Cytotoxic T lymphocytes (CTLs) are critical effectors which play important roles both in anti-tumor and anti-virus immune responses.Through T cell receptors(TCRs),CTLs can specifically recognize MHC- Ⅰ -peptides complexes presented on the surface of target cells,and then release biological substances such as perforin and granzymes into the target cells and dissolve them.Since the significant potential value of CTLs,more and more people are focusing on its basic and appliedstudies.Most researches are about the transformation of the TCR gene.With the development of molecular biology,cloning and transduction of TCR gene have been more mature.Researchers are finding ways to ensure that TCR gene expresses efficiently and assemble correctly.

Objective To devise an improved double J tube for ureteral stenting so as to simplify its postoperative removal. Methods One end of the double J tube was made blind and got through the urinary tract via the ureteral wall or via a weak point of the renal cortex.The blind end was then embeded in the subcutaneous tissue and the ureteral stent was left behind for 4～12 weeks.A small incision (0.5 cm) was made in order to withdraw the stent and cystoscopy could be avoided.The self devised tube has been clinically employed for 60 cases. Results The stent has been satisfactory in all the 60 cases and its postoperative removal has been easy with no need of cystoscopy. Conclusions The subcutaneous embedding of a blind end of double J tube is simple and effective and its postoperative withdrawal is easy with no need of cystoscopy.

Objective To evaluate the surgical treatment of bladder cancer near ureteral orifice. Methods 42 cases of bladder cancer requiring ureteral reimplantation were divided into two groups at random:20 cases in group A:tongue-shaped incision of bladder wall around ureteral orifice was performed to modify Huctch-Ⅱ ureter implantation and 22 cases in group B:severing the ureter just outside the bladder,the ureter was then implanted into the bladder after partial cystectomy.Duration of the procedure,blood loss,amount of post-operation drainage,early complication,bladder ureter reflux,ureter obstruction,and cancer recurrence rate were studied and compared. Results In group A,the surgery took 60.5?18.5 min,blood loss amounted to 50.6?12.8 ml and the post-operative drainage 50.6?17.8 ml.In group B,the operation needed 150.9?22.4 min,the blood loss amounted to 220.5?28.2ml and post-operative drainage 280.6?58.9 ml.All the above three indexes showed siginificant difference between the 2 groups (P0.05). Conclusions Tongue-shaped incision of bladder wall around the ureteral orifice better with less complication,technically easier and worth recommendation.

Objective:To investigate the correlation between serum CXCL10 level and the severity of obstructive sleep apnea syndrome(OSAS) in male patients.Methods:52 male patients and 41 control volunteers were enrolled.Polysomnography was processed to monitor the AHI scores.Serum CXCL10 level was determined by ELISA.The correlation between serum CXCL10 level and AHI scores was analyzed statistically.Results:Serum CXCL10 level(ng/ml) in the OSAS groups was significantly higher than that in the control group [99.18 (70.46-158.01) vs 64.13 (53.5-73.6),P ＜ 0.001].Multivariate logistic regression analysis demonstrated that serum CXCL10 level was the only independent predictor of OSAS(OR:1.021;95％ CI:1.009-1.035;P ＜0.001).The serum CXCL10 level was positively correlated with the severity of OSAS [CXCL10 level in mild OSAS:82.7 (56.76-145.51);in moderate:OSAS 113.28 (87.15-162.67)].Serum CXCL10 level was independently correlated with AHI scores(r =0.476,P ＜ 0.001).Conclusion:Serum CXCL10 level was independently associated with the occurrence and the severity of OSAS.Serum CXCL10 level can be used as a biomarker to diagnose the OSAS and further to assess the severity of OSAS.

Objective:To observe the clinically curative effects of Qingwen Baidu drink(清瘟败毒饮) on epidemic hemorrhagic fever (EHF).Methods:One hundred and eighty cases with EHF who were admitted to hospital within 5 days after onset were randomly divided into two groups.The control group (n=60) was treated with Ribavirin infused intravenously and liquid therapy,and treating complications simultaneously,meanwhile the treated group (n=120) based on the same therapy as control group treated with Qingwen Baidu drink number Ⅰ,Ⅱ or Ⅲtaken orally two times a day according to different course.Results:In treated group all the days of fever,polyuria,recovering platelet to normal,and transforming proteinuria to negative were significantly shorter than those in control group (both P<0.01),otherwise the overphase rates of oliguria and hypotension shock were higher than those in control group too (all P<0.01).The occurance rate of complications in treated group was lower than that in control group(P<0.05).Conclusions:The curative effects adding Qingwen Baidu drink on EHF are significant and worth spreading.

