Objective To discuss the indication,the prevention and treatment of complications of the esophagectomy through cervico-right thoracic-abdominal triple incision.Methods 420 cases of esophageal carcinoma were analyzed retrospectively.Results The success rate of this procedure was 99.81%,and 5 cases died postoperatively,the morality was 1.19%.Lymph node metastases were presenting in 188 cases.The gross rate of the lymph node metastasis was 44.76%,the rate of the lymph node metastasis in neck,chest and abdomen were 4.76%,41.90% and 20.95%.The occurrence rate of the anastomose leakage was 3.80%.326 cases were followed up(90.95%).The overall 3-,5- years survival rate were 61.85%(193/312 cases) and 34.72%(75/216 cases).Conclusion The advantages of this approach are relatively radical resection,less severe complications.

Objective:To explore the regulatory role of exosomes in calcification of rat vascular smooth muscle cells (VSMC) induced by high phosphorus.Methods:VSMC (A7r5 cells) were cultured in vitro and randomly divided into three groups: normal phosphorus group (0.9 mmol/L), high phosphorus group (2.6 mmol/L) and high phosphorus exosomes induction group (i.e. the exosomes extracted from high phosphorus group were added to VSMC in normal culture). Until the 7th day of culture, the culture medium of normal phosphorus group and high phosphorus group obtained during the change of cell culture medium was collected, and the precipitate was obtained by ultracentrifugation and suspended by phosphate buffered saline. The protein content of the precipitate was determined by BCA protein quantitative method. The precipitates were identified. The structure and size of exosomes were observed by transmission electron microscope. The exosomes marker proteins tumor susceptibility gene 101 protein (TSG101) and CD9 were detected by Western blotting. The miRNA in exosomes was extracted, and the expression of related miRNA (miR-30b, miR-204, miR-211) were observed by real-time quantitative PCR. After 7 days of cultivation, the exosomes uptake process of VSMC in high phosphorus exosomes induction group was observed. The calcium deposition was detected by Alizarin stain, and the calcium content was detected by O-cresol complex copper. The content of alkaline phosphatase was detected by colorimetry. The protein expression of Runx2 was quantified by Western blotting. Results:(1) The precipitate obtained by ultracentrifugation of the cell culture fluid was identified as exosomes by electron microscopy morphology. Western blotting confirmed that the expression of the exosomal marker proteins TSG101 and CD9 were positive. (2) The exosomes were rich in miRNAs. The expression of miR-30b, miR-204, miR-211, which negatively regulated the transcription of Runx2, was significantly down-regulated in the high-phosphorus group compared with the normal group ( P<0.05). (3) After culturing rat VSMC with high phosphorus for 7 days, calcium salt deposition was obvious. Compared with the normal phosphorus group, calcium content and alkaline phosphatase activity were significantly increased (both P<0.05), and Runx2 expression was also significantly increased ( P<0.05). (4) Added the obtained high-phosphorus exosomes to the normal cultured VSMC, the exosomes could be taken up by VSMC and successfully induced VSMC calcification. The levels of cell calcification indicators and Runx2 expression were significantly increased. Conclusions:High phosphorus induces calcification of VSMC and promotes the increase of Runx2 expression. The mechanism may be realized by releasing exosomes from VSMC to transmit cell signals.

Aim To study the insulinotropic effects of Efaroxan and the underlying mechanism in rat βcells. Methods Pancreatic islets were isolated by college-nase p digestion.Radioimmunoassay was used to meas-ure insulin secretion and cAMP level in rat pancreatic islets.Results Efaroxan only potentiated insulin se-cretion at high glucose concentrations(8.3,1 1 .1 mmol ·L -1 )but not at low glucose concentrations.KU1 4R,an antagonist of Efaroxan,remarkably inhibited Efarox-an-potentiated insulin secretion;and similarly,KU1 4R significantly inhibited forskolin-induced and IBMX-in-duced insulin secretion.cAMP measurement showed that forskolin and IBMX significantly increased cAMP levels,but Efaroxan and KU1 4R had no effects on cAMP content in pancreatic islets.Conclusion The mechanism of Efaroxan-potentiated insulin secretion is related to downstream of cAMP signaling pathway, KU1 4R antagonized the downstream of cAMP signaling leading to its inhibitory effects on Efaroxan,forskolin and IBMX-induced insulin secretion.

