Objective To investigate the effect of pantoprazole (proton pump inhibitor, PPI) and gefarnate (gastric mucosa protectant) on the prevention of upper gastrointestinal bleeding in patients undergoing post-percutaneous coronary intervention (PCI) dual anti-platelet therapy.Methods This research included 1263 patients taking enteric aspirin and clopidogrel after PCI.The cases were divided into 4 groups: routine treatment group (n=332), PPI group (n=318), gastric mucosa protectant group (n=299), and PPI+gastric mucosa protectant group (n=314).A follow-up for 6 months was observed including gastrointestinal symptoms, upper gastrointestinal bleeding, major adverse cardiac events (MACE), and adverse reactions.Results There were 52 cases of upper gastrointestinal bleeding within 6 months, including 21 cases from routine treatment group, 9 from PPI group, 15 from gastric mucosa protectant group, and 7 from PPI+gastric mucosa protectant group.The incidence of upper gastrointestinal bleeding among the 4 groups within 6 months was statistically different (X2=8.883, P=0.031).The routine treatment group had significant higher rate than the PPI group and the gastric mucosa protectant group (P<0.05), while among other groups there was no significant difference (P>0.05).The upper gastrointestinal bleeding occurred within 3 postoperative months in 34 out of 52 cases (65.4%).There was no statistical significance among the four groups in regard to bleeding occurrence time (X2=4.212,P=0.648).Conclusions Patients undergoing post-PCI dual anti-platelet treatment can reduce the incidence of gastrointestinal bleeding by taking pantoprazole or combined with gefarnate.Intervention against upper gastrointestinal bleeding should start on the first day after PCI and last for a minimum of 3-6 months.

Objective To investigate the effects of hypertonic saline/hetastarch solution (HHS) on stress hormones and glucose metabolism in hemorrhagic shock rabbit.Methods Fourteen rabbits of both sexes weighing 2.2-2.6 kg were randomly divided into 2 groups : HHS group ( n = 7) and lactated Ringer's solution (LRS) group ( n = 7). The animals were anesthetized with intravenous 20% urethane 5 ml? kg-1 . Femoral artery was cannulated for BP monitoring and femoral vein was cannulated for removal of blood and fluid infusion. Hemorrhagic shock was induced according to Wiggers. MAP was maintained at 45 mm Hg for 45 min. Then the animals in HHS group received HHS 6 ml? kg-1 and those in LRS group LRS 6 ml? kg-1 . Venous blood samples were taken before shock (baseline), during shock before resuscitation, and 30, 60, 120 min after fluid resuscitation for determination of plasma epinephrine, glucagon, insulin and blood glucose concentration. The insulin sensitivity index (ISI) was calculated.Results After resuscitation MAP returned to baseline level in HHS group while in LRS group MAP was still lower than the baseline. The plasma epinephrine, glucagon and blood glucose concentration increased significantly while plasma insulin concentration decreased significantly during shock before fluid resuscitation compared to the baseline in both groups. After fluid resuscitation plasma epinephrine and glucagon concentration decreased significantly and plasma insulin concentration increased significantly in HHS group whereas in LRS group plasma epinephrine, glucagon and insulin concentration kept increasing. The blood glucose level was significantly lower at 60 and 120 min after resuscitation in HHS group than in LRS group. ISI was decreased after resuscitation in both groups but was significantly lower at 60 and 120 min after resuscitation in LRS group than in HHS group.Conclusion Resuscitation with HHS can reduce the stress response and ameliorate the decrease in insulin sensitivity during hemorrhagic shock.

