10.3969/j.issn.1007-3969.2013.04.012

RET gene is an important oncogene,which is closely associated with the development of various types of human tumors. The mainly mechanisms of RET gene associated tumor are mutation and over-expression of wild type. Activated RET protein participates in the proliferation,apoptosis,metastasis through some signal pathways and influences the tumorigenesis and development.

Lung cancer is characterized by high malignancy and the majority of patients are diagnosed at the advanced or late stage.Chemoradiotherapy has insufficient effect on this malignant tumor.At present the immune therapy has become a new choice for lung cancer treatment.Ipilimumab,antibody to programmed death-1 ,immune cells,cytokines,melanoma-associated antigen A3 vaccine,liposomal BLP25,belagen-pumatucel-L and polypeptide vaccine have been proved effective for lung cancer through various clinical trials. Futhermore,most of them have been moved forward to phase Ⅲ clinical trials in order to get more strong evidence to support the immunotherapy incorporated into the multidisciplinary treatment of lung cancer.

Objective To investigate the effects of phosphocreatine on apoptosis following myocardial ischemia-reperfusion (I/R) in diabetic rats. Methods Male SD rats weighing 150-170 g were used in this study.Diabetes mellitus was induced by high fat diet and intraperitoneal streptozotocin. Twenty-seven rats in which diabetes mellitus was successfully induced were randomly divided into 3 groups ( n = 9 each): sham operation group (group S);myocardial I/R group(group I/R )and phosphocreatine group (group PP). Myocardial I/R was induced by 30 min occlusion of left anterior descending branch of coronary artery followed by 2 h reperfusion in I/R and PP groups. In group PP phosphocreatine 1 g/kg was given intraperitoneally 30 min before myocardial I/R. Blood samples were collected at the end of 2 h reperfusion for determination of plasma concentration of calcium troponin T (cTnT). The animals were then sacrificed and iscbemic myocardial specimens were isolated. The expression of Bcl-2, Bax and Caspase-3 in isehemic myocarcdium was determined and Bcl-2/Bax ratio was calculated. Myocardial apoptosis was detected by TUNEL and apoptotic index was calculated. The ultrastructure of cardiomyocytes was examined with electron microscope. Results Myocardial I/R significantly increased plasma cTnT concentration and Bcl-2, Bax and Caspase-3 expression in myocardium and apoptosis index and decreased Bcl-2/Bax ratio. Phosphocreatine significantly attenuated I/R-induced above-mentioned changes and myocardial damage. Conclusion Phosphocreatine can reduce myocardial I/R injury in diabetic mellitus rats by reducing myocardial apoptosis through up-regulation of Bcl-2 expression and down-regulation of Bax and Caspase-3 expression.

Objective To investigate the clinical value of video-assisted thoracoscopic surgery (VATS) in the treatment of lung cancer. Methods The study included 49 patients with non-small cell lung cancer at stage Ⅰ~Ⅱ from January 2005 to June 2006. Lobectomy with mediastinal lymph node resection was performed by using VATS in 22 patients (Thoracoscopic Group) and by using conventional surgery in 27 patients (Conventional Group). The pulmonary functions and levels of C-reactive protein (CRP) were compared between the two groups. Results In the Thoracoscopic Group, a conversion to thoracotomy (12~15 cm of incision length) was required in 2 patients for treating blood vessels safely. The concentrations of CRP rose to the highest on the first day in both of groups. As compared with the Conventional Group, the CRP levels were significantly lower in the Thoracoscopic Group on the first day (56.1?10.9 mg/L vs 73.8?15.1 mg/L; t=-4.603, P=0.000). At 1 week after operation, the Thoracoscopic Group presented significantly lower minute ventilation volume (MV) (95.6?16.4 L vs 81.9?12.7 L; t=3.296, P=0.002) and forced expiratory volume in one second (FEV_1%) (51.7?5.7% vs 51.4?6.9%; t=3.105, P=0.003) than the Conventional Group. Conclusions VATS can be routinely adopted in patients with lung cancer at stage I or Ⅱ, with lesion

