“绘事后素”中“后素”与“后于素”再辩

对于《论语·八佾》中“绘事后素”一词有关“素”在绘事中前后的问题,以郑玄的“后素”说和朱熹的“后于素”说最具代表性。但综合考虑中国古代绘画技法的演变、有关考古发现、孔子和子夏的对话语境,以及孔子的人生观和艺术思想等因素,朱熹的“后于素”说疑点颇多。“绘事后素”之“素”解释为“粉地”不妥,应释为“本色”“素朴”。“后”,除有时间先后的承续关系外,还应将其理解为一种逻辑意义上的形式与内容的关系。“绘事后素”可解释为绘画等美化之事都要以自然、朴素为基本原则。

“绘事后素”语义考辨

以朱熹和郑玄为代表的两派对《论语》中“绘事后素”之“后素”在解读上截然对立。前者解“素”为“粉地”,名词,解“后素”为“后于素”,即布好粉地然后在上面作画;后者解“素”为“以素粉勾勒”,动词,解“后素”为“后素之”,即绘画中“布完众色之后以素粉分布其间”。二者均没有充分关注孔子“起予者商也”之内涵,亦没有将“绘事后素”之语义与整个对话语境结合起来加以审视。基于对《论语》“绘事后素”章节文本结构的逻辑分析,从对话的连贯性和完整性参悟双方意图,推敲其“言外之意”,认为占据学术主流的“朱派”观点理据不足,“郑派”则对“后素”的本义作出了准确判断,惜乎对“素以为绚兮”的解释仍有失偏颇。

强化后期氮素营养对提高水稻结实率及改善米质的作用

加强后期氮素营养能提高杂交水稻碳氨同化能力和结实率,稻米的蛋白质和八种必需氨基酸含量、谷类蛋白的赖氨酸和苏氨酸也有提高。

Chlorophyll Fluorescence and Membrane Lipid Peroxidation in the Flag Leaves of Different High Yield Rice Variety at Late Stage of Development Under Natural Condition

With indica ( Oryza sativa L.) hybrid Shanyou 63 as control, the hybrid rice varieties including Peiai 64S/E32, Peiai 64S/9311, X07S/Zihui 100, Guangyou 881 and japonica 9516 were used to study changes of chlorophyll content, photosynthetic response to light intensity and temperature, chlorophyll fluorescence characteristics and membrane lipid peroxidation in their flag leaves at the late stage of development under natural conditions in Nanjing. The results were as follows:. primary photochemical efficiency of PS II ( F-v / F-m), quantum yield of linear electron transport of PS II (phi(PSII)), electron transfer rate (ETR) in these rice varieties decreased with their decrease of chlorophyll content during this period. This kind of impediment to energy conversion induced the transfer of excessive energy to the reducing side of PS I, hence the accumulation of O-2(radical anion) and peroxidation of membrane lipid, and resulting in the accumulation of malondialdehyde (MDA), that is the destroys of photosynthetic pigments and membranes and the consequent, premature senescence. This phenomenon is variable conspicuously in different rice varieties. Under natural condition in Nanjing, F-v/F-m, phi(PSII), ETR and quenching coefficient ( qP) in japonica 9516 tolerant to photooxidation decreased less and the conversion capacity of light energy was stable, premature senescence was unlikely, and consequently the seed-setting rate was higher. While F-v/F-m, phi(PSII), ETR and photochemical qP in Shanyou 63 sensitive to photooxidation decreased more and therefore premature senescence was easy to happen, thus the seed-setting rate and yield were all reduced. The tolerance to photooxidation and premature senescence in other hybrids derived from typical two line or three line crossing laid in the middle. From the rice breeding for super-high-yield, on the basis of the good plant-type of current rice, considering both hybrid vigor and the prevention premature senescence, it would be a notable strategy to use japonica maternal line or maternal. lines with some japonica genotype as the sterile lines in rice breeding.

