Objective:To investigate the clinical, pathological, and prognostic characteristics of luminal B breast cancer patients with diabetes. Methods:A total of 479 luminal B breast cancer patients with diabetes and 3 392 luminal B breast cancer patients without diabetes who were treated between January 2002 and December 2006 were enrolled in this study. The luminal B breast cancer patients were further divided into the luminal B (high ki67) and luminal B (Her-2/neu+) subgroups. Each subgroup was further grouped into metformin-treated, non-metformin-treated, and non-diabetic groups. The indicators included cancer-specific mortality, clinical, pathological stage, lymph node status, chemotherapy, and endocrine therapy. The survival analysis of each group was performed using the Kaplan-Meier method, and the significance was determined using the logrank test. Cox proportional hazard model was used to examine the correlation between each factor and the prognosis. Results:The Kaplan-Meier analysis results revealed that the breast cancer mortality rates in the metformin-treated, non-metformin-treated, and non-diabetic groups were significantly different in both luminal B (high ki67) and luminal B (Her-2/neu+) subgroups (logrank test:P<0.001, P=0.035), and the respective five-year survival rates were 93.5%, 81%, and 89%for the luminal B (high ki67) subgroup and 84%, 77%, and 83%for the luminal B (Her-2/neu+) subgroup. The Cox multifactorial regression analysis results showed that compared with the metformin-treated group, the non-metformin-treated group was associated with a significantly increased risk of mortality (P<0.001, P=0.044) in the two subgroups. Meanwhile, the non-diabetic group was associated with an increased risk of mortality (P=0.038) in the luminal B (high ki67) subgroup only. The percentage of elderly (P<0.001), menopausal (P<0.001), obese (P<0.001), and patients with cardio-cerebrovascular complications (P<0.001) tended to be higher in the metformin-treated and non-metformin-treated groups than in the diabetic group. Moreover, the metformin-and non-metformin-treated groups in the luminal B (high ki67) subgroup were associated with high percentages of T3/4 pathological stage (P<0.001), lymph node metastasis (P=0.001). The non-metformin-treated group was associated with a lower percentage of invasive ductal carcinoma (P=0.001) compared with the other two groups. Conclusion:The non-metformin-treated group resulted in worse clinical outcomes in both subgroups compared with the metformin-treated group. Meanwhile, the non-diabetic group resulted in the worst prognosis among the three groups in the luminal B (high ki67) subgroup. These findings suggest that the choice of different anti-diabetic drugs may influence the prognosis of luminal B breast cancer patients with diabetes.

Objective To investigate Hospital-acquired infections in patients with liver cirrhosis caused by relevant factors.Methods From Jul.2006 to Jan.2011 the clinical data of 476 cases of hospital-acquired infections in patients with decompensate cirrhosis were retrospectively analyzed by case-control study for the effective factors.Results By logistic regression analysis,17 factors are found to affect Hospital-acquired infections ; 16 risk factors:Occupation in manual labor ( OR =4.119,95 ％ CI:2.631-6.325 ) ; Age ( OR =3.014,95 ％ CI:1.163-7.136) ; The cirrhosis disease history ( OR =1.761,95 ％ CI:1.439-2.130) ; Length of stay in hospital (OR =17.354,95 ％ CI:2.539-101.304) ; Interventional procedures ( OR =5.379,95％ CI:2.354-17.594) ;Peotein intake ( OR =3.201,95％ CI:1.539-4.528) ; Alcohol drinking history ( OR =3.158,95％CI:2.274-7.153 ) ; Development of complication ( OR =8.367,95 ％ CI:2.023-11.736 ) ; ALB ( OR =4.613,95％ CI:2.157-9.936 ) ; PCR-HBV DNA quantitative ( OR =3.628,95％ CI:2.245-7.129 ) ; WBC ( OR =3.758,95％ CI:2.276-7.018 ) ; CHE ( OR =3.148,95％ CI:2.202-6.038 ) ; TC ( OR =3.210,95％ CI:2.102-5.107) ;TBIL(OR =2.748,95％ CI:1.283-3.153) ; Antiviral agents (OR =0.257,95％ CI:0.145-0.382 ) ; Preventive application of antibiotics ( OR =3.147,95％ CI:2.236-7.182 ) ; PTA ( OR =2.798,95％CI:1.293-4.182) ;Liver function of Child B and C (OR =4.164,95％ CI:2.236-6.761 ).Conclusion Age,length of stay in hospital,interventional procedures,alcohol drinking history,development of complication,ALB,PCR-HBVDNA quantitative,WBC,TC,Preventive application of antibiotics,liver function of Child are risk factors.Use of anti-virus drug are protective factors.

