Objective To investigate the expression and relationship between hepatocyte cell adhesion molecule (hepaCAM) protein and some multidrug resistance proteins in renal carcinoma tissue.Methods Expressions of hepaCAM,multidrug resistance associated protein (MRP),P-glycoprotein (P-gp),lung resistance protein (LRP),and topoisomerase Ⅱ (TOPO Ⅱ) protein were detected by immunohistochemistry in different areas of human renal cell carcinoma tissues and their relationships were analyzed.Results In the peripheral zone of renal tumor,hepaCAM,MRP,P-gp and LRP protein were showed positive expression.In the central region of the renal tumor,the expressions of hepaCAM,P-gp and LRP were negative or weakly positive,while the expressions of MRP and TOPO Ⅱ protein were positive.The expressions of MRP and TOPO Ⅱ protein in the central region of tumor were stronger than those in the peripheral zone of tunor (31.23 ±5.67 vs.23.89 ±4.56;45.66 ±2.34 vs.5.23 ±0.66),with statistically significant differences (t =-6.20,P =0.00;t =-100.16,P =0.00).While the expressions of other proteins (hepaCAM,P-gp and LRP) in the central region of tumor were weaker than those in the peripheral zone of tumor (3.21 ±1.12 vs.27.25±2.23;2.34±0.33 vs.51.23±3.45;4.22±1.78 vs.44.23 ± 1.45),with statistically significant differences (t =60.87,P =0.00;t =90.35,P =0.00;t =107.18,P =0.00).Correlation analysis showed that the expression of hepaCAM protein in the central region of renal carcinoma was related with the expression of MRP protein (r =0.94,P =0.01),but it was not related with the expressions of P-gp,LRP and TOPO Ⅱ protein (r=0.22,P=0.44;r=0.14,P=0.80;r=0.34,P=0.07).Conclusion The expression of hepaCAM protein in renal carcinoma may be related to tumor drug-resistance.

Objective To investigate the expression of miR-23a in peripheral blood and analyze its correlation with the clinic-pathological features of patients with lung cancer. Methods The level of miR-23a in peripheral blood of 63 patients with lung cancer and 60 healthy persons was detected using real-time reverse transcription-polymerase chain reaction (RT-PCR), The correlation between miR-23a level and the clinic-pathological features was analyzed. Results The expression level of miR-23a in peripheral blood of patients with lung cancer was significantly higher than that in the healthy persons (P < 0.01).The level of miR-23a was associated with TNM stage (P < 0.05), Lymphatic metastasis (P < 0.01) and the number of chemotherapy (P <0.01). Conclusion The miR-23a level in peripheral blood might be a molecular marker for the diagnosis and prognosis of patients with lung cancer.

Objecitive Under the fluorescent microscope ,we used fluorescein sodium fluorescence to determine glioma boundary ,thus gliomas removed through surgery more thoroughly .Mtehods We randomly se-lected 14 patients who were admitted in the First Hospital of JiLin University as the research objects ,patients with glioma were diagnosed as glioma according to the physical signs ,physical examination a,nd imaging findings before surgery.Diagnosed with glioma,intraoperative application of fluorescein sodium yellow fluorescence was deter -mined the tumor boundary ,and removal of the tumor ,according to the fluorescence intensity strength is different . The pathological diagnosis was to determine the boundary of fluorescent was accurate .Postoperative examined MRI was performed in order to make clear the excision of the tumor ,and the neurological condition of postoperative was observed.Results Glioma could be inspired by yellow fluorescence under fluorescent microscope .The normal brain tissue was not light .Postoperative pathological results showed that the fluorescent yellow area contained a lot of glioma cells,pale yellow fluorescence area found a small amount of glioma cells .Postoperative enhanced MRI scan had confirmed that application of fluorescein sodium could be more thoroughly resection of glioma ,postopera-tive dysfunction was reduced .Conclusion This method is prior to tumor boundary observasion without fluoresent staining and reducing the recurrence of the tumor and reducing the normal brain tissue damage ,and therefore,im-proving the quality of postoperative survival of patients .

