Objective: To explore the effect of high mobility group box-1 protein (HMGB1) on the balance of Th17/Treg in patients with immune thrombocytopenia (ITP). Methods: A total of 30 patients who were first diagnosed as ITP in the Fifth People's Hospital of Datong from July 2017 to April 2018 were selected as the case group, and another 30 healthy volunteers in the corresponding period were taken as the control group. The proportion of Th17 and Treg cells was detected by using flow cytometry, and the concentration of HMGB1, interleukin (IL)-17 and transforming growth factor β (TGF-β) in plasma was tested by using enzyme-linked immunosorbent assay (ELISA). Isolated peripheral blood mononuclear cells (PBMC) were cultured in vitro. After the treatment with recombinant human HMGB1 (rhHMGB1), real-time polymerase chain reaction (RT-PCR) was applied to detect the mRNA expression changes in Treg cell transcription factor intracellular forkhead helix transcription factor 3 (Foxp3) and Th17 cell transcription factor retinoid related orphan receptor γt (RORγt). The differences of indicators in Treg cell transcription factor peripheral blood between the case group and the control group were compared, and the balance correlation between HMGB1 and Th17/Treg was analyzed. Results: Compared with the healthy control group, the proportion of Th17 cells and the expression level of HMGB1 and IL-17 in peripheral blood of ITP patients were increased (all P < 0.01), while the proportion of Treg cells and the level of TGF-β were decreased (all P < 0.01). The proportion of Th17 cells and the expression level of IL-17 and HMGB1 in peripheral blood of ITP patients were positively correlated with the concentration of HMGB1 (all P < 0.01); the proportion of Treg cells and the level of TGF-β were negatively correlated with the expression level of HMGB1 (all P < 0.01). In vitro experiments, the expression of intracellular RORγt mRNA was increased compared with the negative control group (1.50±0.24 vs. 0.93±0.22, t = 9.612, P < 0.01), and the expression of Foxp3 mRNA was decreased compared with the negative control group after the stimulation of PBMC by rhHMGB1 (0.72±0.19 vs. 1.08±0.18, t = 7.387, P < 0.01). Conclusion The high level of HMGB1 in the peripheral blood of ITP patients induces Th17/Treg imbalance and aggravates inflammatory reactions, which may be an important cause of ITP.

Objective To evaluate the effectiveness of uterine arterial embolization (UAE) in the management of uterine fibroids (UF) and adenomyoma. Methods The UAE was carried out in 22 cases of UF and 2 cases of adenomyoma, including bilateral UAE in 23 cases and unilateral UAE in 1 case, by using polyvinyl alcohol (PVA) particles as embolic materials. Results The success rate of UAE in the study was 95 8% (23/24). No serious complications occurred. The uterine and UF volume decreased remarkably in size 6 months after the treatment ( t =2 391 and 3 990, respectively; P =0 022 and 0.000, respectively). In the patient who underwent unilateral UAE, the UF gradually increased in size and a hysterectomy was required. The 2 patients with adenomyoma experienced relief with this treatment but had a recurrence 4 months after the surgery. Conclusions UAE is a safe and effective method in the management of UF but its long-term effects remains a question to be answered through further observations . The efficacy of treatment of this method for adenomyoma is not apparent.

