Objective To analyze the clinical characteristics of Klebsiella pneumoniae infection in preterm infants. Methods Clinical data of 75 preterm infants infected with Klebsiella pneumoniae treated in BaYi Children's Hospital from February 6,2008 to February 10,2010 were retrospectively analyzed.The difference of auxiliary examination between early-onset and late-onset infection group were compared by two independent samples t test.Spearman correlation analysis and non-conditional Logistic regression analysis were used to analyze the high risk factors and the prognostic factors of Klebsiella pneumoniae infection in preterm infants. Results The incidence of Klebsiella pneumoniae infection was 2.8％ (75/2721) in preterm infants,and the mortality rate was 9.3％ (7/75). There were 71 cases of Klebsiella pneumoniae sepsis and 4 cases of Klebsiella pneumoniae pneumonia.Among 75 cases,63 cases were early-onset infection (onset age≤72 h) and 12 were late-onset infection (onset age＞72 h).All patients presented with poor response,heart rate during quiet sleep ＞ 160/min and low oxygen saturation.The mean corpuscular volume and mean corpuscular hemoglobin concentration in early-onset Klebsiella pneunoniae infection cases were higher than those in late-onset neonates [(128.87±24.60) fl vs (113.72±13.54) fl,t=-2.07,P＜0.05and (38.11±2.15) pg vs (36.98±1.05) pg,t=-2.76,P＜0.05].Low birth weight and caesarean section were associated with early-onset Klebsiella pneumoniae sepsis (r=0.250 and -0.240,P＜0.05). The prognosis of Klebsiella pneumoniae infection was associated with hospital stay and duration of premature rupture of membranes (r=0.368 and 0.318,P＜0.05). Conclusions There were no specific clinical manifestations for Klebsiella pneumoniae infection in preterm infants.Preterm infants with low birth weight,long duration of premature rupture of membranes,delivered by caesarean section and received invasive operation are likely to develop Klebsiella pneumoniae infection.

Objective To observe the immunologic effect of transplantation of MSCs by studying the early and later period of collagen induced arthritis. Methods Rats MSCs were isolated and expanded from bone marrow cells by density gradient centrifugation and adhering to the culture plastic bottle, and the phenotypes were assessed by flow cytometry. We established collagen induced arthritis rats model. MSCs wereinjected from tail veins. We observed the expression of Foxp3 mRNA using RT-PCR, and the level of CD4+CD25+ T cell was tested by flow cytometry. One-way ANOVA and LSD-t test were used for statistical analysis.Results The percentage of CD4+ CD25+ T cells in early and later CIA groups was lower than that of normal control group and treatment groups, which showed statistically significant difference (P＜0.05). The level of CD4+ CD25+ T cell in early MSCs treatment group was higher than the later MSNs treatment group, which showed statistically significant difference (P＜0.05). Compared to the normal group and treatment groups, the expression level of Foxp3 mRNA in the early and later CIA groups was decreased markedly, while the early MSNs treatment group versus the later treatment group showed no statistically significant difference (P＞0.05).The intensity of Foxp3 mRNA in the treatment groups was similar to normal control group. Conclusion In this study, MSCs has shown significant immune-modulatory effects. It up-regulates the level of CD4+ CD25+ T cell in CIA rats, accelerate the expression of Foxp3 mRNA. The early treatment group is more effective than the late treatment group.

