Evidence-based medicine(EBM) is an inevitable tendency of development of 21 century clinical medicine education.Its core thingking is to abide by evidence,which means clinical decision must be based on objective research result.The thinking of EBM will best promote the conversion of conception and model of clinical education,and will make significant influence on clinical teaching,scientific research,and clinical practice.

The anthors have analyzed the problems in current clinical teaching and dicussed the application of PBL methodology for the purpose of improvement of the clinical teaching quality of urology and the comprehensive practice quality of medical students.

Objective:To evaluate the effect and to improve the treatment level of transcatheter arterial embolization therapy in patients with urinary tumor.Methods:Catheters were transcutaneously inserted into femur artery by Seldinger's method and intervene embolized selected arteries by gelatin-sponge or a mixture of anhydrous alcohol and iodised oil.37 cases of renal carcinoma,8 cases of renal angiomyolipomas,2 cases of advanced bladder tumor were embolized and treated selectively or superselectively by Seldinger's catheteration.Among all patients,33 cases were treated before surgery,and 14 cases were therapeutic embolization.Results:The tumor size decreased,the perirenal edema area became clear and bleeding in operation reduced in 33 cases of renal carcinoma.The tumor size had no change and the patient had to undergo operation in 1 case.Therapeutic embolization was given to 2 cases with stage-IV renal carcinoma.The mean survival time was 12-17 months. And hematuria hasn't occurred;1 case with tumor relapse after nephrectomy was complicated of paraplegia after embolization treapy.8 cases with renal angiomyolipoma were followed-up 8 months to more than 5 years.Tumor size decreased,no blood supply and no one relapse.2 cases with advanced bladder tumor bleeding stopped.Survival quality of life has been significantly improved after embolization.Conclusion:Intervene embolization is an effective method for urinary tumor.It can improve the success rate of operation,maximumly reserve normal renal tissue or significantly improve survival quality.The complication of embolization is rare,but if it occurs,it is serious.Much more attention must be paid to it.

Objective:To improve the realization, diagnosis and treatment level of bladder sarcomatoid carcinomas.Methods:The tissue resource,the pathological and immunohistochemistry characters,the diagnosis and prognosis of sarcomatoid carcinomas were analyzed and differential diagnosis from bladder carcionomas was established by summarizing the clinical,pathological data and existing related articles.Results:2 cases in this group were diagnosed as transitional cell carcinoma of bladder.The patients underwent partial cystectomy.The pathological study indicated the tumor composed of many fusiform cells,and the transitional cell carcinoma,squamous carcinoma,adenocarcinoma and small cell nest were all included.There was transitional area between fusiform cells and tumor cells.Immunohistochemical examination showed that sarcomatous compoments were stained for epithelial markers.The patiems recovered well without radiotherapy and chemotherapy.However,these 2 patients died of tumor recurrence and metastasis 10 months later.Conclusion:Like general bladder tumor,hematuria is the chief symptom of sarcomatoid carcinomas.B-ultrasonography,CT and MRI can help turnor staging.Final diagnosis depends on pathology and immunohistochemistry.Differential diagnosis between sarcomatoid carcinoma and carcinosaroma should be made.The tumor will undergo blood metastasis in early stage.Prognosis of this kind is poor.The key to improve the prognosis is its early detection.

Objective: To study the immune responses of cytotoxic T-lymphocytes against Renal carcinoma cell 786-0(RCC) after activiated by dendritic cells(DCs) loaded with RCC freeze thawing antigen.Methods:DCs were obtained by cultured plastic-adherent monocytes isolated from health human peripheral blood with granulocyte-monocyte colony-stimulating factor(GM-CSF) and interleukin-4(IL-4) and Tumor necrosis factor(TNF) for 9 days.Host lymphocytes were stimulated with freeze thawing antigen of RCC 786-0 under the culture medium containing interleukin-2(IL-2) for 5 day.Killing activity and cytokine release were measured by MTT assay and ELISA.Results:The immune response of CTL activiated by DCs loaded with tumor soluble antigen was demonstrated by the following facts:(1)DCs loaded with tumor antigen could induce the growth of CTL.(2)The cyotoxicity of obtained specific CTL against RCC-7860 was highly enhanced with a significant difference from that of non-specific CTL.(3)The interleukin-12 release/secretion was increased by tumor antigen,which suggest an improved anti-tumor effect.(4)Apoptosis was observed in the RCCs after treated with CTL obtained.Conclution: These findings indicate that specific CTL induced by DCs sensibilized by RCC freeze thawing antigen exerts a remarkable killing activity on RCC 786-0.It is suggestd that DCs antitumor vaccines poses a clinically useful prospect with RCC.

