Breast cancer should be considered as a family of diseases which are significantly different from each other in molecule level rather than a single disease, and clinical heterogeneity of breast cancer origins from molecular heterogeneity. Gene-expression signatures have been developed based on gene expression profiling of breast cancer, such as the 70-gene signature, 21 -gene signature and intrinsic subtypes of breast cancer. These signatures are valuable and have a good prospect in prognosis predicting and clinical decision of breast cancer.

Objective To explore the effect of N -acetylcysteine(NAC)in adjunctive treatment of neonatal bronchopneumonia and its influence on serum inflammatory factors.Methods 62 neonatus with bronchopneumonia treated in our hospital from June 2012 to December 2014 were randomly divided into observation group(32 cases)and control group(30 cases)with random number table.The control group was treated with basic therapy,such as relieving a cough and asthma,defervescing,oxygen inhalation,keeping respiratory tract unobstructed,nutritional support,while the observation group was added aerosol inhalation of NAC on the basis of basic therapy.Then the effect of the average time of body temperature returned to normal,the disappearance time of cough,asthma and pulmonary rale,and average hospitalization days of two groups were observed and compared,the levels of serum tumor necrosis factor -α(TNF -α), interleukin -1(IL -1),interleukin -6(IL -6)and interleukin -10(IL -10)of the two groups before and after treatment were detected.Results The total effective rate of the observation group was 90.63%,which was higher than 70% of the control group (χ2 =4.220,P <0.05).The average time of body temperature returned to normal, disappearance time of cough asthma and pulmonary rale,and average hospitalization days of the observation group were shorter than those of the control group (t =-4.211,-3.472,-4.240,-5.413,-7.822,all P <0.05).The levels of serum TNF -α,IL -1,IL -6 and IL -10 of the observation group after treatment were lower than those of the control group (t =-6.421,-3.892,-15.452,-9.773,all P <0.05).Conclusion Using aerosol inhalation of NAC in adjunctive treatment of neonatal bronchopneumonia can significantly improve the clinical effect and shorten the course of disease,meanwhile,it will eases the systemic inflammatory response to damage the organs by regulating the level of inflammatory factors,which is good for the recover of neonatus as soon as possible.

Objective:To investigate the protection of acupuncture on damaged myelin sheath from the poinr of view of neurological functional recovery and morphological changes of the myelin sheath.Methods:Eighty-nine adult male Sprague-Dawley rats were randomly allocated to normal (n=5),sham-operation (n=21),model (n=21),early acupuncture (n=21) and late acupancture (n=21) groups.A model of middle cerebral artery occlusion was induced by the intraluminal filament method.Acupuncture was performed at different time points after ischemia.Neurological function and morphological changes of the myelin sheath of ischemic focus were observed by using the methods of neurological deficit scores and Pal-Weigert's myelin staining.Results:Neurological deficit scores at 2.5 hours after the procedure in the model group increased significantly (P＜0.05).qhe scores decreased somewhat as the time elapsed.The internal capsule had obvious demyelination and recovered slowly.Neurological deficit scores in rats at each time point decreased faster in the acupuncture group compared with the model group,and they decreased significantly at day 3 (P＜0.05);the extent of demyelination was significantly alleviated.Neurological deficit scores decreased faster in the early acupuncture group compared with the late acupuncture group (P＜0.05);and demyelination in the early acupuncture group seemed milder at day one.Conclusions:Early acupuncture is beneficial to remyelination and neurological functional recovery after cerebral ischemia.

