Objective To study the relationship between serum Estradiol(E2 ) andβ-amyloid protein(β-AP) in patients with cer-ebral infarction .Methods A total of 46 female patients with cerebral infarction were selected from 2011 January to 2014 June into observation group ,46 cases were divided as 20 cases in mild group ,16 cases in moderate group ,10 cases in severe group on the basis of neural function defect score standard ,according to the size of infarct volume 46 patients were divided into small infarct volume group with 21 patients ,moderate infarct volume group with 14 cases ,larger infarction volume group with 11 cases .In the same peri-od ,64 healthy women were recruited into control group .Serum E2 ,β-AP levels of serum and cerebrospinal fluid were detected and compared ,and the relationship of serum E2 andβ-AP level in serum ,cerebrospinal fluid were analyzed .Results Theβ-AP levels in serum and cerebrospinal fluid in observation group were higher than those of control group ,the serum E2 level was significant lower than that of the control group ,the differences were significant(P<0 .05) .With more severe cerebral infarction ,β-AP levels in serum cerebrospinal fluid showed an upward trend ,with more severe cerebral infarction ,the serum level of E2 was significantly decreased , andβ-AP ,E2 levels in mild ,moderate ,severe group had significant differences(P<0 .05) .Theβ-AP levels of serum and cerebrospi-nal fluid in higher infarct group were higher than those in small ,moderate infarction group ,but E2 levels were lower than those in small ,moderate infarction group ,the differences had significant(P<0 .05) .There were no significant difference inβ-AP of serum and cerebrospinal fluid ,Serum E2 level between small and moderate infarction group(P>0 .05) .The expression of serum E2 andβ-AP in serum and cerebrospinal fluid were negatively correlated(r= -0 .428 ,P=0 .009;r= -0 .476 ,P=0 .005) .Conclusion β-AP levels in serum and cerebrospinal fluid in patients with cerebral infarction are high ,closely related with the severity of cerebral in-farction .β-AP levels of cerebrospinal fluid ,serum in cerebral infarction patients are negatively related to the level of serum E2 .

[Objective]To explore the correlation of the expression of alpha-fetoprotein(AFP)mRNA in the peripheral blood and postoperative survival and metastasis of patients with liver cancer.[Methods] A total of 66 patients with liver cancer who received radical resection surgery from January 2005to December 2006 was enrolled in this study.The cell total RNA was extracted from peripheral blood and the expression of AFP mRNA was detected by nested PCR.All the patients were followed up for 60 months after surgery.[Results]The expression rate of AFP mRNA in the peripheral blood was 40.91％(27/66).The expression of AFP mRNA in the peripheral blood in patients with liver cancer was significantly related to microvascular invasion and metastasis(P ＜ 0.05 or ＜ 0.01),but the expression had no relationship with sex,age,HBV infection,cirrhosis,AFP concentration,tumour size and number,and Edmondson grading(P＞0.05).The overall 1,2,and ＞ 3 years survival rates of patients with positive AFP mRNA after surgery were 66.7％(18/27),38.9％(7/18),28.6％(2/7),respectively.The overall 1,2,and ≥3 years survival rates of patients with negative AFP mRNA after surgery were 84.6％(33/39),60.6％(20/33),45.0％(9/20).There was statistical significance between the survival rates of AFP mRNA-negative patients and AFP mRNApositive patients(P ＜ 0.01).[Conclusions] The detection of AFP mRNA in the peripheral blood may provide clue for early microscopic metastasis.It can be a prediction index for postoperative recurrence.

