Objective To study the diagnostic value of proton magnetic resonance spectroscopy(MRS) in patients with minimal hepatic encephalopathy(MHE).Methods MRS of cingulated cortex and frontal lobe were acquired using point resolved echo spin spectroscopy(PRESS) sequences in 26 patients with MHE.Peak area of each metabolite,including NAA,Cr,Cho,mI,Glx and their ratios to Cr were computed,respectively.Then the results were compared with normal control group.Results Compared with the normal control group,MHE group showed significant decreased Cho/Cr,mI/Cr(P0.05).Conclusions The patients with MHE show that Cho and mI significantly decrease and Glx significantly elevate in cingulate cortex and frontal lobe on MRS.Diagnostic value of MRS is significant to MHE.

Objective To discuss the curative effect and safety issues of Telsartan(Micardis) and Valsartan (Diovan) Capsule in curing light and to moderate essential hypertension patients. Methods The 126 light or moderate essential hypertension patients were divided into two groups randonly:63 patients in Micardis group(80mg qd)and 63 patients in Diovan group(160mg qd). The courses of treatment of each group were 8 weeks. The medicine was taken by patients after breakfast everyday. Data of blood pressure, heart rhythm, blood and urine routine test, hepatic and renal function, blood biochemistry test, ECG and side effects was recorded everyday before and after the treatment. Results After 8 weeks treatment, the average SBP of blood pressure was reduced from ( 156.3 ± 13.3 ) mm Hg to(128.6 ± 10.9) mm Hg(Micardis group)and (129.3 ± 11.3) mm Hg(Diovan group). The average DBP was reduced from(98.3±11.6) mm Hg to(80.3±7.1) mm Hg(Micardis group)and(80.6 ±7.3) mm Hg(Diovan group). The blood pressure of both group had notable decreasing after taking medicine(P ＜ 0.01). The total effective rates were 79.36% and 73.02%. In the same term,the curative effect of both group have significant difference(P＜0.05). In Micardis group,total Cholesterol(TC) level reduced from(5.6 ± 1.2) mmol/L to( 4.9 ± 1.1 ) mmol/L; Triglyceride (TG) level reduced from (2.38 ± 0.31) mmol/L to (2.23 ± 0.33) mmoL/L; Low Density Lipoprotein Cholesterol(LDL-C) level reduced from( 3.26 ± 0.38 ) mmol/L to( 2.89 ± 0.46 ) mmol/L; High Density Lipoprotein Cholesterol (HDL-C) level increased from ( 1.3 ± 0.6 ) mmol/L to ( 1.5 ± 0.3 ) mmol/L. As comparison, in the Diovan group only the TC level reduced from (5.6 ± 1.2) mmol/L to(5.2 ± 1.3) mmol/L. Both groups did not have significant adverse reactions. Conclusion As the Angiotensin Ⅱ Receptor Antagonist ( ARA), both the Telsartan and Valsartan Capsule were effective medicines in curing light and moderate essential hypertension patients. These two medicines which were reliable and safety,had good tolerance and few side effects. However,Telsartan had better effects than Diovan in reducing blood pressure and triglyceride on light or moderate essential hypertension patients. Also, Telsartan had longer half-life period(18-24h) and lower price.

Objective To investigate the influence of microbleeds on the onset and development of different types of stroke. Methods According to stroke subtypes, 163 patients were classified into lacunar infarction (n= 56), transient iscbemia attach (n=31), atherothrombotic infarction (n=37), intracerebral hemorrhage (n=39), and control groups (n=43). Suaceptibility-weighted imaging , T1WI, T2WI and diffusion-weighted imaging were performed with 3.0 T system to observe cerebral microbleed and infarction. Results The incidence and the number of micrehleeds were significantly greater in patients with intracerebral hemorrhage (75.6% and 14.5±11.6, re-spectively),then lacunar infarction and therothrombetic infarction atherothrombotic infarction [(55.3% and 8.1± 3.4), (37.8% and 4.5±2.6)] and the incidence and the number of microhleeds in above groups are higher than transient ischemia attach (9.7% and 0.3±0.1), and controls (9.3% and 0.2±0.1) (P<0.01). There was a correlation between the number of microbleeds and the severity of lacunar infarction, aslo a correlation between the number of microbleeds and the number of intracerebral hemorrahages (r=0.402, P<0.001). Conclusion Microb-leeds are closely associated with stroke, which may indicate more advanced microangiopathy and higher risk of bleeding.

