A-kinase anchoring protein 12 (AKAP12) ,is a kind of cell scaffold proteins,and can organize the complex of protein kinase A(PKA) and PKC as well as other signal molecules such as cyclin D1,and it is an important regulator of the β2-adrenergic receptor complex,which demonstrates the participation of AKAP12 in diverse signal transduction pathways.AKAP12 contains deletions or downregulation in variours tumors,including prostate cancers,gastric carcinomas and esophagus cancer,suggesting that the inactivation of AKAP12 expression may be linked to oncogenesis.AKAP12 is also a potential suppressor gene in metastasis of cancers.

Objective To study the association among gastric mucosal lesions caused by primary pathological duodenogastric reflux(DGR),H.pylori infection,and bile reflux.Methods Twenty-four hour intragastric bilirubin monitoring were performed on 58 patients with primary pathological DGR.The patients were divided into high reflux group(n=29)and lOW reflux group(n=29)based on the severity of bile reflux(＜23.60%).The association among gastric mucosal lesions,H.pylori infection,and bile reflux were analyzed.Results The positive rate of H.pylori infection was 20.7% (6/29)in high reflux group and 48.3%(14/29)in low reflux group(P＜0.05).The frequency of intestinal metaplasia in gastric antrum and angularis in high reflux group was higher than that in low reflux group(P＜0.05).The pathological scores of gastric antrum and angularis in H.pylori positive group and high reflux group were higher than those in H.pylori negative group and low reflux group (P＜0.05).The time percentage of bilirubin absorbance≥0.25 in H.pylori positive group was lower than that in negative group(P＜0.05),while the difference in short reflux frequency,long reflux frequency,longest reflux time,maximum,mean and median value of absorbance between H.pylori positive and negative groups showed no significant difference(P＞0.05).The time percentage of bilirubin absorbance≥0.25 was positively correlated with pathological scores of gastric antrum and angularis in both H.pylori positive and negative groups(P＜0.05),but was not correlated with that of gastric body(P＞0.05).Conclusions In patients with primary pathological DGR,excessive bile reflux is related to chronic lesion of gastric mucosa.regardless of H.pylori infection.Bile reflux may inhibit H.pylori to locate in gastric mucosa.H.pylori infection and bile reflux may co-contribute to gastric mucosal lesions.

Objective To investigate the clinicopathological features of gastric cardia cancer with neuroendo-crine cell differentiation(NED).Methods From September 2007 to October 2014,the clinicopathological features of 70 gastric cardia cancer patients with NED and 76 cases without NED confirmed by surgical pathology specimens and immunohistochemistry (Syn and CgA)in the First Affiliated Hospital of Shantou University Medical College were ret-rospectively analyzed and compared.Results The positive expression rates of synaptophysin(Syn)and chromogranin A(CgA)were 43.2% and 22.6%,respectively.Tumor differentiation was significantly related with NED (χ2 =4.989,P =0.026).Tumors with NED were larger and had deeper invasion,but they were not statistically significant. Conclusion Immunohistochemistry is important to the diagnosis of NED.Gastric cardia cancer with NED has poorer differentiation.

