Objective To improve the diagnostic accurate rate by studying best values of chest posterior-anterior digital medical images in soft-copy reading. Methods 100 normal adults’ chest posterior-anterior digital medical images in recent 10 days in our hospital were randomly chosen. Five specialists of our department were invited to see these images by soft-copy reading and the best WW/WL values of different parts of the chest they selected were recorded. All the data were analyzed in statistics and the best WW/WL was got. Results The best WW/WL values of soft tissues of chest wall were 2 083/4 840,ribs 2 667/4 908,lung fiber 2 067/4 960,hilum of lung 1 848/5 130,heart and large vessels 2 206/5 438,mediastinum and diaphragm 2 180/5 530,thoracic vertebrae 1 471/5 801,ribs that covered by heart and diaphragm1 428/5 975. Conclusion Different parts in chest poster -anterior digital medical images need special WW/WL in soft-copy reading for better diagnosis of images.

A study on the microbial transformation of glycyrrhetinic acid (GA) was conducted by a fungus, Cunninghamella blakesleeana CGMCC 3.970 systematically. After incubation with the cell cultures of C. blakesleeana CGMCC 3.970 at 25 degrees C for 7 days on a rotary shaker operating at 135 r x min(-1), GA was converted into one major product and five minor products. The products were extracted and purified by solvent extraction, macroporous adsorbent resin, silica gel column chromatography, and semi-preparative RP-HPLC chromatography. Their structures were identified as 3-oxo-15α-hydroxy-18β-glycyrrhetinic acid(1), 3-oxo-15β-hydroxy-18β-glycyrrhetinic acid (2), 7β,15α-dihydroxy-18β-glycyrrhetinic acid (3), 3-oxo-7β, 15α-dihydroxy-18β-glycyrrhetinic acid (4), 7β-hydroxy-18β-glycyrrhetinic acid(5) and 15α-hydroxy-18β-glycyrrhetinic acid(6) by the analyses of MS, 1H-NMR and 13C-NMR spectroscopic data respectively. Among them, 2 was a new compound. These results suggest that C. blakesleeana CGMCC 3.970 has the capability of selective ketonization and hydroxylation for GA. [Key words] glycyrrhetinic acid; Cunninghamella blakesleeana CGMCC 3. 970; microbial transformation
Biotransformation ; Cunninghamella ; metabolism ; Glycyrrhetinic Acid ; analogs & derivatives ; chemistry ; metabolism ; Molecular Structure ; Spectrometry, Mass, Electrospray Ionization

Objective To compare the difference of the clinical efficacy on post-stroke shoulder-hand syndrome treated by acupuncture at stellate ganglion and by conventional acupuncture. Methods Ninety cases of post-stroke shoulder-hand syndrome ( at stageⅠ or stageⅡ) were randomized into treatment group and control group, 45 cases in each group. Both groups received basic rehabilitation training. Additionally, the treatment group received acupuncture at the bilateral stellate ganglions of the neck, with reducing acupuncture by rotating the needles. The control group received the conventional acupuncture on Jiquan ( HT 1) , Chize ( LU 5) , Jianyu (LI 15), Quchi (LI 11), Shousanli (LI 10), Hegu (LI 4), with reducing acupuncture by lifting and thrusting the needle on Jiquan ( HT 1) and Chize ( LU 5) , and with mild reinforcing and reducong acupuncture on the other acupoints. The treatment for both groups was given once every day, and 14 times in total. The total syndrome scores, visual analogue scale (VAS) scores, modified Fugl-Meyer Assessment of motor function scale (FMA) scores, and modified Barthel index (MBI) were observed to evaluate the changes of symptoms, pain and motor function of the upper limbs, and activity of daily life before and after treatment in the two groups. The clinical efficacy was also compared between the two groups. Results The total syndrome scores, VAS scores, FMA scores and the modified Barthel index were improved apparently after treatment in the two groups (all P<0.01), and the improvement in the treatment group as more obvious (all P<0.01) . The total effective rate was 93.33% (42/45) in the treatment group, which was better than 73.33% (33/45) in the control group ( P<0.05) . During the treatment, patients of both groups had good compliance, and all completed the trial. No obvious adverse reaction was found in the two groups. Conclusion Acupuncture at stellate ganglion is effective and safe for the treatment of post-stroke shoulder-hand syndrome, and it has higher efficiency than the conventional acupuncture.

