Objective To analyze the drug therapeutic regimen and duration of the chemotherapy in the spinal tuberculosis in order to determine the best therapeutic regimen and duration of the spinal anti-tuberculo-sis. Methods The medication plan and duration of 890 hospitalized patients with spinal tuberculosis in our hospital from January 2001 to December 2008 were retrospectively investigated. We collected the plan of the initial treatment,retreatment,recrudescence and drug resistance. We also studied the individuation therapeutic regimen of the patients with tuberculosis at other parts or complications. On the basis of these data,we analyzed the interferential appearance that the antituberculosis drug acted on different onsets,manifestations and operations. Results In 890 patients of spinal tuberculosis,596 cases ( 67% ) were initial treatment,294 ( 33% ) were retreatment,recur cases were 110 ( 12. 3% ) ,drug resistance cases were 74( 8. 3% ) ,and those compli-cated with tuberculosis in other parts were 273 ( 30. 7% ) . The main chemotherapeutic regimen was the usual tetragenous protocol ( H12 /R12 /E9 /Z5 /S3) . The retreatment cases were given second-line drugs such as levo-floxacin. The drug resistance cases were also given second-line drugs and intravenous infusion. According to the anti-tubercle bacillus spectrum,individuation treatments were adopted,and the plan was changed in time. The medication duration continued for 9-36 months. All the 890 patients were cured. Conclusion For the treatment of spinal tuberculosis,it is significance to make a efficient and standardized anti-tuberculosis chemotherapy.

Objective To investigate the causes and treatment strategies of spinal multidrug-resistance tuberculosis.Methods Data of 16 patients with spinal multidrug-resistance tuberculosis from Jane 2007 to September 2012 were retrospectively analyzed.There were 12 males and 4 females,with an average age of 26.6 years (range,10-49 years).The 16 patients involved 44 vertebrae,with an average of 2.75 vertebrae.The involved segments included:9 thoracic segments,1 thoracic-lumbar segment,2 lumbar segments and 3 lumbar-sacral segments.1 patient involved jumping segments including T8.9,T12L1.Among them,5 suffered from pulmonary tuberculosis,4 tuberculous pleurisy,3 tuberculous empyema,1 tuberculosis of cervical lymph nodes,1 tuberculosis of sternum,1 tuberculosis of chest wall and 1 nephrotic syndrome.We analyzed the reasons of multidrug-resistance.All patients received individualized chemotherapy based on drug sensitivity test.The operation process and time were also collected.The treatment effects were determined by long-term follow-up.Results Among all the 16 patients,6 received 1 operation; 7 received 2 operations; 2 received 3 operations and the last operation was one-stage posterior instrumentation and anterior debridement,bone grafting which conducted in our hospital; 1 received 4 operations and the last of which was excision of sinus in our hospital.All patients were followed up for 10 to 60 months (average,28.4 months).The time of chemotherapy which accorded to the drug sensitivity test was 24 months.2 cases recurred after 22 months and 46 months of the 1st surgery and received operation again.At the last follow-up,all patients were in a stable state of tuberculosis.In 16 patients,2 were initial drug resistance and 14 were acquired drug resistance.The causes of acquired drug resistance were multiple organs tuberculosis caused by failure chemotherapy,times of failed surgeries without adjusted schedules,suspension of the anti-tuberculosis chemotherapy due to serious adverse drug reactions and so on.Conclusion It is very important to carry through the culture of tubercle bacillus and acquire the results of drug sensitive test earlier.The key to prevent and cure multidrug-resistant tuberculosis of spine are formulating individualized anti-tuberculosis chemotherapy program,monitoring closely the adverse drug reactions and selecting the appropriate time for surgery.

