Chop and Grp78 genes are key genes in endoplasmic reticulum stress(ERS).To explore the gene alteration of Chop and Grp78 in embryo with spina bifida,we studied Chop and Grp78 gene expression by qRT-PCR in neural tube of rat with spina bifida in E12 and primary cultured neuroepithelial stem cells(NEP).We found higher expression of both Chop and Grp78 in neural tube of rat with spina bifida than normal rats.While Chop and Grp78 genes were up-regulated after NEP differentiated into neuron.The up-regulation of Chop and Grp78 genes in neural rube of rat and NEP might be involved in the abnormal apoptosis in spina bifida related with ERS.And we found the primary culture of NEP provided a good model for embryo early development research.

Objective To study the influence of artifical liver support system (ALSS) on bone marrow stem cell (BMSC) differentiation factors in patients with chronic severe hepatitis B.Methods Fifty patients with chronic severe hepatitis B were divided into ALSS treatment group (n=25) and control group (n=25).The patients in control group received combined medical treatment and those in ALSS treatment group received ALSS treatment within 1 week of admission on the basis of combined medical treatment.The concentrations of hepatocyte growth factor(HGF),fibroblast growth factor-4 (FGF-4),epidermal growth factor (EGF) and basic fibroblast growth factor (bFGF) were detected before and 2 weeks after therapy.The data were analyzed by t test.Results The serum levels of HGF,FGF-4,EGF and bFGF of patients before ALSS treatment in treatment group were (689.10± 337.68) ng/L,(124.88±87.67) ng/L,(323.85±44.40) ng/L and (9.29± 1.38) ng/L,respectively; while the levels of those cytokines after ALSS treatment were (1081.50±356.66) ng/L,(110.76±79.71) ng/L,(347.80±71.73) ng/L and (9.57±1.15) ng/L,respectively,among which HGF level increased significantly after ALSS treatment (t =10.042,P＜0.01) and was higher than control group(t=6.670,P＜0.01).However,the levels of HGF,FGF-4,EGF and bFGF were not significantly different from those in the control group.And levels of all HGF,FGF-4,EGF and bFGF in control group were not statistically different before and after treatment.ConclusionALSS treatment can increase the serum HGF level but not FGF-4,EGF and bFGF,which may contribute to BMSC transdifferentiation that is involved in the hepatocyte repair and regeneration in chronic severe hepatitis B.

Objective To analyze the application effect and safety of streamlined liner of the pharynx airway (SLIPA) anesthesia in painless fiberoptic bronchoscopy (FB).Methods Two hundred and eighty-two patients who undorwent FB examination in Kaifeng Second People's Hospital from January 2015 to January 2017 were selected and divided into observation group and control group,with 141 patients in each group.The patients in observation group were given SLIPA assisted anesthesia;the patients in control group were given endoscopic mask assisted anesthesia.The oxygen saturation (SpO2),systolic blood pressure (SBP),diastolic pressure (DBP) and heart rate (HR) of patients in the two groups were monitored.The changes of SBP,DBP and HR,the incidence of adverse reactions and the satisfaction of patient to the anesthesia were compared between the two groups.Results The fluctuation of HR,SBP and DBP of patients in the observation group was (3.52 ± 2.92) times · min-1,(7.04 ±5.30) mmHg(1 mmHg =0.133 kPa),(1.52 ± 1.63) mmHg respectively and in the control group was (5.52 ± 1.89) times · min-1,(30.12 ± 8.88) mmHg,(4.06 ± 5.78) mmHg respectively;the fluctuations of HR,SBP and DBP of patients in the observation group were significantly less than those in the control group(P ＜ 0.05).In the observation group,12 patients with cough,8 patients with abdominal distension,6 patients with pharyngeal pain,2 patients with SpO2 ≤90％,4 patients with SpO2 ＜ 85％;in the control group,57 patients with cough,32 patients with abdominal distension,47 patients with pharyngeal pain,28 patients with SpO2 ≤90％,19 patients with SpO2 ＜ 85％.The incidence of adverse reactions of patients in the observation group was significantly lower than that in the control group (x2 =27.10,61.82,41.59,72.46,87.75;P ＜0.05).The anesthesia satisfaction of patients in the observation group(97.87％) was significantly higher than that in the control group(82.98％) (x2 =29.97,P ＜ 0.05).Conclusion SLIPA assisted anesthesia has good clinical effect and safety in patients with painless FB.

