Objective To observe leptin level before and after rosiglitazone administration and to explore the possible mechanism of rosiglitazone's improving insulin sensitivity.Methods A total of 30 patients newly diagnosed with type 2 diabetes were separated into three groups at random,and treated with rosiglitazone(4mg/d),metform(750mg/d) and gliclazide(160mg/d),respectively.Serum leptin,insulin and GHbA1c were measured after 12 weeks.Results After 12 weeks' treatment,the fasting glucose and GHbA1c in each group declined sharply,while free insulin did not change.The leptin level in rosiglitazone group decreased and insulin sensitivity was improved after administration,but there was no change in metformin and sulfonylureas groups.Conclusion Leptin may play a role in rosiglitazone's mediating the insulin-sensitizing effects.

Objective To induce highly active hepatocellular carcinoma (HCC) specific cytotoxic T-lymphocyte (H-S-CTL) lines by co-culture of lymphocytes and hepatocellular carcinoma cells. Methods H-S-CTL were established by co-culture of autologous HCC cells and lymphocytes, under stimulation of IL-1,IL-2,IL-4 and IL-6.The cytotoxic activity of H-S-CTL for target cells were detected by 51Cr release assay and indirect immunofluorescence assay. Results Compared with auto-LAK, H-S-CTL showed much higher antitumor activity of significantly increased CD3+, CD4+ and CD8+ cells. Conclusions H-S-CTL lines with massive proliferations and high antitumor activity can be successfully obtained by ex vivo co-culture under the stimulation of interlukins.

Objective:To discuss the early diagnosis of malignant hyperthermia(MH) and its treatment regimen without dantrolene.Methods: A patient of American Society of Anesthesiologist class Ⅰhad sudden muscle spasms and masseter muscle spasm during induction of anesthesia for idiopathic scoliosis surgery,and was diagnosed as having MH.Without using dantrolene,the patient was treated promptly with removal of inducement,control of temperature,adequate oxygen supply,maintaining of pH,water and electrolyte balance,and protection of renal function.The dynamic changes of the myoglobin in the blood and urine,serum creatine kinase,the blood gas indicators,and EtCO2,together with the pathological changes of the quadriceps were observed.Our experience on diagnosis and treatment was summarized.Results: The patient fully recovered and was discharged without any complications.The myoglobin in the blood and urine,serum creatine kinase and its isoenzyme increased rapidly and reached the peak one hour after MH,and maintained for about ten hours,then returned gradually to normal level about five days later.The temperature and EtCO2 increased immediately after development of MH,arterial blood gas quickly showed hypercapnic acidosis,but pH maintained normal or partial alkali during the treatment due to sodium bicarbonate administration;the alkali maintained obviously higher.Some quadriceps muscle cell had vacuolar degeneration and lysis.Conclusion: Non-ventilation induced increase of EtCO2 is a reliable indicator for early diagnosis of MH.Anesthetics,such as succinylcholine,should be avoided in patients at high risk of MH,and EtCO2 should be monitored.Once MH is diagnosed,dantrolene is the first choice.When without dantrolene,satisfactory outcome can be achieved through early diagnosis,timely removal of incentives,control of temperature,adequate oxygen supply,maintaining of stable internal environment,control of arrhythmia and protection of renal function.

Objective To evaluate the efficacy of whole body hyperthermia(WBH) in the treatment of advanced hepatic carcinoma and its effect on liver function.Methods From 2001 to 2004,39 cases of advanced hepatic carcinoma were treated with WBH.The effect of WBH on liver function was assessed by liver function test before and after treatment.Results ①The effective rate of WBH was 61.5%(24/39) in the treatment of advanced hepatic carcinoma with declined AFP in 60.0%(9/15) of patient and 100% of patients had pain relieve.The survival rates of 6 months,1 year and 2 years were 76.9%(30/39),59.0%(23/39) and 12.8%(5/39),respectively.②Alanine aminotransferase(ALT) elevated obviously in 1-3 d after treatment(P

Barium ; Diagnostic Errors ; Esophagus ; Foreign Bodies ; Humans

Objective To observe the expression of CD166 in advanced non-small cell lung cancer (NSCLC),and to explore the relationship between expression of CD166 and clinical characteristics,platinum-based chemotherapy effect of NSCLC patients.Methods A total of 64 cases of NSCLC patients at stage of Ⅲ,Ⅳ were enrolled.Tumor tissue samples were obtained before chemotherapy by bronchoscopy or lung biopsy,and immunohistochemical was used to detect the expression of CD166.All patients received platinum-based chemotherapy(NP/TC/ GP) for 2-4 cycles as the first line treatment.RECIST criterion was used for therapeutic evaluation.Results 46.9% (3 0 cases) of the patients with CD 1 6 6 was positive.The CD 1 6 6 expression was related with smoking (smoking 62.1%,no-smoking 34.3%,x2 =4.916,P =0.027) and degree of differentiation (moderately,low grade 68.2%,high grade 35.7%,x2 =6.112,P =0.013).The effectiveness rate of chemotherapy in CD166 positive patients was 23.3% (7 cases),was significantly lower than 61.8% in CD166 negative patients(21 cases,x2 =9.565,P =0.002).Conclusion NSCLC had CD166 expression,and the expression positive rate was increased in patients with smoking,and low differentiation cancer.The effectiveness rate of platinum-based was decreased in patients with CD166 positive expression,and detection of CD166 can predict the late NSCLC platinum-based chemotherapy effect.

