It is still difficult to achieve optimal nutritional effect in the septic patient.The objectives of this prospective study are to determine the effect of increasing N intake on the metabolic response to TPN in the septic patient,containing either0 .2 5 g N/ (kg? d) or0 .35 g N/(kg? d) .On the high- but not the low- N intake there were further beneficial effects on net protein levels in blood and nitrogen balance.The results showed that TPN containing high N instake can further achieve nitrogen bal- ance in the septic patient,although it may stimulate the catabolism of protein and further evoke the stress to responses.

Objective To explore the different methods of decoloration for immunohistochemical HE slides,and their influence on tissue antigen expression.Methods Antigen retrieval solution (EDTA or citric acid solution) was used in immunohistochemistry to decolor HE slides,and was compared with the method of hydrochloric acid solution decoloration in normal temperature.Results Antigen heat retrieval decolors completely.Compared with other methods,it has shorter decoloration time (1 ～ 2min),more than 90％ of completely decoloration rate,the difference was significant(x2 =27.6,23.9,all P ＜ 0.01).Meanwhile,the method dose not damage slides,and the immunohistoehemical results are exact,without background coloring and unusual coloring,antigen expression rate and intensity are high.Conclusion Antigen heat retrieval decoloration not only simplifies the coloration process,but also protects tissue antigen activity better.It is the preferable method of decoloration and protecting antigen resource,which possesses some practical value in the pathology diagnosis.

Extended liver resection may provide longterm survival in selected patients with hilar cholangiocarcinoma.In May 2013,a patient with hilar cholangiocarcinoma received right hemihepatectomy combined with caudate lobectomy under the guidance of precision hepatectomy technique.The porta hepatis was clamped in the operation for 3 times intermittently.The operation time was 8 hours,and the volume of intraoperative blood loss was 600 mL.The patient was discharged at postoperative day 14.The results of pathological examination confirmed that the patient had moderately-highly differentiated adenocarcinoma with full-thickness infiltration of the bile duct and tumorfree margins.No tumor recurrence was detected during the followup which was lasted for 6 months.The operation was carried out based on the three dimensional reconstruction,liver reserve function evaluation,intraoperative controlled low central venous pressure and precision hepatectomy technique,and the results were satisfactory.

Objective To investigate the expression of Bcl-2 associated athanogene 3 (BAG3) in cervical cancer tissues and cells and its role in epithelial mesenchymal transition (EMT) of cervical cancer.Methods (1) Cervical cancer samples were collected from September 2015 to March 2017 in the Qilu Hospital of Shandong University and Shangdong Provincial Hospital.While,50 normal tissues were collected from August 2015 to March 2017 in the Dezhou Municiple Hospital,which were obtained from patients with uterine mnyoma underwent hysterectomy and patients with cervical biopsy.Reverse transcription (RT)-PCR and western blot were used to detect the expression of BAG3 mRNA and protein,and their clinical significances were analyzed.(2) The expression of BAG3 mRNA and protein was detected using RT-PCR and western blot method in HeLa and SiHa cell lines and normal cervical epithelial cells.The experiment was divided into two groups,BAG3 small interfering RNA transfected group (st-BAG3) and the control group transfected with small interfering RNA (siRNA).Cell counting kit 8 (CCK-8) analysis was used to detect cell proliferation of two groups.Wound-healing and transwell assay were used to detect the migration and invasion ability of HeLa and SiHa cells.The xenograft model of cervical cancer in nude mice was used to observe the effect of BAG3 on tumor xenografts and the tumor-related biomarkers were tested by western blot.Results (1) The expression levels of BAG3 mRNA and protein in cervical carcinoma tissues were 1.20±0.15 and 1.10±0.16,which were significantly higher than that in normal cervical tissue,0.23± 0.04 and 0.29 ± 0.03 (both P＜0.01).The results showed that the expression levels of BAG3 mRNA and protein were significantly correlated with cervical carcinoma staging and lymph node metastasis (P＜0.05).However,its expression was not conrelated with the patient's age,pathological grade,and diameter of tumor (all P＞0.05).(2) Compared with normal cervical epithelial cells,the expression of BAG3 mRNA and protein levels in HeLa and SiHa cells were significantly increased (P＜0.01),the expression levels of BAG3 mRNA and protein in HeLa and SiHa cells transfected with si-BAG3 were significantly lower than that in control group (all P＜0.01).After post-transfected 72 hours,A value of HeLa and SiHa with transfection were significantly lower than those in control group [(0.88±0.08) vs (1.22±0.13),(0.92±0.09) vs (1.35±0.12);both P＜0.01].After post-transfected 24 hours,the migration level of HeLa and SiHa cells with transfection were significantly lower than those in the control group [(20.1±2.1)％ vs (58.6±5.6)％,and (21.1±2.1)％ vs (61.7± 5.4)％;both P＜0.01].The transmembrane cell number in HeLa and SiHa cells with transfection were 76± 11 and 71±8,which were significantly less than those in control group (131± 12 and 129± 14;both P＜0.01).After the inoculation into nude mice,tumor formation time of HeLa and SiHa cells with transfection were (9.5±0.5) and (10.5 ± 1.3) days,respectively,which were significantly longer than those in control group [(4.5±0.5) and (5.2± 1.1) days;both P＜0.05].Compared with those in the control group,the expression level of Slug,N-cadherin and matrix metalloproteinase-2 (MMP-2) protein in HeLa and SiHa cells with transfected in tumor tissues were significantly decreased (all P＜0.01),while the expression level of E-cadberin protein was significantly increased (P＜0.01).Conclusion BAG3 could be involved in the proliferation,migration and invasion of cervical cancer cells by affecting cervical cancer EMT,and BAG3 may be an effective target for the treatment of cervical cancer.

