Purpose:To investigate the prognostic factors f or local-regional control and survival in patients with regional lymph nodes re currence following mastectomy. Methods:Seventy-seven patients with their first recurrences in the regional lymph nodes treated during 1994-2003 were retrospectively analyze d. The recurrence were confined to supraclavicular region in 45 patients, in axi llary nodes in 16 patients, in internal mammary nodes in 6 patients, and with mo re than one lymph node region involved in 10 patients. The median follow-up was 34.4months. All patients were treated with radiotherapy to a total dose ranged from 50-74 Gy with a median dose of 60 Gy. Results:The median survival time was 4.67 years with 2-,5-an d 8- year survival rate of 77.8%,47.4% and 31.5% respectively. Disease-free i nterval, hormonal-receptor status were independent prognostic factors for survi val. Thirty patients had a second recurrence either in the original recurrent si te (4 patients) or in the other local-regional sites (26 patients). Chest-wall was the most frequently involved site for second recurrence, with 18 patients h ad a second recurrence including chest-wall, representing 23% of the whole coho rt. The axillary lymph nodes metastatic status of primary surgery was the only i ndependent prognostic factor for local control. Conclusions:Radiotherapy provides an efficient treatment for re gional lymph nodes recurrence following mastectomy. Twenty-three percent of pat ients present a second recurrence involving chest-wall, which suggests the sign ificance of an elective radiation to the chest-wall, especially in patients wit h 4 or more lymph nodes involved in primary surgery. Sub-group with a disease- free interval of more than 2 years, receptor positive has a better survival. The role of systemic treatment in the regional lymph nodes recurrent patients has n ot been established.

Objective To evaluate the outcome , side effects and prognosis of prostate carcinoma treated with external radiotherapy. Methods From 1990 to 1999, a total of 45 prostate carcinoma patients were treated. Four cases were lost during follow up. Forty one patients underwent orchiectomy before radiation therapy , 29 received orchiectomy combined with hormone treatment. All patients received conventional radiation therapy with a median dose of 68.3 ?Gy (50.4 75.9?Gy), 1.8 2.0?Gy per fraction, five fractions weekly. Results The median follow up duration was 28 months (1 111 months). The overall 5 year survival was 76.4% and the 5 year disease specific survival was 76.5%. In terms of acute GI side effects, the frequencies of Grade Ⅰ, Ⅱ or Ⅲ reactions were 53.5%, 7.0% and 9.3% while Grade Ⅰ or Ⅱ , acute GU side effects were 41.9% and 4.7%, respectively. For the long term deleterious effects,Grade Ⅰ or Ⅱ in GI late complications were 16.7% and 7.1% and the GU late morbidities of Grade Ⅰ,Ⅱ or Ⅲ were 23.8%, 4.8% and 2.4%, respectively. Regional lymph node metastasis was closely correlated with both overall survival (P= 0.002 ) and disease specific survival (P= 0.002 ). Multivariate analysis revealed, only regional lymph node metastasis was of prognostic value to predict the overall survival and disease specific survival. Conclusion The outcome of radiation therapy for patients with T 2 T 4 prostate carcinoma is satisfactory with the side effects tolerable to most patients.

Objective On basis of physical dose optimization, LQ model was used to investigate the difference between the curves of biological effective dose and physical isodose. The influence of applying the biological dose concept on three dimensional conformal radiotherapy of prostate carcinoma was discussed. Methods Four treatment plannings were designed for physical dose optimization: three fields, four-box fields, five fields and six fields. Target dose uniformity and protection of the critical tissue -rectum were used as the principal standard for designing the treatment planning. Biological effective dose (BED) was calculated by LQ model. The difference between the BED curve drawn in the central layer and the physical isodose curve was studied. The difference between the adjusted physical dose (APD) and the physical dose was also studied. Results Five field planning was the best in target dose uniformity and protection of the critical tissue -rectum. The physical dose was uniform in the target, but the biological effective doses revealed great discrepancy in the biological model. Adjusted physical dose distribution also displayed larger discrepancy than the physical dose unadjusted. Conclusions Intensified Modulated Radiotherapy (IMRT) technique with inversion planning using biological dose concept may be much more advantageous to reach a high tumor control probability and low normal tissue complication probability.

