Objective To evaluate the distribution characteristics of left ventricular systolic dyssynchrony (LV-SD) in dilated cardiomyopathy (DCM) patients with chronic heart failure (CHF) and normal QRS wave width, by pulsed-wave Doppler tissue imaging (PW-DTI), and study its relation with left ventricular systolic function, ventricular remodeling, and functional mitral regurgitation (FMR). Methods The time to peak systolic velocity (Ts) in 12 left ventricular segments was evaluated by PW-DTI, from which the standard deviation (SD) of Ts in the 12 segments (Ts-SD) and maximum Ts difference (Ts-maxD) were calculated. Results Ts-SD and Ts-maxD in the 12 LV segments of the DCM patients with CHF were significantly higher than those of the healthy controls (P＜0.01). In DCM patients with CHF and normal QRS wave width, the incidence of LV-SD was 29.8% (14/47) and the inferior wall was the most frequent distribution site of contraction delay. Linear regression analysis revealed a negative correlation between Ts-SD, Ts-maxD, and left ventricular ejection fraction (LVEF) (P＜0.01), but a positive correlation between Ts-SD, Ts-maxD and left ventricular end-diastolic volume (LVEDV), lefe ventricular end-systolic volume (LVESV), New York Heart Association (NYHA) cardiac function, FMR (P＜0.01) in DCM patients with CHF. Conclusion LV-SD exists in DCM patients with normal QRS width. LV-SD aggravates the LV systolic function damage, which is closely associated with left ventricular remodeling. LV-SD may contribute to the FMR in DCM patients.

Objective To explore the changes of GRO-α and VEGF in the peritoneal fluid of women with endometriosis and their correlation. Methods The levels of GRO-α and VEGF were detected by enzyme linked immunosorbent assay ( ELISA ) method in 39 cases of endometriosis and 25 normal cases of without endometriosis. Results The levels of GRO-αand VEGF in the peritoneal fluid of EMs group were ( 108.77 ± 20. 58 ) pg/ml and ( 199. 67 ± 99. 26 ) pg/ml separately, and it was significantly higher than those in control group ( 71.07 ± 18. 96 ) pg/ml, ( 115.46 ± 32. 39 ) pg/ml. The differences were statically significant( P <0. 05). The level of GRO-α in the peritoneal fluid of the patients in stage Ⅰ and Ⅱ was sig-nificantly lower than that in stage Ⅲ and Ⅳ[(99.43 ± 16.05)pg/ml vs (117.65 ± 20.8)pg/ml, P <0. 05] , while the level of VEGF in the peritoneal fluid of the patients in stage Ⅰ and Ⅱ was significantly higher than that in stage Ⅲ and Ⅳ[(246. 89 ± 114. 34) pg/ml vs ( 152. 82 ± 54. 55 ) pg/ml, P < 0. 05] .There was positive correlation between the level of GRO-α and r-AFS ( r = 0. 439, P < 0. 05 ), but no cor-relation between the level of VEGF and r-AFS ( r = -0. 210, P >0.05). There was no correlation be-tween peritoneal fluid levels of GRO-α and VEGF in the EMs group ( r =-0. 05, P>0. 05). Conclusion Compared with control group, the levels of GRO-α and VEGF in peritoneal fluid of women with endome-triosis were significantly increased, which indicated that the increased GR0-α and VEGF secretion involved in the pathogenesis of this disease. There was correlation between the peritoneal fluid level of GRO-α and the degree of EMs.

