Her-2 targeting therapy is an important part of the treatment for breast cancer with Her -2 overexpression.However,the therapeutic effectiveness is largely influenced by Her -2 resistance.Previous studies have confirmed that PI3K/AKT/mTOR signaling pathway is activated during the process of drug resistance to Her-2-targeting therapy.Therefore,investigating the PI3K/AKT/mTOR signaling pathway and drugs -targeted pathway are important for the treatment of breast cancer .

This paper introduces the background, implication and construction of the county health services community (County medical alliance) model in Anhui Province under the background of new medical reform,and briefly introduces the relationship between medical insurance, enhancing the ability to upgrade and standardize services and medical treatment integration of the typical experience.It also analyses the challenges faced in the construction of medical syndicate, such as the mechanism of regional environmental restriction, compensation and assessment mechanisms which have not been established yet, and the sustainable development of information technology that has lagged behind, and put forward the policy suggestion to improve the construction of medical community, with a view to providing reference for the next work.

Objective:To investigate the correlation between the expression of angiogenic factors (MVD, IGF-1, and STAT3) in colorectal carcinoma and adenoma and the microvascular characteristics under narrow band imaging (NBI), in order to evaluate the fea-sibility of NBI in real-time observation of angiogenesis. Methods:Patients with pathologically confirmed colorectal polyps were re-cruited and examined by NBI. Vascular patterns were classified into typeⅠ(invisible or faintly visible), typeⅡ(clearly visible and regularly arranged in a round, oval honeycomb-like pattern), and typeⅢ(clearly visible and irregularly arranged in terms of size and caliber or irregularly winded). Immunohistochemical staining was performed to determine the expression of CD34, IGF-1, and STAT3. Histological results were compared with the vascular patterns under NBI. Results:The NBI endoscopy results of 64 sites (15 adenocar-cinomas, 29 adenomas, and 20 normal tissues) from 58 patients were introduced and examined in this study. Adenomas ranked the first (82.1%, 23/28) among the vascular patternⅡcases, whereas early adenocarcinomas dominated the vascular patternⅢcases (66.7%, 10/15). The expression levels of MVD-CD34 and IGF-1 in normal mucosa, adenomas, and adenocarcinomas were significantly differ-ent (P<0.0001 and P=0.0062, respectively). All the expression levels of MVD-CD34, IGF-1, and STAT3 in sites displaying vascular pat-ternsⅠ,Ⅱ, andⅢwere significantly different (P<0.0001, P=0.0010, and P=0.0055, respectively). Spearman correlation coefficients between the NBI vascular patterns and the MVD-CD34, IGF-1, and STAT3 expression levels were 0.67, 0.41, and 0.40, respectively. Conclusion:Vascular pattern analysis through an NBI system can be a promising tool to evaluate angiogenesis of colorectal lesions in real-time endoscopic observation.

OBJECTIVETo assess the possibility of using arterial pressure waveform or pulse oximetry plethysmographic waveform variation to estimate the pulmonary arterial wedge pressure (PAWP).

METHODSFourteen American Society of Anesthesiologists grade I - II patients aged 33 - 69 years and weighing 62.0 +/- 9.5 kg scheduled for elective abdominal tumor surgery were studied. Their hemoglobin exceeded 120 g/L and hematocrit exceeded 35 percent. Pre-operative acute hypervolemic hemodilution was applied immediately after general anesthestic induction and tracheal intubation. PAWP, systolic pressure variation (SPV), delta down (dDown), SPV(plet), dDown(plet) and other hemodynamic parameters were measured and recorded when total fluid volume (crystalloid and colloid) infused reached 10 ml/kg and 20 ml/kg and again at the end of the operation. Central venous pressure was maintained at 10 - 12 mm Hg during operation. Systolic blood pressure at the end of Valsalva maneuver (airway pressure was kept at 22 mm Hg) and the systolic pressure before the Valsalva manoeuvre during apnea were used to calculate arterial pressure ratio (APR).

