Diabetic retinopathy (DR) is one of the common and serious diabetic complications,with a complex nosogenesis.Studies have shown that transforming growth factor-β (TGF-β) participates in the occurrence and development of DR,and Smads protein is able to mediate and activate TGF-β/Smads signal transduction pathway and further involves in the pathogenesis of DR.Smurf is one of the ubiquitin ligases in ubiquitin-proteasome pathway,and it is clarified to regulate TGF-β/Smads signal transduction pathway degradation.At present,the study on the relationship between TGF-β/Smads pathway and DR has made great progress.The role of ubiquitin-proteasome pathway regulating TGF-β/Smads signal transduction pathway in DR is reviewed in this article.

Objective To identify whether cisplatin can induce autophagy of bladder cancer T24 cells and the possible mechanism, and to observe the relationship between outophagy and apoptosis.Methods MTT assay was applied to investigate the effects of various concentration of cisplatin( 0 , 10 , 20 and 40 μg/mL) on T24 survival.TEM was performed to detect the autophagosome formation .Western blot assay was used to analyze the expression changes of LC3-Ⅱ, P62 and extracellular signal-regulated kinase ( ERK1/2 ) and p-ERK at the protein level.The effects of autophagy on the survival and apoptosis of bladder cancer cells were investiga-ted.Results DDP observably inhibited proliferation of bladder cancer cells in a dose-dependent manner ( P<0.05), the 50% inhibiting concentration(IC50) was (30.3 ±2.4)μg/mL;DDP induced autophagy of bladder cancer cells, observably increased autophagosome induced by DDP; up-regulated expression levels of LC3-Ⅱproteins ( P<0.05 ) , down-regulated expression of P62 proteins ( P<0.05 );DDP increased the protein level of p-ERK (P<0.05); The inhibitor of ERK pathway U0126 inhibited DDP-induced autophagy, as evidenced by decrease in the expression of LC3-Ⅱproteins ( P<0.05 ) .After inhibition of autophagy by WTM in DDP-treated cells, cell viability was obviously decreased and apoptosis was increased (P<0.05);DDP combined with WTM observably enhanced cleavage of poly ADP-ribose polymerase 1 ( PARP-1 ) and cleaved-caspase-3 which is apop-tosis related proteins ( P<0.05 ) .Conclusions Autophagy can protect T24 cells against ciplatin-induced apop-tosis, the possible mechanism of autophagy is the ERK signaling pathway is activated .

Objective To propose an approach for developing a physical examination information system by analyzing the requirements for physical examination and the implementation of the system.Methods The development was realized from four aspects of customer service platform,system integration and data sharing,data processing and statistical analysis,external examination flow design and data archiving.Physical examination flow was modified accordingly,and the business flow and data flow were integrated from the physical examination system,HIS,PACS and LIS.Results The system established a human-oriented customer service platform,realized data sharing and automatic processing,and transformed external examination into digital mode from manual mode.Conclusion The system needs continuously improving and gifting with multi functions to provide enhanced service to the customer.

BACKGROUND: Bone and exact reduction and internal fixation should be kept to fully repair the function of patella in comminuted patellar fracture operation. Currently, comminuted patellar fracture without a unified therapeutic standard has been a difficulty in clinic.OBJECTIVE: To compare the effects of modified AO tension band, titanium cable cerclage and nickel-titanium (Ni-Ti) patellar concentrator fixation in the treatment of comminuted patellar fracture.DESIGN: Prospective comparative observation.PARTICIPANTS: Totally 60 patients with simple unilateral closed comminuted patellar fracture were enrolled at Department of Orthopaedics of Changzheng Hospital from November 2004 to November 2006, including 32 males and 28 females aged 28-59 years. Inclusive criteria contained diagnosis of having simple unilateral closed comminuted patellar fracture and injury timing of less than 7 days. The patients all signed the informed consent.METHODS: The patients were assigned into modified AO tension band group (n =22), titanium cable cerclage group (n = 21) and Ni-Ti patellar concentrator group (n =17) according to their will. Twelve patients in the modified AO tension band group received simple modified AO tension band internal fixation, and ten received modified AO tension band internal fixation and extraction. Patients in the titanium cable cerclage group received titanium cable cerclage. Ten patients in the Ni-Ti patellar concentrator group received simple Ni-Ti patellar concentrator internal fixation, and seven received internal fixation and extraction.MAIN OUTCOME MEASURES: ①Postoperative host and material reaction, intraoperative blood loss, medical cost and workday loss, and ②active range of knee motion at month 3 after operation and functional recovery and curative effect at month 6 after operation.RESULTS: Totally 60 patients were involved in the result analysis. ①Host and material reaction was not found in all patients. Blood loss was significantly more in the patients of simple Ni-Ti patellar concentrator internal fixation group than patients of simple modified AO tension band internal fixation group and titanium cable cerclage group, whereas workday loss was less than that of the simple modified AO tension band internal fixation group (P < 0.05). Medical cost was obviously more in the titanium cable cerclage group than the simple Ni-Ti patellar concentrator internal fixation group and the simple modified AO tension band internal fixation group (P < 0.05). ②Active range of knee motion was the largest, about mean 108°, and long-term functional score of injured knee was the highest, about mean 21.3 points, with the excellent and good rate of 95.2%, and no sever complication appeared in the titanium cable cerclage group. These were much better than those of the other groups (P < 0.05).CONCLUSION: Modified AO tension band fixation and patellar concentrator fixation in the treatment of comminuted patellar fracture have excellent effects in some patients. Titanium cable cerclage fits for the treatment of comminuted patellar fracture and has better recovery of knee joint function.

