Objective To observe the change of interleukin-8(IL-8) during perioperative period, and to define whether the increase of IL-8 in response to cardiac surgery is related to the presence of a certain allele in a functional polymorphism. To explore the relationship between postoperative inflammation and clinical outcome. Methods One hundred and forty-five patients undergoing selective off-pump coronary artery bypass (OPCAB) for the first time were enrolled. The IL-8 (-251A >T) polymorphisms were analyzed by using polymerase chain reaction (PCR) and gene sequencing. The plasma levels of cytokine, troponin T (TnT). creatine kinase-MB (CK-MB) and creatinine (Cr) were measured before and 4, 24 and 72 hours after operation by suspension array system. Results After surgery, the IL-8 concentration increased and reached the highest level at 4 hours after surgery [18.0 (8.4, 37.1) ng/L, P = 0.000], and then it decreased to the preoperative level at 3 days after surgery. Four hours after surgery, the patients with IL-8-251 AA homozygous genotype had higher concentration of IL-8 C33.1 (16.6, 49.5) ng/L, P =0.0353. They had higher TnT and CK-MB levels than patients homozygous for AT and TT genotype 4 hours after surgery [TnT:0.53 (0.43, 4.92) ng/ml, P = 0.037; CK-MB: 41.5 (28.8, 65.5) U/L, P=0.025], and patients homozygous for AT genotype had higher Cr level 24 hours after surgery C93.1 (76.4, 121.5) μmol/L, P = 0. 021]. The patients who underwent ventilation for more than 1 day or post-operative hospital stay for more than 14 days had higher IL-8 levels (P=0.036, 0.038). IL-8-251AA genotype was an independent risk factor for patients undergoing ventilation for more than 1 day (OR=11.80, 95% CI: 1.87-74.48) and post-operative hospital stay for more than 14 days (OR=38.00, 95% CI:4.15-347. 87) . Conclusions OPCAB results in postoperative inflammatory response. IL-8-251AA genotype is associated with longer mechanical ventilation and hospital staying. Genetic background might alter the extent of inflammatory response and relate to postoperative prognosis. 、

Objective To investigate the relationship between 4G/5G polymorphism in the promotor of plasminogen activator inhibitor-1 (PAI-1) gene and pulmonary thromboembolism (PTE). And to detect whether it plays an important role in the pathogenesis of PTE. Methods The 76 patients with PTE, 74 gender and age matched healthy controls were recruited in this study. Genome DNA was extracted from whole blood using phenol-chloroform. Subjects were genotyped for the 4G/ 5G polymorphism of PAI-1 gene using polymerase chain reaction and restriction fragment length polymorphism analysis. Results Significant difference was found in the frequency of 4G/4G genotype between PTE group and control group (50.0% vs.24.3%,P<0.01). And there were no significant differences in 4G/5G and 5G/5G genotype between the two groups. The 4G allele frequency was higher in PTE group than in control group (72.4% vs. 55.4% , P<0.01) . The recessive allele model was informative and the odd ratio of 4G/4G genotype was much higher than of other two genotypes (OR=3.40, P<0.01). Further stratification showed 4G/4G genotype was associated with high risk of PTE for those individuals without traditional environment risk factors. Conclusions The 4G/5G polymorphism of PAI-1 gene is associated with PTE and 4G allele is recessive. 4G/4G genotype increases the risk of PTE for individuals who have no traditional risk factors of PTE.

Objective To evaluate the impact of age on the bladder-urethral function and the outcome of transurethral resection of the prostate (TURP) in the elderly men with benign prostatic hyperpiasia (BPH). Methods The elderly men with BPH undergoing TURP were divided into young elderly group [n=158, mean age of 68 + 4 years] and elderly group [n=47, mean age of 80± 3 years]. All patients were evaluated by International Prostate Symptom Score (IPSS). Quality of life (QOL). transrectal ultrasound and urodynamic examination one week before TURP, and they were followed by IPSS, QOL. free uroflowmetry and postvoid residual urine volume (PVR) measurement at 3 months after TURP. Results The incidence rates of detrusor overactivity, low compliance bladder, detrusor underactivity and benign prostatic obstruction in elderly group were 70%, 34%, 19% and 77% respectively, and they were significantly higher than in young elderly group (42%, 18%, 6.3% and 58%,x2 =10.623, 4.328, 5.637,4.771,P<0.05). However, the mean max detrusor voided pressure [62±29) cm H2O] was significantly lower in elderly group than in young elderly group [(76±22) cm H2O,t =3.265, P<0.05]. Moreover, the mean prostatic length, static functional length and bladder neck pressure were (52±8) mm, (63±11) mm and (36 15) cm H2O respectively, they were significantly higher in elderly group than in young elderly group [(47±7)mm, (59±6) mm and (25±13) cm H2O, t=4.157, 3.388 and 4.912,P<0.05]. The IPSS, QOL and PVR were significantly lower after TURP than beforeTURP, and the max flow rate (MFR) was significantly higher after TURP than before TURP in both groups (tyoung elderly group= 19.744, 64.671, 23.342 and 27.504;t elderly group= 27.308, 19.311,9.694 and 11.671, P<0.05). However, the MFR was significantly lower in elderly group than in young elderly group, and PVR and QOL were significantly higher in elderly group than in young elderly group after TURP (t=3.493, 15.245 and 10.750, P<0.05). Conclusions The risk of bladder-urethral dysfunction is increased and the therapeutic effects of TURP is decreased with ageing in the elderly men with BPH. It would be beneficial to have an urodynamic study for their treatment.

