Objective:To explore the mechanism of infiltration and transfer of bladder carcinoma. Meth-ods:Ager single diffusion method and immunoenzyme technique were adopted to determine the level anddistribution of fibrin in serum and tissues of bladder carcinoma. Results :Fibrin level in patients with blad-der carcinoma significantly decreased than that in control (P＜0. 01). In tissues of bladder carcinoma,mostpart of FN was expressed in cellular matrix,and a little FN was on the surface of cell membrane. Positiveexpression in transfer bladder carcinoma significantly decreased than that in non-transfer bladder carcino-ma. Conclusion :FN level relates to the infiltration and transfer in bladder carcinoma patients.

Objective To explore the relationship between body composition and β-cell function in obese females with normal glucose metabolism. Methods Seventy-five obese women with normal blood glucose and without family history of diabetes were investigated. They were assigned to 4 groups based on body mass index (BMI). Body fat content was measured by dual-energy X-ray absorptiometry (DEXA), and intravenous glucose tolerance test (IVGTT) was performed. The acute insulin response (AIR), the area under the curve (AUC) of insulin (AUCins) and homeostasis model assessment (HOMA) for β-cell function (HOMA2-% B) were calculated. Insulin resistance index(HOMA2-IR) and the ratio of AUCins to AUC of glucose (AUCins/AUCglu) were calculated to assess insulin resistance. Results Women with higher BMI appeared to have more total body fat content and trunk fat content. The similar distribution was also found in other parameters, including the plasma glucose levels at 0 and 10 min, AUCins, AIR, AUCins/AUCglu and the difference of insulin level between 0 and 10 min [INS (10-0)] during IVGTF. AUCins, AIR, AUCins/AUCglu and [INS (10-0)] were positively correlated with the age, BMI,total body fat content and trunk fat content. After adjustment of age, the trunk fat content was independently associated with the AIR in a good linear manner. Conclusion The obese females show change in body composition with more trunk fat content. They show significant insulin resistance with compensated elevation of insulin secretion. Body composition assessment is a valid and more accurate method than BMI and waist circumference in predicting early damaged β-cell function in obese patients.

[Objective]To investigate the disturbance between Th17 and Treg cell balance in ovarian endometriosis patients.[Methods]Case-control study comparing 40 women with histo-pathologically confirmed ovarian endometriosis and with 40 control infertility women without visible endometriosis foci ,pelvic inflammations who were subjected to laparoscopic surgery during the same period. Peripheral blood,peritoneal fluid,ovarian ectopic endometrial tissue and eutopic endometrial tissue of ovarian endometriosis patients and controls were collected during surgery. T lymphocytes subpopulations in peripheral blood were analyzed by flow cytometry using specific monoclonal antibodies recognizing CD4+,CD25+and CD127-markers and CD3+,CD8-and IL-17A+markers. Then, IL-17,IL-22,IL-10and TGF-βconcentration in the serum and peritoneal fluid was determined using enzyme linked immunosorbent assay(ELISA). Also,Q-PCR was performed to verify Foxp3 mRNA and ROR-γt mRNA expression differences in eutopic and ectopic endometrial tissue.[Results]1.The percentage of CD4+CD25+CD127-Treg cells was significantly decreased in the peripheral blood ofwomen with ovarian endometriosis compared with control women. On the other hand ,the proportion of CD3+CD8-IL-17A+Th17 cells was significantly increased in the peripheral blood of women with endometriosis compared with control wom en. 2. Comparing with the controls ,the concentration of IL-17 and IL-22 was significantly higher in the serum of women with ovarian endometriosis ,and the levels of IL-10 and TGF-β were significantly lower in the serum of women with endometriosis. On the contrast ,in the peritoneal fluid of women with ovarian endometriosis ,the concentration of IL-17 and IL-22 were lower ,and the concentration of IL-10 and TGF-β were significantly higher than the controls. 3.Foxp3 mRNA expression level was significantly elevated in ectopic endometrial tissue of patients with ovarian endometriosis compared with eutopic endometrial tissue ,while the ROR-γt mRNA expression level of ectopic endometrial tissue was significantly decreased than eutopic endometrial tissue.[Conclusion]The present study verifies the imbalance of Th17/Treg in peripheral blood ,peritoneal fluid and endometrial tissue in ovarian endometriosis patients ,which implies the immune dysregulation and the disturbance of immunity homeostasis in the establishment and progression of endometriosis.

