Leptin,a peptide hormone synthesized and secreted primarily by adipose tissue,plays an important role in the regulation of body weight,metabolic and endocrine responses.It has emerged recently as a protective factor in multiple organ resistance to injury.We reviewed the protective effect of leptin and its possible mechanism.

ObjectiveTo investigate the effects of norepinephrine on oxygen metabolism and postoperative outcomes in the elderly patients undergoing fluid-restored abdominal surgery.MethodsAfter hospital ethics committee approval,and written informed consent was obtained from all patients,40 elderly patients,aged ＞ 64 yr,with a body mass index of 18-24 kg/m2,undergoing elective colorectal surgery,were randomly divided into 2 groups (n =20 each):routine fluid administration group (group A) and restricted fluid administration group (group B).In group A,lactated Ringer's solution was given routinely.Lactated Ringer's solution was given at a rate of 5 ml· kg- 1 · h- 1 and small dose of norepinephrine was infused intravenously at 0.01-0.03 μg· kg- 1 · h - 1 simultaneously during the surgery,and MAP was maintained ≥65 mm Hg in group B.Intraoperative blood loss was replaced with the equal volume of 6％ hydroxyethyl starch 130/0.4.Before the surgery ( baseline),1 and 2 h after beginning of the surgery,and while leaving postanesthesia care unit,mean arterial pressure (MAP),heart rate (HR),cardiac index (CI) and central venous pressure (CVP) were recorded,and arterial and central venous blood samples were drawn for blood gas analysis.Oxygen delivery index (DO2 I ),oxygen consumption index (YO2I) and oxygen extraction ratio (ERO2) were calculated.The gastric mucosal pH was determined before the surgery and 1 h after beginning of the surgery.Blood samples were taken form the peripheral vein to determine the concentration of Hb,serum albumin,blood urea nitrogen (BUN) and creatinine (Cr) concentrations before the surgery and 1 day after the surgery.The extubation time,duration of stay in hospital,the time when the patients passed the flatus,pulmonary complications,gastrointestinal complications,and wound infections were recorded.ResultsCompared with group A,CI,Hb,ScvO2 and DO2I were significantly increased,CVP and ERO2 were decreased during the surgery,the concentrations of Hb and serum albumin were significantly increased,1 day after the surgery,and the incidence of pulmonary complications and wound infections was significantly decreased after the surgery in group B (P ＜ 0.05 ).There were no significant differences in gastric muscosal pH,the indexes of renal function,extubatiotn time,the time when the patients passed the flatus,duration of stay in hospital and the incidence of gastrointestinal complications between the two groups ( P ＞ 0.05).ConclusionWhen small dose of norepinephrine is used to treat perioperative hypotension induced by fluid restriction,it can increase oxygen delivery,and reduce the incidence of postoperative complications,and has no adverse effects on gastrointestinal microcirculation and oxygen consumption in the elderly patients undergoing colorectal surgery.

Objective To study the value of 4‐item examination of gastric function in the evaluation of disease severity and course of peptic ulcer .Methods The 4‐item examination of gastric function ,including PGⅠ ,PGⅡ ,PGⅠ /PGⅡ ,gastrin 17 and He‐licobacter pylori(Hp) positive rate ,were detected by adopting enzyme linked immunosorbent assay (ELISA) in 175 cases of peptic ulcer(study group) and 60 persons undergoing physical examination(control group) .The Spearman correlation coefficient was used to analyze the relationship between the 4‐item gastric function examination with the severity and course of peptic ulcer .Results The levels of PGⅠ ,PGⅡ ,gastrin 17 and Hp positive rate in the study group were significantly higher than those in the control group(P<0 .05) ,while PGⅠ /PGⅡwas significantly lower than that in the control group(P<0 .05) .The values of PG Ⅰ /PGⅡfrom high to low were in turn the scarring stage group ,healing stage group and active stage group ,other indexes from high to low were in turn active stage group ,healing stage group and scarring stage group .The levels of PGⅠ ,PGⅡand gastrin 17 and Hp posi‐tive rate in the patients with disease course ≥3 years were significantly higher than those in the patients with disease course<3 years(P<0 .05) .The severity and disease course in the patients with peptic ulcer were positively correlated with the levels of PGⅠ ,PGⅡ ,gastrin 17 and Hp positive rate(P<0 .05) and negatively correlated with PG Ⅰ /PGⅡ(P<0 .05) .Conclusion In the pa‐tients with peptic ulcer ,4‐item gastric function examination is closely correlated with the severity and course of illness ,which can serve as the index for evaluate the severity and course of disease ,thus increases the clinical treatment pertinence ,reduces the occur‐rence of antibacterial drugs abuse ,and is worthy of being promoted and applied in clinic .

