Objective To study the incidence, spreading path, prognosis and treatment of the umbilical metastasis Sister Mary Joseph nodule (SMJN) from malignancies Methods To analyse the clinical feature from 3 cases of SMJN and to review pertinent literatures Results Three cases SMJN were come from advanced primary peritoneal carcinoma in case 1, recurrent mucinous ovarian papillary adenocarcinoma in case 2 after primary cytoreductive surgery and systemic chemotherapy and case 3 with recurrent endometrial carcinoma All patients received umbilical resection and the umbilical metastasis was comfirmed pathologically, while case 3 was diagnosed adenocarcinoma spreading by fine needle respiration before the surgery The mean survival was 63 months following surgery or chemotherapy or radiotherapy, case 1 died of advanced malignancy, while case 2 and case 3 were still alive 58 and 44 months, respectively Conclusions Although the incidence being low, SMJN was the important sign of one of the vast metastatic malignancy and has grave prognosis Umbilical resection should be performed on some patients of SMJN with relative good condition, and chemotherapy or radiotherapy should also performed accordingly

Objective To assess the short-time economics of various glutamine dipeptide-enriched parenteral nutrition (PN) for patients undergoing elective surgery for gastrointestinal tumors, with an attempt to provide evidence for decision makers on clinical nutrition support.Methods A prospective cohort study was designed.From payer/disburser''s perspective, a cost-effectiveness decision-tree model was developed to assess the clinical outcomes and short-time economic effects of glutamine dipeptide-enriched PN that used in different time points (early postoperative or perioperative).Cost-effectiveness analysis, cost-utility analysis, and incremental cost-effectiveness analysis were adopted in the decision-tree model.One-way sensitivity analysis was performed to determine the robustness of the results.Results Totally 107 patients were included.There was no significant difference between the perioperative alanine(Ala) glutamine(Gln) nutrition support (group A) and early postoperative Ala-Gln nutrition support (group B) in the ratio of 5％ weight declines on the 8th day after surgery and infection-related postoperative complications (72.1％ vs.78.1％, χ2=0.509, P=0.498 and 2.32％ vs.4.69％, χ2=0.060, P=0.806).The levels of prealbumin (PA) and albumin(Alb) and the level of total lymphocyte count(TLC) also the time of recovering gastrointestinal function, length of stay nutritional discharge index(LOSNDI), and direct costs were significantly different [PA:(208.19±56.92)mg/L vs.(187.97±62.05)mg/L, t=2.283,P=0.039;Alb:(33.82±3.91)×109 vs.(31.96±4.57)×109, t=2.184, P=0.036;TLC:(1.19±0.55)×109 vs.(0.89±0.66)×109, t=2.461, P=0.015;the time of recovering gastrointestinal function(3.06±0.28)d vs.(3.39 ± 0.34)d, t=-3.675, P=0.000;LOSNDI:(16.84±2.92)d vs.(18.52 ±3.47)d, t=-2.613, P=0.011;direct costs:￥(17 029.05±317.28) vs.￥(15 610.64±292.56), t=23.764, P=0.000].When LOSNDI and quality-adjusted life years (QALYs) were estimated as indicators of effectiveness, the incremental cost-effectiveness ratios and incremental cost-utility ratios of group A were ￥844.3 and ￥70 920.5, respectively.Net monetary benefit of group B was more than that of group A.One-way sensitivity analysis showed that parameters had no significant effect on the model.Conclusion When using local per capita gross domestic product as threshold, early postoperative Ala-Gln PN was more economical than perioperative Ala-Gln PN strategy evaluation.

