Objective To investigate the effect and safety of alprostadil in the treatment of diabetes complicating chronic kid‐ney disease to provide reference for clinical treatment .Methods 84 cases of diabetes complicating chronic kidney disease in this hospital from September 2013 to January 2015 were selected and divided into the observation group(44 cases) and the control group (40 cases) according to the voluntary principle .The control group used the epalrestat treatment ,while the observation group was combined with using alprostadil on the basis of control group .The effective rate ,serum creatinine ,blood urea nitrogen(BUN) ,uri‐nary albumin excretion rate ,C‐reactive protein(CRP) ,IL‐6 levels and adverse reactions were compared between the two groups .Re‐sults The effective rate of the observation group was 93 .18% ,which was significantly higher than 80 .00% in the control group , the difference was statistically significant (χ2 =4 .251 ,P=0 .005);the CRP and IL‐6 levels after treatment in the observation group were improved ,the difference was statistically significant (P<0 .05);the CRP and IL‐6 levels after treatment in the observation group[(0 .45 ± 0 .05)mg/L ,[(0 .72 ± 0 .11)μg/L] were significantly superior than[(1 .05 ± 0 .14)mg/L ,(1 .25 ± 0 .24)μg/L] in the control group ,the differences were statistically significant(P<0 .05);BUN ,urinary albumin excretion rate ,TNF‐αand endogenous creatinine clearance rate after treatment in the observation group were (6 .41 ± 1 .12)mmol/L ,(41 .12 ± 4 .46)μg/min ,(75 .54 ± 6 .64)ng/L and (92 .94 ± 8 .24)% ,which in the control group were (7 .39 ± 1 .05)mmol/L ,(91 .48 ± 7 .31)mmol/L ,(111 .42 ± 7 .69)ng/L and (81 .55 ± 9 .54)% respectively ,the improvement in the observation group was better than the control group ,the difference was statistically significant (P<0 .05);the occurrence rate of adverse reactions was 18 .18% in the observation group and 17 .50% in the control group ,showing the difference was not statistically significant (P>0 .05) .Conclusion Alprostadil in treating diabetes complicating chronic kidney disease has better effect ,conduces to improve the level of urinary albumin and inflammatory with high safety ,and is worthy of clinical promotion and application .

Objective To analyzethe expression level of peripheral blood mononuclear cell Toll like receptor 4(TLR4)in patients with acute coronary syndrome(ACS)undergoing elective percutaneous coronary intervention(PCI),and intensive atorvastatin on Toll like receptor 4 in clinical treatment.Methods 100 cases of patients with ACS were selected in our hospital from May 2014 to May 2016 were randomly divided into control group and experimental group,control group were given atorvastatin treatment after admission,20mg/d PCI postoperative continuous,after one month still maintain dose of 20mg/d.The experimental group were given atorvastatin treatment after admission,40mg/d,PCI postoperative continuous,after one month reduced to 20mg/d.After admission and a course of treatment,the expression level of peripheral blood mononuclear cells TLR4 was detected by flow cytometry and the Gensini scoring system on coronary lesion degree.At the same time,50 healthy subjects were selected as normal group.Results Compared with healthy subjects,the peripheral blood mononuclear cells TLR4 level in ACS patients has been significantly increased,and the level in patients with unstable angina pectoris is far lower than the level increased in patients with acute myocardial infarction,triple branch lesions groups were significantly higher than them in single and double branch lesion groups,the difference between the three obviously,with statistical significance(P<0.01); According to stepwise multiple linear regression and othercorrelation analysis showed that ACS category and the severity of coronary artery stenosis,coronary artery stenosis score were positively associated with the levels of TLR4(P<0.05); After treatment for one month,the levels of TLR4,the expression of low density lipoprotein cholesterol and total cholesterol levels were significantly lower,high density lipoprotein Cholesterol levels were significantly increased,the differences were statistically significant(P<0.01); compared with the normal group,the experimental group peripheral blood mononuclear cells of patients with Toll like receptor 4 expression level,total cholesterol,low density lipoprotein cholesterol level in the experimental group is higher than the normal group,high density lipoprotein cholesterol increased significantly,comparison between groups the differences were statistically significant(P<0.01).Conclusion The degree of lesions and the occurrence of acute coronary syndrome in patients with peripheral blood mononuclear cells of Toll like receptor 4 expression level increase has certain effect,increase the dosage of atorvastatin can significantly reduce the ACS after PCI in patients with peripheral blood mononuclear cells of patients with Toll4 like receptor expression.

