Objective Less than a decade ago, ER-positive and PgR-positive diagnostic criteria decrease from 10%to 1%. Up to 20%of current immunohistochemical determinations of ER and PgR worldwide may be inaccu-rate. It is necessary to study patients whose tumors are between luminal A (LABC) and triple-negative (TNBC) breast cancer. Methods Survival analysis grouping by the level of positive hormone receptor, CK5/6 and EGFR, and en-docrine therapy was carried out in 206 patients whose tumors were junction zone between LABC and TNBC. Re-sults There were no significant differences between the low-positive (1%-9%) HR group and positive HR (10%-19%) group in overall survival (OS) and disease-free survival (DFS). There was an apparent difference between the nor-mal-like group and basal-like group in OS and DFS, and between the patients with and without endocrine therapy. There were significant differences between death and tumor progression for EGFR and CK5/6, chemotherapy, and endocrine therapy. Conclusions We conclude that EGFR and CK5/6 are better prognostic indicators than the lev-el of positive HR in patients whose tumors are junction zone at the junction zone between LABC and TNBC. En-docrine therapy can be highly beneficial to these patients regardless of the positive HR level.

Objective:To evaluate the efficacy and safety of Chinese medicine Jianpi Antai formula in infertile women undergoing in vitro fertilization-embryo transfer(IVF-ET).Methods:A total of 300 infertile women who underwent 2 frozen embryo transfer procedures at the Reproductive Medicine Center,Sir Run Run Shaw Hospital were included in the study.The participants were randomly divided into study group and control group.The study group received routine medication plus the Jianpi Antai formula during the period of embryo transfer,while the control group received routine medication only.The general condition,embryo implantation rate,clinical pregnancy rate,live birth rate,and the blood routine and liver and kidney function were evaluated and compared between two groups.Results:There were 277 cases who completed the study,including 134 in the study group and 143 in the control group.The embryo implantation rate(68.7%vs.55.9%),the clinical pregnancy rate(56.7%vs.44.8%)and the live birth rate(50.7%vs.37.8%)in the study group were all higher than those in the control group(all P＜0.05).Subgroup analysis revealed that in patients of advanced age(≥35 years)and those with decreased ovarian reserve function(anti-Müllerian hormone＜1.68 ng/mL),the embryo implantation rate,clinical pregnancy rate,and live birth rate in the study group were all higher than those in the control group(all P＜0.05).During the follow-up period,there were no abnormalities in the basic vital signs of both groups,and no adverse events were reported.Conclusion:Jianpi Antai formula can safely improve the embryo implantation rate in infertile women undergoing IVF-ET,reduce the embryo miscarriage rate,increase the live birth rate as well as improve the clinical outcomes.

ObjectiveTo explore the influence of centralized management mode on disinfection and sterilization of flexible endoscopes in Central Sterile Supply Department(CSSD). MethodsBy cluster sampling,the endoscopes processed in the First People＇s Hospital of Shangqiu in He＇nan province from 2015 to 2016 were selected for investigation. The endoscopes processed from 2015 to 2018 were put into the control group (n=47 250)and those processed from 2017 to 2018 were in the experimental group(n=55 319). The cleaning and sterilization room was set up to manage the flexible endoscopes in the control group while the CSSD centralized management mode was adopted in the experimental group. The quality of sterilization and disinfection in the two groups were compared. ResultsThere were statistically significant differences between the two groups of endoscopes in the sterilization and disinfection quality monitoring results(P＜0.05). ConclusionsThe cleaning, disinfection and sterilization of flexible endoscopes under the CSSD centralized management mode ensures the quality of disinfection and sterilization of flexible endoscopes and the safety of doctors, nurses and patients by reasonably equipping facilities and personnel and strict quality control.

Objective: To investigate the effect of resilience on fear of cancer recurrence in breast cancer patients and to find the specific role of perceived social support between them. Methods: From April 2018 to January 2019, we invited 456 breast cancer patients hospitalized in the Department of Breast surgery in Qilu Hospital of Shandong University in Jinan to participate in the study and to finish a questionnaire survey which including the general information questionnaire, Chinese version of the Fear of Progression Questionnaire-Short Form, The Connor-Davidson Resilience Scale and Perceived Social Support Scale. Results: The average score of fear of cancer recurrence in breast cancer patients was (41.5±7.7), and 85.99% (313/364) of the patients′ score was clinically significant (total score ≥ 34). Resilience could negatively predict the fear of cancer recurrence (β=-0.240 P < 0.01). Perceived social support is the moderation between resilience and fear of cancer recurrence (β=-0.179, P<0.01). Conclusions The level of resilience could affect the level of fear of cancer recurrence in breast cancer patients, and the increase in the level of perceived social support could enhance the effect of resilience on the fear of cancer recurrence, thus further reducing the level of patient′s fear of recurrence.

