The activation of CD40-CD40L costimulatory signal channel plays a necessary role in T cellmediated immune response. Activation of CD40 on antigen presenting cells by CD40L which expressed on Tlymphocytes, while contributing to the pro-in? ammatory response necessary for eradication of infection, accounts for the pathology in autoimmunity. Meanwhile, there is evidence that CD40 is also expressed on T-lymphocytes and can act as a costimulatory molecule. Further dissection of the exact nature and role of CD40 in T cell activation could lead the way to novel therapeutics for diseases which include organ-graft refection, autoimmune diseases,tumor, and inflammation.

Hospital acquired pneumonia (HAP) and ventilatorassociated pneumonia (VAP) are common hospital-acquired infections with higher mortality, longer hospital stay and more hospitalization expenses. With the latest research results and evidence-based guideline methodology, Infectious Diseases Society of America (IDSA) and American Thoracic Society (ATS) have collaborated to create updated guidelines for the diagnosis and treatment of HAP and VAP in 2016. It is worth critically reading and thinking that most recommendations are supported by low-quality or very-low quality evidence and some strong recommendations is different from the actual clinical work in China. We will focus on these topics that are associated closely with clinical practice and inconsistent with the current implementation in China to provide better understanding of the guideline.

Physical activity is closely related to the quality of life of postoperative patients with breast cancer, which is expressed in fre-quency, duration, intensity, and others factors. There is no uniform measurement of physical activity, the common measurements may be classified as subjective and objective, such as exercise log, physical activity questionnaire and self-reported physical activities of the former;doubly labeled water, indirect calorimetry, motion sensors and heart rate monitors of the latter. The age, educational level, social and eco-nomic status, and body mass index are related to the level of physical activity in patients post operation for breast cancer, while illness and treatment, psychological and social support, and health-related quality of life also affect the level of physical activity, which suggest that such patients need to improve their physical activity before operation.

Objective To research some parameters' influence on signal-to-noise ratio (SNR) of MR. Methods Magphan phantom was used to do experiments on 1.5T, 0.5T and 0.23T MRI. Scan parameters such as NEX, scan matrix and slice thickness were altered.Evaluate whether the change of SNR varied with parameter to be in accordance with the SNR law.Results (1) When spin echo pulse applied and NEX changed, the results of high field device A and B weren't in accordance with SNR theory, and high filed device C and low field device F were in accordance with SNR theory. When fast spin echo pulse applied and NEX changed, the result of device B was in accordance with SNR theory. (2) When scan matrix changed, measured value was lower than ideal value for little matrix, and vice versa. (3) The measured value was very closely to ideal value for little slice thickness. When slice thickness exceed 5 mm, the difference between the measured value and ideal value was significance.Conclusion Based on the SNR theory, the user of MRI should consider the running characteristic of MR system to select scan parameters.

Objective To evaluate the effect of ecoimmunonutrition enteral nutrition on systemic inflammatory response and prognosis in patients with acute severe acute pancreatitis. Methods Fifty-seven patients with severe acute pancreatitis were randomly divided into two groups: parenteral nutrition (PN) group(28 cases), and ecoimmunonutrition(EIN) group (29 cases), each of the two nutrition formulas was given to each group respectively for 7 days. The level of plasma endotoxin and serum concentrations of TNF-α ,IL-1β ,IL-6 and IL-10 and monocyte NF-κB were tested at admission,1 d,3 d,5 d,7 d after nutrition support. Statistics the two groups results of clinical prognosis. Results The levels of endotoxin, TNF-α ,IL-1β ,IL-6 and IL-10 , NF-κB activities in EIN group were no significant difference compared with PN group at admission. After nutrition support 7 d, the levels of endotoxin, TNF-α ,IL-1β ,IL-6 and IL-10 , NF-κB activities in EIN group were (2.70 ± 0.13) ng/L, (30.13 ± 8.12) ng/L, (20.17 ± 8.04) ng/L, (36.43 ± 8.24)ng/L, (86.45 ± 14.54) ng/L, (70.4 ± 3.2)% respectively, which all were significantly lower than those in PN group [(3.25 ±0.32) ng/L, (313.42 ± 144.35) ng/L,( 155.29 ±32.78) ng/L, (324.15 ± 31.47) ng/L, (472.72 ±48.55) ng/L, (88.4±53)% ](P<0.05 or <0.01). Conclusion EIN can attenuate endotoxemia.decrease NF-κB activities and concentrations of cytokines, maintain the balance of pro-and anti-inflammation, improve patients' condition and prognosis.

