Objective To investigate the value of prevention of cerebral ischemia with multi-modality neuroelectrophysiological monitoring in intracranial aneurysm embolization. Methods The clinical data of 44 patients with intracranial aneurysm treated with endovascular embolization from May 2013 to June 2014 were analyzed retrospectively. The patients were divided into two groups according to whether they used intraoperative neuroelectrophysiological monitoring. There were 21 patients in a monitoring group and 21 in a non-monitoring group. According to the site of the aneurysms,somatosensory evoked potential ( SEP),motion evoked potential( MEP),scalp electroencephalogram,and brainstem auditory evoked potential (BAEP)were monitored,and at one day after procedure,their newly developed neurological deficits and the follow up observation after 3 months in both groups were compared and analyzed. Results The intraoperative SEP,MEP,and scalp EEG changes in the monitoring group were observed in 9,3 and 4 patients,respectively. Timely preventive measures were taken for 9 of the patients with cerebral ischemia revealed by neuroelectro-physiological monitoring. At the first day after procedure,the incidence of patients with new neurological deficit was 17. 4%(4/23)in the monitoring group,and that was 47. 6%(10/21)in the non-monitoring group. There was significant difference between the 2 groups(χ2 =4. 623;P<0. 05). There was significant difference in the good prognosis rates(87. 0%[20/23]vs. 57. 1%[12/21])after 3-month follow-up (χ2 =4. 919;P<0. 05)between the 2 groups. There were no deaths in both groups. Conclusion Multimode in combination with neuroelectrophysiological monitoring may decrease ischemic complications in aneurysm interventional treatment and improve the safety of procedure.

Objective To explore the protocol of tissue matching and anti-rejection therapy in highly sensitized patients (HSP). Method The panel reactive antibody (PRA), human leukocyte antigen (HLA) matching and renal transplantation outcomes of 45 HSPs were retrospectively analyzed. Results Hyperacute rejection occurred in 2 patients. Acute rejection occurred in 9 patients and reversed by anti-rejection therapy. One year patient/graft survival rate was 95.6% / 91.1% respectively. Conclusions To avoid specific antibody through HLA matching is the key point for successful renal transplantation of HSP. Antithymocyte globulin (ATG) induction therapy combined with tacrolimus, mycophenolate mofetil therapy can decrease the rate of acute rejection and prolong graft survival.

Objective To investigate the expression of Bcl-2 associated athanogene 3 (BAG3) in cervical cancer tissues and cells and its role in epithelial mesenchymal transition (EMT) of cervical cancer.Methods (1) Cervical cancer samples were collected from September 2015 to March 2017 in the Qilu Hospital of Shandong University and Shangdong Provincial Hospital.While,50 normal tissues were collected from August 2015 to March 2017 in the Dezhou Municiple Hospital,which were obtained from patients with uterine mnyoma underwent hysterectomy and patients with cervical biopsy.Reverse transcription (RT)-PCR and western blot were used to detect the expression of BAG3 mRNA and protein,and their clinical significances were analyzed.(2) The expression of BAG3 mRNA and protein was detected using RT-PCR and western blot method in HeLa and SiHa cell lines and normal cervical epithelial cells.The experiment was divided into two groups,BAG3 small interfering RNA transfected group (st-BAG3) and the control group transfected with small interfering RNA (siRNA).Cell counting kit 8 (CCK-8) analysis was used to detect cell proliferation of two groups.Wound-healing and transwell assay were used to detect the migration and invasion ability of HeLa and SiHa cells.The xenograft model of cervical cancer in nude mice was used to observe the effect of BAG3 on tumor xenografts and the tumor-related biomarkers were tested by western blot.Results (1) The expression levels of BAG3 mRNA and protein in cervical carcinoma tissues were 1.20±0.15 and 1.10±0.16,which were significantly higher than that in normal cervical tissue,0.23± 0.04 and 0.29 ± 0.03 (both P＜0.01).The results showed that the expression levels of BAG3 mRNA and protein were significantly correlated with cervical carcinoma staging and lymph node metastasis (P＜0.05).However,its expression was not conrelated with the patient's age,pathological grade,and diameter of tumor (all P＞0.05).(2) Compared with normal cervical epithelial cells,the expression of BAG3 mRNA and protein levels in HeLa and SiHa cells were significantly increased (P＜0.01),the expression levels of BAG3 mRNA and protein in HeLa and SiHa cells transfected with si-BAG3 were significantly lower than that in control group (all P＜0.01).After post-transfected 72 hours,A value of HeLa and SiHa with transfection were significantly lower than those in control group [(0.88±0.08) vs (1.22±0.13),(0.92±0.09) vs (1.35±0.12);both P＜0.01].After post-transfected 24 hours,the migration level of HeLa and SiHa cells with transfection were significantly lower than those in the control group [(20.1±2.1)％ vs (58.6±5.6)％,and (21.1±2.1)％ vs (61.7± 5.4)％;both P＜0.01].The transmembrane cell number in HeLa and SiHa cells with transfection were 76± 11 and 71±8,which were significantly less than those in control group (131± 12 and 129± 14;both P＜0.01).After the inoculation into nude mice,tumor formation time of HeLa and SiHa cells with transfection were (9.5±0.5) and (10.5 ± 1.3) days,respectively,which were significantly longer than those in control group [(4.5±0.5) and (5.2± 1.1) days;both P＜0.05].Compared with those in the control group,the expression level of Slug,N-cadherin and matrix metalloproteinase-2 (MMP-2) protein in HeLa and SiHa cells with transfected in tumor tissues were significantly decreased (all P＜0.01),while the expression level of E-cadberin protein was significantly increased (P＜0.01).Conclusion BAG3 could be involved in the proliferation,migration and invasion of cervical cancer cells by affecting cervical cancer EMT,and BAG3 may be an effective target for the treatment of cervical cancer.

