Objective To explore the morphologic changes of the epithelial cells in the thymic cortex in diabetes rats, and its possible mechanism of thymocyte apoptosis and thymus involution. Methods The ultrastructure changes of the epithelial cells in the thymic cortex in diabetes rats were observed under electron microscope. Results The type 2 epithelial cells had four kinds of the changes on ultrastructure:1 the endocrine disorder like changes with a large number of the degenerative cystic vacuoles;2 the degenerative like changes with lots of the abnormal secretory vacuoles and myelin like bodies and bulky tonofilament bundles; 3 the phagocyte like changes with a great number of the dense lysosome like granulae and the phagocytosed apoptotic cells and bodies; 4 the apoptosis like changes with the early morphologic changes of apoptosis. The type 3 epithelial cells had two kinds of the changes on ultrastructure:1 degenerative like changes with groups of dense granulae which secrete peptide hormones;2 the proliferative like changes with numerous collage fibrils in the vicivity of their perikarya. In addition, a lot of the apoptotic thymocytes and the reduction of thymocyte number were found in thymic cortex.Conclusion The varied ultrastructure changes of the epithelial cells in rat thymic cortex could be induced by diabetes, which might be the one of major mechanisms on influencing the thymocyte development and causing the thymocyte apoptosis and thymus involution.\;[

The innervation in the thymus was observed by silver stain and acetylcho linesterase (AChE) histochemical method. It was shown by silver stain that nerve fibers constituted a complex network in the thymic medulla. In the cortex and medulla there were AChE-containing nerve fibers. which terminated near or encircled the thymocytes. AChE-containing nerve fibers contacted with mast cells. Some mast cells had AChE-containing substance. This study suggests that the cortex and medulla of thymus are innervated by parasympathetic cholinergic nerve fibers, which may regulate the thymocytes and mast cells.

OBJECTIVE To obtain the primary differential items between bacillary dysentery and other infectious diarrhea through risk factor analysis.METHODS The epidemiology and clinical manifestation of 138 bacillary dysentery patients and 205 other infectious diarrhea patients were investigated.The Logistic regression was used to screen the correlation factors to differentiate bacillary dysentery from other infectious diarrhea.RESULTS The mean temperature of bacillary dysentery patients was(38.4?0.7)℃,while that of other infectious diarrhea was(38.1?0.6)℃(P=0.023).Bacillary dysentery patients with tenesmus and mucous stool were 34.1% and 55.8%,respectively but of 11.7% and 1.5% of other infectious diarrhea patients(P

