Objective To evaluate the saf ety and efficiency of phacoemulsificatio n combined with intraocular lens implant and trabeculectomy in patients with glau coma and cataract after filtrating surge ry failure. Methods Thirty-two cases （32 eyes） patients underwent phacoemulsific ation combined with intraocular lens imp lant and trabeculectomy after filtrating surgery failure. Outcome measures inclu ded intraocular pressure （IOP） and visua l acuity. The followed-up periods rang ed from 6 months to 2 years. Results In 21 of the 32 eyes（66％），postoperative vi sual acuity were above 0.5. In 6 of the 32 eyes（18％），postoperative visual acuity were between 0.1 to 0.4. In 27 of 32 e yes（84.3％）， postoperative IOP were between 12.23 to 20.55 mmHg. Conclusion phac oemulsification combined with intraocula r lens implant and trabeculectomy in patients with glaucoma and cataract after f iltrating surgery failure is a safe and effective treatment for these patients.

Objective To investigate the effectiveness of intensive sit-to-stand training in improving the balance and walking of hemiplegic stroke patients. Methods Sixty hemiplegic stroke patients were randomly divided into an observation group and a control group with 30 cases in each.Both groups were treated with routine rehabilitation.The observation group also underwent extensive sit-to-stand training.The training lasted for 15 min/time,6 times/week for 4 weeks.All of the patients were assessed with respect to their body weight distribution,Berg balance scale (BBS) scores,timed up & go test (TUGT) times and using footprint gait analysis,before the treatment and 4 weeks post treatment. Results After 4 weeks of treatment body weight distribution,BBS scores,TUGT times and gait improved significantly in both groups.The BBS,TUGT and gait improvements were significantly greater in the observation than in the control group.There was no significant difference between the two groups in terms of body weight distribution. Conclusions Extensive sit-to-stand training combined with routine rehabilitation can distinctly improve the balance and walking of hemiplegic stroke survivors.

Objective To investigate the biological effect of GM-CSF on splenic dentritic cells (DCs)when used to treat severe sepsis and the influence on the prognosis.Methods All 160 male Kunming mice were randomly(random number)divided into four groups:control group(n =50),the mice didnt receive special treatment; CLP group(n =42),the mice underwent cecal ligation and puncture;conventional treatment group(n =34),the mice received intraperitoneal injection of 5 mg/kg ceftriaxone at 12,24,36,48,60,72 and 84 h after surgery; GM-CSF treatment group(n =34),the mice received hypodermic injection of 20 μg/kg GM-CSF besides ceftriaxone at 12,36,60,and 84 h after surgery.The mice were sacrificed at 0,12,24,48 and 72 h after CLP by cervical dislocation.The amount of splenic DCs and apoptosis rate were measured by flow cytometry,and the serum concentrations of IL-12 were detected by ELISA in each group.Meanwhile the survival prognosis was observed at 96 h.Results At every time point,the apoptosis of splenic DCs increased and the amount markedly reduced in severe sepsis(P ＜0.05),the serum concentration of IL-12 increased on an one-way curve type(P ＜0.05).The treatment of cephalosporin exacerbated the loss of DCs(P ＜ 0.05),while hadnt any effect on IL-12(P ＞ 0.05).GMCSF treatment increased the amount of DCs(P ＜ 0.05),and decreased IL-12 concentrations(P ＜ 0.05).The OR of GM-CSF was 0.079 computed by Logist regression analysis.Conclusions GM-CSF treatment severe sepsis can increase the amount of splenic DCs,decrease serum levels of IL-12,and improve prognosis.

The β-adrenergic receptor has close relationship with the occurrence and development of tumor.The β-adrenergic receptors were expressed in a variety of tumors.Its activation can stimulate tumor growth by promoting cell proliferation,inhibite apoptosis,promote angiogenesis,and enhance tumor invasion and metastasis.The β-adrenergic receptor blockers can suppress the tumor growth,which may become one of the effective methods of cancer prevention and treatment.

