BACKGROUND: Pathogenesy of immunoglobulin A nephropathy (IgAN) is not clear up to now. Present research has verified that the key pathogenetic pathway is abnormalities of IgA1 molecular O-glycosylation induced by decrease of β1, 3-galactosyltranferase activity in IgA1 hinge region of IgAN patients. Prophase study by the authors supposed that the key of IgAN O-glycosylation abnormality might be due to the decrease of β1, 3-galactosyltranferase specific molecular protein chaperone Cosmc in B lymphocyte of peripheral blood in IgAN patients.OBJECTIVE: To measure DNA sequence of β1, 3-galactosyltranferase specific molecular chaperone in coding region of Cosmc gene in IgAN patients, and compared with the sequence of Gene Bank.DESIGN: Case-controlled observation.SETTING: Department of Nephrology, West China Hospital, Sichuan University.PARTICIPANTS: Totally 27 IgAN patients and 10 non-IgAN patients were recruited in Department of Nephrology of West China Hospital of Sichuan University from November 2005 to August 2006, and five normal controls were included in this study. All the subjects knew the fact and agreed to participate in the experiment.METHODS: The experiment was performed at the State Key Laboratory of Biotherapy of Sichuan University. 2 mL peripheral venous blood of all the samples were taken into heparin sodium anticoagulated tubes, from which total genomic DNA were extracted by phenol/chloroform precipitation method. Concentration of DNA was determined by ultraviolet spectrophotometer. The polymerase chain reaction (PCR) was used to amplify the coding region of β1, 3-galactosyltranferase specific molecular chaperone Cosmc gene in all the subjects and direct sequencing was done in PCR products of each subjects. The results of all the sequencing were compared with Gene Bank one by one.MAIN OUTCOME MEASURES: Amplification findings and sequencing of coding region of β1, 3-galactosyltranferase specific molecular chaperone Cosmc gene by PCR.RESULTS: ①Coding region of Cosmc gene located at 257-1 213, and amplified Cosmc gene was 1 247 bp. ②The sequence of Cosmc gene coding region was similar in IgAN patients, non-IgAN patients and normal controls, and no difference of gene sequence was noticed in all the result sequences as compared with the Gene Bank registered sequence.CONCLUSION: No abnormal sequence is found in coding region of Cosmc gene in IgAN patients, suggesting that this coding region probably is not associated with the abnormalities of IgA1 O-glycosylation in IgAN.

Objective To evaluate the clinical application of anterior approach microendoscopic discectomy for cervical spondylosis. Methods Clinical data of 21 cases of cervical spondylosis from October 2001 to June 2002 treated by anterior approach decompression with bone allograft or autograft for cervical fusion by means of microendoscopic discectomy system were reviewed. Results The mean intraoperative blood loss was 150 ml. The drainage was removed 48 hours and the stitches taken out 5 days after the operations. The mean hospital stay was 10 days. All the patients got out of bed for motion wearing a cervical collar 2 days after the operations. Follow-up ranged 6～12 months with a mean of 9 months.The outcome was determined using Odom grading. Of the 21 cases, 16 were classified as excellent results, 4 as good, 1 as poor, the rate of excellent or good results being 95%.Complications were found in 3 cases:rupture of threaded fusion cage in 1 case;hoarseness in 1 case;and multiple infarction of brain stem in 1 case. Conclusions Anterior approach microendoscopic discectomy in the treatment of cervical spondylosis has the advantages of minimal invasion and rapid recovery. It offers a clear surgical vision for vertebral posterior margin and effective protection for blood vessels and nerves, conforming to the standards of minimally invasive surgery.

AIM: To study the effect of bFGF on cell proliferation, secretion of type I collagen and expression of integrin ? 1 in human kidney fibroblasts (KFB). METHODS: The KFB was cultured and stimulated by bFGF in vitro. The proliferation and collagen I secreting of KFB, the expression of integrin ? 1 were measured by MTT, ELISA and flow cytometer, respectively. RESULTS: bFGF (25-50 ?g/L) could obviously stimulate the cell proliferation ( P

