Objective To systematically evaluate the type and magnitude of effectiveness of pulmonary rehabilitation program on patients diagnosed with chronic obstructive pulmonary disease (COPD) in none-acute phases.Methods Two investigators independently searched three databases including Cochrane library,Pub Med and CNKI to collect randomized controlled trials about Pulmonary Rehabilitation Program on COPD Patients.A total of 17 trials were included.The quality of these RCTs was evaluated by two investigators and the combination of study results was conducted using RevMan 5.0.2 software.Results Pulmonary Rehabilitation Program could improve COPD patients' exercise tolerance,quality of life,lung function and blood oxygen level.It was also beneficial to patients' discomforts including dyspnea and fatigue.Conclusions The meta-analysis had identified a significant effect of pulmonary rehabilitation program on COPD patients,so nurses are suggested to integrate effective programs into clinical practice.

Circulating cell-free DNA (cfDNA), which is released by normal cells and cancer cells, is defined as extracellular DNA in the blood. The cfDNA levels in breast cancer patients are higher than those in healthy control donors. cfDNA also carries the features of tumor tissue, such as mutations, methylations, copy number changes, and loss of heterozygosis. cfDNA is a potential bio-marker in the diagnosis, management, and prognosis of breast cancer. In this review, the authors briefly describe the biological features of cfDNA, and discuss its clinical utility as a blood biomarker in quantitative and qualitative research.

The spindle assembly checkpoint ( SAC) is an important monitoring mechanism to monitor the connection between centromeres and microtubules and to ensure proper chromosome separation in human .Mitotic arrest defective protein(Mad)family,as an important part of SAC,plays a crucial role in the process of mitosis. Mutations or altered expressions of Mad may lead to abnormal separations of chromosomes and play a partial role in tumorigenesis ,poor prognosis and chemotherapy drug resistance .

In the context of precision medicine, although individual treatment of breast cancer under the guidance of molecular classi-fication has become the norm, a precision treatment program with increased efficiency and quality is still required. Compared with the traditional real-time fluorescent quantitative polymerase chain reaction (PCR), the droplet digital PCR (ddPCR) has obvious advantages in the detection of rare mutations and copy number variations, as well as the integration with the second-generation-sequencing tech-nology. This paper reviews the application of a ddPCR platform in different breast cancer subtypes and explores new horizons of breast cancer research through the ddPCR technology.

BACKGROUND: The oriented migration of bone marrow mesenchymal stem cells may depend on the interaction between local chemotactic factors and cellsurface receptors. However, which chemotactic factors may mediate the oriented migration of bone marrow mesenchymal stem cells towards the fracture site remains unclear. OBJECTIVE: To tag autologous bone marrow mesenchymal stem cells, evaluate its role in bone healing, and detect the highly expressed factors associated with migration of bone marrow mesenchymal stem cells in the microenvironment. METHODS: The fluorescence/chimeric C57BL/6 mouse models were established, then left shankbone fracture models were also produced. The percentages of green fluorescent protein positive cells to al cells at the fracture site and the percentage of osteoblasts differentiated from bone marrow mesenchymal stem cells to al the osteoblasts were detected at different time points. The role of bone marrow mesenchymal stem cells in the fracture repairing was evaluated. The levels of chemotactic factors protein expression at the fracture site in different time points were detected with immunohistochemistry technology. RESULTS AND CONCLUSION: The percentage of green fluorescent protein positive cells to al cells at the fracture site was (3.011±0.911)%, (9.031±0.145)%, (12.064±0.145)% at 1, 5, 14 days postoperatively; and osteoblasts differentiated from bone marrow mesenchymal stem cells accounted for 50% of al the osteoblasts. After fracture, the stromal cel derived factor-1, colony stimulating factor, hepatocyte growth factor, monocyte chemoattractant protein-1, and matrix metal oproteinases-9 were expressed to varying degrees in the microenvironment, while the expression of granulocyte colony-stimulating factor was negative. The expression of stromal cel derived factor-1 in the fracture microenvironment was the highest, mainly due to the migration of bone marrow mesenchymal stem cells. Experimental findings indicate that, autologous bone marrow mesenchymal stem cells participate in and play an important role in bone healing. The stromal cel derived factor-1 plays an important role in promoting bone marrow mesenchymal stem cells migration and promoting bone healing.

