Toll-like receptors (TLRs), a large family consisting of at least 10 members, are evolutionarily conserved to recognize pathogen-associated molecular patterns (PAMPs). TLRs activation not only initiates innate immunity, but also regulates enhance antigen-specific acquired immunity, and thus associates innate and adaptive immunity. In recent years, studies on the TLRs signaling, especially their negative regulation, rapidly progressed. TLRs signaling pathway and their roles in regulating immune responses against invading pathogens were reviewed.

Objective To summarize experience to prevent the main postoperative complications after hypospadias repairs. Method The clinical data of 189 cases of hypospadias repairs was from May 2005 to August 2010,retrospectively analyzed. Results One hundred and seventy-four cases were surgically cured by single-stage operation. All cases had been followed up for 4-36 (18.5 ± 5.5) months, the cases who had become adults were normal penile development and erectile function. Postoperative complications occurred in 15 cases,9 cases of them were urethral fistulas,6 cases were urethral strictures,all were cured or improved after symptomatic treatments. Conclusions Some methods are necessary to raise single-stage urethroplasty success rate and decrease the incidence of fistulas and strictures, such as preoperative antibiotic prophylaxis,appropriate procedure,intraoperative suprapublic urinary diversion,the good blood supply of the flap, modified enswathement, postoperative manage and nursing.

BACKGROUND:O-arm navigation integrates CT image quality and the flexible mobility of the C-arm. Surgery for severe spinal deformity is very difficult, with high incidence of nerve injury, so it is a chalenging surgery for spinal surgery. The role of O-arm in the correction of spinal deformity is particularly important. OBJECTIVE:To explore the effect and safety of pedicle screw placement in severe spinal deformity under the guidance of O-arm navigation system. METHODS:Clinical data of 25 patients with severe spinal deformity with the aid of O-arm navigation were retrospectively analyzed. We observed pedicle screw insertion, operation time, intraoperative blood loss, correction of scoliosis and correction of kyphosis, and assessed the safety of screw insertion. RESULTS AND CONCLUSION:(1) Totaly 326 pedicle screws were implanted in 25 patients. According to NEO classification, 280 pedicle screws (92%) belonged to grade 0 (no perforation of pedicle cortex). Grade 1: perforation of pedicle cortex, < 2 mm, including 44 screws (8%); grade 2: perforation of pedicle cortex, > 2 mm, < 4 mm, including 0 screw (0%); grade 3: perforation of pedicle cortex, > 4 mm, including 0 screw (0%). (2) Operation time was (272.3±17.3) minutes. Intraoperative blood loss was (1 710.0±229.1) mL. (3) Cobb angle of scoliosis was changed from (70.5±6.0)° preoperatively to (22.8±4.8)° postoperatively. Cobb angle of kyphosis was changed from (72.0±5.2)° preoperatively to (28.1±5.7)° postoperatively. Significant differences were detected (P< 0.05). (4) These findings verify that with the guide of the O-arm navigation system, the accuracy of screw insertion is high. The risk of intraoperative nerve injury was reduced. The scoliosis and kyphosis deformity were improved effectively.

A total of 3499 cases of influenza A (H1N1) were included in this study for analysis.Epidemiological and clinical data of these cases were input into EpiData software and analyzed by SPSS software. Throat swabs were collected from the cases and detected for nucleic acid of influenza A ( H1N1 )virus using real-time polymerase chain reaction (RT-PCR) with fluorescence quantitative method, and time of viral excretion and clinical features of the cases were analyzed. Results showed that 0. 37% of the cases were in-apparent and asymptomatic and the most common symptom of the cases was fever (86. 77% ).Throat swabs converted to negative on the sixth day of onset in average, and no factors related to the time of conversion was found with logistic regression analysis.

OBJECTIVETo explore the variation and association of intestinal epithelial tight junctions, E.coli, and expression of Toll-like receptor-4 (TLR-4) and tumor necrosis factor-alpha (TNFα) in a rabbit model of non-alcoholic fatty liver disease (NAFLD).

METHODSFourteen male New Zealand rabbits were randomly divided into two groups. The control group was given a normal diet, while the NAFLD group was given a high-fat diet. After 12 weeks, the two groups were sacrificed. Both length and width of the tight junctions of ileum epithelial cells were measured by electron microscopy. Enzyme-linked immunosorbent assay was used to detect the concentration of TNFα in venous blood serum. Location and expression of TLR-4 were observed by immunohistochemical staining. Copies of E.coli genes were measured by RT-PCR. The relationship between TNFα and tight junctions, TLR-4, and E.coli were respectively analyzed by stepwise multiple linear regression.

