Background:The results of the Trial Assigning IndividuaLized Options for Treatment (TAILORx) suggested that approximately 70％ of T1-2N0M0,hormone receptor-positive,human epidermal growth factor receptor 2 (HER2)-negative breast cancer patients can avoid chemotherapy and receive only adjuvant endocrine therapy.We conducted a retrospective analysis of the clinicopathologic features and prognostic factors of patients with breast cancer who met the inclusion criteria of the TAILORx trial.Methods:According to the enrollment criteria of the TAILORx trial,a retrospective analysis was performed on patients with breast cancer who were treated from January 2008 to December 2015 at Peking University First Hospital.The clinicopathologic characteristics of all patients were analyzed,and prognoses were calculated using the Kaplan-Meier method and a Cox proportionate hazards model.Results:A total of 2430 patients with early stage breast cancer who were admitted at our hospital had complete clinicopathologic data and follow-up information.Of these patients,722 met the inclusion criteria and were enrolled in the present study,accounting for 29.7％ of all patients.Among them,417 (57.8％) patients received only adjuvant endocrine therapy (the non-chemo group),and 305 (42.2％) patients received adjuvant chemotherapy followed by adjuvant endocrine therapy (the chemo group).No statistically significant difference was observed in overall survival (OS) between the two groups (non-chemo vs.chemo:5-year OS:97.9％ vs.97.9％,x2=1.00,P =0.995;hazard ratio [HR] =1.00,95％ confidence interval [CI]:0.46-2.21).A significant difference was observed in disease-free survival (DFS) between the two groups (non-chemo vs.chemo:5-year DFS:97.9％ vs.94.7％,x2 =8.65,P =0.003;HR =3.05,95％ CI:1.40-6.67).The choice of adjuvant therapy was associated with clinicopathologic factors,such as the age at diagnosis,T stage,histologic grade,the Ki67 index,the presence of intravascular tumor thrombus (P ＜ 0.001),pathologic type,and menstrual status (P =0.014).Conclusions:In the absence of internationally recognized multigene testing methods,for patients with early hormone receptorpositive,HER2-negative breast cancer,clinicians can develop a treatment plan based on clinicopathologic features only,which can effectively screen some patients who do not need adjuvant chemotherapy.However,nearly half of patients still receive adjuvant chemotherapy,and whether these patients can be exempted from chemotherapy warrants further exploration.

OBJECTIVETo assess the effect of neoadjuvant chemotherapy and the factors related with pathological complete response (pCR) of neoadjuvant chemotherapy in breast cancer.

METHODSThe data of 159 primary breast cancer patients who had received neoadjuvant chemotherapy and operation with complete MRI data and histopathology evaluation in this center from January 2009 to December 2011 was analyzed. All the patients were female, aging from 28 to 70 years with a median of 50 years. The neoadjuvant chemotherapy regimens were based on anthracyclines or taxanes, and trastuzumab was used in almost half of the human epidermalgrowth factor receptor 2 positive patients. The response of neoadjuvant chemotherapy was comprehensively evaluated based on RECIST 1.1 and Miller-Payne grading system. SPSS 18.0 was used for statistical analysis.

RESULTSAmong the 159 patients, 10.1% patients had achieved complete response according to the MRI evaluation, and the rate of partial response, stable disease, and progressive disease was 65.4%, 24.5%, and 0 respectively. According to the Miller-Payne grading system, 27.7% patients had pathological response evaluated as G5 (pCR), and the response evaluated as G4, G3, G2, and G1 were 28.3%, 18.9%, 12.6%, and 12.6% respectively. The higher histological grade were correlated with pCR statistically (Z = -2.820, P = 0.005). Meanwhile strong expression of Ki67 (Z = -1.989, P = 0.047) and p53 (Z = -2.457, P = 0.014) were related to pCR in a significant statistically way.

CONCLUSIONSThe response of neoadjuvant chemotherapy can be predicted. The histological grade and the immunohistochemistry results of Ki67 and p53 are related to pCR of neoadjuvant chemotherapy for primary breast cancer. Basal-like breast cancer had a higher pCR statistically.

Adult ; Aged ; Anthracyclines ; administration & dosage ; Antibodies, Monoclonal ; administration & dosage ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Breast Neoplasms ; drug therapy ; pathology ; Female ; Humans ; Ki-67 Antigen ; metabolism ; Middle Aged ; Neoadjuvant Therapy ; Taxoids ; administration & dosage ; Tumor Suppressor Protein p53 ; metabolism

OBJECTIVETo observe the therapeutic effect and safety of perineal, crissal and progenital pruritus treated with acupuncture according to differentiation.

