Objective To explore the best formula of the 0 5% liposome podophyllotoxin chitosan film. Methods Chitosan,acetic acid and gelatin were selected as three factors to prepare film, each factor including three levels, and 0 5% liposome podophyllotoxin served as blank factor. The films of different formula were prepared according to orthogonal design. The evaluation was made on the basis of the characteristics of conglutination and dissolution, then the best formula was determined finally. Results The results showed that the conglutination and dissolution of the film which was made of 2% chitosan, 1%acetic acid, 2% gelatin and 0 5% liposome podophyllotoxin chitosan was the most perfect. Conclusion The film designed according to orthogonal experiment was coincidenced with the requirements in aspect of conglutination and dissolution, and its appearance was perfect.

OBJECTIVE To get knowledge of the drugs resistance change of Pseudomonas aeruginosa in intensive care unit ICU, so as to offer the first-hand information to the clinical preventive and therapeutic countermeasures. METHODS Antimicrobial susceptibility tests of Staphylococcus aureus(SAU) were performed from 2001 to 2006. RESULTS The most frequent isolates were P. aeruginosa, Klebsiella pneumonia and Acinetobacter baumannii in 2001-2004. S. aureus were more than A. baumannii in 2006 and became the majore isolated bacteria in the sputum of the ICU patients. The incidence of drug resistance increased yearly(0, 25.0%, 29.4%, 74.4%, 87.7%, 92.7%, respectively) in S. aureus, and it was susceptibte to vancomycin. CONCLUSIONS It was showed that P. aeruginosa, K. pneumonia, A. baumannii and S. aureus were the major pathogens in the ICU, showing high drug resistance. Doctors should pay more attention to analyze the bacterial resistance profile in order to decrease the incidence of drug resistance and use the antibiotics properly.

