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.

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.

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％.

AIM: To explore the effects of glucocorticoids on fracture healing in a rat model of tibial fracture. METHODS: Sixty three months old female SD rats were divided into control and glucocorticoid-treated group. A glucocorticoid-induced osteoporosis model was established by intramuscular injection of prednisolone acetate (5 mg·kg~(-1)·d~(-1) for 3 weeks), in which the tibial was osteotomized by a wire saw as fracture healing model and internal fixed with a Kirschner pin. The rats were scarified at different time points after operation. The callus formation was monitored over a period of 6 weeks by histological method, bone mineral density (BMD) detection and biomechanical examination. Western blotting was used to measure the expression of type II collagen. RESULTS: A glucocorticoid-induced osteoporosis model was successfully established and conformed by BMD measurement. The formation of primary callus was observed in both groups 3 days after fracture. At 2 weeks after injury, the glucocorticoid-treated group had a lower BMD and less cartilage matrix as compared to control group. An increase in bone callus and chondrogenesis was observed at 4 to 6 weeks after fracture in glucocorticoid-treated group as compared to control group. The expression of type II collagen was delayed in glucocorticoid-treated group. Biomechanical measurement showed that the actual maximum load was increased by 35.8% in control group as compared to glucocorticoid-treated group at 6th week. CONCLUSION: These results indicate that chondrogenesis and transformation from cartilage callus to bony callus are delayed by glucocorticoids. The retardation of collagen Ⅱ production may be the reason for the inhibition of fracture healing.

Objective To compar the cerebrospinal fluid (CSF) flow between empty sella syndrome (ESS) and normal volunteer in the cerebral aqueduct with MRI in phase contrast cine mode. Methods Thirty-eight ESS patients (ESS group) and 38 normal volunteers (control group ) were involved in this study.The aqueduct CSF flow image was positioned perpendicularly to the midbrain aqueduct at the middle sagittal T1WI or T2WI image. The waveforms were analyzed for the flow direction, flow rate, flow volume rate and cardiac cycle. Results The CSF flow of the aqueduct in control group and ESS group had two directions which was downward flow during the systolic period and upward flow during the diastolic period of the cardiac cycle. The.systolic period downward peak flow rate, diastolic period upward peak flow rate, mean downward flow rate, mean upward flow rate and mean flow rate were (5.231 ± 0.262), (4.902 ± 0.281 ),(3.083 ± 0.191 ), (3.032 ± 0.151 ), (3.151 ± 0.162) cm/s in control group, and (6.244 ± 0.356), (6.091 ±0.430), (3.916 ± 0.196), (3.812 ± 0.273 ), (3.690 ± 0.291 ) cm/s in ESS group respectively,and there was no significant difference between the two groups ( P ＞ 0.05 ). The systolic period downward peak flow volume rate, diastolic period upward peak flow volume rate, mean downward flow volume rate,mean upward flow volume rate and mean flow volume rate were (0.050 ± 0.003 ), (0.050 ± 0.004), (0.030± 0.002), (0.031 ±0.002), (0.030 ± 0.003 ), ( 0.004 ± 0.001 )ml/s in control group, and (0.058 ± 0.003 ), (0.063 ± 0.005),(0.039 ±0.002), (0.038 ±0.003), (0.038 ±0.003), (0.004 ±0.001) ml/s in ESS group respectively,and there was no significant difference between the two groups(P ＞ 0.05 ). The correspond cardiac cycle of systolic period downward peak flow rate, correspond cardiac cycle of diastolic period upward peak flow rate, mean cardiac cycle were (40.890 ± 37.096), (501.026 ± 19.374), (719.511 ± 14.946) ms in control group,and (35.921 ±6.218), (531.553 ± 16.764), (770.700 ±21.579) ms in ESS group,and there was no significant difference between the two groups (P ＞ 0.05 ). Conclusion Part of CSF flows into the area of saddle in ESS patients, but it has no effect on CSF indexes in area of cerebral aqueduct.

Objective To explore the clinico-pathological features, immunophenotype, treatment and prognosis of urologic primary primitive neuroectodermal tumor (PNET). Methods The clinical data of 3 patients with urologic PNET were analyzed retrospectively. All patients were male, aged 29, 32 and 75 years respectively. Two of the lesions were located in the kidney, and the third was located in the bladder. The sizes of renal tumors were 7.7 cm×6.2 cm and 12.6 cm×9.4 cm respectively. Imaging examinations revealed a well-defined mass with inhomogeneous echo inside. The size of bladder tumor was 10.0 cm×10.0 cm. CT scan demonstrated irregular thickening of the bladder wall, and the density of the wall was inhomogeneous. In the 2 cases of renal PNET radical surgery was performed, while an emergency palliative surgery to remove a blood clot and biopsy were performed in the bladder PNET case. Results In light microscope, the tumors were characterized by uniform small round or oval cells and nest-like or dense sheet structures surrounded by sparse fibrovascular stroma. Homer-Wright rosettes or pseudorosettes were observed, as well as mitoses. Immunohistochemical study revealed that all cases showed positive staining for CD99, synaptophysin and vimentin. One of the renal tumor cells showed positive for CD56, and the other renal tumor and urocystic tumor cells were focally positive for chromogranin A. Additionally, in 1 of the cases of renal tumor there was a high positive rate of 80% for Ki67 staining while the other case showed less than 5%. All 3 cases were eventually diagnosed as PNET. The first renal tumor case was not treated with radiotherapy and chemotherapy postoperatively, and the patient died of recurrence 14 months after surgery. Both the second renal tumor case and the bladder tumor case underwent chemotherapy postoperatively, and they died 4 and 6 months after surgery respectively. Conclusions The urologic primary PNET is a very rare, highly malignant soft tissue tumor, and the diagnosis must be based on pathologic findings and immunohistochemical phenotypes. The multimodal treatment for urologic primary PNET consists of surgery, chemotherapy and radiotherapy.