Objective To study the effect of 17?-estradial(E-2) on apoptosis of cardiomyocytes induced by norepinephrine(NE) in vitro and its mechanism. Methods The cultured neonatal rat cardiomyocytes were treated with NE(50??mol/L),E-2(10?nmol/L) or NE(50??mol/L)+E-2(10?nmol/L) respectively in serum-free DMEM for 48?h.The morphological changes of myocytes were studied by phase-microscopy and transmission electron microscopy;apoptosis was identified by DNA laddering and apoptotic rate was assayed by flow cytometer;cfos protein in cardiomyocytes was detected using semiquantitative immunofluorescence cytochemistry technique. Results 17?-estradiol inhibited the morphological changes of apoptotic cardiomyocytes induced by norepinephine such as cell atrophy,condensed chromatin clumps against the nuclear envelope associated with swelling of mitochondria and presentation of apoptotic body,DNA laddering disappeared,the apoptotic rate decreased and the expression of c-fos protein inhibited in cardiomyocytes.Conclusion 17?-estradiol can protect cultured cardiomyocytes from apoptosis induced by norepinephrine,its mechanism might associate with suppression of c-fos protein expression.

Objective: To investigate the prognostic factors related to the severity of acute pancreatitis and to establish the multiple predictor models of severe acute pancreatitis(SAP) in elderly patients. Methods: Clinical data of 146 consecutive elderly patients who met the inclusion criteria between January 2014 and May 2017 at Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University were retrospectively collected and analyzed, wherein 88 cases were mild acute pancreatitis, 29 cases were moderately severe acute pancreatitis and 29 cases were SAP. The patients data were subjected to univariate analysis and multiple classified Logistic regression analysis for independent prognostic factors of the severity of acute pancreatitis in elderly patients. Unweighted predictive score(unwScore) and weighted predictive score(wScore)for SAP in elderly patients were established according which the receiver-operating characteristic(ROC) curves of independent prognostic factors and predictor models were produced. The cutoff values of independeut prognostic factors and predictor models were determined. The area under the curve, the sensitivity, the specificity, the positive predictive value and the negative predictive value to verify the predictive efficiency of the independent prognostic factors and predictor models were calculated. Results: Procalcitonin(PCT)(Z=10.564, P=0.000), blood urea nitrogen(BUN)(Z=22.231, P=0.003), serum creatinine(Scr)(Z=14.151, P=0.030), serum calcium(Z=34.979, P=0.032) and pleural effusion(χ²=28.463, P=0.015) were independent prognostic factors of the severity of acute pancreatitis by univariate analysis and multiple classified Logistic regression analysis in elderly patients. Respectively, the area under the curve of PCT, BUN, Scr, serum calcium and pleural effusion were 0.908, 0.737, 0.701, 0.753, 0.712, the sensitivity were 0.828, 0.621, 0.552, 0.690, 0.517, the specificity were 0.915, 0.786, 0.846, 0.966, 0.906, the positive predictive value were 70.6%, 41.9%, 47.1%, 83.3%, 57.7%, the negative predictive value were 95.5%, 89.3%, 88.4%, 92.6%, 88.3%. Respectively, the area under the curve of unwScore and wScore were 0.915 and 0.953, the sensitivity were 0.759 and 0.931, the specificity were 0.889 and 0.915, the positive predictive value were 62.9% and 73.0%, the negative predictive value were 93.7% and 98.2%. Conclusions PCT, BUN, Scr, serum calcium and pleural effusion were independent prognostic factors of the severity of acute pancreatitis in elderly patients. The multiple predictor models of SAP in elderly patients have a good predictive efficiency, which may provide valuable clinical reference for prediction and treatment.

Objective To evaluate the early predictive and diagnostic value of procalcitonin (PCT) in abdominal infection after pancreatoduodenectomy(PD).Methods The clinical data of 62 patients with PD in the First Affiliated Hospital of Harbin Medical University from April 2016 to April 2017 were retrospectively analyzed.The general data and postoperative conditions of the patients were recorded.Serum PCT,C-reactive protein (CRP) levels and WBC counts were measured before and 1,3,and 5 days after surgery.According to the postoperative abdominal infection,the patients were divided into abdominal infection group (n =10) and control group(n =52).The area under the ROC curve (AUC) was calculated by plotting the receiver operating characteristic (ROC) curve,and the cut-off value was determined to compare the sensitivity and specificity of the two groups of patients.Results There were no significant difference between two groups on age,gender,BMI,diabetes mellitus,preoperative laboratory indicators,anesthetic time,operation time,intraoperative bleeding and blood transfusion,surgical procedures and Braun anastomosis,which were comparable.The incidence of postoperative hyperglycemia,surgical incision infection,pancreatic fistula,biliary fistula,mortality,postoperative hospital stay and total medical costs of abdominal infection group were significantly higher than those of control group (P ＜ 0.05).There were no significant differences on PCT,CRP,and WBC between the two groups before surgery.The PCT level of the abdominal infection group was significantly higher than that of the control group at the 1st postoperative day and the difference was statistically significant (P ＜0.05).The sensitivity of predicting abdominal infection was 90％ and the specificity was 75％,which was significantly higher than those of CRP and WBC.There were no significant differences on the sensitivity and specificity of PCT,CRP and WBC for postoperative abdominal infection at 3 and 5 days after surgery,but the sensitivity of the combined diagnosis was as high as 100％ and 90％,significantly higher than 3 indicators alone,respectively.Conclusions Serum PCT level may predict in advance or diagnose early abdominal infection after PD.The combination of PCT,CRP and WBC might be more valuable for the diagnosis of abdominal infection after PD.

