Objective To investigate the influence of hydroxyethyl starch solution on exogenous coagulation and active protein C (APC) in the patients with septic shock.Methods A single-center prospective study was conducted.Eighty-four consecutive patients with septic shock admitted to intensive care unit (ICU) of Peking University People's Hospital from November 2009 to October 2014 were enrolled.The patients were randomized into two study groups by random digits table:Ringer lactate solution group (RL group,n =40) and hydroxyethyl starch group (HES group,n =44),and Ringer lactate solution or hydroxyethl starch 130/0.4 was used for resuscitation respectively.Peripheral blood was collected at four time points:before resuscitation,6,12,and 24 hours after resuscitation.The prothrombin time (PT),tissue factor (TF),tissue factor pathway inhibitor (TFPI) and APC were determined,and the length of ICU stay and the mortality were recorded.Results There were no significant differences in PT,TF,TFPI,and APC before and after resuscitation in RL group.No change in PT was found after resuscitation in HES group,and no significant difference was found as compared with RL group.TF after resuscitation in HES group was decreased gradually,and the level at the 24 hours after resuscitation was significantly lower than that before resuscitation (U/L:15.80±7.32 vs.31.40±2.75,P ＜ 0.05); but there was no significant difference at all time points when compared with that of RL group (all P ＞ 0.05).TFPI at 12 hours and 24 hours after resuscitation in HES group was increased when compared with before resuscitation (μg/L:1.32±0.22,1.14±0.09 vs.0.63±0.54).TFPI in HES group was significantly higher than that in RL group (μg/L:0.84 ± 0.69,0.95 ± 0.30),but there was no significant differences between two groups (both P ＞ 0.05).APC after resuscitation in HES group was decreased gradually,which was significantly lower than that in RL group at 6,12,24 hours after resuscitation (mg/L:3.38±3.00 vs.5.98±4.12,3.31 ± 1.94 vs.5.33 ± 3.71,3.42 ± 2.64 vs.7.53 ± 4.67,P ＜ 0.05 or P ＜ 0.01).The length of ICU stay in HES group was significantly shorter than that in RL group (days:12.50 ± 8.83 vs.17.10± 16.60,t =9.037,P ＜ 0.001),but there was no significant difference in mortality between HES group and RL group [40.9％ (18/44) vs.60.0％ (24/40),x 2=2.339,P =0.126].Conclusions Both RL and hydroxyethyl starch fluid resuscitation did not affect the PT of the patients.The use of hydroxyethyl starch probably inhibits excessive activation of the exogenous coagulation and hyper-coagulation in the early stage of sepsis,and inhibits activation of protein C as well.

Objective To investigate the influences of Xuebijing injection on organs' ultra-microstructure in septic shock rats. Methods Fifteen male Sprague-Dawley (SD) rats of clean grade were selected. According to the method of random digits table, all of them were divided into three groups: sham operation group, model group and Xuebijing treated group, 5 rats being in each group. Cecal ligation and puncture (CLP) was adopted to reproduce abdominal cavity infection leading to sepsis model formation. While the rats in sham operation group just underwent abdominal median incision, abdominal exploration and closure of abdominal wall after flipping retrocecal region. In the Xuebijing treated group, within 1 hour after the operation, Xuebijing injection (4 mL/kg) was transfused through the catheter inserted in the femoral vein, and then normal saline (2 mL·kg-1·h-1) was continuously transfused until the rat being sacrificed. In the sham operation group and model group, equal volume of normal saline was given after operation. The blood pressure of all the rats was monitored continuously by a pressure device connected with a catheter inserted in the right carotid artery. The rats were observed for 12 hours, afterwards they were sacrificed, the samples of heart, lung, kidney and liver were taken, and their ultrastructural changes were observed under an electron microscope. Results The blood pressure of sham operation group was decreased a little with time extension, but within normal limits. The mean arterial pressure (MAP) of model group and Xuebijing treated group developed into a state of sepsis shock at 9 hours and 10 hours after operation respectively, and MAP were lower than 70 mmHg (1 mmHg=0.133 kPa). The MAP levels of model and Xuebijing groups at 11 hours after operation were lower significantly than those of sham operation group (mmHg:58.7±7.0, 58.7±8.3 vs. 91.0±8.2, both P<0.01), and they were persistently decreased at 12 hours after operation;the MAP in Xuebijing group was a little higher than that of model group at the same period (mmHg:55.4±4.0 vs. 48.8±12.9, P>0.05). The results of the observation with electron microscope:the structures of heart, lung, liver and kidney in sham operation group were basically normal;all the organs of model group appeared different degrees of structural damage. Compared with model group, the injury of heart and lung in Xuebijing treated group was milder, especially, the changes of cellular mitochondria were obvious;however, there was no significant difference in injury of kidney and liver between the model and Xuebijing treated groups. Conclusion Xuebijing injection can play a certain role in stabilizing the circulatory system in rats with septic shock, and can possibly ameliorate the heart and lung damage caused by infection and shock.

