Objective:To explore the placental expression of farnesoid X receptor( FXR) ,as well as the total bile acid (TBA) levels in maternal and umbilical cord serum in intrahepatic cholestasis of pregnancy (ICP) and normal late pregnancy. To evaluate the roles of placental FXR in the pathological mechanism of ICP. Methods:Maternal and umbilical cord blood as well as placentas were collected in gravidas of 33 ICP (ICP group) and 33 normal late pregnancy (control group). According to maternal serum TBA levels, ICP group was divided into mild and severe subgroup, the latter with TBA ≥40 μmol/L TBA levels were measured by velocimetry and the placental FXR mRNA expression were examined by real time nested RT-PCR. Results:①Comparing the rate of meconium -stain of amniotic fluid: The rate in ICP group was significantly higher than that in control group(χ~2=7.543,P=0.013); The rate in serve ICP group was significantly higher than that in mild ICP group(χ~2= 7.637,P=0.013). ②The expression of FXR mRNA in placentas: placental FXR mRNA expression was significantly higher in ICP group than that in control group (z = -2. 391, P = 0.017). Placental FXR mRNA expression was higher in severe ICP group than that in mild ICP group (z= -2.391 ,P=0.017).③ln ICP group, a positive correlation was found between the placental FXR mRNA expression and the maternal serum TBA levels as well as umbilical serum TBA levels(r_s =0.348,P=0.047; r_s =0.284,P=0.027). There were no significant correlations between maternal serum as well as umbilical serum TBA levels and placental FXR mRNA expression in control group ( r_s = - 0.068, P = 0.716; r_s = 0.010,P=0.959). Conclusions:Placental FXR mRNA expression is up regulated by increased bile acid levels in ICP, which may represent a compensatory (anti-cholestatic) mechanism of placenta in ICP.

Objective To understand the functional status and radiation protection requirements of helical tomotherapy (TOMO) unit when it is applied in clinic treatment so as to promote the construction of TOMO quality control system.Methods A helical tomotherapy unit with a type of tomotherapy Hi-Art was employed as the radiotherapy unit.A series of tests and analyses on dosimetric and radiation safety performance parameters of the TOMO unit were conducted with the use of a A1SL ionization chamber,a set of solid water equivalent phantoms and other test equipments.The performance parameters were compared with that of a conventional 6 MV accelerator with a type of ARTISTE.Results The deviations of static and dynamic output dose were-1.51％ and 1.18％,respectively.The values of PDD10/PDD1.5 and PDD20/PDD1.5 were 0.608 and 0.318 within the range of X-ray quality parameters calibration.Under the different field conditions of 40 cm × 5 cm,40 cm × 2.5 cm and 40 cm × 1 cm,the stability of transverse/longitudinal dose distribution curve was no more than 1.20％ and the offset distance of Jaw width was smaller than 0.5 mm.Radiation leakage ratio of the treatment rotating center from the muhileaf collimator (MLC) was 0.20％.No matter the average or the maximum value of the leakage radiation from couch plane was less than 0.02％.Conclusions The performances and testing requirements of TOMO unit are different from a conventional electron linear accelerator,the quality control index of TOMO unit should be set seperately and tested strictly in terms of the specific requirements of the unit by complying with the QC programme.The reliable quality control system should be established and effectively implemented to serve the radiotherapy quality and radiation safety effectively in the tomotherapy.

A case of ulerythema ophryogenes (UO) is reported.A 12-year-old boy presented with erythema and follicular papules on the eyebrows and cheeks for 7 years.The lesions started as follicular papules surrounded by erythema,then spread symmetrically to the cheeks and forehead followed by the loss of eyebrows.There was no complaint of pruritus.Physical examination showed pinhead- to grain-sized,smooth,slightly indurated follicular hyperkeratotic papules surrounded by erythematous halo on the eyebrows,forehead and cheeks.Both eyebrows were nearly completely lost.Histological analysis of lesions from eyebrows revealed dilated follicular infundibulum with orthokeratotic plugs,sparse perivascular and perifollicular lymphohistiocytic infiltrate,widened and sclerotic collagen fibers in the dermis.According to the clinical manifestations and histopathological findings,the patient was diagnosed with ulerythema ophryogenes,and given oral vitamin A 2.5 million unit once a day,vitamin E 100 mg once a day,topical vitamine E cream twice a day,0.025％tretinoin ointment once at night.Two weeks later,the lesions improved.

