Expression and significance of immune cells in patients with hepatitis B virus-related acute-on-chronic pre-liver failure / 临床肝胆病杂志

Objective To investigate the expression of myeloid-derived suppressor cells (MDSC), regulatory T cells (Treg), IL-17-producing CD4 + T cells (Th17), and CD8 + T cells (Tc17) in hepatitis B virus-related acute-on-chronic pre-liver failure (pre-ACHBLF), and to provide ideas for the early treatment of acute-on-chronic hepatitis B liver failure (ACHBLF). Methods A total of patients with pre-ACHBLF and 15 patients with ACHBLF who were hospitalized in Shijiazhuang Fifth Hospital, from August 2018 to May 2019 were enrolled as subjects, and 15 patients with chronic hepatitis B (CHB) and 15 healthy controls (HC) who underwent physical examination were enrolled as controls. Flow cytometry was used to measure the expression levels of MDSC and Th17, Treg, and Tc17 cells in peripheral blood; a blood analyzer was used to measure routine blood parameters and calculate neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index(SIRS) to evaluate the degree of inflammation, and the correlation between the expression of immune cells and the degree of inflammation was analyzed. An analysis of variance for independent samples was used for comparison of normally distributed continuous data between multiple groups, and the least significant difference t -test was used for further comparison between two groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups, and the Nemenyi test was used for further comparison between two groups. A Pearson linear correlation analysis or Spearman's rank correlation analysis was used to investigate the correlation between variables. Results Compared with the CHB group, the ACHBLF and pre-ACHBLF groups had significant increases in the expression levels of Th17, Treg, and Tc17 cells, and the pre-ACHBLF group also had a significant increase in the expression level of MDSC (all P < 0.05). The correlation analysis showed that in pre-ACHBLF patients, MDSC were positively correlated with leukocyte count, neutrophil count, NLR, MLR, and SII ( r =0.775, 0.727, 0.571, 0.786, and 0.846, all P < 0.05), and Treg cells were only positively correlated with leukocyte count ( r =0.618, P =0.043); Th17/Treg ratio and Tc17 cells were negatively correlated with the number of lymphocytes ( r =-0.790 and -0.795, both P < 0.05). Conclusion Cellular immune dysfunction is observed in patients with pre-ACHBLF, and the expression of MDSC is closely associated with the degree of inflammation and should be taken seriously in the early stage.

Bronchial arteriography CT combined with bronchoscopy in diagnosis of Dieulafoy′s disease (a report of 5 cases) / 中国医师杂志

Objective:To investigate the diagnostic value of bronchial arteriography CT (BA-ACT) combined with bronchoscopy (BS) in bronchial Dieulafoy′s disease (BDD), and the role of bronchial artery embolization (BAE) in the treatment of BDD.Methods:Retrospective analysis was made on the clinical data of 5 patients suspected of being BDD treated by BS in Guangzhou First People′s Hospital or Guangzhou Thoracic Hospital from January 2008 to January 2018 due to hemoptysis. Bronchial arteriography (BAG) and BA-ACT were performed during the operation of interventional embolization. BAG rotary acquisition data were post-processed according to BS findings, and BA-ACT reconstruction images of the diseased bronchi and bronchial arteries were obtained. BS reexamination and clinical follow-up observation were carried out after embolization to analyze the effect of embolization.Results:There were one BDD lesion for the five patients respectively, and the BAG lacked characteristic manifestations. Bronchoscopy revealed BDD foci to present as papillary (case 1-case 3), nodular (case 4), or lirellate (case 5) subbronchial submucosal protrusion lesions. On the BA-ACT reconstruction plot, the BDD lesions of papillary, nodular and carination manifested correspondingly as a bronchial artery branches locally " pointed arch" shaped (cases 1-case 4) or " bead-like" (case 5) fold and protruding toward the bronchial lumen. The BDD lesions of the cases 1-case 4 retraction and disappearance after one BAE were observed by BS examination, and no hemoptysis recurrence during the follow-up period (54-91 months). The ridge like BDD lesion of the case 5 remained unchanged after BAE, and hemoptysis recurred at 71 months after the first BAE; the uncollapsed foci were supplied by two collateral vessels that confirmed by second BAG and BA-ACT, and no hemoptysis for 71 months followed up after second BAE.Conclusions:BA-ACT combined with BS enables a locative and qualitative diagnosis of BDD, and BAE is a very effective treatment method for BDD.

