Objective To observe the association between clinical pharmacokinetic of paclitaxel and adverse reactions in patients with gynecological malignant tumor.Methods 78 patients with female malignant tumor selected from Jan.2009 to Dec.2013 in Kailuan General Hospital were treated with paclitaxel (intravenous drip 175 mg/m2 3 h).The blood drug level of paclitaxel was measured at different time after treating.The DAS software was used to calculate the parameter of pharmacokinetic of paclitaxel,and the SPSS software was used to analyze the association between clinical pharmacokinetic of paclitaxel and adverse reaction in patients with female malignant tumor.Results The peak plasma concentrations (Cmax)was (3.99 ± 1.07)mg/L,the areas under the plasma concentration-time curve (AUC)was (9.74 ±2.45)mg/(h·L),the plasma elimination half-life (t1/2z)was (13.7 ±3.2)h,the apparent volumes of distribution (Vd)was (162.9 ±49.5)L/m2,the plasma clearance rates (CL)was (8.2 ±1.0)L/(h·kg).The kinetics of paclitaxel was fitted to two-compartment model.The time of drug concentration >0.1 μmol/L (t>0.1 )in responder patients (16.8 ± 4.8)h was higher than that in nonresponder patients (13.5 ±2.9)h,and the difference was significant (P<0.05).The Cmax in patients with severity adverse reactions (4.61 ±0.86)mg/L were higher than those in patients without severity adverse reaction (3.65 ±1.13)mg/L,and the difference was significant (P<0.01).Conclusion The Cmax of paclitaxel is associated with efficacy after treatment and severity adverse reactions.

Objective To explore the mRNA expressions of NLRP1 (NOD-like receptor 1 ) and NLRP3 inflammasomescomponents and related pro-inflammation cytokines in peripheral blood mononuclear cells (PBMCs).Methods A total of 21 septic patients,20 non-infectious SIRS patients and 20 health subjects were enrolled in this study.The mRNA expressions of inflammasomes components and related proinflammation cytokines were measured by using RT-PCR,and serum levels of IL-1β and IL-18 were measured using ELISA.One-way ANOVA was usedd to compare the data of all three groups,and SNK-q was employed to compare thedata among different groups.Spearman correlation analysis was used to analyze the correlation between these biomarkers and the severity of septic patients.Results ①The mRNA expression of NLRP1 in PBMCs of septic patients in early stage and non-infectious SIRS patients was down-regulated in comparison with healthy subjects (P ＜0.01 ).The expression of NLRP3 in septic patients was not differentfrom that in healthy subjects ( P ＞ 0.05 ),but NLRP3 mRNA expression in non-infectious SIRS patients was significantly higher than that in septic patients and in healthy subjects ( P ＜ 0.01 ).ASC ( apoptosis associated speck like protein containing a CARD) and caspase-1 mRNA expressions in septic patients and non-infectious SIRS patients were higher than those in healthy subjects ( P ＜ 0.01 ).There was no difference in level of IL-1β found among all groups.IL-18 mRNA expression in septic patients and non-infectious SIRS patients was higher than that in healthy subjects ( P ＜ 0.01 ),and that in non-infectious SIRS patients was highest.②)Serum protein level of IL-1β in septic patients was lower than that in healthy subjects (P ＜0.05 ),and serum level of IL-18 in septic patients was significantly higher than that in non-infectious SIRS patients and in healthy subjects ( P ＜ 0.01 ).③NLRP1 was negatively related to SOFA ( sepsis-related organ failure assessment) score (r =-0.44,P ＜ 0.05 ) and negatively related to APACHE Ⅱ score as well ( r =- 0.52,P ＜ 0.05 ).Conclusions NLRP1 mRNA expression was down regulated in patients with early sepsis and its expression was negatively correlated to the severity of septic patients,indicating the lower NLRP1 mRNA expression the severer illness.

