Objective A meta-analysis of clinical trials of prehospital thrombolysis versus in-hospital thrombolysis or PCI for acute myocardia infarction (AMI). Method We collected the literature on prehospital thrombolysis for AMI published at home and abroad from January 1989 to April 2009. Recanalization rate of infarct-related arter, complication incidence and mortality ( ＜ 30 d) were regarded as result indicators. Software RevMan 4.2.8 was used to process meta-analysis. Results There were only 27 literatures selected. Prehospital thrombolysis was associated with higher recanalization rate of infarct-related arter[OR 2.67,95%CI(1.86 ～ 3.85);P ＜0.01] and lower mortality ( ＜ 30 d ) [OR 0.71,95%CI(0.64 ～ 0.78); P ＜ 0.01] than in-hospital thrombolysis. There was no significant difference in complications between them. Compared with PCI, prehospital thrombolysis was associated with higher complication incidence [OR 2.91,95% CI ( 1.26 ～ 3.80); P = O.005]. There was no significant statistical difference of mortality ( ＜30 d ),but the sensitivity analysis was not good. Conchusions The effect and prognosis of prehospital thrombolytic are superior to that of in-hospital thrombolysis,and the same with PCI,but prehospital thrombolytic has higher incidences of complications,and the sensitivity is not good.

Objective To observe leptin level before and after rosiglitazone administration and to explore the possible mechanism of rosiglitazone's improving insulin sensitivity.Methods A total of 30 patients newly diagnosed with type 2 diabetes were separated into three groups at random,and treated with rosiglitazone(4mg/d),metform(750mg/d) and gliclazide(160mg/d),respectively.Serum leptin,insulin and GHbA1c were measured after 12 weeks.Results After 12 weeks' treatment,the fasting glucose and GHbA1c in each group declined sharply,while free insulin did not change.The leptin level in rosiglitazone group decreased and insulin sensitivity was improved after administration,but there was no change in metformin and sulfonylureas groups.Conclusion Leptin may play a role in rosiglitazone's mediating the insulin-sensitizing effects.

Objective To observe the ultrastructural changes of Candida albicans by the effect of oyster antibiosis protein which was extracted from muscle of oyster.Methods The colonies of candida albicans exposed to oyster antibiosis protein for 24 hours,with a blank control group and the differences of their ultrastructure were studied under electron microscope.Results After affected by oyster antibiosis protein for 4h,the cell walls were lacked and had reductus with pyknotic cytoplasm.16 hours later,most cells became global shape and their cytomatrix components were lost and some vacuoles appeared in the cytoplasm.24 hours later,the cell walls depleted and the cells spitted.Conclusion oyster antibiosis protein affected commendably the function of candida albicans.

From the view of medical ethics,the importance of the communication between intern and patient are illustrated.The author holds that the intern should develop the communication consciousness,realize the patient's expectation,and satisfy the patient's desire with humanism consciousness and role-switch consciousness.

Objective To study the effects of polypeptide from Chlamys farreri(PCF) on PI3K/Akt and ASK1-JNK signal transduction pathway in thymocytes after ultraviolet B radiation.Methods Murine thymocytes were exposed to UVB radiation.The reactive oxygen species(ROS) level in thymocytes was detected by colormatching.The activation of Akt was investigated by western-blot.ASK1,JNK activation,mitochondria memberine potential and DNA ladder were also investigated after pretreatment with or without PI3K/Akt pathway inhibitor LY294002.Results PCF could activate Akt,inhibit the activation of the ASK1 apoptosis pathway in murine thymocyte radiated by UVB.Conclusion PCF decreased ROS level,increased Akt activity and inducing ASK1 degradation leading to the inhibition of ASK1-JNK induced apoptosis.

Objective To evaluate the safety and efficacy of ischiospinous ligament fixation in treatment of stage Ⅲ pelvic organ prolapse (POP).Methods Between March 2007 and December 2009,65 patients with stage Ⅲ POP who underwent ischiospinous ligament fixation in Peking Union Medical College Hospital were enrolled in this study.Among 21 cases complicated with stress urinary incontinence (SUI) underwent transobturator tension-free vaginal tape (TVT-O) concomitantly.Clinical parameter associated with perioperation,objective and subjective successful rate and complication were recorded.Results The mean operating time was (71 ±22) min and the mean blood loss was (93 ±40) ml.No intraoperative blood transfusion and viscera injury cases were observed.All patients were able to recover spontaneous micturition.Two cases experienced pelvic hematoma with diameter of 7 cm,after conservative treatment,they all recovered later.The objective success rate was 100％ at 6 weeks follow-up by POP-Q scoring.And 46.2％ (30/65) were followed up at range of 1 -3 years,recurrence rate were 10％ (3/30),and however,no operation were needed.At median of 20 months,all patients were followed up by telephone,the subjective successful rate was 95.4％ (62/65).At 6 weeks after operation,6.2％ (4/65) patients suffered from lower back pain and right thigh pain,visual analogue scale of pain was at range of 3 to 5,which relieved gradually after treatment and disappeared totally within 2 years.The rate of suture exposure was 10％ (3/30),the new urinary incontinence 4.6％ (3/65),and the new dyspareunia 12.5％ (3/24).Conclusions Ischiospinous ligament fixation is a safe and efficacious management.

