Objective To explore the effects of herceptin on the serum tumor markers in patients with HER-2 positive advanced breast cancer treated with chemotherapy and its influence on the immune function.Methods Seventy-six patients with HER2-positive advanced breast cancer from January 2013 to June 2014 in Xiangyang No.1 People's Hospital Affiliated to Hubei University of Medicine were divided into the observation group (38 cases) and the control group (38 cases),fifty healthy subjects in the same period were selected as the blank group.The control group received gemcitabine combined with capecitabine,gemcitabine 1000 mg / m2 via intravenous infusion in the first and eighth day,capecitabine 2500 mg/m2 via intravenous drip from the first day to fourteenth day;the observation group were given trastuzumab on the basis of the control group,4 mg/kg for the first time,then 2 mg/kg,1 time/week,three weeks for a course,have been given for four courses.The peripheral blood lymphocyte subsets were detected by flow cytometry,the Carcinoembryonic antigen (CEA),cancer-associated glycoprotein antigen (CA153) and tissue polypeptide specific antigen (TPS) were detected by enzyme-linked immunoassay.The short-term efficacy,survival and adverse reactions incidence rate in the two groups were compared.Results (1) The clinical benefit rate of the observation group was higher than that of the control group (89.47% vs.63.15%,χ2=8.508,P<0.05),the 1-year survival rate of the observation group was 65.79%,the control group was 39.47%,the difference was statistically significant (χ2=5.278,P<0.05),the 2-year survival rate of the observation group was 42.11%,the control group was 21.05%,the difference was statistically significant (χ2=3.897,P<0.05).(2) The CD3+,CD4+ and CD4+/CD8+ of the observation group and the control group after treatment were (51.5±5.2)%,(52.7±4.4)%,(24.1±5.6)%,(26.7±5.0)%,(0.81±0.10),(0.86±0.13),respectively,which were lower than those collected before treatment (t=5.734,4.824,6.056,5.428,3.602,3.643,P<0.05)),there were no significant differences in lymphocyte subset between the observation group and the control group before and after treatment (P>0.05),the CD3+,CD4+,CD4+/CD8+ of the observation group and the control group after treatment were significantly lower than those of the blank group (F=14.484,9.371,8.213,P<0.01).(3) The CEA,CA153 and TPS of the observation group and the control group after treatment were (5.05±2.03) μg/L,(7.25±2.70)μg/L,(36.04±12.05) IU/ml,(55.42±18.23) IU/ml,(262.43±53.38) IU/ml,(355.21±47.80) IU/ml,which were significantly lower than those before treatment (t=8.743,3.805,7.929,5.271,9.512,6.389,P<0.05),the observation group was significantly lower than the control group (t=3.353、3.665、3.442,P<0.05).(4) The incidence rate of pain and fever in the observation group were 34.21% and 28.95%,respectively,which were significantly higher than those in the control group,the difference was statistically significant (χ2=15.683,12.862,P<0.01).Conclusion Trastuzumab can synergistically reduce the serum tumor marker content in the treatment of patients with HER 2-positive advanced breast cancer,effectively improve the short-term efficacy of conventional chemotherapy,extend the life span,without the cause of significant damage to the immune function,but it can significantly increase the incidence rate of pain and fever,so it is necessary to carry out targeted method to improve chemotherapy compliance.

Against the backdrop of ongoing healthcare system reform and escalating competitions among hospitals in China,more and more specialists and scholars on hospital administration begin to focus their studies on the theories and practice of hospital flows.Methodology frequently called into play in such study include out-patient flow refom,progressive flow improvement,and attention to management and service.Discussed in this paper are the advantages and disadvantages of these three methods as a reference for an appropriate choice by hospitals at large.

Objective To study the effect of the PDCA management on safety management of venous transfusion by indwelling needles?.Method The measures included standardizing nurses manipulation,improving the management system related to venous transfusion,and regulating details management process for tube fixing and dressing and tube maintenance.Results The rates of unstandardized maintenance and obstruction of tubes after the enforcement of details management were significantly lower than those before its enforcement(P<0?05).Conclusions PDCA management is effective for standardizing nursing implementation and ensuring the safety of venous transfusion by indwelling needle?

