Objective To assess the value of endorectal elastography in the diagnosis of malignant rectal adenoma. Methods Sixty patients referred to the department of basic surgery of Peking Union Medical College Hospital for the evaluation of rectal adenoma from January 2011 to May 2013 were included in this prospective cohort. All patients underwent elasticity score (ES) and strain ratio(SR) examine before operation. To evaluate the reproducibility of the strain-ratio measurements, the intraclass correlation coefficient (ICC) was calculated. Compared with final operational pathological results,the diagnostic values of elasticity score and strain ratio method were assessed. Results Histopathological result showed there were 20 adenomas and 40 adenocarcinomas. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ERUS was 68%(27/40), 40%(8/20), 58%(35/60), 69%(27/39), 38%(8/21), respectively. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of elasticity score was 85%(34/40), 70%(14/20), 80%(48/60), 85%(34/40), 70%(14/20), respectively. The SR of adenocarcinomas was significantly higher than that of adenomas(2.82±1.81 vs 1.23±0.57, t=3.333, P < 0.05). The differences among the SR of benign adenoma, benign adenoma with severe atypical hyperplasia and completely malignant lesions were statistically significant (1.26±0.84 vs 2.94±1.95, 1.42±0.55 vs 2.94±1.95, t=2.619, 2.415, P=0.013, 0.021). When 1.240 was chosen as the best cut-off value of SR, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of strain ratio was 82%(33/40), 75%(15/20), 80%(48/60), 87%(33/38), 68%(15/22), respectively. Conclusion Endorectal elasotgraphy can accurately diagnose the malignant rectal adenoma, which can provide reliable preoperative imaging evidence for clinical operation mode.

Objective To investigate the effects of ischemic postconditioning on apoptosis, structural and functional changes of mitochondria induced by myocardial isehemia/reperfusion (I/R) injury of rabbits and potential mechanism. Methods Eighty healthy rabbits were divided randomly into five groups: sham operation group ( Group Sham) , ischemic reperfusion group (Group IR) , ischemic preconditioning group (Group IP) , ischemic postconditioning group (Group PC) and 5-HD plus ischemic postconditioning group (Group PC +5-HD). All rabbits in the five groups were killed 4 h after reperfusion. The hearts were quickly collected for microscopy by TUNEL. We observed ultrastructural changes of myocardium under electron microscope and examined mitochondrial membrane potential and Ca~(2+) concentration, MDA content and SOD activity of myocardial mitochondria. Results Compared with group IR, the damage of mitoehondrial ultrastrueture was milder, the apoptosis rate decreased and Ca concentration and MDA content were much lower in group IP and group PC ( P < 0. 05 ). Mitochondrial membrane potential and SOD activity of myocardial mitochondria in group IP and group PC was significantly higher than that in group IR(P<0.05). The protective effect of PC against I/R injury was partially counteracted by 5-HD .Conclusion Ischemic posteonditioning can protect the heart from I/R injury, this is supported by improvement mitochondrial ultrastructure and by decreasing apoptosis, increasing mitochondrial membrane potential and SOD activity, alleviating Ca~(2+) overload and decreasing MDA content in myocardial mitochondria. The cardio protective effects may be explained by mitochondrial ATP sensitive potassium channel.

Objective Our objective was to design a new type of bedpan (inflatable, bed urinal) and compare its effect with common bedpan. Methods We divided 144 patients with bone fracture and lying in bed into the test group and the control group with 72 cases in each group from May 2006 to February 2007. Inflatable bed urinals were used in the test group and common bedpans were used in the control group. The pain alleviation, comfort degree, staining of bed sheet and skin injury were observed and evaluated in each group. Results Application of inflatable bed urinal was superior to common bedpan in the following aspects: alleviation of pain, comfort degree, staining of bed sheets and skin injury. Conclusions Adoption of inflatable bed urinal could alleviate pain, prevent the incidence of complication and reduce the workload of nurses.

OBJECTIVETo assess the significance of platelet activation in unstable angina pectoris (UA) and acute myocardial infarction (AMI), and to explore the relationship of clinical effect of Xuefu Zhuyu concentrated pill (XCP) in vivo and the serum pharmacological anti-platelet activating effect of XCP in vitro.

METHODSBy flow cytometry and special labelled antibodys to detect the whole blood platelet membranous glycoprotein CD62P and CD41/45 expressions in UA patients before and after XCP treatment, as well as those in peripheral blood of AMI rats before and after co-cultured with XCP containing serum from patients at 37 degrees C for 30 min.