Objective To evaluate the safety and efficacy of magnetic resonance-guided focused ultrasound surgery (MRgFUS) in treatment of symptomatic uterine leiomyoma among Chinese reproductive age women.Methods From April 2010 to April 2012,80 premenopausal women with symptomatic leiomyoma volunteered to participate in this prospective study in Department of Outpatient of Peking Union Medical College Hospital.Among 23 reproductive aged patients with size of uterus less than 16th gestational weeks,2.5 to 10 cm of diameter of myoma,less than 10 myomas and expressing symptoms clearly were treated by MRgFUS.Treatment data,non-perfused volume ratio (NPVR) and adverse events were recorded.After treatment,patients were followed up at 1 week,1,3,6,12 and 24 months,respectively.Patients at initial screening and each time of the follow-up filled out uterine fibroid symptoms quality of life (UFS-QOL),which include symptoms severity score (SSS) and health-related quality of life (HRQL).The volumes of leiomyoma and uterine were evaluated on MRI before and after the treatment (at 6 and 12 months,respectively).Before operation,routine blood test were performed on all patients,anemia patients at 3 months and 1 year after treatment were checked with blood test.Results (1) Treatment data and adverse events:the mean therapeutic temperature was (69 ± 7) ℃,the mean treatment time was (144 ±62) min,the mean NPVR was (62 ±23)％.Adverse events included mild erythema(1/23),abdominal cramp(8/23),vaginal discharge (5/23),and leg numbness (4/23).(2) The rate of secondary surgery:one patient was treated by myoectomy and hysterectomy within one year following up and 4 patients chose surgical treatment during the second-year follow-up.(3) Volume change:the volumes of leiomyoma before the treatment and 6,12 months after the treatment are 75.6 (P25 =43.8,P75 =128.9),52.3 (P25 =23.8,P75 =111.2),45.9 (P25 =26.3,P75 =71.7) cm3,respectively; and the volumes of uterine before the treatment and 6,12 months after the treatment are 270.0 (P25 =208.4,P75 =390.3),216.4 (P25 =151.1,P75 =290.0),200.0 (P25 =149.1,P75 =267.6) cm3,respectively.Both leiomyoma and uterine volumes decreased significantly after treatments (P ＜ 0.01).(4) UFS-QOL change:the symptoms severity score (SSS) before the treatment and 3,12 months after the treatment are (34 13),(22 ± 11),(19 ± 12),which decreased significantly (P ＜ 0.01).The health-related quality of life (HRQL) before the treatment and 3,12 months after the treatment are (74 ± 15),(82 ± 13),(89 ± 10),which increased dramatically (P ＜0.01).(5) Hemoglobin(HGB) change:eleven patients suffered from anemia before treatments,the mean HGB before treatment was (87 ±6) g/L and were (106 ± 14) g/L 3 months after treatment,(112 ± 10) g/L 12 months after treatment.The HGB was increased significantly after treatments (P＜0.01).Conclusions MRgFUS is a safe and effective non-invasive management for symptomatic uterine leiomyoma in short-term follow up.But there is additional treatment ratio after MRgFUS.

Objective We investigated if the proliferative capacity of endothelial progenitor cells was affected by hypoxia and exercise. Methods Twenty four male Sprague-Dawley rats were randomly and averagely divided into 4 groups: (1) living at low altitude (LL), (2) living and training at low altitude (LLTL), (3) living at high altitude (LH), and (4) living at high altitude and training at low altitude (LHTL). Eight-week incremental treadmill exercise and hypoxic simulation were used to establish LHTL animal model. Mononuclear cells from peripheral blood were obtained by density gradient centrifugation 12 hours by the end of 8-week experiment. The cells were suspended in conditioned medium 199 for culturing in vitro. Their phenotypes were confirmed by uptake of acetylated LDL and binding of fluoresce in isothiocyanate (FITC)-labeled Ulex europaeus agglutinin 1 (UEA-1) lectin. Inverted microscopic observation was used to identify the morphological changes in endothelial progenitor cells and measure the cell count. Results Adherent cells and early CFUs in groups LLTL, LH and LHTL increased more obviously than in group LL(P<0.01), whereas the number of attached cells between group LH and LHTL was not different (P>0.05). Conclusion Proliferative capacity of endothelial progenitor cells can be promoted by both hypoxic stimulation and exercise, and the promotion is more significant if combination of hypoxia and exercise was employed simultaneously.

