Objective To explore the effects of insulin-like growth factor-l (IGF-l),insulin-like growth factor binding protein-1 (IGFBP-1) and growth hormone (GH) on the generation, development and treatment of diabetes chronic complications. Methods 20 healthy controls,10 type 1 diabetes mellitus patients and 62 type 2 diabetes mellitus patients were enrolled into the study. IGF-1, IGFBP-1, GH, HbAlc. serum insulin (INS) and serum C-peptide (C-P) were measured. Results ①Serum level of IGF-1 was obviously lower in the diabetes mellitus group than that in controls (type 1 P＜0. 05,type 2 P＜0. 05). ②Serum level of IGFBP-1 was significantly higher in type I diabetes mellitus than that in controls (P＜0. 05),and it was obviously lower in type 2 diabetes mellitus with obesity and hyperinsulinism than that in contris (P＜0. 05). ③Serum level of GH was higher in type 1 diabetes mellitus than that in controls (P＜0. 05 ) and was not significantly different from that in controls (P＞0. 05). ④The level of IGF-l was higher in diabetes nephropathy (DN) patients and diabetes retinopathy (DR) patients than that in controls (P＜0. 05). ⑤The level of IGF1 was negatively correlated with HbAlc (P＜0. 01, type 1r=- 0.73, type 2r=-0. 62). Conclusion Measurement of IGF-1, IGFBP-1 and GH may play an important role in diabetes chronic complications,especially in the generation,development of diabetic microvascular.

Objective The purpose of this study was to explore the lived experience of infertile women who terminated treatment after in vitro fertilization (IVF) failure. Methods Using a qualitative research de-sign, 12 subjects were recruited who had experienced IVF failure for many times. Data were collected through deep interviews, and analyzed using interpretive research strategies of phenomenology. Results Informed consent was obtained from each subject. There were four themes of lived experience which emerged from the data: frustration, high pressure, giving up pregnancy, and replaning the future. Conclusions Infertile women who received in vitro fertilization treatment will eventually accept the reality and mark out their future life after experiencing hustrated sense and various pressure by failure treatment.Nurses should give more loving care and persuasion during this process.

Objective To analyze clinical manifestation,diagnosis and treatment of 8 patients with gas gangrene in Wenchuan earthquake.Methods Eight patients with gas gangrene in Wenchuan earthquake were selected for analysis on their clinical manifestations.We finally diagnosed gas gangrene based on patients'clinical manifestation and the cultured ciostridium in the focus of infection.All the patients were treated with antibiotics,repeated surgical debridement,hyperbaric oxygen and nutritional support.Results Most patients had no erepitation of the extremities but found gas in interstice of tissues identified by X-ray,B-ultrasound and CT scanning.Film preparation of efflusion of all patients showed clostridium and bacterial culture manifested mainly perfringens.Most patients were demonstrated to be with polyinfection.In addition,all patients were characterized by pitchy necrotic tissues,effusion,systemic decrease of red blood cells,increase of white blood cells and platelet.No death or amputation occurred under active combined therapy.Conciusions Earthquake induces mainly open trauma often combined with mixed infection,when gas gangrene is one of main special infections.The predominant combined therapies include utility of antibiotics and thorough surgical debridement,while hyperbaric oxygen and nutritional support are important and effective adjunctive therapies.

Objectives To investigate the clinical features of clomiphene citrate (CC) resisitant in patients with the polycystic ovary syndrome(PCOS). Methods A total of 145 women with PCOS were analyzed in the center for reproductive medicine of our hospital. According to the responses to CC ,patients were divided into two groups:(1)the CC resistant group(n = 32),(2)the CC response group(n = 113). The clinical features were compared between these two groups. Results (1)Body weight,body mass index(BMI),blood pressure and F?G scores were significantly higher in the CC resistant group than those in the CC response group (P < 0.05, respectively).(2)Basic antral follicle counts(AFC),C reaction protein(CRP),fasting insulin(FI)and HOMA?IR in the CC resistant group were significantly higher than those in the CC response group (P < 0.05, respectively),however,no significant difference was observed in sex hormones between these two groups. Conclusion PCOS patients with CC resistant are more likely to have higher body weight,BMI,blood pressure, insulin resistant?indexes and basic AFC ,the clinical doctors should consider these features before the treatment of ovulation induction.

