Surgery is still the basic treatment of esophageal carcinoma. Quality of life, a new evaluation criterion for the health and disease, reflects the surgical outcome of esophageal cancer comprehensively. The findings of clinical research demonstrate that in the surgical treatment of esophageal carcinoma, quality of life could provide us with new selections such as surgical method, lymph node dissection and digestive tract reconstruction. Further application of quality of life scale in esophageal carcinoma surgical treatment, will greatly enhance the surgical outcome and improve patients'quality of life.

Objective To investigate the expression of nuclear factor kappa B (NF-?B ) in focal cerebral ischemia and reperfusion and effects of N-acetylcysteine (NAC) pretreatment.Methods The focal cerebral ischemia and reperfusion model was made by suture occlusion of right middle cerebral artery. The rats were randomly assigned to nine groups: sham operated group, 6 hours and 24 hours ischemia groups, 6 hours and 24 hours reperfusion groups, corresponding NAC treatment groups. NAC groups’ rats were treated with NAC (150 mg/kg) prior to occlusion. NF-?B p65 were detected by immunohistochemistry. Brain was stained with 1% triphenyltetrazolium chloride for assessment of the volume of infarction. Apoptosis was detected by terminal-deoxynucleotidyl transferase mediated nick end labeling (TUNEL).Results The translocation of NF-?B from cytoplasm to nucleus increased significantly after ischemia and reperfusion. The expression of NF-?B p65 decreased in NAC pretreatment groups, which were respectively (0.462% ? 0.022%) in 6 hours ischemia-reperfusion groups, (0.452% ? 0.015%) in 24 hours ischemia-reperfusion groups, as compared with saline control groups which were (0.563% ? 0.028%) and (0.554% ? 0.013%) (P

BACKGROUND: Nuclear factor-kappa B (NF-κB) is an important transcription factor, which can promote the transcription of many target genes after activated.OBJECTIVE: To investigate the expressions of NF-κB in local cerebral ischemia-reperfusion and the influence of the pretreatment of the N-acetylcysteine.DESIGN: Randomized grouping experiment with animals as subjects.SETTING: Department of Neurology, the Second Clinical Medical College, Harbin Medical University.MATERIALS: The experiment was finished in the Animal Experimental Center and Laboratory of Pathology of Harbin Medical University. Ninetynine male healthy Wister rats were randomly divided into 3 groups: Sham-operated group(n=l 1), saline control group(n=44), N-acetylcysteine group(n=44).METHODS: Rat models of cerebral ischemia were made with the method of thread blocking improved by Longa et al in rats of the three groups. A nylon line with a smooth spherical captular end of 0.26 mm in diameter made by heating was inserted through the cut of crotch of the common carotid artery. The prepared line for common carotid artery was tied tightly and the arteriole clamp of internal carotid artery was unclamped. The nylon line entered the common carotid artery and the inserted length of the saline control group and the N-acetylcysteine group from the crotch of the internal and external carotid artery was calculated about (18.5±0.5)mm in order to obstruct the blood supply of the middle cerebral artery. The inserted depth in sham-operated group was less than 15 mm and the blood supply of the middle cerebral artery was kept normal. Intraperitoneal injection of N-acetylcysteine was given with 150 mg/kg at 30 minutes before ischemia in N-acetylcysteine group and injection of normal saline was given with equal volume at 30 minutes before ischemia in saline control group.Eleven rats each time in saline control group and N-acetylcysteine group were killed by cutting off heads at the time points of ischemia 6, 24 hours,and reperfusion 1 hour after ischemia 6, 24 hours. The express of NF-κB of brain tissue was observed with immunchistochemical method. Percentage of cerebral infarction of rats in each group was determined by dyeing of tetrachloro red tetrazoline. Apoptosis of brain tissue cells was detected with terminal deoxynucleotide transferase-mediated dUTP nick-end labeling (TUNEL).MAIN OUTCOME MESURES: Percentage of cerebral infart volume of rats in each group, the activity of combination of the NF-κB and apoptosis of cells.RESULTS: Ninety-nine animals attended the experiment, all of them entered the final analysis. ① Percentages of infarct volume at 1 hour of ischemia and 6, 24 hours of reperfusion in N-acetylcysteine group were (8.39±2.54)%, (24.54±6.02)% respectively, and that of corresponding saline control group were (15.50±4.18)%,(32.22±3.99)%. The focus of infartion with ischemia for 24 hours in each group was increased as compared with that for 6 hours and the infarct volume in group with N-acetylcysteine was obviously decreased as compared with that in saline control group (P ＜ 0.01). ② NF-κB p56 transfered from the kytoplasm to the nucelus after the ischemia and reperfusion. The rates of p56 masculine cells in N-acetylcysteine group of ischemia for 6 and 24 hours were (0.462±0.022)%, (0.452±0.015)% respectively, the express of which was decreased as compared with that in saline control group [(0.563±0.028 )%,(0.554±0.013)%] (P ＜ 0.01 ). ③ Cells of apoptosis pretreated with N-acetylcysteine were obviously decreased as compared with that pretreated with normal saline.CONCLUSION: Focal cerebral ischemia and reperfusion can activate NF-κB p65, which participate in the damage of cerebral ischemia and reperfusion. NF-κB can inhibit the express of p65, and relieve the nerve injury and so have the effct of protection for brain.

