2012年 · 第125卷第15期

Abstract：Background Bladder urothelial cancer has been diagnosed at an increasing rate among young adults in China while the clinical outcomes remain highly controversial.To optimize the management of young patients with bladder cancer,we examined whether bladder urothelial cancer in young patients behaved differently from that in the elder patients.Methods From 1994 to 2008,a database of bladder urothelial cancer patients at a major tertiary medical center was retrospectively reviewed.The clinical and pathological parameters of patients who were less than 40 years of age and a series of patients older than 40 years of age as the control group during the same period were compared.A survival analysis was performed using the Kaplan-Meier method and log-rank test,and Cox regression was performed to identify clinical parameters that affected the clinic outcomes.Results Young bladder cancer patients had a lower male-to-female ratio and were less likely to have advanced stages and high-grade cancers at the initial diagnosis.Tumors in young bladder cancer patients tended to be less multifocal at diagnosis.In addition,young patients had a lower recurrence rate and longer recurrence interval than older patients.The Kaplan-Meier curve and Log-rank test showed that young patients had significantly better cancer specific survival than old patients.The univariats and multivariate Cox regression analysis revealed that tumor grade is the sole predictor for tumor recurrence in young patients.Conclusions Young patients with bladder cancer have favorable pathological features and clinical outcomes than older patients.These findings argue for more conservative management approaches for young patients with bladder cancer。

Abstract：Background It has been long suggested that abnormal clinical factors in the body,such as dyslipidemia and diabetes.can affect the presence of atherosclerosis.However,few studies on the effect of factors within the normal range,such as the loss of renal function with age,on the prevalence of atherosclerosis are few know in healthy individuals.The aim of this study was to investigate risk factors affecting the presence of asymptomatic carotid plaques in a middle-aged and elderly healthy population.Methods In this regard,we prospectively evaluated 245 healthy individuals (98 males and 147 females) at baseline and after 5 years.Changes in the presence of carotid plaque between 2003 and 2008 were categorized into four groups,i.e.subjects without plaque at entry (n=165):Group 1 (without plaque on two occasions,n=129) and Group 2 (with nascent plaque at follow-up,n=36); subjects with plaque at entry (n=80); Group 3 (with plaque regression at follow-up,n=29) and Group 4 (with plaque on two occasions,n=51).Results Univariate analysis showed that the positive rate of carotid plaques in males was higher than that in females at the baseline,and that a significantly inverse correlation existed between the prevalence rate of plaque and aging.Logistic regression analysis of cross-sectional research showed that independent risk factors for the prevalence of atherosclerosis were male gender,lower estimated glomerular filtration rate (eGFR) and higher low-density lipoprotein cholesterol (LDL-C) at the baseline,and older age and lower eGFR were involved in the presence of carotid plaques at follow-up point.However,logistic regression analysis of the longitudinal data showed that older age,decreased eGFR and increased systolic blood pressure (SBP) independently predicted the presence of carotid plaques after 5 years in subjects without plaque at entry.In addition,in subjects with plaque at entry,age,changes in eGFR and the baseline levels of serum albumin (ALB) and serum total bilirubin (BIL) dependently influenced the outcome of carotid plaque.Conclusion Physiological decline of renal function,together with advancing age,was an independent risk factor which consistently affected the presence of carotid atherosclerosis in two categories of healthy individuals。

