Objective:To explore the influence of tumor-associated macrophages (TAMs) on endocrine resistance in breast cancer through the forkhead box M1 (FOXM1) /Wnt/ β-catenin pathway. Methods:Tamoxifen-resistant breast cancer cells were cultured, THP-1 cells were induced into macrophages (MΦ), and further induced into TAMs. After being cultured in the conditioned medium (CM) of MCF-7 cells for 24 hours, MΦ were defined as MS cells. After being cultured in the CM of MCF-7R cells for 24 hours, MΦ were defined as MR cells. MCF-7 cells, after being cultured in the CM of macrophages for 24 hours, were defined as MCF-7 (MΦ) cells. MCF-7 cells, after being cultured in the CM of MS cells for 24 hours, were defined as MCF-7 (MS) cells. MCF-7 cells, after being cultured in the CM of MR cells for 24 hours, were defined as MCF-7 (MR) cells. Cell viability and invasion ability were evaluated using CCK-8 and Transwell assays. The protein levels of CD163, Wnt1, β-catenin, and FOXM1 in different groups were examined by qRT-PCR and Western blot. Results:Compared to the MS group (mRNA: 1.49±0.12, protein: 1.15±0.12), CD163 expression was higher in the MR group (mRNA: 2.33±0.16, protein 1.52±0.11) ( t=7.28, P=0.002) ( t=3.94, P=0.017), indicating that tamoxifen-resistant breast cancer cells can induce polarization of more MΦ into TAMs. TAMs increased the expression of FOXM1 in breast cancer cells, which further activated the Wnt/ β-catenin pathway. Compared to the MCF-7 (MΦ) group, the MCF-7 (MS) and MCF-7 (MR) groups showed enhanced cell viability and invasion, with the most significant increase observed in the MCF-7 (MR) group. Compared with MCF-7 (MΦ) cells, the levels of Wnt1, β-catenin, and FOXM1 in MCF-7 (MS) and MCF-7 (MR) cells were significantly increased, with the highest levels observed in the MCF-7 (MR) group with the most TAM polarization. Compared to the MCF-7 group, both the MCF-7 (MR) and MCF-7+pcDNA-FOXM1 groups showed increased levels of Wnt1 and β-catenin, enhanced cell viability and invasion. Compared to the MCF-7 (MR) group, the MCF-7 (MR) + si-FOXM1 group showed reduced levels of Wnt1 and β-catenin, weakened cell viability and invasion. Conclusion:TAMs promote endocrine resistance in breast cancer by upregulating FOXM1 and activating the Wnt/ β-catenin pathway.

Sixty general practitioners of in-service training undertaking rotation in gastroenterology department of Qingdao Municipal Hospital from July 2017 to July 2019 were randomized assigned in trial group ( n=30) and control group ( n=30). The problem-oriented mode was applied in trial group and conventional mode was applied in control group for teaching of two typical digestive diseases (upper gastrointestinal bleeding and acute pancreatitis). The formative evaluation and questionnaire survey were used to compare the teaching effects and the results of evaluation were compared with χ 2 test by SPSS 17.0 between two groups. The excellent and good rates of evaluation for the clinical psychological quality, clinical reasoning ability, doctor-patient communication ability and practice-based learning and improvement ability in trial group were significantly higher than those in the control group(χ2=7.38, P=0.03; χ2=12.96, P<0.01; χ2=23.33, P<0.01; χ2=16.14, P<0.01). Questionnaire survey showed more satisfaction towards teaching method in trial group was higher than that in control group(χ2=12.86, P<0.01); and the clinical reasoning ability, learning initiative and self-confidence in trial group were improved more markedly than those in control group(χ2=8.26, P=0.02; χ2=19.48, P<0.01; χ2=21.46, P<0.01). The problem-oriented clinical thinking teaching model demonstrates good effects on clinical comprehensive ability for general practitioners of in-service training during gastroenterology rotation, which is worth further promotion.

Waardenburg syndrome (WS), also known as auditorypigmentary syndrome, is characterized by non-progressive sensorineural hearing loss and anomalous pigmentation. Its mode of inheritance is either autosomal dominant or autosomal recessive. So far only PAX3, MITF, SOX10 and EDNRB mutations have been identified among Chinese patients with WS. This review has provided an update for WS-related genes, mutation databases, molecular and functional data, and a discussion over the molecular diagnosis of WS.

Objective To investigate effect of high dose irradiation on the performances of thermolumines-cence detectors (LiF:Mg, Cu, P). Methods The high-dose irradiated thermoluminescence detector was annealed by a thermoluminescence annealing furnace until the annealing was completed, and then the annealed thermoluminescent detector was irradiated 0.5Gy by 137Cs irradiator to verify the accuracy of the thermoluminescentdetector. Results The thermoluminescence detector after high-dose irradiation could not be completely annealed under the temperature condition of 240 ℃, and it could be completely annealed at a high temperature as 400℃. After 0.5 Gy irradiation by 137Cs irradiator, the measurement results of the annealed thermoluminescence detector were significantly smaller, and the dose response and dispersion of the detector were also changed significantly. Conclusions After a more than 5 Gy irradiation, the crystal structure of the thermoluminescence detector has changed, and a high temperature peak above 240 ℃ has appeared, which leads to the failure to completely anneal at normal temperature. Therefore, the thermoluminescence detector can no longer be used for dosimetry after high-dose irradiation.

