Objective To evaluate the clinical value of ultrasonography guided percutaneous core needle biopsy in pancreatic lesions. Methods Thirty-four patients with 36 pancreatic lesions in Shanghai First People′s Hospital Afifliated to Shanghai Jiao Tong University from February 2012 to November 2013 underwent conventional ultrasound-guided percutaneous core needle biopsy using automatic gun and 18-gauge biopsy needles. The site, size, internal and surrounding vascularity, the sampling number of the lesions, and whether the specimens′ quality was satisfied were recorded. Then specimens were sent for pathological examination, and all above observations were compared with the ifnal diagnosis. Results The number of lesions with 2, 3 and 4 samplings was 32, 2 and 2, respectively. The average number of sampling was 2.2 (mean, 2.17;standard deviation, 0.51) and the acquisition rate of satisifed specimens was 89%(32/36). The pathological results of biopsy were malignant in 31 of 36 lesions including 27 cases of ductal adenocarcinoma, 2 cases of lymphoma, 1 case of small cell neuroendocrine carcinoma and 1 case of uterine leiomyosarcoma metastasis. The other 5 lesions were non-malignant including 3 cases of benign lesion, 1 cases of atypical hyperplasia and 1 cases of granulation tissue. The 36 lesions were ifnally diagnosed as 34 cases of pancreatic malignancy, 2 cases of non-malignant neoplasm. The sensitivity, speciifcity, accuracy, positive predictive value and negative predictive value of ultrasonography guided percutaneous core needle biopsy in pancreatic lesions were 91%(31/34), 100%(2/2), 92%(33/36), 100%(31/31) and 40%(2/5), respectively. Youden index was 0.91. Two patients had mild upper abdominal pain and 1 patient had transient elevated serum amylase. No pancreatitis, pancreatic fistula, peritonitis, bleeding or dispersion of malignant cells along the penetrating channel or other serious complications occurred. Conclusion Ultrasonography guided percutaneous core needle biopsy is a simple, rapid, safe and effective diagnostic method in pancreatic lesions with high clinical value.

OBJECTIVETo screen the differentially expressed proteins especially at the precancerous stage of diethylnitrosamine (DEN) induced hepatocarcinogenesis by comparative proteome research.

METHODSRats were divided into normal and DEN groups and sacrificed periodically. The liver samples were stained with gamma-glutamyl transpeptidase (GGT) and HE to distinguish the preneoplastic lesion (pre-HCC) from the normal and HCC tissues. The two-dimensional electrophoresis (2-DE) and mass spectrometry (MALDI-TOF-MS/MS) were then applied to analyze the differentially expressed protein between pre-HCC and normal tissues, pre-HCC and HCC, as well as HCC and normal tissues. A few of the candidate proteins such as laminin receptor 1 (67LR) and agmatinase were validated by Western blot and RT-PCR.

RESULTSTotally, there were 82 proteins that differentially expressed two fold or more in one kind of tissues sample than the other, 47 of which occurred in the pre-HCC tissues. Eight proteins including 67LR were consistently up-regulated from normal tissue to pre-HCC and then to HCC tissues, while 22 proteins including agmatinase showed progressively down-regulated in these tissues samples.

CONCLUSIONThe protein expression profiles are different during the process of hepatocarcinogenesis. Further study on the differentially expressed protein, especially these upregulated in the precancerous stage such as 67LR and agmatinase, might contribute to prevention and early diagnosis of human HCC.

Animals ; Blotting, Western ; Carcinoma, Hepatocellular ; chemically induced ; metabolism ; pathology ; Diethylnitrosamine ; Liver ; metabolism ; pathology ; Liver Neoplasms, Experimental ; chemically induced ; metabolism ; pathology ; Male ; Neoplasm Proteins ; metabolism ; Precancerous Conditions ; metabolism ; pathology ; Proteins ; metabolism ; Proteome ; Rats ; Rats, Wistar ; Receptors, Laminin ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization ; Ureohydrolases ; metabolism ; gamma-Glutamyltransferase

BACKGROUNDThe interaction between activated microglia and T lymphocytes can yield abundant pro-inflammatory cytokines. Our previous study proved that thymus immune tolerance could alleviate the inflammatory response. This study aimed to investigate whether intrathymic injection of myelin basic protein (MBP) in mice could suppress the inflammatory response after co-culture of T lymphocytes and BV-2 microglia cells.

