Nonalcoholic fatty liver disease(NAFLD)is a kind of metabolic and stress-related liver damage closely related with insulin resistance and inherited susceptibility. Its incidence is increasing recently in China. Liver biopsy is the gold standard for the diagnosis of NAFLD,but which is an invasive procedure with certain risks. Therefore,finding a simple and accurate diagnostic method is an eager task,and searching of non-invasive biomarkers for diagnosis of NAFLD has become a hot spot of study. This article reviewed the progress in studies on biomarkers for diagnosis of NAFLD.

OBJECTIVE To explore the pathogen distribution and their resistance in ICU of Geriatric hospital.METHODS 111 strains isolated from lower respiratory tract were collected from Sep 2006 to August 2007.The antibiotic resistance were tested.RESULTS Among 111 strains,G-strains accounted for 70.27%,in which Pseudomonas aeruginosa was the most common(20.72%).The G+bacteria were multi-resistant to most of the antibiotics except impenem.CONCLUSIONS The most common pathogens in ICU of geriatric hospital is G-bacteria with multi-resistance.The Antibiotics should be selected reasonably.

Objective To investigate the expression of insulin receptor substrate-2(IRS-2)in the liver of nonalcoholic fatty liver(NAFL)mice.Methods Ten female C57BL6J mice fed with normal diet were served as controls,while fifteen fed with high fat and sugar diet for either 8 weeks(group-A)or 16 weeks(group B)were as NAFL mice models.Abdominal fat mass,total cholesterol(TC),triglycerides(TG),high density lipoprotein cholesterol(HDL-C),fasting blood glucose(FBG)insulin(INS)and liver function,liver weight were measured.And the expression of IRS-2 and the content of lipid in the liver were also detected.Results The abdominal fat mass serum TC,and FBG were significantly higher in high fat and sugar diet fed mice than that in controls(P

OBJECTIVE:To study the contents changes of polysaccharide and 5-HMF in Polygonati rhizoma from different pro-ducing areas after different processing,and provide reference for the development of processing technology of Polygonati rhizoma from different producing areas and the quality standard of different processing products. METHODS:UV spectrophotometry and HPLC were conducted to respectively determine the contents of polysaccharide and 5-HMF,and compare the content differences of polysaccharide and 5-HMF in Polygonati rhizoma from different producing areas [Shaanxi Lueyang County,Shaanxi Huangling County,Yunnan Fumin County (genuine producing areas),Shaanxi Taibai County] by fresh-cutting,dry-cutting,steaming and steaming with wine. RESULTS:Polysaccharide of sample from Yunnan Fumin County showed the highest content in fresh-cut sam-ples(13.4%),no 5-HMF(0)was detected;polysaccharide contents were respectively 10.8%-13.4%,8.9%-10.8%,5.5%-6.9%, 5.6%-6.5% after fresh-cut,dry-cut,steamed and steamed with wine,5-HMF contents were 0,0,0.21%-0.50%,0.25%-0.72%. Compared with no processing samples (fresh-cut),polysaccharide contents in Polygonati rhizoma were decreased in turn after dry-cut,steamed and steamed with wine,5-HMF contents were increased in turn after steamed and steamed with wine. CONCLU-SIONS:It is suggested to consider origin factor in developing processing technology of Polygonati rhizoma from genuine and non-genuine producing areas. 5-HMF content determination index should be added into quality standard of processing products after steamed and steamed with wine.

