Objective To assess the toxicity of anthracyclinc to left ventricle function in patients withbreast cancer,and to compare the clinical values between two-dimensional speckle tracking echocardiography (2D-STE) and 3D-STE.Methods 50 patients with breast cancer who had received surgical treatment and epirubicinbased chemotherapy were recruited to study groups.All the patients had undergone up to 6 cycles of chemotherapy.Different stages wcre identified according to accumulated doses of epirubicin reaching 0 mg/m2,120 mg/m2,240 mg/m2 and 360 mg/m2.2D-STE and 3D-STE parameters were measured before chemotherapy and after different stage of chemotherapy.The receiver operating characteristics curves (ROC) of parameters (2D-GLS,3D-GLS,3D-GCS,3DGAS) were graphed to evaluate the specificity and sensitivity of detecting dysfunction of the left ventricles.25 healthy volunteers were recruited to a control group.Results As compared with the control group and the baselines,2D-GLS and 3D-GCS was significantly declined (P ＜ 0.05),3D-GAS and 3D-GLS were significantly lowered after interim period and later period (P ＜ 0.05),while 3D-GRS was not changed significantly during the whole chemotherapy period.The ROC curves revealed the sensitivity of 2D-GLS,3D-GCS,3D-GLS and 3D-GAS for assessing dysfunction of the left ventricles was 60.7％,65.3％,62.7％,and 80.7％,while the specificity was 50.0％,54.0％,64.0％,and 82.0％,respectively.Conclusions As compared with 2D-STE,3D-STE can detect the dysfunction of left ventricles earlier and more accurately.Furthermore,the specificity and sensitivity of 3D-GAS are the highest among all parameters in detecting the early dysfunction of left ventricles.

Objective To investigate the effects of sustained inflation (SI) combined with small tidal volume ventilation on lung recruitment and hemodynamics in patients with acute lung injury (ALI). Methods Patients with severe trauma followed by ALI were selected for this study. Patients underwent small tidal volume ventilation (baseline) for 1 h and then SI with 20 cm H 2O?30 s(SI 1), 30 cm H 2O?30 s(SI 2), 40 cm H 2O?30 s(SI 3) and 50 cm H 2O?30 s(SI 4) for 1 h, respectively. Parameters of pulmonary mechanics and hemodynamics were measured at 1 h after baseline, SI and returning baseline, respectively. Results Compared with those of the baseline, no changes of parameters were found after SI 1 and SI 2, but EELV and Cst increased significantly after SI 3 and SI 4. Paw, PAP and PVRI decreased significantly after SI 3 and SI 4. After SI interruption, all the physiological variables returned to baseline. SI had no significant effect on HR, AP and CI. Conclusion Treatment with SI combined with small tidal volume ventilation in patients with ALI can provide lung recruitment and improve lung compliance, but it has no significant side effect on hemodynamics.

Objective To explore the clinical manifestations and epidemiological profiles of hospitalized infants with Bordetella pertussis infection and to improve the knowledge for its early diagnosis and treatment.Methods Using a retrospective analysis method,the data of 142 hospitalized infants with Bordetella pertussis infection in Shenzhen Children's Hospital from 2011 to 2013 were collected,which was confirmed by a real-time polymerase chain reaction(PCR) of nasopharyngeal secretion.The SPSS 16.0 software was used for statistical analysis.Results Of the 142hospitalized infants with Bordetella pertussis infection,the ratio of male to female was 2.1∶ 1.0 (96/41 cases).Ninetythree (65.5％) cases were aged less than 3 months old,26 cases (18.3％) were 3-6 months old and 23 cases (16.2％) were 6-36 months old.One hundred and twenty-six (88.7％) patients were unvaccinated or incompletely vaccinated.The most common clinical manifestation was paroxysmal cough which accounts for 104/142 (73.2％) cases,and 6 cases of which had roaring(4.2％).Peripheral blood WBC level of 83 cases increased,and 75 (90.4％) cases were lymphocytosis.The positive rate of X-ray was 60.6％.Eighty-one cases were complicated with bacteria,respiratory virus or mycoplasma pneumonia infection.There were significant differences in symptom of fever and infection of respiratory tract pathogen among 3 groups.The symptom of fever in the group aged less than 3 months old group was significantly lower than the other 2 groups (x2 =11.45,P ＜ 0.01 ;x2 =34.56,P ＜ 0.01),and 6-36 months old group was significantly higher than the other 2 groups(x2 =7.590,P ＜ 0.01 ;x2 =6.928,P ＜ 0.01).Conclusions Bordetella pertussis is an important pathogen for the infants with persistent cough,especially in unvaccinated or incompletely vaccinated infants,but the clinical manifestation and signs of pertussis are atypical,which may lead to a misdiagnosis and delay proper treatment.As a rapid and sensitive method of detecting Bordetella pertussis,PCR may be used for early diagnosis.