To study the bioactive polypeptides included in Bufo skin and its secretions the plasmid skin cDNA library of adult Japanese toad Bufo japonicus formosus was prepared. The pSD64TR has been used as the vector and the cloning sites are Xho I and EcoR I. To screen cDNAs encoding bioactive components, the plasmid cDNA library was transformed into E. coli DH5 competent cells, and positive colonies were screened by colony PCR (polymerase chain reaction). The suspension of a single colony in LB medium was used as the template, SP6 (the upstream primer of the plasmid cDNA library) and a primer with Xho I site and polyT were used as the primers. As the result, 465 positive colonies out of 1 344 were obtained and their plasmid were collected and sequenced. By homologous analysis, it was found that one of the cDNAs encoding a peptide with high homolog with transgelin-2, which was registered in GenBank (accession number: JX197456), and it was indicated as a partial cDNA sequence with a deletion at the 5' end. The transcript is 997 bp consisting of 31 bp 5', 618 bp 3' untranslated region (UTR) and an open reading frame (ORF) of 348 bp encoding a polypeptide of 115 amino acids. In the putative protein product, there is a calponin homology domain, two cysteine residues for a disulfide bond and three a-helix domains, and five potential phosphorylation sites. The homologous analysis indicates 90% similarity with Xenopus (Silurana) tropicalis and 89% with Xenopus laevis, and 71%-85% with other species.

Objective To investigate the chang and impaction of TM and D- Dimer on peripherally inserted central catheter (PICC) associated thrombosis in cancer patients. Methods The expression of TM and D-Dimer from 207 cancer patients with PICC was examined using nzyme-linked immunoassay. Paitents were divided into thrombosis group and control group according to Doppler Sonography. Results The thrombosis group had 33 cases and the control group had 174 cases in 207 malignant tumor patients with PICC. Compared with that in control group, the expression of TM (6.806 ± 1.805)μg/L and D-Dimer (0.786 ± 0.294) mg/L was significantly higher in thrombosis group and respectively statistically significant (P<0.05), The expression of TM and D-Dimer was positively correlated with thrombosis respectively (r=0.572 and 0.530, P<0.05). The multi-factor Logistics analysis showed the odd ratio of TM was 1.899 and the odd ratio of D-Dimer was 7.292, and the difference was statistically significant (P<0.05). Patients were dichotomized into elevated and noneelevated groups according to the 50th percentile of the levels of TM and D-Dimer of the total study population. In multivariable analysis, the odd ratio of both elevated TM and elevated D-Dimer was 2.04, which was higher than elevated TM (1.286) alone and elevated D-Dimer (1.044) alone, and there was difference in statistics (P<0.05). The results showed that the risk of PICC associated with thrombosis in both elevated TM and elevated D-Dimer TM increased 2.042 times. The expression of TM and D-Dimer was correlated with clinical stage respectively (r=0.477 and 0.492, P<0.05);but was not correlated with age, sex, site of tumor and concurrent radiochemotherapy (P>0.05). Conclusions The expression of TM, D-Dimer is elevated, which is expected to assess the early diagnosis and clinical value of PICC associated thrombosis in cancer.

Objective To investigate the application value of extracorporeal extended field radiotherapy in locally advanced cervical cancer. Methods A total of one hundred and twenty patients with stage IIB?IVA cervical cancer in the First Affiliated Hospital of Hebei North University from June 2012 to June 2014 were randomly divided into two groups:the control group and the observation group,each with 60 cases. The routine concurrent chemoradiotherapy was adopted in the control group. The observation group was treated with extracorporeal extended field radiotherapy combined with concurrent chemotherapy. The patients have been followed up for three years. The total efficacy rate,toxicity reaction,local progression free survival time ( PFS) and survival rate of the two groups were compared. Results The total efficacy rate in the observation group was significantly higher than that of the control group ( 88. 3%( 53/60 ) vs. 73. 3%( 44/60 ) , χ2 = 4. 357, P=0. 037),while the incidences of toxicity reaction in the two groups were 18. 3%(11/60) and 16. 7%(10/60), the difference was not statistically significant (χ2=0. 058,P=0. 810) ,the percentages of I and II degree in the two groups were 3. 4%( 2/60 ) and 3. 4%( 2/60 ) , the difference between the two groups was not statistically significant (Z=0. 000,P=1. 000). The PFS value in the observation group was significantly longer than that of the control group ( 25. 6 months vs. 13. 8 months,χ2 = 25. 624, P= 0. 000 ) , and the survival rate in the observation group improved significantly ( 53. 3%( 32/60 ) vs. 33. 3%( 20/60 ) , the difference was statistically significant (χ2 = 4. 887, P= 0. 027 ) . Conclusion Extracorporeal extended field radiotherapy is safe and effective in the treatment of locally advanced cervical cancer.

