Epithelial-mesenchymal transition (EMT) is an important biological process in embryonic development and tumori-genesis. In this process, epithelial tumor cells can obtain mesenchymal phenotypes and promote tumor invasion and metastasis. EMT is controlled by multiple transcription factors, signal pathways, and microRNAs. EMT and cancer stem cells are closely related. EMT also promotes the self-renewal ability of tumor cells and the overexpression of EMT-related markers in tumor cells with stemness. Some mi-croRNAs can control EMT process and stemness. In this study, recent developments on EMT and cancer stem cells in tumor metastasis were summarized to provide new insights into target therapy of tumor metastasis and recurrence.

This paper reviews the development of physician professionalism and its research at home and abroad in recent decades.Content,evaluation,the problems and challenges,and the affecting factors of physician professionalism are analyzed.With regard to the status quo of physician professionalism in China,some ideas to improve and build physician professionalism in China are proposed.

Objective To study the change of serum procalcitonin(PCT) expression level and to investigate its clinical value for predicting the prognosis in the patients with severe acute pancreatitis (SAP) .Methods Totallay 48 inpatients with SAP in our hos‐pital from April 2012 to April 2014 were retrospectively analyzed .The PCT levels during different hospitalization period in the sur‐vial group and the death group were detected and analyzed .The scores of acute physiological and chronic health evaluation Ⅱ (A‐PACHE Ⅱ) were compared between these two groups .Results (1)The clinical characreristics of gender ,body temperature and WBC had no statistically significant differences beween the survival group and the death group (P>0 .05) ,but the PCT level had statistical differencet (P<0 .05) .(2)There was no statistically significant difference in the PCT level and APACHE Ⅱ score at ad‐mission between the two groups .In the later treatment process ,the PCT level and APACHE Ⅱ score in the survival group were progressively decreased ,while which in the death group were progressively inecreased (P<0 .05) .WT5HZ〗Conclusion PCT has an important clinical value in forcasting the prognosis of SAP .

Objective To investigate the clinical effect of low molecular heparin combined with mesalazine in patients with active ulcerative colitis(UC).Methods 90 cases of patients with UC were randomly divided into three groups:A group,B group and C group,with 30 cases in each group.A group was given oral treatment with sulfasalazine enteric-coated tablets,B group was given oral treatment with mesalazine and C group was given low molecular heparin calcium combined with mesalazine (4100 iu,1 /d).The three groups were treated for 2 weeks. Coagulant function index such as activated partial prothrombin time (APTT),fibrinogen(FIB),platelet count(PLT), platelet maximum aggregation rate(PAG(Max)),D-dimer(D-D),C-reactive protein(CRP)were detected in the two groups before and after treatment of 7 and 14d.Mayo disease activity index score was also recorded before and after treatment of 7 and 14d.And the differences among three groups were compared.Results There were significant differences in APTT,FIB,PLT and PAG(Max)after 7d,14d treatment among A,B and C groups(7d:F value were 17.652,12.427,42.873,14.318 respectively;14d:F value were 43.804,139.172,51.932,79.440 respectively,all P value <0.05).APTT of C group after 7d,14d[(36.32 ±3.56)μg/mL,(40.15 ±4.24)μg/mL]were higher than B group[(32.14 ±2.86)μg/mL,(33.04 ±3.32)μg/mL]and A group [(31.82 ±3.36 )μg/mL,(32.15 ± 3.24)μg/mL];FIB of C group after 7d,14d[(4.07 ±0.41 )g/L,(3.14 ±0.28)g/L]were lower than B group [(4.47 ±0.40)g/L,(4.06 ±0.33)g/L]and A group[(4.58 ±0.44)g/L,(4.23 ±0.37)g/L];PLT of C group af-ter 7d,14d[(262.22 ±60.61)×109 /L,(201.38 ±49.42)×109 /L]were lower than B group[(296.34 ±63.51)× 109 /L,(253.25 ±55.47)×109 /L]and A group[(301.71 ±70.62)×109 /L,(262.05 ±64.11)×109 /L];PAG (Max)of C group after 7d,14d[(0.46 ±0.08),(0.30 ±0.05)]were lower than B group[(0.57 ±0.10),(0.46 ± 0.06)]and A group[(0.59 ±0.12),(0.51 ±0.08)].There were significant differences in CRP,D-D after 14d treatment among A,B and C groups(F value were 91.967,139.172 respectively,all P value <0.05).CRP of C group after 14d[(7.50 ±1.35)mg/L]were lower than B group[(10.80 ±1.37)mg/L]and A group[(12.12 ±1.64)mg/L];D-D of C group after 14d[(0.26 ±0.02)mg/L]were lower than B group[(0.47 ±0.03)mg/L]and A group[(0.51 ± 0.04)mg/L].There were significant differences in Mayo index score,△Mayo index score after 14d treatment among A,B and C groups (F value were 182.170,89.802 respectively,all P value <0.05).Mayo index score of C group after 14d(1.51 ±0.33)were lower than B group(2.93 ±0.46)and A group(3.42 ±0.63);.△Mayo index score of C group after 14d(5.67 ±1.60)were lower than B group(4.25 ±1.32)and A group(3.79 ±1.21);Pearson corre-lation analysis showed that △Mayo Mayo index score were positively correlated with PAG(Max)reduction△PAG (Max),△D-D,△CRP,△PTL(r value were 0.616,0.702,0.734,0.569,respectively,all P <0.05).Multiple step-wise linear regression analysis showed that △PAG(Max),△D-D,△CRP,△PTL were closely related to △Mayo Mayo index score(partial regression coefficient were 4.209,2.451,0.801 respectively;t value were 7.890,4.787, 2.201,respectively,all P <0.05).Conclusion The clinical effect of low molecular heparin combined with mesala-zine in patients with active ulcerative colitis is effective,and the method can significantly improve the inflammation in patients with UC and high coagulation state,improving the clinical symptoms is better than the single drug,and worth clinical recommendations.

