Objective To investigate the clinical value of knee joint infection indexes of white blood cell (WBC),C reactive protein (CRP),erythrocyte sedimentation rate (ESR) and procalcitonin (PCT),interleukin-6 (IL-6) and absolute value of neutrophil (GR).Methods One hundred and twelve cases of preoperative knee joint infection in our hospital from June 2010 to March 2015 were selected as the research group and contemporaneous 112 cases of no preoperative and postoperative knee joint infection were selected as the control group.The venous blood was collected for observing the changes of the above indexes before operation and at postoperative 1,3,5,7,14 d.Results The levels of WBC,CRP,ESR,PCT,IL-6 and GR before operation and at postoperative 1d in the study group were significantly higher than those in the control group (P<0.05);the levels of WBC,CRP,PCT and IL-6 at postoperative 3 d in the study group were significantly higher than those in the control group (P<0.05);the levels of WBC,CRP,ESR and IL-6 at postoperative 5 d in the study group were significantly higher than those in the control group (P<0.05);the difference at the other time points between the two groups was not statistically significant (P>0.05);in the Logistic regression analysis,the six indicators of WBC,CRP,ESR,PCT,IL-6 and GR6 all could predict knee joint infection (P=0.005,0.004,0.000,0.002,0.003,0.007).Conclusion WBC,CRP,ESR,PCT,IL-6 and GR have certain value for early diagnosis and prevention of infection,and further study on expanded sample size cn carry on.

Objective To discuss the ways to train qualified clinical engineers,and thereby to enhance the teamwork of clinical engineers.Methods The problems in training the clinical engineer were pointed out in training mode,knowledge reserve,innovation and etc,and some countermeasures were put forward accordingly.Results The countermeasures were proposed from the aspects of basic theoretical system,continuing education system,self-adaptive working mode,enhanced communication and etc.Conclusion The clinical engineer needs to utilize their own advantages to elevate their personal qualities and raise their profiles so as to meet the requirements of social and technological development.

Objective To investigate the prevalence of H.Pylori infection and antibiotic resistance in patients with peptic ulcer.Methods A retrospective analysis of 429 endoscopy and H.Pylori culture results in the First People's Hospital of Hangzhou from 2012 to 2013 was conducted.The rate of H.Pylori infection in patients with peptic ulcer, and the resistance rates of H.Pylori to metronidazole, levofloxacin, clarithromycin,amoxicillin, gentamicin, furazolidone were analysed.Results The positive rate of H.Pylori in people with peptic ulcer was 53.1％ (228/429).The resistance rates to metronidazole, levofloxacin, clarithromycin,amoxicillin, gentamicin and furazolidone were 94.7％ (216/228), 18.9％ (43/228), 18.9％ (43/228), 0, 0 and 0.Double antibacterial resistant rates of metronidazole and clarithromycin, metronidazole and levofloxacin were 18.0％ (41/228) and 17.1％ (39/228).Triple antibacterial resistant percentage of levofloxacin + metronidazole + clarithromycin was 8.3％ (19/228).The resistance rate of clarithromycin in 43 patients who were also resistant to levofloxacin was 46.5％ (20/43), while the resistance rate of clarithromycin in 185 patients who were also sensitive to levofloxacin was 12.4％ (23/185)with significant difference(x2 =26.480,P =0.000).A positive association between the resistance to levofloxacin and to clarithromycin was found.Conclusion The H.Pylori infection is closely related to the occurrence of peptic ulcer.Without the basis of culture results in patients with H.Pylori positive, amoxicillin, gentamicin and furazolidone could be the first choices in clinical,because of their low resistance rates.Clarithromycin can be used as an alternative.

