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OBJECTIVE To prepare quercetin-human serum albumin-nanoparticles （Que-HSA-NPs），and to evaluate the in vivo and in vitro inhibitory effects of Que-HSA-NPs on hepatic fibrosis of non-alcoholic steatohepatitis （NASH）. METHODS Que-HSA-NPs were prepared by desolvation-chemical cross-linking method ，their appearance characteristics were observed ，and their particle size ，polydispersity index （PDI），Zeta potential and drug loading were detected. Quercetin （Que）and Que-HSA-NPs were applied to murine HSC-T 6 cells. The effects of them on survival rate of HSC-T 6，mRNA expression of transforming growth factor β（TGF-β），Type Ⅰ collagen α1（COL1A1）and α-smooth muscle actin （α-SMA）were compared. Que and Que-HSA-NPs were applied to mice fed with low methionine and choline deficient high-fat diet. The serum levels of liver injury indexes ，liver pathological characteristics ，mRNA expressions of TGF-β，COL1A1 and α-SMA，protein expression of α-SMA in liver tissue were determined to evaluate the improvement effects of them on hepatic fibrosis of NASH in mice. RESULTS The prepared Que-HSA-NPs was spherical ，the particle size was （172.9±2.2）nm，the PDI was 0.233，the Zeta potential was －29.2 mV，and the drug loading was 2.99％. Que and Que-HSA-NPs were nontoxic to HSC-T 6 at concentrations of 0-250 μg/mL. Both of them could significantly decrease mRNA expressions of TGF-β，COL1A1 and α-SMA，especially Que-HSA-NPs （P＜0.05）. They also could significantly decrease the serum levels of liver inju ry index ，relieve liver injury and down-regulate mRNA expressions of TGF-β，COL1A1 and α-SMA and protein expression of α-SMA， especially Que-HSA-NPs （P＜0.05）. CONCLUSIONS Que- HSA-NPs is successfully prepared ，and confirm that its anti- NASH hepatic fibrosis effect is better than that of Que .
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Objective:To investigate the serum hepcidin level and risk factors associated with peripheral arterial disease (PAD) and foot ulcer in type 2 diabetic patients.Methods:From January 2019 to June 2019, 70 patients with type 2 diabetes in Department of Endocrinology of Xiangya Third Hospital were selected, including 21 newly diagnosed patients with type 2 diabetes (DM group), 23 patients with lower extremity vascular disease (PAD group) and 26 patients with foot ulcer (DF group). Serum hepcidin was determined by enzyme linked immunosorbent assay (ELISA). The serum levels of hepcidin in different groups were compared, and the correlation between diabetic lower extremity vascular disease and foot ulcer was analyzed.Results:⑴ The hemoglobin, albumin, triglycerides and total cholesterol were significantly lower in DF group compared with PAD and DM groups ( P<0.05), while the DF group patients were with higher white blood cell (WBC) count and high sensitivity C reactive protein (hs-CRP) than patients in PAD and DM groups ( P<0.05). DF group also showed significantly higher WBC, hs-CRP and neutrophil ratio level (NEUT%) than DM group ( P<0.05). The inflammatory indicators of WBC, hs-CRP and NEUT% showed no significant difference between DM group and PAD group ( P>0.05). ⑵ The levels of hepcidin in DF and PAD groups were higher than those in DM group, while that in DF group were higher than those in PAD group ( P<0.05); Hepcidin was positively correlated with systolic blood pressure, WBC count, NEUT% and ferritin ( P<0.05), and negatively correlated with hemoglobin, glycosylated hemoglobin, albumin and 25-hydroxyvitamin D ( P<0.05). ⑶ Binary multivariate logistic regression analysis showed that elevated hepcidin level was an independent risk factor for diabetic foot ulcer [ OR=1.755, 95% CI: 1.063-2.897, P=0.028]. Conclusions:The fluctuation of serum hepcidin level in diabetic patients is related to the stimulation of inflammation, the degree of anemia and the nutritional status, which means it might be an early indicator of inflammation in diabetic patients with peripheral arterial disease. Moreover, the increase of hepcidin is an independent risk factor for diabetic foot ulcers in our study.
