ObjectiveTo investigate whether early goal-directed therapy (EGDT) could improve the mortality rate in patients with severe sepsis or septic shock.Methods Articles were retrieved from PubMed, Cochrane Library, Embase data, Wanfang data, and CNKI from January 1980 to May 2015. Inclusion criteria included the subjects concerning patients with severe sepsis or septic shock reported as randomized controlled trial (RCT), clinical controlled trial (CCT), case-control studies, cohort studies with complete data, which endpoints were the short-term mortality [in-hospital, intensive care unit (ICU) or 28-day] and long-term mortality (60-day, 90-day or 1 year). RevMan 5.2 software was used for Meta analysis of effect of EGDT on mortality rate in patients with severe sepsis or septic shock, and funnel plot was drawn to evaluate the quality of enrolled literature.Results There were 12 studies meeting inclusive criteria including 5 528 patients, 4 RCTs, 3 case-control studies, 4 cohort studies, and 1 quasi-experimental research. It was shown by Meta analysis that EGDT was associated with significant decrease in the short-term mortality [relative risk (RR) = 0.72, 95% confidence interval (95%CI) = 0.64-0.80,P< 0.000 01], but not associated with decrease of long-term mortality (RR = 0.99, 95%CI = 0.92-1.06,P = 0.81). The funnel plot showed that there was no publication bias. EGDT was recommended as grade C.Conclusions EGDT was associated with significant improvement in short-term mortality but not with long-term mortality in patients with severe sepsis or septic shock. Grade C was recommended by our study.

Objective To evaluate the therapeutic efficacy of neoadjuvant chemotherapy in cervical carcinoma. Methods TAC(DDP, EPI and BLM) was applied in 68 patients with cervical carcinoma. Therapeutic efficacy and side effects were documented. Results After 1～3 cycles of neoadjuvant chemotherapy, clinical symptoms remission rares reached 100% ,response rate were 100% (40/40) in Ⅰ b～Ⅱ a,90.9% (20/22) in Ⅱ b and 50% (2/4)in Ⅲ a, respectively. Radical resection reached 91.2 %, and only 6 patients of advanced disease failed to radical resection and turned to radiotherapy. Conclusion Neoadjuvant chemotherapy is a safe and effective therapeutic option which could alleviate clinical symptoms, decrease tumor size, down-staging and increase the radical resection rate.

Objective To explore the biological characteristics of pancreatic cancer vascular endothelial cells,including the aspects of morphology,species,genetics,vascular formation ability,and proliferation ability in vitro.Methods The human pancreatic cancer cells were inoculated in nude mice pancreas to get pancreatic cancer vascular endothlial cell.The pancreatic cancer vascular endothelial cells were cultured in vitro.The passage number and passage time were recorded.The morphological features under common microscopy of each passage were observed.The species origin and genetic characteristics of the pancreatic cancer vascular endothelial cells were detected by karyotype assay.The ability of angiogenesis of the pancreatic cancer vascular endothelial cells in vitro was determined by tube formation assay.The proliferation of the pancreatic cancer vascular endothelial cells in vitro was measured by MTT method.The data were analyzed by one way analysis of variance and paired difference test.Results Under appropriate culture condition, the pancreatic cancer endothelial cells were passaged every two to three days.Once confluence was attained,the cells were in monolayer growth and with cobblestone feature.The species type of the pancreatic cancer vascular endothelial cells was human type.A large number of polyploid cells, non-integer multiple chromosomes cells, nuclear chromosome loss, nuclear chromosome dislocation, and unanalyzable fragments were observed.The pancreatic cancer vascular endothelial cells could form a hollow tubular structure in vitro.After cultured for 48 and 72 hours,the absorbance of the pancreatic cancer vascular endothelial cells was 0.581 ± 0.014 and 1.082 ± 0.033 respectively,both were significantly higher than those of human umbilical vein vascular endothelial cells (0.379± 0.038,t=8.720,P=0.001;0.604±0.026,t=19.883,P＜0.01).Conclusions The species origin of pancreatic cancer vascular endothelial cells is same as human pancreatic cancer cells.The cells have typical morphological features and in vitro angiogenesis formation ability of vascular endothelial cells,whose genetic feature is instable and proliferation is active.

