目的 观察集束化护理预防儿童重症监护室(PICU)呼吸机相关性肺炎的效果.方法 本研究回顾性分析郑州大学第一附属医院郑东院区 2020 年 6 月至 2022 年 6 月收治的 86 例PICU患儿为临床资料,其中接受常规护理干预的 43 例患儿为常规组,接受集束化护理干预的 43 例患儿为集束组.比较两组患儿呼吸机相关性肺炎(VAP)发生情况、不良护理事件发生率、呼吸指标改善情况、PICU入住期间并发症发生率及恢复情况,并调查患儿家属对护理服务的满意度.结果 集束组患儿VAP发生率及不良护理事件发生率均低于常规组,差异有统计学意义(P＜0.05).干预后,两组患儿血氧分压(PaO2)及氧合指数(PaO2/FiO2)均高于干预前,二氧化碳分压(PaCO2)明显低于干预前,且集束组各项指标改善幅度大于常规组,差异有统计学意义(P＜0.05).集束组患儿PICU入住期间并发症(口腔溃疡、误吸、口鼻处压疮)发生率低于常规组,差异有统计学意义(P＜0.05).集束组患儿机械通气、PICU治疗及住院时长均短于常规组,差异有统计学意义(P＜0.05).集束组患儿家属对护士业务能力、认知干预、风险防范及责任心的满意评分均高于常规组,差异有统计学意义(P＜0.05).结论 集束化护理模式用于临床PICU患儿中,可预防VAP发生,减少不良护理事件,加快康复进程,有效改善其呼吸指标,还可以提高家属满意度.

目的 探讨Encor、Mammotome及Hologic 3种真空辅助旋切系统在超声引导下乳腺微创旋切术应用中的差异.方法 收集2020年2月1日至2020年9月30日郑州大学第一附属医院乳腺外科收治的2 528例乳腺肿块手术患者的资料,选取临床资料及随访资料完整的患者共1 019例,按使用系统分为Encor组379例(病灶548个)、Mammotome组362例(病灶513个)及Hologic组278例(病灶433个).回顾分析比较3组病理结果、肿块大小、肿块切除率、手术时间、术中出血量、术后并发症情况及患者对手术满意度.结果 3组患者在病理结果、肿块切除率和术后并发症方面比较,差异无统计学意义(P＞0.05).Hologic系统切除肿块最大直径[13(10,18)mm]大于Encor系统[12(9,16)mm]和Mammotome系统[11(8,15)mm],差异有统计学意义(P＜0.05).Hologic 组手术时间[11.5(7,18)min]短于 Encor 组[27(18,38)min]及 Mammotome 组[24(18,32)min],差异有统计学意义(P＜0.05).Mammotome 组术中出血量[2.5(2,5)mL]少于Encor组[3(2,5)mL]及Hologic组[5(4,10)mL],差异有统计学意义(P＜0.05).Encor系统术后满意度(97.89％)高于 Mammotome 组(96.13％)及 Hologic 组(94.96％),差异有统计学意义(P＜0.05).结论 Encor、Mammo-tome及Hologic均是有效安全的微创旋切系统.Encor系统术后满意度高,但手术时间长.Mammotome系统术后出血量少,但切除肿块较小.Hologic系统切除肿块较大且手术时间短,但术中出血量较多,术后满意度较差.合适的选择将使旋切技术在乳腺手术中得到更有效的应用.

