Objective To evaluate the role of spinal nicotinamide-adenine dinucletide phosphate (NADPH) oxidase in the development and maintenance of neuropathic pain (NP) in rats.Methods Twenty-four pathogen-free healthy male Sprague-Dawley rats,aged 200-250 g,were divided into 3 groups (n =8 each) using a random number table:sham operation group (S group),NP group and NADPH oxidase inhibitor group (NI group).The left sciatic nerve was exposed but not ligated in group S.The left sciatic nerve was exposed and 4 loose ligatures were placed on the sciatic nerve at 1 mm intervals with 4-0 silk thread to establish the NP model in group NP.In group NI,the NP model was established at 3 days after intrathecal catheterization,and NADPH oxidase inhibitor 5 μg/10 μ1 was injected intrathecally once a day for 7 consecutive days starting from 30 min before operation.The mechanical paw withdraw threshold (MWT) was measured at 1 day before operation and 1,3,5 and 7 days after operation.The rats were sacrificed at 8 days after operation,and the spinal cord was removed for determination of NeuN positive cells (by immuno-histochemistry) and expression of NADPH oxidase (by Western blot).Results Compared with group S,the MWT at each time point after operation and ratio of NeuN positive cells at 8 days after operation were significantly decreased in NP and NI groups,the expression of NADPH oxidase was upregulated in group NP,and the expression of NADPH oxidase was down-regulated in group NI (P＜0.05).Compared with group NP,the MWT at each time point after operation and ratio of NeuN positive cells at 8 days after operation were significantly increased,and the expression of NADPH oxidase was down-regulated in group NI (P＜0.05).Conclusion Up-regulated expression of spinal NADPH oxidase is involved in the development and maintenance of NP in rats.

Objective To explore the effect of GAS MAN assisted instruction on theory learning of volatile anesthetics in anesthesiology residency training.Methods A total of 32 residents in the first stage of anesthesiology training were enrolled and randomly assigned to either study(S) or control (C) group.Theory-test l(Test-1) was conducted for all residents after the lecture-based learning (LBL).Next,reference book self-reading strategy was used in both groups while computer-based simulation(CBS) using GAS MAN was only developed in S group.Then,theory-test 2(Test-2)was conducted for residents in both groups and residents in S group completed the questionnaire smvey.In addition,thirty-four resident teachers observed the CBS courses and completed the questionnaire smvey.Results The mean scores of Test-1 did not differ significantly between the two groups(P=0.64).However,the mean Test-2 score of S group(81.3 ± 13.6) was significantly higher than that of C group(61.3 ± 15.4) (P=0.001).100％(16/16) residents believed that CBS was beneficial to the theoretical study of volatile anesthetics,93.8％(15/16) residents considered GAS MAN could help understand the concepts and improve efficiency during self-learning.97.1％ (33/34) and 91.2％ (31/34)resident teachers agreed that CBS was helpful for analyzing complex concepts and improving study effectiveness,respectively.Conclusions CBS using GAS MAN improves theory knowledge and study effectiveness for anesthesia residents.Both residents and resident teachers find GAS MAN highly ac ceptable.Therefore,GAS MAN has the potential to be the assistant teaching tool for LBL in anesthesiology residency-training program.