Objective To explore the factors associated with delayed defecation in long-term ventilated patients in intensivecare unit (ICU) and their potential effect on prognosis.Methods A prospective observational cohort study was conducted. The patients admitted to general ICU of the Affiliated Hospital of Qingdao University from October 1st in 2013 to September 30th in 2015 who underwent mechanical ventilation (MV) for ≥6 days were enrolled, and they were divided into early defecation group (< 6 days) and late defecation group (≥6 days). At admission, clinical nutritional support were given as usual, and gender, age, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, admission reasons, MV reasons, the usage of morphine and epinephrine/norepinephrine, the highest positive end-expiratory pressure (PEEP), the lowest oxygenation index (PaO2/FiO2) and the lowest systolic blood pressure were collected. Logistic regression analysis was used to analyze the influencing factors of the first defecation time. ICU mortality, the length of ICU stay, central venous catheter (CVC) indwelling time, duration of MV, ICU acquired bacterial infection rate, and the incidence of ventilator associated pneumonia (VAP) were compared between early defecation group and late defecation group. Logisticorgan dysfunction system (LOD) scores and gastric residual volume per day were recorded at the different time of MV.Results Totally 189 patients were enrolled, 39 patients did not satisfied the inclusion criteria and 13 patients gave up treatment or referrals were excluded. Finally 137 patients were enrolled in the analysis, 83 patients in late defecation group and 54 in early defecation group. There were no significant differences in the baseline characteristics such as gender, age, APACHE Ⅱ score, LOD score at 1 day of MV, admission reasons, MV reasons, disgorging and gastric residual volume per day during the first 5 days of MV, enteral nutrition, lactulose treatment in patients with hepatic encephalopathy during the first 5 days of MV, and blood purification treatment between the two groups (allP > 0.05). Compared with the early defecation group, late defecation group had less patients with loose stools or watery stool at first time [15.7% (13/83) vs. 33.3% (18/54)], more patients using morphine and the usage of epinephrine/norepinephrine more than 24 hours [48.2% (40/83) vs. 40.7% (22/54), 42.2%(35/83) vs. 29.6% (16/54)], higher the maximum PEEP level [cmH2O (1 cmH2O = 0.098 kPa): 7.9±3.7 vs. 6.7±3.5], lower the minimal systolic blood pressure [mmHg (1 mmHg = 0.133 kPa): 74.8±28.1 vs. 88.9±30.2] and more severe of hypoxemia [PaO2/FiO2 < 150 mmHg, 54.2% (5/83) vs. 44.4% (24/53)], all of which had significant differences (allP < 0.05). Factors found statistical significances by single factor analysis were enrolled in the multiple regression analysis, which showed that PaO2/FiO2 < 150 mmHg and systolic blood pressure < 90 mmHg were independently associated with a delay in defecation in patients undergoing long-term MV [PaO2/FiO2 < 150 mmHg: adjusted hazard rate: 1.415, 95% confidence interval (95%CI) = 1.061-1.590,P = 0.026; systolic blood pressure 70-89 mmHg:HR = 1.461, 95%CI = 1.164-1.788, P = 0.002; systolic blood pressure ≤ 69 mmHg: adjusted hazard rate= 1.273, 95%CI = 1.010-1.587,P = 0.034). ICU mortality, the length of ICU stay, CVC indwelling time, duration of MV, ICU acquired bacterial infection rate, and the incidence of VAP at 7 days of MV in late defecation group were significantly higher than those of early defecation group [ICU mortality rate: 15.7% (13/83) vs. 7.4% (4/54), the length of ICU stay (day): 17.0 (14.0, 23.0) vs. 15.0 (13.8, 20.0), CVC indwelling time (days): 12.0 (10.0, 14.0) vs. 10.0 (9.0, 11.3), duration of MV (days): 14.0 (10.0, 20.0) vs. 11.0 (9.8, 15.3), ICU acquired bacterial infections rate: 60.2% (50/83) vs. 14.8% (8/54), the incidence of VAP: 32.5% (27/83) vs. 14.8% (8/54); allP < 0.05]. There was no significant difference in LOD score between both groups. The LOD scores at 4 days and 9 days of MV in late defecation group were significantly higher than those of early defecation group (6.41±4.37 vs. 5.21±3.12, 4.33±2.20 vs. 3.50±2.90, bothP < 0.01).Conclusions PaO2/FiO2 < 150 mmHg and systolic blood pressure < 90 mmHg during the first 5 days of MV were independently associated with a delay in defecation in patients undergoing long-term MV. The results suggest that constipation is associated with adverse outcomes in long-term ventilated patients.

Objective To evaluate the levels of ghrelin, adiponectin, leptin and true insulin in human milk from mothers with and without gestational diabetes mellitus (GDM), and to assess the effects of these parameters on infant growth. Methods Fifty-two GDM mothers and their healthy infants (GDM group) and 49 non-GDM mothers and their healthy infants (control group) were enrolled from Beijing Obstetrics and Gynecology Hospital and Peking Union Medical College Hospital from January 2010 to August 2010. The levels of ghrelin, adiponectin, leptin and true insulin in colostrum and human milk 90 days postpartum (mature milk) were determined by enzyme-linked immunosorbent assay. Infant weight, length and head circumference at birth and at 90 days old were measured. The two-sample t-test, sum-rank test and Spearman correlation analysis were used for statistical analysis. Results Compared with the control group, ghrelin was significantly lower in human milk from GDM mothers both in colostrum [136.7 (102.7-181.4) vs 175.4 (137.5-235.0) ng/L, t= -2.737] and mature milk [111.8 (77.5-184.2) vs 210.9 (147.3-381.9) ng/L, t= -3.268]. Adiponectin was also significantly lower in human milk from GDM mothers both in colostrum [21.7 (14.6-51.8) vs 57.0 (23.1-113.9)μg/L, t=-2.858] and mature milk [11.7 (8.4-14.4) vs 15.1 (11.9-18.5)μg/L, t=-2.625], however, true insulin level was higher in colostrum [22.8 (13.4-50.2) vs 20.4 (7.8-30.8) mU/L, t=-2.007] and mature milk [33.6 (22.5-54.1) vs 23.5 (13.5-31.6) mU/L, t=-2.009]. The differences were statistically significant (all P < 0.05). (2) In the colostrums of the GDM group, true insulin level was negatively associated with ghrelin (r=-0.342), but positively associated with adiponectin (r=0.305). In the control group, the level of true insulin in mature milk was positive associated with leptin in colostrums( r=0.456)and mature milk(r=0.629). The differences were statistically significant (all P < 0.05). (3) In the GDM group, adiponectin level in colostrum was negatively associated with neonatal birth weight (r= - 0.323, P=0.025); the leptin/adiponectin ratio was negatively associated with neonatal birth weight (r= -0.403, P=0.005) and head circumference (r= -0.327, P=0.039) at birth. Adiponectin level in mature milk was negatively associated with infant length 90 days postpartum (r=-0.406, P=0.040). In the control group, the leptin/adiponectin ratio in colostrum was negatively associated with neonatal head circumference at birth (r= -0.370, P=0.024). Adiponectin level in mature milk was positively associated with infant weight 90 days postpartum (r=0.432, P=0.007). Conclusion Women with GDM have different levels of ghrelin, adiponectin and true insulin in their milk from the normal controls, which may affect infant growth.

