Showing papers in "National Medical Journal of China in 2015"

Efficacies of fluid resuscitation as guided by lactate clearance rate and central venous oxygen saturation in patients with septic shock

Abstract: Objective To estimate the efficacies of fluid resuscitations as guided by lactate clearance rate (LC) and central venous oxygen saturation (ScvO2) in patients with septic shock. Methods 100 patients diagnosed with septic shock from June 2012 to June 2014 in department of critical care medicine of sixteen hospitals were enrolled. They were randomly divided into two groups of study and control (each n=50). After a diagnosis of sepsis shock, they were treated symptomatically timely and fluid resuscitation was started as early as possible according to the 2008 Guideline for Managing Sepsis & Septic Shock. Central venous pressure (CVP) ≥8 mmHg (1 mmHg=0.133 kPa), mean arterial pressure (MAP) ≥65 mmHg, urine output ≥ 0.5 ml·kg–1·h–1, ScvO2 ≥70% and LC≥10% (or lactate≤ 2.0 mmol) served as target values for fluid resuscitation therapy in study group versus CVP ≥8 mmHg, MAP ≥65 mmHg, urine output ≥ 0.5 ml·kg–1·h–1 and ScvO2 ≥70% in control group. The general conditions and clinical characteristics, changes in CVP, MAP, urine output, ScvO2, lactate level and/or LC before (0 hour) and every hour (1–6 h) after the start of fluid resuscitation and other related outcome indicators were recorded. Results No significant difference existed in general data. The 28–day mortality was 40% for study group versus 56% for control group. There was no significant inter–group difference (P>0.05). The time of mechanical ventilation and length of intensive care unit (ICU) stay were lower in study group than those in control group [mechanical ventilation time (11.200 ±17.069) vs (15.760±14.215), P=0.150; length of ICU stay (13.240±17.127) vs (23.980±18.298), P=0.003]. The 28–day mortality was independently associated with LC and ScvO2 reaching target values for fluid resuscitation in study group (χ2=10.930, P=0.001) while the 28–day mortality was independently associated with ScvO2 reaching target value for fluid resuscitation in control group (χ2=6.395, P=0.011). Among all patients, the 28–day mortality was independently associated with ScvO2 reaching target value for fluid resuscitation (χ2=14.530, P=0.000), but not LC (χ2=1.175, P=0.278). Conclusion A combination of LC and ScvO2 may serve an index in confirming the endpoint of fluid resuscitation for patients with septic shock. Fluid resuscitation therapy under the guidance of LC and ScvO2 is more accurate and reliable than the guidance of ScvO2 alone. Key words: Shock, septic; Catheterization, central venous; Oximetry; Lactic acid

Study of immunomodulatory function of exosomes derived from human umbilical cord mesenchymal stem cells

Abstract: Objective To investigate the immumodulation ability of exosomes secreted from human umbilical cord–derived mesenchymal stem cells (hUC–MSCs). Methods hUC–MSCs were isolated and cultured.Exosomes were isolated from the culture media of the third–generation hUC–MSCs.The expression of specific surface marker CD9 and CD81 were detected by Western blot, and the concentration of hUC–MSCs exosomes(hUC–MSCs–ex) was evaluated by BCA assay.CD3/CD28–stimulated peripheral blood mononuclear cells(PBMCs) from healthy donor were co–cultured with different concentration of hUC–MSCs–ex for 72 h. The percentage of Th17 and Treg cells and the proliferation of CD4+ and CD8+ T cells were detected by flow cytometry.ELISA was used to test the level of IFN–γ, IL–6, TNF–α and TGF–β1. Results hUC–MSCs–ex inhibited the proliferation of CD4+ and CD8+ cells obviously, and increased the proportion of CD4+ CD25+ FoxP3+ Treg cells, with high expression of CD81 and CD9.After CD3/CD28 monoclonal antibody stimulated, the percentage of CD45+ CD4+ Ki67+ and CD45+ CD8+ Ki67+ cells were 85.3%±5.6% and 72.6%±6.3%, respectively. Meanwhile, the level of TGF–β1 were elevated and the level of IFN–γ, IL–6 and TNF–α were decreased (P<0.05). Conclusion hUC–MSCs–ex has the immunomodulatory functionin vitro, which could be a new therapeutic agent for the treatment of immune disorders. Key words: Mesenchymal stem cells; Umbilical cord; Exosomes; Immunity

The effect of propofol and sevoflurane on the perioperative immunity in patients under laparoscopic radical resection of colorectal cancer

Abstract: Objective To compare the effect of propofol and sevoflurane on perioperative immunity and surgical outcomes in patients undergoing laparoscopic radical resection of colorectal cancer Methods During September 2012 to April 2014 in Sir Run Run Shaw Hospital, thirty patients scheduled for laparoscopic colorectal cancer radical resection were randomly assigned into two groups: propofol TCI anesthesia and sevoflurane inhale anesthesia Venous blood was taken before induction, on finishing the surgery and 24 h after surgery for lymphocyte subtype study by flow cytometry Postoperative outcomes including intestinal obstruction, urine retention, anastomotic fistula and incision healing, antibiotic using time, hospital-stay time were compared Results In the sevoflurane group, the percentage of CD3+, CD4+ and CD19+ subtype were increased immediately after surgery((640±135)%,(375±118)%,(123±45)%) comparing to preoperative level((590±120)%,(330±83)%,(99±43)%)(t= 3423, 2543, 2768 respectively, all P 005) NK cell began to recover at 24 h((222±126)%) comparing to the postoperative level(t= 2941, P 005) There were no difference in hospital-stay time, antibiotic using time, the time to anal exhaust or defecate, postoperative fever, incision infection, neither other complications such as intestinal obstruction, urine retention, anastomotic fistula or intraperitoneal infection(all P>005) The incision infection rate was 0 in the propofol group while 143% in the sevoflurane group, which was quite clinically obvious though not statistically significant Conclusions Propofol may have less or shorter impact on immunity However, whether anesthesia with propofol could be superior to that with sevoflurane for patients' immune function is still undetermined and needs further study Key words: Propofol; Sevoflurane; Perioperation; Immunity

Clinical efficacy and safety of ulinastatin plus octreotide for patients with severe acute pancreatitis

Abstract: Objective To explore the clinical efficacy and safety of ulinastatin plus octreotide for patients with severe acute pancreatitis (SAP). Methods During January 2011 to January 2014 at our hospital, 120 SAP patients were randomly divided into control and observation groups (n=60 each). The control group received an injection of octreotide injection while the observation group had a combination of ulinastatin and octreotide. After treatment, clinical efficiency, serum indicators and their improvements and complications were compared for two groups. Results The overall efficiency of observation group was significantly higher than that of control group (83.3% vs 65.0%, P<0.05). And abdominal pain relief time, decompression time, surgical intervention rate, length of stay and mortality rate of observation group (1.9±0.9 d, 6.3±2.2 d, 1.7%, 11.8±0.5 d, 5%) were significantly lower than those of control group (3.6±0.7 d, 10.4±3.1 d, 8.3%, 23.7±2.1 d, 15.0%) (P<0.05). After treatment, the levels of blood amylase, white blood cell (WBC), C-reactive protein (CRP) and interleukin 6 (IL-6) of observation group (107.2±9.1 U/L, 6.2±1.0×109/L, 7.3±3.4 mg/L, 28.3±4.3 pg/ml) were significantly lower than those of control group (430.8±20.2) U/L, (11.2±1.2)×109/L, (16.3±5.2) mg/L, (45.3±5.9) ng/L, (P<0.05). And the incidences of such complications as acute respiratory distress syndrome (ARDS), acute renal failure and shock of observation group (10.0%, 5.0%, 13.3%) were significantly lower than those of control group (36.7%, 21.7%, 33.3%) (P<0.05). Conclusion Ulinastatin plus octreotide can significantly improve the serum and clinical parameters and reduce the incidence of complications in SAP patients. And it is worthy of wider popularization. Key words: Pancreatitis; Octreotide; Ulinastatin

[Changes of miRNA-17-5p, miRNA-21 and miRNA-106a level during rat kidney ischemia-reperfusion injury].

