Objective To illustrate the relationship between the temporary alteration of renal functions of rats with obstructive jaundice due to ischemia reperfusion injury(RI) and lipid peroxidation and the expression of heat shock protein 70 in rat kidney. Methods Wistar rats were divided into 4 groups of sham operation group(S group), sham operation and renal RI group(SRI group), common bile duct ligation group(J group), common bile duct ligation and renal RI group(JRI group). One week after bile duct ligation, rat bilateral renal arteries were transiently occluded for 10 minutes. The variations of renal function were observed at different time phases after renal reperfusion. Simultaneously, the expression of heat shock protein 70 in kidney was evaluated by immunohistochemistry. Results In JRI group, endogenous creatinine clearance rate(Ccr) decreased progressively along with the prolongation of the duration of reperfusion. In J and JRI groups, the level of malondealdehyde(MDA) in renal tissue increased but superoxide dismutase(SOD) decreased. In JRI group, the expression of heat shock protein 70 reached its peak at the 4th hour after reperfusion and began to decrease at the 12 th hour and became lowest at the 24 th hour. No expression of HSP70 was found in other groups. Conclusion The sensitivity of rat kidneys with obstructive jaundice to ischemia reperfusion injury is significantly elevated. Ischemia reperfusion injury, as well as lipid oxidative stress, may be involved in acute renal failure(ARF) after obstructive jaundice surgery. The expression of heat shock protein 70 is a protective response to RI.

With the child behavioral questionnaire developed by Rutter,39 Chinesechildren(group 1-C),27 Japanese children(group 1-J)and 87 South Korean children(group1-S)were identfied as with behavioral problems,together with matched norman children of27 from China(group 2-C),30 from Japan(group 2-J)and 26 from South Korea(group 2-S)respectively,to engage in this EEG study.In a comparison between behavioral problemschildren and normal ones in each country no significant difference was found in EEG data.However,in the comparison among group 1s,group 2s and ADD-H children(group 3s:41from China as group 3-C,21 from Japan as group 3-J and,29 from South Korea as group3-S)diagnosed clinically with DSM-Ⅲ,significant difference among groups was found inEEG analyses in each country respectively.Some index of slow wave of group 3s'EEG weremuch higher than that of normal ones(group 2s).EEG data from group 3-C and gruop 3-Jshowed that the frequency-peak moved to slow frequency area.This indicates the develop-ment of ADD-H may associate with some functional abnormalities of nervious system.

Objective To compare the curative effects between one‐stage anterior debridement bone graft fusion and posteri‐or fixation fusion combined with anterior debridement bone graft fusion in the treatment of multiple lower thoracic spinal tuberculo‐sis .Methods A total of 62 patients with multiple lower thoracic spinal tuberculosis in our hospital from March 2002 to March 2010 were treated by the anterior debridement bone graft fusion ,including 32 cases of anterior internal fixation by one screw‐rod system (group A) and 30 cases of posterior internal fixation by two nail‐stick systems(group B) .The cure rate ,operation time ,bleeding volume ,the Cobb′s angle and recovery situation of spinal cord injury were compared between the two groups .Results All patients were followed up for 24-36 months (average 28 months) and showed successful bone graft fusion .In the Frankel classification e‐valuation at postoperative 12 months ,the improvement rate of spinal cord injury was 76 .92% (10/13) in the group A and 81 .82%(9/11) in the group B ,showing no statistically significant difference (χ2 =0 .087 ,P>0 .05) .The total cure rate was 84 .38% (27/32) in the group A and 85 .48% (26/30) in the group B ,showing no statistically significant difference (χ2 =0 .066 ,P>0 .05) .The Cobb′s angles before operation ,immediately after operation and at the last follow‐up were (28 .16 ± 4 .16)° ,(5 .03 ± 3 .24)° and (8 .81 ± 2 .44)° in the group A and (26 .83 ± 5 .41)° ,(5 .50 ± 3 .03)° and(8 .06 ± 2 .45)° in the group B ,showing no statistically sig‐nificant difference (t=1 .038 ,t=0 .588 ,t=1 .200 ,all P>0 .05) .The operation time was (171 .31 ± 12 .84)min in the group A and (219 .23 ± 21 .44)min in the group B ,showing statistically significant difference (t=10 .754 ,P<0 .05) .The bleeding volume was (341 .25 ± 76 .10)mL in the group A and (440 .67 ± 67 .16)mL in the group B ,showing statistically significant difference (t=5 .439 ,P<0 .05) .Conclusion One‐stage anterior debridement ,and anterior or posterior internal fixation for treating multiple lower thoracic spinal tuberculosis can obtain the better curative effect ,but selecting case is very important .

