Pregnancy associated breast cancer(PABC) is a special kind of breast cancer,it is difficult to diagnose at early stage since the mammary epithelial cells are actively proliferative.Whether pregnancy will affect the biological behavior of breast cancer and how the treatment strategy for the patients with PABC impact on the outcome in terms of side effects,response,etc,those factors have to be taken into special consideration.The standard management of PABC still remain controversial.This article summarized the studies on PABC and discusses the advances in the management of the disease.

Ankylosing spondylitis (AS) is a chronic rheumatic disease involving the spine and sacral hip.AS is the prototype disease of seronegative arthritis of the spine.Besides the violations of the spine,AS can also lead to violations of the peripheral joints,even the eyes,intestine,aortic root,and other tissues and organs.The pathogenesis of AS has remained unclear.AS,a genetic disease,is influenced by the genetic and environmental factors.Studies have suggested that HLA-B27 is the most critical genes to AS,and forming three kinds of hypotheses associated with HLA-B27.This paper reviews the molecular genetics and pathogenesis of AS.

Tumor suppressor CYLD is a deubiquitination enzyme that could regulate NF-?B and JNK signal pathways by deubiquitinating TRAFs,NEMO,Bcl-3 and p53,and in turn regulating the cell cycle and apoptosis.Loss or deficiency of CYLD would lead to the development of skin tumor,including multiple familial trichoepithelioma(MFT),familial cylindromatosis(FC),Brooke-Spiegler syndrome(BSS).Cancers like uterine cervix,kidney,and colon and hepatocellular carcinoma are related to the down-regulation of CYLD.

Objective To investigate infection rate of human papillomavirus as well as the correlation between cervical precancerous lesions and co-infection of human HPV,herpes simple virus-2 (HSV-2) and cytomegalovirus (CMV) in Chinese women of childbearing age in Kunming,Yunnan province.Methods A total of 2128 women (18-24,25-34,35-49 years of age),who had healthy care examination in our institute from January 2010 to March 2011,were selected prospectively in this study.The infection of HPV,HSV-2 and CMV were detected by real-time fluorescence quantitative polymerase chain reaction (FQ-PCR) and cervical precancerous lesions were determined by the ThinPrep liquid-based cytology test (TCT).Results The overall infection rates of high risk HPV (HR-HPV),HSV-2,CMV were 11.04％(235/2128),3.52％ (75/2128) and 5.26％ (112/2128),respectively.The HR-HPV infection rates in groups of Negative for Intraepithelial Lesion or Malignancy (NILM),Atypical Squamous Cells of Undetermined Significance (ASCUS),Low grade Squamous Intraepithelial Lesion (LSIL),High grade Squamous Intraepithelial Lesion(HSIL),and Squamous Cell Carcinoma (SCC) were 4.29％ (82/1912),55.93％ (66/118),84.62％ (44/52),93.19％ (41/44) and 2/2,respectively.HR-HPV infection rates was increased with the development of cervical lesion (r =0.644,P =0.000).No significant difference on the infection rates of HR-HPV and HSV-2 was identified between different age groups (x2 =2.979,P =0.226; x2 =0.798,P =0.671).The peak age groups for CMV infection (7.62％) were 18 to 24 years old and the infection rates of CMV decrease with age.No significant difference of HSV-2 and HR-HPV coinfection was found between the TCT-abnormal (3.24％,7/216) and control groups (2.41％,46/1912,x2 =0.557,P=0.455),and no relationship was found between HSV-2 and HR-HPV infection groups (OR =0.56,95％ CI:0.17-1.82).The infection of HR-HPV were related significantly with CMV infection (OR =3.14,95％ CI:1.25-7.86).Conclusion HR-HPV infection appears to be the key risk factor for cervical cancer and synergistic interaction may occur between CMV and HPV infections in the development of cervical lesion.

Objective To study the therapeutic effect of three dimensional valve prosthetic ring treatment of tricuspid incompetence at the same time in the replacement of mitral valve in patients with rheumatic mitral valve disease combined with tricuspid incompetence.Methods Eighteen patients with rheumatic mitral valve disease combined with tricuspid incompetence were given three dimensional valve prosthetic ring treatment of tricuspid incompetence at the same time in the replacement of mitral valve as treatment group.The same period 18 patients selected as control group,they were given De Vega purposes banding surgery at the same time in the replacement of mitral valve.The index of operation and echocardiogram after 2 weeks and 6 months were observed and compared.Results Two groups of patients were discharged.Right atrium transverse diameter,right ventricle transverse diameter and tricuspid regurgitation by ultrasonic examination after 2 weeks and 6 months were significantly improved,there were statistical differences (P ＜ 0.05),and the indexes in treatment group were significantly better than those in control group,there were statistical differences (P ＜ 0.05).Conclusion Three dimensional valve prosthetic ring in the treatment of tricuspid incompetence is safe and effective.