Angiographic anatomy of lateral costal artery and its clinical significance / 中国医师杂志

Objective:To study the angiographic anatomy of the lateral costal artery (LCA) and its effect on hemoptysis.Methods:The CT data of angiography and angiographic-CT in 303 patients with hemoptysis in Guangzhou First People′s Hospital were analyzed retrospectively. The origin and travel of the lateral costal artery and the blood supply of the LCA involved in the pulmonary lesion were analyzed.Results:In 303 patients with hemoptysis, 30 LCA were detected in 24 cases, including 12 on the left and 18 on the right, 18 on one side and 6 on both sides. All of them were the first branch of the first segment of the internal thoracic artery (ITA). The level of LCA originating from ITA was located in 1(3.3%) branch above clavicle, 27(90.0%) branches behind clavicle and 2(6.7%) branches below clavicle. LCA entered into the chest behind the first anterior rib, and walked along inner surface of the thorax from the anterior and superior direction to the outer and posterior direction, between the rib-intercostal medial muscle and pleura (i.e., anatomical intrathoracic fascia), and mostly terminated at the axillary midline plane. 28 LCA in 23 patients which can be used for morphological analysis, roughly manifested as follow three shapes: ⑴ 13(46.4%) of them were arc-shaped. The developed LCA was longer and showed shallow or deep arc-shaped curve; ⑵ High flat shape, total 11 LCA (39.3%), the LCA were relatively shorter, position higher and more gentle; ⑶ 4(14.3%) were straight and oblique. The developed LCA was relatively long, and the angle between LCA and ITA was linear. 11 vessels (36.67%) of 10 patients participated in the blood supply of pulmonary lesions, among which 2, 5, 1, 2 and 1 vessels were responsible for the first, second, third, fourth and fifth hemoptysis respectively.Conclusions:The LCA is a relatively common blood vessel and it can be well shown by angiography and angiographic CT. It is of great clinical significance to understand LCA.

Effects of Oxycodone Patient-controlled Intravenous Analgesia on Related Indicators of Patients after Laparoscopic Radical Resection of Cervical Cancer / 中国药房

OBJECTIVE:To investigate the effects of oxycodone patient-controlled intravenous analgesia (PCIA) on related indicators of patients after laparoscopic radical resection of cervical cancer. METHODS:A total of 120 patients underwent selective laparoscopic radical resection of cervical cancer were selected from our hospital during Feb. 2016-May 2017. They were divided into control group(60 cases)and observation group(60 cases)according to random number table. After laparoscopic radical resection of cervical cancer,control group was given Fentanyl citrate injection 20 μg/kg,added into 0.9% Sodium chloride injection to 150 mL, at 3.5 mL/h with initial dose of 4 mL,PCIA dose of 2 mL and self-control locking time of 10 min. Observation group was given Oxycodone hydrochloride injection 0.4 mg/kg,added into 0.9%Sodium chloride injection to 150 mL,at 3.5 mL/h with initial dose of 4 mL,PCIA dose of 2 mL and self-control locking time of 10 min. VAS scores 12,24,48 h after surgery,serum levels of IFN-γ, IL-10,NK cells,CD3+,CD4+and CD8+30 min before surgery and 24,48,72 h after surgery,the occurrence of ADR were observed in 2 groups. RESULTS:All patients of both groups completed the study. VAS scores of 2 groups 24,48 h after surgery were significantly lower than 12 h after surgery,with statistical significance (P＜0.05). There was no statistical significance between 2 groups(P＞0.05). Thirty min before surgery,there was no statistical significance in the levels of IFN-γ,IL-10,NK cells,CD3+, CD4+or CD8+between 2 groups(P＞0.05);24,48,72 h after surgery,the levels of IFN-γ and IL-10 in 2 groups were significantly higher than 30 min before surgery,and the observation group was lower than the control group,with statistical significance(P＜0.05);the levels of NK cells,CD3+,CD4+and CD8+in 2 groups were significantly lower than 30 min before surgery,but increased gradually as time;the indexes above of observation group was significantly higher than the control group 24,48 h after surgery,with statistical significance(P＜0.05). The incidence of ADR in observation group(8.33%)was significantly lower than control group (20.00%),with statistical significance(P＜0.05). CONCLUSIONS:Oxycodone PCIA shows good analgesic effect after laparoscopic radical resection of cervical cancer and can effectively decrease the levels of serum inflammatory factors and improve immune function with good safety.

