Objective To explore the effect of Periplaneta americana reversing multiple drug resistance (MDR) of hepatocellular carcinoma in vitro. Methods Drug resistance of Hepatocellular carcinoma cell line HepG2/ADM was established by Adriamycin ( ADM ) increasing concentration gradient method;determined cell growth curve, doubling time change using Trypan blue staining method;detected sensitivity of 4 kinds of chemotherapeutic drugs of HepG2 and HepG2/ADM by methyl thiazolyl tetrazolium method; detected the non toxic dose of Periplaneta americana CⅡ-3 and the skim cream of HepG2/ADM by MTT method; detected the inhibition rate differences of CⅡ-3, skim cream, ADM, CⅡ-3 and ADM, skim cream and ADM of hepatocellular carcinoma drug resistance cell line HepG2/ADM by MTT method.Results Drug-resistant cell line doubling time was extended obviously compared with parent cells,HepG2/ADM showed resistance to variety of chemotherapeutic drugs, ADM resistant index was especially high,that was 15.25 times.When the concentration of CⅡ-3 and skim cream were 28.76 and 45.08μg/mL respectively, the growth inhibition rate of HepG2 and HepG2/ADM two cell lines were<10%,no obvious toxic effect.The inhibition rate of the drug-resistant cell of 7.5,15,30μg/mL concentration CⅡ-3 joint with ADM concentration (1/2 IC50 ) were (24.52 ±2.05)%,( 34.78 ±3.08)%,( 45.09 ±3.56)% respectively; The inhibition rate of the drug-resistant cell of 12.5,25,50μg/mL concentration skimmed cream joint with ADM concentration (1/2 IC50 ) were (19.28 ±2.56)%,(35.08 ±2.13)%,(43.85 ±3.05)%respectively.Conclusion The cell line HepG2/ADM established has basic multidrug-resistant biological characteristics.Periplaneta americana extract can inhibit the growth of HepG2/ADM,and has good effect to reverse drug resistance at the same time.

Objective To investigate the predictive value of neutrophil to lymphocyte ratio (NLR) in rheumatoid arthritis (RA) by using the retrospectively analysis method .Methods The blood cell differential counting in 150 patients with RA ,101 patients with non‐RA diseases and 151 individuals undergoing the healthy physical examination were selected in a hospital from January 2014 and February 2015 .Blood cells classification and count were performed .Then the NLR difference was compared among these three groups .The clinical and laboratory data in the patients with RA were collected and the association between NLR and other in‐flammatory indicators was statistically analyzed .Moreover ,the diagnostic and predictive value of NLR for RA was also analyzed by using the receiver operating characteristic (ROC) curve .Results The NLR level in the RA patients was significantly higher than that in the non‐RA patients with autoimmune disease and the healthy controls .The diagnostic sensitivity of NLR and neutrophil count(NC) for RA was equivalent(62 .4% vs .67 .5% ) ,but NLR had higher diagnostic specificity than NC (85 .5% vs .68 .7% ) . The correlation analysis indicated that NLR revealed a weak but significant correlation with ESR (r=0 .210 ,P=0 .043) and CRP (r=0 .149 ,P=0 .043) respectively .Conclusion NLR has more predictive value for RA than those traditional inflammatory mark‐ers including CRP ,NC and lymphocyte count ,which is expected to serve as a new biomarker for independently predicting the RA in‐flammation severity .

Objective:To understand the current situation of physicians′ competency in China and statistically analyze its influencing factors, hence providing referential evidences for promoting their competency.Methods:The evaluation scale for Chinese physicians′ competency was developed by referring to sophisticated overseas evaluation frameworks. Based on the electronic platform of the medical alliance, stratified sampling was conducted at 39 hospitals in 13 provinces, from which 2 156 physicians were surveyed, and statistical analysis was made on the current situation and influential factor of their competency in 6 dimensions(medical knowledge, diagnosis and treatment, scientific research and teaching, interpersonal communication, spirit of professionalism, population health)Results:The score range in multiple dimensions of physicians′ competency was between 2.85 and 3.89(5 in total), among which spirit of professionalism dimension scores the highest, and teaching and research dimension scores the lowest. Logistic regression analysis shows that their competency level in 6 dimensions is correlated to a range of factors, including gender, degree, title, supervisor qualifications, standardized training program of specialist physicians, and affiliation or not to teaching hospitals( P<0.05). Conclusions:Their overall competency is expected to be elevated. To name a few, they are lack of teaching and research abilities, and need to conduct clinical-oriented scientific research; they are expected to enrich knowledge structure, and need to embrace a wider concept of health; they need to improve their non-technical service abilities, and should further emphasize their humanistic quality; physicians′ practice competency depends upon their extent of medical education, and ensuring the quality of standardized training becomes the key measure.

