Objective To evaluate the effects of angiotensin Ⅱreceptor antagonist (ARB) on expression of plasminogen activator inhibitor(PAI)-1 in the human renal biopsy of patients with chronic kidney disease(CKD)and analyse its clinical significance.Methods PAI-1 expression of 63 specimens with CKD was detected by immunohistochemistry and quantitative analysis was achieved by image analysis system. meanwhile, the patients'clinical data were collected,and PAI-1 expression of 63 specimens with CKD was compared with that of normal renal tissue(19 cases).Results Compared with the normal renal tissue,the expression of PAI-1 in CKD 1,2 and 3 stage wag respectively drastically increased(P<0.05).The expression of PAI-1 in CKD 3 stage was higher than that in CKD 1 and 2 stage(P<0.05).The expression of PAI-1 in the patients treated by valsartan[renal corpuscle(4.73±1.18)%,renal tubule(37.16±6.81)%]was lower than that with no treatment[renal corpuscle(5.81±1.95)%,renal tubule(43.22 ±10.25)%](P<0.05).Conclusions It suggests that the abnormal expression of PAI-1 in CKD play an important role in the progression of glomerular and tubulointerstitiai sclerosis in patients with CKD.ARB may prevent the development of renal inflammation and sclerosis by inhibiting the production of PAI-1.ARB may contribute to the prevention and therapy of CKD.

Objective To explore the new methods to fill local temporal depression or augment superciliary with autotissue graft.Methods Applying upper eyebrow perdicled dermis -fat petal to fill the local temporal depression or augment superciliary, accompanied with eyebrow lifting.Results Augmentation superciliary arch plasty with upper eyebrow perdicled dermis-fat petal was performed in 5 patients. All 5 patients' superciliary arch showed good shape and accompanied with no complications. Filling of local depression of temporal with derma-fat flap was performed in 6 patients, with dermis-fat flap and prosthesis was performed in 8 patients. 2 cases had hematoma. Conclusion Upper eyebrow perdicled dermis-fat petal as a material being ultilized to augment superciliary or to fill local temporal depression has advantages of better localization and more natural shape.[

SUMMARY A 15-year-old boy was admitted with nephritic and nephrotic syndrome,renal dysfunction and decreased serum C3,who suffered from varicella for two months.His renal histopathology revealed endocapillary proliferative glomerulonephritis with podocytes proliferation and severe tubular injury by light microscopy.Direct immunofluorescence showed global granular deposition of IgG,IgA,IgM,C3,Clq and fibrinogen in mesangium and along glomerular capillary wall.Electron microscopic examination showed electron-dense deposits in multiple sites of glomeruli.Furthermore,specific serum IgM antibodies against varicella-zoster virus (VZV) were detected.VZV antigen and mRNA were demonstrated in glomerular and tubular epithelial cells by immunohistochemical staining and in-situ hybridization.Virus particles and virus inclusions were identified by electron microscopy and special staining ( Methylene Blue and Eosion staining or Mann staining).The patient also experienced epileptic episodes and his brain MRI and electroenephalogram indicated herpes encephalitis with secondary epilepsy.Therefore,the diagnosis of VZV-associated glomerulonephritis and encephalitis was established.This is the first case of VZV-associated glomerulonephritis with renal histooathological evidence using in situ hybridization technique.

Objective To analyze clinical and pathologic features of a rare vascular amyloid deposits of amyloid nephropathy ( VADAN) in 6 patients, so as to improve its diagnosis and treatment. Methods All patients received immunopathology, microscopy and electron microscopy examination, and amyloid types were analyzed. Results There were 3 males and 3 females with ages ranging from 52 to 73 years. Two patients suffered from multiple myeloma. Majority patients had slight albuminuria and hematuria. One patient combined with minimal change glomerular disease presented nephrotic syndrome. One patient combined with IgA nephropathy had albuminuria and hematuria. And one patient had myeloma cast nephropathy with acute renal failure. Kidney biopsy proved amyloid deposits along interlobular arterial wall only in all 6 patients. Two cases secondary from multiple myeloma were κ amyloid, and the rests were λ amyloid. Conclusions VADAN is a rare type of amyloid nephropathy. Its clinical manifestation is different from common amyloid nephropathy. Kidney biopsy will benefit its differential diagnosis.

