Objective To investigate the association between intima-media thickness (IMT) and free fatty acids (FFA) in hypertensive patients with metabolic syndrome (MS). Methods IMT, FFA and body mass index (BMI) were measured in 69 hypertensive patients with metabolic syndrome (MS group) ,57 hypertensive patients without metabolic syndrome ( Non-MS group) ,and 50 healthy controls ( NC group). Results In the MS group,The BMI, serum levels of triglyceride (TG), fasting blood glucose (FPG) and FFA were ( 26.0 ± 2.1 ) kg/m2, (24.0 ±0.81 ) mmol/L and (5.64 ± 0.82) mmol/L respectively, which were significantly higher than those in the Non-MS group ( (24.9 ± 2.3 ) kg/m2, ( 1.93 ± 0. 55 ) mmol/L and ( 5.10 ± 1.08 ) mmol/L respectively ) and the NC group ( (23.6 ± 1.6), ( 1.49 ± 0.36) mmol/L and (4.70 ± 0.90) mmol/L respectively) ( F = 20.06, 30.96 and 15.17,P ＜0.05 or 0.01 ). FFA in the MS group ((562.11 ± 55.12)μmol/L) were significantly higher than that in the Non-MS group (402.65 ± 49.53 ) μmol/L) and the NC group ( ( 356.23 ± 45.93 ) μmol/L) ( F = 277.28, P ＜0. 01 ). IMT in the MS group, Non-MS group and NC group were (1. 10 ± 0. 13 )mm, (0. 82 ± 0. 12 )mm and (0.70 ± 0.11 ) mm, respectively, with significantly difference ( P ＜ 0. 01 ). In addition, the incidence of thickening was 28.99% (20/69), 17.54% ( 10/57 ) and 2.00% ( 1/50 ), respectively, with significantly difference ( P ＜0.01 ). Conclusions Serum level of FFA is associated with IMT in hypertensive patients with metabolic syndrome.

Objective: To summarize our experience on laparoscopic radical prostatectomy via single incision in treatment of early localized prostate cancer. Methods: From June 2009 to August 2009, five patients with localized prostate cancer(T1c) received laparoscopic radical prostatectomy via single incision. A home-made multichannel port was inserted extraperitoneally through a 3 cm incision under the umbilicus. A 10 mm TROCAR and two 5 mm TROCAR were inserted. The prostate was isolated and excised, then the bladder urethral anastomosis was performed. Results The procedures were successful in all the five cases with no transversion to open or standard laparoscopic approach. The mean operating time, the mean operative time for prostate excision, and the mean time for urethrovesical anastomosis were (167±31. 5) min(ranging 135-210 min), (115±26) min (ranging 90-150 min), and (52±5. 7) min(ranging 45-60 min), respectively. The estimated blood loss averaged (90±62) ml (ranging 50-200 ml). Positive margin occurred in one case. Transient incontinence occurred in two cases after the catheter was removed one week later. All patients had a prostate-special antigen level < 0. 2 μg/L during a follow-up of 4-12 weeks. Conclusion: Laparoscopic radical prostatectomy via single incision is feasible and safety. Excellent instruments and skilled surgeon are the keys for the success of the operation.

OBJECTIVE： To evaluate the economic effectiveness of different pharmacotherapeutic schemes for the same disease.METHODS： Using pharmacoeconomical cost-effectiveness analysis， six schemes for upper urinary tract infections were compared.RESULTS： The total effective rate and cost were both the lowest in group B(70.00％ ).The cost-effectiveness ratios of A， B， C， D， E， F were 28.60、 19.13、 43.27、 29.99、 43.02、 29.14， respectively.They became 23.65、 18.01、 34.00、 24.87、 33.91、 24.20 by sensitivity.CONCLUSION： The A and F were both the most inexpensive and effective schemes.

Objective To explore the expressions of ER,PR and CerbB-2 in human papillary thyroid carcinoma,and their correlation with the clinical features.Methods The expressions of ER,PR and CerbB-2 were detected by immunohistochemistry in 89 papillary thyroid carcinoma samples and 13 nodular goiter samples.Results In papillary thyroid carcinoma samples,ER,PR and CerbB-2 were detected for 50.56 ％(45/89),43.82 ％ (39/89),24.72 ％ (22/89),respectively.In nodular goiter,ER,PR and CerbB-2 were detected for 15.38 ％ (2/13),7.69 ％ (1/13),0,respectively,there were significant differences between the two groups (x2 =5.649,P=0.017,x2 =6.211,P=0.013,x2 =4.097,P=0.043).The positive rates of PR were 56.26 ％(26/46) in without lymph node metastasis,compared with those lymph node metastasis 30.2 3％ (13/43) were significantly higher,the difference was statistically significant (x2 =6.239,P =0.012).Conclusion The expressions of ER,PR and CerbB-2 are significant higher in papillary thyroid carcinoma.The detection of ER,PR and CerbB-2 might be helpful for early diagnosis and prognosis of papillary thyroid carcinoma.

