Dose-response relationship of alfentanil inhibiting gag reflex when combined with propofol in elderly patients undergoing painless gastroscopy / 中华麻醉学杂志

Objective:To evaluate the dose-response relationship of alfentanil inhibiting gag reflex when combined with propofol in elderly patients undergoing painless gastroscopy.Methods:Patients of American Society of Anesthesiologists physical statusⅠor Ⅱ, aged ≥60 yr, scheduled for elective painless gastroscopy, were selected. Propofol 1.5 mg/kg combined with alfentanil was given intravenously in all the patients. The dose of alfentanil was determined by the Dixon up-and-down method. The initial dose of alfentanil was set at 5 μg/kg. The dose of alfentanil in the next patient was determined according to the development of gag reflex, and the ratio between the two successive doses was 1.1. The median effective dose (ED 50) and 95% confidence interval of alfentanil-induced inhibition of gag reflex when combined with propofol in elderly patients undergoing painless gastroscopy were calculated using the by up-and-down sequential allocation. Results:The ED 50 (95% confidence interval) of alfentanil-induced inhibition of gag reflex when combined with propofol 1.5 mg/kg was 2.8 (2.4-3.2) μg/kg in elderly patients undergoing painless gastroscopy. Conclusion:When combined with propofol 1.5 mg/kg, the ED 50 of alfentanil inhibiting gag reflex is 2.8 μg/kg in elderly patients undergoing painless gastroscopy.

Effects of Rho-associated coiled-coil-forming kinase inhibitor Y27632 on mouse preantral follicles development in vitro / 解剖学报

Objective To investigate the effects of Rho-associated coiled-coil-forming kinase (ROCK) inhibitor Y27632 on the development of mouse preantral follicles in vitro. Methods The ovaries of 12.5-day-old mice were collected and single preantral follicle was isolated by mechanical method to culture Nunclon Sphera 96-well U-bottom 3D cell culture plate in vitro. Set up a control group and treated group containing Y27632, and evaluate the overall development of the follicles through follicular morphology, follicle diameter, the number of mature follicles, and changes in oocyte spindles. The expression of oocytes [bone morphogenetic protein 15(BMP 15), growth differentiation factor 9(GDF9)], granulosa cells [follicle stimulating hormone receptor (FSHR)] and apoptosis related genes (Bad, Bax and Caspase-3) were also assessed by the Real-time PCR technique. Meanwhile, the follicle viability was detected by follicular activity test during follicular development. Results Rock inhibitor Y27632 had no significant effect on the growth diameter and basic development indicators (follicle survival rate, cavity formation rate and maturation rate) (P>0.05). And abnormal spindle assembly occurred during follicle development in the control group. After 8 days of culture, compared with the control group, the granulosa cell-specific gene FSHR was up-regulated in the experimental group; As well as the oocyte-specific genes BMP 15 and GDF9 were up-regulated, while forkhead box 03(Fox03) was down-regulated; The apoptosis genes Bax, Bad and Caspase-3 were also showed down-regulated. And the granulosa cell apoptosis in the experimental group was significantly less than that in the control group. Conclusion ROCK inhibitor Y27632 can inhibit the apoptosis of granulosa cells and prevents the abnormal assembly of oocyte spindles to improve the quality of follicle development in vitro.

Observation on the application of ventilator internal circuit disinfection in mechanically ventilated patients / 中华危重病急救医学

