Toll-like receptors ( TLRs) are pattern recognition receptors, which exist in both cell membrane and cytoplasm, and participate in inflammatory reactions. Some studies have shown that TLR2/4-NF-κB signal pathways mediated by TLR2 and TLR4 could regulate the production of inflammatory factor IL-1β, which played an important role in the attack of gouty arthritis. The article focused on the pathogenesis of gouty arthritis, discussed the structure and distribution of TLRs, the ligands and its mediated signal pathways, the validity in the treatment of gouty arthritis using the signal pathways as the target points and the relationship between the signal pathways and gouty arthritis, and reviewed the research progress in Chinese medicines using the signal pathways as the guidance.

Objective:To explore the pharmaceutical care points in advanced lung cancer patients with brain metastases. Meth-ods:Clinical pharmacists participated in the drug treatment process of one case of small cell cancer patient with brain metastases. Pharmaceutical care was carried out from various aspects, including brain metastases treatment, chemotherapy, antiviral therapy and patient education. Results:Cerebral transfer symptoms and quality of life of the patient were effectively improved and adverse reactions were reduced by the pharmaceutical care. Conclusion:By the implementation of pharmaceutical care on the patient, clinical pharma-cists can not only improve their own knowledge base and exploit professional advantage, but also provide suggestions on rational drug use for health care professionals.

Objective To investigate the MRI features of intracranial lymphoplasmacyte-rich meningioma and the corelation between the MRI features and pathologic findings. Methods The MRI and pathologic data of 7 patients with lymphoplasmacyte-rich meningioma were reviewed retrospectively. All cases were proved by surgery and pathological examinations. Results All lesions were solitary. The tumors crawled along meninges in 6 cases and in 5 cases the tumors did not appear as mass lesions. In 2 cases, the tumors appeared as half-moon. The boundary of all of the tumors was unclear, accompanying heavy peritumoral brain edema. The brain invasion can be seen in 7 cases. The lesions showed hypo-isointense signal on T1 WI in 7 cases, hyper-isointense signal in 5 cases and hypo-isointense in 2 cases on T2 WI.Enhancement scan demonstrated marked enhancement in 7 cases. Extensive thickening of the meninges was observed in 6 cases. Pathological results showed that the cells were abundant and diversified, with a great quantity of lymphoplasmacytes, and there were typical meningeal epithelial cells area in the surgical specimen. Conclusion The MRI findings of lymphoplasmacyte-rich meningioma show some features different from other common meningiomas, which would be helpful to the diagnosis and differential diagnosis.

Objective To investigate the clinical manifestation,pathogenesis and imaging features of hemichorea associated with hyperglycemia in primary diabetes mellitus(DM).Methods Analyze the clinical manifestations,the neuroimaging features and the treatment of the three patients with hemichorea induced by hyperglycaemia in primary DM,and review the literatures about this disease.Results All of the three cases had a long history of uncontrolled diabetes,among whom,two were non-ketotic hyperglycemic patients and one was ketotic hyperglycemic patient.All of them had an acute onset hemichorea which was almost continuous during awakeness and ceased during sleep.The early CT findings in this disorder were high density in the caudate nucleus,putamen and/or globus pallidus on the side contralateral to the involved limbs,but showed decreased attenuation or completely resolved in about a month.T1-weighted MR images in all cases showed high-signal intensities without edema or mass effect in the diseased region which decreased after several months,while the T2-weighted images were more variable.Conclusion Hemichorea induced by hyperglycemia often happens in the patients with poorly controlled DM,and both of the non-ketotic hyperglycemic and the ketotic hyperglycemic state can be the cause.In the major affected region-corpora striata,CT shows hyperdense lesions,T1-weighted MR images show hyperintense lesions and T2-weighted images show variable lesions in the early time.