OBJECTIVE: To discuss the positive effect of the revolutionary step in drug circulation(Trusteeship of Hospital Drugstore) on the reduction of drug costs and patients' medical expenses as well as on hospital management and development.METHODS: Based on the practice of "Trusteeship of Hospital Drugstore" in our hospital,this article analyzed and expounded the nine "possible" biased view points put forward in research paper entitled "Thoughts on 'Trusteeship of Hospital Drugstore'" published in the magazine "China Pharmacy"(Issue 13 of Vol.18,2007 May).RESULTS & CONCLUSIONS: The innovative practice of "Trusteeship of Hospital Drugstore" carried out currently in Nanjing is an attempt beneficial for drug circulation,which plays a positive and effective role in controlling the drug price over a reasonable range and alleviating patients' burden on medical expenses.

ObjectiveTo summarizeand the law of lymph node metastases from adenocareinoma of esophagogastric junction ( AEG),analyses the extent of lymphadenectomy for AEG.Methods198 cases of AEG had been retrospectively analyzed from 2006.6.6 to 2010.12.31,and kept detailed record of the operation type、Siewert's type、TNM stage and group of metastatic lymph nodes.ResultsThe thoraco-abdominal two field lymph node dissection had been performed for 198 AEG,the total number of lymph nodes had been dissected was 3069,the average number was 15.50,the number of metastases lymph nodes was 859.In the 198 AEG,132 cases with lymph node positive,The metastatic rate and incidence was 66.67％ and 27.99％,respectively.The manner of the metastasis about 130 cases was station by station and 2 cases was skipping over station,accout for 98.48％ and 1.52％ of all nodes-positive cases,1 case skiped to left gastric and celiac axis and another case skiped to tracheal bifurcation.The location of positive lymph nodes about Siewert Ⅰ and Ⅱ were recorded:tracheal bifurcation(6.25％,3.33％ ) 、lower posterior mediastinum and paraoesophageai(25.00％,14.67％ ),right paracardiac (47.92％,52.00％ ),left paracardiac (31.25％,36.67％ ) 、lesser curvatura(43.75％,43.33％ ),greater curvatura( 27.08％,22.00％ ) 、left gastric and celiac axis( 27.08％,30.00％ ).The lymph nodes metastastic rate of stage T1 + T2 and T3 + T4 were 40.43％,74.83％,respectively,the difference were significantly.The lymph nodes metastastic rate of different tumor length were analyzed,≤ 3cm group were 40.74％,3 ～5cm group were 70.71％ and ≥5cm group were 88.89％,the difference were significantly;but there were no significant difference related to different differentiation grades and different Siewert types.The mediastinal lymph node metastase rates between Siewert Ⅰ (27.08％) and Siewert Ⅱ (14.67％) were significant difference,but the difference were not found in pericardiac lymph nodes.ConclusionSiewert Ⅰ 、Ⅱ AEG trend to metastasized to middle and low mediastinal and pericardiac,the modified left thansthoracic route and two field lymph node dissection maybe suitable to the lymphadenectomy for AEG.

Objective To investigate the effects of hypoxia-inducible factor-1α (HIF-1α)expression on pathogenesis of retinopathy of prematurity (ROP) and to find new target for gene therapy.Methods After liposome-mediated small interference RNA (siRNA) transfection into rat retinal endothelial cells,the cells were cultured in medium with CoCl2-induced hypoxic condition.Expression of HIF-1α mRNA was determined by fluorenscence quantitative reverse transcription-polymerase chain reaction(RT-PCR),HIF-1α protein expression was detected by Western Blot after cocultured for 8 hours.Cell proliferation was measured with 3-(4,5)-dimethylthiazol (-2-yl)-2,5-diphenyltetrazolium bromide(MTT) assay after cocultured for 24 hours.Difference between groups was compared with independent samples t test.Results Rat retinal vascular endothelial cells were successfully transfected with siRNA.Fluorescence quantitative RT-PCR results showed that at 48 hours of transfection,the expression of HIF-1α mRNA in the interference group of siRNA1,siRNA2 and siRNA4 were 0.1620 ± 0.0147,0.2034 ± 0.0251 and 0.3049 ± 0.0165,which were 16.20％,20.34 ％ and 30.49％ of blank control group (1.0000±0.0344),and were lower than that of negative control group (0.8334±0.0242) (t=16.786,8.953 and 4.087,P＜0.05 respectively).Western Blot results showed that HIF-1α protein expression was significantly inhibited by siRNA1(0.4956 ± 0.0421 ) and siRNA2 (0.6544 ± 1.0032) comparing with blank control group (3.5105 ±0.4084) and negative control group (3.4019 ± 1.0677) (t =6.861,2.893,4.567 and 5.072,P＜0.05 respectively).As for cellular proliferation activity,(49.5±2.9) ％ and (67.4±1.2) ％ of cells growth inhibition were observed after transfection with siRNA1 and siRNA2,which were higher than those of negative control group [(15.7±1.5) ％ ] (t=2.786 and 6.904,P＜0.05).Conclusions The synthetic HIF-1α siRNA could effectively inhibit the expression of HIF-1α gene and reduce cell proliferation in rat retinal endothelial cells under hypoxic condition.RNA interference technology targeting HIF-1α might become a new strategy for gene therapy of ROP.

