Objective To investigate the difference in the incidence of postextubation throat complications between severe patients treated with methylprednisolone intravenously with and without budesonide suspension inhalation immediately after postextubation.Methods 75 patients with tracheal intubation were divided into group A (n=36,patients received methylprednisolone 40 mg intravenously before extubation) and group B (n=39,patients received methylprednisolone 40 mg intravenously before extubation and budesonide suspension inhalation 1 mg immediately after extubation).Postextubation thoat complications including sore throat,hoarseness and laryngeal edema were observed in the two groups.Clinical efficacies in the two groups were analyzed.Results The incidences of sore throat,hoarseness and laryngeal edema after extubation were 50.0％ (18/ 36),55.6％ (20/36) and 5.6％ (2/36) respectively in group A and 30.8％ (12/39),35.7％ (14/ 39) and 2.6％ (1/39) respectively in group B.There were no significant differences in the incidences of sore throat,hoarseness and laryngeal edema after extubation between the two groups,but the tendencies of complication incidences were decreased in group B as compared with group A.Conclusions The application of intravenous methylprednisolone before extubation and budesonide suspension inhalation after extubation can reduce the incidences of sore throat,hoarseness and laryngeal edema after extubation.

Objective To estimate the success rate of emergency endoscopic treatment in patients with esophagogastric variceal bleeding using self-made gastroscope outer casing and to investigate bow to prevent complications. Methods A total of 11 patients with esophagogastric variceal bleeding underwent endoscopic treatment with self-made gastroscope outer casing, which consisted of a wire reinforced plastic casing (1.05 cm in inner diameter, 1.35 cm in outer diameter and 50 cm in length), a 3.8 cm×3.8 cm balloon fixed on the casing head and its cavity connected to the gas pipeline placed in casing tail, an anti-reflux pad in the insert entrance of the endoscope tail as well.as a flushing hole. The endoscopy was introduced to the esophagus or stomch together with outer casing to wash and pump the hematocele out from the side of flushing hole. In patients with hemorrhagic lesion in esophageal vein, the balloon was used to press bleeding vein and intravascular sclerotherapy was performed simutanously. In those with hemorrhagic lesion in gastric vein, the balloon was pressed on esophageal vein near to the cardia and intravascular sclerotherapy was performed. Results During the process of examination, the hemorrhagic lesion was fully exposed because of flushing, and bleeding was controlted in all patients after sclerotherapy. No complication such as aspiration or perforation was seen. Conclusions For emergency endoscopic treatment of esophagogastric variceal bleeding, gastroscope outer casing is helpful in removing intragastric hematocele and maintaining a clear field of vision. It can be effectively improving the efficacy of sclerot herapy.

ObjectiveTo investigate the expression and the clinical significance of diacylglycerol kinase α (DGKα) and protein kinase C (PKC) in human hepatocellular carcinoma (HCC).MethodsDGKα and PKC expressions in the samples from 60 pathologically confirmed HCC patients were analyzed by immunohistochemistry. The relationship between DGKo expression and clinical pathology factors was analyzed.ResultsThe expression positive rates of DGKo and PKC were highest in normal liver tissues [90.0％ (9/10) and 100.0％ (10/10)].The positive rates were 81.7 ％ (49/60) and 71.7 ％ (43/60) in HCC tissues,respectively,and were 58.3 ％ (35/60) and 61.7 ％ (37/60) in carcinoma adjacent tissues,respectively.In three liver tissues,the positive rates of DGKα and PKC were significantly different (P ＜0.05).The location of both kinases in hepatocytes translocated from cytoplasm/nucleus to membrane.The expressions of DGKα and PKC were positively correlation(r =0.495, P ＜ 0.05), The DGKα expression was correlated to differentiation type,portal venous tumor thrombus and TNM staging(all P ＜ 0.05).ConclusionDGKa is expressed with high activity in advanced stage and poorly differentiated HCC. It may be promote the pathological process of HCC.

