Objective To investigate the expression and clinical significance of androgen receptor (AR) and embryonic stem cell associated transcripts 4 (NANOG) in breast cancer patients with human epidermal growth factor receptor 2 (HER-2) over-expression, and to analyze its relationship with clinicopathologic features of breast cancer. Methods 143 breast cancer patients with HER-2 over-expression were selected from the screening of 1052 cases of invasive breast cancer according to estrogen receptor (ER), progesterone receptor (PR) and HER-2 status. The protein expression of AR and NANOG was assayed by using immunohistochemistry.The relationship between AR expression and clinicopathological features was analyzed by χ2 test. The correlation between AR expression and NANOG expression was analyzed by Spearman correlation analysis. Results The positive expression of AR was 35.7 % (51/143). The AR expression was not associated with age and menstruation status (both P>0.05), and was associated with tumor size, clinical TNM staging and lymphatic metastasis (all P< 0.05). The positive rate of NANOG were 53.1 %(76/143), and NANOG proteins were negative in adjacent normal breast tissue and benign breast lesions. The positive rate of AR was 27.6%(21/76) in NANOG-positive cases, whereas the positive rate of AR was 44.8%(30/67) in NANOG-negative cases, and the difference was statistically significant (χ2=4.526, P=0.033). There was an inverse correlation between NANOG and AR expressions (r= -0.255, P= 0.002). Conclusion AR and NANOG may be new targets for endocrine therapy and molecular biological therapy.

Objective To compare the clinical efficacy and the complications of two ventilation modes in the premature infants with neonatal respiratory distress syndrome(NRDS).Two different noninva-sive ventilation methods,synchronized nasal intermittent positive pressure ventilation(SNIPPV) and nasal continuous positive airway pressure(NCPAP) combined with Curosurf were used in the treatment of patients with NRDS.Methods A retrospective study was conducted in 46 infants with NRDS admitted to our hospi-tal during January 2016 to December 2017. The subjects were divided into SNIPPV group(n =24) and NCPAP group(n =22),respectively combined with Curosurf treatment. PaO2,PaCO2,oxygenation index (OI)(PaO2/FiO2),duration of oxygen therapy,noninvasive ventilation time,reintubation cases for the use of pulmonary surfactant,starting time of feeding,length of hospital stay,incidence of abdominal distention, intracranial hemorrhage,air leakage and other complications were compared between the two groups before and after treatment.Results After treatment,the blood gas indexes of PaO2and OI at 24 h both in the two groups were significantly higher than those before the treatment(P<0.05).After treatment,PaCO2was lower in both SNIPPV group and NCPAP group,but there was no statistical difference between the two groups(P>0.05).The OI at 24 h[(219 ± 23)mmHg,1 mmHg=0.133 kPa] was significantly higher in SNIPPV group than that in NCPAP group[(199 ± 26)mmHg](P<0.05).There was no difference in PaO2,PaCO2and OI between the two groups before treatment.Duration of oxygen therapy,starting time of feeding,the time of using noninvasive ventilation,length of hospital stay were shorter in SNIPPV group[(82.8 ± 11.7)h vs. (107.6 ± 20.3)h,(32.0 ± 8.0)h vs.(47.0 ± 7.2)h,(62.3 ± 10.8)h vs.(99.6 ± 17.1)h,(12.0 ± 3.5)d vs.(15.0 ± 3.8)d] than those in NCPAP group,the differences were statistically significant(P <0.05). Reintubation cases for the use of pulmonary surfactant and the incidence rate of abdominal distension, intracranial hemorrhage,air leakage showed no statistical significance between the two groups(P>0.05). Conclusion SNIPPV and NCPAP combined with Curosurf treatment have similar clinical effects in premature infants with NRDS. While SNIPPV can reduce the starting time of feeding,the time of using noninvasive ventilation,duration of oxygen therapy,length of hospital stay in the patients with NRDS,and the clinical effect is more significant.

