Objective To evaluate clinical features, diagnosis and treatment of anorectal malignant melanoma (ARMM).Methods The clinical data of 15 patients of ARMM in our hospital and 18 patients in the First Affiliated Hospital of China Medical University from 1990 to 2010 were reviewed.Twenty-five patients underwent curative surgical resection, 14 patients underwent abdominoperineal excision of the rectum (APR), and 11 patients underwent local excision (LE).Survival analysis was carried out.Fisher's exact test and Log-rank test was used to compare the effects of these two different surgical procedures.Results ARMM had a female predominance, the mean age was 22 -77(54.5 ± 7.6) years.The major clinical signs included hematochezia, anus pain.The misdiagnosis rate was 67% (22/33).The average tumor size was (3.5 ±1.7) cm.Thirty-one petients(94% ,31/33) had ARMM within 5 cm from anus margin.Mean survival time was (14.0 ± 6.5)months.The overall 1-,3-,and 5-year survival rates were 48% ,22% , and 10% , respectively.Local recurrence after curative LE was higher than APR (LE,64% vs APR, 21% , P = 0.049) , The overall 3-year disease-specific survival rates after curative LE was not significantly different from that of APR (LE, 28% vs APR ,31%, x2 = 0.268, P = 0.582).Conclusions Anorectal malignant melanoma has a high rate of misdiagnosis.Radical resection could not prolong the survival time significantly in anorectal malignent melanoma patients.

BACKGROUND: Bone marrow mesenchymal stem cells (BMSCs) are conveniently cultured and separated in vitro because theirimmunogenicity is low. Therefore, BMSCs are suitable for cell transplantation. Research has shown that BMSCs are potential to repair neurological defect. OBJECTIVE: To determine whether in vitro cultured BMSCs can be transplanted to repair peripheral nerve injury or not, and to investigate its mechanisms. DESIGN, TIME AND SETTING: Randomized controlled animal study This study was performed in Department of Toxicology, Public Health College of Jilin University from March 2006 to March 2007.MATERIALS: Fifty healthy female Wistar rats aging 2 months and six 1-week-old female Wistar rats were used for extraction of BMSCs. Rabbit-anti-nerve growth factor (NGF) monoclonal antibody was provided by Santa Cruz Company. METHODS:BMSCs were separated and cultured with adherent method. In the 3rd generation, BMSCs were preiabeled with bromodeoxyuridine (BrdU) 48 hours before transplantation. Fifty healthy Wistar rats were selected to prepare sciatic nerve crush injury models with clamping method.Subsequently, rats were randomly divided into transplantation group and control group, with 25 rats in each group. Rats in the transplantation group underwent transplantation of BrdU-labeied BMSCs at nerve injured sites; while, the same volume DMEM was injected into rats in the control group. MAIN OUTCOME MEASURES: Injured nerve in the transplantation group suffered from anti-BrdU staining 1, 2, 4, and 6 weeks after surgery. Distal injured nerve in both groups suffered from NGF immunohistochemical staining 1, 2, 4, and 6 weeks after surgery. Image analysis system was adopted to analyze integrated absorbance of positive expression. Gait analysis was performed every week after surgery to measure sciatic nerve function index, and it was also adopted to measure regenerated nerve conduction velocity 6 weeks after surgery. Subsequently, amount and inner diameter of medullated nerve fibers were calculated after luxol fast blue staining, while wet weight of experimental-lateral gastrocnemius muscle and cross section area of muscle fiber were measured at the same time. RESULTS: Fifty rats were included in the final analysis. BrdU-labeled positive cells could be found at injured nerve in the transplantation group 1, 2, and 4 weeks after surgery. Integrated absorbance of NGF protein expression in the transplantation group was significantly higher than that in the control group 1 and 2 weeks after surgery (P < 0.01), but there were no significant differences between the two groups 4 and 6 weeks after surgery (P > 0.05). Sciatic nerve function index in the transplantation group superiorly recovered to that in the control group 3-6 weeks after surgery. Furthermore, 6 weeks after surgery, nerve conduction velocity, amount and diameter of medullated nerve fibers, wet weight and cross section area of gastrocnemius muscle in the transplantation group were significantly higher than those in the control group (P < 0.05-0.01). CONCLUSION: BMSCs can be transplantated into injuried nerve tissue, and promote the recovery of nerve function in the micro-enviroment, improve NGF expression in an early phase may be one of its mechanisms.