Objective To investigate the effects of different treatment modes on the prognosis of patients with severe trauma.Methods The general data of 396 patients with severe trauma [injurey severity scores (ISS) ≥25] in our hospital emergency for treatment from January 1,2008 to January 1,2012 was collected.The trauma patients were divided into study group and control group.In the study group,the trauma patients were cared by emergency physician of our hospital for pre-hospital treatment during transportation by ambulance since January 1,2010.In the control group,the trauma patients were served with traditional pre-hospital emergency care by the 120 and 999 before January 1,2010.The injury severity score,medical care and outcomes were recorded in trauma database and the efficiency and quality of medical care were compared between two groups.Results The emergency treatment time,length of hospital stays,ICU admission rate,prehospital mortality rate,long-term (6 months) disability rate,and complication rate in the study group were lower than those in the control group,presenting (78.23 ± 21.57) min vs.(96.45 ± 35.14) min,(23.55±12.46) dvs.(28.67±20.72) d,8.1％ (18/222)vs.65.5％ (114/174),13.3％ (34/256) vs.21.6％ (48/222),4.1％ (9/222)vs.9.2％ (16/174),8.1％ (18/222)vs.18.4％ (32/174),in which the differences were statistically significant (P ＜ 0.05).Hospital mortality in the study group was also lower than that in the control group,showing 8.1％ (18/222) vs.12.6％ (22/174),but there was no statistically significant difference (P ＜ 0.05).There was no significant difference in time from occurrence of injury to receiving treatment between the two groups.Conclusion Emergency physicians-cared mode had advantages to improve treatment success rates and reduce mortality in patients with multiple trauma compared with the current conventional emergency mode.It is a good alternative emergency mode.

Objective To investigate 13 high-risk types of HPV (HR HPV) infection rates in women with different grades of cervical lesions.Methods A total of 350 women, who were hospitalized in the department of gynecology in Bao′an Maternity & Child health hospital, were enrolled for the study.TCT technology was used to evaluate the cervical epithelium.The group were divided according to the cytology results.Multiplex real time PCR (mRT PCR) was used to detect the viral loads.HR HPV infection rate of different groups were analyzed using χ2 test or Fisher exact test.HR HPV viral loads of patients in different grades of cervical lesion groups were compared using Kruskal-Wallis or Wilcoxon test, and the age distribution of HR HPV positive group and negative group was analyzed by using Wilcoxon test.Results The HR HPV infection rates of NILM, ASCUS, LSIL, HSIL were 3.4% (10/295), 20.0% (7/35), 78.6% (11/14) and 100.0% (6/6), respectively.HR HPV positivity in NILM was lower than ASCUS (χ2=14.43,P<0.01) and LSIL (χ2=107.69,P<0.01), HR HPV positivity in ASCUS was lower than LSIL (χ2=14.76,P<0.01). The median of HR HPV viral loads in NILM, ASCUS, LSIL and HSIL were 4.10 (3.38-6.27), 5.33 (3.63-6.66), 5.77 (4.01-7.01) and 5.58 (4.19-5.85) respectively (copies/ml,lg).Combined ASCUS, LSIL and HSIL groups into cervical lesion group, HR HPV viral load of which was higher than that of NILM (U=43.0, P<0.05).The median Ages of HR HPV positive group and negative group were 36 and 33, respectively.No statistical significance was found between them (U=4 544, P>0.05).Conclusions The present study revealed that HR HPV infection was related to cervical lesion, but there was no correlation between viral load and cervical lesion grade. In additional, no difference in age distribution was found between HR HPV positive group and negative group.