Objective To investigate the effects of aldosterone on the expression of endothelin(ET)in cultured neonatal rat cardiac fibroblasts(CFs).Methods CFs were isolated by trypsin digestion.ET concentration in conditioned medium was measured by radioimmunoassay,intracellular ET-1 level was evaluated by immunofluorescence assay,and the expression of preproendothelin-1(ppET-1)was detected using reverse transcriptase-polymerase chain reaction(RT-PCR)method.Results Aldosterone(10-9,10-8,10-7 mol/L)induced a dose-dependent changes in ppET-1 mRNA expression,as well as ET-1 synthesis and secretion in CFs.Meanwhile,aldosterone(10-7 mol/L)time-related induced ppET-1 mRNA expression in CFs,which began to increase in 2 h and reached the highest level in 4 h,thereafter decreased.The effects of aldosterone(10-7 mol/L)were significantly inhibited by the pre-incubation with spironolactone(10-6 mol/L).Conclusion Aldosterone increases the expression of ppET-1 mRNA,ET-1 synthesis and secretion via mineralocorticoid receptor.

Objective To investigate the risk factors for early hypoglycemia and its relationship with prognosis of patients with cerebral infarction.Methods A total of 273 patients with cerebral infarction were divided into the normal blood glucose(NBG) and severe hypoglycemia (SHG)and mild hypoglycemia(MHG) groups in our hospital.Biochemical indicators,the National Institute of Health stroke scale(NIHSS)and mortality were compared between the three groups.According to prognosis,patients were divided into death group and survival group.The NIHSS score,blood glucose concentration and incidence of hypoglycemia were compared between death and survival groups.Pearson relationship between hypoglycemia and NIHSS score,and spearman rank correlation between hypoglycemia severity and mortality were analyzed.Results Levels of lactic acid (6.3 ± 2.8) mmol/L,creatinine(268.7 ± 63.9) mmol/L,urea nitrogen (13.8 ± 3.7) mmol/L,albumin (25.6 ±4.9) g/L,alanine aminotransferase (150 ± 19.7) U/L,NIHSS (22.3 ± 9.2) scores,and mortality rates (38.1 ％)were higher in severe hypoglycemia group than in both NBG group and severe hypoglycemia group[(lactic acid:4.7±2.3 mmol/L and 3.3±1.5 mmol/L),(creatinine 134.8±51.3 mmol/L and 78.7±40.8 mmol/L),(urea nitrogen 7.9±4.2 mmol/L and 7.7±3.3 mmol/L),(albumin 36.9±3.8 g/L and 35.6±4.3 g/L),(alanine aminotransferase 85.8± 18.3U/L and 46.3± 13.8U/L),(NHISS 14.6±5.9 scores and 10.5 ± 5.4 scores)and(mortality rates 20.8％,11.0％)] (all P＜0.01).There was a negative correlation between hypoglycemia and NIHSS score(r=-0.45,P＜＜0.05).There was a positive correlation between hypoglycemic severity and mortality (r =0.41,P ＜ 0.05).Multiple Logistic regression showed that creatinine and alanine aminotransferase were correlated with hypoglycemia and prognosis of patients with cerebral infarction(both P＜0.05).Conclusions Early hypoglycemia in patients with severe cerebral infarction is closely correlated with the liver and kidney insufficiency,and a severe cerebral infarction combined with hypoglycemia often indicate a poor prognosis.

Objective To evaluate the clinical outcome and the acute toxicity in nasopharyngeal carcinoma (NPC) treated with tomotherapy followed by the anti-EGFR monoclonal antibody.Methods Between March 2008 and November 2009,34 newly diagnosed NPC patients were treated with helical tomotherapy combined with nimotuzumab or cetuximab.All the patients underwent tomotherapy at the dose of 70 Gy/33F for the gross tumor volume (pGTVns) and positive lymphnodes (GTVnd) ,and 60 Gy/33F for the high risk clinical target volume (PTV1),and 56 Gy/33 F for the low risk clinical target volume (PTV2),respectively.17 patients in group N were given weekly injection of 200 mg for 6-7 times and 17 patients in group C were given initial dosage 400 mg/m2 followed by subsequent weekly dosage of 250 mg/m2 for 6-7 times.Acute lesions were evaluated with the RTOG/EORTC criteria.Result The median follow-up time was 22 months.The effective rates (CR + PR) in 3,6 and 12 months were 14/17,12/17,12/17 in group N and 15/17,14/17,14/17 in group C.The 1 year survival rate was 15/17 in group Nand 17/17 in group C.Nimotuzumab had less acute mucositis reaction (u = 2.25,P < 0.05),weight loss(t=2.56,P=0.02) and rash (u=4.36,P＜0.01) compared with cetuximab.Conclusions Helical tomotherapy combined with nimotuzumab or cetuximab was effective and made no difference in the shortterm efficacy and 1 year survival rate for the patients with NPC.Nimotuzumab has less acute reaction than cetuximab.More studies should be done to prove long-term effects.

