Objective To explore the current situation of nursing students′ self-learning and its influencing factors in the western China.Methods Based on the method of proportion allocation in stratified random sampling,the self-made general questionnaire and Williamson self-directed learning rating scale(translated by Shen Wangqin)were used for questionnaire survey among full-time nursing undergraduates and junior college students in four universities.Results The self-directed learning ability of nursing students was in general at a medium level;and the dimensions with the highest score and the lowest score were interpersonal relationship skills and learning behaviors.The self-directed learning ability of top public university was better than that of basic public universities(P<0.01);and the degree of self-directed learning ability of nursing students who were girls,in senior classes,voluntarily choosing and showing interest in this major was higher than those of other students(P<0.05);the motivation,learning interest,self-directed learning time per week were positive factors,and the learning difficulties acted as a negative impact factor.Conclusion The main factors influencing the self-directed learning ability of nursing students include the grade,gender,the willingness to choose the nursing major,the degree of preference for the nursing major,learning motivation,and learning interest.

Objective To investigate two kinds of methods of lymph node dissection for early effects on the prognosis of the patients in the treatment of lung cancer by comparative study,and provide guidance for clinical treat-ment.Methods 98 cases of early stage lung cancer patients who were taken using elective surgery were selected in the study.According to the random number table,they were divided into two groups of 49 cases for each other.Sort of an odd number of patients in the observation group,and given systematic lymph node dissection (LND);sort of an even number of patients in the control group,which was systematically sampled lymph node dissection (LNS).After dissection from the relevant data,following -up of 5 -year survival,relapse rate,quality of life and other data for com-parison and statistical analysis were accessed.Results In the observation group,the number of lymphatic vessels in the cleaning,operation time,3 years,the survival rate of 5 years,2 years,3 years and 5 years recurrence rate and survival quality total score comparison is superior to the control group,with significant difference (P <0.05);The amount of bleeding,3 months and 2 years the survival rate,quality of life of each individual score data comparison of the two groups had no significant differences (all P >0.05);The nerve injury rate of the observation group was higher than the control group,there was significant difference (P <0.05).Conclusion Systematic lymph node dissection for treatment of early lung cancer has a thorough cleaning,operation time is short,the short -term survival rate is high,low recurrence rate,high quality of life and other advantages,and has the value of popularization.But there was the amount of bleeding,nerve injury and high rate of defects,it needs to be further perfected.

【Objective】To improve the adaptation of Plat-Ⅱceramic crown.【Method】The Plat-Ⅱcastable ceramic crowns were made by three methods,namely routine method,die spacer technique,and the model investing method.24 crowns were made by these three methods individually and adhered to the corresponding model die with zinc phosphate to measure the adhesive thickness and compare their adaptation.【Result】The average adhesive thickness at different parts of crown of these three groups were 52 μm、42 μm、30 μm and the margins discrepence were 63 μm、59 μm、42 μm,respectively.There is statistically difference in both the adhesive thickness and the margin discrepence with these three methods (P<0.01).【Conclusion】The crowns made from the die spacer technique and the model investing method could improve the adaptation significantly.

BACKGROUND: Multiple sclerosis(MS) is a chronic autoimmune disease induced by the interaction between genetic and environmental factors. Its pathogen and the mechanism of the relapse and remission m the course of the disease are still unknown. Most of the MS research centers are looking for the pathogenic polypeptide epitope in proteolipid protein(PLP), myelin sheath basic protein (MBP) and oligodendrocyte glycoprotein (MOG) OBJECTIVE: To compare the proliferation of T cell lines(TCL) in MS induced by myelin sheath and delipidated myelin sheath towards 11 components of myelin sheath to mainly search the possible pathogenic polypeptide epitope in PLP, and investigate the possible effects of abnormal dcgrease in myelin sheath.DESIGN: A case-controlled trial.SETTING: Department of neurology in a hospital of a university.PARTICIPANTS: Mononuclear cells(MNC) of 16 MS cases(clinical relapsing-remitting type, patients did not receive any immunosuppresant for at least 3 months when their peripheral blood samples were taken) and 12 HLA-DR15 healthy volunteers were furnished by Dr. Trotter JL of MS Research Center of Washington University from the cell database.INTERVENTIONS: MS-TCL and normal TCL were induced twice by stimulation with myelin sheath and delipidated myelin sheath in vitro by cell culture in vitro. TCL proliferation was tested by 11 antigens including PLP,MBP, M87-106, P30-49, P40-60, P89-106, P95-117, P117-137,P139-151, P178-191, and P185-206.MAIN OUTCOME MEASURES: Difference of scintillation counting in every minute of every well, and the stimulative index of each well were calculated, and the mean wells with positive proliferation of TCL towards each antigen were confirmed as well.RESULTS: The general specific proliferation towards myelin sheath antigens was bigger in MS group than control group 5.49 ±5.31 to 3.10 ± 3. 17, and delipidated myelin sheath-induced TCL was bigger than myelin sheath-induced one 5. 49 ± 5.31 to 3.41 ± 4. 83 . Delipidated myelin sheath significantly changed the immune responses of MS group,especially the changes of responses towards P30-49, P40-60, P89-106,P117-137, P139-161, and P185-206 were significant compared with that the control group only responded to two polypeptides, which indicated that the antigen epitope of MBP, PLP, M87-106, P95-117, P40-60, and P185-206 might have significance in the triggering of MS autoimmune responses.CONCLUSION: TCL induced by MS myelin sheath has different proliferation towards antigen components of myelin sheath from control group. Delipidated myelin sheath significantly increases TCL proliferation in MS group, which suggests that if MS patients developed abnormal degrease in myelin sheath, TCL would produce autoimmune response towards self-myelin sheath, MBP, PLP and its polypeptide segments all can trigger MS or aggravate the state of the illness. Our finding supports the hypothesis of MS autoimmune pathogenic mechanism.