The change of pitutary hormones can occur in any time after traumatic brain injury, the main cause is primary or secondary impairment of hypothalamus as well as pituitary after brain injury. It is important to further research when to test hormone and to carry on the hormone replacement therapy.

ObjectiveTo study the effect of a course of regular rehabilitation treatment on patients with different traumatic brain injury(TBI) course, explore the costs of one rehabilitation course in patients with different TBI course, and study the timing and focus of rehabilitation on patiens with different stages.Methods250 TBI patients were distributed to five groups by different TBI courses: <3 months, 3～6 months, 6 months～1 year, 1～2 years and >2 years. The clinical data and initial function evaluation were done at the admission. All of them received at least one regular rehabilitation treatment, then another function evaluation was done. Effects and costs of one rehabilitation course in patients with different TBI course were investigated.ResultsThe longer the duration of illness, the higher the cost-effectiveness ratio. The cost-effectiveness ratio of the second treatment course was higher than the first one. The patients within 12 months should receive a comprehensive rehabilitation treatment, and should be prevented and treated hydrocephalus and other complications; for patients within 1～2 years, there would be no significant improvement in balance and lower limb function, should enhance the training of activity of daily living (ADL) and upper extremity function; for the patients more than two years just improved ADL using of residual function.ConclusionTBI patients should accept rehabilitation as soon as possible, and should be conducted corresponding trainings according to different disease course.

ObjectiveTo observe the changes of thyroid hormone and reproductive hormone in post-acute traumatic brain injury(TBI).Methods70 post-acute TBI patients were selected from Beijing Charity Hospital from September 2009 to March 2010. The levels of thyroid stimulating hormone(TSH), triiodothyronine(T3), thyroxine(T4), free triiodothyronine(FT3), free thyroxine (FT4), follicie stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), progesterone (P), and testosterone (T) were measured at 7 a.m. to 8 a.m. on the second day of admisson. According to the reference ranges, the total abnormal rate and the single hormone abnormal rate were calculated. According to the level of hormone, the subjects were divided into the normal group and the abnormal group. The two groups were compared in gender, age, course of disease, duration of coma, basal fracture and scores of Disability Rating Scale (DRS).ResultsThe total abnormal incidence of anterior pituitary hormone was 77.1% in post-acute TBI. The abnormality of reproductive hormones was higher. The duration of coma was related to the reproductive hormone.ConclusionThe abnormal incidence of anterior pituitary hormone occurs frequently in post-acute TBI. The duration of coma is related to the reproductive hormone.

Objective To discuss the emergency management and treatment measures of critically severe craniocerebral trauma.Methods A retrospective study was conducted on the emergency management in 82 patients with critically severe craniocerebral trauma admitted to our hospital from September 2005 to May 2011.Results According to the Glasgow Outcome scale ( GOS),there were 10 patients with good recovery (12％),17 with moderate disability (21％),12 with severe disability (20％),four in vegetable status (2％) and 39 deaths (48％).Conclusion The success rate in the treatment of critically severe craniocerebral injury can be enhanced through rapid and effective pre-hospital care,prompt surgical intervention,standardized subsequent therapy,adherence to damage control surgery concept,and emphasis on prevention and cure of secondary brain injury.

Objective To evaluate permissive hypocaloric intake in postoperative patients by a prospective, randomized, controlled trial. MethodsForty-two postoperative patients were randomly assigned to receive 117kJ?kg~ -1?d~ -1in control group, and 75kJ?kg~ -1?d~ -1in experimental group intravenously. Blood routine, liver and renal functions were measured one day before and day 1, 3, 5 post operation. Blood glucose level, insulin intervention, infectious complications, hospital stay, and relevant cost were also evaluated. ResultsHypocaloric intake in the experimental group post-operatively did not influence the hemoglobin level, liver function, and other indicators in the serum. The fasting blood glucose and glucose levels after infusion, as well as the volume of insulin intervention were significantly higher in the control group during 4 days of parenteral nutrition. Experimental group had lower relevant hospital cost, while two groups had similar duration of hospital stay. ConclusionPermissive hypocaloric intake shortly after surgery does not influence the patient nutritional status, besides it avoids to some extent the hyperglycemia, reduces the need for insulin intervention .