Background and purpose:Tumor necrosis factor related apoptosis-inducing ligand (TRAIL) is a death receptor ligand that can induce apoptosis in a variety of cancer cell lines, but not all cancer cells . Past studies suggested that some chemotherapeutic drugs intensified the sensitivity of TRAIL induced apoptosis.We investigated the effect and potential mechanism of combined paclitaxel and TRAIL on apoptosis of human gastric cancer cell in vitro. Methods:SGC7901 cells were cultured with paclitaxel at different concentrations(1,5,10,20,40 ?g/ml) and different time(12,24,36,48 hr), methyl thiazolyl tetrazolium (MTT) assay was used to measure the anticancer activity of paclitaxel.The ability of TRAIL alone,paclitaxel alone and TRAIL in combination with paclitaxel to induce apoptosis was measured by a flow cytometer. Expression of DR4,DR5, DcR1,DcR2,Caspase-8 and Bcl-2 mRNA was examined by RT-PCR.Results:The apoptosis rates of control group(C group),paclitaxel group(P group),TRAIL group (T group)and combination group(T+P)in 24 hr were 2.09%,10.65%,7.79% and 24.51%, respectively. The apoptosis rate in T+P group was significantly higher than that in C group, T group and P group(P

Objective To know the condition of cognition of cardiac surgical patients for patient safety.Methods Carried out a semi-structured depth interviews among 8 cardiac surgical patients,and then cleared up the information by phenomenology method.Results Three themes were extracted:patients' consciousness about patient safety,the lack of knowledge of patients in patient safety management,the lack of emotional support of patients in patient safety.Conclusions Some positive counter-measures should be taken by nursing administrators to resolve patients' difficulty and confusion,and then promote patients take part in the course of safety management of patients,ensure patients' safety.

Tumor immune evasion is a hallmark of cancer.There are many mechanisms of tumor escape,which mainly include the direct immune escape of tumor and tumor microenvironment mediated immune escape.Recent studies have shown that the development of nasopharyngeal carcinoma and its tumor cells are closely related to the immune escape.The direct immune escape of tumor which is associated with nasopharyngeal carcinoma including the expression decreased or absent of the major histocompatibility complex-Ⅰ on the surface of tumor cell,the lack of costimulatory molecules of tumor and the Fas/FasL system mediated immune escape.And the tumor microenvironment mediated immune escape which is associated with nasopharyngeal carcinoma including the immunosuppressive molecule and the immunosuppressive cells of tumor.Researches on the mechanisms of tumor immune evasion can provide new target for treatment and prevention of nasopharyngeal carcinoma.

Objective To explore the relationship between the change of serum β-HCG and the effect of　conservative treatment in tubal ectopic pregnancy.Methods 95 patients with tubal ectopic pregnancy were treated with single dose methotrexate injection.Among them,87 patients were successfully cured,16 patients were treated with the 2nd dose and Chinese herbal medicine orally:8 patients failed.The change of serum β-HCG levels after the first and 2nd course of treatment were measured.Results It showed that after the first or 2nd course of treatment,the cases which serum β-HCG level reducing less than 15%in patients who had successful treatment were signiflcantly lower than that in patients who failed(P＜0.05).Conclusion Detecting the change of serum β-HCG concentration can evaluate the therapeutic effect in tubal ectopic pregnancy with conservative treatment,and according that surgical operation should be chosen if serum β-HCG reduce less than 15%after two courses of treatment.

Objective Through analyzing the causes of iodine contrast agent extravasation,nursing managers develop effective solutions timely and take appropriate precautionary measures to ensure the safety of patients effectively.Methods 600 patients undergoing CT contrast enhanced scan were selected,300 patients from May 2009 to April 2010 were set as the control group and were given routine nursing care,300 patients from May 2010 to April 2011 were set as the study group and they adopted effective preventive measures.The incidence of adverse events after injection of iodine contrast agent between the two groups was compared.Results The incidence of iodine contrast medium extravasation in the study group was significantly reduced to 2％ after taking a series of preventive measures,which was lower than 10％ of the control group.Conclusions Taking a series of preventive measures can reduce the incidence of adverse events of iodine contrast agent extravasation,ensure the safety of patients,decrease the frequency of nursing complaints and nursing deficiencies,as well as improve the quality of nursing service.

