Objective To observe the clinical efficacy of plasma exchange(PE),PE combined with plasma bilirubin absorp-tion(PE+PBA),and PE combined with double plasma molecule absorption system(PE+DPMAS),to investigate the best treat-ment options for the patients of hepatitis B-associated subacute severe.Methods Totally 140 patients who had hepatitis B-associat-ed were randomly divided into a PE group,a PE+PBA group,and a PE+DPMAS group.The dinical symptoms and blood rontine, electrolytc and the main biochemical indexes were recorded both before and after treatment and compared among the three groups. Results The total effective rate was higher in the PE +DPMAS group than in the PE group and PE+PBA group,which were 70.8%,60.9%,67.4% respectively,but there was no significant difference(P >0.05).compared with before treatment,serum total bilirubin (TBIL),alanine aminotransferase (ALT),aspartic acid amino shift enzyme (AST),valley aminoacyl transfer peptidase (GGT),alkaline phosphatase (ALP),globulin (GLB)and other biochemical indexes decreased significantly after treatment in 3 groups (P <0.001).PA was increased in the PE group and decreased in the PE+PBA and PE+DPMAS group after treatment,the differences were significant(P <0.05).After treatment,PT was shortened in the PE group,the differences were significant(P <0.05),but there were no significant difference between the PE+PBA and PE+DPMAS groups(P >0.05).Serum K+ and Cl- was obviously declined after treatment in the PE group,there was significant difference(P <0.001).Serum Na+ was obviously declined after treatment between the PE + PBA and PE + DPMAS groups (P < 0.001 ),but the difference was no significant in the PE groups.Serum Ca2+ was significantly decreased in the three groups of patients after treatment(P <0.001).WBC,Hb and PLT were significantly statistical difference after treatment(P <0.05).Conclusion The three groups also can improve liver function and the treatment rate for the patients of subacute hepatitis B-associated severe hepatitis.PE+PBA and PE+DPMAS groups can effective-ly reduce two thirds of the overall usage of the plasma.PE+DPMAS groups that the quantity of Cl- ,Ca2+ ,Hb decline much least in the three groups show larger value in the clinical application.

BACKGROUND:There is a lack of study on material properties and parameters of foot finite element models in China. Vernier caliper is a common method for measuring the width and thickness of ligaments and tendons to calculate the cross-sectional area.
OBJECTIVE:To design a new ligament cross-sectional area measuring instrument to improve the measurement accuracy.
METHODS:The cross-sectional area of the five fresh cadaver ankle ligaments was respectively measured using the new instrument and vernier caliper, and then a comparative analysis of the two measurement methods was performend.
RESULTS AND CONCLUSION:The cross-sectional area of anterior talofibular ligament, calcaneofibular ligament, tibionavicular ligament and calcaneotibial ligament was (20.61±7.52), (22.38±11. 49), (33.09±9.91) and (28.20±10.88) mm2, respectively measured by the vernier caliper, and (17.59±4.03), (20.77±7.91), (28.08±8.14) and (30.39±7.98) mm2 by the new ligament cross-sectional area measuring instrument. These results suggest that this new measuring instrument is accurate, reliable and easy to operate, which can be used as a special instrument to measure ligament cross-sectional area, but further studies wil be necessary.

Background and purpose: Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) can be used for magnetic resonance imaging systemic examination, especially in examing the metastatic lesions, lymph node and bone diseases, and the imaging result is similar with PET. This study aimed to evaluate the application value of magnetic resonance DWIBS and positron emission tomography with computed tomography (PET/CT) on malignant metastatic diseases. Methods: Thirty-six patients confirmed with malignant tumors accompanying metastasis by the pathology of operation or biopsy underwent both DWIBS imaging and PET/CT, chi-square test and Kappa test were used for comparing the detection results of metastasis by these 2 imaging methods. Results:Among the 36 malignant tumor patients with 238 metastatic lesions, 218 (91.6%, 218/238) lesions in DWIBS and 209 (87.8%, 209/238) lesions in PET/CT were detected, with 200 lesions detected by the two methods simultaneously, and the concordance rate was 88.7%(211/238);but there was no statistical signiifcance between this two methods (χ2=1.843, P=0.157). Kappa test showed a fair concordance rate between DWIBS and PET/CT (P=0.000).There were different significance between DWIBS and PET/CT in detecting metastatic lesions of brain and bone (P=0.005 and 0.031);But there was no signiifcant differences (P=0.309 and 1.000) in detecting metastatic lesions of lymph nodes and liver. Conclusion:DWIBS could detect metastatic lesions effectively, and there is ifne consistency with PET/CT. DWIBS is more sensitive than PET/CT in detecting metastatic lesions of brain and bone, so DWIBS could be chosed for screening metastatic lesions according to the characteristics of different primary tumors.