Objective To understand the internal circuit contamination of ventilator in mechanical ventilation patients, to evaluate the effect of ventilator internal circuit disinfection and the impact on the incidence of ventilator-associated pneumonia (VAP). Methods A total of 39 patients with mechanical ventilation admitted to intensive care unit (ICU) of Hangzhou Geriatric Hospital from January 2017 to June 2018 were enrolled. Routine mechanical ventilation treatments for patients included pipeline replacement, aseptic operation, prevention of infection, etc. After 2 weeks of mechanical ventilation, the internal circuit of the ventilator was disinfected using the internal circuit sterilizer of the ventilator. Microorganism sampling and detection at 3 cm to the exhalation port of the internal circuit of the ventilator was performed before and after disinfection. The number of colonies was < 5 cfu/cm2 and no pathogenic bacteria could be detected. During the observation period, if the patient was complicated by VAP for anti-infective treatment, the ventilator with internal loop disinfection was replaced after infection control, and was incorporated again into the group for observation. The number of microbial colonies in the internal circuit of the ventilator before and after disinfection, the microbiological test pass rate and the incidences of VAP during the 2 weeks were observed. Results All 39 patients were included in the analysis, with 23 male and 16 female; with age of 65-97 years old, average (78.7±7.6) years old. Before the disinfection, 9 604 strains were detected in the internal circuit of the ventilator, including 8 687 strains of Gram-negative bacilli (90.4%), 902 strains of Gram-positive cocci (9.4%), and 15 strains of fungi (0.2%), which were detected in the lower respiratory tract of the patients. The strain concordance rate was 41%. The qualified rate of microbial detection in the internal circuit of the ventilator was 5.1%; 13 cases (33.3%) of VAP occurred during 2 weeks of mechanical ventilation. After disinfection, 785 strains of pathogens were detected in the internal circuit of the ventilator, and the number of colonies was significantly reduced compared with that before disinfection [cfu/cm2: 0 (0, 20) vs. 150 (15, 500), P < 0.01], of which 688 strains of Gram-negative bacilli (87.7%), 92 strains of Gram-positive cocci (11.7%) and 5 strains of fungi (0.6%) were found; the qualified rate of microbial detection in the internal circuit of ventilator reached 71.8%, which was significantly higher than that before disinfection (P < 0.01); 2 weeks after mechanical ventilation the incidence of VAP decreased slightly during the period [20.5% (8/39) vs. 33.3% (13/39)], but there was no significant difference (P > 0.05). Conclusions The internal circuit of the ventilator can be used to detect the pathogen and the sputum culture of the patients on mechanical ventilation with a high consistency. The disinfection of the pathogen could significantly reduce the air pollution of the ventilator and reduce the occurrence of VAP in the patients.

Effects of salmeterol fluticasone inhalation on pulmonary function and inflammatory cytokines in patients with acute exacerbation of chronic obstructive pulmonary disease / 中国基层医药

Objective To investigate the effect of salmeterol fluticasone inhalation on pulmonary function and inflammatory cytokines in patients with acute exacerbation of chronic obstructive pulmonary disease ( COPD ) . Methods 110 patients with acute exacerbation of asthma combined with COPD were selected and divided into observation group (55 cases) and control group (55 cases) by the random number table .The control group was given conventional treatment ,while the observation group was given salmeterol fluticasone inhalation therapy on the basis of routine treatment .The pulmonary function ,inflammatory cytokines and curative effects were compared between the two groups.Results After treatment,the FVC,FEV1,FEV1/FVC of the observation group were (2.64 ±0.45) L, (1.98 ±0.46)L and (80.42 ±6.43)％,which were significantly better than those of the control group (t=2.89, 2.59,6.27,all P<0.05),the improvement of lung function was more obvious than that of the control group (P<0.05).After treatment,the levels of TNF-α,IL-8,IL-10 and IL-17 in sputum of the observation group were (30.03 ±6.78)μg/L,(59.96 ±7.73)μg/L,(29.89 ±4.11)μg/L and (92.37 ±9.79)μg/L,respectively,which were significantly lower than those of the control group (t=7.54,6.16,7.04,12.31,all P<0.05).After treatment, the levels of TNF -α, IL -8, IL-10 and IL -17 in peripheral blood of the observation group were ( 14.08 ± 5.36)μg/L,(26.32 ±4.03)μg/L,(30.32 ±5.04)μg/L and (173.82 ±18.19)μg/L,respectively,which were significantly lower than those of the control group (t =4.26,7.95,11.25.5.31,all P<0.05).The decrease of inflammatory cytokines in sputum and peripheral blood of the observation group was more significant than that of the control group (P<0.05).The effective rate of the observation group was 94.55％,which was significantly higher than 81.82％of the control group (P<0.05).Conclusion Salmeterol fluticasone inhalation can improve patients'pulmonary function,decrease the level of inflammatory cytokines in sputum and peripheral blood ,which is worthy of clinical application and spread .

