Based on the background,conception and the core ideas of the evidence-based medicine,the construction and application of domestic clinical cases database was discussed.Problems concerning statistics,management and application in scientific research encountered in the database devel opment were presented,and suggestions were proposed.

Objective To evaluate the semi-quantitative parameters of dynamic contrast enhanced MRI (DCE MRI) with double echo in the diagnosis of breast tumors.Methods Thirty eight patients suspected of breast tumour underwent DCE MRI with double echo examination by using 3.0 T whole-body MR scanner with a sixteen-channel phased-array breast coil.Semi-quantitation of both pharmacokinetic and perfusion parameters were performed including peak enhancement ratio (PER),time from contrast agent arrive to peak enhancement (Tmax),and maximum signal intensity loss (MSIL).The mean PER,Tmax and MSIL of the breast cancer,fibroma and other benign lesions were calculated.One-way ANOVA and receiver operating characteristic curve (ROC) analysis were used to compare the differences between malignant and benign lesions.Results The mean PER,Tmax and MSIL of the lesions were as follows:0.61 ± 0.09,(164.9 ± 20.5) s,and 0.31 ± 0.03 for breast cancers (n =20) ; 0.46 ± 0.07,(183.2 ± 13.7) s,and 0.17± 0.03 for fibromas (n =10) ; 0.23 ± 0.06,(139.4 ± 23.6) s,and 0.24 ± 0.07 other benign lesions (n =8),respectively.There were significant differences among 3 groups in all semi-quantitative parameters (F =4.319,4.154,4.752,respectively.P ＜ 0.05).The areas under the ROC curve of PER,Tmax and MSIL for the diagnosis of malignant lesions were 0.513,0.794 and 0.769,respectively.The sensitivity of PER,Tmax,and MSIL were 60.0％,80.0％ and 62.5％ and the specificity were,62.5％,75.0％ and 90.0％,respectively,with the maximum Youden'index as cut off value.When combining the 3 semi-quantitative parameters,the sensitivity,specificity and accuracy for differential diagnosis of breast tumors were 95.0％ (19/20),83.3％ (15/18),and 89.4％ (34/38),respectively.Conclusion The semi-quantitation of pharmacokinetic parameters (PER,Tmax) and perfusion data (MSIL) can be simultaneously estimated in a dynamic contrast enhanced MRI with double echo in breast lesions.The Accuracy for differential diagnosis of breast tumors can be improved when judge by combination of PER,Tmax and MSIL.

Objective To evaluate the feasibility, efficacy and safety of new nano material occluder of single rivet type (left-disk with no-hub) in treating ventricular septal defect (VSD) in order to provide experimental basis for clinical application. Methods A total of 26 healthy adult dogs were selected for this study . Under thoracotomy , VSD model was established through fluoroscopically-guided percutaneous puncturing of the right ventricular free wall. The models were randomly and equally divided into the study group(n=13, using nano material VSD occluder) and the control group(n=13, using double-hub nitinol occluder). Every two dogs from each group were sacrificed each time at one, 2, and 3 months after percutaneous closure of VSD with corresponding occluder, the tissue samples were collected and sent for gross examination as well as for the optical and electronic microscopy study;the blood concentration of nickel ion was also determined. The state of endothelialization after implantation of the new type occluder was evaluated, and the complications such as residual shunt and superficial thrombus formation were recorded. The results were analyzed. Results By open chest operation with small incision and percutaneous puncturing of the right ventricular free wall, VSD model was successfully established in all 26 dogs. The success rate of the implantation of the VSD occluder in the study group was 100%, while it was 91.7% in the control group. One, 2, 3 and 6 months after the implantation, the heart specimens of 25 dogs were removed and gross examination showed that neither occluder displacement nor alloy wire fracture occurred in both groups. No thrombus formation or vegetation attached on the disk surface was observed. One month after the procedure , in the study group the bilateral disk surfaces of the occluder were covered with thin layer transparent tissue , which were proved to be composed of the fibrous tissue and endothelial cells through pathologic and electronic microscopy study. Six months after implantation, the superficial tissue of the occluder became further thickened and the occluder edge became fused with the surrounding heart tissue. Conclusion The design of the new VSD nano materials occluder, which has a left-disk with no hub, is very scientific. Compared with double-hub nitinol occluder, the new device can shorten the time of complete endothelialization and effectively occlude the VSD. Therefore, this new nano material occluder has promising prospect in clinical application.

