Objective:To observe the relationship between non -dipper heart rate and morbidity of coronary heart disease (CHD) in patients with hypertension .Methods :According to Holter monitored results ,a total of 130 pa‐tients with essential hypertension were divided into dipper heart rate group (n= 77 ) and non -dipper heart rate group (n=53) .Ambulatory blood pressure and dynamic ECG were monitored in two groups ,and CHD was diag‐nosed according to coronary angiography results .Ambulatory blood pressure ,ambulatory heart rate and incidence rate of CHD were compared and analyzed between two groups .Results:Compared with dipper heart rate group , there was significant reduction in daytime mean heart rate [ (73.45 ± 9.57) beats/min vs .(68.77 ± 12.61) beats/min] ,but significant rise in nighttime mean heart rate [ (61.30 ± 7.62) beats/min vs .(65.49 ± 12.97) beats/min] , P<0.05 both ;there were significant reductions in 24h mean diastolic blood pressure (DBP) [ (75.77 ± 10.91) mm‐Hg vs .(71.92 ± 9.30) mmHg] and daytime mean DBP [ (77.16 ± 11.11) mmHg vs .(72.81 ± 9.61) mmHg] , P<0.05 both in non -dipper heart rate group ,there were no significant difference in other blood pressure indexes be‐tween two groups (P>0.05);.Morbidity rate of CHD in non -dipper heart rate group was significantly higher than that of dipper heart rate group (71.70% vs .29.87% ,P=0.001) .Conclusion:Compared with dipper heart rate pa‐tients ,morbidity rate of CHD significantly rises in patients with hypertension and non -dipper heart rate .It may help to reduce occurrence of CHD by monitoring circadian changes of heart rate and recover circadian heart rate rhythm while treating hypertension .

Purpose To explore the role of cell blocks combined with immunohistochemical examination in the diagnosis and differential diagnosis of malignant pleural effusion,and to explore the role of pleural effusion cell blocks in lung adenocarcinoma molecular pathology examination.Methods 142 cases of malignant pleural effusion based cytology,cell blocks of HE staining and immunohistochemical staining by EnVision twostep were retrospectively analysed,the tumor classification was made through analyzing the characteristics of the cells combined with antibody expression.The detection of epidermal growth factor receptor (EGFR) gene mutation of 40 cases of lung adenocarcinoma diagnosed after immunohistochemical staining were used by ARMS-PCR method.Results Among 142 cases of malignant pleural effusion,there were 99 cases caused by lung adenocarcinoma,4 cases of lung small cell carcinoma,3 cases of lung squamous cell carcinoma,13 cases of breast carcinoma,9 cases of ovarian carcinoma,2 cases of gastric carcinoma,1 case of thyroid carcinoma,1 case of endometrial carcinoma,5 cases of mesothelioma,3 cases of lymphoma,1 case of malignant melanoma,1 case of synovial sarcoma.In 40 cases of lung adenocarcinoma pleural effusion cell block,there were 20 cases with EGFR mutations,9 cases of 19del mutations and 11 cases L858R mutations.Conclusion The pleural effusion cell blocks combined immunohistochemistry are useful to improve the accuracy of diagnosis of patients with pleural effusion,and helpful for the determination of classification and the primary site of tumor,assessment of prognosis.Pleural dffusion cell block may used to detect EGFR mutations of lung adenocarcinoma,which provide new source of specimen for the gene detection of lung adenocarcinoma.