ObjectiveTo explore the impact of urinary incontinence on women's quality of life, and the effective measures to improve it.MethodsWe conducted a comprehensive literature review to analyze the present research about quality of life on urinary incontinent women and interventions for improving it.ResultsUrinary incontinence influenced patients' quality of life in many aspects, especially in their physical health, mental health, daily living and sexual life. Regular pelvic floor muscle training could prevent and control the incontinence symptoms and improve patients' quality of life.ConclusionsIt is necessary to carry on a series of activities to propagandize that urinary incontinence can be treated, effective measures should be taken to prevent and manage urinary incontinence in order to improve quality of life in urinary incontinent women.

Objective To develop a computer-auto-controlling and analysis system for Tail suspension .Methods Combining the advantage of computer science , engineering and animal behavior into tail suspension test .The “energy”index was developed .The system was validated with antidepressants such as imipramine and paroxetine .Results The measuring principle is based on the energy developed by mice trying to escape from their suspension .During the test, the movements of the mice are analyzed in terms of force , energy and power developed over time .Each mouse issuspended by the tail using adhesive tape to a hook connected to a tail test sensor .The tail test sensor fixed to suspension bar picks up all movements of the mouse and transmits these to a signal regulation unit and transmission circuit , which amplify , filter and digitalizes the signals.The signals are displayed visually in waveform .Activity time, immobility time, energy are continuously updated .The correlation coefficient of “immobility time” collected by computer and manpower was 0.94. Using this system, both imipramine and paroxetine could decreased the immobility time and paroxetine could increased the energy induced by mice ( both P <0.01 ) .Conclusion A stable computer-auto-controlling and analysis system for Tail suspension was established and could be used to screen the antidepressants .

Background:Myopathy due to smooth muscle cells( SMC)abnormalities is involved in the pathogenesis of diabetic gastroparesis(DGP),however,the relationship between myopathy and advanced glycation end products(AGEs)is not fully clarified. Aims:To investigate the ultrastructural changes of gastric SMC in patients with diabetes mellitus( DM)and the relationship between expressions of contractile proteins and AGEs. Methods:Full-thickness gastric specimens from 30 gastric neoplasm patients undergoing gastrectomy from July 2012 to December 2012 at the First Affiliated Hospital with Nanjing Medical University were collected. Of them 15 patients had DM( DM group)and the other 15 patients without ( control group). Ultrastructure of SMC was observed by transmission electron microscopy. Expressions of three contractile proteins[ myosin heavy chains( MHC),α-actin and calponin]and Nε-carboxymethyllysine( CML),the key component of AGEs in gastric muscular layer were determined by Western blotting,and expressions of MHC,α-actin and calponin mRNA were determined by real-time PCR. Correlations of mRNA expressions of three contractile proteins with protein expression of CML were analyzed by Pearson correlation coefficient. Results:In DM group,significant ultrastructural changes were found in gastric SMC,including disruption of gap junction,swelling of mitochondria,occurring of lipofuscin in cytoplasm,increase in cell membrane alveolae,and thickening of basal lamina. Protein and mRNA expressions of muscular MHC,α-actin and calponin were significantly lower in DM group than in control group(P all ﹤0. 01),while protein expression of CML was significantly higher in DM group(P ﹤0. 01). In gastric muscular layer of DM group, negative correlations were found between expressions of MHC,calponin mRNA and CML protein(r= -0. 59,P=0. 02;r= -0. 63,P=0. 01),but no correlation was seen between α-actin mRNA and CML protein(r= -0. 49,P=0. 06). Conclusions:Disruption of SMC ultrastructure,decrease in contractile proteins and increase in AGEs are existed in gastric muscular layer of DM patients,and there is a negative correlation between contractile proteins and AGEs. These changes may cause impaired contractility of SMC,and subsequently lead to gastric motility disorders in diabetic patients.