RESULTSCompared with the control group, the NAFLD group has significantly shortened ileum epithelial fight junctions (t=5.031, P<0.01), increased copies of E. coli genes (t=-3.492, P<0.01), and increased ileal expression of TLR-4 (t=-44.089, P<0.01). A significant increase of TNFα was also observed in the NAFLD group (t=-17.768, P<0.01). Regression analysis showed that E.coli and intestinal epithelial tight junctions were correlated (standardized beta=-0.385), and showed a positive correlation between E. coli and TLR-4 (standardized beta=0.332 and 0.427).

CONCLUSIONDamage to the intestine as a physical barrier, biological barrier and immune barrier is closely related to TNFα expression, and the relation between the immune barrier and TNFα is more significant.

Animals ; Epithelial Cells ; Escherichia coli ; Intestinal Mucosa ; Male ; Non-alcoholic Fatty Liver Disease ; Rabbits ; Tight Junctions ; Toll-Like Receptor 4 ; Tumor Necrosis Factor-alpha

ObjectiveTo evaluate the effect of aminooxyacetic acid on focal cerebral ischemia injury in rats.MethodsEighty healthy male SD rats aged 2.5 month weighing 250-280 g were randomly divided into five groups( n ＝ 16 each):sham operation group(group S),cerebral ischemia group(group Ⅰ),aminooxoacetic acid low,medium and high dose groups(groups AL,AM and AH ).Focal cerebral ischemia was induced by occlusion of middle cerebral artery using a nylon thread with rounding tip which was inserted into right internal carotid artery in groups I,AL,AM and AH.Intraperitoneal amincoxoacetic acid 25,50 and 100 μmol/kg were administered at 3 h of ischemia in groups AL,AM and AH respectively,while equal volume of normal saline 1 ml/kg were injected in groups S and I.Neurological function was assessed and scored (0＝ no deficit,4＝ unable to move,unconscious) in 8 rats at 21 h after aminooxyacetic acid administration in each group.The animals were then sacrificed and the brains were removed for determination of the cystathionine beta-synthase (CBS) activities in cortex,hippocampus and striatum corpora.The other eight rats of each group were sacrificed at 21 h after amincoxoacetic acid administration for determination of the cerebral infarct volume.ResultsCompared with group S,the neurological deficit scores and the CBS activities in cortex and hippocampus were significantly increased,the infarct volumes were significantly enlarged in group Ⅰ ( P < 0.05).Compared with group Ⅰ,the neurological deficit scores and the CBS activities in cortex and hippocampus were significantly decreased,the cerebral infarct volumes were significantly reduced in groups AM and AH (P < 0.05).There was no significant difference in the above-mentioned variables between groups AL and Ⅰ.ConclusionAminooxoacetic acid can reduce focal cerebral ischemia injury by decreasing CBS activity and reducing H2 S production in rats.

