Neuroendocrine neoplasms (NENs) are heterogeneous neoplasms. NENs arising from the stomach, bowel and pancreas can be divided into high-differentiated neuroendocrine tumors (NET) and neuroendocrine carcinoma, among which high-differentiated NET can be subdivided into NET G1, G2 and NET G3 according to Ki-67 index, and classified into functional NET and non-functional NET according to the function of hormone secretion. NF-NET is the dominant type, manifested with elusive onset. Many patients have local progression and/or distant metastasis upon diagnosis. Transformation therapy is of significance for patients with advanced NET. In this article, common transformation therapies were summarized based on different biological behaviors of advanced tumors. According to the characteristics of different types of tumors, appropriate treatment approaches were determined. Drug combination therapy should be carried out to achieve precise and individualized treatment when necessary.

OBJECTIVE To analyze the risk factors and antimicrobial resistance pattern of Stenotrophomonas maltophilia isolated from 6 hospitals in Beijing,and study the difference in resistance rate of isolates from different hospitals. METHODS In this study,145 cases with S.maltophilia infection were analyzed and their susceptibility was tested.The synergetic screening test was applied to detect metallo-?-lactamases. RESULTS Most of 145 strains were isolated from sputum(86.2%),mainly from ICU(48.3%),and department of respiratory medicine(22.1%).The drug sensitivity tests in vitro showed these strains were resistant to commonly used antibiotics,and drugs whose sensitive rate was over 50% included doxycycline,gatifloxacin,cefoperazone-sulbactam,levofloxacin,compound sulfamethoxazole,ceftazidime-clavulanate and ticarcillin-clavulanate.The antimicrobial resistance of strains isolated from different wards showed some difference.Of all the infected patients,56.7% had underlying diseases;92.2%were treated previously with broad-spectum antibiotics;76.8% underwent invasive examination or treatment. CONCLUSIONS S.maltophilia is resistant to many kinds of antibiotics.The infection caused by S.maltophilia often occurs in patients with severe underlying disease and low immunity.Antibiotics should by chosen by drug sensitivity tests.

Objective To explore the relationship between lung function and bone mineral density (BMD) in nonsmoking women. Method The healthy women who came to our hospital for physical examination from June 2013 to March 2014 were chosen. Totally 508 cases, average age 49.33±8.66 years , were included through the questionnaire and further examination. The lumbar BMD was measured with dual energy X-ray absorption, the subjects were divided into normal bone mass group, osteopenia group, and osteoporosis group according to the diagnostic criteria of WHO. Through questionnaires, the human body composition analyzer, pulmonary function test apparatus were used to acquire their general information, body mass index (BMI) and pulmonary ventilation function. The data were compared by analysis of variance, Pearson correlation analysis and multiple linear stepwise regression analysis were applied to explore the relationship among the pulmonary ventilation function and bone mineral density of lumbar spine and lumbar bone area (BA). Result BMI, forced vital capacity rate of one second (FEV1/FVC) were not significantly different among the three groups (F values were 0.192, 0.296;All P>0.05);the other indicators of pulmonary function including forced vital capacity (FVC),FVC percent predicted (FVC%), forced expiratory volume in first second(FEV1), FEV1 percent predicted(FEV1%),peak expiratory flow rate(PEF)decreased markedly in osteoporosis group compared with normal group and osteopenia group (F=15.313, 5.508, 18.890, 5.440, 6.763;all P<0.05). The lumbar spine BMD and lumbar BA declined significantly in osteoporosis group and osteopenia group comparing with normal group(F=169.053, 205.660, 224.567, 201.086, 276.927, 3.550;all P<0.05). Pearson correlation analysis showed that FVC, FVC%, FEV1, FEV1%, PEF were negatively correlated with age (all P<0.01);FVC, FVC%were negatively correlated with BMI (all P<0.05) , FEV1/FVC was positively correlated with BMI P<0.05);FVC was positively correlated with lumbar BMD and lumbar BA (P<0.01). FEV1 were positively correlated with lumbar BMD and lumbar BA(all P<0.01). Multiple regression showed that age, BMI, and lumbar BA were correlated with FVC, FVC%, FEV1, FEV1/FVC(All P<0.01). Conclusion In healthy nonsmoking women, age, BMI, and lumbar BA are the main influencing factors of pulmonary function;except for FEV1/FVC, the other indicators of pulmonary function decreased markedly in osteoporosis group.