Gastrointestinal stromal tumor (GISTs) are a new recognized tumor entity. The incidence increases with time for the greater awareness of GISTs. Latest reports of the epidemiology of GISTs have been collected and sorted. Besides, it is still a controversy on the management of GISTs. While surgical en-bloc resection is the treatment of choice, imatinib is still optimal for patients with recurrent or metastatic GISTs. Preliminary promising effects have been showed on neo-adjuvant and post-operational adjuvant therapies. Imatinib-resistant GISTs become common and more targeted medication have been investigated and tested.
Gastrointestinal Stromal Tumors ; epidemiology ; therapy ; Humans ; Incidence

It has been confirmed that tumor invasion and metastasis is not only dependent on the charac -teristics of the tumor ,but also dependent on the tumor microenvironment .Tumor-associated macrophage ( TAM) , which constitutes a large number of the tumor -infiltrating immune cells,is stimulated into M1 macrophage and M2 macrophage by different signals in the tumor microenvironment .Whereas the vast majority of studies with nu-merous tumor types show that the presence of M 2 phenotypes in the tumor microenvironment is associated with a worse prognosis ,most studies in gastric cancer also claim the same results .Hypoxia and coagulation factors may both contribute to it .It has identified that the function of TAM could be changed with their location of tumor ,but it has nothing to do with cell differentiation and cell type of gastric cancer .In this review,we summarize the differ-ent and controversial effects of TAM in gastric cancer .

This study was to evaluate the risk factors of nocturnal hypoglycemia in elderly patients with type 2 diabetes by continuous glucose monitoring system. Fifty-one type 2 diabetic patients aged 60 or above were enrolled and the episodes of nocturnal hypoglycemia were documented. The risk factors of nocturnal hypoglycemia were analyzed by logistic regression and the cut-off of glucose levels at bedtime for nocturnal hypoglycemia was evaluated. There were twenty-two patients with total 681 nocturnal hypoglycemic episodes. Logistic regression analysis showed that the lowest glucose level at bedtime was the risk factor of nocturnal hypoglycemia (OR=0.36, 95% CI:0.13-1.00, P<0.05), while the gender, age, diabetes duration, therapy regimen, the highest and average glucose levels at bedtime were not associated to nocturnal hypoglycemia. Receiver operating characteristic curve (ROC) showed that the bedtime glucose at≤6.2 mmol/L was the best cut-off point for predicting nocturnal hypoglycemia.

Objective To discuss the efficacy and safety of decitabine plus aclacinomycin/cytarabine/ G-CSF (CAG) regimen in the treatment of patients with relapsed refractory acute myeloid leukemia (AML).Methods 17 cases with relapsed refractory AML were collected.They were given decitabine (25 mg/d,d1-5) plus CAG regimen (aclacinomycin 20 mg/d,d3-6; cytarabine 10 mg/m2,d3-9; G-CSF 400 μg/d,d0-9).Results After one course treatment by decitabine plus CAG regimen,10 patients (58.8 ％) achieved complete response (CR),1 patient (5.9 ％) achieved partial response (PR) and 6 patients (35.3 ％) displayed no response (NR),the overall response rate was 64.7 ％ (11/17).For karyotyping of chromosomal abnormalities,only 1 case (100 ％) in CR showed normal karyotype.8 cases (66.7 ％) in CR,1 case (8.3 ％) in PR showed medium karyotype.1 case (25.0 ％) in CR showed bad karyotype.Statistical analysis revealed that there were significant differences among different groups (P ＜ 0.05).Follow-up to January 31,2013,15 patients survived,2 patients died early.The median overall survival was 67 d (14-307 d),and the median relapse-free survival was 47 d (14-152 d).Conclusions The combined regimen of decitabine and CAG in the treatment of patients with relapsed refractory AML has a high response rate,little non-hematologic side effects and good tolerance.

