Objective To evaluate the predictive value of serum presepsin (sCD14-ST) for septic myocardial depression (SMD) in patients with severe sepsis or septic shock.Methods This was a prospective cohort study.A total of 84 patients with severe sepsis or septic shock were monitored by pulse indicator continuous cardiac output (PiCCO) system and divided into myocardial depression group (cardiac function index [CFI]<4.1 L/min, n=37) and non-myocardial depression group (CFI≥4.1 L/min, n=47) according to cardiac function index (CFI).Left ventricular ejection fraction (LVEF) was measured by doppler echocardiography at admission.The patients were divided into survival group (n=40) and non-survival group (n=44) based on 28-day mortality.Serum sCD14-ST,B-type natriuretic peptide(BNP), tumor necrosis factor-α(TNF-α), cardiac troponin Ⅰ (cTnⅠ) levels and hemodynamic parameters were observed dynamically at day 1,3,5 after admission.Quantitative data with normal distribution were analyzed using t-test and abnormal distribution data were analyzed using Mann-Whitney U test.Categorical data were analyzed using χ2 test.Results The serum levels of cardiac index (CI), global ejection fraction (GEF) and left ventricular contractility index (dPmax) in myocardial depression group were all significantly lower than those in non-depression group at day 1 after admission (all P<0.01).The serum levels of sCD14-ST, TNF-α and BNP in myocardial depression group were all significantly higher than those in non-depression group (all P<0.01).Serum sCD14-ST levels in 84 septic patients were positively correlated with both BNP and TNF-α (r=0.204, P<0.05 and r=0.516, P<0.01, respectively).The area under the receiver operating characteristics curve (AUC) of sCD14-ST was 0.782 for myocardial depression in patients with sepsis, with a sensitivity of 89.2% and a specificity of 78.0% at the cut-off point of 988 mg/mL.The predictive value of sCD14-ST was inferior to BNP and TNF-α (both P<0.05).The combination of sCD14-ST, TNF-α and BNP could provide better prediction value in septic myocardial depression.Logistic regression analysis showed that serum sCD14-ST was not the in dependent predictor for septic myocardial depression (P>0.05).There were 24 cases died in myocardial depression group.The mortality of myocardial depression group was significantly higher than that of non-depression group (64.9% vs 42.6%, χ2=4.132, P =0.042).The serum levels of sCD14-ST at day 1 and day 3 in myocardial depression group were significantly higher than those in non-myocardial depression group (both P<0.01).sCD14-ST levels in both groups showed downtrend.The serum level of sCD14-ST in non-survival group was significantly higher than that in survival group (P<0.01).Conclusions Myocardial depression is common in patients with severe sepsis and septic shock.High serum level of sCD14-ST is correlated with myocardial depression to some extent, but not an independent predictor.The combination of sCD4-ST, BNP and TNF-α can improve the predictive value for myocardial depression.

Objective To explore the effects of various location methods on the successful rate of placement nails by the entrance spot of lumbar vertebra pedicle. Methods The clinical data of 105 patients with 462 times of internal nail fixation of lumbar vertebra pedicle were analyzed, and the successful rates of placement nails one time were compared among 5 location methods. Results 462 times of internal nail fixation of lumbar vertebral pedicle were performed safely. Postoperative X-ray imagining showed that 322 nails were located in the middle of pedicle of lumbar vertebra, 58 nails in its inferior part, and 82 nails in its superior part. The successful rate of placement nails one time by the location method of four quadrants technique was 86.9%, which was significantly different compared with the other 4 location methods(P

ObjectiveTo investigate the expression of TESTIN gene in endometrial carcinoma and explore the functions of this gene in tumor development and progression.MethodsqRT-PCR and immunochemical staining assay were used to determine the mRNA and protein level of TESTIN in the tumor tissues,and the relationship between TESTIN expression and clinical pathology characteristics was analyzed.Results Compared to normal tissue,76.5％ (52/68) tumor tissues showed TESTIN reduced ( P ＜ 0.01 ),furthermore,this reduction in the subgroup of endometrioid adenocarcinoma was significant,but it was rarely observed in the subgroup of serous papillary adenocarcinoma.ConclusionsTESTIN was obviously down regulated in endometrail carcinoma,especially in endometrioid adenocarcinoma,which indicated TESTIN played an important role in tumorigenesis of uterine.