Association of CA Repeat Polymorphism in Estrogen Receptor β Gene with Postmenopausal Osteoporosis in Chinese

Postmenopausal osteoporosis （PMO） is considered a polygenic disease. The estrogen receptor β （ESR2） gene is a candidate mediating the genetic influence on bone mass and the risk of osteoporosis. The aim of this study is to investigate the association of a cytosine-adenine （CA） repeat polymorphism in the fifth intron of the ESR2 gene with PMO in Chinese Han population. The CA repeat polymorphism was genotyped in a case-control study, involving 78 femoral neck PMO patients vs. 122 controls and 108 lumbar spine （L2-4） PMO patients vs. 92 controls. The （CA）n〈22 and （CA）n≥22 alleles were designated short （S） and long （L）, respectively. ESR2 genotype was categorically defined as SS （2 S alleles）, SL （having the mixed S and L alleles）, and LL （2 L alleles）. At both the femoral neck and the L2-4 region, LL genotype and L allele frequencies of the PMO group were significantly higher than those of the control group （P〈0.01）. The subjects with the SL, the LL, and the combined SL and LL genotype had a significant increased risk of PMO when compared with those with the SS genotype （P〈0.05）. After adjustments for age, years since menopause, menopausal age, and body mass index, logistic regression analysis showed that the subjects with the combined SL and LL genotype had increased risk of PMO when compared with those with the SS genotype both at the femoral neck （adjusted OR 4.923, 95% CI 1.986-12.203 , P=0.001） and the L2-4 （adjusted OR 2.267, 95% CI 1.121-4.598, P=0.023）. This extensive association study has identified the ESR2 CA repeat polymorphism to be independently associated with PMO at the femoral neck and the L2-4 in Chinese Han population. The data also suggested that the presence of the L allele may dominantly increase the risk of PMO at the two regions.

Possible involvement of integrin signaling pathway in the process of recovery from restraint stress in rats

Objective To search novel genes or pathways involved in the recovery process after restraint stress in rats. Methods We compared the hypothalamus transcriptional profiles of two different recovery patterns （fast recovery vs slow recovery） from restraint stress in rats using oligonucleotide microarray, the recovery pattern was determined by the decrement of plasma adrenocorticotropic-hormone （ACTH） and corticosterone levels during one hour recovery period after stress. A real-time quantitative RT-PCR was applied to validate the differential expressed genes. Results Analysis of the microarray data showed that most of genes were not differentially expressed between fast recovery group and slow recovery group. Among the differentially expressed genes we found that talin, together with serine/threonine protein phosphatase PPl-beta catalytic subunit （PP-1B） and integrin α-6 precursor （VLA-6） genes, were at least 1.5 fold upregulated in the fast recovery group, while junctional adhesion molecule 1 （F11r） was 1.5 fold down-regulated in the fast recovery group. Conclusion The results implied that integrin signaling pathway may be involved in the recovery from restraint stress in rats. The present study provided a global overview of hypothalamus transcriptional profiles during the process of recovery from the restraint stress in rats. The integrin signaling pathway seems to be involved in the recovery process, which deserves further study to clarify the integrin-mediated recovery mechanism after restraint stress.

Long-term outcome and prognostic factors of patients with hilar cholangiocarcinoma

AIM： To evaluate the long-term outcome and prognostic factors of patients with hilar cholangiocarinoma. METHODS： Ninety-six consecutive patients underwent treatment for malignant hilar bile duct tumors during 1995-2005. Of the 96 patients, 20 were initially treated with surgery （n = 2 R0 / n = 18 R1）. In non-operated patients, data analysis was performed retrospectively. RESULTS： Among the 96 patients, 76 were treated with endoscopic transpapillary （ERC, n = 45） and/or percutaneous transhepatic biliary drainage （PTBD, n = 31）. The mean survival time of these 76 patients undergoing palliative endoscopic and/or percutaneous drainage was 359 ± 296 d. The mean survival time of patients with initial bilirubin levels 〉 10 mg/dL was significantly lower （P 〈 0.001） than patients with bilirubin levels 〈 10 mg/dL. The mean survival time of patients with Bismuth stage Ⅱ （n = 8）, Ⅲ （n = 28） and Ⅳ （n = 40） was 496 =1= 300 d, 441 ± 385 d and 274 ± 218 d, respectively. Thus, patients with advanced Bismuth stage showed a reduced mean survival time, but the difference was not significant. The type of biliary drainage had no significant benefidal effect on the mean survival time （ERC vs PTBD, P = 0.806）. CONCLUSION： Initial bilirubin level is a significant prognostic factor for survival of patients. In contrast, age, tumor stage according to the Bismuth-Corlette classification, and types of intervention are not significant prognostic parameters for survival. Palliative treatment with endoscopic or percutaneous biliary drainage is still suboptimal, new diagnostic and therapeutic tools need to be evaluated.

