Breast cancer is a group of diseases with considerable inner heterogeneity. Intrinsic subtyping has classified breast cancer into major subtypes, such as Luminal A, Luminal B, HER2-enriched, and basal-like breast carcinomas. This classification is based on the specific expression patterns of certain genes that effectively reflect each distinct biology and clinical outcome. Moreover, this classification is widely accepted and utilized. Epidemiological studies based on intrinsic subtyping shed a new light on breast cancer recognition. Traditionally validated risk factors showed substantial differences in their association with various intrinsic subtypes. The paradox of risk factors for breast cancer development generally exerting protective effects on patient survival has been observed. This phenomenon is highly likely caused by the heterogeneity among intrinsic subtypes. Future epidemiological studies on breast cancer should develop a further precise basis on the intrinsic subtypes, and this article will summarize the advances in epidemiology based on molecular subtyping of breast cancer.

Objective We tried to design a Instructor Rating Scale Identified by Nursing Students,and then evaluate its rehability and validity.Methods The original item pool was formulated by investigating 351 nursing students with convenience samphng method to develop a prehminary scale.Then it was used to investigate 273 nursing students to test its rehability and validity.Results The formal scale consisted of six dimensions,which contained 19 items.The cumative contribution rate of these dimensions was 62.30％.The Cronbach's α coefficient was 0.54,test and re-test reliability was 0.48.Conclusions The Instructor Rating Scale Identified by Nursing Students can be applied to evaluate the instructors by nursing students.

Objective To investigate the trends in incidence and mortality of esophageal cancer from 1981 to 2002 in Tianjin,China and to predict future trends and facilitate future prevention.Methods All new cancer cases registered in the Tianjin Cancer Registry between 1981 and 2002 were reviewed.Yearly age-specific,crude and age-adjusted incidence rates were calculated for males and females.Secular trends of incidence and mortality were indicated by the estimated annual percentage change(EAPC).Results A total of 8206 cases of esophageal cancer were reported in Tianjin form 1981 to 2002,with 5533 males and before 45 years,but increased rapidly after 45 years.The median age of esophageal cancer cases was 69 years,with quartile range from 62 to 75 years.The peak for age specific incidence in females was 75-80 years,which was earlier than that in males(aged 80-85).But recent data indicated that the peak age in females had increased and became similar to that of the males.The crude and age-standardized incidence rates(ASIR)of esophageal cancer decreased in last 22 years.For male and female,crude incidence decreased by 2.22% and 3.56% per year and ASIR decreased by 5.18% and 6.56% per year.The mortality of esophageal cancer decreased in the last 22 years.Conclusion The incidence of esophageal cancer decreased in the last 22 years in Tianjin,but there is little overall improvement in survival.

Objective To investigate the value of low-dose volumetric high-resolution CT (vHRCT)in children with bronchiectasis.Methods Forty-nine children with bronchiectasis were diagnosed by vHRCT.The CT manifestations and follow-up changes were observed. Results Among the 49 cases,there were 43 cases(85.7%)with cylindrical bronchiectasis,2 cases with cystic bronchiectasis(5.7%) and 4 cases with varicose bronchiectasis(8.6%).Forty-four cases with bronchiectasis were complicated with pneumonic illness,among which 9 cases with atelectasis,5 cases with pulmonary fibrotic changes and 3 cases with airway foreign body.And 5 cases were complicated with endobronchial inflammation only.The CT signs of cylindrical bronchiectasis were as follows:bronchial wall thickening in 38(88.4%), double-track sign in 29(67.4%),signet ring sign in 35(81.4%),mucus plugging in 6(14.0%),air bronchogram in 9(20.9%),and bronchi appeared within 1 cm distance from the pleura in 18 cases(41.9%).Following-up 10 cases,bronchial dilatation improved significantly in 4 cases,progressed in 2 cases,and there were 4 cases with no significant change.Conclusion vHRCT is an effective method for early diagnosis of bronchiectasis in children,which is valuable for improvement of bronchiectasis by prompt and effective treatment.

