Objective To study the changes of mesenteric arterioles on the contractile response to norepinephrine in patients with cirrhosis and portal hypertension (PHT) caused by hepatitis B after treatment by high-dose vitamin C.Methods Eleven PHT patients and 6 non-PHT volunteer were those undergoing their respective surgeriesat in our hospital from January 2010 to June 2011.The PHT patients were randomly assigned to vitamin C treatment group and placebo treatment group.After admission and before induction of anesthesia,blood taken to mesure plasma concentration of malonaldehyde (MDA).Intraoperative portal pressure was measured.We took the third level intestinal mesentery vessels with their mesentery next to the jejunum and studied the contractile response to norepinephrine of the intestinal mesenteric arterioles.We also measured RhoA/ROCK pathway associated proteins' expression and activity changes by Western-blot method.Results The average value of the plasma MDA of PHT patients with cirrhosis was much higher than that of non-PHT patients.After treatment by vitamin C,the value decreased.The dose-response curve of isolated mesenteric arterioles to norepinephrine from PHT patients with cirrhosis shifted to the right,and the EC50 value was higher than that of non-PHT patients.But this phenomenon was reversed after the patients treated with vitamin C.The protein expression of RhoA in mesenteric arteries did not change significantly among the three groups.But the protein expression and activity of ROCK-1 was significantly reduced in PHT patients with cirrhosis.After treatment with vitamin C,the expression and activity of ROCK-1 in mesenteric arteries of cirrhosis was significantly increased.Conclusion The PHT patients with cirrhosis are in the situation of oxidative stress.The high-dose vitamin C treatment can reduce oxidative stress level and improve contractile hyporeactivity of mesenteric arterioles of PHT patients with cirrhosis to norepinephrine.The protein expression and activity increasement of ROCK in RhoA/ ROCK pathway is involved in thisphenomenon.

Objective To investigate whether radial augmentation index (AI) associates with cardiovascular risk as well as arterial stiffness.MethodsA total of 4985 subjects, 2417 men and 2568 women, aged 18-96 (50.9 ± 14.7)years,were recruited.AI was measured in the left radial artery using tonometry Colin HEM-9000AI.Carotid-femoral PWV (CFPWV) and carotid-radial PWV (CRPWV) were examined by automatic pulse wave velocity (PWV) measuring system.Framingham risk score and Chinese ischemic cardiovascular disease risk score were applied upon subjects without cardiovascular disease to calculate individual cardiovascular risk respectively.ResultsRadial AI (rAI) was significantly higher in women than in men[(83.18 ± 12.36)％ vs (71.93 ± 15.22)％, P ＜0.01].Simple correlation analysis showed rAI was significantly correlated to two cardiovascular risk scores or CFPWV and CRPWV.After adjusted for multi-factors, rAI was still significantly correlated to Framing, ham risk score or Chinese ischemic cardiovascular disease risk score (r = 0.17 and 0.12) in men respectively (P ＜ 0.05), while r were 0.09 and 0.08 in women respectively (P ＜ 0.05).In multivariate analysis, there was a significant association between CFPWV and rAI (r = 0.14 in men, r = 0.10 in women, P ＜ 0.01), whereas the relation ship between CRPWV and rAI was not found.The relationship between rAI and cardiovascular risk or PWV became weaker for those aged above 50 years.ConclusionAugmentation index might be a useful marker of cardiovascular risk and arterial stiffness, which could be more feasible for younger subjects as a tool for risk differentiation.

Objective To investigate the clinical value of radioactive seed 125Ⅰ implantation combined with gemcitabine(GEM)in treatment for peripheral non-small cell lung cancer(NSCLC).Methods 60 patients(male 35,female 27,mean age 73.3)with peripheral lung carcinoma were confirmed under CT-guided biopsy including 8 bronchoalveolar caicinomas and 17 squamous carcinomas,6 in the stage I,14 in the stage II,34 in the stage III and 6 in the stage IV were designated under clinical staging.All patients were devided into two groups as GEM group and GEM-125Ⅰ group.GEM group underwent chemotherapy with GEM only and GEM-125Ⅰ group was treated under CT guided radioactive seed 125Ⅰ implantation combined with gemcitabine.Results GEM group showed tumors under controlling as PR in 5,SD in 14,PD in 11 cases;the total effective rate was 16% and the total control rate was 63%.The median survival time was 7 months and one years survival rate was 26%.GEM-125Ⅰ group revealed CR in 5,PR in 11,SD in 8,PD in 6 cases and the total effective rate reached 36% with total control rate as 80%.The median survival time was 12.3 months and one year survival rate was 50%.There was a significant difference(P

