Objective To evaluate the influence of different hemoperfusion (HP) intensities on prognosis in patients with acute paraquat (PQ) poisoning. Methods The data of patients with acute PQ poisoning admitted to Department of Emergency of Shengjing Hospital Affiliated to China Medical University from January 2012 to February 2016 were retrospectively analyzed. Patients satisfied the following criteria were enrolled in the study: adult patients, ingestion PQ within 12 hours and receiving HP treatment within 24 hours. Depending on the intensity of HP, patients were divided into lower intensity HP group (LHP, defined as receiving HP for less than 2 hours, 1 column) and higher intensity HP group (HHP, defined as receiving HP longer than 6 hours, 3 columns). Patients were divided into three groups, i.e. small dose (< 20 mL), medium dose (20-40 mL), and high dose (> 40 mL) poisoning groups on the basis of PQ ingestion volume. The baseline data of patients after hospital admission and arterial partial pressure of oxygen (PaO2), white blood cell (WBC), proportion of neutrophils (NEUT), alanine aminotransferase (ALT), total bilirubin (TBil), MB isoenzyme of creatine kinase (CK-MB), blood urea nitrogen (BUN) and serum creatinine (SCr) on the 4th day after hospital admission were compared, and 28-day mortality was followed up. Multiple logistic regression model was used to evaluate the characteristics of the dead patients within 28 days. The predictive value of each indicator for death in early stage of poisoning was analyzed with receiver operating characteristic curve (ROC). Results ① LHP group consisted 67 patients of 144 patients included with 24 in small dose group, 27 in medium dose group and 16 in high dose group. HHP group consisted of 77 patients with 28 in small dose group, 29 in medium dose group and 20 in high dose group. There were no significant differences in age, ingestion dose, time from poisoning to gastric lavage, and the time from the admission to HP between different intensities groups. ② Compared with LHP group, 28-day mortality in HHP group was significantly lowered (46.8% vs. 70.1%, χ2 = 8.032, P = 0.005). The patients receiving HHP in medium and small doses groups had lower 28-day mortality compared with those receiving LHP (41.4% vs. 74.1%, χ2 = 4.841, P = 0.017; 21.4% vs. 50.0%, χ2 = 4.661, P = 0.043). But there was no significant difference in 28-day mortality in high dose group between HHP and LHP (90.0% vs. 93.8%, χ2 = 0.000, P = 1.000). ③ The survival time of 12 patients with high dose poisoning was less than 72 hours, which were excluded for statistical analysis. Compared with LHP, the indexes of medium and small dose groups were obviously improved after HHP for 4 days. ④ Compared with survival group, PQ ingestion dose in non-survival group was increased, time from poisoning to gastric lavage and the time from the admission to HP were prolonged, and lower patients receiving HHP. ⑤ It was indicated by multiple logistic regression model that PQ ingestion dose [medium dose: odds ratio (OR) = 0.018, 95% confidence interval (95%CI) = 0.004-0.085, P < 0.001; high dose: OR = 0.075, 95%CI = 0.018-0.322, P < 0.001], time from poisoning to gastric lavage over 120 minutes (OR = 0.146, 95%CI = 0.045-0.470, P = 0.001), time from admission to HP over 4 hours (OR = 0.108, 95%CI = 0.029-0.395, P = 0.001), and LHP selection (OR = 0.363, 95%CI = 0.142-0.930, P = 0.035) were risk factors for the death at 28 days in patients with acute PQ poisoning. ⑥ It was shown by ROC curve that area under ROC curve (AUC) of PQ ingestion dose was 0.804 (95%CI = 0.723-0.885); when the cut-off value was 5.50 mL, the sensitivity was 94.0%, and the specificity was 65.6%. The AUC of time from poisoning to gastric lavage was 0.702 (95%CI = 0.617-0.786); when the cut-off value was 85.00 minutes, the sensitivity was 48.2%, and the specificity was 83.6%. AUC of time from the admission to HP was 0.719 (95%CI = 0.636-0.801); when the cut-off value was 3.50 hours, the sensitivity was 59.0%, and the specificity was 78.7%. Conclusions PQ ingestion dose, time from poisoning to gastric lavage, and time from the admission to HP are valuable factors for prognosis of the patients. HHP can improve the prognosis of patients with ingestion PQ less than 40 mL as early as possible, but for high dose group patients there was no much effect.