Objective To investigate the dosimetric characteristics and their clinical applications of volumetric modulated Arc therapy (RapidArc) with fixed-fields intensity modulated radiotherapy for early stage nasal NK/T-cell lymphoma.Methods Ten patients with stage Ⅰ E and Ⅱ E nasal NK/T-cell lymphoma were enrolled in the study.Five field coplanar plan (5F),nine field coplanar plan (9F),five field non-coplanar plan (5F-N) and RapidArc plans were designed for each patient,in which 5F plan was set as the control group.Conformity index (CI) and homogeneity index (HI) as well as the maximum dose of organs at risks were compared.Results The target CI of 5F,9F,5F-N and RapidArc plan was 0.419±0.159,0.478 ±0.181,0.465 ±0.121 and 0.518 ±0.111,respectively.Compared with 5F (0.136±0.038),the target HI of 9F and RapidArc plan was 0.111 ±0.027 and 0.112 ±0.031 (t =3.11,3.04,P ＜ 0.05).9F plan significantly increased the Dmax of lens in the contralateral side(t =2.82,P ＜ 0.05) and in ipsilateral side (t =3.25,P ＜ 0.05),while 5F-N plan decreased the Dmax of optical nerves by up to 9％.RapidArc plan effectively reduced the radiation to organs at risk in lens (t =3.25,P ＜0.05),eyes (t =3.25,P ＜0.05),optical nerve (t =2.57,P ＜0.05) and optical chaism(t =7.62,P ＜0.05).The delivery efficiency of four plans ranked as RapidArc ＞ 5F ＞ 5F-N ＞ 9F.Conclusions RapidArc produced statistically significant improvement in the dose distributions of targets,and also reduced the Dmax of organs at risk,which would be the better choice of radiotherapy for nasal NK/T-cell lymphoma.

Objective:To evaluate the effectiveness of abdominal acupuncture plus the Confluent Points of the Eight Extraordinary Meridian in treating chronic pharyngitis. Methods:Thirty eligible subjects with chronic pharyngitis were given abdominal acupuncture plus needling Lieque (LU 7) and Zhaohai (KI 6), two out of the Confluent Points of the Eight Extraordinary Meridian, once a day, 10 sessions as a course, and the therapeutic efficacy was evaluated after a treatment course. Results:After a treatment course, of the 30 subjects, 21 were recovered, 5 showed markedly effective, 2 were improved, and 2 failed,the total effective rate was 93.3%. Conclusion:Abdominal acupuncture plus the Confluent Points of the Eight Extraordinary Meridian is effective in treating chronic pharyngitis, worth promoting in clinic.

Objective To analyze the neuroimaging changes of tree shrew models of Alzheimer’ s disease.Methods Nineteen healthy adult female tree shrews were randomly divided into control (5 animals) and model group (14 animals). The model of Alzheimer’s disease was induced by intracerebroventricular injection of Aβ1-40 using a stereotaxic devise and proved successfully by visuospatial congnitive task.The in vivo microstructural changes in the brain of tree shrew AD models and control group (0, 1, 2, 3, 4 weeks) were observed on 1.5T MRI (T2WI), and on 7.0T MRI (12 week)(T2WI, DTI). Results Reference memory errors were increased in the model group at 3 or 4 weeks (P<0.05), and so working memory errors (P<0.05) and period of time to perform (P<0.05, P<0.05, P<0.01) from 2 to 4 weeks.Thus the model was proved to be established successfully.T2WI test and DTI test were carried out.Hippocampus atrophy of the model group at 3 and 4 weeks was observed compared with that at 0 or 1 week or 2 weeks on a 1.5T Philips Gyroscan.Compared with the control group, the temporal horn width in the model group was significantly increased (P<0.01) at 12 weeks on a 7.0T Bruker Biospec Scanner.DTI test at 12 weeks showed that ADC of bilateral hippocampus was up-regulated in the model group ( P<0.01 ) .In the color coded orientation view, loss of the corpus callosum fibers was obvious in the model group. Conclusions Intracerebroventricular injection of Aβ1-40 can lead to learing and memory impairment in tree shrews.There are abnomal MRI signal changes in the brain, and the temporal horn width, hypocampal apparent diffusion coefficient ( ADC) value and corpus callosum damage may provide reference value for the diagnosis of Alzheimer’ s disease.

