Objective To study the effect of levels of 24-hour mean blood pressure(BP)and blood pressure diurnal rhythm on renal function of patients with chronic renal failure(CRF).Methods 24-hour blood pressure monitoring was obtained in patients with CRF(117cases),the GFR was determined periodically.Results The rate of decline of GFR in patients with CRF to a target blood pressure was slower than in patients with CRF not to a target BP(P

Objective To compare the effect of perineal cleansing with the potassium permanganate or sterile water on mid- stream urine culture. Methods Mid- stream specimens of urine were obtained from inpatients in our hospital between January 2002 and December 2006. All these patients may be diag-nosed as urinary tract infection. The urine specimens were divided into the potassium permanganate group (n=1572, the sterilization group) and the sterile water group (n=544). The change of positive and contami-nation rate of mid-stream urine culture from the specimens was observed. More than two kinds of germs in one urine specimen were defined as contamination. Results 830 patients with urinary tract infection had been enrolled. 2116 specimens were collected and 531 strains of causative organism were detected. The positive rate of the sterilization group and the sterile water group was 20.04% and 39.71%, respectively,and such difference was significant. The rate of identical causative organism from the same patient whose spec-imen was cultivated twice in the sterilization group was 0.012% and the rate was 0.105% in the sterile water group. The difference was significant. The rate of different or one kind of causative organism from the same patient whose specimen was cultivated twice in these two groups hadn't significant deviation. The contami-nation rate of the sterilization group (0.028%) was significantly higher than that of the sterile water group (0.007%). Conclusions Perineal cleansing with sterile water can reduce the false negative rate of mid-stream urine culture without increasing the contamination rate. Potassium permanganate sterilization is re-sponsible for the high false-negative in mid-stream urine culture.

The graft-versus-tumor (GVT) effect of T cells induced by tumor antigen-pulsed CD8α(+) dendritic cells (DCs) in vitro was investigated in this study. Immature CD8α(+) DCs were prepared from C57BL/6 (H-2(b)) bone marrow cells by using a cytokine cocktail. On the 3rd day of culture, CD8α(+) DCs were pulsed by allogeneic (Balb/c, H-2(d)) EL9611 leukemia antigen, or RM-1 syngeneic prostate cancer antigen, with the concentration series of 0, 2.5, 5.0, 10.0, 20.0 μg/mL, respectively, then antigen-loaded immature CD8α(+) DCs were co-cultured with syngeneic T cells according to the DC/T ratio of 1:1, 2:1 and 4:1. T cell proliferation was measured by MTT assay. Cytokines including interferon gamma (IFN-γ) and interleukin-10 (IL-10) in CD8α(+) DCs and T co-culture supernatant were detected by using ELISA. Cytotoxic effect of antigen-specific T cells was tested by LDH release assay. Conventional mature DCs (mDCs) induced from C57BL/6 (H-2(b)) bone marrow cells by using granulocyte-macrophage colony stimulating factor (GM-CSF) and interleukin-4 (IL-4) served as a control. The results showed that the proliferative activity of T cells stimulated by CD8α(+) DCs loaded with allogeneic or syngeneic tumor antigen was augmented with the CD8α(+) DC/T ratio increased (P<0.05). When antigen concentration ≤ 5 μg/mL and CD8α(+) DC/T ratio ≤ 2:1, the ability of CD8α(+) DCs to stimulate T cell proliferation was higher than mDC control in allogeneic tumor antigen-pulsed groups (P<0.05), but not in syngeneic tumor antigen-pulsed groups (P>0.05). The level of IFN-γ and IL-10 in CD8α(+) DCs and T cell co-culture supernatant were increased in both allogeneic and syngeneic antigen-pulsed groups (P<0.05), and the cytokine level was higher in allogeneic antigen-pulsed groups than in syngeneic antigen groups when the CD8α(+) DC/T was 1:1 or 2:1 (P<0.05). There existed a negative correlation between the level of IL-10 and T cell proliferation. T cell cytotoxicity assay showed that when CD8α(+) DCs were pulsed with allogeneic tumor antigen, the maximal T cell killing efficiency could reach (100±7.7)%, whereas syngeneic tumor antigen-pulsed group had only (65.0±3.4)%. It was concluded that syngeneic and allogeneic tumor antigen-pulsed immature CD8α(+) DCs could stimulate T cells to exert the GVT effect in vitro, and the GVT effect was more obvious with allogeneic tumor antigen than with syngeneic tumor antigen. The optimal condition was low allogeneic tumor antigen pulsation (≤ 5 μg/mL) and low CD8α(+) DC/T ratio (1:1 and 2:1).

