Nowadays,one of the most challenging aspects of retinoblastoma (RB) therapy is how to control the resistant or recurrent viable vitreous seeds,for which intravenous chemotherapy appears to be ineffective.Recently,intravitreal chemotherapy offers another option to control advanced stage and vitreous seeds of RB,and may be a promising new approach to RB therapy.However,intravitreal injection for RB patients raises considerable controversy due to concerns of possible extraocular extension along the injection route,and should not replace the primary standard of care for bilateral RB or group E eyes of RB.Close follow-up and further studies are needed to determine appropriate indications,to determine the effective drugs and concentrations,to optimize RB therapy protocols and to investigate the relationship between long-term efficacy and toxicities.

Objective The aim of this study was to explore the association of tumor necrosis factor-α (TNF-α)promoter-308A/G polymorphism with rheumatoid arthritis(RA)susceptibility in East Asian population based on the meta-analysis. Methods We searched all the publications about the association between TNF-α promoter -308A/G polymorphism and RA in East Asian population from PubMed, Ebsco, Chinese Biomedical Literature Database(CBM), Chinese National Knowledge Infrastructure(CNKI), and Wanfang (Chinese). Meta-analysis was performed for genotypes AA versus GG, GA versus GG, AA versus GG+GA,GA+AA versus GG, and A allele versus G allele in a fixed/random effect model. Results A total of 4 studies (957 cases and 1196 controls)were included in the current meta-analysis(three Chinese and one Japanese studies). When all groups were pooled, significant association of A allele and decreased RA risk was found (OR=0.36, 95%CI=0.16～0.80, P=0.01). When analyses were limited to race homogeneous population,significant association of A allele and decreased RA risk was found in Chinese population(OR=0.40, 95%CI=0.16～1.01, P=0.05). Conclusion This meta-analysis demonstrates significant negative association between TNF-α promoter-308A/G polymorphism and RA in East Asian and Chinese population.

Objective To explore the relationship between preoperative serum pro-adrenomedullin (pro-ADM) in the patients with closed rupture of small intestine,and postoperative secondary abdominal infection,and to study the value of postoperative serum pro-ADM in assessment of severity of postoperative secondary abdominal infection of this patients.Methods Eighty-five patients with closed rupture of small intestine treated in the emergency surgery from June 2014 to May 2015 were selected.According to the presence of postoperative abdominal infection or not,these patients were divided into infection group and non-infection group.The infection group was further divided into SIRS,sepsis,severe sepsis,septic shock subgroups as per the severity of infection.The levels of serum pro-ADM,interleukin-6 (IL-6),C-reactive protein (CRP) were determined and the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was calculated at admission and the first day、the second day and the third day after operation.Comparisons of these biomarkers were carried out to find out the factors associated with postoperative abdominal infection.In addition,ROC curve was used to verify the factors for predicting the abdominal infection of these patients after operation.The relationship between serum levels of pro-ADM and APACHE Ⅱ score after operation was analyzed.The severity of abdominal infection after operation was assessed with laboratory findings.Results Compared with non-infection group,preoperative and postoperative serum pro-ADM (P =0.03,P ＜ 0.01),IL-6 (P =0.02,P ＜0.01) levels and APACHE Ⅱ scores (P ＜ 0.01,P ＜ 0.01) were significantly higher in infection group (P ＜ 0.05).In the infection groups,the postoperative levels of serum pro-ADM and APACHE Ⅱ scores were increased with the severity of infection increased (r =0.924),and the difference between the groups was statistically significant (P ＜ 0.05),but there were no significant differences in IL-6 and CRP levels between two groups.Conclusion (1) The serum levels of pro-ADM before operation has value in predicting the genesis of abdominal infection in these patients after operation.(2) The serum levels of pro-ADM after operation has value in severity assessment of abdominal infection in these patients after operation.

