Objective To find out the correlation between MMP-13 and clinicopathological parameters of breast cancer and identify clinical significance of MMP-13 overexpression on overall survival of breast cancer.Methods Immunohistochemistry was performed on paraffin-embedded tissue microarray containing 159 tissue dots from breast cancer patients.The intensity and the extent of IHC were scored by pathologists blind to clinicopathological parameters of the specimens.Different expression profiles of MMP-13 in breat cancer tissues and paraneoplastic tissues,and correlation between MMP-13 and breast cancer clinicopathological parameters were analyzed for statistical significance respectively.The impact of MMP-13 overexpression on overall survival of breast cancer.Results MMP13 expression were significantly higher in breast cancer tissues(54.4％) than in their corresponding paraneoplastic tissues(27.5％)(P =0.003).Expression of MMP-13 in breast cancer positively correlated with lymphma node metastasis(r =0.257,P =0.006),clinical TNM classification (r =0.310,P =0.001),HER2 expression (r =0.192,P =0.041).However,no significant correlation were oberserved between MMP-13 expression and tumor size,MMP-13 expression and tumor grade,MMP-13 expression and ER expression,MMP-13 expression and PR expression respectively.Conclusions Overexpress of MMP-13 is more common in breast cancer tissues than in their corresponding paraneoplastic tissues,and is an independent prognosis indicator of breast cancer.

Activated microglia function after pathologic event has been extensively investigated .In recent decades , it has be-come evident that resting microglia cells are highly dynamic surveillants .Microglia could influence synaptic development and connectiv-ity in the normal and developing brain .Microglia dysfunction results in behavioral deficits , indicating that microglia are essential for normal brain function .Here we summarize the functions of microglia in the physiological conditions , its effects on neural development , the formation of synapses and the regulation of the human′s behavior .

Objective To introduce three-dimensional management mode to manage the devices in the operating room so as to reduce the risks.Methods A three-dimensional quality control group was established to strengthen the devices management.From three dimensions of thinking,communication and action some measures were proposed including training for standardized operation and incident treatment,improving guidance,sticking warning signs,advocating active report of adverse events,preventive maintenance and etc.Efficacy inspection and continuous improvement were carried out.Results The examination scores,inspection results and active reports of adverse events were significantly different before and after the introduction of three-dimensional management mode.Conclusion Three-dimensional management mode,in which the three dimensions connect to and cycle through each other,makes nursing staffs progressively develop the habit of safe operation in an environment of safety culture.Three-dimensional management mode is a scientific and applicable management method to reduce risks in using the devices in the operating room.

ObjectiveTo compare the efficacy and side-effects in locally recurrent nasopharyngeal carcinoma (NPC) treated by intensity-modulated radiotherapy (IMRT) and two-dimensional conventional radiotherapy (2DCRT).MethodsAmong the 292 newly diagnosed,nonmetastatic recurrent NPC,211were treated with IMRT and 81 with 2DCRT.All patients were staged according to the seventh edition of the UICC 2009 staging system.Kaplan-Meier and Logrank methods were used for survival analysis.A Cox proportional hazard model was used to examine prognostic factors.ResultsThe follow-up rate was 91.8％,there are 38 patients in 2DCRT and 106 patients in IMRT group was followed more than 3 years.There were significant differences in the 3-year actuarial overall survival (OS) rate ( 36.9％ and 51.3％,x2 =8.44,P =0.004) and local progression-free survival (LRFS) rate (63.3％ and 86.0％,x2 =13.83,P =0.000),and no significant differences in actuarial distant metastasis free survival rates (79.0％ and 83.5％,x2 =0.25,P=0.618 ) between the 2DCRT group and the IMRT group.Multivariate analysis showed that T category and IMRT ( yes vs.no) were the independently prognostic factors for OS and LRFS ( x2 =9.51,5.20,P =0.002,0.023 and x2 =4.84,9.24,P =0.027,0.002 ).The incidence of grade 3and4 trismus and radiation-induced encephalopathy were 19.9％,8.1％ for the IMRT group and 43.2％,24.7％ for the 2DCRT group ( x2 =16.37,P =0.000 and x2 =14.64,P =0.000).Whereas,severe mucosa necrosis and/or massive hemorrhage in the nasopharynx was observed in IMRT group which was not common in 2DCRT (33.2％∶7.4％,x2 =20.19,P=0.000).ConclusionsHigher local tumor control and overall survival were achieved by IMRT than 2DCRT,the incidence of severe trismus and radiation-induced encephalopathy was also reduced by IMRT,in cost of a higher incidence of mucosa necrosis and/or massive hemorrhage in the nasopharynx.

