BACKGROUND:Bone marrow derived mesenchymal stem cells (BMSCs) will be homing to the lesions after balloon injury in the inflammatory reaction process.However,the molecular mechanism of transforming growth factor-β1 (TGF-β1) to promote BMSC into smooth muscle-like cell remains unclear.OBJECTIVE:To investigate the BMSC differentiation rate under different TGF-β1 levels after acute vascular injury.DESIGN,TIME AND SETTING:A randomized controlled animal experiment and in vitro induced cell observation were performed at the SPF Laboratory Animal Center and Laboratory of Tissue Engineering,Ninth People's Hospital of Shanghai Jiao Tong University Medical School between January 2008 and May 2009.MATERIALS:A total of 24 male SD rats were randomly divided into normal control and model groups with 12 animals in each group.In addition,6 4-weak-old male SD rats were used to prepare BMSCs.METHODS:Model of acute carotid artery injury was established in model group.Serum of normal control group and model group after 1,3,7 days of injury to detect TGF-β1 level after the vascular injury by ABC-ELISA.The BMSCs after one passage were cultured at a density of (1.0-3.0)×10~5 cells/100 mm in culture dish,and divided into two groups:in routine culture group,cells were cultured in high-glucose DMEM containing 20% fetal bovine serum;in TGF-β1 group,cells were induced by different concentrations of TGF-β1 (1,3,5 and 10 μg/L) based on routine culture for 1 week.MAIN OUTCOME MEASURES:Serum TGF-β1 level after the vascular injury;,cell morphological changes by inverted phase contrast microscopy;smooth muscle α-actin expression.RESULTS:The normal serum TGF-β1 level in rat was low,but increased rapidly after 1 day of injury,reached its peak at 3 days,and declined gradually but did not return to the basic level till day 7.After 1 week of induction,BMSCs were confluent,forming peak valley appearance.Immunocytochemistry showed that compared with routine culture,the rate differentiation of smooth muscle-like cell was significantly increased in cells stimulated by TGF-β1,especially 5 and 10 μg/L TGF-β1 (P ＜ 0.01).Real-time quantitative PCR results were similar to immunocytochemistry.CONCLUSION:Serum TGF-β1 level increased after acute vascular injury and peaked at day 3.In vitro,a similar concentration of TGF-β1 could induce cultured BMSC to differentiate into smooth muscle-like cells.

BACKGROUND: Previous studies demonstrated that adventitia fibroblasts exhibit important role in the hyperplasia of newly born endomembrane after blood vessel injury. However, the mechanism regarding phenotypic transition of adventitia fibroblasts in vitro remains unclear. OBJECTIVE: To observe effect of peroxisome proliferators-activated receptor ?agonist (PPAR ?) on phenotypic transition of adventitia fibroblasts induced by transforming growth factor ?1 (TGF-?1) in vitro, as well as the expression of collagen protein Ⅰ. DESIGN, TIME AND SETTING: A randomized grouping control experiment was performed at the Tissue Engineering Laboratory of Ninth Affiliated Hospital of Shanghai Jiao Tong Medical College between July 2007 and October 2008. MATERIALS: The aorta thoracica's adventitial fibroblasts were cultured from Sprague Dawley rats, with 2-month-old, weighing 120 g. The TGF-?1 was supplied by American GenWay Biotech Company. The rosiglitazone power was purchased from Beijing Comens Chemical Co., Ltd. METHODS: The experiment was divided into 3 groups: In the TGF-?1 group, fibroblasts was induced with TGF-?1 with different concentrations (3, 5, 10, 15 ?g/L) for 48 hours; in the rosiglitazone group, fibroblasts was induced with rosiglitazone (5, 10, 30, 50 ?mol/L) for 45 minutes followed by co-culture with 10 ?g/L TGF-?1 for 48 hours. There was no intervention measure in the control group. MAIN OUTCOME MEASURES: The phenotypic transition of fibroblasts was measured by ?-smooth muscle actin, the expression of smooth muscle ? 2-actin, as well as collagen type Ⅰ was determined by protein immunoblotting. RESULTS: Compared with the control group, 5 ?g/L TGF-?1 could significantly stimulate the changes of phenotypic transition of fibroblasts as well as the expression of smooth muscle ?2-actin and collagen type Ⅰ, which reach a peak level when treated with 10 ?g/L TGF-?1 (P 0.05). Compared with control group, 30 ?mol/L rosiglitazone could significantly inhibit changes of phenotypic transition of fibroblasts as well as the expression of smooth muscle ? 2-actin and collagen type Ⅰ(P

