Objective To investigate the clinical application value of insulin intensive therapy for hyperglycemia after craniocerebral trauma by analyzing its improving effect of illness state and inflammatory cytokines.Methods 62 cases of patients with severe craniocerebral injury were retrospectively studied,in which 31 cases were treated with conventional insulin therapy (normal group),and the other 31 cases were treated with insulin intensive therapy(intensive group).Glasgow coma scale(GCS) score,injury severity score(ISS) and acute physiology and chronic health(APACHE Ⅱ)score were before and after treatment.At the same time,the fasting peripheral blood of each patients were extracted to detect blood sugar concentration and serum inflammatory cytokine levels of IL-6,IL-10,TNF-alpha,hs-CRP.In addition,3 months to 2 years' follow-up were completed after treatment to record the infection rate and mortality rate.Results There was no significant difference in the indexes evaluated between groups before treatment(P ＞ 0.05).After treatment,the GCS score of intensive group was higher than that of normal group while the ISS score and APACHE Ⅱ score were opposite,and all the difference was significant(t =2.448,3.174,5.430 ; P =0.038,0.024,0.001) ; and the ISS score and APACHE Ⅱ score had positive correlation property with blood sugar content(R2 =0.699 9,0.636 4; P =0.016,0.023).At the same time,the blood sugar concentration and serum inflammatory cytokine levels of IL-6,TNF-alpha,hs-CRP of intensive group was lower than those of normal group while the IL-10 level was opposite,and all indicators had statistical difference(t =3.996,2.259,2.659,4.585 ; P =0.014,0.047,0.031,0.002) ; IL-6,TNF-alpha and hs-CRP had positive correlation property with blood sugar content,while IL-10 negative (R2 =0.635 1,0.678 3,0.534 3,0.584 4 ; P =0.022,0.018,0.041,0.038).In addition,the infection rate and mortality rate of intensive group were all lower than those of normal group,with mortality rate got significant difference (x2 =4.846,2.621 ; P =0.028,0.109).Conclusion Our research result shows that insulin intensive treatment could remit hyperglycemia after traumatic brain injury and control the inflammatory reaction rapidly,which contribute to more stable neuroendocrine system and benefit to the prognosis of patients.

BACKGROUND:Under certain conditions, stem cel s can be induced to differentiate into vascular endothelial cel s, which can promote the angiogenesis of ischemic lower limbs and the establishment of effective circulation and improve distal blood supply of the ischemic limbs. OBJECTIVE:To review the biological characteristics and pro-angiogenesis mechanism of umbilical cord mesenchymal stem cel s and to investigate the current status of umbilical cord mesenchymal stem cel s in the repair of neuropathy and chronic wounds. METHODS:PubMed, VIP and Wanfang databases were searched for relevant articles published from 2000 to 2015 using the keywords of“stem cel s transplantation, umbilical cord mesenchymal stem cel , diabetic angiopathies”in English and Chinese, respectively. RESULTS AND CONCLUSION:Compared with peripheral blood stem cel s and bone marrow mesenchymal stem cel s, umbilical cord mesenchymal stem cel s are characterized as more widespread sources, easy col ection, stronger amplification ability, no immunogenicity, and no ethical controversy, which have become ideal target and seed cel s for pro-angiogenesis and gene therapy in ischemic diseases. Umbilical cord mesenchymal stem cel s can differentiate into vascular endothelial cel s and fibroblasts involved in wound healing. In addition, these cel s can promote the production and expression of neurotrophic factors, promote nerve regeneration in ischemic tissues, and participate in tissue repair and accelerate healing of ulcers by paracrine and autocrine cytokines, anti-inflammation and immunomodulation. Therefore, umbilical cord mesenchymal stem cel s have a broad prospect in the improvement of diabetic lower limb ischemia, repair of diabetic peripheral neuropathy and promotion of chronic ulcer healing. Compared with stem cel transplantation alone, umbilical cord mesenchymal stem cel s transplantation combined with gene therapy can further enhance cel survival and pro-angiogenesis.

