Objective To investigate the correlation of postoperative cognitive dysfunction (POCD)and the preoperative he-moglobin (HbA1c)in elderly patients with type 2 diabetes mellitus (T2DM).Methods 82 patients with T2DM who were underwent non-cardiac surgery were included in this study,group A had 37 patients with POCD after surgery,group B had 45 patients with non POCD,the patients in two groups used the same anesthesia method,compared the general data and pre-operative HbA1c,fasting blood glucose levels of two groups,compared the incidence of POCD in patients with HbA1c in dif-ferent levels.Results There was no significant difference in gender composition,age,body mass index,preoperative MMSE score,hypertension rate,operation time and bleeding volume in operation,and there was no significant difference in fasting blood glucose of patients in two groups.Fasting blood-glucose (FBG)of two groups were 7.1±2.6 and 6.7±1.8 mmol/L (t=0.821,P=0.424),it was no significant difference;HbA1c of two groups were (7.2±1.3)% and (6.3±1.0)%,the group A was higher than the group B (t=3.543,P=0.001),there was significant difference.The incidence rate of POCD of the group AH was 58.1%(25/43),while the group AL was 30.8% (12/39),the group AH was higher the group AL(χ2=5.131,P=0.024),there was significant difference.Conclusion Preoperative determination of HbA1c in elderly patients with T2DM after surgery has forecast values for the occurrence of POCD,to control HbA1c in the low level can reduce the occurrence of POCD in elderly patients with T2DM.

Objective To investigate the serum levels of soluble human leukocyte antigen (sHLA)-G in patients with polymyositis (PM) or dermatomyositis (DM),and to analyze its association with clinical features and possible role in the pathogenesis of PM/DM.Methods Serum sHLA-G levels of 26 patients with PM,70 patients with DM and 35 matched healthy controls were measured by ELISA.The relationship between the sHLA-G levels and clinical features or seroimmunological data in the patients with PM/DM was analyzed.Results Serum levels of sHLA-G in PM/DM patients were significantly higher compared to healthy controls [(44±70) U/ml vs (4±5) U/ml,P＜0.01].There was statistically significant difference between DM patients and PM patients [(54±81) U/ml vs (27±41) U/ml,P=0.004].The incidence of dysphagia was significantly higher in sHLA-G elevated group than those in sHLA-G normal group (P=0.001).Additionally,Spearman rank correlation analysis showed that the serum sHLA-G levels were positively correlated with serum C3 (r=0.284,P=0.021),but negatively correlated with CD3+ T cells (r=-0.233,P=0.047) and CD4+ T cells (r=-0.287,P=0.015) in the peripheral blood in patients with PM/DM.Serum levels of sHLA-G in non-treated PM/DM patients were significantly higher compared to treated patients [(77±99) U/ml vs (34±52) U/ml,P=0.021].No relationship between serum sHLA-G levels and PM/DM disease activity,or different drug therapy was found.Conclusion Serum levels of sHLA-G are increased in PM/DM patients.The increased production of sHLA-G,paralleled with higher incidence of dysphagia and lower level of CD3+ T cells and CD4+ T cells,indicates that sHLA-G may play an important role in the pathogenesis of PM/DM.

