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 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.

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.

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 explore the prognostic value of resting heart rate(RHR) in patients with coronary heart disease(CAD) after revascularization.Methods The DESIRE-plus(Drug-Eluting Stent Impact on Revascularization-plus) was a single-center registry study of 3631 patients who had coronary revascularization in our institution between 1 July 2004 and 30 September 2005.The patients were followed up by telephone after discharge.We obtained risk estimates for four groups as RHR:

OBJECTIVE:To explore the preventive effect of biomembrane on tendon adhesion. METHODS:A total of 40 Chinese articles about randomized controlled animal experiments and clinical applications which were focus on the preventive effect of biomembrane on tendon adhesion published from 1990 to 2008 were collected. And then,those articles were summed up based on experimental animals,grouping,materials,methods,results,and conclusions. Furthermore,clinical subjects received biomembrane were generally analyzed,and following up and functional evaluation were performed to overall summarize the clinical application of biomembrane for preventing tendon adhesion. RESULTS:Six out of nine articles suggested that cock was the major experimental animals,and the biomembrane could effectively prevent tendon adhesion due to good histocompatibility and permeability,and no effect on normal healing of tendon;therefore,it was an ideal material. Eight out of twelve articles suggested that there were no significant differences in biomembrane between age,sex,and injured region. Evaluation criterion in the domain of total range of active movement and active range of each joint demonstrated that biomembrane could successfully prevent tendon adhesion. CONCLUSION:Biomembrane is an excellent anti-adhesive materials with good histocompatibility and permeability.