Objective To study the influence of long-term use of BZDs on the process and prognosis of elderly CAP.Methods The clinical information of the patients was retrospectively analyzed.According to whether the long-term use of BZDs was divided into the observation group (84 cases) and the control group (103 cases),there was no significant difference between the two groups (P ＞ 0.05).Two groups of patients were treated with conventional CAP,compared the two groups of patients with treatment,progress and prognosis of pneumonia.Results There was significant difference (P ＜ 0.05) in the therapeutic effect between the two groups;CPIS of the observation group after the treatment of 7d was significantly lower than that before treatment (P ＜ 0.05),later than that of the control group.The mortality rate,ICU ratio,hospitalization cost and days of the observation group were significantly higher than those of the control group (P ＜ 0.05).Adverse reactions were no significant difference (P ＞ 0.05) between the two groups.Conclusion Long-term using BZDs is not beneficial to the elderly CAP patients and worsen the prognosis situation.Therefore the clinical application of BZDs to elderly CAP patients should be made with cautiousness.

To investigate the gene typing, molecular characteristics of virulence and resistance associated gene of Clostridium difficile from clinical isolates in China, the genes tcdA,tcdB of toxin A and B, cdtA,cdt B of binary-toxin, and erm B of clindamycin resistance were detected by conventional PCR. Genotyping of toxic C. difficile were conducted by means of analysis of 16s-23s internal spacer region polymorphism with PCR assay. Then the antibiotic resistance of toxic C. difficile to ampiciline, clindamycin, metronidazole and vancomycin was conducted with E-test. It was found that 8 toxic C. difficile strains were demonstrated out of 12 clinical isolates, in which 5 strains were tcdA+ and tcdB+, and 3 strains tcdA- and tcdB+, accounting for 62.5% and 37.5% respectively. Binary-toxin genes detection were negative in all the strains. Clindamycin resistance associated gene ermB was positive in 4 out of 8 toxic C. difficile strains, accounting for 50%. 8 toxic isolates were typed into 4 gene types, the dominant type was ZR I,accounting for 62.5%. Resistance rate of 8 toxic C. difficile strains against ampiciline(AC), clindamycin(CM), metronidazole(MZ) and vancomycin(VA) was 37.5%,87.5%,12.5%, and 0 respectively. No isolates belonged to ribotype 027 or 078. Isolation rate of toxic C. difficile is high to 66.7%. There is obvious gene polymorphism in clinical isolates of Chinese toxic C.difficite, and ZR I is preponderant genotype in 4 genotypes. C. difficile shows some resistance to ampiciline, clindamycin, metronidazole, but susceptive to vancomycin.

Objective To determine the three-dimensional (3D) texture features extracted from intensity and high-order derivative maps that could reflect textural differences between bladder tumors and wall tissues,in order to achieve bladder cancer and wall tissue identification.Methods A total of 62 cancerous and 62 wall volumes of interest (VOI) were extracted from T2-weighted MRI datasets of 62 patients with pathologically confirmed bladder cancer.To reflect heterogeneous distribution of tumor tissues,3D high-order derivative maps (the gradient and curvature maps) were calculated from each VOI.Then 3D Haralick features based on intensity and high-order derivative maps and Tamura features based on intensity maps were extracted from each VOI.Statistical analysis was proposed to first select the features with significant differences and then obtain a more predictive and compact feature subset to verify its differentiation performance.Results From each VOI,a total of 58 texture features were derived.Among them,37 features showed significant inter-class differences (P≤ 0.01).Conclusion The results suggest that 3D texture features deriving from intensity and high-order derivative maps can reflect heterogeneous distribution of cancerous tissues.

?Objective :To construct human skin with full thickness in vitro using tissue engineering techniques. Metheods: Epithelial cells and fibroblasts were isolated from the back skin of legally aborted human foetus. Fibroblasts were seeded into bovine type I collagen gel and cultured for 3 days. Epithelial cells were seeded on the surface of collagen gel and cultured for another 2 days, then the equivalent skin was exposed to air liquid interface to generate a protective cornified layer. 5 days later, equivalent skin was excised and observed under light microscope and transmission electron microscope. Results: Epithelium and dermis were observed in the equivalent skin,similar to those in normal human skin. Epithelium was made up of stratum basale, stratum spinosum, stratum granulosum and stratum corneum. The cells of different layers were connected with intercellular bridge. Horny pearl were also found in epithelium. Basement member was observed between epithelium and dermis. Epithelial spikes bristles of different length were existed in partial dermis. The results of TEM observation showed that desmosome existed between cells of different layer in epithelium. Conclusion: Human skin with full thickness can be tissue engineered with foetus back skin as the sources of epithelial cells and fibroblasts, and bovine I type collagen as carrier.

