Objective To investigate the EUS elastographic patterns of normal pancreas and focal pancreatic lesions, and its value for characterizing and differentiating between benign and malignant pancreatic tissues. Methods Between January and June 2009, 6 patients with normal pancreas and 9 patients with focal pancreatic lesions were enrolled. Real-time elastography was carried out during the conventional EUS examination. The elastographic images were scored with 1 to 5 based on the elastographic pattern. Results Nine focal pancreatic lesions were finally diagnosed as pancreatic cancer (n = 4), cyst-adenocarcinoma (n =1), cyst-adenoma (n = 2) and focal pancreatitis (n = 2), respectively. Pancreatic cancers were scored as 3(n = 1) and 4 (n = 3). Cyst-adenocarcinoma was scored as 5 and cyst-adenomas were scored both as 2,while focal pancreatitis were scored as 2 and 3, respectively. Elastographic pattern was scored as 1 (n = 5)and 2 (n = 1) in 6 normal pancreas. When scores 1 and 2 were assigned to benign lesion and 3 to 5 to malignancy, the overall diagnostic accuracy of EUS elastography for focal pancreatic lesions was 88. 9%(8/9). Conclusion There are apparent differences in elastographic patterns between benign and malignant pancreatic tissues. EUS elastography is a promising method that allows characterization and differentiation of benignancy and malignancy.

Objective To investigate the job stressors and burnout of senior nurses, and explore the possible strategies for alleviating stress and reduction of demission rate of senior nurses. Methods Two hundred and thirty head nurses and senior nurses were included in this study. Nurse Job Stressors Inventory (NJSI) and Maslach Burnout Inventory (MBI) were applied to evaluate the burnout and work-related stress of nurses with the combination of convenience sampling and cluster sampling. Results The NJSI scores of senior nurses and head nurses were (2.62 ± 0.56) points, (2.45 ± 0.47) points, the two scores were significantly different (t=-2.465,P<0.05); the scores of three dimensions of MBI in senior nurses were (30.01±11.86) points, (8.01±5.74) points, (35.35±9.57) points, while the scores in head nurses were (21.65±10.39) points, (5.14±3.37) points, (38.81±8.45) points. Statistically significant difference was seen between the two groups (t=-5.261,-4.705, 2.691,P<0.05). There was a higher positive correlation between job stressors and burnout of senior nurses (r=0.521) than head nurses (r=0.432). Conclusions The level of job burnout is higher in senior nurses than head nurses, attributing to the higher controllability of head nurses. It is suggested to reduce the job burnout of senior nurses and to keep senior nurses in the profession fields, based on the theory of magnetic hospital.

OBJECTIVE:To study the inhibitory effects of phosphatidylinositol 3-kinase (PI3K) inhibitor LY29400 (“LY”) combined with indole-3-carbinol (I3C) on the proliferation of human anaplastic thyroid carcinoma FRO cells. METHODS:RFO cells in logarithmic growth phase were divided into blank control group,I3C (250 μmol/L) group,LY (10 μmol/L) group and combination (I3C of 250 μmol/L + LY of 10 μmol/L) group,which were subject to 24,48 and 72 h drug action. MTT method was used to determine and calculate the inhibitory rates of the cells in all groups,flow cytometry assay to determine the apoptosis rates after 48 h action,Western blot method to determine the expressions of Capspase-3 proteins thereafter and immunohistochemi-cal method to determine the expressions of Bcl-2 and Bax thereafter. RESULTS:The inhibitory rate obviously increased with the ex-tension of drug action time,with statistical significance at each time point in combination group (P<0.05). Compared to I3C group and LY group,combination group had higher inhibitory rate,apoptosis rate and the expressions of Capspase-3 protein and Bax,and lower Bcl-2 expression and ratio of Bcl-2 to Bax,with statistical significance (P<0.01). CONCLUSIONS:LY com-bined with I3C has synergistic inhibitory effects on the proliferation of FRO cells by a mechanism which may be related to apopto-sis induced by down-regulating Bcl-2 expression,up-regulating Bax expression and activating Caspase cascade reaction.

