Rupture of a giant jejunal mesenteric cystic lymphangioma misdiagnosed as ovarian torsion: A case report

BACKGROUND Cystic lymphangioma is a rare benign tumor that affects the lymphatic system.Mesenteric lymphangiomas in the small bowel are extremely uncommon.CASE SUMMARY We present a 21-year-old female patient who complained of abdominal pain.The diagnosis of ovarian torsion was suspected after abdominopelvic unenhanced computed tomography and ultrasound revealed a large cyst in contact with the bladder,ovary,and uterus.The patient underwent emergency laparotomy per-formed by gynecologists,but it was discovered that the cystic tumor originated from the jejunum.Gastrointestinal surgeons were then called in to perform a cystectomy.Pathological examination confirmed the diagnosis of cystic lymphangioma of the mesentery.The patient had an uneventful postoperative recovery.CONCLUSION Mesenteric lymphangiomas can cause abdominal pain,and imaging techniques can help determine their characteristics,location,and size.Complete surgical excision and pathological examination are considered the standard treatment and diagnostic method.

Transparent cap adjusted the stent placed for stenosis after endoscopic injection of esophageal varices:A case report

BACKGROUND The stent embedded in the esophageal mucosa is one of the complications after stenting for esophageal stricture.We present a case of stent adjustment with the aid of a transparent cap after endoscopic injection of an esophageal varices stent.CASE SUMMARY A 61-year-old male patient came to the hospital with discomfort of the chest after the stent implanted for the stenosis because of endoscopic injection of esophageal varices.The gastroscopy was performed,and the stent embedded into the esophageal mucosa.At first,we pulled the recycling line for shrinking the stent,however,the mucosa could not be removed from the stent.Then a forceps was performed to remove the mucosa in the stent,nevertheless,the bleeding form the mucosa was obvious.And then,we used a transparent cap to scrape the mucosa along the stent,and the mucosa were removed successfully without bleeding.CONCLUSION A transparent cap helps gastroscopy to remove the mucosa embedded in the stent after endoscopic injection of the esophageal varices stent.

Special stent for draining the abdominal abscess respectively from colon and duodenum:A case report

BACKGROUND Postoperative abdominal infections are an important and heterogeneous health challenge.Many samll abdominal abscesses are resolved with antibiotics,but larger or symptomatic abscesses may require procedural management.CASE SUMMARY A 65-year-old male patient who suffered operation for the left hepatocellular carcinoma eight months ago,came to our hospital with recurrent abdominal pain,vomit,and fever for one month.Abdominal computed tomography showed that a big low-density dumbbell-shaped mass among the liver and intestine.Colonoscopy showed a submucosal mass with a fistula at colon of liver region.Gastroscopy showed a big rupture on the submucosal mass at the descending duodenum and a fistula at the duodenal bulb.Under colonoscopy,the brown liquid and pus were drained from the mass with“special stent device”.Under gastroscopy,we closed the rupture of the mass with a loop and six clips for purse stitching at the descending duodenum,and the same method as colonoscopy was used to drain the brown liquid and pus from the mass.The symptom of abdominal pain,vomit and fever were relieved after the treatment.CONCLUSION The special stent device could be effectively for draining the abdominal abscess respectively from colon and duodenum.

Liver abscess and tracheal fistula induced by transcatheter arterial chemoembolization for hepatocellular carcinoma:A case report

BACKGROUND Transarterial chemoembolization(TACE)is a standard treatment for intermediate-stage hepatocellular carcinoma(HCC).The complications of TACE include biliary tract infection,liver dysfunction,tumor lysis syndrome,biloma,partial intestinal obstruction,cerebral lipiodol embolism,etc.There are few reports about tracheal fistula induced by TACE.CASE SUMMARY A 42-year-old man came to our hospital with cough and expectoration for 1 month after TACE for HCC.Laboratory test results showed abnormalities of albumin,hemoglobin,prothrombin time,C-reactive protein,D-dimer,and prothrombin.Culture of both phlegm and liver pus revealed growth of Citrobacter flavescens.Computed tomography showed infection in the inferior lobe of the right lung and a low-density lesion with gas in the right liver.Liver ultrasound showed that there was a big hypoechoic liquid lesion without blood flow signal.Drainage for liver abscess by needle puncture under ultrasonic guidance was performed.After 1 month of drainage and anti-infection therapy,the abscess in the liver and the infection in the lung were reduced obviously,and the symptom of expectoration was relieved.CONCLUSION Clinicians should be alert to the possibility of complications of liver abscess and tracheal fistula after TACE for HCC.Drainage for liver abscess by needle puncture under ultrasonic guidance could relieve the liver abscess and tracheal fistula.