Abstract：Background Chromosomal abnormalities have been shown to play an important prognostic role in multiple myeloma (MM).tnterphase fluorescence in situ hybridization (i-FISH) has been much more effective to identify cytogenetic aberrations in MM than conventional cytogenetic technique (CC).To clearly determine the cytogenetic features of Chinese MM patients and identify their prognostic implications,we designed a multicenter study based on i-FISH including 672 patients from 52 hospitals in China.Methods All 672 patients were systematically screened for the following genomic aberrations:del(13q).lgHrearrangement,del(p53) and 1q21 amplifications.Results The analysis showed that the chromosomal changes were detected in 22.1％ patients by CC and in 82.3％patients by i-FISH.The most common abnormalities by CC were chromosome 1 aberrations (48.4％),-13/13q- (37.6％),hyperdiploidy (36.6％),hypodiploidy (30.1％) and lgH rearrangements (23.7％).The most frequent abnormalities by FISH was del(13q),which was found in 60.4％ patients.whereas IgH rearrangement,1q21 amplification and p53 deletions were detected in 57.6％,49.0％ and 34.7％ cases.respectively.By statistical analysis.-13/13q- by CC was associated with low level of platelet (P=0.015).hyperdiploidy was associated with low level of serum albumin (P=0.028),and lgH rearrangement by FISH was associated with high level of β32 microglobulin (P=0.019).Moreover,1q21 amplification and del(p53) by FlSH conferred a high incidence of progressive disease (PD) after initial therapy.Metaphase detection of lgH rearrangements and chromosome 1 aberrations concurrently was associated with a short progression free survival (PFS)(P=0.036).No significant prognostic implications of other cytogenetic abnormalities were found associated with overall survival and PFS.Conclusions Chinese MM patients had similar cytogenetic abnormalities compared with the previous reported studies.However,the prognostic significance of FISH aberrations were not clearly determined and further study is required。

Abstract：Background Incretin-based therapies provide additional options for treating type 2 diabetes.We aimed to evaluate the efficacy and tolerability of exenatide monotherapy in obese patients with type 2 diabetes.Methods A 26-week,mefformin controlled,parallel-group study was conducted among antidiabetic drug-naive obese patients aged ＞18 years,and with type 2 diabetes.Participating patients were randomly assigned to receive exenatide or metformin treatments.Results Fifty-nine patients (age (50.5±8.6) years,body mass index (BMI) (30.2±1.6) kg/m2,and hemoglobin A1C (HbA1c (8.2±1.2)％) were enrolled in the study.Glucose control and weight reduction improved in both groups receiving treatment.HbA1c and oral glucose tolerance test (OGTT) 2 hour glycemia reduction with exenatide was superior to that obtained with mefformin ((-2.10±1.79)％ vs.(-1.66±1.38)％,(-5.11±2.68) mmol/L vs.(-2.80±2.70) mmol/L,P ＜0.05).Fast plasma glucose (FPG) reduction was not significantly different between the two groups ((-1.8±2.0) mmol/L vs.(-1.6±1.7) mmol/L,P ＞0.05).Patients treated with exenatide achieved HbA1c of ＜7％ (97％ of patients) and ＜6.5％ (79％)at end-point,vs.93％ and 73％ with metformin (P ＞0.05).Greater weight reduction was also achieved with exenatide ((-5.80±3.66) kg) than with metformin ((-3.81±1.38) kg,P ＜0.01).Homeostasis model assessment of beta-cell function (HOMA-B) was not significantly increased,but the insulinogenic index and HOMA for insulin sensitivity (HOMA-S) were greatly improved in the exenatide group (P ＜0.05).Nausea was the most common adverse effect in exenatide treatment (30％ vs.8％; P ＜0.05),but most cases were of mild to moderate intensity.One case in the exenatide group was withdrawn earlrly because of severe nausea.Hypoglycemia events were often observed during the first 4 weeks,with 12％of patients in the exenatide and 3.2％ in metformin groups,respectively (P ＜0.05).No incidents of severe hypoglycemia were reported.Conclusions Exenatide demonstrated more beneficial effects on HbA1c.weight reduction and insulin resistance during 26 weeks of treatment,but there were more hypoglycemic events and mild-to-moderate nausea compared with metformin.These results suggested that exenatide monotherapy may provide a viable treatment option in newly developed type 2 diabetes。

