Objective To simplify the manipulation of ketogenic diet recipes through software design.Methods Based on a Chinese food composition database,the software included 3 separate modules for the calculation of recipes for the classic ketogenic diet,modified Atkins diet and low glycemic index diet.It was applied in 10 refractory epilepsy patients,including 8 children and 2 adults,aged from 1 to 34 years,who took an average of 2.7 kinds of medication.Eight patients had daily seizures ;the other 2 cases had seizures 4-15 times per month.Two patients used the classic 4 ∶ 1 ketogenic diet module;4 patients started with the classic 4 ∶ 1 ketogenic diet and then shifted to 1 ∶ 1 to 4 ∶1 modified Atkins diet module after 2 to 5 months;4 patients used the 1 ∶ 1 to 4 ∶ 1 modified Atkins diet module.The software could automatically display the daily recommended intake value of total energy,fat,carbohydrate and protein according to the input of age,height,weight,activity level and the proportion of fat/(carbohydrate and protein),then patients or dietitians were allowed to select a different modules for recipe design.Results Forty percents(4/10 cases) of the patients had seizure reduced to 50％-90％,20％ (2/10 cases) of the patients had seizure reduced to 90％ 99％,and 20％ (2/10 cases) of the patients became seizure free.Half-year retention rate reached 70％ (7/10 cases).Conclusions This specially designed software for Chinese epilepsy patients can help simplify the operation of the ketogenic diet and modified Atkins diet and improve retention rates.It can be used in classic and non-classical ketogenic diets.

Objectives To evaluate the valproate plasma l ev els,the clinical efficacy and adverse effects in patients with epilepsy treated with the conventional preparations and the sustained-release preparations of sodium valproate (VPA-Na?SR).Methods 33 patients received oral conventional formul ation of sodium valproate for over six months and a similar dosage of VPA-Na?SR for 4 weeks.After 12 or 24 hours,the valproate plasma concentr ations of the two formulations were measured respectively before taking drugs in the early mor ning.The valproate plasma concentrations and the clinical efficacy of the VPA-N a?SR were assessed by comparing with that of conventional valproate.The adverse effects were recorded.Results The average valproate plasma trough concentration was s ignificantly higher in patients receiving VPA-Na?SR than that of those receiving conventional valproate.Seizure free in patients was achi eved by 76%(n=25) with VPA-Na?SR and by 45%(n=15) with conventional valproate resp ectively.There was statistical difference between the two formulations.The seizu re frequency was significantly reduced in 5 patients treated with VPA-Na?SR.A dverse ef fects were observed in 2 patients with conventional valproate,5 patients with V PA-Na?SR whose valproate plasma levels were higher than that of conventional p reparations.Adverse effects were related to increased valproate plasm a levels and individual drugtolerance. Conclusions The advantage of VPA-Na?SR is that serum valproa te con centrations may increase smoothly and minimize fluctuation in serum dr ug concentrations during a dosing interval. It is a more effective and more convenient antiepileptic agent.

Vasculogenic mimicry (VM) is a pattern of neoplasm cells,which achieve their blood supplements through deformation and simulating capillary channels.Cumulative studies show that the formation of VM in glioma have a close relation with the glioma stem cells.In addition,some molecules such as microRNA,epithelial cell kinase-A2,vascular endothelial cadherin,transforming growth factor-Jβ,vascular endothelial growth factor receptor-2 and galectin-1 play important roles in the forming process of vasculogenic mimicry.Recently,it is found that VM is associated with the poor prognosis of patients with glioma and anti angiogenesis drug efficacy.So the research on VM about the discovery,formation mechanism,prognostic impact and the clinical significance will provide an opportunity for diagnosis and therapy of glioma in early stage.

Objective To explore the diagnostic value of MR diffusion weighted imaging (DWI) in the differential diagnosis between encephalitis and acute cerebral infarction.Methods The MR DWI appearances of 23 cases of encephalitis including 14 cases with viral encephalitis, 9 cases with demyelinative encephalitis and 30 cases with acute cerebral infarction were retrospectively analyzed.Results The 30 cases of acute cerebral infarction appeared bright signal in DWI with a ADC values of (0.46?0.13)?10 -3mm2/s. 7 cases with viral encephalitis and 9 cases with demyelinative encephalitis appeared slightly high or high signal intensity in DWI with a ADC values of (0. 98?0.18)?10 -3mm2/s and(0. 89?0.07)?10 -3mm2/s respectively. The ADC values of viral encephalitis and demyelinative encephalitis were higher comparing to acute cerebral infarction(?0.05). However, the ADC values showed higher or lower in different areas in 4 cases, and lower ADC values appearing in 3 cases with viral encephalitis comparing normal parenchyma.Conclusion MR DWI is useful in the differential diagnosis between encephalitis and acute cerebral infarction.