Objective To explore the phenotypic characteristics of T lymphocyte subsets in the peripheral blood (PB) of Patients with rheumatoid arthritis.Methods forty-seven patients with ankylosing spondylitis (AS) and 36 health control were selected as our subjects.The patients were divided into definite Diagnosis AS group and potential AS group according to symptom and X-ray,flow cytometry was applied to measure T lymphocyte subsets and HLA-B27 of peripheral blood.At the same time,the levels of ESR,CRP and IgA were also measured.The correlation between T lymphocyte subsets and CRP HLA-B27,IgA level was analyzed.Results There was no significant difference between The definite diagnosis AS patients and healthy controls regarding of the percentages of CD3 + cells in peripheral blood,However the percentage of CD4 + cells in definite diagnosis AS patients was significantly increased than that of healthy controls (P ＜ 0.05).The ratio of CD4 +/CD8 + cells was 3.80 ± 0.28 in AS patients,higher than that of potential AS patients.T lymphocyte subsets were showed an increase tendency as the increase the level of CRP,IgA.Conclusion Lower CD8 + cell and higher CD4 + cell were showed in the peripheral blood of AS patients,which was correlated with the disease activity and suggesting T cells might be involved in the pathogenesis process of AS.Meanwhile our data indicated that the immune response might be a susceptible factor of AS and early detection of T lymphocyte subsets might provide a diagnosis and treatment basis for diagnosis of AS.Therefore the disorder of T lymphocyte subsets might play an important role in the development of rheumatoid arthritis.

Objective To explore the CD4 + CD25 + Foxp3 + regulatory T cell percentage and plasma levels of soluble CD25 molecules in peripheral blood of septic patients and their clinical value through prospective study. Method A total of 37 septic patients and 15 non-infectious SIRS patients, who conformed to the criteria of SIRS and sepsis which proposed by American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference ( ACCP/SCCM ) in 1997, were collected in ICU of Ruijin Hospital ( Shanghai Jiaotong University) from February 2009 to February 2010. Twenty-four health people were from Medical Center of Ruijin Hospital, who were excluded infection and (or) autoimmune diseases. There were 26 male and 11 female in sepsis group, average age ( 61.67 ± 11.87 ) years old; 8 male and 7 female in SIRS group, average age (67.06 ± 12.57)years old; 14 male and 10 female in health control, average age (56.54 ± 6.37 )years old. All selected patrents were excluded the autoimmune diseases and (or) patients within recent (30 days) had used or now used immunosuppressive agents. We therefore measured the Treg cell percentage in peripheral blood by Flow Cytometry and the plasma levels of IL-2sRa, IL-4, IFN-γ by ELISA. The data were analyzed by analysis of variance or nonparametric Kruskal-Wallis H test. Results ① The percentage of CD4 + CD25 + Foxp3 + regulatory T cells among septic patients, SIRS patients, and control group was: ( 66.82 ± 21.79 ) %, ( 51.79 ± 21.79 ) %, ( 56.45 ± 10. 68 ) %, respectively. septic patients showed the highest percentages of CD4 + CD25 + Foxp3 + regulatory T cell among CD4 + CD25 + T cells(P ＜ 0.05 ). ② The plasma levels of soluble CD25 in septic patients (425. 619 ± 270.12 ) were significantly higher than SIRS patients (381. 664 ± 189.83) and the control group ( 164. 1 32 ± 56.37 ) ( P ＜ 0.05 ). ③ The correlation analysis between the concentration of soluble CD25 molecules in plasma and the ratio of CD4 + CD25 + Foxp3 + regulatory T cells to CD4 + CD25 + T cells showed Spearman correlation coefficient =0.390, P = 0.003 ( P ＜ 0.05 ). Conclusion: the expression of natural regulatory T cells characteristically increased in septic patients. And the levels of soluble CD25 in peripheral blood were related to the percentages of natural regulatory T cells, which simplified the assessment of the immune status in Septic patients.

Objective To evaluate antibiotic therapy for the treatment of intraabdominal infection secondary to severe acute pancreatitis.Methods 39 SAP patients with intraabdominal infection were devided into 2 groups: early infection group (early group) and late infection group (late group) according to the onset time of infection. All patients received imipenem and or surgical treatment, and results were compared between the two groups. Results 83 strains of pathogen were isolated among which Gram negative bacteria accounting for 84%, with a ratio of sensitivity to imipenem of 80%; Gram positive bacteria taking up 16%, all were resistant to imipenem. The cure rate was 53% in eraly group and 86% in late group(P=0.02); The rate of bacteria clearance was 47% in early group and 82% in late group(P=0.02). The survival rate of patients in early group was 77% and in late group was 95%(P=0.08); The reinfection rate in early group was 58% and in late group was 37%(P=0.16). Conclusion Imipenem is effective in the treatment of intraabdominal infection secondary to severe acute pancreatitis,and repeated surgical intervention is still necessary for patietns in early infection group.

