Objective To analyze the actions of transforming growth factor ? 1 (TGF-? 1) and tumor necrosis factor ?(TNF-?) in the liver fibrosis formation in chronic viral hepatitis patients and liver cirrhosis patients.Methods Serum levels of TGF-? 1 and TNF-? were measured by ELISA in 107 patients with chronic liver diseases,liver biopsy was performed in 23 patients in order to identify pathological stages under optic microscope.Results The serum levels of TGF-? 1(?g/L) in mild,middle and severe groups of chronic viral hepatitis and liver cirrhosis group were 14 2?5 9,20 1?7 0,30 2?6 7 and 32 6?7 5 respectively.The serum levels of TNF-? (pg/L) were 6 1?3 2,29 8?18 6,57 3?22 5 and 96 7?38 2 respectively.The serum levels of above two markers increased with hepatitis progression.The results of liver biopsy revealed that the changes in these two markers were related to liver cirrhosis degree.Conclusions TGF-? 1 and TNF-? are related to liver cirrhosis formation.

Objective To investigate the value of MRI in evaluation of metastatic axillary lymph nodes in patients with breast carcinoma. Methods 60 patients with breast carcinoma underwent MRI before surgical management.Tumor maximal diameter,tumor SERmax (Maximal Signal Enhancement Ratio),the size,shape,border,signal intensity and enhancement pattern of ipsilateral axillary lymph nodes were recorded respectively.The results of MRI observation were compared with the histopathological results.Results Among the 60 patients,MRI showed that 28 cases had metastatic axillary lymph nodes,and 22 of them were confirmed by pathology.Its sensitivity,specificity and accuracy were 90.91%,78.95%,83.33% in the diagnosis of lymph nodes metastasis.Meanwhile,57 cases were underwent ultrasound examination,its sensitivity,specificity and accuracy were 59.09%,94.29%,80.70%.The sizes of lymph nodes in the patients with metastatic lymph nodes and the patients with no metastatic lymph nodes were(1.20±0.59)cm, (0.85±0.24)cm respectively.There was statistically significant difference between the two groups(t=3.258,P=0.001<0.05). There was statistically significant difference between the above two groups in the tumor maximum of SER(t=4.167,P=0.000<0.05),SERmax in metastatic lymph nodes were higher than in no metastatic ones.Irregular shape and border,inhomogeneous signal intensity and heterogeneous enhancement patterns were suggestive of metastatic lymph nodes.Conclusion MRI is an effective imaging modality in evaluation of axillary lymph nodes status in patients with breast carcinoma comprehensively before operation.

Sepsis, the most common panthogeny, is characterized as multi-system injuries like immune system, inflammatory system and coagulation system, caused by systemic inflammatory response syndrome ( SIRS) and excessive oxidative stress after the invasion of pathogen.Severe cases can lead to multiple organ dysfunction syndrome and even death.Acute kidney injury is an independent risk factor which has an influence on patients'prognosis.Currently, the research of biomarkers of AKI is a significant field.Some new biomarkers are found to be charaterised by early appearance in blood or urine, non-traumatic and sensitivity in recent years, which contribute to their applications in early diagnosis of AKI.At present, the biomarkers of early diagnosis of AKI, such as calprotectin, interleukin-18, neutrophil gelatinase associated lipocalin (NGAL), cysteine protease inhibitor C, kidney injury molecule-1 (KIM-1) and cysteine rich 61, are under study.The current basic research and a few clinical studies show that these indicators may have a better sensitivity .

Objective To investigate the effects of cinnamaldehyde and citral on DNA and RNA of Aspergillus flavus and A. fumigatus cells and their mechanisms. Methods A. flavus and A. fumigatus were incubated on Czapeks agar plate (treated with cinnamaldehyde and citral at different concentrations) at 26.5 ℃ for 3—6 d. The normal and treated cells were observed by laser scanning confocal microscope (LSCM) and image analysis to describe the DNA and RNA levels by quantity and localization. Results DNA and RNA levels were changed greatly and multinucleate coniospores appeared in the treated cells. Conclusion Cinnamaldehyde and citral have directly or indirectly interfered the conventional synthesis of fungal hereditary DNA and RNA and normal differentiation of conidiophore in A. flavus and A. fumigatus, thus inhibiting the normal cell cycle and the growth and propagation of fungi.

Objective To evaluate the predictive value of modified early warning score (MEWS) and SMART-COP score on mechanical ventilation in patients with severe influenza A H1N1. Methods Fifty cases diagnosed with severe influenza A H1N1 were retrospectively analyzed. The MEWS and SMART-COP score were calculated. The area under the receiver operating characteristic (ROC) curve (AUC) was evaluated using ROC curve. MEWS, SMART-COP score and AUC were analyzed by Z test. Results The AUCs of MEWS and SMART-COP score for predicting mechanical ventilation were 0. 923 and 0. 889, respectively, which were not significantly different (Z=0. 548, P =0. 584).Conclusion Both of MEWS and SMART-COP score are predictive factors of mechanical ventilation in the patients with severe influenza A H1N1.