Cell-penetrating peptdie based on peptide array technique inhibiting NR2B phosphorylation in inflammato-ry pain rats / 实用医学杂志

Objective We used peptide array technique to construct a peptide FynP inhibiting the interac-tion between Fyn and PSD95 in vitro therefor with a potential for inbiting NR2B phosphorylation level(p-NR2B). This experiment was designed to examine whether FynP(deliverd with TAT-LK15)can inhibit interaction between Fyn and PSD95 in inflammatory pain rats,and therefore inhibit NR2B phosphorylationin in vivo. Methods TAT-LK15 was complexed with FynP(cell-penetrating peptide Tat-LK15/FynP)or scrambled control FynP(Tat-LK15/mFynP). Changes of p-NR2B were detected using western-blot in SCDH of chronic inflammatory pain rats following intraperitoneal injection of Tat-LK15/FynP,meanwhile,the effect of Tat-LK15/FynP on the interaction between Fyn and PSD-95 was tested by co-immunoprecipitation. Pain control efficacy was evaluated by changes of mechani-cal withdrawal threshold(MWT)and thermal withdrawal duration(TWL)in these rats. Results Interaction be-tween Fyn and PSD-95 was efficiently inhibited by intraperitoneal injection of TAT-LK15/FynP complexes while in-jection of FynP or TAT-LK15/mFynP complexes did not show this inhibitory effect. NR2B phosphorylation level was also inhibited by injection of TAT-LK15/FynP,and the changes of p-NR2B levels were reduced by 52%compared to chronic inflammatory pain rats without treatment. FynP or TAT-LK15/mFynP did not show this effect. Moreover, injection of TAT-LK15/FynP complexes significantly reduced MWT and increased TWL of chronic inflammatory pain rats accordingly. Conclusion FynP delivered by Tat-LK15 can perturb Fyn and PSD95 interaction and then inhibit NR2B phosphorylation activation therfor relieve chronic inflammatory pain.

Cell-penetrating peptdie based on peptide array technique inhibiting NR2B phosphorylation in inflammato-ry pain rats / 实用医学杂志

Objective We used peptide array technique to construct a peptide FynP inhibiting the interac-tion between Fyn and PSD95 in vitro therefor with a potential for inbiting NR2B phosphorylation level(p-NR2B). This experiment was designed to examine whether FynP(deliverd with TAT-LK15)can inhibit interaction between Fyn and PSD95 in inflammatory pain rats,and therefore inhibit NR2B phosphorylationin in vivo. Methods TAT-LK15 was complexed with FynP(cell-penetrating peptide Tat-LK15/FynP)or scrambled control FynP(Tat-LK15/mFynP). Changes of p-NR2B were detected using western-blot in SCDH of chronic inflammatory pain rats following intraperitoneal injection of Tat-LK15/FynP,meanwhile,the effect of Tat-LK15/FynP on the interaction between Fyn and PSD-95 was tested by co-immunoprecipitation. Pain control efficacy was evaluated by changes of mechani-cal withdrawal threshold(MWT)and thermal withdrawal duration(TWL)in these rats. Results Interaction be-tween Fyn and PSD-95 was efficiently inhibited by intraperitoneal injection of TAT-LK15/FynP complexes while in-jection of FynP or TAT-LK15/mFynP complexes did not show this inhibitory effect. NR2B phosphorylation level was also inhibited by injection of TAT-LK15/FynP,and the changes of p-NR2B levels were reduced by 52%compared to chronic inflammatory pain rats without treatment. FynP or TAT-LK15/mFynP did not show this effect. Moreover, injection of TAT-LK15/FynP complexes significantly reduced MWT and increased TWL of chronic inflammatory pain rats accordingly. Conclusion FynP delivered by Tat-LK15 can perturb Fyn and PSD95 interaction and then inhibit NR2B phosphorylation activation therfor relieve chronic inflammatory pain.

Therapeutic effect of Tat-LK15-mediated the interference of siRNA with nNOS expression in the spinal dorsal horn on neuropathic pain in rats / 解放军医学杂志

