Objective To discuss the influence of the holistic nursing careng on clinical value in patients with advanced pancreatic cancer.Methods 70 patients with pancreatic cancer were randomly divided into the observation group and the control group,with 35 cases in each group.The control group was given routine nursing measures.The observation group received the holistic nursing careng on the basis of routine nursing measures.The hospitalization time,satisfaction degree,treatment compliance and mentality were observed.Results The SAS,SDS scores of the observation group after nursing were (56.87 ±6.01)points and (61.79 ±6.17)points,which were significantly lower than (39.11 ±5.68)points and (40.82 ±5.31)points of before nursing(t =9.136,8.561,all P <0.05).The hospi-talization time,exhaust time of the observation group were (32.9 ±6.6)days and (8.21 ±1.29)days,which were significantly lower than (45.1 ±10.2)days and (13.56 ±1.77)days of the control group(t =8.561,3.769,all P <0.05).The treatment satisfaction and treatment compliance in the observation group were also significantly better than the control group(χ2 =8.292,8.156,all P <0.05).Conclusion Hsystematic nursing intervention can significantly improve thepostoperative anxiety and depression,and improve the quality of life of patients with severe pneumonia.

Objective To investigate the expression and clinical significance of peroxisome proliferator activated receptor γ(PPARγ)in bladder urothelial cancer tissues.Methods Parafflin‐embeded specimen of bladder urothelial cancer tissues from 50 cases and normal tissues near the bladder urothelial cancer from 5 cases were harvested from the Pathology Department of the Renmin Hospital of Wuhan University between 2006 and 2009.Those cases had complete pathological and clinical data.The ex‐pression of PPARγ was detected by immunohistochemical SP method.Quantitative analysis of the PPARγ was measured by high definition pathological graphics context report system (HPIAS‐1000).One‐way analysis of variance and SNK (q)tests were used to analyze the mean density and the positive area rate of the immunohistochemical results.All data were processed by SPSS 13.0.Results The expression of PPARγwas significantly higher in bladder urothelial cancer tissues than in para‐carcinoma tis‐sues(P<0.05).Correlation between expression of PPARγ with TNM stag of bladder urothelial cancer was as follows :Positive rate of PPARγin the tissues with primary tumor size ≥3 cm was 72.4% ,significantly higher than 33.3% in the tissues with tumor size <3 cm(P<0.05);positive rate of PPARγin the cases with lymph node metastasis was 72.7% ,significantly higher than 46.4% in the cases without lymph node metastasis(P<0.05);positive rate of PPARγin patients at stage T3‐4 group was 75.0% ,significantly higher than 41.9% and 45.5% in patients at clinical stage T1 and T2(P<0.05);positive rate of PPARγin patients with poor differentiation was 68.2% ,significantly higher than 42.9% in patients with high or middle differentiation group(P<0.05).Conclusion PPARγ plays an important regulating role in the onset and progress of bladder urothelial cancer ;PPARγexpression level was correlated with primary tumor size ,pathological types and differentiation degree ,lymph node me‐tastasis and clinical stage.This result suggested that PPARγ was closely correlated to metastasis of bladder urothelial cancer.

Objective To discuss the clinical value of high-quality nursing care applicated in patients with advanced pancreatic cancer.Methods 70 patients with pancreatic cancer were randomly divided into the observation group and the control group,35 cases in each group.The control group was given routine nursing measures.The obser-vation group received high-quality nursing care on the basis of routine nursing measures.The hospitalization time, satisfaction degree,treatment compliance and mentality were observed.Results The hospitalization time of the obser-vation group was (33.2 ±6.5)days,which was significantly shorter than (44.5 ±10.3)days of the control group(t=5.269,P<0.05).The satisfaction degree of the observation group was 97.14%,which was significantly lower than 77.12%of the control group (χ2 =8.254, P <0.05 ) .The treatment compliance of the observation group was 94.29%,which was significantly lower than 71.43% of the control group(χ2 =8.323,P<0.05).The SAS,SDS scores of the observation group were (39.71 ±5.22)points,(41.36 ±5.41)points,respectively,which were signifi-cantly lower than (48.98 ±5.56)points,(47.72 ±5.76)points of the control group(t =9.336,8.544,all P<0.05).Conclusion High-quality nursing care can significantly improve the postoperative anxiety and depression, and improve the quality of life of patients with advanced pancreatic cancer.