METHODSSelf-control method was applied in these 32 cases. Changqiang (GV 1), Huiyin (CV 1), Qugu (CV 2), Sanyinjiao (SP 6) and Ashi points etc. were punctured as main points, and adjunct points were added according to differentiation: Taichong (LR 3) and Ququan (LR 8) etc. were added for wind and heat excess of liver meridian, Xuehai (SP 10) and Quchi (LI 11) etc. were added for blood deficiency and wind dryness. Itchiness, skin lesions sign scores and therapeutic effects were observed before and after treatment.

RESULTSThe total scores of itchiness before and after treatment were 6.06 +/- 1.46 and 2.19 +/- 1.71 respectively, and the total scores of skin lesions sign were 4.38 +/- 2.21 and 1.50 +/- 1.44, indicating that the scores and the total scores of itchiness and skin lesions sign reduced obviously after treatment (P < 0.05, P < 0.01); the cured and markedly effective rate was 73.4% (11/15) for wind and heat excess of liver meridian, and 70.6% (12/17) for blood deficiency and wind dryness, presenting similar therapeutic effect (P > 0.05). Hematoma or ecchymosis appeared in 2 cases, and disappeared spontaneously after 2-3 days, without obvious adverse reaction.

CONCLUSIONSimple perineal, crissal and progenital pruritus treated with acupuncture according to differentiation is effective, safe and applicable.

Acupuncture Therapy ; Adolescent ; Adult ; Female ; Humans ; Male ; Middle Aged ; Pruritus Ani ; therapy ; Pruritus Vulvae ; therapy ; Treatment Outcome ; Young Adult

Objective To explore knowledge, attitude, practice (KAP) and related determinants on nutrition among caregivers of those rural stranded children under 7 years of age in China and to provide evidence for setting up relevant health education program. Methods 1691 caregivers of the stranded children randomly selected were surveyed by a standard questionnaire. Logistic regression models were used to screen the determinants on KAP regarding nutrition. Results Rates on awareness, positive attitude and approprite behavior were lower in caregivers of children whose parents both left (47.8%, 55.4%, 41.8%, respectively) the countryside, when compared with those only one parent was away from home (59.9%, 59.5%, 38.0%, respectively). Data from multivariable logistic regression models showed that caregivers' KAP on nutrition was related to age, educational background, average family income, and willingness on the job as well as the age of the child. Conclusion Improving caregivers' KAP on nutrition and setting up appropriate health education program were in urgent need.

Objective To explore the approaches of improving nursing teachers' teaching ability of multicultural education.Methods Strengthened the nursing teacher's education philosophy of multicultural nursing,took the training for nursing teacher's sensitivity to cultural diversity,improved the nursing teachers' multicultural cognition level,reconstructed the multicultural knowledge system,promoted the nursing teacher to use multicultural knowledge.Results The proportion of young teachers got the master's degree and the awards of teaching match was 100％ and over 50％ respectively.Young teachers got the multicultural projects authorized by University of South China and Education Board of Hunan province with more than 10 items,and more than 20 pieces of thesis were established in or over the provincial journal and and published 4 multicultural books.Conclusions The measures of reforming can effectively improve the nursing teachers teaching ability of multicultural education.

Objective To evaluate the bond strength of total-etch or self-etch dentin bonding agents after using two different dentin desensitizers on exposed dentin and investigate the bond interface by scanning electron microscope (SEM). Methods Thirty intact and non-carious human third molars were used. The occlusal enamel was removed with the use of a slow-speed saw under water cooling. These teeth were divided into three groups using a table of random numbers with 10 teeth each. These three groups were treated with water(Group C), UltraEZTM (Group U) and MI Paste (Group M) respectively. Then 10 teeth from each group were divided into A subgroup ( n = 5 ) bonded with Single Bond 2 adhesive system and B subgroup (n=5) bonded with Xeno Ⅲ adhesive system according to manufacturers' instructions. A block of composite resin was build up to 4-5mm. All the teeth were sectioned occluso-gingivally to obtain bar-shaped specimens with bonded surface area about 0. 9 mm × 0. 9 mm. The tension of the sample was tested by a microtensile tester at 1 mm/min. The mean values of bond strength were compared using one-way ANOVA.Three samples were chosen randomly from each of six groups for SEM investigation. Results There were no significant differences between Group U and Group C both in A and B subgroups. While there were significant differences between Group M and Group C in two bonding-agent subgroups. For SEM, the hybrid layer was thin and dense in six groups. Both total-etch and self-etch bonding systems could get fair resin tag infiltration in Group C and Group U. In Group M, the resin tags were relatively shorter and fewer than the anterior mentioned two groups. Conclusions UltraEZTM had no effect on bond strength of both kinds of dentin bonding agents, while MI paste could diminish bond strength.