Objective The occurrence and progression of renal cell carcinoma ( RCC) is complicated process associated with DNA abnormal methylation , histone modification , and Wnt signaling pathway .This study aimed to investigate the expression of histone methylase SET8 in RCC, its relationship with the Wnt signaling pathway , its action mechanism in RCC , and its clinical significance . Methods We selected 50 cases of RCC treated by radical nephrectomy , detected the expression of SET 8 in the RCC and adjacent noncancerous kidney tissues by immunohistochemical EliVision two-step staining with β-catenin.We compared the expression levels of SET8 and β-catenin in the two types of tissue and analyzed their relationship with the patients′clinical information and the pathologic stage and grade of tumor as well as the correlation between the SET 8 andβ-catenin expressions . Results SET8 was mainly express in the cytoplasm of the RCC and noncancerous kidney tissues , partially in the cell membrane and nucleus , while theβ-catenin protein chiefly in the cell membrane of renal tubular epithelial cells in the normal kidney tissue .The expression levels of SET 8 and β-catenin in the RCC tissue were closely related to the TNM stage and tumor grade (P<0.05).The positive expression of SET8 in the RCC tissue (76%[38/50]) showed no significant difference from that in the ad-jacent noncancerous kidney tissue (66% [33/50]) (P>0.05), but that of β-catenin was remarkably higher in the former (68%[34/50]) than in the latter (4%[2/50]) (P<0.01).There was a positive correlation between the positive expression of SET 8 and the abnormal expression of β-catenin (r=0.219, P<0.05). Conclusion SET8-activated H4K20me-1 controls the activation and abnormal activities of the Wnt signaling pathway , affects the gene transcription and cell activity , and participates in the occurrence , progression, and distant metastasis of RCC .

Objective To compare the image quality of renal artery in-flow inversion recovery MR angiography (IFIR MRA), CTA and contrast-enhanced MR angiography (CE-MRA) and to assess the value of renal artery IFIR MRA. Methods Thirty five patients were prospectively included in this study.Renal artery CTA was performed in 19 patients and renal artery CE-MRA was performed in 16 patients. In addition to renal artery CTA or CE-MRA, all patients underwent renal artery IFIR MRA. Two radiologists separately graded renal artery image quality, renal venous artifact and the visualization of renal artery branches regarding these three different techniques. Wilcoxon signed rank test of paired samples was used to compare the grading results, t test of paired samples was applied to compare the results of renal artery (accessory renal artery) trunk diameter. The consistency evaluation of renal artery image quality and renal venous artifact grades between two radiologists employed Kappa analysis. Results There was no significant difference between IFIR MRA and CTA with renal artery image quality and renal venous artifact (P>0.05). There was significant difference between IFIR MRA and CE-MRA with renal artery image quality and renal venous artifact (P<0.05). The consistency evaluation results of renal artery image quality and renal venous artifact grades between two radiologists were both good. Kappa value were 0.425 to 1.000. CTA of 19 cases depicted 48 renal arteries (38 renal arteries, 10 accessory renal arteries), IFIR MRA depicted them all. The grades of visualization of renal artery branches about IFIR MRA and CTA were (3.7 ± 0.7) and (3.8 ± 0.6) respectively, renal artery trunk diameter of IFIR MRA and CTA were (4.9 ± 1.3) and (5.0 ± 1.4) mm respectively, there was no significant difference between IFIR MRA and CTA (P>0.05).CE-MRA of 16 cases depicted 38 renal arteries (32 renal arteries, 6 accessory renal arteries), IFIR MRA depicted them all. The grades of visualization of renal artery branches about IFIR MRA and CE-MRA were (3.4±0.8) and (2.5±0.9) respectively, and there was significant difference between IFIR MRA and CE-MRA (Z=-4.040, P<0.01). Renal artery trunk diameter of IFIR MRA and CE-MRA were (4.7±1.3) and (4.7±1.2) mm respectively, there was no significant difference between IFIR MRA and CE-MRA (P>0.05). Conclusions The image quality of renal artery IFIR MRA was equal to CTA and superior to CE-MRA. It could be considered as an alternative technique for renal artery angiography.