Objective To investigate the change of expression of toll like receptor 4( TLR4)on peripheral blood monouclear cells( PBMC) and clinical significance of sepsis acute kidney injury( AKI) patients. Methods ICU admission diagnosis of sepsis patients from May 2012 to December 2013 in the Zhongxin Hospital of Handan were diagnosed AKI according to the KDIGO guidelines of 2012 and were divided into AKI group and non AKI. Meanwhile,patients with AKI were also divided into group Ⅰ(KDIGO Ⅰ period);group Ⅱ( KDIGO Ⅱ period)and group Ⅲ( KDIGO Ⅲ period)according to the AKI stages. Thirty cases health patients were elected as the control group. The expression levels of TLR4,human leucocyte antigen(HLA-DR)on PBMC with of sepsis patients were detected with the flow cytometry. The levels of interleukin-6(IL-6) and interleukin-10(IL-10)in serum were detected by enzyme linked immunosorbent assay(ELISA). The length of ICU stay,ICU mortality and the APACHE Ⅱ in 24 h were recorded. Results (1)The expression levels of TLR4 in sepsis AKI patients was(34. 45 ± 9. 54),higher than that in patients without AKI and control group ((26. 29 ± 6. 76,10. 72 ± 8. 82;F = 55. 351,P < 0. 01). The expression of TLR4 in sepsis AKI patients was higher than sepsis patients without AKI(P < 0. 05). There was significant difference among sub AKI groups in terms of TLR4(F = 13. 235,P < 0. 01),and it significantly lower in group Ⅲ among three groups.(P < 0. 05 or P < 0. 01).(2)The levels of IL-6,IL-10 in sepsis AKI group were(565. 81 ± 106. 27)ng/ L,(76. 78 ± 12. 33) ng/ L,higher than those in non AKI group and control group((321. 85 ± 76. 62)ng/ L,(38. 53 ± 9. 93)ng/ L;(84. 36 ± 36. 91)ng/ L,(17. 53 ± 6. 08)ng/ L;F = 264. 962,254. 398,P < 0. 01). While,the levels of IL-6,IL-10 in sepsis AKI group were higher than those in non AKI group(P < 0. 05). However,there was no significant difference among three sub AKI groups in terms of IL-6 levels. The IL-10 level in group Ⅲ was highest among three sub AKI groups(P < 0. 05).(3)ICU mortality in sepsis AKI group and non AKI group were 34. 8% and 14. 8%(χ2 = 3. 410,P = 0. 065). Meanwhile,ICU mortality in three sub-AKI groups were 20. 0% ,33. 3% , 57. 1% ,and there was no significant difference(P = 0. 120). The length of ICU stay in non ALI group was(4. 14 ± 1. 65)d,shorter than that in AKI group(10. 52 ± 3. 70)d;t = 8. 201,P = 0. 000). Meanwhile,The length of ICU stay in three sub-AKI groups were(8. 93 ± 1. 81)d,(10. 17 ± 2. 31)d,(14. 71. ± 2. 81)d,and the difference was significant(F = 19. 052,P = 0. 000). APACHE-Ⅱ in three sub-AKI groups Ⅰ,group Ⅱ,groupⅢ were 20. 20 ± 4. 07,21. 00 ± 3. 16,30. 57 ± 2. 44 respectively and the difference was significant(P < 0. 05 or P < 0. 01). Conclusion TLR4 mediated inflammation is involved in the sepsis AKI process. Because the damage degree of AKI is aggravating,immune factors also participate in the development of AKI. And with the decrease of HLA-DR,the probability of RRT increases.