Objective To explore the correlation between miR-25 and FBXO33 in renal cell carcinoma (RCC),and to analyze the relationship with apoptosis and prognosis of renal cell carcinoma.Methods The 511 RCC chip results,from 1998 to 2013,were downloaded from the Cancer Genome Atlas (TCGA)database,and were analyzed for the correlation between miR-25 and FBXO33 by Pearson test.The expression of fluorescein were detected with the FBXO33 3’UTR wild-type,mu-tant and blank control luciferase reporter gene treated by miR-25.The viability of cells transient translated by the miR-25 mimic,siRNA and the controls were detected by CCK8 method.The apoptosis of cells transient translated by the miR-25 mimic,siRNA and the controls were detected by flow cytometry.58 cases with follow-up data were screened from TCGA by expression of FBXO33 negative correlation miR-25.The survival was analyzed between low expression of miR-25 combined with FBXO33 high expression group (n=34)with high expression of miR-25 combined with FBXO33 low expression group (n=24),using Log-rank test and Gehan-Breslow-Wilcoxon test.Results FBXO33 was negatively correlated with miR-25 in RCC tissue (r=-0.161 1,Pearson test).Compared with the control group,miR-25 could reduce the RLU of wild type group to 80.2%±2.6%,the difference was statistically significant (t=6.539,P=0.006).The RLU of mutation group was 103.5%±8.4% compared with that of blank control group,the difference was not statistically significant (t=0.041 3,P=0.968 4),compared with the blank group in 72h for the cell varibility,miR-25 siRNA group were elevated by 32.7%± 3.5%,the difference was statistically significant (P<0.05).The miR-25 mimic group were reduced by 23.3%±1.7%,the difference was statistically significant (P<0.05),and compared with the control group,the early apoptosis rate was de-creased in mimic-miR-25-3p group (8.83 ± 0.09 vs 12.83 ± 0.14),while the difference was statistically significant (t=42.17,P=0.005).The late apoptosis rate was slightly escalated (0.41±0.10 vs 0.33±0.15),while the difference was not statistically significant (t=0.75,P=0.639).Compared with the control group,the early apoptosis rate was increased in siR-NA-miR-25-3p group (19.05 ± 1.64 vs 13.68 ± 0.78),while the difference was statistically significant (t=5.12,P=0.006).But the late apoptosis rate was reduced (0.56±0.10 vs 0.62±0.08),while the difference was not statistically sig-nificant (t=0.83,P=0.376).The survival rate was higher in patients with low expression of miR-25 combined with high expression of FBXO33 (n=34)than that of miR-25 high expression combined with low expression of FBXO33 (n=24),the difference was statistically significant (Log-rank test P=0.025 2,Gehan-Breslow-Wilcoxon test P=0.004 9).Conclusion MiR-25 can inhibite FBXO33 in renal cell carcinoma,improve the cell activity,inhibit apoptosis and reduce the prognosis.

Objective To investigate the methylation status of Zonula occludens-1(ZO-1)gene promoter and discuss its role in the pathogenesis and progression of acute leukemia(AL)as a general gene marker.Methods The methylation pattern in promoter region of ZO-1 gene was detected with methylation specific PCR in AL cell lines HL60.Molt4 and NK92 as well as in 121 clinical bone marrow samples including 81 cases of AL and 40 non malignant cases.Resuits The promoter region of ZO-1 gene was completely methyrlated in HL60.Molt4 and NK92 cells:but it was unmethylated in 40 non malignant bone marrow samples.The total methylation frequency of ZO-1 gene promoter region in 81 cases of AL was 60.49%(49/81),there was significant statistic difference among the relapsed AL group(92.86%, 13/14),the newly diagnosed AL group(65.85%,27/41)and the complete remission group(34.62%, 9/26).but no difference between the cases with acute myelocytic leukemia and acute lymphocytic leukemia. Conclusion The hypermethylated status of ZO-1 gene promoter region was specifically detected in human AL,it was closely correlated with the pathogenesis and progression of the disease and will become a general clinical molecular marker of leukemia.

