Objective: To explore the relationship between ERCC 1, Ki67, PCNA expression with anthracycline chemotherapeutic drugs′sensitivities in breast cancer tissues.Methods:The ERCC1,Ki67,PCNA expression in 93 breast cancer tissue was detected by immunohistochemical staining.The efficacy of chemotherapy was observed and the difference of anthracycline chemotherapy effect among patients with different ERCC 1,Ki67,PCNA expression was compared.Results:The positive rate of ERCC1 was 65.59%,the positive rate of Ki67 was 69.89%,the positive rate of PCNA was 64.52%.The total effective rate of ERCC 1-positive group was 50.82%,and ERCC1-negative group was 84.38%.In Ki67-positive group,the effective rate of patients in 25%-50%intensity was 73.68%, the effective rate of patients in 50%-75% intensity was 85.71%, the effective rate of patients in >75%intensity was 88.89%, and Ki67-negative group was 60.71%.In PCNA-positive group , the effective rate of patients in 25%-50%intensity was 52.94%, the effective rate of patients in 50%-75% intensity was 62.07%, the effective rate of patients in >75%intensity was 71.43%, and PCNA-negative group was 81.82%.These differences were all statistically significant ( P<0.01 ,P<0.05 , P<0.05).Conclusion: There are correlations between ERCC1,Ki67,PCNA expression with anthracycline chemotherapeutic drugs′sensitivity of patients with breast cancer.Combined detection of multi-factor in clinical is more helpful for the selection of chemotherapy drugs and the formulation of chemotherapy regimen.

Objective To investigate the expressions of excision repair cross complementation group 1 ( ERCC1) and Ki67 in patients with breast cancer, and the relationships between their expressions and sensitivity of platinum-based chemotherapy. Methods Totally, 129 cases were pathologically diagnosed as breast cancer.Paclitaxel and carboplatin were used simultaneously. Chemotherapy regimen was as follows:Gemcitabine 1 000 mg??( m2 )-1 , IV drop on day 1 and 8;cisplatin 25 mg??( m2 )-1 , IV drop on day 1-3, for six cycles ( 21 days a cycle ) . ERCC1 and Ki67 expression in tumor tissue was observed by immunohistochemical analysis.Platinum-based chemotherapy sensitivity and survival of patients with different levels of ERCC1 and Ki67 expression were analyzed. Results In 129 patients, 18 cases were ERCC1 and Ki67 double-negative ( ERCC1-Ki67-) , and the clinical effective rate and 3-year cumulative survival rate were 88.89%and 83.33%, respectively.Twenty-four cases were ERCC1 positive but Ki67 negative ( ERCC1+Ki67-) , and the clinical effective rate and 3-year cumulative survival rate were 50. 00% and 62.50%, respectively.Thirty-three cases were ERCC1 negative but Ki67 positive (ERCC1-Ki67+), and the clinical effective rate and 3-year cumulative survival rate were 54. 55% and 60. 60%, respectively. Fifty-four patients were ERCC1 and Ki67 double-positive ( ERCC1+Ki67+) , and the clinical effective rate and 3-year cumulative survival rate were 22.78% and 31. 48%, respectively.Compared with ERCC1-Ki67- group, the clinical treatment efficiencies of cisplatin-based chemotherapy in ERCC1+Ki67- group, ERCC1-Ki67+ group, and ERCC1+Ki67+ group were significantly decreased ( P<0. 05 ) . The clinical treatment efficiency in patients of ERCC1+Ki67+ group with cisplatin-based chemotherapy was significantly decreased as compared with ERCC1+Ki67- group and ERCC1-Ki67+ group (P<0.05).Compared with ERCC1- Ki67- group, three-year cumulative survival rate in patients of ERCC1+ Ki67- group and ERCC1- Ki67+ group, ERCC1+Ki67+ group was significantly decreased ( P<0. 05 ) . Compared with ERCC1+Ki67-group and ERCC1-Ki67+group, three-year cumulative survival rate in patients of the ERCC1+Ki67+group was significantly decreased ( P<0.05) . Conclusion The expression levels of ERCC1 and Ki67 in breast cancer were high. Their expression levels are closely related with clinical efficiency of platinum-based chemotherapy.

