Adult ; Aged ; Antineoplastic Agents ; therapeutic use ; Benzamides ; Chemotherapy, Adjuvant ; Female ; Follow-Up Studies ; Gastrointestinal Neoplasms ; drug therapy ; surgery ; Gastrointestinal Stromal Tumors ; drug therapy ; secondary ; surgery ; Humans ; Imatinib Mesylate ; Liver Neoplasms ; secondary ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Piperazines ; therapeutic use ; Pyrimidines ; therapeutic use

Objective To explore the associated factors and clinical significance of acute renal injures in cerebral stroke.Methods The renal function,BUN,CR,UA patients with acute stroke in 7 days were estimated their neurologic impairment by the scardinanvian stroke scare(SSS) were assessed at the same time,then were compared with control group.Results The incidence of acute renal injure of intracerebral hemorrhage(ICH) group and cerebral infarction(CI) group were both higher than that of control group(P

OBJECTIVETo explore clinical characteristics and treatment of posterior Pilon fracture.

METHODSFrom January 2011 to January 2013,18 patients with posterior Pilon fracures were treated. Among them, 13 were male and 5 were female, aged from 22 to 63 years old, with an average age of 46. All the patients were closed fractures. Open reduction and internal fixation were performed after swelling subsided, lateral malleolous and posterior Pilon fracture were exposured through lateral approach on healthy side, plates were used to fixed,screws or small plates were used to fix the posterior prominence of medial malleolus after changed to supine position. AOFAS scoring were applied to evaulate clinical effects.

RESULTSAll patients were followed up with an average of 22(ranged, 12 to 48)months. All patients obtained satisfactory reset except one patient. All factures were recovered well with an average healing of 11 weeks. According to AOFAS score at the final following up, 7 cases were excellent,2 cases were moderate, and the total score was 86.8±9.2.

CONCLUSIONPosterior Pilon fracture is not rare in clinical, its mechanism of injury, traumatic anatomy, surgical procedure and prognosis are different from that of classical ankle fracture and Pilon fracture.

Adult ; Ankle Injuries ; surgery ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tibial Fractures ; surgery ; Treatment Outcome ; Young Adult

Objective To investigate the prognostic value of heart rate turbulence (HRT) in patients with chronic heart failure (CHF). Methods From October 2006 to May 2009, a total of 96 elderly CHF inpatients were selected, and the clinic data were recorded. Based on the echocardiogram and dynamic electrocardiogram, the differences of sinus HRT index of patients with different cardiac function classification were analyzed. During 9-28 months medical follow-up, the treatment endpoint was death from heart disease. Based on Logisitc regression, the prognostic values of HRT, age, hypertension, diabetes, myocardial infarction (MI), left ventricular ejection fraction, ACEI and β- adrenergic blocker for death of CHF patients were analyzed.Results There was no significant difference in HRT between grade Ⅱ and grade Ⅲ cardiac function (χ~2 = 1.60, P>0. 05), and between grade Ⅲ and grade Ⅳ cardiac function (χ~2 = 1.43, P>0. 05). But there was significant difference in HRT between grade Ⅱ and grade Ⅳ cardiac function patients χ~2 =9.84, P<0. 05), and HRT was weaken in grade Ⅳ group. The average follow-up time was (18. 0±9.6) months. Of all 96 patients, there were 34 dead of heart disease. There were correlations of death of CHF with HRT, low LVEF (≤ 45%), age (≥65 years), diabetes, MI and classification of heart function. Conclusions The sinus HRT in CHF patients has a favorable prognostic value.

To adapt to changes in hospital positioning and management incurred by such health reforms as the “Global budget of medical insurance”and “Separation of clinic from pharmacy”,the performance evaluation system needs to be optimized constantly.Such information technology as big data collection,storage and analysis can help the system in supporting the success of the health reform. Combination of medical big data and performance management can guide the hospital toward goals of the reform,and to achieve all-win.