Objective To investigate the surgical treatment strategies and prognostic factors of cT4bM0 primary rectal cancer.Methods The clinical data of 53 patients with cT4bM0 primary rectal cancer who were admitted to the First Hospital of Peking University from January 2000 to December 2010 were retrospectively analyzed.All the patients received en-bloc multivisceral resection and postoperative chemotherapy.The survival and prognostic factors were analyzed.The patients were followed up via out-patient examination,phone call or mail,and the follow-up was ended till December 2012.The survival curve was drawn using the Kaplan-Meier method,and the survival was analyzed using the Log-rank test.Uni-and multivariate analysis were done using chisquare test and COX's proportional hazard model.Results Of all the 53 patients,20 received posterior pelvic exenteration (PPE),20 received total pelvic exenteration (TPE),3 received low anterior resection (LAR) +local resection of ballder,2 received LAR + ovariectomy,2 received LAR + local resection of ureter,1 received LAR + local resection of posterior vaginal wall,1 received LAR + vesiculectomy and vesectomy,3 received abdominoperineal resection (APR) + local resection of posterior vaginal wall,1 received APR + sacrectomy.R0 resection was achieved in all the patients.No intraoperative death was observed,and the incidence of postoperative complication was 9.4％ (5/53).The results of postoperative pathological examination showed that 2 patients were with well-differentiated adenocarcinoma,41 with moderate-differentiated adenocarcinoma,and 10 with poorly differentiated adenocarcinoma.Twenty-four patients were with lymph node metastasis.Four patients were in TNM stage Ⅰ,25 in TNM stage Ⅱ and 24 in TNM stage Ⅲ.Fifty-three patients were followed up postoperatively,and the median time for follow-up was 33 months (range,4-116 months).The overall 5-year survival rates was 57.3％.The 5-year survival rate for patients with or without lymph node metastasis were 77.1％ and 30.4％,respectively,with significant difference between the 2 groups (x2 =7.374,P ＜ 0.05).The 5-year survival rates of patients with malignant infiltration and inflammatory adhesion mere 51.0％ and 68.5％,with no significant difference (x2=1.148,P ＞0.05).The 5-year survival rates of patients with malignant infiltration and inflammatory adhesion in stage Ⅱ were 74.6％ and 85.7％,with no significant difference between the 2 groups (x2=0.118,P ＞ 0.05).The 5-year survival rates of patients with malignant infiltration and inflammatory adhesion in stage Ⅲ were 28.8％ and 37.5％,with no significant difference between the 2 groups (x2 =0.959,P ＞ 0.05).The results of univariate analysis showed that lymph node metastasis and TNM stage were the risk factors influencing the prognosis of patients with cT4bM0 primary rectal cancer (x2=6.468,6.596,P ＜ 0.05).The results of multivariate analysis showed that lymph node metastasis was the independent risk factor (RR =3.797,P ＜ 0.05).Conclusions En-bloc multivisceral resection should be the first surgical treatment choice for patients with cT4bM0 primary rectal cancer,and lymph node metastasis is the independent risk factor.Under the same N stage,the prognosis of patients with malignant infiltration or inflammatory adhesion is similar if R0 resection is achieved.

