Mammalian target of rapamycin(mTOR) inhibitors have the anti-tumor ettect,which have been known early.The traditional mTOR inhibitors include rapamycin and its derivatives,which have been applied in clinical use early.Nowadays,some new small molecule inhibitors such as the PI3K/mTOR duel inhibitor,Torinl,one after another are found to play a unique role in the tumor therapy.

Objective Investigation of satisfaction of clinical nurses and analysis of the influence factors.Methods The ERG theory of Clayton Alderfer is used as the framework to design the questionnaires,for questionnaire investigation of 249 nurses in the hospital in a stratified sampling,Results The score of general satisfaction of nurses for their work is 3.40±0.58;the satisfaction of nurses for the management of their leaders and teamwork is high,as the satisfaction scores are 4.01±0.76 and 3.60±0.71 respectively;their satisfaction for salary,welfare and social identity is low,as the scores are 2.46±0.86 and 2.50±1.02 respectively.Work satisfaction varies with departments,academic levels,monthly income,work shifts,age,seniority,and objectives for their choice of nursing as profession.Conclusion Managers are prompted to enhance their work in view of the satisfaction scores on survival,mutual relations and growth,as well as factors affecting satisfaction,and take various incentives to improve overall satisfaction of nurses.

Carcinoma, Adenoid Cystic ; etiology ; Ear Neoplasms ; etiology ; Humans ; Male ; Middle Aged ; Tympanoplasty ; adverse effects

[Objective] To gain more insight into the presentation,diagnosis of Bertolotti's syndrome and to investigate the indications,the procedure and the early clinical results of minimally invasive transverse process plasty.[Methods]Thirteen cases(Santavirta Type I)with Bertolotti's syndrome underwent minimally invasive transverse process plasty under MED X-tube(Medtronic Sofamor)from Apr.2006 to Dec.2008.The Visual Analogue Scale(VAS),Modified Oswestry Disability Index(ODI)score and subjective sensation of patients were recorded to evaluate the function.[Results]The operation blood loss was from 120 ml to 800 ml and operative time was from 60 to 280 minutes,average 115minutes.There was no severe complication.Nine cases were followed up for 10 to18 months,average 13.6 months.The VAS decreased from(6.7?2.2)before operation to(2.2?0.7)one week after operation and(2.8?0.9)three months after operation.ODI score decreased from(27.8?3.6)before operation to(5.9?2.2)three months after operation.The results were excellent in 10 case and good in 3 cases.[Conclusion]Minimally invasive transverse process plasty is an effective method for Bertolotti's syndrome,especially for Santavirta type I.It shows less blood loss and injury and deserves to be spreaded.Disectomy is recommended in one stage if the patient is complicated with disc herniation.

Objective: To compare the histological, immunological, and biomechanical characteristics of decellularized porcine aortic valve scaffold created by 3 different decellularization protocols and to search for a more suitable technique for creating acellular tissue-engineered cardiac valve conduit. Methods: Porcine aortic valve leaflets and whole aortic roots were decellularized by 3 different protocols. Decellularization procedure in group I involved treatment wit 0.01% trypsin, 1% Triton, and nuclease for 24 h; that in group II involved treatment with 0.01% trypsin (8 h), 1% DCA, and nuclease for 24 h; and that in group III involved treatment with 1% DCA and nuclease for 32 h. All the treatments were conducted during continuous shaking at 37°C. Porcine aortic valve leaflets and whole aortic roots treated with PBS were taken as control. The decellularization efficiencies of each protocol were assessed by H-E staining, scanning electron microscopy, and transmission electron microscopy. The biomechanical features of the acellular valve matrices were examined by stress-strain tests and tensile strength tests. The immunogenicity and inflammatory responses of the decellularized matrices, valve leaflets, and aortic wall were investigated by subcutaneous implantation of them in rats. Results: The native cells in porcine aortic valve leaflets and aortic roots were completely removed in group II, which was superior to group I and III. The values of elasticity modulus and ultimate tensile strength (UTS) of group II were greater than those in group I ([5.77±0.95] MPa vs [4.15±1.13] MPa and [7.82±1.51] MPa vs [4.65±0.85] MPa, respectively; P<0.05). The extension ratios ar 1.5 MPa and at rupture in group II were less than those in group I ([0.33±0.04] vs [0.41±0.09] and [0.45±0.02] vs [0.60±0.06]; P<0.05), but the extension ratio at rupture was similar to that of fresh porcine aortic valves ( [0.45±0.02] vs ([0.46±0.03]). Histological analysis showed only slight inflammatory responses in groupIIand the host cells grew into the matrix, rebuilding the acellular matrices gradually. Conclusion: Decellularization using 8-hour pretreatment with 0. 01% trypsin, followed by 24 hours incubation with 1% DCA plus nuclease is effective and convenient; it not only removes the cells but also decreases the immunogenicity of the aortic valve matrices, making the product an excellent material for tissue-engineered cardiac valve conduit.

