Background:As an important catalytic subunit of telomerase,human telomerase reverse transcriptase (hTERT)plays an important role in the development and progression of many cancers including gastric cancer.It has been reported that several single nucleotide polymorphisms (SNPs)of hTERT had varying degrees of association with risk of neoplasms. Aims:To study the correlation between SNPs of hTERT rs2853676 and rs2853677 and susceptibility to gastric cancer. Methods:Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to detect the genotypes of rs2853676 and rs2853677 of hTERT in 297 gastric cancer patients,105 atrophic gastritis and 402 controls. Helicobacter pylori (Hp)infection was detected by pathological examination and 13 C-urea breath test.Results:Frequency of AA genotype of rs2853676 was significantly higher in gastric cancer group when compared with control group (15.2%vs.6.5%,P =0.01).The risk of gastric cancer in AA genotype carriers increased 2.47-fold (95% CI:1.46-4.16) when compared with GG carriers.No significant differences in the frequencies of CC,TC and TT genotypes of rs2853677 were found among gastric cancer patients,atrophic gastritis patients and controls.Hp infection rates in atrophic gastritis group and gastric cancer group were significantly increased than those in controls (64.8%,56.9% vs.40.3%,P all <0.01),OR were 2.73 (95% CI:1.74-4.26),1.96 (95% CI:1.44-2.67),respectively.Logistic regression analysis showed that there was no significant interaction between Hp infection and gene mutation.Conclusions:Polymorphism of hTERT gene rs2853676 may play a role in susceptibility to gastric cancer,and Hp infection may not be involved in the increase of risk of gastric cancer caused by hTERT gene polymorphism.

Objective To verify the validity and feasibility of national early warning score (NEWS) in evaluation of death risk in elderly patients with critical illness,in order to find out which scoring method is more suitable for elderly critical illness patients.Methods A prospective case-control study was conducted.The critical illness patients aged over 60 years old with the length of hospital stay over 24 hours,and admitted to Department of Emergency of Qingdao Municipal Hospital from January to December 2015 were enrolled.The clinical data including in emergency and the actual outcome of patients were collected,and the patients were divided into death group and survival group according to 30-day outcome.Patients in the two groups were assessed by using NEWS and risk classification according to the first results of vital signs monitoring.Multivariate logistic regression model was used to analyze the relationship between the NEWS classification and the risk of death in elderly critical ill patients.Results 1 950 emergency elderly patients with critical illness were enrolled,with 78 cases (4.0％) dead within 30 days and 1 872 survived (96.0％).Compared with the survival group,patients in death group were older (years:79.8 ± 10.8 vs.75.3 ± 8.9,t =4.335,P ＜0.001),and had higher acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score (22.9± 4.6 vs.18.2 ± 4.8,t =8.487,P ＜ 0.001),lower Glasgow coma scale (GCS) score (12.2 ± 4.5 vs.13.4 ± 5.2,t =-2.007,P =0.045),higher incidence of respiratory system diseases (29.5％ vs.17.9％,x 2 =12.742,P =0.013),higher NEWS score (11.2 ± 5.5 vs.3.9 ± 2.7,t =22.063,P ＜ 0.001),as well as higher proportion of patients with NEWS classification of high risk and very high risk (65.4％ vs.15.8％,x 2 =263.125,P ＜ 0.001).With the increase of NEWS risk classification,mortality rate was also increased,and the mortality rate in the patients with low,medium,high and very high risk were 0.81％ (9/1 108),3.63％ (18/496),5.83％ (13/223),30.89％ (38/123),respectively,with statistically significant difference (x 2 =179.741,P ＜ 0.001).It was showed by logistic regression analysis that the NEWS score of elderly patients with critical illness were positively correlated with 30-day death.The 30-day death risk of patients with middle risk,high risk and very high risk was 4.600,9.052 and 54.598 folds of the patients with low risk respectively.Conclusion NEWS score can be used to assess the risk of death in emergency elderly patients with critical illness.NEWS risk classification can quantify and classify the risk of death in the elderly patients with critical illness.

