[Summary] Bile acid is a main component of bile ,which plays a key role in keeping cholesterol metabolism balance in vivo and promoting lipids digestion in intestine. Recently ,more and more researches focus on bile acid for its regulating effect on glucose ,lipid and energy metabolism as a signal molecule. The reabsorbed bile acid stimulates the secretion of fibroblast growth factor 19 (FGF19) and glucagon-like peptide-1(GLP-1) in the intestine by activating a nuclear receptor farnesoid X-activated receptor (FXR) and a membrane receptor TGR5. FGF19 and GLP-1 regulate hepatic glucose metabolism through different pathways. Here ,we briefly summarize the research progress and relationship between bile acid induced gut hormones and hepatic glucose metabolism.

ObjectiveTo explore the relationship between anastomotic leakage of patients undergoing colonic surgery and the collagen metabolism of colonic wall.Method We measured the overall collagen content of colonic tissue by biochemistry and detected the collagen I, III, MMP-1,MMP-13 by immunohistochemistry in 16 patients with anastomotic leakage compared with 16 control cases. Resultthe overall collagen content and collagen I,III of colonic wall in the leakage group were lower than those in the control group (t=3.417,t=2.841, t=2.261,P

Aged, 80 and over ; Chronic Disease ; Female ; Humans ; Mucor ; pathogenicity ; Mucormycosis ; microbiology ; pathology ; Orbit ; pathology ; Sinusitis ; microbiology ; pathology

BACKGROUND:Spinal cord ischemia-reperfusion injury is a serious secondary injury of the spinal cord. Multifactor could contribute to the mechanism of this injury, and many therapeutic measures emerge, but the therapeutic effect is not ideal.
OBJECTIVE:To investigate the protective effects and mechanism of hydrogen-rich saline on spinal cord ischemia-reperfusion injury in rabbits.
METHODS:ZIVIN method was adopted to prepare the model of spinal cord ischemia-reperfusion injury. The rabbit models were randomly divided into model group, sham operation group, and hydrogen-rich saline group.
RESULTS AND CONCLUSION:Improved Tarlov scores for the evaluation of motor function were significantly increased in hydrogen-rich saline group compared with the model group at 6, 12, 24, 72 hours after reperfusion (P<0.01). The contents of malondialdehyde were significantly lower (P<0.05), while catalase activity was significantly higher (P<0.05) in hydrogen-rich saline group than that in model group at 72 hours after reperfusion. Hematoxylin-eosin staining revealed that, spinal cord anterior-horn motor neurons maintained intact structure in sham operation group;more necrotic spinal cord anterior-horn motor neurons were found in model group, and granular-vacuolar degeneration occurred in the endochylema. In hydrogen-rich saline group, the structure of spinal cord anterior-horn motor neurons was basical y intact, only a smal amount of spinal cord anterior-horn motor neurons appeared vacuolar degeneration. TUNEL staining showed no apoptotic spinal cord anterior-horn motor neurons in sham operation group. Many inflammatory cel s and apoptotic neurons were found in model group. There were few inflammatory cel s and apoptotic neurons in hydrogen-rich saline group. Hydrogen-rich saline can prevent the apoptosis of spinal cord anterior-horn motor neurons in rabbits with spinal cord ischemia-reperfusion injury, and the underlying mechanism is associated with antioxidative effect.

Objective To analyze the problems of doctor of medicine in China,and to explore the efforts to improvethe training quality of doctor of medicine.Methods The paper selected 5medical colleges which participated the thematic evaluation of doctor of medicinedegreeauthorization centers in 2014,then analyzed the relevant data of doctor of medicine during 2011-2015,such as education condition,enrollment scale,training objective,curriculum setting,scientific research trainingand clinical practice by descriptive study.Results The average of affiliated hospitals is 6.0.The number of medical doctor entrance exam increased by 1.5 times during 2011-2015.The training institutions set up clear training objective of applied talents.A three-stage cultivation mode of course learning,clinical practice and scientific research training is widespread enforcement.However,the subject and basiccondition varies in different schools.The teachers’ professional level is uneven.The quality of candidates needsto be improved.Curriculum design is lack of pertinence.Standardization of clinical practice andscientiFlc training system is not enoughat the same time.Conclusions The suggestions to promote the reform of full-time doctor of medicineare:improving the subject building;increasethe number of students enrollment appropriately;strengthening pertinence of curriculum system;perfecting quality evaluating system;exploring the training mode called “5 + 3 + X”.

