Objective To analyze the prognostic factors in the patients with HER2-positive breast cancer adjuvant treated with trastuzumab.Methods We conducted a retrospective analysis of clinical data of 1 246 patients diagnosed with HER2-positive breast cancer between January 2009 and December 2019 who received treatment with trastuzumab.We investigated the factors impacting their prognosis by the Log-rank test univariate analysis and multivariate COX regression analysis.Results HER2-positive patients treated with trastuzumab had a poor prognosis in pT2-3(HR=2.10,P=0.003),pN2-3(HR=2.81,P<0.001),and no endocrine therapy(HR=2.50,P<0.001),and that had a better prognosis combined with taxane or other chemotherapy regimens(HR=0.40,P=0.017).We divided the patients into two subgroups according to the status of lymph node metastasis,and we found that in the negative lymph nodes group the patients with pT2-3 stage had poor prognosis(P=0.020),while the patients combined with taxane or other chemotherapy had better prognosis(P=0.032).In the positive lymph nodes group the patients with pT2-3 stage and no endocrine therapy had poor prognosis(P=0.012,P=0.001).Conclusions The patients with HER2-positive breast cancer treated with trastuzumab can be managed in different categories,for individuals without lymph node involvement and small tumor sizes,combining therapy with non-anthracycline chemotherapy is preferable for achieving improved outcomes,for patients with lymph node metastasis and large tumor sizes,if chemotherapy options are available,it is more recommended to use an anthracycline-free regimen to ensure the same prognosis while reducing the harm caused by the toxic side effects of chemotherapy.

Objective To explore the strategies of desensitization treatment for ABO incompatible (ABOi) related living-donor kidney transplantation .Methods A retrospective analysis was performed for 14 recipients undergoing ABOi related living kidney transplantation from July 2015 to December 2018 .The clinical outcomes and expenditures of desensitization treatment before and after optimizing desensitization were compared .Results After desensitization treatment , 14 recipients successfully underwent ABOi-kidney transplantation . Within 2 weeks post-transplantation , blood group antibody rebounded to 1:64 in only 1 recipient .Within 1 week post-transplantation ,the serum creatinine levels decreased to 85-165 μmol/L in 14 recipients .Thirteen patients stabilized after 1 week while another patient had an elevated level of serum creatinine at Day 12 post-operation and renal allograft function recovered after treatment . Two cases of rejection were diagnosed by clinical manifestations and 1 case was confirmed by pathological biopsy . Five cases of programmed renal allograft biopsy indicated critical or suspected acute T-lymphocytic rejection within 1 year .Thirteen cases (92 .6％ ) demonstrated varying degrees of peritubular capillary deposition of C 4d .One case developed BK viral uropathy within 1 year and four patients of pulmonary infections requiring hospitalization were cured after treatment . During an early stage , the incidence of postoperative infection was 57 .14％ and declined to 14 .29％ after optimized desensitization .The expenditure of early desensitization treatment was (27004 .86 ± 10719 .85) yuan and (10612 .29 ± 8143 .05) yuan after optimization .And the expenditure of optimized desensitization was significantly lowered (P<0 .05) . During follow-ups ,renal allograft function of 14 recipients remained decent .And the survival rate of recipient/allograft was 100％ up to the statistical cut-off point .Conclusions Both desensitization strategies may achieve the goal of desensitization for ABOi kidney transplantation and the outcomes are excellent .The expenditure of desensitization treatment is significantly lowered after optimization .

Objective To explore the effect of static progressive stretching combined with joint mobilization on dysfunction after total knee arthroplasty.Methods Fifty-six patients with knee joint dysfunction after total knee arthroplasty were randomly divided into a treatment group and a control group,each of 28.Both groups were treated with joint mobilization,while the treatment group was additionally provided with static progressive stretching for 8 weeks.Before and after the treatment,both groups' pain and knee function were evaluated using visual analogue scale (VAS) scores,the range of motion and the hospital for special surgery knee score (HSS).Results Before the treatment there were no significant differences between the two groups in any of the measurements.After the treatment,all of the measurements had improved in both groups,on average.Compared with the control group,the treatment group's average range of motion of the knee and HSS score were significantly better.Conclusion Static progressive stretches combined with joint mobilization can effectively relieve pain,expand the range of motion and improve the function of a knee joint after total knee arthroplasty.