Based on the characteristics of oncology clinical teaching and the defects of current teaching methods,we launched teaching reform including the combination of basic and clinical medical curriculum,the practice of clinical problem-based learning (CPBL) method and the introduction of some guidance for medical practice.The teaching reform was effective,but there were drawbacks for improvement.

Abstract?AIM: To evaluate the clinical application of IOL Master by comparing with traditional ultrasound biometry on the accuracy and characteristics of intraocular lens calculation.?METHODS:Data was analyzed from 164 patients ( 206 eyes ) with age - related cataracts who underwent phacoemulsification and intraocular lens ( IOL ) implantation in our hospital from June 2014 to June 2015. Before surgery, axial length and corneal curvature were measured with IOL Master and combined application of ultrasonic or manual keratometry, respectively. Phacoemulsification and foldable lens implantation were done in the patients. IOL power calculation was carried out using the SRK-Ⅱformula with the basis of IOL Master data. The visual acuity and refractive outcome were followed-up for 3mo postoperatively.?RESULTS:There was a significant difference between the two methods on axial length measurement which was 23. 86 ± 1. 05mm by IOL Master and 23. 50 ± 0. 83mm by ultrasound ( P = 0. 025 ). There was also a significant difference between the two methods on corneal curvature measurement which was 44. 18 ± 1. 35D by IOL Master and 43. 70 ± 1. 41D by keratometry ( P = 0. 01 ). The mean absolute error(MAE), at 3mo after operation, was 0. 41± 0. 30D and 0. 93 ± 1. 10D by the IOL Master and ultrasound groups, respectively, there was a significant difference between the two methods(P=0. 027).?CONCLUSION:The IOL Master is a non-contact, safe,easy-to-do and patient-friendly methods for axial length and corneal curvature measurement with high accuracy, thus it can calculate the IOL power more accurate and improve the predictive value for postoperative refraction.

Objective To establish a TaqMan real-time fluorescent quantitative PCR to detect Vibrio vulnificus based on hemolysin gene(vvhA)that coding cytolysin.Method By using software Primer Express, the PCR primers and TaqMan probe,which located in the conserved region of vvhA gene sequence,were designed for establishment of a TaqMan real-time fluorescent quantitative PCR to detect 100 bp amplicon from V.vulnificus DNA.A recombinant plasmid pMD19-vvhA100 as a positive control during detection was constructed using gene cloning technique.Minimal amplification cycles(Ct value)and fluorescence intensity enhancement (△Rn value)were used as observing index to optimize the reaction conditions of the TaqMan real-time fluorescent quantitative PCR.The DNAs with different concentrations from V.vulnificus and other eight bacteria and pMD19- vvhA100 were applied as templates to determine the specificity,sensitivity and reappearance of the TaqMan real- time fluorescent quantitative PCR.ICR mice were intraperitoneally,subcutaneously and orally infected with V. vulnificus,respectively.The detection effect of the TaqMan real-time fluorescent quantitative PCR was measured using the specimens of peripheral blood,subcutaneous tissue and intestinal content collected from the infected mice.Results The established TaqMan real-time fluorescent quantitative PCR showed positive results only for V. vulnificus DNA and pMD19-vvhA100.The detection effectiveness of the TaqMan real-time fluorescent quantitative PCR was as high as 0.01 ng of V.vulnificus DNA or 103 copies of pMD19-vvhA100.The SD values of the detection results repeated for three times using pMD19-vvhA100 with different concentrations were lease than 0.79. The detection results of TaqMan real-time fluorescent quantitative PCR were positive for all the specimens of peripheral blood and subcutaneous tissue.Conclusions The TaqMan real-time fluorescent quantitative PCR established in this study for V.vulnificus vvhA gene detection has advantages such as quickness,stability, sensitivity and specificity,indicating this method can be used for clinical laboratory diagnosis of septicemia and wound infection caused by V.vulnificus.

