Objective To retrospect and probe the clinical applied value and the results of iliac bone with the deep circumflex iliac vessel transplantation for the treatment of avascular necrosis of femoral head.Methods With a composite procedure including synovectomy,fenestration,curettage and vascularized iliac bone graft with pedicle of the ipsilateral deep circumflex iliac vessels.Results Follow-up period average 2 years 8 months(range:for 6 month-5 years) and all patients were roentgenographied.According to new grading treatment system four items and six grades for avascular necrosis of femoral head was evaluated.Excellent and good rate was 84 4%.Post-operative radiological assessment demonstrated that there was no incidence of deterioration or further collapse of the femoral head and certain extent of re-sphering and re-surfacing of the head was observed in all of the collapsed heads.Conclusions The results of this study suggest that the technique is suitable for the treatment of avascular necrosis of femoral head of the stage Ⅰ Ⅱ Ⅲ and younger patients of late stage.

The sagittal and transverse diameters of spinal canal were measured from 344 cases including dry specimens,preserved vertebral colomns and X-ray films.Based on these data several conclusions have been drawn. (1)The morphology of spinal canal is consistent with the external feature of spinal cord. (2)The mean values of various measurement of cervical(C),thoracic(T),and lumbar(L)vertebrae of spinal canal in dry specimens are as follows: Transverse diameter(mm.) Sagittal diameter(mm.) C T L C T L Male 23.6 16.7 23.4 14.4 14.9 16.5 Eemale 23.1 16.1 22.4 13.7 14.2 16.0 (3)The mean values of measurement of spinal canal in X-ray films are as fol- lows: Transverse diameter(mm.) Sagittal diameter(mm.) L C L Male 27.8 16.5 19.8 Female 27.0 15.7 19.1 The data measured from X-ray films are approximately 20% larger than those from the actual specimens. (4)The ratio between the sagittal diameters of the cervical canal and vertebral body is 80～90% in male and 90～100% in female.The normal ratio between the products of sagittal and transverse diameters of the lumbar spinal canal and of the vertebral body is 1:4.Ratios lower than this value is considered to denote a diagnostic significance for spinal stenosis.

Objective:To explore the protective effect of curcumin on type 2 diabetic nephropathy rats and the possible mechanism.Methods:30 Wistar rats were randomly divided into control group,the DN group and curcumin group,10 cases in each group,rats in DN and curcumin group were fed with high fat,after that they were used the streptozotocin injection to set up DN model.In addition,rats in curcumin group were given 200 mg/kg curcumin once a day,other two group were given sodium carboxymethylcellulose half-and-half.After 12 weeks,the 24 h urine were collected at the last delivery,the blood glucose(BG),total cholesterol(TC),triglyceride(TG),blood urea nitrogen(BUN),serum creatinine(Scr),microalbu minuria(mAlb) were tested,the urinary albumin excretion rate(UAER) was calculated.Furthermore,rats were sacrificed,kidney mass weighed,and the kidney index(KI) was calculated.Renal cortical was fixed with polymers cresol for hematoxylin-eosin(HE) staining,renal cortical was also made renal cortex homogenate and the SOD activity,MDA were detected,the expression of nuclear factor related factor 2(Nrf2) and heme oxygenase 1(HO-1) protein in the kidney tissues was detected with Western blot detection.Results:BG,TC,TG,KI,BUN,Scr,UAER,MDA of DN group and curcumin group were significantly higher than control group,and BM,KM,SOD was significantly lower than the control group,the amplitude raising or reducing in curcumin group were less than DN group,the difference had statistical significance(P<0.05);HE staining results showed that,compared with DN group,renal tubule degeneration in curcumin group was obviously reduced,inflammatory cells infiltration was decreased significantly;Western blot results showed that expression of Nrf2 and HO-1 protein in control group were significantly lower than DN group and curcumin group,and curcumin group was significantly higher than the DN group,the differences were statistically significant(P<0.05).Conclusion:Curcumin may play a role of kidney protection through the activation of Nrf2/ARE signaling pathway to reduce oxidative stress in diabetic nephropathy rats.