TSPAN1 protein expression:A significant prognostic indicator for patients with colorectal adenocarcinoma

AIM:To determine if TSPAN1 overexpression is associated with clinicopathological and prognostic factors in human colorectal adenocarcinoma.METHODS:Total RNA was extracted in 20 human adenocarcinoma tissues for TSPAN1 mRNA assay by RT-PCR.Eighty-eight specimens of human colorectal adenocarcinoma were surgically removed.TSPAN1 protein levels in cancer tissues were determined by immunohistochemistry using a polyclonal antibody against self-prepared TSPAN1.The correlation between TSPAN1 expression and the clinicopathological factors and the overall survival rate was analyzed by univariate and multivariate assay.RESULTS:TSPAN1 mRNA was detected in 90.0%(18/20) of cancerous tissues.The light density of TSPAN1 mRNA expression levels was 0.89 ± 0.30 in adenocarcinoma by gel-image system.TSPAN1 protein expression was detected in 78.41%(69/88) and weakly expressed in 40% normal colorectal tissues.There were significant differences between colorectal adenocarcinoma and normal control epithelium(P < 0.05).TSPAN1 protein expression in colorectal cancerous tissue was significantly correlated with the histological grade,cell expression PCNA,lymph nodal metastasis and TNM staging of the disease.Patients with TSPAN1 protein overexpression had a significantly shorter survival period than that in patients with TSPAN1 protein negative or weak expression,respectively(P < 0.05).Furthermore,by multivariate analysis,TSPAN1 protein expression demonstrated an independent prognostic factor for human colorectal cancers(P < 0.05,relative risk 0.755;95% confidence interval 0.302-1.208).CONCLUSION:The expression of TSPAN1 gene is increased in colorectal carcinoma,suggesting that TSPAN1 might serve as an independent prognostic factor for the colorectal adenocarcinoma patients.

Prognostic significance of preoperative and postoperative CK19 and CEA m RNA levels in peripheral blood of patients with gastric cardia cancer

AIM To evaluate the clinical and prognostic significance of preoperative and postoperative cytokeratin 19(CK19) and carcinoembryonic antigen(CEA) m RNA levels in peripheral blood of patients with gastric cardia cancer(GCC).METHODS We detected the preoperative and postoperative mR NA levels of CK19 and CEA in peripheral blood of 129 GCC patients by using reverse transcription-polymerase chain reaction and evaluated their clinical and prognostic significance by univariate Kaplan-Meier survival analysis and multivariate Cox proportional hazard analysis. A new prognostic model which stratified patients into three different risk groups was established based on the independent prognostic factors.RESULTS Elevated preoperative and postoperative CK19 and CEA mR NA levels in peripheral blood of GCC patients were associated with lymph node metastasis. Univariate analysis showed that tumor size, histological grade, depth of tumor invasion, lymph node metastasis, preoperative CK19 m RNA, and preoperative and postoperative CEA m RNA levels were correlated with the prognosis of GCC patients. The multivariate analysis showed that lymph node status(P = 0.018), preoperative CK19(P = 0.035) and CEA(P = 0.011) m RNA levels were independent prognostic factors for overall survival(OS). The 5-year OS rates for the low-, intermediate-, and high-risk groups were 48.3%, 22.6%, and 4.6%, respectively(P < 0.001).CONCLUSION Elevated preoperative CK19 and CEA mR NA levels may be regarded as promising biomarkers for predicting lymph node metastasis and poor prognosis in patients with GCC. This new prognostic model may help us identify the subpopulations of GCC patients with the highest risk.