OBJECTIVE To study the isolation rate,distribution characteristics and antimicrobial resistance of Acinetobacter baumannii infection.METHODS Surveillance data of A.baumannii infection,distribution and resistance rates to 12 kinds of antibiotics in our hospital for 3 years were analyzed.RESULTS During the 3-year infection surveillance,194 strains of A.baumannii were isolated in our hospital.The isolation rate was 7.8% in 2006,though 2.4% in 2004.Eighty strains(41.2%) of A.baumannii were from intensive care unit;95 strains were from over 60-year-old sufferers;compared with 2004 and 2005,the resistance rates of A.baumannii in 2006 to 12 kinds of antibiotics were increasing at different degree.The antibacterial susceptibility to imipenem/meropenem was the highest.CONCLUSIONS The isolation rate of A.baumannii and antimicrobial resistance rate are increasing year by year.The A.baumannii strains shows obvious multiple antibacterial resistance.We must keep monitoring of A.baumannii infection and drug-resistant changes in order to prevent nosocomial infections.

Objective To explore the diagnostic values of dual energy lung perfusion in the diagnosis of pulmonary embolism by using dual-source CT (DSCT). Methods Thirty patients with clinically suspected pulmonary embolism underwent dual-energy scanning with dual-source CT. The scanned data were integrated into three groups including 140, 80 kV and coefficient of 0.3. According to the CT pulmonary angiography (CTPA) of the fusion data, the patients were divided into pulmonary embolism group and normal group. The thin-slice reconstruction of data was analyzed using dual-energy perfusion imaging analysis software. The lung field was divided into upper, middle and lower part to make quantitative analysis of lung tissue perfusion. Paired t-tests were used in the normal patients to compare bilateral lungs, and independent samples t-tests were applied to compare the embolism group and normal group, while minimum intensity projection images (MinIP) were utilized in the assessment of lung ventilation. Results Dual energy CT showed symmetrical homogeneous perfusion in 16 normal cases, without significant perfusion defects. Quantitative analysis showed that left and right lung perfusion were (27 ± 7) and (28 ± 8 ) HU respectively, and no significant difference was found between the two sides ( t=-1.73, P ＞0.05 ).Perfusion of the left upper, middle and lower lung was ( 23 ± 6), (24 ± 6), and (28 ± 8) HU respectively, while the perfusion of right upper, middle and lower lung was (26 ±8), (27 ±8), and (28 ±9) HU respectively, showing no statistical significant difference between the two sides (t=-1.91, -1.96,-1.73 ,P＞0.05 ). Angiography of pulmonary embolism group(14 cases)showed filling defects in the pulmonary trunk, segments and sub-segments. Pulmonary perfusion imaging showed low perfusion or defectsin lung field that dominated by embolic vessels. Quantitative analysis showed that the perfusion of the whole lung and the middle and lower lung were (22 ±5), (22 ±8), and (21 ±8) HU in the embolism group,which were significantly different from the normal group (t=-2. 10, -2.32, -2.63, P＜0.05).Minimum intensity projection images showed a good consistency of abnormal ventilation zone area and perfusion abnormalities. Conclusions Pulmonary perfusion status, especially pulmonary embolism, can be analyzed by dual energy CT scanning. It helps to early discover and precisely locate the embolism.