1.The sagittal and transverse diameters of 1,456 transverse foramina in 728cervical vertebrae were measured.The data are as follows:transverse diameter(mm) sagittal diameter (mm)Left Right Left RightMale(702 cases) 6.0?1.0 5.9?1.1 5.4?1.2 5.3?1.1Female(754 cases) 5.9?1.0 5.8?1.1 5.3?1.1 5.1?1.12.Among the 710 transverse foramina of 357 cervical vertebrae observed,mostof them are of the elliptical type.3.19.3% of double transverse foramen were found in 710 transverse foraminawhich were mostly encountered at the 6 th cervical vertebra.4.The mean value of the external diameter of the cervical part of the vertebralartery is 4?0.7mm.in 40 sides of specimens.5.63.1% of the vertebral artery in the 710 transverse foramina were foundmedial to its accompanying vein.6.According to the relationship between the sagittal(X_1)and transversediameter(X_2)of the transverse foramen and the diameter(Y)of the vertebralartery,a formula,(?)=1.859+0.172 X_1+0.24 X_2,of multiple regression was formulatedThus,the estimated diameter of the vertebral artery from the sagittal diameter X_1and transverse diameter X_2 of the transverse foramen could be obtained and it maybe helpful for clinical practice.7.In case of arthrosis,the vertebral artery could be compressed by the unco-vertebral joint which are found mostly at the level of the 4～5th cervicalvertebrae.

OBJECTIVE: To observe the correlated serum inflammatory factor and cytokine changes in patients with coronary stent implantation, and to explore the significance of these changes.METHODS: Chinese Journal Full-Text Database was retrieved with search terms of coronary artery disease, percutaneous coronary interventions, inflammation, intimal hyperplasia, apoptosis and platelet-derived growth factor from 1995 to 2008. The language was restrained Chinese. A total of 17 literatures were collected, which concerns the changes of correlated inflammatory factor and cytokine levels and its significance. The literatures were sorted according to research object, experimental grouping,sample collection, assay method, experimental result, as well as experimental conclusion. Simultaneously, the patients received coronary stent implantation was analyzed to explore the significance of inflammatory factor and cytokine changes.RESULTS: The dynamic changed serum inflammatory factor and cytokine in patients with coronary stent implantation may be associated with the following mechanisms:①Endothelial cells were easily damaged in the balloon dilatation or stent implantation,therefore, inflammatory mediators or inflammatory factors were exposed to blood circulation, which stimulating neutrophilic granulocytes and up-regulating leukocyte adhesion molecule CD11b expression. ②Many stimulus could arise nuclear factor induced inflammatory reaction, produce interleukin 6, and stimulate C-reactive protein generation. ③The level of angiotensin Ⅱ increased at several days following stent implantation, and heightened with time prolonged, the proliferation of angiotensin Ⅱ was regulated by platelet-derived growth factor. By increasing the expression of endothelin, the synthesis of endothelin was accelerated, the proliferation and migration of vascular smooth muscle cells was promoted, which ultimately resulted in atherogenesis, balloon damage also involved in this process, which may be one of the mechanisms of restenosis.CONCLUSION: The changes of correlated inflammatory factor and cytokine can be served as inflammatory reaction indexes;moreover, soluble CD40 ligand, C-reactive protein and matrix metalloproteinase 9 may be associated with in-stent restenosis.

Crush syndrome in patients rescued from earthquake is a complex clinical syndrome with many medical conditions.The most complications are hyperkalemia,acute kidney injury,shock,infection,ARDS,malnutrition and multiorgan dysfunction.Managing these critical issues appropriately is essential for effective treatment of the crush syndrome.

