Objective To evaluate the efficacy of lamivudine and adefovir in the treatment of patients with decompensated hepatitis B cirrhosis . Methods 90 cases of patients with hepatitis B cirrhosis of the liver decompensation period from August 2013 to June 2015 in our hospital were researched.According to the random number table method divided into observation group and control group , each of 45 cases, the total course of treatment was one year.The observation group was treated with lamivudine combined with adefovir dipivoxil , control group was treated with lamivudine.The clinical effect, the indexes of liver function, the changes of HBV-DNA and Child-pugh score were compared between the two groups after treatment.Results After treatment, the total effective rate of the observation group ( 93.33%) was obviously higher than that of control group (48.89%), the difference was statistically significant (P<0.05), the observation group alanine amino acid, total bilirubin, aspartate aminotransferase were (71.23 ±21.32)U/L, (28.32 ±4.65)Umol/lL, (4.65 ±9.25)U/L, they were significantly lower than control group (111.54 ±16.25)U/L, (46.53 ±4.89 ) Umol/L, ( 4.89 ±12.11 ) U/L, the observation group albumin ( 39.82 ±2.62 ) g/L was significantly higher than control group (35.55 ±2.22)g/L, the difference was statistically significant (P<0.05), after treatment, the observation group hepatitis b HBV DNA levels, Dhild pugh score (2.78 ±0.45)log10 copies/mL, (6.12 ±1.23) were significantly lower than the control group (3.89 ±0.65)log10 copies/mL, (7.89 ± 1.21)scores, the difference was statistically significant (P <0.05).Conclusion The combination of lamivudine and adefovir dipivoxil significantly decompensated hepatitis B cirrhosis has a curative effect, it could effectively improve the patient's liver function, Dhild-pugh score, HBV-DNA level.

Objective:To identify the differentially expressed genes and pathways of minimal change disease (MCD) by bioinformatics analysis, and to explore the pathogenesis of MCD.Methods:The gene expression omnibus (GEO) under the National Center for Biotechnology Information (NCBI) platform of the United States was used, and the data chips GSE104948 and GSE104954 containing MCD information were selected. The data set contained the gene expression array data of 19 cases of MCD renal biopsy tissue and 36 cases of normal renal tissue. The online tool GEO2R was used to analyze data and screen differentially expressed genes, and DAVID 6.8 database was used to perform GO and KEGG functional enrichment analysis of differentially expressed genes and network analysis of genes involved in metabolic pathways. The String 11.0 database and Cytoscape 3.7.2 software were used to analyze the relationship between MCD differentially expressed genes and perform visual analysis. At the same time, the CytoHubba plug-in was used to analyze the degree of association of protein interaction networks and screen key expressed genes.Results:A total of 302 highly expressed differentially expressed genes were identified by online tool GEO2R. GO analysis showed that the products of these differential genes were mostly located in the extracellular matrix, exosomes, pernucleus and other regions, exerting cell adhesion molecule binding, deoxycytidine deaminase activity, protein homodimerization activity, 2'-5'-oligoadenylic acid synthase activity and other functions, as well as participating in the formation of extracellular matrix, cell lysis, cell apoptosis, inflammatory response, immune response and other biological processes. KEGG analysis showed that differentially expressed genes were enriched in local adhesion, NOD-like receptor and other signal pathways. Combining the results of GO analysis and Cyto Hubba analysis, the PYCARD gene was screened out as the key gene that induced the inflammatory response in MCD kidney. Conclusions:The inflammatory response may be involved in the occurrence and development of MCD, and the PYCARD gene may be a key gene in the induction of inflammatory response in MCD.