RESULTSCD62P and CD41/45 expressions increased significantly in UA patients to 24.36 +/- 7.91% and 29.51 +/- 12.21% respectively. After effective treatment, they decreased to 19.57 +/- 7.22% and 20.87 +/- 8.73% respectively accompanied with increase of platelet adhesion and aggregation rate. The difference of CD62P before and after treatment was significant (P < 0.05). CD62P in blood of AMI rats was 39.73 +/- 12.36%, after being co-cultured with XCP containing serum from patients treated effectively, it reduced to 30.41 +/- 10.36% (P < 0.05), but after co-cultured with the serum from patients treated ineffectively, it showed less intervention effect (P > 0.05).

CONCLUSIONPlatelet was highly activated in UA patients and AMI rats. The consistency between clinical holistic effect of XCP and serum pharmacological effect of XCP in platelet activation inhibition reflects a good correlation between serum pharmacological effect of Chinese herbal medicine and its clinical holistic effect.

Aged ; Angina, Unstable ; blood ; drug therapy ; Animals ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; blood ; P-Selectin ; blood ; Phytotherapy ; Platelet Activation ; drug effects ; Platelet Aggregation Inhibitors ; pharmacology ; therapeutic use ; Platelet Membrane Glycoprotein IIb ; blood ; Rats ; Rats, Wistar

Objective To investigate the alterations of connexin 43 (Cx43) expression and its distribution at different stages of myocardial infarction (MI) in rats after transplantation of allogenic mesenchymal stem cells (MSCs).Methods Wistar rats were ligated on the left anterior descending coronary artery to make MI models.They were injected with allogenic MSCs,which were induced by 5-aza and labelled by DAPI,during the second operation after 7 days of MI.In subgroups,MSCs were detected by fluorescence microscope.Cx43 expression and GJ distribu-tion were examined by immunohistochemistry after 4,8 or 12 weeks respectively.Results MSCs differentiated into cardiac muscle cell-like cells which were capable of pulsing spontaneously,expressing cTnT and forming myofilament in vitro.Transplanted MSCs can survive in MI host and upregulate Cx43 expression and normalize Cx43 distribution at ischemic zones after 4,8 and 12w.No change of Cx43 was seen at infarcted zones.Conclusion MSCs have the plasticity of differentiating into cardiac muscle cell-like cells which can continuously upregulate Cx43 expression and normalize Cx43 distribution at ischemic zones after 4,8 and 12w.

Objective To retrospectively assess the prognostic impact of diabetes mellitus (DM) on patients with hepatocellular carcinoma (HCC) after curative resection.Methods A total of 417 HCC patients who had undergone curative hepatic resection were included into two groups.108 patients were classified into DM group and 309 patients into the non-DM group.Overall survival,disease-free survival,postoperative morbidity and mortality were compared between the two groups after reducing confounding bias by propensity score matching.Independent prognostic predictors were determined by Cox proportional hazards model.Results Propensity score matching resulted in 89 patients in each group,and variables were balanced between two groups.In the matched cohort,DM and non-DM groups showed similar morbidity and 30-and 90-day mortality after curative hepatectomy (respectively x2 =0.837,x2 =Fisher,x2 =Fisher,all P ＞ 0.05),the 1-,3-,and 5-year overall survival rates were 82.0％,59.9％,and 33.4％ in DM group and 90.7％,79.1％,and 69.3％ in non-DM group,respectively(P =0.001),however,there was no significant difference in disease-free survival between DM and non-DM groups.Cox multivariate analysis revealed that DM is an independent risk factor for overall survival in patients with HCC after curative resection,but not for disease-free survival.Conclusions DM does not increase the postoperative morbidity or mortality for patients with HCC after curative resection,however,DM may increase the risk of mortality of HCC patients in the long-term.

Objective To explore the efficacy of postoperative adjuvant transarterial chemoembolization (TACE) on the survival of patients after radical resection for hepatocellular carcinoma (HCC).Methods Between March 2007 and March 2010,229 HCC patients who underwent radical resection were retrospectively studied.Patients who underwent resection alone were used as the control group (138 patients) while those who received post-operative adjuvant TACE was used as the interventional group.In order to balance the covariates between the groups,a matched comparison of the patients was done by selecting patients using the propensity score matching (PSM).Then,the efficacy of adjuvant TACE upon survival was evaluated.Results After PSM,we obtained 67 pairs of patients.The survival time for the interventional and the control groups were 32.1 months and 28.3 months respectively.The survival rates at year 1,2,3 post-resection were 94.0％,84.8％ and 75.3％ in the interventional group versus 83.6％,69.9％ and 61.5％ in the control group respectively.There were no significant differences between the two groups (P =0.062).Univariate analysis showed the serum level of AFP,tumor size,number of tumor,BCLC stage,and adjuvant TACE significantly affected the survival of HCC patients who received radical resection (P ＜0.05).Cox model suggested that AFP≥400 μg/L and tumor diameter ＞ 5 cm were independent risk factors of survival for HCC patients who received radical resection (P ＜ 0.05).Conclusion Postoperative adjuvant TACE had no positive effect on survival,and AFP level ≥ 400 μg/L and tumor size ＞5 cm were independent risk factors of survival of HCC patients who received radical resection.