Objective:To analyse the methord and effects of intermaxillary traction(IMT)screws used in the treatment of jaw frac-ture.Methods:In the treatment of 1 68 cases of jaw fracture IMT screws were used for the restoration of normal and stable occlusion. The screw number,position,traction effect and postoperative complications of the treatment were analysed.Results:705 screws were used in 168 patients,4 screws were used in each of 147 cased (88%),6 in 12(7%),5 in 9(5%).336(47.7%)screws were fixed between the roots of first and second premolar,292(41 .4%)between the roots of canine and first premolar,50 (7.1%)be-tween the roots of second premolar and first molar,27(3.8%)between the other tooth roots.Normal postoperative occlusion relation was achived by the use of screws in 92 cases without traction.Occlusion disharmony or deviation was found in 76 cases by the used of screws and was restored to normlal by 1 4-day traction in 71 cases.The total efficiency of the treatment was 97%.Pain of the mucosa surrounding the screws was observed in 23 cases (1 3.7%).Root damage,traction screw loosening and adjacent tooth dislocation were observed in 1 3(1 .8%),1 1 (1 .6%)and 2(0.3%)cases respectively.Conclusion:For the fixation of IMT screws,the posi-tions between tooth root from canine to first molar were most common and safe.The fixation point should be in 5 ~8mm below the gin-gival margin.Use of 4-6 screws can meet treatment need.

Objective To investigate the diagnostic value of high frequency color Doppler ultrasound combined with gastrointestinal filling in infants with duodenal obstruction . Methods One hundred infants who were suspected with duodenal obstruction underwent both gastrointestinal ultrasound and upper gastrointestinal tract ,put the surgical results as the ?gold standard ,the values of ultrasonic and upper gastrointestinal tract in the diagnosis of pediatric congenital duodenal obstruction were compared . Results The diagnostic accuracy of ultrasound and upper gastrointestinal tract in duodenal obstruction was 100%and 94% respectively ,the difference was statistically significant ( P = 0 .041) . The accuracy rate of obstruction location was 98 .04% and 84 .31% respectively , also was considered to denote statistical significance ( P = 0 .023 ) . The total diagnostic accuracy of congenital disorders caused by duodenal obstruction was 89% and 49% respectively ,and P = 0 .001 implies statistically significant difference . Conclusions There is a high diagnostic accuracy in high frequency ultrasound combined with gastrointestinal filling in children with congenital duodenal obstruction ,and the diagnosis of some diseases is better than that of the upper gastroenterography .

Objective:To study the effects of the surgical treatment of nerve avulsion inside and outside the mandibular cannel.Methods:34 patients with trigeminal neuralgia of the third division,received neurotomy and avulsion of inferior alveolar nerve in the mandibular cannel above the lingual or through the mental foramen,concurrently with the avulsion of buccal nerve.Patients were fol-lowed up for 2-4 years.Results:All the operations were successfully completed,The wounds were well-healed.All patients felt that pain disappeared in the area innervated by inferior alveolar nerve.During the 2-4 years of follow-up,no recurrence was found.Conclusion:Inferior alveolar nerve neurotomy and avulsion in the mandibular cannel is simple,safe and effective in the treatment of trigeminal neuralgia of the third division.

Objective: To study the prognostic significance of the subtype of SYT-SSX fusion gene, E-cadherin, β-Catenin and clinicopathologicel parameters for the metastasis of synovial sarcomas. Methods: A total of 98 synovial sar-coma patients with complete clinical and follow-up data were reviewed. RT-PCR was used to detect the subtype of SYT-SSX fusion geneo The expression of E-cadherin and β-catenin was detected by immunohistochemistry. Univariate and multivariate analyses were performed to analyze the influence of the above factors and clinicopathological parameters on the metastasis free survival to explore the factors affecting the metastasis of synovial sarcoma. Results: Of all the pa-tients, 69.4% (68/98) had metastasis during follow-up. The median metastasis free survival was 48 months. The metastasis free 1-, 2-, 3-, 4-, and 5-year survival rate after surgery was 97.5%, 75.5%, 63.5%, 54.0%, and 48.5%, respectively; 31.6% (31/98) patients were found with SYT-SSX1 and 68.4% (67/98) patients with SYI-SSX2. The positive rate of E-cadherin ex-pression was 38.8% (38/98), the positive rate of β-catenin expression was 39.8% (39198) on cellular membrane and 53.1% (52/98) in cellular nucleus/cytoplasm. Univariate analysis showed that age (P=0.003), mitotic figure (P=0.002), histological grade (P=0.001), the subtype fusion gene of SYT-SSX (P=0.014), E-cadherin expression (P=0.015) and β-catenin expres-sion on cellular membrane (P=0.020) were significantly correlated with metastasis free survival of synovial sarcoma pa-tients. Sex (P=0.190), tumor location (P=0.105), tumor size (P=0.180), histological type (P=0.354), necrosis (P=0.451), β-catenin expression in cell nucleus/cytoplasm (P=0.911), radiotherapy (P=0.193), and chemotherapy (P=0.249) had no sig-nificant correlation with metastasis free survival of synovial sarcoma patients. Multivariate analysis revealed that the sub-type of SYT-SSX1 fusion gene (RR=2.505, P=0.003), negative expression of E-cadherin (RR=3.282, P=0.000), patient age (RR=2.157, P=0.004), and grade Ⅲ (RR=1.784, P=0.030) were independent risk factors for metastasis of synovial sarco-ma. Conclusion: The subtype of SYT-SSX, expression of E-cadherin, histological grade and the age of patients are impor-tant factors for evaluating the metastasis and prognosis of synovial sarcoma.

