Sepsis is a serious problem among the elderly population as its incidence and mortality rates dramatically increase with advanced age. More importantly, the elderly has increased vulnerability to developing sepsis due to diminished physiologic reserve, presence of comorbidities, immunosenescence and frequent instrumentation. Those who survive severe sepsis are more likely to have irreversible organ damage, cognitive impairments, and diminished overall function. Additionally, elderly patients with sepsis often present with atypical symptoms which further complicates and potentially delays diagnosis. Although sepsis is a serious life-threatening disease, recognition of this problem is very low compared to other age-associated diseases. Therefore, the purpose of this review is to analyze the challenges facing this cohort and how to optimize their management.

Fluid overload is frequently found in patients with intravenous fluid resuscitation,and recent studies showed the potential risks of fluid overload for organ failure and mortality.To avoid volume overload and its associated complications,strategies to identify fluid responsiveness are necessary.Apart from the amount of fluid utilized for resuscitation,the type of fluid used also impacts patient outcome.In recent years,there has also been an increasing focus on comparing various resuscitation fluids with respect to both benefits and risks.In this article,through analyzing the impact of fluid overload on patient outcome,we describe the differences in static and dynamic estimates of fluid responsiveness,and review the current literature regarding choice of intravenous fluids for resuscitation in critically ill patients to help clinicians to make appropriative decision on intravenous fluids prescription and to optimize patient outcome.

Objective To improve the microsurgical results of solid hemangioblastoma in the posterior fossa. Methods A retrospective review of 34 patients with solid hemangioblastoma in the posterior fossa was conducted including the clinical manifestations,diagnostic modalities and microsurgical outcomes. Results Total tumor removal was achieved in 29 cases,subtotal removal of tumor in 5 cases. Neurological function improved in 24 cases postoperatively,deteriorated in 6 cases,died 4 cases because of brain stem ischemia or edema. Conclusion it is an effective and importent method by using the microsurgical technique to removal solid hemangioblastoma in posterior fossa

Course construction is the groundwork for vocational college to improve education quality. The first thing for the excellent course construction is to raise awareness. The fundamental starting point and destination are benefitial to students. It must start from the teachers themselves, and have entire optimization in the teaching content,teaching methods ,teaching materials, the means of teaching and so on.

Objective To elucidate the effect of multi-kinase inhibitor sorafenib on anaplastic thyroid carcinoma cells in the presence or absence of metformin.Methods SW1736 and C643 cells were treated with sorafenib in the presence or absence of metformin for various periods of time.Cell viability was detected by MTT.Cell cycle and cell apoptosis were measured by flow cytometry.Caspase-3 activity was detected by colorimetric kit.Western blot was used to analyze pERK phosphorylation and cyclinD1 expression.Results Sorafenib inhibited the growth of anaplastic thyroid carcinoma cells and induced cell cycle arrest and cell apoptosis.The EC50 of sorafenib in SW1736 and C643 was 3.68 μmol/L and 4.87 μmol/L respectively.After sorafenib ± metformin treatment,the caspase3 activity was 131.5 ％ and 278.0％ (P＜0.01) in SW1736 cells,127.2％ and 196.6％ (P＜0.01) in C643 cells.On the molecular level,sorafenib inhibited the phosphorylation of ERK and decreased the expression of cyclinD1.Metformin amplified the growth inhibitory effect of sorafenib on anaplastic thyroid carcinoma cells.The cell viability was 0.76 ± 0.17 and 0.30 ± 0.04 (P＜0.01) in SW1736 cells,0.72 ± 0.09 and 0.34 ± 0.10 (P＜0.001) in C643 cells after 2.5 μmol/L sorafenib without or with 5 mmol/L metformin treatment.Conclusions The combination of sorafenib and metformin may be a potent strategy for the treatment of anaplastic thyroid carcinoma and other advanced cancers.

Objective To construct a fusion expression vector with subunit B of Escherichia coli heat labile enterotoxin. Methods Gene encoding LTB without stop codon obtained by PCR was introduced to a linker and was recombined on vector Pinpoint Xa I through Eco RⅠ and Eco RⅤ sites and then fused with ureB. The recombinant was used to transform E. coli JM109. The expression of LTB was analyzed by SDS PAGE and Western blotting. Results The fusion expression plasmid was successfully constructed. The subunit B of urease of Helicobacter pylori (Hp) fusogenic protein with LTB with the ability to bind GM 1 and the reactogenicity with polyclonal antibodies against Hp was harvested. Conclusion The successfully constructed vector provides experimental base for the studies of intramolecular adjuvant vaccine.

