Node negative breast cancer is a prevalent form of breast cancer .With the improvement of breast cancer screening and disease awareness ,the rates of node negative breast cancer are gradually increasing . Although node negative breast cancer patients have much lower recurrence rates as compared with node positive patients,node-negative breast cancer is unequal to a low risk disease .Thus,it is important for oncologist to esti-mate the risk factors of node negative disease ,to carry out risk assessment and to guide the best regimen for these patients.In current review ,we discuss the value of traditional prognostic factors and new prognostic factors ,such as the urokinase -type plasminogen activator/plasminogen activator inhibitor 1,oncotype DX,MammaPrint and tumor associated macrophages ,on the predictive and treatment decisions in node negative breast cancer .

Objective To explore the significances of expression of tumor associated macrophages ( TAMs) and its correlation with microvessel density ( MVD) in triple negative breast cancer ( TNBC) .Methods Immunohistochemistry was used to detect TAMs and MVD expression in 108 TNBC tissues and to analyze the cor-relation between TAMs with clinicopathological features ,prognosis and MVD.Results The expression of TAMs was correlated with the tumor size,lymph node metastasis,histological grade,TNM stage and MVD,but had no statistically significant association with age .TAMs was correlated with 5 year disease free survival ( DFS) and over-all survival( OS);MVD was correlated with 5 year DFS, while no correlation with OS .Univariate and multivariate analyses showed that TAMs was an independent unfavorable prognostic factor for patients with TNBC .Conclusion High infiltration of TAMs indicated poor survival rate for patients with TNBC .The infiltration of TAMs was a new,important risk factor for TNBC recurrence .TAMs were closely related to MVD ,by promoting tumor angiogen-esis,thereby promoting TNBC growth ,invasion and metastasis ,and further affect the prognosis of patients with TN-BC.

Objective To summarize the clinical features and possible impacts of Goodpasture's syndrome in pregnancy on the pulmonary and kidney of the newborn and the mothers. Methods One patient diagnosed Goodpasture's syndrome in pregnancy hospitalized in Peking Union Medical College Hospital on August 23 in 2011 delivered a neonate with bullae of lung. And literatures including 8 cases of pregnancy complicated by Goodpasture's syndrome worldwide through Medline were reviewed. Results (1) Case report:one 31-year-old women presented with acute renal failure at 30+6 weeks of gestation and delivered a male infant with birth weight 1 900 g by caesarean section at 31+1 weeks of gestation. Diagnosis was confirmed as Goodpasture's syndrome with anti-glomerular basement membrane(GBM) antibodies in serum and renal biopsy after delivery. Then she was treated with methylprednisolone, cyclophosphamide, plasmapheresis and dialysis. The neonate showed the lung bullae in the right middle lobe and bilateral intraventricular hemorrhage but renal function was transient normal with anti-GBM as 113.1 EU/ml. The baby was treated by glucocorticoid for two months and clinical symptoms were improved. Anti-GBM antibodies and chest CT showed normal. After been followed up for two years, the baby was normal. (2) Literatures review:the main manifestations of Goodpasture's syndrome in pregnancy were malignant hypertension and renal failure but respiratory symptoms were not obvious. Treated with plasmapheresis, hematodialysis and glucocorticoid maybe have good effects. Most cases had premature delivery. Neonatal anti-GBM antibodies coming from mothers could result to cerebral, renal and pulmonary injury which could be treated by glucocorticoid. Conclusions The Clinical features of pregnancy complicating the Goodpasture's syndrome are malignant hypertension and renal failure. Diagnosis was depended on positive anti-GBM antibodies and renal pathological changes and treatment were depended on plasmapheresis, hematodialysis and glucocorticoid. Neonatal cerebral, renal and pulmonary injury resulting from anti-GBM antibodies coming from mothers should be followed up, and glucocorticoid should be taken if necessary.