Objective To compare the prognosis of sentinel node-positive breast cancer patients forgoing axillary lymph node dissection.Methods A systematic literature search (Medline,Embase,Cochrane Library)ended in April 2014 was performed to identify all eligible articles.Two reviewers independently screened and extracted data.RevMan5 was used for statistical analysis.Results A total of 1026 abstracts were retrieved and 18 clinical controlled studies finally included,the total number of patients were 47 894,7389 had micrometastases in sentinel lymph node,35 217 had macrometastases in sentinel lymph node and 5288 had positive sentinel lymph node regardless of micrometastases or macrometastases.For patients with MIC,the 5-year axillary recurrence rate,5-year disease free survival and 5-year overall survival had no significant difference between patients who only received sentinel lymph node biopsy and patients who received further axillary lymph node dissection,(OR =1.78;95％ CI:0.72-4.39,P=0.21),(OR =0.76,95％CI:0.56-1.04,P=0.08),(OR=0.77,95％CI:0.43-1.40,P=0.39).For patients with MAC,the 5-year axillary recurrence rate had no significant difference between patients who only received sentinel lymph node biopsy and patients who received further axillary lymph node dissection,(OR =1.21;95％ CI:O.76-1.91,P =0.42).For patients with positive sentinel lymph node regardless of micrometastases or macrometastases,the 5-year axillary recurrence rate and 5-year overall survival had no significant difference between patients who only received sentinel lymph node biopsy and patients who received further axillary lymph node dissection,(OR =1.29;95％ CI:0.92-1.80,P =0.14),(OR =0.96,95％ CI:0.64-1.45,P =0.84).Conclusions Among patients with limited positive SLN of breast cancer,patients forgoing ALND compared with ALND did not have obvious affect on long-term survival.

Digestive tract reconstruction is an important part of gastric carcinoma operation as well as tumor resection and lymph node dissection.Surgeons are seeking the optimal reconstruction method that reduces the occurrence of complications and maintains better quality of postoperative life extremely.Uncut Roux-en-Y anastomosis is a modified procedure in which an artificial jejunal occlusion is devised to avoid Roux stasis syndrome based on Billroth Ⅱ and Braun's anastomosis.Compared to the conventional Roux-en-Y anastomosis,the uncut Roux-en-Y anastomosis retains the advantage of preventing biliary and pancreatic secretions reflux,furthermore,it can decrease the symptoms associated with Roux stasis owing to the abnormal myoelectrical conduction of Roux limb.Because the early studies indicated that there was higher incidence of dehiscence or recanalization of the jejunal occlusion,the uncut Roux-en-Y anastomosis has not been widely applied.Since jejunal occlusion has been optimized recently,the uncut Roux-en-Y reconstruction may be an optional and appropriate method of digestive tract reconstruction after distal gastrectomy.

Aim To study the effect of 2,3,4′,5-tetrahydroxystilbene-2-O-?-D glucoside(TSG) on vascular smooth muscle cells(VSMCs) proliferation induced by fetal bovine serum and explore the underlying mechanisms.Methods VSMCs were cultured from rat aorta using explant technique.VSMCs proliferation was analyzed by 5-bromo-2-deoxyuridine(Brdu) incorporation assay.Cell cycle phase distributions were determined by flow cytometry.The expression of proliferating cell nuclear antigen(PCNA) was evaluated by Western blot analysis.The level of intracellular reactive oxygen species(ROS) was estimated through fluorescence assay.The intracellular activities of superoxide dismutase(SOD),catalase(CAT),and glutathi one peroxidase(GSH-px) were measured using biochemical method.Results TSG in the experimental concentration 0.1～100 ?mol?L~-1 exhibited no apparent cytotoxocity.10 ?mol?L~-1 and 100 ?mol?L~-1 TSG significantly inhibited the proliferation of VSMCs induced by serum,cell cycle transition from G0/G1phase to S phase,PCNA expression in nucleus of VSMCs and level of intracellular ROS.100 ?mol?L~-1 TSG markedly increased the activities of SOD and GSH-px.Conclusions Certain concentration of TSG can prevent VSMCs proliferation effect mediated by serum;the mechanism about TSG effect may be associated with arresting G0/G1 to S progression,decreasing PCNA expression and improving the antioxidation of VSMCs.

Objective Tiam1, a member of guanine nucleotide exchange factors, plays an important role in tumor invasion and metastasis.This study aimed to construct Tiam1 truncated recombinant plasmids and induce the expression of GST-tagged human Tiam1 fusion proteins in Escherichia coli (E.coli), followed by purification and identification of the GST-Tiam1 fusion protein.Methods The cDNA fragments of Tiam1 C685, C751 and C1199 were amplified by PCR and cloned into the pGEX-4T-1 vector.After verified by DNA sequencing, the recombinant plasmid was transformed into E.coli BL21 (DE3) competent cells, and the expression of the fusion protein was induced by IPTG.The GST-tagged human Tiam1 fusion proteins were purified with glutathione-agarose resin and indentified by Western blot.Results Three Tiam1 truncated recombinant plasmids were constructed successfully.The recombinant fusion proteins GST-Tiam1 C685, GST-Tiam1 C751, and GST-Tiam1 C1199 were expressed mainly in the form of soluble proteins in the cell lysate supernatant with expected relative molecular weight of 100, 108, and 157 kD.Conclusion The recombinant plasmids expressing the bioactive fusion proteins were constructed successfully, which has prepared the ground for the subsequent studies of the Tiam1 protein.

The clinical manifestations and CT findings of 26 patients,who were full-time cooks working in small restaurants,were analyzed retrospectively.The main clinical manifestations were chest congestion,shortness of breath,chest pain,cough and hemoptysis.Lung CT scanning revealed lung carcinoma in 1 case,pulmonary nodules in 16 cases including 2 cancerous nodules confirmed in the followup review,puhnonary bulla in 6 cases,emphysema in 4 cases,fibro-proliferative lesions in 8 cases,interstitial pneumonia in 4 cases and fungal ball in 1 case.Among 26 patients,12 had two or more concurrent intrapulmonary lesions.The results suggest that long-term exposure to cooking oil fume may lead to a series of pulmonary pathological changes,and attention should be paid to the occupational hazards of cooks.

