Objective To investigate the expression and significance of big mitogen-activated protein kinase 1(BMK1 or ERK5)in the pancreatic acinus of diabetic rats.MethodsTwenty SD rats were randomly divided into normal control group(n=10)and streptozotocin(STZ)-induced diabetic group(n=10).At the end of 14 weeks inducement,all rats were sacrificed and venous blood and pancreatic tissues were collected.The levels of fasting blood glucose,insulin and blood fat were determined to identify the establishment of diabetic rat model.The specimens of pancreas were fixed and embedded.Hematoxylin-eosin staining was performed to observe the morphological changes.Periodic acid-Schiff(PAS)staining was carried out for the vascular changes.The expressions of type Ⅰ and Ⅳ collagen were determined by inmmunohistochemical method.BMK1/ERK5-mRNA was detected by in situ hybridization.ResultsCompared with the control,in diabetic group the vascular wall was thickening,inflammatory cells were infiltrated in perivascular area,local acinus was atrophy and the expression of type Ⅳ collagen was mainly expressed in vascular basement membrane,while type Ⅰ collagen was in local atrophy acinus tissue with inflammation(P

Objective To investigate the value of three-dimensional CT volume rendering in predicting ARDS following pulmonary contusion and identifying high-risk patients.Methods Seventy-one cases of pulmonary contusion (AIS ＞ 2 points) confirmed by chest CT during an emergency admission between July 2010 and June 2011 were enrolled.Using computer-generated three-dimensional reconstruction,contusion volume was measured and expressed as a percentage of total lung volume.The admission data,such as blood gas analysis results,systolic arterial pressure,hematocrit,AIS,ISS,and injury distribution,were prospectively collected.Independent predictive factors of ARDS following pulmonary contusion was identified using logistic regression analysis and further estimation on accuracy and value of the predictors were performed.Influence of contusion volume percentage on clinical outcomes was detected.Results Of all,mean contusion volume percentage was (22.07 ± 14.50)％ (range,5.60％-61.00％),which was not strongly correlated to the admission PaO2/FiO2 ratio (R2 =0.059).ARDS and infection were diagnosed in 31 cases and 25 cases respectively.PaO2/FiO2 ratio and contusion volume percentage were independent predictive factors of ARDS after pulmonary contusion.The best cut-off of contusion percentage in predicting ARDS development was 21.5％ with a specificity of 80.0％,sensitivity of 71.0％,positive predictive value of 73.3％,and negative predictive value of 78.1％.Conclusion Three-dimensional CT volume rendering technique allows quantification of pulmonary contusion and identification of patients at high risk of ARDS,to whom further treatment may be directed.

Objective To investigate the mechanism of extremely low frequency electromagnetic field (ELF-EMF) and X-ray irradiation on liver carcinoma cell lines BEL-7402. Methods Liver carcinoma cell lines BEL-7402 had been incubated with ELF-EMF (100 Hz, 0.7 mT, 30 min, 3 days) after X-ray irradiation at different doses (0, 2, 4, 6, 8,10 Gy). The cells were observed on morphologic changes with scanning electron microscope. Flow cytometry and gene microarray were used to investigate the mechanism of cell apeptosis. Results ELF-EMF plus X-ray induced apoptosis on BEL-7402 was observed under scanning electron microscope.When X-irradiation was 2, 4, 6, 8 and 10 Gy, the apoptosis ratios of combined group and only X-irradiation group were 10.0%, 14.5%, 4.3%, 5.1%, 7.1% and 0.1%, 8.1%, 0.1%, 0.4%, 2.2% (P < 0.05) on flow cytometry. The result of microarray indicated that 1465 genes were up-regulated and 1108 down*regulated in the ELF-EMF plus X-ray group in comparison with the control group. The change rates of 110 apoptosis related genes were above 2 times, which including 71 up-regulated and 39 down-regulated. Gene microarray showed that ELF-EMF and X-ray irradiation had a mainly effect on different gene of apoptosis paths (CDC25 and CHKI, ATM, p38, PTEN, p53, G1/S, Fas, G2/M, Cell Cycle, Apoptosis and Caspase). The same genes of ELF-EMF plus X-ray group were showed 13 in ELF-EMF group and 42 in X-ray group. Conclusions Apoptosis paths were significantly different between ELF-EMF and X-irradiation. ELF-EMF cooperates with X-irradiation on inducing BEL-7402 cell apoptosis.