Objective To evaluate the value of different methods of hormone measurement and image study before surgery.Methods We retro spectively reviewed 99 patients with insulinoma confirmed by pathological report after surgery in the PUMC Hospital from December 1989 to August 2005.Results The main clinical manifestations were hypoglycemia coma,weight gain,perspiration,disorientation,hypomnesis,and dizziness.The sensitivity of diagnosis of insulinoma with fasting blood-glucose less than 2.78 mmol/L was 66.6%.The ratio of serum insulin to blood-glucose greater than 0.3 when hypoglycemia attacks was 90% sensitive.The sensitivity of perfusion CT was highest which was 100%.Conclusion Typical “Whipple's triad” and the ratio of serum insulin to blood-glucose greater than 0.3 when hypoglycemia attacks are best for the qualitative diagnosis of insulinoma.Perfusion CT has the best sensitivity and specificity among image studies currently used.

Objective To explore the technical feasibility and effects of ant erior cervical discectomy and interbody fusion using endoscopic technique. Metho ds A retrospective study was undertaken in 23 patients with single segmental cer vical fracture and dislocation or cervical spondylotic myelopathy. There were 14 males and 9 females with an average age of 41.5 years (range, 23 to 64). The fr acture and dislocation patients consisted of 2 cases with complete tetraplegia e ither of C3,4 or C4,5, 3 with incomplete tetraplegia of C5,6 and 2 of C4,5 free from nervous symptoms. The operative procedures included anterior cervical disce ctomy and interbody fusion with insertion of cage or/and plate fixation through an endoscopic working canal. Results All 23 cases were followed-up from 6 to 18 months. The operative incisions healed smoothly. All patients achieved interbody fusion, and no loosening or displacement of the cage and plate occurred. For th e cervical fracture and dislocation patients, by Frankel's classification, 2 cas es with complete tetraplegia showed no any improvement, 2 cases with incomplete tetraplegia improved from grade C preoperatively to grade D postoperatively, 1 c ase with incomplete tetraplegia upgrade from C to E, 2 cases without nervous sym ptoms maintained preoperative status. For cervical spondylotic myelopathy patien ts, according to Odom's scoring system, 10 cases were assessed as excellent (dis appearance of all symptoms), 5 good (alleviation of main symptoms), 1 fair (alle viation of partial symptoms). 94% patients gained excellent and good results. No complications occurred in this series. Conclusion With the improvement of the t echnique and instrument, the endoscopic procedures can be used for anterior cerv ical discectomy, interbody fusion and internal fixation. It presents microsurgic al advantages such as minimal incision, less traumatic reaction, clear intraoper ative visualization, and less postoperative discomfort comparing to traditional approach.

Objective To explore a method for rapid bedside temporary pacing by the right internal jugular vein approach.Method The right internal jugular veni puncture was taken by Jernigan technique and self made J tipped introducer was introduced to get to the high right atrium by the vein approach,then the J curvature of the introducer at the distal end is turned and directed at the tricusped valve outside the body,the lead attached to external pacemaker was inserted and advanced through the introducer until continuous ventricular captures appeared on the fluoroscopy.Results 30 patients in total were paced rapidly and successfully at bedside without Roentgenography.Continuous right ventricular pacing was got within 1～3 (median 2) minutes from vein puncture and within 6～30(median 13) seconds after the placement of the introducer had been completed,respectively.Conclusions The rapid bedside temporary pacing can be performed safely and rapidly through the J tipped introducer by the right internal jugular vein approach without Roentgenography.

Objective To discuss the changes of plasma TXA2 and PGI2 levels in the rabbit model of pulmonary hypertension (PHA)induced by monocrotaline (MCT)when transplanted with endothelial progenitor cells (EPCs). Methods The rabbit pulmonary hypertension model was constructed by MCT induction. Rabbit endothelial progenitor cells were induced,separated and identified in vitro.50 New Zealand white rabbits were randomly divided into 3 groups,normal control group and model group were given M199 culture medium by tail vein injection,EPCs treatment group were given EPCs marked with fluorescent though tail vein injection. The levels of plasma TXB2 and 6-keto-PGF1αwere detected and their ratio were calculated after three weeks. Results Compared with model group,the content of 6-keto-PGFlαin plasma in EPCs group was (130.67 ±17.54)u mol/L,which was increased sinnificantly. The content of TXB2 was (402.89 ±27.98 )u mol/L,which was decreased significantly.The ratio of TXB2 to 6-keto-PGF1 alpha between two groups was statistically significant(P<0.01 ). Conclusion EPCs transplantation can reduce the content of TXA2 and increase the content of PGI2 in the pulmonary hypertension rabbits induced by monocrotaline,then reverse the damage of pulmonary hypertension.

