Objective To discuss application value of intestinal electromyography in patients with hepatic cirrhosis and to observe intestinal myoeletric activity.Methods There were 65 cases of hepatic cirrhosis in expermental group and 30 cases in control group. All the cases were recorded body surface intestinal electromyography using gastrointestinal myoelectric analyzer(WCDF-4B, Hefei , P.R.China). The parameters included average peak range-Ap, main frequency-Fp, average over zero frequency-Fz and special wave form were surveyed.Results Sharp higher Fz abnormal rate and emergence rate of special wave form in hepatic cirrhosis group were higher than in control group,P0 05.Conclusions In hepatic cirrhosis group,Fz was much higher than that in control group. And the intestinal myoelectric activity increased in the patients with hepatic cirrhosis,which represented by appearance of characteristic wave form that was frequent micromigration wave as well as load wave. Those changes accounted for heighten and irregularity of excitability intestinal myoelectric activity. Moreover, it will increase for the incidence of abnormality of intestinal myoelectric activity along with damage degree of hepatic function. Intestinal electromyography is a reliable method to judge intestinal myoelectric activity, the method has characteristics of harmless,free pain, convenient, safty and steady.

Purpose:To study the mutual relationships between apoptosis,cell proliferation correlative gene PCNA and tumor suppressor gene P27 Kip1 as well as to investigate if they have something to do with the occurrence,development,and prognosis in esophagus squamous cell carcinoma.Methods:47 cases of primary esophagus squamous cell carcinoma were put into investigative group whose tumor samples from operation resection were studied. 20 cases with normal esophagus cell mucous membrane tissue were put into the control group. Expression level of PCNA,P27 Kip1 was detected by immunohistochemistry method (S-ABC) in both groups. Apoptotic index was detected by TdT mediated deoxyuridylic acid(dUMP)nicking end labeling (TUNEL method) in both groups.Results:①In the group of 47 cases of esophagus squamous cell carcinoma,there were 17 cases of positive expression in P27 Kip1 ,and the positive rate was 36.17% , average proliferation index(PI) was 45.86?19.11%,average apoptotic index is 1.05%?0.59%,ratio of PI/AI is 57.37? 45.17 ,all of which were statistically significant for difference between normal tissue and carcinoma in esophagus squamous cell (P

Objective To evaluate the clinical efficacy of nerve-related acupoints electrical stimulation in preventing urinary retention after hemorrhoid surgery. Method Ninety-seven patients were randomized into two groups: the treatment group received nerve-related acupoints electrical stimulation 1 h after Milligan-Morgan hemorrhoidectomy for mixed hemorrhoids, while the control group was taken as a blank control. The incidence of postoperative urinary retention, residual urine volume after the first urination, general urinary condition score, and satisfaction evaluation were compared between the two groups. Result The incidence of postoperative urinary retention and residual urine volume after the first urinary were lower, and the general urination condition and satisfaction evaluation were higher in the treatment group compared to those in the control group. Conclusion Nerve-related acupoints electrical stimulation can prevent and reduce the adverse reactions such as urinary retention after hemorrhoidectomy, and it can effectively protect the bladder function and improve the prognosis.

