GDF-15,a distant member of the TGF-superfamily,is identified as an apoptotic accelerat- ing,anti-tumorigenesis and nerve2nutritional factor in varied injures and tumors and has cardioprotective ac- tivity.The characteristics and roles of GDF-15 gene/protein and antibodies are expounded besides the rela- tionship between GDF-15 serum level/genetypes and CRC.It is also discussed here that some antitumorigenic substances inducing GDF-15 in CRC tissues and CRC cells.

Objective To analyze family clustering of inpatient service utilization in rural areas of Hubei Province.Method Inpatient service information of all families in rural areas of sample counties was obtained on the basis of New Cooperative Medical System (NCMS) inpatient database;Lorentz curve was drawn by area graph and scatter diagram of Excel 2010,so was Gini coefficient;descriptive statistic,variance analysis and so on were carried by IBM SPSS Statistic 20.0.Result 3％ family takes up 19％ inpatient service,and rural family's Gini coefficient of inpatient service utilization is 0.366;high inpatient service utilization family(HIUF) uses less outpatient service(29.2±26.9) than middle inpatient service utilization family (31.7±23.5).Inpatient member of HIUF used more inpatient service than other families,except the low inpatient service utilization member(NHH9.2＞NMH4,NHM2.4＞NMM2.2＞NLM1.7);HIUF use least time to reach county hospital(tH44.3＜tM44.9＜tL45.2),have more inpatient members than others (NM＞4.5＞NH4.4＞NL3.9).Conclusion Great family clustering of inpatient service utilization exists in rural area,and irrationality exists in some way;more outpatient service utilization may reduce inpatient service utilization.

Objective To analyze family clustering of outpatient service utilization in rural areas of China.Method Outpatient service information of all families in rural area of sample county was obtained on the basis of new cooperative medical system (NCMS) outpatient database,and family outpatient service utilization database was cleared out with the help of functions like IF,LOOKUP and so on in Excel 2010.Lorentz curve was drawn by area graph and scatter diagram with Excel 2010,so was Gini coefficient.Descriptive statistic,variance analysis and so on were carried by IBM SPSS Statistic 20.0.Result 20％ family takes up 53％ of outpatient service,and rural family's Gini coefficient of outpatient service utilization is 0.516.Members of high outpatient service utilization family (HOUF) used (17.7) more outpatient service than other families (10.4,4.2).HOUF were mainly distributed in towns with high capability of township hospital and low capability of township hospital.Conclusion Great family clustering of outpatient service utilization exists in rural areas.Family homogenization is distinct,in which irrationality exists.The capability of primary medical institutions influences the outpatient service utilization of residents in rural area.

Gastric cancer is one of the common malignant tumors in digestive system. The incidence of gastric cancer in China is higher than that in developed countries. The prognosis of gastric cancer is closely related to the stage of cancer, and the prognosis of advanced gastric cancer is poor. Improving the detection rate of early gastric cancer is the key to improve the survival of patients with gastric cancer. Endoscopic technology developed rapidly in recent years,various forms of endoscopy have been applied in clinical practice,and the detection rate of early gastric cancer was increased. This article reviewed the advances in study on endoscopic diagnosis of early gastric cancer.

[Objective]To investigate surgical protocol for treatment of thoracolumbar fracture with ankylosing spondylitis. [Method]A retrospective study was performed in 8 thoracolumbar-fracture patients with ankylosing spondylitis. Of them, 6 patients were neurological intact and 2 had neurological defect(Frankel grades the C level). Under general anesthesia, all of the 8 patients underwent open reduction and internal fixation with pedicle screws at two segments in both ends of the fracture. Laminectomy for decompression of the nerve tissue was performed in the 2 patients with neurological defect simultaneously.[Result]All of the 8 patients were followed up for 8 to 30 months. Solid bone healing was achieved in all of the patients. Two patients with eurological compromise had improved by two Frankel grades (complete recovery).[Conclusion]Thoracolumbar fracture in ankylosing spondylitis traverse both bone and ligaments, producing an extremely unstable situation similar to a shearing type of fracture. Reduction of the displacement and stabilization is best achieved with a pedicle screw system at two segments in both ends of the fracture.

Objective: To construct a polycistron tandem repeated Echistatin (Ecs) gene. Methods: Three Ecs genes with independent initiation and termination codon were ligated tandem through restriction enzyme sites after amplified with 3 pairs of primers using pMD18T-Ecs as template. The polycistron Ecs gene was inserted into pET30a and expressed in E.coli BL21(DE3) with IPTG induction. The expression results were identified by 18% SDS-PAGE and Western blot. Results: The expression of Ecs polycistron was accomplished with 18% expression level of total protein determined by SDS-PAGE and Western blot. Conclusion: The successful expression of Ecs polycistron provided a new method for the preparation of low molecular weight protein.

