Objective: To investigate the effect of survivin and bcl-2 antisense oligodeoxynucleotides ( AsODN) combined transfection on the human gallbladder carcinoma cell line GBC-SD in vitro. Methods: Survivin and Bcl-2 protein expressions were detected by immunohistochemical method; Cultured cells were divided into 4 groups: Nomal control group, survivin antisense observed group, bcl-2 antisense observed group and combined group. After transfected for 24 h, the expression of survivin mRNA was detected by reverse transcription polymerase chain reaction (RT-PCR). Cell morphological changes were observed under electron microscopy. Apoptosis index (AI) was examined by flow cytometry; Inhibitory rate (IR) was determined by the colorimetri MTT cell viability and proliferation assay. Results: Survivin and Bcl-2 protein were highly expressed in gall bladder carcinoma cells; The expression of survivin mRNA was decreased 47. 8%. Abnormal morphological changes of cells were observed in the three AsODN transfection groups; The AI in survivin antisense observed group,bcl-2 antisense observed group,and combined group was 11.38%?3.91% , 9.26%?4.15% , 28.45%?6.34% respectively and significantly higher than the nomal control group (P

Objective To guide the implementation of home enteral nutrition (EN) for outpatients with Crohn's disease, and to observe its effect.Methods In this observational study, 26 patients at active period of Crohn's disease were collected between April 2014 and June 2015 in the clinic of Clinical Nutrition Center of Nanjing General Hospital of Nanjing Military Command.Home EN combined with medication was administered.The nutritional status, Crohn's Disease Activity Index (CDAI), and quality of life before and after EN were compared.Results After home EN therapy, body mass index (BMI) of the patients increased from (17.7 ± 2.1) kg/m2 to (19.8 ± 2.0) kg/m2 (P ＜ 0.001), proportion of lymphocytes from (0.216 ± 0.066) to (0.305 ± 0.106) (P =0.007), albumin level from (40.3 ± 5.9) g/L to (43.7 ± 5.4) g/L (P =0.038), prealbumin from (233.1 ± 71.5) mg/L to (306.0 ± 72.1) mg/L (P =0.009), and transferrin from (2.7 ± 0.6) g/L to (3.1 ±0.7) g/L (P =0.038).In the indicators reflecting the activity of Crohn's disease, CDAI declined from 197.0 ±55.8 to 113.2 ±33.4 (P ＜0.001) after EN, C-reactive protein from 28.50 (18.00-32.80) mg/L to 2.00 (0.58-6.33) mg/L (P ＜0.001), erythrocyte sedimentation rate from (29.6 ± 9.9) mm/h to (9.4 ± 7.6) mm/h (P ＜ 0.001).The patient's disease activity scores and inflammatory reaction indexes all reached the normal levels after EN, show that the patients were in remission stage.In inflammatory bowel disease quality of life score, the score of intestinal symptoms rose from 41.2 ± 13.3 to 57.0 ±9.6 (P ＜ 0.001), the score of systemic symptom from 20.7 ± 5.5 to 28.9 ± 4.2 (P ＜ 0.001), emotional ability from 43.6±16.1 to 61.0 ± 15.9 (P=0.002), and social ability from 20.6 ±4.9 to 28.4 ±5.6 (P＜0.001), all showing statistical significance.Conclusions Standardized home enteral nutrition in patients at active period of Crohn's disease, when implemented under professional guidance of nutritional support team and well followed up, may improve nutritional status, induce remission, and improved quality of life.

Objective To evaluate the effect of dexmedetomidine on the intestinal mucosal injury in the patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Forty patients of both sexes with rheumatic heart disease,aged 32-64 yr,weighing 40-75 kg,of ASA physical status Ⅱ or Ⅲ (NYHA class Ⅱ or Ⅲ),scheduled for elective cardiac valve replacement with CPB,were randomly divided into 2 groups (n =20 each) using a random number table:control group (group C) and dexmedetomidine group (group D).After induction of anesthesia,the patients were endotracheally intubated and mechanically ventilated.Anesthesia was maintained with 0.8％-2.0％ sevoflurane inhalation and intermittent iv boluses of sufentanil 0.5-1.0 μg/kg and vecuronium 0.04-0.06 mg/kg.Before routine induction of anesthesia,a loading dose of dexmedetomidine 1 μg/kg was injected intravenously over 10 min,followed by continuous infusion at 0.3 μg · kg-1 · h-1 until the end of surgery in group D,while the equal volume of normal saline was given in group C.Before CPB,at 30 min after aortic clamping,at the termination of CPB,at the end of surgery and at 6 and 24 h after surgery,central venous blood samples were taken for determination of concentrations of tumor necrosis factor-alpha,interleukin-6 (IL-6) and IL-10 and intestinal fatty acid binding protein in plasma (by ELISA),and the plasma concentration of endotoxin (using turbidimetry).The time of postoperative mechanical ventilation and duration of ICU stay were recorded.Results Compared with group C,the concentrations of tumor necrosis factor-alpha,IL-6,IL-10 and endotoxin and intestinal fatty acid binding protein in plasma were significantly decreased,and the time of postoperative mechanical ventilation and duration of ICU stay were shortened in group D.Conclusion Dexmedetomidine infused continuously at 0.3 μg · kg-1 · h-1 (until the end of surgery) after a loading dose of 1 μg/kg before routine induction of anesthesia can reduce intestinal mucosal injury in the patients undergoing cardiac valve replacement with CPB.

