OBJECTIVE:To study induction effect of entecavir on the apoptosis of hepatocellular carcinoma HepG2 cells and its mechanism. METHODS:After treated with 0(normal control),10,30 and 100 μmol/L(low,medium and high concentration groups)entecavir for 48 h,MTT method was adopted to detect HepG2 cell viability. AnnexinⅤ-PI flow double staining was used to detect cell apoptosis. Western blot was used to determine the phosphorylation of nuclear factor kappa B p65(NF-κB p65)and nu-clear factor kappa B inhibitor α(IκBα),and the protein expression of Bax,Bcl-2,Survivin and C-myc. RESULTS:Compared with normal control group,the cell viability,the phosphorylation of NF-κB p65 and IκBα,and the protein expression of Survivin, C-myc and Bcl-2 of entecavir low,medium and high concentration groups all decreased;the apoptotic rate,the protein expression of Bax increased(P<0.05 or P<0.01),in concentration-dependent manner. CONCLUSIONS:Entecavir can decrease viability of HepG2 cells and induce cell apoptosis,which is related to up-regulation expression of Bax,down-regulation expression of Sur-vivin,C-myc and Bcl-2,and blocking the activation of NF-κB/IκBαsignaling pathway.

Hair can be easily collected,the collection method does not cause any harm to body.It can provide long and convinced information about drug uses.It possess irreplaceable advantages of blood,urine and other biological samples.The review summarizes the basic information and recent studies of hair analysis.It introducs the hair-shaft structure,the mechanisms of drug incorporation,extraction/purification methods and all kinds of analytical techniques.The advantages,drawbacks and promising prospects about hair in drug monitoring are also discussed.

Objective To analyze the radiological images of osteonecrosis in rare positions in recovered SARS patients, and to study the correlation with the hormone application.Methods The extremities of 41 SARS patients in the recovery stage from June to August in 2003 were examined by using X-ray and 0.5T MR scanner, then the correlation of MR examination results and the application of hormone was analyzed.The mean time interval between the imaging examination and initial hormone application was 88.2 days (66～106 days), the mean maximum hormone (metastab) dose was 392 mg (320-480 mg), and the average medication time was 47.2 days (30-70 days).Results The osteonecrosis of rare positions was revealed in 5 cases involving 11 positions, including bilateral heads of humerus (3), right scaphoid bone (1), right talus (1), bilateral calcaneus (1), and right ischium (1).The main MR manifestation was irregular abnormal signal.Osteonecrosis of right ischium was demonstrated on plain film in only one case.Conclusion MR examination, especially the multi-location scan is necessary in finding the osteonecrosis in SARS patients in the earlier phase.The hormone dose, the medication duration, the sensitivity to hormone, and the difference of individuals are important causes of osteonecrosis.

Objective To explore the clinical efficacy and adverse reactions of transarterial chemoembolization(TACE)combined with sorafenib for the treatment of liver carcinoma.Methods Forty-eight cases of intermediate-advanced liver carcinoma patients were divided into TACE combined with sorafenib group(test group)and TACE only group(control group)according to the wishes of the patient,with 24 patients in each group.The median Survival Time(mOS),clinical efficacy,quality of life,liver function indexes and adverse reactions were compared in two groups.Results Until the deadline of follow-up time,the mOS in test group(15.9 months)was significantly higher than that in control group(9.3 months).The difference was statistically significant(P<0.05).The ORR,CBR in test group(58.3%,87.5%)were significantly higher than those in control group(33.3%, 54.2%).The difference was statistically significant(P<0.05).The quality of life improvement rate in test group(79.2%)was significantly higher than that in control group(37.5%).The differences were statistically significant (P<0.05 ).The ALB,TBIL increased significantly after treatment than before treatment in both groups.The differences were statistically significant(P<0.05 ).Conclusion TACE combined with sorafenib is more efficiency than TACE only treatment,and it could effectively extend the period of life to guarantee the quality of life.What's more,it has well tolerated adverse reactions,which is worthy of promoting.

