The organophosphorus insecticides including a large group of insecticides were widely used in the world in the agriculture and household. Over 80% of the pesticides used in China are organophosphorus pesticides. Workers and the general population may be exposed to insecticides mixtures through water,air and the residue of food. After entering into human body,the insecticide mixtures can cause a combined toxicity. In this paper,the effects and toxicity mechanisms of combined exposures on health were expounded.

Objective To investigate the effect and possible mechanism of curcumin on the proliferation and apoptosis of cell strain of bladder carcinoma.Methods In curcumin group,T24 cells were treated with curcumin of 1,10,100 ?mol/L respectively,while no curcumin treatment in control group.The growth,apoptosis,AKT1 protein activity and mRNA level,caspase 3 content of T24 cells were observed by MTT,TUNEL,RT-PCR,immunoblot and image analysis technology 12,24 and 48 h after the commencement of curcumin treatment.Results In the curcumin group,the inhibition rate,apoptosis and the content of caspase 3 of T24 cells increased significantly.The activity of AKT1 protein decreased,but the mRNA level of AKT1 showed no changes.Conclusion Curcumin can inhibit the growth of T24 cells and induce the cell apoptosis,which mechanism is related to the inhibition of AKT1 signal pathway of T24 cells.

Objective　To analyze the clinicopathologic characteristics and treatment of primary and secondary bladder mucosa lymphoma.　Methods　From June 1996 to September 2011,8 cases of bladder mucosa lymphoma patients including primary bladder mucosa lymphoma patients (2 males and 3 females)and secondary bladder mucosa lymphoma patients ( 1 male and 2 females) were treated in our institute.The patient's mean age was 68 years (ranged from 57 to 78 years),and the other 3 secondary bladder mucosa lymphoma patient's mean age was 61 years (ranged from 41 to 81 years).7 of 8 patients accepted transurethral resection of bladder tumor combined with CHOP chemotherapy and radiotherapy,and 1 patient abandoned treatment.CHOP chemotherapy and radiotherapy were performed at 2 weeks post-operatively.Secondary bladder mucosa lymphoma patients accepted 3-dimensional conformal 6000 cGy radiotherapy.Urinary CT examination showed that there were round or oval irregular tumors in the wall of urinary bladder,whose diameters were 1 to 4 cm.Tumor edges were glossy and tumor density were uniform.In addition,the bladder wall with tumor was uneven.In contrasted CT,the tumors appeared obviously enhanced.7 cases had cauliflower-like tumors found by cystoscope,and there were necrosis-calcification area in the center of tumors.1case appeared multiple tumors,which consisted of one big tumor and three smaller ones.　Results　There were 5 cases of primary bladder mucosa lymphoma, including 3 bladder mucosa associated lymphoma (MAL) cases and 2 diffuse large B cell lymphoma cases.There were 3 secondary bladder mucosa lymphoma cases including 2 diffuse large B cell lymphoma cases and 1 generalized follicular cystic central lymphoma case,which belongs to the tuberous sclerosis Hodgkin lymphoma.Immunohistochemical analysis showed that CD20,CD21,CD43 staining were positive in low grade MAL (3 cases).However,CD3,CD20,CD31 staining were positivein high grade MAL (5 cases). All patients were followed up 3 to 44 months.3 cases of secondary malignant lymphoma patients died after diagnosed after 3 to 13 months.5 cases of primary malignant lymphoma patients were all survived. 1 case recurred 14 months after surgery and accepted TURBT and CHOP chemotherapy again.Pathologic diagnosis showed the transformation from peripheral zone of bladder mucosa associated lymphoma to diffuse large B cell lymphoma.The patient was free of recurrence.　Conclusions　MAL and diffuse large B cell lymphoma are the most common type of bladder mucosa lymphoma.Primary and secondary diffuse large B cell lymphoma have similarities in histological analysis,but the former prognosis is better than the latter's. Transurethral resection of bladder tumor combined with chemotherapy and radiotherapy can prevent the relapse of MAL in short term and long term with good tolerance,and can be used as ideal treatment of MALT.