Objective To observe the mitochondrial damage associated with protein-energy wasting of skeletal muscle in diabetic kidney disease (DKD) model of Goto-Kakizaki(GK) rats and evaluate the effects of low-protein diet supplemented with α-keto acids on muscle wasting.Methods Forty-five male 24-week-age GK rats were randomly divided into three groups,normal protein diet group (NPD),low-protein diet group (LPD) and LPD +or-keto group (Keto).Fifteen gender and age matched Wistar rats were served as control group (CTL).The living condition of GK rats was observed and the weight was measured once a week.Urine albumin,serum glucose,creatinine and urea nitrogen were measured at 24,32,40,48 week age.Soleus muscle was observed to calculate the muscle size and the percentage of Ⅰ and Ⅱ type muscle fiber with software after SDH and NADH staining at 48-week-age.Tissue ultrastructure was observed under the transmission electron microscopy.The activity of citrate synthase was detected by spectrophotometer.Expression of mitochondrial DNA was examined by Q-PCR.Results Compared with the CTL group,NPD,LPD and Keto groups had lower body weight,higher urine albumin,higher serum creatinine and urea nitrogen (P ＜ 0.05).The crosssectional area of muscle fibers was larger in CTL group.Compared with CTL group,the muscle fiber was partly broken,the mitochondrial morphology was obviously changed,the percentage of type Ⅱmuscle fiber was increased significantly (P ＜ 0.05),and the activity of citrate synthase and the number of mitochondrial DNA were decreased significantly in NPD,LPD and Keto groups (P ＜ 0.05).In Keto group,muscle wasting was improved compared with NPD and LPD group (P ＜ 0.05),the crosssectional area of soleus muscle increased and the percentage of type Ⅱ muscle fiber decreased,levels of urine albumin,semm creatinine and urea nitrogen decreased (P ＜ 0.05).Under transmission electron microscopy,the muscle fiber of keto group was intact and mitochondiral morphology was close to that of CTL group.The activity of citrate synthase and number of mitochondiral DNA were higher as compared to CTL group (P ＜ 0.05).There were no significant differences between NPD and LPD group.Conclusions In DKD condition,protein degradation in the skeletal muscle is accelerated,mitochondrion is swelling,the number of mitochondrial DNA is decreased and mitochondrial function is impaired.Low-protein diet supplemented with α-keto acids can improve mitochondrial damage and muscle wasting induced by DKD.

Objective To investigate the incidence and associated factors of pre-eclampsia in women with abnormal glucose metabolism in pregnancy. Methods A retrospective study was conducted on 1202 pregnant women with abnormal glucose metabolism who delivered their babies in our hospital between 1981-2003. All women were divided into 2 groups: group Ⅰ included 151 women with pre-eclampsia; group Ⅱ consisted of 1050 women without pre-eclampsia. The risk factors of pre-eclampsia were analyzed. Results (1)The incidence of pre-eclampsia was 12.6% as a whole and was 34.8%(39/112), 11.8%(89/753) and 6.8% (23/337) in diabetes mellitus(DM), gestational diabetes mellitus(GDM) and gestational impaired glucose tolerance(GIGT) groups, respectively ( P

Objective To observe the muscle wasting in diabetic kidney disease (DKD) model of type 2 and non-obese diabetes mellitus in Goto-Kakizaki (GK) rats,and to evaluate the effect of lowprotein diet supplemented with α-keto acids on muscle wasting.Methods Forty-five male 24-weekage GK rats were randomly divided into three groups:normal protein diet group (22％ casein diet,NPD),low protein diet group (6％ casein diet,LPD) and LPD + α-keto group (5％ casein + 1％ α-keto,Keto).Fifteen gender-and age-matched Wistar rats were served as the control group (CTL).The living condition of GK rats was observed and body weight was measured once a week.Urine albumin,serum glucose,lipids,albumin,creatinine and urea nitrogen were measured at the age of 24,32,40,48 weeks.Soleus muscle at the age of 48-week was observed to calculate the muscle size with software.Expressions of atrogin-1,MuRF-1 and MyoD,myogenin were examined by Q-PCR and Western blotting.Results Compared with the CTL group,NPD,LPD,Keto groups had lower body weight [(317.90± 13.81),(330.38±11.96),(390.44±12.25) g vs (429.43± 16.85) g,all P ＜ 0.05],higher urine albumin [(14.36±5.52),(8.12±4.61),(5.58±3.50) mg/24 h vs (0.61±0.16) mg/24 h,all P ＜ 0.05],higher serum creatinine [(81.50±7.88),(66.32±8.36),(63.44±8.21) μmol/L vs (24.43±6.15) μmol/L,all P ＜0.05] and urea nitrogen [(7.53±1.05),(5.63±1.40),(5.54±0.97) mmol/L vs (2.98±0.62) mmol/L,all P ＜0.05].The cross-sectional area of soleus muscle fibers was larger in CTL group.Compared with CTL group,the expression levels of atrogin-1 and MuRF-1 increased significantly (all P ＜ 0.05),and of MyoD and myogenin decreased significantly in NPD,LPD,Keto groups (all P ＜ 0.05).In Keto group after 40 weeks,muscle wasting was improved compared with NPD and LPD group [body weight (381.62± 15.82) g vs (331.50±17.58),(326.60± 13.43) g,all P ＜ 0.05],cross-sectional area of soleus muscle increased,levels of urine albumin,serum creatinine and urea nitrogen decreased (all P ＜ 0.05),the protein expressions of atrogin-1 and MuRF-1 decreased,and myogenin and MyoD were higher as compared to CTL group (all P ＜ 0.05).There were no significant differences between NPD and LPD group.Conclusions In DKD condition,protein degradation in the skeletal muscle is accelerated,the genes which control muscle atrophy are activated,and proliferation and differentiation of the muscle satellite cells are impaired.Low-protein diet supplemented with α-keto acids can improve muscle wasting induced by DKD.

