Objective:To investigate the effect of sufentanil in preventing the adverse effects of hamabate in the patients undergoing cesarean section.Methods:Forty patients who would have been injected with hamabate were selected,they were undergoing elective cesarean section with continuous epidural anesthesia and randomly divided into sufentanil group and 0.9％ sodium chloride injection group.When the fetus was removed and hamabate was injected,simultaneously patients in sufentanil group were injected sufentanil 0.1 μg/ kg,and patients in 0.9％ sodium chloride group were injected equal dose of normal saline.MAP,HR,SpO2 and RR were monitored in the two groups.Adverse reactions after hamabate injecting into the body of the uteru,such as nausea,vomiting,chest pain,dizziness and facial flushing were recorded,and Ramsay sedation score was recorded before anesthesia,at 30 min after hamabate was injected and at the ending of the operation.Results:After 30 min using hamabate,MAP,H R and RR of sufentanil group were more stable than 0.9％ sodium chloride group(P ＜ 0.05),Ramsay sedation score of sufentanil group was higher than 0.9％ sodium chloride group(P＜0.05).Adverse reactions such as nausea,chest pain,dizziness and facial flushing were lower in sufentanil group than those in 0.9％ sodium chloride group(P ＜0.05).Conclusions.Small doses of sufentanil can reduce the adverse effects of hamabate in cesarean section,and hemodynamic can be more stable,also it is a certain better sedation,and can be usesd safely.

Objective To explore the short-and mid-term curative effect and influence factors of hepaticojejunostomy(Kasai operation) for biliary atresia.Methods The clinical data of 66 children with biliary atresia treated with Kasai operation were analyzed retrospectively.The jaundice fading rate,2-year survival rate and influence factors of prognostic were analyzed.Results The jaundice fading rate of 62 cases was 58.1％ after Kasai operatiou.The patients also had a 2-year native liver survival rate of 53.2％.The jaundice fading rate,2-year survival rate of type Ⅰ,Ⅱ and Ⅲ had no significant differences (χ2 =1.91,0.76,all P ＞ 0.05).The 2-year survival rate of children underwent Kasai operation as younger than 60 days was higher rate than that of the children as 61 to 90 days and older than 90 days(χ2 =4.72,P ＜ 0.05).The 2-year survival rate of children with cytoinegalovirus infection and postoperative cholangitis were 43.6％,39.5％,respectively,which were lower than those of children without cytomegalovirus infection and postoperative cholangitis (69.6％.75.0％) (χ2 =3.92,7.46,all P ＜ 0.05).Conclusion Kasai operation is still the preferred method for the treatinent of biliary atresia.Type of the disease was not related with the short-and mid-term effects of Kasai operation.Age at operation was the main factor affecting the prognosis.Therefore,it is very important to make early surgery,enhance the anti-viral treatment and prevent postoperative cholangitis.

Objective To explore the clinical significance of immunocyte subsets before and after immunosuppressive therapy in the peripheral blood of patients with immune thrombocytopenic purpura (ITP).MethodsThe percentages of immunocyte subsets in the peripheral blood of 35 patients with ITP and 20 healthy controls were detected by flow cytometry,including CD3+,CD4+,CD8+,CD56+,CD19+ lymphocytes and CD4+/CD8+.Results The percentages of CD3+ T lymphocyte (61.58 ± 6.45 ) %,CD4+ T lymphocyte (28.38 ±4.89)% and the ratio of CD4+/CD8+ 0.99 0.22 in patients with ITP were lower than those in healthy controls[( 67.85 ± 4.68 ) %,( 38.00 ± 3.37 ) %,1.54 ± 0.13,all P ＜ 0.05].After immunosuppressive therapy,the percentages of CD3+ T lymphocyte ( 69.41 ± 5.03 ) %,CD4+ T lymphocyte (38.17 ±3.18)% and the ratio of CD4+/CD8+ 1.60 ±0.15 recovered to control levels.The percentages of CD8+ T lymphocyte (29.20 ±4.50)% and CD19+B lymphocyte ( 17.74 ±4.14)% were higher than those in healthy controls[( 24.82 ± 2.93 ) % and ( 12.09 ± 3.51 ) %,all P ＜ 0.05].After the immunosuppressive therapy,the percentages of CD8+ T lymphocyte ( 24.06 ± 3.02 ) % and CD19+ B lymphocyte ( 10.90 ± 3.55 ) %recovered to control levels.There were no significant difference of the percentage of CD56+ lymphocyte among ITP patients ( 15.80 ± 2.85 )%,ITP patients after immunosuppressive therapy ( 15.16 ± 2.77 )% and healthy controls ( 16.36 ± 2.75 ) %.ConclusionThe aberrant immunocyte subsets are involved in the pathogenesis of ITP,and detection of immunocyte subsets might be helpful for the diagnosis and determination of therapeutic outcome of ITP.

