To explore the clinical ,pathological and immunohistochemical features of carcinoma with multi-directional differentiation derived from junction of bladder and prostate .We collected clinical data and tissue samples of three typical cases of carcinoma from our hospital .Routine preparation of slides and immunohistochem-ical methods combined with clinical data and pathological changes analysis were adopted .We found that all 3 ca-ses occurred in the elderly lesions involving the bladder and prostate .Dysuria was the main common symptom .All the cases had a history of chronic inflammation in urethral and prostate gland .The following up data showed that survival time in two of them were no more than 15 months.The third patient without chemotherapy who took drugs of bicalutamide,enantone and pamidronate still was alive after 28 months.The pathological changes of these cases had the common features with diversity .They all showed the structure with nests ,papillary,solid,adenoid,single or syncytial cells .The nuclear of cancer cell was enlarged with hyperchromatic feature .The mitotic figures were easily found.The metaplasia and atypical hyperplasia of prostate were all found .The immunohistochemistry results showed positive results for HCK,LCK,p53,p63,PSA,P504S and negative for vimentin and S -100.The average proliferation index of Ki-67 was 77%.

Objective To deepen and promote the development of nursing higher education internationalization through the analyzation of the status,existing problems and future trends of research about nursing higher education.Methods Searching literatures in China National Knowledge Infrastructure (CNKI),VIP and WANFANG databases from 1984 until 2014.Results 79 references were selected from 44 journals and the numbers increased each year.69.62％ (55/79) of them were accepted by statistical source core journals and 54.43％ (43/79) of them were funded.The authors came from 19 provinces.There were only 4 articles reported international education about graduates and most of them were about undergraduate students.The main reformation measures included curriculum and english teaching reform et al.Conclusions The educator paid more attention to nursing higher education internationalization than before,also the policy's support and the quality of literatures were optimistic.However,the breadth,depth and integrity of research should be strengthened in future.

Epidermal growth factor receptor (EGFR) is found to express at high levels in a variety of solid tumors including gliomas. This study was to examine the effect of an EGFR-tyrosine kinase inhibitor (AG1478) alone or in combination with cisplatin (CDDP) on the growth of glioma cells (U87). U87 glioma cells were treated with AG1478 (10 μmol/L) or CDDP (25 μmol/L) as a single agent or in combination for 24 or 48 h. The expression of EGFR and the components in its downstream signaling pathway [extracellular signal-regulated kinase (ERK), protein kinase B (AKT)] in U87 glioma cells was detected by Western blotting. Cell growth, cell cycle distribution and cell apoptosis were determined by MTT method and flow cytometry, respectively. The results showed that CDDP could induce the activation of EGFR and the components in its downstream signaling pathways in a concentration-dependent manner. The combined treatment of AG1478 with CDDP could inhibit the proliferation of U87 glioma cells, arrest the cell cycle and promote cell apoptosis. In the EGFR signaling pathway, AG1478 decreased the phosphorylation of ERK, AKT and EGFR in U87 glioma cells. It was concluded that the combined treatment of AG1478 and CDDP may exert synergistic inhibitory effects on the growth of glioma cells by suppressing the activities of EGFR, AKT and ERK.

Objective To determine the influence of continuous mild sedation versus usual sedation on the sedative effect and inflammatory factor level in ICU patients with multiple trauma.Methods In this prospective, randomized double-blind investigation, 58 multiple trauma patients hospitalized from October 2013 to April 2015 were randomized into continuous mild sedation group (continuous group, n =30) and conventional sedation group (conventional group, n =28) using the sealed envelopes.Between-group differences were made on the duration of mechanical ventilation, length of stay in the ICU, ratio of inception of continuous renal replacement therapy (CRRT), tracheotomy rate, accidental extubation rate, sepsis rate, multiple organ failure (MOF) rate and mortality.Serum inflammatory factor levels of the patients were recorded.Results There were 3 deaths (10％) in continuous group versus 4 deaths (14％) in conventional group (P ＞ 0.05).Patients in continuous group showed significantly less time spent on mechanical ventilation [(4.8 ±2.7) vs.(8.9 ±3.1)d] and in the ICU [(10.7 ± 5.4) vs.(16.9 ± 7.3) d] compared with conventional group (P ＜ 0.01).Between-group differences were insignificant regarding the ratio of CRRT inception, tracheotomy rate, accidental extubation rate, sepsis rate and MOF rate (P ＞ 0.05).Serum levels of interleukin (IL)-6, tumor necrosis factor (TNF)-α, Creactive protein (CRP) were lower in continuous group than those in conventional group at 24 h, 48 h and 72 h post-ICU, but significant differences were only observed at 48 h (P ＜ 0.05).At these time periods, serum IL-10 levels in continuous group were significantly higher than those in conventional group (P ＜0.05).In receiver operative characteristic curve (ROC) analysis, the area under the curve for IL-6, IL-10, TNF-α and CRP in continuous group was 0.726, 0.608, 0.729 and 0.757 respectively at 48 h post-ICU, indicating a predictive value of these markers for sepsis.Conclusion Continuous mild sedation results in shortened length of stay in the ICU and decreased inflammatory response in the treatment of patients with multiple trauma.