Objective To investigate the therapeutic effect of cell penetrating peptide Tat-LK15 mediating small interfering RNA (siRNA) interference with the expression of neuronal nitric oxide synthase (nNOS) in rat spinal dorsal horn on neuropathic pain. Methods The transfection reagent, Tat-LK15, was used to mediate the transfection of rat spinal dorsal horn (SDH) neuronal cells with carboxyfluorescein (FAM), and then the transfection effect was observed under inverted fluorescence microscope. Fifty healthy male SD rats were randomly divided into 5 groups (n=10): control group, sham operation group (sham group), neuropathic pain group (SNL group), Tat-LK15-nNOS siRNA group (TS group) and Tat-LK15-NC siRNA group (TN group). Neuropathic pain was induced by spinal nerve ligation (SNL), rats in control group did not receive operation and only the spinal nerve was exposed in sham group. Groups SNL, TS and TN were made into the models by SNL and implanted intrathecal catheter, intrathecal administration was performed from the 7th day after model establishment, and 10μl normal saline, 10μl TS complex (including 5μg siRNA) and 10μl TN (including 5μg siRNA) were injected intrathecally each day for 7 days. Paw withdrawal mechanical threshold (PWMT) and paw withdrawal thermal latency (PWTL) were measured at 1 day before (baseline) and 3, 7, 10 and 14 days after model establishment. Then animals were sacrificed on the 14th day after the operation and the lumbar segment (L4-6) of the spinal cord was removed to detect the expressions of nNOS mRNA and protein using q-PCR and Western blotting analysis. Results Tat-LK15 effectively mediated FAM-siRNA into SDH neuronal cells. Compared with sham group, SNL significantly decreased PWMT and PWTL and increased expressions of nNOS mRNA and protein from the 3rd day (P<0.01), but there was no significant difference between the sham and control group. Tat-LK15-nNOS siRNA complex significantly increased PWMT and PWTL and down-regulated nNOS mRNA and protein expressions in TS group compared with SNL group on the days 10 and 14. There was no significant difference between TN and SNL group. Conclusion Tat-LK15 not only can mediate successful nNOS siRNA transfection and inhibit the expression of nNOS, but also effectively relieve SNL-induced neuropathic pain in rats.

Early diagnosis and early treatment for liver cancer in Qidong: survival of patients and effectiveness of screening / 中华肿瘤杂志

Objective@#To evaluate the patients′ survival and effectiveness of the live cancer screening for population at high risk for liver cancer in Qidong.@*Methods@#According to the Expert Scheme proposed the Expert Committee of Early Detection and Early Treatment, China Cancer Foundation, diagnostical screening by using combined methods of alpha-fetoprotein and B ultrasound monitoring were carried out biannually in individuals with positive HBsAg who were screened from Qidong area. The evaluation indices of the effectiveness are task completion rate of screening, detection rate of liver cancer, early diagnosis rate, and treatment rate. The deadline of the follow-up for the surviving outcome was March 31, 2016. The life-table method was used to calculate the observed survival, and to make comparison and significant tests between survival rates in Group A (those found via repeated periodic screening) and Group B (those diagnosed without periodic screening).@*Results@#Since 2007, 38 016 target population have been screened, and 3 703(9.74%) individuals with positive HBsAg were found. Except for 29 patients with liver cancer at the initial screening, 3 674 persons in the cohort were followed up; 268 patients with liver cancer were detected from the 33 199 person-times screening, with an annual detection rate of 1.61%. Of them, 186 patients were found in Group A(1.12%), in which 149 patients were the early cases, with an early detection rate of 80.11%; 167 out of 186(89.78%) patients received treatment after diagnosis. The incidence of liver cancer in this HBsAg (+ ) cohort of 25 452 person-years was 1 052.96 per 100 000 annually, 187 cases in males(1 488.45/100 000)and 81 cases in females(628.46/100 000). The 1-, 3-, 5-, and 8-year survival of all patients with liver cancer were 64.55%, 40.50%, 32.54%, and 19.65%, respectively. The 1-, 3-, 5-, and 8-year survival rates were 77.16%, 49.04%, 38.53%, and 24.25% in Group A, and were 36.25%, 21.21%, 21.21%, and 0% in Group B, respectively, with significant differences between two groups (P<0.05).@*Conclusion@#The findings show that screening of individuals at high-risk of development of liver cancer, with semiannual AFP and B ultrasound, according to the Expert Scheme, is effective not only in increasing detection rate but also in detecting liver cancer at early stage, and in improving patients′ survival as well.

Enlightment of foreign management system of rare diseases to China / 基础医学与临床

Through analyses of rare diseases management of several countries and regions , successful practice has been discussed .Legislation of rare diseases should be activated as soon as possible to release specific standard of rare diseases .Accelerating development of translational medicine is a feasible approach to improve the level of diag -nosis and treatment of rare diseases .Strengthening the orientation of management policy should be put into a more significant position to promote incentives of stakeholder in this area .Both enhancing the joint collaboration of differ-ent departments and perfecting medical insurance system could be forceful accelerants to create and optimize the management system of rare diseases in China .