Effect of viral load on T-lymphocyte failure in patients with chronic hepatitis B

AIM: To investigate peripheral T-lymphocyte sub-population profile and its correlation with hepatitis B virus (HBV) replication in patients with chronic hepatitis B (CHB).METHODS: Distribution of T-lymphocyte subpopulations in peripheral blood was measured by flow cytometry in 206 CHB patients. HBV markers were detected with ELISA. Serum HBV DNA load was assessed with quantitative real-time polymerase chain reaction (PCR). The relationship between HBV replication and variation in peripheral T-cell subsets was analyzed.RESULTS: CHB patients had significantly decreased CD3+ and CD4+ cells and CD4+/CD8+ ratio, and increased CD8+ cells compared with uninfected controls (55.44 ± 12.39 vs 71.07 ± 4.76, 30.92 ± 7.48 vs 38.94 ± 3.39, 1.01 ± 0.49 vs 1.67 ± 0.33, and 34.39 ± 9.22 vs 24.02 ± 4.35; P < 0.001, respectively). Univariate analysis showed a similar pattern of these parameters was significantly associated with high viral load, presence of serum hepatitis B e antigen (HBeAg) expression, liver disease severity, history of maternal HBV infection, and young age at HBV infection, all with P < 0.01. There was a significant linear relationship between viral load and these parameters of T-lymphocyte subpopulations (linear trend test P < 0.001). There was a negative correlation between the levels of CD3+ and CD4+ cells and CD4+/CD8+ ratio and serum level of viral load in CHB patients (r = -0.68, -0.65 and -0.75, all P < 0.0001), and a positive correlation between CD8+ cells and viral load (r = 0.70, P < 0.0001). There was a significant decreasing trend in CD3+ and CD4+ cells and CD4+/CD8+ ratio with increasing severity of hepatocyte damage and decreasing age at HBV infection (linear trend test P < 0.01). In multiple regression (after adjustment for age at HBV infection, maternal HBV infection status and hepatocyte damage severity) log copies of HBV DNA maintained a highly significant predictive coefficient on T-lymphocyte subpopulations, and was the strongest predictor of variation in CD3+, CD4+, CD8+ cells and CD4+/CD8+ ratio. However, the effect of HBeAg was not significant.CONCLUSION: T-lymphocyte failure was signifi-cantly associated with viral replication level. The substantial linear dose-response relationship and strong independent predictive effect of viral load on T-lymphocyte subpopulations suggests the possibility of a causal relationship between them, and indicates the importance of viral load in the pathogenesis of T cell hyporesponsiveness in these patients.

Efficacy of thymosin alpha-1 and interferon alpha in treatment of chronic viral hepatitis B:A randomized controlled study

