Five kinds of probiotic bacteria are immobilized and cultured continuously in simulated intestinal systems with corn fiber as the carrier.The biomass and the colonization in biofilm are investigated by selective culture methods and scanning electron microscope.Bifidobacteriurn longum TQ21-2-2,Lactobacillus acidophile CICC06005,Clostridum butyric TO-A,Bacillus mesentericus TO-A and Enterococcus faecalis T-110 can coexist stably.The biomass of five probiotics in the immobilized phase is greater than that of liquid in the continuous shake flask reactor.Five kinds of probiotic bacteria formed biofilm on corn fiber which be observed by SEM.Continuous culture of immobilized cells could be used better model than that of liquid, the model can be used to study for microecology and microecologocal agent.

Objective To evaluate the influence of cytochrome P450 (CYP2C9 and CYP4F2) polymorphisms on anticoagulant intensity of warfarin after cardiac valve replacement.Methods A total of 136 patients tak ing warfarin after cardiac valve replacement were identified and classified into 4 groups:CYP2C9 wild type group (CYP2C9*1*1),CYP2C9 mutated type group (CYP2C9*3),CYP4F2 rs2108622 wild type group (CC) and CYP4F2 rs2108622 mutated type group (CT or TT).The patients' baseline data,initial dose of warfarin and base INR measurement resuhs were recorded and then the follow-up was conducted.The initial administration of warfarin to INR standard time for the first time,total amount of warfarin and the average daily amount were recorded.Results Patients carrying CYP2C9* 1* 1 had increased time to reach INR target value for the first time (P ＜ 0.05);and the total warfarin doses and average daily dose when INR reached target value were higher than those carrying CYP2C9*3 (P ＜ 0.05).When compared with those in two wild type groups,patients carrying CYP2C9 and CYP4F2 rs2108622 mutated type needed the shortest time when INR reached target value for the first time,and the total warfarin doses and average daily dose when INR first reached target value was the lowest,which showed significant difference (P ＜ 0.05).And when compared with CYP2C9 mutated type group,the INR average time to reach the first target was shortened and the total warfarin dose of patients carrying CYP2C9 and CYP4F2 rs2108622 mutated type was lower (P ＜ 0.05).Conclusion The gene polymorphisms of CYP2C9 and CYP4F2 are significant hereditary factors influencing warfarin dose.Detection of CYP2C9 and CYP4F2 genotypes prior to medication and predicating warfarin dosage may result in lower incidence of over-anticoagulation and reduce the dosage-adjusting time of warfarin.

Objective To explore the diagnosis and treatment of Castleman's disease (CD) of the abdomen and pelvis.Methods The clinical data of 51 cases of abdomen and pelvis CD were analyzed retrospectively from Jan 2007 to Oct 2017 in the First Affiliated Hospital of Zhengzhou University.Patients were divided into two groups according to the different clinical classifications:Localized CD (n =42) and Multicentric CD (n =9).Results 32 cases of LCD were asymptomatic (76％),others accompanied by abdominal or waist pain,abdominal distention.The main pathological type was hyaline vascular (93％),which can be cured by surgical treatment (41/42).MCD always accompanied by multiple superficial and deep lymph node enlargement in the whole body.Most of them suffered from anemia,fever,weight loss and dyspnea.CRP increased,hypoproteinemia,globulin increased,neutropenia were found.The main pathological type was plasma cell type (56％).There were no progress in 3 cases,and 6 cases were on remission after operation.Conclusion The diagnosis of abdomen and pelvis CD depends on pathological examination.LCD clinical symptoms are mild and good prognosis after surgery.However,MCD clinical manifestations are complex,and relatively poor prognosis after comprehensive treatment.

