Objective To detect the esophageal and fundal varices and their related collateral ves-sels by multi-detector row CT ( MDCT) in helping to find out the objective evidences for selecting treatment measure and predicting prognosis. Methods Fifty-one patients with clinical diagnosis of cirrhosis were in-cluded in this study. Esophageal varices were confirmed by endoscopy in all patients, of which 31 accompa-nied with fundal varices. All patients underwent MDCT angiography to demonstrate collaterals between the systemic and portal circulation as well as the esophageal varicose. Results Good or excellent image quality was obtained in all patients. Gastric fundal varices were found in 31 of 51 patients (60. 8% )by endoscopies. By MDCT angiography esophageal varies were confirmed in all patients, gastric fundal varices were in 32 of 51 (62. 7% ). There are high degree of concordance Kappa =0. 876 between them. Esophageal varices were supplied mainly by the left gastric vein ( LGV) , by anterior branch of LGV alone in 30 of 51 (58. 8% ). There were paraesophageal veins in 21 of 51 patients (41.2%). Gastric fundal varices were supplied by LGV in 24 of 32 patients (75% ), by short gastric veins /posterior gastric veins in 3 of 32 patients (9. 4% ) and by short gastric veins /posterior gastric veins and LGV together in 5 of 32 patients ( 15. 6% ). Short gas-tric veins and posterior gastric veins participate in forming of esophageal varices in these patients. Conclusion MDCT angiography shows an excellent vascular maps and highly in concordance with endoscopy in terms of the detection of esophageal and gastric fundal varices. Esophagal varices were supplied mainly by LGV, more than half of them were by its anterior branch, and paraesophageal veins participated to it in some patients too. The blood flow in gastric fundal varices were supplied from LGV in most of the patients, and the rest from short gastric veins.

Objective To discuss the clinical application value of Omaha system-based targeting nursing care for patients with hepatocellular carcinoma (HCC) who were treated with transcatheter arterial chemoembolization (TACE).Methods A total of 60 advanced HCC patients,who were planned to receive TACE,were prospectively and randomly divided into the control group (n=30) and the observation group (n=30).Routine nursing mode was adopted for the patients in the control group,while Omaha system nursing model was employed for the patients in the observation group.The patients of the observation group were evaluated with Omaha system at the time of admission,the key common problems were screened out and targeted nursing measures were employed.Meanwhile,on the days of admission and discharge all the patients of both groups were asked to fill in the forms of Hamilton depression scale (HAMD-17),Hamilton anxiety scale (HAMA),social support rating scale (SSQ) and numerical pain rating scale (NRS);and the degrees of depression,anxiety,social support and pain were respectively assessed.Results Both nursing modes could improve the degrees of depression and anxiety as well as the social support system of HCC patients,but the curative effect of these two aspects in the observation group were obviously better than those in the control group (P＜0.05).No statistically significant difference in the improvement of pain degree existed between the two nursing models,but Omaha system-based targeting nursing mode could alleviate the patient's pain to a certain extent.Conclusion For patients with advanced HCC,Omaha system-based targeting nursing care can alleviate the patient's negative emotion and promote the patients to establish effective social support system,this nursing mode is superior to conventional nursing mode.Therefore,Omaha system-based targeting nursing has great application potential in clinical practice.