The effect of enteral nutrition liquid containing slow release starch on clinical efficacy in elderly patients with diabetes under mechanical ventilation / 中国中西医结合急救杂志

Objective To observe the clinical therapeutic effect of enteral nutrition (EN) liquid containing slow release starch for treatment of elderly patients with diabetes under mechanical ventilation (MV). Methods Fifty-six senile patients with diabetes treated with MV were admitted to Hangzhou Geriatric Hospital from January 2015 to December 2016, they were divided into an observation group (29 cases) treated with continuous instillation of EN liquid containing slow-release starch (Fresubin diabetes) and a control group (27 cases) treated with instillation of standard EN liquid (TPF) by nasointestinal tubes. After treatment for 14 days, the clinical efficacy was evaluated in the two groups. The levels of fasting blood glucose (FBG), 2-hour postprandial blood glucose (2 h PBG), glycosylated hemoglobin (HbA1c), serum albumin (ALB), pre-albumin (PA), arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), and 14-day and 28-day survival rates were observed after treatment in the two groups. Results The blood glucose fluctuation in the observation group was small, while the blood glucose in the control group was significantly elevated necessary to add insulin for treatment. After treatment for 7 days and 14 days, the FBG, 2 h PBG and PaCO2in the observation group were significantly lower than those in the control group [7 days after treatment: FBG (mmol/L) was 8.18±1.91 vs. 8.83±2.08, 2 h PBG (mmol/L) was 9.54±1.86 vs. 9.94±3.01, PaCO2(mmHg, 1 mmHg =0.133 kPa) was 39.0±4.3 vs. 43.0±4.5; 14 days after treatment: FBG (mmol/L) was 7.11±1.01 vs. 9.01±1.22, 2 h PBG (mmol/L) was 8.15±2.35 vs. 10.28±2.77, PaCO2(mmHg): 37.0±3.9 vs. 41.0±4.1], PaO2were significantly higher than those of the control group (mmHg: 7 days after treatment was 81.8±10.1 vs. 76.6±10.7, 14 days after treatment was 92.2±10.0 vs. 77.7±11.2), and the differences were all statistically significant (all P < 0.05). After treatment, the HbA1c in the observation group was lower than that before treatment, and serum ALB and PA were higher than those before treatment, however, there were no statistical significant differences between the two groups (all P > 0.05). The 14-day and 28-day survival rates of the observation group were significantly higher than those of the control group [14 days: 93.1% (27/29) vs. 88.8% (24/27), 28 days: 89.7% (26/29) vs. 85.2% (23/27), all P < 0.05]. Conclusion Using EN preparation containing sustained-release starch for treatment of elderly diabetic patients under MV, their blood glucose levels are stable, the ventilation function and gas exchange of lung are improved, and their survival rates are obviously elevated.

Effect of enteral nutrition support containing equal non-protein calories but different protein contents on protein metabolism of elderly patients with severe pneumonia / 中国中西医结合急救杂志

Objective To study the enteral nutritional (EN) approach to decrease the risk of developing hypo-albuminemia in elderly patients with severe pneumonia. Methods Sixty elderly patients with severe pneumonia admitted to the intensive care unit (ICU) of Hangzhou Geriatric Hospital from January 2016 to January 2017 were enrolled, and they were given EN support with different protein contents but the same non-protein calories (125.52 kJ·kg-1·d-1). Thirty patients given standard EN formula [supplied as nutrition fibre, thermal nitrogen ratio (HRN) = 130:1] were assigned as the standard EN group, another 30 patients fed with high-protein EN formula (supplied as fresubin 750 MCT, HRN = 100:1) were arranged as the high-protein EN group, and the clinical efficacy in the two groups was evaluated after treatment for 14 days. The serum levels of total protein (TP), albumin (Alb), pre albumin (PA), total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL) of both groups were compared at admission and after treatment. Results The levels of TP, Alb, PA, TC, HDL, LDL in two groups on 7 and 14 days after treatment were lower than those on admission, but the degrees of reduction in high-protein EN group were not as significant as those in standard EN group; the levels of blood glucose (Glu) in the standared EN group after treatment were lower than those on admission, Glu in high-protein EN group were higher than those on admission;after treatment for 14 days, the levels of TP (g/L: 62.1±7.6 vs. 60.1±5.2), Alb (g/L: 33.0±4.8 vs. 32.0±4.2), PA (mg/L: 226.79±79.22 vs. 202.79±71.78), TC (mmol/L: 4.88±1.09 vs. 4.09±0.80), HDL (mmol/L: 1.07±0.2 vs. 0.92±0.20), LDL (mmol/L: 3.16±0.76 vs. 2.50±0.56), Glu (mmol/L: 7.68±2.44 vs. 6.72±1.75) in high-protein EN group were significantly higher than those in standard EN group; after treatment, TG showed a trend of firstly decreasing and then increasing, while TG in high-protein EN group manifested continuously increasing, after 7 days of treatment, TG in the high-protein EN group was significantly higher than that in the standard EN group (mmol/L: 3.56±1.43 vs. 2.78±0.81, P < 0.05). Within 14 days after disease onset, the incidence of hypoalbuminemia in high-protein EN group was significantly lower than that in standard EN group in patients with acute physiology and chronic health evaluationⅡ (APACHE Ⅱ) score > 19 score [66.67% (10/15) vs. 100.00% (13/13), P < 0.05]; there was no statistical significant difference in the incidence of hypoalbuminemia between the two groups in patients with APACHE Ⅱ score < 19 score [54.54% (6/11) vs. 44.44% (4/9), P > 0.05]. Compared with standard EN group, the 3-month mortality in high-protein EN group showed a trend of decreasing [14 days: 13.3% (4/30) vs. 26.7% (8/30), 28 days: 20.0% (6/30) vs. 30.0% (9/30), 60 days: 30.0% (9/30) vs. 33.3% (10/30), 90 days: 36.7% (11/30) vs. 40.0% (12/30)], but there was no statistical significant difference between the two groups (all P > 0.05). Conclusion Application of high-protein EN in elderly patients with severe pneumonia can improve protein metabolism, and reduce the incidence of hypoalbuminemia.

