Volume 94  ·   Issue 41  ·  2014

At present, many disasters in the world have serious consequences. Once a disaster occurs, the most important thing is to save human lives. How to carry out scientific and efficient emergency medical rescue has become a hot topic in various countries. Especially in recent years, developed countries such as the United States, Canada, Britain and Japan have taken the information transformation as an opportunity in the field of emergency medical rescue, and continuously increased their fiscal budgets every year to build a more agile and solid emergency mechanism and management system, aiming at effectively responding to various emergencies that threaten human normal production and life. The United States has built a relatively complete Emergency "Emergency Management System" (EMS), five European countries have developed a "Major Emergency Intelligent Management System" (MEMS) under the Eureka Plan, and Japan has also built a "Disaster Response System" (DRS) for natural disasters. The established system, such as Phoenix Disaster Management System used in Hyogo Prefecture, Japan, is a disaster prevention response system based on the practical experience and lessons of Hanshin earthquake. Phoenix Disaster Management System is the core system of Hyogo Disaster Prevention Center and the most perfect disaster prevention emergency system in Japan. These projects and systems have played a positive role in human response to a variety of disasters. At present, China has not established a complete injury assessment and rescue decision-making system for dealing with sudden disasters. In the face of complex sudden major disasters, how to define the number of casualties, injuries and types of injuries, whether there are enough local rescue forces to deal with them, and how to draw reasonable personnel and equipment for emergency rescue teams often rely more on comprehensive plans and empirical decision-making. The preparations for emergency medical rescue teams lack predictability and pertinence. After the disaster, a large number of rescue organizations are integrated into the incident site, resulting in congestion of rescue routes, surge of local load, lack of effective preparation and scattered rescue operations. In order to solve the above problems and improve the efficiency of emergency rescue, it is necessary to develop a major disaster injury assessment and rescue decision support system. The system is implemented by JavaEE platform, and Struts, Spring and Hibernate frameworks are applied to the emergency rescue model, and WebGIS, web crawling and cloud push technologies are adopted to realize data acquisition and user interaction. It can realize the general assessment of casualties caused by emergencies such as earthquakes, floods, fires, mudslides, infectious diseases, violent terrorist activities, etc., and on the premise that the destructive force of disasters exceeds the local emergency medical force and needs external support, it can generate emergency plans of users' personnel, equipment, medicinal materials and routes in a targeted manner, which can not only provide auxiliary decision-making for rescue preparation, but also integrate with the "emergency medical rescue platform" to provide early data management services for the whole rescue operation.

To explore the relationship between etiology and severity of acute pancreatitis (AP).

A total of 486 AP patients, hospitalized at digestive, general surgery or critical care medicine departments from May 2012 to May 2014, were recruited retrospectively. And the data of clinical features, etiology and severity classification of AP according to the revised Atlanta criteria (2012) were collected. The relationships between different gender, age group, etiology and severity of disease were compared.

The etiology distribution was as follows: gallstone (n=296, 60.9%), hyperlipidemia (n=93, 19.1%), alcohol (n=48, 9.9%) and other causes (n=49, 10.1%). And the severity was mild AP (MAP, n=387, 79.6%), moderate-severe AP (MSAP, n=53, 10.9%) and severe AP (SAP, n=46, 9.5%). The proportion of females for gallstone AP was slightly higher than that of males(1.23∶1). However, for hyperlipidemic and alcoholic AP, the proportion of males was significantly higher than that of females (P=0.00). The onset age of gallstone AP was generally over 40 years while hyperlipidemic and alcoholic AP tended to occur in patients aged under 60 years (P=0.00). Among all age groups, the group of over 60 years had the highest MSAP incidence of 14% while <40-year-old group the highest incidence of SAP at 11.3%. And the >60-year-old group had the highest total incidence of MSAP and SAP at 22.2%. Compared with gallstone, alcohol and other causes, hyperlipidemic AP had a higher risk of MSAP and SAP ( P=0.028).

Gallstone remains a leading cause of AP. Hyperlipidemic pancreatitis has shown a rising tendency in recent years and it often result in a more serious clinical process. And the clinicians should paymore attention to health education of patients.

