Objective To study the thalamic metabolic alterations and its correlation with cognitive impairment in patients with cerebral small vessel disease(CSVD).Methods The cognitive function of 34 patients with CSVD and 26 matched volunteers were evaluated by Montreal cognitive assessment(MoCA), and received single voxel 1H-MRS examination to detect the content of NAA,Cho and Cr,and record the ratio of NAA/Cr and Cho/Cr on bilateral thalami.The differences of NAA/Cr, Cho/Cr on bilateral thalami between the two groups were compared, and the correlation between NAA/Cr,Cho/Cr and MoCA total score and its sub-items score in CSVD group were analyzed.Results ①The MoCA of total score as well as its sub-items such as visual space and executive ability,memory,attention and language for CSVD group were significantly lower than that for the control group(P<0.05);②NAA/Cr on bilateral thalami in CSVD group were both lower than that in the control group(left 1.57±0.18,1.68±0.17,t=2.46,P=0.02;right 1.66±0.21,1.78±0.19,t=2.23,P=0.03), the differences were statistically significant (P<0.05);there were no significantly differences in the ratio of Cho/Cr between the two groups(P>0.05);③In CSVD group, the ratio of NAA/Cr on both bilateral thalami were significantly positively correlated with MoCA score (left r=0.83,right r=0.79,P<0.05)as well as visual space and executive ability(left r=0.65,right r=0.46,P<0.05), memory(left r=0.59, right r=0.50, P<0.05), attention(left r=0.42, right r=0.52, P<0.05),language(left r=0.52, right r=0.41, P<0.05), abstraction(left r=0.47, right r=0.40, P<0.05), orientation(left r=0.48,right r=0.42, P<0.05),Cho/Cr were not significantly correlated with MoCA total score and its sub-items(P>0.05).Conclusion The thalamic neuron has been damaged and dysfunctioned in patients with CSVD,and this metabolic abnormality may be related to a wide range of cognitive impairment in CSVD patients.

Objective To study the expression of insulin-like growth factor-Ⅱ receptor(IGF-Ⅱ R) and its relationship with the prognosis of human epidermalgrowth factor receptor 2 (HER2) positive breast cancer.Methods The expression of IGF-Ⅱ R in 104 specimens of HER2 positive breast cancer was evaluated by immunohistochemistry.The expression was rated on 2 scales:negative and positive.The age,pathological type,tumor size,lymph node involvement,status of estrogen receptor(ER),and progesterone receptor(PR) of all the cases were reviewed.The relationship between the expression of IGF-Ⅱ R and the above pathological parameters were analyzed by statistical methods.The relationship between the expression of IGF-Ⅱ R and the disease-free survival and overall survival was studied.Results The positive expression rate of IGF-Ⅱ R was 43.3％ (45/104).The positive rate of IGF-Ⅱ R was significantly higher in the lymph node positive group than in the lymph node negative group (61.5 ％ vs 25.0％,P =0.000).No significant correlation was observed between the expression of IGF-Ⅱ R and age,pathological type,tumor size,status of ER,or PR.The disease-free survival and overall survival was significantly lower in IGF-Ⅱ R positive group than in IGF-Ⅱ R negative group.(The 5-year disease-free survival:62.6％ vs 84.7％,P =0.022; The 5-year overall survival:71.5％ vs 89.6％,P =0.024).Cox regressive analysis showed that the lymph node status was an independent risk factor of disease-free survival and overall survival,while the IGF-Ⅱ R was not.Conclusion The positive expression of IGF-Ⅱ R in HER2 positive breast cancer indicates poor prognosis.The expression of IGF-Ⅱ R may be regulated by insulin-like growth factor-Ⅱ (IGF-Ⅱ).

The teaching model of Problem-Based Learning(PBL)is quite effective in developing the students’learning capacity, analytical and problem resolution skill and their ability to think independently and logically. The article summed up the instructional design, implementation of training and teaching effectiveness of PBL teaching model in medical microbiology.

AIM:To investigate the effect of all-trans retinoic acid ( ATRA) on the viability of gastric cancer cell SGC-7901 and the sensitivity to radiotherapy .METHODS:MTT assay was used to examine the cell viability .Radio-sensitivity and cell cycle were determined by colony formation assay and flow cytometry , respectively .The mRNA levels of Bax, Bcl-2, survivin and NF-κB in the cells were measured by RT-qPCR.RESULTS: ATRA inhibited the viability of SGC-7901 cells in a concentration-dependent manner .The maximal inhibition was at concentration of 8 μmol/L.Colony formation assay revealed that the combination of ATRA with X-ray treatment significantly reduced the values of D 0 and Dq, and shifted down the fitting survival curve , as compared with radiotherapy alone .Moreover , ATAR markedly decreased the percentage of G2/M phase in the SGC-7901 cells (P<0.05).In addition, following ATRA treatment, the mRNA levels of Bcl-2 and survivin were decreased (P<0.05), whereas the mRNA levels of Bax and NF-κB were increased (P<0.05). CONCLUSION:ATRA enhances the sensitivity of SGC-7901 cells to radiotherapy , inhibits G2/M arrest and regulates the mRNA expression of Bax , Bcl-2, survivin and NF-κB.