【Objective】To observe the expression of PI3-K phosphorylated products and elucidate the correlation between PI3-K phosphorylated products and Th2 cytokine in peripheral blood mononuclear cell (PBMC).【Methods】14 patients with active lupus nephritis and 12 controls were selected,PI3-K phosphorylated products were detected by immunoprecipitation and Western blotting,RT-PCR was used to observe interleukin-6 mRNA and interleukin-10 mRNA expression.【Results】In either spontaneous condition or stimulated by anti-CD3 antibody,the expression of PI3-K phosphorylated products in patients with active lupus nephritis were higher than those of the controls(1.14±0.23 vs 0.46±(0.12，P=0.023;2.09±0.63 vs 0.65±0.14，P=0.016).The expression of PI3-K phosphorylated products in active lupus nephritis showed a positive correlation with interleukin-6 mRNA and interleukin-10 mRNA (r=0.652,P=0.008;r=0.718,P=0.007).PY294002,one of specific inhibitor of PI3-K,inhibited significantly the expression of interleukin-6 mRNA(2.32±0.51 vs 0.57±0.15,P=0.009) and interleukin-10 mRNA (1.71±0.33 vs 0.67±0.11,P=0.006) in stimulated PBMC in active lupus nephritis.【Conclusion】PI3-K can involve in the pathogenesis of lupus nephritis by inducing the overexpression of interleukin-6 and interleukin-10.

We immobilized carbonic anhydrase (CA) onto the surface of membrane oxygenator of polymethyl pentene (PMP) to enhance the removal of carbon dioxide in blood by two steps. We first introduced hydroxyl groups onto PMP surface by water plasma treatment, and then coupled CA onto PMP surface by using cyanate bromide (CNBr) as a crosslinker. After plasma treatment, the contact angle with water and chemical composition of PMP surface were characterized by analysis system of surface contact angle and XPS. Using p-nitrophenyl acetate (p-NPA) as a substrate, the activity, concentration, storage stability and re-usability of immobilized CA on PMP hollow fibers were studied by ultraviolet spectrophotometer. The preliminary data showed that hydroxyl groups could be introduced on the surface of PMP by water plasma treatment, and CA with catalysis activity could be successfully introduced onto PMP surface in high immobilization efficiency. The activity of covalently immobilized CA increased with the increase of concentration of CNBr, and the maximum was 73% of the theoretical activity of CA spread on PMP surface in monolayer in studied range. Covalently immobilized CA showed higher reusability compared to physically adsorbed CA, and higher storage stability compared to free CA in solution at 37 degrees C. The method would be used potentially in the membrane oxygenator to improve the capacity of removal of carbon dioxide in blood in the future.
Carbonic Anhydrases ; chemistry ; metabolism ; Enzymes, Immobilized ; Membranes, Artificial ; Oxygenators, Membrane ; Polyenes ; chemistry

