Objective To study the expression levels of inducible costimulator (ICOS) on CD4+ T cells in peripheral blood in patients with chronic hepatitis B and its change after treated with interferon.Methods All 56 patients were divided into two groups (interferon group has 28 cases,lamivudine group has 28 cases),and interferon group treated by PEG-IFN-α 2a,lamivudine group treated by lamivudine,respectively.There were 20 healthy individuals as control group.The levels of ICOS on CD4+ T cells of patients with chronic hepatitis B were kinetically detected by flow cytometry.The copies of HBV DNA in sera were dynamically detected by real-time PCR.Results The levels of ICOS on CD4+ T cells in patients with chronic hepatitis B was higher than that of normal controls(P＜0.001 ).However,the expressions of ICOS on CD4+ T cells in patients could be deduced by PEG-IFN-α 2a and obviously decreased after treatment.There was significant difference between interferon group and lamivudine group (P＜0.05 in 24 weeks,and P＜0.01 in 48 weeks).After treatment,the change values of ICOS in interferon group was positively correlated with the change copies of HBV DNA (r =0.972,P＜0.001 ).However,the change values mentioned above that did not find correlation in lamivudine group(r=-0.101,P=0.608).Conclusion The study shows the patients with chronic hepatitis B have disordered in cellular immunity and increased with the expression of ICOS on CD4+ T cells.PEG-IFN-α 2a could decrease the expression of ICOS on CD4+ T cells in patients,and correct the Th2 type immune polarization to some extent,and that plays a positive role in antiHBV.

Objective To investigate the duration for silicon gastric tube to indwell in stomach of aged patients.Methods One hundred elderly patients needing long-term nutrition support were equally randomized into two groups: control group and observation group.The former had the gastric tubes indwelled in the stomach for 4 weeks and the latter for 3 weeks.The two groups were compared about the used tubes in terms of the color of tube at the length of the first 10cm,the indentation by reflection for 10 seconds at the tube of first 10 cm,the hardness of the tube at the length of the first 10 cm and the springback angle of tube at the first 10cm after reflection.Results The tubes in the observation group were significantly better than those in the control group in terms of color,indentation,hardness and springback angle(all P<0?01).Conclusion The duration of indwelling silicon gastric tubes in stomach can be three weeks for old patients needing long-term nutrition support via indwelling silicon tubes in their stomach.

Objectives To compare the safety and efficacy of radial artery access versus femoral artery access for percutaneous coronary intervention in acute myocardial infarction population. Methods From June 2004 to December 2006, 446 patients with acute myocardial infarction treated with percutaneous stenting were reviewed retrospectively. The radial artery approach was used in 242 patients, and the femoral artery approach in 204 patients. The success of the procedure, procedure duration, X-ray exposition, volume of contrast, incidence of major adverse cardiac events and complications were compared between the radial artery and femoral artery approach. Results Total procedure duration, X-ray exposition, the immediate success of the procedure and the proportion of patients with reperfusion time above 60min are higher in patients with radial artery acess than that with femoral artery access [(62. 1 ± 23. 4) min vs(56. 8 ± 16. 7)min,(2829. 4 ± 1365.2) mGY vs (2352. 3 ± 903.1) mGY, 4% vs 0.9% and 7.44% vs 2.94%respectively, all P ＜ 0. 05]. Conclusions In non-selected patients with acute myocardial infarction treated with primary stent implantation, the success rate of the radial artery approach is lower than the femoral artery approach and could prolong the reperfusion time. It is suitable to change artery access immediately if abnormality is found via radial artery access.

In this article,from the view of the cognitive structure,we talk about the role of transfer of learning in medical innovative education,and propose the strategies on how to increase the positive transfer of learning through the rational organization of teaching contents,improved teaching methods,highlighting the dominant status of student to raise innovative talents.

