Objective To explore the effect of miRNA‐106a(miR‐106a) expression on multidrug resistance(MDR)of gastric cancer(GC)cells and the involvement of runt‐related transcription factor 3 RUNX3.Methods The expression of miR‐106a was detected in two human gastric adenocarcinoma cell lines with MDR by immunoblotting and apoptosis assay. The sensitivity of GC cells to anticancer drugs was observed by detecting the expression of miR‐106a by using immunoblotting and PCR ,and the relationship between miR‐106a and RUNX3 was determined by luciferase activity assay.Results miR‐106a was significantly in‐creased in GC cells with MDR ,and it suppressed the sensitivity of GC cells to anticancer drugs. It could modulate MDR by tar‐geting RUNX3.Conclusion miR‐106a can induce the MDR by targeting RUNX3 in GC.

OBJECTIVE: To explore the needle insertion parameters of deep acupuncture at Baliao points for clinic and teaching. METHODS: A retrospective analysis of 100 cases of prone pelvic CT from January to June 2016 in Nanjing Hospital was carried out. The 3 D images were scanned with continuous 5 mm slice thickness. The optimum needle angle is defined as the angle of the needle along the central axis of sacral anterior and posterior hole, and the angle between the needle body and the skin surface and the center line of the body was observed. The effect needle depth is defined as the thickness of the sacral back soft tissue plus 1/2 sacral depth, to observe the best needle angle of deep acupuncture parameters of Baliao points. RESULTS: For deep acupuncture at Baliao, the oblique thorn method should be used with the needle-point toward the inner bottom. The best insertion angle between needle body and skin surface is: Shangliao(BL 31) (61.04±12.15)°， Ciliao(BL 32) (57.57±10.01)°， Zhongliao(BL 33) (58.25±8.69)°， Xialiao(BL 34) (54.39±10.94)°. The optimum angle of insertion between the needle body and the posterior midline of the human body is: BL 31 (24.54±6.21)°， BL 32 (18.58±7.76)°， BL 33 (17.36±7.90)°， BL 34 (30.73±9.45)°. The effective insertion depth show a decreasing trend: BL 31 (58.16±12.43) mm, BL 32 (44.57±11.55) mm, BL 33 (33.96±10.74) mm, BL 34 (31.13±10.94) mm. The effective depth is positively correlated with BMI, and has no correlation with gender and weight. CONCLUSIONS: The study of the parameters of needle insertion should be taken into account both clinical efficacy and safety, and CT three-dimensional reconstruction can accurately, rationally and scientifically perform acupoint anatomical measurements.

Objective To evaluate the clinical value of epicardial echocardiographic examination in cardiac valve surgery.Methods Epicardial echocardiography were performed in 46 patients undergoing valvular plasty or valvular replacement surgery to estimate the function of valve and left ventricle and residual shunt during cardiac surgery.Results Twelve cases of 46(26.1％)showed abnormality during cardiac surgery.Two cases of 15 patients performed valvuloplasty were changed to valvular replacement because of remarkable regurgitation of native valves.There was 1 case of periprosthetic leakage,3 cases of left atrial appendage thrombus,1 case of patent foramen ovale and 5 cases of low ejection of left ventricle in all 31 cases of valvular replacement.Conclusions Epicardial echocardiograpyc examination is an effective examination in cardiac valve surgery with clearly image,simplicity operation and promptness.

ObjectiveTo evaluate the intraoperative neuromonitoring of the external branch of the superior laryngeal nerve (EBSLN) during Micooli's endoscopic thyroidectomy in order to avoid nerve injury.MethodsIn this study,36 patients with 56 nerves at risk were enrolled from February 2011 to September 2011.A positive signal is determined by observing contractions of the cricothyroid muscle to locate the EBSLN.The relationship between EBSLN and the upper pole of the thyroid or the inferior constrictor muscle was studied.The VHI-10 table was used for evaluation pre- and postoperatively. ResultsAll 56 nerves were located successfully,26 nerves(46.4％ ) crossed the superior thyroid artery more than 1 cm apart from the upper pole of the thyroid gland,while the other 30 nerves(53.6％ ) did less than 1 cm.In cases where the diameter was longer than 5 cm,the nerves crossed the artery at less than 1.0 cm from the upper pole in 73％ cases(P =0.006).There was no significant difference between VHI-10 results before and after surgery (P ＞ 0.05). ConclusionsIntraoperative neuromonitoring is useful and helpful in avoiding nerve injury by locating EBSLN.

