Objective To investigate the effects of all trans-retinoic acid (ATRA) on the expressions of iron metabolism-related genes and their products in K562 cells and the possible relationship. Methods (1) The characteristics of K562 leukemic cell differentiation induced by ATRA was evaluated by Benzidine, Wright's, NSE and NBT staining.(2) The expression levels of cellular surface antigens (CD71 and CD 13) in K562 cells cultured with ATRA were measured by flow cytometry. (3) IRP/IRE binding activity was assessed by RNA/protein band-shift assay.(4) Ferritin was determined by radioimmunoassay.(5) The mRNA expression levels of H-Fn, TfR and IRP2 in K562 cells cultured with different concentrations of ATRA were delineated by RT-PCR method, confirmed by sequencing of RT-PCR products. Results K562 cells could be induced to differentiate into neutrophils by ATRA, confirmed by cytochemical staining. The expression of CD71 decreased while CD13 increased. The mRNA expression levels of TfR and IRP2 were decreased while mRNA expression level of H-Fn was increased in K562 cells cultured with ATRA, compared to that in control cells. Concomitantly,IRP binding activity was significantly decreased but the level of ferritin was significantly increased in K562 cells cultured with ATRA. Conclusions During the course of K562 cells induction and differentiation to myelocytes by ATRA, the expression level of iron metabolism-related genes and products were changed but the upstream-regulation mechanism still remains unclear.

Objective To investigate the clinical features,recanalization after medical treatment and clinical outcome of cerebral artery dissection.Methods We reviewed the clinical records of ischemic stroke patients with cerebral artery dissection who visited the First Affiliated Hospital of Zhejiang University between October 2010 and December 2013.We recorded patients' general information,neurological deficit,imaging and clinical treatment.We followed up the patients and statistically analyzed demographic data,recanalization and clinical outcome.Results Among 28 cases of cerebral artery dissection,carotid dissection was the most common (n =19,67.9％),followed by vertebral artery dissection (n =7,25.0％),while the combination of carotid and vertebral artery dissection was rare (n =2,7.1％).In the imaging of cerebral artery dissection,wire beads and occlusion were the most common signs (n =15,53.6％),followed by rat tail sign (n =7,25.0％),aneurysmal dilatation (n =4,14.3％) and dualchamber levy (n =2,7.1％).There were 18 cases of acute cerebral infarction in the 28 studied cases,but there was no significant difference between the degree of stenosis and cerebral infarction caused by cerebral artery dissection.All patients received standard antithrombotic therapy.The difference of the recanalization rate between using anti-platelet aggregation and anticoagulant therapy was not statistically significant (5/6 vs 9/13,P =0.37).Conclusions Although cerebral artery dissection is relatively rare clinically,the typical clinical manifestations of the disease and the characteristic imaging are helpful for the diagnosis.Standardization of antithrombotic treatment is still the first-line treatment of cerebral artery dissection.

A competency dictionary of advanced health informatization application persons was compiled by inter-viewing 20 health information persons with behavior events interview , their competency characteristics were coded By Nvivo, the coding frequency and characteristics score in good performance group and ordinary group were ana-lyzed by variance analysis, which showed 8 characteristics of key competency and 12 characteristics of basic compe-tency in advanced health information application persons.

Objective To make a further understanding of mammographic features of simple cyst of the breast (SCB).Methods Molybdenum target radiographic signs in 39 cases with SCB proved pathologically and were retrospectively analyzed. Results Of the 56 SCB in 39 cases, 23 were diagnosed rightly as SCB, 10 as fibroadenoma, 2 as cancer and the remaining 4 were undefined. The diagnostic accuracy and misdiagnosis were 59.0% and 41.0% respectively. Radiograph showed round in 12, ovoid in 38, mild lobed in 4 and comet tail form in 2. The borders of cyst were distinct and sharp in 26, distinct partly and indistinct partly in 27,indistinct completely in 3. The density was homogeneous in 54 with calcifications in 2. Of the 56 SCB, the length axes of cyst were upright to chest wall in 20 and towards nipple in 18. The cysts could be transformed with pressure in 4.Conclusion Careful analysis of radiographic features of SCB is helpful for diagnosing accurately this disease.

