Objective To detect the serum expression level of Pokemon and explore its clinical value combines with AFP,AFP-L3 or DCP in hepatocellular carcinoma (HCC).Methods In this study,the serum levels of Pokemon,AFP,AFP-L3 and DCP in 30 patients with HCC,34 patients with benign liver diseases and 30 healthy controls were examined by enzyme-linked immunosorbent assay.Then,the clinical significance of Pokemon expression level was analyzed.In the end,the diagnostic evaluation of four serum biomarker alone detection was used to analyze the sensitivity,specificity,the area under the curve and Youden index in the diagnosis of HCC.Results The serum expression level of Pokemon in patients with HCC was (22.63 ± 6.82) ng/ml,which was significantly higher than that in the group with benign liver diseases and healthy controls [(3.54±1.26)ng/ml,t =8.594,P＜0.001;(1.95 ±0.57)ng/ml,t =10.021,P＜0.001].The expression level of Pokemon in HCC patients was correlated to tumor size (t =2.678,P =0.021) and TNM stag (t =2.578,P =0.034).The serum expression levels of AFP,AFP-L3 and DCP in patients with HCC were (774.56 ± 96.52) ng/ml,(26.37 ± 2.54) ng/ml and (93.49 ± 30.45) mAU/ml,which were significantly higher than those in the group with benign liver diseases [(22.21 ± 3.57) ng/ml,(7.05 ± 2.71) ng/ml,(34.68 ± 10.13) mAU/ml] and healthy controls [(14.65 ± 4.45) ng/ml,(3.84 ± 1.09) ng/ml,(25.87 ± 9.01)mAU/ml,F=58.46,P=0.000;F=12.47,P=0.000;F=23.41,P=0.000].The sensitivity and specificity of Pokemon,AFP,AFP-L3,DCP in the diagnosis of HCC were 84.6％ and 87.5％,52.5％ and 78.9％,95.0％ and 80.0％,77.1％ and 87.5％,respectively.Conclusion The enhanced Pokemon serum level,with its sensitivity and specificity higher than AFP,points out Pokemon may be a potentially useful biomarker to diagnose HCC.

Objective To analyze the impac factors of serum N?terminal pro?brain natriuretic peptide (NT?proBNP) in patients with renal failure in non?dialysis phase, and to determine the cut?off point of as a diagnostic values in these patients with heart failure (HF). Methods Cross?sectional study was applied. Clinical data of 145 patients (37 cases of CKD4, 89 cases of CKD5, and 19 cases of acute renal injury (AKI) with renal failure in non?dialysis phase were collected. Comparison between groups and lineal regression analysis were utilized to investigate the impact factors of NT?proBNP, and the receiver operating characteristic curve (ROC curve) to select a better cut?off point of diagnosis in these patients with HF. Results (1) Compared with patients without HF, patients with HF had significantly higher edema, cardiac troponin I, serum phosphorus concentration, and left atrial diameter (LA), while ALB and left ventricular ejection fraction (LVEF) were decreased (P<0.05). (2) The NT?proBNP was divided into 4 groups with four points: First groups of 36 cases, NT?proBNP 1 ?862 ng/L, second groups 37 cases, 866?2670 ng/L, third groups 37 cases, 2790?20 000 ng/L, fourth groups 35 cases, 20 900?35 000 ng/L. With the increase of NT?proBNP levels, the occurrence of AKI and CKD4 decreased gradually while the occurrence of CKD and edema were significantly increased (P<0.01). Systolic blood pressure, troponin I, uric acid, serum phosphorus, parathyroid hormone, 24 hours urine protein, LA, interventricular septum thickness (IVS), left ventricular posterior wall thickness (LVPW) level gradually increased. Hb, ALB, calcium, CO2, eGFR, LVEF significantly decreased (P<0.01). The serum NT?proBNP of patients with HF was significantly higher than that of patients without HF (19 150 ng/L vs 1530 ng/L, P<0.01). The serum NT?proBNP of patients with edema was significantly higher than that in patients without edema (5460 ng/L vs 1630 ng/L, P<0.01). (3) Single factor linear regression analysis indicated that higher NT?proBNP was positive correlated with HF, edema, cardiac troponin I, uric acid, serum phosphorus, LA, IVS and LVPW (P<0.05), while negative correlated with Hb, eGFR, ALB, serum calcium, CO2, LVEF (P<0.05), and not correlated with eGFR, uric acid, serum calcium (P>0.05). (4) The best cut?off point of NT?proBNP predicting HF in patients with renal failure in non?dialysis phase was 3805 ng/L, AUC=0.848, 95%CI 0.786?0.910. Sensitivity was 82.4%, specificity 74.5%, positive predictive value 62.1%, negative predictive value 87.3%, positive likelihood ratio 3.2, negative likelihood ratio 0.24. Conclusions The level of NT?proBNP>20 000 ng/L is mainly found in end?stage renal disease patients with HF. HF is a main factor for the increase of NT?proBNP in patients with renal failure in non?dialysis phase. High phosphorus viremia, anemia, and hypoalbuminemia are closely related to NT?proBNP. Therefore NT?proBNP predicting HF should take into account the effects of these confounding factors in these patients.