Cyclooxygenase-2 expression is associated with initiation of hepatocellular carcinoma, while prostaglandin receptor-1 expression predicts survival

AIM to determine whether cyclooxygenase-2(COX-2) and prostaglandin E1 receptor(EP1) contribute to disease and whether they help predict prognosis.METHODS We retrospectively reviewed the records of 116 patients with hepatocellular carcinoma(HCC) who underwent surgery between 2008 and 2011 at our hospital. Expression of COX-2 and EP1 receptor was examined by immunohistochemistry of formalin-fixed, paraffinembedded tissues using polyclonal antibodies. Possible associations between immunohistochemical scores and survival were determined.RESULTS Factors associated with poor overall survival(OS) were alpha-fetoprotein > 400 ng/m L, tumor size ≥ 5 cm, and high EP1 receptor expression, but not high COX-2 expression. Disease-free survival was not significantly different between patients with low or high levels of COX-2 or EP1. COX-2 immunoreactivity was significantly higher in well-differentiated HCC tissues(Edmondson grade Ⅰ-Ⅱ) than in poorly differentiated tissues(Edmondson grade Ⅲ-Ⅳ)(P = 0.003). EP1 receptor immunoreactivity was significantly higher in poorly differentiated tissue than in well-differentiated tissue(P = 0.001).CONCLUSION COX-2 expression appears to be linked to early HCC events(initiation), while EP1 receptor expression may participate in tumor progression and predict survival.

The risk factors of postpartum urinary retention after vaginal delivery:A systematic review

Objectives:This review aimed to explore the independent risk factors of postpartum urinary retention(PUR)after a vaginal delivery.Methods:The Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)was followed and relevant studies were retrieved from eleven databases.The quality of the included articles was assessed using Critical Appraisal Skills Programme tools or the Appraisal tool for Cross-Sectional Studies.The data analysis was performed using Review Manager version 5.3.Results:A total of nine articles were included and five risk factors were identified,namely,episiotomy(OR=2.99,95%CI=1.31e6.79,P=0.009),epidural analgesia(OR=2.48,95%CI=1.09e5.68,P=0.03),primiparity(OR=2.17,95%CI=1.06e4.46,P=0.03),instrumental delivery(OR=4.01,95%CI=1.97 e8.18,P<0.001),and the duration of the second stage of labor(MD=15.24,95%CI=11.20e19.28,P<0.001).However,fetal birth weights of more than 3800 g were not identified as an independent risk factor(MD=64.41,95%CI=-12.59 to 141.41,P=0.10).Conclusion:This systematic review indicated that the independent risk factors for PUR were found to include episiotomy,epidural analgesia,instrumental delivery,primiparity,and a longer second stage of labor.In clinical practice,healthcare providers could pay more attention to women with these factors and prevent postpartum urinary retention.

Prognostic factors for 5-year survival after local excision of rectal cancer

AIM:To evaluate the prognostic factors for 5-year survival after local excision of rectal cancer,and to examine the therapeutic efficacy and surgical indications for this procedure. METHODS:Clinical data,obtained from 106 local rectal cancer excisions performed between January 1980 and December 2005,were retrospectively analyzed.Survival analysis was performed using the Kaplan-Meier method,statistical comparisons were performed using the log-rank test,and multivariate analysis was performed using the Cox proportional hazards model. RESULTS:Transanal,transsacral,and transvaginal excisions were performed in 92,12,and 2 cases, respectively.The rate of complication,local recurrence, and 5-year survival was 6.6%,17.0%,and 86.7%, respectively.Univariate analysis showed that T stage, vascular invasion,and local recurrence were related to the prognosis of the cases(P<0.05).Multivariate analysis showed that T stage[P=0.011,95% confidence interval(CI)=1.194-3.878]and local recurrence(P=0.022,95%CI=1.194-10.160)were the major prognostic factors for 5-year survival of cases after local excision of rectal cancer. CONCLUSION:Local rectal cancer excision is associated with few complications,and suitable for stages Tis and T1 rectal cancer.Prevention of local recurrence,active postoperative follow-up,and administration of salvage therapy are the effective methods to increase the efficacy of local excision of rectal cancer.

