Inflammatory diseases of the biliary system are important risk factors for cholangiocarcinoma (CCA). Among them, chronic inflammation-related conditions such as choledocholithiasis, primary sclerosing cholangitis, Caroli disease, and liver fluke infection have been identified as major precursor diseases of CCA, with chronic inflammation being the key driver of malignant transformation of benign biliary diseases. This article reviews the association between the aforementioned precursor diseases and CCA, focusing on elaborating that chronic inflammation promotes abnormal cell proliferation by releasing relevant cytokines and activating multiple signaling pathways. Meanwhile, oxidative stress leading to cumulative DNA damage, immune evasion, and imbalance of the tumor microenvironment also contribute to the carcinogenesis process. Common related biliary inflammatory diseases further include cholelithiasis, biliary cysts, and fibrocystic liver disease, whose pathological changes such as chronic inflammatory status and cholestasis increase the risk of carcinogenesis through multiple pathways. Currently, the diagnosis and treatment of these diseases still face challenges such as difficulty in early diagnosis and limitations in therapeutic approaches. In-depth exploration of the association between biliary inflammation and CCA may provide a theoretical basis for the early prevention, precise treatment, and prognosis improvement of CCA.

BACKGROUND:With the deepening of the aging of the world population,the prevalence rate of osteoarthritis is increasing.In recent years,more and more attention has been paid to the study of osteoarthritis.Studies have shown that autophagy and apoptosis are strongly associated with the occurrence and development of osteoarthritis,and play an important role in it. OBJECTIVE:To review the molecular mechanisms of the interaction between autophagy and apoptosis in osteoarthritis,aiming to explore the relationship between autophagy and apoptosis in osteoarthritis and the coupling mechanism of the two to mediate the occurrence and development of osteoarthritis,so as to provide new ideas for the treatment of osteoarthritis. METHODS:The Chinese and English key words"osteoarthritis,autophagy,apoptosis"were searched in the CNKI and PubMed.After screening by reading the title,abstract and key words,the relevant literature was carefully read.After excluding studies unrelated to the content of the paper and repetitive studies,68 articles were finally included for the summary. RESULTS AND CONCLUSION:(1)The occurrence and development of osteoarthritis are related to autophagy and apoptosis of chondrocytes.Autophagy protects chondrocytes from stress damage,but excessive autophagy also induces or promotes chondrocyte apoptosis and reduces the survival rate of chondrocytes.The two perturb each other to regulate the degeneration of articular cartilage.(2)miRNA,Beclin-1 and oxidative stress are all involved in the regulation of autophagy and apoptosis on osteoarthritis,and affect the development of osteoarthritis.

Objective:To investigate the effect of total saponins of Panax notoginseng (TSPN) on learning and memory of post-stroke depression (PSD) rats and its mechanism.Methods:Four-vessel occlusion method was used to build the rat stroke model and 7 days later these rats were given solitary breeding with chronic unpredictable mild stress (CUMS) to make depression model. Rats were randomly divided into Sham group ( n=10), Model group ( n=10), PSD group ( n=10) and TSPN group ( n=10). The rats in the Model group and PSD group were injected administered with equal volume of 0.9% saline 30 min post-brain ischemia, one injection per day for 30 days. while TSPN group were treated with TSPN. The dose of TSPN (75 mg/kg) was dissolved in 0.9% saline 10 g/L, once per day for 30 days. Then the learning and memory of rats were tested by Morris water maze.The protein levels of DCX and Nestin in the hippocampus were detected by Western blot. Furthermore, the DCX/Ki67 co-labeled cells in the SGZ of hippocampus were observed by the immunofluorescence. Results:The escape latency at the fifth day of PSD group((31.8±3.8)s) was longer than that in the Sham group((10.4±3.2)s) and Model group((19.8±3.7)s) ( t=9.23, 5.15; both P<0.05). The escape latency ((14.2±2.8)s) of TSPN group was shortened significantly than PSD group ( t=8.56, P<0.05). The times across the platform in the Sham group was (10.3±1.7), and the PSD group was (4.1±1.1), difference was statistically significant between two groups( t=11.24, P<0.05). The times across the platform (8.4±1.6) of TSPN group statistically increased compared with PSD group ( t=5.77, P<0.05). The protein levels of DCX and Nestin in the PSD group were (0.60±0.02), (0.58±0.03) respectively, and in the TSPN group were (1.07±0.07), (0.95±0.11) correspondingly, there were significant differences of the DCX, Nestin protein level between the two groups( t=20.22, 7.68, both P<0.01). Moreover, there was significant difference in the number of the DCX/Ki67cells in the hippocampus SGZ between the PSD group((16.2±2.8) /mm 2) and TSPN group ((21.2±3.1) /mm 2)( t=2.42, P<0.05). Conclusion:TSPN could improve the learning and memory of the rats with post-stroke depression through enhancing the hippocampus neurogenesis.