Service quality in the outpatient department reflects the overall capacity of a hospital.It has become the focus of hospital administrators' attention how to improve service quality by following the patients-centered policy,renewing service ideas and innovating the service mode in order to satisfy patients' needs to the best extent.The authors aim to summarize the experience in and explore the effective ways of improving service quality in the outpatient department.

Objective To study the clinical characteristics of acute leukemia(AL) patients with cross‐lineage antigen expression . Methods Patients were diagnosed and classified by morphology ,cytochemistry and immunology assay ,and prognostic acting factor were also analyzed .Results According to FAB standards ,acute myeloid leukemia(AML)‐M2 ,acute lymphocytic leukemia (ALL)‐L2 and no‐classified type were common in 320 patients with cross‐lineage antigen expression .The immunophenotype with B and my‐eloid mixed expression was the most common(176 cases) ,followed by cross expression of antigen T and myeloid(131 cases) ,and the co‐expression of B ,T and myeloid antigen was found in only 10 cases .In lymphoid antigenpositive AML(Ly+ AML) ,CD19 anti‐gen was the most common among B lineage ,CD7 was the most common in T lineage .In myeloid antigen positive ALL(My+ ALL) , CD33 was the most common myeloid antigen .Forty‐five cases were with mixed expression of myeloid antigen and CD56 expression . Correlation existed between CD7 and CD34(P< 0 .05) ,CD19 and CD34(P< 0 .05) .There were 9 patients with CD34 ,CD7 and CD19 co‐expression ,7 patients with CD34 ,CD7 and CD56 co‐express .In Ly+ AML patients ,23 cases were with recurrent chromo‐some abnormality ,including 11 cases with t(8 ;21)(q22 ;q22) ,RUNX1‐RUNX1T1 ,3 cases with t(15;17)(q22 ;q11‐12) ,PML/RAR ,6 cases with bone marrow eosinophilia inv(16)(p13 ;q22) ,CBF beta /MYH11 ,and 3 cases with t(9;11)(p22;q23) , MLLT3‐MLL .In My+ ALL ,15 patients were with recurrent chromosome abnormality ,including 9 cases of B‐ALL with t(9;22) (q34 ;q11 .2) ,BCR‐ABL1 ,3 cases of B‐ALL with t(v ;11q23) ,MLL rearrangement ,and 3 cases of T‐ALL with 14q11 .2 .Among the presence of reproducible chromosomal abnormalities in AL ,the antigen expression of mistranslation was still with a certain fea‐ture:Ly+ AML patients often mistranslated CD19 ,CD56 ,CD2 ,and My+ ALL patients often mistranslated CD13 and CD33 .Com‐pared with the lymphoid antigennegative AML(Ly - ALL) group ,CD7+ AML group ,CD19+ AML group and CD56+ AML group had significant difference in survival curves(with P value of 0 .01 ,0 .02 and 0 .02) .There was no significant difference in survival curves between myeloid antigen negative ALL(My -ALL) group and CD13/33+ ALL group(P<0 .05) .CD7 was also positive com‐monly(53 cases) and related with CD34(P<0 .05) .So it significantly influenced the prognosis .If patients were with co‐expression of CD34 ,CD7 and CD19 ,the prognosis could be worse .Conclusion AL with cross‐lineage antigen expression might be a special type and confirmed by immunotype .Furthermore ,expression types of differentiation antigen could be critical for prognosis and sur‐vival .

