BACKGROUND:Systemic lupus erythematosus is a complex autoimmune disease of unknown origin affecting virtual y every organ in the human body. It is characterized by abnormal activation of T, B lymphocytes. While aberrant T cells provide help to autoreactive B cells, the autoreactive B cells produce a variety of pathological autoantibodies and immune complex deposition, which could infiltrate the smal blood vessels directly or deposit in the vessel wal , thereby causing inflammatory necrosis of the vessel wal s. These changes wil narrow the vascular lumen, and promote thrombosis, leading to local tissue ischemia and dysfunction. Mesenchymal stem cells can regulate the immune disorders, play an anti-inflammatory role, and repair the immune thrombosis.
OBJECTIVE:To summarize the pathogenesis of immune thrombosis in systemic lupus erythematosus, as wel as to introduce the mechanism of mesenchymal stem celltherapy for immunity thrombosis.
METHODS:We searched the PubMed database, Springlink database, ScienceDirect database and HighWire database from January 1990 to June 2013 with the key words of“systemic lupus erythematosus, mesenchymal stem cell, thrombosis, T cells, B cells”in English. An online search of CNKI database, Wanfang database, VIP database from January 1990 to June 2013 was also conducted with the key words of“systemic lupus erythematosus, mesenchymal stem cell, thrombosis, T cells, B cells”in Chinese. A total of 267 literatures were screened out, and 48 documents were included in the review based on the inclusion and exclusion criteria.
RESULTS AND CONCLUSION:Mesenchymal stem cells are multipotential nonhematopoietic progenitor cells capable of multi-directional differentiating into various celltypes. Mesenchymal stem cells can suppress T-lymphocyte activation and proliferation, and inhibit secretion of interferon-γ, interleukin-4. Mesenchymal stem cells can also inhibit the proliferation of B cells and the secretion of pathogenic immunoglobulin IgM, IgG, IgA. Thus, mesenchymal stem cells can regulate immune homeostasis and reduce the deposition of autoantibodies and immune complexes, thereby protecting the blood vessels from injury, reducing the secretion of inflammatory cytokines, balancing the coagulation-anticoagulation, and decreasing thrombosis in systemic lupus erythematosus.

Objective To investigate the etiology of and therapy for duodenal fistula caused by distal common bile duct operation. Methods An retrospective analysis of 19 cases of duodenal fistula after distal common bile duct operation was made.All cases received surgical management after the fistula was identified.Surgical procedures included abdominal abscess drainage in 2 cases, gastrostomy and jejunostomy combined with abscess drainage in 11 cases, gastrostomy and jejunostomy combined with duodenal repair?abscess drainage in 3 cases,gastrojejunostomy with pyloric exclusion combined jejunostomy in 1 case, repair of fistula with padicled intestinal seromuscular patch combined with gastrostomy and jejunostomy in 1 case, and repair of fistula with padicled intestinal seromuscular patch combined with gastrostomy and jejunostomy plus sphincteroplasty in one case. Results Among 19 cases,15 were cured. Two died of gastrointestinal bleeding, one of severe retroperitoneal infection,one of severe pancreatitis. ConclusionsEarly diagnosis is of great importance for the treatment of duodenal injury. Drainage is the mainstay for the treatment of iatrogenic duodenal fistula, while enough enteral nutrition should be given to accelerate spontaneous closure of the fistula.

Oral tuberculosis is one of oral infectious diseases and there are some difficulties in its diagnosis.This article describes a case of oral gingival tuberculosis for that the diagnosis had not been confirmed by biopsy.Local injection with streptomycin was undertaken.1 month after treatment the gingival lesion was improved.

The study focused on the therapeutic efficacy of Tibetan medicines on cerebral ischemia. The combined medication methods and administration habits in clinic for more than 10 years were simulated. Three typical Tibetan medicines, i.e., 25-Herb Shanhu pill, Wishful-Treasure pill and 20-Herb Chenxiang pill, were administered to the animal model of permanent middle cerebral artery occlusion in the morning, noon and evening, respectively. On the second day after the final administration, the activity of serum oxidative stress marker SOD and the content of MDA were evaluated. Infarct volumes were quantified through TTC staining. Inflammatory reaction maker NF-kappaB p65 gene and apoptosis. makers Bax and Cyct were selected to study the molecular mechanism of combined herbs with the immunohistochemistry technique. According to the result, the respective combination of 25-Herb Shanhu pill, Wishful-Treasure pill and 20-Herb Chenxiang pill in the morning, noon and evening showed unique advantages in reducing the damage of oxidative stress, infarct volumes, encephaledema caused by ischemia, inflammatory factor aggregation and inhibiting apoptosis, with consistent therapeutic efficacies in clinic.
Animals ; Brain Ischemia ; drug therapy ; metabolism ; Lipid Peroxidation ; Male ; Medicine, Tibetan Traditional ; Rats ; Superoxide Dismutase ; metabolism ; Time Factors ; Transcription Factor RelA ; physiology