Objective To evaluate the effects of aerobic combined strength and balance exercise on cognitive function and satisfaction in patients with cognitive impairment no dementia. Methods Four hundred and twenty patients with cognitive impairment no dementia were divided into control group (200 cases) and experimental group (220 cases) by random digits table method. The control group received general health education and rehabilitation training. The experimental group received aerobic combined strength and balance exercise. The patients were assessed with Montreal Cognitive Assessment (MoCA) to evaluate their cognition before training, as well as after training. And the patients′satisfaction with the questionnaire was evaluated. Results The total scores of MoCA, scores of name, attention, language, memory and directionafter training were (23.47 ±2.38), (2.77 ±0.42), (5.09 ±0.86), (2.50 ±0.65), (3.42 ±0.68), (5.03 ± 0.10) points in the experimental group, and (21.20±2.55), (2.31±0.76), (4.71±1.10), (2.35±0.70), (2.23±0.81), (4.48±0.96) points in the control group, and there were significant differences, P<0.05. There were no significant differences in the space and abstract thinking between experimental group and control group:(3.61±0.91) points vs. (3.45±1.09) points, (1.83±0.76 ) points vs. (1.72±0.52) points, P>0.05. The scores of satisfaction in the experimental group was significantly higher than that in the control group:(49.33 ±1.57) points vs. ( 48.20 ±2.14) points, P<0.01. Conclusion The application of aerobic combined strength and balance exercise could improve the cognitive function and patients′satisfaction.

Objective To investigate the relationship between personal disposable income and female depression,and to examine the moderating roles of personality in this link.Methods The demographic questionnaire,self-rating depression scale (SDS) and eysenck's personality questionnaire short scale (EPQ-RSC) were used to survey 139 cases of married female patients with depression.Results Personal disposable income could be used to significantly and negatively predict female depression(β=-0.669,P＜0.01).The interaction between personal disposable income and introversion-extroversion,personal disposable income and neuroticism was significant (β=0.142,P＜0.05.β=-0.232,P＜0.01).In the groups of higher and lower scores on the introversion-extroversion dimension,personal disposable income could be used to significantly predict female depression(β=-0.397,P ＜0.05.β=-0.452,P＜0.05).In the group of higher scores on the neuroticism dimension,personal disposable income could be used to significantly predict female depression(β=-0.553,P＜0.01),but not in the group of lower scores(β=-0.349,P＞0.05).Conclusion Personal disposable income has significantly negative prediction effect on female depression,and introversion-extroversion and neuroticism have significant moderating effects on the relationship between personal disposable income and female depression.