[Objective]To investigate the influence of different pre-pregnancy body mass index(BMI)on blood glucose and serum lipid and pregnancy outcome during pregnancy.[Methods]Clinical records of 1115 singleton pregnant women who underwent obstetric examination and delivered in the first affiliated hospital of Sun Yat-sen University between January 1,2013 and December 31,2013 were collected. The patients were divided into 3 groups based on pre-pregnancy BMI,underweight(G1):BMI<18.5 kg/m2, normal weight(G2):18.5 ~ 23.9 kg/m2 ,overweight (G3):≥ 24.0 kg/m2. The characteristics of blood glucose ,serum lipid and pregnancy outcome during pregnancy were analyzed and compared among groups.[Results](1)1 115 cases of pregnant women were Included in the study. The cases of G1 to G3 were 245,757 and 113.(2)With the increase of pre-pregnancy BMI,the blood glucoseof 75 oral glucose tolerance test(OGTT)fasting,1 h and glycosylated hemoglobin(HbA1c)was gradually rising(P < 0.05). The average blood glucose of 75 OGTT fasting among groups were(4.21 ± 0.34)(4.34 ± 0.35)(4.56 ± 0.50)mmol/L,75 OGTT 1 h were (7.51 ± 1.60),(7.83 ± 1.59),(8.83 ± 1.88)mmol/L,HbA1c were(4.81 ± 0.37)(4.90 ± 0.34)(5.03 ± 0.38)%,there was statistical difference among groups(P<0.05). The average FBG of G1 was lower than that of G2 and G3 group(P<0.05). The average blood glucose of 75 g OGTT 2 h of G3 was obviously higher than that of G1 and G2 group(P < 0.05). By Pearson analysis,FBG,75 g OGTT fasting ,1 h ,2 h ,HbA1c had significantly positive relationship with pre-pregnancy BMI(P < 0.05). The incidence of gestational diabetes of G3 group was higher than that of G1 and G2 group,but the incidence of gestational diabetes between G1 and G2 group had no obvious difference.(3)The triglycerides(TG)of G3 was obviously higher than that of G1 and G2 group(P<0.05), the total cholesterol(TC)and high density lipoprotein cholesterol(HDL-C)of G3 was lower than that of G1 and G2(P < 0.05). But There was no statistical difference about apolipoprotein A1(apoA1),B(apoB),E(apoE),Lp(a),Apo A1/Apo B among groups (P > 0.05). By Pearson analysis,TG had significantly positive relationship with pre-pregnancy BMI(P < 0.05),but TC,LDL-C, HDL-C had negative relationship with pre-pregnancy BMI(P<0.05).(4)With the increase of pre-pregnancy BMI,the weight and head circumference of the newborn was gradually rising(P < 0.05). The average weight of the newborn among groups were(3.03 ± 0.42),(3.18 ± 0.45),(3.30 ± 0.46)kg,the head circumference were(32.98 ± 1.59),(33.43 ± 1.64),(33.87 ± 1.60)cm,there was statistical difference among groups(P<0.05). The shoulder circumference of the newborn of G1 was obviously lower than that of G2 and G3 group(P<0.05). Pearson analysis showed that the weight,body length,head circumference,shoulder circumference of the newborn had positive relationship with pre-pregnancy BMI(P < 0.05).[Conclusion]With the increase of pre-pregnancy BMI, the blood glucose at each time point,serum lipid and growth index of the newborn was gradually rising. We suggest that overweight and obese women should lose weight before pregnancy.

