The pathological subtypes of breast cancer can be further divided into different molecular subtypes based on their immunohistochemical staining, such as estrogen receptor (ER) , progesterone receptor (PR) , human epidermal growth factor receptor2 (HER2) and Ki67 expression, including luminal subtype, HER2 overexpression subtype and triple negative subtype. The luminal subtype is defined as ER and/or PR positive. In molecular mechanism, the expression activity of ER can regulate the expression of PR, so the expression of ER and PR is usually consistent. However, in the process of detection, some breast cancers with inconsistent ER/PR expression often appear, especially those with ER (-) /PR (+) . There is still controversy about whether such cases are true. Patients with this type of breast cancer should be subjected to ER and PR immunohistochemical staining again, and then reclassified according to HER2 status. The expression of ER/PR is closely related to the efficacy of endocrine therapy for breast cancer, so its test results will directly affect the treatment options of clinician. This article will review and discuss the research progress of the causes and mechanisms of ER (-) /PR (+) breast cancer.

Objective To investigate the effect of endoplasmic reticulum stress in renal damage caused by hyperlipidemia. Methods Forty male Wistar rats were randomly divided into two groups: normal control group (NC, n=20) and high-fat group (HF, n=20). Rats in NC group were fed with normal diet while those in HF group were fed with high-fat diet. Five rats in each group were randomly chosen in week 4, 8, 12 and 18. Serum lipid, urine protein in 24 hours and the pathological changes of renal tissues were observed; the apoptosis of renal cells was detected by TUNEL staining; the expression of GRP78 protein in the kidney was examined by immunohistochemistry. The expression of GRP78 mRNA and CHOP mRNA was examined by RT-PCR. Results Compared with those in NC group, serum lipid as well as the expression of GRP78 mRNA and protein in the kidney were increased in week 4, 8, 12 and 18 in HF group(P<0.05). In contrast, urine protein in 24 hours, the apoptosis index of renal cells and the expression of CHOP mRNA were increased in week 8, 12 and 18 (P<0.05). Conclusion CHOP pathway of endoplasmic reticulum stress is involved in renal damage caused by hyperlipidemia.

AIM: To investigate the role of endoplasmic reticulum stress in renal injury caused by hyperlipidemia and the influence effect of simvastatin. METHODS: Thirty male Wistar rats were randomly divided into three groups: rats in control group (n=10) were fed with normal diet; rats in high fat group (n=10) were fed with high fat diet; animals in simvastatin+high fat group (n=10) were fed with high fat diet and were received simvastatin 10 mg·kg~(-1)·d~(-1) by gastric irrigation. After 18 weeks, the quantitative urine protein in 24 h, the serum cholesterol and triglycerides levels were tested. The pathological changes of renal tissue were observed under optic microscope. The expressions of GRP78 and p-JNK in renal tissues were examined by immunohistochemistry. The apoptotic cells in the kidney were detected by TUNEL staining. The mRNA expressions of GRP78 and CHOP were examined by RT-PCR. RESULTS: The quantitative urine protein in 24 h, the serum lipid, the expressions of GRP78 and p-JNK proteins, the mRNA expressions of GRP78 and CHOP as well as the apoptotic cells in renal tissues were increased in high fat group (P<0.01).The quantitative urine protein in 24 h, the serum lipid, the expression of GRP78 and p-JNK proteins, the mRNA expressions of GRP78 and CHOP as well as the apoptotic cells in renal tissues were remarkably reduced in simvastatin+high fat group than those in high fat group (P<0.05). CONCLUSION: The endoplasmic reticulum stress is engaged in the renal injury caused by hyperlipidemia. The simvastatin play a role in renal protection by inhibiting the endoplasmic reticulum stress in the kidney.

Clinical data of 15 patients with penetrating injury in the distal segment of the common bile duct during biliary tract exploration were retrospectively analyzed.Nine injuries were found during the surgical procedures and successfully treated with common bile duct T tube and peritoneal drainage before discharged from the hospital (mean hospitalization time 16 days).Six penetrating wounds were found post-operatively, and underwent another operation.Four patients were fully recovered at 8 to 12 weeks, and 2 died from multiple organ failure caused by infectious shock.Our investigation suggests that for the penetrating injury in the distal part of the common bile duct, early diagnosis, proper management and effective draining may improve the survival of the patients and avoid serious complications.