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Objective@#To define the connotation of village doctors′ vulnerability.@*Methods@#On the basis of document analysis, Delphic method was used to consult and argument the connotation of village doctors′ vulnerability from October 2015 to November 2015.@*Results@#Twenty and 16 specialists were consulted in two rounds of the consulting. According to these consultations, the acceptance rate of the specialists for the seven consulting units increased from 74.29% to 93.16%.@*Conclusions@#The vulnerability of village doctors was identified, as a status in which their self-ability and support against their exterior environment could not to cope with the disturbances they faced, while the vulnerability was co-determined by disturbance and response ability of village doctors.
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Objective:To investigate the safety and effect of the operation of the upper sternum small incision assisted by normothermic cardiopulmonary bypass in the treatment of aortic valve disease.Methods:From March 2014 to June 2016, the clinical data of 25 patients who underwent single incision minimally invasive aortic valve replacement assisted by normothermic cardiopulmonary bypass in The Second Hospital of Hebei Medical University and 25 patients who underwent aortic valve replacement under hypothermia cardiopulmonary bypass were analyzed retrospectively.The former was used as minimally invasive surgery group, and the sternum was sawn in " J" shape through a small incision on the upper sternum.In the latter group, aortic valve replacement was performed under cardiopulmonary bypass.The operation effect and complications of the two groups were compared.Results:There was no death in the two groups.There was no significant difference in operation time between minimally invasive surgery group and routine operation group ( P>0.05). The time of aortic occlusion and cardiopulmonary bypass in minimally invasive surgery group ((50.0±6.8), (69.5±9.7) min) was longer than those in routine operation group ((45.8±7.2), (65.0±8.8) min), the difference was statistically significant ( t=2.120, 2.052, all P<0.05). In the minimally invasive operation group, red cell volume, plasma volume, intraoperative bleeding volume, incision length, postoperative 24-h drainage volume, postoperative 24-h leukocyte count, postoperative 24-h C-reactive protein concentration, postoperative 24-h total blood transfusion volume, ventilator-assisted time, ICU stay time and drainage tube retention time(85.1(42.3, 181.3) ml, 108.5(79.4, 173.8) ml, 186.4(132.6, 307.6) ml, (4.2±0.8) cm, 130.0(88.1, 224.3) ml, 14.2(9.8, 17.1)×10 9/L, 14.0(9.9, 23.2) mg/L, 186.6(135.3, 302.1) ml, 3.7(2.3, 6.8) h, 25.2(20.6, 35.6) h, 31.2(26.4, 41.9) h) were lower than those in the routine operation group (354.2(150.2, 507.2) ml, 211.9(119.2, 281.5) ml, 378.4(220.9, 496.5) ml, (13.8±6.5) cm, 365.8(171.8, 511.3) ml, 20.4(13.6, 24.7)×10 9/L, 28.6(14.4, 39.3) mg/L, 405.1(185.3, 570.1) ml, 7.7(4.2, 10.2) h, 52.8(30.8, 69.3) h, 57.2(37.6, 71.9) h), the difference between the two groups was statistically significant ((the statistical values were Z=3.393, 2.696, 2.781, t=7.329, Z=3.151, 2.638, 2.493, 2.597, 2.472, 3.254, 3.338, respectively; all P<0.05). There was no significant difference between the minimally invasive operation group and the routine operation group( P>0.05). The total incidence of postoperative complications in the minimally invasive operation group and the routine operation group was (12% (3/25) and 44% (11/25)), the difference was statistically significant ( P=0.025). Conclusion:CPB with normal temperature has the advantages of less trauma, fewer complications and faster recovery in the operation of single incision in the upper part of sternum.
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Objective:To define the connotation of village doctors′ vulnerability.Methods:On the basis of document analysis, Delphic method was used to consult and argument the connotation of village doctors′ vulnerability from October 2015 to November 2015.Results:Twenty and 16 specialists were consulted in two rounds of the consulting. According to these consultations, the acceptance rate of the specialists for the seven consulting units increased from 74.29% to 93.16%.Conclusions:The vulnerability of village doctors was identified, as a status in which their self-ability and support against their exterior environment could not to cope with the disturbances they faced, while the vulnerability was co-determined by disturbance and response ability of village doctors.
