Objective To study the relationship between the T helper cells (Th22)/interleukin (IL)-22 and rheumatoid arthritis (RA) with interstitial lung disease (ILD), and to define the clinical significance of Th22 cells for RA. Methods The quantity of Th22 cells in the peripheral blood from 40 patients with RA (20 RA with ILD, 20 RA without ILD) were examined by flow cytometry, the level of IL-22 in the sera was detected by enzyme-linked immunosorbent assay (ELISA). Comparisons between groups were analyzed by t-test, rank sum test, and the correlation of parameters were tested by linear correlation analysis. Results The quantities of CD4+IL-22+ cells (Th22) in RA patients [(0.15 ±0.07)%] were significantly higher than normal controls [(0.09 ±0.05)%] (t=4.097, P<0.01), and IL-22 levels in RA patients [(83 ±7) ng/L] were significantly higher than normal controls [(61±5) ng/L] (t=13.057, P<0.01). The quantities of Th22 cells in RA-ILD patients [(0.18±0.07)%] were significantly higher than RA-NILD patients [(0.13±0.05)%] (t=2.919, P=0.008), and IL-22 levels in RA-ILD patients [(87±6) ng/L] were significantly higher than RA-NILD patients [(80±6)ng/L] (t=3.624, P=0.001). The quantities of Th22 cells were positively correlated with erythrocyte sedimentation rate (ESR), rheumatoid factor(RF) and 1.4 disease activity score (DAS)28 (r=0.336, 0.377, 0.577, P<0.05),and the level of IL-22 were also positively correlated with ESR and DAS28 (r=0.406, 0.576, P<0.05). Conclusion The quantities of Th22 cells and IL-22 level are increased in RA patients, especially in RA-ILD patients. The quantities of Th22 cells and IL-22 level are positively correlated with ESR and DAS28. It may play a certain role in RA especially in RA with ILD.

The Human Milk Banking Association of North America(HMBANA) is a professional association for supporters of non-profit donor human milk banking.HMBANA develops guidelines for donor human milk banking practices.The construction of China's human milk bank has just begun in few areas in 2013.To further promote the development and implementation of donor human milk banking in our country,this review introduce the guideline for establishment and operation of a donor human milk bank which drafted by HMBANA in 2013.The guideline can provide the basis for the development of human milk bank in our country.

Objective To evaluate the safety and effects of feeding very low birth weight infants and extremely low birth weight infants with human donors' milk in China.Methods One hundred and ninety-nine very low birth weight infants and extremely low birth weight infants (VLBWI/ELBWI) admitted to NICU in Nanjing Maternity and Child Health Care Hospital were analyzed retrospectively (from August 1,2013 to July 31,2014) one year before and one year after the establishment of human donors' milk bank.Only 1 infant's parents(1/199 cases) refused to use donor milk,and 198 infants were fed with donors' milk since their own mothers' milk was unavailable.One hundred and forty-eight infants admitted to NICU from August 1,2012 to July 31,2013 were chosen as the control group,who were fed with formula milk since their own mothers' milk was unavailable.The mortality,incidence of necrotizing enterocolitis (NEC) and sepsis,time to full enteral feeding and hospital stay between 2 groups were analyzed.Results One year before the establishment of breast milk bank,there were 148 cases of very low or extremely low birth weight infants receiving mixed feeding,and 16 cases of them had neonatal necrotizing enterocolitis,the incidence rate was 10.81％.Since the establishment of human milk bank,187 women donated breast milk in the first year and 260 555 mL of human milk were collected and delivered.Only 1 infant (1/199 cases) refused to use donor milk,and 198 infants were fed with donors' milk since their own mothers' milk was unavailable.Nine babies with VLBWI/ELBWI were diagnosed as NEC in donor milk feeding group,and 16 cases were diagnosed as NEC in formula-feeding group.The incidence rate of NEC was lower in the donor-milk-feeding group (4.52％ vs 10.81％,x2 =5.02,P ＜ 0.05).Donor-milk-feeding group reached full enteral feeding[(16.4 ± 5.3) d vs (18.2 ± 6.2) d,t =2.84,P ＜ 0.05] and had shorter period of hospital stay[(35.1 ± 9.5) d vs (37.3 ± 10.4) d,t =2.05,P ＜ 0.05] compared with formula feeding group.The mortality and incidence of sepsis had no difference between 2 groups (all P ＞ 0.05).Conclusions Donors' breast milk is associated with a lower risk of NEC,sooner full enteral feeding and shorter hospital stay.Further research is needed to confirm these findings and measure the growth and long term neurodevelopment effects of donors' breast milk.

