The physicians and nurses in the intensive care unit often discuss about withdrawing or withholding life-support therapy of critical ill patients with them or their family members.In this article,we expatiate on the importance,approach,agendas and medical ethical issues of the communication about end-of-life care between clinicians and families.

Post-operative recurrence and metastasis remain the leading causes of death for patients with gastric cancer. The major determinants of recurrence and metastasis are the biological characteristics of cancer cells and the immunological status of the patients. In recent years, due to the target-specificity, biotherapy has yielded efficacious responses in diverse clinical applications for cancer treatment, partially for the treatment of recurrence and metastasis of gastric cancer. However, because of the high diversities in clinical manifestations, patients' condition, and tumor's characteristics, there is no ideal strategy of biotherapy established for the prevention and treatment of recurrence and metastasis in gastric cancer. Therefore, a lot of work need to be done in basic research and clinical trial to make the biotherapy effective in treatment of gastric cancer recurrence.
Biological Therapy ; Humans ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Stomach Neoplasms ; pathology ; therapy ; Treatment Outcome

Humans ; Liver Neoplasms ; metabolism ; pathology

In pregnant women,positive rate of thyroid peroxidase antibody(TPOAb) is approximately 3%~10%.It is still controversial whether thyroid antibody positive rate is higher in women undergoing artificial assistant reproductive technologies.TAI might have a negative effect on pregnant outcome,which has been proved in different groups of women.Intravenous immunoglobulin,thyroxin replacement therapy and selenium therapy have been used for TAI intervention.More evidence is needed to demonstrate mechanism and evaluate effect for each therapy.

Objective To investigate the etiology and prognostic factors of acute kidney injury (AKI) in pediatric patients . Methods The clinical data of children patients with AKI in this hospital ,including the clinical features ,causes and outcomes ,were retrospectively analyzed .The relationship between the risk factors and prognosis was analyzed .Results Infants were dominated by the prerenal factors and the other age groups were dominated by the renal factors .The univariate analysis revealed that the AKI stage ,etiology ,mechanical ventilation ,sepsis/septic shock ,MODS ,acidosis ,creatinine initial value ,creatinine peak value and serum potassium were the factors affecting prognosis .The Logistic regression analysis showed that mechanical ventilation ,MODS and sep-sis/septic shock were the independent risk factors affecting prognosis .Conclusion The etiology of AKI in children is diverse and its distribution has the age characteristics .Mechanical ventilation ,MODS and sepsis/septic shock are the independent risk factors af-fecting prognosis .The early diagnosis and the active treatment conduces to improve prognosis .

Polymerase chain reaction (PCR) is one of the common techniques in molecular biology, which can amplify nucleic acids through the cycle of denaturation, annealing and extension. Based on the principle of common PCR, rapid PCR is to realize the amplification of nucleic acids in less time without affecting the specificity, sensitivity and fidelity of the reaction. A lot of research work in this field has been going on in recent years. This article will make a review of the development of rapid PCR with emphases on the improvement of DNA polymerase, the choice of additives and the improvement of thermocyclers.

Formation of malignant tumor originating from normal healthy cell is a multistep process including genetic and epigenetic lesions. Previous studies of cell line model systems displayed that early important epigenetic events happened in stepwise fashion prior to cell immortalization. Once these epigenetic alterations are integrated into chromatin, they will perform vertical propagation through cell subculture. Hence, status of epigenetics is dramatically important in maintaining of cell identity. Histone modification is another factor of epigenetic alterations during human oncogenesis. Histones, one of main components of chromatin, can be modified post-translationally. Histone tail modifications are regulated by corresponding modification enzymes. This review focuses on the description of relationship between the main sites of histone modification and oncogenesis.

Objective To evaluate the targeted antimicrobial prophylaxis in men undergoing trans-rectal ultrasound guided prostate biopsy based on rectal swab culture results.Methods From July 2008 to April 2012 we studied differences in infectious complications in men who received targeted vs standard empirical ciprofloxacin prophylaxis before transrectal ultrasound guided prostate biopsy.All 344 patients were divided into 3 groups according to their hospital records,inculding group A:without antimicrobial prophylaxis(105 eases) ;group B:antimicrobial prophylaxis with fluoroquinolone(117 cases) ;group C:targeted prophylaxis used rectal swab cultures results(122eases).All cases received enema with diluted iodophors before biopsy.We identified men with infectious complications within 7 days after transrectal ultrasound guided prostate biopsy using the electronic medical record,following 3 conditions.Results In group A of 105 case,17 cases of fever were recorded,including prostatic abscess of 3 cases and septicemia of 1 case.Three cases of fever were occurred in group B,including 1 case of bacteremia and 1 case of prostatitis.No infectious complications were recorded in group C.Conclusions Targeted antimicrobial prophylaxis was associated with a notable decrease in the incidence of infections complications after transrectal ultrasound guided prostate biopsy,although fiuoroquinolone can provide good protective effets.