Objective:To explore changes of peripheral blood levels of C reactive protein (CRP)and matrix metallo-proteinase-9 (MMP-9)in patients with coronary heart diseases (CHD)and percutaneous coronary intervention (PCI),and analyze their relationship with patients'prognosis.Methods:A total of 278 CHD patients undergoing PCI in our hospital from Jul 2009 to Apr 2011 were regarded as PCI group;another 234 CHD patients not receiving PCI were enrolled as CHD control group.According to results of coronary angiography,PCI group was further di-vided into single-vessel (n=143),double-vessel (n=92)and triple-vessel disease group (n=43).Changes of CRP and MMP-9 levels were compared between two groups in different time,and the relationship among these two in-flammatory factors and coronary disease,its prognosis was analyzed.Results:Compared with on admission,there were significant rise in levels of CRP [(2.43±0.62)mg/L vs.(2.87±0.73)mg/L,(2.98±0.87)mg/L]and MMP-9 [(12.63±2.68)ng/ml vs.(14.62±3.49)ng/ml,(19.62±4.63)ng/ml]in PCI group on 24h and 48h after PCI,P <0.05~<0.01;there were no significant difference in CRP and MMP-9 levels between on admission and 14d after PCI,P >0.05;The more severe coronary lesion was,the higher CRP and MMP-9 levels were,CRP and MMP-9 levels of triple-vessel group [(2.51 ±0.64)mg/L,(14.67±2.97)ng/ml]were significantly higher than those of single-vessel group [(1.83±0.51)mg/L,(9.68±1.42)ng/ml]and double-vessel group [(2.17±0.59) mg/L,(11.62±2.19)ng/ml],P <0.05~<0.01;incidence rates of cardiovascular events in patients with CRP≥3 mg/L and MMP-9≥15 ng/ml (33.3%,29.1%)were significantly higher than those of patients with CRP <3 mg/L and MMP-9<15 ng/ml (16.1%,18.2%)respectively,P <0.05 both.Conclusion:Serum levels of CRP and MMP-9 significantly rise in CHD patients on 48h after PCI,and their increasing level is related with extent of coronary ar-tery lesion and prognosis.

Objective To investigate the changes of surfactant associated protein A (ST-A) concentration inBALF and its relatiomhips with pulmonary injury after blast injury and blast injury combined with hypoxia. MethodTotally 131 Wistar rats (purchased from animal center of research Institute of Surgery, Daping Hospital, ThirdMilitary Medical University) were randomly divided into four groups: blast injury group ( BI group), blast injurycombined with hypoxia group Ⅰ (BAg Ⅰ group), blast injury combined with hypoxia group Ⅱ (BA Ⅱ group) andnormal control group. After blast injury was made by KST - Ⅰ bio-shock tube, rats of BA Ⅰ and BA Ⅱ groups wereput into hypoxia cabins immediately, where gas mixtures of 12.5% and 10.0% oxygeon were given, respectively.Rats were sacrificed at 1, 3 and 6 hours after injury for gross anatomic examination, light and electron microscopeobservation and lung water determination. The level of SP-A in BALF was detected by Western blot. The data wereprocessed by t test or Chi-square test. Results The respiration increased with shortness of breath and dysphoria inrats of BA Ⅰ and BA Ⅱ groups, and obvious cyanosis on the lips and nose in rats of BA Ⅱ group after blast injury.The lung water in rats of all injury groups was significantly higher than that in normal control group (P<0.05).Gross anatomy changes were mainly pulmonary bleeding and edema. Under light microscope, incrassation of alveo-lar wall, bleeding in alveolar and mesenchyme edema were found. Whereas under electron microscope, breakageof alveolar wall and decrease of lamellar bodies in type Ⅱ cell were observed. All these changes were most obviousin BA Ⅱ group followed by BA Ⅰ and BI groups in severity decling order, with mortality rate of 37.5%, 11.1%and 2.1% respectively at 6 hours (P<0.01). The SP-A level in BALF decreased significantly (P<0.01) andhad a good negative relationship with the lung water after injury (r=0.796, P<0.001 ). Conclusions Blastinjury combined with hypoxia significantly deteriorates the lung injury. More severe and longer hypoxia may resultin more severe lung injury and higher mortality rate. A decrease in SP-A value in BALF shows a good negative re-lationship with the pulmonary edema. The SP-A can be a good indicator for lung injury severity after blast injuryand blast injury combined with hypoxia.

