Objective To investigation the present situation of full‐time bachelor and upgraded clinical nurses ,in order to provide effective basis for the reasonable nursing hierarchical management and job arrangement .Methods Using cluster sampling method ,the working status of clinical nurses self‐designed questionnaire survey for 566 clinical nurses from 13 three level of first‐class hospitals of Nanning city were investigated by self‐designed questionnaire survey .Results The total score of full‐time bache‐lor and upgraded clinical nurses working status showed low satisfaction;the total score of working status of the upgraded nurse was higher than full‐time bachelor nurses .The upgraded clinical nurse in 4 dimensions of welfare treatment ,nursing working character‐istics and identity ,the work to be recognized ,interpersonal relationship scored higher than full‐time bachelor nurse(P<0 .05);in the dimension of scientific research and teaching opportunities scored lower than full‐time bachelor nurses(P<0 .05);in 3 dimen‐sions of scheduling ,job autonomy ,personal professional development opportunities ,the difference was not statistically significant (P>0 .05) .Conclusion The overall performance of working statute of full‐time bachelor nurses is worse than upgraded nurses ,and some aspects including the occupation identification need to be further strengthened .The nursing managers need to increase the nursing hierarchical using of strength ,promote the rationalization process of job responsibility and arrangement of the high degree of clinical nurses ,in order to reduce the flow loss rate .

Objective To provide the effective references for reasonable arrangement of nursing post by comparison on the core competence level and characteristics between the upgraded and the fulltime bachelor nurses.Methods Questionnaire survey based on the basic demographic data and the Competency Inventory for Chinese Registered Nurse for 391 clinical nurses from 13 three level of firstclass hospitals.Results The core competence score of the upgraded and the full-time bachelor nurses showed a moderate degree of satisfaction; the full-time bachelor nurses' total scores were higher than those of the upgraded nurses,and there were statistically significant differences among 6 dimensions included critical thinking and scientific research ability; there was no significant difference in clinical nursing dimension.Conclusions The full-time bachelor nurses' core competence is higher than that of the upgraded nurses in general,but no significant difference exists in clinical nursing dimension.

Objective: To study the clinicopathological features of breast invasive micropapillary carcinoma and its treatment and prognosis. Methods: Clinical data, radiological examination, histopathology, immunohistochemistry, therapeutic regimen and follow-up results of 16 cases of invasive micropapillary carcinoma of the breast were collected. The clinicopathological features, immunophenotype, imaging findings, treatment and prognosis were retrospectively analyzed. Results: All the 16 cases were female, with mean age of 56.3 years (40 to 89 years) . Of the 16 patients, 4 cases were pure invasive micropapillary carcinoma, and 12 cases were mixed invasive micropapillary carcinoma. Among the 12 cases of mixed invasive micropapillary carcinoma, 1 case was mixed with invasive ductal carcinoma, mucinous carcinoma and invasive micropapillary carcinoma, and the remaining 11 cases were all non-specific invasive ductal carcinoma with invasive micropapillary carcinoma. Out of the 16 cases, 13 (81.25%) were invasive micropapillary carcinoma with axillary lymph node metastasis, axillary lymph node metastasis which was more than 4 had 7 cases (43.75%) , clinical stage Ⅲ had 8 cases (50%) . According to the pathological results, 16 cases were treated with individualized comprehensive treatment. Of the 16 patients, 14 were followed up and 2 were lost. Conclusion Breast infiltrating micropapillary carcinoma is a rare type of breast cancer, with high rate of axillary lymph nodes metastasis, aggressive lymphatic invasiveness, high malignancy degree and poor prognosis.

OBJECTIVETo investigate the clinicopathologic characteristics and prognosis of multiple primary synchronous colorectal carcinoma (synchronous CRC) and single colorectal carcinoma (single CRC).

METHODSClinicopathological data of 39 patients with synchronous CRC and 528 patients with single CRC from May 1996 to June 2001 were reviewed retrospectively.