BACKGROUND:Study confirmed that the de-epidermized dermis(DED)can be used as dermal substitute and may form epidermal structure after incubating keratinocytes.However,the cell biological activity,tissue structure characteristics and the basement membrane component analysis of dermal substitute have been reported less.OBJECTIVE:To investigate the cell activity and the tissue structure characteristics of DED.METHODS:Skin flap was treated with 56℃ phosphate buffered solution to remove the epidermis,and the dermal cell components were deleted by freezing and thawing with liquid nitrogen to obtain DED.The DED cell activity was detected with tissue culture method,hematoxylin nuclear staining was used to determine the DED cell nuclei,and vimentin immunohistochemistry was applied for fibroblast determinations.The basement membrane and its components were detected using Periodic Acid-Schiff staining and collagen type Ⅳ immunohistochemistry.Van Gieson stain,Weigart stain and those double staining were respectively used to determine DED collagen fibers and elastic fibers.The DED ultrastructure was observed under transmission and scanning electron microscope.RESULTS AND CONCLUSlON:Using tissue culture method,the cultured DED did not exhibit cell growth at 2 weeks.Hematoxylin-eosin staining showed no nuclear in DED,vimentin immunohistochemistry showed no vimentin expressed in DED.Van Gieson staining showed DED collagen fibers were stained as rose red,Weigert staining showed DED elastic fibers were stained as pu rplish black double staining further demonstrated uniform arrangement of collagen fibers and elastic fibers.DED surface and the remaining appendages were strongly positive for Periodic Acid-Schiff staining,and type Ⅳ collagen expression was significant.Transmission and scanning electron microscope results showed that,the DED elastic fibers and collagen overlap arranged with pore intervals,they intercrossed into a network.There is no living cell component in DED,dermal matrix surface and appending organ luminal wall still retain glycogen,type Ⅳ collagen and other basement membrane components,dermal matrix is rich in collagen and elastic fibers.it is a three-dimensional collagen matrix similar to in vivo dermis.

AIM: To explore the mutual effect of co-culture of wild-type astrocytes (ASC) and motor neurons VSC4.1 (VSC) on the respective ability to produce reactive oxygen species (ROS). METHODS: The inhibition rates of cell growth in ASC and VSC in co-culture or independent culture was detected after exposed to excitatory stimulus by MTT method. Real-time observation of ROS production by ASC and VSC labeled with Hoechst 33342 was detected by confocal microscopy under the conditions of co-culture or independent culture. RESULTS: Higher concentration of glutamate induced a higher inhibition rate in mixed cell growth than that in ASC alone, while lower concentration of glutamate induced a higher inhibition rate in mixed cell growth than that in VSC only. Real-time observation by confocal microscopy showed that ROS production by VSC under the condition of co-culture, which showed a notable increase at 15 min, was significant less than that in independent culture, which peaked at 5 min and was gradually decreased. ROS production by ASC in co-culture began to increase significantly at 10 min. CONCLUSION: Compared to independent culture, ASC reduces the resting ROS production by co-cultured with VSC, while ASC prolongs the duration of ROS production by VSC after exposed to excitatory stimulus.

Objective To investigate the lipid profiles of patients with primary Sjogren's syndrome (pSS) and to analyze the correlation between abnormal serum lipids and the inflammationsof SS. Methods One hundred and fourteen pSS patients and 20 gendermatehed healthy controls were studied. Serum lipids were measured in both groups. Results There was statistically significant difference between SS and healthy controls, and the serum HDL-c and apoA<,1 concentrations were significantly lower in patients (P<0.05). The incidence of abnormal serum lipids was 39.5% in these patients. Patients with abnormal lipids had longer course of disease, higher ESR level, lower salivary flow rate and more frequent parotid gland enlargement than those without abnormal lipids(P<0.05). Logistic regression analysis revealed statistically significant association between serum lipids levels and occurrence of parotid gland enlargement. Conclusion Findings from this study suggest that patients with SS have altered lipid profiles and the decrease of apoA, and HDL-c levels may be the correlated factors of SS. The inflammation of SS may cause changes in lipids metabolisms.

