Objective　To investigate the possible roles of the different subnuclei of hypothalamic paraventricular nucleus （PNV） which may regulate splenic immune function. Methods　4 SD rats received splenic injection of pseudorabies virus（PRV）.96 hours after injection， a block containing hypothalamus was taken and cut into 40 μm sections with cryostat. Immunohistochemical technique and stereology method were used to detect the distributing character of transsynaptic PRV infection neurons in the PVN and the localization relationship between PRV neurons and AVP neurons in the PVN.Results　Transsynaptic PRV infection neurons distributed through out the PVN， but mainly concentrated in the lateral parvocellular （LP） subnucleus of PVN and posterior magnocellular （PM） subnuclei of PVN （occupied 73.49％ of total surface area），a few distributed in the anterior， dorsal and periventricular parvocellular （AP，DP and PP）nuclei of PVN，few scatted in the rest of nuclei of PVN. In the LP and PM some of the PRV neurons distributed among the AVP neurons.Conclusions　Besides the classical neuro-immuno-endocrine modulation， the PVN may regulate the splenic immune function through direct innervation .The AVP neurons in the PM and neurons projecting to the proganglionic neurons in the dorsal medulla and lateral horn of spinal cord in the LP，DP and AP regulate the immune function of spleen through sympathetic and para-sympathetic innovation.

ObjectiveTo evaluate the effect and safety d sorafenib in treatment of patients with metastatic renal cell carcinoma.Methods40 patients with metastatic renal cell carcinoma,were given sorafenib tablets methanesulfonate treatment,the initial dose of 800mg/d,bid,continuous administration of 21d,stopping 7d,The adverse reactions,efficacy and immunohistochemistry results were observed.Results40 cases with metastatic renal cell carcinoma were not found complete remission (CR) and partial remission (PR) ; The 32 cases in stable disease (SD)(80.0％ ) and 8 cases ( 20.0％ ) in PD; The incidence of 28 cases ( 70.0％ ) in digestive system; The expression of positive rate 30.5％ of local in connexin 32,Cx32 was significantly lower than that 1.2％ in metastatic renal cell carcinoma( x2 =8.123,P ＜0.01 ),The expression of Cx32 was negatively correlated with the clinical stage( r =-0.419,P ＜0.05 ) ;The expression positive rate of vascular endothelial growth factor(VEGF) in renal cell carcinoma was significantly higher than 18.5％ in normal renal tissue( x2 =8.723,P ＜ 0.01 ) ; The expression positive rate 72.0％ in the limitations of renal cell carcinoma and metastatic renal cell carcinoma 89.1％ was not statistically significant( x2 =1.978,P ＞ 0.05 ).ConclusionSorafenibin for advanced kidney cancer had better disease control effect,and was new choice for treatment of metastatic renal cell carcinoma.

Objective To optimize the treatment process of patients in Ophthalmology Outpatient, so as to enhance patient′s satisfaction and quality of care service. Methods The nurse manager of Department of Ophthalmology experienced treatment process in other hospital with team and summarized the feeling of other hospital′s treatment process, and improve the treatment process according to the existed problems including reconstruction of Outpatient work process, the implementation of registration system in Outpatient, building up Office of Returning Visit, doing extended nursing, developing “I am patient” activity, training communication ability and skills for constructing doctor-patient relationship, strengthening health education and other nursing services. Results 2014 and 2015 in Ophthalmology Outpatient of our hospital, the patients′ waiting time for treatment became short after carrying out the experience of nurses′transposition experience ( P<0.05) , and the patients′satisfaction were significantly improved after exchanging ( P<0. 05 ) , as well as the reduction of effective complaint rate (P<0.05).Conclusions To optimize the treatment process of patients in Department of Ophthalmology can shorten the time of treatment waiting time, improve the satisfaction of outpatients, so as to improve the quality of nursing service.