Objective: To investigate the effect of intraoperative routine fluid therapy and goal-directed fluid therapy(GDFT) by FloTrac/Vigileo monitoring system on the recovery of intestinal function in aged patients with rectal cancer. Methods: Sixty ASAⅠ~Ⅲ patients undergoing laparoscopic anterior resection of rectal cancer(Dixon operation), who were treated in the Third People's Hospital of Datong from August 2018 to May 2019 were selected and randomly divided into two groups according to the digital table, with 30 cases in each group.Group C received routine intraoperative fluid administration, and the total rate of fluid=deficit+ maintenance administration+ loss+ third space losses.Group G fluid therapy goal: cardiac index (CI) 2.5~4.0 L·min^-1·(m²)^-1, stroke volume variability (SVV)<13%, mean arterial pressure (MAP) 65~110 mmHg; if CI<2.5 L·min^-1·(m²)^-1, SVV>13%, rapidly infused sodium lactate Ringer's injection 3 mL/kg(within 10 min via an infusion pump); if CI<2.5 L·min^-1·(m²)^-1, SVV<13%, infused dobutamine; if MAP<65 mmHg, CI≥2.5 L·min^-1·(m²)^-1, infused norepinephrine.Two groups were continously infused sodium lactate Ringer's injection 3 mL·kg^-1·h^-1.Equivalent volume 6% hetastarch was infused to supplement the blood loss.During the operation, Hb<80 g/L and red blood cells were transfused when bleeding continued.The total fluid intake, bleeding volume, urine volume, postoperative hospital stay days, postoperative intestinal function recovery(postoperative flatus time and eating time), the incidence of postoperative intestinal complications(postoperative inflammatory bowel obstruction, anastomotic leakage and anastomotic bleeding) were recorded.Intestinal fatty aid binding protein (iFABP) was measured at T0(before the induction), T1(at the end of surgery), T2(2 h after surgery), T3(24 h after surgery) by using ELISA kits. Results: The intraoperative fluid intake was (2 051±466)mL in group C, and (1 811±413)mL in group G, there was statistically significant difference between the two groups(t=2.111, P=0.039). The postoperative exhaust time and hospitalization days in group G were 28.6(23.3, 32.1)h and 10.2(9.9, 12.1)d, respecticely, which were shorter than those in group C [32.6(27.1, 40.9)h and 11.6(10.7, 12.2)d] (Z=2.321, P=0.020, Z=2.435, P=0.015). The incidence of postoperative complications was 13%(4/30) in group C, and 10%(3/30) in group G, there was no statistically significant difference(P>0.05). The iFABP of group C at T1 and T2 after operation was significantly higher than those of group G(t=2.445, 3.098, P=0.018, 0.003). Conclusion GDFT can reduce intraoperative crystalloid infusion, promote early intestinal function recovery in elderly patients with rectal cancer, and reduce perioperative intestinal mucosal ischemic injury.

【Objective】 To explore the effect and mechanism of Fasudil in the treatment of experimental autoimmune myocarditis (EAM) in mice so as to provide a theoretical basis for the clinical use of Fasudil in treating myocarditis. 【Methods】 Balb/c male mice were used as the research objects, and the EAM mice model was constructed using MyHC-α614-629 polypeptide. Mononuclear cells were isolated and cultured to detect the number of mononuclear cells in mouse spleen. Inflammation infiltration, fibrosis and IL-6 expression in mouse myocardial tissue were detected by HE staining, Masson staining and immunohistochemistry, respectively. The protein expressions of Notch1 and IL-6 were detected by Western blotting. qRT-PCR was used to detect the expressions of pro-inflammatory factors (IL-1α, IL-1β and IL-6) as well as key genes of TLRs and NOTCH signaling pathway. 【Results】 EAM mice showed increased HW, decreased BW, increased HW/e-BW, and increased inflammatory infiltration and fibrosis in myocardial tissue. The above-mentioned symptoms or pathological features were improved in EAM mice treated with Fasudil. The analysis showed that the pro-inflammatory factors IL-1α, IL-1β and IL-6 in the myocardial tissue of EAM mice were significantly increased, but only the expression of IL-6 was statistically different after Fasudil treatment compared with the control group. In addition, TLRs signaling pathway might also play an important role in the EAM mice treated with Fasudil. The expressions of IL-6 and Notch1 were consistent, and the expressions of the key genes of NOTCH signaling pathway (Notch1, Hes1 and Jag2) were down-regulated after Fasudil treatment. 【Conclusion】 Fasudil exerts a protective effect on down-regulation of IL-6 expression by inhibiting the NOTCH signaling pathway in EAM mice.

Objective To inspect the correlation of synthetic effect criteria to sensitivity,reliability of late stage lung cancer curative effect verdict and median survival time. Method Using size change of tumor,symptom change related to tumor,Karnofsky score,body weight etc.as synthetic effect criteria and nstituting clinical synthetic effect criteria,to assess the curative effect of late stage lung cancer patients who received different treatment in department of tumor of Xiyuan Hospital between March 1997 and March 2000, to analysis medium survival time, and being compared with RR of tumor.Result 52 patients entered this experiment, in which 42 patients were assessable (follow up), 13 patients were effective(30.95％ ),17 were patients stable(40.48％ ),12 patients deteriorated (28.57％ ).The result of tumor objective remission rate: CR is 0,PR is 16.67％ (7 patients),NC is 64.29％ (27 patients) and PD is 19.05％ (8 patients).There was apparent difference between two effect criteria(P< 0.05).The mean survival time of this group is (9.3± 1.6)months,median survival time is 10.5 months(2～ 8months),survival rate of one year is 33.33％ (14 patients).In the patients who live longer than median survival time, most of them survive associated with tumor existence who are in NC of tumor objective remission rate, but also in the effective column of synthetic effect criteria. Compared with tumor objective remission rate,the synthetic effect criteria have more apparent correlation to survival time. Conclusion In the assessment of late stage lung cancer,synthetic effect criteria has better sensitivity and reliability,and emphasize survival quality,at same time it reflect the reaction of tumor and host to treatment,it reflect prognosis of tumor preferably and have better correlation to the survival time. It can be used as clinical effect criteria of late stage lung cancer after further consummation.