BACKGROUND:IPS e. max Press porcelain crown has been widely used in clinical restoration because of its aesthetic effect and biological properties. OBJECTIVE:To explore the effect of IPS e. max Press porcelain crown in esthetic restoration of anterior teeth in terms of marginal adaptation and color match. METHODS:Total y 52 patients with 138 defective anterior teeth (20 males and 32 females, 18-45 years old, including 62 anterior tooth defects, 46 tooth traumas, 30 denticles) were divided into two groups randomly:treatment group (26 cases) and control group (26 cases) were given IPS e.max Press porcelain crown and conditional Co-Cr al oy handcuffed ceramic crowns, respectively. Al the cases were asked for a second visit in 1 week after restoration, and the integrity of ceramic veneer, marginal adaptation, gingival health and color match were evaluated during 6-month and 2-year fol ow-ups. RESULTS AND CONCLUSION:The degrees of satisfaction on the color, shape and adaptation in the treatment group were al higher than those in the control group (P<0.05). At 6 months after restoration, the marginal adaptation, gingival health and color match in the treatment group were al better than those in the control group (P<0.05). At 2 years after restoration, there was also a significant difference in the marginal adaptation, gingival health and color match between the two groups (P<0.05). IPS e.max Press porcelain crown has the advantages of aesthetics and biological characteristics, so it can be used as an ideal restoration method for esthetic restoration of anterior teeth.

Objective To investigate the effect of clotrimazole on apoptosis of hepatic cells after ischemia-reperfusion injury and its mechanism. Methods Hepatic ischemia-reperfusion rat model was established. Thirty-two male Sprague-Dawley rats were randomly allocated into sham-operated group, model control group, low dose clotrimazole group and high dose clotrimazole group. Apoptosis in hepatic tissue was assessed by TUNEL method. Protein expression levels of CYP3A1,Bcl-2,Bax and PARP were measured by Western blotting. Results As compared with model control group, the apoptosis rate, tissue injury,activity of plasma enzymes and the Bax/Bcl-2 expression ratio were reduced in low and high dose clotrimazole groups. The apoptotic index in both clotrimazole-treated groups was lower than that of model control group with statistically significant difference. CYP3A1 expression was significantly induced by clotrimazole compared to the sham-operated group. Conclusion Clotrimazole may inhibit apoptosis of hepatic cells by up-regulating Bcl-2 and down-regulating Bax, thus produce a protective effect on hepatic ischemia-reperfusion injury and it is also related to the inhibition of PARP shear.

Objective To explore the association between glycated hemoglobin (HbA1c) level at admission and coronary plaque characteristics under intravenous ultrasound (IVUS) study in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). Methods 118 patients with NSTE-ACS were divided into the low(HbA1c ≤ 5.6％), medium(HbA1c 5.7％-6.4％)and high(HbA1c ≥ 6.5％)level groups based on admission HbA1c. IVUS was performed in all target lesions. Results As compared with the other two groups, patients with high level HbA1c had higher mean body weight index, higher co-morbidities of diabetes mellitus, dyslipidemia and non-ST-elevation acute myocardial infarction.The high HbA1c level group had more diffuse coronary atherosclerosis ,increased plaque burden and higher rates of positive remodeling, soft plaque and plaque rupture. Conculsions The HbAlc level of admission is associated with plaque vulnerability in NSTE-ACS patients.

Objective To evaluate the efficacy and safety of intravenous itraconazole followed by itraconazole capsule.Methods An open-label,randomized,non-controlled study was conducted.Itraconazole was administered intravenously at a dose of 200 mg,q12h for the first 2 days,then once daily from the 3rd to the 14th day and followed by itraconazole capsule,200 mg,q12h for 2 to 4 weeks.Results A total of 25 patients were enrolled in the study,including 12 documented cases of invasive fungal in- fection,11 probable cases and 2 possible cases.Twenty-two patients were eligible for clinical efficacy analysis,of which 11 were cured,4 significant improved,2 improved and 5 failed.The effective rate was 68.2%(15/22),and the cure rate was 50.0%(11/22).Twenty-four strains of fungus were obtained,including 22 strains of Candida spp.and one each of Aspergil- lus and Histoplasma capsulatum.Eighteen strains of fungus were eradicated after itraconazole treatment.The eradication rate was 75.0%(18/24).In the 25 cases who received at least one dose of intravenous itraconazole,itraconazole-related or proba- bly-related clinical adverse event was reported in 3 patients,including drug fever,chest discomfort,palpitation and decreased appetite,Itraconazole-related or probably-related laboratory abnormality was reported in 4 cases.AST or ALT elevation was the most common laboratory abnormality.One patient was found to have increased blood creatinine,BUN and hemolysis.Most adverse effects were mild and tolerable except one serious adverse effect.Conclusions Intravenous itraconazole followed by itraconazole capsule therapy has good efficacy in the treatment of systematic fungal infection.The regimen is well-tolerated in most patients.