Objective To investigate the biological characteristics of recombinant hIFN-α-2B-BCG and its direct effect to bladder tumor cells in vitro. Methods BCG and recombinant BCG(rBCG) wild-type growth and morphology were compared. After 10 generations, hIFN-α-2B content was analyzed by ELISA, of bacteria in vivo and in vitro. The effects of rBCG on bladder cancer cells EJ, MB49, were detected by elec-tron microscopy and cell inhibitory rate from MTT. Results The normal BCG and rBCG had no significant difference in growth phase. They were both positive for acid-fast stain, maintaining the characteristics of cell's connection. While rBCG slightly larger than normal BCG, no else abnormality was obvious between them. IFN-α-2B was 997.2 pg/ml in secretions, 99.3 pg. In bacteria in vivo, 990.3 pg/ml in 10th genera-tion's sections, of rBCG. Compared with 1st generation, rBCG had no significant differences in morphology and interferon expression. Normal BCG and rBCG both had, anti-proliferation directly on bladder tumor cell in vitro, the rBCG is most effective in all. After rBCG cultivated with bladder tumor cell together, tumor cell's slow proliferation, detach, quantity decreasing and death were observed under microscope. Different degeneration in degree on most of tumor cells, disorganization on organelle, aggregation on chromatin, pyc-nosis on nucleolus, and cytoplasm lysis were on tumor cell under transmission electro microscopy. MTT as-say showed rBCG inhibited the proliferation of bladder caner cell and more active than normal BCG. Conclu-sion These results suggest that the rBCG have the same characteristics in growth phase as normal BCG, and stable properties in interferon expression and morphology by generations, rBCG has more anti-tumor effects in vitro than normal BCG.

AIM To explore the effect of long-term nebulized inhalation of nitroglycerin (Neb-NTG) on high pulmonary blood flow-induced pulmonary artery hypertension (PAH). METHODS 24 male Wistar rats were randomly divided into shunting group, Neb group and control group. An arteries-venous shunt was performed between the abdominal aorta and inferior vena cava shunting was produced in rats of Neb and shunt groups. Twelve weeks after the operation, nebulized nitroglycerin was inhaled by rats in the Neb group using pressurized air ejection mobilization, while nebulized saline was inhaled by rats of the other two groups. Ten minutes inhalation was given each day for each rat. After three weeks of inhalation, pulmonary artery systolic pressure (PASP) and mean pressure (PAMP) of each rat were evaluated by using a right cardiac catheterization procedure. Systemic arterial pressure (SAP) was reorded continuously by catheterization procedure. The ratio of right ventricular mass to body weight (RV/BW) and the ratio of right ventricular mass to left ventricular plus septal mass (RV/LV+S) were detected. Pulmonary vascular microstructure was measured. RESULTS PASP, RV/BW and RV/LV+S were significantly increased in shunt rats as compared with those of normal controls (P0.05). Muscularization of small pulmonary artery was obviously decreased in Neb-group compared with shunt group. CONCLUSION Long-term Neb-NTG ameliorates high pulmonary blood flow-induced PAH and pulmonary vascular remodeling.

OBJECTIVE To investigate the incidence of nosocomial infection (NI) in our hospital,analyze the related factors,and provide theoretical basis for better prevention and control of NI. METHODS A total of 19 203 inpatients from Dec 2006 to Nov 2007 were retrospectively analyzed,of which 387 inpatients suffering from NI. RESULTS The rate of NI was 2.02%,the highest infected rate was in ICU (24.32%). The main infection site was respiratory tract (57.58%). The species were predominated by Gram-negatives (52.00%). CONCLUSIONS The incidence of NI is connected with factors such as age,underlying diseases,invasive operation and the misusage of antibiotics.

