Objective To evaluate the role of protein kinase B (Akt)/mammalian target of rapamycin (mTOR) signaling pathway in ulinastatin-induced reduction of oxidative stress injury to cardiomyocytes of rats.Methods H9c2 cells were inoculated in 96-well plates at a density of 104 cells/well.The cells were divided into 5 groups using a random nomber table:control group (group C,n =12),H2O2 group (n=12),H2O2 plus ulinastatin group (group HU,n=12),H2O2 plus ulinastatin plus LY294002 group (group HUL,n=9) and H2O2 plus LY294002 group (group HL,n=9).In group H2O2,H2O2 (final concentration 200 μ mol/L) was added,and the cells were incubated for 12 h in the incubator.In HU,HL and HUL groups,ulinastatin (final concentration 50 U/ml),LY294002 (final concentration 10 μmol/L),and ulinastatin (final concentration 50 U/ml) plus LY294002 (final concentration 10 μmol/L)were added,respectively,the cells were incubated for 2 h,H2O2 (final concentration 200 μmol/L) was then added,and the cells were incubated for 12 h in the incubator.The cell survival rate was measured by methyl thiazolyl tetrazolium assay.The levels of superoxide dismutase (SOD) and malondialdehyde (MDA) were determined by using water soluble tetrazolium-1 and thiobarbituric acid colorimetric assays.Cell apoptosis was measured by flow cytometry,and apoptosis rate (AR) was calculated.The expression of Akt,phosphorylated Akt (p-Akt),mTOR,phosphorylated mTOR (p-mTOR),activated caspase-3 and activated poty-ADP-ribose polymerase (PARP) was detected by Western blot.The p-Akt/AKT and pmTOR/mTOR ratios were calculated.Results Compared with group C,the cell survival rate was significantly decreased,AR was increased,the SOD activity was decreased,the MDA content was increased,the expression of activated caspase-3 and PARP was up-regulated (P＜0.05),and no significant change was found in p-Akt/AKT ratio or p-mTOR/mTOR ratio in group H2O2 (P＞0.05).Compared with group H2O2,the cell survival rate was significantly increased,AR was decreased,the SOD activity was increased,the MDA content was decreased,the p-Akt/AKT and p-mTOR/oTOR ratios were increased,and the expression of activated caspase-3 and PARP was down-regulated in group HU (P＜0.05).Compared with group HU,the cell survival rate was significantly decreased,AR was increased,and the expression of activated caspase-3 and PARP was up-regulated in group HUL (P＜0.05).Conclusion The mechanism by which ulinastatin reduces oxidative stress injury to cardiomyocytes is related to activation of Akt/mTOR signaling pathway in rats.

Objective To examine the white matter micro structural changes of hippocampus in the mid-die-aged major depression, and hypothesis that the hippocampal neurogenesis during the effective antidepressants can be found by diffusion tensor imaging(DTI) technology. Methods Middle-aged patients with major depression were enrolled, twenty patients received open but controlled with SSRIs for 10 weeks,twenty age, gender, education-matched healthy controls were involved as control group. All the subjects were scanned by DTI,using both whole-brain,voxel-based analysis(VBA) and Regions of interests (ROIs) methods to analyze the data. Results The VBA analysis found the post treatment patients made significant improvement in the fight inferior frontal lobe, left cingulate gyms of iimbic lobe and the right sub-gyral of occipital,but no significant difference in the hippocampus were found between any groups (all P<0.01, cluster>20). For the hippocampal relative FA of ROIs analysis,there were no significant difference between the patients before and after treatment, even no difference between the prior-treatment patients and healthy control,the remitted patients and the healthy controls(P<0.05). Conclusions Micro structural white matter changes in the frontal gyms, temporal and cingulated gyms are associated with mid-die-aged depression,no changes were found in the hippocampus. These findings do not support the hypothesis that the hippocampal neurogenesis can be found by DTI technology.