Objective To explore the impact of pre-setted generation adaptive statistical iterative reconstruction Veo (ASiR-V) on chest CT radiation dose and image quality.Methods The chest model and 120 patients (divided into 6 groups,each n=20) were scanned by GE Revolution CT under the condition of pre-setted ASiR-V weights for 0,20％,40％,60％,80％ and 100％ respectively.The tube voltage was 120 kV,the tube current was automated mAs (Smart mA10-500) technology,the noise index was 11.The dose-length product of each chest model group and patients group were record,the effective dose (ED) of each group was calculated and compared.The image quality among groups through combining the objective CT and standard deviation (SD) values of different organizations (lung tissue,the soft tissue near by spine,the aorta and vertebral body) in chest model and the image subjective rating of patients were compared,and the subjective score of patients' images was also compared among groups.Results With the increase of pre-setted ASiR-V,the ED of chest model and patients reduced as a logarithmic fitting,there are no obvious changes of the CT value and image noise SD value of different organizations in model.The subjective score of mediastinal and pulmonary window was begin to decline at 40％ weighted ASiR-V.The subjective score of mediastinal and pulmonary window descend obviously at 60％ weighted ASiR-V compare to 40％ (P＜0.05).ED of pre-setted 40％ weighted ASiR-V reduced to 57.21％ compared to that of 0 weighted ASiR-V.Conclusion The pre-setted ASiR-V can reduce the radiation dose,and does not affect the objective image quality at the same time.The pre-setted 40 ％ weighted ASiR-V has the highest clinical application value due to the radiation dose can be obviously reduced with ensuring the image quality,which can meet the demand of diagnosis.

Objective To clone the cheA and cheY genes of Helicobacter pylori for construction of their prokaryotic expression systems, and to establish chemotactic model in vitro of H. pylori for determing chemotaxis-inducing substances and to understand the effects of specific antibody and closantel on inhibiting chemotactic behavior of the microbe. Methods The segments of entire cheA and cheY genes were amplified by PGR and then sequenced after T-A cloning. Prokaryotic expression systems of the genes were subsequent-ly constructed. SDS-PAGE plus Bio-Rad Gel Image Analyzer were used to examine the expression of target recombinant proteins rCheA and rCheY, and Ni-NTA affinity chromatography was performed to extract rCheA and rCheY. Rabbits were immunized with rCheA and rCheY to obtain antisera and IgG in each of the anti-sera was extracted by saturated ammonium sulfate precipitation and DEAE-32 ion exchange chromatography. Immunodiffusion assay was performed to measure the titers of antisera and their IgGs. Chemotactic model in vitro of H. pylori based on hard-agar plus method was established to determine the chemotaxis-inducing effects of eleven candidate substances. Simultaneously, the effects of rCheA-lgG and closantel sodium on blocking the bacterial chemotactic behavior were also observed. Results The segments with expected sizes of cheA and cheY genes were obtained by PCR, and their nucleotide and putative amino acid sequences were 100% idenities to the reports. The constructed prokaryotic systems could efficiently express rCheA and rCheY. The two rabbit antisera and IgG aginst rCheA and rCheY had 1 : 4 and 1 : 2 immunodiffusion titers, respectively. Hydrochloric acid, sulfuric acid and acetic acid were able to induce chemotactic movement of H. pylori. Both rCheA-IgG and closantel sodium with certain concentrations could weaken the chemotactic ability of H. pylori(P<0.05). Conclusion The prokaryotic expression systems of H. pylori cheA and cheY genes were successfully generated in this study. Hydrogen ion (H~+) is the inducer for chemotaxis of H. py-lori. rCheA-IgG, as well as closantel sodium can inhibit H~+-induced chemotaxis of H. pylori.