Natural killer ( NK) cells have historically been considered short-lived cytolytic cells that can rapidly respond against microbial pathogens and tumors in an antigen-independent manner.Recently,NK cells have been shown to possess features of a-daptive immunity with immunological memory in a manner similar to that of T and B cells.Three major viewpoints of NK cell memory initially arose from the studies of NK cell memory to recall to mouse cytomegalovirus ( MCMV ) , cytokine and skin-contact hypersensitive chemical antigens.Currently,NK cell memory has been reported in acute infection of mouse HSV ,influenza virus,HCMV and simian immunodeficiency virus ( SIV).Here,we review the latest discoveries and unsolved questions regarding NK cell memory in these models.Studies to reveal the mechanisms for NK cell memory may provide opportunities for the therapeutic use of NK cells in in -fectious diseases and cancer.

Objective To investigate the incidence of depression of coronary artery bypass grafting before and after surgery in patients with coronary heart disease and the impact of depression on patients undergoing coronary artery bypass grafting.Methods 345 patients treat with CABG were divided into depression and non depression groups based on Serf-rating depression scale(SDS).Compare the change of different degree of depression occurrence rate before and after surgery.All patients were followed up for 24 months after procedure for the occurrence major adverse cardiovascular events(MACE),then make the non MACE survival analysis and Cox regression.Results Baseline data of BMI(body mass index) and history of hypertension,cerebrovascular disease was statistically significant difference between groups.Depression in patients after CABG was significantly higher than that before procedure(40.9％ vs 24.3％,P ＜0.05).The MACE rate was significantly higher in patients with post-procedure depression than that in patients without depression(16.5％ vs 5.2％,P ＜0.01),and the incidences of myocardial infarction and target lesion revascularization were also significantly higher in depression patients than in non-depression patients(6.8％ vs 2.1％,6.6％ vs 1.6％,P ＜ 0.05).There was no significant difference on accumulative mortality between two groups(3.3％ vs 1.6％,P =0.315).The survival analysis curve of Kaplan-Meier show the incidences of non MACE survival rate was significantly lower in depression patients than in non-depression patients (P ＜0.001).There was no significant difference on death survival analysis(P =0.309).Depression,old myocardial infarction and LVEF(left ventricular ejection fraction)were independent risk factors for MACE.Conclusion The proportion was higher in patients with post-procedure and pre-procedure who have different degree of depression,the MACE rate was significantly higher in patients with postprocedure depression than in patients without depression.Depression is dangerous factors for prognosis of patients with coronary artery bypass grafting.

Background and purpose: Ductal carcinoma in situ (DCIS), is precursor lesions of invasive breast cancer, belongs to non-systemic ductal lesions, which is similar to other ductal lesions on imaging. This study aimed to investigate the differential diagnostic value of MRI in DCIS between DCIS with microinvasion (DCIS-MI) and breast intraductal papilloma (BIDP). Methods:All the cases were surgico-pathologically conifrmed. Twenty-four patients were DCIS, 9 patients were DCIS-MI, and 20 patients were BIDP. The MRI charateristics of DCIS, DCIS-MI and BIDP were analyzed and compared. Results:DCIS and DCIS-MI’s performance in the form of MRI is dififcult to differentiate (P<0.05). Compared with BIDP, the ductal and segmental enhancement, typeⅢtime-signal intensity curve (TIC), and the red pseudo-color image were associated with the DCIS. The local area enhancement, typeⅡTIC, and no-red pseudo-color image were associated with BIDP. Conclusion:MRI is a useful for differentiate between DCIS and BIDP, but is dififcult for DCIS and DCIS-MI.

Objective To analyze the changes of Blood Cell Count and D-dimer concentration in lung cancer patients with thrombosis.Methods ①554 cases of patients with lung cancer were included between January 2012 and November 2013,75 patients with other diseases which lead to high coagulation state were excluded,blood cell count and D-dimer concentration were compared between 64 lung cancer patients were the cases with thrombosis with 415 lung cancer patients were the con-trol group without thrombosis.②Color doppler ultrasonography was taken as the golden standard,receiver operating charac-teristic curves (ROC)were drawn for indexes which had significance in method.Results ①Compared with lung cancer pa-tients without thrombosis,lung cancer patients without thrombosis had decreased red blood cell count (RBC),increased white blood cell count (WBC)and D-dimer.And there were no significant change in platelet (PLT).②The area under curve (AUC)of ROC in RBC,WBC and D-dimer were 0.662,0.637 and 0.896,respectively.By thecut-off values of RBC>4.06× 1012 L,WBC<5.37×109/L and D-dimer<4.02 mg/L,the negative predictive values of RBC,WBC and D-dimer for diagno-sis of lung cancer patient with thrombosis were 93%,93% and 96%,respectively.By the cut-off value of D-dimer>4.02 mg/L,the positive predictive value of D-dimer for diagnosis of lung cancer patient with thrombosis was 6 6%.Conclusion RBC,WBC and D-dimer were related with the progress of thrombosis in lung cancer patients.RBC,WBC and D-dimer have good negative prediction effect on lung cancer patients with thrombosis.D-dimer had positive effect for diagnosis of lung cancer with thrombosis.