Objective To discuss the diagnostic and therapeutic value of duodenoscopy for chronic pancreatitis. Methods A total of 67 patients with chronic pancreatitis were treated with duodenoscopy in our hospital from January 2000 to December 2006. Among the patients, 19 patients who had duodenal papilla stenosis without obvious dilation of the pancreatic duct were treated with EST; 48 patients who had dilation of the pancreatic duct underwent EST combined with EPS. ERBD was performed on 21 patients who had stenosis of the inferior segment of the common bile duct, among which 12 received insertions of two stents into the biliary pancreatic duct. In 27 patients with stones in the pancreatic duct, the stenotic segment of the pancreatic duct was dilated after EPS, and then the stones were removed using basket or balloon. Afterwards, ERPD was performed if necessary. These patients were followed up with ERCP every 3 months, stents were used if necessary. Results Duodenoscopy was completed in 62 of the 67 patients with a success rate of 92.5% (62/67). Abdominal pain disappeared or markedly relieved in 60 cases after the treatment showing an effective rate of 96.8% (60/62). The operation was ineffective in 2 patient, who had no relief of their abdominal pain. The failure of stent insertion was due to the multiple stenosis of the pancreatic duct. Abdominal pain was markedly relieved in 21 patients who received ERBD and 38 patients who underwent ERPD. During a 39.5-month follow-up (5-70 months), no recurrence of the symptom was found. In the 27 patients with stones in the pancreatic duct, the stones were removed in 19 patients. After the treatment, 15 patients developed transient hyperamylasemia, 5 had acute pancreatitis, 3 had hemorrhage. No perforation, conversion to an open surgery, or death occurred in this series. Conclusions Duodenoscopy, which is safe, effective, and minimally invasive, is the first choice for chronic pancreatitis. The treatment outcomes can be improved by combining duodenoscopy with other therapies.

Objective Experiment the effective method to improve cell injury of cerebral ischemia.MethodMake Mongolirn-Gerbil acute full cerebral ischemia model with ligation of double main carotid arteries,observe the influence of intervening abdomen injection of western medicine Nimodipin and TCM Xingnaojing on MDA and SOD in cerebral tissue of Mongolirn-Gerbil in acute period of ischemia reperfusion.ResultIt finds that Nimodipin and Xingnaojing both can markedly increase SOD activity and decrease MDA content,there’s no obvious difference between them,while there’s difference among different dosages of Xingnaojing,the effect is rising with dosage increased.ConclusionAs a Chinese drug of anti-free radical injury,Xingnaojing has similiar effect with Nimodipin.

Objective To study the clinical and pathologic features,and endoscopic diagnosis as well as therapy and prognosis of the primary gastrointrestinal lymphoma(PGIL), and to improve its diagnosis and therapy efficiency. Methods The clinical data in 29 cases of PGIL were retrospectively reviewed. Results In these cases, the tumor was mainly located at stomach (n=21), colon(n=6) and small intestine(n=2). The type of pathology was mucosa associated lymphoid tissue lymphoma(n=8), diffuse large B-cell lymphoma(n=18), T-cell lymphoma(n=3). The commom manifestation include abdominal pain, anaemia, abdominal distention, melena or hemafecia, loss of weigh etc. The tumor appeared infilitrative in 11 cases, ulcerative in 10 cases, protruding in 6 cases, 9 cases were diagnosed by firstly routine biopsy endoscopiccally. 10 cases were treated by operation and chemotherapy, 19 cases were treated by chemotherapy. Up to now, 6 cases survival in operation group, 13 cases survival in chemotherapy group, the difference was not statistically significant . Conclusions PGIL was mainly located at stomach, which was not specific clinical manifestation; The type of pathology was mainly diffuse large B-cell lymphoma; the diagnositic rate of routine endoscopic biopsy was low. chemotherapy was the first treatment of PGIL.

Objective To assess the diagnostic value and safety of push enteroscopy in intestinal diseases. Methods From March.1998 to December 2006,345 patients were examined by push enteroscopy.Results The enteroscope bypassed the Treize ligament in 318 cases, The average examination spend 30 minutes. 144 patients were diagnosed intestinal diseases, the detection rate was 41.74%. 28 patients underwent endoscopic haemostasis treatment, 13 patients received endoscopic polypectomy. No complication of perforate, hemorrhage, abdominal pain occurred. Conclusions Push enteroscopy is an efective and safe method for diagnosing intestinal diseases, and could undertook corresponding therapy.