AIM： To observe the efficiency and safety of thymosin-α1 treatment in patients with hepatitis B e antigen （HBeAg） and HBV DNA positive chronic hepatitis. METHODS： Sixty-two patients were randomly divided into groups A and B. The patients in group A received subcutaneous injection of 1.6 mg thymosin-α1, twice a week （T-α1 group） for six months, and the patients in group B received 5 MU interferon alpha （IFN-α） each day for fifteen days, then three times weekly （IFN-α group） for six months. The results between two groups treated with and the group untreated with IFN-α which was followed up for 12 mo （historical control group consisting of 30 patients） were compared, and three groups were comparable between each other （P 〉 0.05） at baseline （age, sex, clinical history, biochemical, and serological parameters）. RESULTS： At the end of treatment, complete response, which was defined as alanine aminotransferase （ALT） normalization and HBV DNA and HBeAg loss, occurred in 9 of 29 （31.0%） patients in the T-α1 group and in 15 of 33 （45.5%） patients in the IFN-α group （χ^2= 1.36, P 〉 0.05）. After a follow-up period of six months, a complete response was observed in 14 of 29 （48.3%） patients in the T-α1 group and in 9 of 33 （27.3%） patients in the IFN-α group （χ^2= 2.93, P 〉 0.05）. Compared with the results observed in the historical control （HC） group untreated with IFN-α which was followed up for 12 mo, the rate of complete response was significantly higher in IFN-α group at the end of therapy （1 of 30 vs 15 of 33, 7：2 = 14.72, P 〈 0.001） and in the T-α1 group at the end of follow-up （1 of 30 vs 14 of 29,χ^2 = 15.71, P 〈 0.001）. In T-α1 and IFN-α treatment groups, the area under （the plasma concentration time） curve （AUC） of negative HBV DNA and HBeAg was 340, 17%, 31% and 19% smaller than that in the HC group. By the end of the follow-up period, the proportions of ALT normalization and negative HBV DNA in the T-α1 group were significantly higher than those in the IFN-α and HC groups. The odds of ALT normalization and negative HBV DNA at the end of the follow-up was three-fold higher in the T-α1 group than in the IFN-α group. Unlike IFN-α, T-α1 was well tolerated by all patients, and no side effects appeared in T-α1 group. CONCLUSION： The results suggest that a 6-too course of T-α1 therapy is effective and safe in patients with chronic hepatitis B. T-α1 is able to reduce HBV replication in patients with chronic hepatitis B. Furthermore, T-α1 is better tolerated than IFN-α and can gradually induce more sustained ALT normalization and HBV DNA and HBeAg loss. However, a response rate of 48.3% is still less ideal. A more effective therapeutic approach warrants further study.

Determination of the upper cut-off values of serum alanine aminotransferase and aspartate aminotransferase in Chinese

AIM:To determine the upper cut-off values of serumalanine aminotransferase(ALT)and aspartate aminotransferase(AST)in a Northern Chinese population.METHODS:A total of 3769 subjects in Jilin Province Northeast China were stratified to determine the potential factors affecting serum ALT and AST levels.The upper cut-off values of serum ALT and AST in these subjects were determined using receiver operating characteristic analysis and their sensitivity and specificity were evaluated.RESULTS:Stratification analysis revealed that serum ALT and AST levels were associated with gender,alcohol consumption,serum cholesterol and triglyceride levels,and body mass index.The upper cut-off values of serum ALT and AST were 22.15 U/L and 25.35 U/L for healthy men and 22.40 U/L and 24.25 U/L for healthy women,respectively.The new cut-off values had a higher sensitivity,but a slightly lower specificity than the current standards.CONCLUSION:Our results indicate that the new upper cut-off values of serum ALT and AST are markedly lower than current standards and may be valuable for the evaluation of liver function.

Value of regulatory T cell in predicting the chronic hepatitis C

Objective:To explore the proportion and clinical predictive value of serum regulatory T cells (CD4+CD25+Treg cell) in the treatment process of chronic hepatitis C (CHC) by the interferon. Methods:A total of 94 patients with CHC who were admitted in our hospital for the treatment of peglyated interferon-α and ribavirin were included in the study and were divided into low, moderate, and high loading capacity groups according to HCV-RNA content before treatment. The correlation of different loading capacity with the clinical materials was analyzed. HCV-RNA and the proportion of peripheral blood CD4+CD25+Treg cells after treatment in patients with different response were detected and compared.Results: The comparison of the proportion of peripheral blood CD4+CD25+Treg cells and HCV-RNA among the three groups was statistically significant (P<0.05), and both of them were positively correlated (r=0.845, P=0.001). Among 94 patients, 90 patients had completed 48-week treatment, among which 55 had continuous response, 25 had partial response, and 10 had no response. The proportion of CD4+CD25+Treg cells in the continuous response group and partial response group was significantly reduced when compared with before treatment (P<0.05), while that in the no response group was significantly elevated when compared with before treatment (P<0.05). The comparison of the proportion of CD4+CD25+Treg cells 24 and 48 weeks after treatment among the three groups was statistically significant (P<0.05). CD3+, CD4+, CD8+, and CD4+/CD8+ after treatment in the continuous response and partial response groups were significantly elevated when compared with before treatment (P<0.05). The comparison of CD3+, CD4+, CD8+, and CD4+/CD8+ among the three groups was statistically significant (P<0.05). Conclusions:Interferon in the treatment of CHC can reduce HCV-RNA loading capacity and the proportion of CD4+CD25+Treg cells. HCV-RNA loading capacity in patients with CHC has no correlation with the gender and age, but is positively correlated with the proportion of peripheral blood CD4+CD25+Treg cells. The change of CD4+CD25+Treg cell level can provide a new thought to predict the efficacy in CHC patients.