Objective: To investigate the feasibility of constructing a tissue-engineered heart valve (TEHV) with endothelial cells differentiated from bone marrow mesenchymal stem cells (BMSCs) and acellular porcine aortic valve matrices. Methods: Primary ovine BMSCs were cultured in M199 medium supplemented with basic fibroblast growth factor (bFGF), epidermal growth factor (EGF), insulin like growth factor (IGF) and heparin, and were induced to differentiate into endothelial cells with vascular endothelial growth factor (VEGF). Decellularized valve matrices were developed from porcine aortic valves treated with detergent and enzymatic procedure. TEHV was constructed by seeding differentiated endothelial cells onto acellular matrices. Morphological characteristics of TEHV were evaluated by histological and electron microscopic observations. Results: H-E staining, scanning electron microscopy (SEM) and transmission electron microscopy (TEM) demonstrated that the surface of tissue-engineered valve leaflets and the inner surface of tissue-engineered valve conduits were confluent, covered with a monolayer of spindle-shaped cells positive of CD34 and factor VIII related antigen. Conclusion: Endothelial cells differentiated from BMSCs have the same biological characteristics as mature endothelial cells. Development of TEHV with differentiated endothelial cells (induced by BMSCs) is feasible and simple.

OBJECTIVE: To review the applications and progress in research of chitosan derivatives in bioadhesive drug delivery system.

Objective:To investigate the effect of body mass index (BMI) on setup errors in intensity-modulated radiotherapy for cervical cancer and explore the optimal position for patients with different BMI without taking into account the rotation error and the changes in target area and adjacent organs.Methods:A total of 90 patients were divided into three groups according to their BMI: light weight group (BMI≤18.4 kg/m 2), normal weight group (18.5 kg/m 2≤BMI≤23.9 kg/m 2) and overweight group (BMI≥24 kg/m 2). Thirty patients were assigned into each group including15 patients in the supine position and 15 patients in the prone position. In total, 2 250 sets of CBCT scan data of 90 patients were obtained. The setup errors were recorded and analyzed in each group. The margins of the optimal position were calculated according to the formula of M PTV=2.5+ 0.7. Results:When BMI was not taken into account, there was no significant difference in the setup errors between the supine and prone positions in the x, y and z directions (all P>0.05). When BMI was considered, the setup error in the supine position were significantly smaller than those in the prone position in the x and y directions in the light weight group, whereas there was no significant difference in the setup errors between the supine and prone positions in the z direction ( P>0.05). The corresponding M PTV in the supine position was 4.76, 4.27 and 5.73 mm, respectively. In the normal weight group, there was no significant difference in the setup errors between the supine and prone positions in the x and y directions (both P>0.05), whereas the setup error in the prone position was smaller than that in the supine position in the z direction. The corresponding M PTV in the prone position were 6.42, 10.21 and 4.91 mm, respectively. In the overweight group, there was no significant difference in the setup errors between the supine and prone positions in the x and z directions (all P>0.05), whereas the setup error in the prone position was smaller than that in the supine position in the y direction. The corresponding M PTV in the prone position were 5.88, 5.26 and 5.32 mm, respectively. Conclusions:Without taking into account the rotation error and the changes in target area and adjacent organs, when the BMI≤18.4, the supine position is recommended. When the BMI≥18.5, it is better to choose the prone position.

In recent years,research on autoimmune pancreatitis (AIP) has gained significant progress.AIP is a special type of chronic pancreatitis which is mediated by an autoimmune mechanism.It is characterized by the infiltration of lymphocytes and plasma cells leading to pancreatic fibrosis and dysfunction.AIP can affect the bile ducts,salivary glands,kidneys and other organs outside the pancreas.The common manifestations include obstructive jaundice,abdominal pain,and weight loss,which are similar to pancreatic cancer.Steroid therapy is of significant effect.There is no consensus nowadays on the diagnostic criteria of AIP across the world.There are many studies on the pathological subtypes,imaging,serological markers and biopsy techniques on AIP,and research focuses on the differential diagnosis from pancreatic cancer.

Objective To investigate effect of urinary conditions and lower urinary tract symptoms (LUTS) in patients before and after the reconstructive pelvic surgery (RPS) for pelvic organ prolapse (POP) as well as effect of urinary conditions and LUTS by tension-free vaginal tape-obturator (TVT-O).Methods From Jan. 2007 to Dec. 2009, 213 patients with POP underwent RPS, the factors on preoperative, postoperative urinary conditions and qualities of life and postoperative urinary incontinence were studied prospectively. Results Totally 193 patients who was followed up for more than 3 months after surgery attend questionnaires, and 165 preoperative patients of 193 (85.5%) had LUTS, 105 postoperative patients of 193 (54.4%) had LUTS, which reached statistical difference (P ＜0. 01 ). The rate of LUTS before and after operation: urinary frequency ( 57.0% and 25.9% ), urinary urgency ( 51.8% and 28.0% ), urinary leakage due to cough ( 50. 3% and 15.0% ), dropping urinary leakage ( 44. 6% and 14. 5% ), dysuria (34. 7% and 23.3% ), vesicaltenesmus (49.2% and 19. 7% ) and hand assist urination (31.1% and 2.6% ). The incidence of LUTS after surgery is much lower than that of pre-operation ( P ＜0. 05 ). POP patients with stress urinary incontinence ( SUI ) before the operation, surgery without TVT-O simultaneously are the risk factors of unimproved symptom ( OR = 4. 933, 95% CI: 1. 353 - 17. 990, P=0. 016). Conclusions RPS have alleviated LUTS in patients with POP. RPS with TVT-O are more effective than traditional RPS in treatment of the urinary incontinence if the POP patient with SUI or occult SUI.