Objective To evaluate the effect of inhibition of ubiquitin carboxy terminal hydrolase LI (UCHL1) on cerebral ischemia/reperfusion injury in mice. Methods Male BALB/c mice were randomly divided into sham group, ischemia/reperfusion (I/R) group, UCHL1 small interfering RNA (siRNA)group and scramble siRNA (control) group, 10 mice in each group. I/R model was established by reperfusion 24 hours after middle cerebral artery occlusion (MCAO) 60 minutes. In the siRNA group and control group, 10 JJLI UCHL1 siRNA or scramble siRNA was injected into the brain through the lateral ventricle 24 hours before MCAO. The expression of UCHL1 was detected by RT-PCR and Western blotting; the volume of cerebral infarction and the rate of edema were assessed by 2, 3, 5-triphenyl tetrazolium chloride (TTC) staining; and the score of neurological symptoms was assessed by neurobehavioral scoring. Results Compared with the sham group, the level of UCHL1 mRNA and protein in ischemic penumbra of I/R group were significantly higher (P< 0.05), while the expression of UCHL1 protein and mRNA in siRNA group were significantly lower (P< 0.05); at the same time, the volume of cerebral infarction, edema rate and neurobehavioral damage in I/R group increased significantly, while the volume and edema rate of cerebral infarction and neurobehavioral damage in siRNA group further increased (P< 0.05). Conclusion Inhibition of UCHL1 can aggravate the cerebral ischemia/reperfusion injury in mice, suggesting that the induction of UCHL1 after MCAO has a protective effect on the cerebral ischemia/reperfusion injury in mice.

OBJECTIVETo investigate the efficacy of pressure reduction by peritoneal catheterization in patients with malignant ascites-induced abdominal compartment syndrome (ACS).

METHODSClinical data of 29 patients with malignant ascites-induced ACS from October 2002 to October 2008 were analyzed retrospectively. Intra-abdominal pressure (IAP) was reduced by peritoneal catheterization. Changes of intra-abdominal pressure and ascites volume were observed during treatment. Clinical signs and urinary volume were monitored.

RESULTSIAP was less than 25 cm H(2)O in 2 cases, 25 to 35 cm H(2)O in 21 cases, more than 35 cm H(2)O in 6 cases. IAP decreased significantly after drainage of 1000 to 1500 ml of ascites, then IAP curve leveled off. With all the ascites drained, IAP maintained at 11 to 12 cm H(2)O and at 6 to 8 cm H(2)O after 24 hours. Blood pressure was stable without significant changes before and after IAP reduction (P>0.05). The breathing rate and heart rate were improved, and 24 h urinary volume increased significantly after IAP reduction (P<0.01).

CONCLUSIONEarly peritoneal catheterization can improve the cardiac, pulmonary, and renal function in malignant ascites-induced ACS.

Adult ; Aged ; Aged, 80 and over ; Ascites ; complications ; etiology ; Catheterization ; Compartment Syndromes ; etiology ; surgery ; Decompression, Surgical ; methods ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

AIMThe present study was designed to determined the cardiovascular effects of IMD1-53 in rats and its possible mechanism.

METHODSIsolated rat hearts were perfused by Iangendorff mode, and ventricular function was measured after IMD1-53 perfusion. Meanwhere, we investigated the effects of IMDI) on arterial pressure after intravenous administration of IMD. And cAMP content was detected in rat ventricular and aortic tissues.

RESULTSThe results showed that perfusion with IMD significantly enhanced cardiac function and resulted in higher LVSP, +dp/dt(max) and -dp/dt(max) by 45%, 51% and 37%, respectively, compared with control and increased coronary infusion flow. The effects of IMD1-53 on cardiac function were antagonized by H-89, an inhibitor of PKA. The content of cAMP in the ventricular tissues after IMD perfusion was 131% higher than control. In addition, intravenous administration of IMD induced a potent decrease in arterial pressureand heart rate, and in aortic tissues, IMD incubation resulted in a 236% increase in cAMP content compared with control group.