BacKground:The mechanism of diabetic gastrointestinaI dysmotiIity is stiII uncIear. More and more studies showed that gastrointestinaI smooth muscIe derived factors pIay an important roIe in gastrointestinaI dysmotiIity. RecentIy,the roIe of RhoA/ROCK signaIing pathway in diabetic compIications become a research hotspot. Aims:To investigate the possibIe roIe of RhoA/ROCK signaIing pathway in diabetic coIon dysmotiIity by examining the expressions of major signaIing moIecuIes in diabetic coIon muscIe. Methods:NormaI coIon tissue sampIes taken from patients undergoing radicaI surgery for coIonic cancer from Sept. 2012 to Dec. 2013 at the First AffiIiated HospitaI of Nanjing MedicaI University were coIIected. According to gIycated hemogIobin IeveI,the patients were divided into diabetes meIIitus( DM)group and controI group. The expressions of major signaIing moIecuIes in RhoA/ROCK1 signaIing pathway incIuding RhoA,ROCK1,MYPT1 and p-MYPT1 were determined by immunohistochemistry or Western bIotting. Results:Immunohistochemistry showed that expression of RhoA protein in DM group was significantIy Iower than that in controI group(P<0. 05). Western bIotting showed that expression IeveIs of RhoA,ROCK1 and p-MYPT1 proteins were significantIy Iower in DM group than in controI group(0. 62 ± 0. 42 vs. 1. 15 ± 0. 69,0. 54 ± 0. 09 vs. 0. 75 ± 0. 05,0. 70 ± 0. 28 vs. 1. 04 ± 0. 47;P<0. 05),whereas no significant difference in expression IeveI of MYPT1 protein was found between DM group and controI group(0. 94 ± 0. 50 vs. 1. 21 ± 0. 80,P>0. 05). Conclusions:The inhibition of RhoA/ROCK signaIing pathway in diabetic coIon muscIe may have some correIation with diabetic coIon dysmotiIity.

OBJECTIVE:To establish the method for simultaneous determination of 5 saponins in Lonicerae Flos. METHODS:Using macranthoidin B as a reference,HPLC method was adopted to calculate the relative correction factor(RCF)of it to macran-thoidin A,dipsacoside B,macranthoside A and macranthoside B. The contents of above 4 saponins were calculated through RCF. Using the contents of saponins determined by external standard method as measured value,the calculated value was compared with measured value. RESULTS:The linear ranges of macranthoidin A,macranthoidin B,dipsacoside B,macranthoside A and macran-thoside B were 0.316-6.32 μg(r=0.9973),0.453-9.06 μg(r=0.9982),0.231-4.62 μg(r=0.9996),0.342-6.84 μg(r=0.9984) and 0.147-2.94 μg(r=0.9961),respectively. RSDs of precision,stability and reproducibility tests were all lower than 2.0%. The recoveries were 97.74%-104.51%(RSD=2.37%,n=6)、96.70%-103.20%(RSD=2.37%,n=6)、96.12%-103.61%(RSD=2.45%, n=6)、98.80%-104.70%(RSD=2.32%,n=6)、99.21%-102.92%(RSD=1.39%,n=6),respectively. There was no statistical sig-nificance between calculated value and measured value(P>0.05). CONCLUSIONS:The method is simple,precise,stable and re-producible. It can be used for the determination of saponins in Lonicerae Flos.

Objective To explore the relationship among psychological resilience, self-efficacy and core competence in psychiatric nurses. Methods Totally 237 psychiatric nurses in a psychiatric hospital in Shandong province were recruited and assessed with general information questionnaire, Connor-Davidson Resilience Scale, General Self-Efficacy Scale and Competency Inventory for Registered Nurse. Results The total core competence of psychiatric nurses was (2.59 ± 0.66) points, at a moderate level. Psychological resilience were positively corrected with self- efficacy (r=0.454,P=0.000) and core competence (r=0.647, P=0.000), self-efficacy were positively corrected with core competence (r=0.487, P=0.000). Psychological resilience partially mediate the relationship between self- efficacy and core competence, It′s mediating effect was 44.8%. Conclusions Psychological resilience plays an important role to core competence in psychiatric nurses.Nursing managers should carry out related training, improve the psychological resilience and self-efficacy of psychiatric nurses, and comprehensively improve the level of core competencies.

