OBJECTIVE:To investigate the effects of alanyl-glutamine dipeptide-intensified early enteral nutrition (EN) sup-port on nutritional indexes,immune indexes,renal indexes and complications of sepsis patients. METHODS:A total of 112 cases of sepsis admitted into our hospital during May 2013-Jan. 2015 were selected and divided into observation group and control group according to random number table,with 56 cases in each group. Both groups received routine antibiotic therapy and early EN support(48 h)with nitrogen supplement 0.2 g/kg,calories 25 kcal/kg and nonprotein calories 19-21 kcal/kg each day. Observation group was additionally given Alanyl-glutamine for injection 0.5 g/kg with 0.9% sodium chloride injection 100 mL,continuous pump within 24 h,for 4 d. The levels of nutritional indexes (ALB,PAB,Hb),immune indexes (CRP,IgG,IgA and IgM), APACHEⅡ scores,SOFA scores,liver and renal function indexes (the levels of ALT,AST,Cr and BUN) were compared be-tween 2 groups before and after treatment. The prognosis and the occurrence of complication were also observed in 2 groups. RE-SULTS:Before treatment,there was no statistical significance in the levels of ALB,PAB,Hb,CRP,IgG,IgA,IgM,ALT, AST,Cr,BUN and APACHEⅡ scores,SOFA scores between 2 groups(P>0.05). After treatment,the levels of ALB and PAB in observation group were increased significantly compared to before treatment,and the observation groups was significantly higher than control group,with statistical significance(P<0.05). APACHEⅡ score and SOFA score of 2 groups were decreased significantly compared to before treatment,and the observation group was significantly lower than the control group,with statis-tical significance(P<0.05). CRP of 2 groups were decreased significantly while IgG were increased significantly;the observa-tion group was significantly better than the control group,with statistical significance (P<0.05). Cr and BUN levels of 2 groups were decreased significantly compared to before treatment,and the level of Cr in observation group was significantly con-trol group,with statistical significance (P<0.05). The time of ICU stay,ventilator supporting time and antibiotics application time in observation group were significantly shorter than control group,and the incidence of diarrhea and gastric retention were significantly lower than control group,with statistical significance (P<0.05). CONCLUSIONS:Alanyl-glutamine dipeptide-in-tensified early EN support can significantly improve immune function and liver and renal function of sepsis patients and reduce the occurrence of complications.

To distinguish the degrees of frostbite in early stage after freezing-thawing injuries is a most impor- tant yet difficult task. In order to seek the indicators of severity of injuries, we observed the relationship between the degrees of cold injuries and serum creatine phosphokinase (SCPK) levels. Results showed that after freezing the rabbit paws to 0℃, SCPK level began to rise. Freezing in the range of 0℃ to-25℃, SCPK levels rose inversely with the lowering of tissue temperature. The elevation of SCPK activity usually appeared 1 hr after freezing, reaching thepeak at 12 hours, and it began decline at 24 hours,returning to normal level at 72 hours after freezing.

Objective To discuss the diagnosis value of transrectal ultrasound and transabdominal ultrasound in fat sufferers with bladder tumor.Methods In own control,transabdominal and transrectal ultrasound were used to examine 87 fat patients with suspected bladder tumor.The tumors were confirmed by cystoscope and pathological section.They were divided into 3 groups according to the size:＜10 mm,10-20 mm,and＞20 mm,the detection rates of the tumors and blood flow in tumors,the diagnose accordance rates of the tumor stage of the two methods were analyzed.Results Of the 92 lesions pathologically confirmed to be bladder tumors,the diagnose accordance rate of transabdominal ultrasound was 79.3%,missed diagnosis rate was 1 7.4%,misdiagnosis rate was 3.3%,while the diagnose accordance rate of transrectal ultrasound was 95.6%,misseddiagnosis rate was 4.4%,misdiagnosis rate was 0.There was statistical significance on the detection rate of thetumor and blood flow in tumor of the two methods(P＜0.05).Also there was statistical significance on the diagnosis accordance rate of the tumor staging on Ta,T1,T2(P＜0.05).Conclusions As to detecting bladder tumors in fat sufferers,transreetal ultrasound iS obviously superior to transabdominal ultrasound.