Objective This study intends to evaluate different acoustic windows that can be used to obtain the midsagittal plane of fetal brain during abdominal ultrasound scanning and the application of acoustic windows in practice.Methods The midsagittal planes were obtained respectively through anterior fontanel,posterior fontanel,sagittal suture and forehead seam of 12 aborted fetuses,and feasible acoustic windows were used as standard acoustic windows to obtain midsagittal planes of second trimester screening fetuses,which were divided into two groups according to the position of fetal brain,cephalic presentation group (367 cases) and non-cephalic presentation group (384 cases).The success rates were compared between groups.Results Of the second trimester fetuses,497 midsagittal planes of 751 cases were successfully obtained.The success rate of the cephalic presentation fetuses (32.7％,120/367) was statistically lower than that of the non-cephalic presentation fetuses (98.2％,377/384,P ＜ 0.01).Of the cephalic presentation fetuses,the combined acoustic windows acquisition success rate of the forehead,anterior fontanelle,sagittal suture and posterior fontanel acoustic window was 32.7％ (32.7％,120/367),significantly higher than the single acquisition success rate of the forehead,anterior fontanelle,sagittal suture and posterior fontanel acoustic window (17.2％,25.9％,1.6％ and 7.6％,all P ＜ 0.01).Of the non-cephalic presentation fetuses,the combined acoustic windows acquisition success rate of the forehead,sagittal suture and posterior fontanel acoustic window was 98.2％ (98.2％,377/384),significantly higher than the single acquisition success rate of the forehead,anterior fontanelle,sagittal suture and posterior fontanel acoustic window (31.8％,61.2％,64.8％ and 62.0％,all P ＜ 0.01).Conclusions The midsagittal plane of fetal brain can be obtained through forehead seam,anterior fontanel,posterior fontanel and sagittal suture acoustic windows in transabdominal screening.The combination of four acoustic windows can increase the success rate of obtaining midsagittal planes.

Objective To investigate the clinical effect of early use of enteral nutrition therapy in elderly diabetic patients suffering from severe lower respiratory tract infection.Methods A prospective,randomized,open,controlled trial was conducted.Patients aged ≥ 60 years old with diabetes mellitus complicated by severe lower respiratory tract infection admitted to Department of Geriatrics of the Ninth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine from July 2013 to June 2015 were enrolled,and they were divided into the observation group (nasogastric tube infusion of fresubin) and control group (ordinary liquid diet) according to the random number table method,with 60 patients in each group.Nutritional status,inflammation state and immunological indexes before treatment (0 day) and 4,7,14 days after treatment,the outcome of the disease and the nutrition related complications were compared between two groups.Results After treatment,serum albumin (ALB),pro-albumin (PA),immunoglobulin A and G (IgA,IgG) were significantly increased compared with those before treatment in both groups [at 7 days,ALB (g/L):28.37 ± 0.40 vs.26.72 ± 0.37 in control group,29.12 ± 0.25 vs.26.86 ± 0.26 in observation group;PA (mg/L):53.80 ± 6.28 vs.43.76 ± 6.93 in control group,58.46 ± 8.70 vs.44.68 ± 7.33 in observation group;IgG (g/L):11.62±4.72 vs.9.98±3.71 in control group,13.36±4.58 vs.9.88±3.27 in observation group;IgA (g/L):2.31 ±0.35 vs.1.50±0.39 in control group,3.07±0.48 vs.1.37±0.29 in observation group;all P ＜ 0.05].Compared with the control group,the level of PA in observation group was significantly increased from 7 days on (mg/L:58.46 ± 8.70 vs.53.80 ± 6.28,P ＜ 0.05),while ALB,IgG,IgA levels in observation group increased at 14 days [ALB (g/L):33.24 ± 0.45 vs.30.76±0.79,IgG (g/L):15.03 ±3.73 vs.11.45 ±2.83,IgA (g/L):3.56±0.32 vs.2.50±0.16,all P ＜ 0.05].The levels of C-reactive protein (CRP) and procalcitonin (PCT) in both groups gradually lowered,but they were significantly lower in observation group than those in the control group from 4 days on [CRP (mg/L):17.72±4.23 vs.20.96±5.83,PCT (ng/L):123±37 vs.257±88,both P ＜ 0.05],up to 14 days.The hospital mortality rate of the observation group was lowered compared with that of the control group (6.67％ vs.8.89％),and the duration of mechanical ventilation was significantly shortened (hours:145.00±19.39 vs.193.00± 18.97,P ＜ 0.05),insulin dosage was also significantly decreased (U:33.52 ± 5.74 vs.49.71 ± 6.99,P ＜ 0.05).There was no significant difference in the incidence of abdominal distension,diarrhea and reflux of gastric contents between the two groups,and they were relieved after treatment and had no influence on further enteral nutrition therapy.Conclusion Early administration of the complicated enteral nutrition in elderly diabetic patients with severe lower respiratory tract infection cannot only decrease the levels of pro-inflammatory factors in patients,but also shorten the duration of mechanical ventilation,enhance immunity,improve the curative effect with little influence on the blood glucose level.

