Most patients with ischemic cerebrovascular diseases,after treated in hospitals during the acute stage,can return home or back to the community.Therefore,secondary prevention of the disease in the community is very important.

Objective To study the clinical value of neoadjuvant radiotherapy (NRT),neoadjuvant chemoradiotherapy (NCRT) or surgery alone (S) in treatment of middle and low rectal cancer.Methods 139 cases were divided into 3 groups:47 cases were given NRT (50 Gy/25 f/5 w) as group NRT,46 cases were given NCRT (Capox+ radiotherapy) as group NCRT,and the remaining 46 cases were treated with surgery alone as group S.Patients in 3 groups were followed-up for 3 years for the observation of the rates of anuspreserving and 3-year survival rates.Results Compared with the patients in group S,the rates of anuspreserving in group NRT and NCRT were significant improvement [74.47 ％ (35/47) and 73.91％ (34/46) vs 54.35 ％ (25/46)],(x2 =4.111,3.827; P=0.043,0.050).The 1,2,3-year survival rates of the 3 groups had no significantly different (P ＞0.05).However,the 1-year survival rates might be lower in group NRT and group NCRT than that in group S [87.23 ％ (41/47) and 88.89 ％ (40/45) vs 97.83 ％ (45/46)] (x2 =4.611,P =0.100).Conclusion NRT and NCRT can improve the rate of anus-preserving,but might not improve the 1,2,3-year survival rate,instead,the death rate may increase in the first year.

AIM:To explore whether A3 adenosine receptor plays a role in the modulation of vascular reactivity after hemorrhagic shock in rat,and to find out the prospective drug target to restore the decreased vascular reactivity following hemorrhagic shock. METHODS:The hemorrhagic shock (40 mmHg) model was established in rat,and the reactivity of superior mesenteric artery (SMA) to norepinephrine (NE) was observed. A3AR expression at protein level and mRNA level were measured by Western blotting and RT-PCR respectively. RESULTS:The vascular reactivity of SMA to NE after hemorrhagic shock (40 mmHg) was decreased significantly in a biphasic response manner. The expression of A3AR mRNA in SMA after hemorrhagic shock decreased without significant difference. The expression of A3AR protein has a slight increase without statistical difference after 30 min of hemorrhagic shock and then has a significant decrease (especially at 2 h and 4 h after hemorrhagic shock). The usage of IB-MECA,a selective A3AR agonist,significantly increased the responsiveness of SMA to NE in hemorrhagic shock in rat. MRS1523,the selective A3AR antagonist,significantly abolished the restoration of the vascular reactivity to NE by IB-MECA in hemorrhagic shock in rat. CONCLUSION:A3AR plays a role in the modulation of vascular responsiveness to NE in hemorrhagic shock in rat,and the selective agonist of A3AR could restore the reactivity of SMA to NE in hemorrhagic shock in rat.

Colon ; pathology ; Colonic Polyps ; pathology ; Diagnosis, Differential ; Female ; Humans ; Intestinal Mucosa ; pathology ; Male ; Middle Aged

Objective To compare the application of three automated microbiology identification and rapid susceptibility assessment systems,Vitek1,Viket2 and BD Phoenix,in detection of extended-spectrum beta-lactamases(ESBLs).Methods The genotypes of 67 clinical isolates of ESBLs-producing E.coli and K.phneumoniae,which were collected from the 1st and 2nd Affiliated Hospital of Zhejiang University,were determined by PCR amplification and sequencing.Meanwhile,these isolates were analyzed by the three automatic microbiology identification system,and the minimum inhibitory concentration(MIC)s for antibiotics were determined.Results Majority of the 67 isolates produced CTXM type of ESBL.Among them,CTX-M-14,CTX-M-22,CTX-M24 and CTX-M-3 were the most frequently detectable types.By using Vitek-AMS,60 isolates(89.6%)were detected to be ESBLs-producing.By using Vitek2,62 isolates(92.5%) were ESBLsproducing.No SHV-12,CTX-M-14 and SHV-28 were detected by the 3 automatic systems.The results of MICs analysis indicated these isolates showed either high resistance for multiple antibiotics or around the boundary areas of MICs test.Conclusions The three automatic analysis systems are able to provide a detectable rate of more than 98% for ESBLs.However,it is needed to further improve the detection for high resistant strain or the strains carrying multiple resistant genes.

