BACKGROUND: There are so many experimental and clinical researches on levels of nitrogen monoxide (NO) in serum and endothelins in plasma of patients with stroke; however, ratio and significance between them are still unclear.OBJECTIVE: To observe dynamic changes of levels of NO in serum and endothelins in plasma of patients with stroke.DESIGN: Case-controlled observation.SETTING: Neurological Department and Clinical Neurological Laboratory of the Second Hospital affiliated to Suzhou University.PARTICIPANTS: A total of 216 patients with acute cerebral infarction including 133 males and 83 females and 112 cases with cerebral hemorrhage including 68 males and 44 females were selected from Neurological Department of the Second Hospital affiliated to Suzhou University from September 1999 to December 2001. Another 106 subjects including 63males and 43 females were regarded as healthy control group.METHODS: Contents of NO in serum and endothelins in plasma were measured on 328 patients with stroke and 106 healthy subjects in the courses of 1-3 days, 1, 2, 4, 8 and 12 weeks with nitrate reductase and radio-immunity methods, respectively.MAIN OUTCOME MEASURES: Contents of NO in serum and endothelins in plasma; ratio between NO in serum and endothelins in plasma (NO/endothelins).RESULTS: ① As compared with those in the control group, content of NO in serum of patients with cerebral infarction and cerebral hemorrhage was decreased and reached the lowest value during acute period (within 1-3 days), and then increased gradually and closed to the normal level at about 4 weeks. In addition, content of endothelins in plasma was increased obviously during acute period, reached the peak at 2 weeks, and then decreased gradually. The level was still high at stage of recovery and closed to normal value within 4-8 weeks. ② As compared with that in the control group, NO/endothelins was decreased in cerebral infarction group at the courses of 1-3 days (P ＜ 0.05), reached the lowest value at 1 week (P ＜ 0.001), and increased to the normal level at 2 weeks. Moreover,NO/endothelins was remarkably decreased in cerebral hemorrhage group at the courses of 1-3 days (P ＜ 0.001), reached the lowest value at 1week (P ＜ 0.001), and increased gradually. The changes of course were great and the level reached above normal value at 8 weeks. There was significant difference of dynamic changes of NO/endothelins between cerebral hemorrhage group and cerebral infarction group (P ＜ 0.05).CONCLUSION: NO and endothelins play an important role in onset and development of ischemic cerebrovascular disease and hemorrhagic cerebrovascular disease, and their contents are related to prognosis.

Objective To investigate the factors influencing the incidence of acute pancreatitis (AP) in patients with organophosphorus poisoning and explore the effectiveness of measures for its prevention and treatment. Methods Clinical data of 50 patients with organophosphorus poisoning were reviewed retrospectively in our center between January 2001 and December 2006. Results The incidence of AP in patients with organophosphorus poisoning was 30% (15/50), and 14 patients suffered from MAP, while one patient occurred SAP. 13 of 15 AP patients underwent gastric lavage with cold normal saline; gastric tube was placed in 14 patients; toxic doses over 50 ml were observed in 10 patients; atropine overdose were observed in 11 patients. There were 35 cases of organophosphorus poisoning alone, and 2 of them underwent gastric lavage with cold normal saline; gastric tube was not placed in 1 patient; toxic doses over 50 ml were not observed in all the patients. The toxic dose, water temperature for gastric lavage, gastric tube placement, duration from poisoning to treatment between the two groups were significantly different (P＜0.01). All the patients with organophosphorus poisoning alone survived, while in these 15 patients with AP, 14 patients were cured, 1 patient died. Conclusions Organophosphorus poisoning can induce AP and development of AP was possibly related to organophosphorus poisoning and improper treatment.

