Objective Secretory breast cancer is a rare and specific subtype of breast carcinoma,and most reports on it are case report.This study is to explore the clinicopathological and prognosis characteristics of secretory breast cancer in Chinese.Methods The clinicopathological data of 39 patients of secretory breast cancer diagnosed from Jan.1986 to Mar.2012 at Tianjin Medical University Cancer Hospital were retrospectively analyzed.The postoperative follow-up was 2 to 221 months,with a median follow-up of 73 months.The clinicopathological features and survival condition were observed.Results There were 2 male and 37 female patients,ranging from 11 to 75 years old,with the median age of 52 years old.The main clinical manifestation of secretory breast cancer was breast mass.30 patients(76.9％)were in T2 breast cancer(2 cm ＜ T ≤5 cm),29 patients (74.4％)were in clinical stage Ⅱ according to TNM stage,and 24 patients (61.5％)had no lymph node metastasis.17 patients(54.8％)had positive expression of estrogen receptor(ER),11 patients(37.9％)had positive expression of progesterone receptor(PR),and 9 patients (42.9％) were triple negative breast cancer.During the follow-up,2 patients(5.1％)died from the disease,and 2 patients under than 20 had no recurrence or metastasis.Conclusions Secretory breast cancer occurs in both sexes with a wide age range,mostly in an early clinical stage.The positive expression rate of hormone receptor is low.The proportion of triple negative breast cancer is high.The overall prognosis of patients with secretory breast cancer is good.Because of the risk of metastasis,patients should be followed up for a long time.It seems that juvenile patients have a better prognosis.

ObjectiveTo investigate the association between the Clock T3111C and T257G gene polymorphisms and sleep epilepsy patients in Han population of Hunan province.MethodsThree hundred and eleven subjects with epilepsy ( sleep epilepsy group ( n =112 ),aperiodic group ( n =95 ),awakening epilepsy group ( n =104 ) ) and 300 sex- and age-matched healthy controls were enrolled in the study.Genomic DNAs were extracted from peripheral blood leucocytes by phenol-chloroform methods.The Clock T3111C and T257G polymorphisms were detected by polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP).Results(1) Two genotypes(TT and TC) were detected in Clock T3111C.The frequency of Clock site T3111C genotypes in all of the people was 86.09％ (TT,526/611),13.91％(TC,85/611),0( CC),T allele gene frequency was 93.04％ (1134/1222) and C allele gene frequency was 6.96％ (85/1222).There was no significant difference in genotype and gene distribution of Clock gene T3111C polymorphism between sleep epilepsy group,aperiodic group,awakening epilepsy group and control group.(2)Two genotypes(TT and TG) were detected in Clock T257G.The frequency of Clock site T257G genotypes in all of the people was 85.92％ (TT,525/611 ),14.08％ (TG,86/611 ),0( GG),T allele gene frequency was 92.96％ (1136/1222) and G allele gene frequency was 7.04％ (86/1222).There was no significant difference in genotype and gene distribution of Clock gene T257G polymorphisms between sleep epilepsy group,aperiodic epilepsy group,awakening epilepsy group and control group.(3)There was an almost complete correspondence (complete linkage disequilibrium) of bases between the positions 257 and 3111.ConclusionClock gene T3111C and T257G polymorphisms are not associated with sleep epilepsy in Han population of Hunan province.

Objective To study the association between serum interleukin-33 (IL-33) level and human stromelysin-2 (ST2) level in patients with rheumatoid arthritis (RA) associated with interstitial lung disease (RA-ILD) and its correlation with lung function and other laboratory parameters.Methods Two hundred and forty-five newly diagnosed RA patients during March 2012 to March 2013 in the in-patient and out-patient clinic of the First Affiliated Hospital of Liaoning Medical College were enrolled into this study.Patients were further divided into RA group (n=187) and RA-ILD group (n=58).Sixty subjects who came to the hospital for routine health check-up was composed of the normal control group.The clinical data of the two groups and controls were collected and their serum IL-33 and ST2 concentrations were measured.The t test was used to compare the difference between the two groups.Multiple variance analysis was used to com-pare the difference between groups.Pearson's correlation analysis was applied to explore the relationship between IL-33 concentrations and related variables.Results ① This study showed that the prevalence of RA associated interstitial lung disease was 23.7％(58/245).② The concentration of IL-33 [(746±43) pg/ml] and ST2 [(3413±169)pg/ml] of the RA-ILD group was significantly higher than that of the RA group [(433±42) pg/ml,(1500±147) pg/ml] (P＜0.01).③The vital capacity (VC％),forced vital capac-ity (FVC％),maximal midexpiratary flow curve (MMF％) and carbon monoxide diffusing capacity (DLCO) of the RA-ILD group were significantly lower than those of the RA group.④ The serum level of IL-33 was negatively correlated with that of RF and ACPA (IL-33 and RF,r=0.82,P＜0.01; IL-33 and ACPA,r=0.55,P＜0.01).Serum level of IL-33 was negaitively correlated with DLCO (r=-0.80,P＜0.01).Conclusion IL-33 participates in the pathogenesis of RA; and may be involved in the pathogenesis of RA-ILD.