METHODSTotally, 72 male C57BL/6 mice were randomly assigned to three groups (n = 24 in each): Group A: intrathymic injection of 100 μl MBP (1 mg/ml); Group B: intrathymic injection of 100 μl phosphate-buffered saline (PBS); and Group C: sham operation group. Every eight mice in each group were sacrificed to obtain the spleen at postoperative days 3, 7, and 14, respectively. T lymphocytes those were extracted and purified from the spleens were then co-cultured with activated BV-2 microglia cells at a proportion of 1:2 in the medium containing MBP for 3 days. After identified the T lymphocytes by CD3, surface antigens of T lymphocytes (CD4, CD8, CD152, and CD154) and BV-2 microglia cells (CD45 and CD54) were detected by flow cytometry. The expressions of pro-inflammatory factors of BV-2 microglia cells (interleukin [IL]-1β, tumor necrosis factor-α [TNF-α], and inducible nitric oxide synthase [iNOS]) were detected by quantitative real-time polymerase chain reaction (PCR). One-way analysis of variance (ANOVA) and the least significant difference test were used for data analysis.

RESULTSThe levels of CD152 in Group A showed an upward trend from the 3rd to 7th day, with a downward trend from the 7th to 14th day (20.12 ± 0.71%, 30.71 ± 1.14%, 13.50 ± 0.71% at postoperative days 3, 7, and 14, respectively, P < 0.05). The levels of CD154 in Group A showed a downward trend from the 3rd to 7th day, with an upward trend from the 7th to 14th day (10.00 ± 0.23%, 5.28 ± 0.69%, 14.67 ± 2.71% at postoperative days 3, 7, and 14, respectively, P < 0.05). The ratio of CD4+/CD8 + T in Group A showed a downward trend from the 3rd to 7th day, with the minimum at postoperative day 7, then an upward trend from the 7th to 14th day (P < 0.05). Meanwhile, the levels of CD45 and CD54 in Group A were found as the same trend as the ratio of CD4+/CD8 + T (CD45: 83.39 ± 2.56%, 82.74 ± 2.09%, 87.56 ± 2.11%; CD54: 3.80 ± 0.24%, 0.94 ± 0.40%, 3.41 ± 0.33% at postoperative days 3, 7, and 14, respectively, P < 0.05). The expressions of TNF-α, IL-1β, and iNOS in Group A were significantly lower than those in Groups B and C, and the values at postoperative day 7 were the lowest compared with those at postoperative days 3 and 14 (P < 0.05). No significant difference was found between Groups B and C.

CONCLUSIONSIntrathymic injection of MBP could suppress the immune reaction that might reduce the secondary immune injury of brain tissue induced by an inflammatory response.

Animals ; Anti-Inflammatory Agents ; pharmacology ; Antigens, Surface ; analysis ; Brain Injuries, Traumatic ; drug therapy ; CD4-CD8 Ratio ; Coculture Techniques ; Male ; Mice ; Mice, Inbred C57BL ; Microglia ; immunology ; Myelin Basic Protein ; administration & dosage ; pharmacology ; T-Lymphocytes ; immunology

