Objective To evaluate the effects of small dose of dopamine on the renal blood flow in the elderly patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB).Methods Sixty elderly patients,of ASA physical status Ⅱ or Ⅲ,aged 65-74 yr,weighing 52-77 kg,scheduled for elective cardiac valve replacement under CPB,were randomized to receive either normal saline (group C,n =30) or dopamine (group D,n =30).After beginning of surgery,CPB was established routinely.In group D,dopamine was continuously infused for 20 min at a rate of 2 μg· kg-1 · min-1 starting from 10 min after the hearts were perfused with cardioplegic solution for the first time,while the equal volume of normal saline was given in group C.The left renal blood flow velocity was measured by transesophageal echocardiography and mean arterial pressure was recorded before and after dopamine infusion.Blood samples were obtained before surgery and at 24 h after surgery for determination of blood urea nitrogen concentrations.Results Blood urea nitrogen concentrations were significantly increased at 24 h after surgery than that before surgery in the two groups.There was no significant difference in mean arterial pressure and the left renal blood flow velocity before and after dopamine infusion between the two groups.Conclusion Small dose of dopamine (2 μg· kg-1· min-1) dose not increase the renal blood flow or improve the postoperative renal function in the elderly patients undergoing cardiac valve replacement under CPB.

Objective To explore the characteristics of occult damage of cerebral white matter in patients with small vessel disease by using diffusion tensor imaging (DTI)technology,and its relationship with cognitive impairment.Methods Twenty-eight patients with CSVD and twenty-three matched volunteers all received T1 WI,T2 WI,DTI examination and montperllier cognitive function scale (MoCA).Then compare the difference between the two groups,and analysis the correlation between ADC and FA value of each re-gion of interested and MoCA score in CSVD group.Results ①FA values on bilateral frontal white matter in CSVD group were lower than control group,and ADC values were higher than control group,the difference was statistically significant (P <0.05 ).There were no significant differences in FA and ADC values on corpus callosum genu and splenium between two groups (P >0.05 );②In CSVD group,the FA value of bilateral frontal lobe white matter were positively correlated with the MoCA score (P <0.05 ),and the ADC value were negatively correlated with the MoCA score (P <0.05 ).there were no significantly correlations between FA and ADC values on corpus callosum genu and splenium and MoCA score (P >0.05 ).Conclusion Bilateral frontal white matter exist fi-ber occult damage in patients with CSVD,and the change of FA and ADC value can reflect the severity of cognitive impairment on a certain degree in patients with CSVD.

To investigate the expression and significance of the ? glucuronidase(? G) gene in the patients with primary hepatocellular carcinoma(HCL), ? G gene was detected in the carcinoma tissue of 54 cases of HCL, 51 cases of cirrhosis tissue of HCL and 10 normal liver tissue by immuno fluorescence, immunohistochemistry and in situ hybridization respectively. The results showed that the expression level of ? G gene in HCL was much higher than that in the normal tissue and the expression level of ? G gene in peri carcinoma tissue was much higher than that in the carcinoma tissue. The data also showed that the expression level of ? G gene was highly correlated with metastasis and differentiation, but not related to tumor size, pathologic type, AFP and serum HBsAg level. It suggested that ? G gene could be used as a predictor for diagnosis and metastasis of hepatocellular carcinoma.

Objective To investigate the reflectance confocal microscopy (RCM) features of mycosis fungoides (MF).Methods Four male and two female patients with MF,who were aged 7-73 years with a clinical course of 1-5 years,were collected from June 2011 to May 2012 in the department of dermatology.Of the six patients,two were in patch stage,three in plaque stage,and one in tumor stage.All the cases were confirmed by histopathological,immunohistochemical and relevant examinations.For each patient,three lesions were selected and investigated using RCM,and one of the three lesions was subjected to histopathological examination.Results RCM features of MF included hyperkeratosis,disarray of honeycomb of stratum spinosum,reduced refractivity of dermal papillary rings,roundish or round scattered hyperrefractive cells in the epidermis,infiltration of a small quantity of inflammatory cells in the papillary dermis.Occasionally,some round to oval hyporefractive cells aggregated to form vesicle-like structures.These RCM features correlated well with histopathologic findings.Conclusion Combined with clinical manifestations,RCM may serve as a noninvasive auxiliary tool for the diagnosis of MF.

Objective To investigate the effect of xuezhikang on heart in patients with hypertension. Meth-ods 60 systemic hypertension (HT) patients with normal cholesterol were randomized into placebo group and Xu-ezhikang group (1200 mg/d) for 72 weeks. Extended-released nifedipine were administrated by HT patients. Plasma was obtained at baseline, after 24 weeks and 72 weeks of Xuezhikang therapy. Em/Am ratio at atrioventricular ring , E/A ratio at mitral orifice, IVSTd, LVIDd, LVPWTd were measured by echocardiography. Type Ⅰ collagen car-boxypropeptide (PIP) was determined. Results After 72 weeks treatment, the differences of LVWT, IVSTd, LVP-WTd and LVIDd between Xuezhikang group and the control group were not significant; E/A,Em/Am ratios at atrio-ventricoiar ring were significantly increased except that Em/Am at right atrioventricular ring with right ventricular lateral wall(P <0.01 ,P <0.05). After 24 weeks treatment the levels of plasma PIP were significantly decreased in Xuezhikang group compared with the placebo group (P < 0.01, P < 0.05). Conclusion Xuezhikang exerts cooper-ativity in improving those parameters related to myocardial fibrosis so to protect heart function of hypertension pa-tients.

