In order to improve the clinical outcomes and promote the development of enhanced recovery after surgery(ERAS),a full-time specialized role of nurse navigator(NN) was established in Department of Surgery in February,2016. Clinical pathway for ERAS was designed,and role functions,core competencies and responsibilities of NN were formulated. According to the functions and the working frame,NN connected and coordinated teamwork activities,monitored the implementation of ERAS during the overall process. After implementation,the NN had dealt with 10 unusual incidents,the execution efficiency of the 14(82.4%) measurements were 100%,1 measurement was 97%,2 measurements were 94.1%,and 33 patients and 42 medical staff thought highly of the NN. This practice effectively promoted the development of ERAS team and specialist nurse role in our hospital.

[Objective]To establish a novel noninvasive fluorescent animal model for endometriosis in vitro and in vivo.[Methods]Adenovirus encoding enhancing green fluorescent protein(Ad-eGFP)was used to transfect endometrial glandular cells and stromal cells(cells transfection and injection,Method No.1),and fragments(tissues transfection and injection,Method No.2).Transfection efficiencies were compared between the two methods in vitro.Then GFP transfected glandular cells and stromal cells suspension were injected into nude mice subcutaneously(Method No.1),taking Method No.2 as a comparison.In vivo observation last for 25 days,and positive rates and duration times of fluorescent lesions were calculated.Histological examination was used to confirmed lesion formation.[Results]On the fifth day after injection,lesion positive rate of Method No.1 was 88.9%,which was statistically significantly higher than that of Method No.2(22.2%),P=0.015＜0.05.The fluorescent positive duration of Method No.1 and No.2 were 12 ± 8 days and 7±4 days.The structures of lesions were all identified as human original endometrium by histological examination,including HE staining and immunofluoresceney.[Conclusion]Noninvasive animal model of endometriosis can be built up by subcutaneously injection of Ad-EGFP transfected endometrial glandular cells and stromal cells suspension with higher positive rate and longer observation time

Objective To determine the antigen-specific CTL in PBMC induced by a fusional family-gene vaccine of the immunoglobulin heavy chain variable gene framework region combined with the sequence of cytokine CM-CSF in vitro with MHC pentamer. Methods Peripheral blood samples were collected from two healthy donors and two patients. One was follicular lymphoma and another was hair cell leukemia. PBMC were isolated by density gradient centrifugalization with Ficoll and then subsequently differentiated into immature DCs (imDCs) induced by recombinant human GM-CSF and recombinant human IL-4. Gene gun was used to deliver the plasmids of the gene vaccine or the control plasmids into the imDCs. RT-PCR and ELISA assay were used to detect IgHVl-GM-CSF mRNA and GM-CSF in order to validate the transfection of the vaccine. After adding the cytokine cocktail, the imDCs became mature DCs. Then the mature DCs were co-cultured with lymphocytes from the blood samples for the induction of the antigen-specific CTL. The cultured cells were classified into vaccine group and control group and harvested at different time points of 0 d,7d, 17 d and 24 d after transfection. The subset of CD3+CD8+ T cells was analyzed by FCM assay. Finally, the CTL levels were detected with fluorescently labeled MHC pentamer antibody targeting vaccine epitopes. Results With the induction of cytokines, the imDCs with typical morphology were generated in PBMC. After delivering, the efficient expressions of the vaccine in the imDCs were determined by RT-PCR. And ELISA results also confirmed that GM-CSF was produced at a level of (28 ±6) ng/106 cells of the imDCs loaded with the vaccine, which was significantly different from that of control group (10 ± 3) ng/106 cells (t = 5. 191, P <0.01). FCM assay result showed that the CD3+ CD8+ T cells increased in a stepwise pattern during the culture. For control group, the levels at 0 d,7d, 17d and 24 d were ( 34. 24 ± 2. 72 )% , (46.06 ± 3.08)%, ( 65. 34 ± 4. 26 )% and (73.86 ±4.85 )% , respectively. For vaccine group, the results were (32. 28 ± 2. 08 ) % , (45. 32 ± 3. 81)% , ( 63. 37 ± 4. 21)% and (75. 01 ±3. 20)%. The differences between each time point had statistical significance (F = 176. 966 ,P <0.01) ,but there was no statistical differences between vaccine group and control group ( F = 0.657,P>0.05). The MHC pentamer analysis showed that the DCs loaded with IgHV1-GM-CSF fusional vaccine could efficiently induce the antigen-specific CTL response and the CTL levels increased gradually with the culture time, with the highest level of 4. 36% in the lymphoma blood and 3. 89% in the hair cell leukemia blood. Conclusions MHC pentamer assay could efficiently determine the antigen-specific CTLs response induced by the gene vaccine of family IgHV frame region in vitro. It could be a useful method for monitoring of anti-tumor cell immunity and evaluating of diagnosis and prognosis of the tumors in clinical application.

