Imbalance of energy metabolism is a major cause for metabolic syndrome. AMP-activated protein kinase AMPK is a central component of a protein kinase cascade that plays a pivotal role in the regulation of intracellular energy status.AMPK activity is a response to the ratio of AMP/ATP in the cell.When a stress causes an inhibition of ATP production or an increase of ATP consumption,cellular AMP/ATP ratio increases,AMPK is activated.Once activated,AMPK initiates a series of responses to restore the energy balance within the cell.AMPK switches on catabolic pathways,such as fatty acid oxidation and glycolysis,to generate ATP,and switches off anabolic pathways,such as fatty acid synthesis and protein synthesis,to reduce ATP-consumption.Therefore,AMPK functions in an ideal position not only as an energy sensor at cellular level,but also as a pivotal player in the regulating pathways that control both energy expenditure and energy intake,in particular by mediating the effects of hormones and cytokines such as leptin,adiponectin and ghrelin.The recent finding that anti-diabetic drug metformin and TZD regulates glucose metabolism through the activation of AMPK suggested a possible role of AMPK in protecting the body from metabolic diseases such as metabolic syndrome,obesity and type 2 diabetes.Thus,further work in this field in the next several years will be necessary in order to fullyunderstand the role of AMPK in regulating the balance of energy storage and expenditure in different tissues and at the whole body level.Targeting to AMPK cascade would also have potentially pharmaceutical application for obesity and metabolic syndrome.

Objective To observe the parameters of echocardiography in persistent pulmonary hypertension of the newborn(PPHN),and to discuss the influence of persistent pulmonary hypertension on cardiac geometry and left ventricul ar function.Methods 25 cases with PPHN were selected,including 11 mild,9 moderate,and 5 severe cases.Another 23 cases of neonatal jaundice were selected as control group.The left atrium diameter(LAD),left ventricular end diastolic diameter (LVDd),right ventricular end diastolic diameter (RVDd),right atrium diameter (RAD),left ventricular posterior wall thickness (LVPW),interventricular septum thickness (IVS) were measured by echocardiography.The results of echocardiography were analyzed.Results Compared with the control group,the RVDd and RAD of PPHN group were significantly increased,RVDd and RAD dilated with the increasing of pulmonary artery systolic pressure in PPHN group (t =2.53,7.09,2.14,4.77,2.88,2.04,4.59,7.12,2.34,5.12,3.07,all P ＜0.05) ;LVDd decreased in severe group (14.80 ±2.16) mm compared with that in the control group (15.26 ±1.83) mm,mild (16.55 ± 1.50) mm and moderate group (15.67 ± 1.87) mm(t =3.76,4.80,3.74,all P ＜ 0.05).Conclusion Echocardiography is one of the most important method to diagnose PPHN,and can be observed in newborns with non-invasive cardiac changes directly.lt has important value in judgement of severity degree,and provide a reliable basis for clinical diagnosis and treatment.

Objective To explore the nursing strategies for preoperative ventilator-dependent patients undergoing discontinuing mechanical ventilation after lung transplantation.Methods The clinical data and nursing experiences of 10 preoperative ventilator-dependent patients undergoing discontinuing mechanical ventilation after lung transplantation from September 2002 to December 2008 were retrospectively analyzed.Results The time of discontinuing mechanical ventilation ranged from 7 to 30 days and the average time was 16.5 days.Conclusion The key points to ensure the success of discontinuing mechanical ventilation were careful observation of ventilation modes,preparations before discontinuing,airway management,nutritional support and psychological nursing.

Objective To investigate the effects of intrathecal different doses of dexmedetomidine hydrochloride in spinal block by ropivacaine hydrochloride . Methods Forty lower limb surgery scheduled for elective under spinal anesthesia, were randomly divided into 2 groups (n = 20 each): the control and the treatment groups.The control and the treatment group were intrathecally injected with 4,12 μg dexmedetomidine hydrochloride respectively.The 0.75% ropivacaine hydrochloride 1.5 mL was injected for spinal anesthesia.SBP,DBP,HR,SpO2 and Ramsay Sedation Score were recorded before the spinal anesthesia conduct and thereafter every five minutes. And the onset and duration of block were recorded,adverse reaction like nausea, vomiting and respiratory depression were also observed. Results Compared with the control group,the onset of sensory block was shorter [(6.9±2.6) min vs (8.7±2.9) min] (P<0.05),and the duration of sensory and motor block was longer in the treatment group[(130.8±30.1) min vs (115.9±23.9) min] (P<0.05) and [(145.9±29.0) min vs (130.0±30.1) min] (P<0.05). Conclusion Intrathecal dexmedetomidine hydrochloride at 12 μg improves anesthesia via shortening the sensory block onset and prolonging sensory and motor block,which maintains hemodynamically stable,and does not generate adverse reactions as nausea,vomiting,bradycardia and respiratory depression.

