Objective To investigate the clinical effect and immunologic function of Moxifloxacin combined with small dose of hormone in the treatment of Ventilator pneumonia in elder.Methods 64 cases of Ventilator pneumonia in our hospital were collected and randomly divided into experiment group and control group, 32 cases each.Two groups were given conventional treatment, the control group received Methylprednisolone Sodium Succinate 1 mg/kg qd, the experiment group was given Methylprednisolone Sodium Succinate 1 mg/kg qd, and Moxifloxacin Hydrochloride and Sodium Chloride Injection 400 mg qd.Two groups of patients were continuous treated for 10 days.After treatment,T lymphocyte subsets, NK cells, white blood cell count, C reactive protein, clinical symptoms disappeared time, mechanical ventilation time, ICU length of stay and mortality rate were compared. Results After treatment, the total effective rate in the experiment group 75% was higher than the control group 50%( P <0.05 ).The levels CD3 +, CD4 +, CD4 +/CD8 +and NK cell in two groups increased(P<0.05), levels of CD8 +decreased(P<0.05),levels of WBC, CPR and PCT decreased in the two groups(P<0.05), and compared with the control group, the levels CD3 +, CD4 +, CD4 +/CD8 +and NK cell in the experiment group were higher(P<0.05), levels of CD8 + were lower(P<0.05),levels of WBC,CPR and PCT were lower(P <0.05), the rales disappeared time, cough disappeared time, fever disappeared time were significantly shorter than the control group(P <0.05), the duration of mechanical ventilation and the length of hospital stay were significantly shorter(P<0.05).Conclusion Moxifloxacin combined with small dose of hormone in the treatment of Ventilator pneumonia in elder was significantly effective, and it can relieve inflammation, prevention of infection control, enhance immune function.

Objective To explore the pathological characteristics, diagnosis and operative treatment of Mirizzi Syndrome(MS). Methods The clinical data of 95 cases of Mirizzi Syndrome admitted to our hospital in recent 12 years were reviewed retrospectively. Results All of the 95 cases underwent operative therapy. In the 95 patients, simple cholecystectomy was performed in 2 patients, cholecystectomy and choledochotomy with T tube drainage in 58 patients, cholecystectomy and choledoscopic bile duct examination via cystic duct in 15 patients, partial cholecystectomy plus repair of choledochal fistula in 18 patients, and cholecystectomy plus repair of the injured choledochus in 2 patients. 65 cases were folloned up for 1-5 years, and all of them have been in good health. Conclusions Mirizzi Syndrome consists of varied pathology. The selection of rational operation for different types of Mirizzi Syndrome can give satisfactory results.

Dynamin-related protein 1 (Drpl) is a major protein for regulating mitochondrial fission.Its activity is associated with the post-translational modification,mainly including phosphorylation,ubiquitination,sumoylation,and S-nitrosylation.During the cerebral ischemia,Drpl is activated and translocates from the cytoplasm to the mitochondrial outer membrane,mediates mitochondrial fission and eliminates damaged mitochondria.Drpl plays the important roles in the pathological processes of ischemic neuronal apoptosis,necrotic apoptosis,and mitophagy.Excessive mitochondria fission or accumulation of damaged mitochondria will aggravate neuronal injury.

Objective To study the effect of Sirtuin1 (Sirt1) on the pathological process through its activity of deacetylation to improve the clinical outcome of acute sepsis. After searching data base, microRNA-211 (miR-211) was found to have action potentially targeting at Sirt1.The present study aimed to find the interaction between miR-211 and Sirt1 in the pathogenesis of hypoxic injury to cardiomyocytes in the presence of lipopolysaccharide ( LPS ) . Methods Primary neonatal rat cardiomyocytes ( NRC ) isolated from neonatal SD rats and H9c2 ( cardiomyocytes after culture with 10% fetal serum of cattle and DMEM under 37 ℃ and 5% CO2 ) cell line were used in the experiments.The miR-211 expression was quantified by qRT-PCR after LPS exposure for 4 hours, and the changes in Sirt1 protein level were also detected in both NRC and H9c2 by western blot.At the same time, CCK-8 assay and TUNEL staining were also performed to measure cell proliferation and apoptosis activation when either treated with LPS alone or followed by exposure to hypoxia.Results Compared to the control group, the doses of 20μg/mL, 40μg/mL LPS treatment for 4 hours had no significant effects on H9c2 cell proliferation at 24 h, 48 h, 72 h, but it could significantly induce the cell apoptosis of neonatal rat cardiomyocytes and H9c2 cells after hypoxia, and the apoptosis rate increased all over 100% in both NRC and H9c2.At the same time, LPS treatment could significant up-regulate miR-211 expression which was closely associated with decrease in Sirt1 protein levels.Conclusions LPS enhanced cardiomyocytes injury after exposure to hypoxia which was closely associated with up-regulating miR-211 expression and in turn to suppress Sirt1 expression.