Objective To investigate the protective effect of Klotho on renal ischema-reperfusion injury (IRI).Methods Plasmid expression vector of secreting type Klotho (pV5-sKlotho) was injected through the tail vein 24 h before operation.The renal ischemia-reperfusion model was established and the experiment was divided into 6 groups:sham group of young mice,sham group of aged mice,control group of young mice,control group of aged mice group,Klotho transfected group of young mice and Klotho transfected group of aged mice.The serum creatinine (Cr) and blood urea nitrogen (BUN) levels were determined at 1st,3rd,7th,and 14th after reperfusion.The mRNA expression of Klotho and P53 in the renal tissue,concentration of the malondialdehyde (MDA),superoxide dismutase (SOD) and pathological changes in the renal tissue were examined.Results As compared with young mice group,the Cr and BUN levels were significantly increased after reperfusion (P<0.05),the expression of Klotho mRNA was significantly decreased (P<0.05) and the expression of P53 mRNA was significantly increased (P<0.05),the MDA level in the renal kidney tissue was significantly increased and SOD level was significantly decreased (P<0.05) in aged mice.Vacuolar degeneration and necrosis in tubules were major pathological changes 24 h after operation in aged mice,and at 14th day after IRI renal tubular atrophy,fibrosis and inflammatory cell infiltration were seen in aged mice.After transfection with pV5-sKlotho,as compared with control group of aged mice,the kidney function was significantly improved in Klotho transfected group of aged mice (P<0.05),and the up-regulated expression of Klotho and down-regulated expression of P53 were detected in Klotho transfected group of aged mice (P<0.05),also the MDA level in the renal tissue was obviously reduced and SOD level was obviously increased (P<0.05).Vacuolar degeneration and necrosis in tubules at 24th h after IRI and tubular atrophy,fibrosis and inflammatory cell infiltration at 14th day after IRI were significantly improved in Klotho transfected group of aged mice.Conclusion Transfection with Klotho can protect the acute kidney injury and chronic kidney disease induced by IRI in aged mice.

Objective To assess the applicative effect of the flipped classroom in nutrition and food hygiene. Methods 48 students of Class One from Grade 2011 majoring in preventive medicine were taken as the TBL group, with 49 students of Class Two as the flipped classroom group. The TBL group used TBL and the formative assessment, while the flipped classroom group used the flipped classroom and the forma-tive assessment. The teaching effect was evaluated through the unified examination and teaching satisfaction questionnaire survey. SPSS 17.0 statistical software was used for the data t test between the groups, and Wilcoxon test, chi square test were used for the linear correlation analysis of the usual grade and final grade of the flipped classroom group. Results The experimental scores (9.21 ±1.14) and the final scores (66.76±4.53) of the flipped classroom group students were significantly higher than the experimental scores (8.31±1.01) and final scores (61.31±4.37) of the TBL group and the difference was statistically significant (t=4.50, P=0.004; t=5.45, P=0.003). The excellent distribution of the flipped classroom group's overall results were higher than that of the TBL group (u=21.36, P=0.002). The usual scores and the final scores were positively correlated (r=0.960, P=0.000) in the flipped classroom group. The results of the question-naire showed that the flipped classroom group students' satisfaction with the positive impact the teaching methods had on all aspects of their own was higher than that of TBL group (P<0.05). Conclusion The flipped classroom teaching can help improve the students' learning enthusiasm, thinking activity and com-municative competence.

