Objective To investigate change of TLR4 in OLETF (Otsuka Long-Evans Tokushima fatty) rats with in-sulin resistance (IR), and to study the effect of pioglitazone (PIO) on the expression of TLR4, and to explore the possible mechanisms of the PIO reducing the risk of cardiovascular diseases. Methods Twenty four OLETF rats were fed with high-fat diet for 20 weeks to establish the IR model then they were randomly assigned into two groups:the model group (group M), in which the rats were fed with high-fat diet;the PIO group (group P), in which the rats were fed with PIO in addition to high-fat diet . Control group include 12 OLETF rats fed with normal diet (group NC). After 20 weeks of drug intervention, plasma levels of FINS (Fasting INSulin), FBG (Fasting Blood Glucose), blood lipid, IL-18 and TLR4 were assessed in every group. Results Comparing with group NC, FBG, Blood lipid, IL-18 and TLR4 were significantly increased in group M(P＜0.05 or P＜0.01), comparing with group M, FBG, Blood lipid were improved in group P, and serum IL-18, TLR4 were signifi-cantly lower in the group P than that in group M(P＜0.05 or P＜0.01). Conclusion TLR4 may be involved in IR by pro-moting inflammatory response, and PIO can significantly improve IR and inflammatory, and reduce the risk of cardiovascular diseases by inhibiting the expression of TLR4.

Objective:To investigate the influence of Mannan Peptide combined with 5-Fu on the proliferation and apoptosis of HepG2 cells and to explore the related mechanism.Methods:HepG2 cells were divided into four groups:the control group,5-Fu group,Mannan Peptide group and combination group.Cell proliferation was evaluated by MTT assay.Flow cytometry was used to examine the cell cycle,proliferation index(PI)and apoptosis ratio.The expression of Bcl-2 protein in each group was analyzed by immunocytochemical method.Results:The inhibitive effect of 5-Fu plus Mannan Peptide was significantly stronger than that of Mannan Peptide alone,in a time-and dose-dependent manner. Cells were treated with medicine for 48 hours.Compared with cells in the control group and 5-Fu group,the percentage of cells in G_0/G_1 stage and the apoptosis ratio in the combination group were increased(P<0.01).In immunocytochemical analysis,the combination of Mannan Peptide and 5-Fu could significantly decrease Bcl-2 protein level(P<0.01).Conclusion:The combination of Mannan Peptide and 5-Fu can synergistically suppress the proliferation and induce apoptosis of human hepatoma HepG2 cells.The mechanism might be associated with down-regulation of Bcl-2 protein expression.

Objective:To promote the application of the best evidence in the prevention of venous thrombosis in patients with lung cancer in thoracic surgery, so as to improve the nursing management, elevate the nursing quality and reduce the incidence of venous thrombosis.Methods:High quality literature guidelines related to perioperative venous thromboembolism prevention of lung cancer were searched and screened, and the evidence was extracted. Combined with clinical background, nursing strategies were generated through expert demonstration meetings and used as clinical review indicators. On the basis of evidence-based i-PARIHS as the theoretical framework, through the establishment of core groups, removal of existing obstacles, education and training and quality control, the evidence was applied to the clinical practice effectively, and the data were collected by means of on-the-spot observation and consulting cases, and the effect of evidence application was evaluated from the three aspects including system, nurses and patients.Results:Systemically speaking, in the process of evidence application, the department established the standards and procedures for perioperative venous thromboembolism prevention of lung cancer patients, improved thrombus risk assessment tools, made educational materials, brought thrombus prevention into the scope of quality control, and optimized the organizational environment with full consideration of manpower and materials. For nurses, after the application of evidence, the scores of nurses' knowledge, attitude and practice of venous thromboembolism prevention were (17.6 ± 1.8), (17.4 ± 1.8), (18.8 ± 1.2), (53.8 ± 2.9) respectively, which were higher than those before the application of evidence (12.0 ± 2.9), (14.5 ± 2.8), (11.6 ± 2.7), (38.3 ± 5.1), the differences were significant ( t values were -11.40 - -3.90, all P<0.05). For patients, the incidence of venous thromboembolism before the application of evidence was 4.7% (19/403), and venous thromboembolism after the application of evidence was 0 (0/118), and the difference was statistically significant ( χ2 value was 5.774, P<0.05). Conclusions:The best evidence of perioperative venous thromboembolism of lung cancer on the basis of evidence-based is of great scientificity. Its application on clinical practice could effectively optimize the systematic organizational environment, standardize nursing behavior, improve nursing quality, and reduce the occurrence of venous thromboembolism in patients with lung cancer surgical procedures.