Objective To investigate the correlation between the prognosis and the early lactate clearance in patients with postcardiac surgery undergoing cardiopulmonary bypass.Methods The clinical data of 73 patients who underwent postcardiotomy undergoing cardiopulmonary bypass in SuBei Hospital of Jiangsu Provience,from March 2006 to February 2010,were prospectively collected and analyzed.The collection data including:( 1 ) Preoperative factors:including gender,age,diagnosis preoperative,NYHA grade,APACHE Ⅱ score and left ventricular end-diastolic diameter.(2) Operative factors:operation time,block aorta time.(3)Postoperation factors:hemorrhage volume,mechanical ventilation time,and factors of hemodynamics and oxygen metabolism at 6 hour postoperative:heart rate(HR),central venous pressure(CVP),pulmonary capilary wedged pressure( PCWP),cardiac output index( CI),arterial blood lactic acid,6 h lactate clearance,partial pressure of oxygen( PO2 ),mixed venous oxygen saturation ( SvO2 ),oxygen delivery index ( DO2I),oxygen consume index (VO2I),oxygen extraction ratio(O2ext).Patients were divided into survival group,control group,high level of lactate clearance group( lactate clearance rate ＞ 30％ ) and low level of lactate clearance group.Firstly,the data analyzed with process of single variable analysis and some parameters,which showed the significant difference,were sorted out from two groups.Then these parameters were put to the Logistic regression analysis.Consequently,the independent risk factors of death of postcardiac surgery could be found.Results The mortality in high lactate clearance group ( 4.55％ [ 2/44 ] ) was significantly less than the low lactate group (34.48％ [ 10/29] ) ( x2 =11.889,P ＜0.01 ).The single variable analysis had shown that there were significant difference on APACHE Ⅱ score ( [ 16.9 ± 2.9 ] vs [ 19.2 ± 2.6 ],t =2.537 ),left ventricular end-diastolic diameter( [ 53.9 ± 5.6 ] mm vs [ 63.8 ± 4.6 ] mm,t =5.847 ),block aorta time ( [ 101.2 ± 34.2 ] min vs [ 122.7 ±22.7 ] min,t =2.078 ),hemorrhage volume( [464.0 ± 158.8 ] ml vs [ 603.2 ± 159.5 ] ml,t =2.773 ),mechanical ventilation time( [ 22.6 ± 5.1 ] h vs [ 28.8 ± 5.2 ] h,t =3.857 ),arterial blood lactic acid ( [ 3.5 ±1.3 ] mmol/L vs [5.1 ± 1.5 ] mmol/L,t =3.912),lactate clearance ( [38.8 ± 17.4]％ vs [ 14.6 ±9.7]％,t =4.846),and SvO2( [69.1 ±4.2]％ vs [59.2 ±6.9]％,t =5.847) (P＜0.05 or P ＜0.001)between survival group and control group.Multiple regression analysis showed that lactate clearance and left ventricular enddiastolic diameter were the two independent risk factors of death,and the odds ratio(OR) were 7.773 (95％ CI 1.364-44.306,P ＜0.05) and 15.186(95％ CI 2.758-83.162,P ＜0.01).Conclusion Early lactate clearance rate can be used as an important indicator to evaluate the prognosis of patients with postcardiac surgery undergoing cardiopulmonary bypass.

Objective To evaluate PICCO (pulse indicator continuous cardiac output) to predict fluid responsiveness in patients with acute lung injury secondary to septic shock.Methods We conducted a prospective study on 42 patients with acute lung injury secondary to septic shock.global end-diastolic volume index (GEDVI),pulse pressure variation (PPV),stroke volume variation (SVV),central vein pressure (CVP) and other haemodynamic data were recorded before and after fluid administration of 500 mL of 6％ hydroxyethyl starch.Responders were defined as patients with an increase in stroke volume index of at least 15％ after fluid loading.Performance of variables was analyzed using receiver operator characteristics analysis.Results GEDVI and PPV,but not SVV and CVP,were able to predict fluid responsiveness in patients with acute lung injury secondary to septic shock 1 hrs after admission to intensive care unit (ICU).The best area under the ROC curve (AUC) was found for GEDVI (AUC 0.802,P ＜0.01) and PPV (AUC 0.752,P ＜0.01) ; the optimal cut-off of GEDVI and PPV were 643.5 mL/m2 and 13.5％,respectively.At this cut point,the sensitivity was 90.9％,the specificity was 91.9％,however,only GEDVI was able to predict fluid responsiveness in patients with acute lung injury secondary to septic shock 6hrs afteradmission to ICU.The best area under the ROC curve (AUC) was found for GEDVI (AUC 0.788,P ＜ 0.01).the GEDVI ＜ 559 mL/m2 during loading were found to predict volume responsiveness with a sensitivity of 100％,specificity of 62.5％.Conclusions GEDVI and PPV predict fluid responsiveness in patients with acute lung injury secondary to septic shock in the early hours.

