Objectives:To investigate the effects of enteral immunonutrition (Stresson) on immunological function and inflammatory responses in severe scalded rats. Methods:Sixty four SD rats inflicted by 30% TBSA Ⅲ degree scalds were randomly divided into enteral immunonutrition(EIN) and enteral nutrition (EN) groups.Animals of both groups were fed isocaloric enteral nutrition. Lymphocyte subsets, serum levels of immunoglobulins,endotoxin,IL 6,TNF ? were determined on the 1st,4th,7th and 10th day postburn. Results:CD3 + ,CD4 + ,CD4 + /CD8 + in EIN group were higher( P

Objective To evaluate the diagnostic approaches and influencing factors of prognosis after repeated hepatectomy for recurrent liver cancer. Methods Fifty seven cases of recurrent liver cancer underwent surgical resection. The disease free survival, cumulative survival and possible influencing factors of prognosis were studied. Results The 1-, 3-, 5- and 10-year disease free survival rates after first resection were 63.9%, 38.3%, 26.6% and 12.8%, respectively. The 1-, 3-, 5- and 10-year survival rates of resection for recurrent liver cancer were 56.6%, 37.7%, 31.9% and 16.2% and the 1-, 3-, 5- and 10-year cumulative survival rates were 82.1%, 60.85, 47.6% and 19.5%, respectively. The influencing factors of prognosis after repeated hepatectomy for recurrent liver cancer size, number of nodules, tumor-free duration and weather when the patients underwent curative resection. Conclusions For early detection of recurrent liver cancer, AFP test, sonography each month and computed tomography every 3 months should be conducted for patients after the first hepatectomy. For the recurrent liver cancer, surgical resection is an effective treating measure when it is possible. The influencing factors of prognosis after repeated hepatectomy for recurrent liver cancer are tumor size, number of nodules, tumor-free duration, tumor capsule and manner of repeated hepatectomy.

Objective To discuss the prevention and treatment for complications following laparoscopic cholecystectomy (LC). Methods A total of 902 cases were summarized retrospectively with regard to causes, prevention and treatment of complications following LC. Results Out of the 902 cases, there were 2 cases of bile duct injury, 2 cases of residual calculi of common bile duct, and 4 cases of scrotum emphysema. The bile duct injury and residual calculi were all cured by re-operation, while the scrotum emphysema dissolved of itself without medical treatment. A conversion to open surgery was required in 31 cases. All the cases in the study were cured. Conclusions Emphasis should be laid on the prevention of complications after LC. A prompt conversion to open cholecystectomy is the key to the lowering of complication rate.

OBJECTIVETo study the drug resistance of Acinetobacter baumannii (AB) producing VIM-2-type metallo-β-lactamase (MBL) isolated from burn patients of our ward against carbapenem antibiotics and its homology.

METHODSA total of 400 strains of AB (identified) were isolated from sputum, urine, blood, pus, and wound drainage. of burn patients hospitalized in our ward from September 2011 to March 2014. Drug resistance of the 400 strains of AB to 15 antibiotics, including compound sulfamothoxazole, aztreonam, etc. , was tested using the automatic microorganism identifying and drug sensitivity analyzer. Among the carbapenems-resistant AB isolates, modified Hodge test was applied to screen carbapenemase-producing strains. The carbapenemase genes of the carbapenemase-producing strains, and the mobile genetic elements class I-integron (Intl1) gene and conserved sequence (CS) of carbapenemase-producing strains carrying blaVIM-2 gene were determined with PCR and DNA sequencing. For carbapenemase-producing strains carrying blaVIM-2 gene, synergism test with imipenem-ethylene diamine tetraacetic acid (EDTA) and enhancement test with imipenem-EDTA and ceftazidime-EDTA were used to verify the MBL-producing status. Drug resistance of the VIM-2-type MBL-producing AB strains was analyzed. For VIM-2-type MBL-producing AB strains, plasmid conjugation experiment was used to explore the transfer of plasmid; outer membrane protein (OMP) CarO gene was detected by PCR. For VIM-2-type MBL-producing AB strains carrying CarO gene, the protein content of CarO was analyzed with sodium dodecyl sulfate polyacrylamide gel electro- phoresis. The repetitive consensus sequence of Enterobacteriaceae genome PCR (ERIC-PCR) was carried out for gene typing of VIM-2-type MBL-producing AB strains to analyze their homology.