Objective To analyze effects of antithymocyte globulin(ATG) in preventing the occurrence of graft-versus-host disease(GVHD) in allogeneic stem cells transplantation. Methods Twenty-seven patients with leukemia were divided into two groups.The source of the transplantation donor and the type of acute leukemia were similar between the two groups,including HLA-sibling donors,HLA-unrelated donors and HLA-haploidentical donors.The 12 patients in group A adopted the classic method(CsA + MTX) to prevent GVHD.The 15 patients in group B adopted CsA + MTX +ATG to prevent the occurrence of GVHD. Results The 15 patients in group B have been all survived.Four of them presented Ⅱ0 acute GVHD(aGVHD),while the rest 11 patients only presented Ⅰ0 GVHD in approximately 30 d after transplantation with control very soon.In group A,Ⅳ? ultra-acute GVHD occurred in 3 HLA-haploidentical patients at day 7,9 and 10 after transplantation.One HLA-unrelated patient presented Ⅲ? aGVHD.The 4 patients above mentioned died due to pulmonary infection secondary to severe GVHD.The rest 8 HLA-sibling patients presented Ⅱ?-Ⅲ? aGVHD. ConclusionUsing ATG before allogeneic stem cells transplantation can efficiently prevent the occurrence of GVHD or relieve its severity.It can significantly diminish the transplantation related mortality rate.

Objective To evaluate the effect of penehyclidine hydrochloride on Toll-like receptor 4 (TLR4)/nuclear factor kappa B (NF-κB) signaling pathway in the myocardium of pediatric patients undergoing radical correction of tetralogy of Fallot with cardiopulmonary bypass (CPB).Methods One hundred pediatric patients of both sexes,aged 5 months-3 yr,with body mass index of 13.9-16.0 kg/m2,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ (New York Heart Association classification Ⅱ or Ⅲ),with the left ventricular ejection fraction＞50％,scheduled for elective radical correction of tetralogy of Fallot with CPB,were divided into 2 groups (n =50 each) using a random number table:penehyclidine hydrochloride group (group P) and control group (group C).Penehyclidine hydrochloride was intravenously injected at a dose of O.04 mg/kg immediately after successful internal jugular vein puncture in group P,and the equal volume of normal saline was given instead at the same time in group C.Before anesthesia induction,at 10 min after induction,after re warming to 36 ℃,at 1 h after termination of CPB,at the end of surgery and at 24 h after surgery,venous blood samples were collected to detect the concentrations of tumor necrosis factor-alpha,interleukin-6 (IL-6),IL-8 and cardiac troponin T in plasma (by enzyme-linked immunosorbent assay).Myocardial specimens were obtained from the right auricular appendage after opening of pericardium and at 1 h after aortic unclamping for microscopic examination and for determination of activated NF-κB and TLR4 protein and mRNA expression (by Western blot and real-time polymerase chain reaction,respectively).Results Compared to group C,the concentrations of plasma tumor necrosis factor-alpha,IL-6,IL-8 and cardiac tropnin T were significantly decreased after re-warming to 36 ℃C,at 1 h after termination of CPB,at the end of surgery and at 24 h after surgery,the expression of activated NF-κB and TLR4 protein and mRNA was down-regulated at 1 h after aortic unclamping (P＜0.05),and the pathological changes of myocardium were significantly attenuated in group P.Conclusion The mechanism by which penehyclidine hydrochloride reduces inflammatory responses is related to inhibition of the activation of NF-κB/TLR4 signaling pathway in the myocardium of pediatric patients undergoing radical correction of tetralogy of Fallot with CPB.

