In the treatment of human epidermal growth factor receptor 2 (Her-2) overexpressing breast cancer,some patients have drug resistance to trastuzumab.Potential mechanisms of resistance to trastuzumab include impaired access of trastuzumab to Her-2 ; alternative signaling from insulin-like growth factor-1 receptor (IGF-1R),hepatocyte growth factor receptor (HGFR) and so on; aberrant downstream signaling caused by loss of phosphatase and tensin homologs deleted from chromosome 10 (PTEN);phosphatidylinositol 3-kinase catalytic alpha polypeptide gene (PIK3CA) mutation; over-expression of heat shock protein 90 (HSP90) and CD44. Additionally,potential strategies for overcoming resistance to trastuzumab include using new targeted medicines,such as pertuzumab,lapatinib and trastuzumab-DM1.

Objective To study the correlation of the number and ratio of involved lymph nodes and the prognosis of gastric carcinoma .Methods 174 patients with positive gastric lymph nodes were included,they were treated by radical gastrectomy and lymph nodes dissection (D2 or D3)in our department. The number and ratio of metastastic gastric lymph nodes were calculated. Their influence and their interrelation with pathogenic parameters were analyzed. Results The overall 5 year survival rate was 29.59%, and the five year survival rates of patients with 1 20 per cent and more than 20% positive lymph nodes were 70.58%,11.86% respectively, one to five positive lymph nodes and five more were 46.47%,17.35% respectively, the five year survival rate was decreased as the ratio and number of involved lymph nodes increased. Studies also indicated that with the increase of depth of cancer invasion ,the number and ratio of involved lymph node elevated.Conclusions The results shows that the number and ratio of involved lymph nodes correlated to tumour progression and the five survival rate.Perigastric lymph node status can be considered as a simple and effective prognosis factor.

Objective To investigate the short-term effects of glucocorticoid therapy on patients with idiopathic interstitial pneumonia using high resolution CT semi quantitative scores. Methods According to the different HRCT scores will be January 2015 -2017 year in January in our hospital for diagnosis and treatment of idiopathic interstitial pneumonia patients with 60 cases of groups: control group with HRCT score < 20%, the observation group with HRCT score more than 20%; the patients in the two groups of experimental data were recorded in detail and analyzed and discussed the high resolution CT semi quantitative score judgment of idiopathic interstitial pneumonia patients treated with glucocorticoid efficacy. Results The observation group (HRCT score≥20%) accuracy is higher than that of the control group (HRCT score<20%), the difference between groups was statistically significant (P<0.05). Conclusion The treatment of idiopathic interstitial pneumonia in patients with glucocorticoid selection of high resolution CT;semi quantitative score to determine significant short-term effect, HRCT score of the best critical value was 20%, the diagnostic accordance rate can obtain excellent.

