Purpose To study clinical pathological significance of the expression of PTEN, p53 and epidermal growth factor receptor ( EGFR) in breast carcinoma and their correlation. Methods Immunohistochemical MaxVision method was used to detect the expres-sion of PTEN, p53, EGFR in 209 cases of infiltrating ductal carcinoma of breast and 40 cases of benign breast diseases. Results The over-expression rate of PTEN, p53 and EGFR protein in breast carcinoma was 57. 9%, 55. 0% and 38. 3% respectively, which was significantly different from those in benign breast diseases (P<0. 05). The expression of PTEN, p53 and EGFR in breast cancer was correlated with tumor size, histological grade, lymph node metastasis, ER status, PR status and molecular subtype (P<0. 05). There was an association between PTEN or p53 and TNM stage, PTEN or EGFR and HER-2 status. There was a negative correlation in the protein expression of PTEN vs EGFR or PTEN vs p53 (P<0. 01). There was a positive correlation between EGFR and p53 protein ex-pression (P=0. 000). The expression of PTEN or EGFR was correlated with the prognosis of breast cancer, but not independent prog-nostic factors. The survival rate of patients with PTEN- /p53 + /EGFR+ was lower than those with other combined expression of PTEN/p53/EGFR (P=0. 008). Conclusions Low or loss expression of PTEN, p53 mutation and EGFR over-expression may be coordinate-ly involved in the pathogenesis and progression of breast cancer. The combined detection of these markers may play an important role in making treatment and indicating prognosis for breast cancer patients.

Objective To observe the effect of local pain alleviation by wet compress with room temperature and low temperature lidocaine and cold wet compress in fructose infusion in children. Meth-ods 120 children patients with pain during fructose infusion were randomly divided into the wet compress group, the room temperature lidocaine group and the low temperature lidocaine group with 40 cases in each group. The analgesic effect was observed in the three groups. Results Analgesic effect of the low temper-ature lidocaine group was significantly better than the other two groups. Conclusions The wet compress with low temperature lidocaine can relieve the local pain in fructose infusion in children.

Objective T o explore the crim inal characteristics of forensic psychiatry expertise in depression patients and schizophrenics w ith hom icide behavior. Methods A total of 40 depression (depressive episode) patients and 50 schizophrenics w ith hom icide behavior w ere random ly assigned into the study group and control group, respectively. D ata of dem ographic and crim inal characteristic of the tw o groups w ere collected by a self-designed questionnaire, and then w ere com pared. Results T here w ere no statis-tical differences in age, education level and career betw een study and control groups (P>0.05). C om pared w ith the control group, the victim s in the study group w ere m ainly the patient's children and parents, and m ost offenders had suicidal behavior after hom icide (70% ). In study group, the m otives of crim e w ere m ainly extended suicide and indirect suicide, and m ost offenders had attem pted suicide (85% ) and dim inished capacity of crim inal responsibility (70% ), w hich in control group had no capacity of crim inal responsibility (56% ). E xcept for crim inal site, there w ere statistical differences in other crim inal charac-teristics betw een tw o groups (P<0.05). Conclusion T here are different crim inal characteristics betw een de-pression patients and schizophrenics w ith hom icide behavior in forensic psychiatry, and these characteris-tics should be considered w hen these tw o diagnoses are distinguished in forensic psychiatry expertise.