AbstractBACKGROUND: Fas and P53 are important regulator and control gene which can promote apoptosis. They belong to the receptor family part of tumor necrotic factor/nerve growth factor. Their expression products have effects on apoptosis signal transmission, and can regulate and control cell apoptosis in cerebral ischemia-reperfusion injury. And puerarin can alleviate the level of cell apoptosis.OBJECTIVE: To observe the effect of puerarin on Fas and P53, the apoptosis-related gene of nerve cell in hippocampns CA1 region of rats af ter cerebral resuscitation.DESIGN: Randomized controlled trial. SETTING: Department of Emergency, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. MATERIALS: The experiment was carried out at Emergency Department, Tongji Hospital, Tongji Medical College, Huazhong University ofScience and Technology from September 2001 to Februray 2002. Totally 45 of 3 months old Wistar rats of clean grade were selected, and randomly divided into 3 groups: sham operation group, model control group and puerarin treatment group with 15 rats in each group.METHODS: Acute global brain ischemia-reperfusion models were established in rats of puerarin treatment group and model control group. In rats of sham operation group, stigmata of both flanks of the first cervical vertebrae were isolated, but bilateral vertebral arteries were not electric coagulated, and biolateral common carotid arteries were only isolatedwithout clamping close. Rats in puerarin treatment group were given puerarin injection 100 mg/kg, 1 hour before ischemia, and model control group were given normal saline in equivalence while rats in sham operation group were not given medicine. Death of rats in each group was performed separately in the 3rd, 6th, 12th, 24th and 48th hours after cerebral ischemia-reperfusion with 3 rats per group in each time. Hippocampus tissues of rats were isolated, and tissue slices were preparated. And the changes of- the protein expression levels and the number of apoptosis cells of rats in each group at different time point after cerebral ischemia-reperfusion were detected in immuno-histochemical method and end labelling in situ method. MAIN OUTCOME MEASURES: ① The number of positive cells inprotein expression of Fas and P53 in hippocampus CA1 region of rats in each group at different time point after cerebral ischemia-reperfusion was studied. ② Comparison of the number of apoptosis cells in hippocampus CA1 region of rats between groups at different time point after cerebral ischemia-reperfusion were studied, too.RESULTS: All the 45 rats enrolled in research were entered the stage of result analysis: ① The number of positive cells in protein expression of Fas in hippocampus CA1 region of rats in each group at different time point after cerebral ischemia-reperfusion: Obvious gene expression of Fas was not found in sham operation group. In contrast with model control group, obvious decrease was found at all time points after cerebral ischemi a-reperfusion in puerarin treatment group, and in the 6th, 12th, 24th and 48th hour the differences were significant [(15.0±4.3), (13.5±4.9); (40.7±3.4), (27.2±3.1); (37.0±4.8), (22.0±2.1); (24.7±4.1), (18.9±5.3)/mm; P < 0.05,P < 0.01]. ② The number of positive cells in protein expression of P53 in hippocanpus CA1 region of rats in each group at different time point after cerebral ischemia-reperfusion: Obvious gene expression of P53 was not found in sham operation group. In contrast with model control group, obvious decrease was found in the 24th and 48th hour after cerebral ischemiareperfusion in puerarin treatment group [(25.3±4.4), (12.8±2.7); (24.3±3.6), (10.9±3.0)/mm; P < 0.01]. ③ Comparison of the number of apoptosis cells in hippocampus CA1 region of rats between groups at different time point after cerebral ischemia-reperfusion :In contrast with model control group,obvious decrease was found in the 12th, 24th and 48th hour after cerebral is chemia-reperfusion in puerarin treatment group [(34.0±3.7), (21.0±3.7); (41.0±4.2), (33.0±4.8); (71.0±5.5), (41.0±3.4)/mm; P < 0.01].CONCLUSION: In rats which were given puerarin treatment, the expression of Fas decrease obviously in 6 to 48 hours after cerebral ischemiareperfusion, and the expression of P53 decreased obviously in the 24th to 48th hour after cerebral ischemia-reperfusion, and a descent tendency could be found in the number of apoptosis cells. These can further prove the cerebral protective effect of puerarin, and indicate that the inhibition of puerarin to cell apotosis after cerebral resuscitation is related to its effect on the decrease in protein expression of apoptosis-promoting gene, Fas and P53.Puerarin has a protective effect on cerebral ischemia-reperfusion injury of rats. In comparison with model control group, the expression of Fas in puerarin treatment group has an obvious decrease inthe 6th to 48th hour after cerebral ischemia-reperfusion, the expression of P53 has an obvious decrease in the 24th to 48th hour after cerebral ischemia-reperfusion, and the number of apoptosis cells decrease obviously, too, which further improves the cerebral protective effect of puerarin and indicates that the inhibition of puerarin to cell apoptosis after cerebral resuscitation is related to its effect on the decrease in protein expression of apoptosis-promoting gene Fas and P53.