Objective To investigate the relation among clinical nurses′resilience, emotional, the pressure load and self-efficacy with the 10-item Connor-Davidson Resilience Scale. Methods A total of 449 nurse in Guangzhou were recruited to investigate by 10-item Connor-Davidson Resilience Scale (CD-RISC-10), Kessler 10 Scale (K10), General Self-Efficacy Scale (GSES), Chinese Stress Overload Scale (SOS). Results The average score was 23.6±6.7 for CD-RISC-10 , 24.4±8.2 for K10,24.7±5.7 for GSES , 63.3 ±16.6 for SOS ,and the individual vulnerability scoring was (31.2±10.0) points, events load was (32.0±7.5) points. High mental toughness of nurses in general self-efficacy scores higher than that of low mental toughness group (t=-8.53, P<0.01), in the K10 dated, S0S scores were lower than low mental toughness group (t=11.23, 7.70, P<0.01). Nurse relevant regression analysis results showed that gender, general self-efficacy, K10 dated, SOS as the main factors influencing nurses mental toughness, could explain 40%of variances. Conclusions The CD-RISC-10 can better reflect the level of clinical nurses′resilience, and the gender, self-efficacy were the main effects, as well as effectively predict the nurses′emotional distress and stress level. However how to improve the toughness of the clinical nurses need more research.

The research of sleep staging is not only the basis of diagnosing sleep related diseases, but also the precondition of evaluating sleep quality, and has important clinical significance. In recent years, the research of automatic sleep staging based on computer has become a hotspot and made some achievements. Feature extraction and feature classification are two key technologies in automatic sleep staging system. In order to achieve effective automatic sleep staging, we proposed a new automatic sleep staging method which combines the energy features and least squares support vector machines (LS-SVM). Firstly, we used FIR band-pass filter to extract the energy features of Pz-Oz channel sleep electroencephalogram (EEG) signals, and compared them with those from wavelet packet transform method. Then we designed an LS-SVM classifier to realize the automatic sleep stage classification. The research showed that FIR band-pass filter (with the Kaiser window) performed better than wavelet packet transform (WPT) for energy feature extraction just in terms of the data from the Sleep-EDF Database and the LS-SVM classifier (with the RBF Kernel function) designed was good, and the automatic sleep staging method proposed in this paper was better than many similar methods from other studies with an average accuracy of 88.89% and had a very prosperous application future.
Electroencephalography ; Humans ; Least-Squares Analysis ; Sleep Stages ; Support Vector Machine

Objective To investigate the clinical application of statins for secondary prevention and its efficacy in patients with ischemic stroke.Methods A total of 300 patients with ischemic stroke were divided into statins group (n=91) and control group (n=209) according to whether statins was received or not.Serum lipid parameters,liver and kidney function,carotid artery intimamedia thickness (IMT) and plaque area were compared between the two groups.Results In 209 patients not taking statins,68 cases (32.5％) were not advised by clinic doctor; 55 cases (27.8％)were reluctant to take statins in fear of adverse reactions; 77 cases (36.8％) discontinued stains when serum lipids were normal; 3 cases (1.4％) developed skin allergic reaction and the skin rash that disappeared after stains discontinuance; 3 cases (1.4％) had elevated liver enzyme levels and the enzyme levels were declined to normal after stains discontinuance.The levels of total cholesterol (TC),triglyceride (TG) and low density lipoprotein cholesterol (LDL-C) were significantly lower in statin group than in control group [(4.93±0.45) mmol/L vs.(5.87±0.38) mmol/L,(1.68±0.61)mmol/L vs.(2.01±0.58) mmol/L,(2.49±0.57) mmol/L vs.(3.76±0.44) mmol/L,t=18.60,4.46,20.94,P=0.000,0.007,0.000,respectively].High density lipoprotein (HDL-C) level was significantly higher in stain group than in control group [(1.36±0.31) mmol/L vs.(1.03±0.25)mmol/L,t=9.75,P=0.001].There were no significant differences in liver and kidney function parameters such as alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase,serum total bilirubin,direct bilirubin,indirect bilirubin,glutamyl transferase,blood urea nitrogen and serum creatinine between the two groups (all P＞0.05).The carotid IMT and carotid atherosclerotic plaque area were significantly lower in stain group than in control group [(1.62 ± 0.23) mm vs.(1.74±0.31) mm,(0.57±0.12) cm2 vs.(0.65±0.18) cm2,t=3.32,3.88,P=0.008,0.002,respectively].Conclusions Most patients with ischemic stroke are still not taking statin for secondary prevention.Statins can improve the blood lipid levels and carotid arteriosclerosis status,and no obvious adverse reactions are observed.

Objective: To observe the controlled hypotension effects of nicardipine in 2 different ways for spinal tumor operalion. Methods: Twenty-four adult patients, scheduled for selective spinal tumor operation, were randomly divided into 2 groups. In groupⅠ(n=12), the nicardipine was infused at a rate of 10 μg*kg-1*min-1 and the infusion continued until MAP was at the level of 7.33-8.66 kPa, and then the rate was decreased to 1 μg*kg-1*min-1. In Group Ⅱ(n=12), nicardipine was given 0.01-0.02 mg/kg as the load dose, then infused at 1-2 μg*kg-1*min-1. Results: During the period of controlled hypotension, cardiac index(CI) increased significantly, other hemodynamic variables were stable and no hypertension rebound occurred in both groups. Reaching time of target blood pressure in groupⅡ was shorter than that in groupⅠ（P＜0.05）. The dose required to obtain target blood pressure in group Ⅱwas less than that in group Ⅰ（P＜0.05）. BP recovery time from discontinuing nicardipine infusion to pre-hypotension level,bleeding volume and transfusion volume were similar between 2 groups（P＞0.05）.During mass bleeding,　serious arrhythmia and oliguria did not occur in any case. Conclusion: Controlled hypotension with nicardipine is rapid, stable and easily controlled without hypertension rebound. Nicardipine has considerable protective effects on heart and kidney during mass bleeding. The method of bolus injection followed with intravenous infusion is more suitable to clinical application.