Objective To analyze the characteristics of the F waves,H-reflex and nerve conductions and its diagnostic value in the patients with Guillain-Barré syndrome(GBS)onset within 4 weeks.Methods The electrophysiological data of the 40 patients with GBS were analyzed retrospectively.These patients were divided into 2 groups according to the duration of illness including in 2 week' s group and over 2 week' s group.The results of the F waves,H-reflex,the motor nerve conduction velocity (MCV),and the sensory nerve conduction velocity(SCV)of these patients were analyzed.Results The abnormality rate of the F waves was 17/20 and 7/18 respectively in less 2 week' s group and over 2 week' s.The H-reflexes were 13/20 and 12/19.The MCV was 28.4％(25/88)and 32.9％(26/79).The distal motor latency was 40.9％(36/88)and 36.7％(29/79).The compound muscle action potential amplitude was 35.2％(31/88)and 32.9％(26/79)respectively in these two groups.The abnormality rate of the SCV was 11.2％(10/89)and 25.2％(24/95)respectively in the two groups.The higher abnormality rate of these tests was the F waves and H-reflex in both the groups.The abnormality rates of the F waves(x2 =8.657,P =0.003)and SCV(x2 =6.002,P =0.014)were significantly different between the two groups.There were no significant differences in the other tests.Conclusion The electrophysiological tests are valuable in the diagnosis of GBS.The F waves and H-reflex are more significant for early diagnosis of GBS.

Objective To investigate whether the clinical outcomes of HBV infection are associated with single nucleotide polymorphisms of Toll-like receptor (TLR) 9 gene promoter region.Methods The polymorphisms of three positions at TLR9 gene promoter region including A-1923C, T-1486C and T-1237C were detected using real-time fluorescence quantitative polymerase chain reaction in 96 patients with severe chronic hepatitis B, 156 patients with chronic hepatitis B and 151 cases of HBV spontaneous clearance, then the differences between the groups were analyzed.Analysis of variance was performed for measurement data,and χ2 test or Fisher exact probability test were used for enumeration data.Results The frequency of AC genotype at TLR9 gene A-1923C site in chronic hepatitis B group was 3.8%, which was significantly lower than that in HBV spontaneous clearance group (11.3%) (χ2=6.082, P ＜ 0.05), but no significant difference was found between severe chronic hepatitis B group (8.3%) and HBV spontaneous clearance group (χ2=0.552, P ＞0.05).No significant differences of genotype distribution were found between chronic severe hepatitis B group and HBV spontaneous clearance group , chronic hepatitis B group and HBV spontaneous clearance group at polymorphism sites of T-1486C and T-1237C (χ2=1.534 and 0.745, P ＞ 0.05).Conclusions Genotype AC at TLR9 gene A-1923C site is associated with HBV spontaneous clearance, but not correlated with chronic HBV infection and liver failure; there is no correlation of polymorphisms in T-1486C and T-1237C at TLR9 gene promoter region with the clinical outcomes of HBV infection.

Objective To compare zinc-finger BED domain-containing 3 ( ZBED3 ) expression in various tissues of C57BL/6J mice and the effects of liraglutide, glucose, and insulin on the levels of ZBED3 protein expression in C57BL/6J mice and db/db mice. Methods The mRNA level of ZBED3 in various tissues of C57BL/6J mice was measured by realtime PCR. The protein level of ZBED3 was measured by using western blot. Results ZBED3 mRNA levels were detected in muscle, spleen, kidney, brain, heart, lung, and liver of C57BL/6J mice, yielding the highest expression in muscle. Additionally, The liver ZBED3 levels were higher in db/db mice compared with C57BL/6J mice (P<0. 01). Furthermore, the protein expression of ZBED3 was significantly increased in liver tissues of db/db mice treated with high concentrations of liraglutide, glucose or insulin(P<0. 05), however, the expression of ZBED3 only responded to high concentration of glucose in liver tissues of C57BL/6J mice. Conclusion ZBED3 may act as a novel factor in regulating glucose metabolism. The expression of ZBED3 can be regulated by liraglutide, glucose, and insulin. Thus, ZBED3 may play an important role in conditioning of hyperglycemia.

Objective To investigate the changes of sex hormones after lamivudine antiviral treatment in male hepa-titis B patients with compensated cirrhosis, and the significance of changes thereof. Methods Forty-six male patients with compensated cirrhosis were included in patient group. The patient group was given lamivudine antiviral treatment for 24 weeks. The sex hormone levels were compared between before and after treatment. Patients were divided into two groups (complete response group and incomplete response group) according to their response to the treatment. The sex hormone lev-els were compared between these two groups. Results (1)The level of PRL was significantly decreased, and the levels of T and E2 were significantly increased after lamivudine antiviral treatment in patient group.(2)There were significant differenc-es in levels of PRL, T and E2 between complete response group and incomplete response group. Conclusion (1)The lami-vudine antiviral treatment can improve the dysfunction of sex hormones.(2)There was a relationship between the changes of sex hormones and the responses of antiviral treatment.

