The treatment modalities of stem cells repairing infarction myocardial include stem cell transplantation and mobilization.The inflammatory factors and cytokines play an important role in the process of repairing infracted myocardium. In this paper we will review the effect of cytokines on the process of stem cells mobilization, homing, proliferation and differentiation in after acute myocardium infraction.

The authors conceive of dispersing and transferring medical risks by means of insurance. They suggest developing two modules of insurance business, including malpractice insurance and medical accident insurance. They also discuss such basic issues as risk financing, financial compensation and choice of insurance undertakers.

Objective To investigate fracture patients' perception about pain and analgesic.Methods In-depth interview for 30 min was done for 20 fracture patients within 12 h after their admission.Data were analyzed based on Colaizzi phenomenological research method.Results Fracture patients underestimated the influence that pain had dosne to them.When they were suffering from pain,most of them chose to endure until they couldn't endure anymore.For analgesics,most of them chose to avoid from using them unless they couldn't endure anymore.Conclusions Pain management education should be done to help patients correct their bias about pain,know more about analgesics according to their personal conditions,and help them self-report their pain and manage their pain timely and properly.

Objective To evaluate the effectiveness of uterine arterial embolization (UAE) in the management of uterine fibroids (UF) and adenomyoma. Methods The UAE was carried out in 22 cases of UF and 2 cases of adenomyoma, including bilateral UAE in 23 cases and unilateral UAE in 1 case, by using polyvinyl alcohol (PVA) particles as embolic materials. Results The success rate of UAE in the study was 95 8% (23/24). No serious complications occurred. The uterine and UF volume decreased remarkably in size 6 months after the treatment ( t =2 391 and 3 990, respectively; P =0 022 and 0.000, respectively). In the patient who underwent unilateral UAE, the UF gradually increased in size and a hysterectomy was required. The 2 patients with adenomyoma experienced relief with this treatment but had a recurrence 4 months after the surgery. Conclusions UAE is a safe and effective method in the management of UF but its long-term effects remains a question to be answered through further observations . The efficacy of treatment of this method for adenomyoma is not apparent.

Objective To compare the effects of Ephedrine and combined with small dose cisatracurium treatments on the onset time of cisatracurium and hemodynamics in elderly patients.Methods Sixty cases of elderly patients undergoing elective surgery under general anesthesia were randomly divided into 4 groups:E group (ephedrine pretreatment),P group (cisatracurium primin),PE group (cisatracurium priming and ephedrine pretreatment) and C group(control),and each group of 15 cases.Cisatracurium 0.15 mg/kg were given in P group and PE group,and then ephedrine 70 μg/kg were given in PE group and E group.Anesthesia was induced with target controlled infusion of propofol (target plasma concentration 3-5 pg/ml),fentanyl 3-4 pg/kg.Cisatracurium 0.015 mg/kg were given in E group and C group,and P group and PE group dose intravenous cannula remaining.Tracheal intubation was performed when the twitch height depressed to 0.Results The Onset time of PE,C,E and P group were (164±28) s,(306±61) s,(187±31) s and (193±40) s and there were significant differences(F=33.990,P＜0.01).The onset time of PE group was shorter than that in C,E,P group,and the difference was significant (P＜0.05).Systolic pressure (SBP) and mean arterial pressure (MAP) levels in four groups after induction were lower than those before induction (F =35.783,30.015,P =0.000).SBP,diastolic blood pressure (DBP),MAP in PE group and E group were significant higher than those in C group(P＜0.05).After inductions,heart rate(HR) in PE group was significant different form that in C group(P ＜0.05),and HR of C group was significantly decrease than before inductions(P＜0.05).After inductions,the cases with DBP were 11 patients(73.3％) in C group,10 patients(66.7％) in P group:,5 patients(33.3％) in E group,and 4 patients (26.7％) in PE group,the different were significant (x2 =9.867,P ＜ 0.05).After intubation,cases with increase blood press were 3 patients (20.0％) in C group,5 patients(33.3％) in E group,and 4 patients(26.7％) in E group and PE group(P＞0.05).Conclusion Ephedrine of 70 μg/kg can relief the circulatory depression and accelerate the onset time of cisatracurium in the elderly patients.Combined with cisatracurium priming can further shorten the onset time and be for elders.

A retrospective analysis was carried out in 10 antineutrophil cytoplasmic antibody (ANCA) positive patients treated with propylthiouracil (PTU). Six patients were diagnosed to be suffering from vasculitis via lung or renal biopsy. All 10 patients′ symptom disappeared and the titer of ANCA fell down after discontinuing PTU or using immunosuppressive agents.

Objective To report a new surgical approach (modified anconeus flap approach) in which the anconeus and part of triceps are reflected in the treatment of distal intercondylar humerus fracture (AO type C).Methods To design the modified anconeus flap approach,the anatomy of the distal tendon of the triceps brachii and the anconeus was studied using 15 cadaveric adult specimens (30 sides).The new surgical approach was compared with the triceps-reflecting anconeus pedicle (TRAP) approach in terms of the area of exposure at the distal humeral articular surface.Furthermore,the new surgical approach was applied in 16 patients who had been treated for intercondylar humerus fracture (AO type C) from May 2005 to May 2013.The clinical outcomes were evaluated using the Mayo elbow performance score (MEPS) and Broberg-Morrey scoring systems.Results The blood supply and innervation of the anconeus was interrupted minimally during incision along the radical edge of triceps tendon.The area of exposure at the distal humeral articular surface provided by the part triceps and anconeus reflecting approach and the medial humerus approach was 42.66％ ± 0.03％ at the elbow flexion from 0° to 50°.This was significantly smnaller than that provided by the TRAP approach (46.11％ ±0.03％) (P ＜0.05).Of the 16 patients,15 obtained complete follow-ups from 6 months to 4 years(average,16.5 months).The mean MEPS at the last follow-up was 90.5 points (range,from 82 to 93 points),with 10 excellent and 4 good cases and one poor case.The Broberg & Morrey score system showed 11 patients with no articular cartilage degeneration (level-0),3 patients with level-1 degeneration,and 2 patients with level-2 degeneration.Conclusion The modified anconeus flap approach proposed in the present study provides clear surgical vision and needs no olecranon osteotomy or olecranon dissection or ablation of the major triceps brachii tendon for intercondylar humerus fractures,thereby leading to early active motion and satisfactory clinical outcomes.

