BACKGROUND:As the potent, specific immunosuppressants emerge, the survival rate after intestinal transplantation is improved to some extent. However, the adverse effects of immunosuppressants and expensive treatment costs are not tolerable for many patients. Therefore, it is clinical y meaningful to choose traditional Chinese medicine which presents immunosuppressive effects. Artesunate has immune suppression effect, reduces acute rejection fol owing smal intestine transplantation, and improves the success rate of smal intestine transplantation.
OBJECTIVE:To observe the effect and action mechanism of artesunate in acute rejection after smal intestine transplantation in rats.
METHODS:Al ogeneic smal intestine transplantation models were established in the closed group of
Sprague-Dawley rats and Wistar rats, and then were randomly divided into three groups, syngenic transplantation group (SD→SD), al ogeneic transplantation group (Wistar→SD), and artesunate treatment group (Wistar→SD+artesunate 60 mg/kg per day, intraperitoneal injection).
RESULTS AND CONCLUSION:Rats in syngenic transplantation group survived for more than 10 days and they were al kil ed on day 10. The average survival of rats in al ogeneic transplantation group and artesunate treatment group was respectively (6.73±0.58) days and (8.50±0.74) days, with significant differences between the two groups (P<0.01). Histopathological examination showed that, there was no apparent rejection in syngenic transplantation group specimens, but mild, moderate and severe rejections in al ogeneic transplantation group on days 3, 5, 7. In treatment group, some specimens had mild rejection, but appeared relatively late to a low degree. Enzyme linked immunosorbent assay results revealed that, serum interleukin-2 and interferon-gamma expression levels in al ogeneic transplantation group were significantly higher than other two groups after surgery (P<0.01), serum interleukin-2 gene expression level in treatment group was also higher than syngenic transplantation group, but there was no significant difference (P>0.05), serum interferon-gamma expression level in treatment group was higher than syngenic transplantation group (P<0.05). Artesunate can inhibit acute rejection after rat smal intestine transplantation, and its mechanism may be related to inhibition effect on the secretion and expression of interleukin-2, interferon-gamma and other cytokines.

Objective To systematically assess the relation between angiotensin-I converting enzyme(ACE) gene insertion/deletion (I/D) variation and type 2 diabetic nephropathy (T2DN) onset risk among Chinese population.Methods The related literatures were retrieved from the China National Knowledge Infrastructure (CNKI) and Wanfang Data until June 1st,2016.The RevMan 5.0 was used to conduct the statistical analysis.The merge OR value and corresponding 95% confidence interval(95%CI) were used to assess ACE gene I/D polymorphism and T2DN onset risk.Results Totally 29 papers with 4 357 subjects were included according to the inclusion and exclusion standard,including 2 208 cases of DN and 2 149 cases of T2DM without DN.Meta analysis showed that compared with ACE gene I/D polymorphism I allele,D allele could significantly increase the risk of T2DM patients suffering from DN,the OR value and corresponding 95%CI were 1.44(1.25,1.66);the gene analysis showed that ACE gene I/D polymorphism loci were significantly correlated with DN onset risk in the Asian population.The corresponding relative onset risk OR and 95%CI were 1.42(1.15,1.76) and 1.75(1.46,2.10) in the dominant and recessive genetic model.The Begg′s test showed that the included data had no obvious publication bias existence.Conclusion ACE gene I/D polymorphism is closely correlated with the onset risk of T2DN,and D allele might be a risk genetic factor for DN occurrence in the patients with T2DM.