Objective To evaluate the values of maternal serum levels of lipid and uric acid at second trimester in predicting preeclampsia,gestational diabetes mellitus and macrosomia. Methods Concentrations of selected metabolic markers including total cholesterol,triglyceride,low density lipoprotein-cholesterol,high density lipoprotein-cholesterol,apolipoprotein AI,apolipoprotein B and uric acid were examined in 1000 healthy singleton primiparous who accepted regular prenatal healthcare in Naniing Drum Tower Hospital,at 20 weeks of gestation from June 2009 to January 2010.All the pregnant women were followed up to their deliveries.Pregnancy complications,such as preeclampsia and gestational diabetes mellitus (GDM),the data of maternal and neonatal outcomes such as gestational age at delivery,neonatal birthweight were recorded.Relationship between adverse outcome and blood lipid,uric acid levels was analyzed by Logistic regression,and the risk factors were confirmed; predictive values of those sensitivity and specificity were calculated by receiver operating characteristic curve. Results Among the 1000 pregnant women, 61 (6.1％) developed preeclampsia and 100 (10.0％) developed GDM.The mean gestational age of delivery was (39.3±1.2) weeks,and the incidence of preterm delivery was 1.5％ (15/1000).The mean birthweight was (3389.6±4 422.8) g,and the prevalence of macrosomia was 8.9％ (89/1000).Women who had elevated triglyceride levels had a 3.42-fold increased risk of preeclampsia (95 ％ CI:1.88-6.22,P =0.000) and 2.12-fold increased risk of GDM (95％ CI:1.38-3.35,P =0.001).Hyperuricemic women experienced a 2.09-fold increased risk of preeclampsia (95％CI:1.24-3.53,P=0.005) and 2.22-fold increased risk of GDM (95％CI:1.32-3.43,P=0.002).Women who had decreased high density lipoprotein-cholesterol level experienced a 2.34-fold increased risk of preeclampsia (95 ％ CI:1.20-4.55,P =0.011),2.03-fold increased risk of GDM (95 ％ CIr:1.33-3.11,P =0.001 ) and 1.67-fold increased risk of macrosomia (95％CI:1.06-2.64,P=0.026).The area under receiver operating characteristic curve of these metabolic markers was 0.56-0.65, the sensitivity was 28％-82％ and the specificity was 34％-85％. Conclusions Hypertriglycemia,hyperuricemia,and hypo high density lipoprotein-cholesterolcmia at 20 weeks of gestation might relate to preeclampsia,GDM and macrosomia,but the predictive values of them are limited.

Objective To evaluate the clinical effectiveness of the treatment for hip osteoid osteoma by CT-guided percutaneous microwave ablation. Methods From August 2006 to January 2010, 8 patients with the osteoid osteomas of the hip were treated with CT-guided percutaneous microwave ablation, including 5 males and 3 females with an average age of 18.8 years (range, 12 to 25). The history of local pain was ranging from 2 months to 10 years, with aggravation of pain at night. The locations of the lesions contained: 4cases in the neck of femur, 2 in the lesser trochanter, 1 in the greater trochanter and 1 in the femoral intertrochanteric line. After localization of the nidus with CT, osseous access was established with a Gallini puncturatio needle. After scanning the nidus with CT, a trocar was used to obtain specimens for pathological examination. Subsequently, a microwave probe was introduced through the biopsy needle to the nidus. Microwave ablation was performed at 90 ℃ for 4 to 6 minutes. Prophylactic antibiotics were used two days postoperatively. Results Three patients were diagnosed as osteoid osteoma with the pathological confirmation after the operation, 5 cases were not diagnosed by the pathological confirmation. All the cases were followed up for 6 to 21 months. All the patients reported alleviated pain in the first 24 hours postoperation. One case with lesion in the right proximate femur retained mild pain without nonsteroidal antiinflammatory drugs 5 month after operation. The same procedure was done once more on this patient, and the outcome was good. No osteonecrosis of the femoral head and other complications were observed in all patients. Conclusion By CT-guided percutaneous microwave ablation for osteoid osteomas of hip reliably relieves pain with few complications and recurrences. The short-term efficacy is satisfactory. It is a safe and effective technique for treatment of osteoid osteoma.

AIM: To investigate the effect of mfn2 on mitochondrial function in steatosis hepatocytes. METHODS: Plasmid pEGFP-mfn2 was transfected into hepatocyte strain L02 by Lipofectamine 2000 in vitro, then the steatosis model of hepatocytes was establish by oleic acid induction. RT-PCR was used to evaluate mRNA expression and Western blotting was use to detect the protein expression. ATP level was determined by firefly luciferase bioluminescent. ROS production was measured by fluorescence probe DCFH-DA. Chondrosome transmembrane potential of L02 was observed by labeling of JC-1 and FCM. RESULTS: The stable expression of ectogenesis mitofusin2 in L02 cells was confirmed by RT-PCR and Western blotting. In the model of oleic acids induced lipid formation, Mfn2 obviously inhibited the descent of chondrosome transmembrane potential and ATP level, and increased ROS production in L02 cells. CONCLUSION: Up-regulated expression of mfn2 attenuates mitochondria dysfunction caused by oleic acids induced lipid formation.