目的 分析乳腺癌骨转移患者的临床病理特征,构建乳腺癌骨转移发生的预测模型.方法 回顾性分析2019年6月1日至2019年12月31日郑州大学第一附属医院收治的201例乳腺癌患者的临床资料.根据首次转移部位,将其分为骨转移组与非骨转移组.通过t检验、Mann-Whitney U检验、χ2检验分析各临床病理特征与患者发生骨转移之间的关系.采用logistic回归筛选变量构建预测模型,并制作列线图.采用受试者操作特征曲线(ROC曲线)评估该模型的可靠性.结果 单因素分析结果 显示,淋巴结转移情况、激素受体状态、Ki-67、pS2、CK5/6、TOP-Ⅱ、P53及E-cadherin表达差异有统计学意义(P<0.05).多因素分析结果 显示,患者有淋巴结转移(OR=3.115,95％CI:0.992～9.785,P=0.043)、Ki-67高表达(OR=1.993,95％CI:1.975～2.012,P=0.032)、pS2表达阴性(OR=0.040,95％CI:0.040～0.430,P=0.002)、P120表达阴性(OR=0.261,95％CI:0.078～0.877,P=0.025)、E-cadherin表达阴性(OR=0.129,95％CI=0.037～0.455,P=0.001)及TOP-Ⅱ高表达(OR=1.491,95％CI:1.620～1.020,P=0.001)是患者发生骨转移的独立危险因素,也是构建列线图的显著变量.该列线图通过了校正和验证步骤,训练组和验证组的曲线下面积(AUC)分别为0.767和0.855.结论 该模型是预测乳腺癌患者骨转移的可靠工具,有助于临床医生为患者提供更加准确的决策依据并优化治疗方案.

Objective:To explore the role and possible mechanism of receptor-interacting serine/threonine protein kinase 4 (RIPK4) in the occurrence and development of breast cancer.Methods:The expression of RIPK4 protein in 96 cases of breast cancer and adjacent normal tissues was detected by immunohistochemistry, and the relationship between the expression of RIPK4 protein and the clinicopathological features of breast cancer was also analyzed. Small interfering RNA (siRNA) targeting RIPK4 was transiently transfected into breast cancer cell lines: MCF-7 and MDA-MB-231, beside the experimental group, there are also the blank control group and the negative siRNA transfection group. Western blotting was used to detect the inhibitory effects of these siRNAs. Cell counting kit-8 (CCK-8) and transwell assays were used to detect the effects of RIPK4 siRNA on the proliferation, invasion and metastasis abilities of MCF-7 and MDA-MB-231 cells. Western blotting was also used to detect the effects of RIPK4 siRNA on Wnt/β-catenin signaling pathway.Results:Immunohistochemistry showed that the expression of RIPK4 was significantly higher in breast cancer tissues (71.9%, 69/96) than that in normal tissues (21.9%, 21/96) and the differences were statistically significant ( χ2=48.188, P<0.01). The abnormal expression of RIPK4 was positively correlated with TNM stage, histological type and lymph node metastasis in breast cancer ( χ2=17.524, 40.697, 9.458, P<0.05). SiRNA targeting RIPK4 could inhibit the expression of RIPK4 protein in breast cancer cell lines: MCF-7 and MDA-MB-231. CCK-8 and transwell assays also showed that the proliferation, invasion and metastasis abilities of MCF-7 and MDA-MB-231 cells were decreased greatly after transfection with RIPK4 siRNA. Additionally, the expression of β-catenin and Vimentin in Wnt/β-catenin signaling pathway was decreased, and that of E-cadherin was increased in MCF-7 and MDA-MB-231 cells after transfection with RIPK4 siRNA. Conclusion:The expression of RIPK4 protein was abnormally high in breast cancer tissues. Inhibiting the expression of RIPK4 protein reduced the proliferation, invasion and metastasis of breast cancer cells by suppressing the occurrence of Wnt/β-catenin signal pathway related epithelial-mesenchymal transition.

目的:探究小儿重症监护病房(PICU)中振幅整合脑电图(aEEG)监测过程中伪差的影响因素及护理对策。方法:选取2018年1～12月在该院PICU进行aEEG监测的126例患儿，记录其在进行aEEG监测时伪差的发生概率及其影响因素，并根据其具体情况提出护理对策。结果:126例患儿中，出现伪差共计97例，发生概率为76.98%，其影响因素包括操作干扰、电磁干扰、电极松脱、心电伪差、电极位置不当及电极线断裂，且以操作干扰为主，占其全部的39.18%，之后为电磁干扰，占其30.93%。结论:由此我们可以知道，在患儿进行aEEG监测时，伪差产生的影响因素众多，护理人员要对患儿进行专业的护理，尽可能地降低脑电图监测过程中产生的伪差，从而更好地提高aEEG监测的准确性，更准确地判断出患儿脑损伤类型。

