To study parameters influencing the prognosis of patients suffering from gallbladder carcinoma.MethodsA retrospective clinical analysis was made on 56 cases of gallbladder carcinoma, admitted to our hospital between 1995～2001.ResultsThere were 20 males and 36 femals. Thirty four patients(61%) complicated with gallstons.Abdominal pain(47/56,84%) and jaundice(23/56,41%) were the major complaints.Ultrasonography,CT scan and CA 19 9 measurement were helpful for preoperative diagnosis. Thirty cases(including 5 Nevin stage Ⅱ cases,3 stage Ⅲ cases,4 stage Ⅳ cases,and 18 stage Ⅴ cases) received radical or extended radical chelecystectomy, 11 cases with Nevin stage Ⅴ underwent palliative resection and 15 cases of Nevin stage Ⅴ were subjected to bypass procedure and/ or biopsy.The statistical analysis showed staging of Nevin,surgical procedure,gallstone,adjuvant radiotherapy and chemotherapy significantly affected the survival.Conclusions Early diagnosis, radical resection, active and comprehensive adjuvant radiotherapy with/or chemotherapy help to improve the prognosis of gallbladder carcinoma.

Objective To investigate the effect of evidence-based nursing on the clinical curative effect and prognosis of patients with hypertensive cerebral hemorrhage.Methods 120 patients with hypertensive cerebral hemorrhage were selected,and they were randomly divided into observation group(60 cases) and control group(60 cases) according to the digital table.The control group was treated with routine nursing,the observation group was treated with routine nursing and evidence-based nursing.Before and after nursing,the SDS,self rating anxiety scale (SAS),neurological deficit score NIHSS,Barthel score,the incidence of sequelae,hospitalization time,nursing quality score and patients’ satisfaction with nursing were compared between the two groups.Results There were no statistically significant differences in SDS,SAS,NIHSS and Barthel scores between the two groups before nursing intervention(all P ＞ 0.05).After nursing intervention,the SDS,SAS,NIHSS and Barthel scores of the observation group were (38.74 ± 6.21) points,(35.83 ± 8.17) points,(11.24 ± 3.08) points,(92.58 ± 6.46) points,respectively,which in the control group were (44.58 ± 7.10) points,(43.66 ± 8.06) points,(15.34 ± 3.29) points,(84.27 ± 5.82) points,there were significant differences between the two groups (t =4.796,5.285,7.047,7.403,all P ＜0.05).,The incidence rate of venous thrombosis,muscle atrophy and joint ankylosis sequelae of the observation group was 8.33％,which was lower than 40.00％ of the control group,there was significant difference between the two groups(x2 =16.415,P ＜ 0.05).The hospitalization time of the observation group was (9.55 ± 2.43)d,which was shorter than (15.97 ± 4.68) d of the control group (t =9.430,P ＜ 0.05).The health education nursing quality score,ward management score,basic nursing score,nursing care of critical patients score,nursing document writing score of the observation group were (97.66 ± 2.45) points,(98.23 ± 3.46) points,(97.54 ± 3.18) points,(96.88 ± 3.49) points,(98.76 ± 1.31)points,respectively,which were higher than those of the control group [(88.79 ± 2.37) points,(90.72 ±3.52) points,(91.05 ±3.16) points,(91.67 ± 5.34) points,(93.04 ± 1.12) points],there were significant differences between the two groups(t =20.156,11.786,11.214,6.326,25.707,all P ＜ 0.05).The patients’ nursing satisfaction of the observation group (96.67％) was higher than that of the control group (85.00％),there was significant difference between the two groups (x2 =4.904,P ＜ 0.05).Conclusion Evidence -based nursing can effectively relieve patients’ anxiety and depression of patients with hypertensive cerebral hemorrhage,improve the quality of life of patients,reduce the incidence of complications,shorten the hospitalization time,improve patients'satisfaction.