Objective To investigate the clinical effects of synthetic medical calcium phosphate and calcium sulfate as the bone replacements for bone defects.MethodsA total of 85 bone trauma patients combined with bone defects treated between February 2000 and October 2011 were randomized to calcium phosphate group ( n =43 ) and calcium sulfate group ( n =42 ) according to bone substitutes.The patients had orthopedic conventional treatment and then received external fixation ( external fixators,plasters) or internal fixation (plates,needles).Forty-three patients in the calcium phosphate group were all treated with medical calcium phosphate and 42 patients in the calcium sulfate group were all treated with medical calcium sulfate.Postoperative complications,fracture healing time and bone substitute absorption time of the two groups were observed and compared.ResultsAfter artificial bone filling for bone defects,all fractures were healed,with average healing time of 12.5 weeks ( range,9-17 weeks) in the calcium phosphate group and 11.3 weeks (range,7-15 weeks) in the calcium sulfate group.No complications or abnormal reactions occurred in the calcium sulfate group,whereas four patients with incision exudation was founded in the calcium phosphate group,and was cured after dressing change.The average follow-up period was 54.5 weeks (range,14-70 weeks).Average absorption time of bone substitute for the calcium phosphate group was 7.3 weeks,longer than that for the calcium sulfate group (P ＜ 0.05 ).Conclusions Medical calcium phosphate and calcium sulfate artificial bones can both be used as bone substitutes and are characterized by convenience,safety and good healing under the auxiliary of internal and external fixators.The calcium sulfate is sturdier and has relatively stronger supporting ability than the calcium phosphate.As the bone substitute,the calcium sulfate has more precise clinical effects,fewer complications and shorter healing time than the calcium phosphate.

Objective To knock out the entire LuxS gene of Streptococcus mutans UA159 strain via homologous recombination and construct a LuxS-deleted mutant strain of S.mutans.Methods The erythromycin resistance gene(Eymr)was inserted between the two DNA fragments located in the upper and downstream of LuxS gene that had been amplified by PCR.Then the two DNA fragments along with the inserted Eymr were engineered into pUCl9 plasmid to construct the recombination plasmid pUCluxKO.Electrotransformation of S. mutans cells with pUCluxKO-mutant resulted in the isolation of erythromycin resistant S.mutans,transformants,which was then subjected to polymerase chain reaction,Vibrio harveyi BBl70 luminescence bioassay and sequencing analysis.Results Restriction endonuclease analysis showed that pUCluxKOmutant vector had been successfully recombined.The deletion of LuxS of S. mutans mutants was confirmed bv PCR with primers specific for the genes of LuxS and the erythromycin resistance.S.mutans mutant could not induce bioluminescence.indicating the mutant had been successfully recombined.The constructed Chinese S.mutans showed good stability after 20 generations of cultivation.Conclusion The S.mutans gene allelic exchange plasmid is constructed correctively and a LuxS-negative mutant of S.mutans has been constructed.which can be helpful for further study of the role of LuxS in the pathogenesis of S.mutans.

Objective:To evaluate the efficiency of using artificial intelligence reading label system in diabetic retinopathy (DR) grading training among junior ophthalmologists and medical students.Methods:520 diabetic fundus images were randomly divided into 8 groups with 65 images in each group. 13 junior ophthalmologists and medical students were selected as the research objects. Each of them read 8 groups of pictures and evaluated the DR grading of each fundus image. The sensitivity, specificity and diagnostic test consistency (Q-kappa value) of grading results were analyzed with the DR grading given by 3 senior ophthalmologists as the gold standard. The average Q-kappa values of 13 subjects were compared between the first four times and the last four times.Results:Through 8 round reading, the average Q-kappa was elevated from 0.67 to 0.81. Average Q-kappa of round 1 to 4 was 0.77, and average Q-kappa of round 5 to 8 was 0.81. The participants were divided into two groups. Participants in group 1 were junior ophthalmologists and participants in group 2 were medical students. Average Q-kappa of group 1 was elevated from 0.71 to 0.76. Average Q-kappa of group 2 was elevated from 0.63 to 0.84.Conclusions:The artificial intelligence reading label system was a useful tool in training junior ophthalmologists and medical students in doing diabetic retinopathy grading.