Objective To investigate the effect of tripterygium glycosides on the resistance to immune rejection after allogeneic islet transplantation in mice.Methods Twenty C57BL/6 mice were treated with STZ diabetes mellitus and transplanted the islets from Balb/c mice donor,then recipient mice were randomly divided into two groups:triptolide group and model control group(n=10),and were intraperitoneal injected with tripterygium glycoside solutin and equivalent solvent of 5 mg·kg-1·d-1 for 14 days.Blood glucose and body weight were measured within 4 weeks after transplantation.Two weeks later,two groups of grafted islets were stained by HE staining and immunohistochemical staining,the expression of IL-2 protein were detected by Western blotting.Results The level of blood glucose were decreased to normal in the triptolide group and model control group after islet transplantation,but blood glucose gradually increased in the model control group after two weeks.Compared with the model control group,the inflammatory cells were less infiltrated and the immunohistochemical staining of insulin was deeper in the triptolide group.The expression of IL-2 in the triptolide group was significantly decreased(P<0.05).Conclusion Tripterygium glucoside could significantly decrease the inflammatory cell infiltration and inflammation factor expression in the allogeneic islet recipients to reduce the immune rejection and improve graft survival.

Objective To evaluate the effect of angiotensin Ⅱ ( Ang Ⅱ ),angiotensin- (1-7) [ Ang- ( 1-7 ) ],and co-action of Ang Ⅱ and Ang-( 1-7 ) on β cell insulin signaling pathway.Methods Mouse pancreatic β cell line NIT-1 was incubated with( 1 )0,10-7,10-6,10-s,10-4 mol/L concentrations of Ang Ⅱ for 24 h ; ( 2 )0,10-7,10-6,10 -5,10-4 mol/L concentrations of Ang- ( 1-7 ) for 24 h; ( 3 ) co-administration of Ang Ⅱ and Ang- ( 1-7 ) was divided into control,10-5mol/L Ang Ⅱ,10-6mol/L Ang-( 1-7 ),10-5mol/L Ang Ⅱ + 10-6mol/L Ang-( 1-7 ) group.Tyrosine phosphorylation of insulin receptor β subunit(IR-β-Tyr) and serine phophorylation of protein kinase B(Akt-Ser) were detected by Western blot.ResultsInsulin-stimulated IR-β-Tyr and Akt-Ser phosphorylation was significantly decreased in Ang Ⅱ 10-5 and 10-4 mol/L group; no significant changes in insulin-stimulated IR-β-Tyr and Akt-Ser phosphorylation were detected between Ang-( 1-7 ) treatment groups and control; Ang-( 1-7 ) blocked the inhibitory effect of Ang Ⅱ on Akt-Ser phosphorylation,yet exerted no effect on Ang Ⅱ-induced IR-β-Tyr phosphorylation inhibition.Conclusion Ang Ⅱ significantly inhibits insulin signaling pathway in β cell; Ang-( 1-7 ) reverts the inhibitory effect of Ang Ⅱ on insulin-stimulated Akt-Ser phosphorylation in β cell.