Considering the weak relevance between the stages of C,D,I and O and the weak operability of CDIO theory in teaching,mind map is introduced into CDIO theory to drive medical English teaching.Firstly,how mind map and CDIO theory are mutually complementary is discussed,based on which,along the main clue of CDIO theory,a further discussion is carried out from four levels:conceiving the main structure and content of a passage,designing sentence teaching,implementing vocabulary memorization and operating self-directed learning,all with mind map as an assistance.Moreover,specific cases are used to exemplify how mind map is applied to CDIO medical English teaching.Using.mind maps in CDIO medical English teaching is highly coherent and operable.It helps to integrate the four stages of C,D,I and O and enhances teaching quality and learning efficiency.

BACKGROUND: The primary qualification of peripheral blood stem cell transplantation (PBSCT) is the effective mobilization and harvesting of hematopoietic stem cells. The mobilization efficacy is closely related to the selection of high-efficacy low-toxicity regimen, the timing of mobilization and harvesting as well.OBJECTIVE: To investigate the efficacy of mitoxantone (MIT) combined with high-dose arabinosylcytosin (Ara-C),followed by granulocyte colony-stimulating factor (G-CSF) alone or combination of G-CSF and granulocyte-macrophage colony-stimulating factor (GM-CSF) on mobilizing PBSCs in patients with hematological malignancies and solid tumors.DESIGN: Controlled study with observation.SETTTNG: Department of Hematology, the Affiliated Hospital of Xuzhou Medical College.PARTICIPANTS: Forty-two patients with hematological malignancies and solid tumors admitted to Department of Hematology, Xuzhou Medical College from September 1998 to December 2006 were involved in this study. They were diagnosed according to FAB classification criteria and new WHO proposals. The involved patients, 25 male and 17 female, averaged 29 years ranging from 7 to 54 years and weighted (52±18) kg. Among them, 12 were patients with acute myeloblastic leukemia, 6 were patients with acute lymphoblastic leukemia (ALL), 1 was patient with chronic granulocytic leukemia (CGL) at chronic phase, 15 were patients with non-Hodgkin lymphoma (NHL), 4 were patients with Hodgkin lymphoma (HL), 2 was patient with multiple myeloma (MM), 2 were patients with advanced breast cancer. All the patients apprcached to or got complete remission after conventional chemotherapy. No tumor cell infiltration was observed in bone marrow cytological examination. The functions of the main organs such as heart, lung, liver and kidney,and so on, were normal. The patients underwent an average of 8-course chemotherapy before the mobilization. Informed consents of all the patients were obtained.METHODS: MIT was intravenously injected at 10 mg/(m2·d)for 2 to 3 days, then Ara-C was also intravenously injected at 2 g/m2 every 12 hours for 1 to 2 days. When white blood cell (WBC) count recovered from the lowest value, 5 to 7.5 μg/ (kg·d)G-CSF was applied in 20 patients for 3 to 5 days successively. And 5 to 7.5 μg/ (kg·d)G-CSF and 5 to 7 μ g/(kg·d)GM-CSF were applied in another 22 patients at 6:00 in the morning and in the evening, respectively. PBSCs harvesting started when WBC ＞ 2.5×109 L-1, especially when CD34+ cells≥ 1%,WBC was doubly increased. Autologous peripheral blood mononuclear cells (MNCs) were collected with CS3000 plus blood cell separator for detecting the level of CD34+ cells and T lymphocyte subsets. CFU-GM assays were performed in a methyl-cellulose-based clonogenic assay.① MNCs mixed with FITC-labeled CD34+, CD3 and CD8 monoclonal antibodies as well as CD4 PE-labeled CD monoclonal antibody at 4 ℃ for 30 minutes. 5×105 cells were determined, and CD3 and CD34+ levels, CD4/CD8 were determined by flow cytometer.Colony forming unit-granulocyte macrophage (CFU-GM) was determined with methyl cellulose. ② Related adverse reactions were observed after operation. ③ Aiming to different types of diseases,autologous PBSCs were back infused 36 to 48 hours after pre-disposal treatment. MNCs count and trypan-blue drying were done. Levels of CFU-GM and CD34+ cells were determined after unfreezing.MATN OUTCOME MEASURES: ① Changes in CD34+ cells and T lymphocyte subsets before and after mobilization. ② Postoperative related adverse reactions. ③ Back perfusion volume of autologous PBSCs (MNCs count, the number of CFU-GM and CD34+ cells).RESULTS: Forty-two involved patients participated in the final analysis. ① Changes in CD34+ cells and T lymphocyte subsets before and after mobilization: Without using hematopoietic growth factors (HGF), the percentage of CD34+ cells in peripheral blood of the patients was (0.054±0.032)%. After using G-CSF/GM-CSF treatment, it was (1.82±0.76)%,which was obviously increased compared with that of without using HGF (P ＜ 0.001). The CD34+ cells and CFU-GM yields of 22 patients in C-CSF plus GM-CSF combination group [(8.76±3.39)×106/kg, (3.52±1.33)×105/kg, respectively]were significantly higher than those of 20 patients in G-CSF alone group [(6.12±2.11)×106/kg, (2.03±1.07)×105/kg,respectively (P ＜ 0.05)]. There were no obvious changes of T lymphocyte subsets in the patients when using G-CSF/GM-CSF for some days except that CD34+ cells increased gradually (P ＞ 0.05). ② Postoperative related adverse reactions: Ⅱ to Ⅲ degree hair-loss was seen in all the patients. Blood platelets dropped to (54.43±26.14)×109 L-1 at different degrees. Infective fevers (37.8 ℃ to 41.0 ℃) occurred in 21 patients. But they were controlled in short term after antibiotics treatment. All the side effects of G-CSF and GM-CSF were mild and reversible, easily controlled with paracetamol or steroids. Bone pain (mainly in lumbosacral region) occurred in 13 patients when WBC went up quickly. ③ Back perfusion volume of autologous PBSCs: PBSCs were cryopreserved at -80 ℃ without program control for 2.0 to 6.5 months. The cell recovery rate was (88.7±7.4) %. Trypan blue exclusion rate was (92.1±5.5) %. The back perfusion volume of MNCs, CD34+ cells and CFU-GM yields were (5.21±2.44)×108/kg, (6.89±3.55)×106/kg, (2.58±2.33)×105/kg,respectively. ④Circulation blood volume were 10 to 16 L (end-point separation blood volume were all above trebling TBV). Hematopoiesis was well reconstituted in 40 patients received autologous PBSCT.CONCLUSTON: MIT and high-dose Ara-C chemotherapy combined with both G-CSF alone and G-CSF plus GM-CSF can safely and effectively mobilize autologous PBSCs, while G-CSF plus GM-CSF is superior to G-CSF alone.Large-volume leukapheresis is an important method to enhance the productive rate of stem cells and decrease the times of harvesting.

