Leptospirosis is an important zoonosis with worldwide distribution. As the first procedure in immunity system, the role and significance of innate immunity in controlling infection at the early stage of the disease have gradually been emphasized. Macrophages can phagocytize and kill leptospira, while the pathogenic leptospira can evade the killing by macrophages. In addition, neutrophils, complement system and cytokines also contribute to the defence of leptospira infection.

Objective To analyse the economies of scale in public hospitals in Zhejiang Province. Methods One hundred and twenty-five public hospitals in Zhejiang Province with qualification no less than class two level two were selected as sample hospitals. Douglas production function was employed to analyse the relationship between investment and output in sample hospitals between 2004 to 2006, with two types of production models established by medical service and incomes in hospitals as dependent variables. Results From 2004 to 2006, the medical service and incomes of sample hospitals were in line with economies of scale. The production increase rate was higher than investment increase rate. The medical service, incomes, total assets and number of staff in class three hospitals were higher than those in class two hospitals (P =0.000). Conclusion Economies of scale is the ultimate incentive to continuous outstretch for hospitals. Hospitals should rationally control the scale so as to avoid problems in medical service caused by overstretch.

Objective To investigate the methods of diagnosis and treatment of pediatric and hebetic adrenocorticotropic hormone ( ACTH) secreting pituitary microadenoma. Methods The data of 10 patients with ACTH secreting pituitary microadenoma were retrospectively analysed. ACTH secreting pituitary microadenoma was diagnosed by clinical manifestations, biochemical and imaging findings, and 5 patients underwent bilateral inferior petrosal sinus sampling ( BIPSS). Transsphenoidal surgery was performed on all the patients under microscope, and the tumor specimens were detected by immunohistochemistry. Results Immunohistochemical examination revealed that ACTH was positive in 8 cases and negative in 2 cases. Patients were followed up for 12 to 63 months, 7 cases (70%) were cured, one (10%) achieved remission, and the other two (20%) experienced recurrence. Conclusion BIPSS is helpful in the diagnosis and localization of pediatric and hebetic ACTH pituitary microadenoma, and transsphenoidal surgery is the optimal choice of treatment.

Objective To investigate the clinical application of minimally invagive fixation of complex proximal tibia fractures by uniaxial and polyaxial locking plates. Methods The clinical data of 38 patients with minimally invagive fixation of complex proximal tibia fractures by uniaxial(n=21)and polyaxial(n=17)locking plates from January 2008 to June 2009 were retrospectively analysed,and the union rates and function recovery were compared between groups.Results All patients were followed up for 3 to 20 months,with an average of 12 months.All patients had bone union.The time of fracture union for fixation by uniaxial locking plates was 10 to 20 weeks,with an average of 14 weeks;and that for fixation by polyaxial locking plates was 11 to 18 weeks,with au average of 13 weeks.Evaluated by Johner-Wruhs method, there were 14 "excellent" cases,5 "better" eases,2 "good" cases and 0 "poor" case for fixation by uniaxial locking plates (rate of "excellent and better",90.4%),and there were 11 "excellent" cases,5 "better" cases,1 "good" cage and 0 "poor" case for fixation by polyaxial locking plates (rate of "excellent and better",94.1%). Conclusion Minimally invagive fixation of complex proximal tibia fractures by uniaxial and polyaxial locking plates is stable,has less effects on bone blood supply,high bone union rate and favourable function recovery,and is an effective way in the treatment of complex proximal tibia fractures.Fixation by uniaxial locking plate has a better mechanical intensity,while fixation by polyaxial locking plate can adjust the screw angle according to fracture situation,which can be clinically applied accordingly.