Objective To explore the application value of plastic biliary stent and fully covered self-expandable metallic stent (FCSEMS) in endoscopic retrograde cholangio pancreatography (ERCP) for treatment of benign biliary stricture after liver transplantation.Methods The retrospective cross-sectional study was conducted.The clinical data of 54 patients with benign biliary stricture after liver transplantation undergoing ERCP treatment who were admitted to the First Affiliated Hospital of Xi'an Jiaotong University between January 2010 and August 2016 were collected.Among 54 patients,44 had simple anastomotic stricture and 10 had non-anastomotic stricture.All the patients underwent stent implantation by ERCP.Patients with stricture within 1 month postoperatively initially selected single plastic stent or endoscopic nasobiliary drainage (ENBD),and then changed into multiple plastic stents at the second stent replacement.Patients with stricture after 1 month postoperatively selected multiple plastic stents,multiple plastic stents after balloon dilation or FCSEMS.Observation indicators:ERCP situations,stent implantation,time of stent indwelling,postoperative complications,stent dislocation,treatment outcome and follow-up situations.Patients were followed up by outpatient examination and telephone interview up to November 2016.Clinical symptoms of patients were observed within 1 month postoperatively and liver function and abdominal ultrasound were retested.Liver function and remission degree of biliary stricture were monitored regularly once every 3 months.Measurement data were described as average (range).Results All the patients underwent successful ERCP,of which 53 completed the process of ERCP and 1 rejected treatment due to economic problems.All the 54 patients received 140 times ERCPs with an average of 2.59 times per person,21 times ENBDs,11 times FCSEMSs and 108 times plastic stent implantations (including 35 times single stent implantations,46 times double stents implantations,23 times 3-stents implantations and 4 times 4-stents implantations).All the 54 patients were followed up for 3-143 months,with an average time of 73 months.Of 44 with anastomotic stricture,34 received plastic stent implantation and 98 times ERCPs,with an average number of stent implantation of 2 (range,1-4) and an average time of stent indwelling of 10.7 months (range,9.0-13.0months);the postoperative acute pancreatitis,biliary infection,hyperamylasemia and adverse stent implantation or dislocation were detected in 4 persons every time,7 persons every time,10 persons every time and 3 persons every time,respectively;26 patients were cured and 5 were improved,with an effective rate of 91.2％ (31/34);3 patients with noneffective treatment continued to undergo ERCP and 3 patients had recurrence of anastomotic stricture.Among 10 patients with initial FCSEMS implantation,12 times ERCPs were performed,with an average time of stent indwelling of 7.6 months (range,6.0-12.0 months);postoperative biliary infection,hyperamylasemia and stent dislocation were detected in 1 person every time,1 person every time and 1 person every time,respectively;8 patients were cured,with an effective rate of 8/10;of 2 patients with persistent stricture,1 patient received contrast examination after stent removal,showing a comparative stricture in level 1 branch of intrahepatic duct and considering combined ischaemia,and then underwent the second implantation using multiple plastic stents;the other patient had elevated level of jaundice at 3 months after stents removal and received ERCP,showing anastomotic inflammatory polyp,and then underwent FCSEMS implantation again.Ten patients with non-anastomotic stricture received plastic stent implantation and 30 times ERCPs,with an average number of stent implantation of 3 (range,2-4) and an average time of stent indwelling of 11.3 months (range,10.0-14.0 months);the postoperative acute pancreatitis,biliary infection,hyperamylasemia and adverse stent implantation or dislocation were detected in 2 persons every time,5 persons every time,2 persons every time and 1 person every time,respectively;3 patients were cured and 3 were improved,with an effective rate of 6/10;of 4 patients with noneffective treatment,2 died of gradually deteriorating liver function and 2 underwent the second liver transplantation.Conclusions Stent implantation in ERCP is safe and effective for treatment of benign biliary stricture after liver transplantation,single plastic stent should be used in the early period (within 1 month) and multiple plastic stents should be used in the later period.Although FCSEMS has a higher displacement rate,it should be recommended due to a better clinical effect,lower incidence of complications and simple operation.For patients with non-anastomotic stricture,plastic stent should be used for extrahepatic biliary stricture,with a good clinical effect,and there is worse effect in stent implantation through ERCP for multiple intrahepatic biliary strictures.

