Objective To prepare chitosans of high degree of deacetylation with different molecular weights.Methods A series of chitosan samples of high degree of deacetylation were prepared by different approaches of hydrolysis from commercial chitosan in the presence of strong base.The obtained deacetylchitosans were then degraded into samples with medium or low molecular weight in the system of acetic acid and hydrogen peroxide.Their corresponding molecular weights were further determinied with Ubbelohde viscometer.Results Chitosans of high degree of deacetylation with different molecular weights were successfully prepared under the experiment conditions.Their characteristics were indicated and analysed by IR and 1H-NMR.Conclusion Chitosans of 90%~100% degree of deacetylation can be prepared by the intermittent approach of hydrolysis using 10mol?L-1 NaOH solution at 110℃.Chitosan samples with the viscosity-average molecular weigh between 10,000 ~100,000 Da can be prepared in the system of 0.35 mol?L-1 acetic acid and 0.45 mol?L-1 hydrogen hyperoxide.

AIM:To investigate the effect of Dachengqi decoction(DD)on the acute respiratory distress syndrome(ARDS)in rat model induced by endotoxin "two-hit".METHODS:48 healthy male Wistar rats were randomly divided into 4 groups:control group,ARDS model group,ARDS+DD treatment group and ARDS+dexamethasone treatment group(12 in each group).E.coli lipopolysaccharide(LPS)"two-hit" induced ARDS model in rats was established.The arterial blood gas analysis,lung wet/dry weight(W/D)ratio and lung tissue pathology observation and scoring were measured to evaluate the pharmacological effects of DD on ARDS.The levels of TNF-?,IL-1 and IL-10 were determined by ELISA to explore the immune regulatory mechanism of DD.RESULTS:(1)Treatment with DD significantly improved blood pressure in rats,increased oxygen saturation,decreased lung wet/dry weight ratio and lung injury score,relieved pulmonary edema and the inflammatory responses.(2)DD suppressed the productions of systemic and pulmonary pro-inflammatory mediators and promoted the release of anti-inflammatory mediators in lung.CONCLUSION:The inhibitory effects of DD treatment on pulmonary inflammatory response are not only related to reducing the extent of systemic inflammatory response,but also promote pulmonary anti-inflammatory production and regulate the balance of pulmonary pro-inflammatory mediators and anti-inflammatory cytokines.This specific regulatory effect protects the target organ from excessive inflammatory organ injury,discloses that DD has advantages in the treatment of endotoxic ARDS.

Recent studies have found that peptide therapies tar-geting specific epitopes can avoid nonspecific immune suppres-sion induced by traditional medicines for the treatment of autoim-mune diseases, and have shown great therapeutic effect in ani-mal models of autoimmune diseases and clinical trials. The pa-per summaries the research progress and trends of peptide drugs for the treatment of autoimmune diseases from candidate peptide sources and their suppression mechanisms, which can provide a theoretical basis for the in-depth understanding of immune toler-ance and allow for discovery of new treatment for autoimmune diseases.

OBJECTIVE To investigate the epidemiological characteristic of lower respiratory infection among the hospitalized patients in Tianlin Community Health Service Center so as to take effective measures to control the infection and reduce the emergence of drug resistant strains.METHODS Totally 6150 cases of patients discharged from our Center during from Jan 2004 to Sept 2006 were collected and among them 141 cases occurred hospital onset of lower respiratory infection and drug resistance was analyzed through contrasting.RESULTS The incidence rate of hospital onset of lower respiratory infection and drug resistance were 2.29% and 58.62%.Among the 141 cases,the incidence rate of ESBLs was 28.36% which mainly produced from Escherichia coli and Klebsiella pneumoniae.CONCLUSIONS Primary affection should actively treated and antibiotics should use rationally according to the drug sensitive cultivation to control the abuse of antibiotics and reduce the emergence of drug resistant strains.

Total 406 community residents entered in fitness improvement program with “management by objectives model of health promotion” from 2009 to 2011.The fitness status was monitored by Xuhui Physical Constitution Center before and after entering the program.The results showed that the level of fitness assessment,the composite score,lung capacity and reaction time were improved with the years (P ＜ 0.01) ; the step index and sitting-and-reach test in 2010 was better than those in 2009(P ＜ 0.01) ; the grip strength in 2010 and 2011 was better than that in 2009 (P ＜ 0.01); the test of single leg-standing with closing eyes in 2011 was better than that in 2009(P ＜ 0.05).There was no difference in body mass index before and after program (P ＞ 0.05).The results indicate that physical fitness and overall health can be improved by management by objectives model for health promotion.

Objective To evaluate patient outcomes of sustained low flow oxygen inhalation therapy with humidifying and non-humidifying oxygen.Methods Randomized controlled trial (RCT) about sustained low flow oxygen therapy with humidifying and non-humidifying oxygen were searched from China National Knowledge Infrastructure (CNKI),Wanfang database,VIP database,PubMed on line.Literatures were searched from the database had been established till now.The primary outcome of the rate of unpleasant respiratory symptoms,oxygen humidification cylinder pollution as well as secondary lower respiratory tract infections were attached importance to.Two reviewers evaluated the literatures independently according to the RCT authentic assessment manual of Cochrane Collaboration.Negotiation took as the measure to attach an agreement.RevMan 5.2 was used to analyses the result of the study.Results A total of 15 met the inclusion criteria,Meta-analysis showed that humidifying and non-humidifying oxygen was not statistically significant with the rate of unpleasant respiratory symptoms (P ＞ 0.05).Non-humidifying group was better than humidity group at the rate of oxygen humidification cylinder pollution and the secondary lower respiratory symptoms (Z=2.50,2.44,P ＜ 0.05).Conclusions Low flow nasal oxygen inhalation therapy may not have to use humidifying oxygen.

