Peking Union Medical College Hospital, as one of the most stressful medical institutions in China, is facing the problem of emergency department overcrowding. In order to effectively alleviate the emergency overcrowding, improve the medical quality and patients′ medical experience, the hospital firmly grasped the two incremental links of " throughput" and " output" factors, established a multidisciplinary and multi-department cooperation team, constructed a close medical alliance cooperation mode, and innovated and explored a harmonious emergency overcrowding relief mode with the goal of unblocking the " exit" of patients. The practice showed that the comprehensive measures could effectively alleviate the problem of emergency overcrowding, and improve the medical environment and medical quality.

Objective To establish a neural network model based on enhanced CT for distinguishing ISUP grade of clear cell renal cell carcinoma (ccRCC). Methods We collected 131 cases of ccRCC, with 92 cases of low ISUP grade and 39 cases of high ISUP grade. Patients were divided into training set and validation set according to 5:5 stratified sampling. The enhanced CT images of each ccRCC patient were evaluated by the radiologist. Recursive feature elimination (RFE) was used to reduce the dimension of patients' general features and enhanced CT features, which was used for neural network modeling and validation. Results Patients' general features and enhanced CT features were verified by RFE method and then reduced to 14 features. The top 5 features were growth pattern, necrosis, enlargement of lymph nodes, tumor size and capsule. The AUC of the neural network model based on these 5 features in training set was 0.8844 (95%CI: 0.8062-0.9626), sensitivity was 89.47% and specificity was 82.61%; and those in validation set were 0.7924 (95%CI: 0.6567-0.9280), 75.00% and 86.96%, respectively. Conclusion The neural network model of ccRCC ISUP grade based on enhanced CT has relatively high diagnostic efficiency.

[Summary] A 32 year-old woman in the third trimester of pregnancy was admitted for severe acute pancreatitis due to hypertriglyceridemia . During hospitalization she developed multiorgan dysfunction , infected pancreatic necrosis , abdominal compartment syndrome and intrauterine fetal death . She was successfully treated by multidisciplinary team including department of emergency medicine , ICU, gastroenterology, obstetrics, endocrinology, ultrasonography, radiology, infectious disease, nutrition and surgery.

Objective To discuss the methods and clinical effects of phased treatment of ankylosing spondylitis (AS) combined with severe hip flexion contracture.Methods The study enrolled 8 cases (12 hips) of AS combined with severe hip flexion contracture hospitalized from September 2011 to November 2012.Phased treatments included lateral hip arthrolysis,articular capsulectomy,stripping of the reflected head of rectus femoris,femoral neck osteotomy,traction and stage Ⅱ biotype total hip arthroplasty (THA).Preoperative and postoperative Harris score,hip range of motion,and complication of femoral nerve injury were detected.Results Period of follow-up was 6-12 months (mean 10 months).One case developed heterotopic ossification,which affected postoperative hip activity and received resection one year later.One case sustained fissure fracture of calcar femorale during implantation of the prosthetic femoral stem,but no special handling was provided.Of all cases,active flexion and extension of the hip were both 0° before operation,but increased to (96.25 ± 4.33) ° and (24.17 ± 4.69)° respectively after operation ; mean Harris score was improved from (26.67 ± 2.39) points preoperatively to (90.92 ± 5.66) points postoperatively (P ＜ 0.01).Besides,no femoral nerve injury was observed.Conclusion Phased treatment of AS combined with severe hip flexion contracture restores hip function and minimizes femoral nerve injury following THA.

Objective To construct a T-bet response reporter gene, for the detection of T-bet tran-scriptional activity and application in high-throughput screening for the functional genomies. Methods The cis-acting DNA element, ThRE, based on CNS-22 T box site of IFN-γ gene, was recombined into a reporter vector pLUC-MCS. The reporter gene was transfected into HEK 293T cells to detect its response to T-bet. And the binding of T-bot to TbRE was identified with electrophoretic mobility shift assay(EMSA). Results ThBE was successfully cloned into pLUC-MCS, named as TbRE-LUC. Using a luciferase assay, expression of the reporter gene is found to be induced by T-bet in a dose dependent manner and correlate with T-bet ex-pression positively with activation up to 20 folds. Moreover, the binding specificity of T-bet to TbRE is vali-dated by EMSA. Conclusion We successfully constructed a T-bet response reporter gene, ThRE-LUC, which responds to T-bet keenly and specifically. TbRE-LUC will be a useful tool in high-throughput screen-ing for human genes associated with transcription activity of T-bet.