OBJECTIVE:To study the effect of paroxetine combined with low dose of olanzapine on sleep process and architec-ture of depression patients with insomnia. METHODS:84 depression patients with insomnia were randomly divided into control group and observation group. Control group was given 20 mg Paroxetine tablet,once every morning;observation group was addi-tionally given 2.5 mg Olanzapine tablet,once before going to bed. Sleep quality [Pittsburgh Sleep Quality Index(PSQI)],depres-sion scores [Hamilton Depression Scale (HAMD)],sleep process [sleep latency (SL),awakening times (AT),the actual total sleep time (TST),sleep efficiency (SE),rapid eye movement (REM) sleep latency (RL)] and sleep architecture [sleep stage 1 (S1),2(S2),3(S3)and the proportion of REM to sleep] in 2 groups before and 3,6 months after treatment and the incidence of adverse reactions(ADR)were observed. RESULTS:After treatment,PSQI and HAMD scores in 2 groups were significantly lower than before,and gradually decreased by time,and observation group was lower than control group;TST in observation group was significantly higher than before and control group,S1 in observation group was significantly lower than before,SE,S3 and REM in 2 groups were significantly higher than before,and observation group was higher than control group,SL,AT,RL and S2 were significantly lower than before,and observation group was lower than control group,the differences were statistically significant (P<0.05). There were no obvious ADR in 2 groups. CONCLUSIONS:Paroxetine combined with low dose of olanzapine can sig-nificantly relieve depression,optimize sleep process and sleep architecture,then impove sleep quality.

Objective:To study the surgical approach to the orbital floor and infraorbital rim.Method:15 cases of fractures of the orbital floor and infraorbital rim were treated with the transconjunctival approach.Result:All fractures of the orbital floor and infraorbital rim were repositioned and fixed through transconjunctival approach. Except for 1 case with mild canthal malposition, no other complication was observed.Conclusion:The transconjunctival approach can provide adequate exposure of the infraorbital rim and orbital floor without scar formation in the face.

Objective To investigate the expression of Toll-like receptor 4 (TLR4) of peripheral blood mononuclear cell (PBMC) in the different prognosis of patients with severe sepsis and its relation with endotoxin-tolerant.Methods Thirty-five patients with severe sepsis (severe sepsis group) and 15 healthy volunteers (control group),respectively stayed in ICU 24 h and physical examination in the day measured TLR4 expression of PBMC by flow cytometry and measured the serum of tumor necrosis factor (TNF)-α and interleukin (IL)-10 by enzyme-linked immunosorbentassay.Simultaneous separation of peripheral blood of PBMC,addition of 40 μ g/ml lipopolysaccharide (LPS) cultured for 24 h,and TLR4 expression of PBMC was measured in the same manner and the culture supernatant of TNF-α and IL-10.Results Thirty-five patients with severe sepsis survivor 25 cases (survivor group) and death 10 cases (death group),28 d death rate was 28.6％ (10/35).The TLR4 expression of PBMC in severe sepsis group was significantly lower than that in control group [(11.09 ± 8.90) MFI vs.(33.72 ± 12.59) MFI,P ＜ 0.01],the serum TNF-α and IL-10 in severe sepsis group were significantly higher than those in control group [(96.66 ± 45.33) ng/L vs.(2.53 ± 1.21) ng/L,(149.79 ± 67.15) ng/L vs.(34.56 ± 19.08) ng/L,P ＜ 0.01].There was no significant difference in TLR4 expression of PBMC between survivor group and death group (P ＞ 0.05).The TLR4 expression of PBMC in control group after LPS stimulation was significantly higher than that before LPS stimulation [(50.22 ± 19.23) MFI vs.(33.72 ± 12.59) MFI,P ＜ 0.05],survivor group and death group after LPS stimulation were significantly lower than those before LPS stimulation [(4.55 ± 2.30) MFI vs.(11.21 ±7.92) M FI and (5.46 ± 3.44) M FI vs.(10.15 ± 9.70) MFI,P ＜ 0.01].The culture supernatant of TNF-α,IL-10 in survivor group and death group were significantly lower than those in control group [(22.34 ± 8.27)and (19.49 ±5.35) ng/L vs.(88.70 ±34.21) ng/L,(54.29 ±32.89) and (98.04 ±40.26) ng/L vs.(146.56 ± 52.18) ng/L,P ＜ 0.01],but the culture supernatant of IL-10 in death group was significantly higher than that in survivor group (P ＜ 0.05).Conclusion Different prognosis of patients with severe sepsis have endotoxin tolerance and different inflammatory cytokine secretion abifity.