Objective To determine the effect of cheA gene of Helicobacter pylori in the bacterial chemotaxis in vitro and colonization in vivo. Methods The entire cheA and cheY genes were amplified and cloned from genomic DNA of H. pylori NCTC11637 strain. Subsequently, the prokaryotic expression systems of cheA and cheY genes were generated and the target recombinant proteins rCheA and rCheY were extracted by Ni-NTA affinity chromatography. Rabbits were immunized with either rCheA or rCheY for obtaining antisera, and rCheA-IgG and rCheY-IgG in the antisera were prepared using ammonium sulfate precipitation plus DEAE-52 column chromatography. A suicide plasmid of cheA gene was constructed and then a cheA gene knock-out mutant ( cheA - ) was generated based on homologous recombinant exchange using the suicide plasmid. The cheA- mutant was identified using PCR and sequencing. The phosphorylation levels of CheA and CheY molecules of cheA - and wild-type strain were determined by using rCheA-IgG and rCheY-IgG anchoring the target proteins and protein phosphorylation detection kit. The differences of chemotaxis in vitro and colonization in vivo between cheA- mutant and wild-type strain were compared using chemotactic model and BALB/c infection model of H. pylori. Results The cheA gene knock-out in genome of cheA- mutant was confirmed by the results of PCR and sequencing. After treated with 0. 001-0. 1 mol/L HCI for 10 min, the phosphorylation levels of CheA and CheY molecules of wild-type strain were rapidly descended from ( 59.6 ±11.5) μmol and (55.5 ± 10.2) μmol to ( 10.8 ± 2.6) and (5. 5 ± 1.2) μmol (P ＜ 0.05 ), while the phosphorylation of CheY molecule of cheA - mutant was no markedly changed with a persistent lower level ( P ＞0.05). The diameters [(10-20) ± (2-3) mm] of chemotactic aggregative rings of cheA- mutant were significantly less than those [(16-24) ± (2-3)mm] of wild-type strain (P ＜0.05). The positive isolation rate (90%) of H. pylori in gastric biopsy specimens of mice that infected with wild-type strain was remarkably higher than that (40%) of mice that infected with cheA- mutant (P ＜0.05). The result of fluorescence quantitative was also showed that the numbers (6.3 × 103 ±2.1 × 103 copies/mg) of H. pylori in gastric biopsy specimens of wild-type strain infected mice were significantly larger than those (8.3 × 101 ±3. 1 × 101 copies/mg) in gastric biopsy specimens ofcheA- mutant infected mice (P＜0.05). Conclusion The cheA gene of H. pylori has an important role in the bacterial chemotaxis in vitro and colonization in vivo.

BACKGROUND: Previous studies have confirmed that atrial natriuretic peptide (ANP) exists in different regions of rat gastric mucosa in different densities, and ANP can inhibit the spontaneous contraction of gastric smooth muscles in rat, guinea pig and human.OBJECTIVE: To investigate the ultrastructural localization of ANP-synthesizing cells and the correlation between ANP-synthesizing cells and microvessel density in rat gastric mucosa.DESIGN: Single sampling study.SETTING: Affiliated Hospital of Chengde Medical College. MATERIALS: Eighteen adult male Wistar rats of clean grade, weighing 300-350 g, were used in this study.METHODS: This study was conducted in the Laboratory of Chinese Materia Medica Immunology, Chengde Medical College from October 2004 to July 2007. The ultrastructural localization of ANP-synthesizing cells in rat gastric mucosa was performed by postembedding immunoelectron microscopy technique. The area density of ANP-synthesizing cell distribution was calculated by histochemical technique (saffron solution and toluidine solution staining included). Microvessels of rat gastric mucosa were revealed distinctively by tannic acid-ferric chloride staining method and scanning electron microscope technique.MAIN OUTCOME MEASURES:①The ultrastructural localization of ANP-synthesizing cells in rat gastric mucosa.②The distribution characteristics of gastric microvessels in different regions of rat gastric mucosa.③The distribution characteristics of ANP-synthesizing cells in rat gastric mucosa.④Correlation between ANP-synthesizing cell distribution and microvessel density.RESULTS: ① Ultrastructural localization of ANP-synthesizing cells: It was confirmed that ANP-cells were the enterochrochromaffin (EC) cells. ② Observation of microvessels: The microvessels were stained successfully by tannic acid-ferric chloride and scanning electron microscope technology. Microvessels of gastric mucous were in wriggled way and cut in different cross-sections. They could be clearly observed in distinct three-dimensions. The microvessel density was the largest in the basal glands of rat gastric mucous. ③ Distribution of ANP-synthesizing cells: It was identified that EC cell was only a chromaffin cell in the rat gastric mucosa. The chromaffin granules (brown granules) were localized in the cytoplasm of EC cells. Negative staining for chromaffin granules was detected in the submucosa and smooth muscle. EC cells had different distribution densities in different regions. The density order of EC cells was gastric cardiac region ＞ gastric pyloric region ＞ gastric fundic region in mucosal layer. ④ Correlation between ANP-synthesizing cells and microvessel density: Correlation analysis showed that there was a positive correlation between ANP-synthesizing cells and microvessel density in the gastric cardiac region(r = 0.53, P ＜ 0.05, n=18), and there was a negative correlation between above-mentioned two indices in the gastric pyloric region(r = 0.38, P ＞ 0.05 , n=18)and in the gastric fundic region(r = -0.29, P ＞ 0.05, n=18).CONCLUSION: ANP-synthesizing cells are the EC cells of gastric mucosa. There is a positive correlation between ANP-synthesizing cells and microvessels in the rat gastric cardiac region, while there is a negative correlation between ANP-synthesizing cells and microvessels in the rat gastric pyloric region and in the gastric fundic region.

