Systemic chemotherapy is the main treatment which can improve the survival time of bladder cancer patients,though its efficacy is quite limited.The applications of targeted therapeutic drugs in bladder cancer has become more needed in clinic.At present the targeted drugs for bladder cancer include bevacizumab,cetuximab,sunitinib,gefitinib,everolimus and the inhibitor of programmed cell death-1 and its ligand,they provide a new direction for the treatment of advanced bladder cancer.

Objective To investigate the effect of different methods of endotracheal catheter cuff inflation on cuff pressure and tracheal mucosal damage postoperatively .Methods 120 patients undergoing gynecological tumorectomy as a selective operation with general anesthesia were randomly divided into 3 groups with different methods of cuff inflation :finger kneading method ,spe-cialized cuff pressure meter ,and minimum closing volume method .The cuff pressure were measured by specialized cuff pressure gauge and the tracheal mucous membrane was examined by fibrolaryngoscope at the time of withdrawal of endotracheal tube .The cuff pressure and the tracheal mucosal change with different cuff inflation methods were compared .Results The average cuff pres-sure with finger kneading method(49 ± 11 .8 cm H2 O)was obviously higher than specialized cuff pressure meter group (27 ± 1 .5 cm H2O)and minimum closing volume method group(25 ± 2 .1 cm H2O) .The incidence of tracheal mucosal damage was obviously higher in the group with finger kneading method(87 .5% ) than other groups(20 .0% and 15 .0% respectively) .There were no obvi-ous differences in the incidence of tracheal mucosal damage between the rest two groups (P>0 .05) .Conclusion The cuff pressure in the finger kneading method was higher than the permitted value and it make the incidence of tracheal mucosal damage increase . The cuff inflation with specialized cuff pressure meter and minimum closing volume method can make the cuff pressure properly a-mong the permitted value and decrease the complications related to endotracheal intubation .

Objective To study the influence of tumor necrosis factor-alpha (TNF-?) gene polymorphism on infections in old kidney allograft recipients. Methods The TNF-? genotype in -308 promoter position was determined in 87 old kidney transplant recipients from January 1998 to January 2001 by PCR using sequence -specific primer(PCR-SSP), and then the effects of genotypes on the frequency of rejection and infection, and the survival rate of the patient and graft were observed. Results 58 recipients were low TNF-? production genotype and 29 were high TNF-? production genotype. There were no significant differences in the frequency of rejection, median day of first infection and kinds of infections between the two genotypes. The frequency and times of infections were higher in low TNF-? genotype recipients than those in high TNF-? genotype recipients(67 2% vs 41 4%, P=0 021; 1 68 vs 0 86, P=0 017). The survival rates of the patients and grafts were equal in both the two groups. Conclusion The old recipients with low TNF-? production genotype may be susceptible to infections under routine immunosuppression. It is helpful for old recipients to perform more individual immunosuppression regimens according to TNF-? genotype.

Objective To evaluate the role of nicotinamide phosphoribosyltransferase (Nampt in lipopolysaccharide (LPS)-induced myocardial injury in rats.Methods Forty male Sprague-Dawley rats,aged 12 weeks,weighing 210-230 g,were randomly divided into 3 groups (n =10 each) using a random number table:control group (group C),LPS group and FK866 (specific Nampt inhibitor) group (group F).LPS 4 mg/kg was injected intraperitoneally in LPS and F groups,and then FK866 10 mg/kg was injected intraperitoneally in group F.At 6 h after the end of administration,the blood samples were taken from the abdominal aorta for determination of serum concentrations of cardiac troponin Ⅰ (cTnI).Then the animals were sacrificed and myocardial specimens were removed for determination of tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6),and malondialdehyde (MDA) contents,glutathion (GSH)/oxidized glutathione (GSSG) ratio,caspase-3 activity and apoptosis rate.Results Compared with group C,the levels of cTnI,TNF-α,IL-6,MDA and caspase-3 were significantly increased,and GSH/GSSG ratio was decreased in LPS and F groups.Compared with group LPS,the levels of cTnI,TNF-α,IL-6,MDA and caspase-3 were significantly decreased,and GSH/GSSG ratio was increased in group F.There was no significant difference in apoptosis rate among the 3 groups.Conelusion Nampt activation can induce inflammatory responses and oxidative damage and promote cell apoptosis,thus being involved in LPS-induced myocardial injury in rats.

