Objective To investigate the clinical characteristics,pathogenic causes and treatment outcomes of acute kidney injury (AKI) in very old patients in order to improving the diagnosis and treatment.Methods 39 AKI patients aged ≥80 years in the department of geriatric medicine of our hospital were enrolled and followed up for 3 months.Clinical and laboratory data were analyzed and the pathogenic causes as well as the treatment outcomes were summarized.Results Among the 39 very old patients,31(79.5％) were male,8(20.5％) were female,and the mean age was (93.5±4.6) years.33 (84.6％)patients had chronic kidney diseases.The pathogenic causes of AKI were mainly as follows:urological infections (71.8％),blood volume deficiency (48.7％),cardiac dysfunction (23.1％) and hypotension (15.4％).2 to 4 pathogenic causes were co present in 64.1％ patients.Renal function was improved and recovered in 69.2 ％ patients and the death rate was 25.6％ after treatment.The main causes of death were septic shock (30.0％),multiple organ failure (20.0％),massive gastrointestinal hemorrhage (20.0％) et al.Conclusions Most of the very old patients may suffer from AKI on the basis of chronic kidney disease.AKI is often induced by multiple pathogenic causes.The main factors leading to AKI are urological infections,followed by blood volume deficiency and cardiac dysfunction.Most patients with AKI can recover after the precipitating factors are removed and supportive treatments are administered in time.Septic shock is the main cause of death.

Objective To explore the clinical characteristics of neonatal-onset carbamoyl phosphate synthetase I deficiency (CPS1D). Methods Clinical data and result of genetic detection of one neonate with CPS1D were retrospectively analyzed. The pertinent literature was reviewed. Results A 3-day old girl, with onset symptoms of nonspecific performance, such as poor feeding, less activity, tachypnea, and seizures. After fasting, anti-infection, and respiratory support etc. the condition was improved. However, the condition deteriorated and developed rapidly after feeding restarted. MRI showed extensive cerebral white matter lesions. Blood ammonia?>?500 μmol/L. Gene detection found two heterozygous mutations in pathogenic gene CPS1 in twentieth exon of c.2407C?>?G (p.803, R, G) and fourth exon C.323G?>?A (p.108, G, E), according to which CPS1D was diagnosed finally. Conclusions For neonate with normal birth, had feeding difficulty, seizures, and consciousness disorder after establishment of normal feeding, if blood ammonia level significantly increased, the blood and urine amino acids analysis and gene detection should be performed to confirm the diagnosis.

OBJECTIVETo compare the differences in clinical efficacy on peripheral facial paralysis at acute stage between the opposing needling technique and routine acupuncture at the affected side so as to provide the evidence on the acupuncture treatment for peripheral facial paralysis at acute stage.

METHODSForty patients were rando- mized into an opposing needling technique group (19 cases) and an affected side needling technique group (21 cases). The basic medication was same in the two groups. The acupoints were Fengchi (GB 20), Yangbai (GB 14) to Yuyao (EX-HN 4) (penetrating needling method), Jingming (BL 1), Chengqi (ST 1), Xiaguan (ST 7), Jiache (ST 6) to Dicang (ST 4), Hegu (LI 4) and Zusanli (ST 36). In supplementation, in the opposing needling technique group, the acupoints were stimulated on the face of healthy side. In the affected side needling technique group, the acupoints were stimulated on the face of the affected side. The treatment was given three times a week, for 4 weeks. House-Brackmann (H-B) facial nerve function assessment was used to evaluate facial nerve function before and after treatment in the patients of the two groups. The efficacy was compared between the two groups.

RESULTSThe facial nerve function was recovered in the two groups and the total effective rate was 100.0% in the two groups (P>0.05). The curative rate was 68.4% (13/19) in the opposing needling technique group and better than 47.6% (10/21) in the affected side needling technique group (P<0.05). On the 7th and 14th day, scores of H-B in the opposing needling technique group were better than those in the affected side needling technique group (both P<0.05). The curative time in the opposing needling technique group was apparently shorter than that in the affected side needling technique group ((23.95 +/- 4.30) days vs. (29.14 +/- 5.43) days, P<0.01).

