Objec ive: o inves iga e he effec s of differen dose of bisoprolol on neurohormonal ac ivi y,cy okines,cardiac func ion,cardiac dea h in chronic sys olic hear failure pa ien s Me hods: One hundred and wen y chronic hear failure pa ien s were randomly divided in o large dose group (average 8 5? 1 2 mg) and small dose group (average 3 5?1 2 mg) he changes of norepinephrine (NE) ,angio ensionⅡ (AngⅡ) ,aldos erone (Ald) ,endo helin (E ) ,in erleukin 6 BF (IL 6) , umour necrosis fac or ? ( NF ?) Q ,plasm rennin ac ivi y (PRA) ,cardiona rin (ANP) ,brain na riure ic pep ide (BNP) ,cardiac func ion,cardiac dea h were observed Resul s:Af er rea men , he hear ra e were decreased in wo groups, p

Objective To evaluate the efficacy and safety in treatment of patients with mild to moderate Alzheimer’s disease (AD). Methods A total of 233 patients with mild to moderate potential AD were enrolled in a 16-week multi-center double blind clinical trial. All patients were randomized into two groups. 110 patients in galantamine group and 108 patients in donepezil group were enrolled in efficacy analysis. The scales of Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-cog), Alzheimer’s Disease Cooperative Study Activities of Daily Living Scale (ADCS-ADL) and The Neuropsychiatric Inventory (NPI) were used to assess the effect at both baseline and the end of 16 weeks. Safety issues, including vital signs, lab assays and ECG examinations were measured. Results Patients in both groups were obviously improved in the total score of ADAS-cog (-5.4?6.4) in the galantamine group and (-4.0?7.3) in the donepezil group, P=0.098). 76% patients of the galantamine group had a score of ADAS-cog less than 20 at the end of 16 weeks treatment, which was higher than that of the donepezil group (58%, P=0.015). The sub-score of speech ability in ADAS-cog were improved in the galantamine group (baseline 2.8?2.9,16 weeks 1.8?2.5) compared with the donepezil group (baseline 2.8?3.0, 16 weeks 2.3?2.9, P=0.035). No significant difference of ADSC-ADL and NPI scale was found between the two groups (P=0.447 and 0.936 respectively). The sleep/night behavior was improved in the donepezil group (baseline 14%, 16 weeks 10%) compared with the galantamine group (baseline 23%, 16 weeks 22%, P=0.012). Two drug-related severe adverse events occurred during the trial, which were platelet reduction in the galantamine group and acute drug-induced hepatic injury in the donepezil group. The incidence of adverse events was 44% in the galantamine group and 47% in the donepezil group respectively. Galantamine had little influence on vital signs and lab assays. Conclusion Safe and well tolerated, galantamine improves the cognition, activities of daily living and neuropsychiatric symptoms of patients with mild to moderate AD.

Objective:To investigate the effects of a loading dose of clopidogrel hydrogen sulfate on hemorheology and neurological function in patients with acute progressive cerebral infarction.Methods:A total of 110 patients with acute progressive cerebral infarction who received treatment between January 2018 and January 2019 in the Affiliated Hospital of Shaoxing University, China were included in this study. They were randomly assigned to receive either conventional treatment (control group, n = 55) or treatment with a loading dose of clopidogrel hydrogen sulfate based on conventional treatment (study group, n = 55) for 2 weeks. Hemorheological parameters, National Institute Health of Stroke Scale (NIHSS) scores and adverse reactions were compared between the study and control groups. Results:After treatment, the levels of hemorheological parameters in both groups were obviously decreased. Plasma viscosity, high-shear whole blood viscosity, low-shear whole blood viscosity, fibrinogen level and hematocrit in the study group were (1.01± 0.37) mPa/s, (4.23 ± 0.35) mPa/s, (8.36 ± 1.64) mPa/s, (1.23 ± 0.28) g/L, (40.08 ± 5.04) %, respectively, which were significantly lower than those in the control group [(1.84 ± 0.52) mPa/s, (5.44 ± 0.39) mPa/s, (10.54 ± 1.79) mPa/s, (2.30 ± 0.37) g/L, (44.36 ± 5.12) %, t = 5.485, 8.594, 9.523, 7.789, 11.236, P = 0.019, 0.006, 0.004, 0.007, 0.001]. After treatment, NIHSS scores in the study group were significantly lower than those in the control group [(3.11 ± 1.17) points vs. (6.43 ± 2.25) points, t = 10.416, P = 0.003). There was no significant difference in the incidence of adverse reactions between study and control groups [5.45% (3/55) vs. 9.09% (5/55), χ2 = 0.539, P = 0.463). Conclusion:The loading dose of clopidogrel hydrogen sulfate is highly effective in the treatment of acute progressive cerebral infarction and it can greatly improve hemorheological parameters and neurological function.