Objective To study the effect of glutamine (Gln) on the intestinal mucosa inflammatory reaction and permeability after intestine ischemia-reperfusion injury in rats.Methods The rat model of intestinal ischemia-reperfusion injury was established by clamping the mesenteric superior artery and then restoring blood flow.Forty-eight model rats were divided into control group (n =24) and model + Gln group (n =24)according to the stochastic indicator method.Both groups were given enteral nutrition with equal energy and nitrogen [energy 125.4 kJ/ (kg · d) and nitrogen 0.2 g/ (kg · d)].The model +Gln group was fed with enteral nutrition plus 3％ Gln,while the control group was fed with enteral nutrition plus 3％ soybean protein.The experiment lasted 8 days after modeling.The intestinal mucosa and the plasma levels of nuclear factor-κB (NF-κB),tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6),Gln,D-LACtic acid and diamine oxidase (DAO) were observed in rats before and after modeling and on the 3rb and 8rd day of the experiment.Changes in the morphology of intestinal mucosa were observed by electron microscopy.Results After modeling in control and model + Gln group,the level of NF-κB in intestinal mucosa [18 cases (75.0％) and 17 cases (70.8％)] were significantly higher than those before modeling [0 case (0.0％),P =0.013,P =0.019],the level of IL-6 in intestinal mucosa [(313.27±75.28) pg/g and (321.75±76.46) pg/g] were significantly higher than those before modeling [(227.52 ±58.13) pg/g,P =0.023,P =0.043],and the level of TNF-α in intestinal mucosa [(241.28 ±65.29) pg/g and (240.35 ±64.86) pg/g] were significantly higher than those before modeling [(172.45 ±33.76) pg/g,P=0.036,P=0.011].The plasma level of IL-6 [(150.32 ± 18.74) ng/L and (148.21 ±20.19) ng/L] were significantly higher than those before modeling [(116.37 ± 14.59) ng/L,P =0.032,P =0.025],the plasma level of TNF-α [(127.62 ± 14.24) ng/Land (123.86 ± 13.75) ng/L] were significantly higher than those before modeling [(85.18 ± 8.84) ng/L,P =0.018,P =0.035],and the plasma level of D-LAC [(0.46 ±0.03) mmol/L and (0.51 ±0.04) mmol/L]were significantly higher than those before modeling [(0.27 ±0.02) mmol/L,P =0.041,P =0.018],and the plasma level ofDAO [(2.76±0.57) U/ml and (2.58 ±0.51) U/ml] were significantly higher than those before modeling [(1.52±0.24) U/ml,P=0.015,P=0.037],while the plasma level of Gln [(0.18 ±0.01) g/L and (0.21 ± 0.01) g/L] were significantly lower than those before modeling [(0.39 ± 0.03) g/L,P =0.026,P =0.031].On the 3rd and 8th days of the experiment in the control group,the level of NF-κB in intestinal mucosa [16 cases (66.7％),15 cases (62.5％)] were significantly higher than those before modeling (P =0.027,P =0.002),the level of TNF-α in intestinal mucosa [(226.23 ±55.35) pg/g and (214.76 ±54.82) pg/g] were significantly higher than those before modeling (P=0.042,P =0.038)],the level of IL-6in intestinal mucosa [(297.56 ± 71.39) pg/g and (291.49 ± 68.46) pg/g] were significantly higher than those before modeling (P =0.031,P =0.012).On the 3rd and 8th days in the control group,the plasma level of IL-6[(147.38 ± 17.25) ng/L and (144.65 ± 15.32) ng/L] were significantly higher than those before modeling (P =0.016,P =0.034),the plasma level of TNF-α [(121.75 ± 13.72) ng/L and (113.83 ± 11.69) ng/L] were significantly higher than those before modeling (P =0.025,P =0.041),the plasma level of D-LAC [(0.41 ±0.03) mmol/L and (0.53 ±0.05) mmol/L)] were significantly higher than those before modeling (P =0.029,P =0.030),the plasma level of DAO [(2.51 ± 0.52) U/ml and (1.76 ± 0.34) U/ml] were significantly higher than those before modeling (P =0.034,P =0.016).The plasma level of Gln [(0.22 ±0.01) g/L and (0.21 ±0.03) g/L] were significantly lower than those before modeling (P =0.042,P =0.035).On the 3rd day of the experiment in the model + Gln group,the levels of NF-κB,TNF-α,and IL-6 in intestinal mucosa [14 cases (58.3％),(213.78 ±43.76) pg/g,(293.72 ±69.86) pg/g] were significantly higher than those before modeling (P =0.038,P =0.026,P =0.013) ; the plasma level of IL-6,TNF-α,D-LAC,and DAO [(135.61 ±14.25) ng/L,(117.35 ±11.29) ng/L,(0.45 ±0.03) mmol/L,and (2.26 ± 0.43) U/ml] were significantly higher than those before modeling (P =0.021,P =0.032,P =0.032,P =0.025).On the 8th day of the experiment in the model + Gln group,the levels of NF-κB,TNF-α,and IL-6 in intestinal mucosa [9 cases (37.5％),(184.53 ± 42.16) pg/g,and (236.83 ±66.52) pg/g] were significantly lower than those after modeling and those in the control group (P =0.024,P=0.027; P=0.026,P=0.039; P=0.013,P=0.028) ; the plasma levels of IL-6,TNF-α,D-LAC,and DAO [(126.35±12.74) ng/L,(92.76±9.42) ng/L,(0.31 ±0.02) mmol/L,and (1.76±0.34) U/ml]were significantly lower than those after modeling and those in the control group (P =0.021,P =0.030; P =0.032,P =0.025 ; P =0.024,P =0.037 ; P =0.022,P =0.036) ; the plasma level of Gln [(0.40 ±0.03) g/L] was significantly higher than those after modeling and in the control group (P =0.028,P =0.032).Under the electron microscope,the structure of villus and recess was damaged after modeling,villi were sparse and short,with a lot of inflammatory cell infiltration in the lamina propria.Lymphangiectasia and edema occured after modeling.On the 8th day,compared with after modeling and the control group,intestinal villi and recess structure were significantly restored in the model + Gln group; compared with the after-modeling status,the recovery of intestinal mucosa villi and recess structure was not obvious,and the inflammatory cell infiltration in the lamina propria persisted in the control group.Conclusion Gln repairs ischemia-reperfusion injury in the intestinal mucosa by regulating intestinal mucosa inflammatory cytokine release,inhibitng inflammatory response,and reducing the permeability of the intestinal mucosa.

