Background and purpose:The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial has been described as practice-changing of sentinel lymph node (SLN) positive breast cancers. The goal of this study was to determine the exportability of the criteria deifned by Z0011 trial for selecting patients who are eligible for avoiding axillary lymph node dissection (ALND) after a positive sentinel lymph node biopsy (SLNB) result in China.Methods:We collected 194 breast cancer patients with positive SLNs and classiifed them into two groups according to Z0011 criteria. One group was consisted of patients who were eligible for omitting ALND and with SLNB only. The other one was ALND group. Then the patients of SLNB group were compared with cohort included in the Z0011 trial and the ALND group of this study separately.Results:Seventy-seven patients were potentially eligible for omitting ALND and 117 patients were still needed to have ALND. Compared with Z0011 cohort, the SLNB group in this research had signiifcantly more T1 stage and ER positive tumors (P<0.05). More patients in SLNB group had positive LNs with the number less than 3 and negative NSLNs (P<0.05). The ALND group had more T2 and T3 stage tumors than the SLNB group but the difference was not signiifcantly. The number of positive LNs in ALND group was higher than the SLNB group signiifcantly (P<0.05). More patients in the ALND group had positive non-sentinel lymph node (NSLN) than the SLNB group and the difference was also signiifcantly (P<0.05).Conclusion:Applied to the SLN positive patients in this study, Z0011 criteria could make patients with better prognosis and lower risk than Z0011 cohort be selected and let these patients avoiding ALND more safely.

As a new learning tool, mind mapping helps students master the learning content in a visual and radical way. This paper intro-duced the concept and method of making the mind map and analyzed the advantages of mind mapping in improving learning efficiency and its application in rehabilitation. It is pointed out that the use of mind mapping would help students to integrate new and old knowledge, to improve the ability to solve clinical problems, and to train innovative talents by stimulating students' divergent thinking. It is believed that the mind map has a broad application prospect in rehabilitation education in China.

AIM: To establish hybrid mouse embryonic stem (ES) cell line from blastocysts of the (C57BL/6J × 129/J) F1 mouse. METHODS: 3.5 days post- coitus (d.p.c.) blastocysts were cultured on mouse embryonic fibroblasts (MEFs) in the medium, after 3 - 4 days, Inner cell mass were picked up and disaggregated, then reseeded. After the ES - like colonies appeared, passaged them to give permanent ES cell lines. The pluripotent propertes of ES cells obtained were analyzed by alkaline phosphatase (AKP) activity, expression of SSEA- 1 and Oct-4, and their capacity to form teratoma. RESULTS: Two hybrid ES cell lines, SC1001, SC1002 were obtained from blastocysts of the (C57BL/6J × 129/J) F1 genotype. Most of these ES cells had a normal karyotype and an XY sex chromosome composition. The pluripotent properties of the cell lines were analyzed on the basis of their alkaline phosphatase activity, expression of SSEA - 1 and Oct - 4, and their capacity to form teratoma in severe combined immunodeficiency (SCID) mice. CONCLUSION: Two hybrid mouse ES cell lines having pluripotent properties and capacity for long - term self renewal were generated from blastocysts of the ( C57BL/6J × 129/J) F1 genotype.

AIM: To establish hybrid mouse embryonic stem (ES) cell line from blastocysts of the (C57BL/6J?129/J) F1 mouse. METHODS: 3.5 days post-coitus (d.p.c.) blastocysts were cultured on mouse embryonic fibroblasts (MEFs) in the medium, after 3-4 days, Inner cell mass were picked up and disaggregated, then reseeded. After the ES-like colonies appeared, passaged them to give permanent ES cell lines. The pluripotent properties of ES cells obtained were analyzed by alkaline phosphatase (AKP) activity, expression of SSEA-1 and Oct-4, and their capacity to form teratoma. RESULTS: Two hybrid ES cell lines, SC1001, SC1002 were obtained from blastocysts of the (C57BL/6J?129/J) F1 genotype. Most of these ES cells had a normal karyotype and an XY sex chromosome composition. The pluripotent properties of the cell lines were analyzed on the basis of their alkaline phosphatase activity, expression of SSEA-1 and Oct-4, and their capacity to form teratoma in severe combined immunodeficiency (SCID) mice. CONCLUSION: Two hybrid mouse ES cell lines having pluripotent properties and capacity for long-term self renewal were generated from blastocysts of the (C57BL/6J?129/J) F1 genotype.