Objective To explore the expression of SP-A in surface active substance of sputum pulmonary of dysfunctional venti-latory weaning response patients and to study changes of expression of SP-A and oxygenation index ,arterial partial pressure of oxy-gen .Methods The mechanical ventilatory patients were divide into dysfunctional ventilatory weaning response group (group A) and easily weaning group(group B) ,then collected sputum from ventilators at different times :on the first day ,two and seven days after using ventilators .Used ELISA to test level of SP-A and oxygenation index ,arterial partial pressure of oxygen in sputum of group A and group B .Results For group A ,SP-A content oxygenation index and arterial partial pressure of oxygen were significantly less than those for group B(P<0 .05);after two days ,for group A ,SP-A content in sputum was significantly less than that on the first day ,and SP-A content in sputum was significantly less than that on the second day (P<0 .05);two days later ,oxygenation index and arterial partial pressure of oxygen were significantly lmore than those on the first day (P<0 .05) and there was no statistical difference in oxygenation index and arterial partial pressure of oxygen between the seventh day and the second day (P>0 .05) .Con-clusion Dysfunctional ventilatory weaning response and lung injury related to ventilator can be diagnosed early through the test of SP-A content in sputum ,which provides a brand-new way and method of treatment in dysfunctional ventilatory weaning response and lung injury related to ventilator .

Objective To investigate the effect of micro-ecological agent on the intestinal flora of patients with posterior lumbar spine surgery.Methods Seventy-two patients with lumbar spine surgery were selected as our subjects.Of them,42 patients with occurred the intestinal flora dysfunction were served as experimental group (group A),other 30 patients were as control group (group B).The levels of plasma endotoxin,plasma tumor necrosis factor-α (TNF-α),Interleukin 6 (IL-6) were detected before and after operation.The patients in group A were treated with micro-ecological agent Jinshuangqi.Collected stool samples at preoperative,postoperative first natural defecation (after 1-4 d),and compared intestinal flora difference and Bifidobacterium (B)/Enterobacteriaceae (E) value of two groups patients.Results The levels of plasma endotoxin in group A were (1.82 ±0.12),(2.29 ±0.15),(1.91 ±0.08) ng/L at before surgery,the 2nd and 7th day after surgery,and that in group B were(1.91 ±0.21),(2.35 ±0.16),(2.26 ±0.24) ng/L The TNF-α level in group A were (275 ±51),(309 ±45),(276 ±34) ng/L and that in group B were (269 ±48),(318±67),(297 ±53) ng/L at before surgery,the 2nd and 7th day after surgery.The IL-6 levels in group A were (138 ± 22),(159 ± 15),(137 ± 17) ng/L and that in group B were (159 ± 16),(187 ± 19),(174 ± 21) ng/Lat before surgery,the 2nd and 7th day after surgery.The repeated measured repeated measures analysis of variance showed that among three indexes of plasma endotoxin,TNF-α,IL-6 levels,differences of between group and interaction were statistically significant (P ＜ 0.05),but there was no significant difference within groups (P＞ 0.05).The levels of plasma endotoxin,TNF-α,IL-6 decreased after surgery ware gradually decreasing with hospitalization prolonged.There was significant difference between before surgery and at the 2nd,7th day after surgery(P ＜ 0.05),and there was significant difference between the 2nd and the 7th day after surgery(P＜ 0.05).At the 2nd day after surgery,there was significant difference between group A and group B in terms of the level of plasma endotoxin,TNF-α,IL-6.At the 7th day,the levels of plasma endotoxin,TNF-α,IL-6 were slowly decreased in group A,and there were significant difference compared to group B (P ＜ 0.05).The numbers of intestinal Bifidobacterium,Bacteroides,and B/E values of group A were decreased after surgery compared to group B((9.17 ±0.54) lg cfu/g vs.(10.01 ± 0.75) lg cfu/g,(9.23 ± 0.47) lg cfu/g vs.(10.09 ± 0.81)lg cfu/g,(1.01 ± 0.16) vs.(1.20 ± 0.11)),and the difference was significant (P =0.031,0.042,0.029respectively).The levels of Enterobacter and Enterococcus in group A were (9.11 ± 1.02) lg cfu/g,(7.80± 1.02) lg cfu/g,higher than that of group B ((8.81 ± 0.89) lg cfu/g,(7.29 ± 0.98) lg cfu/g(P =0.037,0.043)).There was no significant difference between two groups in terms of small clostridium and lactobacillus (P ＞ 0.05).After treated with micro-ecological agent Jinshuangqi,the levels of intestinal Bifidobacterium,Bacteroides,and B/E value at was increased compared to before treated in group A (Bifidobacterium:(13.01±0.87) lg cfu/g vs.(9.17 ±0.54) lg cfu/g; Bacteroides:(14.12 ±0.75) lg cfu/g vs.(9.23 ±0.47)lg cfu/g; B/E value:(1.28 ± 0.45) vs.(1.01 ± 0.16) ;P =0.045,0.034,0.038 respectively).No significant difference was seen in terms of the levels of Enterobacter,Enterococcus,small clostridium and lactobacillus between two groups(8.71 ±0.91) lg cfu/g vs.(9.11 ± 1.02) lg cfu/g,(7.01 ±0.54) lg cfu/g vs.(7.80± 1.02) lg cfu/g,(5.23 ± 1.04) lg cfu/g vs.(5.15 ± 0.89) lg cfu/g,(6.71 ± 1.04) lg cfu/g vs.(6.53± 0.86) lg cfu/g respectively; P ＞ 0.05).Conclusion Posterior lumbar operation patients with intestinal dysbacteriosis often associated with endotoxemia and inflammatory reaction,the levels of bifidobacteria,Bacteroides intestinal Enterobacteriaceae decrease while Enterococcus,opportunistic pathogens increase,and intestinal microbial colonization resistance decrease.Micro-ecological agent Jinshuangqi treatment can ease the body's endotoxemia and inflammatory response,improved lumbar surgery intestinal flora after surgery,and beneficial to rebuild the intestinal microflora balance.

