Objective To investigate the significance of intensity modulated radiation therapy(IMRT)for spinal metastases during different target areas setting and evaluate the efficacy of pain relief before and after radiotherapy. Methods Forty-four cases of spinal metastases were treated with intensity modulated radiation therapy, including 18 males and 26 females; aging from 40 to 68 years with a mean of 56 years.Frankel grade before treatment: stage A in 2 patients, B in 2, C in 3, D in 3, E in 34. The target area was determined according to preoperative imaging, CT localization before radiotherapy and different anatomical characteristics of spinal cord segments. And then the intensity modulated radiation therapy was performed by means of 5-field irradiation. Prescription dose: 30-56 Gy, the average 40.5 Gy, the median dose of 40 Gy, 2-3 Gy/times, 5 times/week. Before and after radiotherapy for pain relief in patients, neurological function of spinal cord were compared and comprehensively evaluated. Results Among 44 patients undergone pain intensity modulated radiation therapy, 21 patients achieved complete remission, 17 achieved partial remission and 6 achieved minor effect, with a relief rate of 86.4% (38/44). Pain rating before treatment was not correlative with the state of pain relief. Evaluation of the effect of radiotherapy showed complete remission in 4 cases and partial remission in 33, no change in 7, with an efficiency rate of 84.1%(37/44). There was no relationship between pain relief with implant nails and implant bone cement. Ten patients with different degrees of neurological impairment before treatment were improved in Frankel grade after treatment. Conclusion IMRT can improve pain in patients with metastatic spinal tumors, and nerve dysfunction and other symptoms, which was not easy to result in radioactivity spinal cord and nerve injury.

Purpose To study the clinicopathologic features and differential diagnosis of primary mucosal melanoma of the nasal cavity (PMMNC).Methods 17 cases of PMMNC diagnosed from January 2003 to September 2016 were studied by clinical pathological analysis and immunohistochemical staining,and relevant literatures were reviewed.Results 73％ of the PMMNC was characterized by unilateral nasal congestion and intermittent epistaxis and 61％ of the PMMNC occurred in the nasal septum and nasal side wall.Microscopically,the organizational structure and morphology were complex and diverse,which had several cell types including epithelioid cell type (6cases,35.3％),spindle cell type (3 cases,17.6％) and snall cell type (5 cases,29.4％),the other 3 cases (17.6％)were mixed cell type.Mitotic activity and tumor necrosis were more likely to be seen in PMMNC,among other clinicopathological features with a small amount of fibrous stroma and melanoma and rich blood vessels.The immunohistochemical study showed that the positive rate of S-100 and HMB-45 were both 93.8％(15 cases) and those of Melan-A and vimentin were both 87.5％ (14 cases),while CK and EMA were both negative (16 cases).Conclusion PMMNC is a rare disease and the phenotype of S-100,HMB-45,Melan-A and vimentin are useful for diagnosis of PMMNC.

Objective Gambogic acid ( GA) can suppress the growth of multiple tumor cells , including gastric carcinoma , hepatoma , hematologic neoplasms and breast carcinoma , but there have been few reports about its effect on urologic neoplasms .This study was to investigate the possible mechanisms of GA inducing bladder cancer cell apoptosis and cell cycle arrest . Methods We cultured human bladder cancer BIU8-7 cell lines in vitor and treated the cells in the logarithmic growth phase with isotonic saline solu-tion (negative control)or GA at the concentrations of 1.0, 2.0, and 3.0μmol/L, respectively.We determined the expression of the Caspase-3 protein in the tumor tissue using the immunohistochemical S-P method and detected GA-induced apoptosis of the bladder cancer cells and cell cycle changes by flow cytometry . Results The expressions of the Caspase-3 protein were 4.28 ±1.86, 5.03 ± 0.78, and 6.47 ±1.31 in the 1.0, 2.0, and 3.0μmol/L GA groups, respectively, significantly higher than 2.13 ±1.27 in the nega-tive control (P<0.05).Flow cytometry showed a gradual decrease of the cells in the G 0/G1 phase and a gradual increase in the G2/M phase , but no obvious change in the S phase . Conclusion Gambogic acid can promote the apoptosis , arrest the cell cycle , and in-hibit the proliferation of bladder cancer cells by increasing the expression of the Caspase -3 protein.

Objective To explore the clinicopathological features and diagnosis of adenoid cystic carci noma of the breast (ACCB).Methods Clinical data of 3 cases of ACCB were collected and followed up to observe the clinical pathological features.Immunohistochemistry was used to determine the immune phenotype.Results All the 3 cases were female,aging from 55 to 72 years old (61 years old as the average).The tumors were found in subareolar region well-circumscribed.ACCB was characterized by the presence of a dual cell population of luminal and basaloid cells arranged in cribriform and tubular-trabecular patterns.On immunohistochemical staining,the myoepithelial cells expressed SMA,CK5/6,P63,CD117 and the glandular epithelium cells were mostly positive for CK18,EMA,CK7,while no expression of ER,PR,HER-2,CD10 was observed.Conclusions ACCB is a rare neoplasm with a triple-negative,basal-like phenotype,but exhibits an indolent clinical behavior.The diagnosis can be worked out by evaluation of clinical characterstics,histological and immunohistochemical features.