Objective To investigate the infection status of Mycoplasma pirum among male HIV/AIDS patients in Jiangsu and analyze the risk factors.The genome sequencing of Mycoplasma pirum was completed for the first time.Methods Male HIV infected individuals and AIDS patients confirmed in Jiangsu province were enrolled for 4 repeated cross-sectional studies by means of detecting the first flow urine sample and venous blood sample collected and questionnaire survey after informed consent.Genome sequencing was conducted for Mycoplasma pirum by using Illumina Hiseq 2000 sequencing platform.Results A total of 1 541 HIV/AIDS patients were surveyed in this study.The infection rates of Mycoplasma pirurm was 15.4％.The patients who received no HAART had higher risk to be infected with Mycoplasma pirum (OR=1.344,95％CI:1.008-1.792).Otherwise,high CD4+T counts was a protective factor for Mycoplasma pirum infection (OR=0.600,95％CI:0.444-0.810).Based on the sequencing result,the genome size of Mycoplasma pirum was 850 704 bp,the GC content was 24.21％ the genome contained 708 genes,the total length of genes was 734 085 bp,the average length was 1 037 bp,accounting for 86.29％ of genome.Conclusion More attention should be paid to the high infection rate of Mycoplasma pirum among male HIV/AIDS patients in the future AIDS prevention and control.The first genome sequencing of standard Mycoplasma pirum strain was completed in this study (registering Serial number:AZHZ00000001),which can provide evidence for the further research of gene function and pathogenic mechanism of Mycoplasma pirum.

Objective To evaluate the mechanical stability of alternative reconstruction methods after total en bloc spon?dylectomy in the lower lumbar spine. Methods Eight adult fresh cadaveric lumbosacral spines (L1-S1) were adopted. Total en bloc spondylecotmy of the L4 vertebra was performed after intact testing. Four designed reconstruction samples were tested for the range of motion (ROM) of the spine:1) expandable artificial vertebral body and short posterior instrumentation at L3-L5 (SP), 2) ex?pandable artificial vertebral body and short posterior instrumentation with additional anterolateral fixation at L 3-L5 (ASP), 3) ex?pandable artificial vertebral body and multilevel posterior instrumentation at L2-S1 (MP), 4) expandable artificial vertebral body and multilevel posterior instrumentation with additional anterolateral fixation at L2-S1 (AMP). Nondestructive biomechanical test?ing was performed on each construct under loading control. The ROM for each construct was obtained by applying pure moments in flexion, extension, lateral bending, and axial rotation. Results In flexion, extension and lateral bending, the ROM of all the re?constructed constructs significantly decreased compared to the intact. The ROM of specimens with anterolateral fixation was less when compared to the ones without additional fixation. In lateral bending, MP (L:1.87° ± 0.32° , R:1.97° ± 0.33° ), ASP (L:1.89° ± 0.37°, R:2.08°±0.36°) and AMP (L:1.32°±0.29°, R:1.61°±0.33°) provided significantly less ROM than the SP (L:3.14°±0.35°, R:3.44°±0.34°). In axial rotation, the ROM of ASP (L:4.21°±0.58°, R:4.02°±0.59°) and AMP (L:3.56°±0.55°, R:3.52°±0.48°) was significant decreased when compared to the intact state (L: 7.47° ± 1.00° , R:7.57° ± 0.84° ). MP (L:6.33° ± 0.71° , R:5.88° ± 0.62°), ASP and AMP showed significantly less ROM than the short posterior fixation (L:9.28°±1.01°, R:9.48°±0.98°). AMP sig?nificantly decreased the ROM compared to MP. Conclusion After total en bloc spondylectomy of lower lumbar, long segmental fixation provided more stability to the construct than the short one. Compared to posterior fixation, circumferential fixations showed a higher stability. In contrast, multilevel segmental instrumentation with circumferential fixation did not provided more stability than the short constructs.

Objective To study the feasibility and safety of total en bloc spondylectomy (TES) for bone tumors of the fourth lumbar spine and evaluate the clinical outcomes.Methods From March 2011 to December 2013,21 patients undergone total en bloc spondylectomy in posterior-only approach were retrospectively reviewed.The patients included 9 males and 12 females,with a mean age of 47.1± 15.6 years old (range,15-71 years old).This series included 12 cases of primary bone tumors and 9 cases of solitary metastases.Preoperative evaluation according to clinical,imaging and pathologic features was performed meticulously to select patients.The length of surgery,estimated blood loss,surgical margins,instrumentation failure,perioperative complications,Frankel scale,visual analogue scale (VAS) for pain,local control rate and overall survival were reviewed and analyzed.Results Total en bloc spondylectomy was performed successfully in all patients.Average operative time and estimated blood loss were 297.6±44.6 min (range,225-420 min) and 2 247.1±904.5 ml (range,900-4100 ml),respectively.The mean follow-up time was 50.4± 17.1 mons (range,24-79 mons).All patients encountered nerve roots stretch and 5 patients (23.8％) showed lower extremeties neurological dysfunction.All of them improved in 2-4 weeks postoperatively and recovered completely at 6-month follow -up.Cerebrospinal fluid leak was found in 4 patients (19.0％).The VAS score was 1.5±1.4 at post-operation,which was significantly lower than the 6.2± 1.6 in average at operation (P=0.008).Three patients with metastatic tumors died during the follow-up.Titanium mesh cage subsidence was observed in 7 patients (33.3％).No implant failure was occurred during the follow-up.Conclusion Total en bloc spondylectomy for tumors of the fourth lumbar spine in a posterior-only approach is feasible.However,there are many intraoperative neurological complications and the indications for TES are extremely limited.

