Objective To investigate the expression of CD40 protein in bladder urothelium cancer and to explore its correlation with clinical stage, pathological grades, cell apoptosis. Methods Expression of CD4o protein was evaluated by immunohistochemistry in paracancerous tissues (20 cases) and bladder urothelium cancer tissues (78 cases). Apoptosis of bladder urothelium cancer tissues was detected by Hoechst to determine the apoptotic rate (AR). Results The expression rate of CD40 protein was 2/20(10 %) in the cases of paracancerous tissues, 55/78(70.5%) in the cases of bladder urothelium cancer tissues, a statistically significant differences of CD40 staining was observed between paracancerous tissues and bladder urothelium cancer tissues (P ＜0.01). Overexpression of CD40 was strongly inversely related to the tumor grade and clinical stage; the positive group of CD40 protein was (12.60±0.38)%, the negative group of CD40 protein was (6.77±0.53)%, a statistically significant differences of apoptosis were observed between CD40 protein positive group and CD40 protein negative group (P ＜0.01). It showed CD40 protein might induce cell apoptosis. Conclusion Expression of CD40 protein is closely related with clinical stage, pathological grade and cell apoptotic rate and may offer reliable evidence for diagnosis, treatment and prognosis in bladder urothelium cancer.

OBJECTIVE: To investigate the relationship between single nucleotide polymorphism of gene and ischemic stroke and search for predisposing genes of ischemic stroke.DATA SOURCES: The Medline database was searched for articles of gene polymorphism of fibrinogen and ischemic stroke published from 1980 to 2005 with the key words of "stroke, plasma fibrinogen, polymorphism"in English. Meanwhile, Vip Information Database was also searched for literatures of gene polymorphism of fibrinogen and schemic stroke published between 1995 and 2005 with the key terms of "ischemic stroke, fibrinogen,gene polymorphism" in Chinese. Full-texts were gotten by correspondence with the authors.STUDY SELECTION: Included literatures were only case control study literatures. Literatures of contrast study, experience summary, individual case and so on were excluded.DATA EXTRACTION: Totally 50 articles of gene polymorphism of fibrinogen and ischemic stroke were retrieved. Twenty articles were accorded with inclusive criteria, and thirty articles were excluded.DATA SYNTHESIS: Level of plasma fibrinogen was co-affected by heredity and environment. Gene polymorphism of fibrinogen has important regulatory effects on the level of plasma fibrinogen. The fibrinogen accelerates thrombotic formation. As a result, the incidence rate of ischemic stroke increased by participating atherosclerosis, helping thrombocytic aggregation and changing the status of hemorheology. But definite mechanism and molecular function of gene polymorphism of fibrinogen deserved further research.CONCLUSION: The relationship between single nucleotide polymorphism of fibrinogen and ischemic stroke remains obscure. It also needs further study.

Objective To study the clinical efficacy of epirubicin combined with paclitaxel in the treatment of three negative breast cancer.Methods 100 patients with breast cancer who were treated in Shanxi Cancer Hospital from January 2014 to December 2016 were selected as the research object in this study.They were randomly divided into the control group and the experimental group, with each group having a total of 50 patients.The control group was treated with epirubicin, and the experimental group was treated with epirubicin combined with paclitaxel.The short-term remission rate, Karnofsky score and the incidence of adverse symptoms were compared between the experimental group and the control group.Results After treatment, the Karnofsky score of the experimental group was(89.76±10.12), and the Karnofsky score of the control group was(71.23±11.67).The Karnofsky score of the experimental group was significantly higher than that of the control group (P<0.05).In the experimental group, the number of short-term remission was 44 cases, the short-term remission rate was 88.0%, and the number of patients in the control group in the recent remission was in the number of cases, the short-term remission rate was 72.0%, and the number of patients in the control group was about 36.The results showed that the short-term remission rate of the experimental group was significantly higher than that of the control group, with statistical difference (P<0.05).After treatment, there was no significant difference between the control group and the experimental group in the incidence of complications, which was not statistically significant.Conclusion The clinical effect of doxorubicin plus paclitaxel in the treatment of three negative breast cancer, can improve the remission rate in a large extent, improve the quality of life of patients, with further clinical promotion and application significance.

Chemotherapy resist is the problem for clinic,and some researches find that chemotherapy with anthracycline and oxaliplatin not only induces the tumor cell apoptosis,but also the celt immunogenic cell death (ICD) by inducing the tumor cell apoptosis and releasing three kinds of signals:exposure of calreticulin on the cell surface to stimulate the dendritic cell (DC) to engulf,and the secretion of adenosine triphosphate to recruit DC to enter into tumor bed,and the release of the high mobility group B1 to promote DC to steadily bind with dying tumor cell to induce specific T cell antitumor immune response.It is with great meaning to promote the chemotherapy protocol by studying the ICD induced by chemotherapy.

Objective To provide evidence for the application of nutritional intervention strategy by analyzing perioperative nutritional status of retroperitoneal liposarcoma patients.Methods 60retroperitoneal liposarcoma patients were divided into primary group (27 cases) and relapse group (33cases).These patients were put on nutritional risk evaluation using nutritional risk screening (2002)(NRS2002) within 24 hours of admission,and the serum albumin (ALB) value was recorded.Results Preoperative NRS2002 score showed that relapse group had a higher chance of cacotrophy.Serum albumin level from different time point showed that patients in relapse group were more prone to cacotrophy (respectively t =9.174,4.720,10.950,8.772,10.960,all P ＜ 0.05) and subject to slower recovery of gastrointestinal function [(86 ± 15) h vs.(61 ± 6) h] (t =7.903,P ＜ 0.05),prolonged antibiotic use [(15.5 ± 5.6) d vs.(7.3 ± 0.7) d],t =7.55,P ＜ 0.05),the average length of hospital stay was longer [(25.5±6.0) d vs.(14.1 ± 1.7)d] (t =9.571,P＜0.05),and higher inhospita cost [(13.2±5.6) × 104 yuan vs.(6.8 ± 0.9) × 104 yuan] (t =5.871,P ＜ 0.05).Though there was no difference between the two groups in incision complication rates (x2 =2.625,P ＞ 0.05)Conclusions Retroperitoneal liposarcoma patients has perioperative nutritional risk.Compared with the primary group,patients from relapse group have higher chance to got cacotrophy.NRS2002 scoring system is simple,it could be used in predicting nutritional risk for those patients.

