Neutrophil gelatinase associated lipocalin(NGAL),also known as lipocalin 2,has close relationship with human neoplasias,which is up-regulated in a number of malignancy and involves in the process of tumor development.But it appears to exist paradoxical effects attributed to NGAL in human neoplasias.For instance,through protecting MMP9 from autodegradation,NGAL has a clear pro-tumoral and pro-metastatic effect,as has already been observed in breast cancer and esophageal cancer.However,on the contrary,for pancreatic cancer and ovarian cancer,NGAL can inhibit FAK phosphorylation and vascular epidermal growth factor synthesis,having an anti-tumoral and anti-metastatic effect.This review summarizes the current knowledge about the dual effects of NGAL in the process of tumor development,and attempts to explore the possible underlyins mechanism.

Purpose To study the therapeutic methods of fatigue syndrome. Methods Seventy-nine cases of fatigue syndrome were treated by Tuina manipulation and a comprehensive assessment of main complaints and accompanied symptoms was made. Results After 3month's Tuina treatment, 21 cases were cured, 43 cases improved, 15 cases obtained no effects. Conclusion Tuina has a unique therapeutic effect on fatigue syndrome.

Objective To investigate the clinical value of the combination of routine magnetic resonance imaging (MRI),magnetic resonance cholangiopancreatography (MRCP),diffusion weighted imaging (DWI)and enhanced magnetic resonance imaging in the diagnosis of recurrent pyogenic cholangitis (RPC).Methods The clinical and MRI data of 2 1 cases of RPC confirmed by surgery or puncture were retrospectivly analyized.Results All of 2 1 patients were performded with routine MRI (FSE T2 WI,FSPGR T1 WI and FIASTA),MRCP and DWI.1 2 cases were underwent three-dimensional dynamic contrast-enhanced MRI with a liver volume accelerated acquisition sequence (LAVA).The raw data was uploaded to GE ADW4.4 station and the three dimensional MRCP and DWI were analyzed.(1)All of 21 cases were hepatolithiasis complicated with irregular expansion.11 cases were involved left intra-hepatic bile duct,7 cases were right intrahepatic duct,and 3 cases were involved left and right intrahepatic bile duct.Wall thickening was in 19 cases,normal biliary duct wall was in 2 cases.(2)Common bile duct disease:calculus of intrahepatic and extrahepatic bile duct complicated with bile duct dilatation were in 8 cases.Calculus of intrahepatic bile duct were individually in 13 cases.(3)Gall-bladder disease:there were 5 cases of gallstone,9 cases of chronic cholecystitis,3 cases of acute cholecystitis and 4 cases of chole-cystectomy.(4)Liver parenchyma disease:there were 6 cases of liver atrophy in all the cases (left lobe atrophy of 4 cases,right lobe atrophy of 4 cases).The inflammatory changes around dilated bile ducts were found in 1 2 cases.The MRI findings of those were slight patchy hyperintensity signal on conventional T2 WI,the area of hyperintensity signal on T2 WI was extended on DWI.On dynamic contrast-enhanced MRI,the inflammatory areas were uniformity minor enhancement on arterial phase,and hardening in-creases on portal and delayed phase.Conclusion Multi-sequences MRI can be more fully reflected the pathologic changes of RPC, which is important for imaging diagnosis of the disease.

Objective To investigate and analyze the health care seeking behavior,financial burden and relative factors of patients with rheumatic diseases in Fujian Province.Methods Patients diagnosed with rheumatic diseases were investigated in Fujian Provincial Hospital from December 2013 to February 2014,including demographic data,health care seeking behavior and financial burden.Relevant factors were analyzed by Logistic regression.Results ① In this study,474 patients were enrolled.The ratio of male to female was 1∶2.38.② At the onset of symptoms,51.9％(246 cases) of patients visited a doctor as soon as possible,and 36.1％(171 cases) of them went to hospital within a month after disease onset.③ 74.1％(351 cases) of patients could adhere to medication regimen prescribed by doctors,and the most common reason for stopping medication was symptoms relieved (33.3％,41 cases).④ 63.1％(299 cases) of patients learned about the knowledge of rheumatic diseases from hospitals and doctors.⑤ 34.2％(162 cases) of patients spent 1 000-5 000 yuan every month on treatment.⑥ Insurance type could affect the time of first visit to hospital (P=0.004),while income and cost of therapy might impact patients' compliance (P=0.013,P=0.004).Conclusion Most patients will go to hospital as soon as possible and adhere to treatment.Economic situation is the main factor influencing health care seeking behavior of patients with rheumatic diseases.