CONCLUSIONThe study reveals that IMD can increase cardiac function and decrease arterial pressure in rat and the effects may be related to cAMP pathway.

Adrenomedullin ; metabolism ; pharmacology ; Animals ; Blood Pressure ; drug effects ; Cardiovascular Physiological Phenomena ; drug effects ; Cyclic AMP ; metabolism ; Heart ; drug effects ; In Vitro Techniques ; Male ; Neuropeptides ; metabolism ; pharmacology ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Ventricular Function ; drug effects

OBJECTIVETo investigate the expression of placenta-derived RASSF1A gene in maternal plasma during first and second trimesters, and to explore its value for the prediction of pre-eclampsia.

METHODSFor 325 pregnant women of the first trimester, free DNA of plasma samples was extracted at 7-12, 13-18, and 19-24 gestational weeks, respectively. Methylation-sensitive restriction enzyme digestion followed by fluorescence quantitative PCR (MSRE+ PCR) was employed for analyzing the concentrations of hypermethylated RASSF1A gene. Blood pressure, proteinuria and clinical feature were monitored at the same time. Those who had subsequently developed pre-eclampsia were selected as the pre-eclamptic group, 30 normal pregnant women were selected as the control group. Hypermethylated RASSF1A gene in maternal plasma was retrospectively analyzed. The relationship between clinical classification, type of pre-eclampsia and concentrations of the gene were further analyzed.

RESULTSTwenty-six out of the 325 pregnant women developed pre-eclampsia as their only complication. At 13-18 gestational weeks, the mean concentrations of fetus-specific RASSF1A sequences were 141.62 copies/mL in maternal plasma of pre-eclamptic pregnancies, which was significantly greater than that of the controls (98.90 copies/mL). Fetus-derived RASSF1A levels were 2.03 fold higher in pre-eclamptic subjects than controls at 19-24 gestational weeks. There was a significant difference in the level of hypermethylated RASSF1A gene between the mild and severe pre-clamptic subjects at 13-24 gestational weeks (P< 0.05). The concentrations of the sequences were significantly higher in early-onset severe pre-eclampsia than late-onset severe pre-eclampsia at 19-24 gestational weeks (P< 0.05).

CONCLUSIONAltered expression of hypermethylated RASSF1A gene may be detected in maternal plasma during second trimester, which has important significance for early prediction of pre-eclampsia.

Female ; Gestational Age ; Humans ; Placenta ; metabolism ; Pre-Eclampsia ; blood ; diagnosis ; genetics ; metabolism ; Predictive Value of Tests ; Pregnancy ; Pregnancy Trimester, Second ; Prenatal Diagnosis ; methods ; Tumor Suppressor Proteins ; blood ; genetics

Objective To explore the value of peripheral blood serum levels of PCT,CRP,TNF-α and free DNA of cells in predicting the development of MODS in patients with multiple trauma.Methods Complete detail clinical data of 54 casualties with multiple trauma admitted within 24 hours after accident from January 2011 through January 2012 were collected for retrospective study.The patients were divided into MODS group and non-MODS group according the criteria set forth by the Chinese Society of Critical Care and Emergency Medicine in 1995 national conference.The data of two groups are comparable,and data of another 20 healthy subjects undertaking routine annual physical examination were taken as control.The peripheral blood levels of PCT,CRP,TNF-α and free DNA of patients of two groups were determined 1 d,2 d,3 d,and 5 days after admission.Then the results were analyzed and compared between groups.Results Compared with non MODS group,the levels of PCT,CRP,free DNA of cells in MODS group were significantly higher (P ＜ 0.05),but there was no deference in TNF-α between MODS group and non-MODS group (P ＞ 0.05).When the relative risks of increased PCT (PCT≥6 mg/L),increased CRP (CRP≥ 130 mg/L)、and increased free DNA of cells (free DNA ≥ 10 0005/L) were analyzed,the presence of these 3 biomarkers with high levels occurred at the same time was the most accurate way to predicts MODS in 6.00 relative risk (RR),and the positive predictive value was 100％.Conclusions PCT,CRP,free DNA of cells could be the predictors of MODS in patients with severe multiple trauma,and the presence of high levels of these three biomarkers appearing together had high sensitivity and specificity for prediction.