Objective To evaluate the treatment effect of management by nursing objectives in the extracorporeal membrane oxygenation ( ECMO) treatment on the first case of avian influenza H7N9 infection patient with severe pneumonia .Methods The overall goal was to ensure ECMO machine running smoothly and without any nursing complications . According to the overall objective , eight specific sub-objectives were developed .Various care measures were implemented in accordance with the eight specific sub -objectives . Results During the 153 hours of ECMO treatment , the machine ran smoothly without the occurrence of detachment, embolism and hemolysis, thrombosis, pressure sores or any other nursing complications .The patient was successfully off-line.Conclusions Management by nursing objectives makes the nursing goal orientate clearly and effectively , which avoids the blindness and subjectivity during work .It is a strong guarantee for the success of ECMO treatment and should be widely applied .

Objective:To explore the protective effect and mechanism of scutellarin (Scu) on sepsis associated-acute kidney injury (SA-AKI).Methods:① In vivo experiment: 36 male C57BL/6 mice were divided into normal saline (NS) control group, lipopolysaccharide (LPS) induced SA-AKI model group (LPS group), 20 mg/kg Scu control group (Scu 20 control group), and 5, 10, 20 mg/kg Scu pretreatment groups by random number table with 6 mice in each group. The SA-AKI model was reproduced by intraperitoneal injection of 10 mg/kg LPS. The NS control group was injected with NS intraperitoneally. The Scu pretreatment groups were intraperitoneally injected with different doses of Scu every day before LPS injection for 1 week. Scu 20 control group was injected with 20 mg/kg Scu for 1 week. After 24 hours of LPS treatment, mice in each group were sacrificed, kidney tissues were collected, and kidney injury was detected by hematoxylin-eosin (HE) staining. Western blotting was used to detect the protein expression levels of nuclear factor-κB (NF-κB) signaling pathway related molecules, apoptosis-related proteins and cysteine-rich protein 61-connective tissue growth factor-nephroblastoma overexpressed gene 1 (CCN1). ② In vitro experiment: human renal tubular epithelial cell line HK-2 was cultured in vitro and used for experiment when the cells fused to 80%. In the cells without LPS treatment and after 100 g/L LPS treatment, pcDNA3.1-CCN1 and small interfering RNA (siRNA) CCN1 sequence were transfected to overexpress and inhibit CCN1 expression, respectively, to observe whether CCN1 was involved in NF-κB signaling pathway activation and apoptosis. In addition, 100g/L LPS and 20 μmol/L Scu were added into HK-2 cells transfected with and without CCN1 siRNA to investigate the mechanism of protective effect of Scu on LPS-induced HK-2 cells injury. Results:① The results of in vivo experiment: the renal function of SA-AKI mice induced by LPS was significantly decreased, and had kidney histological damage and severely damaged renal tubules. Scu could alleviate renal function and histological damage in a dose-dependent manner. Western blotting results showed Scu could reduce the protein expression of NF-κB signaling pathway related molecules and CCN1 in the renal tissue, and had a significant alleviating effect on apoptosis, indicating that CCN1 was involved in NF-κB signaling pathway activation and apoptosis. ② The results of in vitro experiment: in HK-2 cells not treated with LPS, CCN1 overexpression had no effect on apoptosis related protein and pro-inflammatory factors of NF-κB signaling pathway. In HK-2 cells treated with LPS, overexpression of CCN1 significantly inhibited the mRNA expressions of interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α) and monocyte chemoattractant protein-1 (MCP-1), with significant differences as compared with cells stimulated only by LPS [IL-1β mRNA (2 -ΔΔCT): 3.20±0.57 vs. 4.88±0.69, TNF-α mRNA (2 -ΔΔCT): 2.99±0.44 vs. 5.00±0.81, MCP-1 mRNA (2 -ΔΔCT): 2.81±0.50 vs. 5.41±0.75, all P < 0.05], and the apoptosis-related protein was significantly down-regulated. However, when siRNA was used to inhibit the expression of CCN1, the mRNA expressions of pro-inflammatory factors were significantly increased as compared with cells stimulated only by LPS [IL-1β mRNA (2 -ΔΔCT): 6.01±1.13 vs. 4.88±0.69, TNF-α mRNA (2 -ΔΔCT): 5.15±0.86 vs. 5.00±0.81, all P < 0.05], and apoptosis-related protein was significantly up-regulated. In the LPS-induced HK-2 cells, the mRNA expressions of pro-inflammatory factors were significantly down-regulated after Scu treatment as compared with cells stimulated only by LPS [IL-1β mRNA (2 -ΔΔCT) : 2.55±0.50 vs. 6.15±1.04, TNF-α mRNA (2 -ΔΔCT): 2.58±0.40 vs. 3.95±0.52, MCP-1 mRNA (2 -ΔΔCT): 2.64±0.44 vs. 6.21±0.96, all P < 0.05], and apoptosis-related protein was also significantly reduced. When the expression of CCN1 was inhibited by siRNA, the protective effect of Scu on cells was weakened, which showed that the mRNA expressions of pro-inflammatory factors in cells was significantly up-regulated compared with the cells without inhibition of CCN1 expression [IL-1β mRNA (2 -ΔΔCT): 5.34±0.76 vs. 2.55±0.50, TNF-α mRNA (2 -ΔΔCT): 3.66±0.54 vs. 2.58±0.40, MCP-1 mRNA (2 -ΔΔCT): 5.15±0.79 vs. 2.64±0.44, all P < 0.05], and the expression of apoptosis related protein was also significantly up-regulated. Conclusions:Scu could protect the renal function in SA-AKI mice, and the protective effect is associated with NF-κB signaling pathway and CCN1. Thus, Scu could alleviate LPS-induced kidney injury by regulating the NF-κB signaling pathway.