Nuclear factor κB (NF-κB) is an important cellular transcription factor. The important role of NF-κB-mediated cell signal transduction pathway in apoptosis is a hot topic at home and abroad. In order to discover new regulators in NF-κB signaling pathway, a high-throughput cell-based screening model based on dual luciferase reporters system was established, a number of genes that can activate NF-κB signal pathway were obtained by screening of 439 novel function genes. Among them, TMEM9B can obviously activate NF-κB signaling pathway. Further experiments showed that TMEM9B activated NF-κB signaling pathway in a dose-dependent pattern. Western blotting and EMSA experiments confirmed that TMEM9B can promote the degradation of IκBα (a cytoplasm inhibitor of NF-κB), and cause NF-κB shift from the cytoplasm to nucleus. At the same time, flow cytometry result demonstrated TMEM9B can induce apoptosis in HEK293T and HeLa cells. In short, a stable and effective screening system for NF-κB has been established, through which TMEM9B was identified to be able to significantly activate NF-κB signal transduction pathway and thus cause cells apoptosis.

ment with simple operation, high successful rate, high safety, less invasiveness and low complication rate.

Objective To evaluate the clinical value of speckle tracking imaging in the measurement of two-dimensional strain in patients with myocardial infarction. Methods High frame rate two-dimensional echocardiography were performed in 30 healthy subjects,21patients with anterior myocardial infarction and 15 patients with inferior myocardial infarction. Longitudinal strain (LS), radial velocity (Vs), regional shortening fraction (RFS),radial strain (RS) were measured in the apical two-chamber view and short-axis view(the level of papillary muscle) using two-dimensional strain software. Results Compared with healthy subjects, LS, Vs, RFS, RS decreased in the segments with infarction(P<0.05). LS, Vs, RFS, RS of the two myocardial infarction groups had partly differences(P<0.05). Conclusions Regional wall motion of left ventricle in patients with myocardial infarction can be evaluated accurately with speckle tracking imaging.

Objective To study the effect of 3,4-oxo-isopropylidene-shikimic acid (ISA) on transcription factor STAT1, STAT3 and NF-?B in human cervix cancer Hela cell. Methods The cell proliferation was assessed by MTT assay. The luciferase activity of transcription factor STAT1, STAT3 and NF-?B was determined by the Dual-Luciferase Reporter Assay System. Results ISA can not inhibited the growth of Hela cell. The luciferase activity of transcription factor NF-?B in Hela cells treated with ISA was inhibited, while the luciferase activities of transcription factor STAT1 and STAT3 were not inhibited. Conclusion ISA can inhibit inflammation, which may be related with suppression of NF-?B transcriptional activity.

OBJECTIVETo determine the clinical results of selected CD34(+) cell autologous transplantation in advanced malignant tumors.

METHODSAfter pretreatment, fifteen patients aged 12 - 70 (49.5) years with various Stage III or IV malignant tumors were given the sorted CD34(+) cells collected by magnetic-activated cell sorting (Clini MACS, Milteny Biotech, Germany).

RESULTSPeripheral blood progenitor cells (PBPC) from the patients were mobilized by chemotherapy and G-CSF 5 micro g/kg per day. CD34(+) cells gave 2.0 - 5 log depletion after cell sorting, with a median yield of CD34(+) selected cells of 2.4 (0.15 - 12.03) x 10(6)/kg. It gave a median recovery of 64 (52 - 81.4)% and median purity of 98.2 (83.2 - 99.7)%. The median time of neutrophil recovery > 1.0 x 10(9)/L and platelet recovery > 20 x 10(9)/L post-transplantation were 14 (8 - 26) days and 13 (11 - 35) days, respectively. On follow-up of 2 - 33 (11) months, the event-free survival rate was 53.3% (8/15) and the overall survival rate was 66.7% (10/15).

CONCLUSIONTransplantation of autologous selected PBPC CD34(+) cells gives prompt and stable engraftment. Selected CD34(+) cell transplantation, being a safe approach, may improve the clinical outcome even in patients with advanced malignant tumors.

Adolescent ; Adult ; Aged ; Antigens, CD34 ; analysis ; Child ; Female ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Male ; Middle Aged ; Neoplasms ; mortality ; therapy ; Survival Rate ; Transplantation, Autologous