Objective To observe the antihypertensive effect of indapamide combined with enalapril on spontaneously hypertensive rats(SHRs).Methods Forty SHRs were randomly divided into 4 groups: control,indapamide,enalapril,and indapamide+enalapril(n=10 in each group).Medicine in varied doses was given to rats by intragastric administration.Variations of weight,heart rate and blood pressure were measured. Results Varied doses of medicine did not exert significant effects to the weight and heart rate of SHRs during and after the administration.In indapamide+enalapril group,the pressure of SHRs was significantly decreased with varied doses compared to that before the administration(P

Objective To investigate the factors related to choice of community health service centers (CHSCs) in standardized training general practitioners (GPs) in Shanghai.Methods Totally 152 GPs,(including those of Traditional Chinese Medicine) who completed the residency training in 2013 and signed employment contract with community in Shanghai were surveyed with a self-designed questionnaire.Results Among all the participants,113 (74.3％) attached the greatest importance to the salary level when choosing CHSC,58 (38.2％) expected annual salary more than 120 000 Yuan during the first 3 years.GPs tended to work in the city center(40.1％) or CHSCs near to their home(38.2％),mainly because of the job commuting (59.9％).Considering career development,the CHSCs with high level comprehensive service (51.3％) and with large population (5.0％) were more attractive.GPs paid more attention to the national demonstration community (57.2％) and CHSCs with member ofShanghai outstanding young physician training program(51.7％).In this survey,household register was the main influencing factor for choosing CHSCs,Shanghai natives paid more attention to the location of the community than those not Shanghai natives (61.8％ vs.34.2％),more inclined to CHSCs that close to their house (55.3％ vs.21.1％),non-Shanghai natives preferred authorized strength (51.3％ vs.28.9％).GPs of Western medicine expected higher salary than GPs of TCM (x2 =13.648,P ＜ 0.05),Males expected higher salary than females (x2 =7.799,P ＜ 0.05),Conclusions GPs pay the most attention on salaries and tend to work in the city central area,prefer CHSC with high level comprehensive service and large served population.The main factor influencing GPs to chose CHSCs is the household register,the category of Gps and gender.

Objective: To investigate the seroprevalence and influencing factors of serum neutralizing antibodies among SARS-CoV-2 infected individuals, so as to provide the evidence for developing the health management and COVID-19 vaccination strategy among SARS-CoV-2 infected individuals. Methods: Recovered SARS-CoV-2 infected individuals from January 1st, 2020 to February 10th, 2021 in Zhejiang Province were recruited in March 2021. Participants' demographics, underlying diseases, date of definitive diagnosis and severity of clinical symptoms were collected using questionnaire surveys, and serum neutralizing antibody against SARS-CoV-2 was detected using a fluorescent immunoassay. In addition, factors affecting the seropositivity of neutralizing antibody against SARS-CoV-2 were identified using a multivariable logistic regression model. Results: A total of 559 SARS-CoV-2 infected individuals were enrolled, including 480 confirmed cases and 79 asymptomatic carriers, with an median (interquartile range) age of 47.00 (22.00) years, and all participants had never received COVID-19 vaccination. The median (interquartile range) duration from diagnosis to serum sampling was 387.00 (11.00) days, and the seroprevalence of neutralizing antibody against SARS-CoV-2 was 83.90%. The serum neutralizing antibody against SARS-CoV-2 was all positive 9 months after diagnosis, and the seroprevalence of neutralizing antibody against SARS-CoV-2 appeared no tendency towards a decline with time within 14 months after diagnosis (P>0.05). Multivariable logistic regression analysis showed that women were 1.892 times (95%CI: 1.169-3.064) more likely to produce serum neutralizing antibodies against SARS-CoV-2 than men, and mild, common and severe/critically ill SARS-CoV-2 infected cases were 2.438 (95%CI: 1.305-4.557), 4.481 (95%CI: 2.318-8.663), and 23.525 (95%CI: 2.990-185.068) times more likely to produce serum neutralizing antibodies against SARS-CoV-2 than asymptomatic carrier, respectively. Conclusions The seroprevalence of neutralizing antibody was 100.00% among SARS-CoV-2 infected individuals within 9 months after diagnosis. Individuals' gender and severity of clinical symptoms correlate with the seroprevalence of neutralizing antibody against SARS-CoV-2.

This study was aimed to analyze the environment and situation of patent strategy implementation of manufacturing industry of Chinese patent medicines in G uangdong province . This article pointed out that G uang-dong Chinese patent medicines manufacturing implementation patent strategy faced huge opportunities and chal-lenges. It was suggested that the fully understanding, mastering and using of beneficial conditions as well as con-trolling and eliminating the adverse factors will contribute to the better implementation of Chinese patent medicines manufacturing patent strategy in G uangdong province .

