Objective To investigate the risk factors related with postoperative complications following radical gnstrectomy for gastric cancer in cirrhotic patients. Methods In this study, 1474 cases underwent radical gastrectomy for gastric carcinoma in the past six years and the postoperative complications were retrospectively reviewed. The risk factors related with postoperative complications of cirrhotic patients were analyzed by Logistic regressive analysis. Results The postoperative morbidity rates of the 2 groups with or without liver cirrhosis were 51.22% and 23.94% (X2 = 15.955, P<0.01), and the mortality rate was 7.32% and 0.91% (P = 0.009), respectively. The main complications of the group with liver cirrhosis were postoperative aseites (5 cases), hepatic failure (4 cases), wound infection or dehiscence (4 cases), intra-abdominal infection (4 cases), etc, and three patients in the group died from extensive bleeding, jejunal fistula and hepatic failure respectively. Univariate Logistic analysis revealed that age (OR = 1.277, 95% CI:0.991 ～ 1.646), preoperative nscites (OR = 20.900,95% CI: 2.349 - 185.933), the albumin level (OR =0.160,95% CI:0.041 ～ 0.629), Child classification (OR = 9.500,95% CI: 1.046 ～ 86.261), portal hypertension (OR = 4.000,95% CI: 1.057 ～ 15.138), esophageal variees (OR = 4.400,95% CI: 1.095 ～ 17.676), transfusion (OR =3.714,95% CI: 1.021 ～ 13.511) and blood loss (OR = 1.442, 95% CI:1.023 ～ 2.034) were the main factors associated with postoperative complications of the group with liver cirrhosis. Muhivariable Logistic analysis showed that preoperative ascites (OR = 19.213,95% CI: 1.569 ～ 231.255), Child classification (OR = 12.661,95% CI: 0.721 ～ 222.458), esophageal varices (OR =6.008,95% CI:0.857 ～42.097) and blood loss (OR = 1.574,95% (7,1:0.938 ～ 2.640) were the independent risk factors. Conclusion Gastrectomy for gastric carcinoma in cirrhotic patients engenders considerably high postoperative mortality and morbidity. Preoperative ascites, Child classifation, esophageal variees and intraoperative blood loss were factors closely related with postoperative complications.

Objective To evaluate the effect of ulinastatin on the expression of aquaporin-4 (AQP4) during focal cerebral ischemia-reperfusion (I/R) in rats.Methods One hundred and thirty-five male adult SpragueDawley rats,weighing 230-280 g,were randomly divided into 3 groups (n =45 each):sham operation group (S group),I/R group and ulinastatin group (group U).The rats were anesthetized with intraperitoneal 10％ chloral hydrate 3.5 ml/kg.Focal cerebral ischemia was induced by 2 h middle cerebral artery occlusion followed by 24 repeffusion.In U group,ulinastatin 100000 U/kg was injected immediately after beginning of reperfusion,while the equal volume of normal saline was injected in S and I/R groups.The rats were sacrificed at 6,24 and 48 h of repeffusion and brains were removed for determination of infract volume (by TTC),brain water content and expression of AQP4 (by immunohistochemistry) in brain tissues.Results Compared with S group,the infarct volume and brain water content were significantly increased,and the expression of AQP4 was up-regulated at each time point in I/R and U groups (P ＜ 0.05).Compared with I/R group,the infarct volume and brain water content were significantly decreased,and the expression of AQP4 was down-regulated at each time point in U group (P ＜0.05).Conclusion The mechanism by which ulinastatin mitigates focal cerebral I/R injury is related to down-regulation of AQP4 expression in brain tissues.

Objective To study the effect of teaching methods of question type and discussion type that are adopted during the clinical probation of hematology. Methods 200 students of 5-year system of clinical medical of zhongshan medical college of Sun Yat-sen University were sclected to use the teaching methods of question type and discussion type during the clinical probation of hematology. Results It displayed that the probation teaching methods of question type and discussion type received good evaluation from the students, and obtained good probation effect. Conclusions The problem-based teaching methods evoked and guided the students proceeding transversal and lenth clinical wise; The case discussion elevatered the students’ ability to resovle practical problems with theoretical knowledge.