Objective To report 11 cases with the tissue defects of their upper or lower limbs repaired with the anastomsed medial sural artery perforator flaps.Methods The free medial sural artery perforator flaps,with length of 8 cm to 15 cm and width of 6 cm to 14 cm were used for tissue defect reconstruction of the distal upper or lower limbs in 11 cases,including 6 females and 5 males.The flap was harvested from the ho- mo-lateral calf,confined between the posterior-medial edge of the tibia and the middle line of the calf and a- bove the distal half part of the medial sural muscle,with a same axis of this muscle.Results Ten cases survived very well,which was relatively thin,and the donor site can be acceptable.One case resulted in a complete flap necrotized and covered with a split skin graft.No obvious motor function defect was observed of the donor leg.Conclusion The anastomsed medial sural artery perforator flap is alternative donor flap for the upper or lower limb tissue defect repair,especially for the defect in the hand or foot.

In order to obtain higher L-lactic acid yield industrial strain, the original strain Rhizopus oryzae PW352 was mutated by means of N+ ions implantation and a mutant strain Rhizopus oryzae RE3303 was obtained. Its lactic acid yield was increased by 75% than that of the original one. The acid producing condition was optimized by orthogonal design. The concentration of L-lactic acid reached to 131～136g/L and the conversion rate of glucose was as high as 86%～90% under the optimum condition.

Objective To analyze the risk factors of hospital acquired pneumonia (HAP) caused by nonfermentative bacteria in ICU.Methods Using binary logistic regression analysis,we reviewed the related risk factors of hospital acquired pneumonia caused by nonfermentative bacteria from January,2002 to May,2006 in ICU of our hospital.Results Univariate regression ana- lysis identified 22 variables associated with HAP,including age,diabetes mellitus,malignant tumor,chronic obstructive pul- monary disease (COPD),smoking,Glasgow Coma Scale (GCS) score,Acute Physiology and Chronic Healthy EvaluationⅡ(APACHEⅡ) score.Multivariate regression analysis confirmed 6 high risk factors:aspiration,COPD,use of antacids,seda- tive agents,mechanical ventilation and tracheal intubation or tracheostomy.Conclusions Aspiration,COPD,use of antacids, sedative agents,mechanical ventilation,tracheal intubation or tracheostomy are high risk factors associated with HAP.

OBJECTIVETo investigate the effects of enteral nutrition on intestinal intraepithelial lymphocytes and the barrier of mucus in patients with stomal type enteric fistulas.

METHODSTen patients with stomal type enteric fistulas after long-term fasting were observed. They received enteral nutrition of 146 kJ.kg(-1).d(-1) non-protein calorie and 0.25 g.kg(-1).d(-1) nitrogen per day. Intestinal mucosa were taken by endoscope through stoma of fistula before, 5 and 10 days after enteral nutrition support. Hematoxylin-eosin stain and immunohistochemical stain were performed to count the cell counts of intestinal intraepithelial lymphocytes (iIELs) and mucin-2 (MUC2) positive cells, specific stain (Alcian Blue) was performed to test the thickness of mucus.

RESULTSFive days after enteral nutrition, MUC2 positive cells and the thickness of mucus were significantly higher than that before enteral nutrition support (P<0.05). Ten days after enteral nutrition, iIEL cell and CD8 counts were also significantly higher than that before enteral nutrition support (P<0.05), MUC2 positive cells and the thickness of mucus showed a significant increase (P<0.01).

CONCLUSIONEnteral nutrition is effective in protecting the gut mucosal and improving the immune function of the intestinal intraepithelial in patients with stomal type fistula.