ObjectiveTo analyze the characteristics of severe trauma patients with acute kidney injury (AKI) receiving renal replacement therapy (RRT), in order to look for the risk factors of AKI and the opportune time for the initiation of RRT on prognosis.Methods A retrospective cohort study involving consecutive patients with severe trauma in emergency intensive care unit (ICU) in the Second Affiliated Hospital of Zhejiang University School of Medicine, from August 2011 to December 2014, was conducted. Inclusion criteria included age≥18 years, injury severity score (ISS)> 16, AKI receiving RRT, and the duration of hospital stay> 24 hours. The general data, the risk factors of AKI, the prognostic indicators, and the information of RRT were recorded. All patients were divided into two groups according to the prognosis, the time of onset of AKI and the initiation time of RRT. The independent risk factors for prognosis were screened by binary logistic regression analysis.Results Seventy-three patients were eligible for enrollment, including 48 deaths (65.8%); 49 patients suffered from AKI≤48 hours after trauma (early stage group), and in 24 patients it was longer than 48 hours (late stage group). In 55 patients RRT was routinely started (routine RRT group), 18 patients underwent RRT ahead of routine criteria decided by the judgment of the attending doctor (earlier RRT group). The main risk factors of RRT in traumatic patients with AKI were shock and sepsis, each accounted for 90.4% and 53.4%. Compared with survival group, in death group, the proportion of male patients was lower (70.8% vs. 100.0%,χ2 = 7.238,P = 0.007), acute physiology and chronic health evaluationⅡ (APACHEⅡ) scores were higher (23.7±5.1 vs. 14.4±3.7,t = 8.031,P< 0.001), Glasgow coma score (GCS) was lower [5.0 (3.0, 15.0) vs. 15.0 (8.0, 15.0),U = 320.000,P = 0.001], incidence of shock and sepsis was higher (97.9% vs. 76.0%,χ2 =6.755,P = 0.009; 64.6% vs. 32.0%,χ2 = 7.014,P = 0.008), the rate of use of contrast medium was lower (27.1% vs. 56.0%,χ2 = 5.898,P = 0.015), the time for the diagnosis of AKI post trauma was delayed [days: 2 (1, 5) vs. 2 (1, 2), U = 762.000,P = 0.049], the time for the initiation of RRT post trauma was later [days: 6.0 (3.0, 12.0) vs. 3.0 (2.0, 4.5), U = 868.500,P = 0.002], the recovery rate of renal function at discharge was lower (10.4% vs. 100.0%,χ2 = 54.497, P< 0.001). Compared with late stage group, in early stage group, the mortality was lower (55.1% vs. 87.5%,χ2 =7.509,P = 0.006), and the incidence of sepsis before AKI was also lower (38.8% vs. 83.3%,χ2 = 12.854,P< 0.001). Compared with routine RRT group, the recovery of renal function at discharge was better with a lower mortality rate in the earlier RRT group, but the difference was considered to be insignificant (55.6% vs. 36.4%,χ2 = 2.064,P = 0.151;50.0% vs. 70.9%,χ2 = 2.633,P = 0.105). Logistic regression analysis showed GCS [odds ratio (OR) = 0.852, 95%confidence interval (95%CI) = 0.747-0.972,P = 0.017], shock before AKI (OR = 85.350, 95%CI = 5.682-1 282.073, P = 0.001), and sepsis before AKI (OR = 11.499, 95%CI = 2.127 - 62.161,P = 0.005) were independent risk factors for the judgment of prognosis.Conclusions Shock and sepsis are the major risk factors of RRT in trauma patients with AKI. Shock, sepsis and traumatic brain injury are the independent risk factors of death. Perhaps early initiation of routine RRT cannot improve the outcome of the patients with posttraumatic renal insuficiency.

Objective:To study the environment suitability of multi-parameter patient monitor. Methods: Choosing six different types of multi-parameter patient monitor from different manufactures, we tested six main parameters of the multi-parameter patient monitor when they had gone through the environmental tests, and the test limits come from field environment. Results:Each of the samples was not up to the standards. Conclusion:At present a clear most of the multi-parameter patient monitor in the market are designed and produced for using indoors, which are not suitable for using in field environment. We need to enhance the protection of the multi-parameter patient monitor against field environment, and improve the environment suitability.

Objective]To measure and compare the MRI artifacts caused by common metal ic dental materials and common ceramic dental materials on different field-strength magnets.[Methods] A total of 3 common metal ic dental materials and 2 common ceramic dental materials were tested with 0.35T, 1.5T and 3.0T MR imagers. The artifact areas on these 3 different field-strength magnets were measured and statistical y compared. [Results]Zirconia in three field magnetic resonance(NMR) in T1 and T2 as no artifacts, casting porcelain, metal al oy, nickel chromium al oy and CoCr-al oy in three fields magnetic resonance(NMR) in T1 and T2 as al can produce different degree of artifacts, and artifacts area increased in turn. Cobalt chromium al oy and nickel chromium al oy measurements on the high side, the cobalt chromium al oy than other four kinds of materials on the high side( P<0.05),high nickel-chromium al oy was precious metal al oy, casting porcelain( P<0.05). [Conclusions]Commonly used metal ic dental materials could cause MR artifacts and image degradation. Compared with that on 0.35T, the artifact was increased on 1.5T magnet. Compared with that on 1.5T, the artifact was increased on 3.0T magnet.

Objective Both kidneys of mice used To investigate the surgical procedures for establishment of murine kidney transplantation models by using bilaterial donor kidneys as grafts for two recipients.Method Using Balb/c male mice as donors/receptors,through careful dissection and trimming of donor renal vessels and abdominal great vessels,both right and left kidneys were harvested and separately transplanted into two recipients.The anastomosis between the aorta and vena cava of the graft and recipient mouse was made in end to-side manner using the 10-0 sutures.The artery and vein was anastomosed by dual point 180 continuous sutures.The technique of pulling the end of graft ureter into recipient's bladder and external fixation method were used for urethral reconstruction.Five days later the recipient's kidney was removed after transplantation.Result The kidneys in 30 mice were transplanted (15 left kidneys and 15 right kidneys) and model survival rate was 76.7％ (12/15 for the left and 11/15 for the right).The average operating time of donor was 339 min and that of recipient was 46 12 min.Cold ischemia time for the first and second transplantation was about 0.5 h and 1.5 h respectively.Conclusion Through careful microsurgical operation we establish the mouse kidney transplantation models using both donor kidneys as grafts,which reduces the costs of microsurgery experiments.