Objective To compare the efficacy and toxicity of different cycles of neo-adjuvant chemotherapy for locally advanced breast cancer. Methods Seventy-five patients with locally advanced breast cancer were treated with epirubicin (Epi) plus paclitaxel (TAX, ET regimen). Two cycles were used in 39 patients (2 cycles group) and 4 cycles were used in 36 patients (4 cycles group). Results The overall response rate (RR) was 74% (29/39) in 2 cycles group and 94% (34/36) in 4 cycles group. One patient got clinically complete response (CR), 28 cases had partial response (PR),10 with no change (NC) in 2 cycles group, while 21 patients showed CR including 11 patients with pathologically complete response, 13 with PR, and 2 with NC in 4 cycles group. There was no progression to advanced stage in either groups. Axillary lymph nodes were palpable in all 75 patients before ET regimen, lymph nodes became non-palpable in 46% (18/39) cases in 2 cycles group and in 75% (27/36) cases in 4 cycles group. Toxicities including leukopenia, gastroenteric reactions were similar in the 2 groups, though arthralgia, myalgia, and neurotoxicity were more common in 4 cycles group than 2 cycles group. Conclusion Neo-adjuvant chemotherapy with ET regimen for 4 cycles were more effective than 2 cycles to down staging locally advanced breast cancer. Toxicities including arthralgia, myalgia, and neurotoxicity were more common in 4 cycles group than 2 cycles group.

OBJECTIVE:To establish the method for simultaneous determination of liquiritin and glycyrrhizic acid in Fuzi lizhong pills (condensed pills).METHODS:HPLC method was adopted.The determination was performed on WondaSil C18 column with mobile phase consisted of acetonitfile-0.05％ phosphate solution (gradient elution) at the flow rate of 1.0 mL/min.The detection wavelength was set at 237 nm,and column temperature was 35 ℃.The sample size was 10 μL.RESULTS:The linear range ofliquiritin and glycyrrhizic acid were 9.68-96.8 μg/mL(r=0.999 1)and 14.08-140.8 μg/mL(r=0.999 2).The limits of quantitation were 0.2,0.3 μg/mL,and the limits of detection were 0.1,0.01 μg/mL.RSDs of precision,stability and reproducibility tests were all lower than 2.0％.The average recoveries were 98.9％-101.2％ (RSD=0.62％,n=9),98.6％-101.5％ (RSD=1.06％,n=9).CONCLUSIONS:The method is simple and accurate,and can be used for simultaneous determination of liquiritin and glycyrrhizic acid in Fuzi lizhong pills (condensed pills).

OBJECTIVETo compare the efficacy and toxicity of two different regimens as neoadjuvant chemotherapy for breast cancer.

METHODSForty-eight patients with stage II, III breast cancer as proved by cytology biopsy, were treated with either 5-Fu, epirubicin, cyclophosphamide (FEC) or epirubicin, paclitaxel (ET) regimens for 2 cycles every 3 - 4 weeks. Clinical responses in the breast and lymph nodes were assessed after 2 cycles of neoadjuvant chemotherapy. Patients in FEC arm received combination of 5-fluorouracil (5-Fu) 500 mg/m(2) by 4-hour continuous infusion on D1 and D8, epirubicin (EPI) 50 mg/m(2) by intravenous injection on D1, and cyclophosphamide (CTX) 500 mg/m(2) by intravenous injection on D1 and D8. Patients assigned to the ET arm received EPI 60 mg/m(2) by intravenous injection on D1, paclitaxel (TAX) 150 mg/m(2) by 3-hour continuous infusion on D2. All patients were treated by operation 2 weeks later and radiotherapy was added to some.

RESULTSFor primary tumor in the breast, the overall response rate (RR) was 50.0% (12/24) in FEC arm and 79.2% (19/24) in ET arm. One patient showed clinical complete response (cCR), 11 partial response (PR), 12 no change (NC) after the FEC therapy, while 1 patient showed CR, 18 PR, 5 NC after ET therapy. There was no pathologic complete response or progressive disease, though a higher proportion of RR was observed in stage II than stage III patients in these two groups. Clinically palpable axillary lymph nodes which had been found in all 48 patients before 2 cycles of treatment, 50.0% (12/24) in the FEC patients and 66.7% (16/24) in the ET patients became in-palpable. The major toxicity, including leukopenia, gastroenteric reactions, were similar in both groups, but alopecia was more severe and arthralgia, myalgia, neurotoxicity and flushing of face were the unique features of the ET regimen.