Objective To evaluate the efficacy of gentamicin solution in transurethral ureteroscopic lithotripsy to prevent postop- erative infection.Methods Prospective clinical randomized control study was conducted.From July 2003 to June 2006,116 ca- ses of ureteral stones at high risk of postoperative infection were randomized into control group or gentamicin group.Patients in gentamicin group received gentamicin solution for washing in the operation.All the patients undergoing operation were followed up for 2 weeks after operation.Diagnosis of postoperative infection was based on clinical manifestations.Results A total of 109 patients received operation in all the 116 cases,including 58 cases in gentamicin group and 51 cases in control group.Thirteen cases of postoperative infection were identified in all the patients receiving operation (11.93%),3 cases in gentamicin group and 10 in control group.The incidence of postoperative infection was significantly different between the two groups (X~2= 5.3342,P=0.0209).Eight cases had positive bacterial culture.Of the microbiological isolates,2 were gram-positive bacteria, 5 gram-negative bacteria and 1 Candida albicans.Conclusions The most common pathogen causing postoperative infection after transurethral ureteroscopic lithotripsy is gram-negative bacteria.The use of gentamicin solution for washing in the operation can reduce the incidence of postoperative infection.

Objective To evaluate the correlation of the ion selectivity electrode assay and arsenazo Ⅲ assay for serum calcium determination and compare the differences between two methods.Methods 142 serum samples were collected from patients and detected by ion selectivity electrode assay and arsenazo Ⅲ assay,the differences of two methods were compared,person correlation and Bland -Altman was used to discuss the correlation.Results The serum calcium concentration detected by ion selectivity electrode assay was (2.23 ±0.10)mmol/L and detected by arsenazo Ⅲ assay was (2.24 ±0.12)mmol/L,the difference between the two methods was not statistically significant (t =-1.09,P >0.05).The person correlation analysis demonstrated that the two methods had a positive correlation (r =0.393,P <0.01).The Bland -Altman consistency analysis showed that ion selectivity electrode assay was agreed with arsenazo Ⅲ assay.Conclusion The two methods for serum calcium concentration determination,the ion selectivity electrode assay was coincidence with the arsenazo Ⅲ assay.

OBJECTIVETo explore the clinical effects of Dynesys system combined with posterior lumbar interbody fusion (PLIF) in treating multiple lumbar degenerative disease.

METHODSThe clinical data of 46 patients with multiple lumbar degenerative diseases treated by Dynesys system combined with PLIF from September 2010 to May 2013 were retrospectively analyzed. There were 17 males and 29 females, aged from 38 to 68 years old with an average of (56.38±11.63) years. Operation section was in L2-L5 of 16 patients (6 with fusion of L4,5 and 10 with fusion of L4,5,L5S1) and in L3-S1 of 30 patients (11 with fusion of L5S1 and 19 with fusion of L4,5,L5S1). Patients were followed up for three times: postoperative 3 months, 1 year and final follow-up. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to assess clinical symptoms preoperatively and postoperatively. All patients underwent flexion/extension radiographs examinations before surgery and at final follow-up. Range of motion (ROM) and disc height index (DHI) were recorded.

RESULTSAll patients were followed up from 16 to 48 months with the mean of (23.23±7.34) months. At third follow-up after operation, ODI and VAS of lumbago and leg pain were significant improved than that of preoperative (P<0.01). DHI of fusion segment was significantly increased than that of preoperative (P<0.05). There was no significant difference in adjacent non-fusion segment between preoperative and postoperative (P>0.05). Postoperative ROM of fusion and non-fusion segments were obviously decreased than that of preoperative. There was no significant difference in ROM of upper adjacent non-fusion segment between 3 months and 1 year after operation (P>0.05), but at final follow-up, the ROM was increased (P<0.05).

CONCLUSIONThe preliminary clinical results of the Dynesys system combined with PLIF in the treatment of multiple lumbar degenerative diseases are satisfactory. It can be determined in fusion or non-fusion according to the individual needs and can reserve the some intervertebral motion, prevent the early degeneration of adjacent segments. However, its long-term clinical efficacy should be verified with long time.