A total of 55 children aged under 14 years with cholecystolithiasis were treated at our hospital between January 2005 to December 2011.Their clinical data were collected and analyzed.The etiologies included pseudolithiasis (n =36),chronic hemolytic disease (n =2),obesity (n =9) and unknown (n =8).Among 50 cases on conservative treatment,42 cases were cured.Four cases underwent laparoscopic cholecystectomy.During a follow-up period of 2-4 years,there was no occurrence of significant complications.The removal of gallbladder stone was performed via laparoscopy plus choledochoscope in 1 case.There was no recurrence during a follow-up period of 2 years.Ceftriaxone sodium and obesity were the major cause of pediatric cholecystolithiasis.A proper selection of treatment regimens should be based upon the considerations of etiologies and symptoms.

Objective To investigate the diagnostic value of quantitative analysis of the color change of iodine staining for early esophageal cancer.Methods A total of 58 patients with suspected esophageal diseases were recruited to this study.The lesions were stained with lugols iodine,and biopsies were performed.Quantitative analysis of color change under endoscopy was also performed by analysis software and the results were compared with pathological findings.Results A total of 62 iodine-unstained lesions in 58 patients were found,includiug 19 chronic inflammation,13 low-grade intraepithelial neoplasia,11 high-grade intraepithelial neoplasia and 19 squamous cell cancer.The color parameters of R/R'(red) and H/H'(hue) were significantly different among the four groups (P＜0.05).Conclusion Computerized chromoendoscopy is helpful in determining pathological characteristics of esophageal lesions,thereby improving the accuracy of endoscopic biopsy and the diagnosis rate of early esophageal cancer.

Objective To investigate the role of metastatic lymph node ratio (MLR) in the evaluation of prognosis of patients with gastric cancer (GC) at different lymph node numbers examined.Methods Clinical data were reviewed retrospectively in a total 535 patients who underwent surgery for GC.Spearman correlation analysis between MLR or number of metastatic lymph nodes (N) and examined lymph node numbers,Kaplan-Meier method was used for comparison survival rates of N stage and MLR stage.A receiver operating characteristic (ROC) curve was used to evaluate the role of N stage and MLR stage in the prognosis of GC patients.Results Metastatic lymph node ratio and number of metastatic lymph nodes correlated with the examined lymph node numbers (r =0.146,r =0.378,P ＜ 0.01,P ＜ 0.001).The 5 year survival rate of MLR0,MLR1,MLR2 and MLR3 patients were 57.5％,69.9％,40.0％ and 21.7％ respectively when examined lymph node numbers ＜ 6 (P ＜ 0.01).The 5-YSR of MLR0,MLR1,MLR2 and MLR3 patients were 86.8％,59.2％,35.8％ and 39.2％ respectively when between 6-10 (P ＜0.001) and the 5-YSR of MLR0,MLR1,MLR2 and MLR3 patients were 88.7％,62.5％,0 and 17.7％ respectively when they ＞ 10(P ＜0.001).AUC of MLR staging was 0.68 ±0.05 when the numbers ＜ 6 (P ＜ 0.001).AUC of MLR staging was 0.72 ± 0.04 at numbers 6-10 (P ＜ 0.001).AUC of MLR staging was 0.79 ± 0.03 when numbers ＞ 10 (P ＜ 0.001).Conclusions MLR was less influenced by lymph node number examined than N.MLR stage has potential superiority to that the N stage in assessing prognosis of GC patients,especially for patients with more than 6 lymph nodes examined.

Objective Brain metastasis of non-small cell lung cancer (NSCLC) significantly reduces the survival time of the patients, and no effective tool is yet available for the prediction of the risk.This study aimed to develop an effective and feasible nomogram for predicting brain metastasis of NSCLC after radical surgery.Methods This retrospective study included 636 cases of NSCLC treated by radical resection of the tumor in our hospitals between January 2010 and January 2014.Based on the analysis of the risk factors for brain metastasis, we developed a nomogram using logistic regression with the R-language, calculated the confidence interval (CI) of the C-index using the bootstrap, and then internally verified the overfitting degree of the model to evaluate its stability.Results Brain metastasis developed in 94 of the 636 patients.According to the results logistic regression analysis, the risk factors for brain metastasis included history of cigarette smoking (OR=1.783, 95% CI: 1.037-3.066), pathological types (OR=0.453, 95% CI: 0.275-0.744), the T stage (OR=2.047, 95% CI: 1.511-2.774), and the N stage (OR=1.588, 95% CI: 1.154-2.184).The nomogram showed a coefficient of coincidence of 0.73 (0.71-0.82) and a mean absolute error rate of 0.012, which indicated an excellent stability.Conclusion The nomogram we developed can be used to predict the risk of brain metastasis in individual NSCLC patients after surgery, contributing to follow-up programs and preventive strategies for brain metastasis.

