Objective To analyze the relationship between plasma copeptin level and prognosis in patients with severe acute pancreatitis(SAP).Methods The clinical data of 48 SAP patients from January 2010 to October 2014 were collected and another 48 patients who accepted healthexamination dur-ing the same period were selected as controls.Difference in plasma copeptin level was compared between groups.The results of APACHEⅡ,Ranson and modified Marshall scores were also collected to evaluate the severity of disease and the existence of MODS.The prevalence of pancreas and peripancreatic tissues effusion,necrosis,pancreas and peripancreatic abscess,pancreatic pseudocyst and mortality of the experi-mental group were recorded to analyze the relationship among plasma copeptin,complications and mortali-ty.Results The plasma level of copeptin of the experimental group was 0.83 ~5.49ng/ml,with a mean of(3.48 ±1.32)ng/ml;while in the control group,it was 0.09 ~1.46ng/ml,with a mean of(0.23 ± 0.06)ng/ml.There was significant difference between the groups(P <0.05).Patient with a high plasma copeptin level may have a higher risk for local complication,MODS and mortality,and there was significant difference between the groups(P <0.05).A ROC curve identified that a plasma copeptin level >4.02 ng/mL predicted in-hospital mortality of patients,with a sensitivity of 72.7%and a specificity of 81.0%(AUC =0.831,95%CI =1.051 ~1.679,P <0.001).Conclusion SAP patients have elevated levels of plasma copeptin,and higher copeptin levels predict high risks of complications and mortality.

Anorexia of aging is one of the common clinical geriatric syndrome in clinic, characterized by the persistent and significant decreasing of appetite and/or by reducing a food intake in the elderly, which can cause various adverse consequences and increase the morbidity and mortality.However, clinicians have insufficient understanding of anorexia in the elderly, and often regard the anorexia of aging as the normal phenomenon of aging and might ignore it.This article reviews the domestic and foreign relevant literatures on anorexia of aging.

BACKGROUND:For vertebral compression fractures treated by bal oon vertebroplasty, there were stil controversies in biomechanical and clinical studies about adjacent vertebral fractures is the result of osteoporosis progress, or the result of vertebral intervention and strengthening by injecting bone cement. More accurate conclusions can be obtained through more in-depth research and long-term fol ow-up. OBJECTIVE:To evaluate the effect of bal oon vertebroplasty on biomechanical properties of vertebral body with compression fractures and unstrengthened adjacent vertebral body. METHODS:Total y 40 pig specimens with vertebral compression fractures were prepared and randomly divided into study and control groups. Specimens in the study group were subjected to bal oon vertebroplasty. Specimens in the control group only wrapped with normal saline gauze. The biomechanical properties (vertebral height, maximum load), stress, strain and displacement values of specimens under 500 N loading in these two groups were compared. The stress and strain values of unstrengthened adjacent vertebral body before and after the bal oon vertebroplasty in the study group were measured, and compared with the control group. RESULTS AND CONCLUSION:Compared with the original height, specimens in the study group can restore to its original height after bal oon vertebroplasty, the differences were not significant (P>0.05). The former, back, left and right vertebral height in the study group were significantly higher than those in the control group (P<0.01). After the bone cement augmentation, the stiffness of vertebral body in the study group was significantly lower than that in the control group, the maximum loading was significantly increased compared with that in the control group (P<0.05). Under a fixed loading of 500N, compared with the control group, the disc displacement value after the bal oon vertebroplasty was significantly reduced and the disc strain and stress values were significantly increased in the study group (P<0.05). There were no significant differences in the strain and stress values of the unstrengthened adjacent vertebral body before and after the bal oon vertebroplasty in the study group (P>0.05). There were no significant differences in the strain and stress values of the unstrengthened adjacent vertebral body after the bal oon vertebroplasty between study group and control group (P>0.05). These results suggest that vertebral maximum loading and stiffness recover wel after the treatment of bal oon vertebroplasty for vertebral compression fractures, which can achieve the effect of preventing vertebral fractures again. Meanwhile, bal oon vertebroplasty treatment can not alter the biomechanical properties of adjacent vertebrae, and it is difficult to influence and lead vertebral fractures again, with a better security.

Objective:To investigate the effect of PBL+LBL double-track mode in Ophthalmology teaching.Methods:121 students were divided into two groups.Trial group practiced PBL+LBL double-track teaching,while control group practiced LBL teaching.Results:The results of exam showed that the students in trial group had a significant higher score in sum score and analysis subjects than those in control group(P