The contents of coumarins in the sulfur fumigated Angelicae Dahuricae Radix (Baizhi, ADR) were reduced significantly. To achieve the quality control of ADR, the qualitative identification of sulfur fumigated ADR and quantitative model of imperatorin content should be established. The near-infrared (NIR) spectrograms of non-sulfur and sulfur fumigated ADR were collected by NIR diffuse reflectance spectroscopy technology and pretreated by the method of first derivative derivation and vector normalization. The Ward's Algorithm method was used for the cluster analysis. The non-sulfur and sulfur fumigated ADR can be quickly identified in the range of 8,806. 0-3 811.0 cm(-1) based on the cluster analysis. The NIR quantitative model of imperatorin was established by the contents of imperatorin determined by HPLC in combination with partial least squares regression analysis. According to the calibration model established in this study, correlation coefficients (R2), the root-mean-square error of cross-validation (RMSECV), and the root-mean-square error of prediction (RMSEP) for imperatorin were 0.982 8, 0.006 8, 0.011 8, respectively. The quantitative model of imperatorin can be applied to determine the content of imperatorin in ADR accurately.
Angelica ; chemistry ; classification ; China ; Chromatography, High Pressure Liquid ; Drugs, Chinese Herbal ; chemistry ; Quality Control ; Spectroscopy, Near-Infrared ; methods ; Sulfur ; chemistry

Objective Investigates expression of PTEN(Phosphatase and tensin homology deleted on chromosome ten , PTEN) in bladder transitional cell carcinoma (BTCC) and its clinical significance.Methods Fifty-one cases of bladder transitional carcino -ma, forty-two cases of Cystitis Glandularis(CG) and ten cases of normal bladder tissue 10 cases of normal bladder tissue were collect -ed.All samples were derived from cystoscopic biopsy and were subjected to histopathological examination to confirm the diagnosis .Im-munohistochemistry S-P methods is used to demonstrate the expression of PTEN .Results The positive rate of PTEN expression in BTCC, CG and normal bladder tissue are 58.8%, 81% 100%,and there is statistic significance ( P <0.01) among three groups.51 cases of BTCC are divided into group G Ⅰ ,GⅡ ,GⅢ and Tis -T1 ,T2-T4 ,and there is statistic significance among group G Ⅰ and GⅡ, GⅢ ( P <0.01),between group Tis -T1 and T2-T4 ( P <0.05).Conclusions The reduced expression or loss of PETN might play an important role in carcinogenesis and progression of bladder cancer .The positive rate of PTEN expression was negatively correlated to the clinical and grade staging of tumor .

Background and purpose: Ductal carcinoma in situ (DCIS), is precursor lesions of invasive breast cancer, belongs to non-systemic ductal lesions, which is similar to other ductal lesions on imaging. This study aimed to investigate the differential diagnostic value of MRI in DCIS between DCIS with microinvasion (DCIS-MI) and breast intraductal papilloma (BIDP). Methods:All the cases were surgico-pathologically conifrmed. Twenty-four patients were DCIS, 9 patients were DCIS-MI, and 20 patients were BIDP. The MRI charateristics of DCIS, DCIS-MI and BIDP were analyzed and compared. Results:DCIS and DCIS-MI’s performance in the form of MRI is dififcult to differentiate (P<0.05). Compared with BIDP, the ductal and segmental enhancement, typeⅢtime-signal intensity curve (TIC), and the red pseudo-color image were associated with the DCIS. The local area enhancement, typeⅡTIC, and no-red pseudo-color image were associated with BIDP. Conclusion:MRI is a useful for differentiate between DCIS and BIDP, but is dififcult for DCIS and DCIS-MI.

Objective:To investigate the inhibitory effect of cytokine-induced killer cells (CIK) against implanted gastric cancer cells. Methods:Gastric cancer SGC-7901 cells were subcutaneously injected into the inguina of nude mice to establish gastric cancer model. The tumor bearing mice were randomly divided into CIK group and fibroblasts group,in which mice were subcutaneously injected with fluorescence dye SP-DiI labeled CIK and fibroblasts HFL-I cells,respectively. Distribution of CIK and HFL-I cells in different tissues of gastric cancer bearing mice were observed. Meanwhile,tumor volume was measured after different treatments and tumor inhibitory rate was calculated. Tumor necrosis areas in different groups were observed. Results:SP-DiI labeled CIK was mainly located in the gastric cancer tissues 10 d after injection,and was hardly detected at the injection sites,liver,spleen and lung tissues (P