A 64-year old man was admitted on July 2011 with masses both in liver and right kidney.After PET-CT and blood test examination,dual primary advanced cancers were speculated to be co-existed in this patient,which having poor prognosis.By evaluation with comprehensive geriatric assessment,the patient also had hypertension,diabetes and atherosclerosis,liver and renal insufficiency.After multidisciplinary consultation and detailed discussion with the patient,the decision of no surgery and just keep the follow-up was made.The patient has been followed up for 18 months and the functional evaluation is the same as before.It is very important to evaluate the risk/benefit equation and improve the standard of care,and make the decision as patient centered rather than disease-centered in the elderly patients.

Objective To investigate mRNA expression level changes of dopamine transporter gene (DAT1) and dopamine receptor gene(DRD4) in attention deficit hyperactivity disorder(ADHD) children's peripheral blood before and after methylphenidate treatment,and to explore associations between the mRNA expression level and symptom severity,as well as methylphenidate response.Methods Forty five ADHD children by DSM-Ⅳ diagnostic criteria,aged six to fifteen years old participated in a six-week drug titration treatment of metbylphenidate.ADHD-RS-Ⅳ Home Version, WCST and VCPT were used to evaluate the ADHD clinical symptoms and cognitive functions.RNA Simple Total RNA Kit was used to extract the total RNA.After reverse transcription, the obtained c-DNA was used in the following qRT-PCR to evaluate relative mRNA expression of the candidate genges before and after medication.Results The DRD4 mRNA relative expression level after taking methylphenidate was significantly higher than that before methylphenidate treatment (0.23 ± 0.23 vs 0.16± 0.18, P =0.041).There was no significant difference between DAT1 mRNA relative expression level before (0.43 ± 0.40) and after (0.43±0.40) methylphenidate treatment.No significant difference was found on eitber basal DAT1/DRD4 mRNA expression or fold change of DAT1/DRD4 mRNA expression before and after medication between methylphenidate treatment responders and non-responders groups.There was a positively significant correlation between baseline DRD4 mRNA relative expression level and erroneous T score of CPT(r=0.424, P=0.025) , however, no other statistically significant correlation was found between basal DRD4 mRNA relative expression level and ADHD-RS-Ⅳ total score,WCST conceptual level, CPT missing T score, and CPT reaction T sco~ (all P＞0.05).There was also no statistical significant correlation between basal DAT1 mRNA relative expression level and ADHD-RS-Ⅳ total score,WCST conceptual level,and CPT T scores(all P＞0.05).Conclusion DRD4 gene function may be increased after methylphenidate treatment and play an important role in impulsivity behavior of ADHD.Therefore, DRD4 mRNA expression level might be a biomarker for ADHD diagnosis and a predicting indicator of drug efficacy.

Objective To study the correlation between amino terminal B-type natriuretic peptide precursor(NT-proBNP) and risk factors of acute coronary syndrome (ACS) with elder patients.Methods One hundred and twenty-eight ACS patients were divided into unstable angina pectoris (UAP) group with 52 samples,ST elevation myocardial infarction (STEMI) group with 35 samples and non-ST elevation myocardial infarction (NSTEMI) group with 41 samples.Meanwhile 45 healthy elder people were adopted as control group.Firstly,the subjects of blood pressure,body mass index (BMI) and smoking numbers were measured.Secondly,venous blood was collected to assay NT-proBNP,cardiac troponin Ⅰ (cTn Ⅰ),homocysteine (Hcy),blood-lipoids and C-reactive protein(CRP).Lastly,ultrasonic cardiogram was used to test left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter (LVESD) and left ventricular ejection fraction (LVEF).In addition,correlation analysis was researched between NT-proBNP and other factors.Results NT-proBNP levels of UAP,STEMI and NSTEMI groups were significantly higher than the control group ((794.18±182.64) ng/L,(872.43±245.67) ng/L,(557.25±163.81) ng/L) and (125.84±59.27) ng/L,P ＜ 0.05).NT-proBNP was positive correlation with systolic blood pressure,diastolic blood pressure,Hcy and CRP (r=0.182,0.176,0.281,0.191;P=0.040,0.043,0.001,0.031),however negative with LVEF(r=-0.247,P =0.005).Conclusion NT-proBNP level is sensitive to monitor ACS variety,and it is significant to test NT-proBNP combining Hcy,CRP,and cTn Ⅰ for diagnosing and treating ACS.