Objective:To explore the role and significance of IL-17 on the pathogenesis of rheumatoid arthritis ( RA).Methods:The levels of IL-17 mRNA in peripheral blood mononuclear cell ( PBMC) of 66 RA patients (32 active,34 inactive) and 44 healthy controls were detected by reverse transcription-polymerase chain reaction ( RT-PCR ).The levels of serum IL-17 were detected by enzyme-linked immunosorbent assay ( ELISA).The levels of RF were detected by immunoturbidimetric assay.The correlations of serum IL-17 and RF were analyzed.Results: In RA patients the levels of IL-17 mRNA in PBMC were significantly higher than those in healthy controls ( P＜0.05 ) , but there was no difference between the active and inactive RA ( P>0.05 ).The serum IL-17 levels in active RA patients were significantly higher than those in inactive RA patients and healthy controls ( P＜0.05 ).The levels of serum IL-17 were positively correlated with RF in RA patients.Conclusion: IL-17 and RF play an important role in the pathogenesis and pathology process of RA ,and IL-17 may be associated with RA activity.

Objective To evaluate the nutritional status of extremely low birth weight (ELBW) infants and the effects of nutritional support strategy alterations on their growth during hospitalization.Method From 2005 to 2014,clinical data of ELBW infants admitted to the neonatal intensive care unit (NICU) in our hospital were retrospectively analyzed.The clinical data included their general status,enteral and parental nutritional support strategy and complications during hospitalization The patients were assigned into pre5 group and late5 group.Those who survived and discharged from 2005 to 2009 were the pre5 group,and those who survived and discharged fromn 2010 to 2014 were the late5 group.The independent t test and chi square test were used for statistical analysis.Result A total of 58 ELBW infants were enrolled in the study,including 18 patients in the pre5 group and 40 in the late5 group.No statistically significant differences existed between the two groups on gestational age,birth weight,Z score (weight for length and gender),birth length,head circumference and main complications during hospitalization (P ＞0.05).Pre5 group had higher incidence of small for gestational age (SGA) than late5 group (16/18 vs.25/40,P =0.037),while the EUGR ratio at discharge (14/18 vs.21/40,P =0.061) was similar.When compared with pre5 group,late5 group had larger amount of initial enteral feeding volume [4.4 ml/(kg · d) vs.2.4 ml/(kg · d),P =0.014] and feeding volume at the end of the first week [(19.8 ± 16.0) ml/(kg · d) vs.(12.2 ±9.5) ml/(kg · d),P =0.036].Similarly,the starting dose of amino acids in parenteral nutrition [2.0g/(kg· d) vs.1.0 g/(kg· d),P＜0.001],maximum dose of amino acids [4.0g/(kg.d) vs.3.5 g/(kg · d),P ＜ 0.001],total calories at the end of the first week [(82.6 ± 12.6) kcal/(kg · d) vs.(71.1±15.2) kcal/(kg· d),P=0.004] and the second week [(103.7 ±19.8) kcal/(kg· d) vs.(92.3 ± 17.9) kcal/(kg · d),P =0.041],the weight gain velocity from birth to discharge [(18.7 ± 2.9) g/(kg.d) vs.(16.9±2.8) g/(kg· d),P=0.031] and change of Z scores (AZ) [-0.6 (-1.0,-0.4) vs.-1.2 (-1.6,-0.8),P =0.004] showed significantl differences between the two groups,with better outcomes in late5 group.However,the duration of parenteral nutrition,the total amount of amino acids,the time reaching total enteral feeding,the length of hospital stay were similar between the two groups.Ten cases(61.1％)of infants in pre5 group were breastfed,and four of them used human milk fortifier (HMF) (fortified rate was 22％).32 cases (80％) in late5 group were breastfed and 23 cases used HMF (fortified rate was 57.5％).The time to initiate HMF in the late5 group was at (30.2 ± 13.2) days,and human milk amount was (89.9 ± 34.5) ml/kg,fortified duration was (32.8 ± 15.7) days.Conclusion The enteral feeding strategy were more vigorous in the last 5 years than before,the initial feeding volume,the increasing rate,the initial dosage of amino acid,and maximum dosage of amino acid had been increased.Human milk and HMF of preterm infants were preferred.The vigorous nutritional support strategy were effective for the weight gain of ELBW infants without obvious side effects during hospitalization.

