Objective To observe the effects of Yishen-Pinggan dcoction on the urine microalbumin and the expression of ACE2, AngⅡin the spontaneously hypertensive rat kidney(SHR);to observe the kidney level hepatic side of the protective effect of early renal in SHR hypertension. Methods The same old male SHR and normal rats(Wistar-Kyoto rats, WKY) for the study, at 10 weeks of age, SHR rats were randomly divided into a model group, a Chinese medicine group, and a lotensin group;while WKY rats were served as a normal control group(n=8). They were continuously treated for 12 weeks. Urine mAlb and β2-MG of rats were quantified at pre-experiment and after experiment, immuno-histochemical detection of renal ACE2 and AngⅡwere performed, the obtained results were statistically analyzed by computer image analysis. Result At the 12th week, compared with urinary mAlb(509.3±160.3)ng/ml,β2-MG(0.150±0.037)μg/ml, Ang kidneyⅡ(7 174.24±1 068.99)μm2,kidney ACE2(2 158.90±376.60)μm2 in the WKY group, the urinary mAlb(908.3 ±13.2)ng/ml, β2-MG(0.378±0.099)μg/ml, kidney AngⅡ(11 085.37±1 398.03)μm2 in the hypertension model group were significantly higher(P<0.01), and kidney ACE2(1 375.77±466.21)μm2 was decreased significantly(P<0.01); compared with hypertensive model group, rat urinary mAlb(574.9±197.8)ng/ml,β2-MG(0.198±0.040)μg/ml, kidney AngⅡ(8 462.91±781.23)μm2 in Chinese medicine group, rat urinary mAlb(644.4±147.5)ng/ml, β2-MG(0.206±0.044)μg/ml, kidney AngⅡ(8 696.88±679.70)μm2 in lotensin group were significantly decreased(P<0.01); while kidney ACE2(1 904.02 ± 454.08)μm2 in Chinese medicine group, kidney ACE2(1896.11±445.43)μm2 in lotensin group was significantly increased(P<0.01). Conclusion Yishen-Pinggan decoction can reduce the SHR urinary microalbumin excretion so as to reduce high blood pressure early kidney damage; its role may be associated with its increasing local renal ACE2 expression and reducing the kidney Ang Ⅱ expression.

Objective To assess the efficacy of NaClO irrigation of root canal at different temperatures.(Methods Thirty) human teeth with single root-canal mandible premolar were instrumented using standard technique,then were divided into 3 groups,carrying on root-canal irrigation.group A: 5.25% NaClO+System B,group B:5.25% NaClO+15% EDTA,group C:5.25% NaClO+System B+15% EDTA.After the teeth root were split,the scanning electron microscope was used to observe the coronal third,middle third and apical third parts.(Results The) amount of remaining debris on root canal wall in group C decreased significantly,compared with group A and B.The differences of coronal third and middle third between group A and B,group B and C,group A and C were significant(P0.05),but there were significant differences between group A,B and C(P

Objective To compare vacuum-assisted excision with periareola incision surgery for benign breast cancer.Methods One hundred and twenty one patients with benign breast nodules treated in our hospital from October 2014 to October 2015 were enrolled in the study,including 58 cases received vacuum-assisted excision (study group) and 63 cases received periareola incision surgery (control group).There were no differences in age[(30.2 ±5.4) vs.(32.1 ±6.2) years] and tumor diameter[(1.3 ±0.4) vs.(1.5 ± 0.3) cm] between two groups.Results There were no severe complications in both groups.Compared with the control group,the operation time was shorter] (20.4 ±4.7) vs.(48.2 ± 15.4)min,t =3.165,P =0.006],intraoperative blood loss was less [(18.4 ± 5.7) vs.(17.2 ± 3.7) ml,t =-0.297,P =0.672],malformation rate was lower [5.2％ (3/58)vs.22.2％ (14/63),x2 =7.27,P =0.007],incidence of postoperative hematoma was higher [20.7％ (10/58) vs.6.3％ (4/63),x2 =3.502,P =0.041],and the cost of surgery was more expensive(5 100 ± 300) vs.(3 400 ± 1 200) Yuan,t =2.181,P =0.023].Conclusion Comparing with conventional periareolar incision surgery,the vacuum-assisted excision has its advantages and disadvantages for treatment benign breast tumors,and two surgical modalities can be chosen accordingly.

