Circulating microparticles (MPs) derive from a variety of cells,including platelets,leukocytes,endothelial cells and erythrocytes.In addition,tumor cells release MPs into blood.MPs are formed as a result of membrane lipid remodeling and proteolytic cleavage of cytoskeleton.Exposure of phosphatidylserine (PS) and tissue factor (TF) provide a surface for the assembly of Xase and prothrombianse to activate coagulation and induce thrombosis.Considerable levels of platelet-derived PS+ MPs are detected in healthy subjects.However,the level of PS+ and TF+ MPs,the latter of which predominantly derived from monocytes,greatly increased in thrombotic diseases,such as sepsis,cancer,and myocardial infarction.Therefore,MPs could be a useful biomarker for the evaluation of thrombosis risk.

BACKGROUND: Serum cytokines in patients with dilated cardiomyopathy are increased obviously, and the expression of interleukin-6mRNA is also observed in myocardial tissues. High epidural anesthesia can block the vicious cycle involving cytokines and improve cardiac function. OBJECTIVE: To observe the changes of interleukin-6 and soluble interleukin-2 receptor in patients with dilated cardiomyopathy after high epidural anesthesia treatment. DESIGN: A case-controlled analysis. PARTICIPANTS: Thirty-five inpatients with dilated cardiomyopathy were selected from the Department of Cardiology, First Hospital Affiliated to Harbin Medical University, from October 2001 to May 2002. All the patients were randomly divided into high epidural anesthesia group and conventianal treatment group. High epidural anesthesia group consisted of 22patients, 15 males and 7 females, whose cardiac function was classified into grade Ⅱ in 4 patients, grade Ⅲ in 9 and grade Ⅳ in 9. Conventional treatment group consisted of 13 patients, 11 males and 2 females, whose cardiac function was grade Ⅱ in 1 patient, grade Ⅲ in 5 and grade Ⅳ in 7. Healthy control group comprised 21 people, 13 males and 8 females,who received physical examination at the same period. INTERVENTIONS: Patients with dilated cardiomyopathy were treated with high epidural anesthesia and conventional method, whereas those in conventional treatment group were treated with conventional method only.Elbow venous blood of 3 Ml was sampled from all patients on empty stomach in the morning before treatment and after 4-week treatment. The level of serum interleukin-6 and soluble interleukin-2 receptor was measured with enzyme-linked immunoadsorbent assay. MAIN OUTCOME MEASURES: The level of serum interleukin-6 and soluble interleukin-2 receptor of patients in eachgroup. RESULTS: Blood samples of the 56 subjects were qualified and entered the final analysis.①The level of serum interleukin-6 was higher in dilated car diomyopathy group (13.9ng/L) than in healthy control group (11.22 ng/L) (z= -3.072, P ＜ 0.05). ② The level of serum interleukin-6 in high epidural anesthesia group was obviously decreased aftertreatment (11.42 ng/L) as compared with that before treatment (20.42ng/L) (z =2.582 9, P ＜ 0.05).The le vel of serum interleukin-6 in conventional treatment group was similar before and after treatmant(12.16 ng/L and 12.80 mg/L, z = -1.89,P ＞ 0.05). The difference of interleukin-6 level in high epidural anesthesiagroup (-2.04 ng/L)was obviously higher than that in conventional treat ment group (0.28 ng/L) (P ＜ 0.01) before and after treatment.③The level of serum soluble interleukin-2 receptor was higher in dilated car diomyopathy group[(1 306.17±1.46)ng/L]than in healthy control group [(1078.95±1.23) ng/L] (t =2.51, P ＜ 0.05). ④ The level of soluble intedeukin-2 receptor in high epidural anesthesia group was decreased after treatment [(1 086.68±1.34)ng/L]as compared with thatbeforetreatment [(1 328.01±1.51) ng/L], (t =2.145, P ＜ 0.05). The level of soluble interleukin-2 receptor in conventional treatment group was similar before and after treatment [(1 473.33±1.66) ng/L and (1 331.07±1.52) ng/L,t=-1.06, P ＞ 0.05]. CONCLUSION:The level of serum interleukin-6 and soluble inter leukin-2 receptor is significantly decreased after high epidural anesthesia, suggesting that high epidural anesthesia can regulate cytokines better than conventional treatment.The regulation of high epidural anesthesia is related to inhibition of sympathetic nervous system and humoral-im mune system.

