Toil-like receptors (TLRs) present in the cell membrane and are transmembrane receptors.TLR4 is a key member of the TLRs family involved in inflammatory response and recognizing microbes. Gut barrier mainly include mechanical, immunological, chemical and biological barrier four major sections. Liver transplantation leads to intestinal ischemia-reperfusion (I/R) injury, then intestinal bacteria and endotoxin translocate into the blood circulation and at the same time, I/R injury stimulates the release of a large number of endogenous molecules. TLR4 is combined with both endotoxin and endogenous ligand and promotes the release of multi-kinds of cytokines and inflammatory mediators, causing a series of inflammatory reactions,and even leading to liver failure.

[Summary] Hypogonadotropic hypogonadism (HH) in women is characterized by failure of ovarian function secondary to deficient gonadotropin secretion,resulting from either a hypothalamic or pituitary defect.Estrogenprogestin therapy can induce and maintain secondary sex characteristic and artificial menstrual evcle.If the patient requires fertility,ovulation and even pregnancy can be induced either with exogenous gonadotropins or with pulsatile gonadotropin releasing hormone therapy.In the present article,different ovulation induction therapies of female HH were reviewed.

In the paper, 32 lots of intravenous immunoglobulin (IVIG)were tested by an animal model,the hypotensive test of rats. A linear correlation was found between prekallikrein activator (PKA)activity and hypotensive reaction if the inflow of human IVIG was made rapid (r=0.96,n=23). The preliminary observations indicated that it would be satisfactory that the PKA activity was below 35IU/ ml and the size of reduction in blood pressure was not 15% higher than that of control animal's level.The rat model can provide a method for safe usage of the intravenous immunoglobulin and reliable detection of and control over the residual PKA activity in blood products.

Objective To explore electrophysiological features of infantile spinal muscular atrophy (SMA), and to evaluate diagnostic value of electrophysiological examinations in patients with SMA.Methods Tweenty-seven SMA children from Jan 2011 to Nov 2015 diagnosed in Wuxi People''s Hospital were enralled.All patients had neurogenic changes by EMG and finally confirmed by genetic test as SMA.Basic clinical data were retrospectively analyzed.Nerve conduction velocity was tested in each patient;While EMG was performed in no less than six muscles in each patient.Results All these patients were characterized by progressive flaccid paralysis in limbs.In all cases, amplitude of CMAP in median nerve was significantly decreased, apparent decreased in ulnar nerve and peroneal nerve;while mild decrease of MCV was appeared in ulnar nerve.Nothing abnormal were detected in sensory nerve conduction.EMG demonstrated neurogenic damage.Conclusion Typical clinical symptoms of infantile SMA are progressive symmetrical loss of muscle control and atrophy in limbs, and specificity electrophysiological representation provides very important basis for the diagnosis.

Objective To evaluate the prognostic value of MTV measured by pretreatment 18F-FDG PET/CT imaging in patients with pancreatic cancer (PC).Methods The clinical data of 52 patients (31 males,21 females,median age 58.5 years) with pathologically or clinically proved PC from January 2011 to October 2014 were retrospectively analyzed.Serum CA19-9 was measured within 1 week before PET/CT examination.SUVmax and MTV were measured respectively,and PET/CT staging was obtained simultaneously.All patients were followed up until January 2015.The CA19-9,MTV,SUVmax,PET/CT staging and clinical factors(age,gender,treatment methods) were assessed by ROC curve analysis,Kaplan-Meier analysis and multivariate Cox model.Results The median survival time of 52 patients was (11.20±7.25) months.ROC curve analysis showed that the AUC of MTV,SUVmax and CA19-9 were 0.735,0.614 and 0.527 respectively.Kaplan-Meier survival analysis manifested that the survival times were significantly different between patients with different MTV (＜ 12.14 cm3 vs ≥ 12.14 cm3),different SUVmax (＜ 8.95 vs ≥ 8.95),different PET/CT staging and different treatment methods (x2 =4.272-11.693,all P＜0.05).The survival time of patients with MTV ＜ 12.14 cm3 and that of patients with MTV ≥ 12.14 cm3 were (13.44±8.40) and (7.00± 4.82) months,respectively.Cox single-factor analyses indicated that MTV,PET/CT staging and SUVmax were risk factors of survival,the hazard ratios (HR) were 0.393,0.503,0.547 respectively (P=0.002,0.020,0.027).Cox multi-factor analyses indicated that MTV and PET/CT staging were independent risk predictors of survival.Conclusion MTV and PET/CT staging are significant factors in prognosis prediction of patients with PC,which would be helpful to make individual treatment for patients with high risks.