BACKGROUND: Simple drug therapy can not acquire satisfactory effects in treatment of fungal keretitis. At present, penetrating keratoplasy (PKP) has been considered a primary means to cure the fungal keratitis to save eyeball and vision.OBJECTIVE: To evaluate the clinical efficacy of PKP in the treatment of high-risk fungal keratitis.DESIGN, TIME AND SETTING: A retrospective case analysis was performed at the Department of Ophthalmology, Affiliated Hospital of Qingdao University Medical University between January 2000 and January 2007.PARTICIPANTS: A total of 51 patients (51 eyes) with high-risk fungal keratitis who underwent PKP in the Affiliated Hospital of Qingdao University Medical College were recruited into this study. Of these patients, 12 suffered from perfored, 35 from hypopyon, 8 from complicated cataract prior to surgery, and 5 from complicated glaucoma.METHODS: All patients received antifungal and antibacterial treatments prior to surgery and underwent PKP within 4 days following admission. After surgery, antifungal and antibacterial treatments were performed locally and systemically. All patients were followed-up for 6--24 months.MAIN OUTCOME MEASURES: Postoperative visual acuity, recurred fungal infection, rejection of implants, secondary glaucoma, and ulceration of implant.RESULTS: ① Of 51 patients, 18 were followed-up for 6-12 months, 2 for 13-18 months, and 8 for 19-24 months. ② A total of 49 (96.1%) out of 51 patients preserved the eyeballs and the visual acuity improved to different degrees in 48 (94.1%) patients. ③ After surgery, fungal infection recurred in 6 eyes (11.6%), 4 of which were controlled by antifungal medication and 2 was enucleated because of uncontrolled endophthalmitis. Graft rejection was found in 18 (35.3%) eyes, 13 of which recovered transparent by medication and 5 received secondary PKP. Graft ulceration was present in 4 (7.84%) eyes, 3 of which were cured and the remaining one was re-grafted because of severe endothelial cell loss. Secondary glaucoma appeared in 7(13.7%) eyes, and the intraocular pressure was controlled medically and surgically. Complicated cataract occurred in 6 (11.8%) eyes, 3 of which underwent cataract extraction. Most complications were successfully controlled. In the final follow-up period, 45 (88.2%) grafts were transparent.CONCLUSION: PKP is an effective approach to preservation of eyeballs and restoration of visual function in patients with high-risk fungal keratitis, which can not be treated by conservative therapy.

Objective To evaluate the calculation and report of detection index and the statistics analysis of group comparison in high risk group,a problem of medical science study.Methods Relevant literature was consulted so that the methods could be listed of the detection index and the current statistic analysis of group comparison in high risk group.Results The current report about detection ratio and the statistics analysis of group comparison in high risk group proved to be mistaken,and the statistics analysis of group comparison was not the comparison of detection ratios in high risk group.Conclusions It is necessary to calculate and report the detection ratio when expressing the detection index.The statistics difference should be tested about constituent ratio in the group comparison,after excluding patient group.At the same time,some explanation should be given by the author in the composition.

Obiective To evaluate the efficacy of health package for the nurse in train evacuation, Methods The self-manufactured new mobile health package for the nurses provides shortcut and completed equipment in various basic nursing care, therapic procedure, condition observation, emergency aid and treatment for nursing staff who performed transportation in train evacuation.Results The potable health package can play an important role in several medical support training and have special mission. Conclusion The health package has mobile applicability and operability, which is an important equipment for successful medical support training.