Objective To investigate the influence of nebulized Pulmieort respules inhalation after endoscopic sinus surgery (ESS)on the expression of epithelial Na~+ channel(ENaC)protein in nasal mucosa. Methods Forty-four patients with nasal polyps undergoing ESS were randomly divided into Pulmieort respules treatment group(n=21,nebulized Pulmieort respules inhalation for 10 d after ESS)and Rhinocort control group(n=23,Rhinoeort aqueous nasal spray for 10 d after ESS).All the patients were performed biopsy of membrane on the residual middle turbinate 14 d after ESS,eosinophils (Eos)and neutrophils(Neu)per hundred inflammation cells were counted under microscope during ESS and after ESS,and the expression of ENaC protein was detected by immunofluorescence assay. Results The percentages of Eos and Neu decreased in two groups after treatment,and the percentage of Neu in Pulmieort respules treatment group was significantly lower than that in Rhinoeort control group(P<0.05).The expression of ENaC protein after treatment in Pulmieort respules treatment group was significantly lower than that in Rhinoeort control group(P<0.01). Conclusion Application of pulmieort respules after ESS can decrease Neu infiltration and inhibit expression of ENaC protein,which can relieve acute inflammation and edema of nasal mucosa.

Reactive oxygen species(ROS)play an important role in the cardiac ischemic and reperfusion injury.However,accumulating evidences have demonstrated that ROS are pivotal components of redox signaling cascade relevant to cardioprotection induced by either preconditioning or postconditioning. In this review,the definition, source and detection methods of ROS are introduced.Besides,the role of ROS in the cardioprotection offered by preconditioning or postconditioning and the effects of either preconditioning or postconditioning on ROS are summarized.

Schizophrenia is one of the most severe psychiatric disorders.Although the etiology is unknown,schizophrenia appears to be a polygenic disorder associated with environmental factors.There are evidences that intracellular signaling plays an important role in the pathogenesis of schizophrenia.Canonical Wnt pathway,which is closely related to the development and function maintenance of central nervous system,have drawn wide attention.Evidences for potential disturbances of Wnt signaling pathways in schizophrenia have accumulated,which are in favour of the hypothesis that Wnt signaling alterations may be important in the pathogenesis of schizophrenia.The research advances in the relationship between canonical Wnt signaling pathway and schizophrenia are reviewed in this paper.

Objective To analyse the changes of metabolic parameters and condition of metabolic syndrome(MS)in females with obstructive sleep apnea-hypopnea syndrome(OSAHS),and explore the interaction between OSAHS and MS.Methods Sixty females undergoing polysomnography were included,and were divided into simple snorer group(n=19),mild OSAHS group(n=21)and moderate to severe OSAHS group(n=20).Epworth sleepiness scale(ESS)scores and metabolic parameters were compared among groups.Forty-one patients with OSAHS were subdivided into group with MS(MS group,n=15)and group without MS(non-MS group,n=26).ESS scores,apnea hypopnea index(AHI),oxygen desaturation index(ODI)and lowest pulse oxygen saturation(LSpO_2)were compared between MS group and non-MS group.Results There was no significant difference in age,body mass index(BMI),total cholesterol(TC),triglyceride(TG),low density cholesterol(LDL),high density cholesterol(HDL),apolipoprotein A-I(apoA-I)and apolipoprotein B(apoB) among simple snorer group,mild OSAHS group and moderate to severe OSAHS group(P>0.05).Correlation analysis revealed ESS was positively related to AHI(r=0.327,P=0.011).ESS scores and proportions of hypertension,fasting plasma glucose(FPG)and MS were significantly higher in moderate to severe OSAHS group than those in simple snorer group(P<0.05).BMI,FPG,TG,proportion of hypertension,ODI and ESS score in MS group were significantly higher than those in non-MS group(P<0.05),while there was no significant difference in AHI and LspO_2 between these two groups(P>0.05). Conclusion ESS score may reflect the severity of OSAHS in females.Females with OSAHS matched for age and BMI have no difference in blood fat.With the increase of severity of OSAHS,glycometabolism can be impaired,the prevalences of hypertension and MS increase.MS can exacerbate the severity of OSAHS,indicating that MS and OSAHS interact with each other.