Aim: To study the therapeutic effects of ZK_(14), a novel nitric oxide donor, on hepatic fibrosis in rats. Methods: Rats were injected intraperitoneally with CCl_4 and induced to hepatic fibrosis, followed by intra-gasrtic administration with high dose of 20 mg/kg and low dose of 10 mg/kg of ZK_(14) for 4 weeks. The effects were evaluated in the content of nitric oxide of serum and nitric oxide synthases of liver, in serum levels of the hepatic functions indices and hepatic fibrotic index and in liver histopathology. Results: The biochemical indices and pathology grade were effectively improved in the group of ZK_(14) 20 mg/kg, and liver function was also effectively protected in this group. Conclusion: ZK_(14), a novel nitric oxide donating biphenyldicarboxylate derivative, showed preferable therapeutic effects on hepatic fibrosis of rats induced with CC14, and it may be of potential value in the treatment of hepatic fibrosis.

Aiming at status of training the rural order directed free medical educational talents, we should improve the understanding of training the free medical students, perfect the relevant management system, strengthen medical ethics education of students, pay attention to humanistic care of students,strengthen the continuing education of students, standardize the access system of students, reform the medical distribution system, to ensure the quality of training free medical students.

Objective:To introduce the method of cylindrical abdominoperineal resection(APR)for low rectal cancer.Methods:Cylindrical APR was performed for 6 patients with advanced ultralow rectal cancer according to standard protocol in Stockholm from February to May in 2009.The procedure involved careful mobilization of the mesorectum as low as the origins of the levator muscle.After stoma formation,the abdomen was closed,the patient was rotated into the prone position,and an extended perineal dissection was performed.This included the sphinctercomplex and followed the inferior surface of the levators to a point laterally where they originated on the pelvic sidewall.This point should be just inferior to the level where the abdominal procedure was terminated.Results:The cylindrical technique removed more tissue in the distal rectum.There was no bowel perforation,perineal wounds were uneventfully.One patient developed perineal seroma.One patient developed peritoneocele hernia of pelvic floor.Conclusion:Cylin-drical APR performed in the prone position for low rectal cancer removes more tissue around the tumor that leads to a reduction in CRM involvement and intraoperative perforations,which should reduce local disease recurrence.

ObjectiveTo evaluate the diagnostic performance of bone SPECT and CT fusion imaging in bone metastases from pediatric neuroblastoma.MethodsTwenty-four pediatric patients with neuroblastoma were included in this retrospective study.All patients underwent planar imaging and SPECT integrated with CT.Lesion visibility,diagnostic certainty and diagnostic performance were evaluated with KolmogorovSmirnov test andx2 test.ResultsLesion visibility of SPECT alone,SPECT integrated with CT were significantly better than that of planar imaging ( both H =69.000,P ＜ 0.05 ).SPECT and CT fusion imaging,SPECT alone both detected five more bone lesions than planar bone imaging (77 vs 72).The diagnostic accuracy of SPECT imaging (62.34％,48/77 )was significantly higher than that of planar imaging (45.45％,35/77; x2 =4.416,P ＜ 0.05 ).The sensitivity,specificity and accuracy of SPECT and CT fusion imaging for diagnosing malignant bone lesions were significantly higher than those of planar imaging:82.35％ (42/51) vs 53.19％ ( 25/47),88.46％ ( 23/26 ) vs 40.00％ ( 10/25 ),84.42％ ( 65/77 ) vs 45.45％ (35/77 ; x2 =12.571,14.016,25.667,all P ＜ 0.01 ).The diagnostic specificity and accuracy of SPECT and CT fusion imaging were significantly higher than those of SPECT alone ( 53.85％,14/26 ;62.34％,48/77) (x2 =7.589,9.606,both P ＜0.01 ).However,there was no significant difference of sensitivity between the two methods (x2 =2.942,P ＞ 0.05 ).Diagnostic certainty by SPECT and CT fusion imaging was significantly higher than that by SPECT alone ( H =28.000,P ＜ 0.05 ) and by planar imaging (H =21.000,P ＜ 0.05).ConclusionSPECT and CT fusion imaging can detect more bone lesions in patients with pediatric neuroblastoma.It is helpful for diagnosing bone metastases from pediatric neuroblastoma.

Objective To analyze the regulation of NEF3 expression in SH - SY5Y after RA induction. Methods The expression of NEF3 and Brg1 genes was individually detected by realtime RT - PCR and Western blot analyses. Then, the CAT reporter driven by 5' flanking region ofNEF3 gene (pBLCAT3 -2. 8k - NEF3) was co - transfccted with eukaryotic expression plasmids of pBJ5 - Brgl or pBJ5 - Brg1 - NTP into SH - SY5Y respectively. Promoter activity of the NEF3 gene was detected by competitive RT - PCR assay. Results Similar changes in the mRNA expression of NEF3 and Brg1 and that of the protein expression of Brgl were detected in Sh - SY5Y cells af-ter RA treatment for 12 -24h. Wild type Brgl can promote the expression of pBLCAT3 -2.8k -NEF3 promoter after RA induction, but not mutant Brg1. Conclusion Brgl helpes regulating the expression of NEF3 gene possibly via changes in chromatin conformation in the SH -SY5Y cells after RA induction.