Objective To investigate the clinical efficacy of purging fu-organs traditional Chinese medicine (TCM)therapy for treatment of patients with severe pneumonia and sthenia-heat. Methods According to random number table method,71 patients with sthenia-heat of severe pneumonia were divided into a treatment group (35 cases)and a control group(36 cases). Conventional basic treatment was given to both groups,and additionally, small chengqi decoction was applied nasogastrically for the therapy in treatment group for 2 weeks. The clinical pulmonary infection score(CPIS),Marshall score,integration score of TCM syndromes and the mortalities in 28 days and 60 days were used to compare the clinical efficacy of the two groups. Results With the prolongation of treatment,the CPIS,Marshall score and integration score of syndromes in the two groups were gradually decreased. In treatment group,CPIS and Marshall scores were lower than those of control group on the 4th day ,and there were statistically significant differences(CPIS score:5.8±1.7 vs. 6.8±1.9,Marshall score:5.3±2.3 vs. 6.6±2.7,both P<0.05);the above 2 scores in treatment group were also lower than those of control group on the 7th and 14th day after treatment(7th day CPIS score:5.3±1.5 vs. 5.6±1.4,Marshall score:5.1±1.9 vs. 5.7±1.8;14th day CPIS score:3.9±1.7 vs. 4.4±2.3,Marshall score:4.2±1.9 vs. 4.9±2.5),but there were no statistically significant differences(all P>0.05). In addition,the integration scores of syndromes were significantly decreased on the 4th, 7th and 14th day in the treatment group significantly lower than those in the control group(4th day:7.6±2.3 vs. 10.6±2.7,7th day:7.4±2.5 vs. 9.2±2.1,14th day:6.1±1.9 vs. 8.3±2.4,all P<0.05). However,there were no statistically significant differences in mortality rates in 28 days and 60 days respectively between control group and treatment group(28 days:16.7% vs. 11.4%,60 days:25.0% vs. 20.3%,both P>0.05). Conclusion Purging fu-organs therapy not only can decrease the CPIS and Marshall scores of patients with sthenia-heat of severe pneumonia,but also can improve their syndromes.

Objective This study was to analyze the causes of the complications of ultrasound -guided percutaneous renal bi-opsy in children . Methods We retrospectively analyzed the complications of ultrasound-guided percutaneous renal biopsy in 236 children along with the age, sex, sample length, times of puncture, and types of disease of the patients .We used the binary Logistic regression model to analyze the influences of various factors on the post -biopsy complications . Results After renal biopsy , 22 (9.3%) of the patients experienced various degrees of but no severe complications .The incidence of complications was significantly correlated with the sample length (P<0.05), but not with the age, sex, sample length, times of puncture, and types of disease of the patients. Conclusion Ultrasound-guided percutaneous renal biopsy is an effective diagnostic method for children , with a high suc-cess rate and a low incidence of complications .And the incidence of complications can be reduced by improving the skills of puncturing and accuracy of ultrasound positioning .

Objective To evaluate application effects of mind map in standardized training courses for the new nurses.Method 73 new nurses who graduated for 1-3 years were random divided into an experimental group (n=37) and a control group (n=36).Nursing department organized standardized training course for 73 new nurses for one year.The control group used conventional teaching methods,while the experimental group introduced mind mapping in teaching.Effects were evaluated after one year.Results The average scores of both theory and operation examination in experimental group were better than the control group,and there was significant difference between two groups (P=0.002,0.000).The score of critical thinking ability:the total score of experimental group was (303.89 ±23.81),higher than the total score of the control group (280.36 ± 17.22),and the total score and seven dimension score difference had statistical significance(P＜0.05,for all).Besides,the total score of selfstudy ability in the experimental group (126.54 ± 5.65),was higher than those in the control group (116.58-± 6.36),and the total score and four dimension score difference had statistical significance (P＜0.05).Conclusion Using mind mapping in the standardized training courses for nurses can arouse nurses' interest in learning,improve their critical thinking skills and autonomous self-study ability,and enhance the effectiveness of training.