Objective To investigate the expression of CD133 mRNA in tissues of gastric cancer,and explore its relationship with clinicopathological features. Methods The tissues of gastric cancer and normal tissues adjacent to gastric cancer were obtained from 31 patients.The expression of CD133 mRNA was detected by semi-quantitative RT-PCR,and its relationship with clinicopathological features such as sex,age,tumor diameter,infiltration depth,TNM staging,tumor differentiation,lymph node metastasis and Ki-67 proliferation index was analysed. Results The relative gray scale values of CD133 mRNA in tissues of gastric cancer and normal tissues adjacent to gastric cancer were 0.378 3±0.141 1 and 0.038 1 ±0.091 9,respectively(P=0.000).The relative gray scale values of CD133 mRNA in tissues of gastric cancer with tumor diameter>5 cm were significantly higher than those with tumor diameter≤5 cm[(0.439 3±0.148 4)vs(0.334 3±0.121 2)](P=0.041),and those in tissues with lymph node metastasis were significantly higher than those without lymph node metastasis[(0.426 6±0.132 0)vs(0.239 5±0.030 9)](P=0.004).The rate of lymph node metastasis and the number of metastatic lymph nodes were positively related to relative gray scale values of CD133 mRNA(r=0.466,P=0.008;r=0.464,P=0.009).The relative gray scale values of CD133 mRNA in those with low expression of Ki-67 were significantly higher than those with high expression of Ki-67[(0.436 4±0.139 8)vs(0.316 4±0.117 4)](P=0.02),and expression of Ki-67 were negatively related to relative gray scale values of CD133 mRNA(r=-0.461,P=0.009).Conclusion The expression of CD133 mRNA in tissues of gastric cancer was associated with the rate of lymph node metastasis,number of metastatic lymph nodes and expression of Ki-67,which reflect the status of lymph node metastasis and proliferation of gastric cancer.

Objective To explore the value of glypican-3(GPC-3)mRNA and paternally expressed 10(PEG10)mRNA in peripheral blood in diagnosis of metastasis in hepatocellular carcinoma(HCC). Methods With SYBR Green I as fluorescence signal,real-time fluorescent quantitative reverse transcription-polymerase chain reaction was employed to detect the expression of GPC-3 mRNA and PEG10 mRNA in peripheral blood from patients with HCC with metastasis(n=8),HCC without metastasis(n=12)and hepatic cirrhosis(n=11),and receiver operator characteristics curve(ROC)and specific parameters were adopted to analyse their value in predictive and exclusive diagnosis. Results The expression of GPC-3 mRNA and PEG10 mRNA in HCC with metastasis was significantly higher than that in HCC without metastasis and in hepatic cirrhosis(P<0.05),while there was no significant difference in the expression of GPC-3 mRNA and PEG10 mRNA between HCC without metastasis and hepatic cirrhosis.In single test,the sensitivities in the differential diagnosis between HCC with metastasis and HCC without metastasis were 66.7%for GPC-3 mRNA and 72.2%for PEG10 mRNA,and the specificities were 91.7%and 91.7%.respectively.The areas under ROC were 0.748 for GPC-3 mRNA and 0.812 for PEG10 mRNA.With two markers in parallel test,the sensitivity,specificity,negative likelihood and diagnostic accuracy were 90.7%,84.O%,0.11 and 83.3%,respectively.In serial test,the sensitivity,specificity,positive likelihood and diagnostic accuracy were 60.5%,98.7%,45.5 and 73.3%,respectively. Conclusion Detection of GPC-3 mRNA and PEG10 mRNA in peripheral blood may help to predict blood metastasis and extrahepatic metastasis of HCC,and PEG10 mRNA works better than GPC-3 mRNA.The serial test of GPC-3 mRNA and PEG10 mRNA is helpful to the predictive diagnosis of peripheral blood metastasis of HCC.