Objective There are differences in the diagnosis and treatment of primary melanocytoma in central nervous sys -tem.The article was to investigate the experience of its diagnosis and treatment . Methods Retrospective analysis were made on the clinical data of 14 cases with primary melanocytoma in central nervous system ( CNS) from January 1999 to December 2012, among which were 5 males and 9 females.The incidence ages were 14-52, average 32.7.The course of disease ranged from half a month to 19 years, geometric average 7.9 months.5 cases recurred and 9 cases occurred first.10 cases were intracranial and 4 were intraspinal. Results 14 patients underwent surgery and had pathologic diagnosis of melanocytoma .Total resection was performed in 7 patients, subtotal resection in 3, and partial resection in 1.Immunohistochemical study showed , in all cases, S-100 and HMB-45 were positive, GFAP and EMA were negative .Vimentin was positive in 8 cases and MelanA positive in 5 cases.12 cases recovered well and dis-charged except for paraplegia and facial paralysis in 1 case each. Conclusion Primary melanocytoma in CNS is very rare .Diagnosis is based on intraoperative findings , surgical pathology and immunohistochemistry results .Surgery is the primary therapy and early total resection is advocated .Adjuvant radiotherapy can reduce the recurrence rate .

Objective To investigate the expression and distribution of Diacylglycerol Kinase α (DGKα) mRNA in human hepatocellular carcinoma (HCC),and to explore the function of DGKα in the metastasis of hepatocellular carcinoma.Methods Tissues from 30 cases of HCC and 5 normal liver tissues were collected immediately after surgical resection.Semi-quantitative RT-PCR and in situ hybridization were used to detect the expression levels and distribution of DGKα mRNA,respectively.Results Semi-quantitative RT-PCR showed that the expression level of DGKα mRNA in HCC (0.798±0.317) and normal tissues (0.908±0.425) was significantly higher than those in carcinoma adjacent tissue with cirrhosis (0.205±0.102,P<0.05).In situ hybridization demonstrated that the number of DGKα mRNA positive hepatocytes in HCC [(57.6±6.3)/mm2] and normal tissues [69.8±8.7)/mm2] was significantly higher than those in carcinoma adjacent tissue with cirrhosis [(26.3±4.9)/mm2,P<0.05]; DGKα mRNA was expressed in the cytoplasm of hepatocytes in HCC and carcinoma adjacent tissue with cirrhosis,and in the nuclear of hepatocytes in normal tissues.Conclusion The present study suggests that DGKa may play important roles in carcinogenesis and progressing of HCC.

Objective To study the clinical value of simultaneous amplification and testing for detection of Mycobacteria tuberculosis(SAT-TB)in sputum samples and bronchoalveolar lavage fluid(BALF)samples. Methods Totally 169 sputum samples and 151 BALF samples from suspected pulmonary tuberculosis patients were detected by both SAT and Bactec MGIT960.The sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of the samples using SAT-TB were calculated. Results Taken the results of BD960 as the reference,the sensitivity,specificity,PPV and NPV using SAT-TB of sputum samples were 84.00% (42/50),93.06%(67/72),89.36%(42/47)and 89.33%(67/75)respectively;and those of BALF samples 89.19% (33/37),95.12%(39/41),94.29%(33/35)and 42.39%(39/92)respectively.Taken clinical diagnostic results as reference standard,the sensitivity,specificity,PPV and NPV using SAT-TB of the sputum samples were 57.73% (56/97),93.06%(67/72),91.80%(56/61),and 62.04%(67/108)respectively;and those of BALF samples 51.82%(57/110),94.29%(39/41),96.61%(57/59)and、42.39%(39/92)respectively.The sensitivity,specificity, PPV and NPV using BD960 of the sputum samples were 51.55%(50/97),95.83%(69/72),94.34%(50/53),and 59.48%(69/116)respectively;and those of BALF samples 33.64%(37/110),90.24%(37/41),90.24%(37/41) and 33.64%(37/110)respectively.Conclusion SAT-TB is a rapid and sensitive method for the detection of Myco-bacteria tuberculosis in sputum and BALF samples.It can improve the detection rate of mycobaterium tuberculosis.

