Objectives To compare the differences in intestinal phylum firmicutes between elderly patients with type 2 diabetes (T2DM)and the healthy elder people.Methods 37 elderly patients with T2DM and 69 healthy controls in Shaoxin city were recruited.DNA of phylum firmicutes from fecal samples was extracted.The real-time quantitative PCR was used with special primers for bacterial genus including Faecalibacterium prausnitzii,Eubacterium rectale,Clostridium leptum,and Peptostrepyococc.The differences in content of different bacteria between two groups were analyzed and compared.Results In healthy elderly group versus the elder patient with T2DM,the contents of intestinal phylum firmicutes were[(6.22±1.41) × 107 versus(5.41± 1.40) × 107,t=2.83,P=0.006] in Eubacterium rectale,[(7.46 ± 0.98) × 107 versus (6.96 ± 1.40) × 107),t =2.13,P =0.036] in Faecali bacterium prausnitzii,[(7.89±0.89) × 107 versus(7.46±1.11) × 107,t=2.15,P=0.034]in Clostridium leptum,and[(4.86 ± 1.33) × 107 versus (4.21 ± 1.24) × 107,t=2.45,P =0.016] in Peptostrepyococc,which showed that the contents of intestinal phylum firmicutes were less in T2DM group than in healthy elderly group.Conclusions There are some differences in intestinal flora between the elderly patients with T2DM and healthy people.These intestinal flora may play an important role in the development of T2DM.This study may provide new evidences for probiotic treatment of T2DM.

In the present study, platelet GSH_(px), SOD activities and cAMP contents, as well as whole blood, erythrocyte, plasma and hair selenium levels were comparatively measured in children from Keshan disease endemic and non-endemic areas. The results showed that blood and hair selenium contents were significantly lower in children of the endemic area than in those of the non-endemic area; children in the endemic area had a signifi cantly lower platelet GSH_(px) activities as compared to those in the non-endemic area, but no remarkable difference of platelet SOD activities and cAMP contents between children in the two areas was observed. The results indicate that the reduced GSH_(px) activity of low-selenium children in the endemic area may result in alterations in platelet functions and arachidonic acid metabolism.

Objective To investigate the relationship between the prothrombotic state and leukoaraiosis(LA)in elderly patients with metabolic syndrome.Methods A total of 350 metabolic syndrome patients in the affiliated hospital of Zhejiang University who received treatment from January 2013 to January 2015.According to the results of head MRI,patients were divided into LA group(n=203)and non-LA group(n=147).The severity of LA was graded by its MRI appearance and the Blennow scale.The plasma levels of fibrinogen (Fib),prothrombin time (PT),thrombin time (TT),activated partial blood coagulation time(APTT),D-dimer (D-D) and yon willebrand factor (vWF) were measured and compared between the two groups.Results The levels of Fib,vWF and D-D were higher in LA group than in non-LA group(all P＜0.05).Spearman correlation analysis showed that the severity of leukoaraiosis was positively correlated with Fib,vWF and D-D(r=0.014,0.089,0.215,respectively,all P ＜ 0.05).Multivariate linear regression analysis showed that Fib,course of hypertension,vWF and HbA1c were the main influencing factors with the standardized regression coefficient of 2.516,0.312,0.206 and 0.167 respectively for leukoaraiosis in elderly patients with metabolic syndrome.Conclusions The course of hypertension and HbAlc level are positively related with LA.The prothrombotic state markers including Fib and vWF can be considered as the predictors for LA severity in elderly patients with metabolic syndrome.

ObjectiveTo analyze intrathoracic or extrathoracic recurrence pattern after surgical resection of thoracic esophageal squamous cell carcinoma (TESCC) and its help for further modify and improvement on the target of postoperative radiation therapy. Methods One hundred and ninety-five patients who had undergone resection of TESCC at the Cancer Hospital,Chinese Academy of Medical Sciences enrolled from April 1999 to July 2007.Sites of failure on different primary location of esophageal cancer were documented.Results Patients with upper or middle thoracic esophageal cancer had higher proportion of intrathoracic recurrence.Patients with lower thoracic esophageal cancer had more intrathoracic reccurence and abdominal lymph node metastatic recurrence.Histological lymph node status has nothing to do with intrathoracic recurrence,supraclavicular lymph node ( SLN ) metastasis or distant metastasis ( χ2 =1.58,0.06,0.04,P =0.134,0.467,0.489,respectively),whereas the chance of abdominal lymph node metastases in N positive patients was significantly higher than that in N0 patients (28.7％: 10.6％,χ2 =9.94,P =0.001 ),and so did in middle thoracic esophageal cancer ( 20.0％: 5.6％,χ2 =5.67,P =0.015). Anatomic recurrence rate of patients with proximal resection margin no more than 3 cm was significantly higher compared to those more than 3 cm (25.0％: 11.3％,χ2=5.65,P=0.019).ConclusionsMediastinum is the most common recurrence site.According to recurrence site,the following radiation targets are recommended:when tumor was located at the upper or middle thoracic esophagus with negative N status,the mediastinum,the tumor bed and the supraclavicular region should be included as postoperative RT target;when tumor was located at the middle thoracic esophagus with positive N or located at the lower thoracic esophagus,the abdominal lymph node should be added.If the proximal resection margin was no more than 3 cm,the anastomotic-stoma should be included.

