ObjectiveThrough the examination of Clostridium difficile (Cd) in the stool of inflammatory bowel disease (IBD) patients to investigate its infection status in IBD patients and the relationship with IBD.MethodsFrom December 2009 to January 2011,a total of 130 diagnosed IBD patients were collected in the Department of Gastroenterology,Ruijin Hospital,Shanghai Jiaotong University School of medicine,including 60 ulcerative colitis (UC) patients and 70 Crohn's disease (CD) patients.At same time.60 irritable bowel syndrome patients and 60 healthy volunteers were collected as control.Stool samples were tested by PCR and Cd toxin A/B test kit (CDTK).SPSS statistical software was used for statistical analysis.ResultsIn 130 enrolled IBD patients,16 cases (12.3％) were Cd infected,of which 10 were UC cases (16.7％) and 6 were CD cases (8.6％).No Cd infection was found positive in control group (x2 =15.779,P=0.000).The infection rate of Cd in the patients of active stage was higher than that in the patients of inactive stage (x2 =10.092,P=0.001).The infection rate of coion-type CD patients was 4/14,which was significantly higher than those of other types CD patients (x2 =13.125,P=0.001).The infection rate of Cd was 4.5％ in mild UC patients,14.3％ in moderate and 6/17 in severe (x2 =6.667,P=0.037) ; the infection rate were 0％ in mild CD patients,4.2％ in moderate and 5/16 in severe.The infection rate increased along with the increase of The disease severity (x2 =13.907,P=0.000).There was no significant difference in the infection rate of Cd between broad-spectrum antibiotics used and not used patients (x2 =1.414,P =0.378), or between patients with broad-spectrum antibioticsused aloneand combinedwith immunosuppressant (x2 =0.330,P=0.962).ConclusionsThere was certain infection rate of Cd in IBD patients,especially the patients in active stage. The infection rate increased along with the increase of the IBD severity.

Pachychoroid spectrum diseases includes central serous chorioretinopathy (CSC),pachychoroid pigment epitheliopathy,pachychoroid neovasculopathy,and polypoidal choroidal vasculopathy,which share common characteristics,including focal or diffused increased choroidal thickness,choroidal hyperpermeability,and dilated choroidal vessels.These diseases are likely to represent a continuum of the same pathogenic process.Similar features and association among them suggest that they may have similar etiology.It is of great clinical significance to understand the composition and typical morphological changes of pachychoroid-related diseases and to explore its possible pathogenesis.

Dengue virus (DENV) nonstructural protein 1 (NS1) is a highly conserved 46-kDa protein that contains 2 glycosylation sites (Asn-130 and Asn-207) and 12 conserved cysteine (Cys) residues. Here, we performed site-directed mutagenesis to generate systematic mutants of viral strain TSV01. The results of the subsequent analysis showed that an alanine substitution at the second N-linked glycan Asn-207 in NS1 delayed viral RNA synthesis, reduced virus plaque size, and weakened the cytopathic effect. Three mutants at Cys sites (Cys-4, Cys-55, Cys-291) and a C-terminal deletion (ΔC) mutant signiifcantly impaired RNA synthesis, and consequently abolished viral growth, whereas alanine mutations at Asn-130 and Glu-173 resulted in phenotypes that were similar to the wild-type (WT) virus. Further analysis showed that the Asn-207 mutation slightly delayed viral replication. These results suggest that the three conserved disulifde bonds and the second N-linked glycan in NS1 are required for DENV-2 replication.

Vitamin D participates in a variety of biological processes. 1,25-dihydroxyvitamin D [1,25-(OH)2D]is the active form of vitamin D. Besides its classical role in bone and calcium homeostasis, 1,25-(OH)2D has many non-classical functions such as regulating proliferation and differentiation of cells in various tissues, including tumor cells as well. However, the role of 1,25-(OH)2D in thyroid cancer is not clear yet. There are three integral components of the vitamin D pathway in thyroid cells. These components are the vitamin D receptor, 1α-hydroxylase (CYP27B1), and 24-hydroxylase (CYP24A1). Differences in the expression levels of these components in normal thyroid tissue and thyroid cancer tissue may offer clues and lay the foundation for study of the inhibitory function in the pathogenesis of thyroid cancer.This review focuses on the insights gained in the elucidation of the role of 1,25-(OH)2D pathway in thyroid cancer, one of the most common endocrine malignancies.