Objective To assess the safety and effectiveness of prenatal multiple and single course glucocorticoids treatment on preterm birth infants. Method Seven researches on the treatment of preterm birth infants with glucocorticids were meta analyzed. Results Multiple courses of glucocorticoids treatment before labor may lower the incidence of patent ductus arteriosus (PDA) of preterm babies (OR=0.51,95% CI 0.49~0.54),and so did the respiratory distress syndrome (RDS), (OR=0.72,95% CI 0.49~1.07).But it may increase the septicemia of preterm infants (OR=1.62, 95%CI 1.07~2.44),and could not decrease the morbidity and mortality of intracranial hemorrhage (ICH)(OR=0.65, 95% CI 0.37~1.15)? necrosis enterocolonitis (NEC)(OR=1.30, 95% CI 0.79~2.12)and chronic lung disease (CLD)(OR=0.94,95%IC 0.59~1.49)? It cound not decrease the use of pulmonary surfactant after the birth of preterm infants. (OR=0.86,95% CI 0.48~1.55). Conclusions It suggests that multiple courses treatment with glucocorticoids is not safer and more effective than single course before labor.

Objective To evaluate the relationship between the spatial structure of pulmonary vascular tree and oxygen partial pressure in patients with chronic obstructive pulmonary disease(COPD) by the fractal dimension method.Methods 106 patients with COPD and 100 healthy people without COPD as controls were included in this study.All of the patients underwent multidetector CT scan and blood gas analysis.The pulmonary vascular trees were generated using post-processing software,and the FD of the pulmonary vascular trees were determined with ImageJ software in a personal computer.The fractal dimension were evaluated in the two groups.The relationship between FD and oxygen partial pressure in patients with COPD was analyzed.Results The FD value of the patients with COPD was lower than that of the patients without COPD (t =5.21,P＜ 0.01).There was a significant correlation between FD and the PaO2 in patients with COPD (r=0.692,P＜ 0.01).Conclusion FD analysis can effectively evaluate the process of pulmonary vascular remodeling induced by hypoxia in patients with COPD,which may be used as an important index for quantitative evaluation of pulmonary vascular remodeling in the course of COPD.

Objective To characterize the effects of AQP1 expression on kidney damage in rat disseminated intravascular coagulation(DIC) caused by lipopolysaccharide(LPS) dosing. Method Fifty male Wistar rats (clean grade) were randomly assigned into 5 groups of 10 rats. The 10 control rats were dosed with 10 ml of 0.9%NaCl solution by a drip via the vena caudalis within 4 h, and blood and tissues were obtained after treatment completion. In the DIC groups, the rats were dosed with LPS (30 mg/kg body weight in 10 ml of 0.9% NaCl solution) by a drip via the vena caudalis within 4 h, and blood and tissues were obtained at 4, 6, 8 and 10 h. The blood platelet(PLT) count, prothrombin time(PT) , activated partial thromboplastin time(APTT), fibrin(FIB) and D-dimer(D-D) were detected. Hematoxylin and eosin(HE) staining was used to examine the pathologic changes in the lung and kidney tissues of each group (both hematologic parameters and tissue pathologic changes were used to judge the course of DIC). The AQP1 gene expression levels in the kidney tissues from the groups were evaluated by the mRNA levels using RT-PCR. Statistical analyses were performed by the SNK- q method. Results The PLT count, PT, APTT, FIB and D-D examinations revealed remarkable changes in all DIC groups compared with the control group (P < 0.01). The AQP1 mRNA level was significantly decreased in the DIC group at 4 h compared with the control group (P < 0.01) , and further decreased to the minimum level in the DIC group at 6 h. Moreover, cloudy swelling of renal tubular cells was observed at 6 h and cell degeneration and necrosis were observed at 8 h among the DIC groups. Conclusions Downregulation of AQP1 mRNA expression occurred before damage to the renal tubular cells in DIC, indicating that AQP1 expression may be involved in the kidney damage observed in rat DIC.