CONCLUSIONThe opposing needling technique accelerates the recovery of facial nerve function in peripheral facial paralysis at acute stage and apparently shortens the curative time. The efficacy is better than that in acupuncture on the affect- ed side of the face.

Acupuncture Points ; Acupuncture Therapy ; methods ; Adolescent ; Adult ; Child ; Facial Paralysis ; therapy ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

To construct a scFv library by phage display technique from the spleen cells of mice immunized with B3HM cells. Three mice were immunized with B3HM cells, and their spleen cells were harvested. The genes of VH and Vk were amplified by RT-PCR from the cDNA of the immunized spleen cells and a scFv-phage display antibody library was constructed. The capacity of library was measured,and the variety of the library was analyzed by digesting with restriction endonuclease BstNI.ScFv phage clones were randomly picked and identified phage-scFv clone by binding B3HM cells using immunofluorescein.A scFv library containing 5?106 individual clones which showed different patterns after digested with restriction endonuclease BstNI was produced. Individnal phage-scFv clone showed B3HM cells positive using immunofluorescein. A scFv library of anti-B3HM cell surface molecules has been constructed. It will be useful for finding out some novel genes of causing leukemia, and establishs the infarctate foundation of clarifying the pathogenesis of leukemiagenesis.

Adenocarcinoma ; complications ; Aged ; Humans ; Lung Neoplasms ; complications ; Male ; Pulmonary Embolism ; complications

Objective To investigate the effect of carbachol on local gut inflammation during entetal resuscitation of rats with bum shock. Method Thirty-eight Wistar rats were subjected to 35%TBSA full thickness scald injury, and enteral fluid was infused into animal intestines via duodenal stomas 30 minutes post bum. The animals were randomly divided into four groups: no resuscitation (Control, n = 8), enteral resuscitation using either a glucose electrolyte solution (GES, n = 10) or GES plus carbachol (60 μg·kg-1,GES/CAR, n = 10), or carbachol alone (CAR, n = 10) .The volumeof GES infusion was based on the Parkland formula (4 ml· 1% TB-SA-1·Kg-1) - All animals were sacrificed 4 hours post bum, and specimens of jejunal tissue were collected to determine the levels of tumor necrosis factor (TNF)-α, nitric oxide (NO), nitric oxide synthase (NOS) and myeloperoxidase (MPO). Serum assays for plasma diamine oxidase (DAO) activities were also performed. Results There were no statistical differences in the intestinal levels of NOS, NO, TNF-α and MPO, and plasma OAO activities, between the GES group and the control group. Compared to the GES group, the GES/CAR group showed significantly lowered levels of intestinal NOS (1.276 ±0.391 vs. 1.818 ±0.436, P＜0.05), NO (0.925 ±0.402 vs. 1.561 ±0.190, P ＜ 0.05, TNF-α (0.87±0.13 vs. 1.94±0.47, P ＜0.01) and MPO (0.465 ±0.092 vs. 0.832±0.214, P＜0.05),and reduction in plasma DAO activites (0.732±0.192 vs. 1.381 ±0.564, P ＜0.05). The CAR group also showed significantly lowered levels of intestinal NOS, NO, TNF-α and MPO and reduced plasma DAO activites, compared to the GES group. Conclusions Theses results suggest that carbachol significantly inhibits the release of proinflammatory mediator and attenuates local inflammation in gut during enteral fluid resuscitation of rats in rats with bum shock. We postulate that carbachol may exert its and-inflammatory effects via the cholinergic anti-inflammatory pathway.