Taking full advantage of professional knowledge,clinical pharmacist involved in the whole treatment process of one case of mycobacterium infection by assisting doctors in determining and optimizing the anti-infective treatment plan, and performing pharmaceutical care. After the active, rational and effective anti-infective treatment, the patient's infection was controlled effectively. The active participation of clinical pharmacist gains clinical experience for the treatment of rare bacterial infections.

Objective: To analyze effects of cooperation between physicians in department of burn surgery and department of intensive care medicine on rescue and treatment of severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident. Methods: On August 2nd, 2014, 15 extremely severe burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident were admitted to temporary burn treatment center established in Department of Critical Care Medicine of the Second Affiliated Hospital of Soochow University. The 15 patients were equally divided into 3 groups, with 5 patients in each group. Fifteen surgeons and 30 nurses from department of burn surgery and 15 physicians and 30 nurses from department of intensive care medicine from different hospitals in China were divided into 3 groups, with 5 physicians and 10 nurses from department of burn surgery and 5 physicians and 10 nurses from department of intensive care medicine in each group. Each group of physicians and nurses were responsible for treatment of 5 patients. Treatment of patients was leaded by surgeons from department of burn surgery, who were responsible for wound dealing and operation. Physicians from department of intensive care medicine were responsible for systemic treatment and adjustment of relevant equipment's parameters. Volume of fluid infusion and urine output in shock period, severe systemic complication during period of treatment, using time and kind of antibiotics, death in 1 month after admission, length of hospital stay, and survival of patients were monitored. Results: Volume of fluid infusion of 15 extremely severe burn patients within the first 24 hours post injury was 10 360-17 162 (12 998±1 811) mL, including (1.62±0.23) mL·% total body surface area (TBSA)^-1·kg^-1 electrolyte and colloid and (2 850±232) mL glucose, with electrolyte and colloid ratio of (1.76±0.23)∶1.00. Volume of urine output within the first 24 hours post injury was (2 384±1 242) mL, with (99±52) mL in each hour. Volume of fluid infusion of 15 extremely severe burn patients within the second 24 hours post injury was 8 720-11 616 (9 406±1 277) mL, including (1.04±0.22) mL·%TBSA^-1·kg^-1 electrolyte and colloid and (2 910±187) mL glucose, with electrolyte and colloid ratio of (1.53±0.31)∶1.00. Volume of urine output within the second 24 hours post injury of patients was (2 299±1 362) mL , with (108±61) mL in each hour. One patient had pulmonary infection, and 7 patients had fungal infection, and no patient had gut microbiota dysbiosis. Patients were treated with combined 2 kinds of antibiotics for 21-85 (50±16) d. No patient died within 1 month after admission. The length of hospital stay was 53-132 (98±44) d. Ten patients survived finally. Conclusions After being treated by cooperation between physicians in department of burn surgery and department of intensive care medicine, severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident had hemodynamic stability and could stably experience shock period, with less complication, shorter length of hospital stay, no death within 1 month after admission, more survived patients, which can provide reference for rescue and treatment of severe mass burn patients.

Objective To investigate the expression of unfolded protein response (UPR) gene glucose regulated protein 78(GRP78) and X-box binding protein 1(XBP1) in esophageal squamous cell carcinoma, its effect on activation of the endoplasmic reticulum stress (ERS) and its mechanism in the growth of esophageal squamous cell carcinoma. Methods The expressions of GRP78 and XBP1 were detected by immunohistochemistry in 30 samples of esophageal squamous cell carcinoma and 30 samples of normal esophageal squamous epithelium. The correlation between expressions of both proteins and prognosis was analyzed. Results GRP78 positive rate was 83.3 %(25/30) in esophageal carcinoma, while the proportion was 20.0 %(6/30) in normal esophageal (χ2=25.833, P<0.05). XBP1 positive rate was 70.0 % (21/30) in esophageal carcinoma, while the proportion was 26.7%(8/30) in normal esophageal(χ2=20.872, P<0.05). The positive rates of GRP78 and XBP1 in invasive muscular layer of esophageal squamous cell carcinoma were significantly higher than those in invasive mucous layer. Conclusion GRP78 and XBP1 are highly expressed in esophageal squamous cell carcinoma, which may involve the occurrence and development of the esophageal carcinoma.