BACKGROUND: Puerarin possesses various biological efficacies, such as the protective efficacy on hypertension, cardiac disease, diabetes mellitus and blood disease, and the extracts of puerarin can inhibit the proliferation of S180 sarcoma and Lewis lung cancer to some extent.OBJECTIVE: To investigate the modulation effects of total flavone of puerarin (TFP) on the growth of pheochromocytoma PC12 cells and the protective efficacy on the H2O2-induced cellular oxidative damage.DESIGN: Complete randomization design and control experiment.SETTING: Department of Biochemistry and Institute of Geriatrics, Chinese PLA General Hospital.MATERIALS: Puerarin was bought from Tongrentang drug store, and TFP was extracted and purified routinely by ethanol and ether acetate, then was evaluated with thin-layer chromatography. The content of puerarin in extracts was 31.79% in quantitative assay. Methyl thiazolyl tetrazolium (MTT), luminal and anti-oxidative activity reagent xanthine oxidase were all from Sigma Company. PC12 cells were given by Institute of Geriatrics,Chinese PLA General Hospital as a present.METHODS: The experiment was conducted at the Institute of Geriatrics, Chinese PLA General Hospital from January to July in·2001.① The cells were cultured in 20 g/L DMEM (pH 7.1-7.2), and randomized into two groups: TFP group and H2O2-injury+TFP group, and each group was divided into 5 mass concentrations (0, 1.0, 10, 100 mg/L and 1.0 g/L). There were 8 holes for parallel culture with 100 mL culture medium in each hole (containing 1 ×l09 L-1 cells). TFP group:TFP was added for 72-hour culture at 37 ℃; H2O2 injury+TFP group:TFP was firstly cultured for 48 hours at 37 ℃, then 500 mmol/L H2O2 was added and co-cultured for other 24 hours.②The activity of cultured PC12 cells was monitored by MTF assays, the content of nitrite was measured by Griess reagents, and the antioxidant activity of superoxidedismutase (SOD) was monitored by hypoxanthine/xanthine oxidase.H2O2-initiated PC12 cellular oxidative damage had been used as experimental model to study the protective efficacy of TFP, and expressed as inhibition ratio [(blank A value-detection A value)/blank A value × 100%]. The higher inhibition ratio indicated the strong ability of clearing O2-. ③ One-factor analysis of variance was used to compare the difference between data. MAIN OUTCOME MEASURES: The influence of TFP on the nitrite content, SOD activity and cell activity in PC12 cells.RESULTS: ①Effect of TFP on PC12 cell activity: 1-10 mg/L TFP hadno obvious effects on the growth of PC12 cells, and 100 mg/L TFP in creased the cell growth (P ＜ 0.05), whereas the TFP concentration was increased to 1.0 g/L, the activity of PC12 cells was inhibited obviously (P ＜ 0.01). TFP of 1-100 mg/L could protect the cultured cells from the oxidative damages of H2O2 concentration dependently (P ＜ 0.05).② Effect of TFP on clearing O2-: The ability of clearing O2 increased withthe mass concentrations of TFP in both groups with obvious dose-effect relation, except when 1 mg/L TFP was added in the H2O2 injury+TFP group. The SOD activity in PC12 cell culture liquid was obviously en hanced after adding 100 mg/L and 1 g/L TFP, compared with that without TFP addition (P ＜ 0.05-0.01). ③Modulation of TFP on nitrite: TFP of low concentration (1-100 mg/L) reduced the production of cellnitrite, whereas increased the nitrite production at the concentration of1.0 mg/mL.CONCLUSION: ①TFP can regulate the growth of PC12 cells, which canbe enhanced by low-concentration (1-100 mg/L) TFP whereas inhibited byhigh-concentration (1 g/L) TFP. However, the anti-oxidation of TFP is themost powerful. ②TFP can protect the PC12 cells obviously from the oxidative damages induced by H2O2 at low concentration.

Objective To meagure the serum eareinoembryonic antigen(CEA)value and tissue CEA stainingin patients with gastric carcinoma and precancerous lesions,in order to apply the index for the diagnosis and monitoring on gastric carcinoma and precancerous lesions.Methods The gemm CEA level of patients with gastric carcinoma(111 cases),precancerous lesions(167 cases,including chronic atrophic gastritis 104 cases,gastric ulcer 31 cases,mucosa intestinal metaplasia 32 cases)was measured by radioimmunoassay,gastric tissue CEA was measured by immunohistochemical SP staining,and 31 cases with superticial gastritis were admired as controls.Results(1)In patients with gastric carcinoma,the positive rate of tissue CEA(89.2%,99/111)Was higher than that in patients with precancerous lesions[chronic atrophic gastritis 52.9%(55/104),mucosa intestinal metaplasia 53.1%(17/32),gastric ulcer 48.4%(15/31)]and superficial gastritis(19.4%,6/31)(P＜0.01).(2)The positive rate of tissue CEA increased significantly than that of the serum levels in patients with gastric carcinoma and precancerous lesions.(3)The serum CEA level in precancerous lesions showed no significant differences compared with that of superficial gastritis(P＞0.05).Conclusions The tissue CEA could be useful diagnostic and monitoring indicators in patients with gastric carcinoma and precancerous lesions.The serum CEA levels in patients with gastric carcinoma may have value in the diagnosis of gastric carcinoma,but have little value for the precancerous lesions.

