Objective:To determine whether alpha-fetoprotein(AFP) messenger RNA(mRNA),a specifically hepatocyte-expressed gene,could be a marker of metastasis in hepatocellular carcinoma. Methods:Peripheral blood samples were obtained from 30 patients with hepatocellular carcinoma (HCC).A sensitive reverse transcription polymerase chain reaction( RT-PCR) technique was used to detect the human AFP mRNA in the blood.Results:Of the 30 HCC patients,14(46.7%) patients had positive AFP mRNA.The presence of AFP mRNA correlated with the TNM clinical stages,the size of tumor,extrahepatic metastasis or with portal vein carcinothrombosis(P0.05).Conclusion:The positive of AFP mRNA in the peripheral blood can indicate the presence of hematogenous metastasis in patients with HCC.

Objective To investigate the clinical characteristics,manifestation and management of adrenal ganglioneuromas. Methods The data of 15 cases of ganglioneuromas diagnosed by pathology were reviewed retrospectively.Of the 15 cases,5 was male,aged 24 to 45 with an average of 29 years,and other 10 was female,aged 25 to 69 with an average of 31.Ten tumors were located in the right side,which was twice as many as that of the left side.There were 8 patients discovered by B ultrasonograpgy during health check-up,4 patients were detected because of paroxysmal abdominal pain. Three cases mainly presented with paroxysmally hypertension,and one of them had a high level of aldosterone ( 112 pmol/L). One of them had a high level of epinephrine (210 nmol) and nor-epinephrine (496 nmol). The B-ultrasound showed low-echo in all cases.Five cases showed calcification,the border was legible.The border lines of the tumors are not clear with vana cava in two cases. On unenhanced CT scanning,all cases showed low density areas.Eleven of the 15 cases underwent the enhanced CT,but 10 cases showed no enhanced areas on CT scanning.One case underwent MRI and showed low signals in T1 WI and inhomogeneous high signals in T2WI. Results Twelve cases underwent adrenal glands tumorectomy with abdominal NO.11 intercostals incision while other 3 underwent adrenal glands tumorectomy through posterior abdominal laparoscope.The tumors were completely removed in 14 cases,partly removed in 1 case.All patients recovered soon without complications such as bleeding or adrenal crisis.All cases were followed-up 13 to 74 months.The blood pressure of 3 cases with hypertension decreased to normal.The tumors recurred in 1 case,but no metastasis 55 months later. Conclusions It is difficult to differentiate adrenal medullary tumor from ganglioneuromas.The imaging data of iconography before surgery can give helpful information in the diagnosis of ganglioneuroma.Complete surgical excision is the only method for curing and the outcome is satisfactory.

Objective:To stimulate the PBMCs of systemic lupus erythematosus patients with recombinant human high mobility group box1 (HMGB1) protein,observe the effect of HMGB1 on the expression of LC3Ⅱ/Ⅰ protein in active lupus nephritis and inactive lupus nephritis patients.Evaluate the effect of recombinant human high mobility group box 1 ( HMGB1 ) on the proliferation of PBMCs in patients with SLE.Methods:Western blot was used to detect the expression of LC 3II/I protein in PBMCs of active lupus ne-phritis and inactive lupus nephritis patients after stimulated by 1 μg/ml HMGB1 for 0,6,24 and 48 h.CCK-8 assay was used to detect the effects of PBMCs proliferation in patients with SLE after 1 μg/ml HMGB1 stimulation 72 hours.The statistical software SPSS17.0 was used to analyzed the results.Results: Western bolt showed an increasing expression of LC 3Ⅱ/Ⅰ protein in SLE patients after stimulated by HMGB1 ( P<0.05 ) , and this effect was time dependent.Compared with inactive lupus nephritis group , the increasing level of autophagy in active lupus nephritis group was more obviously.1 μg/ml HMGB1 could inhibit the proliferation of PBMCs in patients of SLE significantly ( P<0.001 ).Conclusion: HMGB1 may promote autophagy in SLE especially patients with active lupus nephritis and involved in the pathogenesis of SLE and lupus nephritis.Monoclonal antibodies targeting to HMGB 1 or modulators of mam-malian autophagy may provide new way for the treatment of SLE especially LN.