Objective:To analyze the nuclear proliferation in breast cancer tissue related antigen (Ki-67) and proliferating cell nucleus antigen ( PCNA ) expression changes and the relationship between breast cancer and its relationship to breast cancer chemotherapy sensitivity, provide theoretical basis for clinical effective chemotherapy of breast cancer.Methods: Subjects from our hospital in recent years,by clinical examination,84 cases of patients diagnosed with breast cancer,breast cancer tissue were measured with immunohistochemical method of Ki-67 and PCNA content, compared different Ki-67 and PCNA expression levels of patients undergoing chemotherapy curative effect difference.Results:Ki-67 positive cases for 52 cases,PCNA positive cases of 62 cases.Ki-67 positive rate and the patients with lymph node metastasis and tumor classification stage were positively correlated,the difference was sta-tistically significant,P<0.05).The PCNA positive rate and the tumor was closely relative to lymph node metastasis,P<0.05,has nothing to do with tumor clinical classification stage(P>0.05).The total effective rate of Ki-67+was significantly higher than that of Ki-67-(80.8%and 56.2%,P<0.05).Effective rate of PCNA-significantly higher than that of PCNA+(72.7% to 45.2%,P<0.05).Conclusion:Ki-67 clinical data and PCNA expression is closely related to breast cancer and chemotherapy sensitivity.It can be used as a prediction index of curative effect of chemotherapy.

Objective: To evaluate the surgical efficacy of valve replacement for severe paravalvular leakage (PVL) by echocardiogram. Methods: From June 2000 to December 2007, 26 patients with severe PVL were admittted to our hospital. The patients included 19 males and 7 females, with a mean age of 48 years (ranging 33 to 68 years). Severe PVL was reported in 11 cases after aortic valve replacement and 15 mitral valve replacement. The grades of cardiac function was in NYHA III (16 cases) and IV (10 cases). Preoperation echocardiogram combined with intraoperation findings was the main diagnosis approach. Nineteen patients (73.1%) underwent a second valve replacement (RO group) and 7 (26.9%) were managed conservatively (MC group). Results: One patient died of MODS early after operation in the RO group. During 2 months to 8 years follow-up (mean 2.7 years), one patient had recurrence of paravalvular leakage 2 months later and died of heart failure 5 months later after refusing a second operation. In MC group, one patient died of multiple organ failure in hospital; the rest died within 6 months after operation. Conclusion: Surgical treatment for patients with echocardiogram-diagnosed severe PVL should be performed as early as possible. The mortality and morbidity of conservative therapy are extremely high. Re-operation can greatly improve the long-term survival of the patient and the heart function.

Objective: To investigate the surgical procedure for mitral valve prolapse complicated by infective endocarditis. Methods: From June 2000 to December 2007,40 patients with mitral valve prolapse complicated by infective endocarditis received operation in our hospital. The patients included 30 males and 10 females,with a mean age of 39.2 years (ranging 13-63 years). The positive blood culture rate was 42.5% before operation. Combination of echocardiogram with post-operative pathology was the main method for diagnosis. The grades of cardiac function of the patients were in NYHA II (15 cases), III (21 cases)and N (4 cases). Mitral valve repair was performed in 5 patients and mitral valve replacement was done in 35 cases, all with artificial mechanical heart valves. Results: One patient died of renal failure early after operation. One patient had complete AV block and received pacemaker implantation. All the patients had normal body temperature on discharge. During follow-up (mean 2.7 years, ranging 6 months to 8 years), 39 patients survived without later mortality, recurrence of endocarditis and paravalvular leakage. Conclusion: Surgical treatment for patients with mitral valve prolapse complicated by progressive moderate or severe mitral regurgitation and infective endocarditis should be performed as early as possible. Radical debridement of the infected tissues and application of sensitive and high dose of antibiotics are the keys for preventing postoperative endocarditis recurrence. Replacement or annuloplasty should be chosen according to the quality of the valve during surgery. The results of mechanical prosthetic valve are excellent.

In this paper, a segmentation method, supervised FCM, is used to segment multi-spectrum MR imaging. The qualitative evaluation of human brain can be provided by the results for diagnostics. It can improve the results using FCM.

Objective To provide basis for the formulation of policies and measures that will reduce the work pressure on nurses and to provide them with a better working environment. Methods An investigation was made via questionnaires into 942 nurses working in designated SARS hospitals and a comprehensive analysis was conducted by means of multivariant stepwise regression. Results The major factors affecting the pressure on nurses include: lack of support from and communications with families, arduousness of tasks to an unbearable point, extreme strictness in management, and unsoundness of treatment and living conditions. Conclusion Good communications with families are of great significance to nurses working in isolated areas. It is imperative to rationally allocate the human resources of nurses, show more concern for them, encourage them to participate in management, and strengthen scientific prevention so as to create a better working environment.