Objective To investigate the effect of human hepatocellular carcinoma HepG2 cell-derived Exosome on the differentiation of mesenchymal stem cells(MSC)into cancer-associated myofibroblasts(CAF)and the impacts of CAF on liver cancer cell proliferation,migration,and invasion. Methods The protein expression of HepG2 cell-derived Exosome was detected by Western blotting. MSCs were separated from human adipose tissue and cultured with HepG2 cell-derived Exosome(100 ng/nl)to initiate differentiation. The expressions of mesenchymal markers and several interleukins were also detected by Western blotting. HepG2 cells were co-cultured with the conditioned media(CM),in which HepG2 Exosome induced the differentiation of MSC into CAF. The expressions of epithelial and mesenchymal markers were detected by real-time polymerase chain reaction(PCR)and Western blotting. Cell proliferation was assessed using MTS assay. Transwell chambers were used in the in vitro migration and invasion assay. Results HepG2 cell-derived particles expressed CD63,70 kilodalton heat shock proteins,and 90 kilodalton heat shock proteins. With the treatment of HepG2 cell-derived Exosome,the expressions of mesenchymal marker α-smooth muscle actin,fibroblast activation protein α,interleukin(IL)-6,IL-8,and IL-1β were up-regulated,while vascular endothelial growth factor had no significant change. The conditioned media which HepG2 Exosome induced MSC differentiation CAF(CAF-CM)could significantly promote HepG2 cells proliferation(1.075±0.104),compared to BSA control(0.874±0.066,P=0.023)and MSC-CM(0.649±0.034,P=0.0005). CAF-CM could significantly enhance cell migration [(42.5±9.1) cells vs.(18.5±3.1) cells,P=0.001] and invasion [(29.0±3.5) cells vs.(13.1±3.7) cells,P=0.009] compared to its control group. Moreover the conditioned medium which HepG2 Exosome induced MSC to differentiate into CAF could also promote the expressions of mesenchyme-related genes Smad interacting protein 1(P=0.040),β-catenin(P=0.038),fibronectin(P=0.029),and Vimentin(P=0.013)and inhibit the expression of epithelial related genes zonula ocdudens-1(P=0.010).Conclusions Exosome extracted from HepG2 cells can induce human adipose-derived MSC to differentiate into cancer-associated myofibroblasts. CAF-like cells can promote the migration of the liver cancer cell line HepG2.

Objective To understand the experience of stroke patients during the period of com-munity rehabilitation by analysis of the in-depth feeling of them in order to supply reference for communi ty rehabilitation nursing. Methods According to the possible problems of stroke patients including in-nermost feelings, difficulties during community rehabilitation, and the expectation of getting solution, by the instruction of Van Manen's hermeneutic phenomenological methods and adoption of in- depth inter-view, the data of 11 participants were collected and analyzed deeply. Results By using the principle of reflection, comparison and induction six mutually exclusive themes emerged, which were tided: sadness and dread, frustration and useless, fate, unfair and punishment, infeh disguise, self-balance and aspiration of the professional guidance. Conclusions The professional instruction for stroke patients and their families is impending during the period of community rehabilitation.

Objective To study the expression and clinical significance of Notch intracellular domain (NICD) in cervical cancer and the effects of N-[N-(3,5-difluorophenyl)acetyl-L-alanyl]-S-phenyl glycine t-butyl ester (DAPT), a γ-secretase inhibitor on the proliferation and apoptosis of cervical cancer cell lines. Methods Western blot was used to detect the expression of NICD in the tissues of 40 cervical cancers and 21 normal cervix and its relationship with clinical features of cervical cancer was also analyzed. Proliferation of SiHa and HeLa cervical cells was determined by methyl thiazolyl tetrazolium (MTT) assay, cell cycles and apoptosis and index of proliferation were detected by flow cytometry method. The expression of NICD in SiHa and HeLa cells incubated with DAPT was detected by western blot. Results The expression level of NICD in cervical cancers was significantly higher than that of normal cervical tissues (1.237±0.353 vs 0.938±0.105, P<0.05). The NICD expression was higher in cervical cancers with high grade,lymph node involvement and parametrial invasion than that with low-middle grade (1.496±0.540 vs 1.150±0.216), without lymph node involvement (1.419±0.532 vs 1.159±0.210) and no parametrial invasion (1.718±0.710 vs 1.183±0.258), respectively (all P<0.05). The expression of NICD in cervical adenocarcinoma was higher than that of squamous cell cancer (1.463±0.395 vs 1.162±0.187, P<0.05). After SiHa and HeLa cells were incubated with DAPT, NICD expression was significantly lower than that in control (P<0.05). The effects of DAPT inhibited the proliferation and prompted the apoptosis of SiHa and HeLa cells was depended on its concentrations and times. Conclusions NICD may play a key role in the occurrence and progress of cervical cancer. The mechanism of DAPT inhibited the proliferation and prompted the apoptosis of SiHa and HeLa cells may be due to decreased the formation of NICD.