Objective:To assess the relative stability and kinematics of the lumbar intervertebral segmental stiffness among posterior lumbar interbody fusion(PLIF) using one anatomical posterolateral cage with or without transpedicular screw rod fixation. Methods: Each of the 6 bovine lumbar functional spinal units(FSV) was tested under 6 different treatments. Test order was intact and every group differed in internal fixation of transpedicular screw. Group 1 referred to the normal lumbar functional spinal units. Group 2 was treated by left unilateral facetectomy and discoidectomy. Group 3 had anatomical threaded cages inserted on the left. Group 4 had anatomical threaded cages inserted on the left and fixed by right transpedicular screws. Group 5 had left inserted anatomical threaded cages and was fixed by left transpedicular screws. Group 6 had anatomical threaded cages inserted on the left side and was fixed by bilateral transpedicular screws. Nondestructive tests were performed in pure compression, flexion, extension, and lateral bending. Results: Unilateral discectomy and facetectomy had lower stiffness than normal FSU by 69% and 44% in pure compression, flexion, extension, and lateral bending. Single anatomical posterolateral cage group had higher stiffness than discectomy and facetectomy group, up by 55% and 28%. However, its stiffness was lower than normal FSU by 41% and 23%. Single anatomical cage with unilateral transpedicular screw fixation (left or right) had higher stiffness than normal FSU by 15% 17% and 20% 50% respectively. Single anatomical cage with transpedicular screw fixation was much stiffer than normal FSU by 18% and 65%. Conclusion: Adequate postoperative stability can be achieved by posterior lumbar interbody fusion with insertion of a single anatomical cage combined with a transpedicular screw.

75% compared with the pre-embolism;the intra-operative bleeding ranged 500 to 2000 ml and averaged 810 ml;the surgical removal was successful;the tumor cell necrotic rate was 91% to 95% through post-operative sample pathological examination;and the painful remission rate was 95% to 100%.No severe complications occurred in this series.Conclusion The pre-operative chemotherapy and SAE for spinal tumor are effective,simple,safe and reliable methods

Objective To investigate the impact of ultrapure dialysate on long-term survival rate and complication in maintenance hemodialysis patients.Methods Seventy maintenance hemodialysis patients were selected,and they were divided into ultrapure dialysate group (36 cases) and control group (34 cases) by random digits table method.The 1-,3-,5-year mortality,death causes and the incidences of cardiovascular complication,infection,cerebrovascular accident were recorded.Results The 3-and 5-year mortality in ultrapure dialysate group were significantly lower than those in control group:30.6％ (11/36) vs.41.2％ (14/34) and 41.7％ (15/36) vs.82.4％ (28/34),and there were statistical differences (P ＜ 0.05).The mortality of infection in ultrapure dialysate group was significantly lower than that in control group:1/15 vs.21.4％ (6/28),and there was statistical difference (P ＜ 0.05).The incidences of cardiovascular complication,cerebrovascular accident,infection in ultrapure dialysate group were significantly lower than those in control group:47.2％ (17/36) vs.79.4％ (27/34),27.8％ (10/36) vs.41.2％ (14/34) and 41.7％ (15/36) vs.73.5％ (25/34),and there were statistical differences (P ＜ 0.05).Conclusion Ultrapure dialysate can increase long-term survival rate and decrease incidence of complication in maintenance hemodialysis patients.