Background and purpose:Insulin-like growth factor-1 (IGF-1) is a peptide that participates in many biological processes by stimulating the downstream signaling pathways through their interaction with IGF-1 re-ceptor (IGF-1R) and insulin receptor (IR). Bone morphogenetic proteins (BMPs) are a group of functional proteins which participate in the biological processes of proliferation and migration in many kinds of cancers and have become a hot area of cancer research. The study aimed to investigate the effects of silencingIGF-1R gene on the expression level ofBMP2 gene, and the cell proliferation and apoptosis of SMMC7721 cells.Methods:The RNAi plasmid targetingIGF-1R gene was constructed and transfected into SMMC7721 cells. Then the inhibition effect on the expression level of IGF-1R and BMP2 gene was detected by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot. The SMMC7721 growth curve and cell apoptosis were detected by MTT assay and flow cytometry after they were transfected with RNAi plasmid.Results:The RNAi plasmid targetingIGF-1R gene was constructed successfully. The inhibition efficiencies at mRNA expression levels were 68.9% and 80.7% (IGF-1R gene), 79.5% and 83.3% (BMP2 gene), respectively, after transfection with IGF-1R-siRNA-1 and IGF-1R-siRNA-2 plasmid (P<0.05). The inhibition efficiencies at protein levels were 46.1% and 62.1% (IGF-1R gene,P<0.05), 42.5% and 60.9% (BMP2 gene,P<0.05), respectively. The results of MTT growth curve showed that the proliferation rate in the transfected SMMC7721 cells was significantly slower than that in the control group (P<0.05). The proportion of apoptotic cells in transfected groups was significantly higher than that in the control group (P<0.05).Conclusion:SilencingIGF-1R gene can downregulate the expression ofBMP2 gene at different levels that results in inhibition of cell proliferation and promotion of apoptosis in SMMC7721 cells.

Objective To review the experience on the surgical management for advanced gastric carcinoma with portal hypertension. Methods In this study, 14 advanced gastric carcinoma with portal hypertension patients were analyzed retrospectively, liver cirrhosis was found in 13 cases. In 10 esophageal variceal patients, 5 had upper gastrointestinal bleeding history. All of those cases were associated with different degree of hypersplenism. The tumours situated at the upper third of the stomach in 2 patients, middle and upper third in 2 and lower third in 10. Five patients underwent curative distal subtotal gastrectomy and splenectomy, 2 cases did radical distal subtotal gatrectomy and pericardial devascularizaion, 2 curative distal subtotal gastrectomy combined with splenic artery ligation,2 did total gastrectomy and pericardial devascularizaion,2 cases did radical proximal gastrectomy and pericardial devascularization and 1 patient did distal subtotal gastrectomy only. Results Three died from extensive wound bleeding, jejunal fistula and liver failure respectively. 3 patients were complicated by left subdiaphragmatic abscess, hepatic dysfunction and massive ascites individually. The morbidity and mortality rate were 42.86% and 21.43% respectively. Conclusion The surgical procedures for patients of advanced gastric carcinoma with portal hypertension caused a considerably high postoperative mortality and morbidity rate.

Aim To observe whether the activation of aldehyde dehydrogenase 2 ( ALDH2 ) can protect a-gainst diabetes induced liver injury in rat model, and analyze the role of JNK pathway in the liver protection induced by activation of ALDH2 . Methods All male SD rats were randomly divided into three groups: nor-mal control group ( Con ) , diabetes group ( DM ) and ethanol + diabetes group ( EtOH + DM ) . After 8 weeks, the fasting blood glucose ( FBG) level, glyco-sylated hemoglobin ( HbA1c) level, serum AST and ALT levels were measured. The changes of hepatic pa-thology were observed by hematoxylin and eosin ( HE) staining method. The protein expressions of ALDH2, JNK and p-JNK in liver tissue were measured. Result Compared with control group, in DM group, the lev-els of FBG and HbA1c, serum AST and ALT levels were increased significantly. The structure of liver mor-phology was destroyed, disarranged and unclear, the hepatocyte was swollen, and a large number of inflam-matory cells were infiltrated. ALDH2 protein expres-sion was decreased, while the expressions of JNK, p-JNK and the ratio of p-JNK/JNK were increased. Com-pared with DM group, in EtOH+DM group, the levels of FBG and HbA1c, serum AST and ALT levels were decreased. The expression of ALDH2 protein was in-creased, accompanying with the decrease of JNK, p-JNK protein expressions and the ratio of p-JNK/JNK. Conclusion Activation of ALDH2 can protect the liv-er against diabetes induced liver damage in rat model, which may be relevant with inhibiting the JNK path-way.

