Objective To discuss the safety of endoscopic sphincterotomy (EST) in treatment of choledocholithiasis in patients over 80 years.Methods From 2005 to 2007,893 patients with choledocholithiasis were divided into group A (n= 148,aged over 80 years) and group B (n=745,aged below 60 years).The clinical data,complications and EST successful rate were retrospectively reviewed between two groups.Results ① The important chronic concomitant diseases were significantly higher in group A than those in group B ( 29.3 % vs 8.1 % ,P＜0.01).② The EST successful rate in group A and B was 95.6% and 96.5%,respectively ( P＞0.05).③ Sixteen patients in group A had complications including 13 caused by EST itself,3 related with EST and one died of aspiration pneumonia.While in group B,41 complications were caused by EST itself and no EST related complications.There was a statistically difference in EST related complications between two groups (P < 0.01 ).In complications caused by EST itself,there was no difference between two groups (P 0.05 ).④ The average hospital stay was ( 7.2 ± 2.2) days in group A and (5.1 ± 1.4) days in group B with no significant difference (P 0.05),Conclusion The EST is safe and effective in treatment of patients over 80 years.

Objective To supervise military training by application of clinical classification of fatigue fracture so as to decrease the occurrence and development of fatigue fracture. Methods From Feb.1999 to Feb.2002, the knowledge of clinical classification of fatigue fracture was applied in the military training in which it was essential to prevent and treat fatigue fracture. Results From 1999 to 2002, the incidence of fatigue fracture decreased year by year. Types Ⅱand Ⅲof fatigue fracture decreased significantly. Conclusion Clinical classification plays an important role in decreasing the occurrence and development of fatigue fracture.

Objective To construct of shRNA lentiviral expression vector targeting APRIL (aproliferation-inducing ligand) gene in CFPAC-1 cell of human pancreatic cancer. Methods We used gene engineering to screen RNA interference targeting sequence of APRIL gene. The complementary DNA containing both sense and antisense Oligo DNA of the targeting sequence was designed, synthesized and cloned into the pGCL-GFP vector. The resulting lentiviral vector containing shAPRIL were named LV-shAPRIL. Then it was conformed by PCR and DNA sequencing identification. 293T cells were eotransfected with LV-shAPRIL,pHelper 1.0 and pHelper 2.0 to product ientivirus. The titer of virus was tested according to the expression level of GFP in the 293T cells. After recombinant lentivirus infection into CFPAC-1 cells, we used real-time RT-PCR and Western blotting to examine APRIL mRNA and protein expression at different cell culture period.Results PCR analysis and DNA sequencing conformed that shAPRIL DNA was successfully inserted into the lentiviral vector. The titer of concentrated virus were 5 × 107 TU/ml. APRIL expression in CFPAC-1 cells were inhibited significantly at both mRNA and protein level. APRIL mRNA expression were decreased 73%, 70%and 71% , respectively, after the infection of 4 days, 4 weeks and 8 weeks by LV-shAPRIL. APRIL protein expression were decreased 66%, 63% and 62%, respectively , after the infection of 4 days , 4 weeks and 8weeks by LV-shAPRIL. Conclusions ShRNA lentiviral expression vector targeting APRIL gene has been successully constructed, and it can effectively inhibit the expression of APRIL gene in CFPAC-1 ceils. This study lays a foundatin for in vivo research APRIL gene scilence in pancreatic cancer cell using the model of nude mice.

Objective To analyze the hospitalization expenses of cancer patients covered with byitem payment and quota payment packages,and probe into the impacts on such expenses for the two payment packages.Methods Inpatient records of 600 cancer patients were sampled by random from the medical insurance databases of Zhengzhou and Fuzhou to learn their hospitalization expenses and impact factors.Results Under the by-item payment package,the expenses of urban workers’ medical insurance were found higher than those of urban residents' medical insurance,with a per capita expense of RMB 32747.70 ± 32035.01 and 23035.83 ± 22875.65 respectively.Under the quota payment package however,there were no significant differences between expenses of the two kinds of inpatients,with a per capita expense of RMB 66043.41±47562.09 and 66576.54±73417.29 respectively.Conclusion There are gaps of reimbursement level between the two basic insurance schemes,which may not disappear in a short time.Under the by-item payment package,the gap exists in the difference of perreimbursement amount; under the quota payment package,the gap is negligible between the two populations under different insurance schemes.It is recommended to make reasonable use of these different payment schemes to minimize the relative gaps in medical service accessibility caused by the difference in reimbursement level.

Objective To construct small hairpin RNA(shRNA) lentiviral vectors targeting human a proliferation-inducing ligand(APRIL) gene and detect the titer of virus and suitable multiplicity of infection (MOI) after 293T cells were infected by the lentival vectors. Methods Three RNA interference targeting sequences of APRIL gene were screened including shAPRIL1210, shAPRIL1754 and shAPRIL1604. Both sense and antisense Oligo DNA of the targeting sequences were synthesized and cloned into the pGCL-GFP vector, respectively. The resulting lentiviral vectors containing shAPRIL were named LV-shAPRIL1210, LV-shAPRIL1754, LV-shAPRILI604. Then they were confirmed by PCR and DNA sequencing. 293T cells were co-transfected with LV-shAPRIL, pHelper 1.0 and pHelper 2. 0 to product lentivirus, respectively. The titer of virus and suitable MOI were tested according to the expression level of GFP in the 293T cells. Results PCR analysis and DNA sequencing confirmed that three shAPRIL DNA were successfully inserted into the lentiviral vectors. The titers of concentrated virus were 5 × 107, 6 × 107 and 4 × 107(transduction units )TU/ml, respectively, and the suitable MOI was 5. Conclusions Three shRNA lentiviral vectors targeting human APRIL gene have been successfully constructed, which lays a foundation for future studying APRIL's gene silencing in related target cells.

