Objective To assess the application of intracavitary electrocardiography (IC-ECG) during the insertion of the Groshong peripherally inserted central catheters (PICC).Methods A total of 168 patients (aged 20-76 years) with gynecologic tumors who required the insertion of Groshong PICC because of various clinical conditions between January 2013 and December 2014 were selected into this study in Zhongnan Hospital of Wuhan University.During PICC insertion, the P-wave of IC-ECG helped general judgments about the position and direction of the tip of catheters, hence guiding the intubation.Precise position was determined by Xray following the fastening of catheters, based on which the accuracy and sensitivity of IC-ECG in the insertion of Groshong PICC were evaluated.Results All the cases presented typical changes of P-wave.However, 15 cases exhibited no such alternations in the first placement however deep or shallow the catheters were, in whom the typical P-wave was induced after withdrawal and replacement of the catheters with adjustment of patient position.According to the X-ray (gold standard), the accuracy and sensitivity of IC-ECG in diagnosing position of tip in the superior vena cava (SVC) were 98.8％ and 98.8％, respectively.The accuracy of diagnosing the position at the optimum location in the SVC reached 97.0％.Conclusions A high peaked P-wave of similar shape could be observed in IC-ECG in the insertion of Groshong PICC.IC-ECG could remarkably increase the positioning accuracy of PICC tip into the SVC;meanwhile, the optimal inserted length of the catheters could be determined by monitoring the changes of the P-wave with IC-ECG during insertion.

Objective To detect the effect of the antiphospholipid antibodies on the Schwann cells in vitro and to find if the Extract of Ginkgo biloba 761(EGb761)has any protective effects.Methods The immunoglobulins(Ig)were extracted from the serum of the patient with autoimmune polyneuropathies and those with controls.Ig only or Ig plus calf serum(served as complement)were added into the culture solutions of the Schwann cells.The density of the cell in one high power field,the cell perimeter and area were detected and compared to those blank and those controls.Results The shape of the Schwann cells in both the Ig and Ig plus calf serum solution were greatly changed.The densities of the cells in them were both lower than the blank ones,with more severe in the cells with calf serum.There was no significant different between the solutions with or without EGb761.Conclusion Ig from the patients with autoimmune polyneuropathies could attack the Schwann cells in vitro,with the existence of complements,the destruction was even more severe.No protection of EGb761 could be found in these situations.

1. The subnucleus caudalis of the spinal trigeminal nucleus of cat was injected with 30% HRP (Sigma, type Ⅵ). Well localized groups of labeled neurons were observed in the dorsolateral horn of the contralateral red nucleus. This dorsolateral horn, being present in the rostral and middle thirds of the nucleus, consisted mainly of middle-sized and small neurons.2. Injections were also made into the second and third segments of the cervical spinal cord and the caudal part of the bulbar reticular formation. The labeled neurons appearing in these experiments were diffusely distributed in the red nucleus, yet limited in the rostral third of it.3. Summarizing our findings and the data from the literature, we got the impression that the rostral two thirds of the red nucleus gave projections to the central structures rostral to the upper cervical spinal cord, and the caudal two thirds of it to those caudal to the lower cervical cord, which indicating a somatotopic organization of the red nucleus neurons giving descending projection fibers.