BACKGROUND: Severe acute pancreatitis (SAP) can result in intestinal mucosal barrier (IMB) dysfunction. This study was undertaken to demonstrate the effect of IGF-I on the intestinal mucosal barrier in rats with SAP and its possible mechanisms. METHODS: Seventy-two male Wistar rats were randomly divided into three groups: a sham operation (SO group,n=24), a SAP group not treated with IGF-I (SAP group,n=24), and a SAP group treated with IGF-I (IGF-I group,n=24). SAP was induced in the rats by injecting 5.0％ sodium taurocholate into the biliary-pancreatic duct. The SO rats were given an infusion of normal saline instead. The rats in the IGF-I group underwent the SAP procedure and were given a subcutaneous injection of IGF-I at 30 minutes before the operation and at 3 hours after the operation. Eight rats in each group were sacrificed at 6, 12 and 24 hours after operation. Apoptosis of mucosal cells in the small intestine was determined by TUNEL. The levels of endotoxin and DAO and serum amylase were also measured. Pathologic changes in the small intestine were monitored. Changes of bax and bcl-2 mRNA expression in the small intestine were determined by reverse transcription polymerase chain reaction (RT-PCR). RESULTS: The levels of serum amylase were lower in the IGF-I group than in the SAP group at all three time points (P<0.05). The levels of endotoxin in the IGF-I group were higher than those in the SAP group at 6 hours, but lower in the IGF-I group than in the SAP group at 12 and 24 hours (P<0.05). The levels of diamine oxidase were higher in the IGF-I group at 6 hours but lower than those in the SAP group at 12 and 24 hours. The pathological score of the small intestine was lower in the IGF-I group than in the SAP group, and the difference was statistically significant at 12 and 24 hours. The pathologic changes observed under electron microscopy were better in the IGF-I group than those in the SAP group. The apoptosis index of intestinal epithelial cells was significantly decreased in the IGF-I group compared with the SAP group. Compared with the SO group, the mRNA expression levels of bax were increased at each time point in the SAP group, and were significantly decreased in the IGF-I group as compared with the SAP group at each time point (P<0.05). The expression levels of bcl-2 were weak and not different between the SO group and the SAP group (P>0.05). They were significantly increased in the IGF-I group versus the SO and SAP groups (P<0.05). The ratio of bax and bcl-2 mRNA expression levels at each time point in the SAP group were significantly higher than those in the SO group, but they were obviously decreased in the IGF-I group. CONCLUSIONS: Exogenous IGF-I seems to protect mucosal cells in the small intestine against SAP-induced apoptosis and could alleviate SAP-induced injury of the intestinal mucosa. The underlying mechanisms include enhanced mRNA expression of bcl-2 and inhibition of bax mRNA expression.

Objective To investigate the correlation between dose volume histogram(DVH)of tumor targets and organs at risk(OAR)at CT-image based 192Ir brachytherapy and effects and complications for patients with locally advanced cervical cancer. Methods Ten patients with FIGO stage ⅢB cervical cancer received CT image-based 192Ir intracavitary brachytherapy after 54 Gy of three-dimentional four-field pelvic external beam radiotherapy and concurrent weekly cisplatin chemotherapy. Before each brachytherapy,CT images were acquired with applicators in place. Gross tumor volume(GTV), clinical target volume (CTV)and OAR were contoured and inverse treatment planning was designed and optimized by using PLATO treatment planning system. Conventional two-dimensional plans were also designed for comparison.The total intracavitary brachytherapy dose was 30 -42 Gy in 5 -7 fractions. The patients were followed, and the local control and complications were analyzed. The biologically equivalent dose(BED)and biologically equivalent dose in 2 Gy fractions(BED2)for GTV, CTV and OAR were calculated. The minimum dose in the most irradiated tissue volume 2 cm3(D2 cm3)adjacent to the applicator of the sigmoid colon, rectum,bladder and small bowel was determined from the DVH. Results The 1-year local pelvic control rate was 90% and grade 1-2 late complication of sigmoid colon and rectum was 50%. No grade 3 or more complications developed. On CT-image based planning, the BED and BED2 to 90% of the CTV(D90)were 95.50 Gy ± 7. 81 Gy and 79. 73 Gy ± 6. 57 Gy. The BED and BED2 to 90% of the GTV(D90)were 101.86 Gy ± 7.27 Gy and 84. 95 Gy ± 6. 1 Gy. The volume enclosed by 90% of prescribed dose(V90)for GTV and CTV were 92% ±4% and 87% ±7% respectively. The D2cm3 for rectum and sigmoid colon were 74. 97 Gy ±1.64 Gy and 67. 93 Gy ± 4. 30 Gy(EQD2, α/β = 3). Comparing with 2D brachytherapy plans , CT - image based planning has improved D90 and V90 for GTV and CTV with similar dose at point A and rectum reference point. Conclusions Computer tomography-image based 192Ir brachytherapy has resulted in the better dose distribution to the tumor targets with excellent tumor control and acceptable toxicity.