AIM:To investigate the regulation of miR-222 on BCL2L13 gene and its effect on the growth and apoptosis of HBx-HepG2 cells, and to explore the underlying molecular mechanisms .METHODS:The expression level of miR-222 was detected by RT-qPCR.The HBx-HepG2 cell growth was examined by MTT and colony formation assays .The cell cycle and apoptosis were analyzed by flow cytometry .The recombination vector pmirGLO-BCL2L13 was constructed, and dual-luciferase reporter experiment was performed to validate the target of miR-222.RESULTS:The expression level of miR-222 in the HBx-HepG2 cells was significantly higher than that in the L 02 cells ( P<0.05 ) .Over-expression of miR-222 enhanced HBx-HepG2 cell growth, changed cell cycle, and inhibited apoptosis (P<0.05).Knockdown of miR-222 reduced HBx-HepG2 cell growth, changed cell cycle, and increased cell apoptotic rate (P<0.05).BCL2L13 was down-regulated in the HBx-HepG2 cells as compared with L02 cells (P<0.05), and knockdown of miR-222 in the HBx-HepG2 cells increased the expression level of BCL2L13 (P<0.05).The results of dual-luciferase reporter assay and re-store experiment showed that miR-222 negatively regulated the expression of BCL2L13 via targeting 3’ UTR of BCL2L13, resulting in the promotion of HBx-HepG2 cell growth .CONCLUSION: miR-222 enhances HBx-HepG2 cell growth via down-regulation of BCL2L13.

Objective To examine the caregivers' burden and quality of life (QOL) of main caregivers of patients with Parkinson's disease by analyzing caregiver and patient-related factors. Methods A total of 53 cases with Parkinson's disease seen from October 2012 to December 2013 in Yantaishan hospital of Yantai City were selected. Assessments: (a) EuroQol-5 questionnaires, including: EQ-5 dimensions (EQ -5d) and visual analogue scale (VAS). (b) Unified Parkinson's Disease Rating Scale. (c) Hoehn-Yahr(H-Y) stage; (d) Parkinson's disease sleep scale (PDSS), 15 items; (e) Hamilton Anxiety Rating Scale (HAMD-14), Hamilton Depression Rating Scale (HAMA-24); (f) Chinese version of Zarit caregiver burden interview. Results Spearman correlation analysis showed that the EQ-5D index and EQ-VAS negatively correlated with HAMD-14 of caregivers of Parkinson diseasepatients (r=- 0.318, - 0.046) (P<0.05), and negatively correlated with H-Y staging (r=-0.592, -0.531), UPDRSI (r=-0.434, -0.316) , UPDRS Ⅱ (r=0.521, 0.513) , UPDRS Ⅲ (r=0.520, 0.534), UPDRS Ⅳ (r=0.564, 0.509), PDSS in patients with Parkinson's disease (r=0.547, 0.490), HAMD-14 (r=0.315, 0.350), HAMA-24 (r=0.413, 0.401) of Parkinson's disease patients (P<0.05). Caregiver burden was related with HAMD-14 (r=0.496), HAMA-24 (r=0.551),H-Y stage (r=0.697), PDSS (r=0.659), UPDRS Ⅰ-Ⅳ (r=0.538, 0.668, 0.696, 0.600), EQ-5D index of Parkinson disease patients (r=0.682), EQ-VAS of Parkinson disease patients (r=0.670) (P<0.05); and positively related with anxiety of caregivers (r=0.275) , and a negative correlation with the caregivers' quality of lives (r=0.665) (P<0.05). Bivariate analyses showed significant correlations between caregiver burden and patients' sleep, scores of Parkinson's motor symptoms, and caregivers' depression. Based on multiple regression analysis, Zarit score proved to be the main predictor of caregivers' QOL. Caregivers' age, total numbers of caregivers and H-Y stage also proved to be a relevant factor. Conclusion Improvement of patient's sleep, motor symptoms anddepression might alleviate caregivers' strain. There is a correlation between caregivers' burden and QOL. QOL of caregivers can be improved through reducing their care-burden.