Objective To investigate how gene silence of CD40 by small interfering RNA(siRNA)influences the balance between Th1 / Th2 and Th17 / Treg in rats with experimental autoimmune myocarditis(EAM). Methods Lewis rats were divided into a normal - control group,EAM group,CD40 siRNA - therapy group and siRNA - control group by using random number table. EAM,CD40 siRNA - therapy and siRNA - control groups were immunized on day 0 and day 7 with purified porcine cardiac myosin to establish EAM,and CD40 siRNA was administered intravenously on day 7. The basic data of each group were observed,and the rats were executed on day 21 to study the pathology of myo-cardial tissues and the myocardial histopathology scores were calculated,and than the changes in electrocardiograms (ECG)and echocardiogram were recorded. Enzyme - linked immunosorbent assay(ELISA)was used to determine the levels of interferon(IFN) - γ,interleukin(IL) - 10,IL - 17 and transforming growth factor(TGF)- β in peripheral blood. Results (1)The overall incidence of EAM,CD40 siRNA - therapy and siRNA - control group was 100% ,and no rats died from day 0 to day 21.(2)There were only 2 premature rats in EAM and siRNA - control groups,and the ECGs of normal - control group and CD40 siRNA - therapy group were normal.(3)The echocardiogram of EAM,CD40 siRNA - therapy and siRNA - control group,displayed the left ventricular dilatation,hypertrophy of the left ventricle, the weakening of the left ventricular wall motion,and heart failure,and pericardial effusion was discovered. The left ven-tricular fractional shortening(LVFS)and the left ventricular ejection fraction(LVEF)of rats treated by CD40 siRNA were higher than those of rats in the EAM group[(46. 70 ± 8. 25)% vs(34. 28 ± 11. 81)% ,(80. 92 ± 11. 76)% vs (64. 03 ± 12. 60)% ,F = 0. 652,0. 234,all P ﹤ 0. 05].(4)Pathologic examination of the EAM group,CD40 siRNA therapy group and siRNA control groups,showed myocardial fiber fracture,myocardial tissue necrosis and inflammatory cell infiltration. But myocardial tissue pathological scores of the cardiac tissue of CD40 siRNA therapy group was lower than those of the EAM group(2. 10 ± 1. 07 vs 3. 40 ± 0. 72,F = 1. 290,P ﹤ 0. 05).(5)ELISA method examination re-vealed that the levels of IFN - γ,IL - 4,IL - 17 and TGF - β in EAM group were increased compared with those of nor-mal control group[(1 245. 55 ± 244. 56)ng/ L vs(501. 53 ± 18. 93)ng/ L,(78. 03 ± 10. 47)ng/ L vs(30. 77 ± 1. 74)ng/ L,(80. 82 ± 13. 33)ng/ L vs(27. 98 ± 3. 01)ng/ L,(156. 27 ± 12. 11)ng/ L vs(4. 33 ± 0. 79)ng/ L,t =7. 408,10. 764,9. 250,30. 608,all P ﹤ 0. 05]. However,the levels of IFN - γ and IL - 17 in CD40 siRNA therapy group were lower than those in the EAM group[(940. 62 ± 128. 40)ng/ L vs(1 245. 55 ± 244. 56)ng/ L,(60. 42 ± 12. 40) ng/ L vs(80. 82 ± 13. 33)ng/ L,t = 2. 704,2. 745,all P ﹤ 0. 05],while the levels of IL - 4 and TGF - β were higher [(97. 91 ± 13. 62)ng/ L vs(78. 03 ± 10. 47)ng/ L,(178. 84 ± 12. 10)ng/ L vs(156. 27 ± 12. 11)ng/ L,t = 2. 835, 3. 229,all P ﹤ 0. 05]. Conclusions The administration of CD40 siRNA markedly reduces myocardial inflammation of EAM rats and improves their cardiac function,which can be explained by Th1 - type and Th17 - type cytokines inhibi-ted,Th2 - type and Treg - type cytokines increased,and so then the imbalance of Th1 / Th2 and Th17 / Treg corrected.

Near-infrared spectroscopy (NIRS) with its fast and nondestructive advantages can be qualified for the real-time quantitative analysis. This paper demonstrates that NIRS combined with partial least squares (PLS) regression can be used as a rapid analytical method to simultaneously quantify L-glutamic acid (L-Glu) andγ-aminobutyric acid (GABA) in a biotransformation process and to guide the optimization of production conditions when the merits of NIRS are combined with response surface methodology. The high performance liquid chromatography (HPLC) reference analysis was performed by the o-phthaldialdehyde pre-column derivatization. NIRS measurements of two batches of 141 samples were firstly analyzed by PLS with several spectral pre-processing methods. Compared with those of the HPLC reference analysis, the resulting determination coefficients (R2), root mean square error of prediction (RMSEP) and residual predictive deviation (RPD) of the external validation for the L-Glu concentration were 99.5%, 1.62 g/L, and 11.3, respectively. For the GABA concentration, R2, RMSEP, and RPD were 99.8%, 4.00 g/L, and 16.4, re-spectively. This NIRS model was then used to optimize the biotransformation process through a Box-Behnken experimental design. Under the optimal conditions without pH adjustment, 200 g/L L-Glu could be catalyzed by 7148 U/L glutamate decarboxylase (GAD) to GABA, reaching 99%conversion at the fifth hour. NIRS analysis provided timely information on the conversion from L-Glu to GABA. The results suggest that the NIRS model can not only be used for the routine profiling of enzymatic conversion, providing a simple and effective method of monitoring the biotransformation process of GABA, but also be considered to be an optimal tool to guide the optimization of production conditions.