Objective To develop a simple and effective method for monitoring cortical ischemia after temporary occlusion of the parent arteries during anterior circulation intracranial aneurysm surgery. Methods Fifty-two patients with anterior circulation aneurysm (58 aneurysms) received craniotomy from April to November 2008, and at the same time,cortical electroencephalograpby (EEG) and scalp EEG were monitored during the surgery.According to the international 10/20 electrode placement system, scalp electrodes were placed on O1, O2, P3, P4, T5, and T6 for monitoring the changes in the depth of anesthesia. A cortical strip electrode was placed on the cortical surface supplied by the artery that was possibly blocked during the operation, which was used to monitor the possible cortical ischemia. For patients who had cortical EEG suppression after the temporary occlusion of the parent arteries Were compared with the changes of scalp EEG. Whether there were ischemic events in the corresponding supply territory after vascular occlusion were observed after surgery. Results Of the 58 aneurysms, 40 aneurysms and 41 major arteries were occluded temporarily. After being occluded temporarily in 19 arteries of 18 patients, cortical EEG changed significantly,while scalp EEG did not change significantly. Only 9 patients had ischemic events in the corresponding supply territories after the occlusion in the cortical EEG significant change group. The changes in the depth of anesthesia had the consistent impact on cortical and scalp EEG. Conelusions Simultaneous monitoring of cortical and scalp EEG is a simple and effective method for monitoring cortical ischemia during anterior circulation intracranial aneurysm surgery, and may effectively identify the effect of anesthesia on EEG.

Objective:To explore the effects of estrogen receptor α (ERα) encoded by protein encoding gene ESR1 on the radiation resistance of breast cancer cells and their molecular mechanisms.Methods:The ESR1 overexpression plasmid was transfected into estrogen receptor (ER)-negative breast cancer cells. Then, the shRNA-ESR1 vector was introduced into ER-positive cell to establish models with different phenotype. The ATG5 mRNA level and protein expression levels of LC3B-I, LC3B-II, P62, FIP200, ATG5, ATG7, ATG12, Beclin1, ULK1 were detected using qPCR and Western blot techniques. Cell death was measured using flow cytometry. The radiation sensitivity was determined through the colony formation assay. The mortality of breast cancer cells under the autophagy gene knockdown and overexpression or treated with estrogen receptor inhibitor (TAM) combined with ionizing radiation were detected by trypan blue staining.Results:Under the condition of 8 Gy X-ray irradiation, the knockdown of ESR1 in ER-positive ZR75 breast cancer cells promoted cell death ( t = 3.49, 3.13, P < 0.05), while the overexpression of ESR1 in ER-negative MDA-MB-231 breast cancer cells inhibited cell death ( t = 4.16, 7.48, P < 0.05). Compared to the control group, the treatment with chloroquine increased the number of formed colonies of ESR1 knockdown ZR75 cells ( t = 8.49, P < 0.05), and inhibiting autophagy could reduce the death of ZR75 cells caused by ESR1 silencing. Under the treatment with ionizing radiation, the overexpression of ESR1 in MDA-MB-231 cells promoted protective autophagy, which, however, was reduced after ESR1 knockdown in ZR75 cells. Furthermore, it was observed that the knockdown of ATG5 in ZR75 cells was associated with reduced autophagy and an increase in cell death ( t = 4.19, 6.39, P < 0.05). In contrast, the overexpression of ATG5 in ZR75 cells reversed the increase in cell death caused by ESR1 knockdown ( t = 1.70, 4.65, P < 0.05). After the treatment of ER-positive ZR75 breast cancer cells with TAM, the expressions of ATG5 and ATG12 decreased, suggesting inhibited autophagy and an increase in cell death ( t = 18.70, P < 0.05). Furthermore, these processes were promoted by ionizing radiation ( t = 16.82, P < 0.05). Conclusions:The estrogen receptor encoded by ESR1 promotes protective autophagy of ER-positive breast cancer cells by increasing ATG5, further leading to radiation resistance in ER-positive breast cancer cells. Treatment with tamoxifen combined with ionizing radiation can increase the radiation sensitivity of ER-positive breast cancer cells.