Objective To determine the content of taurine in Mactra veneriformis by pre-column derivation HPLC.Methods Ultrasound method was used for the extraction of taurine from Mactra veneriformis.In alkaline condition,amino acids reacted with phenyl isothiocyanate and resulted in the derivatives of benzene isothiocyanate-amino acid complex.Kromasil C18 column(4.6 mm ?250 mm,5 ?m) was used and the absorbance at 254 nm was measured.The mobile phase consisted of sodium acetate solution,water and methanol.Results Corresponding chromatographic peaks of taurine were obtained in extract sample and the control.The linear range of taurine was from 10.04 ?g?mL-1 to 50.20 ?g?mL-1,and the recovery was 97.95 %(RSD=1.41%,n=9).Conclusion This method is simple,accurate and reproducible.The seasonal variation range of taurine level is from 10.56 mg/g to 20.91 mg/g,and the taurine level arrived to the peak in June.

Objective To increase the killing effect of aminolevulinic acid (ALA)-based photodynamic therapy (PDT) on a human skin squamous cell carcinoma cell line A431 by poly lactic-co-glycolic acid nanoparticles (PLGA NPs).Methods ALA-loaded PLGA NPs (ALA PLGA NPs) were prepared using a modified double emulsion solvent evaporation method,and characterized in terms of size,encapsulation efficiency,loading capacity and morphology.Transmission electron microscopy was carried out to observe the morphology of A431 cells after uptake of ALA PLGA NPs.To optimize incubation time,multi-mode microplate reader was used to describe the fluorescence kinetics of protoporphyrin Ⅸ generated by A431 cells during 24 hours of incubation with 0.1 mmol/L ALA,1 mmol/L ALA,2.7 g/L ALA PLGA NPs containing about 0.1 mmol/L ALA,and PLGA NPs without ALA separately.Some A431 cells were divided into 10 groups:control group receiving neither treatment nor irradiation,0.1 and 1 mmol/L ALA dark/PDT group incubated 0.1 and 1 mmol/L ALA respectively,ALA PLGA NP dark/PDT group incubated with ALA PLGA NPs of 2.7 g/L,PLGA NP dark/PDT group incubated with PLGA NPs of 2.7 g/L,simple irradiation group irradiated with a He-Ne laser (wavelength:635 nm,power density:8.6 mW/cm2,energy density:8 J/cm2) only.The dark groups were kept in darkness strictly by wrapping in aluminum foil,and PDT groups were irradiated using a He-Ne laser.After another 24 hours of culture following irradiation,methyl thiazolyl tetrazolium (MTF) assay was conducted to estimate the survival rate of cells.To study the effect of ALA PLGA NPs on cell apoptosis,some A431 cells were divided into three groups:control group receiving neither treatment nor irradiation,ALA-PDT group and ALA PLGA NP PDT group receiving PDT after incubation with ALA and ALA PLGA NPs respectively.Flow cytometry was performed to detect the apoptosis of A431 cells at 12 and 24 hours,separately,after the photodynamic therapy.Data were statistically analyzed using SPSS 13.0 software package by means of a t test.Results The prepared ALA PLGA NPs were spherical with a mean particle size of (65.6 ± 26) nm,encapsulation efficiency of (65.8 ± 7.2) ％,and drug loading capacity of (0.62 ± 0.27)％.ALA PLGA NPs could be uptaken by A431 cells and gathered in the cytoplasm.The PpIX fluorescence kinetic study showed that the fluorescence intensity increased with time within 24 hours in A431 cells incubated with ALA or ALA PLGA NPs.After 6 and 24 hours of incubation,the A431 cells incubated with 2.7 g/L ALA PLGA NPs showed a significant increase in the protoporphyrin Ⅸ fluorescence intensity compared with those incubated with 0.1 mmol/L ALA (both P ＜ 0.01).Further more,the survival rate of A431 cells was statistically lower in the ALA PLGA NP PDT group than in the 0.1 mmol/L ALA PDT group at 6 and 24 hours (t =35.685,5.262,respectively,both P ＜ 0.01).Elevated apoptosis rate was observed in the ALA PLGA NP PDT group compared with the ALA PDT group at 12 ((13.10 ± 0.50)％ vs.(4.90 ± 0.13)％,t =9.074,P＜ 0.01) and 24 ((30.17 ± 1.02)％ vs.(11.6 ± 0.59)％,t =9.095,P ＜ 0.01) hours.Conclusions ALA PLGA NPs can promote the formation of protoporphyrin Ⅸ,strengthen the killing effect of ALA-PDT on A431 cells in vitro,and enhance the apoptosis induced by ALA-PDT in tumor cells.