Objective: To screen the Hub genes associated with the occurrence and development of esophageal squamous cell carcinoma (ESCC) and to analyze their biological functions by using various bioinformatics analysis tools. Methods: ESCC chip profile GSE100942 from GEO database was used as study subject; GEO2R tool was used to analyze the data and to screen the differentially expressed genes (DEGs), and the bioinformatics tools (DAVID, String, Cytoscape) were further used to construct protein-protein interaction (PPI) network and identify the key Hub genes. GO and KEGG were used for the biological function enrichment analysis. In the meanwhile, MiRDB was applied to identify the miRNAs that might regulate Hub genes and to construct Hub gene–miRNA network. Importantly, the expression of DEGs and the patient survival were verified by the GEPIA analysis tool. Results: By analyzing GSE100942 database, a total of 1229 DEGs with difference of 2 times and 223 DEGs with difference of 4 times were screened out. In addition, 20 Hub genes, which were all up-regulated in ESCC tissues, were also identified. The functional enrichment analysis showed that these DEGs were mainly enriched in cancer related pathways and involved in cell division and mitotic nuclear division. Among those 20 Hub genes, DLGAP5, BUB1B, TPX2, TTK, CDC20, CCNB2, AURKA and DEPDC1 were identified as 8 key Hub genes that related with ESCC, and involved in many important biological processes, such as cell proliferation, cell cycle and signal pathway. Five Hub genes, CEP55, ECT2, NEK2, DEPDC1 and NUSAP1, were identified to be highly regulated by the miRNA regulatory network. Conclusion: Microarray combined with bioinformatics can effectively analyze the DEGs associated with the occurrence and development of ESCC. The identification of the 20 Hub genes and the 8 key Hub genes can provide theoretical guidance for further research on the molecular mechanism and molecular marker screening of ESCC. ·

Objective To study the distribution pattern of liposome podophyllotoxin(LP)in rat skin.Methods The rats were divided into two groups:0.5%liposome podophyllotoxin suspension was ap-plied to LP group,0.5%podophyllotoxin tincture was applied to control group.The skin specimens were ob-tained1?2?4?6?12and24h after drug application,the amount of fluorescent stain was observed under con-focal laser scanning microscope and converted to the values of area under the curve(AUC).Results The epidermal AUC of fluorescent amount in LP group was1.5-fold than that in control group,dermal AUC was2.3-fold higher.The unit area fluorescent amount in both epidermis and dermis was highest2hours after topical medication in control group(1585.52/?m 2 and2005.66?m 2 ),and quickly reduced after4hours.But the epidermal and dermal unit area fluorescent amount in LP group was rather low in4hours after topi-cal medication,and gradually increased after6hours,and peaked after12hours(750.28/?m 2 and1073.08/?m 2 ).Conclusion Liposome preparation of podophyllotoxin can be slowly released and lasts longer in the skin.

Objective To study the effects of stratum corneum on the percutaneous absorption of fluorescein sodium (NaFl) liposome in rat skin. Methods Stratum corneum was stripped off by Scotch adhesive tape, and the NaFl content in the stratum corneum and the skin with no stratum corneum were detected by spectrofluorimetry at regular intervals. The dynamic permeated amount of different preparations of NaFl in the skin at different intervals in Franz diffuse cell was determined and the distribution of NaFl at 4 h after stripping off the stratum corneum was observed by fluorescence microscope. Results The concentrations of NaFl in the stratum corneum and the skin with no stratum corneum after applying liposome NaFl preparation were significantly higher than those of NaFl solution and gel preparations (P 0.05). Conclusions It is suggested that liposome can increase and change the penetration of NaFl into the stratum corneum and the skin with no stratum corneum in vitro. Hair follicular structure may not play an important role in the drug diffusion when stratum corneum is removed.

