Objective To investigate the clinical effectiveness of procedure for prolapse and hemorrhoids(PPH)in the treatment of outlet obstructive constipation caused by moderate and severe recto-cele. Methods A total of 48 patients with moderate or severe rectocele were treated with PPH. Patients were followed up for 4 ~ 6 months. The preoperative and postoperative parameters from rectoanal manome-try were compared and analyzed. Results After the surgery,patients had loose stool for 1 ~ 2 times a day. Sense of defecation obstruction in all patients was obviously improved. After the surgery,there were no significant changes in rectum resting pressure,anal resting pressure and various rectal sensitivity( P >0. 05). However,the decrease of inside rectal pressure and residual anal pressure were significantly re-duced(P < 0. 05). Conclusion The subjective defecation feeling of postoperative patients with PPH is unblock. Objective results of rectoanal manometry is clearly improved and the function of the rectum and anal canal is obviously restored.

Objective: To explore the therapeutic effects of immediate breast reconstruction after modified radical mastectomy of breast cancer with nipple-areolar complex preservation and partial skin-sparing. Meth- ods- We studied 24 eady stage breast cancer patients who received immediate breast reconstruction after modified radical mastectomy with nipple-areolar complex preservation and partial skin-sparing. Nine patients had silicone prosthesis, 3 patients had transverse rectus abdominis myocutaneous flap (TRAM), and 12 pa-tients had silicone prosthesis combined with part of latissmus dorsi-myocutaneous flap (LDMF). The effects of breast reconstruction were evaluated according to objective and subjective criteria after surgery. Results: All of the 24 patients obtained successful breast reconstruction. The appearance of the reconstructed breast was perfect and the two sides seemed symmetrical. The aesthetic outcome was good in 23 patients and satisfacto-ry rate was up to 95.83%, and the subjective evaluation was up to 100%. Necrosis of part of the nipple was found in only one case. Hematoma appeared in one patient and vanished after 3 months. All patients received adjuvant chemotherapy after surgery. No local recurrence and distant metastasis occurred during the follow up period (5～48 months). One patient died of primary hepatic carcinoma at 2 years after surgery. Conclusion:Immediate breast reconstruction after modified radical mastectomy of breast cancer with preservation of nip-ple-areolar complex and partial skin-sparing is safe and effective for early stage breast cancer patients. The reconstructed breast is satisfactory. Breast reconstruction surgery is economical and can reduce patients' psy-chological pressure due to loss of the breast, and improve quality of life. Immediate breast reconstruction does not affect postoperative adjuvant therapy and long-term therapeutic effect. Breast reconstruction surgery has been gradually accepted by more and more eady stage breast cancer patients.

Objective To study the clinical characteristics and treatment of adult patients with tsutsugamushi disease in Nantong area,and to reduce the misdiagnosis and missed diagnosis.Methods Clinical data of 24 adult patients with tsutsugamushi disease who were admitted between 2010 and 2012 at Department of Emergency Medicine in Affiliated Hospital of Nantong University were reviewed retrospectively.The patients were 13 males and 11 females who were aged from 25 to 70 years old.Minocycline capsule was orally administrated as the mainstay of the therapy.Results All of the 24 cases of tsutsugamushi disease were presented with fever,predominantly with high fever.The body temperature of higher than 39 ℃ was recorded in 23 cases,and temperature of 38.0 ℃ to 38.9 ℃ was recorded in one case.Three cases complained with sore throat and cough,and 1 case with palpitation and chest distress.One eschar or ulcer was seen in 21 cases,2 eschars or ulcers only in 1 case.Twenty-one cases were presented with lymphadenopathy,11 cases with rash,3 cases with enlargement of the liver,and 4 cases with splenomegaly.The distribution of eschar or ulcer included inaxillary fossa,groin,external genitalia and crissum,waist,popliteal fossa,the lower edge of the female breast and skin folds of chest wall,the inside of the wrist,ankle,neck,retroauricular region,chest-back and the buttocks.The white blood cell count of (2.5-3.9) × 109/L in blood routine test was seen in 4 cases,(10.1-18.6) × 109/L in 3 cases.The blood platelet count was decreased in 1 case.Urinary protein was positive in 4 cases by urine routine examination.Blood biochemical examination revealed that elevated serum alanine aminotransferase was seen in 2 cases,elevated serum creatinine was in 1 case,mildly elevated cardiac troporin I was in 1 case,increased C-reactive protein was found in 19 cases.On Weil-Felix test,17 cases showed OXk titers of 1∶160-1∶320.Four cases showed an increase in overall lung markings,localized pulmonary infiltration shadow and even small pleural effusion on chest radiography.Electrocardiogram showed premature ventricular beats and slight ST segment changes in 2 patients.Oral minocycline showed obvious effect.Conclusions The clinical manifestations of tsutsugamushi disease can be variable.Multi organ dysfunction could be presented besides fever.The skin eschar and ulcer are the most pathognomonic for this disease and thus should be thoroughly examined for its presence to avoid misdiagnosis.