Congenital cataract is a highly heterogeneous disorder at both the genetic and the clinical-phenotypic levels. A unique cataract was observed in a 4-generation Chinese family, which was characterized by autosomal dominant inheritance and late-onset. Mutations in the 13 known genes (CRYAA, CRYAB, CRYBB1, CRYBB2, CRYGC, CRYBA1/A3, CRYGD, Connexin50, Connexin46, intrinsic membrane protein LIM2, cytoskeletal protein BFSP2, the major intrinsic protein-MIP and the heat shock factor HSF4) have previously been demonstrated to be the frequent reason for isolated congenital cataracts, but the exact molecular basis and underlying mechanisms of congenital cataract still remain unclear. This study was designed to find whether these 13 genes developed any mutation in the family members and to identify the disease-causing gene. Polymerase chain reaction (PCR) and direct DNA sequence analysis were carried out to detect the 13 genes. The results showed that no mutation causing amino acid alternations was found in these potential candidate genes among all patients in the family, and only several single-nucleotide polymorphisms (SNPs) were identified. A transitional mutation in the fourth intron of CRYBB2 and some silent mutations in the first exon of BFSP2 and CRYGD were found in the cataract family, but further study showed that these mutations could also be found in normal controls. It was concluded that some unidentified genes may underlie the occurrence of late-onset cataract in this family. A genome-wide screening will be carried out in the next study.

Polymerase chain reaction was employed to amplify the whole HBV CP region from the serum of patients with chronic hepatitis B virus(HBV) infection, and then the PCR products were subcloned into pGEM Teasy vectors. Clones were randomly selected to be sequenced and the selected clones were compared to look for the difference.The sequencing results suggested that each sequence of selected clones was different and there were HBV quasispecies groups in patients. There were hot deletion region and point mutation near the TATA like box of CP gene. To address whether the mutations were responsible for the transcriptional activity, the wild type(wt) and the mutants of HBV CP genes were subcloned into pcDNA3 1( ) vectors, respectively. The reverse oriented clones were digested with KpnI and XhoI, and cloned into the KpnI and XhoI sites of the chloramphenicol acetyltransferase (CAT) expressing vector (pCAT3 basic).The recombinant CAT plasmids were transfected into HepG2 cells using lipofectamine PLUS reagent, and the CAT expression which indirectly represented the transcriptional activity of HBV CP lying upstream of CAT gene was detected with a CAT ELISA kit. The restriction enzyme digesting results indicated that the recombinant CAT plasmids were successfully constructed, and the transfection tests indicated that the transcriptional activity of the mutants with deletion or substitute point mutation of TATA like box were reduced in comparison with that of CPwt. The HBV CP gene heterogeneity downregulated the transcriptional activity to some extent.

Objective To analyze plague epidemic tendency in the Three-River Region of Qinghai.Methods Using retrospective study,the Three-River Region during 1954-2006 year pestis epidemic focus were investigated and analyzed.Result Pestis prevailed mainly in Yushu,Chindu,Qumalai,Nangqian,Zhiduo and the Geermu.Tanghla Township.It was first found that the nature plague focus of miefitus existed in Chengduo County.There are 1 5 kinds of 12 branches in 8 trees infected plague animals were founded,336 Yersinia pestis were separated from the driven objects.Among them there were 291 Himalayas marmot body,account for 86.60%of the total,13 of Tibet sheep,accounts for 3.87%.10 of Qinghai field-mouse,accounts for 2.98%,Also there were 114 Yersinia pestis which were separated from each kind of vector insect in vivo.And,46 pestis strains came from the axe shape of flea in vivo account for 40.35%(46/114),38 pestis strains separated from Xie mountain flea,account for 33.33% (38/114).During 1960-2006 years there were 85 human plague cases were founded,238 occurred,134 died,the case fatality rate wero 56.30%(134/238),the popular seasons were started from May to November,the peak season happened in Aug and Sep.After Oct mainly due to Tibet sheep pestis which will cause as the origin of infection.The majority of sickness was pulmonary plague,account for 49.58%(117/238),whereas the first round case caused by the gland bubonic plague,account for 77.12%(91/118).Conclusions There are two pestis strains natural epidemic focus places in Three-River Source Region of Qinghai including the Himalayas marmot pestis strain and the Qinghai field-mouse pestis strain.The case of human pestis strain causes by the marmot strain,the fiehl-mouse mold mushroom spawn causes human pestis strain has not yet discovered,Three-River Source Region of Qinghai is a pestis strain key popular area in Qinghai Province.