Objective To investigate the feasibility and effect of synchronization imaging technology of 64-slice spiral CT on urography and angiography(CTUA).Methods 36 adult patients with urinary symptoms that apply for the conventional CTU were selected. Exclusion of iodine allergy,serious heart,liver and renal insufficiency,multiple myeloma,long-term diabetes,hyperthyroidism,etc.All patients were placed intravenous tube.100 mL iohexol(300 mg I/mL),divided into 40-60 mL and 35-40 mL,shall be injected respectively by interval about 25-45 min,and the corresponding injection rate was 2-2.5 mL/s and 3.5-4.0 mL/s.About 20-30 s after the second injection,scan urinary tract for a quick CTUA source image,then scan urinary tract again for a quick source image of CTU with 5 min delay.Two groups of data with reconstruction technique(including MPR,MIP,VR etc.)should be read and diagnosed independently and double-blinded by two doctors with many years'experience in CTU.They also need to evaluate the image quality of the kidneys,urinary tracts and renal vessels,and make a statistical analysis to judge whether the CTUA inspection technique was feasible and effective.Results CTUA was good at showing renal parenchyma,ureters,urinary bladder and renal vessels,and the display rate was respectively:0.83,0.916,1,0.806,by contrast,the conventional CTU was 0,0.972,1,0,accordingly.Compared with the conventional CTU,CTUA was obviously different from the CTU,especial in displaying the distinction between renal cortex and medulla,renal vessels,and CTUA was better than the conventional CTU.While in display of ureters and urinary bladder,they had no difference,both show good.Conclusion CTUA inspection technology is superior to the conventional CTU technique,and using a routine dose contrast medium with twice bolus injection and one scanning can provide information such as the kidneys,urinary tract and renal vessels.