Objective To investigate the different distribution of regulatory T cells (Tregs) and CD8+T cells in the local immune microenvironment of mucosal malignant melanoma and cutaneous malignant melanoma, and analyze the relationship between the two indicators and the prognosis of patients. Methods Immunohistochemistry staining was used to assess the ex?pression of Foxp3+Tregs and CD8+T cells in tumor microenvironment of 58 patients with malignant melanoma. The correlation between two factors, clinicopathological characteristics, and prognosis were analyzed. Results There is no correlation be?tween the expression of Foxp3 and CD8. The number of Foxp3+Tregs was significantly higher in mucosa malignant melanoma than that in cutaneous malignant melanoma (t=2.648, P=0.011). The proportion of Foxp3highTregs was significantly higher in pa?tients with tumor diameter≥3 cm, lymph node metastasis and distant metastasis than that in patients with tumor diameter<3 cm, no lymph node metastasis and no distant metastasis (P<0.05). In addition, in patients with ulceration that proportion was significantly higher in CD8high group than that in patients without ulceration (33.3%vs 5.9%, P<0.05). The median progres?sion-free surial (PFS) was 12 months in Foxp3high group, which was significantly longer than that of Foxp3low group (31 months, P<0.05). The median PFS was significantly higher in CD8high group (25 months) than that of CD8low group (12 months, P<0.05). Subgroup analysis showed that the median PFS was 7 months in Foxp3high CD8low group, which was significantly lower than that of Foxp3highCD8high group (25 months) and Foxp3lowCD8low group (18 months, P=0.003). Univariate analysis showed that median PFS was different in patients with different tumor location, different number of Foxp3+Treg, different number of CD8+T cells, and distant metastases. Conclusion The number of Tregs is closely associated with metastasis in patients with malig?nant melanoma. Compared with cutaneous malignant melanoma, our results indicate that the poor prognosis of mucosal malig?nant melanoma may be associated with the infiltration of more Tregs.

Objective To investigate the application value of anatomic segmental hepatectomy in treatment of left hepatolithus.Methods The 80 patients with left hepatolithuswere divided into the control group (n =40)and the observation group (n =40)in accordance with dif-ferent surgical methods,and they were given traditional surgery and precise pedicle anatomic segmental hepatectomy respectively.Operation index levels,postoperative complications and stress reaction levels before and after surgery of the two groups were compared.Results The blood loss,operative time,the time of drainage tube remove,time of analgesic drug use,and postoperative hospital stay of the observation group were significantly less than the control group,and the difference was statistically significant (P <0.05).The rate of postoperative com-plications was 17.50% in the control group,while it was 15.00% in the observation group,which showed no significant difference between the two groups (P >0.05).During the surgery,epinephrine,cortisol,IL-6 and CRP levels of patients decreased after a slight increase, while NK cell levels of patients decreased firstly and then increased.There were statistically significant differences in trems of the above inde-xes immediately after surgery to 24 hours after surgery (P <0.05),and the rangeability of the observation group was less than the control group (P <0.05).Until 48 hours after surgery the above indexes recovered to the preoperative level.Followed up for 3 to 24 months,the calculi recurrence rate and abdominal ache recurrence rate of the observation group were lower than the control group,and the difference was statistically significant(P <0.05).Conclusion Precise pedicle anatomic segmental hepatectomy applied in the treatment of left hepatolithus showed makedly curative effect,and it has little effect on the stress response of patients.

To investigate the clinical significance of serum soluble programmed cell death ligand-1 (PD-L1) in adult patients with community-acquired pneumonia (CAP). A total of 44 CAP patients, 54 severe CAP patients and 30 healthy volunteers were recruited in this study. Serum soluble PD-L1 were detected. Univariate and multivariate regression analyses were used to assess the influence of multiple clinical variables on prognosis. Serum soluble PD-L1 level in severe CAP group was 98.20(57.94, 128.90) ng/L, which was significantly higher than that in the CAP group [59.32(33.55, 92.58) ng/L] and healthy controls [20.44(12.15, 36.20) ng/L] (all P<0.001). PD-L1 level was positively correlated with CRUB-65( r=0.481, P<0.001) and the pneumonia severity index (PSI) score ( r=0.442, P<0.001). Univariate regression analysis showed that CURB-65 ( HR=2.544, 95% CI 1.324-4.889, P=0.005), PSI score ( HR=1.036, 95% CI 1.012-1.061, P=0.004), soluble PD-L1( HR=1.013, 95% CI 1.001-1.026, P=0.041) were risk factors of mortality during hospitalization. Multivariate regression analysis suggested that PSI score ( HR=1.042, 95% CI 1.012-1.073, P=0.005), soluble PD-L1 ( HR=1.011, 95% CI 1.002-1.071, P=0.020) were independent predictors for mortality risk in CAP patients. CAP patients with soluble PD-L1≥98.20 ng/L had a significantly lower survival rate than those with soluble PD-L1<98.20 ng/L ( P=0.033). In conclusion, this study indicates that serum soluble PD-L1 level in CAP patients is correlated with the survival prognosis.