RESULTSThe patients with synchronous CRC accounted for 6.9% of all the patients with colorectal carcinoma treated in our hospital during the same period. Compared with concurrent lesions, Dukes stage of the index lesions of synchronous CRC was more developed and the lymph node metastasis and vessel invasion occurred more frequently. In addition, it also had poorer differentiation. There were significant differences of Dukes stages and lymph node metastasis between the index lesions and single CRC. The incidence of adenomatous polyp in synchronous CRC was higher than that in single CRC(59.0% vs 25.0%,P<0.01). The sensitivity of preoperative colonoscopy examination was 76.9%, which was significantly higher than that of barium examination and exploration during operation. The total 5-year survival rate of synchronous CRC was significantly lower than that of single CRC (5.1% vs 28.2%,P=0.042), and no significant difference of total 5-year survival rate was found between single CRC patients and synchronous CRC patients undergone radical operation. Synchronous CRC patients undergone radical operation had longer survival as compared to those undergone palliative operation(P<0.01). Multivariate analysis indicated that Dukes stages, lymph node metastasis, vessel invasion and the type of operation were independent prognostic factors of synchronous CRC.

CONCLUSIONSSynchronous CRC and single CRC are not always similar in clinicopathologic characteristics and prognosis. Early finding, early diagnosis and radical operation are the keys to improve the survival rate of synchronous CRC.

Aged ; Colorectal Neoplasms ; pathology ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Neoplasms, Multiple Primary ; pathology ; Prognosis ; Retrospective Studies ; Survival Rate

OBJECTIVETo study the expression of fascin-1 protein in breast cancer and to evaluate its correlation with clinicopathologic features of the tumor.

METHODSImmunohistochemical EnVision method was performed to evaluate the expression of fascin-1 in 23 cases of normal breast tissues, 69 cases of benign breast lesions, 58 cases of usual ductal hyperplasia (UDH), 61 cases of ductal carcinoma in situ (DCIS) and 221 cases of breast cancer from March 2007 to December 2011.

RESULTSFascin-1 protein expression rates in normal breast tissues, benign breast lesions, UDH, DCIS and breast cancer were 100.0% (23/23), 89.9% (62/69), 13.8% (8/58), 19.7% (12/61), and 42.1% (93/221), respectively. Fascin-1 expression in normal breast tissues and benign breast lesions was significantly higher than those in UDH, DCIS and breast cancer (P < 0.01); Fascin-1 expression in breast cancer was significantly higher than those in UDH and DCIS (P < 0.01). There was a tendency of increased fascin-1 expression in DCIS compared to UDH, but the difference was not statistically significant (P > 0.05). Fascin-1 positive rates in patients with DCIS grade III (26.8%, 11/41) was significantly higher than that in patients with DCIS grade I-II (1/20, P < 0.05). Fascin-1 protein expression in breast cancer increased with increasing histologic grade and clinical stage (P < 0.01). Fascin-1 protein expression was also significantly higher in tumors with negative estrogen receptor (ER) and progestone receptor (PR) status and > 3 axillary lymph node metastases compared to tumors that were ER and PR positive and ≤ 3 axillary lymph node metastases (P < 0.01 and P < 0.05, respectively). Logistic regression analysis showed that fascin-1 expression correlated positively with high clinical stage (OR = 1.568, 95% CI = 1.029-2.387, P < 0.05) , but negatively with ER expression (OR = 0.149, 95% CI = 0.079-0.281, P < 0.01) .

CONCLUSIONSFascin-1 is highly expressed in normal breast tissues and benign breast lesions, suggesting that it may be a biological marker of mature mammary ductal epithelium. Fascin-1 protein expression shows a significantly increasing trend from UDH, DCIS to invasive breast cancer, suggesting that fascin-1 plays an important role in breast carcinogenesis and may be a potential target for therapy.

