110?),5 good(90?-109?)and 1 acceptable(60?～89?)and no poor results(

Retinoid acid and its derivatives have shown promising perspective in clinical use and lab research on the leukemia and other solid tumor cells.Some of these compounds have a stronger apoptotic potential,a lower level of cytotoxicity and a better pharmacokinetic profile than all-trans retinoic acid.The apoptosis pathways induced by these compounds are different from traditional p53-dependent pathway which recruited by many chemotherapeutics.Due to its specific molecular mechanism,these compounds could induce apoptosis in retinoic acid-resistant or multi-drug-resistant tumor cells.This paper reviews the current research on apoptosis induced by analogues of retinoid acid.

Objective To explore the inhibition of different immunosuppressive drugs or immunosuppressive combination regiments on the development of de novo donor specific antibodies (dnDSA).Methods We used BABL/c mice and C57BL/6 mice alloimmunized using donor splenocytes for establishing model of producing dnDSA.After that,mice were divided into 10 groups,and were administrated with mycophenolate mofetil (MMF,300 mg· kg-1 · d-1);sirolimus (0.3 mg·kg-1 ·d-1);tacrolimus(0.9 mg· kg-1 · d-1);cyclosporine A (45 mg· kg-1 · d-1);MMF (150 mg· kg-1· d-1) + tacrolimus(0.45 mg · kg-1 · d-1);MMF (150 mg · kg-1 · d-1) + cyclosporine A (22.5 mg·kg-1 ·d-1);MMF (150 mg·kg-1 ·d-1) + sirolimus (0.15 mg·kg-1 ·d-1);sirolimus (0.15 mg· kg-1 · d-1) + tacrolimus (0.45 mg· kg-1 · d-1);sirolimus (0.15 mg· kg-1 · d-1) + cyclosporine A (22.5 mg· kg-1 · d-1);and placebo;respectively.Anti-serum was harvested and tested using flow cytometry.Results (1) Four weeks after sensitization,the dnDSA level in BALB/c and C57BL/6 group was 88.86％ and 25.58％.Comparing with control group(25.33％),there was a significant increase in BALB/c group(89.23％ versus 25.33％;P＜0.001),whereas no change was found in C57BL/6 group (25.58％ versus 25.33％;P =0.259),that we chose BABL/c mice as the model for sensitization.(2)After 4 weeks of sensitization and immunosupression,dnDSA level was 29.31％,46.33％,57.10％ and 66.35％ in MMF,sirolimus,cyclosporine A and tacrolimus monotherapy group respectively.In comparison to sensitization group,dnDSA level in all monotherapy arm reduced significantly.Intra-group analysis found MMF monotherapy had the most effective inhibition of dnDSA production,sirolimus came the second,and tacrolimus and cyelosporine A had equivalent effectiveness.dnDSA level was 31.00％,33.12％,45.18％,44.62％ and 61.60％ in MMF+ sirolimus,MMF+ tacrolimus,MMF+ cyclosporine A,sirolimus + cyclosporine A and sirolimus + tacrolimus combination treatment arm,respectively,which was much lower than that of sensitization group (P＜0.001,P＜0.001,P＜0.001,P＜0.001,P =0.015).MMF + tacrolimus and MMF+ sirolimus combination treatment had comparable effectiveness in dnDSA inhibition,which is greater than that of the rest of three combination.Conclusion Our data show that the effects of single immunosuppressive drugs on the level of dnDSA is MMF＞sirolimus＞cyclosporine A =tacrolimus,and that in combination regimens is MMF + tacrolimus =MMF + sirolimus＞MMF + cyclosporine A =sirolimus + cyclosporine A =sirolimus + tacrolimus.In conclusion,this study demonstrates that MMF+ tacrolimus combination treatment arm can minimize the development of dnDSA.But,this conclusion remains to be confirmed by future clinical studies.