Objective:To study the genomic sequence of Coxsackievirus A8 (CV-A8) associated with hand, foot and mouth disease (HFMD) from 2013 to 2018 in China and to analyze the genetic evolution of each coding region of the full-length genome.Methods:The genome sequences of 11 CV-A8 strains isolated from patients with HFMD in different regions of China from 2013 to 2018 were determined. Sequence alignment and genetic evolution analysis were performed by Sequencher 5.0 and MEGA 7.0 software, etc.Results:Sequence alignment showed that the genome length of 11 CV-A8 strains ranged from 7 393 bp to 7 400 bp. There was no base insertion or deletion in the coding region compared with the prototype strain, but there were individual base insertion or deletion in the non-coding region. The nucleotide and amino acid similarities in the VP1 region of 11 CV-A8 strains were 78.3%-98.6% and 92.6%-99.7%, respectively, and the nucleotide and amino acid sequences identities with the CV-A8 prototype strain were 78.3%-98.2% and 92.6%-99.7%, respectively. Based on the phylogenetic analysis of VP1 region sequences, the CV-A8 can be divided into five genotypes: A, B, C, D and E. The 11 CV-A8 strains in this study belonged to genotypes C (1 strain), D (2 strains) and E (8 strains). The nucleotide and amino acid similarities of 11 CV-A8 full-length genomes were 81.3%-98.8% and 95.9%-99.5%, respectively. The phylogenetic tree of the P2 region showed that the eight E genotypes CV-A8 had the closest evolutionary distance with CV-A4, CV-A14, and CV-A16. The phylogenetic tree of the P3 region showed that the eight E genotypes CV-A8 had a close evolutionary distance with CV-A5, CV-A16, CV-A14 and CV-A4.Conclusions:The 11 CV-A8 stains in this study showed significant intra-genotype diversity in capsid region and recombinant diversity in non-capsid region which indicated that CV-A8 quasispecies were still undergoing dynamics variation. CV-A8 may become an important pathogen of HFMD and the monitoring of CV-A8 needs to be further strengthened.