Objective To evaluate the efficacy and safety of sirolimus and tacrolimus after renal transplantation.Method PubMed,Web of knowledge,Medline and the Cochrane Library were searched with the terms and Boolean operators as (kidney transplantation OR renal transplantation) AND (sirolimus OR rapamycin) AND (tacrclimus OR FKS06).Results retrieved were last updated on June 9,2014.Language limit of English and Chinese only was applied.Trials were excluded if enrolling recipients of organs other than kidneys,reporting none of the outcomes in point or combining sirolimus with tacrolimus.Patient and graft survival,acute rejection and adverse events were evaluated as primary outcomes and glomerular filtration rate (GFR) was an additional surrogate for renal function.Professional meta-analysis software RevMan 5.1 was employed to analyze the pooled risk ratio (RR) and mean difference (M D) followed by subgroup analysis and sensitivity analysis.Result Fifteen studies were included with 2480 patients.Patients in the sirolimus group showed an increased rate of acute rejection within one-year's follow-up 2.02 (95％ CI 1.37-2.99,P＜0.05) and also a higher risk of adverse events 1.31 (95％ CI 1.02-1.68,P＜0.05).The incidence of hyperlipidaemia was significantly higher with RR =1.75 (95％ CI 1.17-2.61,P＜ 0.01) in the sirolimus group.The other outcomes were insignificantly different between two groups.In subgroups with ATG as immunity induction and higher sirolimus concentration (＞4-8 μg/L),the difference was insignificant (P ＞ 0.05).Conclusion This meta-analysis concluded that sirolimus showed no advantage over tacrolimus when used early after transplantation.When used with higher concentrations,or with ATG as immunity induction,the disadvantages may be avoided.More clinical evidence is needed.

Objective To evaluate the value of the thumper cardiopulmonary resuscitator in the emergency cardiopulmonary resuscitation(CPR).Methods Fifty cardiac mspiratory sudden stop patients with thumper cardiopulmonary resuscitator from January 2004 to December 2007 were recruited into treatment group,and 80 cardiac respiratory sudden stop patients with barehanded CPR from May 2000 to December 2003 were recruited into control group.The SBP and blood oxygen saturation 5 to 10 minutes after the resuscitation was compared.The rate of restoration of spontaneous circulation(ROSC),hospitalization and the complication in the two groups was compared.Results The treatment group was better than the control group in improving the SBP and blood oxygen saturation(P＜0.05).The rates of ROSC and hospitalization in the treatment group were higher than those in the control group(44%,40%and 25%,21%).P＜0.05.The rate of complications had no significant difference between the two groups.Conclusions Thumper cardiopulmonary resuscitator Can surmount the factors of medical staff or patients.It can make the CPR more standard andmore effective.MeanwhileitCan raisethe SBP,strokevolume and blood supplv to the heart and brain,and then mcrease the successful rate of CPR.

