Objective To study the antitumor effect of dendritic cell(DC) induced cytotoxic T lymphocyte (CTL). Method CTL induced by DC extracorporeally, were co-cultured with Bxpc-3 cells, CTL activity was observed by counting the killing of Bxpc-3 cells in vitro. Nude mice with Bxpc-3 cell transplant tumors were treated by injection of CTL on the edge of tumors, and kinetics of tumor growth was recorded, RT-PCR-ELISA was used to determine the telomerase of transplant tumor. Result CTL activity was 71.6%. Thirty-one days after transplantation tumor size and telomerase activity were not statistically different among therapy group and control group, whereas after fifty-five days tumor size (38?6)mm 2 , and telomerase activity (1.33?0.03) in CTL group were statistically different from that of ( 74? 33)mm 2 and (4.16?0.32) in control group. ConclusionDC induced CTLs suppress the experimental pancreatic tumor growth, providing an evidence for clinical immunotherapy of pancreatic cancer.

Objective The changes of telomerase activity were dynamically observed after DMBA was used to induce breast cancer in Wistar rats. Methods Apoptosis was determined quantitatively by TUNEL,and telomerase activity was detected by RT PCR ELISA method. Results Telomerase activity was gradually increased after breast cancer occurred.Conclusion\ As breast cancer occurred,the telomerase activity gradually increased while apoptosis decreased.Telomerase could be a useful marker for diagnosis of the breast cancer.\;[

event and treat circular,respiratory and renal insufficiency.

Objective To summarize clinical characteristics and experiences in treatment of severe hyperlipidemic pancreatitis (SHLP). Methods A retrospective analysis for 22 cases of SHLP and 91 cases of severe acute biliary pancreatitis (SABP) hospitalized during January 1, 2000 to December 31, 2006 was carried out to compare their clinical characteristics and treatment outcomes. Results Activities of serum and urine amylase in SHLP patients at admission were (715 ± 99) and (382 ± 56) U/L, respectively, significantly lower than those in SABP patients (1551 ± 107) and (773 ± 66) U/L, respectively (P < 0.01). About 55% (12/22) of SHLP patients had pulmonary infection, 36% (8/22) with circulatory failure, 41% (9/22) with respiratory failure and 23 % (5/22) with renal failure, all significantly higher than those in SABP patients SABP [32% (29/91), 14% (13/91), 7% (6/91) and 5% (5/91), respectively, P < 0.01]. Two died of SHLP and 11 of SABP, respectively. Conclusions In diagnosis of SHLP, it should be noticed that no remarkable elevation of activities in serum and urine amylase usually, so during the course of treatment for SHLP, it is important to prevent and treat multi-organ failure, respiratory failure and renal failure in an active way.

Objective To study the difference in outcomes between two treatment regimens of goal-directed fluid therapy in patients with severe acute pancreatitis. Methods From January 2000 to January 2010, 80 patients with severe acute pancreatitis were assigned into 2 groups. In group A,patients received fluid therapy aiming at the following goals in 24 hours: (1) Blood pressure >90/60 mm Hg;(2) CVP between 8-12 mm Hg;(3) Urine output >0. 5 ml · kg-1 · h-1. In group B, patients received fluid therapy aiming at the following goals in 6 hours (according to SSC guideline,2004): (1) mean arterial blood pressure >65 mm Hg;(2) CVP between 8-12 mm Hg;(3) Urine output >0. 5 ml · kg-1 · h-1 ;(4) central venous oxygen saturation >70%. After therapy for 3 days we measured the Marshall score, APACHE Ⅱ score, and the peri-pancreatic infection and mortality rates. Results The Marshall score was 6. 82±4. 69 and 4. 48±3. 78 in group A and B, respectively (P=0. 02). The APACHE Ⅱ score was 11. 35±5. 96 and 8. 22±4. 53 in group A and B, respectively (P=0. 01). The peri-pancreatic infection rate was 44% and 37% in group A and B, respectively, and there was no significant difference between the 2 groups (P = 0. 65). The mortality rate was 24% and 17% in group A and B. There was no significant difference between the 2 groups(P=0. 57). Conclusion Goal-directed fluid therapy in patients with severe acute pancreatitis according to the SSC guideline improved organ function but it did not reduce peri-pancreatic infection and mortality rates.