Objective To evaluate the clinical value of CT perfusion (CTP) imaging for providing quantitative information about angiogenesis in patients with lung carcinoma and investigate the correlation of CTP enhancement parameters and histological microvessel density (MVD) with lymphatic involvement in peripheral lung carcinoma. MethodsFifty-three patients with pathology-proved peripheral lung carcinoma underwent CT perfusion scan before operation. The enhancement parameters of CTP were calculated based on the time-density curves (TDC) of fist pass phase. All cases were classified into two groups according to pathologic results: tumor with and without lymph node involvement. Two-sample t test was used for the statistics. The ROC curve was used to assess the efficiency of the enhancement parameters of CT perfusion and MVD for predicting lymphatic involvement.Results Tumors with lymph node involvement had significantly higher value of MVD than those without lymph node involvement (64.69±16.34 and 42.67± 16.78, respectively,t=4.84,P<0.01). Tumors with lymph node involvement had significantly higher value of CTP enhancement parameters (PH, M/A, PV) than those without lymph node involvement [PH= (41.79±15.50) and (29.99±10.91) HU,M/A =0.24±0.09 and 0.15±0.06, PV=(2.14±1.09) and (1.27±0.53) ml·min~(-1)·ml~(-1), t=3.21,3.95, 3.66, P<0.01, respectively]. The CTP enhancement parameters (PH, M/A, PV) of lung cancer correlated positively with the MVD, the highest correlation coefficient was between the PV and MVD (r=0.716, P<0.01). MVD and PV had higher values for predicting lymph node involvement in ROC curve analysis.The sensitivity, specificity and accuracy for predicting lymph node involvement were 80.8%, 81.5% and 81.1% or 84.6% ,85.2% and 84.9% respectively if MVD>52/0.74 mm~2 or PV>1.52 ml·min~(-1)·ml~(-1). ConclusionThe CT perfusion PV and histological MVD have good correlation with lymph node involvement in peripheral lung carcinoma and are important predicting parameters before operation.