Objective To investigate the expressions and clinical significanees of suppressors of cytokine signaling-1 (SOCS-1) and SOCS-3 in myocardium of patients with sudden cardiac death (SCD). Method This study included myocardial autopsy specimens of 24 patients admitted between 2005 and 2006. Of them, 9 cases had the findings of autopsy examination consistent with coronary atberosclerosis (non-myocardial infarction) leading to SCD (non-MI group), 7 patients died of acute myocardial infarction (MI group) and 8 patients died of traffic accidents and trauma The expressions of SOCS-1 mRNA and SOCS-3 mRNA in the myocardium of non-MI and con-trol group were detected by using RT-PCR. The levels of SOCS-1 protein and SOCS-3 protein were detected by us-ing immunohistochemistry. Statistical analysis were performed by using SPSS version 13.0 software and the data were processed with ANOVA test. Results The expressions of SOCS-1 mRNA and SOCS-3 mRNA in non-MI and MI groups were were significantly higher than those in control group (0. 788±0. 101) and (0. 741±0.111) vs.(0.436±0.044) (P <0.01); (0.841±0.092) and (0.776±0.070) vs.(0.454±0.076), P <0.01, re-spectively). The antibody-positive cells of SOCS-1 protein in myocardium of non-MI group and MI group were significantly higher than those in myoeardium of control group (320.00±48.48) and (347.14±70.88) vs.(42.50±10.35) (P < 0.01), respectively. The antibody-positive cells of SOCS-3 protein in myoeardium of non-MI group and MI group were significantly higher than those in myocardium of control group (381.11±59.25) vs.(40.00±10.69), (P < 0.01)and (332.86±111.91) vs. (40.00±10.69), (P =0.001). Conclusions The expressions of SOCS rnRNA and SOCS-3 mRNA in myoeardium of patients with SCD from coronary diseases are significantly increased contributing to the pathogenesis of SCD.

Objective To investigate the influencing factors for knowledge,attitude and practice(KAP)of the Three-manager mode about hierarchical medical system of Chronic diseases of the community residents in Xiamen,and provide references for the implementation of hierarchical medical system.Methods Multi-stage random sampling method was adopted,and 400 residents were randomly sampled from 5 communities of Xiamen for questionnaire survey.The survey features the dependent variable of the community residents′ knowing and joining-in the Three-manager mode,the internal factors(social demographic characteristics),and the external factors(medical expenditure and healthcare insurance).On such basis,four logistic regression models were built for analysis of such influencing factors.Results 41.10% of the surveyed were aware of the Three-manager mode,and 39.71% of the hypertension/diabetes patients among them joined in the hypertension network or diabetes network.Age,education,medical expenditure and referral experiences were significant influencing factors for KAP level of the Three-manager mode,while the residents of older age,higher education and referral experiences were high in their KAP;those of lower per capita monthly income,hypertension or diabetes,with coverage of medical insurance and satisfied with medical consultation in community were high in their awareness of Three-manager mode.Conclusions The KAP level of Three-manager mode of the community residents in Xiamen is acceptable,yet expected of further improvement.Room of further improvement includes enhancement of synergy of the Three-manager mode,enhanced motivation of government financial support and medical insurance,better service functions of community institutions,and especially the construction of hierarchical medical system.

Objective To find the key miRNA that relative to peritoneal fibrosis associated with peritoneal dialysis (PD) by microarray technology,and verify its expression in vitro and in vivo.Methods The peritoneal fibrosis mouse model associated with PD were established by intraperitoneal injection of lipopolysaccharide (LPS)+ 4.25％ peritoneal dialysate.The expression of miRNA was detected by microarray in peritoneal tissues.The expression of miRNA profiles between fibrotic and normal peritoneal tissues was compared.The differentially expressed miRNA (miR-200a) was validated by real-time PCR in lager sample size cohorts.The expressions of miR-200a were also detected in the epithelial-mesenchymal transition (EMT) process of human peritoneal mesothelium cells.Results In mice model of PD,peritoneal tissue was markedly thickened and with a massive extracellular matrix accumulation.In contrast with control,the expression level of epithelial marker E-cadherin was significantly decreased,α-SMA,Col-Ⅰ and FN were remarkably increased (P ＜ 0.05).By miRNA microarray analysis,miR-200a was significantly down-regulated (3.31 folds change,P ＜ 0.05) in fibrotic peritoneal tissues.The down-regulated expression level of miR-200a was also validated by realtime PCR in larger cohorts (P ＜ 0.05).Then,the expression level of miR-200a was detected in the EMT process of human peritoneal mesothelium cells.During the process of TGF-β1 induced EMT,miR -200a was significantly down-regulated compared with the control (P ＜ 0.05).Conclusions Downregulated expression of miR-200a was observed both during peritoneal fibrosis and TGF-β 1 induced EMT in vivo and in vitro,suggesting that miR-200a may be involved in the peritoneum fibrosis by regulating the target genes of EMT.

