ObjectiveToexplorefeasibilityofinterpleuralblockviacostodiaphragmaticrecessesfortreating functionaldyspepsia(FD).Methods 88FDpatientsincludingthreesubtype:postprandialdistresssyndrome(PDS 24cases),epigastric pain syndrome(EPS 28 cases)and PDS overlapping EPS( 36 cases)were divided into two groups randomly according to FD subtype:treatment group and control group.The control group were treated with paroxetine, metoclopramide and omeprazole,PO,8 weeks per course of treatment;The treatment group were treated by interplural blocks via costodiaphragmatic recesses ( CDR ) on the basis of treatment of control group, sterile syringe needles of 20mL were inserted vertically by the methods of resistance lossing into CDR,the widest position of interplural space through superior borders of the ninth ribs of the affected sides in midaxillary lines.Weekly injections of 20 mL of anti-phlogistic and analgetic solution were given over a four-week period.VAS,SCL-90 and degree of postprandial distress were evaluated before treatment,at 1 week and 6 months after treatment.Results The patients of the two groups a-chieved pain,depression and anxiety and postprandial distress relief obviously after treatment,VAS and SCL-90 de-creased significantly.Before the treatment,the VAS scores of the two group were (7.66 ±1.14) points,(7.57 ± 1.18)points,respectively,which after the treatment were (1.13 ±0.33) points,(3.22 ±0.66) points;Before the treatment,the SCL-90 scores of the two group were (173.56 ±10.21) points, (174.50 ±11.18) points,respectively, which after the treatment were (106.52 ±9.91) points,(106.38 ±10.12) points.There were statistically significant differences between pretreatment and posttreament in the two groups(all P<0.05),and the treatment group was bet-ter and lasted longer than that of control group(all P<0.05).Conclusion Interplural block via CDRs for treating FD is a feasible,simple,safe,effective approach and can be provided on an outpatient basis.

Objective To improve the level of diagnosis and treatment of hilar cholangiocarcinoma by investgating it′s clinical characteristics.Methods The clinical data of 98 patients with hilar cholangiocarcinoma were analyzed retrospectively.Results According to the Bismuth-Corlitte grouping: typeⅠ,8 cases;typeⅡ,19 cases;type Ⅲ,17 cases;type Ⅲb,14 cases;and type Ⅳ,40 cases.Radical resection(49),palliative operation(12),endoscopic retrograde biliary drainage(16),and PTCD(5) were performed The median survival time of radical resection group was 28.6 months and the survival rate at 1,2,3,and 5 years was 74.2%,65.3%,37.5%,and 3.9% respectively,while the median survival time of palliative operation group was 17.6 months and the survival rate at 1,2,3,and 5 years was 71.7%,26.8%,8.9%,and 0% respectively.The median survival time of endoscopic retrograde biliary drainage group was 4.5 months and the survival rate at 1,2,3,and 5 years was 21%,13%,and 0% respectively.Conclusions Early diagnosis by adjunctive examinations is vital to treatment of hilar cholangiocarcinoma.Radical resection is the sole procedure to improve the outcome and prognosis of hilar cholangiocarcinoma.Multiple therapeutic methods should be adopted and should be individualized.

Objective To explore the relationship between preoperative serum pro-adrenomedullin (pro-ADM) in the patients with closed rupture of small intestine,and postoperative secondary abdominal infection,and to study the value of postoperative serum pro-ADM in assessment of severity of postoperative secondary abdominal infection of this patients.Methods Eighty-five patients with closed rupture of small intestine treated in the emergency surgery from June 2014 to May 2015 were selected.According to the presence of postoperative abdominal infection or not,these patients were divided into infection group and non-infection group.The infection group was further divided into SIRS,sepsis,severe sepsis,septic shock subgroups as per the severity of infection.The levels of serum pro-ADM,interleukin-6 (IL-6),C-reactive protein (CRP) were determined and the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was calculated at admission and the first day、the second day and the third day after operation.Comparisons of these biomarkers were carried out to find out the factors associated with postoperative abdominal infection.In addition,ROC curve was used to verify the factors for predicting the abdominal infection of these patients after operation.The relationship between serum levels of pro-ADM and APACHE Ⅱ score after operation was analyzed.The severity of abdominal infection after operation was assessed with laboratory findings.Results Compared with non-infection group,preoperative and postoperative serum pro-ADM (P =0.03,P ＜ 0.01),IL-6 (P =0.02,P ＜0.01) levels and APACHE Ⅱ scores (P ＜ 0.01,P ＜ 0.01) were significantly higher in infection group (P ＜ 0.05).In the infection groups,the postoperative levels of serum pro-ADM and APACHE Ⅱ scores were increased with the severity of infection increased (r =0.924),and the difference between the groups was statistically significant (P ＜ 0.05),but there were no significant differences in IL-6 and CRP levels between two groups.Conclusion (1) The serum levels of pro-ADM before operation has value in predicting the genesis of abdominal infection in these patients after operation.(2) The serum levels of pro-ADM after operation has value in severity assessment of abdominal infection in these patients after operation.