Objective To investigate the effects of β-adrenoceptor (β-AR) activation on the apoptosis in human mesangial cells and it's mechanism.Methods Cultured HMC were used in experiments and were divied into four groups:the control group; β-AR activation (β-AR agonist NE/Pra) group; β-AR inhibitor (Prop) group; antioxidants group.The experiments technology including PCR,confocal scanning microscope,immunofluorescence and Tunel.Results The results of RTPCR and confocal scanning microscope showed that β1-AR and β2-AR were expressed in human HMC.β-AR activation induced reactive oxygen species (ROS) increase in human MCs,the relative levels of ROS were elevated as early as 0.5 h after β-AR activation,and gradually increased and peaked at 4 h on a concentration and time dependent manner.Tunel results demonstrated that β-AR activation induced apoptosis with ROS on a concentration and time dependent manner,β-AR blocking agent-propranolol significantly inhibited β-AR activation induced apoptosis.Antioxidants including vitamin C and NAC could inhibited β-AR activation induced apoptosis (all P ＜ 0.01).Conclusions β-AR is functionally expressed in human mesangial cell,furthermore β-AR activation-induced ROS increase mediate apoptosis.Antioxidants can inhibit β-AR activation induced apoptosis.

Objective To compare the therapeutic effects of closed reduction and transverse fixation with Kirschner wires and open reduction and fixation with mini-plates or Kirschner wires for the fifth metacarpal base fracture.Methods Data of 50 patients,who had been treated in our hospital for the fifth metacarpal base fracture from August 2005 to May 2012,were enrolled in this study.Twenty-six patients underwent closed closed reduction and transverse fixation with Kirschner wires,including 22 males and 4 females,aged from 17 to 41 years; according to the OTA classification,there were 8 of type A1,11 of type B1,and 7 of type C1.Twenty-four patients underwent open reduction and fixation with mini-plates or Kirschner wires,including 21 males and 3 females,aged from 19 to 46 years (average,26 years); according to the OTA classification,there were 11 of type A1,8 of type B1 and 5 of type C1.The total active motion (TAM) score of Chinese Medical Associaition was used to evaluate the range of motion of the joint.Results In closed reduction group,the operation time ranged from 14 to 33 min; the treatment costs ranged from 2018 to 2995 yuan; 23 patients were followed up for 6 to 26 months; X-rays showed the anatomic reduction was achieved in all patients,and the fracture healing time ranged from 4 to 7 weeks; according to the TAM score,the result was excellent in 15,good in 6 and fair in 2,and the excellent and good rate was 91.3％.In open reduction group,the operation time ranged from 45 to 105 min; the treatment costs ranged from 3874 to 4793 yuan; 22 patients were followed up for 6 to 21 months; X-rays showed the anatomic reduction was achieved in all patients,and the fracture healing time ranged from 4 to 8 weeks; according to the TAM score,the result was excellent in 13,good in 7 and fair in 2,and the excellent and good rate was 90.9％.Conclusion Closed reduction and transverse fixation with Kirschner wires is an effective method for the fifth metacarpal base fracture,which has several advantages,such as simple operation,stable fixation,satisfactory results,short operation time and low treatment costs.

