Objective:To investigate the prognostic value of molecular subtypes in patients with resected invasive breast cancer.Methods:Between 2015 and 2018 7 869 patients with invasive breast cancer after undergoing surgery were included in this analysis. Breast cancer was classified into four subtypes according to the status of hormone receptor (HR) and HER2: HR+/HER2-, HR+/HER2+, HR-/HER2+, and HR-/HER2-. Kaplan-Meier curves and COX regression were used to compare disease-free survival (DFS) and overall survival (OS) among different subtypes.Results:The 5-year DFS and OS were 86.30% and 94.29%, respectively. Proportions of HR+/HER2-、HR+/HER2+、HR-/HER2+ and HR-/HER2- were 52.9%、17.5%、14.1%和15.5%, respectively. The 5-year DFS of HR+/HER2- subtype (88.12%) was higher than HR+/HER2+ (84.67%, P=0.026), HR-/HER2+ (84.19%, P<0.001) and HR-/HER2- (83.70%, P<0.001). The 5-year OS of HR+/HER2- (95.38%) was not different from HR+/HER2+ (95.17%, P=0.187), while it was higher than that of HR-/HER2+ (92.26%, P<0.001) and HR-/HER2- (91.69%, P<0.001). Subtype was still a significant factor regarding DFS and OS in multivariable analyses adjusting for age, sex, stage, Ki67, types and time of surgery. The DFS ( P=0.257) and OS ( P=0.511) was not different between HR-/HER2+与HR+/HER2- subtypes, while HR-/HER2+ and HR-/HER2- patients had worse DFS ( P<0.05) and OS ( P<0.05) than that with HR+/HER2-. Conclusions:Molecular subtype is a significant independent prognostic factor for DFS and OS in operable invasive breast cancer. HR+ subtypes have better prognosis compared with HR- subtypes. The DFS and OS were not different between HR+/HER2- and HR+/HER2+, or between HR-/HER2+ and HR-/HER2-.

Pediatric acute lung injury(ALI)is a common disease in pediatric intensive care unit with a high fatality rate.Because the etiology of ALI is complex, the exact pathogenesis of ALI is not clear.At present, it is known that the important factors leading to the incidence of ALI in children are oxidative stress and dysregulation of inflammatory response.Progressive hypoxemia and respiratory distress are the main clinical manifestations of ALI.Respiratory support and drug control are the common treatment measures.In recent years, stem cell and molecular targeted therapy as new treatment pathways of ALI, have achieved certain achievements in the research, and are expected to become new treatment methods of ALI in chidren.

The patients with trauma have a high mortality and disability rate, and the incidence of trauma is increasing year by year.Rapid and accurate diagnosis is the key to improve the prognosis of patients with trauma.The traditional diagnostic imaging techniques are X-ray and CT examination.Although X-ray examination can be completed at the bedside, its sensitivity is not high.The diagnostic sensitivity of CT examination is high, but it can not be completed by bedside.Moreover, the process of repeated transportation of patients will delay the best treatment time, even cause secondary injury.Bedside ultrasound has the advantages of fast, real-time, noninvasive and repeatable operation.With the continuous development of bedside ultrasound technology, it has been widely used in the diagnosis of trauma.This review summarized the clinical applications of bedside ultrasound in trauma patients.

Objective:To investigate the correlation between ipsilateral metastatic supraclavicular lymph nodes(ISLN) pathologically complete response (spCR) and the prognosis in breast cancer after neoadjuvant chemotherapy(NAC) and lymphadenectomy.Methods:Clinical data of 234 breast cancer patients with ISLN at the time of diagnosis and receiving supraclavicular lymph node dissection following NAC were retrospectively analyzed.Results:All patients were female, with a median age of 52 years. The spCR rate was 52.6%. Multivariate analysis showed that the expression level of Ki67, the pathological status of breast and axillary nodes and the dissection number of supraclavicular lymph node were independent relate factors for spCR (all P<0.05). After a median follow-up of 16.6 months, the risk of recurrence and metastasis in the spCR group was 51%. It was lower than that in the non-spCR group ( HR=0.49, 95% CI 0.27-0.89, P=0.020). It was mainly manifested in hormone receptor negative patients. Supraclavicular spCR was an independent prognostic factor for DFS. Conclusions:The expression level of Ki67, pathological state of breast and axillary node and the dissection number of supraclavicular lymph node were independent related factors of spCR, which was also an independent predictor of DFS.

