It has been shown that the PIK3CA mutation in HER2 positive breast cancer is up to 25%, and thus activates PI3K-Akt signaling pathway,promotes HER2 mediated tumor cell epithelial transformation, alters the intrinsic phenotype of HER2 overexpression breast cancer,and finally leads to resistance to anti HER2 targeted therapy.Some studies have shown that the PIK3CA gene mutation is associated with the efficacy of anti-HER2 targeted therapy.Therefore,real-time monitoring of PIK3CA gene mutation will promote indivi-dualized anti-HER2 targeted therapy.

ObjectiveTo investigate the disinfection effects of two different methods on the ventilator circuits. MethodsThe ventilator circuits which had been used by patients were disinfected by the artificial brushing method and the strict program of the full automatic cleaning-disinfecting machine,respectively.Samples from circuits were cultured after disinfection,and the numbers of bacterium colony forming unit (CFU) were counted. ResultsThe qualified rate of disinfection of the ventilator circuits by the strict program of the full automatic cleaning-disinfecting machine was 100％,which was significantly higher than that by artificial brushing method.50 samples disinfected by artificial brushing method were selected,among which 14 samples had pathogenic bacteria.100 samples disinfected by the strict program of the full automatic cleaning-disinfecting machine were selected and total bacterial count≤5 cfu/cm2. ConclusionsThe sterilization of the ventilator circuits with the full automatic cleaning-disinfecting machine is effective and safe,which can make the disinfection work more standardized.

Triple negative breast cancer is a subtype of breast cancer with poor prognosis and lack of effective treatment. Cyclin dependent kinase (CDK) 4/6 inhibitors promote antitumor immunity by influencing the triple negative breast cancer immune microenvironment, such as increasing the tumor cell surface pragrammed death-ligand 1 protein expression, enhancing T cell activation and antigen presentation, changing the proportion of T cell subgroup and inducing lymphocyte infiltration. The change of immune microenvironment is related to tumor progression, but its mechanism is extremely complex. Exploring the mechanism of CDK4/6 inhibitor affecting immune microenvironment and its biomarkers can provide a new direction for the diagnosis and treatment of triple negative breast cancer.

Objective:To explore the effects of FOCUS-PDCA management on the improvement of disinfection quality of flexible endoscopes.Methods:From January 2018 to February 2020, a total of 124 flexible endoscopes and 23 nurses in Endoscopy Center of The First People's Hospital of Shangqiu were selected as the research objects by the convenient sampling method. From January 2018 to January 2019, the flexible endoscopes that were disinfected by conventional methods were set as the control group ( n=62) . From February 2019 to February 2020, the flexible endoscopes treated with Focus-PDCA disinfection were set as the observation group ( n=62) . The implementation status of the cleaning and disinfection specifications, the incidence of validity management defects and the quality of disinfection management of flexible endoscopes were compared between the two groups. Results:The observation group's flexible endoscope cleaning, disinfection specifications, and management evaluation scores were higher than those of the control group, and the differences were statistically significant ( P<0.01) . The disinfection and management defects of the flexible endoscope in the observation group were lower than those in the control group, the completeness rate of cleaning and disinfection records, the standard rate of cleaning operations, the qualification rate of biological test results, and the implementation rate of disinfection protection measures in the observation group were all higher than those of the control group, the differences were statistically significant. ( P<0.05) . Conclusions:The FOCUS-PDCA management model can effectively improve the cleanliness and disinfection quality of flexible endoscopes, which is worthy of clinical promotion.

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 explore the effects of post level management and secondary performance distribution in the Central Supply Service Department.Methods:From January 2019, the job categories, job labor intensity, technical risk level, division of professional staff, specialist training, job description revision, job capability and other aspects of all staff ( n=67) of Central Supply Service Department of the First People's Hospital of Shangqiu, Henan were set up, and the competitive employment mechanism was applied. Based on the total amount of performance issued by the Nursing Department according to the total number of people in the disinfection supply center, the scientific design and implementation of post performance secondary assessment distribution and post promotion were carried out according to post workload, work quality, technical research, service satisfaction and so on. Results:The difference in the results of comprehensive skills assessment of nurses before and after the performance of secondary assessment and distribution management was statistically significant ( P<0.05) . The difference of job satisfaction of disinfection and supply center among different departments was statistically significant ( P<0.05) . There was statistical significance in the comparison of quality control defects in quality control examination of department ( P<0.05) . In the democratic evaluation of staff, 43 were very satisfied with the performance distribution, 3 were dissatisfied. The content of dissatisfaction was the coefficient in lactation has no difference from other posts. Conclusions:The implementation of the post level management and secondary performance assessment in the Central Supply Service Department has stimulated the potential of nurses at all levels, aroused their enthusiasm for work, and set up goals for everybody. All staff participating in the management improved the work efficiency and quality, guaranteed the nursing safety and the work operation, achieving the satisfactory effect.