Axilla ; Breast ; metabolism ; pathology ; Breast Neoplasms ; metabolism ; pathology ; Carcinoma in Situ ; metabolism ; pathology ; Carcinoma, Ductal, Breast ; metabolism ; pathology ; Carrier Proteins ; metabolism ; Estrogen Receptor alpha ; metabolism ; Female ; Humans ; Hyperplasia ; metabolism ; Lymph Nodes ; metabolism ; Lymphatic Metastasis ; Microfilament Proteins ; metabolism ; Receptors, Estrogen ; metabolism

ObjectiveInvestigate the value and feasibility of image registration with reverse rotation in lateral cerebral DSA.Methods ( 1 ) Experimental study:the target images were subtracted directly,and subtracted again after reverse rotation.Software of registration and subtraction with reverse rotation edited by the author utilizing Visual Basic.The function of the automatic angle detection by the software were evaluated to see whether it detected the angle of line.The subtraction function of DSA by the software was evaluated.(2) Clinical retrospective study:the untreated mask and target inages of 15 patients with motion along vertical axis during lateral cerebral DSA were uploaded to the software.The target images were processed with and without the software to get two sets of images.( 3 ) Evaluation:four experienced radiologists read and compared the two sets of the images,and graded their findings.Results ( 1 ) The automatic detection by the software suggested that the target images should be rotated counterclockwise 1.3°. The subtraction result of the software was satisfactory.(2)In the 15 sets of images,there were only three sets of images deemed optimal after traditional subtraction.After reverse rotation,artifacts were significantly reduced and the image sharper. There were ten cases with significant artifacts after traditional subtraction,and those images were sharper and showed more peripheral vessels after reverse rotation. The traditional subtraction images of two sets could not be interpreted,the reverse rotation registration images reached the diagnostic quality.(3)Subjective evaluation: there were more information and less noise and distortion in the registration images with reverse rotation than in the traditional subtraction. But the image resolution decreased slightly after reverse rotation registration.ConclusionThe registration of digital angiography with reverse rotation can improve the image quality in lateral cerebral DSA.

Objective To assess the safety and efficacy of the treatment for symptomatic atherosclerotic high-grade stenosis in middle cerebral artery with Wingspan stent.Methods The medical records of Wingspan stenting for 102 cases with symptomatic middle cerebral artery high-grade stenosis from February 2008 to May 2012 in our hospital were reviewed retrospectively.All of the patients suffered from ischemic stroke or transient ischemic attack ( TIA ) attributed to the atherosclerotic high-grade stenosis in middle cerebral artery and the stenosis of 70%to 99%was confirmed by DSA before the stenting procedure.All the stroke, death, TIA within 30 days after the stenting procedure or during the follow-up beyond 30 days were observed and recorded.In-stent restenosis were recorded after DSA or CTA was performed 6 months later.χ2 test or Fisher exact test was used to compare in-stent restenosis rate among patients with different clinical and pathological conditions.Results Stenting procedure were successfully performed in 100 patients (98.0%,100/102).The mean degree of stenosis was reduced from (81.0 ±8.4)% to (15.3 ±6.7)%right after surgery.Eight adverse cardiovascular events (7.8 %, 8/102) occured within 30 days ,including seven stroke or death ( 6.9%, 7/102 ) and 1 TIA.The mean clinical follow-up duration was ( 29 ± 15) months in 82 patients, and 9 ischemic events were documented (4 cases of ipsilateral recurrent stroke , 3 cases of ipsilateral TIA, and 2 cases of contralateral ischemic stroke ).The mean radiological follow-up duration was (11 ±9) months in 55 patients.Among them, 8 patients (14.3%) had in-stent restenosis and 3 patients had symptomatic restenosis.The restenosis rate in patients with age ≤49 years.(25.0%,7/28) was higher than those with age >49 years ( 3.7%,1/27 ) ( P>0.05 ).The restenosis rate in patients with lesion size>7.5 mm(25.0%,7/28) was higher than those with lesion size ≤7.5 mm (3.7%,1/27)(P>0.05).Conclusions The treatment of symptomatic middle cerebral artery high-grade stenosis with Wingspan system was relatively safe and associated with a low perioperative complication rate.The long-term efficacy of the treatment for symptomatic atherosclerotic high-grade stenosis in middle cerebral artery with Wingspan stent is prominent.