Objective To evaluate the clinical outcomes of modified eggshell technique through posterior approach for the treatment of hard thoracic disc herniation. Methods From January 2006 to June 2009, 22 patients admitted for hard thoracic disc herniation were reviewed, including 13 males and 9 females, with an average age of 49.5 years (range, 33-69). The courses of disease were 11 months on the average (range, 3-18 ). The lesions located in T8-9 for 4 cases, T9-10 for 9, T10-11 for 7, T11-12 for 2. Each of the patients underwent X-ray, CT scanning and MRI examination before surgery. There were 16 cases of central type, and 6 cases of paracentral type. All patients were treated surgically by modified eggshell technique via posterior approach. Results The mean operative time was 210 min (range, 180-300 min), with a mean blood loss of 860 ml (range, 600-1200 ml). All surgeries were performed successfully without neurological symptoms aggravation. Surgical complications included dural laceration in 2 cases, both dural lacerations were repaired intraoperatively, epidural hematoma in 1 case with lower extremity neurological symptoms, full neurologic recovery was observed after surgical removal of the hematoma. All patients were followed up for average 27.5 months (range, 12-54). The mean JOA score increased from 3.36±1.79 before operation to 7.45±2.99 after the operation at 12 months follow up, and the mean improvement rate of neurological status was 58.3%±30.7%. There was significant difference in JOA score before and after surgery(t=10. 12,P＜0.01 ).The results of 14 cases were ranked as good, 6 as fair, 2 as unchanged, and none as worsened. All cases obtained bony fusion without instrument failure. Conclusion Modified eggshell technique enable ventral and dorsal spinal decompression from the posterior approach in cases of hard thoracic disc herniation, with reduction of the rate of postoperative paralysis.

Objective Acute type A aortic dissection associated pregnancy severely threatens the lives of both the mother and her ferus.We retrospectively reviewed our clinical experience with this life-threatening condition in six cases.Methods Between January 2007 and February 2012,6 women with acute type A aotic dissection associated pregnancy were treated by our group,with an average of 3 1 years (range 24 -37 weeks)and a mean gestation weeks of 24.5 (range,12 -38 weeks ).The etiology was Marfan syndrome in 4 cases and gestational hypertension in 2.The pathology was the modified Stanford type A3S in I case,A2C in 2 and A3C in 3.- Five patients were treated surgically and 1 medically.Surgical operations were performed under hypothermic cardiopulmonary bypass or deep hypothermic circulatory arrest,including Bentall procedure in 1case,Bentall + Sun's procedure in 2,ascending aortic replacement + Sun's procedure in 2.Results The woman treated medically and her fetus died from aortic rupture 9 days after admission.The cardiopulmonary bypass and cross clamp time and circulatory arrest time averaged 167 rninites(range,75 -210 minites) and 98 minites(range,83 - 145 minites) and 23.5minites(range,19 -27 minutes),respectively.Five patients treaed surgically survived the operation.Three fetuses survived rand two fetuses died.After a mean follow-up of 2.2 years (range,1 - 3.5 years ),5 patients were doing well.CT angiogram detected nonmal aortic and valvular structures,with no signs of distal dilation.Three babies were normal in development and neurocognitive functios.Conclusion Palients with aortic dissection associated with pregnancy should be operated on ugently and medical treatment carries high risks of aortic rupture and maternal and fetal death.Methods of surgical repair,peffusion techniques and delivery should be chosen based on the underlying aortic pathology and gestational age,so as to maximize the safety of the mother and her baby.

Objective To evaluate the diagnostic value of dual-source CT angiography (DSCTA) for intracranial aneurysms.Methods The data of DSCTA and digital subtraction angiography (DSA) were collected from 95 patients with subarachnoid hemorrhage (SAH).The efficacies of detection and description of morphologic features of intracranial aneurysms were analyzed retrospectively.Results A total of 117 aneurysms in 88 patients were detected with DSCTA.Two patients were suspected of having aneurysms,and no aneurysrms were detected in 5 patients.These patients were reexamined with DSA,4 were diagnosed as having aneurysm,and the aneurysms were not detected in 3 patients.DSA results were considered as gold standard,the specificity,sensitivity and accuracy of DSCTA for the detection of intracranial aneurysms were 100％,96.7％and 96.8％,respectively.The larger volume of intracranial aneurysm was,the higher the sensitivity of DSCTA diagnosis would be.Even for small aneurysms,the sensitivity of DSCTA diagnose was more than 90％.In addition,tmeasurement results of the maximum diameter and neck width of aneurysms measured by DSCTA were almost consistent with DSA.Condclusions SCTA is a non-invasive,quick,reliable,and effective method,and can provide accurate imaging information for surgery.The specificity and sensitivity of the diagnosis of aneurysms with DSCTA are almost the same with DSA.It has more advantages than DSA in the emergency operation of intracranial aneurysms.