Epidemiology is a discipline characterized by complicated theory and practice.How to make the practice course function better is a topic worthy of exploring in educational reform for clinical students.The article explored the‘Student-Dominated’ Model based on ‘Problem-Based Learning ’ and ‘Team Based Learning ’ in teaching process and compared the model with the traditional one ( Teacher-Dominated Model) .Suggestions were given to further improve effectiveness of epidemiology practice courses.

Objective To probe the value of multi-slice spiral CT angiography (MSCTA) in decreasing surgical trauma of the cranial base meningioma. Methods Thirty-two patients with cranial base meningioma were examined preoperatively with MSCTA to observe the shape and the relationship with the adjacent vessels and the skull base. Three-dimensional images were reconstructed to imitate the approach of operation and compared with surgical findings. Meanwhile, 22 patients withnot MSCTA were selected randomly as control group. The amount of blood transfusion and the occurrence rate of complications were compared between the two groups. Results MSCTA depiceted clear three dimensional images of the meningioma and the relationship with the adjacent vessels and the skull base, corresponded very well to the surgery. By imitating the operation, all patients were designed the incision size of bone appropriately, the vessels of peritumoral were kept off effectively and the risk of the embedded vascular were assessed accurately. The conventional surgical approach and method were changed in 9 patients, 4 formulated the planning of the sub-total resection and radiotherapy preoperatively. Compared with control group, the amount of blood transfusion reduced significantly (P<0.05) and postoperative complications decreased. Conclusion MSCTA can imitate the surgical operations in multi-angle and supply the vital information for choosing the proper surgical approach, thereby reducing surgical trauma and postoperative complications.

OBJECTIVETo detect bcl-2 gene expression in Epstein-Barr virus (EBV)-infected human gastric epithelial cell line GES-1 for understanding the role of bcl-2 gene in the carcinogenesis of EBV-associated gastric carcinoma.

METHODSAkata 1061 cells producing recombined EBV carrying neomycin resistance gene (NEOr) was used to mediate the EBV infection of human gastric epithelial cell line GES-1 via close contact, with the empty plasmid pcDNA3-transfected GES-1 cells via lipofectamine method as a control. The EBV-infected and pcDNA3-transfected cells were cloned by limited dilution and the positive clones selected with G418. Immunocytochemical staining was performed to detect the expressions of EBNA1 and Bcl-2 protein.

RESULTSBcl-2 protein expression was detected in EBV-infected cells but not in the control cells.

CONCLUSIONEBV infection can increase Bcl-2 expression in gastric epithelial cells, and such cell transformation effect of EBV is related to the overexpression of bcl-2 gene.

Cell Line, Transformed ; Cell Transformation, Viral ; Epithelial Cells ; cytology ; metabolism ; virology ; Herpesvirus 4, Human ; Humans ; Immunohistochemistry ; Proto-Oncogene Proteins c-bcl-2 ; biosynthesis ; Stomach ; cytology

AIMPoly (methoxypolyethyleneglycol cyanoacrylate-co-hexadecyl cyanoacrylate) (PEG-PHDCA) and PHDCA niosomes were prepared and the influence of the PEG chain length on the niosomes physicochemical characteristics, complement consumption and phagocytic uptake were studied.

METHODSThe physicochemical parameters of PEG-PHDCA niosomes were characterized in terms of particle size, zeta aqueous layer thickness. The relationship between physicochemical characteristics and in vitro complement consumption and phagocytic uptake was further illustrated.

RESULTSExperimental results showed that PEG10,000-PHDCA had most loose structure and least PEG surface density among three groups. Configuration simulation through fixed aqueous layer thickness confirmed that PEG folding and less flexibility of the PEG chains of PEG10,000-PHDCA niosomes were accountable for its poor stealth effects. Compared with PEG2,000-PHDCA, PEG5,000-PHDCA showed a thicker fixed aqueous layer (FALT) of 4.20 nm, less negative zeta potential of -10.03 mV, and enhanced PEG surface density of 0.49 PEG x nm(-2), leading to the best effects of reduction of complement consumption and phagocytic uptake.

CONCLUSIONExcessive chain length of PEG was not necessary for stealth effects of PEG-PHDCA niosomes. PEG5,000-PHDCA niosomes had best effects on evading complement consumption and subsequent phagocytic uptake.

