OBJECTIVETo compare the clinical outcomes of intrasacrospinal muscular approach and posterior midline approach in treating far lateral lumbar disc herniation.

METHODSThe clinical data of 32 patients with far lateral lumbar disc herniation underwent transforaminal lumbar interbody fusion from January 2004 to January 2011 were retrospectively analyzed. The patients were divided into intrasacrospinal muscular approach group (11 males and 6 females ) and posterior midline approach group (10 males and 5 females). All patients were followed up from 12 to 18 months with an average of 15.3 months. Operative time, blood loss, postoperative draining volume were recorded and pre-and post-operative visual analog scale (VAS) and Oswestry Disability Index (ODI) were compared between two groups.

RESULTSOperative time, blood loss, postoperative draining volume in intrasacrospinal muscular approach group was less than that of posterior midline approach group (P < 0.05). There was no significant difference in VAS at final follow-up between two groups (P > 0.05); and the mean ODI in intrasacrospinal muscular approach group was less than that of posterior midline approach group (P < 0.05).

CONCLUSIONFor the treatment of far lateral lumbar disc herniation, intrasacrospinal muscular approach has less injury for paraspinal muscle and more satisfactory clinical outcome and is better method than posterior midline approach.

Adult ; Aged ; Case-Control Studies ; Female ; Humans ; Intervertebral Disc Displacement ; surgery ; Lumbar Vertebrae ; surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Spinal Fusion ; methods ; Tomography, X-Ray Computed

OBJECTIVETo observe the effect of sirolimus-based immunosuppression administered on heart transplant recipients with chronic renal dysfunction.

METHODSFrom June 2004 to December 2008, standard calcineurin inhibitors (CNI)-based immunosuppressive regimen was changed to reduced-dose CNI plus sirolimus due to CNI-related chronic renal dysfunction in 20 out of 138 cardiac transplant recipients at Fuwai Hospital. The standard immunosuppressive regimen included steroid, CNI (cyclosporine or tacrolimus), and mycophenolate mofetil or azathioprine. Sirolimus was started at 0.75 - 1.50 mg/d with titration to achieve levels of 5 - 15 µg/L, and CNI dose was reduced gradually to 1/2-2/3 of the baseline level. Patients were followed for changes in renal function, lipid level and clinical side effects related to immunosuppressive therapy. Endomyocardial biopsy (EMB) was performed routinely at 3 weeks, 3, 6 and 12 months after transplantation. EMB was also performed at 3 months after regimen change within 1 year post-transplantation or when rejections were suspected in patients beyond 1 year post-transplantation. Echocardiography was performed for monitoring purpose.

RESULTSThe mean follow-up after regimen change was (7.9 ± 6.3) months. Final sirolimus dose was (0.89 ± 0.22) mg/d and blood drug level was (7.6 ± 3.8)µg/L. Cyclosporine dose was reduced from (191.7 ± 60.0) mg/d to (123.6 ± 34.8) mg/d, with blood drug concentration reduced from (175.5 ± 58.0) µg/L to (111.9 ± 56.0) µg/L in 18 patients (P < 0.01). Tacrolimus average dose was reduced from 4.25 mg/d to 3.00 mg/d, with blood drug concentration reduced from 13.5 µg/L to 10.5 µg/L in 2 patients. Serum creatinine level fell from (160.4 ± 25.5) µmol/L to (134.4 ± 26.8) µmol/L (P < 0.01) and urea nitrogen fell from (13.8 ± 4.7) µmol/L to (10.4 ± 3.0) µmol/L (P < 0.01) at one month after regimen change. Twenty two EMBs were performed in 11 patients within 1 year post-transplant, there were 4 episodes of acute rejected (ISHLT grade 2). Twenty patients are all alive and cardiac function was normal. The most common side effect was hyperlipidemia, and triglycerides, total cholesterol and low density lipoprotein levels were significantly increased at 1 month post regimen change (P < 0.05 or P < 0.01). Leukocyte, hemoglobin and platelet as well as liver function remained unchanged at 1 month post regimen change (all P > 0.05).

CONCLUSIONOur results show that change from CNI-based immunosuppressive regimen to reduced-dose CNI plus sirolimus is an effective and safe approach for the management of patients with CNI-related chronic renal dysfunction, leading to an improvement in renal function without compromise in anti-rejection efficacy and with tolerable side effects.