Objective To evaluate the treatment outcome, prognostic factors, radiation dose, and toxicities in patients with early-stage primary diffuse large B-cell lymphoma of Waldeyer's ring (WR-DLBCL) treated with intensity-modulated radiotherapy (IMRT).Methods This study included 80 patients with a confirmed diagnosis of stage Ⅰ-Ⅱ primary WR-DLBCL who were admitted to our hospital from 2008 to 2015.Only 3 patients received radiotherapy alone, and the other patients received radiotherapy and chemotherapy.After chemotherapy, 24 patients achieved complete remission (CR), and 53 patients achieved partial remission (PR).IMRT was given to the primary lesion and cervical lymphatic drainage region.Survival analysis was performed using the Kaplan-Meier method and log-rank test.The Cox model was used for analysis of prognostic factors.The toxicities were scored using the RTOG criteria.Results The median follow-up was 64 months.The 5-year locoregional control (LRC), overall survival (OS), and progression-free survival (PFS) rates were 94%, 88%, and 84%, respectively.The dose-volume histogram showed that the maximum, mean, and minimum doses to primary gross tumor volume were 54.47 Gy, 52.27 Gy, and 38.83 Gy, respectively.Prognostic analysis showed that age>60 years and increased lactate dehydrogenase (LDH) were influencing factors for OS (P=0.009 and 0.002), and that aged>60 years, IPI ≥2, and increased LDH were influencing factors for PFS (P=0.001, 0.035, and 0.007).Among all patients, 12, 53, and 8 experienced grade 1-3 radiation-induced acute oral mucositis, respectively, and 16 and 13 experienced grade 1 and 2 xerostomia as the late toxicity, respectively.Conclusions For patients with early-stage primary WR-DLBCL, IMRT results in satisfactory OS, PFS, and LRC and has tolerable early or late radiation-induced toxicities.

Objective To analyze the popular characteristic and drug resistance of Pseudomonas aeruginosa in a hospital of Guiy-ang from January 201 1 to December 2013.Methods The distribution characteristic and drug resistance of Pseudomonas aeruginosa isolated from clinical samples from January 201 1 to December 2013 were analyzed retrospectively.Results A total of 642 strains of Pseudomonas aeruginosa were isolated for three years in our hospital from January 201 1 to December 2013,there was 57.0% isola-ted from sputum specimens,and 27.9% isolated from excreta of wound.The infected endemic area distribution was made up of Or-thopedic Surgery,ICU,Geriatrics Department and Respiratory Department accounting for 22.9%,20.1%,18.8% and 1 5.9% re-spectively.Pseudomonas aeruginosa was most sensitive to polymyxin bacillosporin.The drug resistance rates to Trimethoprim,Am-picillin and Cefazolin were all 100.0%.The drug resistance rates to Ampicillin/sulbactam and Ceftriaxone were 90.0%. Conclusion Pseudomonas aeruginosa is the main cause of lower respiratory tract infections in patients and wound infection and show serious multi-drug resistant,so it is necessary to use drugs reasonably according to the drug susceptibility results.

〔Abstract〕 In a response to problems and needs in the current daily work of the blood purification center , the intelligent service plat-form for the patient -oriented blood purification centers should be constructed .The design philosophy , composition and basic functions of the platform are introduced in the paper .This platform can meet the needs of the patient -oriented service , improve work productivity , standardize the medical process and save social resources .

Objective To analyze the risk factors of pancreatic fistula after pancreaticoduodenectomy,in order to provide evidence to reduce post-operative complication in clinical practice.Methods The clinical data of 352 patients with malignancy who received pancreaticoduodenectomy at the Shanghai Renji Hospital from September 2009 to September 2012 were retrospectively analyzed.The patients were divided into pancreatic fistula group and non-pancreatic fistula group.Peri-operative risk factors of pancreatic fistula after pancreaticoduodenectomy were analyzed by univariate and multivariate logistic regression analysis.Results Forty-nine cases of pancreatic fistula occurred,and the incidence rate of pancreatic fistula was 13.9％ (49/352).Univariate and multivariate logistic regression analysis showed sex,age,history of diabetes,operation time,intra-operative blood loss,vessel reconstruction,pancreatic tube placement,anastomosis time,type of digestive tract reconstruction were not risk factors of pancreatic fistula; however,brittle pancreatic tissue,diameter of pancreatic duct ＜3 mm,pre-operative total bilirubin level ＞ 171 μmol/l,duration of preoperative jaundice ＞ 8 weeks,pre-operative albumin level ＜30 g/L were the independent risk factors of pancreatic fistula (P ＜ 0.05).Conclusions Brittle pancreatic tissue,small pancreatic duct,high level of serum bilirubin,long duration of preoperative jaundice,low level of serum albumin are the independent risk factors of pancreatic fistula after pancreaticoduodenectomy.

