Objective To study the role of TLR2 in AngⅡ-induced cardiac fibrosis in hypertensive mice .Methods Eighteen wild C57 mice were randomly divided into blank control group ,AngⅡgroup and TLR2 blocking group (6 in each group) .A hypertension model was established by sub-cutaneous infusion of AngⅡthrough a mini-pump for 7 days .Cardiac fibrosis in mice was observed with immunohistochemical staining .Results The area of cardiac fibrosis was significantly larger and the expression levels of collagen Ⅰ and TGF-βwere significantly higher in Ang Ⅱgroup than in blank control group (P<0 .05) .The area of cardiac fibrosis was 71 .2% smaller ,the expression level of collagen Ⅰ was 75 .5% ,and the expression level of TLR2 was 77 .7% lower in TLR2 blocking group than in Ang Ⅱgroup (P<0 .05) .Conclusion TLR2 is involved in Ang Ⅱ-induced cardiac fibrosis in hypertensive mice .

Objective To explore the rationality for the examination mode of residents' clinical laboratory clinical skills in the second stage and to provide scientific and reasonable basis for the second stage training. Method Statistical analysis was made on the results of the assessment of the clinical skills of the residents who took the clinical skills examination in inspection division second stage in Beijing from year 2014 to 2016. The differences between the results of the assessment of the base hospitals and non-base hospitals, three level hospitals and non-three level hospitals and different assessment modules were compared between the three groups. SPSS 17.0 statistical software was used to analyze the data. The com-parison between the measured data was done by independent sample t test, and the comparison between the data was analyzed by chi square test. The test level wasα=0.05. Result From the assessment pass rate, three level hospitals were higher than non-three level hospitals (P=0.01), the base hospital was higher than non-base hospital (P=0.01), and physicians' passing rate was higher than technician'. There was statistical significance (P=0.02, P=0.01) in the auxiliary examination of the written test module of three assessment modules in 2014 and 2015. In 2015 and in 2016, there was significance (P=0.02, P=0.01) in the mean scores of case analysis. Conclusion The second stage clinical skills assessment model is more reasonable, and the non-base and non-three level hospitals should strengthen the training and management of the sec-ond stage.

Objective To assess the clinical value of MRI in evaluation of acute spinal cord in-jury. Methods A total of 50 patients with acute spinal cord injury were examined with magnetic reso-nance (MRI), X-ray and CT. Of all, 15 patients for spinal MR imaging were examined with axial and sngittal spin-echo and fast spin-echo imaging and 17 with coronal imaging. All imaging was performed on 1.5T superconducting system (GE/SIEMENS) with spine surface coil. Results Among 50 patients with acute spinal cord injury, spinal cord edema was detected by MRI in 16 patients, by CT in four but none by X-ray. Intraspinal cord hemorrhage was detected by MRI in 21 patients, by CT in 11 but none by X-ray. Compression and dislocation were detected by MRI in 34 patients, by CT in 15 but none by X-ray. Incomplete and complete transection of spinal cord was found by MRI in 10 patients, by CT in three but none by X-ray. Conclusion MRI is superior to CT scanning and X-ray in detection and evaluation of a-cute spinal cord injury and is the optimal method for examination and diagnosis of acute spinal cord injury.

Administration, Oral ; Adolescent ; Female ; Histiocytosis, Langerhans-Cell ; complications ; drug therapy ; pathology ; Humans ; Lymph Nodes ; pathology ; Prednisone ; administration & dosage ; therapeutic use ; Retrospective Studies ; Skin Ulcer ; drug therapy ; etiology ; pathology ; Thalidomide ; administration & dosage ; therapeutic use ; Treatment Outcome