Objective To investigate the pathological role of endoplasmic reticulum stress in fluomsisinduced apoptosis in human hepatocellular carcinoma cell line (HepG2).Methods Under stimulation of 1,3,6,9 mmol/L concentrations of NaF in vitro for 24 h,while normal control group was cultured under normal condition,the apoptosis of HepG2 cells was measured by flow cytometry.The endoplasmic reticulum stress markers (glucose regulative proteins 78,94;GRP78,GRP94) and CCAAT/enhancer-binding protein homologous protein (CHOP) in HepG2 cells were measured at both mRNA and protein levels by real-time PCR and Western blotting,respectively.Results After treated with 0,1,3,6,9 mmol/L NaF for 24 h,the apoptosis rate of HepG2 cells was (6.25 ± 1.27)％,(13.48 ± 1.00)％,(24.08 ± 1.88)％,(30.19 ± 3.07)％ and (37.72 ± 4.43)％,respectively,and the difference was statistically significant among groups (F =65.828,P ＜ 0.01).After treated with 3 mmol/L NaF for 24 h,the mRNA level of GRP78,GRP94 and CHOP was (1 172.41 ± 459.60)％,(946.95 ± 635.85)％ and (7 846.97 ± 1 670.01)％,which was increased compared to those of the control groups [(100.00 ± 1.77)％,(100.00 ± 2.08)％,(100.00 ± 0.74)％,t =12.77,4.67,11.50,all P ＜ 0.01].Under the same condition,the protein levels of GRP78 and CHOP were (159.99 ± 67.59)％ and (155.15 ± 94.24)％,which were increased compared to those of the control groups [(100.00 ± 30.68)％,(100.00 ± 41.44)％,t =-3.27,-1.99,all P ＜ 0.05],while GRP94 protein level [(46.40 ± 41.46)％] was decreased compared to that of the control group [(100.00 ± 68.86)％,t =4.02,P ＜ 0.05].Conclusion Endoplasmic reticulum stress may be involved in NaF-induced cell death in HepG2 cells.

Ovarian epithelial carcinomas are the most common lethal gynecological malignancies. Ovarian carcinomas are divid-ed into Types I and II based on different morphologies, genetic alterations, and biomarker expression. Low-grade micropapillary serous carcinoma are Type I tumors. Type I tumors are slow growing, generally confined to the ovary at diagnosis, and with better prognosis. These tumors develop from well established precursor lesions that are termedborderlinetumors. Type 1 tumors are genetically stable and are characterized by mutations in a number of different genes including KRAS, BRAF, PTEN, and beta-catenin. Type II tumors are rapidly growing and highly aggressive neoplasms, for which well defined precursor lesions have not been described. They may arise in the fimbrial epithelium of the oviduct with advanced stage, more aggressive behavior, and worse prognosis. High-grade serous carcino-ma belongs to Type II tumors. This group of tumors has a high level of genetic instability and is characterized by TP53 mutation. Hence, ovarian cancer comprises a heterogeneous group of tumors with distinctly different histological characteristics, molecular genet-ic features, and clinical course.