Objective:To study urine albumin excretion (UAE) and its related factors in patients with essential hyper‐tension (EH) .Methods :A total of 113 EH patients without significant target organ damage were enrolled as EH group ,while another 92 healthy subjects were regarded as healthy control group .Ratio of morning urinary albumin to creatinine was measured and regarded as UAE index .Plasma homocysteine (Hcy) ,serum uric acid ,creatinine , blood urea nitrogen ,blood glucose ,blood lipids etc .levels were measured ,and compared between two groups Re‐sults:Compared with healthy control group ,there were significant rise in UAE ,body mass index (BMI) ,waist hip ratio ,blood pressure ,pulse pressure ,heart rate ,plasma levels of triglyceride (TG) ,low density lipoprotein choles‐terol (LDL‐C) ,serum uric acid and Hcy (P<0.05 or <0.01) ,and significant reduction in level of high density lip‐oprotein cholesterol (HDL‐C) in EH group ( P=0.001) .Pearson correlation analysis indicated that lgUAE was pos‐itively correlated with lgTG (r=0.257 ,P=0.015) and estimated glomerular filtration rate (eGFR ,r=0.284 ,P=0.007) ,and inversely correlated with lg creatinine (r= -0.277 ,P=0.008) in healthy control group ,while in EH group ,lgUAE was positively correlated BMI (r=0.231 ,P=0.014) ,lgTG (r=0.200 ,P=0.034) and lgHcy (r=0.244 , P=0.009) .Muti-factor gradual regression analysis indicated that lg TG (β=0.265 ,P=0.001) and lg Hcy (β=0.170 , P=0.012) were independently positively correlated with lg UAE , R2 =0.112.Conclusion:UAE level significantly rises in EH patients ,and it′s significantly positively correlated with plasma levels of TG and Hcy .

Objective To explore the role of hydrogen peroxide in mesenteric artery contraction of cirrhotic rats with portal hypertension,which was induced by bile duct ligation.Possible mechanism in RhoA/ROCK signal pathway was also part of the focus.Methods The bile duct ligation-induced cirrhotic rats and normal rats (control group) were treated equally with PEG-catalase(10 000 U/kg-1 · d-1,ip.) or by its vehicle for 8 days.Then the level of H2O2 in mesenteric arteries was detected.The contractile response to norepinephrine of arterioles was analyzed by vascular perfusion system.The protein expressions of the α1 adrenergic receptor,β-arrestin-2 and Rho kinase-1 (ROCK-1),and the activity of ROCK-1 were measured by western blot.In addition,the interaction of α1-adrenergic receptor with β-arrestin-2 was assessed by co-immunoprecipitation.Results Compared to normal rats,the dose-response curve of the mesenteric arterioles in response to norepinephrine shifted to the right,and the EC 50 increased in the rats with portal hypertension.PEG-catalase treatment can decrease the hydrogen peroxide level in arteries,thus significantly lowered EC50 and improved the reactivity to norepinephrine of the mesenteric arterioles in portal hypertension rats.No significant difference in the α1-adrenergic receptor amounts was observed among groups.There was remarkable decreases in the protein expressions of β-arrestin-2 and its interaction with the α1-adrenergic receptor in cirrhotic rats with PEG-catalase treatment.PEG-catalase also increased the amount and activity of ROCK-1 in cirrhotic rats.Conclusions The level of hydrogen peroxide increases in the mesenteric arteries in bile duct ligation-induced cirrhotic rats.And it enhances the β-arrestin-2 expression and its interaction with the α1-adrenergic receptor,which subsequently decreases the amount and activity of ROCK as well as the contractility of mesenteric arteries in response to vasoconstrictors.

Objective To explore the microsurgical treatment strategy of ruptured anterior communicating artery aneurysms.Methods From September 2009 to February 2013,thirty-three patients with ruptured anterior communicating artery aneurysms were treated with microsurgical clipping via modified pterion approach.The clinical and follow-up data were analyzed retrospectively.Results At 3 to 44 months period followed-up after microsurgical clipping of ruptured anterior communicating artery aneurysms were obtained in 32 patients.According to Glasgow Outcome Score,the curative effects score were 5 in 28 cases,four in 2 cases,three in 1 case and death in 1 case.Conclusion Microsurgical clipping of ruptured anterior communicating artery aneurysms via modified pterional approach was an effective method with sufficient exposure.It has less invasiveness to the brain tissue,reliable neck clipping and satisfactory results.Safety and effectiveness of this procedure are based on preoperative radiological evaluation of three-dimensional morphological specificity of aneurysms,identification of the parental arteries and its branches,as well as temporary proximal occlusion.