Objective To evaluate the application and risk of hematogenous tumor dissemination of intraoperative autologous blood salvage on radical nephrectomy for renal carcinoma with inferior vena cava tumor thrombus.Methods Between July 1999 and October 2005,19 patients with renal cell carcinoma invading inferior vena cava were used by the intraoperative autologous blood salvage.Preoperative and postoperative clinical data were analyzed and compared.The blood sparing effect and follow-up were evaluated.Results The intraoperative autologous blood salvage of all cases was successful.The levels of HCT,Hb and RBC on the 1st and 7th postoperative day were significantly lower than preoperative day.Although the level of PLT decreased on the 1st postoperative day,it recovered on the 7th day.The markers of liver and renal function did not change during treat time.Packed red blood cells were collected during surgery with a mean value of 1 765 ml(300～6 000 ml) per patient.The average amount of allogenic transfusion per patient was 2 247ml(0～8000 ml).The perioperative mortality rate was 10.5%(2/19).The postoperative metastasis rate was 35.3%(6/17).No difference was found in the prognosis between two groups.Conclusion The intraoperative autologous blood salvage does not markedly change the clinic test data and not increase the recurrence and metastasis of renal cell carcinoma.

Objective To study the characteristics of liver injury induced by simvastatin combined with HRZ (Isoniazid,Rifampicin and Pyrazinamide) in SD rats.Methods Fifty-four 8-week-old SD rats were randomly divided into 3 groups:group A (control),group B (HRZ) and group C (simvastatin combined to HRZ),half of each group were male.We calculated the accurate dose respectively before those rats were given intragastrical administration of corresponding drugs.Six rats were killed in each group on 10th,20th and 40th day,respectively.Before this,blood was fastened from femoral of every rat that would be killed to test liver function,liver tissue slices were made in order to observe the pathological characteristic.Results Alanine amiotransferase of group C elevated in line with time and reached statistic difference on 40th day,furthermore,it was significantly higher than group A (P＜0.05).Total bilirubin and direct Bilirubin of group C were significantly higher than those of group A from the beginning to the end (P＜0.05),however,they declined rapidly on 10th day,this trend also had statistic difference (P＜0.05) At the end of this experiment,hepatic cords was disordered slightly,but swelling liver cells and vacuolar degeneration were observed,the nuleus of cell condensed.Soakage of monocytes,neutrophils,and lymphocytes occurred in the portal and lobule regions,or even spotty necrosis occasionally.Conclusion Cholestasis occurs at the early stage when simvastatin is combined with HRZ in SD rats,however,it has a rapidly degressive trend.In contrast,Alanine amiotransferase elevates,furthermore,pathological injury or even spotty necrosis can emerge in liver tissue slices.

Objective:To study the effects of the conditioned medium (CM) from human lung adenocarcinoma cell line A549 on the viability and apoptosis of human umbilical vein endothelial cells (HUVECs) and the role of PI3K-Akt signaling pathway in the process. Methods:HUVECs were cultured with CM of A549 cells. Cell viability was detected by XTT assay. The morphological changes of HUVECs were analyzed by Hoechst 33258 staining and fluorescence microscopy. The apoptosis was detected by flow cytometry. Expression levels of total Akt and phosphorylated Akt were assessed by Western blotting. PI3K inhibitors wortmannin(WT)and Akt1 siRNA(siAkt1)were used to block PI3K-Akt signaling pathway. The mRNA transcription of Akt subtype was determined by RT-PCR.Results:A549 CM significantly increased cell viability after 24 h treatment (P=0.037) and inhibited apoptosis (P=0.001) of HUVECs. CM time-dependently activated phosphorylation of Akt. Akt was phosphorylated at 15 min after CM treatment and reached the peak at 30 min and then tended to decline. Both WT and siAkt1 blocked the effects of CM. Conclusion:The CM of A549 cells increased the survival and inhibit the apoptosis of HUVECs. Akt1 played a significant role in the process.

