Objective To investigate the role of blood motilin and anorectal function in the pathogenesis of functional outlet obstructive constipation (OOC), and study if motilin and its receptor agonist are effective to treat OOC. [WTHZ]Methods Patients with OOC were selected according to colonic transit time and transit index. Twenty healthy subjects were also selected as control group. Anorectal manometry was performed, and blood motilin level was measured in patients with OOC and healthy subjects. Correlation between blood motilin level and anorectal function was analyzed. [WTHZ]Results Compared with healthy subjects, OOC patients had higher anal resting pressure, lower defecating pressure difference,larger minimum relaxation volume to elicit anorectal inhibitory reflex, and higher rectal sensation threshold. The plasma level of motilin was positively correlated with anal resting pressure, maximum squeeze pressure and anal defecating pressure, but was negatively correlated with defecating pressure difference between rectum and anal canal. Conclusion OOC patients had anal sphincter dysfunction in relaxtion, discoordination of annorectum during defecation, and Low sensitivity of rectum. OCC patients with the normal level of blood motilin may have more severe outlet obstructive tendency, and motilin and its receptor agonist are not suitable for treating OOC patients.

Purpose:To constract and identify eukaryotic expression vector carrying human VEGF cDNA to cure human ovarian cancer with antiangiogenesis method. Methods:Reverse transcription PCR for VEGF, VEGF was inserted into eukaryotic exprssion vector pcDNA3 to construct pcDNA3-VEGF(-), in which restriction enzyme analysis was used to confirm the reverse orientation fo the VEGF cDNA from the individual transformants. The vector was transfected into human ovarian cancer cell HO-8910 and the positive clone was screened by G418,VEGF expression was confirmed by RNA dot blot. The VEGF expression of HO-8910 cells before or after transfection was detected by Western blot and imunofluorescence.The biological characteristics of HO-8910 cells before and after transfectionwas inspected. Results: VEGF gene was obtained by RT-PCR, the pcDNA3-VEGF(-) vector was obtained. VEGF expression was blocked by anisense VEGF RNA. The clone formation ability of singal cell was decreased after transfected, G 1 phase cells were increased and S Phase celIs were decreased in cell cycle. The proliferation of HO-89l0 cell was reduced. The formation rate and growth speed of xengrafted tumor slowed down. Conclusions:The successful construction of antisense VEGF eukaryotic expression vector is of significance for ovarian cancer-specific antisense gene therapy.

Objective To evaluate the effectiveness of applying simulation based medical education (SBME) in critical care medicine PBL teaching. Methods Totally 46 undergraduates in medical college of Shanghai JiaoTong University , who participated in critical care medicine PBL teaching in our Hospital from 2012 to 2013 were chosen as research objects. These students were divided into two groups: PBL group (2009 grade, n=24) and SBME-PBL group (2010 grade, n=22). The teaching effectiveness was evaluated by questionnaire survey, theoretical exam, direct observation of procedural skills (DOPS) and mini-clinical evaluation exercise (Mini-CEX). Data were analyzed by SPSS 17.0 software. The data of questionnaire survey were expressed as percentage and the assessment results were expressed as x±s. Chi-square and t test were used to do statistical analysis. P<0.05 signi-fies for statistically significant differences . Results ①The results of questionnaire survey showed that:there was no significant difference between two groups in study interests(P=0.665, 0.937, 0.746) and study ability(P=0.937, 0.665). But regarding collaboration ability, SBME-PBL group performed better than PBL group (P=0.019, 0.038, 0.024). ②These was no significant difference in the theo-retical knowledge exam between PBL and SBME-PBL group(P=0.743). But the DOPS scores of car-diopulmonary resuscitation (P=0.000), endotracheal intubation (P=0.023), defibrillation (P=0.002) and central venous catheterization(P=0.047) were all significantly higher in SBME-PBL group than in PBL group. ③In Mini-CEX, there was no statistical difference in physical examination skills (P=0.790) and clinic judgment(P=0.426) between the two groups. However, SBME-PBL group performed better in medical interviewing capacity(P=0.002), humanistic care (P=0.001), counseling skills(P=0.017), organization efficiency(P=0.029) and overall clinical competence(P=0.024) than PBL group. Conclusions SBME can promote the students' team work spirit, basic clinical skills and comprehen-sive clinical capacity in critical care medicine PBL teaching and can improve the teaching quality of critical care medicine.

Objective To evaluate the prognostic effect of different ratios of fresh frozen plasma (FFP) to packed red blood cells (PRBC) in massively transfused trauma patients.Methods A retrospective cohort study was conducted for 210 trauma patients who received more than 10 units of PRBC during the initial 24 hours from January 2007 to June 2015.The patients were divided into four groups:Group A(PRBC:FFP ≤1,n=41),GroupB (1 ＜PRBC:FFP≤1.5,n=63),GroupC(1.5＜PRBC:FFP≤2,n=30) and Group D (PRBC:FFP ＞2,n =76).At 24 hours after admission,blood transfusion amount,blood transfusion ratios,post-transfusion adverse reactions (allergy,non-hemolytic febrile transfusion reaction,hemolysis,congestive heart failure,pulmonary edema,etc) and coagulation changes [hemoglobin (Hb),platelet count (PC),prothrombin time(PT),activated partial thromboplastin time(APTT),international normalized ratio (INR),etc] were compared among groups.Prognostic markers including sequential organ failure assessment(SOFA),hospital stay,ICU stay,30-day mortality and causes of death were also evaluated.Results Use of PRBC was decreased significantly in Group A than in other groups (P ＜ 0.01),and there were no differences in blood transfusion adverse reactions among all groups (P ＞ 0.05).The coagulation indices (PT,APTT and INR) in Groups A and B were significantly decreased compared to Group D after transfusion (P ＜ 0.05).There were no differences in length of hospital stay and ICU stay among all groups (P ＞ 0.05).Group D was associated with higher SOFA and higher 30-day mortality than other groups(P ＜0.01),but no differences were found in Group A,B and C (P ＞0.05).Meanwhile,ratio of patients died of massive hemorrhage in Group D was also higher than other groups (P ＜0.01).Kaplan-Meier survival analysis showed the survival interval was the shortest in Group D,while the longest in Group B and C.Conclusions Modest transfusion ratios (1.5 ＜ PRBC:FFP ≤2)within 24 hours can substantially improve outcomes in trauma patients.Aggressive ratios may improve coagulation indices and reduce use of PRBC,with no more benefit to the outcomes.

Objective To discuss the relationship of drip velocity of nitrate on blood pressure while treating coronary disease,in order to provide appropriate drip velocity for clinical treatment.Methods 155 patients with coronary disease using nitrate to lower blood pressure were selected.They were divided into the nitro glycerin group(85 cases) and the isosorbide mononitrate group( 70 cases) according to difference of medication.The velocity of drugs was adjusted on basis of blood pressure changes.The blood pressure changes at different drip velocities were observed and compared.Results The systolic pressure and the diastolic pressure between two groups showed no difference at 20 drops/min,but the results were the opposite at 30 drops/min.The systolic pressure and the diastolic pressure in the nitro glycerin group showed evident changes at different drip velocities,but in the isosorbide mononitrate group,these changes were not so significant.9 patients in the nitro glycerin group had headache during treatment,no headache occurred in the isosorbide mononitrate group.Conclusions Intravenous use of nitrate at a velocity of 20 drops/min is relative secure.The risk of hypotension will increase if the medication speed increases.lsosorbide mononitrate has little influence on blood pressure.