Abstract：Background Endometriosis affects natural fertility through various approaches,and in vitro fertilization (IVF) is a good treatment.But the IVF result of endometriosis patients is still under debate.We investigated the effect of endometriosis on IVF by analyzing the data from a single reproductive center.Methods A retrospective,database-searched cohort study was performed.Relevant information was collected from the electronic records of women who underwent IVF/intracytoplasmic sperm injection between January 2006 and December 2010 in the Assisted Reproductive Unit of Sir Run Run Shaw Hospital.Patients with endometriosis were enrolled the study group.The rest of the women formed the control group.The main outcome was the clinical pregnancy rate.Secondary outcomes were oocytes retrieved number,fertilization rate,high-quality embryo rate,number of high-quality embryo for embryo transplantation,and implantation embryo/high-quality embryo ratio (IE/HQE ratio).Comparisons were performed by the x2-test and independent t-test.Results The endometriosis group (n=177) had a markedly lower oocytes retrieved number,fertilization rate,implantation rate,and clinical pregnancy rate (7.6±5.1,63.6％,27.7％,and 45.2％,respectively) compared with the non-endometriosis group (n=4267; 11.8±7.3,68.4％,36.2％,and 55.2％,respectively).Stratified analysis showed that this difference was found in the subgroup younger than 35-years old,while only fertilization rate and implantation rate were different in the elder subgroup.The ratio of high-quality embryos transferred is lower in endometriosis group (53.7％ vs.71.8％,P ＜0.05),but there is no difference in IE/HQE ratio between two groups.There is no significant difference in fertilization rate,implantation rate,and clinical pregnancy rate between mild and severe endometriosis patients.Conclusions Endometriosis patients suffer a decreasing IVF pregnancy rates mainly caused by reducing oocytes number and fertilization rate,regardless of the severity of the disease.Appropriate intracytoplasmic sperm injection manipulation might improve the outcomes of IVF。

Abstract：Background Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) is associated with fewer unfavorable events.However,the hemodynamic change in FFR after different stenting approaches for bifurcation lesions is still not fully studied.The aim of this study was to analyze the hemodynamic changes in FFR after double kissing (DK)crush and provisional side branch (SB) stenting (PS) for true coronary bifurcation lesions.Methods Seventy-five patients with true bifurcated lesions were randomly divided into DK (n=38) and PS (n=37)groups.Additional SB stenting in the PS group was required if there was any pinched SB ostium ＞70％ stenosis.or ≥ type B dissection,or TIMI flow ＜grade 3.FFR at hyperemia in the main vessel (MV) and SB was measured prior- and post-stenting,and at 8 months follow-up.Results Baseline clinical,angiographic and lesion characteristics were matched well between the two groups,with the exception of the final kissing balloon inflation (FKBI,100.0％ in the DK vs.83.8％ in the PS group,P ＜0.001).Baseline FFR was comparable between the DK and the PS groups,however,the acute gain and late loss of SB FFR at 8-month follow-up in the DK group were 0.18±0.15 and -0.06±0.11,compared to 0.12±0.18 (P=0.044) and -0.002±0.07 (P=0.037)in the PS group,respectively.MV FFR post-stenting ＞0.94 was seen in about 40％ of patients.There was no significant difference in the clinical events at 1-year follow-up between the two groups.Conclusions DK crush was associated with improved acute gain and late loss of SB FFR.The lower rate of FFR ＞0.94 after stenting underscored the further improvement of stenting quality。

Abstract：Background Mycoplasma pneumoniae (M.pneumoniae) is one of the common pathogens causing atypical pneumonia.In recent years,resistance to macrolides has become more common,especially in China.Previous studies have confirmed that the mutation at position 2063 in domain V of the 23S rRNA is the most prevalent,followed by the mutation at position 2064.Reported molecular detection methods for the identification of these mutations include direct sequencing,restriction fragment length polymorphism analysis,real-time polymerase chain reaction (PCR) with high-resolution melt analysis,and nested PCR-linked with capillary electrophoresis,etc.The most commonly used method for monitoring resistance-conferring mutations in M.pneumoniae is direct DNA sequencing of PCR or nested PCR products.However,these methods are time-consuming,labor-intensive or need expensive equipments.Therefore the development of rapid and sensitive methods is very important for monitoring the resistance globally.Methods In this study,we reported a fast and cost-effective method for detecting 2063 and/or 2064 macrolide resistant mutations from specimens using a modified allele-specific PCR analysis,and all results were compared with the sequencing data.We also analyzed the clinical courses of these samples to confirm the modified allele-specific PCR results.Results Among 97 M.pneumoniae specimens,88 were found to possess mutations by this method,and all modified allele-specific PCR analysis results were consistent with the sequencing data.The data of the clinical courses of these 97cases showed that they suffered from severe pneumonia.Erythromycin showed better efficacy on cases from which no macrolide resistance mutation was found on their specimens.However,in some cases from which mutations were detected,erythromycin monotherapy had poor efficacy,and on these patients severe symptoms improved only when azithromycin was added to the treatment.Conclusions The drug-resistant M.pneumoniae is very common in Beijing,China.Our modified allele-specific PCR analysis can identify erythromycin resistant mutations more rapidly from specimens than any other method currently available.Erythromycin is still effective for treating patients infected with the mutation negative M.pneumoniae,but this treatment fails to work on mutant organisms.This method can facilitate clinicians in selecting appropriate therapy within short timescales。