Objective To discuss and observe the clinical effect of intervertebral pedicle internal fixation and debride?ment combined with bone graft through posterior approach/trans-intervertebral space approach on the treatment of uni/multi-segmental lumbosacral vertebral tuberculosis (TB). Methods A cohort of 37 patients, with single or multiple segmental ver?tebral destruction due to TB, were treated by trans-intervertebral debridement, posterior pedicle screw system internal fixa?tion and intervertebral bone graft. All patients underwent X-ray,CT and MRI examination to observe the combination treat?ment effect. Results Most patients (n=34) enjoyed primary healing, in which include only 4 cases that presented symptom of nerve root stretch injury during operation but all recovered after 3 months. Other 3 patients underwent secondary healing due to sinus but two were rectifying with anti-TB therapy and wound dressing. The other 1 case suffered from sinus tract was healed through second debridement and rectifying therapy. X-ray, CT and MR at 6 months after operation indicated that all patients present great graft osseous fusion, good recovering of height of vertebral body without kyphosis deformity nor internal fixation loosening nor screw breakage. Conclusion Intervertebral pedicle internal fixation and debridement combined with bone graft through posterior approach/trans-intervertebral space approach is with minimum invasion but good graft fusion ef?fects, harder fixation and satisfactory clinical effects in the treatment of uni/multi-segmental lumbosacral vertebral tuberculosis.

Objective To study the apoptosis of gallbladder carcinoma cell line GBC-SD induced by antisense oligodeoxynucleotide (ASODN) targeting survivin. Methods ASODN targeting survivin was transfected into GBC-SD cells mediated by lipofectin. Cultured cells were divided into 3 groups: control group,sense oligonucleotide (SODN) group and ASODN group. After transfected for 16 h, the cultured cells were harvested and the following texts were carried out. The expression of survivin mRNA was detected by RT-PCR. Flow cytometer were used to detect apoptosis. Morphological changes were observed by electron microscopy. Results The expression of survivin mRNA was decreased 47.83% in ASODN group while apoptosis was increased from (0.50?0.23)% to (26.28? 3.91)%. Abnormal morphological changes of cells were observed in ASODN group and apoptosis bodies were found in some gallbladder carcinoma cells. Conclusion The expression of survivin may be decreased in GBC-SD cells after ASODN transfection.ASODN targeting survivin could induce gallbladder carcinoma cells apoptosis effectively.

Objective To explore the safety of mobilization and collection as well as the feasibility of selection of autologous peripheral blood stem cells (auto-PBSC) from patients with juvenile severe autoimmune diseases (AID) for autologous hematopoietic stem cell transplantation (auto-HSCT). The clinical significance of these procedure is evaluated. Methods Eight patients with AID, including four patients with systemic lupus erythematosus(SLE),two patients with dermatomysoitis, one patient with juvenile rheumatoid arthritis (JRA), one patient with multiple sclerosis(MS),underwent auto-HSCT. Auto-PBSCs were mobilized in 8 patients using cyclophosphamide(CTX) and granulocyte colony-stimulating factor (G-CSF), and their PBSCs were collected by CS-3000 Blood Cell Separator, then the CD34+cells were selected and purified by CliniMACS CD34+cell selection device. The CD34+ cells were frozenand preserved under -80 ℃ ALL patients received non-myeloablative or lymphoablative conditioning regimens which consisted of CTX/Mel/ATG or CTX/ATG or BEAM/ATG. All patient received CD34+ cells transplantation. The safety of mobilization and collection process of auto-PBSC as well asthe feasibility of selection and purification of CD34+cells were recorded and hematopoietic reconstruction were evaluated. Results All patients tolerated the collection process well, and there was no mobilization-related mortality. The number of collected MNCs and CD34+ cells were 8.35×108/kg and 7.92×106/kg respectively. The number of CD34+ and CD3+ cells after purification was 6.28×106/kg and0.71 ×105/kg respectively. The mean granulocytes and platelet engraftment occurred on days 11 and 15 after G-CSF regimen, and they can be collected using CS-3000 instrument. PBSC mobilization and collection from patients with juvenile severe AID is safe. The CD34+ cell can be highly purified. The auto-PBSC CD34+cell transplantation is an alternative therapy for severe AIDs that do not respond to conventional treatments.