Bcl-2 expression is a poor predictor for hepatocellular carcinoma prognosis of andropause-age patients

Objective: The expression of B-cell lymphoma 2(Bcl-2) seems to be influenced by the endocrine environment. Numerous reports demonstrate the diverse expression of Bcl-2 family members under sex steroid regulation. With the exception of estrogen-related tumors, androgen-related tumors have shown their characteristics in Bcl-2 expression. In this study, the status of Bcl-2 expression in male hepatocellular carcinoma(HCC) patients was examined to verify the high incidence of HCC in males.Methods: Tumor tissue microarray was used to examine Bcl-2 expression levels in 374 HCC cases including 306 males and 68 females. Kaplan-Meier method, log-rank test, and Cox proportional hazards model were applied to investigate the predictive value of Bcl-2 in HCC patients.Results: Immunohistochemistry analysis showed that male patients with higher Bcl-2 levels had significantly longer median survival time and recurrence time than those with lower levels. However, no significant differences in outcomes were found between different Bcl-2 levels in female patients. When the male patients were stratified into several age points, the level of Bcl-2expression showed poorer predictive efficiency in the 45–49 and 55–60 age groups in andropause-age patients compared with other age groups. Bcl-2 was an independent prognostic factor for both overall survival(P < 0.0001) and recurrence time(P =0.0001) in male patients. After excluding male patients in the 45–60 age group, the predictive efficiency was enhanced(n = 147,OS, P = 0.0002, TTR, P < 0.0001).Conclusions: Bcl-2 expression is an independent predictor of survival and recurrence in male HCC. Bcl-2 levels may also be regulated by androgens or androgen receptors in male HCC patients. Bcl-2 levels change and exhibit poor predictive efficiency when androgen levels vary dramatically(andropause age).

Patterns and prognosis of locally recurrent rectal cancer following multidisciplinary treatment

AIM:To investigate the patterns and decisive prognostic factors for local recurrence of rectal cancer treated with a multidisciplinary team(MDT) modality.METHODS:Ninety patients with local recurrence were studied,out of 1079 consecutive rectal cancer patients who underwent curative surgery from 1999 to 2007.For each patient,the recurrence pattern was assessed by specialist radiologists from the MDT using imaging,and the treatment strategy was decided after discussion by the MDT.The associations between clinicopathological factors and long-term outcomes were evaluated using both univariate and multivariate analysis.RESULTS:The recurrence pattern was classified as follows:Twenty-seven(30%) recurrent tumors were evaluated as axial type,21(23.3%) were anterior type,8(8.9%) were posterior type,and 13(25.6%) were lateral type.Forty-one patients had tumors that were evaluated as resectable by the MDT and ultimately received surgery,and R0 resection was achieved in 36(87.8%) of these patients.The recurrence pattern was closely associated with resectability and R0 resection rate(P < 0.001).The recurrence pattern,interval to recurrence,and R0 resection were significantly associated with 5-year survival rate in univariate analysis.Multivariate analysis showed that the R0 resection was the unique independent factor affecting long-term survival.CONCLUSION:The MDT modality improves patient selection for surgery by enabling accurate classification of the recurrence pattern;R0 resection is the most significant factor affecting long-term survival.

Clinical features and prognosis of obese breast cancer patients: a retrospective study

Objective:The aim of our study was to investigate the prognosis of obese breast cancer patients.Methods:This study was conducted on a total of 317 breast cancer patients who were histopathologically and clinically diagnosed at the General Hospital of Shenyang Military Region(China)from 2004 to 2006.Clinical data including height,weight,age at diagnosis,tumor size,lymph node status,menopausal status,family history of cancer and hormone receptor status were collected.Log-rank test was performed to compare the disease free survival(DFS)and overall survival(OS).Cox proportional hazards regression analysis was conducted to make multivariate analysis.The Chi square test was used to compare the clinical features among normal weight group,overweight group,and obese group.Results:Obesity was an independent prognostic factor for DFS(P=0.022)and OS(P=0.032)in breast cancer patients.In the stratified analysis based on the hormone receptor status,obesity was independently associated with OS in patients with negative ER/PR(P=0.002),but such association was not observed in patients with positive hormone receptors.Obesity was also associated with lymph node status(P=0.001)and smoking(P=0.009).Conclusion:Obesity is associated with poor DFS and OS in patients with breast cancer.Therefore,maintaining normal weight may benefit breast cancer patients.