0.05).Conclusion:The CT perfusion parameters can be regarded as a surrogate marker of tumor angiogenic activity,which is a useful method in estimating the degree of angiogenesis.

Objective To investigate the suitable mode of cognitive-behavioral therapy for lung transplant recipients during waiting for lung and evaluate the effect to improve patients' physical and mental state.Methods 50 cases were randomly divided into the experimental group and the control group,each group with 25 cases.The control group received conventional treatment.The experimental group received cognitive-behavioral therapy in addition to conventional treatment.SAS and vital signs were measured in the two groups on admission,2 weeks and 4 weeks after admission.Results The SAS score of the experimental group was lower than the control group 2 weeks and 4 weeks after admission and SAS score decreased as the intervention extended.The SBp of the experimental group was lower than the control group 4 weeks after admission.There was no significant difference of DBp between two groups.The heart rate of the experimental group was lower than the control group 4 weeks after admission.The heart rate of the experimental group was lower on 2 weeks and 4 weeks after admission than on admission.4weeks after admission,the respiratory rate of the experimental group was lower than the control group and on admission.Conclusions Cognitive-behavioral therapy can reduce the level of anxiety and keep vital signs stable with good feasibility and effectiveness.

Objective To investigate the practice and effect of specialist nursing inspection of intravenous infusion in the quality control of specialist nursing. Methods Intravenous infusion treatment nursing group used feed-forward control theory and methods, taking cross-sectional research methods yearly from 2014 to 2016 and referencing intravenous infusion special quality checklist to fully understand the hospital infusion tool selection situation and quality. Intravenous infusion related treatment system operational procedures was established and improved, the monthly quality control plan was made to do quality nursing of intravenous infusion specialist inspections and timely feedback of each month to various sections of the hospital. Results The rational choice of the hospital infusion tool was more reasonable. The proportion of steel needle in 2016 compared with in 2015 and 2014 was decreased by 8.9%(321/920-212/846), 18.8%(321/920-156/968). Intravenous infusion quality was significantly improved in the catheters′normative fix, nursing staffs′mastery of the skills and related expertise control rate, intravenous infusion treatment-related complications e.g. Phlebitis above grade two in 2016 were reduced 22 cases and 30 cases compared with in 2015 and in 2014, meanwhile the number was 18 and 31 in drug extravasation case. Conclusions Special nursing of intravenous infusion has a good effect on the improvement of nursing quality, and feed-forward control is an effective method for quality control of intravenous infusion therapy.

Objective To evaluate the value of MR threedimensional arterial spin labeling (3D-ASL) perfusion imaging and intravoxel incoherent motion(IVIM) DWI in differential diagnosis and quantitative analysis of musculoskeletal tumors.Methods Forty-four patients with musculoskeletal tumors were included.According to pathologic results,there were 12 cases of benign tumors,10cases of intermediate tumors and 22 cases of malignant tumors.3D-ASL and IVIM DWI were both performed on forty-four patients to gain tumor blood flow (TBF),standard ADC (ADCstandard),slow ADC (ADCslow)and fast ADC (ADCfast).Immunohistochemical staining of specimens was performed by using CD34 monoclonal antibody to calculate microvessel density (MVD) counts.MVD,TBF,ADCfast and ADCslow of different groups were compared by one-way ANOVA analysis.ADCstandard was compared by Kruskal-Wallis test.ROC curve was used to analyze ASL and IVIM DWI,in order to determine the threshold and diagnostic reliability.Results The MVD of benign tumors was 10±4,the MVD of intermediate tumors was 15±6,and malignant tumors was 33 ± 1 1.There was significant difference among three groups of MVD(F=28.33,P＜0.05).There was better intra-observer agreement for ADCstandard,ADCfast,ADCslow and TBF(ICC=0.970,0.885,0.778,0.891,respectively,P＜0.05).The TBF of benign tumors was(30±10)ml· min-1· 100 g-1,intermediate tumors was(30± 12) ml·min 1· 100 g-1,and malignant tumors was(84±29)ml·min 1· 100 g-1.There was significant difference among three groups of TBF(F=32.34,P＜0.05).According to the ROC analysis,when the cut-offvalue of TBF was 45.5 ml·min-1· 100 g-1,the area under ROC curve was 0.95 1,and the sensitivity and specificity of TBF in diagnosing malignant tumors were 90.9％ and 95.5％ respectively.There was no significant difference among three groups of ADCstandard,ADCfastand ADCslow of benign tumors were(9.9±5.1)× 10-3,(1.9±0.5) × 10-3mm2/s respectively.ADCfast and ADCalow of intermediate tumors were(8.2 ± 3.6) × 10-3,(1.5 ± 0.6) × 10-3mm2/s respectively.ADCfast and ADCalow of malignant tumors were (16.9 ± 5.8) × 10 3,(1.4 ± 0.6) × 10-3mm2/s respectively.There were significant difference of ADCfast and ADCslow among three groups (F=12.75,5.60,P＜ 0.05).According to the ROC analysis,when the cut-off value of ADCfast was 9.4× 10-3mm2/s,the area under ROC curve was 0.861,the sensitivity and specificity of them in diagnosing malignant tumors were 95.5％ and 68.2％ respectively.Conclusion 3D-ASL and IVIM DWI are valuable in the differential diagnosis of musculoskeletal tumors.

