Objective To explore the association of lipid metabolism and bomocysteine with hypertensive disorders in pregnancy and observe the inflammatory reaction and the pathological change of placenta.Methods We conducted a prospective randomized placebo-controlled study.Seventy-four cases with hypertensive disorders in pregnancy were recruited as the experimental group and 77 cases of normal pregnant women were recruited as matched control group from Aug.2008 to Mar.2010.The relationship between lipid metabolism and homocysteine was analyzed.Results There was significant difference between the two groups in body-mass index before pregnancy(29.03±4.52 vs.23.99±5.90,t =5.88),cholesterol[(6.16±1.48)mmol/L vs.(5.01±1.05) mmmol/L,t =5.52],low density lipoprotein[(3.46±1.35) mmol/L vs.(2.26±0.86) mmol/L,t =6.54]and C-reactive protein[(29.04±14.90) mmol/L vs.(15.48±4.57) mmol/L,t =7.62](P ＜ 0.05).No significant difference was found on triglycerides[(3.29±1.03) mmol/L vs.(3.49±1.37) mmol/L],high density lipoprotein[(1.84±0.40) mmol/L vs.(1.88±0.35) mmol/L],homocysteine [(8.77±2.65) mmol/L vs.(8.40±2.03) mmol/L]and neonatal weight[(3547±519)g vs.(3431±461)g](P ＞ 0.05).Significant difference exists in placenta pathology of infarction(54.55％ vs.31.04％),villi dysplasia,fit nodules form and hypoxia(65.46％ vs.39.66％)(P ＜0.05).Conclusion We should detect lipid,homocysteine and C-reactive protein by dynamic combinational ways,pay more attention to women with high BMI before pregnancy,and value placenta pathology research on hypertensive disorders in pregnant women.This has high clinical significance in revealing the etiology of hypertensive disorders in pregnant women and improving pregnant outcomes.

ObjectiveTo evaluate the efficacy of etanercept in the treatment of active ankylosing spondylitis ( AS) with enthesitis and explore an easy and accurate scoring method.MethodsWe designed this 12-week double-blind,placebo-controlled,randomized clinical study in active AS patients.The first part was a 6-week placebo-controlled period that patients received etanercept or placebo,followed by a 6-week open-label period that all patients received etanercept. At week 0,2,4,6,8,10,12,the scores of enthesitis were recorded.The primary efficacy endpoint was the Mander Index in the two groups. We compared the Maastricht AS Enthesis Score ( MASFS) index,Spondyloarthritis Research Consortium of Canada ( SPARCC) index,Berlin index and San Francisco index with the Mander Index. Results A total of 127 patients were included with 92 in the etanercept group and 35 in the placebo group.In etanercept group there were 25,41,47 patients without enthesitis at week 2,4,6 separately. At week 12,more than 70％ patients' enthesitis in two groups turned negative.The primary endpoint,as the Mander Index at week 6,was achieved by 0(0,2) score in the etanercept group compared with 1 (0,3) score in the placebo group (P =0.0286). Among the four Indexes.the San Francisco Index was the one most COrrelated with the Mander Index.Conclusion Etanercept can improve the symptoms of enthesitis fast and significantly. In clinics,the San Francisco Index is easier to operate and more accurate for assessment.

Investigation of simvastatin and its related substances was carried out using a reversed phase ultra performance liquid chromatography/tandem mass spectrometry method. The identification of impurities in simvastatin was performed with a triple-quadrupole mass spectrometer, with an electrospray ionization (ESI) source in the negative/positive ion mode. A total of 12 compounds were characterized in commercial samples, among which 2 impurities had never been reported. All the impurities were deduced based on the MS fragment pathways of simvastatin and the biosynthetic pathway of lovastatin. This work provides very useful information for quality control of simvastatin.