Objective To investigate the relationship between sarcoplasmic reticulum Ca2+modulation proteins and postresuscitation myocardial dysfunction. Methods Thirty-eight SPF male Sprague-Dawley (SD) rats were randomly divided into control group(n=12)and cardiac arrest(CA)group(n=26). CA was induced by intravenous bolus of potassium chloride(40μg/g),and cardiopulmonary resuscitation(CPR)was conducted 8 minutes later. No CA was induced in control group except catheter placement for monitoring cardiopulmonary parameters after anesthesia. Invasive hemodynamic parameters were monitored for 1 hour after CPR. Echocardiogram was performed to evaluate cardiac function. Myocardial samples were harvested 5 minutes and 1 hour after restoration of spontaneous circulation (ROSC),and sarcoplasmic reticulum Ca2+ ATPase (SERCA2a),phosphorylated phospholamban (p-PLB) and rynodine receptor(RyR)were determined by Western Blot. Results ROSC rate of CA group was 92.3%(24/26),and mean recovery time was (68 ±39)seconds. Cardiac function was significantly impaired in CA group at 1 hour after resuscitation, and ejection fraction, fraction shortening (FS), the maximal rate of left ventricular pressure increase/decline (±dp/dt max)were significantly decreased compared with those in control group 〔ejection fraction:0.548±0.060 vs. 0.809±0.043,F=71.692,P=0.000;FS:(34.4±4.4)%vs. (46.0±3.5)%,F=55.443,P=0.000;+dp/dt max(mmHg/s):4 718±743 vs. 7 098±394,P<0.01;-dp/dt max(mmHg/s):-3 824±612 vs.-6 187±473,P<0.01〕. Compared with control group,the expression levels of p-PLB (gray value)was significantly decreased at 5 minutes and 60 minutes(5 minutes:0.64±0.15 vs. 1.29±0.13,P<0.01;60 minutes:0.95±0.08 vs. 1.30±0.09,P<0.05)after resuscitation in CA group,while the level of sarcoplasmic SERCA2a(gray value)and RyR (gray value)showed no significant differences(SERCA2a 5 minutes:1.01±0.18 vs. 1.24±0.07,60 minutes:1.03± 0.14 vs. 1.25 ±0.06;RyR 5 minutes:0.96 ±0.13 vs. 0.97 ±0.13,60 minutes:0.88 ±0.14 vs. 0.99 ±0.11,all P>0.05). Conclusions The impairment of the p-PLB is closely related to postresuscitation myocardial dysfunction.

Objective To investigate the clinical short-term outcomes after laparoscopic total mesorectal excision (TME)for rectal cancer in China.Methods A systematic literature searching was performed to identify all randomized controlled trial(RCT) studies or well-designed retrospective studies on laparoscopic surgery(LS) and open surgery(OS) for rectal cancer published from January 2003 to October 2010 in China.Two reviewers independently screened and extracted the data.The reports which matched the inclusion criteria were analyzed with Revman 5.2.Results A total of 17 RCT studies and 3 retrospective studies (2246 patients)was included in this study.The basic features of 2 groups were balance.Compared to group OR,the incidence of complications such as postoperative wound infection (RR =0.30,95 ％ CI:0.17 ～0.54,P ＜ 0.01),pulmonary infection (RR =0.47,95％ CI:0.25 ～0.91,P ＜0.05),and ileus (RR =0.41,95％ CI:0.19 ～0.88,P ＜0.05)were significantly lower in group LS.No difference was observed in the incidence of peritoneal abscess(RR =0.78,95％ CI:0.38 ～ 1.60,P ＞0.05),anastomotic leakage(RR =0.66,95％ CI:0.38 ～ 1.16,P ＞0.05),and uroschesis(RR =0.57,95％ CI:0.26 ～ 1.25,P ＞0.05).Furthermore,parameters of postoperative recovery were compared between groups,LS group manifested early recovery.Conclusions Laparoscopic total mesorectal excision for rectal cancer,with minimal invasion,benefits the postoperative recovery and reduces incidence of complications.LS radical resection of rectal cancer is technically feasible,safe,and prospectively favorable.

Objective To evaluate the effect of permissive hypercapnia on pulmonary function and in-flammatory responses of the collapsed lung of patients underwent video-assisted pulmonary lobectomy after one-lung ventilation.Methods Fifty patients,aged 38-65 years,ASA Ⅱ or Ⅲ,including 30 males and 20 females,scheduled for video-assisted pulmonary lobectomy were selected and divided into two groups ran-domly,with 25 patients in each group.During the surgery,PaCO2 of patients in group C were maintained during 35 to 45 mm Hg,while in group H the value were 55 to 65 mm Hg.The arterial blood samples were collected at 1 min before one-lung ventilate (T1 ),30 min after one-lung ventilate (T2 )and 30 min after re-flow of the collapsed lung (T3 )for arterial blood gas analysis,then the respiratory index of each patient was evaluated.Peripheral venous blood and bronchoalveolar lavage fluid draw from left lower lobar of the col-lapsed lung were collected to evaluate the levels of TNF-α,IL-6,and IL-10 at T1 ,T2 and T3 .The peak in-spiratory pressure,plateau pressure and tidal volume were also recorded to calculate lung dynamic compli-ance.Results Compared to group C,peak inspiratory pressure of group H was significantly higher;the IL-10 level of bronchoalveolar lavage fluid of the collapsed lung and the pulmonary dynamic compliance of group H were significantly higher at T2 and T3 ,and the concentrations of TNF-α,IL-6 of bronchoalveolar lavage fluid,the peak pressure,and respiratory index of group H were lower significantly at the same point of time (P <0.05).Conclusion Permissive hypercapnia would inhibit inflammation response of collapsed lung after one-lung ventilation effectively,improve lung diffusion capacity and pulmonary compliance.