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

Objective To compare everolimus (EVR) with calcineurin inhibitor (CNI) minimization or withdrawal on renal function of liver transplant patients with standard CNI therapy.Methods A search was conducted on databases which included the PubMed,Embase and Cochrane library for randomized controlled trials (RCTs) comparing EVR with CNI with minimization or withdrawal (the EVR group) with standard CNI therapy (the standard CNIs group) on renal function of liver transplant patients.A metaanalysis was performed using RevMan 5.3 software.Results Five RCTs which included 1 264 patients were selected into this study.There were 790 patients in the EVR group and 474 patients in the standard CNIs group.On meta-analysis,the EVR group had significantly better renal function (SMD =0.36,95％ CI 0.09 ～ 0.64,P ＜ 0.05),but higher rates of infection (RR =1.37,95％ CI 1.08 ～ 1.74,P ＜ 0.05),dyslipidemia (RR =2.46,95％ CI 1.79 ～ 3.38) and leukopenia (RR =2.37,95％ CI 1.32 ～ 4.26).No significant differences were found on the mortality and the acute rejection rates between the two groups (all P ＜ 0.05).Conclusions EVR with CNI minimization or withdrawal after liver transplantation provided effective immunosuppression and improved patients' renal function.The treatment increased the rates of infection,dyslipidemia and leukopenia.

Objective To investigate the value of clinical application of mammotome under ultrasonic guidance for minimal excision and biopsy of breast tumor.Methods Excision and biopsy of 152 breast masses from 115 patients were performed using mammatome under ultrasonic guidance,and the patients were followed up.Results Total resection of 152 breast tumors were accurately performed by mammotome vacuum device and biopsy was performed.On pathological examination,86 cases were fibroadenoma,34 cases were adenosis,2 cases were fat necrosis,3 cases were gynecomastia,1 case was ductal inflammatory change and 26 cases were breast cancer.Postoperatively,hematoma was found in 3 cases,subcutaneous ecchymosis in 4 cases and skin injury in one case.All cases were followed up for a period of time and no residual or recurrent masses were found.Conclusions Mammotome vacuum system is an exact,effective and safe method.It is an ideal minimally invasive operation in treating benign breast masses with few complications.It can also be applied to biopsy for breast cancer before operation.

Objective To conduct a systematic review on the safety and efficacy of enhanced recov -ery after surgery ( ERAS) in perioperative management of hepatectomy .Methods A literature search was conducted on databases which included the PubMed , Embase, Cochrane Library, Sinomed, Wangfang, VIP and CNKI for randomized controlled trials ( RCTs) on application of ERAS in patients after hepatectomy . The data collection ended in August 2015.A meta-analysis was performed using RevMan 5.3 software.Re-sults Eleven RCTs which included 1074 patients were selected into this study .There were 530 patients in the ERAS group and 544 patients in the control group .On Meta-analysis, when compared with the control group, the ERAS group had significantly shorter length of hospital day (WMD=-2.36, 95%CI: -3.19~-1.54 , P<0.05 ) , shorter time for functional recovery ( WMD=-2.30 , 95%CI: -3.77 ~-0.83 , P<0.05), lower total complication rate (RR=0.65, 95%CI:0.52~0.80, P<0.05), and significantly decreased rates of postoperative pulmonary infection (RR=0.36, 95%CI:0.14~0.91, P<0.05) and nausea and vomiting (RR=0.48, 95%CI:0.26~0.89, P<0.05).There were no significant differences between the two groups on the rates of postoperative bleeding , biliary fistula, abdominal infection, delayed incisional healing, wound infection and urinary tract infection (P>0.05).The ERAS group had significant-ly lower hospitalization cost (SMD=-1.61, 95%CI:-2.42~-0.80, P<0.05), but the differences between the two groups on mortality and re-admission rates were not significant (P>0.05).When compared with the control group , the drainage tube removal time ( WMD=-2.83 , 95% CI:-3.92~-1.76 , P<0.05), time to first mobilization (SMD=-2.34, 95%CI:-2.98~-1.70, P<0.05), time to first feeding ( SMD=-5.08 , 95%CI: -9.33~-0.83 , P<0.05) , time to passage of first flatus ( SMD=-3.60, 95%CI:-4.85~-2.34, P<0.05) in the ERAS group were significantly shorter , but there was no significant difference on the time to the first bowel motion ( P>0.05 ) .Conclusions ERAS in the peri-operative management of hepatectomy was safe and beneficial .