ObjectiveTo investigate the effect of immunoglobulin G (IgG) extravasated from blood circulation on the expression of toll-like receptor 4 (TLR4) induced by peripheral lipopolysaccharide (LPS) in rat brain. Methods The rats were divided into four groups in random, 5 rats in each. Group one received LPS 100μg/kg by intraperitoneal administration, normal saline was given by intravenous injection 6 hours later; group two was injected with adrenalin (AD) 15μg/kg intravenously; group three was treated with LPS intraperitoneally, AD was injected 6 hours later; group four was injected normal saline intravenously as control. For all groups, the animals were sacrificed 30 min after the last injection, and the brains were taken for investigation of the TLR4 expressions by immunofluorescence staining and RT-PCR. Result Immunofluorescence staining showed that IgG immunoreactive product was patch-like, distributed in the brain parenchyma in all the animals that received AD. In the LPS+normal saline group, IgG was found merely around the blood vessels. Meanwhile, in LPS+AD animals, TLR4 immunoreactive product coexisted with microglia marker Iba-1 within the IgG extravasated area. The double-labeled cells dispersed in the brain parenchyma and near to the cerebral vessels. In the LPS+saline group, TLR4 positive cells were endothelial-like. RT-PCR results indicated that the expression level of TLR4 in the LPS+AD group were significantly higher than that in the LPS+saline group or AD group or the saline control (P<0.01). Conclusion Extravasated circulating IgG may enhance the TLR4 expression in the rat brain induced by peripheral LPS.

Objective To provide the basis for early detection and treatment of precancerous lesions of gastric carcinoma, and reference for early discovery, diagnoses and treatment of gastric cancer, by examining the differences of expression of Helicobaeter pylori (Hp), both in the gastric mueosa and in blood serum, between precancerous lesions of gastric carcinoma patients and gastric cancer patients. Methods Used immunechromatographic method and protein chip system to determine the expression of Hp in blood serum and used immunohistochemistry to detect the expression of Hp in gastric mucosa. The patients had been diagnosed by pathological methods, 170 patients with precancerous lesions of gastric carcinoma, 111 patients with gastric carcinoma and 31 patients with superficial gastritis. Results The expression of Hp was detected on every stage of precancerous lesions and gastric carcinoma. Compared with the detection rates of Hp, precancerous lesions of gastric carcinoma was higher than gastric carcinoma and superficial gastritis, superficial gastritis was the lowest. The differences of the three were significant (P<0.01). The detection rate of Hp in the gastric mueosa (86.2%, 66.7%, 38.7%, respectively)was obviously higher than in blood serum (80.6%, 52.3%, 32.3%, respectively). Conclusions Hp participates in the process of the precancerous lesions and gastric carcinoma. The expression of Hp both in the gastric mueosa and in the blood serum could be one of the indexes, which might report the process and curative effect of precancerous lesions. With such advantages as simple and applicability, the detection of Hp in the blood serum could be used widely. The endoscopy and the detection of Hp in the gastric mucosa are suggested for patients with Hp positive in the blood serum.

Command of the JCI standard is conducive to promoting the "Patient-centered" quality management concept awareness and realizing the patient safety objective. To this end, a campaign to stage the hospital quality management system and bottom-up quality activities has been launched. These efforts may help improve the hospital quality management system, covering such aspects as standardized document management, human resource management, normalized diagnosis and therapy management centering on clinical path, clinical nursing service quality, safety management, equipment and facility management, as well as data analysis and quality improvement system. These have been subject to and certified by JCI with a gold medal.