Objective To investigate effect of Wenjingtongluo prescription combined with acupuncture and moxibustion on ESR, Fib and hemorheology in patients with cervical spondylosis.Methods 110 cases of cervical spondylosis were divided into two groups, 55 cases in each group.The control group was treated with acupuncture and moxibustion.Experimental group on the basis of acupuncture treatment, were given Wenjingtongluo prescription.The PRI index, VAS score and blood rheology of the two groups were compared.Results The total effective rate of the experimental group was significantly higher than that of the control group (92.73% vs 76.36%) .There was a significant difference (χ2 =5.636, P <0.05) .After treatment, the two groups of PRI index ( emotional score, sensory score, total score ) , VAS score were significantly reduced ( P <0.05 ) .After treatment, the PRI index ( sensory score, total score) and VAS score of the experimental group were significantly lower than those of the control group after treatment.The difference was statistically significant(P<0.05).After treatment, two groups of ESR, Fib, PCV, whole blood viscosity, whole blood viscosity decreased significantly( P<0.05).The experimental group after treatment, ESR, Fib, PCV, whole blood viscosity, whole blood viscosity was significantly lower than the control group after treatment.The difference was statistically significant(P<0.05).Conclusion Wenjingtongluo prescription combined with acupuncture can significantly improve the clinical symptoms, reduce the pain of patients and improve the level of blood rheology.

Objective To investigate the diagnostic and prognostic value of serum soluble CD163 (sCD163 )and the positive rate of membrane -bound CD163 (mCD163 )in peripheral blood mononuclear cells (PBMC)in children with infection -associated hemophagocytic syndrome (IAHS).Methods Between July 2012 and June 2016,26 pediatric patients with IAHS (IAHS group)and 28 pediatric patients with sepsis(sepsis group)admitted to Children′s Hospital Affiliated to Shanghai Jiaotong University were selected,and 20 healthy children were taken as healthy control group. Sandwich enzyme linked immunosorbent assay was used to detect serum sCD163 .The population of circulating mCD163 positive monocytes was determined by using flow cytometry.Receiver operating characteristic (ROC)curves were used to evaluate the diagnostic and prognostic values of sCD163 and mCD163 in children with IAHS compared with the diagnos-tic and prognostic values of plasma ferritin,and so on.Results The serum levels of sCD163 in patients of IAHS group, sepsis group and healthy control group were (1264 ±538)mg/L,(862 ±332)mg/L,(610 ±316)mg/L,respective-ly.And the population of mCD163 -positive PBMC in patients of IAHS group,sepsis group and healthy control group was (88.3 ±9.7)%,(68.5 ±18.3)%,(28.9 ±5.2)%,respectively.Both serum sCD163 and the population of mCD163 -positive PBMC were significantly higher in IAHS group compared with those of sepsis group (t =2.031 ,P =0.048;t =3.191 ,P =0.002,respectively).The serum sCD163 and population of mCD163 -positive PBMC in sepsis group were higher than controls (t =3.848,P =0.002;t =4.049,P =0.000,respectively).Moreover,the areas under the ROC curve (AUC)for the mCD163 ,sCD163 ,were 0.853(P =0.013),0.762(P =0.004),0.755(P =0.049),respec-tively.mCD163 at a cutoff of 83.7% had a high diagnosis sensitivity (81 .8%)and specificity (72.4%).The optimal cutoff values of sCD163 and ferritin for predicting IAHS was 888 mg/L (sensitivity 66.7% and specificity 63.3%)and 2880 μg/L (sensitivity 80.0% and specificity 54.5%).In addition,the serum level of sCD163 and the population of mCD163 -positive PBMCs were significantly increased in acute phase and decreased in recovery phase[(1553 ±542) mg/L vs.(866 ±92)mg/L,(91 .0 ±6.4)% vs.(79.0 ±4.6)%,t =2.450,χ2 =3.419,P =0.036,0.007]in IAHS group.Furthermore,subgroup analysis indicated that the serum level of sCD163 and the population of mCD163 -positive PBMCs were significantly higher in dead patients than those in survived patients [(1748.91 ±518.17)mg/L vs. (909.69 ±171 .35)mg/L,t =3.070,P =0.011 ;(93.50 ±8.42)% vs.(77.30 ±3.28)%,χ2 =3.005,P =0.024, respectively].Conclusion Serum sCD163 and the population of mCD163 -positive PMSCs are specific and validity bio-markers for early diagnosis of IAHS,which also are associated with treatment response assessment and prognostic analy-sis in IAHS.

BACKGROUND:Compared with bone marrow and autologous peripheral blood stem cells, umbilical cord mesenchymal stem cells are characterized as more primitive, more powerful amplification and lower immunogenicity, no ethical problems, which are more important to the elderly patients with diabetes mel itus. OBJECTIVE:To evaluate the efficacy and safety of umbilical cord mesenchymal stem cells transplantation in the treatment of the elderly patients with diabetic lower limb vascular disease. METHODS:Fifty-six elderly patients with diabetic lower limb vascular disease were randomly divided into observation group and control group. The control group was treated with conventional therapy, while the observation group was treated with umbilical cord mesenchymal stem cells transplantation. RESULTS AND CONCLUSION:Observation group showed a higher efficiency than the control group, with significant difference (P<0.05). After treatment, foot skin temperature, transcutaneous oxygen pressure, and ankle brachial index were al improved in both two groups, and the ankle brachial index showed a better value in the observation group (P<0.05). There were no significant adverse reactions in the two groups. Umbilical cord mesenchymal stem cells transplantation is a simple, safe and effective therapy for the elderly patients with diabetic lower limb vascular disease, with better short-term curative effect.