Objective To research the significance of application of clinical nursing pathway in patients undertaking glossectomy and forearm flap reconstruction.Methods Sixty patients with tongue cancer who undertook glossectomy and forearm flap reconstruction were enrolled.The patients were randomly divided into the experimental group and the control group (30 cases in each group).The patients of the experimental group received nursing following clinical nursing pathway,and the patients in the control group received routine nursing service.The patients and doctors satisfaction evaluation were compared between the two groups with a self-designed nursing quality evaluation form.The qualities of care achieved in 2 groups were compared.Results It took less in-ward time and expenditure in the experimental group compared with the control group.The quality of care,the satisfactory degree of patients and doctors in the exipermental group were significantly higher than those of the control group.Conclusions The establishment and application of the clinical nursing pathway in patients undertaking glossectomy and forearm flap reconstrucition contributes to improve the satisfaction of patients and doctors and the quality of nursing service.

Objective To investigate the effects of endothelin-1 on the proliferation of HCT-116 cells. Methods The expression of endothelin-1 and endothelin receptors A and B in the HCT-116 cells was detected by RT-PCR and immunohistochemistry method.The effects of endothelin-1 at different concentrations and action time points on HCT-116 cells were measured by MTT assay and were analyzed by variance analysis.Results The expression of endothelin-1 and endothelin receptors A and B at the gene and protein levels in HCT-116 cells was detected.Endothelin-1 had significant effects on the proliferation of HCT-116 cells.The proliferation peak of HCT-116 cells was reached when the concentration of endothelin-1 was 1×10-7mol/L and the action time was 48 hours.Conclusions Endothelin-1 promotes proliferation of HCT-116 cells in a dose-and time-dependent manner,and the process is mediated by endothelin receptors.

Objective To investigate whether fasting obestatin level is different in patients with impaired glucose tolerance or type 2 diabetes, and to explore the association between obestatin and lipid metabolism. Methods Eighty-four subjects without known diabetes were divided into three groups: normal glucose tolerance(NGT), impaired glucose tolerance (IGT) and type 2 diabetes (DM) Plasma obestatin levels were measured with a radioimmunoassay. The relationship between fasting obestatin levels and metabolic parameters was also analyzed. Results Fasting obestatin levels were lower in DM group [(2.82±0.78)ng/ml] and IGT group [(3.25±0.29)ng/ml] than in NGT group[(3.55±0.57) ng/ml, P＜0.01]. Triglycerides and low density lipoprotein cholesterol levels gradually increased among the three groups (P＜0.05). Multiple linear regression analysis revealed fasting obestatin level was independently associated with waist-to-hip ratio, triglyeride and low density lipoprotein cholesterol. The regression equation was obestatin=6.953-3.412×W/H-0.175×TG-0.123×LDL-C. Conclusions The decreased obestatin may be associated with IGR and T2DM, and obestatin level may be associated with lipid metabolism.

Objective To study the method and clinical value of preservation of intercostobrachial nerve( ICBN) by fat dissolving meth-od during breast cancer operation. Methods The clinical data of 50 cases withⅠ~Ⅲa stage breast cancer from January 2013 to June 2013 were analyzed. Fifty patients were randomly divided into two groups,there were 26 patients in preservation group,whose ICBN were preserved by fat dissolving method during axillary lymph nodes dissection,and 24 patients in resection group,whose ICBN were not preserved by routine method during axillary lymph nodes dissection. Comparison of operation times,bleeding volume,the number of axillary lymph nodes dissection and upper arm sensory function of patients after operation between both groups was done. Results The mean time of operation was (102. 3 ± 15. 6) min in preservation group and(95. 6 ± 12. 4) min in resection group,while the number of axillary lymph nodes dissection was (19. 5 ± 8. 8 ) in preservation group and ( 19. 2 ± 9. 5 ) in resection group, with no significant difference between both groups (P>0. 05). Bleeding volume was (51. 2 ± 11. 5)mL in preservation group and (98. 5 ± 13. 4)mL in resection group,with significant differ-ences(P<0. 05). After postoperative one month,we observed upper arm sensory function of patients. It showed that 3 cases of sensory numb-ness or pain occurred in preservation group (11. 5%),20 cases of sensory abnormality occurred in resection group (83. 3%),mainly as sen-sory loss,numbness,pain or burning sensation,there was significant difference between both groups (P<0. 05). All patients were followed up half a year,patients with sensory abnormality in preservation group recovered,and recovery in resection group was not obvious,it still showed sensory abnormality in varying degrees. During the follow-up,no local recurrence or distant metastasis was found in both groups. Conclusion Preserving intercostobrachial nerve by fat dissolving method in breast cancer operation is based on conventional operation and made a few of improvements. It is simple and feasible. During the operation,we find that the axillary neurovascular is clearer,preservation of ICBN is easier. It does not affect the axillary lymph node dissection and operation time,while it can reduce incidence of postoperative sensory abnormality and improve the quality of life of patients,therefore it is worthy of clinical application.

