Objective To study the expression of carbonic anhydrase 9(CA9) in clear cell renal carcinoma(ccRCC), and the relationship between the expression and recurrence .Methods Paraffin-embedded tissues from 53 ccRCC cases were collected during the past 3 years,and immunohistochemistry was used to detect the expression of CA 9.Fifty-three cases were followed up to evaluate the disease-free survival ( DFS) and recurrence .Association of CA9 expression with recurrence was then analyzed .Results Localized RCC recurred in eleven cases , the median DFS was 10 months, the integral optical density ( IOD) of the recurrent cases was 230 879 .84 ±64 878 .72 while the IOD of the thirteen nonrecurrent cases was much higher,444 993.31 ±146 946.27(P<0.01).Conclusion There might be a positive correlation between the low expression of CA9 and the recurrence of ccRCC .CA9 may help predict the ccRCC patients ’ prognosis.

Objective To define the risk period of acute pancreafifis-associated lung injury (APALI) by aserial study including a dynamic changes in total water content of lung, ultrastructure and number of type Ⅱ alveo-lar epithelial, and reactive oxygen metabolisms (ROMs) of lung tissue in mice with severe acute pancreatits (SAP)and a clinical analysis of APALI patients. Method ICR mice were selected to establish SAP model. The animalsreceived 7 intraperitoneal injections of caerulein (50 μg/kg body weight) at hourly intervals followed by intraperi-toueal injection of lipopolysaccharide (15 mg/kg body weight). The total water content, uhrastrueture and numberof type Ⅱ alveolar epithelial cells, and ROMs of lung tissue were detected before (0 h) and 6 hours, 12 hours,lday, 4 days and 7 days after SAP model establishment, respectively. In addition, 215 patients with APALI (PaO2< 60 mmHg) collected from the First Affiliated Hospital of Zhejiaug University between January 1998 and Decem-ber 2006 were analyzed. Statistical analysis were performed by using F-test. P-values less than 0.05 were regardedas statistically significant. Results The total water content and ultrastructure mitochondria and lamellar bodies intype Ⅱ alveolar epithelial cells of lung in SAP mice were significantly altered at 12 hours after SAP model estab-lishment, and reached maximum at 1 to 4 days later. A decrease in number of type Ⅱ alveolar epithelial cells andincrease in ROMs reached a maximum at 1 day after SAP model establishment. Furthermore, the results of clinicalstudy showed that the lung injury occurred at (3.1435±1.0199) days after SAP. The data were almost consistentwith the resalts from SAP model. Conclusions The risk period of APALI occurres between the 1st day and the4th day during the course of SAP.

Objective To evaluate the predictive value of serum macrophage migration inhibitory factor (MIF) for myocardial depression in severe sepsis patients.Methods Taken prospective study method,42 cases of severe sepsis patients were enrolled from December 2011 to June 2013.The patients were monitored by PICCO system after informing consent into ICU day,and given the corresponding treatment.According to the hemodynamic parameters were divided into two groups,myocardial depression group:cardiac index ＜ 3 L/(min· m2) and global end diastolic volume index ＞ 800 ml/m2,the remaining were in non myocardial depression group,and the patients were divided into survival group and death group according to 28-d mortality.Hemodynamic parameters and serum MIF,B-type natriuretic peptide (BNP),cardiac troponin Ⅰ (cTnI) level at the 1st,3rd,Sth day after admission.Results Fortty-two severe sepsis patients,non myocardial depression in 22 cases (non myocardial depression group),myocardial suppression in 20 cases (myocardial depression group).At 28 d,20 patients of survival (survival group),22 patients of death (death group).The serum MIF in death group was higher than that in survival group at the 1st,3rd,5th day (P ＜ 0.01) ; BNP and cTnI at the 1st day in two groups had no statistical significance (P ＞0.05),BNP and cTnI at the 3rd,5th day in death group was higher than that in survival group(P ＜ 0.01).The serum MIF at each time point in myocardial depression group was higher than that in non myocardial depression group [survival:8.70(3.53,16.80) μ g/L vs.1.20(0.80,1.77) μ g/L,2.30(1.33,8.40) μ g/L vs.0.60 (0.60,0.99) μg/L,0.50 (0.31,2.50) μg/Lvs.0.16 (0.15,0.20) μg/L;death:11.43(8.10,17.16) μ g/L vs.2.30(1.96,3.69) μ g/L,9.70(6.55,14.65) μ g/L vs.1.90(1.88,5.27) μ g/L,7.50(5.15,14.20)μ g/L vs.2.40(0.80,8.46) μ g/L] (P ＜ 0.05).The serum MIF of death patients in two groups was higher than that of survival patients (P ＜ 0.05).MIF at the 5th day had biggest prediction value,AUC was 0.952,when the cut-off point of 0.65 μg/L,the sensitivity was 100％ (22/22) and specificity was 85％ (17/20).Multivariable Logistic regression analysis results showed that only APACHE Ⅱ scores was the independent risk factor for 28-d mortality (P ＜ 0.01),while MIF couldn' t independent forecast 28-d mortality (P ＞ 0.05).Conclusions Elevation of serum MIF prompts severe sepsis patient with poor outcome,and dynamic changes of MIF is helpful to evaluate the prognosis and severity of severe sepsis patients with myocardial depression,but MIF is not an independent risk factor for predicting 28-d mortality.

