The blockade of targeted immune checkpoint is one of the most promising approaches to activate therapeutic antitu-mor immunity. The immune checkpoint refers to a plethora of inhibitory pathways in the immune system. These pathways are crucial for maintaining self-tolerance and modulating the duration and amplitude of physiological immune responses in peripheral tissues to minimize collateral tissue damage. Tumors co-opt certain immune-checkpoint pathways as a major mechanism of immune resistance. Cytotoxic T-lymphocyte-associated antigen 4 antibodies were the first of this class of immunotherapeutics to acquire approval from the US Food and Drug Administration. Preliminary clinical findings with blockers of additional immune-checkpoint proteins, such as pro-grammed cell death protein 1, indicate broad and diverse opportunities to enhance anti-tumor immunity with the potential to produce du-rable clinical responses. Classic chemotherapy exerts significant immunomodulatory effects on tumor cells via multiple mechanisms. Therefore, the combination of immunotherapy, including immune checkpoint blockade with chemotherapy, is a new promising trend in anti-tumor immunotherapy.

Objective To observe and assess the effect about bundles of cure Rule of three three in the treatment for residual stones after Flexible Ureteroscope.Methods 120 patients with a single stone after urinary lithotripsy were divided into two groups according to the different indwelling time.Two cases of the control group were rejected because of severe hematuria.The control group (n=58) was subjected to the regular education (drinking water 3 000 ml per day with moderate exercise);The experiment group (n=60) was subjected to the Rule of three three (drinking 3 cups of water in thc morning、midday and night,with contralateral position 30 minutes,hot towel applying and gently tapping the kidney region 30 minutes).Results The calculi discharge rate and the net rate of experiment group [86.67％ (52/60),55.00％ (33/60)] were higher than the control group [53.45％(32/58),18.97％(11/58)] 14 days after surgery.The difference was statistically significant (P ＜ 0.01).Further analysis showed that the discharge rate of residual stones in lower renal calyx in experiment group [86.67％(26/30)] was higher than the control group [32.14％(9/28)].The difference was statistically significant (P ＜ 0.01).Conclusions The bundles of cure called rule of three three can improve the discharge rate of residual calculi after flexible ureteroscope and increase the discharge rate of residual stones in lower renal calyx significantly.

Objective To develop coronary artery disease self-management scale and evaluate its reliability and validity.Methods The item pool was based on the theory of chronic disease self-management and the evidence of behavioral medical science related to coronary heart disease.Firstly,the preliminary scale was developed through specialist evaluation;then it was reviewed by 10 patients and specialists again;At last,209 patients were surveyed and based on the pilot data,a series of statistic analysis was conducted such as factor analysis,correlation analysis,etc.To deduce the items to 27 and then a comprehensive set of psychometric tests was performed on the final version.Results Psychometric tests with the application of stringent criteria confirmed the test-retest reliability(ICC=0.910),internal consistency(Cronbach's ?=0.913),criterion-related validity(r=0.271-0.573),construct validity(factor analysis confirms the hypothesis of the scale),responsiveness(t=9.011,P

Objective To investigate the self management behaviors and analyze the related factors in patients with coronary heart disease(CHD) in order to provide the evidence for strategy making on health education and secondary prevention of CHD.Methods Totally 209 patients with verified CHD who were from 3 grade-A hospitals in Chongqing from October 2007 to January 2008 were investigated with Coronary Heart Disease Self Management Scale(including three sub-scales: daily management,medical management and emotional management).Their general information and the disease related information were also collected.Results The score of self management in the cohort of patients was(52.69?18.47).The multi-variable stepwise regression showed there were statistically significant correlation between the daily life management and working status;between the medical management and education background,hypertension,classification of CHD and duration of CHD;between the emotional management and disease perception,economic status(P

Objective To get a view of the participation, motivation and barrier of voluntary activities in medical graduates, and to provide valuable advices for improving such behaviors. Methods The convenience sample method was used in medical graduates in 2014 and the total sample was 348. The data of voluntary service were collected by self-designed questionnaire, including whether partici-pating in voluntary service, times, types, motivations and barriers. SPSS 20.0 were used in statistic analysis and data were processed by description analysis and χ2 test. Results The effective response rate is 80.7%(281). The proportion of the post graduated students participation in voluntary activities is 65.8%(185), however, only 13.4%(28) claimed such activities more than 3 times. The proportion of participation in male, student leaders and party members were higher than those female, non-student leaders and non-party members, the different is statistically significant (P<0.05). The proportion of medical related voluntary activities is 52.6%. The primary motivation of voluntary behaviors is social responsibility (30.1%), while the primary obstacle is lack of medium (39.50%)and limitation of personal time and energy (30.0%). Conclusions The participation and persistence of voluntary activity in graduated students are not high enough. The colleges need to strength the organization and management of voluntary activities and focus on social responsible education, inspire and guide the postgradu ate students to participate in voluntary activities persistently by using their specialties.

Objective To test the effect and safety of′cocktail′wet compression on alleviate the swelling arm after the inter‐vention through the radial artery .Methods Patients whose arm were swollen after the intervention through radial artery were di‐vided into two groups (experiment group ,47 patients vs .control group ,46 patients) .The experiment group adopt the′cocktail′wet compress plus traditional therapy (including elevate and immobile the swelling arm);the control group only use the traditional ther‐apy .The levels of pain ,swelling index and the number of the blister were compared between two groups .Results None of the limbs necrosis was observed in two groups .The level of pain(2 .62 ± 0 .86 vs .5 .46 ± 1 .02) ,swelling index (3 .3% ± 2% vs .5 .8% ± 3% ) of the arm ,and the number of blister (0 vs .4) in experiment group were lower than in the control group (P<0 .05) .Conclusion The bundle of therapy strategy which named'cocktail'wet compress can lessen the swelling of the arm induced by intervention through radial artery ;it is both safe and effective thus deserves widely application .

