Objective To study the relationship between serum Estradiol(E2 ) andβ-amyloid protein(β-AP) in patients with cer-ebral infarction .Methods A total of 46 female patients with cerebral infarction were selected from 2011 January to 2014 June into observation group ,46 cases were divided as 20 cases in mild group ,16 cases in moderate group ,10 cases in severe group on the basis of neural function defect score standard ,according to the size of infarct volume 46 patients were divided into small infarct volume group with 21 patients ,moderate infarct volume group with 14 cases ,larger infarction volume group with 11 cases .In the same peri-od ,64 healthy women were recruited into control group .Serum E2 ,β-AP levels of serum and cerebrospinal fluid were detected and compared ,and the relationship of serum E2 andβ-AP level in serum ,cerebrospinal fluid were analyzed .Results Theβ-AP levels in serum and cerebrospinal fluid in observation group were higher than those of control group ,the serum E2 level was significant lower than that of the control group ,the differences were significant(P<0 .05) .With more severe cerebral infarction ,β-AP levels in serum cerebrospinal fluid showed an upward trend ,with more severe cerebral infarction ,the serum level of E2 was significantly decreased , andβ-AP ,E2 levels in mild ,moderate ,severe group had significant differences(P<0 .05) .Theβ-AP levels of serum and cerebrospi-nal fluid in higher infarct group were higher than those in small ,moderate infarction group ,but E2 levels were lower than those in small ,moderate infarction group ,the differences had significant(P<0 .05) .There were no significant difference inβ-AP of serum and cerebrospinal fluid ,Serum E2 level between small and moderate infarction group(P>0 .05) .The expression of serum E2 andβ-AP in serum and cerebrospinal fluid were negatively correlated(r= -0 .428 ,P=0 .009;r= -0 .476 ,P=0 .005) .Conclusion β-AP levels in serum and cerebrospinal fluid in patients with cerebral infarction are high ,closely related with the severity of cerebral in-farction .β-AP levels of cerebrospinal fluid ,serum in cerebral infarction patients are negatively related to the level of serum E2 .

Objective To explore the potential mechanism of severe liver injury shortly after withdrawal of antiviral therapy in chronic hepatitis B (CHB) patients.Methods Forty-nine patients with chronic hepatitis B virus (HBV) infection from the Department of Infectious Diseases of the First Affiliated Hospital of Nanchang University and 8 healthy volunteers from August 2014 to March 2015 were included in this study.All of them were human leukocyte antigen (HLA)-A2-positive.CHB patients were classified into three groups,including 15 cases in immune-tolerance group,20 cases in sustained antiviral treatment group,and 14 cases in recurrence of drug withdrawal group.The frequency of peripheral HLA-A0201-restricted hepatitis B core antigen (HBcAg)18-27 pentamer complex specific CD8+ T cells in CHB patients was analyzed by flow cytometry.Enzyme linked immunospot assay(ELISPOT) was used to detect interferon-gamma (IFN-γ) and tumor necrosis factor-α (TNF-α) secretions of HBcAg18-27-specific CD8+ T cells.The experimental data were analyzed using non-parametric U tests.Results In healthy control group,immune-tolerance group,sustained antiviral treatment group and recurrence of drug withdrawal group,the frequencies of HBcAg-specific CD8+T cells were (0.17 ± 0.16) ％,(1.46±0.72)％,(3.24± 1.60)％ and (4.67±2.43)％,respectively.Compared with healthy control group,the difference were all statistically significant in the three groups (Z=-3.583,-4.018 and-3.823,respectively;all P＜0.01).The frequencies of HBcAg-specific CD8+T cells in immune tolerance group or recurrence of drug withdrawal group were both significantly different from that in sustained antiviral therapy group (Z=-3.400 and-2.030,respectively;both P＜0.05).The difference between immune-tolerance group and recurrence of drug withdrawal group was also significant (Z =-3.230,P＜0.01).The secretion levels of IFN-γ of HBcAg-specific CD8+T cells in healthy control group,immune-tolerance group,sustained antiviral treatment group and recurrence of drug withdrawal group were2 (0-6),16 (2-53),106 (14-254) and 156 (28-395) spot forming cell (SFC)/106 peripheral blood mononuclear cell (PBMC),respectively.The differences between healthy control group and immune-tolerance group,sustained antiviral treatment group or recurrence of drug withdrawal group were all statistically significant (Z=-3.585,-4.069 and-3.824,respectively;all P＜0.01).The IFN-γ level of HBcAg-specific CD8+ T cells in recurrence of drug withdrawal group was significantly higher than that in sustained antiviral therapy group (Z=-2.205,P=0.027),and that in sustained antiviral therapy group was significantly higher than that in immune-tolerance group (Z=-4.700,P＜ 0.01).The TNF-α levels secreted by HBcAg-specific CD8+ T cells in each group were 2 (0-5),16 (2-32),112 (15-283),and 195 (55-537) SFC/106PBMC,respectively.The differences between healthy control group and immune-tolerance group,sustained antiviral treament group or recurrence of drug withdrawal group were all statistically significant (Z=-3.619,-4.069 and-3.824,respectively;all P＜0.01).The TNF-α level secreted by HBcAg-specific CD8+T cells in recurrence of drug withdrawal group was significantly higher than that in sustained antiviral therapy group (Z=-2.449,P=0.014),and that in sustained antiviral therapy group was significantly higher than that in immune-tolerance group (Z=-4.350,P＜0.01).Conclusions The changes of frequency and immune function of HBcAg-specific CD8+T cells in CHB patients may be one of the reasons causing severe liver damage after irregular withdrawal of nucleoside analogues.