Objective To explore the clinical effect of rosuvastatin in treatment of unstable angina and the influence of levels on blood lipids,hypersensitive C-reactive protein(hs-CRP),homocysteine(Hcy)and cardiac troponin(cTnl).Methods 200 patients with unstable angina pectoris(UAP)in our hospital from March 2014 to March 2016 were selected as the subjects of the study,they were randomly divided into control group and experimental group,each group had 100 cases.The control group was given conventional treatment,the experimental group was given rosuvastatin on the basis of conventional treatment,the clinical efficacy between two groups was observed and compared,and the levels of blood lipid and C reactive protein(hs-CRP),homocysteine(Hcy)troponin I(cTnl)pre-and post-treatment were detected.Results The total effective rate of the experimental group was 92％and the control group was 80％,the difference was statistically significant(P<0.05).Before treatment,the blood lipid,hs-CRP,Hcy and cTnl between two groups showed no significant difference; after treatment,the blood lipid,hs-CRP,Hcy and cTnl in both two groups were decreased,high density lipoprotein cholesterol(HDL-C)levels than before treatment significantly increased,and the experimental group decreased or increased significantly compared with the control group,the difference was statistically significant(P<0.05).Conclusion Rosuvastatin has remarkable curative effect in clinical treatment for UAP,not only can significantly reduce the blood lipid,and reduce inflammation in patients,the clinical treatment of unstable angina patients have help,it is worthy of clinical application.

ObjectiveTo probe into the clinical efficiency of reconstruction to person who had composite tissue defect of the floor of mouth and the lower part of face with the free forearm flap and free iliac bone in the same term.MethodsBefore the surgery, the surgeon should carefully evaluate the scope and shape of defects in 11 cases who had the composite tissue defects of the floor of mouth and the lower part of face, to design the individual forearm flap, so that it matches with the defect region. During surgery, the first resumption of defects using titanium plates forming the basic shape of mandible and the occlusal relationship,then used to re-sawing to take modeling of the iliac bone,transplanted free iliac bone and fixed after the inside of the titanium plate, thereby restoring the continuity of mandible missing.ResultsFree forearm flap and free iliac bone all survived in 11 cases, the success rate of 100％. The patients were followed up for 6 to 12 months, although the shape of restoration areas were different levels of fat, but eating, swallowing and other oral function had been well improved, 7/11 could enter normal diet, 4/11 to enter liquid diet, At the same time, the patients in social activities can communicate in a language daily, sensory function of skin flap and facial appearance has been satisfactory recovery.ConclusionConformal free forearm flap and free iliac bone is an ideal way to reconstruct the composite tissue defects of the floor of mouth and the lower part of face in the same period, not only safe, practical prognostic effect, and also can significantly improve the patients quality of life, which is worthy of reference and use.

Objective To discuss the technique and value of preoperative reformatting with three-dimensional computed tomography technique for C_2 pedicle screw track.Methods GE Light Speed 16 Pro spinal CT scans of 15 adult dry vertebrae were loaded into an imaging station (software ADW4.2).Two methods of C_2 pedicle screw techniques were analyzed through virtual screw trajectory by VR (volume rendering) and MPR (multiple planar reformatting) techniques,in method A,screw entry point was the intersection between the media-vertical and the cranial line of C_2 inferior facet joint,in method B,the screw track was from the cranial and medial quadrant of the dorsal part of C_2 inferior facet joint.Results The screw track could be observed dynamically from any plane.Two vertebrae were ob- served with smaller height in isthmus and the medial edge of the transverse foramen since no space was a- vailable for the screw.The screw trajectories data were compared between method A and method B,which showed that the angles towards the cephalad (in sagittal plane) and midline (in transverse plane) were bigger in method A than in method B (P＜0.05,0.01),but the safe screw diameter was smaller in method A than in method B (P＜0.05),and there was no difference of the screw length between the two methods(P＜0.05 ).Conclusion In this research,the individual C_2 pedicle screw entry points, screw diameter and security screw angle can be simulated,and the screw track can be observed dynami- cally to make sure if it transits the bone structure completely.Preoperative three-dimensional computed tomography reformatting for pedicle screw track is of great value in clinical and basic researches.