Objective To investigate the major risk factors for posterior circulation stroke and the clinical and imaging features of posterior circulation stroke patients with diabetes.Methods The patients with acute cerebral infarction were enrolled.The clinical data of patients with posterior circulation and anterior circulation stroke were compared.The patients with posterior circulation stroke were further divided into either a diabetic group or a non-diabetic group,and the vascular risk factors and imaging features of both groups were compared.The patients with posterior circulation stroke were divided into proximal segment,middle segment and distal segment and mixed groups according to the distribution of vascular lesions.The correlations between diabetes and each group and the imaging features were analyzed.Results A total of 328 patients with posterior circulation stroke (male 194,the diabetic group 108) and 336 patients with anterior circulation stroke (male 214,the diabetes group 59)were enrolled.The proportions of patients with diabetes (32.9％ vs.21.7％ ; x2 =10.501,P =0.001),hyperlipidemia (60.1％ vs.47.9％ ;x2 =9.852,P =0.002),previous stroke or transient ischemic attack (TIA) (29.0％ vs.22.0％ ;x2 =4.213,P =0.040) in the posterior circulation ischemic stroke group were significantly higher than those in the anterior circulation ischemic stroke group,and the proportion of smoking patients was significantly lower than that in the anterior circulation ischemic stroke group (18.3％ vs.26.2％ ; x2 =5.977,P =0.014).The levels of total cholesterol (4.72 ±1.07 mmol/L vs.4.56 ± 0.98 mmol/L; t =2.079,P =0.038),triglycerides (1.54 ± 1.07 mmol/L vs.1.33±0.71 mmol/L; t=3.085,P=0.002) and low-density lipoprotein cholesterol (2.91±0.90 mmol/L vs.2.75 ±0.80 mmol/L; t =2.373,P =0.018) were significantly higher than those in the anterior circulation ischemic stroke group,and the level of high-density lipoprotein cholesterol was significantly lower than that in the anterior circulation ischemic stroke group (1.13 ± 0.31 mmol/L vs.1.18 ±0.32 mmol/L; t =2.045,P=0.041).Multivariate logistic regression analysis showed that diabetes (odds ratio [OR] 1.560,95％ confidence interval [CI] 1.086-2.239; P =0.016) and previous stroke or TIA history (OR 1.455,95％ CI 1.013-2.090; P =0.042) were the independent risk factors for posterior circulation ischemic stroke.In patients with posterior circulation ischemic stroke,the patient's proportions of hyperllpidemia (66.7％ vs.55.5％ ;x2 =5.069,P =0.024) and drinking (13.0％ vs.4.5％;x2 =7.568,P=0.006) in the diabetic group (n =108) were significantly higher than those in the non-diabetic group (n =220); the proportion of atrial fibrillation patients was significantly lower than that in the non-diabetic group (3.7％ vs.11.4％ ;x2 =5.274,P =0.022).The levels of triglycerides (1.70 ± 0.93 rnmol/L vs.1.45 ± 1.11 mmol/L; t =1.989,P =0.048),fasting glucose (8.46 ± 2.96) mmol/L vs.5.30± 0.96 mmol/L; t=10.706,P=0.000) and glycosylated hemoglobin (8.36％ ± 1.94％ vs.6.07％ ± 0.55％ ; t =10.576,P =0.000) in the diabetic group were significantly higher than those in the non-diabetic group.The proportion of patients with large artery atherosclerosis stroke in the diabetic group was significantly higher than that in the non-diabetic group (73.1％ vs.60.0％; x2=5.457,P=0.019); the proportion of the patients with cardioembolism was significantly lower than that of the non-diabetic group (2.8％ vs.9.1％;x2 =4.428,P =0.035).The proportion of patients with posterior circulation middle segment infarction in the diabetic group was significantly higher than that of the non-diabetic group (49.1％ vs.31.4％ ;x2 =9.726,P =0.002).The proportions of the patients with brainstem infarction (60.2％ vs.48.2％ ;x2 =4.182,P =0.041) and single brainstem infarction (55.6％ vs.30.5％ ;x2 =19.235,P =0.000) in the diabetic group were significantly higher than those in the non-diabetic group.In patients with single brainstem infarction,the proportions of the patients with pontine infarction (43.5％ vs.25.9％ ;x2 =10.374,P =0.001) and medulla oblongata infarction (7.4％ vs.1.8％ ; P =0.023) in the diabetic group were significantly higher than those in the non-diabetic group.Conclusions Diabetes and previous stroke or TIA history are the independent risk factor for posterior circulation stroke.Diabetes is closely associated with brainstem infarction,and it is more likely to result in pontine infarction.

