The de novo transcription of hTERT gene represents a rate-limiting step in the activation of human telomerase.The expression of hTERT is strictly regulated with several oncogene products and tumor suppressor gene products in normal cells.The construction of a reverse-transcriptional virus vector that contains the promoter of hTERT without losing its specificity can dramatically augment the expressions of anticancer genes in telomerase-positive cancer cells,which prompts the use of an hTERT promoter for anticancer gene therapies.Firstly,we briefly introduce the structure and regulation of hTERT gene,and then we also review the present knowledge of its biological function in cancer progression.

Objective To study the role of risk factors associated with hemodynamics in patients with intracranial artery stenosis.Methods Eighteen patients with local stenosis of middle cerebral artery were recruited in this study retrospectively.According to patients′clinical symptoms and magnetic resonance imaging findings, they were divided into the symptomatic group (n=13) and the asymptomatic group (n=5).Wall shear stress ( WSS) , oscillatory shear index ( OSI) , velocity and pressure of the stenotic artery wall were compared between the two groups after reconstructing 3-dimentional model of hemodynamics.Then related risk factors of hemodynamics were analyzed in symptomatic intracranial atherosclerotic stenosis.Results There were no statistically significant differences between the two groups in the parameters such as age, sex, degree of artery stenosis, mean arterial pressure and some medical histories of hypertension and diabetes.The results showed obvious changes of hemodynamics in local artery stenosis.The WSS(78.69(68.15,117.65) Pa vs 39.34(22.76,60.54) Pa,U=4,P=0.003), pressure of the stenotic artery wall (1 815.14(1 242.44,4 398.84) Pa vs 735.55(361.17,1 528.78) Pa,U =7,P=0.010)and velocity of the local stenosis(3.87(2.58, 4.52) m/s vs 2.31(1.38,3.12) m/s,U=12,P=0.046) in the symptomatic group were much higher than those in the asymptomatic group; however, there were no significant differences between the two groups in OSI.Conclusions Hemodynamic features do exist in local intracranial atherosclerotic stenosis.The WSS, wall pressure and velocity of the local stenosis may be vital risk factors associated with symptomatic intracranial atherosclerotic stenosis.

A 37-year-old male patient presented with persistent generalized itching erythema and papules for more than 1 month.The patient had received surgical treatment for type B3 thymoma in stage Ⅳ.Five months prior to the presentation,he developed myasthenia gravis.He also complained of chronic diarrhea for two years.Physical examination revealed white patches in the oral mucosa as well as scaly erythema of varying size on the face,trunk and extremities.Lamellar scales could be seen after scratching,while removal of scales could not result in the appearance of bleeding points.There was scaly hyperkeratotic erythema of palms and soles.Histopathological examination revealed psoriasis-like epidermal hyperplasia and parakeratosis with multiple dyskeratocytes,and some of the dyskeratocytes were surrounded by lymphocytes.There was a perivascular infiltration with a small number of lymphocytes.Immunohistochemical study showed positive staining for CD3,CD4 (dermis),CD8 (epidermis) and CD45RO,but negative staining for CD20,CD68 and CD30.The patient was diagnosed as thymoma-associated graftversus-host-like disease,myasthenia gravis and mucosal candidiasis.After treatment with tacrolimus and prednisone,the condition was gradually relieved.

Objective To explore the role of mitogen-activated protein kinase(MAPK)in lipopolysaccharide(LPS)-induced iNOS expression and NO production in rat Schwann cells by the use of inhibitors PD98059 selective for extracellular signal-regulated kinase 1/2(EPK1/2), SB202190 for P38 MAPK and SP600125 for the c-Jun NH_2-terminal kinase (JNK). Methods Schwann cells were pretreated with PD98059 (30, 50, 70?mol/L), SB202190 (10, 20, 40?mol/L) and SP600125 (10, 30, 50?mol/L) at the indicated concentrations for 1 hour before the stimulation with LPS (10mg/L) for 4 hour. The estimation of iNOS mRNA, IL-6 mRNA and TNF-? mRNA was performed by RT-PCR; the changes of iNOS protein expression were investigated by Western blotting. The NO level was observed with measurement of nitrite in the cell culture medium. Results LPS could significantly activate MAPK signal pathway and lead to the expression of iNOS and NO production. The iNOS expression and NO production induced by LPS stimulation were significantly inhibited by the three highly specific inhibitors of MAPK. In addition, the inhibitors decreased LPS-induced the expression of IL-6 mRNA and TNF-? mRNA. Conclusion Activation of MAPK pathway is involved in iNOS expression and NO production in rat Schwann cells, and the inhibition of the signal transduction pathway can be effective to reduce the production of iNOS and NO, which may be a useful strategy against inflammatory and immune reaction after peripheral nerve injury.