Objectives To study the prevailing status of coal-burning type endemic fluorosis in Fuyuan County of Yunnan Province, and to provide a scientific basis for fluorosis control and prevention. Methods In 2013, five towns were selected from the villages and towns which the defluoridation stove project was implemented and by the end of 2007 defluoridation stove rate was higher than 95%(including 95%), and two natural villages were selected in each township to carry out the investigation. Dental fluorosis was examined of all children aged 8 to 12 of survey points. At least 20 people were selected in each village. At the same time, 20 copies of instant urine samples were collected from these children of half male and half female, and urinary fluoride was determined. Then five natural villages were sampled from all survey points, and permanent residents were divided into25-,35-,45-,55-and≥65groups according to age. Six people were selected from each group with male and female in half who were conducted examination of adult skeletal fluorosis by X-ray. Dental fluorosis diagnosis was based on theDental Fluorosis Diagnosis(WS/T 208-2011). Urinary fluoride determination was done in accordance withUrine-Determination of Fluoride-Ion Specific Electrode Method(WS/T 30-1996). Skeletal fluorosis diagnosis was carried out according to Diagnostic Criteria for Endemic Skeletal Fluorosis (WS 192-2008). Results A total of 556 children aged 8 to 12 were monitored, the detection rate of dental fluorosis was 41.55%(231/556), the dental fluorosis index was 0.78. The very mild, mild, moderate and severe proportions of children's dental fluorosis were 20.50%(114/556), 17.09%(95/556), 3.60%(20/556) and 0.36%(2/556), respectively, given priority to very mild. The prevalence of dental fluorosis in children was increased with increasing age (χ2=74.27, P<0.05). One hundred and ninety-three copies of child urine samples were tested, the geometric mean of urinary fluoride was 0.62 mg/L, and the urinary fluoride contents were between 0.10-2.93 mg/L. A total of 116 adults were examined, and the detection rate of skeletal fluorosis was 9.48%(11/116). Detected cases of skeletal fluorosis was given priority to mild (9 cases, accounted for 81.81%), more men cases [16.36% (9/55)] than those of women [3.28% (2/61), χ2 = 5.77, P< 0.05]. Conclusion The hazard of coal-burning type fluorosis has been reduced in Fuyuan County , the affect of defluoridation stove project is obvious.

OBJECTIVETo investigate the association between the PNPLA3 rs738409 polymorphism and chronic hepatitis B (CH[B) in a Han Chinese population residing in Qingdao.

METHODSPeripheral blood samples were collected from 185 CHB patients and 164 healthy controls and subjected to polymerase chain reaction (PCR) and DNA sequencing to determine the PNPLA3 genotypes. The relative risk of the rs738409 polymorphism for CHB was estimated by calculating the odds ratio (OR) and 95% confidence interval.

RESULTSThe rs738409 G allele frequency was significantly different between the CHB and control groups (31.9% vs.21.9% respectively, P less than 0.05). Compared to he rs738409 C allele, the G allele was associated with an increased risk of developing CHB (OR =1.67, 95% CI:1.18-2.34, P =0.003). Logistic regression model analysis, with adjustment for confounding factors, indicated that carriers of the PNPLA3 rs738409 GG + GC genotype had increased risk of CHB than carriers of the CC genotype (OR =1.76 ,95% CI:1.14-2.71, P =0.011).

CONCLUSIONQingdao Han Chinese who are carriers of the rs738409 G allele are at increased risk of CHB.

Adult ; Aged ; Asian Continental Ancestry Group ; genetics ; Case-Control Studies ; China ; epidemiology ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; Genotype ; Hepatitis B, Chronic ; epidemiology ; genetics ; Humans ; Lipase ; genetics ; Male ; Membrane Proteins ; genetics ; Middle Aged ; Polymorphism, Single Nucleotide ; Risk Factors ; Young Adult