Xenotransplantation can probably overcome the critical shortage of human organ donors for clinical transplantation.Recently,research progresses in the biology of xenograft rejection and zoonotic infections,and the generation of α1,3-galactosyltransferase-deficient pigs have moved this approach closer to clinical application,but immunological rejection is also the primary barrier in the study of xenotransplantation.This review sumarries the research progress of immunological rejection of xenotransplantation,providing some advices for the future of clinical xenotransplantation.

Objective To observe the bipolar radiofrequency ablation maze procedure (BRAMP) combined with heart valve replacement for rheumatic heart disease (RHD) complicated with atrial fibrillation (AF), and discuss the curative effect of the new operation method. Methods Fifteen patients with RHD complicated with AF were treated with heart valve replacement and BRAMP (treatment group). At the same time, 15 patients with RHD complicated with AF were only heart valve replacement without BR AMP(control group). Results Treatment group were all cured, and they had the sinoatrial rhythm after operation.Followed up 6 months, 14 patients maintained sinus rhythm,one had AF occasionally. In control group, 13 patients had AF after operation,2 patients had the sinoatrial rhythm after operation, but they tumed to AF one or two days later,and amiodarone hydrochloride had no effect to them. The two groups had obvious differences in the length of left atria, the length of left ventricle, the size of the heart, the function of the heart and LVEF before and after operation (P ＜ 0.01 or ＜ 0.05). But in treatment group, the length of left atria and the size of the heart had obvious difference after operation compared with control group [ (31.06 ± 2.28 ) mm vs. (36.16 ±2.23) mm,t = 11.645,P =0.002; (50 ±9)% vs. (56 ± 10)% ,t =8.052,P =0.008].Conclusion Compared with the operation that heart valve replacement without BRAMP,BRAMP is simple and little, should be promising.

The shortage of organs and cells from the donors continues to restrict allotransplantation.To carry out the xenotransplantation of pig as the donor is a very important method to alleviate the problem.At present,the organs of pigs (such as islet cells,neurons,liver ceils and cornea) have been initially used in clinical practice.However,significant barriers to be overcome before pig organ xenotransplantation can become a clinical therapy because of the immune and physiological disorders.With pigs that express one or more human thromboregulatory or anti-inflammatory genes being developed,the research of the xenotransplantation has made significant progress,the survival time is logner,at the same time,risk of cross-infection between species is smaller.However,immune rejection and physiological obstacles still prevent organ xenotransplantation from clinical application.This review will draw attention to the latest progress of the xenotransplantation,and provide some references for researchers.

Objective To observe and analyse the application effect and value of problem based learning (PBL) combined evidence-based learning (EBL) in emergency medicine clinical teaching.Methods A total of 53 clinical medicine students were selected.The combined teaching method was applied in emergency clinical teaching.After the end of the teaching,the teaching effectiveness survey and theory test of the combined teaching group was performed,and the theory test scores was compared with the traditional teaching group.Results The combined teaching method could stimulate learning enthusiasm,improve learning efficiency,the abilities of selfstudy,literature retrieval,and the ability to analyze and solve problems.77.4％ of students thought this new teaching method had good application value in clinical teaching.Furthermore,the excellent rate of the theory test scores combined teaching group was better than traditional teaching group (41.5％ vs 15.6％,x2 =7.868,P =0.007).Conclusions The PBL joint EBL pedagogy can overcome diadvantages of tradional teaching and provide higher interest,ability of self-study as well as higher teaching quality of the medical students.It will be worth to spread in medical clinical teaching.

Objective To investigate the epidemiological situation and the mode of inheritance of ankylosing spondylitis (AS).Methods The AS prevalence investigation was carried out from three different areas in Shandong Province to investigate the incidence of the 80 patients' family members of sick group and calculate the heritability of AS.Results After the investigation and calculation we found the incidence of primary relatives was 7.23％,the heritability was 85.94％,the incidence of secondary relatives was 0.94％ and the heritability was 57.4％,the incidence of thirdly relatives was 0.39％,the heritability is 36.2％,the average heritability among primary,secondary and thirdly was 68.47％ ± 1.64％.Separation ratio was 0.088 9.Conclusion AS is a polygenic disease,its average heritability was 68.47％ ± 1.64％ and separation ratio is 0.088 9.By this research,the incidence risk of AS patients' pedigree offspring can be assessed,then strengthen protective factors to reduce the incidence of the disease to provide the basis for eugenics.