Objective To investigate the prognostic value of prognostic nutritional index (PNI) in patients with non-small cell lung cancer.Methods A total of 179 patients with non small cell lung cancer was enrolled in our hospital from November 2010 to January 2014.All patients were pathologically confirmed to be non small cell lung cancer.The clinical data of patients were collected,and the PNI values of each patient were calculated.The patients were divided into 4 groups according to the patients in the PNI of the patients in the treatment group (PNIQ0-25 group,PNIQ25-50 group,PNIQ50-75 group and PNIQ75-100 group).The survival curve was drawn by Kaplan-Meier method,and the difference of progression free survival (DFS) and overall survival (OS) of each group was compared by Log-rank method.Results (1) compared with PNIQ0-25 group,PNIQ25-50 group,PNIQ50-75 group and PNIQ75-100 group,there was signifi cant difference in age,smoking and KPS score (P ＜ 0.05).(2) the PNIQ0-25 group had a median overall survival of 11.5 months (95％ CI:6.6 ～ 15.4),the 3 year survival rate was 6.7％;PNIQ25-50 group had a median overall survival of 12.2 months (95％ CI:9.1 ～ 18),the 3 year survival rate was 6.4％ in PNIQ50-75 group;the median overall survival was 14.1 the month of (95％ CI:8.7 ～ 13.3),the 3 year survival rate was 11.4％,the PNIQ75-100 group had a median overall survival of 15 months (95％ CI:12.3 ～ 17.8),the 3 year survival rate was 11.6％.The Log-rank test,the four groups of patients with a significant difference in overall survival (x2 =15.6,P =0.001).(3) the PNIQ0-25 group had a median progres sion free survival was 5 months for (95％ CI:4.3 ～5.6),the 3 year progression free survival rate was 4.4％;PNIQ25-50 group had a median progression free survival was 6.4 months for (95％ CI:4.7 ～8.1),the 3 year progression free survival rate was 4.3％ in the PNIQ50-75 group;the median progression free survival was 7.4 months (95％ CI:6 ～ 8.7),the 3 year progression free survival rate was 9.1％ in PNIQ75-100 group,the median progression free survival was 8.9 months for (95％ CI:6.4 ～ 10.8),the 3 year progression free survival rate was 9.3％ by Log-rank test,survival was statistically significant was no difference between the four groups (x2 =26.7,P =0.000).Conclusions PNI has a good application value in the prognosis of patients with non-small cell lung cancer.

Objective To prepare the Elderly Functional Constipation(FC) Health Education Scale, and verify its reliability and validity. Methods The Elderly FC Health Education Scale was prepared by qualitative interviews, literature review, and Delphi method. The elderly patients who were over 60 years old and at Chinese PLA 181st Hospital were recruited by the purposive sampling method from January 2013 to August 2015.The diagnostic criteria of RomanⅢwas used to diagnose FC, the data of preliminary investigation and large sample test was used to form the formal scale, and its reliability and validity were further verified. Results The Elderly FC Health Education Scale was compiled with 6 dimensions and 28 items, and the Cronbach alpha coefficient which was the internal consistency reliability of the 6 factor was 0.965; the correlation coefficient analysis of equality reliability Kendall tau-b rank and various index variables score were positive correlation significantly. Both item level content validity index and scale level content validity index of the content validity were as a result of 1. The structure validity of the cumulated variance contribution ratio of the 6 factors were 60.15%. All factor loading coefficients between the items were more than 0.5, which indicated the fitting was good. Conclusions The reliability and validity of the Elderly FC Health Education Scale are good, and the scale may be used as a tool to prevent the elderly FC health education, and also be applied to the elderly FC patients in self-management and continue nursing after leaving hospital.

Objective To understand the status of depression and quality of life in the patients with advanced gastric cancer , and to explore their relationship .Methods The depression self rating scale (SDS) and the Chinese Scale of World Health Organiza‐tion Quality of Life Scale‐Brief Form Questionnaire (WHOQOL‐BREF) were adopted to conduct the questionnaire investigation on 131 patients with advanced gastric cancer ,then the results were compared with those of the health population .Results Among 131 patients with advanced gastric cancer ,the prevalence rate of depression was 47 .33% ,and the average SDS score was 45 .99 ± 15 .47 ,which were higher than those of the health population .The scores of quality of life were 61 .61 ± 12 .66 for the physiologic health domain ,59 .54 ± 12 .49 for the mental health domain ,64 .95 ± 14 .16 for the social relation domain and 52 .93 ± 14 .07 for the surrounding environment domain .There was a significant correlation between the depression score with the four domains scores of life quality ,in which the correlation with the mental health domain was strongest (r= -0 .636 ,r2 =0 .405) .Conclusion High depression level and poor quality of life exist in the patients with advanced gastric cancer ,and there is a correlation between them , in which the correlation between depression with the mental health domain is strongest .

