Objective To explore the role of the Hedgehog singaling in the pathogenesis of esophageal cancer.Methods Tissue samples of normal esophageal mucosa,low-grade dysplasia,high-grade dysplasia and esophageal cancer were collected.Immunohistochemical stain,Western-blot and RT-PCR were employed to detect theexpression of Hedgehog protein and gene,methylation special PCR was used to detect the methylation status of Hedgehog gene.Results There was no difference in the expression of SHh protein among nornaml esophageal and low-grade dysplasia,high-grade dysplasia and esophageal cancer(LGD vs.N:t=1.96,P=0.67;HGD vs.EC:t=1.59,P=0.53).However,the expression of SHh protein in high-grade dysplasia and esophageal cancer was higher than that in normal esophageal mucosa and low-grade dysplasia(HGD vs.N:t=0.593,P=0.004;HGD vs.LGD:t=1.308,P=0.325;EC vs.N:t=0.292,P=0.000;EC vs.LGD:t=0.734,P=0.004).The expression of Hedgehog gene in esophageal cancer was higher than that in normal esophageal mucosa,low-grade dysplasia and high-grade dysplasia(EC vs.N:t=0.909,P=0.019,EC vs.LGD:t=0.398,P=0.007;EC vs.HGD:t=0.843,P=0.012).The gene methylation in esophageal cancer was lower than that in normal esophageal mucosa,low-grade dysplasia and high-grade dysplasia(EC vs.N:t=0.0340,P=0.000;EC vs.LGD:t=0.102,P=0.000;EC vs.HGD:t=0.367,P=0.018).Conclusion Hedgehog signaling may play a role in the pathogenesis and development of esophageal cancer,however,demethylation of Hedgehog gene may be one of the mechanism that cause the activity of oncogene in esophageal cancer.

Objective To report the clinical characteristics, biochemical profiles, diagnosis and treatment of one Chinese pedigree with glucocorticoid remediable aldosteronism. Methods Plasma and urine aldo~sterone and cortisol and plasma renin activity were dynamically tested and diagnostic therapy was undergone in 3 affected subjects. Results All of 4 affected members had hypertension, hypokalemia, 3 patients had low basic and provoked renin activity (0.017?0.015 vs 0.13?0.08)?g?L -1 ?h -1 . 3 patients were treated with 2 mg dexamethasone for 5～7 days, then the medication was reduced gradually and maintained at 0.5～0.75 mg per day after 1～1.5 month(s). 5 days after treatment, the plasma aldosterone concentrations (PACs) decreased significantly from (192?9)ng/L to (87?7)ng/L (P

ObjectiveTo study the clinical feature, diagnosis, treatment and prognosis of hepatic angiomyolipoma.Methods The clinical materials of eight surgically treated patients with hepatic AML were retrospectively analyzed.ResultsThere were five females and three males, with age ranging from 25 to 59 years (mean 39 6 years). Tumors were located in the right lobe of the liver in 5 cases, and in the left lobe in 3 cases. Ultrasonography and computed tomography were performed in all cases. Magnetic resonance imaging and angiography were done in two each cases. The myoid cells in all tumors showed over expression of HMB 45. One patient died of postoperative heart failure, seven were followed up for 9 mos to 12 years without tumor recurrence. Conclusions Comprehensive imaging features can reveal the characteristic components of hepatic angiomyolipoma. HMB 45 immunostaining can be used to confirm the diagnosis. Surgical resection is an effective treatment of hepatic AML.

Objective To study the clinical feature, diagnosis and surgical treatment of mixed hepatocellular and cholangiocellular carcinoma(MHC).Methods The clinical materials of 14 surgically treated patients with MHC were retrospectively analyzed.Results There were nine males and five females, with age ranging from 33 to 62 years (mean 50 years). Some patients had a history of hepatitis B(71%), and cirrhosis(64%). Elevation of serum alpha-fetaprotein(AFP) was observed in nine patients(64%). The resection rate was 86%(12/14), and postoperative overall 1-, 3-, 5-year survival rates were 71%(10/14)?43%(6/14)?and 29%(4/14), respectively. In the tumor-resected patients, the 1-, 3-, 5-year survival rates were 83%(10/12)?50%(6/12)?and 33%(4/12),respectively. Conclusions MHC patients lack typical clinical manifestations. Radical surgery is an effective treatment for this disease. The cholangiocellular carcinoma component appears to determine the prognosis.