Objective To explore the feasibility of combining anterior and posterior fontanelle acoustic windows for fetal median sagittal plane cranial scanning in prenatal ultrasound.Methods From July 5 to August 25 in 2012,200 pregnant women in Huai'an First Hospital at 22 to 24 gestational weeks accepted transabdominal uhrasonography,with anterior fontanelle,longitudinal suture and posterior fontanelle as acoustic windows to obtain the median sagittal plane.In the mean time,ten aborted or induced fetuses (with malformations or maternal complications) underwent cranial ultrasound with the same acoustic windows.The successful rates of obtaining median sagittal plane were calculated.Data were analyzed by Chi-square test.Results (1) Among the ten aborted or induced fetuses,all median sagittal planes were successfully obtained through anterior,posterior fontanelle,or longitudinal suture alone.(2) Among the 200 cases of prenatal uhrasonography,the successful rate of obtaining median sagittal plane through posterior fontanelle alone was 76.0％(152/200),which was higher than that through anterior fontanelle alone [59.5％ (119/200),x2=12.5,P＜0.01].The successful rate was 95.5％ (191/200) when combining the anterior and posterior fontanelle,which was higher than that through anterior fontanelle or posterior fontanelle alone (x2 =74.3 and 31.1,both P＜0.01).The successful rate of obtaining median sagittal plane through posterior fontanelle was 67.3％ (65/102) in cephalic presentation,which was also higher than that through anterior fontanelle [37.3％ (38/102),x2 =14.3,P＜0.01].The successful rate was 88.8％ (87/98) through posterior fontanelle in non-cephalic presentation,which was similar to that through anterior fontanelle [82.7％(81/98),x2 =1.5,P＞0.05].When both anterior and posterior fontanelle applied,the successful rate in cephalic presentation was 9.8％ (10/102),lower than that in non-cephalic presentation fetuses [71.4％ (70/98),x2 =79.1,P＜0.01].Conclusions The successful rate in obtaining median sagittal plane through posterior fontanelle is higher than that through anterior fontanelle,and might be increased when both anterior and posterior fontanelle were used.

Objective To analyze the blood perfusion modes of retroperitoneal benign and malignant masses by real-time contrast-enhanced ultrasonography (CEUS). Methods Forty-five patients with retroperitoneal masses, including 18 benign and 27 malignant masses, were performed with CEUS. The perfusion of contrast agent, entering style and the vascular patterns of contrast agent were described. And the diagnosis value of perfusion characteristics was evaluated in retroperitoneal benign and malignant masses. Results The perfusion of CEUS showed significant differences in the entering style of contrast agent and the vascular patterns in malignant masses in comparison to benign masses. In the entering style of contrast agent, center enhancement of malignant masses was 70. 37% (19/27), periphery enhancement of benign masses was 72.22% (13/18) ,there was statistical significane in the result( P = 0.0069). To the vascular patterns level,there were 2 with level 0 and 11 with level 1 in benign group, 10 with level 2 and 9 with level 3 in malignant group, there was statistical significane between malignant group and benign group too( P=0.0206). Conclusions CEUS is benefit to improve the accuracy of diagnosis of retroperitonea malignant and benign masses.