[Objective] To observe the clinical efficacy of treatment on Frequent Postoperative Posner-Schlossmann syndrome in cataract intraocular lens using Chinese medicine with the effect of tonifying the liver and kidney, nourishing yin and suppressing hyperactive yang.[Methods] 46 cases of Posner-Schlossmann syndrome were randomly divided into two groups, one was the Chinese Medicine group ,in which al cases were treated with Chinese herbs and local eyedrop at the time of first onset after operation; another was the control group, in which al cases were treated with local eyedrop. [Results] Within two years after treatment, compared with the control, in the Chinese Medicine group, the cases of recurrence of Posner-Schlossmann syndrome were obviously decreased. [Conclusion] Chinese medicine with the effect of tonifying the liver and kidney, nourishing yin and suppressing hyperactive yang shows definite effect on postoperative Posner-Schlossmann syndrome, it can decrease the occurrence frequency of number.

OBJECTIVEThis study aims to identify the crack tip stress intensity factor of the propagation process, crack propagation path, and the changes in the shape of the crack tip by the finite element method.

METHODSThe finite element model of dentino-enamel junction was established with ANSYS software, and the length of the initial crack in the single edge was set to 0.1 mm. The lower end of the sample was fixed. The tensile load of 1 MPa with frequency of 5 Hz was applied to the upper end. The stress intensity factor, deflection angle, and changes in the shape of the crack tip in the crack propagation were calculated by ANSYS.

RESULTSThe stress intensity factor suddenly and continuously decreased in dentino-enamel junction as the crack extended. A large skewed angle appeared, and the stress on crack tip was reduced.

CONCLUSIONThe dentino-enamel junction on human teeth may resist crack propagation through stress reduction.

Objective To study the 2244G→A, 2299 A→G single nucleotide polymorphism (SNP) in the 5' regulatory regions of Toll-like receptor 4 (TLR4) in patients with Gram negative bacteria infection in Shenzhen locality, and to discuss the occurrence, course and prognosis of patients with sepsis. Method Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was used to detect the genotype of TLR4. After the whole blood DNA of patient was extracted and PCR was amplified, the products were 500bp and 599 bp, and were cut by endonuclease Mae Ⅱ and Sph Ⅰ respectively to determine the SNP 2244G→A and 2299 A→G in TLR4. These two kinds of allele frequencies were statistically calculated in all patients. In the meantime, the incidence of septic shock, average hospitalized days, cost and prognosis of all patients were recorded. Statistical analysis was performed with SPSS version 16 software. ANOVA was used for comparison among multiple groups, and t -test and Sighed rank test were used for paired comparison. Results The 2299 and 2244 sites in the 5' regulatory regions of TLR4 gene of patients with Gram negative bacteria infection in Shenzhen locality had various degrees of changes in single nucleotide. Compared with the documented data from Chinese people in general, there was a significant difference in 2299A→G genotype frequency in residents of Shenzhen locality ( P < 0.05). But there were no statistically significant difference in mortality, incidence of septic shock, average days of ICU stay or ICU cost between TLR4 SNP positive and negative groups of patients. Conclusions There is a wide range of genetic variation in the 2299 and 2244 sites in the 5' regulatory regions of TLR4 among citizens of Shenzhen locality with unique distribution. The 2299A→G genotype frequency probably has differences in distribution and population. The pathogenesis and the prognostic factors of sepsis are complicated, whereas the gene polymorphism may be just one of the factors affecting the prognosis of patients with Gram negative bacteria infection.

This paper summarizes professor LU Zhi-zheng’s clinical experience of treating thoracic obstruction from regulating spleen and stomach.Seven kinds of syndromes and treatments are concluded and analyzed.Proved cases were included in order to provide reference for the clinical treatment of thoracic obstruction.

Objective:To systematically review the teaching effects of flipped classroom (FC) in undergraduate medical education in China.Methods:Such databases as CNKI, VIP Data, and WanFang, were electronically searched for literature of randomized controlled trials (RCTs) on FC versus lecture-based learning (LBL) applied in medical education in China up to March, 2018. The included literature were evaluated for the quality, and RevMan5.3 software was used for Meta-analysis.Results:A total of 26 RCTs were included in the study, including 4 249 students, of whom the FC group had 2 135 cases, while LBL group had 2 114 cases. The students in FC group got significantly higher scores than those of the students in LBL group in the theoretical scores (WMD = 7.81, 95%CI = 5.18 -10.43, P < 0.05), skills tests (WMD = 4.69, 95%CI = 0.65 -8.73, P < 0.05). Conclusion:The FC can significantly improve the teaching results in undergraduate medical education.