Objective: To evaluate the efficacy of articular compression molding techniques in the surgery for acetabular posterior wall fracture. Methods: A retrospective study was conducted of the 28 patients (28 hips) with fracture of acetabular posterior wall plus comminuted compression of articular surface who had been treated using the articular compression molding techniques at Department of Orthopedics, The Hospital of 81 Group Army of PLA from January 2014 to January 2018. They were 25 males and 3 females, aged from 26 to 63 years (average, 49.3 years). The time from injury to surgery ranged from 4 to 12 days (average, 7.8 days). According to the Letournel-Judet classification, all were single element (simple) posterior wall fractures combined with posterior dislocation of the femoral head and articular compression of different degrees; transient sciatic nerve injury was complicated in 12 cases. The posterior hip dislocations were timely and successful reset at emergency treatment. The compression fractures of the posterior wall and hip joint were treated by open reduction and internal fixation via the acetabular posterior (K-L) approach. The articular compression was treated by 4 stabilization techniques: absorbable screwing and blocking technique in 10 cases, indwelling screwing in 12 cases, indwelling Kirschner wiring in 2 cases and die push and squeeze tamping in 4 cases. The operation time, intraoperative bleeding and complications were recorded. The therapeutic efficacy was evaluated by the modified Merle d’Aubigne & Postel scoring criteria at the final follow-up. Results: The operation time lasted from 76 to 118 minutes (average, 94.2 minutes); the intraoperative bleeding ranged from 100 to 320 mL (average,220.8 mL). No incision liquefaction, infection or other complications occurred. The 28 patients were followed up for 10 to 36 months (average, 17.6 months). According to the Matta scoring criteria, 24 cases achieved anatomical reduction but 4 dissatisfactory reduction. By the modified Merle d’Aubigne & Postel scoring criteria at the final follow-up, the efficacy was evaluated as excellent in 26 cases and as good in 2. Heterotopic ossification was observed in 3 cases and microscopic free dense shadow in the joint cavity (about 2 mm in the round ligament) in 3 cases. There were no cases of obvious traumatic arthritis or osteoarthritis, femoral head necrosis, walking pain, lameness or hip abduction weakness. The 12 patients complicated with preoperative transient sciatic nerve injury recovered within 3 months after surgery. Conclusion The articular compression molding techniques can effectively treat severely comminuted articular compression in the acetabular posterior wall fracture and improve reduction of articular surface and hip joint matching, leading to stability and good joint function.

Multiple organs are physiologically and pathologically interconnected during aging, and the brain plays a central role in this process. There is a direct two-way communication between the brain and the gut called “brain-gut interaction”, which is of great significance for the study of aging, and the molecular mechanism remains to be further studied. The aim of this study is to explore the mechanism of aging in the context of brain-gut interaction. The results of general physical signs of mice showed that the amount of exercise decreased, body weight and food intake decreased significantly in aged mice (P < 0. 001, P<0. 05). The thymus index of aged mice was significantly lower than that of normal mice (P< 0. 05), and the thymic pathological results showed that the thymic cortex of aging mice was thinner, the boundary between medulla and cortex was blurred, and the cells were loosely arranged. Metabolomics analysis revealed 317 differential metabolites in feces and 100 differential metabolites in hippocampus. The results of microbiome showed that Bacteroidetes and Firmicutes were the dominant phyla of gut microbiota. Bacteroidetes showed an upward trend and Firmicutes showed a downward trend after aging. KEGG pathway results showed that 26 metabolic pathways were related to the study of aging, among which galactose metabolism, ABC transporter and purine metabolism were of great significance for the brain-gut interaction. The results of Spearman correlation analysis of the three groups showed that the types of metabolites involved were mainly lipids and lipid-like molecules and organic acids and derivatives, and the gut microbiota involved were mainly Bacteroidetes and Firmicutes. In conclusion, the present study demonstrated that the synergistic changes between brain and gut in aging mice were related to the mechanism of aging, which provided new insights into the mechanism of aging process.