Objective To investigate the way of gene therapy on congestive heart failure and other heart diseases. Methods Recombinant adeno associated viruses (AAV) encoding the human ? 2 adrenergic receptor(AR) and enhanced green fluorescent protein (EGFP) were constructed and the ? 2 AR and EGFP cDNA were transfected in vitro to the neonate rat ventricular myocytes. The expression of ? 2 AR and EGFP on cultured neonate rat ventricular myocytes and the ability of ? 2 AR to potentiate the beta adrenergic signaling were assessed. Results The presence of human ? 2 AR mRNA was demonstrated by Northern blot, the expression of the ? 2 AR gene was demonstrated by Westernimmuno blot. The density of ? AR in the myocytes was greater than that in the control 〔(204.0 ? 6.4) fmol/mg protein vs (76.0 ? 2.8) fmol/mg protein〕 according to a ligand binding assay. Human ? 2 AR gene significantly increased isoproterenol stimulated cAMP as compared with the control〔(116.2?5.8) pmol/10 6 cell vs (58.4 ? 4.6) pmol/10 6 cell〕. EGFP was also expressed in the transfected cardiomyocytes. Conclusions Human ? 2 AR gene could be transfected into cardiomyocytes by AAV vector and could potentiate the beta adrenergic signaling.

Objective To evaluate the relationship between the mechanism of spinal monocyte chemoattractant protein-1 (MCP-1)-mediated maintenance of chronic pathological pain and synaptic transmission in spinal dorsal horns of rats.Methods Female Sprague-Dawley rats,aged 2-3 weeks after birth,weighing 150-210 g,were studied.The experiment was performed in 2 parts.Experiment Ⅰ Eighteen Sprague-Dawley rats were randomly divided into 2 groups (n =9 each) on 7 days after intrathecal catheters were inserted:phosphate buffer solution (PBS) group and MCP-1 group.PBS 10 μl was intrathecally injected in group PBS,and PBS 10 μ1 containing 100 ng MCP-1 was intrathecally injected in group MCP-1.The mechanical pain threshold was measured at 30 and 60 min before intrathecal injection,and 30,60,90,120,150 and 180 min and 1,2 and 3 days after intrathecal injection.Experiment Ⅱ The transverse spinal cord slices were prepared,and substantia gelatinosa neurons were selected for whole-cell patch-clamp recording.Electrophysiological recording was performed at 1 h of incubation with artificial cerebrospinal fluid (ACSF) and immediately after adding MCP-1:for excitatory synaptic transmission recording,MCP-1 (final concentration 100 nmol/L),N-methyl-D-aspartate (NMDA,final concentration 100 μmol/L) and α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA,final concentration 20 μmol/L) were added to ACSF,and spontaneous excitatory postsynaptic currents (sEPSCs),AMPA receptors-mediated currents and NMDA receptors-mediated currents were recorded;for inhibitory synaptic transmission recording,MCP-1 (final concentration 100 nmol/L) and γ-aminobutyric acid (GABA,final concentration 1 mmol/L) were added to ACSF,and spontaneous inhibitory postsynaptic currents (sIPSCs) and GABA receptors-mediated currents were recorded.Results Compared with group PBS,the mechanical pain threshold was significantly decreased at 30 min-2 days after intrathecal injection in group MCP-1 (P＜0.01).Compared with those at 1 h of incubation with ACSF,the frequency and amplitude of sEPSCs were significantly increased,the amplitude of NMDA receptors-and AMPA receptors-mediated currents were increased,the frequency and amplitude of sIPSCs were decreased,and the amplitude of GABA receptors-mediated currents was decreased immediately after adding MCP-1 (P＜0.05).Conclusion MCP-1 enhances excitatory synaptic transmission through enhancing the function of NMDA and AMPA receptors in the posterior substantia gelatinosa neurons of the spinal cord;MCP-1 weakens inhibitory synaptic transmission through inhibiting GABA receptor function,which may be involved in MCP-l-mediated maintenance of chronic pathological pain in rats.

Immune checkpoint inhibitor (ICI) has become one of the important therapeutic strategies for the patients with advanced non-small cell lung cancer (NSCLC). The latest clinical studies have shown that immunotherapy can bring more survival benefits to patients with early lung cancer and operable patients with locally advanced lung cancer. However, the strategies of neoadjuvant immunotherapy, the timing of operation, the evaluation system of curative effect, predictive markers and other problems still need to be explored in the clinical practice of large samples. This paper reviews the progress of neoadjuvant immunotherapy in NSCLC.