Objective: To evaluate the feasibility,the safety and the effect of early postoperative enteral nutrition in patients with esophageal cancer.Methods: On the first postoperative day,40 patients were randomly divided into two groups.One group was given isocaloric total parenteral nutrition through central vein(TPN group) and the other group was fed with enteral nutrition through nasoenteric tubes or jejunostomy tubes which were inserted during the operation(EEN group).All variables were measured before operation and on postoperative day 1 and 8.Blood was drawn at different time points to assess albumin,prealbumin and transferrin.Immune response was determined by immunoglobins,total lymphocytes,T-lymphocyte subsets and NK cells. Inflammatory response were determined by C-reactive protein,IL-6 and TNF-?.Morbidity,mortality and length of hospital stay were also evaluated. Results: Tolerance of enteral nutrition was excellent.Neither mortality nor serious morbidity occurred in all patients during the period of study.After the study,the levels of serum prealbumin,total lymphocytes,CD3,CD4 and CD4/CD8 ratio in the EEN group were significantly higher than the levels in the TPN group.The concentrations of IL-6 and the length of hospital stay in the EEN group were significantly lower than in the TPN group.Conclusion: Early postoperative enteral nutrition in patients with esophageal cancer is safe,and also has the benefit effects of enhancing the body status of nutrition and immune function,and reducing the inflammatory response and the length of hospital stay.

Objective To assess the effectiveness and safety of non-insufflation intra-abdominal compression as a prehospital hemostatic technique in treatment of liver injury.Methods Twenty-nine male Wistar rats were enrolled and randomly assigned into four experimental groups:IAP0 group ( n =8 ),IAP5 group (n =8),IAP10 group (n =8) and IAP15 group (n =5).Then,the anticoagulated rat models of severe liver injury were established with different intra-abdominal pressures ( 0,5,10 and 15 mm Hg) by using a non-expansible insufflated gas bag.Once the mean artery pressure (MAP) was less than 95 mm Hg,Lactated Ringer' s solution was infused through the right jugular vein at speed of 3.3 ml · min-1 · kg-1 until MAP reached 100 mm Hg.Thirty minutes later,the animals were killed by intravenous injection of 0.2 ml saturated potassium chloride solution to measure the intraperitoneal total blood loss,liver weight,volume of infused solution and MAP.Results No death was observed in IAP0,lAP5 and IAP10 groups and four rats (4/5) died at 10-15 minutes following exposure to the 15 mm Hg intra-abdominal pressure in IAP15 group.Total blood loss was reduced to ( 54.20 ±11.30)ml/kg in IAP0 group,(43.98 ±9.2) ml/kg in IAP5 group,(32.49 ±7.40) ml/kg in IAP10group and (25.77 ± 14.16) ml/kg in IAP15group ( P ＜0.01 ).The infused volume of resuscitation solution was (31.06 ± 3.14) ml in IAP10 group,which was higher than (24.94 ±6.67) ml in IAP0 group,(23.06 ± 7.98) ml in IAP5 group and (16.50 ±7.27) ml in IAP15 group (P ＜0.05).Liver weight was ( 11.18 ± 1.45) g in IAP5 group,( 12.13 ± 0.96) g in IAP10 group and ( 11.41 ± 1.20) g in IAP15 group,which was significantly higher than (10.03 ±0.58) g in IAP0 group (P＜0.05).The MAP was (64.81 ± 19.65) mm Hg in IAP5 group and (65.80 ± 15.36) mm Hg in IAP10 group ( insignificant difference between groups,P ＞ 0.05 ),which was higher than (41.22 ± 10.00) mm Hg in IAP0 group and (44.50 ±28.60) mm Hg in IAP15 group (P ＜0.05).Conclusions Non-pneumatic intra-abdominal compression can effectively control bleeding in rat models of severe liver injury,while the adverse effect of intra-abdominal hypertension should be avoided.

Objective To explore the relationship between KCNJ11-E23K polymorphism and essential hypertension (EH) in Kazakh from Xinjiang. Methods PCR-RFLP method was used to test KCNJ11-E23K genotypes of Kazakh from Xinjiang,including 237 EH patients and 221 normotension (NT). Logistic regression analysis was used to analyze the risk factors associated with EH. Results The frequencies of KCNJ11-E23K genotype (EE and (EK + KK)) and allele (E and K) were 34.18%, 65.82%, 61.60% and 38.40%respectively in EH group. There was a significant difference between two groups (P < 0.05). Weight and EE genotype were risk factors affecting EH in Kazakh from Xinjiang. Individual who carried EE genotype and allele E were 2.501 and 1.388 times than (EK + KK) and allele K suffered from EH respectively. Conclusion KCNJ11-E23K polymorphism was associated with EH in Kazakh from Xinjiang.