Objective To explore the safety of the human bone marrow‐derived mesenchymal stem cells (hBMSCs) after silencing of human leukocyte antigen A2 expression .Methods We divided the cells into three groups:normal cultured cells of the 8th passage served as control group , and hBMSCs after HLA A2 silencing expression of the 5th and 15th passage as experimental groups 1 and 2 ,respectively .The hBMSCs were recultured by sterile methods .The growth curve ,telomerase activation ,and expressions of P27 ,cyclin D2 and cyclin‐dependent kinase 4 (CDK4) were utilized to explore the safety of the hBMSCs induced by LV‐siRNA‐HLA A2 .The BMSCs were transplanted to the subcutaneous layer of nude mice .Tissue types were detected 24 weeks after transplantation . Results The cell curves had no obvious left or right shift in all the groups . The telomerease activation in experimental groups 1 and 2 did not significantly differ from those in control group . The expressions of anti‐oncogene P27 ,cyclin D2 and CDK4 had no obvious difference between the two experimental groups and control group , either . There was only ectopic osteogenesis 24 weeks after the BMSCs (HLA A2 gene silenced ) were transplanted to the subcutaneous layer of the nude mice .Conclusion There was no obvious evidence to support that hBMSCs had undergone change in safety after the silencing of HLA A 2 expression .

Objective To evaluate the efficacy and safety of paclitaxel plus cisplatin combination in treatment patients with advanced or metastatic squamous-cell carcinoma of the esophagus(ESCC).Methods Twenty-five patients with advanced or metastatic ESCC received paclitaxel 175mg/m2 by 3-hour infusion on day 1 and cisplatin 25mg/m2 by infusion on day 1 ～ 3.3 weeks as one cycle.Results Twenty-four patients were eligible to be evaluated the efficacy and safety.The overall response rate was 45.8％ with complete and partial response rates of 4.1％ and 41.7％,respectively.The median survival time of all patients was 11 months(95％ CI:8.35 ～ 13.65 months).There was significant difference in the median overall survival between the patients who had showed response versus those who had not(P =0.022).Median survival was 12.5 months(95％ CI:9.11 ～ 15.90 months) and 8 months(95％CI:5.50 -9.50 months),respectively.The 1-year survival probability was 37.3％.The most common toxicities were leukopenia,neutropenia,thrombocytopenia and alopecia.Conclusion The effect of paclitaxel and cisplatin which seems beneficial as first-line therapy in advanced squamous-cell carcinoma of the esophagus had a high effective rate with acceptable toxicity.