Vitamin D is a necessary fat-soluble vitamin in the body.It is found that not only does vitamin D deficiency associate with infant nutritional rickets, but it can also affect the functions of nervous, respiratory, immune, cardiovascular, endocrine, skin, kidney, and other function of systems.This paper made an overview of factors influencing infant vitamin D levels, including season of birth, sunshine time, eating habits, feeding patterns and prenatal vitamin D supplement dose.Among the above, as the vitamin D deficiency of infants and young children in plateau areas is quite special, thus it is emphasized in this review, in order for prevention and treatment of vitamin D deficiency.

Objective: To investigate the influence of lumpectomy on axillary lymph node status of breast cancer patients. Methods: The clinical data of 738 invasive breast cancer patients with non-palpable axillary lymph node and sentinel lymph node (SLN) biopsy from November 2011 to August 2013 in Henan Provincial Cancer Hospital were collected and retrospectively analyzed. Among them, 136 patients underwent preoperative lumpectomy (lumpectomy group) and 602 patients underwent puncture biopsy only (biopsy group). The difference of axillary lymph node status and positive ratio of SLN detected by color Doppler ultrasound were compared between these two groups. Results: Among the 738 breast cancer patients, the axillary lymph nodes of 444 (60.2%) cases could be detected by ultrasound. Among them, 92 cases belonged to lumpectomy group, significantly less than 352 cases of biopsy group (P=0.048). Among the patients with ultrasound-visible lymph nodes, the proportion of the biggest diameter of axillary lymph node >1 cm of lumpectomy group or biopsy group was 58.7% (54/92) or 52.8% (186/352), respectively, without significant difference (P=0.316). The proportion of patients with the ratio of long diameter to short diameter <2 of lumpectomy group or biopsy group was 37.0% (34/92) or 38.6% (136/352), respectively, with marginal difference (P=0.768). The positive rate of SLN of lumpectomy group or biopsy group was 23.5% (32/136) or 26.9% (162/602), respectively, without significant difference (P=0.419). The incidence rate of the ultrasound visible axillary lymph nodes of patients whose postoperative time ≤ 7 days or > 7days was 71.1% (64/90) or 60.9% (8/46), respectively, without significant difference (P=0.227). However, the positive rate of SLN of these two groups was 28.9% (26/90) and 13.0% (6/46), respectively, with significant difference (P=0.039). The number of ultrasound visible axillary lymph nodes, the biggest diameter of axillary lymph nodes and the ratio of the long diameter to short diameter <2 were substantially correlated with the positive rate of SLN (P<0.05). Conclusions The incidence rate of ultrasound visible axillary lymph node in the patients with lumpectomy is higher than that of patients with puncture biopsy only. The positive rate of SLN of the patients with a long postoperative time is lower than that of patients with a short postoperative time, even though the axillary lymph nodes are ultrasound visible.

Objective To investigate the nonsentinel lymph nodal (NSLN) status in 1-2 sentinel lymph node positive early breast cancer and to compare with that in Z0011 ALND group.Methods A total of 234 T1,T2 invasive breast cancer with 1-2 positive sentinel lymph nodes were collected in Henan Tumorr Hospital from Jul 2010 to Aug 2014.The data was compared with that of Z0011 ALND group.Results 234 female patients were enrolled.76 cases had non sentinel lymph node metastases.The proportion of 1 and 2 sentinel lymph node metastases was 75.2％ and 24.8％,respectively.The number of positive sentinel lymph nodes and that of negative ones were independent predictors of the non sentinel lymph node status (all P ＜ 0.05).Menstrual status,hormone receptor,Ki67 level and HER2 were not associated with nonsentinel lymph node metastasis (all P ＞ 0.05).They had nonsentinel lymph node positive rate (P ＞ 0.05) similar to that of Z0011 ALND group.Conclusious The number of sentinel lymph nodes and negative sentinel lymph nodes were associated with nonsentinel lymph node metastasis in the 1-2 sentinel lymph positive early stage breast cancer.Those patients had similar positive nonsentinel lymph node rate to that of Z0011 ALND group.

A simple,fast and highly sensitive fluorescence analysis method for detection of mercury ion was developed based on N-methyl-mesoporphyrin IX (NMM)/G-quadruplex DNA system and specific T-Hg-T mismatches.In this strategy,a large number of thymine was introduced into guanine-rich oigonucleotides which could form G-quadruplex.In the presence of Hg2+,guanine-rich oigonucleotides and complementary strand could form double-stranded DNA molecule by specific T-Hg-T mismatch pair,leading to destruction of G-quadruplex DNA structure.In the absence of Hg2+,guanine-rich oigonucleotides spontaneously formed G-quadruplex DNA structure that could bound NMM to generate intense fluorescence.Based on the above facts,a sensitive fluorescence biosensor for determination of Hg2+ was fabricated.And the optimal conditions for Hg2+ determination were as follows:buffer solution pH of 6.7,20 mmol/L KCl and 2.5 μmol/L NMM in buffer and incubation for 2 h.Under the optimal conditions,the fluorescence intensity signal change (F0-F) and the Hg2+ concentration exhibited a linear correlation within 50 nmol/L to 1000 nmol/L range with a low detection limit of 22.8 nmol/L (3σ).The biosensor exhibited good selectivity toward common metal ions.The developed method was successfully employed to detect Hg2+ in tap water with recovery of 106.1％-107.8％.