The left ventricular function of 103 normal subjects in the age range of 17 to 48 were examined with three echocardiographic methods, the Pombo's method (Method I), Fortuin's method (Method II) and Lalani's method (Method III), in order to evaluate their relative efficiency. The results were as following:( 1 ) The value of left ventricular end diastolic volume determined with Method II was larger than that determined with Method 1(123. 9?22.6vsl05. 43?26.0 ml, P0. 05).( 2 ) The values of stroke volume, stroke index, cardiac output, and cardiac index were the largest as determined with Method II, the second with Method I and the smallest with Method III. For instance, the value of cardiac index was 4.66 ?1.21 /m2/min wita Method 11,3.81?1.0 with Method I, and 2.96?0.8 with Method III(P0. 05).( 4 ) All the parameters obtained from Methods I and II were correlated with each other closely (r = 0.72 - 0.96, P0.05).( 5 ) Methods I and II are simple to operate and easy to reproduce and there have been a lot of parameters obtained with these two methodds. However the systolic mitral closure slope of Method III is rather difficult to determine and the parameters obtained with Method III are comparatively less in number.It is concluded that Methods I and I of the echocardiographic technique are the methods of choice in determining the left ventricular function of a normals-sized or nearly normal-sized heart since they are simple, effective and accurate.

Objective To investigate the influencing factors and technical points of induced membrane technique for treatment of bone defect.Methods All of 20 patients of bone defect were treated by induced membrane technique in our hospital from January 2008 to November 2014,including 15 males and 5 females;aged 13-69,average 38.5;infectious bone defect in 16 cases and non-infectious bone defect in 4 cases.Record the complications,evaluate the healing of bone defect and functional recovery of adjacent joints by Paley method,respectively,and grade the range of movement (ROM) of adjacent joints by authors's method.Results In the first stage of surgery,1 case needed a second operation as the wound gradually spitted and bone cement contaminated after tighten closure of the skin flap,while others had no infection or recurrence of infection.In the second stage of surgery,3 cases had induced membrane damage and defect.All were followed-up from 12 to 50 months (average 19.7 months);all the bone defects healed,the clinical healing time was 3.0 to 7.0 months (average 4.7 months).The healing time in the 3 cases with induced membrane damage and defect (average 6.0 months) was longer than that in patients without induced membrane damage and defect(average 4.6 months).1 case of infectious bone defect with induced membrane damage and defect had local infection in 6 months after the second stage of surgery,for whom the conservative treatment was invalid but got controlled after second operation while 1 case of infectious bone defect without induced membrane damage and defect had local infection in 12 months after second stage of surgery,in whom the infection was controlled by the conservative treatment,the others had no infection or recurrence of infection,no broken of fixators noted;at the last follow-up,all the bone defect healing graded excellent,the functional recovery of the adjacent joints graded:excellent in 8 cases,good in 10 cases,and fair in 2 cases (the excellent and good rate was 90％),the ROM of the adjacent joints graded:excellent and good in 8 cases,respectively,fair and poor in 2 cases,respectively (the excellent and good rate was 80％).Conclusion Induced membrane technique has advantages of simple surgery,faster healing of bone defect,no correlation between the healing time and the length of bone defect,fewer complications,etc,but in clinical application,the operators must understand the therapy principle and pay attention to the influencing factors and technical points so as to avoid operation errors,reduce complications and improve therapeutic effect.

Objective To study the effect of Xuebijing injection on the change of intestinal tract mucosa barriers and the expression of macrophage antihody in rats with sepsis. Method Totally 150 Wistar rats were ran-domly divided into three groups: sham group, sepsis group, and Xuebijing group. Sepsis models were estabhshed in rats by cecal ligation and puncture. The success standards of sepsis included fever, the increase of respiration rate,increased heart rate and change in leukocyte count. At 12 hours before operation, and after operation the rats in the Xuebijing group were injected with 4 mL/kg Xuebijing (once every 12 hours for 3 days), and the rats in the others two groups were injected with the same volume of saline, the image analytical system were used to detect the pathological change of intestinal tract mucosa harriers and the expression of macrophage antibody in three groups. All the data were analyzed by rank-sum test and variance analysis(F test). Results Almost all the mucous mem-brahe of small intestine in sham groups were normal. The mucous membrane lesions of small intestine developed in sepsis and Xuebijing groups after 12,24,48,72 hours, and the lesion was severer in sepsis group than that in the Xuebijing group (H=19.732, P<0.01). There were no significant differences on the expression of macrophage antibody in mucous membrane of small intestine between three groups at 3 hours. But at 12, 24, 48 and 72 hours, the expression of macmphage antibody of sepsis and Xnebijing groups increased with time (F=560.13, P< 0.05). Conclusions At the early period of sepsis, intestinal tract mucosa barriers develops varying degrees of damage, and Xnebijing can partly protect intestinal tract mucosa barriers.

