In order to promote rehabilitation exercises for breast cancer patients and to improve their quality of life,as well as to promote the development of nursing profession, our hospital has estab-lished a specialistnursing clinic for breast cancer since January 2016. We standardized nurses' qualification and training requirements, and performed management in patients'symptom assessment, nursingtechniqueguidance for breast cancer, sleep guidance, health education, long-term follow up, etc. After one year of implementation, symptom assessment was conducted 1283 times, rehabilitationexerciseguidance was 329 times, lymphatic drainage guidance was 297 times, sleep guidance was 159 times, health education was 591 times, sexual life with spouse guidance was 107 times, in-hospital nursing consultation was 48 times, family on-site demonstration was 29 times. The satis-faction rate was 98.4% which was higher than average level of the hospital according to outpatient investigation.

Objective To guide new nurses to establish positive and correct occupational self-concept, enhance occupational identity and delay job burnout by adding traditional culture education in the standardized training for newly recruited nurses. Methods Randomly selected 56 new nurses of our hospital in recent years as research objects. 28 nurses enrolled in 2013 formed the experimental group and 28 nurses enrolled in 2014 formed the control group. The experimental group focused on nurses themselves. In the 10-month standardized training, 30 class-hour traditional culture education was added and more than 180 times of social practices were conducted; for the control group, only standardized training was carried out. Effects before and after, all subjects were examined occupational self-concept and desert jobs rate after work 2 years. Results The occupational self-concept of the experimental group tended to reach a positive level, which was (33.14±2.15) points, obviously higher than that of the control group, which was only (30.57 ± 3.03) points. Therefore, the difference was statistically significant(t=3.703 4,P<0.01). In terms of dimensions of comprehensive self- concept, employee relationships and communication ability were (4.92 ± 0.50), (6.34 ± 0.54), (5.87 ± 0.44) points in the experimental group and (4.40 ± 0.63), (5.89 ± 0.77),(5.55 ± 0.64) points in the control group, the experimental group had significant improvements (t=3.458 1, 2.561 9, 2.206 4, P<0.01). Comparing the separation rates of the two groups after two years, the difference was not statistically significant (P>0.05). Conclusions Adding traditional culture education in the standardized training for newly recruited nurses plays a positive role in promoting their occupational self-concept.

Objective To investigate the clinical and pathologic features of patients with gastric neuroendocrine neoplasms (g-NENs).Methods A total of 50 cases of g-NENs diagnosed by pathology in the First Hospital of Jilin University from May 2012 to January 2016 were retrospective analyzed to summarize the clinical manifestations and pathological features.The location of lesion,gross morphology,maximum diameter,lymph node metastasis rate,distant metastasis rate,and survival time between patients with neuroendocrine tumors and neuroendocrine carcinomas were compared.Results Among the 50 patients,34 were males and 16 were females with a male to female ratio of 2.125 ∶ 1.Their age ranged from 33 to 77 years with an mean age of 60± 11 years.There were 13 cases (26％) of neuroendocrine tumors,31 (62％) neuroendocrine carcinomas,and 6 (12％) mixed adenoneuroendocrine carcinomas.The maximum diameter of lesion was less than 2 cm in 8 cases (16％),and equal or greater than 2 cm in 42 cases (84％).There was single lesion in 48 cases (96％) and multiple lesions in 2 cases (4％).There were 19 cases (38％) located in gastric antrum,16 (32％) in gastric body,11 (22％) in gastric fundus or cardia,3 (6％) in gastric angle,and 1 (2％) in the junction of gastric antrum and body.Thirty-two patients (64％) had metastasis,including 20 cases of lymph node metastasis and 12 cases of distant metastasis.The clinical symptoms of the patients were different,mainly were digestive system symptoms and tumor occupying symptoms,and no carcinoid syndrome was reported.The gross morphology (x2 =24.446.P =0.000).maximum diameter (t =-4.044,P =0.001),lymph node metastasis rate (x2=4.435,P =0.035),and survival time (t =2.925,P =0.000) were significantly differences between 13 cases of neuroendocrine tumors and 37 cases of neuroendocrine carcinoma.But the location of lesion (x2 =6.921,P=0.082) and distant metastasis rate (x2 =0.715,P =0.389) were no statistically different between the two groups.Conclusion Gastric neuroendocrine neoplasms can occur in any part of stomach,majority of tumor is single lesion and lack of specific clinical manifestations.The mostly gross morphology of gastric neuroendocrine carcinoma and mixed adenoneuro-endocrine carcinoma are ulcer type with a large diameter and poor prognosis.