RESULTS(1) The resistant rates of the 400 strains of AB against levofloxacin and compound sulfamethoxazole were low. A total of 381 carbapenems-resistant AB strains were screened, including 240 carbepenemase-producing strains. (2) Out of the 240 carbepenemase-producing strains, 18 strains were found to harbor the blaVIM-2 gene, accounting for 7.5%; 133 strains carried the blaTEM-1 gene, accounting for 55.42%; 195 strains carried the blaOXA23 gene, accounting for 81.25%; 188 strains carried the bla(armA) gene, accounting for 78.33%. (3) Eighteen carbepenemase-producing strains which carried the bla(VIM-2) gene were found to carry the Intl1 gene, showing the Intl1-VIM linkage. Simultaneously, Intl1 variable area CS showed diversity. (4) Eighteen carbepenemase-producing strains which carried the blaVIM-2 gene were verified to produce MBL. The resistant rates of the 18 strains of AB against compound sulfamethoxazole were the lowest, followed by levofloxacin and cefoperazone/sulbactam, and those against the other antibiotics were above 60.00%. (5) Through multiple joint tests, plasmid conjugation experiment positive transfer strain was not found in 18 VIM-2-type MBL-producing AB strains. (6) Nine out of the 18 VIM-2-type MBL-producing AB strains were found to carry CarO gene. The OMP CarO of VIM-2-type MBL-producing AB strains carrying CarO gene was lost or lowered in the protein content. (7) The 18 VIM-2-type MBL-producing AB strains were classified into 6 genotypes by the ERIC-PCR. There were respectively 6, 4, 3, and 1 stain (s) in genotypes A, B, C, and F, and there were 2 strains in genotypes D and E respectively.

CONCLUSIONSThe resistance mechanism of AB against carbapenems is mainly mediated by blaTEM-1, blaOXA-23, and bla(arma); meanwhile, VIM-2-type MBL-producing and lack or change in OMP CarO are attributable to carbapenems resistance of clinically isolated AB from burn wards, and the Intl1 gene may take a part in blaVIM-2 gene transmission.

Acinetobacter baumannii ; drug effects ; enzymology ; genetics ; isolation & purification ; Anti-Bacterial Agents ; pharmacology ; therapeutic use ; Bacterial Proteins ; Burns ; drug therapy ; microbiology ; Carbapenems ; pharmacology ; Drug Resistance, Bacterial ; Genes, Bacterial ; Humans ; Imipenem ; pharmacology ; Microbial Sensitivity Tests ; Sulbactam ; pharmacology ; beta-Lactamases ; genetics

Objective To study the diagnostic value of computer tomography(CT),magnetic resonance cholangiopancreatography (MRCP),ultrasonography combined with serum CA19-9 and CEA for periampullary carcinomas.Methods We analyd the imaging findings and laboratory testings of 87 patients with periampullary carcinomas which were confirmed by surgical or biopsy specimen of ERCP.Results ①CT or MRCP was better than US in diagnosing periampullary carcinomas.② There was significant differences in serum CEA between four categories of periampullary carcinomas (x2 =9.97,P ＜ 0.05),while the serum CA19-9 had no statistical difference.③CT,MRCP,US combined with serum CA19-9 and CEA improved the diagnostic accuracy of the periampullary carcinomas.Conclusion CT,MRCP,US combined with serum CA19-9 and CEA can improve the early diagnosis of periampullary carcinomas and help for clinical treatment plan.