Objective To detect the expressions of nerve growth factor (NGF) and its receptors tyrosine kinase A (TrkA) as well as p75 neurotrophin receptor (p75NTR) in the lesions of lichen planus.Methods Biopsy specimens were collected from the lesions of 32 patients with lichen planus and normal skin of 12 healthy human controls and subjected to paraffin embedding.Immunohistochemical avidin-biotin complex (ABC) method was used to detect the expressions of NGF,TrkA and p75NTR.Results NGF and TrkA,which were located in the cytoplasm of keratinocytes,were strongly or moderately expressed in the lesional skin specimens,but absent or weakly expressed in the normal skin specimens (both P ＜ 0.01).No significant differences were observed in the expression of p75NTR between the lesional and normal skin specimens,or in the expressions of NGF,TrkA or p75NTR among specimens from patients in different age groups,patients of different gender or lesions at different sites (all P ＞ 0.05).There was a positive correlation between the expression of NGF and TrkA in the lesions of lichen planus (R2 =0.535,P ＜ 0.01).Conclusion NGF may play a certain role in the development of lichen planus via its highaffinity receptor TrkA.

Objectives To investigate clinic outcome of ticagrelor in treatment of patients with acute ST-segment elevation my ocardial infarction receiving primary percutaneous coronary intervention.Methods Sixty-two consecutive patients with ST segment elevation myocardial infarction (STEMI) receiving primary percutaneous coronary intervention (PCI) were included in this study.The clinic characteristics,thrombolysis in myocardial infarction (TIMI) refuse after PCI,clinical outcomes after 30 d of patients were compared between patients who were treated with ticagrelor (group A 30 cases) and clopidogrel (group B 32 cases).Results There was no difference in the age,proportion of women,hypertension,and diabetics (P ＞ 0.05).TIMI 3 refuse after PCI were significantly higher in group A than group B (96.7％ vs 87.5％,P ＜ 0.05).The 30 d re-angina pectoris was lower in group A than group B (3.3％ vs 12.5％,P ＜0.05).However,tiny bleeding of group A was higher than group B (13.3％ vs 3.1％,P ＜0.05).Conclusions Ticagrelortreatment can improve the prognosis of STEMI receiving primary PCI,but increase the risk of bleeding.

Objective To summarize our experience in surgical treatment of cervical intramedullary spinal cord tumors and to identify the prognostic factors associated with postoperative-neurological status. Methods The clinical data of 65 consecutive patients with cervical intramedullary spinal cord tumors undergoing operation between Jan. 2009 and Dec. 2013 were retrospectively reviewed. McCormick Scale was applied to evaluate the preoperative and postoperative neurological functions. Multivariate logistic regression analysis was used to determine the independent prognostic factors of postoperative neurological status. Results Laminectomy was performed in 61 patients and unilateral multilevel interlaminar fenestration (UMIF) was applied in 4 patients. Of all the 65 patients, 48 received total resection, 4 received subtotal resection and 13 received partial resection. The follow-up time was from 4 months to15 years. The median follow-up time was 68 months. The clinical symptoms were relieved in 42 patients after operation, maintained unchanged in 14 and aggravated in 9. The pain remission rate of the patients was the highest (82. 4%), followed by the sphincter dysfunction remission rate (68. 8%), and the sensory disturbance remission rate of the patients was the lowest (39. 6%). Based on McCormick Scale, the postoperative neurological functions was improved in 18 patients (27. 7%) and maintained unchanged in 39 (60%) , while eight patients (12. 3%) developed neurological deterioration. Multivariate logistic regression analysis revealed that good preoperative neurological function (OR=19. 87, 95% CI; 4. 10-96. 23, 7 = 0. 000)and total resection (OR=7. 40, 95% CI; 1. 34-40. 95, 7 = 0. 022) were the independent protective factors for postoperative neurological status. Conclusion Microsurgical resection is the first-line treatment for cervical intramedullary spinal cord tumors , which can achieve a satisfying outcome in most cases. Preoperative neurological status and surgical extent are significantly associated with the postoperative functional outcome of patients.