Objective: To explore the turnover intention of nurses in Quzhou and its influential factors. Methods: From July to August in 2017 cross-sectional study and self-filled questionnaire are used to investigate 980 nurses from 7 hospitals in Quzhou, including two third-level hospitals and five second-level ones. T-test, F-test, Pearson and linear regression are used in data with the method of statistical analysis. Results: The total score of turnover intention of nurses was (14.95±3.17) points, and the index value was 62.27%, of which the turnover intention was above 78%. The analysis of Single factor showed that age (F=4.895) , Department (F=2.971) , title, nursing age (F=5.863) , self-assessment of physical conditions (F=4.092) were closely related to nurses’ turnover intention(P<0.05). According to Person’s correlation analysis, there are positive correlations between turnover intention and source of stressor, and moral distress (P<0.05) . Multiple linear regression showed that the nurses’ turnover intention was age, Department, health selfevaluation, stressor and moral distress. Conclusion The turnover intention of nurses is high, which is related to age, Department, self-evaluation of health, stressor and moral distress.

Objective To design a new method of posterior wall reconstruction for severely corn-minuted and obsolete fracture of the posterior wall of the aeetabulum. Methods (1) Biomechanical study (from two perspectives: the stability and the stress distribution on the femoral head and the acetabu-lure) : six fresh adult' s pelvis and femur specimens were collected and divided into experimental group ( consisted of the left sides) and control group ( consisted of the right sides). After the defects of the pos-terior wall were made, the defects were anatomically reconstructed with the harvested ilium by acetabular tridimentional memory fixation system (ATMFS) in the experimental group, whereas the acetabular frag-ments were repositioned to the defect sites and fixated by the plates and screws in the control group. Lon-gitudinal and latitudinal displacement, stability of the anatomically reconstructed posterior wall of the ace-tabulum, the fitness of femoral head to the acetabulum after anatomical reconstruction and mean and maxi-mum pressure of anterior wall, posterior and cupuh of the acetabuhm were analysed and compared. (2) Cinical study: The posterior wall defect on the harvested ilium piece was repaired with 3-directional loc-king of ATMFS in 10 male patients (at age of 16-50 years, mean 36.4 years) from January 2000 to June 2002. There were seven patients with flesh acetabular fractures and three with old acetabular fractures.The period from fracture to reconstruction for the patients with old fractures was 58-251 days ( 137.7 days an average). The patients were foUowed up for 5.8 years (average 5.2-7.1 years). Results (1) Biomechanical study showed no statistical difference upon stability and fitness of femoral head to acetabu-lum after reconstruction in experimental and control groups. (2) Clinical study: postoperative X-ray film showed no repeated displacement of the fracture and the patients began out-of-bed movement with weight bearing after 1.6 months (1.2-2.1 months). Heterotopic ossification was found in two patients, with no influence on the joint function. According to the elinieal ranking standard of Modified d' Aubigne and Postal, the excellence rate was 93%. Conclusions Anatomical reconstruction of posterior wall of the acetabulum by using serf ilium with ATMS has good stability and stress distribution of the femoral head and the reconstructed acetabulum in clinical application and offers a new method for treatment of severely comminuted and obsolete fracture of posterior wall of acetabulum.

Objective To translate Moral Distress Scale(MDS-R), and to test the reliability and validity of the Chinese version of MDS-R. Methods The MDS-R was translated, back translation and adapted according to Chinese culture. The reliability and validity of Chinese version of MDS-R was tested in 750 nurses in Quzhou city by item correlation analysis, content validity, exploratory factor analysis, confirmatory factor analysis, Cronbach′s Alpha coefficient and test-retest reliability. Results The internal consistency coefficient of the Chinese version of MDS-R ranged from 0.119-0.756 (P<0.01). The content validity was 0.952. validity.Factor analysis extracted three common factors, which explained 64.537％ of variance of the total scale. Based on the exploratory factor analysis, a theoretical model was established for the scale and each factor, and the fitting degree of the theoretical model was verified by the data. After fitting the model, the fitness values of the first and the second order confirmatory factor analysis were all up to the standard level. The Cronbach's Alpha coefficient of the scale was 0.925, and the test-retest reliability was 0.900. Conclusions The Chinese version of MDS-R is reliable and valid, and can be used to measure the moral distress of nurses.