In recent years,several studies have revealed that diabetic patients may have decreased mortality compared with non-diabetic patients from acute hyperglycemia in intensive care units (ICUs),and the patients without diabetic history are most likely to benefit from intensive insulin therapy.This probably suggests a potential "protective" effect in diabetic patients with critical illness.Possible "protective" mechanisms include the adaptive reaction to chronic oxidative stress state in diabetes,the decreased incidence of acute complications followed by critical illness,and some non-biological factors.Thus much more attention of glycemic management should be paid to those hyperglyemic patients without diabetic history in ICUs.

Nasopharyngeal carcinoma is the commonest head and neck cancer in China and especially sensitive to both chemotherapy and radiotherapy. But radiotherapy alone has disappointing effect to local advanced cases. Nevertheless,chemoradiotherapy provides long term survival. This paper summarized the current status of the different ways of chemoradiotherapy such as induction,concurrent,adjuvant chemotherapy.

Objective To investigate the frequency of JAK2 46/1 haplotype,tagged by the C-allele of SNP rs 12343867(C/T) in Chinese Han patients with PV and ET,and study the relationship between the JAK2 V617F mutation.Methods The whole blood was collected from 125 PV patients,87 ET patients and 213 healthy people.The JAK2 46/1-linked tagged SNP was screened and genotyped with high-resolution DNA melting analysis.20 random selection copies was certificated by DNA sequencing.The frequencies of genotypes and alleles at tSNP was compared between the case and healthy groups by the chi-square test.Results The C-allele frequency of 125 PV patients was 62.8% and T-allele was 37.2%.Also C-allele frequency of 87 ET patients was 45.4% and T-allele was 54.6%.The random selection copies was verified by DNA sequencing.The results showed that the distribution of JAK2 46/1 tSNP genotypes were significantly different(x2 =78.69,P＜0.01).CC and CT had a higher risk for MPNs compared to TT homozygotes(CC vs TT OR = 18.56,95 % CI = 8.70-39.58; CT vs TT OR = 3.60,95 % CI = 2.28-5.69,all of P＜ 0.01).SNP rs 12343867 was genotyped in 212 patients with concomitant analysis of V617F allele burden.Cenotype distributions did not show significant difference compared with JAK2V617F in PV patients(x2 = 2.47,P =0.12).But in ET patients,compared with V617F-negative,the frequency of C-allele showed difference (x2 =7.75,P＜0.01).Conclusions The incidence of the JAK2 46/1-linked C allele is significantly increased the disease risk of PV and ET.Results indicate that JAK2 46/1 haplotype is associated with an increased risk of acquiring a specific somatic mutation.

Objective To investigate the effects and mechanisms of G protein-coupled receptor 91 (GPR91) on blood-retinal barrier (BRB) in diabetic rats.Methods A lentiviral vector of shRNA targeting rat GPR91 and scrambled shRNA were constructed.Healthy male Sprague-Dawley (SD) rats were selected in this study.The 60 rats were randomized into 4 groups and treated as follows:(1) control group (Group A,n=15),the rats received injections of an equal volume of 0.1％ citrate buffer;(2) streptozocin (STZ) group (Group B,n=15),the rats received injections of STZ;(3) LV.shScrambled group (Group C,n=15),diabetic rats received an intravitreal injection of 1 μl 1 × 10s TU/ml scrambled shRNA lentiviral particles at 2 weeks after the induction of diabetes;(4) LV.shGPRg1 group (Group D,n=15),diabetic rats received an intravitreal injection of 1 μl 1 × 108 TU/ml pGCSIL-GFP-shGPR91 lentiviral particles.At 12 weeks after intravitreal injection,immunohistochemistry and Western blot were used to assess the expression of GPRg1,p-extracellular signal-regulated kinase(ERK)1/2,t-ERK1/2,p-Jun N-terminal kinase (JNK),t-JNK,p-p38 mitogen-activated protein kinase (MAPK) and t-p38 MAPK.Haematoxylin and eosin (HE) staining and Evans blue dye were used to assess the structure and function of the retinal vessel.Immunohistochemistry enzyme-linked immunosorbent assay (ELISA) was used to test the protein level of VEGF.Results Immunohistochemistry staining showed that GPR91 was predominantly localized to the cell bodies of the ganglion cell layer.Western blot showed that GPR91 expression in Group D decreased significantly compared with Group C (F=39.31,P＜0.01).HE staining showed that the retina tissue in Group B and C developed telangiectatic vessels in the inner layer of retina,while the telangiectatic vessels attenuated in Group D.It was also demonstrated in Evans blue dye that the microvascular leakage in Group D decreased by (33.8±4.11)％ compared with Group C and there was significant difference (F =30.35,P＜0.05).The results of ELISA showed the VEGF secretion of Group B and C increased compared with Group A and the VEGF expression in Group D was significantly down regulated after silencing GPR91 gene (F=253.15,P＜0.05).The results of Western blot indicated that compared with Group A,the expressions of p-ERK1/2,p-JNK and p-p38 MAPK were significantly upregulated (q=6.38,2.94,3.45;P＜0.05).Meanwhile,the activation of ERK1/2 was inhibited by GPR91 shRNA and the difference was statistically significant (F=22.50,P＜0.05).Conclusions The intravitreal injection of GPR91 shRNA attenuated the leakage of BRB in diabetic rats.GPR91 regulated the VEGF release and the leakage of BRB possibly through the ERK1/2 signaling pathway.