To assess the effects of losartan on the frequency and phenotype of respiratory dendritic cells (DC) in lipopolysaccharide (LPS)-induced acute lung injury (ALI) mice.

The C57BL/6 mice were randomly divided into 3 groups of control, ALI and ALI+ losartan. ALI animals received 2 mg/kg of LPS; ALI+ losartan animals 2 mg/kg of LPS and 15 mg/kg of losartan 30 min before an intratracheal injection of LPS; control animals phosphate buffer saline (PBS) instead of LPS. Lung wet weight/body weight (LW/BW) was recorded to assess lung injury. The pathological changes were examined under optical microscope. The frequency and phenotype of pulmonary DC were characterized by flow cytometry. Meanwhile, the levels of IL-6 in lung homogenates were assessed by enzyme-linked immunosorbent assay (ELISA).

(1) The LPS-induced rise in LW/BW was partially prevented by a pretreatment of losartan. (2) Histologically, widespread alveolar wall thickening caused by edema, severe hemorrhage in interstitium and alveolus and marked and diffuse interstitial infiltration of inflammatory cells were observed in the ALI group. Whereas, losartan effectively attenuated the LPS-induced pulmonary hemorrhage, leukocytic infiltration in interstitium and alveolus. (3) Meanwhile, the levels of IL-6 in lung tissue were significantly enhanced in the LPS-induced ALI mice. Yet after a pretreatment of losartan, the pulmonary level of IL-6 markedly decreased. (4) LPS dosing resulted in a rapid accumulation of DC in lung tissues and an up-regulated expression of CD80 in LPS-induced ALI. In contrast, the expression of MHC Ⅱ on respiratory DC was not significantly different among groups. A pretreatment of losartan led to a marked reduction in CD80 expression on pulmonary DC (P<0.05 vs ALI).

Losartan may down-regulate pulmonary injury by inhibiting the activation of pulmonary DC.

To evaluate the efficacy and safety of dexmedetomidine for post-operative elder patients on mechanical ventilation (MV).

For this randomized controlled trial, 108 cases of post-operative patients on MV were enrolled and assigned into either dexmedetomidine group (n=54) or propofol group (n=54) for sedation. And propofol was used for rescue. The dose of sedation was regulated by Ramsay score for maintaining a sedative score of 3-4. In both groups, fentanyl was provided intravenously continually for analgesia. The amount of fentanyl was adjusted according to the numerical rating scale (NRS) score for maintaining an analgesic score of 0-3. The average Ramsay score, the frequency of propofol, the highest score of NRS, the total dosage of fentanyl and recovery time were compared. Additional outcomes included duration of mechanical ventilation and intensive care unit (ICU) length. And the incidence of delirium and cardiovascular adverse events were compared for two groups.

No significant inter-group difference existed in the effectiveness of sedation. Compare with propofol group, the highest score of NRS decreased(1.8±1.12 vs 3.1±1.24, P<0.05), the total dosage of fentanyl significantly decreased(427.6±14.1 vs 658.4±27.3 μg,P<0.05) and recovery time became significantly shortened (0.3±0.02 h vs 1.1±0.3 h,P<0.05) in dexmedetomidine group. Median duration of mechanical ventilation in dexmedetomidine group(21.0 h, 95%CI: 18.6-21.4 h)was significantly shorter than that in propofol group(28.0 h, 95%CI: 25.6-30.4 h)(P<0.05). No inter-group differences existed in the ICU length of stay and the incidence of delirium. Two cases in dexmedetomidine group developed bradycardia while hypotension occurred in two cases of propofol group.

Sedative effects of dexmedetomidine are safe and effective for post-operative elder patients on MV. And it offers a better efficacy of analgesia and shorter durations of MV and recovery time. Butdexmedetomidine had no significant influence on the ICU length of stay or the incidence of delirium.

To explore the change of fluid balance in patients with septic shock for seven continuous days and examine its effect on clinical prognosis.

A retrospective study was conducted for 105 patients with septic shock admitted into our intensive care unit (ICU) from May 2013 to February 2014. They were divided into non-survivors and survivors. Their baseline data, net balance quantity of fluid for seven continuous days and laboratory results were recorded and analyzed.