Objective To evaluate the distribution of pathogens causing bone and joint purulent infections and the bacterial resistance to antibiotics,and to provide reference of clinical antibiotic therapy.Methods A total of 514 patients who had bone and joint purulent infections in Department of Orthopedics of Shangrao People’s Hospital from Jan 2009 to Jun 2013 were retrospectively analyzed. Results 296 strains of Gram-negative bacteria were isolated,the infection rate was 47.2%,among which 296 strains of Escherichia coli were the most common infection pathogen,the infection rate was 15.6%,followed by Acinetobacter baumannii,Pseudomonas aeruginosa,and the infection rates were 11.8%,11.3%.331 strains of Gram-positive bacteria were isolated,the infection rate was 52.8%.Staphylococcus epidermidis,Staphylococcus aureus,were the common infection pathogens,following the infection rates were 21.5%,13.7%.Gram-negative bacteria had the highest sensitivity to imipenem,while Gram-positive bacteria had sensitivity to vancomycin.Conclusion Gram-positive bacteria is the main pathogens with bone and joint purulent infections.Selection of antibiotics according to the drug sensitive test has important clinical significance.

Objective To explore the risk factors of severe pneumonia caused by multi-drug resistant Klebsiella pneumonia,and antimicrobial drug resistance among these isolates.It may help to prevent and control the disease and promote to rational use of antibiotics.Methods We conducted the case-control study in our PICU.It included 89 patients with severe pneumonia caused by multi-drug resistant Klebsiella pneumonia as case group and 68 patients with severe pneumonia caused by Klebsiella pneumonia as control group during the same period.To compare the two groups on irrationality use of antibiotics (especial for third generation cephalosporin),length of stay,tracheal cannula,time of mechanical ventilation and underlying conditions (malnutrition,congenital heart disease,heredity and metabolic disease).Antimicrobial susceptibilities among 89 multi-drug resistant Klebsiella pneumonia isolates were analyzed.Results There were 63 cases (70.79％) for irrationality use antibiotics in case group,while there were 27 cases (39.70％) in control group (P ＜ 0.01).The cases for length of stay over 7 days in case group (48 cases,53.93％) were more than those cases with the same situation in control group (12 cases,17.65 ％) (P ＜ 0.01).Thirty-eight cases (42.69 ％) needed mechanical ventilation therapy in case group,while 16 cases (23.53％) needed mechanical ventilation therapy in control group (P ＜ 0.01).The cases for duration of mechanical ventilation over 5 days in case group (18 cases,20.22％) were more than those cases in control group (5 cases,7.35％) (P ＜0.05).The cases with underlying disease in case group (13 cases,14.61％) were more than those cases in control group (2 cases,2.94％) (P ＜ 0.05).Multi-drug resistant Klebsiella pneumonia isolates demonstrated that high-level resistance for penicillins,cephalosporins,aminoglycosides and quinolones,but still susceptible to carbapenems.Conclusion Several risk factors are associated with severe pneumonia caused by multi-drug resistant Klebsiella pneumonia,including irrational use of antibiotics (especial for third generation cephalosporin),long term of length of stay,endotracheal intubation,long term of mechanical ventilation,and having underlying disease (malnutrition,congenital heart disease,heredity and metabolic disease).Multi-drug resistant Klebsiella pneumonia isolates demonstrated that high-level resistance for penicillins,cephalosporins,aminoglycosides and quinolones,but still susceptible to Carbapenems.Carbapenems should be used as first-line drugs for severe pneumonia caused by multi-drug resistant Klebsiella pneumonia.