Objective The articular neurohistology is a new approach to explore stabilized and chronic pain mechanisms for joint research. Furthermore, the distribution of mechanoreceptors and their functional condition play an important role in the movement and stability of joint. The animal experimental study suggest that there is a various characteristics of the type and amount of mechanoreceptors in different joints. Pacini corpuscle, Ruffini corpuscle and Golgi tendon organs as joint mechanoreceptors are widely distributed on nearly all of human joint, and have impact on stabilization of joint. The present investigates the neurohistological features of Pacini corpuscle, Ruffini corpuscle and Golgi tendon organs in the rotator cuff and the capsule, and explores their behaviors for maintaining stability of the shoulder joint. Methods Six rotator cuffs and capsules of shoulder joint were obtained from cadavers died of the accident. The tendinous tissue of subscapularis, supraspinatus、infraspinatus, and teres minis were resected from the interface of tendon and muscle to great and lesser tuberosity of humerus, the capsule tissues of glenohumeral were harvested as well. Then, the tissues were cut into a small fragments fixed with the formalin buffer solution, and embed in paraffin. The section was made along the longitudinal axis of the tendon at 150 ?m interval with Leitz 1516 machine. The modified Bielschowsky staining and the S-100 immuohistochemical staining were adopted to observe the mechanoreceptors of Pacini corpuscle, Ruffini corpuscle and Golgi tendon organs. The distribution density and size of the sensitive nerve endings were analyzed with Leica imaging process system. Results The tendinous part of rotator cuff could be divided into three layers: synovial, intermediate and articular layer. The morphology of the these three types of mechanoreceptors, Pacini corpuscle, Ruffini corpuscle and Golgi tendon organs, could be identified clearly in the every layer of the tendious tissues under microscopic examination. Pacini corpuscle was ellipse and had multi layer capsule with the thickness of 20-40 ?m; Ruffini corpuscle was columnar and 350-550 ?m in size; Most of Golgi tendon organs were found at the interface of tendon and muscle. Among of them, the Pacini corpuscle and Ruffini corpuscle were much more than the Golgi tendon organs in rotator cuff and capsule of shoulder. The results of immuohistochemical staining and the counting of nerve ending assisted by the computer showed the number of sensory nerve endings in the subscapularis, supraspinatus and anterior capsule of the shoulder were much more than in the infraspinatus, teres minis and posterior capsule. The diameter of nerve bundle in the subscapularis, supraspinatus and anterior capsule was thicker than in the other periarticular structures. In periarticular structures, the mean value of nerve fiber counting were 25 in infraspinatus, 25 in supraspinatus, 13 in subscapularis, 10 in teres minis, 22 in anterior capsule and 12 in posterior capsule. Conclusion Shoulder capsule and rotator cuff are rich in the three type of mechanoreceptors, Pacini corpuscle, Ruffini corpuscle and Golgi tendon organs. However, there are a different distribution density and size of them in rotator cuff and capsule of shoulder, but the three of mechanoreceptors are mainly concentrated in the subscapularis, supraspinatus and the anterior capsule. S-100 immuohistochemical staining is much more sensitive than the modified Bielschowsky silver staining in displaying the innervations of the rotator cuff and capsule. The characters of the sensory nerve ending distribution in shoulder imply that the innervations of the shoulder play an important role in keeping the stability and mobility of the shoulder.

Identifying the similarity and differences of malpractice,medical negligence and medical error has realistic meaning to deal with medical disputes efficiently.They are all subjective negligence and belong to the category of medical behavior.This paper mainly discussed the criteria and civil liability of their differences.