Objective To investigate the clinical value of bile reinfusion combined with enteral nutrition before R0 resection of hilar cholangiocarcinoma.Methods The clinical data of 46 patients with hilar cholangiocarcinoma who underwent R0 resection at the Affiliated Drum Tower Hospital of Medical School of Nanjing University from January 2010 to January 2014 were analyzed retrospectively.The clinical data of 21 patients (the experimental group) who received bile reinfusion by preoperative percutaneous transhepatic cholangiography and drainage (PTCD) combined with enteral nutrition with nasojejunal tube were compared with 25 patients (the control group) who received neither PTCD nor enteral nutrition.The differences in the clinical indicators between the 2 groups were analyzed.Results In the experimental group,the levels of ALT,AKP,TBil and DBil decreased significantly after PTCD as compared with the original levels (t =4.433,4.547,5.648,4.681,P ＜ 0.05).The operation time and blood loss in the experimental group was reduced significantly when compared with the control group (t =-2.810,-2.047,P ＜ 0.05).The volume of postoperative albumin transfusion and the postoperative hospitalization in the experimental group was significantly reduced when compared with the control group (t =-3.083,t =-3.083,P ＜ 0.05).Conclusion Bile reinfusion combined with enteral nutrition facilitated the recovery of preoperative hepatic function in patients who underwent R0 resection of hilar cholangiocarcinoma,thus improving the safety of surgery and facilitated postoperative rehabilitation.

AIM: To study the expression of connective tissue growth factor (CTGF) induced by hypoxia, and the role and mechanism of hypoxia on promoting renal interstitial fibrosis. METHODS: Renal interstitial fibrosis was induced by unilateral ureteral obstruction (UUO) in rat animal model for 9 days as in vivo studies; marker of hypoxia-HIF-1? mRNA and protein, the expression of CTGF in the obstructed kidneys were assessed by RT-PCR, immunohistochemistry and Western blotting respectively. In vitro , normal rat kidney interstitial fibroblast cells (NRK-49F) were exposed to hypoxia (1%O 2) for up to 6 hours, hypoxia was confirmed by detecting the expression of HIF-1? protein in cells, cellular level of CTGF mRNA and protein were assessed by RT-PCR and Western blotting respectively. RESULTS: Neither HIF-1? mRNA nor HIF-1? protein was expressed in the kidney from sham-operated group of rats. High level of HIF-1? mRNA were occurred, and strongly HIF-1? positive immunostaining were seen in the tubular and interstitial cells in kidney from UUO rats. Expression and location of CTGF protein were paralleled and relevant with the expression of HIF-1? protein in kidney of UUO rats. In cultured NRK-49F cell line, subjected to hypoxia even for 6 hours stimulated the expression of CTGF mRNA and protein. CONCLUSION: Our results indicated that hypoxia could stimulate the expression of CTGF mRNA and protein in kidney from UUO rats, which may in turn contribute to renal interstitial fibrosis.

Objective To analyze the clinical features of infantile cytomegalovirus(CMV) hepatitis with cholestasis and investigate intrahepatic cholestasis due to hepatocytic impairment caused by CMV infection.Methods Forty-seven children with CMV cholestatic he-patitis were divided into 2 groups according to the level of total bilirubin(TB):22 cases with serum TB lower than 136.8 ?mol/L(groupⅠ),and 25 cases with serum TB higher than 136.8 ?mol/L(groupⅡ).All children were treated with both gangciclovir and routine met-hods,and serum biochemistry were checked before and after treatment.SPSS 13.0 software was used to analyze the data.Results Forty-seven cases of infantile CMV cholestatic hepatitis had different degrees of jaundice,hepatosplenomegaly and abnormal liver functions.The differences of serum ALT and AST between the 2 groups had statistical significance,the levels of serum gamma glutamy transferase(GGT) and alkaline phosphatase(ALP) were lightly higher in groupⅡcompared with those in groupⅠ,but there were no statistical significance.TB,direct bilirubin(DB),ALT and AST were decreased in the 2 groups after treatment,GGT and ALP hadn′t decreased significantly after treatment.Conclusions CMV infection can injure hepatocytes and epithelials on each grade of bile duct,thus CMV hepatitis causes intrahepatic cholestasis.Cholestasis due to hepatocytic impairment deserves emphasis and intervention should be done as early as possible.Gangciclovir therapy for CMV infection manifest effective and safe in short-term.