Uch37 is a de-ubiquitinating enzyme that is activated by Rpn13 and involved in the proteasomal degradation of proteins. The full-length Uch37 was shown to exhibit low iso-peptidase activity and is thought to be auto-inhibited. Structural comparisons revealed that within a homo-dimer of Uch37, each of the catalytic domains was blocking the other's ubiquitin (Ub)-binding site. This blockage likely prevented Ub from entering the active site of Uch37 and might form the basis of auto-inhibition. To understand the mode of auto-inhibition clearly and shed light on the activation mechanism of Uch37 by Rpn13, we investigated the Uch37-Rpn13 complex using a combination of mutagenesis, biochemical, NMR, and small-angle X-ray scattering (SAXS) techniques. Our results also proved that Uch37 oligomerized in solution and had very low activity against the fluorogenic substrate ubiquitin-7-amino-4-methylcoumarin (Ub-AMC) of de-ubiquitinating enzymes. Uch37Δ(Hb,Hc,KEKE), a truncation removal of the C-terminal extension region (residues 256-329) converted oligomeric Uch37 into a monomeric form that exhibited iso-peptidase activity comparable to that of a truncation-containing the Uch37 catalytic domain only. We also demonstrated that Rpn13C (Rpn13 residues 270-407) could disrupt the oligomerization of Uch37 by sequestering Uch37 and forming a Uch37-Rpn13 complex. Uch37 was activated in such a complex, exhibiting 12-fold-higher activity than Uch37 alone. Time-resolved SAXS (TR-SAXS) and FRET experiments supported the proposed mode of auto-inhibition and the activation mechanism of Uch37 by Rpn13. Rpn13 activated Uch37 by forming a 1:1 stoichiometric complex in which the active site of Uch37 was accessible to Ub.
Binding Sites ; Catalytic Domain ; Chromatography, Gel ; Crystallography, X-Ray ; Humans ; Membrane Glycoproteins ; chemistry ; genetics ; metabolism ; Nuclear Magnetic Resonance, Biomolecular ; Protein Binding ; Protein Conformation ; Protein Multimerization ; Scattering, Small Angle ; Ubiquitin Thiolesterase ; chemistry ; genetics ; metabolism ; Ultracentrifugation

Objective:To compare the training effect between the laparoscopic simulated uterine model (LSUM) with multi-angle suture and the traditional surgical model and to identify a laparoscopic model more suitable for gynecological resident training.Methods:Forty-eight residents who were trained in Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine from February 2021 to February 2023 were selected. They were trained in batches, with each batch randomly divided into two groups of the same size. The observation group was trained with the traditional surgical model and general surgical videos, while the experimental group was trained with a self-developed LSUM with multi-angle suture and corresponding surgical videos. Finally, the two groups were compared for the assessment results, and a questionnaire survey was conducted in the experimental group. The statistical software SPSS 20.0 was used for t-test or chi-square test of the results. Results:There were no significant differences between the two groups in age, gender distribution, education level, and clinical experience. In theoretical assessment results, no significant difference was shown between the experimental group and the observation group [(82.63±3.93) vs. (85.00±6.15), P>0.05]. In skill assessment results, there was no significant difference between the two groups in the anterior wall assessment [(83.08±4.47) vs. (82.79±3.58), P=0.804]. However, in the assessment of the lateral and posterior walls, the proficiency, accuracy, and degree of coordination between two hands of the experimental group were better than those of the observation group, with the total score being significantly different [(64.13±3.34) vs. (46.75±3.50), (62.25±4.41) vs. (45.00±2.89), P<0.001]. In the questionnaire survey, the experimental group had a high degree of satisfaction with the LSUM and thought that the highly simulated model was beneficial to their training. Conclusions:Compared with the traditional surgical model, the LSUM with multi-angle suture can effectively improve the operation level of residents, which provides a new idea for the laparoscopic simulation training of gynecological residents in the future.

Objective To evaluate the clinical outcome of kidney transplantation from donation after brain death(DBD)donors complicated with acute kidney injury(AKI).Methods Clinical data of 216 DBD donors were retrospectively analyzed,and they were divided into the AKI group(n=69)and control group(n=147)according to the Kidney Disease:Improving Global Outcomes(KDIGO)guidelines.Donors in the AKI group were further divided into the KDIGO stage 1 and stage 2-3 subgroups.One hundred and thirty-five recipients were assigned into the AKI group and 288 recipients in the control group.Postoperative recovery of renal function and clinical outcomes of the recipients were recorded.The risk factors of delayed graft function(DGF)were identified.Results The highest serum creatinine(Scr)level,Scr level before procurement,the highest blood sodium level and blood sodium level before procurement in the AKI group were higher than those in the control group.The application duration of vasopressors in the AKI group was longer than that in the control group.In the AKI group,the amount of fluid resuscitation within 48 h was higher,the HCO3-level at admission was lower,and the incidence of diabetes insipidus and hypotension was higher than those in the control group.The highest Scr level and the Scr level before procurement in KDIGO stage 2-3 donors were significantly higher than those in KDIGO stage 1 counterparts(all P＜0.05).Compared with the control group,the incidence of DGF and acute rejection was higher,the proportion of continuous renal replacement therapy was higher,the Scr level within postoperative 90 d was higher,and the urine amount within postoperative 3 d was less than those of recipients in the AKI group.Compared with KDIGO stage 1 recipients,KDIGO stage 2-3 recipients had higher Scr levels at postoperative 3,4,5 and 15 d,and less urine amount at postoperative 2 d(all P＜0.05).Univariate analysis showed that donor age,the highest Scr level,the highest blood sodium level and the amount of fluid resuscitation within 48 h were the risk factors for DGF in recipients after kidney transplantation.Multivariate analysis showed that donor age was the independent risk factor for DGF in recipients after kidney transplantation(all P＜0.05).Conclusions For the application of DBD donors complicated with AKI,active organ maintenance should be performed to alleviate AKI.It exerts no effect upon graft function and survival rate at postoperative 6 months,which may achieve equivalent efficacy as non-AKI donors and may be used as a source of extended criteria donor kidneys.