[Objective]This study was designed to observe the effects of endotoxin(LPS)on the growth activity and gap junction(GJ)of NRK52E cells.[Methods]The NRK52E cells were divided into control group and LPS groups,and the NRK52E cells in LPS groups were treated with LPS 10 ng/mL,50 ng/mL,100 ng/mL,500 ng/mL,and 1 000 ng/mL for 24 h respectively.The NRK52E cells growth activity was measured through MTT method,and the function of gap junction of NRK52E cells was measured through the method of fluoroimmunoassay.The protein expression of connexin 43(Cx43)in control group,LPS 10 ng/mL group,and LPS 100 ng/mL group were also determined by Western blotting.[Results]①Compared with control group and LPS 10 ng/mL group,The NRK52E cells growth activity decreased significantly in LPS 50 ng/mL,100 ng/mL,500 ng/mL,and 1 000 ng/mL groups(P＜0.01).②Compared with control group,the function of GJ decreased significantly in LPS 100 ng/mL,500 ng/mL,and 1 000 ng/mL groups(P＜0.01).③There were negative correlations among the concentration of LPS and NRK52E cells growth activity and GJ function respectively(r=-0.941,-0.872,P＜0.01).④Compared with control group,the protein expression of Cx43 were decreased significantly in LPS 10 ng/mL and 100 ng/mL groups(P＜0.01).[Conclusions]LPS can inhibit the NRK52E cells growth activity in a dose-depend manner.GJ function is one of the mechanisms.

Objective To evaluate the cardiac function of the patients with liver cirrhosis before orthotopic liver transplantation(OLT)using Swan-Ganz catheter.Methods Sixty ASAⅡ-Ⅳ patients aged 45-64 yr with liver cirrhosis scheduled for OLT without veno-venous bypass were allocated into 2 groups according to preoperative liver function:compensated group(group C,n=28)and decompensated group(group H,n=32).Anesthesia was induced with midazolam 3-5 mg,fentanyl 0.15-0.2 mg,propofol 1 mg/kg and vecuronium 0.1 mg/ks and maintained with 0.5%-3.0% isoflurane,fentanyl 0.05-0.10 mg and vecuronium 4 mg/h.The patients were mechanically ventilated after tracheal intubation,and P_(ET)CO_2 was maintained at 30-45 mm Hg.Radial artery was cannulated and Swan-Ganz catheter was placed via right internal jugular vein for monitoring of mean arterial pressure(MAP),cardiac output(co),cardiac index(CI),right ventricular ejection fraction(RVEF),mean pulmonary arterial pressure(MPAP),pulmonary arterial wedge pressure(PAWP),right atrial pressure(RAP),right ventricular end-diastolic volume(RVEDV),fight ventricular end-systolic volume(RVESV)and stroke volume index(SVI).Right and left ventricular stroke work index(RVSWI,LVSWI)and systolic and pulmonary vascular resistance(SVR,PVR)were calculated.Results CO,CI,SVI,MPAP,PAWP,RVEDV,RVESV,RVSWI and LVSWI were significantly elevated in group H as compared with group C indicating hyper-hemodynamic state.The SVR and PVR were significantly decreased in group H.There was no significant difference in HR,MAP,RAP and RVEF between the two groups.Conclusion The patients with decompensated liver function before OLT are in a hyper-hemodynamic state.More attention should be paid to perioperative myocardial protection.

Objective To evaluate the safety and feasibility of the modified apnea test (MAT) for brain death evaluation. Method A prospective, controlled clinical study was carried out. Forty-three patients with suspected brain death underwent a total of 85 MATs. The patient's spontaneous breathing, hemodynamics and oxy genarion were monitored during MAT; arterial blood pH, PaCO2, PaO2 were measured before and after the MAT. Paired t test was used for statistical analysis to determine significant differences in measurements before and after MAT on the same patient. The Wilcoxon Signed-Rank Test was used to determine statistical significance for skew distribution of PaO2 before and after apnea testing. Informed consent was obtained from the kinfolk of all participants and all of the procedures were done in accordance with national and international laws and policies. Results Hemodynamics and oxygenarion were stable in all patients during MAT, and none regained spontaneous respiration. About 89.4% of tests were completed within 4 minutes, and 10.6% within 8 minutes. The mean value of Pa CO2 rise was (23.1 ±4.8), and the average rate of PaCO2 increase was 5.3 mmHg per minute. Conclusions Modified apnea test can be done safely for brain death evaluation and is a useful supplement to the common apnea test.

