Objective To study the changes of serum high mobility group box 1 protein ( HMGB-1 ) in patients with traumatic acute lung injury (ALI) and determine its correlations with MODS,acute physiology and chronic health evaluation ( APACHE Ⅱ ) scores and whether it can predict the incidence of MODS and mortality.Methods Forty cases of ALI were divided into MODS group (n =13) and nonMODS group (n =27) according to the MODS evaluation standard.The serum HMGB-1 was determined in the control group ( 10 healthy persons) and the MODS and non-MODS groups at days 1,4 and 7.The MODS and APACHE Ⅱ scores were also evaluated.Results Between the groups,the HMGB-1 level at days 1,4 and 7 in non-MODS group was higher than that in the control group,while lower than that in MODS group (P＜0.05).Within the non-MODS group,the expression of HMGB-1 showed a high level at day 4 compared with that at day 1 ( P ＜0.01 ) ; the HMGB-1 showed a low level at day 7 with clinical symptom improvement compared with that at day 4,and was even lower than that at day 1 ( P ＜ 0.01 ).Within the MODS group,the serum HMGB-1 level was significantly increased,and continued for several days; the HMGB-1 was decreased slightly at day 7 in comparison with that at day 4,but was still higher than that at day 1.The difference of MODS and APACHE Ⅱ score was significant,with the dynamic change of HMGB-1 level at days 1,4 and 7 after traumatic ALI.The correlative analysis showed that HMGB-1 expression level was remarkably related with MODS score and APACHE Ⅱ score.Conclusions HMGB-1 shows a high expression in patients with traumatic ALI.As a late mediator of inflammation,HMGB-1 usually increases relatively late and lasts for a long duration.HMGB-I level and concurrency MODS are closely related.Routine test of serum HMGB-1 level and joint assessment of MODS and APACHE Ⅱ score are contributive to the prediction of organ dysfunction after traumatic ALI.

Objective To establish the technique of loading trehalose into human platelets including temperature, time and concentration of trehalose loading. Methods Intracellular trehalose concentration versus loading time curves at 37℃ and 16℃, mean plateletee volume(MPV) versus loading time curves, and loading concentration curves were investigated and compared. Then loading time and temperature for high loading efficiency of trehalose into human platelets were ascertained. Intracellular trehalose versus trehalose loading concentration curves were made, and loading efficiency was caculated. Results The trehalose loading efficiency of 4 hours at 37℃ was significantly higher than that at 16℃ (11.6% vs 5.6%). MPV at 16℃ increased 43.2% compared with at 37℃, but had no changes along with the change of loading time and concentration. When loading at 37℃, MPV change was positively related with loading time and concentration, and loading time and loading concentration had a cooperative effect. MPV had no changes in 1～4hours loading when trehalose loading concentration was under 50mM. MPV increased with the increase of loading time and concentration when trehalose loading concentration was above 50mM. When trehalose loading concentration was 45mM, loading efficiency at 37℃ reached 13.86% 4 hours aftr loading. Conclusion The basic parameter of trehalose loading technique of human platelets was loading temperature at 37℃, loading time for 4 hours, and loading concentration of 45mM.

Objective To study the clinical significance of plasma adrenomedullin (ADM) and brain natriuretic peptide (BNP) levels in the elderly patients with chronic cor pulmonale. Methods The levels of ADM and BNP in plasma of the elderly patients with chronic cor pulmonale (39 cases in the acute stage and 30 cases in remission stage) were detected by radioimmunoassay. Their correlations with PaO 2,ET-1 and the ratio of right ventricular pre-ejection period to the pulmonary flow acceleration time (RVPEP /AT), which reflected the degree of pulmonary hypertension, were investigated. 27 elderly healthy subjects served as a normal control group. Results The levels of ADM and BNP in the acute and remission stages of cor pulmonale groups were both significantly higher 〔(27.31?6.27)ng/L,(17.22?4.15)ng/L and (66.21?12.79)ng/L,(52.74?8.85)ng/L, respectively〕 than those in the normal control group〔(11.18?3.95)ng/L, (34.52?3.34)ng/L, respectively〕. The levels of ADM and BNP in the acute stage were both significantly higher than those in the remission stage (all P0.05). Conclusions The study suggests that ADM and BNP involve in the pathophysiological process of chronic cor pulmonale in the elderly patients and may play a compensatory role in the disease.