Objective To investigate the renal expression of stem cell factor (SCF) in lupus nephritis (LN) and its correlation with disease activity and renal injury parameters. Methods Histochemical stain was used to examine all renal specimens (LN group n=34, chronic glomerulonephritis n=16, control group n=8). Hyhridization in situ and immunohistochemistry were used to detect the expression of SCF and infiltration of mast cells, macrophages , α-SMA (+) cells in renal tissues of the two groups. SPS software was used for tissue of the control group. However, they increased markedly in lupus nephritis and CGN (t=6.03～14.25, P< 0.01). But there was no significant difference between LN and CGN in SCF and mast cells in renal interstitium. Positive correlation was observed among the expression of SCF and α-SMA and the number of mast cells and macrophages (r=0.47～0.84, P<0.01) at their corresponding locations. The expression of SCF and ot-SMA and the number of macruphages were positively correlated with renal pathological active index, chronic index, albuminuria and the injury of renal interstitium (r=0.34～0.93, P<0.05 or 0.01); meanwhile, it was negatively correlated with Ccr(r=-0.39～0.61, P<0.01). There was significant correlation between SCF, macrophages and anti-dsDNA antibody, complement C3 level, SLE disease activity index (SLEDAI). The number of mast cells in renal interstitium was positively correlated with chronic indexes and the injury of renal interstitium (r=-0.86, r=0.93, P<0.01) and negatively correlated with Ccr (r=-0.56, P<0.01), but not correlated with active index and albuminuria (r=0.27, r=0.23, P>0.05). Conclusion The expression of SCF is widespread in kidney, and it is markedly eorrelated with various kinds of inflammatory cells, renal inherent cells, renal function, and urine protein levels. SCF may be an critical participant in the initiation and progression of renal injuries in human lupus nephritis.

Standardized training of residents is a necessary way for clinical medical personnel train-ing. Residents graduating from medical colleges and universities should accept the standardized, scientific, strict pre-service training, in order to realize role conversion from medical students to hospital physicians. This paper summarizes and analyzes the pre-service training, focusing on the training object, course design, organization implementation, evaluation, questionnaire survey, and puts forward some thoughts and sugges-tions on strengthening and improving pre-service training form, expanding the content of training, and quan-tifying the evaluation of training effect.

AIM:To investigate the role of PI3K/Akt and JAK2/STAT3 pathways in the protection of sulfur dioxide (SO2) against limb ischemia/reperfusion (I/R)-induced acute lung injury (ALI) in rats.METHODS:ALI was induced by limb I/R in the SD rats.Na2 SO3 (0.54 mmol/kg, ip)/NaHSO3 (0.18 mmol/kg, ip) as SO2 donor was injec-ted at 20 min before reperfusion.The inhibitors of JAK2/STAT3 and PI3K/Akt pathways, Stattic (3 mg/kg, iv) and LY294002 (40 mg/kg, iv), respectively, were injected at 1 h before reperfusion.Peripheral blood and lung tissues were collected for determining the contents of the cytokines, the protein levels of the molecules related to the signaling pathways, apoptosis and histopathologic changes by ELISA, TUNEL and Western blot.RESULTS:Compared with control group, the content of MDA, the activity of MPO, lung coefficient, apoptotic index, cytokine expression, and the protein levels of p-Akt and p-STAT3 in I/R group all increased significantly, and administration of Na2 SO3/NaHSO3 attenuated the damage in the lung.Besides, the results of Western blot showed that the rat lung tissues expressed p-STAT3 protein and p-Akt pro-tein.After I/R, the protein levels of p-STAT3 and p-Akt were increased.After using Na2 SO3/NaHSO3 , p-Akt was in-creased, but p-STAT3 was decreased (P<0.05).CONCLUSION:Both JAK2/STAT3 and PI3K/Akt pathways are like-ly involved in the protective effect of SO2 against limb I/R-induced ALI in rats.The activation of JAK2/STAT3 signaling pathway increases I/R injury.Reversely, the activation of PI3K/Akt signaling pathway reduces I/R injury.Besides, JAK2/STAT3 and PI3K/Akt signaling pathways may have crosstalk during I/R-induced ALI and JAK2/STAT3 pathway may have an impact on the P13K/Akt pathway.

BACKGROUND:Some studies have shown that blocking the venous return can promote fracture healing but there is no study about the effect of repeated transient ischemia on promoting fracture healing. OBJECTIVE:To observe the promoting effect of repeated transient ischemia on early fracture healing based on micro-CT technique. METHODS: Forty-eight Wistar rats were used to make animal models of right tibial midpiece closed fractures folowed by K-wire fixation. Rats were randomly divided into four groups: 24-hour group, 48-hour group, 72-hour group and control group. Tourniquet was used on the root of the affected thigh, inflated for 10 minutes, and then released for 10 minutes. Three above-mentioned cycles were taken as an ischemic treatment. At 24 hours after fracture fixation, the ischemic treatment was first carried out, and after that, it was done every 24 hours in the 24-hour group, every 48 hours in the 48-hour group and every 72 hours in the 72-hour group. In the control group, the tourniquet with no inflation was used once on the right lower limb every 24 hours after fixation. Al the rats were kiled at 2 weeks after modeling to take out the right tibia with removal of K-wires for micro-CT observation. RESULTS AND CONCLUSION:The trabecular bone volume and total volume in the regions of interest were significantly higher in the 24-hour group than the other three groups (P < 0.05), but the tissue mineral density and calus tissue mineral density were significantly lower in the 24-hour group than the other three groups (P < 0.05).There was no significant statistical difference in the bone volume fraction among the four groups (P > 0.05). These findings indicate that within 2 weeks after fractures, the repeated transient ischemia can promote fracture healing, which may be related to the improvement in the secretion of growth factor, revascularization and osteoblast proliferation induced by repeated transient ischemia.

