Objective:To investigate the role of vitamin D-induced autophagy in macrophages against Mycobacterium tuberculosis(Mtb).Methods:Induce U937 cells to differentiate into macrophages with phagocytic capacity by phorbol 12-myristate 13-acetate(PMA).The cells were randomly divided into negative control group,vitamin D group,autophagy inhibitor(3-MA)+vitamin D group,positive control(rapamycin)group.Infect all groups with Mtb for 6 hours.In the 4th day after infection,the mRNA expressions of autophagy-related genes ATG5, Beclin-1 and LL-37, LC3B were determined by semi-quantitative RT-PCR.LC3B-Ⅱ+and/or Mycobacterium tuberculosis antigen 85A+( Ag85A+)-cells were counted by flow cytometry.Results:Compared with the control groups, the mRNA expressions of ATG5,Beclin-1,LL-37 and LC3B were enhanced(P<0.01),the numbers of LC3B-Ⅱ+-cells increased,the numbers of Ag85A+-cells decreased, and the numbers of LC3B-Ⅱ+-Ag85A--cells increased ( vitamin D group 38.0% vs negative control group1.08%).Compared with the vitamin D group,the mRNA expressions of ATG5,Beclin-1 and LC3B were suppressed in the autophagy inhibitor(3-MA)+Vitamin D group,the mRNA expressions of LL-37 were reduced,and 3-MA inhibited the expression of LC3B-Ⅱ in cells with inhibition of LC3B-Ⅱ+-Ag85A--cells increase as well.Conclusion: Vitamin D can induce macrophage autophagy and further contribute to scavenging Mycobacterium tuberculosis.

Objective To compare the abnormal influence of Ureaplasma urealyticum(UU) and human papillomavirus(HPV) infection on early pregnant women,and to investigate the correlation between reproductive tract infection with spontaneous abortion in early pregnant women.Methods A total of 460 pregnant women were included in the observation subjects,including 230 cases of spontaneous abortion (observation group) and other 230 normal pregnant women of delivery as the control group.The cervical swab samples were collected from the research subjects of the two groups and performed the UU and different types of HPV detections by using corresponding PCR reaction reagents.Results The UU total infection rate among 460 pregnant women was 17.83%(82/460),which of the observation group was 24.8%(57/230) and which the control group was only 10.9%(25/230),the difference between the two groups was statistically significant(P<0.01).The HPV total infection rate was 20.2%(93/460),which of the observation group was 29.1%(67/230) and which of the control group was only 11.3%(26/230),the difference was statistically significant.Among them,the single subtype HPV infection proportion was 14.1%(65/460),the multiple subtype HPV mixed infection proportion was 6.1%(28/460),while the high risk type HPV infection rate was 18.3%(84/460) and the low risk type HPV infection rate was 8.91%(41/460).The infection rate of UU combined HPV was 2.6%(12/460),in which the observation had 11 case and control group had 1 case,the difference was statistically significant (P<0.01).Conclusion Infection of UU and HPV in early pregnant women may lead to spontaneous abortion.But its concrete mechanism and the role of different types of HPV need to be further studied.

Objective To analyze antimicrobial resistance of clinically isolated Burkholderia cepacia (B.cepacia),and provide evidence for clinical rational antimicrobial use.Methods B.cepacia isolated from clinical specimens between January 2013 and December 2014 were analyzed retrospectively,antimicrobial susceptibility results were statistically analyzed.Results A total of 98 isolates of B.cepacia between January 2013 and December 2014 were isolated,the main specimen was sputum(n =86,87.76 ％),the main department distribution was intensive care unit(n =46,46.94％),resistance rate of B.cepacia to ticarcillin / clavulanic acid was highest(73.47％),resistance rates to piperacillin / tazobactam and cefoperazone / sulbactam were both 16.33％,resistance rate to minocycline was the lowest(5.10％).Conclusion Infection caused by B.cepacia is high,prevention and control of healthcare-associated infection should be strengthened,early etiological examination should be performed,antimicrobial treatment should be combined with antimicrobial susceptibility results.

