Objective To clone the human mucin (MUC)5AC gene promoter and construct its luciferase reporter vector for human MUC5AC gene and analyze its transcriptional activity. Methods The 1 348 bp DNA sequence at the human MUC5AC gene 5 end was analyzed by the Vector NTI software.After the target sequence from human A549 cells genomic DNA was amplified by PCR method, and the product of PCR was sequenced.By promoter deletion analysis, 3 promoter segments with diferent lengths were amplified by PCR, then the products were identified by DNA sequencing, and 4 promotor segments were inserted into pGL3- enhancer vectors.Site-specific mutagenesis technique was used to establish mutants of specificity protein (SP)-l and nuclear factor-kappa B (NF-кB) site in MUC5AC gene promoter. The relative luciferase activities were detected in the transfected A549 cells. Results Sequence analysis indicated that there were many cis-acting elements in the regions of 1 348 bp DNA sequence at the human MUC5AC gene 5 end.The 4 reporter gene vectors with promoter segments with different lengths were constructed successfully.Dual-luciferase assay revealed the 372 bp fragment including activity with the minimal fragment. Neutrophil elastase (NE) could increase the expression of luciferase reporter gene plasmid containing mutated NF-кB version (P＜0.05 vs. contro1) of MUC5AC promoter in the transfected A549 cells. The induction by NE decreased markedly when the SP-l element in MUC5AC promoter were mutated. Conclusion This research may provide an important basis for the further study of human MUC5AC gene promoter activity and regulation of gene expression.There is an up-regulative element of gene transcription in the region of -324 to -64 bp in MUC5AC gene upstream. SP-l site of the promotor mediates NE-induced MUC5AC expression in human A549 cells.

Objective To investigate the effect of myeloid differentiation factor 88 inhibitor ST2825 on the autophagy of THP?1 cells infected by re?combinant mycobacterium smegmatis. Methods The myeloid differentiation factor 88 inhibitor ST2825 was applied on the THP?1 cells infected by recombinant mycobacterium smegmatis,and three groups were defined:the test group with ST2825 treatment,the control group without ST2825 treatment,and the blank group. Autophagosomes were observed under the fluorescence microscope,and the mRNA expression of Beclin?1 gene and Bcl?2gene was analyzed by RT?PCR. Results Compared with the control group,the number of autophagy fluorescent dots in the test group was ob?viously reduced(P<0. 05),and the expression levels of Beclin 1 gene and Bcl?2 gene were declined as indicated by the RT?PCR detection. Con?clusion The myeloid differentiation factor 88 inhibitor ST2825 might inhibit the autophagy of THP?1 cells through interfering the separation of Be?clin?1 and Bcl?2.

Objective:To investigate the influence of electroacupuncture on auditory evoked potential index (AAI) during propofol sedation.Methods: According to propofol effect site concentration, 24 patients for operation were randomly allocated to group 1 (1.0 μg/mL), group 2 (1.5 μg/mL) and group 3 (2.0 μg/mL). Propofol was administered intravenously, points Hegu (LI4) and Neiguan (PC6) were electro-acupunctured, and changes in AAI were recorded.Results:AAI significantly rose in all groups during the initial several minutes after electro-acupuncture and significantly fell in group 2 at 20 min after electro-acupuncture(P＜0.05).Conclusion:AAI can sensitively reflect pain response during electro-acupuncture and electro-acupuncture can strengthen propofol sedation at its medium concentration.

Objective To summarize the perioperative outcomes of patients undergoing endovascular repair,and to screen out related preoperative risk factors in order to provide reference for the promotion of postoperative rehabilitation of patients.Methods The clinical data of 2 896 patients undergoing elective endovascular repair in the Department of Vascular Surgery,Zhongshan Hospital,Fudan University from Jan.2013 to Dec.2014 were analyzed to screen out related preoperative risk factors of postoperative complications retrospectively.Results A total of 148 patients had postoperative complications,including 2 cases of death during hospitalization.The incidence of complications in the patients older than 75 years old,with hypertension,diabetic mellitus,renal dysfunction,chronic obstructive pulmonary disease (COPD) or ASA physical status more than grade Ⅱ is 9.7％,8.1 ％,14.3 ％,8.0 ％,29.7 ％,6.3 ％,respectively.The multivariate Logistic regression analysis identified that patients older than 75 years old (P =0.000,OR =43.29,95％CI:22.51-83.28),with hypertension (P=0.000,OR=3.822,95 ％CI:2.37-6.16),diabetic mellitus (P=0.025,OR=1.714,95％CI:1.07 -2.75),renal dysfunction (P =0.017,OR =2.692,95 ％ CI:1.19-6.07) or COPD (P =0.000,OR =7.158,95％CI:3.83-13.37) and ASA physical status more than grade Ⅱ (P =0.000,OR =27.77,95％CI:13.79-55.93) were the independent risk factors with postoperative complications of endovascular repair surgery.Conclusions The patients older than 75 years old,with hypertension,diabetic mellitus,renal dysfunction or COPD and ASA physical status more than grade Ⅱ were the independent risk factors for endovascular repair surgery.