ObjectiveTo explore the clinical diagnosis and surgical treatment of primary retroperitonealneurilemoma(schwannoma). MethodsClinicaldataof 47patientsof primary retroperitoneal schwannoma admitted and surgically treated from January 1995 to December 2009 were retrospectivelly reviewed.ResultsAs diagnosed by pathology there were 36 cases of Benign schwannoma,with a median age at onset of 41years, among those 11 patients were symptomatic, and 25 were asymptomatic. There were 11 malignant 11 cases, the median age was 38 years, among those 6 patients were symptomatic, and 5 were asymptomatic. The positive diagnostic rate of preoperative CT and MRI were 36. 2％ ( 17/47 ) and 58. 3％ ( 7/12 ) respectively. Immunohistochemically positive rates of S-100 were 100％ and 81.8％(9/11) in benign and malignant group respectively.All cases underwent surgical treatment. Surgical resection rates for benign and malignant groups were 100％ and 90. 9％(10/11)respectively. There was no perioperative death, Overall 5-year survival rates were 100％ and 45.5％ for benign and malignant tumors groups respectively. In benign group 2 cases recurred, in malignant group 4 cases recurred, and 3 had distant metastasis.ConclusionsPrimary retroperitoneal schwannomas are less common. It is difficult to make an accurate preoperative diagnosis. Surgery is the most effective therapy.Prognosis is good for benign and poor for malignant retroperitoneal neurilemomas.

Objective To investigate the radiation dose levels to the adults examined from diagnostic exposure in Beijing. Methods The radiation doses to the examined individuals were measured by using individual diagnostic radiology equipments in 30 random hospitals from a total of 10 districts and suburban areas, including 1 182 samples of X-ray photography,542 samples of mammography and 410 samples of CT examination. Results 2 134 samples were measured in this study. The dose ranges of X-ray photography, CR, and DR were 0?4 -24?1, 0?3 -13?9 and 0?1 -15?9 mGy, respectively. The average dose range of glandular breast was 0?3-5?4 mGy. In 410 CT samples the value of CTDIw , CTDIvol and DLP were 28?1 - 96?3 mGy, 7?0 - 23?4 mGy, and 162?2 - 898?1 mGy·cm, respectively. Conclusions Several dose levels from diagnostic examination were higher than guidance level for medical exposure in GB 18871-2002,which should be noted.

Objective:To systematically evaluate the qualitative researches on the real psychological experience and coping of patients with hematopoietic stem cell transplantation during their stay in the laminar flow room, and provide reference for nursing staff to provide supportive care.Methods:The Cochrane Library, PubMed, Web of Science, Scopus, CNKI, China Biology Medicine disc, Wanfang and other Chinese and English databases were searched for qualitative research on the psychological experience of patients undergoing hematopoietic stem cell transplantation during their stay in the laminar flow room. The quality of the included studies was evaluated using the Australian JBI Evidence-based Health Care Center Qualitative Research Quality Evaluation Standard (2016) , and the research results were integrated using the pooled integration method.Results:A total of 15 literatures were included, and 99 results were extracted. They were summarized into 9 new categories and summarized into 3 integrated results, which were the imbalance of the external environment after admission of patients with hematopoietic stem cell transplantation to the laminar flow room, the real experience of hematopoietic stem cell transplant patients after being admitted to the laminar flow room, and the coping strategies for psychological changes after hematopoietic stem cell transplantation patients are admitted to the laminar flow room.Conclusions:The imbalance of the external environment is the main reason for the negative psychological experience of hematopoietic stem cell transplant patients after they are admitted to the laminar flow room. Nursing staff need to accurately identify complex emotions of the patients and provide professional guidance and support to help patients reduce negative emotions.