Objective To investigate the clinical effect of adductor magnus tendon transposition with arthroscopic in reconstruction medial patellofemoral ligament (MPFL) for the treatment of patellofemoral joint instability of adolescents. Methods Eighteen juvenile patients (21 knees) with patellofemoral joint instability (including chronic patellar dislocation and recurrent patellar dislocation) were treated with adductor magnus tendon transposition for MPFL reconstruction, combined with lateral patellofemoral ligament release. They were followed up for 12- 30 months. The complications, patellofemoral angles and Lysholm scores before and after operation were recorded and compared. Results There was no complications such as wound infection, redislocation, patellofemoral joint instability and epiphyses injured. All patients got excellent knee flexion and extension function. Patella fear tests were all negative. The patellofemoral angles and Lysholm scores after operation were improved significantly than those before operation:(10.3 ± 4.1)° vs. (-3.8 ± 4.9)°, (92.7 ± 3.6) scores vs. (61.5 ±2.4) scores, P<0.01. Conclusions Adductor magnus tendon transposition with arthroscopic in reconstruction MPFL can significantly improve the stability of patellofemoral joints. This is one of the effective methods for the treatment of patellofemoral joint instability of adolescents.

Objective To investigate circulating level of growth differentiation factor-15 (GDF-15) in patients with non-valvular atrial fibrillation (AF). Methods We enrolled 104 consecutive patients with AF (67 are paroxymal AF and 37 are persistent AF) that presented to our hospital between August 2012 and June 2013. Subjects without AF (n=67) was used as controls who were matched for sex, age and atherosclerotic risk factors enrolled in the same period. Serum GDF-15 con-centration was detected by enzyme linked immunosorbent assay (ELISA). Echocardiography and laboratory parameters were compared among three groups. The correlation of GDF- 15 and hypersensitive c-reactive protein (hs-CRP) as well as the risk factors of development of AF were also analyzed. Results No significant difference in age, history of hypertension, coro-nary heart disease, and stroke was found among three groups (P>0.05). GDF-15 had significant difference between pa-tients with paroxysmal AF and controls [(1 473.14±628.52)μg/L vs (1 233.592±262.76)μg/L, P=0.012]. GDF-15 level was correlated with hs-CRP (rs=0.172,P=0.044). Multivariable analysis demonstrated that high GDF-15 is a risk factor of devel-opment of paroxysmal AF/AF (OR:1.002, 95%CI:1.000-1.003, P<0.05). Conclusion Patients with AF have a higher se-rum level of GDF-15 compared with controls and GDF-15 level is a risk factor of development of paroxysmal AF/AF.

Objective To evaluate the life quality of gastroesophageal reflux disease (GERD) patients. Methods Classify the definite GERD patients by differentiation of symptoms and signs first, and then evaluate their quality of life from physiological function, physiological role, body pain, general health, activity, social function, affection function and mental health with scale SF-36. At the same time, 100 healthy persons were brought into the study as control. Results The life quality of GERD patients decreased, and the body pain, general health, social function and mental health decreased more obviously. Difference also lies among the life quality of patients of different syndromes, and the scores of physiological function, physiological role, general health and mental health show significant differences among the four syndromes. Conclusion The life quality of GERD patients decreased obviously.

Objective To observe the effects of penehydidine hydrochloride (PHC) on t acute lung injury ( ALI) . To investigate into the expression of TLR4 on peripheral monocytes, kinetics of inflammatory and anti- inflammatory mediators. To explore the mechanism of TLR4 in ALI. Method A total of 45 patients with ALI were randomly divided into PHC treatment group(experimental group, n =21) and routine treatment group (control group, n = 24) . Patients of both groups were given with the routine treatment,and patients in experimental group were given with PHC in addition (1 mg,im,ql2h) . Therapeutic effects, average length of hospital stay, ICU stay,PaO_2 and PaO_2/FiO_2 > as well as the expression of TLR4 and some cytokines were observed for 48 hours. Results Patients of both groups got better gradually after treatment. The PaO_2 and PaO_2/FiO_2 of patients of both groups progressively increased. At 6 hours, 12 hours, 24 hours and 48 hours after treatment, the PaO_2 and PaO_2/FiO_2significantly increased than 0 hour ( P < 0.05). The improvement in experimental group was obviously better than that in control group at 6 hours, 24 hours and 48 hours after treatment (P < 0.05). There were no differences in average length of hospital stay between the two groups. The ICU stay was significantly shorter in the experimental group ( P < 0.01) . The expressions of TLR4 were higher in patients of both groups than in healthy ones (P <0.01) . TLR4 decreased significantly at 24 hours and 48 hours, while it was lower in experimental group than that in the control group (P < 0.05). The higher level of TLR4in the early stage implied worse prognosis. Most of them deteriorated to ARDS stage. At 24 hours, the incidence of ARDS in experimental group was 23.8 % , and 29.17% in control group. Two patients in control group didn' t become ARDS till 48 hours. Serum IL-1, IL-8 and TNF-α level reduced atr 24 hours in both groups. The reduction of IL-8 and TNF-α in experimental group was more obvious than in control group ( P < 0.05). IL-13 increased gradually from 0 hour to 24 hours, then descended a little at 48 hours. There was no difference in IL-13 some difference between the two groups ( P > 0.05) . Conclusions PHC can improve the arterial oxygen pressure, down-regulate TLR4, restrain inflammatory factors in its signal transduction downstream. This inhibitory action is not accomplished by increase in anti-inflammatory factors,but by down-regulating TLR4. PHC can prevent the development of ALI, and can be considered to act as an effective medicine for the treatment of ALI. TLR4 plays an important role in ALT process, and it is suggested that TLR4 can be used as a prognostic factor.