Tat-LK15-mediated delivery of nNOS siRNA in rats with chronic inflammatory pain / 实用医学杂志

Objective To investigate the potential application of a non-viral gene carrier , TAT-LK15 , for delivering nNOSsiRNAin vivo and to study whether TAT-LK15/siRNA can be a new treatment method for chronic inflammatory pain. Method TAT-LK15 was complexed with nNOSsiRNA or scrambled control siRNA. The expression of nNOS was determined in SCDH of chronic inflammatory pain rats by western-blot assay. Pain control efficacy was evaluated by mechanical withdrawal threshold (MWT) and thermal withdrawal duration (TWD) assays. Results nNOS protein expression was efficiently inhibited by intrathecal injection of TAT-LK15/siRNA complexes , with the reduction of nNOS protein by 52%. Moreover , injection of TAT-LK15/siRNA com-plexes significantly could decrease MWT , but increase TWD in rats with chronic inflammatory pain. Conclusions TAT-LK15 can efficiently deliver nNOSsiRNAin vivo and nNOSsiRNA can relieve chronic inflammatory pain in rats.

Long-term efficacy of neonatal hepatitis B vaccination against chronic hepatitis B virus infection and chronic liver disease: a cross-sectional study based on Qidong Hepatitis B Intervention Study / 中华流行病学杂志

<p><b>OBJECTIVE</b>To evaluate the long-term protection efficacy of neonatal hepatitis B vaccination on chronic hepatitis B (CHB) and liver fibrosis and cirrhosis in adults.</p><p><b>METHODS</b>From January to October, 2013, a cross-sectional study was conducted among the participants from Qidong Hepatitis B Intervention Study (QHBIS), who were selected through stratified random sampling. The detections of serum alanine aminotransferase (ALT), HBsAg, anti-HBs, anti-HBc, HBeAg, and anti-HBe were conducted and ultrasonography on liver, gallbladder and spleen was performed for them. The positive rates of each serologic markers, the prevalence of active CHB and liver fibrosis and cirrhosis were calculated, the gender specific differences between vaccination group and control group were compared with Chi-square test.</p><p><b>RESULTS</b>A total of 4 421 participants aged (25.59±1.84) years in vaccination group and 3 880 participants aged (26.61±2.24) years in control group were surveyed. The positive rates of HBsAg, anti-HBs, anti-HBc, HBeAg and anti-HBe were 2.38%, 37.73%, 3.78%, 0.57% and 2.15% in vaccination group, and 9.02%, 29.41%, 16.83%, 2.73% and 8.87% in control group, respectively, the differences between two groups were statistically significant (all P<0.05). The prevalence of active CHB and liver fibrosis and cirrhosis were 0.45% and 0.16% in vaccination group, 1.29% and 0.39% in control group, the differences between two groups were statistically significant (P<0.05). The active CHB prevalence was lower in females than in males in both vaccination group and control group (P<0.05). The liver fibrosis and cirrhosis prevalence was lower in females than in males in control group (P<0.05); whereas, no statistical significant difference in liver fibrosis & cirrhosis prevalence between males and females was found in vaccination group (P>0.05).</p><p><b>CONCLUSIONS</b>Protection conferred by neonatal hepatitis B vaccination could last to marrying age. The gender specific difference in protection efficacy needs further study.</p>

Analysis of the assessment of clinical students' doctor-patient communication skills and recom-mendations for improvement / 中华医学教育探索杂志

Objective To investigate the mastery of clinical students' doctor-patient communi-cation skills and to assess the teaching effectiveness about the doctor-patient communication, and then propose some improvement ideas. Methods We conducted a study in students of clinical medicine of Nanjing Medical University in Grade 2009, using Objective Structured Clinical Examination (OSCE) after internship, which included graduation assessment of doctor-patient communication skills. Then we analyzed the doctor-patient communication skills and related scores of students trained in different clinical medical programs. Results The average score of doctor-patient communication skills of 549 students was (82.72±4.23), of which, the average score of 329 five-year students of clinical medicine was (81.88±4.23) and the average score of seven-year students was (83.96±3.91) in. The average score of seven-year students of clinical medicine was significantly higher than five-year students (P=0.000). Moreover, there was a significant positive correlation between the total score of OSCE and the score of doctor-patient communication skills in both five-year and seven-year students of clinical medicine (five year program students' score correlation coefficient was 0.520, P=0.000;seven year pro-gram students' score correlation coefficient 0.416, P=0.000). Conclusion The teaching effectiveness of doctor-patient communication has proved to be quite effective, and it is definitely of great significance in improving clinical students' doctor-patient communication skills. The score of the assessment of the doctor-patient communication reflects not only the training effectiveness of the communication skills, but also the comprehensive capacity.

