Objective To investigate the early diagnostic value of high‐sensitivity C‐reactive protein(hs‐CRP) ,D‐dimer and cTnI in ACS .Methods All the 83 blood samples of patients with chest pain in the emergency department of our hospital were enrolled in the study ,and 30 healthy people were recruited as the control group .According to the final clinical diagnosis ,29 patients were grouped into non‐ischemic chest pain(NICP) group and 54 patients were grouped into ACS group .Venous blood samples were col‐lected and the concentrations of serum hs‐CRP ,cTnI ,plasma D‐dimer were measured .The diagnostic value of the 3 indicators and their combined test for ACS was evaluated by using the receiver operating characteristic(ROC) curve and Youden index .Results The levels of hs‐CRP ,cTnI and D‐dimer in ACS group were significantly higher than those of the control group and the NICP group (P<0 .05) .The levels of hs‐CRP and D‐dimer in ACS group were significantly higher than those of the NICP group(P<0 .05) . ROC showed that the area under urve of hs‐CRP ,D‐dimer and cTnI were 0 .564 ,0 .631 and 0 .639 respectively .The sensitivity ,spe‐cificity and accuracy of the combined detection of hs‐CRP ,cTnI and D‐dimer were 88 .1% ,58 .7% ,53 .2% respectively . Conclusion To some extent ,the levels of hs‐CRP ,cTnI and D‐dimer all could be used as indicators in the diagnosis of ACS .But combined detection of hs‐CRP ,cTnI and D‐dimer could improve the sensitivity and specificity ,and had value to guide clinical diagno‐sis of ACS in the early stage .

Aim To investigate the interaction between regulatory proteins related to the activation of eNOS and CYP4A/20-HETE.Methods The endothelia of pulmonary artery of new born bovine were cultured and divided into four groups: controlling group: ethanol solvent as vehicle (the volume is the same with 1?10~ -6 mol?L~ -1 20-HETE) was added to culture dish and incubated for 10 min; 20-HETE 5 min treatment group:1?10~ -6 mol?L~ -1 20-HETE was added to culture dish and incubated for 5 min; 20-HETE 10 min treatment group:1?10~ -6 mol?L~ -1 20-HETE was added to culture dish and incubated for 10 min; VEGF 10 min treatment group: 1?10~ -8 mol?L~ -1 VEGF was added to culture dish and incubated for 10 min. CYP4A,eNOS and proteins related to the activation of eNOS were measured by Immunoprecipitating and immunobloting.Results Expressions of eNOS and phospho-eNOS(Ser1177)in PAECs were upregulated after the cells were treated with 20-HETE, and similar phenomena were observed when 20-HETE was replaced by VEGF; 20-HETE increased the binding of Hsp、Akt and eNOS.Conclusions ①20-HETE phosphorylates eNOS at Ser1177 site which activates the eNOS to catalyze L-aginine to produce nitric oxide.②eNOS binds with Hsp90 and Akt in endothelial cell of pulmonary artery and 20-HETE increase the binding. ③eNOS binds with CYP4A in endothelial cell of pulmonary artery.

Background:Prognosis of early colorectal carcinoma( ECC)is well because of low rate of lymph-node metastasis ( LNM). How to improve the detection rate and select appropriate therapy for ECC has been an eager task in clinical practice. Aims:To analyze the pathological features of ECC treated by endoscopic resection(ER)or surgery,and evaluate the therapeutic efficacy of ER. Methods:Pathological data of 503 ECC lesions treated by ER or surgery were retrospectively analyzed. Risk factors of infiltration depth,LNM of ECC were analyzed,and therapeutic efficacy of ER was evaluated. Results:The overall detection rate of ECC was 10. 7%. The incidence of LNM was 1. 2%(6/503);the LNM incidence of mucosal high-grade neoplasia was 0%( 0/247 ),while was 2. 3%( 6/256 ) in submucosal carcinoma. The LNM incidence of submucosal superficial carcinoma treated by ER was 0%( 0/31 ). Tumor location, size,histological type and LNM had significant impacts on infiltration depth(P<0. 05). The rates of en bloc,complete and curative resection by ER were 96. 0%,94. 2% and 82. 1%,respectively. Infiltration depth was the risk factor of piecemeal,incomplete and noncurative resection of ER(P<0. 05). Conclusions:The incidence of LNM in ECC is extremely low. Accurate evaluation of character and infiltration depth of lesion before operation is helpful for selecting appropriate therapy. It should be cautious to choose ER for lesions infiltrated into submucosa,thereby to improve the therapeutic efficacy of ER.