Objective To evaluate the effects of fluid restriction in combination with small dose of norepinephrine on cerebral oxygen metabolism in elderly patients undergoing gastrointestinal surgery.Methods Forty elderly patients of both sexes,aged 65-80 yr,with body mass index of 18-24 kg/m2,of ASA physical status Ⅰ or Ⅱ (NYHA Ⅰ or Ⅱ),with left ventricular ejection fraction≥50％,undergoing elective gastrointestinal surgery,were randomly divided into 2 groups (n =20 each) using a random number table:routine fluid administration group (group S) and restricted fluid administration + small dose of norepinephrine group (group RN).In group S,lactated Ringer's solution was given routinely,ephedrine 5 mg (per time) was injected intravenously,and MAP was maintained ≥ 65 mmHg during operation.In group RN,lactated Ringer's solution was infused intravenously at 5 ml · kg-1 · h-1 starting from 30 min before anesthesia,norepinephrine was infused intravenously at 0.01-0.03 μg · kg-1 · min-1 after induction of anesthesia,and MAP was maintained ≥ 65 mmHg.Intraoperative blood loss was replaced with the equal volume of 6％ hydroxyethyl starch 130/0.4 sodium chloride injection in both groups.At 5 min before skin incision,1 and 2 h after skin incision and postanesthesia care unit discharge time,arterial and jugular bulb venous blood samples were obtained for blood gas analysis,and arterial oxygen content,jugular bulb venous oxygen content,arteriovenous oxygen content difference,cerebral oxygen extraction rate,and the ratio of cerebral blood flow to cerebral oxygen metabolic rate were calculated.Results There were no significant differences between the two groups in arterial oxygen content,jugular bulb venous oxygen content,arteriovenous oxygen content difference,cerebral oxygen extraction rate,and the ratio of cerebral blood flow to cerebral oxygen metabolic rate.Conclusion Fluid restriction combined with small dose of norepinephrine produces no effects on cerebral oxygen metabolism in elderly patients undergoing gastrointestinal surgery.

Objective To investigate the clinical efficacy of intraoperative methylprednisolone used in combination with perioperative enteral nutrition support in improving liver synthetic function after hepatectomy and postoperative recovery.Methods In this prospective controlled trial,79 patients treated with hepatectomy at Departement of Hepatobiliary Pancreatic Surgery in Drum Tower Hospital between June 2013 and May 2014 were included and divided into control group (n =39) and steroid group (n =40) according to the order of surgery.The control group underwent hepatectomy only,while the steroid group received intraoperative methylprednisolone (500 mg) at the start of liver excision.Both of the two groups were given the same perioperative enteral nutrition support.Liver function,prealbumin (PA),and C-reactive protein (CRP) levels were measured before and on days 1,3,and 5 after the operation.Human blood albumin infusion volume,postoperative gas passing,postoperative hospital stay,and incidence of complications were recorded.Results The serum level of PA on day 3 after hepatectomy was significantly higher in the steroid group than in the control group [(101.26 ±61.17) mg/L vs.(81.84 ±43.58) mg/L,t =-1.607,P =0.049].The serum level of cholinesterase on day 1 after hepatectomy was significantly higher in the steroid group than in the control group [(5.60±1.54) kU/Lvs.(4.68±1.01) kU/L,t=-3.136,P=0.004].On day1 and day 3 after hepatectomy,the serum levels of CRP were significantly lower in the steroid group than in the control group [(41.79 ±20.86) mg/L vs.(62.08 ±38.33) mg/L,t =2.933,P=0.027;(64.14 ±32.38) mg/L vs.(102.64 ± 49.05) mg/L,t =4.127,P =0.006].The postoperative hospital stay was significantly shorter in the steroid group than in the control group [(12.62 ±5.74) d vs.(15.41 ± 10.00)d,t =1.514,P =0.002].Conclusion Intraoperative use of methylprednisolone combined with perioperative enteral nutrition support may inhibit postoperative inflammatory response,promote early recovery of liver synthetic function,and help to promote rehabilitation after hepatectomy.