Objective To compare the clinical effects between uniportal video-assisted thoracic surgery (VATS) and 3-portal VATS lobectomy for patients with lung cancer. Methods Patients were divided into uniportal VATS lobectomy group (n=45) and 3-portal VATS lobectomy group (n=53). The clinical data were compared between two groups, including the oper-ation time, intraoperative blood loss, number of lymph node dissection, length of incision, postoperative extubation time, post-operative pain score and postoperative hospitalization. Results There were no significant differences in intraoperative blood lose (128.75±18.32) mL vs (129.15±17.69) mL, lymph node dissection number (13.33±1.05) vs (13.12±1.38), duration of chest drainage (4.90±0.75)d vs (4.75±0.70)d, duration of hospital stay (7.52±1.16)d vs (7.55±1.10)d and incidence of seri-ous postoperative complications between two groups (P>0.05). The incision length (5.36±0.22)cm vs (7.44±0.35)cm, numeric pain intensity scale including first day(6.47±0.54) vs (6.86±0.52),third day(3.59±0.29) vs (4.05±0.25), and patient satisfac-tion scores (91.03 ± 2.62) vs (88.35 ± 2.97) were significantly better in uniportal VATS group than those of 3-portal VATS group (P<0.05). The operation time (143.81±17.97) min vs(130.11±15.03)min was longer in uniportal VATS group than that of 3-portal VATS group (P < 0.05). Conclusion Uniportal VATS lobectomy is safe and reliable for patients with early-stage lung cancer, which has less surgical injury, slighter pain, and higher satisfaction than 3-portal VATS lobectomy.

Objective To study a scoring method for assessing function status of cardiovascular system quantitatively. Methods First, exercise heart rate variability (EHRV) was obtained from the primary dynamic electrocardiogram (ECG) recorded during exercise testing. Then appropriate entropy, relative complexity, and other three parameters extracted from poincare dispersed-dot plot were extracted from the EHRV. Discriminant analysis was used to classify two extreme groups.Results Based on the values of two groups from the discriminant formula, a scoring formula was proposed and four ranks were divided according to different score domains. A novel scoring method was established. To validate the proposed scoring method, 60 middle-aged hypertensives, 50 elder subjects and 110 young healthy subjects were examined and scored. Conclusion Scores of 220 subjects are consistent with their real health status. The proposed scoring method reflects the status of the subject's cardiovascular system effectively.

0.05),between the two groups,but in body mass index [(24.451?3.752) vs(22.468?2.434),P=0.030],previous history of pancreatitis(23.8% vs.7.5%,P=0.046) and bloody ascites(95.24% vs.46.24%,P0.05).MODS rate was higher in HL-group(52.4% vs.29%,P=0.04).The two groups had similar operation rates(66.7% vs 80.6%,P=0.178),hospitalization days [(25.476?14.383) vs(22.796?7.191),P=0.216] and mortality rate(28.6% vs.11.8%,P=0.069).Conclusions Hyperlipidemic severe acute pancreatitis has the characters of heavier weight habitus,history of frequent recurrence,high incidence of bloody ascites and prone to develop MOF.

Objective To evaluate the clinical value of breast localization needle placed via mammary ductoscopy in surgical treatment of patients with intraductal neoplasms. Methods In this study,76 patients with intraductal neoplasms diagnosized by mammary ductoscopy from January 2009 to March 2010 in the Second Affiliated Hospital of Soochow University were randomly divided into two groups.For methylene blue group,ducts with the lesion were marked by methylene blue injection before operation.For localization needle group,ducts were marked by localization needle placed via ductoscopy.The operative time,specimen weight,incision length and diagnostic coincidence rate were compared among the two groups. Results Compared to the methylene blue group,the localization needle group had a significantly shorter operative time (31 ± 8 min vs.42 ± 9 min),lighter specimen weight (1.51 ± 1.36 g vs.2.95 ± 2.07 g),and shorter incision (23.2 ± 7.8 mm vs.34.4 ± 7.1 mm).All the breast cancer cases dianosised by mammary ductoscopy were confirmed by postoperative pathology,but the localization needle group had a higher diagnostic coincidence rate than the methylene blue group (94.7% vs. 76.3%). Conclusion Localization needle under mammary ductoscopy is a reliable technique for localizing intraductal neolasms.The surgical excision guided by localization needle is accurate and less traumatic,and should be a routine method marking the tumor involved duct before operation.