Objective To explore imaging fingdings of pigmented villonodular synovitis (PVS) so as to improve the diagnostic accuracy of PVS. Methods Imaging data of 12 patients with PVS confirmed by operation and pathology were analyzed retrospectively.12 cases were all examined with X-ray and MR imaging,5 cases examined with CT.Results In total 12 cases, swelling of soft tissue was seen in 8 cases on plain films.CT showed subcartilaginous bony erosion in 3 cases.MRI showed synovium nodular hyperplasia irregularly, deposition of paramagnetic hemosiderin-containing in all cases,and the invasion of ligament in 5 cases , menisci in 1 case and infrapatellar fat pad in 3 cases; subcartilaginous and cartilaginous erosion in 3 cases, joint effusion in 9 cases. Conclusion PVS has typical imaging characteristics,PVS can be diagnosed accurately with MRI.

Objective To investigate the correlation of father involvement with early social adaptation behaviors.Methods With social adaptation scale for infant-junior middle school' s student and a self-made questionnaire,1246 normal children,age from 16 to 72 months,were investigated.Regression analysis was performed to get the correlation of social adaptation with time and activities of father involved.Results After controlling for mother-,child- and family-related factors,the regression analysis showed that standard score of social adaptation was positively rehted with the time of father involved ( β =0.05,P=0.03 ),the time father invloved explain 12％of the variation of social adaptation.The father-child activities were related with social adaptation behavior,playing was related with work skills (β =0.09,P＜0.01 ) and socialization ( β =0.06,P＜0.05),story listening related with communication ( β =0.07,P ＜ 0.05) and self-management ( β =0.06,P ＜ 0.05 ),other activities related with self-dependence ( β =0.07,P＜0.05) and work skills ( β =0.06,P＜0.05).Conclusion The time and activities of father involved are related with children' s social adaptation.The effect of father involvement on early social adaptation is positive.

Objective:To screen the plasma microRNAs( miRNAs) of differential expression in a high fat diet-induced insulin resistance in mouse models;further investigations on the mice with insulin resistance treated by TLR4 inhibitors TAK-242,and to study the changes of plasma miRNAs expression profile and the relationship among TLR4, miRNAs and high fat diet-induced insulin resistance. Methods:The plasma samples were from 3 mouse groups of previous study,namely,the control group with general basic diet ( low fat diet,LFD) ,TLR4 inhibitors TAK-242 treatment group with a high fat diet ( HFD-T) and the high fat diet control group( HFD-C) . The differential expressed miRNAs was screened by expression profiling of plasma miRNAs, which was detected using mouse miRNA microarray. The quantitative Real-Time PCR ( qRT-PCR ) was used to verify the results of microarray. The target genes of differential expressed miRNAs were predicted in TLR4 signaling pathway using bioinformatics methods,and the GO and KEGG database molecular annotation system were used to investigate the main effects of the miRNAs targeted genes on the biological functions or signal pathway. Results:The screening results of miRNA microarray chip showed that,comparing miRNAs expression between HFD group and LFD control group,185 miRNAs were significant in the high fat diet group,including 6 up-regulated and 179 down-regulated miRANs. A significant difference of miRANs was also found between HFD-T group and LFD control group,the total number of differential expression miRNAs was 171,and all of them were down-regulated. Comparing miRNAs expression between HFD-C group and HFD-T group,13
miRNAs were significant in HFD-T group,all of them were down-regulated. Bioinformatics analysis results showed that a total of 10 in-teraction proteins with TLR4 were predicted;the difference of mmu-miR-3095-3p,mmu-miR-5113,mmu-miR-709 and mmu-miR-335-3p expression levels was more than 1 000 times between HFD-C group and HFD-T group,and their target genes can be found in TLR4-in-teraction protein or Toll like receptor signaling pathway;GO and KEGG analysis showed 74% of these target genes belonged to the biological processes genes, and the transcription factors accounted for 82%. The expression of mmu-miR-3095-3p, mmu-miR-5113, mmu-miR-709 and mmu-miR-335-3p detected by qRT-PCR exhibited the similar patterns of down regulation to those shown in microarray results. Conclusion:When insulin resistance occurs,there is a change in plasma miRNAs expression profile,this change is associated with TLR4 and its signaling pathways. The finding enrichs the possible mechanisms of insulin resistance and provides a basis for finding miRNAs diagnostic markers for early diagnosis of insulin resistance.