Objective To investigate the effect of bifidobacterial adhesin (BA) on nuclear factor of κB (NF-κB) and cytokines of intestinal mucosa of stressed rats.Methods Forty-eight rats were divided into stress group (n =24) and BA group (n =24) using the stochastic indicator method.After the stressed rat models were established withfettering as the stress condition,the experiment lasted 8 days.Both groups were given enteral nutrition (EN) with heat 125.4 kJ/(kg · d) and nitrogen 0.2 g/(kg · d).The BA group was fed with EN plus 5 mg/ (kg · d) bifidobacterial adhesin,and the stress group was fed with EN plus equivalent volume of normal saline [5 mg/ (kg · d)].The levels of NF-κB,interleukin-10 (IL-10),tumor necrosis factor (TNF-α),and interferon-γ (IFN-γ) were measured in both groups before modeling,after modeling,on the 3rd intervention day,and on the 8th intervention day.The changes in the morphology of intestinal mucosal were observed by transmission electron microscopy.Results (1) Expression of NF-κB:The positive expression rate of NF-κB in the intestinal mucosa was 0,79.2％,63.5％,and 66.7％ in the control group and 0,68.4％,55.7％,and 45.8％ in the BA group before modeling,after modeling,on the 3rd intervention day,and on the 8th intervention day.The expressions of NF-κB in both groups significantly increased after the modeling (both P =0.000).Even on the 3rd and 8th intervention days,the positive expression rates of NF-κB in the intestinal mucosa were still significantly higher than the pre-modeling level (both P =0.000).Compared with the levels after modeling and in the control group,the expression of NF-κB in the intestinal mucosa in the BA group on the 8th intervention day was significantly down-regulated (P =0.015,P =0.021).(2) Quantitative expressions of TNF-α and IFN-γ:Compared with the pre-modeling levels,the intestinal mncosa levels of TNF-α [stressed group:(154.63 ± 17.52) pg/g,(198.72 ±26.59) pg/g; BA group:(154.63 ±17.52) pg/g,(201.45 ±28.16) pg/g],IFN-γ [stressed group:(39.47 ±5.76) pg/g,(55.32 ±5.93) pg/g; BA group:(39.47 ± 5.76),(60.75 ± 7.68) pg/g] and the plasma levels of TNF-α [stressed group:(17.35±2.62) pg/g,(30.56±4.85) ng/L; BA group:(83.31 ±9.78) pg/g,(114.82±13.78) ng/L] and IFN-γ [stressed group:(17.35 ±2.62) pg/g,(28.73 ±4.17) ng/L; BA group:(17.35 ± 2.62) pg/g,(30.56 ± 4.85) ng/L] significantl increased (all P ＜ 0.05).On the 3rd and 8th intervention day,the intestinal mucosa levels of IFN-γ [(58.16 ± 7.38) pg/g,(56.37 ± 7.29) pg/g] and TNF-α [(215.76 ±31.54) pg/g and (211.83 ±33.61) pg/g] and plasma levels of IFN-γ [(29.35 ±4.76) ng/L,(30.25±3.67) ng/L] andTNF-α [(125.71 ±17.38) ng/L,(141.26±19.65) ng/L] in the stressed group were significantly higher than the pre-modeling levels (all P ＜ 0.05).On the 3rd and 8th intervention day,the intestinal mucosa levels of IFN-γ [(165.43 ± 24.58) pg/g,(171.57 ± 26.87) pg/g]and IFN-γ [(42.35 ±4.92) pg/g,(40.58 ±4.65) pg/g] and the plasma levels of TNF-α [(103.96 ±13.68) ng/L,(94.53±12.66) ng/L] and IFN-γ [(20.78±2.84) ng/L,(19.65±2.45) ng/L] in the BA group were significantly lower than the post-modeling levels (all P ＜ 0.05),whereas those of IL (intestinal mucosa:(62.82 ±8.34) pg/g,(75.16 ±9.65) pg/g; plasma:(43.32 ±5.28) ng/L,(55.64 ±6.87) ng/L] were significantly higher than the post-modeling levels (all P ＜ 0.05).Compared with the stressed group,the intestinal mucosa levels of TNF-α and IFN-γand plasma levels of IFN-γ and TNF-α significantly decreased while the IL-10 level significantly increased (all P ＜0.05) in the BA group.(3) Histomorphology showed that,compared that the ileal mucosal villi and crypt structure were recovered in the BA group on the 8th intervention day.Compared with the post-modeling conditions,the ileal mucosal villi and crypt structure were damaged in the stressed group,showing edema of the lamina propria,in which inflammatory cell infiltration was observed.Conclusions BA is helpful for the repair of the intestinal mucosa injury after stress by regulating the release of inflammatory mediators and cytokines of intestinal mucosa.