RESULTSAPR, SPV, dDown, SPV(plet) and dDown(plet) all correlated well with PAWP (r = 0.717, -0.695, -0.680, -0.522 and -0.624 respectively, P < 0.01). There was a closer linear correlation between APR and PAWP than between the other parameters. The regression equation was PAWP (mm Hg) = 0.207 x APR (%) - 0.382.

CONCLUSIONDuring positive pressure mechanical ventilation, APR, SPV, dDown, SPV(plet) and dDown(plet) can be used to estimate PAWP effectively.

Adult ; Aged ; Blood Pressure Determination ; methods ; Humans ; Middle Aged ; Oximetry ; Plethysmography ; Positive-Pressure Respiration ; Pulmonary Wedge Pressure

Background: The incidence rate and mortality of colorectal cancer (CRC) in China are increasing, and the age of onset is tending to be younger. Aims: To analyze the results of colonoscopy in patients positive for CRC screening, and to explore the significance of a CRC screening protocol that combines risk assessment questionnaire with fecal occult blood test (FOBT) in early diagnosis of colorectal neoplasms. Methods: Individuals who were positive for the first stage of screening (questionnaire + FOBT) in a community CRC screening program in Shanghai Huangpu District from May 2013 to October 2019 and then received the second stage of screening (colonoscopy) in Ruijin Hospital Luwan Branch were enrolled consecutively. Biopsy or polypectomy specimens were taken for pathological examination if any lesions were found endoscopically. Patients who underwent colonoscopy due to changes in bowel habits in the same period were served as controls. The detection rates of colorectal neoplasms in these two groups and the disease characteristics in the screening positive group were analyzed. Results: The screening positive group included 1 329 residents positive for the first stage of screening. The overall detection rate of colorectal lesions was 63.3%, and the detection rates of CRC, colorectal polyps and adenomatous polyps were 2.6% (34 cases), 60.7% (807 cases) and 35.2% (468 cases), respectively. While in control group (n=22 438), the rates were 43.6%, 1.8%, 41.5%, and 21.6%, respectively, all were significantly lower than those in screening positive group (all P<0.05). In screening positive group, the overall detection rate of colorectal lesions was higher in male than in female (73.7% vs. 54.2%, P<0.05) and increased with aging (P<0.05). Most of the CRC cases were in 60-79 years old age group with no gender difference. All CRC and most of the adenomas with dysplasia were greater than or equal to 1 cm in diameter, while most of the adenomas without dysplasia, hyperplastic polyps and inflammatory polyps were less than 1 cm in diameter. Conclusions: The community CRC screening program practiced in China can increase the detection rates of CRC and precancerous lesions effectively.

As the perioperative chemotherapy and conversion therapy has been widely implemented on the standard treatment of gastric cancer patients, it is of great importance to evaluate the efficacy of these patients accurately by effective methods. Being an important grading standard for histomorphological evaluation of excision specimens after neoadjuvant chemotherapy, pathological tumor regression grade (TRG) system is mainly used to assess the degree of fibrosis of tumor tissue and the proportion of residual tumor cells. TRG evaluation may provide important information referring to clinical decision making and prognostic judgment, and may imply on different efficacy and survival rates. Currently, four TRG standards can be used to evaluate the efficacy of neoadjuvant chemotherapy or translational therapy for primary gastric cancer, including Becker, Mandard, Ninomiya and Ryan, among which Ryan's 0-3 classification system is the most widely used. The main factors influencing the outcome of postoperative pathological TRG evaluation of gastric cancer include tumor localization, macroscopic observation and dissection of specimens, microscopic evaluation, as well as TRG evaluation criteria that are too complicated and difficult to operate. Although some studies have found that tumor regression of gastric cancer may be associated with some molecular markers, it may bring greater benefits to the choice of treatment decisions and prognosis judgment if further studies can confirm that specific biomarkers can help estimate the efficacy of neoadjuvant chemotherapy and translational therapy for gastric cancer after endoscopic biopsy.