Objective To investigate the effects of PTD4-GFP-Apoptin protein on proliferation inhibition and apoptosis-inducing of different types of leukemia cells. Methods Genetic engineering was used to restructure a carrier containing PTD4-GFP-Apoptin gene, and MTT was applied to detect the expressed PTD4-GFP-Apoptin fusion protein and its effect on the leukemia cell proliferation. Flow cytometry (FCM) was used to detect the effects on cell apoptosis. Results MTT cell proliferation inhibitory experiment showed that PTD4-GFP-Apoptin had different degree of proliferation inhibition on different types of leukemia cells;furthermore, the inhibitory effect presented positive correlation with time and concentration. FCM showed that PTD4-GFP-Apoptin had apoptosis-inducing effect on HL-60 cells, and the apoptotic rate had significant difference compared with the control group (P <0.05). Conclusions PTD4 can carry large proteins to penetrate the cell membrane, and PTD4-GFP-Apoptin may produce the inhibiting proliferation in vitro for a variety of leukemia cells. Apoptin can induce tumor cell apoptosis without affecting normal cells, which might become a new agent for the clinical treatment of leukemia.

Objective To investigate the effect of birth order on outcomes of renal transplantation from siblings.Method We conducted a retrospective study to examine the immune effect exerted by birth order in kidney transplantation between siblings.227 kidney transplants were included and we stratified the cohort by birth order,old to young parings (group A,104 pairs) and young to old pairings (group B,123 pairs),using old to young parings as reference group.Result During the follow-up period,4 recipients suffered graft failure and 2 died.The survival rate of recipients and grafts was 98％ and 95％,respectively.After adjusting the effect of confounding factors in demography,young to old pairings were found at a higher risk of developing death uncensored graft failure (Hazards ratio,HR =2.77,95％ CI..0.23,33.00),which was not significantly different from group A (P =0.42).And group B had a higher risk of developing death censored graft failure (HR =10.79,95％ CI:0.30-389.43),with no statistically significant difference (P＞0.05).Most rejections occurred in two months after transplantation,and the rejection-free rate in 3 years post-transplantation was 86％.Similarly,no significant difference was detected between the two groups in terms of death censored graft failure,and no benefit of birth order was found in rejection protection (HR =1.266,95％ CI:0.391,4.103,P =0.694).Conclusion Birth order may not be taken into consideration in kidney transplantation between siblings.

