Lipocalin-2 is an adipocytokine secreted mainly by adipose tissue. Increasing lines of evidence suggest that lipocalin-2 is an inflammatory factor associated with insulin resistence, obesity and its complications. The precise mechanism of the development of obesity-related disorders induced by lipocalin-2 is not very clear, however, it may be a useful target in drug therapy for obesity-related metabolic and cardiovascular diseases.

Objective To study the clinical characteristics and treatment of primary appendicular tumor. Methods The clinical data of 13 patients with primary appendicular tumor treated in our hospital from 1979 to 1999 were retrospectively analyzed. Results The primary appendicular tumors included 4 cases of mucinous tumor, 5 cases of carcinoid, 3 cases of adenocarcinoma and 1 case of leiomyosarcoma. None was diagnosed correctly before operation. All 13 cases were treated by operation. Right hemicolectomy was performed in carcinoid, diameter of which was longer than 1cm, right hemicolectomy and regional lymphadenectomy were performed in adenocarcinoma, and the other five cases were only received appendectomy. The patients were in good general condition after operation. Conclusions Primary appendicular tumor lacked particular symptoms, and the rate of misdiagnosis was extremely high. Barium radiography and ultrasonography were helpful for diagnosis. Intraoperative frozen section detection was very important for diagnosis. Operation is a principle therapy, and suitable operation plan may be key factor for improving the prognosis of the patients with appendicular tumor.

Objective To study the early diagnosis and treatment of liver trauma.Methods Retrospective(analysis) of the clinical data of different therapeutic means for liver trauma was made on 124 cases of liver trauma.Of these, 99 patients underwent operative treatment and 25 patients nonoperative treatment .Results In nonoperative treatment group ,22 patients were cured and 3 patients changed to operation.In operative treatment group, including 3 non-opcrative treatment patients changed to opcration,95 patients were cured ,7 patients died.In this series,the cure rate was 94.4%(117/124); mortality rate was 5.6%(7/124),including 5 patients who died of major blood vessel injury ,and 2 patients who died of multiple organ failure. All patients with postoperative(complications) were cured, including subphrenic infection in 3(cases), hepatic(abscess) in 6 cases , pleural(hydrops) in 8 cases, incisional infection in 7 cases,and(intraabdominal)(abscess) in 2 cases. Conclutions Type I liver trauma can be treated by(nonoperation) ; type II～IV blunt liver trauma can be treated by(nonoperation) under the condition of hemodynamic stability and(intensive)(monitoring) .Type II～VI liver trauma accompanied by massive intra-abdominal bleeding and(injury) of other(organs) should be (operated) (emergently .)

Objective To investigate the characteristics and patterns of lymph node metastasis in lung cancer and to provide evidence for determining the range of lymph node dissection.Methods One hundred and eighteen patients with lung cancer received complete resection combined with systematic lymph node dissection according to the mapping system developed by Naruke.Results A total of 835 lymph nodes were dissected from 118 lung cancer patients.The positive ratios of N1 and N2 were 15.6% and 17.4% respectively.Fifteen patients were found with skipping N2 which were located in 2,4,5,6 and 7 lymph node groups respectively.There was no significant relationship between the size of primary tumor and lymph node metastasis.Small cell lung cancer showed the highest risk of lymph node metastasis.The metastatic rate of lymph node in adenocarcinoma was markedly higher than that of squamous cell carcinoma.Skipping mediastinal lymphatic metastasis was found more frequently in lower lobar tumors than that in upper lobar ones.Conclusion Lymph node metastasis of lung cancer may occur in multiple groups and regions,even in a skipping pattern.Systematic lymph node dissection may be routinely performed in pulmonary resection for lung cancer.