Objective The aim of this study was to evaluate whether the reoperation is the risk factor for mortality after Sun's procedure(Total aortic arch replacement + frozen elephant trunk) for Stanford type A aortic dissection involving aortic arch.Methods Between February 2009 to February 2012,data from 383 patients who underwent Sun's procedure for Stanford type A aortic dissection involving aortic arch were collected retrospectively.35 patients had history of cardiac surgery.Of these patients,16 patients had underwent Bentall procedure,7 patients ascending aortic replacement,4 patients Wheat surgery,4 patients aortic valve replacement,2 patents Bentall combined with mitral valve replacement or plasty,1 patient bivalve replacement,1 patient atrial septal defect repair,1 patient coronary artery surgery.All the risk factors related to mortality were analyzed by univariate statistical analysis.Significant univariate variables were entered into multiple logistic analysis.Results Total 31 patients died in the hospital and the mortality was 8.07％.Of the 35 patients with history of cardiac surgery,3 patients died and the mortality was 8.33％.Univariate analysis showed that symptom onset before surgery less than 1 week,preoperative limb ischemia,combining with coronary artery surgery and cardiopulmonary bypass time longer than 300 minutes in the operative were risk factors for mortality.After these factors were entered into multiple logistic regression analysis,the result showed that symptom onset before surgery less than 1 week (P =0.038,OR =2.43),cardiopulmonary bypass time longer than 300 minutes(PP ＜0.001,OR =12.05) were final independent risk factors for mortality.Reoperation was not the independent risk factor for mortality.The intensive care unit and mechanical ventilation length of reoperation group was (2.09 ± 1.89) days and(30.09 ±33.42) hours respectively,while that of primary group was(2.71 ±3.01) days (P =0.25) and(33.86 ±40.98) hours(P =0.61) respectively.The incidence of postoperative bleeding of reoperation group was 3.03％,while that of primary group was 1.88％ (P =0.50).Conclusion Reoperation was not the independent risk factor for mortality after Sun's procedure for Stanford type A aortic dissection involving aortic arch and the morbidity was also not higher than primary surgery.For these patients,sun' s procedure should be advocated.

Objective To establish the risk scoring system in predicting prolonged intensive care unit(ICU) stay after Sun' s procedure(total aortic arch replacement with stented elephant trunk implantation) for Stanford type A aortic dissection.Accumulate experience in establishing the mathematical model in predicting the prognosis of Chinese people undergoing aortic surgery.Methods Between February 2009 and February 2012,data from 384 consecutive patients in Bejing Anzhen Hospotal,who underwent aortic surgery using Sun' s procedure,were collected retrospectively.Lengths of ICU stay longer than 7 days was defined as prolonged ICU stay.All the factors related to prolonged ICU stay were entered into univariate analysis.Then the variables with statistical difference were entered into multiple logistic analysis.The mathematical model was established based on the logistic analysis.The C-statistic was used to test discrimination of the model.Calibration was assessed with the Hosmer-Lemeshow goodness-of-fit statistic.Results The in-hospital mortality was 8.07％.The mean length of ICU stay was 3.06 days.42 patients stayed in ICU for 7 days or more.Logistic regression identified that preoperative stroke history(P =0.001,0R =9.40,regression coefficient =2.24),creatinine clearance ≤ 50 ml/min (P =0.03,OR =2.91,regression coefficient =1.07) surgical period from symptom onset shorter than 1 week (P =0.003,OR =2.89,regression coefficient =1.06),combining with coronary artery bypass grafting(P =0.03,OR =3.14,regression coefficient =1.15) were final independent risk factor for prolonged ICU stay.Simple logistic score were defined as:stroke history 22 points,creatinine clearance ≤50 ml/min 11 points,surgical period from symptom onset shorter than 1 week 11 points,combining with coronary artery bypass grafting 12 points.Additive score was defined as:stroke history 9 points,surgical period from symptom onset shorter than 1 week 3 points,creatinine clearance≤50 ml/min 11 points 3 points,combining with coronary artery bypass grafting 3 points.C statistic (receiver operating characteristic curve) for logistic algorithm was 0.72 and for additive model was 0.71.However,Hosmer Lemeshow goodness-of-fit was good (P ＞ 0.05) for logistic algorithm,was poor for additive model(P ＜ 0.05).Conclusion Using logistic regression to establish a scoring system predicting the prognosis of aortic surgery is feasible.The predicting model utilizing regression coefficient is accurate and is convenient for clinical using.Additive algorithm is not accurate and should be abandoned.