Objective To explore the role of TLR2 and TLR4 in the pathogenesis of Henoch-Schonlein purpura ( HSP) by investigating their expression at mRNA and protein levels in peripheral blood mononuclear cells ( PBMCs ) and their influences on Th 1/Th2 immune response in children with HSP . Methods 64 hospitalized children with HSP in the Affiliated Hospital of Qingdao University Medical Col -lege from October 2011 to November 2012 were enrolled in the study .They were further divided into non-He-noch-Schonlein purpura nephritis ( NHSPN ) group ( n =36 ) and Henoch-Schonlein purpura nephritis (HSPN) group (n=28).30 age-matched healthy children from Child Health Division of the same hospital were selected as controls .The expression of TLR2 and TLR4 at mRNA level in PBMCs were detected by re-al-time fluorescent polymerase chain reaction .The expression of TLR2 and TLR4 at protein level and T cells subset were detected by flow cytometry .The levels of IFN-γ, IL-4 and IL-6 in plasma were determined by enzyme-linked immunosorbent assay (ELISA).Results (1)Compared with the control group , the expres-sion of TLR2 and TLR4 at mRNA and protein levels were remarkably increased in children with HSP , espe-cially in HSPN group.(2)Compared with the control group, the percentage of CD3+T cells and CD3+CD4+T cells were down-regulated in HSP group , but the percentage of CD 3+CD8+T cells and CD3+HLADR+T cells were up-regulated.(3)The level of IFN-γand the ratio of IFN-γ/IL-4 in plasma from children with HSP were significantly lower than those of the controls , while the level of IL-4 and IL-6 were remarkably higher than those of the controls .(4)The expression of TLR2 and TLR4 at protein level in PBMCs from chil-dren with HSP showed significant positive correlations with the expression of TLR 2 and TLR4 at mRNA level and plasma concentration of IL-4 and IL-6, but a negative correlation with the ratio of IFN-γ/IL-4.Conclu-sions The aberrant activation of TLR 2 and TLR4 might be correlated with the immunological pathogenesis of HSP by enhancing Th2 immune response.The hyper-activation of TLR2 and TLR4 might result in renal injury in patients with HSP .

Objective To investigate the score changes of graduates majoring in clinical medicine after using the method of “role of identification”. Methods Sixty students who were undertaking internship in Endocrinology Department of Shanghai Traditional Chinese Medicine Hospital received three-week clinical teaching and examination. Then they got into one-week “role of identification”, and were appointed as clinical teachers to teach what they have learned during the last 3 weeks to the next batch of interns and make another examination. Scores of the two examinations were compared. Results Scores of the examination after received the method in“role of identification”improved significantly (P<0.01). Conclusion The method of“role of identification”can enhance clinical medicine graduates’ mastery of professional knowledge.

Aged ; Aged, 80 and over ; Combined Modality Therapy ; Female ; Humans ; Male ; Middle Aged ; Otorhinolaryngologic Diseases ; therapy ; Retrospective Studies

Animals ; Coxsackievirus Infections ; metabolism ; Enterovirus B, Human ; Female ; Male ; Mice ; Myocarditis ; metabolism ; Myocardium ; metabolism ; Tumor Necrosis Factor-alpha ; metabolism

ObjectiveTo explore the best treatment method for patients with pancreatic cancer by analyzing the clinical and survival features.MethodsThe clinical data of 74 patients with pancreatic cancer diagnosed by pathology diagnosis(surgical pathology or biopsy) or clinical diagnosis(imaging + tumor marker CA19-9) were collected.The cases were divided into 5 groups according to different therapy methods:surgery alone group(11 cases),postoperative chemotherapy group(20 cases),palliative chemotherapy group ( 13 cases),palliative radiotherapy group ( 13 cases),untreated group ( 17 cases).The clinical features and overall survival time of patients with pancreatic cancer were analyzed.ResultsThe median overall survival time of postoperative chemotherapy group was longer than that of untreated group (300 d vs.119 d,P ＜ 0.01 ) ; The median overall survival time of surgery alone group,palliative chemotherapy and palliative radiotherapy group had no significant difference compared with that of untreated group (120,164,109 d vs.119 d,P＞ 0.05 ).The patients with advanced pancreatic cancer often suffered from abdominal pain,jaundice,nausea,vomiting,weight loss and other associated symptoms.The incidence of jaundice of patients undergoing surgery was lower compared with non-surgical patients,but the difference was not significant [ 19.35％ (6/31 ) vs.37.21％ (16/43),X2 =2.75,P =0.10 ].The incidence of abdominal pain of patients with radiotherapy was lower than that of non-radiotherapy patients[ 23.08％ (3/13) vs.68.85％(42/61 ),x2 =12.59,P =0.00 ].The ascites incidence rate was 75.68％ (56/74) which shortened the overall survival time,and untreated group had the highest risk rate of ascites.ConclusionsOperation combined with chemotherapy is a better treatment that can improve the overall survival time of patients with pancreatic cancer.Radiotherapy can obviously relieve the abdominal pain.Ascites is a signal of poor prognosis during the treatment process.