Objective To identify the association of oxygen saturation of arterial hemoglobin (SaO2) with late-onset hypertension in the Chinese Han population located in the Daxinganling area.Methods A total participants were selected by convenience sampling methods from the Daxinganling area.All data were collected from each person by the questionnaire record of physical examinations as well as biochemical index measuring.SaO2 was noninvasively measured with finger pulse oxymetry,the reported SaO2 was the average of three readings taken 10 seconds apart.Results There were significant differences for SaO2 within the population of individuals,the mean SaO2 values was 97.71%±6.14%,with range from 88% to 100%.There was association of SaO2 with sex,BMI and age.SaO2 level declined with BMI and age increasing.Particularly,it was found that the risk increasing to hypertension was marked association with SaO2 rapid drop.During the period from 40-50 years of age,SaO2 declined from 97.85% to 97.64%,The risk to hypertension increased more than 10 times(P<0.001).That implicated hypoxia mightinvolve in the etiology of hypertension.Conclusions The preliminary results demonstrated the rapid decline of SaO2 with lapse of age may be one of the major risk factors to hypertension,it may be helpful to explain late-onset hypertension to some extent at least.

Objective To investigate the expression and significance of CD68,E-cadherin and transforming growth factor-β1 (TGF-β1) in breast cancer.Methods Immunohistochemistry was used to detect the expression of CD68,E-cadherin and TGF-β1 in breast cancer tissues.The relationship between the expression of proteins with the clinicopathological parameters and the recurrence of breast cancer was analyzed.And the correlation among the three proteins was also analyzed.Results The positive expression rate of CD68 and E-cadherin was 70.4％ and 72.6％,respectively,which was significantly higher than that in adjacent tissues(CD68:x2=44.278,P=0.000;TGF-β1:x2=121.529,P=0.000).The positive expression rate of E-cadherin in breast cancer was 29.1％,which was significantly lower than that in adjacent tissues(x2=244.965,P=0.000).The expression of CD68 protein was closely related to clinical stage (x2=11.720,P=0.003),lymph node metastasis (x2=9.394,P=0.002) and ER status (x2=5.204,P=0.023).The expression of E-cadherin protein was significantly correlated with the histological grade(x2=6.561,P=0.038) and lymph node metastasis(x2=6.892,P=0.009),and the expression of TGF-β1 protein was significantly correlated with the histological grade(x2=6.427,P=0.040) and ER status(x2=5.755,P=0.016) of patients.The three proteins were all significantly related to the 5 year recurrence of breast cancer (CD68:γ=0.152,P=0.021;TGF-β1:γ=0.157,P=0.017:E-cadherin:γ=-0.145,P=0.028).The expression of CD68 protein was negatively correlated with E-cadherin protein (γ=-0.151,P=0.022),and positively correlated with the expression of TGF-[β1 (γ=0.200,P=0.002).E-cadherin protein was negatively correlated with the expression of TGF-β1 protein(γ=-0.143,P=0.031).Conclusion CD68 positive cells (tumor associated macrophages,TAMs),E-cadherin and TGF-β1 may be involved in the progression of breast cancer,detection of the expression will provide the theoretical basis and guidance for the clinical pathological diagnosis and treatment of breast cancer.

Objective To explore the application and effect of Quality Control Circle (QCC) in improving the overall quality of new nurses.Methods Totally 6 QCC teaching activities were conducted in 6 pilot departments throughout Suqian Hospital of TCM, which involved 31 new nurses as an observation group, while another 46 new nurses from other departments received the traditional one-to-one teaching model as a control group for 6 months. Their comprehensive competency composed of theoretical knowledge, practical skills and on-site reply examined by the steering group from the Nursing Dept. was compared, in addition to their average core competency score measured with Competency Inventory for Registered Nurse (CIRN).Results The 6 QCC activities for the observation group showed better scores, and the new nurses in this group had better theoretical knowledge, practical skills, on-site reply as well as core competency scores than the new nurses in the control group (P<0.01).Conclusions The QCC teaching model can improve new nurses' theoretical learning, practical ability and core competency and contribute to their better comprehensive quality, thus worthy of further promotion in clinical practice.