Background: LncRNA expression was up-regulated or down-regulated in gastric cancer, but the mechanism of role of LncRNA in the development and progression of gastric cancer was not been fully clarified. Aims: To investigate the mechanism of LncRNA DDX11-AS1 in regulating the proliferation, migration and apoptosis of gastric cancer cells by targeting the expression of miR-497-5p. Methods: qRT-PCR was used to detect the expressions of DDX11-AS1 and miR-497-5p in gastric cancer tissue and cell lines. Pearson method was used to analyze the correlation between DDX11-AS1 and miR-497-5p in gastric cancer tissue. Gastric cancer HGC-27 cells were randomly divided into NC group, si-con group, si-DDX11-AS1 group, miR-con group, miR-497-5p group, si-DDX11-AS1+anti-miR-con group, si-DDX11-AS1+anti-miR-497-5p group. The cell proliferation was detected by MTT. The cell apoptosis was detected by flow cytometry. Transwell assay was used to detect the migration and invasion ability. The dual luciferase reporter system assay was used to verify the targeted regulatory relationship between DDX11-AS1 and miR-497-5p. The protein expressions of cyclin D1, cleaved caspase-3, MMP-2 and MMP-9 were detected by Western blotting. Results: The expression of DDX11-AS1 in gastric cancer tissue and cell lines was significantly increased (P<0.05), while the expression of miR-497-5p was significantly decreased (P<0.05), DDX11-AS1 was negatively correlated with miR-497-5p (r=-0.754, P<0.05). Interfering the expression of DDX11-AS1 or up-regulating the expression of miR-497-5p significantly inhibited cell proliferation, migration and invasion (P<0.05), apoptosis rate was significantly increased (P<0.05), and the expressions of cyclin D1, MMP-2 and MMP-9 were significantly decreased (P<0.05), and the expression of cleaved caspase-3 was significantly increased (P<0.05). The dual luciferase reporter assay demonstrated that DDX11-AS1 negatively regulated the expression and activity of miR-497-5p. Inhibition of miR-497-5p expression reversed the effect of interference with DDX11-AS1 expression on the biological behavior of gastric cancer cells. Conclusions: Interference with LncRNA DDX11-AS1 expression can inhibit the proliferation, migration, invasion and induce apoptosis of gastric cancer cells by targeting and up-regulating the expression of miR-497-5p.

Objective To investigate the correlation between spatial memory and sleep architecture and hippocampal volumes in patients with chronic insomnia disorder.Methods Twenty-two chronic insomnia patients and 17 normal sleepers (controls) were selected to evaluate the subjective insomnia using Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI) and the objective insomnia by polysomnography (PSG).The cognitive function was measured by Montreal Cognitive Assessment (MoCA).Spatial memory and object-memory were measured by Nine-box Maze, and object-recognition memory was detected by picture recognition test.MRI was used to detect hippocampus volumes.Results Compared with controls, a significant reduction in total sleep time (328.3 (310.4, 387.9) min vs 418.0 (375.8, 45.5) min, Z=2.607, P=0.009), sleep efficiency (%) (77.7 (73.1, 84.0) vs 93.0 (87.2, 93.9), Z=3.739,P=0.000), proportion of N3 (%) (5.5 (0.4, 14.4) vs 13.7 (7.7, 18.3), Z=2.664, P=0.008) and proportion of rapid eye movement (REM) (%) (14.4 (10.7, 17.2) vs 17.3 (15.9, 23.3), Z=2.890, P=0.004) was seen in insomnia patients, whereas sleep latency was delayed.The error numbers of spatial working-memory (4.5 (2.0, 7.3) vs 1.0 (0.0, 3.0), Z=3.007, P=0.003) in chronic insomnia patients were more than those in controls.There was no statistically significant difference in object reference memory, spatial reference memory and object recognition in two groups.A significant reduction of the left (2 818.0 (2 534.9, 3 191.8) mm3 vs 3 453.3 (3 081.2, 3 764.4) mm3, Z=3.314, P=0.001), right (2 780.5 (2 451.2, 3 191.8) mm3 vs 3 479.8 (3 024.1, 3 786.7) mm3, Z=3.484,P=0.000) and whole hippocampal volumes (5 561.7 (4 956.6, 6 396.9) mm3 vs 6 898.9 (6 017.1, 7 540.1) mm3, Z=3.455, P=0.001) was seen in chronic insomnia patients compared with controls.The hippocampal volumes were negatively correlated with sleep latency (r=-0.432, P=0.006), but positively correlated with sleep efficiency, proportion of N3 (r=0.323, 0.376;P=0.045, 0.018).There was a negative correlation between the error numbers of spatial working-memory and hippocampal volumes (r=-0.351, P=0.029).The hippocampal volumes were negatively correlated with the duration of disease in chronic insomnia patients (r=-0.734, P<0.01).Conclusion The spatial memory may be associated with decreased proportion of REM and reduced hippocampal volumes in chronic insomnia patients.