Objective To investigate the value of percutaneous transhepatic cholangioscopy (PTCS) for diagnosis and treatment of biliary cast after liver transplantation. Methods Data of 11 patients with biliary cast after liver transplantation, who underwent PTCS from April 2008 to November 2010, were retrospectively analyzed. Results In 11 patients , one had biliary cast in common bile duct, 3 in right intra-hepatic bile duct, 4 in left intra-hepatic bile duct, and 3 distributed in intra- and extra-hepatic bile ducts. A total of 68 times of PTCS were performed in 11 patients, achieving significant decrease in levels of serum transaminase and bilirubin in 10. Occasional fever occurred in 1 patient after closure of drainage tube,which was managed by replacement with a thinner one. There were no severe complications such as biliary fistula or uncontrollable bleeding. Partial rupture of fistula occurred in 1 case. All patients were followed up for 10-30 months and were all in good condition except one patient died from other disease during the followup. Conclusion PTCS is a safe, effective and applicable method to treat the biliary cast after liver transplantation.

Background and purpose:Neoadjuvant chemotherapy with docetaxel was gaining more attention in the treatment for locoregionally advanced nasopharyngeal carcinoma (NPC). The prediction of the sensitivity to neoadjuvant chemotherapy with docetaxel could enable clinicians to individualize treatment protocols for NPC. Recently we found that 99mTc-MIBI imaging in NPC could predict tumor response to chemotherapy with cisplatin plus 5-FU. However, there was no study to support similar findings in NPC patients receiving chemotherapy containing docetaxel. This study was to evaluate the value of double-phase 99mTc-MIBI SPECT/CT in predicting response to neoadjuvant chemotherapy with docetaxel-based regimen for nasopharyngeal carcinoma. Methods:Thirty-one nasopharyngeal carcinoma patients participated in this prospective study. Before treatment, early and delayed single-photon emission computed tomography/compute tomography (SPECT/CT) images were obtained instantly and 2 hours after an intravenous injection of 25-30 mCi 99mTc-MIBI. All patients received neoadjuvant chemotherapy consisting of docetaxel, cisplatin plus 5-FU for two cycles. The relationships between efficacy of neoadjuvant chemotherapy and the early uptake ratio, late uptake ratio and washout rate of 99mTc-MIBI were evaluated.Results:According to the MRI, the early uptake of 99mTc-MIBI (2.67±0.83) in the lesions which were sensitive to chemotherapy was significantly higher compared with that (1.69±0.46) in the insensitive lesions(P=0.003). The difference of the late uptake between the sensitive(1.46±0.39) and the insensitive (1.06±0.62) was also statistically significant (P=0.026). However, the washout rate of 99mTc-MIBI was not significantly different between the two groups (P=0.23). Through ROC curve analysis, the AUC for early uptake of 99mTc-MIBI and late uptake were 0.84. The sensitivity, specificity, positive predictive value and negative predictive value were 74.2%, 87.5%, 95.8%and 46.7%for early uptake when the cut off value of 1.97 was used. Conclusion:The uptake of 99mTc-MIBI in both early phase and late phase could predict the efficacy of neoadjuvant chemotherapy with docetaxel-based regimen.

