Objective To explore the clinical significance of APACHE Ⅱ score on risk stratification in patients with acute myocardial infarction.Methods One hundred and forty-two patients with acute myocardial infarction were included in the study who were admitted to hospital consecutively from Jan.2011 to Dec.2012.High risk group and low risk group were divided by the APACHE Ⅱ score.Some clinical variables at the first 24 h after admitted to hospital and occurring during the following 1 year were recorded Results The age in high risk group was 78.9 ±8.1,significantly higher than that in low risk group (65.8 ± 10.2;t =6.835,P ＜ 0.001).The cases with Killip Ⅲ and Ⅳ in high risk group were 10(29.4％) and 2(1.8％),lower than in low risk group (6 (1.8％) and 0 (0％) ; x2 =21.950,15.777 ; P ＜ 0.005).The level of creatine kinase-MB (CK-MB) and cardiac troponin Ⅰ in high risk group were (147.7 ±21.5) U/L and (105.5 ± 17.6) U/L,higher than in low risk group((105.5 ± 17.6) U/L,(42.9 ± 6.3) U/L; t =11.541,5.785 ; P ＜ 0.001).The incidence of severe cardiac events(malignant arrhythmia,heart failure,non fatal myocardial infarction and death from any cause in high risk group were 58.8％ (20/34),47.0％ (16/34),17.6％ (6/34) and 17.6％ (6/34),higher than in low risk group (29.6％ (32/108),3.7％ (4/108),6.4％ (7/108) and 6.4％ (7/108) ; x2 =8.274,36.665,3.876 and 3.876 ; P ＜ 0.05).Conclusion APACHE Ⅱ score is likely to be a simple and practical tool for risk stratification in patients with acute myocardial infarction.

Background and purpose: Unbalance of apoptosis regulation plays an important role in tumor initiation and progression. Survivin and caspase-3 all take part in the regulation of cell cycle and apoptosis. The expressions of survivin and caspase-3 were detected in the tissues of gastric cancer to explore their association with the carcinogenesis of gastric cancer. Methods: The expressions of survivin and caspase-3 in 79 cases of gastric cancer and 30 cases of adjacent were detected by using reverse-transcription PCR (RT-PCR) and immunohistochemistry. Results: The expressions of survivin mRNA and caspase-3 mRNA were significantly related with the depth of invasion, lymph-node metastasis and TNM stage (P<0.05). The expressions of survivin mRNA and caspase-3 mRNA had significantly differences in gastric cancer (P<0.01). Conclusion: Survivin and caspase-3 are both important factors that cause tumorigenesis of gastric cancer, while survivin may promote the progression of gastric cancer through inhibiting the expression of caspase-3.

BACKGROUND: MyoD gene is one of family members of muscle transcription factors. Transfection MyoD gene can switch on the procedure of differentiation of muscles, and transit non-muscle cells into muscle cells.The MyoD gene only expresses in skeletal muscles. Based on the same contractive structure in myocardial cells and skeletal muscle cells, it is imagined that the conversion from exogenous MyoD gene-induced fibroblast in local myocardium into skeletal muscle cells that had contractive function may become another method in the treatment of congestive heart failure on clinic.OBJECTIVE: To construct and identify a recombinant adenoviral vector carrying MyoD gene for further studies on the recovery function of MyoD gene in myocardial injury.DESIGN: Single sample experiment.SETTING: Department of Cardiology, First Affiliated Hospital, Nanjing Medical University.MATERIALS: The experiment was conducted at the Laboratory of Microbiology and Immunology, Nanjing Medical University between September 2004 and September 2005. MyoD gene and non-replicating form expressive vector of adenovirus were taken as research materials.METHODS: MyoD cDNA fragments were extracted from plasmids pEMSV-MyoD with polymerase chain reaction (PCR), and PCR was used to clone the whole-length gene of MyoD. After adding CACC sequence at 5' end, MyoD gene was cloned by orient topology into transfer ventor, pENTR/D-TOPO. Objective gene was transferred into adenoviral expression vector DNA via pENTR/D-TOPO vector. The recombinant adenoviral vectors transfected into HEK293A cells by using lipofectamine were packaged and amplified.MAIN OUTCOME MEASURES: Evaluation of PCR and DNA sequencing were used for confirming the size of segment and correctness of rank of MyoD cDNA and detecting the titre of virus.RESULTS: MyoD recombinant adenovirus contained target segment with precise length confirmed by PCR and DNA sequence that was correct. The titre of virus was 1.3×1011 pfu/mL.CONCLUSION: The recombinant adenoviral vector carrying MyoD gene is constructed successfully.

ObjectiveTo evaluate prognostic factors and the surgical results of pulmonary carcinoid tumors.Methods We retrospectively reviewed the medical records of 62 patients who were diagnosed as pulmonary carcinoid tumors between January 2000 and October 2010 at Department of Thoracic Surgery,Shanghai Chest Hospital.The following information was available for each of the 62 patients:age,sex,pathological type,and TNM stage.ResultsThere were no operative death.The 3-year and 5-year survival rates after surgery were 92.1％ and 77.8％,respectively.Of the 62 patients,42 were diagnosed as typical carcinoid tumor,and among them,4 patients (8.3％) had lymph node metastases.Their 3-year and 5-year survival rates were 97.8％ and 94.7％,respectively.The remaining 20 patients were diagnosed as atypical carcinoid tumor,and among them,6 patients (37.5％) had lymph node metastases.Their 3-year and 5-year survival rates were 84.4％ and 58.8％,which were statistically significant compared with typical carcinoid tumor( P =0.0047 ).There was significant difference in survival rate between the patients with lymph node metastases and the patients without lymph node metastases (P =0.0048).CondusionThe main risk factors affecting survival rate of those patients who were diagnosed as pulmonary carcinoid tumors were pathological types and lymph node metastases.