Objective To investigate the efficacy and complications of therapeutic ERCP for patients over 80 years. Methods Data of 80 patients aging over 80 years, who tnderwent therapeutic ERCP from August 2007 to August 2009 were retrospectively studied. The etiology, complications and therapeutic effects were evaluated. Results A total of 51 patients (63. 8% ) were accompanied by cardiovascular diseases, and 43 patients were diagnosed as having malignant bile duct stricture (53. 8% ). The overail therapeutic efficacy was 96. 3%. The incidence of post-operative complications was 12. 5% (10/80). Occurrence of complications in patients with malignant tumors ( 18. 6% ) was significantly higher than that in patients with bile duct stones (5.6% ,P ＜0. 05). Incidence of complications in those with cardiopulmonary diseases was similar with that in patients without (11.8% vs. 13.8%,P＞0.05). Conclusion Age more than 80should not be considered as contraindication of ERCP. Therapeutic ERCP is effective in senior patients. Patients with advanced ages shows a relatively high incidence of complication after ERCP, which may not be related to other accompanying diseases.

Objective: To investigate the effect of sevolfurane (SEVO) post-conditioning on protein kinase B (AKT)/mammalian target of rapamycin (mTOR) pathway for protecting ischemia/reperfusion (I/R) injury in isolated rat’s heart. Methods: A total of 84 isolated rat’s heart prepared by Langendorff method were randomly divided into 7 groups andn=12 in each group.①Sham group,②I/R group,③SEVO post- conditioning (SPC) group,④NVP-BEZ235 solvent dimenthyl sulfoxide (DMSO) group,⑤Phosphatidyl inositol 3-kinase (PI3K)/mTOR dual inhibitor NVP-BEZ235 (BEZ) group,⑥BEZ+SPC group and⑦SEVO alone group. The hearts received 30 min ischemia followed by 120 min reperfusion with relevant treatment except for Sham group and SEVO group in which the hearts were without ischemia process. Myocardial infarct (MI) size and tissue pathological changes were observed, protein expressions of phosphor-AKT (P-AKT)/total-AKT, P-mTOR/total-mTOR, Beclin1, Bax/Bcl-2 and cleaved Caspase-3 were examined at the end of reperfusion respectively. Results: Compared with I/R group, SPC group presented decreased MI size (26.28±4.00) % vs (49.22±3.66) % and reduced tissue pathological changes; up-regulated protein expressions of P-AKT/total-AKT and P-mTOR/total-mTOR by 79.85% and 67.02%, while down-regulated protein expressions of Beclin1, Bax/Bcl-2 and cleaved Caspase-3 by 33.77%, 69.26% and 48.84%respectively, allP<0.05. Compared with SPC group, BEZ+SPC group sowed increased MI size (53.85±4.06) % vs (26.28±4.00) %and elevated tissue pathological changes; down-regulated proteins expressions of P-AKT/total-AKT and P-mTOR/total-mTOR by 46.06% and 42.95%, while up-regulated protein expressions of Beclin1, Bax/Bcl-2 and cleaved Caspase-3 by 29.90%, 206.85% and 114.65% respectively, allP<0.05. Conclusion: SPC may activate AKT/mTOR pathway and inhibit cardiomyocyte autophagy and apoptosis, thereby attenuate I/R injury in isolated rats’ heart.

Objective To investigate the effects of sevoflurane post-conditioning on oxidative stress and inflammatory reaction during rat cerebral ischemia-reperfusion, and to explore its cerebral protective mechanism.Methods Thirty-six health male Sprague-Dawley rats (aged 12-14 weeks, weighing 220-260 g) were randomly divided into 3 groups (n=12 each): sham control group (group Sham), cerebral ischemia-reperfusion group (group IR), sevoflurane post-conditioning group (group SPC).Cerebral ischemia-reperfusion model was established, ischemia for 30 min followed by reperfusion 24 h.Rat middle cerebral artery was not occluded in group Sham.Cerebral ischemia-reperfusion model was established in group IR.Group SPC was subjected to 2.6% sevoflurane for 15 min in the beginning of reperfusion.At the end of reperfusion, rats were cut off the head to take out the brain tissue.The expression level of Iba-1 and HO-1 proteins was measured by western blot.The levels of reactive oxygen species (ROS), malondialdehyde (MDA), TNF-α, IL-1β and the activity of superoxide dismutase (SOD) were evaluated.Results Compared with group Sham, the expression of cerebral cortex Iba-1 protein was higher than that in groups IR and SPC (P＜0.05), the expression of Iba-1 protein in group SPC was lower than that in group IR (P＜0.05).Compared with group Sham, the contents of ROS, MDA, TNF-α and IL-1β were increased in groups IR and SPC (P＜0.05), but the activity of SOD and expression of HO-1 protein were decreased (P＜0.05).And the contents of ROS, MDA, TNF-α and IL-1β in group SPC were less than those in group IR, the activity of SOD and expression of HO-1 protein in group SPC were higher than those in group IR.Conclusion Sevoflurane post-conditioning can mitigate the microglia activation, reduce cerebral oxidative stress and inflammation, thus protect rat cerebral against ischemia reperfusion injury.