BACKGROUND:Tranexamic acid is a synthetic anti-fibrinolytic drug, and can effectively control blood loss after total knee arthroplasty through vein. OBJECTIVE:To evaluate the effectiveness and safety of tranexamic acid in reducing blood loss after primary unilateral total knee arthroplasty. METHODS:From 2014 to 2015, 100 patients from the Department of Lower Limb, Sichuan Orthopaedic Hospital underwent primary unilateral total knee arthroplasty, and randomly divided into test group which used tranexamic acid and control group which used tranexamic acid, with 50 cases in each group. 1 g tranexamic acid was infused into the vein at 10 minutes before total knee arthroplasty in the test group, but tranexamic acid was not given in the control group. RESULTS AND CONCLUSION:The amount of total blood loss, postoperative wound drainage in 24 hours, and the amount of blood transfusion were significantly less in the test group than in the control group (P < 0.05). No significant differences in intraoperative blood loss and the number of patients receiving blood transfusion were found between the test and control groups. No significant difference in preoperative hemoglobin levels was detected before surgery, but hemoglobin levels were decreased after surgery between the two groups. Postoperative hemoglobin levels were apparently higher in the test group than in the control group after surgery. At 24 hours after surgery, no significant difference in coagulation was detectable between the two groups. At 6 days, double lower limb vein color Doppler ultrasound examination did not reveal deep vein thrombosis in both groups. These findings verify that treatment with tranexamic acid in the vein before primary unilateral total knee arthroplasty can evidently diminish the amount of perioperative blood loss and blood transfusion, reduce the risk and cost of blood transfusion, which is good for rehabilitation and does not increase the risk of deep vein thrombosis.

Objective To compare the effects of peripatellar peripheral nerve partially and totally depolarized in total knee arthroplasty (TKA). Methods 66 TKA patients were divided into partially depolarized group (A, 42 knees) and totally depolarized group (B, 38 knees). The scores of knee-joint, Feller and Visual Analogue Scale were recorded. Results There was no significant difference in all the scores between 2 groups before operation (P>0.05). All the scores improved after operation (P<0.05), however, there was still no significant difference between 2 groups (P>0.05). Conclusion Patellar peripheral nerve partially depolarization technique can reduce postoperative knee pain, which has the same effect with totally depolarization.

Objective To study the value of high frequency sonography in diagnosis of peripheral nerve lipofibroma hamartoma.Methods The high frequency sonography images of seventeen patients with diagnosed peripheral nerve lipofibroma hamartoma were retrospective analyzed.The sonography features were compared with clinical surgery.Results The position and internal structure of nerve can be found by high frequency ultrasound,and which nerve fascicle,location and scope of lipofibroma hamartoma can be displayed clearly.The involved peripheral nerve was showed expansive growth.Because the hyperechoic fat tissue and hypoechoic nerve fibers alternated with one and another,the feature of high frequency sonography was lotus-like,there was no blood flow signal in nerve.Conclusions High frequency sonography is the preferred imaging method for diagnosis of lipofibroma hamartoma.