ObjectiveTo evaluate the effects of selective cyclooxygenase-2 inhibitor nimesulide lone and combined with cisplatin on tumor growth,and Ki67 and Caspase-3 expression in lung cancer xenografts in nude mice. Methods The mice were randomly divided into 4 groups:the control group,the nimesulide group,the cisplatin group and the nimesulide combined with cisplatin group. A549 cells were injected into BALB/c nude mice subcutaneously.On the 21st day after treatment tumor tissues were collected,and the xenografts growth were observed. The expression of Ki67 and Caspase-3 were detected by immunohistochemical method.ResultsNimesulide combined with cisplatin could significantly inhibited the xenografts growth compared with nimesulide or cisplatin.The tumor inhibition rate was 44.33％ in the nimesulide group,53.61％ in the cisplatin group and 80.41％ in the nimesulide combined with cisplatin group (P ＜ 0.05).Immunohistochemical analysis showed that the expression rates of Caspase-3 was significantly increased in the nimesulide combined with cisplatin group (67.43 ± 23.57 ) ％,the cisplatin group (48.40 ± 20.37 ) ％,and the nimesulide group (38.65 ± 15.37)％,compared with the control group (27.63 ± 13.03)％ (P ＜ 0.05).The expression rate of Caspase-3 was significantly increased in the nimesulide combined with cisplatin group compared with the nimesulide group or the cisplatin group (P ＜ 0.05 ).The expression rate of Ki67 was significantly decreased in the nimesulide group combined with cisplatin group (24.34 ± 15.90)％,the cisplatin group (40.85 ± 22.47)％ and the nimesulide group (53.33 ± 19.67)％ compared with the control group ( 80.43 ± 16.88 ) ％ ( P ＜ 0.05 ).The expression of Ki67 was significantly decreased in the nimesulide combined with cisplatin group compared with the nimesulide group or the cisplatin group ( P ＜ 0.05 ).Conclusion Nimesulide can inhibit human lung cancer A549 cells xenografts in nude mice growth,Nimesulide enhanced the inhibitory effects of cisplatin.The mechanism may be related to inhibition of tumor cell Ki-67 expression,increased expression of Caspase-3,inhibition of tumor cell proliferation,and inducing tumor cell apoptosis.

p21 activated kinase 4 (PAK4) is a member of a family of serine/threonine kinase.PAK4plays an important role in a variety of cellular functions including cell cycle,cell proliferation,apoptosis,and cytoskeletal reorganization.Recently,PAK4 has been shown to overexpress in a variety of malignancies,and contribute to cancer cell migration and invasion through multiple signalling pathways.

Objective To investigate the clinical characteristic and surgical treatment of MGIST. Methods 40 cases MGIST surgical meterials were retrospectively analyzed. Results All cases were used surgery,the situation of the tumor is clear and most of them are not coated clearly. The diameter of the tumor is 5～16cm, in average (8.6±2.4)cm ;no lymph nodes metastasis during the surgery. No serious postoperative complications. Follow-up the pa-tients for 8～68 months, 14 of them died. Conclusion There is no specific characteristic on MGIST clinical perform-ance, pathological examination is the basis for the diagnosis. Surgical resection is the main treatment method.

ObjectiveTo understand knowledge level about chronic obstructive pulmonary disease (COPD)of medical doctors practising at district hospitals and community health service and impact of different models of continuing medical education on their knowledge level.MethodsKnowledge of COPD was investigated with a close-book examination in 372 medical doctors working at the grassroots of 10 urban copies of finished examination papers were returned in this investigation.with an average score of 50.1 and pass rate of 42.5%.About 67.7%and 67.5%of medical doctors passed the examination of knowledge on definition,risk factors and non.pharmacological treatment for COPD.respectively,and 19.9%of them passed the examination on pharmacological treatment for COPD.Different modes of continuing medical education made varied impacts on their acquisition of COPD knowledge.with an average score of 67 and pass rate of 73.3%in the intensified education group,respectively,significantly higher than those in general education group and non-education group.ConclusionsClinical knowledge and skills of COPD for medical doctors working at the grassroots in Beijing Was not so satisfactory and education should be strengthened urgently to raise their knowledge on COPD prevention and control.

Objective To determine the minimum alveolar concentration(MAC)of sevoflurane for blunting the responses to removal of the laryngeal mask airway(LMA)in 50%anesthetized children.Methods Twenty-five ASA Ⅰ or Ⅱ children aged 3-8 yr undergoing elective surgery under general anesthesia weTe enrolled in this stuay.Anesthesia was induced with inhalation of 8%Sevoflurane.LMA was inserted when the children lost eyelash reflex and the lower jaw was relaxed.Anesthesia was maintained with 3%sevoflurane.All the children kept spontaneous breathing during operation.Assisted ventilation waw performed when necessary to maintain PET CO2 at 35-45 mm Hg.After the surgery the target end-tidal sevoflurane concentration was maintained for 10 min before LMA was removed.Up-and-down sequential allocation was used to determine山e MAC.The initial end-tidal concentration was 1%and was increased/decreased by 20%in the next patient if the extubation response was positive or negative.Limb movement,breath-holding,laryngosposm and hypoxemia(SpO2<95%)were considered to be the signs of positive response.The midpoint from positive response to negative response was made the balance point.and the mean value ofthe concentrations of sevoflurane at all the balance points were calculated as MAC.Results The end-tidal sevoflurane concentration for blunting the responses to removal of LMA was 0.98%.Conclusion The MAC of sevoflilrane for blunting the responses to removal of LMA in 50%anesthetized children(aged 3-8 yr)is 0.98%.

As the largest protective barrier of the body,gastrointestinal tract helps the organism resist the invasion and attacks of harmful substances from the outside world.There are three kinds of protective barriers:mechanical barrier,biotical barrier,and immune barrier.In recent years,increasing researches indicate the importance of gastrointestinal immune barrier and the important immunologic mechanism of enteral nutrition in improving the clinical outcome.This article reviews the effect of gut immunity in the improvement of clinical outcome by enteral nutrition.