Objective To investigate the inhibitive effect of shRNA (short hairpin RNA) targeting APRIL gene on the pancreatic cancer cells in vitro and in vivo, in order to explore the feasibility of gene therapy for pancreatic cancer. Methods The LV-shAPRIL targeting APRIL gene had been constructed before, and was used to infect the CFPAC-1 cells. Cell proliferation and apoptosis were examined by MTT and flow cytometry. Then CFPAC-1 cells were used to construct the model of transplantation tumor into the nude mice, the tumor growth was assessed after LV-shAPRIL treatment. Results 96 hours after the LV-shAPRIL infection into CFPAC-1 cells, the cell proliferation was significantly inhibited when compared with control group and lentivirus infection group (P＜0.05 ). Flow cytometry showed the apoptosis ratio of the CFPAC-1 cells was (17.35±0.96)% in LV-shAPRIL group, which was higher than that in control group and lentivirus infection group (P＜0.05 ). After LV-shAPRIL injection into the model of nude mice, the tumor growth was slower than that in the two control groups. The tumor's volume of the LV-shAPRIL group was(821.8±123.3) mm3 and the mass was (2.16±0.18)g at 27 day, and were obviously depressed, when compared with two control groups (P±0.05). Conclusions LV-shAPRIL targeting APRIL gene can inhibit the growth of the CFPAC-1 cells in vitro and vivo. This may provide a new gene therapy approach for pancreatic cancer.

Purpose To investigate the diagnostic value of the arrhythmogenic right ventricular dysplasia (ARVD) using multi-slice spiral CT (MSCT). Materials and Methods Thirty-four patients who were suspected as ARVD received right ventricular radiography, including 16 ARVD patients and 15 non-ARVD patients regarded as control group. The structural and shaped change of heart on reconstructed images of long axis, short axis and four cavity surface and analyze were observed, and MSCT features of right ventricular radiography characteristics were analyzed for ARVD patients. Results Sixteen cases of ARVD were correctly diagnosed by MSCT, and 14 cases had fatty infiltration including 11 cases of apex of heart, 8 cases of inferior wall, 5 cases of anterior wall, 5 cases of anterior wall of funnel area, 3 cases of diagram, 4 cases of papillary muscle, 6 cases of muscular trabecula and moderator band and 1 case of whole right ventricular free wall. Five cases showed scallop sign, 16 cases excessive trabecular change, 11 cases thinned changes, and 16 cases enlarged changes of right ventricular wall. Conclusion MSCT features of right ventricular for ARVD have relative diagnostic characteristics, and the scallop sign and excessive trabecular change of right ventricular wall are its specific imaging characteristics.

OBJECTIVE To analyze resistance and detect plasmid-mediated AmpC genes in Klebsiella pneumoniae.METHODS The susceptibility of the K.pneumoniae to 13 antibiotics was tested by K-B method.Modified three-dimensional extract test was adopted to detect AmpC lactamases in K.pneumoniae.The genotypes of AmpC lactamases were determined by polymerase chain reaction and sequencing.RESULTS Among the 105 isolates,the rate of extended spectrum ?-lactamases(ESBLs) was 41.90%,the rate of AmpC ?-lactamases was 0.95% strains,and the rate of ESBLs and AmpC ?-lactamases was 2.86%.DNA sequence analysis conformed that AmpC lactamases positive isolates were DHA AmpC gene.The resistance rate to penicillins,cephalosporins,?-lactam/?-lactam inhibitors,monobactams,and fluoroquinolones was very high.The susceptibility rate to imipenem was 100.00%.CONCLUSIONS The plasmid-mediated AmpC gene is present in clinically isolated K.pneumoniae.The resistance can be transferred to homologous or different genera of bacteria.

OBJECTIVE To analyze the cause of Acinetobacter baumannii resistance to ?-lactam and the aminoglycoside-modifying antibacterials. METHODS Three-dimensional test was used to analyze and classify the ?-lactamases. Proper primers was used to do PCR and determined by sequencing. RESULTS A. baumannii clinical isolate harbored blaOXA2-23,blaTEM and blaADC genes and aac(3)-Ⅰ,aac(6')-Ⅰb and ant(3″)-Ⅰ aminoglycoside-modifying enzyme genes. CONCLUSIONS An A. baumannii strain which carries TEM,OXA-23,ADC ?-lactams and aac(3)-Ⅰ,aac(6')-Ⅰb,ant(3″)-Ⅰ aminoglycoside-modifying enzyme genes is detected.

Objective To investigate the anticoagultive effectiveness and specialty of sodium citrate comparing with hep- arin in continuous venovenous hemodiafiltration (CVVHDF).Methods 50 multiple organ disorder patients undergoing CWHDF were randomly divided into two groups:group A(sodium citrate)27 cases,group B(heparin)23 cases,blood e- lectrolyte,acid-alkali degree,cruor index changes,the blood coagulation of tube path way and blood filter were recor- ded.As the same time,side effects were observed in theraphy.Results The patients of two groups were kept stable vital signs,serum electrolyte and blood gas markers during the therapeutic periods.Moreover,ideal serum creatinine and urea clearance rate and uhrafiltration rate were obtained in all patients.The coagulation and longevity of blood filter of Group A are better than Group B,Group A without sigaificantly prolonged cruor index inside body,the dosage of calcium gluco- nate in Group A are greater than Group B.Conclusion Out body anticongulation of sodium citrate is more effective and reliable than regular heparin anticoagulation.