Objective To define a suitable threshold setting for gross tumor volume (GTV)when using 18F-fluoro-deoxyglucose positron emission tomography and computed tomogram (PET/CT) for radiotherapy planning in Nasopharyngeal carcinoma(NPC).Methods Sixteen NPC patients respectively received PET/CT and MRI scan before their radiation treatment.All of the images were transferred to the radiotherapy planning system (TPS).MRI/CT-based primary GTV was defined as GTVf.Biological target volumes (BTVs) were derived from PET/CT-based GTVs of primary tumors.The BTVs were defined as the volumes when adjusting different percentage of the maximal standardized uptake value (SUVmax).GTVfs were compared with BTVs.The suitable threshold level (sTL) could be determined when BTV value and its morphology using a certain threshold level were observed to be the fittest GTVf.The suitable standardized uptake value (sSUV) was calculated as the sTL multiplied by the SUVmax.Results Our result demonstrated no single sTL or sSUV method could achieve an optimized volumetric match with the GTVf.The sTL was [20.93％±6.51％(15％-40％)],whereas the sSUV was [2.27±0.48(1.56-3.25)].The sTL was inversely correlated with the SUVmax sTL =-0.144ln(SUVmax) + 0.5548 (R2 =0.85,F =78.57,P＜0.01.The sSUV showed a linear correlation with the SUVmax sSUV =0.104(SUVmax) + 1.0398,(R2=0.75,F=41.88,P＜0.01).The sTL was not associated with the value of GTVf.Conclusions In PET/CT-based BTV for NPC,SUVmax threshold method is feasible.sTL is not a fixed value,which is correlated with the SUVmax instead of the value of tumor.

Objective To analyze the expression of serum anti M phospholipase A2 receptor (PLA2R)antibody in idiopathic membranous nephropathy (IMN),and to investigate its value in the diagnosis and evaluation of idiopathic membranous ne-phropathy.Methods One hundred and eighteen patients with biopsy-proved glomerular diseases were involved in this study, including 97 cases with IMN,21 cases with IgA nephropathy (IgAN)and 19 healthy people.ELISA was used to detect ser-um anti-PLA2R antibodies.Correlations of anti-PLA2R antibody level with laboratory parameters,including serum albumin, 24-hour urine protein of IMN patients were evaluated.Results The median of anti PLA2R antibody in IMN group,IgAN group and healthy group was 45.2(3.6~705.9)RU/ml,5.9(2.3~10.6)RU/ml and 1.2(0.6~9.3)RU/ml.The levels of serum anti PLA2R antibody in IMN group were higher than those in IgA nephropathy group and healthy control group.The difference was statistically significant (t=-5.027,-3.077;P=0.05).Among 97 cases with IMN,76 cases showed posi-tive anti-PLA2R antibodies (positive rate 78.35%).There was none patient showed positive anti-PLA2R antibody respec-tively in IgAN and healthy people.Furthermore,anti-PLA2R antibody level was negatively correlated with serum albumin (r=-0.453,P=0.000)and positively correlated with CREA,TC,ESR,24 hour urine protein (r=0.233,0.234,0.363, 0.586;P=0.004,0.217,0.021,0.000)in IMN patients.Conclusion Serum anti PLA2R antibody may be used as a IMN specific marker for the diagnosis of IMN,and it has important reference value for evaluating the severity of IMN.

An introduction to the Basic service module featuring holistic,full flow and seamless connection built by the hospital.Authors described their experiences in achieving homogenous clinical nursing care,and pointed out that integrating medical humanistic care into the daily nursing process,can improve doctor-patient relationship and patients satisfaction,thus raising medical service quality and efficiency.

Background and purpose:Bladder cancer radical surgery is dififcult with many perioperative complications, and the learning curve is long. To introduce the clinical application of complete retrograde radical cystectomy and consequent abdominal cavity reconstruction in male bladder cancer, and to provide a standardized surgical procedure with minimum perioperative complications and short learning curve. Methods:From Apr. 2012 to Apr. 2013, 110 cases of male patients with bladder cancer received this procedure in our department, with a median age of 64 (35-83) years;Preoperative characters, surgical parameters, perioperative complications, pathology, long-term complications and short-term prognosis were collected and analyzed. Results:The median number of lymph nodes resected in operation was 12 (8-16);Neurovascular bundles were reserved bilaterally in 65 cases, and unilaterally in 31 cases;The complete procedure including urinary diversion took 4.4 (2.2-6.0) hours, with a median time of opened abdominal cavity of 43.0 (5.0-75.0) minutes;The median blood loss was 140.0 (50.0-600.0) mL, and 4 patients needed transfusion; Median time of abdominal and pelvic drainage was 10.0 (6.0-15.0) days, the median gastrointestinal recovery time was 2.5 (1.0-12.0) days, and the median postoperative hospital stay was 17.0 (10.0-39.0) days;Grade 2 Clavien-Dindo classiifcation (CDC) of surgical complications that required medical intervention were found in 19 cases, CDC grade 3 or above were found in 8 cases;Mild to moderate postoperative ileus happened in 5 cases, all recovered in median 2 (1-4) weeks with supportive treatments;There were no perioperative deaths. All samples were sent to pathological analyses. After a median follow-up of 9 (3-15) months, no complications of or above CDC grade 3 happened, and there were no recurrence. Conclusion:Complete retrograde radical cystectomy in male bladder cancer provided clear anatomical approach, reliable neurovascular bundle preservation, less blood loss, limited abdominal organs disturbance and better surgical exposure; With respect to tumor control, more peritoneal was retained for subsequent abdominal cavity reconstruction. The introduced procedure effectively speeded up gastrointestinal recovery, reduced postoperative complications, especially the incidence of ileus and its severity, and shortened hospital stay. The learning curve of this procedure for urologists was short, and further investigation was warranted.