Effect of Corydalis Rhizoma and L-tetrahydropalmatine on dopamine system of hippocampus and striatum in morphine-induced conditioned place preference rats / 中国中药杂志

To investigate the effects of Corydalis Rhizoma and L-tetrahydropalma-tine (L-THP) on the levels of dopamine neurotransmitter (DA), dopamine transporter (DAT) and the second dopamine receptor (D2R) in learning and memory-related brain areas, hippocampus and striatum, the DA, DAT and D2R were detected in conditioned place preference (CPP) rats suffered from morphine. And comparation the degree of similarity and consistency of the pharmacological effects was also studied. The rats were trained in black compartments and white ones (drug-paired compartment) with the increasing doses of morphine for 10 days (hypodermically injected from 10 mg•kg⁻¹ to 100 mg•kg⁻¹). Models of CPP were validated in those psychological dependence rats after 48 h training. The dopamine contents were detected as soon as the materials of hippocampus and striatum are harvested from rats of NS control group and model group. The DAT and D2R levels are measured by Western blot. The high, medium and low dose group of Corydalis Rhizoma are given Corydalis Rhizoma 2, 1, 0.5 g•kg⁻¹ water extraction liquid respectively (which contains L-THP were 0.274, 0.137 and 0.137 mg respectively), and the high, medium and low dose group of L-THP were given L-THP 3.76, 1.88, 0.94 mg•kg⁻¹ lavage treatment respectively, NS treatment group were lavaged normal saline for 6 days and they were killed after test of CPP, again tested DA levels and expression of DAT and D2R similar to the front of materials. The reduction effects of CPP were observed in the groups of both Corydalis Rhizoma (2, 1 g•kg⁻¹) and L-THP (3.76, 1.88 mg•kg⁻¹) subjected to medicine for 6 days (P<0.01). Compared with the NS treatment group and the model group, the higher values including in the contents of neurotransmitter dopamine were detected of hippocampus and striatum (P<0.01, P<0.05), the DAT and D2R protein expression of Corydalis Rhizoma (2, 1 g•kg⁻¹) and L-THP (3.76, 1.88 mg•kg⁻¹) increased in hippocampus and striatum (P<0.01). Learning and memory-related brain regions hippocampus and striatum was another neuroanatomical sites of action in the treatment of mental dependence of fumarate and L-THP, its mechanism was related to lowering its elevated DA neurotransmitter levels, and increasing the expression of DAT and D2R. Corydalis Rhizoma could be play 14-times roles in effect of L-THP. The similar effects were observed on the neurotransmitter dopamine, DAT and D2R in learning and memory-related brain areas, hippocampus and striatum of the morphine- dependent rats.

Clinical and pathological features of autoimmune hepatitis: no significant differences between genders / 中华肝脏病杂志