Primary liver cancer is the fourth most common malignancy and the second most common cause of cancer death in China, posing a serious threat to the health of Chinese people. Hepatocellular carcinoma (HCC) represents more than 90% of primary liver cancers, among them 66% of patients are with intermediate-advanced HCC. Therefore, prevention strategies and conversion therapies to patients with intermediate-advanced HCC are particularly important. Hepatic arterial infusion chemotherapy (HAIC) is one of the important treatment methods to treat intermediate-advanced HCC. The tumor objective response rates and surgery conversion rates of HAIC-based conversion therapies are promising. The authors review the history of HAIC and the HAIC-based conversion therapies in this article.

Objective To examine the levels of serum tissue inhibitor of metalloproteinase in severe sepsis patients with disseminated intra-vascular coagulation (DIC) and evaluate its diagnostic value in severe sepsis with DIC.Methods Sixty patients were divided into 3 groups,namely severe sepsis group (SS group,n =28),severe sepsis with DIC group (SSD group,n =12) and normal group (n =20).Clinical data including APACHE Ⅱ score and DIC score of these patients were collected.Serum levels of TIMP-1 and TIMP-2 of these patients were measured by using ELISA.Results The patients of SS group had higher levels of TIMP-1 (723.74 ± 96.27) and lower levels of TIMP-2 (68.08 ± 14.87) than healthy control subjects (TIMP-1:574.24 ± 79.99,TIMP-2:89.99 ± 18.45) (P ＜ 0.05).The patients of SSD group had higher levels of TIMP-1 (907.56 ± 200.20) and lower levels of TIMP-2 (44.84 ± 22.13) than patients of SS group (P ＜ 0.05).An association was found between TIMP-1 and fibrinogen (FIB) (r =-0.392,P ＜ 0.05),TIMP-1 and D-dimer (r =0.407,P ＜ 0.05),TIMP-2 and PLT (r =0.484,P ＜0.01),TIMP-2 and PCT (r=-0.523,P＜0.01),TIMP-2 and DIC score (r=-0.579,P＜0.01).The areas under the curves (AUC) for TIMP-1/TIMP-2 was 0.896 (95％ CI:0.843 ～ 0.950 (P ＜ 0.05).Conclusions Serum levels of TIMP-1 in patients with severe sepsis complicated with DIC increased and TIMP-2 decreased,suggesting they were valuable in diagnosis of severe sepsis complicated with DIC.

Stroke is one of the most devastating complications after cardiac surgery,and contributes to both mortality and morbidity.Coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) are the common procedures for the treatment of coronary artery disease.This article reviews the pathophysiologic mechanisms,risk factors,treatment and prognosis of stroke after CABG and PCI.

OBJECTIVE：To study the therapeutic effect and safety of domestic tolterodine tartrate in treating patients with urinary bladder overactivity.METHODS：56 cases of bladder overactivity were divided into two groups randomly：tolterodine and control(oxybutynin)group.The course of treatment was 6 weeks.RESULTS：The effect of tolterodine in treatment group was comparable to that of oxybutynin in control group,however,the adverse reactions in oxybutynin group were more common than those in tolterodine group.CONCLUSION：Tolterodine is a suitable drug to treat bladder overactivity.

Objective To determine a method for amplification of cytochrome C oxidase subunit Ⅰ (CO Ⅰ) gene of Brandt's vole.Methods 发he Brandt's Voles were captured in Abagaqi Xilingol League Inner Mongolia,and DNA was extracted from liver tissue.CO Ⅰ gene was amplified by nested PCR and sequenced afterwards.Results A band of 657 bp and 1 132 bp was amplified by internal and external PCR primers,respectively,which were consistent with expected sizes.A total of 12 segments of Brandt's Vole CO Ⅰ gene sequences were amplified by PCR and verified by sequencing.一he sequence number was KF182196-KF182207 in GenBank.After gene sequence alignment of the 12 CO Ⅰ gene sequences,it was found that the similarity was 100％,and no base mutation.Conclusion CO Ⅰ gene of Brandt's Vole could be amplified by nested PCR without pseudo gene.