Objective To guide fluid management for sever heart failure patients by using PICCO indicators, in order to direct clinical fluid management and nursing care. Methods Sixty-four heart failure patients with level IV cardiac function were randomly divided into the control group and the experimental group according to random number table, and each one had 32 patients. Fluid management for patients in the control group was implemented with CVP monitoring technology, while the patients in the experimental group accepted PICCO monitoring technology as fluid management. Then compare these indicators between the two groups--length of stay in ICU, mortality rate of 28 days, daily fluid intake, output and time of achieving negative fluid balance, and observe the change of cardiac function index (CFI) and capacity indicators (ITBVI, GEDVI, EVLWI) in the experiment group before and after treatment. Results Indicators of ITBVI、GEDVI、EVLWI in the experiment group recovered to normal state and CFI improved. The indicators which had mentioned above was (1 203.41±111.08) ml/m2, (1 087.78±66.91) ml/m2, (12.91±3.54) ml/kg, (2.91±0.29) L·min-1·m-2 respectively when before the treatment, while the values after the treatment was (895.50 ± 50.27) ml/m2, (728.19 ± 73.33) ml/m2, (6.51 ± 0.75) ml/kg, (4.61 ± 0.69) L · min-1 · m-2, the difference was significant (t=-18.52-54.42, P<0.05). The length of stay in ICU, mortality rate of 28 days, daily fluid intake, output and time of achieving negative fluid balance of the experimental group were significantly lower than those in the control group(t=-17.19,-76.80,-12.38, χ2=3.26, P<0.05). Conclusions PICCO monitoring indicators are better than CVP method in the aspect of fluid management for patients with sever heart failure, which can increase the rescue success rate, promote the treatment effect, improve prognosis, and promote the rehabilitation of patients.

Objective To design a method for detecting multileaf collimator (MLC) leaf position accuracy in implementing a static intensity-modulated plan and to analyze the impacts of leaf errors on dose of targets and normal organs.Methods Static intensity-modulated planning for twenty lung cancer cases through dose verification was sorted in an ascending order according to the number of segment,and then the first and the last 10 plans were sorted as the simple plan group and the complex plan group,respectively.These plans were transmitted to a Varian 600CD accelerator and implemented by it.Photos were taken with PV aS500 electronic portal imaging device (EPID) and actual position of leafs was determined by gradient algorithm to calculate the pass rate for leaf verification.MLC files were modified according to examination results and the plans were re-calculated while keeping other parameters unchanged.Thus,difference of targets and normal organs dose distribution before and after the appearance of leaf errors were obtained.Results The dose distribution of most organs after leaf errors were increased or decreased,and the maximum dose of spinal cord in the sixth and thirteen cases exceeded the limit of 45 Gy.In the group of simple plan only the changes of maximum dose to the spinal cord were statistically significant(t =-3.08,P ＜ 0.05),while in the group of the complex plan all changes of D95％ of PGTV and PTV,maximum dose of the spinal cord,V20 of lung and V40 of heart were statistically significant(t =-1.89,-1.99,-2.36,-2.55,-1.85,P ＜ 0.05).Conclusions To ensure the safety and effects,it was necessary to detect leaf position,particularly the complex intensity-modulated planning.Electronic portal imaging devices and treatment planning system could detect leaf positions during the implementation of a plan and obtain the actual dose of targets and normal organs.

Objective To observe the safety and effectiveness of high-dose chemotherapy(HDT) supported by autologous peripheral blood hematopoietic stem cells transplantation(APBHSCT) in the patients of terminal or relapsed malignant tumors.Methods The patients achieved CR or PR after 4 cycles of conventional salvage chemotherapy were divided into two groups randomly.26 patients in the research group were adapted APBHSC+HDC,50 patients in the control group were adapted 2～4 cycles of routine chemotherapy.Results In the research group,hematopoiesis was reconstructed in all patients,8 out of 17 patients who achieved PR after 4 cycles of conventional salvage chemotherapy turned into CR after APBHSC+HDC(CR rate 47.1%).In the control group,33 patients who achieved PR after 4 cycles of conventional salvage chemotherapy were still PR after 2～4 cycles of routine chemotherapy.The median survival period in the research group was 11 months,which was longer than the one in the control group.The survival rates of 2,3 and 4 years in the research group were evidently higher than the ones in the control group(P