Objective To explore the clinical phenotype of airways disease in elderly patients using hierarchical cluster analysis.Methods A total of 67 elderly patients with respiratory symptoms were enrolled in a prospective study.Demographic and clinical data,such as respiratory symptoms,cumulative tobacco cigarette consumption,acute exacerbation,atopic symptoms and peak flow diary were collected.Pulmonary function tests,blood tests (total serum IgE level and blood eosinophil level) were performed in each patient during the stable stage.Then patients with different clinical phenotype were identified by hierarchical cluster analysis.Results Four clusters were identified with the following characteristics by hierarchical cluster analysis:cluster 1,atopic patients with no smoking,normal lung function,but increased total serum IgE levels and asthma symptom;cluster 2,patients with no smoking and normal pulmonary function with wheezing but without chronic cough;cluster 3,patients with chronic obstructive pulmonary disease and smoking,severe airflow limitation and poor quality of life;cluster 4,patients with asthma-chronic obstructive pulmonary disease overlap syndrome and smoking,airflow limitation and increased total serum IgE levels.The forced expiratory volume in 1 second (FEV1) / forced vital capacity (FVC) ratio,FEV1/predicted value,rate of FEV1 change,maximal mid-expiratory flow (MMEF)/ predicted value,the diffusion lung capacity for carbon monoxide (DLCO)/alveolar volume (VA)/predicted value,residual volume (RV)/ predicted value,total serum Ig E levels,cumulative tobacco cigarette consumption,the St.George's Respiratory Questionnaire (SGRQ) score had significant differences in patients before versus after treatment (all P＜0.05 or P＜0.01).Conclusions Based on hierarchical cluster analysis,distinct clinical phenotypes of airways disease in elderly patients can be identified.Conclusions With patients having asthma or COPD alone,patients with Asthma-COPD overlap syndrome (ACOS) always experience a more rapid decline in lung function and frequent exacerbations,having poor health-related quality-of-life (HRQOL) outcomes,which deserve our high attention.

Objective To conduct breath test with a relatively large number of subjects for new data regarding breath acetone in diabetes using a high accuracy and high data throughput breath acetone analyzer based on the cavity ringdown spectroscopy (CRDS) technique.Methods The CRDS breath analyzer was validated by standard acetone gas samples with various concentrations and golden standard gas chromatography-mass spectrometry (GC-MS).A total of 917 breath samples from 260 type 2 diabetic (T2D) patients and 30 healthy individuals were collected under each of 4 different conditions: fasting, 2 h post-breakfast, 2 h post-lunch, and 2 h post-dinner, and the samples were tested by the breath analyzer.Results The linear fitting curve of standard acetone samples with various concentration had good linearity (R=1, P＜0.05).The linear fitting of the results of GC-MS and CRDS was 0.98, suggesting that the obtained acetone concentrations using both methods were consistent.For the 260 T2D subjects, the exhaled breath acetone concentrations ranged from 0.0 to 10.6×10-6, while for the 30 healthy subjects, the breath acetone concentration ranged from 0.1 × 10-6 to 2.0× 10-6.The mean breath acetone concentration of the 260 T2D subjects was (1.5±1.l)× 10-6, which was 1.4 times of(1.1±0.5)×10-6 for the 30 healthy subjects.The mean breath acetone concentrations under the 4 conditions for the 260 T2D subjects ((1.6±1.2)×10-6, (1.4±1.0)×10-6~, (1.4±0.9)×10-6, and (1.4±1.2)× 10-6) were higher than that of the 30 healthy subjects ((1.3±0.3)×10-6, (1.0±0.6)×10-6, (1.0±0.6)×10-6, and (1.1±0.4)×10-6), respectively.No correlation was found between the breath acetone concentration and the blood glucose level of the T2D subjects and the healthy individuals.Conclusions The GC-MS validation confirms that the CRDS breath acetone analyzer is a reliable instrument for fast response and on-line breath acetone measurement.An elevated mean breath acetone concentration exists in T2D subjects.The relationship between breath acetone level and physiological parameters needs to be further investigated.