10% and 20% HRP aqueous solution was injected into the anterior wall of the stomach of rabbit, and both the afferent and efferent nerve connections of this region were examined.1. Large number of labeled cells appeared in the dorsal motor nucleus of the vagus nerve (dmnX) on both sides throughout its whole length, except the very rostral and caudal ends of it. The labeled cells were more numerous in the middle part of the nucleus at levels above and below the obex. The distribution of the labeled cells showed certain localization characteristics. Those in the caudal part of the nucleus occupied the medial portion, those in the levels around the obex distributed widely in the nucleus, while in the rostral part they were smaller in number and showed no definite localization.2. In the area between the dorsomedial border of the dmnX and the area pos- trema, the so-called area subpostrema, some disseminated labeled cells, the form of which was similar to that the labeled cells in the dmnX, were also observed.3. Numerous labeled cells appeared in the nodose ganglia on both sides, the number of which was several times more than that in the spinal ganglia, indicating that the afferent connection of the stomach via the vagus nerve predominated over that via the sympathetic nerve. The small-sized labeled cells in the ganglion, however, appeared up to more than 40% of all the labeled cells in it, the functional significance of them, as well as the relation between them and the labeled small cells in the spinal ganglia, is worth further investigation.4. The labeled neurons appeared in the spinal ganglia from Th_3 to L_3, most of them were in Th_3 to Th_(10), showing that the afferents of the stomach via the sympathetic system were diffusely arranged and at the same time concentrated in certain segments.5. Our observations confirmed that the stomach is innervated by elements of bilateral origin. In the vagus system the afferent and efferent neurons appeared almost equally in both dmnX and both nodose ganglia. And in the sympathetic system, the afferent neurons on the left side were 1 to 2 times more than those on the right, i. e., the left side is predominant.

To investigate the relationship between Snail and renal tubular epithelial-mesenchymal transition (EMT) or tubulointerstitial fibrosis (TIF) at tissue and cellular levels and to observe the changes of miRNA profile after transfecting Snail gene into human renal tubular epithelial cells (HK-2),to further elucidate the importance of miRNA in the pathogenesis of renal fibrosis.Methods The expression of Snail and EMT-related proteins vimentin,SMA,E-cadherin was detected by immunohistochemistry in renal tissues of 40 patients with IgA nephropathy.The expression of Snail,E-cadherin and SMA in normal control group,empty transfection group and Snail gene transfection group was detected by Western blot and RT-PCR.Furthermore,differentially expressed miRNAs were screened by gene chip.Results By immunohistochemistry,Snail expression was positively correlated with vimentin and SMA,negatively correlated with E-cadherin in IgA nephropathy.The higher degree of the TIF,the stronger the expression of Snail.Compared with the control group,the expression of Snail,vimentin and SMA in the snail transfected group increased.However,E-cadherin decreased at gene and protein level by the RT-PCR and Western blot (P ＜ 0.05).The difference was statistically significant.Five distinctly different miRNAs were screened by gene chip after Snail gene was transfected into HK-2 cells,and then 5 026 potential target genes were predicted.Conclusion Snail expression is closely related with renal tubular epithelial mesenchymal transition and tubulointerstitial fibrosis,and it may be used as a new target in EMT prevention.Differentially expressed miRNAs may be involved in the development of EMT and TIF.

Objective To analyze the changes of P wave of intracavitary electrocardiogram (ECC) in the placement of periph erally inserted central venous catheters (PICC), and to explore whether the intracavitary ECG can be used to guide the procedure. Methods PICC was inserted in 62 adult patients under intracavitary ECC-guided technique. The intracavitary ECC were recorded in different parts of vessel access through micro-guidewire. Results The intracavitary ECG extracted through micro-guidewire were accurately recorded in all patients. The amplitudes of P wave were (1.11 ±0.36)mm, (1.12±0.28)mm,(1.56±0.45)mm, (4.03±1.87)mm, (5.90±2.45)mm, (7.90±2.95)mm, (9.87±2.77)mm, (5.00±1.76)mm, (2.50±1.73)mm when PICC tip was located in the axillary, subclavian and brachiocephalic vein, in the superior, middle and inferior SVC, at the SVC-right atrium junction, and in the middle, inferior right atrium,respectively. The amplitude of P wave was 1.14±0.34mm in 10 patients with PICC tip malposition in the internal jugular vein. Conclusions The intracavitary ECG can be extracted with the microguidewire of PICC system. The amplitude of P wave is related to the location of PICC tip, which can be used to guide the PICC insertion and positioning.