Objectives To compare the migrating motor complex (MMC) in irritable bowel syndrome (IBS) patients with that in healthy controls. To explore whether discrete clustered contractions (DCC) are connected with abdominal pain in IBS patients. To improve the method of measuring gastroenteric motility (esp. jejunum). Methods By using 16-channel water-perfused catheter and manometry instruments, MMC in 16 cases of IBS with constipation (IBS-C), 18 cases of IBS with diarrhea (IBS-D) and 18 cases of healthy controls were monitored. Results The MMC durations of IBS-C and IBS-D patients were (127.5±25.5) min and (74.5±18.7) min, respectively. Comparision with those in the control group [(87.5±24.2) min]showed significant differences (P<0. 001). The contraction amplitudes of stage Ⅲ in different sites of IBS-C patients decreased significantly as compared with those in the controls [jejunum, (39.8±11.7) mm Hg vs. (61.1±14.1) mm Hg,P<0.001,1 mm Hg=0.133 kPa]. The propagation velocities of stage Ⅲ in different sites of IBS-C patients also decreased significantly as compared with those in the controls [jejunum, (1.8±0.9) cm/min vs. (2.6±0.8) cm/min,P<0.01].The contraction amplitudes of stage Ⅲ in different sites of IBS-D patients increased significantly as compared with those in the controls [jejunum, (69.7±20.5) mm Hg vs. (61.1±14.1) mm Hg, P<0.01]. The propagation velocities of stage Ⅲ in different sites of IBS-D patients also increased significantly as compared with those in the controls [jejunum, (4.1±2.5) cm/min vs. (2.6±0.8) cm/min, P < 0. 01]. DCC incidences of IBS-C and IBS-D were 87.5% and 88. 8%, respectively. Comperision with those in the normal group (83.3%) did not show significant difference (P>0.05). The prevalences of abnormal stage Ⅲ contractions (include disturbances and interferences of stage Ⅲ contractions) in IBS-C and IBS-D patients were 68.8% and 66. 7%, respectively; there were no significant differences between the two groups (P > 0. 05). However abnormal stage Ⅲ contractions did not exist in healthy controls. Conclusions (1) The MMC of IBS-C and IBS-D patients are changed, as compared with that in healthy people; this implies that small intestinal motility dysfunction is one of the pathogenetic factors of IBS. The abnormal stage Ⅲ contractions in jejunum may be a predominant change in IBS gastroenteric motility. (2) No apparent connection is found between DCC and pain in IBS. (3) By using 16-channel water-perfused catheter, we first carried out the method of monitoring jejunum contractions in China. Parameters of MMC in Chinese healthy people were investigated, esp. those of jejunum.

Background The injury or surgery of cornea cause the proliferation of corneal stromal cells and scar formation.Recent research showed that cureumin can obviously reduce the degree of fibrosis of tissue.But if curcumm play inhibitory effect on corneal keratocytes fibrosis is rarely reported.Objecttve This studv was to investigate the effect of curcumin on the transformation of corneal keratocytes into fibroblasts in vitro and further explore the antifibrotic effect of curcumin on corneal keratocytes.Methods The murine corneal keratocytes from 150 BALB/c mice were isolated and primary culture in DMEM culture medium containing 10% fetal bovine serum and then divided into blank control group(inducer group,CG),low-dose group(CG+7.5 mg/L curcumin),mediumdose group(CG+10.0 mg/L curcumin),high-dose group(CG+12.5 mg/L curcumin),non-inducer group.Seven days following intervention,the expression of cell markers such as keratocan,aldehyde dehydrogenase(ALDH),decorin and fibronectin-1 in keratocytes were analyzed by RT-PCR.The effect of curcumin on cultured murine corneal keratocytes proliferation was evaluated by MTS technique.The expression of fibronectin-1 in murine cornea was investigated by immunofluorescence assay.Results The primarily cultured keratocytes showed tlIe fusiform-like shape with the abundant cytoplasm and big nuclei.In the presence of curcumin,the mRNA levels of keratocan and ALDH were down-regulated and those of CD90 and decorin were up-regulated,showing the significantly differences with the increase of dose(P<0.05),but the expression pf fibronectin-i was not obviously changed with the alteration of dose of curcumin. MTS showed that the inhibitory rates of curcumin on keratocytes in 10.0 mg/L and 2. 5 mg/L groups were enhanced in comparison with 7.5 mg/L group, showing statistically significant difference among three groups( F = 956.00, P<0.05). The expression of fibronectin-1 was found in the corneal keratocytes with the red fluorescence in stroma. Conclusion Curcumin can inhibit the fibrosis of corneal keratoeytes in a dose-dependent manner. These results offer a preliminary theoretical basis for the application of curcumin in controlling corneal scar formation during wound healing.