Abstract: Objective Ischemia-reperfusion (I/R) is a main cause of acute kidney injury (AKI). The renal expression profiles of microRNA (miRNA) and time course of their changes after renal I/R were explored to screen acute AKI prognostic-related microRNAs and biomarkers. Methods The expression profile of miRNA was analyzed for detecting miRNAs in kidney after renal I/R injury. Real-time polymerase chain reaction (PCR) was performed to validate the results of microarray. And the relationship was examined between kidney injury and time course of changes in selected miRNAs. Results Twenty-one miRNAs were differentially expressed in kidney of rats with renal I/R injury. And 5 miRNAs had prominent differences. miR-17-5p, miR-21 and miR-106a were selected for further confirmation by quantitative real-time-PCR. And the results were consistent with those of microarry. During early stage (4 h) after I/R, the expression level of miR-17-5p significantly increased (P<0.05). And it occurred earlier than those of BUN level and plasma concentration of neutrophil gelatinase-associated lipocalin (NGAL). Renal expressions of miR-21 and miR-106a were significantly elevated in ischemia 20 min and 30 min groups at 12 h and 24 h post-reperfusion (P<0.01). And the trend was in accordance with those of BUN and NGAL. Conclusions miR-21, miR-17-5p and miR-106a are differentially expressed during different phases of renal I/R injury. And miR-17-5p is more sensitive than BUN and NGAL so that it is a more ideal biomarker for AKI. Key words: Kidney failure, acute; Reperfusion injury; Biological markers; microRNA

[Narrow band imaging-assisted holmium laser resection reduced the recurrence rate of non-muscle invasive bladder cancer: a prospective, randomized controlled study].

Abstract: Objective To compare the differential effects of narrow band imaging (NBI)–assisted holmium laser with transurethral resection on the 1–year recurrence rate of non–muscle invasive bladder cancer (NMIBC), and to evaluate the clinical values of NBI–assisted holmium laser resection for NMIBC (NBI–HoLRBt). Methods During the period of February 2013 to February 2014, 178 cases of NMIBC were randomly divided into NBI–HoLRBt group and white light imaging (WLI) assisted transurethral resection of bladder tumor (WLI–TURBt) group . In NBI–HoLRBt, all suspicious lesion identified by either WLI or NBI were resected with WLI and in NBI mode for lesion only visible with NBI. At the end of the procedure, a NBI cystoscopic examination was performed to assess the margins of the resection areas and to identify eventual residual lesions. In WLI–TURBt group, only WLI and TURBt were applied. All patients underwent routine follow–up with WLI and NBI cystoscopy supplemented with cytology every 3 month. The recurrence risk of patients with NMIBC subjected to either NBI–HoLRBt or WLI–TURBt was compared at 3 and 12 month. Results The 3–month and 1–year recurrence rate was 18.48% (17/92) and 38.04% (35/92) respectively in the WLI–TURBt group, it was 5.81% (5/86) and 18.60% (16/86) in the NBI–HoLRBt group (both P<0.05). In addition, the in situ recurrence rate was less in the NBI–HoLRBt than WLI–TURBt group (2.33% vs 14.13%, P<0.05). Conclusion NBI–assisted holmium laser resection of bladder tumor can reduce the 3–month and 1–year recurrence risk of NMIBC and should be considered a valuable clinical therapeutic method for NMIBC. Key words: Bladder neoplasms; Laser therapy; Holmium; Narrow band imaging

[Effects of patient-controlled intravenous analgesia with dexmedetomidine and sufentanil on postoperative cognition in elderly patients after spine surgery].

Abstract: Objective To explore the effect of patient-controlled intravenous analgesia (PCIA) with dexmedetomidine and sufentanil on early postoperative cognition in elderly patients after spine surgery. Methods One hundred fifty-two patients aged more than 60 yr with ASA I-Ⅲ undergoing elective spine surgery were randomly assigned into two groups: Group S received PCIA with only sufentanil (n=77); Group D received PCIA with dexmedetomidine and sufentanil (n=75). The severity of pain at rest and upon movement was measured at 1, 2, 6, 12, 24 and 48 h after surgery using the 11-point numerical rating scale (NRS). Delirium was assessed daily within three days after surgery via the confusion assessment method. Cognitive function was measured at the day before surgery and at one week after surgery using a battery of neuropsychologic tests including Digit Span (forward and backward) subtests and Visual Retention and Paired Associate Verbal Learning subtests of Wechsler Memory Scale, Stroop Color Word Interference Test, Digit Symbol Substitution subtest of Wechsler Adult Intelligence Scale (DSST) and Trail Making Test (Part A). Results The NRS scores at rest and upon movement at 6 to 48 h after surgery were lower in Group D than those in Group S (P 0.05). Two patients with POD in Group S were treated with risperidone. Postoperative cognitive dysfunction (POCD) was present in 15 (19.5%) patients in Group S and 6 (8.0%) patients in Group D (χ2=4.206, P<0.05). Compared with the preoperative baselines, the scores of Digit Span backward, Visual Retention and DSST were significantly lower (3.7±1.3 vs 4.1±1.1, 7.7±2.0 vs 8.8±1.8, 25.2±7.8 vs 28.2±7.6; t=2.132, 3.585, 2.427, respectively, P<0.05) and the time to complete Stroop test was significantly longer in Group S (56.9±14.8 vs 50.2±14.7, t=-2.822, P<0.05), while only the score of Digit Span backward was significantly lower in Group D (3.6±1.2 vs 4.0±1.2, t=2.144, P<0.05). Conclusion Dexmedetomidine combined with sufentanil in postoperative PCIA can result in superior analgesia and improve early postoperative cognitive function. Key words: Aged; Cognitive disorders; Patient-controlled analgesia; Dexmedetomidine; Sufentanil

Clinical Values of Hemodynamics Assessment by Parametric Color Coding of Digital Subtraction Angiography Before and After Endovascular Therapy for Critical Limb Ischaemia