Acute nonvariceal upper gastrointestinal bleeding (ANVUGIB)is a commonly seen gastrointestinal emergency.Rockall and Blatchford scoring system are commonly used for risk stratification in ANVUGIB.Aims:To investigate the predictive values of Rockall and Blatchford scoring system for assessing the risk of blood transfusion,surgical intervention and mortality in patients with ANVUGIB.Methods:Five hundred and ninety hospitalized patients with ANVUGIB were scored by Rockall and Blatchford scoring system,respectively.Predictive values of these two scoring systems for assessing the risk of blood transfusion,surgical intervention and mortality were assessed by area under the receiver operating characteristic (ROC)curve (AUC).Results:Rockall and Blatchford scores in patients with blood transfusion,surgical intervention and died were significantly higher than those in patients without blood transfusion,surgical intervention and survived (P <0.01 ).The AUC of Rockall scoring system for predicting blood transfusion,surgical intervention and mortality were 0.785 (95% CI:0.743-0.828,P=0.000),0.765 (95% CI:0.693-0.837,P=0.000),0.835 (95% CI:0.703-0.966,P=0.005),respectively.The AUC of Blatchford scoring system for predicting blood transfusion,surgical intervention and mortality were 0.812 (95%CI:0.775-0.848,P=0.000),0.870 (95%CI:0.811-0.930,P=0.000),0.784 (95% CI:0.614-0.954,P=0.017),respectively.Conclusions:Rockall and Blatchford scoring system have high predictive value for blood transfusion,surgical intervention and mortality in patients with ANVUGIB.Rockall scoring system is better for predicting mortality,while Blatchford scoring system is better for predicting blood transfusion and surgical intervention.

Objective To investigate the in vitro effects of bone marrow mesenchymal stem cells (BM MSCs) on the replication of HBV with the participation of lymphocytes and to analyze the possible mechanism.Methods The HBV genomic DNA transfected HepG2.2.15 cell line was used to evaluate the HBV replication.Bone marrow and spleen samples were collected from BN rats for the isolation of BM MSCs and T lymphocyte cells, respectively.Five groups of co-culturing with different cells were designed in this study.The cellular activities of lymphocytes and HepG2.2.15 cells were detected at the time of 24 h, 48 h and 72 h after co-culturing by using MTT method.The levels of HBV DNA and HBV cccDNA were detected by real-time polymerase chain reaction ( PCR) .T cell subsets in co-culture were measured by using fluores-cence labeled antibodies and flow cytometry analysis.ELISA was used to detect the levels of cytokines in the supernatant of cultured cells.Results Compared with HepG2.2.15 cells group, BM MSCs+HepG2.2.15 cells and splenic lymphocytes+HepG2.2.15 cells co-culture groups, the levels of HBV DNA and HBV cccDNA were significantly decreased in splenic lymphocytes+BM MSCs+HepG2.2.15 cells co-culture group after 48 h of culture [ HBV DNA: ( 181.000 ±14.731 ) IU/ml vs ( 6270.000 ±300.450 ) IU/ml, (2564.000±231.058) IU/ml, (2433.300±302.379) IU/ml;HBV cccDNA: (4.330×105 ±0.464×105 ) IU/ml vs (11.100×105±0.375×105) IU/ml, (8.930×105±0.778×105) IU/ml, (9.850×105±0.810× 105) IU/ml;P<0.01].The secretion of IFN-γin the supernatant of co-cultured cells was negatively corre-lated with HBV DNA level, but the levels of IL-10 and IL-22 were positively correlated with HBV DNA.The ratio of CD4+/CD8+cells was increased in splenic lymphocytes+BM MSCs+HepG2.2.15 cells co-culture group.The percentage of CD8+cells showed a positive correlation with HBV DNA.Conclusion BM MSCs could inhibit the expression of HBV DNA to enhance the clearance of HBV strains.It might be possibly due to rebalancing of Tc1/Tc2 cells and regulating the expression of autocrine agents and cytokines.

