Objective To investigate the effect of globular adiponectin on the high expression of monocyte chemotactic protein-1 (MCP-1) induced by high glucose in rat renal tubular epithelial cells (NRK52E),and its relationship with adiponectin receptors and p38MAPK.Methods NRK52E cells were cultured in vitro and divided into six groups:normal glucose group (NG,5.6 mmol/L glucose),high glucose group(HG,25 mmol/L glucose),gAd groupl (HG+gAd 2 mg/L),gAd group2 (HG+gAd 5 mg/L),gAd group3 (HG+gAd 10 mg/L),p38MAPK antagonist group:(SB,HG+SB203580 10 μmol/L).The protein expression of phosphorylated p38MAPK (p-p38MAPK),total p38MAPK (t-p38MAPK),MCP-1 and AdipoR1/AdipoR2 were examined by western blotting.The mRNA expression of MCP-1 and AdipoR1/AdipoR2 were detected by RT-PCR and real-time PCR respectively.Results Compared with NG group,the mRNA and protein expression of MCP-1 increased significantly in HG group (all P＜ 0.05).The phosphorylation of p38MAPK increased (P＜ 0.05) with no change in t-p38MAPK protein.The addition of gAd or SB203580 inhibited the unregulation of MCP-1 and p-p38MAPK induced by HG.Two kinds of adipoR,adipoR1 and adipoR2,were all detectable in NG group,and mRNA and protein expression of adipoR1 was higher than that of adipoR2 (P＜ 0.01).Compared with NG group,the expression of adipoR decreased in HG group,but the difference had no statistical significance(P ＞ 0.05).Compared to HG group,the mRNA and protein expression of adipoR1 increased in gAd groups (all P ＜ 0.01).Conclusion The gAd can dose-dependently attenuate the overexpression of MCP-1 induced by high glucose,and this protective effect may be mediated by adipoR1 and p38MAPK.

Objective To evaluate the value of intraduetal ultrasonography (IDUS) in diagnosing biliary and pancreatic disorders. Methods The findings by endoscopic retrograde cholangiopancreatography (ERCP) and IDUS from 19 patients with suspected biliary and pancreatic disorders from July 2006 to August 2007 in our hospital were analyzed retrospectively. Results Of the 19 patients, 17 had obstructive jaundice (including 6 eases of cholangiocarcinoma, 2 pancreatic adenocareinoma, 2 gallbladder carcinoma, 2 chole-docholithiasis with bile duct stricture, 2 autoimmune pancreatitis, 1 papillary adenocarcinoma, 1 papillary adenoma, and 1 sclerosing cholangitis) and 2 intraduetal papillary mueinous tumor (IPMT). The diagnosis was confirmed by surgery and pathological findings in 11 patients. The diagnostic accuracy of ERCP and IDUS was 73. 7% (14/19) and 84. 2% (16/19), respectively, and that of ERCP combined with IDUS was 89. 5% (17/19). The sensitivity and specificity of ERCP to differentiate benign bile duct strictures from ma-lignant ones were 100. 0% (11/11) and 83.3% (5/6), respectively; and those of IDUS were 100. 0%(11/11) and 100. 0% (6/6), respectively. The sensitivity and specificity of ERCP in diagnosing cholan-gioeareinoma were 83.3% (5/6) and 60% (3/5), respectively; and those of IDUS were 100. 0% (6/6) and 40. 0% (2/5), respectively. Conclusion Combination of ERCP with IDUS can improve the diagnostic accuracy of pancreaticobiliary disorders. Additionally, IDUS shows higher sensitivity and specificity in differ-entiation between benign and malignant bile duct strictures, but it is still difficult to identify the etiologic factors of malignant bile duet strictures by IDUS.