Aim To explore the influence of metformin(a first-line drug for type 2 diabetes) on ATP-induced inflammasome activation and the release of interleukin-1β(IL-1β) by LPS-activated peritoneal macrophages, a commonly-used inflammatory cell model.Methods Peritoneal macrophages were elicited by intraperitoneal injection of 30 g·L-1 thioglycollate into C57BL/6 mice.Inflammasome was activated and cell pyroptosis was induced by LPS plus ATP treatment, and the pyroptotic cells were calculated after propidium iodide(PI) staining.The protein levels of IL-1β and caspase-1 expressed in the cells and released from them into the supernatant were evaluated by Western blot.Immunofluorescent microscopy was recruited to detect the subcellular distribution and fluorescent intensity of the purinergic P2X7 receptor(P2X7R).Results Metformin per se did not induce pyroptosis in LPS-activated peritoneal macrophages, but it significantly and dose-dependently increased cell pyroptosis induced by ATP treatment.At protein levels, maturated IL-1β(17 ku) could not be released from the cells upon single LPS or LPS plus metformin stimulation;but after ATP was added, maturated IL-1β was released into the supernatants of the cells.Moreover, metformin dose-dependently increased the protein levels of both maturated IL-1β and active caspase-1 released by the LPS-activated peritoneal macrophages upon ATP stimulation.Conclusion Metformin intensifies the activation of inflammasome and increases the release of active caspase-1 and maturated IL-1β upon ATP stimulation in the LPS-activated peritoneal macrophages, which should promote inflammatory responses.

Objective To evaluate the prognostic value of the extracapsular spread (ECS) of regional lymph nodes in nasopharyngeal carcinoma (NPC) based on magnetic resonance imaging.Methods A retrospective review was performed for 477 previously untreated patients with NPC who were treated in Yuebei People′s Hospital from January 2009 to December 2013.Univariate and multivariate survival analyses were performed to identify the prognostic value of ECS in NPC.Results There were 216 patients with ECS and 261 patients without ECS,and the median survival of the two groups of patients was 38.5 months and 39.0 months,respectively.The 3-year overall survival (OS),progression-free survival (PFS),local recurrence-free survival (LRFS),and distant metastasis-free survival (DMFS) rates of the patients with ECS versus those without ECS were 81.9% versus 90.7%,65.8% versus 85.0%,87.8% versus 95.8%,and 80.3% versus 92.9%,respectively (all P=0.000).The univariate analysis showed that N stage and ECS were important prognostic factors for OS,PFS,LRFS,and DMFS in NPC patients (P=0.000-0.004),and T stage and TNM stage were associated with OS,PFS,and DMFS (all P=0.000).The multivariate analysis using the Cox regression model showed that T stage was an independent prognostic factor for the survival of NPC patients,and ECS was an important prognostic factor for PFS,LRFS,and DMFS.Conclusion ECS of regional lymph nodes is a risk factor for local recurrence or distant metastasis in patients with NPC.

AIM:To explore the depression-like behavior and cystathionine β-synthase (CBS)/hydrogen sulfide (H2S) levels of amygdala in posttraumatic stress disorder (PTSD) rats and to study the effect of exogenous H2S on PTSD rats.METHODS:Single prolonged stress paradigm was adopted to prepare PTSD animal model.Forced swimming test and sucrose preference test were used to evaluate the depression-like behavior.The content of CBS/H2S in amygdala tissue was measured by Western blot and methylene blue method.In vivo extracellular single unit recordings was used to examine the frequency of spontaneous discharges of amygdala neurons.RESULTS:The immobility time in forced swimming test of PTSD group increased and sucrose preference in sucrose preference test of PTSD group decreased compare with normal group (P<0.01).CBS/H2S level in amygdala tissue of PTSD group decreased compared with normal group (P<0.01).The immobility time of the rats in forced swimming test of NaHS+PTSD group decreased and the sucrose prefe-rence in sucrose preference test of NaHS+PTSD group increased compare with PTSD group (P<0.01).L-cysteine increased the frequency of spontaneous discharges of amygdala neurons (P<0.01).CONCLUSION:Depression-like behavior is aggravated in PTSD model rats owing to the inhibition of CBS/H2S content in amygdala tissue.The mechanism of behavior-improving effect of H2S on PTSD model rats is possibly related to excitating amygdala neurons and increasing the frequency of spontaneous discharges.