Objective To investigate the significance of permissive hypercapnia( PHC) in the treat-ment of neonates with respiratory failure using synchronized nasal intermittent positive pressure ventilation. Methods A retrospective study was conducted in 47 neonates with respiratory failure admitted to our NICU during January 2015 to December 2017. The subjects were divided into PHC group ( n =27, PaCO245 ～70 mmHg,1 mmHg=0. 133 kPa) and non-permissive hypercapnia( non-PHC) group( n=20,PaCO235～45 mmHg),respectively. The blood gas indicators(PaO2,PaCO2,PaO2/FiO2) before and after non-invasive ventilation treatment were compared;Ventilator parameters of the two groups ( PIP, PEEP, PiO2 , Ti ) were compared. Duration of oxygen therapy,non-invasive ventilation time,starting time of feeding,length of hospi-tal stay,the incidence of intracranial hemorrhage,air leakage,ventilation induced lung injury,and reintubation rate were compared between the two groups. Results After treatment,the blood gas indexes of PaO2 and OI at 24h in two groups were significantly higher than those before the treatment(P<0. 05). There was no sig-nificant difference on PaO2 and OI between two groups both before and after treatment. PaCO2 was lower in non-PHC group after treatment than that before the treatment(P<0. 05),but it showed no difference in PHC group (P>0. 05). The PIP value of the ventilator parameters in PHC group[(19. 9 ± 2. 7) mmHg] was sig-nificantly lower than that in the non-PHC group[(21. 7 ± 2. 3) mmHg](P<0. 05),and there was no statisti-cally significant difference between the two groups in the other ventilator parameters(P>0. 05). Duration of oxygen therapy,starting time of feeding,the time of using noninvasive ventilation,length of hospital stay in PHC group were shorter obviously than those in non-PHC group [ ( 79. 5 ± 10. 8 ) h vs. ( 92. 7 ± 19. 1 ) h;(34.3±8.8)hvs.(47.1±10.8)h;(67.4±12.3)hvs.(97.6±17.3)h;(11.0±4.6)dvs.(14.0±3.9) d](P<0. 05). The incidences of air leakage,and intracranial hemorrhage showed no significant difference between PHC group and non-PHC group(3/27 cases vs. 4/20 cases;3/27 cases vs. 2/20 cases)(P>0. 05). There was no significant difference between the two groups in the rate of reintubation of invasive ventilation after non-invasive ventilation failure ( 2/27 cases vs. 3/20 cases, P > 0. 05 ) . The incidence of ventilator induced lung injury was significantly lower in PHC group than that in non-PHC group ( 2/27 cases vs. 7/20 cases) ( P<0. 05 ) . Conclusion The effects of treating respiratory failure were similar in PHC group and non-PHC group. However,the PHC treatment could shorten the time of oxygen therapy,non-invasive ventila-tion time and hospitalization time,reduce the incidence of lung injury associated with ventilator. The clinical efficacy of PHC was more significant.

Objective:To understand the relationship between occupational stress and carotid atherosclerosis in police population of Tianjin City.Methods:A total of 866 male police officers who underwent medical examination and treatment were selected as the survey object. A uniformly designed health questionnaire and occupational stress scale were used for epidemiological investigation. The blood pressure, blood sugar and blood lipid testing, and carotid ultrasound examination were conducted. Multi-factor unconditional logistic regression model was used for statistical analysis.Results:According to the norms of occupational stress of security service personnel, the classification standards of occupational tasks and individual nervous, occupational stress levels were divided into low, moderate, medium and high level. The possibility of occurring CAS in the civilian police population with high and medium individual nervous is 4.37 (95% CI: 1.92~11.59) and 3.28 times (95% CI: 1.84~5.62) than that in the police without nervous. The possibility of occurring CAS in the civilian police population with medium and high level of occupational tasks is 0.19 times (95% CI: 0.06~0.32) and 0.26 times (95% CI: 0.07~0.53) than that in the police with low level of occupational tasks. Conclusions:Occupational stress may be an independent risk factor for CAS occurring in the police population. Therefore, regular psychological counseling is particularly important for the physical and mental health of the police population, which can alleviate occupational stress and psychological pressure.

ObjectiveTo explore an appropriate way and its effect on neonatal resuscitation training in Uygur area of Xinjiang, China.MethodsFrom October 2014 to February 2015, obstetricians, neonatologists (pediatricians), midwives and anesthetists from Turpan Region Central Hospital, Turpan City People's Hospital,Aksu Region First People's Hospital and other five hospitals at county level were chosen to attend the training course of neonatal resuscitation. The textbook for the course was Guidelines for Resuscitation which had been translated to Uygur language from English and the class was lead by less than ten Uygur trainees with Mandarin and Uygur when necessary in addressing some difficult or important points. The duration of theoretic courses took 6 h and the operational course took 8 h. Theorectical exam was taken before, immediately after and three months after (before re-training) the training. The accuracy rate was applied to assess the effect of training through evaluation for each resuscitation techniques. Repeated measures analysis of variance andChi-square test were used for statistical analysis.ResultsA total of 220 health care staff were included in the study. The average score of theoretical examination after the training was higher than that before (85.68±8.52 vs 65.37±12.08,t=18.532,P=0.000), and that before re-training was lower than that after training (80.08±12.70 vs 85.68±8.52,t=-4.943,P=0.000). After the training, the proportions of Done in each item, including rapid assessment, preliminary resuscitation, correct positive pressure artificial ventilation, external cardiac massage together with artificial ventilation, proper endotracheal intubation and proper administration of resuscitation drugs, were all higher that those before [72.7%(160/220) vs 1.4%(3/220), 40.0%(88/220) vs 0%(0/220), 15.9%(35/220) vs 0%(0/220), 37.7%(83/220) vs 8.2%(18/220), 51.8%(114/220) vs 5.9%(13/220) and 48.2%(106/220) vs 10.5%(23/220), allP<0.01]. But at the time before re-training, only one proportion ofDone which was higher than those immediately after initial training was proper administration of resuscitation drugs [49.6%(109/220) vs 48.2%(106/220),χ2=9.129,P<0.05].ConclusionBilingual (Mandarin and Uygur) neonatal resuscitation training in Xinjiang minority areas might enhance the recovery skills for local medical personnel.