Objective To investigate the incidence and high risk factors of brain injury in very low birth weight infants(VLBWI),to reduce the morbidity of brain injury,and improve the developmental outcome of VLBWI. Methods Data of 181 VLBWI admitted in the neonatal intensive care unit(NICU)between October 2008 and September 2009 were retrospectively analyzed. The difference in basic information,maternity diseases,treatment and complication were analyzed between two groups(brain injury group and normal newborn group),and Logistic regression analysis was adopted to analyze the risk factors for brain injury. Results Seventy-eight of the 181 neonates(43.09%)were found to have brain injury,including 67 neonates(37.01% )with periventricular/intraventricular hemorrhage(43 with intraventricular hemorrhage(IVH)gradeⅠ,12 with IVH grade Ⅱ,10 with IVH grade Ⅲ,and 2 with IVH grade Ⅳ)and 12 neonates(6.63%,one complicated with IVH grade Ⅲ)with periventricular leukomalacia. The younger the gestational age,the higher the brain injury rate was observed. Concerning the brain injury rate,there were no differences in gender,single birth/plural births,birth weight,the mode of delivery,fetal distress,premature rupture of membrane,hypertension during pregnancy,placenta abruption,and intrauterine growth restriction(IUGR)between these two groups(P ＞ 0.05). The difference in therapeutic measures such as pulmonary surfactant therapy,nasal continuous positive airway pressure(nCPAP),conventional mechanical ventilation,and high-frequency oscillatory ventilation was significant(P ＜ 0.05),except aminophylline therapy(P ＞ 0.05). As to the complication,there were significant differences in the incidences of asphyxia,neonatal respiratory distress syndrome(NRDS),hypercapnia,metabolic acidosis,hyperglycemia,anemia,and personal digital assistant(PDA)(P < 0.05). However,there was no difference in the incidences of hypoglycemia,sepsis,thrombocytopenia,apnea,pulmonary hemorrhage,and hyperbilirubinemia between these two groups(P ＞ 0.05). Further Logistic regression analysis showed that NRDS,high-frequency oscillatory ventilation,and PDA were the main risk factors for brain injury in VLBWI. Conclusions VLBWI is the high-risk population of brain injury. Pulmonary surfactant therapy,nCPAP,conventional mechanical ventilation,high-frequency oscillatory ventilation,asphyxia,NRDS,hypercapnia,metabolic acidosis,hyperglycemia,anemia,and PDA were confirmed to be the high-risk factors for brain injury in VLBWI. And,NRDS,high-frequency oscillatory ventilation and PDA were main risk factors.

Objective To discuss the feasibility of preoperative diet by measuring gastric emptying time of carbohydrate and protein nutrient solutions in healthy volunteers.Methods A total of 20 healthy volunteers were collected from August 2013 to May 2014.On the morning of the trial,baseline gastric residual volume of each volunteer was measured with magnetic resonance imaging at 8 a.m.,then each of the 20 healthy volunteers took 12.5％ carbohydrate solution 400 ml (containing 40 g of maltodextrin and 10 g of sucrose) or 12.5％ whey protein solution (containing 50 g whey protein) in 5 minutes.Magnetic resonance imaging was conducted to measure the gastric residual volume every 25 minutes.The volunteers were shifted to the other nutrient solution after a 1-week interval.The gastric emptying time of both nutrient solutions was calculated to generate the curves illustrating the process of gastric emptying.Results The baseline gastric residual volume of the volunteers was (14.90 ± 9.39) ml.The total gastric emptying time of carbohydrate solution was (104.90 ± 27.98) min (95 ％ CI 98.64-111.16 min),while that of whey protein solution was (199.6 ± 34.17) min (95％ CI 184.47-214.73 min).There was a significant difference between these two types of nutrient solution in terms of gastric emptying time (P ＜ 0.000 1).Conclusions The induction of anesthesia could be performed 2 hours after carbohydrate administration,and at least 4 hours after whey protein administration.