Objective To investigate the clinical efficacy of preoperative full reset combined with minimally invasive treatment of extreme distal pilon fractures.Methods A retrospective analysis was made on 34 patients (35 ankles) with tibial fractures extremely close to the distal articular surface treated surgically between January 2011 and January 2015.There were 21 mnales and 13 females,aged 20-71 years (mean,36.2 years).Injury resulted from traffic accidents in 32 patients and high falls in two.Using the AO/OTA fracture classification system,type 43-B3 was noted in three patients,43-C1 in five patients,43-C2 in 18 patients and 43-C3 in eight patients.Calcaneal traction combined with manipulative reduction was used to correct fracture displacement preoperatively.All fractures were stabilized by minimally invasive percutaneous plate osteosynthesis (MIPPO) through single or combined medial,anteromedial and anterolateral approaches while minimizing damage to bone attachment and continuity of soft tissue,after soft tissue swelling subsided.For the patients with articular surface collapsing with severe comminution,a series of procedures were done under direct vision including using the talus articular surface as a mold,stable fixation with fine Kirschner (1-1.5 mm) and thin screws (2.1-2.7 mm series) and impaction bone grafting below subchondral bone.Thereafter,distal tibia anatomical short multi-directional locking plate fixation,distal nail support and early ankle joint functional exercise were done.Burwell-Charnley radiological evaluation system was used for radiological assessment,and TeenyWiss scoring system for ankle clinical symptoms and function.Postoperative complications were recorded.Results Follow-up lasted for 11-38 months (mean,16.6 months).No infection,wound disunion,or plate exposure occurred.Burwell-Charnley radiological evaluation system showed anatomic reduction in 32 patients,unsatisfactory reduction in one,and poor reduction in one.According to the Teeny-Wiss scoring system,the results were excellent in 31 patients,good in two and poor in one,with the excellentgood rate of 97％.Three patients suffered traumatic arthritis after operation and alleviated after oral administration of painkiller.Conclusion With use of full reset combined with manipulative reduction to correct fracture displacement,minimally invasive locking plate,distal row of nails,impaction bone grafting and limited fixation,the patients with extremely distal tibial pilon fractures achieve satisfactory reduction,stable fixation,and early functional exercise.

Objective: To explore the impact of echocardiographic parameter of diastolic dysfunction (E/A) on the recurrence of atrial ifbrillation (AF) in patients after catheter ablation.
Methods: We retrospectively studied 277 consecutive AF patients with circumferential pulmonary vein ablation (CPVA) in our hospital. According to E/A ratio, the patients were divided into 3 groups: Normal group, the patients with 0.75< E/A<2, n=203, Mild abnormal group, E/A≤0.75, n=53 and Severe abnormal group, E/A>2, n=21. The late AF recurrent rates were compared among different groups. The patients were divided into another 2 groups upon AF recurrence after CPVA: Recurrent group, n=57 patients with atrial arrhythmia lasted more than 30 seconds at 3 months after CPVA and Non-recurrent group, n=220. The clinical conditions were compared between 2 groups.
Results: The patients were followed-up for (374 ± 276) days. The AF recurrent rate in Severe abnormal group was 33.3%, in Mild abnormal group was 23.5% and in Normal group was 18.5%, P>0.05. The E/A ratio in Recurrent group was 1.22 ± 0.54, in Non-recurrent group was 1.19 ± 0.49, P=0.653. Univariate analysis indicated that the risk factors for AF recurrence included LVEDD and gender, not E/A ratio (P=0.236). Cox multivariate analysis indicated that with adjusted gender, hypertension, diabetes, LVEDD and LVESD, abnormal E/A ratio was the predictor for late AF recurrence (HR 2.29, 95%CI 1.01-5.19, P=0.046). With further adjusted LVEDD and E/A, the severe abnormal E/A ratio was still the predictor for AF recurrence (HR 2.27, 95%CI 1.01-5.12, P=0.047).
Conclusion: E/A ratio was the important predictor for AF recurrence in patients after CPVA.