Objective:To compare the clinical effect and safety of modified Simiao San and colchicines on the damp heat gout.Methods:120 patients with damp heat gout admitted in our hospital in 2015 were selected and randomly divided into group A,group B and group C with 40 cases in each group.Patients in group A were given modified Simiao San,patients in group B were given colchicine,patients in group C were given modified Simiao San combined with colchicine.Then the clinical effect,scores of symptoms,expression levels of inflammatory factors and other biochemical indexes,adverse reactions and recurrence rate of 3 groups were compared berween three groups.Results:The total effective rate and effectually effective rate of group A were 92.5％ and 57.5％ respectively,which were 95.0％ and 65.0％ in group C was,obviously higher than 77.5％ and 35.0％ of group B (P＜0.05).The symptom scores of 3 groups after treatment were all lower than those before treatment (P＜0.05).The variety of ESR and UA of group C were greater than other groups (P＜0.05).The incidence rate of adverse reaction in group A and group C were 5.0％ and 7.5％ respectively,obviously lower than 22.5 of group B with statistically signficance (P＜0.05).The SF-36 score of group C was obviously lower than those of group A and group B with statistically significance (P＜0.05).Conclusion:Modified Simiao San combined with colchicine had better effect and safety compared to single medicine,which could greatly improve the quality of life.

Objective To investigate the effects of bone morphogenetic protein-7 ( BMP7 ) on insulin signaling transduction in C2C12 myotubes and HepG2 hepatocytes, and the underlying mechanisms were studied preliminarily.Methods The C2C12 myotubes and HepG2 cells were treated with BMP7 at different concentrations.The insulin signal transduction was analyzed by Western blot.Meanwhile, total RNA was extracted and quantitative PCR was employed for detecting the effects of BMP7 on gene expressions of effectors involved in insulin signal pathway.Furthermore, JNK signal pathway was also measured.Results The protein levels of p-IR, p-Akt and p-GSK3β, as well as glucose uptake, were significantly stimulated by insulin in the C2C12 myotubes and HepG2 cells.However, these stimulations induced by insulin were largely attenuated by BMP7.The mRNA levels of Akt1, Igf1r, Insr, and Irs1 were not altered by the treatment of BMP7.The JNK signal pathway was activated by a 5-min exposure of BMP7 in the HepG2 cells, and this activation was gradually reduced along with the treating time.Conclusion BMP7 attenuates the insulin signal transduction in the HepG2 cells and C2C12 myotubes, and this attenuation effect may be through JNK activation.