Objective:To investigate the expression pattern of MMP-11 and MMP-14 in breast carcinoma, and the effect of MMP-11 on breast carcinoma cell migration and invasion. Methods:MMP-11 and MMP-14 expression were examined in 161 invasive breast carcinoma tissue samples and 10 normal breast tissue samples. siRNA was used to knockout MMP-11 in breast carcinoma cell line MB-231 and Transwells were used to evaluate changes in migration ability and invasion ability. Results:Both MMP-11 and MMP-14 were highly expressed in breast carcinoma samples,122 and 149 samples out of 161,respectively. The expression of both proteins were correlated with lymph node metastasis and TNM staging. After knockout of MMP-11,the expression of both proteins decreased in MB-231 cell line and experiments show that the cell′s migration and invasion abilities were significantly weakened. Conclusion:MMP-11 and MMP-14 could promote invasion and metastasis of breast carcinoma. Knockout of MMP-11 results in the downregulated expression of MMP-14,and the inhibition of breast carcinoma cell′s migration and invasion. They could be potential prognostic markers and treatment targets for of breast carcinoma.

Objective:To study B cells proliferation and activation induced by tumor derived-autophagosomes ( TDA). Methods:Splenocytes of mice were incubated with 10μg/ml TDAs in vitro ( with the 10μg/ml whole cell lysate as the control).At the 3rd day,the expression of MHCⅠ,Ⅱand co-stimulate molecules including CD86,CD40 were detected by flow cytometry,and B cells proliferation was detected at the 5th day.B cells were selected from spleen of mice using anti-CD43 dynabeads,and incubated with 10μg/ml TDA in vitro ( with the same concentrated whole tumor cell lysate as the control).At the 7th day,IgM in the supernatant were tested by ELISA.Results:When compared with whole cell lysate stimulated B cells,TDA efficently stimulated B cells division in vitro ( TDA group:28.6%, Whole cell lysate group:4.4%) , and significantly up-regulated the expression of MHC class Ⅰ,Ⅱ and co-stimulatory molecules (CD86 and CD40) on B cells,and enhanced the levels of total IgM secretion in vitro.Conclusion:Tumor-derived autophagosomes ( TDA) ,as a vacuole antigen vector, could stimulate B cells proliferation, activation, and increased IgM secretion in vitro.

Objective To evaluate the efficiency of combined screening for chromosomal abnormalities in the first trimester and the ultrasound characteristics of these fetuses.Methods Retrospective study for 5000 singleton pregnancies by combined screening of trisomies 21,18,13 and Turner syndrome.Risk algorithms were developed for calculation of patient-specific risks for each of the three trisomies based on maternal age,fetal nuchal translucency,free β human chorionic gonadotropin and serum pregnancy associated plasma protein A at 11 to 13 +6 weeks of pregnant.The value of nuchal translucency (NT) and β-hCG and pregnancy-associated plasma protein A (PAPP-A) level were inputted computer,and calculate the risk value (≥ 1 ∶ 270) by automatic analysis software.Two hundred and four cases with high risk were performed transabdominal chorionic villus biopsy to detect the fetal chromosomal karyotypes.Meanwhile,other ultrasonic characteristics of fetal were elevated.Results (1) Five thousand cases of pregnant women were detected,including 4983 normal cases,62 cases were induced labor for a variety of reasons in the second trimester,including 40 cases with normal karyotype but with congenital heart disease,17 cases of chromosome abnormalities (9 cases trisomy 21,2 cases trisomy 18,1 cases trisomy 13,4 cases 45X),2 cases spina bifida,2 cases digestive tract obstruction,1 cases giant bladder.One case with low risk of fetal chromosomal abnormalities in combined screening,but high risk of age (maternal age were over 40 years old),it was 21 trisomy syndrome after the prenatal diagnosis.(2) Five cases of nasal bone loss in 9 cases of trisomy 21 (5/9),5 cases with three tricuspid regurgitation (5/9),4 cases of venous ductus a wave flow reverse (4/9),3 cases of fetal nasal bone loss accompanied by tricuspid regurgitation and venous ductus a wave flow reverse (3/9).One case of nasal bone loss in 2 cases of trisomy 18,2 cases were tricuspid regurgitation and venous ductus a wave flow reverse.Two cases in 4 cases of 45X had venous ductus a wave flow reverse.There were 8 cases (0.16％) nasal bone absence in 4983 cases of normal karyotype fetus,48 cases (0.96％) of tricuspid regurgitation and 44 cases (0.88％) of venous ductus a wave flow reverse.Thirty-two cases in 40 cases (80％) of fetal congenital heart disease were tricuspid regurgitation,30 cases of venous ductus a wave flow reverse (75％).Eight cases of nasal bone absence normal karyotype fetus were found the nasal bone at 20 weeks gestation.Conclusion Combination screening of nuchal translucency with serum markers in the first trimester were high detection rate and low false positive rate; a wave reversion and fetal nasal bone absence accompanied by tricuspid regurgitation can improve the detection rate of abnormal karyotype; abnormalities ultrasound marker may be associated with fetal congenital heart disease at 11-13 +6 weeks of pregnancy.

Our hospital has set up a relatively complete assessment methods after nearly 10 years of residents/medical specialist training, including the day-to-day assessment, periodic assessment,comprehensive assessment,and completed the corresponding management evaluation.