Objective To detect the nucleation-promoting potency of retinol binding protein (RBP) in the simulated bile system,and observe the process of cholesterol nucleation and crystallization.Methods Small and synthetic bile systems were synthesized.RBP (RBP group),α1-acid glycoprotein (AAG,AAG group) and albumin ( Alb,Alb group) were added into the Small bile respectively.The derived indices of nucleation time,crystal growth rate and final concentration of crystal were studied by Busch method.Alb ( control group) and RBP (experimental group) were added into the Small and synthetic bile systems respectively.The nucleation time was detected by polarizing microscopy according to the Holan method and the nucleation-promoting potency was calculated according to the Holzbach method. The morphological dynamics of cholesterol nucleation and crystallization were observed under a light microscope.All data were analyzed by using the analysis of variance or the t test.Results The derived indices of nucleation time,crystal growth rate and final concentration of crystal were 0.66,1.29 and 1.01 in the AAG group,and 0.73,1.02,0.95 in the RBP group,respectively.In the Small bile system,the average nucleation time of cholesterol monohydrate crrystals were ( 12.2 ± 1.2 )days in the control group and (8.2 ± 1.5)days in the experimental group,respectively,with a significant difference between the 2 groups (t =2.97,P ＜ 0.05 ).The nucleation activity of RBP was 0.67 in the Small bile system.In the synthetic bile system,the average nucleation time of cholesterol monohydrate crystals were (9.5 ± 1.1 ) days in the control group and (7.5 ± 1.1 )days in the experimental group,respectively,with a significant difference between the 2 groups ( t =2.35,P ＜ 0.05 ).The nucleation activity of RBP was 0.79 in the synthetic bile system.The process of cholesterol nucleation and crystallization was divided into 4 stages,and the split phenomenon appeared in the bile system at day 21.Conclusion RBP is a pro-nucleation factor in simulated bile system.

Objective To explore the effect of CD40 small interfering RNA(siRNA)on the expressions of pe-ripheral blood interleukin(IL)-21 and IL -35 in rats with experimental autoimmune myocarditis (EAM)and its sig-nificance.Methods Twenty 6 -8 week male Lewis rats were divided into normal group,EAMgroup,CD40 siRNA group and siRNA group by using random number table,with 5 rats in each group.The normal rats were induced with phos-phate buffer saline in double foot pads on day 0 and day 7,while the rest 3 groups were induced with cardiac myosin protein to establish EAMmodels.The rats in CD40 siRNA group and siRNA group were respectively injected with CD40 siRNA and siRNA slow virus expression vector through the tail vein of rats on day 7.The rats were executed on 21 day after echocardiogram examination was made.The histopathologic changes were observed by using light microscope and the myocardial histopathology scores were calculated.Enzyme -linked immunosorbent assay was used to determine the levels of IL -21 and IL -35 in peripheral blood.Results (1)Except the normal group,the total incidence rate of rats of each group was 100%,and there was no rat death.(2)Compared with EAM group,the heart mass/body ratio and myocardial histopathology scores were lower in CD40 siRNA group,and the differences were significant (3.13 ±0.21 vs 3.80 ±0.29,2.22 ±0.43 vs 3.32 ±0.51,F =0.332,0.456,all P <0.05).(3)The echocardiogram showed that there was only 1 rat in EAM group with massive pericardial effusion,and there was no pericardial effusion in CD40 siRNA group.EAMgroup,CD40 siRNA group and siRNA group displayed hypertrophy of the ventricular septum and left ventricular wall,narrow heart cavity and weakening of ventricular wall motion.The left ventricular shortening rate in CD40 siRNA group was significantly higher than that in the EAMgroup[(63.34 ±11.06)% vs (38.56 ±6.98)%,F =16.080,P <0.05].(4)The peripheral blood level of IL -21 in CD40 siRNA group was lower than that in EAM group [(141.19 ±17.46)ng/L vs (157.81 ±17.58)ng/L,F =57.008,P <0.05],while its level of IL -35 was signifi-cantly higher than that in the EAMgroup [(195.96 ±18.26)ng/L vs (174.78 ±13.91 )ng/L,F =31.727,P <0.05].(5)The level of IL -21 in peripheral blood was positively correlated with myocardial histopathology scores in EAM group (r = 0.69,P < 0.05 ),but IL -35 was negatively correlated with myocardial histopathology scores (r =-0.64,P <0.05).Conclusions CD40 siRNA might relieve the myocardial inflammation and reduce the myocar-dial injury of EAMrats.The levels of IL -21 and IL -35 can partly reflect the degree of myocardial injury.The mecha-nism may be related to down -regulating the expression IL -21 and up -regulating the expression of IL -35.

OBJECTIVETo investigate the predominance ticks and the infectious status of severe fever with thrombocytopenia (SFTSV) in Penglai and Laizhou counties, Shandong province.

METHODSTwo towns with high incidence rate were selected in Penglai and Laizhou, respectively, then three villages were selected in each towns. Parasitic ticks were collected from the host skin by hand manually and free ticks manually with white cloth from the grassland, monthly, during April to December in 2011. Samples were classified by original, varieties, developmental stages, then extracted RNA, using Realtime RT-PCR to test severe fever thrombocytopenia syndrome virus, S fragments were amplified with nested PCR, then isolated virus. By neighbor joining method in the phylogenetic tree, the minimum infection rate (MIR) was used to represent the infection status of ticks in novel bunyavirus.