Objective:To examine the expression of CLC-3 in colorectal tissues and the effect of CLC-3 on the viability and invasion of colorectal cancer (CRC) SW480 and SW620 cells. Methods:The mRNA levels of CLC-3 in CRC cell lines were determined by RT-PCR. CLC-3 expression was inhibited by adding DIDS or NPPB to the CRC cells. Subsequently, cell viability and invasion were assessed by CCK-8 assay and Transwell assay, respectively. In addition, the effects of DIDS and NPPB on the Wnt orβ-catenin signaling pathways were de-termined by Western blot analysis. Results:The mRNA level of CLC-3 was remarkably increased in the CRC tissues compared with that in normal colorectal tissues (P<0.05) and was positively correlated with the T stage of CRC. The blockade of CLC-3 inhibited the viability and invasion of CRC cells (P<0.05). The expression ofβ-catenin, C-myc, cyclin D1, Ki-67, and survivin were evidently reduced by the in-hibition of CLC-3 (P<0.05). Conclusion:The inhibition of CLC-3 decreases the cell viability and invasion of CRC cells by reducing the ex-pression of the proteins related to the Wnt orβ-catenin signaling pathway.

The control handles( including financing, provider payment, organization, regulation and behavior) proposed by World Bank in health policy research as the basic framework,and the nature and positioning of family doctors′ contract-based service as the precondition, we recommended the system framework of such a mechanism, comprising one contract, three regulations, five control handles and seven supporting policies. Such a framework can serve as the cornerstone for family doctors′ contract-based service experiment in Zhejiang province for the sake of hierarchical medical system.

Objective To explore the association of arachidonic acid (AA) level in gastric cancer (GC) tissue with tumor differentiation and patients' gender.Methods The contents of AA in GC tissue and adjacent matched normal mucosa were measured using gas chromatography/mass spectrometry.The relationships of AA with GC differentiation and patients' gender were analyzed.Results The level of AA significantly decreased in GC tissue (0.190％ ± 0.255 ％) compared with normal tissue (0.274％ ± 0.254％,n =30,P =0.011 ),while the level of AA had no significant difference in the tissues of matched normal mucosa and different TNM stages or among different TNM stages ( all P ＞ 0.05).The AA levels in well and moderately differentiated adenocarcinoma (0.173％ ±0.244％ ) and in poorly differentiated adenocarcinoma (0.195％ ±0.264％) were significantly decreased when compared with those in the paired normal mucosa (0.334％ ± 0.170％,P =0.018; 0.256％ ± 0.275％,P =0.043,respectively),while no significant difference was observed between the different differentiated grades (P =0.895).The level of AA significantly decreased in male patients (0.137％ ± 0.209％ ) as compared with paired normal mucosa (0.275％:± 0.238％,P =0.010),while no positive correlation was observed in female patients as compared with normal group (P=0.477) or in the comparison between male and female groups (P =0.139).Conclusions The AA level remarkably decreases in GC tissue,which may be associated with differentiated grades and patients'gender.In addition,more AA is utilized in male GC patients than female patients.

Objective To explore the clinical application of 64-slice spiral CT(64SCT) in evaluation of female patients with primary osteoporosis.Methods 912 patients were clinically diagnosed as primary osteoporosis and were examined by 64SCT. The osteoporosis and pathologic fractures were evaluated on CT images.Results 912 patients in the group were diagnosed the osteoporosis in different degree.203 patients had pathologic fractures.Conclusion 64SCT can evaluate the extent of the primary osteoporosis of the females and can predict the adventures of the pathologic fracture.

Objective To explore the clinical treatment of procedure for prolapse and hemorrhoids (PPH) combined with transrectal Block for rectocele (Block procedure).Methods Eighty-six hospitalized patients with rectocele were divided into two groups according the odevity of month:A group (odd month,PPH combined with Block procedure group,49 cases) and B group [even month,stapled trans-anal rectal resection (STARR),37 cases].The treatment conditions were compared between two groups.Results There were no statistical differences in degree of postoperative pain,healing rate between two groups (P ＞ 0.05).The operating time,postoperative hemorrhage rate,cost of hospitalization,patient satisfaction score and rectocele depth after 1 year in A group were significantly better than those in B group [(25.5 ± 2.8) min vs.(36.8 ± 4.6) rmin,2.0％(1/49) vs.13.5％(5/37),(7 359 ± 580) yuan vs.(10 928 ± 610) yuan,(9.1 ± 0.8) scores vs.(8.2 ± 0.7) scores,(5.02 ± 0.71) mm vs.(9.73 ± 1.31) mm],there were statistical differences (P ＜ 0.05).Conclusions PPH combined with Block procedure for rectocele had a significant clinical effect,it is a safe new method with small surgical trauma,a better choice to prevent the recurrence of rectocele,reduces the patients economic pressure obviously.So it is worth to clinical promotion.

Real-time fluorescent quantitative PCR was used to examine PGC-1α mRNA expression in brown adipose tissue and skeletal muscle of rats. The results showed that the expression levels of PGC-1α mRNA in brown adipose tissue and skeletal muscle of obese rats were lower than those of the normal ones (all P<0.01). After high dose glucocorticoid treatment, the levels of PGC-1α mRNA expression in brown adipose tissue and skeletal muscle, both in normal and obese rats, were decreased significantly.