Objective:To compare oxytocin combined with ergometrine with oxytocin alone in terms of primary prophylaxis for postpartum hemorrhage (PPH) at the time of cesarean section (CS).Methods:This was a multicenter double-blind randomized controlled interventional study comparing ergometrine combined with oxytocin and oxytocin alone administered at CS. From December 2018 to November 2019, a total of 298 parturients were enrolled in 16 hospitals nationwide. They were randomly divided into experimental group (ergometrine intra-myometrial injection following oxytocin intravenously; 148 cases) and control group (oxytocin intra-myometrial injection following oxytocin intravenously; 150 cases) according to 1∶1 random allocation. The following indexes were compared between the two groups: (1) main index: blood loss 2 hours (h) after delivery; (2) secondary indicators: postpartum blood loss at 6 h and 24 h, placental retention time, incidence of PPH, the proportion of additional use of uterine contraction drugs, hemostatic drugs or other hemostatic measures at 2 h and 24 h after delivery, the proportion requiring blood transfusion, and the proportion of prolonged hospital stay due to poor uterine involution; (3) safety indicators: nausea, vomiting, dizziness and other adverse reactions, and blood pressure at each time point of administration.Results:(1) The blood loss at 2 h after delivery in the experimental group [(402±18) ml] was less than that in the control group [(505±18) ml], and the difference was statistically significant ( P<0.05). (2) The blood loss at 6 h and 24 h after delivery in the experimental group were less than those in the control group, and the differences were statistically significant (all P<0.05). There were no significant differences between the two groups in the incidence of PPH, the proportion of additional use of uterine contraction drugs, hemostatic drugs or other hemostatic measures at 2 h and 24 h after delivery, the proportion requiring blood transfusion, and the proportion of prolonged hospital stay due to poor uterine involution (all P>0.05). (3) Adverse reactions occurred in 2 cases (1.4%, 2/148) in the experimental group and 1 case (0.7%, 1/150) in the control group. There was no significant difference between the two groups ( P>0.05). The systolic blood pressure within 2.0 h and diastolic blood pressure within 1.5 h of drug administration in the experimental group were higher than those in the control group, and the differences were statistically significant ( P<0.05), but the blood pressure of the two groups were in the normal range. Conclusion:The use of ergometrine injection in CS could reduce the amount of PPH, which is safe and feasible.

BACKGROUNDReduced endometrial receptivity in hyperstimulated cycles may lead to a lower implantation rate and a lower clinical pregnancy rate, but it is unclear if it is also associated with an increase in pregnancy loss rate. The aim of this study was to compare the implantation, miscarriage, and pregnancy rates between fresh and frozen thawed transfer of one or two day-3 embryos, with a view to understanding whether or not reduced endometrial receptivity encountered in hyperstimulated cycles is associated with an increase in miscarriage rate.

METHODSThis study involved a consecutive series of 1 551 single day-3 embryo transfer cycles and consecutive 5 919 double day-3 embryo transfer cycles in the Assisted Reproductive Unit of the Sir Run Run Shaw Hospital, Hangzhou, China, between January 2010 and December 2012.

RESULTSThe implantation and clinical pregnancy rates (single embryo 30.7% and double embryos 33.4% and 51.4%) using fresh cycle were both significantly lower than that of frozen-thawed cycles (single embryo 35.8% and double embryos 38.1% and 57.8%). There was no difference in biochemical loss or clinical miscarriage rates between the two groups.

CONCLUSIONSImpairment of endometrial receptivity associated with ovarian hyperstimulation leads to implantation failure at a very early stage, resulting in an increased number of non-pregnancy. It does not lead to increase in biochemical or clinical losses. The significantly reduced ongoing pregnancy rates in both fresh single and double embryo transfer are therefore due to failure to achieve a pregnancy, rather than pregnancy loss after conception.

Adult ; Cryopreservation ; Embryo Implantation ; physiology ; Embryo Transfer ; methods ; statistics & numerical data ; Female ; Fertilization in Vitro ; methods ; statistics & numerical data ; Humans ; Male ; Pregnancy ; Pregnancy Rate ; Retrospective Studies