<p><b>UNLABELLED</b>To explore the clinical and pathological features of male and female autoimmune hepatitis (AIH) patients.</p><p><b>METHODS</b>One hundred and sixty-nine AIH patients were enrolled. The clinical and histological data of the male cases were compared with the female ones.</p><p><b>RESULTS</b>There were 23 (13.6%) male patients in our study. The general status, biochemical and immunological test, and histological findings between two groups had no significant difference (P more than 0.05). The IAIHG's revised original scoring system pretreatment scores of male patients (14.4+/-2.3) were lower than that of female ones (16.6+/-2.6, Z= -3.728, P=0.000), whereas the simplified scoring system scores of male patients (7.2+/-0.8) were higher than that of female ones (6.5+/-1.2, Z=-2.372, P=0.018). There were 15 male AIH patients treated with immunosuppressive therapy, then 12 of them reached complete biochemical remission, the other three cases were incomplete response. The complete biochemical remission rate in our male cases was 80%. Median duration of remission was 3 months (95% CI 2.070-3.930 months).</p><p><b>CONCLUSION</b>There are no significant differences in clinical and pathological features of AIH between genders. The diagnosis of AIH should be suspected in male patients with any abnormality in serum aminotransferases levels. Liver biopsy examination is recommended to establish the diagnosis of AIH. The simplified criteria have good diagnostic value for male AIH patients.</p>

Clinical and pathological features of primary biliary cirrhotic patients with negative anti-mitochondria antibody / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To explore the clinical and pathological features of primary biliary cirrhosis (PBC) patients with negative anti-mitochondria antibody (AMA).</p><p><b>METHODS</b>Two hundreds and eight PBC patients were enrolled. The clinical and histological data of the negative AMA cases were compared with the AMA/AMA-M2 positive cases.</p><p><b>RESULTS</b>30 out of the 208 cases (14.4%) were AMA negative patients in our study. The general status, biochemical tests and histological findings between the two groups had no significant difference (P > 0.05). The Gamma-globulin, IgG, IgM and IgA levels of AMA/AMA-M2 positive PBC patients were higher than that of the AMA negative cases (P < 0.05). The abnormal rate of cholesterol in AMA negative PBC patients was 65.4% as compared to 50.4% in AMA/AMA-M2 positive cases, no significant difference existed between (P > 0.05). Anti-nuclear antibody (ANA) was observed in 29 (96.7%) AMA negative PBC patients, including 14 (48.3%) with granular pattern, 8 (27.6%) with nuclear membrane pattern, 6 (20.7%) with kinetochore pattern and 1 (3.4%) with homogeneous pattern. AMA negative PBC patients had elevated serum ALP, GGT, IgM and cholesterol levels, and decreased serum AST, IgG and IgA levels as compared with that of autoimmune hepatitis patients (P < 0.05, respectively).</p><p><b>CONCLUSION</b>In cholestatic patients with elevated IgM and cholesterol levels, ANA positive with non-homogeneous pattern, the diagnosis of PBC should be suspected, albeit AMA negative. The clinical, biochemical and histological features of the AMA negative PBC patients were similar to classic PBC patients, but quite different from autoimmune hepatitis.</p>

Validation of transient elastography (Fibroscan) in assessment of hepatic fibrosis in autoimmune hepatitis / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To validate transient elastography (Fibroscan) in assessment of hepatic fibrosis in autoimmune hepatitis (AIH).</p><p><b>METHODS</b>Liver stiffness was assessed using Fibroscan in totally 30 patients with AIH. We compared the results of Fibroscan with the Scheuer fibrosis stage in liver biopsy in each patient.</p><p><b>RESULTS</b>4 patients were shown as liver fibrosis stage S0, 6 as S1, 5 as S2, 11 as S3 and 4 as S4. Failure of the Fibroscan measurement occurred in 1 case (3.3%) because of her increased body mass index (BMI). The stiffness of Fibroscan was significantly correlated with the liver biopsy fibrosis stage (r = 0.801, P less than 0.001). The liver stiffnesses between mild and moderate fibrosis (S0-2) and advanced fibrosis (S3-4) were significantly different (t = -3.937, P = 0.001).</p><p><b>CONCLUSION</b>Transient elastography (Fibroscan) is a promising non-invasive method for detection of fibrosis in patients with autoimmune hepatitis. Its use for the follow up and management of these patients and should be evaluated further.</p>

Testicular mixed nonseminomatous germ cell cancer: a case report and review of the literature / 中华男科学杂志

