Objective To observe the glucose profile in type 2 diabetic gastroparesis.Methods 31 patients diagnosed with type 2 diabetes were enrolled into this study for measurement of gastric emptying of solids and continuous glucose monitoring to observe blood glucose 1evels for 72 hours on a balanced diet;the results were compared with 7 subjects with norinal glucose regulation.Results 58.1%of 31 type 2 diabetic patients were found to have delayed gastric emptying of solids.The average glucose level was lower after breakfast[(7.82±1.42)mmol/L vs(9.35±2.28)mmol/L,P<0.01]in the patients with gastroparesis than in those without.Maximal blood glucose level after breakfast[(10.21±2.17)mmol/L vs (12.24±2.82)mmol/L,P<0.01]was lower in the patients with gastroparesis but it reached the peak at a similar time.Two hour AUC was also lower after breakfast in the patients with gastroparesis[(877.62±Post-prandial glucose levelin type 2 diabetic patients with gastroparesis tends to be lower than those without.

Objective To investigate the effects of the exercise training on the cognitive function ,choline acetyltransferase (ChAT) activity and acetylcholinesterase (AchE) activity in stroke prone spontaneously hypertensive rat (SHR/SP) vascular de-mentia model .Methods 30 male SHR/SP rats were randomly divided into sham operation group ,model group and exercise group (n=10) .The VD model was established by the fractional ligation of bilateral carotid artery (2-VO) .The sham operation group and the model group were given the normal feeding without intervention after operation ;the exercise group adopted the treadmill exer-cise(DSPT-1) for 8 weeks .After the exercise ,the Morris maze test was conducted for evaluating the cognitive function in each group .The rats were finally killed for detecting the ChAT activity and AchE activity of hippocampus .Results In the positioning navigation training ,the latency period of the sham operation group was significantly short than that of the exercise group and the model group ,but the latency period of the exercise group was obviously short than that of rats in the model group (P<0 .05);in the spatial exploration test ,the rats in the sham operation group had more frequency of crossing platform than the other two groups ,the exercise group had more frequency of crossing platform in platform quadrant than the model group (P<0 .05);the exercise training could increase the ChAT activity and lower the AchE activity of hippocampus .Conclusion The exercise training can improve the function of hippocampal cholinergic system in SHR/SP and then increase the cognitive ability .

ObjectiveTo study the impact of allocation of organ arteries and their reconstruction for donor livers on arterial complications after liver transplantation from organ clusters obtained by combined liver,kidney,pancreas and duodenum harvesting.The aim is to guide future use of donor organs more safely and rationally with a decrease in postoperative complications.MethodWe studied 11 patients.ResultsThere was no hepatic artery anomaly.A Carrol artery patch was obtained at the bifurcation of the proper hepatic artery and the gastroduodenal artery in these donor livers.In one patient,an arterial graft was used because of inadequate arterial length,and arterial thrombosis developed which required re-transplantation.The hepatic arterial reconstruction was successful for the remaining 10 patients.One patient died of pulmonary infection 5 months post transplantation.ConclusionWhen combined liver,kidney,pancreas and duodenum harvesting was used,enough arterial length of the recipient must be preserved.There should be adequate and prompt communication between the teams carrying out the donor operation and the recipient operation.A Carrol arterial patch of the proper hepatic artery and the gastroduodenal artery for the donor liver,and the use of microsurgical vascular anastomosis in the operation are the keys to prevent hepatic arterial complications after liver transplantation.Multi-organ harvesting can be used for obtaining donor livers in liver transplantation.

Objective To evaluate the in vitro activity of seven imidazole antifungals against clinical isolates of common Candida species.Methods According to the Clinical and Laboratory Standards Institute (CLSI) microdilution method M27-A3,the in vitro activity of luliconazole,ketoconazole,miconazole,econazole,clotrimazole,sertaconazole and bifonazole was determined among 183 clinical isolates belonging to 5 species of Candida.Results The minimal inhibitory concentration range was 0.03-8 (geometric mean:0.067) mg/L for ketoconazole,0.03-16 (geometric mean:0.071 ) mg/L for miconazole,0.03-8 (geometric mean:0.207) mg/L for econazole,0.03-8 (geometric mean:0.061 ) mg/L for clotrimazole,0.03-16 (geometric mean:0.187) mg/L for sertaconazole and 0.03 -＞16 (geometric mean:1.050) mg/L for bifonazole. Luliconazole exhibited a superior activity against the 5 species of Candida in vitro,with the MIC range being 0.03-8 mg/L,geometric mean MIC 0.087 mg/L,MIC50 0.06 mg/L and MIC90 0.5 mg/L,respectively.However,some Candida isolates were identified to be relatively insensitive to these tested antifungals,including luliconazole.Conclusion All the tested imidazole antifungals,except for bifonazole,show an excellent activity against Candida species in vitro,but there exist a few Candida strains with relative insensitivity.

