Objective To assess the diagnostic value of 3D-CE MRA for nutcracker syndrome (NCS).Methods The 3D-CE MRA appearances of 4 patients of NCS and control group ( 30 persons) were analyzed.Results The left kidney vein (LKV) crossed before abdominal aorta in 4 NCS patients and 30 controls- The average angle of the origin of the superior mesenteric artery (SMA) from the abdominal aorta was (84.50±3.60)° in control group,and became small (<30°) in 4 NCS patients.The distance of the origin of the SMA to the beginning of descent was (13.40±5.10) mm,and the SMA and abdominal aorta in the axial plane crossing the LKV was (16.40±5.10) mm in controls,and all decreased in 4 NCS patients whose LKV was obviously compressed.The average ratio of expansion to stenosis caliber of the LKV was 4,5 in 4 NCS patients,whereas 1.4 in the controls.Conclusion 3D-CE MRA can display relation between abdominal aorta,SMA and LKV,thus exactly diagnose the nutcracker syndrome.

By means of the questionnaire surveys,we try to understand the medical students' employment intentions,the problems during employment preparation and job-hunting period,and the students'requirement on the guidance work of employment. Based on the analysis of the survey and the current work,we give some constructive and operable advice to improve our guidance work of employment.

Background:Multidrug resistance of tumor cells is one of the important factors that cause failure of chemotherapy in advanced gastric cancer. Tumor necrosis factor-related apoptosis-inducing ligand(TRAIL)may enhance the killing effect of chemotherapeutics on tumor cells,and reverse drug-resistant cell lines to sensitive cell lines,but its mechanism is not yet clear. Aims:To study the effect of TRAIL on expression of multidrug resistance gene glutathione S-transferase-π(GST-π)in drug-resistant human gastric cancer cell line SGC-7901 / VCR and the potential mechanism of TRAIL in reversing multidrug resistance of gastric cancer cells. Methods:SGC-7901 / VCR cells were treated with TRAIL in different doses (50,100,200 and 400 μg/ L)for 48 hours. After treatment,expression of GST-π mRNA in SGC-7901 / VCR cells and concentration of GST-π in culture supernatant were detected by RT-PCR and ELISA,respectively. Results:TRAIL could inhibit mRNA expression and protein secretion of GST-π in SGC-7901 / VCR cells in a dose-dependent manner within a certain range(≤200 μg/ L). The relative expression levels of GST-π mRNA in 50,100,200 and 400 μg/ L TRAIL groups were 0. 89 ± 0. 04,0. 77 ± 0. 08,0. 65 ± 0. 06 and 0. 61 ± 0. 03,respectively,and the concentrations of GST-π in culture supernatant in these groups were(57. 56 ± 1. 19)ng/ mL,(56. 30 ± 0. 80)ng/ mL,(31. 41 ± 1. 65)ng/ mL and (30. 80 ± 1. 34)ng/ mL,respectively,all were significantly lower than those in control group[1. 01 ± 0. 13 and(58. 62 ± 1. 38)ng/ mL,P all < 0. 05]. Conclusions:TRAIL may play a potential role in reversing multidrug resistance of gastric cancer cells through down-regulating GST-π expression.

Objective To investigate the effects of different methods of volume therapy on the inflammatory response in patients undergoing liver cancer resection.Methods Forty ASA Ⅰ or Ⅱ patients,aged 40-60 yr,with body mass index 20-25 kg/m2,undergoing liver cancer resection,were randomly divided into 2 groups ( n =20 each):routine fluid replacement group (group Ⅰ ) and goal-directed fluid replacement group (group Ⅱ ).The fluid replacement regime in group Ⅰ =compensatory volume expansion (CVE) + physiological requirements + cumulative loss + confinued loss + the third space losses.CVE was replaced with lactated Ringer's (LR) solution 5 mg/kg before anesthesia induction.The physiological requirements and cumulative loss were replaced with LR solution according to the principle of 4-2-1.The continued loss equal to the intraoperative blood loss was replaced with the equal volume of 6％ hydroxyethyl s tarch ( HES 130/0.4).The 3rd space losses were replaced with LR solution 5 ml·kg-1 ·h-1.In group Ⅱ,CVE was replaced with LR sol6ution as in group Ⅰ.LR solution was infused after anesthesia induction at 5 ml·kg-1 ·h-1.6％ HES was infused to maintain left ventricular ejection time (LVETc) between 350-400 ms.When 350 ms ＜ LVETc ＜ 400 ms and the amplitude of stroke volume ( SV ) increased by ＞ 10％,6％ HES was infused continuously until the amplitude of SV increased by ≤ 10％.Blood samples were taken before anesthesia induction and at the end of operation for measurement of serum TNF-α,IL-2,IL-4,IL-6 and IL-8 concentrations.The adverse cardiovascular reactions were recorded.Results Compared with group Ⅰ,the serum TNF-α,IL-6,IL-8 concentrations were significantly decreased,the serum IL-2 and IL-4 concentrations were significantly increase,and the incidence of hypotension and tachycardia was significantly decreased in group Ⅱ ( P ＜ 0.05).No adverse cardiovascular reactions were found in both groups.Conclusion LVETc and SV-guided volume therapy can maintain the blood volume and inhibit the inflammatory response and is suitable for the patients undergoing liver cancer resection.