OBJECTIVESTo investigate the incidence of syphilis infection and to determine the risk factors related to syphilis infection among young men who had sex with men (YMSM), which were documented for developing effective intervention to prevent sexually transmitted diseases among YMSM.

METHODSA cohort study was conducted in 8 cities (Beijing, Shanghai, Kunming,Guiyang, Chongqing, Chengdu, Urumqi and Nanning) from May to December, 2009. A total of 1 037 syphilis-negative YMSM aged 18-25 were enrolled in the cohort and the two follow-up surveys were carried out every six months. The contents of study included sociodemographic characteristics, HIV-related knowledge, sexual behavior and condom use in the 6 months prior to survey. All participants were tested for syphilis with whole blood specimens. Chi-square test was used to compare demographic characteristics of participants in baseline with those of two follow-up, and Cox regression analysis was used to identify risk factors associated with syphilis infection.

RESULTSThe rates of participants in 6, 12 months follow-up surveys was 79.85% (828/1 037) and 82.16% (852/1 037) respectively.39 syphilis seroconversions were found in the 12 months follow-up survey. Cumulative observed person-years during follow-up time was 1 106.67. The syphilis incidence rate was 3.5%. The Multivariate Cox regression analysis showed that the education of senior high school (senior high school vs some college or higher, RR = 2.19, 95% CI:1.21-3.98), bisexual orientation (bisexual orientation vs homosexual orientation, RR = 2.19, 95% CI:1.21-3.97), score of HIV/AIDS knowledge <8 (score of HIV/AIDS knowledge <8 vs knowledge = 8, RR = 2.39, 95%CI:1.35-4.21), had two and more sexual partners and inconsistent condom use in the past 6 months (inconsistent condom use vs consistent condom use, RR = 3.10, 95% CI:1.39-6.91) were significantly associated with syphilis seroconversion in the 12-month period.

CONCLUSIONSThe syphilis incidence was high and risk behaviors were common among YMSM of China.

Adolescent ; Adult ; China ; epidemiology ; Cohort Studies ; Homosexuality, Male ; Humans ; Male ; Risk Factors ; Risk-Taking ; Syphilis ; epidemiology ; Young Adult

Objective:To explore the long-term preservation value and repair effect of normothermic machine perfusion (NMP) on clinically discarded kidneys.Methods:A case of clinical discarded donor kidney was collected, and NMP was carried out in vitro for 9 hours with recovered blood. The dynamic changes of renal appearance, blood gas and biochemistry analysis of perfusate and renal pathology were recorded. Results:In the second to fifth hour of NMP, the appearance of renal was pink and ex vivo normothermic perfusion assessment score (EVNP) was grade Ⅰ. While, the sixth hour and beyond of NMP, the appearance of kidney turned to dark red and EVNP was grade Ⅲ. The renal perfusion blood flow maintained above 150 ml/min in the first 6 hours and decreased significantly after that, and at the end, was only 50 ml/min. During the whole process of perfusion, urine output was maintained at about 100 ml/h. PO 2 remained above 100 mmHg in the first 5 hours of perfusion and from the 6th hour, was lower than 80 mmHg and continued to decline, and was close to 0 at the end of perfusion. The results showed that although the K + concentration changes in blood and urine in the first 5 hours of NMP had a good consistency, the lactic acid level had been rising. In addition, there was no significant change in the histopathology at the fourth hour of perfusion compared with that before zero-point puncture, and the fibrinous thrombus in glomeruli was improved compared with that before perfusion. However, at the sixth hour after perfusion and before the end of perfusion, the pathological changes of renal tissue were significantly worse. There were a large of thrombosis in glomerular blood vessels, renal tubular atrophy and acute tubular necrosis. Conclusions:NMP can realize the evaluation of extended criteria donors before transplantation, and it proves the feasibility and repair potential of NMP in kidney to a certain extent. At the same time, NMP also provides a new way to expand the source of donor kidney and to pre-treat organ in vitro.