Tumor size as a prognostic factor in patients with advanced gastric cancer in the lower third of the stomach

AIM: To explore the impact of tumor size on outcomes in patients with advanced gastric cancer in the lower third of the stomach. METHODS: We retrospectively analyzed the clinical records of 430 patients with advanced gastric cancer in the lower third of the stomach who underwent distal subtotal gastrectomy and D2 lymphadenectomy in our hospital from January 1998 to June 2004. Receiver-operating characteristic (ROC) curve analysis was used to determine the appropriate cutoff value for tumor size, which was measured as maximum tumor diameter. Based on this cutoff value, patients were divided into two groups: those with large-sized tumors (LSTs) and those with small-sized tumors (SSTs). The correlations between other clinicopathologic factors and tumor size were investigated, and the 5-year overall survival (OS) rate was compared between the two groups. Potential prognostic factors were evaluated by univariate KaplanMeier survival analysis and multivariate Cox's propor-tional hazard model analysis. The 5-year OS rates in the two groups were compared according to pT stage and pN stage. RESULTS: The 5-year OS rate in the 430 patients with advanced gastric cancer in the lower third of the stomach was 53.7%. The mean ± SD tumor size was 4.9 ± 1.9 cm, and the median tumor size was 5.0 cm. ROC analysis indicated that the sensitivity and specificity results for the appropriate tumor size cutoff value of 4.8 cm were 80.0% and 68.2%, respectively (AUC=0.795, 95%CI: 0.751-0.839, P=0.000). Using this cutoff value, 222 patients (51.6%) had LSTs (tumor size ≥ 4.8 cm) and 208 (48.4%) had SSTs (tumor size<4.8 cm). Tumor size was significantly correlated with histological type (P=0.039), Borrmann type (P=0.000), depth of tumor invasion (P=0.000), lymph node metastasis (P=0.000), tumor-nodes metastasis stage (P=0.000), mean number of metastatic lymph nodes (P=0.000) and metastatic lymph node ratio (P=0.000). Patients with LSTs had a significantly lower 5-year OS rate than those with SSTs (37.1% vs 63.3%, P=0.000). Univariate analysis showed that depth of tumor invasion (c 2=69.581, P=0.000), lymph node metastasis (c 2=138.815, P=0.000), tumor size (c 2=78.184, P=0.000) and metastatic lymph node ratio (c 2=139.034, P=0.000) were significantly associated with 5-year OS rate. Multivariate analysis revealed that depth of tumor invasion (P=0.000), lymph node metastasis (P=0.019) and tumor size (P=0.000) were independent prognostic factors. Gastric cancers were divided into 12 subgroups: pT2N0; pT2N1; pT2N2; pT2N3; pT3N0; pT3N1; pT3N2; pT3N3; pT4aN0; pT4aN1; pT4aN2; and pT4aN3. In patients with pT2-3N3 stage tumors and patients with pT4a stage tumors, 5-year OS rates were significantly lower for LSTs than for SSTs (P<0.05 each), but there were no significant differences in the 5-year OS rates in LST and SST patients with pT23N0-2 stage tumors (P > 0.05). CONCLUSION: Using a tumor size cutoff value of 4.8cm, tumor size is a prognostic factor in patients with pN3 stage or pT4a stage advanced gastric cancer located in the lower third of the stomach.

Surgical treatment of hepatocellular carcinoma: Evidence-based outcomes

Surgeons may be severely criticized from the perspective of evidence-based medicine because the majority of surgical publications appear not to be convincing. In the top nine surgical journals in 1996, half of the 175 publications refer to pilot studies lacking a control group, 18% to animal experiments, and only 5% to randomized controlled trials (RCT). There are five levels of clinical evidence:level 1 (randomized controlled trial), level 2 (prospective concurrent cohort study), level 3 (retrospective historical cohort study), level 4 (pre-post study), and level 5 (case report). Recently, a Japanese evidence-based guideline for the surgical treatment of hepatocellular carcinoma (HCC) was made by a committee (Chairman, Professor Makuuchi and five members). We searched the literature using the Medline Dialog System with four Keywords:HCC, surgery, English papers, in the last 20 years. A total of 915 publications were identified systematically reviewed. At the first selection (in which surgery-dominant papers were selected), 478 papers survived. In the second selection (clearly concluded papers), 181 papers survived. In the final selection (clinically significant papers), 100 papers survived. The evidence level of the 100 surviving papers is shown here:level-1 papers (13%), level-2 papers (11%), level-3 papers (52%), and level-4 papers (24%);therefore, there were 24% prospective papers and 76% retrospective papers. Here, we present a part of the guideline on the five main surgical issues:indication to operation, operative procedure, peri-operative care, prognostic factor, and post-operative adjuvant therapy.