Objective To observe the effect of Arm Spasticity Inhibitor worn in rehabilitation training on patients with upper extremities spasticity and shoulder subluxation after stroke. Methods 80 stroke patients with flexor spasm in upper extremities complicated with subluxation of shoulder were divided into treatment group and control group equally. Both groups accepted routine medicine and rehabilitation, and the treatment group wore the Arm Spasticity Inhibitor developed ourselves during the rehabilitation training. Their acromio-humeral interval (AHI) was measured with the X- ray; and they were assessed with modified Ashworth Scale (MAS), range of motion of shoulder (ROM) and elbow before and 2 months after treatment. Results It improved more in the AHI, score of MAS and ROM in the treatment group than in the control group after treatment (P<0.001). Conclusion Wearing Arm Spasticity Inhibitor during rehabilitation training may release the spasticity of upper extremities and shoulder subluxation, and improve shoulder function in patients after stroke.

Objective To compare the effect of continuous positive airway pressure (CPAP)and bilevel positive airway pressure(BiPAP)on the cardiac structure and function of patients with obstructive sleep apnea and hypopnea syndrome(OSAHS).Methods 100 patients with OSAHS were selected as the research subjects.The patients were randomly divided into two groups by digital table method,CPAP group had 50 cases,adopted the CPAP ventilation mode,BiPAP group had 50 cases,adopted the BiPAP ventilation mode.The heart rate,blood pressure, blood brain natriuretic peptide(BNP),nitric oxide(NO),endothelin -1 protease,matrix metalloprotein 9(MMP -9), C -reactive protein (CRP) and polysomnography (PSG) related indicators,cardiac structure and function and endothelial function changes before and after treatment were observed in the two groups,compared the clinical effect of the two modes.Results Before treatment,in both groups,there were no statistical differences in blood pressure,heart rate,BNP,NO,endothelin -1,MMP -9,CRP,PSG related indicators,cardiac structure and function,endothelial function.After six months of noninvasive ventilator treatment,results of the heart rate,systolic pressure,diastolic blood pressure,blood oxygen saturation,oxygen partial pressure,the BNP,endothelin -1,NO,MMP -9,CRP,body mass index,the Epworth sleepiness scale(ESS),Apnea hypoventilation index(AHI),oxygen and lowest at night,aortic di-ameter(AO),left ventricular inner diameter (LA),right ventricular(RV)inside diameter,left ventricular ejection fraction(LVEF),pulmonary artery systolic pressure(PASP)of the CPAP group were (79.83 ±11.47)times/min, (114.06 ±11.45)mmHg,(72.44 ±7.38)mmHg,(97.6 ±1.45)%,(93.17 ±1.86)mmHg,(110.78 ±38.32)ng/L, (17.58 ±2.07)ng/L,(8.55 ±0.55)μmol/L,(372.73 ±189.00)μg/L,(3.34 ±2.29)mg/L,(23.87 ±1.59), (0.98 ±0.70),(0.65 ±0.30),(94.04 ±1.62)%,(31.52 ±2.17 )mm,(31.19 ±1.09 )mm,(20.86 ± 1.69)mm,(61.13 ±5.02)%,(20.74 ±5.49)mmHg.which of the BiPAP group were (80.96 ±8.56)times/min, (114.58 ±9.34)mmHg,(71.67 ±8.57)mmHg,(96.96 ±1.43)%,(94.52 ±1.66)mmHg,(87.63 ±28.33)ng/L, (17.76 ±2.20)ng/L,(8.54 ±0.52)μmol/L,(359.63 ±268.95)μg/L,(4.96 ±2.00)mg/L,(24.15 ±1.65), (0.85 ±0.75 ),(0.58 ±0.19 ),(94.50 ±1.18)%,(31.73 ±1.57 )mm,(31.97 ±1.12)mm,(21.58 ± 2.43)mm,(62.24 ±5.79)%,(21.45 ±3.76)mmHg.In the oxygen partial pressure,the BNP,MMP -9,CRP,ESS score,AHI,LA,LVEF and other indicators,BiPAP mode were better than CPAP mode(t =2.13,4.32,2.13,4.32, 1.39,4.93,2.58,4.36,all P <0.05 ).Conclusion BiPAP mode and CPAP mode can improve cardiovascular function in patients with OSAHS,improve the symptoms of low ventilation,reduce obesity,but in terms of reducing cardiac load,improve blood vessel function,BiPAP mode is better than CPAP.