Objective:To evaluate the application of visual feedback coaching method, which is embedded in an optical surface monitoring system, in deep inspiration breath holding during the radiotherapy in left breast cancer patients after breast-conserving surgery.Methods:Thirty patients with left breast cancer, who were scheduled to receive the whole breast radiotherapy after breast-conserving surgery, met the requirements of deep inspiration breath holding after respiratory coaching with the visual feedback coaching module in the optical surface monitoring system. Active breathing control equipment was used to control breath-holding state and CT simulation was performed. During treatment, optical surface monitoring system was used to guide radiotherapy. All patients were randomly divided into two groups. In group A ( n=15), visual feedback respiratory training method was utilized and not employed in group B ( n=15). In group A, the visual feedback coaching bar of the optical surface monitoring system was implemented, while audio interactive method was employed to guide patients to hold their breath. Real-time data of optical body surface monitoring were used to compare the interfraction reproducibility and intrafraction stability of breath holding fraction between two groups. Besides, the number of breath holding and treatment time per fraction were also compared. GraphPad prism 6.0 software was used for data processing and mapping, and SPSS 21.0 software was used for analyzing mean value and normality testing. Results:Compared with the control group, the reproducibility in the experiment group was reduced from 1.5 mm to 0.7 mm, the stability was reduced from 1.1 mm to 0.8 mm, the mean number of breath holding required per fraction was decreased from 4.6 to 2.4, the mean beam-on time per fraction from 336 s to 235 s, and the treatment time per fraction was shortened from 847 s to 602 s (all P<0.05), respectively. Conclusions:The application of visual feedback coaching method can improve the reproducibility and stability of breath holding during radiotherapy for left breast cancer, and it can also effectively reduce the number of breath holding and shorten the treatment time per fraction.

Objective:To investigate the effects of microRNA-451 on proliferation, invasion and migration of multiple myeloma RPMI-8226 cells and its mechanism.Methods:RPMI-8226 cells cultured in vitro were divided into blank control group (untransfected), negative control (NC) group and miR-451 mimic transfected (miR-451) group. The expression of miR-451 was detected by real-time quantitative PCR (qRT-PCR), cell proliferation was detected by 3-(4, 5-dimethyl-2-thiazolyl)-2, 5-diphenyl-2-H-tetrazolium bromide (MTT) array and clone formation experiment, cell invasion and migration were detected by Transwell, and the expressions of c-Myc, MMP-2 and MMP-9 proteins were detected by western blot. The targeting relationship between miR-451 and c-Myc was detected by double luciferase reporter gene assay. Results:Compared to the blank control group, the expression level of miR-451 was increased (2.85±0.27 vs 1.02±0.06), while the cell survival rate [(47.28±3.15)% vs (93.65±6.52)%], cloning formation rate [(15.03±1.34)% vs (28.48±2.12)%], invasive cell number (86.65±5.58 vs 135.47±9.85), migrating cell number (106.36±6.48 vs 165.28±11.05) and the expression level of c-Myc(0.35±0.03 vs 0.66±0.05), MMP-2 (0.20±0.02 vs 0.48±0.03) and MMP-9 (0.28±0.03 vs 0.59±0.06) protein were significantly decreased in the miR-451 group ( P<0.05). In the negative control group, the expression level of miR-451, cell viability, clone formation rate, invasive cell number, migrating cell number, c-Myc protein, MMP-2 protein and MMP-9 protein were 0.94±0.05, (95.16±5.04)%, (27.55±2.26)%, (128.96±8.32) and (158.65±8.76), 0.68±0.06, 0.51±0.03, 0.54±0.03, respectively. There were no significant differences between the blank control group and the NC group ( P>0.05). Double luciferase reporter gene experiment confirmed that c-Myc was a potential target gene of miR-451. Conclusion:miR-451 can inhibit the proliferation, invasion and migration of RPMI-8226 cells by targeting c-Myc.