Calcineurin Inhibitors ; Female ; Heart Transplantation ; Humans ; Immunosuppressive Agents ; administration & dosage ; therapeutic use ; Kidney Failure, Chronic ; drug therapy ; Male ; Middle Aged ; Retrospective Studies ; Sirolimus ; therapeutic use

In order to profoundly understand the clinical and laboratorial characteristics and inducing factors of hemophagocytic lymphohistiocytosis syndrome (HLH), 28 HLH patients received from 2004 to 2009 years in our hospital were analyzed retrospectively. The results indicated that all of the patients had a history with prolonged fever (more than 1 week), pancytopenia, hepatosplenomegaly, elevated ferritin level, hypofibrinogen, and hemophagocytosis in bone marrow. HLH was the first characteristic sign of malignant lymphoma in 9 patients; 1 patient had a clinical manifestation similar to fulminant hepatic failure; severe psycho-abnormality occurred in 1 HLH patient and pronounced hemophagocytosis were detected in his cerebrospinal fluid; 1 patient was eventually diagnosed as having HLH by the findings in a lymph node biopsy showing obvious hemophagocytosis. Additionally, the analysis of underlying factors in 28 patients with HLH indicated 11 patients with EB virus-associated HLH, 11 with lymphoma-associated HLH, 2 with Leishmania-associated HLH, and 3 with autoimmune disease-associated HLH. It is concluded that HLH disease is characterised with high heterogenicity in both clinical features and inducing factors; in addition, the patients from a pasturing area should be paid attention to parasite infection such as leishmania.
Adolescent ; Adult ; Aged ; Autoimmune Diseases ; complications ; Child ; Child, Preschool ; Female ; Herpesvirus 4, Human ; isolation & purification ; Humans ; Leishmania ; isolation & purification ; Lymphohistiocytosis, Hemophagocytic ; complications ; diagnosis ; parasitology ; virology ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

In large prospective studies, plasma fibrinogen levels have been shown to be an independent risk factor of vascular disease, including ischemic stroke. Elevated plasma fibrinogen in an individual could be due to the presence of predisposing genetic and/or environmental factors, such as smoking. Of the polymorphisms studies to date, the beta-fibrinogen-455 (beta-Fg-455) G-->A substitution in the 5' flanking region is associated with the most consistent difference in plasma fibrinogen levels in both case-control studies and in selected groups of healthy individuals. In order to further elucidate the role of the beta-Fg-455 G-->A substitution in determining fibrinogen levels and susceptibility to ischemic stroke in case-control population, including 104 individuals with verified ischemic stroke and 156 healthy individuals. Turbidimetriy assays were used to measure plasma fibrinogen levels of all samples. The beta-Fg-455 G-->A mutation was identified by the polymerase chain reaction followed by restriction enzyme digestion of the amplified DNA with HaeIII. The plasma fibrinogen level in patients with ischemic stroke [(3.51 +/- 1.09) g/L] was significantly higher than that in the control [(3.08 +/- 0.71) g/L] (P < 0.01). The A-allele is associated with elevated fibrinogen levels in both patients and controls. The plasma fibrinogen levels in controls with A-allele in elder people were higher than in younger people (P < 0.05). Those with A allele in males of ischemic stroke had significantly higher plasma fibrinogen levels in smokers than in non-smokers and ex-smokers (P < 0.05), but it was not significantly difference in subjects of GG genotype (P > 0.05). Our data demonstrates an association of the beta-Fg promoter A-455 allele with higher fibrinogen levels in the general population, and suggests that the A-allele may be a susceptible predictor of ischemic stroke, particularly in aging and smoking.

Objective To improve the quality of registration and reporting and the efficiency of examination and approval of ClassⅡactive medical devices in China.Methods Classification analysis of common problems in the submitted materials was executed based on the requirements of new laws and regulations for ClassⅡactive medical devices and the experience, and then some measures were put forward with considerations on the new laws and regulations. Results The common problems in the registration and submitting of ClassⅡactive medical devices were described in detail,and some counter-measures were brought out based on the laws and regulations related to provide guidance for other enterprises.Conclusion The enterprise has to study related laws,regulations,standards and guidance when executing registration and application,so that the quality of submitted materials can be enhanced to facilitate the evaluation and approval of ClassⅡactive medical devices.