OBJECTIVE To analyze the pathogenic distribution and antimicrobial resistance in our hospital in 2006 and provide the rational information to use antibiotics reasonably.METHODS Flora cultivation and isolation were operated with the methods described by the National Clinical Laboratory Operational Regulations.Flora was identified with the VITEK32 automatic identifier,and bacteria-susceptibility test was operated with Kirby-Bauer method.RESULTS Totally 967 strains of pathogenic bacteria were isolated;they comprised 326 strains of Gram-positive bacteria,541 strains of Gram-negative bacteria and 100 strains of fungi.The main Gram-positive microorganisms included Staphylococcus aureus and Enterococcus faecalis,et al.The main Gram-negative microorganisms included Escherichia coli,Klebsiella pneumoniae,Acinetobacter baumannii,Stenotrophomonas maltophilia and Pseudomonas aerugiinosa,et al.Specimen samples mainly isolated from sputum(43.85%),urine(22.34%),and secretion(10.03%).G+ microorganisms were sensitive to nitrofurantoin and vancomycin.G-microorganisms except A.baumannii and S.maltophilia were sensitive to cefoxitin,piperacillin/tazobactam,imipenem,and amikacin;the average resistant rates of A.baumannii and S.maltophilia to antibiotics were 68.20% and 64.43%,respectively.CONCLUSIONS The severe degree of bacterial multi-drug resistance is increasing,it is urgent to carry out surveillance of bacterial resistance for reasonabe use of antibiotics and decreasing the morbidity rate and the fatality rate.

Objective To explore the effect of Valpar occupational assessment training system on cognitive dysfunction in schizophrenia. Methods Sixty patients with schizophrenia were randomly assigned into Valpar therapy group ( experiment group, n=30) and traditional rehabilitation therapy group ( control group, n=30) according to the order number. The duration of the treatment was six weeks. The brief assess?ment of cognition in schizophrenia ( BACS) and Wisconsin card sorting test ( WCST) were conducted as pre?and post?treatment assessment. Results There were significant differences between scores of BASC in pre?and post?treatment assessment in experiment group. More specifically, the BASC scores in symbol coding (37.50±6.50, t=-4.60, P<0.01),token movement(60.80±8.72, t=-2.54, P=0.017),verbal memory (44.40±11.29, t=-2.19, P=0.037)),and word fluency(14.23±4.35, t=-3.39, P=0.002) were signifi?cantly different when comparing pre?and post?treatment assessment outcomes. In control group,the only sig?nificant difference was found in word fluency (14.23±4.35, t=-3.39, P=0.002).In addition,response errors (57.80±10.35, t=-3.06, P=0.005) and repeat errors (34.67±6.96, t=3.41, P=0.002) in WCST in exper?iment group were significantly different in pre?and post?treatment assessment while only repeat errors (34.30 ±7.01, t=4.36, P=0.000) was different in control group. It was further discovered that scores in in symbol cod?ing( t=2.010, P=0.048),token movement ( t=2.124, P=0.038),response errors ( t=2.413, P=0.020) and repeat errors( t=2.009, P=0.047) in WCST were different between two groups. Conclusion Valpar professional evaluation train?ing system can significantly improve the cognitive function of people with schizophrenia.

Objective To investigate clinical feature,therapy and prognosis of 63 (rhabdomyolysis,RM) patients.Methods Retrospective analysis was used for the 63 patients who were from Nanjing from Janurary 2010 to August of 2016.Results Clinical history:the pathogenic factors mainly contained eating lobster,excessive exercise,lipid-lowering drugs,and minority patients were induced by infection,cardiac defibrillation,alcohol,and unexplained factors.Clinical features:most patients presented different degree of muscle soreness and weakness,and urine color of soy sauce;and few patients manifested a fever,respiratory distress and sound hoarse.Of which 11 RM patients concurrent acute kidney injury (AKI),there was no obvious bias of pathogenic factors among 11 patients.Clinical examination:the data was described by median,including creatine kinase 6 400 U/L,aspartate aminotransferase 399 U/L,lactate dehydrogenase 816 U/L,α-hydroxybutyric acid 445 U/L,and myoglobin 1 200 ng/ml.Creatine kinase and myoglobin were selected to measure muscle injure,there was no significant difference among the groups (P ＞ 0.05).Renal tubular injury index such as urincosmotic pressure,urine retinol-binding protein and N-acetyl-beta-D-glucosaminidase (NAG) enzyme,the abnormal percentage were 62.5％,50％,and 47.6％.Treatment:patients without complications through resting,water infusion,urine alkalization,were cured;and 11 cases of patients with AKI,1 case gave up,5 cases underwent hemodialysis,and 5 cases underwent conservative treatment,creatinine decreased to the basic level.Conclusions Among different pathogenic factors of RM,there were no obvious differences in clinlcal symptom,muscle damage degree,and whether the coexistence of AKI and prognosis.The understanding of RM,early diagnosis and treatment would prevent AKI and improve the prognosis.