Among them, 28 patients died. Duration of mechanical ventilation, sequential organ failure assessment (SOFA) score and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score were all lower in survivors than those in non-survivors (6 d vs 11 d, P=0.002; 7 d vs 9 d, P<0.001; 15 vs 19,P=0.035). Yet hospitalization time in survivors was longer than that in non-survivors (30 d vs 18 d, P=0.026). According to trend graph on net balance of each day, the cumulative net negative fluid balance in survivors increased over time while it remained stable in non-survivors. Among seven days, the cumulative net fluid balance at Day 7 was most negatively correlated with survival days (r=-0.278, P=0.006). Logistic regression analysis showed that SOFA score and cumulative net balance at Day 7 were the independent prognostic risk factors for septic shock. Moreover, at Day 7, no statistically significant inter-group difference existed in serum creatinine, alanine aminotransferase, PO₂/FIO₂ and cardiac troponin Ⅰ levels. But serum total bilirubin in survivors was lower than that in non-survivors (16.0 vs 27.9, P=0.031).

Cumulative net negative balance quantity of fluid in survivors was much more than that in non-survivors. SOFA score and net balance quantity of fluid at Day 7 were the independent prognostic risk factors for septic shock. Cumulative net fluid balance at Day 7 was most negatively correlated withsurvival days. No significant inter-group difference existed in organ function at Day 7.

To evaluate the computed tomograph (CT) findings of IgG4-related disease (RD) involving soft tissue adjacent to thoracic vertebrae.

The chest and abdomen CT findings of 22 cases of IgG4-RD proved by orbital pathology and/or laboratory examination were retrospectively reviewed. The CT findings of paravertebral soft tissue in posterior mediastinum and the corresponding follow-up after therapy were primarily observed.

Among them, there were 8 males and 2 females with an average age of 57.6 (42-70) years. CT showed diffuse thickening of soft tissue in thoracic paravertebral space forming a crescent-shaped mass encasing bilateral thoracic vertebrae without abnormal bone change. There was consistent inhomogeneous density of paravertebral adipose tissue adjacent to paravertebral mass lesion with multiple dilated vessels joining azygos vein or vena hemiazygos finally. Other abnormalities were as follows: multiple lymphadenopathy of neck, mediastinum and/or retroperitoneal space (n=10), interstitial pneumonitis (n=4), diffuse pancreatic thickening (n=2) and slightly hypodense soft tissue shadow with a hazy border of retroperitoneal space (n=8). On follow-up CTs, there was marked relief after regular therapy in 4 cases.

The thoracic paravertebrae space is commonly involved by IgG4-RD. And it occurs frequently in senile males. The characteristic CT feature is diffuse thickening of soft tissue with multiple prominentbands in adjacent thoracic paravertebral space.

To summarize the characteristics of clinical features, laboratory tests, treatments and outcomes of childhood systemic lupus erythematosus (SLE).

A retrospective study was conducted for 130 cases of first-confirmed childhood SLE hospitalized from 2001 to 2008. Their clinical data of initial manifestations, system involvements, laboratory tests, treatments and outcomes were recorded and analyzed. Among them, there were 25 males and 105 females with a gender ratio of 1∶4.2. The youngest was 4 years old and the oldest 16 years old. And the mean age of onset was 11.5±2.2 years.

The initial manifestations included fever (66%), rash (62.33%) and fatigue (47.33%). And the cutaneous-mucosal system (80%), hematological system (70.77%) and kidney (66.15%) were frequently involved. Anemia (64.62%) and urine protein positivity (66.15%)were the most common abnormalities. All patients had positive ANA. The positive rate of anti-dsDNA was 88.37%. Six patients had antiphospholipid syndrome (APS). The levels of IgM-aCL and IgM-anti-β₂-GP-Ⅰwere moderately or higher positive. Glucocorticoid was the first-line medication. All patients took steroids. Different immunodepressants were also used depending on the severity of illness. The effective rates of one month and one year were 80.7% and 95.1% respectively. Six patients died.