Objective To study the effect oftenuigenin (TEN) on the processes of neural stem cells (NSCs) injured by β-amyloid (Aβ) protein. Methods Mouse NSCs were generated from the hippocampi of Kunming mice within 24 hour from birth and cultured with epidermal growth factor (EGF)and basic fibroblast growth factor (bFGF) (20 ng/mL each) in 50-mm uncoated culture flasks.The third passage NSCs were cultured in Aβ medium (12.5 μmol/L) and TEN medium (5 mg/L,20 mg/L,100mg/L) respectively and observed under a scanning electron microscope (SEM) after 3 days.Optical microscopy was used to detect the length and amount of the processes of NSCs. The statistical significance between group comparisons was determined by t test.P value ＜0.05 was considered to be statistically significant. Results The length and amount of NSC processes in Aβ1-42 group were both significantly shorter and smaller than in the control group (P＜0.05). The length and amount of NSC processes in 20 mg/L and 100 mg/L groups were both significantly longer and larger than in the Aβ-42group (P＜0.05). Conclusion TEN can significantly increase the length and amount of NSC processes injured by Aβ.

The objective of this study was to explore the clinical significance of measuring serum free light chains (sFLC) and to compare with serum total light chains (free and binded) in multiple myeloma (MM). sFLC in 20 newly diagnosed MM patients and 20 cases of healthy people as control were measured by immuno-nephelometric assays; the serum light chains and kappa/lambda ratio were measured in all patients, while immunofixation electrophoresis (IFE) tests were carried out at the same time in 18 out of 20 patients. The results showed that the abnormality of serum free light chains and kappa/lambda ratio were found in all of the 20 newly diagnosed MM patients (p < 0.01). The measurement of sFLC showed higher sensitivity than the total serum chains (p < 0.01). It is concluded that the method testing sFLC by immuno-nephelometric assay combined with kappa/lambda ratio is valuable for MM diagnosis, and the measurement of sFLC can be used as one of indicators for MM diagnosis.
Adult ; Aged ; Biomarkers, Tumor ; blood ; Female ; Humans ; Immunoglobulin kappa-Chains ; blood ; Immunoglobulin lambda-Chains ; blood ; Male ; Middle Aged ; Multiple Myeloma ; blood

OBJECTIVEThe aim of the present work was to investigate the potential relationship between acute rejection and serum concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP)/high sensitivity C reactive protein (hs-CRP) in post-transplant patients.

METHODSSixty-one consecutive orthotopic heart transplantation recipients were prospectively recruited from the cardiac transplantation programme at Fuwai Hospital. Endomyocardial biopsies (EMB) were performed routinely at 3 weeks, 3, 6 and 12 months after transplantation. EMB were also performed when patients had new symptoms of heart failure or at 2 weeks after steroid pulse therapy. Serum NT-proBNP and hs-CRP were simultaneously measured before EMB procedure.

RESULTSA total of 126 biopsy samples were obtained from the 61 patients. Serum NT-proBNP concentrations progressively decreased after transplantation (spearman correlation coefficient -0.520, P = 0.000). NT-proBNP levels within 6 months after transplantation were significantly higher than those beyond 6 months post transplantation [(11.86 +/- 11.16) x 10(-16) mol/L vs.(5.83 +/- 6.58) x 10(-16) mol/L, P = 0.002]. NT-proBNP concentrations in patients with rejection tended to be higher than patients without rejection (13.68 x 10(-16) mol/L vs. 9.26 x 10(-16) mol/L, P = 0.073). After time adjustment, the difference of NT-proBNP concentrations between patients with or without rejection becomes statistically significant (14.45 x 10(-16) mol/L vs. 9.1 x 10(-16) mol/L, P = 0.025). Receiver operating characteristics analysis for NT-proBNP versus rejection grade revealed an area under the curve of 0.566, indicating a low predictive value for NT-proBNP. A cutoff of 6.00 x 10(-16) mol/L yielded poor specificity (44.8%) and sensitivity (57.1%), the sensitivity and specificity were 38.1% and 61.0%, respectively with a cutoff of 8.00 x 10(-16) mol/L. hs-CRP levels within 6 months after transplantation tended to be higher than those beyond 6 months [(2.39 +/- 3.90) mg/L vs. (1.34 +/- 2.73) mg/L, P = 0.069]. hs-CRP concentrations in patients with rejection were similar as patients without rejection (2.995 mg/L vs. 1.833 mg/L, P = 0.138). The incidence of rejection was similar in patients with two higher biomarkers (5/20, 25%) compared to patients with two low biomarkers (3/26, 11.5%, P = 0.232).