Objective To observe the ultrastructural characteristics of human retinal progenitor cells cultured in vitro. Methods Six 5-month-old human fetuses(12 eyes)without eye diseases were selected. Retinal progenitor cells from the retina of one eye of each fetus were cultured in vitro,and observed by transmission electronic microscopy(TEM); while those from the other eye were directly observed by TEM. Results Abundant heterochromatin were found in the karyon of 5-month embryonic retinal neuroepithelial cells,and the figure of the karyons was irregular.A few scattered initial cells were seen in retinal neuroepithelial layer with large karyon,smooth surface,abundant euchromatin,and distinct nucleolus.The human retinal progenitor cells cultured in vitro had the same ultrastructural characteristics as the initial cells:with huge karyon which almost occupied the whole cell,little cytoplasm,distint nucleolus,abundant euchromatin,and little heterochromatin.The cells clung to each other in the neural globoid cell mass.The size of the outer cells was large,and karyokinesis could be found. Conclusion The cultured human retinal progenitor cells are provided with the same ultrastructure characteristics as the initial cells.

Objective To observe the long-term effect of suramin on the inhibition of proliferation of human retinal pigment epithelial (RPE) cells in vitro. Methods RPE cells grown in 9 pieces of 96-well plate (12 wells each plate) were divided into experimental and control group, with 6 wells in each group. The concentration of 0.1 ml RPE cells in each well is 5?104 cells/ml. After the change of the medium, RPE cells were treated with suramin (250 ?g/ml) in experimental group while treated with nothing in the control group. The medium of the 2 groups were changed to the normal medium after 4 days. At the 1~st , 2~nd , and 4~th day after the addition of suramin and at the 1~st , 2~nd , 3~rd , 5~th , 6~th , 7~th , 9~th , 11~th and 13~th day after removing suramin, 1 plate was randomly selected to stop culturing, and the proliferation of RPE cells were detected by methyl thiazolyl tetrazolium (MTT) assay. Results Under reversed microscope, RPE cells in control group were fused completely at the 7~th day after inoculation. The extracellular space of RPE cells in experimental groups was larger than that in the control group, and remained unfused at the 13~th day after inoculation. The inhibitory rate of proliferation of RPE cells at the first day after treated with suramin was 14.85% and increased to the highest 25.79% at the 4~th day. The first day after the suramin-containing media was removed, the inhibitory rate decreased to 12.35%, and then raised gradually to over 20% at the 3~rd to 5~th day. Finally, the rate drop to 14.71%. Conclusion Suramin has the long-term effect on the inhibition of RPE cells induced by serum, especially the inhibitive effect after the remove of suramin, which indicates the specific double-peak inhibition during the whole process.

Objective To investigate the effect of autologous platelet rich plasma (PRP) gel in arthroscopic rotator cuff re?pair. Methods All of 44 patients with rotator cuff tear undergent arthroscopic rotator cuff repair were randomly divided into two groups:PRP group (22 patients were received autologous PRP and hemocoagulase) and normal saline (NS) group (22 patients were received NS and hemocoagulase). All patients had the same accelerated rehabilitation protocol and were followed up in 1, 3, 12 months. Evaluation consisted of inflammatory reaction, wound healed, visual analogue scores (VAS), University of California at An?geles (UCLA) Shoulder Scores and American Shoulder and Elbow Surgeons (ASES) Scores. Results After operation, no inflam?matory reaction was in 20 cases of PRP group and 19 cases of NS group, mid inflammatory reaction 1 case in PRP group and 2 cas?es in NS group, moderate inflammatory reaction 1 case in PRP group and 1 case in NS group. Wound healed by first intention in all of PRP group and 21 patients of NS group. In PRP group, the preoperative, 3 months and 12 months postoperative VAS were 6.6±2.0, 3.4±1.8, 1.8±1.3, UCLA were 15.2±2.9, 24.3±2.7, 32.4±2.1, ASES were 35.6±12.4, 63.4±10.4, 92.3±7.5. In NS group, the preoperative, 3 months and 12 months postoperative VAS were 6.7 ± 1.9, 4.6 ± 1.9, 2.0 ± 1.2, UCLA were 14.8 ± 3.0, 21.2 ± 2.5, 31.7 ± 2.3, ASES were 32.7 ± 13.8, 55.8 ± 11.8, 90.7 ± 8.1. Three months postoperative VAS, UCLA, ASES were statistically signifi?cant differenece in PRP group and NS group. Twelve months postoperative VAS, UCLA, ASES were not statistically significant dif?ferenece in the two groups. Conclusion Using autologous PRP gel in arthroscopic rotator cuff repair can speed up the healing of operation incision with no adverse effect, reduce pain in the postoperation three months, accelerate the rotator cuff repair and re?covery of the function of shoulder joint. It has good short?term clinical effect.

