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 discuss the clinical treatment of unstable dislocation of the sternoclavicular joint with clavicle hook plates. Methods From April 2005 to October 2007, 19 cases of unstable dislo-cation of stemoclavicular joint were treated with open reduction and internal fixation by clavicle hook plates. There were 17 cases of Grade type Ⅲ and 2 cases of Grade type Ⅱ. After open reduction and internal fixation, all patients received arthroplasty and repair of eostoclavicular and sternoclavicular ligaments. Results None had intraoperative injury to nerves and blood vessels. Follow-ups from 6 to 24 (mean, 8) months showed 16 excellent cases, 2 good cases and 1 fair case by Roekwood criteria, the good to excellent rate being 94.7%. The healing duration lasted 3 to 6 (averaging 4) weeks. No infection, sliding or loosening of internal fixation, nonunion or re-dislocation was found postoperatively. Conclusion The clavicle hook plate is an effective and advanced surgical treatment of sternoclavieular joint injuries, because its easy and mini-invasive operation can provide sturdy fixation and lead to good functional recovery.

Objective To analyze the differences of nutritional parameters and body composition in the protein energy wasting (PEW) patients on maintenance hemodialysis with or without diabetic kidney disease (DKD).Methods The patients with PEW were screened by subjective global assessment (SGA) from patients on maintenance hemodialysis from March 2014 to June 2015 in the Fourth Central Hospital of Tianjin.Anthropometric and nutritional parameters were collected before dialysis, and body composition and energy expenditure were examined by the bioelectrica] impedance method.The indexes of the two groups were compared.Results A total of 301 patients on maintenance hemodialysis (DKD 112, non-DKD 189), whose average age was (63.05±14.42) years old, were screened.Among which, 75 patients were diagnosed with PEW, and the overall prevalence rate was 24.92％, including 41 DKD cases with the prevalence of 36.61％ (41/112) and 34 non-DKD cases with the prevalence of 17.99％ (34/189).Compared with uon-PEW patients, the body mass index (BMI), hemoglobin (Hb), albumin (ALB), and total cholestero (TC) of patients with PEW were significantly lower, and C-reactive protein (CRP) were significantly higher (P＜0.05).In the DKD group, the average age of PEW onset ((59.61±13.74) years old), the maintenance dialysis time before PEW ((64± 12.50) months), ALB ((31.34±3.32) g/L), and TC ((4.17±0.95) mol/L) were all lower than those in the non-DKD group ((70.68±14.05) years old, (116.61 ±32.85) months, (32.34±4.64) g/L, (4.95±1.52) mol/L) (P＜ 0.05), respectively.The body composition results showed that muscle mass in the DKD group ((24.84±3.36) kg/ (45.32±6.95)％) was less than that of the non-DKD group ((28.53±3.75) kg/(50.67±7.28)％) (P＜0.05).Conclusions This study indicates that compared with non-DKD dialysis patients, the prevalence of PEW in dialysis patients with DKD is higher, onset age of PEW is younger, the duration of dialysis is shorter, and the muscle consumption is more obvious.

Objective To investigate the effect of therapeutic dual-plasmid HBV DNA vaccine on specific humoral and cellular immunity in cancrivorous monkey (Macaca fascicularis). Methods The eukaryotic expression plasmids encoding human IL-2 and IFN-? fusion protein (pFP) were constructed to enhance the cellular immunity of therapeutic HBV DNA vaccine (pS2.S) encoding HBV envelope middle protein in the form of dual-plasmid (pS2.S+pFP). Thirty cancrivorous monkeys were randomly divided into 5 groups (6 each) with sex rotio of 1∶1, namely the dual-plasmid DNA vaccine group in high dosage (2000?g/kg), medium dosage (660?g/kg), low dosage (200?g/kg), and EP-mediated pFP (330?g/kg) or PBS administration groups as the controls. The monkeys were vaccinated repeatedly with the dual-plasmid HBV DNA vaccine, and then the immune responses including level of serum anti-HBs and number of IFN-? secreting T-cells induced by HBsAg were examined by means of enzyme-linked immunosobent assay (ELISA) and enzyme-linked immunosobent spot assay (ELISPOT) respectively. Results Ten weeks after immunization of HBV DNA vaccine, various levels of serum anti-HBs was detected in all the monkeys of three different dose groups. Sixteen weeks after administration of EP-mediated HBV DNA vaccine, the positive HBsAg-specific INF-? T cell responses was found in 3, 2 and 3 out of 3 monkeys, respectively in the high, medium and low losage groups, and HBsAg-specific INF-? T cell responses were positive in all the animals with the respective cell count of 30.0?13.5 SFCs/3?105 PBMCs, 30.7?26.3 SFCs/3?105 PBMCs and 17.7?6.4 SFCs/3?105 PBMCs in each corresponding group at the 29th week. However, HBsAg-specific INF-? T cell responses were negative in the pFP and PBS group at the same time. Conclusion Electroporation-mediated vaccination of the HBV DNA vaccine can effectively induce both humoral and cellular HBsAg-specific immune responses in cancrivorous monkeys.