<p><b>OBJECTIVE</b>Testicular mixed nonseminomatous germ cell cancer (TMNGCC) is rarely reported. This study aimed to explore the clinical symptoms, pathological characteristics and treatment methods of TMNGCC.</p><p><b>METHODS</b>We analyzed the clinical data of 1 case of TMNGCC, observed its pathological characteristics under the light microscope by histology, cytochemistry, immunohistochemistry and immune marking, and investigated the clinical features of such tumors by reviewing the relevant literature.</p><p><b>RESULTS</b>The patient presented with a chief complaint of painless testicular swelling for 3 years. Histopathological examinations revealed a tumor of papillary, fissural or adenoid structure, with large polygonal or columnar cells with one or more irregular vesicular nuclei, the nuclear membrane clear, the cytoplasm eosinophilic or basophilic, and the interstitium infiltrated by a few lymphocytes. Here are the immunohistochemical results: CD117 -, CK8-18 + +, CD30 + +, CK + + +, vimentin -, PLAP +/-, P53 +, AFP + and EMA + +. The tumor was pathologically diagnosed as teratogenic embryonic testicular cancer, and treated by radical surgery, followed by adjuvant chemotherapy according to the treatment of TMNGCC. One-year follow-up found the patient to be alive.</p><p><b>CONCLUSION</b>TMNGCC is a rare malignant tumor, mostly with unobvious clinical symptoms. Its diagnosis primarily depends on physical examination, ultrasonography, CT, and measurement of serum tumor markers; its confirmation necessitates pathological examination, and its first-choice treatment is surgical resection.</p>

Clinical features of 107 autoimmune hepatitis patients and 30 of them with AIH-primary biliary cirrhosis overlap syndrome / 中华肝脏病杂志

<p><b>OBJECTIVE</b>In order to provide a reliable basis for the diagnosis and treatment of autoimmune hepatitis (AIH) and its overlap syndrome, we investigated the clinical, immunological characteristics of and the therapeutic methods for AIH and AIH-primary biliary cirrhosis (PBC) overlap syndrome.</p><p><b>METHODS</b>One hundred seven patients (77 with AIH and 30 with AIH-PBC overlap syndrome) were enrolled in the study. Their clinical manifestations, serum liver function tests (LFTs) findings, serum immunoglobulins, liver histopathological changes and their responsiveness to the therapies were investigated.</p><p><b>RESULTS</b>The age distribution of AIH patients showed a single peak during their fifties and their main clinical manifestations were malaise, abdominal distension, anorexia and jaundice. Serum gamma globulin and IgG were significantly higher than their normal levels. 74% of the patients were positive for anti-nuclear antibody (ANA), 32% of the patients were positive for anti-smooth muscle antibody (AMA), and over 50% of the patients suffered from concurrent extrahepatic autoimmune diseases. The main histological changes in the liver biopsies were interface hepatitis (65%), lobular hepatitis and rosette formation of liver cells. Bridging necrosis was observed in severe AIH cases. In the AIH-PBC overlap syndrome patients, the levels of serum ALT, AST, GGT, ALP and incidences of ANA and AMA/AMA-M2 were all significantly higher than those of the AIH group. After treating AIH patients with prednisolone and azathioprine (Aza), complete response was seen in 42 cases (70%), sustained response was seen in 26 cases (43%). Sixteen cases had relapses after the withdrawal of the treatment or prednisolone dosage was reduced lower than 10 mg/d. The cases having normal serum ALT, AST, gamma-globulin and IgG levels after treatment were still responding to the reduced prednisolone dosage of 5-10 mg/d without azathioprine added. After combination with ursodeoxycholic acid (UDCA) treatment, the liver function tests (AST, ALT, TBil) of AIH-PBC overlap syndrome patients also significantly improved compared to those before the treatment (P<0.01).</p><p><b>CONCLUSION</b>AIH and AIH-PBC overlap syndrome are not rare in our clinics. Their diagnoses should be based on the clinical presentations, biochemical and immunological indices and liver histological changes. In AIH cases, once their AST, ALT, gamma-globulin and IgG levels return to normal, the prednisolone dosage can be maintained at 5-10 mg/d and Aza can even be withdrawn. Good improvement for patients with AIH-PBC overlap syndrome can be obtained with UDCA and immunosuppression treatment.</p>

Assessment of the health-related quality of life of patients with minimal hepatic encephalopathy / 中华肝脏病杂志

