Ultrastructural changes of the inner cell mass (ICM) in rabbit blastocysts from 4 to 7 days post coitum (p.c.) were observed with transmission electron microscope. It revealed that ICM of blastocyst on day 5 p.c. began to differentiate after they were arranged into a single layer, and under which the primitive endoderm appeared. It is suggested that the primitive endodermal cells in rabbit blastocysts are derived from the scattered ICM-like cells at the inner surface of the mural trophoblast rather than delaminated from ICM proper. In this paper, disruption and disappearance of polar trophoblast are described and discussed.

Objective To study the clinical effect of peritoneal and abdominal indwelling tube by ultrasound for patients with severe acute pancreatitis.Methods Sixty-eight patients with severe acute pancreatitis from January 2010 to December 2013 were analyzed retrospectively.The patients were divided into experiment group (48 cases) and control group (20 cases).The patients in control group were given the common drugs treatment,and the patients in experiment group were given the common drugs and the peritoneal and abdominal indwelling tube by ultrasound.The clinical effects and complication were compared.Results The total efficacy rate in experiment group was 93.75％(45/48),in control group was 35.00％(7/20),and there was significant difference (P ＜ 0.05).Seven patients in experiment group occurred complication,after the symptomatic treatment 6 patients recovered and 1 patient died of multiple organ failure;7 patients in control group occurred complication,after the symptomatic treatment 3 patients recovered and 4 patitents died of infection recurrence.The complication rate in experiment group was 14.58％(7/48),in control group was 35.00％ (7/20),and there was significant difference (P ＜ 0.05).Conclusion Peritoneal and abdominal indwelling tube by ultrasound could improve clinical efficacy and decrease complication rate for patients with severe acute pancreatitis.

Objective To evaluate catheterization in pancreatic duct before endoscopic papillary bal-loon dilation (EPBD)to prevent pancreatitis after EPBD.Methods Forty-three patients with normal serum amylase levels,diagnosed as having bile duct stones,underwent EPBD.Twenty-three were assigned to experi-mental group,where catheters(ERCP imaging tube)were placed in pancreatic duct before EPBD,then the pa-pillary balloon was expanded to 10 mm.Twenty were assigned to control group where eight-millimeter-diameter papillary balloon was used to remove the stones.The serum amylase levels before EPBD,6 hours and 24 hours after EPBD,the incidence of pancreatitis and high serum amylase levels associated with EPBD,as well as the mean time and success rate of removing the stones of the two groups were compared.Results Post-EPBD pan-creatitis occurred in one patient in experimental group (4.35%),and seven in control group (35.00%), which was significantly different(P <0.05).Meanwhile,the mean levels of serum amylase 6 h and 24 h after EPBD in the experimental group were (102.61 ±98.99)U /L and (60.35 ±26.18)U /L respectively,lower than those in the control group (398.25 ±259.32)U /L and (230.50 ±281.31)U /L(P <0.05).After the papillary balloon was expanded to 10 mm in experimental group,the mean time of removing stones was (10.43 ±2.27)min,which was shorter than that of control group (17.90 ±4.49)min (P <0.05).Stone-re-moving rate of two groups had no difference and they all succeeded one time.Conclusion Placing catheter in pancreatic duct before EPBD to prevent pancreatitis after EPBD makes it easier to remove stones in shorter op-eration time.It can prevent pancreatitis and high amylase blood disease after EPBD.

Objective:To analyze and optimize the extraction technology of Geum aleppicum by Box-Behnken design and response surface methodology. Methods:With the content of total flavonoids as the index, the effects of three factors including the solvent-solid ratio, ethanol concentration and extraction time on the content of total flavonoids were studied by single factor experiment, and the ex-traction technology was optimized by Box-Behnken design and response surface methodology. Results: The optimal extraction condi-tions of Geum aleppicum were as follows:the solvent-solid ratio was 4. 2, the ethanol concentration was 50% and the extraction time was 80 min. Under the above conditions, the average yield was 12. 590 0 mg·g-1 . Conclusion: Optimizing extraction technology of the total flavonoids in Geum aleppicum by Box-Behnken design and response surface methodology is reasonable, and the mathematical mod-el is consistent with the experimental data, which has good predictability.

Objective To compare and analyze the detection situation of common pathogens in child respiratory tract infection in our hospital and to provide the basis for clinical accurate diagnosis and reasonable treatment .Methods A total of 6 032 specimens were collected from the children patients with acute respiratory tract infection in the Gansu Provincial Maternity and Child Health Care Hospital from January to December 2015 .The immunodot test technology was adopted to detect the 6 kinds of early specific serum antibody IgM of common respiratory pathogens :adenovirus (ADV ) ,influenza virus (IV ) ,parainfluenza (PIV ) ,respiratory syncytial virus (RSV) ,mycoplasma pneumoniae (MP) and chlamydia pneumonia (CP) .The differences in children infection pat‐terns ,different ages ,seasons and genders were analyzed .Results Among 6 032 specimens ,2 279 cases were positive with the posi‐tive rate of 37 .8% .The positive rates of 6 kinds of respiratory pathogens were in turn 12 .2% for ADV ,9 .6% for IV ,7 .9% for CP ,4 .6% for MP ,3 .0% for RSV and 0 .3% for PIV .The detection rate of respiratory tract pathogens was higher in spring and summer ;age groups of 1-3 years old and 4-6 years old had higher positive detection rate .Conclusion The main common patho‐gen of respiratory tract infection in this hospital is ADV ,followed by IV .Their infection has obvious seasonality .The mycoplasma and chlamydia also are the common pathogens of respiratory tract infection ,which are dominated by MP and CP .