OBJECTIVE To detect AmpC ?-lactamases from isolates of extended spectrum ?-lactamases(ESBLs) positive Escherichia coli and Klebsiella pneumoniae,which were isolated from four hospitals in Hangzhou from 2005 to 2006,and to analyze the antimicrobial activity of clinically commonly used antibiotics in vitro.METHODS Amount of 324 ESBLs positive isolates including E.coli and K.pneumoniae were collected from Zhejiang Provincial People′s Hospital;1st Affiliated Hospital of Zhejiang University;2nd Affiliated Hospital of Zhejiang University and Hangzhou Traditional Chinese Medicine Hospital perspectivly.AmpC ?-lactamase was identified by disc screening testing and three dimensional test,and the genotypes of AmpC ?-lactamase were also determined by multiplex polymerase chain reaction(Multi-PCR).Minimal inhibitory concentrations(MICs) of ten clinically commonly used antibiotics were determined by agar dilution for AmpC ?-lactamases positive isolates,and the data were analyzed by WHONET 5.3.RESULTS AmpC ?-lactamase phenotype test revealed that 76 AmpC ?-lactamase positive isolates(23.5%) were identified among 324 ESBLs positive isolates of E.coli and K.pneumoniae from four hospitals in Huzhou.69.7% Of the AmpC ?-lactamase phenotype positive isolates were positively amplified by Multi-PCR.The value of MIC50 for carbapenem was lower 0.25 ?g/ml.We also found four carbapenem-resistant strains in this study.CONCLUSIONS We found that the incidence rate of AmpC ?-lactamase is high among the ESBLs producing E.coli and K.pneumoniae strains in Hangzhou.Carbapenem antibiotics have higher antimicrobial activity than other tested antibiotics.

Objective To investigate the nutritional state in elderly hospitalized patients(≥70 years old)and provide clinical evi-dence for nutritional support in elderly people .Methods From June to December 2012 ,342 elderly hospitalized patients(≥70 years old)in Daping Hospital ,the Third Military Medical University were included .All of these patients were originally screened by resi-dent doctor ,and were revaluated by dietitians in the Department of Nutrition for the nutritional status .The revaluation was conduc-ted by Nutritional Risk Screening 2002(NRS 2002) ,which recommended by ESPEN ,and combined with the laboratory examina-tion .Results In 342 cases ,the nutritional risk rate was 96 .49% ,the incidence of malnutrition was 28 .79% ,and the incidence of a-nemia was 59 .24% .The incidence of low total serum protein ,low albumin ,and low prealbumin were 51 .40% 、93 .18% and 85 . 30% ,respectively .Conclusion Elderly hospitalized patients(≥70 years old)have high nutritional risk ,high incidence of malnutri-tion ,anemia ,and low blood albumin .Clinical nutritional support is necessary for bad nutritional status elderly patients .

Objective:To screen the binding peptide against adenovirus type 7(Ad7) and evaluate the relevance with the ade-novirus receptor .Methods:Binding peptide against Ad 7 was screened by panning the phage display 12 peptides library .The antibody against the selected peptide was prepared and was used to study the binding to the membrane by immunofluorescence technique .Re-sults:Using Ad7 as the target protein , GTS09 peptide was selected from the phage display 12 peptides library by biopanning .GTS09-phage complex could significantly bind Ad 7, with the affinity constant up to 1.93 ×1010 L/mol;at the same time, immunofluorescence showed that antibody of GTS09 could specifically bind to membrane of 293 cell.Conclusion: Antibody against GTS09 peptide could specifically bind to membrane of 293 cell,which shows that the peptide may presumably have homology with the cell receptors of Ad 7.

OBJECTIVE:To study the process of acetylized racemization of D-penicillamine in the acidic condition. METHODS:The acetylized racemic mixture of D-penicillamine was prepared by racemizing acetyl chloride in acetic acid solu_tion with D-penicillamine as feedstock.The preparation process was optimized with the quantities of solvent and acetyl chloride,the reaction temperature,the reaction time etc.as parameters.The influence of reaction temperature,reaction time on the specific optical rotation in the acetylized process was determined and the kinetic equation of acylation process was computed. RESULTS:The optimal condition for racemization was the following,the quantity ratios of D-penicillamine-acetic acid -acetyl chloride were 1∶7∶2,the reaction temperature was 80℃ and the reaction time was 5h.The kinetic equation of acylation process fitted first order linear relation. CONCLUSION:This preparation process is mild and simple,and it offers direct feedstock for the preparation of D,L-penicillamine.

Objective To learn the damage on infants and effect of treatment of congenital cytomegalovirus(CMV) infection and non-congenital cytomegalovirus infection which included perinatal infection and postnatal infection.Methods According to the diagnosis standard of cytomegalovirus infection in China,46 infants diagnosed CMV infection were retrospectively reviewed.In this research,CMV infection was diagnosed if serum CMV-IgM or CMV-pp65 in polymorphous leukocytes was positive.According to beginning time of CMV infection symptom,46 cases were divided into 2 groups: congenital infection and non-congenital infection,clinical features of 2 groups were compared.Ganciclovir was given to the infants with infantile hepatic syndrome of 2 groups,and compared liver transaminases and bilirulin with itself after treatment,side-effect was observed.Infants of 2 groups were followed up,and prognosis was compared.Results In 46 infants,21 were enrolled congenital infection group,25 were non-congenital infection group.CMV-IgM was positive in 38 cases of 46 patients,CMV-pp65 was positive in 19 cases of 43 patients,both CMVIgM and CMV-pp65 were positive in 11 cases.More congenital malformation were found in congenital group than non-congenital group,there was significant difference between 2 groups((P