OBJECTIVE:To investigate the efficacy of compound azintamide enteric-coated tablet plus mosapride citrate dispersible tablet for abdominal distention in patients with functional dyspepsia(FD).METHODS:A total of 80 patients with the chief complaint of abdominal distention were randomized to treatment group(Group A,n=40) to be treated with mosapride citrate dispersed tablets plus compound azintamide enteric-coated tablet,or control group in which the patients were treated bu mosapride citrate dispersed tablets(Group B,n=20) or compound azintamide enteric-coated tablets(Group C,n=20).Comp-ound azintamide enteric-coated tablets were administered orally tid(2 tablets) immediately after meal while the mosapride citrate dispersed tablets(5mg) were administered orally tid 30min before meal for 2 weeks.The main outcome measures were changes of symptom scores of abdominal distension,the total effective rates in improvement of abdominal distension,and drug side effects before and after treatment.RESULTS:After 1-week and 2-week treatment,the average index scores of abdominal distention in the treatment group(Group A) were significantly lower than in the control groups(Group B and Group C) (P

Wuhan Pu Ai Hospital implemented the pharmaceutical direct supply mode since October 2006 as an experiment.The pilot proved the mode as successful in reducing drug costs proportion,promoting rational use of drugs,and raising business volume of the hospital.Authors also recommend to further efforts in drug supply price supervision mechanism,government subsidy mechanism,direct supply catalogue and drug supply mode among others.Other recommendations include innovation in directly supply mode,hospital internal reform,packaged performance appraisal and incentive mechanism for medical workers,and building a ceiling mechanism for total medical expense control.

Objective To study the preventive effect of spironolactone on renal tubulointerstitial fibrosis of diabetic nephropathy (DN)in rats.Methods Sixty adult SD rats were random divided into sham operation group(C),diabetic nephropathy group(D)and spironolactone interventional group(A).After diabetes WaS induced by administrating strep tozotocin(STZ),spironolactone was perfused into the stomach of rats in group A.On the 7th,14th,21st,28th days after treatment,rats were put to death,their kidneys were removed to observe the expressions of TGF-β1 and MMP-9 by immunohistochemistry method.The blood potassium,natrium,glucose, serum creatinine,cholesterol,triglyceride and urinary albumin quantification were measured.Results Urine protein in group A wag lower than that in group D.The blood potassium,natrium,glucose,serum creatinine,cholesterol and triglyceride had no difference between group A and group D(P＞0.05).Compared with group D,the expressions of TGF-β1 in group A Was decreased(P＜0.01),the expressions of MMP-9 in group A was hisher than that in group D(P＜0.01).Conclusion Spironolactone could decrease the expression of TGF-β1 and increase the expression of MMP-9 in the tubulointerstitial of diabetic nephropathy,which may delay the progress of renal tubulointerstitial fibrosis.

Objective: Analyzing the protein expression of biomarkers CK7, Vim, and P53 to investigate their possible pathogenic roles in the development of variant subtypes of endometrial carcinoma. Methods:Biomarkers CK7, Vim, and P53 were immunohistochemistry-stained among 131 endometrial carcinoma specimens including 93 endometroid, 8 adenoacanthoma, and 32 rare subtypes of adenosquamas carcinoma, clean cell carcinoma, and papillary carcinoma, which had been confirmed clinically and pathologically, and studied statistically with Fisher test and Cochran-Mantel-Haenszel (CMH) Test. Results: Positive correlation was demonstrated among CK7, Vim, and P53 expression levels. The CK7 protein expression is increased, while the Vim and P53 are decreased in the subtype of endometrioid carcinoma. The clinical staging of endometriroid carcinoma is positively correlated with the expression of Vim. The positive rate of Vim and P53 is correlated with cytological differentiation of the carcinoma cells. Conclusion:Biomarkers CK7, Vim, and P53 are playing pathogenic roles, assuming as a mutual transcriptional modulator, and Vim but not P53 is likely the favorable prognostic factor, in the development of variant subtypes of endometrial carcinoma in addition to a evaluating the treatment.

The design aims at improving and enriching nurturance theories and practice paradigms related with medical students' doctor-patient communicating competence.It is based on the view about cultivating and evaluating undergraduates' doctor-patient communicating competence and the theoretical basis about the existing research achievement and follows teaching practice regular pattern.Doctorpatient communicating competence of undergraduates has its own multidimensional meanings.Construction methods are as follows:taking one course as the core; enrolling multidimensional discipline in classroom teaching; combining classroom teaching with varieties of practice; establishing medical case communication training model; introducing appropriate evaluation system.Its construction principles should be found on the humanistic essence.