Objective To observe the effect of changes in CD34+ cell level on various degrees of chronic heart failure (CHF) in the elderly. Methods The enrolled patients were divided into four CHF groups according to the New York Heare Association(NYHA) functional class: NYHA class I (n=23), Ⅱ (n=27), Ⅲ (n = 20) and IV group (n= 16) , and there were 41 healthy controls over the same period. The levels of peripheral blood CD34+ cells were measured, and the tumor necrosis factor-α (TNF-α). its soluble receptors (sTNFR-1 and sTNFR-2) and vascular endothelial growth factor (VEGF) were also measured. Results The levels of CD34+ cells were elevated in the early CHF and depressed in the advanced CHF in elderly patients. The levels of CD34+ cells were (0. 6± 0.2) 109/L in control group, (2.4±0. 4) 109/L in NYHA class I group, (1.9±0.2)×109/L in NYHA class Ⅱ group, (1.3±0.1)×109/L in NYHA class Ⅲ group and (0.5±0.2)×109/L in NYHA class Ⅳ group, respectively (all P<0.01).And TNF-α, sTNFR-1, sTNFR-2 and VEGF were increased in severe chronic left ventricular failure CNYHA class IV vs. I group:TNF-α: (61.4± 15.7) ng/L vs. (28.4±10.8)ng/L; sTNFR-1: (2820.9±1282.8)ng/L vs. (690.8±62.7) ng/L; sTNFR-2: (4113.1±1102.2) ng/L vs. (740.8± 112.3)ng/L; VEGF: (996.3±487.1)ng/L vs. (423. 3±147. 9)ng/L, all P<0. 013. Conclusions The changes of CD34+ cell level may predict various degrees of chronic heart failure in elderly patients.

Objective To evaluate the effect of different regimens of antiplatelet drugs on the major adverse cardiac events (MACEs) in elderly patients undergoing selected percutaneous coronary intervention (PCI) in direction of the adenosine diphosphate (ADP) -induced platelet aggregation index. Methods The 1230 cases aged 60-80 years, mean (67. 2±10. 2) years undergoing selected PCI with the drug eluting stent were enrolled. The 615 cases of the ADP guided group according to the ADP-induced platelet aggregation index. After the first loading dose of clopidogrel (300 mg) , once the decrease of ADP-induced platelet aggregation index was more than 50% as compared with the basic level, the dose of 75 mg each day would be maintained for one year. If the decrease of the index was less than 50%. the another 300 mg of clopidogrel would be given again, until up to 900 mg on the 3th day. If the decrease of the index was still not enough, the combination of clopidogrel 75 mg, cilostazol 100 mg and aspirin 100 mg each day would be suggested. The rest 615 patients in the routine dosage group took the routine dose of clopidogrel (the first loading dosage 300 mg was taken, then 75 mg each day for one year ) . The MACEs, including cardiac death, myocardium infarction, revascularization and stent thrombosis, were observed for 12 months. Results After the first 300 mg of clopidogrel, only 45% of patients reached the standards. Until reaching 900 mg, 67.5% of patients in the ADP guided group were eligible. The tailored clopidogrel loading dose in the ADP guided group yielded a better effect on the inhibition of platelet aggregation (the routine dose vs. the tailored loading dose: 45% vs. 67. 5% , P=0. 028). After one year follow up, the MACEs were less in ADP guided group than in routine dosage group (2. 8% vs. 4. 9% , P = 0. 035). All of patients had no major bleeding, and the minor bleeding and other drug adverse events in two groups had no significant differences. Conclusions The patients undergoing selected PCI should receive ADP -induced platelet aggregation test in order to assess the inhibition effect of clopidogrel on the platelet aggregation. It is safe and effective to modify the antiplatelet drugs regimen during the peri-PCI procedure in direction of ADP-induced platelet aggregation.