Objective: To study the clinicopathological characteristics and the prognostic determinants of the invasive lobular carcinoma breast cancer. Methods: This was a retrospective single-center study of invasive lobular breast cancer cases diagnosed from January 2008 to December 2014 at Peking University First Hospital Breast Disease Center. The study enrolled 68 invasive lobular breast cancer patients, which represented 3.64% (68/1 870) of total invasive breast cancer. The median age of all selected patients was 46 years ranging from 36 to 83 years. All patients were restaged based on the 8^th edition of AJCC cancer staging system and follow-up data including disease-free survival (DFS) and overall survival (OS) were analyzed to explore the prognostic determinants. The 5-year OS and DFS were calculated using Kaplan-Meier method; the significance of correlations between clinicopathological features and prognostic factors was estimated using log-rank test. Results: There were significant differences in OS between patients with different anatomic stage, prognostic stage, lymph node metastasis, progesterone receptor (PR) expression, lymphvascular invasion and perineural invasion (χ^2: 4.318 to 32.394, all P<0.05); significant differences in DFS were also observed between patients with different anatomic stage, prognostic stage, lymph node metastasis, PR expression, human epidermal growth factor receptor-2 expression, Ki-67 level, histological grade and lymphvascular invasion (χ^2: 4.347 to 27.369, all P<0.05). Prognostic stages of 52.9% patients changed compared with anatomic stage, among which Luminal subtype mainly downstaged (22/30), however, triple negative subtype mainly upstaged (6/6). Conclusions Anatomic stage, prognostic stage, lymph node metastasis, PR expression, lymphvascular invasion are the prognostic factors of invasive lobular breast cancer. Regard to invasive lobular breast cancer patients, clinicians should pay close attention to the differences between prognostic stage and anatomic stage.

Objective: To discuss the androgen receptor (AR) expresion and its association with clinicopathological features and prognosis in early stage triple-negative breast cancer patients (TNBC). Methods: The present study retrospectively analyzed the clinic data of 1 018 patients with early-stage invasive breast cancer treated at the Breast Disease Center at Peking University First Hospital between January 2014 and December 2016, including 1 011 females and 7 males; the age range was 21 to 92 years, and the median age was 57 years. Patients with TNBC were enrolled, and divided into AR positive group and AR negative group according to the expression of AR.The clinicopathological features were analysed, including menopause status, pathological type, T staging, lymph node involvement, anatomic staging, prognostic staging, Ki-67 index, histological grade, vascular tumor thrombus and neuroinvation, and the correlation between the expression of AR and clinicopathological features, curative effect of neoadjuvant chemotherapy and prognosis were calculated. The Student’s t test was used to compare continuous data, the Pearson χ² test or Fisher exact test was used to compare categorical variables, and the Mann-Whitney U test was used for quantitative data. The Kaplan-Meier method was used to analyze survival status, and comparisons between groups were calculated by the log-rank test. Results: This study included 148 TNBC, accounting for 14.5% of all patients, in which all patients were females, and the median age was 55 years, ranging from 27 years to 75 years. The number of AR-positive TNBC was 59, accounted for 39.9% of all TNBC patients, and the numbers of AR-negative were 89, accounted for 60.1%. Ki-67 index, histological grade and prognostic stage were significantly different in AR-positive and AR-negative TNBC(P<0.05). There was no statistically significant difference between AR-positive TNBC and AR-negative TNBC in OS (98.3% vs 95.4%, P=0.830) or in DFS (91.4% vs 91.0%, P=0.812). Among TNBC who received neoadjuvant chemotherapy, AR-positive patients showed a lower pCR rate than AR-negative patients(χ²=4.381, P=0.046). Conclusions AR expression is associated with lower respond to neoadjuvant chemotherapy in TNBC. However, the association between AR expression and prognosis in TNBCs was still not clear.