Prognostic Factors of Ampulla of Vater Carcinoma after Radical Surgery

OBJECTIVE Ampullary carcinoma is a rare disease with betterprognosis than other periampullary neoplasms. This studyinvestigated the association between clinicopathologic factors andprognosis after radical resection of ampulla of Vater carcinoma.METHODS Clinical data from 105 patients who underwentradical pancreaticoduodenectomy from January 1990 to December2005 were retrospectively analyzed by the Kaplan-Meier method,log-rank test, and the Cox proportional hazard model.RESULTS The in-hospital mortality rate was 8.6%, the lymphnode metastasis rate was 37.1%, and the five-year survival ratewas 42.8%. Pancreatic involvement (P = 0.027), tumor diameter (P= 0.008), T stage (P = 0.003), TNM stage (P < 0.001), and number ofmetastatic lymph nodes (P < 0.001) were associated with prognosiswhen the univariate analysis was used. Multivariate analysisshowed that the number of lymph node metastases (P < 0.001;OR: 1.923; CI: 1.367-2.705) and tumor diameter (P = 0.03; OR: 1.432;CI: 1.035-1.981) were the independent prognostic factors.CONCLUSION The number of metastatic lymph nodes andtumor diameter are important pathologic factors predictingprognosis of ampulla of Vater carcinoma after radical resection,and lymph node dissection during the radical surgery effectivelyimproves the survival rate.

Clinical characteristics and prognosis of triple-negative breast cancer

Objective： We investigated the clinical characteristics, and the prognostic factors of triple-negative breast cancer. Methods： 130 triple-negative breast cancer patients were reviewed on clinical characteristics and prognosis. All cases were lack of expression of estrogen receptor, progesterone receptor, and HER2/neu determined by immunohistochemistry. Results： 17.1% of all breast cancer patients （774 cases） were triple-negative breast cancer, and 68.9% of triple-negative breast cancer patients （91 cases） were premenopausal. 53.8% of patients （71 cases） had the tumors with T2 size, and 39.4% of them （52 patients） had lymph node metastasis. The rate of relapse in patients with lymph node metastasis was obviously higher than that in patients without lymph node metastasis （P = 0.001）. The median time of follow-up was 63 months. 33 cases relapsed and 20 patients died. 23 patients had at least two organs metastasis. The 5-year disease-free and overall survival rates were 73.8% and 85.7%. Conclusion： Triple-negative breast cancer patients commonly have high rate of multiple distant metastasis in 2-3 years after treatment. The status of lymph node is the most important prognostic factor. The triple-negative breast caner patients with lymph node metastasis have poor prognosis.

礼以遂其美——《论语》“绘事后素”章旨研味

《论语·八佾》“绘事后素”章的诠释传统,以郑玄、朱熹为代表,大致形成了素在后与素在先两条路向,或曰天然禀赋待礼以修治,或谓道德品质乃礼之根本。分歧的核心是如何看待礼的性能和意义。参详该章的师生问答,“素以为绚兮”是话题之由,若对其中的“为”字足够重视,当可从动态塑造的向度给解读带来启发。由子夏“何谓也”之款叩到孔子“可与言《诗》”之欣叹,以美事之遂成作为潜台词,连贯的义脉乃得显发:献疑于容色,解喻以绘功,触悟在礼意;进而回思开端,由礼观诗。塑造和转化之功,贯穿于问答的始终。人的自我完善亦须礼以成全,谦约成身而成之于行,切己成就深具教养的纯正之美。