OBJECTIVE To explore the risk factors in elderly patients with ventilator-associated pneumonia(VAP) and to provide the corresponding clinical prevention strategies.METHODS The ages,underlying diseases,mechanical ventilation method,use of antibiotics,and pathogenic bacteria of the VAP patients were investigated and analyzed.RESULTS Totally 105 elderly patients with VAP had serious underlying diseases,and were treated with broad-spectrum antibiotics,tracheal intubation or trachea incision.Most pathogenic bacteria were multiresistant.CONCLUSIONS Prevention of VAP is the priority of treatment for elderly patients.In order to control the occurrence and spread of VAP,clinicians should shorten the time of ventilator treatment,pay more attention to sterilization and isolation,and strengthen the attendance of the patients.

Present basic researches on hepatic stem cells have obtained great progress. It is believed that hepatic stem cells can differentiate into hepatic cells and biliary duct cells. Hepatic stem cells are isolated and cultured by two-step collagenase digestion method, density gradient centrifugation, centrifugal elutriation, fluorescent activation screening method and immunomagnetic beads screening method. Directional differentiation of hepatic stem cells is a complicated process, which is affected by exterior and interior cell factors under liver microenvironment where are beneficial to growth, differentiation and function of stem cells. Hepatocyte growth factor can promote the proliferation of hepatic stem cells, and accelerate the differentiation into mature hepatic cells. Transcription factor of hepatic cells play a crucial effect in regulating the differentiation of hepatic stem cells. Incomplete or abnormal differentiation of hepatic stem cells can be responsible for liver cancer. Hepatic stem cells are the potential carrier cells as a target gene for liver cancer.

Objective　Genetic analysis was performed on a female child with chromosome Xq28 heterozygous deletion and suspected X-linked recessive disease to determine the morbidity and prognosis. Methods　A female child was admitted to the hospital on day 20 because of "jaundice for 20 days and difficulty in stopping bleeding at acupuncture sites". Low depth whole genome test of amniocentesis in late pregnancy suggested missing copy number of hemophilia A and X-linked mental retardation type 72. In order to further confirm the diagnosis and prognosis, peripheral blood of the children and their parents were collected for gene testing, chromosome inactivation test and genetic analysis. Results　Chromosome Xq28 of the child had 439.4 kb copy number heterozygous deletion variation, which was a clear disease-coding gene for functional loss included in ClinGen database. Chromosome inactivation test showed that the paternal X chromosome of the child was extremely inactivated. Haplotype analysis suggested that the normal chromosome of the subject was inherited from the mother, and there was heterozygous deletion on the paternal X chromosome, so it was inferred that the child will not develop disease or just have mild symptoms. Conclusion　It is necessary to analyze the X chromosome inactivation test for female patients with the pathogenic variation of X-linked recessive genetic disease to determine the possibility of the disease.

Patients who suffer from recurrent patellar dislocation frequently complain of diffuse pain around the knee, swelling and dislocation or subluxation of the patella. Anatomical abnormalities should be responsible for the condition, such as increased Q angle, a high-riding patella, dysplasia of the femoral condyles, abnormal shape of the patella, atrophy of the vastus medialis and hypertrophy of the vastus lateralis. We reviewed 45 reports about the treatment of recurrent dislocation of the patella. The current more than 100 methods can be classified as: lateral release, proximal realignment, distal realignment, proximal and distal realignment, patella-tomy and plastic repair of quadriceps. Of all these methods, proximal realignment is the best, but there has been no method which can successfully and generally repair the recurrent patellar dislocation.

Objective To investigate the optimal combination and the value of functional magnetic resonance imaging in the diagnosis of breast tumors. Methods One hundred and forty patients who had been clinically and pathologically diagnosed as breast tumors in our hospital during the period of 2009 to 2013 were collected. 63 of whom had breast cancer and 77 had benign tumor. All the patients received 1H-MRS, DWI and dynamic enhanced MRI at the same time. The obtained images were analyzed and then compared with the pathological findings. The accuracy, sensitivity, and specificity of MRS combined with DWI or dynamic enhanced MRI, or DwI combined with enhanced MRI in the diagnosis of breast cancer were obtained. Results All the diagnosis were pathologically confirmed. The accuracy, sensitivity, and specificity were 89.8%, 90.1%, and 90.0% for DWI combined with dynamic contrast-enhanced MRI; 77.9%, 77.3% and 79.3% for MRS in combination with enhanced MRI; and 76.3%, 77.8% and 77.1% for DWI combined with MRS. There were significant differences among the three kinds of combination detection in diagnosis of breast cancer , χ2= 9.057, P = 0.011. Conclusions The sensitivity, specificity and accuracy is the highest in DWI combined with dynamic enhanced MRI in the diagnosis of breast tumor , which can be used as the best combination imaging for breast tumor.

