Objective To investigate the effect of continuous renal replacement therapy on the levels of IL-27 in peripheral blood of patients with chronic heart failure concurrence acute kidney failure. Methods 78 patients with chronic heart failure were enrolled from June 2012 to December 2013 in Zhujiang hospital affiliated Southern medical university. According to patient′s condition, 38 patients with chronic heart failure concurrence acute kidney failure undertaking CRRT, 40 patients with chronic heart failure undertaking conventional therapy. Heart function were determined by cardiac ultrasound, the levels of IL-27 and BNP were determined by ELISA. Results Compared with chronic heart failure patients, the levels of IL-27 were decreasing but BNP were increasing in patients with chronic heart failure concurrence acute kidney failure (P < 0.05). After CRRT, the levels of IL-27 were increasing but BNP were decreasing in patients with chronic heart failure concurrence acute kidney failure. Correlation analysis showed that the levels of IL-27 is negatively correlated with the levels of BNP , but positively correlated with LVEF (P<0.05). Conclusion IL-27 participated in the development of chronic heart failure concurrence acute kidney failure. CRRT regulating and controlling the heart and kidney function may partly through effecting on immune-inflammatory mechanism.

Objective To study the diagnostic value of CT combined with serum carbohydrate antigen 19-9(CA19-9), carcinoembryonic antigen(CEA), carbohydrate antigen 125(CA125)in diagnosis of pancreatic cancer.Methods 68 patients with pancreatic occupying lesions were selected and they were divided into pancre -atic cancer group(n=43)and non-pancreatic cancer group(n=25)according to pathological diagnosis.34 cases from physical examination were set as the control group .All patients received CT examination and the consistency between CT diagnosis and pathological results was analyzed .Serum CA19-9, CEA, and CA125 were detected by chemiluminescence method.The sensitivity, specificity and accuracy of CT combined serum CA 19-9, CEA, CA125 were analyzed.Results Among the 68 cases, 35 cases were pancreatic cancer diagnosed by CT , and the CT diagnosis was not ideal compared with pathological results .Nonparametric test found that serum CA 19-9, CEA and CA125 in pancreatic cancer group were higher than those of the non-pancreatic cancer group and the control group, and the difference had statistical significance ( P<0.05 ) , while the difference between non-pancreatic cancer group and the control group had no statistical significance ( P>0.05 ) .Conclusion CT diagnosis had high susceptibility and low specificity ,CT combined with serum CA19-9,CEA, and CA125 can improve accuracy of pancreatic cancer diagnosis .

Twenty adult male rats, weighing 200～300 g were divided into 3 groups: (1) Six. animals were stimulated through two electrodes fixed on the tail to produce somatic pain.(2) Six animals were stimulated by increasing pressure in the stomach through an air balloon to cause visceral pain. And 8 animals served as control.All the animals were sacrificed and their neurohypophysis were fixed in 4％ glutaraldehyde and 1％ OsO_4 successively. Their section were cut with an LKB microtome and observed under H 500 electron microscope.The experimental results summarized as follows:1. The bodies of pituicytes under the pain stimulation were hypertrophied. The rough endoplasmic reticulum, polyribosomes and mitochondria were increased. The Golgi complex was well developed. There were numerous elliptical vesicles appearing in the cytoplasm of pituicytes.2. The number of large lipid masses was increased while the processes of pituicytes engulfed the degenerative neurosecretory terminal into them and the pituicyte digted it finally.3. Neurosecretory granules were decreased but the synaptic small vesicles were increased in the dilated parts of neurosecretory fibers after the pain stimulation.4. The continuous network of perivascular space and interstitial space between the dilated parts of neurosecretory fibers were widened.

Pain just tolerable was caused intermittently by electric stimulation on rat's tail or by distented baloon in stomach for 30 min. The changes of intermediate lobe are summarized as follows: (1) The cell body, nucleus or nucleolus was hypertrophied. The number of rough endoplasmic reticulum, particularly of its vesicular cisternae was increased. Golgi complex enlarged. The ribosome multiplied. All of these change indicated that the activity of cells was increased and the rate of synthesis enhanced. (2) Both the secretory granules shifted to the periphery of cell body and some of them showed pale density. These changes were interpreted as increase of seretory activity. (3) The mitochondria became enlarged and the crsitae in them were changed into tubular form. This suggested an acceleration of cell metabolism, which might provide a large amount of energy. (4) There was no degenerative change. (5) The cytological changes caused by visceral pain were simillar with, but more striking than, those caused by somatic pain. (6) The secretions were increased, among which ?-endorphin and ACTH etc were known to be closely related to analgesia.