Objective To investigate the significance of "merge" model versus "traditional" model in rotation training for professional clinical postgraduate students in department of gastroenterology. Methods The professional clinical postgraduate students who underwent rotation training in Qingdao Municipal Hospital from July 2012 to July 2016 were enrolled as subjects and were trained with the"merge" model and the "traditional" model, respectively. The two groups of subjects were compared in terms of clinical knowledge , skills , and core competencies . Results The postgraduates trained by the"merge" model had a significantly higher total score of clinical examinations than those trained by the"traditional" model [(92.60±2.52) vs. (83.80±3.14), t=10.93, P<0.01], while there were no significant differences in professional quality and doctor-patient communication between the two groups. Compared with those trained with the"traditional"model, the postgraduates trained by the"merge"model had significantly better understanding of clinical knowledge and clinical thinking ability, diagnosis and treatment skills, and psychological quality (χ2=27.00, 10.23, and 12.21, all P<0.01);however, there was no significant difference in clinical research ability between the two groups (χ2=1.39, P=0.24). Conclusion The model of professional clinical postgraduate training combined with standardized training of residents is superior to the traditional training model, and compared with the "traditional" model, the "merge" model is more beneficial to the training of comprehensive clinical practice abilities and thus holds promise for further application.

Objective To investigate the value of serum amyloid A (SAA) and retinol binding protein (RBP) in diagnosis of early type 2 diabetic kidney disease (DKD).Methods A total of 182 type 2 diabetic patients hospitalized in department of Endocrinology and Nephrology of Lianyungang Second People's Hospital from January to December 2017 were randomly collected as subjects.According to urinary albumincreatinine ratio (UACR),all subjects were divided into three groups of normal albuminuria group (NA,60 cases),microalbuminuria group (MA,63 cases) and clinical proteinuria (CP,59 cases).In the same period,60 healthy persons were selected as normal control (NC).The levels of serum SAA and RBP were detected by automatic biochemical analyzer.Receiver operating curve (ROC) was used to analysis the diagnostic efficiency of DKD and the risk factors of DKD were further estimated.Results The levels of SAA were (6.88±2.82) and (37.21±20.58) mg/L in control group and case group.And levels of serum SAA in the NA group,MA group and CP group were (16.33±5.98),(40.97± 15.62),(54.43±22.91) mg/L respectively.The levels of RBP were (37.56± 10.51) and (69.26±21.23) mg/L in control group and case group.And levels of RBP in the NA group,MA group and CP group were (52.66 ± 14.31),(69.66 ± ± 15.52),(85.70± 19.51) mg/L respectively.The concentrations of serum SAA and RBP in type 2 diabetic patients were significantly higher than those normal controls (t =10.36,P＜0.05;t =11.11,P＜0.05) and increased with DKD progression (F =83.6,P＜ 0.05;F =59.2,P＜ 0.05).Diagnostic sensitivity of serumSAA,RBP in DKD was 81.8％ and 84.1％ respectively.Diagnostic sensitivity of combined detection was 90.9％.Regression analysis showed that SAA,RBP and UACR were independent risk factors for DKD (OR (95％ CI) =1.391 (1.068-1.812),1.212 (1.085-1.353),1.148 (1.038-1.270);all P ＜0.05).Conclusion Both of serum SAA and RBP were significantly elevated in diabetic patients with renal injury so that they had great value in early diagnosis of DKD.

Objective To investigate the clinical value of serum lipoprotein (a) and free fatty acid (FFA) in the diagnosis of type 2 diabetic nephropathy (DN).Methods From January to October of 2016,120 cases with type 2 diabetes in the Second People's Hospital of Lianyungang were selected.According to urinary albumin creatinine ratio (UACR),the patients were divided into three groups:normal albuminuria group (NA),microalbuminuria group (MA) and macroalbuminuria group (LA).And 40 healthy subjects were selected as control group.The levels of serum lipoprotein (a) and FFA were measured,and the correlation was analyzed by Pearson analysis.Furthermore,the receiver operating curve was used to evaluate the positive diagnostic rate of DN.Results The levels of lipoprotein (a) in the NA,MA,LA and control group were (212.8 ±69.0)mg/L,(281.7 ±70.5)mg/L,(337.2 ±71.5)mg/L and (187.4 ± 74.0)mg/L,respectively.The levels of lipoprotein (a) in the MA and LA groups were significantly higher than those in the NA and control groups (F =35.08,P ＜ 0.05).The levels of FFA in the four groups were (0.63 ±0.15)mmol/L,(0.84 ±0.13) mmol/L,(1.07 ±0.19) mmol/L and (0.47 ±0.10) mmol/L,respectively.The level of FFA in the DN group was higher than that of the control group,the difference was statistically significant (F =102.13,P ＜ 0.05),and increased with the progression of DN.Pearson correlation analysis showed that the serum lipoprotein (a) was positively correlated with FFA (r =0.64,P ＜0.05).The positive rates of serum lipoprotein (a) and FFA were 64.2％ and 73.3％ in early diagnosis of DN,the positive rate of combined detection was 84.2％ (P ＜ 0.05).Conclusion Serum lipoprotein (a) and FFA levels are significantly increased in diabetic patients with renal injury.Both of them have important clinical value in early diagnosis of type 2 DN.