Background Primary conjunctival lymphoid hyperplasia exhibit atypical clinical symptoms and easy to cause misdiagnosis and mistreatment.Understanding the clinical characteristics of primary conjunctival lymphoid hyperplasia is of an important clinical significance.Objective This study was to analyze the clinical characteristics and therapeutic outcome of patients with primary conjunctival lymphoid hyperplasia.Methods The medical records of 20 patients with primary conjunctival lymphoid hyperplasia who was treated in Beijing Tongren Hospital from January 2012 to December 2014 were retrospectively analyed.The age,symptoms,therapy,prognosis,histopathological features and immonochemistry results were reviewed,and the treating approach targeting to different types of conjunctival lymphoid hyperplasia was evaluated.The fellow-up duration was 1-2 years.Results Age of the patients ranged from 27 to 83 years old.The lesions were classified as benign lymphocytic hyperplasia,atypical lymphoid hyperplasia and lymphoma.Majority of lesions located in fornix conjunctiva tissue (90％).Follicle-like appearance was seen in the benign lymphocytic hyperplasia,and pink elavation was exhibited at the bulbar conjunctiva in the atypical lymphoid hyperplasia.A diffuse salmon fish like appearance in conjunctiva was the primary feature of conjunctival lymphoma.Histopathological examination showed that conjunctival benign lymphocytic hyperplasia had follicle-like tissue in lesions,atypical lymphoid hyperplasia exhibited diffuse lymphocyte filtration,and conjunctival lymphoma appeared monocyte filtration.The 3 tpyes of lesions also could be differentiated by immunochemistry.The medicine was applied in the eyes with benign lymphocytic hyperplasia,and the combination of resection of lesions with conjunctival tissue or amniotic membrane transplantation was used for the atypical lymphoid hyperplasia or lymphoma eyes.No recurrence of the lesions was found during fellow-up duration.Conclusions The clinical manifestations of conjunctival lymphoid hyperplasia lesions are varied,and it is easy to be confused with chronic ocular surface diseases.Pathology and immunochemistry are helpful for the differential diagnosis.The treating regimen is dependent on the lesion type.Most patients have a favorable prognosis with treatment.

Objective To explore the diagnostic value of quantitative contrast‐enhanced ultrasonography(CEUS) for crush injury in the hind limb muscle of rabbits .Methods A totle of 120 New Zealand white rabbits were randomized to receive compression on the left hind limb for either 2 h( n =56) or 4 h( n = 56) to induce muscle crush injury ,another 8 animals were not injured and served as normal controls .CEUS parameters such as peak intensity(PI) ,area under curve(AUC) ,ascending slop(AS) and descending slop(DS) were measured at 0 5. h ,2 h ,6 h ,24 h ,3 d ,7 d ,14 d after decompression .Results Compared with the uninjured muscle ,reperfusion of the injured muscles showed early and high enhancement in CEUS .The time‐intensity curve showed a trend of rapid lift and gradual drop .The PI and AUC values differed significantly among the three groups and were positively correlated with serum and tissue biomarkers .Rabbits of the 4 h compression group showed significantly higher PI and AUC values compared with the 2 h compression group at each time points .Conclusions CEUS can effectively detect muscle crush injury and monitor dynamic changes of the injured muscle in rabbits .PI and AUC are promising diagnostic parameters for this disease .CEUS might play an important role in the pre‐hospital and bedside settings for the diagnosis of muscle crush injury .

To identify and analyze the virulence of a bacteria strain isolated from the blood of a patient with suspected Streptococcus suis (S.suis) infection in a hospital of Beijing,we inoculated the bacteria strain isolated from the blood of the patient to the Columbia with sheep blood agar plate,after Gram staining and microscopical examination,serum agglutination test,VITEK 2 Compact microbial identification system test and matrix assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) test,S,suis species specific gene 16SrRNA,S.suis species serotype 2 specific virulence gene capsule polysaccharide 2J (cps2J) and virulence gene muramidase-released protein (mrp),hemolysin (sly),extracellular factor protein (ef),glutamate dehydrogenase (gdh) genes,fibronectin-binding protein (fbps),glyceraldehyde-3-phosphate dehydrogenase (gapdh) genes and virulence correlated gene orf2 were further detected by PCR.Results showed that the suspicious bacteria strain of S.suis was identified as S.suis type 2 (S.suis 2) by conventional methods,MALDI-TOF-MS and PCR.PCR results showed that cps2J,sly,ef,gdh,fbps,gapdh and or f2 genes were positive,and mrp gene was negative.In conclusion,the bacteria strain isolated from the patient's blood is sly+/ef+/mrp-virulent S.suis 2.