Objective To explore the variation of insulin like growth factor-I (IGF-I) and glucose and correlation in children with sepsis. Methods Forty-two children with sepsis in pediatric intense care unit were enrolled from January 2009 to January 2010. In the morning (2nd morning) after admission, the blood glucose, serum IGF-I, cortisol, insulin, IL-6, and IGF-binding protein-I (IGFBP-1) were detected. In the 3rd and 5th morning, the serum IGF-1 was detected again. According to the blood glucose level of the 2nd morning, the children with sepsis were divided into hyperglycemia group and normal group. Meanwhile, 60 healthy children were served as control group. The data had been compared among three groups. Results In the 2nd morning, the levels of blood glucose, serum IGF-I, cortisol, insulin, and IL-6 were signiifcantly different among three groups (all P<0.05), but the serum IGFBP-I was not signiifcantly different (P>0.05). Compared with control group, the sepsis children with hyperglycemia and with normal blood glucose all had signiifcantly higher serum levels of cortisol and IL-6, and signiifcantly lower serum level of IGF-I. In the 2nd, 3rd, and 5th morning, the serum levels of IGF-1 were not signiifcantly changed with time in sepsis children with hyperglycemia and with normal blood glucose (all P>0.05). Meanwhile, there were no signiifcant differ-ences in the serum levels of IGF-1 between sepsis children with hyperglycemia and with normal blood glucose in the 2nd, 3rd, and 5th morning (all P>0.05). In children with sepsis, the blood glucose and serum IGF-1 was not correlated in the next morning (r=0.152, P=0.267). Conclusions The serum level of IGF-I decreased but maintain stable in children with sepsis. The change of blood glucose may be not related with IGF-I.

Objective To investigate the variation of interleukin-6 ( IL-6 ) , vascular endothelial growth factor(VEGF),E-selectin and intercellular adhesion molecule-1(ICAM-1)in children with sepsis and the clinical significance. Methods This was a prospective and control study. Thirty-two children diagnosed as sepsis in PICU from December 2008 to December 2009 served as the sepsis group. According to whether there was a shock, sepsis group were divided into shock subgroup and no shock subgroup. Fifteen healthy children served as control group. The serum levels of IL-6,VEGF,E-selectin and ICAM-1 were detected with enzyme linked immunosorbent assay. Results The serum level of IL-6 was 65. 00(30. 49~237. 14) ng/L in shock subgroup and 48. 68(30. 25~75. 00) ng/L in no shock subgroup,which were significantly higher than that in control group[0. 80(0. 60 ~1. 00) ng/L](P<0. 05). There was no significant difference between shock subgroup and no shock subgroup. The serum levels of VEGF and E-selectin showed no significant differences among the three groups. The serum level of ICAM-1 was 998. 72(666. 93~1 526. 44) ng/ml in shock subgroup,and 925. 71(683. 53~1 225. 12) ng/ml in no shok subgroup,which were significantly high-er than that in control group[660. 59(525. 48~685. 47) ng/ml]. Compared with those who survived in sep-sis group,the serum levels of VEGF and E-selectin in the died children with sepsis showed no significant difference,but IL-6 and ICAM-1 significantly increased(P<0. 05). Conclusion IL-6 and ICAM-1 increase greatly and accentuate inflammation in septic patients,the changes of which may help to determine the prog-nosis of sepsis.

BACKGROUND:Bone ultrastructural destruction is an important cause for bone strength decrease,bone friability and bone fracture incidence increase in osteoporosis.OBJECTIVE:To observe the ultrastructural changes of distal femur cancellous bone in glucocorticoid (GC)-treated rats by scanning electron microscopy (SEM).METHODS:A total of 32 female Sprague-Dawley rats,aged 3.5 months old,were respectively treated with methylprednisolone 3.5 mg/kg per day by subcutaneous injection to induce osteoporosis and normal saline.At 4 and 9 weeks,the distal femurs were coronary sectioned and rinsed with distilled water,dehydrated in graded ethanol,coated with gold,and observed by SEM.RESULIS AND CONCLUSION:Compared to the control,the number of bone trabeculae in the GC group was significantly decreased,and the bone trabeculae became thin,fragile,discontinuous;network structures of bone trabeculae were destroyed,and bone resorption surface increased,with disorderly arranged collagenous fibers and increased micro-damage.Rats treated with GC for 4 weeks maintained better bone ultrestructure compared with rats treated with GC for 9 weeks.Results show that GC can induce bone mass lost,destroy network structures of bone trabeculae,accelerate bone resorption in rat cancellous bone,and accordingly lead to increased bone brittleness and decreased bone functional of biodynamics.