Objective:To systematically evaluate the attitudes and experiences of nursing assistants in nursing homes on physical restraint, so as provide a reference for regulating and reducing the physical restraint.Methods:Cochrane Library, PubMed, Embase, EBSCO, Web of Science, China Biology Medicine (CBM) , China National Knowledge Infrastructure, WanFang Data, VIP and other domestic and foreign databases were searched by computer. The retrieval time limit was from the establishment of the database to June 2021. The quality of the article was evaluated using the quality evaluation criteria for qualitative research of the Joanna Briggs Institute Evidence-Based Health Care Center in Australia, and the Meta synthesis was used to summarize and interpret the results.Results:A total of 7 articles were included, and 58 results, 11 categories and four synthesis results were extracted. That was, the factors that affected the implementation of physical restraint (the elderly's own factors, the factors of nursing assistants, the influence of other personnel, the factors of elderly care institutions) , the attitude towards physical restraint (support attitude, opposition attitude and neutral attitude) , emotional experience and release methods (emotional experience and ways of release) , existing deficiencies and suggestions for restraint use (existing deficiencies, related suggestions) .Conclusions:The use of physical restraint in elderly care institutions is the result of many factors. Nursing assistants have positive, negative and neutral attitudes and emotional experiences in the implementation of physical restraint, and based on their rich clinical experience, they can find existing problems in restraint use and make relevant suggestions. Relevant departments need to fully consider the interests of all parties when formulating physical restraint norms and restraint reduction strategies, and effectively solve the problem of physical restraint abuse from the root cause.

Objective To explore the correlation between lumbar spine bone mineral density and the occurrence of large rotator cuff tears.Methods A total of 109 patients with arthroscopic shoulder surgery in the Department of Arthroplasty Surgery in Kunshan Hospital of Traditional Chinese Medicine from January 2018 to October 2023 were selected and divided into large rotator cuff tear group(n=27)and small rotator cuff tear group(n=82)according to the severity of the rotator cuff tears.Gen-eral materials of patients were collected,and multivariate Logistic regression analysis was used to in-vestigate the correlation between lumbar spine bone mineral density and the occurrence of large rotator cuff tears.Results The large rotator cuff tear group had significant higher age and higher proportion of patients with a history of trauma compared to the small rotator cuff tear group(P＜0.05);addition-ally,the levels of total cholesterol,albumin,serum magnesium,total hip bone mineral density,and lumbar spine bone mineral density were significantly lower in the large rotator cuff tear group(P＜0.05).The results of multivariate Logistic regression analysis indicated that lumbar spine bone mineral density was associated with the occurrence of large rotator cuff tears.The prevalence of large rotator cuff tears across the four quartile intervals of lumbar spine bone mineral density named as Q1(＜0.870 g/cm2),Q2(0.870～＜0.991 g/cm2),Q3(0.991～1.137 g/cm2),and Q4(＞1.137 g/cm2)were 48.15％,29.63％,18.52％and 3.70％respectively,showing a gradual decreasing trend with significant differences(P＜0.05).Conclusion There is a correlation between lumbar spine bone mineral density and large rotator cuff tears.The lower the bone density of the lumbar spine is,the higher the risk of large rotator cuff tears will be.

Objective To explore the correlation between lumbar spine bone mineral density and the occurrence of large rotator cuff tears.Methods A total of 109 patients with arthroscopic shoulder surgery in the Department of Arthroplasty Surgery in Kunshan Hospital of Traditional Chinese Medicine from January 2018 to October 2023 were selected and divided into large rotator cuff tear group(n=27)and small rotator cuff tear group(n=82)according to the severity of the rotator cuff tears.Gen-eral materials of patients were collected,and multivariate Logistic regression analysis was used to in-vestigate the correlation between lumbar spine bone mineral density and the occurrence of large rotator cuff tears.Results The large rotator cuff tear group had significant higher age and higher proportion of patients with a history of trauma compared to the small rotator cuff tear group(P＜0.05);addition-ally,the levels of total cholesterol,albumin,serum magnesium,total hip bone mineral density,and lumbar spine bone mineral density were significantly lower in the large rotator cuff tear group(P＜0.05).The results of multivariate Logistic regression analysis indicated that lumbar spine bone mineral density was associated with the occurrence of large rotator cuff tears.The prevalence of large rotator cuff tears across the four quartile intervals of lumbar spine bone mineral density named as Q1(＜0.870 g/cm2),Q2(0.870～＜0.991 g/cm2),Q3(0.991～1.137 g/cm2),and Q4(＞1.137 g/cm2)were 48.15％,29.63％,18.52％and 3.70％respectively,showing a gradual decreasing trend with significant differences(P＜0.05).Conclusion There is a correlation between lumbar spine bone mineral density and large rotator cuff tears.The lower the bone density of the lumbar spine is,the higher the risk of large rotator cuff tears will be.