It is considered that cancer-related malnutrition is caused by the imbalance of the nutritional consumption of patients,the tumor itself and the nutrient available internal.Patients with abdominal neoplasm have a great risk of getting malnutrition,which is resulting from the changes of their biochemical status,clinical symptoms and the impacts by surgery.In 1980s,people began to realize that it is important to assess the nutritional status of patients and now so do the most of doctors.Until now,there is some acceptable assessment questionnaire,by using which,we find that a large proportion of patients with abdominal cancer have malnutrition,and when it comes to different kind of abdominal cancer,the rate is not same.

Objective To describe the current status and existing problems on the specialist nurse in China and provide references for nurse management.Methods The following databases were searched:Chinese Biomedical Literature Database (SinoMed),China Academic Journal database,Chinese Science and Technology journals database,using the key words specialty nurse,clinical nurse specialist and advanced practice nurse.Strict inclusion and exclusion criteria were applied.Results Seven hundred and eighteen papers were eligible for inclusion.The earliest paper was published in 1992,then the number increased yearly.Most of the papers were reviews or summaries of experience,and the hotspot were about the nurse specialist in ICU,operating room,emergency,oncology and diabetes department.Conclusions The attempt about nurse specialist have been carried out in the whole country,but further improvement and practice are needed to solve the existing problems such as the definition,training,certification and nurse management,and it is urgent for us to explore a suitable way for the development of specialist nurse in China.

[Summary] When accompanied with pulmonary disease ,the lung functions of diabetic patients usually represent decreases of diffusing capacity ,ventilation function ,bronchomotor tone and respiratory muscles. The mechanisms of lung damage may include non‐enzymatic glycosylation of proteins ,oxidative stress ,IR ,local defensive ability change ,and autonomic neuropathy. Diabetes mellitus is a risk factor for lung function damage ,and lung function damage is an independently predictive factor of diabetes mellitus. The change of lung function in diabetic patients is associated with age ,duration ,blood glucose level and complications.