Objective To investigate the significantly elevated incidence of hepatitis C and mortality of cirrhosis and hepatocellular carcinoma (HCC) in Jianping county, and to explore the epidemiological features. Methods The data from database of death registry and infectious disease surveillance in Jianping county, Liaoning Province were analyzed. The distributions of incidence of hepatitis B and hepatitis C, mortality of cirrhosis and HCC in 23 villages and towns were investigated.Spearman's correlation was used to explore the correlations between hepatitis, cirrhosis and HCC.Results The standardized mortality of HCC in males and females in Jianping county were 77. 6/10~5and 22. 0/10~5, respectively, which were 2. 0 and 1. 7 times, respectively of the average levels of Liaoning rural areas. The incidence of hepatitis C was 58. 0/10~5 , which was 9. 5 times of the averagelevel of Liaoning Province. There were positive correlations between incidence of hepatitis C and mortality of cirrhosis (r=0. 495, P = 0. 008), and mortality of cirrhosis and HCC (r=0. 646, P<0.01). Conclusions The incidence of hepatitis C and mortality of cirrhosis and HCC in Jianping county are significantly higher than the average levels of Liaoning Province. Further investigations of the suspected causes are needed.

Objective To evaluate the changes in mRNA expressions of Toll-like receptor 4 (TLR4) and its down-stream cytokines IL-1β,IL-6 and TNF-a in incisional tissues from a rat with postoperative pain.Methods Incisional pain was induced in 74 male adult SD rats weighing 200-250 g.Paw mechanical withdrawal threshold (PMWT) around the wound on the operated and nonoperated sides was measured at 1 day before operation and at 0.5,1,2,6 and 12 hours as well as 1,2,3,5 and 7 days after operation.Skin incisional tissues were removed for determination of mRNA expressions of TLR4,IL-1β,IL-6 and TNF-a using real-time quantitative PCR at 1 day before operation and at 2 and 8 hours as well as 1,2,3,5 and 7 days after operation.Results Compared with the baseline value before operation,PMWT on the operated side was significantly decreased at 0.5 hours-5 days after operation,mRNA expression of TLR4 around the wounds on the operated side was down-regulated at 2 hours after operation followed by a gradual increase,mRNA expressions of IL-1β,IL-6 and TNF-α on the operative side were up-regulated at 2 and 8 hours as well as 1,2,3 and 5 days after operation (P ＜ 0.05),but no significant changes were found in PMWT and mRNA expressions of TLR4,IL-1β,IL-6 and TNF-α on the non-operated side(P ＞ 0.05).PMWT on the operated side was lowest at 6 hours after operation followed by the gradual increase,mRNA expression of TLR4 on the operated side peaked at 2 days after operation,and mRNA expressions of IL-1β,IL-6 and TNF-a respectively peaked at 2 hours,1 day and 3 days after operation (P ＜ 0.05).mRNA expressions of TLR4,IL-1β,IL-6 and TNF-a were negatively correlated with PMWT on the operative side (r =-0.501,-0.743,-0.893,-0.657,P ＜ 0.05),and mRNA expressions of IL-1 β,IL-6 and TNF-a were positively correlated with the level of TLR4 mRNA(r=0.764,0.283,0.667,P＜0.05).Conclusion mRNA expressions of TLR4 and its down-stream cytokines IL-1 β,IL-6 and TNF-a in skin incisional tissues are up-regulated,which may be involved in the development and maintenance of postoperative pain.