Objective To evaluate the clinical efficacy of modified Chen's biliojejunostomy technique in treating hilar cholangiocarcinoma.Methods The clinical data of the patients with hilar cholangiocarcinoma from January 2011 to June 2014 in the PLA general hospital and its first affiliated hospital were retrospective ly studied,and 17 of them underwent modified biliojejunostomy.There were 10 male and 7 female patients with a mean of 65 years old (range 34 ～82).Cases diagnosed as Bismuth-Corlette Type Ⅱ,Ⅲ a,Ⅲ b and Ⅳ were 2,6,4,and 5,respectively.Results Liver segment Ⅳ were resected from 2 patients,segment Ⅳ + Ⅴ from 7 patients and segment Ⅳ + Ⅴ + Ⅰ from 8 patients.No death was observed during the study period.One patient had mild bile leakage,2 patients had cholangititis,and another patient had biliary intestinal anastomotic bleeding.Three patients received resection and reconstruction of the portal vein.Three right hepatic arteries and 1 anterior branch of right hepatic artery were resected in combination with the tumor because of invasion.All the complications were alleviated under conservative treatment.Twelve cases had been followed up for a median time of 16 months (range 3 ～ 24).Two cases had cholangititis intermittently.One case underwent radiotherapy because of local recurrence in 2 years after the surgery.MRCP and relevant enzymes were within the normal range.Conclusion Modified Chen's biliojejunostomy is a simple,effective and safe method,which can be widely used when there are multiple biliary intestinal anastomoses.

Objective To analyze the fusion genes derived from 29 types of chromosome structural aberrations in leukemia patients,and the significances on the MICM typing,risk grouping,and minimal residual disease(MRD)monitoring of leukemia.Methods The bone ulan-ow or blood samples from 141 leukemia patients were analyzed with a novel multiplex nested RT-PCR.In addition.chromosomal karyotypes were investigated in some patients.Results Of the 141 leukemic samples,66(46.8%)carried 13 types of MLL/AF6,MLL/AF9,dupMLL MLI/ENL,CBFβ/MYH11 and TLS,ERG.Fusion genes were positive in 27 of 57 ALL patients(47.4 q%),and 33 of 78 AML patients(42.3%),respectively.In these ALL or AML patients,7 or 6 chromosome structural aberrations were found. Conclusion This multiplex nested RT-PCR reaction could screen 29 types of chromosome structural aberrations at the same time. It may be helpful for the diagnosis, risk grouping,prognosis evaluation and the detection of minimal residual diseases after chemotherapy and bone marrow transplantation in these leukemia patients.

Objective To evaluate accurately the cardiac output, an early post-operative indicator for the cardiac function, after cardiac surgery in the neonates with congenital heart diseases and assess the risk factors for surgery, with an aim at exploring the early strategy for decressing the mortality. Methods From January 2007 to November 2007, forty-seven consec-utive neonates with complex congenital heart diseases underwent surgical correction at Shanghai Children's medical center.There were 38 boys and 9 girls with age from 3 days to 29 days [mean age (21.98 +8.15) days] and weight from 2.6 kg to 4.2 kg [ mean (3.49±0.51 ) kg]. 15 patients had delayed sternal clousure. The operations were performed with hypothermia, deep hypothermia low flow, or deep hypothermia circulatory arrest techniques. Cardiac index (CI) was derived from pulse contour analysis and calculated with the PiCCO plus system. Meanwhile, serum cardiac troponin I ( cTnl), mixed venous oxygen saturation ( SvO_2 ) and cardiopulmonary bypass (CPB) time were measured. Finally, the risk factors for surgical treatment in survivors and that associated with an increased mortality were analyzed. The association between post-operative cardiac output and the death after surgery was examined. Results Four neonates died after surgery, with a surgical mortality of 8.5%. CIvalue in the neonates [ (2.0±0.3 ) liters per minute per square meter of body surface was less than normal 2.5±0. 3. CI was associated inversely with CPB time but had a positive correlation with SvO_2. No significant difference association between CI and cTnI was observed. The value of cTnl was associated with the type of surgical procedures. Cases for which DHCA and low flow cerebral pefusion technique were used were free from neurological complications, ischemia in the lower extremities and oli-guria. The duration of cardiopulmonary bypass, urgent state of the operation and the abnormal coronary artery were associated with high mortality in the neonates after cardiac surgery. Conclusion The cardiac output of the neonates in whom cardiac pro-cedures were performed is adequate for the the oxygen supply required by the whole body though it is slightly lower than nomad after cardiac surgery. Higher mortality in the neonates during early postoperative period may be due to the complexity of the primary diseases, prolonged cardiopulmonary bypass time, residual abnormalities and severe acidosis before operation. Various techniques for CPB and that for the myocardial protection are safe and can provide an appropriate operative field.