Objective To summarize the common types and clinical characteristics of ureter disease;which can increase manipulation difficulties and adverse events during rigid ureteroscopic procedures. Methods From Jan 2001 to Dec 2010,our team performed 317 rigid ureteroscopic Drocedures for ureteroscopic examination or treatment;including 60 difficult procedures(34 male and 26 female).The mean age of the patients was 37 years (range,18 to 71).The ureteral diseases were classifted into five types according to the pathological characteristics:Type Ⅰ calculous stenosis,Type Ⅱ neoplastic stenosis;Type Ⅲ non-congenital stenosis,Type Ⅳ congenital stenosis,Type Ⅴ expansion of tortuous ureters.The operative time,complications,and conversion to open surgery were evaluated,and the therapeutic methods were analyzed. Results Of the 60 difficuhly-manipulated procedures,the mean manipulated time was 75 min (range,31 to 200).Intra-operative complications occurred in 9 procedures,including 4 cases of mucosal bleeding,2 cases of submucosaI false passage and 3 cases of ureteral perforation.Eleven procedures were converted to open surgery. In five procedures only a double J tube was inserted for drainage due to the difficulty of entering the ureter.Fiftyfive patients were followed up for 17 months (range,3 to 110);48 patients were cured,5 patients improved and 2 patients were unchanged. Conclusions The five types of ureteral disease can increase operative difficulties and risks of rigid ureteroscopic procedures.We should be cautious during surgery and should stop manipulation or convert to other surgeries if necessary.

ObjectiveTo explore and analyze the effect of simulation-based learning combined with debriefing in neonatal resuscitation training.MethodsA total of 114 clinical medical staffs attended the neonatal resuscitation training course hold by Department of Neonatology, Quzhou Maternal and Child Health Hospital from November 2014 to May 2015, and were randomly assigned to observation (n=60) and control group (n=84) by coin tossing. Staffs in the observation group adopted to training skills with simulation-based learning combined with debriefing,while those in the control group were educated with traditional method. The examinations on theoretical knowledge were taken before and after the training. Operational exam and self-confident questionnaire for all staffs on each procedure taught in the course were taken at last. Scores of the exams and self-confident questionnaire were compared between the two groups witht-test and Mann-WhitneyU test.ResultsThe mean score of theoretical test rose up significantly after the training in both observation and control group (25.19±2.62 vs 20.17±3.71,t=7.725,P<0.01; 25.44±2.64 vs 18.90±4.27,t=11.170,P<0.01), but no difference was found in this score after the training between the two groups (t=0.492,P=0.624). The practical operation examination score in the observation group was higher than that in the control (34.05±1.34 vs 31.32±4.10,t=4.183,P<0.01). All questionnaires sent to the staffs were retrieved (100%), and the total values after the training in the observation group were higher than in the control (mean rank: 92.81 vs 57.99; rank sum:5 569 vs 4 872,Z=-4.96,P<0.01).ConclusionsSimulation-based learning combined with debriefing is a much more effective teaching methods for neonatal resuscitation training, which might quickly improve the resuscitation skills of clinical staffs.

Abstract: Objective　To identify the species of Mycobacteroides abscessus complex (MABC) in patients with pulmonary infection from the Second Affiliated Hospital of Hainan Medical University, and to investigate the species types, drug sensitivity and population distribution of MABC in pulmonary infection in Hainan. Methods　Respiratory tract specimens were collected from suspected tuberculosis patients who visited the Second Affiliated Hospital of Hainan Medical University from January 2014 to December 2021 and cultured for Mycobacterium isolation. Non-tuberculous mycobacteria (NTM) strains were preliminarily identified by p-nitrobenzoic acid/thiophen-2-carbohydrazide (PNB/TCH) medium and DNA microarray chip, and then MABC and its subspecies were identified by hsp65 and rpoB gene sequencing. In vitro antimicrobial susceptibility test was performed by broth microdilution method. Results　A total of 3 025 respiratory specimens from suspected pulmonary tuberculosis patients were collected during the study period. Among the 123 patients with identified MABC isolates, 124 MABC strains were isolated and identified, including 74 strains of Mycobacteroides abscessus subsp. abscessus, 38 strains of Mycobacteroides abscessus subsp. massiliense and 12 strains of Mycobacteroides abscessus subsp. bolletii. Among them, 118 patients had single MABC subspecies infection, one patient had mixed infection with two MABC subspecies, two patients had mixed infection with MABC and other NTM, and two cases had mixed infection with MABC and M.tuberculosis. There were more female patients than male patients with a ratio of 1:0.64, and those aged 50 and above amounted to 76.42% (94/123, 95%CI: 67.93%-83.61%). There was no significant difference in age distribution between male and female patients (Z=-0.944, P=0.347). The drug susceptibility results showed that all MABC strains were sensitive to Tigecycline (TGC), with a resistance rate of 0.81% (1/124) to Amikacin (AK), and resistance rates of 6.45% (8/124), 32.26% (40/124), and 74.19% (92/124) to Cefoxitin (FOX), Linezolid (LZD), and Imipenem (IPM), respectively. For Clarithromycin (CLR), MABC showed induced resistance , and there was a statistically significant difference in the CLR (14D) resistance rates among the three subspecies (χ2=66.335, P<0.001). The resistance rates to Tobramycin (TOB), Doxycycline (DOX), Moxifloxacin (MFX), Ciprofoxacin (CIP), Trimethoprim/Sulfamethoxazole (TMP-SMX), and Amoxicillin/Clavulanic acid (AMC) were high, all >80%. Conclusion　 In Hainan Province, pulmonary infections with MABC are mainly caused by Mycobacteroides abscessus subsp. Abscessus, which show high rates of inducible resistance to CLR. Timely and accurate identification of MABC to subspecies and drug susceptibility testing are of significant important for clinical decision-making.

