Objective To evaluate the clinical value of Nevin and AJCC staging system for gallbladder carcinoma. Methods In this study 90 patients diagnosed as gallbladder carcinoma underwent operation in Renji Hospital from February 2000 to October 2006. Patients were staged according to Nevin and AJCC staging system. The difference of survival rate, tumor resection rate, ratio of tumor-free resection margin and surgical procedures were analyzed. Results The survival rate, tumor resection rate and ratio of tumor-free resection margin decreased progressively with increasing Nevin and AJCC stage (P < 0. 05). There was no significant difference between the survival rate for Nevin Ⅲ or Ⅳ patients undergoing radical resection and simple cholecystectomy (P > 0. 05). In Nevin Ⅴ patients, the survival rate for radical and extensive radical resection patients was higher than for palliative patients (P < 0. 05). In AJCC Ⅲ patients, the survival rate for radical patients was significant higher than for palliative patients (P < 0. 05). Nosignificant difference was found between radical and palliative patients in survival time in AJCC Ⅳ (P > 0. 05). 52 patients in AJCC Ⅲ and Ⅳ were staged to Nevin Ⅴ according to Nevin staging system. The survival rate and resectable rate for the patients in AJCC Ⅲ were higher than in AJCC Ⅳ (P = 0. 0001, 0. 001 respectively). The rate of radical operation in AJCC Ⅲ was higher (P = 0. 001), and the rate of palliative operation in AJCC Ⅳ was higher (P = 0. 001). Conclusion Both Nevin and AJCC staging system are useful in the judgement of survival, reeectability, ratio of tumor-free resection margin and the optimal operation. AJCC staging system is more applicable for gallbladder carcinoma patients at advanced stage in terms of predicting prognosis.

Aging is associated with declines of the muscular strength and cardiorespiratory functions, resulting in an impaired capacity to perform daily activities. Frailty is a clinical geriatric syndrome characterized by decreases in the biological functional reserve and resis-tance to stressors, which puts older individuals at special risk of disability. To counteract the muscular strength and cardiorespiratory func-tions declines associated with aging, as well as to prevent and treat the frailty syndrome, the strength and endurance training seems to be an effective strategy to improve muscular strength and endurance performance. This article reviewed the exercise prescription in health and frail elderly subjects according to the current situation of the researches about muscular strength and cardiorespiratory function training. Based on the results found, for the healthy older adults, strength training should be performed at moderate-to high-intensity (60%-80%of 1 RM ), and moderate volume (2-3 sets per exercise, 2-3 times/week ). Also, endurance training should be performed at moderate-to high-in-tensity (60%-85% of VO2max), and moderat volume (25-40 min). The frail older adults should exercise 2-3 times a week, for 45-60 min. Strength, endurance, flexibility, and balance training components should be incorporated, and strength and balance training should be empha-sized.

[Objective] To discuss the mechanism and relative problems of lumbar traction. [Method] Relevant articles and retrospect clinical data in the author's hospital were reviewed. Review relevant articles and retrospect clinical data of our hospital. [ Result ] Traction force : 40 kg + 15% ～ 20% of body weight, fineness rate reached 83.5% in 1606 patients being treated. According to course of disease, fineness rate was 90. 1% in the group of less than 3 years, 68.2% in the group of more than 3 years. [ Conclusion] Lumbosacral nerve root leave the peak of the protruding nucleus and establish a new harmonious "root-disc" relationship after traction. The pressure and tension to the nerve root reduces or disappears, meanwhile, the pain of low back and leg is alleviated or eradicated. Appropriate traction weight and correct traction body posture are key factors of good therapeutic effect.

ObjectiveTo investigate the cause,diagnosis and treatment measures of neonatal pneumothorax.MethodsThe clinical data of 98 cases with neonatal pneumothorax in our hospital from Mar 2005 to Mar 2010 were reviewed retrospectively.ResultsThere were 27 premature neonates and 71 full-term neonates in the 98 cases.Ten cases were spontaneous pneumothorax and 88 cases were non spontaneous pneumothorax.After the treatnent of primary disease,pleural aspiration,chest drainage and mechanical ventilation,88 cases were cured,8 cases were improved and 2 cases died.ConclusionNeonatal pneumothorax is related with cesarean section,improper use of endotracheal intubation,meconium aspiration,premature hyaline membrane disease using pulmonary surfactant and ventilator therapy.Most pneumothorax is due to lung disease.The prevention of preterm birth and asphyxia can reduce the incidence of neonatal pneumothorax.

Objective To evaluate KISS1 expression, and its significance in the prognosis of GIST patients. Methods In this study, 137 GIST cases and 73 non-GIST sarcoma cases were evaluated for clinicopathological characteristics and immunohistochemistry for KISS1 antibodies. Result The expression rate of KISS1 was 40.9% (56/137) in GISTs,which was significantly correlated with tumor size, disease extent, cellularity, presence of pseudocapaule, Fletcher's risk stratification and metastatic status after resection (P＜0.05). Patients with positive KISS1 expression had significantly worse disease free survival and disease specific survival (P ＜ 0.05 ). Conclusions KISS1 expression was associated with some clinicopathological characteristics as well as malignant behaviors in patients with GISTs. KISS1 might be a predictor in prognosis for GIST patients.