Objective To explore the relationship between the fall of postprandial blood pressure and superior mesenteric artery (SMA) blood flow in elderly patients aged 80 years and over.Methods The study included 25 inpatients aged 80 years and over with postprandial hypotension (PPH group) and 27 age matched cases without PPH (control group).The changes in blood pressure and the hemodynamics of SMA at fasting stage and 2 hour after meal were observed.The differences between the two groups were compared.Results The incidence of abnormal glucose metabolism (including diabetes and impaired glucose tolerance) was significantly higher in PPH group than in control group [[92.0％ (23 cases) vs.40.7％ (11 cases), P＜0.05].There were no significant differences in other clinical data between the two groups (all P＞0.05).The blood pressure in two groups at different time points was decreased after meal significantly as compared with that at fasting stage (all P＞0.05).The maximal fall of postprandial systolic blood pressure and diastolic blood pressure was significantly increased in PPH group as compared with in control group [(31.3± 14.8)mmHg(1 mmHg=0.133 kPa) vs.(6.9±16.5) mmHg, (13.1±6.6) mmHg vs.(9.0±3.9)mmHg, both P＜0.05].The postprandial SMA blood flow at different time points was significantly increased after meal as compared with that at fasting stage in two groups (all P＞0.05).The maximal increase of postprandial SMA blood flow was larger in PPH group than in control group [(550.5±149.5) ml/min vs.(312.8±241.4) ml/min, P＜0.05].The maximal fall of postprandial systolic blood pressure was positively associated with the maximal increase of postprandial SMA blood flow (r=0.352, P=0.025).Conclusions The fall of postprandial blood pressure is associated with the increase of the SMA blood flow.Postprandial increase in splanchnic perfusion is one of the mechanisms for the formation of PPH.

Background Autologous and allograft renal transplantation exist some disadvantages of less donor source and rejection.As a scaffold of cell in tissue engineering,fibroin was determined to have a good biocompatibility.But whether the fibroin membrane can become a substitution for tissue defect is seldom reported.Objective This experiment aimed to investigate the feasibility of silk fibroin membrane in the rabbit eyelid reconstruction in situ.Methods A 4 mmx3 mm tarsi defect model was created on the upper eyelids of 18 healthy New Zealand white rabbits.The eyelid reconstruction in situ was performed with regenerated silk fibroin membrane material in the right upper eyelids (silk fibroin group ) and allogenic sclera material (sclera group ) on the upper eyelids of fellow eyes.The grafts were clinically examined for the evaluation of inflammation and implant exposure at the first,second and forth week after operation.The inflammation response and collagen distribution were examined by hematoxylin & eosin staining and Masson staining.Expression of basic fibroblast growth factor(bFGF) in the grafts was detected by immunohistochemistry,and ImagePro Plus software was used for statistical analysis.Results All eyelid defects showed a primary healing.The surface of palpebral conjunctival was smooth and the inflammation of ocular surface was mild.The eyelid margin in the sclera group was more notch than that in the silk fibroin group.Results of pathological examination revealed that the arrangement of collagen fibers in the sclera group was more disordered,but that in the silk fibroin group was regular.The expression level(A value) of b-FGF in the operative area in silk fibroin group were 0.027 67±0.004 69,0.051 73±0.008 72,0.058 72±0.006 88,and those in the sclera group were 0.056 48±0.009 14,0.072 83 ± 0.009 17 and 0.078 73 ±0.010 84 in 1,2,4 weeks after operation,showing statistically significant differences between two groups in various time points ( t =- 6.38,t =- 4.99,t =- 2.87,P ＜0.05 ).Conclusions Silk fibroin membrane can reconstruct the eyelid shape in situ with the less inflammation response and good biocompatibility.Silk fibroin membrane could be used to support the eyelid as a new tarsal repairing materials.