Objective To investigate the value of intraoperative neuromonitoring(IONM) for preventing recurrent laryngeal nerve(RLN) injury in thyroid surgery.Methods 1087 consecutive patients undergoing thyroid surgery at Wuhan Central Hospital from Oct 2010 to Dec 2012 were evaluated.277 cases(the study group) underwent thyroidectomy with RLN identification by naked eye plus IONM.810 cases(the control group)underwent thyroidectomy with RLN identification by naked eye only.Results In the control group,733 RLNs (90.49％,733/810)were successfully identified and 77 RLNs were failed to be identified.In the study group,all the 277 RLNs(100％,277/277)were successfully identified.28 cases had postoperative temporal RLN injury,among whom 26 cases were in the control group and 2 cases were in the study group.18 cases in the control group and 2 cases in the study group recovered in 2 weeks after surgery.The rest recovered in 2 months after surgery.RLN injury rate was significantly lower in the study group than in the control group.There was no significant difference in RLN injury for low-risk surgical patients between the 2 groups; however,the study group had advantages in RLN injury than the control group for high-risk patients.Conclusions IONM in thyroid surgery can improve the recognition rate of RLN during thyroidectomy.IONM can significantly reduce the incidence of RLN injury,especially in high-risk surgery.

Objective The extremely xerothermic environment of desert easily causes heatstroke and consequently multiple organ damage.Few reports are seen at home and abroad on heatstroke-induced lung injury associated with dry heat of desert.This stud-y explored the changes of the injured lungs in heatstroke rats in xerothermic desert. Methods Forty-eight male SD rats were ran-domly divided into six groups of equal number: mild, moderate and severe heatstroke groups and their corresponding controls.The rats of the three heatstroke groups were exposed to a temperature of 41 ℃and humidity of 10%, while those in the three corresponding control groups to a temperature of 25 ℃ and humidity of 35% for 70, 110 and 145 minutes, respectively.Then all the rats were sacrificed and the bronchoalveolar lavage fluid ( BALF) and lung tissues were collected for observation of pathological changes, obtainment of lung in-jury scores, calculation of the wet/dry weight ratio of the lungs, measurement of the total protein level in the BALF, and determination of the malondialdehyde ( MDA) content in the lung tissue. Results The mild, moderate and severe heatstroke groups showed re-markable increases compared with the three corresponding control groups in lung injury scores (3.25 ±0.50, 6.50 ±0.58 and 8 ± 0.82 vs 1.25 ±0.50, 1.00 ±0.00 and 1.25 ±0.50), the wet/dry weight ratio of the lungs (3.50 ±0.57, 4.85 ±0.19 and 4.10 ± 0.07 vs 1.78 ±0.66, 1.67 ±0.68 and 1.67 ±0.25), the total protein level in the BALF ([93.51 ±5.54], [141.24 ±6.07] and [160.76 ±6.74] μg/mL vs [42.6 ±8.67], [45.25 ±6.78] and [41.68 ±3.62] μg/mL), and the content of MDA in the lung tis-sue ([1.79 ±0.08], [2.79 ±0.11] and [3.52 ±0.36] nmol/mg prot vs [1.21 ±0.12], [1.20 ±0.12] and [1.28 ±0.19] nmol/mg prot) .The lung injury scores, the total protein level in the BALF, and the content of MDA in the lung tissue were increased with the prolonging of the time of exposure to dry heat, while the wet/dry weight ratio of the lungs was the highest in the moderate heat-stroke group.The lung injury scores were positively correlated with the wet/dry weight ratio of the lungs, the total protein level in the BALF, and the content of MDA in the lung tissue (P<0.01). Conclusion Heatstroke in the xerothermic environment of desert can cause lung injury in rats, which deteriorates with the prolonging of the time of exposure to dry heat.As for the management of such heatstroke, more attention should be paid to the protection against lung injury.