Background lnterleuldn-18(IL- 18) plays a key role in the development,progression and outcome of coronary artery disease and its complications.However,its variability relation to the characterization of atherosclerotic plaque and percutaneous coronary intervention are still unknown.Methods Fifty four patients with coronary artery disease [22 patients with stable angina (SA) and 32 patients with acute coronary syndrome (ACS)] were enrolled in this study.All patients underwent percutaneous coronary intervention (PCI).The stability of the plaques at the criminal vessels was assessed with analogical IVUS.Serum IL-18 levels were measured at the time points of 5 rain before PCI,and Oh,6h,24h and lmonth after PCI in all patients.Results ACS group consisted mainly of lipidic unstable plaques while SA group of fibrous stable plaques.Moreover,compared with those in SA group,eccentricity index (EI) and remodeling index (RI) were significantly higher in ACS group.Positive remodeling was seen in ACS group while negative or no remodeling in SA group.Further,serum IL-18 levels were significantly elevated in patients with ACS than those in SA group before PCI,increased at Oh,6h,24h after PCI (P＜0.05)and were not significant different at 1 month after PCI from those before PCI.Conclusions There is significant difference in the composition and structural characteristics of atherosclerotic plaques between ACS and UA groups.PCI triggersd and enhances the inflammatory response in a short time.Serum levels of IL- 18 are the predictors of progression of unstable plaque in atherosclerosis.Post-operative complications of PCI might be reduced by inhibiting IL- 18.(J Geriatr Cardiol 2008;5:21-24)

Objective To investigate the safety and effectiveness of endoscopic resection of tumors originated from gastric fundus muscularis propria.Methods Data of 53 patients with tumors originated from gastric fundus muscularis propria detected by endoscopic ultrasonograpy,treated by endoscopic resection and followed up at our hospital between January 2012 and June 2014 were reviewed.The postoperative pathology and complications were retrospectively analyzed to evaluate the therapeutic effect and safety.Results The procedure was successfully performed on all patients and all lesions were removed in one procedure.The lesion size ranged from 0.5 to 4.5 cm and the operation time was 25-155 min[mean(46.7 ±18.2)min].Mild bleeding (5 ~150 ml)occurred in all cases,which was successfully managed by argon plasma coagulation,hot biopsy probe or endoclip.Perforation occurred in 8 patients(8 /53),seven of whom were closed with titanium clips and titanium clips combined with nylon cord.Laparoscopic intervention was applied to 1 case because of severe perforation.Gastrointestinal decompression,acid suppression with proton pump inhibitors and antibiotics were performed on all cases.No severe hemorrhage occurred.The average length of hospitalization was (5.3 ± 1.4)days(3-14 d).Pathology confirmed 46 cases of gastrointestinal stromal tumors and 7 cases of leiomyoma. The patients were followed up for 3 to 27 months,and no tumor residue or recurrence was observed. Conclusion Endoscopic resection is a method not only to get the accurate pathologic diagnosis but also to meet principle of the local resection for stomach.It is safe,effective and worthy of recommendation.