Objective To study the clinical efficacy and safety of posterior laminoplasty combined with foraminotomy in the treatment of mixed cervical spondylosis.Methods A total of 70 patients with mixed type cervical spondylosis from January 2012 to January 2014 in our hospital were randomly divided into observation group and control group.Patients in observation group received posterior laminoplasty com-bined with foraminotomy,and patients in control group received anterior cervical discectomy and fusion surgery.The operation time,intraoper-ative blood lossing,postoperative JOA scores and NDI scores between two groups were compared.The cervical curvature and range of motion were measured by X-ray.Results There was no significant difference in postoperative JOA scores,cervical curvature and range of motion be-tween two groups(P >0.05).The operative time and intraoperative blood loss of observation group was less than those of control group,the difference was no significance.The NDI scores of carrying and drive in observation group were higher than those in control group,while the NDI scores of other items between two groups had no significant difference(P >0.05).The incidence of complications in observation group was 10.81% (4 /37),the control group was 24.42% (8 /33),the difference between two groups was statistically significant,(χ2 =3.428, P <0.05).Conclusion The posterior laminoplasty combined with foraminotomy have good clinical effect for mixed type cervical spondylosis with advantages of a shorter operation time,simple operation,less intraoperative bleeding,lower incidence of complications,which is a kind of safe and effective surgical method.

Objective To review the clinical features of drug-induced liver injury (DILI) in elderly Chinese patients.Methods A literature search was conducted with the key wordsdrug-induced liver injury ordrug-induced liver disease andelderly; four Chinese medical databases were used:including Chinese Biomedical Literature Database (CBM),Chinese Science and Technology Periodical Database (VIP),Wanfang Database and China National Knowledge Infrastructure (CNKI),from when the bases established to December 2011.Data from retrieved literatures of retrospective controlled studies of DILI were analyzed by SPSS 14.0 software.Results Five studies met the inclusion criteria,including 275 elderly patients (aged group) and 602 non-elderly patients (non-aged group) with DILL There was no significant difference in gender between the two groups (P ＞ 0.05).Clinical manifestations of jaundice,fatigue,anorexia,and skin itching were more commonly seen in the aged group (P ＜ 0.01).Cholestatic hepatic injury occurred more frequently in the aged group than in the non-aged group [24.9％ (61/245) vs.18.8％ (102/245),P ＜ 0.05],while hepatocellular type occurred more frequently in the non-aged group [64.3％ (350/544) vs.55.1％ (135/245),P ＜ 0.05].More DILI were induced by Chinese herb medicine and cardiovascular drugs in the aged group than in the non-aged group [47.0％ (79/168) vs.35.9％ (93/254) and 8.3％ (14/168) vs 1.2％ (3/259) respectively,P ＜ 0.05].As for the prognosis,there was no significant difference in clinical cure and improvement rate between the two groups [84.4％ (141/167) vs.81.5％ (291/357),P ＞0.05].Conclusion The elderly are more sensitive to the drugs and have a high risk of DILI.Prevention and timely diagnosis and treatment of DILI are particularly important for elderly patients.

Objective To investigate the changes of liver histology and ultrastructure in aged Beagles dogs.Methods A total of fifteen healthy Beagles,1 .5 to 10.6 years old,were divided into middle-aged group (n=8,average (2.21 ±0.94)years old)and aged group (n=7,average (8.26±1 .52) years old)according to age.After intravenous anesthesia,the liver tissues of dogs were taken to compare number and morphology of hepatocytes and extra cellular matrix (ECM)of two groups under light microscope with hematoxylin-eosin staining.The number density, morphology and area fraction of mitochondria,the morphology and area fraction of endoplasmic reticulum,the changes of number density and morphology of microbody,the thickness of hepatic sinusoidal endothelial cell as well as the density and the diameter of fenestrae,the changes of morphology and number of lipofuscin in two groups were compared under electron microscope.Independent sample t-test was performed for comparison between two groups.Results Under light microscope,hepatocytes were arranged radially around the central veins,especially obvious in the middle aged group. Hepatocytes were circular or oval,most were mononuclear or binuclear.The cytoplasma of hepatocyte in middle-aged group was dense eosinophilic pink.Vacuolar lipid droplets were small and scanty.The cell boundary was clear.In aged group, cytoplasmic vacuolization of hepatocyte was more obvious,bigger vacuolated lipid droplets were observed, eosinophillic granules were scattered in the cytoplasma,cellular boundary was blurry and the number of hepatocytes significantly decreased when compared with middle-aged group ((75 .80 ±5 .76 )/high power field (HPF)vs (97.80 ±6.45 )/HPF,t = -2.510,P =0.026 ).There were no obvious infiltration of inflammatory cells in the liver tissue of Beagles dogs in both middle-aged group and aged group.Compared with middle aged group, cell gap and ECM increased in aged group. Under electron microscope, mitochondria of normal hepatocyte was oval,round or horseshoe-shaped with double membranes,ridge was observed inside and distributed around nucleus.Compared with middle-aged group,the shape of hepatocyte mitochondria in aged group was varied,the number density of mitochondria significantly decreased (0.202±0.021 vs 0.248 ±0.040,t = -2.683,P =0.020)and the area fraction remarkably reduced (0.136 ±0.015 vs 0.202 ±0.019,t = -6.083,P <0.01 ).Endoplasmic reticulum was mesh laminated arranged,scattered flake distributed and was mostly seen around nucleus in flat or stacked shape.Compared with middle aged group,the area fraction of endoplasmic reticulum of hepatocyte in aged group was obviously reduced (0.006±0.001 vs 0.011 ±0.004,t=-3.338,P =0.005).Lipofuscin was shaped as round or irregular structure without membrane and pigment unevenly distributed inside.The number of lipofuscin in aged group was significantly higher than that in middle-aged group (0.028±0.025 vs 0.001 ±0.000,t=2.880,P =0.014).The number of microbody in aged group was slightly less than that of middle aged group and the difference was not statistically significant (P =0.603).The thickness of the liver sinusoidal endothelium in aged group significantly increased compared with that in middle-aged group ((0.242±0.047)μm vs (0.114±0.075)μm,t=3.881 ,P =0.002).The diameter and density of endothelial fenestration in aged group ((1 .895 ± 0.439 )μm and (0.260 ± 0.120 )/μm)obviously decreased compared with those in middle-aged group ((3.186±0.332)μm and (0.723±0.184)/μm,t=6.345 and -4.511 ,both P <0.01).Conclusions There were significant degradations of liver in quality and quantity among aged individuals.These degradations were the structure basis of decreased hepatic reserve function and involved directly or indirectly in high prevelance of hepatic diseases among elders.