Objective To observe the recent clinical efficacy of the sequential therapy hormone in the treatment of active rheumatoid arthritis.Methods In accordance with the principle of digital sheet,160 patients with active rheumatoid arthritis were randomly divided into the observation group and the control group,80 cases in each group.On the basis of methotrexate and leflunomide in both groups,the hormone sequential therapy was given in the observation group,but prednisone was given in the control group.The clinical efficacy of treatment after 1 week and 3 months were compared in two groups.Results In the observation group,the indicators in 7 d after treatment were significantly reduced,compared with untreated(t =19.90,7.63,14.73,7.58,6.84,14.09,all P ＜0.01),In the control group,three indicators of the duration of morning stiffness,joint tenderness index and joint swelling index in 7d after treatment were significantly reduced,compared with untreated (t =13.42,3.34,7.24,all P ＜ 0.01),Compared the indicators in the two groups in 7 d after treatment,there were statistically significant differences (t =13.07,4.92,10.51,5.23,5.74,15.03,all P ＜ 0.01).The indicators in the 3 months after treatment in both groups were signifi cantly decreased,buttherewasnosignificantdifferencebetweenthetwogroups (t =1.80,1.73,1.59,1.22,1.21,1.35,all P ＞ 0.05).The total effective rate was 80% in the observation group; but the rate was 75 % in the control group;there was no statistically significant difference in the two groups(x2 =0.57,P ＞ 0.05).Conclusion The sequential hormone therapy is an effective means for the treatment of active rheumatoid arthritis,by controlled the symptoms of rheumatoid arthritis effectively and alleviated the patient's condition.

Aged ; Humans ; Lung Diseases, Fungal ; complications ; Silicosis ; complications ; microbiology ; Tuberculosis, Pulmonary ; complications

Objective To observe the improvement of postoperative pulmonary function and oxygen partial pressure during general anesthesia for open abdominal surgery with lung protective ventilation strategies and alveolar recruitment maneuvers. Methods Seventy patients who underwent selective open abdominal surgery were selected, and they were divided into standard ventilation group (tidal volume 8 ml/kg) and protective ventilation group (tidal volume 6 ml/kg, 5 cmH2O positive end-expiratory pressure, and alveolar recruitment maneuvers, 1 cmH2O=0.098 kPa) according to the random digits table method with 35 cases each. The airway pressure, blood pressure, pulse oxygen saturation (SpO2), end-tidal partial pressure of carbon dioxide (PETCO2) and adverse reactions were observed. The SpO2, partial pressure of O2 (PaO2) and pulmonary function before surgery and 1, 3, 5 d after surgery were measured. Results The respiratory rate, airway pressure and PETCO2 levels in protective ventilation group were significantly higher than those in standard ventilation group: (12.3 ± 2.1) times/min vs. (10.2 ± 1.0) times/min, (15.1 ± 2.8) cmH2O vs. (13.5 ± 2.3) cmH2O, (34.6 ± 2.1) mmHg (1 mmHg=0.133 kPa) vs. (32.1 ± 1.4) mmHg, and there were statistical differences (P<0.05). The SpO2 in 2 groups was maintained at 0.99. There was no statistical difference in the incidence of postoperative complications between 2 groups (P>0.05). The SpO2 and PaO2 levels at 1, 3 d after surgery in protective ventilation group were significantly higher than those in standard ventilation group:0.951 ± 0.018 vs. 0.936 ± 0.016 and 0.964 ± 0.018 vs. 0.949 ± 0.018, (74.8 ± 6.8) mmHg vs. (65.0 ± 6.2) mmHg and (79.6 ± 6.0) mmHg vs. (70.6 ± 5.3) mmHg, and there were statistical differences (P<0.05). The forced expiratory volume in 1 s (FEV1), percentage of the estimated value of FEV1, forced vital capacity (FVC) and percentage of the estimated value of FVC at 1, 3 and 5 d after surgery in protective ventilation group were significantly higher than those in standard ventilation group, the FEV1/FVC at 1 d after surgery was significantly higher than that in standard ventilation group, and there were statistical differences (P<0.05). Conclusions The lung protective ventilation strategy and alveolar recruitment maneuvers can improve the postoperative pulmonary function and oxygen partial pressure during general anesthesia for abdominal surgery. Low vital volume, appropriate positive end-expiratory pressure and recruitment maneuvers can protect the lung in general anesthesia patients.