Objective To observe the influence of trastuzumab on DNA break repair and Her-2 nuclear import after radiation in breast cancer cell line SKBR3,and discuss the radiosensitivity mechanism of trastuzumab.Methods Clone formation assay was used to analyze the difference of survival fractions between radiation group and radiation plus trastuzumab group.Confocal microscopy was applied to observe the influence of trastuzumab in the nuclear import process of Her-2 and the expression of γH2AX after radiation,which is considered as the marker of DNA double strand break.Western blotting was used to detect the expression of Her-2 and DNA-PKcs in nuclei after radiation.Results The result of clone formation assayshowed that the SF2 in radiation group was 0.547±0.046 and 0.321±0.022 in the radiation plus trastuzumab group were significantly decreased,the results of confocal microscopy showed that trastuzumab postponed the nuclear import process of Her-2 (52.80±19.74 in radiation group,21.41±10.55 in the radiation group),and increased expression of γH2AX after radiation (85.40±25.63 in radiation group,18.53±44.32 in the radiation group),and western blotting revealed trastuzumab reduced the expression of Her-2,DNA-PKcs in nuclei.Conclusion Trastuzumab can inhibit the radiation induced nuclear import of Her-2,and decrease Her-2,DNA-PKcs in nuclei to increase the DSB on early stage after radiation.

This study examined the radiation-induced ERBB2 nuclear transport in the BT474 breast cancer cell line and the relationship between caveolin-1 and radiation-induced ERBB2 nuclear transport. The BT474 cells were treated with herceptin (200 nmol/L), PP2 (a caveolin-1 inhibitor, 100 nmol/L) and irradiation combined or alone. Confocal microscopy was used to observe the nuclear import of ERBB2 and caveolin-1 after irradiation. Western blotting was employed to detect the expression of ERBB2, caveolin-1 and DNA-PKcs after irradiation, and immunoprecipitation to identify the ERBB2 and caveolin-1 complex before perinuclear ERBB2 localization. Confocal microscopy showed the transport of ERBB2 and caveolin-1 from the cell membrane to the nucleus 15 min after irradiation and the proteins accumulated at the perinuclear region within 45 min. Western blotting revealed that the expression levels of ERBB2, caveolin-1 and DNA-PKcs were increased after irradiation and reached a peak 45 min later. Both herceptin and PP2 treatments were found to decrease ERBB2 expression. An immune complex composed of ERBB2 and caveolin-1 was found in the herceptin group after irradiation. It was concluded that after irradiation, ERBB2 may be transported from the cell membrane to the nucleus and activate DNA-PKcs to trigger DNA double-strand break (DSB) repair; caveolin-1 may participate in this process. Treatments involving the downregulation of caveolin-1 may increase the radiosensitization of breast cancer cells.

Objective To investigate the feasibility of ultrasmall superparamagnetic iron oxide- enhanced(USPIO)-enhanced MR imaging for monitoring synovitis of antigen-induced arthritis in rabbit model and explore the optimal MR imaging sequences.Methods Nine female white rabbits with antigen(0.5 ml mBSA,2 mg/ml)induced arthritis of the right knees were used in the study.The left knees of these rabbits and both knees of another 3 rabbits served as the control.Nine to 28 days(mean 21.3 d)after successful model induction,all knees were imaged before and 24 h after intravenously injection of USPIO (0.3 ml/kg),among which 2 rabbits were also imaged at 48 and 72 h after administration of USPIO respectively.The MR protocol included spin-echo(SE) T_1WI,fast spin-echo(FSE)T_2WI,gradient echo (GRE)T_2~* WI and short tau inversion recovery(STIR).Images were analyzed quantitatively and qualitatively based on signal characteristics and patterns of the synovium.Paired t-test was used for the analysis of the signal intensity of inflammatory synovial membrane before and 24 h after injection of USPIO. MR findings were correlated with histopathology.Results Arthritis was successfully induced in all 9 right knees with intraarticular injection of mBSA.Pathological examination revealed hyperplasia of synovium with infiltration of USPIO-loaded-macrophages.MR depicted synovial thickening(thickness 2.07?0.97 mm) and joint effusion.Synovium and joint fluid appeared as slightly hypo- or iso-intense on T_1 WI and hyper- intense on T_2 WI or T_2~* WI.Twenty four hours after USPIO injection,significant T_1 enhancement(ASNR 41.91%?27.94%),negative T_2 and T_2~* enhancement(△SNR -34.92%?11.77% and -57.24%? 16.05%)were demonstrated in the region of synovial inflammation respectively.The signal at 48 h and 72 h changed less than that at hour 24.No signs of arthritis occurred in all left knees and in all knees of the artificial model group.Conclusion Iron oxide phagocytized into macrophages can be a root cause resulted in signal change on USPIO-enhanced MR images.The gradient echo sequence should be the optimal sequence to be used in USPIO-enhanced MR imaging in antigen-induced arthritis.