10.3969/j.issn.2095-4344.2013.25.007

Objective To improve the diagnosis and treatment based on the retrospective clinical analysis of 86 patients with leishmaniasis, an endemic disease caused by various species of Leishmania. Methods The data of 86 consecutive patients with visceral leishmaniasis and lymph node leishmaniasis were retrospectively reviewed, including epidemiological data, clinical manifestations, laboratory features, diagnosis, therapeutic procedures and prognosis. Results There were specific endemic zones of leishmaniasis in Sichuan province. The main clinical symptoms and signs in the initial evaluation were: fever (100%), splenomegaly (100%), enlarged lymph nodes with hepatosplenomegaly (58.1%). All patients were treated with sodium pentavalent antimony gluconate (SPAG). About 95.3% (82/86) of the patients were cured, 3.5% (3/86) improved, and 1.2% (1/86) relapsed. Splenotomy was carried out for 2.3% (2/86) of the patients. The misdiagnosis rate was 30.2%.Conclusions Visceral leishmaniasis has no specific manifestations and is easily misdiagnosed. If leishmaniasis is suspected, bone marrow biopsy and smear examination, lymph node biopsy, rk-39 strip test for visceral leishmaniasis pathogen should be done to improve the outcome. SPAG is the first choice for leishmaniasis chemotherapy.

Objective To evaluate the techniques of separating, fusing, opacifying and falsecoloring- volume rendering( SFOF-VR)3D imaging on the bone and blood vessels in the region of atlantoaxial joint(AAJ). Methods SFOF-VR 3D imaging was performed on 35 cases, including normal (n = 6),variations and lesions( n =29), which were selected from cases with the head-neck CTA examination. With the original scanning data, the VR imaging was performed, then SFOF-VR imaging. Comparisons were made between the features of 3D images of SFOF-VR and VR in showing the anatomy, diagnosing the variation and lesion of AAJ and VA, and the results were analyzed by using the Fisher exact test. Results The results of 35 cases included 6 normal cases in the region of atlantoaxial joint and VA, 16 variations in atlantoaxial joint or VA, 6 cases with arteriosclerosis in VA and 7 cases with fracture or dislocation of atlantoaxial joint. All SFOF-VR imaging are satisfactory. SFOF-VR imaging can show the atlas, epistropheus and VA independently or jointly, cut or color the structures freely and get 3D measurements in any direction.Comparisons showed that SFOF-VR images were much clearer and more comprehensive than VR in displaying the anatomy, variation and lesions of AAJ and VA. Statistical differences were found in showing the spatial structure, blocking structure, space measurement, variation and disease and image edge ( there are25,7,3,0, 31,3,1,0, 26,3,6,0, 23,7,5,0, 0,10,20,5 cases for SFOF-VR image with excellent,good, ordinary and poor quality, and 2,5,24,4, 0,2,8,25, 0,7,25,3, 5,6,23,1, 29,4,2,0 cases for VR;χ2 values 40. 259, 61.444, 42.245, 24.220, 51.299, P<0. 01 ). Conclusions SFOF-VR is a new 3D imaging technique which can clearly and directly show the bones and blood vessels in the region of AAJ.It can provide anatomical information for imaging diagnosis and surgical operation.

AIM: To observe the expression of corticotropin releasing hormone (CRH) within the paraventricular nucleus of hypothalamus (PVN) and to explore the relationship between the activated CRH-containing neurons and sympathetic activity in rats with heart failure (HF).METHODS: Healthy male Sprague-Dawley (SD) rats were subjected to coronary artery ligation to induce HF, and chronic intracerebroventricular (ICV) infusion was performed by osmotic pump for 4 weeks.The rats in sham group and HF group were given vehicle (VEH;artificial cerebrospinal fluid 0.25 μL/h).The rats in HF plus treatment group were treated with CRH competitive inhibitor αh-CRH (15 mg/h).Meanwhile, the Lewis rats and Fischer 344 rats for control study also underwent coronary ligation to induce HF or sham surgery.After 4 weeks, left ventricular end-diastolic pressure (LVEDP) and maximum positive/negative change in pressure over time (±dp/dtmax) were determined.The right ventricular-to-body weight (RV/BW) and lung-to-body weight (lung/BW) ratios were calculated.The renal sympathetic nerve activity (RSNA) was recorded and the plasma norepinephrine (NE) level was measured.The expression of CRH in the PVN combined with the plasma adrenocorticotrophic hormone (ACTH) levels were measured.RESULTS: Compared with the sham-SD rats, the HF-SD rats had a greater number of CRH positive neurons in the PVN (accordingly the plasma ACTH levels were increased), accompanied by decreased ±dp/dtmax and increased RSNA, plasma NE, LVEDP, lung/BW and RV/BW.However, ICV treatment with αh-CRH attenuated these changes in the HF-SD rats (P<0.05).Compared with the sham-Fisher 344 rats, the HF-Fisher 344 rats also had a greater number of CRH positive neurons in the PVN (accordingly the plasma ACTH levels were increased).In addition, they had significantly increased RSNA and plasma NE level, higher LVEDP, RV/BW and lung/BW, and lower ±dp/dtmax (P<0.05).Compared with the SHAM-Lewis rats, the HF-Lewis rats had not significantly changed in the above parameters.CONCLUSION: In CHF, the CRH-containing neurons in PVN are activated, thus aggravating cardiac function by increasing sympathoexcitation.