ObjectiveTo evaluate creatinine proficiency testing data by robust Z-score analysis.MethodsThe data were collected from three proficiency surveys of routine biochemical test in 2009,to which 1 179,1 169 and 1 168 laboratories participated respectively.Creatinine data were divided into Jaffe group and enzymatic group based on the analytical method used.The results tested by both methods were compared using Mann-Whitney test.The outliers were deleted using the TUKEY fence established by quartile values.The normality of raw data and trimmed data was tested using one-sample Kolmogorov-Smirnov test.The performance of the laboratories was assessed using robust Z-score,whose values were considered satisfactory when ｜ Z-score｜ ≤2,questionable when 2 ＜ ｜ Z-score ｜ ＜ 3 and unsatisfactory when ｜ Z-score ｜ ≥3.Results86.7％ results tested using Jaffe and enzymatic methods were not comparable.The raw data in all research groups were not normally distributed.After deletion of outliers,73.3％ trimmed data in most research groups were normally distributed.For the three proficiency tests in 2009,in Jaffe group,the satisfactory rates were 89.8％( 495/551 ),87.2％( 468/537 ) and 89.5％( 476/532 ) respectively,unsatisfactory rates were 3.3％ ( 18/551 ),6.5％ (35/537) and 4.5％ (24/532) respectively; while in enzymatic group,the satisfactory rates were 88.8％ (558/628),89.3％ (564/632) and 88.1％ (560/636) respectively,unsatisfactory rates were 5.6％( 35/628 ),5.2％ (33/632) and 6.6％(42/636) respectively.Conclusion It is reasonable to choose robust Z-score as a proficiency testing assessment index,because it avoids the influence of the outliers on evaluation results.

Objective To explore the feasibility and efficacy of desensitization protocol for highly sensitized renal transplant patients (HSP). Methods Thirty-five HSPs ( HLA class-Ⅰ panel reactive antibody ＞50 %), including 27 patients with a positive T and/or B cell cytotoxicity crossmatch (XM) and 8 patients with a negative T and B cell XM, received plasmapheresis plus intravenous immunoglobulin (PP-IVIG)treatment. Results The positive XM was rendered negative by PP-IVIG treatment in 25 of 27 (92.6 %)HSPs, and subsequent transplantation was performed. Two patients did not receive renal transplants due to persistent positive XM. In 25 patients receiving renal transplants, no hyperacute rejection occurred. There were 8 cases of acute rejection, including 5 cases of acute humoral rejection (AHR). All rejection episodes were reversed. During a follow-up period of 52 ± 26 months, the serum creatinine levels at 12th and 24th month were 112± 18 and 130 ± 38 mol/L respectively. The 1- and 3-year graft survival rate was 96. 0 %and 80. 0 % respectively. Conclusion The desensitization therapy by PP-IVIG is effective for HSP. High rate of AHR is the major defect of this protocol. The short-term graft survival rate after this protocol is acceptable but the long-term survival rate needs to be defined.