Objective To investigate the variance levels of plasma soluble leukocyte differentiation antigens CD40 (sCD40) and soluble CD40 ligand (sCD40L) in preeclamptic patients with renal damage and its relationship. Methods A total of 63 pregnant women attended the Department of Obstetrics, Affiliated Hospital of Qingdao University Medical College between August 2008 and June 2010. In the present study included 28 pregnant women with mild preeclampsia and 35 patients with severe preeclampsia. Thirty matched normotensive pregnant women were enrolled in the study as the control group. Expression of sCD40 and sCD40L were determined by ELISA. At the same time, the blood routine, C reaction protein ( CRP),urine routine, 24 hours urine protein excretion, and serum uric acid (UA), creatinine (Cr), blood urea nitrogen (BUN) were measured. The correlation analysis was performed between the sCD40/sCD40L and the blood biochemical indexes in 3 groups. Results ( 1 ) The median levels of CRP in severe preeclampsia (10. 8 mg/L)and mild preeclampsia group(7. I mg/L)are significantly higher than that of control group (3. 3 mg/L,P ＜ 0. 05 ); The level of CRP in severe preeclampsia group was also higher than that of mild preeclampsia group ( P ＜ 0. 05 ). The median gestational age at delivery in severe preeclampsia ( 32. 5 weeks)was significantly less than that of mild preeclampsia group ( 37. 2 weeks) and normal group ( 38. 6 weeks,P ＜ 0. 05). However no significant differences were observed between mild preeclampsia group and normal group ( P ＞0. 05 ). The platelet count in severe preeclampsia ( 132 × 109/L) was significantly less than those of mild preeclampsia group (212 × 109/L) and normal group ( 216 × 109/L, P ＜ 0. 01 ), but no significant differences were observed in blood platelet amount between mild preeclampsia group and normal group ( P ＞0. 05 ). There was no significant difference in hemoglobin level and white blood cell in three groups ( P ＞0. 05). (2) The sCD40 plasma concentration in severe, mild preeclampsia and normal group was 133.6,126. 5 and 90. 7 ng/L, respectively. The sCD40 L plasma concentrations were 12. 5, 10. 4 and 4. 4 ng/L respectively in the 3 groups. 24 hours urinary protein quantitative was 4. 5 g/d,0. 8 g/d and 0 in the 3 groups respectively. And the UA level was 486 μ mol/L,289 μmol/L and 162 μmol/L. In the above three groups,the monitoring indicators were significantly higher in women with severe preeclampsia group compared with mild preeclampsia and control groups (P ＜ 0. 01 ), and there were also higher in mild preeclampsia group than that in control groups ( P ＜ 0. 01 ). The level of plasma Cr ( 89 μmol/L) and BUN ( 5. 32 mmol/L) in severe preeclampsia group were higher than those of mild preeclampsia group (66 μmol/L and 4. 49mmol/L) and control group ( 57 μmol/L and 3.32 mmol/L, P ＜ 0. 05 ). There was no significant difference between mild preeclampsia group and normal group (P ＞ 0. 05 ). (3) The correlation analysis indicated that the level of sCD40 has a positive correlation with 24 hours urinary protein quantitative( r = 0. 434, P ＜ 0. 05 ),also significant positive correlation( r =0. 536,0. 528 ,P ＜ 0. 01 ) between the level of sCD40 and UA or CRP in women with preeclampsia. There was no significant correlation between the level of sCD40 and systolic blood pressure, diastolic blood pressure, delivery gestational age, Cr, BUN, and platelet count(r =0. 135,0. 183, -0. 133,0. 190,0. 167, -0. 221 ,all P ＞0. 05 ). There were positive correlation between the level of sCD40L and 24 hours urine protein excretion, either UA or CRP( r =0. 591,0. 445,0. 539 ,all P ＜0. 01 ). No significant correlation was found between sCD40 L and systolic blood pressure, diastolic blood pressure,delivery gestational age, Cr, BUN, and platelet count( r =0. 178,0. 212, -0. 292,0. 144,0. 135, -0. 273,all P ＞0. 05). There was significant positive correlation between plasma sCD40 and sCD40L ( r =0. 707 ,P ＜0. 01 ). There was no relationship between the level of sCD40, sCD40L and the blood biochemical indexes in normotensive pregnant women ( P ＞ 0. 05 ). Conclusions The plasma concentrations of sCD40 and sCD40 L are significantly higher in pregnant women with preeclampsia compared with the control, which may be involved in the development of preeclampsia and contribute to the kidney damage. The variance levels of sCD40 and sCD40L may be also related to the severity of preeclampsia.

Objective To investigate an optimum extracting technology for total glycosides from dried barks of Ilex rotunda Thunb. Methods The yields of pedunculoside and syringin by high performance liquid chromatography (HPLC) determination were taken as the indexes. Some parameters of the extraction technology were evaluated with an L9(3)4 orthogonal design. The optimum extraction parameters were used to extract total glycosides in laboratory. The feasibility was checked by determining the chemical constituents by means of HPLC method. Results The optimum extracting conditions were 12 times volumes of 50% ethanol as the solvent and refluxing 90 min each time for 3 times. An extract yield of total glycosides was 19.5% from barks of Ilex rotunda. Pedunculoside (292 mg/g), syringin (59.5 mg/g), sinapaldehyde glucoside, syringaresinol 4'-O-β-D-glucopyranoside, and syringaresinol 4',4'-di-O-β-D-glucopyranoside were detected in the extract. Conclusion Some glycosides were found in the extract with the optimum extraction technology in laboratory. The extraction technology is practicable and valid.