Objective:To investigate the expression of Plk1 ( Polo-like kinase 1 ) and Chk1/2 ( Checkpoint kinase 1/2 ) in primary hepatic carcinoma tissue and HepG2 cell. Methods: Using immunohistochemistry chemical method detected expression of Plk1,Chk1/2 protein in 40 cases of primary hepatic carcinoma tissue and 16 cases of non-tumor tissue of liver. Western blot was applied to detect the expression of Plk1 and Chk1/2 protein in HepG2 cells, and gray value was measured by using the quantitative analysis. Results:The positive rate of Plk1,Chk1/2 protein expression in primary hepatic carcinoma was 57. 5%,75. 0% and 22. 5%respectively,compared with positive rate in the liver of non-tumor tissue were 0%,25. 0% and 56. 3%. The expression of Plk1 and Chk1 protein in primary hepatic carcinoma tissue is higher than that in non-tumor tissue of liver,and the difference was statistically sig-nificant( P<0. 05 ) . The expression of Chk2 in primary hepatic carcinoma was lower than that in hepatic non-tumor tissue, and the difference was statistically significant(P<0. 05) too. The expression of Plk1,Chk1/2 protein were detected in HepG2 cells and the relative expression rate of Plk1,Chk1/2 protein were 0.39±0.0226,0.08±0.0249 and 0.01±0.0066 respectively,the difference between them was statistically significant. The expression degree was Plk1>Chk1>Chk2. Conclusion: Plk1,Chk1 protein in primary hepatic carcinoma was up-regulated,while Chk2 protein was down-regulated in these tissues. The expression degree was Plk1> Chk1>Chk2. There were relatively selective expression in primary hepatic carcinoma tissue of Plk1,Chk1 protein,then Plk1 and Chk1 might be ideal targets for therapy of primary hepatic carcinoma.

The gap between foreign and domestic medical and health information construction levels was described and the major factors that influence the domestic medical and health information construction level were analyzed by analyzing the medical and health information construction levels in USA, Britain, Canada, Germany, Japan, Aus-tralia and China according to the input-output data in WIOD, with suggestions put forward for the improvement of domestic medical and health information construction.

Objective To evaluate the correlation between stroke volume variation (SVV) and blood volume during one-lung ventilation (OLV).Methods Forty ASA Ⅱ male patients,aged 50-60 yr,with body mass index 20-25 kg/m2,scheduled for elective resection of esophageal cancer,were studied.Anesthesia was induced with fentanyl 4 μg/kg,propofol 2 mg/kg,and rocuronium 0.6 mg/kg.Double-lumen tube was inserted.Correct position was verified by fiberoptic bronchoscopy.The patients were mechanically ventilated (VT 8 ml/kg,RR 15 bpm,Ⅰ ∶ E 1 ∶ 2).6％ hydroxyethyl statch (HES) 130/0.4 was infused intravenously at a rate of 0.67 ml· kg-1 · min-1 starting from 30 min of OLV.SVV,cardiac output (CO),SV and cardiac index (CI) were monitored and recorded using the FloTrac/Vigileo (Edwards Lifesciences,USA) system before HES was infused and when the dose of HES reached 2,4,6,8,10 and 12 ml/kg.Spearman rank sum correlation coefficient was used to analyze the data.Results SVV was negatively correlated with the blood volume during OLV and the correlation coefficient was rSVV =-0.249.CI,CO and SV were positively correlated with the blood volume during OLV and the correlation coefficients were rCO =0.570,rSV =0.552 and rCI =0.550,respectively.Conclusion SVV is poorly correlated with the blood volume during OLV and can not reflect the blood volume accurately.