Distribution and morphologic features of AChE-containing neurons were observed by the technique of AChE regeneration. There are three kinds: AChE-staining cells--heavily stained cells, medium stained cells and lightly stained cells. Most heavily stained cells are larger multipolar cells. They are located mainly in striatum, basal forebrain, hypothalamus, substantia nigra, locus coeruleus, red nucleus, ventral tegmental nucleus, parabrachial nucleus, pontine tegmental nucleus and the motor nuclei of cranial nerves. The results of AChE-staining were compared with the date of ChAT immunohistochemistry. The relationship between AChE and cholinergic neurons as well as the nature of AChE-containing neurons were discussed.

Objective To investigate the empathy of obstetric nurses and the related factors.Methods Chinese Version of the Jefferson Scale of Empathy was used to investigate the empathy of 80 obstetric nurses in our hospital and the related factors.Results The score on empathy of obstetric nurses was 65~137,averaged 108.87±10.62 and ranked at the medium level.The empathy was mainly influenced by whether the nurses had studied the empathy-related courses and the satisfaction with their occupation and working environment.Conclusion The empathy of obstetric nurses is at the medium level.Their empathy is mainly influenced by whether the nurses have studied the empathy-related courses and the satisfaction of their occupation and working environment.In addition to promote the training,the nursing manager should improve the satisfaction of the occupation and working environment.

Objective To study the expression of high mobility group box 1 (HMGB1),matrix metalloproteinase-9(MMP-9) and vascular endothelial growth factor-C (VEGF-C)gene in papillary thyroid carcinoma (PTC) and their significance.Methods Expression of HMGB1,MMP-9,VEGF-C proteins and HMGB1 mRNA was detected by technology of immunohistochemistry(SP) and in situ hybridization in 58 cases of PTC tissues,20 cases of thyroid adenoma tissues,25 cases of nodular goiter tissues and 10 cases of normal thyroid tissues.Results Expression of HMGB1,MMP-9,VEGF-C proteins and HMGB1 mRNA in PTC tissues was much higher than that in the 3 non-cancerous tissues (P ＜ 0.05).The positive expression rate of HMGB1,MMP-9 proteins and HMGB1 mRNA was closely associated with the thyroid carcinoma size and lymph node metastasis (P ＜0.05).There was also closely association between the positive expression rate of VEGF-C protein and lymph node metastasis(P ＜ 0.05).The positive expression rate of HMGB1,MMP-9,VEGF-C proteins and HMGB1 mRNA had no association with patients' sex or age(P ＞ 0.05).The expression of HMGB1,MMP-9 and VEGF-C proteins had positive correlation with each other(P ＜ 0.05).The expression of HMGB1 protein and HMGB1 mRNA was also positively correlated with each other(P ＜0.05).Conclusion Expression of HMGB1,MMP-9,VEGFC proteins and HMGB1 mRNA in PTC is correlated with the progress,invasion,metastasis of PTC,by detecting them may help to predict the clinical progress and prognosis.

BACKGROUND:In the past, the culture and differentiation of bone marrow mesenchymal stem celsin vitrowere mostly reported in the adult or animal rather than in children.
OBJECTIVE: To explore the ability of bone marrow mesenchymal stem cels from children differentiating into neural stem cels and nerve cels.
METHODS: Bone marrow mesenchymal stem cels from children were isolated and cultured, and passage 12 cels were cultured in the pre-induction medium (DMEM culture medium containing 10% fetal bovine serum and 1 mmol/L β-mercapto ethanol) and induction medium (DMEM containing 2% dimethyl sulfoxide and 150 μmol/L butylated hydroxyanisole). Expression of nestin and β-tublin III was detected using immunocytochemistry method at 30 minutes and 7 days after induction, while RT-PCR was used to detect nestin mRNA expression at 0, 5.5, 6 days after induction.
RESULTS AND CONCLUSION: After combined induction, the cels shrank from round shape to tapered, polygonal or oval shape, and cel processes extended gradualy and became filament-like shape. Interconnected cels formed a network at 6 days after combined induction. The expression of nestin antigen was positive at 30 minutes after induction, while the expression of β-tublin was positive at 7 days. RT-PCR findings showed that positive expression of nestin mRNA was detected at 5.5 hours of induction, and then disappeared at 6 days. These findings show that the combined use of dimethyl sulfoxide and butylated hydroxyanisole can induce bone marrow mesenchymal stem cels from children to differentiate into neural stem cels and nerve cels in vitro.

Hypoxia is the most common tumor microenvironment caused by rapid proliferation of tumor cells, and hypoxia-inducible factor (HIF) is the main transcription factor for tumor cells to adapt to hypoxia. Current research has found that HIF can interact with a variety of mesenchymal cells such as fibroblasts, endothelial cells and immune cells in the tumor microenvironment, leading to the transcription and expression of target genes in response to hypoxia, which ultimately promotes tumor angiogenesis, and induces physiological changes such as migration, invasion, and immune escape of tumor cells. However, the signaling pathways involved in the HIF regulatory mechanism are complex, and the mechanism of HIF in the tumor microenvironment need to be further investigated, also most HIF inhibitors are still in the preclinical research stage. This paper reviews the research progress on the effects of HIF on tumor mesenchymal stromal cells to provide a theoretical basis for the diagnosis, prevention and treatment of tumors targeting HIF.