Abstract: Objective To investigate the feasibility of parametric color coding of digital subtraction angiography(Syngo iFlow)for hemodynamics assessment in patients with critical limb ischemia in pre-and post-endovascular therapy. To explore the correlation between Syngo iFlow and the conventional techniques. Methods from January 2013 to December 2014, Clinical data of 21 patients with TASC Ⅱ type B and type C femoropopliteal arteriosclerotic occlusive disease who were treated by percutaneous transluminal angioplasty and/or primary stent implantation in Nanjing first hospital were analyzed retrospectively. Of these patients there were 10 males and 11 females with an average age of (72±6) years (range from 58–85 years). The treatment efficacy was assessed by the variation of a series of clinical symptoms indexes (such as pain score, cold sensation score and intermittent claudication score), ankle braehial index(ABI) and transcutaneous oxygen pressure (TcPO2). Angiography was performed with the same protocol before and after treatment and parametric color coding of digital subtraction angiography was created by Syngo iFlow software on a dedicated workstation. The time to peak (TTP) of artery and tissue perfusion selected at the same regions of foot and ankle were measured and analyzed to evaluate the improvement of microcirculation and hemodynamics of the ischemic limb. The correlations between Syngo iFlow and the traditional clinical evaluation methods were explored using the Spearman rank correlation test. Results All patients (21 limbs) underwent successful endovaseular therapy. The mean pain score, cold sensation score , intermittent claudication score, ABI and TcPO2 before treatment were(0.48±0.68), (2.71±0.72), (2.86±0.85), ABI(0.33±0.07), TcPO2(26.83±3.41)mmHg. While 1 week after treatment all above indicators were (2.57±0.93), (0.33±0.48), (0.90±0.54), (0.69±0.11), TcPO2(53.75±3.60)mmHg respectively. There were significant statistical differences between pre- and post-treatment(P<0.05=. The pre- and post-operative TTP of artery and tissue perfusion were (14.07±1.77) vs (10.43±2.05)s, (18.75±2.72) vs (15.38±2.78)s. For assessment of hemodynamic changes during and after treatment, parametric color coding of digital subtraction angiography(Syngo iFlow) was assumed to show the limb blood flow and perfusion were improved and the differences were statistically significant. The Spearman rank correlation test showed the TTP of artery was positively correlated with ABI, TcPO2(r=0.65, 0.73, P<0.05=, the TTP of tissue perfusion was also positively correlated with ABI, TcPO2(r=0.60, 0.60, P<0.05=. Conclusion Parametric color coding of digital subtraction angiography(Syngo iFlow) is a real-time, sensitive and quantitative tool that might provide additional support in the hemodynamics evaluation of endovascular treatment for patients with lower extremity peripheral arterial occlusion disease. Key words: Lower extremity; Radiology, interventional; Ankle braehial index; Transcutaneous oxygen pressure

[Randomized control multi-center clinical study of mycophenolate mofetil and cyclophosphamide in the treatment of connective tissue disease related interstitial lung disease]

Abstract: Objective To investigate the efficacy and safety of mycophenolate mofetil (MMF) in the treatment of connective tissue disease-related interstitial lung disease (CTD-ILD). Methods A total of 60 patients with CTD-ILD, confirmed by high resolution computer tomography (HRCT), were enrolled from five clinical centers from July 2010 to July 2014. In addition to the basic glucocorticoid treatment, patients received intravenous cyclophosphamide (Group A) or oral MMF (Group B) for one year. Pulmonary function was assessed at the 3, 6, 12 months. All adverse events were recorded and efficacy and safety were evaluated at the end of this trial. Results Total 60 patients were enrolled, each group had 30 patients. 5 patients withdrew voluntarily from each group, 2 and 3 patients died in group A and B, respectively. Total 45 patients completed this trial. Neither lung function, HRCT nor adverse events had differences between the two groups or within group (P>0.05). When the analysis was done among patients with forced vital capacity (FVC) ≤75% and forced expiratory volume in one second (FEV1)%≤75%, there were significantly statistical differences in FVC and FEV1 at 6th month compared with prior treatment in group A (both P 0.05). Conclusions MMF has comparative effect as cyclophosphamide in the remission or stability of lung function and HRCT manifestations of CTD-ILD patients. MMF is generally well-tolerated, but its efficacy in maintenance therapy and long-term safety remains to be clarified. Key words: Connective tissue disease; Lung disease, interstitial; Mycophenolate mofetil; Cyclophosphamide; Treatment

Early diagnosis of diabetic autonomic neuropathy by corneal confocal microscopy

Abstract: Objective To investigate the early diagnostic value of corneal confocal microscopy by observing corneal innervation alteration in patients with autonomic neuropathy with impaired glucose tolerance. Methods A total of 50 subjects with neuropathy with impaired glucose tolerance or newly diagnosed type 2 diabetes, including 20 subjects with diabetic autonomic neuropathy (AN) and 30 subjects with non-autonomic neuropathy (NAN) according to the result of cardiovascular autonomic function test, and 50 aged-matched control subjects were included in this study.All the subjects came from the Department of Neurology and Endocrine from Jan to Aug 2014, and underwent a detailed evaluation of neuropathic symptoms, corneal confocal microscopy, the Survey of Autonomic Symptoms, sympathetic skin response and contact heat evoked potential test. Results T test indicated patients with AN had significant reductions in nerve branch density (NBD) and nerve fiber density (NFD), and increase in corneal nerve fiber tortuosity (NFT) compared with the NAN patients (t=10.17, 4.81, 7.78; P=0.002, 0.031, 0.003). Though corneal nerve fiber length (NFL) decreased( (15±5) vs (13±5) mm/mm2), there is no statistic significance (t=1.275, P=0.232). Pearson's correlation analysis showed the severity of autonomic neuropathy significantly correlated with cornea nerves damage.The Survey of Autonomic Symptoms (SAS) significantly correlated with NFT, NFD, NFL (r=0.628, -0.304, -0.217; P<0.001, P=0.002, 0.03). NFT was the most significant determinant for the severity of autonomic neuropathy among the four observed parameters. Conclusion Corneal confocal microscopy provides a new sensitive non-invasive means to detect autonomic nerve fiber damage in patients with impaired glucose tolerance and would be of value in assessing neuropathic autonomic symptoms in clinical practice and epidemiologic studies. Key words: Dabetic neuropathy; Autonomic neuropathy; Corneal confocal microscopy; Contact heat evoked potential; Early diagnosis

[Association study of serum uric acid levels with clinical outcome and hemorrhagic transformation in stroke patients with rt-PA intravenous thrombolysis].