BACKGROUND: Present existed procedure protocol for urinary fistula has some limitations, which can not reflect diseased region, pathological change, or severe condition of patients, OBJECTIVE: To establish the procedure protocol for urinary fistula diagnosis and treatment following renal transplantation, in addition, to investigate its significance in clinical practice. METHODS: A total of 102 cases with urinary fistula, including 67 male and 35 female, range in age from 21 to 57 years. According to the business management mode, we have designed the "five-step procedure protocol" for the diagnosis and treatment of urinary fistula after renal transplantation. Four diagnosis steps consisting of qualitative, located, quantitative and classified, as well as one treatment step. Among 102 cases of urinary fistula, 34 were adopted conservative treatment, including 24 cases with drainage tube and retention type catheter, 10 cases with indwelling ureteric stents at tubal bladder. Other 68 cases received surgical treatment. In 47 cases with simple fistula, 36 cases received ureter/bladder replantation, 11 cases with ureteral anastomosis. Twenty-one cases with complex fistula were treated with surgical prosthesis using omentum majus after repairing. RESULTS AND CONCLUSION: Among the 34 cases receiving conservative treatment, 2 got urinary tract infection repeatedly, and 5 got the stenosis of ureterovesical anastomotic stoma. Among the 68 cases receiving surgical treatment, 2 had ureteral stoma stricture, 1 ureterovesical anastomotic stoma stricture, and 1 ureteral countercurrent. In the surgical treatment series, 3 cases died from severe pulmonary infection elicited by urinary fistula. 77 cases were available for long-term follow-up, 22 were dropped out. In the 57 cases with simple fistula were followed up for 1-10 years, the transplanted renal function was normal in 40 cases, and 17 cases suffered from chronic rejection. 20 cases with complex fistula treated with surgical prosthesis using omentum majus were followed up for 1-7 years, 19 cases were normal, 1 patient had increased creatinine, which was returned to normal after intravenous glucocorticoid therapy. The design of "qualitative, located, quantitative and classified" standard for urinary fistula diagnosis following renal transplantation, and the establishment of "five-step procedure protocol", make urinary fistula diagnosis and treatment more ordered and standard, which is more feasible for selecting optimal therapeutic scheme.

Objective To explore the clinical significance of a series of cytokines and peripheral blood immunocyte subsets before and after immunosuppressive therapy in patients with immune thrombocytopenia (ITP).Methods The percentages of immunocyte subsets in the peripheral blood of 20 patients with ITP and 20 healthy controls were detected by flow cytometry,including CD3+,CD4+,CD8+,CD4+/CD8+,CD1~.ELISA was applied to detect the level of serum TNFα,IL-2,IL-6,IL-4,IL-10,IL-11,IL-17,IL-27,transforming growth factor β (TGFβ),thrombopoietin (TPO) of 20 patients with ITP and 20 healthy controls.Results The percentage of CD3+ T lymphocyte,CD4+ T lymphocyte and the ratio of CD4+ / CD8+ T lymphocyte in patients with ITP were lower than those in healthy controls [(62.66 ± 6.58) ％ vs (69.93 ± 4.81) ％,(29.46 ± 5.02) ％ vs (39.08 ± 3.50) ％,0.97 ± 0.35 vs 1.56 ± 0.26,all P ＜ 0.05].After immunosuppressive therapy,the percentage of CD3+ T lymphocyte,CD4+ T lymphocyte and the ratio of CD4+/CD8+ T lymphocyte [(71.49 ±5.16)％,(39.25 ±3.21)％ and 1.56 ±0.28] recovered to the same levels in healthy controls.The percentage of CD8+ T lymphocyte and CD19+ B lymphocyte in patients with ITP were higher than those in the healthy controls [(30.28 ±4.63)％ vs (25.90±3.06)％,(18.92 ± 4.27)％ vs (13.17 ± 3.64)％,all P ＜ 0.05].After treatment of immunosuppressive therapy,the percentage of CD8+ T lymphocyte and CD19+ B lymphocyte [(25.16 ± 3.45) ％ and (11.98 ± 3.68) ％] recovered to the similar levels in healthy controls.The serum levels of IL-4,IL-6,IL-11,IL-17 and TPO in patients with ITP were significantly higher than those in healthy controls.While TGFβ level was significantly decreased.There was no significant difference of IL-27 between ITP patients and healthy controls.After the treatment of immunosuppressive therapy,IL-4,IL-6,IL-11,IL-17,TPO and TGFβ were down-regulated while IL-27 was up-regulated.There was no significant difference of IFNγ,TNFα,IL-2 and IL-10 among ITP patients before or after immunosuppressive therapy and healthy controls.Conclusions The present study suggests that the aberrant immunocyte subsets and cytokines are involved in the pathogenesis of ITP.Hyper-function of Th2 and Th17,dysfunction of Treg cells,up-regulation of IL-27,IL-11,TPO and other factors may contribute to the pathogenesis of ITP.