OBJECTIVESTo evaluate the value of ultrasound (US) in predicting axilla status and to investigate the clinic pathologic characters in the axillary node metastasis.

METHODSFrom June 2012 to June 2013, 323 female primary breast cancer patients who received both axilla ultrasound and pathology examinations were reviewed retrospectively. The features of axillary nodes including diameter, longitudinal-transverse axis ratio, cortical thickness and blood flow grade were used to evaluate axillary status. US accuracy of axillary node metastasis was analyzed correlated with the final pathology results. The clinical and histological features associated with axillary node metastasis was analyzed by χ² test.

RESULTSThe proportions of Luminal A-like, Luminal B-like, human epidermalgrowth factor receptor-2 positive and triple negative breast cancer were 11.1% (36/323), 58.5% (189/323), 13.3% (43/323) and 17.0% (55/323) . The sensitivity, specificity, positive predictive value and negative predictive value of axilla US in the diagnosis of nodal metastasis were 35.6% (46/129), 98.9% (181/183), 95.8% (46/48) and 68.6% (181/264). Axillary lymph node metastasis had statistically significant correlation with menopausal status and clinical tumor size (χ² = 4.337, 11.100; P = 0.037, 0.001).

CONCLUSIONSStandardized ultrasound is the basic way to evaluate axilla status. Sentinel lymph node biopsy should be done to acquire accurate preoperative staging of axilla when US shows no signs of metastasis. Axillary lymph node metastasis is significantly related to menopausal status and clinical tumor size, but not significantly related to subtype classification of primary breast cancer.

Axilla ; Breast Neoplasms ; pathology ; Female ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; diagnostic imaging ; Neoplasm Staging ; Retrospective Studies ; Sensitivity and Specificity ; Sentinel Lymph Node Biopsy ; Ultrasonography

OBJECTIVESTo explore the clinical and pathological characteristics of stage IV breast cancer and to analyze their relationship with the morbidity and prognosis.

METHODSThe records of 66 patients presenting from January 2008 to December 2014 with stage IV breast cancer were reviewed. All of the patients were women and the median age was 57.5 (31 to 80) years, accounted for 3.01% (66/2 189) among the breast cancer patients treated in the same period. Statistical methods were used to analyze the correlation between clinical and pathological characteristics such as T-stage, N-stage, immuno-histo-chemistry and the morbidity and prognosis of stage IV breast cancer. The influence of patients characteristics to metastasis were compared by χ(2) test. Kaplan-Meier curves were reported for overall survival (OS), and the Log-rank test was used to compare the difference in groups. Cox proportional models were fitted for multivariate analysis.

RESULTSThe median survival time of stage IV breast cancer was 56.0 months and the 5-year survival rate was 40%. To metastasis, the effects of age, subtypes, histological grade, hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2)had no significant statistics differences. It was concluded that the expression of HER2 (P=0.003) and HR (P=0.001) as well as single metastasis (P=0.029) were the influencing factors of the survival by multivariate Cox regression analysis. Primary tumor R0 surgery group and no surgery group had no significant statistics differences of overall survival and the 5-year survival rate (P=0.102).

CONCLUSIONSClinical and pathological characteristics have no effect on metastasis. The expression of HER2 and HR as well as single metastasis play important roles in survival.

Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms ; Female ; Humans ; Middle Aged ; Multivariate Analysis ; Neoplasm Staging ; Prognosis ; Proportional Hazards Models ; Receptor, ErbB-2 ; Survival Rate