Objective Using real-time fluorescence quantitative PCR to detect the gene expression of MMP-2,T1MP-1 in the rats' lung intoxicated by paraquat, and to discuss the effect of the MMP-2,T1MP-1 in the acute lung injury and pulmonary fibrosis afltr paraquat intoxication. Method Eighty Sprague-Dawley rats were randomly divided into control group and the intoxication group. The rats of the control group were given equivalent volume of normal saline, and the rats of the intoxication group were given a intraperitoneal injection of paraquat(18 mg/kg) . At 1,3,5,7,14 and 28 days after intoxication, the pathological changes were observed under the light microscope and the expression of MMP-2, TTMP-1 mRNA in the rats lung were detected by using real-time fluorescence quantitative PCR. Results Compared with the control group, in the early days after intoxication, the lung tissue of the intoxication group showed obvious inflammation, pulmonary edema and bleeding. Five daye after intoxication, pulmonary fibrosis could be ideatified and the fibrosis became obvious. At 28 days later the expression of MMP-2 mRNA was remarkably increased in lung tissue from the day of intoxication, and reached the peak 7 days later, It was control group, that in and then gradually, declined however, higher than that in control group (P < 0.01). The expression of TIMP-1 mRNA in lung tissue was also higher than the control group on the day 1, then increased gradually, reached the peak on day 14,7.28 times more than the control group, decreased from the fourteenth day,higher than the control group on day 28 (P < 0.01) . Conclusions MMP-2,TIMP-1 played a very important role in the acute lung injury induced by paraquat, meanwhile the development of pulmonary fibrosis had great relations on their disproportion.

Objective To explore the related risk factors of cerebral hemorrhage complicated with stress ulcer (SU). Methods The clinical data of 1 185 patients with cerebral hemorrhage admitted to Department of Emergency Medicine of Nanjing General Hospital from March 2006 to March 2014 were retrospectively analyzed. Patients were divided into two groups according to whether patients complicated with SU or not. Data was collected within 8 hours after admission in two groups including gender,age,amount of bleeding,the bleeding site (basal ganglia,thalamus, brainstem,brain lobe,ventricle,subarachnoid,and cerebellum),disturbance of consciousness,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,systolic blood pressure(SBP),history of hypertension,and history of cerebral hemorrhage. The statistically significant risk factors found using univariate analysis was selected and was analyzed to find independent risk factors with multivariate logistic regression analysis. The receiver operating characteristic curve (ROC curve)was plotted to analyze the independent risk factors and evaluate their power of test. Results 1 185 patients with cerebral hemorrhage were enrolled in the study,293 cases occurred SU,accounting for 24.7%,and 892 cases without SU,which accounted for 75.3%. As shown by univariate analysis,risk factors for cerebral hemorrhage complicated with SU included age,amount of bleeding,the bleeding site,disturbance of consciousness,APACHEⅡscore,SBP. As to the site of bleeding,brain,thalamus,brainstem hemorrhage complicated with SU were higher proportion,45.3%(43/95),39.1%(63/161),36.9%(48/130),which were significantly higher than those of the lobes of the brain 〔26.2% (33/126)〕,cerebellum 〔18.8% (15/80)〕,basal ganglia〔16.1%(78/485)〕,arachnoid the inferior vena cava 〔12.0% (13/108)〕. Multivariate logistic regression analysis showed that amount of bleeding 〔odds ratio (OR)=3.305,P=0.001,95%confidence interval (95%CI)2.213-48.634〕,the bleeding site (OR=1.762,P=0.008,95%CI 0.123-2.743),SBP (OR=1.223,P=0.034,95%CI 0.245-2.812) were independent risk factors of cerebral hemorrhage complicated with SU. The area under the ROC curve (AUC)of amount of bleeding and SBP were 0.846 and 0.597,suggesting that amount of bleeding has moderate diagnostic value and SBP has low diagnostic value. Conclusions Cerebral hemorrhage patients with large amount of bleeding,the bleeding site in the ventricle,thalamus or brainstem,high SBP are of great risk. We should lower blood pressure and give preventive treatment for SU as soon as possible.