Background::After neoadjuvant chemotherapy (NAC), non-pathological complete response of breast cancer patients can benefit from tailored adjuvant chemotherapy. However, it is difficult to select patients with poorer prognosis for additional adjuvant chemotherapy to maximize the benefits. Our study aimed to explore whether the subtypes of tumor-infiltrating lymphocytes (TILs) in residual tumors (RT) is related to the prognosis of triple-negative breast cancer (TNBC) after NAC.Methods::Data from patients with primary TNBC consecutively diagnosed at the Breast Disease Center of Peking University First Hospital from 2008 to 2014 were retrieved, and the cases with RT in the breast after NAC were enrolled. TILs subtypes in RT were observed by double-staining immunohistochemistry, and counted with the median TILs value per square millimeter as the cut-off to define high versus low TILs density in each subtype. The relationships between the TIL density of each subgroup and the clinicopathological characteristics of the RT after NAC patients were analyzed by Fisher exact test. Disease-free survival (DFS) and overall survival (OS) were analyzed by the Kaplan-Meier method and log-rank statistics.Results::A total of 37 eligible patients were included in this study, and the median follow-up period was 50 months (range 17–106 months). There was no significant correlation between the infiltrate density of CD4 +, CD8 +, CD20 +, and CD68 + lymphocytes and clinic-pathological characteristics. Significantly better prognosis was observed in patients with high CD4 +-TILs (DFS: P = 0.005, OS: P = 0.021) and high CD8 +-TILs (DFS: P = 0.018) and low CD20 +-TILs (OS: P = 0.042). Further analysis showed that patients with CD4 +/CD20 + ratio greater than 1 (DFS: P = 0.001, OS: P = 0.002) or CD8 +/CD20 + ratio greater than 1 (DFS: P = 0.009, OS: P = 0.022) had a better prognosis. Conclusions::Subtypes of TILs in RT is a potential predictive biomarker of survival in TNBC patients after NAC.

OBJECTIVETo explore the way to induce mesenchymal stem cells (MSCs) to differentiate into dopaminergic neurons in vitro.

METHODSMSCs were obtained from rat bone marrow, cultured and passaged. MSCs used in this experiment had multipotency, which was indirectly proved by being induced to differentiate into chondrocytes and adipocytes. MSCs were cultured in medium containing 0.5 mmol/L IBMX for 2 days. Then the medium was replaced with induction medium, which contained GDNF, IL-1beta, mesencephalic glial-cell-conditioned medium and flash-frozen mesencephalic membrane fragments. The surface markers of the differentiated neurons, such as NSE, nestin, MAP-2a, b and TH were detected by immunocytochemistry and Western blot after MSCs were cultured in induction medium for 7 days and 15 days.

RESULTSMSCs differentiated into neural progenitors and expressed nestin after MSCs were incubated with medium containing IBMX for 2 d. After the medium was replaced with induction medium containing many inducing agents, MSCs differentiated into neuron-like cells and dopaminergic neuron-like cells and expressed NSE, MAP-2a, b and TH. The percentage of NSE-positive cells, MAP-2a, b-positive cells and TH-positive cells was 30.032 +/- 2.489%, 41.580 +/- 5.101% and 34.958 +/- 5.534%, respectively after MSCs were induced in medium containing GDNF, IL-1beta, mesencephalic glial-cell-conditioned medium and flash-frozen mesencephalic membrane fragments for 15 days.

CONCLUSIONMSCs can differentiate into dopaminergic neuron-like cells and are a new cell source for the treatment of neurodegeneration diseases and have a great potential for wide application.