Objective To evaluate the role of 11C-methionine positron emission tomographv(MET PET-CT)in differentiating tumor recurrence from radiation necrosis in brain slioma patients.Methods From June 2008 to September 2009,30 brain glioma patients with suspected tumor recurvence or radiation necrosis after radiotherapy were evaluated by MET PET-CT.The median time between initial radiotherapy and PET examination was 13.5 months.Tumor recurrence were confirmed by histological analysis while necrosis was based on histological analysis or the subsequent clinical follow-up.Results Eighteen out of 19 patients were histologically confirmed tumor recurrence among those tumor recurrence shown by MET PET-CT after surgery or stereotactic biopsy.11 patients were considered to have radiation necrosis because of stable neurological sympotoms and without massive enlargement of the lesion during the after follow-up.The sensitivity,specificity and accuracy of MET PET-CT for detecting tumor recurrence were 100%,91.7%and 96.7%respectively.Conclusion MET PET-CT is a powerful tool in differentiating brain tumor recurrence from radiation necrosis after radiotherapy.

Objective:To understand the characteristics of the callers with the diagnosis of mental disorders called Beijing Psychological Crisis Hotline for help,in order to provide specific psychological intervention services for them in future.Methods:From December 2002 to December 2008,24217 different callers'data collected from a computer-based operating system of the Beijing Psychological Crisis Hotline were analyzed.According to their self-reported of having the diagnoses of mental disorder or not,the callers were divided into the ones with diagnosis (n=6516)and the ones without diagnosis (n =17701).The callers'demographic characteristics,their main counseling problems and the suicide-related factors in the two groups were compared.Results:The top five main counseling problems in the group with diagnosis were mental problems,the mental illness related knowledge,the problems of family relationships,working problems and interpersonal problems.Mental problem ranked first in both groups.Compared to the group without diagnosis,the diagnosed ones were more likely to be found in such group of people as women,aged between 20 -29 and 30 -44,having 10 or more years of education and the unem-ployed.The results of the assessments of 11 suicide-related risk factors showed that callers with diagnoses had higher prevalence of most suicide-related factors than those in the other group(P <0.001 or 0.05),which included suicidal intention and behavior while calling,history of attempted suicide,severe depressive symptoms,severe physi-cal illness,history of being abused,afraid of being attacked,suicidal history of relatives or associates,severe of hopeless.Conclusion:The hotline counselors should be aware of the necessity of assessing the severity of depres-sion and other suicide-related factors for the callers with mental disorder diagnoses before providing any psychologi-cal intervention.Moreover,except for providing interventions on the callers'psychiatric problems,the hotline coun-selors should also identify and help to deal with the stress events in their lives.

Ophthalmic microsurgery has its own characteristics: high precision , complicated operation , and long learning curve.It is important for young ophthalmologists to master the basic operation skills through standardized and systematic training during graduate studies .The teaching method , integrating theoretical teaching , animal operation and simulative ophthalmic surgery training , have important meanings in promoting the post-graduate students to master the practical and correct ophthalmic microsurgery technique . The aim of this study was to introduce the curriculum design and practice , and to evaluate the model through the examination scores .

Objective To Compare characteristics between the psychological aids hotline callers who had single attempted suicide and those callers who had repeated attempted suicide. Methods The analysis was conducted on the da?tabase of Beijing psychological aids hotline from Dec., 2002 to Dec., 2008. All the effective callers were consulted by pro?fessional hotline operators. During the calling, the callers were interviewed on their attempted suicides, depression and 11 correlates associated with caller's suicidal behaviors. Results Among 4519 callers who had attempted suicide, 2441 (54%) of them had attempted suicide once, and the other 2078 (46.0%) callers had repeated suicide attempts. After ad?justed for gender, age, and the other 4 demographic variables, history of being abused (OR=1.35, 95%CI: 1.08~1.67), afraid of being attack (OR=1.35, 95%CI: 1.01~1.59), relatives or associates with prior suicidal behavior history (OR=1.17, 95%CI: 1.001~1.36), hopelessness (OR=1.20, 95%CI: 1.02~1.40), and psychological treatment history (OR=0.73, 95%CI:0.62~0.86) were associated with repeated suicide among hotline callers. Conclusions To improve the effective?ness of hotline based suicide prevention, assessment of risk of repeated attempted suicide among the callers with a histo?ry of prior attempted suicide should focus on the history of being abused, afraid of being attack, hopelessness, relatives or associates with prior suicide history, and psychological treatment history.