Objective To construct the objective system of 5+3 integrated clinical medicine personnel training mode.Methods For the attitude,knowledge and ability clinical medical students should have,who received 5+3 integrated training,we adopted literature research,expert interviews intending to make a preliminary questionnaire items,and invited experts and graduates to modify the expressions of the items a number of times,and eventually formed the final questionnaire that met the study objective.We asked 500 teachers in basic medicine,clinical medicine,and medical humanities and so on,to evaluate the importance of the questionnaire.406 valid questionnaires were recovered and the effective recovery rate was 81.2％.Epidata 3.1 and SPSS 19.0 were used for survey data summary statistics,exploratory factor analysis and factor weighting method were used to get the goal of talent training base,and on these basis target system was constructed.Results In 5+3 integrated medical education model,clinical medical personnel training target system included knowledge,attitude and ability of the part,a total of 9 target groups.Each group contained elements in the training target system for different weights,among which attitude included a common factor,proportion of 27.51％;knowledge consisted of three factors,the proportion of 29.34％;and the ability contained five common factors,accounting for highest proportion of 43.15％.Conclusion 5+3 integrated clinical medical talents training target system established in this study highlights the ability requirements,emphasizes the comprehensive quality training,which accords with the principles of talent training goal and the requirements of 5+3 medical education model,has certain guiding significance for the curriculum reform,and can be used for reference in the development of talents training program for medical colleges and universities.

Objective Previous investigations suggest that severe acute pancreatitis (SAP) is one of the main causes of intra-ahdominal pressure (lAP) increase. The aims of this study were, to evaluate the increased IAP in patients with SAP and the correlation between LAP and severity or prognosis. Method Data of 75 SAP patients admitted to Xuan-Wu Hospital of Capital Medical University intensive care unit with SAP from January 2000 to Jan-uary 2008 were collected. All the patients had at least one organ dysfunction, and they were diagnozed with en-hanced CT, lAP were monitored in the 56 patients. The 56 patients were divided into three groups according to IAP, group A (7- 15 mmHg), group B (16-25 mmHg) and group C (26-31 mmHg). Maximal APECHE Ⅱscore, maximal Ranson score, maximal C-response protein (CRP), maximal arterial lactate, maximal creatinine, organ dysfunction, length of stay and mortality were compared. Results The 56 patients (24 male and 32 female)with average age of (52±14.1) years (ranging 21 - 72 years) and average body mass index (BMI) of 28±12.5(ranging 21 - 35) were monitored with IAP. The etiologic causes of SAP were biliary in 27 patients, alcohol in 14cases, hyperlipidemia in 11 cases and idiopathic in 4 cases. The rate of intra-abdominal hypertension was 89% (50/56), and 32% (18/56) patients complicated with abdominal compartment syndrome. There were 22, 26 and 8 patients in the A, B and C groups respectively. With the increasing of IAP, the maximal APACHE Ⅱ, maximal Ranson score, maximal CRP, maximal creatinine, organ dysfunction and mortality were also increased significant-ly. The mortality of the three groups was 13.6% (3/22), 23.1% (6/26) and 62.5% (5/8) respectively (χ2 =7.56, p = 0.023), and the total mortality of the 56 patients was 25%. The hospital stay of the three groups had no significant differenee(F = 2.23,P = 0.117). Conclusions IAP may be one of the markers used to evaluate the severity of SAP, and the monitoring of IAP is useful to assess the prognosis in patients with SAP.