Objective To investigate the role of vitamin D receptor (VDR) in the protection of bufalin on podocyte injury induced by adriamycin (ADR).Methods (1) In vitro:the toxic effect of different concentrations of bufalin (10-9,10-8,10-7,104 mol/L) on podocyte was evaluated by lactate dehydrogenase (LDH) test;Annexin V-FITC and RT-PCR were utilized for podocyte apoptosis and VDR mRNA level respectively.Western blotting was used to analyze the protein expression of VDR and nephrin.SiRNA intervene was also applied to evaluate the role of VDR in bufalin's protective effect on podocyte injury induced by ADR.(2) In vitro:24 SD rats were randomly divided into three groups:control group,ADR group and ADR+bufalin group.TUNEL assay was applied to detect the apoptosis of podocytes in the kidney.Immunofluorescence and transmission electron microscope (TEM) were applied to analyze the expression of VDR and the ultrastructure of the glomerulus.Results Bufalin concentration lower than 10-7 mol/L had no toxicity on normal podocyte.Bufalin reduced the urinary protein excretion (P ＜ 0.05),alleviated the removal of podocyte foot processes and attenuated the changes in nephrin expression in the glomerulus of the adriamycin (ADR) rats (P ＜ 0.05).Bufalin notably inhibited the down-regulation of VDR in protein levels on the glomerulus of the ADR rats.Additionally,bufalin inhibited the down-regulation of VDR in both mRNA levels and protein levels (P ＜ 0.05),nephrin protein expression (P＜ 0.05),and apoptosis induced by ADR in cultured podocytes.Additionally,VDR specific siRNA intervene abolished the protective effect of bufalin in ADR-induced podocyte injury.Conclusion Bufalin can alleviate ADR-induced podocyte injury via enhancing VDR expression.

Objective To evaluate the effect of contrast-enhanced ultrasound(CEUS) in the real-time monitoring treatment of ultrasound-guided high intensity focused ultrasound (HIFU ) for uterine adenomyosis .Methods From January 2013 to September 2013 ,a total of 67 patients who were clinically diagnosticated as uterine adenomyosis were enrolled in this study .49 patients were diffuse type and 18 patients were localized .CEUS was used before ,in ,after ultrasonic treatment to make sure lesions and evaluate the ablation effect .Results 67 patients were 100% perfused before HIFU treatment by CEUS ,the non-perfused volume ratio of 15 patients(22 .4% ) were not enough during treatment ,and more energy were given .During HIFU treatment ,uniform grey scale change was observed in 42 of 67(62 .7% ) patients and massive grey scale change was observed in 25 of 67(37 .3% ) patients .The margin of targets and the non-perfused volume were clearly detected by CEUS .The size of target andymyosis ,the volume ,the non-perfused volume ,and non-perfused volume ratio were(4 .8 ± 1 .5)cm ,(63 .1 ± 57 .2)cm3 ,(59 .1 ± 53 .4 )cm3 ,(76 .4 ± 27 .0)% .The adverse effects occurred in the treatment were not related to CEUS .Conclusion CEUS is an accurate method in assessing the treat-ment effect of HIFU and could be safely used during HIFU treatment for uterine adenomyosis .

Objective To investigate general and clinicopathological characteristics of male breast cancer and analyze the factors affecting the outcomes of the patients.Methods Fifty-nine male breast cancer patients treated at Cancer Hospital of Zhengzhou University from January 2002 to December 2011 were included into the study.The clinicopathologic features and 5-year survival rate were retrospectively analyzed.The clinicopathologieal characteristics were investigated by univariate analysis to evaluate the impact of these factors on patient survival.Results The median age at diagnosis was 64 years old in these patients.The positive rate of ER/PR was 74.6 ％ (44/59).The patients were followed up for 9-123 months.The 5-year survival rate was 61％.Patients in stages Ⅰ and Ⅱ had better overall survival than those in stages Ⅲ and Ⅳ.Conclusion The male breast cancer patient has special clinical characteristics.TNM stage is a significant predictor of the overall survival.

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