Objective:To evaluate the effect of decalcified freeze-dried bone allograft(DFDBA) and DFDBA with platelet-rich plasma(PRP) in the treatment of periodontal infrabony defects.Methods: Fifteen periodontal infrabony defects(30 sites) in 12 patients with periodontitis(9 patients with chronic periodontitis and 3 patients with aggressive periodontitis) were selected.Three months after initial therapy,they were assigned to either the DFDBA group(10 defects with 20 sites) or the DFDBA with PRP group(5 defects with 10 sites).The patients were evaluated for plaque index(PI),bleeding index(BI),probing depths(PD) and clinical attachment loss(CAL) before the treatment and at 6 months after periodontal bone graft surgery.Results: The PI,BI,PD and CAL in the DFDBA group were 1.7,2.7,6.0 mm and 7.0 mm at baseline;1.5,1.8,3.9 mm and 4.4 mm at the 6 months after periodontal surgery.The PD,CAL and BI in DFDBA with PRP group at baseline were 6.2 mm,7.1 mm and 2.9;3.2 mm,3.6 mm and 1.7 at the 6 months after periodontal surgery.The PI did not change significantly after surgery in both groups.While both groups showed significant improvement(P

Objective To evaluate the effects of a novel inducible nitric oxide synthase (iNOS) inhibitor (FR260330) in prevention of chronic rejection in a model of rat aortic allograft and to investigate the mechanism of the arterial wall lesion of chronically rejecting solid organ grafts. Methods Male Lewis (LEW, RT1~ l) rats received male ACI (RT1~ a) aorta allografts or LEW aorta isografts. Seven groups (n≥12) were involved in this study. FR260330 and/or tacrolimus were administered orally for 14 or 90 days according to protocol. The degree of intimal proliferation of graft aorta was determined by a computerized image system.Results Both low and high doses of FR260330 or tacrolimus treated grafts showed significantly decreased intima/(intima+media) ratios at day 90 compared with placebo controls. Combined therapy of low-dose of FR260330 with low-dose of tacrolimus produced a significant decrease of intima/(intima+media) ratios with intact endothelium as compared with placebo controls. Anti-?-actin immunohistochemical staining demonstrated that one of the mechanisms of intimal proliferation was related to migration of vascular smooth muscle cells. The intima in iNOS inhibition groups was more smooth than in placebo control group and low-dose FK506 treated groups.Conclusions A selective inhibitor of nitric oxide synthase, FR260330 plays a protective role in chronic aortic allograft rejection in the rat. Combined therapy of low-dose of FR260330 with tacrolimus produces significant protection of immune injury and may serve to improve long-term graft survival and function.

AlM:To discuss the clinical effect and safety of the combined surgeries of phacoemulsification and goniosynechialysis for patients with primary angle -closure glaucoma ( PACG) .METHODS:Eighty-three eyes of 83 patients with PACG and cataract were ranomized into two groups. Group A:39 patients with 39 eyes of angle-closure <180.;Group B:44 patients with 44 eyes angle - closure ≥180.. The changes of visual acuity, anterior chamber depth ( ACD) , anterior chamber angle and lOP after operation were measured. The follow-up period was for 1a.RESULTS: The visual acuity was improved significantly in both group after operation. No significantly difference in ACD, anterior chamber angle after operation in two groups (P>0. 05). The lOP in group A was lower than that in group B 3mo after operation, there was statistical significance (P<0. 05).CONCLUSlON:Phacoemulsification and goniosynechialysis can deepen ACD significantly. This method make the anterior chamber angle open, can reduce lOP and improve the patients’ visual acuity, especially in patients with PACG. lt is a safe and effective approach to patients with PACG and cataract.