In order to meet the needs of national clinical medical education strategy, to train medical students’ability of analyzing and solving problems, it is imminent to carry out the reform on comprehensive experiment in basic medi-cal teaching.During the practice, the basic medical college of Hebei North University tried to integrate functional ex-periment and morphological experiment, and had some experience to share with medical education colleagues.

[Objects]To isolate and identify the pathogen of the large outbreak of dengue in Guangdong province in 2014. To understand the origin and the phylogenetic characteristics of the isolates ,and provide scientific foundation for the surveillance and prevention of dengue fever.[Methods]Collected the patient serum samples over all the Guangdong province during the 2014 outbreakperiod,isolated and identified the virus from these samples. Amplified complete E gene and complete genome with certain primers and sequenced all the products. Then the Phylogenetic ,Bayesian phylogeography and mutations analysis were carried.[Results]40 DENV-1 strains were isolated and identified. 40 complete E gene sequences and 6 complete genome sequences of DENV-1 were obtained. Phylogenetic analysis with E gene sequences revealed that the 40 isolates were classified into two genotypes including 16 genotypeⅠ(Asia)and 24 genotypeⅤ(America/Africa). 14 genotypeⅠisolates were clustered closest with isolates from Guangdong province(2013)and Sigapore(2013)which share the nucletide identities of 99.6% ~ 99.9%,other two genotypeⅠisolates were clustered with strains from Malaysia (2013) and both share the nucletide identities of 99.7%;24 genotypeⅤisolates were all classified in one clade with striains from Bangladesh(2009),China(2009)and Bhutan(2013)which share nucletide identities of 99.0%-99.9%. Further analysis with six complete genome sequences showed that five isolates were clustered closest with strains isolated from Guangdong province(2013)share the nucletide identities of 99.6%-99.8% while the sixth stains closest with strains isolated from Myanmar(2002)share the nucletide identities of 98.8%. The isolates have five amino acid mutations compared with strains epidemic in Guangdong province in 2013,three mutations(S88V,E203G,T275R)are in the EⅡdomain and one mutation (S305P)is in the EⅢdomain which associated with virulence.[Conclusions]During the outbreak in Guangdong province in 2014, DENV-1 is the predominant causative serotype,and there are at least two different kinds of genotypes of DENV-1 largely epidemiced in the whole province. Evolution analysis reveals the multiple origins of the isolates which may origin from Guangdong province , Sigapore,Malaysia,Myanmar so that we should enhance the study and surveillance of autochthonous and vectors in order to understand the epidemic way of dengue in Guangdong province. The isolates have had four mutations in the domain associated with virulence which remain further study to know their biological effects.

BACKGROUND:Several studies have shown the improvement of heart function through the introduction of mesenchymal stem cells(MSCs)from bone marrow,which may be attributed to secretion of various cytokines that accelerate endogenous reparative process,but not regeneration of cardiomyocytes.OBJECTIVE:To observe the anti-apoptotic effects of MSCs on adriamycin(ADR)-injured cardiomyocytes apoptosis in vitro through paracrine pathway.METHODS:In vitro cultured neonatal rat cardiomyocytes(3×10~8/L)were incubated into a 6-well plate,3 mL/well.72 hours later,these cells were assigned into 3 groups.The primary cultured neonatal rat cardiomyocytes in the ADR-injured and coculture groups were exposed to 1 mg/L ADR for 4 hours to establish experimental models of toxic cardiomyocytes.The normal control group was left intact.In the coculture group,rat bone marrow MSCs(BMSCs)at passage 3 were regulated to 3×10~8/L,3 mL/well was added into Millicell device for 24 hours.Following model induction,the Millicell device was inseted into above-mentioned 6-well plate to establish coculture system.The levels of cytokines were measured in the conditioned medium from three cardiomyocytes groups.Effects of BMSCs on Caspase-9 and Caspase-3 activities,apoptosis and Bcl-2 and Bax protein expression in ADR-injured cardiomyocytes were measured.RESULTS AND CONCLUSION:Compared with the normal control group.the level of cytokine including insulin-like growth factor (IGF-1)and hepatocyte growth factor(HGF)was significantly higher in the medium from ADR-injured group.the activity of caspase-9,caspase-3 and the apoptosis rate increased significantly,the expression of Bax protein was higher and Bcf-2 Protein was lower in ADR-injured group(P ＜ 0.05).Compared with the ADR-injured group,the level of IGF-1 and HGF in co-cultured group increased significantly,the apoptosis rate,Caspase-3 and Caspase-9 activities decreased significantly,the expression of Bax protein was lower while Bcl-2 Protein was higher than ADR-injured group(P ＜ 0.05).Results indicated that BMSCs show increased cytokine secretion and significant anti-apoptotic effects on ADR-injured cardiomyocytes through paracrine pathway.