BACKGROUND:Hepatocyte transplantation has attracted more and more attention as a therapeutic measure for liver failure and genetic metabolic liver diseases.OBJECTIVE:TO evaluate the efficacy and safety of human hepatocyte transplantation in treating hepatitis B related liver failure in one case by a 2-year follow-up.DESIGN:A case-report of 2-year follow-up.SETTING:No.9 Department of Infectious Diseases,Bioengineering Research Room,the 302 Hospital of Chinese PLA.PARTICI PANT:One inpatient with hepatitis B related liver failure was selected from the 302 Hospital of Chinese PLA.and she was diagnosed according the laboratory tests.The transplanted hepatocytes were originated frOm the healthy liver of a 24-year-old man,who had signed the protocol for liver donation before death.METHODS:The hepatocyte transplantation was completed in the Department of Radiology,the 302 Hospital of Chinese PLA in December 2004.Liver was isolated to obtain human primary hepatocytes, and then cryopreserved.The hepatocytes were transplanted into recipient spleen via femoral vein after resuscitation.The clinical symptoms,changes of blood biochemical indexes,and changes of spleen MRI signals were observed before and after operation.The patient was reexamined every half a year after operation, including liver function, blood coagulation function,B-mode ultrasonography,gastroscopy and MRI,and she was followed up for 2 years. MAIN OUTCOME MEASURES:Liver function,blood coagulation function, imaging indexes, immunological indexes,complication and rejection.RESULTS:①Totally(1-2)×1010 hepatocytes were harvested,and the viability of rewarmed hepatocytes was 60%,and finally 2×109 hepatocytes were transplanted.②Two months later,the clinical symptoms of the recipient were obviously ameliorated,and serum bilirubin and aspartate aminotransferase(AST)were obviously decreased,while prothrombin activity was markedly increased.20 months later,the MRI results showed that there was hepatocyte image in spleen.Two years after operation.the total bilirubin level was 20 μmol/L,direct bilirubin level was 7 μmol/L, alanine aminotransferase was 416.75 nkat/L,AST was 533.44 nkat/L,albumin was 37 g/L,prothrombin activity was 90%,which were all obviously ameliorated as compared with those before operation(474.5 μmol/L,340.3 μmol/L,400.08 nkat/L,1 200.24 nkat/L,38 g/L,25%).The patient left the hospital 2 months later and could do light-burdened job.No complications of hydroperitonia and liver function failure, etc.were observed,and no rejection occurred.Several reexaminations by B-mode ultrasonography all indicated the further aggravations of liver cirrhosis and esophageal varices.She was admitted to hospital for twice because of esophageal varices bleeding,and cured by endoscopic variceal sclerosis therapy.CONCLUSION:Hepatocyte transplantation can ameliorate liver function without rejection,but it cannot relieve portal hypertension.

Objective:To evaluate the association between preoperative serum β 2-microglobulin (β 2MG) concentrations and postoperative delirium (POD) in elderly patients. Methods:The study selected patients who underwent knee or hip arthroplasty under spinal-epidural anesthesia on an elective basis at Qingdao Municipal Hospital from May 2021 to November 2022. The patients were divided into a POD group and a non-POD group based on the occurrence of POD. The study was conducted as part of the Perioperative Neurocognitive Impairment and Biomarkers Lifestyle Cohort, which was a nested case-control study. The study collected baseline data from two groups of patients and analyzed the differences between them. Logistic regression was used to identify the risk factors for POD. The stability of the regression model was tested using sensitivity analysis. The mediation model was used to examine whether cerebrospinal fluid (CSF) biomarkers mediated the relationship between β 2MG and POD. The receiver operating characteristic curve was drawn and the area under the curve was calculated to evaluate the accuracy of preoperative β 2MG concentrations and CSF biomarker concentration in predicting POD. Results:There were 57 cases in POD group and 449 cases in non-POD group. The results of logistic regression analysis showed that the increased β 2MG and CSF total tau protein (t-tau) concentrations were risk factors for POD, and the increased CSF β-amyloid 42 concentration was a protective factor for POD after adjustment for multiple confounders such as age, gender, education, Mini-Mental State Examination, history of hypertension and infusion volume ( P<0.05). The results of mediation analysis showed that the serum β 2MG′s effect on POD was partly mediated by t-tau (18.1%). The results of the receiver operating characteristic curve showed that the area under the curve of the β 2MG concentration combined with the CSF biomarker concentration was 0.742. Conclusions:Elevated preoperative serum β 2MG concentration is a risk factor for POD in elderly patients, and the relationship may be partly mediated by CSF t-tau.