Objective To investigate the difference between nodular gastritis and atrophy gastritis.Methods During 2004.4～2005.3, the clinical, endoscopic and pathological findings of nodular gastritis and atrophy gastritis were analysed.Results Nodular gastritis is usually classified as nodular type A(nodular gastritis) and type B(atrophic gastritis with nodular changes). The endoscopic appearance of nodular gastritis was characterized as uniform miliary pattern and predominantly affected young women. The incidence of dyspeptic symptom was higher in patients with nodular gastritis than in atrophy gastritis. Nodular gastritis in adults is caused by Helicobacter pylori infection. Antral biopsy specimens showed lymphoid follicle formation and/or marked lymphoid aggregates. The prevalence of lymphoid follicle formation in the antrum was higher in patients with nodular gastritis than atrophy gastritis. Moderate to severe atrophy gastritis also usually has the same nodular endoscopic appearance,but that is not uniform and intensive.Conclusion Nodular gastritis is a very special gastritis with Helicobacter pylori infection and is different from atrophy gastritis.It is worth to be noticed.

Abstract?AlM: To investigate the effect of zebularine ( Zeb ) loaded Poly ( ethylene glycol ) - block - poly ( ε -caprolactone) methyl ether ( MePEG-PCL) nanoparticles ( NPs) on the viability, attachment, and apoptosis of in vitro cultured lens epithelial cells ( LECs) .?METHODS: In vitro cultured infant human lens tissue HLE B-3 immortalized cells were distributed randomly divided into six groups. Each group was administered with free Zeb 50μmol/L ( ZebF1 group ) , 100μmol/L ( ZebF2 group) , Zeb -loaded MePEG-PCL NPs 50μmol/L ( ZebNP1 group) , Zeb -loaded MePEG-PCL NPs 100μmol/L ( ZebNP2 group) , MePEG-PCL empty NPs( NPs group) or blank medium (group C) respectively. A tetrazolium dye assay ( MTT) test and modified MTT test were performed to determine cell viability and cell attachment. DNA ladder was used to detect the cell apoptosis.?RESULTS: Determined by MTT colorimetric method:Cell proliferation rate of LECs were suppressed by all Zeb administration groups in a concentration-time dependent manner (P<0. 05). Compared with the free Zeb groups, the viability of LECs were suppressed more effectively by the same dose of Zeb loaded MePEG-PCL NPs after 24, 48, 96h ( P < 0. 05 ). Determined by improved MTT colorimetric method: The attachment of LECs were decreased in all Zeb administration groups, Zeb loaded MePEG-PCL NPs had better effect on suppressing the attachment of LECs than the free Zeb groups with same dose (P<0. 05). The DNA ladder confirmed that after administration of 96h, group C, NPs group and ZebF1 group showed no DNA fragment, however the DNA fragment were performed in ZebF2, ZebNP1, ZebNP2 groups and displays the trend of ZebNP2> ZebNP1>ZebF2 (P<0. 05).?CONCLUSlON: Zeb loaded MePEG-PCL NPs had better effect on suppressing the viability and attachment of in vitro cultured LECs than the free Zeb groups , as well as enhancing the apoptosis.

AIM: To investigate the clinical effectiveness of reformed nonperforating trabeculectomy (NPT) in the patients with primary glaucoma.METHODS: 30 eyes of 21 patients with primary glaucoma patients underwent reformed NPT, in which 1.0mm3.0mm out layer of trabecular meshwork with Schlemm's canal was excised, but the innermost tissue was reserved. The clinical effectiveness was observed with short-term follow-up (1wk;1,6mo) and the long-term follow-up (1a and over, 10a the longest).RESULTS: The intraocular pressure (IOP) was controlled in 28 eyes (93%) without anti-glaucoma medicine during short-term follow-up, and in 27 eyes (90%)for long-term ones. There were no serious post-operative complications in all cases.CONCLUSION: The elevated IOP in patients with primary glaucoma can be effectively reduced by reformed NPT during short-term and long-term follow-up. The post-operative complications are much less because of no intra-operative penetration of the anterior chamber. The reformed NPT is an ideal surgical procedure for primary glaucoma.

AlM:To observe the effects of double incision combined surgery of single - stab trabeculectomy and phacoemulsification.
METHODS: Totally 28 cases ( 30 eyes ) with glaucoma and cataract undertook the modified combined surgery of single - stab trabeculectomy and phacoemulsification. After traditional phacoemulsification, cut the bulbar conjunctiva and Tenons capsule from the 11 o'clock to 1 o'clock, then puncture into the anterior chamber in 2mm behind the corneal limbus with 3mm tunnel knife, shaping a 3mm wide, 1/3-1/4 thickness scleral tunnel. Getting into the trabecular tunnel, bite off 3 pieces of trabecular tissue about 1mm × 1mm size. The changes in the imtraocular pressure ( lOP ) and the visual acuity before and after the surgery as well as filtering bleb ( OCT confirmed) and complications were carefully observed in 3-6mo postoperatively.
RESULTS: The postoperative visual acuity in 1wk postoperatively less than 0. 1 was found in 3 eyes, from 0. 1 to 0. 3 was found in 6 eyes,from 0. 3 to 0. 6 in 13 eyes, from 0. 6 to 0. 8 in 8 eyes. One eye had malignant glaucoma, and 8 eyes had cornea edema and slightly fibrin exudation in the pupil area; ln all cases maintained function conjunctival blebs of filtering, OCT confirmed this. lOP remained normal in 28 eyes in 3-6mo follow up, lOP of 2 other eyes could be controlled by anti-glaucoma eye drops.
CONCLUSlON:Double incision combined surgery of single- stab trabeculectomy and phacoemulsification is effective and safe, reduces the postoperative complications and is worthy of promotion.