Objective To perform calibration verification for the blood glucose test in Hitachi and Olympus automatic biochemistry analyzers and present a method of calibration verification and evaluate the results.Methods The glucose test results were divided into two groups:Hitachi and Olympus groups according to the different analytical instruments.The calibration verification was performed following the current College of American Pathologists strategies.The slope and intercept of the calibration line were tested by one-sample t test and the percentage differences were calculated.The percentage differences were compared with allowable errors.If the slope and intercept had no statistically significant difference from 1 and 0 respectively and the percentage differences were within the limits of allowable errors,the calibration line was evaluated as verified 1 ; if the slope and intercept had no statistically significant difference from 1 and 0 respectively and at least one of the percentage differences exceeded the limits of allowable errors,the calibration line was evaluated as different 1 ; if the slope or intercept had statistically significant difference from 1 and 0 respectively and the percentage differences were within the limits of allowable errors,the calibration line was evaluated as verified 2; if the slope or intercept had statistically significant difference from 1 and 0 respectively and at least one of the percentage differences exceeded the limits of allowable errors,the calibration line was evaluated as different 2.Results In Hitachi group,verified 1,different 1,verified 2 and different 2 were 5.4％ ( 4/74 ),0.0％ ( 0/74 ),68.9％ ( 51/74 ) and 25.7％ ( 19/74 ),respectively.In Olympus group,verified 1,different 1,verified 2 and different 2 were 16.4％ (12/73),0.0％ (0/73),58.9％ (43/73) and 24.7％ ( 18/73 ),respectively.Conclusions The current College of American Pathologist strategies could be performed as a reasonable and feasible method for calibration verification.Most of participating laboratories ( 74.8％,110/147 passed the assessment of calibration verification.

Objective To investigate the epitope of HLA class I specific antibody in the serum of highly sensitized patients (HSP). Methods The specificities and epitopes of HLA class I specific antibody from 54 HSP were monitored continually by enzyme linked immunosorbent assay (ELISA). Results 90.7 % of HSP had public epitopes of HLA class I antibody. The common public epitopes were 163E, 142 145TTKH, 83R, 71 74AQTD, 127K, 163R, 163L, 41T, 62 66RNTRN and 41 45ASPRT. The public epitopes were stable in the course of continual monitoring, and it could reflect antibody spectrum more accurately than antibody specificity analysis. Conclusion Most HSP produce HLA class I antibodies in a fairly predictable fashion. These antibodies direct against a small number of high frequency public amino acid residues with high immunogenicity. Analysis of public epitopes of HLA antibodies is very useful to predict acceptable mismatches.

Objective To investigate the linearity on testing creatinine in various assay instntments,in order to evaluate creatinine testing ability of clinical laboratories. Methods Statistically standard linearity and nonlinearity were judged via polynomial regression analysis recommended by EP6-A guideline. The imprecision of analytical data were analyzed and the average deviation of best fitting curve from linearity were determined by Dr. Kroll's EP6-A extended methods. In accordance with the instruments used, the testing data were divided into four groups: Beckman LX (28 Labs), Beckman CX ( 14 Labs), Hitachi (62 Labs)and Olympus (72 Labs) groups. Results This research found that in samples analyzed by Beckman LX,Beckman CX, Hitachi and Olympus instruments, the imprecision ranged from 0. 30%-3.01%, 0.09%-3.46%, 0. 14%-4. 91% and 0. 17% -16. 44%, respectively. The imprecision in one laboratory in Olympus group exceeded the acceptable limit, while the imprecision in the remaining laboratories were precision for linear survey. The average deviations of best fitting curve from linearity ranged from 0%-2. 38%, 0%-2. 51%, 0% -5.46% and 0% -4. 66%, respectively. The linearity with statistical significance were 21.4% (6/28), 35.7% (5/14), 11.3% (7/62) and 18. 1% (13/72), respectively. The linearity with clinical significance were 78.6% (22/28), 64. 3% (9/14), 88. 7% (55/62) and 80. 6% (58/72), respectively.The percentages of laboratories whose creatinine testing met the linearity criteria were 100% (28/28),100% ( 14/14 ), 100% ( 62/62 ) and 98. 6% ( 71/72 ), respectively. Conclusion Majority of the laboratories involved in the linearity survey present good capability for creatinine testing.

