Objective:To investigate the clinical, pathological, and prognostic characteristics of luminal B breast cancer patients with diabetes. Methods:A total of 479 luminal B breast cancer patients with diabetes and 3 392 luminal B breast cancer patients without diabetes who were treated between January 2002 and December 2006 were enrolled in this study. The luminal B breast cancer patients were further divided into the luminal B (high ki67) and luminal B (Her-2/neu+) subgroups. Each subgroup was further grouped into metformin-treated, non-metformin-treated, and non-diabetic groups. The indicators included cancer-specific mortality, clinical, pathological stage, lymph node status, chemotherapy, and endocrine therapy. The survival analysis of each group was performed using the Kaplan-Meier method, and the significance was determined using the logrank test. Cox proportional hazard model was used to examine the correlation between each factor and the prognosis. Results:The Kaplan-Meier analysis results revealed that the breast cancer mortality rates in the metformin-treated, non-metformin-treated, and non-diabetic groups were significantly different in both luminal B (high ki67) and luminal B (Her-2/neu+) subgroups (logrank test:P<0.001, P=0.035), and the respective five-year survival rates were 93.5%, 81%, and 89%for the luminal B (high ki67) subgroup and 84%, 77%, and 83%for the luminal B (Her-2/neu+) subgroup. The Cox multifactorial regression analysis results showed that compared with the metformin-treated group, the non-metformin-treated group was associated with a significantly increased risk of mortality (P<0.001, P=0.044) in the two subgroups. Meanwhile, the non-diabetic group was associated with an increased risk of mortality (P=0.038) in the luminal B (high ki67) subgroup only. The percentage of elderly (P<0.001), menopausal (P<0.001), obese (P<0.001), and patients with cardio-cerebrovascular complications (P<0.001) tended to be higher in the metformin-treated and non-metformin-treated groups than in the diabetic group. Moreover, the metformin-and non-metformin-treated groups in the luminal B (high ki67) subgroup were associated with high percentages of T3/4 pathological stage (P<0.001), lymph node metastasis (P=0.001). The non-metformin-treated group was associated with a lower percentage of invasive ductal carcinoma (P=0.001) compared with the other two groups. Conclusion:The non-metformin-treated group resulted in worse clinical outcomes in both subgroups compared with the metformin-treated group. Meanwhile, the non-diabetic group resulted in the worst prognosis among the three groups in the luminal B (high ki67) subgroup. These findings suggest that the choice of different anti-diabetic drugs may influence the prognosis of luminal B breast cancer patients with diabetes.

Background:Myopathy due to smooth muscle cells( SMC)abnormalities is involved in the pathogenesis of diabetic gastroparesis(DGP),however,the relationship between myopathy and advanced glycation end products(AGEs)is not fully clarified. Aims:To investigate the ultrastructural changes of gastric SMC in patients with diabetes mellitus( DM)and the relationship between expressions of contractile proteins and AGEs. Methods:Full-thickness gastric specimens from 30 gastric neoplasm patients undergoing gastrectomy from July 2012 to December 2012 at the First Affiliated Hospital with Nanjing Medical University were collected. Of them 15 patients had DM( DM group)and the other 15 patients without ( control group). Ultrastructure of SMC was observed by transmission electron microscopy. Expressions of three contractile proteins[ myosin heavy chains( MHC),α-actin and calponin]and Nε-carboxymethyllysine( CML),the key component of AGEs in gastric muscular layer were determined by Western blotting,and expressions of MHC,α-actin and calponin mRNA were determined by real-time PCR. Correlations of mRNA expressions of three contractile proteins with protein expression of CML were analyzed by Pearson correlation coefficient. Results:In DM group,significant ultrastructural changes were found in gastric SMC,including disruption of gap junction,swelling of mitochondria,occurring of lipofuscin in cytoplasm,increase in cell membrane alveolae,and thickening of basal lamina. Protein and mRNA expressions of muscular MHC,α-actin and calponin were significantly lower in DM group than in control group(P all ﹤0. 01),while protein expression of CML was significantly higher in DM group(P ﹤0. 01). In gastric muscular layer of DM group, negative correlations were found between expressions of MHC,calponin mRNA and CML protein(r= -0. 59,P=0. 02;r= -0. 63,P=0. 01),but no correlation was seen between α-actin mRNA and CML protein(r= -0. 49,P=0. 06). Conclusions:Disruption of SMC ultrastructure,decrease in contractile proteins and increase in AGEs are existed in gastric muscular layer of DM patients,and there is a negative correlation between contractile proteins and AGEs. These changes may cause impaired contractility of SMC,and subsequently lead to gastric motility disorders in diabetic patients.