Objective To assess the value of end-tidal carbon dioxide partial pressure (PETCO2) combined passive leg raising (PLR) test on volume responsiveness assessment in shocked patients post cardiac operation.Methods A prospective,self-controlled,and observational study was conducted.The shocked patients post cardiac operation undergoing complete mechanical ventilation admitted to Department of Critical Care Medicine of First Affiliated Hospital of College of Medicine,Zhejiang University from June 2014 to October 2015 were enrolled.PETCO2 and hemodynamic parameters including stroke volume variation (SVV),cardiac index (CI),mean arterial pressure (MAP) monitored by a pulse indicator continuous cardiac output (PiCCO) were determined before and after PLR and volume expansion (VE).Volume responsiveness was defined as an increase in CI (△ CI) of 15％ or greater after VE,namely response group (△ CI ≥ 15％) and non-response group (△ CI ＜ 15％).The value of PLR-induced PETCO2 change (△PETCO2 PLH) to predict volume responsiveness was evaluated by receiver operating.characteristic curves (ROC).Results Among the 41 patients enrolled,21 had volume responsiveness (response group),and 20 had no responsiveness (non-response group).After PLR,the changes in CI and PETCO2 were both significantly increased in the response group compared with non-response group [△ CI:(13.5 ± 4.6)％ vs.(3.6± 3.5)％,△ PETCO2:(7.4 ± 3.4)％ vs.(2.8 ± 2.5)％,both P ＜ 0.05].△ PETCO2 PLR and baseline SVV were positively correlated with PLR-induced CI change (△ CI PLR) (r1 =0.50,r2 =0.38,both P ＜ 0.05).VE-induced PETCO2 change (△ PETCO2 VE),baseline SVV and △ CI PLR were positively correlated with VE-induced CI (△ CI VE) (r1 =0.58,r2 =0.56 and r3 =0.84,all P ＜ 0.01).The area under ROC curve (AUC) of △ PETCO2 PLR was 0.875±0.054 [95％ confidence interval (95％CI) =0.769-0.981,P ＜ 0.05].△ PETCO2 PLR ≥ 5.8％ predicted volume responsiveness with sensitivity of 76.2％ and specificity of 90.0％.AUC of △CI PLR was 0.933±0.036 (95％CI =0.862-1.000,P ＜ 0.05).△CI PLR ≥ 10.4％ predicted volume responsiveness with sensitivity of 81.0％ and specificity of 90.0％.AUC of baseline SVV was 0.831 ±0.066 (95％CI =0.702-0.960,P ＜ 0.05).Baseline SVV ≥ 12.5％ predicted volume responsiveness with sensitivity of 85.7％ and specificity of 75.0％.Conclusion The change in PETCO2 induced by PLR is a convenient,reliable and non-invasive indicator to predict volume responsiveness in shocked patients post cardiac operation with mechanical ventilation.

OBJECTIVE: To systematically evaluate the efficacy and safety of harmonic scalpel in neck dissection. METHOD: Available literatures of PubMed, EMBASE, Cochrane Library, Google Scholar, CBM, CNKI, WangFang and VIP published before June 2014 were searched. Inclusion criteria and quality assessment were performed. All data were analyzed by using RevMan 5.2 software. RESULT: Fourteen studies including 632 cases were enrolled. Among them, 319 cases were in harmonic scalpel group and 313 cases in conventional resection group. Compared with conventional resection group, the harmonic scalpel group showed shorter surgery time(weighted mean difference [95% confidence intetval]: -28.01 [-36.83, -19.19], Z = 6.22, P < 0.01)and less intra-operative blood loss (weighted mean difference [95% confidence intetval]: -46.68 [-57.25, -36.12], Z = 8.66, P < 0.01). The number of cervical lymph nodes dissected and the incidence of postoperative chylous leakage were similar in both groups. CONCLUSION Using the harmonic scalpel in neck dissection was as efficient and safe as that of the conventional technique with the advantage of shorter time of surgery and less intraoperative blood loss.
Blood Loss, Surgical ; Humans ; Lymph Nodes ; Neck ; surgery ; Neck Dissection ; instrumentation ; Postoperative Period ; Surgical Instruments

Objective To evaluate endoscopic ultrasonography (EUS) for TN restaging and predicting response to advanced gastric cancer after neoadjuvant chemotherapy. Methods A total of 22 patients,15 males and 7 females, mean age 64 (36-80 years ), with advanced gastric cancer were recruited to the study from June 2007 to December 2009 with written informed consents. All patients underwent 3 cycles of neoadjuvant chemotherapy ( Folfox 6 ), and subsequent surgery ( R0 resction) in 3-4 weeks after chemotherapy. EUS was performed 1-2 weeks before and 1-2 weeks after chemotherapy. EUS TN staging was compared with pathological findings. The correlation of peri-chemotherapy EUS TN staging with postoperative pathological response was evaluated. Results After chemotherapy, the overall accuracy of EUS T staging was 63.6% (14/22), with overstaging (36. 4%, 8/22) more frequent than understaging (0). The overall accuracy of N staging was 54. 5% (12/22) with 4 ( 18. 2%, 4/22) overstaging and 6 ( 27. 3%, 6/22 ) understaging. EUS revealed T and/or N downstaging ( concyrrence of T and N downstaging was accounted once) after chemotherapy in 10 patients, with 9 T downstaging (4 from T3 to T2, 5 from T4 to T3) and 4 N downstaging (4 from N1 to N0). TN downstaging was correlated with pathological response, with 7 patients achieving pathological response 2 and 1 patient 3. Conclusion T and N restaging by EUS after neoadjuvant chemotherapy in patients with locally advanced gastric cancer is not accurate enough. However, T and/or N downstaging confirmed by EUS is well correlated with a better degree of pathological response to chemotherapy.