Objective To investigate the effects of therapeutic hypercapnia on type Ⅱ alveolar cells (ATⅡ ) in the transplanted lung in rats.Methods Twenty-eight pathogen free adult male Wistar rats weighing 180-220 g were randomly divided into 2 groups (n= 14 each) : control group (group C) and therapeutic hypercapnia group (group T). The animals were anesthetized with intraperitoneal 3% pentobarbital 30 mg/kg, tracheostomized and mechanically ventilated with 50% O2-50% N2 (VT 10 ml/kg, RR 60 bpm, I∶ E1∶1). Left lung transplantation was performed. In group T starting from the beginning of reperiusion of the transplanted lung, the animals were ventilated with a mixture of 50% O2-N2 and C02(in appropriate concentrations) to keep PaCO2 between 80-100 mm Hg. After 90 min of reperfusion of the transplanted lung, blood samples were collected from pulmonary vein of the transplanted lung and blood gas analysis was performed. Oxygenation index was calculated.AT II cells were isolated from the transplanted lung and purified and examined with electronic microscope. The apoptosis rate of AT Ⅱ cells was detected by flow cytometry. Results Oxygenation index was significantly higher, the apoptotic rate of ATⅡ cells lower, the damage to ATⅡ cells was less in group T than in group C.Conclusion Therapeutic hypercapnia can protect the AT Ⅱ cells in the transplanted lung and improve the function of the trans planted lung.

Objective To evaluate intervention in combination with choledochoscopic in treatment of biliary obstruction after orthotopic liver transplantation.Methods A retrospective review was performed in the 36 patiants with biliary strictures and bilary cast after the liver tiamsplantalion.All the patients received changing catheters,T-tube sinus tract dilation,choledochoscopic treatment,keeping catheters drainage and supporting.Result 26 patiants got satisfactory results and 8 controlled.The left 3 patients underwent retransplantation.Conclusion Intervention in combination with choledochoscopic treatment is effective to deal with biliary obstruction after liver transplantation.

Background and purpose:Radiotherapy is the main method to manage head and neck tumors.About half of the patients with malignant tumor in head and neck could obtain long term survival through radiotherapy or other therapy combined with radiotherapy.However,it is necessary to clinically detect whether carotid stenosis is a major sequela of head and neck irradiation,especially in long term survivors such as patients with nasopharyngeal carcinoma.We analyzed this injury and the degree of carotid stenosis,and its related factors to provide information to reduce and delay the incidence of this injury.Methods:We analyzed the degree of arterial stenosis of the nasopharyngeal carcinoma patients who received radiotherapy and had survived more than three years in Cancer Hospital Fudan University,compared with newly diagnosed as nasopharyngeal carcinoma before radiotherapy.The degree of carotid artery injury was observed and the clinical factors which affect its occurrence and development.All patients were low differentiated squamous cell carcinoma confirmed by pathology.All patients were examined with color doppler ultrasound to detect the carotid artery.The main end points were the diameter of carotid artery,the peak systolic and end diastolic velocities.Results:Arterial stenosis was more common in the reserch group than the control group(80% vs 20%,P＜0.001).The common and internal carotid arteries were most commonly involved(70% vs 20%,P＜0.001;6313% vs 10%,P＜0.001),followed by the external carotid artery(30% vs 3.3%,P=0.015).Significant stenosis was only found in the research group,common carotid arteries 36.7%,internal carotid arteries 23.3%,external carotid arteries10%.Conclusion:This study showed that radiation could cause significant carotid stenosis in nasopharyngeal carcinoma patients who had received radiotherapy more than 3 years previously.Carotid stenosis developed more frequently in the common carotid artery and intemal carotid artery on the side that had received radiotherapy.