A kinetics model was developed for predicting and simulating immobilized cellulase performance, which follows Michaelis-Menten kinetics with competitive product inhibition. Taking into account the effects of competitive product inhibition, inner diffusional limitation, substrate concentration and carrier size, the substrate distribution and the product distribution in carriers were investigated, and the effectiveness factors were also calculated over a wide range of parameters. The effects of competitive product inhibition are shown to increase the substrate concentration in the carrier, and, additionally, to increase the effectiveness factors slightly. With the increase of inner diffusion coefficient, both the effectiveness factors and the substrate concentration in the carrier increase. As the carrier size increases, on the other hand, these values decrease. The effectiveness factors and the substrate concentration in the carrier are found to increase when substrate concentration in the reaction system increases.
Cellulase ; metabolism ; Diffusion ; Enzymes, Immobilized ; metabolism ; Kinetics ; Microspheres ; Models, Chemical ; Particle Size ; Substrate Specificity

Objective To investigate the diagnostic value of trans-gastric peritoneoscopy with technique of natural orifice transluminal endoscopic surgery(NOTES)for tuberculosis peritonitis.Methods Clinical data of 20 patients with tuberculosis peritonitis diagnosed by trans-gastric peritoneoscopy via NOTES were retrospectively analyzed.Results All diagnoses were confirmed by biopsy.The findings of peritoneoscopy were defined as miliary type with miliary nodes scattered in ascites and on peritoneum,adhesive type with thickening of peritoneum and adhesion between peritoneum and intestines,cheese-like type with parietal peritoneal ulcer and cheese-like substances,and mixed type with 2 or 3 of above mentioned types.Positive findings in other laboratory examinations were hemoglobin decrease in 10(50％)patients,blood sedimentation rate increase in 16(80％),C reactive protein increase in 13(65％),CA125 increase in 18(90％),and positive tuberculin test in 9(45％).Abnormal findings were detected by chest X-ray in 8(40％)patients,by abdominal ultrasonography examination in 2(10％),by abdominal CT in 7(35％),and by colonoscopy in 1(5％).No abnormal results were found in all patients in anti-tuberculosis antibody test,ascites bacteria culture and gastroscopy.Conclusion Trans-gastric peritoneoscopy via NOTES with biopsy is effective for diagnosis of tuberculosis peritonitis.

ObjectiveTo explore the tumor igenic property of side population cells (SP) from human gallbladder carcinoma cell line GBC-SD. Methods SP and non-SP cells were isolated from GBC-SD staining with Hoechst33342 dye by fluorescence-activated cell sorting (FACS). The soft agar clonal assay and xenograft assay were performed to characterize tumorigenic property of side population cells in vitro and in vivo, respectively. The percentage of SP cells was analyzed by FACS in 5 hu man gallbladder carcinoma specimens. ResultsThe percentage of SP cells accounted for approximately 0.87 ％ of GBC-SD cells. The clone-formed rates of SP was more frequent than that of non-SP cells (14.74％ ± 3.53％ vs 5.17％ ± 1.05％), there was statistically significant difference (t =2.75,P＜0. 05). SP cells could generate tumors with as few as 5 × 103 cells (four of seven animals), whereas at least 1 × 105 non-SP cells were needed to form a tumor (one of seven animals). Re-analysis of SPderived tumors by FACS showed that SP cells under in vivo conditions also have the capacity to regenerate the SP and non-SP fractions. Besides, analysis of Hoechst33342 revealed s small fraction of SP cells, ranging from 0. 27％ to 2.3％ in gallbladder carcinoma specimens. ConclusionSP cells from GBC-SD are highly tumorigenic similar as the cancer stem cells.

The implementation of knowledge management (KM) in hospitals affects efficiency and outcomes of hospitals.However,few studies explored the implementation of KM in China.Twenty-two questions were designed concerning KM implementation status in over 50 hospitals.In order to understand the KM level and attitude to KM of the hospital's managers,a random sampling survey was conducted among 138 managers from 50 different scales of hospitals in 15 provinces of China.The survey showed that overall level of KM implementation in Chinese hospitals was still low and differed among different scales of hospitals (P＜0.05,or P＜0.01).In all the hospitals investigated,63.8％ did not implement KM yet,among which 46％ even had not planned for that.49.8％ of the hospitals investigated had no training program about KM ever and the main source of hospital staff to get knowledge was iuternet.It suggested that hospital managers should make much more efforts to get to know and understand theories on KM,so that hospital KM could be promoted more rapidly.

Objective To investigate the relationship between the nerve growth factor ( NGF ) induced hippocampal neuroregeneration and homeobox gene Lhx 8.Methods Seventy-two SD rats were divided into control group , transected group, NGF group, transected combined with NGF group after right fimbria-fornix transection and NGF intracerebroventricular injection . Real-time PCR and Western blotting were applied to detect the gene and protein expression of Lhx8 in each group.The choline acetyltransferase ( ChAT)/Lhx8 double labeled cells in subgranular zone ( SGZ) of hippocampus in each group were detected by immunofluorescence .Results The expression of Lhx8 gene and protein in the transected , NGF group and especially in the transected combined with NGF group was obviously higher than in the control group .The number of ChAT/Lhx8 double labeled cells in the NGF group and the transected combined with NGF group was obviously more than in the control group and transected group . Conclusion The hippocampal neuroregeneration which induced by NGF intracerebroventricular injection was associated with the higher expression of Lhx8.