BACKGROUND: The incidence of the adjacent vertebral fracture after kyphoplasty is about 2.4%-23.0%, and 2/3 of new fractures occurred in adjacent vertebrae in 6 months. There is controversy addressing the reason which is the development of osteoporosis or the result of bone cement augment at present.OBJECTIVE: To determine the correlations between percutaneous kyphoplasty on adjacent vertebral endoplates stresses pressure under physiologianl load and a new fracture of adjacent vertebral body in physiological load.METHODS: Computed tomography (CT) data of an old female osteoporotic patient was selected, and a three-dimensional finite element model of the osteoporetic thoracolumbar spine T_(12)-L_1-L_2 was created by using kinds of computer aided design software.The height of vertebral L_1 was compressed by 60% to simulated the compressed fracture, and the height of L_1 became the 90% of normal to simulate the replacement, two columns-like PAMA mass (4 mL) was placed in vertebral L_1 to simulate pemutaneous kyphoplasty. The stress on inferior endplate of L_(12) and superior endplate of L_2 was compared with three models. RESULTS AND CONCLUSION: Compared to the normal vertebral body, the maximum stress in the adiacent vertebral bodies endplates increased by 76% for L_1 compress fracture model and increased by 27% for kyphoplasty model, respectively. The stress on the posterior part of vertebral body after percutaneous kyphoplasty have an average increase of 13.2%, of which 4.5% increase in the pedicle, isthmus, and 6.15% increased in the key points 25.6%, but with the wedge-shaped fracture of L_1 vertebral body compared to the model, percutaneous kyphoplasty after pedicle, isthmus and the articular process had reduced stress. The results indicate that the stress on inferior endplate of L-(12) and superior endplate of L_1 increased after percutaneous kyphoplasty under all loading conditions. Increased stress may lead endplate fracture, and increase the risk of adjacent vertebral body fracture. Further researches are needed to support the conclusion.

AIM: To investigate the activation dynamics and the intracellular localization of p38 protein kinase in Raw264.7 cells after lipopolysaccharide (LPS) stimulation.METHODS: Protein kinase assay and immunogold electron microscope technique were used to check the activation dynamics and distribution of p38 MAPK in Raw264.7 cells before and after LPS stimulation. RESULTS: The kinase assay results showed that a marked increase in p38 activity was detected 15 min after LPS treatment, and reached maximal activity 30 min post stimulation, then dropped down and got closed to the pre-stimulated level 2 h later. The optimal LPS concentration for treatment was 100 ?g/L. The immunogold electron microscope data showed that p38 spread evenly in every part of the cytosol of the non-stimulated and EGF stimulated Raw264.7 cells, such as endoplasmic reticulum, mitochondria, lysosome, while the golden granules intensity in the cytosol area decreased and in the nuclear area increased significantly after LPS stimulation.CONCLUSION: p38 MAPK moves to the nuclei of Raw264.7 cells on account of stimulation by LPS.

Objective To investigate the correlation between serum levels of B cell activating factor (BAFF) and disease activity in the patients with dermatomyositis (DM).Methods Serum BAFF levels of 61 patients with DM and 25 matched healthy controls were measured by ELISA.The results of the two groups were compared using unpaired Mann-Whitney U test and the relevance was analyzed using Spearman correlation analysis.Results Serum levels of BAFF in DM patients were significantly higher compared to healthy controls [(274 7±264 6) pg/ml 与 (832±170) pg/ml,Z=-5.492,P＜0.01].A cross-sectional assessment revealed that serum BAFF levels were positively correlated with global disease activity (r=0.501,P＜0.001),muscle disease activity (r=0.303,P＜0.05),and cutaneous disease activity (r=0.467,P＜0.01).High serum BAFF levels were associated with increased incidence of interstitial lung disease (x2=17.238,P＜0.01).The longitudinal study showed modest correlations between serum BAFF levels and global disease activity (r=0.658,P＜0.01),muscle disease activity (r=0.307,P＜0.05),as well as cutaneous disease activity (r=0.565,P＜0.01).Conclusion Serum levels of BAFF correlate with disease activity in DM patients.The results of this study suggest that BAFF is a serological biomarker for DM disease activity.

Objective To investigate the expression of human epidermal growth factor receptor?2(HER?2)and Survivin protein in gastric cancer tissue,and explore its relationship with clinicopathological characteristics. Methods Immunohistochemistry assay was used for detection of HER?2 and Survivin protein expression in 70 gastric cancer biopsy samples. The relationship with the clinicoathological parameters in patients with gas?tric cancer was analyzed. Results The expression of HER?2 and Survivin protein was correlated with tumor differentiation ,TNM stage and lymph node metastasis(all P<0.05),but not with sex,age,the diameter of tumor. The correlation analysis of positive rate and the semi?quantitative pro?tein expression showed that the expression of Survivin and HER?2 was significantly positively related(all P<0.01). Conclusion The positive ex?pression of HER?2 and Survivin protein in gastric cancer correlates with tumor differentiation ,TNM stage and lymph node metastasis. HER?2 ex?pression significantly correlates with Survivin at the protein level in gastric cancer tissues.