With the changes in the social structure of China, medical aid to the poor has become a hot issue in our society. The authors analyze the current state of medical aid to the poor in China, disenss the difficulties in providing medical aid to the poor at present, and put forward the idea of providing medical aid to the poor through specifying aid funds, conducting fundraising in every way, establishing foundations, adopting a variety of aid patterns, obtaining the active cooperation of local hospitals, and coordinating aid organizations.

Objective To study the best multiple concentration of target controlled infusion of propofol and remifentanil in elderly patients during the induction of general anesthesia. Methods Fifty elderly patients were randomized into five groups, according to the effect site concentration of remifentanil (0, 2, 4, 6, 8 ng/mL). We started the effect site concentration of propofol (PEC) at 2 μg/mL, and added 1 μg/mL every 2 min until bispectral index (BIS) was stable at 40±5. During the induction,we recorded the effect site concentration of remifentanil (REC) and propofol (PEC), heart rate (HR), arterial blood pressure (ABP), BIS, AAI, and isolated forearm technique (IFT). After statistic analysis, the best multiple concentration was judged. Results There was no significant difference (P<0.05) in the changes of hypertension and hypotension among these five groups during intubation. The most smooth hemodynamic conditions were found in group B, i.e. 20% and 10%, respectively. When consciousness was lost, there was a negative correlation between PEC and REC. Group B was the minimum on the change of IFT and the cardiovascular system among these five groups at tracheal intubation. Conclusions It is safe and stable to use REC 2 μg/mL for TCI, combined with propofol in elderly patients under general anesthesia. PEC is (3.5±0.8)μg/mL when the patients' consciousness is lost. And PEC is 5.3 μg/mL at tracheal intubation.

Objective:To compare the clinical efficacy and safety between spleen total resection splenectomy and spleen partial splenectomy in the treatment of patients with traumatic spleen rupture.Methods:84 cases of patients with traumatic spleen rupture from March 2013 to March 2016 were selected and divided into two groups.42 cases in the spleen total resection group were treated with spleen total resection,while the other 42 cases in the spleen partial nephrectomy group were treated with spleen partial splenectomy.The operative effect,the levels of platelet count,serum IgA,IgG,IgM,CD3 +,CD4 +,CD8 +,CD4 + / CD8 + levels before and after treatment,the incidence of complications were compared between two groups.Results:The intraoperative blood loss,exhaust time,length of hospital stay of spleen partial nephrectomy group were shorter than those of the spleen total resection group,but the operation time of research group was longer than that of the spleen total resection group (P＜0.05).The platelet count,CD8+ of spleen partial nephrectomy group were lower than those of the spleen total resection group (P＜0.05).The IgA,IgG,IgM,CD3+,CD4+,CD8+,CD4+/CD8+ of spleen partial nephrectomy group were significantly higher than those of the spleen total resection group (P＜0.05).The incidence rate of complications in the spleen partial nephrectomy group was lower than that of the spleen total resection group (P＜0.05).Conclusion:Spleen partial splenectomy was more effective than spleen total resection in the treatment of traumatic splenic rupture,which had little effect on the platelet and immune function.