Objective:To propose and verify a surgical classification system for the axial primary malignant and aggressive benign tumor.Methods:The CZH surgical classification system was originally developed for the axial primary malignant and aggressive benign tumor. The CZH surgical classification system includes seven types, according to the anatomic features and the extension of tumor violation. A total of 136 patients (79 males and 57 females) with axial primary malignant and aggressive benign tumor from multiple tertiary centers who received surgery from July 2006 to July 2019 were included. The average age was 44.40±17.55 years (8-83 years) old. There were 99 malignant tumors and 37 aggressive benign tumors included. The number of patients with each classification was presented as followed, Type I 13, Type II 15, Type IIIa 3, Type IIIb 20, Type IVa 43, Type IVb 12, Type Va 21, Type Vb 3, Type VI 2, Type VIIa 3 and Type VIIb 1. Surgical procedures were selected according to different types in classification. The inter- and intra-observer consistencies were evaluated by the Kendall's W test. The VAS, Frankel score, overall survival and recurrence free survival were recorded during the follow-up. Results:The inter- and intra-observer consistent coefficient was 0.973 and 0.996, respectively ( P<0.05). The single posterior approach was adopted for the Type II tumors. Other patients underwent surgery by the combined antero-posterior approach. The majority in anterior approach (113 cases) was the modified submandibular approach. The reconstruction modes included anterior "T" shape titanium mesh (112 cases) or the 3D printed prothesis (7 cases) combined with the posterior occipto-cervical fusion (92 cases) or the pedicle screw system (44 cases). The average surgical duration and the volume of intraoperative bleeding was 348.40±136.14 min (60-760 min) and 1 225.69±859.40 ml (80-4 000 ml), respectively. The operation duration and volume of intraoperative bleeding among each type were with statistical difference. The patients with Type IV, V tumors had longer operation duration than those with Type II tumors. Those with Type V and VII tumors had longer operation duration than those with Type I tumors. The patients with Type V tumors had more intraoperative bleeding than those with Type I-IV tumors. The average preoperative VAS score was 4.15±2.25 and then was reduced significantly to 0.62±0.71 and 0.38±0.59 at one and three months after operation, respectively. The Frankel score was also significantly ameliorated at one and three months postoperatively. There were 22 postoperative complications (16.2%). The complications included cerebral spinal fluid leak (12.5%), dysphagia and/or dysphonia (7.4%), dyspnea (5.1%), wound infection (3.7%), wound hemorrhage (2.2%) and pharyngeal dehiscence (1.5%). The incidence of postoperative complication was 25.9% in Type IV-VII tumors, while 11.8% in Type I-III tumors. Conclusion:CZH surgical classification system was verified with high observer consistency. This classification system could assist surgeons to select proper surgical approaches, resection modes and reconstruction modes, and thus ensure the safety of surgery and reduce the recurrence. The tumors in Type IV, V and VII may be with more challenging for surgeons. The incidence of postoperative complication in Type IV-VII tumors may be higher than that in Type I-III tumors.

Endogenously eliminating the hematoma is a favorable strategy in addressing intracerebral hemorrhage (ICH). This study sought to determine the role of retinoid X receptor-α (RXR-α) in the context of hematoma absorption after ICH. Our results showed that pharmacologically activating RXR-α with bexarotene significantly accelerated hematoma clearance and alleviated neurological dysfunction after ICH. RXR-α was expressed in microglia/macrophages, neurons, and astrocytes. Mechanistically, bexarotene promoted the nuclear translocation of RXR-α and PPAR-γ, as well as reducing neuroinflammation by modulating microglia/macrophage reprograming from the M1 into the M2 phenotype. Furthermore, all the beneficial effects of RXR-α in ICH were reversed by the PPAR-γ inhibitor GW9662. In conclusion, the pharmacological activation of RXR-α confers robust neuroprotection against ICH by accelerating hematoma clearance and repolarizing microglia/macrophages towards the M2 phenotype through PPAR-γ-related mechanisms. Our data support the notion that RXR-α might be a promising therapeutic target for ICH.