OBJECTIVE: To explore the correlations between symptom-based principal factors of rheumatoid arthritis (RA) and the effect of traditional Chinese medicine or Western medicine on RA after factor analysis of RA symptoms. METHODS: Four hundred and thirteen RA patients from 9 clinical centers were included in the clinical trial. They were randomly divided into Western medicine (WM) treated group with 204 cases and traditional Chinese medicine (CM) treated group with 209 cases. A complete physical examination and 18 common clinical manifestations were recorded before the randomization and after the treatment. The WM therapy included voltaren extended action tablet, methotrexate and sulfasalazine. The CM therapy included glucosidorum Tripterygll totorum tablet and Yishen Juanbi Tablet. The American College of Rheumatology 20 (ACR20) was used for efficacy evaluation. All data were analyzed on SAS 8.2 statistical package. Eighteen symptoms in the RA patients were analyzed by factor analysis and the relationships between the factors and effects were analyzed with Chi-Square test. RESULTS: Four principal factors were obtained from the analysis results of the 18 symptoms. The factors could represent the symptoms related to joints, cold-syndrome, deficiency syndrome and heat-syndrome in traditional Chinese medicine (TCM), respectively. The effect of WM therapy was better than CM therapy. After 12 weeks of treatment, the effect of CM on patients without deficiency-syndrome was better than the patients with deficiency-syndrome. After 24 weeks of treatment, WM therapy showed better effect on patients with cold syndrome than patients without cold syndrome. CONCLUSION: The results based on the factor analysis of RA symptoms are similar to the results of syndrome differentiation of TCM, and the factor-related different categories of symptoms are associated with the curative effect, thus further research on the symptoms is necessary.

Objective To study the relationship between anti-transcription intermediary factor 1 family proteins (TIF1) autoantibodies profiles and cancer-associated dermatomyositis (CAM) and to define the diagnostic value of different subtypes of anti-TIF1 aotuantibodies for CAM.Methods The sera from 156 patients with dermatomyositis (DM),55 with polymyositis (PM),70 with systemic lupus erythematosus (SLE),60 with rheumatoid arthritis (RA),46 with primary Sj(o)gren syndrome (pSS),14 with systemic sclerosis (SSc),49 with kinds of malignancies and 40 healthy subjects were examined by immunoprecipitation assays followed by western blotting.Statistical analysis were performed using ANOVA,t test Mann-Wittney U and x2 test or Fisher exact test,nonparametric method was used to evaluate the sensitivity and specificity through calculating the area under the receiver operating characteristic curve (ROC).Results In summary,32 of 156 sera from patients with DM (20.5％) were positive for at least one anti-TIF1 autoantibodies.There are four subtypes of anti-TIF1 autoantibodies profiles existed in patients with DM,including 4 patients with only positive anti-TIF1-α (12.5％),20 with only positive anti-TIF1-γ (62.5％),7 with both positive anti-TIF1-α and anti-TIF1-γ (21.9％) and 1 with both positive anti-TIF1-β and anti-TIF1-γ (3.1％).However,only positive anti-TIF1-α (7.3％) was observed in 4 patients with PM.No patients with other CTDs as well as malignancy and healthy subjects were positive for these autoantibodies.The sensitivity and specificity of presence of anti-TIF1-α antibodies for the diagnosis of CAM were 42.9％ and 96.5％,respectively and those of anti-TIF1-β antibodies were 0 and 99.3％,respectively and those of anti-TIF-1-γ antibodies were 64.3％ and 86.6％,respectively.Application of areas of ROC to identify the best performance of test of anti-TIF1 antibodies profiles were 0.70,0.50,0.76,0.74 and 0.71,respectively.Conclusion Joint detection of antiTIF1 autoantibodies profiles can improve the diagnostic capbility for CAM.