Objective To understand the whole situation of neonatal resuscitation in high risk deliveries.Methods Totally,3 420 neonates born from high risk pregnant mothers in Tianjin Central Obstetrics and Gynecology Hospital from September 2013 to November 2014 were recruited and divided into four groups according the needs of resuscitation,including no resuscitation group (Group A),initial resuscitation group (Group B),initial resuscitation plus bag-and-mask or T-piece ventilation (positive pressure ventilation group,Group C),tracheal intubation and/or external chest compression and/or epinephrine administation (tracheal intubation group,Group D).Variance analysis,Chi-square test and Logistic regression analysis were applied to compare the differences of clinical conditions among these groups and to analyze risk factors of tracheal intubation requirement for extensive resuscitation.Results Among the 3 420 newborns,2 360(69.0％) were assigned to Group A,565 (16.5％) to Group B,408 (11.9％) to Group C and 87 (2.5％) to Group D.Statistical differences were shown in the gestational age [(35.5 ± 4.1),(33.0 ± 4.3) and (32.1 ± 4.8) weeks],birth weight [(2 593.8 ± 663.6),(2 063.3 ± 973.9) and (1 839.0 ± 977.9) g],and the incidence of multiple births [66(11.7％),65(15.9％) and 23(26.4％)],abruptio placentae [15(2.7％),35(8.6％) and 9(10.3％)],umbilical cord prolapse [0(0.0％),2(0.5％),and 10(11.5％)],abnormal fetal heart rate in labor [28(5.0％),45(11.0％) and 46(52.9％)],prolonged labor [36(6.4％),35(8.6％),and 20(23.0％)],meconium stained liquor [32(5.7％),0(0.0％),and 8(9.2％)],and congenital anomaly [8(1.4％),12(2.9％) and 7(8.0％)] among Group B,C and D (F or x2=233.188,105.050,14.535,19.934,91.434,149.366,26.525,28.602 and 13.765,all P ≤ 0.05).Multiple regression analysis revealed that gestational age ≤ 28 weeks (OR=1.290,95％ CI:1.167-1.425),abnormal fetal heart rate in labor (OR=1.350,95％CI:1.184-6.862) and meconium stained liquor (OR=1.397,95％CI:1.051-6.825) were independent risk factors for endotracheal intubation requirement (all P ≤ 0.05).Conclusions More newborns born from high risk mothers may need resuscitation,especially for those in small gestational age,with abnormal fetal heart rate during labor and meconium-stained liquor,thus close monitoring and management are necessary.

Objective To assess the efficacy of stone fragmentation and clearance of this new intracorporeal ultrasound lithotripter (CQS-01) compared with currently available ultrasound units (EMS-Ⅲ/Ⅳ).Methods Twenty phantom stones composed of dental gypsum were randomly divided into four groups,and CQS-01 ultrasound lithotripter (70％ power and 70％ duty factor),EMS-Ⅲ ultrasound lithotripter (70％ power and 70％ duty factor),EMS-Ⅳ ultrasound lithotripter (type A,70％ power and 70％ duty factor) and EMS-Ⅳ ultrasound lithotripter (type B,70％ power and 100％ duty factor) were used to fragment and removepbantom stones.The mean stone breakdown time and fragment removal time and stone fragmental sizes for the standard ultrasound devices were compared to determine the completeness and efficiency of stone fragmentation and removal.Results The average time for stone breakdown was 7.4 ± 1.9 s,9.4 ± 1.6 s,82.2 ± 12.6 s and 51.4 ± 18.7 s,respectively.There was no significant difference between CQS-01 and EMS-Ⅲ (P ＞ 0.05),but there was significant difference between CQS-01 and EMS-Ⅳ (A or B) (P ＜ 0.001).The average time for stone clearance using the ultrasound devices was 387.8 ± 68.0 s,41 1.6 ± 57.6 s,568.0 ± 119.1 s and 383.6 ± 75.6 s,respectively.In addition,the average size of the largest fragments removed was the same among the groups (＜ 3 mm).Conclusion The ultrasound capabilities in a newly developed lithotriter (CQS-01) exhibited the same ability to fragment and clear phantom stones compared with standard ultrasound devices.