Objective: To analyze the risk factors affecting prognosis of calciifc aortic stenosis in patients elder than 75 years of age and to compare the safety among different treatments. Methods: A total of 421 consecutive aortic stenosispatients treated in our hospital from 2008-01-01 to 2015-01-01 were retrospectively studied. The patients were at the age of (79.1 ± 3.5) years and with 243 (57.7%) of male gender. According to echocardiography data, the patients were divided into 3 groups: Mild stenosis group,n=112, Moderate stenosis group,n=83 and Severe stenosis group,n=226. All patients were followed-up for 1 year to observe the end point of all cause and cardiac death. In Severe stenosis group, mortalities by different treatments were compared; the risk factors related to death were calculated by Logistic regression analysis. Results: The overall 1 year all cause and cardiac mortalities were 22.3% (94/421) and 19.7% (83/421) respectively, both all cause and cardiac mortalities were similar among 3 groups,P>0.05. Multivariate Logistic regression analysis indicated that peripheral vascular disease (OR=2.31, 95% CI 1.215-4.392), LVEF (OR=0.966, 95% CI 0.942-0.991) and NT-proBNP (OR=2.022, 95% CI 1.140-3.586) were the independent risk factors for 1 year all cause death; diabetes (OR=2.157, 95% CI 1.213-3.836), LVEF (OR=0.975, 95% CI 0.950-1.000), NT-proBNP (OR=2.786, 95% CI 1.449-5.356) and blood levels of phosphorus (OR=5.755, 95% CI 1.462-22.657) were the independent risk factors for 1 year cardiac death. In Severe stenosis group, the all cause mortalities by medication, PBAV, TAVR and SAVR were 43.6%, 57.1%, 7.3% and 6.45% respectively, the patients with TAVR, SAVR had the lower mortality than those with medication, P<0.0001, while the mortality was similar between the patients with TAVR and SAVR, P>0.05. Conclusion: All cause and cardiac mortalities within 1 year were increasing with the age accordingly, while aortic stenosis grade was not related to mortality in elder patients with calcific aortic stenosis. Peripheral vascular disease and blood levels of phosphorus were the risk factors affecting prognosis. TAVR and SAVR had better effect for treating the patients with severe aortic stenosis.

Objective To clone and identify the heat shock factors(HSFs)of Schistosoma japonicum and analyze its molec?ular structure and alternative splicing pattern. Methods The New Zealand rabbits were infected with the cercariae of Schistoso?ma japonicum and were killed and dissected 42 days post?infection,and the adult worms of S. japonicum and the livers of the rabbits were harvested. Then,the total RNA was extracted by using Trizol reagent. The Sj?hsf open reading frame(ORF)and the alternative splicing fragments were amplified by RT?PCR from the female,male and egg samples,then cloned and verified by enzyme digestion and sequencing. DNAMAN 8.0,InterPro,Mega 6 combined with the Internet databases were utilized to clarify the gene structure,functional domains,alternative splicing pattern,and the homology and phylogenetic tree of HSFs. Re?sults Sj?hsf ORF and the alternative splicing fragments were amplified from the female,male and egg samples of S. japonicum by RT?PCR. After cloning,the positive recombinant plasmids pBSjHSFf?F,pBSjHSFf?M,pBSjHSFf?E containing Sj?hsf ORF, pBSjHSFs?F,pBSjHSFs?M,pBSjHSFs?E with Sj?hsf alternative splicing fragments were identified by enzyme digestion and se?quencing. Three alternative splicing Sj?hsf isoforms were observed through sequence analysis:Sj?hsf?isoform1(2 050 bp),Sj?hsf ?isoform2(2 086 bp)and Sj?hsf?isoform3(2 111 bp);the GenBank accession numbers were KU954546,KX119143 and KX119144,respectively. All the three isoforms located in the same Contig SJC_S000780 of S. japonicum genome and all ex?pressed at female,male and egg stages,but Sj?hsf?isoform1 with a high?level expression. Sj?HSF?isoform1(671 aa)and Sj?HSF?isoform2(683 aa)had DBD(DNA binding domain),HR?A/B and HR?C domains,while Sj?HSF?isoform3(282 aa)stopped in advance without HR?C domain. Phylogenetic tree analysis of HSFs illustrated that Sj?HSFs belonged to HSF1 family,with a close phylogenetic relationship to Sm?HSFs. Conclusions There are three alternative splicing isoforms of Sj?HSF existing in the female,male and egg stages of S. japonicum,but Sj?HSF?isoform1 expresses in a high?level. This study lays the foundation for further study on molecular mechanisms of Sj?HSFs in regulating the heat shock response system.