OBJECTIVE:To investigate the status of the use of angiotensin Ⅱ receptor blocker(ARB)in the outpatient of our hospital,and provide reference for the clinical rational drug use. METHODS:Totally 2 460 prescriptions of hypertension treated by ARB drugs in the outpatient of our hospital in 2013 were statistically collected,and the use of such drugs were comprehensively an-alyzed. RESULTS:The ratio of ARB in the treatment of hypertension in the outpatient of our hospital in 2013 was 36.22%,and the common ARB drugs were Irbesartan tablets,Irbesartan and hydrochlorothiazide tablets,Valsartan capsules and Telmisartan tab-lets. The prescriptions of hypertension in our hospital were mostly two-drug combination,the common combination of ARB drugs were ARB+calcium channel blocker(CCB)and ARB+potassium-sparing diuretics;the three-drug combination of ARB drugs were ARB+β-receptor blockers (β-RB)+CCB and ARB+CCB+potassium-sparing diuretics. Among 2 460 prescriptions of hypertension treated by ARB drugs,1 103 prescriptions were irrational,accounting for 44.84%;77 prescriptions were ARB combined with po-tassium-sparing diuretics with no clear indication,accounting for 6.98%;39 prescriptions were ARB combined with ACEI with no clear indication,accounting for 3.54%;330 prescriptions were ARB combined with β-RB with no clear indication,accounting for 29.92%;617 prescriptions had inappropriate frequency of ARB use,accounting for 55.94%;and 40 prescriptions were other irra-tional use,accounting for 3.63%. CONCLUSIONS:ARB drugs are commonly used for hypertension patients in outpatient of our hospital. However,there are still many problems of irrational use in clinical treatment. Therefore,hospital should take appropriate interventions to promote the rational drug use through the joint efforts of physicians,pharmacists and hospitals.

Objective To provide evidence for decision-making on bladder cancer prevention through investigating the main risk factors related to the incidence of bladder cancer in Chinese population.Methods Using the search terms "bladder neoplasm" and "smoking", the literature from January 1979 to June 2005 on the relationship between risk factors and bladder carcinoma was searched from MEDLINE database and PubMed database,and was studied by Meta-analysis.At the same time,ORs of randomized model and fixed model were calculated to evaluate the sensitivity.Results Totally,23 epidemiological studies on risk factors of bladder cancer were analyzed synthetically by Meta-analysis.The cumulative cases and controls were 7 600 and 5 002,respectively.The pooled odds ratio(OR) values and 95% CIs were as follows:smoking,1.38(1.22-1.57);contacting chemicals,1.95(1.74-2.19);drinking alcohol,2.53(1.60-4.00);drinking coffee,1.31(1.04-1.64);family history of bladder cancer,4.43(3.54-5.53);and gender,4.12(3.71-8.14);respectively(P

Objective To study the clinical characteristics of neonatal pertussis.Method From January 2011 to December 2015,clinical data of newborns with pertussis treated in our hospital were retrospectively analyzed,including the general information,clinical manifestations,laboratory examinations,treatment and prognosis.Result A total of 68 newborns with pertussis were found during the study period,including 1 case in 2011,5 cases in 2012,1 case in 2013,18 cases in 2014 and 43 cases in 2015.The time needed for diagnosis was 7 to 35 days after onset of symptoms,and 80.9％ (55/68) in 14 days.The predominant manifestation was paroxysmal cough (68 cases,100％).Other common symptoms included flushing in 45 cases (66.2％) and cyanosis with coughing in 40 cases (58.8％).The uncommon symptoms included whooping cough (20 cases,29.4％),wheezing (10 cases,14.7％),fever (3 cases,4.4％) and apnea with decreased heart rate during cough (2 cases,2.9％).12 patients (17.6％) had elevated peripheral white blood cells or lymphocytes.The clinical manifestations didn't disappear despite erythromycin therapy,and the whooping cough continued for 12 to 42 days during the course of disease.22 cases (32.4％) had complications,including pneumonia in 12 cases,myocardial damage in 10 cases,heart failure in 2 cases,respiratory failure in 1 case,atrial tachycardia in 1 case and lung consolidation in 1 case.Conclusion Neonatal pertussis is not uncommon and has a tendency to increase year by year,and it's challenging for early diagnosis.The patients who have a whooping cough without fever should be considered of pertussis until otherwise ruled out.Leukocyte and lymphocyte count are of little value in the diagnosis of this disease.