Objective To observe the clinical efficacy of thread embedding at Back-Shu points in treating stroke-associated pneumonia.Method Seventy patients with stroke-associated pneumonia were randomized into a treatment group and a control group, 35 cases in each group. The control group was intervened by regular medications, while the treatment group was additionally intervened by thread embedding at the Back-Shu points. Before and after the intervention, C-reactive protein (CRP), white blood cell (WBC), neutrophil ratio (NE%), and symptoms and signs scores were observed, and the clinical efficacies were compared between the two groups.Result The CRP, WBC, NE%, and symptoms and signs scores were significantly changed after intervention in both groups (P<0.05). After intervention, the CRP, WBC, NE%, and symptoms and signs scores in the treatment group were significantly different from that in the control group (P<0.05). The total effective rate was 91.4% in the treatment group, versus 82.9% in the control group, and the difference was statistically significant (P<0.05).Conclusion Thread embedding at the Back-Shu points can promote the treatment of stroke-associated pneumonia.

Objective To discuss the important role of undergraduate students' social practice in medical education.Methods Questionnaires on social practice activity were answered by medical students,and the characteristics and shortages of social practice were analyzed.The development policy was proposed after expert inquiry and comparison with other universities. Results Undergraduate students' social practice in School of Medicine,Shanghai Jiaotong University presentd the four characteristics: positive participation,obvious characteristic,abundance items,and wide range of services.But there were insufficiencies in form of action,multiplication of selected topic,socialized operation method,and time arrangement. Conclusion The results suggest that further improvement is necessary in the service quality,advance in the activities' pertinence,development in innovation ability,and enhancement in base construction and support system.

Objective To evaluate the sufentanil-sparing effect of ketorolac tromethamine for postoperative analgesia in the elderly patients.Methods Sixty ASA Ⅱ or Ⅲ patients,aged ≥ 65 yr,with a body mass index of 18-24 kg/m2,undergoing elective gynecological operations,were randomly divided into 2 groups(n =30 each):sufentanil group(group S)and ketorolac tromethamine plus sufentanil group(group T).Both groups received combined intravenous-inhalational anesthesia and patient-controlled intravenous analgesia(PCIA)after operation.PCIA solution contained ketorolac tromethamine 180 mg and sufentanil 100 μg in 100 ml of normal saline in group T.After a loading dose of ketorolac tromethamine 30 mg was injected intravenously at 15 min before the end of operation,the PCA pump was set up with a 1.6 ml bolus dose,a 20 rain lockout interval and background infusion at a rate of 1.5 ml/h in group T.PCIA solution contained sufentanil 100 μg in 100 ml of normal saline in group S.After a loading dose of sufentanil 5 μg was injected intravenously at 15 min before the end of operation,the PCA pump was set up with a 1.6 ml bolus dose,a 20 min lockout interval and background infusion at a rate of 1.5 ml/h in group S.The effective analgesia(postoperative VAS scores at rest and during activity ＜ 3)was maintained within 48 h after operation.The amount of sufentanil consumed within 48 h after operation and adverse effects were recorded.Results Compared with group S,the amount of sufentanil consumed within 48 h after operation was significantly reduced,and the incidence of nausea and vomiting,urinary retention and pruritus was significantly decreased in group T(P ＜ 0.05).Conclusion Ketorolac tromethamine used with PCIA with sufenlanil has a significant sufentanil-sparing effecl for posloperative analgesia and improves the safety of analgesia in the elderly patients.