Objective To explore the correlations of serum vascular endothelial growth factor(VEGF),matrix metalloproteinase-9(MMP-9)and tissue inhibitor of metalloproteinases-1(TIMP-1)with grading of myelofibrosis(MF)in patients with myeloproliferative neoplasms(MPN).Methods Ninety patients with Philadelphia chromosome negative(Ph-)MPN were selected as MPN group.According to the grading criteria for myelofibrosis by the World Health Organization(WHO)in 2016,MPN pa-tients were divided into pre-fibrosis or early fibrosis group with 54 cases and significant fibrosis group with 36 cases;another 50 healthy volunteers were selected as the control group.Levels of serum VEGF,MMP-9 and TIMP-1 were detected by enzyme-linked immunosorbent assay,and the ratio of TIMP-1 to MMP-9(TIMP-1/MMP-9)was calculated.Spearman rank correlation test was used to analyze the correlations of VEGF,MMP-9,TIMP-1 and TIMP-1/MMP-9 with MF grading.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of each indicator a-lone or their combination for diagnosing MPN or distinguishing MF grading.Results Compared with the control group,the serum levels of VEGF,MMP-9 and TIMP-1 in the MPN group increased significantly(P＜0.05).Values of area under the curve(AUC)of VEGF,MMP-9,TIMP-1 and TIMP-1/MMP-9 for diagnosing MPN were 0,834,0.745,0.923 and 0.618 respectively;the AUC of the combined diagnosis of MPN by VEGF,MMP-9 and TIMP-1 was 0.960;when the optimal cut-off value was 0.627,the sensitivity was 85.56％,and the specificity was 92.00％.Compared with the pre-fibrosis or early fibrosis group,the serum levels of VEGF,TIMP-1 and TIMP-1/MMP-9 in the significant fibrosis group increased significantly(P＜0.05).Spearman correlation analysis showed that VEGF(r=0.378,P=0.001),TIMP-1(r=0.512,P＜0.001)and TIMP-1/MMP-9(r=0.353,P=0.001)were positively correlated with the MF grading of MPN patients(P＜0.05).ROC curve analysis showed that the values of AUC of VEGF,MMP-9,TIMP-1 and TIMP-1/MMP-9 for distinguishing patients with pre-fibrosis or early fibrosis from those with significant fibrosis were 0.723,0.523,0.802 and 0.708 respectively;the AUC of the combined detection of VEGF,TIMP-1 and TIMP-1/MMP-9 for distinguishing patients with pre-fibrosis or early fibrosis from those with significant fibrosis was 0.838;when the optimal cut-off value was 0.530,the sensitivity was 72.22％,and the specificity was 85.19％.Conclusion Serum VEGF,TIMP-1 and TIMP-1/MMP-9 can reflect the MF progression of MPN patients,and the combined detection of these indica-tors can predict the MF degree of MPN patients.

Objective:To investigate the effects of microRNA-451 on proliferation, invasion and migration of multiple myeloma RPMI-8226 cells and its mechanism.Methods:RPMI-8226 cells cultured in vitro were divided into blank control group (untransfected), negative control (NC) group and miR-451 mimic transfected (miR-451) group. The expression of miR-451 was detected by real-time quantitative PCR (qRT-PCR), cell proliferation was detected by 3-(4, 5-dimethyl-2-thiazolyl)-2, 5-diphenyl-2-H-tetrazolium bromide (MTT) array and clone formation experiment, cell invasion and migration were detected by Transwell, and the expressions of c-Myc, MMP-2 and MMP-9 proteins were detected by western blot. The targeting relationship between miR-451 and c-Myc was detected by double luciferase reporter gene assay. Results:Compared to the blank control group, the expression level of miR-451 was increased (2.85±0.27 vs 1.02±0.06), while the cell survival rate [(47.28±3.15)% vs (93.65±6.52)%], cloning formation rate [(15.03±1.34)% vs (28.48±2.12)%], invasive cell number (86.65±5.58 vs 135.47±9.85), migrating cell number (106.36±6.48 vs 165.28±11.05) and the expression level of c-Myc(0.35±0.03 vs 0.66±0.05), MMP-2 (0.20±0.02 vs 0.48±0.03) and MMP-9 (0.28±0.03 vs 0.59±0.06) protein were significantly decreased in the miR-451 group ( P<0.05). In the negative control group, the expression level of miR-451, cell viability, clone formation rate, invasive cell number, migrating cell number, c-Myc protein, MMP-2 protein and MMP-9 protein were 0.94±0.05, (95.16±5.04)%, (27.55±2.26)%, (128.96±8.32) and (158.65±8.76), 0.68±0.06, 0.51±0.03, 0.54±0.03, respectively. There were no significant differences between the blank control group and the NC group ( P>0.05). Double luciferase reporter gene experiment confirmed that c-Myc was a potential target gene of miR-451. Conclusion:miR-451 can inhibit the proliferation, invasion and migration of RPMI-8226 cells by targeting c-Myc.