Objective To enhance understanding of the vertebral compressed fracture in old patients so as to reduce its misdiagnosis. Methods 30 aged patients with vertebral compressed fracture were treated from 1998 to 2004 in our department. Their clinic data were retrospectively analyzed. There were 27 males and 3 females, aged from 70 to 90 years (averaging 82.5 years). Results All the patients were diagnosed definitely. There were 2 cases of T11 fracture, 13 cases of T12 fracture, 11 cases of L1 fracture, 3cases of L2 fracture, and 1 case of L3 fracture. At first 1 case was overlooked, and segmental positioning was wrong in 3 cases but the mistakes were corrected later. Conclusion Meticulous review of the history and clinical manifestation in addition to supplemental imageological examination are essential to early diagnosis of the majority of vertebral compressed fractures. As for some difficult early diagnoses, fat suppression MRI and nuclide bone scanning are helpful.

Objective To study the role of early intravenous nutrition given aggressively combined with early minimal feeding on very low birth weight infants (VLBWI),and to evaluate the clinical value of intestinal barrier protein and MicroRNA.Methods All of 62 cases of VLBWI admitted in NICU,the Maternal and Child Health Hospital of Nantong Affiliated to Nantong University from January 2006 to June 2014 were recruited.Sixty-two VLBWI were randomly divided into group A and group B.Thirty infants in group A were exposed to conventional intravenous nutrition.Thirty-two infants in group B were treated with early intravenous nutrition aggressively combined with early minimal feeding.The time of birth weight recovery,days with intravenous nutrition,hospital stay and complications were recorded.The liver and kidney functions,electrolytes,blood gas analysis were monitored.Enzyme-linked immunosorbent method was used to detect intestinal fatty acid binding protein (Ⅰ-FABP),an intestinal barrier protein in plasma.Infection related MicroRNA155 was detected with fluorescent quantitative polymerase chain reaction (RT-PCR).Results Group B was superior to group A in weight loss after birth [(13.70 ± 3.10) ％ vs (5.46 ± 2.64) ％,P ＜ 0.05],shorter recovery time of body weight [(12.20 ± 3.38) d vs (6.82 ± 3.20) d,P ＜ 0.05],fewer days with intravenous nutrition [(29.62 ± 4.16) d vs (20.80 ± 3.20) d,P ＜ 0.05] and shorter hospital stays [(44.60 ± 6.32) d vs (28.91 ± 4.36) d,P ＜ 0.05].Compared with group A,the infants in group B had less complications,including hyperbilirubinemia (31.2％ vs 56.7％),extrauterine growth retardation (34.3％ vs 73.3％),cholestasis (6.2％ vs 23.3％),feeding intolerance (15.6％ vs 53.3％) and necrotizing enterocolitis (0 vs 16.7％) (all P ＜ 0.05).Although Ⅰ-FABP had a higher plasma concentration in group A than that of group B [(9.083 ± 1.059) μg/L vs (7.563 ± 0.739) μg/L],the difference was not significant (t =1.190,P =0.076 4).However,the plasma levels of Ⅰ-FABP in infants with necrotizing enterocolitis were significantly higher than those of group B [(19.500 ± 3.510) μg/L vs (7.563 ±0.739) μg/L,t =5.231,P =0.035 0].The expression of MicroRNA155 in group A was markedly higher than that of group B (2-△△ct were 0.81 ± 0.12 and 0.24 ± 0.08,respectively,P ＜ 0.05).Conclusions Giving aggressive intravenous nutrition early combined with early minimal feeding was safety and effective to VLBWI,which was of benefit to their growth and development,reducing complications and shorting hospital stays.The detection of intestinal barrier protein Ⅰ-FABP and MicroRNA155 is useful for monitoring feeding complications of VLBWI.