Objective To summarize the clinical efficacy of Millikan's modified modality using tension-free mesh-plug inguinal herniorrhaphy. Methods A retrospective study was performed in 185 cases with in-guinal hernias. They received surgical treatment using Millikan's modality in our hospital from Jan. 2005 to Dec. 2006. Results There were 184 males and 1 female in these patients with a average age of 47 years ( range 32 - 75 years). Among them, 7 cases had bilateral hernia. The mean operative time of each hernia was 49 min (range 30 -70 min), and the average postoperative hospital stay was 5. 1 days (range 3 - 18 d). The complication rate was 10. 8% (20/185). All patients had no recurrence after following-up over 24 months. Conclusion Millikan's modified mesh-plug hemioplasty is a safe and effective modality in the pri-mary inguinal hernia repair, and has fewer complications and lower recurrence rate.

Objective To investigate the selection and efficacy of operative medality for pancreatic transec-tion with major duct injury. Methods The clinical data were retrospectively analyzed in 21 patients with pancreatic disruption. They were treated in our hospital from Jan. 1995 to Feb. 2009. There were 14 males and 7 females in these cases with a mean age of 26 years (range 9-53 years). The trauma causes of them were blunt injuries in 13 and patent injuries in 8 cases. The injury grade (according to American Association for the Surgery of Trauma) distribution for these patients was grade Ⅲin 8 cases, grade Ⅳ in 8 cases, and grade V in 3. The early emergency operation was performed in eighteen within 12 hours, and delayed opera-tion was in three cases. Of these operative medalities, Roux-en-Y distal panereatojejunostomy was in 10 ca-ses, pancreatoduodenectomy was in 3, modified duodenal diverticulizatian was in 2, distal pancreatectomy was in 3, tube installing in major duct and external drainage, and suture of pancreatic section was in 2, su-ture of two broken sides in 1 (Roux-en-Y distal pancreatojejunostomy in second time). Results Twenty patients were cured, and one was died after a procedure of pancreatoduodenectomy. The postoperative pan-creatic fistula happened in 3 cases and recovered well with conservative line of management. Conclusions For improving the outcome of pancreatic transection, the earlier exploratory laparotomy and carrying out concept of "Damage Control Surgery" are critical. The individual operative modality based on the grade should be a-dopted in the surgical procedure.

Objective To summarize the experience in diagnosis and management for severe and complicated pancreatic trauma. Methods The clinical data of 21 patients with severe pancreatic trauma treated in our hospital were retrospectively analyzed. Of the 21 with a mean age of 26 (9-53), 14were male and 7 female. The causes of trauma were blunt injuries in 13 and patent injuries in 8 of them. The injury grade distribution for these patients was grade Ⅲ in 8 cases, grade Ⅳ in 8, and grade V in 3. The main diagnostic modalities included amylase measurement, ultrasonography, CT,endoscopic retrograde cholangiopancreatography (ERCP), and magnetic resonance cholangiopancreatography (MRCP) etc. All patients received surgical procedures. Roux-en-Y distal pancreatojejunostomy was performed in 10 patients, pancreatoduodenectomy in 3, modified duodenal diverticulization in 2, distal pancreatectomy in 3, tube installing in major duct and external drainage, and suture of pancreatic section in 2, and suture of two broken side respectively (delayed distal pancreatojejunostomy in the second time) in 1. Results Pancreatic injury was confirmed in 11 cases preoperatively and intraoperatively in the others. The early emergency operation was performed in 18 patients within 12hours, and delayed operation was done in 3 cases. Twenty patients were cured and 1 died after a procedure of pancreatoduodenectomy. The postoperative pancreatic fistula happened in 3 cases and recovered well with conservative line of management. Conclusion The diagnosis of severe and complicated pancreatic trauma is difficultly yet, so the earlier exploratory laparotomy should be suggested. The individual surgical modality based on the grade should be adopted in the operation and the concept of "Damage Control Surgery" should be carried out in the procedure. Extended operation should be avoided.

