Objective To explore the clinical value of serum tumor markers including CEA,AFP,CA199,CA125,CK19,CA242 and CA724 in diagnosis of pancreatic adenocarcinoma in the elderly.Methods Totally 158 elderly and 102 middle-aged patients with pancreatic adenocarcinoma were selected.Pancreatic adenocarcinoma in all patients were confirmed by pathological examination,cytological examination and CT.100 elderly and 100 middle-aged patients with benign diseases were selected as control groups.The levels of serum tumor markers were detected and their sensitivities and specificities were calculated and compared between groups.Results The levels of serum CEA,CA199,CA125,CK19,CA242 and CA724 were higher in elderly patients with pancreatic adenocarcinoma than in the elderly control group [(70.9±11.4) g/L vs.(1.6±0.4) g/L,(158.9±19.1)U/mlvs.(12.6±3.2)U/ml,(53.9±15.4)U/mlvs.(11.6±1.1)U/ml,(70.2±16.3)U/ml vs.(1.4±0.2)U/ml,(96.4±18.5)U/ml vs.(7.9±2.2)U/ml,(57.6±13.6)U/ml vs.(4.4± 0.6)U/ml,t=26.13,31.63,17.57,19.03,20.95,15.59,respectively,all P＜0.05].The sensitivities of serum CEA,AFP,CA199,CA125,and CA242 were higher in the elderly patients than in the middle aged patients (61.72％ vs.48.69％,19.56％ vs.4.13％,80.31％ vs.69.55％,70.21％ vs.46.77％,75.24％ vs.59.44％,x2=4.28,12.63,3.94,14.32,7.23,respectively,all P＜0.05).The specificities of serum CEA,AFP,CA199,CA125,and CA242 had no significant differences between the elderly and middle aged patients (all P＞0.05).Conclusions Serum tumor markers may provide effective reference for the clinical diagnosis of pancreatic adenocarcinoma in the elderly,which has important value for pancreatic adenocarcinoma control and reversal.

Objective To evaluate the value of quantized diffusion-weighted imaging (DWI)in diagnosis of focal liver lesions. Methods A retrospective analysis was performed in 120 patients with focal liver lesions and in 12 healthy controls who underwent DWI and routine non-enhanced MRI at 3.0T.In 120 patients,there were 1 79 focal liver lesions including 53 hepatocellular carcinomas (HCC),61 metastatic tumors,32 hemangiomas and 33 cysts.The DWI and apparent diffusion coefficient (ADC)maps and ADC val-ues of the lesions and the normal liver were analyzed and measured with a b value of 800 s/mm2 ,and the statistical differences be-tween two groups were compared.Results DWI showed 33 hepatic cysts with low signal,and 5 1 hepatocellular carcinomas,61 he-patic metastases and 32 hepatic hemangiomas with high signal,thus the signal difference between hepatic cyst and other lesions was significant (P <0.05).The ADC images of HCC and metastatic tumors were cold colour,and those of hepatic cysts and hemangio-mas were hot colour.The ADC value between HCC,liver metastatic tumors,hepatic hemangioma and cysts were significant different (P <0.05).However,there were no significant differences in ADC value between HCC and metastatic tumors (P >0.05).In addit-on,the ratios of the ADC values of lesion to background liver between hepatocellular carcinoma and metastases were significantly dif-ferent (P <0.05).Conclusion DWI and ADC maps,and ADC value can provide importantly additional information for the diagnosis and differential diagnosis of focal liver lesions.