Abstract: Objective To evaluate the relation of serum uric acid levels on admission with short-term clinical outcome and hemorrhagic transformation (HT) in patients with acute ischemic stroke treated with thrombolysis. Methods A total of 230 acute ischemic stroke patients treated with thrombolysis in our stroke unit from 2010 to 2013 were included. Demographics, disease severity, the uric acid levels on admission and hemorrhagic transformation were prospectively collected. At 90 days, the scores of the modified Rankin Scale>2 (mRS>2) was defined as poor prognosis and the scores of mRS≤2 was defined as excellent outcome. Stepwise Logistic regression models were used to analyze potential factors affecting the prognosis. Results The levels of serum uric acid in the patients with excellent outcome were significantly higher than in patients with poor outcome [(375±42) μmol/L vs(250±36)μmol/L, P=0.0026]. Logistic regression analysis revealed that high level of serum uric acid was related to excellent outcome(OR=1.25, 95%CI, 1.04-1.47, P=0.013). The serum uric acid level of non HT patients was significantly higher than the HT patients[(350±51) μmol/L vs (282±38) μmol/L, P=0.015]. After adjustment for the influence factors including age and hypertension, the level of uric acid was still negatively correlated with HT. Conclusion Increased serum uric acid levels are associated with low incidence of HT and better prognosis in patients with stroke treated with reperfusion therapy. Key words: Uric acid; Acute ischemic stroke; Thrombolysis; Prognosis; Hemorrhagic transformation

Relationship between maternal age and hypertensive disorders in pregnancy

Abstract: Objective To explore the current status of maternal age and hypertensive disorders in pregnancy related to maternal age in China. Methods The clinical data were collected from 39 hospitals in mainland China. All deliveries were performed after 28 weeks of completed gestation between January 1 and December 31, 2011. A total of 110 450 cases were enrolled and divided into 6 groups at 5-year intervals according to maternal age. The 25-29 age group was selected as a reference group. The odds ratio (OR) and 95% confidence interval (CI) were calculated by unadjusted binary-Logistic regression as appropriate. Results The mean age of pregnant women at the time of delivery was 28.18±4.70 (14-52) years. The risk of hypertensive disorders in pregnancy increased in the 3 age groups above 30 years (OR: 30-34 age group=1.3, 35-39 age group=2.3, ≥40 age group=3.3). The risks of chronic hypertension and pregnancy-induced hypertension increased gradually with maternal age. The risks of preeclampsia and severe preeclampsia showed a U-type distribution. The risk was the lowest in the 25-29 age group and the highest in the ≥40 age group (OR=3.6 and 3.4). The rate of eclampsia was 0 in the ≥40 age group and the highest in the teenage group (OR=8.7). And it was higher in the 20-24 age group (OR=2.6). No significant difference existed between other age groups and the 25-29 age group. Conclusion The risk of hypertensive disorders in pregnancy increases gradually with age in pregnant women aged over 35 years. And the risks of preeclampsia and eclampsia rise in teenage pregnancy. Better management helps to reduce the incidence of eclampsia and improve the outcomes of pregnancy in pregnant women with advanced maternal age and teenages. Key words: Hypertensive disorders in pregnancy; Preeclampsia; Eclampsia; Maternal age

[Magnetic resonance guided focused ultrasound surgery for pain palliation of bone metastases: early experience of clinical application in China].

Abstract: Objective To evaluate the safety and efficacy of magnetic resonance guided focused ultrasound surgery (MRgFUS) in treatment for pain palliation of bone metastases. Methods Eighty-one patients of painful bone metastases were volunteered to screen for this study in Shanghai General Hospital from June 2014 to February 2015. Twenty-three patients among them were treated by MRgFUS, who was more than 18-years old, having the ability to fully understand the informed consent of the research, suffering with pain of numeric rating scale (NRS) ≥4, non-received radiotherapy or chemotherapy for pain palliation of bone metastases in the past two weeks. The NRS, the standard question of Brief Pain Inventory (BPI-QoL), and the standard question of Europe Organization for Research and Treatment of Cancer Quality of Life Questionnaire- Bone Metastases22 (EORTC QLQ-BM22) were respectively recorded before and 1-week, 1-month, 3-month after the treatment. The related adverse events of MRgFUS were observed and recorded in 3 months after the treatment as well. Results (1)Twenty-three metastatic bone tumor lesions of 23 patients were treated by MRgFUS, the treatment data was as follows: the meantreatment time was (88±33) minutes, the mean sonication number was 13±8. (2) Adverse events included: pain in therapy area 3/23, which spontaneous relieving within one week; numbness in lower limb (1/23), which relieved after physiotherapy. (3) The NRS of before treatment and at 1-week, 1-month, and 3-month after treatment respectively was 6.0±1.5, 3.7±1.7, 3.1±2.0, and 2.2±1.0, which significantly decreased after the treatment (P<0.01). (4) The BPI-QoL score of before treatment and at 1-week, 1-month, and 3-month after treatment respectively was 39±16, 27±18, 26±18, and 21±18, which significantly decreased after the treatment (P<0.01). (5) The EORTC QLQ-BM22 score of before treatment and at 1-week, 1-month, and 3-month after treatment respectively was 52±13, 44±12, 42±12, and 39±12, which also significantly decreased after the treatment (P<0.01). Conclusions MRgFUS can be used as a non-invasive, safe, and effective method for treating painful bone metastases. Its clinical benefits of pain palliation and patient's quality of life improving are sustained after the treatment at least to 3 months. Key words: Magnetic resonance imaging, interventional; High-intensity focused ultrasound ablation; Bone neoplasms; Pain palliation

Effects of soluble programmed death ligand 1 on regulating the proliferation of T lymphocytes and its mechanism

Abstract: Objective To explore the effects of soluble programmed death ligand 1 (sPD-L1) on the proliferation of T lymphocytes and its mechanism. Methods T lymphocytes were isolated from healthy human peripheral blood and activated by phytohemagglutinin (PHA). The experiment had group A: resting T lymphocytes, group B: activated T lymphocytes, group C: activated T lymphocytes+ sPD-L1Ig, group D: activated T lymphocytes+ sPD-L1Ig+ membrance-bound immunoglobulin (mIgG) and group E: activated T lymphocytes+ sPD-L1Ig+ anti-PD-L1 antibody (2H11). The absorbance value (A) of T lymphocytes in each group was measured by cell counting kit (CCK-8). The cell cycle and apoptosis of T lymphocytes induced by sPD-L1 were measured by flow cytometry. And the phosphorylation level of programmed death 1 (PD-1) signaling motif tyrosine was measured by Western blot. Furthermore, the amounts of signal adaptor molecule Src homology 2 domain-containing tyrosine phosphatase (SHP)-1 and SHP-2 were quantified by immunoprecipitation. And the exciting mechanism of sPD-L1 was explored for PD-1 inhibitory signals. Results CCK-8 study showed that A values in each group were 0.42±0.03, 1.20±0.06, 0.87±0.05, 0.78±0.05 and 1.11±0.09 respectively when the concentration of sPD-L1Ig was 250 ng/ml. The proliferation of T lymphocytes in group C significantly decreased compared with group B (t=3.946, P=0.017) while group E significantly increased compared with group D (t=3.139, P=0.035). The percentage of cell number in G1 phase of the above-mentioned 5 groups were (94.49±0.50)%, (79.22±0.50)%, (89.62±0.33)%, (92.89±0.80)% and (87.94±0.87)% respectively and group C significantly increased compared with group B (t=17.310, P 0.05). However, the expressions of p-SHP-1 and p-SHP-2 in group C was higher than those in group B (t=10.790, P<0.001; t=13.051, P<0.001) while the expression of p-SHP-1 decreased in group E compared with group D (t=3.361, P=0.028). Conclusions Soluble PD-L1 can effectively inhibit the proliferation of T lymphocytes. The phosphorylation of SHP-1 and SHP-2 contributes to the inhibitory signaling of PD-1/sPD-L1 pathway. And anti-PD-L1 blocking antibody may partially restore the proliferation of T lymphocytes through a down-regulated expression of p-SHP-1. Key words: T-lymphocytes; Cell proliferation; Soluble Programmed death ligand 1; Programmed death receptor 1; Signal transduction

[Effect of hydrogen-rich saline on cardiomyocyte autophagy during myocardial ischemia-reperfusion in aged rats].