Objective: To investigate the etiology, diagnosis and treatment of granulomatous cheilitis（GC）. Methods: For a patient with recurrent granulomatous cheilitis for more than 1 year in whom no medical treatment was used, only systemic treatment of the teeth was performed, and its efficacy was observed. We also reviewed the relevant literature. Results: The vermilion of the right lower lip of the patient was obviously swollen and soft. There was rebound and no pitting edema with palpation. A large dark red rash with local desquamation was observed on the skin over the right mandible. There were residual roots in tooth 35, 46, and 47, a porcelain bridge on 11-24, deep caries in 15, 16, 26, and 36, and many calculi in the whole mouth, and the gingival margin was obviously congested and swollen. Histopathological examination showed many lymphocytes infiltrated the superficial dermis, and granulation tissue, plasma cells and eosinophils infiltrated locally. The diagnosis was as follows: ① GC; ② 35, 46, and 47 residual roots; ③ 15, 16, 26, and 36 deep caries; ④ gingivitis. The treatment included extraction of 35, 46, and 47 residual roots, periodontal basic treatment, and fillings for 15, 16, 26, and 36. No drugs were administered except for 3 days after tooth extraction. After 5 weeks of treatment, the swelling of the lower lip and the skin rash completely disappeared. There was no recurrence in the follow-up observation at six months. Through a literature review and analysis, we found that GC may be related to various factors such as immunity, infection, and genetics. Local oral infections may be closely related to the incidence of GC. Conclusion Resolution of local oral infections is effective for the treatment of granulomatous cheilitis, and local oral infections may be closely related to the onset of granulomatous cheilitis. In the treatment of granulomatous cheilitis, attention should be paid to the systematic examination of the oral condition, and the treatment of suspected lesions in the oral cavity should begin in the early stages of treatment.

Objective To investigate the clinical predictive value of rheumatoid factor (RF), anti-keratin antibodies (AKA), anti-cyclic citrullinated peptide (anti-CCP) antibody and anti-perinuclear factor (APF) in the transition from undifferentiated arthritis (UA) to rheumatoid arthritis (RA), and to analyze the clinical relevant factors. Methods 271 patients with UA who were followed up for a year were enrolled into the investigation. RF was measured by the rate scatting immunity method. APF and AKA were detected by immuniofluorescence method(IFA). Anti-CCP was measured by ELISA. Erythrocyte sedimentation rate (ESR) was analyzed by Wilcoxon method. The duration of morning stiffness, the numbers of swelling and tender joints, tender joints involved and DAS28 score were recorded and analyzed. Results 99% patients who had four-antibody-positive finally convetted from UA to RA. The conversation rate for those who had two or more than two antibody-positive was 83.0% and 65.9% respectively. The sensitivity and specificity of RF and anti-CCP antibody-positive in those who converted from UA to RA was 77.8% and 80.5% respectively. The percentage of polyarticular swelling in antibody-negative, one-antibody-positive, two-antibody-positive, three-antibody- positive and four-antibody-positive was 48%, 57%, 59%, 70% and 70% respectively. Meanwhile, the percentage of multi-small-joint involvement was 71%, 71%, 72%, 76% and 83% respectively. The proportion of elbow involvement in antibody-negative patients was 72%, which was the highest among all joint area involvement. The conversion differences of the group with more than 3 swelling joints or more than 3 small joints involvement ranked the first and second in frequency. Conclusion The combined detection of these autoantibodies could increase the specificity of early diagnosis of RA. The more positive antibodies present, the more likely the concersion form UA to RA. The sensitivity and specificity of RF and anti-CCP-positive is high, so the latter is expected to become one of the diagnostic criteria. The polyarticular swelling and multi-small-joint involvement are valuable in predicting the transformation from UA to RA.

Objective To study the inhibitory effect of curcumin on the proliferation,migration and invasion of non-small cell lung cancer cell A549,and to discuss further if it is closely related to the expression of c-Jun N-terminal kinase (JNK) and relative protein p38.Methods A549 cells were cultured by conventional method,and then treated with different concentration of curcumin (10,20,40,80 μmol · L-1).The proliferation,migration and invasion of A549 cells were measured by real-time cellular analysis (RTCA).The expression levels of JNK,p-JNK,p38 and P-p38 were detected by real-time PCR and Western blotting.Results Curcumin showed an antiproliferation effect against A549 cells with IC50 =40 μmol · L-1,and curcumin exhibited obviously inhibitory effect on the migration and invasion of A549 cells.Additionally,compared with control group,curcumin suppressed the expression of JNK and p38 at the gene level,and significantly inhibited the expression of JNK,P-JNK,p38 and p38 (P＜0.05) at the protein level.Conclusion These results demonstrated that curcumin can inhibit the proliferation,migration and invasion of A549 cells via reducing the level of JNK,p38 phosphorylation,and blocking JNK signal transduction pathway.