Objective To study the baseline level of fraction anisotropy (FA) and the normal value of apparent diffusion coefficient (ADC) in deep white matter of preterm and its application.Methods From Oct.2010 to Dec.2013,in Department of Neonatology,Jiangsu Province Hospital,magnetic resonance imaging (MRI) (T1,T2) and diffusion tensor imaging (DTI) were done on 13 preterm infants of less than 37 weeks of corrected gestational age (CA),42 preterm infants of term-matched age,and 15 term infants.ADC and FA were measured in genu and splenium of corpus callosum (CC),anterior limb and posterior limb of internal capsule (IC).Results 1.The ADC values in genu,splenium,anterior limb of right IC,posterior limb of right IC,anterior limb of left IC,posterior limb of left IC in CA ＜ 37 weeks infants were higher than those in term-matched infants and in term infants.The ADC values in the 6 regions in term-matched infants and in term infants were significantly different with those in CA ＜ 37 weeks infant(F =5.559,5.775,21.948,19.462,30.586,15.452,all P ＜ 0.01).The differences of ADC values between CA ＜ 37 weeks infants and term-matched infants,between CA ＜37 weeks infants and term infants were significant(all P ＜0.05),except that in CC between CA ＜ 37 weeks infants and term-matched infants.2 The FA values in genu,splenium,anterior limb of right IC,posterior limb of right IC,anterior limb of left IC,posterior limb of left IC in CA ＜ 37 weeks infants were lower than those in term-matched infants and in term infants.The FA values in the 6 regions in term-matched infants and in term infants were significantly different from those in CA ＜ 37 weeks infants (F =9.835,7.500,4.811,11.430,8.674,12.666,all P ＜ 0.01).The differences of FA values between CA ＜ 37 weeks infants and term-matched infants (P ＜ 0.05),between CA ＜ 37 weeks infants and term infants were significant (all P ＜ 0.05).Conclusions The baseline values of FA and ADC in different deep white matters were obtained.As corrected gestational age of preterm babies' increased,FA values in brain white matter increased,while ADC values decreased.The myelination in most white matter of preterm infants at matched term can catch up with that of term infants.The diagnostic value of ADC and FA needs to be studied further.

Objective To explore the potential of autologous dendritic cells (DC) pulsed with HLA-A201-binding peptide E613-21(KLPDLCTEL) and E786-94(TLGIVCPI)in inducing specific T cells respouse in vitro.Methods Cervical carcinoma patients with positive HLA-A201 were enrolled and their monocytes isolated and induced into dendritic cells and pulsed with HLA-A201-binding peptide E613-21 and E786-94.PBLs were primed by DCs every week for thee times.The cytokine level of supernatant of CTLs was tested by ELISA.The percentage of special CTLs was tested by flow cytometry.The specific killing effect of CTLs was tested by MTT.Results the numbers of DCs of eleven cervical carcinoma patients were (10.79±0.88) ×106(100 ml peripheral blood).CDllc+HLA-DR+(97.15±2.41)％,CD80+(84.28+5.39)％,CD83 +(85.17±5.06) ％,CD86 + (97.74+0.87) ％.Proliferation index of PBLs primed by DCs three times was 15.4± 1.5.Cytokine levels including IL-2,IL-12,IFN-γ and TNF-α were obviously higher than nonpriming PBLs[(2551.9+195.3) pg/ml,(554.9±64.0) pg/ml,(2416.9±281.7) pg/ml,(632.4 +71.1)pg/ml,respectively] (P＜0.05),but IL-10 was no significant difference between priming CTLs and nonpriming CTLs.The average percentage of special CTLs was obviously higher than control group[(6.32±1.54)％,P＜0.05].The killing effect of CTLs was obviously higher than control group(P＜0.05).Conclusion Dendritic cells pulsed with peptide E613-21 and E786-94 can induce special CTLs in vitro and stimulate CTLs secret cytokines.This will provide science basis for research of therapeutic HPV vaccine.