RESULTSA total of 3 145 ticks were collected totally from 5 categories, there were 3 048(96.92%) of Haemaphysalis longicornis, 73(2.32%) of Rhinpicephalus sanguineus, 10(0.32%) of microplus Boophilus, 9(0.29%) of Haemaphysalis campanulata, 5(0.16%) of Dermacentor sinicus, respectively. The positive rate of nucleic acid of 2 044 samples was 6.16% (126/2 044), minimum infection rate (MIR) was 4.01%, there were 122(96.83%) of Haemaphysalis longicornis, 3(2.38%) of Rhinpicephalus sanguineus, and 1(0.79%) of microplus Boophilus, MIR was 4.00%, 4.11%, and 10.00%, respectively. There were no nucleic acid positive samples in Haemaphysalis campanulata and Dermacentor sinicus. The 11 S segments were amplified in 126 positive samples, the homology of S fragment was 95.6%-99.9% with 11 strains isolated from the identified SFTS cases in local area, 3 strains isolated from animals, and 11 strains isolated from other areas. There was no significant difference among original, varieties and developmental stages.

CONCLUSIONHaemaphysalis longicornis was the predominant species in Penglai and Laizhou counties, it could be propagation medium with Rhipicephalus sanguineus and microplus Boophilus, S sequence in ticks was higher homology with virus isolated from local SFTS cases.

Objective:To investigate the clinical features of patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis misdiagnosed as mental disorder, improve the early diagnosis rate and reduce misdiagnosis.Methods:The clinical data of patients with anti-NMDA receptor encephalitis diagnosed at the First Affiliated Hospital of Zhengzhou University from 2012 to 2018 were collected. Patients misdiagnosed as mental disorders were screened out. Their psychiatric symptom characteristics, disease course characteristics, imaging and laboratory findings, treatment and prognosis were retrospectively analyzed.Results:A total of 121 cases of anti-NMDA receptor encephalitis were collected, and 43 cases of mental disorders were screened out. Sixteen of the 43 patients (37.2%) had prodromal symptoms, and all the patients had psychiatric behavioral abnormalities (100%), including 32 cases (74.4%) of seizures, 13 cases (30.2%) of decreased level of consciousness, 21 cases (48.8%) of involuntary movements, 15 cases (34.9%) of decreased memory, 8 cases (18.6%) of speech dysfunction, and 8 cases (18.6%) of other neurological symptoms (central hyperventilation, autonomic dysfunction). Memory loss was observed in 15 cases (34.9%), speech dysfunction in 8 cases (18.6%), other neurological symptoms (central hypoventilation, autonomic dysfunction) in 8 cases (18.6%), and various symptoms may appear simultaneously or successively in the same patient. Thirty-eight cases had complete resolution of symptoms or only minor physical impairment, and 5 cases had recurrent admissions with mental abnormalities and seizures. The recurrence rate accounted for 11.6% (5/43).Conclusions:The clinical manifestations of anti-NMDA receptor encephalitis are complex and varied. Most of them have mental behavior abnormalities as the first symptom, which is easily misdiagnosed as mental disorder and delayed treatment will lead to prolonged disease course and poor prognosis.

Objective:To investigate therole of serum amylase elevation in the evaluation of diabetic ketoacidosis (DKA) patients and the related factors affecting serum amylase (AMS) levels in patients with diabetic ketoacidosis.Methods:A total of 249 patients with DKA who were admitted to the First Affiliated Hospital of Zhengzhou University from November 2011 to August 2018 were selected for this retrospective study. The patients were divided into the normal group ( n=176) and the elevated group ( n=73) according to the AMS level measured by fasting venous blood samples. The enumeration data such as sex, type of DM, diabetic vascular complications, number of deaths, number of ICU monitoring, and number of acute pancreatitis (AP) after discharge were analyzed by chi-square test or Fisher test, and the measurement data such as age, pH, HbA1c, CO 2CP, Ca 2+, BUN, and Scr were analyzed by independent sample t test to compare the difference between the two groups. Results:The intensive care unit (ICU) monitoring rate was 50.7%, the median length of stay in ICU was 4 days, the median length of hospital stay was 14 days, and the median treatment cost was 28 000 yuan, which were higher in the elevated group than those in the normal group ( P<0.05). There were no significant differences in mortality, AP during hospitalization, and the probability of AP after discharge between the elevated group and the normal group ( P>0.05). The duration of diabetes, the number of previous DKA, the incidence of diabetic vascular complications, HbA1c, pH, BUN, and Scr in the elevated group were all higher than those in the normal group ( P<0.01 or P<0.05). Conclusions:DKA patients with elevated AMS are more likely to be admitted to ICU, and the length of stay in ICU, total length of hospital stay and total cost of treatment are all increased. Where as the overall mortality rate during hospitalization and the likelihood of AP after discharge are not increased.