This paper presented the conventional methods for signal detection of adverse drug reactions (ADRs) and their applications, the research progress in ADRs signal mining based on healthcare big data, and briefed the methods and uses of ADRs prediction using machine learning technology in the era of healthcare big data.The conclusion was that deep learning, as a fast growing tool in machine learning, will become hotspot of research, expected to help with ADRs signal mining and rational clinical drug use.

Objective Refractory constipation,when complicated with megacolon,is difficult to manage.This study aimed to compare the clinical outcomes of different preoperative nutritional therapies on refractory constipation patients complicated with megacolon.Methods Patients of refractory mixed constipation complicated with megacolon receiving surgical interventions between 2006 Jun and 2011 Jun were enrolled.Perioperafive nutrition support was evaluated in terms of postoperative recovery.Results 78 constipation patients received therapies of NPM,gastrointestinal decompression and total parenteral nutrition during the first 7-14 days.34 patients retained intestine patency and after 2 weeks of enteral nutrition therapy,they (enteral nutrition group) successfully received selective surgery.The other 44 patients (non-enteral nutrition group) received emergency surgery after correcting homeostasis.The surgical procedures included Jinling procedure (n =45),Jinling procedure plus ileostomy (n =6),total colectomy plus ileum-rectum side-to-side anastomosis (n =18) and total colectomy plus ileostomy (n =9).EN group patients had a significant low rate of pneumonia (0％ vs 11.4％),anastomotic leakage (0％ vs 11.4％),anastomotic bleeding (2.9％ vs 18.2％) and ostomy (0％ vs 34.1％),compared with N-EN group.At one month follow up,the nutrition status was significantly better in EN group than that in N-EN group.Condusions Refractory constipation complicated with megacolon required surgical intervention.Recovering the intestinal patency and receiving enteral nutritional support therapy preoperatively benefits patient's recovery.

Recently,as the exposure of the incident of‘octuplet’in Guangdong province,China's underground surrogate market has once again surfaced and led to a wide range of discussion.In this paper,the connotation and characteristics of surrogacy were analyzed and related laws and regulations of surrogacy in foreign countries were discussed.The main types of surrogacy-related legislation and regulations abroad are autonomy of private law,governmental regulation and complete prohibition.This paper carried out thorough legal analysis on whether to prohibit strictly or establish an authoritative legal system in view of the existing and ineffectively prohibited underground surrogate market in our country.

Objective To explore the pulmonary function,DVH and radiation pneumonitis after three-dimensional conformal radiation treatment ofⅢphase non-small-cell lung cancer.Methods 71 pa- tients (male 52,female 19,median age 63,KPS≥80) were evaluated by pulmonary function tests before radiotherapy and in M1 and M3 after radiotherapy respectively.After 3 months of follow-up time,it reviewed the appearance and grade of radiation pneumonitis.Then V_(20),V_(30) and MLD were worked out from dose vol- ume histogram.Results All patients completed radiotherapy,and total dose was 66-70 Gy.FVC (L), FEV1 (L) and CLCO were (2.58?0.65) L,(1.85?0.58) L and (15.15?4.65)ml/(min)before radio- therapy,with (2.96?0.76) L,(2.13?0.65) L and (14.71?3.92) ml/(min) in Ml after radiotherapy, with (2.65?0.61) L,(1.92?0.52) L and (13.15?3.71)ml/(min)in M3 after radiotherapy.The ac- cidence of radiation pneumonitis was 30%,moderate and severe radiation pneumonitis was 7%.With V_(20), V_(30) and MLD increasing,the grade of radiation pneumonitis was increasing.V_(20),V_(30) and MLD were related to the change in CLCO value among before,M1 and M3 after radiotherapy,and the correlation coefficient was more than 0.2.Conclusions There is a relationship in the pulmonary function,DVH and radiation pneu- monitis surely.The change in C_LCO value between before radiotherapy and M1 after radiotherapy could pre- dict the radiation pneumonitis.V_(20),V_(30) and MLD are not only correlated to radiation pneumonitis evidently but the change in FEV_1 and C_LCO after radiotherapy.

Objective To summarize the experience of the therapy and diagnosis of thoracictuberculosis. Methods Diagnosis and operation of 163 cases of thoracictuberculosis were analyzed.Results 163 cases of thoracic- tuberculosis were treated with focuspurge upon two weeks' anti-tuberculosis treatment.153 cases were cured upon one operation.10 cases suffered incision delayed healing and there were no recurrence cases.Conclusion Thoraeictu- berculosis was treated with focuspurge upon two weeks anti-tuberculosis treatment before operation.Complete purge of focus and postoperative compression band and residual cavity filled with music flap were important measures to prevent incision delayed healing and recurrence.

0.05).In simple obesity group,there was positive correlation between BMI and urinary 24 h-Alb content(r=0.626,P