Objective To observe the therapeutic effect and toxicity of chemoradiation of locally advanced non-small cell lung cancer by intensity modulated irradiation combined with pemetrexed and cisplatin. Methods Fourty-two patients presented with Ⅲ - stage non-small cell lung cancer(Ⅲ、 25 patients, ⅢB 17 patients)received concurrent chemoradiotherapy. Intensity modulated irradiation technique was used to the total dose of 66 Gy and concurrent chemotherapy consisted of pemetrexed 500 mg/m2 on Day 1 and cisplatin 75 mg/m2 on Day 1 by intravenous infusion once every 3 weeks at the initiation of radiation.Patients received 4 cycles of chemotherapy. Results Thirty-four patients finished the whole of therapeutic schedule. And 2 patients received radiation with total dose of 54 Gy, 2 patients 56 Gy;3 patients received 2 cycles of chemotherapy, 1 patients 3 cycles of chemotherapy. Total effective rate was 79%. There were 2 patients with ≥3 grade marrow depression, 3 patients with 3 grade radiation esophagitis, 4 patients with ≥2 radiation pneumonitis, and 1 patient with 3 grade mucositis. The 1-year survival rate was 65%.Conclusion Recent effect was favourable and toxicity was tolerable for chemoradiation of locally advanced non-small cell lung cancer by intensity modulated irradiation combined with pemetrexed and cisplatin.

BACKGROUND:Skul repair materials cannot only restore the normal shape of the skul , but also play an important role in brain functional recovery. OBJECTIVE:To summarize the research status of polyetheretherketone (PEEK), titanium al oy and tissue engineering technique in cranioplasty and the prospect of three-dimensional (3D) printing technology. METHODS:Literatures related to skul repair materials were retrieved in databases of CNKI and PubMed published from 1995 to 2016, using the keywords of“bone regeneration material in calvarial, 3d printing bone scaffold”in Chinese and English, respectively. RESULTS AND CONCLUSION:Although titanium and PEEK have been used in clinic, titanium holds conductivity, thermal conductivity, while PEEK that may be displaced or lost is not involved in osseointegration. Tissue engineering technology participates in the skul tissue reconstruction, achieving satisfactory repair outcomes, but the problems of scaffold selection and preparation, seed cel obtainment, and growth factor release need to be overcomed. 3D printing technology can print personalized shape, fit the defect precisely, but the raw materials should have good biocompatibility and biomechanical property. Combination of tissue engineering technology with 3D printing technology shows a broad prospect in cranioplasty.