Late-onset Cholestasis with Paucity of Portal Area Secondary

Hepatocyte nuclear factor 1β(HNF1β)is essential for biliary development,while its genetic defect triggers the dysplasia of interlobular bile ducts,leading to life-threatening hepatitis and cholestasis.To date,this disorder has mainly been docu-mented in neonates.Here,we report a case of cholestasis in an adult patient caused by a de novo HNF1β mutation.A liver biopsy revealed remarkable shrinkage of the portal area accompanied by a decrease or absence of interlobular bile ducts,veins,and arteries in the portal area.Our case showed that an HNF1β defect could induce late-onset cholestasis with paucity of the portal area in adulthood.

胃癌组织PAKl表达及其与临床病理特征和生存的关系(英文)

Background and Objective:Recent studies proved that P21-activated kinase 1(PAK1) is highly expressed in many kinds of tumor and plays an important role in genesis,development,and metastasis of tumor.We aimed to detect the expression of PAK1 in gastric carcinoma and to analyze its relationship with clinicopathological features and prognosis of gastric carcinoma.Met hods:Tissue microarray and immunohistochemical staining were performed to detect PAK1 in paraffin specimens of 189 gastric carcinomas,54 paracancer tissues,40 lymph nodes and 30 healthy tissues.Clinicopathologic features and follow-up data of the patients were analyzed by the χ2 test and the Kaplan-Meier method.Result s:Positive rate of PAK1 was 73.0% in gastric carcinoma,57.4% in paracancer tissues and 23.3% in healthy controls(χ2 = 29.364,P < 0.05).Expression of PAK1 was significantly correlated with tumor size,tumor differentiation,lymph node metastasis,Lauren classification and invasive depth(all P < 0.05).The positive rate of PAK1 was significantly higher in primary gastric carcinomas than in metastatic lymph nodes(75.0% vs.52.5%,χ2 = 4.381,P < 0.05).Survival analysis using the Kaplan-Meier method showed that the expression of PAK1 was a predictor for poor prognosis of the patients with gastric carcinoma(χ2 = 6.857,P < 0.01).Conclusions:Expression of PAK1 is an early molecular event in the tumorigenesis of gastric carcinoma.It is also closely correlated the development of gastric carcinoma and the patients' prognosis.

Relationship between interleukin-6 polymorphism and susceptibility to chronic hepatitis B virus infection

AIM:To identify the relationship between tag single nucleotide polymorphisms(tag SNPs) of interleukin-6(IL-6) gene and susceptibility to chronic hepatitis B virus(HBV) infection in a Han Chinese population.METHODS:We performed a case-control study of501 Chinese patients with chronic HBV infection and301 self-limiting HBV-infected individuals as controls.Genomic DNA was isolated from the whole blood of all subjects using phenol/chloroform with MaXtract highdensity tubes. Tag SNPs were identified using genotype data from the panel(Han Chinese in Beijing) of the phase II HapMap Project. Four tag SNPs in IL-6(rs17147230A/T,rs2066992G/T,rs2069837A/G and rs2069852A/G) were genotyped by the Multiplex Snapshot technique. The genotype and allele frequencies were calculated and analyzed.RESULTS:Five haplotypes were involved in the analysis,with frequencies higher than 0.03. One of the haplotypes,TTAA,was significantly different between the two groups. Overall haplotype P values were:ATAA,P = 0.605,OR(95%CI) = 1.056(0.860-1.297); TGAG,P = 0.385,OR(95%CI) = 1.179(0.813-1.709); TGGG,P = 0.549,OR(95%CI) = 1.087(0.827-1.429); TTAA,P = 0.004,OR(95%CI) = 0.655(0.491-0.873); TTAG,P = 0.266,OR(95%CI) = 1.272(0.832-1.944). However,the four SNPs showed no significant genotype/allele associations with susceptibility to chronic HBV infection. Overall allele P values were:rs17147230,P = 0.696,OR(95%CI) = 1.041(0.850-1.276); rs2066992,P = 0.460,OR(95%CI)= 1.090(0.868-1.369); rs2069837,P = 0.898,OR(95%CI) = 0.983(0.759-1.274); rs2069852,P = 0.165,OR(95%CI) = 0.859(0.693-1.064). Overall genotype P values were:rs17147230,P = 0.625; rs2066992,P= 0.500; rs2069837,P = 0.853; and rs2069852,P =0.380.CONCLUSION:The four tag SNPs of IL-6 gene may be associated with susceptibility to chronic HBV infection in the Han Chinese population.