Objective To study the association between house dust endotoxin levels and the airway responsiveness as well as allergen sensitization in adolescence in the urban and rural areas of Guangdong province.Methods Middle school students,aged 13-14,188 (male 109,female 79) from Guangzhou,129(male 70,female 59) from Conghua with positive responses,and 231 (male 125,female 106) and 307(male 145,female 162) of their respective reference students are selected from questionnaire prescreening.A detailed questionnaire,the lung function test,histamine bronchial provocation test,skin prick test and peripheral blood eosinophil count are undertaken.Seventy-six students from Guangzhou and 80 from Conghua were selected randomly for mattress dust sample collection to detect the levels of endotoxin.Results The prevalence of wheeze symptom,diagnosed asthma,nasal symptoms and allergic rhinitis of Guangzhou was significantly higher than that of Conghua (P＜0.0001),with 28.6％,27.7％,66.0％,46.4％ for Guangzhou respectively,and 5.0％,2.5％,31.0％,6.2％ for Conghua respectively.The positive rates of bronchial provocation test and skin sensitization against Dermatophagoides pteronyssinus(Der.p),D.farinae (Der.f),cat and dog allergen in the students of Guangzhou were significantly higher than that of Conghua (P＜0.0001).The positive rate of cockroach of Conghua was significantly higher than that of Guangzhou (P＜0.0001).The levels of endotoxin (amount,concentration and load) of samples from Conghua were significantly higher than that from Guangzhou (Conghua:6452 EU,10.95 EU/mg,1794 EU/m2 ;Guangzhou:1591 EU,6.45 EU/mg,508.80 EU/m2,respectively).PD20-FEV1 was correlated positively with endotoxin amount(r=0.174,P＜0.05).The diameters of the skin wheal size for Der.p and Der.f were correlated inversely with endotoxin amount and load (P＜0.001).Conclusion The prevalence of wheeze symptom,diagnosed asthma,nasal symptoms and allergic rhinitis in 13-14 year-old adolescent of Guangzhou was significantly higher than that of Conghua.Cockroach was the second major allergen of Conghua followed by house dust mite.The level of endotoxin was correlated positively with PD20-FEV1,but correlated inversely with skin sensitization to Def.p and Der.f.The study suggests that environmental endotoxin may have effect to protect children from developing allergic diseases.

Breast cancer is the leading cause of malignancy-related mortality in women worldwide. The more accurate prediction of lymph node metastasis and evaluation of personalized prognosis of breast cancer patients could provide evidence and reference for individualized comprehensive treatment and clinical decision-making. Nomogram is statistical calculation model developed to generate individualized prediction of a certain clinical event through the factors associated with it. Currently breast cancer related nomogram models is most commonly used in the prediction of non-sentinel lymph node status in patients with sentinel lymph node-positive breast cancer, sentinel lymph node metastasis in clinical node-negative breast cancer and prognosis evaluation of breast cancer. This article reviewed the recent advances in breast cancer related nomograms according to the above mentioned three aspects, and evaluated respectively the predictive factors, accuracy, characteristics and clinical application potential.

ObjectiveTo explore the regulation of claudin-4 expression in endometrial adenocarcinoma cell lines by progesterone.Methods Ishikawa cells were treated with various concentrations of megestrol acetate (MA:2,5,10,15,20 mg/L).After cultured for 24,48 and 72 hours,cells growth were measured by methyl thiazolyl tetrazolium (MTT).The group of Ishikawa cells incubated with MA at the 50％ inhibitory concentration ( IC50 ) was selected for cell apoptosis assay by using transmission electron microscopy and flow cytometry method.Real-time PCR and western blot were used for detecting the mRNA and protein expression levels of claudin-4.The localization of claudin-4 was examined by immunofluorescent staining.Results The inhibitory effects of megestrol acetate on the growth of Ishikawa cells were dosedependent and time-dependent.IC50 of MA on Ishikawa cells was 15 mg/L after incubated for 72 hours.After MA treatment,Ishikawa cells showed shrinkage,nuclear chromatin condensation,fractures of nuclear membrane and endoplasmic reticulum expansion,even round apoptotic bodies were found.The apoptosis rate of cells before MA treatment was (0.076 ±0.024)％,and the rate was (3.934 ±0.816)％ by MA treated for 72 hours,in which there were signicant difference( P ＜ 0.05 ).The relative quantification of claudin-4 mRNA and protein of the cells before MA treatment were 0.64 ± 0.20 and 0.94 ± 0.18,while they were 0.47 -0.15 and 0.62 ±0.15 after MA treated.The expression of claudin-4 was significantly decreased after MA treatment ( P ＜ 0.05 ).The localization of claudin-4 transferred from cytomembrane to cytoplasm and nucleus after MA treatment.Conclusions MA could inhibite the growth of Ishikawa cells,in which the mechanism may be decrease the expression of claudin-4 and the apoptosis of cells.The distribution change of claudin-4 may be related to the anti-cancer effect of progesterone.