A brief introduction to the development milestones of postgraduate medical education in the world, highlighting the present details of such systems in the United States, United Kingdom, France, Germany and some Asian countries.It is held that common patterns can be identified despite the gaps found in such systems of these countries.In view of the training management system cornmonalities of thecountries,the authors proposed the development directions of residency training in China to enhance thehands-on capability and competence of clinical doctors in a standardized manner.

_ Objective_ To explore the relationship between the waist circumference ( WC) level and the non-alcoholic fatty liver disease ( NAFLD) in the Kailuan Group population. Methods A total of 7 896 individuals were selected as observed subjects from the Kailuan Group in 2011-2012 health physical examination. A questionnaire survey, blood biochemical, and abdominal ultrasound examination were finished by trained medical staff. According to the WC measurement and its quartile in the health examination, the observed subjects were divided into four groups (first, second, third, and forth quartile groups). Multivariate logistic regression analysis was used to analyze the relationship between the WC level and the NAFLD. Results ( 1 ) The detection rate of NAFLD in central obesity groupwashigherthanthatinnon-obesitygroup(67.1% vs27.9%,P<0.01). AlongwithincreasingWClevelinthe 4 quartile groups, the incidences of NAFLD were progressively increased, being 7. 1%, 23. 4%, 33. 4%, and 36. 1%, respectively. In the total population, the detection rates were 18. 8%, 42. 5%, 62. 0%, and 76. 1% in males;5. 4%, 24. 1%, 44. 7% and 62. 9% in females. (2)Multivariate logistic regression analysis showed that WC is an independent risk factor after adjusting age, gender, and other risk factors, the OR value being 1. 08. It was also noticed that compared with the first quartile group, the second, third, and forth quartile groups had increased risk of NAFLD after adjusting above factors in different genders, with the OR values being 2. 74, 6. 59, and 11. 15 in males, while 2. 61, 5. 03, and 3. 67 in females, respectively. Conclusion WC was an independent risk factor for NAFLD;the incidence of NAFLD increased with increasing WC level in the Kailuan Group population.

To investigate the effects of Losartan,an angiotensinⅡ(AngⅡ)receptor(AT_1) antagonist,on pancreatic stellate cells(PSCs)and its possible mechanisms.Methods (1)PSCs were isolated from pancreatic cancerous samples to test the expressions of AT_1 and collagenⅠafter incubated with AngⅡor/and Losartan.(2)Ninety S-D rats were divided into normal group,control group and treatment group,with 30 rats in each.The rats in control and treatment groups were induced pancreatic fibrosis by injection of 2% trinitrobenenze sulfonic acid(TNBS)into biliopancreatic duct.Rats in treat- ment group were then treated with Losartan by garage daily and rats in control group were only given distilled water.The rats were sacrificed on day 3,7,14,21 and 28,respectively,and pancreas were removed.The histological abnormalities were observed by electron microscope.The mRNAs of trans- forming growth factor?_1(TGF?_1)and procollagenⅠwere detected by reverse transcription-polymerase chain reaction(RT-PCR).The expression of TGF?_1 and?-smooth muscle actin(?-SMA)proteins was assessed by immunohistochemistry and the level of?-SMA protein was quantified by Western blot. Results In vitro,there existed AT_1 expression in PSCs,and Losartan reduced expression of collagenⅠ.Losartan treatment reversed the histological abnormalities observed by electron microscope,com- pared to treatment with distill water.The expression of?-SMA,TGF?_1 and procollagenⅠwere signifi- cantly higher in the control group than those in normal group and were reduced by Losartan to different extent in treatment group.Conclusion AT_1 antagonist can inhibit the activation and the profibrogenic action of PSCs by blocking AT_1 receptor-mediated pathways.