The clinical value of plasma M type phospholipase A2 receptor antibody and IgG subtypes deposition in diagnosis of hepatitis B virus-associated membranous nephropathy / 国际检验医学杂志

Objective To investigate the different expressions of plasma M type phospholipase A2 receptor antibody and IgG subtypes deposition of kidney tissues in idiopathic membranous nephropathy and hepatitis B virus-associated membranous nephropa-thy,and to evaluate the significance of plasma M type phospholipase A2 receptor antibody and IgG subtypes in diagnosis of hepatitis B virus-associated membranous nephropathy.Methods Plasma samples were obtained from patients with idiopathic membranous nephropathy,hepatitis B virus-associated membranous nephropathy and minimal change disease,respectively,before immunosup-pressive therapy.Concentration of plasma M type phospholipase A2 receptor antibody was detected by sandwich ELISA and concen-tration of IgG subtypes were measured by immunofluorescence.Results Concentration of plasma M type phospholipase A2 receptor antibody was (15.4±7.2)μg/mL in idiopathic membranous nephropathy group,higher than that in the hepatitis B virus-associated membranous nephropathy group (10.3±5.7)μg/mL (P <0.01),between idiopathic membranous nephropathy group and hepatitis B virus-associated membranous nephropathy group.There was no distinct difference of IgG subtypes deposition in glomerlar capil-lary wall.Conclusion There is obvious clinical significance of concentration of plasma M type phospholipase A2 receptor antibody in differential diagnosis of idiopathic membranous nephropathy and hepatitis B virus-associated membranous nephropathy,while no distinct significance of IgG subtypes deposition.

Delivery of therapeutic siRNA by Tat-LK15 targeting nNOS fusion gene in RGC-5 cells / 中国药理学通报

Aim To investigate the potential applica-tion of a non-viral gene carrier Tat-LK15 for delivering siRNA targeting nNOS in vitro, which provides evi-dence of Tat-LK15 mediating siRNA targeting nNOS in vivo for treatment of neuropathic pain. Methods 1. Tat-LK15 was mixed with siRNA, then the mixture was analyzed the best ratio by Gel retardation. The trans-fection efficiency of FAM-siRNA mediated by Tat-LK15 on RGC-5 cells was examined by Flow Cytome-try. The apoptosis ratio of RGC-5 was identified by Flow Cytometry 24 h after treated with the different do-ses of Tat-LK15 (1, 2. 5, 5, 10 and 20 μg). 2. The model of RGC-5 cell overexpression of nNOS protein was prepared. 3. RGC-5 cells were randomly divided into 5 groups:control group,model group, Tat-S group ( Tat-LK15 mediate nNOS/siRNA transfection model cell) , Lipo-S group ( LipofectamineTM RNAiMAX me-diate nNOS/siRNA transfection model cell) and Tat-N group ( Tat-LK15 mediate NCsiRNA transfection model cell) . Real-time Quantitative polymerase chain reac-tion( Q-PCR) and Western blot were used to evaluate nNOS expression level assay. Results It indicated that the Tat-LK15/siRNA complex completely formed at the weight ratio of 2∶ 1 (μg/μg) , and the transfec-tion efficiency was (84. 4 ± 3. 9)%. It caused cotytox-icity when Tat-LK15 dose was 20 μg ( 6. 1 μmol · L-1 ) , and the apoptosis rate more than control group [(10. 3 ± 1. 1)% vs (7. 4 ± 0. 9)%, P<0. 05]. The nNOS protein level of RGC-5 cells was significantly el-evated after modeling. Compared with that of model group, Tat-LK15/siRNA efficiently inhibited the ex-pression of nNOS at transcriptional level or protein leve1 of Tat-S group ( P <0. 05 ) , and there was no significant difference of the efficiency inhibited between Tat-S group and Lipo-S group. Conclusions Tat-LK15’ advantage is with high efficiency, low cytotox-icity. The Tat-LK15 can deliver siRNA targeting nNOS in vitro efficiently and safely.