BACKGROUND:Previous research has shown that stem cells at different age stages had various proliferation and differentiation in vitro.Therefore,biological characteristics of bone marrow-derived mesenchymal stem cells at different age stages play a key role in evaluating differentiation into myocardial cells and determining proliferation and differentiation parameters in vitro.OBJECTIVE:To compare in vitro proliferation,surface marking,and differentiation into myocardial cells of bone marrow-derived mesenchymal stem cells from different aged rats.DESIGN,TIME AND SETTING:An in vitro contrast cytological observation was performed at the Laboratory of Biochemistry and Molecular Biology,Shanxi Medical University from May 2008 to May 2009.MATERIALS:A total of 15 healthy male Wistar rats were divided into three groups:1-month-old,3-month-old,and 12-month-old groups,with 5 rats in each group.METHODS:Bone marrow-derived mesenchymal stem cells were cultured using adherence screening method.At the third passage,cells differentiated into myocardium-like cells by the induction of 5-azacytidine.MAIN OUTCOME MEASURES:Cell proliferation was observed using MTT;cell surface marking was detected using flow cytometry;cardiac-specific myosin heavy chain mRNA expression was measured using RT-PCR.RESULTS:Bone marrow-derived mesenchymal stem cells were adherent in each group,and the proliferation curve was similar to each other.Under the same culture condition,the proliferation in the 1-month-old and 3-month-old groups was faster than 12-month-old group (F=28.71,P ＜ 0.05).The third-passage cells strongly expressed CD44 and CD71 but weakly expressed CD34 and CD45.At 2 weeks after 5-azacytidine induction,cardiac-specific myosin heavy chain mRNA was observed in all groups;however,the cardiac-specific myosin heavy chain mRNA expression in both 1-month-old and 3-month-old groups was significantly greater than 12-month-old group (t=5.140,2.827,P ＜ 0.05).CONCLUSION:With the age increasing of rats,proliferation,survival time,and differentiation of bone marrow-derived mesenchymal stem cells were weakened.

Objective To study the clinical features,differential diagnosis and treatment of caesarean scar pregnancy (CSP) with sonographic mass.Methods A retrospective analysis was performed on 39 patients of CSP with sonographic mass undergoing treatment in Peking Union Medical College Hospital from 2005 to 2012.14 cases with misdiagnosis of gestational trophoblastic neoplasm,among 4 cases were administered by chemotherapy with methotrexate (MTX),cisplatin,fluorouracil (5-FU) and dactinomycin.According to treatment methods,39 cases were divided into five groups: 3 cases in methotrexate,16 cases in dilation and curettage,15 cases in excision of CSP lesion via laparoscopy,6 cases in excision of CSP lesion via laparotomy,and 4 cases in transabdominal hysterectomy (TAH).Results (1)Clinical characteristics: the mean age was (33 ± 5) years old.Five patients had undergone two prior caesarean sections.The median interval from the last caesarean delivery to CSP was 4 years.Thirty-five cases presented vaginal bleeding or abnormal serum β-hCG level from 5 cases with medical abortion,9 cases with artificial abortion and 21 cases with dilation and curettage.The sonography showed cystic-solid or solid mass with mixed echoes in the lower segment of anterior uterine wall,surrounded by peritrophoblastic vasculature.(2) Treatment outcome: diagnosis of gestational trophoblastic neoplasm was suspected or made in 20 patients,four of whom were even treated by chemotherapy.MTX therapy was given to 3 patients,2 of whom were cured.Dilation and curettages were given to 16 patients,11 of whom were cured.8 patients underwent curettage with sonographic guidance after uterine artery embolism,and 8 patients with laparoscopic or hysteroscopic guidance.All of 15 patients underwent excision of CSP lesion via laparoscopy were cured.4 patients were treated by TAH.(3) Time of in hospital and operation:in laparoscopy group,the average hospitalization days were (3.5 ± 1.6) days,the average operation duration was (54 ± 16)minutes.In laparotomy group,the average hospitalization days were (9.7 ± 5.8) days,and the average surgical duration was (87 ± 15) minutes.It reached significant difference (P ＜ 0.05).Conclusions CSP with sonographic mass was the consequence of continued growth of residual pregnancy mass after incomplete abortion or curettage of CSP with gestation sac.The similar sonographic image might lead to misdiagnosis.Individual therapy was recommended.Excision of CSP lesion via laparoscopy might be the primary option for its advantages in differential diagnosis,caesarean scar defect repair and successful ratio.