Objective To investigate the relationship of pulmonary function and metabolic indexes in overweight as well as obesity people.Methods Three hundred and five health examination adults were selected as our subjects.The basic parameters,metabolic indexes and pulmonary function were measured.Of which,pulmonary function indexes include forced vital capacity (FVC),forced expiratory volume in one(FEV1),peak expiratory flow(PEF),the ratio of the forced expiratory volume in the first one second to the forced vital capacity (FEV1/FVC),the ratio of the forced expiratory volume in the first one second to the vital capacity(FEV1/VC),maximal expiratory flow after 50％ of the FVC (MEF50),maximal expiratory flow after 25％ of the FVC (MEF25),and each index value of lung function was expressed the ratio of the measured value/the predictive value.Metabolic indexes include triglycerides (TG),total cholesterol (TC),low-density lipoprotein cholesterol (LDL-C),fasting plasma glucose (FPG)),C-reactive protein (CRP),high-sensitivity C-reactive (hs-CRP),superoxide dismutase(SOD),systoloc blood pressure (SBP) and diastolic blood pressure (DBP).Statistical analysis methods include one-way analysis of variance and Spearman correlation analysis.Results The levels of FVC,FEV1,FEV1/FVC in overweight and the obesity group were (85.74 ± 13.94)％ and (82.85±13.34)％,(84.52 ± 14.62)％ and (82.74 ± 14.18)％,(103.40 ± 13.05)％ and (103.17 ±8.99)％respectively,lower than that of normal weight group [(95.79 ± 26.83) ％,(92.65 ± 26.93) ％,(99.98± 11.88) ％,all P values less than 0.05)].Compared with the normal weight group,the levels of TG,SBP,FPG in overweight group and the obesity group were significantly increased.The levels of LDL-C,DBP,hs-CRP in obesity were (5.05 ± 0.83) rmtmol/L,(86.64 ± 10.49) mmHg,(3.74 ± 5.51) mg/L respectively,higher than that of normal group [(3.08 ±0.96) mmol/L,(77.69 ± 13.20) mmHg,(2.33 ±4.67) mg/L,P ＜0.05)].SOD activities in overweight and obesity group were (140.82 ± 13.16),(144.89 ± 13.82) U/L respectively,significantly lower than that of normal weight group[(148.64 ± 14.94) U/L,P ＜0.05)).The levels of SBP,DBP,hs-CRP in the over weight group were (127.77 ± 19.07) mmHg,(80.87 ± 12.21) mmHg,(2.31± 3.73) mg/L),higher than that of obesity group.Among metabolic indices,TG,SBP,DBP,FBG,CRP,hs-CRP and SOD were related with FVC (r =-0.129,-0.129,-0.136,-0.180,-0.220,-0.217 respectively,P ＜ 0.05 or P ＜ 0.01).There was negatively correlated relationship between SBP,FBG,CRP,hs-CRP and FEV1 (r =-0.128,-0.127,-0.148,-0.198 respectively,P ＜0.05 or P ＜0.01),So were SBP,CRP,hs-CRP and PEF (r =-0.137,-0.117,-0.133 respectively,P ＜ 0.05).Negatively correlated relationship between hsCRP,SBP and MEF50 were seen (r =-0.126,-0.124,P ＜ 0.05).Meanwhile there was negatively correlated relationship between SOD and FVC,FEV1/FEV,PEF,MEF50 (r =0.149,0.094,0.119,0.141,0.129respectively,P ＜ 0.05 or P ＜ 0.01).Conclusion Impaired pulmonary function and metabolic disorders were showed in the overweight and obesity people.Metabolic indexes were related with pulmonary function.

Objective To evaluate the significance of sIL 2R and TNF ? in chronic cor pulmonale.Methods The sIL 2R and TNF ? were detected by means of ELISA.The correlation with PaO 2 and PaCO 2 was analyzed using linear correlation.Results The levels of sIL 2R and TNF ? in patients at exacerbation stage were higher than that of remission stage and normal controls (P

The medical progress provides the care in medicine both to psychological factors and social factors.So,it's necessary to advocate human care in medicine.It is also an important condition form technique supremacy transforming into human care in practice,the medical care not only to human being but to technique,psychology health,and life care.

liver fire exuberant syndrome. Conclusion Hs-CRP and IMT can be used as important indexes of TCM syndrome differentiation of MS.