Objective To investigate the predictive value of PCT for postoperative pancreatic fistula (POPF) in advance.Methods Clinical data of 62 consecutive patients who underwent pancreaticoduodenectomy(PD) and 19 consecutive patients who underwent distal pancreatectomy (DP) between Apr 2016 and Apr 2017 in the First Affiliated Hospital of Harbin Medical University and met the inclusion criteria were retrospectively collected and analyzed.Patients with PD and DP were divided into pancreatic fistula group (12 cases,3 cases),and non-pancreatic fistula group (50 cases,16 case).The PCT,CRP and WBC count levels of preoperative and postoperative day 1,3,5 (POD1,POD3,POD5) were compared between two groups.The data were subjected to independent sample t-test,Mann-Whitney rank sum test,x2 test or Fisher exact test.Receiver operating characteristic (ROC) curve was drawn and area under curve (AUC) was calculated to determine the cutoff value,sensitivity and specificity.Results For PD and DP patients,there were no significant difference on age,gender,BMI,diabetes,obstructive jaundice,preoperative laboratory test,operation time,intraoperative blood loss,tumor type between the two groups,which were comparable.For PD patients,postoperative hyperglycemia rate,postoperative ICU admission rate and total hospital stay of pancreatic fistula group were significantly higher than those of non-pancreatic fistula group (P =0.011,P =0.023,P ＜0.001).The PCT levels of POD1,POD3 and POD5 of pancreatic fistula group were significantly higher than those of non-pancreatic fistula group (P ＜ 0.001,P =0.010,P =0.002).PCT of POD1 had the highest sensitivity (100％) and specificity (80％) and PCT ＞0.76 μg/L was the risk factor for POPF.For DP patients,the PCT levels of POD1,POD3 and POD5 had the same predictive value for pancreatic fistula.Conclusion PCT has early predictive value for POPF of PD patients.

Objective To investigate the risk factors of death and to establish an early multi-index predictive model for mortality moderately of severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) in elderly patients.Methods Clinical data of 58 digible elderly patients of MSAP and SAP between January 2014 and May 2017 in First Affiliated Hospital of Harbin Medical University were analyzed retrospectively,including 18 cases (31.0％) in the death group and 40 cases in the control group (69.0％).Univariate analysis and logistic regression analysis were used to screen out the independent risk factors related to death,combined with these independent risk factors,the unweighted predictive model (unwScore) and weighted predictive model (wScore) for mortality were established.The receiver-operating characteristic (ROC) curves of independent risk factors and predictive models were drawn to determine the cut-off value,to calculate the area under the curve (AUC),sensitivity,specificity,positive predictive value and negative predictive value and to observe the clinical predictive effectiveness.Student's t-test was used to analyze continuous variables that complied with a normal distribution expressed as ((x) ± s).Mann-Whitney U test was used to analyze abnormally distributed variables expressed as median (quartile range) [M(P25,P75)].chi-square test or Fisher's exact test was used to analyze categorical data expressed by rate (％).Univariate analysis was used to screen out data with statistically significant difference,and then Logistic regression analysis was performed to determine independent predictors.Results Univariate analysis showed that there were statistically significant differences in pro-calcitonin,serum albumin (ALB),serum calcium,D-dimers,mean arterial pressure,pleural effusion and peritoneal effusion between the two groups (P ＜0.05);multivariate analysis showed that ALB,pleural effusion and peritoneal effusion were independent risk factors for mortality of MSAP,SAP in early patients,which AUC were 0.815,0.678,0.696,sensitivity were 0.611,0.556,0.667,specificity were 0.825,0.800,0.725,the positive predictive values were 61.1％,55.6％,52.2％,and the negative predictive values were 82.5％,80.0％,89.9％,respectively.The AUC of unwScore and wScore were 0.852 and 0.863,the sensitivity were 0.667 and 0.778,the specificity were O.875 and 0.800,the positive predictive values were 70.6％ and 63.6％,and the negative predictive values were 85.4％ and 88.9％,respectively.Conclusion ALB,pleural effusion and peritoneal effusion were independent risk factors for mortality of MSAP,SAP in elderly patients.The multi-index predictive model had good clinical predictive effectiveness,which could provide clinical references for the treatment of MSAP and SAP in elderly patients.

Objective To analyze the exposed dose of hippocampus(HC)of T3,T4nasopharyngeal carcinoma patients treated with intensity modulated radiotherapy(IMRT). Methods The bilateral HCs were delineated and were divided into head(HH),body(HB)and tail(HT)for 62 nasopharyngeal carcinoma patients treated with IMRT.The dose parameters of HC were then analyzed. Results The mean dose of left and right HC was(1 127±704)cGy,(1 173±762)cGy. The mean dose of left HH,HB and HT was(1 732±1029)cGy,(820±632)cGy,(423±366)cGy(P=0.000);while the mean dose of right HH, HB and HT was(1 985±1101)cGy,(837±531)cGy,(432±343)cGy(P=0.000).The exposed dose and the volume exposed in different dose of HH were obviously higher than those of HB and HT.The dose parameters of HH,HB and HT decreased in turn. The involvement of sphenoid sinus,ethmoid sinus and cavernous sinus correlated with high exposed dose of HC. Conclusions The exposed dose of HH,HB and HT was different in nasopharyngeal carcinoma patients treated with IMRT.The exposed dose of HH was the highest,which should be emphasized especially. The involvement of sphenoid sinus,ethmoid sinus and cavernous sinus suggest high exposed dose of HC.