Objective To explore the potential mechanism of severe liver injury shortly after withdrawal of antiviral therapy in chronic hepatitis B (CHB) patients.Methods Forty-nine patients with chronic hepatitis B virus (HBV) infection from the Department of Infectious Diseases of the First Affiliated Hospital of Nanchang University and 8 healthy volunteers from August 2014 to March 2015 were included in this study.All of them were human leukocyte antigen (HLA)-A2-positive.CHB patients were classified into three groups,including 15 cases in immune-tolerance group,20 cases in sustained antiviral treatment group,and 14 cases in recurrence of drug withdrawal group.The frequency of peripheral HLA-A0201-restricted hepatitis B core antigen (HBcAg)18-27 pentamer complex specific CD8+ T cells in CHB patients was analyzed by flow cytometry.Enzyme linked immunospot assay(ELISPOT) was used to detect interferon-gamma (IFN-γ) and tumor necrosis factor-α (TNF-α) secretions of HBcAg18-27-specific CD8+ T cells.The experimental data were analyzed using non-parametric U tests.Results In healthy control group,immune-tolerance group,sustained antiviral treatment group and recurrence of drug withdrawal group,the frequencies of HBcAg-specific CD8+T cells were (0.17 ± 0.16) ％,(1.46±0.72)％,(3.24± 1.60)％ and (4.67±2.43)％,respectively.Compared with healthy control group,the difference were all statistically significant in the three groups (Z=-3.583,-4.018 and-3.823,respectively;all P＜0.01).The frequencies of HBcAg-specific CD8+T cells in immune tolerance group or recurrence of drug withdrawal group were both significantly different from that in sustained antiviral therapy group (Z=-3.400 and-2.030,respectively;both P＜0.05).The difference between immune-tolerance group and recurrence of drug withdrawal group was also significant (Z =-3.230,P＜0.01).The secretion levels of IFN-γ of HBcAg-specific CD8+T cells in healthy control group,immune-tolerance group,sustained antiviral treatment group and recurrence of drug withdrawal group were2 (0-6),16 (2-53),106 (14-254) and 156 (28-395) spot forming cell (SFC)/106 peripheral blood mononuclear cell (PBMC),respectively.The differences between healthy control group and immune-tolerance group,sustained antiviral treatment group or recurrence of drug withdrawal group were all statistically significant (Z=-3.585,-4.069 and-3.824,respectively;all P＜0.01).The IFN-γ level of HBcAg-specific CD8+ T cells in recurrence of drug withdrawal group was significantly higher than that in sustained antiviral therapy group (Z=-2.205,P=0.027),and that in sustained antiviral therapy group was significantly higher than that in immune-tolerance group (Z=-4.700,P＜ 0.01).The TNF-α levels secreted by HBcAg-specific CD8+ T cells in each group were 2 (0-5),16 (2-32),112 (15-283),and 195 (55-537) SFC/106PBMC,respectively.The differences between healthy control group and immune-tolerance group,sustained antiviral treament group or recurrence of drug withdrawal group were all statistically significant (Z=-3.619,-4.069 and-3.824,respectively;all P＜0.01).The TNF-α level secreted by HBcAg-specific CD8+T cells in recurrence of drug withdrawal group was significantly higher than that in sustained antiviral therapy group (Z=-2.449,P=0.014),and that in sustained antiviral therapy group was significantly higher than that in immune-tolerance group (Z=-4.350,P＜0.01).Conclusions The changes of frequency and immune function of HBcAg-specific CD8+T cells in CHB patients may be one of the reasons causing severe liver damage after irregular withdrawal of nucleoside analogues.

Objective To study the In vitro expansion of human CD8+ CD28- suppressor T cells and their immunological regulatory effect.Methods Human CD8 + CD28- suppressor T cells were expanded in vitro driven by the combination of cytokines and allogeneic antigen presenting cells (APCs).Flow cytometry was used to assess the development of CD28- subpopulation.Expanded CD8+ CD28- T cells were isolated by immunomagnetic microspheres and then added as third part modulators into mixed lymphocyte culture to assess their immunological regulatory characteristics.Results The combination of cytokines included IL-2,IL-7 and IL-15 and allogeneic APCs could increase the portion of CD8 + CD28- T cell subtype,and expansion fold of CD8+ CD28- T cell subtype was significantly increased as compared with others (P＜0.05).Expanded CD8+ CD28- T cells could suppress the proliferation of CD4+ T cells stimulated by allogeneic APCs.Moreover,this suppression had antigen specificity.Conclusion Human CD8 + CD28- suppressor T cells can be in vitro expanded in large amounts driven by the combination of cytokines and allogeneic APCs.Expanded CD8 + CD28- T cells in this study have antigen specific regulatory characteristics.

Objective Through investigating the effect of mesenchymal stem cells (MSCs) on the expression of yon Willebrand factor (vWF) and soluble thrumbomodulin (sTM) of vascular endothelial cells stimulated by serum of systemic lupus erythematosus (SLE) patients to discuss the repairing effect of MSCs on injured endothelium of SLE patients.Methods When human umbilical vein endothelial cell strain ECV-304 was co-cultivated with serum of SLE patients in vitro for twelve hours in order to induce endothelial cells injury,then MSCs were seeded for three days.Enzyme linked immunosorbent assay (ELISA) was used to detect the expression of vWF and sTM in the supernatant.Results When ECV-304 was stimulated by serum of SLE patients,the expression of vWF and sTM in the supernatant was significantly higher than that in the groups not stimulated by serum of SLE patients;When MSCs were seeded ,the expression of vWF in the Lupus serum stimulated group in which MSCs were seeded was significantly lower than that in the lupus serum stimulated group in which MSCs were not seeded,but the expression of sTM between the lupus serum stimulated group which MSCs were seeded and the lupus serum stimulated group in which MSCs were not seeded was not significantly deviatied.Conclusion Serum of lupus patients at active stage can cause injure vascular endothelial cells.MSCs can downregulate the expression of vWF of vascular endothelial cells.These suggest it may participate in the repairing of injured vascular endothelium of SLE patients.