OBJECTIVE To investigate the conditions and associated risk factors of nosocomial infections caused by Stenotrophomonas maltophilia.METHODS Thirty isolates of S.maltophilia causing nosocomial infections were collected and identified with API 20NE test strips.Minimal inhibitory concentration(MIC) of 14 antimicrobial agents against 30 isolates was determined by broth microdilution method.Case-control study and multivariate Logistic regression analysis were used for statistics to verify risk factors of infections caused by S.maltophilia.RESULTS Thirty isolates of S.maltophilia were highly resistant to imipenem,meropenem,cefotaxime, aztreonam and amikacin,but showed certain susceptibility to cefoperazone/sulbactam,piperacillin/tazobactam,trimethoprim-sulfamethoxazole and ticarcillin/clavulanic acid(96.7%,76.7%,73.3% and 60.0%,respectively).The independent risk factors leading to infections of S.maltophilia were mechanical ventilation(OR=7.629) and over 60 days of length of stay(OR=4.466).CONCLUSIONS S.maltophilia shows multiresistance to commonly used antimicrobial agents.The mechanical ventilation and over 60 days of length of stay are the independant risk factors for nosocomial infections caused by S.maltophilia.

OBJECTIVE To compare commonly used antibiotics including cefotaxime,ceftazidime imipenem and meropenem inductivity to L1,L2 ?-lactamases from Stenotrophomonas maltophilia.METHODS RT-PCR method was used to determine the expression of L1,L2 ?-lactamases under the condition of different concentrations(1/4,1,4?MIC)of antimicrobial agents.Electrophoresis strip of L1,L2 ?-lactamases was quantified by software Image J.Minimal inhibitory concentrations(MICs)were detected by agar dilution method when different concentrations of antibiotics were as inductors.RESULTS Different concentrations of four antibiotics being used as inductors,electrophoresis strips of L1,L2 amplicons were not found in strains of blank control and those whose media had imipenem,meropenem or cefotaxime(4?MIC).The weaker electrophoresis strips were found in the isolates whose media had ceftazidime(1/4,1,4?MIC)or cefotaxime(1/4?MIC),but the strongest electrophoresis strips,the most quantities of expression and higher MICs were shown in the isolates whose media had cefotaxime(1?MIC)(P

Objective: To investigate the physical and intellectual development and mutation characteristics of the phenylalanine hydroxylase (PAH) gene among 53 newborns with phenylketonuria (PKU), so as to provide insights into the management and genetic counseling of PKU Methods: The medical records of 54 children with definitive diagnosis of PKU and standardized therapy until 2 years at the Center for Neonatal Disease Screening of Shanxi Children' s Hospital from 2018 to 2021 were collected. Newborns' body weight and height developments were evaluated using the World Health Organization growth chart (2006 version), and the intellectual development was assessed using the national criteria of Development Behavior Assessment Scale among Children at Ages of 0 to 6 Years (WS/T 580-2017). The gene mutations were detected among neonates and their children, and the physical, intellectual developments and genetic characteristics of neonates with PKU were descriptively analyzed. Results: The 53 PKU cases included 29 male children and 24 female children, 36 cases with classic PKU and 17 cases with mild PKU, and 30 cases from rural areas and 23 cases from urban areas. The study subjects had a median age of 30 (10) d at initial therapy, and a mean blood phenylalanine concentration of (1 507±685) μmol/L at definitive diagnosis. There were 52 cases with normal height developments (98.11%), and all cases had normal weight and intellectual developments. The mean developmental functional quotient (DFQ) was significantly greater among urban children with PKU than among rural children [(94.92±8.57) vs. (87.65±6.57); t=-3.498, P=0.001], and the mean DFQ was significantly higher among children with mild PKU than among those with classic PKU [(95.55±8.76) vs. (88.57±7.11); t=-3.095, P=0.003]. There were 37 mutations detected in the PAH gene, which were mainly distributed in exons 3, 6, 7, 11, 12 and intron 4. Three high-frequency mutation sites were detected, including c.728G>A, c.611A>G and c.1197A>T, including three novel mutations (c.674C>G, c.1316-2A>C and c.1069T>C). Conclusions Following standardized treatment, the children with PKU have comparable physical and intellectual developments as compared to normal children. c.728G>A, c.611A>G and c.1197A>T were predominant mutations in the PAH gene among these 53 children with PKU, and three novel mutations were identified, including c.674C>G, c.1316-2A>C and c.1069T>C.