Background and purpose: One of the main mechanism of chemotherapy is inducing tuomr apoptosis. Molecular imaging can allow noninvasively and dynamically monitor tumor apoptosis in vivo, and help to drug screening and therapeutic evaluation. The purpose of this study was to evaluate the feasibility of 18F-SFB-Annexin B1 in detecting apoptosis at an early phase after chemotheraphy. Methods:Annexin B1 was labeled with 18F using SFB as a chelating agent. Tissue distribution of 18F-SFB-Annexin B1 was studied in healthy mice by the dissection method. W256 tumor-bearing rats were injected with 18F-SFB-Annexin B1 intravenously at 24 h after the treatment of cyclophosphamide (CTX 200 mg/kg) or saline. Then imaging was acquired at 1, 2, 3, and 4 h postinjection on a PET/CT, and the tumor-to-muscle ratio of SUVmax (T/M) and the AI from TUNEL testing were compared. Results: 18F-SFB-Annexin B1 had a radiochemical pruity (RCP)>95%. Biodistribution of this probe showed a predominant uptake in the kidney, then was liver, spleen, and myocardium, rapid clearance from blood and urinary was observed. The radios of T/M were 4.38±0.56, 6.75±1.16, 6.44±1.12, 4.81±0.17, respectively at 1, 2, 3, 4 h post injection of the chemotherapy group, much higher than that of the saline group (2.35±0.14, 2.99±0.55, 3.04±0.41, 2.33±0.47, respectively). The differences between the two groups were significant (F=23.790, 16.913, 14.046, 77.517, respectively, all P<0.05). TUNEL staining revealed that chemotherapy treatment significantly increased the percentage of apoptosis cells with an AI of (21.00±0.04)%in the chemotherapy group, higher than that in the saline group (8.58±0.01)%, the difference was significant (F=21.539, P<0.05). The radios of T/M were significantly correlated with the values of AI (r=0.91, P<0.05). Conclusion: 18F-SFB-Annexin B1 can be used to apoptosis imaging and early therapeutic evaluation in vivo because it can reflect apoptosis at an early stage after chemotheraphy.

Background and purpose: 18F-FDG has been considered to be of limited value for the detection of bladder lesions because of interference by the 18F-FDG excreted in urine. Delayed pelvic images with“diluted and iflled bladder”use a method of 18F-FDG PET/CT with delayed images after oral hydration so as to increase the detection rate of 18F-lfuorodeoxyglucose(FDG) PET/CT imaging for the lesions of bladder. Methods:48 patients with bladder lesions(35 patients with bladder primary tumor and 13 patients with metastatic tumor) underwent 18F-FDG PET/CT detection and were required oral hydration of 1200-1800 mL water, urination frequently, holding urine when the more scan began. Lesions conifrmed by histopathology, MRI, CT or clinical follow-up at least 1 year. Results:89%(43/48) of patients were obtained good clearance and the urine SUVmax declined from 33.14(9-66.80)to 3.23(1.35-5.65) signiifcantly and the statistical difference was signiifcant (t=8.703, P<0.01). The interval time between two scan was 2 h approximately. At the same time, the SUVmax of bladder lesion was 2.8-25.0. Detection sensitivity, speciifcity and accuracy were 90.47%(19/21), 81.48%(22/27)and 85.41%(41/48), respectively. Conclusion: 18F-FDG activity in the bladder signiifcantly decreased in most patients with“diluted and iflled bladder”. The PET/CT scan can highly detect lesions of bladder tissues. Our method with high accuracy and better endurance could be applied to detect the lesions in bladder.

Objective To investigate the expression levels of somatostatin (SST) gene in endometrial adenocarcinoma tissues and cell lines,and the effects of over-expression of SST gene on the proliferation and invasion of endometrial cancer cell line Ishikawa in vitro.Methods Tissue sections of normal endometrium,endometrioid adenocarcinoma and uterine papillary serous carcinoma were selected to detect the expressions of SST by immunohistochemical method.The total RNA was extracted from fresh specimens that were confirmed as endometrioid adenocarcinoma.According to FIGO staging,samples included G1 (7 cases),G2 (6 cases) and G3 (5 cases) of endometrioid adenocarcinoma.The SST expression levels were detected by real-time PCR.Three endometrial cancer cell lines,Ishikawa,HEC-1A and KLE,were selected and the expression levels of SST were detected by real-time PCR and Western blot assay.Transfection was performed with pLVX-SST and pLVX.The transfection efficiency was observed by fluorescence confocal microscopy.The protein levels of SST were detected by Western blot assay.The assays of CCK-8 and transwell were applied to examine variations in cell proliferation and invasion.Results Immunohistochemical results showed that SST expression was increased in endometrioid adenocarcinoma and uterine papillary serous carcinoma compared with that of normal endometrium.Real-time PCR showed that SST expression was significantly increased in G3 compared with that of G1 and G2 in endometrioid adenocarcinoma (P ＜ 0.05).No matter mRNA or protein,SST levels were significantly increased in endometrial cancer cell line KLE compared with those of Ishikawa and HEC-1A,and the expression levels of SST mRNA and protein were significantly increased in HEC-1A group than those of Ishikawa group (P＜0.05).The expression of SST protein was significantly higher in the group of Ish-SST after 2 generations compared with that of Ish-ctr group.There were no significant differences in cell proliferation and invasive ability after over-expression of SST between Ishikawa cell group and control group (P ＞ 0.05).Conclusion SST is highly expressed in poorly differentiated endometrial cancer cells.The proliferation and invasion are not increased after the over-expression of SST in Ishikawa cell line of endometrial cancer.