Objective To identify the prevalence of anti-transcriptional intermediary factor (TIF)1-γ antibody in Chinese patients with idiopathic inflammatory myositis and to define its role in the assessment of early diagnosis of cancer associated myositis (CAM) in a large cohort.Methods Sera from 96 Chinese patients with dermatomyositis(DM),50 patients with polymyositis (PM),33 patients with systemic lupus erythem-atosus (SLE),54 patients with rheumatoid arthritis (RA),8 patients with systemic sclerosis (SSc),and 40 healthy controls were examined by immunoprecipitation assays followed by Western blotting.The distribution of these antibodies in each group was assessed and the association between this autoantibody and CAM in a large cohort was further revealed.T test,Mann-Wittney U test,Chi-square test and Fisher exact test were used for statistical analysis.Results Sera from 17 of 96 DM patients (18％),including 1 with juvenile dermatomyositis (JDM) (17％),2 with clinical amyopathic dermatomyositis (CADM) (25％),and 9 with CAM (64％) were found to have anti-TIF1-γ antibody by immunoprecipitation assays followed by Western blotting.Only 1 patient with PM (2％) was observed with anti-TIF1-γ autoantibody,and no patients with other connective tissue disease patients as well as healthy controls were positive for this autoantibody.The risk of -developing CAM in anti-TIF1γ-positive patients was significantly increased compared to the anti-TIF1-γnegative group,with an OR of 17.74 (95％CI,5.68-55.40).In DM,the negative and positive predictive value of anti-TIF1-γ autoantibody for the diagnosis of CAM was 90.8％ and 56.3％,respectively.Anti-TIF1γ-positive DM patients were significantly older than anti-TIF1-γ-negative DM patients (63±11 vs 48 ±14,P＜0.01).Notably,three of the anti-TIF1γ-positive patients had ILD,one patient was classified as having CAM and the other two were DM patients without cancer,but anti-TIF1γ-positive patients still had a significantly lower incidence of interstitial lung disease (19％ vs 54％,P＜0.05).In contrast to anti-TIF1-γγ-negative DM patients,anti-TIF1-γ antibody-positive patients were more frequently (81％ vs 50％,P＜0.01).There was no significant difference between these groups in terms of other clinical and laboratory parameters.Conclusion Anti-TIF1-γ antibodies may act as a useful diagnostic serological marker for early diagnosis of CAM in Chinese patients.For patients with DM,anti-TIF1-γ antibodies should be assessed at the time of disease diagnosis.This antibody may have impo-rtant significance in the early diagnosis of tumor and improving prognosis.

Objective To evalute the effect of Ilizarov technique in the treatment of hypertrophic nonunion.Methods Form June 2008 to December 2010,12 patients with hypertrophic nonunion were treated with Ilizarov technique,including 10 males and 2 females with an average age of 46.5 years.The pathology sites of nonunion were kept as closed as possible without any bone graft during operation.As to patients who had ever been treated with plate or intramedullary nail,the hardware should be removed by minimal invasive approach.These procedures aimed to keep the vascularity of nonunion site intact.Ilizarov apparatus were preoperatively constructed.Distal segment and proximal segment of nonunion were mounted respectively with two external circle using the smooth wires and half pins.The two-circle stabilizing one segment was nominated with transosseous modules.Distal module and proximal one was connected with a pair of axial hinges.The pathology sites were gradually distracted from the seventh day postoperatively,0.25 mm/d.Accompanying with deformity correction,limb length discrepancy (LLD) also were restored simultaneously.Then,all the screws and nuts in the apparatus should be tightened,which was favourable to the callus consolidation.Results All 12 cases of nonunion healed without any bone graft.The fixator wearing time lasted 6-12 months,with an average of 8 months.Correction of deformity and LLD were achieved.The average lengthening was 3.0 cm (range,2.0-5.5 cm),the average correction angle was 23° (range,10°-30°).After 6-18 months follow-up,all the patients restored satisfactory function.Conclusion Hypertrophic nonunion can be treated successfully with Ilizarov technique.The key of successful callus distraction is strictly identifying the indications.