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Objective To characterize the expressions of androgen receptor (AR) and estrogen receptor (ER) in penis skin of patients with congenital hypospadias. Methods Dorsal prepuce, ventral prepuce, and urethral plate were harvested from 30 patients with congenital hypospadias. The expressions of AR and ER in epidermal cells and dermal fibroblasts were assessed respectively by automated immunohistochemistry. Image Pro plus 6.0 was used to analyze the optical density (OD) value of AR and ER in different parts of epidermal cells and dermal fibroblasts. Results AR and ER were located mainly in nucleis of the squamous basal cells and prickle cells, and were also found in nucleis of subcutaneous fibroblast cells. The expression of AR was lower in epidermis of urethral plate than that of dorsal prepuce and ventral prepuce (P<0.05), but no significant difference was detected in dermal fibroblasts. The expression of ER was higher in epidermis of dorsal prepuce than that of urethral plate and ventral prepuce (P<0.05). The dermal expression of ER in fibroblast cells was increased successively in dorsal prepuce, ventral prepuce and urethral plate (P<0.05). Conclusion Lower expression of AR in urethral plate may contribute the development of hypospadias. Disorder of ER in dermal fibroblast cells of prepuce may play an important role in hypospadias.
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Objective To explore the operative indication operation time and post-operative care for infants with large ventricular septal defects (VSD).Methods Eighty-eight infants who suffered from large VSD were selected,male 53 cases,female 35 cases,aged from 3 to 18 months[average (7.5-±2.9) months],weight from 5 to 13 kg [average (7.9 ± 1.9) kg].All patients underwent VSD repair and other accompanied anomaly corrections under cardiopulmonary bypass.Fifty-eight cases were operated through right atrium,14 cases through pulmonary artery and 16 cases through right ventricle.Patch repairs were done in all patients,78 cases given bovine pericardium patches,10 cases given self pericardium patches treated by Glutaral.Patients were sent to the intensive care unit after surgery,vasoactive drugs were used as a routine method.Antibotics were selected based on their sputum cultures postoperatively.Nutritional support was given in the earlier stage.Results There were no hospital death,average hospitalization days were (15.2 ± 5.9) days (from 11 to 32 days).The main complication were pneumonia (5 cases),bad coalesce of incision (4 cases),atelectasis (3 cases),minimal residual shunt of VSD (3 cases).All patients were discharged from hospital,76 cases were followed up from 1 to 12 months,2 cases had residual shunt of VSD,the residual shunt of the other case disappeared;76 patients had no clinical symptom,28 patients body weight returned to normal after 6 months of operation.There was no other complication and death.Conclusion Early surgical treatment for infants with large VSD is a safe and effective way with a better prognosis.
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Objective To investigate the dynamic changes in the fibrinolytic system during and after open heart surgery performed with cardiopulmonary bypass (CPB) and the effect of epsilon-aminocaproic acid (EACA) on fibrinolysis, postoperative blood loss and transfusion requirements.Methods Forty patients (24 males, 16 females) aged 17-43 yr undergoing valve replacement with CPB were randomized to receive EACA 200 mg?kg-1 (group A) or normal saline (group B) added to the priming solution. The patients were premedicated with intramuscular morphine 0.2 mg?kg-1 and scopolamine 0.3 mg. Anesthesia was induced with midazolam 0.2 mg ? kg, fentanyl 10 ?g?kg-1 and vecuronium 0.1 mg?kg-1 and maintained with isoflurane inhalation and intermittent i.v. boluses of fentanyl and vecuronium. The patients were mechanically ventilated (VT = 10 ml?kg-1 , RR = 10-12 bpm, I:E = 1:2) after tracheal intubation. Blood samples were taken before skin incision (baseline) , 8 and 30 min on CPB, 10 min after protamine administration and 2 h after operation for determination of tissue type plasminogen activator (t-PA) activity, plasminogen activator inhibitor (PAI) activity, plasmin (Plm) activity and D-dimer. The amount of blood drained from chest and bank blood infused within 24 h after operation were recorded.Results (1) Group B (control group): PAI activity was maintained stable perioperatively. The t-PA activity and t-PA/PAI ratio increased significantly during operation but returned to the baseline value 2 h after operation. D-dimer level also significantly increased during and after operation. The Plm activity increased significantly at 8h on CPB and 10 min after protamine administration compared to the baseline value. (2) The t-PA activity and t-PA /PAI ratio were significantly lower in group A than in group B. The D-dimer level and Plm activity were also significantly lower in group A than in group B during and after operation. The amount of blood loss and bank blood infused within 24 h after operation was 40% and 37% less than that in group B.Conclusion Fibrinolytic system is activated during CPB as shown by the increase in plasminogen and t-PA/PAI ratio. EACA is effective in reducing postoperative blood loss and blood transfusion through inhibition of the activation of fibrinolytic system.