Background Researches demonstrated that dendritic cells(DCs) are uniformly immature in the central cornea but mature in the peripheral region of cornea.So an important question is which factor impact the maturation of DCs,especially in terms of corneal transplant rejection and the known roles of DCs in the development and persistence of some corneal diseases.Objective This study aimed to examine whether corneal stroma cells (CSCs) inhibit DCs maturation through secreting transforming growth factor beta 2 (TGF-β2) and prostaglandin E2 (PGE2).Methods DCs,T cells and CSCs were isolated and cultured from clean BALB/c and C57BL/6 mice.The level of PGE2 and TGF-β2in CSCs culture supernatant and the fresh RPMI 1640 medium were then analyzed by enzyme linked immunosorbent assay (ELISA).During the DCs maturation stage,the neutralizing TGF-β2 antibody and the EP2 receptor antagonist AH6809 were added in the CSCs culture supernatant respectively.According to the different treatment,cultured cells were assigned to different groups as follows:control group,CSCs culture supernatant group,AH6809 group,TGF-β2 antibody group,AH6809 +TGF-β2 antibody group.Subsequently,the cellular surface markers for DCs,including CD11c,CD80,CD86,and MHC- Ⅱ,were analyzed by flow cytometry.The capability of stimulating the proliferation of T lymphocytes was evaluated by allogeneic mixed lymphocyte reactions,and the function of endocytosis was assessed by fluorescein isothiocyanate-dextran(FITC) uptake.Results The data of ELISA showed a higher concentration of TGF-β2 and PGE2 in murine CSCs culture supernatant than in the fresh RPMI 1640 medium.Compared with the CSCs culture supernatant group,the expression of CD80,CD86,and MHC- Ⅱ was up-regulated ( P ＜ 0.05 ),the expression of dextran was down-regulated ( P ＜ 0.05 ),and the stimulate index was increased( P＜ 0.05 ) in the TGF-β2 antibody group; the expression of CD86,and MHC-Ⅱ was up-regulated (P＜0.05),the expression of dextran was down-regulated ( F =13.740,P =0.006 ),and the stimulate index was increased(P＜0.05) in the AH6809 group;the expression of MHC-Ⅱ was up-regulated and the stimulate index was increased with statistical difference in interaction(P＜0.05 ) in the AH6809+TGF-β2 antibody group.Compared with the control group,the expression of CD80 and CD86,and the stimulate index was still lower(P＜0.05 ).Conclusions TGF-β2 and PGE2 contribute to the inhibitory effects on DCs maturation mediated by murine CSCs in vitro and further have additive effect on the immunosuppression of DCs.

Objective To observe the therapeutic efficacy of extended therapy with interferon and a nucleoside analogue for treating patients with HBeAg?positive chronic hepatitis B( CHB)?Methods Sixty cases patients diagnosed with CHB in You′an Hospital of Beijing Affiliated to Capital Medical University from March 2012 to May 2015 were retrospectively analyzed?They were divided into group A with 29 cases and group B with 31 cases according to different treatment methods?Group A were treated with pegylated interferonα?2a( Peg?IFNα?2a) combined with adefovir dipivoxil for 96 weeks,group B were treated with Peg?IFN α?2a combined with adefovir and lamivudine for 96 weeks?The patients'recovery rate of ALT,hepatitis B virus( HBV) DNA response rate and HBeAg and HBsAg seroconversion rate and conversion rate of 12,24,48,96 weeks in the treatment were observed?Results There were no significant differences in recovery rate of ALT,hepatitis B virus( HBV) DNA response rate,HBeAg seroconversion rate and HBsAg seroconversion rate between the two groups at differenct time points( P>0?05)?HBeAg seroconversion rates in group A were 34?5% at 48 weeks,62?1% at 96 weeks, and the difference was significant( P=0?036)?HBeAg seroconversion rates in group B were 35?5% at 48 weeks, 61?3% at 96 weeks,and the difference was significant ( P=0?042)?Conclusion The treatment of peginterferonα?2a in combination with adefovir dipivoxil and lamivudine is not more efficacious than peginterferon α?2a in combination with adefovir dipivoxil?The extended treatment of Peg? IFNα?2a plus a nucleoside analogue can achieve high rates of HBeAg seroconversion in patients with HBeAg?positive CHB.