Aged ; Atherosclerosis ; Case-Control Studies ; Coronary Artery Bypass ; methods ; Coronary Artery Disease ; surgery ; Female ; Hemodynamics ; physiology ; Humans ; Male ; Mammary Arteries ; physiology ; transplantation ; Middle Aged ; Pulsatile Flow ; Radial Artery ; physiology ; transplantation ; Rheology ; Saphenous Vein ; physiology ; transplantation ; Shear Strength ; Stress, Mechanical ; Vascular Patency ; physiology

Objectives:To describe and summarize international evidences on policies and programs for training health personnel in rural areas,to identify best practice to increase health manpower in rural areas, and to provide references for China's policy of targeted admission program. Methods:This is a literature review based research. 48 literatures in Chinese and English were selected about the training of health professionals in rural areas at home and a-broad. Thematic framework approach was applied to review and analyze the related strategies and practices,and les-sons learned. Results: Common measures to train health personnel in rural areas included: enrollment of students with a rural background,tutoring system in medical training,internship in rural health institutions, financial incen-tives,and compulsory rural services after graduation. Lessons learnt:(1) adequate financial resources are a prereq-uisite for smooth program implementation;(2) Good project management and evaluation are critical aspects of effec-tive project implementation;(3) choosing the right combination of various practices to implement such projects can improve effectiveness. Conclusions:The policy of targeted admission program is suitable for China's current situation. Meanwhile,international experiences can provide valuable lessons to improve China's program design and implemen-tation and these include:increasing capital investment,strengthening management and evaluation,and strengthening sector cooperation to further improve targeted admission program.

Objective To analyze the resistance proifle of bacterial strains isolated from geriatric patients in 17 hospitals across China from 2005 to 2014.Methods A total of 17 representative general hospitals were involved in this program. Bacterial susceptibility testing was carried out by means of a uniifed protocol using Kirby-Bauer method and MIC determination. The results were analyzed according to CLSI 2014 breakpoints.Results The proportion of the strains isolated from geriatric patients among all the clinical isolates increased with time from 30.0% in 2005 to 32.7% in 2014. A total of 159 888 clinical isolates were collected from geriatric patient during the period from 2005 to 2014, about 33.1% of the whole patient population. Gram negative organisms and gram positive cocci accounted for 77.1% (123 229/159 888) and 22.9% (36 659/159 888), respectively. Majority (92.8%, 148 376/159 888) of the isolates were from inpatients and more than half (55.2%, 88 201/159 888) of the isolates were from sputum or other respiratory tract specimens. Methicillin-resistant strains inS. aureus (MRSA) and coagulase negativeStaphylococcus (MRCNS) accounted for an average of 67.1% and 75.9%, respectively. The resistance rates of methicillin-resistant strains to β-lactams and other antimicrobial agents were much higher than those of methicillin-susceptible strains. No staphylococcal strains were found resistant to vancomycin, teicoplanin or linezolid. Some strains ofE. faecalis (0.4%) andE. faecium (4.6%) were resistant to vancomycin, which was higher than average national level (0.3%, 3.2%). Vancomycin-resistant strains ofE. faecalisandE. faecium were mainly VanA type and VanB type based on their phenotype. The prevalence of penicillin-susceptibleS. pneumoniae strains was 78.2%, slightly lower than the 95.0% in Chinese adults in year 2014. The prevalence of ESBLs-producing strains was 67.5% inE. coli, 40.4% inKlebsiella (K. pneumoniae andK. oxytoca) and 34.3% inProteus mirabilis isolates on average. The strains ofEnterobacteriaceae were still highly susceptible to carbapenems (<10% resistant), followed by amikacin and the beta-lactam and beta-lactamase inhibitor combinations. Overall, 35.9% and 33.0% of theP. aeruginosa strains were resistant to imipenem and meropenem. More than 50% of theA. baumannii strains were resistant to imipenem and meropenem. The prevalence of extensively drug-resistant (XDR)P. aeruginosa (4.0%-1.8%) was higher than the average national level (2.1%-1.6%). The prevalence of XDR A. baumannii (19.2%-15.5%) and XDREnterobacteriaceae (0.1%-1.0%) was lower than the average national level (21.4%-19.7% and 0.3%-3.2%).Conclusions The proportion of clinical isolates from geriatric patients is different from average national level at the same period. The isolates from geriatric patients are more likely from inpatients, respiratory tract specimens and more likely non-fermentative gram-negative bacilli compared to average national level. The proportion of fastidious bacteria andEnterobacteriaceae species is generally lower than average national level. MRSA, VRE, ESBLs-producing strains and XDRP. aeruginosa are more prevalent in geriatric patients than in general Chinese patient population. This study suggests that surveillance of antimicrobial resistance for the clinical isolates from geriatric patients is very important for rational antimicrobial therapy.