Objective To analyze the effect of combined detection of serum tumor markers, Ki-67 and P-glycoprotein (PGP) in lymph node metastasis and postoperative recurrence of colorectal cancerpatients. Methods The clinical data of 517 colorectal cancer patients who had underwent surgicaltreatment were retrospectively analyzed. Among them, lymph node metastasis was found in 165 cases(lymph metastasis group), and 352 cases did not have lymph node metastasis (non lymphoid metastasis);postoperative recurrence was found in 224 cases (postoperative recurrence group), and 293 cases did havepostoperative recurrence (non postoperative recurrence group). The serum tumor markers levels of cancerantigen 19- 9 (CA19- 9), carcinoembryonic antigen (CEA), cancer antigen 125 (CA125) and theexpressions of Ki-67, PGP were compared. The correlation between the serum tumor markers levels andthe expressions of Ki-67, PGP was analyzed. Results The serum levels of CEA, CA19-9 and CA125 and the positive expression rates of Ki-67 and PGP in lymph metastasis group were significantly higher than those in non lymph metastasis group:(21.39 ± 3.15)μg/L vs. (10.12 ± 2.48)μg/L, (68.48 ± 5.82) U/L vs. (35.26 ± 3.51) U/L, (82.16 ± 7.53) U/L vs. (32.46 ± 6.24) U/L, 69.70% (115/165) vs. 13.64% (48/352) and 72.73%(120/165) vs. 14.77%(52/352), and there were statistical differences (P<0.01). The serum levels of CEA, CA19-9 and CA125 and the positive expression rates of Ki-67 and PGP in postoperative recurrence group were significantly higher than those in non postoperative recurrence group:(18.26 ± 2.34)μg/L vs. (9.18 ± 1.26)μg/L, (47.52 ± 4.85) U/L vs. (21.43 ± 2.18) U/L, (59.16 ± 4.25) U/L vs. (33.17 ± 3.46) U/L, 60.27% (135/224) vs. 9.56% (28/293) and 6.70% (15/224) vs. 7.51% (22/293), and there were statistical differences (P<0.01). The correlation analysis results showed that the positive expression rates of Ki-67 and PGP were positive correlated with the serum levels of CEA, CA19-9 and CA125 (P<0.05). Conclusions The levels of serum tumor markers and the positive expression rates of PGP and Ki-67 in colorectal cancer patients with lymph metastasis and postoperative recurrence are high. The levels of tumor markers are closely related to the positive expression rates of Ki-67 and PGP, which indicates that the combined detection of these indexes has a good effect on evaluating lymph metastasis and postoperative recurrence of colorectal cancer patients.

Objective To establish a satisfactory method of isolating,culturing and determining gut neural crest stem cells,which may provide theoretical basis for clinical application.Methods The guts of embryonic mice removed and dissociated were plated into serum-free DMEM/F12 medium.The mitogen-free DMEM/F12 medium supplementd with 10% fetal bovine serum was used to induce differentiation of GNCSCs.Neurospheres and their derivations were determined with immunocytochemical and immunofluorescent staning.Results Neurospheres were generated in the simplified serum-free medium.The staining results showed that enteric neurospheres were GNCSCs and could differentiate into neurons,glial cells and smooth muscle cells by serum-induction.Conclusion GNCSCs have the capacity of self-renewal and proliferation,and give rise to neurons,glial cells and myofibroblasts.

Nucleolin is implicated in many pathological processes,particularly in inflammatory diseases,viral infection and neoplasms.Nucleolin levels are increased in several neoplasms and its localization changed,which play important roles in cell proliferation,apoptosis and metastasis of neoplasms.

AIM: To investigate the involvement of calcineruin (CaN) signal pathway mediated by angiotension Ⅱ (Ang Ⅱ) in the myocardial remodeling mechanism in patients with congestive heart failure (CHF). METHODS: 39 patients of mitral valve disease with CHF were randomly selected and 30 cases of healthy persons were included as controls. Cardiac function parameters were measured by echocardiography. Concentration of Ang Ⅱ in plasma and myocardial tissues were determined by radioimmunoassay. Immunoprecitipation was used to assay the protein expression and phosphorylation CaN, nuclear factor of activated T cells (NFAT_3),zinc finger transcription factor (GATA_4) in myocardial tissues. The mRNA expression of ?-myosin heavy chain (?-MHC) was measured by RT-PCR. RESULTS: The Ang Ⅱ concentrations in patients with CHF were positively correlated with the parameters of the cardiac dialtion respectively, but negatively correlated with the paremeters of cardiac function. Compared to the control group, protein of CaN and GATA_4, phosphorylation of CaN, and ?-MHC mRNA expression in myocardial tissues in CHF groups were highly expressed and their expression were positively correlated to the levels of CHF, but the phosphorylation of NFAT_3 was negatively correlated with the levels of CHF. CONCLUSION: CaN signal pathway may play important roles in the myocardial remodeling in CHF.