Objective To design a new type of hybrid bioartificial liver (HBAL), evaluate its efficacy in vitro, and explore the feasibility in clinical application.Methods CL-1 human hepatocytes were cultured on microcarriers for 5 days, when cell count reached about 4.0 × 109 with cell density of about 4.0 × 107/ml.CL-1 cells cultured on microcarriers in home-made bioreactor constitute the biological part of the HBAL.The abiotic part included blood perfusion and bilirubin adsorption, and blood pump was employed as the circulation driver, which were parts of HBAL.The changes of the concentrations of indirect bilirubin (UBD), chenodeoxycholic acid (CDCD), cholic acid (CA), blood ammonia (AA), AST, ALT and LDH were observed under the condition of in vitro circulation.Meanwhile, the function, morphology and the cell activity of CL-1 cells were also observed.Results After in vitro circulation for 24 h, the concentrations of UBD, CDCD, CA and AA significantly decreased from (335.3 ± 6.0) μmol/L, (395.0 ± 5.6) μmol/L, (155.7 ± 4.5) μmol/L, (39.0 ± 2.6) μmol/L at 0 h to (106.0 ± 10.9) μmol/L, (131.8 ± 28.7) μmol/L, (42.2 ± 7.3) μmol/L, (3.5 ± 1.0) μmol/L, respectively.At 48 h, ALT, AST and LDH significantly increased from (25.9 ± 4.2) IU/L, (22.0 ± 3.6) IU/L, (0.28 ± 0.09) μmol/L to (31.0 ± 2.6) IU/L,(31.6 ± 8.0) IU/L, (0.41 ± 0.12) μmol/L, meanwhile the count and vitality of CL-1 cells were significant declined.Conclusions (1) In the new HBAL system, CL-1 cells can keep its viability and function in vitro;and (2) the HBAL appears to be effective in purifying the serum in liver failure simulation model by clearing out non-conjugated bilirubin, chenodeoxycholic acid, cholic acid and ammonium chloride, which seems to be a promising therapeutic option.

The palliative care has become an important part of social civilization. Its treatment of advanced patients with no response to the treatment of patients with positive and comprehensive care, paying attention to the people-oriented conforms to the Chinese nationHeperfectly. In palliative care practice,Heconcept penetrates in the happening of the disease and development, treatment and special and complex and changeful in interpersonal relationship. The ultimate goal of He is also a palliative care. The concept of reconciliation will promote the development of palliative care.

Carrying out researches in urban community health service centers can effectively promote the improvement of management system, the cultivation of talents and the formation of characteristic service, leading to the institutional development.This paper summarizes the role and significance of researches in promoting the overall development of urban community health service center in order to provide reference for the relevant medical institutions based on the experiences in Shanghai Fenglin Community Health Service Center.

Objective To investigate the role of PI_3 K/Akt signal pathway in Ephrin-Al gene mediated invasion,metastasis of Huh-7 cells.Methods Western blot was used to test the protein expression of phosphatidylinositol 3-kinase(PI_3 K)and mitogen-activated protein kinase(MAPK)after Huh-7 cells were treated with Ephrin-A1/Fc fusion protein.According to the protein expression,LY294002 was used to block PI_3 K/Akt pathway specifically,then p-Akt protein expression,mobility and invasive ability of Huh-7 cells were examined.Results In Huh-7 cells actived by Ephrin-Al/Fc fusion protein,p-Akt expression was higher than that in control group(t=4.564,P＜0.05),but there was no difference of p-p38MAPK expression between Ephrin-Al/Fc fusion protein group and IgG/Fc fusion protein group(P＞0.05).PI_3 K/Akt pathway was specifically blocked by LY294002,the p-Akt protein expression decreased in Huh-7 cells,and the mobility and invasive ability mediated by Ephrin-Al in Huh-7 cells decreased(P＜0.05).Conclusions PI_3 K/Akt pathway effects an important role in mobility and invasive ability of Huh-7 cells mediated by Ephrin-A1.