Adipocytes ; cytology ; Animals ; Blotting, Western ; Bone Marrow Cells ; Carboxylesterase ; analysis ; Cell Differentiation ; Cells, Cultured ; Chondrocytes ; cytology ; Culture Media, Conditioned ; Dopamine ; analysis ; Intermediate Filament Proteins ; analysis ; Mesencephalon ; cytology ; Mesenchymal Stromal Cells ; cytology ; Nerve Tissue Proteins ; analysis ; Nestin ; Neurons ; cytology ; metabolism ; Phosphoprotein Phosphatases ; analysis ; Rats ; Rats, Wistar

OBJECTIVETo investigate the relationship between Ki67 expression and tumor response to neoadjuvant chemotherapy with anthracyclines plus taxanes in breast cancer.

METHODSFrom January 2008 to June 2009, 129 patients with primary breast invasive ductal cancer received neoadjuvant chemotherapy with anthracyclines plus taxanes. The expression of Ki67 in the tumor tissues was determined by using immunohistochemistry with core needle biopsy specimens prior to the chemotherapy. The tumor response to the chemotherapy was evaluated by dynamic enhanced MRI based on RECIST2000 criteria, pathologic response was assessed according to Miller-Payne grading system, and the clinical comprehensive response was evaluated based on MRI combined with pathologic response.

RESULTSDynamic enhanced MRI classified 87 cases (67.4%) as effective. According to the Miller-Payne grading system, 99 cases (76.7%) were ranged effective. One hundred and ten cases (85.5%) were recognized as clinically comprehensive effective. The effective rates of neoadjuvant chemotherapy in patients with a Ki67 expression >10% evaluated by the above-mentioned three standards were 73.2%, 81.4% and 89.7%, respectively; and those in patients with a Ki67 expression < or = 10% were 50.0%, 62.5% and 71.9%, respectively. Compared with patients with a Ki67 expression < or = 10%, the patients with a Ki67 expression >10% had better response rates determined by all the three standards (P values were 0.020, 0.030 and 0.010, respectively). The Ki67 expression in the tumor tissue was linearly correlated with clinically comprehensive response on the Linear-Linear association analysis.

CONCLUSIONSThere is a statistic association between Ki67 expression and tumor response to the neoadjuvant chemotherapy with anthracyclines plus taxanes in breast cancer, and the patients with a higher expression of Ki67 has a better tumor response to the chemotherapy.

Adult ; Aged ; Anthracyclines ; administration & dosage ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Breast Neoplasms ; drug therapy ; metabolism ; Chemotherapy, Adjuvant ; Female ; Humans ; Ki-67 Antigen ; metabolism ; Middle Aged ; Prospective Studies ; Taxoids ; administration & dosage ; therapeutic use ; Treatment Outcome

BACKGROUNDEarlier studies have examined the association between the diameter of primary tumors measured by magnetic resonance imaging (MRI) and histopathology in breast cancer patients. However, the diameter does not completely describe the dimensions of the breast tumor or its volumetric proportion relative to the whole breast. The association between breast tumor volume/breast volume ratios measured by these two techniques has not been reported.

METHODSSeventy-three patients were recruited from female patients with primary breast tumors admitted to our center between January and December 2010. They were divided into two groups. Group A (n = 46) underwent modified radical mastectomy (MRM), and Group B (n = 27) underwent preoperative neoadjuvant chemotherapy before MRM. They were examined by dynamic-contrast enhanced MRI (DCE-MRI) to measure breast volumes (BVs), tumor volumes (TVs), and tumor volume/breast volume ratios (TV/BV). These measurements were compared with histopathology results after MRM, and the associations between MRI and pathology were analyzed by linear regression and Bland-Altman analysis.

RESULTSFor Group A, the correlation coefficients for BVs, TVs, and TV/BV ratios measured by the two techniques were 0.938, 0.921, and 0.897 (all P < 0.001), respectively. For Group B, the correlation coefficients for BVs, TVs, and TV/BV ratios were 0.936, 0.902, and 0.869 (all P < 0.01), respectively. The results suggest statistically significant correlations between these parameters measured by the two techniques for both groups.

CONCLUSIONFor these patients, BVs, TVs, and TV/BV ratios measured by DCE-MRI significantly correlated with those determined by histopathology.

Adult ; Aged ; Breast ; pathology ; Breast Neoplasms ; pathology ; surgery ; Contrast Media ; Female ; Humans ; Image Enhancement ; Magnetic Resonance Imaging ; methods ; Mastectomy, Modified Radical ; Middle Aged ; Prospective Studies ; Tumor Burden