Objective To explore the diagnosis and treatment of cancerization relative to breast intraductal papilloma. Methods Clinical and pathological data of 52 patients with cancerous change of intraductal papilloma were studied retrospectively from January 1998 to December 2008. Results 39 of the 52 cases were diagnosed as malignance or suspected malignance by at least one of the preoperative imaging examinations such as ultrasonography, breast mammography or ductography. Cancer cells were found in 13 of the 46 patients who received fine needle aspiration. Frozen section established the malignance in 18 of the 39 cases. In a postoperative pathological report, 32 cases were cancerization of intraductal papilloma (carcinoma in situ) and 16 were cancerous change with microinvasion, only 4 patients with invasive carcinoma. All the patients received surgical management, 26 of the 52 cases were treated with modified radical mastectomy, 8 of them were performed with breast-conserving surgery (segmental resection plus axillary lymph node resection),7 cases underwent total mastectomy and 11 were just conducted with segmental resection. Only one people was found with axillary node metastasis among the 34 patients who received axillary lymph node dissection.Conclusion The correct preoperative diagnosis of the carcinomatous change of breast intraductal papilloma are always difficult and inconclusive, the frozen section may be helpful and the final diagnosis relied on the fully drawing materials of pathology after the operation. Treatment should be varied based on different pathological findings.

BACKGROUND: One of the key neuropathological changes in Alzheimer disease is that neurofibrils over phosphorylated cytoskeletal protein (such as r and neurofilaments) composed of entwist together, and the phosphorylation of τ protein can be catalyzed by cyclin dependent kinase 5 (CDK5),however whether the phosphorylation of neurofilaments can be catalyzed by CDK5, as well as its role in the pathogenesis of Alzheimer diseases is less acknowledged.OBJECTIVE: To explore the role of over-expression of intracellular CDK5 in the phosphorylation of neurofilamentsDESIGN: Randomized controlled study.SETTING: Biochemical and Molecular Biological Department of Tongji Medical College, Huazhong University of Science and Technology.MATERIALS: This study was conduced at Biochemical and Molecular Biological Department of Tongji Medical College, Huazhong University of Science and Technology between February and May 2001. In vitro cultured rat neuroblastoma cell strain (N2a) was adopted as subjects.METHODS: In vitro cultured N2a cells were divided into 2 groups, namely transfection group and non-transfection group. In transfection group,CDK5 gene was transfected into N2a cell line by using liposome transfection technique so as to obtain N2a/CDK5 cell line stably expressing CDK5, immune-precipitation and enzyme activity assay was used to detect the CDK5 activity, meanwhile immunofluorescence technique and immuneblot assay was used to detect CDK5 expression and phosphorylation of neurofilaments.MAIN OUTCOME MEASURES: Phosphorylation of neurofilaments in both groups.RESULTS: In transfection group of N2a cell line, CDK5 expression increased presented by deep coloration of SMI31 antibody and weak coloration of SMI32 antibody, implying hyper-phosphorylation of neurofilaments. Meanwhile, the activity of CDK5 was 3.5 times higher than that in non-transfection group.CONCLUSION: Intracellular over-expressison of CDK5 would lead to hyperactivity of CDK5 and hyper-phosphorylation of neurofilaments, however the hyper-phosphorylation of neurofilamentsmight invlove in the pathological development of AD.

Transient ischemic attack (TIA) is a high-risk signal of acute ischemic cerebrovascular diseases, indicates a significant increase in the risk of ischemic stroke, especially within 7 days.Risk assessment and stratification are important in patients with TIA.A variety of simple prediction scales were developed based on the risk factors for stroke in patients with TIA, such as the California scale, ABCD scale, and ABCD2 scale.Among them, the ABCD scale score is used most commonly, but as its application becomes more and more common, the defects of this scale are also increasingly apparent.In recent years, some derived scales of ABCD score were introduced in order to improve the sensitivity and specificity of prediction.This article reviews the evolution, contents, characteristics, and predictive value of the ABCD score and its derived scales in the prediction of stroke risk in patients with TIA.