Background and purpose. Gastric stromal tumor (GST) is the most common mesenchymal tumor of the gastrointestinal tract and most often arises in the stomach. In the past, surgery was the only effective treatment. The diagnosis and treatment of GST has been revolutionized over the past, since expression of the receptor tyrosine kinase KIT (CD117) was shown to occur on these tumors, the outcome of GST treatment has dramatically been improved. This study focused on the therapeutic experience of GST and analyzed the pathological features and prognostic factors of GST in our center. Methods: All the 26 cases underwent surgical resection and three of them were treated over 6 months with imatinib 400 mg/d. The clinical pathological and follow-up data of 26 patients with GST admitted in our hospital between Jan. 2000 and Dec. 2008 were analyzed retrospectively. Results. All the cases underwent curative resections, including palliative liver resection in 3 patients with liver metastasis. Recurrence occured on 6 patients, including 1 case with low risk group, 1 case with intermediate risk group, 4 cases with high risk group. Tumor size ranged from 2 to 15 cm with the mean of 5.5 cm. The immunohistochemistry results revealed that the positive rates of CD117, CD34 and Vimentin were 92.3%, 80.8% and 96.2% respectively. After operation, three patients accepted imatinib mesylate therapy over 6 months. Two of them were alive, but one had liver metastasis. The follow-up period ranged from 4 to 36 months (median: 28 months). Four cases were lost. The 1-, 3-year overall survival rates of 26 cases were 96.2% and 84.6%. Conclusion: Tumor size, location, mitosis and immunohistochemical data are important variables to evaluate GST behavior and prognosis. Surgical resection is the main therapy for GST and targeted therapy will improve the prognosis.

Objective To investigate the effect of the multimodal analgesia on postoperative pain after renal transplantation and the cytokines .Methods 40 cases of allogaft renal transplantation due to chronic renal failure were randomly divided into two groups (n=20) .The group D received the multimodal analgesia :preemptive analgesia plus patient controlled epidural analgesia(PCEA) and the group C(control) received analgesic drugs by intermittent intramuscular injection .The visual analogue scale(VAS) scores , the Ramsay sedation scores ,HR ,MAP and SPO2 at postoperative 2 ,6 ,12 ,24 ,48 h were recorded .Blood interleukin-2(IL-2) ,in-terleukin-6(IL-6) and interleukin-10(IL-10) levels were measured before anesthesia ,at the end of operation and postoperative 6 , 24 ,48 h .Results Postoperative MAP and SPO2 had no obvious change in the two groups ,no statistical differences in the various time points existed between the two groups (P>0 .05) .HR was significantly increased at 6 ,24 h after operation in the group C , which had statistical difference compared with that at the same time points in the group D (P<0 .05) .The VAS scores at postoper-ative 6 ,12 ,24 h in the group D were significantly lower than those in the group C ,the difference showed statistical significance (P<0 .05) .The sedation scores at various time points had no statistical difference between the two groups (P>0 .05) .The levels of IL-2 and IL-10 at postoperative 6 ,24 ,48 h in the two groups were significantly higher than those before anesthesia and at the end of operation (P<0 .05) .The levels of IL-2 and IL-6 at postoperative 6 ,24 ,48 h in the group D were significantly lower than those in the group C(P<0 .05) .Conclusion Multimodal analgesia can reach the effective analgesic effect ,down-regulate the pro-inflam-matory cytokines and up-regulate anti-inflammatory cytokines for maintaining postaperative serum cytokines balance .