Objective To evaluate the clinical significance of positive peritoneal cytology in patients with endometrial cancer.Methods The records of 315 patients with endometrial cancer who were operated at Cancer Hospital, Fudan University between January 1996 and December 2008 were reviewed.Peritoneal cytology were performed and diagnosed in all patients.Factors related with peritoneal cytology were analyzed by correlation analysis.Log-rank test and Cox regression test was used for the analysis of prognosis,respectively.Results (1) Peritoneal cytology were positive in 30 (9.5%) patients.Positive peritoneal cytology was associated with pathological subtype ( P = 0.013 ), stage ( P = 0.000 ), myometrial invasion ( P =0.012), lymph-vascular space invasion ( P = 0.012 ), serosal involvement ( P = 0.004 ), cervical involvement ( P = 0.016), adnexal involvement ( P = 0.000), and omental involvement ( P = 0.000), with no association with grade ( P = 0.152 ) and lymph node metastasis ( P = 0.066 ).( 2 ) Three-year overall survival (OS) and progression-free survival(PFS) were 93.0% and 85.5% ,respectively.Positive peritoneal cytology, surgical stage, pathological subtype, myometrial invasion, grade, and lymph-vascular space invasion were significantly associated with worse prognosis by univariate analysis ( P ＜ 0.05 ), while only surgical-pathology stage and myometrial invasion were independent prognostic factors by multivariate analysis ( P ＜ 0.05 ).For 30 cases with positive peritoneal cytology, the patients with no high risk factors shown significantly prognoses better than those with any risk factors.The results shown that for patients with late stage (stage Ⅲ - Ⅳ ) endometrial cancer with positive peritoneal cytology was significantly associated with the worse OS and PFS by multivariate analysis ( P = 0.006).Conclusions Positive peritoneal cytology was associated with serosal involvement, cervical involvement, adnexal involvement, omental involvement, and late stage.Therefore, peritoneal cytology should be performed and reported separately as a part of full surgical staging procedure.

Objective To observe the effects of brazilin on proliferation and apoptosis in T24 cells.Methods Trypan blue exclusion test was performed to detect the inhibition of brazilin on the growth of T24 cell lines in vitro cultured within different time.After exposure to different concentrations of brazilin,homogeneous bioluminescence assay was used to detect the inhibitory action of brazilin,Caspase-3 and Caspase-9 activity on T24 cells.Cellular apoptosis was measured by flow cytometry (FCM) and observed by laser scanning confocal microscope.Results Brazilin could significantly inhibit the proliferation of T24 cells after 8 hours,the inhibitory rates of the brazilin at concentration of 25,50,100,200 μg/ml against T24 cells respectively were 43.19 ％,60.73 ％,86.38 ％ and 93.89 ％ (P ＜ 0.05).After exposured to 50 μg/ml of brazilin,the inhibition ration to T24 cells increased with time prolonging (52.72 ％ in 4 h,60.73 ％ in 8 h,91.77 ％ in 24 h,96.41％ in 48 h) (P ＜ 0.05).The activity of Caspase-3 and Caspase-9 increased slightly when brazilin was at 25 μg/ml,but there was no statistical differences compared with that in the control group (P ＞ 0.05).When cells were treated with an increase of the concentration of brazilin from range of 7.5-60 μg/ml for 16 hours,the apoptosis ratio in turn showed a upward trend of 0.15 ％,1.35 ％,2.91％,34.76 ％.It could be seen by laser scanning confocal microscope that the apoptosis occurred in the cells.Conclusion Brazilin can effectively inhibit the proliferation of T24 cells and induce apoptosis in a dose and time dependent manner.