Objective: To study the prognostic significance of cell proliferation and apoptosis, MVD and clinicopathologi-cal parameters for the recurrence of synovial sarcoma. Methods: We analyzed the clinical and follow-up data of 56 synovial sarcoma patients without metastasis. RT-PCR was used to detect the subtype of SYT-SSX fusion gene. The expression of Ki67 and MVD was detected by immunohistochemistry. Univariate analysis was employed to analyze the influence of the above factors and clinicopathological parameters on the recurrence free survival and to explore the influencing factors for the recurrence of synovial sarcoma. Results: Of all the patients, 73.2% (41/56) had recurrence during the follow-up. The median recurrence free survival was 19.5 months. The recurrence free 1-, 2-, 3-, 4-, and 5-year survival rates after surgery were 45.0%, 41.0%, 34.0%, 28.0%, and 28.0%, respectively. Ki-67 labeling index (LI) was 19.98%±11.64% and MVD was 51.83±21.92 per ×400. There was no significant difference in apoptotic index (AI) between the two groups (P=0.607). Χ~2 analysis showed that histological type (P=0.000) and MVD (P=0.045) were significantly correlated with the recurrence of sy-novial sarcoma. Univariate analysis showed that Ki67 LI (P=0.009), histological type (P=0.012) and radiotherapy (P= 0.014) were significantly correlated with the recurrence free survival of synovial sarcoma patients. Sex (P=0.015), tumor lo-cation (P=0.411), tumor size (P=0.801), necrosis (P=0.486), MVD (P=0.454), chemotherapy (P=0.272), and apoptotic grade (P=0.899) were not correlated with the recurrence free survival of synovial sarcoma patients. Multivariate analysis re-vealed that higher expression of Ki67 (RR=1.944, P=0.045), radiotherapy (RR=0.482, P=0.04), and histological type (RR= 0.207, P=0.031) were independent risk factors for the recurrence of synovial sarcoma. Conclusion: The expression of Ki67, radiotherapy and histological type are important factors for evaluating the recurrence and prognosis of synovial sarcoma.

Objective Establish a method for measuring the activities of Galactocerebrosidase (GALC), α-Glucosidase(GAA), α-Galactosidase (GLA) and α-L-Iduronidase (IDUA) in dried blood spots specimen by tandem mass spectrometry ( MS/MS ).Methods A total of 2175 dried blood spot samples forinborn errors of metabolism in neonatalscreening center of Shanghai Xinhua hospital were collected in July and November, 2013.And twenty dried blood spot samples from patients withlysosomalstorage disorders( LSDs) of Shanghai Xin Hua Hospital were collected from September 2012 to January 2014.The extraction of DBS was incubated with enzyme substrates and internal standards.After liquid-liquid and solid-phase extraction, the extraction solution was dried under nitrogen and reconstituted.Then enzyme reaction products and internal standards were analyzed by MS/MS.Linearity, precision, accuracy and the limit of detection were evaluated.2175 dried blood spot samples were detected to establish the normal reference range for the activities of four enzymes according to 0.5th to 99.5th percentiles.20 specimens from patients withLSDs were detected to verify the reference range inclinical judgment.Results The intraassay and interassay precisions ranged from 1.7%to 11.8%, and the intraassay and interassay accuracies ranged from 85%to 115%.The linear coefficients for measured concentration of enzyme products/internal standards and theoretical concentration were 0.997-0.999.The limits of detection forGALC, GAA, GLA and GLA were 0.03 μmol/(L· h), 0.09 μmol/(L· h), 0.12 μmol/(L· h) and 0.16 μmol/(L· h) .The normal reference values for GALC, GAA, GLA and GLAwere 0.51-8.51μmol( L· h) ,1.99-22.22μmol/( L· h),1.68-41.59 μmol/(L· h) and 2.36-19.21 μmol/(L· h).The enzymes of 20 patients with LSDs were remarkably decreased compared to the normal range.The Krabbe, Pompe, Fabry, MPSⅠpatients can be effectively detected by this MS/MS method.Conclusions A MS/MS method for measuring GALC, GAA, GLA and IDUA enzyme activities in DBShas been established.