Autophagy is a cellular catabolic pathway that is essential for survival,differentiation,development and homeostasis.The dual roles of autophagy as a tumor-promoting mechanism and a tumor suppressor mechanism have been elucidated in the recent cancer research.The double function is accomplished by some neoplasms-associated signaling pathways which include mTOR-dependent signaling pathway,Beclin1 network,LKB1-AMPK signaling pathway,p53 and p53-related regulators of autophagy.Thus it can be seen that these signaling pathways function dependently and correlatively as inducing and inhibiting autophagy and play different roles in the process that involves growth and development of neoplasms.

Objective To determine the effect of willed movement on the expression of Nogo-A and Rho-associated kinase (ROCK) in adult rats with cerebral ischemia.Methods Cerebral ischemia/reperfusion injury was established by middle cerebral artery occlusion (MCAO) for 2 h,followed by a 24 h reperfusion in 54 adult rats and the degree of their neurological deficit was evaluated using Longa scale.They were then divided randomly into 3 groups,namely the MCAO group,the environmental modification (EM) group,and the willed movement (WM) group.The rats of MCAO group were raised in a regular breeding box,where they could get food and water freely.Meanwhile,those of the other two groups were raised in a homemade box.For the WM group,the water bottle and food were located on the roof of the homemade box.In each group,six rats were killed on day 3,7 and 15 after reperfusion and their neurological deficits were evaluated respectively.Immunohistochemistry assay was employed to examine the expression of Nogo-A and ROCK in the brain tissue around the ischemic foci.Results The rats of the WM group showed lessened neurological deficits on day 15 compared with the model and EM group.Their expression of Nogo-A decreases from(28.92 ± 2.17)/hpf on day 7 to (24.38 ± 2.29)/hpf on day 15 and that of ROCK did from (40.03 ± 2.14)/hpf to (38.08 ± 2.07) / hpf,lower than those of the model and EM group.However,no significant differences were found in the expression of Nogo-A and ROCK between the model group and EM group at any time points.Conclusion Willed movement could promote the functional recovery of neurological deficits in rats with ischemia after reperfusion,which is probably in relation to restrained expression of Nogo-A and Rho-associated in the tissue around the brain ischemic foci.

BACKGROUND:Bone marrow mesenchymal stem cells (BMSCs) can be induced to differentiate into neuron-like cells directional y. Accordingly, BMSCs can be used as seed cells theoretical y in constructing tissue-engineered peripheral nerves.
OBJECTIVE:Using combination of two cytokines to induce BMSCs differentiating into neuron-like cells directional y, and further to discusse its application in peripheral nerve injury.
METHODS:BMSCs were isolated and purificated from the bone marrow of Wistar rats by using the differential adherence method. Basic fibroblast growth factor and epidermal growth factor were used to induce the BMSCs differentiating into neuron-like cells. The morphological change was observed and the neuronal specific markers were detected by immunohistochemistry technique. The morphological and immunohistological changes were also studied after the induce agent were removed.
RESULTS AND CONCLUSION:With presence of morphological and immunohistochemical features of nerve cells induced by neurotrophic factors, BMSCs exhibited two or more processes that were interconnected as a meshwork;cellnucleus and nucleus could be observed with strong light refraction of cytoplasm. After immunohistochemical staining, neuroln specific enolase, neurofilament protein and synaptophysin protein positive cells were detected. A great amount of cells reversed to their original fibroblast-like morphology, and the expression of the three above-mentioned proteins decreased as the induce agent withdrawn. Our study showed that BMSCs can be induced to differentiate into neuron-like cells, but the transdifferentiation is a short-time reversible phenomenon.