Objective To evaluated the effect of first-line epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI)on advanced non-small cell lung cancer (NSCLC)patients with different EGFR mutation status (exon 1 9 deletion and exon 21 mutation).Methods Seventy-two advanced NSCLC patients with EGFR mutation confirmed by histopathology were enrolled.All of the patients received first-line EGFR-TKI.The relationships between EGFR mutation status and objective response rate (ORR),disease control rate (DCR),progression free survival (PFS ) and overall survival (OS ) were analyzed.Results Of the 72 patients,37 patients expressed exon 1 9 deletion,35 patients expressed exon 21 mutation,and all of them could be evaluated.The ORR and DCR of patients with exon 1 9 deletion were higher than those of patients with exon 21 mutation (75.7%vs.51 .4%,χ2 =4.583,P=0.032;89.2%vs.68.6%,χ2 =4.636,P=0.031 ).The modified median PFS of patients with exon 1 9 deletion was significantly higher than that of patients with exon 21 mutation (1 3.2 month vs.1 0.8 month,χ2 =4.700,P=0.030).The median OS of patients with exon 1 9 deletion was significantly higher than that of patients with exon 21 mutation (30.2 month vs.25.6 month,χ2 =4.686,P=0.030).The side effects were similar between the two groups.The most common adverse reaction was rash,and the incidence had no significant difference between the two groups (48.7% vs.48.6%,χ2 =0.000,P=0.995 ).Conclusion EGFR mutation status is a predictor for PFS,OS and ORR of first-line EGFR-TKI in patients with advanced NSCLC.NSCLC patients with EGFR exon 1 9 deletion are associated with longer survival time and better response rate compared with those with exon 21 mutation.

OBJECTIVE:To observe the clinical efficacy and safety of Yinzhihuang oral liquid in the adjuvant treatment of neo-natal breast-feeding faundice. METHODS:112 newborns with faundice were randomly divided into control group and observation group. Control group stopped breast-feeding for 3 d and given artificial feeding,as well as keeping warm,nutritional support, maintaining water and electrolyte and acid-base balance,blue light irradiation and severe patients were given liver protection,en-zyme inducers;observation group was additionally given Yinzhihuang oral liquid 10 ml,twice a day. The treatment course was 7 d. Clinical efficacy,and serum total bilirubin(TBIL)level before and after treatment,and incidence of adverse reactions in 2 groups were observed. RESULTS:The total effective rate in observation group was significantly higher than control group,the difference was statistically significant(P<0.05). After treatment,TBIL level in 2 groups was significantly lower than before and gradually de-creased with time,and observation group was lower than control group,the differences were statistically significant(P<0.05). The incidence of adverse reactions of 2 groups was no statistically significant(P>0.05). CONCLUSIONS:Based on the conventional treatment,Yinzhihuang oral liquid can be used in the adjuvant treatment of neonatal breast-feeding faundice,with good efficacy and good safety.

Objective To further understand factors that influence health-related quality of life (HRQOL) in patients with ulcerative colitis (UC),especially the role of perceived stress and coping modes in Chinese patients with UC.Methods This study was a cross-sectional study.Patients with UC were recruited from July 2013 to September 2014 in Peking Union Medical College Hospital.HRQOL was measured using the inflammatory bowel disease questionnaire (IBDQ).Perceived stress was measured by Perceived Stress Scale (PSS).Coping strategy was evaluated using Medical Coping Modes Questionnaire (MCMQ).Demographic data,course of the disease,clinical disease activity,and disease phenotype according to Montreal classification were also collected.Univariate analyses were conducted to determine which variables were associated with HRQOL,and those were statistically significant were entered into a multivariate regression model.Results We recruited 214 patients (response rate 92.2％),whose median age was 37.5 (29.0,49.3) years old and median course of UC was 4 (2,9) years.Through univariate analyses,better HRQOL was significantly associated with regular medical visits,lower number of previous relapses and hospitalizations,no steroid use,Montreal E1,lower Mayo scores,clinical remission,less perceived stress and less acceptance strategy use.However,multivariate analyses revealed that perceived stress (OR =1.112,95％ CI 1.058-1.169),acceptance (OR =0.310,95％ CI 0.141-0.685),number of hospitalizations (OR =2.924,95 ％ CI 1.328-6.437) and clinical activity (OR =5.058,95 ％ CI 2.312-11.066) were most strongly related to HRQOL.Conclusions HRQOL of UC patients are not only associated with clinical activity of the disease,but also associated with coping strategy and perceivedstress.Further research needs to focus on whether or not relieving stress and guiding patients to cope with ulcerative colitis would improve HRQOL.

