Objective To observe the effects of simvastatin combined with aspirin on the heart allograft and detect its mechanism. Methods Heterotopic heart transplantation was performed from Wistar to Sprague-Dawley (SD) rats. All SD rats were randomly assigned to Sham; HT (heart transplantation); HT + simvastatin(HT + S);HT + aspirin (HT + A); HT + aspirin + simvastatin (HT + A + S) group at different time points (day 3, 7, 10, 15, 20, 30 and 40) after transplantation (n=20). eNOS expression was detected by immunohistochemical methods and NO levels was measured by Griess assay. Meanwhile , the analysis of CD4+CD25+Tregs was performed by flow cytometry and histological examination for pathological change of heart and vascular. Results Simvastatin combined with aspirin significantly prolonged the mean survival time of heart allografts in HT + A + S group to (39 ± 5.3) days (n = 19) and in HT group to (8 ± 1.2) days (n = 18) (P < 0.001); simvastatin combined with aspirin delayed pathological changes of the transplanted hearts and protected vascular damage; simvastatin combined with aspirin upregulated eNOS and enhanced NO secretion. The level of CD4+CD25+Tregs in the blood of HT + A + S rats was significantly increased (2.2 ± 0.5)%, (2.9 ± 0.8)%, (4.3 ± 1.0)%, (8.3 ± 1.7)% and (14.3 ± 3.7)% for sham, HT, HT + S, HT + A and HT + A + S group respectively, HT vs. HT + A (P < 0.05) or HT + A + S (P < 0.01). Conclusion Simvastatin combined with aspirin delays the development pathology of myocardial and vascular damage and prolongs the survival time of cardiac allograft. The responsible mechanism is associated with activating CD4+ CD25+ Treg cells induction immune tolerance and enhancing vascular endothelial cell protection.

Objective To investigate the effect of splenectomy on peripheral lymphocyte apoptosis and CD4+ CD25+ Treg cells in rat with heart transplantation. Methods Abdominal heterotopic heart transplantation was performed from Wistar (donors) to SD (recipients) rats. Splenectomy was done at the same time in recipients (heart graft splenectomy group), non-splenectomy recipients (heart graft group), single splenectomy in SD rats (spleneetomy group), and SD rats (no operation) were designed as the control group. The transplanted hearts and peripheral blood in each group were collected on the 1st, 3rd, 5th and 7th day after operation. Histopathological and ultrastructural changes in transplanted hearts were observed by microscope and electronic microscope. Apoptosis rate of peripheral lymphocytes and CD4+ CD25+ Treg cells were measured by flow cytometry. The expression of Foxp3 mRNA in CD4+ CD25+ Treg cells was detected by RT-PCR, and survival time of the transplanted hearts was recorded. Results The survival time of the transplanted hearts in heart graft splenectomy group was 17.63±4.54 days, significantly longer than that in heart graft group (7.47±2.24 days) (P<0.05). The transplanted hearts in heart graft group were swelling, hard, dark, with interstitial edema, hemorrhage, diffuse infiltration of inflammatory cells, necrosis and cytolysis of a lot of myocardial cells, blurred cross striations; The transplanted hearts in heart graft splenectomy group were soft, red, partially gray white, with focal edema of subepicardial cells,infiltration of inflammatory cells, intact myocardial cell structure, and clear cross striations; Compared to heart graft group, the ultrastructural changes of transplanted hearts in heart graft splenectomy group were lighter significantly. On the 5th and 7th day after operation, apoptosis of peripheral lymphocytes in heart graft splenectomy group was (7.62±2.15)% and (9.41±3.82)% respectively, significantly higher than in heart graft group (both P<0.05). On the 3rd, 5 th and 7th day after operation, the number of CD4+ CD25+ Treg cells in heart graft splenectomy group was more (all P<0.01), and the expression level of Foxp3 mRNA higher than in heart graft group. Conclusion Splenectomy can increase apoptosis rate of peripheral blood lymphocytes and the number of regulatory T lymphocytes, and up-regulate the Foxp3 mRNA regulation in rats with heart transplantation, which has a negative correlation with pathological changes of transplanted hearts.

Pancreatic enzyme replacement therapy is given to manage pancreatic exocrine insufficiency (PEI) in cystic fibrosis (CF) and following pancreatectomy, total gastrectomy or chronic pancreatitis. The article reviews on aspects of pancreatic enzyme replacement therapy containing the assement of pancreatic exocrine function, the pathogenesis of exocrine pancreatic insufficiency, pancreatic enzyme preparations and their efficiency, dosing of pancreatic enzymes, enteral nutrition and pancreatic enzyme replacement, the modulation of pancreatic exocrine and adverse reactions to pancreatic enzyme.