目的 探讨唑来膦酸联合同期放化疗治疗晚期乳腺癌骨转移患者的近期临床效果.方法 分析郑州大学第一附属医院乳腺外科收治的64例发生骨转移的晚期乳腺癌患者的临床资料,将仅接受放化疗的32例患者作为对照组,将接受唑来膦酸联合同期放化疗的32例患者作为观察组,治疗6个月后,根据两组骨转移病灶、肿瘤标志物水平及疼痛缓解程度分析两组近期治疗效果,并统计两组不良反应发生率.结果 观察组骨转移病灶缓解的总有效率(68.8％)高于对照组(43.8％),差异有统计学意义(P<0.05);观察组骨痛缓解的总有效率(93.8％)高于对照组(71.9％),血清肿瘤标志物水平低于对照组,差异有统计学意义(P均<0.05),两组不良反应发生率差异无统计学意义(P>0.05).结论 唑来膦酸联合同期放化疗治疗晚期乳腺癌骨转移效果确切,不良反应经对症处理后均好转,值得进一步推广使用.

Objective To investigate the effect of As4S4 inhibit the growth of breast cancer cell by regulating phosphatidylinositol 3 kinase (PI3K)/protein kinase B (Akt)/mammalian target of rapamycin (mTOR) signal pathway.Methods Methyl thiazol tetrazolium (MTT) assay was used to detect breast cancer cell MCF-7 proliferation after 0,20,40,60,80 μmol/L As4S4 treatment for 24,48,72 h,and 10 μmol/L LY294002 treatment 48 h.Wound healing and transwell were used to detect the distance of MCF-7 cell migration and invasion after As4S4 dealing with 48 h.Flow cytometry was used to detect MCF-7 cell apoptosis after and 10 μmol/L LY294002 treatment 48 h.Western blotting was used to detect PI3K,p-Akt,mTOR expression levels in MCF-7 cell after As4S4 and 10 μmol/L LY294002 dealing with 48 h.Results Compared with 0 μmol/L treatment,20 μmol/L As4S4 had no significant inhibition of cell proliferation at 24 h (P =0.065),it had a significant inhibition of cell proliferation at 48 h and 72 h (P =0.033) with the inhibition ratio of 11.1％ and14.3％,respectively.40,60,80 μmol/L As4S4 treatment had the most obvious inhibitory effect at 72 h (P =0.002) the inhibition ratio of 47.9％,58.8％,67.1％,respectively.Mter60 As4 S4 treatment for 48 h,the migration rate and invasion ability of MCF-7 cell were lower than the control group (with decrease of 42.4％),the difference was significant (P =0.005),the apptosis rate was significant increased to (19.56 ± 1.12)％ (P =0.009),the expression of PI3K in MCF-7 cell had no significantly change and p-Akt,mTOR were significantly decreased than control group (P =0.008) with the decrease of 64.3[J]％ and 58.7％,respectively.The results of proliferation and apoptosis was consistent with the LY294002 treatment.Conclusion As4S4 may inhibit breast cancer MCF-7 cell proliferation and metastasis and promote apoptosis by inhibiting PI3K/Akt/mTOR signaling pathway.

