Objective To investigate the prognostic significance of proteolysis-inducing factor (PIF) in gastric cancer patients.Methods Biopsies of the rectus abdominis muscle were obtained intra operatively from 53 gastric cancer patients and 53 subjects undergoing surgery for benign abdominal diseases,muscle and serum PIF,ubiquitin expression,and proteasome proteolytic activities were assessed through reverse-transcription polymerase chain reaction (RT-PCR),Western blot,and enzyme-linked immunosorbent assay (ELISA).Results PIF was significantly upregulated in muscle of gastric cancer compared to control muscles.PIF was upregulated in 60％ (32/53) muscle of gastric cancer.Over expression of PIF in muscles of gastric cancer were associated with level of serum albumin,tumor node metastasis (TNM) stage,and percent of weight loss.The survival rate of patients with a high expression of PIF was significantly lower than those in patients with low expression (P ＜ 0.05).Conclusions PIF was significantly upregulated in muscle of gastric cancer,over expression of PIF in muscles of gastric cancer was associated with level of serum albumin,TNM stage,percent of weight loss,and prognosis.PIF might play an important role in progression and prognosis of gastric cancer.

Objective To investigate the relationship between abnormalities of maternal serum markers in Down syndrome screening in second trimester and adverse pregnancy outcome.Methods Totally,1935 pregnant women were screened for Down syndrome with maternal serum tri marker with time-resolved fluorescence assay,including alpha fetoprotein (AFP),free β-human chorionic gonadotropin (β-hCG) and unconjugated estriol (uE3),between 15 and 20+6 gestational weeks at Peking Union Hospital from January 1,2009 to January 31,2011,and were followed up till delivery.The relationship between incidence of adverse pregnancy outcomes and women with normal or abnormal levels of serum markers in Down syndrome screening was investigated.T-test or Chi-square test were applied for statistical comparison.Results (1) Among the 1935 pregnant women,normal levels of serum markers were found in 1255(normal group) and 680 were abnormal(abnormal group),in which 577 with only one abnormal serum marker,89 with two and 14 with three abnormal serum markers.According to the serum marker level,the 577 women with one abnormal serum marker were further divided into five groups,including high AFP group (n=17),low AFP group (n=114),high β-hCG group (n=242),low β-hCG group (n=139) and low uE3 group (n=65).The birth weight of infants in lower AFP group and the gestational age at delivery in low β-hCG group were greater than those in normal group [(61.3±9.1) kg vs (59.5±8.3) kg,(272.6±11.8) d vs (274.4±10.1) d,t=2.21 and 1.99,both P＜0.01].(2) The incidence of adverse pregnancy outcome in normal group was 42.8％(537/1255),while comparing with the abnormal group(43.7％,297/680),no statistical significance was shown (RR =1.02,P =0.71).While comparing with the normal group,the incidences of placenta previa [25.5％ (32/1255) vs 2/17,RR=4.61,P＜0.05] and abnormal placental morphology were higher in high AFP group [4.1％ (51/1255) vs 5/17,RR=7.24,P＜ 0.05],the incidence of gestational diabetes mellitus (GDM) was higher in low AFP group [8.1％ (101/1255) vs 14.4％(16/114),RR=1.74,P＜0.05],the incidence of placenta and membrane retention was higher in high β-hCG group [3.5％ (44/1255) vs 6.2％(15/242),RR=1.77,P＜0.05],the incidence of pre-eclampsia was higher in low β-hCG group [1.7％ (21/1255) vs 6.5％ (9/ 139),RR=3.87,P＜0.05].(3) There were 89 women with two abnormal serum markers.Comparing with the normal group,the incidences of small for gestional age (SGA) infants,oligohydramnios,abruptio placenta were higher in women with low AFP but high β-hCG [SGA infants:6.9％(2/29) vs 1.8％(22/1255),RR=3.94; oligohydramnios:20.7％(6/29) vs 6.4％(80/ 1255),RR=3.24; both P＜0.05],the incidences of oligohydramnios was higher in women with both low AFP and low uE3[3/14 vs 6.4％(80/1255),RR=3.36,P＜0.05],the incidence of premature birth and GDM were higher in women with both low β-hCG and low uE3 [premature birth:2/6 vs 4.3％(54/1255),RR=7.75; GDM:3/6 vs 8.0％ (101/1255),RR=6.21; both P＜0.05].(4) There were 14 women with three abnormal serum markers.The relationship between adverse outcome and abnormal serum markers did not show any statistical significance.Conclusions The abnormality of serum markers of Down syndrome screening is closely related to adverse pregnancy outcomes,and women with abnormal serum markers should be carefully monitored during pregnancy.