Objective To study the clinical efficacy and operative skill of multi-endoscopic technique in treatment of post-traumatic urethrostenosis in male patients.Methods A retrospective analysis was done on clinical data of 47 male patients with post-traumatic urethrostenosis treated with direct visional incision urethrotomy combined with transurethral resection of scar tissue and ureteroscopic incision.There were 29 patients with anterior urethral strictures and 18 with posterior urethral strictures.Results Of all,43 patients underwent successful endoscopic surgeries at the first time but one underwent secondary surgery because of unsuccessful endoscopic incision.These patients achieved satisfactory results without urinary incontinence,fistula or reoperation.The left three patients underwent open surgeries because of unsuccessful endoscopic incision,in which one patient could micturate at maximal flow rate of 9-12 ml/s,without therapeutic urethral dilation,one could micturate under regular therapeutic dilation and the other one could not micturate.Conclusions With the advantages of safety,high success rate and good long-term efficiency,multi-endoscopic technique can be used as an initial treatment for male patients with post-traumatic urethrostenosis and is worthy to be popularized.

Objective To assess the clinical value of intravesical prostatic protrusion (IPP) measured by transabdominal uhrasonography in judgement of benign prostatic obstruction (BPO). Methods According to pressure-flow study, 109 patients with benign prostatic hyperplasia were di-vided into 3 groups (non-obstruction, equivocal obstruction and obstruction). IPP was measured by transabdominal ultrasonography in all patients. The difference of IPP between different groups was studied and the correlation between IPP and the parameters reflecting BPO was analyzed. Results IPP value of the non-obstruction group, equivocal obstruction group and obstruction group was 2.7 ±1.2 mm, 2.9±1.4 mm and 15.4±6.5 mm. There was significant difference in IPP between the non-obstruction group, equivocal obstruction group and obstruction group (P<0.01). IPP was correlated with the parameters including Pdet. Qbeg, Pdet. Qmax, Pdet. Qend, Qmax and A-G number, Spearman's ratio was 0. 628, 0. 714, 0. 591, -0. 450 and 0. 729(P<0.01), respectively. The sensi-tivity and specificity of judging BPO were 89.9% and 97.5% if the cut-off was IPP≥10 mm. Con-clasion IPP measured by transabdominal ultrasonography could be a convenient and accurate method in diagnosis of BPO.

Objective:To systematically evaluate the effect of hydrocortisone combined with vitamin C and vitamin B1 on the efficacy of patients with sepsis or septic shock.Methods:Databases including CNKI, Sino Med, VIP, Wanfang, PubMed, the Cochrane Library, and Embase were searched from inception to January 2021 for the randomized controlled trial (RCT) about hydrocortisone combined with vitamin C and vitamin B1 to treat sepsis or septic shock. The experimental group was given intravenous injection of hydrocortisone, vitamin B1 and vitamin C based on conventional treatment; the control group was given conventional treatment or placebo/hydrocortisone/hydrocortisone+vitamin B1 based on conventional treatment. Outcome indicators included sequential organ failure assessment (SOFA), mortality, the duration of vasoactive drugs, new acute kidney injury (AKI) patients, length of stay in intensive care unit (ICU) and in hospital. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias in the included studies. RevMan 5.3 software was then used to perform Meta-analysis. Funnel plot was used to test publication bias.Results:A total of 6 articles involving 816 patients were included, with 411 patients in the experimental group and 405 patients in the control group. The Meta-analysis results showed that the duration of vasoactive drugs in the experimental group was significantly shorter than that in the control group [mean difference ( MD) = -24.02, 95% confidence interval (95% CI) was -32.36 to -15.68, P < 0.000 01]. However, there were no significant differences in SOFA, mortality, new AKI patients, the length of ICU stay and hospital stay between the two groups [SOFA: MD = -0.14, 95% CI was -1.15 to 0.87, P = 0.79; mortality: relative risk ( RR) = 0.99, 95% CI was 0.81 to 1.21, P = 0.92; new AKI patients: RR = 1.10, 95% CI was 0.42 to 2.87, P = 0.84; length of ICU stay: MD = 1.33, 95% CI was -2.22 to 4.89, P = 0.46; length of hospital stay: MD = 1.02, 95% CI was -0.66 to 2.69, P = 0.23]. The funnel plot showed that most of the points were symmetrical and showed an inverted funnel shape, suggesting that the publication bias among the studies was small. There was no significant publication bias on this Meta-analysis. Conclusions:Hydrocortisone combined with vitamin C and vitamin B1 can shorten the duration of vasoactive drugs in patients with sepsis or septic shock, but it cannot effectively reduce the SOFA score, mortality, new AKI patients, length of stay in ICU and in hospital. Limited by the number and quality of the included studies, further large-scale, multi-center, blinded, RCT are still needed for verification.