Objective To study the application value of microvascular density (MVD)in determination of transrectal ultrasound hemodgynamics in the differential diagnosis of prostate cancer and chronic prostatitis, and to provide imageological basis for their differential diagnosis.Methods A total of 6 1 patients suspected of prostate cancer underwent transrectal ultrasound scan and ultrasound guided biopsy.38 cases of prostate cancer and 23 cases of chronic prostatitis were confirmed by pathology and retrospectively analyzed.The peak systolic blood flow velocity (Vs)and blood flow classification of the suspicious lesions were compared and analyzed.The MVD was observed by Weidner method with monoclonal antibody CD34 immunohisochemistry staning. Results The Vs and the blood flow classification of the suspicious lesions in prostate cancer group were significant higher than those in chronic prostatitis group (P<0.05).The MVD in prostate cancer group and chronic prostatitis group were 46.70±13.87 and 34.38±7.28,respectively(P<0.05);the MVD in prostate cancer (C+D)stage and (A+B)stage were 56.99±12.85 and 39.97±10.21,respectively(P<0.05);the MVD in prostate cancer with high Gleason score group and low Gleason score group were 53.79±13.30 and 36.96±7.24,respectively(P<0.05).The Vs and the blood flow classification of the suspicious lesions of prostate cancer had a significantly positive correlation with the MVD (r=0.793,P<0.05;r=0.723,P<0.05).Conclusion The Vs and the blood flow classification of prostate cancer by ultrasound can well reflect the changes of the micrangium in tumor tissue. The Vs and blood supply grade of suspicious lesions in the patients with prostate cancer are significantly higher than those in the patients with chronic prostatitis.They may be useful for the identification of prostate cancer and chronic prostatitis.

Objective To use a simple bedside technique to verify the pathophysiological mechanism of pulmonary hypertension (PH) in different races. Method The Valsalva maneuver (VM) was performed in patients referred to a specialty PH clinic. The blood pressure response of patients to VM was in different fashions. The blood pressure (BP) was measured by using cuff and stethoscope. When the cuff was inflated to 15 mmHg above the systolic pressure, sound could be heard by auscultation during VM and when the cuff was deflated the sound disappeared over 3 heart beats which was considered as abnormal BP response, and less than 3 heart beats defined as normal BP response. The right heart catheterization in patients with PH as a part of the standard evaluation. Results This study included 84 patients with a mean age of (63 ± 16) years. Those with abnormal BP response to VM had higher pulmonary artery wedge pressure (PAWP) [(22.5±6.6) vs. (11.9±4.3) mmHg, P ＜0.0001] and lower pulmonary vascular resistance [(5.8 ± 4.0) vs. (8.1 ± 4.6 ) WU, P = 0.01]. Blood pressure response to VM did not correlate with mean pulmonary artery (PA) pressure [(46.2 ± 9.9) vs. (43.4 ±10.4) mmHg, P =0.20] or cardiac index (both 2.4 ± 0.6 L/min/m2). The abnormal BP response to VM had high sensitivity (89.4%), specificity (86.1%) and accuracy (86.9%) for determining PAWP＞ 15 mmHg.Conclusions BP response to Valsalva maneuver provides important information about left heart filling pressures in patients with PH.

Objective To observe the effect of gheocorticoid by oral medication or intrathoracic iniection on the expression of IL-6,IL-8 and sIL-2R in gerum and pleural fluid in patients of tuberculous pleurisy.Methods Twenty tuberculous pleurisy patients were treated with ghcocortieoid by oral medication (oral group)and 20 cases by intrathoracic injection(injection group).ELISA wag employed to detect the levels of IL-6,IL-8 and sIL-2R in serum and pleural fluid before treatment and 3,6 and 9 days after treatment.Results The levels of serum IL-6 and IL-8 decreased and sIL-2R increased obviously in injection group at 3,6 and 9 days after treatment(P＜0.01).Meanwhile the levels of IL-6 and IL-8 in pleural fluid decreased and sIL-2R increased obviously(P＜0.01).The levels of IL-6 and IL-8 were significantly lower and the levels of aIL-2R were significantly higher in injection group than those in oral group(P＜0.01).One month after treatment,the rate of complete absorpion of pleural fluid was higher in injection group(80%)than thatin oral group(45%),the rate of pachynsis pleurae was lower in injection group(10%)than that in oral group(40%),P＜0.05.Conclusions Intrathoracic injection of ghcocorticoid shows stronger suppression of cellular immune function in cavum pleurae and weaker suppression of the general immune sysmm than oral medication.Intrathoracic injection of glucocorticoid can increase the therapeutic effect and decrease side effect in tuberculous pleurisy.

Objectives To investigate medical students' satisfaction degree clinical practice,to find out the shortages of the clinical practice teaching,and to further put forward the measures of clinical practice.Methods By using a selfdesigned questionnaire,115 student interns were surveyed with anonymous questions,to collect data about the satisfaction degree of the hospital teaching conditions,conditions of teachers,practice quality of clinical departments,management department intern management work,the practical effect and views of clinical practice and other information.99 effective copies were retrieved using Excel analyze data.Results Interns' overall satisfaction with clinical practice is not high,and the satisfaction degree to the management department' work is the lowest,the satisfaction degree to the conditions of teachers of hospital is the highest.Conclusion Medical students'clin-ical practice satisfaction needs improving.To this end,we should improve the system and teaching conditions and strengthen management to meet the needs of students and improve their practice quality.