Objective To assess whether anemia is an independent predictor of poor long-term outcome after percutaneous coronary intervention(PCI).Methods The second drug-eluting stent impact on revascularization registry(DESIRE-2)is a single-center registry of 6005 patients undergoing coronary revascularization from July 2003 to September.2005.We examined the clinical data and outcome of 3809 PCI patients based on hemoglobin(Hb)value before the interventional procedure.Patients were classified as anemia using the World Health Organization deftnition(＜120 g/L in women and＜130g/L in men). 744 of the 3809 patients were anemic.We compared the clinical features and prognosis of the patients with or without anemia.Results Anemic patients were older and had a higher percentage of comorbidities as compared with the nonanemic ones.When compared with nonanemic patients,anemic patients had higher mortality(4.7%VS 1.5%,P＜0.001)and higher major adverse event end points,including nonfatal myocardial infarction,stroke and revascularization(14.0%vs10.8%,P=0.014).After adjustment for comorbidities,anemia was associated with a higher risk of mortality after percutaneous coronary intervention(RR 2.216,95%CI 1.019-4.428;P=0.024).Conclusions Anemia is an independent predictor of mortality after PCI.Since PCI iS a common procedure and anemia is a frequent condition in the general population,strategies for the management of anemic PCI patients should be developed.

Objective To analyze the neurological complications in treatment of severe thoracolumbar spinal deformity with one stage posterior vertebral column resection (pVCR) and discuss the related risk factors. Methods There were 67 patients with severe thoracolumbar spinal deformity who underwent one-stage pVCR from February 2000 to September 2010.There were 29 males and 38 females at an average age of 31.4 years old(range,14-62 years).There were 21 patients at age less than 18 years old and 46 at age more than 18 years old.Patients were divided into four pathological types:severe scoliosis group(n=11,mean Cobb angle 90.4°),kyphoscoliosis group(n=25,mean scoliosis 94.5°,and mean kyphosis 65.5°),angular kyphosis group(n=28,mean kyphosis 74.3°)and global kyphosis group(n=3,mean kyphosis 91.1°).of all the patients,59 patients underwent primary surgery and eight underwent revision surgery.Surgical methods included posterior apex vertebral column resection,segemental pedicle screw fixation and correction as well as 360° bone fusion.Neurological complication was statistically analyzed. Results The average follow-up was 14 months (range,3-69 months),which showed severe neurologic complication in eight patients(11.9%)after surgery.Severe neurologic complication occurred in three patients (4.5%),among whom one patient presented delayed complete paraplegia 23 hours after surgery.Five patients had mild neurologic deficits(7.5%),the incidence of which was higher than 23.1%for thoracic osteotomy (P<0.05).Multilevel pVCR had high rate of neurological complications (P<0.05).The incidence rate was 33.3% for patients with preoperative neurologic compromise and 7.3%for patients mthom preoperative neuroiogic compromise (P<0.05).The incidence rate was increased in the revision surgery (P<0.05).Eight patients with neurological deficits had kyphotic angle of raore than 60°although there was no statistical difference (P>0.05). Conclusions pVCR is an effective surgical method for the correction of severe thoracolumbar spinal deformity.The neurological complications,however,should be paid attention to the surgeons.The risk factors for neurologic complications include improper manipulation,massive blood losing,preoperative neurologic compromise,osteotomy at thoracic rein,multi-level vertebrectomy,revision surgery and severe kyphosis.