Objective:To investigate the relationship between TP53 gene mutation and overall survival (OS) time of myelodysplastic syndrome (MDS).Methods:Databases, including PubMed, Cochrane Library and Embase were searched for relevant studies published up to 20 October, 2019. The corresponding hazard ratio ( HR) and their 95% confidence interval ( CI) for OS from multivariate Cox proportional hazard models were extracted. The combined HR with their 95% CI was calculated by using fixed or random effect models. Meta-analysis was performed by using Revman 5.3 software. Results:A total of 1 033 patients from 6 studies were enrolled. Meta-analysis results showed that OS time in TP53 gene mutation group was shorter than that in wild type group for patients with MDS ( HR = 2.16, 95% CI 1.52-3.07, P < 0.01). The prognostic risk for post-transplantation patients with MDS ( HR = 2.69, 95% CI 1.63-4.43, P < 0.01) was lower compared with that for patients treated by azacitidine( HR = 2.89, 95% CI 1.37-6.08, P = 0.005). Conclusion:TP53 gene mutation is a risk factor affecting OS of MDS patients.

BACKGROUND: Children and adolescents are in the growth and development stage, so the use of the same reconstruction methods as adults is easy to induce complications including limb length differences, high graft failure rate and re-surgical intervention. Simultaneously, the occurrence of osteoarthritis will also be advanced. OBJECTIVE: To explore the anatomical characteristics of the anterior cruciate ligament between children, adolescents and adults on MRI, and to provide an anatomical basis for the reconstruction of the anterior cruciate ligament in children and adolescents. METHODS: A retrospective analysis of patients undergoing knee MRI examination in Qingdao Municipal Hospital from October 2016 to October 2018 was conducted. These patients were divided into child and adolescent group and adult group (n=48 per group). The angle between the anterior cruciate ligament and the tibia and femur on the sagittal plane and the position of the anterior cruciate ligament tibial insertion, the angle between the anterior cruciate ligament and the tibia on the coronal plane, the tibial insertion of the anterior cruciate ligament and femur, and the position of the femur stop point on the axial position were measured in both groups. The data obtained from the measurement of the anterior cruciate ligament of children and adolescents were processed. The growth curves of the shape and position of the anterior cruciate ligament of children and adolescents were drawn, and the law of its growth changes was analyzed. RESULTS AND CONCLUSION: (1) The angle between the sagittal plane of the anterior cruciate ligament and the femur (t=﹣2.906, P<0.05), the angle between the sagittal plane of the anterior cruciate ligament and the tibia (t=﹣10.280, P < 0.05), the anterior cruciate ligament angle between the coronal plane and the tibia (t=﹣5.714, P<0.05) were smaller in the child and adolescent group than those of the adult group, and the difference was significant. (2) The ratio of the tibia coronal plane of the anterior cruciate ligament (t=﹣7.263, P < 0.05) and the ratio of the anterior cruciate ligament and femur axial plane (t=﹣7.378, P < 0.05) were lower in the child and adolescent group than those of the adult group, and the difference was significant. (3) There was no significant difference in the anterior cruciate ligament and tibia sagittal plane ratio (t=﹣1.588, P>0.05) and anterior cruciate ligament and femoral coronal surface ratio (t=﹣1.647, P>0.05) between the child and adolescent group and the adult group. (4) The growth curve results showed that during the growth and development, the angle between the anterior cruciate ligament and the femur and tibia on the sagittal plane and the angle with the tibia on the coronal plane changed from small to large (P<0.05). The relative position of the tibial insertion in the coronal position changed from small to large, which indicates that during the growth and development, the tibial insertion moved from inside to outside relative to the inside of the tibial plateau on the coronal plane (P < 0.05). (5) The relative position of femoral insertion in the axial position changed from small to large, suggesting that during the growth and development, the femoral insertion moved from the outside to the inside relative to the lateral femoral condyle (P<0.05). (6) There was no significant difference in the tibial insertion and the femoral insertion between the child and adolescent group and adult group (P>0.05).