BACKGROUND: Experimental evidence suggests that growth factors can promote myocardial angiogenesis, but the effect and mechanism of basic fibroblast growth factor (bFGF) in controlled release delivered via fibrin glue has not been fully recognized.OBJECTIVE: To evaluate the effect of controlled-release bFGF delivered via fibrin glue in the myocardium on the expressions of vascular growth factors and cell proliferation in the local acute myocardial infarct area in canines, and assess the therapeutic effect of this strategy.DESIGN: Completely randomized controlled experiment.SETTING: Department of Cardiology, Beijing Anzhen Hospital, Capital University of Medical Sciences; Department of Cardiology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology; Shanghai Xinxing Blood Product Research Institute.MATERIALS: This experiment was carried out in the Laboratory of Animal Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, and the Experimental Animal Center of Chinese PLA General Hospital between June 2001 And March 2003.Twelve clean healthy adult mongrel dogs of either sex were selected and randomized into transmyocardial laser revascularization group and bFGF group with 6 in each group.METHODS: With appropriate anesthesia, the chest of the dog was opened and the left anterior descending (LAD) branch of the coronary artery was ligated to establish acute myocardial infarction (AMI) model.The dogs were then randomized into transmyocardial laser revascularization group to receive transmural myocardial penetration 30 minutes after AMI and bFGF group with non-transmural myocardial penetration 30 minutes after AMI and subsequent injection of bFGF-containing fibrin glue into the channel. The expressions of vascular epithelial growth factor (VEGF), transforming growth factor beta 1 (TGFβ1) and proliferating cell nuclear antigen (PCNA) in the loacl ischemic myocardium were examined immunohistochemically (IHC) at postoperative 18 weeks.MAIN OUTCOME MEASURES: Quantitative IHC analysis of VEGF,TGFβ1 and the PCNA expressions in the local ischemic myocardia in transmyocardial laser revascularization group and bFGF group.RESULTS: Five dogs in the transmyocardial laser revascularization group and 6 in the bFGF group survived the operations. Quantitative IHC analysis revealed obviously larger positive area stained for myocardial VEGF,TGFβ1 and PCNA in bFGF group than in transmyocardial laser revascularization group (t=-7.505, -2.690 and -6.895, P ＜ 0.05), and the average absorbance of PCNA staining in bFGF group was greater than that in the transmyocardial laser revascularization group (t= -5.271, P ＜ 0.05).CONCLUSION: Controlled-releasing bFGF delivered in the myocardium can increase local expressions of the vascular growth factors in the ischemic myocardium and enhance cell proliferation, promoting revascularization after AMI.

Objective To We Used high-dose paraquat to induce apoptosis of A549 cells,and observed the expression of E-cadherin,α-SMA,caspase-8,caspase-3 and caspase-9.Then explored the possible mechanisms of apoptosis.Methods A549 cells were treated with various concentrations of PQ (0.1-1.0 mmol/L) for 24 and 48 hours,then observe the cell morphology and measured cell survival rate respectively determined by MTT method.A549 cells were treated with various concentrations of PQ (0.1,0.2,0.3 mmol/L) for 24 hours.The expressions of the mRNAs for α-SMA、E-cadherin,caspase-8,caspase-3 and caspase-9 were analysed by quantitative real-time PCR.Exposed to various concentrations of PQ (0.1,0.2,0.3mmol/L) for 24 hours,we analysed the protein expressions of α-SMA、E-cadherin、caspase-8、caspase-3 and caspase-9 by Western blot analysis.Results Treated with various concentrations of PQ (0.1-1.0mmol/L) for 24 hours,the A549 cells survival rate significantly reduced by MTT method.For 48 hours,the survival rate was lower.So,in subsequent experiments,we used 0.1,0.2 and 0.3 mmol/L concentration of paraquat to A549 cells,trained for 24 hours.After high-dose (0.1,0.2 and 0.3 mmol/L) exposure to PQ,a decrease in E-cadherin was observed while a decrease in α-SMA was also detected of the mRNAs.While the expressions of the mRNAs for caspase-8、caspase-3 and caspase-9 wereincrease.The protein expressions of α-SMA and E-cadherin were decrease with the increase of concen trations by Western blot analysis,and the levels of caspase-8、caspase-3 and caspase-9 were increase.Conclusions After high-dose short-time exposure to PQ,the survival rate of A549 cells is decreased obviously,cell morphology changed significantly,and the expressions of α-SMA and E-cadherin were decrease.But the expressions of caspase-8、caspase-3 and caspase-9 were increase.

