Tumor may generate from tumor stem cell and the microenvironment,and cancer stem cells are derived from the mutation of normal stem cells according to cancer stem cells hypothesis. Breast cancer stem cells are the first identified cancer stem cells in solid tumor. Breast cancer stem cells have been isolated successfully by many kinds of strategies, and their biological behaviors are gradually studied deeply. Self-renewal and differentiation of breast cancer stem cells are regulated by microenviroment and many signaling pathways. Therapy targeting breast cancer stem cells is gradually becoming the focus of tumor targeted therapy study.

Objective To study biological significance of CD44v6 and p63 protein expression in buccal squamous cell carcinomas (BSCC). Methods Immunohistochemical method was used to examine the expression of CD44v6 and p63 protein in 52 cases of BSCC,10 cases of atypical hyperplasia and 10 cases of normal buccal mucosa,which were analyzed based on clinic and pathology characteristics.Results In normal tissue,atypical hyperplastic tissue of buccal mucosa and BSCC tissue,the expression of CD44v6 decreased gradually 90.0 ％ (9/10),80.0 ％ (8/10) and 55.8 ％ (29/52),respectively,and the layers of positive expression was decreased,and the expression of p63 increased gradually,30.0 ％ (3/10),40.0 ％ (4/10) and 90.4 ％(47/52),respectively.The differences of their expression rates were significant (P ＜0.05).The expression of CD44v6 and p63 had no relationship with gender,age,tumor classification,pathological differentiation (P ＞0.05).CD44v6 was relevant with invasion style and lymphatic node metastasis of BSCC (P ＜ 0.05),while p63 has no relevance with lymphatic node metastasis of BSCC (P ＞0.05).Conclusion CD44v6 and p63 participate in the regulation of generation and deve-lopment process of BSCC.CD44v6 can be utilized as a useful marker of BSCC for detection and prediction of prognosis.p63 play a role as oncogene,which can be a useful marker for BSCC detection.CD44v6 and p63 have independent function in generation,development,metastasis and aversion of BSCC.

Objective To explore the causes of bile duct injury during laparoscopic cholecystectomy and its treatment.Methods From January 1998 to February 2007,totally 8600 cases of LC were performed in our hospital.Bile duct injury occurred in 36 of them,among which,the common hepatic duct was cut in 20 cases,the common bile duct was severed in 4 patients,the common hepatic duct was cut and freed in 4;incomplete clipping of the common hepatic duct or common bile duct occurred in 3 and 1 cases respectively;3 cases had injury to the conjunction of the cystic duct and common hepatic duct;electrical burn injury happened in 1 patient.Thirty one of the injured cases were detected during the laparoscopic surgery,while the other five were found because of jaundice or biliary leakage.The patients received bile duct repair and T tube drainage(24),T tube drainage(4),Roux-en-Y bowel biliary anastomosis(4),bile duct anastomosis(1),or removal of the titanium clips after the accidents.Results One of the patients who received bile duct anastomosis developed biliary stenosis after the T tube was withdrawn in 2 months after the surgery,Roux-en-Y bowel biliary anastomosis was thus performed 3 months later.Two patients who underwent Roux-en-Y anastomosis developed anastomotic stenosis after the operation,and thus received a second anastomosis in 11 months.These 3 patients who received totally 3 operations,were followed up for 2 to 3 years,none of them developed cholangitis or biliary stones.One patient in this series had refractory cholangitis,jaundice,and liver function impairment,and was cured after 1-year anti-inflammation and liver support therapy.In the other 32 patients,an 8-to 36-month follow-up(mean,16 months) was achieved,during which none of them showed any complications.Conclusions Bile duct injury can be due to lacking experience and knowledge of the complications of laparoscopic cholecystectomy,inappropriate enrollment of the patients,inaccurate operation,misuse of the surgical instruments,or being unable to discern the Calot's triangle.Strict indications for the operation,advanced training for young doctors,and appropriate timing for conversion to an open surgery are necessary to decrease the rate of bile duct injury.

This article analyses the measures concerning how to improve the quality and ensure the effect of pre-graduate practice on the enlarging of enrollments of GDPU.By discussing the multi-aspects of pre-graduate practice,such as integrating concentrate practice with decentralization practice,setting up the steady practice base,double-tutor system,strengthening the monitor of practice,multi-model of practice,in combination with industry,education and research etc.the article explores the approach to the reform of mode of the pre-graduate practice.

Objective To analyze the clinicopathological features of bilateral primary breast cancer (BPBC) by molecular subtypes.Methods Clinical data of 145 BPBC patients were reviewed focusing on the clinicopathological features of different molecular subtype and the concordance of molecular subtype between first and second primary breast cancers.Results Of the first primary breast cancers ( FPBC),91 cases (62.8％ ) were Luminal A subtype,Luminal B subtype in 13 cases (9.0％ ),Human epidermal growth factor receptor 2 (HER-2) subtype in 14 cases (9.7％ ),triple negative breast cancer (TNBC) in 27 cases ( 18.6％ ).Of the second primary breast cancers ( SPBC ),Luminal A subtype was found in 93 (64.1％ ) cases,Luminal B subtype in 10(6.9％ ) cases,HER-2 subtype in 14(9.7％ ) cases and TNBC in 28( 19.3％ ) cases.Most TNBC patients were young ( age ≤ 50 ) with high frequency of grade Ⅲ in FPBC.Molecular subtypes do not vary with tumor size,clinical stage,lymph node status and pathological types ( P ＞ 0.05 ).Most FPBC of Luminal A and TNBC were concordant same subtypes in SPBC ( K ＞ 0.04 ),while Luminal B and HER-2 subtypes often had discordant phenotypes in SPBC ( K ＜ 0.04).BPBC were more likely to have concordant subtypes if the two tumors developed in short time interval.Conclusions The distribution and clinical leatures of each subtype in BPBC is similar to unilateral breast cancer.Patients whose FPBC are Luminal A or TNBC often have concordant phenotypes for their SPBC,a short time interval between two cancers also predicts concordance.