Relationship between Postoperative Cognitive Dysfunction and the Level of Preoperative Hemoglobin in Elderly Patients with Type 2 Diabetes Mellitus / 现代检验医学杂志

Objective To investigate the correlation of postoperative cognitive dysfunction (POCD)and the preoperative he-moglobin (HbA1c)in elderly patients with type 2 diabetes mellitus (T2DM).Methods 82 patients with T2DM who were underwent non-cardiac surgery were included in this study,group A had 37 patients with POCD after surgery,group B had 45 patients with non POCD,the patients in two groups used the same anesthesia method,compared the general data and pre-operative HbA1c,fasting blood glucose levels of two groups,compared the incidence of POCD in patients with HbA1c in dif-ferent levels.Results There was no significant difference in gender composition,age,body mass index,preoperative MMSE score,hypertension rate,operation time and bleeding volume in operation,and there was no significant difference in fasting blood glucose of patients in two groups.Fasting blood-glucose (FBG)of two groups were 7.1±2.6 and 6.7±1.8 mmol/L (t=0.821,P=0.424),it was no significant difference;HbA1c of two groups were (7.2±1.3)% and (6.3±1.0)%,the group A was higher than the group B (t=3.543,P=0.001),there was significant difference.The incidence rate of POCD of the group AH was 58.1%(25/43),while the group AL was 30.8% (12/39),the group AH was higher the group AL(χ2=5.131,P=0.024),there was significant difference.Conclusion Preoperative determination of HbA1c in elderly patients with T2DM after surgery has forecast values for the occurrence of POCD,to control HbA1c in the low level can reduce the occurrence of POCD in elderly patients with T2DM.

Influence on expressions of inflammatory cytokines by different postoperative analgesic in elder patients with hip replacement / 实用医学杂志

Objective To evaluate influence of patient-controlled intravenous analgesia (PCIA) and patient-controlled epidural analgesia (PCEA) on expressions of serum inflammatory cytokines in elderly patients with hemi or whole hip replacement using cemented artificial joint. Methods Elderly patients undergoing hip replacement were selected and were divided into PCIA group and PCEA group. VAS scores were calculated at 12 h postoperatively. Patients whose VAS scores were not more than 2 at postoperative 12h were included. 30 cases in each group were finally included. Fifteen cases were randomly chosen in each group and underwent sample blood drawing for assays. Expressions of serum inflammatory cytokines were detected by ELISA , RT-PCR and Western-blot. Results Gene and protein expressions of TNF-a as well as IL-6 in group PCEA were lower and expression of IL-10 was higher than that in group PCIA. Serum level of TGb-β was higher in group PCEA detected by ELISA. There was no significant difference in expression of IL-8 between groups. Conclusions PCEA may better promote expressions of anti-inflammatory cytokines and inhibit expressions of proinflammatory cytokines. PCEA is superior in maintenance of inflammatory cytokine balance.

Effect of intraperitoneal WSLP/NR2B siRNA compound on neuropathic pain in rats / 中华麻醉学杂志

Objective To evaluate the effect of intraperitoneal water soluble lipopolymer (WSLP)/ N-methyl-D-aspartate receptor subunit 2B (NR2B) siRNA compound on the neuropathic pain (NP) in rats.Methods Eighty-four healthy male Sprague-Dawley rats,aged 6 weeks,weighing 180-220 g,were randomly divided into 7 groups (n =12 each) using a random number table:control group (group C),sham operation group (group S),NP group,WSLP/NR2B siRNA group (siWSLP group),WSLP/negative control siRNA group (ncWSLP group),PEI/NR2B siRNA group (PEI group) and WSLP group (WSLP group).NP was produced by ligation of the left L5 spinal nerve.In group S,the left L5 spinal nerve was only exposed,but not ligated.In group C,the rats underwent no treatment.Groups siWSLP,ncWSLP,PEI and WSLP received single intraperitoneal injection of WSLP/NR2B siRNA,WSLP/negative control siRNA,PEI/NR2B siRNA and WSLP compound 2 ml,respectively,at 10 days after NP.At 1 day before operation,7 days after operation,and 3,7,14 and 21 days after intraperitoneal injection,6 rats in each group were chosen randomly to measure mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL).At 3 days after intraperitoneal injection,the left 6 rats in each group were sacrificed and the spinal cord was removed for detection of NP2B mRNA expression (using PCR) and NR2B expression (by Western blot).Results Compared with group C,MWT was significantly decreased,and TWL was shortened on 7 days after operation and 3,7 and 21 days after intraperitoneal injection,and the expression of NR2B mRNA and protein was down-regulated on 3 days after administration in the other groups.Compared with group NP,MWT was significantly increased,and TWL was prolonged on day 3 and 7 after intraperitoneal injection,and the expression of NR2B mRNA and protein was down-regulated on day 3 after administration in siWSLP group.Conclusion Intraperitoneal WSLP/NR2B siRNA compound can effectively relieve the NP in rats.