Humans ; Hypertension ; Large-Conductance Calcium-Activated Potassium Channels

ObjectiveTo investigate the clinical features and pregnant outcomes of the pregnant women with congenital adrenal hyperplasia (CAH) 21-hydroxylase deficiency (21-OHD).MethodsThe clinical features,therapies,pregnant outcomes of the pregnant women with 21-OHD were retrospectively reviewed in Peking Union Medical College Hospital,from January 2005 to April 2011.ResultsThere were 8 pregnant womenwith 21-OHD including 5siinplevirilizing patientsand 3nonclassical 21-OHD women.Eightpatientswereacceptedprogestationalandprenatalcontinuallowerglucocorticoid treatment.During the gestational period,the dosage of glucocorticoid was adjusted in one pregnancy.The serum level of 17-alpha hydroxyprogesterone (17-OHP) were elevated after pregnancy [ (70 ± 38 ) versus (24 ±23) nmol/L,P ＜ 0.05].The fertility and offspring rate of 8 patients was 8/12,the fertility and offspring rate of patients who started treatment at preadolescence was significantly increased (4/5 versus 4/7).Four patients were accepted genital reconstructive surgery ( clitorectomy,clitoroplasty,vulvoplasty) before pregnancy.The incidence of GDM was 1/8.All patients selected caesarean at from 37 +6 gestation weeks to 39+6 gestation weeks.The average newborn birth weight was (3210 ± 447 ) g,and height was (48 ±2) cm of 8 neonates,none of them was CAH.Conclusions Medical and surgical therapy provides satisfactory fertility and pregnancy outcomes for women with 21-OHD.It is safe to pregnant women with 21-OHD and their fetus in continual lower glucocorticoid treatment.The dosage of glucocorticoid should be carefully adjusted during the pregnancy individually according to serum level of 17-OHP.

Objective To study the effects of Poly(I:C) on lung adenocarcinoma A549 cells viability and illuminate the mechanism of Poly (I:C)-induced apoptosis in A549 cells.Methods A549 cells were transfected with the complex of Poly(I:C) and lipofectamine 3000.The viability of A549 cells was tested by methyl thiazolyl tetrazolium (MTF) method.The apoptotic cells were tested by flow cytometry.The caspase proteins were tested by Western blotting and the expressions of interferon-β (IFN-β) and CXCL-10 were assayed by real-time PCR.After employing the pan-caspase inhibitor Z-VAD-FMK and caspase-8 inhibitor Z-IETD-FMK,the variation of Poly (I:C) proapoptosis in A549 cells was observed.RNA interfering experiments were employed to knock down melanoma differentiation related antigen 5 (MDA5) or retinoic acidinduced gene Ⅰ (RIG-Ⅰ),and the above indexes were tested.Results The viability of A549 cells was significantly reduced to 74.92％ ±--6.24％ after 200 ng/ml Poly (I:C) transfection compared with that before transfection (95.32％ ± 3.05％,t =2.883,P =0.041).The apoptotic rates induced by 100,200,400 ng/ml Poly(I:C) were 9.97％-± 0.88％,23.63％-± 1.41％,32.57％-± 2.39％,respectively.All of them were higher than that in the control group (0.74％-± 0.15％),with significant differences (t =4.489,P =0.002;t =11.616,P =0.000;t =16.932,P =0.000).Besides,the death receptor pathway proteins such as TNF-related apoptosis inducing ligand (TRAIL),cleaved-caspase-8 and cleaved-caspase-3 increased obviously.MDA5/RIG-Ⅰ pathway was also activated dramatically and the expressions of IFN-β,CXCL-10 were significantly up-regulated.The apoptotic rates reduced to 3.17％ ± 0.66％,5.35％ ± 0.64％ with pancaspase inhibitor Z-VAD-FMK and caspase-8 inhibitor Z-IETD-FMK pretreatment,compared with the control group (15.87％ ±0.93％),and the differences were statistically significant (t =8.643,P =0.001;t =6.824,P =0.002).Moreover,the expressions of TRAIL,IFN-β and CXCL-10 induced by Poly (I:C) were inhibited with MDA5 or RIG-Ⅰ depletion.Conclusion Poly(I:C) can reduce the survival rate of A549 cells and promote the apoptosis mainly by activating the death-receptor pathway mediated by MDA5/RIG-Ⅰ probably,which may involve in IFN-β,CXCL-10.