The patients with serious organ involvements as the initial manifestations end to have a worse prognosis. Cutaneous-mucosal system, hematological system and kidney are the most frequently involved. Most patients have a high level of ANA titer. IgM-aCL and IgM-anti-β₂-GP-Ⅰare sensitive for diagnosing antiphospholipid syndrome. Early diagnosis, appropriate treatment and regularfollow-ups may help to improve the clinical prognosis of SLE.

To determine whether luteal support of dydrogesterone may enhance the outcome of frozen-thawed embryo transfer (FET) in natural cycles by comparing the FET outcomes of different luteal support methods.

A total of 2 248 natural FET cycles with an endometrial thickness of 8-12 mm and type A on ovulation day, from January 2011 to March 2013 were chosen. Oral dydrogesterone (n=1 967) or intramuscular progesterone (n=281) was used for luteal support. The rates of clinical pregnancy, implantation, ectopic pregnancy, miscarriage and live birth were compared among these groups.

The patients receiving oral dydrogesterone or intramuscular progesterone had similar profiles of age, type of infertility, endometrial thickness and average numbers of embryo transfer. The dydrogesterone group had higher rates of clinical pregnancy (43.26% vs 38.79%) and implantation (25.76% vs 21.13%). However a lower miscarriage rate (17.27% vs 22.02%) was insignificant. The rates of ectopic pregnancy, premature birth and live birth were also similar. When infertile factors were considered, the dydrogesterone group had significantly higher clinical pregnancy rates(43.78% vs 34.38%, P<0.05), lowered miscarriage rates (16.54% vs 29.55%,P<0.05) and increased live birth rates(34.16% vs 23.44%,P<0.05)among simple tubal factor patients.

Oral administration of dydrogesterone for luteal support offers more advantages in natural cycle FETthan intramuscular progesterone, especially for simple tubal factor infertility.

To explore the prevalence of maternal near miss (MNM) and adverse pregnancy outcomes in Zhejiang province by MNM surveillance system.

A cross-sectional study was conducted during 2012 and 2013. All MNM cases were recruited from the MNM surveillance system. The information was reported by direct network report system, including personal information, obstetric complications, maternal rescue measures, rescue process and severe maternal and perinatal outcomes.

A total of 826 MNM patients were recruited. The MNM rate was 5.6 cases/1 000 live births (LB). Maternal gestational hypertension was the most common disease among MNM, accounting for 19.9%(n=164). The second prevalent one was insufficient uterine contraction, accounting for 19.6%(n=162). Placenta previa was the third one accounting for 17.7%(n=146). Among adverse pregnancy outcomes, 139 cases underwent hysterectomy (n=139, 16.8%). There were 81 perinatal deaths with a perinatal mortality of 10.4%. And 279 cases (39.9%) were preterm.

MNM surveillance system is valuable for grasping the prevalence of MNM. And it helps to reduce MNMrate by improving the quality of obstetrics and lower the preterm rate and perinatal mortality.

To introduce a novel technique of reducing fixed atlantoaxial dislocation (FAAD) and basilar invagination (BI) with C1-C2 screw and rod system.

From January 2009 to December 2011, 26 patients of FAAD and BI were reduced successfully with an insertion of C1 lateral mass and C2 pedicle/pars screw and rod system. The cohort had 17 females and 9 males. And their most common presenting symptoms were extremity muscle weakness, restricted neck movement and paresthesia.

All of them achieved effective reduction. Among them, 18 attained complete reduction and 8 partial reduction (over 60% extent of reduction). The mean atlanto-dental interval (ADI) value was 2.1 mm postoperatively versus 8.8 mm preoperatively(t=21.1, P<0.01). All of them had relieved compression of dura and medulla oblongata and cervical cord. All clinical symptoms improved. One case had pulmonary infection while another case delayed healing of incision. Both recovered well after symptomatic treatments. Bony fusion reached 100% during a mean follow-up period of 22 months.

The C1-C2 screw and rod system may achieve effective reduction and fixation for FAAD and BI. Capable of preserving atlanto-occipital joints in patients without atlas assimilation, this procedure providemore solid immobilization than occipitocervical fusion in those with atlas assimilation.