Objective To isolate, culture and identify mouse umbilical cord mesenchymal stem cells( mUCMSCs) and to study whether they can be induced to differentiate into adipocytes, chondrocytes and osteoblasts.Methods The mUCMSCs were isolated and expanded by adherent culture from fresh mouse umbilical cord.The morphological characteris-tics of the resulting cells were observed under inverted phase contrast microscope, and their expression of mesenchymal sur-face markers was identified and analyzed by flow cytometry.Then mUCMSCs were induced to differentiate into chondro-cytes, adipocytes and osteoblasts in vitro.Results Fibroblast-like cells could be isolated from the fresh umbilical cord by adherent culture.These adherent cells highly expressed mesenchymal markers including CD29, CD90 and CD105 while low expression of CD34.The cells were successfully induced to differentiate into chondrocytes, adipocytes and osteoblasts. Conclusions The mUCMSCs isolated from fresh mouse umbilical cord by adherent culture have potential of differentiation into chondrocytes, adipocytes and osteoblasts.

Objective: To investigate the effects of Tacrolimus(FK506) and Puromycin aminonucleoside(PAN) on apoptosis and expression of α-actinin-4 mRNA and protein in mouse glomerular podocytes in order to explore the protective effect of FK506 on podocytes. Methods: Mouse glomerular podocytes were cultured in vitro, and the control group, PAN group and FK506 group were established.After 8 h, 24 h and 48 h of treatment, the cell morphology was observed and the apoptosis rate was detected.The cells were collected by real-time PCR and Western blot was used to detect the mRNA and protein expression of α-actinin-4. Results: The cell body area of the PAN group was significantly smaller than that of the control group, and the cell area of the FK506 group was larger than that of the PAN group.There was no significant difference in the rate of podocyte apoptosis between those groups at 8 h (all P>0.05). At 24 h and 48 h, the apoptotic rate of podocytes in PAN group[(8.21±0.41)%, (16.32±0.17)%] were significantly higher than those in the control group[(4.28±0.35)%, (6.27±0.28)%], and the differences were significant (all P<0.05). The apoptosis rate of podocytes in FK506 group[(6.26±0.24)%, (13.32±0.24)%] were significantly lower than those in PAN group, and the differences were significant (all P<0.05). At 8 h, there was no significant difference in the expression of α-actinin-4 mRNA and protein(all P>0.05). The expression of mRNA (2.42±0.21, 3.78±0.25) and protein(0.77±0.04, 1.22±0.10) in the PAN group was significantly higher than mRNA(1.50±0.22, 2.15±0.15) and protein(0.44±0.03, 0.83±0.07) in the control group at 24 h and 48 h, and the differences were significant (all P<0.01). The expression of mRNA (1.65±0.24, 1.70±0.32) and protein (0.52±0.05, 0.56±0.07) in FK506 group was significantly lower than that of PAN group, and the differences were significant (all P<0.05). Conclusions FK506 can effectively inhibit the damage of PAN on podocytes and stabilize the expression of α-actinin-4, which provides a basis for the clinical application of FK506 in the treatment of glomerular diseases.