Objective:To study the relationship between the expression of carnitine palmitoyltransferase 1α (CPT1α) and progression of renal interstitial fibrosis and chronic kidney disease (CKD), and to evaluate the value of CPT1α as a biomarker in pathological diagnosis of renal interstitial fibrosis and CKD.Methods:As a retrospective cohort study, information of CKD patients dignosed with tubulointerstitial fibrosis by renal biopsy and receiving follow-up from March 1, 2010 to July 30, 2017 in the Second Affiliated Hospital of Nanjing Medical University were collected. Renal tissues were stained by immunohistochemistry to detect the expression of CPT1α protein and then divided into three groups according to the quartile of proportion of CPT1α positive staining cells, including group Q1(>67.89%), group Q2(49.84%-67.89%) and group Q3(<49.84%). The degree of renal interstitial fibrosis was measured by Masson staining and lipid deposition was represented by Bodipy staining. Messenger RNA of CPT1α and collagen as well as other extracellular matrix genes were detected by real time-PCR. Relationships between proportion of CPT1α positive staining cells and renal interstitial fibrosis and renal function were analyzed by linear regression analysis. The relationship between CPT1α positive cell number ratio and renal function progression was measured by Pearson correlation analysis and generalized linear model. The effect of lipid-lowering medicine on renal function of CKD patients was analyzed by paired comparative analysis.Results:Ninety patients with CKD were included in this study. Renal interstitial fibrosis and lipid droplets deposition area increased in Q2/Q3 group compared with Q1 group by Masson and Bodipy staining (all P<0.05). Messenger RNA level of extracellular matrix-related proteins increased in Q2/Q3 group by real time-PCR than those of Q1 group (all P<0.05). Linear regression analysis showed that fibrosis area was negatively correlated with the proportion of CPT1α positive staining cells ( r=-0.309, P<0.01). The baseline expression of CPT1α in renal issues was negatively related with serum creatinine (Scr) ( r=-2.801, P<0.001), positively related with estimated glomerular filtration rate (eGFR) ( r=1.240, P<0.001). After a medium follow-up of 3.47 years, CPT1α positive cell number ratio was positively correlated with eGFR change rate by Pearson analysis ( r=0.220, P=0.038). Paired stratified analysis showed that taking lipid-lowering medicines attenuated the decrease of eGFR in Q2 group and Q3 group but not in Q1 group (both P<0.05). Conclusions:The decline of CPT1α in renal tissues of CKD patients is associated with the increase of Scr, the decrease of eGFR and renal interstitial fibrosis. CPT1α is a promising molecular marker to evaluate the degree of renal fibrosis and the progression of CKD.

Objective:To explore CT and MRI features of the endolymphatic sac tumor (ELST).Methods:The CT and MRI morphology confirmed by surgical pathology for 19 patients with ELST were retrospectively analyzed from June 2011 to May 2019 in Eye & ENT Hospital of Fudan University. The features of CT and MRI included location, size, adjacent structures invasion, CT values, bone destruction, features of T 1WI and T 2WI, enhancement distribution characteristics, dynamic enhancement curve morphology, DWI signal characteristics. The ADC values of the lesions and ipsilateral medial pterygoid muscles were compared using a paired t test. Results:Nineteen ELST patients (one with bilateral diseases) were included. Totally 20 ears (right 9 and left 11) of 13 females and 6 males were studied. The masses with slightly high-density and obscure boundary were located around the vestibular aqueduct at the posterior edge of the petrosal bone. Bone destruction involved mastoid process of the middle ear (16 ears), jugular foramen (11 ears), semicircular canal (10 ears), facial nerve canal (7 ears) and internal auditory canal (9 ears). A large amount of residual bone could be found in the interior of nineteen masses. The CT value was (78.6±21.9) HU. The lesion showed central iso-intensity and peripheral hyperintensity on T 1WI and T 2WI in 16 ears, while no obvious hyperintensity on T 1WI in the other 4 ears. The hyperintensity on T 1WI was around the margin of the lesion in 10 ears, situated at lateral side in 5 ears and all over the lesion in 1 ear. Flow voids signals could be seen in 9 ears as well. Liquid-liquid plane was seen on T 2WI in 2 ears. The solid mass portion which showed iso-intensity on both T 1WI and T 2WI presented marked enhancement on contrast-enhanced T 1WI, while other part of the mass no enhancement. DWI of 14 ears illustrates no evidence of restricted diffusion, and the ADC value [(1.25±0.08)×10 -3 mm 2/s] was slightly higher than that of the medial pterygoid muscles ( t=4.437, P=0.001). The style of time-signal intensity curves of the dynamic contrast-enhanced MRI was rapidly ascending followed by descending curves in 2 ears. Conclusion:Imaging findings of ELST have some characteristics, including located around the vestibular aqueduct at the posterior edge of the petrosal bone, bone destruction, peripheral hyperintensity on T 1WI and no restricted diffusion, which is helpful for its diagnosis.