Objective To explore the clinical characteristics of portal vein thrombosis(PVT) after splenocaval shunt plus devascularization in treatment of portal hypertension and find Out ways for its prevention.Methods The formation,diagnosis,treatment of PVT and variceal rehemorrhage in 110 patients with portal hypertension who received splenocaval shunt plus devascularization procedures (Combined Group)and 92 patients subjected to pericardial devascularization operation(PCDV Group) were retrospectively analyzed.Meanwhile,the effect of two procedures on PVT was compared.Results The incidence of PVT was 10.0%in combined group and 22.8%in PCDV group (P<0.05).The rebleeding rate from esophagogastric varices because of PVT in combined group was 3.6%,which was significantly lower than that of 10.8%in PCDV group(P<0.05).Conclusion Splenoeaval shunt plus devascularization is a better choice to decrease the incidence of PVT.The postoperative anti-coagulation therapy in the early stage is important for the prevention of PVT.

Objective To evaluate the effects,hemodynamies and hepatic functional reserve of a combined procedure of modified pmximal splenocaval shunt and pericardial devascularlzation (PCDV) in the treatment of portal hypertension.Methods From 1997 to 2007,a total of 255 patients with cirrhotic portal hypertension received combined (135 cases) or PCDV procedure (120 cases,) in our hospital.The clinical results were retrospectively analyzed.Changes of hemodynamics of the portal venous system were studied by Doppler color flow imaging and intraoperative free portal pressure (FPP) measurement.The hepatic functional reserve was evaluated by indocyanine green (ICG) retention ratio and functional hepatic flow(FHF).Results Postoperative mortality was 2.2% in combined group and 4.3% in PCDV group.The long term rebleeding rate was 5.5%as revealed by follow-up in combined group,which was significantly lower than that in PCDV group of 14.1%(P<0.05).The incidence of encephalopathy was 6.4%and 5.4%in combined group and PCDV group respectively(P>0.05).The 1-,3-,5-and 10 year-survival rates were 96.4%,90.0%,81.3%and 62.5% in combined group and 95.7%,86.7%,75.0%,57.1%in PCDV group.In combined group,the FPP、PVF and FHFwere(32.0±1.5)cm H_2O、(880±260)ml/min and(430±1 80)ml/min respectively,a significant decrease when compared with preoperative parameters (P<0.05),while R_(15) (30%±4%)increased (P<0.01).The similar results were observed in PCDV group postoperatively (P<0.05).Compared to PCDV group,the decrease of FPP in combined group was more significant(P<0.05),but the PVF,FHF and R_(15) were not significantly different (P>0.05).Conclusions The combined procedure is safe and effective in treatment of portal hypertension with better clinical outcome,moderate homodynamic changes and good maintenance of hepatic functional reserve.

Objective To investigate the clinical effects of a modified splenocaval shunt combined with pericardial devascularization ( PCDV ) in the treatment of gastroesophageal variceal bleeding. Methods From 1997 to 2007, 168 patients with gastroesophageal variceal bleeding caused by portal hypertension were treated at the People's Hospital of Shaanxi Province. Among all the patients, 90 received a splenocaval shunt + PCDV(combined group) and the remaining 78 received PCDV (PCDV group). Changes in intra- and postoperative hemodynamics of the portal venous system were detected by Doppler color flow imaging, and free portal pressure was measured intraoperatively. All data were analysed using analysis of variance, the paired t test and chi-square test.Results The mortality was 3% (3/90) in the combined group and 5% (4/78) in the PCDV group, with no significant difference between the two groups (x2 = 0.038, P ＞0.05 ). The postoperative rebleeding rate was 6%(5/79) in the combined group, which was significantly lower than 13% (8/60) in the PCDV group (x2 =4.824,P ＜ 0.05 ). The incidence of hepatic encephalopathy was 6% (5/79) in the combined group and 7% (4/60) in the PCDV group, with no significant difference between the two groups ( x2 = 0.072, P ＞ 0.05 ). The 1-, 3-, 5-,and 10-year survival rates were 97% (77/79), 92% (55/60), 80% (16/20) and 60% (3/5) in the combined group, and 97% (58/60), 83% (40/48), 73% (22/30) and 53% (8/15) in the PCDV group, respecitvely,with no significant difference between the two groups ( x2 = 0.731, P ＞ 0.05 ). The intra- and postoperative portal pressures in the combined group were (38.8±4.2) cm H20 ( 1 cm H2O =0. 098 kPa) and (33.1 ± 1.5) cm H2O,with a significant difference ( t = 8. 574, P ＜ 0.05 ). The intra-and postoperative portal pressures in the PCDV group were (38.9±2.5) cm H2O and (34.6±2.6) cm H2O, with a significant difference (t =6. 530, P ＜0.05 ). There was also a significant difference in postoperative portal pressure between the two groups ( t = 2. 859,P ＜ 0.05 ). The intra-and postoperative diameters of the portal vein in the combined group were (1.40 ± 0.41 )cm and ( 1.22 ± 0. 15) cm, respectively, with a significant difference ( t = 2. 608, P ＜ 0.05 ). The intra-and postoperative portal venous flows in the combined group were (1280 ±350) ml/min and (830±360) ml/min, with a significant difference ( t = 5. 668, P ＜ 0. 05 ). The intra-and postoperative diameters of the portal vein in the PCDV group were ( 1.41 ±0.32) cm and ( 1.27 ±0.32) cm, respectively, with no significant difference between the two groups (t = 1. 637, P ＞ 0.05 ). The intra-and postoperative portal venous flows in the combined group were ( 1350 ± 380) ml/min and (980 ± 290) ml/min, with a significant difference ( t = 4. 096, P ＜ 0.05 ). There was no significant difference in postoperative portal venous flow between the two groups ( t = 1.871, P ＞ 0.05 ).Conclusions The modified splenocaval shunt combined with PCDV is safe and effective with a low rate of recurrent rebleeding. The clinical outcome and rational hemodynamic changes show that the combined procedure of splenocaval shunt and PCDV is a good choice for treatment of gastroesophageal variceal bleeding.