The hospital grade assessment is an effective approach to measure the comprehensive strength and the overall level of a hospital, and it is also an effective carrier which can promote the standardized management , improve the quality of connotation and accelerate the development of the hospital .This article aims to expound the effective and concrete methods for preparation in the hospi -tal grade assessment by introducing the practice and experience of Jinling Hospital in grade assessement .It also points out that:defi-ning the purpose of the assessment is the fundation , having a thorough grasp of the assessment criteria is the basis , having a compre-hensive knowledge of the hospital is the premise , establishing and implementing the plan strictly is the crux .All these might be helpful to promote the hospital grade assessment .

Objective Diagnosis related groups ( DRGs) is a system to classify hospital cases into groups , which is effective in the control of medical cost .The article was to explore the DRGs grouping method and quality control indexes of cerebrovascular dis -ease in Nanjing first-class hospitals at grade 3. Methods Polytomous logistic regression for ordinal response was used in the factor analysis of hospitalization cost .E -CHAID decision tree method was applied in the DRGs grouping of cerebrovascular patients . Results Totally 9095 cases were enrolled in this study with the average age was (64.52 ±14.85).The average of stay lengths and expenses were (11.77 ±9.26)d and (25921.04 ±23096.76)rmb respectively.Hospitalization expense was associated with neurologi-cal surgery, main diagnosis, interventional surgery, main complication and ICU days.Taking neurological surgery as the first forced variable, cerebrovascular cases could be divided into 14 DRGs groups. Conclusion The terminal quality control index , the step warning index and case maximum index of cerebrovascular disease established by the DRGs grouping method are suitable in the area .

Objective: α-asarone is a major effective component that can be isolated from Acorus tatarinowii Schott,a Chinese herbal medicine. Clinical investigations have shown that α-asarone has strong sedative and anti-convulsive action in the central nervous system. In recent years, several medicines containing a-asarone were applied in treatment of asthma, bronchitis, expectorant, or epilepsy. However, the underlying cellular mechanism of ct-asarone is still unknown. Here the authors considered EAAC1, the transporter for the excitatory glutamate, as a possible target. Methods: Supercritical CO2 fluid extraction and silica gel column chromatography were used to obtain ct-asarone from the rhizomes of Acorus tatarinowii Schott. Xenopus oocytes with heterologously expressed EAAC 1 were used as a model system. Rate of glutamate uptake was measured by means of isotopic tracer technique. Glutamate-induced current was recorded under two-electrode voltage clamp. 40μg/mL of ct-asarone was used for testing its effect on EAAC1 activity. Results: ct-asarone induced a slight, but still significant stimulation of rate of glutamate uptake by 15%. In contrast, EAACl-mediated current became reduced (by 30% at -100 mV). Since EAAC 1 can operate in transport and also in an ion-channel mode, the result indicates strong inhibition of the channel mode. This inhibition is voltage-dependent becoming larger at more negative potentials. Conclusion: The stimulation of glutamate uptake reduces glutamate concentration in the synaptic cleft and, hence, reduces excitatory synaptic activity. The inhibition on the ion-channel mode stabilizes the membrane potential, and therefore, also contributes to reduced excitatory activity.

Objective: To evaluate the clinical value of clinical pharmacists in clinical treatment team through participating in the treatment of one case of MRSA infection.Methods: According to the infection site, MRSA infection treatment principle and the characteristics of drug treatment, clinical pharmacists assisted physicians in optimizing the therapy plan and provided the pharmaceutical care.Results: Physicians adopted the clinical pharmacist's suggestions, and the symptoms of patient were improved with effectively reduced ADR.Conclusion: The participation of clinical pharmacists in the optimization of anti-infective therapy plan can improve efficacy and security.