Background:The incidence of inflammatory bowel disease(IBD)is increasing recently. However,the pathogenesis has not been fully clarified. Aims:To investigate the expressions and significance of interleukin-22( IL-22),matrix metalloproteinase-9(MMP-9)and macrophage migration inhibitory factor(MIF)in peripheral blood of patients with IBD. Methods:A total of 80 patients with IBD admitted from May 2011 to Nov. 2014 at the First Affiliated Hospital of Soochow University were enrolled,in which 43 cases were Crohn’s disease(CD),37 cases were ulcerative colitis(UC). Forty healthy subjects were served as normal controls. Peripheral levels of IL-22,MMP-9 and MIF were detected by ELISA. Multivariate Logistic regression model was used to analyze IL-22,MMP-9 and MIF in active CD and UC and ROC curve was used to evaluate the diagnostic performance of these markers for screening of active CD and UC. Results:Compared with normal control group,peripheral levels of IL-22,MMP-9 and MIF increased significantly in CD and UC groups(P <0. 05),while no significant difference was found between CD and UC groups(P > 0. 05). Peripheral levels of IL-22, MMP-9 and MIF in active CD and UC were significantly higher than those in remission stage(P < 0. 05). For screening of active IBD,the area under ROC curve(AUC)of combined detection of IL-22 and MMP-9(0. 853 for CD,0. 867 for UC) was superior to that of IL-22,MMP-9 or MIF only(0. 747,0. 770 and 0. 699 for CD,0. 774,0. 815 and 0. 761 for UC). Conclusions:Peripheral levels of IL-22,MMP-9 and MIF increase markedly in IBD patients,which are correlated closely with the activity of IBD. Combined detection of IL-22 and MMP-9 might greatly increase the accuracy for screening of active IBD.

BACKGROUND:The method of ligating or resecting rat lower limb femoral or iliac artery has been widely used to make rat models of lower limb ischemia, but there have been no stable and efective methods used to establish diabetic models of chronic atherosclerotic occlusive diseases and to evaluate the ischemic status of hindlimbs of models. OBJECTIVE: To establish type 2 diabetes rat models of lower limb ischemia by feeding with high-fat diet and to evaluate them. METHODS:Twenty rats were randomly and evenly divided into diabetes group (n=10) and control group (n=10). Rats in the diabetes group were fed with high-fat diet for 6 months, and were intraperitonealy injected with streptozotocin (50 mg/kg) to induce diabetes. Rats in the control group were fed with normal diet for 6 months. Rats in these two groups were subjected to ligation of femoral artery to establish right lower limb ischemia models. RESULTS AND CONCLUSION:At the first day of modeling, color Doppler flow imaging and CT angiography showed obviously decreased blood flow suggesting the success of establishing ischemia model. At 7 and14 days after modeling, the blood flow of rats in these two groups showed a gradual recovery as detected by color Doppler flow imaging. At 28 days after modeling, blood flow of rats in the diabetes group was significantly slower than that in the control group (P < 0.05). CT angiography showed that at 28 days after modeling, only a smal amount of compensatory increase in blood flow of the blood vessels at the ligation position of proximal right lower limb femoral artery was seen in the diabetes group, while no obvious blow was observed in the distal part. Histopathologic and immunohistochemical staining showed that at 28 days after modeling, destroyed tissue structure and inflammatory cel infiltration were observed in the ischemic region and capilary density on the affected side was lower than that on the healthy side. The protein expression of vascular endothelial growth factor in the ischemic muscle tissue of rats in the diabetes group was significantly increased compared with that in the control group (P < 0.05). These results show that diabetic rat models of lower limb ischemia can be successfuly established by long term high-fat diet feeding and femoral artery ligation and they can be validated by CT angiography.