Objective To investigate the status of clinical nutrition management in patients in PICU,and to provide data for promoting the improvement and development of clinical nutrition of pediatric critically ill patients.Methods A questionnaire survey was conducted on PICU specialists.The nutrition assessment,nutrition intervention and nutrition management of critically ill children in PICU were investigated.The results were summarized and analyzed.Results A total of 39 PICU specialists were involved in this survey.The nutritional assessment methods and guidelines in domestic PICU were not unified.Twenty-five respondents (64.1%) believed that both clinical performance and the scales as the basis can decide whether the patients should be fed or not;all respondents believed that nutritional assessment and intervention time need to be determined by the needs of the patients;23 respondents(58.9%) used weight only as their nutritional monitoring indicators.Twenty-eight respondents(71.8%) considered that gastric tube was the first choice way to feeding for the critically ill children;20 respondents(51.3%) believed that critically ill children should be fed within 24 hours.Twelve respondents (33.3%) believed that critically ill children should be fed between 24 to 48 hours.Thirty-three respondents(84.6%) advocated early enteral nutrition;36 respondents (92.3%) considered that the main reasons of fasting in critically ill children were vomiting or abdominal distension or gastrointestinal bleeding.Twenty-eight respondents(71.8%) believed that according to the results of gastrointestinal function evaluation,they made decisions whether the patient to fast or not.Twenty-three respondents(59.0%) considered that specialists in PICU were the decision maker of the clinical nutrition in critically ill children.Twenty-four (61.5%) of the respondents believed that we needed to establish our own routines in management of nutrition in PICU.Conclusion At present in China,a lot of achievements have been made in the nutritional assessment,monitoring,early enteral nutrition intervention and management in critically ill children,but it is not enough.We need to make more effort to enhance the critically nutrition level in PICU,and we have a lot of research to do about nutrition assessment and nutrition intervention mode.It is recommended to establish Chinese guidelines or consensus to enhance the level of nutritional treatment of critically ill children.

Objective To observe and discus the clinical features and outcome of aseptic encephali-tis in children. Methods One hundred and one cases treated in PICU of Shengjing Hospital of China Medi-cal University and diagnosed with aseptic encephalitis from December 2009 to December 2012 were enrolled. Results The clinical manifestations, signs, laboratory examinations and outcome were analyzed retrospec-tively. Among them, 54 cases were male,47 cases were female,12 cases aged from 1 month old to 6 months old,12 cases aged from 7 months old to 1 year old,36 cases aged from 2 years old to 3 years old,12 cases aged from 4 years old to 6 years old,19 cases aged from 7 years old to 14 years old. The fever was the most common clinical manifestation, a total of 92 cases ( 91. 1%) , followed by convulsions, a total of 79 cases (78. 2%),63 cases with meningeal irritation or pathological signs positive(62. 4%). The sensitivity of elec-troencephalography( EEG) was the highest for diagnosis of aseptic encephalitis,89 cases underwent EEG with abnormal rate of 84. 3%(75/101). Followed by head MRI scan,97 cases underwent head MRI scan with ab-normal rate of 55. 7%(54/101). All cases underwent cerebrospinal fluid examination,50 cases with white blood cells and(or) protein increased(49. 5%). The sensitivity of head CT scan was the lowest,the abnor-malities were found in 11 cases ( 17. 5%) among 63 cases underwent head CT scan. All cases were given comprehensive treatment of sedation, antifebrile, reducing intracranial pressure and nerve nutrational treat-ment. Seventy cases were cured,20 cases left neurological sequelae,7 cases gave up treatment,4 cases died. Conclusion The children aseptic encephalitis occurs in infants and young children,the incidence of male and female are equal. The clinical manifestations are diverse,the most common manifestations are fever and con-vulsion,EEG and MRI are with high sensitivity. Most patients have good outcome if received symptomatic treatment early. A few cases left neurological sequelae,such as consciousness and dyskinesia. Respiratory fail-ure,neurogenic shock,eventually death would occour if the brainstem was involved.