Objective:To investigate the diagnostic value of GATA binding protein 3 (GATA3) , mammaglobin (MGB) and gross cystic disease fluid protein-15 (GCDFP-15) in breast cancer.Methods:Immunohistochemistry was performed to detect the expression of GATA3, MGB, GCDFP-15, estrogen receptor (ER) , progesterone receptor (PR) , human epidermal growth factor receptor 2 (HER2) and Ki-67 in breast cancer. The breast cancer was divided into primary/metastatic breast cancer, hormone receptor positive/negative, or different molecular types of breast cancer according to the tissue origin and immunophenotype. The positive rates of GATA3, MGB and GCDFP-15 were statistically analyzed.Results:The positive rate of GATA3 in primary/metastatic breast cancer (92.5%; 94.25%) was significantly higher than that of MGB (42.11%; 29.17%) and GCDFP-15 (55.77%; 31.34%) ( P<0.01) , and GATA3 had better sensitivity for evaluating the tumor of unknown origin, especially in malignant hydrops. In addition, the positive rate of MGB and GCDFP-15 in hormone receptor negative and triple negative breast cancer was low, which further increased the difficulty of diagnosis of these two kinds of metastatic breast cancer. However, the positive rate of GATA3 in hormone receptor negative (90.38%) or triple negative breast cancer (85.29%) was significantly higher than that of MGB (20.00%; 5.00%) and GCDFP-15 (35.09%; 33.33%) ( P<0.01) , suggesting that it had great potential diagnostic value in hormone receptor negative and triple negative metastatic breast cancer and was a specific marker superior to MGB and GCDFP-15. Conclusion:GATA3 has a higher diagnostic value than MGB and GCDFP-15 for the assessment of tumors of unknown origin, especially in malignant hydrops, or breast cancer with an immunophenotype of hormone receptor negative and triple negative breast cancer.

OBJECTIVEThe survey will reveal current status of subclinical vitamin A deficiency (SVAD) and explore its affecting factors in children of China.

METHODSTotally 8 669 children aged under 6 years were randomly selected from 14 provinces for clinical examination, health and dietary questionnaire and serum level of vitamin A measurement with fluorescence method. The cut-off value for SVAD was defined as

RESULTSPrevalence of SVAD was 11.7% and that of suspected SVAD 39.2% in all subjects, which decreased with the increase of gross domestic product, average annual family income, mother's schooling and children's age. Prevalence of SVAD and suspected SVAD higher in rural areas (15.0%) than in urban areas (5.2%), and higher in children with a minority mother (22.6%) than in those with a Han nationality mother (8.7%). Prevalence of SVAD and suspected SVAD was higher in children whose blood samples were collected within one week in-taking vitamin A-rich food (12.6%-22.6%) than those in-taking vitamin A daily (4.1%-10.0%), and higher in children suffering from respiratory infection, fever and diarrhea two weeks before their blood collection (15.2%-20.3%) than in those without those diseases (10.1%-11.1%). Logistic regression analysis showed that poor family economic status, living in rural areas, children with a minority mother, younger age, no-dairy milk products intake, and respiratory infection and fever all were risk factors for SVAD.

CONCLUSIONSMore than half of children under six years old in China (50.9%) had vitamin A nutrition problem. Varied factors played roles to different extent in SVAD in children.

Child ; Child, Preschool ; China ; epidemiology ; Female ; Humans ; Infant ; Male ; Prevalence ; Vitamin A ; blood ; Vitamin A Deficiency ; epidemiology ; etiology

Objective:To explore the status and influencing factors of incontinence-associated dermatitis among elderly inpatients in 52 hospitals nationwide, and to analyze the nursing of elderly inpatients with incontinence, so as to provide a reference for clinical intervention.Methods:On March 31, 2021, convenience sampling was used to select 14 675 elderly inpatients from 52 hospitals across the country as the research object. The self-designed Incontinence-associated Dermatitis Questionnaire for Elderly Inpatients was used to collect general demographic data, health status, incontinence, and skin nursing. Binomial Logistic regression was used to investigate the influencing factors of incontinence-associated dermatitis in elderly inpatients.Results:Among 14 675 elderly inpatients, the prevalence rates of xerosis cutis, incontinence and incontinence-associated dermatitis were 38.78% (5 691/14 675) , 11.06% (1 623/14 675) and 1.91% (280/14 675) , respectively. The prevalence of mild, moderate and severe incontinence-associated dermatitis were 1.27% (186/14 675) , 0.55% (81/14 675) , and 0.09% (13/14 675) , respectively. Among the nursing of 1 623 elderly inpatients with incontinence, the items with low implementation rate were the use neutral lotion to clean skin (14.17%, 230/1 623) , use of skin protectant after moisturizing (17.68%, 287/1 623) , moisturizing after cleansing the skin (28.90%, 469/1 623) . The results of binomial Logistic regression analysis showed that xeroderma, fecal incontinence, urinary and fecal incontinence, ≥2 kinds of combined medication, and hospital stay >30 days were risk factors for incontinence-associated dermatitis in elderly inpatients.Conclusions:The risk factors of incontinence-associated dermatitis in elderly inpatients mainly include xerosis cutis, type of incontinence, ≥2 kinds of combined medication, and hospital stay >30 days.