Objective: To explore the effect of circ_0005075 on the proliferation and invasion of liver cancer cells and its underlying mechanism. Methods:Atotal of 35 cases of cancer tissues and corresponding para-cancerous tissues from liver cancer patients, who underwent surgical resection in Tangshan Workers’Hospital from March 2015 to March 2018, were collected for this study. qPCR was used to detect the expression levels of circ_0005075 and miR-335 in liver cancer tissues, para-cancerous tissues, liver cancer cell lines (HCCC9810, HepG2, HLE and hepatic epithelial THLE-3 cells). Dual luciferase reporter gene assay was used to verify the targeting relationship among circ 0005075, mir-335 and CCND1. By using liposome-mediated method, Sh-circ_0005075, miR-335 mimics, miR335 mimics+pcDNA-CCND1, sh-circ_0005075+pcDNA-CCND1, pcDNA-circ_0005075+miR-335 mimics, sh-CCND1+pcDNA-circ_ 0005075 were transfected into HCCC9810 cells, respectively. The effects of circ_0005075/miR-335/CCND1 molecular axis on the proliferation and invasion of HCCC9810 cells were detected by MTT and Transwell methods. Results: circ_0005075 was highly expressed in liver cancer tissues and cell lines (P<0.01) ,and the highest expression in HCCC9810 cells (P<0.05). Dual luciferase reporter gene results showed that circ_0005075 negatively regulated miR-335 (P<0.05), and CCND1 was a target gene of miR-335 (P<0.05). Further experiments proved that knockdown of circ_0005075 or overexpression of miR-335 could inhibit the proliferation and invasion of HCCC9810 cells by regulating CCND1（P<0.05 or P<0.01） . Conclusion: Circ_0005075 upregulates the expression level of CCND1 by sponging miR-335, thereby promoting the proliferation and invasion of HCCC9810 cells.

OBJECTIVETo summarize the reason and treatment of redo surgery in Hirschsprung disease for postoperative distension and constipation.

METHODSFrom January to December 2014, 35 patients with constipation and distention after pull-through done elsewhere were referred to our institution. The reasons procedures and outcomes of redo surgery were a retrospectively analyzed.

RESULTSThe indication of reoperation in 21 cases was pathological problems, including residual aganglionosis, retained transition zone bowel, and in 13 cases was anatomical problems, including retained dilated segment, obstructive Soave cuff. One case had both pathological and anatomical problems. Among them, 5 cases belonged to total colonic aganglionosis. All the cases received conservative treatment for about 6 months before reoperation. Five cases had enterostomy before redo pull through surgery. Thirty cases underwent Soave surgery with or without laparoscopy or laparotomy. Twenty-six cases underwent transabdominal Soave surgery, 3 cases transanal Soave surgery, 1 case transanal Soave surgery with laparoscopy. Other surgery included Ikeda surgery, excision of diaphragm or scar, and anoplasty. Postoperative complications were found in 3 patients. One had rectovesical fistula and was cured after operation. Two cases had anastomotic leakage and then underwent diverting ileostomy. Thirty-three cases had a mean follow-up of 59 months. During the follow-up, 32 cases had no distension and constipation. Two cases presented occasional dirty pants, 2 cases frequent soiling, 1 case daily soiling.

CONCLUSIONSReasons of distension and constipation in Hirschsprung's disease after surgery are pathological and anatomical problems. Operation procedure is chosen based on reasons. Transabdominal Soave surgery is safe and effective.

Anastomotic Leak ; Cicatrix ; Constipation ; Digestive System Surgical Procedures ; Hirschsprung Disease ; Humans ; Ileostomy ; Laparoscopy ; Laparotomy ; Postoperative Complications ; Postoperative Period ; Reoperation ; Retrospective Studies

T,and 916-917 ins G were SLC26A4 mutations unreported hitherto, which may be specific to the Chinese population. CONCLUSION The EVA syndrome is a typical autosomal recessivehereditary disease caused by mutations in SLC26A4 gene. Genetic testing of SLC26A4 is the one of the important diagnostic methods for EVA syndrome.