Objective To determine the contents of elements Fe, Mn, Ni, Cu, Zn, Ca, Mg and Cr in Gentiana macrophlla and Gentiana officinalis. Methods The contents of elements were determined by flame atomic absorption spectrometry. Results The recovery rates obtained by standard addition method were between 88.1%～114.5%, and the RSDs were lower than 3.18%. Gentiana macrophlla is rich in the trace elements such as Fe, Ni, Cu, Ca, Mg, and Gentiana officinalis is rich in the trace elements such as Mn, Zn, Cr. Conclusion There are some difference between wild and planted Gentiana officinalis in element content, that may be related to their growing environment.

Objective To study the utility of acute gastrointestinal injury (AGI) grading system in the strategy of diagnosis and treatment of severe acute pancreatitis (SAP) in patients for the guidance of nutritional support.Methods Forty-five patients with SAP admitted to the ICU from January 2012 to December 2013 were enrolled for study.The diagnosis of SAP was made as per the 2013 Chinese guideline of dliagnosis and treatment of acute pancreatitis.The patients with aged ＜ 18 years,length of hospital stay ＜72 h,and those included in other experimental study were excluded.The patients were divided into two groups:AGI group (n =24) and control group (n =21).There were no statistically significant differences in age,gender,APACHE Ⅱ between two groups (P ＞ 0.05).The length of hospital stay,in-hospital mortality,the incidence of complications such as infection,the time of starting enteral nutrition (EN) and reaching caloric goal were compared between the two groups.The t test or Mann-Whitney U test was used for continuous variables and x2 test or Fisher exact test was used for categorical variables,and P ＜ 0.05 was considered statistically significant.Results (1) Between two groups,there were statistically significant differences in the time of starting EN (2.0 d vs.5.7 d,Z =-4.149,P ＜0.01) and reaching caloric goal (5.5 d vs.10.4 d,Z =-3.392,P =0.001).(2) Between two groups,there were statistically significant differences in the incidence of pneumonia (25％ vs.57.14％,P =0.028 1) and catheterrelated infection (0％ vs.23.81％,P =0.039 4).(3) Between two groups,there was no statistically significant difference in in-hospital mortality (16.67％ vs.33.33％,P =0.194 3).In addition,there was significant difference in length of hospital stay between two groups (23.13 ± 10.58) d vs.(31.10 ± 15.33) d,P =0.046.Conclusions The diagnosis and treatment strategy based on AGI grading system is associated with earlier initiation of EN and reaching caloric goal,and partly reduces the incidence of infections and shortens the length of hospital stay,in the meantime,provides guidance for the rationale of nutritional support in the patients with SAP.

Objective To study the predictive value of acute gastrointestinal injury (AGI) grading system introduced into Sequential Organ Failure Assessment (SOFA) score in patients with severe acute pancreatitis (SAP) in order to provide a reliable clinical tool for the evaluation of prognosis of SAP.Methods Patients with acute pancreatitis admitted to ICU from July 2012 to July 2014 were enrolled for study.The criteria of exclusion were the age below 18 years old,pregnancy,or patients without consent to the treatment.A total of 63 patients with 37 males and 26 females aged (47 ± 15.3) years were included.The data of their acute physiology and chronic health evaluation (APACHE) Ⅱ score,the highest SOFA score and AGI grade within the first week,and the 28-day mortality rate were collected.Patients without AGI were defined as zero point,and AGI grade Ⅰ-Ⅳ were defined as 1-4 points.The receiver operating characteristic curve (ROC) was used to evaluate the value of APACHE Ⅱ score,SOFA score,and SOFA + AGI score in predicting the prognosis of SAP.The areas under ROC curve (AUC) of the APACHE Ⅱ score,SOFA score,and SOFA + AGI score were compared with MedCalc software,and P value less than 0.01 was considered to be statistical significance.Results (1) The 28-day mortality of the 63 patients with SAP was 20.6％ (13/63),in which 50 patients in the survival group,13 patients in the death group.The APACHEⅡ scores of two groups were (15.62 ± 4.33 vs.12.10 ± 3.74,P=0.0048),the SOFA scores were (14.77 ± 3.09 vs.9.24 ± 2.88,P ＜0.01),and the SOFA + AGI scores were (18.77 ±3.09 vs.10.74 ± 3.17,P＜0.01).(2) The AUC of APACHEⅡ score was0.748 ± 0.084 (95％ CI:0.622-0.849),the AUC of SOFA score was 0.902 ± 0.059 (95％ CI:0.801-0.962),and the AUC of SOFA +AGI score was 0.963 ± 0.037 (95％ CI,0.882-0.994);There was no significant difference in AUC between APACHE Ⅱ score and SOFA score (P =0.10),and there was statistical significance between the AUC of APACHE Ⅱ score and that of SOFA + AGI score (P =0.013),and the difference in AUC between SOFA score and SOFA + AGI score was statistically significant (P =0.008).The Youden index and the positive likelihood ratio of SOFA + AGI score system were the greatest to be 0.863 and 15.38,respectively.Conclusions SOFA scoring system has better predictive value in patients with SAP when AGI grading system was introduced into it.