Objective To know the ability of rural health doctors, find out the scope of job satis-faction and desire of training and extending for chosen extending rural health doctors. Methods Various factors were analyzed, which affect the appropriate health technology extension in rural areas based on the study in Liaoning province with the method of the questionnaire and the categorical data statistics. Results The quality of medical human resources in rural area was low. The main influencing factors for training were practicality of the training, rescannable time and whether increasing income. Meanwhile, The appropriate health technology extension was affected by the rationality, validity, safety of techniques, acceptance degrees of patients as well as the individual professional basis. Conclusion It was necessary to focus on continued medical education to improve the rural doctor's ability. Some tactics was also put forward to promote the technology extension effect. This study provided some suggestions which could be used as references for the government making decision.

Objective To investigate the factors that influence the temperament characteristics in the preschool children. Methods We used the cluster random sampling methods to extract 120 cases in the Zhejiang Shengzhou region from November to December 2013. The Chinese children aged 3-6 temperament questionnaire, Achenbach child behavior questionnaire and preschoolers general questionnaire were utilized to investigate their demographic data, temperament and behavior conditions, and related statistical analysis were given and analyzed by logistic regression analysis. Results In 120 cases of preschool children′s temperament type distributions, plain type were 74. 2% (89/120), intermediate type 17. 5% (21/120), and trouble type 8. 3%(10/120). The CBCL questionnaire presented 5 dimensions that activities level was (15. 09 ± 2. 10) points, rhythmicity (15. 78 ± 3. 19) points, phobotaxis (14. 98 ± 3. 00) points, adaptability (13. 45 ± 2. 78) points, and response intensity ( 14. 00 ± 3. 13 ) points. The withdrawal, somatic complaints, anxiety, depression, social, and thought had statistical significance with different temperament characteristics ( P <0. 05). Pearson correlation analysis showed that each temperament characteristics dimensions had positive correlation with back down of behavior, social behavior, anxiety and depressed dimension (P<0. 05). Logistic regression analysis presented that the maternal education level, family type, age of the mother and child rearing patterns were the main risk factors affected temperament (β =0. 549,0. 724,0. 114,0. 009;P <0. 05). Conclusions Preschool children′temperament characteristics plays a important role on child behavior, and its factors are related to many factors as family factors which required active intervention to strengthen families.

Objective To investigate the association between non-Hodgkin lymphoma (NHL) and hepatitis B virus (HBV). Methods The serum HBV markers in 305 NHL patients who were diagnosed in the Affiliated Hospital of Southwest Medical University from January 2014 to December 2016 was detected by automatic chemiluminescence immunoassay. The infection rate of HBV in NHL patients was compared with that in 312 colorectal cancer patients and the national general population (81775 peoples). Results The positive rates of hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb) and hepatitis B core antibody (HBcAb) in 305 patients of NHL were compared with the general population [19.0 ％ (58/305) vs. 7.2 ％ (5888/81775), 44.3 ％ (135/305) vs. 50.1 ％ (40969/81775), 45.9 ％ (140/305) vs. 34.1 ％(27885/81775)], and the differences were statistically significant (χ2 values were 63.1, 4.1, 18.8, all P<0.05). The positive rate of HBsAg in NHL patients was compared with colorectal cancer patients and the general population, and the differences were statistically significant (χ2= 65.7, P< 0.01). The positive rate of HBsAg in B-cell NHL was statistically different from T-cell NHL [21.3％(51/239) vs. 10.6％(7/66),χ2=3.869, P<0.05]. But the positive rate of HBcAb and HBsAb in B-cell NHL were compared with T-cell NHL, and there was no statistically significant difference (both P> 0.05). Among 133 NHL patients, the HBV DNA positive rate was 33.1 ％ (44/133), and 74.1 ％ (43/58) in 58 cases of HBsAg-positive NHL, while 4.2 ％ (1/24) in 24 cases of HBsAg-negative but HBcAb-positive NHL. Conclusions The infection rate of HBV in NHL patients is higher than that in colorectal cancer patients and the general population, in which the occult HBV infection is worthy of much attention. The positive rate of HBsAg in T-cell NHL patients is lower than that in B-cell NHL patients. For NHL patients with HBV infection, anti-HBV treatment to prevent reactivation of the virus should be given before the anti-tumor treatment.