Objective:To investigate changes in mRNA and protein expression of interleukin-27(IL-27)in glomerular podocyte injury caused by Puromycinonucleoside(PAN), and to explore the mechanism of the protective effect of Tacrolimus(FK506)on glomerular podocyte injury.Methods:Glomerular foot cells from mice were cultured in vitro and divided into 3 groups, which were the control group, PAN group and FK506 group.The morphology of 3 groups of foot cells was observed under a microscope after 8 h, 24 h, and 48 h treatment.The changes in IL-27 concentrations were detected by analyzing the enzyme-linked immunosorbent assay(ELISA)method.The cultured foot cells were then collected.The changes of IL-27 mRNA expression were measured by real-time fluorescence quantitative PCR(qPCR), and the changes of IL-27 protein expression were detected by Western blot. Results:(1)At each time point(8 h, 24 h, 48 h), the cells of the PAN group had smaller volume and different morphology than the cells of the control group, and the cells of the FK506 group was larger and fuller than the cells of the PAN group.(2)The concentrations of IL-27 in the PAN group [(110.00±3.52) ng/L, (302.00±6.23) ng/L, (397.00±8.92) ng/L] were significantly higher than those in the control group [(90.00±5.12) ng/L, (85.00±4.21) ng/L, (88.00±4.20) ng/L] and those in the FK506 group [(96.00±4.17) ng/L, (107.00±4.86) ng/L, (112.00±6.24) ng/L] at 8 h, 24 h and 48 h(all P<0.05). (3)At each time point(8 h, 24 h, 48 h), the IL-27 mRNA expression of the PAN group(1.25±0.11, 1.57±0.08, 1.73±0.13)was significantly higher than that of the control group(1.02±0.02, 1.10±0.04, 0.96±0.02)(all P<0.05). Compared with the control group, the IL-27 mRNA expression of the FK506 group did not significantly increase at 8 h (1.10±0.06), and showed a slight increase at 24 h and 48 h(1.21±0.04, 1.30±0.09). Compared with PAN group, HC506 group were all lower (all P<0.05). (4)At each time point(8 h, 24 h, 48 h), the expression of IL-27 protein in the PAN group(0.94±0.04, 1.56±0.07, 1.63±0.04) was significantly higher than that in the control group(0.83±0.04, 0.85±0.03, 0.83±0.05), there was significant difference(all P<0.05). Compared with the PAN group, the expression of IL-27 protein in the FK506 group(0.84±0.05, 0.89±0.04, 0.91±0.06)was not significantly different at 8 h, but decreased significantly at 24 h and 48 h, there was significant difference ( P<0.05). Conclusions:IL-27 is involved in the pathogenesis of kidney diseases.FK506 can prevent the glomerular podocyte injury by reducing the expression of IL-27.This study provides experimental basis for clinical application of FK506 in the treatment of kidney diseases.

OBJECTIVE: To explore the relationship between the chronic periodontitis (CP) and the depression-anxiety psychological factors. METHODS: Thirty-one patients and 29 age, gender-matched volunteers were enrolled for this study. In order to assess the depression-anxiety psychological index, the subjects filled the questionnaire regarding the demographic and socioeconomic information, the oral hygiene habit, the Center for Epidemiologic Studies Depression Scale (CES-D) and the Self Rating Anxiety Scale(ASA). Calculus index (CI), bleeding on probing (BOP), probing depth (PD), clinical attachment loss (CAL), furcation involvement (FI) and tooth mobility were assessed at 6 sites per tooth of all erupted teeth by a manual periodontal probe. The data were analyzed by the analysis of variance, χ(2) test, and multivariable logistic step wise analysis via the software of SPSS 15.0. RESULTS: The mean CAL of the control group was 0.46 ± 0.16,the mean CAL of the moderate, high, and severe CP group was 2.84 ± 0.12, 3.51 ± 0.34, and 4.71 ± 0.51, respectively, which is significant difference between each other (P<0.01). The depression index of the volunteers, the moderate CP, the high CP, and the severe CP was 30.52 ± 3.73, 35.83 ± 7.76, 37.25 ± 6.16, 37.82 ± 5.94, respectively. The anxiety index among the 4 groups was 26.69 ± 3.55, 37.67 ± 6.31, 32.87 ± 5.54, and 35.94 ± 6.30, respectively. The depression and anxiety indexes of the periodontitis groups were higher than those of the control (P<0.01) while there was no significant difference among the 3 CP groups (P>0.05). The multivariate logistic analysis of the relationship between CP and the depression-anxiety psychological factors showed that the depression psychological factor was B=2.301,OR=9.988 while the optimistic coping style was B=-5.174,OR=0.006 in the equation of the regression. CONCLUSION The depression psychological factor was related to the progression of CP. In addition, the optimistic coping style could prevent the progression of the CP.
Anxiety ; complications ; psychology ; Chronic Periodontitis ; etiology ; psychology ; Depression ; complications ; psychology ; Female ; Humans ; Logistic Models ; Male ; Surveys and Questionnaires