Abstract：Background Recently,the combination of sevoflurane and remifentanil has been widely used in general anesthesia.In this study,we investigated the sevoflurane-remifentanil pharmacodynamic interactions at clinical concentrations using the observer's assessment of alertness/sedation (OAA/S) and the bispectral index (BIS) by response surface analysis.Methods Totally 65 American Society of Anesthesiologists (ASA) I patients age 20 to 50 years old were included in this study.Patients were randomly assigned to be anesthetized with different target end-tidal sevoflurane concentrations that ranged from 0.2％ to 3.4％ in increments of 0.2％.The end-tidal sevoflurane concentration was maintained constant throughout the study.Remifentanil was infused with a target controlled infusion (TCI) system at increasing step-wise concentrations from 1 ng/ml to 10 ng/ml.The values of OAA/S and BIS at different sevoflurane-remifentanil concentration combinations were measured.The pharmacodynamic interactions between sevoflurane and remifentanil were analyzed by a response surface method.The three-dimensional response surfaces were constructed with Minitab Software.Model parameters were estimated with NONMEM program.Results Sevoflurane and remifentanil acted synergistically on OAA/S.Sevoflurene alone could produce OAA/S ≤1 at a minimal alveolar concentration (MAC) of 0.93％.When used in combination with remifentanil at 1,3,6,and 10 ng/ml,the corresponding sevoflurane MACs were reduced to 0.79％,0.58％,0.48％,and 0.38％,with reductions of 17.2％,37.6％,48.4％,and 62.0％ from baseline,respectively.In patients administered remifentanil alone,the OAA/S score was ≥3 even when the remifentanil cencentration reached 10 ng/ml.BIS was closely associated with the sevoflurane concentration and the remifentanil concentration did not noticeably influence the relationship between the sevoflurane concentration and BIS.A sevoflurane concentration of (1.04±0.19)％ to (1.81±0.21)％ could maintain a BIS between 60 and 40.Conclusions The response surface method can analyze the pharmacodynamic interactions between remifentanil and sevoflurane qualitatively and quantitatively.Within the range of our study (remifentanil ≤10 ng/ml,sevoflurane ≤3.4％),the two drugs produced synergistic effects on OAA/S but had no interactive effect on BIS.A guideline of BIS between 40 and 60 may cause excessive anesthesia when opioids are used to maintain anesthesia。

Abstract：Background Noninvasive functional magnetic resonance imaging (fMRI) techniques have opened a “window” into the brain.allowing us to investigate the anatomical and physiological function involving acupuncture needling.Imaging its sustained effect rather than acute effect on the brain networks may further help elucidate the mechanisms by which acupuncture achieves its therapeutic effects.In this study,we aimed to investigate the functional brain networks during the post-resting state following acupuncture at KI3 in comparison with acupuncture at GB40.Methods Needling at acupoints GB40 and KI3 was performed in twelve subjects.Six minutes of scanning at rest were adopted before and after acupuncture at different acupoints.Then we divided the whole brain into 39 regions and constructed functional brain networks during the post-acupuncture resting states (PARS).Results For direct comparisons.increased correlations during post-resting state following acupuncture at KI3compared to resting state (RS) were primarily located between the dorsolateral prefrontal cortex (DLPFC) and post temporal cortex,ventromedial prefrontal cortex (vmPFC) and post temporal cortex.These brain regions were all cognitive-related functions.In contrast.the increased connections between the anterior insula and temporal cortex mainly emerged following acupuncture at GB40 compared with the RS.Conclusions The present study demonstrates that acupuncture at different acupoints belonging to the same anatomic segment can exert different modulatory effects on the reorganizations of post-acupuncture RS networks.The heterogeneous modulation patterns between two conditions may relate to the functional specific modulatory effects of acupuncture。