Objective To study the relationship between neurodevelopment and early nutritional status of very low birth weight(VLBW)infants in NICU.Methods VLBW infants admitted to NICU of our hospital from January 2013 to December 2014 and received regular follow-up management at our high-risk infant outpatient clinic were retrospectively studied. All infantsˊdevelopmental quotient ( DQ) were evaluated at 3 months of corrected gestational age ( cGA) . DQ ≥130 was defined as excellent, 115-129 above medium, 85-114 medium, 70 -84 below medium and ≤69 abnormal. According to their DQ scores, infants were assigned into two groups, normal neurodevelopment group ( DQ≥85 ) and abnormal neurodevelopment group ( DQ<85 ) . Nutritional status during hospitalization between the two groups were compared.Results A total of 125 VLBW infants were recruited.At three months of cGA, 2 cases ( 1. 6℅) had excellent DQ score; 3 ( 2. 4℅) above medium; 63 ( 50. 4℅) medium;57 (45. 6℅) below medium. 68 cases (54. 4℅) in the normal development group and 57 (45. 6℅) in the abnormal group. The total energy intake, the proportion of enteral energy supply on 4 d, 7 d, 14 d after birth and amino acid supply on 4 d, 7 d were significantly higher in the normal neurodevelopment group than the abnormal group (P<0. 05). Comparing with the abnormal group, weight loss of VLBW infants in the normal neurodevelopment group was less; the time needed to reach birth weight and exclusive enteral nutrition in the normal neurodevelopment group was shorter. The differences were statistically significant between the two groups(P<0.05).Conclusions VLBW infantsˊearly nutritional status may influence their neurodevelopmental outcome.

Objective To observe the effect of abdominal obesity on lung function in the perioperative period of complete video-assisted thoracoscopic lobectomy.Methods Collected 36 cases of peripheral lung cancer and could complete video-assisted thoracoscopic lobectomy by access conditions,18 cases in abdominal obesity group who had body mass index (BMI) ＞ 35 kg/m2 and the waist circumference ＞ 95 cm on men the waist circumference ＞ 90 cm on women,18 cases in normal weight group who had BMI ＜ 25 kg/m2 and the waist circumference ＜ 85 cm on men the waist circumference ＜ 80 cm on women.All cases had complete video-assisted thoracoscopic lobectomy and lymph node dissection with 4 holes,and recorded the operation time,before and after operation had blood gas analysis and lung function,at the same time recorded the cases of complication after operation,compared the parameters in two groups.Results The blood gas analysis had no difference before operation,but after 12 h of operation,the arterial blood oxygen partial pressure (PaO2) declined and alveolar-arterial blood oxygen partial pressure difference(PA-aO2) increased in abdominal obesity group,while the PaO2 declined and arterial blood CO2 partial pressure (PaCO2),PA-aO2 increased compared with normal weight group(P ＜ 0.05).The forced vital capacity (FVC),forced expiratory volume in 1 second(FEV1) had statistical significance in two groups before operation(P ＜ 0.05),on the third day after operation,the abdominal obesity group to himself the FVC,FEV1,maximal voluntary rentilation (MVV),functional residual capacity (FRC),carbon monoxide diffusion amount (DLCO) declined obviously except FEV1/FVC (P ＜ 0.05),compared with normal weight group,the FVC,FEV1,FRC,DLCO declined obviously (P ＜ 0.05).After operation,the lung function in abdominal obesity group,the FVC,FEV1,MVV,FRC,DLCO declined 25.8％,27.8％,20.4％,32.1％,39.1％,compared with normal weight group the FVC,FEV1,FRC,DLCO declined 31.8％,37.2％,30.2％,30.6％.The abdominal obesity group had more complication.Conclusion In the perioperative period of complete video-assisted thoracoscopic lobectomy,the abdominal obesity has more effect to lung function and must have more attentions on it,and effective weight control has important significance to operation patients.