Objective To explore methods of quickly identifying loopholes in medical quality management and to improve medical quality by means of analyzing low-risk death cases.Methods Two rounds of analysis of 1 14 low-risk death cases of hospitals in Beijing in 2012 in terms of data quality and medical procedures,in an effort to identify problems and to verify the feasibility and accuracy of the method through interaction with other data.Results Totally 585 760 inpatients were discharged in 2012 from 21 hospitals,of whom 1 5 1 1 93 being low-risk cases.Such cases included 1 14 low-risk death cases, accounting for 0.01 9% of the total discharged,and 0.075% of low-risk discharged cases.Analysis of these medical records found 50 cases of problematic diagnosis (43.86%),45 cases of possible defects in diagnosis and treatment (39.47%),39 cases of missing items of secondary diagnosis (34.21%),and 28 cases of missing items of surgery/operation (24.56%). Some of the abovementioned cases had overlapping mistakes.Conclusion Analysis of low-risk death cases can help focus among massive data of medical records,problems of diagnostic and therapeutic insufficiency,pinpointing common problems in medical service and improving medical quality and fine management of hospitals.

Objective To investigate the effect of several scoring systems including of acute physiol-ogy and chronic health evaluation Ⅱ (APACHE Ⅱ)score,sequential organ failure assessment (SOFA) score,pediatric risk of mortality score(PRISM),pediatric critical illness score(PCIS)and paediatric index of mortality(PIM)in estimating the prognosis of illness in pediatric severe cases.To select a more appropriate scoring system for PICU.Methods From January 2013 to December 2014,486 cases admissed in PICU of Shengjing Hospital of China Medical University were enrolled in the study,including 42 hospital death cases (dead group)and 444 survived or cured cases(survival group).We estimated each patient with APACHEⅡ,SOFA,PCIS,PRISM and PIM on admission and compared the scores between dead group and survival group.Results The results of APACHE Ⅱ,SOFA,PCIS,PRISM,PIM showed significant defferences be-tween dead group and survival group(13.43 ±8.70 vs.3.48 ±3.94;78.38 ±9.33 vs.88.24 ±6.84;0.142 0 ±0.214 7 vs.0.015 3 ±0.030 7;5.48 ±3.42 vs.1.73 ±1.94;22.02 ±8.48 vs.12.68 ±4.88,P <0.001 ). Areas under the receiver operating characteristic curves of APACHE Ⅱ,SOFA,PRISM,PCIS and PIM (95%CI)were 0.854 (0.798,0.910 ),0.838 (0.778,0.898 ),0.881 (0.828,0.934 ),0.808 (0.748, 0.869),0.936(0.913,0.960).Areas under the receiver operating characteristic curves of PIM was the lar-gest.Conclusion All the 5 kinds of severe scoring systems are effective and have a good ability to asses the prognosis and severity of diseases.It seems that PIM is the most effective.

Objective To investigate the influence of intravenous infusion by double-lumen peripherally inserted central catheter (PICC)on continuous dynamic central venous pressure(CVP)monitoring.Methods In the patient undergoing the double-lemon PICC,continuous dynamic CVP monitoring was performed by a lumen and the intravenous infusion was conducted by another lu-men.Whether the simultaneous venous infusion affecting the values of continuous dynamic CVP monitoring was observed.Results Intravenous infusion through double-lumen PICC had no influence on simultaneously continuous dynamic CVP monitoring (P>0.05),which could influence the values of CVP monitoring when simultaneously using the intravenous infusion pump(P<0.05). The speed of pumping fluid had no influence in a shout time(10 min),with significant difference(P>0.05).The CVP values could recovered to the status before infusion when continuously infusing after stopping using the infusion pump.Compared with before in-fusion,the CVP values after stopping intravenous infusion had no obvious change(P>0.05).Conclusion Intravenous infusion by double-lumen PICC has no influence on continuous dynamic CVP monitoring.But simultaneously adding infusion pump has certain influence on the CVP monitoring values.