Our experiments were designed to observe the cytological changes of the anterior lobes in rats pituitary at electron microscopic level after electric pain-stimulation. obvious changes were founded in the ACTH, GH and PRL cells and slight changes in the FSH and TSH cells. However, the LH cells remained to resemble the normal cells. In the experiment group of the somatic painful stimulation the results were as follows: The ACTH cells were irregularly shaped, with extended thin and long plasmatic processes which interdigitated with GH cells. The processes filled with secretory granules. Some of the Secretory granules aligning along the plasmatic membrane showed pale density. The flat cisternae of rough endoplasmic reticulum (RER) appeared to be slightly dilated. The sizes of the bodies of GH and PRL cells increased. In the GH cells there were numera media cisternae in RER, their Golgi complex was well developed, and the secretory granules were distributed to the periphery of the cell bodies. All these phenomenous showed the secretory activity of these cells was enhanced. The PRL cells contained well developed Golgi complex and abundant RER. In the experiment group of the visceral painful stimulation the results were as follows: There were more striking changes of parenchymal cells of anterior lobes in rats pituitary than those of the experimental group of the somatic painful stimulation. The cell bodies of ACTH, GH and PRL cells showed hypertrophy, the nucleus enlarged and nucleolus were relatively prominent. The dense granules decreased in number and the pale or empty visicles almost situated near the plasmic membrane in ACTH cells. In the GH cells large vacuoles were distributed throughout the cytoplasma. The number and density of the secretory granules decreased. In PRL cells the Golgi complex were extended, the dictyosomes increased, in addition, RER, polyribosomes and mitochandria were more aboundant than that in these normal cells. These cytological changes suggested secretory and synthetic activity of these cells were enhanced. At last, pain in relation to several hormones such as ?-endorphin, ?-LPH, ACTH and ?-MSH etc. were discussed by the author.

The purpose of this research work is to study the influence of experimentally produced pain on the uhrastructural changes of the nerve endings of the neurosecretory fibers from hypothalamus to neurohypophysis.Twenty adult male rats, weighing 200～300 g were divided into 3 groups: (1) Six animals were stimulated through two electrodes fixed on the tail to produce somatic pain. (2) Six animals were stimulated by increasing pressure in the stomach through an air balloon to cause visceral pain. And 8 animals served as control.All the animals were sacrificed and their neurohypophysis were fixed in 40％ glutaraldehyde and 1％ OsO_4 successively. Sections were cut with an LKB microtome and observed under H500 electron microscope.The following conclusions were drawn from the observed results:1. The neurosecretory granules in the fibers from hypothalamus to neurohypophysis grew up to maturity by increasing in size gradually as they passing down from hypothalamus to neurohypophysis.2. Basing on the morphological exhibition of the neurosecretory granules, we get the impression that the neurosecretion might be released either by molecular dispersion or by exocytosis.3. There were a great number of discrete smooth vesicles grouped in cluster in the dilated parts of neurosecretory fibers. These vesicles had been called as "synaptic" or "synaptoid" vesicles. They might be really synaptic vesicles and containing acetylcholine. Other vesicles with irregular profile and varying in size, collapsing vesicles and vacuoles might be the residues of the neurosecretory granules after discharging their content.4. Many synaptic vesicles were concentrated at the axolemma of the dilated parts of neurosecretory fibers and the membranes were thickened and leaving a synaptic cleft.5. In the exprimental groups after pain stimulation the neurosecretory granules decreased in number and the synaptoid vesicles increased in number and the neurosecretory granules showed a wide pale halo. The number of irregular vesicles and ghost of granules were increased. This phenomenon might show that the excretion of neurosecretory material and neurotransmitters was enhanced.6. Neurohemal zones were the barrier for the neurosecretory material entering into blood. Acetylcholine, endogenous opiatelike substances and gamma-aminobutyric acid (GABA) might play a control role for neurosecretion at this site.7. This experimental results supported the action mechanism of endogenous opaitelike substance and morphine could produce an important role directly in neurohypophysis.

This article analyzes the current characteristic of cardiology teaching.In light of advantages of network education,it discusses the prospect of network-based education and some problems.