To discuss about the pathologic and imaging origins and characteristics of CT scaning and X-ray radiography for acute and chronic aspiration pneumonia.

Imaging data from 30 patients with aspiration pneumonia were retrospectively analyzed, CT scaning was performed in 27 patients, which PMVR reconstruction was performed in 21 cases; 3 exammed by X-ray with 2 used by esophagography.

Opaque bodies were detected in trachea by CT scaning in 12 patients.7 patients in acute phase rapidly developed into acute respiratory distress syndrome(ARDS). CT signs of 30 patients with acute and chronic aspiration pneumonia included: centrilobular nodules were detected in 2 cases with acute phase, 4 cases with subacute phase and 4 cases with chronic phase; the imaging of ground glass opacity were detected in 9 cases with acute phase, 2 cases with subacute phase and 3 cases with chronic phase; the imaging of bronchiectasis was detected in 8 cases with chronic phase, which mucilage embolism was detected in 3 of 8 cases; the imaging of atelectasis was detected in 6 cases with chronic phase; the imaging of sheeted consolidation was detected in 5 cases with chronic phase, 8 case with acute phase; the imaging of interstitial fibrosis was detected in 3 cases with chronic phase. Lesions of inferior lobe of right lung were detected in 9 cases with chronic phase, 4 cases with subacute phase, 11 case with acute phase; lesions of inferior lobe of left lung were detected in 6 cases with chronic phase and 3 cases with subacute group, 11 case with acute phase.

The imaging features of acute and chronic aspiration pneumonia overlap with GGO and centrilobular nodules in every group. While the imaging features of atelectasis, bronchiectasis or mucilage embolism are found in chronic phase.The chest CT scaning may accurately evaluate the dynamic change ofaspiration pneumonia.

To explore the patterns of mediastinal lymph node metastases and prognostic factors of recurrence in patients undergoing curative resection of stage ⅢA-N2 non-small cell lung cancer (NSCLC).

A total of 92 patients underwent curative operation and pathologically diagnosed as stage ⅢA-N2 NSCLC were retrospectively reviewed. The clinicopathological data were compared between the recurrence and non-recurrence groups. And the potential prognostic factors were included for multivariate analysis using Cox proportional hazard model.

The 3 and 5-year recurrence rates were 61.0% and 70.2% respectively. For univariate analysis, the prognostic factors were number of metastatic lymph nodes, positive lymph node ratio, number of metastatic mediastinal lymph nodes (MLN), positive MLN ratio, number of MLN metastasis >3, multiple station metastasis, trans-regional metastasis and multi-zonal metastasis. A multivariate analysis using Cox regression identified 2 independent factors of prognosis: trans-regional MLN metastasis ( P=0.035) and number of MLN metastasis >3 ( P=0.045). The recurrence risk of patients with trans-regional MLN metastasis was 2.0 times higher than those with regional MLN metastasis while the recurrence risk of patients with number of MLN metastasis >3 was 2.2 times higher than those with number of MLN metastasis of 1-3.

Recurrence risk of stage ⅢA-N2 non-small cell lung cancer (NSCLC) after curative resection may be estimated by location and number of MLN metastasis. And the subgroup with trans-regional MLNmetastasis and number of MLN metastasis >3 carries the highest risk of recurrence.

To explore the reproducible metabolic test and gender difference and investigate the distribution rules of metabolite concentration in different hippocampal regions (head, body and tail) of normal cognitive people for elucidating the pathological metabolic changes.

The hippocampal multi-voxel proton spectroscopy of 24 normal cognitive young volunteers scanned by a 3.0 T magnetic resonance (MR). Every volunteer was scanned thrice. The data was processed by MR post-processing workstation. The hippocampus was divided into three parts (head, body and tail) and the ratios of N-acetylaspartate (NAA)/creatine (Cr), myoinositol (MI)/Cr, MI/NAA and choline (Cho)/Cr were calculated separately. We compared the metabolic ratios of each region of bilateral hippocampi between male and female groups and three different tests, also analyzed the distribution rule of each metabolite along the long axis of hippocampus.