Objective To study the safety and efficacy of damage control using percutaneous transhepatic biliary drainage (PTBD) in acute cholangitis of severe type (ACST) secondary to intrahepatic choledocholithiasis.Methods The clinical data of 8 patients who received PTBD after hospital admission followed by conventional surgery for ACST when their general condition improved were retrospectively studied.Results All patients received PTBD successfully and the amount of bile drained was 100-400 ml in the first day.The general condition of these 8 patients became better after 24 h and the total bilirubin decreased for about 25-100 mmol/L after 48 h.Three patients with a platelet count of less than 20 × 109/L showed an improved count to more than 50 × 109/L 72 h after PTBD.All patients were operated at different times after the PTBD:2 received T-tube drainage,3 T-tube drainage combined with left hepatectomy,and 3 choledochojejunostomy.Seven patients recovered uneventfully,but 1 developed hepatic failure with the total billurubin rose to more than 200 μmol/L.He was discharged home with the PTBD tube.During the waiting time of 7 days to 3 months before surgery,the tubes were kept patent and no mortality or morbidity such as bleeding,bile leakage,and peritonitis occurred.Conclusions PTBD was a safe and efficacious procedure for patients who were in a serious condition with ACST secondary to intrahepatic choledocholithiasis.It was more likely to be successful as it is minimally invasive and therefore well-tolerented.It reduced the biliary pressure,relieved the ongoing sepsis,and was a good preparatory procedure before any conventional surgery.

Objective To evaluate the effect of duodenal shunt procedures for the treatment of cholangitis caused by peripapi llary duodenal diverticulum. Methods Three types of shunt procedure were adopted i.e. Roux-en-Y gastrojejunost omy (14 cases), Billroth-Ⅱ operation (24 cases), duodenojejunostomy (4 cases). Results There was no severe co mplication nor recurrent cholangitis postoperatively in 42 patients at a follow up of 1～10 years. Four patients suffering from moderate delayed empting wer e relieved by conservative measures.Conclusion Duodenal shunt procedures are effective for the treatment of ch olangitis caused by peripapillary duodenal diverticulam.

Objective: To evaluate the diagnostic value of saline infusion test (SIT) in patients with primary aldosteronism (PHA). Methods: A total of 116 patients with PHA or essential hypertension (EH) treated in our hospital from 1994-06 to 2013-05 were retrospectively studied. The patients were divided into 2 groups: PHA group,n=72 and EH group, the patients with excluded PHA,n=44. post-SIT plasma levels of aldosterone and post-SIT ratio of aldosterone/renin activity were evaluated by ROC curve in order to analyze the diagnostic capability and the best diagnostic cut-off point. Results: The area under curve (AUC) by ROC for post-SIT aldosterone level was 0.759, the sensitivity and speciifcity were 74.6% and 63.6% respectively; AUC for post-SIT ratio of aldosterone/renin activity was 0.899, the sensitivity and speciifcity were 83.6% and 88.6% with the best diagnostic cut-off point at 111 [ng/dl:ng/(ml?h)]. Conclusion: Post-SIT plasma level of aldosterone and post-SIT ratio of aldosterone/renin activity had the diagnostic value of PHA; post-SIT ratio of aldosterone/renin activity had the higher diagnostic value of PHA.