Tight junctions(TJ) are the primary junctions between intestinal epithelia.TJ serves as the maintenance of epithelial cell polarity and the rate-limiting barrier to passive movement of hydrophilic solutes across intestinal epithelia.The disrupture of TJ may cause or promote some diseases.This review is about structure,biological functions,molecular regulating mechanisms of intestinal epithelial tight junctions and some related diseases.

Objective: A marked deficiency of glutamine in clinical critical illness is correlated with mortality in the intensive care unit, and intestinal glutamine transport was reported to be impaired in late sepsis. Berberine was reported to protect against the intestine injury, and improve the survival rate in sepsis. We designed this study to gain further knowledge of the intestinal glutamine transport in early and late sepsis, and to find out whether beberine pretreatment has some effect on glutamine transport in sepsis. Methods: Berberine (50 mg/kg) was given intragastrically once a day for 5 days, and sepsis was induced by cecal ligation and puncture on day 5. The small intestinal samples were collected at 0, 2, 6, 12, 24 h. Intestinal brush border membrane vesicles were prepared by Mg~(2+) aggregation-differential centrifugation techniques, and brush border glutamine transport was studied by a rapid filtration technique. Results: Under control condition, Na~+-dependent glutamine transport accounted for about 90% of the total transport. The relative contributions of ATA2, ATB~(0,+), B~0AT1 were about 12, 25, 63%, respectively. Septic rats showed an early increase and a late decrease in intestinal glutamine transport. ATA2 had an earlier increase in the early stage, while B0AT1 had no significant increase. Berberine pretreated group had a relative less increase in early phase and a less decrease in late phase compared to sepsis group. Conclusion: Rat intestinal glutamine transport showed an early increase and a late decrease in sepsis, and berberine pretreatment could attenuate the impairment of glutamine transport in sepsis. It may provide some information for sepsis treatment.

Objective: To investigate the potential role and our experience of perioperative nutritional support in the management of patients with Crohn's disease (CD).Methods: 150 CD patients (male to female=101:49) performed with operation and from the year 1997 to 2007 were analyzed retrospectively. Their nutritional index, Crohn's Disease Activity Index (CDAI), sites of lesion, causes and procedures of operation, usage of nutritional support pre-operatively and post-operatively, and operation-related complications were all recorded.Results: Malnutrition, as indicated as BMI<18.5 kg/m2 or decrease of body weight>10% over the recent 3 months,occurred in 130 patients (88.67%)on admission.After aggressive nutritional support,patients' nutritional index, such as blood haemoglobin, serum albumin, pre-albumin, transferrin and lymphocytes counts all increased significantly pre-operatively and on discharge compared with on admission, while the change of BMI was not significant. For 53 patients receiving home enteral nutrition after discharge, their BMI increased significantly on last follow-up compared with on admission (19.24 vs 17.64, P<0.001). Operation-related complications occurred in 14 patients (9.33%), and two of them died due to severe intra-abdominal infections. Two patients with severe retroperitoneal infection on admission were successfully treated using the damage-control surgery.Conclusion: Malnutrition is a common complication in CD patients receiving surgery, and aggressive perioperative nutritional support may have a positive effect on the morbidity and mortality in such patients. Long-term maintenance therapy with enteral nutrition may delay the postoperative recurrence of the Crohn's disease and should be considered. For critically ill CD, damage-control surgery may get a better outcome than conventional treatment procedures.

This paper presents some ideas and practices to realize the homogeneity quality management process within the Beijing Children Hospital Group,the largest specialized medical group in the country.This research aims at providing references and thoughts on homogeneity quality management for trans-regional medical unions in the country.