Ovarian epithelial carcinomas are the most common lethal gynecological malignancies. Ovarian carcinomas are divid-ed into Types I and II based on different morphologies, genetic alterations, and biomarker expression. Low-grade micropapillary serous carcinoma are Type I tumors. Type I tumors are slow growing, generally confined to the ovary at diagnosis, and with better prognosis. These tumors develop from well established precursor lesions that are termedborderlinetumors. Type 1 tumors are genetically stable and are characterized by mutations in a number of different genes including KRAS, BRAF, PTEN, and beta-catenin. Type II tumors are rapidly growing and highly aggressive neoplasms, for which well defined precursor lesions have not been described. They may arise in the fimbrial epithelium of the oviduct with advanced stage, more aggressive behavior, and worse prognosis. High-grade serous carcino-ma belongs to Type II tumors. This group of tumors has a high level of genetic instability and is characterized by TP53 mutation. Hence, ovarian cancer comprises a heterogeneous group of tumors with distinctly different histological characteristics, molecular genet-ic features, and clinical course.

[Objective]To explore the correlation of the expression of alpha-fetoprotein(AFP)mRNA in the peripheral blood and postoperative survival and metastasis of patients with liver cancer.[Methods] A total of 66 patients with liver cancer who received radical resection surgery from January 2005to December 2006 was enrolled in this study.The cell total RNA was extracted from peripheral blood and the expression of AFP mRNA was detected by nested PCR.All the patients were followed up for 60 months after surgery.[Results]The expression rate of AFP mRNA in the peripheral blood was 40.91％(27/66).The expression of AFP mRNA in the peripheral blood in patients with liver cancer was significantly related to microvascular invasion and metastasis(P ＜ 0.05 or ＜ 0.01),but the expression had no relationship with sex,age,HBV infection,cirrhosis,AFP concentration,tumour size and number,and Edmondson grading(P＞0.05).The overall 1,2,and ＞ 3 years survival rates of patients with positive AFP mRNA after surgery were 66.7％(18/27),38.9％(7/18),28.6％(2/7),respectively.The overall 1,2,and ≥3 years survival rates of patients with negative AFP mRNA after surgery were 84.6％(33/39),60.6％(20/33),45.0％(9/20).There was statistical significance between the survival rates of AFP mRNA-negative patients and AFP mRNApositive patients(P ＜ 0.01).[Conclusions] The detection of AFP mRNA in the peripheral blood may provide clue for early microscopic metastasis.It can be a prediction index for postoperative recurrence.