Objective To investigate the sedative effects of different doses of dexmedetomidine with mid-azolam in spinal anesthesia. Methods 130 cases of spinal anesthesia were randomly divided into 2 groups,group D1 and group D2,with 65 cases in each group. Patients in 2 groups were given midazolam and dexmedetomidine with different doses. The heart rates ,blood pressure ,SpO2 ,Narcotrend value and Ramsay sedation scores were recorded at mutiple time points. The working time ,maintaining time of sedative effect ,and adverse reactions were compared between 2 groups. Results MAP,HR and NT decreased significantly in 2 groups(P < 0.05,respec-tively). The keeping time was relatively longer in group D1 compared with group D2(P<0.05). The working time was faster in group D2 compared with group D1. The rate of bradycardia in group D2 was relatively higher than that in group D1. Conclusion Good sedative effect can be obtained by drug in 2 groups. Group D1,with midazolam 0.05 mg/kg+dexmedetomidine 0.3μg/kg,may have a certain advantage in anaesthesia in the spinal canal.

ObjectiveTo assess the diagnostic value of ultrasonography in the diagnosis and pathological classifi cation of appendicitis with pathological results.MethodsThe study included 111 cases who confi rmed by surgery and pathology in the Six Affi liated Hospital of Sun Yat-sen University from June2012 to December 2013. The image characteristics of ultrasonic images performed before surgery were analyzed retrospectively. The cases were divided into five groups based on the pathology: 6 acute simple appendicitis, 45 acute suppurative appendicitis, 15 acute gangrenous appendicitis, 33 chronic appendicitis, and 12 acute attack of chronic appendicitis. The length, width and wall thickness of the appendicitis measured by preoperative ultrasound between various pathological type were compared with Kruskal-Wallis statistical methord, and also used the same method to compared the one which had statistically signifi cance between the fi ve groups. As in the above case, Fisher Exact Test was used to compare the characters′ of ultrasonography included gradations of the appendix, the tube cavity expansion, stercorolith, the appendiceal abscess, mergering lymph node enlargement and the appendix around effusion, if there was statistically signifi cance, the same methord was used to the further comparison between thefi ve groups.ResultsTotally 90 of 111 cases of were reminded appendicitis by preoperative ultrasound, the diagnostic accuracy rate was 81.08%, including acute suppurative appendicitis 91.11% (41/45), acute gangrenous appendicitis 93.33% (14/15), acute simple appendicitis 83.33% (5/6), chronic appendicitis 60.61% (20/33), chronic appendicitis onset acute 83.33% (10/12). There were no statistical differences of preoperative ultrasound measured between various pathological type of appendicitis in length, while the appendix width measured by preoperative ultrasound of acute gangrenous appendicitis was wider than the acute simple group and chronic group, and there were statistically signifi cance between them (P<0.05), in the aspect of wall thickness, the acute suppurative appendicitis and the acute gangrenous appendicitis groups were thicker than the chronic group, and these differences had statistically signifi cance (P<0.05). The stercorolith, lymph node enlargement and the appendiceal abscess in different types of appendicitis had no statistical difference. There were statistically differences (P<0.05) between the acute suppurative goup, acute gangrenous group and the chronic group respectively, both in gradations of the appendix and the tube cavity expansion. Also there were statistically difference (P<0.05) between the acute gangrenous appendicitis group and the chronic group in the aspect of the appendix around effusion.ConclusionsUltrasound is valuable in the diagnosis of appendicitis, especially for acute gangrenous appendicitis and acute purulent appendicitis. The measurement of appendix with wide diameter, wall thickness by ultrasond preoperatively, and the characteristics of the wall layers, lumen expansion degree and the appendix around effusion are valuable in identifying chronic appendicitis, acute suppurative appendicitis, and acute gangrene appendicitis; The ultrasonic measurement of appendix wide diameter could identify acute gangrenous appendicitis and acute simple appendicitis. Ultrasound had limited value in identifying acute suppurative, acute gangrenous appendicitis, acute simple appendicitis, chronic appendicitis, and chronic appendicitis onset acute.

Objective:To investigate the expression of maternally expressed gene 3 (MEG3), a long non-coding RNA gene, in gastric can-cer tissues;determine the relationship of MEG3 with the prognosis of gastric cancer;and explore the relationship between MEG3 and apoptosis-associated protein P53 as well as murine double minute 2 (MDM2). Methods:Fifty-five consecutive patients with gastric cancer admitted to Qingdao Municipal Hospital for surgical treatment from September 2012 to June 2013 were included in this study. Gastric cancer and paired normal tissues were collected. The expression of MEG3 was tested through real-time quantitative poly-merase chain reaction (qRT-PCR). Western blot analysis was used to detect the expression of P53 and MDM2 in gastric cancer and eval-uate their correlations with MEG3. Results:The expression of MEG3 decreased in cancer tissues (7.98±0.19) relative to the correspond-ing normal tissues (9.47±0.18) (P<0.05). P53 and MDM2 showed negative relationships in the gastric cancer and normal tissues. A posi-tive relationship was found between P53 and MEG3 (r=0.591, P<0.05), whereas a negative relationship was found between MDM2 and MEG3 (r=?0.346, P<0.05). The median survival time was significantly prolonged in patients with high MEG3 expression compared with patients with low MEG3 expression. Conclusion:MEG3 exerts an inhibiting effect on the development of gastric cancer. MEG3, P53, and MDM2 may have important relationships in the biological mechanisms of gastric cancer development. Detecting the expression level of MEG3 may be useful for the prognosis of gastric cancer.