Aim To prepare for psoriasis transgenic animals, psoriasis susceptible gene was constructed. Methods Extract gDNA from blood preparations of psoriasis patients, screen positive gDNA owns HLA-Cw*0602 gene, then copy the whole sequence and link it to pMD-19T Simple Vector. Results The identification showed the construction of psoriasis susceptible gene was sucessful. Conclusion The successful construction of HLA-Cw*0602 gene will lay the foundation for development of transgenic animal models of psoriasis.

Objective To evaluate the value of phased array probe of transesophageal echocardiography miniature (micro-TEE) in the neonatal and infant cardiac surgery intraoperation.Methods Micro-TEE probe was used in children with weight ≤5 kg undergoing cardiac surgery to detect the atrial and ventricular cavity size,the left and right ventricular outflow tract diameter were detected by transthoracic echocardiography(TTE) 3-7 d after operation,and compared with the measured value immediately after the TEE.Results Before and after intubation,airway index not statistically significant (P ＞ 0.05).Preoperative TEE and TTE inspection results were consistent with intraoperative diagnosis.Postoperative TEE measuring intracardiac structural data (each room,chamber size and left and right ventricular outflow tract diameter) and postoperative TTE measurement value representing the difference was not statistically significant (P ＞ 0.05).Conclusions Micro TEE intraoperative guardianship of low birth weight infants is safe and feasible,and can supplement and improve the preoperative diagnosis,and can accurately and timely evaluate postoperative curative effect.

Objective To evaluate the value of single leaflet replacement of bovine pericardium in the treatment of aortic valve insufficiency using transthoracic echocardiography(TTE) and transesophageal echocardiography(TEE).Methods TTE and TEE examination were performed for 25 cases pre-operation,postpump intraoperative and 3-6 months after the operation,to judge the structure and the regurgitation of the aortic valve.And the inside diameter of left atrium(LA)and left ventricle(LV)in the same plane and the same phase were also been measured.Results The degree of aortic regurgitation(AR)before operation were significantly different with that postpump intraoperative(P＜0.001)evaluated by TEE.There was no difference in the degree of AR by postpump intraoperative TEE and those of AR by TTE 3-6 months after surgery(P＞0.1).The inside diameter of LA[(3.80±1.37)em]and LV[(5.75±1.32)cm]before repair were larger than those 3～6 months after surgery[LA(3.19±0.90)cm,LV(4.72±1.19)cm,P＜0.001].Conclusions The replacement of single aortic valve with bovine pericardium to treat aortic valve insufficiency is a good alternative for patients with satisfactory short-term results,but long-term results are not clear.

Objective:To explore the application value of transesophageal echocardiography (TEE)in secondum atri-al septal defect (ASD)intervention and minimally invasive occlusion surgery in adult patients.Methods:A total of 134 cases adult patients (>15 years)with pure secondum ASD (including 91 cases undergoing interventional occlu-sion and 43 cases undergoing minimally invasive occlusion surgery),who were screened via transthoracic echocardio-graphy (TTE)and TEE from Jan 2012 to Dec 2012,were selected.Intervention group and minimally invasive sur-gery group received TTE and TEE monitoring respectively during operation.Preoperative TTE and TEE parameters and operation results were compared and analyzed.Results:The parameters of ASD diameter measured by TEE were significantly higher than those measured by TTE in two groups (P <0.01 all).Maximum defect diameter of ASD measured by TEE was significantly higher than that of measured by TTE [(19.8±5.2)mm vs.(18.7±4.9)mm], P <0.01. The correlation between maximum defect diameter measured by TTE and occluder size (intervention group r =0.926,minimally invasive surgery group r =0.215)was all lower than that of TEE (intervention group r=0.965,minimally invasive surgery group r =0.627),P <0.01 both.Conclusion:TEE is better than TTE in as-sessment of ASD size.It should be regarded as a routine preoperative screening method for adult ASD patients.It has important value in real-time monitoring,guidance and immediate evaluation of therapeutic effects during mini-mally invasive ASD occlusion surgery.