Objective To assess the value of exercise treadmill testing (bruce protocol) in diagnosing early atherosclerotic lesions of the lower limb. Methods Between March and September 2008, 173 outpatients with high risks of peripheral arterial disease (PAD) were enrolled randomly from the cardiology clinic of Chinese PLA General Hospital. The patients were subjected to exercise treadmill testing (Bruce protocol) and ankle-brachial index (ABI) determination, as well as lower limb artery ultrasonography within one week. Using ultrasonic findings as diagnostic criteria, the diagnostic sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of exercise treadmill testing for early atherosclerotic lesions of the lower limb were analyzed, and the diagnostic value of exercise treadmill testing was assessed using the ROC curve. Results After exercise, ABI decrement (R value) increased in subjects with high risks for PAD with atherosclerotic lesions of the lower limb aggravating. Using the presence of large atherosclerotic plaques (area > 20 mm2 ), atherosclerotic plaques and atherosclerotic lesions in lower limb arteries as positive diagnostic criteria, the area under curve of ROC was 0. 80 (95% CI: 0.72-0.88), 0.78 (95% CI: 0.71-0.85) and 0. 60 (95% CI: 0.44-0.76), respectively. Using the presence of large atherosclerotic plaques in lower extremities as positive diagnosis, R value was 0.80, with a sensitivity of 54. 0%, a specificity of 96. 7%, a LR+ of 16. 4, and a LR- of 0. 58, meanwhile, R value was 0. 85, with a sensitivity of 70.0%, a specificity of 91.9%, a LR + of 8.64, and a LR- of 0.33. Conclusions Exercise treadmill testing (Bruce protocol) in combination with ABI determination is a safe, accurate, objective tool for detecting early atherosclerotic lesions of the lower limb. Immediately after exercise, 0.85 is the cut-off R value appropriate for diagnosing large atherosclerotic plaques of the lower limb (area > 20 mm2).

Objective To compare the similarities and differences in changes of cardiac muscle structure between the rat models of chronic cor pulmonale induced by hypoxia and active immunization of M2-muscarinic receptor under light microscope and electron microscope, and to explore the dependablity of the antibody effects on cardiac architecture. Methods The 48 healthy male Wistar rats were randomly divided into 4 groups: (1) Hypoxia group: the typical model of chronic cor pulmonale was established according to XUE's method; (2) Active immunization group was immunized by M2-muscarinic receptor peptide; (3) Control group was fed in normal condition; (4) Cyclosporin A group: the hypoxia group plus cyclosporin A treatment at the same time. The antibody against M2-muscarinic receptor was detected by SA-ELISA, and the pathological exemplar of cardiac muscle was observed by light microscope and transmission electron microscope. Results (1) Antibody level of M2-muscarinic receptor; the P/N values gradually increased along with the process of experiment, and the max value in active immunization group was 5. 13. At the end of the second week, the value in hypoxia group increased to 2.08, but was still less than in active immunization group (4.66). (2) Under light microscope: in hypoxia group and active immunization group, the hearts displayed significant alterations including disorder of cardiac muscle fiber, necrosis of myocardial cells together with the infiltration of inflammatory cells. There were no differences in light microscopic findings between hypoxia and cyclosporin A group. (3) Under transmission electronic microscope examination in both active immunization group and hypoxia group, the hearts showed s1imilar significant alterations such as focal cardiac muscle fiberlysis, loss of normal muscle fiber banding pattern, mitochondrial swelling and condensation, sarcoplasmic vacuolation and deposition of dense granules in both the sarcoplasmic and muscle fiber. The contour of myocyte was irregular and plasma membranes were discontinuous in some cells. All altered myocytes were fairly widely distributed throughout the myocardium. The interstitium showed edema, deposits of flocculent serum protein, activated fibroblasts and increased amounts of collagen fibers. No obvious alterations were observed in cyclosporin A group. Conclusions The positive rate and the titer of antibody against M2-muscarinic receptor are obviously increased in the rat model of chronic cor pulmonale, which indicates that there is a relationship between the antibody against M2-muscarinic receptor and the pathogenesis of chronic cor pulmonale.

