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 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.

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 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.

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 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.

Objective To explore the nutritional risk factors in patients with chronic hepatitis C (CHC), who have been accepted pegylated interferon (IFN) and ribavirin (RVB) therapy (PR). Methods A total of 175 CHC patients treated with PR were included in this study. Data of heights, body weights, and calculated body mass index (BMI) were recorded in patients. At the same time, patients were evaluated nutritional risk with Nutritional Risk Screen 2002 (NRS 2002), and divided into risk group (n=35) and non-risk group (n=140). Results There were significant differences in age, HCV genotype (1b type and not 1b), clinical type (CHC/cirrhosis), the length of treatment time and the tolerance degree for PR therapy between two groups (P<0.05). Logistic regression analysis showed that age (OR=16.068,β=2.777), IFN dosage (OR=3.096, β=1.130), RVB dosage (OR=3.382, β=1.219) and clinical type (OR=5.092, β=1.628) were nutritional risk factors. The HCV genotype (OR=0.384; β=-0.957) was protective factors for nutritional risk. Conclusion There is higher occurrence rate of nutritional risk for CHC patients accepted PR therapy. The dependant nutritional risk factors are advanced age, intolerance for PR therapy and cirrhosis associated CHC. HCV without genotypes 1b is not a nutritional risk factor.

Aim To study the effects of Dicliptera chinensis polysaccharide(DCP)on alcoholic fatty liver disease(AFLD)in rats based on anti-inflammation and antioxidation.Methods 60 rats were randomly divid-ed into six groups:control group,model group,silybin group and DCP of high,medium and low dose groups. The control group was fed with normal diet, other groups were fed with high sugar and high fat diet,and given 5% alcohol 5 mL·kg-1 by gavage.The alcohol consistency increased 5%every week until AFLD mod-els in rats were made after 7 weeks.Except control group,other groups were fed with high sugar and high fat diet,and given 35% alcohol 5 mL · kg-1 and DCP.All rats were killed after five weeks,and blood and liver tissues were collected.The activity of alanine aminotransaminase (ALT),aspartate aminotransferase (AST ), alkaline phosphatase (AKP ), triglyceride (TG),total cholesterol (TC ),low-density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cho-lesterol(HDL-C)in serum were detected by using bio-chemical method. The contents of malondialdehyde (MDA),superoxide dismutase (SOD),reduced gluta-thione(GSH)in liver tissues were detected.The con-tents of tumor necrosis factor-α(TNF-α),interleukin-6 (IL-6 )and transforming growth factor-β1 (TGF-β1 ) were determined by enzyme-linked immunosorbent as-say(ELISA)in liver tissues.The liver tissues were ob-tained and histologic analysis was done through HE. Results DCP reduced the activity or content of ALT, AST,AKP,TG,TC,LDL-C,HDL-C,TNF-α,IL-6, TGF-β1 in serum and liver tissues of rats(P<0.05 ), and increased the activity or content of HDL-C,SOD and GSH (P<0.05 ).DCP could remarkably inhibit the NF-κB expression in liver tissues(P<0.01 ).The pathological examination indicated that DCP could ob-viously alleviate the inflammation and fat denaturation of the liver cells.Conclusion DCP can inhibit the de-velopment of AFLD.The mechanism may be related to antioxidation,free radical scavenging, inhibition of lipidperoxidation,anti-inflammation,and inhibition of the TGF-β1 and NF-κB expression.