Adolescent ; Adult ; Aged ; Cell Count ; Enteral Nutrition ; Female ; Humans ; Intestinal Fistula ; physiopathology ; therapy ; Intestinal Mucosa ; immunology ; physiopathology ; Intestine, Small ; Lymphocytes ; metabolism ; Male ; Middle Aged ; Mucus ; immunology ; Young Adult

OBJECTIVETo study the impact of complicated intra-abdominal infections on albumin synthesis rate.

METHODSEight patients with complicated intra-abdominal infections associated with intestinal fistula were admitted to the Research Institute of General Surgery at the Jinling Hospital between December 2009 and October 2010. Eight healthy volunteers matched for age, sex, and body mass index were enrolled as controls. All the subjects were given a primed, constant infusion of sterile L-[ring-(2)H(5)]-phenylalanine solution (priming dose: 4 μmol/kg, infusion rate: 6 μmol·kg(-1)·min(-1)) via peripheral venous lines in fast state. Arterial blood samples(3 ml) were drawn before and throughout the infusion at hourly intervals. The enrichment of L-[ring-(2)H(5)]-phenylalanine from the plasma free amino acid pool and from albumin were determined by gas chromatography/mass spectrometry analysis.

RESULTSBoth plasma total protein concentration(62.2±1.0) g/L and plasma albumin concentration (32.5±4.0) g/L in patients with complicated intra-abdominal infection were lower compared with controls[(74.2±1.7) g/L and (46.1±2.6) g/L, both P<0.05]. Body temperature, neutrophil count and plasma C-reactive protein concentration in patients with infection were significantly greater than the levels in control subjects(P<0.05). Albumin synthesis rate in patients with intra-abdominal infection was significantly lower than that in the control group [(5.3±1.6)%/d and (7.8±1.2)%/d respectively, P<0.05]. The measurement of plasma free amino acid concentration showed that plasma glutamic acid level was greater than that in control subjects, and that plasma phenylalanine and proline levels were lower than those in controls.

CONCLUSIONComplicated intra-abdominal infection inhibits albumin synthesis rate in patients with intestinal fistula, which may partially contribute to the decrease of plasma albumin concentration.

Adolescent ; Adult ; Case-Control Studies ; Female ; Humans ; Intraabdominal Infections ; blood ; Male ; Middle Aged ; Serum Albumin ; biosynthesis ; Young Adult

OBJECTIVETo evaluate protein loss in critically ill patients with acute renal failure during continuous veno-venous hemofiltration (CVVH) and analysis the major factor impacting protein clearance.

METHODSA analysis was carried out in eighteen (twelve male and six female) sepsis or severe acute pancreatitis patients with acute renal failure from September 2008 to September 2009. The average age was 45 years (39 - 62 years). CVVH was conducted for 24 h in all patients. Effluent volume, blood speed, ultrafiltration rate and transmembrane pressure (TMP) were 4000 ml/h, (277 ± 89) ml/h, (179 ± 4) ml/min and (173 ± 48) mm Hg (1 mm Hg = 0.133 kPa) respectively. Blood samples were collected before and after filtration in order to detect protein concentration. Ultrafiltrate was obtained hourly to measure protein concentration and calculate protein loss during session.

RESULTSMean protein concentration was (231 ± 67) mg/L and protein loss was (22 ± 6) g/d in ultrafiltrate samples. The difference in serum protein level during hemofiltration was not significant [(56 ± 6) g/L vs. (55 ± 10) g/L, P > 0.05], while there was a weak, but statistically significant correlation between the ultrafiltrate protein concentration and the corresponding value for serum protein (r = 0.481, P < 0.05). However, there was a strong and statistically significant correlation between the ultrafiltrate protein concentration and the TMP (r = 0.564, P < 0.01). Stepwise multiple regression analysis showed that TMP and serum protein concentration played a pivotal role in ultrafiltrate protein loss.

CONCLUSIONSIn addition to renal replacement therapy, serum protein would be cleared through hemofilter during CVVH. TMP and serum protein concentration are the main factors that affect protein loss in ultrafiltrate. As a result, it is necessary to take account of the protein loss in ultrafiltrate when setting nutritional schedule.

Acute Kidney Injury ; therapy ; Adult ; Blood Proteins ; deficiency ; Critical Illness ; Female ; Hemofiltration ; adverse effects ; Humans ; Male ; Malnutrition ; etiology ; Middle Aged