CONCLUSIONSNT-proBNP level decreased after transplantation. Although increased NT-proBNP concentrations were related to rejection, the diagnostic capacity was low. Elevated hs-CRP concentrations were not related to rejection after heart transplantation.

Adolescent ; Adult ; Aged ; C-Reactive Protein ; metabolism ; Female ; Graft Rejection ; blood ; Heart Transplantation ; Humans ; Male ; Middle Aged ; Natriuretic Peptide, Brain ; blood ; Peptide Fragments ; blood ; Prognosis ; Retrospective Studies ; Young Adult

Cytomegalovirus (CMV) infection is a dangerous complication in patients with chronic graft versus host disease (cGVHD). CMV-specific immunity depends on the activity of T cells. This study was aimed to investigate the effect of CMV pp65 gene modified dendritic cells (DCs) on activation of autologous T cells. Lentivirus system was utilized to introduce the CMV full-length pp65 gene into mouse DCs; CpG-DNA was used to induce mature DCs; flow cytometry and immunofluorescence were used to determine the expression of antigen and IFNgamma in T lymphocytes. The results showed that the DCs were infected with lentivirus at a multiplicity of infection (MOI) of 50 with optimal infectious efficiency of 30%-40%; mature DCs expressing pp65 gene could stimulate autologous naive T cells to express CD69 specifically; mature DCs expressing PP65 could stimulate autologous CD4+ or CD8+ T cells to produce IFNgamma. It is concluded that CMV pp65-modified and CpG-DNA-induced mature DCs can activate CMV-specific T lymphocytes in vitro.
Animals ; Antigens, CD ; genetics ; metabolism ; Antigens, Differentiation, T-Lymphocyte ; genetics ; metabolism ; Antigens, Viral ; immunology ; CD4-Positive T-Lymphocytes ; immunology ; CD8-Positive T-Lymphocytes ; immunology ; CpG Islands ; genetics ; Cytomegalovirus ; immunology ; DNA ; genetics ; Dendritic Cells ; cytology ; immunology ; metabolism ; Humans ; Interferon-gamma ; genetics ; metabolism ; Lectins, C-Type ; Lentivirus ; genetics ; metabolism ; Mice ; Phosphoproteins ; genetics ; metabolism ; Viral Matrix Proteins ; genetics ; metabolism

This study was purposed to investigate the effect of xbp-1 gene silencing on bortezomib-induced apoptosis in multiple myeloma cell line NCI-H929 (H929). After xbp-1 gene expression was interfered by small hairpin RNA, the cell apoptosis was assayed by flow cytometry with Annexin V-FITC/PI staining, and the expression level of XBP-1 protein was detected by Western blot. The results showed that XBP-1 protein level of H929 cells was inhibited effectively by the PLL3.7 lentiviral vector mediated expression xbp-1 shRNA. The apoptosis rate was significantly higher in xbp-1 shRNA-expressing cells than in untreated control group [(10.13±0.61)% vs (2.5±0.2)%, p<0.05]. After treatment with bortezomib, the apoptosis rate of XBP-1 protein functionally deficient H929 cells was significantly higher than those in vector control group [(45.07±1)% vs (19.53±0.8)%, p<0.05]. It is concluded that xbp-1 gene silencing can significantly enhance the pro-apoptotic activity of bortezomib in multiple myeloma cells.
Apoptosis ; drug effects ; Boronic Acids ; pharmacology ; Bortezomib ; Cell Line, Tumor ; DNA-Binding Proteins ; genetics ; Gene Silencing ; Humans ; Multiple Myeloma ; genetics ; Pyrazines ; pharmacology ; RNA, Small Interfering ; genetics ; Regulatory Factor X Transcription Factors ; Transcription Factors ; genetics ; X-Box Binding Protein 1