Objective To explore the curative effect of triple lumen feeding tube on upper gastroin-testinal tract perforation after endoscopic operation.Methods A total of 1 12 patients with upper gastrointes-tinal perforation after endoscopic operation were involved in this prospective control test.The remission rate of abdominal pain and abdominal distension,gastric pH,lesion healing time,length of stay and the success rate of conservative treatment were compared between the control group (indwelling traditional gastric tube and intravenous use of omeprazole injection)and the experimental group (intestinal administration of PPI through triple lumen feeding tube).Results The remission rate of abdominal pain of the experimental group was 61. 3% at 6 hours,and 83. 2% at 12 h,which were significantly higher than those of the control group (P<0. 05 ).The lesion healing time(of cases where lesions were not clipped)and length of hospitalization of the experimental group were significantly shorter than those of the control group(P<0. 05 ).The gastric pH and success rate of conservative treatment of the two groups had no significant difference(P>0. 05 ).Con-clusion The curative effect of triple lumen feeding tube on upper gastrointestinal tract perforation after endo-scopic operation is ideal.

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Objective To evaluate endoscopically insertion of feeding tube via nose(EIFTN). Method Jejunal feeding tube was placed endoscopically via the nose in all 136 coma patients. Results This procedure was successful in all patients. The procedure took an average time of 5 minutes. In patients with deep coma,the procedure had no influence on HR,MAP, ECG and SaO2; In semicoma patients, HR and R increased during the procedure (t=3.902, P

Objective To investigate the effect of EST and EPBD on the gallbladder function.Methods Fifty-eight patients who underwent common bile duct lithotomy were divided into three groups,the EST major incision group (21),the EST minor incision group (20) and the endoscopic papillary balloon dilation group (17).Twenty healthy people were involved as the control group.The hepatobiliary dynamic imaging was used to evaluate the gallbladder function,indices including (1) Half time of liver excretion (TEX),(2)Peak time of common bile duct excretion (CBD Tup),(3)Gallbladder imaging time(GBVT),(4) Half time of gallbladder excretion (GBT1/2),(5)Gallbladder excretion fraction at the 30th minute (GBEF30min),(6) Gallbladder excretion rate at the 30th minute (GBER 30 min),(7)Duodenum imaging time (DUT),(8) Peak time of bile flowing in duodenal (DU Tup),(9) Bile ratio in gallbladder at the 30th minute(Fgb),(10)Bile ratio in intestinal at the 30th minute (Fsi).Effects of the three operative methods on the gallbladder function were evaluated.Results Compared with the other two treatment groups and control group respectively,the TEX of the EST major incision group was significantly shorter (P ＜0.05),CBD Tup,DUT and DU Tup appeared earlier (P ＜0.05),GBVT was delayed (P ＜0.001),GBT1/2 was shorter (P ＜0.001),GBEF 30 min was higher (P ＜0.001) and GBER 30 min was faster (P ＜0.001) in this group.Gallbladder and intestines ratio (Fgb,Fsi) at the 30th minute were significantly different (P ＜0.001) with Fgb reducing while Fsi increasing in this group,compared with others.Compared with the control group respectively,neither the minor incision group nor the EPBD group (P ＞ 0.05) showed significant differences in these indices.Conclusion The storage function of gallbladder has been injured and excretion has been enhanced after EST major incision.Neither minor incision nor the EPBD leads to significant change in the gallbladder function.

Objective To understand the correlations between HIV-1 subtypes and changes in CD4+T cell count over time in patients with different subtypes of HIV-1 infection.Methods A total of 94 patients who were diagnosed with HIV-1 infection in Nanjing and received at least twice CD4+T cell counting test before antiretroviral therapy (ART) were recruited in this study.Descriptive analysis was used to present the rates of CD4+T cell decline for different HIV-1 subtypes.Logistic regression analysis and nonparametric test were conducted to investigate the factors responsible for CD4+T cell decline and to analyze the correlations between the rates of CD4+T cell decline and HIV-1 subtypes.Results The median monthly rate of CD4+T cell decline was-2.20 [interquartile range (IQR):-11.36-2.13] cell/μl.Of all patients,25.5% (24/94) had a significant decline (≥30%) in CD4+T cell count.Compared with the patients infected with CRF01_AE,those infected with CRF07_BC (OR=0.28,95%CI: 1.7-6.5) or other subtypes (OR=0.16,95%CI: 1.0-2.9) had a lower risk of significant decline in CD4+T cell count.In addition,results of the nonparametric test showed that the patients infected with CRF01_AE (M=-21.54,IQR:-30.97——11.92 cell/μl) had a faster CD4+T cell loss than those infected with CRF07_BC (M=-11.26,IQR:-14.06——5.63 cell/μl) (P=0.033).Conclusion HIV-1 subtype is associated with the rate of CD4+T cell decline.It is important to monitor the changes in CD4+T cell count in patients infected with CRF01_AE and to carry out timely ART.