Objective To investigate the expression of soluble vascular endothelial growth factor receptor 1 (sFlt1) in human umbilical cord-derived mesenchymal stem cells (HUCMSC) under the condition of inflammatory cytokine and co-culture with rheumatoid arthritis fibroblast-like synoviocytes (RA-FLSs).Methods ① HUCMSC were cultured alone or stimulated by Tumour necrosis factor (TNF)-αt,interferon (IFN)-γor the combination of TNF-α and IFN-γ.The sFh1 levels of each group were detected by enzyme-linked immunosorbent assay (ELISA) at 24 h,48 h and 72 h respectively.② RA-FLSs and HUCMSC were cocultured in a transwell system with both of them cultured alone as control for 72 hours.ELISA was used to detect sFlt1 levels in each group.T test was used for comparison between two groups,and ANOVA was used to compare multi-group variables.Results ① The sFlt1 levels of TNF-α + IFN-γ group were significantly higher than those of the control group at 24 h and 48 h (24 h (5.4±0.4) ng/ml vs (2.8±1.7) ng/ml,t=0.942,P=0.026;48 h (7.2±0.8) vs (4.3±1.0) ng/ml,t=4.285,P=0.005),while that at 72 h was not significantly different [(9.1±1.7) ng/ml vs (7.0±1.4) ng/ml,t=0.683,P=0.52].And no significant difference in sFlt1 levels between control group and TNF-α group or IFN-γ stimulation group were observed.② Compared with RA-FLSs,the expression of sFlt1 in HUCMSC was significantly higher (8.19±3.64) ng/ml vs (0.19±0.08) ng/ml,t=7.280,P＜0.01].After co-cultured with RA-FLSs and HUCMSC,the sFlt1 concentration of the co-culture group was significantly higher than that of HUCMSC group [(17.26±6.92) ng/ml vs (8.19±3.64) ng/ml,t=3.985,P=0.000 7].Conclusion The sFlt1 expression of HUCMSC is up-regulated by inflammatory cytokine TNF-α combined with IFN-γ.RA FLSs may promote the co-cultured HUCMSC to increase sFlt1 expression by secreting inflammatory factors.

Objective: To investigate the clinical effect and safety of long-acting pegylated interferon-α-2b (Peg-IFN-α-2b) (Y shape, 40 kD) injection (180 μg/week) in the treatment of HBeAg-positive chronic hepatitis B (CHB) patients, with standard-dose Peg-IFN-α-2a as positive control. Methods: This study was a multicenter, randomized, open-label, and positive-controlled phase III clinical trial. Eligible HBeAg-positive CHB patients were screened out and randomized to Peg-IFN-α-2b (Y shape, 40 kD) trial group and Peg-IFN-α-2a control group at a ratio of 2:1. The course of treatment was 48 weeks and the patients were followed up for 24 weeks after drug withdrawal. Plasma samples were collected at screening, baseline, and 12, 24, 36, 48, 60, and 72 weeks for centralized detection. COBAS® Ampliprep/COBAS® TaqMan® HBV Test was used to measure HBV DNA level by quantitative real-time PCR. Electrochemiluminescence immunoassay with Elecsys kit was used to measure HBV markers (HBsAg, anti-HBs, HBeAg, anti-HBe). Adverse events were recorded in detail. The primary outcome measure was HBeAg seroconversion rate after the 24-week follow-up, and non-inferiority was also tested. The difference in HBeAg seroconversion rate after treatment between the trial group and the control group and two-sided confidence interval (CI) were calculated, and non-inferiority was demonstrated if the lower limit of 95% CI was > -10%. The t-test, chi-square test, or rank sum test was used according to the types and features of data. Results: A total of 855 HBeAg-positive CHB patients were enrolled and 820 of them received treatment (538 in the trial group and 282 in the control group). The data of the full analysis set showed that HBeAg seroconversion rate at week 72 was 27.32% in the trial group and 22.70% in the control group with a rate difference of 4.63% (95% CI -1.54% to 10.80%, P = 0.1493). The data of the per-protocol set showed that HBeAg seroconversion rate at week 72 was 30.75% in the trial group and 27.14% in the control group with a rate difference of 3.61% (95% CI -3.87% to 11.09%, P = 0.3436). 95% CI met the non-inferiority criteria, and the trial group was non-inferior to the control group. The two groups had similar incidence rates of adverse events, serious adverse events, and common adverse events. Conclusion In Peg-IFN-α regimen for HBeAg-positive CHB patients, the new drug Peg-IFN-α-2b (Y shape, 40 kD) has comparable effect and safety to the control drug Peg-IFN-α-2a.