BacKground:The mechanism of diabetic gastrointestinaI dysmotiIity is stiII uncIear. More and more studies showed that gastrointestinaI smooth muscIe derived factors pIay an important roIe in gastrointestinaI dysmotiIity. RecentIy,the roIe of RhoA/ROCK signaIing pathway in diabetic compIications become a research hotspot. Aims:To investigate the possibIe roIe of RhoA/ROCK signaIing pathway in diabetic coIon dysmotiIity by examining the expressions of major signaIing moIecuIes in diabetic coIon muscIe. Methods:NormaI coIon tissue sampIes taken from patients undergoing radicaI surgery for coIonic cancer from Sept. 2012 to Dec. 2013 at the First AffiIiated HospitaI of Nanjing MedicaI University were coIIected. According to gIycated hemogIobin IeveI,the patients were divided into diabetes meIIitus( DM)group and controI group. The expressions of major signaIing moIecuIes in RhoA/ROCK1 signaIing pathway incIuding RhoA,ROCK1,MYPT1 and p-MYPT1 were determined by immunohistochemistry or Western bIotting. Results:Immunohistochemistry showed that expression of RhoA protein in DM group was significantIy Iower than that in controI group(P<0. 05). Western bIotting showed that expression IeveIs of RhoA,ROCK1 and p-MYPT1 proteins were significantIy Iower in DM group than in controI group(0. 62 ± 0. 42 vs. 1. 15 ± 0. 69,0. 54 ± 0. 09 vs. 0. 75 ± 0. 05,0. 70 ± 0. 28 vs. 1. 04 ± 0. 47;P<0. 05),whereas no significant difference in expression IeveI of MYPT1 protein was found between DM group and controI group(0. 94 ± 0. 50 vs. 1. 21 ± 0. 80,P>0. 05). Conclusions:The inhibition of RhoA/ROCK signaIing pathway in diabetic coIon muscIe may have some correIation with diabetic coIon dysmotiIity.

Objective To develop a computer-auto-controlling and analysis system for Tail suspension .Methods Combining the advantage of computer science , engineering and animal behavior into tail suspension test .The “energy”index was developed .The system was validated with antidepressants such as imipramine and paroxetine .Results The measuring principle is based on the energy developed by mice trying to escape from their suspension .During the test, the movements of the mice are analyzed in terms of force , energy and power developed over time .Each mouse issuspended by the tail using adhesive tape to a hook connected to a tail test sensor .The tail test sensor fixed to suspension bar picks up all movements of the mouse and transmits these to a signal regulation unit and transmission circuit , which amplify , filter and digitalizes the signals.The signals are displayed visually in waveform .Activity time, immobility time, energy are continuously updated .The correlation coefficient of “immobility time” collected by computer and manpower was 0.94. Using this system, both imipramine and paroxetine could decreased the immobility time and paroxetine could increased the energy induced by mice ( both P <0.01 ) .Conclusion A stable computer-auto-controlling and analysis system for Tail suspension was established and could be used to screen the antidepressants .