Objectives To compare endovascular aortic repair (EVR) and medical therapy for acute type B aortic dissection (AD) in terms of treatment results.Methods From January 2004 to October 2010 116 cases were collected and were divided into two groups,with treatment of EVR (n =60)and medical therapy (n ＝ 56).Treatment outcomes were assessed.Results Clinical manifestations of AD are complex and variable,with the most common symptom being pain on chest and back (74.1％).CTA is the most valuable method in confirming the diagnosis of aortic dissection.In conservative group of 56 patients admitted to hospital,30-day mortality rate was 16.1％.In EVR group of 60 patients with grafts successfully released,the 30-day mortality was 1.7％.There is significant difference between the two groups on mortality rate during 30-day(P ＜0.05).Follow-up rate in conservative group and the EVR group was 71.4％ and 86.7％,with average follow-up time of (38 ± 16) months and (35 ± 14) months.The 5-year survival rates were 87.5％ and 88.5％ respectively in conservative group and EVR group (P ＞ 0.05).Conclusions EVR is considered to be the first choice for acute Stanford type B dissection.EVR can improve patients' 30-day survival,though long term result is comparable with that of conservative treatment.

Objective To compare the X-ray radiation dose from atrial fibrillation (AF) ablation guided by magnetic navigation system (MNS) and manual procedure (CON).Methods 94 AF patients were randomly divided into MNS group (34 cases) and CON group(60 cases).The dose area product (DAP),cumulative radiation dose (CD),fluoroscopy time of patients,the X-ray exposure time and dose of operators were recorded and analyzed.Results The results from the patients in MNS group and CON group were CD values (0.54 ±0.45) and (1.61 ±0.89) Gy (t =2.44,P ＜0.05),DAP values (46.86 ±27.09) and (139.71 ±76.69) Gy·cm2(t =3.89,P ＜0.05) and fluoroscopy time (15.60 ±7.52) and (39.50 ± 8.82) min (t =1.96,P ＜ 0.05),respectively.The X-ray exposure dose in both groups were (22.68 ± 6.87) and (62.74 ± 20.92) μSv (t =2.02,P ＜ 0.05) for operation doctor (19.38 ± 5.64) and (49.42 ± 10.67) μ Sv (t =3.58,P ＜ 0.05) for operation assistant and (18.98 ± 4.99) and (47.77 ± 13.65) μ Sv (t =3.17,P ＜ 0.05) for nurse,respectively.The X-ray exposure time experienced in both groups were (11.48 ±7.59) and (30.50 ±14.82) min (t =2.75,P ＜0.05) for operation doctor,(8.96 ±5.88) and (24.49 ±9.09) min (t =4.20,P ＜0.05) for operation assistant and (8.33 ±6.35) and (22.99 ± 13.36) min(t =2.76,P ＜ 0.05) for nurse,respectively.Conclusions Compared with manual procedure,the MNS applied in AF ablation has the potential to decrease X-ray exposure dose.

Objective To investigate D-Dimer, C-reactive protein and brain natriuretic peptide in clinical diagnosis of patients with pulmonary embolism and to compare the sensitivity, specificity and accuracy.Methods 45 cases of large area pulmonary embolism and 45 cases of small areapulmonary embolism were selected, at the same time, 45 cases of normal people were selected as the control group.D-dimer, CRP and BNP levels were detected and compared of each group before and after treatment.The relevance between D-Dimer, CRP, BNP levels and pulmonary embolism was analyzed by Logistic analysis.The gold standard of pulmonary embolism with D-dimer test, CRP test and BNP test were compared.the sensitivity, specificity and accuracy ofD-dimer test, CRP test and BNP test wer calculated.Results D-Dimer, CRP and BNP levels of the large area group and small area group were significantly higher than those in the control group before treatment (P<0.05);the D-Dimer, CRP and BNP levels of large area group were significantly higher than those in small area group (P<0.05).After treatment, the D-Dimer, CRP and BNP levels of large area group and small area were significantly decreased (P<0.05), and had no significant difference compared with normal control group.Logistic analysis showed that there was significant positive correlation between plasma, D-Dimer, CRP and BNP levels and pulmonary embolism (r=3.11, P<0.05;r=4.36, P<0.05;r=2.86, P<0.05) .There was no significant difference of sensitivity, specificity and accuracy of three methods.Conclusion There is a positive correlation between the occurrence of pulmonary embolism and D-dimer, CRP, BNP levels, which are important indexs to evaluate the patient's condition, it has very important clinical value.