Child ; Cord Blood Stem Cell Transplantation ; adverse effects ; Cytomegalovirus Infections ; etiology ; Humans

Objective There is no quantization scheme for the early ambulation in patients with gastrointestinal tumor after operation of enhanced recovery .The aim of this study was to explore a suitable objective method of postoperative ambulation for gastro -intestinal tumor patients . Methods Sixty six gastrointestinal tumor postoperative patients were randomly assigned to two groups :ex-perimental group ( 33 cases ) and control group ( 33 cases ) .Enhanced recovery was adopted in the both groups afterthe operation . Wireless smart bracelets ( fitbit flex) were used in the experimental group , and the ambulation of patients was monitored by the hand of synchronous real time computer digital panel .At the same time, the patients was supervised for positive ambulation . Traditional quantitative methods of electronic pedometer were used in the control group.The postoperative ambulation , effect and compliance were compared between the two groups . Results Postoperative ambula-tion steps in the experimental group were increased compared with the control group on the days 1, 2, and 3postoperative, and the data were (208.70 ±45.76) vs (144.36 ±47.68), (560.73 ±148.67) vs (407.00 ±85.92), and (894.70 ±91.68) vs (674.00 ±73.06) steps (P<0.05).The first time of early ambulation, flatus, ca-tharsis, and compliance of ambulation showed significant difference in the two groups (P<0.05). Conclusion Wireless intelligent monitoring bracelet is objective and effective for monitoring and quantifying postoperative ambulation .It is superior to the traditional quantitative methods , and can improve the effect and compliance of the ambulation .Moreover , it can promote postoperative recovery in patient with enhanced recovery surgery .

BACKGROUND:Lots of bone graft materials such as autologous iliac bone, autologous rib, titanium mesh plus alograft are available in the treatment of bone defects after spinal tuberculosis debridement. OBJECTIVE: To compare the fixation effect of different kinds of bone graft materialsvia pedicle approach fixation for treatment of thoracic spinal tuberculosis. METHODS: Totaly 40 patients with thoracic spinal tuberculosis were enroled, including 18 patients accompanied with paraplegia and 15 patients accompanied with kyphosis deformity. Both of them were subjected to by standard anti-tuberculosis treatment for 2-4 weeks and consequent posterior pedicle screw fixation combined with debridement/bone grafting fusion. They were grouped by the variables of bone graft materials: autologous iliac bone, autologous rib, titanium mesh plus alograft groups. Al patients were folowed up for 24 months. The lesion healing, bone graft fusion, rehabilitation of paraplegia, correction of kyphosis and incidence of adverse reaction were observed. RESULTS AND CONCLUSION: The time of bone graft fusion in the autologous iliac bone group was shorter than that in the autologous rib and titanium mesh plus alograft groups (P < 0.05), and there was no significant difference between autologous rib and titanium mesh plus alograft groups. No adverse phenomenons such as grafts and titanium mesh faling off, fracture and displacement, nonunion and pseudarthrosis, tuberculosis recurrence were found in these three groups. After the symptomatic therapy for 3-6 months, the muscle strength of patients with paraplegia and spinal kyphosis deformity basically recovered, spinal kyphosis deformity was basically corrected. These results demonstrate that the treatment effect of autologous iliac bone is the best; however, the treatment effect of autologous rib is as good as the titanium mesh plus allograft.

Objective:To investigate the feasibility and safety of a new method of natural orifice transluminal endoscopic surgery(NOTES) -totally transtracheal endoscopic thyroidectomy(TTET) .Methods:Three miniature swines and 6 beagle dogs were underwent TTET.Under general anesthesia,special designed endotracheal tube with 2-channel was used and endoscope and instruments were inserted through the respective channel.Incision of tracheal anterior wall was accomplished and partial or subtotal thyroidectomy was performed.Finally,the defects in the trachea were sutured with ENDO STITCH instrument.Results:Partial thyroidectomy was successfully accomplished on 3 pigs and subtotal thyroidectomy was done on 6 dogs.No serious complications such as anoxia,asphyxia,airway obstruction and death occurred during the operation.Animals were sacrificed 2h after the procedure and incision of trachea was found to be closely sutured.There were no subcutaneous emphysema and haematoma formation.Conclusion:Preliminary experimental results showed the feasibility and safety of TTET.Transtracheal access maintains the integrity of cervical tissues and achieves an optimal cosmetic outcome.TTET may open up a new field of NOTES on thyroid surgery.