Objective To analyze the blood perfusion characteristics of retroperitoneal benign and malignant tumors by real-time contrast enhanced ultrasonography and discuss its value in the differential diagnosis.Methods The study involved 42 patients with pathological evidence through surgery or needle biopsy,including 12 patients with benign retroperitoneal tumors and 30 patients with malignant retroperitoneal tumors.The blood perfusion characteristics of two groups were observed under low mechanical index after the injection of contrast ultrasound agent(SonoVue),and the changes of twodimensional ultrasonography and the time-intensity curve(TIC)were analyzed. Results During real time contrast enhancement,the different characteristics of retroperitoneal benign and malignant tumors were observed.Malignant tumors in retro peritoneum presented the pattern of ultrasound contrast agent(UCA) enhancement from center to periphery and enhanced overall uneven mainly,begin tumors presented peripheral enhancement pattern or uniformity and overall strengthening of the main.TIC curve between benign and malignant tumors displayed that contrast enhanced intensity of region of interest(P＜0.00 1),ascending slop and halftime of descending were statistically significant(P＜0.05).Conclusions Real-time contrast-enhanced ultrasonography is a valued method to provide information for the differential diagnosis in retroperitoneal benign and malignant tumors.

Objective To predict the value of advanced glycation end products (AGEs) in the risk and severity of coronary heart disease in diabetic patients.Methods Totally 120 cases were divided into 3 groups.Group A had no diabetes mellitus (DM) and no coronary atherosclerotic heart disease (CAD).Group B had DM without CAD.Group C had DM with CAD.The levels of AGEs,low density lipoprotein cholesterol (LDL-C),glycosylated hemoglobin,and the severity of coronary stenosis were detected.Receiver operating characteristic (ROC) curve was used to evaluate the sensitivities and specificities of AGEs for the diagnosis of DM with CAD.Results The highest level of AGEs,LDL-C,glycosylated hemoglobin and carotid plaque was in the C group,with a statistically significant difference (P ＜ 0.05).The severity of AGEs was significantly correlated with the severity of CAD and the Gensini score of AGEs (r =0.445).ROC curve showed that the sensitivity,specificity and area under ROC curve of AGEs determination of DM with CAD were 80.0％,75.0％,and 0.86,respectivity.Conclusions The level of AGEs is significantly correlated with atherosclerosis and prognosis in DM.The severity of CAD was higher in the patients with higher AGEs,and the incidence and severity of restenosis increased.

Objective To investigate the effect of quadratus lumborum block on postoperative analgesia and T lympho-cyte subsets in patients receiving transabdominal radical resection of rectal cancer, so as to provide clinical references. Methods From May 2016 to November 2017, 30 patients receiving selective radical resection of rectal cancer in our hospital were selected. The random number table was used to divide the patients into quadratus lumborum block group(experimental group) and incision partial infiltration block group (control group), with 15 patients in each group. After induction of general anesthesia, the experimental group underwent ultrasound-guided bilateral anterior lateral quadratus lumborum block. Each side was injected with 0. 375％ ropivacaine of 20 mL. The control group was induced by general anesthesia and 0. 375％ ropivacaine of 40 mL was injected for local infiltration block. The surgery time, volume of blood loss, total infusion volume of propofol, effective analgesia time, the amount of sufentanil infusion every 12 hours after surgery and resting VAS scores at postoperative different time points (2, 6, 12, 24, 36, 48 hours postoperatively) were observed and recorded. Venous blood (1 mL) was drawn 30 minutes before anesthesia(TO), 2 hours after surgery(T1), 1 day after surgery(T2) and 3 days after surgery(T3). T lymphocyte subsets were detected by flow cytometry(CD3+, CD4+, CD8+, CD4+/CD8+). Results Compared with the control group, the dosage of propofol in the experimental group was significantly less than that in the control group (P＜0. 05); the effective analgesia time in the experimental group was significantly longer than that in the control group (P＜0. 0l); the amount of sufentanil in the experimental group was significantly less than that in the control group at 0-12 h and 12-24 h after surgery (P＜0. 05); the resting VAS scores in the experimental group at 6 h and 12 h after the surgery were significantly lower than those in the control group (P＜0. 05); the levels of CD3+, CD4+, CD4+/CD8+ in the experimental group were significantly higher than those in control group at T2 (P＜0. 05). Compared with TO, CD3+, CD4+, CD4+/CD8+ at T1 and T2 in the two groups were significantly lower than those at TO(P＜0. 05); at T2, CD8+ in the control group was significantly lower than that at TO(P＜0. 05). Conclusion Bilateral quadratus lumborum block can significantly improve postoperative analgesia effect in patients receiving radical resection of rectal cancer and reduce the inhibition of T lymphocytes by surgical stress.