Objective:To study and analyze the application effect of intervention plan based on unplanned readmission risk model (LACE) in the rehabilitation of patients with acute myocardial infarction (AMI) complicated with cardiac shock (CS) after percutaneous coronary intervention (PCI).Methods:Ninety-three patients with AMI complicated with CS who received PCI in Tianjin Union Medical Center from January 2019 to December 2020 were enrolled. The patients were divided into LACE intervention group ( n = 46) and routine intervention group ( n = 47) according to the different nursing intervention methods. The patients in the routine intervention group received routine interventions, including drug care, diet care, psychological care, health education and telephone follow-up, while those in the LACE intervention group were assessed for the risk of LACE, and then intervention measures were formulated according to the score of LACE index, including strengthening risk awareness, life behavior, daily life ability, self-care ability, health recovery and health needs. The follow-up period in both groups was 3 months. The changes of cardiac function, incidence of adverse cardiac events, readmission rate, self-management ability after intervention and quality of life level before and after intervention were compared between the two groups. Results:There was no significant difference in cardiac function or quality of life before intervention between the two groups. After intervention for 3 months, the cardiac function and quality of life in the two groups were improved as compared with those before intervention. The left ventricular ejection fraction (LVEF) in the LACE intervention group was significantly higher than that in the routine intervention group (0.533±0.076 vs. 0.492±0.072, P < 0.05), the left ventricular end diastolic diameter (LVEDD) was significantly lower than that in the routine intervention group (mm: 47.09±7.01 vs. 53.23±7.15, P < 0.01), and the World Health Organization Quality of Life-brief (WHOQOL-BREF) score was also significantly higher than that in the routine intervention group (66.32±6.19 vs. 55.79±7.26, P < 0.01). The scores of self-management ability in the coronary heart disease self-management scale (CSMS) after intervention in the LACE intervention group were significantly higher than those in the routine intervention group (adverse hobbies score: 17.37±3.24 vs. 14.21±2.73, symptoms score: 14.82±3.11 vs. 10.56±2.65, emotional cognition score: 16.17±2.83 vs. 12.95±2.41, first aid score: 11.85±1.94 vs. 10.62±1.56, disease knowledge score: 15.58±2.73 vs. 12.68±2.61, daily life score: 17.80±2.61 vs. 14.33±2.36, treatment compliance score: 11.47±1.84 vs. 8.56±1.23, all P < 0.01). The incidence of adverse cardiac events and readmission rate in the LACE intervention group were significantly lower than those in the routine intervention group (10.87% vs. 29.79%, 4.35% vs. 17.02%, both P < 0.05). Conclusion:The intervention plan based on LACE risk model can effectively promote postoperative rehabilitation of patients with AMI complicated with CS after PCI, and also help to improve patients' self-management ability and quality of life, which is worthy of clinical promotion and application.

Objective To investigate the diagnostic value of DTI anisotropy parameters in breast malignant tumors.Methods Fifty four patients,including 33 patients with malignant tumors and 21 patients with benign lesions,were retrospectively analyzed.The E1,MD and FA of lesions were measured and compared by paired t test between the malignant tumors and the contralateral healthy breast tissue.The difference between malignant tumors and benign lesions was analyzed by independent sample t test.Logistic regression analysis was made using E1,FA,MD as predictors in detecting and differentiating the malignant tumors,ROC curve analysis was performed to compare diagnostic performance based on the area under the curve (AUC).Results E1,MD and FA in malignant tumors were (0.99 ± 0.12) × 10-3mm2/s,(0.85 ±0.26) × 10-3mm2/s and 0.20 ±0.08 respectively,and those in normal breast tissues were(1.46 ± 0.55) × 10-3 mm2/s、(1.48 ± 0.44) × 10-3 mm2/s and 0.29 ± 0.17 respectively.Those parameters in benign lesions were (1.80 ±0.42) × 10-3mm2/s,(1.38 ±0.52) × 10-3mm2/s and 0.22 ± 0.10 respectively.Significant statistic differences were found between malignant tumors and normal breast tissues in E1,MD and FA (t =-4.889,-6.449,-2.842 ; P ＜ 0.01).Significant statistic differences were also found between malignant tumors and benign lesions in E1 and MD (t =-10.476,-4.394; P ＜ 0.01) with no difference found in FA (P ＞ 0.05).E1,MD and FA are independent predictors in malignant tumors' detection,and the combination of E1,MD and FA significantly improved discrimination between cancer and normal tissue over each one alone with the sensitivity 97.0％ (32/33),specificity 97.0％ (32/33),accuracy 97.0％ (64/66).Combination of E1 and MD had a similar AUC with E1 and a more AUC than MD and FA,with the sensitivity 97.0％ (32/33),specificity 100.0％ (21/21),accuracy 98.1％ (53/54).Conclusion The regression model combining E1,MD and FA is most valuable in breast cancer detection and E1 is the preferred index for the differentiation of breast cancers from benigin lesions.

Objective To discuss the experiences of management of female duplicated kidney with urinary incontinence. Methods The clinical data of 25 cases with duplicated kidney with urinary incontinence were retrospectively analyzed. They were all female, age ranged from 2 to 12 years old, averaging 7. Fifteen cases were with right side lesions, 10 with left side. The main complaint was urinary incontinence and itching of pudendum. The diagnosis was set up by physical examinations and imaging methods. Results Twenty-five cases reported continent after operation. For the patients taken ureteral replant, the upper kidney function kept or recovered during follow-up. Conclusions Sonography, IVU, and MRU play an important part in the diagnosis of duplicated kidney with urinary incontinence. Operation is the key treatment for this disease.