Objective To evaluate the efficacy of modified quadruple therapy for patients who were failed in previous Helicobacter pylori ( Hp) eradication treatment .Methods A total of 86 patients with confirmed Hp infection and failed in previous Hp eradication treatment were collected from Qingdao Municipal Hospital during January 2012 and January 2014.Patients were randomly assigned into two group:43 patients in control group were given conventional quadruple therapy ( rabeprazole +colloidal bismuth pectin +amoxicillin +clarithromycin for 14 d ) , and 43 patients in test group were given modified quadruple therapy ( rabeprazole +colloidal bismuth pectin +amoxicillin +clarithromycin for 7 d, and lansoprazole +colloidal bismuth pectin +levofloxacin +metronidazole for 7 d).Chi square test was performed to analyze per-protocol (PP) eradication rates, intent-to-treat (ITT) eradication rates, and Hp recurrence rates between two groups .Results Among 43 patients in test group , 42 completed treatments with PP eradication rate of 100.00% and ITT eradication rate of 97.67%.All patients in control group completed treatments , and Hp eradication was observed in 24 patients , and both PP and ITT eradication rates were 55.81%.The differences in PP and ITT eradication rates between two groups were of statistical significance (χ2 =23.90 and 21.11, P<0.05).The 3-month and 6-month Hp recurrence rates in test group (14.29%and 20.00%) tended to be lower than those in control group (20.83%and 34.78%), but the differences were not of statistical significance (χ2 =0.12 and 1.68, P>0.05).Conclusion The efficacy of modified quadruple therapy for patients who were failed in the previous Hp eradication treatment is satisfactory.

Objective To study the effect of osgentide (OST) on proliferation of mouse preosteoblast MC3T3-E1 under simulated microgravity ( SMG ) .Methods Under normal conditions , cell proliferation was evaluated by MTT assay to screen an OST compound of an effective concentration after MC 3T3-E1 cells were treated with series OSTs .Furthermore, cell proliferation and cell cycle distribution of MC 3T3-E1 cells were analyzed after treatment with 1 nmol/L OST5 by MTT assay and by flow cytometry ( FCM) scanning under SMG .Results Under normal conditions , 1 nmol/L OST5 was able to significantly promote the proliferation of MC3T3-E1 cells (P<0.01).Under SMG, proliferation of MC3T3-E1 cells was significantly inhibited and more cells entered G 1 than under normal conditions (CN).The proportion of S phase of MC3T3-E1 cells after treatment with 1 nmol/L OST5 ( OST-SMG) for 3 d was higher than that of untreated MC 3T3-E1 cells under SMG,suggesting that OST5 could promote DNA synthesis ( P<0.05 ) .Conclusion OST5 facilitates the proliferation of MC3T3-E1 cells under SMG, which provides a basis for the use of OST5 in the prevention and treatment of bone loss relat-ed to microgravity .

Objective To explore the effect of dose rate of X-rays on migration of non-small cell lung cancer (NSCLC) cells and provide the experimental basis for developing radiotherapy scheme. Methods Human NSCLC cell line A549 was cultured and irradiated with X-rays at dose of 6 Gy from a linear accelerator. The dose rates of 1, 2, 4 and 6 Gy/min were selected. Monolayer adherent cells were scratched and photographed at 0 hour and 24 hours under a microscope to measure the scratch width. Results After 24 hours, the scratch width of nonirradiated control cells was (640.7±8.1)μm. The scratch widths of cells were different when cells were irradiated with X-rays of various dose rates. Scratch widths were the largest in cells irradiated at dose rates of 1 Gy/min [(691.4±7.6)μm] and 6 Gy/min [(691.8±12.1)μm]. The scratch width was (666.2±1.3) μm of X-rays at 4 Gy/min, and there were significant differences compared with nonirradiated group (all P< 0.01), which suggested that inhibitory effect of X-rays at dose rates on A549 cell migration was obvious. However, the scratch width of cells irradiated at 2 Gy/min [(643.5 ±6.8) μm] had no difference compared with the control cells (t=-0.336, P=0.742). Conclusions The effect of X-rays irradiation on cell migration of human NSCLC cell line A549 is related with irradiated dose rate. The effect of different dose rates on cell migration is significantly different. Selecting appropriate dose rates for irradiation may help to improve the efficacy of radiotherapy.