Objective To explore the clinical feasibility of ambulatory surgery for inguinal hernia in 70 years of age or older patients.Methods The retrospective cohort study was adopted.The clinical data of 675 patients undergoing ambulatory surgery for inguinal hernia and 464 patients (age ≥ 70 years) undergoing inpatient surgery for inguinal hernia who were admitted to the West China Hospital of Sichuan University from January 2015 to May 2016 were collected.Of 675 patients undergoing ambulatory surgery,594 patients with age ＜ 70 years and 81 with age≥70 years were respectively allocated into the under 70 years group and 70 years or older group.Four hundred sixty-four patients undergoing inpatient surgery with age ≥ 70 years were allocated into the inpatient surgery group.Observation indicators included:(1) efficacies of patients undergoing ambulatory surgery:① type of anesthesia,surgical procedures and operation time,② cases with delayed discharge and cases with unplanned readmission,③postoperative complications,including wound infection and dehiscence,edema of scrotum,urinary retention,chronic pain and patch infection.(2) Efficacies of patients with inpatient surgery:①type of anesthesia,surgical procedures and operation time,② postoperative complications,including wound infection and dehiscence,edema of scrotum,urinary retention,chronic pain and patch infection,③ duration of postoperative hospital stay.(3) Follow-up.Patients were regularly followed up using telephone interview at postoperative day 1,2,3,and using outpatient examination and telephone interview at postoperative week 2 and month 3,6,12 up to July 2016.Follow-up included the survival of patients,recurrence of hernia and number of readmission.Measurement data with normal distribution were represented as （x） ± s and comparison between groups was evaluated with the t test.Comparison of count data were analyzed using the chi-square or Fisher exact probability.Results (1) Efficacies of patients undergoing ambulatory surgery:① type of anesthesia,surgical procedures and operation time:patients in the under 70 years group and 70 years or older group underwent tensionfree repair under local anesthesia.The operation time in the under 70 years group and 70 years or older group was respectively (29 ± 11) minutes and (28 ± 10) minutes,with no statistically significant difference between 2 groups (t =0.378,P ＞ 0.05).② The cases with delayed discharge and with unplanned readmission:there were 2 patients with delayed discharge and 1 with unplanned readmission in the under 70 years group and no case in the 70 years older group,with no statistically significant difference between the 2 groups (x2=0.601,0.137,P ＞ 0.05).③ The postoperative complications:wound infection and dehiscence,edema of scrotum,urinary retention and chronic pain were detected in 4,2,1,3 patients in the under 70 years group and 1,0,0,1 patients in the70 years or older group,respectively,showing no statistically significant difference between the 2 groups (P ＞ 0.05).No patch infection occurred.(2) Efficacies of patients undergoing inpatient surgery:① type of anesthesia,surgical procedures and operation time:patients in the inpatient surgery group underwent tension-free repair under local anesthesia and operation time was (29 ± 10) minutes.There was no statistically significant difference in operation time between the inpatient surgery group and 70 years or older group (t =0.806,P ＞ 0.05).② The wound infection and dehiscence,edema of scrotum,urinary retention and chronic pain in the inpatient surgery group were respectively detected in 3,1,1,2 patients,showing no statistically significant difference between the inpatient surgery group and 70 years or older group (P ＞ 0.05).No patch infection occurred.③ Duration of postoperative hospital stay was less than 1 day in 439 patients and more than 1 day in 25 patients in the inpatient surgery group,respectively.(3) Follow-up:625 of 675 patients undergoing ambulatory surgery were followed up for a median time of 9 months (range,2-18 months).One patient in the under 70 years group was complicated with recurrence of hernia and then was cured by reoperation.There was no recurrence of hernia in the 70 years or older group.Of 464 patients in the inpatient surgery group,432 were followed up for a median time of 9 months (range,2-18 months),and 1 patient with recurrence of hernia was cured by reoperation.Conclusion Ambulatory surgery for inguinal hernia is feasible in 70 years or older patients.

PURPOSE: The objective of this phenomenological study was to explore nursing students' emotional experiences in the school life. METHODS: Twenty-four nursing students participated in the study. Data were collected from May 2017 to February 2018 using focus group interviews and later analyzed using the Colaizzi's method. RESULTS: In our study, 311 meanings were obtained from the participants, including 19 sub-themes and seven theme clusters. The seven theme clusters were; ‘looking back on the past,’ ‘face to reality,’ ‘recognizing me,’ ‘anxiety about uncertainty,’ ‘nursing student's way,’ ‘looking around,’ and ‘patting for my mind.’ The emotional experiences of nursing students in college life were classified into four categories: ‘self-reflection for growth,’ ‘discovery for growth,’ ‘hoping for growth,’ and ‘search for the growth.’ CONCLUSION: Although nursing students may be equally exposed to anxious and stressful situations, their activities, adaptability and levels of achievement vary depending on emotional experiences of each person. Considering the continuous curriculum of nursing, it is necessary to develop emotional management strategies and relevant training programs considering different types and levels of emotional issues for the nursing students.
Curriculum ; Education ; Focus Groups ; Humans ; Methods ; Nursing ; Qualitative Research ; Students, Nursing