Objective To estimate the value of fecal tumor M2-PK in the detection of colorectal adenoma and to evaluate its potential as a screening tool for colorectal adenoma.Methods Enzyme-linked immunosorbent assay (ELISA) was used to detect the fecal tumor M2-PK in stool samples of 65 patients with colorectal adenoma and 25 controls.At the same time,the peripheral blood tumor markers such as carcinoembryonic antigen (CEA),carbohydrate antigen (CA) 19-9,CA24-2 and fecal occult blood test (FOBT) were detected in the colorectal adenoma group.Results The detection value of fecal tumor M2-PK in the colorectal adenoma group showed a significant increase,compared with the control group((6.033±4.123) U/ml vs.(2.782±1.464) U/ml,t=-3.839,P=0.000).The highest detection value was found in the group where the diameter of adenoma was greater than or equal to 2 cm ((8.775±6.548) U/ml,t=9.635,P=0.034).The larger the diameter of adenoma,the higher the positive rate of fecal tumor M2-PK (85.7% vs.41.7% vs.29.6%,χ2=11.977,P=0.003).In the colorectal adenoma group,The positive detection rate of fecal tumor M2-PK was significantly higher than that of CEA,CA19-9,CA24-2 and FOBT (46.2% vs.6.2% vs.1.5% vs.1.5% vs.27.7%,?2=76.607,P=0.000).Conclusion Fecal tumor M2 pyruvate kinase has a good clinical value in the diagnosis of colorectal adenoma.

Objective: To analyze the incidence and secular trend of lung cancer in Hexi District, Tianjin, between 1992 and 2012. Methods: To collect the incidence data of lung cancer for residents in Hexi District between 1992 and 2012 from Tianjin Cancer Registry. The lung cancer crude incidence, age standardized incidence, proportion, age specific incidence, cumulative incidence, truncated incidence, percent change and annual percent change were calculated. The incidence and secular trend of lung cancer for male Results: Between 1992 and 2012, a total of 8 177 new cases of lung cancer were collected in Hexi District, the crude incidence was 53.66/100 000, Chinese age standardized incidence was 31.81/100 000, and the world standardized incidence was 31.74/100 000. The crude incidence and standardized incidence of patients with lung cancer in males were higher than those in females. Lung cancer ranked the top 1 among all cancers, accounting for 23.56% of all cancer cases. The cumulative incidence for age 0-64 years was 1.49%, and was 4.05% for age 0 - 74 years. The truncated incidence was 39.83/100 000 for age 35-64 years, and was 274.89/100 000 for age older than 65 years. The incidence of lung cancer increased with age after twenty years old, especially after age 40 years, reaching its peak in age 80-84 years, with incidence of 334.79/100 000. An increasing trend was observed for lung cancer incidence, from 34.99/100 000 in 1992 to 87.37/100 000 in 2012, which increased by 149.70%, and the annual percent change was 4.68%. The incidence for females increased more than males. Increasing trend was also observed for age standardized incidence, though at a lower rate. Conclusion: There is an increasing trend of the incidence of lung cancer in Hexi District, Tianjin. People aged more than 65 years is a high-risk population of lung cancer, therefor the particular attention should be paid for this population.

One 51 years old man was admitted to the rheumatology department with a history of prominent eyes, headache and blurred vision for half year. The main manifestations included retrobulbar inflammatory pseudotumor and retroperitoneal fibrosis. He was initially diagnosed as granulomatosis with polyangiitis. Prednisone and cyclophosphamide were administrated and effective. New mass of dura mater and osteosclerosis presented during follow up. Finally Erdheim Chester disease(ECD) was diagnosed by biopsy and pathological examination. Vemurafenib, a v-raf murine sarcoma viral oncogenes homolog B1 (BRAF) inhibitor, 480 mg was given twice a day. The patient′s condition is stable and still in follow-up. Although ECD is a rare histiocytosis, clinicians should pay attention to its manifestations and differential diagnoses.

OBJECTIVE:To study on the phlorotannins in Ecklonia kurome. METHODS:Silica gel column chromatography and Sephadex LH-20 column chromatography were conducted for isolation and identification of phlorotannins,and the compound structures were analyzed and identified based on physicochemical properties and spectral data. RESULTS:Totally 7 phlorotannins were isolated from E. kurome,namely Phloroglucinol(1),Eckol(2),Fucodiphloroethol G(3),Phlorofucofuroeckol A(4),1-(3′, 5′-dihydro-xyphenoxy)-7-(2″,4″,6-trihydro-xyphenoxy)-2,4,9-trihydroxydibenzo-1,4-dioxin(5),Dieckol(6)and 6,6′-bieckol (7). CONCLUSIONS:Compound 5 and 7 are isolated from E. kurome for the first time,and the study has laid a foundation for its quality evaluation.