This study aimed to review the improvement of artificial joint materials to search ideal materials for artificial joint. The developing process of metal artificial joint, high polymer artificial joint, ceramic-made artificial joint and compound material artificial joint was introduced and the material surface processing was explored. Selection of materials for artificial joint is determined by many factors. Each material has the specific benefits and drawbacks, so we can improve their performance by certain processing. Although there are many studies about materials for artificial joint, no ideal material is identified. To develop the materials for artificial joint with high mechanical strength, good biocompatibility, strong abradability and long-term service life is the focus in future bone tissue engineering.

ObjectiveTo investigate the amount of bacteria and the expression of amylase and lipases in the drainage fluid in patients with intestinal fistulas with time courses.MethodsThe samples were collected from 16 patients with high intestinal fistulas from July 1998 to January 2008.The amounts of bacteria from the drainage fluid were measured 0,2 and 4 hours after taking out from the patients.At the respective time points,the intestinal juices were also collected to measure the amylase and lipase expressions.After reinfusion of succus entericus,thelevels of albumin,prealbumin,transferring,and fibronectin were measured at 0,7,and 14 days,ResultsThere was no significant increase of bacteria in the drainage fluid within 4 hours ( F(0,2) =18 812.50,P ＞ 0.05 ; F(0,4) =387 625.00,P ＞ 0.05).and there was no change in the expressions of amylase ( F(0,2) =190.60,P ＞ 0.05 ;F(0,4) =631.75,P＞0.05) and lipase within 4 hours (F(0,2) =204.10,P＞0.05; F(0,4) =1080.05,P＞0.05).After succus entericus reinfusion,the fibronectin (F(0,14) =74.24,P ＜ 0.01 ; F(7,14) =59.78,P ＜0.01),transferring (F(0,14) =0.46,P ＜ 0.01 ; F(7,14) =0.39,P ＜ 0.05 ),and prealbumin ( F(0,14) =54.37,P ＜ 0.05) were increased significantly.ConclusionsBacteria and enzymes do not increase in the drainage fluid within 4 hours in patients with intestinal fistulas.Therefore,it is safe and effective to reinfuse succus entericus.

ObjectiveTo observe the effect of succus entericus reinfusion with continuous enteral nutrition on the barrier function of intestinal mucosa and nutritional status in patients with stomal type fistulas. Methods Sixteen patients with stomal type fistula from July 1995 to May 2008 were enrolled in the study. A]l patients met the following conditions: gut function returned normal; abdominal infection was controlled; total enteral nutrition was provided ; and the length of small intestine for succus entericus reinfusion was more than 50 cm. Intestinal mucosa was taken at 25 to 30 cm away from stoma of fistula by endoscope 0, 7, and 14 days after reinfusior. Hematoxylineosin staining was performed to count the number of intestinal intraepithelial lymphocytes (IIELS). In addition,proliferating cell nuclear antigen (PCNA) was measured with immunohistochemical staining. Serum protein levels were determined by immunonephelometry. ResultsThe percentage of IIELS in intestinal mucosa ( 19.06％ ±4.81％ vs. 12.81％ ±2.95％, P=0.000) and the percentage of PCNA positive cells ( 12.13％ ±4.33％ vs.6.44％ ± 2.34％, P =0.000) 14 days after succus entericus reinfusion were significantly higher than those on the day of reinfusion. Serum fibronectin level increased from ( 152.80 ± 16.50 ) to ( 227.05 ± 45.36 ) mg/L ( P =0.000), and transferring protein level increased from ( 2.16 ± 0.52 ) to ( 2.62 ± 0.41 ) g/L ( P =0.017 ) 14days after succus entericus reinfusion. ConclusionSuccus entericus reinfusion is effective in protecting the intestinal mucosa in patients with stomal type fistulas.