Objective To investigate the effects of alveolar epithelial cells (AEC) on bronchopulmonary dysplasis(BPD) induced by hyperoxia in newborn rats.Methods The model of BPD induced by hyperoxia in neonatal rats was established.HE staining was used to observe the alveolar septum and alveoli development.The expression of the specific surfactant protein C (SPC) on type Ⅱ alveolar epithelial cells (AEC Ⅱ) and the expression of specific aquaporin 5 (aquaporin5 AQP5) on type Ⅰ alveolar epithelial cells (type Ⅰ alveolar epithelialcells,AECⅠ) were measured by immunohistochemistry.Results There was no significant difference of AQP5 between experimental groups and control group at 1 d,but significantly lower expression of AQP5 could be seen in experimental group1 on day3 (P ＜ 0.05).And then,the AQP5 level of lung tissue of newborn rats at 5,7,14d after experiment in groupl was significantly lower than that of in air control group (P ＜ 0.05).The expression of SPC protein had no significant difference between experimental groups and control group at 1 d,but the SPC level of lung tissue of newborn rats at 3,7,14d after experiment in group1 was significant lower than that of in air control group (P ＜ 0.05).Conclusion Hyperoxia exposure leads to the expression of SP-C and AQP5 decreased,which may be key points for the development of BPD.AECⅡ may play an important role in the repairation of alveolar epithelial cells in neonatal rats with BPD induced by hyperoxia.

Objective To investigate the distribution of pathogenic bacteria characteristics and antimicrobial susceptibility results in children with positive urine culture specimen in order to provide some references for the clinical rational use of antimicrobial agents.Methods The pathogenic data of children in our hospital in 2017 with positive urine culture specimen were collected and statistical analyzed.Results A total of 364 strains of 23 pathogens have been isolated,which the Escherichia coli was dominant,accounting for 41.21％ (150strains).followed by Enterococcus faecium (18.41％),Klebsiella pneumoniae (14.29％) and Enterococcus faecalis (7.15％).Different pathogenic bacterias have varying degrees of drug resistance to commonly used antibiotics.The drug resistance rates of Escherichia coli to ampicillin,piperacillin,cefmenorr and cefazolin were 88.36％,85.71％,81.58％ and 81.16％.The drug resistance rates of Enterococcus faecium to ampicillin,clindamycin and penicillin G were 100％;the drug resistance rates of Klebsiella pneumoniae to ampicillin,tetracycline,cefazolin and cefuroxime axetil were 96.08％,92.31％,82.98％ and 80％;All Enterococcus faecalis detected were sensitive to qulnupristin/dalfopristin and clindamycin.Conclusion Escherichia coil,Enterococcus faecium,Klebsiella pneumoniae and Enterococcus faecalis ate common pathogens in positive urine culture of children.Clinicians should use antibiotics reasonably according to the pathogenic characteristics.

Immune checkpoint inhibitors(ICIs)are an emerging tumor treatment approach following traditional surgery,chemoradiotherapy and targeted therapy.They have proven to be effective in a variety of cancers.However,they may induce immune-related adverse events(irAEs)during treatment,which may affect patients'quality of life and lead to treatment interruption or cessation.The key to preventing irAEs is early evaluation and identification of medical staff.Therefore,this article reviews the clinical manifestations and influencing factors of irAEs to help the early identification of high-risk groups and provide reference for clinical nursing work.

Objective Summarizes the current research status of defensive medicine in China and provides references for future research.Methods The search period spans from the inception of the database to March 2024.CNKI,Wan-fang Data,Web of Science,PubMed databases were queried,followed by literature screening based on predeter-mined inclusion and exclusion criteria.The current landscape of defensive medicine research in China was synthe-sized and categorized based on fundamental research characteristics,measurement methodologies,influencing fac-tors,and other relevant aspects.Results A total of 24 Chinese literature sources and 4 foreign literature sources were incorporated,indicating a prevalent occurrence of defensive medicine in China.Measurement tools for defen-sive medicine exhibit variability across different studies.Key influencing factors encompass doctor's demographic vari-ables such as gender,age,and professional status,institutional factors like legal frameworks and medical in-surance,and sociol-cultural factors such as doctor-patient relationships and adverse public perceptions.Conclusion Defensive medicine is relatively widespread and influenced by various factors in China.It's urgent to explore the for-mation mechanism of defensive medicine from multiple perspectives and provide evidence for passive defen-sive medicine governance.

Objective To clarify the influencing factors of defensive medicine and provide ideas for preventing and re-solving defensive medicine.Methods Literature related to defensive medicine was searched,personnel related to de-fensive medicine were interviewed,and literature and interview data were coded with the method of grounded theo-ry,and related concepts and categories were summarized.Results After three levels of coding,52 initial concepts,23 initial categories,7 sub-categories and 3 main categories were sorted out,and the correlation among influencing factors was analyzed to build a three-dimensional model of"doctor-patient relationship-institutional system-social environment"influencing factors and their mechanism of action.Conclusion The influencing factors of defensive medi-cine mainly include doctor-patient relationship,institutional system and social environment.The three factors have an impact on defensive medicine through different mechanisms of action,which provides qualitative evidence for comprehensive analysis of factors in related studies of defensive medicine.