Objective To evaluate the effect of electro-acupuncture (EA) at Zusanli (ST36) acupoint on blood coagulation during intestinal ischemia-reperfusion (I/R) in rats.Methods Forty healthy male Sprague-Dawley rats,aged 6-8 months,weighing 250-300 g,were divided into 5 groups (n =8 each) using a random number table:sham operation group (group S),intestinal I/R group (group I/R),EA at Zusanli acupoint group (group EA),EA at non-acupoint group (group NE) and α7 nicotinic acetylcholine receptor antagonist α-bungarotoxin (α-BGT) group (group α-BGT).Intestinal I/R was induced by clamping the superior mesenteric artery for 4-5 min followed by 120 min of reperfusion.Bilateral Zusanli acupoints were stimulated with an electric stimulator (frequency 3 Hz,voltage 2-4 V,wave length 2 ms) for 30 min starting from the time point immediately after beginning of ischemia in group EA,while EA was performed at the points 5 mm lateral to the bilateral Zusanli instead in group NE.In group α-BGT,α-BGT 1 μg/kg was intraperitoneally injected at 45 min before ischemia,and the other treatments were similar to those previously described in group EA.Blood samples were collected from the abdominal aorta at 120 min of reperfusion for determination of the concentrations of tumor necrosis factor alpha (TNFα),tissue factor (TF),antithrombin (AT),tissue plasminogen activator (tPA),fiber plasminogen activator inhibitor-1 (PAl-l) and D-dimer in plasma (by enzyme-linked immunosorbent assay) and platelet count (PLT).The animals were sacrificed after blood sampling,the distal ileum specimens were removed for examination of the pathological changes with a light microscope,and the damage to the intestinal mucous membrane was assessed and scored according to Chin.Results Compared with group S,the concentrations of plasma TNFα,TF,tPA,PAI-1 and D-dimer were significantly increased,and the plasma AT concentration and PLT were decreased in I/R,NE and α-BGT groups,the concentrations of plasma TNFα and TF were significantly increased,and the plasma AT concentration was decreased in group EA,and Chiu's scores were significantly increased in I/R,EA,NE and α-BGT groups (P＜ 0.05).Compared with group I/R,the concentrations of plasma TNFα,TF,tPA,PAI-1 and D-dimer were significantly decreased,the plasma AT concentration and PLT were increased,and Chiu's scores were decreased in group EA (P＜0.05),and no significant change was found in the variables mentioned above in NE and α-BGT groups (P＞0.05).Compared with group EA,the concentrations of plasma TNFα,TF,tPA,PAI-1 and D-dimer were significantly increased,the plasma AT concentration and PLT were decreased,and Chiu's scores were increased in group NE (P＜0.05).Conclusion EA at Zusanli acupoint can improve blood coagulation during intestinal I/R in rats,and the mechanism is related to activating the cholinergic anti-inflammatory pathway.

Objective To investigate the correlation of short-term systolic blood pressure variability (SBPV) with esti?mated glomeruar filtration rate (eGFR) in the elderly. Methods In physical examination for the third time of kailuan group, the method of cluster sampling was used to collect randomly retired employees, age≥60 in kailuan group. The 24-hour am?bulatory blood pressure monitoring was given to these objects. Finally, 1 405 participants with integral data were recruited in?to the survey. SBPV indices were standard deviation of systolic blood pressure (SD), variability independent of the mean (VIM), maximum-minimum difference (MMD), and average real variability (ARV). Multivariate stepwise linear regression models were used to analyze the influence of short-term SBPV on eGFR. Results (1) Among 1 405 participants (67.16 ± 5.82) years, 933 individuals (66.4%) were male and 472 (33.6%) were female. (2) Study population were divided into four groups based on the 24-hour mean SBP, daytime mean SBP, night time mean SBP (group 1:mean SBP<120 mmHg, group 2:120≤mean SBP<140 mmHg, group 3:140≤mean SBP<160 mmHg, group 4:mean SBP≥160 mmHg), respectively. Values of SD, MMD and ARV, but not VIM were increased with increased mean SBP. (3) The participants were grouped according to the median SBPV with between-group comparison of the eGFR. The average eGFR levels were lower in the high 24-hour SB?PV group (SD, VIM, MMD and ARV), day-time SBPV group (SD, VIM, MMD and ARV) and night-time SBPV group (SD, MMD and ARV) than those in the low SBPV groups (P<0.05). (4) Multivariate stepwise linear regression showed that eGFR increased with 3 indices of 24-hour SBPV (SD, MMD and ARV) and 2 indices of day-time SBPV (MMD and ARV) but not for night-time SBPV (β=-0.07,-0.11,-0.07,-0.12 and-0.07, respectively). Conclusion There is a certain degree of asso?ciation between short-term SBPV indices and eGFR.

Objective To investigate the correlation of the supine hypertension (SP) with carotid intima-media thickness (IMT) in the elderly. Methods Kailuan study is a functional community-based cardiovascular risk factor study. From June 2006, there was a physical examination every two years. In the examination, demographic data, smoking, drinking, physical exercise situation and medication situation were recorded. Levels of triglyceride, high sensitivity C-reactive protein, low density lipoprotein and other biochemical indexes were observed. Using cluster random sampling, 3 064 retired employees of 60 years of age or older were selected. A total of 2 464 subjects took part in an additional examination, including the 24-hour ambulatory blood pressure monitoring, brachial-ankle pulse wave velocity, blood pressure of different positions and urine albumin. Multiple linear regression was used to analyze the correlation between supine systolic blood pressure (SBP) and IMT. Multivariate Logistic regression was used to analyze the effect of SP on IMT. Results (1) Among 2 220 participants (67.29±6.09) years, 1 463 (65.9%) individuals were male and 757 (34.1%) were females, and the average IMT was (0.92 ± 0.18) mm. (2) There was a positive correlation between supine SBP and IMT (r=0.175, P<0.01). (3) After adjusting the confounds, supine SBP was significantly associated with IMT, with an increase of 1 SD (+20.42 mmHg, 1 mmHg=0.133 kPa) in SBP corresponding to an increase of IMT by 0.01 mm (P<0.01). (4) Multiple Logistic regression analysis showed that after adjusting for sitting SBP, age, gender and other factors, SP was still a risk factor of increased IMT (OR=1.37, 95%CI:1.03-1.80), and independent of sitting SBP. Conclusion The supine hypertension is a risk factor of increased IMT, and independent of sitting SBP.