Objective To study the prognosis of infants with bronchiolitis by testing urine leukotriene E4 (LTE4) level and investigating atopy's influences. Methods Urine LTE4 was tested in 38 eases with mild bronchiolitis (47 in acute stage, 17 in convalescent stage), 9 severe bronchiolitis cases, 15 atopic cases, 25 control cases. Peripheral blood was used to determine eosinophils count (EC) in acute bronchiolitis cases. Results (1) The level of urine LTE4 is obviously higher in cases of acute group (62.11 ± 12.23 pmol/L) than that of control group (22.19±1.50 pmol/L) , and the convalescent group (34.86 ±5.75 pmol/L) (F = 132.42, P < 0.01) ;Urine LTE4 level of convalescent group is higher than that of the control group (P < 0.01). (2) Urine LTE4 level is significantly higher in severe group (98.04 ± 8.04 pmol/L) than that of mild group (59.16 ± 12.25 pmol/L) (t = 9.92, P < 0.01). (3) Urine LTE4 level of atopy positive (88.75 ± 10.45 pmol/L) infants with bronchiolitis is significantly higher than atopy negative infants (55.28 ± 11.44 pmol/L)(t = 8.63, P < 0.01). (4) There is no significant correlation between the levels of urine LTE4 and EC for acute bronchiolitis. Condusions The level of urine LTE4 in acute bronehiolitis patients increases and remains high in convalescent stage;Higher urine LTE4 level in severe bronchiolitis cases indicates that urine LTE4 level is related to the severity of the disease;cysteinylleukotrenes is an important mediator of inflammation that may influence the prognosis of atopy positive infants with bronchiolitis;EC is not a good index to present the airway inflammation of infants with bronehiolitis.

Objective To do research on Multi-points EGFR gene mutation and heterogeneity in lung adenocarcinoma and its influence on the prognosis,to analyze EGFR gene mutation and its heterogeneity influence on patients'overall prognosis.Methods The clinical features of patients with lung adenocarcinoma at stage Ⅲa from January 2006 to January 2007 at our institution were retrospectively reviewed.The primary lung tumors and corresponding metastatic lymph nodes tissue specimens were obtained by surgery.The adenocarcinoma primary nodes and corresponding metastatic lymph nodes EGFR mutation were detected by amplification refractory mutation system (ARMS).Univariate analysis and multivariate analysis by Cox proportional-hazard model were used to analyze the impact of EGFR mutation and its heterogeneity as influential factor on patients 'prognosis.Results 76 patients with the adenocarcinoma primary nodes and corresponding metastatic lymph nodes were detected by epidermal growth factor receptor (EGFR) mutation.40 patients with EGFR mutation were detected (40/76,52.63％).There were 9 specimens out of 40 who had lung primary nodes and corresponding metastatic lymph nodes EGFR gene heterogeneity (9/40,22.5％).Log-Rank univariate analysis showed that there was no significant difference in overall survival period between EGFR mutation patients and wild-type patients(x2 =0.382,P =0.537),but there was significant difference in illnessfree progression period(x2 =4.147,P =0.042).Gene heterogeneity factor does not affect on the overall survival period and illness-free progression period of the patients with EGFR gene mutation (x2 =1.774,P =0.183 ;x2 =1.249,P =0.264).Multivariate analysis by Cox proportional-hazard model showed that EGFR gene mutation is not the independent risk factor that has 赵 impact on the prognosis of patients with lung adenocarcinoma.Conclusion Assessment of EGFR gene mutations in a single-point specimen can not reflect the whole EGFR gene mutation status,which may probably cause difference between targeted drugs'predicted effect and its actual usage effect.

Objective To evaluate the possibility of no-beparin open operation at low costal arch in live donor nephrectomy via retroperitoneal approach. Methods The effects of 134 cases no-beparin operation and 82 eases heparinized operation at low costal arch in live donor nephrectomy via retroperitoneal approach during 2003.5 to 2008.5 in our hospital were retrospective analyzed. Results The kidneys of the donors in two groups were successfully harvested. The operation time varied from 110 rain to 200 rnin, and warm isebemia time varied from lOs to 20s. Delayed graft function (DGF) was oceurred in one ease in each group. There was no signifieant difference in live donor nephreetomy between the two groups(P >0. 05), but the no-beparin group had less bleeding. Conclusion The no-beparin open operation at low eostal arch in live donor nephrectomy via retroperitoneal approach is technieal]y feasible and safe, and has less bleeding, and little influence on the allograft.

Objective: To develop the Risk Assessment Scale of Severe Psychiatric Patients in Community and test its reliability and validity. Methods: A random sample of 860 severe psychiatric patients, which was selected from 8 communities in Chaoyang District of Beijing, completed the Risk Assessment Scale of Severe Psychiatric Patients in Community. The internal consistency reliability, the observer reliability, and the correlative coefficients between the total and items of the scale were analyzed, and the exploratory factor analysis was conducted. Results: (1) The Cronbach's coefficient of the scale was 0. 86, and the observer coefficient was 0.92. (2) The Spearman correlative coefficients between the total and items ranged from 0.40 ～ 0.56. (3) Exploratory factor analysis showed that the scale had 4 main factors, all of which could account for 68.14 percent of the whole variance, and the ten item loadings ranged from 0. 60 ～0.91. (4) The patient who scored higher than 35 was called high risk patient Causing trouble behavior of high risk patient was obviously higher than others. Conclusion: The results indicate that the Risk Assessment Scale of Severe Psychiatric Patients in Community has good reliability and validity. It can be used to assess the risk of severe psychiatric patients in community.