BACKGROUND: Cristata L flavonoid is a kind of plant estrin, which possesses multiple physiological function, has no toxicity and adverse effect, and is effective in treating and preventing osteoporosis.OBJECTIVE: To study the effect of cristata L flavonoid on bone morphogenetic protein, urine inorganic salt and content of lysozyme of rats with diabetes mellitus (DM).DESIGN: Randomized grouping design and controlled study.SETTING: Pharmaceutical Laboratory of Xinxiang Medical College.MATERIALS: The experiment was completed in the Xinxiang Medical College from September to December 2003. Totally 24 health male SD rats were randomly divided into three groups: normal control group, diabetes mellitus (DM) group, DM + cristata L flavonoid group with 8 in each group.were injected intraperineally with 60 mg/kg streptozotocin, and 48-72 hours later, blood of rear caudal vein was collected to measure total blood glucose.Rats were determined as DM if the blood glucose was ≥ 16.7 mmol/L; oth erwise, 60 mg/kg streptozotocin was injected once more. After modeling,cristata L flavonoid and rats in normal control group were given the same was measured with atomic absorbency method and content of urine sodium histochemistry of bone morphogenic protein-2 (BMP2) in bone was detected with streptavidin tagged by peroxidase and immunohistochemic expression lysozyme reflected reabsorption function of renal tubule was measured with with t-test. MAIN OUTCOME MEASURES: Comparison between content of calcium, sodium, kalium in urine and lysozyme and immunohistochemic expression of BMP2 10-week intervention later.calcium and sodium in urine in DM model group were obviously higher than those in normal control group, but content of kalium in urine was obviously lower (P ＜ 0.05-0.01). Contents of calcium in urine in DM +cristata L flavonoid group were obvioualy lower than those in DM model group and normal control group were obviously higher than those in DM model group, and content of lysozyme in urine in those groups was obviously lower than that in DM model group (P ＜ 0.05-0.01).CONCLUSION: Expression of BMP2 of DM rats is decreased, but after supplement of cristata L flavonoid compound, the expression is increased.In addition, output of urine calcium and sodium in DM rats is decreased,and reabsorption function of renal tubule is increased.

Objective:To detect the expression of Shank1 protein in renal cell carcinoma (RCC), to investigate its difference between the tumor and carcinoma adjacent tissue, and to analyze its correlation with RCC clinicopathological characteristics and prognosis. Methods:The renal carcinoma and carcinoma adjacent tissues of 120 patients were selected from Cangzhou Central Hospital and Ji'nan Central Hospital from May 2008 to December 2014. The expression level of Shank1 was determined by immunohistochemistry and Western blot. Statistical analysis was performed to determine the relationship between the expression of Shank1 and the clinicopathological features of RCC patients. Results:Results of immunohistochemistry showed that the expression level of Shank1 in renal cancer tissue was significantly higher than that in carcinoma adjacent tissue, and the difference was statistically significant (P<0.05). Western blot results showed that the expression level of Shank1 protein in renal cancer tissue was also significantly higher than in carcinoma adjacent tissue. Correlation analysis found that the high expression level of Shank1 in renal cancer tissue was not significantly related to gender, age, tumor size, and TNM stage, but was significantly associated with the histological differentiation of RCC (P<0.05). Conclusion:Shank1 is abnormal y expressed in RCC renal cancer tissues and is correlated with the histological differentiation of RCC.

Objective To investigate the expression of a proliferation-inducing ligand (APRIL) in urothelial carcinoma tissue and its clinical significance. Methods We investigated the expression of APRIL mR-NA in urothelial carcinoma tissue of 33 patients in urothelial carcinoma in Cangzhou Central Hospital from July 2013 to March 2015, Among of them, 23 cases of adjacent pericancerous tissues were detected by qRT-PCR. Immunohistochemistry and western blot were used to detect the APRIL protein expression level in urothelial carci-noma tissue and adjacent pericancerous tissues. We analyzed the relationship between APRIL expression and clinical pathology in patients with urothelial carcinoma by statistical methods. Results The qRT-PCR revealed that the expression of APRIL in urothelial carcinoma tissue was significantly higher than that in the adjacent peri-cancerous tissues (P < 0.05). Immunohistochemistry and western blot showed that the expression of APRIL in urothelial carcinoma tissue was higher than that in the adjacent pericancerous tissues. Correlation analysis found that the high expression of APRIL in urothelial carcinoma tissue was not significantly related to gender , age , size of tumor, lymph node metastasizing or not, and clinical stages (P > 0.05). Conclusion The APRIL is a high abnormal expression in urothelial carcinoma tissues , and maybe related to the occurrence and development of urothelial carcinoma.

Objective The study was designed to investigate the serum levels of HE4 in patients with lung cancer,and explore its prognostic value.Methods Blood samples of 106 healthy adults and 191 patients with lung cancer before treatment were measured by means of ELISA for HE4 levels in different stages and pathological types,for analyzing prognostic effect of HE4.Results The serum levels of HE4 in patients with lung cancer (median level 91.63 pmol/L) were significantly higher than control group (median level 56.42 pmol/L) (U =3 081.00,P ＜ 0.05).AUC of serum HE4 was 0.85,with a cut-off value of 82.70 pmol/L (specificity =95.31％,sensitivity =62.32％).HE4 expression was not statistically related to clinical stage and pathological types of lung cancer.The median overall survival (mOS) was 36.87 months in the HE4-low group and 30.43 months in the HE4-high group (P ＜0.05),respectively.HE4 level was an independent prognostic factor for overall survival (HR =2.15,95％ CI 1.49-3.12,P ＜ 0.05).Conclusions The prognosis of patients with high HE4 expression is poor.Therefore,it might be necessary for patients with high level of HE4 to receive more aggressive adjuvant therapy.