Background:Recently,the American Society for Gastrointestinal Endoscopy published the PIVI( Preservation and Incorporation of Valuable Endoscopic Innovations)initiative regarding to the“predict,resect,and discard”strategy on diminutive(≤5 mm)colorectal polyps. The low prevalence of adenoma with advanced histology( containing ≥25%villous component,or high-grade intraepithelial neoplasia,or submucosal invasive carcinoma)in diminutive polyps would provide high confidence for endoscopists to adopt the strategy. Aims:To investigate the prevalence of adenoma with advanced histology in diminutive colorectal polyps. Methods:Data of diameter,location and morphology of colorectal polyps were collected prospectively from patients undergoing colonoscopy at Digestive Endoscopy Centre,Shanghai Ren Ji Hospital from Jan. 2013 to Jun. 2013. The polyps were resected,placed in a unique specimen vial,and sent for histological evaluation. Results:A total of 1 986 colorectal polyps were enrolled in the study,including 900(45. 3%) diminutive polyps(≤5 mm),521(26. 2%)small polyps(6-9 mm)and 565(28. 4%)large polyps(≥10 mm). Prevalence of adenoma with advanced histology in diminutive polyps was significantly lower than those in small and large polyps(1. 1% vs. 8. 4% and 43. 7%,P<0. 05),and was not correlated with the location and morphology of diminutive polyps. Submucosal invasive carcinoma was found in 4. 6% of large polyps,0. 4% of small polyps,and 0% of diminutive polyps. Conclusions:The very low prevalence of adenoma with advanced histology and absence of submucosal invasive carcinoma in diminutive colorectal polyps favours the potential practice of“predict,resect,and discard”strategy in the patient population studied.

Objective To investigate the effect of platelet-rich plasma (PRP) in anterior cruciate ligament (ACL) reconstruction.Methods From January 2010 to January 2013,40 patients with ACL ruptures who underwent arthroscopic ACL reconstruction with gracilis and semitendinosus tendon were randomly divided into two groups:PRP group and normal saline group.20 patients received graft soaked with PRP and hemocoagulase while 20 patients received graft soaked with normal saline and hemocoagulase.All patients were followed up in 1,3 and 12 months.Evaluation consisted of postoperative drainage volume,inflammatory reaction,grade of wound healed,anterior drawer test,Lachman test,pivot shift,Lysholm knee score and KNEELAX3.Results The average follow-up period was 18 months.Postoperative drainage volume was 142±24 ml in PRP group and 324±22 ml in saline group.The difference was statistically significant.At 4 days after the operation,no inflammatory reaction was observed in 18 cases of PRP group and in 16 cases of saline group,mid inflammatory reaction in 1 case of PRP group and 2 cases of sa line group,and moderate inflammatory reaction in 1 case of PRP group and 2 cases of saline group.Wound healed by first intention in 20 patients of PRP group and in 19 patients of saline group.The preoperative results of anterior drawer test,Lachman test and pivot shift were positive,while postoperative results were negative in both two groups.In PRP group,the preoperative and postoperative Lysholm knee scores of patients in 12 months were 39.8±8.9 and 92.1±2.7 points respectively.In saline group,the preoperative and postoperative Lysholm knee scores of patients in 12 months were 38.7±9.8 and 89.9±4.1points respectively.The differences were not statistically significant.KNEELAX3 measuring results:in PRP group,preoperative measurement was 9.4±1.2 mm in average,while measurement in 12 months postoperatively was 1.2±1.1 mm.In saline group,preoperative measurement was 9.6±1.3 mm,while measurement in 12 months postoperatively was 2.2±1.2 mm.The differences were statistically significant.Conclusion Using graft soaked with PRP in ACL reconstruction could reduce postoperative drainage volume,accelerate the healing of tendon-bone interface in the bone tunnel and the recovery of knee joint function.