Objective To observe the effect of Shengmai Injection (a Chinese herbal medicine preparation) on the serum levels of TNF-α used as indicators of organ function in post cardiopulmonary resuscitation rabbits.Methods Rabbit cardiac arrest model was made with asphyxia by clamping the trachea of rabbit.A total of 30 rabbits were randomly (random number) divided into two groups,namely the normal saline group (n =15) and the Shengmai injection group (n =15).Rabbits in Shengmai injection group were injected with 2 ml/kg Shengmai Injection immediately at the beginning of cardiopulmonary resuscitation (CPR),and the same dose of Shengmai injection given 10 min after CPR.Rabbits in saline group were injected with the same volume of physiological saline instead at the same intervals as previous group.The rate of restoration of spontaneous circulation (ROSC) and survival rates at 6,12,24 and 48 h after ROSC were observed.The serum levels of TNF-α were measured by enzyme-linked immunosorbent assay (ELISA).Biochemical methods were used to detect myocardial MB-isoenzyme of creatine kinase (CK-MB),alanine aminotransferase (ALT),creatinine (Cr),glucose (Glu) and arterial partial pressure of oxygen (PaO2) before resuscitation and 12,24 and 48 h after ROSC simultaneously in the two groups.Results There was no statistically significant difference in the ROSC rate and survival rate after resuscitation between the two groups (P ＞ 0.05).Before asphyxia,there was no significant difference in the level of TNF-α found between the two groups (P ＞ 0.05),but at 12,24 and 48 h after ROSC,the levels of TNF-α in Shengmai group were much lower than those in Saline group (P ＜ 0.05).At 24 h after ROSC,the levels of serum CK-MB,ALT,and Cr in Shengmai group were much lower than those in Saline group (P ＜0.05).Furthermore,at 48 h after ROSC,the levels of CK-MB and ALT in Shengmai group were still lower than those in Saline group (P ＜ 0.05),but there was no significant difference in the level of Cr between the two groups (P ＞ 0.05).There was also no significant difference in the blood glucose and arterial partial pressure of oxygen between the two groups (P ＞ 0.05).Conclusions Shengmai Injection has significant inhibiting effect on the serum level of TNF-α in post cardiopulmonary resuscitation rabbits,and it also has more or less some degrees of protective effect on organ function of heart,liver and kidney in rabbits after ROSC.

