Objective To investigate the clinical significance of dynamic change of serum IL‐17A/IL‐23 in131 I treatment of Graves hyperthyroidism by dynamically detecting the serum IL‐23/Th17 axis related factor levels before and after 131 I treatment of Graves hyperthyroidism .Methods 30 untreated inpatients with Graves disease(GD) in our hospital were selected as the T0 group , those treated by 1- ,3- ,6-month 131 I treatment were taken as the group T1 ,T3 and T6 .Contemporeneous 30 individuals under‐going healthy physical examination were selected as the normal control (NC) group .The various groups had no statistical differences in the aspects of the age ,gender and disease course ,and had the comparability (P>0 .05) .Serum concentration of IL‐17A and IL‐23 was measured by the enzyme‐linked immunosorbent assay (ELISA) technique .FT3 ,FT4 and TSH were detected by combing with clinic .Results The levels of serum IL‐17A and IL‐23 before131I treatment were significantly higher than those in the NC group(P<0 .05);with the treatment proceeding ,which at ,1 ,3 ,6 months were gradually decreased ,the differences were statistically signifi‐cant but(P<0 .05);after 6 -month 131 I treatment in the GD patients ,the effects of IL‐17A and IL‐23 double negative in the T6 group were better than those of single negative ,and better than those of double positive ,the differences were statistically (Fisher value=13 .273 ,P<0 .05) .Conclusion Dynamically monitoring the serum IL‐23/Th17 axis related factor levels has the significance for guiding treatment ,judging the curative effect and predicting recurrence .

Objective To explore the effect of individualized nursing intervention on life quality and efficacy of senile patients undergoing percutaneous coronary intervention (PCI) during perioperative period. Methods 212 senile patients with PCI were divided randomly into the control group and the study group with 106 patients in each. The individualized nursing intervention and routine nursing were used in the study group, while only routine nursing was used in the control group. The patients in both groups were investigated in 3 days after PCI with questionnaire designed by the author to compare life quality and efficacy during perioperative period. Results The occurring rate of side-effect of the study group was lower than that of the control group, and the satisfaction degree, quality of life and efficacy were also higher than those of the control group. Conclusions Effective individualized nursing intervention can cor-rect the patients' pre-treatment behavior, provide more health information to the patients and give them the rules of self-nursing, so as to reduce the occurrence rate of complication, improve the patients quality of life and curative effect.

Background and purpose:Overexpression of inhibitor of protein phosphatase 2 A-2 (I2PP2A) in many tumors including gastric cancer suggests that I2PP2A may contribute to the development of gastric cancer. To further study the biological function of I2PP2A and its role in gastric cancer, we established a BGC823 cell line for stable expression of shRNA targeting human I2PP2A gene. Methods: A double-stranded shRNA targeting the I2PP2A was designed, synthesized and was inserted into a lentivirus vector (pGLV2), and the insertion was identiifed by restriction endonuclease analysis and DNA sequencing. BGC823 cells were then transfected with the packaged recombinant lentivirus, and resistant cell clones were selected with puromycin. The expression of I2PP2A was examined using real-time PCR (RT-PCR) and Western blot. Results:Sequencing result proved that recombinant lentivirus vector pGLV2-shRNA-I2PP2A was constructed correctly. RT-PCR and Western blot results conifrmed that the expression of I2PP2A was signiifcantly down-regulated in this infected BGC823 cell line. The efifciency of siRNA interference of I2PP2A could be up to about 90%. Conclusion:A lentiviral vector carrying a shRNA targeting the I2PP2A gene is successfully constructed, and a BGC823 cell line stably expressing I2PP2A shRNA is established with this lentiviral system.