Objective To investigate the effect of bevacizumab combined with chemotherapy on the expression of EGFR and HER in the patients with metastatic colorectal cancer .Methods Sixty patients with metastatic colorectal cancer treated in this hos-pital from January 2013 to October 2016 were selected and randomly divided into the experiment group (bevacizumab combined with FOLFOX-6 chemotherapy regimen) and control group (FOLFOX-6 chemotherapy regimen) 30 cases in each group .The curative effects were observed in the two groups .The levels of serum HER and EGFR were detected by enzyme-linked immunosorbent assay (ELISA) .Results The total effective rate after treatment in the experiment group was 53 .33% ,which in the control group was 33 .33% ,the difference was statistically significant (P< 0 .05) .After treatment ,the levels of serum HER and EGHR in the two groups were decreased to some extent ,moreover the experiment group had more decrease than the control group ,the difference be-tween the two groups was statistically significant (P<0 .05) .The occurrence rate of adverse reactions had no statistical difference between the two groups (P>0 .05) .Conclusion Bevacizumab combined with chemotherapy has good effect in the patients with metastatic colorectal cancer .

This research studies the status quo of credit system implementation in medical colleges and universities in Shandong Province, and finds that there are some problems, for examples, the number of courses can't meet the requirements of the credit system, teaching management is still difficult to adapt to the reform of the credit system, students lack guidance in choosing courses, and course resources are limited. Some suggestions are put forward, such as changing teachers' concept of teaching, intensifying teaching reform, increasing teaching resources input, promoting mutual recognition of credits, strengthening the construction of teaching staff, perfecting academic tutorial system, and constructing a credit system model that conforms to the laws of medical education.

Purpose: The influence of fasting blood glucose (FBG) and cholesterolemia primary liver cancer (PLC) in china was analyzed via a large prospective cohort study based on a community population, and the combined effects between them were investigated. Materials and Methods: Overall, 98,936 staff from the Kailuan Group who participated in and finished physical examinations between 2006 and 2007 were included in the cohort study. Their medical information was collected and they were followed up after examination. The correlations of serum FBG or TC with PLC were analyzed. Then, we categorized all staff into four groups: normal FBG/ non-hypocholesterolemia, normal FBG/hypocholesterolemia, elevated FBGon-hypocholesterolemia, elevated FBG/hypocholesterolemia and normal FBG/ non-hypocholesterolemia was used as a control group. The combined effects of elevated FBG and hypocholesterolemia with PLC were analyzed using the Age-scale Cox proportional hazard regression model. Results: During 1,134,843.68 person*years follow up, a total of 388 PLC cases occured. We found the elevated FBG and hypocholesterolemia increases the risk for PLC, respectively. Compared with the non-hypocholesterolemiaormal FBG group, the risk of PLC was significantly increased in the non-hypocholesterolemia/elevated FBG group (HR=1.19,95%CI 0.88–1.62) and hypocholesterolemiaormal FBG group (HR=1.53,95%CI 1.19–1.97), and in the hypocholesterolemia/elevated FBG group (HR=3.16 95%CI2.13-4.69). And, a significant interaction effect was found of FBG and TC on PLC. All results were independent from the influence of liver disease. Conclusion Elevated serum FBG and hypocholesterolemia are risk factors for PLC, especially when combined. Thus, for the prevention and treatment of PLC, serum FBG and TC levels should be investigated.