Objective To explore the expression of tankyrase (TNKS) and its relationship with WNT/β-catenin signal?ing pathway in lung acinar adenocarcinoma. Methods Seventy-two samples of single subtype alveolar like lung adenocarci?noma (lung adenocarcinoma group) and 67 specimens of normal lung tissue adjacent to carcinoma (adjacent to carcinoma group) were collected. Immunohistochemical method was used to detect expressions of TNKS, beta-catenin (β-catenin) and c-myc protein. The correlation of each protein expression in lung adenocarcinoma tissues was analyzed. The differential ex?pression of TNKS was detected by Western blot assay in two groups. Results Tankyrase protein was mainly expressed in cy?toplasm. The expression ofβ-catenin protein was mainly in cytoplasm and nuclear of lung adenocarcinoma. The expression ofβ-catenin was mainly in cytoplasm, and a small amount was in nuclear of the adjacent group. The c-myc protein was ex?pressed mainly in the nucleus. The positive expression rates of TNKS,β-catenin and c-myc protein were significantly high?er in lung adenocarcinoma group than those of adjacent to carcinoma group (P<0.05). The expression ofβ-catenin in cyto?plasm and nucleus was positively correlated with the expression of TNKS and c-myc (P<0.05). Western blot analysis showed that the relative expression level of TNKS was significantly higher in lung adenocarcinoma group than that of adja?cent to carcinoma group (0.497 ± 0.021 vs. 0.237 ± 0.015, t=13.00, P<0.01). Conclusion Abnormally high expression of TNKS in lung adenocarcinoma may promote the occurrence of lung cancer by regulating the WNT signaling pathways. Inhib?iting TNKS expression may become a new target to treat lung adenocarcinoma.

Aim To investigate the effect of ketamine plus fluoxetine on depressed behavior and the expres-sion of neuronal nitric oxide synthase (nNOS)and CA-PON in prefrontal lobe of mentally depressed rats at different time points,so as to study the possible mecha-nism of ketamine plus fluoxetine inducing antidepres-sant behavior.Methods Healthy adult male Sprague-Dawley rats,aged 2.5 ~3 months,weighing 220 ~270 g,were induced as the rodent model of depression by chronic unpredictable mild stress (CUMS).After the models of depression were established,96 of CUMS modeling successfully depressed rats were selected. Then they were randomly divided into four groups (n =24 each):the depressed group (group D,untreated group),ketamine group (group K,treated with intrap-eritoneal injection of ketamine 1 0 mg·kg -1 once a day for 3 days or 7 days),fluoxetine group (group F,trea-ted with gavage of fluoxetine 1 .8 mg·kg -1 once a day for 3 days or 7 days),or ketamine plus fluoxetine group (group KF,treated with intraperitoneal injection of ketamine 1 0 mg·kg -1 plus gavage of fluoxetine 1 .8 mg·kg -1 once a day for 3 days or 7 days).Open field test and sucrose preference test were performed 1 day before depression model was established,and 1 day before and after treatment.The rats were sacrificed 1 day after the last test for determination of the expres-sion of nNOS and CAPON protein (using immuno-his-tochemisity)and mRNA (by RT-PCR)in the prefron-tal lobe.Results After the models of depression were established,the total distance,rearing number and the sucrose preference percentage (SPP)were decreased significantly compared with those before (P <0.05). There was no significant difference among all groups in the total distance,rearing number and the SPP before treatment (P >0.05 ).Compared with groups D and F,the total distance was prolonged,the number of rea-ring and SPP were significantly increased,the expres-sion of nNOS protein and mRNA was down-regulated and the expression of CAPON protein and mRNA was up-regulated in groups K and KF,with 3 days’treat-ment (P <0.05).Compared with group D,the total distance was prolonged,the number of rearing and SPP were significantly increased,the expression of nNOS protein and mRNA was down-regulated and the expres-sion of CAPON protein and mRNA was up-regulated in groups K,F and KF with 7 days’treatment (P <0.05).Compared with group F,the total distance was prolonged,the number of rearing and SPP were signifi-cantly increased,the expression of nNOS protein and mRNA was down-regulated and the expression of CA-PON protein and mRNA was up-regulated in group KF with 7 days’treatment (P <0.05).Conclusion Co-administration of antidepressant fluoxetine with ket-amine may induce a more pronounced antidepressant activity than treatment with each antidepressant alone and it can shorten the time to improve the depressive state through promoting the expression of CAPON and inhibiting nNOS activity in the prefrontal lobe of men-tally depressed rats.