To increase the rescue competency of residents, also the critical thinking, team dynamics, and the capability to handle with emergencies, Shanghai East Hospital developed a rescue course integrated with 24 standardized simulation cases learning and medical simulation education for residents training pro-gram. The instructor candidates should complete the simulation training and pass the instructor certification. Every course was monitored by the course director to ensure the teaching quality. After two and a half years of practice, it is found that the teaching of case teaching and simulation teaching is better than traditional teaching, and it plays an important role in the security of medical security.

OBJECTIVETo perform a meta-analysis of randomized controlled trials (RCTs) assessing the benefit of providing branched chain amino acid (BCAA)-enriched nutrition to improve hepatic function in patients undergoing hepatic operation.

METHODSThe electronic databases of PubMed, Springerlink, the Chinese Biomedical Database (CBM), the Cochrane Library, and the China National Knowledge Infrastructure (CNKI) were searched for relevant RCTs using the following search terms: nutritional support, enteral nutrition, parenteral nutrition, hepatic/liver surgery, liver cirrhosis, cancer, hepatectomy, and liver transplantation. The quality of the retrieved RCTs was assessed according to the scale developed by the Cochrane Collaboration. The meta-analysis was conducted using RevMan software, version 5.2.

RESULTSA total of 11 relevant RCTs, representing 510 patients, were included in the meta-analysis. Compared to patients in the control (normal nutrition) group, the patients in the BCAA group experienced an effective improvement in hepatic function, as evidenced by significant decreases in total bilirubin (by 0.07 mumol/L; 95% confidence interval (CI): -0.18 to 0.05, P more than 0.05]. In addition, the BCAA group showed improvements in plasma levels of albumin (weighted mean difference (WMD) = 0.07; 95% CI: 0.06, 0.24, P less than 0.05) and alanine aminotransferase (WMD = +5.61; 95% CI: -8.63 to 19.86, P more than 0.05] but neither of the changes reached the threshold of a statistically significant improvement. The BCAA group did however show significantly lower complication rate after operation (65%, 95% CI: 0.48, 0.87, P less than 0.01] and mean duration of hospital stay (4.61 days; 95% CI: -6.61, -2.61, P less than 0.01].

CONCLUSIONBCAA-enriched nutrition improves hepatic function in patients undergoing hepatic operation, thereby helping to reduce the complication risk, duration of hospital stay, and financial burden. BCAA-enriched nutrition is a safe and effective therapy and further clinical application may be beneficial.

Amino Acids, Branched-Chain ; therapeutic use ; Hepatectomy ; methods ; Humans ; Intraoperative Period ; Liver ; physiology ; surgery ; Liver Transplantation ; methods ; Nutritional Support ; methods ; Randomized Controlled Trials as Topic

The contents recorded in the rotation registration manual is not only the quantitative indicators for evaluating the quality of residency training, but also the important basis for training assessment and issuance of training certificates. In order to solve the problems of data authenticity, information delay, and repeated entry in the rotation registration manual for residency training, Shanghai East Hospital, Tongji University, launched a project to dock the electronic rotation registration manual with the hospital information system. Through the establishment of the project team, the development of working mechanisms, and the implementation of the project, data analysis was used for process reformation and system optimization, so as to continuously improve management efficiency and medical safety while solving problems and form a set of implementation system with reference significance in practice.