Objective To investigate the dynamic changes in peripheral blood of patients with acute pancreatitis α-MSH,TNF-α,PCTS and the value of the patient assessment of disease severity.Methods Emergency surgery in the Second Affiliated Hospital of Anhui Medical University from March 2011 to March 2014 were treated 68 cases of acute pancreatitis patients,36 patients with mild,32 cases of severe group.All patients were extracted 1,3,5,7 days after admission blood,and α-MSH was measured by enzymelinked immunosorbent assay,the content of TNF-αand PCT.Results Compared with the mild group,the serum of patients with severe group of α-MSH concentrations were lower (P ＜ 0.05),while serum TNF-αand PCT levels higher than the mild group (P ＜ 0.05);in disease severity assessment,α-MSH sensitivity of 82.35％ and a specificity of 88.24％,the accuracy was 87.5％,TNF-α sensitivity of 76.47％ and a specificity of 82.35％,the accuracy was 81.25％,PCT sensitivity of 70.59％ and a specificity of 76.47％,75.00％ accuracy,PCT + TNF-α + α-MSH sensitivity of 88.24％ and a specificity of 94.12％,93.75％ accuracy;area under the PCT,TNF-α,α-MSH and the combination of the three curves 0.690,0.696,0.768 and 0.885,respectively.Conclusions Serum α-MSH,monitoring TNF-α,PCT levels have some clinical value in patients with acute pancreatitis disease severity assessment,including α-MSH in the condition assessment of the sensitivity,specificity and positive predictive value were higher than the latter two,and peripheral α-MSH in patients with a low level indicates a serious condition,poor prognosis;addition,combined detection with higher clinical value in the assessment of disease severity.

OBJECTIVE To examine the prevalence and trends of drug resistance of nontuberculous mycobacteria(NTM)in Shanghai.METHODS All NTM strains isolated between 1998 and 2004 in Shanghai were identified with conventional biochemical tests.Antimicrobial susceptibility test for all NTM was performed by standard absolute concentration method.RESULTS The prevalence rate was determined as 1.49%,1.17%,1.98%,2.46%,2.66%,2.72% and 3.0% among mycobacteria culture positive patients per year in 1998,1999,2000,2001,2002,2003,and in 2004,respectively.These data indicated the prevalence rate has continuously increased.Distribution of NTM isolates was Group Ⅰ18.7%,Group Ⅱ 5.1%,Group Ⅲ 25.1%,and Group Ⅳ 51.1% accordingly.Group Ⅳ rapidly growing NTM accounted for majority of them.Most of NTM showed high drug resistance to general antituberculotic drug.In particular Group Ⅳ Mycobacterium chelonae and M.fortuitum appeared multi-drug resistance.CONCLUSIONS The prevalence rate of NTM in Shanghai shows increased tendency.Most of NTM isolates are Group Ⅳ rapidly growing NTM.NTM shows high drug resistance to first line antituberculotic substance.

Objective To explore the evaluation value of serum Ghrelin and pleural effusion in patients with acute pancreatitis . Methods Eighty patients with acute pancreatitis treated in our hospital from February 2011 to February 2014 were divided into mild case group (31 patients) and severe case group (49 patients) according to the severity of the disease .Venous blood samples were collected at time point including :admission ,48h after admission and after discharge at empty stomach in the morning ,and CRP level ,WBC ,PCT level of patients were checked .The concentration of serum Ghrelin of patients were mensurated by enzyme linked immunosorbent assay and pleural effusion were diagnosed by sternum .Results Compared with the patients in the mild case group , serum Ghrelin ,CRP level ,APACHE score ,CT score and Ranson score were higher in the severe case group and the hospital day of patients in the severe case group was longer(P<0 .01) .The area under the curve of CRP level ,pleural effusion ,Ghrelin ,Ghrelin combined with pleural effusion of ROC were 0 .708 3 ,0 .749 6 ,0 .852 4 and 0 .910 8 .Ghrelin combined with pleural effusion has the best evaluation effect on the patients with acute pancreatitis .The sensibility ,specificity ,accuracy of CRP were 93 .6% ,69 .4% and 73 .7% ;the sensibility ,specificity ,accuracy of pleural effusion were 75 .2% ,88 .7% and 76 .8% ;the sensibility ,specificity ,accuracy of Ghrelin were 86 .9% ,88 .2% and 85 .3% ;the sensibility ,specificity ,accuracy of Ghrelin combined with pleural effusion were 90 .1% ,92 .6% and 91 .4% .Conclusion Serum Ghrelin and pleural effusion have high sensibility ,specificity and accuracy in pa‐tients with acute pancreatitis and has high clinical value .