Objective To study the effect of preoperative blood pressure control on postoperative cardiovascular events in patients with hypertension and gastrointestinal surgery. Methods A total of 238 hypertensive patients who underwent gastrointestinal surgery were selected and divided into control group (n =118)and non-control group (n =120)according to thehypotensor treatment.During the operation,the same anesthetic regimen was used.The use of vasoactive drugs was recorded during anesthesia.Bladder chalone C (Cys C)and cardiac troponin T (cTnT)were de-tected in blood before and after the operation,and so were N-terminal B type natriuretic peptide (NT-proBNP)level on the 1st and 5th day after the operation.The postoperative hospitalization time,fol-low-up of cardiovascular events 28 and 90 days after discharge were recorded.Results Compared with the non-control group,the total dosage of ephedrine in the control group was significantly re-duced [(3.41±1.04)mg vs (7.46 ± 3.29)mg,P <0.05 ],total dose of phenylephrinewas signifi-cantly reduced [(0.17±0.10)mg vs (0.46 ±0.16)mg,P <0.05],postoperative hospital stay was significantly shorter [(5.92±1.15)d vs (9.65±1.61)d,P <0.05],NT-proBNP level in the control group on the 1st day after the operation [(108.00 ± 47.11 )pg/L vs (250.38 ± 62.92 )pg/L,P <0.01]and 5 days after the operation [(62.07 ±25.31)pg/L vs (199.02 ± 60.32)pg/L,P <0.01 ] was obviously reduced.There was no statistical difference in Cys C andcTnT between the two group-safter operation.The incidence of cardiovascular adverse events in the control group was significantly lower than that in the non-control group (28 d:13.6% vs 62.7%,90 d:23.3% vs 23.3%,P <0.05).Conclusion Strict control of preoperative blood pressure control in patients with hypertension can significantly reduce the incidence of cardiovascular events.

Objective To retrospectively analyze the treatment outcomes and failure patterns in patients with head?and?neck cancer of unknown primary head?and?neck cancer of unknown primary, and to compare the efficacy between elective mucosal irradiation and ipsilateral neck treatment. Methods The clinical data of patients with head?and?neck cancer of unknown primary who were admitted from January 2007 to December 2013 were retrospectively collected. Thirty?one patients received elective pharyngeal mucosal irradiation and 61 patients only received ipsilateral neck treatment. The SPSS 19. 0 software was used for comparison of the survival and local control between the two groups. Results In the 92 patients, the median age was 57 years;79. 3% had metastasis to level Ⅱ lymph nodes;the median follow?up time was 36. 5 months;the 3?year overall survival, mucosal control, and neck control rates were 89. 0%, 86. 6%, and 82. 4%, respectively. Primary sites were found in 15 patients, containing nasopharynx in 4 patients, oropharynx in 3 patients, oral cavity in 3 patients, throat and hypopharyngeal part in 3 patients, maxillary sinus in 1 patient, and esophagus in 1 patient. The patients undergoing elective pharyngeal mucosal irradiation had significantly higher 3?year mucosal control and neck control rates than those undergoing ipsilateral neck treatment ( 100% vs. 74. 9%, P= 0. 040;87. 5% vs. 62. 2%, P= 0. 037 ) . There was no difference in the 3?year overall survival rate between the two groups ( 83. 5% vs. 88. 7%, P= 0. 910 ) . Conclusions For patients with head?and?neck cancer of unknown primary, elective pharyngeal mucosal irradiation can reduce the incidence of primary site and increase the neck control rate. A new standard for target volume delineation should be established as soon as possible for elective prophylactic pharyngeal mucosal irradiation.

Objective To retrospectively analyze the efficacy and toxicity of intensity?modulated radiotherapy ( IMRT) alone and IMRT with concurrent chemotherapy ( CRT) in the treatment of early?stage nasopharyngeal carcinoma ( NPC) using pairwise group comparison. Methods A total of 98 patients with stage T1?2N1M0 NPC were treated with IMRT alone or CRT from 2009 to 2010, and 39 pairs out of them were selected for comparison of efficacy and toxicity. The survival rates were calculated using the Kaplan?Meier method and analyzed using the log?rank test. Results The 3?year follow?up rate was 95%. There were no significant differences in the 3?year overall survival ( OS ) , progression?free survival ( PFS ) , local recurrence?free survival ( LRFS ) , and distant metastasis?free survival ( DMFS ) rates between the IMRT alone group and the CRT group ( 97% vs. 95%, P=0?411;97% vs. 92%, P=0?301;97% vs. 97%, P=0?606;100% vs. 92%, P=0?082) . The incidence rates of leucopenia, anemia, and thrombocytopenia were significantly higher in the CRT group than in the IMRT alone group ( P=0?000;P=0?000;P=0?000 ) . There were no significant differences in the incidence rates of grade 3 oral mucositis and hearing loss between the IMRT alone group and the CRT group ( 26% vs. 23%, P= 0?093;41% vs. 62%, P= 0?100 ) . Conclusions CRT fails to increase the OS, PFS, and LRFS rates and reduce the DMFS rate in patients with stage T1?2 N1 NPC. Moreover, CRT results in higher incidence rates of hematotoxicity, grade 3 mucositis, and hearing loss than IMRT alone.