Objective To evaluate the clinical features and early management of combined thoracoabdominal injury (CTI).Methods A retrospective study was carried out in 29 cases with CTI treated surgically.There were 21 cases with penetrating injuries and 8 cases with blunt injuries.All cases were associated with penumothorax and/or hernothorax at various degrees and 13 cases complicated with shock.In this study thoracotomy was performed in 17 cases,laparotomy in 6 cases,thoracotomy plus laparotomy in 5 cases and combined thoraco-laparotomy in 1 case.Results The injury severity score in this series was (40.16±15.23) scores.Four cases were died from hemorrhagic shock (2 cases),pericardial tampenade(1 case) and multiple organ failure(1 case).Conclusions CTI has high mortality rate,and the most frequent cause of death is hypovolemic shock.The operative approach is based on individual injury condition.Early diagnosis and timely surgical intervention are key to improving the cure rate and reducing mortality in severe CTI.

The aim of this study was to look for the chemical constituents of the bulbs of Fritillaria anhuiensis S.C.Chen et S.E.Yin. The bulbs of Fritillaria anhuiensis were extracted with 95% EtOH at reflux. Isolation and purification were performed by silica gel column chromatography. Structures of pure compounds were established on the basis of spectral analysis. Three compounds were obtained and identified as 12,15-epoxy-8(17),13-labdadien-19-ol (1), ent-3β-acetoxy-kauran-16β,17-diol (2), ent-kaurane-3β,16β,17-triol (3). Compound 1 is a new labdane-type diterpenoid. Compounds 2 and 3 were obtained from Fritillaria anhuiensis for the first time.

Objective To analyze the expressions and clinical significance of human epidermal growth factor receptor-2 (C-erbB-2) protein in sinonasal squamous cell cancer cells.Method Immunohistochemical and RT-PCR methods were used to detect the expression of C-erbB-2 in 62 cases of sinonasal squamous carcinoma tissues,30 cases of nasal polyps and 25 cases with normal nasal mucosa.The relationships between the expression of C-erbB-2 in sinonasal squamous carcinoma tissues and clinical pathological characteristics were analyzed.Results There was significant difference in the expression of C-erbB-2 in sinonasal squamous carcinoma tissues, nasal polyps and normal nasal mucosa tissues(P <0.05).The expression of C-erbB-2 was positively correlated with the clinicopathologic stage, tumor classification and lymph node involvement(P<0.05).Conclusion The expression of C-erbB-2 is correlated with tumorigenesis,invasion and metastasis of sinonasal squamous cell carcinoma.It can be used as an auxiliary diagnostic and prediction maker as well as a new therapeutic target of sinonasal squamous cell cancer.

Objective To evaluate the effects of single long stent and multiple contiguous stents for the therapy of the long coronary lesion. Methods According to the different means of stent implantation,64 cases of patients are divided into two groups:Group A for the single long stent,and Group B for the multiple contiguous stents. All of patient received coronary artery angiography in order to evaluate the rate of restenosis after 6～10 months. Results In hospital period, no acute or subacute thrombosis, no myocardial infarction and death occured. There was no difference for the restenosis rate of the stents between two groups. Conclusion The effects of both the single long stent and the multiple contiguous stents is similarity.

Objective To investigate and compare the short-term and long-term outcomes between percutaneous coronary intervention(PCI) or coronary artery bypass graft(CABG) in coronary heart disease(CHD) patients comorbid with diabetes mellitus.Methods The DESIRE register study(Drug-Cluting Stent Impact on REvascularization) was a single-center retrospective study which enrolled 3763 patients who received revascularization therapy during two distinct pesiod.Our study included 670 CHD patients from the whole DESIRE population who received revascularization during July 2003 to June 2004 and comorbid with diabetes mellitus.According to the revasularizaton strategy,the patients were divided into the PCI group(n=400) and the CABG group(n=270).Adverse cardiac and vascular events were the composite endpoints which included all-cause of death,non-fatal myocardial infarction,non-fatal stroke and revascularization.Results Baseline data had no difference between the two groups.In-hospital adverse cardiac events in the PCI group was fewer than in the CABG group(0.5% vs 4.1%,P=0.001) as shown by a lower mortality in the PCI group compared with the CABG group(0.5% vs 3.3%,P=0.012).Duration of follow-up in the PCI group and the CABG group was 592.6?121.3 days and 581.5?148.3 days respectively.The incidence s of long-term adverse cardiac events had no differnce between the two groups,but an increase trend was observed in the PCI group compared with the CABG group(14.2% vs 9.0%,P=0.056),owing to a higher percentage of revascularization(8.5% vs 2.1%,P=0.001).Two groups had a similar incidence of death,non-fatal myocardial infarction,non-fatal stroke during the follow-up period.Conclusion With the wide-spread of DES application,in-hospital adverse cardiac events in the PCI group was fewer than in the CABG group especially in terms of mortality.Long-term adverse cardiac events had no differnce between two groups,but PCI group had more revascularization.