Objective The aim of this study is to analyze the factors influencing the outcomes of the traditional Chinese medicine (TCM) percutaneous release treatment for the stenosal tendosynovitis. Methods A total of 119 eligible participants, from outpatient of Dongzhimen Hospital during June, 2014 to April, 2017, were included into the study. The participants received TCM percutaneous release treatment, and were followed-up and assessed outcomes at 27 w. Responders were defined as participants with normal movement in week 27 compared with the baseline period. The NRS assessment in both groups was described, and the baseline characteristics of participants potentially related to cure response were mainly analyzed using Logistic regression analysis. Results Cure group and non-cure group were determined according to the cure response. And the outcomes of pain relief along the timeframe showed the feasibility of criteria of cure response. The uni-factor Logistic regression analysis showed that the factors age,course of disease,interventions and pain severity were significantly different between the cure and non-cure groups,and the multi-factor Logistic regression confirmed the four factors influenced the cure response of the TCM percutaneous release treatment for the stenosal tendosynovitis. The cutting knife was 5.85 fold than the traditional needling knife at increasing the cure response (OR=5.853,95% CI 1.853-18.485;P=0.003).All the factors that age equal to or older than 60 years(OR=6.170, 95% CI 1.890-20.141; P=0.003), course of disease more than six months (OR=4.696, 95% CI 1.371-16.085;P=0.014)and pain severity from 6 to 7(OR=5.184,95% CI 1.416-18.975;P=0.013)were negatively associated with clinical response. Conclusions The patients with increasing age, long course of disease and distinct pain severity may be less likely to respond to the TCM percutaneous release treatment. These findings contribute to guiding clinical practice in terms of pretreatment patient selection. Further research is needed to confirm the association.

Objective To evaluate the effectiveness and safety of percutaneous micro-invasive release therapy by using push-cut knife on stenosal tendosynovitis. Methods The patients with stenosal tendosy-novitis were chosen according to inclusion criteria,and then divided,based on random digital table and 1:1 of random concealmert,into push-cut knife group and needle-knife group. The push-cut knife group was given push-cut knife therapy one time, and was given traditional needle-knife one time. The main outcome index was cure rate on the 27thweek after treatment, and secondary indexes included pain scores,joint range of motion (ROM) and trigger indications. The safety indexes included complications and adverse events. Results There were totally 120 patients were chosen,but one quitted due to serious disease in needle-knife group,and 119 patients completed the study and were brought into the statistical analysis of outcome indexes. On the 27thweek after treatment,there were 55 cases(91.67%) cured in push-cut knife group and 39 (66.10%) cured in needle-knife group (P<0.001). The indexes of trig-ger indications,pain and ROM were significantly relieved in 2 groups,and improved more significantly o-ver time. The comparisons at the time points of the 1st,3rd,6th,12thand 27thweeks showed that,the re-liefs of trigger indications, pain and ROM were superior in push-cut knife group than those in needle-knife group (P<0.05). There were no adverse events or complications occurred in 2 groups. Conclu-sion The push-cut knife has higher one-off cure rate in treatment of stenosal tendosynovitis. The signs of pain,ROM and trigger indications are relieved immediately after treatment,and continuously relieved af-ter half year. There are no adverse events occurred.

Objective To study the influencing factors of the competing sentences test in normal-hearing adults, in order to provide references for the preparation of the competing sentences test with children and the development of the diagnostic tools of the central auditory processing disorders.Methods According to the three kinds of test tables of semantic competition, sentence constituent competition and phonetic competition for the competing sentences test, the 2×3×3 factors mixed experimental design were used to test the 48 normal-hearing adults(forty-six right-handed adults and two left-handed adults) with the competing sentences test.The correct rate was obtained and the influencing factors were analyzed.Results ①The average correct rate of the Competing Sentences Test for the forty-six right-handed normal-hearing adults was 94.98%,and for the two left-handed normal-hearing adults was 96.12%.②The right-handed subjects'' right ear accuracy rate was significantly higher than that of the left ear(P<0.01),while the accuracy rate of the left ear was obviously higher than the right ear with left-handed subjects.③The effects of genders on the results of the competing sentences test was not significant(P>0.05)with the right-handed subjects.④For the results of three types sentences,the correct rate of semantic competition was the highest, the second was the sentence constituent competition and phonetic competition was the lowest with the right-handed subjects.Conclusion No gender factors were found to affect the results of the competing sentences test among adults.The normal-hearing right-handed adults have the right ear advantage in the competing sentences test, prompting us to become concerned about the choice of the ear sides.Different competition types of sentences will have a greater impact on the difficulty of the competing sentences test, so we should pay more attention to this in the preparation of competitive sentences test tables.