Objective To explore the relationship between the tumor angiogenesis index (microvessel density,MVD)and biological behavior of the tumor.To analyze the correlations between TBF,standard ADC,fast ADC,slow ADC and MVD counts.Methods From March 2013 to June 2013,a total of 40 patients were involved in the study.3D-ASL and IVIM DWI were both performed on patients with musculoskeletal tumors.TBF,standard ADC,slow ADC,fast ADC were measured by regions of interest.Immunohistochemical staining of specimens were performed by using CD34 monoclonal antibody to calculate MVD counts.Group differences in MVD were assessed by using one-way ANOVA.The correlations between TBF,standard ADC,fast ADC,slow ADC and MVD counts were evaluated using Pearson correlative analysis.Results The MVD of benign tumors was (10.38±4.58)/0.26 mm2,the MVD of intermediate tumors was (14.64±6.69)/0.26 mm2,and the MVD of malignant tumors was (32.97±11.61)/0.26 mm2.The differences of MVD among three groups were statistically significant (F=28.83,P＜0.05).The differences of MVD between benign and malignant group were statistically significant (P＜0.05),as well as intermediate and malignant group (p=0.000).There was a significant positive correlation between TBF and MVD (r=0.784,P=0.000),as well as the correlation between TBF and fast ADC(r=0.727,P=0.000).There was a moderate positive correlation between fast ADC and MVD (r=0.516,P=0.000).There were no significant correlation between slow ADC and MVD,or between standard ADC and MVD.Conclusion The MVD represents the angiogenesis of musculoskeletal tumors,reflecting biological behavior of the tumor.ASL and IVIM DWI can be applied to evaluate the angiogenesis of musculoskeletal tumors by reflecting MVD of musculoskeletal tumors in vivo as a completely noninvasive technique.

Objective To investigate the effect of at-RA in macrophage accumulation in tubulointerstitium of rats with renal tubulointerstitial fibrosis.Methods Unilateral ureteral obstructive(UUO) rat animal models were used for the study.40 SD rats were randomly divided into 5 groups: sham group,UUO group,benazepril group,low-dose at-RA groups and high-dose at-RA groups.The rats were under intragastric administration by benazepril(10mg/(kg?d)) in benazepril group,and by(at-RA)(10mg/(kg?d)) in low-dose at-RA group and 20mg/(kg?d) in high-dose at-RA group and by sodium chloride in tales doses in sham group and UUO group from the day before the operation to 14 day after operation.Immunohistochemistry staining of CD68 and Col Ⅲ was used to define the macrophage accumulation and expression of interstitial Col Ⅲ.The degree of tubulointerstitial damage was scored by HE and Masson staining.Results Tubulointerstitial macrophage infiltration were all significantly reduced by(at-RA) or benazepril treatment.They also improved the histological changes of UUO rats and inhibited interstitial colⅢ deposition.Conclusion Reduction of interstitial macrophage infiltration may be an important event by which(at-RA) or benazepril prevents renal injury caused by UUO.