Objective To compare the efficacy of tramadol for patient-controlled intravenous versus provicial epidural analgesia (PCIA vs PCEA) and their effects on the T-lymphocyte subsets and natural killer (NK) cells during postoperative period in patients undergoing gynecological operation for tumor. Methods Thirty-nine ASA Ⅰ-Ⅱ patients aged 18-83 yr undergoing elective surgery for ovarian cancer or uterine cancer or myoma were randomly divided into two groups : PCIA group (n = 21) and PCEA group ( n = 18). Premedication consisted of intramuscular atropine 0.5 mg and phenobarbital 0.1 g. Operation was performed under epidural anesthesia. Epidural catheter was inserted at T12 -L1 approximately 3-4 cm into epidural space cephalad. The patients received a test dose of 2% lidocaine 5 ml. The first dose was 2% lidocaine 10-12 ml followed by 0.5% bupivacaine 5 ml every 45-60 min. Tramadol 100 mg was given iv in PCIA group or epidurally in PCEA group 15 min before the end of surgery. 100 ml of PCIA solution contained tramadol 800 mg (16 ml), haloperidol 5 mg (1 ml) and normal saline 83 ml and 100 ml of PCEA solution contained tramadol 400 mg (8 ml), haloperidol 5 mg (1 ml) and NS 91 ml. The PCA pump was set to deliver a background infusion at 2 ml?h-1 and a bolus dose 0.5 ml with lock-out interval of 15 min. Analgesia was assessed using VAS. Venous blood samples were taken for determination of T-lymphocyte subset (CD3+ , CD4+ , CD8+) and NK cell counts by flow cytometry the day before surgery and on 1st and 2nd postoperative day. Results The postoperative analgesia was satisfactory in both groups, and there was no significant difference in VAS scores between the two groups. No vomiting and respiratory depression were observed in both groups. The NK cell counts decreased significantly on the 1 st and 2nd postoperative day as compared with the preoperative value (P

Reccent investigations demonstrated that genetically modified tumor cells could be used as vaccines against cancer. In this light, we introduced human interleukin -2 (IL-2) gene into a poorly immunogenic rat fibrosarcoma cell line WBT, a human lung abenocarcinoma cell line AGZY and a highly metastatie sub - cell line Anip973 derived from AGZY. The transduced cells showed no obvious changes in morphology, growth and colony - forming ability in soft agar.Transduction with IL-2 gene rendered the cells more sensitive than the parental cells and cells transduced with NeoR gene alone to the lysis by cytotoxic lymphocytes. High levels of IFN and TNF were detected in the supernatants of cocultured lymphocytes and tumor cells containing IL-2 gene. Tumorigenicity of WBT/IL-2 cells was greatly reduced in syngeneic rats. Metastatic capacity of Anip973 in nude mice was blocked by the transduction of IL-2 gene, but not the transduction of NeoR gene alone. Inoculation of WBT/IL-2 cells conferred rats resistance to the challenge of parental WBT cells.Splenocytes from WBT/IL-2-inoculated rats restimulated with WBT cells in vitro showed high CTL activity against WBT cells. Our results demonstrated the potential application of tumor cells transduced with IL— gene as active vaccine against cancer.

Objective To evaluate the efficacy of the parathyroidectomy (PTX) in the treatment of severe secondary hyperparathyroidism (SHPT) with Sagliker syndrome (SS). Methods A retrospective review was undertaken among 212 SS patients underwent PTX in our hospital and with more than 3 years' follow up. The definitions of the efficacy were based on the postoperative intact parathyroid hormone level (iPTH). Cure showed that the iPTH was ＜ 150 ng/L; marked effectiveness was 150-300 ng/L; effectiveness was 301-500 ng/L;ineffectiveness was ＞500 ng/L. The status was defined as persistent SHPT if iPTH was ＞ 150 ng/L after surgery. The status was considered as SHPT recurrence if iPTH was ＜ 100 ng/L in the first week after surgery, and gradually increased and ＞ 150 ng/L with the follow-up. Results ( 1) Ten patients were involved and the average dialysis time was 142 months [male/female: 4/6; age 30-54 (39. 3 ± 10. 4) years]. All patients had severe bone and joint pain, accompanied with progressive facial increases, chicken breast, kyphosis, hip bone deformities, and body height shortening. (2) Preoperative tests: the median of iPTH 2000(1800-2863) ng/L; serum calcium (2. 45 ±0. 21) mmol/L, phosphorus (2. 19 ±0. 51) mmol/L, alkaline phosphatase ( ALP) (1189. 8 ± 780. 0) IU/L. Two to four enlarged parathyroid glands were confirmed by ultrasound and 99Tcm-MIBI parathyroid scintigraphy. ( 3 ) Surgical procedures: local or general anesthesia for PTX. Supplement with calcium and calcitriol implemented low serum calcium after PTX. (4) Follow-up: symptoms, including bone pain, muscle weakness, skin itching, and insomnia, were significantly improved after surgery. Transient hoarseness occurred in 2 cases. The iPTHs of all patients were decreased significantly after surgery. The median of iPTH was 55.5 ( 10-967) ng/L at 1 month post PTX, and was significantly less than prior to PTX (P＜0. 001). Eight patients were cure , 1 marked effectiveness ,and 1 ineffectiveness. Two patients were persistent SHPT, and 1 died of heart failure in the 4th year after PTX. The development of bone deformities was stopped and malnutrition was improved in long-time follow up. The level of iPTH 135(28-390)ng/L(P＜0. 001 ) , serum calcium, phosphorus, and ALP showed normal in the third year. The SHPT recurrence was appeared in the 2nd and 3rd year in 2 out of 8 patients, respectively. Conclusions Total PTX can effectively treat SS by SHPT. It can improve prognosis for patients, such as bone pain disappearing, bone deformities stopping and malnutrition improving, etc. The level of iPTH may rise again in some patients in the future. Therefore, more attentions should be paid to monitoring.