Objective To analyze the changes of distribution and drug resistance of isolated pathogens for ventilator-associated-pneumonia (VAP) in seven intensive care units from January 2013 to December 2015,so that provides information for clinical antibiotic treatment.Methods Collected the patient records diagnosed with VAP to get the distribution and drug resistance of isolated pathogens for VAP in ICU from January 2013 to December 2015.Compared the distribution of isolated pathogens for VAP among three year with Chi-square tests,and compared the drug resistance of main isolated pathogens with Nonparametric tests.Results 177 patients were diagnosed with VAP from January 2013 to December 2015.A total of 192 strains of pathogens were isolated from the VAP patients in ICU.Among which the gram-negative bacteria were dominant.It took up 90.6％.There was no significant statistical difference for the distribution of pathogens (x2 =2.372,P=0.668＞0.05).Analyzed the drug resistance rate and trends for the primary pathogens like Acinetobacter Bauman,Pseudomonas aeruginosa and Staphylococcus aureus,among which,the drug resistance of Acinetobacter Bauman from 2013 to 2015 made statistical difference.Conclusion The major pathogen isolated from VAP patients was gram-negative bacteria from January 2013 to December 2015,especially for Acinetobacter Bauman.Drug resistance of Acinetobacter Bauman was serious.Should administrated appropriate to treat the VAP infection resulted from Acinetobacter Bauman.

Objeetive To investigate the effects of nimodipine combined with edaravone on cerebral vasospasm (CVS) and delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH).Methods The consecutive patients with aSAH who underwent microsurgical clipping were included retrospectively.All patients received intravenous prophylaxis with nimodipine,and some patients also used edaravone (30 mg,twice a day for 2 weeks).They were divided into either a CVS group or a non-CVS group according to the findings of transcranial Doppler.They were also divided into a DCI group and a non-DCI group according to the findings of CT reexamination and clinical examination.The demographics,baseline clinical data,Glasgow Coma Scale (GCS) score,Fisher grade,Humt-Hess grade,and aneurysm location of all patients were collected.The multivariate logistics regression analysis was used to identify the independent risk factors for CVS and DCI.Results A total of 220 patients with aSAH were enrolled in the study,132 (60.0％) had CVS and 106 (48.2％) had DCI.One hundred twenty-three patients (55.9％)were treated with nimodipine + edaravone,97 were treated with nimodipine alone,none of them died.The incidences of CVS (51.2％ vs.71.1％;x2 =8.962,P =0.003) and DCI (35.0％ vs.65.0％;x2 =19.535,P ＜0.001) in patients receiving nimodipine + edaravone therapy were significantly lower than those receiving nimodipine alone.The proportions of hypertension,hyperlipidemia,diabetes,smoking,high Fisher grade in the CVS group were significantly higher than those in the non-CVS group (all P ＜0.05),while the proportion of patients receiving nimodipine + edaravone therapy (47.7％ vs.68.2％;g2 =8.962,P =0.003) and the GCS score (11.2 ±3.1 vs.13.4 ±2.6;t =5.492,P＜0.001) were significantly lower than those in the non-CVS group.Multivariate logistic regression analysis showed that low GCS score (odds ratio [OR] 6.57,95％ confidence interval [CI] 1.04-12.96;P=0.001),high Fisher grade (OR 5.39,95％ CI 4.09-20.15;P =0.004),hyperlipidemia (OR 4.39,95％ CI 2.97-34.15;P =0.004),hypertension (OR 3.24,95％ CI 1.06-13.47;P=0.016) were the independent risk factors for CVS,while received nimodipine + edaravone was the independent protective factor for CVS (OR 0.39,95％ CI0.13-0.91;P =0.039).The proportions of patients with hypertension,hyperlipidemia,diabetes,smoking,and high Fisher grade in the DCI group were significantly higher than those in the non-DCI group (all P ＜0.05),while the proportion of patients received nimodipine + edaravone (40.6％ vs.70.2％;x2 =19.535,P ＜ 0.001) and the GCS score (10.2 ± 2.4 vs.13.8 ± 2.6;t =10.648,P ＜ 0.001) were significantly lower.Multivariate logistic regression analysis showed that low GCS score (OR 8.92,95％ CI 2.48-26.94;P =0.001),high Fisher grade (OR 7.49,95％ CI 1.96-20.47;P =0.001) were the independent risk factors for DCI,while.received nimodipine +edaravone was an independent protective factor for DCI (OR 0.27,95％ CI 0.08-0.97;P =0.020).Conclusions Compared with nimodipine alone,nimodipine combined with edaravone can significantly reduce the incidences of CVS and DCI.The GCS score,high Fisher grade,and hypertension are the independent risk factors for CVS and DCI in patients with aSAH,and nimodipine combined with edaravone is the independent protective factor for CVS and DCI.