Ginko biloba extract is an active compound with broad biological function.This review summarizes the immuomodulatory effect of Ginko biloba extract on immune organ development, monocyte macrophage, natural killer cell, humoral immunity, cellular immunity, cytokines, red cell immunity and mucosal immunity.

Objective:To explore the expression and clinical significance of late autophagy in per-ipheral blood mononuclear cells (PBMCs) of patients with primary gouty arthritis (GA).Methods:Peripheral blood, clinical data, and laboratory tests were collected from 30 patients with acute gout (AG), 30 patients with intermittent gout (IG), and 50 healthy controls (HC). Quantitative polymerase chain reaction (RT-qPCR) was used to detect mRNA expression levels of autophagy-related genes (ATG5, ATG12, ATG16, ATG3, ATG7, ATG10, ATG4B, LC3-2/LC3B). Measurement data conformed to normal distribution were tested using t test or analysis of variance (ANOVA), and non-normal distribution data were tested using Mann-Whitney test or Kruskal-Wallis H test. SNK was used for pairwise comparison among the three groups. Correlation between variables was tested by Spearman correlation analysis. Results:① The expression level of ATG5 mRNA,ATG12 mRNA, ATG16 mRNA, ATG10 mRNA and LC3-2 mRNA in the AG group was lower than that of the IG group and the HC group, and the expression level of the IG group was lower than that of the HC group[9.16×10 -3(6.04×10 -3, 15.00×10 -3) vs 14.48×10 -3(9.95×10 -3, 21.38×10 -3) vs 0.08×10 -3(12.21×10 -3, 42.79×10 -3), H=19.377, P<0.001; 18.89×10 -3(13.85×10 -3, 24.92×10 -3) vs 21.13×10 -3(12.11×10 -3, 28.06×10 -3) vs 33.57×10 -3(13.11×10 -3, 49.89×10 -3), H=7.545, P=0.023; 8.72×10 -3(4.96×10 -3, 13.74×10 -3) vs 10.62×10 -3(7.48×10 -3, 24.71×10 -3) vs 20.07×10 -3(11.99×10 -3, 39.56×10 -3), H=20.962, P<0.001; 1.05×10 -3(0.73×10 -3, 1.84×10 -3) vs 1.60×10 -3(0.93×10 -3, 2.58×10 -3) vs 1.69×10 -3(1.05×10 -3, 3.54×10 -3), H=8.193, P=0.017; 2.31×10 -3(1.22×10 -3, 3.53×10 -3) vs 2.78×10 -3(1.68×10 -3, 5.96×10 -3) vs 3.68×10 -3(2.00×10 -3, 5.67×10 -3) , H=7.135, P=0.028]. The expression level of ATG4B mRNA in the AG and IG group was higher than that in HC group, and there was significant difference between IG group and AG group, IG group and HC group[9.95×10 -3(6.32×10 -3, 12.23×10 -3) vs 10.86×10 -3 (8.80×10 -3, 17.03×10 -3) vs 8.07×10 -3(5.52×10 -3, 11.63×10 -3), H=8.531, P=0.014]. There was no significant difference between the ATG3 mRNA and ATG7 mRNA groups ( H=0.539, 3.739, bothall P values >0.05). ② The results of Spearman correlation analysis suggested that in patients with acute gout, ATG3 was negatively correlated with PDW and MPV ( r=-0.499, P=0.006; r=-0.463, P=0.011); ATG4B was positively correlated with HDL-C ( r=0.408, P=0.048); ATG7 was negatively correlated with GLOB ( r=-0.554, P=0.001); ATG10 was positively correlated with ALB ( r=0.412, P=0.024) and negatively correlated with Crea and hsCRP ( r=-0.459, P=0.011; r=-0.375, P=0.045); ATG12 was negatively correlated with MO ( r=-0.434, P=0.017); ATG16 was negatively correlated with ALT and AST ( r=-0.389, P=0.034; r=-0.366, P=0.047); LC3-2 was positively correlated with UA ( r=0.381, P=0.041) and negatively correlated with MPV and PDW ( r=-0.413, P=0.026; r=-0.449, P=0.015). In patients with intermittent gout, ATG3 and ATG4B were negatively correlated with apoB100 ( r=-0.555, P=0.011; r=-0.462, P=0.040); ATG5 was negatively correlated with Crea ( r=-0.456, P=0.011); ATG10 was negatively correlated with TC, LDL-C, and apoB100 ( r=-0.526, P=0.017; r=-0.556, P=0.011; r=-0.515, P=0.020). Conclusion:Autophagy is involved in the development of gout, and is correlated with ibflammatory and metabolic indicators, suggesting that autophagy is an important feature in the pathogenesis of GA.