Objective To explore the value of CT in the preoperative assessment of resectability of advanced gastric carcinoma.Methods The relation of CT findings and operative data in 93 cases of advanced gastric carcinoma were retrospectively analyzed.Results There were 23 cases of fundus and cardia carcinoma,59 cases of carcinoma of gastric corpus,and 11 cases of carcinoma of antrum.All cases showed increased thickness of gastric wall in various degrees,some of the cases showed tumor growth in the gastric wall,ulcer of the mucosa,stricture of gastric cavity and cardia,increased thickness of cardiac wall,and invasion of lower esophagus and perigastric organs.The accuracy of location and definitive diagnosis by CT,compared to gastroscopic biopsy and postoperative pathology,was considerable,and the detecting rate of tumor by CT was 100 %.CT had important reference value in preoperative evaluation of tumor resectability.The excision rate in the predicted operable group was 93.3 %;in the predicted unresectable group,the non-excision rate was 75.0%.Conclusions Preoperative CT diagnosis of gastric carcinoma has important clinical significance.CT provides a high reference value for assessing the resectability of gastric carcinoma,and it is worthy of widespread use.

Objective To investigate radiological features on computed tomography (CT) in the di agnosis of portal venous and intestinal wall gas in patients with ischemic bowel disease.Methods The clinic-pathological data of 17 patients with portal venous and intestinal gas associated with ischemic bowel diseases from Wenzhou People's Hospital (n =6),Yueqing People's Hospital (n =5),Shanghai Xuhui Dahua Hospital (n =3) and the Second Affiliated Hospital of Wenzhou Medical University (n =3) from January 2013 to October 2016 were analysed retrospectively.All the patients have been fasting for 8 h prior to CT scans.Enhanced CT study was performed following routine CT with no abdominal pressure for breath less scanting.Portal venous gas,intestinal wall gas,intestinal thickness and density,mesentery thickness,celiac effusion,and severity of intestinal wall enhancement were recorded.Results All the 17 patients ex perienced abdominal distension and pain.Additionally,nausea and vomiting was observed in 9 patients,di arrhea in 7,melena in 7,periumbilical tenderness in 11 and rebound tenderness in 8.CT scans of these 17 patients showed portal venous gas,including massiveprune-tree signs of hepatic vein and portal vein (n =11) and scanty gas shadows in distal hepatic vein (n =6).Intestinal gas sign was determined in all these patients (n =17),including single bubble shadow (n =8),multiple bubble shadow (n =7),and band-shaped bubble (n =2).Furthermore,CT study indicated extensive intestinal wall thickening with edema (n =13),predominate luminal extension of thinner bowels (n =4),scanty celiac effusion (n =3).Enhanced CT scans demonstrated 8 patients with decreased enhancement of intestinal wall and mesentery with diseases,target and halo signs observed in enhanced scans.Conclusions Portal venous and intestinal wall gas may demonstrate distinctive CT imaging.CT study could have superior sensitivity and spe cialty in clinical diagnoses of ischemic bowel diseases.

Objective To investigate the relationship between the resistance of the Klebsiella pneumoni-ae and the Klebsiella pneumoniae plasmid pNDM-LJ carrying blaNDM-1 by high-throughput DNA sequencing. Methods High-throughput DNA sequencing was carried out by the Illumina Miseq platform , and sequencing data were assembled by Edena software. Contigs were annotated by the RAST server and analyzed by the BLAST server. Results The plasmid pNDM-LJ was 54-kb in size with a GC content of 49%. The plasmid encoded 52 putative functional genes and belonged to the IncX3 group in incompatible classifications. Analysis of the plasmid sequence revealed high similarity with other IncX3 plasmids. The blaNDM-1 gene was located in a complicated gene environment possibly constructed by several transposition events. The 5′ and 3′ ends of the blaNDM-1 gene were adjacent to the ISAba125 and IS 26 respectively , forming a 10.8-kb transposon-like structure. Conclusion The plasmid pNDM-LJ carried the blaNDM-1 gene being resistant to carbapenems and played a possibly impor-tant role in transmission of blaNDM-1 in China.

