Objective To investigate the cost-effectiveness of cefoperazone sulbactam sodium in treating nosocomial infection (lower respiratory tract infection).Methods 80 cases of nosocomial infection in Jincheng Second People's Hospital from January 2014 to January 2017 were treated as the subjects: the observation group was treated with cefoperazone sulbactam sodium and the control group was treated with cefodizime sodium.The data of two groups of patients were recorded and the data were analyzed statistically.The cost-effectiveness of cefoperazone sulbactam sodium in hospital infection was discussed.Results There was no significant difference in the clinical curative effect between the two groups.The cost of observation group (cefoperazone sulbactam sodium) was lower than that of the control group (cefodizime sodium), the difference was statistically significant (P< 0.05).Conclusion Patients with nosocomial infection choose to use cefoperazone sulbactam sodium as the treatment method, which has exact clinical efficacy, high cost-effectiveness.It is worthy of clinical wide application.

Objective To investigate the X-ray and clinic manifestations of hereditary multiple osteochondroma(HMO).Methods Five patients with HMO clinically and pathologically confirmed and 63 persons in their pedigree were studied.Results Of 63 cases inquired in this study,there were 21 patients with hereditary multiple exostosis,including 16 men and 5 women.In 5 cases confirmed pathologically,4 patients had hereditary history of pedigree and the members of three generation in 1 patient with HMO had no the history of pedigree.Conclusion HMO has the remarkable sex difference and the typical inherited trend including the location of exostosis.HMO has inherited character of skipping generation.

Programmed death-1 (PD-1) and its ligand PD-L1 are the major members of inhibitory costimulatory molecules and express high in a variety of tumor cells and their associated cells surface,while the proportion of regulatory T cells (Tregs) are abnormally elevated in tumor infiltrating T lymphocytes cells.PD-L1 combined with PD-1 and Treg help tumors evade immune clearance,weaken immune responses and induce immune tolerance.New researches find that PD-L1 plays an important role in the development and function maintenance of inducible Treg (iTreg),and PD-L1 signal can change initial CD4 + CD25-T cells into iTreg to play a role of immunosuppression.Research on PD-1 signaling pathway can provide a new theoretical basis for the inhibition of tumor immune escape in clinical application of immunotherapy and better treatments.

Immunology teaching course includes both basic immunology and clinical im-munology.This paper points out the problems of teaching and knowledge integration between the basic immunology and clinical immunology and suggests that teaching team should include the basic immunology and clinical immunology related content clinical experts to promote teaching quality.

Objective To explore the imaging diagnostic value of gastrointestinal stromal tumor(GIST).Methods The retrospective study on GIST proved by operation and pathology in 11 cases was done.There were pneumobarium double contrast examination in 10 cases,CT scanning in 4 cases,superior mesenteric ateriography in 2 cases and fiberoptic endoscopy in 7 cases.Results The locations of tumors at gastric were 7 cases,intestinal 2,lipper and row oseophagus to gastric cardiac in 1,respectively.The detective rate of GIST was 100%,75%,100% and 100% respectively by pneumobarium double contrast examination,CT,arteriography and fiberoptic endoscopy.Conclusion Pneumobarium double contrast examination and fiberoptic endoscopy are important methods for diagnosis of GIST.CT and arteriography can better show the location of tumors and differential diagnosis of benign and malignant of tumor.