ObjectiveTo investigate the relevant factors influencing the incidence and mortality of post cardiac arrest syndrome (PCAS), and to provide the basis of improvement of resuscitation rate.Methods A single center retrospective study of cardiopulmonary resuscitation (CPR) according to Utstein model was conducted. A clinical case report form was designed to collect clinical data. The clinical data of patients whose spontaneous circulation was restored (ROSC)> 24 hours in intensive care unit (ICU) of the First Hospital of Jilin University from January 2008 to June 2014 were collected and analyzed. The relevant risk factors of the incidence and mortality rate of PCAS were screened and analyzed by multivariate logistic regression analysis.Results① Successful CPR was achieved in 93 patients, of whom 83 patients were shown to have systemic inflammatory response syndrome (SIRS), and 75 patients suffered from PCAS (80.65%). Among them 49 died, and 18 patients who did not suffer from PCAS survived.② The age, gender, history of previous chronic disease, site of occurrence of cardiac arrest, type of rhythm when cardiac arrest occurred, and dosage of adrenaline showed no significant influence on the incidence of PCAS. The incidence of PCAS was elevated when defibrillation was done more than 3 times (χ2= 10.806,P= 0.001), SIRS occurred after ROSC (χ2= 46.687,P< 0.001), interval between collapse and first defibrillation over 5 minutes (χ2 = 6.429,P = 0.011), interval between collapse and CPR longer than 5 minutes (χ2 = 4.638,P = 0.031), interval between collapse and administration of first resuscitation medication> 5 minutes (χ2 = 4.190,P = 0.041), and ROSC time was longer than 10 minutes (χ2 = 20.042,P< 0.001). Bivariate correlation showed that interval between collapse and CPR, interval between collapse and administration of first resuscitation medications, and ROSC time were all correlated (r1 = 0.677,r2 = 0.481,r3 = 0.617, allP< 0.001).③ There were no significant relations between the prognosis of PCAS patients and times of defibrillation, the amount of adrenaline used, and interval between collapse and first defibrillation. The mortality rate of PCAS was relatively elevated when interval between collapse and CRP was longer than 5 minutes (χ2 = 10.792,P = 0.001), interval between collapse and administration of first resuscitation medications was longer than 5 minutes (χ2 = 13.841,P< 0.001), ROSC time> 10 minutes (χ2 = 36.451,P< 0.001), the number of dysfunction organ≥ 4 (χ2 = 28.287,P< 0.001), arterial blood lactate levels> 2 mmol/L (χ2 = 28.926, P< 0.001), and acute physiology and chronic health evaluationⅡ (APACHEⅡ) score> 15 (χ2 = 33.558,P< 0.001). Multivariate logistic regression analysis showed that the risk factors affecting the prognosis were ROSC time [odds ratio (OR) after adjustment = 36.643, 95% confidence interval (95%CI) = 2.382-563.767,P = 0.010], the number of organs with dysfunction (OR = 9.010, 95%CI = 1.140-71.199,P = 0.037), and APACHEⅡ score (OR = 10.001, 95%CI =1.336-74.893,P = 0.025).Conclusions ROSC time, the number of organs with dysfunction, and APACHEⅡ score were independent predictors of PCAS prognosis. Efforts should be given to shorten the rescue time, to shorten the time for restoring the spontaneous circulation, to prevent and treat SIRS after ROSC, and to protect the function of organs, in order to improve the prognosis of patients with PCAS.

Objective To review the clinical features,etiology and differential diagnosis of hypopituitarism.Methods The clinical data of 260 patients with hypopituitarism admitted to our hospital during 2007 to 2011 were retrospectively analyzed.Results In 260 patients 96 were males and 164 were females,the average age of female patients was significantly higher than that of males[ (44 ± 16) vs.(32 ± 20) years; t =3.821,P =0.001 ].Patients under 20 years accounted for the highest proportion in male cases (38/96,39.6％) ; while patients aged 40 - 60 years were the highest proportion for female cases (86/164,52.4％).Pituitary tumor and postoperative damage was the most common cause for hypopituitarism accounting for 36.2％ (94/260),followed by Sheehan syndrome (86/260,33.1％).The most common manifestation of hypopituitarism was anemia (102 eases) ; 26 cases presented all pituitary function failure.The causes leading to hypopituitarism usually showed specific manifestations in imaging examinations.The overall misdiagnosis rate was 40.4％ (105/260)in this series,while that of etiological diagnosis was 25.4％ (66/260).Conclusions This study suggests that hypopituitarism caused by different causes can be diagnosed by disease history,clinical manifestations and pituitary imaging examination.