BACKGROUND: Epidemiologic studies have shown an association between higher insulin levels and coronary artery disease, and metabolic studies have associated insulin resistance and compensatory hyperinsulinemia with non-insulin-dependent diabetes mellitus, hypertension, obesity,and lipid disorders.OBJECTIVE: To investigate the relationship between insulin resistance (IR) and erythrocyte insulin receptors (EIRs) in the patients with cerebral infarction (CI).DESIGN: Case-control trial.SETTING: Department of Neurology, China-Japan Union Hospital of Jilin University.PARTICIPANTS: From January 2004 to October 2004, 40 patients with CI, who were in-patients in China-Japan Union Hospital of Jilin University,were selected for the study. Meanwhile, 30 healthy doctors or nurses were recruited as normal controls.METHODS: The levels of blood glucose and serum insulin under fasting and 2-hour after oral glucose tolerance test (OGTT) were detected in the 40 patients with CI and 30 healthy doctors or nurses. Fasting blood glucose multiplied by fasting serum insulin was insulin resistance index (IRI). The number of insulin receptors and their binding affinity on every erythrocyte were determined using modified Gambhir's method. The correlation between the number of EIRs and IRI was analyzed.MAIN OUTCOME MEASURES: Comparison of CI group with controlRESULTS: Data of 40 patients with CI and 30 controls were analyzed, and under fasting and 2-hour after OGTT: The level of serum insulin under fasting and blood glucose, serum insulin at 2-hour after OGTT in CI group were higher than those in normal group [(13.30±5.15), (9.85±4.36) mU/L,(8.27±1.65), (6.32±1.37) mmol/L, (75.21±21.12), (28.26±6.31)mU/L,P ＜ 0.01,EIRs: The number of insulin receptors with high and low affinity and maximum specific binding rate in the patients with CI were significantly less than those in normal group [20.30±4.50, 23.80±4.10; 2 223.80±509.30,2 610.10±435.10; (10.62±3.55)%, (13.21±2.94)%, P ＜ 0.01]. Multiple linear regression analysis and correlation analysis showed the numbers of two types of EIRs in the patients with CI were negatively correlated with IRI (r=-0.458, -0.439, P ＜ 0.01, both).CONCLUSION: Insulin resistance can lead to cerebral infarction. Decrease in insulin receptors may play an importance role in cerebral infarction induced by insulin resistance.

To evaluate multi-slice computer tomography (MSCT) in mediastinal lymph node metastasis of T1 and T2 non-small cell lung cancer (NSCLC). Methods:A total of 32 patients with T1 and T2 NSCLC from February 2004 to October 2012 were selected. Preoperative MSCT assessment of mediastinal lymph nodes was performed on basis of the pathological results. Results:Lymph nodes with diameters of≥10 mm were evaluated, and the sensitivity and specificity of the MSCT mediastinal lymph node me-tastases were 82.4%and 92.4%, respectively. Lymph node size, primary tumor location, and visceral pleural invasion showed statistical significance in forecasting mediastinal lymph node metastases (P<0.05). Conclusion:MSCT can be used for the effective evaluation of mediastinal lymph node metastasis, lymph node size, and position of primary tumor. and visceral pleural invasion of the tumor had a higher risk of mediastinal lymph node metastasis.

By means of literature review,expert interviews and experts sorting,the authors identified three approaches of medical humanities care,and applied them to three clinical departments of top ten incidence of medical disputes of the hospital in 2012.These departments have similar number of beds,and covered both internal medicine and surgery departments.The purposes of the study are to evaluate the effects of medical humanities care measures in clinical departments,and to make relevant thoughts and suggestions.

Using the method of semi -structure interviews to pre-interview 6 experts and officially interview10 experts , then the record of the interview was compiled into the paper .Using the grounded theory method to encode material of the interview , a summary was made for each case base on data collation and analysis .This paper ana-lyzed the humanities concern the connotation of the application in the construction of a harmonious doctor -patient relationship and the specific measures .On the basis of the application of humanistic care in the construction of a harmonious doctor -patient relationship , significance and limitation is discussed .