Objective To investigate the occurrence of cardiotoxicity of chemotherapeutic drugs in gynecological cancer patients without heart disease,and patients with coronary heart disease or congenital heart disease for providing a basis for the clinical prevention of heart side effects during chemotherapy.Methods Thirty cases with gynecological cancer complication with or without coronary heart disease or congenital heart disease before or during chemotherapy admitted from Jan.2004 to Dec.2010 were retrospectively analyzed.Results For all 30 patients,there were heart failures in 3 cases ( 10％,3/30),myocardial infarction in 3 cases (10％,3/30),angina pectoris in 1 cases (3％,1/30),ST-T or T-wave changes in 9 cases (30％,9/30),and arrhythmia in 8 cases (27％,8/30).Conclusions Cancer chemotherapy drugs to the heart may produce an immediate or long-term toxicity,in which could significantly effects on the survival and prognosis of patients.It is very important to prevent the occurrence of cardiotoxicity of chemotherapeutic drugs in gynecological cancer patients with heart diseases during chemotherapy.

Objective To investigate the biological effects of insulin resistance(IR)on the porcine granulosa cells which iS induced by wortmannin,the PI-3K inhibitor and mediated by key molecules including GLUT4 and MAPK during insulin signaling.Methods The model of IR porcine granulosa cell was established in in vitro culture by treatment of wortmannin,and was assessed the amount of3H glucose uptake as well as medium glucose levels by glucose oxidase method.The protein and mRNA expression of GLUT4 and MAPK were evaluated by immunofluorescence and RT-PCR respectively.Resuits The glucose intake was decreased by 40% with treatment of wortmannin at 1.5 μmol/L(P＜0.05).GLUT4 and MAPK were localized mainly to cytoplasm of grantdose cells.When granulosa cells were insulin resistant,the expression of GLUT4 was down-regulated whereas MAPK was up-regulated as compared with the controls.Conclusions Wortmannin treatment can lcad to decreased expression of GLUT4 and increase of IR granulose cells.This metabolic phenotype could induce increased expression of MAPK and mitogenic potential,indicating the cross-talk between two pathways of insulin signaling within ovarian cells.

Vascular endothelial growth factor (VEGF) is an endothelial cell-specific mitogen.Studies have shown that VEGF is closely associated with ischemic stroke,and this makes it possible to intervene in ischemic stroke from the level of VEGF and its receptor.This article reviews the biological effect of VEGF and its receptor,mechanism of action involving in various stages of ischemic stroke,and the therapeutic prospect in ischemic stroke.