Objective: Epithelial dysplasia of the esophagus and gastric cardia is precancerous lesion, including mild, moderate and severe levels. In 2000 year, WHO recommended to replace dysplasia with intraepithelial neoplasia. Mild and moderate dysplasia were classified as low-grade intraepithelial neoplasia (LIN). Cardia adenocarcinoma was suggested to be called esophageal-gastric junction adenocarcinoma. The risk of cancer development and the rule of time evolution were detected in esophagus and esophageal-gastdc junction LIN in high incidence area of esophageal cancer in Northern China, in an effort to provide scientific data for the prevention of esophageal cancer. Methods: Between October 2001 and October 2002, two townships of Cixian were chosen to carry out endoscopic iodine staining screening cohort study. The total population aged 0-85 was 22,016, of which 6,596 aged 40-69 (3257 males and 3339 females). Except for thoese with contraindications and those who refused to join the study, 3,506 cases were finally recruited in the study, and the screening rate was 53.2%. According to WHO criteria of the pathological diagnosis, the esophageal squamous epithelium with mild and moderate dysplasia and esophageal-gastric junction with mild dysplasia were classified into LIN groups (including 616 cases). The control group contained a total of 2,478 cases without precancerous lesions and free of cancer in endoscopic screening. Results: From June to September in 2008, the cohort was followed up and 174 cases were lost, with a follow-up rate of 95.0%. Follow-up was 3,970.7 person- years in the LIN group and 16,120.0 person-years in the control group.Carcinomous conversion rates were 251.7 and 68.2/per 100,000 person- years respectively in the LIN group and the control group. The median time in the two groups was 38 and 47 months, respectively. Compared with that of the normal population, the relative risk (RR) of LIN was 3.69 (95% CI=1.57-8.69, P=0.001). Conclusion: Population with LIN are at high-risk for esophageal cancer and endoscopic examination every year is absolutely necessary.

Objective To investigate the electrocardiographic characteristics and assess the efficiency of ra-diofrequency catheter ablation(RFCA) in ventricular arrhythmia arising from the aortic sinus of Valsalva. Methods Eighteen patients(6 males and 12 females)were selected to undergo RFCA for ventficular arrhythmia originating from the left aortic sinus of Valsava. All of them were symptomatic,but without evidence of structural heart disease. Activation mapping was performed in the endocardium of the aortic sinus of Valsalva,then ablation was performed at the site with the earliest ventricular wave in endocardium electrograms. At the same time, coronary and aortic angiog-raphy were performed to assess the anatomic relationship between the ventricular tachycardia (VT)/ventricular pre-mature contraction (VPC) origin and coronary arteries and aortic valve before the RF energy delivery. Results Eighteen patients were successfully managed, with no major complications related to the procedure. VT eliminated and VPC counts on 24-hour ECG monitoring decreased significantly after the ablation[18 474(12 399,26 812)/24h vs 4 (1,7)/24 h, Wilcoxon signed-rank test, P<0.05]. During a follow-up period of 6 monthes, there was no recur-rence. Conclusions Ventricular arrhythmia arising from the aortic sinus of Valsalva has specific electrocardiograph-ic characteristics, and it can be successfully and safely treated under the guidance of activation mapping.