Objective To assess the accuracy of contrast-enhanced EUS in differential diagnosis of benign and malignant pancreatic masses.Methods We systematically searched the Medline,PubMed,Web of Science,Embase,Cochrane Central Trials,CNKI and VIP databases for relevant studies published.Study selection,quality assessment and data extraction were performed by two reviewers independently.Meta-Disc (version 1.4) software was used to perform this meta-analysis for sensitivity,specificity,positive likelihood ratio (LR),and negative LR.Pooling results were derived by using the fixed-effect model when significant heterogeneity was not present.The random-effect model was applied otherwise.A summary receiver-operating characteristic (SROC) curve was constructed.Furthermore,to explore the potential sources of heterogeneity,we used meta-regression to estimate the effect of the following characteristics of the studies on the diagnostic accuracy of contrast-enhanced EUS.In addition,the outliers were identified with the method described by Deville and a subgroup analysis was performed by excluding the outliers.We used Stata statistical software (version 10.0) to assess the publication bias with the Begg-Mazumdar indictor and Harbord-Egger indictor.Results Twelve studies involving 1139 patients were included.The pooled sensitivity of contrast-enhanced EUS for the differential diagnosis of pancreatic masses was 94％ (95％ CI,0.91 ～0.95),the specificity was 89％ (95 ％ CI,0.85 ～ 0.92),the positive LR was 8.09 (95 ％ CI,4.47 ～ 14.64),and the negative LR was 0.08 (95％ CI,0.06 ～ 0.10).The area under the curve (AUC) under SROC was 0.9732 (SE =0.02).The subgroup analysis by excluding two outliers provided a sensitivity of 93％ (95％ CI,0.91 ～ 0.95) and a specificity of 93％ (95％ CI,0.89 ～ 0.95).Additionally,the subgroup analysis showed that the heterogeneities were eliminated in pooled estimates when the outliers were excluded and the AUC under SROC was 0.9745 (SE =0.02).Moreover,no significant publication bias was found with the Begg-Mazumdar indictor (P =0.244) or the Harbord-Egger indictor (P =0.442).Conclusion Contrastenhanced EUS is a valuable method in the differential diagnosis of pancreatic masses.

CO2.

microRNAs as novel tumor biomarkers exert important clinical value in early screening and antidiastole of human cancers .They show a broad prospect in clinical application , particularly due to their low invasive and high sensitivity .This review focused on the application of circulating microRNA for diagnosis and monitoring treatment in colorectal cancer based on the recent findings .Meanwhile, the defects in clinical practice by using microRNAs as tumor biomarkers and the major causes which could constraint their application, especially the unreliable detection result caused by many factors , have been discussed.

Objective To assess the efficacy and safety of thiazolidinediones combined with metformin in treatment of polycystic ovary syndrome.Methods Electronic database searching was performed on Medline,Cochrane Library,EMbase,EBSCO,ScienceDirect,OVID,Springer LINK,Wiley,Chinese biology and medicine(CBM),China National Knowledge Infrastructure(CNKI),and Chongqing VIP Database;meanwhile,unpubished literature,conference papers and dissertations were also searched manually.The data included those from the establishment to November 2009.Randomized or clinical controlled trials concerning the thiazolidinediones and metformin combination therapy for PCOS were selected and assessed for the methodological quality,and Meta-analysis was performed using statistical software Revman 5.0.Results Five randomized controlled trials met the inclusion criteria and were included.Compared to metformin group,thiazolidinediones combined with metformin significantly improved insulin resistance(P