Objective To investigate the relationships of nuclear factor кB (NF-кB) activation with protein kinase B (Akt) and glycogen synthase kinase 3β (GSK-3β) during amyloid-β (Aβ) (25-35) -induced apoptosis in pheochromocytoma cells (PC12 cells) of rats. Methods Apoptosis in PC12 cells was induced by A(25-35). The activities of Akt, GSK-3β and NF-кB were analyzed in this process. The Akt and GSK-3β pathways were blocked by their specific inhibitors, respectively, and the relationships of Akt and, GSK-3β with NF-кB during Aβ(25-35)-induced apoptosis in PC12 cells were determined. Results Aβ(25-35) induced apoptosis was in a dose-dependent manner. With 0, 5, 10, 20 μmol/L and 40 μmol/L Aβ(25-35) treaing for 48 h, the apoptosis rates of PC12 cells were (3. 01 ± 0.03)%, (3.08 ±0.03)%, (25.32 ± 0.76)%, ( 42.88 ± 0.60 )% and ( 60.85 ± 2.39 )% , respectively. Compared to control, both Akt and GSK-3β were suppressed during apoptosis, at meantime NF-кB was activated. The inhibited Akt activity by wortmannin leaded to decreased NF-кB activatity and increased GSK-3β activatity. Suppression of GSK-3β with its specific inhibitor LiCl caused the decreased activation of NF-кB too, but it had no significant influence on Akt activity. Conclusions These results suggest that both Akt and GSK-3β are upstream regulators of NF-кB. They co-regulate the activation of NF-кB during Aβ(25-35)-induced apoptosis in PC12 cells. This study contributes to the theoretical base for the pathogenesis of Alzheimer disease (AD) , and provides a new idea to AD prevention and therapy.

Objective To explore the effect of diabetes mellitus (DM) on biological behavior of epidermal keratinocyte in rats. Methods A total of 40 Sprague-Dawley rats were randomized into control group and streptozotocin (STZ) -induced diabetes group. Of each group, 10 rats were implemented with deep partial-thickness scalding. The re-epithelialization rate was observed at the 3rd, 7th, 14th and 21th post-burn day. Histological characteristics and thickness of epidermal tissue in both groups were observed. The adhesion rate, cell cycles, apoptosis rate and migration ability of keratinocyte were measured. The accumulation of advanced glycosylation end products (AGEs) of epidermal tissue was observed. Results The percentages of re-epithelialized area at the 7th, 14th and 21th post-burn day were much lower in DM group than in control group (P<0.05). In DM group, the epidermal thickness was reduced obviously with obscure multilayered epithelium and less amount of prickle cells; The adhesion rates of 12, 24 h after culturing keratinocyte and the percentage of G2/M phase cells were lower in DM group than in control group (P<0.05). However, apoptosis rate of keratinocyte was higher, the amount of migration cell was significantly less in DM group than in control group (both P<0.05). There were lots of AGEs accumulated in epidermal tissue in DM group, while there were hardly AGEs in control group. Conclusions Re-epithelization blocked exists on non-healing wound in DM rats, which is related with the impaired keratinocyte biological behavior. A large of AGEs accumulate in the epidermal tissue of DM rats, which may be a important reason to inhibit keratinocyte function in diabetic environment.

Objective To assess the efficacy and safety of target-controlled infusion of propofol and remifentanil in geriatric patients with hepatocellular carcinoma undergoing percutaneous radiofrequency ablation. Methods Thirty geriatric patients with primary hepatocellular carcinoma of ASA Ⅱ-Ⅲ scheduled for percutaneous radiofrequency ablation under monitored anesthesia care (MAC) were randomly allocated to two groups: target-controlled infusion of propofol and remifentanil group (PR group, n= 15) and intravenous injection of midazolam and fentanyl group (MF group. n= 15). The mean arterial blood pressure (MAP), heart rate (HR) and pulse oxygen saturation (SpO2) of patients were recorded during the treatment. The Ramsay Score, Patient Cooperation Score, VAS Score and postoperative Patient Satisfaction Score were recorded as well. Results The Ramsay Score, Patient Cooperation Score, VAS Score and Patient Satisfaction Score were all higher in PR group than in MF group (all P<0.05). The maximum values of MAP and HR [( 108.7± 8.6) mm Hg, (83.8±7.1) times/min] were significantly higher than the baseline values [( 99.3 ± 8.5) mm Hg, (76.3±7.1) times/min] in MF group, and the degree of increment of MAP and HR were significantly greater in MF group than in PR group (both P<0.05). The minimum values of MAP and HR [(84.5±6.5) mm Hg, (66.6 ± 6.6) times/min] were significantly lower than the baseline values [(97.7±6.5) mm Hg, (75.4±7.3) times/min] in PR group, and the degree of decrement of MAP and HR were significantly greater in PR group than in MF group (both P<0.05). SpO2 of both groups decreased significantly (the minimum values of PR and MF groups were 95.1±2.0 and 95.5± 2.2, respectively), but there was no statistical difference between two groups (P>0.05) . Conclusions MAC with target-controlled infusion of propofol and remifentanil is more suitable for geriatric patients with hepatocellular carcinoma undergoing percutaneous radiofrequency ablation, as it can provide ideal analgesia and sedation, but the respiration and the change of hemodynamics of patients must be observed seriously.