Objective To compare the induction of L1 and L2 ?-lactamase stenotraphomonas maltoptilia by common antimicrobial agents, including imipenem, meropenem, cefotaxime and ceftazidime, and to survey the modulation of L1 and L2 ?-lactamase expression. Methods One clinical strain of S. maltophilia was isolated and identified with VITEK automatic microbic system. L1 and L2 ?-lactamase genes were amplified, cloned and sequenced by PCR method. Minimal inhibitory concentrations (MICs) of four antimicrobial agents against the clinical isolates were determined by agar dilution method. Two hours after being induced by different concentrations of four antimicrobial agents, total RNA was extracted, and RT-PCR method was used to determine the induction of L1 and L2 ?-lactamase by different concentrations (0.25, 1 or 4?MIC) of common antimicrobial agents. Electrophoresis strips of L1 and L2 ?-lactamase were quantified by Image J software. Results The clinical isolates of S. maltophilia with simultaneous production of L1 and L2 ?-lactamse were identified. When different concentrations of four antimicrobial agents were used as inductors, electrophoresis strips of L1 and L2 amplicons were not found in strains of blank control and those in which imipenem, meropenem or cefotaxime (4?MIC) was added to the culture mediam, while light electrophoresis strips were exhibited by the isolates with ceftazidime (0.25, 1 or 4?MIC) or cefotaxime (0.25?MIC) added to the medium. The strongest electrophoresis strips and the strongest expression were found in the isolates with cefotaxime (1?MIC) added to the medium. Conclusions Clinical common antimicrobial agents, e.g. ceftazidime and cefotaxime, are able to induce production of L1 and L2 ?-lactamase, and cefotaxime (1?MIC) is the strongest inductor. Cefotaxime can exert an effect on transcription of L1, L2 genes simultaneously, implying that a significant overlap might exist between the mechanism of modulation of two ?-lactamases.

OBJECTIVE To study the aminoglycosides modifying enzyme genes and intⅠ gene in Stenotrophomonas maltophilia in Chinese Armed Police Forces General Hospital.METHODS The samples of 27 multi-resistant S.maltophilia were collected from inpatiens from Jan 2006 to Oct 2007 in this Hospital.The sensitivity of the isolates to 14 antibacterial agents was determined using a broth induction method.The aminoglycosides modifying enzyme genes and intⅠ 1 gene were detected by PCR.RESULTS The multi-drug resistance of S.maltophilia was a serious problem.In 27 strains of S.maltophilia,the positive ant(2″)-Ⅰ were in 5 strains(18.5%),aac(3)-Ⅱ in 3 strains(11.1%)and aac(6')-Ⅱ in 1 strain(3.7%).The positive intⅠ gene was found in 11 strains(29.6%).CONCLUSIONS Multi-resistant S.maltophilia resistant to aminoglycosides mainly due to the presence of aminoglycoside modifying enzymes ant(2″)-Ⅰ,aac(3)-Ⅱ and aac(6')-Ⅱ.The aminoglycoside modifying enzymes ant(3″)-Ⅰ and aac(6)-ⅠZ were not detected carrying IntⅠ would be the reason of S.maltophilia resistant to aminoglycosides.

Objective To conduct comparative study of vertebral artery blood flow of arteriosclerosis patients and healthy people using color Doppler ultrasound (CDUS),and to discuss the effect of arteriosclerosis on vertebral arterial blood flow.Methods Two hundred and eighty-five cases of vertebral artery test were collected and divided in to normal group of one hundred and thirty-five cases and vertebral artery sclerosis group of one hundred and fifty cases according to the presence of vertebral artery sclerosis.Time averaged maximum velocity (TAMV) and vertebral artery diameter(D) of vertebral artery were measured using CDUS technique.Unilateral vertebral artery blood flow and total blood flow were calculated.Results The vertebral artery TAMV and total blood flow of arteriosclerosis group was both lower than that of normal group (P＜0.05).Left side vertebral artery diameters of the two groups were higher than that of the right side.Conclusions Arteriosclerosis can reduce vertebral artery TAMV and blood flow.The inner diameter of the left side vertebral artery dominates the artery blood flow.