Objective:To explore the relationship between tobacco smoking and liver cancer risk.Methods:Cohort studies of cigarette smoking and risk of liver cancer were identified by searching MEDLINE and CBM databases from January 1989 to September 2009. Results from individual studies were combined synthetically by Meta analysis using R software and Meta package. Results:A total of 19 articles were included in our analysis. The cohort totally included 3 023 558 followed-up persons and 9 525 cases of liver cancer patients. The pooled relative risk (RR) of liver cancer was 1.49 (95%CI: 1.17-1.92) for smokers compared with non-smokers. The results showed a statistically moderate association between tobacco smoking and the risk of liver cancer. Subgroup analysis indicated that the pooled RRs for smoking were 1.53(95%CI : 1.29-1.83)for male smokers and 1.70(95%CI :1.17-2.48)for female smokers, respectively.Conclusion:Tobacco smoking is a risk factor for liver cancer in both males and females.

Objective To analyze the stress state of magnetic attachment in mandibular complete overdenture supported by nature roots and implant, and to provide neference for designing of clinical prosthodentics. Methods Three-dimensional finite models (model,Ⅱ,Ⅲ)of three groups of mandibular overdentures depending on the different location of the implant and natural tooth root, placing three pairs of magnetic attachment, were constructed by application of CT scanning,computer photo processing system,and Solidworks finite element model building software.The natural teeth and implant neck bone stress of the models in three groups under different stress were calculated and compared.Results The stress of the bone around the implant in the area of molar teeth in model with both sides of the implants under oblique load (Model Ⅱ)was significantly increased compared with the model with one side of the implant (Model Ⅲ). The supporting bone stress of oblique load was increased compared with the vertical load;among them under the oblique load at one side’ s molar teeth, the stress of the bone around the implant in the area of molar teeth in modelⅠ,modelⅡ and model Ⅲ was increased about 30%, 43%,and 55%.Conclusion When there only one nature teeth remain,two implants should be at least added, one in the area of opposite cuspid, and the other in the area of molar teeth of the same side. The magnetic attachment is better than other kinds of attachment in preventing the damage of abutment when it suffers inclined load.

To better understand the drugs, frequency and other factors involved in the drug-induced renal failure, 227 cases of renal failure reported in the Chinese medical and pharmaceutical journals were statistically analyzed. Our results showed that the drugs that tend to cause renal failure are antibiotics, involving 80 cases, followed by antituberculosis agents(38 eases)and dehydration agents. Gentamycin (47 cases) and rifrimactane(36 cases) were among the drugs with highest incidence. There were 58 cases of death due to drug-related renal failure.

Objective To analyze and summarize the clinical-pathological features,immunophenotype and prognosis of the lymphoepithelioma-like gastric carcinoma (LELGC).Methods The clinical,radiographic and histological data of four patients with LELGC were retrospectively analyzed.The expression of cytokeratin (CK),CD20,CD3,CD4,CD8,E-cadherin,β-catenin,bcl-2,p16,p53,p63,c-erbB-2,cyclin D1,Ki67 and DNA methyl-transferase 1 (DNMT1) in tumor was detected by Epstein-Barr virus-encoded small RNA (EBER) in situ hybridization and immunohistochemical methods.Results The size of four tumor was 1.8 cm× 1.6 cm,1.5 cm× 2.0 cm,2.5 cm× 2.0 cm and 4.0 cm× 2.5 cm.Under light microscope,tumor cells appeared like cords,small lumps or scattered single infiltration with vacuolized nucleus; clear nucleoli and obvious interstitial lymphocytic infiltration.The results of immunohistochemical examination indicated that in four tumors CK was positive in membrane of all the tumor cells,while EBER was positive in all cell nucleus.The number of lymphocytes with CD3 positive was over those with CD20 positive,which was mainly CD8 positive lymphocytes.The percentage of E cadherin and β-catenin positive in the cell membrane of four tumors was between 10 ％ and 90 ％,and two cases with β-catenin positive in cytoplasm.The expressions of DNMT1,cyclin D1 and bcl-2 were all positive,while p16 and c-erbB-2 were all negative.The expression of p63 was positive in only one case,and p53 was negative in one case.The percentage of Ki67 positive was 40％,15％,60％ and 40％,respectively.Conclusions LELGC is a rare neoplasm with better prognosis.The features of clinical pathology and immunohistology may help to make a correct diagnosis.