OBJECTIVE To investigate the prevalence and resistance of extended spectram ?-lactamases(ESBLs) producers in Escherichia coli and Klebsiella pneumoniae.METHODS ESBLs producing strains were screened by double disk test and confirmed by the NCCLS confirmatory test.Susceptibility test to antimicrobial agents was performed by disk diffusion method and analyzed by WHONET 5.3 and Excel.RESULTS The isolated ratio of ESBLs producing E.coli and K.pneumoniae increased from 14% and 15% in 1999 to 30.1% and 30.4% in 2002.Bacteremia caused by the two kinds of ESBLs producers accounted for 30.2% and 30.4%,respectively.ESBLs producing K.pneumoniae and(ESBLs) producing E.coli were 19.8% and 14.0% for outpatient and 26.6% and 31.6% for inpatient.The resistance of(E.coli) to 17 kinds of agents was similar,no matter it was isolated from blood,urine or sputum.Susceptibility of(ESBLs) producing E.coli and K.pneumoniae in urine to cefoperazone/sulbactam,and piperacillin/tazobactam were 85% and 65.2%,66.6% and 29.4%,although to other 15 agents there were no difference.None of the(isolates) showed resistance to imipenem.CONCLUSIONS There is an increasing trend of ESBLs producing E.coli and K.pneumoniae(isolated) from various kinds of specimens and from different wards.It is important for clinical physicians to understand the distribution and the resistance characteristics of ESBLs producing E.coli and(K.pneumoniae) to antibiotics.

Objective:To investigate the effects of different doses of rosuvastatin on lipid levels in elderly patients with CHD complicated with hyperlipidemia.Methods:120 elderly patients with coronary heart disease admitted in our hospital were retrospectively chosen.By lipid examination,they were all hyperlipidemia.According to the dose of rosuvastatin,they were divided into three groups,and 40 cases in each group.They were given 5 mg,10 mg and 20 mg treatment,respectively.After 2 months,the changes of blood lipid level and the clinical effective rate were compared before and after the treatment.Results:①The blood lipid levels HDL-C [(1.17 ± 0.62) mmol / L] was significantly higher than the other two groups.LDL-C [(3.67 ± 0.83) mmol / L],TC [(4.36 ± 0.96) mmol / L] and TG [(1.68 ± 0.94) mmol / L] were significantly lower than those of the other two groups (P ＜0.05).②The effective rate of treatment in the 20mg group (97.5％) was significantly higher than that in the 5mg group (87.5％) and the 10mg group(85.0％).Conclusions:Rosuvastatin can treat coronary heart disease complicated with hyperlipidemia in elderly patients.The dosage of 20 mg can improve the blood lipid level of the patients,is an effective and convenient method,and with high therapeutic efficiency.

Objective To determine whether glucagon-like peptide-1 (GLP-1) receptor PET/CT with 68Ga-exendin-4 is accurate in localizing insulinomas, by comparing with conventional imaging techniques.Methods In this prospective cohort study, patients with biochemically proven endogenous hyperinsulinemic hypoglycemia from March 2014 to November 2016 were recruited consecutively.68Ga-exendin-4 PET/CT, CT, MRI, endoscopic ultrasound (EUS), and SSTR imaging were performed before elective surgery.Surgical pathology results were considered as the gold standard.Sensitivity based on patient-analysis and positive predictive value (PPV) based on lesion-analysis were calculated and compared using χ2 test and generalized score test.Results A total of 109 patients were recruited (47 males, 62 females;average age (45.1±14.8) years), and 96 of them with insulinomas proved pathologically were included in the main assessment.Thirteen patients with positive 68Ga-exendin-4 PET/CT findings did not undergo surgical intervention.Based on patient-analysis, the sensitivities of 68Ga-exendin-4 PET/CT, CT, MRI, EUS and SSTR imaging for detecting insulinomas were 98.96%(95/96), 81.25%(78/96), 79.41%(54/68), 81.40%(35/43) and 21.84%(19/87), respectively.Based on lesion-analysis, the PPV of the above 5 methods were 100%(102/102), 97.56%(80/82), 95.16%(59/62), 83.72%(36/43) and 90.48%(19/21), respectively.68Ga-exendin-4 PET/CT showed the highest diagnostic sensitivity than others (all P<0.01) and higher PPV than MRI, EUS and SSTR imaging (all P<0.05).Conclusion 68Ga-exendin-4 PET/CT is a highly sensitive imaging technique for detection of insulinoma.