Objective:To explore the pathological type and clinical symptoms of heterotopic gastric mucosa in upper esophagus (HGM).Methods:From December 2018 to August 2019, at the First Affiliated Hospital of Xinjiang Medical University, the patients with HGM, reflux esophagitis (RE), Barrett esophagus (BE) and chronic non-atrophic gastritis (CNAG), who underwent gastroscopy were selected. The pathological type of HGM including acid secretion, mucinous and mixed type. The differences in the symptoms among HGM, RE, BE, and CNAG, as well as the differences in the clinical symptoms of different pathological types of HGM were analyzed. Chi-square test and analysis of variance were used for statistical analysis.Results:There were 82, 104, 76, and 178 cases of HGM, RE, BE, and CNAG, respectively. The acid secretion, mucinous and mixed types of HGM were 22, 20 and 40 cases, respectively. The incidence rates of pharyngeal reflux symptoms foreign body sensation in the throat, swallowing discomfort, hoarseness, and cough of HGM patients were higher than those of RE patients (63.4%, 52/82 vs. 14.4%, 15/104; 58.5%, 48/82 vs. 14.4%, 15/104; 50.0%, 41/82 vs. 6.7%, 7/104; 43.9%, 36/82 vs. 12.5%, 13/104), while the incidence rates of gastroesophageal reflux symptoms acid reflux, heartburn and belching were lower than those of RE patients (34.1%, 28/82 vs. 61.5%, 64/104; 14.6%, 12/82 vs. 72.1%, 75/104; 34.1%, 28/82 vs. 67.3%, 70/104), and the differences were statistically significant ( χ2= 47.80, 39.80, 44.80, 23.30, 13.80, 60.90 and 20.20, all P<0.01). The incidence rates of pharyngeal reflux symptoms foreign body sensation in the throat, swallowing discomfort, hoarseness, and cough of HGM patients were higher than those of BE patients (63.4%, 52/82 vs. 22.4%, 17/76; 58.5%, 48/82 vs. 19.7%, 15/76; 50.0%, 41/82 vs. 9.2%, 7/76; 43.9%, 36/82 vs. 6.6%, 5/76), and the incidence rates of reflux symptoms acid reflux, heartburn, belching, and post-sternal burning sensation were lower than those of BE patients (34.1%, 28/82 vs. 61.8%, 47/76; 14.6%, 12/82 vs. 55.3%, 42/76; 34.1%, 28/82 vs. 65.8%, 50/76; 20.7%, 17/82 vs. 42.1%, 32/76), and the differences were statistically significant ( χ2=27.00, 24.80, 31.00, 28.60, 12.10, 28.90, 15.80 and 8.40, all P<0.01). The incidence rates of pharyngeal reflux symptoms foreign body sensation in the throat, swallowing discomfort, hoarseness and cough, gastroesophageal reflux symptoms acid reflux, heartburn, belching and post-sternal burning, and non-reflux symptoms digestion, bloating and abdominal pain of HGM patients were higher than those of CNAG patients (63.4%, 52/82 vs. 5.1%, 9/178; 58.5%, 48/82 vs. 3.9%, 7/178; 50.0%, 41/82 vs. 3.9%, 7/178; 43.9%, 36/82 vs. 4.5%, 8/178; 34.1%, 28/82 vs. 12.4%, 22/178; 14.6%, 12/82 vs. 2.8%, 5/178; 34.1%, 28/82 vs. 3.9%, 7/178; 20.7%, 17/82 vs. 11.2%, 20/178; 30.5%, 25/82 vs. 15.2%, 27/178; 32.9%, 27/82 vs. 14.6%, 26/178; 15.9%, 13/82 vs. 9.6%, 17/178), and the differences were statistically significant ( χ2=106.50, 100.40, 79.10, 62.00, 17.20, 4.10, 74.00, 12.80, 8.20, 11.60 and 2.20, all P<0.01). The incidence rates of pharyngeal reflux symptoms foreign body sensation, swallowing discomfort, and hoarseness of patients with acid secretion type of HGM were higher than those of mucinous type (72.7%, 16/22 vs. 35.0%, 7/20; 72.7%, 16/22 vs. 15.0%, 3/20; 50.0%, 11/22 vs. 20.0%, 4/20), and the differences were statistically significant ( χ2=6.00, 14.10 and 4.10, all P<0.01). The incidence rates of pharyngeal reflux symptoms foreign body sensation in the throat, swallowing discomfort, hoarseness, and cough of mixed type were higher than those of mucinous type (72.5%, 29/40 vs. 35.0%, 7/20; 72.5%, 29/40 vs. 15.0%, 3/20; 65.0%, 26/40 vs. 20.0%, 4/20; 62.5%, 25/40 vs. 15.0%, 3/20), and the differences were statistically significant ( χ2=7.80, 17.70, 10.80 and 12.10, all P<0.01). Conclusions:The pathological classification of HGM patients with clinical symptoms of pharyngeal reflux may be acid secretion type or mixed type, which can be treated with acid suppression drugs or argon plasma coagulation under gastroendoscopy.

Objective To investigate the effect of axial load test in Taylor spatial frame treatment of external fixation for tibia and fibula fractures.Methods A retrospective case-control study was conducted to analyze the clinical data of 36 patients with open fracture of tibia and fibula admitted to Tianjin Hospital from March 2015 to June 2017.There were 22 males and 14 females,aged 21-71 years[(46.1±14.2)years].All patients received Taylor spatial frame external fixation for tibia and fibula fracture within 1 week after injury.After operation,18 patients received axial load test(experiment group),and the other 18 did not(control group).When the value of axial load test was less than 5% in experiment group,the Taylor spatial frame was removed.The control group used traditional method to remove the Taylor spatial frame.Comparisons were made between the two groups in terms of treatment duration,total cost,re-fracture after Taylor spatial frame removal and incidence of stent-tract infection.Results All patients were followed up for 3-14 months with an average of 8.6 months.Compared with control group,the treatment duration[(36.17±11 .44)weeks vs.(44.50±9.16)weeks]and total cost[(93.7±7.9)thousand yuan vs.(120.1±10.6)thousand yuan]of experiment group were significantly lower(P＜0.05).In the experiment group,there was 0 patient with re-fracture and two patients with stent-tract infection,with the complication incidence of 11%,while there were two patients with re-fracture and three patients with stent-tract infection,with the complication incidence of 28% in the control group(P＞0.05).Conclusions After Taylor spatial frame external fixation for tibia and fibula fractures,regular axial load test can safely and timely guide the removal of Taylor spatial frame.It can reduce the treatment duration and cost compared with the traditional removal method,being safe and reliable.

