Sepsis constitutes a serious threat to human health and represents a major burden to the health care system.Recent years have witnessed a deeper insight into the mechanism of the onset of sepsis,together with some new therapeutic strategies,including early aggressive volume therapy,activated protein C,potentiated insulin therapy,adrenal function replacement therapy,and some new therapeutic targets,which have offered some hope for the management of sepsis.

Objective To investigate the genotype and gene mutation of hepatitis E virus isolated from the serum and stool samples of the patients with epidemic outbreak hepatitis E in certain recruit barracks of Guangzhou. Methods The reverse transcription polymerase chain reaction (RT-PCR) was performed to amplify the partial ORF2 nucleotide acid sequences of hepatitis E virus isolated from 34 and 46 inpatients with epidemic outbreak and sporadic hepatitis E respectively. The PCR products of the positive samples were cloned and sequenced. Results The 14 strains, including 12 epidemic strains and 2 sporadic strains, were isolated from the total 80 inpatients. The homology of nucleotide acid and amino acid sequences of 12 epidemic outbreak strains is 95.3%～100% and 94.0% ～100% . The homology between epidemic outbreak strains and sporadic strains is 95.3%～99.3% and 94.0%～100%. Compared with the standard different genotypes of HEV, these strains have the highest homology to the Jap1 strain which belongs to genotype Ⅳ, with homology of 96.0%～100%, respectively. Phylogenetic analysis indicated that these the nucleotide acid sequence homology of 92.0%～95.3% and amino acid sequence stains and Jap1 strain share the same cluster. Conclusion[KG1]Epidemic outbreak strains isolated from the patients in recruit barracks of Guangzhou belong to the genotype Ⅳ of HEV and the nucleotide acid sequences had partial mutation.

Purpose:To study the expression of CK19 and CK2 0mRNA in peripheral blood patients with FRGO Stage ⅠA to ⅡA cervical carcinoma and to investigate its clinical significance. Methods:Using the reverse transcription polymerase chain reacti on(RT-PCR),CK19 and CK20mRNA expression was examined in peripheral blood fro m 250 patients with early cervical carcinoma before operation,50 Patients with benign gynecological tumors and 18 healthy volunteers. In 250 patients,possible correlations between clinical pathological factors were analyzed. Results:The positive expression rates of CK19 and CK20mRNA were 36% and 24% in 250 cervical carcinomas respectively,in comparison with 3.0% an d 0% with benign gynecological tumors and all subjects in healthy volunteers wer e negative; The expression of CK19 and CK20 mRNA were significantly correlated w ith lymph vascular space involvement,but was not associated with prognostic fac tors including stage,differentiation,pathological types ,lymph node metastasis ,bully tumor size . In patients with CK19 mRNA(+)/CK20 mRNA(+),the rate of lymp h node metastasis and vascular space involvement and recurrence outside the pelv is was significantly higher than that of patients with CK1R mNA9(-)/CK20 mRNA(- )(P

Objective To evaluate the value and limitation of MRI in the diagnosis of meningovascular neurosyphilis. Methods Five cases of neurosyphilis confirmed by clinical history/laboratory were examined with MRI (3 plain MRI, 2 enhanced MRI). The results of blood and CSF TPPA/RPR were positive and HIV was negative. Results Abnormal signals were demonstrated in the temporal lobe in 3 cases, and infarction was revealed in the basal ganglion and periventricular white matter in another 2 cases. There was no marked contrast enhancement in the 2 cases. Conclusion Meningovascular neurosyphilis has no characteristic features on MRI, but MRI is an effective method in delineating the size, range, and characters of neurosyphilis, and it is also an useful modality to follow-up after antibiotic therapy.

AIM To investigate the poteintation of adriamycin induced apoptosis by neferine in resistant human breast cancer cell line MCF 7/Adr. METHODS Apoptosis was detected by PI stain flow cytometry and Tunel assay. The intracellular adriamycin (ADR) accumulation was assayed by HPLC and the expression of P gp was determined by flow cytometry. RESULTS (1)MCF 7/Adr cells resisted the apoptosis induced by ADR while Nef augmented ADR medidated apoptosis; (2) Nef (10 ?mol?L -1 ) increased the accumulation of ADR up to 2 88 fold in MCF 7/Adr cells but not in sensitive cells MCF 7/S; (3) Nef(10 ?mol?L -1 ) reduced the expression of P gp in MCF 7/Adr cells. CONCLUSIONS Nef can overcome apoptosis resistance in MCF 7/Adr cells and its mechanisms are involved in the augment of ADR accumulation and the down-modulation of P gp expression in MCF 7/Adr cells.