Objective To analyze the changes and clinical significance of C-reactive protein (CRP)、hemoglobin (Hb) and erythrocyte sedimentation rate (ESR) in different disease stage of multiple myeloma according the international staging system. Method Thirty untreated MM patients with complete clinical records were included in the stndy. The multiple myeloma patients were classified into three groups according to international staging system (ISS).Thirty megaloblastic anemia patients of similar age 、sex、hemoglobin level as the observation group.Resulets The levels of CRP (24.17±9.87 mg/L)、Hb (71.72±13.27 g/L) and ESR (105.94±27.73 mm/h) of stage Ⅲ patients were statistically different with stage Ⅰ ( CRP 8.54±1.97 mg/L; Hb 91.00±9.92g/L; ESR 73.57±20.53mm/h)、Ⅱ patients ( CRP 14.89±5.51 mg/L; Hb 91.29±8.32g/L; ESR 67.00± 15.56 mm/h) separately (P＜0.05).The levels of CRP (19.40±10.17 mg/L) and ESR (91.90±29.70 mm/h) in the MM patients were significantly higher than that in the observation group Ⅰ ( CRP 7.52±1.57mg/L; ESR 20.20±8.04mm/h) (P＜0.05 respectively).CRP and ESR level in MM patients positively correlated with myeloma cell proportion and β2-microglobulin level (P＜0.05), while Hb level negatively correlated with myeloma cell proportion and β2-microglobulin level (P＜0.05),Conclusion The levels of C-reactive protein、hemoglobin and erythrocyte sedimentation rate are closely associated with the development of multiple myeloma. C-reactive protein and hemoglobin are relatively sensitive response to disease than erythrocyte sedimentation rate. There is a clear clinical implication in detecting the patient' s condition for progress and the prognosis.

BACKGROUND: The urinary fistula rates following kidney transplantation are varying in each center, which lack of unified classification criteria and treatment standard. OBJECTIVE: To explore optimal treatments for urinary fistula following kidney transplantation by retrospective analyzing the characteristics, etiological factors and therapeutic efficacy of urinary fistula. METHODS: Totally 68 patients with urinary fistula were collected, including 42 males and 26 females, aged 21-57 years. The urinary fistula occurred at days 1-17 after operation. According to the location of urinary fistula, patients were divided into stomas fistula and ureter fistula groups. The location of fistula was determined by cystography, magnetic resonance hydrography (MRH) or operation research. In both groups, conservative treatment was first adopted, namely, placing a negative pressure drainage tube draining the wounds and placing a double-J catheter or a urinary canal in, however, if invalid, a surgical repair was performed. There were 45 patients underwent surgery. The location, onset period, therapeutic efficacies of urinary fistula was analyzed. RESULTS AND CONCLUSION: Among the 68 cases of fistula, 20(29.4%) were stomas fistula and 48 (70.6%) were ureter fistula. The onset period was (5.1±2.5) and (8.8±5.5) days after transplantation, respectively (P < 0.05). Fifteen of 20 stomas fistula (75.0%) were cured successfully by conservative treatment. Whereas, for the remaining 5 cases (25.0%), we attempted open surgery, among which 4 were cured, free of recurrence, and 1 case underwent nephrectomy because of acute rejection. For the 48 cases of ureter fisula, only 8 (16.7%) were cured by conservative treatment, but the other 40 (83.3%) must accept further open surgery, among which 35 were cured (including 6 cases of recurrent fistula). Three cases underwent nephrectomy failure of repair owing to acute rejection, besides 2 died of pulmonary infection. The achievement ratio of conservative treatment in lower fistulae was significantly higher than that of upper fistulae (P < 0.01). It is necessary to determine the location of urinary fistula following kidney transplantation. Compared to ureter fistula, stomas fistula occurred earlier with great leaked volume. Conservative treatment can first selected for stomas fistula, only if it is invalid can we resort to open surgery. However, for. ureter fistula, it is wise to adopt open surgery as soon as possible.