This paper introduced the application and effects of mobile operating room nursing information management system (MORNIMS) in the operating room. The MORNIMS was designed by operating room and information center based on the Enterprises Digital Assistant (EDA) and was applied in the operating room for two years. Its application significantly improved work efficiency,optimized the work flow,reduced nursing mistakes,enhanced the retrospective quality monitoring of sterile materials,and realized information management in the operating room.

The clinical values of acetoacetate ( AcAA ) and β hydroxybutyrate ( βHBA ) determination in classification of type 1 and2 diabetes were explored. 102 normal control subjects,33 cases of type 1 diabetes, and 104cases of type 2 diabetes were enrolled. Serum AcAA, βHBA, fasting plasma glucose ( FPG), C-peptide, and insulin levels were measured. The results showed that serum AcAA, βHBA, total ketone tody (TKB) levels in the diabetic groups were significantly higher than those of the normal group( P＜0. 01 ). AcAA, βHBA, TKB levels in type 1diabetes were higher as compared with those of type 2 diabetes( P＜0.01 ). The AcAA, βHBA, and TKB levels were negatively related with C-peptide and insulin in diabetic patients( P＜0. 01 ). All the type 1 diabetic patient were found to have TKB and lower C-peptide levels. TKB positive and lower C-peptide in type 2 diabetes were found in 47% and 26% respectively. Receiver operating characteristic (ROC) curve suggested that the area under the ROC curve of type 1 and type 2 diabetes was 0.926. The optimal operating point of the total ketone body was 0. 532 mmol/L with higher sensitivity and specificity. Enzymatic determination of acetoacetate and β hydroxybutyrate seems to have important clinical values for classification of type 1 and 2 diabetes.

Objective To study the application of standardized patients practice and agent physician system in digestion medical clinical practice. Methods One hundred and fifty five-year-clinical medical students who began digestion medical clinical practice from 2008 to 2009 were selected and randomly divided into teaching reform group and control group, each group containing 75 people. According to teaching reform group students' willingness and through the selection, 69 were identified as agent physician. Standardized patients and agent physician simulation clinical training were applied in the teaching reform group while conventional teaching methods were used in the control group. Sta-tistical analysis of the experimental data was conducted using SPSS 11.0 statistical package. Measure-ment data use independent-samples t test and rank sum test was used for heterogeneity of variance. Results Teaching reform group students' inquiry contents and skills scores for each project were higher than those of control group and the score difference was statistically significant (P<0.05) in chronological order, the transition language, interrogation schedule, repeated questions, summary records, citing verification, instrumentation courtesy, friendly behavior, praise and encouragement, eliciting the patient's views, concerns about the effects of disease, care and support and assistance aspects. After the end of the third internship, two groups were compared in operation results, reform history collection, physical examination skills group score and the excellent and good rate being higher (P=0.002, 0.001). After three times' practice, teaching group students' scoring pass rate in medical ethics demeanor, interrogation techniques and physical examination skills, case analysis is higher than that of the control group students, and the difference was statistically significant(P<0.05). Conclusion Application of standardized patients and implementing agency resident simulation clinical training in the guide teaching of digestion department of internal medicine has achieved good effect.