OBJECTIVE:To study the pharmacokinetics and pharmacodynamics of single dose of intramuscularly injected methotrexate(MTX)in the treatment of ectopic pregnancy so as to provide theoretical bases for the choice dosage regimen.METHODS:Serum concentration of MTX in 8 cases with ectopic pregnancy were determined by fluorescence polarization immunoassay after injected i.m with single dose MTX(50mg/m2);The ?-HCG was monitored both before and after treatment and the lump sizes of the ectopic pregnancy were determined by B ultrasound.RESULTS:The pharmacokinetics of single dose of intramuscularly injected MTX conformed to two-compartment open model;Cmax occurred at 1.9h after drug taking with 2.31 ?mol/L;The time for the recovery of ?-HCG to normal was(24.8?10)days,the patency rate of oviducts of those who demanding procreation was 75%.CONCLUSION:Injection intramuscularly with single dose of MTX 50mg/m2 is effective in the treatment of ectopic pregnancy.

Various pathologic mechanisms and types of lesion have participated in cognitive impairment in patients with vascular dementia.A number of medications have been used in the treatment of patients with vascular dementia in clinical practice,including cholinesterase inhibitors, N-methy-D-aspartate receptor antagonists,calcium channel blockers and neurotrophic drugs. This article reviews the progress in research on the pharmacotherapy of vascular dementia.

Objective: To determine puerarin content in Cuochanglin Granules by HPLC. Methods: The determination was performed on C 18 column with MeOH H 2O(25∶75) as a mobile phase by means of external standard method. Results: There was a linear relationship between puerarin and chromatographical peak area when puerarin concentration was at a range of 0.099?g～0.495?g. Conclusion: The method is simple, accurate and sensible, and can be used for quality control of this preparation.

Objective To investigate the effects of different concentrations of glutnine(Gln) on the procfion of nitric oxide (NO)and reduction in mitochondrial membrane potential in rat heputocytesactivated in by interleukin(IL)-1β.Method The primary cultured rat hepatocytes with high-purity Wfffe isolated from 6-week-old male Sprague-Dawley raL, by flirt in situ circulatory collagenase peffusion method.After incubation for hours.hepatocytes were stimulated by saline,or IL-l(1 nmol/L)or IL-I(1 mnol/L)combined with gIne in concentrations rangiIfrom 2 to 10 mmol/L.The culture muln and hepatocytes were collected at 24 hours after stimulation.The concentrations of alanine aminotransferase(ALT)and NO in the lnllln were detected by biochemical methods.The mitochondrial membrane potential of the hepatocytes was detected with flow cytometry after incubated with fluorescem probe JC-1.Statistic package ofSPSS 11.5 was used for the data analysand significant differences between mean8 were evaluated byQ、4k analysis.Results The average concentration ofand NOinthe culturemedium afterIL-Istimulationwas 38.2U/L and 72.7tmaol/L,respectively,whichwere sis,cantly big,herthanthose ofcontrol group(7.4 U/L and41.7nol/L,respectively,P<0.01).1hemitochondrial membrane potential ofhepatocytes in IL-lgroup was much lowerthan that in control group(30.O%vs.62.8%.P<0.01).Gin inhibited NO production induced byⅡ,lp,Jeleasing and reduction in mitochondrial II brahetential ofcuhured rat hepatocytes in a dose-dependent HmIll.Conclusions Ghtamine,the most abundant free amino acid in the body,call attenuate hepatocye injury mechateel in vitro by pro-inflammatory cytokine mediated.nlis protective effectmay be associatedwiththeinhibition of NO production and thereby amelioration of mitochondrialfunction.

Objective Objective To evaluate the response,survival and toxicity of concurrent chemoradiotherapy for patients with inoperable esophageal cancer. Methods Eighty-eight patients with inoperable esophageal cancer were divided randomly into two groups, 43 patients in group R+C received chemoradiotherapy, while 45 patients in group R received radiotherapy only. For both groups, the same radiation technic was carried out by conventional fractionation, to a total dose of 60-65Gy/30-33Fr/6.0-6.5W. For group R+C patients, concurrent chemotherapy(5-Fu 500mg/d1-4,DDP 20mg/d1-4) was given. Results Complete response rate in group R+C was 33%,while in group R, it was 13% (P