Background Research showed that exposure of 530 nm monochromatic light can induce myopia in animal,and retinal Müller cells participate in the formation of myopia.However,the effect and mechanism of retinal Müller cells during the formation of monochromatic light induced-myopia is below understood.Objective This study was to investigate biologic characteristics of rat retina Müller cells and the expression of cell factors in Müller cells after being illuminated by the 530 nm monochromatic light,and discuss the role of the retina Müller cells in myopia induced by monochromatic light.Methods Immortalized rat retinal Müller cells were cultured with DMEM containing 10％ fetal bovine serum in a self-made cell incubator with monochromatic light by adjusting luminance of 530 nm LED source.The cells were exposed to 125,250 and 500 lx luminance respectively for 6,12 and 24 hours,and the cells without light-irradiation were used as control.The growth of the cells under the different light time and different illuminations was described by MTT as the absorbance at the wavelength 570 nm (A570),and cell cycle analysis of Müller cells was performed by flow cytometry 48 hours after cultured,and the expression of transforming growth factor-beta 1 (TGF-β1),tyrosine hydroxylase(TH),inducible nitric oxide synthase(iNOS) and basic fibroblast growth factor(bFGF)in the cells were detected by reverse transcription PCR(RT-PCR),respectively.Results The Müller cells were uniform in size with polygonal shape and defined edges.No statistically significant difference was found in the A570 value in the cells of the 125 lx and 250 lx illuminated groups compared with the control group in various time points(P＞0.05).However,significant lowing was seen in the A570 value in the cells of the 500 lx illuminating for 12 hours and 24 hours in comparison with the control group (P =0.013,0.001).Compared with the control group,the ratio of the number between G2 and G1 phase was not significantly declined in 125 lx,250 lx illuminating for 48 hours (P =0.073,0.330),and the ratio in the 500 lx illuminating group was significantly lower than those in the 250 lx illuminated group and the control group (P =0.028,0.038).RT-PCR revealed that the expression of TGF-β1 mRNA in the cells was higher in the 250 lx illuminated group than that of the 500 lx illuminated group (P=0.006).The expression of iNOS mRNA was gradually upregulated in the 250 lx illuminated group compared with the control group (P =0.001),but that in the 500 lx illuminated group was downregulated (P =0.000).The expression of bFGF mRNA was raised in the 125 lx and 250 lx groups but reduced in the 500 lx group when compared with the control group(P=0.002,0.000,0.005).Also,the expression of TH mRNA was significantly increased in the 250 lx group(P=0.000),but decreased in the 500 lx group(P=0.000,P=0.001).Conclusions The monochromatic light of 530 nm can inhibit the growth of rat Müller cells and downregulate the expression of myopia-related cell factors and therefore exert effect in the formation of myopia.

?AIM:To compare the changes of the contrast sensitivity after LASIK with femtosecond laser and microkeratome and to explore the influence of different methods making corneal flap on visual quality.? METHODS: There were 212 eyes in 106 myopes underwent excimer operation . According to the different methods of operation, they were divided into two groups:microkeratome group ( SBK group ) and femtosecond laser group ( FS group) . FS group: a total of 112 eyes in 56 patients received LASIK with femtosecond laser. SBK group: a total of 100 eyes in 50 patients received LASIK with microkeratome. Contrast sensitivity was detected preoperatively, and 1wk, 3mo postoperatively and compared between the two groups.? RESULTS: At 1wk after operation, the contrast sensitivity under photopic environment decreased in the two groups, compared with those before operation ( P<0. 05). The differences of contrast sensitivity before and 3mo after operation were not significant (P>0. 05). No statistical significant difference was found in contrast sensitivity under photopic environment at 1wk, 3mo between the two groups ( P>0. 05 ). At 1wk after the operation, the contrast sensitivity under scotopic environment decreased in both groups compared with those before operation ( P< 0. 05 ). In SBK group, it decreased more than in FS group (P<0. 05). After 3mo, the decline of 14. 2c/d spatial frequency contrast sensitivity under scotopic environment in the SBK group was more than other frequency. No statistical significant difference was found in the rest frequency contrast sensitivity under scotopic environment before and after operation (P>0. 05). After 1wk, contrast sensitivity with glare stimulation in both groups decreased, compared with those before operation ( P< 0. 05 ), while in SBK group, it decreased more than in FS group (P<0. 05). After 3mo, except that the decline of 14. 2c/d spatial frequency contrast sensitivity with glare stimulation in the SBK group was significant compared with those before operation, the contrast sensitivity under glare stimulation in both groups had no significant differences compared with before operation(P>0. 05).?CONCLUSION:LASIK with femtosecond laser can get a better visual quality than LASIK with microkeratome.