Objective To evaluate the effect of physical exercise on health-related quality of life (HRQol),fatigue,depression,anxiety and body-image in breast cancer patients.Methods The Cochrane Library,Pubmed,EMBASE,CINAHL,Psycinfo,SportDiscus,CNKI and CBMdisc were searched to collect randomized controlled trials (RCTs) from 2002 to 2011 which mentioned the physical exercise to breast cancer patients.The quality of the RCTs was appraised and the data were extracted.Results In total,16 RCTs were included.Statistically significant results were found for the effect of physical exercise on HRQol,fatigue,depression,anxiety and body-image.The presence of publication bias was explored and no publication bias was detected.Sensitivity analysis were also performed and there were no significant differences with the former results.Conclusions The results indicated that physical exercise improve HRQol and psychological outcomes in breast cancer patients.Breast cancer patients should be taught to do some moderate exercises as part of their lives to promote rehabilitation.

Objective:To observe hemostoisis efficacy and safety of Perclose vascular closure device on femoral artery in transfemoral pathway radiofrequency ablation (RFA) of supraventricular tachycardia (SVT) .Methods :A total of 199 patients undergoing transfemoral RFA of SVT were divided into Perclose vascular closure group (Perclose group ,n=98) and artificial pressing group (n=101) .Immediate success rate ,hemostasis time ,braking time and in-cidence rates of postoperative complications were observed between two groups .Results:There was no significant difference in immediate success rate of hemostasis (98% vs .100% ) between Perclose group and artificial pressing group , P> 0.05. Compared with artificial pressing group , there were significant reductions in hemostasis time [ (18.9 ± 9.1) min vs .(2.7 ± 0.7) min] ,braking time [ (21.6 ± 3.4) min vs .(6.3 ± 2.4) min] and total inci-dence rate of complications (16.8% vs .4.1% ) in Perclose group , P<0.05 or <0.01. Complications:incidence rate of vagal reflex in Perclose group was significantly lower than that of artificial pressing group (0 vs .7.9% ,P<0.05) ,other incidence rates of complications between two groups were no significant difference ( P> 0.05 all) . Conclusion:Perclose vascular closure device could shorten the duration of hemostasis and braking ,and reduce the complications .It could be the preferred choice for femoral artery hemostasis .

Objective To explore the effect of tumor necrosis factor-alpha(TNF-α) blockade therapy on circulating Th17 cell percentage and serum interleukin (IL)-17 level in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Methods Twenty-seven RA and 22 AS patients were recruited, of which 14 cases from both diseases received 40 weeks TNF blockade therapy. Twenty-four healthy blood donors were used as controls. The frequencies of circulating Th17 cells were determined by flowcytometry, and serum IL-17 level were measured by enzyme linked immunosorbent assay(ELISA). Results Significantly higher baseline circulating Th17 cells were observed in active RA and AS patients compared with the healthy controls[RA 1.03%(0.66%,1.78%) vs controls 0.50%(0.43%,0.67%), Z=-3.236, P<0.01; AS(1.16±0.09)%vs controls (0.59 ±0.061)% , t =5.226, P <0.01]. Similarly, serum IL-17 level were significantly elevated in patients with both diseases compared with controls[RA(32.3±2.5) pg/ml vs controls(14.3±2.5) pg/ml, t=5.070, P<0.01; AS 28.98(23.84,36.14) pg/ml vs controls 11.84(5.33,22.12) pg/ml, Z=-4.103, P<0.01]. After TNF-α blockade therapy, serum IL-17 was significantly decreased in both diseases groups[RA △(-13.5± 5.0) pg/ml and AS △(-16.0±1.9) pg/ml]. In contrast, no significant differences were found in the frequencies of circulating Th17 cells[RA △(0.104 5±0.212 6)% and AS △(0.002 5±0.183 8)%]. Conclusion Th17 cells and IL-17 have been implicated in the pathogenesis of RA and AS. TNF-α blockade can partially inhibit the function of Th17 cells. However, it is unable to reduce the frequencies of these cells in the circulation after 40 weeks therapy, which may explain the reasons for the relapse.