Objective To investigate the relationship between helicobacter pylor (Hp) and primary carcinoma of the gallbladder (PCG), providing a theoretical basis for the treatment of PCG.Methods Mucosa and bile of gallbladder samples were collected from 18 patients with PCG (PCG group), 40 patients with chronic cholecystitis or cholelithiasis (CC group), and 20 patients with no PCG and CC (control group). 16S rDNA-based polymerase chain reaction (PCR) followed by DNA sequence analysis of the obtained PCR fragments was performed. A developed search for Hp was also carried out by PCR. Five genes specific for Hp were amplified. Results In the PCG group, 81% samples of mucosa and bile were positive for Helicobacter-specific 16S rRNA gene. The positive rate in PCG group was significantly higher than those of the CC group (50%) and the control group (20%).Of the 16S rDNA sequence of Helicobacter pylori positive samples of mucosa and bile, 52% of samples were positive in cagA, 86% were positive in 26 KDa, 48% were positive in ureA separately. The vacA and rps4 genes were never detected in any of the samples of mucosa and bile. At least one gene was positive in 93% of samples of musca and bile. The sequencing showed more than 99% homology of Helicobacter 16S rRNA in PCG and Hp groups. Conclusion A higher infection rate is present in bile and gallbladder mucosa from patients with PCG. Hp in the biliary system may be one of the risk factors for occurrence of PCG.

Objective To analyze the clinical experience of double lumen endobronchial tube intubation in 41 cases of whole lung lavage .Methods Forty‐one patients with whole lung lavage in our hospital from February 2010 to February 2015 were retro‐spectively analyzed .The effect of bronchoscopy and auscultation location method were explored after double‐lumen endobronchial intubation in whole‐lung lavage .Results Among 41 cases ,39 cases were successfully located by using the auscultation location ,and other 2 cases were successfully positioned by using the bronchoscopy position after repeatedly auscultation location method resulting in lung isolation failure .The catheter depth in 19 cases was adjusted after using bronchoscopy ,and then double lung was isolated well and lavage was successfully conducted .Conclusion The prerequisite for success of whole lung lavage is accurate position of double‐lumen endobronchial tube .Bronchoscopy look positioning has become the gold standard of double‐lumen endobronchial tube position .

By organizing and classifying the literatures related to acupuncture-moxibustion at Jiaji (EX-B 2) points in treating intervertebral disc herniation (IDH) published before December 31, 2013, to summarize the application status and features of Jiaji (EX-B 2) points. It’s found that its most favorable indication is IDH. It also further analyzed the action mechanism of acupuncture-moxibustion at Jiaji (EX-B 2) points in treating IDH, and brought up some ideas to highlight the further study.

Objective To compare and analyze the clinical application of lumbar plexus combined with sciatic nerve block and spinal anesthesia for elderly patients with knee joint surgery.Methods A total of 77 elderly patients with ASAⅠ ~Ⅲ undergoing single knee re-placement surgery were randomly divided into combined group which recieved lumbar plexus combined with sciatic nerve block and spinal an-esthesia group.The baseline values,blood pressure and heart rate at multiple time points,the block area and duration,the volume of intraoper-ative fluid,and other indexes of adverse reaction were observed.Results The MAP,SBP and DBP in the spinal anesthesia group after the op-eration have changed significantly at the time of T1,T2 and T3.The operating of anesthesia in the combined group was shorter than that of spi-nal anesthesia group.The rate of adverse reactions in combined group was significantly lower than that inspinal anesthesia group.Conclusion The spinal anesthesia can be satisfied for operation requirements,but it will cause the unstable circulation and varied adverse reactions.Lum-bar plexus combined with sciatic nerve block is safe and effective with less adverse reactions,less disturbance of hemodynamics,which is much better for the old or the patients with coagulation abnormalities combined heart and lung disease.