Objective To compare the efficacy of internal fixation with non-operative treatment of traumatic flail chest combined with sternal fracture.Methods A retrospective review was made on 102 patients with traumatic flail chest combined with sternal fracture treated from January 2007 to January 2014.There were 71 patients in operation group and 31 patients in non-operation group.Operation group was allocated to pure titanium rib plating (Group Ⅰ,22 cases),porous titanium screw fixation (Group Ⅱ,20 cases),and nickel-titanium memory alloy sternal rib plating (Group Ⅲ,29 cases).Rib traction was performed in non-operation group.Clinical results and incidence of complications were compared between the two groups.Results At 24 and 72 hours,operation group was superior over non-operation group with regard to HR [(100.4 ± 9.5) times/min vs (105.2 ± 10.1) times/min,(92.1 ± 9.9) times/min vs (102.1 ± 9.2) times/min],MAP [(97.7 ± 14.5) mmHg vs (91.0 ± 13.3) mmHg,(112.5 ± 15.2) mmHg vs (93.1 ± 13.8)mmHg] and CVP [(7.8 ±3.7)cmH2O vs (9.4 ±3.8)cmH2O,(6.2 ±2.9)cmH2O vs (9.1 ±3.2) cmH2 O] (P ＜ 0.05).Duration in ICU [(5.1 ± 0.8) days vs (9.3 ± 1.1) days],ventilation time [(4.5 ±1.0)days vs (8.2 ± 1.4)days],hospitalization time [(14.6 ±3.5)days vs (23.3 ±4.4)days] and incidence of complications were significantly lower in operation group than in non-operation group (P ＜ 0.05).Two months after discharge,tidal volume (VT) [(0.52 ±0.04)L vs (0.40 ±0.03)L],inspiratory capacity (IC)[(1.99 ±0.45)L vs (1.22 ±±0.33)L],forced vital capacity (FVC) [(3.52 ±0.51)L vs (2.44 ±0.42)L],total lung capacity (TLC) [(5.41 ±0.82)L vs (3.72 ±0.56)L] and forced expiratory volume in one second (FEV1) [(2.80 ± 0.43) L vs (1.95 ± 0.50) L] showed significantly better results in operation group than in non-operation group (P ＜ 0.05).Operation time,intraoperative bleeding and daily drainage volume were (38.8 ±9.2)min,(43.5 ±7.6)ml and (10.9 ± 1.1)ml in Group Ⅱ versus (62.5 ± 10.1)min,(100.0 ± 10.5) ml and (26.8 ±3.1)ml in Group Ⅰ and (49.3 ±9.6)min,(61.4 ±8.3)min and (19.8 ±1.6)ml in Group Ⅲ (P ＜ 0.01).Conclusion For traumatic flail chest combined with sternal fracture,the internal fixation should be done as early as possible so as to reduce incidence of complications.Relatively,porous titanium screw fixation has better clinical outcome.

Objective To summarize the clinical features and treatment of male urethral duplication.Methods The clinical data of 2 cases treated in June 2011 and April 2014 were analyzed retrospectively.The first case was a 5-year-old boy presented with passages of urine from two orifices in the penis.The second case was a 15-year-old boy presented with dorsal chordee and a sinus on the dorsum of the penis.The patient had a small amount of watery discharge occasionally dripping out of the opening for 10 years.The 2 patients underwent retrograde urethrography, which revealed a complete duplicated urethra with the channel arising from the proximal prostatic urethra ( class ⅡA2 according to the classification of Effman) .The 2 patients underwent excision of the accessory urethra under general anesthesia.Results The pathology reports of the 2 cases were hyperplasia of squamous epithelium and urothelial mucosa.Pathological diagnosis was urethral duplication.The first case was followed up for 1 year with a satisfactory functional and cosmetic outcome.The second case was followed up for 6 months and no watery discharge noticed from the residual dorsal chordee.Conclusions Urethral duplication is a rare congenital anomality affecting mainly boys.Clinical presentation varies depending on the different anatomical patterns of the urethral anatomy. Surgical management must be evaluated for each different anatomical variation.