Objective To explore the relative importance of factors of sleep quality in predicting the anxiety and depression emotion. Methods Sleep quality and emotional condition of 112 patients with coronary heart disease were investigated with Pittsburgh sleep quality index(PSQI), self-rating anxiety scale (SAS)and self-rating depression scale (SDS). The relation between sleep quality and emotional condition was analyzed deeply by dominance regression analysis. Results After controlling the demographic vari-able of the sex,factors of the sleep quality such as sleep efficiency and function in the daytime had predict-ing effect on depression emotion;factors such as function in the daytime, sleep quality, sleep efficiency and sleep time possessed predicting effect on anxiety emotion. Conclusions According to different contribu-tion of various factors of sleep quality to anxiety and depression emotion, we should implement selective medical and nursing intervention during clinical work.

Objective:To investigate the clinical efficacy and effects on hemorheology of acupuncture therapy combined with gaba-pentin in the treatment of patients with tension headache. Methods:Totally 92 cases of patients with tension headache were randomly divided into the observation group (n=46) and the control group (n=46) according to the random number table. The control group was given gabapentin, while the observation group was treated with acupuncture therapy on the basis of treatment in the control group. The treatment course was 4 weeks. The clinical efficacy, changes of the headache indices, VAS score and hemorheology levels before and after the treatments in the two groups were compared, and the incidence of adverse reactions was observed as well. Results:The to-tal effective rate of the observation group (93. 48%) was significantly higher than that of the control group (73. 91%, P<0. 05). Af-ter the treatment, the headache indices in both groups significantly decreased (P<0. 05), and the decrease in the observation group was more significant than that in the control group (P<0. 05). The VAS scores in both groups significantly decreased after the treat-ment (P<0. 05), and the decrease in the observation group was more significant than that in the control group (P<0. 05). The plas-ma viscosity, hematocrit and platelet aggregation rate in both groups significantly decreased after the treatment (P<0. 05), and the decrease in the observation group was more notable than that in the control group (P<0. 05). No severe adverse reactions were shown in both groups during the treatment course. Conclusion: Acupuncture therapy combined with gabapentin in the treatment of patients with tension headache shows striking effects, which can improve hemorheology with promising safety and deserves further studies.

Objective:To investigate the association of the rsl801133 polymorphisms of the methylenetetrahydrofolate reductase (MTHFR)gene and rs2236225 polymorphisms of the methylenetetrahydrofolate dehydrogenase(MTHFD1)gene with non-syndromic cleft lip with or without cleft palate (NSCL/P)in Chinese population of Shanxi Province.Methods:The rsl801133 polymorphism of MTHFR gene and rs2236225 polymorphism of MTHFD1 gene were examined by PCR-RFLP in 265 patients with NSCL/P and 276 healthy controls.Data were statistically analysed.Results:The genotypic distribution of rsl801133 and rs2236225 was not deviated from the Hardy-Weinberg equilibrium.There was no significant difference in allele frequencies of rsl801133 and rs2236225 variants between patients with NSCL/P and healthy individuals(P <0.05).Conclusion:The polymorphism of MTHFR gene and MTHFD1 gene was not associated with NSCL/P in Chinese population of Shanxi Province.

Object To perform detail studies on different species of Ligusticum L (Uumbelliferae) currently prescribing in Yunnan Province for the purpose to clarify the claotic state of its clinical use Methods By literature retrieval, field and market center inspection and pharmacognostic identification in comparison with those documented in classical literatures to arrive at a reasonable evaluation Results Two varieties of Ligusticum L., the Huanggaoben and Heigaoben were currently in common use in Yunnan Province Huanggaoben, the yellow ligusticum, was originated from Sinodielsia yunnanensis Wolff and Ligusticum delavayi Franch Heigaoben, the balck ligusticum, was oringinated from Ligusticum pteridophyllum Franch Conclusion The study may provide references for the further study and clinical use of this medicinal plant

Object To study the chemical constituents of Hedysarum sikkimense Benth. ex Baker var rigidum Hand Mazz Methods The constituents were repeatedly separated and purified on silica gel column They were identified and structurally elucidated by physicochemical data and spectral analysis Results Nine compounds were obtained Eight of them were lupeol (Ⅰ); isoformononetein (Ⅱ); 3 (4 hydroxyphenyl) 6,7 dimethoxy 4H 1 benzopyran 4 one (Ⅲ); ursolic acid (Ⅳ); docosanoic acid 2,3 dihydroxypropyl ester (Ⅴ); lignoceric acid (Ⅵ); ? sitosterol (Ⅶ) and sucrose (Ⅷ) Conclusion All of them are isolated from this plant for the first time