Objective To investigate the changes of extracellular histones during the course of acute liver failure in mice as well as its therapeutic potential.Methods WT mice (C57BL/6) were randomly (random number) allocated to inducing acute liver failure by lethal doses of GalN/LPS injected i.p.Hepatic function,apoptosis of hepatocytes and histological indexes were measured at different intervals following GalN/LPS challenge.The levels of extracellular histones were determined by using ELISA and Western blot methods.Meanwhile,GalN/LPS-treated mice were administered with anti-histone H3 and antihistone H4 neutralized antibodies,respectively.Results Administration of GalN/LPS to mice caused acute liver failure,characterized by significant elevation of plasma ALT levels and massive hepatocyte apoptosis or necrosis.All mice died within 9-12 hours.The levels of nucleosomes and extracellular histones H3 and H4 were increased considerably in a time-dependent manner.The survival rates in GalN/LPS-treated mice were improved remarkably following administration of anti-histone H3 and H4 neutralized antibodies (P =0.037,P =0.025),likely due to the significant inhibition of TNF-production.Conclusions Extracellular histones are an important mediator implicated in the pathogenesis of acute liver failure.Anti-histones show promising potential in the treatment of acute liver failure,which deserves further investigation in the future.

Objective To observe the changes of the peripheral blood T lymphocyte subsets following acute spinal cord injury and investigate the possible mechanism of these changes. Methods The SCI models of rats were made by Allen's method. Forty SD rats were divided into four groups, ie,normal control group, sham operation group, 100 g·cm group and 200 g·cm group. The expressions of CD4 and CD8 subsets of the peripheral blood T lymphocyte of the injured rats were determined by immunofluorescence labelling and flow cytometry at different times after injury. Results It was found that the expression of CD4 was significantly reduced to (30.40±4.76)% in 100 g·cm group and to (26.54± 9.34) % in 200 g·cm group, which were significantly lower than that of normal control group ( P ＜0.01 ). At 36 hours after injury, the ratio of CD4/CD8 was significantly reduced to 1.81 ± 0.55 in 100 g·cm group and and 1.29 ± 0.50 in 200 g·cm group, with statistical difference (P ＜ 0.05).Conclusions The immunoreaction is significantly depressed at the early stage of acute spinal cord injury. The severer injury results in more significant decrease of CD4 and ratio of CD4/CD8. The changes of CD4 and CD4/CD8 ratio can be used to indicate the severity of spinal cord injury.

Objective To explore the humanistic care in the treatment of esophageal cancer patients, reducing surgery anxiety,fear,eliminate the negative psychology,reduce complications and promote early recovery.Methods We continuously strengthened the ideological education of nurses in our hospital and gave psychological preoperative care and enthusiastic postoperative care to 76 esophageal cancer patients since November 2008.then the nursing effect was observed.Results 74 cases(97.37%) surgery patients did not suffer a variety of complications due to emotional tension and fear,they kept quiet and stable vital signs during the operation.Postoperative follow-up showed 75 patients(98.68%) were satisfied with the service.Conclusions Application of humanistic care in patients with esophageal cancer throughout the nursing process can make patients feel the warmth of human caring,so as to reduce anxiety,fear and take the initiative with the operation.It is crucial for the entire success of the operation.

Objective To investigate the risk factors and countermeasure of residual stones after single‐channel percutaneous nephrolithotomy for higher stone‐free rate and better operation result .Methods All patients who underwent single‐channel percu‐taneous nephrolithotomy in our hospital from June 2011 to December 2013 were retrospected and the cause of residual stones were analyzed .Results There were 42 patients who had residual stones after operation among total 262 patients undergone single‐chan‐nel PCNL .21 patients had residual stones because the stones they burdened were too complex .7 patients were concerned with com‐plications such as intraoperative hemorrhage .The stone fragments scattered into the calices in 7 patients with overlarge stone during fragmentation .The other causes concerned with stone residue included anatomic structural abnormalities of the kidneys(3 patients) , operation itself inherent limitations(3 patients) ,insufficient practice and experience in operation(1 patients) .Conclusion The main causes concerned with residual stones of single‐channel PCNL are complexity of urinary calculi ,bleeding ,scattering of stone frag‐ments and anatomic structural abnormalities of the kidney .