Background and purpose: Syndecan-1 and HPA-1 may be involved in the progression of invasion and metastasis of many malignant tumors, but there are few reports about the relationship between the two gene expressions in gastric carcinomas. This study was aimed to explore the expression of Syndecan-1 and HPA-1 mRNA in gastric carcinoma and their relationship with the invasion and metastasis of gastric carcinoma. Methods: Real-time polymerase chain reation (RT-PCR) was used to detect mRNA of Syndecan-1 and HPA-1 in 58 cases of gastric carcinoma, 58 paired adjacent gastric carcinoma (2 cm from carcinoma), and 58 surgical marginal normal gastric mucosa tissues (5 cm from carcinoma). Then we analyzed their relationship with clinico-pathological characteristics of gastric carcinoma. Results: The upregulation of Syndecan-1 mRNA was significantly higher in normal gastric mucosa (98.3%) than that in paired adjacent mucosa (25.9%) and gastric carcinoma (5.2%) (all P<0.001).The upregulation of Syndecan-1 mRNA was significantly higher in paired adjacent mucosa than that in gastric carcinoma (all P<0.05). The upregulation of HPA-1 mRNA was significantly higher in gastric carcinoma (86.2%) than that in paired adjacent gastric carcinoma (27.6%) and normal gastric mucosa (5.2%) (P<0.001). The upregulation of HPA-1 mRNA was significantly higher in paired adjacent gastric carcinoma than that in normal gastric mucosa (all the same P<0.05). The downregulation of Syndecan-1 and the upregulation of HPA-1 had relationship with the degree of differentiation, depth of infiltration, lymph node metastasis, distant metastasis and TNM staging of gastric carcinoma (P<0.05). Conclusion: The upregulation of Syndecan-1 mRNA was significantly higher in normal gastric mucosa. The upregulation of HPA-1 mRNA was significantly higher in gastric carcinoma. Also, the expression of Syndecan-1 and HPA-1 could predict the invasion and metastasis of gastric carcinoma. Determination of Syndecan-1 and HPA-1 may be of value in the treatment as well as in the prediction for prognosis of gastric cancer.

Objective To assess the value of percutaneous posterior ultrasound-guided transgluteal approach for draining presacral abscesses.Methods From June 2013 to December 2015,retrospectively reviewed were performed in 48 patients with presacral abscesses confirmed by CT or magnetic resonance imaging(MRI)were retrospectively reviewed,and these patients underwent percutaneous US-guided transgluteal abscess drainage and catheter placement.The medical records were reviewed to determine the origins,location,and size of the abscesses,size of catheter,duration of catheter drainage,incidence of catheter-related pain and procedure-related complications,and short and long-term outcomes.The duration of drainage among different size of drainage catheter was compared,and the correlation between the volume of abcess and duration of abcess drainage was analyzed.Results The origins of the pelvic abscesses included anastomotic leakage after colorectal cancer surgery(n=38)and congenital macrocolon operation(n=3),radiation proctitis(n=2),recurrence of rectal cancer complicated with intestinal perforation,Crohn disease(n=1),appendicitis with abscess formation(n=1),rectal fistula(n=1),and postoperative pancreatic pseudocyst(n=1).The abscesses were 24-135 mm in diameter.The volume of the abscesses was 4.8-283.4 ml.The sizes of catheters used were 8-12F,and the mean duration of drainage was 13 days(range:1-52).In 42(91.3%)of 46 patients,there was complete resolution of the abscess following transgluteal drainage,without subsequent surgery.In four of 46(8.7%)patients,incomplete resolution necessitated subsequent surgery.No significant difference in drainage time was observed among 8-16F catheters(all P ＞ 0.05).The volume of abscess was positively correlated with the drainage time(r=0.281,P＜0.05).No major complications were observed,either during or after the transgluteal procedure.Conclusion Percutaneous US-guided transgluteal drainage is a safe,effective and well tolerated alternative to surgery for deep pelvic abscesses,and thus is worthy of clinical application.