Objective To evaluate smooth muscle protein of 22 kDa (SM22) in the diagnosis of acute intestinal ischemia.Methods 96 healthy adult SD rats were evenly divided into experimental group and control group,with each group subdivided into 6 subgroups,subject respectively to superior mesenteric artery ligation or sham operation.The venous blood samples were extracted from each group rats' right heart atO.5,1,2,4,8,12 h after the operation,for SM22 testing and small intestines tissues for direct immunofluorescence staining of SM22.Results The serum SM22 concentration reached a peak at 4 h (265 ± 15) mg/L,then gradually decreased (P ＜ 0.05).The I-FABP was mainly expressed in the epithelium of intestinal mucosa.During the 4 hours of intestinal ischemia,The number of SM22 positive particles did not change.After 4 hours,the number of SM22 positive granules had gradually decreased compared with the control group (all P ＜ 0.05).Conclusion SM22 mainly exists in the smooth muscle of intestinal,during the ischemic necrosis of the intestinal muscle layer SM22 leaks into blood stream,resulting in high serum levels of SM22 facilitating early diagnosis of acute intestinal ischemia.

Objective:To investigate the short-term efficacy of left-sided three-port total laparoscopic distal gastrectomy (TPTLDG).Methods:The prospective randomized controlled study was conducted. The 68 patients undergoing laparoscopic distal gastrectomy in the First Affiliated Hospital of Air Force Medical University from March 2022 to March 2023 were collected. All patients were randomly assigned to the TPTLDG group with a double number, and to the five-port laparoscopic distal gastrectomy (FPLDG) group with a single number, respectively. Observation indicators: (1) grouping situations of the enrolled patients; (2) comparison of perioperative condition; (3) comparison of complications during postoperative 30 days; (4) comparison of pathological examination. Measure-ment data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or continuous correction chi-square test. Comparison of ordinal data was analyzed using the non‐parameter rank sum test. Results:(1) Grouping situations of the enrolled patients. A total of 59 patients of gastric cancer were selected for eligibility. There were 40 males and 19 females, aged 59.00(52.00, 67.00)years. The gender (male, female), age, body mass index (BMI), Caprini score (≤2, ≥3), nutritional risk screening 2002 (<3, ≥3), Eastern Coopera-tive Oncology Group performance status (0, 1), preoperative hypersensitive C-reactive protein, preoperative IL-6, preoperative white blood cell count, preoperative albumin were 19, 11, 59.00(51.25,65.25)years, 21.92(20.93,22.73)kg/m 2, 7, 23, 24, 6, 18, 12, 0.78(0.78,1.46)mg/L, 3.07(1.50,10.56)μg/L, 6.07(4.94,7.19)×10 9/L, 44.30(40.83, 46.15) g/L in the 30 patients of TPTLDG group, versus 21, 8, 57.00(51.00, 67.00)years, 21.90(20.95, 23.35)kg/m 2, 11, 18, 24, 5, 17, 12, 1.13(0.78,11.40)mg/L, 5.56(1.88,15.12)μg/L, 5.54(4.71,6.70)×10 9/L, 43.55(40.25,44.88)g/L in the 29 patients of FPLDG group, showing no significant difference in the above indicators between the two groups ( χ2=0.557, Z=-0.444, -0.805, χ2=1.482, 0.074, 0.012, Z=-1.259, -1.262, -0.819, -1.199, P>0.05), confounding bias ensured comparability between the two groups. (2) Comparison of perioperative condition. The length of incision, time to removing drainage tube, IL-6 at postoperative day 3, cost of hospital stay were 6.65(6.48,6.93)cm, 3.00(0,3.00)days, 29.18 (13.67, 43.53)μg/L, 84 164.15(73 084.72, 96 782.14)yuan in the TPTLDG group, versus 8.00(7.50,8.35)cm, 3.00(3.00,4.00)days, 47.56(21.31,85.79)μg/L, 92 120.43(87 069.33, 113 089.74)yuan in the FPLDG group, showing significant differences in the above indicators between the two groups ( Z=-11.065, -2.141, -2.940, -2.220, P<0.05). (3) Comparison of complications during postoperative 30 days. The incidence rate of complications during postoperative 30 days was 30.00%(9/30) and 24.14%(7/29) in the TPTLDG group and FPLDG group, respectively, showing no significant difference between the two groups ( χ2=0.256, P>0.05). (4) Comparison of pathological examination. Cases with pathological N staging as 0 stage, 1 stage, 2 stage, 3 stage were 22, 2, 4, 2 in the TPTLDG group, versus 13, 7, 4, 5 in the FPLDG group, showing a significant difference between the two groups ( Z=-2.021, P<0.05). Conclusion:TPTLDG is safe and feasible for gastric cancer, with a good short-term efficacy.