Objective To discuss the effectiveness of implementation of blending learning in teaching of Fundamental of Nursing.Methods 234 nursing undergraduates were divided into the experimental group and the control group.The experimental group adopted blending learning method,while the control group used traditional teaching method.The final term exam and technical test results were compared between two groups.Results Students' practice scores in the experimental group were higher than those of the control group.In the experimental group,about 90.2％ undergraduates accessed learning resources through online teaching platform,82.4％ students considered that their nursing skills improved and 78.4％ students thought that their self-learning capacity strengthened.Conclusions Blending learning gives students a potential time,environment and recourse to learn.By integrating in-class and after-class studying,undergraduates' self-learning ability and nursing skills improved.

Objective To investigate the role of apoptosis-related gene survivin, caspase-3 and cyclin-B1 in gastric carcinoma by detecting the expressions of survivin, caspase-3 and cyclin-B1 in gastric carcinoma. Methods The expressions of survivin mRNA, caspase-3 mRNA and cyclin-B1 mRNA were determined by reverse transcription-polymerase chain reaction (RT-PCR) method in 30 gastric carcinoma specimens and 10 normal gastric tissue specimens. Results The positive expression rate of survivin mRNA in 30 gastric carcinoma specimens was 66.7%(20/30). While 10 normal gastric tissue specimens did not express survivin mRNA. Although all of 30 gastric carcinoma tissues and 10 normal gastric tissues expressed caspase-3 mRNA and cyclin-B1 mRNA, the expressions of caspase-3 and cyclin-B1 in 20 survivin-positive gastric carcinoma tissues were significantly lower than those of 10 survivin-negative gastric carcinoma tissues (P

Objective To explore the clinical significance of blood flow reserve fraction in the treatment of coronary stent implantation.Methods A total of 46 patients with positive coronary angiography were included.Criteria for positive coronary angiography:coronary angiography confirmed at least a coronary artery stenosis was more than or equal to 50%.According to the results,the patients were divided into the control group(24 cases) and observation group(22 cases).Results 1.There was no significant difference in baseline level(P>0.05);2.The operation time,number of stents and the contrast agent dosage of the observation group were (63.20±9.92)min,(0.50±0.65) and (182.94±39.30)mL,which were significantly less than those of the control group,the differences were statistically significant(operation time t=2.69,P=0.01;number of stents t=2.56,P=0.02;contrast agent dosage t=6.98,P=0.00).There was no significant difference between the control group and the observation group in angina pectoris and MACE attack.Conclusion Blood flow reserve score is an important guiding parameter for PCI treatment of coronary artery stenosis.

Objective To explore the effect of research practical teaching mode on the critical thinking ability and innovation ability of nursing in the course of community nursing teaching.Methods The research practical teaching was provided for 90 nursing students.They were investigated with the WatsonGlaser Critical Thinking Appraisal (WGCTA) and the test of self innovation level scale before and after teaching.Results After the teaching,the total score of critical thinking and the score of innovation ability among nursing students were significantly improved.the recognition hypothesis,deduction, explanation,evaluation discussed dimensions were statistically significant,but before and after teaching reasoningdimensions showed no significant difference.Conclusions Research practical teaching mode can improve critical thinking ability and innovation ability of nursing students in the course of community nursing teaching.

Objective To evaluate operative effect on internal rectal prolapse. Methods Sixty-two patients with internal rectal prolapse who underwent operation were studied by retrospectively analyzing the treatment and followed up results. Results The total success rate of surgical treatment for internal rectal prolapse is 73%. The rate of symptoms improvement as difficulty in defecation,anal aboating, incomplete defecation,asistation with fingers,and defecating dependent on laxatives were 77%,80%,71%,86%,97% respectively. Conclusion the operative indications of internal rectal prolapse should be strictly controlled. Only those who received standard conservative treatment and failed to improve should be a candidate for surgery.

Objective To investigate the application of intraoperative neuromonitoring (IONM) during thyroidectomy for non-recurrent laryngeal nerve (NRLN).Methods From Oct.2013 to Apr.2016,2846 patients underwent thyroidectomy with the application of IONM,and 11 patients with non-recurrent laryngeal nerve were analyzed.Results 11 cases of NRLN were all accurately identified by IONM,and no injury of NRLN occurred during thyroid surgery.Conclusions NRLN is uncommon in clinical and it is difficult to be predicted before surgery and easy to be injured.The application of IONM can reduce the possibility of NRLN injury remarkably.

Objective Study and analyze the benefits and risks of unilateral thyroidectomy for 1 to 4 cm thyroid cancer in primary surgery.Methods The patients who underwent thyroidectomy for 1 to 4 centimeters WDTC (May 2014 to June 2015) were retrospectively reviewed,and the patients with preoperatively known high-risk characteristics were excluded.One hundred and seventy-one patients would have been eligible for lobectomy as the initial operation based on current American Thyroid Association guidelines.The proportion of patients who need secondary surgery was estimated basing on pathological characteristics.Result In this group,49％ patients would have to undergo a secondary surgery if they took lobectomy as the initial operation.Conclusions Patients with 1 to 4 centimeters WDTC who accept unilateral thyroidectomy may take the risk of secondary surgery.Surgeons and patients need to balance the relative benefits and risks of initial TT versus lobectomy before the operation.