Background Most anti-inflammation eyedrops are limited in clinical application owing to multiple adverse effects.A novel peptide GC31 derived from human thrombomodulin has a natural anti-inflammatory activity.Compared with conventional anti-inflammatory eyedrops,GC31 possesses more advantages and potential clinical transforming value.However,relevant study is still lack.Objective The purpose of this study was to evaluate the anti-inflammatory effect of GC31 and the possible mechanisms.Methods Sixty SPF male Wistar rats aged 8-10 weeks were randomized into 6 groups using randomized number table.Non-specific keratitis models were established in 40 rats by intrastromal injection of 10 μl of lipopolysaccharide (LPS) dissolved in PBS.Different doses of GC31 (125 μg or 250 μg) or dexamethason soluble in PBS were sunconjunctically injected in the experimental eyes respectively in the low dose GC31 group,high dose of GC31 group and the dexamethason group,and 10 μl of PBS was used in the same way in the PBS control group.No drug was injected in the model group,and the normal rats were employed as the blank control group.The corneas were examined by slit lamp microscope and were scored based on the criteria of Anand 24 hours after injection.Then the corneas were collected for histopathological examination.Expression of nuclear factor-κB (NF-κB) p65 in the corneas was detected using immunochemistry.Expressions of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) proteins were assayed using ELISA.Real-time PCR was used to detect the expressions of IL-6 mRNA and TNF-α mRNA.The use and care of the experimental animals followed Regulation for the Administration of Affair Concerning Experiment animals by State Science and Techonology Commission.Results A significant difference was seen in the ocular inflammatory scores among the six groups (F =301.238,P =0.000).The inflammatory scores were significantly lower in the high dose of GC31 group than those in the model group (1.85 ± 0.36 versus 2.90± 0.43) (t' =-5.144,P =0.000) ; and the scores in the dexamethason group was lower than those in the high dose of GC31 group(t' =-3.931,P=0.000).Infiltration of inflammatory cells in corneal tissue was milder in the high dose of GC31 and the dexamethason group compared with the model group.The positive response for NF-κB p65 was obviously weaker in the rat corneas in the low and high dose of GC31 groups and the dexamethason group in comparison with the model group.The contents of IL-6 and TNF-α proteins in the corneas were significantly reduced in the low and high dose of GC31 group and the dexamethason group compared with the model group (low dose group:t=-2.626,P=0.009;t'=-2.310,P=0.017.high dose group:t =-3.361,P=0.001 ;t'=-3.151,P=0.002),and the contents of IL-6 and TNF-α proteins in the dexamethason group were lower than those in the high dose of GC31 group (t=-3.361,P=0.001;t'=-3.360,P=0.000).In addition,the expression trend and compared results of IL-6 mRNA and TNF-α mRNA among the groups were similar to those of the IL-6 and TNF-α proteins (all at P＜0.01).Conclusions GC31 suppresses LPS-induced corneal inflammation response by downregulating the expression of inflammatory eytokines.The effect is more dominant in the doses of 250 μg than that in the doses of 125 μg.

Clinical internships play an important role in higher medical education. According to the new standards in undergraduate medical education set by the MOE and MOH,we identified 4 main problems in our internships training,including lack of awareness of career planning,interns'absence from duty,lack of hands-on opportunities,psychological problems,etc. According to these problems,we carried out a series of solutions such as strengthening intern orientation,especially in aspects of professionalism and clinical skills training,optimizing the rotation schedule and improving the evaluation methods etc. Experiential evidence and perceptions of interns and their tutors showed that these changes were effective.