Abstract：Background Ibutilide has been commonly used for pharmacologic cardioversion of atrial fibrillation and flutter in clinical settings.The objective of this study was to investigate the effects of ibutilide on the defibrillation threshold (DFT),restitution properties,dispersion of refractoriness and activation patterns during ventricular fibrillation (VF).Methods lbutilide was administrated intravenously in six open-chest beagles.Before and after the drug administration,20-second episodes of VF were electrically induced and recorded with a 10x10 unipolar electrode plaque sutured on the lateral epicardium of the left ventricle.DFT and VF activation patterns,including type of epicardial activation maps.VF cycle length (VF-CL),conduction velocity.wavelength (WL) and reentry incidence,were measured.Restitution properties and dispersion of refractoriness were estimated from activation recovery intervals (ARI) during pacing.Results Compared to baseline,ibutilide markedly decreased the DFT by 31％ ((491±14) V vs.(337±59) V.P＜0.01).The drug significantly reduced the maximal slope of the restitution curve (1.34::0.08 vs.0.76±0.06.P ＜0.01) and its epicardial dispersion (0.36±0.09 vs.0.21±0.06.coefficient of variation.P=0.03).The dispersion of refractoriness was enhanced at the pacing cycle length of 300 ms to 160 ms by ibutilide.The drug significantly increased the VF-CL ((96±19) ms vs.(112±20) ms,P ＜0.01) and the WL ((41±9) mm vs.(52±14) mm,P=0.02) during VF,and reduced the reentry incidence by 25％ (0.08±0.02 vs.0.06±0.02,P ＜0.01).In the epicardial activation maps,ibutilide significantly reduced the percentage of more complex activation maps during VF.Conclusions Intravenous ibutilide significantly decreased the DFT.It might be due to reduction of activation pattern complexity during VF。

Abstract：Background Multiple organ dysfunction syndrome in the elderly (MODSE) is a problem with high mortality in the critical care of elderly patients.The pathogenesis of MODSE remains elusive.This study aimed to establish rat models of MODSE and to investigate the pathogenetic mechanism responsible for the development of MODSE in the rat models.Methods Twenty-four-month old rats (elderly) received intravenous injection of lipopolysaccharide (LPS) to induce rat model of MODSE.In the model,we observed the physical responses,biochemical indices changes,histopathological features of vital organs,including lung,liver,heart,and kidney.We also investigated the sequence of individual organ dysfunction and changes of proinflammatory factors.Three-month-old rats.serving as young rat controls,received parallel procedures.Besides,normal saline injection was also performed on elderly and young control rats.Results All rats displayed different degree of physical response after LPS injection,preceded by deterioration of respiratory status.At 6 hours,lung injury was observed,which started eariier than other organ injury that was observed in about 24 hours.Furthermore,all vital organ injury was more severe in elderiy rats than in young rats at the same time points.After LPS injection,pulmonary alveolar macrophages apoptosis rate increased obviously,and was more significant in elderly rats ((43.4±8.4)％) than in young rats ((24.2±3.0)％).LPS injection also enhanced tumor necrosis factor α (TNF-α) concentration significantly in these organs.Its peak concentration appeared at 6 hours in lung tissue and at 24 hours in other organs after LPS injection.TNF-α level was higher in elderly rats than in young rats at the same time points.The increase was most significant in lung tissue.After intravenous administration of LPS.toll-like receptor 4(TLR4) expression in lung tissue was upregulated markedly,and peaked at 6 hours.In contrast,upregulation of TLR4expression in liver peaked at 24 hours,lagging behind that in the lung.Conclusion Lung is the first and most seriously injured organ in rat model of MODSE and it may play an “initiating” role in the development of MODSE。