Objective To investigate the effect of low dose lipopolysaccharide ( LPS ) preconditioning on prevention of incision infection by drug-resistant bacteria.Methods Methicillin-resistant Staphylococcus aureus ( MRSA) suspension with concentration of 1.8 ×109 CFU/mL was prepared.Sixty BALB/c mice were randomly divided into five groups (12 in each group, half male and half female).A medical longitudinal incision of the right thigh was made in mice in group 1-4, and 1, 0.5, 0.25 and 0 mL bacteria suspension was dropped on the surface of the incision and the incision was observed 4d after the model established.Group 5 was the blank control.Then 112 BALB/c mice were randomly divided into 7 groups ( each group had sixteen mice, half male and half female ): group A ( preconditioned with LPS 0.25 mg· kg-1· time-1), group B ( preconditioned with LPS 0.5 mg · kg-1 · time-1 ), group C (preconditioned with LPS 1 mg· kg-1 · time-1 ), group D (preconditioned with LPS 1.5 mg· kg-1 · time-1 ) , group E ( preconditioned with sterile normal saline) , group F ( incision infected) , and group G ( blank control) .LPS was given by intraperitoneal injection 48 h and 24 h before the establishing of the infection model.Body temperature was monitored every day after the model established, blood routine examination was performed on d3 and d7, and serum cytokines was detected on d7.All the mice were sacrificed on d7, and soft tissues around the incision were taken for hematoxylin-eosin staining.Repeated measures ANOVA and univariate ANOVA were performed for data analysis. Results Redness and suppuration were observed in 6 mice infected with 0.5 mL bacteria suspension, respectively, then 0.5 mL bacteria suspension was used for LPS preconditioning experiments.With LPS preconditioning, the body temperatures of mice in group B were with relatively minor changes, and the rises of white blood cells and lymphocytes on d3 and d7 were relatively modest.Granulocytes in group B returned to the normal level on d7.Besides, the rises of interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-αin group B were also less, while IL-10 was increased greatly.Suppuration was observed in 4 mice in group B ( 4/16, 25.00%), and the rate was lower than group D, E and F (χ2 =7.988, 19.940 and 19.940,P<0.01). Conclusion LPS (0.5 mg· kg-1 · time-1 ) preconditioning can reduce the severity of incision infection caused by MRSA in mice.

Objective To investigate the clinical features of cryptogenic multifocal ulcerous stenosing enteritis(CMUSE),and to improve the diagnosis of this rare disease.Methods From 2010 to 2015,clinical data of 10 patients with CMUSE were retrospectively analyzed,including clinical features,laboratory examination,imaging examination,appearance under endoscopy,pathologic characteristics,location of lesions,treatment and prognosis.Results Among the 10 patients with CMUSE (male six,female four),the mean age was (35.1±14.8) years.The predominant clinical manifestation was melena (eight cases),abdominal pain (eight cases) and anemia (nine cases).The results of laboratory examination showed normal in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).Among seven patients,hypersensitive C reactive protein (hsCRP) of two patients increased.Imaging examination showed intestinal stricture and appearance under endoscopic examination was intestinal ulcers and stenosis.Pathologic finding was superficial ulcers at mucosal and submucosal layers.Lesions mostly involved small intestine,and one case involving ileocecal valves and rectum.Among the 10 patients,seven patients received combination of surgical resection and prednisone treatment,and three patients were only administrated with medications.After treatment,seven patients remainedremission and three patients relapsed after remission.Immunosuppressors and enteral nutrition was effective in two of them and glucocorticoid resistance happened in one patient.Conclusions The diagnosis of CMUSE should he considered in patients with unexplained recurrent bowel obstruction,melena,anemia and concomitant intestinal ulcer and stricture.Endoscopy plays an important role in the diagnosis.Glueocorticoid is effective but easy to relapse.Immunomodulators and enteral nutrition may be considered as second-line therapy.