Adenocarcinoma, Papillary ; blood supply ; metabolism ; pathology ; Adult ; Aged ; Carcinoma, Pancreatic Ductal ; blood supply ; metabolism ; pathology ; Chemokine CXCL12 ; metabolism ; Female ; Gene Expression Regulation, Neoplastic ; Humans ; Lymph Nodes ; metabolism ; Lymphatic Metastasis ; Male ; Microvessels ; pathology ; Middle Aged ; Neoplasm Staging ; Neovascularization, Pathologic ; metabolism ; pathology ; Pancreas ; metabolism ; Pancreatic Neoplasms ; blood supply ; metabolism ; pathology ; Receptors, CXCR4 ; metabolism

Objective To analyze the risk factors leading to prolonged mechanical ventilation following valve replacement surgery with the purpose of improving the management of these patients.Methods The risk factors of prolonged mechanical ventilation at preoperative,operative and postoperative clinical data of 307 patients who underwent valve replacement surgery were retrospectively analyzed.Binary Logistic regression model was used to assess the factors.Results The time of mechanical ventilation after valve replacement surgery was (15 ± 35) h,and 31.6％ (97/307) of these patients underwent prolonged mechanical ventilation (＞ 8 h).Age ≥ 65 years (P =0.003),smoker (P =0.024),left ventricular ejection fraction (LVEF) preoperative (P =0.002),duration of operation (P =0.000),aortic block time (P =0.046),cardiopulmonary bypass time (P =0.030),number of replaced valve (P =0.001),volume of postoperative chest drainage (P =0.000) and postoperative complications (P =0.010) were risk factors of prolonged mechanical ventilation.Logistic regression analysis showed that LVEF (P =0.026),duration of operation(P =0.037),aortic block time (P =0.001),cardiopulmonary bypass time (P =0.013),number of replaced valve (P =0.017),volume of postoperative chest drainage (P =0.020) and postoperative complications (P =0.014) had extremely affection.Conclusions Greater importance should be attached to healthcare education,early treatment to avoid multivalvular involvement,preoperative heart function regulation,lower duration of operation especially aortic block time and cardiopulmonary bypass time,lower postoperative chest drainage and better preservation of organs during operation to decrease the rate of prolonged mechanical ventilation and optimize the clinical quality.

Objective To explore the essentiality of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) examination before breast-conserving surgery (BCS) in breast cancer patients with young women.Methods The data of DCE-MRI and mammography X-ray in 30 breast cancer patients with young women (＜ 40 years old) who received surgery with pathology-proven were retrospectively analyzed.The detection rate of breast lesion,number,size,extent of invasive and lymph node metastasis of preoperative were observed.The DCE-MRI was assessed accuracy of BCS in accordance with indications for BCS and histopathology results.Results The breast cancer detection rate of DCE-MRI was significantly higher than mammography X-ray [100.00％(30/30) vs.73.33％(22/30),P =0.002].The maximum tumor diameter of DCE-MRI was (3.55 ± 1.50) cm,mammography X-ray was (3.38 ± 1.70) cm,postoperative pathology was (3.51 ± 1.20) cm,and DCE-MRI was closer to postoperative pathology than mammography X-ray.The discovery of additional lesions of DCE-MRI was more than mammography X-ray (P ＜ 0.05).The surrounding tissue invasion of DCE-MRI was detected in 22 cases,mammography X-ray was in 9 cases,postoperative pathology was in 19 cases,there was no significant difference between DCE-MRI and postoperative pathology (P =0.598),there was significant difference between mammography X-ray and postoperative pathology (P =0.010).The number of axillary fossa lymph node metastasis of DCE-MRI was in 127,mammography X-ray was in 48,compared with postoperative pathology (91),there was significant difference (P =0.026,0.034).The detection of microcalcification of mammography X-ray was better than DCE-MRI (7 cases vs.0 case,P =0.001).The number of BCS of postoperative pathology was in 12 cases,DCE-MRI was in 11 cases,mammography X-ray was in 8 cases,DCE-MRI was higher than mammography X-ray,but there was no significant difference (P=0.132).Conclusion DCE-MRI provides comprehensive and accurate information for breast cancer patients with young women for BCS,and it is feasible to assess them using DCE-MRI preoperative for BCS.

Objective To observe and compare the incidence rate of hemolysis while venous blood specimen collecting with two types of venous indwelling needle. To summarize the attentions during blood samples collecting by venous indwelling needle. Methods From January 2014 to January 2015, a total of 400 patients in resuscitation room of emergency department were divided into control group and experimental group by random digits table method with 200 cases each. Type Y indwelling needle was used in control group, while straight type indwelling needle was used in experimental group. Both two types of indwelling needle were required to be connected with the disposable venous blood taking needle joint for blood sample collection. The incidence rate of hemolysis was observed. Results The incidence rate of hemolysis in experimental group was lower than that in control group: 8.0%(16/200) vs. 39.5%(79/200),and there was significant difference, χ2=34.317, P < 0.01. Conclusions The incidence rate of hemolysis during venous blood specimen collecting with straight type indwelling needle is significantly lower than that with Y type indwelling needle. Straight type indwelling needle is worthy of clinical use.