Objective To compare the efficacy and safety of two kinds of homemade sirolimus-eluting stents (Firebird and Excel) for treatment of acute ST segment elevation myocardial infarction (STEMI) in patients who underwent percutaneous coronary intervention (PCI). Methods The 249 consecutive patients with STEMI who underwent PCI were randomly divided into two groups: Excel group (n=136) and Firebird group (n=113). They were followed up for 6-24 months, and coronary angiography was reviewed average 12 months later. The primary endpoints were major adverse cardiac events, including death, reinfarction and target vessel revascularization. The second endpoints included late luminal loss and restenosis 12 months after treatment. Results There were no significant differences in baseline data, coronary arterial lesion before operation, and immediateness condition after PCI between the two groups (all P＞0.05). Within follow-up, there were 2 (1.47%) death cases and 1 (0.88%) death case, 1 (0.74%) and 1 (0.88%) nonfatal myocardial infarction case, 2 (1.47%) and 2 (1.77%) target vessel revascularization cases in the two groups respectively (all P＞0.05). There were no significant differences in late luminal loss of in-stent and in-segment, the rates of in-stent restenosis, in-segment restenosis and stent thrombosis, the in-stent minimal lumen diameter and in-segment minimal lumen diameter between the two groups (all P＞0.05). Conclusions The two kinds of homemade sirolimus-eluting stents may have similar efficacy and safety in patients with STEMI treated with primary PCI.

Objective To summarize the clinical features, neuroimaging findings and pathological characteristics of 26 patients with tumor-like inflammatory demyelinating diseases (TIDD) confirmed by histopathology for better diagnosis and differential diagnosis. Methods The clinical features, neuroimaging findings and pathological characteristics of 26 patients (14 male, 12 female) with pathologically proven TIDD(24 brain-type and 2 spinal cord-type ) were retrospectively analysed. Results The mean onset age was 6-69 (36.7±13.8) years. Twenty-one patients had good prognosis with a median followed-up duration of 51.0 months. Two patients were died of post-operative complication and pulmonary infection respectively and the remaining 3 patients were lost to followed up. The TIDD patients almost showed monophasic clinical setting. Headache, indifference accompanied with hypomnesis were the commonest initial symptoms. The positive or abnormol rates of cerebrospinal fluid oligoclonal bands (OCB) and myelin basic protein (MBP)in TIDD patients were high. The involvements of bilateral and multi-lesions were commonest in TIDD (61.5%, 65.4% respectively). Twenty-two patients with CT unenhanced scanning showed hypodense lesions. Long T1 and long T2 signal intensity was showed on MRI and most cases apeared round-like lesion in shape. Acccording to the shape of enhancement of the 23 patients performed with contrast agents, 11 were shown with open-ring enhancement, 4 cases (including 2 accompanied with open-ring enhancement) with complete ring enhancement, 3 with asymmetrical dotted enhancement, 2 with diffused even enhancement,and no enhancement was seen in the other 6. Furthermore, 14 cases with DWI and 12 with FLAIR all appeared hyperdensity. The typical pathological changes were demyelinating, perivascular inflammatory cells infiltration and reactive gliosis. Occationally, the Creutzfeuldt cells were also found in brain tissue of some patients. Conclusions TIDD is a distinct demyelinating disease entity. In spite of being apt to be confused with the neoplasm in brain and spinal cord. TIDD has its own-features, for example, OCB is frequently positive in patients with TIDD and the level of MBP may be significantly increased. Furthermore, the involvements of bilateral and multi-lesions are the common in TIDD, and most cases showed open-ring enhancement or complete rim enhancement on MRI. In addition, all cases present hypodense lesions on unenhanced CT and patients with hyperdense seemed not to be considered as TIDD.