Objective To investigate the preventive effects of lamivudine combined with chemotherapy drugs on hepatitis B virus reactivation in patients with HBV infection and tumor. Methods From July 2014 to February 2017,a total of one hundred and twenty patients with HBV infection and tumor in Nanchong Central Hospital were selected and were divided into the observation group and control group with 60 cases in each group. The control group received conventional chemotherapy and liver protection treatment,the observation group was given lamivudine prophylaxis treatment(100 mg/d,1 time/d) based on the treatment in the control group, two groups were treated for 8 weeks. Results The rates of hepatitis B virus reactivation in the observation group and the control group were 5. 0％(3/60) and 33. 3％(20/60),respectively,and the difference between the two groups was statistically significant (χ2=15. 692,P<0. 05) . There was no significant difference in serum glutamic acid transferase and aspartic transferase in the patients before and after treatment ( P>0. 05 ) , and the control group showed an upward trend ( P<0. 05) . After treatment,the serum ALT and AST in the observation group ((31. 98±6. 33)U/L,(26. 38±4. 98)U/L) were lower than those in the control group((43. 89±6. 73)U/L, (51. 78±5. 99)U/L)(t=8. 294,11. 842,P<0. 05). After treatment,the HBV DNA in the observation group and the control group((0. 16±0. 04) ×103copies/ml,(5. 02±1. 72) ×103copies/ml) were lower than those before treatment ((14. 55±2. 14)×103copies/ml,(14. 09±1. 98 copies/ml )(t=25. 498,8. 142,P<0. 05),and the HBV DNA in the observation group after treatment was also lower than that of the control group. The difference between the two groups was statistically significant ( t=24. 292,P<0. 05) . Conclusion Lamivudine combined with chemotherapy drugs used in patients with HBV infection and tumor can prevent hepatitis B virus reactivation,it does not affect the patient′s liver function,it can inhibit the replication of hepatitis B virus,so it has good application values.

Objective To explore the effect of two different core temperature monitoring methods on cardiopulmonary bypass and coagulation function in open heart surgery to provide a reference for monitoring the core body temperature in open heart surgery. Methods One hundred and forty patients undergoing open heart surgery in this hospital from June to December 2016 were divided into the control group(n= 70) and observation group (n= 70). The control group monitored the temperature of nasopharynx and bladder. The observation group monitored the temperature of rectum and nasopharynx. The temperature falling time of cardiopul monary bypass, time of blocking ascending aorta,time of rewarming, total time of cardiopulmonary bypass were recorded during operation. The coagulation function was monitored on 1 d before surgery and at the end of surgery,including thrombolytic time (TT), prothrombin time (PT) and activated partial thromboplastin time (APTT). Results The temperature falling time,rewarming time, total time of cardiopulmonary bypass in the control group were more than those in the observation group, the difference was statistically significant(P<0.01);there was no statistically significant difference in coagulation function indicators(TT,PT,APTT) before operation between the two groups (P> 0.05). At the end of the operation, the coagulation function indicators (TT, PT, APTT) had statistically significant difference between the two groups (P<0.01). The coagulation function indicators in the observation group were better than those in the control group. Conclusion Using the rectal temperature for monitoring the core tempera ture in the patients undergoing open heart surgery under cardiopulmonary bypass is better than using bladder temperature, which can shorten the time of cardiopulmonary bypass and improves coagulation function.

Objective : To investigate the spatial distribution and the influencing factors of hypertensive patients aged 45 years and above,and to provide evidence for the prevention and control of hypertension among middle-aged and elderly population. Methods : Multi-stage stratified random sampling method was used to collect 150 counties（cities or districts）from 30 provinces（municipalities or autonomous regions）from CHARLS database in 2015 according to the per capita GDP in different areas. Then the probability proportionate to size sampling method was used to select three villages（neighborhood committees）,80 families were randomly selected from each village（neighborhood committees）,and residents aged 45 years and above were interviewed. Spatial analysis was based on the vector map of China's provincial boundaries,Geoda and ArcGIS 10.2 software were used to analyze the prevalence and influencing factors of hypertension at provincial levels. Results : The health data of 14 880 people aged 45 years and above in 28 provinces（municipalities or autonomous regions）were obtained,including 4 203 patients with hypertension（28.25%）and 5 408 people with pre-hypertension（36.34%）. The results of local spatial analysis showed that the clustering regions of hypertension patients were in northeast and eastern parts of China. The results of spatial regression analysis showed that males,age of 80 years and above and overweight were the main risk factors for hypertension（all P<0.05）,which had greater influence on the middle part of China,north and northeast of China,and the east and north of China,respectively. Conclusion Males,age of 80 years and above and overweight were the main risk factors for hypertension in middle-aged and elderly population in China. The main prevention and control areas of hypertension were eastern and northeast China.