BACKGROUNDCushing's disease (CD) presents a remarkable preponderance in female gender, and a significant minority of patients with CD presented with negative magnetic resonance imaging (MRI) findings. The aim of this study was to evaluate gender-related and MRI classification-related differences in clinical and biochemical characteristics of CD.

METHODSWe retrospectively studied 169 patients with CD, comprising 132 females and 37 males, and 33 patients had no visible adenoma on MRI.

RESULTSWe observed that male and MRI-positive patients presented with high adrenocorticotropic hormone (ACTH) values (P < 0.05). Female patients presented with higher prevalence of hirsutism and hyperpigmentation and lower prevalence of purple striae (P < 0.05). The prevalence of buffalo-hump and hypertension was greater in MRI-negative patients (P < 0.05). In addition, male patients with CD presented at a younger age compared with females (P < 0.05). Patients with fatigue and hypokalaemia presented significantly higher urinary-free cortisol, ACTH and cortisol levels compared with patients without these symptoms (P < 0.05). The prevalence of LH reduction, hyper total cholesterol (TC) and hyper low-density lipoprotein was more frequent in MRI-positive patients (P < 0.05). Hyper-TC levels and PRL reduction were more frequent in males (P < 0.05). T3, T4 and FT3 levels negatively correlated with age at diagnosis (r = -0.310, P < 0.01; r = -0.191, P < 0.05; r = -0.216, P < 0.05). T3, T4, FT3 and FT4 levels significantly negatively correlated with 8-am plasma cortisol levels (r = -0.328, P < 0.01; r = -0.195, P < 0.05; r = -0.333, P < 0.01; r = -0.180, P < 0.05). Females presented higher total protein level (P < 0.01) and lower blood urea nitrogen and serum creatinine levels (P < 0.01), compared with male patients.

CONCLUSIONSCarefulness and caution are required in all patients with CD, because of the complexity of clinical and biochemical characteristics in CD patients of different gender and MRI classification, particularly male patients and MRI-negative patients.

Adolescent ; Adult ; Aged ; Dyslipidemias ; diagnosis ; Female ; Humans ; Hypertension ; diagnosis ; Hypokalemia ; diagnosis ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pituitary ACTH Hypersecretion ; complications ; diagnosis ; Retrospective Studies ; Sex Factors ; Young Adult

BACKGROUNDThe expression of dendritic cell-specific intercellular adhesion molecule 3-grabbing nonintegrin (DC-SIGN) in renal tubular epithelial cells has been thought to be highly correlated with the occurrence of several kidney diseases, but whether it takes place in renal tissues during hemorrhagic shock (HS) is unknown. The present study aimed to investigate this phenomenon and the inhibitory effect of Vitamin C (VitC).

METHODSA Sprague-Dawley rat HS model was established in vivo in this study. The expression level and location of DC-SIGN were observed in kidneys. Also, the degree of histological damage, the concentrations of tumor necrosis factor-μ and interleukin-6 in the renal tissues, and the serum concentration of blood urea nitrogen and creatinine at different times (2-24 h) after HS (six rats in each group), with or without VitC treatment before resuscitation, were evaluated.

RESULTSHS induced DC-SIGN expression in rat tubular epithelial cells. The proinflammatory cytokine concentration, histological damage scores, and functional injury of kidneys had increased. All these phenomena induced by HS were relieved when the rats were treated with VitC before resuscitation.

CONCLUSIONSThe results of the present study illustrated that HS could induce tubular epithelial cells expressing DC-SIGN, and the levels of proinflammatory cytokines in the kidney tissues improved correspondingly. The results also indicated that VitC could suppress the DC-SIGN expression in the tubular epithelial cells induced by HS and alleviate the inflammation and functional injury in the kidney.