Animals ; Antineoplastic Agents, Phytogenic ; administration & dosage ; pharmacokinetics ; Camptothecin ; administration & dosage ; analogs & derivatives ; pharmacokinetics ; Complement System Proteins ; metabolism ; Cyanoacrylates ; chemical synthesis ; chemistry ; Drug Carriers ; Macrophages ; physiology ; Male ; Mice ; Particle Size ; Phagocytosis ; Polyethylene Glycols ; chemical synthesis ; chemistry ; Surface Properties

OBJECTIVETo characterize the variation in V3 loop of HIV-1 B'strains circulating in Chinese blood donors.

METHODSThe c2-c3 regions of the HIV envelop gene were amplified by nest-PCR from 32 HIV-1-infected blood donors in He Nan province in China. The BIOEDIT and MEGA software are used to analyze the sequences of V3 loop.

RESULTSThere are five types of central motifs of the 32 samples, in which GPGR and GPGQ are most common. More variations associated with T tropic/SI phenotype can be seen in AIDS group.

CONCLUSIONThe V3 tip motifs of HIV-1B' strains circulating in Chinese blood donors are various, the different characterization of V3 loop between AIDS and asymptomatic patients indicates different biological phenotype and pathogenesis which warrant additional investigation.

Adult ; Aged ; Amino Acid Motifs ; Amino Acid Sequence ; Blood Donors ; China ; Female ; Genetic Variation ; genetics ; HIV Envelope Protein gp120 ; analysis ; chemistry ; genetics ; HIV Infections ; blood ; virology ; HIV-1 ; chemistry ; classification ; genetics ; isolation & purification ; Humans ; Male ; Middle Aged ; Molecular Sequence Data ; Oligopeptides ; chemistry ; Phenotype

Objctive To explore the clinical value of Chitinase-3-like protein 1(CHI3L1)in patients with chronic hepatitis B (CHB),liver cirrhosis and liver cancer.Methods 96 clinically diagnosed patients in Department of Infectious Diseases Hos-pital of Anhui Provincial Hospital from Jan 2016 to Feb 2017(28CHB,44livercirrhosis,24liver cancer,15healthy controls) were analyzed.The serum level of CHI3L1 was measured by enzyme-linked immunosorbentassay(ELISA).The Golgi pro-tein(GP73)was tested by double-antibody sandwich immunochromatographic assay.The Alpha-fetoprotein(AFP)was tested by means of chemical luminescence.Results There were significant differences between the groups of chronic hepati-tis B(CHB),liver cirrhosis,liver cancer and healthy controls on the CHI3L1 level(χ2=70.249,P<0.001).The CHI3L1 level of the liver cirrhosis group and the liver cancer group increased significantly compared with that of the healthy controls (P<0.001).The GP73 levels of these groups were significantly different(χ2=44.963,P<0.001).The GP73 levels of the CHB group,the liver cirrhosis group and the liver cancer group all increased significantly compared with that of the healthy controls(P<0.05).The AFP levels of these groups were significantly different(χ2=57.606,P<0.001).The AFP level of the liver cancer group increased significantly compared with that of the CHB group,the liver cirrhosis group and the healthy controls(P<0.001).Based on the receiver operating characteristic(ROC)curve of CHI3L1,GP73 and AFP in the CHB group and the liver cirrhosisgroup,the Area Under roc Curve(AUC)of CHI3L1 was 0.953(95%CI:0.902~1.000),the sensitivity was 88.6%,and the specificity was 92.9%,which was higher than GP73 and AFP.Based on the ROC curve of CHI3L1,GP73 and AFP in the liver cirrhosis group and the liver cancer group,the AUC of AFP was 0.930(95% CI:0.871~0.989),the sensitivity was 75.0%,and the specificity was 97.7%,which was higher than CHI3L1 and GP73.The corre-lation between the CHI3L1,GP73 and AFP in CHB,liver cirrhosis and liver cancer groups were analyzed.There was a posi-tive correlation between AFP and GP73(rs=0.491,P<0.001),a positive correlation between AFP and CHI3L1(rs=0.452,P<0.001),a positive correlation between GP73 and CHI3L1(rs=0.554,P<0.001).Conclusion CHI3L1 is good at diagnosis of liver cirrhosism,better than GP73 and AFP.And AFP could be more beneficial in patients with liver cancer, better than CHI3L1 and GP73.