Objective To explore the protective role of lipoxin A4 (LXA4) during early process of atherosclerosis formation in rats with juvenile metabolic syndrome (MS).Methods Rat models of juvenile MS were established with 3-week Sprague-Dawley (SD) rats fed on high-carbonhydrates and high-fat diet for 6 weeks.The other qualified ones were randomly grouped into model group,LXA4 low-dose group,LXA4 middle-dose group,and LXA4high dose group,and a control group fed with normal forage.The low,middle,high-dose groups were injected different doses of LXA4 daily,while the model group and control group were injected with the same dose of isotonic NaCl solution for 2 consecutive weeks.After 2-week medication,the visceral adipose tissue were isolated by laparotomy and heart blood collected by thoracotomy under anesthesia,followed the fixation of thoracic and abdominal aortas in the immobilized rats.The mRNA expression level of inflammation cytokines interleukin-6 (IL-6),tumor necrosis factor-α (TNF-α),C-reactive protein (CRP) in the adipose tissue were determined by semi-quantitative reverse transcription PCR (RT-PCR),respectively.Secretions of IL-6,and TNF-α in serum were determined by enzyme linked immunosorbent assay (ELISA).Immunocytochemistry was used to label endomembrane and middle-membrane of thoracic aorta,and endothelial cell layer in each group and the ratios of thickness of endomembrane and middle-membrane were compared.Results Compared with the control group,weight,body length and abdominal circumference of juvenile MS rats increased significantly (all P ＜ 0.05),and levels of fasting plasma glucose (FPG),triglyceride (TG),high density lipoprotein cholesterol (HDL-C) and insulin in models increased significantly (P ＜ 0.05).RT-PCR showed that the mRNA expressions of inflammatory cytokines IL-6,TNF-α and CRP in adipose tissue in model rats were upexpressed (all P ＜ 0.05).Compared with model rats,mRNA of IL-6,TNF-oα,and CRP in mid,high-dose rats were downexpressed (all P ＜ 0.05),mRNA of TNF-α in low-dose rat downexpressed (all P ＜ 0.05),and there were no significant differences between mRNA expressions of IL-6,CRP in low-dose and model rats according to statistics (all P ＞0.05).Compared with control group,inflammatory cytokines IL-6,TNF-α secreted in serum of model rats were increased significantly (all P ＜ 0.05),and inflammatory cytokines secreted in serum of intervention rats were decreased significantly compared with model rats (P ＜ 0.05).Pathological changes were as follows:HE staining:compared to model group,aortic tunica intima of model rats were remarkably thickened and endothelial cell layer was fragmented and incomplete,which was attenuated in each intervention group.The ratios of endomembrane and middle-membrane in rats:at the end of consecutive medication for 2 weeks,the ratios of endomembrane and middle-membrane in model rats were significantly greater than those of control group (P ＜ O.05),and the ratios of endomembrane and middle-membrane in high-dose intervention rats were significantly smaller than those of the model group (P ＜ 0.05),but still greater than control group,while there were no statistical differences between the ratios in low,middle-dose intervention rats and model rats (P ＞ 0.05).Conclusions The increasing inflammatory cytokines are involved in early process of atherosclerosis formation in rats with juvenile MS.LXA4 by reducing the expression of inflammatory factor level in adipose tissue,thereby reducing the inflammatory cytokines in serum,alleviate the damage of arterial wall.

The paper discussed the current status of the community-based home care of the elderly, mainly studying on present situation of the community elderly quality of life and six aspects of influencing factors such as age, health, economy and so on. From the three aspects of daily life care, specialized care and individualized care, care needs of the elderly were reviewed. The results showed that our country should develop the community elderly services, in particular, nursing services, to meet the demand and development of healthy aging and the positive aging society.

Continuing nursing education is an effective approach that improves comprehensive qualities of nurses,meets the requirements of society and the masses to overall performance and service quality of nurses. It has been increasingly attracting emphasis of hospitals and nurses.We review researches of current continuing education among nurses home and abroad,analyze influencing factors and discuss approaches to the factors so as to improve the implement of high quality nursing service.

Objective To investigate the effect of nurse-surgeon collaborative model to improve comprehensive nursing quality .Methods To develop the entire nurse-surgeon collaborative primary nursing model , the questionnaires were used to collect the cooperative attitude scores , bedside integrated ability assessment results , and patients , doctors and nurses satisfaction data .At the same time , the nursing quality and adverse events data were compared before and after implemented the new model .Results The scores of nurses satisfaction, doctors satisfaction and patients satisfaction were (4.06 ±0.39), (4.18 ±0.41), (4.03 ±0.36) before implemented the nurse-surgeon collaborative model and (4.42 ±0.41), (4.38 ±0.26), (4.36 ±0.38) after implemented the nurse-surgeon collaborative model .There were significant differences before and after implemented the model (t=7.5895,7.0062,3.5418, respectively;P<0.01).The comprehensive bedside ability was improved significantly ( P <0.01).The clinical effect scores of mastering patients'condition, complication prevention, theoretical knowledge and professional nursing ability were (3.04 ±0.55),(2.91 ± 0.31),(3.29 ±0.26),(3.67 ±0.47) before implemented the nurse-surgeon collaborative model and (4.81 ± 0.31),(3.59 ±0.24),(3.92 ±0.44),(3.91 ±0.40) after implemented the nurse-surgeon collaborative model.There were significant differences before and after implemented the model (t=30.711,19.000,13.503, 4.260, respectively;P <0.01 ).Conclusions Implementing the nurse-surgeon collaborative model can effectively improve nursing quality and the ability of professional nursing , and reduce the adverse events .The goal of patient satisfaction is thus achieved .