Objective To comprehensively evaluate the clinical and radiological features of patients with Klebsiella pneumonia liver abscess (KLA) in order to improve treatment. Methods Data of 197 patients with KLA (n=106) or non-KLA (n=56) between March 2001 and January 2009 were collected and retrospectively analyzed on the aspects of underlying diseases, clinical manifestations, laboratory tests, pathogenic and imaging examinations. Results In comparison with non-KLA patients, the underlying diseases such as diabetes (53. 77% vs 25.00%, P = 0. 001) and hepatic adipose infiltration (16. 04% vs 5, 36%, P<0.05) were more common in KLA patients.Whereas the clinical presentations including abdominal pain (57. 14% vs 40. 57%, P<0. 05),hypodynamia (46.43% vs 19.81%, P=0. 001) and hepatomegaly (14.29% vs 4.72%, P<0. 05)were more severe in non-KLA patients than in KLA patients, however, the fasting blood glucose was higher in KLA patients than in non-KLA patients [(7.84±0.36) mmol/L vs (5.76±0.30) mmol/L,P=0. 001] on the admission. In addition, the abscess of KLA often appeared alone in the right lobe of the liver and was liable to generate air cavity (32. 88% vs 13.51%, P<0.05), un-smooth rim (71.23% vs 40.54% ,P<0.05) and dynamic septum enhancement (41.10% vs 16.22% ,P<0.01) in comparison with non-KLA. Conclusions Klebsiella pneumonia has emerged as the main pathogen of pyogenic liver abscess. The patients with KLA are often complicated with diabetes and fatty liver, as well as high prevalence of air cavity. The CT findings may be helpful for prompt treatment of Klebsiella pneumonia liver abscess.

Objective To evaluate the effects of medical residency training program in postgraduate-year-one (PGY-1) residents at Peking Union Medical College (PUMC) Hospital.Methods PGY-I medical residents at PUMC Hospital were surveyed by a self-administered questionnaire after they completed their first year residency.Results Forty-nine residents who completed their first year residency training participated in the survey with a 100％ response rate.Before training,only a few had bedside (n =18) and on-call experiences (n =10).At the end of the one-year-training,all the residents (100％) considered themselves being improved to certain degrees,especially in clinical practice capability,and passed all the examinations.However,53.1％ and 8.2％ of all the residents agreed that they need to improve their abilities in teaching (n =26) and doctor-patient communication (n =4),respectively.All residents hoped to get further improved by taking part in various forms of teaching activities,including experience summary/sharing and basic skills training.During the first year,95.9％ of them participated in all teaching activities in medicine actively.Conclusions The tradition and current models of medical residency training program at PUMC Hospital had a significant impact on professional development of the 1st year resident physicians.It is critical to focus on basic skill training and multi-level teaching to improve residents' clinical competency.

OBJECTIVETo study the effect of genistein (Gen) on MAPK signal pathway in the CIA rat fibroblast-like synoviocytes (FLS).

METHODSThe rat model of collagen-induced arthritis (CIA) was established. The cultured FLS of CIA rats were divided using randomized method. The effects of Gen (at the concentration of 50, 100, and 200 micromol/L, respectively) on the proliferation of FLS in CIA rats using methyl thiazolyl tetrazolium (MTT) assay. Effects of Gen (at the concentration of 50, 100, and 200 pmol/L, respectively) on the expressions of extracellular signal-regulated kinase (ERK) and phosphorylated extracellular signal-regulated kinase (p-ERK) in the FLS of CIA rats were detected.

RESULTSGen could inhibit the proliferation of FLS in CIA rats. The FLS proliferation in the high dose Gen group at 72 h was only 1.10+/-0.04, significantly lower than that in the model group (2.12+/-0.03, P<0.01). Besides, after Gen's action on FLS, the expression of p-ERK was down-regulated. It was only 0.34+/-0.02 in the high dose Gen group, significantly lower than that in the model group (2.68+/-0.14, P<0.01). There was no change in the expression of ERK (P>0.05).

CONCLUSIONSGen could inhibit the proliferation of FLS in CIA rats. Its mechanism of action was mainly correlated to down-regulating the tyrosine kinase of MAPK signal transduction pathway and inhibiting phosphorylation of ERK.

Animals ; Arthritis, Experimental ; metabolism ; Cells, Cultured ; Extracellular Signal-Regulated MAP Kinases ; metabolism ; Female ; Genistein ; pharmacology ; MAP Kinase Signaling System ; drug effects ; Rats ; Rats, Sprague-Dawley ; Synovial Membrane ; cytology ; drug effects ; metabolism