Objective To investigate cognitive function and behavior characteristics in the childhood onset schizo?phrenia patients with or without obsessive-compulsive symptoms. Methods One hundred forty-nine schizophrenia chil?dren were recruited and 72 healthy children served as children control group. According to the Schedule for Affective Dis?orders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL), the patients were fur?ther divided into two groups, the children with obsessive-compulsive disorder group (70 cases) and the children without obsessive-compulsive disorder group (79 cases). All the children were retrospectively surveyed and the Achenbach’s Child Behavior Check-list (CBCL) was used to assess their social competence and behavioral characteristics at the age from 6-year-old to 10-year-old. The cognitive function was estimated with WISC, STROOP color and word test, trail making test, visal spatial memory test and maze test. Results Compare to the control group, the CBCL factor scores of behavior problems were higher (P<0.01), social ability factor scores were lower (P<0.05) and all factor scores in the cog?nitive function tests were lower (P<0.05) in the two patients groups. Compare to the patients without obsessive-compul?sive symptoms, the CBCL factor scores of the school situation (P<0.01), splitting force (P<0.01), and physical complaints (P<0.01) were significantly higher and the scores were significantly lower in the test of common sense (P<0.01), wood (P<0.01), STROOP (P<0.01) and BVMT-R (P<0.01) in those with obsessive-compulsive symptoms. Correlation analysis showed that social competence total scores were positively correlated with similarity in the patients with obsessive-com?pulsive symptoms (r=0.31, P<0.01);while behavior problems total scores were negatively correlated with wood (r=-0.31, P<0.01) and patchwork (r=-0.32, P<0.01) in the patients without obsessive-compulsive symptoms. Conclusion The schizophrenia children with obsessive-compulsive symptoms have more behavioral problems in pre-symptom period and their cognitive dysfunction are more severe following onset of the disease. Cognitive function is related to behavioral prob?lems and social competence in the schizophrenia children with or without obsessive-compulsive symptoms .

Objective To screen an ssDNA aptamer for rabbit mesenchymal stem cells (MSCs) and to identify the ability of the aptamer to recognize MSCs of a variety of species origin.Methods MSCs were isolated from the thigh bone of immature rabbits and identified by induced osteogenic and adipogenic differentiation,respectively.Aptamers were screened by cell SELEX (systematic evolution of ligands by exponential enrichment) technique targeting to isolated MSCs.Enrichment of the 5th pool was evaluated through binding assay of FAM modified pool to MSCs by confocal microscopy.The enriched 5th pool was then cloned into pGE-T vector and the cloned sequences were determined randomly.The candidates were chosen based on primary sequence conservation and predicted secondary structure by RNA structure and MEME online analysis.Flow cytometry analysis was used to identify the aptamers binding to MSCs of rabbit, rat, and human origin.Results The isolated MSCs had the potential of osteogenic differentiation and adipogenic differentiation under certain conditions.Aptamer 5-1-12 from 5th enriched pool was characterized as MSCs recognizing aptamer binding to MSCs of rabbit, rat and human origin.Conclusion Aptamer 5-1-12 that recognizes MSCs of different species origin is obtained through live cell-SELEX.