Objective To investigate the clinical efficacy of Pingchuan cataplasm combined with hyperthermia therapy for stable chronic obstructive pulmonary disease (COPD) with qi deficiency syndrome of both lung and spleen. Methods Sixty patients of stable COPD with TCM syndrome of qi deficiency of both lung and spleen were selected and randomized into treatment group and control group, 30 cases in each group. Based on conventional treatment, the treatment group was treated by Pingchuan cataplasm combined with hyperthermia, and the control group was given analog stick applicator without additional heat treatment. After 6 weeks of treatment, the TCM symptom score and the time of the first exacerbation after treatment were observed. Results Compared with the control group, Pingchuan cataplasm can reduce the patients’ TCM symptom score (F=9.843, P=0.003), and extend the interval of acute exacerbation after treatment (F=4.451, P=0.040). Conclusion Pingchuan cataplasm combined with hyperthermia applicator can improve symptoms and reduce the frequency of acute exacerbation, thus can treat and prevent the acute exacerbation of COPD.

ObjectiveBoth kilovolt (KV) cone-beam computed tomography (CBCT) and KV radiography can determine set-up errors for patients with head-and-neck cancer.This study is to compare their performance.Methods16 patients with head and neck cancer were enrolled in this study.There were 160 sets of CBCT and corresponding orthogonal radiography images.Through registration of CBCT images with the planning CT images,and registration of radiography images with the digitally reconstructed radiographs,translational set-up errors were determined along left-right (x),super-inferior (y),and anterior-posterior (z) directions.Pearson correlation analysis was performed to evaluate the correlation of the set up errors determined by the two methods,and Bland-Altman plot analysis was used to assess the coincidence of these two methods.ResultsThe Pearson coefficient of correlation along all three directions was less than 0.01,and R2 was 0.95,0.84,0.81 on x,y,z,respectively.That means high correlation for two methods.The Bland-Altman plot analysis showed that the 95％ agreement limits of agreement were within preset 2 mm tolerance (x[ 1.3mm,- 1.2mm],y[ 1.6mm,- 1.1mm],z[0.8mm,-1.4 mm] ),which indicates an agreement exists for two methods.ConclusionsFor determination of set-up errors for patients with head and neck cancer,KV radiography is equivalent to CBCT.Considering CBCT delivers higher dose than KV radiography,but provides more soft tissue information.We suggest to use these two methods combinative in clinic.

Objective To investigate the curative effects of oxalic acid Ai Sciplan in assisting psychological therapy for coronary heart disease accompanied with depression. Methods A total of 136 patients of coronary heart disease with de?pression were randomly divided into control group and treatment group. The routine drug treatment was given to control group. Treatment group was given oxalic acid Ai Sciplan which is assisted by the psychological therapy based on the routine drug treatment schedule for six months. HAMD score before treatment, one-week, one-month, 3-month and 6-month after treatment were compared between two groups. Homocysteine (Hcy) and high sensitive C reactive protein (hs-CRP) levels were detected by circulating enzymatic method before treatment and 6-month after treatment. The WHO quality of life scale (WHOQOL-BREF) was used to assess the quality of life in two groups of patients. The improvements of angina and depressive symptoms were evaluated after 6-month treatment. The cardiovascular events were followed up in two groups. Re?sults HAMD scores significantly decreased after treatment in both groups (P < 0.05). HAMD scores at all different time points were significantly lower after treatment than those before treatment in treatment group. In control group, HAMD scores at different time points were also significantly lower after treatment than those before treatment, except time point of one week after treatment. The levels of Hcy and hs-CRP were decreased after treatment in two groups, and the levels were lower in treatment group than those of control group. Values of WHOQOL-BREF score, mental status, social relations and the sur?rounding environment scores were higher after treatment in both groups. Also they are higher in treatment group than that of control group. The angina and depressive symptoms were improved in treatment group. The incidences of angina, myocardial infarction, arrhythmia, heart failure, sudden cardiac death and other cardiovascular events were significantly lower in treat?ment group than those of control group (χ2=9.396, P<0.05). Conclusion Escitalopram oxalate combined with psychological therapy shows a significant beneficial effect and a better prognosis in the treatment of coronary heart disease and depression.