Objective To carry out a meta-analysis on the published data to evaluate therapeutic effects of intact canal wall mastoidectomy and open mastoidectomy for cholesteatoma otitis media .Methods A comprehensive search was performed in VIP (1989-2015) ,WANFANG (1999-2015) ,CNKI (1994-2015) and CAJD databases to collect the randomized controlled trials (RCTs) on the intact canal wall mastoidectomy and open mastoidectomy treat cholesteatoma otitis media ,and to analyze the RCTs in meta -analysis method .Results 1 069 patients were analyzed in the 18 RCTs which met the inclusion criteria .Patients were followed up from 3 months to 7 years .The meta-analysis results suggested that ,compared with the open mastoidectomy group ,the patients had less operative time (test for overall effect :Z=15 .54 ,MD= -18 .36 ,95% CI(-24 .54 ,-12 .18) , P<0 .000 01) ,less dry ear time (test for overall effect :Z=8 .64 ,MD= -13 .90 ,95% CI(-17 .05 ,-10 .75) , P<0 .000 01) ,less complica‐tions (test for overall effect :Z=7 .63 ,OR=0 .19 ,95% CI(0 .12 ,0 .29) , P<0 .000 01) ,and more patients with decreased pure tone air conduction thresholds >10 dB (test for overall effect:Z=2 .83 ,OR=2 .47 ,95% CI(1 .32 , 4 .61) ,P=0 .005) ,more patients with air-bone gaps <20 dB(Z=3 .05 ,OR=1 .60 ,95% CI(1 .18 ,2 .17) ,P=0 .002) ,but the recurrent rate is not different significantly (test for overall effect :Z= 1 .92 ,OR =1 .87 ,95% CI (0 .99 ,3 .53) ,P=0 .05) .Conclusion The illness is suitable to be treated by using the two surgical ways while the intact canal wall mastoidectomy treatment takes less operative time ,dry ear time and complications ,and improve hearing more significantly than the open mastoidectomy ,but the recurrent rate is not different significantly for trea‐ting cholesteatoma otitis media .

Objective To investigate the effect of Tongqiao Yinao decoction ( TYD) on postoperative cogni-tive dysfunction in elderly patients and its underlying mechanisms .Methods 100 anesthetic patients for orthopedic surgery were randomly divided into the TYD-treated group and control group ,50 patients in each group .In TYD-trea-ted group,patients received 150mL TYD orally,twice daily for constitutive 15 days,beginning from the day of admis-sion in addition to conventional symptomatic and supportive treatment .While patients in control group received no TYD.Mini-mental state examination ( MMSE) was used to evaluate the patients′cognitive function before and after anesthesia.Meanwhile,blood samples of patients were also collected to test the expression levels of IL -6.Results There was no significant difference between the two groups before operation .However ,TYD-treated patients had signif-icantly lower incidence rate of POCD than the controls ( 20% in the control group , and 12% in the TYD-treated group;χ2 =4.332,P=0.037) 7 days after operation.The incidence rates of POCD in the TYD-treated group and control group were 30%and 38%1 day after operation ( P>0.05),28% and 20% 3 days after operation ( P>0.05),respectively.Compared with that before operation ,the blood levels of IL-6 in the two groups significantly increased 3 days after operation (control group,t=2.412,P=0.009;TYD-treated group,t=1.429,P=0.039).In contrast to the control group,the level of IL-6 in TYD-treated group declined to the baseline (the control group,t=0.851,P=0.049;TYD-treated group,P=0.404).Interestingly,compared with the controls,the TYD-treated patients had a significant lower level of IL-6 after operation (t=1.198,P=0.035).Furthermore,Pearson correlation analysis showed that change of IL-6 level in blood was negatively correlated with MMSE score (r=-0.782,P=0.022). Conclusion TYD can improve postoperative cognitive dysfunction in elderly patients ,presumably through decreasing the level of IL-6 in blood.

Objective To investigate whether poly arginine as the carrier can carry foreign proteins to penetrate the cell membrane and even penetrate the eyeball barrier.Methods Poly-Args (R9) was used as a CPP in this study.R9-green fluorescent protein (GFP) and GFP were constructed.In vitro,human lens epithelial cells were treated with these two proteins.Then,MTT assay were used to detect whether the protein could affect the proliferation of the cells.Flow cytometry and laser confocal microscopy were used to detect the penetrability of CPPs on the cells.In vivo,eyes of mice were treated with protein in eye drops way for 7 days.Then total protein were extracted,ELISA were used to detect the penetrability of CPPs.Results The results of MTT,flow cytometry and laser confocal microscopy showed that CPPs could carry protein into cells in a dose dependent manner without affecting cell proliferation.In vivo,slit lamp showed that the mice eyeballs had no any abnormal after treated by GFP,R9-GFP,and ELISA results also showed that R9 could effectively get foreign protein into the eyeball.Conelusion R9 can carry foreign protein into the cell membrane and eyeball barrier.This study provides the basis for the eye medication and dosing mode improvement.