ObjectiveToll-like receptors (TLRs) play important role in the progression and tumor immunity of some types of cancer,some research have demonstrated that agonist of TLR3 can trigger apoptosis of cancers.This study was proposed to investigate if Poly(I:C),the specific agonist of TLR3,could impact proliferation or apoptosis of progressive breast cancer cells MDA-MB-231,and to investigate the primary mechanism of the function.MethodsExpression of TLR1-10 mRNA was detected by quantitative real-time reverse transcription-polymerase chain reaction.Cell Counting Kit-8 was used to determine the inhibitory effect of Poly(I:C) on proliferation of MDA-MB-231 cells.Cell apoptosis was assayed by flow cytometry with V-FITC/PI staining.Results First,the toll-like receptors 1-10 were all expressed on MDA-MB-231 cells,while the expression level of TLR8 was lower than that of others.Second,according to the CCK-8,the proliferation of MDA-MB-231 cells was inhibited,but the apoptosis was not affected on the basis of Apoptosis Kit.At last,the mRNA expression of TNF-α、IFN-β and IFN-γ were elevated approximately 20 times after Poly(I:C) stimulation for 6 hours.ConclusionMDA-MB-231 cells express all toll-like receptors on mRNA level,and TLR8 was expressed lower than others.The stimulation of TLR3 with Poly(I:C) can inhibit the proliferation of MDA-MB-231,but had no effect on apoptosis.TNF-α、IFN-β and IFN-γ maybe participate in this process.

Objective To obtain a better understaning of the clinical features of Castleman tumor associated paraneoplastic pemphigus. Methods The clinical features and therapy of 10 cases of this disease, diagnosed in the Department of Dermatology of Peking University First Hospital were analyzed. Results Castleman tumor was shown to be the most common neoplasm associated with paraneoplastic pemphigus in China. The clinical presentations, histopathologic characteristics, CT scan findings, and immunologic features were all unique. The early diagnosis and removal of the Castleman tumor are crucial for the treatment of this tumor-associated autoimmune disease. Conclusions Because Castleman tumor is directly related to the induction of autoimmunity, early diagnosis and prompt removal of the tumor are essential to the management of this disease.

Objective To study the therapeutic window of rapamycin(RPM) concentration in primary recipients of renal transplantation. Methods An open label, multi center study was performed. One hundred primary renal allograft recipients with cadaveric donors were enrolled from 4 transplantation centers in China. The immunosuppressive regimen was triple therapy,i.e.RPM combined with CsA and steroid. A loading dose of RPM 6 mg/d was administered within 48 hours after transplantation, then a maintaining dose of 2 mg/d was administered. The whole blood concentration of RPM was measured by HPLC method. Results The whole blood concentration of RPM in this group was (6.65?2.75)ng/ml, the 10th and 90th percentile for RPM concentration was 3 2 ng/ml and 10 26 ng/ml,respectively.9 5%(8/84)patients suffered from acute rejection during the 6 month period after transplantation in this study, and the concentration of RPM in these was lower than that in non rejection patients(P=0.001). Hyperlipidemia and liver dysfunction were the most frequently adverse events, and RPM concentration was significantly associated with the concentration of triglyceride. Conclusions 4～8 ng/ml is a suitable level for RPM concentration. Regular drug monitoring and reasonable dose modulation may increase the validity and security of RPM.

Abstract OBJECTIVE To develop an ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) method for determination of hynchophylline, isorhynchophylline, isocorynoxeine, corynoxeine, hirsutine and hirsuteine in Uncaria decoction, and investigate the effect of different storage conditions on the stability of active ingredients. METHODS An UHPLC-MS/MS method was established to investigate the effects of different storage temperature and time on the stability of six active components in Uncaria decoction. Separation was performed with a gradient mobile phase system of acetonitrile-0.1% formic water solution, the flow rate was 0.4 mL·min-1, the temperature of column was 30℃, the injection volume was 2 μL, the MS detection was dynamic multiple reaction monitoring mode. The effects of different storage temperature and time on the stability of six active components in Uncaria decoction was investigated. RESULTS Rhynchophylline, isorhynchophylline, corynoxeine, isocorynoxeine, hirsutine and hirsuteine were successfully separated using this method, with good linear relationship in the corresponding concentration range. The precision, repeatability, stability and recovery rate were good. The six alkaloids were basically stable within 14 d under low temperature storage, basically stable within 3 d under normal temperature storage, and not stable under high temperature storage. CONCLUSION The UHPLC-MS/MS method is stable, rapid and reproducible. It can be used to determine the contents of six effective components in Uncaria decoction. Cold storage is beneficial to the stability of Uncaria decoction.