Objective To evaluate the clinical efficacy of tacrolimus and cyclophosphamide (CTX) on lupus nephritis.Methods The clinical trials on treatment of lupus nephritis with tacrolimus and CTX published before October 2012 were searched at Cochrane library,PubMed,OVID,Wanfang database,Chinese Journal full-text Database,Chongqing Weipu Database by using the methods of Cochrane systematic review.At the same time the information from related journals,professional data and network were hand-searched.The homogeneous evaluation was performed by Meta-analysis.Statistical analysis of clinical data was performed by using Stata11 software.Results A total of 4783 reports were found,while only 9 papers (8 randomized controlled trials and 1 cohort study) met the inclusion criteria.Tacrolimus group got better complete remission ratio (Z =4.05,P ＜ 0.01),similar partial remission ratio (Z =0.44,P =0.661),and better overall remission ratio (Z =4.29,P ＜ 0.01) as compared with CTX group.There were no significant differences between tacrolimus group and CTX group in the incidence of infection (Z=1.75,P=0.081),renal damage (Z=0.88,P=0.38) and abnormal glucose metabolism (Z =1.91,P =0.070).Side effects such as liver function impairment (Z =2.65,P＜0.01),gastrointestinal discomfort (Z=2.31,P＜0.05),menstrual disorders (Z=3.88,P＜0.01),bone marrow suppression (Z =3.29,P ＜ 0.01) in tacrolimus group were lower than those in CTX group.Conclusions Compared with CTX,tacrolimus has better complete remission ratio and overall remission ratio,with less side-effects in the treatment of lupus nephritis.However,large scale,multicenter,well-designed clinical trials should be adopted to further confirm the conclusions.

Objective To investigate the risk factors of acute kidney injury (AKI) in patients after acute myocardial infarction (AMI).Methods A total of 1 371 adult patients diagnosed AMI in the First People's Hospital of Changzhou from January 2008 to December 2012 were analyzed retrospectively.AKI was defined according to the 2012 KDIGO AKI criteria.Based on the occurrence of AKI,the patients were divided into AKI group and non-AKI group.According to the AKI timing,the patients were divided into subgroups including conservative treatment groups,coronary angiography (CAG) groups and coronary artery bypass grafting (CABG) groups,respectively.Related risk factors of AKI were analyzed by univariate and multivariate logistic regression.Results Of the 1 371 patients,410(29.9％) developed AKI.Compared to the non-AKI group,in-hospital mortality increased significantly in the AKI group (17.1％ vs 3.9％,x2=68.0,P ＜ 0.001).Multifactor retrospective analysis showed that decreased baseline eGFR (OR=2.049,95％ CI:1.246-3.370),increased fasting plasma glucose(FPG) (OR=1.070,95％CI:1.018-1.124),diuretics (OR=1.867,95％CI:1.220-2.856) and Killip class 4 status (OR=1.362,95％ CI:1.059-3.170) were all independent risk factors of AKI,while increased DBP on admission was a protective factor (OR=0.986,95％ CI:0.974-0.998) for the conservative management group.Decreased baseline eGFR (OR=2.371,95％CI:1.500-3.747),increased FPG(OR=1.009,95％CI:1.005-1.012),diuretics (OR=1.674,95％CI:1.042-2.690),intraoperative hypotension (OR=2.276,95％ CI:1.324-3.575) and acute infection (OR=1.678,95％CI:1.023-2.754) were independent risk factors of AKI for the CAG group.Decreased baseline eGFR (OR=2.246,95％CI:1.340-3.981),increased FPG (OR=1.059,95％CI:1.018-1.124),diuretics (OR=1.723,95％CI:1.122-2.650),and low cardiac output syndrome after operation (OR=2.331,95％ CI:1.277-3.286) were independent risk factors of AKI for CABG group.Conclusions AKI is a common complication and associated with increased mortality after AMI.Decreased baseline renal function,increased FPG and diuretics were common independent risk factors of AKI after AMI.