Objective To observe the protein and mRNA expression of LOX-1,eNOS and PPARγ in type 2 diabetic rat aorta,and to investigate the effect of rosiglitazone intervention.Methods Totally 80 Wistar rats (7-week-old male) were randomized into the control group,high fat diet group,diabetic group,and rosiglitazone treatment group (n=20 each).Type 2 diabetes model was developed by intraperitoneal injection with a low dose of streptozotocin,and rats in rosiglization treatment group were treated with rosiglitazone by intragastric administration.After treatment with rosiglitazone for 6 and 12 weeks,animals were sacrificed.Aorta were collected for detecting the protein and mRNA expressions of LOX-1,eNOS and PPARγ,and the differences in expression levels were compared among groups.Results After 6 and 12 weeks,the protein expressions of LOX-1 were up-regulated in diabetic group and rosiglitazone treatment group as compared with control group and high fat diet group (all P＜ 0.01).The protein expression of LOX-1 was down-regulated in rosiglitazone treatment group as compared with diabetic group (P ＜ 0.05).The aorta protein expressions of LOX-1 in high diet group,diabetes group and rosiglitazone treatment group were upregulated after 12 weeks as compared with 6 weeks (all P＜0.01).After 6 and 12 weeks,the aorta protein expressions of eNOS were down-regulated and PPARγ were up-regulated in high fat diet group,diabetic group and rosiglitazone treatment group as compared with control group (all P＜0.01)The aorta protein expression of eNOS was down-regulated and PPARγwas up-regulated in diabetes group as compared with high fat diet group and rosiglitazone treatment group (all P＜0.01).The aorta protein expressions of eNOS in diabetes group and rosiglitazone treatment group were downregulated after 12 weeks as compared with 6 weeks (all P＜0.01).After 6 and 12 weeks,the aorta mRNA expressions of LOX-1 and PPARγ were up-regulated,but the mRNA expressions of eNOS were down-regulated in high fat diet group,diabetes group and rosiglitazone treatment group as compared with control group (all P＜0.05).The aorta mRNA expressions of LOX-1 and PPARγ were up-regulated,but the mRNA expressions of eNOS were down-regulated in diabetes group and rosiglitazone treatment group as compared with high fat diet group (all P＜0.05).The aorta mRNA expressions of LOX-1 and PPARγ were down-regulated,but the mRNA expressions of eNOS were upregulated in rosiglitazone treatment group as compared to diabetic group (all P＜0.01).Conclusions Both hyperglycemia and hyper-lipoproteinemia can induce early coronary atherosclerosis in rats with the abnormal protein and mRNA expressions of LOX-1,eNOS and PPARγ in rat aorta,and the abnormal expressions are more obvious in hyperglycemia combined with hyperlipoproteinemia.Thiazolidinediones can reverse the above abnormal expressions in diabetic rats.

Hepatectomy for huge hepatocellular carcinoma (HCC) is difficult due to its huge size and the compression and invasion to the surrounding tissues as well as the important vascular systems.Surgical resection of huge carcinoma in the caudate lobe is a big challenge for hepatobiliary surgeons because of its special location and complex anatomical structure.As the improvement of surgical techniques in recent years,especially the promotion of the concept of precision liver surgery,many surgeons begin to take the challenge of resection of huge HCC in the caudate lobe in a variety of ways.In April 2014,a male patient aged 58 years with huge HCC in the caudate lobe was admitted to the Anhui Provincial Hospital.Precision right hemihepatectomy combined with caudate lobectomy was performed on this patient without occlusion of the hepatic inflow,and the efficacy was satisfactory.The key techniques involved in this procedure were discussed in this article.

Objective To explore the mechanism of self-awareness in the heavy smokers(HS)by using regional homogeneity(ReHo)combined with resting-state functional MRI(fMRI).Methods Thirty HS and 31 healthy non-smokers(NS)matched for age and sex underwent a 3.0 T resting-state fMRI.The data were post-processed by SPM 5 and then the ReHo values were calculated by REST software.The ReHo values between the two groups were compared by two-sample t-test.The brain map with significant difference of ReHo value was obtained.Results Compared with that in NS group,the regions with decreased ReHo value included the bilateral precuneus,superior frontal gyrus,medial prefrontal cortex,right angular gyrus,inferior frontal gyrus,inferior occipital gyrus,cerebellum,and left middle frontal gyrus in HS group.The regions of increased ReHo value included the bilateral insula,parahippocampal gyrus,white matter of parietal lobe,pons,left inferior parietal lobule,lingual gyrus,thalamus,inferior orbital gyrus,white matter of temporal-frontal lobe,and cerebellum.The difference was more obvious in the left hemisphere.Conclusions In HS,abnormal ReHo on a resting state which reflects network of smoking addiction.This method may be helpful in understanding the mechanism of self-awareness in HS.