Objective To explore the relationship between apolipoprotein E gene polymorphism and cerebral infarction in Taishun county.Methods Determination of 112 cases of Taishun Siqian cerebral infarction patients and healthy persons 88 cases of ApoE gene polymorphism,and the cerebral infarction patients were admitted to the hospital for different period of time after the NIHSS score.Results The cerebral infarction group and the control group were ApoE -/3 genotype most were 70.5%(79 /112)and 63.6%(56 /88),both had significant difference(P >0.05);The cerebral infarction group and the control group in terms of ApoE -up to 3,respectively 82.1%(92 /112)and 75.6%(66.5 /88),both had no significant difference (P >0.05).The cerebral infarction group epsilon 4 to 9.8%(11 /112),and was significantly higher than that of the control group 4.0%(3.5 /88);E2 was 6.2% (7 /112), which was significantly lower than that of the control group [19.3% (17 /88)],the differences were significant (χ2 =6.189,7.970,all P <0.05).Carrying ApoE -4 of the cerebral infarction patient each time period at the time of admission,admission 7d and 14d NIHSS scores were not carrying epsilon 4 patients increased significantly (t =7.853,6.185,5.165,allP <0.05);and at each time point carrying epsilon 2 gene in patients with and without carry-ing epsilon 2 patients NIHSS scores had no significant difference (P >0.05 ).Conclusion Cerebral infarction patients ApoE gene polymorphism and disease progression and prognosis are closely related,ApoE -4 Taishun Siqian cerebral infarction patients predisposing factors.At the same time,the detection of apoE genotype and NIHSS score is helpful to the prognosis of the patients.

Objective To observe the effect of fluoxetine on the depression neurologic impairment and activity of daily living after cerebral infarction.Methods 80 patients with acute cerebral infarction following depression were randomly divided into treatment group and control group, 40 cases in each group. Two groups were assessed with Modified Edinburgh-Scandinavia Stroke Scale(MESSS), Hamilton Depression Scale(HAMD) and Modified Barthel Index(MBI) before and after treatment.Results There were no significant difference between the two groups before treatment in HAMD, MESSS and MBI（P＞0.05）, while there were significantly different between the two groups in HAMD, MESSS and MBI 6 weeks after treatment（P＜0.01）. Conclusion Fluoxetine can alleviate depression of patients with acute cerebral infarction and improve the symptom of neurological function and the activity of daily living.

: ObjectiveTo study the correlation between mental status and personality of patients with stroke. Methods103 patients with stroke were surveyed by Symptom Checklist 90 (SCL-90) and Eysenck Personality Questionnaire (EPQ). ResultsThe scores of 7 factors which include total scores, somatisation, compulsion, depression, anxiety, panic and psychosis in SCL-90 were higher than norm, but the inter-personal sensitivity was lower. The scores of neuroticism (N) in EPQ were higher than the domestic norm(P<0.05),the scores of extra-introversion (E) and psychoticism (P) in EPQ were lower than the domestic norm(P<0.05); The N of EPQ was positively correlated with all factors of SCL-90, the E was positively correlated with hostility and paranoia factor, and the P was positively correlated with paranoia factor. ConclusionThe mental status of patient with stroke in acute period was poor. The character of neuroticism and introversion may be its personality background.