<p><b>OBJECTIVE</b>The Medical Outcome Study of 36-item Short-Form Health Survey (SF-36) is a well-validated generic questionnaire widely used to assess health-related quality of life (HRQOL), and the Chronic Liver Disease Questionnaire (CLDQ) is a specific HRQOL assessment designed for patients with liver diseases. The aim of our study is to evaluate the HRQOL based on SF-36 and CLDQ (Chinese version) in patients with chronic hepatitis B and liver cirrhosis, especially in the status of minimal hepatic encephalopathy (MHE).</p><p><b>METHODS</b>The SF-36 and CLDQ were answered by 160 healthy volunteers, 20 patients with chronic hepatitis B and 106 patients with cirrhosis. HRQOL scores of the groups with different liver disease severities and with or without MHE were compared. The SF-36 includes one multi-item scale that assesses eight health categories: physical functioning, role-physical, body pain, general health, vitality, social functioning, role-emotion, and mental health. CLDQ assesses 6 categories: abdominal symptoms, fatigue, systemic symptoms, activity, emotional function and worry.</p><p><b>RESULTS</b>Compared with the healthy controls, patients with chronic hepatitis B and liver cirrhosis at baseline had a lower HRQOL on all scales of the SF-36 and CLDQ (P < 0.01 for all). Increased severity of liver cirrhosis (based on the Child-Pugh score but with MHE or without) was associated with a decrease in most components, both in SF-36 and in CLDQ. However, patients with Child-Pugh B and C disease had similar HRQOL scores on both the SF-36 and CLDQ (P > 0.05), except role-physical and vitality on SF-36. There was a significant difference between patients with and without MHE on the SF-36 score (P < 0.01), and no significant difference (P > 0.05) on CLDQ scores except in abdominal symptoms.</p><p><b>CONCLUSION</b>The Chinese version of SF-36 along with CLDQ are valid and reliable methods for testing MHE in patients with liver cirrhosis.</p>

Expression of endotoxin receptors on hepatic stellate cells during their activation / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the role of endotoxin receptor expression in the activation of hepatic stellate cells (HSCs).</p><p><b>METHODS</b>HSCs were isolated from normal rats and the expression of endotoxin receptors on quiet HSCs and in vitro activated HSCs was determined using RT-PCR and immunocytochemical staining methods. A rat model of liver fibrosis and cirrhosis was established. The expressions of CD14 and alpha-SMA in liver tissues were detected by immunohistochemical staining.</p><p><b>RESULTS</b>Freshly isolated HSCs had a low level of CD14 mRNA expression and no expression of TLR4 mRNA was detected. The in vitro activated HSCs had increased expressions of CD14 mRNA and TLR4 mRNA and LPS up-regulated the expression of endotoxin receptors. Immunocytochemical staining showed cytoplasmic and nucleolus staining for CD14 in the cultured HSCs. LPS played a further role on CD14 protein expression. In the development of liver fibrosis, the number of CD14-positive cells in the livers was increased and these cells were distributed along the sinusoids. In the later stage of liver fibrosis, the CD14-positive cells were gathered in the fibrotic septae, which also contained alpha-SMA positive cells.</p><p><b>CONCLUSION</b>The activated HSCs expressed endotoxin receptors. The endotoxin receptors may be involved in the role in which HSCs played in the inflammatory process and liver fibrosis development.</p>

Structure and performance of calcium polyphosphate for bone tissue engineering / 生物医学工程学杂志

Porous calcium polyphosphate (CPP) has shown promise of tissue engineered implant application because of the biocompatibility and biodegradation. CPP with different polymerization degree were prepared by controlling the calcining time, and its polymerization degree could be calculated by developed method in this paper. Different crystal types CPP were prepared by quenching from the melt and crystallization of amorphous CPP. From the in vitro degradation, carried out in Tris-HCl buffer, the degradation velocity of CPP was controllable. The weight loss of CPP with different polymerization degrees and crystal types were different. With the increasing of polymerization degree, the weight loss during the degradation was decreasing, contrarily the strength of CPP was increasing. The amorphous CPP could degrade completely in 17 days while gamma-CPP do completely in 25 days. The degradation velocity beta-CPP and alpha-CPP was slower than gamma-CPP and the weight loss was about 12% and 5% respectively. The results of this study indicate that CPP have potential applications for bone tissue engineering as inorganic polymeric biomaterials.

Advances in research on calcium polyphosphate bioceramic for bone tissue engineering scaffold / 生物医学工程学杂志

Bone tissue engineering is a novel, developing and challenging science which provides a new way to repair bone lost from injury and disease. Porous calcium polyphosphate bioceramic is one kind of absorptable bioceramic. Owing to its fine biocompatibility and degradability, more and more pieces of research wark have been carried out in bone tissue engineering, and because of its special characteristics, calcium polyphosphate bioceramic is regarded as a promising material for solving the problem of how to match the degradation velocity of scaffold with the velocity of cell growth. The recent research of using calcium polyphosphate bioceramic as the scaffold in bone tissue engineering is summarized, including the property, synthesis and advances.