Objective: To investigate the influence of fast tract surgery on the humoral immunity and the chief clinical index of gastric cancer patients.Methods: 56 patients with gastric cancer from December 2007 to June 2008 were randomly divided into two groups: experiment group(fast tract surgery group, n=28)and control group(conventional treatment group, n=28 ). The changes of serum levels of humoral immunity and the chief clinical index were analysed and compared.Results: The serum levels of humoral immunity in both group were decreased. The serum levels of C3 and C4 on the postoperative 1st day were(0.845±0.126)g/L and(0.212±0.070)g/L respectively(P<0.05) in FTS group.The serum levels of IgA, IgM and IgG on the postoperative 3rd day were(1.603±0.468)g/L,(0.845±0.187)g/L,(9.548±1.920)g/L respectively(P<0.05) in FTS group. The duration of antibiotic use, first passage of flatus, the lengh of hospital stay, the occurance of postoperative complications in FTS group were also significiantly lower than those in control group (P<0.01, P<0.05).Conclusion: Fast tract surgery affectes on the humoral immunity of gasrtic cancer patients, and it might contribute to the improved outcomes of postoperative patients.

Objective To evaluate the therapeutic efficacy of a combination of proton pump inhibitor(PPI) and hydrotalcite for endoscopic submucosal dissection (ESD) induced ulcer.Methods Eightyone consecutive patients who underwent ESD were randomly assigned to either the group of PPI and hydrotalcite therapy ( drug combination group,n =41 ) or the PPI group ( n =40).Delayed bleeding rates were monitored and compared.The main upper abdomen symptoms 1-wk later and ulcer healing rates and ulcer diameter 4-wk later were compared between the two groups.Results There was no significant difference in delayed bleeding rate (P ＞ 0.05 ).At the end of first week after ESD,the combination therapy was significantly more effective than the PPI alone in reducing frequencies and severity of upper abdominal pain and upper abdominal distention,while there was no significant difference between the two groups in relieving belch and nausea.A better ulcer healing rates and a smaller ulcer diameter were observed in the combination group at the end of 4 weeks ( P ＜ 0.05 ).Conclusion The combination therapy of hydrotalcite and PPI can relieve upper abdominal symptoms and improve the healing rate of ESD induced ulcer.

Objective To investigate the current status of type 2 diabetic patients who failed to achieve the glycemic control target, and provide theoretic evidences for making corresponding strategies. Methods The 2 diabetic patients who failed to reach the glycemic target were recruited from 181 hospitals in 26 cities and received a standard questionnaire, the conditions of their blood glucose level, lifestyle intervention, blood sugar monitoring, and drug therapy were recorded. Totally 3 861 questionnaires with complete information were collected. And the causes which account for glycemic control status were analyzed. Results Among these patients, the mean HbA1c was 7.9%, the mean fasting plasma glucose was 8.2 mmol/L, and the mean postprandial plasma glucose was 11.5 mmol/L. Only 25.6% of patients take their diet control strictly as prescribed and 44. 5% of patients have little exercise. 35. 8% and 47.8% of patients did not monitor their fasting and postprandial plasma glucose,respectively. Glycemic control in the patients aged ＞ 60 years was similar to the younger patients, but the hypoglycemia incidence in the elder group reached 35.5%, which was higher than those in the other 2 groups (20.8% and 21.4%, both P＜0. 05 ). The proportion of patients with mono-therapy and combination therapy was 46. 1% and 51.7%, while the proportion with combination therapy rose in the patients aged ＞60 years (58.7%;Compared with the other age-groups, all P＜0.05 ). 75 % of patients have adjusted their drug administration regimen since initial treatment. Conclusions Inadequate or inappropriate drug therapy regimen is a major cause responsible for this poor glycemic control status. In addition, the unhealthy life styles, insufficient blood sugar monitoring, and poor compliance were also important causes. Thus, for these patients, it is necessary to further enhance patients' education, to improve life style intervention, as well as to select more effective, safer, and compliant drug therapy regimens. Finally, the glycemic control target for the elder patients should be more flexible.

Objective A previously reported female diagnosed with type A insulin resistance syndrome bearing a heterozygous missense mutation of R1174W in the insulin receptor gene was followed for 7 years since the age of 16 years. Methods Five-hour oral glucose tolerance tests (OGTT) were done on baseline, the 3rd, 6th and 7th year respectively, with serum insulin and C-peptide measured at the same time points. Areas under of curve (AUC) of glucose, insulin and C-peptide were compared between the years.Acute insulin response (AIR) was determined at baseline and the 7th year. The dose response were insulin secretion rates at each time point during OGTT being plotted over the corresponding glucose levels, and the slopes of which quantified the insulin secretion responding to glucose. Results The follow up data showed that the glucose metabolism of the subject did not deteriorate over time with yearly glycosylated hemoglobin A1c (HbAlc) being normal (4.6%-5.5%), and hyperinsulinemic hypoglycemia was a persistent phenomenon observed at 4-5 hours post-load. The fasting and AUCs of serum insulin and C-peptide tended to decline without simultaneously increase of those of plasma glucose. The AIR decreased by 56% as compared to baseline. The dose response curves shifted downward as years went by. Conclusions It supports that with the alleviation of physiological insulin resistance after puberty, the gross hyperinsulinemia tends to ameliorate, and β-cell secretion does not deteriorate over time as glucose homeostasis maintains.