Objective To investigate Hospital-acquired infections in patients with liver cirrhosis caused by relevant factors.Methods From Jul.2006 to Jan.2011 the clinical data of 476 cases of hospital-acquired infections in patients with decompensate cirrhosis were retrospectively analyzed by case-control study for the effective factors.Results By logistic regression analysis,17 factors are found to affect Hospital-acquired infections ; 16 risk factors:Occupation in manual labor ( OR =4.119,95 ％ CI:2.631-6.325 ) ; Age ( OR =3.014,95 ％ CI:1.163-7.136) ; The cirrhosis disease history ( OR =1.761,95 ％ CI:1.439-2.130) ; Length of stay in hospital (OR =17.354,95 ％ CI:2.539-101.304) ; Interventional procedures ( OR =5.379,95％ CI:2.354-17.594) ;Peotein intake ( OR =3.201,95％ CI:1.539-4.528) ; Alcohol drinking history ( OR =3.158,95％CI:2.274-7.153 ) ; Development of complication ( OR =8.367,95 ％ CI:2.023-11.736 ) ; ALB ( OR =4.613,95％ CI:2.157-9.936 ) ; PCR-HBV DNA quantitative ( OR =3.628,95％ CI:2.245-7.129 ) ; WBC ( OR =3.758,95％ CI:2.276-7.018 ) ; CHE ( OR =3.148,95％ CI:2.202-6.038 ) ; TC ( OR =3.210,95％ CI:2.102-5.107) ;TBIL(OR =2.748,95％ CI:1.283-3.153) ; Antiviral agents (OR =0.257,95％ CI:0.145-0.382 ) ; Preventive application of antibiotics ( OR =3.147,95％ CI:2.236-7.182 ) ; PTA ( OR =2.798,95％CI:1.293-4.182) ;Liver function of Child B and C (OR =4.164,95％ CI:2.236-6.761 ).Conclusion Age,length of stay in hospital,interventional procedures,alcohol drinking history,development of complication,ALB,PCR-HBVDNA quantitative,WBC,TC,Preventive application of antibiotics,liver function of Child are risk factors.Use of anti-virus drug are protective factors.

ObjectiveTo explore the impact of urinary incontinence on women's quality of life, and the effective measures to improve it.MethodsWe conducted a comprehensive literature review to analyze the present research about quality of life on urinary incontinent women and interventions for improving it.ResultsUrinary incontinence influenced patients' quality of life in many aspects, especially in their physical health, mental health, daily living and sexual life. Regular pelvic floor muscle training could prevent and control the incontinence symptoms and improve patients' quality of life.ConclusionsIt is necessary to carry on a series of activities to propagandize that urinary incontinence can be treated, effective measures should be taken to prevent and manage urinary incontinence in order to improve quality of life in urinary incontinent women.

OBJECTIVE:To establish the method for simultaneous determination of 5 saponins in Lonicerae Flos. METHODS:Using macranthoidin B as a reference,HPLC method was adopted to calculate the relative correction factor(RCF)of it to macran-thoidin A,dipsacoside B,macranthoside A and macranthoside B. The contents of above 4 saponins were calculated through RCF. Using the contents of saponins determined by external standard method as measured value,the calculated value was compared with measured value. RESULTS:The linear ranges of macranthoidin A,macranthoidin B,dipsacoside B,macranthoside A and macran-thoside B were 0.316-6.32 μg(r=0.9973),0.453-9.06 μg(r=0.9982),0.231-4.62 μg(r=0.9996),0.342-6.84 μg(r=0.9984) and 0.147-2.94 μg(r=0.9961),respectively. RSDs of precision,stability and reproducibility tests were all lower than 2.0%. The recoveries were 97.74%-104.51%(RSD=2.37%,n=6)、96.70%-103.20%(RSD=2.37%,n=6)、96.12%-103.61%(RSD=2.45%, n=6)、98.80%-104.70%(RSD=2.32%,n=6)、99.21%-102.92%(RSD=1.39%,n=6),respectively. There was no statistical sig-nificance between calculated value and measured value(P>0.05). CONCLUSIONS:The method is simple,precise,stable and re-producible. It can be used for the determination of saponins in Lonicerae Flos.