Objective To investigate the mastery of clinical students' doctor-patient communi-cation skills and to assess the teaching effectiveness about the doctor-patient communication, and then propose some improvement ideas. Methods We conducted a study in students of clinical medicine of Nanjing Medical University in Grade 2009, using Objective Structured Clinical Examination (OSCE) after internship, which included graduation assessment of doctor-patient communication skills. Then we analyzed the doctor-patient communication skills and related scores of students trained in different clinical medical programs. Results The average score of doctor-patient communication skills of 549 students was (82.72±4.23), of which, the average score of 329 five-year students of clinical medicine was (81.88±4.23) and the average score of seven-year students was (83.96±3.91) in. The average score of seven-year students of clinical medicine was significantly higher than five-year students (P=0.000). Moreover, there was a significant positive correlation between the total score of OSCE and the score of doctor-patient communication skills in both five-year and seven-year students of clinical medicine (five year program students' score correlation coefficient was 0.520, P=0.000;seven year pro-gram students' score correlation coefficient 0.416, P=0.000). Conclusion The teaching effectiveness of doctor-patient communication has proved to be quite effective, and it is definitely of great significance in improving clinical students' doctor-patient communication skills. The score of the assessment of the doctor-patient communication reflects not only the training effectiveness of the communication skills, but also the comprehensive capacity.

Background and purpose:Lung cancer is the leading cause of morbidity and cancer-related mortality worldwide. A variety of driver genes were detected in lung cancer. Studies have shown that different gene mutations of lung cancer were found between different races. Most of Uyghurs live in Xinjiang, accompanied by a high morbidity of lung cancer. This study aimed to investigate the expression of driver genes in Uyghur patients with lung cancer in Xinjiang, China.Methods:This study collected the tissue specimens of 43 Uyghur patients with lung cancer, with a very different method to detectEGFR gene expression. real-time fluorescent quantitative polymerase chain reaction(RTFQ-PCR) was used to detectK-ras,ALK,ROS1, mutatedBRAF andPIK3CA gene expression. Analysis of the correlation between lung cancer gene mutations in Uyghur and clinical features of patients with lung cancer were performed.Results:Among 43 cases of specimens,EGFR mutation rate was 11.63%, while theEGFR gene mutation rates in adenocarcinoma and squamous cell carcinoma were 26.67% and 4.76%, respectively.EGFR gene mutation was not detected in large cell carcinoma, adenosquamous carcinoma and small cell lung cancer.EGFR gene mutation rate in patients with adenocarcinoma (26.67%) was signiifcantly higher than that in other types of lung cancer (3.57%). The difference was statistically signiifcant (P=0.024). There were 6 patients withK-ras12/13 heterozygous mutation, and the mutation detection rate was 16.28% (6/43). There were 2 patients withPIK3CA heterozygous mutation, and the mu-tation detection rate was 4.65% (2/43).EGFR andK-ras mutations occurred simultaneously in 1 case. No relationship was found betweenEGFR mutations and age, gender, smoking status, TNM staging, ECOG score among Uyghur lung cancer patients. This study did not ifnd mutation inALK,ROS1 fusion gene andBRAF gene among the 43 specimens. Conclusion:Compared with Asian populations, Xinjiang Uyghur patients with lung cancer have a lower rate ofEGFR mutations and a higher rate ofK-ras mutations, which is similar to the characteristics of European Caucasians.