Objective:To investigate the effect of Liangxue Huoxue decoction on intestinal flora, intestinal barrier and NOD-like receptor protein 3 (NLRP3)/caspase-1/gasdermin D (GSDMD) pyroptosis signaling pathway in mice model of sepsis-induced acute kidney injury (AKI).Methods:The model of AKI was established by cecal ligation and perforation (CLP). Thirty male C57BL/6 mice were randomly divided into sham operation group (Sham group), sepsis group (CLP group) and sepsis+Liangxue Huoxue decoction (CLP+LXHX group), with 10 mice in each group. Mice in Sham group only underwent laparotomy. Two hours before model establishment, mice in CLP+LXHX group were treated with Liangxue Huoxue decoction (6 g/kg) by gavage; mice in Sham group and CLP group were given equal volume of normal saline by gavages. After 24 hours of modeling, all mice were sacrificed under anesthesia, and the colon and kidney tissues and fresh feces in the colon were taken. The pathological changes of kidney and colon were observed by hematoxylin-eosin (HE) staining under light microscope. Real-time polymerase chain reaction (RT-PCR) was used to detect inflammatory factors (interleukins, IL-1β and IL-18) in renal tissue. The expressions of NLRP3, caspase-1 and GSDMD were detected by Western blotting. The changes of intestinal flora in mice were detected by 16S rDNA high-throughput sequencing.Results:Compared with the Sham group, the inflammatory cell infiltration of the kidney tissue was increased and the kidney became vacuolated in CLP group, the mRNA expressions of IL-1β, IL-18, and the protein expressions of NLRP3, caspase-1 and GSDMD were significantly increased in CLP group, the species richness of intestinal microflora decreased significantly, the relative abundance of Enterococcus and Escherichia-Shigella increased significantly, and the relative abundance of Ileibacterium, Alloprevotella, Lachnospiraceae, Klebsiella and Parasutterella increased significantly in CLP group. Compared with CLP group, Liangxue Huoxue decoction can significantly reduce the pathological changes of kidney and colon tissue, reduce the pathological score (1.75±0.43 vs. 3.50±0.50 for kidney tissue, 1.25±0.43 vs. 4.50±0.50 for colon tissue, both P < 0.05), improve the composition of intestinal flora, reduce the relative abundance of Enterococcus and Escherichia-Shigella, and significantly increase the relative abundance of Lactobacillus and Akkermansia. In addition, Liangxue Huoxue decoction can significantly reduce mRNA expressions of IL-1β and IL-18 in kidney tissue [IL-1β mRNA (2 -ΔΔCt): 1.59±0.05 vs. 4.61±0.88, IL-18 mRNA (2 -ΔΔCt): 1.69±0.17 vs. 2.86±0.63, both P < 0.05] and the protein expressions of NLRP3, caspase-1 and GSDMD (NLRP3/GAPDH: 0.71±0.04 vs. 0.89±0.01, caspase-1/GAPDH: 1.04±0.04 vs. 1.48±0.04, GSDMD/GAPDH: 0.90±0.01 vs. 1.41±0.02, all P < 0.05). Conclusions:Liangxue Huoxue decoction has obvious protective effect on AKI induced by sepsis. It can improve intestinal barrier by regulating intestinal flora, thereby inhibiting the activation of NLRP3/caspase-1/GSDMD signaling pathway in kidney tissue and reducing the expression of proptosis-related inflammatory factors.

Objective: To explore the clinicopathological features and the renal biopsy process of a case of IgG4-related chronic interstitial nephritis with perirenal capsule involved and review associated literature to improve the clinician's understanding for this disease and to perform a better renal biopsy. Methods: The onset, diagnosis and treatment course of the disease were described and associated literature were reviewed to summary the clinicopathologic features and key points in renal biopsy. Results: The data of the patient showed that the urine specific gravity was 1.011, with urine protein ± and urine sugar 3+. The concentration of hemoglobin was 53 g/L, serum creatinine was 1665 μmol/L, and IgG4 was 9.39 g/L. Computed tomography showed that both kidneys enlarged slightly with decreased density and low density shadow around the kidneys. On contrast-enhanced scan, irregular low-density enhancement areas were found in both kidneys, and the edge of the boundary was not clear. For the first renal biopsy, no renal parenchyma was found except mainly hyaline collagen fibrils. At the second time, 3 pieces of tissues were obtained, which showed chronic interstitial glomerulonephritis. The IgG4 positive plasma cells were about 60/HPF and the IgG4⁺/IgG⁺cells ratio was more than 40%. The diagnosis of IgG4-related chronic interstitial glomerulonephritis was confirmed. After corticosteroid treatment, the serum creatinine decreased to 502 μmol/L after the patient got rid of dialysis. Conclusions There are various manifestations of renal damage caused by IgG4-related disease. It is necessary to pay attention to the involvement of the perirenal capsule, and to balance the risk of bleeding and poor sampling in renal biopsy.