Objective To investigate the pathological role of endoplasmic reticulum stress in fluomsisinduced apoptosis in human hepatocellular carcinoma cell line (HepG2).Methods Under stimulation of 1,3,6,9 mmol/L concentrations of NaF in vitro for 24 h,while normal control group was cultured under normal condition,the apoptosis of HepG2 cells was measured by flow cytometry.The endoplasmic reticulum stress markers (glucose regulative proteins 78,94;GRP78,GRP94) and CCAAT/enhancer-binding protein homologous protein (CHOP) in HepG2 cells were measured at both mRNA and protein levels by real-time PCR and Western blotting,respectively.Results After treated with 0,1,3,6,9 mmol/L NaF for 24 h,the apoptosis rate of HepG2 cells was (6.25 ± 1.27)％,(13.48 ± 1.00)％,(24.08 ± 1.88)％,(30.19 ± 3.07)％ and (37.72 ± 4.43)％,respectively,and the difference was statistically significant among groups (F =65.828,P ＜ 0.01).After treated with 3 mmol/L NaF for 24 h,the mRNA level of GRP78,GRP94 and CHOP was (1 172.41 ± 459.60)％,(946.95 ± 635.85)％ and (7 846.97 ± 1 670.01)％,which was increased compared to those of the control groups [(100.00 ± 1.77)％,(100.00 ± 2.08)％,(100.00 ± 0.74)％,t =12.77,4.67,11.50,all P ＜ 0.01].Under the same condition,the protein levels of GRP78 and CHOP were (159.99 ± 67.59)％ and (155.15 ± 94.24)％,which were increased compared to those of the control groups [(100.00 ± 30.68)％,(100.00 ± 41.44)％,t =-3.27,-1.99,all P ＜ 0.05],while GRP94 protein level [(46.40 ± 41.46)％] was decreased compared to that of the control group [(100.00 ± 68.86)％,t =4.02,P ＜ 0.05].Conclusion Endoplasmic reticulum stress may be involved in NaF-induced cell death in HepG2 cells.

Objective To investigate the possible pathological role of mitochondrial apoptosis pathways and its factors in fluorosis-induced apoptosis of human hepatocellular carcinoma cell strain (HepG2).Methods Under the stimulation of 1,3,6 and 9 mmol/L concentrations of NaF in vitro for 24 h (n =5),while normal control group was cultured under normal condition,the cytotoxicity was measured with MTT.The mitochondrial apoptosis inducing factor (AIF) was measured at both mRNA (n =5) and protein levels (n =6),respectively,by real-time PCR and Western blotting.The mitochondrial apoptosis related factors,such as B-cells lymphoma-2 (Bcl-2),Bcl-associated X protein (Bax),cytochrome C,caspase-9 and caspase-3 were measured at protein levels (n =6).Results After treated with 0,1,3,6 and 9 mmol/L NaF for 24 h,the cell absorbance of HepG2 cells was 0.307 ± 0.031,0.333 ± 0.028,0.230 ± 0.011,0.178 ± 0.001 and 0.152 ± 0.003,respectively,and the differences were statistically significant among groups (F =82.224,P ＜ 0.01).After treated with 3 mol/L NaF for 24 h,the mRNA level of AIF was [(153.14 ± 5.41)％] which was increased compared to the control group [(100.00 ± 4.70)％,t =-4.73,P ＜0.05].Under the same condition,the protein levels of AIF,Bcl-2,cytochrome C in cytoplasm,caspase-9 and caspase-3 were (152.16 ± 47.30)％,(171.90 ± 51.52)％,(458.00 ± 19.48)％,(527.17 ± 200.67)％ and (432.70 ±64.27)％,which were increased compared to those of the control groups [(100.00 ± 48.86)％,(100.00 ± 34.44)％,(100.00 ± 116.59)％,(100.00 ± 19.58)％ and (100.00 ± 137.16)％,t =-3.80,-3.96,-15.76,-4.64,-5.06,all P ＜ 0.05],while the protein levels of Bax and cytochrome C in mitochondrion were (24.66 ± 26.04)％,(72.99 ±45.34)％,which were decreased compared to those of the control groups [(100.00 ± 44.01)％,(100.00 ± 34.14)％,t =6.35,0.68,all P ＜ 0.05].Conclusion The mitochondrial apoptosis pathway and related factors may be involved in NaF-induced cell death in HepG2 cells.

Objective To report a new surgical approach (modified anconeus flap approach) in which the anconeus and part of triceps are reflected in the treatment of distal intercondylar humerus fracture (AO type C).Methods To design the modified anconeus flap approach,the anatomy of the distal tendon of the triceps brachii and the anconeus was studied using 15 cadaveric adult specimens (30 sides).The new surgical approach was compared with the triceps-reflecting anconeus pedicle (TRAP) approach in terms of the area of exposure at the distal humeral articular surface.Furthermore,the new surgical approach was applied in 16 patients who had been treated for intercondylar humerus fracture (AO type C) from May 2005 to May 2013.The clinical outcomes were evaluated using the Mayo elbow performance score (MEPS) and Broberg-Morrey scoring systems.Results The blood supply and innervation of the anconeus was interrupted minimally during incision along the radical edge of triceps tendon.The area of exposure at the distal humeral articular surface provided by the part triceps and anconeus reflecting approach and the medial humerus approach was 42.66％ ± 0.03％ at the elbow flexion from 0° to 50°.This was significantly smnaller than that provided by the TRAP approach (46.11％ ±0.03％) (P ＜0.05).Of the 16 patients,15 obtained complete follow-ups from 6 months to 4 years(average,16.5 months).The mean MEPS at the last follow-up was 90.5 points (range,from 82 to 93 points),with 10 excellent and 4 good cases and one poor case.The Broberg & Morrey score system showed 11 patients with no articular cartilage degeneration (level-0),3 patients with level-1 degeneration,and 2 patients with level-2 degeneration.Conclusion The modified anconeus flap approach proposed in the present study provides clear surgical vision and needs no olecranon osteotomy or olecranon dissection or ablation of the major triceps brachii tendon for intercondylar humerus fractures,thereby leading to early active motion and satisfactory clinical outcomes.