BACKGROUND: The bone marrow stem cell (MSC) transplant treatment have the obvious superiority to tradition graft treatment for bone nonunion, but how to obtain the concentrated and highly effective bone marrow mesenchymal stem cell, as well as the dose-effect relations to fracture healing need further discussions. OBJECTIVE: To observe the curative effect of bone nonunion by using autologous MSC transplant treatment, and to compare with autologous iliac bone graft.DESIGN, TIME AND SETTING: Randomized controlled analysis was performed from January 1999 to June 2005 in the Affiliated Second Hospital of Hebei Northern College.PARTICIPANTS: The admitting 140 patients with humerus and tibia fracture were divided into 2 groups at random, autologous iliac bone graft group and autologous MSC transplant group, with 70 patients in each group. METHODS: Under aseptic condition, autologous MSC transplant group received puncture through posterior superior iliac spine, extracting bone marrow 10-20 mL from different spots, separating MSC using the density gradient centrifugation method, and counting as 4×10~9 nucleated cells/mL under the microscope for later use. In the autologous iliac bone graft group, bone fracture end was implanted with the suitable amount of iliac bone, while autologous MSC transplant group with the mixture of decalcified bone matrix and MSC, followed by suture. After the transplantation, external fixation may assist for 4-6 weeks according to the fixed degree of internal fixation.MAIN OUTCOME MEASURES: ① Bone callus formation and pain conditions in 2 groups at different time points after transplantation. ② Comparison of bone healing time between 2 groups. ③ Adverse events and side effects.RESULTS: According to intention-treatment analysis, experimental adopted 140 patients of humerus and tibia fractures, who all entered the final analysis. ① Bone callus formation and pain at different time points post-surgery: At 1 month after transplantation, bone callus formation in the fracture end was not obvious in autogenous iliac bone graft group, and could be seen in autologous MSC transplant group, both groups of fractures exhibited tenderness. At 2 months after transplantation, bone callus formation was observed in autogenous iliac bone graft group, fracture tenderness was relieved compared with the previous condition; in autologous MSC transplant group, a large number of bone callus formed, fracture tenderness was not obvious. At 3 months after transplantation, there were a large number of bone callus formations in autogenous iliac bone graft group, with slight fracture tenderness; in the autologous MSC transplant group, continuous bone callus formation appeared, without fracture tenderness. ② Bone healing time: The average healing time of autologous MSC transplant group was significantly shorter than autogenous iliac bone graft group [(5.5±1.5), (8.0±2.0) months, P < 0.05]. ③ Adverse events and side effects: Except 4 patients had iliac bone pain, all patients during the treatment had no infection and other complications, there were no re-fracture occurred at the follow-up of 8 months.CONCLUSION: The autologous MSC transplant treatment of exhibits a short duration and good effect for bone non-union, has obvious advantages over traditional bone graft.

Objective To investigate the clinical effect of percutaneous autogenous bone marrow stem cell transplant on bone nonunion. Methods 140 patient with bones nonunion were divided into the autogenous bone transplants (A) group and the autogenous bone marrow stem cell transplant (B) group, with 70 cases in each group. They were assessed 2 and 5 months after operation. Results A few calluses could be observed at the end of fracture in 42 cases in group A 2 months after operation, and massive callus formation could be observed in 46 cases 5 months after operation. However, massive callus formation could be observed in 60 cases in group B 2 months after operation, and continual callus formation could be observed in 45 cases 5 months after operation. The mean healing time was (8.4±1.8) months in group A, and (6.5±2.0) months in group B (P<0.05). No side-effects have been observed during the treatment. Conclusion The percutaneous autogenous bone marrow stem cell transplant is more effective on bone nonunion compared with the traditional treatment.

Objective To study the effect of assistive functional rehabilitation exercise on cardiac functioning of patients with chronic heart failure (CHF). Methods Sixty CHF patients were divided randomly into a treatment group (the rehabilitation group) and a control group, with 30 in each group. All the patients were administered routine therapy. In the treatment group, the patients were administered rehabilitation exercises with the assistance of a electric equipment made by the authors, daily for 5 days a week for a total of 3 months. The New York Heart Association (NYHA) cardiac function grading, the left ventricular ejection fraction(LVEF), the left ventricular end diastolic diameter (LVEDD) and the brain natriuretic peptide (BNP) level in plasma as well as the 6 min walking range were observed in both groups before and after treatment. Results After 3-months of treatment, the NYHA grading, LVEF, LVEDD, BNP level in plasma and 6 min walking range were all significantly improved in both groups when compared with those before the treatment, with the treatment group improved to a significantly larger extent than the control group ( p<0.05 ). Conclusion Assistive rehabilitation exercise in addition to the routine therapy can significantly help improve the cardiac function in CHF patients.

Objective To evaluate the significance of contrast medium (CM) volume and estimated glomerular filtration rate (CM/eGFR) in predicting contrast-induced nephropathy (CIN) after PCI. Methods A total of 307 patients after PCI were enrolled from Nanfang Hospital from May 2014 to October 2015. The patients were divided into the CIN group(n = 29) and the non-CIN group(n = 278) according to whether CIN within 72 hours after PCI. The baseline renal function was assessed by the sCr and CyC, respectively. Results Twenty-nine patients (9.4%, 29/307) developed CIN. There were significant differences in Age, CM、NTpro-BNP、IABP、 Periprocedural Hypotension、Preprocedural sCr/CyC between two groups (P < 0.05, respectively). The result of multivariate logistic regression analysis showed that Age, Cardiac function ≥Ⅲ level, IABP, use CCB, CM/eGFRMDRD, CM/eGFRCyC were independent risk predictors for CIN, respectively. Receiver Operating Characteristic (ROC) curve analysis showed that the area under the curve of CM/eGFRMDRD(AUC = 0.838) was superior to CM/eGFRCyC (AUC = 0.805) without significant difference. The sensitivity and specificity were 79.3%and 76.3%(Cut-off Point = 2.094), respectively. Conclusion Both the CM/eGFRMDRD and CM/eGFRCyC may be good methods to determine maximum CM before PCI and to predict CIN after PCI currently, without significant differences between these two predictors.