Objective To explore the correlations of serum vascular endothelial growth factor(VEGF),matrix metalloproteinase-9(MMP-9)and tissue inhibitor of metalloproteinases-1(TIMP-1)with grading of myelofibrosis(MF)in patients with myeloproliferative neoplasms(MPN).Methods Ninety patients with Philadelphia chromosome negative(Ph-)MPN were selected as MPN group.According to the grading criteria for myelofibrosis by the World Health Organization(WHO)in 2016,MPN pa-tients were divided into pre-fibrosis or early fibrosis group with 54 cases and significant fibrosis group with 36 cases;another 50 healthy volunteers were selected as the control group.Levels of serum VEGF,MMP-9 and TIMP-1 were detected by enzyme-linked immunosorbent assay,and the ratio of TIMP-1 to MMP-9(TIMP-1/MMP-9)was calculated.Spearman rank correlation test was used to analyze the correlations of VEGF,MMP-9,TIMP-1 and TIMP-1/MMP-9 with MF grading.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of each indicator a-lone or their combination for diagnosing MPN or distinguishing MF grading.Results Compared with the control group,the serum levels of VEGF,MMP-9 and TIMP-1 in the MPN group increased significantly(P＜0.05).Values of area under the curve(AUC)of VEGF,MMP-9,TIMP-1 and TIMP-1/MMP-9 for diagnosing MPN were 0,834,0.745,0.923 and 0.618 respectively;the AUC of the combined diagnosis of MPN by VEGF,MMP-9 and TIMP-1 was 0.960;when the optimal cut-off value was 0.627,the sensitivity was 85.56％,and the specificity was 92.00％.Compared with the pre-fibrosis or early fibrosis group,the serum levels of VEGF,TIMP-1 and TIMP-1/MMP-9 in the significant fibrosis group increased significantly(P＜0.05).Spearman correlation analysis showed that VEGF(r=0.378,P=0.001),TIMP-1(r=0.512,P＜0.001)and TIMP-1/MMP-9(r=0.353,P=0.001)were positively correlated with the MF grading of MPN patients(P＜0.05).ROC curve analysis showed that the values of AUC of VEGF,MMP-9,TIMP-1 and TIMP-1/MMP-9 for distinguishing patients with pre-fibrosis or early fibrosis from those with significant fibrosis were 0.723,0.523,0.802 and 0.708 respectively;the AUC of the combined detection of VEGF,TIMP-1 and TIMP-1/MMP-9 for distinguishing patients with pre-fibrosis or early fibrosis from those with significant fibrosis was 0.838;when the optimal cut-off value was 0.530,the sensitivity was 72.22％,and the specificity was 85.19％.Conclusion Serum VEGF,TIMP-1 and TIMP-1/MMP-9 can reflect the MF progression of MPN patients,and the combined detection of these indica-tors can predict the MF degree of MPN patients.

Objective:To investigate the feasibility of surface-guided hypo-fractionated radiotherapy for intracranial metastasis with open face mask immobilization.Methods:Nineteen patients treated with hypo- fractionated radiotherapy for intracranial metastasis in our hospital were included. Before the start of treatment, each patient underwent simulation with open face mask immobilization. During the treatment, cone-beam CT(CBCT)images were collected for verification each time. Laser-guided positioning was used for the first time in the treatment, and surface images were captured after six-dimensional position correction as the reference images for subsequent treatment. Subsequent treatment was randomly divided into laser-guided positioning group(LG, 85/F)and optical surface-guided positioning group(SG, 101/F). The six-dimensional error data of patients with two positioning methods were compared and expressed as mean ± standard deviation. Meanwhile, the correlation and consistency between the optical surface error data and the gold standard CBCT error data were compared in the laser-guided fraction. GraphPad Prism 6.0 software was used for data processing and mapping, and SPSS 21.software was used for mean analysis and normality test. Pearson correlation analysis was used to analyze the correlation, and Bland-Altman plot analysis was used to test the coincidence between two methods.Results:Compared with the laser-guided positioning, the 3D error of optical surface-guided positioning was reduced from(0.35±0.16)cm to(0.14±0.07)cm. The Pearson coefficient of correlation along all three directions was less than 0.01,R 2 was 0.91,0.70 and 0.78 on Lat, Lng and Vrt, and R 2 was 0.75,0.85 and 0.77 on Pitch, Roll and Rtn(all P<0.01), respectively. The measurement results of two methods were positively correlated. The Bland-Altman plot analysis showed that the 95% limits of agreement were within preset 3 mm tolerance([-0.29 cm, 0.19 cm], [-0.25 cm, 0.25 cm], [-0.27 cm, 0.19 cm]), and the 95% limits of agreement were within preset 3° tolerance(Pitch[-1.76°,1.76°], Roll[-1.54°,1.60°], ROT[-2.18°,1.69°]), indicating agreement between two methods. Conclusions:The optical surface-guided positioning can reduce the setup errors in the hypo-fractionated radiotherapy for intracranial metastasis with open face mask immobilization. The optical surface error and CBCT error have good correlation and agreement.

By using optical surface guided radiotherapy technology, the principle of three-dimensional body surface imaging is employed to obtain body surface images in a real-time manner. By comparing with reference images, it can verify the position before treatment, and realize real-time monitoring and gated treatment during treatment. It is a non-invasive and non-radiation technology, which is mainly applied in the treatment of intracranial, head and neck, chest and abdomen, breast, extremities and pediatric tumors. The research progresses consist of four aspects including less body surface markers, less restraint fixation, safer collision prediction and more accurate real-time tracking.