Objective To investigate the role of nucleotide-binding oligomerization domain-containing protein 1 (NOD1) in inducing insulin resistance in differentiated human adipocytes.Methods Human preadipocytes obtained via liposuction were induced to differentiate into mature adipocytes.iE-DAP,a specific ligand for NOD1,was administered to human adipocytes in culture.NF-κB transcriptional activity and proinflammatory cytokines production were determined by luciferase assay and enzyme-linked immunosorbent assay.Glucose uptake in adipocytes was measured by 2-deoxy-D-[3 H] glucose uptake (P＜0.05).The expression of phosphatidylinositol-3-kinase p85 (PI-3K p85),insulin receptor substrate-1 (IRS-1) and Akt phosphorylations were detected by Western blotting.Results NF-κB transcriptional activity and cytokines such as interleukin (IL)-6,IL-8,and monocyte chemotactic protein 1 secretion were markedly increased after stimulation with iE-DAP (P＜0.05 or P＜0.01).Insulin-induced glucose uptake was decreased with the activation of NOD1 in a dose-and time-dependent fashion.NOD1 activation weakened insulin signal transduction as being revealed by increasing IRS-1 Ser307phosphorylation,reducing protein expression of PI-3K p85,and attenuating insulin-induced phosphorylation of Akt on Ser473 and Thr308in human adipocytes.Conclusion These results indicate that NOD1 activation induces inflammatory response and insulin resistance via IRS-1/PI3-K/Akt signaling pathway in human adipocytes.

Objective To investigate the correlation between cytomegalovirus infection and heart rate variability (HRV) in elderly patients with atherosclerosis.Methods 160 patients with coronary heart disease who met World Health Organization diagnostic criteria for coronary heart disease in 1979 were collected.According to the IMTHCMV PP65 antigen test results,patients were divided into positive group (observation group,n=103) and negative group (control group,n=57).We detected the levels of of HRV,metalloprotease-9 (MMP 9) and tumor necrosis factor α (TNF-α) in the two groups in order to access the plaque stability.Results The all sinus standard deviation of RR interval (SDNN),standard deviation of the average NN interval (SDANNI),mean value of sinus standard deviation of RR interval (SDNNI) were lower in observation group than in control group (P ＜0.05).There were no significant differences in square root of the mean squared differences of successive NN intervals (RMSSD) level and percentage of differences exceeding 50ms between adjacent normal number of intervals (PNN50) between the two groups (P＞0.05).The levels of total cholesterol and low density lipoprotein were higher and the levels of MMP 9 AND TNF α were lower in observation group than in the control group (all P＜0.05).Compared with control group,the plaque stability was decreased in observation group [20.4％ (21/103) vs.61.4％ (35/57),x2=4.273,P=0.015].Conclusions Patients with atherosclerosis combined with cytomegalovirus infection have a greater heart rate variability and poorer plaque stability.

Background:Intestinal metaplasia(IM)and dysplasia in Barrett’s esophagus(BE)can be detected by endoscopic biopsy combined with pathological examination. Aims:To evaluate the efficacy of acetic acid stain-guided biopsies in detection of IM and dysplasia in BE under standard endoscopy. Methods:One hundred patients found to have columnar-lined esophagus by endoscopy from January 2012 to November 2014 at Shanghai Jing’an District Central Hospital were enrolled. Under standard endoscopy,acetic acid was sprayed and multi-point biopsies were performed in visible abnormal regions. This was followed by four-quadrant biopsies at every 1 to 2 cm of the remaining BE segments. Detection rates of columnar epithelium,IM and dysplasia were compared between acetic acid stain-guided biopsies and four-quadrant biopsies. Results:A total of 96 patients were diagnosed as BE. Detection rates of columnar epithelium by acetic acid stain-guided biopsies and four-quadrant biopsies were 96. 9%(93 / 96)and 90. 6% (87 / 96),respectively,no significant difference was found between the two methods(McNemar test,P = 0. 146),however,consistency of the two methods was poor(κ = 0. 340). A total of 32 patients were diagnosed as BE with IM. Detection rates of IM by acetic acid stain-guided biopsies and four-quadrant biopsies were 84. 4%(27 / 32)and 40. 6%(13 / 32),respectively,difference in detection rate between the two methods was significant(McNemar test,P = 0. 007),and consistency of the two methods was poor(κ =0. 266). Five cases of low-grade dysplasia were detected by acetic acid stain-guided biopsies only. Conclusions:Acetic acid stain-guided biopsies can detect BE with IM and dysplasia better than four-quadrant biopsies.