Objective To investigate the accuracy of the plasma DNA concentration in evaluating the prognosis in patients with sepsis.Methods One hundred and sixty patients with sepsis were enrolled as the sepsis group (group SE).Another 109 patients without sepsis hospitalized during the same period served as the control group (group C).The venous blood sample was taken on admission for determination of plasma DNA concentration by polymerase chain reaction,C reactive protein (CRP) concentration by ELISA.APACHE Ⅱ score and SOFA score were evaluated at 24 h after admission.The 160 patients with sepsis were divided into two groups according to the result of prognosis:survival group ( n =103) and death group ( n =57).Results Compared with group C,the plasma DNA concentration,CRP concentration,APACHE Ⅱ score and SOFA score were significantly increased in group SE (P＜0.05).Compared with survival group,the plasma DNA concentration,APACHEⅡ score and SOFA score were significantly increased in death group ( P ＜ 0.05).The areas under receiver operating characteristic (ROC) curves of the plasma DNA concentration was significantly larger than those of APACHE Ⅱ score and SOFA score (0.81(95％ CI,0.74-0.88) versus 0.68(95％ CI,0.60-0.77),or 0.72(95％ CI,0.63-0.82)).Conclusion The plasma DNA concentration can accurately evaluate the prognosis in patients with sepsis.As compared with the plasma CRP concentration,APACHE Ⅱ score and SOFA score,the plasma DNA concentration is more accurate to evaluate the prognosis in patients with sepsis.

In proteomic research, to improve protein solubility of membrane proteins and nuclear proteins, buffers containing high concentration of detergent, such as 4% SDS, were widely used. However, high concentration of detergent might severely interfere with the downstream proteomic analysis, including protein quantitation and trypsin digestion. To improve the proteomic compatibility of buffers with high concentration of detergent, we used short gel method to pretreat buffers containing detergent. Protein samples were first separated by a short (2-2.5 mm) SDS-PAGE electrophoresis, and proteins were quantitated by comparing with bovine serum albumin standards via optical density analysis. The gel was then cut and peptides were recovered using in-gel digestion. The quantitative linearity range of this method was 1 to 8 μg. The quantitation was accurate and reproducible. After short gel analysis, recovered peptides generated high mass spectrometry signals. In conclusion, short gel method eliminated the interference of high concentration detergent in the proteomics analysis, and it was suitable for protein samples' pretreatment, and was worth to apply in proteomic research.
Detergents ; chemistry ; Electrophoresis, Polyacrylamide Gel ; methods ; Mass Spectrometry ; Membrane Proteins ; chemistry ; Nuclear Proteins ; chemistry ; Proteins ; chemistry ; Proteomics ; methods ; Trypsin

We described an elderly female with type 2 diabetes referred to our hospital with fever,nausea and upper abdominal pain.The patient had got duodenal tumor and received the pancreaticoduodenectomy (PD) 12 years ago.The laboratory examinations revealed white blood cells (WBC) increasing and severe hypocalcemia.Abdominal computed tomography (CT) revealed a huge gas-forming pyogenic liver abscess (PLA) in left lobe of the liver.The patient got cured after correction of calcium metabolism disorders,treatment with antibiotic and receiving percutaneous tube drainage.We concluded that we should remain on high alert of those patients with DM and the history of cancer,when he or she gets fever of unknown origin and abdominal tenderness.PLA should be considered.