Objective To determine the capability of emergency physicians (EPs) after goaldirected training to make accurate judgement and assessment of left ventricular systolic function (LVSF) as they own manipulated the hand-held echocardiography.Methods Eighty-one patients with acute dyspneic symptom admitted into emergency department of Xinhua Hospital Affiliated to Shanghai qaotong University School of Medicine from November 2011 to February 2012 were enrolled for a prospective,observational study.Patients with a history of trauma or acute myocardial infarction diagnosed by electrocardiogram were excluded.Four EPs after a intensive course of goal-oriented training in a good command of trans-thoracic echocardiography (TTE) in 81 emergency patients using hand-held echocardiography.EPs attempted to obtain images at the parasternal (long and short axis),apical,and subcostal positions,and visually estimated left ventricular ejection fraction (LVEF) and categorized LVSF as normal function,mild or moderate or severely depressed function.The results of echocardiographic LVEF got by EPs were compared quntitatively with those measured by an professional echocardiographer.The kappa statistical test by using SPSS version 13.0 software was used to allow for comparison in agreement between EPs and the professional echocardiographer's interpretations of TTE findings.Results Using the results of TTE measured by the professional echocardiographer as agold standard,EPs correctly distinguished the normal LVSF from decreased LVSF in 89％ patients.The rate of positive predictive value for the EPs identifying any abnormality in LV function was 83％ and the rate of negative predictive value was 93％.The kappa coefficient for the agreement between EPs and the professional echocardiographer' s interpretations for any abnormality in LV function was 0.77 (95％ CI:0.70-0.84,P ＜ 0.01).EPs correctly placed LV function into one of three categories in 68 of 81 cases (84％),The kappa coefficient for the agreement was 0.71 (95％ CI:0.64-0.78,P ＜0.01).Conclusions Emergency physicians after a intensive course of training in mastering echocardiography can accurately determine the left ventricular systolic function.

Objective To explore the diagnostic value and optimal cut-off point of symptom index (SI) in gastroesophageal reflux-induced chronic cough (GERC).Methods The recordings of multichannel intraluminal esophageal impedance and pH monitoring were retrospectively analyzed in 118 patients with suspicious GERC.SI for all the refluxes,acid reflux and non-acid reflux was calculated respectively by analyzing the temporal association between detected reflux and cough recorded on diary card.Based on the favorable response to the anti-reflux therapy,the diagnostic value for GERC of SI was evaluated and compared with that of the symptom association probability (SAP).Results GERC was definitely determined in 100 patients (84.7％).When SI for all the refluxes was used for the diagnosis of GERC,the cut-off point of ≥45％ had the highest diagnostic efficacy,with the sensitivity of 56.0％,the specificity of 83.3％and Youden index of 0.393.SI for acid or non-acid reflux had the same optimal cut-off point of ≥30％ and presented with the similar efficacy in the diagnosis of acid or non-acid GERC.Compared with SAP of ≥75％,SIforall the refluxes of ≥45％ had a lower sensitivity (56.0％ vs 75.0％,x2 =7.988,P=0.005),a higher specificity (83.3％ vs 44.4％,x2 =5.900,P =0.015) and the comparable positive or negative predictive value in the diagnosis of GERC.The diagnostic accuracy for GERC was further improved when combining SI for all the refluxes with SAP.Conclusion SI for all the refluxes has a diagnostic value similar to SAP and its optimal cut-off point for GERC may be ≥45％.

ObjectiveTo explore the influencing factors in neoadjuvant chemotherapy on pathological complete response (pCR),by analyzing the effect of 6 cycles epirubicine combined with docetaxel(ET) regimen in breast cancer patients. MethodsFrom June 2009 to September 2011,clinical date of 52 Ⅱ,Ⅲ stage breast cancer patients treated with ET regimen for neoadjuvant chemotherapy for 6 cycles were retrospectively analyzed.The curative effect was evaluated by palpation and ultrasonography,and finally compared with postoperative pathological results. ResultsIn these 52 patients,the total pCR rate was 42.3％ after 6 cycles chemotherapy.After the first circle of chemotherapy,pCR rate was higher in patients with tumor size reducing ＞ 30％ than those ＜ 30％ as measured by ultrasonography(60.9％ vs.27.6％,P ＜0.05 ).Higher pCR rate was obtained in patients with tumor size ≤3 cm than those in which the initial tumor size ＞ 3 cm(52.9％ vs.22.2％,P ＜0.05) after 6 cycles ET neoadjuvant chemotherapy.PCR rate was higher in patients with positive HER-2 or triple negative breast cancer after 6 cycles than those with luminal type 1breast cancer ( 77.8％,75.0％ and 25.7％,respectively,P ＜ 0.05 ).Logistic regression analysis showed that tumor size and its early response to neoadjuvant chemotherapy evaluated by ultrasonography were the significant predictive factors. ConclusionsHigher pCR rate can be achieved after 6 cycles ET regimen neoadjuvant chemotherapy in stage ]Ⅱ,Ⅲ breast cancer patients.Tumor's early response to chemotherapy as evaluated by ultrasonography could forecast the pCR.Tumor size and molecular type are important influencing factors on pCR in breast cancer patients.