Objective To compare the clinical characters and hemodynamic data of the prone position and supine position percutaneous nephrolithotomy. Methods Patients with kidney stones in 100 cases were randomly assigned into the supine position group and prone position group.There were 50 cases in each group.The following data were recorded at preoperative,intraoperative,change position:the blood pressure,heart rate,respiration,saturation of blood oxygen and blood gas analysis results.The VAS score was recorded in patients for postural comfort,dyspnea and pain score. Results The systolic blood pressure in the preoperative,intraoperative,postoperative on supine position and prone position were as follows:(137±12),(119±15),(115±17) mm Hg and (137±10),(110±18),(104±16) mmHg.The diastalic blood pressure was as follows:( 81 ± 9 ),(74 ± 8 ),(63 ± 14 ) mm Hg and ( 84 ± 8 ),(63 ± 9 ),(60 ± 15) mm Hg.Compared with preoperative,there was a blood pressure decreased in both groups.The blood pH at preoperative,intraoperative,postoperative in supine position and prone position:7.4 ± 0,7.3 ± 0,7.3 ± 0 and 7.4 ± 0,7.3 ± 0,7.3 ± 0.The bass excess (BE) of two groups were:(2.1 ± 0.5),(-2.7 ±0.5),( -1.5 ±0.5) mmol/L and (3.2 ±0.5),(-3.8 ±0.5),(-2.5 ±0.5) mmol/L.Compared with preoperative data,the pH and BE declined in both groups.The prone position had more pronounced decrease in serum sodium,serum potassium; but with no significant difference.Supine group in postural comfort and breathing difficulties were 1.6 ± 0.4 and 7.1 4± 05,while prone group were 7.5 ± 0.2 and 1.4 ± 0.3.The supine position showed better in postural comfort and breathing difficulties with statistical significance. Conclusions Compared with the prone position,the supine positioned percutaneous nephrolithotomy could have less influence on hemodynamics,blood gas analysis.It could have better postural comfort.

Objective To investigate the safety and efficacy of percutaneous nephrolithotomy (PCNL) in a new operative position, flank suspended supine position. Methods The new position hold affected flank suspended by raising the ipsilateral shoulder and haunch with two 3-liter saline bags, and set up waist bridge simultaneously. From March 2010 to October 2010, a series of 173 patients underwent PCNL with the new supine position under epidural anesthesia. The average age was (50± 11) years, and the average bulk of the stone was (2. 9±1.0) cm. All patients were placed in the new supine position. Under ultrasound guidance, the desired calix or pelvis was punctured near the posterior axillary line, then dilating the tract and establishing the 16 F or 20 F tract for PCNL. Results The pelvicaliceal system could be successfully approached in all patients. The procedure was well tolerated in all patients. Mean operation time was (86 ± 34) min. 80. 3% of the patients were rendered free of stones by the initial PCNL. Thirty-four cases had residual stones, and a second PCNL was performed in 16 cases to clear the residual stones. Only 1 patient required blood transfusion.None of the patients suffered visceral injury. Conclusion The new supine position is safe and effective for PCNL.

AscreeningmethodforcriticalaminoacidsinEpitopesusinganti-Epitopeantibodywasdeveloped. The amino acids' frequency of occurrence in Epitopes of shrimp antigen Pen a1 was calculated using MEGA5 software and their conservative property of tropomyosin in SDAP database bank was analyzed using DNAMAN software. Potential critical amino acids based on these two methods were identified, namely Epitope 1 ( K, E, N) , Epitope 2 ( K, L, E) , Epitope 3 ( E, R, D, L, Q) , Epitope 5 ( K, L, Q) . The mutated polypeptides corresponding to these Epitopes in which these critical amino acids were substituted with alanine were synthesized. The IgG binding ability of these mutants was analyzed by competitive immunodot-blot method and indirect ELISA using Epitope antibody to screen the critical amino acids. Experimental results showed that the critical amino acids of the four Epitopes were as follows: Epitope 1 ( Gln ) , Epitope 2 ( Leu and Glu ) , Epitope 3 ( Leu and Asp) , Epitope 5 ( Leu) . The feasibility of this screening method was proved and it also offered a theoretical foundation for research on sensitization mechanism of Pen a1 and desensitization using gene modification.

This paper reported a case of neonatal radial nerve palsy that was successfully treated by conservative therapy. The patient with 39 weeks of gestational age was born vaginally. On the 2nd day after birth, right wrist drop, decreased muscle strength in the right upper limb, the erythema patch, and the subcutaneous nodule on the upper arm were observed. Electromyography revealed acute denervation of the radial nerve. Based on the electromyography results combined with clinical evaluations, neonatal radial nerve palsy was diagnosed. The patient was treated with self-made simple splint fixation along with comprehensive treatment. At 15 days of age, the family members removed the splint fixation themselves (13 days of fixation). At the age of 20 days, the symptoms of right wrist drop had disappeared, and the grasp reflex and Moro reflex of both hands returned to normal. A follow-up electromyography conducted at six months after discharge showed no obvious abnormalities.