Objective To provide theoretical evidences for diagnosis of bladder neoplasm by using more information of imaging features. Methods MRI images of bladder neoplasm were collected for this research. The ROI (region of interest) area was selected manually,and noise reduction and sharpening were applied to the ROI area by using LoG (Laplacian of Gaussian) filter. The texture features of bladder neoplasm and normal bladder wall (smooth muscle),such as mean grey-level intensity,entropy,uniformity were calculated. A statistical analysis was made at last. Results The values of texture features were analyzed by t-test. Entropy and uniformity show significant differences between the two groups. But Mean grey-level intensity hasn't indicated this difference. Conclusion This texture features may be applied to decide the invasive depth of bladder neoplasm,it also means that the stage of bladder neoplasm may be fixed by this system.

Objective To explore the feasibility of applying small private online course (SPOC) in the course of Microcomputer Principle and Interface Technology to solve its problems in complicated knowledge points,abstract contents and difficulty in understanding.Methods The characteristics of the undergraduate students in the military medical university and SPOC mode were analyzed,and then the design and implementation of a SPOC-based Microcomputer Principle and Interface Technology course were explored in the military medical university.Results By applying the SPOC into the teaching of Microcomputer Principle and Interface Technology course,the student could find out the forgotten or leaked knowledge and reiterate them to reinforce the memory of those knowledge points,which promoted their self-regulation of learning.Besides,teaching the students with real cases not only increased the learner's enthusiasm but also strengthened the military medical background.The offline group discussion facilitated the students in understanding and application of knowledge.Conclusion Applying SPOC mode into PMIT teaching no doubt improves the effect and quality of teaching and learning.

Objective To survey on satisfaction degree of preventive medicine undergraduates on tutorial system and to improve the effects of tutorial system.Methods Totally 73 students of preventive medicine,who would graduate in 2012,were asked to fill the questionnaires by themselves.Main contents of questionnaires include effects,satisfaction score,expectations and reality benefits,requirements for the tutors and problems of the tutorial system.Chi-square was used to test the differences between expectations and reality benefits and the significance level was set as P ＜ 0.05.Results More than half of the students thought that the effect of tutorial system was general while 43.8％students thought good and excellent.Percentages of satisfaction score over 50,over 80 and over 90 were 75.3％,41.1％ and 12.3％,respectively.Statistical analysis shown that the real benefits from research activities were more than expectation (P ＜ 0.001),while the real benefits from tutor's academic encouragement,job guidance and life values were lower than expectation (P =0.026,P =0.003,P =0.010).Students expected to have more opportunities with the professors in the future.However,there were 17.8％ students hardly attended the activities of tutorial system,in which lack of understanding of tutorial system was the main reason and without enough time was another reason.Conclusions Students basically satisfies with tutorial system and the satisfaction degree needs to be improved.Roles of tutorial system should be fully strengthened by the management department,tutors and students.

Objective To design a multiplex PCR for simultaneous identification and toxigenic type characterization of Clostridium difficile isolates. MethodsThree pairs of primers were designed for the amplification of a species-specific internal fragment of the tpi( triose phosphate isomerase) gene, an internal fragment of the tcdB ( toxin B) gene, and an internal fragment of the tcdA ( toxin A) gene. Twenty-one standard strains including Clostridium difficile ATCC 9689 and 47 isolates of Clostridium difficile were applied for the assessment of detection limit, specificity and detections of the multiplex PCR, respectively. Toxin A and Toxin B of 47 isolates were analyzed by ELISA. ResultsThe detection limit for DNA concentration of the multiplex PCR was 0.5 pg/μl. The specificity was determined to be 100％. Among the results of 47 isolates detected by multiplex PC R, 37 strains were tpi ( + )/tcdA (+)/tcdB ( + ), 10 strains were tpi ( + )/tcdA (-)/tcdB ( - ). Tpi ( + )/tcdA ( - )/tcdB ( + ) was not found. The toxin detection of 47 isolates by ELISA showed that 20 isolates were positive and 27 isolates were negative. Twenty isolates of toxin (+) by ELISA were all tpi( +)/tcdA( +)/tcdB(+) by multiplex PCR. ConclusionThe multiplex PCR method combined diagnosis and toxigenic type characterization contributes to the diagnosis for Clostridium difficile infection.