Objective To establish a long-term survival prediction model for hepatocellular carcinoma (HCC) patients after liver transplantation based on up-to-seven (Up7) criteria, and to validate the prediction model in different liver transplantation criteria, so as to assist clinical decision-making for the treatment of HCC. Methods We retrospectively analyzed the clinical and follow-up data of 251 HCC patients who underwent liver transplantation with Up7 criteria. Stepwise regression method was used to conduct multivariate Cox regression analysis to obtain the independent predictors of long-term survival after HCC liver transplantation, and to establish the survival Cox regression prediction model. R 3.4.3 software was used to score the prediction model, and the decision tree technique was used to determine the cut-off value. The Kaplan-Meier survival curve of the HCC patients after liver transplantation was drawn to validate the prediction model in different criteria (Shanghai Fudan criteria, University of California, San Francisco [UCSF] criteria and Italy Milancriteria), and the difference between groups was analyzed by log-rank test. The receiver operating characteristic (ROC) curve was used to test the predictive effectiveness of the model. Results Multivariate Cox regression analysis suggested that α-fetoprotein (AFP), total bilirubin (T-Bil), microvascular invasion (MVI) and tumor maximal diameter (Diameter) were the independent predictors of long-term survival of HCC liver transplant recipients after liver transplantion. We built the ATMD (AFP, T-Bil, MVI, Diameter) model using these factors: h (t, x)=h0 (t) exp (0.284×Diameter [cm]+0.773×MVI [yes=1; no=0]+0.404×lg AFP [ng/mL]+0.003×T-Bil [μmol/L]). The cut-off value of ATMD model was 1.44. The scores being more than 1.44 were defined as the high-risk group, and scores being 1.44 or less were defined as the low-risk group. The cases in the high-risk and low-risk groups who met the Up7 criteria, Shanghai Fudan criteria, UCSF criteria and Italy Milan criteria had 87 and 164, 33 and 144, 29 and 134, and 29 and 131, respectively. Kaplan-Meier survival analysis showed that the cumulative survival rates of the liver transplantation recipients with Up7 criteria, Shanghai Fudan criteria, UCSF criteria or Milan criteria were significantly different between the high-and low-risk groups (P<0.001, P=0.008, P<0.001, P=0.001). The areas under the ROC curve of the three-year survival of the liver transplantation recipients predicted by ATMD model were 76.63%, 75.87%, 73.32% and 69.41%, respectively. Conclusion The ATMD model has a good survival prediction ability for the HCC patients meeting Up7 criteria, Shanghai Fudan criteria, UCSF criteria or Milan criteria. It is of great significance for preoperative decision-making and postoperative risk assessment of HCC liver transplantation recipients meeting the above criteria.

Objective To study whether plasma amino acid metabolites in patients with gastric cancer can be used as biomarkers for the diagnosis of gastric cancer. Methods The levels of 24 kinds of plasma amino acids were detected by ultra-high-performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS), and were compared between patients with gastric cancer and normal controls, between patients with different stages of gastric cancer, and between gastric cancer patients before and after operation. Results The levels of 18 kinds of plasma amino acids including alanine (Ala), glycine (Gly) and glutamic acid (Glu) in gastric cancer patients were significantly lower than those in the normal controls, while the levels of valine (Val), arginine (Arg) and serine (Ser) were significantly higher than those in the normal controls (all P0.05); there were no significant differences in symmetric dimethylarginine (SDMA), kynurenine (Kyn) or hippuric acid (HA) levels between the two groups (P0.05). The plasma level of Arg in patients with III-stage of gastric cancer was significantly higher than that in the-Ⅱstage, while the plasma glutamine (Gln), Glu, methionine (Met) and phenylalanine (Phe) levels were significantly lower than those in the-Ⅱstage (all P0.05). The levels of plasma leucine (Leu), Arg and citrulline (Cit) in patients after operation were significantly lower than those before operation, while the plasma Gln, lysine (Lys), Glu and Phe levels were significantly higher than those before operation (all P0.05). Conclusion Amino acids metabolites in plasma of patients with gastric cancer such as Gln and Arg play important roles in the early prediction of gastric cancer.