Background:Resistance of Helicobacter pylori(Hp)to antibiotics is the primary reason for failure of Hp eradication therapies. It has been reported that there are regional differences in the resistance rate of Hp to commonly used antibiotics. Monitoring the regional Hp resistance status is helpful for improving the eradication rate in local area. Aims:To investigate the resistant spectrum of clinical Hp strains to commonly used antibiotics in Jiaxing Area,Zhejiang Province. Methods:A total of 17 402 patients who underwent gastroscopy from Jan. 2009 to Dec. 2013 at Jiaxing First Hospital were recruited for Hp culturing by using gastric antral biopsies. Then a drug sensitive test was performed for the Hp strains obtained from the culturing. Sensitivity of these Hp strains to metronidazole,amoxicillin,gentamicin,furazolidone,clarithromycin and levofloxacin was determined. Results:Among the 17 402 cases of gastric antral biopsies,5 898(33. 9% )were positive for Hp culturing. Drug sensitive test revealed that the resistance rate of metronidazole was extremely high in all year and age groups;the resistance rates of clarithromycin and levofloxacin were increasing by years;and the resistance rates of furazolidone,amoxicillin and gentamicin were considerably low in all year and age groups. When two antibiotics were combined,amoxicillin and gentamicin accounted for the lowest resistance rate,and the next were amoxicillin and furazolidone,and gentamicin and furazolidone,respectively. Conclusions:The clinical Hp strains isolated from all age groups in Jiaxing Area,Zhejiang Province are highly resistant to metronidazole,therefore it is not recommended to be used in first line eradication regimen. Amoxicillin combined with gentamicin/ furazolidone is an ideal antibiotic combination for patients with Hp infection in all age groups;and combination of gentamicin and furazolidone is recommended to patients who are allergic to penicillin.

Objective To investigate the role of β-arrestin-1 in inhibition of endoxin-induced activation of MAPK signaling pathway in pulmonary microvascular endothelial cells (PMVECs) by penehyclidine hydrochloride (PHC).Methods Human PMVECs were seeded in 6-well plates (2 ml/well) or in culture flasks (4 ml/flask) at the density of 1×105 cells/ml,and randomly divided into 5 groups (n=20 each) using a random number table:empty plasmid transfection group (group C),lipopolysaccharide (LPS) + empty plasmid transfection group (LPS group),PHC + LPS + empty plasmid transfection group (P + LPS group),LPS+β-arrestin-1 short hairpin RNA (shRNA) transfection group (LPS+shRNA group),and PHC + LPS+β-arrestin-1 shRNA transfection group (P+LPS+shRNA group).After the cells were transfected with empty plasmid 1.5 μg or with plasmid containing 15 nmol/L β-arrestin-1 shRNA,the cells were incubated for 24 h.At 24 h of incubation,LPS with the final concentration of 0.1 μg/ml was added,and the cells were then incubated for 1 h in LPS and LPS+ shRNA groups.In P+LPS and P+LPS+shRNA groups,PHC with the final concentration of 2 μg/ml was added,and the cells were incubated for 1 h,and then LPS with the final concentration of 0.1 μg/ml was added,and the cells were incubated for 1 h.The expression of filamentous actin (F-actin) was detected by flow cytometry.The expression of myosin light chain kinase (MLCK) and vascular endothelial-cadherin (VE-cadherin) was detected by immunofluorescence.The expression of phosphorylated extracellular signal-regulated kinase 1/2 (p-ERK1/2) and phosphorylated cJun N-terminal kinase (p-JNK) was determined by Western blot.The expression of β-arrestin-1 mRNA was determined by real-time polymerase chain reaction.Results Compared with group C,the expression of Factin,VE-cadherin and β-arrestin-1 mRNA was significantly down-regulated,and the expression of MLCK,p-ERK1/2 and p-JNK was up-regulated in group LPS,and the expression of p-ERK1/2 and p-JNK was significantly up-regulated (P＜0.05),and no significant change was found in the other parameters mentioned above in group P+LPS (P＞0.05).Compared with group LPS,the expression of F-actin,VE-cadherin and β-arrestin-1 mRNA was significantly up-regulated,and the expression of MLCK,p-ERK1/2 and p-JNK was down-regulated in group P+LPS,and the expression of F-actin,VE-cadherin and β-arrestin-1 mRNA was significantly down-regulated,and the expression of MLCK and p-JNK was up-regulated in group LPS+shRNA (P＜0.05).Compared with group P+LPS,the expression of F-actin,VE-cadherin and β-arrestin-1 mRNA was significantly down-regulated,and the expression of MLCK,p-ERK1/2 and p-JNK was up-regulated in group P+LPS+shRNA (P＜0.05).Conclusion The mechanism by which PHC inhibits endoxin-induced activation of MAPK signaling pathway in PMVECs is partially related to up-regulation of β-arrestin-1 expression.