OBJECTIVE:To investigate clinical efficacy and safety of trastuzumab combined with neoadjuvant chemotherapy on breast cancer,and discuss its effects on the expression of HER2 protein,B7 homolog 1(B7-H1)and IL-2. METHODS:62 patients with breast cancer confirmed by pathological biopsy,whose test results of immunohistochemistry combined with fluorescence in situ hybridization(FISH)was overexpression of HER2,were selected as the research object. They were randomly divided into observa-tion group and control group with 31 cases in each group. Control group was given carboplatin combined with docetaxel neoadjuvant chemotherapy before surgery. Observation group was additionally given Trastuzumab for injection intravenously 4 mg/kg in the first week,2 mg/kg in second-eighteenth week,once a week,for consecutive 18 weeks. Modified radical mastectomy was conducted 2 weeks after chemotherapy. Clinical efficacy and the occurrence of ADR were observed in 2 groups. The expression of HER2 protein, B7-H1 and IL-2 in tumor tissues were compared between 2 groups before and after treatment. With 1-year follow-up,tumor recur-rence rates,metastasis rates and survival rates were recorded in 2 groups. RESULTS:After treatment,total effective rate of observa-tion group was 83.87%,which was significantly higher than that of control group (58.06%),with statistical significance (P<0.05);the test result of HER2 protein in lesion tissues was non-overexpression in 19 cases (61.29%) in observation group which was significantly higher than that of control group(11 cases,35.48%),with statistical significance(P<0.05);the positive expres-sion rates of B7-H1 and IL-2 in lesion tissues of observation group were significantly lower than those before treatment and control group after treatment,with statistical significance(P<0.05). There was no statistical significance in the incidence of ADR between 2 groups (P>0.05). During 1-year follow-up period,except that there was no statistically significant difference in survival rate be-tween 2 groups(P>0.05),the recurrence rate and metastasis rate of observation group were significantly lower than those of control group,with statistical significance(P<0.05). CONCLUSIONS:The application of trastuzumab combined with neoadjuvant chemo-therapy before breast cancer modified radical mastectomy can effectively improve the expression levels of HER2 protein,B7-H1 and IL-2 in lesion tissue of patients with breast cancer,promote clinical efficacy with good safety and low risk of tumor recurrence and metastasis after operation.

Objective To understand the situation of iodine of Taishan nuclear power station employees,and assess the relationships between iodine nutrition and thyroid nodule of Taishan nuclear power station in Taishan,Guangdong.Methods Totally 300 people were selected from of Taishan nuclear power station through stratifiedrandom sampling method,random urine samples were collected and urinary iodine level was tested in 2014.According to 20 to 29 years old,30 to 39 years old,40 to 59 years old,3 age groups were sampled,and each age group was 100 people.Drinking water and edible salt samples of the of nuclear power station were collected and iodine level was tested.Daily dietary intake of the staff was investigated,and daily iodine intake was calculated.Result of thyroid B ultrasonic of the employees (1 091) were studied,and detection rate of thyroid nodule was calculated.Results Totally 308 urine samples were tested,and the median urinary iodine was 193 μg/L.The difference of urinary iodine between 20-year-old group (201 μg/L) and 30-year-old group (165 μg/L) was statistically significant (P ＜ 0.05).A total of 9 iodized salt samples were collected,with an average iodine value of (24.4 ± 0.5)mg/kg.A total of 9 water samples were collected,the median of water iodine was 20.5 μg/L in 3 centralized water supply samples.The daily iodine intake per capita of the staff was 274.0 μg/d,the highest contribution among all the varieties of food was iodized salt,the second was seafood,which were 45.26 percent and 41.86 percent,respectively.A total of 99 thyroid nodules and suspicious nodules were detected in 1 091,and the prevalence was 9.07 percent (99/1 091).The prevalence of people aged 40-59 [15.6％ (22/141)] was significantly higher than those of people aged 20 to 29 [8.1％ (51/633)] and aged 30 to 39 [8.2％ (26/317)],and the differences were statistically significant (P ＜ 0.05).Conclusions The iodine nutrition of Taishan nuclear power station employees is appropriate as a whole.The detection rate of thyroid nodules is higher in people aged 40 to 59.