Objective To investigate the influence of truncated apoptosis inducing factor (AIFΔ1-480 ) on the proliferation and invasion of MCF-7 cells,and to clarify the possibility of promoting cancer gene-radiotherapy. Methods The human breast cancer MCF-7 cells were transfected with AIFΔ1-480 recombinant expression vector pcDNA3.1-Egr-1-AIFΔ1-480 (pE-AIFΔ1-480 )mediated by Egr-1;24 h after 2 Gy X-ray irradiation,MTT assay and Transwell invasion assay were performed to measure the changes of cell proliferation and invasion.The MCF-7 cells were diveded into normal control,pcDNA3.1,pE-AIFΔ1-480 ,2 Gy irradiation and pE-AIFΔ1-480+ 2 Gy irradiation groups.Results After transfection and 2 Gy X-ray irradiation,the cells proliferated very fast in normal control, pcDNA3.1 and pE-AIFΔ1-480 groups, and the proliferation regularity was similar. Compared with normal control group,the cell proliferation abilities were significantly decreased in 2 Gy irradiation and pE-AIFΔ1-480 + 2 Gy irradiation groups (P<0.05 ), and it was more obvious in pE-AIFΔ1-480 + 2 Gy irradiation group, and it was significant lower than that in 2 Gy irradiation group (P<0.05).The number of the cells permeating membrane was basically same in normal control,pcDNA3.1 and pE-AIFΔ1-480 groups;compared with normal control group,they were significantly decreased in 2 Gy irradiation and pE-AIFΔ1-480+ 2 Gy irradiation groups(P<0.05 or P<0.01);and it was more significant in pE-AIFΔ1-480+ 2 Gy irradiation group than that in 2 Gy irradiation group (P<0.01). Conclusion AIFΔ1-480 and ionizing radiation could inhibit the proliferation and invasion of human breast cancer MCF-7 cells,both of them have a synergistic effect,and Egr-1 promoter can enhance the suppression effect under radiation conditions.

Objective To investigate the method of endovascular puncture to establish rabbit models of cerebral vasospasm. Methods New Zealand white rabbits were divided into 5 groups (12 h,1 d,2 d,3 d and 7 d) randomly, and each group was separated into subarachinoid hemorrhage (SAH) subgroup (n = 5) and control subgroup (n = 2). cerebral vascular spasm (CVS) models were established atfer SAH with endovascular puncture. CT scans before and after operation were performed. The internal diameters and the wall thicknesses of posterior communicans artery (PcoA) and basilar artery (BA) were measured with HE stain after the animals were executed. Results CVS model was successfully eastblished in 35 rabbits (SAH subgroup 25,control subgroup 10), resulting a successful rate of 48.61% . Compared with control subgroup, PcoA and BA showed shrinkage of internal diameters of 43.60% and 51.82% 12 h after SAH, respectively, and the shrinkage appeared as biphasic patterns until the 7th study day with another peaks of 29.32% and 45.19%, respectively. Conclusions Endovascular puncture is an effective method to establish rabbit of CVS. The death rate of animals can be decreased with the asage of new interventional material and perfection for the details of operation.

Structure of natural product-ursolic acid was modified for increasing its antitumor activity. Ursolic acid was acylated, esterified, hydrolized or oxidized to obtain target pentacyclic triterpenoid compounds with different substitutes. Sixteen derivatives of ursolic acid were designed and synthesized including eleven new compounds. Anti-tumor activities of ursolic acid and these derivatives against HeLa, SKOV3 and BGC-823 cells in vitro were investigated by MTT assay. The results indicated that compounds 7a and 8a were found to have stronger cell growth inhibitory than ursolic acid on HeLa cells and SKOV3 cells separately, and are worth to be intensively studied further.