Single Nucleotide Polymorphisms rs2227284, rs2243283 and rs2243288 in the IL-4 Gene show no Association with Susceptibility to Chronic Hepatitis B in a Chinese Han Population

Objective To investigate the relationship between single nucleotide polymorphisms(SNPs) of the interleukin-4(IL-4) gene and outcome of hepatitis B virus(HBV) infection in a Chinese Han population.Methods Total of 501 patients with chronic hepatitis B virus(HBV) infection and 301 controls with selflimiting HBV infection were studied. Three tag SNPs in the IL-4 gene(rs2227284G/T, rs2243283C/G and rs2243288A/G) were genotyped by the Multiplex snapshot technique. The genotype and allele frequencies were calculated and analyzed.Results The three SNPs showed no significant genotype/allele associations with chronic HBV infection. Overall allele P values were: rs2227284, P = 0.655, odds ratio(OR) [95% confidence interval(CI)] = 1.070(0.793-1.445); rs2243283, P = 0.849, OR(95% CI) = 0.976(0.758-1.257); rs2243288, P = 0.659, OR(95% CI) = 1.060(0.818-1.375). Overall genotype P values were: rs2227284, P = 0.771; rs2243283, P = 0.571; rs2243288, P = 0.902. There were no statistically significant differences between patients with chronic HBV infection and controls. Haplotypes generated by these three SNPs also had no significant differences between the two groups. Conclusions The three tag SNPs of IL-4 were not associated with the outcome of HBV infection in the Han Chinese population.

A cyclodextrin-based nanoformulation achieves co-delivery of ginsenoside Rg3 and quercetin for chemo-immunotherapy in colorectal cancer

The immune checkpoint blockade therapy has profoundly revolutionized the field of cancer immunotherapy. However, despite great promise for a variety of cancers, the efficacy of immune checkpoint inhibitors is still low in colorectal cancer(CRC). This is mainly due to the immunosuppressive feature of the tumor microenvironment(TME). Emerging evidence reveals that certain chemotherapeutic drugs induce immunogenic cell death(ICD), demonstrating great potential for remodeling the immunosuppressive TME. In this study, the potential of ginsenoside Rg3(Rg3) as an ICD inducer against CRC cells was confirmed using in vitro and in vivo experimental approaches. The ICD efficacy of Rg3 could be significantly enhanced by quercetin(QTN) that elicited reactive oxygen species(ROS). To amelioratein vivo delivery barriers associated with chemotherapeutic drugs, a folate(FA)-targeted polyethylene glycol(PEG)-modified amphiphilic cyclodextrin nanoparticle(NP) was developed for co-encapsulation of Rg3 and QTN. The resultant nanoformulation(CD-PEG-FA.Rg3.QTN) significantly prolonged blood circulation and enhanced tumor targeting in an orthotopic CRC mouse model, resulting in the conversion of immunosuppressive TME. Furthermore, the CD-PEG-FA.Rg3.QTN achieved significantly longer survival of animals in combination with Anti-PD-L1. The study provides a promising strategy for the treatment of CRC.