Objective To evaluate the right heart function with echocardiography after right ventricle-pulmonary artery (RV-PA) anastomasis for right ventricle outflow (RVOT) reconstruction in patients with different types of pulmonary atresia and ventricle septal defect(PA/VSD).Methods From Nov 2002 to Aug 2013,31 patients with PA/VSD had undergone right ventricle-pulmonary anastomasis to reconstruct RVOT for radical or palliative repair.Related echocardiography indexs including strain/rate etc.were used to evaluate the right heart function and the progress of the right heart valves regurgitation.Results There were 3 early hospital deaths.No later death during follow-up.The echocardiography suggested the pulmonary artery and tricuspid regurgitation were more serious,however,the right heart function was relatively fine.The regurgitation of tricuspid valve was positive correlation with duration of follow-up (P =0.016).Conclusion The right heart function in follow-up keeps relatively well,and tricuspid valve regurgitation needs a long-term follow-up.

Objective To compare the two different ways of right ventricular outflow tract(RVOT) reconstruction at repair of pulmonary atresia with ventricular septal defect,the direct RV-PA anastomosis and pericardial conduit to find the better way.Methods From Jun.2002 to Oct.2012,66 patients underwent pulmonary atresia with ventricular septal defect repair in our hospital,age at operation from 14 days to 272 months.Patients were divided into 2 groups according to the way of RVOT reconstruction.Group 1:31 of them,using direct RV-PA anastomasis,Group 2:35 of them,using pericardial conduit.Paired t test was used to evaluate the growth of pulmonary arteries.Chi-square test and Kaplan-Meier were used to calculate the postoperative mortality,reopemtion situation and survival time.Results There are 3 early hospital death in group 1 (9.7 ％),and 5 in group 2(14.3％),P =0.71.There is a significant difference between the two groups in restenosis rate of the RV-PA anastomasis and autologous pericardial conduit with pulmonary branch artery(Group 1:22.2％,Group 2:55.6％,P =0.01).The diameters of RV-PA anastomasis and the pulmonary artery branches in follow-up were significantly lager than the earlier diameters(P ＜ 0.05) in group 1.There is no growth on diameters of the pericardial conduit and pulmonary branches except the right pulmonary artery in follow-up in group 2.There is no significant difference between the two groups in later survival(P =0.30).Conclusion Both the direct anastomasis of RV-PA and pericardial conduit are available for RVOT reconstruction in pulmonary atresia with ventricular setal defect repair.There is lower incidence of RVOT and pulmonary stenosis and anastomosis absolutely has the ability for later growth in the former.

Theδ13 C values of volatile organic compounds ( VOCs) in various emission sources and ambient air were analyzed by using thermal desorption coupled with gas chromatography and isotope ratio mass. The lowest sample concentration and peak shape quality needed for high precision and accurate analysis were investigated. Fuel evaporation ( gasoline and diesel) , vehicle exhaust, solvent evaporation, dining fumes and ambient air of different functional zones of Xiamen city were collected using Tenax TA tube, and the significant differences in δ13 C values of VOCs between these sources were observed. The δ13 C value of gasoline exhaust ( 97 # ) was heavier (-25 . 84‰) than that of dining fumes (-30 . 26‰) and theδ13 C values of fuel evaporation were heavier than that of vehicle exhaust after combustion. The average δ13 C value of atmospheric VOCs in Xiamen was at the level of -27 . 03‰ to -25 . 40‰, which was close to the δ13 C value of the evaporation and exhaust of gasoline and diesel, indicating that the VOCs in the atmosphere of Xiamen was highly influenced by transportation related sources.