AIM: To investigate the inhibitory effect of L-carnitine on high glucose-induced apoptosis of human aortic endothelial cells (HAECs) and the molecular mechanisms.METHODS: The apoptosis of HAECs was induced by high-glucose incubation.HAECs were treated with L-carnitine at different concentrations (50, 100 and 200 μmol/L).The cell viability was measured by MTT assay.The cell apoptosis was assessed by Hoechst 33258 staining and flow cytometry.Colorimetric method was employed to detect the caspase-3 activity in the HAECs.The protein expression and phosphorylation levels were determined by Western blot.RESULTS: High-glucose incubation dramatically decreased the cell viability and induced apoptosis.The protein kinase R-like endoplasmic reticulum kinase (PERK), inositol-requiring enzyme-1 (IRE1) and activating transcription factor 6 (ATF6) signaling pathways of endoplasmic reticulum stress were activated to induce cell apoptosis via down-stream caspase-4/3 cascade.However, L-carnitine treatment significantly attenuated the cell apoptosis and increased the cell viability in a concentration-dependent manner.L-carnitine also significantly suppressed endoplasmic reticulum stress and ATF6 signaling in high glucose-incubated HAECs without attenuating PERK and IRE1 signaling.The expression of site-1 protease (S1P) and site-2 protease (S2P) was inhibited by L-carnitine treatment, thus decreasing pro-apoptotic factor ATF6 p50 produced by ATF6 cleavage.CONCLUSION: L-carnitine inhibits high glucose-induced apoptosis of HAECs by inhibiting ATF6 signaling.

BJ-DRGs grouping process was cited as an example, to describe the factors affecting the grouping process, grouping results and assessment results, and the solutions in transferring homepages into WJT form 4-1 for inpatient medical record homepages (WJT form 4-1 for short).Authors analyzed how to better information acquisition quality of such homepages by unifying the data interface standard of WJT form 4-1, for the purposes of enhancing BJ-DRGs grouping efficiency, and expanding its functions as a tool for medical quality management and that for medical insurance payment management.

Objective To investigate the expression of GRP78 in breast cancer,the relationships among the expression and the clinicopathological characteristics,prognosis were also investigated.Methods The expression of GRP78 was detected in 172 paraffin-embedded breast cancer samples with immunohistochemistry Envision method,the relationships among the expression and the clinicopathological characteristics,prognosis were investigated.Results Positive expression of GRP78 is common in breast cancer.Strong expression of GRP78 was detected in 71 cases (41.28％),and weak expression was detected in 101 cases (58.72％).GRP78 expression wasn't associated with the clinicopathological characterristics except T stage and Her-2 status.Univariate analysis (log-rank test) showed that GRP78 expression correlated with disease free survival and overall survival significantly.Patients with strong GRP78 expression had poorer prognosis compared to those with weak GRP78 expression(P ＜ 0.05).Multivariate analysis utilizing Cox regression analysis showed that GRP78 is an independent biomarker of disease free survival (P ＜ 0.05),but not an independent biomarker of overall survival (P ＞ 0.05).Conclusions Positive expression of GRP78 is common in breast cancer and strong expression is associated with poorer survival.

Objective To investigate the application of serum NT-PROBNP and cTn level detection in senior acute coronary syndrome(ACS) patients during PCI perioperative.Methods 67 ACS patients who need PCI treatment in the Second People’s Hospital of Liaocheng from April 2013 to April 2014 were selected and their perioperative serum NT-PROBNP and cTn levels were detected.At the same time,30 healthy senior people were chosed as control and their serum NT-PROBNP and cTn levels were also detected.Perioperative serum NT-PROBNP and cTn levels between ACS patients and heathy people were compared,the relationship between serum NT-PROBNP,cTn level and cardiac function of ACS patients were analyzed,and the ROC curve was used to analyze the predictive value of serum NT-PROBNP and cTn joint detection on cardiac function in ACS patients. Results Serum cTnT,cTnI and NT-PROBNP levels of ACS patients were higher than that of healthy senior people (P<0.05 ).Serum cTnT,cTnI and NT-PROBNP levels of ACS patients in postoperative 4h,12h and 24h were higher than that of preoperative,and serum cTnT,cTnI and NT-PROBNP levels in postoperative 72 were lowered,and the differences were statistically significant(P<0.05 ).Pearson correlation analysis results showed that serum cTnT, cTnI and NT-PROBNP levels and heart function of senior ACS patients were negatively correlated (rcTnT=-0.706,rcTnI =-0.841,rNT-PROBNP =-0.822, P<0.05).Area under the ROC curve was 0.678 to 0.945,which belongs to 0.6 -0.9,serum NT-PROBNP and cTn joint detection could well predict the heart function of senior ACS patients.Conclusion Serum cTnT,cTnI and NT-PROBNP levels and heart function of senior ACS patients are negatively correlated.Serum NT-PROBNP and cTn joint detection can be used as predictor of cardiac function of senior ACS patients treated with PCI.