Objective To investigate the changes of the constitution and its ratio of collagen fiber in the process of masseter reattachment following different osteotomies of the prominent mandibular angle so as to offer guidance for the resection of mandibular angle. Methods Sixteen adult goats were randomized into four groups. In group A we performed unilateral curved osteotomy of the mandibular angle. In group B unilateral curved ostectomy was performed with partial masseter resection. In group C unilateral angle splitting ostectomy, while in group D unilateral dissection of the masseter muscle was conducted. The constitution and its ratio of collagen fiber in the interface were observed at 1-month, 2-month, 3-month, and 6-month after operation. Results On the changes of collagen fiber in the process of muscular reattachment, at 1-month post-operation, the constitution of collagen fiber (types Ⅰ and Ⅲ) in groups A and B were significantly different from that of control group (P<0.05). However, both groups C and D had no statistic difference from control group (P>0.05). At 2-month, 3-month and 6-month post-operation, those of all experimental groups had no statistic difference from control group. And with time, the percentage of collagen fiber type Ⅰ increased and type Ⅲ decreased gradually. Conclusion The recovery sequences of masseter muscle reattachment in this study are firstly group C, secondly group A and finally group B. It suggests that the recoveries of mastication and other oral activities are different. Group B turns out to be with a slow muscle reattachment. Thus, we recommend treating different kinds of mandibular hypertrophy with different ostectomies.

To investigate the gene typing, molecular characteristics of virulence and resistance associated gene of Clostridium difficile from clinical isolates in China, the genes tcdA,tcdB of toxin A and B, cdtA,cdt B of binary-toxin, and erm B of clindamycin resistance were detected by conventional PCR. Genotyping of toxic C. difficile were conducted by means of analysis of 16s-23s internal spacer region polymorphism with PCR assay. Then the antibiotic resistance of toxic C. difficile to ampiciline, clindamycin, metronidazole and vancomycin was conducted with E-test. It was found that 8 toxic C. difficile strains were demonstrated out of 12 clinical isolates, in which 5 strains were tcdA+ and tcdB+, and 3 strains tcdA- and tcdB+, accounting for 62.5% and 37.5% respectively. Binary-toxin genes detection were negative in all the strains. Clindamycin resistance associated gene ermB was positive in 4 out of 8 toxic C. difficile strains, accounting for 50%. 8 toxic isolates were typed into 4 gene types, the dominant type was ZR I,accounting for 62.5%. Resistance rate of 8 toxic C. difficile strains against ampiciline(AC), clindamycin(CM), metronidazole(MZ) and vancomycin(VA) was 37.5%,87.5%,12.5%, and 0 respectively. No isolates belonged to ribotype 027 or 078. Isolation rate of toxic C. difficile is high to 66.7%. There is obvious gene polymorphism in clinical isolates of Chinese toxic C.difficite, and ZR I is preponderant genotype in 4 genotypes. C. difficile shows some resistance to ampiciline, clindamycin, metronidazole, but susceptive to vancomycin.

Objective To investigate the effect of FK506 on the expression of axon guidance cue slit-2 after spinal cord injury(SCI)in rats.Methods A total of 75 adult Sprague-Dawley rats were randomly divided into three groups,ie,sham operation group,SCI group and FK506 treatment group.The SCI model was made by using the modified Allen's technique.Then,the rats were sacrificed and the spinal cord was removed at different time points(at days 1,3,7,14 and 28)for detection of the expression of slit-2 by means of reverse transcription polymerase chain reaction(RT-PCR)and immunohistochemistry.Results The expression of slit-2 changed with time.The expression of slit-2 could be detected at day 1 after SCI,reached the highest at day 7 and then decreased gradually,with higher expression level in the injury group compared with treatment group(P ＜ 0.05).Conclusion Following spinal cord injury,administration of FK506 can up-regulate the expression of slit-2 and may exert important effect on the guidance of the axon regeneration.