Autologous red blood cells (RBC) labeled with fluorescence were immitted into microvessel of SD rat and observed under microscope. The movement of each individual labeled RBC was recorded by microscope video camera system. The recorded videotape is replayed to sample dark background fluorescent images through frame grabber. Sampled frame images were separated into odd and even field sequence images. Then these sequence images were analyzed to get the flow rate. The error between the actual flow velocity value and the flow velocity value of fluorescent globules in the chamber measured under the same system was below 7%. The upper limit was 9.6 mm/s. There are no obvious differences (P > 0.05). This system has been applied in the research of rat microcirculatory disturbance, and the temporal flow rate change in microvessel was obtained.
Animals ; Blood Flow Velocity ; physiology ; Image Processing, Computer-Assisted ; Microcirculation ; physiology ; Microscopy, Fluorescence ; Rats ; Rats, Sprague-Dawley ; Splanchnic Circulation ; physiology ; Videotape Recording

Objective To investigate the clinical therapeutic value of CRRT on severe sepsis coincidence with capillary leak syndrome in surgical patients. Methods 38 patients suffering from severe sepsis coincidence with capillary leak syndrome were random divided into routine group ( n = 18 ) and CRRT group ( n =20). Both groups were given routine treatment, while the patients of CRRT group were given CRRT in addition. Red blood cell count (RBC), haematoglobin level, blood platelets count, leukocyte count, hematocrit (HCT), plasma-albumin level, central venous pressure ( CVP), arterial blood pressure ( ABP), urinary production change of every hour, oxygenation index condition ( PO2\FiO2 ) were measured at 0, 12, 24, 48,72 hour following routine treatment or CRRT. Additionally, serum levels of tumor necrosis factor- a (TNF-α), interleukin-6 (IL-6) and interleukin-8(IL-8) were determined at the same time. Results Blood platelets count, HCT, plasma-albumin level in CRRT group were significantly higher than those of routine group [72 h: (211. 75 ± 45. 23 ) × 109 vs ( 135.67 ± 41.45 ) × 109 ;0. 43 ± 0. 05 vs 0. 35 ±0. 04; (48. 60 ±4. 76) g/L vs (41.17 ±4. 64) g/L, P <0. 01 ]. WBC were significantly lower than those of routine group[72 h:(7.58 ±2.31) ×109 vs (13.77 ±2.67) × 109, P <0.01]. Change of ABP, PO2\FiO2, urinary production for every hour was notably increased than those of routine group [72 h: (94. 25 ±8.60) mmHg vs ( 84. 22 ± 7. 37 ) mmHg; 345. 25 ± 35. 21 vs 304. 22 ± 38. 74; ( 80. 15 ± 14. 54 ) ml vs (62. 72 ± 12. 33) ml, P <0. 01 ]. The serum levels of TNF-α, IL-6 and IL-8 of CRRT group were markedly decreased compared with those of routine group(72 h:249. 55 ±99. 60 vs 368. 83 ±97. 11 ;600. 75 ±98. 31 vs 718. 94 ± 92. 00 ;665. 35 ±138. 44 vs 843. 22 ±123. 95 , P <0. 01,P <0.05). Conclusions CRRT can significantly improve patient's condition, which may be an effective nechanism to treat the surgical patients with severe sepsis coincidence with capillary leak syndrome.

BACKGROUNDTo evaluate the efficacy and toxicity of ITP (ifosfamide + perarubicin + cisplatin) and NP (vinorelbine + cisplatin) regimens in the treatment of advanced non small cell lung cancer (NSCLC).

METHODSOne hundred inoperatable or recurrent patients with stage III and IV NSCLC were randomized into ITP group and NP group treated by the two regimens responsively for 2 or 3 cycles.

RESULTSThe overall response rate was 51.5% for ITP group and 50.9% for the NP group, respectively. There was no statistically significant difference of the overall response rate between the two groups ( P > 0.05). The major side effects were leukopenia and gastrointestinal reaction. The leukopenia incidence was higher in ITP group than that in NC group ( P < 0.05).

CONCLUSIONSBoth ITP and NP regimens are effective for the advanced NSCLC. Compared with ITP regimen, NP regimen has less bone marrow toxicity than ITP regimen.

Primary salivary duct carcinoma(SDC) featured with giant cell tumor(GCT) is a extremely rare, relatively new understanding lesion and its histogenesis has not been fully defined. This paper reported a case of SDC associated with GCT, its clinical, histopathologic features and histological origin were discussed in combination with literature review.
Carcinoma, Ductal ; Carcinoma, Squamous Cell ; Giant Cell Tumors ; Head and Neck Neoplasms ; Humans ; Salivary Ducts ; Salivary Gland Neoplasms