Objective:To investigate the influence and potential mechanism of mannose-capped lipoarabinomannan (ManLAM) to B cells responding to Mycobacterium tuberculosis (Mtb) infection. Methods:B cells were separated from patients with active pulmonary tuberculosis using magnetic beads and then stimulated with ManLAM in combination with CE protein. Flow cytometry was performed to evaluate the apoptosis, proliferation and activation of B cells. The secretion of cytokines and CE protein-specific IgG subclasses were detected by ELISA. ELISPOT assay was used to analyze the influence on the differentiation of B cells into CE protein-specific antibody-secreting cells (ASCs).Results:ManLAM inhibited the CE protein-induced proliferation and activation of B cells and the production of pro-inflammatory cytokines, resulting in significantly increased secretion of the immunosuppressive cytokine IL-10. It also inhibited the differentiation of B cells into CE protein-specific IgG secretory cells, but had no significant influence on the differentiation to IgM secretory cells. Moreover, ManLAM inhibited the secretion of CE protein-specific IgG1 and IgG3 and induced the secretion of immunosuppressive IgG4 via TLR2.Conclusions:This study suggested that ManLAM could inhibit the anti-tuberculosis immune response of B cells, which provided new theoretical reference for better understanding the immune escape mechanism in Mtb infection.

Objective:To analyze the efficacy of blood purification (BP) in the treatment of moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP).Methods:The clinical data of 102 patients of MSAP and SAP in Changhai Hospital affiliated with Navy Medical University from December 2015 to March 2019 were retrospectively analyzed. According to the treatment method and prognostic outcome, patients were divided into control group ( n=46) and BP group ( n=56), control survival group ( n=43), and control death group ( n=3), BP survival group ( n=37) and BP death group ( n=19), respectively. Based on BP treatment duration each time, BP group was sub-divided into BP short-term group (4 h≤T<8 h, n=38) and BP long-term group (8 h≤T≤12 h, n=18). General data, laboratory findings, complications, average daily hospitalization cost, prognosis and effects of BP duration on the blood urea nitrogen improvement were recorded. Results:Compared with control survival group, BP survival group had lower levels of lactic acid, urea nitrogen and other metabolites, and SIRS duration was significantly shortened [12(7, 16) days vs 5(3, 9) days, HR=0.19, 95% CI 0.11-0.35, P<0.0001]. The clearance of urea nitrogen in BP short-term group was more obvious than BP long-term group (χ 2==4.44, P=0.035). APACHEⅡ score on admission( OR=1.33, 95% CI 1.087-1.617, P=0.005) and numbers of organ failure ( OR=3.445, 95% CI 1.426-8.323, P=0.006) were important risk factors affecting MSAP and SAP prognosis under BP therapy. For patients with extremely poor prognosis, it was still difficult for BP to reverse the progression trend and prognosis of MSAP and SAP. Conclusions:BP can effectively remove accumulated metabolites at acute stage and shorten the duration of SIRS. BP duration of 4-8 h each time may be more conducive for improving the severity of the disease.

Objective To explore the clinical value of portal exposure in laparoscopic treatment of children with type Ⅲ biliary atresia (BA).Methods From June 2013 to October 2017,30 infants with type Ⅲ BA who treated with laparoscopic portoenterostomy in Huai'an Women and Children's Hospital were selected.A percutaneous suture was used to snare the round ligament and retract the liver,other percutaneous stay sutures were then introduced and fundus and neck of gallbladder were sutured to elevate the liver to expose the portal hepatis.The fibro cord and hepatic vessels were mobilized,and then two rubber bands were put around the left and right portal veins and hepatic arteries.The portal hepatis was exposed by laterally stretching the two elastic rubber bands.The fibro cord was removed and then laparoscopic portoenterostomy was accomplished.In 20 cases,the liver was enlarged,part of hepatic lobus quadratus was removed laparoscopiclly for exposure of the portal hepatis.Results There were 30 cases in this group,2 cases were converted to open surgery by a micro transverse incision.There was no surgical death.Time of laparoscopic procedure varied from 210 to 280 min.All cases survived the surgery without any intraoperative complications.Blood loss during operation was minimal,without necessity for blood transfusion.One case died of respiratory failure one week after surgery.Two cases were lost follow-up.Twenty-five cases were followed up for 3～51 months(mean 22.4 months).Three cases died because of repeated cholangitis and liver failure at 10,16,35 months postoperatively.Nineteen patients' total bilirubin had dropped to normal,three others' bilirubin levels dropped significantly after surgery.Conclusion The technique of laparoscopic hepatic porta exposure can help to complete hepatic portoenterostomy successfully,reduce the conversion rate of laparoscopic surgery,and improve the surgical effect.