[ABSTRACT]AIM:ToinvestigatetheroleoftinyantisensenucleicacidagainstmiR-155(tinyantimiR-155, t-antimiR-155) in multiple myeloma cells .METHODS:According to the seed sequence of miR-155, t-antimiR-155 was designed and synthesized .t-antimiR-155 was transfected by Lipofectamine TM 2000 into RPMI-8266 cells.The cells were di-vided into t-antimiR-155 group, scrambled control (SCR) group and blank control group .The growth-inhibitory potencies were measured by MTT assay .The ability of cell colony formation was detected by cell colony formation assay .The cell ap-optosis was assessed by flow cytometry with annexin V /PI double staining .RESULTS: The best concentration and time were 0.4 μmol/L and 48 h, respectively.The cell colony forming experiment showed that the circumstances of forming cell community in t-antimiR-155 group was weaker than that in SCR group , and the colony formation inhibitory rate of former was significant higher than the latter .Compared with SCR group , the cell apoptosis in t-antimiR-155 group significantly in-creased.CONCLUSION: The t-antimiR-155 inhibits the progression of multiple myeloma cells by interfering with miR-155.miR-155 may serve as a potential target in gene therapy for treating multiple myeloma .

Objective To explore the effect of topical application of sodium hyaluronate on preventing perivascular adhesion of the vein grafts in rabbits. Methods Thirty-six male New Zealand white rabbits, aged 5 months, were randomly and equally divided into 2 groups: groups A and B. Arterial defect model was established by cutting about 1cm artery from the middle part of the dissected left common carotid artery. A section about 3cm was cut from the right external jugular vein, and the harvested vein was inverted and anastomosed end-to-end to the artery defect. After the anastomosis, the adventitia and two anastomoses of the grafted veins in group A were coated locally with 0.2ml sodium hyaluronate. The grafted veins were obtained 1, 2 and 4 weeks after the operation, with the perivascular adhesion of the vein grafts being examined macroscopically before the resection. HE staining and Masson staining were preformed for histological changes of grafted vein wall and the perivascular adhesion of the vein grafts. At 2, 4 weeks postoperation, the perivascular adhesions of the vein grafts were graded by the grading criteria of adhesion in macroscopic evaluation and histological evaluation. Result At 1, 2 and 4 weeks postoperatively, the macroscopic and histological observation found that the perivascular adhesions in group A were looser than those in group B. The macroscopic grade and histological grade were lower in group A than in group B, there was a significant difference between the two groups at 2 and 4 weeks postoperation (P<0.05). Conclusion Topical application of sodium hyaluronate can reduce the perivascular adhesion and is an ideal treatment strategy for preventing perivascular adhesion of vein grafts.