Objective To investigate the survival of oral arsenic-containing Qinghuang Powder (QHP) and low intensive chemotherapy (LIC) in the treatment of elderly patients with acute myeloid leukemia (AML).Methods Forty-two AML patients older than 60 years in Xiyuan Hospital from January 2015 to December 2017 were retrospectively analyzed.Of them,20 cases were treated with QHP (QHP group),22 cases were treated with LIC (LIC group).The survivals of the two groups were compared.Results There was no significant difference of median survival time (13 months vs.13.5 months,x2 =0.096,P =0.757),1-year survival rates (59.1％ vs.70.0 ％,x2 =0.543,P =0.461),2-year survival rates (13.6 ％ vs.15.0 ％,x2 =0.016,P ＞ 0.05),and 3-year survival rates (4.6 ％ vs.5.0 ％,x2 =0.005,P ＞ 0.05) between LIC and QHP groups.There was no significant difference of median survival time in age ≥75 year (12 months vs.12.5 months,x2 =1.317,P =0.251),performance status scores ＞ 2 (12 months vs.12 months,x2 =0.834,P =0.361),hematopoietic stem cell transplantation with combined disease index ＞ 2 (12 months vs.13 months,x2 =1.726,P =0.189),secondary AML (10 months vs.14 months,x2 =1.552,P =0.213),and poor cytogenetics (12 months vs.8 months,x2 =0.479,P =0.489) between LIC and QHP group.Conclusion The survival of elderly AML patients is considerable in patients treated with oral QHP and LIC,which suggests that oral QHP may be an equivalent alternative treatment since elderly AML (especially more than 75 years) patients refused to LIC therapy.

Objective To investigate the diagnostic value of fine needle aspiration biopsy combined with BRAFV600E gene mutation detection in elderly patients with thyroid nodules.Methods A total of 168 elderly patients with thyroid nodules suspicious for malignancy on ultrasound from January 2017 to December 2017 at our hospital were enrolled in this study.Using color Doppler ultrasound,185 thyroid nodules were found.Fine needle aspiration cytology(FNAC)and BRAFV600E gene mutation detection were performed before surgery and the findings were compared with postoperative pathological results.The diagnostic value of single and combined detection of FNAC and BRAFV600E gene mutation was evaluated.Results Among 185 thyroid nodules,there were 146 malignant lesions including 137 papillary carcinomas and 9 follicular carcinomas,and 39 benign lesions including 31 cases of nodular goiter,5 cases of Hashimoto's thyroiditis and 3 cases of adenoma.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of FNAC were 79.5％,59.0％,75.1％,75.2％,and 45.6％,respectively.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of BRAFV600E gene mutation detection were 78.1％,51.3 ％,72.4 ％,84.4 ％ and 51.2 ％,respectively.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the combined detection were 93.4％,77.5％,86.2％,90.8％ and 53.4％,respectively.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the combined detection were higher than those of either method used alone (all P＜0.05).Conclusions For some thyroid nodules that cannot be unequivocally diagnosed as benign or malignant by FNAC,the combined detection of FNAC and BRAFV600E gene mutation can significantly improve the sensitivity,specificity and accuracy of malignancy detection,differentiate between benign and malignant nodules,and help formulate operation plans and subsequent treatment.