Polyethylene glycol (PEG) is extensively used to increasing the in vivo and in vitro stability of liposomes. However, PEGylated liposomes also produce some negative effects with further research, such as low cellular uptake, poor "endosomal escape" of pH sensitive liposome (PSL) and accelerated blood clearance (ABC) phenomenon, and this situation is referred as the "PEG dilemma". "PEG dilemma" posed severe challenges for the targeted delivery of PEGylated liposomes-loaded anticancer drugs, effective intracellular release of PEGylated PSL-encapsulated gene and protein drugs, and repeated administration of PEGylated liposomes. Therefore, it is urgent to solve the "PEG dilemma". This review focused on the definition, classification of "PEG dilemma", and discussed several possible approaches to overcome "PEG dilemma".
Antineoplastic Agents ; chemistry ; Drug Carriers ; chemistry ; Liposomes ; chemistry ; Polyethylene Glycols ; chemistry

Objective To investigate the effectiveness of Uromentor virtual reality simulator in flexible ureteroscopy training for catechumen.Methods Fifty-one catechumen were selected.After 1 hour training of basic operation in Uromentor virtual reality simulator, all trainees performed special-purpose exercise ( kidney inspection with flexible ureteroscopy ) for 3 hours. Using right kidney inspection, a preliminary assessment for each trainee was made before the special-purpose exercise and data such as total time, number of trauma from the scopes and tools, percentage of kidney surface examined and global rating scale ( GRS ) were recorded.The same assessment was performed once again after the special-purpose exercise ( secondary assessment ) , and data were recorded and compared to the preliminary assessment. Results Each trainee made a significant improvement in flexible ureteroscopic skill after the special-purpose training.The parameters such as total time, number of trauma from the scopes and tools, percentage of kidney surface examined and GRS of all trainees in preliminary assessment were 14.63 ±1.01 min, 8.62 ± 2.67, 51.05%±20.79%and 10.31 ±2.53, respectively;while in secondary assessment, parameters were 7.71 ±1.13 min, 1.67 ±1.23, 98.04% ±5.42% and 29.14 ±3.01, respectively.The differences between the preliminary assessment and the secondary assessment of each parameter were significant ( P<0.01).Conclusions The Uromentor virtual reality simulator can improve the trainee′s skills of flexible ureteroscopy.It is a good instrument of the flexible ureteroscopic training for catechumen.

Objective To evaluate the outcomes of this reform to the hospital in the past two years.Methods Collecting such indexes as expenses composition,service volume and efficiency of the year before,the first year and the second year of the reform made at the hospital.Comparing the statistics and analyzing the effectiveness.Results Average outpatient expenses per visit and outpatient drug costs of patients with medical insurance during the two years of reform were found to be 12.03% and 5.7%respectively lower than the year before;while the average expenses per case fell by 4.08% and 2.69%respectively,with drug costs falling significantly as well.Outpatient visits fell,with steady increase of outpatients with medical insurance coverage.The distribution of outpatient visits varies significantly in terms of medical branches.There are a slight surplus of medical service charges of outpatients,and slight deficit of medical service charge of inpatients,with a smooth shift of the income makeup from dependence on drug price markup to medical service charge,and steady improvement of hospital efficiency.Conclusion The reform can alleviate patients’financial burden,encourage rational visits of doctors,promote fine management and structure adjustment,benefiting patients in the end.