Objective To investigate the relationship between neoadjuvant chemotherapy and the expression levels of ER, PR, Her-2 and Ki-67 in breast cancer.Methods Seventy-six patients with breast cancer treated in the First Affiliated Hospital of Zhengzhou University from September of 2014 to September of 2015 were selected.The expression levels of ER, PR, Her-2 and Ki-67 before and after neoadjuvant chemotherapy were detected.The relationship between neoadjuvant chemotherapy and the expression levels of ER, PR, Her-2 and Ki-67 was analyzed.Results The total effective rates of patients with ER (-), PR (-), Ki-67(+) were higher than patients with ER (+), PR (+), Ki-67(-) (P＜0.05).There was no difference in the positive rates of ER, PR, Her-2 before and after neoadjuvant chemotherapy (P＞0.05).The positive rate of Ki-67 after neoadjuvant chemotherapy was lower than that before neoadjuvant chemotherapy, and the difference was statistically significant (P＜0.05).Conclusion Breast cancer patients with ER (-), PR (-), Ki-67 (+) can obtain a higher clinical therapeutic effect of neoadjuvant chemotherapy.After neoadjuvant chemotherapy, there was no change in the expression levels of ER, PR, Her-2 except Ki-67.

Hepatocellular carcinoma (HCC) is one of the most lethal malignancies worldwide with elusive molecular mechanisms. The aim of this study is to investigate the clinical significance and biological roles of breast cancer-associated protein 3 (BCA3) in HCC. Our investigation demonstrated that BCA3 expression was up-regulated in primary HCC tissues, and BCA3 levels were positively correlated with tumor size, TNM stage, microvascular invasion and poor prognosis. BCA3 promoted tumor growth, metastasis and angiogenesis of HCC in vitro and in vivo. Moreover, we found that BCA3 induced aggressive behaviors were mediated by AKT activation, which in turn activated mTOR signalling pathway and induced cytoplasm-nuclear translocation of NF-κB p65. Blockage of AKT signalling pathway by a specific AKT inhibitor LY294002 impaired BCA3 mediated phenotypes. Collectively, our current study indicated the pleiotropic effects of BCA3 in HCC progression, and blockage of BCA3-AKT pathway might contribute to development of therapeutic measures for HCC.

目的：探讨多西他赛、吡柔比星联合环磷酰胺（TAC）方案术前化疗治疗三阴性乳腺癌（TNBC）的近期疗效和毒副反应。方法77例 TNBC 患者均至少采用 TAC 方案新辅助化疗4周期，每周期化疗前行疗效评估及毒副反应分析，第4周期化疗结束后总体评价近期疗效和毒副反应。结果全组77例 TNBC 患者中，CR 29例（37.66%），PR 41例（53.25%），SD 6例（7.79%），PD 1例（1.30%），总有效率为90.91%。治疗后病理结果提示达到 pCR 者35例（45.4%）。化疗毒副反应主要为骨髓抑制、胃肠道反应、脱发，但均可耐受。结论 TAC 方案术前化疗治疗 TNBC 近期疗效好，化疗毒副反应可耐受。

目的 研究乳腺癌组织中的E-钙黏蛋白(E-cadherin)和锌指转录因子(Snail)的表达水平与新辅助化疗疗效的关系.方法 采用免疫组化SP法检测169例乳腺癌患者新辅助化疗前E-cadhenn和Snail的表达水平,分析其表达水平与临床病理特征、新辅助化疗疗效的关系.结果 乳腺癌E-cadhenn和Snail的表达均与TNM临床分期、淋巴结转移相关(P＜0.05);E-cadherin低表达组的临床总有效率高于E-cadhefin高表达组(P＜0.05).Snail低表达组的临床总有效率高于Snail高表达组(P＜0.05).Spearman等级相关分析显示,E-cadherin和Snail在乳腺癌中的表达呈负相关(r=-0.241,P=0.002).结论 联合检测两种因子可作为乳腺癌新辅助化疗疗效评估的重要手段.

Objective To explore the predictive significance of FOXP3 Tregs in patients with breast cancer on neoadjuvant chemotherapy (NACT).Methods A total of 78 newly diagnosed and untreated patients with invasive breast cancer were recruited for this retrospective study.FOXP3 Tregs were assessed by immunohistochemistry.The relationship between clinicopathological factors,FOXP3 + Tregs and pathological complete response (pCR) rate was analyzed.Results Among 78 patients with TAC neoadjuvant chemotherapy,the pCR rate was 19.2％.The pCR rate of patients with high expressions of FOXP3 + Tregs was significantly lower than that of those with low expressions of FOXP3 + Tregs (9.5％ vs 30.5％,P =0.023).FOXP3 + Tregs expression in breast cancer and efficacy of NACT were negatively correlated.Conclusion FOXP3 + Tregs may serve as a predictor for assessing the efficacy of NACT.