Objective To study the value of magnetic resonance diffusion tensor imaging(MR-DTI) in evaluating the severity of liver cirrhosis.Methods Seventeen patients with Child A liver fibrosis (age=35.0+11.8 years,14 males and 3 females),12 with Child B(age=44.7+14.0 years,5 males and 7 females) and 8 with Child C(age=48.7+7.6 years,3 males and 5 females) were recruited.All patients had clinical data and serum makers in full.Fifty normal controls (age=35.2+14.2,28 males and 22 females) were also recruited.Diffusion tensor imaging(DTI) was performed in all subjects using a GE Propeller HD 1.5T MR scanner by employing a spin echo single-shot EPI(echo planar imaging) sequence.Average diffusion coefficient(DCave) and fractional anisotropy(FA) maps were generated from each P articipants DTI scan using AW 4.2 functool software.All the statistic analysis was performed in SPSS 13.0 , and P value of less than 0.05 was deemed to be significant . Results DCave values were 1.54±0.25 ,1.33±0.18 ,1.02±0.12 ,0.66±0.27 in control group and Child A , B , C respectively , the FA values were 0.46±0.10, 0.42±0.08, 0.56±0.05,0.71±0.41 in control group and Child A, B, C respectively. Significantly low DCave and changed FA in liver fibrosis group were found(P< 0. 05). Among the four groups, significant differences were found in DCave values and FA values(P<0.05) except control group VS Child A group in FA values(P=0.54).Conclusion MR-DTI is relevant to the severity of liver cirrhosis, and may be a useful tool for evaluating the severity of liver cirrhosis.

Aim To observe the effect of ZDY102, a C25 stereo-isomer of ZMS, the active component of Zhimu, on brain M receptor density of dementia model animals and the correlation with its effect on learning/memory ability. Methods The rats were randomly divided into five groups: control group, model group, model given orally for 2 months with 3.6 mg?kg -1?d -1 of ZDY102 treatment, model treated with 9.0 mg?kg -1?d -1 of ZDY102, and model treated with 18.0 mg?kg -1?d -1 of ZDY102. Dementia model was produced by single unilateral injection of 4 ?l of normal saline containing 4 ?g of ?-amyloid (25～35) and 1 ?g of ibotenic acid into right basal ganglion region with the aid of a stereotaxic equipment. The brain muscarinic receptor density was analyzed with single-site binding assay using 3H-quinuclidinyl benzilae(QNB). The learning/memory ability was measured by Y-maze performance. Results Two months after model production, the learning and memory ability as well as the density of muscarinic receptor in brain were significantly decreased in model rats compared with those in control rats. Parallel models treated with daily oral administration of ZDY102 for two months improved in learning and memory ability and their muscarinic receptor density was significantly increased when compared with model rats. The correlation coefficient between total M receptor densities and the learning/memory ability was significant when examined with linear regression. Conclusion ZDY102 can significantly improve the learning and memory ability and increase the brain muscarinic receptor density of the model. Since brain muscarinic receptors are closely correlated to learning and memory, up-regulation of M receptor density might play a very important role in the therapeutic effect of ZDY102.

Objective To design two-point two-line vein pricking for avoiding pain for patients and blood osmosis out of the vein caused by the high-pressure and fast-speed of the current high-pressure injector.Methods 19G butterfly-wing vein transfusion needle in the length of 19mm was used.The first point was needled with the needle tip under the skin and the first needling line was above and parallel the blood vessel in the length of 10-12mm.The second point was needled,with the second needle tip and needle line in the blood vessel,and the length of needling is 7-9mm.Results 100 persons were subjected.All the contrast medium and the physiologic saline were injected in vein in 98 persons,among which 2 had little hard tubercle in injecting area.Conclusion The two-point two-line vein pricking is safe for high pressure injector injecting in vein,and can prevent blood osmosis out of the vein.