Objective To investigate whether the bilateral nipple discharge with the background of hypothyroidism and pituitary tumor causes intraductal neoplasm. Methods Clinical data of 222 bilateral nipple discharge patients with hypothyroidism or pituitary tumor undergoing mammary ductoseopy (MDS) examination were analyzed. Those diagnosed as intraductal papilloma received surgery and pathological exam. 158 cases with inflammatory comedomastitis diagnosed by MDS received milk duct washing with gentamycin, dexamethasone and corresponding medical treatment. Results Among the 222 cases, 158 cases(71.17%) were diagnosed as inflammatory comedomastitis by MDS, 64 cases (28.83%) were diagnosed as intraduetal papilloma (64/222) by MDS and received operation,59 cases were pathologically diagnosed as intraductal papilloma,the other 5 cases were pathologically diagnosed as mammary duct ectasia. The pathological coincidence was 92.2% and no breast cancer was observed. 68.10% of inflammatory comedomastitis cases suffered from breast pain. There were no significant difference in the disease distribution of the ethnic groups. During pre-menopause period, the incidence of period neoplasia is higher in pituitary tumor than hypothyroidism; However, during the post-menopause the situation was vice versa. The color of niplle discharge is mostly milk-like in patients with pituitary tumor, while serous in patients with hypothyroidism. 71.19% of duct papilloma locate at the branch of the main duct. Conclusion The bilateral nipple discharge with hypothyroidism or pituitary are usually concomitant with intraduetal lesions. Mammary ductosopy is helpful to discover intraduetal neoplasia.

BACKGROUND:Plate fixation or intramedulary fixation for clavicle fractures has remained a matter of debate. At present, there is a need for a higher level of evidence to evaluate the advantages and disadvantages of two different surgical methods.
OBJECTIVE:To assess the clinical efficacy of intramedulary fixationversusplate fixation in the treatment of clavicle fractures.
METHODS:We conducted a computerized search of the electronic databases like Cochrane Library, PubMed, Embase, OVID, CBM, CNKI, Wanfang and VIP for relevant randomized controled trials on plate fixation or intramedulary fixation for clavicle fractures. The quality of the included studies was independently assessed with RevMan 5.3 software. The meta-analysis was performed in Stata 13.0.
RESULTS AND CONCLUSION:Eight randomized controlled trials with 527 patients were included in this meta-analysis. The meta-analysis results showed union time, surgery time, incision length, hospital stay and infection rate were less in the intramedullary fixation group than in the plate fixation group (P< 0.05). No significant difference in shoulder function score, upper limb function score, fracture nonunion and refracture was determined between the two groups (P< 0.05). The current evidences suggested that intramedullary fixation is the optimum choice in the treatment of clavicle fractures.

Objective To monitor and compare the breathing mechanics on PC,VC and PRVC during pneumoperitoneum,and to discuss the significance of the clinic use of PRVC.Method Ninety laparoscopic cholecystectomy patients were equally divided into 3 groups (PC,VC,PRVC).Levels of PES,PAWM,PAP,PaCO2,ETCO2,TV MAP and HR were detected before pneumoperitoneum,and at 5,10,15 and 20 minutes postpneumoperitoneum.Results Pneumoperitoneum made three respiratory patterns with different levels of PAWM,PAP,and PES.PES post-pneumoperitoneum in the VC model was obviously higher than that in the PC and PRVC group.At 10 min post-pneumoperitoneum,levels of PaCO2 and ETCO2 increased obviously in the PC and VC group(P ＜ 0.05).Levels of PaCO2 and ETCO2 were increased in the PC group,but TV level post-pneumoperitoneum was significantly lower than that in the other two groups (P ＜ 0.05).Level of PaCO2 and ETCO2 were increased in the PC and VC group post-pneumoperitoneum,along with increases of MAP and HR (P ＜ 0.05).Levels of MAP and HR in the PRVC group post-pneumoperitoneum were significantly lower than those in the PC and VC group (P ＜ 0.05).Conclusion PRVC mode can effectively reduce the increases of pneumoperitoneum-induced PAWM,PAP,PES,without the unusual increase of PaCO2 and ETCO2 during surgeries,contributing to the stability of vital signs of perioperative patients.