Objective To explore the image quality of coronary artery imaging with dual source computed tomography (DSCT) and analyze the coronary artery lesions. Methods Two hundred cases with clinically suspected coronary heart disease, who underwent plain and enhanced DSCT coronary artery imaging without oral Betaloc preparation were retrospectively analyzed. The patients were divided into two groups: the senile group of 126 cases with the average age of (71.3±7.7) years old and the control group of 74 cases with the average age of (50.4±6.2) years old. The clinical characteristics, the average heart rate and breath-holding time for plain and enhanced scan, the average calcium score, the image quality evaluation and the coronary stenosis were compared between the two groups. Results Compared with the control group, the incidences of chest pain or discomfort, hypertension, diabetes mellitus, hypercholesterolemia and old myocardial infarction were significantly higher in the senile group. The average calcium score and the numbers of <50% and ≥50% stenosis were also significantly higher in the senile group than those in the control group (364.9±442.6)points vs. (44.8±106.9)points, 159 vs. 45 branches, 212 vs. 32 branches, respectively, all P<0.01). The average heart rate and breath-holding time of plain and enhanced scan had no significant differences compared with the control group. The proportion of the coronary segments with grade 1 ,grade 2 and grade 3 image quality also had no significant difference compared with the control group (96.5%,2.3% and 1.2% vs. 97.1%, 2.0% and 0.9%, P>0.05). Conclusions DSCT coronary artery imaging in senile patients is noninvasive, safe and simple, and excellent coronary artery image can be obtained without oral Betaloc preparation. It can be used as a routine examination in the clinical diagnosis of coronary heart disease.

Objective To observe the effects of aging on liver and heat shock protein (HSP)70 expression in rats,and explore the role of HSP 70 in the changes of aging liver. Methods 24 healthy Sprague Dawley rats were divided into 4 groups according to age:21-day-old group,3-monthold group,12-month-old group and 18-month-old group (n=6 per group).Routine blood tests and biochemical tests were tested. Liver tissues were observed under light microscopy. The mRNA expression of HSP70 was detected by real-time PCR. Results The ratios of liver weight to body weight were decreased gradually with aging in 4 groups (0.073,0.050,0.025,0.019,respectively,t=78.016,P =0.000).Compared with those of young rats (21-day-old and 3-month-old),serum albumin levels of aged rats (12-months and 18-months) were declined [(35.0±2.7) g/L and (39.8±3.5) g/L vs.(27.3±9.3) g/L and (20.6± 1.7) g/L,t=12.233,P=0.000].Nevertheless serum alkaline phosphatase (ALP) levels were increased with aging [(68.8± 23.3) U/L,(71.6 ± 19.2)U/L,( 185.9 ± 41.5) U/L,(418.6 ± 140.6) U/L,respectively,t =35.454,P=0.000].The differences in other routine biochemical indexes were not found among the age groups (P＞0.05).Liver histological changes including hepatocytes disordered and vacuolization or fatty changes were detected with aging,especially in 18 month-old rats. Real-time PCR results indicated that the expression level of HSP70 mRNA was much lower in 18-month-old rats than in 12-month-old and 3-month-old rats (0.218 vs.0.220 and 0.230,P=0.000). Conclusions HSP70,as a stress protein,may play an important role in the procedure of injury and senescence of liver cell,and then can serve liver aging as one of the influential markers.

To investigate the effects of medicated serum prepared with Chinese herbal medicine Zhizhen Recipe (ZZR) on activity of nuclear factor-κB (NF-κB) and expression and function of P-glycoprotein (P-gp) in human colorectal cancer multidrug-resistant cell line HCT-8/VCR.