Background As one of the most common microvascular complication of diabetes in eyes,diabetic retinopathy (DR) is one of the most important cause of blindness.Nuclear factor-kappa B (NF-κB) is involved in the occurrence and development of the disease through the activation of a series of inflammatory cytokines.Objective The present study was to investigate the effects of peroxisome proliferator-activated receptor-gamma (PPAR-γ) excitomotor,rosiglitazone,on NF-κB expression and apoptosis of the retinal ganglion cells (RGCs) in the retina with diabetes mellitus. Methods Ninety SPF male Wistar rats were randomized into normal control group,diabetic control group and rosiglitazone group.Diabetes mellitus was induced by intraperitoneal injection of 50 mg/kg streptozotocin(STZ).Then 3 mg/kg rosiglitazone was intragastricly administered once per day in the rosiglitazonegroup,and the same volume of saline solution was used at the same way in the normal control group and diabetic control group from 3 days after modeling.The rats were sacrificed and the eye cups specimen was made at 4,8 and 12 weeks after usage of drugs.Retinal histopathological examination was performed by hematine-eosin staining,and expression of NF-κB p65 protein in retina and apoptotic index(AI) of RGCs were detected by immunohistochemistry and TUNEL assay,respectively in different time points mentioned above.The use of the animals complied with the Regulations for the Administration of Affairs Concerning Experimental Animals by State and Technology Commission.Results The blood glucose level was significantly elevated at various time points in the diabetic control group and rosiglitazone group compared with normal control group (P＜0.01 ),and that of the rosiglitazone group was significantly declined in comparison to the diabetic control group (q =0.81,0.82,1.23,P＞ 0.05 ).Normal retinal structure was seen in the normal control group,and edema retinal cell and disorder of retinal layers were exhibited in the diabetic control group.Retinal structure was almost normal in the rosiglitazone group.The NF-κB p65 was expressed weakly in the retina of normal control group,but the expression of NF-κB p65 was significantly elevated in the diabetic control group and rosiglitazone group compared with the normal control group(P＜0.01 ).However,the expression of NF-κB p65(A value)was significantly decreased in the rosiglitazone group compared with diabetic control group at 8 weeks and 12 weeks( q=17.77,15.30,P＜0.01 ).There were a few apoptotic cells in rat retina of the normal control group.Compared with the normal control group,the AI of the diabetic control group and rosiglitazone group was significantly reduced(P＜0.01 ).However,the AI of RGCs in the rosiglitazone group was significantly lower than that of diabetic control group in various time points (q =19.28,27.39,49.92,P＜0.01 ). Conclusions As one of the PPAR-γexcitomotors,rosiglitazone can inhibit apoptosis of RGCs through downregulating the expression of NF-κB in rat retina with diabetes mellitus,indicating a protective effect of rosiglitazone on retina in diabetic rat.

Abstract? AIM: To evaluate the efficiency of two different operation ways, vitrectomy and vitrectomy combined with inferior scleral buckling, for a complex kind of retinal detachment.?METHODS:The complex kind of retinal detachment were diagnosed in 100 cases ( 100 eyes ) , with the common features:1)the course of more than 1mo;2) at least one retinal hole located in the inferior marginal retina;3) the detachment of retina was found proliferated, there was at least 1 retinal fold in retinal detachment area. The patients were randomly divided into two groups: the treatment group ( 50 eyes ) who received vitrectomy combined with inferior scleral buckling;the control group ( 50 eyes ) who received vitrectomy without scleral buckling. The retinal anatomic reattachment, visual function recovery, macular central fovea thickness and complications in two groups were observed.? RESULTS: There were 49 eyes ( 98%) with retinal anatomic reattachment in the treatment group while 42 eyes(84%)in control group(χ2=4.2605, P<0.05);the best corrected visual acuity ( BCVA) was 0.254 ±0.238 in the treatment group while it was 0.219±0.229 in control group (t=1.8879,P>0.05);the macular central fovea thickness was 272 ±32.21μm in the treat group while it was 316 ± 33.46μm(t=12.597,P<0.01).Intraocular pressure in 12 eyes ( 24%) was more than 30mmHg in the treatment group while 4 eyes ( 8%) in control group within 1wk postoperation (χ2=4.7619,P<0.05); intraocular pressure in 100 eyes were controlled below 21mmHg 1mo postoperatively.? CONCLUSION: It is a more effective method to vitrectomy combined with inferior scleral buckling than the single vitrectomy for the special kind of retinal detachment.It can increase the rate of retinal anatomic reattachment and reduce macular edema.