Objective To analyse the negative predictive value of endoscopic ultrasonography (EUS)for detecting pancreatic cancer and to evaluate its clinical value of ruling out malignant cancer. Methods The medical records of patients who were referred to pancreatic EUS with suspected pancreatic cancer and normal EUS findings from January 2005 to December 2013 were reviewed. Moreover,the follow-up data were reviewed to evaluate whether the patient developed pancreatic cancer or other malignancy that could cause the abnormality mentioned above. The follow-up data were obtained by examining the inpatient/outpatient records as well as conducting brief telephone interviews. Results A total of 122 patients were in-cluded in our study. The follow-up data of 108 were accessible,and the mean follow-up period was 52. 4 months. One patient was histopathologically diagnosed as having pancreatic cancer 6 years after the proce-dure,and 107 other patients with a normal pancreatic EUS were free of pancreatic cancer as well as other malignancy during the follow-up period. The negative predictive value of pancreatic EUS was 99. 1%(107/108). Conclusion For patients with suspected pancreatic cancer but normal EUS findings,there is no need for further exploratory surgery. However,if there is a high suspicion of malignancy in the pancreas,a repeat-ed EUS is necessary in case of a false negative EUS result.

Objective To investigate the proportion changes of the CD4 + CD25 + T cells and CD8 + CD28 - T cells in the peripheral blood of gastric cancer patients. Methods The proportions of CD4 + CD25 + T cells and CD8 + CD28 - T cells in the peripheral blood of gastric cancer patients were determined by flow cytometry. 30 patients with gastric cancer and 30 patients with chronic gastritis were enrolled in this study. Results Compared with the chronic gastritis controls, the proportion of the CD4 + CD25 + T cells in the peripheral blood of patients with gastric cancer (8.7%±1.3%) was not significantly changed. But the proportion of the CD8 + CD28 - T cell in the peripheral blood of patients with gastric cancer (30.3%±3.3%) was significantly higher than that of control group (20.3%±2.7%), P<0.05. There was no significant association between the proportions of T regulatory cells and the lymphomatic metastasis of gastric cancer. No relation was found between the proportions of T regulatory cells and pathological types of gastric cancer. Conclusion CD8 + CD28 - T ceils in peripheral blood may be of some value in the progression of gastric cancer.

The paper reviewed the significance and methodology of building a hospital emergency response system, and recommended on coordinating hospital emergency response work. The practices to build emergency response norms include persistent improvement of hospital emergency response system,unifying hospital emergency pre-plan, scheduling emergency drills, training and assessment, performance appraisal, and quantified indicators. The paper also summarized such operation principles as system development, unified management, job division, standardized operation, and routine operations.

Objective To investigate the protective effect and possible mechanism of adiponectin (ADPN) and its receptors in diabetic nephropathy (DN). Methods A total of 64 Sprague-Dawley female rats were equally divided into diabetes mellitus (DM) group with streptozotocin(STZ) 60 mg/kg injection, and normal control (NC) group with the same dose of citric acid buffer randomly. At the end of 2, 6, 10 and 12 weeks, weight, fast blood glucose, 24-hour urinary albumin excretion, serum creatinine and serum fast blood insulin were measured. The level of adiponectin in urine and serum was examined by ELISA. The pathological change of kidney tissue was studied by periodic acid-Schiff's staining (PAS) and the expression of adiponectin receptor 1 (adipoR1), adiponectin receptor 2 (adipoR2) was determined by immunohistochemistry.The NRK-52E cells were cultured with 5 mmol/L glucose (control group), 30 mmol/L glucose (high glucose group), 30 mmol/L glucose+different concentrations of adiponectin (1 mg/L, 5 mg/L, 10 mg/L, ADPN groups), respectively. The mRNA expression of monocyte chemoattractant protein 1 (MCP-1) was measured by RT-PCR after 12 h. Results (1)Both in urine and serum, the levels of ADPN in DM group were higher than that in NC group after 6 weeks (P＜0.01) and increased gradually during the whole experiment. (2)Compared with NC group, the expressions of AdipoR1 and AdipoR2 in kidney tissues were elevated gradually in DM group. There was a significant positive correlation of ADPN with AdipoR1 and AdipoR2 in DM group(r=0.666, P＜0.01;r= 0.684, P＜0.01). (3)The expression of MCP-1 increased in high glucose group, but decreased in 1 mg/L, 5 mg/L, 10 mg/L adiponectin group. Conclusions The level of ADPN in urine and serum is positively correlated with its receptors and elevates with the process of diabetic kidney disease. High level of serum adiponectin plays a protective role through the direct action of AdipoR and the alleviation of MCP-1 expression in renal tubules.