ObjectiveTo investigate the effect of early intervention on shoulder pain in patients with hemiplegia after stroke. MethodsStroke patients were treated with bedside physical therapy on the shoulder 7 d after onset. They were assessed with short-form McGill pain questionnaire and Fugl-Meyer assessment of upper extremity before and 40 d after treatment. ResultsThe score of MPQ in the treatment group was significantly lower than that in the control group, while the score of FMA was significantly higher(P<0.01). ConclusionEarly intervention can reduce the pain and improve the function of the shoulder in patients with shoulder pain after stroke.

Objective To study drug resistance of carbapenem-resistant Klebsiella pneumonia ( CRKP) in neonates hospitalized in the neonatal unit , and to identify the risk factors for CRKP colonization in neonates .Methods Totally 108 neonates with Klebsiella pneumonia colonization admitted in Department of Neonates , the Second Hospital of Tianjin Medical University during January 2012 and June 2014 were enrolled in the study , including 23 cases with CRKP colonization ( case group ) and 85 cases with carbapenem-sensitive Klebsiella pneumonia (CSKP) colonization (control group).Chi-square test and fisher exact test were used to compare the differences in resistance to 21 antibiotics between CRKP and CSKP . Univariate analysis and Logistic regression analysis were performed to identify the risk factors for CRKP colonization in neonates .Results All of the CRKP strains were resistant to penicillins , cephalosporins and SMZco, and 95.7% and 87.0% of the CRKP strains were resistant to meropenem and imipenem , respectively.All of the CRKP strains were susceptible to amikacin , gentamicin, ciprofloxacin and tetracycline, but were highly resistant to the rest 16 antibiotics compared with CSKP strains (all P<0.05). Univariate analysis showed that 14 factors were associated with CRKP colonization: exposure to cefoxitin (χ2 =20.053, P<0.01), sputum suction (χ2 =15.817, P<0.01), gastrointestinal decompression (χ2 =10.731, P<0.01), nasogastric feeding (χ2 =15.146, P<0.01), invasive procedure (χ2 =22.572, P<0.01), birth weight (χ2 =6.026, P<0.05), frequency of sampling for CRKP/CSKP (χ2 =18.577, P<0.01), hypertension of pregnancy (χ2 =8.698, P<0.01), premature birth (χ2 =4.904, P<0.05), prenatal hospitalization experience (χ2 =8.396, P<0.01), adequacy for gestational age (χ2 =7.295, P<0.05), gestational age (χ2 =7.294, P<0.05), rupture of membranes (χ2 =9.397, P<0.01), length of hospitalization (χ2 =14.649, P<0.01) and admission to the neonatal intensive care unit (NICU) (OR=11.050, P<0.01).Multivariate Logistic regression analysis showed that hypertension of pregnancy (OR=9.718, P<0.01), rupture of membranes ( <24 h) (OR=6.640, P<0.01) and admission to NICU ( OR=4.119, P<0.05) were independent risk factors for CRKP colonization .Conclusions CRKP strains are highly resistant to most antibiotics .Preventing hypertension of pregnancy and rupture of membranes , and monitoring bacterial resistance in NICU may help to reduce the occurrence of CRKP colonization and dissemination .

Objective To study the meaning of breast cancer staging system by AJCC eighth edition to invasive lobular carcinoma and analysis the clinical pathological characteristics.Methods According to the eighth edition of the AJCC staging to evaluate the TNM stage and prognosis evaluation of invasive lobular carcinoma cancer patient in Peking University Shenzhen Hospital from 2011 to 2016,and compared with others in clinical pathological data.Results There were 21 cases of invasive lobular carcinoma,accounting for 2.7％ of all invasive breast cancer.We found that invasive lobular carcinoma shows no significant difference (P ＞ 0.05) in ages,menstrual status,molecular features and anatomic staging and prognosis staging with others;histological grade were significantly different (P ＜ 0.05).There were significant differences in the prognosis and staging of invasive lobular carcinoma.Conclusions Eighth AJCC staging systemn provides a new reference for the clinical treatment of breast cancer,should be evaluated with anatomic stage.Histological grade is relatively good in invasive lobular carcinoma and the prognosis is good,needs more research to the individualized treatment of invasive lobular carcinoma.