Protective effect of Jiechangning decoction in treating experimental ulcerative colitis in guinea pigs / 中国结合医学杂志

<p><b>OBJECTIVE</b>To study the therapeutic effects and mechanism of Jiechangning (JCN) decoction on carrageenan induced experimental ulcerative colitis (UC).</p><p><b>METHODS</b>After sensitizing guinea pigs with carrageenan, we established UC animal models by free drinking water containing 2% acid degraded carrageenan (ADC). JCN decoction was orally administered once a day for 2 weeks after carrageenan treatment. Salicylazosulfapyridine (SASP) and normal saline were given to the other two groups as control. The levels of colon lipid peroxide (LPO), acid phosphatase (ACP) activity and tumor necrosis factor-alpha (TNF-alpha) were measured; colitis activity score (CAS) was carried out for assessment of the degree of tissue inflammation and injury; the colonic pathological changes were examined simultaneously with hematoxylin and eosin (HE) and toluidine blue staining used to evaluate the therapeutic effects of JCN decoction and SASP.</p><p><b>RESULTS</b>Experimental colitis models resembling human UC were successfully induced. The levels of tissue LPO, ACP activity and the content of tissue TNF-alpha were markedly increased in the model group as compared with the normal control group (P < 0.01) and were positively correlated with CAS. JCN decoction could reverse these changes like SASP. HE staining showed that JCN decoction and SASP could reduce CAS and the degree of tissue injury, toluidine blue staining revealed that mucosa and submucosa red metachromasia pellets in JCN group and SASP group were markedly fewer than those in the model group.</p><p><b>CONCLUSION</b>JCN decoction is effective in treating experimental UC, which provides theoretical basis for its clinical application.</p>

Effect of T-cell vaccination in murine experimental autoimmune hepatitis / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the effect of T-cell vaccination in murine experimental autoimmune hepatitis (EAH).</p><p><b>METHODS</b>To induce the EAH model, the syngeneic S-100 antigen emulsified in complete Freud's adjuvant was injected intraperitoneally to C57Bl/6 at day 1 and day 7. For T-cell vaccination, splenocytes were removed from animal 2 weeks after induction of EAH and from control animals, and activated in vitro by mitogen stimulation with Concanavalin A (Con A), then inactivated by mitomycin and injected at 5 10(7) cells per animal as T-cell vaccination at 14 and 7 days before first induction of EAH.</p><p><b>RESULTS</b>The histological grade and serum ALT level of the mice who received T-cell vaccination were decrease significantly, compared with that of model group (1.44+/-0.88 vs. 2.33+/-0.87, t=2.24, P<0.05; 63.0U/L+/-23.4U/L vs. 115.0U/L1+/-39.6U/L, t=2.37, P<0.01, respectively); there was no significant change in mice who received irrelevant T-cell vaccination.</p><p><b>CONCLUSION</b>T-cell vaccination with T cells from EAH animals, but not with irrelevant T cells, was able to protect animals from EAH.</p>

The advance in researches for biomedical intelligent polymer materials / 生物医学工程学杂志

The properties of biomedical intelligent polymer materials can be changed obviously when there is a little physical or chemical change in external condition. They are in the forms of solids, solutions and polymers on the surface of carrier, including aqueous solution of hydrophilic polymers, cross-linking hydrophilic polymers (i.e. hydrogels) and the polymers on the surface of carrier. In this paper are reviewed the progress in researches and the application of biomedical intelligent polymer materials.

Cytokine gene polymorphisms in Chinese patients with type I autoimmune hepatitis / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To assess the role of Tumor necrosis factor alpha (TNF-alpha) and interleukin 10 (IL-10) gene polymorphisms in susceptibility to type I autoimmune hepatitis (AIH).</p><p><b>METHODS</b>We detected 2 polymorphisms in TNF-alpha promoter gene at positions -238 and -308 and 3 polymorphic sites in IL-10 gene promoter at positions -1082, -819, -592 by polymerase chain reaction and dot blot with probes in the patients with 32 type I AIH and 48 health controls.</p><p><b>RESULTS</b>Genotypes associated with guanine to adenine substitution at position -308 of TNF-alpha promoter gene occurred more commonly in the patients than in health controls (53.1% vs. 27.1%, RR = 3.05, P < 0.01). There is no significant difference in polymorphisms of TNF-alpha gene at position -238 and 3 polymorphic sites in IL-10 promoter gene between patients and health controls.</p><p><b>CONCLUSION</b>Genotypes associated with guanine to adenine substitution at position -308 of TNF-alpha promoter gene (TNF-308A) may involve in the pathogenesis of type I AIH</p>