BACKGROUND:The nervous reconstruction and repair after spinal cord injury have become a research hotspot.
OBJECTIVE:To investigate the change rule of neurogliocyte reactive hyperplasia after spinal cord injury.
METHODS:Forty-two adult male Sprague-Dawley rats were selected and equivalently randomized into seven groups:normal control group (no intervention), sham operation group (lamina decompression) and operation groups (postoperative 1, 7, 14, 21 and 28 days). After the establishment of spinal cord injury models, the rats were sacrificed at each corresponding time point. The functional recovery of the rat hind limbs was evaluated by Basso, Beattie and Bresnahan scores, and complete spinal cord tissue was removed to undergo hematoxylin-eosin staining, immunohistochemistry staining and immunofluorescence staining.
RESULTS AND CONCLUSION:(1) Basso, Beattie and Bresnahan scores showed that rats in the normal control and sham operation groups had normal neurologic function. Rats at 1 day after spinal cord injury paralyzed completely, the neurologic function of hind limbs began to recover gradual y at the 7th day, and the recovery became most obvious at the 14th day, which had no significant differences compared with the 21st and 28th days. (2) Hematoxylin-eosin staining found that the diffuse hemorrhage and neuronal necrosis were observed in the injured area at 1 day after operation;inflammatory cel infiltration and some vacuoles appeared at the 7th day, and the hemorrhage was absorbed gradual y;the hemorrhage disappeared completely and capsule cavity formed at the 14th day;up to the 28th day, spinal cord structure was completely destroyed and that was replaced by cicatricial tissue accompanying with a large cavity. (3) Immunohistochemistry staining showed that the astrocyte in damaged area proliferated with the cel synapse increasing, which was most overt at the14th day;the axon clearance widened and the structure was in disorder at the 7th day, and the myelin sheath in the damaged area was destroyed at the 21st day. (4) Immunofluorescence staining showed that there were numerous visible glial fibril ary acidic protein+/nestin+cel s in the injured area at 14 days after operation. (5) These results suggest that glial cel hyperplasia and hypertrophy, the up-regulated expressions of glial fibril ary acidic protein and nest protein are advantageous to the early repair of spinal cord injury.

Objective To evaluate the clinical efficacy and complication rate by open or retroperitoneal laparoscopic radical nephrectomy for renal tumor with stages T1N0M0 or T2N0M0.Methods Between October 2003 and October 2006,90 patients with renal cell carcinoma,which were clinically localized stages T1N0M0 or T2NOM0 Based on the patients' options to undergo retroperitoneal laparoscopic radical nephrectomy (group A,49 patients)and open radical nephrectomy(group B,41 patients).The clinical efficacy were compared between group A and group B,retrospectively.Results In group A,the operations of 46 patients were successful,4 cases occurred major complications(8.7%)during the follow-up visit which lasted for (21.9±6.1)months.The operations in group B were all successful.9 cases occurred major complications (22.5%)during the follow-up visit which lasted for(24.9±7.8)months.All cases were renal malignant tumors with pathologically confirmed stages T1N0M0 or T2N0M0 and there were no renal pedical lymph node metastasis.The age,weight,body mass index(BMI),tumor size,operating time and the time of follow-up were no statistically significant differences between the two groups(P＞0.05),while the blood loss,amount of postoperative drainage,time to ambulation,recovery of intestinal function after operation,hospital stay,use of analgesic and transfusion blood or plasma in group A were significantly reduced than those in group B(P＜0.01). Conclusions As compared with open radical nephrectomy,retroperitoneal laparoscopic radical nephrectomy afords patients with renal cell carcinoma an impreved postoperative course with minimal invasion,less pain,quicker recovery and less complications,while providing equally effective cancer control for patients with T1N0M0 or T2N0M0 tumor.