AIM: To explore the role of intestinal lymphatic pathway in MODS pathogenesis by two-hit in rats. METHODS: Mesenteric lymph was diverted by ligating mesenteric lymph duct, and the MODS model was established by two-hit method. 45 Wistar rats were divided into three groups: mesenteric lymph duct ligation group, non-ligation group and sham group. All rats facilitated blood withdrawal for serum sample at pre-experiment and after 24 h. Then organs including kidney, liver, lung, heart and intestine were collected for preparing homogenate. The tumor necrosis factor-alpha (TNF?), nitric oxide (NO), malondialdehyde (MDA) and superoxide dismutase (SOD) were determined. RESULTS: It showed that the MODS model was established successfully. After two-hit, the TNF?, NO 2 -/NO 3 -, NOS, iNOS and MDA in serum of non-ligation group were significantly increased than that in pre-experiment and sham group, and SOD was significantly lower ( P

This study firstly reviews the history and current situation of course construction, then combines closely with the objectives and the summary of current situation of the standardized residency training, and finally puts forward concrete countermeasures from the several angles, such as teaching objectives, teaching team development, teaching content and forms, as well as evaluation mechanism, advocating the promotion of problem-based learning (PBL), medical simulation teaching (MST), literature discussion and other teaching methods, encouraging the integration of humanities education and clinical guidelines into teaching, and adopting objective structured clinical examination + standardized patient (OSCE+SP) assessment method and conducting two-way assessment, so as to assist in the education development of the standardized residency training.

Objective To clarify whether the Cosmc gene down-regnhtion in lgA nephropathy (IgAN) patients is resulted from genetic disorders or external suppressions. Methods Forty IgAN patients, 16 non-IgAN glomerulonephritis patients and 21 healthy controls were enrolled in the study. Genomie DNA was extracted and then Cosmc gene was amplified and sequenced. Peripheral B lymphoeytes were isolated and cultured with RPMI-1640 alone or plus lipopolysaecharide (LPS). The Cosmc mRNA expression levels at baseline, after RPMI-1640 culture or RPMI-1640+LPS treatment were measured respectively by real-time RT-PCR. Results (1) Only 2 missense mutations and 2 silent mutations were detected in coding frame region of Cosine gene in 2 IgAN patients. (2) The baseline Cosmc gene expression level was significantly lower in IgAN patients (31% of that in healthy controls) than that in healthy controls. (3) Relative quantification PCR indicated that Cosmc mRNA expression level was significantly increased (219% of baseline) after RPMI-1640 culture, and treatment of LPS could strongly inhibit this effect. (4) The Cosmc gene expression of healthy control was not affected by RPMI-1640 or LPS. Conclusion It is not genetic disorders but external suppression to cause the down-regulation of Cosmc gene mRNA expression in IgAN.

Objective Recent studies reveal important roles of platelet P-seleetin on progression of atherosclerosis.In the present study,we examine the relation between Platelet P-selectin expression and severity of acute coronary syndromes.Methods One hundredand eighty-four consecutive patients with proven or clinically suspected acute coronary syndromes(ACS)were enrolled in the study.Level of P-selectin expression was determined bv flow cytometry.Platelet P-selectin level was expressed as the percentage of P-selectin positive platelet.Results The level of P-selectin was higher in patients with a single diseased coronary artery or multiplediseased arteries compared to thOSe with normal coronary arteries.P-selectin expression was significantly and positively correlatedwith angiographic Gensini score(r=0.323,P=0.029).Multiple regression analyses showed that the association of the percentage of P-selectin-positive platelets with ACS was independent of other clinical factors. Conclusions Platelet P-selectin is associated withseverity of acute coronary syndromes in patients with acute coronary syndromes.

AIM: To study the protective effect of mese nt eric lymph duct ligation on the functions of liver, kidney and heart, and morpho logy in multiple organ dysfunction syndrome (MODS) rats subjected to two-hit. METHODS: Male Wistar rats were divided into three groups: the me senteric lymph duct ligation group, the non-ligation group and sham group. The M ODS model of two-hit was established by bleeding and LPS administration in both ligation group and non-ligation group. After 24 h, all rats were cannulated to f acilitate blood withdrawal for serum sample, then all rats were killed and organ s including kidney, liver, lung and heart were collected for making microscopic sectio ns. The biochemical indexes of hepatic and renal functions and myocardial enzyme in s erum were determined before and after experiment. RESULTS: After two-hit, the serum contents of AST, ALT, TBA, BUN , Cr and LDH-1 in both non-ligation group and ligation group, and UA content in non-ligation group were obviously increased than those in pre-experiment and sh am group (P