Objective To explore the relationship among psychological resilience, self-efficacy and core competence in psychiatric nurses. Methods Totally 237 psychiatric nurses in a psychiatric hospital in Shandong province were recruited and assessed with general information questionnaire, Connor-Davidson Resilience Scale, General Self-Efficacy Scale and Competency Inventory for Registered Nurse. Results The total core competence of psychiatric nurses was (2.59 ± 0.66) points, at a moderate level. Psychological resilience were positively corrected with self- efficacy (r=0.454,P=0.000) and core competence (r=0.647, P=0.000), self-efficacy were positively corrected with core competence (r=0.487, P=0.000). Psychological resilience partially mediate the relationship between self- efficacy and core competence, It′s mediating effect was 44.8%. Conclusions Psychological resilience plays an important role to core competence in psychiatric nurses.Nursing managers should carry out related training, improve the psychological resilience and self-efficacy of psychiatric nurses, and comprehensively improve the level of core competencies.

Objective Assisted reproductive technology ( ART) is associated with an increased incidence of offspring de-fects.The aim of this study was to investigate the impact of embryo vitrification in in vitro fertilization ( IVF) on the growth and devel-opment of the offspring by comparing the development status of mouse offspring from fresh embryo versus vitrified embryo transplanta-tion. Methods This study included three groups of mouse offspring , from natural fertilization ( n=12 ) , fresh embryo transplanta-tion (FET, n=9), and vitrified embryo transplantation (VET, n=9).We compared the body weight and body fat content in the sex-ually mature stage among the three groups of mice . Results No obvious differences were found in the morphology of the embryos be-tween the FET and VET groups .The body weight of the mouse offspring was significantly higher in the VET than in the natural control group at 0 postnatal (PN) week (P<0.01) and 12 PN weeks (P<0.01), and so was it in the FET group than in the control at 0 PN week (P<0.01) and 6 PN weeks (P<0.05).The body fat content at sexual maturity was remarkably higher in the VET than in the FET and control groups ([9.32 ±4.34] vs [5.24 ±2.56] and [2.80 ± 0.48] g, P<0.05), and so was the muscle content in the VET than in the control ([33.77 ±4.22] vs [27.50 ±1.79] g, P<0.01). Conclusion In IVF, fresh embryo transplantation has less interference with the growth and development of mouse offspring than vitri-fied embryo transplantation .

Objective To compare the curative effect and biomechanical performance of cannulated compression screw (CCS) and dynamic hip screw-blade (DHS-B) in the treatment of patients with femoral neck fracture.Methods Between February 2010 and February 2014,102 patients with femoral neck fracture were treated with CCS or DHS-B at our department.They were 54 males and 48 females,aged from 15 to 86 years.There were 30 subcapital fractures,51 transcervical ones and 21 base ones.CCS was used in 60 patients and DHS-B in 42.In-hospital data were collected retrospectively to compare the curative effects in 2 groups.Furthermore,femoral neck fracture models were established using 12 adult cadaveric femoral specimens.The 12 models were randomized into 2 equal groups (n =6).Group A was subjected to fixation by 3 CCSs and group B to fixation by DHS-B.The 2 groups were compared in terms of axial loading test,rotation test and destructive axial loading test.Results The operation time (59.4 ± 20.2 min),incision size (4.1 ±0.6 cm) and intraoperative blood loss (25.9 ±9.9 mL) in the CCS group were significantly less than those in the DHS-B group (88.6±22.9 min,12.1 ±1.2cmand 156.7±107.1 mL) (P ＜0.05).The Harris hip score for the DHS-B group (91.9±9.8) was significantly higher than that for the CCS group (87.2 ± 9.2) (P ＜ 0.05).There were no significant differences between the 2 groups in hospital stay,partial weight-bearing time,or postoperative complications (P ＞ 0.05).At 500 N vertical loading,the stress values at both medial and lateral sides of the femur in group A were significantly smaller than those in group B (P ＜ 0.05).There were no significant differences between groups A and B in the average sinking displacement of femoral head or the torque at a torsion angle of 6° (P ＞ 0.05).The maximum load in group A (2,135 ±120 N) was significantly smaller than that in group B (2,986 ± 98 N) (P ＜ 0.05).Conclusion In treatment of femoral neck fracture,DHS-B fixation is obviously superior to CCS fixation,because the former is in better agreement with the femoral biomechanical property,and performs better in anti-rotation and anti-compression,leading to better functional recovery of the affected hip.