Objective To study the efficacy of gamma globulin in the early treatment of severe or almost severe hand -foot -mouth disease.Methods 80 children with severe or almost severe hand -foot -mouth disease were randomly divided into treatment group and control group by the random number table.The treatment group received the treatment of early gamma globulin,whereas patients in the control group received conventional therapy.The effective rate of the treatment group was higher than that of the control group(95.0%vs 77.5%,χ2 =5.165,P <0.05).The recovery time of body temperature and hemogram,rash and other adverse symptoms disap-peared in the treatment group were significantly shorter than those of the control group[(2.1 ±0.9)d vs (3.0 ± 1.1)d,(1.9 ±0.8)d vs (2.8 ±1.1)d,(4.1 ±1.3)d vs (6.2 ±2.1)d,(2.6 ±0.8)d vs (4.8 ±1.5)d,t =3.934,3.723,5.378,7.357,all P <0.05].Conclusion Early application of gamma globulin is effective and safe in treating severe hand -foot -mouth disease,which can relieve symptoms,control the disease quickly and improve prognosis.

Objective To discuss the characteristics of extended-spectrum beta-lactamases(ESBLs)-producing Shigella and the relation between them and drug-resistance plasmid. Methods The suspicious ESBLs-producing isolates were screened by K-B disc diffusion method, and the ESBLs-producing strains were confirmed by confirmatory test recommended by the National Committee for Clinical Laboratory Standards. Furthermore, the partial blageneof these isolates were detected by PCR using universal primers for TEM, SHV, CTX-M-1 group, CTX-M-2 group and CTX-M-9 group, respectively. The entire blaCTX-M-9 and blaTEM were amplified by PCR using the primers outside the open reading frame (ORF) of these β-1actamases and products were directly sequenced. The conjugation experiment was performed to determine whether the resistance was transferable. Minimal inhibitory concentration (MIC) was detected with double agar dilution method. Results Of the 275 isolates, 12 strains were identified as ESBLs producers. Among them, 8 strains were CTX-M-14 carriers and 4 strains were CTX-M-3 carriers. All ESBLs-producing isolates are positive for plasmid conjugative transfer test. The transconjugants are only resistance to betalactams. Conclusions High resistance to beta-laetams in Shigella is caused by production of ESBLs in the local area. The ESBLs-produeing isolates can transfer the drug resistance through lateral transfer of plasmid.

Objective To construct bone marrow stem cell sheets and to investigate its effects in the process of osteogenesis.Methods BMSCs were differentiated into osteoblasts and then seeded into a temperature responsive culture dish to construct BMSC sheets.PLGA scaffolds in which both BMSC suspension and BMSC sheets were added,were implanted into the left side of the dogs' mandible.In the other side,PLGA scaffolds that were not wapped with BMSC sheets were implanted as control.At 16 weeks,the samples were processed for radiological analysis and histological examination.Results Cells in the BMSC sheets grew well.In the experimental side,the optical density of the samples was higher than that of the control side (P＜0.05) and plenty of lamellar bones and Haversian system were observed.Conclusions The formation of lamellar bones can be promoted by PLGA scaffolds and BMSC sheets in the process of tissue engineering bone reconstrution.

Objective To explore the application value of MSCT 3D reconstruction technique in flexible ureteroscopy and holium laser lithotripsy (FURL) for subrenal calyx calculus. Methods Data of 67 subrenal calyx calculus patients treated with FURL were analyzed retrospectively. The anatomic difference between surgically cured group and uncured one was compared by measuring the renal pelvis subrenal calyx infundibulopelvic angle (IPA), the calyx width and length, as well as the minimum ratio of subrenal calyx neck width and calyx transverse diameter (minN/T) with MSCT 3D reconstruction technique. The anatomic structure factors that may impact the operative success rate were discussed. Results Among the 67 patients, 52 patients were cured and in cured group, and 15 patients were in uncured group. The average IPA value in cured group was significantly higher than that in uncured group:(54.12 ± 21.32)° vs. (42.12 ± 22.68)° , and there was significantly difference (P<0.05). Twenty-six patients performed CT 3D reconstruction and IVU examination at the same time. The level of IPA in CT 3D reconstruction was significantly higher than that in IVU examination : (53.12 ± 10.16)° vs. (47.67 ± 11.25)° , and there was significant difference (t=1.676, P<0.05). Logistic regression analysis showed that IPA and minN/T levels were the influencing factors of FURL for subrenal calyx calculus. Conclusions The MSCT 3D reconstruction technique can better describe the anatomical relationship of the subrenal calyx. The success rate of FURL relates to the IPA value and the min N/T, which is significant in preoperative indication evaluation.