Objective:To observe and analyze the surface electromyography activity of quadriceps femoris of knee osteoar-thritis(KOA)patients. Method:The surface electromyography of vastus lateralis,rectus femoris,and vastus medialis were recorded and analyzed in 30 KOA patients and 30 normal people during isokinetic knee flexion or extension at veloci-ties of 60 °/s,90 °/s or 180 °/s.We also record clinical indicators(muscle thickness and degree of knee pain)of the KOA group and evaluate the correlation between electromyographic data and clinical indicators. Result:Compared with the healthy control group,the KOA group had significantly lower knee extensor mo-ment during isokinetic knee flexion or extension at velocities of 60°/s(P＜0.001),90°/s(P＜0.01),or 180°/s(P＜0.01).Statistics showed that there were significant differences in the median frequency difference rate of vastus lateralis(P＜0.05)and root mean square value of rectus femoris(P＜0.01)between the healthy control group and the KOA group under 60°/s angular velocities.There was a significant difference in the root mean square value of rectus femoris(P＜0.05)between the two groups at velocities of 90°/s.Statistics revealed that the median frequency difference rate(P＜0.05)and root mean square value(P＜0.05)of rectus femoris had changed significantly at the velocities of 180°/s.The results of both multiple regression and random forest algo-rithm showed that knee extensor moment was the strongest predictor between electromyographic characteristics and clinical indicators. Conclusion:The strength of quadriceps femoris in KOA patients was decreased.Thus,the patient may need more muscles to complete the same action,which was easy to cause muscle fatigue.The knee extensor moment was closely related to the quadriceps femoris thickness and the degree of knee pain.It offers important advantag-es for the diagnosis and assessing the severity,which may provide the way for the future study of KOA.

Objective To investigate the risk factors of abnormal circadian rhythm of blood pres-sure in patients with Stanford type B aortic dissection. Methods Case information of 204 patients with Stanford type B aortic dissection admitted to vascular surgery department of the Second Xiangya hospital of Central South University from January 2016 to December 2018 were retrospectively analyzed. According to patients'blood pressure rhythm during hospitalization, patients were divided into normal blood pressure cir-cadian rhythm group (127 cases) and abnormal blood pressure circadian rhythm group (77 cases). Demo-graphic information, ambulatory blood pressure monitoring results, comorbilities and medication treatment of the two groups were compared by using multivariate logistics regression analysis. Results The difference of the ambulatory blood pressure monitoring results{average night systolic blood pressure [(112. 90 ± 10. 00) mmHg vs (128. 15 ± 15. 20) mmHg], average night diastolic blood pressure [(66. 40 ± 7. 91) mmHg vs (76. 10 ± 7. 97) mmHg]}, comorbilities hyperlipidemia, renal failure, obstructive sleep apnea hypopnea syndrome, smoking and the medication treatment ( analgesics, hypnotics and intravenous antihypertensive medicine) were statistically significant (P<0. 05);multivariate logistic regression analysis showed that ob-structive sleep apnea hypopnea syndrome and renal failure were independent risk factors of abnormal blood pressure rhythm in Stanford type B aortic dissection patients. While analgesics, hypnotics and intravenous antihypertensive medicine were protective factors. Conclusions The risk factors of abnormal circadian rhythm of blood pressure in patients with Stanford type B aortic dissection are renal failure and obstructive sleep apnea hypopnea syndrome. Protective factors were the usage of analgesics, hypnotics and intravenous antihypertensive medicine.