CONCLUSIONNeoadjuvant chemotherapy with two different regimens were effective to the primary tumor and axillary metastatic lymph nodes of breast cancer, and the side effects were tolerable. Higher efficacy and more side effects are observed in ET than in FEC regimen.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Breast Neoplasms ; drug therapy ; Cyclophosphamide ; adverse effects ; therapeutic use ; Epirubicin ; adverse effects ; therapeutic use ; Female ; Fluorouracil ; adverse effects ; therapeutic use ; Humans ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Staging ; Paclitaxel ; adverse effects ; therapeutic use ; Taxoids ; Treatment Outcome

OBJECTIVETo observe the impact of mesenchymal stem cells (BMSCs) transplantation on myocardial myocardin-related transcription factor-A (MRTF-A) and bcl-2 expression in rats with experimental myocardial infarction (MI).

METHODSThirty rats were randomly divided into sham, MI and MI + BMSCs (1 × 10(6) injected into 4 infarct points immediately post coronary artery ligation) groups (n = 10 each).One week later, TUNEL was used to detect cardiomyocyte apoptosis, the myocardial expression of MRTF-A and bcl-2 was detected by laser scanning confocal microscope and Western blot. In vitro plasmid of MRTF-A and co-transfection with plasmids of MRTF-A and bcl-2 or mutated bcl-2 transfection into cardiomyocyte was applied to evaluate the relationship between MRTF-A and bcl-2.

RESULTSThe number of apoptotic cardiomyocytes in the sham group, MI group and MI + BMSCs group were (4.05 ± 1.56)%, (62.38 ± 8.41)% and (22.36 ± 6.17)%, respectively (P < 0.05). The protein expression of MRTF-A and bcl-2 in the MI group were significantly lower than those in sham group, while significantly upregulated in MI + BMSCs group (P < 0.05 vs. MI). In cultured neonatal rat cardiomyocyte, the expression of bcl-2 protein was significantly upregulated after transfection with MRTF-A plasmid, and bcl-2-luciferase activity significantly increased after co-transfection with plasmids of MRTF-A and bcl-2-luciferase, however, the positive regulatory effect of MRTF-A was abolished after transfection with mutated bcl-2.

CONCLUSIONMesenchymal stem cells transplantation can effectively reduce cardiomyocyte apoptosis in this rat MI model, and upregulate the expression of MRTF-A. Consequent up-regulated bcl-2 expression might be involved in the beneficial effects of BMSCs transplantation in this model.

Animals ; Apoptosis ; Heart ; Mesenchymal Stem Cell Transplantation ; Mesenchymal Stromal Cells ; Myocardial Infarction ; Myocardium ; Myocytes, Cardiac ; Nuclear Proteins ; Proto-Oncogene Proteins c-bcl-2 ; Rats ; Rats, Sprague-Dawley ; Trans-Activators ; Transcription Factors ; Transfection