Objective To investigate the relationship of CD4+ and CD8+ T cells with melanocytes in skin of patients with psoriasis,and to study their clinical significance.Methods Tissue specimens were obtained from both lesional and nonlesional skin of 29 patients with progressive psoriasis and 5 patients with regressive psoriasis,as well as from normal skin of 6 healthy individuals.Immunohistochemical staining was performed to determine the quantity and distribution of CD4+ T and CD8+ T cells,as well as the quantity of melanocytes and proportion of cells containing pigment granules in the basal layer of these specimens.Statistical analysis was carried out with the software SPSS 18.0 by one-way analysis of variance (ANOVA),least significant difference (LSD) test and Pearson correlation analysis.Results In patients with psoriasis,the mean number of CD4+ T cells per high-power (× 200) field was significantly larger in lesional skin than in nonlesional skin (epidermis:5.29 ± 4.66 vs.0,P＜ 0.05;dermis:77.50 ± 43.66 vs.9.67 ± 7.73,P＜ 0.05),so was the mean number of CD8+ T cells per high-power (× 200) field (epidermis:7.83 ± 6.27 vs.0.71 ± 1.20,P＜ 0.05;dermis:46.08 ± 34.26 vs.5.54 ± 4.43,P ＜ 0.05).A significant increase was also observed in the number of CD4+ and CD8+ T cells in lesional skin of patients with psoriasis compared with the normal control skin (both P ＜ 0.05).The lesional skin of patients with psoriasis also showed significandy increased number of melanocytes (103.45 ± 16.96),but decreased proportion of pigment granule-containing cells (7.45％ ± 3.86％) in the basal layer compared with nonlesional skin (43.62 ± 14.20,P＜ 0.05;43.10％ ± 14.91％,P＜ 0.05) and normal control skin (43.33 ± 14.02,P＜ 0.05;54.17％ ± 29.40％,P ＜ 0.05).There were no significant differences in either the mean number of CD4+ T cells,CD8+ T cells and melanocytes or the proportion of pigment granule-containing cells between nonlesional psoriatic skin and normal control skin (all P ＞ 0.05).The mean number of melanocytes was significantly higher in regressive psoriatic lesions than in white patches arising in subsided psoriatic lesions (P ＜ 0.05) and normal control skin (P ＜ 0.05),but similar between white patches and normal control skin (P ＞ 0.05),while the proportion of pigment granule-containing cells was insignificantly lower in regressive psoriatic lesions than in white patches (P ＞ 0.05),and significantly lower in regressive psoriatic lesions and white patches than in normal control skin (both P ＜ 0.05).Neither the number of CD4+ T cells nor that of CD8 + T cells was correlated with the number of melanocytes or the proportion of pigment granule-containing cells in progressive psoriatic lesions (both P ＞ 0.05),while the number of both CD4 + T cells and CD8 + T cells was positively correlated with that of melanocytes (r =0.46 and 0.56,respectively,both P ＜ 0.05),but uncorrelated with the proportion of pigment granule-containing cells in nonlesional psoriatic skin (both P ＞ 0.05).Conclusions In progressive psoriatic lesions,there is a significant increase in the number of CD4+ and CD8 + T cells as well as melanocytes in the basal layer,but a significant decrease in the proportion of pigment granule-containing cells.After subsidence of psoriatic lesions,both the number of melanocytes and proportion of pigment granule-containing cells gradually reach the levels in normal skin of healthy individuals.