Objective To investigate the distribution and changing resistance proifle ofSalmonella isolates in hospitals across China during the period from January 2005 to December 2014.Methods Seventeen general hospitals and two children’s hospitals were involved in this program. Antimicrobial susceptibility testing was carried out by means of a unified protocol using Kirby-Bauer method or MIC determination. The results were analyzed according to CLSI 2014 breakpoints.Results The proportion ofSalmonella isolates increased with time from 0.2% in 2005 to 0.7% in 2014. A total of 3 478Salmonella strains were collected from 19 hospitals. The proportion ofSalmonella typhimurium andSalmonella enteritidis was 27.4% and 24.4%, respectively. During the 10-year period, theSalmonella strains showed highest resistance rate to ampicillin (33.3%-64.8%), but low resistance to cefoperazone-sulbactam (0-5.3%) and ciprofloxacin (2.4%-14.3%).S. typhimurium showed higher resistance rate thanS. typhi,S. paratyphi andS. enteritidis. About 76.8% and 50.5% ofS. typhimurium were resistant to ampicillin and trimethoprim-sulfamethoxazole. The average prevalence of multi-drug resistantSalmonellawas 3.9% in the ten-year period, the highest (7.5%) was in 2005, the lowest (1.5%) in 2013.Conclusions During the period from 2004 to 2015, majority of theSalmonella isolates in hospitals across China wasS. typhimurium andS. enteritidis. Ampicillin and trimethoprim-sulfamethoxazole are no longer appropriate for empirical treatment ofS. typhimurium infection due to high resistance rate.Salmonella isolates are relatively more susceptible to third-generation cephalosporins and quinolones. Ongoing monitoring is necessary to identify multi-drug resistant strains ofSalmonella.

Objective To understand the changing resistance proifle ofProteus,Serratia,Citrobacter,Morganella andProvidencia in hospitals across China according to the data from CHINET Antimicrobial Resistance Surveillance Program 2005-2014.Methods Antimicrobial susceptibility was tested by using Kirby-Bauer method or automatic minimum inhibitory concentration determination according to a uniifed protocol.Results A total of 21 663 clinical isolates were collected from January 2005 to December 2014. The proportion ofProteus andSerratia isolates increased with time from 1.41% in 2005 to 2.09% in 2014, and from 0.99% in 2005 to 1.28% in 2014 among all the isolates. No change was found for the proportion ofCitrobacter,Morganella, orProvidencia. Less than 10% of theProteus isolates were resistant to cefoperazone-sulbactam, piperacillin-tazobactam, ceftazidime, cefoxitin, amikacin and tigecycline. Less than 10% of theSerratia isolates were resistant to cefoperazone-sulbactam, piperacillin-tazobactam, amikacin and tigecycline. Less than 20% of theCitrobacter isolates were resistant to cefoperazone-sulbactam, piperacillin-tazobactam, cefepime, amikacin and tigecycline. Less than 10% of theMorganella isolates were resistant to cefoperazone-sulbactam, piperacillin-tazobactam, cefepime, amikacin and tigecycline. Less than 20% of theProvidencia isolates were resistant to cefoperazone-sulbactam, piperacillin-tazobactam, cefepime, cefoxitin and tigecycline.Conclusions The antibiotic resistance ofProteus,Serratia, Citrobacter,Morganella andProvidencia isolates in hospitals across China is growing during the period from 2005 to 2014. Strengthening infection control and rational antibiotic use are effective to slow the growth of drug resistance.