Objective To investigate the application of highly selective alpha 1-blockers in treatment of ureteral stone after extracorporeal shock wave lithotripsy (ESWL). Methods One hundred and twenty patients with ureteral stone who accepted ESWL were divided into three groups by random digits table,each 40 cases. Tamsulosin group received tamsulosin (0.4 mg,once daily) after ESWL,doxazosin group received doxazosin (4 mg,once daily) ,control group were given no ureteral smooth musclar relaxant served. All patients were observed for 2 weeks. Results During the 2 weeks, only 4 patients withdrew due to adverse drug reactions. In tamsulosin group and doxazosin group, the stones expulsion rate [89.7%(35/39), 83.8%(31/37) respectively] were significantly higher than control group [65.0%(26/40)] (P＜0.05), the expulsion time [(3.1-1.2), (3.7 ± 1.4) d] were significantly lower than control group [(6.5 ±1.1) d] (P ＜0.05),the incidence of renal colic [12.8%(5/39), 21.6%(8/37)] and the stone street formation rate [7.7% (3/39), 13.5% (5/37)] were significantly lower than control group [45.0% (18/40) and 40.0% (16/40)] (P ＜ 0.05). But there was no significant difference between tamsulosin group and doxazosin group (P ＞ 0.05). Orthostatic hypotension occurred in 1 patient in tamsulosin group, but 7 patients experienced orthostatic hypotension in doxazosin group,the difference was significant (P ＜ 0.05).Conclusions Highly selective alpha 1-blockers can improve the stone-free rate of ureteral stone after ESWL,reduce expulsion time,decrease renal colic rate,and it is safe and tolerated. It can be regarded as an auxiliary clearance method after ESWL for ureteral stone.

Objective To compare the efficacy of tamsulosin and tolterodine for the adjunctive expulsive therapy in patients with lower ureteral stones.Methods A total of 160 patients with lower ureteral stones(4-10 mm)were included in the study.The patients were divided into 4 groups by block randomization.Group Ⅰ patients received tamsulosin 0.4 mg/d;group Ⅱpatients received tamsulosin 0.4 mg/d plus tolterodine 2 mg(twice a day);group Ⅲ patients received toherodine 2 mg(twice a day);and group Ⅳpatients served as controls.All patients were observed for 2 weeks.Remits The stone expulsion rate of group Ⅰ,Ⅱ,Ⅲ,Ⅳ was 76.9%(30/39),70.0%(28/40),46.2%(18/39)and 42.1%(16/38),respectively.The stone expulsion rate in group ⅠandⅡwas,higher than that in group Ⅲand Ⅳ(P＜0.05).The expulsion time of group Ⅰ,Ⅱ,Ⅲ,Ⅳ was(5.3±2.5),(6.4±2.2),(10.7±1.8),(12.8±3.4)d,respectively,with significant differences between group Ⅰ,Ⅱ andⅢ,Ⅳ,between groupⅢand Ⅳ(P＜0.05).Almost all of the patients tolerated the expulsive therapy and only 4 patients withdrew from treatment.No obvious side effect occurred.Conclusion The use of tamsulosin for the expulsion of lower ureteral stones is effective and safe;however,the use of tolteredine provides no additional advantages.