Objective: To assess the role of NADPH oxidase-related oxidative stress in the intimal hyperplasia induced by adventitial injury. Methods: Animal model of vascular adventitial injury was established by combining collogenase digestion and mechanical dissection. HE staining was used to observe the morphological changes of the vessels after adventitial injury; RT-PCR was used to examine the mRNA expression of NADPH oxidase subunit p22phox and antioxidant heme oxygenase-1; and fluorescence probe was employed to detect the ROS production in the vessels. Results: Adventitial injuries could induce intimal hyperplasia lesions in the vessels; they also led to the elevated expression of p22phox/HO-1 mRNA and increased production of ROS. Conclusion: The vascular adventitia is involved in the pathological process of intimal hyperplasia, and oxidative stress caused by increased NADPH oxidase activity may be one of the mechanisms.

Objective To construct recombinant adenoviral vector expressing autocatalysis caspase- 3 driven by human telomerase reverse transcriptase promoter amplified by two-step transcription amplification (hTERTp-TSTA),and investigate its antitumor effect in ovarian cancer iri vitro and in vivo.Methods Recombinant adenoviruses expressing autocatalytic caspase-3(rev-caspase-3)driven by hTERTp-TSTA were prepared,which were named as AdHTVP2G5-rev-casp3.AdHT-rev-casp3,Ad-rev-casp3 and AdHTVP2G5- EGEP,which express rev-easpase-3 driven by hTERTp,cytomegalovirus promoter(CMVp)and enhanced green fluorescent protein(EGFP),respectively,were used as controls.Western blot,cell counting kit (CCK-8),flow cytometry(FCM)and TdT-mediated dUTP-biotin nick end labeling(TUNEL)were used to detect the expression of p17,active subunit of caspase-3,and p85,and to measure cell survival rates, apoptotic rates and cell cycle distribution in ovarian cell line AO and normal human umbilical vein endothelial cell line HUVEC,following treatments of AdHTVP2G5-rev-casp3.subcutaneous tumor models and abdominally spread tumor models of human ovarian carcinoma using AO cells in BALB/e nude mice were established.Following treatments of AdHTVP2G5-rev-easp3,western blot was used to detect the expression of active caspase-3 in abdominally spread tumors and liver tissues,respectively,and the mouse survival rates and the volume of tumor nodules were measured,and the serum level of alanine transaminase (ALT)and aspartate transaminase(AST)were analyzed to monitor liver damages and HE staining was used to detect the histopathological changes of various organs.Results The levels of p17 expression in AdHTVP2G5-rev-casp3-treated AO cells were significantly higher than that in Ad-rev-casp3 or AdHT-rev- casp3 treated AO cells,while no expression was observed in AdHTVP2G5-rev-casp3-treated HUVEC.There was strong cell killing of AdHTVP2G5-rev-casp3 of hTERT positive AO cells,but not of the hTERT-negative HUVEC cells.Cell survival rate and apoptotic rate of AO cells treated with AdHTVP2G5-rev-casp3 were 17.8% and 40.2%,respectively,significantly different from that treated with AdHT-rev-casp3(75.2% and 16.1%)at the multiplicity of infection(MOI)of 70(P0.05) .Significant expressions of active caspase-3 were shown in AdHTVP2G5-rev-casp3-treated tumors,whereas no expression was shown in liver.In contrast,both tumors and liver tissues showed active caspase-3 expression following treatments of Ad-rev-casp3.AdHTVP2G5-rev-casp3 and Ad-rev-casp3 prolonged mouse survival[mean survival time of(259?14)d and(213?16)d],when compared with treatment with AdHT- rev-casp3[(177?12)d]and AdHTVP2G5-EGFP[(109?7)d;P

Objective To investigate the method and the effect of posterior approach low lumbar spinal nerve root sheath decompression under microendoscope (MED-Ⅱ). Methods Thirty-nine patients with low lumbar disc herniation, accompanying severe preoperative limb numbness and radiculalgia, who were found obvious edema of nerve root with adhesion during surgery, entered the study. In the course of lumbar discectomy, a self-made mini-scalpel was used for the incision and decompression of the nerve root sheath, in which a 3～5 mm longitudinal incision was made along the dorsal side of the nerve root. Results Decompression was achieved under microendoscope (MED-Ⅱ) in all the 39 patients. Limb numbness and radiculalgia subsided completely in 17 patients within 24 postoperative hours, while the symptoms trailed off within 2 weeks following the surgery in the remaining patients. The time to complete disappearance of the symptoms was 1～14 d (mean, 6 5 d). Conclusions Minimally invasive spinal nerve root sheath incision and decompression can give a prompt relief from limb numbness and radiculalgia, improving the recovery of nervous system. Lumbar spinal nerve root sheath incision and decompression under microendoscope (MED-Ⅱ) is a safe and effective procedure.