BACKGROUND:Previous studies have found that electroacupuncture can delay articular cartilage degeneration mediated by JAK-STAT signaling pathway through upregulating the expression level of transforming growth factor β1 as well as mRNA expression levels of STAT3, Smad3 and LepR. In the meanwhile, electroacupuncture can inhibit the mRNA expression of p38 and Fas mRNA mediated by MAPK signaling pathways, further inhibiting the apoptosis of chondrocytes. OBJECTIVE: To explore the effect of electroacupuncture on the degeneration of articular cartilage in rats with knee osteoarthritis based on Ras-Raf-MEK1/2-ERK1/2 signaling pathway. METHODS:120 male healthy Sprague-Dawley rats aged 2 months olds were selected and randomly divided into normal, model, 15-minite electroacupuncture and 30-minute electroacupuncture groups (n=30 per group). The rats in the latter three groups received the intra-articular injection of 4% papain bilaterally, and the remaining rats received no intervention. At 2 weeks after modeling, the latter two groups were respectively given 15- and 30-minute electroacupuncture, five times weekly for consecutive 12 weeks. The morphology of the cartilage was observed by hematoxylin-eosin staining, the expression level of interleukin-1β in the synovium was detected by ELISA assay, and the protein expression levels of Ras, Raf, MEK1/2, ERK1/2, C-MYC, C-FOS, and C-JUN were detected by western blot analysis. RESULTS AND CONCLUSION: Hematoxylin-eosin staining showed that: in the model group, the cartilage surface was rough, the cartilage layer became thinner, and the cartilage structure was damaged with incomplete tidal line; in the 15- and 30-minute electroacupuncture groups, the cartilage structure was complete with clear layers and complete tidal line. ELISA showed that the expression level of interleukin-1β in the model group was significantly higher than that in the normal group (P< 0.01), and the level in the 15- and 30-minute electroacupuncture groups was significantly lower than that in the model group (P < 0.05). Western blot assay found that compared with the normal group, the protein expression levels of Ras, Raf, MEK1/2, ERK1/2, C-MYC, C-FOS, and C-JUN were increased in the model group. However, all above protein levels except ERK1/2 in the 15- and 30-minute electroacupuncture groups were significantly lower than those in the model group (P < 0.01,P < 0.05). To conclude, electroacupuncture inhibits the degeneration of articular cartilage in osteoarthritisvia Ras-Raf-MEK1/2-ERK1/2 signaling pathway and downregulating the expression level of interleukin-1β.

Objective To establish a training program of nurses in the department of orthopedicsbased on the Miller pyramid competency model.Methods Based on G.Miller's pyramid principle,the training program forspecialized nurses in department of orthopedics was constructed by referring to the training program at home and abroad and Combining withthe characteristics of orthopedics nursing work.We used Delphy Method with questionnaires fortworounds in making a consultation to 21experts and carried out statistical analysis.Results The rate of valid questionnaire was 100％.The authority coefficient of expert consultation was from 0.79 to 1.0,the expert coordination coefficient for all indicators is 0.49/0.37/0.25,respectively.Based on the Miller pyramid model,a training scheme for orthopedic nurses was constructed.It included 4 first level indicators,11 secondary indicators and,58 third level indicators.Conclusion The positivecoefficient and authority coefficient of the experts were higher and the results were reliable.The training program of orthopedic nurses is of practical value.

Objective To explore the effect of trauma control concept on severe multiple injuries.Methods From March 2016 to March 2018,74 emergency patients with severe multiple injuries were selected in Yiwu Central Hospital.The patients were divided into the observation group and the control group according to the digital table method,with 37 cases in each group.The control group was treated with one-time surgical treatment,and the observation group was given treatment measures for severe multiple trauma in emergency department under the concept of trauma control.The recovery time of body temperature,the recovery time of prothrombin (PT),the time of shock correction,the occurrence of complications,and the therapeutic effect were compared between the two groups.Results The body temperature recovery time,PT recovery time and shock correction time in the observation group were (6.73 ± 3.29) h,(5.18 ± 1.89) h and (5.84 ± 3.14) h,respectively,which were shorter than those in the control group [(9.85 ± 1.62) h,(9.86 ± 2.41) h,(8.45 ± 0.87) h],and the differences were statistically significant (t =5.175,9.295,4.873,all P ＜0.05).The incidence rate of complications in the observation group was 8.11％ (3/37),which was lower than that in the control group [32.43％ (12/37)],the difference was statistically significant(x2 =6.773,P ＜ 0.05).The cure rate of the observation group was 97.30％ (36/37),which was higher than that of the control group [91.89％ (34/37)],but there was no statistically significant difference (P ＞ 0.05).Conclusion The treatment effect of severe multiple injuries under the concept of trauma control is obvious.It is an effective and feasible method,which can effectively reduce the complications and fatality rate.

The relationship between pyroptosis and immune microenvironment and disease has received increasing attention. Pyroptosis plays a dual role in anti-tumor immunotherapy by promoting the release of inflammatory factors, forming the tumor microenvironment and suppressing tumour immunity on the one hand, and inducing the tumour inflammatory response to inhibit the proliferation of tumor cells on the other hand. The relationship between pyroptosis, immune microenvironment and tumors is different in different tissues and genetic backgrounds. This article reviews the molecular mechanisms of pyroptosis and the regulatory role of tumor immune microenvironment in hematologic malignancies, with a view to providing ideas for the anti-hematologic malignancies treatment and research based on the target of pyroptosis-regulated immune microenvironment.