Objective To analyze the influence of vasoactive drugs on hemodynamics in septic shock patients and to explore the guiding value of systemic vascular resistance index (SVRI) for the application of vasoactive drugs .Methods 21 cases of septic shock in ICU from March 2010 to April 2012 were retrospectively analyzed .The PiCCO monitor technique was applied to monitor the he-modynamic parameters including the cardiac index (CI) ,intrathoracic blood volume index (ITBI) ,systemic cenous resistance index (SVRI) and mean arterial pressure(MAP) ,once per 6-8 h .ITBI>850 mL/m2 was taken as the normal criterion .The data of 202 cases meeting the criterion were collected .These cases were divided into two groups according to whether MAP reach 65 mm Hg , the differences of hemodynamic parameters between the two groups were compared .The MAP≥65 mm Hg group was redivided in-to the group 1 ,2 and 3 according to SVRI .Blood characteristics of pressure ,CI and ITBI were compared among these 3 groups .Re-sults The ITBI value in the MAP<65 mm Hg group and the MAP≥65 mm Hg group was higher than the normal value .The CI and SVRI values in the MAP≥65 mm Hg group were higher than those in the MAP< 65 mm Hg group(P<0 .05) ,while the ITBI value had no difference between the two groups .The ITBI values in the three groups with different SVRI all were higher than the upper normal limit ,furthermore ,in the comparisons among 3 groups ,only comparison between the group 1 and the group 3 had sta-tistical difference(P= 0 .47) .When SVRI was lower ,the CI value was higher than the normal value .Along with the increase of SVRI ,MAP increased gradually ,and CI gradually declined .When SVRI was too high ,MAP had no significant increase ,but the CI value was lower than the lower limit .Conclusion The SVRI monitoring by PiCCO can help to guide the application of vasoactive drugs in septic shock patients ,lower SVRI means the declined vascular reaction and higher SVRI indicates the low cardiac function , moreover blood pressure can not be further enhanced by vascular excessive contraction .

Objective To investigate the clinical effect and nursing methods of bilevel positive air-way pressure(BiPAP)ventilation in patients with neurogenic pulmonary edema(NPE).Methods Totally 11 NPE patients from January 2004 to December 2007 were enrolled.Ventilation support adopted specific invasive BiPAP mode of Puritan-Bennett840.Aiway pressure release ventilation(APRV)tactics was ap- plied in this mode.The blood oxygen saturation rote(SpO2),acidity-alkalinity(pH),arterial oxygen pres-sure(PaO2),arterial carbon dioxide pressure(PaCO2)were analyzed and compared between synchronized intemittent mandatory ventilation(SIMV)mede2 h and 24 h after BiPAP ventilation.Results Among,arterial blood gas analysis of 11 patients,SpO2 and PaO2 were obviously ameliorated after BiPAP ventilation compared with SIMV ventilation.No side-effect occurred.Conclusions The application of invasive Bi- PAP ventilation support in NPE patients proved to be a fast and effective method.

AIM: To clarify the role of nitric oxide(NO) in ischemic preconditioning(IP) and its effects on apoptosis. METHODS: Seventy-two male Wistar rats were divided into the following six groups:ischemia/reperfusion (IR) group,IP group,IR+L-arg group,IP+L-arg group,IR+L-NAME group and IP+L-NAME group,The following changes were measured:cardiac hemodynamic parameters,infarct size,PMNs counting myocardial MPO activity and TUNEL staining.RESULTS: ①L-arg significantly attenuated ischemia/reperfusion-induced heart injury,reduced PMNs infiltration and cardiomyocyte apoptosis.②L-NAME also significantly reduced infarct size,PMNs infiltration and cardiomyocyte apoptosis compared with IR group,however,L-NAME aggravated ischemia/reperfusions-induced cardiac functional injury.③L-arg or L-NAME did not significantly alter the protective effect of ischemic preconditioning. CONCLUSION: Increased production of endogenous NO before prolonged ischemic period can protect hearts and inhibit apoptosis.L-NAME can inhibit iNOS activity and ONOO- production in reperfusion period to protect heart.

OBJECTIVE:To provide feasible basis for establishment of new model of pharmaceutical care in community.METHODS:Pharmaceutical care in time sequence of before or during visiting hospital,after medication were surveyed and analyzed,according to the pharmacy practice of the community medical service stations which belonged to our hospital.RESULTS & CONCLUSIONS:New model was established through pharmaceutical propaganda,medication counseling,consummate patients' information,monitoring of medication process,communication of pharmacists and patients,data analysis,etc.The established model of pharmaceutical care in community is feasible and of high performance.

Future competition in the medical market will in essence be the contest of the core competitiveness of hospitals.It is therefore imperative for hospitals to do a good job in the following aspects in light of trends in medical development,the state of its resources and the needs of the market: enhancing their awareness of the importance of scientific and technological work,setting up a rationally distributed scientific research system,strengthening personnel and disciplinary development,improving the quality of scientific and technological management personnel,and establishing standardized systems for scientific and technological management.The goal is to enhance core competitiveness so as to gain competitive edges for sustainable development.