The metabolic ratio (NAA/Cr, MI/Cr, MI/NAA and Cho/Cr) of each region of bilateral hippocampi between male and female groups and among three tests showed no statistical differences. NAA/Cr gradually rose (P<0.05) while MI/NAA and Cho/Cr gradually declining from bilateral hippocampal head to tail (P<0.05). MI/Cr gradually declined from bilateral hippocampal head to tail, but there was statistical difference only between right hippocampal head and tail (P<0.05).

The hippocampal multi-voxel proton spectroscopy is technically stable. There is no gender difference. And distribution differences and metabolite concentration trends exist along hippocampal head, bodyand tail.

To explore the etiologies and imaging features of longitudinally extensive spinal cord lesion (LESCL).

The etiologies and magnetic resonance (MR) imaging features of 51 hospitalized LESCL patients from January 2011 to August 2013 were reviewed and retrospectively analyzed.

Among them, the causes were neuromyelitis optica spectrum disorder (NMOSD, n=25), isolated longitudinally extensive transverse myelitis (n=6), subacute combined degeneration (n=4), multiple sclerosis (MS, n=3), paraneoplastic myelopathy (n=3), anterior spinal artery syndrome (n=3), acute disseminated encephalomyelitis (n=2), spinal dural arteriovenous fistula (n=2), intramedullary spinal cord metastasis (n=1), myelopathic leukemia (n=1) and syringomyelus (n=1). For MR imaging, at least one lesion of each patient presented continuously longitudinal profile and whole-length spinal cord was involved in 11 patients.

LESCL may be caused by various diseases. And the imaging features may aid its diagnosis despite alack of specificity.

To explore the symptoms of autonomic dysfunction and sympathetic skin response (SSR) abnormality in patients of motor neuron disease (MND).

The clinical features of autonomic dysfunction were collected as follows: dermal numbness or pruritus, parahidrosis, xerostomia, salivation, abnormal skin temperature, orthostatic hypotension, mydriasis, ptosis or abnormal pupillary light reflex, constipation, voiding dysfunction and sexual dysfunction. SSR was performed and the results were judged according to the normal range of our laboratory. Abnormality rate in MND patients was calculated. The relationship between clinical symptoms and SSR parameters were analyzed statistically.

Among a total of 142 MND patients, the symptom incidences of autonomic dysfunction were as follows: dermal numbness (53.5%), dermal pruritus (15.5%), parahidrosis (10.6%), xerostomia (9.1%), salivation (2.1%), abnormal skin temperature (14.8%), orthostatic hypotension (2.1%), constipation (16.2%), voiding dysfunction (9.9%) and sexual dysfunction (1.4%). Abnormal SSR was found in 51/142 (35.9%) patients, including 12(8.5%) in palmar and 47(33.1%) in plantar. The features of abnormal SSR included delayed latency of palmar (P<0.05) and decreased amplitudes of both palmar and plantar compared with normal ranges (P<0.01 respectively). The group of patients with lumbosacral onset had a higher abnormal rate of SSR than those of other onset sites. There was no significant correlation between clinical symptoms and abnormal SSR parameters.

The patients of MND exhibit autonomic dysfunctions of skin, gland secretion, cardiovascular system and sphincters. Some of them show abnormal SSR with prolonged latency and decreased amplitude. The abnormalities of SSR are not related to clinical features of autonomic dysfunction. Those with anonset of lower limbs have a higher rate of abnormal SSR.