Objective To explore the correlations between the social support and the quality of life to them who live in Yunnan sudden unexplained death ward,and provide a scientific basis for taking effective measures to improve the people' s quality of life in the ward.Methods Using the cross-sectional household survey to collect the information of the inhabitants on social support and quality of life by the Social Support Scale,and the WHOQOL-brief Scale.Results The total score of social support,scores of subjective support,objective support in Yunnan sudden death ward ((40.85±8.34),(9.58±3.58),(23.86±4.87)) were lower than those of the control group in the same dimension ((41.82±7.12),(10.47±3.26),(24.51±4.68)) (all P＜0.05).But the score of social support utility in Yunnan sudden death ward (7.41±2.67)was no significant difference between the two groups (6.84±2.56,P＞0.05).After using multiple linear regression to control other confounding factors,such as house-hold income per capita,scores of social support,subjective support,objective support and social support utility were positively correlated with the score of quality of life in Yunnan sudden death ward (the correlation coefficient between the scores of social support and the dimensions related to the quality of life were 0.30,0.11,0.29,0.28,0.36;the correlation coefficient between the scores of objective support and the dimensions related to the quality of life were 0.15,0.05,0.13,0.14,0.19;the correlation coefficient between the scores of subjective social support and the dimensions related to the quality of life were 0.18,0.06,0.21,0.23; the correlation coefficient between the scores of social support utility and the dimensions related to the quality of life were 0.11,0.05,0.10,0.09,0.11 (all P＜0.05).Conclusions The people who live in Yunnan sudden death ward get less social support and social support utility is low,which cause the worse quality of their life.To make this situation better,more social support is necessary to enhance the utilization.

Objective To investigate the change and clinical value of serum cystain C(CysC)level in the patients with HBeAg-negative chronic hepatitis B(CHB).Methods 212 cases of CHB in our hospital were selected and divided into the HBeAg-negative group and the HBeAg-positive group according to the HBeAg status.105 healthy individuals at the same time were enrolled as the control group.The levels of serum CysC,ALT,AST,Cr,BUN and HBV DNA in 3 groups were detected and compared.The corre-lations between serum CysC with AST,AST,Cr,Bun,HBV DNA were analyzed by the Pearson correlation analysis.Results The mean CysC level in the HBeAg-negative group was (1 .40±0.36)mg/L,which was higher than (0.93±0.12)mg/L in the control group and (0.96±0.18)mg/L in the HBeAg-positive group,the differences between them was statistically significant(P <0.05). The CysC was significantly positively correlated with serum Cr level in the HBeAg-negative group(r=0.840,P <0.01).Conclusion The CysC level might be used as an effective index for monitoring the early kidney injury in the patients with HBeAg-negative CHB,which has important significance in the prevention and treatment of HBeAg-negative CHB.

BACKGROUND: Uncontrolled-rate freezing in -80 ℃ refrigerator is convenient, while controlled-rate freezing in -196 ℃ liquid nitrogen is reliable and long-term, the combination of the two can simplify the process and has been successfully used in clinics. OBJECTIVE: To explore the influences of different cryoprotectants by ladder-style freezing from -80 ℃ low temperature refrigerator to liquid nitrogen on the cryopreservation of hemopoietic stem cells. METHODS: The experiments were divided into four groups: 10% dimethyl sulfoxide (DMSO) group, 5% DMSO combined with 3% hydroxyethyl starch group, 5% DMSO combined with 0.25 mol/L trehalose group, 5% DMSO combined with 3% hydroxyethyl starch and 0.25 mol/L trehalose group. Peripheral hemopoietic stem cells were cryopreserved by ladder-style freezing from -80 ℃ low temperature refrigerator to liquid nitrogen. The ultrastructural changes were examined by transmission electron microscopy, the expressions of Annexin-V, PI and Caspase-3 were detected by flow cytometry. RESULTS AND CONCLUSION: There was no significant difference in survival rate, apoptotic rate and necrotic rates of the cryopreserved cells in the four groups (P > 0.05). The ultrastructural changes had no significant difference under the transmission electron microscopy. The viability was more than 90% in frozen-thawed mononuclear cell colonies, and the apoptosis was roughly 50% in the frozen-thawed CD45+ cell population, which contained many mature cells. Of hemopoietic stem cells, early stage cells have greater resistance to damage of cryopreservation than late stage cells. It is concluded that the addition of hydroxyethyl starch or trehalose into DMSO exhibits no synergistic protective effect on the cryopreservation of hemopoietic stem cells.