Objective To analyze the therapeutic effect of Masquelet technique in the treatment of bone defects.Methods From January 2008 to December 2014,20 patients with bone defects were treated by Masquelet technique.There were 15 males and 5 females,from 18 to 69 years of age (average,38.4 years).Four cases had open bone defects and 16 infectious ones.At the first stage,radical debridement of the bone defects and soft tissue was conducted via conventional approaches.The bone defects ranged from 2 to 9 cm,averaging 6.1 cm.At the second stage,internal fixation was applied in 18 cases and external fixation in 2.The interval from the second stage to the first stage operation ranged from 6 to 23 weeks (average,11.5 weeks).The healing of bone defects and the functional recovery of adjacent joint were evaluated by Paley scoring at the last follow-up.Results The 20 patients were followed up for 12 to 50 months (average,19.7 months) after the second stage operation.All the patients obtained uneventful wound healing and control of infection after the first stage operation except the one with infectious defects who had to receive 2 operations to control the infection at the first stage operation.At the second stage operation,obvious injury and defect of the induced membrane occurred in 4 cases.All the patients achieved clinical healing of bone defects after 3 to 6 months (average,4.8 months).The bone defect healing was graded as excellent in all.After bone healing,all the patients resumed weight-bearing activities,with no breakage or infection of fixators,or recurrence of infection.By the Paley scoring at the last follow-up,the functional recovery of the adjacent joint was excellent in 8 cases,good in 10 and fair in 2,yielding an excellent and good rate of 90.0％.Conclusion As a kind of modified free bone grafting,Masquelet technique has advantages of simplicity,limited complications,a high rate of healing,and good control of bone infection.

Objective To evaluate the clinical value of emergency bedside-echocardiography in neonatal intensive care unit.Methods Six hundred and sixty-eight infants with cardiac pathological murmurs,cyanosis and shortness of breath were detected by emergency bedside echocardiography (Sonosite Micromax 1 portable ultrasound or Philips iE33 ultrasonic systems) during January 2007 to July 2011.The accuracy of emergency bedside-echocardiography in the diagnosis of neonatal heart diseases was evaluated according to the results of surgical exploration.Results Among 668 enrolled neonates with the mean age of (7.2±1.3) d,there were 347 males and 321 females,and 309 term infants [mean gestational age (39.1±0.6) weeks (37.0～42.1 weeks)] and 359 premature infants [mean gestational age (33.7±0.91) weeks (28.9～36.9 weeks)].Totally,507 cases were found cardiac abnormality by emergency bedside-echocardiography,including 268 cases of patent ductus arteriosus (232 premature and 36 term infants),115 congenital heart disease,99 persistent fetal circulation and 25 arrythmia.Surgeries were performed on 54 infants and invasive therapy was performed on one infant,and none of them received CT,magnetic resonance imaging or invasive examinations before operation; among which,51 surgeries successed and 4 infants died.Other 452 infants were treated with medications,392 infants recovered and discharged,26 infants did not recover,14 cases died and 20 cases left the hospital before recovery.The accuracy rate of Micromax 1 portable ultrasound in diagnosing congenital heart diseases was 94.5％ (52/55),while 96.4 ％ (53/55) for philips iE33 ultrasonic systems.Conclusions Emergency bedside-echocardiography could provide instant and valuable information of cardiovascular system,which would be helpful in making quick clinical decisions.

Objective To investigate the construction and application in practice of information process management system in the treatment of acute ischemic stroke (AIS).Methods From August 2017 to November 2017,the clinical data of the 597 patients with suspected stroke received green channel treatment for stroke and incorporated into the information process management system at the Cerebrovascular Disease Center,Changhai Hospital,the Second Military Mcdical University were analyzed retrospectively.The operation status and operational efficiency of each link in the AIS treatment process were evaluated.The performance assessment indicators for stroke nurses and visiting doctors were developed.The accuracy and missed diagnosis of stroke determined by the stroke nurses were calculated.The operation ability of stroke nurses was evaluated by the doctor's arrival at triage desk to establishment of intravenous access time and signing of informed consent to rt-PA bolus time,with less than 10 min as the standard.The emergency response capability of consultation physicians was evaluated by calling consultation physician to arriving at the triage desk and establishing venous channel to transport to the CT room time,with less than 5 min as the standard.The standard-reaching rate was calculated.Results A total of 597 patients were prechecked as suspected stroke.Among them,549 patients with stroke were judged by doctors,430 established venous access,443 were transported to CT room,441 completed CT scan,and 52 were treated with venous thrombolysis.In the process,the median time of patients to hospital to doctor to triage desk,doctor to triage desk to establishment of venous channel,establishment of venous channel to transportion to CT room to completion of CT scan,completion of CT scan to rt-PA bolus,patients to hospital to completion of CT scan and patients to hospital to rt-PA bolus was 3 (1,5),8 (3,16),3 (2,5),3 (2,9),9 (3,22),20(10,30) and 27 (19,55) min,respectively.The stroke nurses determined the accuracy and misdiagnosis rate of stroke were 92.0％ (549/597) and 8.4％ (50/597) respectively.The standard-reaching rate of doctor to triage desk to establishment of venous channel,signing informed consent to rt-PA bolus time were 82.1％ (353/430) and 80.8％ (42/52) respectively.The standard-reaching rates of calling consultation doctor to doctor to triage desk,establishment of venous channel to transportion to CT room time were 94.5％ (564/597) and 91.4％ (405/443) respectively.Conclusion A process management system centered on "time management" may help analyze the efficiency of various links and personnel in the AIS treatment process,and optimize the process continuously.