ObjectiveTo study the clinical features of the bilateral frontal brain contusion with cerebral hernia center and its treatment strategies. MethodsThe clinical data of 76 patients with cerebral central hernia were restropectively analyzed. ResultsIn 76 patients,there were 53 cases survive,23 cases died.The life and survival quality of these patients were evaluated according to the Karnofsky scale systerm :46 patients underwent surgery,including 35 cases with good recovery,8 cases with long-term coma or unable to look after themselves,3 cases with death;10 cases underwent a expectant treatment,of which,6 cases with good recovery,4 cases with long-term coma or unable to look after themselves.The other 20 cases died of central brain stem failure,with a central hernia when admissioned. ConclusionPatients with bilateral frontal brain contusion were extremely complicated with central hernia,and had a suddenly deteriored condition.Close observation of changes were critical importance.The surgery should be carried out before "diencephalon period",for most recovery well after surgery.Patients with diffuse brain swelling should go under the depressioning surgery as earlier as possible.

Objective To generate recombinant Pichia pastoris for high-copy expression of human tissue factor pathway inhibitor (TFPI). Methods The cDNA encoding human TFPI was inserted into the expression vector pPIC9K and the constructed expression vector rhTFPI-pPIC9K was confirmed by restriction endonuclease analysis and DNA sequencing. The recombinant plasmids were subsequently transformed into Pichia pastoris GS115 cells, and the transformants were confirmed by PCR amplification of the genomic DNA.The recombinant Pichia pastoris with high copies of TFPI cDNA was screened by G418 selection. Western blot and TFPI ELISA Kit were employed to analyzing. The temperature, time and concentration of methanol for the induction of recombinant protein were optimized. Results PCR analysis and DNA sequencing confirmed the successful construction of the expression vector rhTFPI-pPIC9K. Real time quantitative PCR and Western blot analysis demonstrated the positive correlation between TFPI expression level and the copy number of TFPI cDNA in Pichia pastoris cells. Optimization of the induction condition significantly elevated the expression level and activity of TFPI (9.95±0.78 mg/L and 3.91±1.37 U/mL). Conclusion The Pichia pastoris strain with high copy of TFPI expression was successfully constructed, which lays a solid foundation for the further investigation on the function of TFPI and its application in the prevention and therapy of diseases.

Objective To investigate the immunosuppressive regimen of cyclosporine A(CsA) reduced or withdrawn in the HBV-DNA positive kidney transplanted patients. Methods The program of 64 kidney transplanted patients with HBV-DNA positive from Jan,2004 to Dec,2007 were analyzed, the patients were divided into 3 groups ①CsA + MMF group(A group) ;②FK506 + MMF group(B group) ;③low dose of CsA + SRL group(C group). All the patients received entecavir to resist HBV replication and were followed up for acute rejection incidence,liverfunc- tion and HBV-DNA test for 6 months. Results There was no significant difference in 3 groups about acute rejection incidence rate. Liver dysfunction took place in 12 patients of A group (80%) ,8 patients(53%) in A group HBV-DNA became negative; 5 patients (20%) in B group appeared the liver dysfunction, HBV-DNA became negative in 18 patients(75%). 4 patients in C group(16%) appeared liver dysfunction sHBV-DNA was negative in 18 patients (72%) of C group. Conclusion It was safe and efficient for the immunosuppressive regimen of cyclosporin A re-duced or withdrawn in the HBV-DNA positive kidney transplanted patients,not increasing the incidence of acute re-jection and aggratating the liver injury.