Objective To explore the role of interleukin (IL)-38 in inhibiting inflammatory bowel disease (IBD) in children and to investigate the potential molecular mechanisms.Methods From January 2014 to October 2017,67 patients with ulcerative colitis (UC) and 115 patients with Crohn's disease (CD)admitted to Wuhan Children's Hospital were recruited,and 40 individuals with normal endoscopic findings were selected as control.Serum levels of IL-38 of IBD patients and healthy control were determined by enzyme-linked immunosorbent assay (ELISA).Immunohistochemical staining (IHC) was used to detect the expression level of IL-38,nuclear factor κB (NF-κB),phosphorylated signal transduction and activator of transcription 3 (p-STAT3),C-reaction protein (CRP) and erythrocyte sedimentation rate (ESR) in the intestinal mucosa of IBD patients and healthy controls.The extent of disease,therapeutic agents and disease activity scores (Mayo score system for UC patients,Crohn's disease activity index (CDAI) for CD patients) were evaluated.IL-38-C57BL/6 transgenic mice model was established,and dextran sulfate sodium was used to induce IBD mice model.The intestinal inflammation levels were compared between the wild type IBD mice and IL-38 transgenic IBD mice.The levels of IL-38,NF-κB and p-STAT3 in intestinal mucosa of mice of different groups were determined by IHC.The ratio of CD4 + IL-17 + T helper (Th) 17 cells in peripheral blood of mice of different groups was detected by flow cytometry.Independent sample t test,chi square test and Pearson correlation were performed for statistical analysis.Results The results of ELISA showed that the serum levels of IL-38 of UC and CD patients were (6.1 ± 1.9) ng/L and (9.8 ±2.1) ng/L,respectively,which both were lower than that of healthy controls ((16.4 ± 2.7) ng/L),and the differences were statistically significant (t =23.107 and 15.853,both P ＜ 0.05).The results of IHC indicated that the levels of IL-38 in the intestinal mucosal tissues of UC and CD patients were 0.04 ± 0.01 and 0.03 ± 0.01,respectively,which were both lower than that of healthy controls (0.18 ± 0.02),and the differences were statistically significant (t =48.186 and 69.443,both P ＜ 0.05).The levels of NF-κB and p-STAT3 of UC and CD patients were 0.150 ± 0.030,0.160 ± 0.040 and 0.130 ±0.030,0.110 ±0.010,which were all higher than those of healthy controls (0.020 ±0.003 and 0.010 ± 0.002),and the differences were statistically significant (tUC =27.273 and 23.078,tCD =23.657 and 62.684;all P ＜ 0.05).The number of patients with disease at active phase,CRP level,ESR and disease activity scores of UC and CD patients with low IL-38 expression were all significantly higher than those of patients with high IL-38 expression (x2UC =11.552,tUC =7.118,8.991 and 7.086;x2CD =5.675,tCD =9.559,9.358 and 11.268;all P ＜ 0.05).The results of Pearson correlation analysis demonstrated that the level of IL-38 in the intestinal mucosal tissue of UC patients was negatively correlated with CRP,ESR and Mayo scores (r =-0.291,-0.672 and-0.639;all P ＜ 0.05).And the level of IL-38 in the intestinal mucosal tissue of CD patients was negatively correlated withCRP,ESRandCDAI (r=-0.559,-0.471 and-0.353;allP＜0.05).The IHC results showed that the levels of NF-κB and p-STAT3 of IL-38 transgenic IBD mice were lower than those of wild type IBD mice (0.14±0.02 vs.0.32 ±0.06,0.12 ±0.02 vs.0.44 ±0.07),and the differences were statistically significant (t =6.971 and 10.767,both P ＜ 0.05).The results of flow cytometry showed that the ratio of CD4 + IL.-17+ Th17 cells in the peripheral blood of IL-38 transgenic IBD mice was lower than that of wild type IBD mice (0.030±0.006 vs.0.280 ±0.050),and the difference was statistically significant (t =12.160,P ＜0.05).Conclusions The expression level of IL-38 significantly decreases in the intestinal mucosal tissues of IBD patients,while the level of NF-κB and p-STAT3 significantly increases.IL-38 may inhibit IBD by regulating NF-κB and p-STAT3 signaling pathway to alleviate intestinal immune reaction.

Objective    To evaluate the strategy of chemoradiotherapy following endoscopic R0 resection for esophageal cancer in M3-T1b stage. Methods    There were 45 esophageal cancer patients with M3-T1b stage with endoscopic R0 resection followed by additional chemoradiotherapy from ECETC (Esophageal Cancer Endoscopic Therapy Consortium) as a trial group with 34 males and 11 females at age of 61.37±7.14 years. There were 90 patients with esophagectomy from Fudan University Shanghai Cancer Center as a control group with 63 males and 27 females at age of 61.04±8.17 years. Propensity score match (1:2) was used to balance the factors: gender, age, position, depth of invasion and lymphovascular invasion (LVI), which may influence the outcomes. Overall survival (OS) rate, relapse free survival (RFS) rate, and local recurrence rate were compared between the two groups. Result    There was no statistical difference (HR=2.66 with 95%CI 0.87 to 8.11, P=0.179) in terms of OS rate between the two groups. One, two and three years overall survival rate of patients in the control group was 93%, 86%, and 84%, respectively. Nobody died in the trial group within 3 years after surgery. The RFS rate between the two groups didn’t significantly differ (HR=1.48, 95% CI 0.66 to 3.33, P=0.389). One, two and three years RFS rate of patients in the contorl group was 87%, 78%, and 76%, respectively, while 97%, 93%, and 73% in the trial group, respectively. The local recurrence rates between the two groups didn’t significantly differ either ( HR=0.53，95%CI 0.13 to 2.18, P=0.314). One, two and three years local recurrence rate of patients in the control group was 5%, 6% and 6%, respectively, while 0%, 0% and 21% in the trial group, respectively. Conclusion    Similar outcomes are found regarding OS, RFS and local recurrence rates between the two groups. The strategy of endoscopic R0 resection followed by additional chemoradiotherapy has prospect for the treatment of esophageal cancer in M3-T1b stage. And this kind of therapy may be provided for those with risk factors or can not tolerate surgery.