Objective To analyze the characteristics of proximal deep vein thrombosis (DVT) after total joint arthroplasty.Methods 40 cases of proximal DVT were collected from May 2007 to October 2016 which were all diagnosed by lower limb venography or sonography.There were 9 males and 31 females aged from 38 to 86 years,average 67 years,and body mass index was from 16.94 to 31.25kg/m2,with an average of 24.3 kg/m2.29 cases of THA patients and 11 cases of TKA patients.The anatomical distribution,size,radiological performance,local physical findings were recorded and multivariable analysis was performed to evaluate the relationship between distribution of proximal DVT and related parameters including age,gender (male/female),side of leg(left/right),surgery type(knee and hip),preoperative diagnosis(femoral neck fracture/other disease),time of diagnosis with DVT (during hospitalization/after discharge).Results Among 40 proximal DVT cases,31 cases diagnosed by phlebography and 9 cases were diagnosed by ultrasound.2 cases were isolated proximal DVT while 38 cases connected with distal DVTs.9 cases of blood clots in the proximal and distal thrombosis connected discontinuously.There was no isolated proximal DVT in TKA group and 10 cases (90.9％) of blood clots in the proximal and distal thrombosis connected continuously while there were 2 cases (6.9％) isolated proximal DVTs in THA group and 21 (77.8％) of blood clots in the proximal and distal thrombosis connected discontinuously,and there was no statistic significant difference between the two groups.The average length of proximal was 8.85±9.3 1cm (range from 2-35cm) with 5.0±2.05 cm in TKA group and 10.31 ± 10.55 cmin THA group.A significant difference was found between the 2 groups (P=0.014).13 cases located in femoral veins and upper venous region which were all from THA group.There was a significant difference in the distribution between surgery type and preoperative diagnosis.However,there was no significant difference between other potential factors and distribution of proximal DVT.25 cases accepted the evaluation of symptom of DVT before scanning.However,no significant difference were found in edema,VAS score,Homans sign,Neuof sign between 9 TKA and 16 THA cases.Conclusion Proximal DVTs after knee and hip arthroplasty are more preferred to connect with distal DVT continuously.Surgery type and preoperative diagnosis have a significant effect on the distribution of proximal DVT.Proximal DVTs in THA and patients with preoperative femoral neck fracture could be more easily involving femoral veins and upper parts.

Objective:To explore the incidence and risk factors of preoperative deep vein thrombosis (DVT) of elective total joint arthroplasty (TJA).Methods:Data of 500 patients before TJA from March 2015 to August 2016 who underwent ultrasound surveillance were retrospectively analyzed. All patients were divided into DVT group and non-DVT group according to results of ultrasound. Parameters including demographic data, basic medical history, and surgical information and laboratory indexes were collected. Risk factors were assessed via univariate, multivariate and logistic regression analysis.Results:Preoperative DVT was detected in 23 cases (4.6%, 23/500), all of which occurred in the intermuscular vein with no symptom, and among them there were 16 cases (5.6%, 16/285) before total knee arthroplasty and 7 cases (3.3%, 7/215) before total hip arthroplasty. Univariate analysis showed that age ( t=2.266, P=0.024), female patients ( χ2=4.028, P=0.045), history of hypertension ( χ2=7.907, P=0.005), D-dimer ≥0.5 μg/ml ( χ2=13.171, P < 0.001) were significantly higher than those in non-DVT group, and the differences were statistically significant. Multivariate analysis showed that D-dimer ≥0.5 μg/ml [ OR=6.655, 95% CI (1.929, 22.960), P=0.003] and history of hypertension [ OR=2.715, 95% CI (1.017, 7.250), P=0.046] were independent risk factors for preoperative DVT. Among them, the thrombus of 14 cases located in the operation side, 6 cases in non-operation side, and 3 cases in bilateral sides. Postoperative ultrasound showed that newly DVT occurred in 9 patients of whom 5 cases located in the contralateral muscular veins and 4 cases in the nearby muscular veins. After discharge, 22 patients (95.7%) with preoperative DVT were further evaluated by ultrasound. The average follow-up time was 3.0 months (range from 6 weeks to 9 months). The results showed that thrombus of 7 cases were completely dissolved, 13 cases were partially dissolved, and 2 cases remained unchanged. Thrombus extensions to proximal veins or symptomatic PE were not found. Conclusion:The incidence of preoperative DVT in patients with elective joint replacement was about 4.6%, among which D-dimer ≥0.5 μg/ml and history of hypertension were the risk factors for preoperative thrombosis.