Humans ; Lumbar Vertebrae ; surgery ; Range of Motion, Articular ; Retrospective Studies ; Spinal Diseases ; physiopathology ; surgery ; Spinal Fusion ; methods ; Visual Analog Scale

Objective To investigate the effectiveness of endoscopy and enteral nutrition (EN) in the treatment of acute biliary pancreatitis (ABP) in elderly patients and its impact on prognosis.Methods Eighty-four elderly patients with ABP were randomly divided into two groups,including 42 cases of combination treatment group,42 cases of routine treatment group.The routine treatment group was managed with normal comprehensive treatment,and in combination treatment group,patients were treated with additional endoscopic retrograde cholangiopancreatography (ERCP),endoscopic sphincterotomy (EST) and endoscopic naso-biliary (ENBD) drainage and EN.The clinical symptoms,serum inflammatory cytokines,complications and prognosis were compared.Results The CRP,TNF-α,IL-2,and serum amylase,glucose,AST after treatment were significantly lowered than those before treatment (P ＜ 0.05).In addition,the levels of CRP,TNF-α,IL-2,and serum amylase,glucose,AST,ALB in combination treatment group were significantly lower than those in routine treatment group (P ＜ 0.05).The time to abdominal pain cessation,time to fever cessation,hospital stay in combination treatment group were (4.6± 1.3),(3.7± 1.3),(13.5± 2.7) d,which were significantly lower than those in routine treatment group [(6.1 ± 1.3),(5.5 ± 2.1),(18.1 ± 3.8) d,P ＜ 0.05].The APACHE Ⅱ score of combination group after treatment was (7.l ± 1.8) point,which was significantly lower than that in routine treatment group [(9.2 ± 2.6) point,t =3.41,P ＜ 0.05)].The incidence rates of ARF,ARDS,peri-pancreatic infection and abdominal hemorrhage,in combination group were 7.1％,4.8％,4.8％,4.8％,respectively,which were significantly lower than those in routine treatment group (23.8％,19.1％,21.4 ％,19.1％,P＜0.05).The mortality in combiration group was 4.8％,which was lower than 16.7％ in routine treatment group with no statistical significant.Conclusions It is a safe and effective to treat elderly ABP patients with endoscopy combined with EN,which can significantly reduce complications and mortality.

Objective:To investigate the expression and function of CD226 on NK s ubsets and its coexpression with other activation receptor and inhibition recept or on NK cells. Methods:The expression of CD226 on CD56 bright and CD56 dim NK subsets and coe xpress ion with CD16 and NKG2A in PBMC and MLC in the presence or absence of IL-2 or IL-15 were detected by double fluorescent staining and flow cytometry analysis. The level of IFN-? in the supernatants of PBMC culture and MLC treated with o r without IL-2 or IL-15 were evaluated by ELISA. 51Cr release assay w as employed to measure the specific lysis of NK cells killing target K562 cells. Results:CD226 was mainly expressed on CD56 dim NK subsets in PBMC. When s imulated by IL-2, CD226 expression was shifted to CD56 bright NK subsets, while IL-15 increased the subpopulation of NKG2A+CD226+double positive cell s. In MLC-generated NK cells, CD226 was mainly expressed on CD56 dim NK su bsets, and also shifted to CD56 bright NK subsets in the addition of IL-15 . Furt hermore, the percentage of CD16+CD226+和NKG2A+CD226+ subsets were increa sed when stimulated by IL-2 or IL-15. There was great increase in IFN-? lev el in the supernatants of PBMC culture in the presence of IL-2 or IL-15, but no difference in the supernatants of MLC treated with or without two cytokine s. Moreover, the cytotoxicity of NK cells in PBMC and MLC were greatly enhanced by IL-2 or IL-15. Conclusion:CD226 is mainly expressed on CD56 bright NK subsets in IL-2 or IL-1 5 activated NK cells, and is coexpressed with CD16 and NKG2A preferentiatly, whi ch maybe involve in the modulation of cytotoxicity of NK cells based on the balance of coexpressed activation and inhibition receptors. [