10.3969/j.issn.2095-4344.2013.26.025

0.05).Complications included 6 cases of delayed union,1 cases of severe elbow stiffness,3 cases of heterotopic ossification,2 cases of ulnar nerve palsy,in which one case recovered after 6 months,another case remained symptoms.[Conclusion]With appropriate training aids,the majority of patients have good effect.Same good clinical outcome have been achieved for treatment of intracondylar humeral fractures with either triceps splitting approach or the olecranon osteotomy approach.

Objective To explore the correlation between socioeconomic status (SES) and mortality of patients with diabetic kidney disease (DKD) on hemodialysis by using a retrospective cohort study.Methods Cases with DKD on hemodialysis in the Fourth Central Hospital of Tianjin from Jan.2006 to Mar.2010 were retrospectively reviewed.SES, including education, the average monthly income of household members, occupation type, was surveyed among all the patients.According to the SES, the patients were divided into two groups.The 1-year, 3-year, and 5-year mortality rates of the two groups were compared respectively.Relative risk (RR), attributable risk (AR) and attributable risk percentage (ARP) were calculated.Further, the relevance of SES and other variables were analyzed.Results The baseline of two groups in age, sex, duration of diabetes, kidney disease progression was consistent and comparable.In the low SES group, 1-year death RR was 1.08, AR was 1.5％ and ARP was 8.1％.Three-year death RR was 1.38, AR was 10.9％ and ARP was 27.6％.Five-year death RR was 1.57, AR was 24.5％ and ARP was 36.4％.Correlation analysis showed that SES scores were negatively correlated to body mass index (BMI), glycated hemoglobin (HbA1c) and C-reactive protein (CRP) (r=-0.542,-0.314,-0.392, P＜0.01), while SES scores were positively correlated to serum albumin (ALB), physiological function, general health, social function, emotional function and mental health scores (r=0.539, 0.243, 0.254, 0.268, 0.253, 0.255, P＜0.01).Conclusions SES is an important social-influencing factor of mortality in patients with DKD,and may have effects on long-term survival of hemodialysis patients by influencing the quality of life, glycemic control, nutrition and inflammation.

Objective To investigate the relationship between angiotensin Ⅱ ( AngⅡ) and transformation of vascular fibroblasts phenotype .Methods Eighteen rats were randomly assigned into the untreated group , mini-pump infusion of saline group and mini-pump infusion of AngⅡgroup which was used as the hypertension model .Their systolic pressure and vascular morphology were examined .The expression of catalase ( CAT ) and 4HNE was examined by immunohistochemistry .Western blotting was used to examine the expression of CAT of adventitial fibroblasts which were cultured by different incubation times and concentrations of Ang Ⅱ.Results Compared with untreated and mini-pump infusion of saline groups , the systolic pressure and carotid media thickness stained by HE of mini-pump infusion of AngⅡgroup were significantly higher (P<0.01).The results of immunohistochemistry showed that the expression of CAT ofAngⅡgroup was significantly lower than that of untreated group , however the expression of 4HNE of AngⅡgroupwas higher than that of untreated group (P<0.05).Furthermore, the results of Western blotting indicated that the effect of Ang Ⅱ on down-regulation of CAT function was in a dose and incubation time dependent manner .Conclusion AngⅡdown-regulates adventitial CAT expression and promotes fibroblasts phenotypic transformation which leads to pathological arterial vascular remodeling .

Medical treatment facility(MTF) is the equipment of diagnosis and therapy of patients in medical service.The quality of MTF is directly related to the life safety of people.So it is very important to recognize and discuss the maintainability using overall quality standpoint.This standpoint is set out to satisfy the need of patients,reflect the need ability characteristics of MTF or medical treatment service.To guarantee the quality not only designs and produces quality but also is the very important means to confirm the quality.

Objective To find a novel operative modality with sphincter preservation in the treatment of middle and low rectal carcinoma. Methods Pull through lower resection was performed on 28 rectal cancer patients. The distance between the anal verge and the lower margin of the tumor was 6～8cm(20 patients) or 8～10cm(8 patients), including 8 patients in Dukes A stage, 16 Dukes B and 4 Dukes C. The resected line from tumor distal margin was 2cm, 3cm, and 4cm, respectively. Results There was no operative death, anastomotic fistula or anastomotic stenosis in these cases. Mean follow up period was 30 months. Local recurrence was found in two cases (7.1%) 18 months after the operation, and 26 cases were cancer free till the end of the follow up. Defecation was satisfactorily controlled 8～12 weeks after the operation. Conclusions Pull through Welch procedure could meet the criterion of the radical resection of rectal carcinoma,and keep the internal and external sphincter muscles intact in the superior lower anterior resection. The normal defecationcan can maintain after the operation due to the preservation of internal and external sphincter muscles.