Objective To investigate the effects of different therapeutic strategies on recurrence of postoperative Crohn's disease (CD) patients.Methods From September 2009 to September 2014,85 CD patients with intestinal resection were enrolled.The clinical features and maintenance therapeutic medication were retrospectively analyzed.The patients were divided into non-treatment group (induding continuously or cumulatively taking medicine less than three months),5-aminosalicylic acid (5-ASA) group and immunosuppressant agents group (including azathioprine,methotrexate and thalidomide).Kaplan-Meier method was performed to compare the recurrence rate in postoperative CD with different therapeutic medication and the risk factors of postoperative recurrence were also analyzed.Results Among 85 CD patients,there were 32,21 and 32 patients in non-treatment group,5-ASA group and immunosuppressive agents group,respectively.After surgery,the one year accumulated clinical recurrence rate of immunosuppressant agents group was 12.5％ (4/32),which was significantly lower than that of non-treatment group (56.3％,18/32) and 5-ASA group (38.1％,8/21),and the differences were statistically significant (x2 =12.250,P＜0.01;x2 =4.102,P =0.043).After surgery,the two years accumulated clinical recurrence rate of immunosuppressant agents group was 12.9 ％ (4/31),which was significantly lower than that of non-treatment group (75.9％,22/29) and 5-ASA group (47.6％,10/21),and the differences were statisitcally significant (x2 =17.840,P＜0.01;x2 =6.597,P=0.010).After operation,the one year accumulated endoscopic recurrences rates of non-treatment group,5-ASA group and immunosuppressant agents group were 39.1％ (9/23),5/16 and 34.6％ (9/26),respectively;while the two year accumulated endoscopic recurrence rates were 59.1％ (13/22),6/16 and 44.0％ (11/25),respectively.However,there was no statistically significant difference among the groups (all P＞0.05).Penetrating lesion was an risk factor of postoperative clinical recurrence in CD patients (x2 =4.963,P=0.026,oddsratio (OR) =2.221,95 ％ confidence interval (CI) 1.121 to 5.775).Conclusions Immunosuppressive agents rather than 5-ASA have remarkable effects in preventing postoperative clinical recurrence in CD patients.Postoperative clinical recurrence is more likely to happen in patients with penetrating lesions.

Objective To investigate the triggering receptor expressed on myeloid cells-1(TREM-1) of cord blood leukocytes in neonates and the transcription level of mRNA, and analyze its promoting function of inflammatory cytokine secretion. Methods During the period from September 2013 to March 2014, cord blood was collected from 20 term neonates at the time of birth, and peripheral blood was collected from 20 healthy adults. The expression of TREM-1 and TREM-1 mRNA on leukocytes was observed using flow cytometry and real-time reverse transeription-polymerase chain reaction, respectively. After the whole cord blood was stimulated by lipopolysaccharide (LPS) or LP17 plus LPS, the contents of interleukin (IL)-6, tumor necrosis factor-α (TNF-α), IL-8 and soluble TREM-1 (sTREM-1) in the supernatant were analyzed by enzyme linked immunosorbent assay. The statistical significance was determined using the one-way ANOVA test, t test, q test and Pearson correlation coefficient. Results The mean fluorescence intensity of TREM-1 on leukocytes of newborns was not different compared with healthy adults (P>0.05), while the percentage of TREM-1 positive on polymorphonuclear cells was lower than that of healthy adults [(82.3±7.1)% vs (98.6±4.8)%, P<0.05]. The level of TREM-1 mRNA in newborns was lower than in healthy adults (1.16±0.13 vs 1.63±0.24, t=7.714, P<0.01). The LPS treatment significantly increased sTREM-1 in newborn whole blood compared with the control treatment [(156.7±36.3) vs (34.6±6.1) pg/ml, t=13.623, P<0.01]. The concentration of IL-6, TNF-αand IL-8 decreased significantly when TREM-1 was blocked by LP17. In addition, the concentration of sTREM-1 showed a positive correlation with the levels of TNF-α(r=0.519, P<0.05), IL-6 (r=0.507, P<0.05) and IL-8 (r=0.538, P<0.05). Conclusions Healthy newborns exhibit expression of TREM-1 on monocytes similar to healthy adults, and most PMNs express TREM-1 at the newborn stage. Blocking the TREM-1 signal transduction pathway may reduce inflammatory responses of neonate leukocytes.