Objective To find out the display rules of the key part of the proximal femur and fracture line and obtain the best viewing position and angle by placing the femoral neck at different positions and different angles through X-ray.Methods Six dry specimens of cadaveric femur were from Department of Anatomy,Tianjin Medical University.Three models of complete femoral neck model,tin line fracture model and steel saw fracture model were made respectively.The tin line fracture model was based on the Pauwells angle,using the tin wire(1mm) wrapped around the femoral necks to make three kinds of fracture models (Pauwells angle 30°,50° and 70°);steel saw fracture model was made by hacksaw,then reposition in situ,to make three kinds of fracture models same as the tin line fracture model.The projection manner included different positions and different angles,different projection positions include:parallel with the femoral shaft,perpendicular to the femoral shaft,parallel to the femoral neck and perpendicular to the femoral neck;different projection angles included:from 40°,30°,20°,15°,10° and 5° in the head side to 5°,10°,15 °,20 °,30 °and 40° in the foot side and vertical angle 0°.For the complete femoral neck model,we observed the imaging characteristics of the key parts of the femoral head and neck (tension trabecular bone and pressure trabecular bone;lesser trochanter;intertrochanteric line;length of neck of femur and femoral head shape),looking for the display rules,and obtained the best viewing position.For tin line fracture model and steel saw fracture model,we tried to find the best display angle and position by the different projection position and angle.Results The results of complete femoral neck model:Lesser trochanter:in perpendicular to the femoral shaft position showed the best,gradually increased with the foot side deflection;tension trabecular bone and pressure trabecular bone:in parallel with the femoral shaft position 10°on the head side;intertrochanteric line:no difference between parallel with the femoral shaft with perpendicular to the femoral shaft;Femoral neck shape:deflect to both sides,head of femur was out of shape.The results of tin line fracture model:the Pauwells angle 30° model showed the best position in parallel with the femoral shaft position 20° on the head side;the Pauwells angle 50° model showed the best position in parallel with the femoral shaft position 5° on the head side;the Pauwells angle 70° model showed the best position in parallel with the femoral shaft position 10° on the head side.The results of steel saw fracture model were the same with the tin line fracture model.Conclusion There was the best viewing angles and positions for the key anatomy of the proximal femur and different Pauwells angle classification of femoral neck fracture.The image doctor could make more accurate projection,according to the different types of femoral neck fracture.

Objective To explore the characteristics of diagnosis and treatment of acupuncture and moxibustion for heel pain.Methods We searched the literatures related to heel pain treated by acupuncture and moxibustion in CNKI,WFPD,VIE CBM,PubMed and Embase,then summarized the intervene measures related to acupuncture and moxibustion,clinical characteristics of syndrome differentiation and acupuncture points selection method,frequency,treatment course,treatment effect,follow-up outcomes and safety.Results A total of 47 articles are included in the acupuncture treatment of heel pain commonly used measures like small needling knife,acupuncture,acupoint injection,electro-acupuncture,fire needling,warm needling and moxibustion.The percentage of article involved in treating heel pain by small needling knife was 55.32％ (26/47) and 21.28％ (10/47) by acupuncture.The percentage of articles involved in acupuncture points selection method by differentiation of disease was 93.62％ (44/47).The main acupuncture points in the 47 articles was ashi acpoint (68.09％,32/47).The therapy frequency and treatment courses varied from the differences of the acupuncture and moxibustion methods.For small needling knife,the percentage of treating frequency of one time was 36.17％ (17/47) and evaluating the curative effect after one treatment was 40.43％ (19/47).For acupuncture,the percentage of treating frequency of once a day was 17.02％ (8/47) and 23.40％ (ll/47).The effective rate showed a lot of variation from 69.56％-100％ vary by intervene measures.The follow-up rate was not high,only 27.66％ (13/47).There was only one literature referring to the adverse reaction.Conclusions The literatures review showed that the small needling knife was the most frequent method,followed by acupuncture.Acupuncture points selection by disease differentiation is the common method.The main acupuncture points applied in heel pain is ashi acupoint.Evaluating the effect after one treatment was common used for small needling knife.Once a day and ten times a therapy course were the common treatment frequency and treatment course for the remaining intervene measures.Acupuncture and moxibustion could show immediate and probable long-term positive effect for heel pain without no severe adverse reactions.