Objective To compare the differences between endoscopic resection and laparoscopy?assisted surgery or transanal endoscopic resection for rectal neuroendocrinal tumor. Methods Clinical data of patients who underwent endoscopic or surgical resection of neuroendocrinal tumor of less than 2 cm which were confirmed by pathology from December 2010 to November 2013 were retrospectively analyzed. Results Twenty cases of endoscopic treatment, including 17 cases of ESD, 3 cases of EMR,were included in endoscopy group;while 18 cases treated with surgery were included in surgery group, among which 12 ca?ses underwent transanal endoscopic microsurgery and 6 cases laparoscopic resection. The mean lesion sizes were 7 mm(4?18 mm)and 8 mm(3?15 mm),respectively. Pathology showed there were 16 cases of grade G1 neurocrinal tumor and 2 G2 cases in surgical group. There was no lymphvascular invasion with clear margin in the endoscopy group,but three cases of lymphvascular invasion in surgical group. No treatment?related se?vere adverse event occurred in either group. The time for oral food intake was 2?0 d(1?4 d) in endoscopy group, while that in surgery group was 2?4 d(1?7 d)(P=0?295). The hospital stay was(6?80±2?12) d in endoscopy group and(8?59±2?85)d in surgery group, respectively(P=0?034). And the total hospitalization cost was 10 488(4 128?15 296) yuan and 15 590(3 024?40 503) yuan(P=0?031) in the two groups, re?spectively. The follow?up was 25 months(2?48 months)and no recurrence was found. Conclusion Endo?scopic resection, especially ESD, is a new approach to treat colorectal neuroendocrinal tumor,advantageous over surgery in shorter hospitalization time, minimal invasiveness, faster postoperative recovery, less compli? cation, and reduced hospitalization cost.

Objective To determine the significance of the quantitative parameters obtained from intravoxel incoherent motion ( IVIM) diffusion weighted imaging ( DWI) in differentiating renal tumors from normal renal tissues.Methods Twenty-four patients with surgical pathology-proven renal tumors and 13 volunteers with healthy kidneys were included.DWI was performed with 9 b-values (0, 20, 50, 100, 200, 400, 600, 800 and 1 000 s/mm2).The slow component of diffusion (Dslow), fast component of diffusion ( Dfast ) and fraction of fast ADC ( f) of the biexponential DWI were calculated for the clear cell renal cell carcinoma (CCRCC), the normal renal parenchyma and the non CCRCC ( NCCRCC) .The ADC was calculated for all b-values using linear regression yielding standard ADC ( ADCtot ) .The parameters were compared among the groups, and the receiver operating characteristic ( ROC ) analysis was performed. Results CCRCC showed higher ADCtot (1.73 ±0.43) ×10 -3 mm2/s, Dfast (14.75 ±14.73) ×10 -3 mm2/s, Dslow(1.34 ±0.38) ×10 -3 mm2/s than NCCRCC (ADCtot(1.23 ±0.26) ×10 -3 mm2/s, Dfast(9.47 ± 5.27) ×10 -3 mm2/s, Dslow(0.58 ±0.15) ×10 -3 mm2/s), and the differences of ADCtot(P=0.037) and Dslow(P=0.001) were significant.The normal renal parenchyma showed higher ADCtot (2.25 ±0.11) × 10 -3 mm2/s, Dslow ( 1.74 ±0.17 ) ×10 -3 mm2/s, f ( 35.00% ±9.37%) than CCRCC ( f, 31.13% ± 10.75%) and NCCRCC(f, 33.76%±24.02%), and the differences between the normal renal parenchyma and CCRCC of ADCtot ( P =0.000 ) and Dslow ( P =0.001 ) were significant.There were no differences between the normal renal parenchyma and the tumor ipsilateral renal parenchyma of all parameters.Dslow had higher accuracy ( sensitivity 95%, specificity 100%) in distinguishing CCRCC and NCCRCC, with area under the curve of 0.988.Conclusions Multi-b-value DWI derived quantitative parameters including ADCtot and Dslow may differ significantly between the renal tumor and normal renal parenchyma.Dslow is the best parameter in distinguishing CCRCC and NCCRCC.