Objective To study retrospectively the effects of low-dose glucocorticoids in outcomeof septic shock.Method The present stray was carried out by analysis of septic shock patients treated with norepinephrine or dopamine.A total of 46 patients with a confirmed diagnosis of septic shock admitted from January 2000 to October 2006 were divided into two groups:(1)ghcocorticoids treatment group(n=22),treated with glucocorticoids in addition to conventional treatment from November 2002 to October 2006;(2)conlrol group(n =24),only treated with routine treatment from January 2000 to October 2002.The differences in outcome were compared between the two groups.Results The duration of of vasopressor support was significantly shorter in treatment group com0~ed with control group.The percentage of shock reversal at 7 days was higher in treatment group than that in control group(72.73%vs.41.67%,P=0.034).Furthermore,a reduction in C-reactive protein(CRP)indicated inhibition of inflammatory response due to the effect of glucocorticoids in treatment group within 48-72 hours from admission to ICU(20.05±4.06 mg/dl vs.23.55±4.93 mg/dl,P=0.015).Therefore,APACHE Ⅱ score on 3rd day was significantly lower in treatment group than that in control group(16.76±4.87 vs.21.45±4.02,P=0.001).However,there were no statistical signifieances in the duration of mechanical ventilation,the length of ICU stay,the incidence of multiple organ dysfunction syndrome(MODS)and hospital-mortality between the two groups(P＞0.05).Conclusions Tmatmeut with low-dose gheocorticoids could effectively accelerate the recovery from refractory septic shock and the early withdrawal of vasopressor.It seems to be associated with the reduced production of CRP,suggesting the effects of low-dose glucocorticoids on both stabilization of hemodynamics and inhibition of inflammatory response.The beneficial effects of low-dose steroids regimens on long-term outconm of patients with septic shock have not determined.

Objective To prospectively summary the piercing-out position,direction,length and piercing-in position of perforator,and investigate the feasibility of preoperative design and optimization of the anterolateral thigh flap and its clinical application.Methods All 58 cases of anterolateral thigh flaps were designed and taken from the lateral thigh area from January,2014 to January,2016.Portable Doppler ultrasound was used before an operation to detect the piercing-out position (point P) of perforators.The direction and length (lower subcutaneous segment of perforators) of perforators after leaving piercing-out position were observed during the operation.And the piercing-in positions (point P') on superficial fascia and the dermis were observed.Based on this,we added line B (anterior superior spine-lateral femoral epicondyle) and line C (anterior superior spine-the middle point of superior border of patella) in the lateral and anterior side of original ilium-patella line in the thigh (line A),respectively.Results All perforators found in 58 cases before and during the operations were located on line A or between line A and line B.No perforators were found between line A and line C.Perforators walked toward the anterior medial side after leaving the muscle membrane.The perforator vascular subcutaneous segment (distance between point P and point P') was (2.02±0.23) cm.There was rectus muscle branch in the descending branch of lateral femoral circumflex artery,while no rectus muscle cutaneous branch was seen.20 cases were designed by one-line method,12 cases were designed by two-line method,while 26 cases were designed by three-line method.Conclusion Advanced three-line method is beneficial to detect of the perforators on the anterior thigh lateral region and to reduce the intraoperative injury perforator vessels at the puncture point.Clinical application of the anterior lateral thigh flap is simple and reliable.

Objective To build a multi‐level hierarchical structure model of the influencing factors for hierarchical medical system ,to identify the role relationship between all the factors and transmission pathways ,and to recommend on developing China′s hierarchical medical system . Methods Thirty influencing factors were identified in a screening based on literature review for the hierarchical medical system .On such basis ,16 influencing factors were identified by three health policy experts ,which affect operations of the current system .Interpretative structural modeling was called into play in the end to analyze the hierarchy relationship between various influencing factors and the conduction loops .Results There exist among the 16 factors a 3‐level hierarchical structureand two conduction loops .The factor directly limiting the hierarchical medical system is two‐way referral,and most internal core drivers arehuman resources development and governance mechanism.By means of self‐growth and external constraints ,they exert their influence on the operation of hierarchical medical system .Conclusions There are interactive hierarchical effects among the factors ,merging into three node elements of functional role,inter‐entity relationshipand patient participation.