Objective To evaluate the diagnostic value of 2D ultrasound (2DUS)-based composite score method and contrast enhanced ultrasound (CEUS) in differentiation between thyroid microcarcinomas and benign micronodules. Methods A total of 216 consecutive patients with 258 thyroid micronodules underwent 2DUS and CEUS examinations before thyroidectomy from June 2011 to October 2013. The scoring of each nodule was based on five 2DUS features including hypoechogencity, irregular shape, macrocalcification, and taller than wide in shape. Microcalciifcation was assigned as 2 points and the remaining features were assigned as 1 point. A composite score was ifnally given to each thyroid nodule ranging from 0 to 6 points. The sensitivity, specificity and accuracy of diagnosing thyroid microcarcinoma by 2DUS composite score method and CEUS were calculated. Results The histopathologic results of all 258 nodules were acquired, including 125 papillary microcarcinomas and 133 benign micronodules. Each nodule′s 2DUS compostie score was ranging from 0 to 6 points. The area of receiver operating characteristic (ROC) curve of 2DUS in diagnosing thyroid microcarcinoma was 0.81. The 2DUS composite score method predicted the thyroid microcarcinoma with sensitivity of 78.4%(98/125), speciifcity of 72.9%(97/133), accuracy of 75.6%(195/258), when the nodule with a score greater than or equal to 3 points was deifned as malignant. Thyroid micronodules′enhancement pattern were divided into 7 types, including early hypoenhancement, hypoenhancement, isoenhancement, hyperenhancement, local nonenhancement, nonenhancement, and ring margin ring enhancement. CEUS predicted thyroid malignant micronodules with sensitivity of 87.2%(109/125), specificity of 75.9%(101/133), and accuracy of 81.4%(210/258), when early hypoenhancement and hypoenhancement pattern was defined as malignant patterns. There were no differences in sensitivity, specificity, and accuracy between 2DUS cumulative score method and CEUS in diagnosing thyroid microcarcinoma (McNemar test, P=0.099, 0.608, 0.096). Conclusion Early hypoenhancement and hypoenhancement are CEUS characteristic enhancement pattern for thyroid microcarcinoma, CEUS has higher sensitivity, speciifcity in diagnosis than 2DUS composite score method, while there are no statistical differences.

Objective To investigate the value of global longitudinal strain (GLS) in detecting severe coronary artery stenosis (SCAS) in patients with coronary artery disease. Methods Fourty-two patients with SCAS confirmed with coronary arteriongraphy (CAG) underwent two-dimensional strain echocardiography. GLS, wall motion score index (WMSI) and left ventricular ejection fraction (LVEF) were obtained. Taking CAG as gold standard, the sensitivity, specificity and areas under the ROC curve (AUC) of definition of SCAS with GLS, WMSI and LVEF were calculated, respectively. Fifteen healthy volunteers were recruited as control. Results ①Definition of one or more branches with severe stenosis: The sensitivity and specificity was 77.51% and 100% with GLS of -17.50% as a cutoff value, 70.01% and 100% with WMSI of 1.00, and 57.51% and 100% with LVEF of 59.21%. ②Definition of two or more than two branches with severe stenosis: The sensitivity and specificity was 62.52% and 80.81% with GLS of -11.05% as a cutoff value, 56.22% and 65.31% with WMSI of 1.60 and 56.21% and 65.42% with LVEF of 54.31%. ③The correlation coefficient was 0.78 between GLS and LVEF, and -0.82 between WMSI and LVEF. The AUC of detecting one or more branch with severe stenosis with GLS, WMIS and LVEF was 0.87, 0.80 and 0.78, respectively, and AUC of GLS was more than that of LVEF (P＜0.01). AUC of detecting two or more than two branches with severe stenosis with GLS, WMIS and LVEF was 0.76, 0.64 and 0.64, AUC of GLS was more than that of LVEF and WMSI (all P＜0.01). Conclusion GLS can be used in detecting SCAS, and the value of GLS is better than that of WMIS and LVEF.

After the reform from "4+1" to "3+2",an undergraduate teaching model of clinical medicine,has been implemented in our university,higher demands are set on the training of students' abilities and creativity.This paper explored the basic medicine teaching from the perspectives of creative concepts,teaching staff,curriculum design and practice.