Objective To investigate the mutations of pedocyte molecules in patients with late onset familial focal segmental glomerular sclerosis (FSGS). Methods Thirty-one pedigrees of late onset familial FSGS in Department of Nephrology, Shanghai Ruijin Hospital from Sep 1997 to Oct 2007 were enrolled in this study. The diagnosis standard of familial FSGS was as follows:(1) the age of presentation was more than 12 years old. (2) in one pedigree, two or more individuals were proven as FSGS by renal biopsy, or at least one was proven to be FSGS by renal biopsy, the others presented renal insufficiency or pmteinuria without precise causes. One hundred unrelated healthy people were screened as control group. Genomic DNA extracted from peripheral blood cells were amplified by PCR and then sequenced for mutations of NPHS2, ACTN4 and TRPC6. Results A novel missense heterozygotic mutation L316P of ACTN4 was identified inone pedigree. The mean onset age of the affected members of this pedigree was (38.7±7.4) years old and their kidney injury progress was slow. Proteinuria of the proband's brother was not improved by immunosuppressor. All 3 affected members of this family had such heterozygotic mutation. A novel missense heterozygotic mutation Q889K of TRPC6 was found in another pedigree. The mean onset age of the affected members in this pedigree was (38.0±4.2) years old. Three members presenting renal disease in this family all had such heterozygotic mutation but with different clinical manifestations. A quiescent mutation G467G of TRPC6 was also identified. Above variants were not found in healthy controls. No NPHS2 mutation was found to cause familial FSGS in these pedigrees. Conclusions A novel mutation L316P of ACTN4 and a new mutation Q889K of TRPC6 are identified in Chinese patients of late onset familial FSGS. No NPHS2 mutation is found to induce FSGS in these pedigrees.

Objective To explore the role of serum inflammatory factors in prediction of infection following internal fixation of closed fractures and its significance for surgical timing and infection prophylaxis.Methods A retrospective study was conducted of the 100 patients who had been treated by internal fixation for closed fracture from January 2014 through July 2016.They were 52 men and 48 women,aged from 24 to 76 years (average,45 years).There were 14 femoral fractures,19 tibial plateau fractures,25 patella fractures,8 pilon fractures,22 tibiofibular shaft fractures,and 12 calcaneal fractures.Of them,21 were inflicted by wound infection.The preoperative and postoperative infection indexes,CRP,ESR,PCT and leukocyte count,were recorded.Logistic regression analysis was conducted to test the correlation between the infection indexes and postoperative infection.The optimal cut-off value was determined by the receiver operating characteristic curve.Results CRP showed a significant correlation with postoperative infection while other indexes did not.The optimal cut-off value was 25 mg/L at one day before operation.Conclusions Preoperative determination of CRP may predict the risk of postoperative infection.CRP ＞ 25 mg/L at one day before operation may indicate the following day is not suitable for surgery and active infection prophylaxis should be conducted after surgery.

Objective To investigate the correlation between daytime sleepiness and anxiety,depression in patients with obstructive sleep apnea and hypopnea syndrome(OSAHS).Methods A total of 117 patients with sleep -snoring from September 2015 to September 2017 who admitted to the Department of Respiratory Medicine of Shengjing Hospital Affiliated to China Medical University were collected for general information.ESS,SDS,SAS questionnaire and polysomnography were detected.The differences between simple snoring and OSAHS group were compared,and the correlation between Epworth Sleepiness Scale (ESS),Self-rating Depression Scale (SDS),Self-rating Anxiety Scale(SAS) score was analyzed.Results The scores of ESS,SDS and SAS in the OSAHS group were (16.24 ± 3.82) points,(46.27 ± 9.01) points,(48.21 ± 9.44) points,respectively,which were higher than those in the simple snoring group [(6.0 ± 2.58) points,(35.50 ± 18.40) points,(36.55 ± 17.97) points] (t =-14.425,-2.521,-2.780,all P ＜ 0.05).There was a correlation between SDS or SAS score and ESS score in OSAHS group(r=0.419,0.313,all P ＜0.05).Conclusion The sleepiness and anxiety,depression in OSAHS patients is more severe than simple snoring;ESS score in OSAHS patients can reflect the severity of the disease,the degree of sleepiness in patients with OSAHS is related to depression and anxiety.