Abstract: Objective To investigate the effects of hydrogen-rich saline on cardiomyocyte autophagy during myocardial ischemia-reperfusion in aged rats. Methods One hundred and fifty healthy male Sprague Dawley rats, 18 months old, weighing 400-540 g were selected.The rats were then randomly divided into 5 groups(n=30): Normal control group(group Ⅰ); Sham operation group(group Ⅱ); Myocardial ischemia-reperfusion group (group Ⅲ); Hydrogen-rich saline group(group Ⅳ); Normal saline group(group Ⅴ) .No any processing in group Ⅰ. In group Ⅱ, the anterior descending branch was only exposed but not ligated. Myocardial I/R was induced by occlusion of anterior descending branch of left coronary artery for 30 min followed by 12 h and 24 h of reperfusion with Bimbaum. Hydrogen-rich saline 1 ml/100 g were injected intraperitoneally 5 min before reperfusion in group Ⅳ.Normal saline 1 ml/100 g were injected intraperitoneally 5 min before reperfusion in group Ⅴ.The rats were sacrificed at 12 h and 24 h of reperfusion and hearts were removed .The pathological changes of myocardial tissue were detected by HE staining.The rate of cardiomyocyte autophagy were detected by the MDC fluorescent dye and flow cytometry instrument .The expression of AMPK, mTOR, Beclin1, LC3 in myocardial tissue was investigated by Western blot. Result Compared with groups Ⅰ and Ⅱ, the rate of cardiomyocyte autophagy, the expression of AMPK, mTOR, Beclin1, LC3 in myocardial tissue were significantly increased at 12 h, 24 h in groups Ⅲ, ⅣandⅤ(F=23.45, 26.65, 25.58; F=23.16, 25.15, 27.85; F=21.04, 24.83, 27.43; F=22.15, 25.79, 29.05; F=22.58, 27.25, 28.46), P<0.05. Compared with group Ⅲ and Ⅴ, the rate of cardiomyocyte autophagy, the expression of AMPK, mTOR, Beclin1, LC3 were significantly decreased at 12 h, 24 h in group Ⅳ(F=21.29, 24.71; F=22.37, 25.84; F=20.48, 22.38; F=21.76, 28.43; F=22.54, 27.21), P<0.05. Conclusion Hydrogen-rich saline can attenuate myocardial reperfusion injury through inhibiting cardiomyocyte autophagy.The mechanism may be associated with decreasing the expression of AMPK, mTOR, Beclin1, LC3 in myocardial tissue. Key words: Myocardial Ischemia; Reperfusion injury; Aged; Hydrogen; Autophagy

[Analysis of the changes of serum high mobility group protein B1 and cytokines in first-episode schizophrenia patients].

Abstract: Objective To measure serum levels of high mobility group protein B-1 (HMGB1), interleukin-1β (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) before and after antipsychotic treatment, and further study the role of HMGB1 in schizophrenics. Methods Thirty first-episode schizophrenics who were never treated with neuroleptics from First Affiliated Hospital of Zhengzhou University and thirty healthy subjects were enrolled.Serum levels of cytokines such as HMGB1, IL-1β, IL-6 and TNF-α were examined with enzyme linked immunosorbent assay (ELISA) before and after antipsychotic treatment. Results The serum levels of HMGB1, IL-1β, IL-6 and TNF-α in schizophrenics [(80 zophμ8/L, (51 zo, 441 zo, 591 zopng/L] were significantly higher than those in the healthy subjects [(54 gni)μ4/L, (25 gni, 17 gn, 41 gni) ng/L] (P<0.05). After treating the schizophrenics with the neuroleptic risperidone for 6 months, the serum levels of HMGB1, IL-1β, TNF-α and IL-6 were decreased.The serum levels of HMGB1 were positively correlated to IL-1β, IL-6, TNF-α and Negative Symptoms (r=0.377, r=0.426, r=0.454, r=0.558, P<0.05). Conclusions Schizophrenics show activation of the cytokine system and immune disturbance.HMGB1 may play a proinflammatory role in schizophrenia and the decrease of HMGB1 after neuroleptic risperidone treatment may be a marker of mental symptoms remission. Key words: Schizophrenia; HMGB1protein; Interleukin-1β; Interleukin-6; Tumor necrosis factor-α

[Effectiveness and safety of high dose transcranial magnetic stimulation in schizophrenia with refractory negative symptoms: a randomized controlled study].

Abstract: Objective To evaluate the efficacy and safety of high dose transcranial magnetic stimulation (rTMS) in patients with schizophrenia with refractory negative symptoms. Methods From January 2013 to April 2014 at our institute, 70 hospitalized patients of schizophrenia, according to the diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders-4th Edition (DSM-Ⅳ), aged from 18 to 45 were randomly divided into study group (n=33) and control group (n=37). Both kinds and dosages of antipsychotics were preserved as before.All patients were treated with 10 Hz rTMS.rTMS was delivered to the left dorsolateral prefrontal cortex (DLPFC) with a figure-eight solid core coil at 100% motor threshold, 2 times daily for 10 days within 2 weeks.Sham stimulation was used in control group. In both groups, Positive and Negative Syndrome Scale (PANSS) and Treatment Emergent Symptom Scale (TESS) were used to evaluate the efficacy and safety before treatment, at week 1 and week 2, and subjective visual analogue scale (VAS) score was checked after each rTMS session.PANSS was performed 3 times at follow up visits of week 4, week 8 and week 12. Results Compared with before treatment, the total score of PANSS and the score of negative symptoms at week 2 declined in study group (q=3.780, 4.258, P 0.05). After 2 weeks' treatment, the effective rates were 43.75% and 11.43% in study group and control group, respectively, and there was a significant difference between two groups (χ2=8.888, P=0.003). The incidence of headache in study group was higher than that in control group (37.50% vs 8.57%, χ2=8.051, P=0.005). The highest score of pain was (49±14) in study group, which occurred after the first rTMS treatment.Along with the treatment, the score gradually became lower, and the lowest was (11±5) after 20th treatment. Conclusion Among schizophrenia patients with refractory negative symptoms, 10 Hz rTMS applied 2 times daily within 2 weeks is effective and safe, especially, may improve blunted affect, emotional withdrawal and passive/apathetic social withdrawal. Key words: Transcranial magnetic stimulation; Schizophrenia; Treatment outcome

A comparison of results between percutaneous transforaminal endoscopic discectomy and fenestration discectomy for lumbar disc herniation in the adolscents