Objective:To explore the effects of the γ-aminobutyric acid(GABA) neurons and melanin-concentrating hormone (MCH) neurons of the nucleus accumbens (NAc)-lateral hypothalamic area (LHA) neural pathway on the rewarding feeding(palatable food sweat condensed milk) in the obesity rats.Methods:Total 142 male Wistar rats of SPF grade were divided into normal diet (ND) group ( n=68) and high-fat diet induced obesity (DIO) group ( n=74) according to the principle of body mass matching. The rats in the two groups were given normal diet and high-fat diet for 8 weeks. Eight weeks later, 6 DIO rats were randomly selected to observe the nerve projection from GABA neurons in NAc to MCH neurons in LHA by fluorogold retrograde tracing combined fluorescence immunohistochemistry. And the expressions of c-Fos and MCH in LHA after ingestion of sweet condensed milk(rewarding feeding) were observed by fluorescence immunohistochemistry (6 rats in each group). GABA receptor agonist Musimol or GABA receptor antagonist Bicuculine was microinjected into the nucleus of LHA to observe the effect of GABA on rewarding food intake in ND and DIO rats ( n=8 in each group), and the changes of rewarding food intake after blocking MCH signal ( n=8 in each group). SPSS 17.0 was used for statistical analysis, two-way ANOVA and post hoc Bonferroni test were used for comparison among multiple groups, and t-test was used for comparison between two groups. Results:After 8 weeks of high-fat diet modeling, the intake of delicious food in DIO rats was significantly higher than that in ND rats((12.52±2.29) mL, (7.45±1.23) mL, t=4.778, P<0.01) after satiety.The results of fluorogold retrograde tracing combined with fluorescence immunohistochemistry showed that GABA neurons in NAc projected nerve fibers to neurons in LHA, and GABA A receptors in some neurons in LHA coexisted with MCH.The results of NAc-LHA pathway on delicious food intake showed that the interaction between rat group and drug intervention was significant( F=9.869, P<0.01). Simple effect analysis showed that the intake of delicious food after microinjection of Musimol into LHA nucleus of ND rats was significantly lower than that of microinjection normal saline ((4.25±1.38) mL, (7.29±1.49) mL, P<0.01), while the intake of delicious food after injection of Bicuculine was significantly higher than that of microinjection normal saline((10.72±2.11) mL, (7.29±1.49) mL, P<0.05). The intake of delicious food after microinjection of Musimol into LHA nucleus in DIO group was significantly lower than that of microinjection normal saline((3.51±1.77)mL, (13.68±2.95) mL, P<0.01), but there was no significant difference between microinjection Bicuculine and microinjection normal saline ((14.83±3.44) mL, (13.68±2.95) mL, P>0.05). The results of blocking MCH signal on delicious food intake showed that the interaction effect between SNAP-94847 and Bicuculine intervention was not significant ( F=1.468, P>0.05). The main effect of SNAP-94847 intervention was significant ( F=15.880, P<0.01)and the main effect of Bicuculine intervention was significant ( F=6.930, P<0.05). After intracerebroventricular injection of MCH receptor blocker SNAP-94847, the delicious food intake of ND rats was significantly less than that of injection normal saline((4.78±1.72) mL, (7.63±2.77) mL, P<0.05), and it was not affected by pre injection of Bicuculine in LHA ((6.24±2.18) mL, (4.78±1.72) mL, P>0.05). In the DIO rats, the interaction effect between SNAP-94847 and Bicuculine intervention was not significant( F=0.006, P>0.05). The main effect of SNAP-94847 intervention was significant ( F=18.46, P<0.01) and the main effect of Bicuculine intervention was not significant ( F=2.059, P>0.05). After intracerebroventricular injection of MCH receptor blocker SNAP-94847, the delicious food intake of DIO rats was significantly lower than that of injection normal saline((6.89±2.11) mL, (12.19±4.36) mL, P<0.05), and it was not affected by pre injection of Bicuculine in LHA ((8.72±2.26) mL, (6.89±2.11) mL, P>0.05). Conclusion:GABAergic signal in NAc can regulate the expression of MCH in neurons of LHA. In the DIO rats, the sensitivity of MCH neurons in LHA to satiety signal decreases and the hedonic feeding increases.