Objective To explore the prognostic factors of intensive care unit (ICU) patients. Methods A retrospective cohort study was conducted. The clinical data of patients admitted to ICU of Beijing Geriatric Hospital from January 2005 to December 2016 were collected. According to the prognosis, the patients were divided into death group and survival group, and the mortality trend with time and age was observed. Survival and death were treated as dependent variables, while the gender, age, reason of ICU admission, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, whether undergoing invasive mechanical ventilation (MV), invasive MV reason, duration of invasive MV, whether successful weaning, whether ICU nosocomial infection, hospital acquired pneumonia (HAP), central line-associated bloodstream infection (CLABSI), acute kidney injury (AKI) occurred, whether undergoing continuous blood purification (CBP), whether septic shock occurred, whether undergoing invasive hemodynamic monitoring or blood transfusion and length of ICU stay were used as the independent variables. First, the clinical data was analyzed by univariate analysis. Second, the independent variables influencing the dependent variable were analyzed by logistic regression analysis to screen out prognostic factors of ICU patients. Results During the study period, 1325 patients were treated, 26 patients with missing data, 1299 patients in final group, 865 patients in survival group, and 434 in death group. The proportion of men in the patients was larger (67.7%), and the age span was larger (16-105 years old). The mortality rate in different years showed no significant difference (χ2 = 16.712, P = 0.117), and with the increase of age, the mortality rate of ICU showed an upward trend (χ2 = 16.399, P = 0.022). The univariate analysis showed that ICU deaths were unrelated to gender, but associated with age, APACHE Ⅱ score, invasive MV, invasive MV reason, duration of invasive MV, successful weaning, ICU nosocomial infection, HAP, CLABSI, AKI, septic shock, whether CBP or invasive hemodynamic monitoring, blood transfusion, the reason of ICU admission and the length of ICU stay (all P < 0.05). The relevant factors with statistical difference found in univariate analysis were analyzed in logistic regression analysis, which showed that whether successful weaning [odds ratio (OR) = 0.016, 95% confidence interval (95%CI) = 0.010-0.025], and whether AKI (OR = 3.917, 95%CI = 2.331-6.582) or septic shock occurred (OR = 2.808, 95%CI = 1.604-4.915) were the dependent variables of death or survival (all P = 0.000). Regression coefficient (β value) of successful weaning was -4.155, suggesting that unsuccessful weaning patients were likely to die. The β value of AKI and septic shock was 1.365 and 1.033, suggesting that the patients with AKI or septic shock were more likely to die. Conclusions Whether the success of weaning, whether the occurrence of AKI or septic shock are independent prognostic factors for the prognosis of ICU patients. Measures for the prevention of the above three aspects could improve the prognosis of ICU patients.

Objective To study the interaction of BDNF gene C270T polymorphism and estrogen receptor alpha (ERα)gene Xba Ⅰ loci and Pvu Ⅱ loci polymorphism in late-onset Alzheimer's disease(LOAD)pathogenesis in southern Chinese Han population.Methods BNDF gene C270T locus,ERα gene Xba Ⅰ site and Pvu Ⅱ site polymorphisms were examined in 203 LOAD patients and normal controls using PCR-RFLP technique.Results There was an interaction be-tween BDNF gene and ERα gene,and BDNF gene C270T locus CC genotype and the ERa gene Xba Ⅰ locus xx genotype increased the LOAD incidance risk(OR=2.38,95%CI:1.02～5.53).Conclusions BDNF gene and ERα gene are in-teracted each other in the pathogenesis of LOAD.Patients carrying both BDNF gene C270T locus CC genotype and the ERα gene Xba Ⅰ locus xx genotypes might have an increased risk for LOAD.

Objective To investigate the characteristics of delirium after cerebral infarction in elderly demented patients.Methods40 elderly demented patients with delirium after cerebral infarction were assessed with delirium score scale(DSS),mini-mental state examination (MMSE) during delirium and after delirium disappeared respectively.ResultsThe prominent symptoms from DSS as delirium were disturbance in sleep-awake cycle,speed of onset of behavior change,incoherent thought process,abnormalities of orientation,and misinterpretation of surroundings.The disturbance of sleep-awake cycle and speed of onset of behavior change recovered dramatically as delirium disappeared,however,the abnormalities of orientation and misinterpretation of surroundings mildly improved.The items with lower scores from MMSE as delirium were abilities of attention and calculation,abilities of recall,time disorientation,and three step language orders.The function of language from the items of MMSE improved very well as delirium disappeared,especially the three step language orders,however,the abilities of recall,abilities of attention and calculation,time disorientation mildly improved.ConclusionDetermination of the clinical features of delirium following dementia is helpful to distinguish the delirium from dementia.

