The mortality of septic shock has been reported high.Glucosteroid is widely used in patients with septic shock as one of the assistant therapies of septic shock.However the applied patients,the using time,the duration and the dose of glucosteroid remain controversial.Recently it is recommended using small dose in septic shock according to results of large scale clinical trials.We will review the studies of glucosteroid in septic shock in recent years here.

AIM:To evaluate the expression level of CXC chemokine receptor 7 (CXCR7) in atherosclerotic apolipoprotein E-deficient ( ApoE-/-) mice induced by high-fat diet ( HFD) and the effects of atorvastatin on it .METH-ODS:ApoE-/-male mice (8-week-old) were used and were randomly divided into 3 groups following 1-week normal ro-dent diet:normal diet control (NDC) group , HFD group and HFD+statins (HFD+Sat) group.HE staining and oil red O staining were used to observe the atherosclerotic lesion burdens in the aortas .The expression of CXCR7 on the aortas was detected by Western blot and immunohistochemistry .The expression of Akt and endothelial nitric oxide synthase ( eNOS) in the aorta was determined by Western blot .RESULTS: Few lesions were found in the aortas in NDC group .Apparent atherosclerotic plaque burdens were seen in HFD group and HFD +Sat group, while the atherosclerotic plaque burdens in HFD+Sat group were notably reduced compared with HFD group .The protein levels of CXCR7, eNOS and Akt in aorta in HFD group and HFD+Sat group were significantly decreased compared with NDC group , while those in HFD+Sat group were increased compared with HFD group .The protein level of p-eNOS in the aorta and the concentration of NO in the plas-ma in HFD group were decreased compared with NDC group and HFD +Sat group.CONCLUSION: In ApoE-/-mice, HFD increases the lipid level and promotes the development of atherosclerosis by downregulating the expression of CXCR 7, Akt and eNOS.Atorvastatin reverses the above effect of hypercholesterolemia on the expression of CXCR 7, Akt and eNOS, thus playing the role in treating atherosclerosis .

Objective To investigate the clinical and renal pathologic features of isolated hematuria in children and the relationship between them. Methods A retrospective review of 251 cases of isolated hematuria undergone renal biopsy from 1995 to 2008 in our hospital were conducted to analyze their clinical manifestations and renal pathologic features. Results Among the pathologic changes, minor abnormalities was found in 93 cases (37.05%), normal biopsies in 62 cases (24.70%), IgA nephropathy (IgAN) in 52 cases (20.72%), thin basement membrane nephropathy (TBMN) in 17 cases(6.77%), mesangial proliferative giomerulonephritis(MsPGN) in 16 cases (6.37%), focal segmental glomerulosclerosis (FSGS) in 5 cases (1.99%), focal proliferative glomerulonephritis (FPGN) in 5 cases (1.99%), capillary proliferative glomerulonephritis (EnPGN) in 1 case (0.40%). IgAN was more popular in gross hematuria group than that in microscopic hematuria group (31.88% vs 16.48%, P＜0.05). zcording to Haas classification, the ratio of class Ⅲ in two groups had no statistical significance (microscopic vs gross: 16.67% vs 4.55%, P＞0.05). In the 35 cases (102 cases were detected) with elevated urinary microalbuminuria, the proportion of IgAN Ⅲ was significantly higher than those cases without urinary microalbuminuria (14.28% vs 0%, P＜0.01). There were more FSGS and FPGN (total 20.00%) and less minor abnormalities (28.57%) in these cases as compared to the normal albuminuria cases (1.49% and 58.21%, all P＜0.01). Conclusion The main pathologic changes of isolated hematuria in children are minor abnormalities, normal and IgAN. IgAN is more popular in the cases with gross hematuria. Elevated urinary microalbuminuria may be an indicator of more serious pathologic changes in children with isolated hematuria.

Objective: To investigate the surgical techniques for establishing the rat model of orthotopic liver transplantation.Methods: On the basis of the double-cuff technique of Kamada,we improved the techniques for the separation and perfusion of the donor liver,the shearing and anastomosis of the superior and inferior caval veins,and the anastomosis of the bile duct.Results: Of the 40 rats that underwent orthotopic liver transplantation,80% survived longer than 24 hours and 70% over 7 days.Conclusion: With extreme patience and carefulness,the operator can successfully establish the rat model of orthotopic liver transplantation by shortening the anhepatic phase with skillful surgical techniques.

Objective Probe the value and the operation risk for HIV/AIDS patients with surgical compli-cations. Methods Investigated 27 HIV-infected patients(male 26, female 1, age 27-74 years) were investi-gated. All patients had pre-operative detection of immune function, standardized surgical procedures, careful surgical process to reduce the operation damage, continuous infusion of coagulation factors for haemophilia during operation, conventional application of antibiotics to prevent infection and prompt treatment of compli-cations. Results No incision infected in 8 cases of class one incision, 1 incision infected in 6 cases of class two incision, 3 cases were not healed in 30 days after operation in 13 cases of class three incision. One case died of severe sepsis 12 days after operation, the others discharged with recovery or improvement. Conclu-sion Suitable operation and treatment method may obtain curative effect for HIV-infected patients.

We retrospectively reviewed the tongue images and related clinical data of 118 AIDS patients treated in Shanghai Public Health Clinical Center Affiliated to Fudan University. The tongue images included: cyanotic and purplish tongue ( 33, 28.0% ), light-reddish tongue ( 32, 27.1% ), light-whitish tongue (21, 17.8% ) , bulgy tongue(19, 16.1% ), dark-red tongue (7, 5.9% ) and fissured tongue (6,5.1% ). There were significant differences in counts of CD4+T lymphocytes, white blood cells and red blood cells among different tongue imagine groups. The tongue image can indicate the pathogenic factors of disease as well as the functions of viscera in AIDS patients.