Objective To investigate the relationships between aspirin resistance (AR) and laboratory indexes and different types of traditional Chinese Medicine(TCM)syndrome in patients with acute cerebral infarction. Methods Two hundred and eight different types of TCM syndromes of patients with acute cerebral infarction admitted from January 2012 to November 2013 in the Neurology Department of Shanghai Seventh People's Hospital were divided into AR group and aspirin sensitive(AS)group according to the rate of AR. Simultaneously,28 healthy volunteers in the same period were assigned in a healthy control group. The changes of red blood cell volume distribution width coefficient of variation(RDW-CV),platelet count(PLT)and homocysteine(Hcy)levels were observed in the three groups. The correlation between different types of TCM syndromes and AR,PLT,RDW-CV,and Hcy was analyzed by non-conditional logistic regression. Results The total incidence of AR was 29.32%(61/208)in 208 patients with acute cerebral infarction. There were 165 cases with Qi deficiency and blood stasis syndrome,the incidence of AR being 26.06%(43/165);32 cases with wind phlegm obstructing channel syndrome,the incidence of AR, 43.75%(14/32);11 cases with liver yang hyperactivity syndrome,the incidence of AR,36.36%(4/11);in the comparisons,the incidence rates of AR among the above types of syndromes had no statistical significant differences (P>0.05). Compared with the healthy control group,the levels of PLT,RDW-CV,Hcy in AR group and AS group of various types of TCM syndrome were increased,the PLT and RDW-CV levels in patients with Qi deficiency and blood stasis syndrome in AR group were more significantly elevated in the comparisons between AR and AS groups, there were statistical significant differences〔PLT (×109/L):212.16±66.48 vs. 187.54±56.85, RDW-CV:(14.34±3.16)% vs.(13.20±2.16)%,both P<0.05〕;the level of Hcy in patients with wind phlegm obstructing channel syndrome in AR group was increased more significantly than that in AS group,the difference between the two groups being statistically significant(μmol/L:27.29±18.64 vs. 21.36±14.61,P<0.05). Logistic regression analysis showed,increased PLT〔odds ratio(OR)=1.007 2,95%confidence interval(CI):1.001 2-1.013 2,P=0.018 5〕and RDW-CV〔OR=1.165 4,95%CI:1.007 9-1.347 4,P=0.038 8)was independence risk factor of AS development. Conclusion The elevation of RDW-CV,PLT,Hcy in level reflects the index of AR production, especially in patients with acute cerebral infarction accompanied by Qi deficiency and blood stasis syndrome and wind phlegm obstructing channel syndrome.

Objective To investigate the peripheral blood neutrophil to lymphocyte ratio(NLR) for the early diagnosis of acute coronary syndrome(ACS) .Methods A total of 247 patients with suspected ACS and chest pain ,including 51 cases with acute ST segment elevation myocardial infarction(STEMI) ,42 cases with acute non‐ST segment elevation myocardial infarction(NSTEMI) , 87 cases with unstable angina pectoris(UA) and 67 cases with non‐cardiogenic chest pain(NCCP)were enrolled and detected for white blood cells count and classification .The sensitivity ,specificity ,positive predictive value ,negative predictive value ,receiver op‐erating characteristic(ROC) curve of NLR were analyzed .Results Among all patients ,the most common was UA ,followed by NC‐CP ,STEMI and NSTEMI .Level of neutrophil proportion and white blood cell count were lowest in NCCP group ,followed by UA , NSTEMI and STEMI group ,but lymphocyte proportion was with the opposite change tendency .Diagnostic sensitivity ,specificity , accuracy ,positive predictive value and negative predictive value of NLR for ACS were higher than white blood cell count .Conclusion NLR was with various advantages for the early diagnosis ,prognosis evaluation and state of ACS .

Objective To discuss the effectiveness of anterolateral thigh propeller flaps for treatment of inguinal skin and soft tissue defects.Methods From June,2009 to October,2014,12 patients with inguinal skin and soft tissue defects were treated with anterolateral thigh propeller flaps pedicled with perforator of descending branch of lateral circumflex femoral artery.Of them there were 8 males and 4 females,aged from 22 to 51 years.The left side was involved in 3 cases and right side 9 cases.Defects were caused by traffic accident injury in 5 cases,crash injury of heavy object in 7 cases.There were mere skin and soft tissue in 2 cases,combined with bone fractures,nerves,vessels and muscles injury in 10 cases.The area of defects ranged from 9.0 cm×5.0 cm to 22.0 cm×9.0 cm.During operation,anterolateral thigh propeller flaps ranging from 11.0 cm×7.0 cm to 24.0 cm×1 1.0 cm were used to repair the wounds.Results All flaps and skingrafts survived after operation and the wounds obtained primary healing.After 8-24 months follow-up,all flaps were characterized by soft texture,good color,and satisfactory appearance.According to the Britain's Medical Research Council at 8 months after operation,the sensation of the flaps were recovered to S2 ～ S3+,No obvious scar contracture and chromatosis were observed at donor site.Conclusion Anterolateral thigh propeller flaps pedicled with artery descending branch of lateral circumflex femoral perforator is an ideal choice for the reconstruction for inguinal skin and soft tissue defects.