Abstract：Background With features of high tissue contrast,MRI can be used for the qualitative and quantitative evaluation of atherosclerosis plaques.In this study we investigated the development of atherosclerosis plaque with high resolution 3T MRI in a rabbit model and compared the findings with the histopathological results.Method Twenty male New Zealand white rabbits were randomly allocated into an experimental group (n=16) and a control group (n=4).Atherosclerotic lesions were induced in the abdominal aorta by balloon injury and cholesterol feeding.Multiple sequences MRI examination (ToF,T1WI,T2WI,and CE T1WI) were performed at the 2nd,3rd,and 4th months after aortic denudation.Vessel wall thickness,total vessel area,lumen area,and vessel wall area were recorded.Plaque components were analyzed using histological results as a standard reference.Results Seventeen rabbits (14 in the experimental group and 3 in the control group) received all three MR examinations.Gradually,from 2 months to 4 months,vessel wall thickness and area in the experimental group increased significantly compared with the control group (P ＜0.01).In the lumen area progressive stenosis was not found,even a slight dilation had developed in the experimental group.Lipid,fibretic and calcified plaques can be differentiated by MR image.According to histological results,MRI had good performance in detection of lipid plaque.Conclusion MRI can be used to monitor progression of atherosclerosis and differentiate plaque components。

Abstract：Background Tagged magnetic resonance imaging (MRI) is the non-invasive golden standard to measure myocardial deformity.Tissue Doppler Imaging can be used to assess myocardial deformity,however,it has the limitation of angle-dependence.Our study aimed to compare left ventricular torsion and strains measured by velocity-vector imaging (VVI) using echocardiography (echo-VVI) and MRI (MRI-VVI),and to validate them against harmonic phase tagged MRI (HARP MRI).Methods A total number of 34 subjects (14 normal and 20 patients) were evaluated.Apical and basal image of left ventricular short axis view were acquired for measurements of apical and basal rotation.circumferential and radial strain using both echo-VVI and MRI-VVl.An apical four-chamber view was obtained for measuring the distance between the apical and basal levels.Results The correlations of segmental rotations,circumferential and radial strains were high between echo-VVI and HARP MRI,while the agreement of apical rotation was poor.Left ventricular torsion showed much better correlation and agreement between echo-VVI and HARP MRI than apical rotation:the coefficient was 0.97,P ＜0.001.The correlation between MRI-VVI and HARP MRI in quantifying rotational parameters and strains was similar with echo-VVI and HARP MRI.Echo-VVI could discriminate normal and dysfunctional ventricles on either hypertensive or dilated cardiomyopathy.Conclusion The data from this study show that (1) it is feasible to quantify left ventricular torsion and myocardial strain using echo-VVI and MRI-VVI in normal subjects,patients with left ventricular global systolic dysfunction and segment systolic dysfunction; (2) the agreement among all mechanical parameters derived from echo-VVl,MRI-VVI,and HARP MRI remained with clinically acceptable ranges。

Abstract：Background Clara cell secretory protein (CC16) is an important lung derived protective factor and may play an important role on the pathogenesis of acute lung injury (ALl) induced by endotoxemia.Growth hormone (GH) is an important anabolism hormone secreted by GH cells of the hypophysis.Pravious research showed that GH would significantly exacerbate ALl induced by endotoxemia,but the mechanism is not very clear yet.Whether the effects are related to CC16 or not is undetermined.Methods One hundred and twelve male Sprague-Dawley rats were randomly divided into an ALl group and a GH group.The rats in the two groups were subdivided into seven subgroups,according to injection with lipopolysaccharides (LPS) or not,then according to different intervals of time after LPS injection; 0 hour (pre-injection of LPS,acted as control group),0.5 hour,1 hour,2 hours,4 hours,6 hours and 24 hours for subgroups.Pulmonary alveolar septa area density (PASAD) and ploymorphonuclear cells (PMN) in the lungs were analyzed morphometrically.The levels of tumor necrosis factor (TNF) and interleukin 6 (1L-6) were determined by radioimmunoassay.To analyze the expression and activation of nuclear factor kappa B (NF-kB),the numbers of NF-kB positive cells in lungs were counted after immunofluorescence staining.and the levels of NF-KB inhibitory protein-α (1KB-α) in lung homogenates of rats were detected by Western blotting.The expression levels of CC16 mRNA in lungs of the rats with ALl were determined by semi-quantitative reverse transcription polymerase chain reaction (RT-PCR).The levels of CC16 protein in lung homogenates were detected by Western blotting.Results Half an hour after LPS injury both the PASAD and PMN numbers in lungs of the rats with ALl began to increase significantly and peaked at 6-hour post-injury.They then began to recover and reached normal levels at 24-hour post-injury.Both the PASAD and PMN numbers in the GH group increased more significantly than those in the ALl group.The levels of TNF in lungs of the rats with ALl homogenates increased significantly 0.5-hour post-injury,peaked at 1-hour and maintained a high level until 6 hours then gradually recovered.The content of TNF in the GH group lung homogenates increased more significantly than in the ALl group post-injury.The contents of 1L-6 in rat lung homogenates began to increase significantly at 1-hour post-injury,peaked at 4 hours then gradually returned to normal levels by 6hours post-injury.The levels of 1L-6 in the lung homogenates of the GH group were higher than in the ALl group at different time intervals post-injury.The number of NF-KB positive cells increased dramatically at 0.5-hour post-injury,and the fluorescence intensity was enhanced.Both peaked at 4-hour post-injury.The number of NF-kB positive cells and the enhanced intensity of fluorescence began to decrease from 6-hour post-injury,but the number of NF-kB cells at 24 hours post-injury was still higher than in the control group.The number of NF-KB cells in lungs in the GH group was significantly higher than in the LPS group at the different time intervals post-injury.The 1KB-α expression in lungs of the rats with ALl homogenates decreased dramatically 0.5-hour post-injury,reaching a nadir at 4-hour post-injury and then began to recover.The levels of 1KB-α in GH group were significantly lower than those in ALl group.Both the levels of CC16 mRNA and protein in lungs of the rats with ALl began to decrease significantly 0.5-hour post-injury,reached a nadir at 6 hours,and then began to recover.Both the expression of CC16 mRNA and CC16 protein in the GH group were significantly lower than those in the ALl group at the different time intervals post-injury.Correlation analysis indicates that CC16correlates significantly with all the indices mentioned above.Conclusions Down-regulation of CC16 expression plays a critical role in the pathogenesis of acute lung injury induced by endotoxemia.The application of GH can exacerbate the lung injury induced by endotoxemia through down-regulating the expression of CC16。