Objective To explore the value of peripheral blood serum levels of PCT,CRP,TNF-α and free DNA of cells in predicting the development of MODS in patients with multiple trauma.Methods Complete detail clinical data of 54 casualties with multiple trauma admitted within 24 hours after accident from January 2011 through January 2012 were collected for retrospective study.The patients were divided into MODS group and non-MODS group according the criteria set forth by the Chinese Society of Critical Care and Emergency Medicine in 1995 national conference.The data of two groups are comparable,and data of another 20 healthy subjects undertaking routine annual physical examination were taken as control.The peripheral blood levels of PCT,CRP,TNF-α and free DNA of patients of two groups were determined 1 d,2 d,3 d,and 5 days after admission.Then the results were analyzed and compared between groups.Results Compared with non MODS group,the levels of PCT,CRP,free DNA of cells in MODS group were significantly higher (P ＜ 0.05),but there was no deference in TNF-α between MODS group and non-MODS group (P ＞ 0.05).When the relative risks of increased PCT (PCT≥6 mg/L),increased CRP (CRP≥ 130 mg/L)、and increased free DNA of cells (free DNA ≥ 10 0005/L) were analyzed,the presence of these 3 biomarkers with high levels occurred at the same time was the most accurate way to predicts MODS in 6.00 relative risk (RR),and the positive predictive value was 100％.Conclusions PCT,CRP,free DNA of cells could be the predictors of MODS in patients with severe multiple trauma,and the presence of high levels of these three biomarkers appearing together had high sensitivity and specificity for prediction.

Objective To observe the effect of hyperlipidemia on pancreatic microcirculation in anintact hyperlipidemic acute pancreatitis animal moldel.Methods Among 30 healthy hamsters enrolled,20were fed normally while,the other 10 were given high fat feed for four weeks.Then 10 animals givennormal feed with normal serum lipids and no ultrasonic changes in the organs including liver,biliary tractand pancreas,were randomly (random number) selected and divided into normal control group (C group)and acute pancreatitis group (AP group) averagely.Five animals given high fat feed with 3 times serumnormal triglyceride level and no ultrasonic changes in the organs including liver,biliary tract and pancreas,were randomly selected as hyperlipidemic acute pancreatitis group (HLAP).The animals in C group wereundergone fake surgery.While the animals in other two groups were carried out surgery based on Schmidtmethod and were injected 3.5％ taurocholic acid sodium into pancreatic duct with a infusion pump.Acridineorange (2 mL/kg) was injected in the inferior vena cava 6 hours later,then laser confocal microscopefluorescence imaging system were utilized to dynamically observe pancreatic microcirculation in living animal models and the variables including average microvascular diameter (MVD),functional capillary density (FCD),microvessel flow velocity (MFV) and leukocyte adhesion were recorded.Pancreatic tissue were collected and cut slices for pathological grading.Result When compared with AP group and C group,pancreas microcirculation function index MVD (μm),FCD (piece/mm2),MFV (μm/s) in the HLAP group decreased,while leukocyte adhesion (piece/mm2) increased significantly [MVD:HLAP group 2.40 ± 0.26 vs.AP group 5.54 ± 0.43,C group 7.56 ± 0.42 (P ＜ 0.05);FCD:HLAP group 4.20 ±0.84 vs.AP group 7.56 ± 1.14,C group 11.40 ± 1.14 (P ＜ 0.05);MFV:HLAP group 58.80 ± 9.63 vs.AP group 131.00 ± 12.94,C group 224.40 ± 15.63 (P ＜ 0.05);leukocyte adhesion:HLAP group 343.60±13.86vs.AP group 114.00 ±8.03,C group 18.80 ±2.28;(P＜0.05)].The pancreatic pathology score was higher in HLAP group [HLAP group 10.00 ± 1.59 vs.AP group 6.60 ± 1.14,C group 1.00 ± 0.71 (P ＜ 0.05)].Conclusion Hypedipidemia may aggravate the impair ment of pancreatic microcirculation and promote microcirculation dysfunction.