BACKGROUND: The transplantation of allogeneic cartilage has local immunological rejection, and it is necessary to further reduce the rejection to promote its application in clinic, thus it is significant to perform a series of experiments to induce local immune privilege.OBJECTIVE: To observe the in vivo growth of tissue engineered allogeneic cartilage reconstructed by chondrocytes transfected with recombinant retroviral vector pLNCX2-FasL.DESIGN: A randomized controlled observation.SETTING: Shanghai Jiao Tong University.MATERIALS: Thirty-six allogeneic New Zealand rabbits as recipients and 45 1-week-old chinchillas as donors, either sex,were purchased by the experimental animal center of Chinese Academy of Sciences. Amphotropic recombinant retrovirus coated cell line PT67 was purchased from Clontech Company; Dulbecco's modified eagle medium (DMEM), fetal bovine serum (FBS), G418 and Polybrene were bought from GIBCO BRL.METHODS: The experiment was carried out in original Shanghai Second Medical University from January 2000 to July 2005. The New Zealand rabbits were randomly divided into three groups: FasL-transfected group (n =12), untransfected group (n =12) and blank control group (n =12). The rabbit allogeneic cartilages were constructed by the compound of pLNCX2-FasL transfected chondrocytes and tissue engineered material of pluronic F-127. ① Gross observation and mass changes of the grafts: Corresponding materials were infused subcutaneously, the grafts were removed at 1, 2 and 3 months after transplantation for gross observation and the mass changes. ② Staining observation: The grafts were removed at 1, 2 and 3 months after transplantation, then prepared into sections, and observed by hematoxylin and eosin (HE), Safranin'O and Masson's trichrome stainings. ③ Antibody detection: Blood samples (1 mL) were collected at 1 and 2 months after transplantation, the chondrocytes of the chinchillas were lysed freezingly with lysis antigen as the mixed antigen, and separated by electrophoresis in agarose medium, then acted with serum of recipient to observe whether corresponding antibody generated. ④ Complement dependent cytotoxicity (CDC) test: The chondrocytes of chinchillas were prepared into cell suspension (2×109/L), and then seeded into 96-well plate, attached grew for 24 hours, then recipient serum was added for the CDC test, and the percentage of apoptotic cells was counted under microscope.MAIN OUTCOME MEASURES: ① Gross observation and mass changes of the grafts;② Histological changes; ③ Results of the antibody detection; ④ Percentage of apoptotic cells.RESULTS: All the 81 rabbits were involved in the analysis of results. ① Gross observation and mass changes of the grafts: Two weeks after inoculation, there were obvious nod formations at the inoculated sites, but no nod formed in the blank control group. The new cartilage tissues became smaller gradually and completely disappeared at 4 months in the untransfected group, whereas those in the FasL-transfected group became smaller, but still existed after 7 months. The masses of grafts in the FasL-transfected group were higher than those in the untransfected group (P ＜ 0.05). ②Histological observation: Plenty of lymphocytic infiltrations around cartilage tissue could be observed in the untransfected group, and obviously decreased in the FasL-transfected group. No lymphocyte was observed inside the chondrocytes.Masson's trichrome staining was performed, and it was observed under light microscope that the small white parts in the middle were immature chondrocytes, and there were green collagen around most of the mature chondrocytes. Safranin O staining showed strong positive reaction, suggested that there were rich glycosaminoglycan in matrix. ③ Antibody detection: The chondrocytes of the chinchillas were lysed freezingly with lysis antigen as the mixed antigen, then acted with serum of recipient, and the results showed that no corresponding antibody generated. ④ Percentage of apoptotic cells: The percentages of serum CDC apoptotic cells in the FasL can ransfected group, untransfected group and blank control group were 5%, 6% and 1%, which were all negative.CONCLUSION: Rabbit allogeneic chondrocytes transfected with recombinant retroviral vector pLNCX2-FasL can reconstruct tissue engineered cartilage, and can postpone the degeneration by 3 months.

Background and purpose: With the development of therapy equipments and technology, the treatment for nasopharyngeal carcinoma(NPC) has entered into the era of precision radiotherapy, and setup errors have become a very important factor affecting treatment effects. The purpose of this study was to analyze the set-up errors detected by the kilovoltage cone beam CT(EPID) and the megavoltage electronic portal imaging device(CBCT) using 2 kinds of different immobilization techniques (pillow+head neck shoulder mask and vacuum bag+head neck shoulder mask) for NPC patients. Methods:A total number of 40 NPC patients were randomly assigned into 2 groups (pillow+head neck shoulder mask group and vacuum bag+neck shoulder mask group). Then each group was further divided into CBCT scan group and EPID group for veriifcation before treatment delivery. We matched the EPID images with the DRRs and acquired the set-up errors in x, y, z axis. Setup errors of CBCT were calculated according to its matched and planned CT images in left-right (x), superior-inferior (y) and anterior-posterior (z) directions. Paired t-test was used to evaluate the differences. Results:In the pillow+head neck shoulder mask group, the set-up errors of CBCT in the x, y, z axis were x (0.67±2.01)mm, y (0.51±1.71)mm and z (0.57±2.04)mm, respectively. The errors of EPID were x (0.69±2.19)mm, y (0.54±2.03)mm and z (0.61±2.11)mm. In the vacuum bag+head neck shoulder mask group, the set-up errors of CBCT in the x, y, z axis were x (0.42±1.81)mm, y (0.33±1.55)mm and z (0.50±1.75)mm, respectively. The errors of EPID were x (0.44±1.87)mm, y (0.43±1.70)mm and z (0.54±1.77)mm. The vacuum bag+head neck shoulder mask ifxed technique was more accurate when compared to the pillow + head neck shoulder mask ifxation method (P<0.05). Conclusion:CBCT and EPID were similar in detecting set-up errors for the NPC patients. However, the vacuum bag+neck shoulder mask ifxed technique was more accurate when compared to the pillow+head neck shoulder mask ifxation method.