Objective To study the expressions of α1-AT and VEGF-C in human bronchoalveolarcarcinorrm, and the relation of the expression to the patholo~cM differentiation and clinical stage. Methods All 49 Darffin embedding samples of patients with bronchoalveolar carcinoma were studied. α1-AT and VEGF-C were detected by immunohistochemical SP method.Automated image analyzer was used to quantify α1-AT and VEGF-C expressions.Results The immunohistochemical positive stainings of α1-AT and VEGF-C in brown or dark brown were located in cytopla8m.The expression levels of α1-AT and VEGF-C were not related with the gender,age,tumor position and size,and histology subtypos(P＞0.05).It Was found that the expression of α1-AT in patients with local lymph node metastasis was significantly lower than those without node metastasis(P＜0.001).It was found that the expression of VEGF-C in patients with local node metastasis significantly higher than th08e without node metastasis(P＜0.001).There Was a negative correlation between the expression level of α1-AT and the expression level of VEGF-C in bronchoalveolar carcinoma(r=-0.324,P＜0.05).Conclusion α1-AT and VEGF-C could be secreted by bronehoalveolar carcinoma.Bronehoalveolar carcinoma with lower α1-AT expression and higher VEGF-C expression is more likely to have lymph node metastasis.Lower α1-AT expression and higher VEGF-C expression can participate in the mechanism of lymph node metastasis in carcinoma together.

Objective To compare different dose of remifentanil combined with propofol for painless abortion and approach to an appropriate dose of remifentanil.Methods Ninety pregnant women with ASA 1 were randomly divided into three groups(n=30)before administrating remifetanil,a bolus midazolam 1 mg was injected inminutes later.These two drugs did not stop administration until three minutes before the end of negative suction.MAP,HR,SpO2,BIS,RR,VT,PET CO2 were monitored.The onset,operation and recovery time,sedation score and adverse reaction were recorded.Results Sedation scores were significantly different between group A and C [(3.90±0.97)and(4.90±0.85),t=4.24,P＜0.01].Three cases in group A were found moving.MAP,HR,BIS decreased as compared witll baseline.HR reduced significantly in group C(P＜0.05,P＜0.01).Respiratory movement was lower and shallower.RR,VT decreased compared to preoperative one.PET C02 increased gradually (P＜0.05,P＜0.01).There were two cases of respiratory depressing in group A,four cases in group B and ten cases in group C(five cases apnea more than three minutes).All patients used oxygen mask to maintain SpO2＞95%.Incidence of adverse reactions such as chest titanic,nausea and vomiting,itching were of no difference among three groups(P＞0.05).All patients were satisfied with anesthesia.Conclusion The appropriate infusing dose of remifetory devices such as oxygen mask and monitoring life signs are very important to prevent respiratory depress and bradycardia during operation.

Objective To summarize the experience in diagnosis and management for severe and complicated pancreatic trauma. Methods The clinical data of 21 patients with severe pancreatic trauma treated in our hospital were retrospectively analyzed. Of the 21 with a mean age of 26 (9-53), 14were male and 7 female. The causes of trauma were blunt injuries in 13 and patent injuries in 8 of them. The injury grade distribution for these patients was grade Ⅲ in 8 cases, grade Ⅳ in 8, and grade V in 3. The main diagnostic modalities included amylase measurement, ultrasonography, CT,endoscopic retrograde cholangiopancreatography (ERCP), and magnetic resonance cholangiopancreatography (MRCP) etc. All patients received surgical procedures. Roux-en-Y distal pancreatojejunostomy was performed in 10 patients, pancreatoduodenectomy in 3, modified duodenal diverticulization in 2, distal pancreatectomy in 3, tube installing in major duct and external drainage, and suture of pancreatic section in 2, and suture of two broken side respectively (delayed distal pancreatojejunostomy in the second time) in 1. Results Pancreatic injury was confirmed in 11 cases preoperatively and intraoperatively in the others. The early emergency operation was performed in 18 patients within 12hours, and delayed operation was done in 3 cases. Twenty patients were cured and 1 died after a procedure of pancreatoduodenectomy. The postoperative pancreatic fistula happened in 3 cases and recovered well with conservative line of management. Conclusion The diagnosis of severe and complicated pancreatic trauma is difficultly yet, so the earlier exploratory laparotomy should be suggested. The individual surgical modality based on the grade should be adopted in the operation and the concept of "Damage Control Surgery" should be carried out in the procedure. Extended operation should be avoided.