Abstract：Background Epithelial-mesenchymal transition is a cellular process characterized by the loss of cell adhesion,inhibition of E-cadherin expression,and increased cell mobility.Cells without Napsin A are susceptible to transition.Further studies are required to investigate whether this transition can be reversed by restoration of Napsin A.Methods A Napsin A expression vector PLJM1-Napsin A plasmid was constructed and then transfected into the epithelial cell line A549 by lentivirus transfection to obtain A549-PLJM1-Napsin A cell line.Cell proliferation was assayed by 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyltetrazolium bromide and cell cycle was measured by flow cytometry.The E-cadherin,type I collagen,and focal adhesion kinase mRNA level was detected by reverse transcription-polymerase chain reaction.The Napsin A,E-cadherin,type I collagen,and focal adhesion kinase protein level in A549 cells was detected by Westen blotting.Results Transforming growth factor-β1 induced epithelial-mesenchymal transition in A549 cells,as demonstrated by significant reduction of E-cadherin mRNA and protein levels (P ＜0.01) as well as up-regulation of type I collagen (P ＜0.01 ).Transfection of Napsin A in A549 cells can partially block the transforming growth factor-β1-regulated expression of E-cadherin and type I collagen (P ＜0.01).In addition,transforming growth factor-β1-induced cell proliferation was inhibited by Napsin A (P ＜0.01).Further study demonstrated that Napsin A caused Go/G1 arrest and inhibited the expression of focal adhesion kinase (P ＜0.01),a key protein in the integrin signaling pathway,in the in vitro epithelial-mesenchymal transition model.Conclusions Sustained Napsin A expression in A549 cells can inhibit the transforming growth factor-β1-induced epithelial-mesenchymal transition.This may be due to the Napsin A-mediated inhibition of focal adhesion kinase expression and integrin signaling pathway。

Abstract：Background The neonatal ventral hippocampal lesion (NVHL) rat model has been proposed as an experimental model for schizophrenia.NVHL rats display impaired central nervous system (CNS) inhibition,which may lead to a phenomenon similar to P50 sensory gating deficits observed in schizophrenic patients.In this study,we investigated whether sensory gating deficits occurred in the NVHL rat as a model for schizophrenia.Methods We created the NVHL rat model using ibotenate.The P20 and N40 were measured to assess sensory response and gating in NVHL and sham rats.Epidural electrodes recorded evoked potentials (EPs).from which latencies,amplitudes,difference scores (S1-S2),and gating ratios (S2/S1) were assessed.Results Compared with sham controls,prolonged S1 N40 latency and decreased S2 N40 amplitude were detected in the NVHL group.In neither difference scores nor gating ratios,a significant difference was found between NVHL group and sham controls.Conclusions NVHL rats may be a valid animal model for schizophrenia.This strategy will be useful in future neurobiological studies investigating the etiology of schizophrenia。