Abstract: Objective To compare the preliminary clinical outcomes of percutaneous transforaminal endoscopic discectomy (PTED) and fenestration discectomy (FD) for lumbar disc herniation in the adolscents and further to summarize the clinical experience. Methods The data of 56 patients with single segment lumbar disc herniation who were adopted by our department from January 2011 to December 2013 were retrospectively studied.All patients were divided into 2 groups, including 30 patients undergoing PTED and 26 patients undergoing FD respectively.The factors including the length of skin incision, amount of intraoperative bleeding, operation time and duration of hospitalization were compared.Pfirrmann grading system was used for assessment of lumbar disc degeneration preoperatively and 1 year later.The visual analogue scale (VAS), Oswestry Disability Index (ODI) and Japanese Orthopedic Association (JOA) scores were used to measure the clinical outcomes. Results There were significant differences in the observation factors such as the skin incision length, amount of intraoperative bleeding, operation time and duration of hospitalization between the PTED and FD groups (P 0.05). According to the modified MacNab criteria, there were no statistically significant differences between the 2 groups in the excellent and good rate (P>0.05). Conclusions The preliminary clinical efficacy of both PTED and FD in the treatment of single segment lumbar disc herniation in the adolscents is satisfactory.However, PTED is a better minimally invasive surgical method with such advantages as less trauma, less blood loss, early function recovery, less effect on lumbar spinal stability and so on.The shortterm outcomes of PTED are similar to that of FD. Key words: Endoscopy; Surgical procedures, minimally invasive; Intervertebral disc displacement; Adolescence

[Study on changes of plasma levels of oxidative stress biomarkers and its relation with cognition function in patients with parkinson's disease].

Abstract: Objective To study the changes of plasma levels of oxidative stress biomarkers in patients with parkinson's disease (PD), and to explore its association with cognition function. Methods Seventy-two PD patients from June 2013 to May 2012 were enrolled.All of them were outpatients or inpatients at the First Affiliated Hospital of Nanjing Medical University .And forty-five age- and gender- matched healthy subjects were used as controls. The information including gender, age, illness duration, years of education and Hoehn & Yahr (H-Y) stage were recorded. Cognition function of all the patients with PD and the controls were measured by using Montreal Cognitive Assessment (MoCA) scale. Plasma levels of catalase (CAT), total superoxide dismutase (T-SOD), glutathione peroxidase (GSH-Px), total glutathione (T-GSH) and malondialdehyde (MDA) were measured by ELISA. Then we compared and analyzed the results. Results Plasma levels of CAT, T-SOD and T-GSH in PD group were significantly lower than the control group[(159±9) kU/L vs (170±5) kU/L, P 0.05). Plasma levels of T-GSH in PD group with mild cognitive impairment(MCI) were obviously lower than PD group without MCI[(14±7) μmol/L vs (19±11) μmol/L, P< 0.05]. In PD patients, MoCA scores were positively correlated with years of education (β= 0.634, P= 0.000) and plasma levels of T-GSH (β= 0.204, P= 0.014), and were negatively correlated with H-Y stage (β=-0.194, P= 0.020). Conclusions The damage of plasma antioxidant mechanism may be involved in the pathogenesis of patients with PD. Decrease in plasma levels of T-GSH may be associated with MCI in PD patients. Plasma levels of T-GSH may be a potential early predictive index in PD patients with cognitive dysfunction. Key words: Parkinson's disease; Oxidative stress; Cognitive dysfunction

[Early evaluations of BISAP plus C-reactive protein in predicting the severity of acute pancreatitis].

Abstract: Objective To explore the early evaluations of Bedside Index for Severity in Acute Pancreatitis (BISAP) plus C-reactive protein (CRP) in predicting the severity and prognosis of acute pancreatitis (AP). Methods A total of 114 cases of AP at our hospital over the last 2 years were retrospectively analyzed. The levels of amylase, serum glucose, serum calcium, CRP and D-dimer in 24 hours were measured. According to the evaluation standard, the scores of BISAP, acute physiology and chronic health evaluation (APACHE Ⅱ), Ranson and computed tomography severity index (CTSI) were obtained. Mild acute pancreatitis (MAP), moderately severe acute pancreatitis (MSAP), severe acute pancreatitis (SAP), death toll and their proportion were compared in different BISAP scores. Correlation analyses were conducted for BISAP scores and laboratory indices, CRP and different scoring systems. We compared the evaluative value of BISAP plus CRP and other scoring systems in SAP. Results With rising BISAP scores, both severity and mortality increased in acute pancreatitis (χ2=78.616, P<0.01). BISAP scores were positively correlated with CRP, D-dimer and serum glucose (r=0.451, 0.329, 0.241, P<0.01) and negatively correlated with serum calcium ((r=-0.315, P<0.01). CRP was positively correlated with APACHE-Ⅱ, Ranson's, BISAP and CTSI scores (r=0.407, 0.392, 0.451, 0.427, P<0.001). When CRP was included into the BISAP scores, the area under the curve (AUC) of predicting SAP was 0.873 and the AUC of predicting death 0.909 so that BISAP score plus CRP had a good predictive value for the severity of AP and death. Conclusion In clinical practice, the simple BISAP scoring system may predict the severity of AP. And BISAP score plus CRP has a better predictive value for AP. Key words: BISAP scoring system; C-reactive protein; Pancreatitis; Prognosis

[Relationship between 24-hour urinary sodium and renin-angiotensin-aldosterone system in children with postural tachycardia syndrome].

Abstract: Objective To analyze the relationship between 24 hours urinary sodium and renin-angiotensin-aldosterone system (RAAS) in children with postural tachycardia syndrome (POTS) and to explore low blood volume related pathogenesis of POTS. Methods A total of 39 POTS children who were at the clinic or admitted to the Department of Pediatrics, Peking University First Hospital from June 2012 to February 2013 and 21 healthy children (control group) were enrolled, level of RAAS in plasma, 24-hour urinary sodium and plasma sodium were detected, respectively. Baseline data, levels of RAAS and hemodynamic parameters were compared between POTS and control group, as well as groups with different 24-hour urinary sodium levels of POTS. Results The angiotensin Ⅱ levels of POTS children were significantly higher than that of control group ((105±50) vs (84±28) ng/L, P=0.041), while no statistical significance was found in plasma renin and aldosterone (P>0.05 ). Pearson correlation analysis showed that 24-hour urinary sodium and angiotensin Ⅱ in children with POTS was negatively correlated (r=-0.536, P<0.001). Angiotensin Ⅱ, symptom score, upright heart rate and changes of heart rate were significantly higher in urinary sodium < 124 mmol/24 h group than that in urinary sodium ≥ 124 mmol/24 h group (P<0.05). Conclusion The regulating function disorder of RAAS may involve in the pathogenesis of POTS and cause sustained low blood volume in patients with POTS. Key words: Postural orthostatic tachycardia syndrome; Renin-angiotensin system; Child; Urinary sodium; Angiotensin Ⅱ

Effects of metformin on the polarization and Notch 1 expression of RAW264.7 macrophages