Human cytomegalovirus glycoprotein complex Ⅱ (gC Ⅱ ) consists of two glycoproteins, gM and gN. Although gC Ⅱ specific IgG purified from HCMV positive patient sera can neutralize HCMV, there has been no report on the generation of virus-neutralizing antibodies by immunizing with one epitope of gM. The epitope, termed MAD, was screened from random phage peptide library by subtractive strategy. The peptide sequence of MAD was highly homologous with 32~38 amino acids of HCMV gM. Mice immunized with MAD coupled with keyhole limpet hemocyanin (KLH) could produce specific antibodies against MAD, and the antibodies obtained could bind not only native HCMV particles, but also the recombinant gM30～78 peptide. ELISA analysis results showed that MAD could specifically bind HCMV-positive human serum samples. Virus-neutralizing assay results demonstrated that the antibodies against MAD could inhibit HCMV strain AD169 entering the human embryonic lung cells. The results suggested that MAD could be used as a new potential protective antigen in the development of HCMV vaccine.

BACKGROUNDExperimental studies and preliminary clinical studies have suggested that growth hormone (GH) treatment may improve cardiovascular parameters in chronic heart failure (CHF). Recombinant human GH (rhGH) has been delivered by a recombinant protein, by plasmid DNA, and by genetically engineered cells with different pharmacokinetic and physiological properties. The present study aimed to examine a new method for delivery of rhGH using genetically modified bioartificial muscles (BAMs), and investigate whether the rhGH delivered by this technique improves left ventricular (LV) function in rats with CHF.

METHODSPrimary skeletal myoblasts were isolated from several Sprague-Dawley (SD) rats, cultured, purified, and retrovirally transduced to synthesize and secrete human rhGH, and tissue-engineered into implantable BAMs. Ligation of the left coronary artery or sham operation was performed. The rats that underwent ligation were randomly assigned to 2 groups: CHF control group (n = 6) and CHF treatment group (n = 6). The CHF control group received non-rhGH-secreting BAM (GFP-BAMs) transplantation, and the CHF treatment group received rhGH-secreting BAM (GH-BAMs) transplantation. Another group of rats served as the sham operation group, which was also randomly assigned to 2 subgroups: sham control group (n = 6) and sham treatment group (n = 6). The sham control group underwent GFP-BAM transplantation, and the sham treatment group underwent GH-BAM transplantation. GH-BAMs and GFP-BAMs were implanted subcutaneously into syngeneic rats with ligation of the left coronary artery or sham operation was performed. Eight weeks after the treatment, echocardiography was performed. hGH, insulin-like growth factor-1 (IGF-1) and TNF-alpha levels in rat serum were measured by radioimmunoassay and ELISA, and then the rats were killed and ventricular samples were subjected to immunohistochemistry.

RESULTSPrimary rat myoblasts were retrovirally transduced to secrete rhGH and tissue-engineered into implantable BAMs containing parallel arrays of postmitotic myofibers. In vitro, they secreted 1 to 2 microg of bioactive rhGH per day. When implanted into syngeneic rat, GH-BAMs secreted and delivered rhGH. Eight weeks after therapy, LV ejection fraction (EF) and fractional shortening (FS) were significantly higher in CHF rats treated with GH-BAMs than in those treated with GFP-BAMs ((65.0 +/- 6.5)% vs (48.1 +/- 6.8)%, P < 0.05), ((41.3 +/- 7.4)% vs (26.5 +/- 7.1)%, P < 0.05). LV end-diastolic dimension (LVEDD) was significantly lower in CHF rats treated with GH-BAM than in CHF rats treated with GFP-BAM (P < 0.05). The levels of serum GH and IGF-1 were increased significantly in both CHF and sham rats treated with GH-BAM. The level of serum TNF-alpha decreased more significantly in the CHF treatment group than in the CHF control group.

CONCLUSIONSrhGH significantly improves LV function and prevents cardiac remodeling in rats with CHF. Genetically modified tissue-engineered bioartificial muscle provides a method delivering recombinant protein for the treatment of heart failure.

Animals ; Bioartificial Organs ; Echocardiography ; Heart Failure ; therapy ; Human Growth Hormone ; administration & dosage ; Myoblasts, Skeletal ; metabolism ; Myocardial Infarction ; pathology ; physiopathology ; therapy ; Rats ; Rats, Sprague-Dawley ; Recombinant Proteins ; administration & dosage ; Tissue Engineering ; Tumor Necrosis Factor-alpha ; blood ; Ventricular Function, Left