OBJECTIVE:To study the absorption features of Silymarin enteric coated-polyllactic-co-glycolic acid (PLGA) nanoparticles in rat in situ intestine perfusion model and colonic adenoma Caco-2 cell model. METHODS:HPLC method was used to determine the content of silymarin. The absorption rate constant(Ka)and apparent absorption coefficient(Kapp)of Silymarin sus-pension,Silymarin PLGA nanoparticles and Silymarin enteric coated-PLGA nanoparticles were investigated in duodenum,jejunum, ileum and colon of rat in situ intestine perfusion model;the apparent permeability coefficient (Papp) of those drugs containing low-concentration,medium-concentration and high-concentration(20,40,60 μg/mL)of silymarin in Caco-2 cell model were also investigated. RESULTS:Compared with Silymarin suspension,Ka and Kapp of Silymarin PLGA nanoparticles and Silymarin enteric coated-PLGA nanoparticles were all increased in duodenum,jejunum,ileum and colon(P<0.05);compared with the correspond-ing concentration Silymarin suspension,two-way Papp of Silymarin PLGA nanoparticles and Silymarin enteric coated-PLGA nanopar-ticles containing low-concentration,medium-concentration and high-concentration of silymarin were all increased in Caco-2 cell model (P<0.05);there was no statistical significance between Silymarin PLGA nanoparticles and Silymarin enteric coated-PLGA nanoparticles (P>0.05). CONCLUSIONS:Silymarin enteric coated-PLGA nanoparticles can effectively increase the intestinal ab-sorption,cellular uptake and transmembrane transport rate of silymarin.

Objective:To explore whether the phospholipidoproteinaceous material deposit within the alveoli by a high-ifeld 3T MRI has signal characters and its application for diagnosing pulmonary alveolar proteinosis.Methods:A total of 11 patients with pulmonary alveolar proteinosis previously diagnosed by ifberoptic bronchoscope lung biopsy underwent 64-slice helical CT scans and 3T MRI scans, and the CT scans and the MRI scans were compared.
Results:hTe phospholipidoproteinaceous material deposit within the alveoli presented longer or equal T1 relaxation time and longer T2 relaxation time, without characters of fatty or deposits of protein-like substance signals and enhancement. The distribution, form, number and size of the lesions at T2WI were almost the same as those at CT, the lesions were irregular in morphology, and there was a clear boundary between the lesions and the adjacent normal lung tissues. Dynamic contrast-enhanced MRI showed thickened pulmonary arteriolae and venulae in the lesions with more obviously thickened pulmonary venulae, which were in conformity with the pulmonary artery and venule enhancement. CT scan in 1 out of the 11 cases showed lesions in both lungs mainly consisted of stripe-shaped and reticular structures, and no obvious sign of pulmonary alveolar proteinosis residue was found. MRI scan detected alveolar proteinosis that failed to be shown by CT scan.
Conclusion:3T MRI T2WI can easily detect the lesions of long T2 signals formed by the lipoproteinaceous material deposit within the alveoli. In the lesions, geographic appearance was presented, and the crazy paving pattern was dimly visualized. MRI can relfect the morphological characters of PAP like CT and it is slightly better compared with CT in such aspects as evaluating the theraputic effect of lung lavage. As supplement to CT, high-field 3T MRI can serve as an important examination for lung diseases.

OBJECTIVE: To evaluate the diagnostic value and limits of transbronchial lung biopsy (TBLB) in pulmonary alveolar proteinosis (PAP). METHODS: The complete hospital data from Second Xiangya Hospital, Central South University, between June, 2006 and December, 2012, were analyzed retrospectively in 25 patients with PAP (who were diagnosed pathologically by TBLB or not by TBLB) and in 4 patients with other disease (who were misdiagnosed by TBLB). RESULTS: Among the 25 patients with PAP, 14 patients were confirmed by TBLB in the fi rst time [TBLB positive rate in the first time was 56% (14/25)]; 6 patients who were misdiagnosed by TBLB in the fi rst time were confirmed by TBLB in the second time [the positive rate in the second time was 24% (6/25)]. Th e total positive rate was 80% (20/25). Th e total negative rate was 20% (5/25). Five patients with PAP, who showed negative results in TBLB analysis, were confirmed by the typical CT as well as the whole lung lavage. In addition, 4 patients with other diseases were misdiagnosed as PAP by TBLB. CONCLUSION TBLB is a very good diagnosis method. But the negative results in the first time cannot exclude PAP. TBLB should be repeated if conditions allow. If clinical manifestation and CT results are typical, it can be used for diagnosis of PAP combined with the positive results from bronchoalveolar lavage fluid check. However, for non-typical cases, it needs TBLB pathological diagnosis.
Biopsy ; Diagnostic Errors ; Humans ; Lung ; pathology ; Pulmonary Alveolar Proteinosis ; diagnosis ; pathology ; Retrospective Studies