Objective To study the effects about rhizoma drynariae poly (lactic-co-glycolic acid) (DR-PLGA) /Calcium phosphate cement (CPC) composite scaffold on treating rabbit femoral bone defect.Methods Eight Newzealand rabbits were randomly divided into experiment group(n =4) and control group (n =4).The preparation of rabbit femoral bone defect model,separately implanted DR-PLGA/CPC scaffold and PLGA/CPC scaffold.After 4,8 weeks,we took out the materials,observed with X-ray,gross anatomy,histology observation to evaluate the osteogenetic activity,the effect of accelerating the healing of bone defect.Resuits At the 4th week and 8th week after implantation,the effect of promoting fracture healing and osteogenic activity of the experiment group were greater than those in the control group.Conclusions DR-PLGA combined with CPC could induce new bone formation,promote the healing of rabbit femoral defect.

BACKGROUND:Microcapsules is one of the main directions of targeted therapeutic dosing system. With a size of several microns to several hundred microns, it can be used for injection, oral, arterial administration and local treatment of targeted organs and other treatment approaches. OBJECTIVE: To prepare rhizoma drynariae total flavonoids/polylactic-co-glycolic acid microcapsules and optimize the preparation conditions. METHODS: The rhizoma drynariae total flavonoids/polylactic-co-glycolic acid microcapsules was prepared by ultrasonic emulsification. The effect of the mass concentration (60, 100, 140, 180 g/L), stirring speed (50, 1 000, 2 000, 4 000 r/minutes), colostrum emulsification time (2, 4, 6, 8 minutes), colostrum water oil ratio (1:5, 1:10, 1:15, 1:20) of rhizoma drynariae total flavonoids/polylactic-co-glycolic acid microcapsules on gross morphology, particle size distribution width and total flavonoids encapsulation efficiency of microcapsules was univariately analyzed. The rhizoma drynariae total flavonoids/polylactic-co-glycolic acid microcapsules with smaler particle size, uniform dispersion and higher encapsulation efficiency was filtered out. RESULTS AND CONCLUSION: The optimum process parameters were as folows: 140 g/L polylactic acid-glycolic acid solution, the stirring speed of 2 000 r/min, the colostrum emulsification time of 6 minutes, and the colostrum water-oil ratio of 1:15. The microcapsules prepared in the optimized process displayed a uniform distribution and its average particle size was (789.8±712.3) nm, which distributed relative narrowly and basicaly less than 5 μm. Microcapsules presented round, with a regular edge under scanning electron microscope. The average encapsulation efficiency was 47.72%.

A liquid chromatographic-tandem mass spectrometric (LC-MS/MS) method was developed for the determination of lopinavir and ritonavir in human plasma. Analytes were separated from plasma by a combination of alkalinized protein precipitation and liquid-liquid extraction with ethyl acetate. Chromatographic separation was performed on a Agilent ZORBAX Eclipse XDB-C18 column with the mobile phase consisted of methanol-0.1% formic acid in water (80:20). A tandem mass spectrometer equipped with electrospray ionization source was used as detector and operated in the positive ion mode. Quantification was performed using multiple reaction monitoring (MRM) of the transitions m/z 629.6 --> 155.2, m/z 721.4 --> 268.2, and m/z 515.2 --> 276.2 for lopinavir, ritonavir and telmisartan (internal standard), respectively. The method showed a good linearity in a concentration range of 62.5 - 10000 ng mL(-1) for lopinavir, and 12.5 - 2000 ng mL(-1) for ritonavir. The lower limits of quantification were 15 pg mL(-1) and 8 pg mL(-1) for lopinavir and ritonavir, respectively. The intra- and inter-day precision was less than 15% and the absolute recovery was above 75%. This method was selective and rapid, sensitive for investigating blood drug concentrations in clinics.

ObjectiveTo find specific biomarkers related to HAART treatment in plasma samples of AIDS patients for clinical therapeautic efficacy evaluation and guidance for the prognosis of HIV treatment.MethodPlasma samples of AIDS patients were collected from Infectious Disease Department 1 of Shanghai Public Health Clinical Center in June of 2008 to February of 2009,including 11 successfully HAART treated cases (HIV load ＞ 50 copies/ml) and 11 unsuccessfully HAART treated cases (HIV load ＜50 copies/ml).Patients' age ranged from 22 to 63.Plasma samples were treated by Bio-rad AurumTM Serum Protein Mini Kit to remove high abundant proteins:albumin and immunoglobulin were removed.The treatedplasmaproteinswereseparatedbytwo-dimensionalelectrophoresisandanalyzedby electrophoretogram using Imagemaster software to find differentially-expressed proteins related to therapeutic efficacy.After digestion by trypsin,the differentially-expressed proteins were identified by online reversed-phasenano-flow liquid chromatography coupled with electrospray ionization ion trap mass spectrometry.ResultsLow abundant proteins were efficiently enriched after the AurumTM Serum Protein Mini Kit treatment.Six differentially-expressed proteins were detected while comparing successfully and unsuccessfully HAART treated group.These proteins were accurately identified by tandem Mass spectrometry (MS), including serum transferrin, serum β-fibrinogen, etc.ConclusionsOur proteomic research revealed that the differentially-expressed proteins such as transferrin,which is related to plasma virus loading in AIDS patients in the process of treatment,might be potential biomarkers evaluating HAART therapeutic efficacy.