Objective:To investigate the short-term clinical efficacy of Kamikawa anasto-mosis and jejunal interposed double channel anastomosis in laparoscopic proximal gastrectomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 68 patients with esophagogastric junctional tumors and upper gastric tumors who underwent laparoscopic proximal gastrectomy in two medical centers, including 63 cases in the Changzhi People's Hospital Affiliated to Changzhi Medical College and 5 cases in the Heji Hospital Affiliated to Changzhi Medical College, from March 2018 to December 2020 were collected. There were 57 males and 11 females, aged 62(range, 39?78)years. Of 68 patients, 35 patients undergoing Kamikawa anastomosis in laparoscopic proximal gastrectomy were allocated into Kamikawa group, and 33 patients under-going jejunal interposed double channel anastomosis in laparoscopic proximal gastrectomy were allocated into double channel group. Observation indicators: (1) intraoperative situations; (2) post-operative situations; (3) follow-up. The patients were followed up by outpatient examinations and telephone interview to detect the postoperative score of chew-wun wu special symptoms, post-operative reflux anastomotic esophagitis and anastomotic stenosis up to December 2021. Measure-ment data with normal distri-bution were represented as Mean±SD, and comparison between groups was performed by the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted by Mann-Whitney U test. Comparison of ordinal data was performed by nonparametric rank sum test. Count data were expressed as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability method. Results:(1) Intraoperative situations. All the 68 patients successfully under-went laparoscopic proximal gastrectomy combined with D 1+ lymph node dissection. The operation time and volume of intraoperative blood loss of the Kamikawa group were (5.15±0.31)hours and (89±11)mL, versus (4.21±0.11)hours and (142±20)mL of the double channel group, respectively, showing significant differences between the two groups ( t=2.81, ?2.34, P<0.05). The digestive tract reconstruction time and the number of lymph node dissection were (1.95±0.13)hours and 30.4±2.4 of the Kamikawa group, versus (1.69±0.76)hours and 28.0±2.4 of the double channel group, respectively, showing no significant difference between the two groups ( t=1.79, 0.73, P>0.05). (2) Postoperative situations. The time to postoperative first flatus, duration of drainage tube placement, duration of postoperative hospital stay were (3.03±0.12)days, (5.46±0.22)days, (13.00±0.50)days of the Kamikawa group, versus (4.42±0.21)days, (9.97±0.76)days, (16.46±0.92)days of the double channel group, showing significant differences in the above indicators between the two groups ( t=?5.80,?5.58, 3.40, P<0.05). Cases with or without drainage tube placement were 32 and 3 of the Kamikawa group, versus 33 and 0 of the double channel group, respectively, showing no significant difference between the two groups ( P>0.05). Cases with grade 1, grade 2, grade 3, grade 4 complica-tions of Clavien-Dindo classification were 31, 0, 4, 0 of the Kamikawa group, versus 27, 3, 1, 2 of the double channel group, respectively, showing a significant difference between the two groups ( Z=?6.28, P<0.05). Postoperative anastomotic stenous, reflux symptoms, anastomotic fistula, pancreatic fistula, pulmonary infection were found in 4, 2, 0, 0, 0 case of the Kamikawa group and 0, 1, 3, 1, 2 cases of the double channel group, respectively. There was no significant difference in the above indicators between the two groups ( P>0.05). There was no complication of incisional infection, abdominal hemorrhage, lymphatic fistula or gastroparesis in either group. Of the 4 patients with perioperative anastomotic stenosis in the Kamikawa group, 2 cases were improved after once gastroscopic balloon dilatation, 2 cases were improved after 4 times of gastro-scopic balloon dilatation. (3) Follow-up. All the 68 patients were followed up at postoperative 3, 6, 12 months. The scores of chew-wun wu special symptoms scale at postopertaive 12 months of the Kamikawa group and double channel group were 16.8±0.7 and 14.6±0.7, respectively, showing a significant difference between the two groups ( t=2.20, P<0.05). There were 2 cases of grade B reflux esophagitis and 1 case of grade B reflux esophagitis, respectively, showing no significant difference between the two groups ( P>0.05). There was no anastomotic stenosis occurred in either group. Conclusions:Laparos-copic proximal gastrectomy with Kamikawa anastomosis or jejunal interposed double channel anastomosis is safe and feasible for esophagogastric junction tumors and upper gastric tumors. The Kamikawa anastomosis has less volume of intraoperative blood loss, shorter time to postoperative first flatus, duration of drainage tube placement and postoperative hospital stay, higher quality of postoperative lfe.