BACKGROUND: The occurrenceand development of rheumatoid arthritis were strongly associated with unbalance proliferation and apoptosis of synovial cells and lymphocytes. Some synovial cell apoptosis was abnormal. OBJECTIVE: To observe effects of heterogenic double umbilical cord blood stem cell transplantation on Bcl-2 and Bax expression in mice with type Ⅱcollagen-induced arthritis. METHODS: C57BL/6(H-2b) mice were induced with Freund's complete adjuvant and type Ⅱcollagen to establish mouse models of type Ⅱcollagen-induced arthritis.At 2days after secondary immunity incubation, mice were injected with saline via tail vein in the model and normal control groups. Umbilical cord blood hemopoietic stem cells were injected into mouse tail vein in the UBSCs transplantation groups (single dose:2×106/50 g; double dose: 1×106/50 g each, totally 2×106/50 g). Mice were intragastrically administrated methotrexate in the methotrexate positive control group, 0.017 5 g/kg once, once every 5 days, totally six times. RESULTS AND CONCLUSION: Joint tissue below knee and elbow was obtained at42 days following transplantation. Histopathology displayed that smooth and glossy articular surface, no inflammatory cell infiltration in the synovial layer and normal chondrocytes in the normal control group. Hyperplasia, a lot of inflammatory cell infiltration and damaged cartilage surface were visible in the model group. Slight hyperplasia and a little inflammatory cell infiltration were detectable in the methotrexate positive controlgroup and single UBSCs transplantation group. Double UBSCs transplantation group exhibited smooth and glossy articular cartilage surface, no damage, a little inflammatory cell infiltration. Immunohistochemistry demonstrated that Bcl-2 and Bax expression was lower in the double UBSCs transplantation group compared with single UBSCs transplantation group (P < 0.05). Compared with normal control group, no significant difference was detected (P > 0.05). Results suggest that double umbilical cord blood stem cells can induce synovial cell apoptosis in mice with type Ⅱcollagen-induced arthritis in a certain number and action time, and protect synovial membrane against damage.

BACKGROUND: Matrix metalloproteinase (MMP) degrades extracellular matrix, which is a necessity of joint destruction in rheumatoid arthritis patients. MMP-2 and MMP-9 can evaluate rheumatoid arthritis and serve as an index to predict progressive destruction of the joint. OBJECTIVE: To observe heterogenous allogeneic umbilical cord blood stem cell (UBSC) transplantation on MMP-2 and MMP-9 expression in the spleen of mice with type Ⅱ collagen-induced arthritis. METHODS: Fetus cord blood was sterilely obtained and cord blood stem cells were separated. The C57BL/6(H-2b) mice were assigned to five groups (n=10). Except normal control group, models of collagen-induced arthritis were established using complete Freund's adjuvant + type Ⅱ collagen. Mice from the methopterin group were intragastrically administered methopterin suspension 0.017 5 g/kg, once every 5 days. Other groups used caudal vein injection. Mice from the model and normal control groups were injected with saline. Mice from the mono-UBSCs group and double-UBSCs group were injected with 2×106/kg UBSCs from one and two parents. At 42 days following injection, animals were sacrificed and the ankle joint was obtained for histopathological detection. MMP-2 and MMP-9 mRNA expression in the spleen was examined using reverse transcription-polymerase chain reaction. RESULTS AND CONCLUSION: Double-UBSC transplantation could significantly inhibit inflammatory cell infiltration in synovial tissue of mice with type Ⅱ collagen-induced arthritis, repaired impaired cartilage tissue. The repair effect was better than that in methopterin group and mono-UBSCs group. MMP-2 and MMP-9 mRNA expression in the spleen was significantly lower in the double-UBSCs group than the mono-UBSCs group (P < 0.01). These suggest that heterogenous allogeneic double-UBSCs transplantation participated in pathological changes in rheumatoid arthritis cartilage and in synthesis of cartilage extracellular matrix and effectively treated rheumatoid arthritis by regulating MMP-2 and MMP-9 mRNA expression.

Objective To evaluate the nutritional status in maintenance hemodialysis patients using objective score of nutrition on dialysis.Methods Patients on maintenance hemodialysis were randomly selected and divided into three groups based on objective score of nutrition on dialysis:normal nutritional status group,moderate nutritional status group,and low nutritional status group.Logistic regression analysis was performed to identify factors of malnutrition.Furthermore,the results were compared with those of subjective global assessment.Results Totally 75 patients(male:female =1.13∶1)with a mean age of(54.90 ± 12.10)years and a mean vintage of (85.37 ± 54.17)months were enrolled.As determined by objective score of nutrition on dialysis,15 patients (20％)were divided into normal nutritional status group,42(56％)into moderate nutritional status group,and 18(24％)into low nutritional status group.Compared with the normal nutritional status group,the low nutritional status group had significantly different body mass index[(19.81 ± 2.22)vs(23.90 ± 2.44)kg/m2,P =0.030]and dry weight[(50.85 ± 7.60)vs(59.94 ± 10.89)kg,P =0.020].In addition,compared with normal nutritional status group,the moderate nutritional status group and low nutritional status group had significantly different total cholesterol[(4.60 ± 0.84)and(3.73 ± 0.68)mmol/L vs(5.71 ± 1.64)mmol/L,P =0.011,P =0.000],normalized protein catabolic rate[1.17 and 1.15 g/(kg · d)vs 1.45 g/(kg · d),P =0.030,P =0.010],triceps skinfold thickness[(1.44±0.77)and(1.00±0.41)cmvs(1.80±0.63)cm,P=0.032,P=0.020],mid-ann circumference[(24.85±1.48)and(21.66±1.48)cmvs(24.99 ±2.30)cm,P=0.046,P =0.037].Logistic regression analysis indicated C-reactive protein(OR =12.482,95％ CI =0.190-130.928,P =0.035)and normalized protein catabolic rate(OR =0.128,95％ CI =0.022-0.736,P =0.021)were significantly correlated with malnutrition.Conclusion Malnutrition is common in hemodialysis patients,with inflammation and low protein intake being its independent factors.