Objective To establish a risk warning model for surgical site infection(SSI), provide support for screening high risk population and finding suspected cases.Methods Clinical data of 5 067 patients who underwent abdominal surgery in 6 domestic hospitals from January 2013 to December 2015 were collected retrospectively, all cases were randomly divided into modeling group and validation group according to a 6:4 ratio, warning model was established by employing logistic regression, the area under the receiver operating characteristic curve (AUC) was used to evaluate discriminant ability of evaluation model, the maximum Youden index was as the optimum cut-off point.Results For the warning model of high-risk patients, AUC was 0.823, sensitivity and specificity were 78.81% and 74.33% respectively, positive predictive value and negative predictive value were 19.67% and 97.78% respectively.For the discriminant model of suspected infection cases, AUC was 0.978, sensitivity and specificity were 93.38% and 95.62% respectively, positive predictive value and negative predictive value were 62.95% and 99.45% respectively.Conclusion The early-warning model established in this study has better discrimination ability, which can provide a reference for the development of early warning and discrimination of healthcare-associated infection information system.

objective To investigate the epidemiological and molecular typing features of the pathogenic Haemophilus influenzae(H.influenzae)by biotyping,serotyping and pulsed-field gel electrophoresis(PFGE).Methods A total of 273 invasive isolates of H influenzae were collected from the pediatric patients with pneumonia at Chengdu Children Hospital of Sichuan province from 1988 and 2004 to 2007.The idenbfication of H.influenzae strains were done according to the laboratory standard methodology described by Manual of Clinical Microbiology(American).All strains were biotyped according to Kilian's classification with the API[R]NH system.And serotyped by a slide agglutination assay with type a to f specific antlaerum as described by Pittman.PCR method for identification of H.influenzae were performed as described by Falla.One hundred of 273 strains were analyzed by PFGE as described by Saito with some modifications.The resuIts of PFGE were analyzed by Bionumerics soft(Version 4.0,Applied Maths BVBA,Belium).Restilts 78.2%of 273 cases occurred under 1 years old.Eight biotypes were found among the 273 H.influenzae isolates.17.6%(48/273)of all isolates belonged to biotype Ⅰ,43.6%(119/273)were biotype Ⅱ,22.7%(62/273)were biotype Ⅲ,7.3%(20/273)were biotype Ⅳ,5.9%(16/273)were biotype Ⅴ,0.4%(1/273)were biotype Ⅵ,1.8%(5/273)were biotype Ⅶ and 0.7%(2/273)were biotype Ⅷ.respeetively.99.6% of all 273 isolates were nontypeable.There was only one isolate was serotvpe f Ninty-six PFGE genotypes were obtained in this study.One hundred strains demonstrated a variety of genomic Datterns by PFGE.The most isolates of the flame PFGE genotype(type 35)was 3 isolates.Each of93 PFGE genotypes was represented by only a single isolate.The genotypes distribution didn't correlate with the time distribution of the strains were isolated.Conclusion Nontypeable H.influenzae primarily caused acute Dneumoma in children under 1 years old.They mostly belonged to biotype Ⅰ,Ⅱ and Ⅲ biotypes.The nontypeable H.influenzae strains appeared to more heterogeneous patterns by PFGE genotyping.Genotyping may helP understand the molecular characteristics of outbreak and endemicity according to the results of PFGE.PFGE genotyping proved to have a much stronger discriminatory power than either serotyping or biotyping.Our findings suggest that PFGE analysis is useful for the epidemiologieal study of H.influenzae infections.

OBJECTIVETo evaluate the therapeutic effect of ulinastatin combined with thymosin α1 in the treatment of severe sepsis in rats.

METHODSNormal Wistar rats were subject to cecal ligation and puncture (CLP) to establish models of severe sepsis. The rats were then randomized into 4 groups for treatment with saline (control), ulinastatin, thymosin α1, or the combination of the latter two injected through the caudal vein or subcutaneously at 6, 24, 48 and 72 h after modeling. The mortality rate was recorded daily and the rats were executed at 24, 48, 72 and 96 h after CLP to harvest the heart, liver, spleen, lung, kidney and small intestines for pathological examination. The spleen of the rats were taken for detection of apoptosis of the spleen cells.

RESULTSThe mortality rate of the septic rats in the combined treatment group was decreased significantly (P=0.0325). The control group showed the most severe organ damage, which was moderate in single drug treatment group and the mildest in combined treatment group. Obvious spleen cell apoptosis was found in the control group, and was significantly ameliorated in the combined treatment group[(47.4∓10.9)% vs (39.3∓11.4)%, P=0.0000].

CONCLUSIONCombined treatment with ulinastatin and thymosin α1 can significantly improve the prognosis and ameliorate organ damage and spleen cell apoptosis in rats with sever sepsis.

Animals ; Apoptosis ; Drug Therapy, Combination ; Glycoproteins ; therapeutic use ; Male ; Rats ; Rats, Wistar ; Sepsis ; drug therapy ; pathology ; Spleen ; cytology ; pathology ; Thymosin ; analogs & derivatives ; therapeutic use