Objective To explore the role of CD3 +CD8 +T cells in children with severe bacterial meningitis at early stage by studying the changes of CD3 +CD8 +T cells and its relationships with markers of inflammation and humoral immunity. Methods Thirty-nine cases aged ≤14 years old were enrolled in this retrospective study,who were admitted in our PICU from Aug 1. 2014 to Dec 31. 2015 with diagnosis of se-vere bacterial meningitis. The patients were divided into 2 groups according to the changes of CD3 +CD8 + T cells:group A:normal or elevated(≥190/mm3,n=22),group B:decreased( <190/mm3,n=17). Distribu-tion and differences of biomarkers of inflammation,humoral immunity and changes in cerebrospinal fluid be-tween the two groups were analyzed. Results The ratio of CD3 + CD8 + T cells were decreased in 17 (43. 6%)cases. Though there was no statisticly significant difference,the percentile of patients in group B (58. 8%) with Glasgow coma score lower than 8 was higher than that in group A(31. 8%). All the four death were in group B. The mean values of C-reactive protein and procalcitonin were 251. 0(26. 2,417. 0) mg/L,32. 7(0. 9,100. 0) ng/L in group B,which were higher than those in group A[106. 5(12. 0,458. 0) mg/L,4. 5(0. 1,200. 0)ng/L],respectively(P<0. 05). Six cases(35. 3%) in group B with WBC<4 × 109/L was more than 1 case(4. 6%) in group A,and 12 cases(70. 6%) in group B with ratio of neutrophils>80% was more than 7 cases(31. 8%) in group A,there were significant differences(P<0. 05). Fourteen cases(82. 3%) with glucose concentration lower than 2. 0 mmol/L in group B was more than 11 cases (50. 0%) in group A,the difference was significant(P<0. 05). Conclusion CD3 +CD8 +T cells might be suppressed in children with severe bacterial meningitis at early stage,and might associate to the damaging de-gree of brain,inflammation reaction and prognosis in those patients,which should be helpful in using of im-mune regulators for children with severe bacterial meningitis.

Objective To observe the clinical effect of plasma exchange(PE) combined with continuous veno-venous hemodialysis filtration(CVVHDF) in children with acute liver failure.Methods Thirty-nine cases with acute liver failure admitted to pediatric intensive care unit of Shengjing Hospital Affiliated to China Medical University from August 2008 to January 2014 were treated with PE combined with CVVHDF.CVVHDF was performed after PE immediately,each PE + CVVHDF lasted 24 ～ 72 hours.Prothrombin time,blood ammonia,alanine transaminase,aspartate transaminase,serum total bilirubin,conjugated bilirubin were detected before and after PE + CVVHDF treatment.Glasgow Coma Scale were assessed before and after PE +CVVHDF in the thirty-five cases with hepatic encephalopathy.Results After the treatment of PE + CVVHDF,20 children were clinical recover,7 died,12 abandoned the treatment and the results of follow-up were death.PE + CVVHDF was effective in the treatment by decreasing serum total bilirubin,conjugated bilirubin,alanine transaminase,aspartate transaminase [(128.8 ± 82.6) μmol/L vs (73.2 ± 92.4) μmol/L; (90.2 ±71.5) μmol/L vs (55.1 ± 42.6) μmol/L; (3 024.1 ± 2 457.0) U/L vs (1 256.8 ± 757.8) U/L; (3 420.6 ±2 216.3) U/L v s (579.4 ± 338.6) U/L] (P ＜ 0.05),increasing Glasgow Coma Scale (9.5 ± 3.1 vs 12.1 ±2.9) (P ＜0.01),shortening prothrombin time[(40.4 ± 23.0) s vs (22.8 ±9.4) s] (P ＜0.01),in association with the improvement of hemorrhage tendency.Conclusion PE + CVVHDF significantly improves clinical symptoms and biochemical abnormalities in children with acute liver failure.Security of PE + CVVHDF is good and with no obvious adverse reactions.