Abstract：In this report,we present two cases of bronchial foreign body granulomas caused by the suture ties used in bronchial surgery for esophageal cancer.Both of them was hospitalized as “tumor transfer or an invasion”,but pathological examination of the neoplasms indicated an inflammatory granuloma showing reaction to the foreign body,These two cases give us an attention that the neoplasms in tracheal or bronchial was not only the invasion or transfer of the primary tumor,but also the possibility of grenuloma development due to the surgical sutures。

Abstract：Thrombolysis with intravenous tissue plasminogen activator (t-PA) is currently an approved therapy for patients with acute ischemic stroke.Acute myocardial infarction (AMI) immediately following t-PA treatment for stroke is a rare but serious complication.A case of acute myocardial infarction (MI) following IV t-PA infusion for acute stroke was observed.This is a 52-year-old male with a known history of hypertension and chest pain,who subsequently developed MI four hours after IV t-PA was administered for acute ischemic stroke.The disruption of intra-cardiac thrombus and subsequent embolization to the coronary arteries may be an important mechanism.In addition.spontaneous recanalization of infarct-related arteries may be associated with 9reater myocardial salvage and better prognosis。

Abstract：The incidence of multiple noncontiguous spinal injuries (MNSI) in the cervical spine is rare but has catastrophic consequences.The patient in this report was a 34-year-old woman with five-level cervical MNSI.CT and MRI showed that injuries included atlantoaxial instability,burst fracture of C6,dislocation of G6/7,rupture of the intervertebal disc or ligamentous complex,and irreversible cord damage.The mechanism for this case was a combined pattern of hyperflexion,compression,and hyperextension injuries.A review of the literature revealed that this case is the first report in the literature of a vehicle related accident causing five-level noncontiguous injuries of the cervical spine。

Abstract：We reported a case of multiple type Ⅱ endoleaks detected by duplex ultrasound after endovascular abdominal aneurysm repair.The patient was undergoing warfarin therapy.Duplex ultrasound was applied as the sole surveillance method during follow-up and provided the concerned information for reintervention.The endoleaks were successfully repaired by coil embolization of the collaterals from the internal iliac artery feeding the fourth lumbar artery。

Abstract：A patient referred to our hospital,diagnosed with left idiopathic chronic orchialgia,was evaluated with a thorough medical and psychiatric history,physical examination,scrotal ultrasound and magnetic resonance imaging.Conservative management failed.The patient had temporary pain relief after undergoing outpatient cord block three times.Microsurgical denervation of the left spermatic cord was operated in March,2011.A pain questionnaire was used to determine efficacy before and after operation,and complete pain relief was noted at one week after operation.The follow up period was 12 months,at the end of which the pain score was still zero.No complications,including testicular atrophy and hydrocele,occurred.Microsurgical denervation of the spermatic cord can be a minimally invasive,safe and effective management option for treatment of idiopathic chronic orchialgia。

Abstract：Intracranial germinomas are malignant neoplasms of gonadal origin,which have some features in terms of age,sex,and clinical manifestations.They mainly occur in children and adolescents.Patients with intracranial germinomas mainly manifest with hypothalamic pituitary axis dysfunction and/or compression syndromes.Visual disturbance is one of the most significant clinical presentations.which is mainly caused by tumor cell infiltration into the optic pathway.In this article,we present three cases of patient with intracranial germinoma to analyze the ocular manifestations.All the three patients presented with endocrine symptoms in the early stage and with visual disturbances (including decreased visual acuity and visual field defects) later.In general,germinoma is diagnosed by its characteristic radiological appearance,supported by tumor markers and/or stereotactic biopsy.However,decisive diagnoses were established when ocular manifestations were presented.A suspicion for germinoma should be considered,when young patients manifest visual disturbances accompanied by endocrine symptoms。