Aim: To examine transforming growth factor beta 1( TGF-β1) levels in right ventricular in juvenile rats with right heart failure( RHF) and the intervention effects of captopril and sildenafil citrate on them. Methods: A total of 78 SD rats were randomized into two groups: RHF and control. Rats in the RHF group were injected monocrotaline for 4 weeks to induce RHF,then were randomly allocated into group F 1,group F 2,captopril( C) group,sildenafil citrate( S) group and group C + S. Rats in the control group were injected with normal saline,and randomly allocated into group N 1 and group N 2. The rats in the F 1 and N 1 groups were sacrificed for observing pathological changes in the myocardium. At the same time,group C,group S,group C + S were separately given intragastric administration of captopril,sildenafil citrate,captopril and sildenafil citrate for 2 weeks. Group F 2 and N 2 were given distilled water of equal dose for 2 weeks. Some physiological indexes were measured. Serum TGF-β1 levels were measured using ELISA. TGF-β1 protein expression was measured by immunhistochemistry. Results: Serum TGF-β1 levels and TGF-β1 protein were higher in group F 2 than those in group N 2( t =10. 088,7. 259,P <0. 001). Right ventricular hypertrophy index and TGF-β1 protein in group C and group S were lower than those in group F 2( P <0. 05). There was significant interaction between captopril and sildenafil citrate( F =6. 630, 7. 183,14. 905,P < 0. 05). There was a positive correlation between serum TGF-β1 levels and myocardial TGF-β1 protein expression in group F 2( r =0. 665,P < 0. 001). Conclusion: Captopril and sildenafil citrate could have protection for RHF,and the combined use of the 2 drugs shows marked curative effect than single use any one of them.

Objective To investigate the application value of vacuum-assisted biopsy system in the minimally invasive biopsy for breast lesions.Methods The 294 female patients with breast lesions underwent minimal invasive biopsy excision and the operative outcomes were retrospectively analyzed.Results The 14 cases(4.8%) were diagnosed as cancer and 280 cases(95.2%) were diagnosed as benign.The 14 cases of cancer after modified radical mastectomy were followed for 12(9-16) months and no tumor recurrence was detected on the affected side chest wall.The others of the benign tumors after removed the tumor were followed for 9(6-12) months and no tumor residue or recurrence was detected in the original suspicious lesions place.Conclusion The vacuum-assisted biopsy technique for breast lesions is accurate,reliable,and provides reliable basis for the next treatment.The breast lesions with benign biopsy can be completely removed,which reduce the risk of canceration.Therefore,the vacuum-assisted biopsy technique can be used as one preferred method for breast lesions excision biopsy.

<正>男性乳腺发育症是指男性体内雌、雄激素比例失调或其他器质性病变导致乳腺组织异常发育、乳腺结缔组织异常增生的一组疾病,表现为男性一侧或两侧乳房呈女性样发育、肥大,有时有乳汁样的分泌等症状[1-2]。作者通过对114例男性乳腺发育症的病因总结归纳并结合国内外文献进行分析,针对不同病因进行相关诊断和治疗。