Objective To explore the value of brain CT scanning for distinguishing tumor-like inflammatory demyelinating diseases (TIDD) from glioma or primary central nervous system lymphoma.Methods The brain CT features in 20 patients with TIDD(10 female,10 male;mean age (35.6±14.0)years;range,6-51 years)and 32 gliomas(16 female,16 male;mean age(42.0±19.8)years;range,12-75 years)and 6 lymphomas(3 female,3 male;mean age(53.8±11.8)years;range,32-68 years)were retrospectively reviewed and compared between brain tumors and TIDD.Results (1)Among the 38 primary brain tumors,there were 19 cases(50%,14 gliomas,5 lymphomas)with hyperdense lesions,10 cases(26.3%,9 gliomas,1 lymphomas)with isodense lesions,and 9 glionms (23.7%)with hypodense lesions.In contrast,the brain unenhanced CT manifestation of 20 TIDD all showed with hypodense lesions.(2)On unenhanced CT the lesions of 6 lymphomas all were hyperdense or isodense,like 90% of 20 high grade gliomas(WHO grade Ⅲ and Ⅳ),but this rate for grade Ⅱ was only 41.7%.(3)According to the shape of hyperdense lesions of the 19 primary brain tumors with,7 cages(6 gliomas,1 lymphomas)manifested with asymmetric hyperdense small-patches,4 cases(1 gliomas,3 lymphomas)with symmetric hyperdense large-patches,4 cases(3 gliomas,1 lymphomas)with diffused hyperdensed lesions,and 4 cases(4 gliomas)with ring-shaped hyperdensed lesions.Furthermore,4 primary brain tumors(4 lymphomas)underwent CT enhanced scanning and all the cases showed strong enhancement(3 cases with hyperdense lesions and 1 with isodense lesions on unenhanced CT),but only 3 cases of 7 TIDD showed mild enhancement in contrast.(4)By Spearman's relevant analysis,hyperdense and isodense on unenhanced CT was proved to have significant positive correlation between the grade of gliomas(r=0.435,P=0.013).Therefore,the frequency of hyperdense and isodense lesions in lymphomas and WHO grade Ⅲ and Ⅳ astrocytoma was higher in contrast with low grade astrocytoma.Conclusions Brain CT as a simple,economical and practical examination method has significant meaning for differentiating TIDD from glioma or PCNSL and could be used as an adjuvant method for MRI and magnetic resonance spectroscopy.Patients with hyperdense or isodense on unenhanced CT or strong enhancement could be excluded from TIDD.

Objective To determine whether field triage would reduce median contact-to-device ( C2D ) time in patients with ST-segment elevation acute myocardial infarction ( STEMI ) . Methods Consecutive patients with STEMI underwent primary percutaneous coronary intervention( PCI) from March 2010 to February 2014 in Shanghai Pudong Gongli Hospital were analyzed. Patients were divided into two groups. A total of 121 patients were admitted by field triage and 101 patients by non-field triage. The primary study point was C2D time and the study points secondary included ( door-to-balloor, D2B) time, peak Troponin I ( TnI) levels, hospital mortality and 30 days follow-up mortality. Results Baseline and procedural characteristics between the two groups were comparable. Comparing to non-field triage group, the C2D time was reduced [(92. 0 ± 56. 0)min vs. (131. 0 ± 61. 0)min,P﹤0. 01]. The D2B time was lower in the field triage group vs. the non-field triage group [(55. 0 ±26. 0)min vs. (96. 0 ±31. 0)min,P﹤0. 01]. The percentage of patients with C2D time less than 90 minutes increased significantly from 85. 1% to 98. 3%( P﹤0. 01 ) in the field triage group. Peak TnI level was significantly reduced in the field triage group [(23. 5 ±22. 0) μg/L vs. (43. 5 ± 39. 0) μg/L,P﹤0. 01]. In-hospital mortality and 30 days follow-up mortality did not significantly differ between the 2 groups (3. 3% and 3. 0%, P=0. 885;3. 3% and 5. 0%, P=0. 544, respectively). Conclusions In STEMI patients, field triage was associated with significantly reduced C2D and D2B times.