs. 13.9%), N3 stage (20.0% vs. 9.6%) and positive No.6 lymph nodes (33.1% vs. 16.0%).

CONCLUSIONCompared with D2 lymph node dissection, D2+ lymph node dissection may benefit some patients with large, poorly differentiated, or late-stage tumor.

Humans ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Metastasis ; Multivariate Analysis ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; Survival Rate

OBJECTIVETo determine whether the level of serum cardiac troponin T (cTnT) was increased in patients with congestive heart failure (CHF).

METHODSThis study consisted of 265 patients with CHF and 75 healthy people. Serum cTnT was measured by electrochemiluminescence immunoassay using an Elecsys 1010 automatic analyzer.

RESULTScTnT concentration was 0.181 +/- 0.536 ng/mL in CHF patients and 0.003 +/- 0.001 ng/mL in controls (P < 0.001). Patients were categorized according to the levels of heart function and left ventricular ejection fraction (LVEF). In the first group consisting of 105 patients with LVEF 35%, cTnT was 0.07 +/- 0.0 5 ng/mL (P < 0.01). In patients with NYHA class I, II, III and IV, cTnT values were 0.062 +/- 0.022 ng/mL, 0.113 +/- 0.121 mg/mL, 0.191 +/- 0.231 mg/ml and 0.384 +/- 0.211 mg/mL, respectively (class I vs class II P > 0.05, class II vs class III P < 0.01, class III vs class IV P < 0.01). A negative correlation was observed between serum cTnT concentration and LVEF in 265 patients with CHF (r = -0.493, P < 0.001).

CONCLUSIONSThis study shows that the level of serum cTnT is increased in patients with CHF and that the increased level indicates the severity of CHF.

Adult ; Aged ; Female ; Heart Failure ; blood ; physiopathology ; Humans ; Male ; Middle Aged ; Stroke Volume ; Troponin T ; blood ; Ventricular Function, Left

Objective:To analyze the changes in plasma endothelin-1 (ET-1) concentrations in the patients with acute respiratory distress syndrome (ARDS).Methods:Fourteen patients with ARDS induced by trauma, 8 males and 6 females, aged 19-80 yr, were studied. The severity of ARDS was graded according to the Berlin definition of ARDS after admission to intensive care unit (ICU). Venous blood samples were obtained on 1st, 3rd and 5th days after admission to ICU, the plasma ET-1 concentrations were measured by radioimmunoassay, the pulmonary vascular permeability index (PVPI) was determined by PiCCO technique, and multiple organ dysfunction (MOD) score and lung injury score (LIS) were assessed. Spearman correlation of plasma ET-1 concentrations with MOD score, LIS and PVPI was analyzed.Results:MOD score, LIS, PVPI and plasma ET-1 concentrations were significantly decreased in mild ARDS patients ( n=5) as compared with moderate ARDS patients ( n=9, P<0.05). The plasma ET-1 concentration was positively correlated with MOD score, LIS and PVPI ( r=0.69, 0.76, 0.62, P<0.001). Conclusions:Plasma ET-1 concentrations can reflect the pulmonary vascular permeability and even the severity of the disease in the early stage of ARDS, so it is necessary to carry out dynamic monitoring in the patients.