Role of polymorphisms of the IGF2 and IGFBP3 genes and risk of gastric carcinoma in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The insulin-like growth factor signaling pathway plays an important role in the modulation of cell growth and proliferation. The aim of this study was to investigate the role of polymorphisms of the insulin-like growth factor 2 (IGF2) and IGF-binding protein 3 (IGFBP3) genes, which encode key proteins of this pathway, as risk factors for gastric carcinoma (GC).</p><p><b>METHODS</b>A case-control study including 404 histologically confirmed GC patients and 424 healthy controls of the same ethnicity was conducted to retrospectively investigate the genetic polymorphisms of two genes, IGF2+820A>G (rs680) and IGFBP3 A-202C (rs2854744). Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using Logistic regression.</p><p><b>RESULTS</b>The IGF2 genetic variants examined contributed to GC risk individually (OR, 1.26; 95% CI, 1.08-1.46). The genotype frequencies of IGFBP3 A-202C were not significantly different between the cancer cases and controls (P > 0.05). Compared to the IGF2 AA genotype, carriers of one variant combined genotype were more pronounced among young subjects (<60 years), male subjects, never smokers, and those with a family history of cancer (OR = 1.36, 95% CI = 1.09-1.72, P < 0.05; OR = 1.61, 95% CI = 1.28-2.08, P < 0.05; OR = 1.46, 95% CI = 1.11-1.98, P < 0.05; OR = 1.53, 95% CI = 0.91-2.6, P < 0.05; respectively). Moreover, when the combined effects of the risk genotypes were investigated, significant associations were detected between highrisk genotypes in IGF2 and IGFBP3 (OR, 2.47; 95% CI, 1.75-3.49).</p><p><b>CONCLUSIONS</b>Our results suggest that polymorphic variants of the IGF2 genes modulate gastric carcinogenesis. Moreover, when the IGF2 and IGFBP3 variants are evaluated together, a greater effect on GC risk is observed.</p>

Investigation and analysis of the feedback of seven-year students of clinical medicine about the PBL teaching method / 中华医学教育探索杂志

Objective To understand the feedback of seven-year students of clinical medicine about the application of PBL teaching method and investigate its related factors.Methods Four classes of seven-year students of clinical medicine of Nanjing Medical University which had received PBL teaching method were randomly selected in grade 2009 and 2010 (243 students)and 233 valid questionnaires were analyzed statistically.The questionnaire has four main parts and they are about basic situation,factors that may affect the PBL Teaching,students' subjective attitude,their effect evaluation and suggestion for improvements.SPSS 11.0 was used to analyze the first part of the resuhs withx2 analysis(P＜0.05).Results 233valid questionnaires were recovered and 79.0％(184/233) of students held a favorable position toward PBL application in their course.It is irrelevant to no other related factors but the accessibility of information(P=0.000).More than half of the students think it is suitable for PBL on the clinical medical students(57.5％,134/233),PBL teaching is more free and easy(51.9％,121/233)and can improve their awareness of participation(72.5％,169/233).However more students (193) are in favor of more traditional teaching combined with PBL,with the former dominated.Conclusion PBL teaching method in seven-year clinical medical program has been proved to be quite effective.Though with certain drawbacks,it is a good supplement to the traditional teaching methods in many aspects,and it is definitely of great significance in improving the quality of teaching.

Balloon dilation of pulmonary valve stenosis with 10 F domestic balloon catheter in children≥10 kg / 中国介入心脏病学杂志

Objective To assess the safety and efficacy of balloon dilation of pulmonary valve stenosis with 10 F domestic balloon catheter in children ≥ 10 kg. Methods From May 2009 to June 2014, eighty-three consecutive children with weight ≥ 10 kg and age of (4.5±2.8)(ranged from 1-12) years underwent percutaneous balloon pulmonary valvoloplasty(PBPV) with 10 F domestic balloon catheter. Indication for treatment, procedural details, catheterization data, complication rate, peak-to-peak systolic gradient across the valve and pulmonary insufficiency on echocardiography were respectively analyzed. Forty-four patients were followed up 6-44 months after procedure. Results All procedures were completed successfully. The peak-to-peak systolic gradient across the pulmonary valve decreased from (67.7±26.2) mmHg to (15.4±11.6) mmHg (P < 0.01) immediately after PBPV. Two patients developed reactive infundibular spasm after dilation. They were relieved at 6 months post PBPV. No patient had severe pulmonary insufficiency, tricuspid regurgitation or reintervetion. Conclusions PBPV with 10 F domestic balloon catheter in children with weight≥10 kg is a safe and effective method.