The aim of this study was to evaluate the diagnostic value of MRCP and ERCP in patients with chronic pancreatitis. A total of 262 patients were diagnosed as charonic pancreatitis by clinical feature, screenage and pathology from January 1993 to December 2001 in Changhai Hospital. Among them 120 patients who had been subjected to MRCP and ERCP were analyzed retrospectively. There were 106 patients discovered constriction, dilatation and calculuses of pancreatic, bile ducts, and diagnosed chronic pancreatitis by MRCP, the sensitivity was 88 3%. Also there were 108 patients discovered cholangiopancreatic disorder and diagnosed chronic pancreatitis by ERCP, the sensitivity was 90%. No statistical difference was found between interpretations based upon MRCP and ERCP( P =0 678). Results from both MRCP and ERCP discovered 96 patients with chronic pancreatitis; the agreement rate in diagnosis was 81 4%. Furthermore, 118 patients were diagnosed chronic pancreaitis by MRCP or ERCP, and the sensitivity was up to 98 3%. In addition, all examined patients were succeeded and no severe complications were found in regard to examination itself. So MRCP is as sensitive as ERCP when detecting chronic pancreatitis. Furthermore, it is feasible to presume that all chronic pancreatitis cases could be diagnosed by MRCP combined with ERCP.

To evaluate the possible method for the diagnosis and treatment of chronic pancreatitis (CP), two hundred and sixty two cases of CP from January 1993 to May 2001 were involved and analyzed retrospectively. Etiologic factors in this group included 68 3% of biliary disorders, 21 4% of alcoholic intake, 29 8% of acute pancreatitis (AP) episode history, and 13% of pancreatic divisum (PD). The major symptom of CP was discomfort or pain over the upper abdominal. Ultrasonography, CT, MRCP, ERCP, and EUS were useful for the diagnosis of CP. One hundred and thirty two patients were treated conservatively, and 78 patients were treated with endoscopy, while only 52 patients were treated with operation. The short term remission rates of symptoms were satisfactory in all cases, and long term ones in 238 patients. Biliary disorders were the most common etiology for CP in this group.The results suggest that the clinical symptoms of CP are not specific and choices of image tools for diagnosis of CP are important. Medication can be used in mild CP patients, but in patients ac companied with sever complications and stubborn abdominal pain surgical operation should be carried out. Furthermore, endoscopy is a useful tool not only for the diagnosis of CP but also for its treatment.

Background Quality of life(QOL) refers to the person's subjective appraisal of well-being,life satisfaction,health and functional performance. For those stroke patients who cannot finish the scale themselves,we can try the proxy measurement. However,until recently no QOL scale for proxies were induced to Chinese stroke patients. The goal of this research is to translate and test the SIS 3.0 for proxy,and differences between patient and proxy scores. To translate and test the SIS 3.0 for proxy, and analyzed differences between patient and proxy scores.Methods Ten pairs of patients and their proxies were involved in the primary test. Two hundreds and thirty-three pairs were involved in the formal test. We analyzed the validity, responsiveness, reliability and feasibility of the SIS 3.0 for proxy, as well as the validity in proxy assessment. Results The feasibility was sufficient. Both Split reliability and α coefficient were more than 0.8, demonstrating SIS a reliable instrument. SIS had a good content validity with correlation coefficient more than 0.6. Good criterion validity was established by comparing the scores on various domains to standardized measures with P=0.000. Construct validity was also good as indicated by factor analysis. Proxy scores were significantly different across OHS scales which showed domain responsiveness was good. Comparison of patient and proxy responses resulted in no significant difference. Conclusions SIS for proxy is satisfactory for chinese patients. It is feasible to use a proxy respondent to answer questions on the patient's behalf.