Dermatomyositis(DM)is an autoimmune disease often complicated with malignant tumors.More than 50%of DM patients have myositis specific autoantibodies in their bodies.DM specific autoantibodies[including anti-migration inhibitory factor(Mi)-2 antibody,anti-nuclear matrix protein(NXP)-2 antibody,anti-transcription intermediary factor(TIF)1-γ antibody,and anti-small ubiquitin like modifier activating enzyme(SAE)antibody]play important roles in the pathogenesis of malignancy associated DM.Revealing the role of DM specific autoantibodies in the development of malignant tumors in DM patients can provide important evidence for accurately assessing the risk of developing malignant tumors in DM patients,and also provide new ideas for clinical diagnosis of DM and precise treatment.

OBJECTIVETo construct a three-dimensional finite element model of the upper airway and adjacent structure of an obstructive sleep apnea hypopnea syndrome (OSAHS) patient for biomechanical analysis. And to study the influence of glossopharyngeum of an OSAHS patient with three-dimensional finite element model during titrated mandible advancement.

METHODSDICOM format image information of an OSAHS patient's upper airway was obtained by thin-section CT scanning and digital image processing were utilized to construct a three-dimensional finite element model by Mimics 10.0, Imageware 10.0 and Ansys software. The changes and the law of glossopharyngeum were observed by biomechanics and morphology after loading with titrated mandible advancement.

RESULTSA three-dimensional finite element model of the adjacent upper airway structure of OSAHS was established successfully. After loading, the transverse diameter of epiglottis tip of glossopharyngeum increased significantly, although the sagittal diameter decreased correspondingly. The principal stress was mainly distributed in anterior wall of the upper airway. The location of principal stress concentration did not change significantly with the increasing of distance. The stress of glossopharyngeum increased during titrated mandible advancement.

CONCLUSIONA more precise three-dimensional finite model of upper airway and adjacent structure of an OSAHS patient is established and improved efficiency by Mimics, Imageware and Ansys software. The glossopharyngeum of finite element model of OSAHS is analyzed by titrated mandible advancement and can effectively show the relationship between mandible advancement and the glossopharyngeum.

Objective To evaluate the accuracy of respiratory variations of internal jugular vein (IJV) in monitoring fluid responsiveness in patients undergoing radical gastrectomy for gastric cancer.Methods Fifty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 40-64 yr,scheduled for elective radical gastrectomy for gastric cancer,were enrolled in this study.Before induction of anesthesia,the hemodynamic parameters such as heart rate,central venous pressure,cardiac index,stroke volume index (SVI),stroke volume variation and respiratory variation of IJV were recorded after haemodynamics was stable and were recorded again at 10 min after endotracheal intubation,and a loading dose of 6％ 130/0.4 hydroxyethyl starch 7 ml/kg was infused over 15 min.The parameters mentioned above were recorded within 5 min after loading dose.Patients were divided into 2 groups according to the percentage of increase in SVI (△SVI) after volume expansion:△SVI≥ 15％ was considered to be a positive response (responder group) and △SVI＜15％ was considered to be a negative response after volume expansion (non-responder group).Results The area under the receiver operating characteristic curve of respiratory variations of IJV in monitoring fluid responsiveness and 95％ confidence interval were 0.852 (0.744-0.961).Respiratory variation of IJV 24.6％ was considered as the cut-off value and used to monitor fluid responsiveness,and the sensitivity and specificity were 67.6％ and 92.3％,respectively.Conclusion Respiratory variation of IJV can be considered as an effective index in monitoring fluid responsiveness in the patients undergoing radical gastrectomy for gastric cancer.