Objective To investigate the application value of choledochoscopy and imaging examination in the diagnosis and treatment of residual bile duct stones.Methods The retrospective descriptive study was conducted.The clinical data of 618 patients who underwent choledochoscopy and imaging examination after operation of hepatolithiasis in the First Affiliated Hospital of Zhengzhou University between April 2014 and September 2018 were collected,including 300 males and 318 females,aged from 19 to 89 years,with an average age of (58 ± 12)years.Observation indicators:(1) situations of residual bile duct stones diagnosed by choledochoscopy and imaging examination;(2) stone extraction situations of patients with hepatolithiasis.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were described as M (range).Count data were represented as absolute number or percentage,and analyzed using the chi-square test or Fisher exact propability.Results (1) Situations of residual bile duct stones diagnosed by choledochoscopy and imaging examination:all the 618 patients underwent choledochoscopy,and 505 of them underwent the imaging examination before choledochoscopy.① Of patients undergoing single imaging examination,72 received ultrasonography,with false-negative rate of 29.17％ (21/72);37 received CT examination,with false-negative rate of 10.81％(4/37);33 received T-tube cholangiography,with false-negative rate of 39.39％ (13/33).② Of patients undergoing combined two imaging examinations,61 received ultrasonography + CT,with false-negative rate of 8.20％ (5/61);129 received ultrasonography + T-tube cholangiography,with false-negative rate of 12.40％ (16/129);52 received CT + T-tube cholangiography,with false-negative rate of 5.77％(3/52).③ There were 121 receiving ultrasound+CT+T-tube cholangiography,with false-negative rate of 7.44％ (9/121).There were statistically significant differences in the false-negative rates of combined two or three examinations of ultrasound + CT+ T-tube cholangiography and single imaging examination (x2=40.83,P＜0.05).The further analysis showed a statistically significant difference among the single imaging examination (x2=7.70,P＜0.05).There was no statistically significant difference among the combined two of imaging examinations (x2=2.10,P＞0.05).There were statistically significant differences in the combined three examinations of ultrasound +CT+T-tube cholangiography and ultrasound and T-tube cholangiography examination respectively (x2=16.23,21.62,P＜0.05).There was no statistically significant difference in the combined three of imaging examinations and CT examination and combination of CT+T-tube cholangiography respectively (P＞ 0.05).There was no statistically significant difference in the combined three of imaging examinations and combination of ultrasound+CT examinations and combination of ultrasound+T-tube cholangiography (x2=0.33,1.71,P＞0.05).Seventy-one patients without residual bile duct stone by preoperative imaging examination were detected residual bile duct stones by intraoperative choledochoscopy,and residual bile duct stones of 36,31 and 4 patients are respectively distributed around the distal common bile duct,small intrahepatic bile duct,left and right hepatic ducts,common hepatic duct and remaining common bile duct.(2) Stone extraction situations of patients with hepatolithiasis:of 618 patients,cases with 1,2,3,4,5,6,7,8,9 and 10 times of residual bile duct stones clearance were respectively 392,116,48,39,9,6,3,2,2 and 1.Residual bile duct stones clearance frequency of patients was an average of 1.73 times.There were 63.43％(392/618) and 96.28％(595/618) of patients had stone clearance with once and ≤ 4 times of stone extraction,respectively.Conclusion The negative results of preoperative imaging examinations cannot be as standards of bile duct stone clearance before choledochoscopy,and the best choice is to detect whether there are residual bile duct stones and remove the stones combined with choledochoscopy.

Hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) is rare and enhanced CT or MRI can be used for its diagnosis. Surgical procedure is the main treatment for HCC with BDTT. The authors introduce the experiences of recurrent patient with HCC and BDTT who was treated with targeted therapy plus immunotherapy, in order to provide reference for its clinical diagnosis and treatment.

Objective: To explore the diagnosis and treatment of head and neck Castleman′s disease (CD), and to improve the understanding of the disease. Methods: The clinical data of 41 patients with head and neck CD treated from January 2007 to July 2017 in the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively. The patients were divided into two groups: localized CD (LCD, n=27) and multicentric CD (MCD, n=14). The clinical manifestations, laboratory examinations, operations, pathological findings and follow-up data were analyzed. Results: LCD was characterized by asymptomatic enlargement of the single lymph node with mild clinical symptoms. The main pathological type was hyaline vascular type, which can be cured by surgical treatment. MCD accompanied by fever 9 cases(64.3%), anemia 8 cases (57.1%), splenomegaly 7 cases (50.0%), respiratory symptoms 6 cases (42.9%), with multiple enlarged superficial and deep lymph nodes with pain, pleural effusion, and edema of lower extremity, C-reaction protein increased in 8 cases (57.1%), hypoproteinemia 8 cases(57.1%), globulin increased 7 cases (50.0%) and neutropenia 6 cases(42.9%). The main pathological type was plasma cell type in 7 cases (50.0%), and also there were 4 cases of hyaline vascular type and 2 cases of mixed type. Chemotherapy with or without rituximab was the main treatment. Most patients received complete or partial remission except for 2 patients who died of lung infection due to chemotherapy. Conclusions The diagnosis of head and neck CD depends on pathological examination. LCD shows mild symptoms and good prognosis after surgery. However, clinical manifestations of MCD are complex, with relatively poor prognosis after comprehensive treatment.