Objective To observe the expression of P21 and CDK6 in cervical squamous cell carcinoma,and to investigate the relationship between their expression and cervical squamous cell carcinoma.Methods The expression of CDK6 and P21 in 100 cases of cervical squamous cell carcinoma,20 cases of cervical CIN lesions and 20 cases of normal cervical tissues were detected by immunohistochemical ABC method,and the relationship between them and tumor differentiation,invasion depth,lymph node metastasis and clinical stage were analyzed.Results The expression rates of P21 and CDK6 in cervical squamous cell carcinoma tissues were significantly higher than those in CIN lesions and normal cervical tissues;The low expression of P21 was associated with the depth of tumor invasion,lymph node metastasis and clinical stage (P＜0.05),and was not associated with the degree of tumor differentiation (P＞0.05);The high expression of CDK6 was associated with tumor differentiation,invasion depth,lymph node metastasis and clinical stage (P＜0.05).Conclusion The abnormal expression of P21 and CDK6 may play an important role in the occurrence and development of cervical squamous cell carcinoma,and the two may have a certain significance in the prognosis of cervical squamous cell carcinoma.

A study of the quality assurance system building made at the training bases in Zhejiang since 2011 found the following.Five management systems on training quality have been established, covering basic clinical conditions, training management, faculty management and training, training assessment,and training incentives.PDCA is called into play for continuous improvement and perfection to develop a training quality management system of local features and continuous improvement.

Objective To observe the regulative effect of high dose of glucocorticoid (GC) on protein synthesis and mRNA transcription of corticotropin-releasing hormone (CRH) in paraventricular hypothalamic nucleus (PVN) so to ascertain whether there exists difference upon effect of GC either at high dose or at normal dose. Methods A total of 60 Wistar rats were divided into five groups, ie, blank control group, 10 -6 mol/L dexamethasone (DEX) group, 10 -9 mol/L DEX group, 9 g/L saline group and group that was treated with 10 -4 mol/L RU486 first and then with 10 -6 mol/L DEX. The drugs were given through femoral vein. CRH protein expression was measured by means of immunohistochemistry and laser confocal scanning microscophy (LCSM); CRH mRNA transcription level was investigated by in situ hybridization. Results There appeared positive CRH mRNA granules in cytoplasm of PVN after administration with 10 -6 mol/L DEX for 20 minutes but could be seen positive fluorescent granules of CRH protein 30 minutes later, which was reversed at an in advance blockage of GR, as was free in 10 -9 mol/L DEX group, 9 g/L saline group and blank control group. Conclusions High dose of GC can up regulate CRH gene expression in PVN and differs much from the traditional effect of GC at normal dose, as may be due to that high dose of GC exerts effects depending on membrane glucocorticoid receptor but normal dose of GC dose via iGR.

Objective To analyze the causes,cardiac function grading and drug application related to heart failure of the patients with chronic heart failure in Yongchuan district people's hospital.Methods The cases of chronic heart failure of department of cardiology in our hospital from January 1st,2012 to December 31st,2015 were counted and retrospectively analyzed.Results 3 320 cases of chronic heart failure in our hospital chosen from 8 126 medical records accounted for 40.86% of total discharged patients in the same period,including 2 262 cases of coronary disease (68.13%),353 cases of rheumatic heart disease (10.63%)and 265 cases of pulmonary heart disease (7.98%),who took up the top three in the spectrum of disease;2 683 cases of NYHA heart function Ⅲ magnitude accounted for 80.81%;The utilization rate of diuretic,digoxin,spironolactone,angiotensin -converting enzyme inhibi-tor,angiotonin receptor blocker,beta adrenergic receptor were 71.23%,27.23%,70.48%,30.75%,30.78%respectively.The statistical analysis showed that the differences were statistically significant between the patients using diuretics and the patients using spirolactone(χ2 =2.386,P <0.001),the patients with hypertension and the patients with no hypertension using ACEI /ARB(χ2 =2.727,P <0.001),and merged chronic bronchitis patients and the chro-nic bronchitis patients using beta -blocker(χ2 =61.807,P <0.001).Conclusion The patients with chronic heart failure takes up a higher portion among the inpatients in department of cardiology in the district level hospital.The heart function decreases significantly and the normative drug therapy needs to be improved.