Objective To analyze the clinical features of tsutsugamushi disease.Methods 113 cases of tsutsugamushi disease from 1991-2005 were reviewed.Results The symptoms of fever,eschar or ulcer,tetter and lymph node tu- mescence accounted for 100%,80.5% (91/113),6.2% (7/113) and 75.2% (85/113) respectively.Liver damage and pulmonary damage were observed in 75.2% (85/113) and 47.8% (54/113) cases.78.8% (89/113) cases were masculine in OX_K check.Conclusion Tsutsugamushi diseases showed complicated and multiple clinical manifestations and more attention should be paid to for avoiding misdiagnosis.

Objective To explore the expressions of histamine receptor subtypes (H1, H2, H3, H4 receptor) in children's mid-urethral striated muscles and during mouse C2C12 striated myogenesis.Methods Children's mid-urethral striated muscle samples were paraffin embedded and tissue sections were made, then immunohistochemical staining was used to check H1, H2, H3, H4 receptors.C2C12 myogenesis was induced, the early differentiation early markers of desmin, middle marker of myogenin, late marker of myosin heavy chain and histamine 4 receptor subtype mRNA were checked by quantitative real-time polymerase chain reaction.Immunofluorescence staining was done to check 3 differentiation markers and histamine H3 receptor protein.Results During myogenesis, the expression of desmin mRNA in the differentiation of 2,4,6 days were 12,68,60 times as many as that of the undifferentiated myoblasts;the expression of myogenin mRNA in the differentiation of 2,4,6 days were 631,1 408,914 times as many as that of the undifferentiated myoblasts;the expression of myosin heavy chain mRNA in the differentiation of 2,4,6 days were 7 718,9 448,286 288 times as many as that of the undifferentiated myoblasts.The expression level of H1 receptor mRNA in the differentiation of 6 days was about 25％ to undifferentiated cells;the expression of H2 receptor mRNA in undifferentiated cells and differentiated cells groups had no significant difference (F =1.47, P ＞ 0.05);the expression of H3 receptor mRNA in the differentiation of 2,4,6 days was 28,103,198 times to undifferentiated cells;H4 receptor mRNA was not detected.In immunofluorescence staining, H3 receptor protein staining intensity increased with the differentiation.Immunohistochemistry of pediatric urethral striated staining indicated that H1, H2, H3 receptor staining was positive,H1 receptor showed strong positive staining, H3 receptor moderate positive staining,and H2 receptor showed weak positive staining.Conclusions Histamine receptor subtypes of H1 receptor, H2 receptor and H3 receptor were found during mouse striated myogenesis and in the children's mid-urethral striated muscles.The increasing expression of H3R with myogenesis might indicate it plays a role in mature striated muscle cells.

Objective To summarize the clinical treatment experience of blood culture-negative infective endocarditis,and to explore the surgery chance and therapeutic strategy of blood culture-negative endocarditis. Methods One hundred and sixty-six patients who were diagnosed blood culture-negative endocarditis in the Aisa Heart Hospital of Wuhan from Jul. 2008 to Dec. 2012 were recruited in the study. Broad-spectrum antibiotics including cefuroxime axetil and levofloxacin were used before the result of blood culture,and sensitive antibiotics were selected to control patient's condition when getting the result of blood culture. But broad-spectrum antibiotics were continuously used to the blood culture-negative endocarditis until stable condition. When the conditions were stable,active preparation before surgery should be carried out. Thoroughly clear the vegetation and protect the cardiorespiratory function during operating. Kata-step antibiotics were used to control patient's condition until normal temperature,as well as the number of leukocytes decreased,blood sedimentation normalized and C-reaction protein decreased. Then,the narrow-spectrum antibiotics were selected including cephalosporin until discharged from hospital,and continued treatment of antibiotics for 4 - 6 weeks. Results Five patients died after the operation,including 1 case died of low cardiac output syndrome,2 cases died of multiple organ failure,1 case died of septicemia and the 1 case died of cerebral embolism. All the other patients discharged from hospital successfully. Conclusion The patients with blood culture-negative IE should be controlled rapidly. The duration and dose of antibiotics should be enough. Active operative preparation should be taken and then surgery timely. Thus,the hospital mortality could decrease and prompt the long-term outcome.