Objective To investigate the regulatory role of programmed death ligand-1 (PD-L1) on acute lung injury (ALI), and its molecular mechanism. Methods Twenty C57BL/6 male mice and 20 PD-L1 knock out male mice were collected, and they were divided into two groups by random number table, respectively: namely sham group and ALI group, 10 mice in each group. The model of ALI was reproduced by two-hit of hemorrhagic shock and sepsis, and the mice in sham group were only got bilateral femoral artery exposure and ligation without bleeding, cecal separation without ligation and perforation. The mice were sacrificed 24 hours after model reproduction, and the lung tissue and bronchoalveolar lavage fluid (BALF) were collected. The mRNA and protein expression levels of PD-L1 in the lungs were determined by real-time quantitative reverse transcription-polymerase chain reaction (RT-qPCR) and Western Blot. The pathological changes were observed with microscopy. The protein levels in BALF were determined. The granulocyte differentiation antigen 1 (Gr1) positive cells was determined by cytometry, and myeloperoxidase (MPO) activity in lung tissue was determined. The levels of proinflammatory factors interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and chemotatic factors keratinocyte chemoattractant (KC), macrophage inflammatory protein-2 (MIP-2) in lung homogenates and BALF were determined by enzyme-linked immunosorbent assay (ELISA). Results Compared with sham group, the mRNA and protein levels of PD-L1 in lung tissue of C57BL/6 mice in ALI group were significantly elevated [PD-L1 mRNA (2-ΔΔCt): 3.20±0.76 vs. 1.01±0.03, PD-L1 protein (A value): 0.98±0.16 vs. 0.15±0.04, both P < 0.05]. It was shown by light microscopy that the alveolar wall was thickened, congestive, edema and spot bleeding with a large number of inflammatory cell infiltration in the lung tissue of C57BL/6 mice in ALI group, and an obvious protein leakage was found in BALF (ng/L: 0.18±0.06 vs. 0.05±0.01, P < 0.05). The lung injury degree of PD-L1 knockout ALI mice was significantly less than that of C57BL/6 ALI mice, and the protein leakage was significantly reduced in BALF (ng/L: 0.11±0.02 vs. 0.18±0.06, P < 0.05). Compared with corresponding sham group, the number of Gr1 positive cells, MPO activity in lung tissue as well as the levels proinflammatory factors and chemotatic factors in lung tissue and BALF in ALI group were significantly increased. However, when compared with C57BL/6 ALI mice, above parameters in lung homogenates and BALF were significantly decreased in PD-L1 knockout ALI mice [number of Gr1 positive cells: (39.0±4.0)% vs. (45.0±8.0)%, MPO activity (U·μg-1·min-1): 2.85±0.62 vs. 4.52±1.16; lung IL-6 (ng/g): 461±111 vs. 728±28, TNF-α (ng/g): 1 123±175 vs. 1 500±327, KC (ng/g): 150±34 vs. 250±28, MIP-2 (ng/g): 1 263±468 vs. 1 763±323; BALF IL-6 (ng/L): 134±22 vs. 258±38, TNF-α (ng/L): 598±102 vs. 889±139, KC (ng/L): 934±286 vs. 1 258±336, MIP-2 (ng/L): 650±130 vs. 950±256; all P < 0.05]. Conclusion PD-L1 may play an important protective role in the immunological mechanism of ALI, which may be mediated by decreasing chemotactic factor KC and MIP-2 and mitigating neutrophil chemotaxis in lung tissue.

Objective To investigate the clinical effect of rhG-CSF combined transplantation of autologous bone marrow mesenchymal stem cells on cerebral infarction. Methods 42 acute cerebral infarction patients were randomly divided into tow groups: Injection rhGCSF combined autologous bone marrow mesenchymal stem cells group(treatment group, n=20)and conventionality therapy group(control group, n=22).The efficacy was assessed by National Institutes of Health Stroke Scale(NIHSS), Barthel Index(BI)and diffusion-weighted imaging(DWI),perfusion-weighted imaging(PWI)at baseline and the 3rd month after treatment. Result The scores of NHISS and BI treatment group were 4.8±2.0 and 78.5±7.2 respectively. while were 7.2±2.4 and 56.1±6.3 in control group at the 3rd month after treatment. The difference were significant(P＜0.01).PWI in treatment group Was higher than that in control group. There was no significant side-effect in treatment group. Conclusion rHG-CSF combined autologous bone marrow mesenchymal stem cells is a safe, efficient treatment for acute cerebral infarction patients, which is a better way than conventionality therapy.