Objective To describe the changes of thrombosed venous sinus on MRI after administration of contrast material and evaluate the sensitivity and specificity of thread-like enhancement around sinus to diagnose thrombosis in the corresponding sinus.Methods Patients with cerebral venous sinus thrombosis (CVST) admitted to our department from January 2005 to December 2014 and undergone a MRI scan with administration of contrast material were included in this study.The enhancement features of venous sinus were studied in the plane parallel to the interested sinus.The features of enhancement were classified as peripheral thread-like enhancement, partial enhancement and complete enhancement.The proportion of these three type of enhancement in thrombosed sinuses and normal sinuses were described and compared.The sensitivity and specificity of peripheral thread-like enhancement to diagnose thrombosis in corresponding sinus were calculated.The proportion of each type of enhancement was also described and compared in acute (≤ 7 d), subacute (8-30 d) and chronic (≥ 31 d) stage after onset of symptoms.Results Peripheral thread-like enhancement, partial enhancement and complete enhancement were all found in both thrombosed and normal sinuses.There was a significant difference of enhancement features between normal and thrombosed sinus in superior sagittal sinus (100％ (30/30) vs 60％ (27/45), x2 =13.789, P =0.001), left trans verse sinus, and right sigrnoid sinus.The sensitivity and specificity of peripheral thread-like enhancement to diagnose thrombosis in the corresponding sinus were 10.5％-44.4％ and 53.3％-76.7％ respectively.There was no significant difference of contrast features at different stage after onset.Conclusion The value of peripheral thread-like enhancement to diagnose CVST is limited because of low sensitivity and specificity.

Professional postgraduates in geriatric medicine are one of the most important re-courses of geriatric specialists. However, training model for geriatric postgraduates is still unclear in China. In general, geriatric medicine has no independent training plan, and is included in internal medicine training. Such model cannot represent the feature of geriatric medicine. The present paper aimed to discuss the ability construction for geriatric postgraduates based on the geriatric medicine specialist training experience both at home and abroad, including diagnosis and treatment of multi-system diseases, ability of geriatric assessment, management of geriatric syndromes, consultation for geriatric rehabilitation and ability for continuity health service in order to cultivate the compound tal-ents suitable for the aging society requirement for geriatric medicine in China.

Objective: To observe the iodine nutrition level and ultrasonic manifestations of thyroid in forest and non-forest land residents of Heilongjiang province. Methods: Using random sampling method, 3 645 residents form 13 forests and 17 non-forests sites were selected and divided into 5 groups according to ages, i.e. group A (20-30 years), B (31-40 years), C (41-50 years), D (51-60 years) and E (61-70 years), and the ratio of male and female in each group was 1:1. Then all objects underwent thyroid ultrasound and urinary iodine. Results: ①The median urinary iodine of forest residents was lower than non-forest residents (P<0.05). In group B, C, D and E, the median urinary iodine of forest residents were all lower than non-forest (all P<0.05). ②Along with the age growth, thyroid structure abnormal rate increased in both forest and non-forest residents (all P<0.05). The abnormal thyroid structure rate of forest residents was higher than that of non-forest residents (P<0.05). There was no statistical difference of the number of residents with abnormal ultrasonic manifestations between forest and non-forest residents (P>0.05). Thyroid structure abnormal rate of group D and E in forest residents were both higher than those in non-forest (both P<0.05). ③The urine iodine median in forest residents with ultrasonic abnormal thyroid was lower than in non-forest (P<0.05), while in forest residents in group D and E were both lower than non-forest (both P<0.05). Conclusion: The rate of thyroid structure abnormality increased with aging in both forest and non-forest residents of Heilongjiang province, the thyroid structure abnormal rate in middle-aged and elderly forest residents was higher, whereas the urine iodine median was lower than non-forest. Iodine nutritional status were at adequate levels in forest and non-forest 20-29 years old residents, while at appropriate levels in all other ages. The urine iodine content in forest residents were lower than that in non-forest of the same ages.