Clinical Observation on the Treatment of Chronic Severe Hepatitis B by Retention Enema with Huchang Jiedu Decoction(护肠解毒汤)

Objective： To observe the efficacy of retention enema with Huchang Jiedu Decoction （护肠解毒汤, HJD） in treating chronic severe hepatitis B （CSHB）. Methods： Sixty patients of CSHB were equally randomized into the treated group and the control group. Both groups were treated with conventional integrative medicine, but to patients in the treated group, retention enema with HJD was given in addition, once every day for 3 weeks. The dominant symptoms, physical signs, and related biochemical indices, as well as the incidence of complications in patients before and after treatment, were observed. Results： Good therapeutic effects were shown in the treated group, with a total effective rate better than that in the control group （83.3% versus 60.0%, P〈0.05）, superior in terms of lowering alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, total bilirubin （TBil）, globulin （GIb）, and endotoxin （ET） levels and increasing prothrombin activity （PTA）, total cholesterol （TC）, and calcium （Ca） levels, as well as eliminating ascites and preventing hepatic encephalopathy （P〈0.05）; especially in treating middle/early stage patients with Chinese medicine syndrome differentiated as water-toxin accumulation pattern. Conclusion： Retention enema with HJD is surely effective in treating CSHB, and its primary mechanism may be related to the mitigation of enterogenous endotoxemia.

Effect of Chinese Medicine Therapy for Strengthening-Pi and Nourishing-Shen in Preventing Lamivudine Induced YMDD Mutation and Its Immunologic Mechanism

Objective： To observe the effect of Chinese medicine therapy for strengthening-Pi （脾） and nourishing-Shen （肾, SPNS） in preventing lamivudine induced YMDD mutation and its immunological mechanism. Methods： One hundred and sixty chronic hepatitis B （CHB） patients with positive HBeAg were equally assigned to two groups at random： the observation group and the control group. Patients in the observation group were treated with lamivudine combined with SPNS, and those in the control group were treated with lamivudine only, with the treatment lasting for 52 weeks in total. Changes in indexes, including liver function, HbeAg, HBV-DNA, YMDD variation, CD4, CD4/CD8 ratio, interferon- γ, （IFN-γ）, interleukin-4 （IL-4）, blood routine, renal function, as well as any adverse reactions that occurred in patients, were observed at different time points. Results： The ALT, AST recovery rate and HBV-DNA negatively inversing rate at the 24th week, the 36th week and the 52nd week were all higher （P〈0.05）; meanwhile, the YMDD mutation rate at the 36th week and the 52nd week was lower （P〈0.05） in the observation group than in the control group. The post- treatment levels of CD4, CD4/CD8 ratio, IFN- γ, and IL-4 as well as the pre-post treatment difference of these indexes in the observation group were significantly different from those in the control group （n=〈0.05）. Conclusion： Chinese medicine SPNS therapy can significantly reduce the YMDD variation of HBV, and the mechanism may be related to its regulation of the CD4 level, CD4/CD8 ratio and Th1/Th2 balance. KEYWORDS Chinese medicine therapy for strengthening-Pi and nourishing-Shen, lamivudine, YMDD mutation, mechanism

Evaluation on Quality of Life and Analysis on Its Correlation with TCM Syndromes in Patients of Chronic Hepatitis B

Objective:To evaluate the quality of life(QOL) in patients with chronic hepatitis B(CHB) and analyze its correlation with traditional Chinese medicine(TCM) syndrome types.Methods:With cross-sectional investigation adopted,the QOL of 335 CHB patients was studied by the World Health Organization Quality of Life BREF Questionnaire(WHOQOL-BREF) and the chronic liver disease questionnaire(CLDQ).The results was compared with that of 30 healthy persons.Results:The QOL of the patients with chronic hepatitis B was l...