Abstract: Objective To explore the possible effects of metformin on regulating the Notch1 expression and the polarization of RAW264.7 macrophages. Methods RAW264.7 macrophages were divided into two groups according to different metformin concentrations (0, 1, 5, 10 mmol/L) and treatment length (0, 12, 24, 48 h). The expressions of interleukin-1β (IL-1β) and interleukin-10 (IL-10) mRNA were detected by real time quantity-polymerase chain reaction (RTQ-PCR). RAW264.7 macrophages were divided into control, metformin-treated, lipopolysaccharide (LPS)-treated and LPS-metformin-treated groups. Then the expressions of IL-1β, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), arginase 1 (Arg1), IL-10, interleukin-4 (IL-4), macrophage galactose-type lectin-1 (Mgl1) and Notch1 mRNA were detected with RTQ-PCR. The expression of Notch1 protein was examined by Western blot. Results At the concentrations of 0-10 mmol/L for 0-48 h, metformin in concentration and time-dependent ways promoted the expression of IL-10 mRNA and inhibited the mRNA expression of IL-1β in RAW264.7 macrophages (both P 0.05). On the contrary, in LPS-metformin-treated cells, the gene expressions of IL-1β (P<0.001), IL-6 (P=0.005), TNF-α (P=0.029) and Notch1 (P=0.006) mRNA (along with protein) were down-regulated while Arg1 (P=0.005), IL-10 (P<0.001), IL-4 (P<0.001) and Mgl1 (P=0.001) mRNA expressions up-regulated. Conclusions Metformin regulates RAW264.7 macrophages with/without LPS toward a M2 phenotype. And Notch1 signaling may play a critical role. Key words: Metformin; Macrophages; Inflammation; Receptors, Notch1

[Placental characteristics of twin-to-twin transfusion syndrome].

Abstract: Objective To explore the prevalence, number and size of anastomoses, placenta sharing and placental cord insertion in twin-to-twin transfusion syndrome (TTTS). Methods A total of 97 monochorionic placentas were collected from June 2013 to June 2014 during fetoscopic laser surgery or selective feticide.After eliminating 23 placentas of selective intrauterine growth restriction (sIUGR), 79 placents were analyzed.There were 24 placentas of TTTS and 32 placentas of normal monochorionic twins (McT) without complex twin preganancy.Placental sharing, placental cord insertion, angioarchitecture and diameter of vascular anastomosis were assessed by placental injection with colored dye and compared between TTTS and McT without complex twin preganancy. Results (1) Arterio-arterial (AA) anastomoses were detected in 37.5% of TTTS placentas versus 75.0% in normal McT placentas (P 0.05), velamentous insertion (25.0% vs 6.3%, P>0.05) in TTTS and normal McT had no difference respectively.The placental territory discordance (PTD) had no difference between TTTS and normal McT (0.33 vs 0.22, P>0.05). Conclusion AA anastomosis occurs less frequently in TTTS placentas, supporting the concept of a protective role of AA anastomoses in TTTS. McT placentas without AA anastomosis have high risk for TTTS.The compensatory ablitiy of AA anastomosis may determine the time of TTTS onset.Non-central or velamentous cord insertion, placental sharing discordance are not risk factors for TTTS. Key words: Arteriovenous anastomosis; Fetofetal transfusion; Placenta; Pregnancy, twin

[Relationship between serum thyroxin-stimulating hormone and papillary thyroid micrcarcinoma in nodular thyroid disease].

Abstract: Objective To explore the relationship between serum level of thyroxin-stimulating hormone (TSH) and development and progression of papillary thyroid microcarcinoma (PTMC) in nodular thyroid disease. Methods A total of 365 eligible patients with thyroid nodules undergoing initial thyroidectomy were enrolled, including 113 patients with PTMC diagnosed by postoperative pathology (PTMC group) and 252 patients with benign thyroid nodules (BTN group). Their clinical data were retrospectively reviewed. The serum levels of TSH in two groups and the proportion of PTMC in different serum TSH level groups in all patients were compared respectively. The relationship of preoperative serum TSH levels with tumor size and lymphatic metastasis in patients with PTMC were analyzed. Results No significant difference existed in serum TSH levels between PTMC and BTN groups (P>0.05). The median age was younger in PTMC group than that in BTN group (Z=-2.877, P=0.004). And the TGAb levels were higher in PTMC group than those in BTN group (Z=-2.887, P=0.004). They were divided into 6 groups according to the serum TSH levels, and there weren't significant difference in the proportion of PTMC among those group (P>0.05). Binary logistic regression analysis showed age was the only risk factor of PTMC (OR=0.971, 95%CI: 0.953-0.990, P=0.003). The serum TSH levels were positively correlated with tumor size in patients with PTMC (r=0.218, P=0.025). However, the proportions of lymphatic metastasis were comparable among different TSH levels groups in patients with PTMC (P>0.05). Conclusion Serum TSH is probably associated with the de novo oncogenesis of PTMC. However, serum TSH may be involved in the growth of preexisting PTMC. Key words: Thyroid Neoplasms; Thyrotropin; Thyroid nodule

[Effects of hydrogen-rich saline on Akt/GSK3β signaling pathways and cardiac function during myocardial ischemia-reperfusion in rats].

Abstract: Objective To explore the effects of hydrogen-rich saline on Akt/GSK3β signaling pathways and cardiac function during myocardial ischemia-reperfusion (I/R) in rats. Methods A total of 150 healthy male Sprague-Dawley rats were selected and divided randomly into 5 groups of normal control (Ⅰ), sham operation (Ⅱ), myocardial ischemia-reperfusion (Ⅲ), hydrogen-rich saline (Ⅳ) and normal saline group (Ⅴ) (n=30 each). Group Ⅰ had no treatment at all. In group Ⅱ, anterior descending branch was merely exposed but not ligated. Myocardial I/R was induced by 30-min occlusion of anterior descending branch of left coronary artery followed by 12/24 h reperfusion of Bimbaum. Hydrogen-rich saline 1 ml/100 g were injected intraperitoneally 5 min before reperfusion in group Ⅳ.Normal saline 1 ml/100 g was injected intraperitoneally 5 min before reperfusion in group Ⅴ. The values of ±dp/dt max, left ventricular diastolic pressure (LVDP) and left ventricular systolic pressure (LVSP) during the procedure were recorded by BL - 420 biological function experimental system at pre-ischemia, ischemia 30 min, 60 min and 120 min of reperfusion. The animals were sacrificed at 60 min, 120 min of reperfusion and hearts harvested. The pathological changes of myocardial tissue were detected by hematoxylin and eosin staining. And the expressions of Akt and GSK3β in myocardial tissue were examined by Western blot. Results Compared with groups Ⅰ and Ⅱ, the values of ±dp/dt max, LVDP and LVSP significantly increased. And the expressions of Akt and GSK3β in myocardial tissue significantly increased in groups Ⅲ, Ⅳ and Ⅴ. Compared with groups Ⅲ and Ⅴ, the values of ±dp/dt max, LVDP and LVSP significantly decreased. And the expressions of Akt and GSK3β in myocardial tissue significantly decreased in group Ⅳ. Compared with T0, the values of ±dp/dt max, LVDP and LVSP significantly decreased at T1-3 in groups Ⅲ, Ⅳ and Ⅴ. Compared with T1, the values of ±dp/dt max, LVDP and LVSP significantly increased at T2-3 in group Ⅳ. Compared with T2, the expressions of Akt and GSK3β in myocardial tissue significantly decreased at T3 in group Ⅳ. Conclusion Hydrogen-rich saline can reduce myocardial reperfusion injury and improve heart function. The mechanism may be due to associated with the down-regulated expressions of Akt and GSK3β in myocardial tissue. Key words: Hydrogen; Myocardial ischemia; Reperfusion injury, brain; Protein Kinases; Glycogen synthase kinases; Heart function