Objective To study the curative efficacy and safety of single-unit umbilical cord blood transplantation (sUCBT) for malignant hematologic diseases,which is provided by China's public cord blood bank.Methods We retrospectively analyzed 409 cases of malignant hematologic diseases who accepted myeloablative single-unit unrelated donor UCBT without ATG at our center between May 2008 and December 2016.A comparative analysis was made on the total nuclear cells (TNC) of the umbilical cord blood before freezing and after thawing,the cells of CD34+,the recovery rate of cells and the clinical effect of UCBT.Result 409 units of umbilical cord blood used in UCBT respectively came from eight China's public cord blood banks.The average TNC of 409 units of umbilical cord blood before freezing and after the tubular recovery were respectively 18.5 × 108 and 16.34 × 108 (p =0.000).The average recovery rate of the tubular recovery was 88.5％,and there was significant difference among cord blood banks (P =0.000).The average TNC of umbilical cord blood before freezing and transfusion were respectively 18.5 × 108 and 15.86 × 108 (p =0.000).The average recovery rate of umbilical cord blood transfusion was 85.9％,with the difference being significant among cord blood banks (P =0.000).The average number of CD34+ cells before freezing and after the tubular recovery was 11.18 × 106and 8.68 × 106 (p =0.000).The average recovery rate of CD34+ cells after the tubular recovery was 80.75 ％,with the difference being significant among the cord blood banks (P =0.000).At 42nd day after UCBT,the cumulative incidence of neutrophil engraftment was 95.4％,and the median time of the engraftment was 17 days (11-38 days).The cumulative incidence of platelet engraftment at 120th day was 84.6％,and the median time of the engraftment was 36 days (14-93 days).The cumulative incidence of erythrocyte engraftment at 60th day was 92％,and the median time of engraftment was 22 days (9d-60 days).After the umbilical cord blood provided by each bank was used in UCBT,it got the difference in cumulative incidence of engraftment.The P values for cumulative incidence of neutrophil,platelet and erythrocyte engraftment were respectively 0.004,0.01 and 0.000 2,with the differences being statistically significant.At 100th day after UCBT,the cumulative incidence of Ⅱ-Ⅳ and Ⅲ-Ⅳ degrees of acute graft-versus-host disease (aGVHD) was respectively 28.63％ and 15.7％.After umbilical cord blood provided by each bank was used in UCBT,it got the difference in cumulative incidence of aGVHD.There was no significant difference between Ⅱ-Ⅳ and Ⅲ-Ⅳ degrees (P =0.809 and 0.68 respectively).At 3rd year after UCBT,the cumulative incidence of relapse was 15.89％.After umbilical cord blood provided by each bank was used in UCBT,there was no significant difference in the cumulative incidence of relapse (P =0.898).At 3rd year after UCBT,the overall survival (OS) rate and disease free survival (DFS) rate were respectively 66.7％ and 59％.After umbilical cord blood provided by each bank was used in UCBT,it got the difference in OS and DFS.There was no significant difference in OS and DFS (P =0.566 and 0.703 respectively).At 3rd year after sUCBT,the rate of graft-versus-host diseases/relapse-free survival (GRFS) was 54.3％.After umbilical cord blood provided by each bank was used in UCBT,there was no significant difference in the rate of GRFS (P =0.449).Conclusion The umbilical cord blood provided by China's public cord blood bank was used in UCBT.It has a high safety and good efficacy in treating malignant hematologic diseases.But it needs to set up the standardized and normalized quality-control system of umbilical cord blood for China's public cord blood bank.