OBJECTIVE: To study the effects of occlusal trauma on the ultra-structure of synovial membrane and articular cartilage in rabbit's temporomandibular joints (TMJ). METHODS: TMJs from six rabbits with occlusal trauma and three control rabbits were studied by transmission electron microscopy. RESULTS: Degenerative changes in synovial membrane and articular cartilage of TMJ were induced following occlusal trauma. The structure of the articular surface was damaged, and chondrocytes in cartilage showed signs of degeneration. The synovial lining cells contained dense accumulations of vimentin intermediate filaments (IFs), which were especially prevalent in the cellular processes as well as paranuclearly. Microvilli on the synovial cell membrane were commonly seen. The "vermiform bodies" in the deeper interstitium of the synovial tissue were also found. Our findings of the punctate adherens between synovial lining cells were described in detail. CONCLUSIONS: The occlusal trauma is really a factor inducing degenerative changes of the TMJ.

Objective To investigate the effects of metformin and exaliplatin on proliferation and apoptosis of gastric cancer cell line SGC-7901. The antitumor effects of metformin combined with exaliplatin on gastric cancer cell line SGC-7901 were compared. Methods SGC-7901 cells were cultured in vitro. The proliferation inhibition rate of cancer cell after treatment with various concentrations of metformin(5.0,10.0,15.0 mmol/L)、exaliplatin(2.5,5.0,10.0 μmol/L)or 15.0 mmol/L metformin combined with 10.0 μmol/L exaliplatin was analyzed via MTT colorimetric assay at 24,48,72 h.After 24 h, the SGC-7901 cell apoptosis was detected by flow cytometry, and the relative activity of caspase-3 and bax was detected by western blot. Results The co-administration of metformin and exaliplatin or single agent treatment could increase the proliferation inhibition rates of SGC-7901 cell in a time-and dose-dependent manner, while there was a significant higher proliferation inhibition rate in co-administration versus single-agent treatment (P < 0.05). The apoptosis rate induced by 15.0 mmol/L metformin and 10.0 μmol/L exaliplatin and combined treatment was (16.0 ± 2.1)%, (19.0 ± 2.7)%, (29.0 ± 3.5)%, higher than that in blank control group (10.0 ± 1.1)%, and there was significant difference (P <0.05). Both of metformin and exaliplatin could increase caspase-3 and Bax activity.Caspase-3 and Bax activity in the combination of metformin and exaliplatin was significantly higher than that of metformin group and exaliplatin group (P < 0.05). Conclusions Metformin combined with exaliplatin has synergistic effect in inhibiting the growth and inducing apoptosis of gastric cancer cell line SGC-7901.Enhancing caspase-3 and Bax expression may be the related mechanism

Objective To study the prevalence,treatment policy and control of hypertension in patients with maintenance hemodialysis, and to analyze the influencing factors of hypertension control.Methods We studied the current status of 1382 patients with maintenance hemodialysis in 11 dialysis centers in Shanghai, among them 809 were male, and 573 were female.Hypertension was defined as systolic blood pressure(SBP) ≥ 140 and/or diastolic blood pressure (DBP) ≥90 mm Hg ( 1 mm Hg = 0.133 kPa).Those who had a history of hypertension and requiring antihypertensive therapy were also diagnosed as hypertension though their blood pressure was within normal range during the survey.Hypertension control was defined as blood pressure ＜ 140/90 mm Hg before each dialysis session.Results The prevalence of hypertension in the hemodialysis patients was 86.3%.The treatment rate and control rate in those patients were 96.8% and 25.5% respectively.More than half (50.4% ) of patients were treated with only one kind of anti-hypertensive drug, and 34.4% with 2 kinds, 14.2% with 3 kinds, 1.0% with 4 kinds or more.Calcium channel blocker (CCB) was the most frequently prescribed drug (61.0%), followed by angiotensin Ⅱ receptor blockers ( 56.4% ), centrally acting anti-hypertensive agent ( 26.4% ), beta blockers and alpha, beta-blockers( 14.0% ).The control rate of hypertension in those hemodialysis people was aggravated by the existence of coronary artery disease.The patients who need more kinds of antihypertensive agents have a poorer control rate of hypertension.The hypertension control rate elevated significantly with the adequate hemodialysis.Conclusions There is a very high prevalence of hypertension in maintenance hemodialysis patients.Although the treatment rate is high, the control rate is unsatisfactory.So the control of hypertension in hemodialysis patient is still a clinical challenge.Appropriate dialysis adequacy, reasonable use of erythropoietin, treatment of heart disease and judicious use of antihypertensive drugs may be helpful to improve the clinical outcome.

Medical big data is a hot research topic in China,and it is also the main research direction in the field of emergency medicine.The current situation of the construction of the first-aid big data platform and the construction of the first-aid clinical decision support system were analyzed,the problems existing in the development of the first-aid big data research field were enumerated,to explore the theoretical methods for promoting the development of domestic first-aid big data,so as to provide references for the research in related fields.