A 15-year-old male was diagnosed with dermatomyositis. He was admitted to the hospital due to rash, facial edema and fatigue for 1 week. Physical examination: Body temperature 37.1 ℃. He likes to lie on the right side, with large erythema on the face, not higher than the skin surface, and does not fade when pressed, edema on the face, and a surgical scar of about 15 cm can be seen in the middle of the sternum. The breathing sounds of both lungs were slightly thick, no dry or wet rales were heard, no abnormalities in cardiac signs, no palpation of the liver and spleen under the costs, small superficial lymph nodes, no tenderness in the muscles of the limbs, and weakened muscle strength, grade 3. Previous ventricular septal repair. On admission, CT from outside hospital reported pulmonary infectious lesions, which may be fungal infection. The chest radiograph was basically normal 3 days before admission (FIG. 1A), CT showed that the scope of the lesion was significantly enlarged at admission, showing exudative foci and small nodular foci with vague margins, accompanied by mild emphysema, mainly distributed in the right upper lobe and right lower lobe, and there were almost no lesions in the left lobe (FIG. 1B，Figure 1C，Figure 1D), the lesions have the characteristics of gravity distribution, which is not in line with the common leaf segmental distribution characteristics of infectious lesions. Patients with dermatomyositis have aspiration factors due to esophageal muscle involvement. Patients like to lie in the right lateral position with postural factors. At the same time, there are no obvious infection symptoms such as cough, expectoration and fever. Therefore, imaging combined with clinical diagnosis was dermatomyositis complicated with aspiration pneumonia. A gastric tube was inserted to correct the aspiration factors, and the patient was instructed to perform postural drainage in the left lateral recumbent position to correct the postural factors. No antibiotics were used. After 3 days, CT was re-examined. CT showed that the right lung lesions almost completely disappeared, and a few cord foci were seen in the lingual segment of the left upper lobe (Figure 1E，Figure 1F)。 Discharge diagnosis: (1) dermatomyositis, (2) aspiration pneumonia.

To explore the fabrication of a tissue-engineered mesh fabricated with autologous adipose-derived mesenchymal stem cells (ADSC) and silk fibroin scaffold for female pelvic reconstruction.

Sprague-Dawley rat adipose tissue was obtained from inguinal region. Mesenchymal stem cells were isolated and proliferated in vitro. The sericin of silk was removed after knitting in to web. Then a compound scaffold freeze-dried of silk fibroin web and silk fibroin solution was prepared for ADSC seeding. after 1-week culturing, the cellular morphology and extracellular matrix secretion on scaffold were observed by scanning electronic microscopy. The tissue-engineered meshes were implanted subcutaneously into the homologous rats while silk fibroin scaffolds served as control. Then the biomechanics, collagen matrix and local tissue response to tissue-engineered meshes in vivo with that to silk fibroin scaffolds were estimated.

ADSC were fibroblast-like and proliferated well in vitro. SEM showed that the scaffold had an interwoven structure with a smooth surface and the silk sponges in scaffold had a uniform and porous structure. ADSC adhered firmly to the scaffold, secreted extracellular matrix and formed cell sheets on scaffold. In vivo studies showed that the tissue matrix of tissue-engineered meshes was better organized than silk fibroin scaffolds. They also had higher failure force (3.081±0.121 vs 2.167±0.148 N) and Young's modulus (3.191±0.146 vs 2.263±0.213 MPa) and more collagen content (18.648±0.867 vs 14.123±0.989 μg/mg) than silk fibroin scaffolds (P<0.05).

As a suitable cell type for tissue engineering, ADSC may be successfully isolated and stably proliferated in vitro. The tissue-engineered meshes have an excellent biocompatibility andappropriate properties for pelvic floor reconstruction.

To explore the role of ubiquitin-proteasome system (UPS) in the injury of human umbilical vein endothelial cells (HUVECs) induced by oxidative low density lipoprotein (ox-LDL).

After exposure to ox-LDL, the levels of ubiquitin (Ub), E1 (ubiquitin activation enzyme), E2 (ubiquitin conjugating enzymes) and E3 (ubiquitin protein ligating enzymes) were detected by Western blot.

The levels of Ub, E1, E2 and E3 were up-regulated after induced by ox-LDL(grey level: 0.46±0.08 vs 0.25±0.09; 0.63±0.09 vs 0.45±0.09; 0.49±0.07 vs 0.35±0.06; 0.67±0.05 vs 0.45±0.05; ox-LDL 100 μg/ml, P<0.05). The regulations peaked at 12 h and 24 h (12 h grey level: 0.58±0.08 vs 0.25±0.09; 0.72±0.08 vs 0.45±0.08; 0.65±0.10 vs 0.35±0.06; 0.65±0.05 vs 0.43±0.05,P<0.05; 24h grey level: 0.72±0.08 vs 0.25±0.09; 0.79±0.08 vs 0.45±0.08; 0.72±0.04 vs 0.35±0.06; 0.65±0.05 vs 0.43±0.05,P<0.05).