Relationship of GSTP1 lower expression and multidrug resistance reversing of curcumin on human colon carcinoma cells

Abstract: Objective To explore the proteomic differences among with and without curcumin treatment of vincristine-resistance HCT-8/VCR cells of human colon carcinoma by using mass spectrometry and two-dimensional gel electrophore-sis(2-DE). Methods The total proteins of the both groups were extracted from serum were run in immobilized pH gradient isoelectic focusing (IPG-IEF)at the first dimension.The proteins pots in gels were visualized by silver staining protocol, scanned by using a molecular imager GS-800 calibrated densitometer. The differentially expressed proteins were identified and analyzed by PDQuest 8.0 software.The diferentially displayed protein spots were searched and identifiyed by Matrix Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF-MS), the interested proteins were further validated by RT-PCR and Western blot. Results The 2-DE HCT-8/VCR cells patterns were acquired with clear background, well-resolution and reproduction. And 1 070±96 protein spots were detected in control HCT-8/VCR cells and 1 030±69 in curcumin-treated HCT-8/VCR cells.Twenty-nine differential protein spots were found to be differentially expressed. Glutathione S-transferase pi1 gene (GSTP1), a diferentiaI expression protein was identified which one of these proteins. RT-PCR and Western blotting results showed that the expressions of GSTP1 mRNA(0.49±0.09)and protein(0.29±0.07)in curcumin-treated group were significantly lower than in control group(GSTP1 mRNA 1.19±0.21 and protein 0.70±0.13, both P<0.05), indicating that curcumin down regulated these expressions. Conclusions The suppression of GSTP1 by curcumin could enhance the vincristine chemosensitivity in HCT-8/VCR.GSTP1 overexpression may be involved in the vincristine -resistance of human colon carcinoma cells. Key words: Colonic neoplasms; Proteome; Drugs, chinese herbal; Drug resistance, neoplasm

[Analysis of pathogen spectrum and resistance of clinical common organisms causing bloodstream infections, hospital-acquired pneumonia and intra-abdominal infections from thirteen teaching hospitals in 2013].

Abstract: Objective To investigate the spectrum and antimicrobial resistance of major pathogensthat causing nosocomial infections in China, 2013. Methods Nosocomial cases as well as pathogens causing bloodstream infections (BSI), hospital-acquired pneumonia (HAP) and intra-abdominal infections (IAI) from 13 teaching hospital around China were collected. The minimum inhibitory concentrations (MICs) were determined by the agar dilution method. The CLSI M100-S23 criteria were used for interpretation. Results Of all cases, 1 022 cases were from BSI, 683 from HAP and 674 from IAI.Escherichia coli and Klebsiella pneumoniae were the most prevalent pathogens causing BSI and IAI while Acinetobacter baumanii (34.6%) and Pseudomonas aeruginosa were dominated in HAP. Tigecycline, imipenem and meropenem exhibited high potency against Enterobacteriaceae and the susceptibilities rates were 95.6%, 94.2%and 95.2% respectively.Enterobacteriaceae demonstrated high resistance against cephalosporins (52.3%) and fluoroquinolones (38.9%) but were susceptible to β-lactam+ inhibitor. Of all the Enterobacteriaceae, 30.5% were ESBLs positive and 4.3% were carbapenem resistant.Acinetobacter baumanii showed low susceptibilities to the microbial agents except for tigecycline (90.5%) and colistin (100%). The rate of carbapenem resistant Acinetobacter baumanii was 76.6%. Amikacin, ciprofloxacin, cefepime and piperacillin/tazobactam showed high antibacterial activity against Pseudomonas aeruginosa with susceptible rate 88.5%, 77.6%, 72.7% and 64.5% respectively.The resistant rate to imipenem and meropenem were 42.1% and 32.2%. All Staphylococcus aureus (166 strains) were susceptible to tigecycline, linezolid, daptomycin and glycopeptides. MRSA accounted for 46.9% of all the Staphylococcus aureus. The prevalence of MRSA in IAI (55.2%) and HAP (54.4%) were higher that that in BSI (35.0%). No Enterococcus strains were found resistant to tigecycline, linezolid and daptomycin. VRE was found in Enterococcus faecium, accounting for 1.9% of all Enterococcus faecium strains. Conclusions Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa are the most common pathogens causing nosocomial infections. Nosocomial pathogens showed high susceptibilities against tigecycline. For ESBLs-producing Enterobacteriaceae strains, β-lactam+ Inhibitor show high antibacterial activities. Vancomycin, teicoplanin and linezolid exhibit high potency to Staphylococcus aureus and Enterococcus. Key words: Bloodstream infections; Hospital-acquired pneumonia; Intra-abdominal infections; Resistance surveillance; Methicillin-resistant staphylococcus aureus; Extended spectrum β-lactamase

[A comparison of high versus standard-volume hemofiltration in critically ill children with severe sepsis]

Abstract: Objective High-volume hemofiltration (HVHF) is an potential therapy for the treatment of sverve sepsis in intensive care unit, but little information is avialible in children. The aim of our study was to evaluate the effects of HVHF compared with standard-volume continuous veno-venous hemofiltration (CVVH) for critically ill children with severe sepsis, and to evaluate the feasibility and tolerance. Methods A single-center prospective trial was performed on the data of critically ill children with sverve sepsis, who were treated with 48hours HVHF (effluent rate 50-70 ml·kg-1·h-1) versus more than 48hours CVVH (effluent rate 35 ml·kg-1·h-1) from May, 2009 to April, 2014 in Shanghai Children's Hospital, Shanghai Jiao Tong University. Biomarkers and clinical outcomes were compared between the HVHF and standard-volume CVVH groups included 28-day mortality, lengths of PICU stays, vasopressor dose reduction and adverse events. Results A total of 72 critically ill patients with severe sepsis comfirmed less than 72 hours were enrolled. male 42 cases (58.3%) and female 30 cases (41.7%), median age was 56 months (range from 3 to 168 months). Patients were randomized to either HVHF (n=34) at 50-70 ml·kg-1·h-1 or standard-volume CVVH (n=38). There were no signifcant difference either PRISM Ⅲ score or pediatric critical illness score betwwen HVHF and standard-volume CVVH group (P>0.05). Death occurred in 24 cases, the total mortality was 33.3%. Mortality at 28 days was lower than expected but not statistically significant differences HVHF 29.4% compared with standard-volume CVVH 36.8% (χ2=0.45, P= 0.50). After blood hemofiltration therapy the dosage of heparin in HVHF group are lower than CVVH group (P<0.05). Complications of hypernatremia, alkali imbalance and glucose abnormalities in HVHF group is higher than that of standard-volume CVVH group (P<0.05 or P<0.01). Conclusions Compared with standard -volume CVVH, HVHF is safe on severe sepsis in children and is trend to reduce the case fatality rate. But still expect the multi-center and larger sample study for evaluation the 28days mortality in pediatric critically ill with severe sepsis. Key words: Sepsis; Hemofiltration; Mortality; Child