Objective To study the antihypertensive efficacy and influence on the blood pressure parameters of nifedipine GITS therapy in patients with subacute cerebral infarction with essential hypertension by ambulatory blood pressure monitoring (ABPM).Methods Fifty-one cases of subacute cerebral infarction with essential hypertension were treated with nifedipine GITS for 14 days.ABPM were performed in all cases before and after treatment.The blood pressure parameters of blood pressure variability (BPV),morning blood pressure surge(MBPS),Trough/Peak(T/P),and smoothness index(SI) were analyzed.Results (1) After treatment with nifedipine GITS 30 mg/d for two weeks,the average 24-hour systolic blood pressure (SBP),day-time systolic blood pressure (dSBP),night-time systolic blood pressure (nSBP),24-hour diastolic blood pressure (DBP),day-time diastolic blood pressure (dDBP),night-time diastolic blood pressure (nDBP) significantly decreased((144.70 ± 14.89) mm Hg vs (163.10 ± 16.48) mm Hg,(145.67 ± 15.20) mm Hg vs (164.55 ±16.81) mm Hg,(140.85 ± 19.46) mm Hg vs (156.73 ±20.55) mm Hg,(81.24 ±8.88) mm Hg vs(89.49 ± 10.06) mm Hg,(81.25 ±9.40) mm Hg vs (90.18 ± 10.64) mm Hg,(81.34 ± 12.10) mm Hg vs (86.28 ±12.11) mmHg;t=11.01,11.53,5.29,8.71,7.53,2.31;P＜0.05)).(2) Defining the standard deviation(SD) of average blood pressure as the indexes of BPV,the blood pressure variability of systolic blood pressure(SBPV),day-time systolic blood pressure variability (dSBPV),night-time systolic blood pressure (nSBPV) decreased significantly ((16.52 ± 4.38) mm Hg vs (19.78 ± 6.72) mm Hg,(15.45 ± 4.71)mm Hg vs (17.88 ± 7.25)mm Hg,(14.94 ± 5.89) mm Hg vs (19.17 ± 8.27) mm Hg; t =3.38,2.19,2.99 ;P ＜0.05)) and the diastolic blood pressure didn't change.(3) There was negative correlation between smoothness index (SI) and BPV (r =-0.28 ; P ＜ 0.05).(4) The decreases of morning blood pressure surge (MBPS) of SBP was more significant after treatment ((22.65 ± 12.77) mm Hg) than that before treatment ((31.94 ±16.36) mm Hg).(5) The median of T/P ratio calculated by group methods was 0.721 for SBP and 0.676 for DBP,and it was 0.588 ± 0.360 for SBP and 0.628 ± 0.433 for DBP calculated by individual method.The medians of T/P ratio were above 0.5 by both methods.Conclusion It is of great significance to effectively control blood pressure and BPV in patients with stroke.Nifedipine GITS can constantly release medicine;it can lower the blood pressure,and significantly reduce BPV and MBPS.

Objeetive To investigate the clinical efficacy of treating stomach cance belonging to spleen and stomach deficient cold type with self-designed formula and chemotherapy.Methods 100 patients of stomach cancer belonging to stomach and spleen deficient cold were randomly grouped into a control group and a treatment group,with 50 cases in each group.The control group was only treated with chemotherapy,and the treatment group was additionally treated with self-designed Chinese formula on the basis of the control group.After 3 months' treatment,the curative effect,the improvement of life quality,the changes of body weight,the improvement of peripheral blood and immune function,and the occurrence of adverse reaction were observed.The survival rate of patients after 1,3 and 5 years' treatment was investigated.Results ① Short term curative effect:the total effectiveness of the control group and the treatment group was 60.0％ (30/50) and 30.0％ (15/50) respectively,with the treatment group being better than the control group(Z=-2.100,P＜0.05);② life quality:theimprovement rate of life quality in the treatment group and the control group was 64.0％ (32/50) and 20.0％ (10/50) respectively,with the treatment group being better than the control group (Z=-3.259,P＜0.05); ③ body weight:the improvement rate of body weight in the treatment group and the control group was 24.0％ and 16.0％ respectively,and there was no significant difference (Z=-1.815,P＞0.05) ; ④ peripheral blood:the peripheral blood abnormality rates of treatment group was obviously lower than the control group (Z=-4.286,P＜0.05) ;⑤ immune function changes:CD4+、CD8+、and the activity of NK cell of two groups after the treatment [the treatment group was (40.8 ± 4.1)％,(26.1-3.2)％,(83.57-2.52)％ respectively; the control group was (31.7±2.9)％、(33.8±3.0)％、(92.88±3.83)％ respectively] wasobviously improved compared with the same group before the treatment [the treatment group was (34.2±3.5)％,(31.0±2.0)％,(85.01±2.92)％ respectively; the control group was (34.0±3.2)％,(30.9±2.2)％,(85.02± 3.48) ％ respectively].The immune indexes (CD4+、CD8++、CD4+/CDg+and the activity of NK cell)in the treatment group presented significant difference (P＜0.01) than the control group after the treatment.⑥adverse reaction:compared with the control group,the occurrence rate of adverse reaction of the treatment group was obviously lower than the control group,and there was significant difference (Z=-5.297,P＜0.05).⑦survival rate:the survival rate of patients after 1,3 and 5 years' treatment in the treatment group was better than the control group,and there was significant difference (x2=5.263,12.96,7.895,P＜0.05).Conclusion The combination of self-designed Chinese formula and chemotherapy could effectively relieve the clinical symptoms,improve the immunity,reduce the occurrence of adverse reaction,and improve the life quality of patients with stomach cancer belonging to stomach and spleen deficient cold type.