The treatment of ox-LDL may activate the UPS to promote the degradation of HUVECs.

To establish murine liver cancer cell line (Hepa1-6) and human mesenchymal stem cells (hMSCs) with dual-modality imaging lentiviral vector transfection and monitor the development of liver tumors and dynamically tracking of hMSCs by bioluminescent imaging in vivo.

The cell lines of Hepa 1-6 and hMSCs were constructed abd tranfected with RL-eGFP and FL2-mKate2 lentiviruses respectively. Then the eGFP⁺ -Hepa1-6 and mKate2⁺ -hMSCs cell lines were selected by fluorescence activated cell sorting (FACS). The bioluminescent imaging technology was employed to evaluate their bioluminescent abilities in vitro and in vivo. And the capacity of mKate2⁺ -hMSCs migrating to HCC cell line (eGFP⁺ -Hepa1-6) was evaluated by Transwell migration assay.

DNA sequencing analysis confirmed that gene sequences of lentiviral vectors were correct without mutation. We successfully constructed the lentivirus vector, produced lentivirus and infected Hepa1-6 and hMSCs respectively. Subsequently eGFP⁺ -Hepa1-6 cells and mKate2⁺ -hMSCs were obtained by FACS. The expressions of fluorescent protein eGFP and mKate were confirmed by fluorescence microscope. By bioluminescent imaging system, bioluminescence intensity strongly correlated with cell number. The Transwell assay showed that hMSCs migrated toward heptocellular carcinoma (HCC) cells.

A lentivirus vector has been successfully constructed for infecting Hepa1-6 and hMSCs and analyzed by fluorescence and bioluminescent imaging. And that makes it technically feasible to further monitor the interaction of hMSCs and liver tumor cells. These results provide rationales for further studying themechanism of MSCs in the development and progression of HCC.

FHL1 belongs to a member of the LIM protein family. The LIM protein family of human FHL includes five members, namely FHL1, FHL2, FHL3, FHL4 and ACT (also known as FHL5)^[1,2,3,4]。 The expression levels of FHL1 and FHL3 were relatively high in skeletal muscle, but they were also expressed in myocardium; FHL2 is mainly expressed in the heart and at relatively low levels in skeletal muscle; FHL4 and ACT are specifically expressed in the testis^[5,6,7]。 Differential expression of FHL family members in different tissues may determine their biological function in these tissues. The FHL protein family is characterized by containing a specially arranged LIM secondary structure (C – X2 – C – X16 – 21 – H – X2 – C – X2 – C – X17 – C – X2 – C). All FHL proteins are made up of four complete LIM domains arranged in tandem and separated by eight different amino acid residues^[4]。 FHL1 is one of the more studied members of the FHL family. The human FHL1 gene is located at Xq27.2 and contains 5 exons. The cDNA is 2441 bases in length and encodes 280 amino acids. The splicing variants of FHL1 are: FHL1A (also known as Slim1, KyoT1, or transcriptional variant 3 in mice), FHL1B (Slimmer, KyoT3, or transcriptional variant 1), and FHL1C (KyoT2, or transcriptional variant 4), consisting of four-half, three-half, and two-half LIM domains, respectively^[8,9]。 Different splicing results in different nuclear localization sequences and formation of RBP – J junction domains at the C-terminus of FHL1B, FHL1C subunits. On the one hand, FHL1 can function as a co – factor and protein interaction; On the other hand, FHL1 can act as a transcription factor to regulate the expression of downstream target genes. For example, FHL1 plays a role in cytoskeletal rearrangement, fiber formation, and assembly of sarcomeriae, and plays an important role in regulating homeostasis and oxidative capacity within mitochondria. To date, FHL1 mutations in 27 humans have been found to be associated with the occurrence of at least 6 different muscular dystrophies. Therefore, this paper reviews the role of FHL1 gene in skeletal muscle development and its relationship with human muscle diseases.