Objective To investigate the application value of uItrasonography in the classifying patients,preventing and treating the major earthquake-induced complications.Methods Seven hundred and forty-three patients were divided into four sorts by region of injuries:thoracic cavity,abdominal cavity,blood vessels of limbs and crush.According to the admission time,there were two phases and the data was analyzed respectively.Results Abnormal ultrasonic image was found in 218 of all patients,with positive ratio 29.3%.In the first phase,the morbidity of crush-induced hematoma was the highest,followed by pleural effusion,spleen rupture,liver fracture,injury of blood vessels,renal damage,intestinal rupture and crush syndrome with renal failure.Compared with that of the first phase,the morbidity of the injury of blood vessels and crush syndrome with renal failure increased in the second phase.Conclusions It was important to analyze the earthquake-induced injury because the major earthquake often cause the damage of multiple organs.

Objective To investigate the effects of subthreshold micropulse yellow laser (577 nm) on vascular endothelial growth factor (VEGF),nerve growth factor (NGF) and Chemerin expressions in retina of early stage diabetic rats.Methods A total of 40 Brown Norway rats were treated with streptozocin (65 mg · kg-1) to establish the diabetic model.20 diabetic BN rats' right eyes were received subthreshold micropulse yellow laser (577 run) therapy after 2 weeks.The left eyes were used as control group.At 3 days,7 days,14 days,28 days after laser therapy,5 BN rats were randomly chosen to perform RT-PCR and Weston-blot.The expressions of mRNA and protein of VEGF,NGF and Chemerin were analyzed.Results The expression of VEGF mRNA and protein increased in control group at 3 days,7 days,14 days and 28 days (all P ＜ 0.05).Compared with the control group,VEGF mRNA and protein decreased in the subthreshold micropulse yellow laser (577 nm) group (all P ＜ 0.05).The expression of NGF mRNA and protein decreased in the control group at 3 days,7 days,14 days and 28 days (all P ＜ 0.05),however,the difference was not statistically significant between 3 days and 7 days(P ＞0.05).Compared with control group,NGF mRNA and protein increased in the subthreshold micropulse yellow laser (577 nm) group (all P ＜ 0.05),with maximum expression at 14 days.The expression of chemerin mRNA and protein increased at 3 days,7 days,14 days and 28 days in the control group (all P ＜0.05).Compared with the control group,chemerin mRNA and protein decreased in the subthreshold micropulse yellow laser (577 urn) group (all P ＜ 0.05).Conclusion Subthreshold micropulse yellow laser (577 urn) can suppress VEGF,Chemerin expression and upregulate NGF expression in early stage diabetic rats.

Aim To observe the effects of glucose-stim-ulated insulin secretion ( GSIS ) on rat islets after S1 P treatments and the underlying molecular mechanisms. Methods Collagenase P and Histopaque 1077 were used to digest and isolate rat pancreatic islets, and Dispase II was used to digest pancreatic islet to obtain pancreatic cells. Insulin secretions were measured after S1P (0~20 μmol·L-1 ) treatment under low glucose ( LG, 2. 8 mmol·L-1 ) and high glucose ( HG, 16. 7 mmol·L-1 ) conditions. Patch-clamp recordings were applied to monitor voltage-dependent potassium chan-nel currents (Kv currents) after S1P treatment. Calci-um image technique was used to measure the changes of intracellular Ca2+ concentration after S1P ( 0 ~20μmol·L-1 ) treatments. Results HG group signifi-cantly increased insulin secretion compared to LG group ( P<0. 01 ) . S1 P had no effect on insulin se-cretion under LG condition ( P>0. 05 ) . S1 P increased insulin secretion significantly in a dose-dependent man-ner under HG condition ( P<0. 01 ) . Kv currents ofβcells were inhibited significantly after S1 P treatment ( P<0. 01 ) . S1 P increased the concentrations of in-tracellular Ca2+ in a dose-dependent manner under HG condition( P <0. 01) . Conclusion S1P may pro-mote GSIS by inhibiting Kv currents and increasing the level of intracellular Ca2+.