Objective To observe the changes of neuron structure and the identification marker proteins of synapse reconstruction,as well as the influence of Naomaitong(NMT)on the changes,then to explore the way of combination of NMT and BMSCs transplantation in promoting the restoration of nervous function. Methods Rats whole bone marrow were cultivated and BMSCs were purified and increased by methods of adherence and selection in vitro.Middle cerebral artery occlusion(MCAO) model was duplicated with nylon thread.Rats of transplantation and combination groups were transplanted with BMSCs via carotid artery at 24 h after cerebral ischemia reperFusion.NMT was used by intragastric administration.Rats general neural function(GNF) were measured and neurons synapse structure was observed by using transmission electron microscopy,then the expression of NF-200,GAP-43 and Syn were determined by using immunohistochemical method at 7d(earlier period),14d(metaphase)and 28d(anaphase)after BMSCs transplantation as the specific identification marker of neuron structure and synapse reconstruction. Results Rats GNF in each model group was lower than that in sham operation group.Rats GNF in each NMT and combination group,28d transplantation group all increased in comparison with that of model groups.Rats GNF in 7d and 28d combination groups was higher than that in transplantation groups.Rats NF-200,GAP-43 and Syn in each model group was lower than that in sham operation group.Comparing with model groups,the expression of NF-200,GAP-43 and Syn in NMT and transplantation 28d,14d and 28d combination groups all increased obviously.Rats' expression of NF-200 and GAP-43 in 14d and 28d,and Syn in 28d combination groups enhanced obviously than that in transplantation groups. Conclusion Rats neuron structure was damaged obviously being caused by cerebral ischemic injury,and appeared the progressively enhanced tendency following the prolongation of reperfusion,while the synapse reconstruction attenuated.BMSCs transplantation showed no significant effect on nervous function restoration in earlier period.NMT could make the effect of BMSCs transplantation on GNF recovery ahead of schedule and enhance the effects of BMSCs transplantation.The way of combination administration might be related to up-regulation of GAP-43 and then to improve the neural synapse reconstruction.

Objective:To explore the expression and clinical significance of paxillin and caspase-3 in breast invasive ductal carcinoma (IDC ).Methods:The paxillin and caspase-3 expression in IDC tissue and normal mammary specimens were detected by immunohistochemistry.Then,the correlation between the expression of these two proteins and the clinicopathologic characteristics of breast IDC was analyzed.Results:The paxillin expression was significantly higher in IDC tissue than in normal mammary tissue(P < 0.05 ), whereas the caspase-3 expression was significantly lower in IDC tissue than in normal mammary tissue(P < 0.05 ).In IDC,the paxillin expression was correlated with the Her-2 level,whereas the paxillin and caspase-3 expression was closely correlated with the lymph-node metastasis and histological grades(P < 0.05 ).Moreover,negative correlations were observed between the paxillin and caspase-3 expression (r=-0.32;P=0.013 ).Conclusion:The abnormal expression of paxillin and caspase-3 plays important roles roles in the occurrence and development of IDC and correlates with the invasion and metastasis of breast IDC.

OBJECTIVE:To explore the effects of all trans retinoic acid (ATRA) on the cell proliferation and expression alterations of beta-protein 1 (BP1) in human breast cancer cells lines of MDA-MB-468 and MCF-7.METHOD:The proliferation changes were detected by thiazolyl blue tetrazolium bromide (MTT) after the treatment of ATRA. At the dose of 10(-5) mol/L ATRA, the expression of BP1 was measured by reverse transcription-polymerase chain reaction (RT-PCR) and immunochemistry.RESULTS:After the treatment of ATRA, the proliferation of cells and the expression of BP1 decreased. Optical density ratio (ODR) of each group decreased from 0.85 ± 0.01, 0.71 ± 0.01 to 0.75 ± 0.02, 0.72 ± 0.06 at 24 h, 0.55 ± 0.01, 0.52 ± 0.05 at 48 h and 0.34 ± 0.02, 0.48 ± 0.03 at 72 h. Significant differences existed among different time groups (P < 0.01). The mean optical density (MOD) of each group decreased from 0.509 ± 0.081, 0.826 ± 0.015 to 0.509 ± 0.081, 0.826 ± 0.015 at 24 h, 0.270 ± 0.022, 0.641 ± 0.041 at 48 h and 0.145 ± 0.019 and 0.206 ± 0.179 at 72 h. Significant differences existed among different time groups (P < 0.01).CONCLUSION:ATRA can inhibit the proliferation and the expression of BP1 in breast cancer cells. And BP1 gene may become a therapeutic target for the ATRA-mediated inhibited growth of breast cancer cells.