Objective:To observe the morphological changes of the sylvian fissure on the transthalamic section of fetal brain at 20-32 weeks, and grade the fetal sylvian fissure development by means of a simple scoring system and explore its clinical feasibility.Methods:From September 2018 to June 2020, 487 normal single fetuses of 20-32 weeks were examined in Shenzhen Maternal and Child Health Hospital Affiliated to Southern Medical University. The sylvian fissure maturation was analyzed on the transthalamic section of fetal brain at 20-32 weeks and was graded from 0 to 5: un-visualized (grade 0), shallow arc (grade 1), obtuse-angled platform (grade 2), right-angled platform (grade 3), acute-angled platform (grade 4), and closed operculum (grade 5). The pregnancy outcomes and gestational age were recorded.Statistical analysis was performed by SPSS 20.0 software using box plot, Mann-Whitney U test, Weighted Kappa coefficient. Results:Left sylvian fissuer grades were obtained in 280 fetuses and right sylvian fissure grades were obtained in 247 fetuses. The fetal sylvian fissure maturation at 20-32 weeks was graded from 0 to 5, which increased with advancing gestation. Grade 0 only appeared in 3 fetuses at 20 weeks, and 99.4% fetuses at 20 weeks had grade ≥1. Grade 1 appeared in 20-22 weeks, grade 2 in 20-25 weeks, grade 3 in 22-26 weeks, grade 4 in 25-32 weeks, and grade 5 in 27-32 weeks. Box-plot and Mann-Whitney U test showed that gestational week distribution of sylvian fissure at all grades was symmetric on both sides ( P>0.05). The Weighted Kappa coefficients were 0.857(95% CI=0.750-0.957) and 0.939 (95% CI=0.859-1.000), respectively, with strong consistency regarding inter- and intra-observer agreements. Conclusions:Fetal sylvian fissure maturation at 20-32 weeks can be evaluated by means of a simple scoring system with symmetrical grading of both sides.

Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.

Objective To study the relationship of the tibial plateau subchondral trabecular bone (STB) microstructure and the cartilage degeneration with the lower limb alignment based on individual trabecula segmentation (ITS) and histology analysis in knee osteoarthritis (OA). Methods Hip-knee-ankle (HKA) angles were measured on the full-length lower extremity films of patients before total knee arthroplasty (TKA). The tibial plateau excised from the TKA were collected for micro-CT scanning and ITS analysis. The cartilage degeneration was evaluated by histology. The relationship between the HKA angle and the changes in microstructural parameters of STB and cartilage degeneration were analyzed. ResultsThe plate, rod and axial bone trabecular volume fraction (BV/TV, pBV/TV, pBV/TV), ratio of trabecular plate versus rod (P/R), plate trabecular number density (pTb.N), plate trabecular thickness (pTb.Th), trabecular plate surface area (pTb.S), trabecular rod length (rTb.L), and plate-plate and plate-rod junction density (P-P Junc.D, P-R Junc.D) of the subchondral bone of the tibial plateau were significantly related to the cartilage degeneration OARSI score and the HKA angle. The greater the deviation of the lower limb alignment, the greater the number of subchondral trabeculae, the thicker the trabeculae, the greater the bone mass, the stronger the connectivity, especially the plate trabeculae on the affected side of tibial plateau, and the higher the OARSI score of cartilage degeneration. Conclusions Abnormal lower limb alignment may cause abnormal microstructure of the plate and rod STB of the tibial plateau by changing the stress distribution of the knee, especially the significant increase and thickening of the plate trabecular and axial trabecular bone, which may be an important risk factor that further aggravates the degeneration of articular cartilage and the progress of OA. Therefore, lower limb alignment correction with surgical intervention and improving STB with bone metabolism agents may efficiently contribute to preventing cartilage damage and mitigate OA progression.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic is a global public health crisis, which elicits psychological problems in different population This study is to investigate the impact of COVID-19 on mental health in the front-line staff. METHODS: Patient Health Questionnare-9 (PHQ-9), Self-Rating Anxiety Scale (SAS), and Fatigue Self-assessment Scale (FSAS) were used to assess the depression, anxiety, and fatigue in front-line staff. RESULTS: The detection rates of depression, anxiety, and fatigue were 49.1%, 21.8%, and 76.0% among the front-line staff. The rates of depression, anxiety, and fatigue in community workers were higher than those in medical workers and other occupational staff (<0.01). The PHQ-9 of front-line staffs was negatively correlated with age, family income, family members' support, satisfaction of service objects, and sleep quality (all <0.01), while positively correlated with education level, fatigue, fear of pneumonia, and the duration of daily attention to the COVID-19 (all <0.01). SAS was negatively correlated with age, family income, family support, satisfaction of objects service, and sleep quality (all <0.01), while positively correlated with gender, fatigue, fear of pneumonia, and duration of daily attention to the COVID-19 (all <0.01). CONCLUSIONS The front-line workers should manage work and rest time reasonably to adjust their negative mood and fatigue. The government and the society should pay more attention to the psychological state of the front-line staff, particularly for the staff working in the community or villages and towns in preventing the COVID-19 pandemic. Thus, front-line staff can be obtained mental intervention or be taken a rest from the high-intensive work.
Anxiety ; diagnosis ; Betacoronavirus ; Coronavirus Infections ; prevention & control ; psychology ; Depression ; diagnosis ; Fatigue ; diagnosis ; Health Personnel ; psychology ; Humans ; Mental Health ; Pandemics ; prevention & control ; Pneumonia, Viral ; prevention & control ; psychology