Animals ; Ascorbic Acid ; therapeutic use ; Blotting, Western ; Cell Adhesion Molecules ; metabolism ; Epithelial Cells ; drug effects ; metabolism ; pathology ; Immunohistochemistry ; Kidney Tubules ; drug effects ; metabolism ; pathology ; Lectins, C-Type ; metabolism ; Male ; Rats ; Rats, Sprague-Dawley ; Receptors, Cell Surface ; metabolism ; Shock, Hemorrhagic ; complications ; drug therapy ; metabolism

OBJECTIVE: To compare the subjective perception of surgeons with 4K-resolution(4K) and three-dimensional(3D) systems in the laparoscopic colorectal surgery.METHODS: A self-filling questionnaire survey wasdeveloped in the surgeons between August 2018 and February 2019 in Department of Gastrointestinal Surgery,RuijinHospital Affiliated to Shanghai Jiao Tong University School of Medicine. The data of questionnaires from surgeons indifferent position( major surgeons,first assistants,scopists) who performed laparoscopic colorectal surgeries with 4K,3D and 2D systems were collected. The questionnaires concerning asthenopia,motion sickness,topographical orientation,control coordination of visual angle,visual acuity,radiance,resolution ratio,depth description,color resolution,sense ofcontrols,optimum viewing distance,frames and refresh rate and contrast.RESULTS: There were 124 questionnairesscreened eligibility in the survey. Among them,there were 38 questionnaires for 2D group,43 questionnaires for 3D group and 43 questionnaires for 4 K group.(1)Overall comparison of the subjective scores:In the three groups,therewere significant difference in control coordination of visual angle,visual acuity,resolution ratio,depth description,color resolution,optimum viewing distance,frames andrefresh rate(P<0.05).(2)Subjective scores betweenmajor surgeons:In the three groups,there weresignificant difference in resolution ratio,depth description,color resolution and sense of controls(P<0.05);the most advantages could be found on resolution ratio andcolor resolution in 4 K group,and also could be found on depth description and sense of controls in 3 D group.(3)Subjective scores between first assistants: In the three groups,there were significant difference in asthenopia,controlcoordination of visual angle,resolution ratio,depth description,sense of controls,frames and refresh rate(P<0.05);In 4K group,it showed advantages on control coordination of visual angle and resolution ratio. Motion sickness was morepronounced in 3D group,but the most advantages could be found on depth description and sense of controls.(4)Subjective scores between scopists: In the three groups,there were significant difference in visual acuity,resolution ratio,depth description,sense of controls,optimum viewing distance and contrast(P<0.05). The most advantages could befound on visual acuity,resolution ratio and contrast in 4 K group,and also could be found on depth description and senseof controls in 3D group.CONCLUSION: Comparing with the traditional two-dimensional system during laparoscopiccolorectal surgery,4 K system could apply better resolution ratio,control coordination of visual angle,visual acuity andcolor resolution. 3D system could apply better depth description and sense of controls.

OBJECTIVE: To compare dorsal-and-medial hybrid approach and medial-to-lateral approach in laparoscopic right hemicolectomy with complete mesocolic excision(CME). METHODS: Patients undergone laparoscopic right hemicolectomy in Department of Gastrointestinal Surgery in Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from July 2017 to April 2018 were prospectively included.Patients were divided into two groups:dorsal group and medial group. Clinical and pathological data were collected and compared between the two groups. RESULTS: There were 35 patients in medial group and 40 patients in dorsal group. No significant differences were found between the two groups in baseline characteristics,perioperative outcomes and pathological results. No significant difference was found between the two groups in length of bowel(24 cm vs. 22 cm),A line distance(9.8 cm vs.9.4 cm),B line distance(9.0 cm vs. 8.5 cm),area of mesentery(112.4 cm~2 vs. 109.0 cm~2),total lymph node count(19 vs.19),lymph node adequate ratio(97.1% vs. 97.5%)and CME ratio(80% vs. 85%). Obesity was found to be an independent risk factor of CME ratio(P=0.019). CONCLUSION: Dorsal-and-medial hybrid approach and medial-to-lateral approach are comparable in safety,feasibility and effectiveness in laparoscopic right hemicolectomy with complete mesocolic excision. Randomized clinical trials with larger sample size are needed.