Objective To investigate the effects of levator ani muscle exposure in abdominal periueal resection for rectal cancer.Methods The clinical data of 109 patients with rectal cancer who were admitted to the First Affiliated Hospital of Nanjing Medical University from January 2001 to January 2008 were retrospectively analyzed.There were 55 patients received traditional procedure (conventional method group) and 54 patients received modified procedure with levator ani muscle exposure (levator ani muscle exposure group).The mesorectum was sharply dissected according to the total mesorectal excision principle.It is essential to remove the rectum along with the mesorectum up to the level of the levators.Preoperative bowel preparation,anesthesia,body position,abdominal incision,perineal incision and suture of the 2 groups were the same as Miles procedure.In the conventional method group,the superficial dissection was carried out with electrocautery or ultracision harmonic scalpel.The presacral space was entered by dividing the rectococcygeus muscle,commencing at the level of the tip of the coccygeus.The levators were then divided near the pelvic wall attachments and next procedures were performed without levator ani muscle exposure.In levator ani muscle exposure group,once the ischiorectal fat was cleared by electrocautery,the planes of levator ani muscle were identified and exposed after dividing the rectococcygeus muscle and next procedures were performed.The patients in stage Ⅰ only needed to follow-up; the patients in stage Ⅱ had to receive chemotherapy with following situation:poor differentiation,T4 stage,blood vessel or lymphatic invasion,number of lymph nodcs detected ＜ 12.Patients in stage Ⅲ or Ⅳ needed adjuvant chemotherapy.The follow-up evaluation included blood routine examination,hepatic and renal function examination,chest radiography,hepatobiliary ultrasonographic evaluation and determination of CEA levels (once every 3 months in the first year after operation,and once every 6 months after one year).Abdominal CT scan and colonoscopy should be employed every year.All the patients were followed up till December of 2012.All data were analyzed using the chi-square test or t test.The survival curve was drawn using the Kaplan-Meier method,and the prognosis was analyzed using the Log-rank test.Results The operation time were (60 ± 15)minutes and (30 ± 10) minutes in the conventional method group and the levator ani muscle exposure group,with significant difference between the 2 groups (t =3.936,P ＜ 0.05).The intraoperative blood loss were (300 ± 60) mL and (30±20) mL in the conventional method group and the levator ani muscle exposure group,with significant difference between the 2 groups (t =5.687,P ＜ 0.05).Three patients were with rectal injury,1 with urethral injury,1 with vaginal injury,and 10 with incision infection in the conventional method group.There were 9 patients with incision infection in the levator ani muscle exposure group.The course of chemotherapy was under 12 in 30 patients,and above 6 in 41 patients.The median time of follow-up of the patients was 56 months (range,15-95 months).Of the 109 patients,10 missed the follow-up,15 patients had local recurrence,30 had distal metastasis,and 35 patients died.The 1-,3-,5-year cumulative survival rates were 93.4％,76.0％ and 65.6％.The 5-year survival rates were 65.2％ and 66.3％ for patients in the conventional method group and the levator ani muscle exposure group,with no significant difference between the 2 groups (x2=4.210,P ＞0.05).Conclusion Levator ani muscle exposure method provides clearer vision of operational field,shorter operation time,less blood loss and less injury to the rectum or urinary tract (vagina).

Objective To explore the clinical characteristics of vestibular migraine in patients from the clinic and ward of the neurological department in comprehensive hospitals.Methods A total of 226 patients diagnosed as vestibular migraine were enrolled in the study.Clinical data were collected and analyzed,including the medical history,clinical symptoms and signs,as well as the result of diagnostic examinations.Results The mean age of the patients at the visit was 51.7 years old,with the male to female ratio of 1:1.48.The occurrence of vertigo and migraine varied in order,with 53.1％ (120/226) patients presented migraine several years before vertigo.The duration time of vertigo ranged from seconds to days,with 1.8％ (4/226) patients presented no headache during the whole course.Several punctate long T2 or high FLARE (fluid attented inversion recovery) signals scattered at the centrum ovale.Conclusions Vestibular migraine has complex mechanism and presents multiple clinical manifestations with certain regularities of the onset.Differential diagnosis should be made from the similar diseases.