Objective To evaluate the protective effects of different modes of ventilation on the lungs on the operated side during one-lung ventilation (OLV ) in patients undergoing thoracic surgery .Methods Forty-five ASA physical status Ⅰ or Ⅱ patients of both sexes ,aged 45-64 yr ,weighing 65-80 kg ,were randomly divided into 3 groups (n=15 each) using a random number table :group A ,group B and group C .After induction of anesthesia ,the patients were intubated with double-lumen tube and OLV was performed .During OLV ,the lung on the operated side was collapsed naturally in group A ,positive pressure ventilation (FGF 2 L/min) was applied in the lung on the operated side in group B ,and high-frequency jet ventilation (frequency 100 beats/min ,driving pressure 0.5 kg/cm2 ) was used in the lung on the operated side in group C .Immediately after intubation (T0 ) , and at 1.5 h (T1 ) and 2 h (T2 ) of OLV ,blood samples were taken from the central vein and radial artery for determination of the serum interleukin-6 (IL-6 ) and IL-8 concentrations .The net release of IL-6 and IL-8 was calculated .Blood samples were taken from the radial artery at T0-2 for blood gas analysis and for determination of surfactant protein A (SP-A) concentration in the serum .Respiratory index (RI) was calculated .The non-cancer tissues 1.0 cm × 1.0 cm × 1.0 cm which were extracted from the lung cancer specimens were used for microscopic examination of the pathological changes of lungs which were scored .Results Compared with group A ,the net release of IL-6 and IL-8 ,serum SP-A concentration ,RI and pathological scores were significantly decreased at T1 ,2 in B and C groups ( P<0.05) .Compared with group B ,the serum SP-A concentration and RI were significantly decreased at T1 ,2 , and the net release of IL-6 was increased at T2 in group C ( P< 0.05 ) .Conclusion Continuous positive ventilation and high-frequency jet ventilation both can effectively protect the lungs on the operated side during OLV in patients undergoing thoracic surgery ,and the efficacy of high-frequency jet ventilation is better .

Objective: To evaluate the intervention effect of clinical pharmacists in hypertension chronic disease management. Methods:All the patients with hypertensive chronic diseases from Ziyang community, Xingan Street, Beilun district were involved in the study. Combined with community doctors, clinical pharmacists provided pharmaceutical care for the patients, such as regular face-to-face medication guide, telephone communication, home follow-up, special lectures on health and so on. The cognitive level, blood pressure control level and medication compliance were statistically analyzed and compared before and after the pharmacy intervention. Results:After the intervention of clinical pharmacists, the level of hypertension cognition and the level of antihypertensive drug under-standingof the patients was improved significantly (P<0. 05 or 0. 01), the level of blood pressure control and medication compliance of the patients were improved significantly (P<0. 01), and unscheduled outpatient rate, emergency rate, hospitalization rate and fre-quency were decreased (P<0. 05 or 0. 01). Conclusion: Pharmacy intervention carried out by clinical pharmacists for the patients with hypertension chronic diseases can provide reasonable medication security and improve the quality of life, and the pharmacy inter-vention mode for the hypertension chronic disease management is worthy of promotion.

Objective To evaluate the predictive performance of propofol target-controlled infusion (TCI) system incorporating the Schnider pharmacokinetic parameters in Chinese patients. Methods Forty ASA Ⅰ or Ⅱ patients, aged 25-45 yr, with body mass index 20-25 kg/m2 , scheduled for gynecological laparoscopic surgery un der general anesthesia, were enrolled in this study. Anesthesia was induced with TCI of propofol (target plasma concentration (Cp) 3 μg/ml) and remifentanil (Cp 4 ng/ml) . Propofol was infused by Orchestra TCI system incorporating the Schnider pharmacokinetic parameters. Tracheal intubation was facilitated with rocuronium 0.6 mg/kgafter the patients lost consciousness. The patients were mechanically ventilated. PETCO2 was maintained at 30-40 mm Hg. Anesthesia was maintained with TCI of remifentanil (Cp 4 ng/ml) and propofol (Cp 3-5 μg/ml) and intermittent iv boluses of atracurium 0.2 mg/kg. BIS value was maintained at 40-45. Venous blood samples were obtained at 15, 30, 45 and 60 min after pneumoperitoneum for measurement of blood propofol concentrations by high performance liquid chromatography with fluorescence detector. Performance error, median prediction performance error, median absolute performance error, wobble and divergence of propofol TCI system were calculated. Results The value for performance error was 21 % (13%), for median prediction performance error 6.7 % (37.4%),for median absolute performance error 19% (18%), for divergence - 0.65%/h (0.82%/h) and for wobble 16.3% (15.2% ) . Conclusion The accuracy of propofol TCI system incorporating the Schnider pharmacokinetic parameters is high in Chinese patients and its predictive performance is acceptable clinically.