Objective To evaluate the reproducibility of the three-dimensional volume measurement and two-dimensional measurement of pulmonary nodule volume with 64-detector computed tomography.Methods Thirty-three patients with pulmonary nodule who underwent the examination with 64-detector spiral CT(Lightspeed VCT,GE) were included,in whom sixty solid nodules with the diameter less than 3 cm were found.There were 18 women and 15 men.CT images were analysed by two radiologists,respectively,the volumes of pulmonary nodules were measured with ALA software continuously,and two-dimensional measurements which were separated a month apart were also done in the GE AW4.2 workstation independently.Intra-and inter-reader agreement were determined by using Bland and Altman method and the Spearman correlation coefficients,the variability between three-dimensional measurements and two-dimensional ones were identified.Results 57 nodules in 60 were successfully segmented and 3 were segmented incorrectly or unsuccessfully,the ratio of successful segmentation was 95%.Three-dimensional measurements between two readers were highly correlated with r of 0.998,and the r was 0.974 in the two-dimensional measurements.The difference between the two correlation coefficients was significant.The three-dimensional measurements between two readers had completely agreed with each other for nodules that of the diameter

Objective To preliminarily evaluate the performance of glucose detention reagents with three kinds of different chro-mogens and to investigate their anti-interference performance according to NCCLS document.Methods According to the protocol EP10-A2 provided by the National Committee for Clinical Laboratory Standards(NCCLS),the samples with low,middle and high level of glucose were detected by the glucose reagent kits with 3 kinds of different chromogens.The bias,total imprecision,inter-cepts,slope rates,nonlinearities,carryover rate and drifts were calculated.The interference evaluation test was performed according to the document EP7-A2.Results The bias and total imprecision of three kinds of reagent kits were all within allowed ranges.No statistically significant differences were showed in intercepts,slope rates,nonlinearities,carryover rate and drifts.1450 turbidity chyle,5 g/L hematoglobin and 0.03 g/L vitamin C did not interfere with the assay of three kinds of glucose reagent kits with differ-ent chromogens.342 μmol/L free bilirubin,342 μmol/L conjugated bilirubin did not interfere with the detection of reagent with MAOS.Conclusion The glucose detention reagents with three different chromogens have good accuracy and precision,and various performance indexes all conform to the clinical application requirements,reagent with chromogen MAOS is better than other chro-mogenic reagents in the anti-interference performance.

Objective The purpose of this study was to assess the incidence,treatment and prognosis of silent pulmonary embolism (PE) after off-pump coronary artery bypass graft (CABG).Methods From December 2009 to September 2012,582 consecutive patients underwent off-pump CABG by a same surgeon.Their age ranged from 16 to 86 years with a mean age of (61.4 ± 9.3) years.Left internal mammary artery and saphenous vein were harvested routinely.A dose of 20 mg unfractionated heparin was given intravenously every 6 hours on the operative day after postoperative pleural fluid less than 50 ml per hour.All patients received aspirin 100 mg daily starting on postoperative day 1.The 64-slice coronary MDCT was performed to assess the graft patency on postoperative day 5 ～ 7.Results There were no in-hospital death.PE,which involved the lobar or more proximal arteries,was detected on the CT images of 10 patients (1.7％).In these 10 patients,there were no significant dyspnea or hypoxemia postoperatively ; echocardiography and ECG showed no specific signs of PE ; all bypass grafts were patent in CT images except a LIMA to LAD graft with LAD endarterectomy.PE involved both lungs in 6 patients,and only the right lung in 4 patients.All patients received anticoagulation with warfarin for 3 to 6 months except one.All patients were with good quality of life during 6 to 18 months of follow-up.Three to six months after discharge,8 patients received repeated MDCT,which showed diminish of PE.Conclusion Acute PE after off-pump CABG was an uncommon complication and was difficult to diagnose.MDCT played an important role in examining the patency of graft vessels and helped detect silent PE in CABG patients.The prognosis of acute PE after off-pump CABG was acceptable.PE diminished after 3 months of anticoagulation with warfarin.