Objective To investigate the correlations between P53 expression and clinicopathologic factors and prognosis of Luminal breast cancer.Methods From January 2009 to December 2012,a total of 283 patients with Luminal breast cancer in the Shanghai General Hospital Affiliated to Shanghai Jiaotong Univer-sity were included.P53 expressions of them were assayed by immunohistochemistry.Survival analysis was applied using Kaplan-Meier curve and Log-rank test.Single factor analysis and mutiple-factor analysis were applied using Cox proportional hazard regression model.Results The rate of P53 expression was associated with tumor size (χ2 =6.285,P =0.043),lymph node metastasis (χ2 =15.881,P =0.000),histological grade (χ2 =8.132,P =0.043)and Ki-67 (χ2 =6.476,P =0.039),but it was not associated with age (χ2 =0.955,P =0.328),menopausal status (χ2 =3.808,P =0.051),pathological pattern (χ2 =0.847,P =0.655),estrogen receptor (χ2 =1.867,P =0.172),progesterone receptor (χ2 =0.937,P =0.333)and human epidermal growth factor receptor-2 (χ2 =0.110,P =0.741 ).In all the 283 patients,the 5-year relapse-free survival rates for P53-positive group and P53-negative group were 66.7% and 90.7% respectively (χ2 =12.609,P =0.000),while the 5-year overall survival rates were 84.4% and 93.4% respectively (χ2 =4.153,P =0.042),with significant differences.In Cox mutiple-factor analysis,lymph node metastasis (HR =2.484,95%CI:1.393-4.431,χ2 =9.497,P =0.002)and P53 over-expression (HR =3.627,95%CI:1.061-12.401,χ2 =4.220,P =0.040)were independent prognostic factors for the relapse-free survival of patients with Luminal breast cancer,and lymph node metastasis (HR =3.451,95%CI:1.891-6.297,χ2 =16.290,P =0.000)and higher histological grade (HR =2.806,95%CI:1.091-7.219,χ2 =4.582,P =0.032)were independent prognostic factors for overall survival.Conclusion P53 over-expression of patients with Luminal breast cancer is associated with prognostic factors such as lymph node metastasis and histological grade,which indicates the worse prognosis.

Objective To observe and discuss the application and clinical effect of different forms of ear cartilage in nasal tip plasty.Methods Auricular cartilage was used to prune it as "halberd" shape at first,and then the extended transplantation and the cartilage fornix reconstruction were carried out by using single or combined septum cartilage.Meanwhile,nasal tip plasty was performed by using "cap shape" or "shield shape" cartilage grafting.Results 136 patients were followed up for 6 to 24 months after operation.119 cases were satisfied,accounting for 87.5％,of which 11 cases (ear cartilage weakness) were not improved obviously,accounting for 8％.However,there were only 6 cases with the unsatisfactory feedback as the nasal tip that was decreased by 1～2 mm one year after the operation,accounting for 4.41％.Conclusions The auricular cartilage is pruned as "halberd" shape singly or combined with septal cartilage as an extended graft,reconstructing the cartilage fornix in the meantime,which is the way better than the traditional way of making nasal tip plasty to obtain the ideal nasal tip protrusion.

OBJECTIVETo introduce an operation for fingertip reconstruction.

METHODSThe vascularity of the reverse dorsal island flap is augmented by performing an arteriovenous anastomosis between the dorsal vein in the flap and a digital artery at the fingertip. The flap was used in ten patients for reconstruction of their fingertip defects.

RESULTSAll the ten flaps survived and the appearance was good.

CONCLUSIONThe method is easy except for the necessity of performing standard microvascular surgery. The flap is a good option for repairing fingertip defects.