?? [Abstract]? Objective? To explore the effect of physical cooling method by the use of external cooling ice-packs for treatment of the in-patients with fever. Methods? In accordance with the model of Australian JBI evidence-based health care, the evidence was applied to the clinical practice after evidence generation, and synthesis. Admitted from November 2017 to June 2018 into the hematology department in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, the hyperpyretic patients with blood disease were divided into two groups-observation group and control group randomly. 68 patients were included in each group. The patients in observation group were given by 0.5 g acetaminophen orally along with ice-packs while the patients in control group were just given by 0.5 g oral acetaminophen. The temperature lowering effect in both groups was compared and studied. Results? In the observation group, patients' temperature was (38.90±0.37)℃ before intervention, (38.85±0.36)℃ in 30 minutes after intervention, (38.63±0.52)℃ in 1 hour and (38.07±0.76)℃ in 2 hours. And those for control group were (38.89±0.39),(38.82±0.40),(38.58± 0.59),(37.90±0.67)℃,respectively. Repeated measurement analysis of variance indicated that patients' temperature showed significant differences at each point of time during the study in both group (Ftime=77.862,P＜ 0.01). The intervention methods in the two groups did not interact with different point of time (Finteraction=0.728, P＞0.05). The effect of intervention in different groups at different point of time was not significant (Fgroups=0.909, P＞ 0.05). Conclusions? The use of physical cooling method along with medication is proved to be not significant in the patients' temperature control. Health workers should or not select the physical cooling method based on patients' condition and willingness in order to ensure their vital signs' stability and their comfort.

BACKGROUNDColorectal carcinoma is one of the most common malignant tumors. Despite advances in therapy, mortality is still very high. The aim of this study was to evaluate the expression of paxillin in the human colon adenocarcinoma cell line SW480 and its role in cell cycle and apoptosis. We also investigated the expression of paxillin in colorectal carcinoma tissues and its relationship to clinicopathological features and survival.

METHODSPaxillin short hairpin RNA (shRNA) was constructed and transfected into the colon adenocarcinoma cell line SW480. The influence of paxillin shRNA on the cell cycle and cell apoptosis was analyzed by flow cytometry. Immunohistochemistry staining was used to assess the expression of paxillin and its association with the expression of carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9, p53 and Bcl-2 in 102 patients with primary colorectal carcinoma. Western blotting was also used to investigate the expression of paxillin. Medical records were reviewed and a clinicopathological analysis was performed.

RESULTSIn vitro, the percentage of cells in S phase was (45.23±1.05)%, (43.53±1.23)%, and (36.13±0.57)% in the blank control group, negative control group, and paxillin shRNA group respectively. It was significantly decreased in the paxillin shRNA group (P = 0.000). The early apoptosis index of the paxillin shRNA group (17.2±1.18%) was significantly increased compared to the control shRNA group ((13.17±1.15)%, P = 0.013). Paxillin was positive in 71 (69.6%) patients, and it was found to be overexpressed in tumor tissues compared with normal adjacent tissues. Paxillin positive rate was higher in patients who are less than 50-years old (100.0% vs. 65.6%, P = 0.016). Paxillin expression was associated with a high histologic grade of carcinoma (81.4% vs. 61.0%, P = 0.031), a high rate of regional lymph node metastasis (22.5% vs. 13.0%, P = 0.031), mesenteric artery lymph node metastasis (100.0% vs. 64.8%, P = 0.008), distant metastasis (94.1% vs. 64.7%, P = 0.016) and a high Tumor Node Metastasis (TNM) stage (94.1%, 73.2%, 60.0%, and 50%, P = 0.030). Multivariate analyses revealed that recurrence was associated with the rate of regional lymph node metastasis (P = 0.001) and paxillin expression (P = 0.024). Multivariate analysis indicated that the overall survival is related to the TNM stage (P = 0.000).

CONCLUSIONSIn vitro, paxillin may promote cell proliferation and inhibit apoptosis in SW480 cells. Paxillin may be a potential metastasis predictor, and an independent prognosis factor of recurrence. It may also be related to poor patient outcomes, but was not an independent predictor of survival.

Apoptosis ; genetics ; physiology ; Biomarkers, Tumor ; genetics ; metabolism ; Carcinoembryonic Antigen ; metabolism ; Cell Cycle ; genetics ; physiology ; Cell Line, Tumor ; Cell Proliferation ; Colorectal Neoplasms ; genetics ; metabolism ; Female ; Humans ; Immunohistochemistry ; In Vitro Techniques ; Male ; Paxillin ; genetics ; metabolism ; RNA, Small Interfering ; genetics