Objective To evaluate dexmedetomidine-induced cardioprotection in a mouse model of lung ischemia-reperfusion (I/R) and the relationship with endoplasmic reticulum stress.Methods Forty healthy SPF male C57BL/6J mice,weighing 20-24 g,aged 8-10 weeks,were divided into 4 groups (n=10 each) using a random number table:sham operation group (Sham group),lung I/R group (I/R group),dexmedetomidine group (Dex group) and dexmedetomidine plus atipamezole (specific α2-adrenergic receptor antagonist) group (DA group).The model of lung I/R injury was established by clamping the left hilum of lung for 30 min followed by 180 min of reperfusion.In group Sham,only sternotomy was performed,the hilum of lung was not clamped,and the mice were mechanically ventilated for 210 min.In Dex and DA groups,dexmedetomidine 20 μg/kg and dexmedetomidine 20 μg/kg plus atipamezole 250 μg/kg were injected intraperitoneally,respectively,at 30 min before establishment of the model.At 180 min of reperfusion,blood samples were collected from the orbit for determination of creatine kinase-MB (CK-MB) and lactic dehydrogenase (LDH) activities in serum.The animals were then sacrificed,and hearts were removed for determination of apoptosis in cardiomyocytes (by TUNEL) and expression of phosphorylated c-Jun N-terminal kinase (p-JNK),caspase-12,CCAAT/enhancer-binding protein homologous protein (CHOP) and glucose-regulated protein 78 (GRP78) in myocardial tissues (by Western blot),and expression of JNK,caspase-12,CHOP,GRP78 mRNA in myocardial tissues (by real-time polymerase chain reaction).Apoptosis index was calculated.Results Compared with Sham group,the serum CKMB and LDH activities and apoptosis index were significantly increased,the expression of p-JNK,JNK mRNA,and caspase-12,CHOP and GRP78 protein and mRNA was up-regulated in I/R,Dex and DA groups (P＜0.01).Compared with I/R group,the serum CK-MB and LDH activities and apoptosis index were significantly decreased,the expression of p-JNK,JNK mRNA,and caspase-12 and CHOP protein and mRNA was down-regulated,the expression of GRP78 protein and mRNA was up-regulated in group Dex,and the expression of GRP78 protein and mRNA was significantly up-regulated (P＜0.01),and no significant change was found in the other parameters in group DA (P＞0.05).Compared with DEX group,the serum CK-MB and LDH activities and apoptosis index were significantly increased,the expression of pJNK,JNK mRNA,and caspase-12 and CHOP protein and mRNA was up-regulated (P＜0.01),and no significant change was found in the expression of GRP78 protein and mRNA in DA group (P＞0.05).Conclusion Dexmedetomidine can reduce myocardial injury induced by lung I/R,and the mechanism may be related to activation of α2-adrenergic receptors and inhibition of endoplasmic reticulum stress in myocardial cells of mice.

AIM: To set the model of rat bone marrow me se nchymal stem cells (BMMSCs) that differentiate into cardiomyocytes and observe t he connection structure between cells. METHODS: BMMSCs were isolated by adhering to culture plates and cultured in vitro to expand. Induction of BMMSCs to differentiate into cardi omyo cytes was conducted by treating the cells with 5-aza. Immunocytochemical stainin g was used to identify sarcomeric actin and intercalated disc-like structure wh en the cells were cultured for additional 1 week, 2 or 3 weeks, respectively. RESULTS: Sarcomeric actin positive cells were observed in 1 week , 2 or 3 weeks after 5-aza treatment. Some cells stained positive for connexin4 3 at 1 week and 2 weeks after 5-aza treatment, with brown pellet located disper sively around nucleus. 3 weeks after 5-aza treatment, connexin43 positive cells s howed brown pellet arranging in thready structure around nucleus, such structure could be seen between very few cells which was similar to intercalated disc-lik e structure in normal heart tissue. CONCLUSION: During the process of BMMSCs differentiating into ca rdiomyocytes, intercalated disc-like structure is gradually formed with increas e in culture time and cell density.

A total of 180 community medical staff in Jiangning District of Nanjing received continuous education in practical emergency medicine through theory teaching,practice and scene simulation once a year from 2011 to 2013.And the training outcomes were evaluated before and after training and the feedbacks of community medical staff collected each time.The assessment results of theory and practical skills after training in 2013 were better than before training in 2011 [theory:(61.72 ± 5.03) vs.(92.11 ± 5.56) points ; operation skills (55.28 ± 6.18) vs.(93.33 ± 3.45) points] (P ＜ 0.05).And the total satisfaction rate was 98.0％.