Objectives The purpose of this study is to observe the effects of valsartan on hepapetic fibrosis. Methods Thirty male Sprague-Dawley rats were randomly divided into three groups: valsartan -prevetive group (A), modle group of hepatic fibrosis (B)and valsar-tan-treating group (C). The model of hepatic fibrosis in rats was induced by intraperitoneai injection of dimethylnitrosamine (DMN) for 4 weeks(2ml/kg everyday, three times a week). Valsartan (10mg/kg everyday) was given together with injection of DMN per intrngastric (Ig) in group A for 8 weeks. After stop injection of DMN, the S valsartan(10mg/kg, everyday)was given per Ig in group C for 4 weeks. After modeling, normal saline were given per Ig everyday in group B. At the end of eighth week, the histomorphylogic structure of the liver was ob-served with light microscope. Immunohistoebemical staining was used to evaluate the expression of a-SMA. Results In group B, there was a large necrotic area and a number of pesudolobes appeared in the liver tissue. In group A, there were normal hepatic cords. In the group C, there was fibrosis interval formation and portal area expansion and fibrotie intervals extending to the lobule. The quantitative analysis of Mas-son staining showed that the collagen quantities in group B was higher than that of other group(P<0.01). The collagen quantities in group A was lower than that of group C(P<0.05). The results of immanohistochemical staining showed that the expression of a-SMA in group B was strong positive, middle positive in group C, and weak positive in group A (P<0.05). Conclusion The valsartan has preventive and treatment effects on hepatic fibrosis in rats of hepatic fibrosis model induced by DMN, and the preventive effect of valsartan is better than its treatment effect. The valsartan can ameliorate the hver cirrhosis by partly suppressing the activation of HSC.

Objective:To evaluate the diagnostic performance of probe-based confocal laser endomicroscopy (pCLE) for indeterminate biliary strictures.Methods:Twelve patients with indeterminate biliary strictures who underwent pCLE and brush cytology from April 1, 2013 to December 30, 2016 were enrolled. Clinical data, the results of endoscopic retrograde cholangiopancreatography, pCLE examination and brush cytology were collected. Compared with post-operative pathology and follow-up over 12 months, sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV), and accuracy of pCLE and brush cytology of the diagnosis of malignant biliary strictures were analyzed.Results:The final diagnosis were 9 malignant and 3 benign. The sensitivity, specificity, PPV, NPV and accuracy of brush cytology were 3/9, 3/3, 3/3, 3/9 and 50.0%(6/12), respectively. The corresponding indicators of pCLE were 9/9, 2/3, 9/10, 2/2, and 91.7%(11/12), respectively.Conclusion:pCLE can be used for differential diagnosis of indeterminate biliary stricture.

Objective To study the effect of procyanidins (PC) on mRNA and protein expression of par-4 and bcl-2 genes in PC12 cells induced by A?_ 25-35 . Methods Cell survival rate was evaluated by MTT assay and apoptosis was analyzed by Hoechst 33258-PI fluorescence staining. The expressions of mRNA and protein for par-4 and bcl-2 were tested by RT-PCR and Western blotting. Results Pretreatment with different concentrations of PC (5、10、20, and 30 mg/L) for 1 h increased the survival rate of PC12 cell in a dose-dependent manner. PC prevented the PC12 cells nuclei from shrinkage, condensation, and cleavage induced by A?_ 25-35 . PC decreased the expression of par-4 mRNA and protein, and increased the expression of bcl-2 mRNA and protein. Conclusion PC can protect PC12 cells from apoptosis induced by A?_ 25-35 in a dose dependent manner. The mechanism of protection is likely related to decreasing the par-4 gene expression and increasing the bcl-2 gene expression.

Objective To investigate how to improve the survival rate,and to avoid the serious complications in fat grafting.Methods Under comprehensive design of facial filling area,the fat was harvested by concentration in mesh;under the micro autologous fat transplantation gun with blunt needle injection technique,the fat was filled into the face to achieve the effect of improving the facial contour and the rejuvenation.From June 2014 to July 2015,78 patients with facial contour and facial soft tissue relaxation depression were treatment by the technique.Results The follow-up of 2 months to 1 year showed that 64 patients had the soft,young,significantly enhanced facial contour;7 patients had second times grafts and the remaining were satisfied.7 patients gave up the second times grafts because the other reasons.The surgical complications such as facial nerve injury and infection and embolism were not seen.Conclusions This technique by comprehensive design and purification of autogenous fat granules achieves a better effect on facial rejuvenation with fewer complications.

Objective To investigate the effect and clinical application of two kinds of endoscopic titanium clip in treatment of iatrogenic or iatrogenic perforation of duodenal descending part. Methods For 15 cases of perforation of duodenal descending part, according to the specific location of the perforation, select different endoscopic, compare the closing efficiency and success rate. Results 8 cases closed under gastroscopy in 15 cases of descending part of duodenum perforation, successfully closed in 7 cases, success rate was 87.5 %; 7 cases closed under duodenoscopy, successfully closed in 7 cases, the success rate 100.0%. 14 cases successfully closed by endoscopic titanium clip in 15 cases, 1 case failed, the success rate was 93.3 %. The effective titanium clip quantity, invalid (loss) titanium clip quantity and the closing time between the two groups has no statistically significance (P > 0.05). Conclusion It is safe and effective to use two kinds of endoscopic titanium clips in treatment of iatrogenic or iatrogenic duodenal per-foration.

Objective To compare the success rate, operation time, complication rate and the degree of tolerance of two kinds of endoscopic placement of small intestine decompression tube. Method 68 intestinal obstruction patients treated with transnasal ileus tube were randomly divided into 2 groups, group A and group B, 34 cases in each. Patients in group A were treated by endoscopic placement, while in group B placement was guided by nasal endoscope. Results The catheterization success rate and complications between the two groups have no statistical significance (P > 0.05) while the differences of catheter operation time (P < 0.05) and placement tolerance (P < 0.01) have statistical significance. Conclusion Endoscopic placement of small intestinal decompression tube has clinical application value while placement guided by nasal endoscope has certain advantages.