Objective To evaluate the risk factors for healthcare-associated infection (HAI)in patients in depart-ment of cardiology.Methods Clinical data of inpatients were performed retrospective case-control analysis,patients with HAI were as case group,while without HAI were as control group,factors for HAI between two groups were compared.Results 117 cases of HAI occurred among 2 308 patients,infection rate was 5.07%.The main infection site was respiratory tract (n=71 ,60.68%);a total of 90 pathogenic isolates were isolated,gram-negative bacteria, gram-positive bacteria,and fungi accounted for 72.22%(n=65),22.22%(n=20),and 5.56%(n=5)respective-ly.Univariate analysis revealed that 7 variables were risk factors for HAI,multivariate non-conditional logistic re-gression analysis revealed that independent risk factors for HAI were age,cardiac function classification,serum al-bumin level,and invasive operation.Conclusion HAI rate is higher among cardiology inpatients,which is related to many factors.Attention should be paid to the elderly,long term hospitalization,heart failure correcting,treatment for complications,reducing of invasive procedure,and strict sterile manipulation.

Objective To analyze the various common causes of acute pancreatitis distribution and related factors.Methods 131 cases of acute pancreatitis patients from April 2007 to August 2013 were chosen.The medical records were retrospectively analyzed .Patients were recorded and analyzed in age ,gender,etiology,clinical pancreatitis type.With biliary tract disease,overeating or high-fat meal,alcoholism,hyperlipidemia,other causes such as to cause the group to 18-29 years of age(youth group),29-44 years old(middle-aged group),44-59 years old(middle-aged group),≥59 years of age(age group) for the sector for the age group,for different reasons,the AP′s gender,age and different clinical types such as distribution were analyzed .Results Biliary disease 61 cases(46.3%);overeating or high-fat meal 38 cases(29.4%);alcoholism 21 cases(16.1%);high ester hyperlipidemia 8 cases(5.9%);other three cases(2.3%).Adult group overeating or high-fat meal,alcoholism and hyperlipidemia constituent ratio were higher than other groups,but with no significant difference(Pearson χ2 =19.1,df=12,P=0.085).Clinical types in a variety of different etiology than AP was no significant difference ( Pearson χ2 =1.9, df =4, P =0.753 ). Conclusion Biliary tract disease remains a major cause of AP ,followed by overeating or a high-fat meal,alcoholism, hyperlipidemia.AP has a clear upward trend,the treatment must remove the cause,to strengthen the integrated man-agement of AP .

Objective To study the expressions and correlation of nuclear factor kappa B ( NF-B) p65 and trefoil factor family-3(TFF3) in gastric cancer,in order to evaluate the roles of NF-Bp65 and TFF3 in the occurrence and development of gastric cancer,and their correlation with Helicobacter pylori (Hp) infection.Methods The expressions of NF-Bp65 and TFF3 were detected by immunohistochemistey in 30 normal gastric mucosa specimens ,32 dysplasia specimens and 70 gastric cancer specimens .At the same time,the infection of Hp was detected .Results In normal gastric mucosa ,dysplasia and gastric cancer ,the expression of NF-Bp65 had a increasing tendency ( compared with the normal gastric mucosa group ,χ2 =18.632,44.291,all P<0.01).The expression of NF-Bp65 in gastric cancer group was higher than that in dysplasia group (χ2 =5.205,P<0.05).The expression of TFF3 in three groups also had a increasing tendency (compared with the normal gastric mucosa group ,χ2 =16.944,22.917,all P <0.01).The expression of TFF3 in gastric cancer group was higher than dysplasia group ,but there was no significant difference between the two groups (χ2 =0.162,P>0.05).In dysplasia group,the expressions of TFF3 and NF-κBp65 in Hp positive patients were significantly higher than those in Hp negative patients (P<0.01 or P<0.05).There was significantly positive correlation between expression of NF-Bp65 and TFF3 in gastric cancer group ( r=0.350,P=0.003).Conclusion High expressions of NF-Bp65 and TFF3 may be involved in an early event of gastric cancer . NF-Bp65 expression is positively correlated with the abnormal expression of TFF 3,both of which may be involved in the development and progression of gastric cancer .