Three encoding sequence genes (Lab, 3C, 3D) from 19 isolates of O-serotype of foot and mouth disease virus(FMDV) were down-loaded from GenBank. And the coding and amino acid sequences of 3 FMDV proteases (Lpro, 3Cpro, 3Dpol) were compared with the FMDV OA/58 serotype Lab, 3C, 3D sequences abstracted in our laboratory and qualified by variance analysis and multiple analysis(Duncan method). The experimental results revealed that the Lab, 3C and 3D genes had similar nucleotide mutation rates(P>0.05). However, overall analysis of the amino acid substitutions revealed that the Lpro- coding region was more prone to amino acid alterations than 3Cpro and 3Dpol- coding regions(P<0.01), but via multiple comparison, at the amino acid mutation, both 3Cpro and 3Dpol showed no significant difference. Depending on Swiss--pdb-Viewer sofe to simulate amino acid alterations at mutation hotspots, the findings showed that these alterations at hotspots failed to ruin the spatial structures of these 3 proteases. This result presents that the nucleotide mutation just acts on dynamics related to FMDV mutation, but the real evolutionary power must depend on the infected host cells to select functions with each viral proteases.

Objective To investigate the effect of treatment of avascular necrosis of femoral head in adolescence by implanting a composite of autogenous bone marrow, bone morphogenetic protein(BMP), and noncelluar tissue engineered bone allograft. Methods The BMP was partially purified from bovine cortical bone (bBMP) by Urist method. The bone allograft chips were mixed with bBMP and bone marrow. The composite was implanted into the necrotic area of the femoral head after core decompression, then partial deminerallized allograft fibula segments were inserted in the core decompression holes to support the necrotic area in preventing the collapse in 64 adolescent patients (78 hips). Results 55 cases (67 hips) were followed up for 3 months to 6 years(mean 44 months). 28 case(36 hips) in FicatⅠ,Ⅱ were followed up over 3 years, of whom there were no obvious pain and dysfunction in 18 cases(22 hips), high density new bone was shown in core decompression area in CT scanning, and no evidence of progressive necrosis. There was no worsening of the symptoms in 4 cases(6 hips) in Ficat Ⅰand Ⅱ, but the lesion progressed. In 6 cases (8 hips) in Ficat Ⅲ, there were no obvious pain and dysfunction in 2 cases, but 4 cases underwent total hip replacement because of persistent pain and progressive lesion. Conclusion The partial demineralized allograft fibula can provide direct mechanical support to prevent the necrotic femoral head from progress and collapse, autogenous bone marrow and BMP is able to promote new bone formation. The method can be used as an alternative for the treatment of osteonecrosis of femoral head at stage Ⅰ,Ⅱ.

Objective To investigate the therapy of DHS,PFNA and Intertan nail for the treatment in elderly patients with intertrochanteric femoral fractures.Methods One hundred and one elderly patients with intertrochanteric fractures were collected.Thirty-four cases of them were undertaken DHS (DHS group),33 cases for PFNA (PFNA group),and 34 cases for Intertan nail (INTERTAN group).Operative time,blood loss and complications were observed.Results The Operative time of patients in DHS,PFNA and Intertan groups were (85.1 ± 8.9) min,(63.1 ± 8.2) min,(57.9 ± 9.2) min respectively and the difference was significant (F=12.761,P＜0.001).The blood loss amount in DHS group were (350.1 ±80.2)ml,lower that those in PFNA and Intertan groups ((137.5 ± 35.4) ml and (125.2 ± 38.2) ml,F =20.462,P ＜ 0.001).Meanwhile,the postoperative drainage in DHS group was (125.3 ± 20.4) ml,significantly higher than PFNA group and INTERTAN group ((69.4 ± 9.2) ml and (74.6 ± 10.4) ml; F =15.871,P ＜0.001).Operative time,blood loss amount in INTERTAN group were less than that in PFNA group,but no significant difference (P ＞0.05).Nonunion in DHS group was significantly higher than the other two groups (8.82％ vs 0％ and 0％,x2 =6.092,P =0.047).Excellent rate in DHS group,PFNA group and Intertan group were 82.3％ (28/ 34),87.8％ (29/33),85.3％ (29/34) respectively,and there was no significant difference (x2 =0.591,P ＞ 0.05).Conclusion Compared with DHS,Intertan nail and PFNA have advantage of shorter operative time,stronger anti-rotation capability and less various postoperative complication rates,thus they are more suitable for elderly osteoporotic intertrochanteric fracture.