Objective To evaluate the efficacy and safety of sirolimus and tacrolimus after renal transplantation.Method PubMed,Web of knowledge,Medline and the Cochrane Library were searched with the terms and Boolean operators as (kidney transplantation OR renal transplantation) AND (sirolimus OR rapamycin) AND (tacrclimus OR FKS06).Results retrieved were last updated on June 9,2014.Language limit of English and Chinese only was applied.Trials were excluded if enrolling recipients of organs other than kidneys,reporting none of the outcomes in point or combining sirolimus with tacrolimus.Patient and graft survival,acute rejection and adverse events were evaluated as primary outcomes and glomerular filtration rate (GFR) was an additional surrogate for renal function.Professional meta-analysis software RevMan 5.1 was employed to analyze the pooled risk ratio (RR) and mean difference (M D) followed by subgroup analysis and sensitivity analysis.Result Fifteen studies were included with 2480 patients.Patients in the sirolimus group showed an increased rate of acute rejection within one-year's follow-up 2.02 (95％ CI 1.37-2.99,P＜0.05) and also a higher risk of adverse events 1.31 (95％ CI 1.02-1.68,P＜0.05).The incidence of hyperlipidaemia was significantly higher with RR =1.75 (95％ CI 1.17-2.61,P＜ 0.01) in the sirolimus group.The other outcomes were insignificantly different between two groups.In subgroups with ATG as immunity induction and higher sirolimus concentration (＞4-8 μg/L),the difference was insignificant (P ＞ 0.05).Conclusion This meta-analysis concluded that sirolimus showed no advantage over tacrolimus when used early after transplantation.When used with higher concentrations,or with ATG as immunity induction,the disadvantages may be avoided.More clinical evidence is needed.

Objective To investigate the respiratory burst function of neutrophils in very low birth weight infants (VLBWI).Methods Twenty two VLBWI was divided into two groups:neonatal respiratory distress syndrome (NRDS) and non NRDS (11 in each).The respiratory burst function of neutrophils in the peripheral blood of VLBWI within 48 hours after birth was determined using the flow cytometrydihydrorhodamine 1,2,3 method before and after the chemical stimulation of phorbol-12-myrismte 14 acetate (PMA),and the gp91Phox was also measured in resting neutrophils by flow cytometry.Twenty healthy term neonates served as controls.Mann-Whitney U test was used for statistical analysis.Results Before the stimulation of PMA,the percentage of activated neutrophils of VLBWI [(49.10±20.19) ％] producing a respiratory burst was higher than that of term neonates [(18.73 ±6.81) ％] (Z--4.911,P=0.000),however,after the stimulation of PMA,the percentage of activated neutrophils of VLBWI [(96.58 ± 3.44) ％] was lower than that of term neonates [(99.20±0.62) ％] (Z--3.186,P=0.001),and the stimulation index (SI) of VLBWI (171.40 ± 103.35) was lower than that of term neonates (306.30 ± 138.47),with significant difference (Z=-3.413,P=0.001).The geometric mean of gp91Phox in VLBWI (21.66± 19.87) was higher compared with term neonates (19.60±8.03),however,the difference was not significant (P=0.350).The percentage of neutrophils that expressed gp91Phox [(56.11 ± 29.40) ％] was lower in VLBWI than that in term neonates [(80.14± 14.87) ％],with significant difference (Z=-2.374,P=0.018).Before the stimulation of PMA,the percentage of activated neutrophils of VLBWI with NRDS (63.40± 16.45) ％] was higher than that of VLBWI without NRDS [(34.80± 11.65) ％],with significant difference (Z=-3.382,P=0.001),the SI of VLBWI with NRDS (129.46 ± 75.36) was significantly lower than that of VLBWI without NRDS (213.35 ± 113.49) (Z=-2.331,P=0.020).Conclusions Neutrophils producing a respiratory burst in both VLBWI and term neonates are active without stimulation of PMA,while the phenomenon is more obvious in VLBWI.Neutrophils in VLBWI and term infants can be activated by the stimulation of PMA,and express gp91Phox.The activation and gp91Phox expression of neutrophils in VLBWI with NRDS tend to be lower than those in VLBWI without NRDS.