Small cell lung cancer (SCLC) is an aggressive neuroendocrine carcinoma with a very high degree of malignancy. Currently, the standard treatment for SCLC is still chemoradiotherapy, and although SCLC is sensitive to chemotherapy in the early stage, recurrence and metastasis often occur due to drug resis-tance. In recent years, immunotherapy has made some progress in the study of SCLC. The immunodetection point programmed death-1 (PD-1) and its ligand (PD-L1) inhibitors, such as nivolumab, atezolizumab and pabolizumab, have shown good antitumor activity in clinical studies of SCLC, and PD-1/PD-L1 inhibitors combined with chemotherapy have shown better efficacy, providing a new strategy for the treatment of SCLC.

Targeted therapy and immunotherapy are important methods for the treatment of metastatic melanoma, but monitoring the patient′s disease progress and treatment response during the treatment is the key to accurate treatment and personalized treatment.Circulating tumor DNA (ctDNA) as a non-invasive " liquid biopsy" method, due to its high sensitivity and specificity for gene mutations, and the advantages of being qualitative, quantitative and traceable, which has shown great application value in monitoring metastatic melanoma progression, evaluating efficacy, and predicting prognosis during targeted therapy and immuno-therapy.

Objective To investigate the differences of all discomfort perceived by patients and with mechanical ventilation and nursing care .Methods A total number of 220 patients admitted to ICU accepted mechanical ventilation , and 68 nurses with over 1 year experience conducting ventilation were investigated on their perception with self-designed questionnaires .Results The total score of patients′comfort was (48.956 ± 7.136), of which physiological comfort was (27.816 ±4.158), psychological comfort (14.475 ±4.335), society comfort (8.141 ±3.895), while total patients′comfort score of nurses′perception was (59.110 ± 9.002), of which physiological comfort was (30.089 ±4.637), psychological comfort (11.032 ±4.076).The perception between nurses and patients had statistically differences (t=-8.512,-3.618,-6.708,-5.165, respectively;P<0.05).Conclusions The inconformity of perception between patients and nurses affects both evaluation of patients′discomfort and nursing care .Nurses should access discomfort of patients precisely in order to provide comfortable nursing .

Objective:To explore the clinical effects of the "Disease-Characteristics" project in improving the nursing quality of patients with diabetic retinopathy (DR) .Methods:Based on the content framework of "Disease-Characteristics", authoritative data of UpToTate and various guidelines were transformed into evidence for clinical application through the steps of evidence-based nursing, and a standardized "Disease-Characteristics" project for DR patients was constructed. Convenience sampling was adopted to select nurses who worked in the Shanghai Eye Hospital and the Ophthalmology Department of Shanghai First People's Hospital from January 1, 2018 to June 30, 2019 as research nurses. Convenience sampling was used to select 223 DR patients admitted to the two hospitals from October 30, 2018 to January 31, 2019 (before implementation) as the control group, and 261 patients with DR admitted from February 1, 2019 to April 30, 2019 (after implementation) as the observation group. We observed and compared indicators such as the correct rate of nurses' assessment of each key link of DR patients before and after implementation, the awareness rate of patients' DR-related knowledge, and the incidence of postoperative complications of patients.Results:After the implementation, the scores of the nurses in the assessment of each key link of DR patients increased from (90.36±1.16) to (96.72±1.13) , and the difference was statistically significant ( t=52.990, P<0.05) . The disease-related knowledge score of DR patients increased from (74.330±12.154) to (78.386±10.094) , and the difference was statistically significant ( t=4.010, P<0.05) . Postoperative complications such as persistent high intraocular pressure, vitreous rebleeding, inflammatory edema and diplopia were improved, and the differences were statistically significant ( χ2=7.131, 5.618, 5.788, 6.128; P<0.05) . Conclusions:The "Disease-Characteristics" project plan based on the best evidence has a certain significance for improving the nursing quality of DR and the prognosis of patients.