Objective To investigate the prevalence of chronic kidney disease (CKD)and risk factors in the adult population of Tianshan district in Urumqi, Xinjiang. Methods A total of 2131 residents from 4 communities in Tianshan district of Urumqi city were randomly selected using a stratified, multistage sampling. All the residents were interviewed and tested for morning spot urine of albumin to creatinine ratio (ACR) (abnormal ≥ 30 mg/g), morning spot urine dipstick of hematuria ( abnormal ＞3 red blood cells/HP or greater) and pyuria ( abnormal＞ 5 white blood cells/HP) confirmed by microscopy. Renal function was determined with abbreviated MDRD equation [reduced estimated glomerular filtration rate (eGFR)＜60 ml ·min-1 ·(1.73 m2)-1]. The associations of kidney damage indicators with age, gender, hypertension, diabetes mellitus, income,education, cholesterol, triglyceride and smoking were examined. Results Eligible data of 2131 subjects were collected in the study. After the adjustment of age and gender component, the prevalence of albuminuria was found in 2.63％ (95％CI:1.78％-3.48％) of subjects, hematuria in 7.43％(95％CI:6.11％-8.75％) and reduced renal function in 1.72％(95％CI:1.08％-2.35％).Approximately 9.99％(95％CI:8.47％-11.55％) of subjects had at least one indicator of kidney damage. Multivariate logistic regression revealed that albuminuria, hematuria, age and hyperuricemia were independently associated with reduced renal function. Hematuria and reduced renal function were independently associated with albuminuria. Albuminuria, reduced renal function and female were independently associated with hematuria. Conclusion In urban adult population over 35 years old of Urumqi, a big city in western China, the prevalence of CKD is 9.99％, the recognition is 2.44％ and the risk factors of CKD are similar to those of other domestic big cities and western developed countries.

OBJECTIVE:To optimize the hypoglycemic active parts from the leaves of Dimocarpus longan for type 2 diabetes mellitus mice,and to provide reference for material basis study of it. METHODS:Total extract was obtained from the leaves of D. longan with 95% ethanol percolation extraction. After confirming hypoglycemic effect of total extract,extract was suspended with water. Relevant extract was obtained by using petroleum ether,ethyl acetate and n-butanol in turn(respectively marked as ST,YT,ZT and WT). The model of type 2 diabetes mellitus mice was established by high glucose and high fat diet combined with STZ. Model mice were randomly divided into model group(distilled water),positive control group(metformin,0.1 g/kg), ST low-dose,medium-dose and high-dose groups(22.2,29.6,44 g/kg,calculated by crude drug,similarly hereinafter),YT low-dose,medium-dose and high-dose groups(10.7,16,32 g/kg),ZT low-dose,medium-dose and high-dose groups(10.5, 15.8,31.6 g/kg),WT low-dose,medium-dose and high-dose groups(18.5,24.6,37 g/kg),with 10 mice in each group. Other 10 normal mice were included in normal group(distilled water). Those groups were given relevant medicine intragastrically,once a day,for consecutive 28 d.The growth of mice and the change of body weight were observed and recorded. Fasting blood glucose(FBG)of mice was detected,and glucose tolerance test of mice was conducted. The contents of TC,TG,HDL-C and LDL-C in serum of mice were also determined. RESULTS:Compared with normal group,body weight and serum content of HDL-C in model group were decreased;FBG and the blood sugar after giving glucose for 0.5,1,2 h and area under glucose tolerance curve of mice were increased,and serum contents of TC,TG and LDL-C were alse increased,with statistical significance(P<0.01). compared with model group,body weight of mice in YT high-dose group after administration of 25 d was increased,FBG of mice in YT groups and ZT medium-dose,high-dose groups were decreased(P<0.05 or P<0.01);blood sugar of mice in YT medium-dose,high-dose groups and ZT high-dose group after giving glucose for 1 h as well as blood sugar of mice in YT high-dose group after giving glucose for 2 h were all decreased;area under glucose tolerance curve of mice and serum content of TC were decreased in YT groups and ZT high-dose group,while serum content of HDL-C was increased. Serum content of TG and LDL-C in YT high-dose group and ZT high-dose group as well as serum content of TG in YT medium-dose group were all decreased,serum content of HDL-C in ZT medium-dose group was increased,with statistical significance(P<0.05 or P<0.01). CONCLUSIONS:The ethyl acetate part and n-butanol part from the leaves of D. longan show good hypoglycemic effect on type 2 diabetes mellitus mice.