BACKGROUND: Ischemic preconditioning (IPC) can effectively improve the ischemic resistance of skeletal muscle and reduce the necrotic areas during ischemia-reperfusion; However, the impacts of IPC on contractile function of skeletal muscle during ischemia-reperfusion is unclear.OBJECTIVE: To investigate the effect of IPC on contractile function of skeletal muscle during ischemia-reperfusion.DESIGN: A randomized controlled study by employing experimental animals as subjects.SETTING: Tongji Medical College, Huazhong University of Science and Technology and the 252 Hospital of Chinese PLA.MATERIALS: The experiment was completed in the 252 hospital of Chinese PLA. Totally 14 healthy SD rats were involved.METHODS: A rat right hindlimb ischemic model was utilized, 14 SD rats were randomly divided into control group and experimental group. Control group: sustained ischemia for 4 hours and reperfusion of 1 hour. Experimental group: ischemia for 5 minutes and reperfusion for 5 minutes, after 3 cycles, ischemia for 4 hours and reperfusion for 1 hour continuously of IPC.The isometric twitch contractile force of the right gastrocnemius muscle was measured as a parameter indicating the muscle functional status during is chemia reperfusion. The changes of creatine kinase (CK), malondialdehyde (MDA) in blood sample and the uptake of 99Tcm-methylene diphosphonate (99TcmMDP) in skeletal muscle were measured after 1 hour of reperfusion.MAIN OUTCOME MEASURES: The impacts of IPC on contractile force of gastroenemius and serous CK, MDA and the uptake of 99TcmMDP.RESULTS: The muscle contractile force in the experimental group after four hours of ischemia was (14.32 ± 5.05) g or (25.71 ± 7.58) g after one-hour reperfusion, which was significantly higher than 0 g or (4. 73 ± 2.05) g of control group(P ＜0. 05). The serous levelsofCK [(104.85 ±9. 84) nkat/L], MDA [ (3 988.60 ± 455.92) nmol/L] and the uptake of 99TcmMDP [ (56.0± 8.1 ) mBq/g per minute] were significantly lower in the experimental group than control group [CK(136.36 ± 14.50) nkat/L, MDA (6 542.90±536.72)nmol/L, and 99TcmMDP (97.3 ±5.8) mBq/g per minute, P＜0.05, P ＜0.01].CONCLUSION: IPC can effectively ameliorate the contractile force of skeletal muscle and reduce the necrotic degree of skeletal muscle. Therefore, IPC has a protective effect on the contractile force of ischemic skeletal muscle.

Objective To explore the correlation of posttraumatic growth with social support in patients with gastrointestinal neoplasms at the end of life.Methods Cluster random sampling was used to select 280 patients with gastrointestinal neoplasms who were predicted to survive no longer than 6 months in 10 first-class hospitals in Beijing and Tangshan,and they were investigated by Posttraumatic Growth Inventor (PTGI) and Social Support Rate Scale (SSRS).Results The total score of PTGI (61.13 ± 16.78)and the scores of appreciation of life (23.71±7.34),personal strength(10.67±3.55),new possibility(10.07±2.11),relating to others(12.54±5.14),spititual change(10.89±4.35)were higher than median value.The total score of SSRS(41.21±8.48) and objective support(10.27±2.75) were higer than the normal level((39.05±6.35),(8.42±2.27)) (P＜0.05).The appreciation of life was positively correlated with subjective support and the total score of SSRS (r=0.25,r=0.26,P＜0.05),personal strength was positively correlated with objective support,subjective support and the total score of SSRS(r=0.24,r=0.29,r=0.23,P＜0.05),new possibility was positively correlated with subjective support(r=0.21,P＜0.05),relating to others was positively correlated with objective support and the total score of SSRS (r=0.26,r=0.26,P＜0.05),spititual change was positively correlated with objective support and subjective support (r=0.28,r=0.31,P＜0.05).The total score of PTGI was positively correlated with subjective support and the total score of SSRS (r=0.29,r=0.29,P＜0.05).Conclusion Patients with gastrointestinal neoplasms at the end of life experience a certain extent of posttraumatic growth and high level of social support.Posttraumatic growth is positively correlated with social support.

Objective The discussion on the strategy for developing nursing human resources was carried out through truthfully understanding the medical managers' experiences of developing nursing human resources. We aimed to supply reference for establishment of policies by relevant government departments. Methods We collected data of 13 medical managers by in-depth interview and took notes (or recording) on the spot. The data were analyzed by Colaizzi's analysis program. Results Two aspects were summarized through reading, analyzing, reflecting, classifying and extracting. One was policy guidance for developing nursing human resource (4 items) and the other was policies and measures for developing nursing human resource (7 items). Conclusions The development of nursing human resource was influenced by many factors. It needs the common efforts by government, society, hospital and nurses.