BACKGROUND:Estrogen/progestins replacement therapy prevents excess bone loss in postmenopausal women.Recently osteoprotegerin (OPG) has been identified in osteoblast and displayed to inhibit bone resorption.OBJECTIVE: To compare the action between 17β-estradiol (E2) and progesterone on OPG expression in cultured normal human osteoblast-like cells (hOB).DESIGN: A comparative investigation.SETTING: Institute of Metabolic Endocrinology, the Second Xiangya Hospital of Central South University.MATERIALS: α-MEM (Sigma Chemical Corp., St. Louis, MO, USA); Type Ⅳ collagenase (Sigma); Fetal bovine serum (Gibco-BRL Corp., Grand Island, NY, USA); Osteocalcin radioimmunoassay kit (DiaSorin Corp., Stillwater, MN, USA).METHODS: The experiments were carried out in the Institute of Metabolic Endocrinology, Second Xiangya Hospital of Central South University from January 2003 to March 2006. The osteoblasts were extracted from the cancelous bone of anterior superior iliac spine of normal people, then cultured. The hOB were treated with E2 and progesterone, and the expressions of OPG mRNA and OPG protein were determined by Northern blot analysis and enzyme-linked immunoabsorbent assay (ELISA) respectively.MAIN OUTCOME MEASURES: ①Characterization of human osteoblast-like cells; ②Effect of E2 and progesterone on OPG mRNA levels by Northern blot analysis; ③ Effect of E2 and progesterone on OPG protein levels in the conditioned medium by ELISA.RESULTS: ① Characterization of hOB in vitro The ALP levels in normal human osteoblasts were (74.3±4.7) U/g protein,and the detectable osteocalcin levels was (3.84±0.39) μg/L protein], which suggested that osteoblasts were the primary cell type found in our bone-derived cell cultures from donors. ② Effects of E2 and progesterone on the levels of OPG mRNA by Northern blot analysis: The OPG mRNA band was week in the control group [(12.3±3.5)%], treatment with 1 × 10-10, 1 ×10-9 1 ×10-8 mol/L E2 caused an increase in the levels of OPG mRNA. The expression of OPG mRNA in the 1×10-8 mol/L E2 group was gradually increased at 12, 24 and 48 hours. Progesterone had no influence on OPG mRNA expression. ③ Effects of E2 and progesterone on OPG protein production in conditioned medium determined with ELISA:ELISA revealed that treatment with 1 ×10-10, 1 ×10-9, 1 ×10-8 mol/L E2 induced obvious increase in the levels of OPG protein in cells media as compared with that in the control group [(1.27±0.26), (2.34±0.35), (3.62±0.23), (0.64±0.14)μg/L, P ＜ 0.01]. In the presence of 1×10-8 mol/L E2, OPG protein production in cells media at 12, 24 and 48 hours were significantly higher than that in the control group [(1.30±0.30), (3.07±0.14), (3.50±0.33), (0.62±0.12) μg/L, P ＜ 0.01]. 1 × 10-10, 1 ×10-9 1 × 10-8 mol/L progesterone had no influence on the OPG protein production after 12-24 hours (P ＞ 0.05).CONCLUSION: The different regulation of OPG production in osteoblasts by E2 and progesterone may contribute to the mechanisms by which estrogen or progestins exerts its different action on bone resorption.

Objective To systematically review the existing evidence about the effect of medial and lateral (crossed) entry pins versus only lateral entry pin fixation on the supracondylar fractures of the humerus in children.Methods Eligible studies were identified in Cochrane library,the Cochrane Bone,Joint and Muscle Trauma Group (till March 2011 ),Medline (from 1966 to March 2011 ),EMbase (from 1966 to 2011 ),CBM (from January 1979 to March 2011 ),PubMed,Wanfang Data (from 2000 to March 2011 ) and CNKI and the references of the included studies and several Chinese orthopedic journals were manually searched.Then,the randomized controlled trials (RCTs) and quasi-randomized controlled trials (CCTs) about two entries (crossed and only lateral pinning) for supracondylar fractures of humerus in children were collected.After evaluation of methodology with the enrolled studies,available data was extracted and systematic review was conducted via the method recommended by the Cochrane Collaboration.Results In total,five RCTs involving 311 patients were involved.Compared with the preoperative data,the meta-analysis results showed no significant difference in reduction stability in terms of change in Baumann angle and Carrying angle between the two groups.For the postoperative function outcome including complete reduction,Flynn grade and full return to function,no significant difference was found between the two groups.For the postoperative complications,there was no difference in the infection of pin tract,though lateral entry resulted in a significant lower incidence of the iatrogenic nerve injury compared with the medial and lateral entry.Conclusions With the Kirschner wire fixation for supracondylar fractures of humerus in children,current existing evidences indicate that the lateral entry of pinning has similar results in reduction stability,function outcome and incidence of pin tract infection compared with medial and lateral entry.Nevertheless,lateral entry,as a safe pinning technique,may effectively decrease the risk of iatrogenic nerve injury