Objective: To summarize the characteristics of arrhythmia with the relevant factors affecting its prognosis in patients of apical hypertrophic cardiomyopathy (AHCM). Methods: A total 283 AHCM patients with echocardiography or cardiac magnetic resonance (CMR) conifrmed diagnosis in our hospital from 2005-01 to 2012-08 were summarized. The patients were divided into 2 groups: With arrhythmia group, n=103 and Without arrhythmia group,n=180. The endpoint event was followed-up by clinical and telephone visits in both groups and the relevant risk factors affecting AHCM prognosis were investigated by Cox regression analysis. Results: There were 269 patients ifnished the follow-up investigation, 98 in With arrhythmia group, 171 in Without arrhythmia group, and the death rate was 4.08% vs 1.17%, the occurrence of endpoint event was 18.37% vs 5.58%respectively. Cox regression analysis indicated that age (HR=23.051, 95% CI 1.08-1.068,P<0.005), left atrial diameter (HR=4.113, 95%CI 1.002-1.119,P=0.043) and NT-proBNP (HR= 18.653, 95% CI 3.433-26.650,P<0.005) were the independent risk factors affecting prognosis in AHCM patients. Conclusion: Arrhythmia is one of the common presentations of AHCM, it does not have much impact on survival, while it may cause ventricular ifbrillation and increase the occurrence of cardiovascular events.

Objective To explore the microsurgery methods in patients with early intracranial aneurysm rupture. Methods Sixty-seven patients with early intracranial aneurysm rupture received the emergency microsurgery after releasing cerebrospinal fluid from improved Paine point via pterion craniotomy. Thirty-nine patients received surgery within 1 d after intracranial aneurysm rupture, and the other 28 patients were within 1-3 d. Results The therapeutic effect was evaluated by Glasgow outcome score (GOS) at discharge. Among the 45 patients with Hunt-Hess Ⅰ-Ⅲ grade, cure was in 41 cases, improved in 4 cases. Among the 22 patients with Hunt-HessⅣ-Ⅴgrade, cure was in 6 cases, improved in 6 cases, moderate disability in 4 cases, severe disability in 1 case, and death was in 5 cases. Conclusions The microsurgery of clipping aneurysm directly via pterion approach is still by far the most reliable treatment. And releasing cerebrospinal fluid from improved Paine points can effectively reduce the acute brain swelling of early operation, which will make it an effective adjuvant therapy to emergency microsurgery of clipping aneurysm.

To increase the rescue competency of residents, also the critical thinking, team dynamics, and the capability to handle with emergencies, Shanghai East Hospital developed a rescue course integrated with 24 standardized simulation cases learning and medical simulation education for residents training pro-gram. The instructor candidates should complete the simulation training and pass the instructor certification. Every course was monitored by the course director to ensure the teaching quality. After two and a half years of practice, it is found that the teaching of case teaching and simulation teaching is better than traditional teaching, and it plays an important role in the security of medical security.

AIM: To investigate the influence of irbesartan (Irb), a new angiotensin II receptor 1 antagonist, on renal hypertrophy in streptozotocin (STZ)-induced diabetic rats. METHODS: Sprague-Dawley (SD) rats were randomly divided into three groups: normal group (Group N, n=7), diabetic group (Group DN, n=6) and irbesartan treated group (Group DNI, n=7). In the experimental group, after the rats subjected to uninephrectomy, STZ was given by peritoneally injection at bolus dose of 50 mg/kg to induce diabetes. Blood glucose (BG), body weight (BW), urinary albumin excretion (Ualb), 24 hour proteinuria (24 h Upro) were measured at week 4, 8, 12, respectively. By the end of experiment at week 12, creatinine clearance (Ccr), kidney weight (KW), indicator of renal hypertrophy (KW/BW), renal total protein content (RTP), glomerular area (AG) and glomerular volume (VG) as well as glomerular basement membrane (GBM) were determined by semi-quantitative pathology technique. RESULTS: It was showed that there was no significant difference in BG between group DN and DNI, while Irb significantly reduced the increasing of Ualb, 24 h Upro in diabetic rats compared to control group (P