Objective To investigate the effect of several scoring systems including of acute physiol-ogy and chronic health evaluation Ⅱ (APACHE Ⅱ)score,sequential organ failure assessment (SOFA) score,pediatric risk of mortality score(PRISM),pediatric critical illness score(PCIS)and paediatric index of mortality(PIM)in estimating the prognosis of illness in pediatric severe cases.To select a more appropriate scoring system for PICU.Methods From January 2013 to December 2014,486 cases admissed in PICU of Shengjing Hospital of China Medical University were enrolled in the study,including 42 hospital death cases (dead group)and 444 survived or cured cases(survival group).We estimated each patient with APACHEⅡ,SOFA,PCIS,PRISM and PIM on admission and compared the scores between dead group and survival group.Results The results of APACHE Ⅱ,SOFA,PCIS,PRISM,PIM showed significant defferences be-tween dead group and survival group(13.43 ±8.70 vs.3.48 ±3.94;78.38 ±9.33 vs.88.24 ±6.84;0.142 0 ±0.214 7 vs.0.015 3 ±0.030 7;5.48 ±3.42 vs.1.73 ±1.94;22.02 ±8.48 vs.12.68 ±4.88,P <0.001 ). Areas under the receiver operating characteristic curves of APACHE Ⅱ,SOFA,PRISM,PCIS and PIM (95%CI)were 0.854 (0.798,0.910 ),0.838 (0.778,0.898 ),0.881 (0.828,0.934 ),0.808 (0.748, 0.869),0.936(0.913,0.960).Areas under the receiver operating characteristic curves of PIM was the lar-gest.Conclusion All the 5 kinds of severe scoring systems are effective and have a good ability to asses the prognosis and severity of diseases.It seems that PIM is the most effective.

Objective To explore methods of quickly identifying loopholes in medical quality management and to improve medical quality by means of analyzing low-risk death cases.Methods Two rounds of analysis of 1 14 low-risk death cases of hospitals in Beijing in 2012 in terms of data quality and medical procedures,in an effort to identify problems and to verify the feasibility and accuracy of the method through interaction with other data.Results Totally 585 760 inpatients were discharged in 2012 from 21 hospitals,of whom 1 5 1 1 93 being low-risk cases.Such cases included 1 14 low-risk death cases, accounting for 0.01 9% of the total discharged,and 0.075% of low-risk discharged cases.Analysis of these medical records found 50 cases of problematic diagnosis (43.86%),45 cases of possible defects in diagnosis and treatment (39.47%),39 cases of missing items of secondary diagnosis (34.21%),and 28 cases of missing items of surgery/operation (24.56%). Some of the abovementioned cases had overlapping mistakes.Conclusion Analysis of low-risk death cases can help focus among massive data of medical records,problems of diagnostic and therapeutic insufficiency,pinpointing common problems in medical service and improving medical quality and fine management of hospitals.

Objective To detect the expression of E-cadherin and ?-catenin in breast carcinoma and analyze the relationship between E-cadherin and ?-catenin and the clinicopathological features. Methods The expression of E-cadherin and ?-catenin in breast cancer, paracarcinoma breast tissue, simple mastoplasia and atypical mastoplasia were detected by immunohistochemical method and the results were compared. Results The abnormal expression rates of E-cadherin and ?-catenin in breast cancer tissue were 51.9% and 61.1 %,respectively. Abnormal expression of E-cadherin was significantly correlated with histological grade. Abnormal expression of ?-catenin was significantly correlated with TNM staging, axillary lymph nodes metastasis and postoperative distant metastasis. COX multiple factor analysis showed that neither E-cadherin nor ?-catenin expression was an independent indicator for the prognosis of breast cancer. Conclusions Abnormal expressions of E-cadherin and ?-catenin are correlated with occurrence and development of breast carcinoma. Abnormal expressions of E-cadherin and ?-catenin are good indicators to judge invasion and metastasis of breast carcinoma.