Objective Role of melanocortin receptor 4 (MCAR) in excitatory amino acid release from rat astrocytes in spinal cord. Methods Astrocytes were isolated from the spinal cord of newborn pathogen-free Wistar rats ( 1-3 days after birth) and cultured in serum-free Neurobasal/B27 liquid culture medium. After 4 passages the primary cultured astrocytes were randomly divided into 3 groups (6 wells each): group Ⅰ control (group C); group Ⅱ the astrocytes were exposed to TNF-α 10 μg/L (group T) and group Ⅲ the astrocytes were exposed to TNF-α 10 μg/L and HS014 (selective MC4R antagonist) 1 μmol/L (group TH). The astrocytes were incubated at 37 ℃ for 3 h. The supernatant was collected for determination of glutamic acid (Glu) and aspartic acid (Asp)concentrations by HPLC-MS/MS. Results TNF-α significantly increased Glu and Asp release from astrocytes in group T as compared with group C. The Glu and Asp concentrations were significantly lower in group TH than in group T. Conclusion MG4R is involved in the excitatory amino acid release from astrocytes in the spinal cord.

Objective To analyze the detection of lymph node in normal human and patients with gastric cancer by helical CT.Methods Helical CT examinations of upper abdomen were performed in 88 normal person and 106 patients with gastric cancer.The detection of lymph nodes were analyzed.Results There was obvious difference in the detecting rate of lymph node by helical CT between normal and gastric cancer cases.The total detecting rate of lymph nodes by helical CT was 39.7%,while for metastatic nodes was 69.2%.Conclusion The density increase of lymph node is important to its CT detecting rate.CT detecting rate of lymph node has significance correlation to gastric cancer.High attention much be paid to detecting lymph node of lymphatic drainage area of gastric cancer.

Objective To observe the distribution of sentinel nodes(SN) in gastric cancer,and investigate their clinical significance.Methods The extent and features of intraoperatively stained sentinel nodes in 288 cases of gastric cancer were analyzed retrospectively.Methylene blue was injected intraoperatively into the(subseral) muscle and submucosa of the normal gastric wall adjacent to the neoplasms,then lymphadenography was performed,and the nodes were resected for histopathological examination.Results The pathological(diagnosis) of the 288 cases with gastric cancer was T_1 in 102 cases,T_2 106 cases and T_3 60 cases.Stained nodes were detectable in 270 cases(success rate: 93.8%).One hundred and two cases were found to have lymph node metastasis;66 cases had metastasis in both SNs and non-SNs;18 cases in SNs alone;and 18 cases in non-SNs alone.Conclusions Sentinel lymph nodes can accurately predict the lymph node metastatic status of gastric cancer patients during operation.Intraoperative sentinal lymph node mapping can avoid routine lymph node dissection in patients with gastric cancer with negative lymph node metastasis.

Objective: To explore the risk factors in patients with chronic heart failure (CHF) combining atrial ifbrillation (AF) and to identify the predictive factors for AF recurrence after cardio version. Methods: A total of 246 CHF patients treated in our hospital were divided into 2 groups: CHF+AF (AF) group,n=71 and CHF without AF (Non-AF) group,n=175. The baseline information was recorded. The risk factors for AF occurrence were screened by Logistic regression analysis. There were 66 AF patients with successful cardio verse and they were followed-up for 18 months, the predictors for AF recurrence were studied by Cox regression analysis. Results: The baseline information showed that age, CHF duration, left atria diameter (LAD), the levels of BNP, uric acid and serum creatinine in AF group were all higher than those in Non-AF group, allP<0.05. Logistic regression analysis presented that age (RR=1.89, 95% CI 1.08-3.31,P<0.05), CHF duration (RR=1.35, 95% CI 1.05-1.74,P<0.05), BNP level (RR=1.82, 95% CI 1.30-2.53,P<0.01), LAD (RR=1.51, 95% CI 1.09-2.08,P<0.05) were the risk factors for AF occurrence. Cox regression analysis indicated that BNP level (RR=1.30, 95% CI 1.09-1.54,P<0.01) and LAD (RR=1.74, 95% CI 1.30-2.34, P<0.01) were the predictors for AF recurrence. Conclusion: The elder age, longer CHF duration, increased BNP level and LAD were the risk factors for AF occurrence in CHF patients. The increased BNP level and LAD were the objective predictors for AF recurrence after cardio version.