Therapeutic potential of traditional Chinese medicine for the treatment of NAFLD:A promising drug Potentilla discolor Bunge

Nonalcoholic fatty liver disease(NAFLD)is characterized by excessive accumulation of hepatic lipids and metabolic stress-induced liver injury.There are currently no approved effective pharmacological treatments for NAFLD.Traditional Chinese medicine(TCM)has been used for centuries to treat patients with chronic liver diseases without clear disease types and mechanisms.More recently,TCM has been shown to have unique advantages in the treatment of NAFLD.We performed a systematic review of the medical literature published over the last two decades and found that many TCM formulas have been reported to be beneficial for the treatment of metabolic dysfunctions,including Potentilla discolor Bunge(PDB).PDB has a variety of active compounds,including flavonoids,terpenoids,organic acids,steroids and tannins.Many compounds have been shown to exhibit a series of beneficial effects for the treatment of NAFLD,including anti-oxidative and anti-inflammatory functions,improvement of lipid metabolism and reversal of insulin resistance.In this review,we summarize potential therapeutic effects of TCM formulas for the treatment of NAFLD,focusing on the medicinal properties of natural active compounds from PDB and their underlying mechanisms.We point out that PDB can be classified as a novel candidate for the treatment and prevention of NAFLD.

Causes of death after hip fracture in senile patients

Hip trauma has been a leading cause of death in senile patients for more than a centenary.Although the mortality decreased due to the advanced technique in medication,surgery and nursing,the increasing mortality should not be neglected in elders after orthopedic operation nowadays.Many factors are considered to influence the causes of death after trauma,such as age,gender,personal customs,comorbidities,types of fracture,timing of surgery,procedure,anesthesia,complications,medical treatment,activity of daily living,or even marriage status.This article reviews these causes from the aspects of patient＇s own factors,iatrogenic factors,medical treatment and other factors and provides some clues for further clinical application according to the recent foreign and domestic researches.According to the present research,it is essential for surgeons to perform a comprehensive estimation for patients suffering from hip trauma.

Inhibition of methicillin-resistant Staphylococcus aureus by the compound Qingre granules

Background The infection rate of methicillin-resistant Staphylococcus aureus （MRSA） is increasing yearly due to the overprescription of antibiotics. Traditional Chinese compound medicines are less inclined to induce bacterial resistance in the clinical setting because of their multi-acting mechanisms. However, most current research is limited to bacteriostasis in vitro using single extracts or formulations. Plasma pharmacology is an in vitro method, using what is called ＂medicine serum＂. The aim of this study was to investigate whether the medicine serum of compound Qingre granules （QRKL） alone or in combination with antibiotics may treat MRSA infection in the clinic. Methods An animal model of MRSA resistance was created by injecting rabbits with the standard strain of MRSA ATCC43300. Infected rabbits were treated with QRKL by intragastric administration. Sixty minutes after the last intragastric administration, serum was obtained from the rabbits by heart puncture to obtain what is termed ＂medicine serum＂. The minimum inhibitory concentration （MIC） of QRKL, medicine serum alone, or serum combined with antibiotics was assessed by agar dilution. Results were compared with the growth of sixteen isolates of MRSA. Results The MIC of QRKL to the standard strain ATCC43300 was 10.00 mg/ml. The MICgo of vancomycin was 1.00 pg/ml, which, when combined with QRKL, dropped to 0.50 lJg/ml. The MICg0 of cefuroxime alone was 512.00 pg/ml. This level also decreased to 256.00 tJg/ml when combined with QRKL. The addition of QRKL thus significantly reduced the MIC of both cefuroxime and vancomycin compared with antibiotics alone （P 〈0.01）. The MICgo of vancomycin with medicine serum decreased to 0.50 pg/ml, and the MIC of vancomycin with medicine serum also descended compared with using vancomycin alone （P 〈0.01）. Conclusions The growth of MRSA can be inhibited by QRKL or medicine serum of QRKL in vitro. The addition of QRKL results in increased sensitivity of MRSA to vancomycin and this may provide a novel treatment for patients with MRSA infection.

Influence of TCM Therapy for Supplementing Pi(脾) and Nourishing Shen(肾) on Dendritic Cell Function in Patients with Chronic Hepatitis B Treated by Lamivudine

Objective:To observe the influence of traditional Chinese medicine(TCM) therapy for supplementing Pi(脾) and nourishing Shen(肾,SPNS) on dendritic cell function in patients with chronic hepatitis B (CHB) treated by lamivudine.Methods:Sixty CHB patients with positive HBeAg were equally randomized by digital table into two groups:the observation group and the control group.Patients in the control group were treated with lamivudine only,while patients in the observation group were treated with lamivudine combine...