Objective To evaluate a normative and systematic training mode for teachers of community general practice.Methods A total of 16 general practice teachers,who came from Fenglin community health service centre in Shanghai,participated three-stage training mode during March 2011 to February 2012.The clinical competence evaluation and questionnaire survey were conducted before and after training.Fifty trainees trained by the teachers also received clinical competence evaluation.Results After the three-stage training,the test score in medical knowledge,physical examination and clinical skills of the teachers did not change significantly (P =0.794,0.674 and 0.326).The self assessment questionnaire survey of general practice teachers indicated a significant increase,especially in practice capability (t =-2.840,P =0.015) and overall quality (t =-3.017,P =0.011).After training by the teachers,the medical knowledge (t =-9.200,P =0.000),physical examination (t =-9.947,P =0.000) and clinical skills (t =-14.828,P =0.000) of 50 trainees increased markedly.Conclusions Differed from conventional training courses,the three-stage training enhances teaching ability and overall quality of community general practice teachers,and provides a effective training model.

Objective To investigate the change of intestinal barrier function and the protection of pentoxifylline (PTX) to intestinal barrier. Methods Fifty-four SD male rats were randomly divided into 3groups, including sham operation group, ANP group, PTX group. ANP rat model were induced by retrograde injection of 5% sodium taurocholate into pancreatic and bile duct. Rats in sham operation group underwent operation without injection of taurocholate. After ANP induction, the rats in PTX group received PTX at a dose of 25 mg/kg weight via penis vein. The rats were sacrificed 3, 6, 24 h after operation, the serum levels of amylase, D-lactic acid, TNF-α were determined. The pancreas tissue and terminal ileum were harvested for pathological examination; ZO-1 levels of ileum epithelial tight junction were analyzed by immunohistochemistry. Results Six hours after induction, the serum levels of amylase, TNF-α, D-lactic acid in ANP group were(9141±672)U/L, (347.96±79.47) pg/ml and (10.21±1.08 ) rmg/L, which were significantly higher than those in sham operation group [(1723 ± 57 )U/L, (134.09 ± 31.36 )pg/ml and (4.33 ±0.49)mg/L, P ＜0.01]. The serum levels of amylase, TNF-α, D-lactic acid in PTX group were (7965 ± 318 ) U/L, (238.48 ± 44.35 ) pg/ml and ( 8.75 ± 1.28 ) mg/L, which were significantly lower than those in ANP group, but they were significantly higher than those in sham group ( P＜0.05 or ＜0.01). The positive rate of ZO-1 was (3.29±0.36)% in sham operation group, and it was (1.91 ± 0. 32)% in ANP group,which was significantly lower than that in sham operation group (P ＜ 0.05 ); and the value was (2.53±0.43)%in PTX group, which was lower than that in sham group, but it was higher than that in ANP group(P＜0.05).Conclusions PTX may attenuate intestinal barrier function injury by decreasing the breakdown of intestinal ZO-1.

Objective To compare the clinical target volume (CTV) expanding margins in the mid-and upper-thoracic esophageal carcinoma during radiotherapy measured with and without online image guidance technique by CT on rail.Methods 100 patients with mid-and upper-thoracic esophageal carcinoma undergoing intensity modulated radiotherapy received CT scanning.Image registration was conducted between the scanning results and the planned CT images,thus set-up error data were acquired and got on-line correction.Fifty patients were randomly selected to undergo additional post-treatment CT scanningso as to analyze the revised residuals,displacement during treatment,and infra-fraction GTV shifts.Results Compared to the radiotherapy without CT-based image guidance,the CTV expanding margins obtained with CT-based image guidance was reduced significantly from 9.1,8.8 and 6.1 mm to 4.1,4.5 and 4.3 mm in the left-right,head-feet,and belly-back directions respectively.Conclusions The on-line image-guided technology significantly improves the accuracy of target and reduces the CTV expanding margins.

Objective To explore the effective method for treatment of fracture of scapular neck.Methods A retrospective analysis of 40 patients with fractures of scapular neck was done.The patients were treated by operation or non-operation from August 1995 to August 2005.According to the degree of displacement,40 cases included 22 mild displaced fractures(≤10 mm,≤40°),and 18 severe displaced fractures (＞10 mm,＞40°),26 cases were non-operation and 14 cases by operation.Herscovici score was adopted.Results Forty patients were followed up for 1-3 years.Among 26 patients treated by non-operation,Herscovici score showed that 16 cases achieved the excellent result,2 cases good,3 cases fair and 5 cases poor.of 14 patients treated by operation,Herscovici score showed that 12 cases achieved the excellent result,2 cases good. Conclusion Fractures of scapular neck with mild displacement can be treated by non-operation while fractures of scapular with severe displacement or associated with ipsilateral clavical fractures should be treated by operation to reconstruct the stabihty of shoulder and minimize the complications.