Objective To investigate the effect of Salvianolic acid on endoplasmic reticulum stress (ERS) pathway in brain hippocampus of PAP mice. Methods Twenty PAP dual transgenic male mice were selected, they were randomly divided into a PAP mice model group and a Salvianolic acid group, 10 mice in each group; another 10 SPF grade C57BL/6J male mice were selected as a normal control group. In the Salvianolic acid group, 0.9% normal saline solution of Salvianolic lyophilized injection (400 g/L) of dosage 21 mg·kg-1·d-1 was injected intravenously through a tail vein of mice; the PAP mice model and normal control groups were given the same amount of 0.9% normal saline, and the therapeutic course was consecutive 4 weeks in the three groups. At the end of the 4th week, the Morris water maze test was carried out to observe the changes of escape latency, the third quadrant residence time (RTQ), entry angle into water and cross-platform times of mice in each group; amyloid precursor protein (APP) positive cell expression in cerebral hippocampus of mice were detected by immunohistochemistry; Western Blot was used to detect the expression level of PER like endoplasmic reticulum kinase-eukaryon initiation factor 2α-C/EBP homogenous protein (PERK-eIF2α-CHOP) pathway related proteins in hippocampus of mice. Results The escape latency of the PAP mice model group on the 1st to 5th day were significantly longer than those of the normal control group, although a downward trend was observed on the 5th day, it was still significantly longer than that of the model group (seconds: 58.41±2.36 vs. 28.60±10.15); compared with the PAP mice model group, the escape latency of Salvianolic acid group was shorter at each time point, and reached the shortest level on the 5th day (seconds: 31.97±8.36 vs. 58.41±2.36). In the PAP mice model group, the RTQ and the number of crossing platforms were significantly lower than those in the normal control group [RTQ (seconds): 8.27±2.95 vs. 15.97±7.33, numbers of crossing platforms (frequency/90 s): 0.70±0.95 vs. 2.70±0.48]; the entry angle was obviously greater than that of the normal control group [(47.94±4.68)°vs. (32.66±2.55)°, P < 0.05]. Compared with PAP mice model group, in Salvianolic acid group, the RTQ and number of crossing platform were significantly higher [RTQ (seconds): 13.57±1.86 vs. 8.27±2.95, number of crossing platforms (frequency/90 s):1.60±0.97 vs. 0.70±0.47], the entry angle was markedly smaller [(35.46±6.79)°vs. (47.94±4.68)°,P < 0.05]. The positive expression rate of APP and the protein expressions of CHOP, p-eIF2α in PAP mice model group were significantly higher than those in the normal control group [the positive rate of APP: (60.44±6.19)% vs. (21.05±5.87)%, CHOP protein expression (gray value): 3.09±0.07 vs. 1.46±0.09, p-eIF2αprotein expression (gray value): 0.98±0.09 vs. 0.47±0.06, all P < 0.01], the expression of PERK and p-PERK were lower than those in normal control group [PERK (gray value): 0.42±0.06 vs. 0.82±0.11, p-PERK protein expression (gray value): 0.98±0.09 vs. 0.64±0.10, both P < 0.01]; the positive expression rate of APP and protein expressions of CHOP, p-eIF2α in Salvianolic acid group were significantly lower than those in PAP mice model group [positive expression rate of APP: (33.09±10.33)% vs. (60.44±6.19)%, CHOP protein expression (gray value): 1.57±0.12 vs. 3.09±0.07, p-eIF2α protein expression (gray value): 0.80±0.07 vs. 0.98±0.09, all P < 0.01], while PERK and p-PERK expression were significantly higher than those in the model group [PERK (gray value): 0.89±0.12 vs. 0.42±0.06, p-PERK (gray value): 0.78±0.08 vs. 0.98±0.09, both P < 0.01]. Conclusion Salvianolic acid might work through the PERK-eIF2α-CHOP pathway to reduce the retention of APP in the hippocampus tissue of PAP dual-transgenic mice, thereby the learning ability of the mice is improved, and the progression of brain injury delayed.

Objective To evaluate recurrence risk factors in postoperative breast cancer patients after 5-year adjuvant endocrine therapy.Methods From Jan 2006 to Dec 2011,a total of 327 patients were enrolled for this study.Kaplan-Meier curves were applied to estimate survival rates and COX's proportional hazards model to identify prognostic variables.Results Among these 327 eligible patients,42 (12.8％) patients suffered from distant metastasis and 34 (10.4％) patients experienced locoregional recurrence after 5-year adjuvant endocrine therapy.Survival analysis showed that patients with histologic grade 3 disease,lymph node metastasis,Ki-67 high expression,high TNM stage and radiotherapy were statistically significant with poorer relapse-free survival (RFS,P =0.000,0.003,0.000,0.003,0.034)and poorer distant metastasis-free survival (DMFS,P =0.000,0.002,0.000,0.002,0.023),respectively.In multivariate analysis,patients with histological grade 3 disease (P =0.002) and more than 3 positive nodes (P =0.032) were risk factors for lower RFS.However,only histological grade 3 (P =0.015) was risk factor for DMFS.Conclusions Late relapse after completion of 5-year adjuvant endocrine therapy was still common,patients with grade 3 disease and more than 3 positive nodes may benefit from extended endocrine therapy.