Objective:To explore whether internal mammary node irradiation (IMNI) can control the normal tissue volume dose within a reasonable range under inverse-planned intensity-modulated radiation therapy (IP-IMRT).Methods:The patients with breast cancer received postmastectomy combined with radiotherapy from January 2015 to July 2016 in Department of Radiation Oncology in Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine were retrospectively screened and sampled. The prescription dose was 50 Gy/25 times. The whole heart and ipsilateral lung were outlined on CT scan, and the dose-volume histogram parameters were quantified in the RT planning system (ADAC Pinnacle).Results:For the left breast cancer patients ( n=67) who received IMNI, the total heart dose-volume histogram parameters in 2016 were significantly decreased compared with those in 2015. The D mean in 2015 was (976.65±411.16) cGy, significantly larger than (687.47±134.65) cGy in 2016( P=0.008). Among the same sampled population, the percentage of whole heart D mean at the doses of 12 Gy, 10 Gy, 8 Gy was 33.3%, 33.3%, and 66.7% in 2015, and 0%, 3.8%, and 11.5% in 2016, respectively. For the right breast cancer patients ( n=65) , D mean, V 2Gy, V 10Gy, V 15Gy and V 20Gy of the heart in the IMNI group were significantly higher than those in the non-IMNI group in 2016(all P<0.05). For the ipsilateral lung, D mean, V 10Gy, V 20Gy, and V 30Gy in the IMNI group were remarkably higher than those in the non-IMNI group (all P<0.05). Conclusions:IMNⅡs found to be associated with increased cardiopulmonary dose volume with IP-IMRT technique. Nevertheless, with the practical experience of IMRT and the increasing awareness of cardiac dose limitation, it is feasible to control the cardiac dose increment within a limited range.

BACKGROUNDLymphocyte function and homeostasis is associated with immune defence to infection. Apoptosis of lymphocytes might be a considerably important component which has an impact on immunity to infections in people with hyperglycemia. The aim of this study was to explore the mitochondrial apoptosis pathway of lymphocyte in diabetic patients.

METHODSSixty patients with type 2 diabetes mellitus and fifty healthy volunteers were included in this study. Annexin V and propidiumiodide (PI) were joined in the isolated lymphocytes and the rate of lymphocyte apoptosis was calculated with flow cytometry. Observation of the lymphocytes was done using transmission electron microscopy; mitochondria had been extracted and then mitochondrial membrane potential (MMP) was detected to assess mitochondrial function; the mRNA level of Bcl-2, cytochrome c (Cyt-C), caspase-9 and caspase-3 were analyzed by real-time reverse transcription-polymerase chain reaction (RT-PCR).

RESULTSApoptosis rate of lymphocyte was significantly higher in diabetic group than that in normal control group (P < 0.05). Transmission electron microscopy showed lymphocyte shrinkage and breakage, chromatin condensation and less mitochondria; a fall in MMP levels was also evident; Bcl-2 concentration was reduced and the expressions of caspase-9, caspase-3 and Cyt-C were elevated (P < 0.05) in diabetic patients.

CONCLUSIONSThe rate of lymphocyte apoptosis was significantly higher in type 2 diabetic patients than that in normal population. Mitochondrial apoptosis pathway may play a very important role in decreasing function of lymphocyte in diabetes.

Aged ; Aged, 80 and over ; Apoptosis ; physiology ; Caspase 3 ; genetics ; Caspase 9 ; genetics ; Diabetes Mellitus, Type 2 ; metabolism ; Female ; Humans ; Lymphocytes ; cytology ; metabolism ; ultrastructure ; Male ; Microscopy, Electron, Transmission ; Mitochondria ; metabolism ; Real-Time Polymerase Chain Reaction ; bcl-2-Associated X Protein ; genetics