Female ; Humans ; Infant, Newborn ; Maple Syrup Urine Disease ; diagnosis ; therapy

Objective The aim of this study was to describe the FICE application on gastric mucosa characteristics including normal and pathological changes, with or without H.pylori infection, and its corre-lation with histopathoingical evidence. Methods A total of 32 patients with dyspepsia symptoms and 5 healthy controls were enrolled into study. Each one underwent esophngogastreduedenoscopy (EGD) examina-tion with FICE and magnified observation. The whole stomach was examined by 3 steps: including conven-tional endoscopy followed by magnifying and FICE observation of the gastric antrum and body as well as biop-sies. All the patients were asked to take the rapid urease test (RUT) 、13C -urea breath test (13C-UBT) . Gastric antrum and body were both sub-classified into following 3 patterns by FICE observation and high reso-lution magnifying endoscopy. The sensitivity, specificity of each FICE pattern of both gastric antrum and body were analysed for the assessment of H. pylori infection, and the consistency with the results of RUT and 13C-UBT. Furthermore, the histopathologic parameters including inflammation、activity、atrophy and intestinal metaplasia were also assessed, Results FICE patterns of gastric antrum and body of all 5 control subjects were type Ⅰ, corresponded to an H. pylori negative and non-atrephy gastric mueosa. In study group on gastric antrum, 14 cases of FICE type Ⅰ pattern were noted and only 1/14(7. 1%) corresponded to an H. pylori positive gastric mucosa. 13 cases of FICE type Ⅱ pattern were noted and 10/13 (76. 9%) corresponded to an H.pylori positive mucosa and 9/13(69. 2%) were positive for both gastric atrophy. 5 cases of FICE type Ⅲ pattern were noted and 5/5 (100%) corresponded to an H. pylori positive mucosa and 3/5 (60%) were positive for both gastric atrophy and intestinal metaplasia. There was statistical difference in prediction of H. pylori infection between type Ⅰ FICE pattern and type Ⅱ or type Ⅲ pattern on gastric antrum (P <0. 01). In study group on gastric body, 15 cases of FICE type Ⅰ pattern were noted and only 1/14(7. 1%) corre-sponded to an H. pylori positive gastric mucosa. 13 cases of FICE type Ⅱ pattern were noted and 11/13 (84. 6%) corresponded to an H. pylori positive mucosa. 4 cases of FICE type Ⅲ pattern were noted and 4/4 (100%) corresponded to an H.pylori positive mucosa. There was statistical difference in prediction of H. pylori infection between type Ⅰ FICE pattern and type Ⅱ or type Ⅲ pattern on gastric body (P < 0. 01). Conclusion FICE in combination with high resolution magnifying endoscopy is valuable for identifying the normal gastric mucosa, H.pylori infection and its associated gastritis, gastric atrophy as well as intestinal metaplasia.

Objective To determine attention networks impairmnet in patients with localized brain injury and to examine the characteristics of the impairment.Methods The attention network test was used to compare patients(n=59)with controls(n=53)on the efficiency of 3 anatomically defined attention networks:alerting,orienting,and executive control.Results Firstly,patients with frontal lobe injury showed a significant deficit in the executive network(frontal lobe injury,controls:(143.7±46.6),(91.6±46.4)ms,Z=-4.714,P＜0.01)and also a significant deficit in the orienting network(frontal lobe injury,controls:(71.2±35.2),(55.1±21.8)ms,Z=-2.125,P＜0.05).There was no deficit in the alerting network(Z=-0.901,P＞0.05).Secondly,the orienting network effect was significantly lower in patients with parietal lobe injury((34.9±25.2)ms)than in normal controls((55.1±21.8)ms.Z=-2.418.P＜0.05).However,there were no significant difierences between the other two networks and between the patients and the controls(Z=-1.873,-0.186.P＞0.05).Thirdly,patients with temporal lobe injury showed no deficit in the three networks(Z=-0.037,-1.224,-0.718,all P＞0.05)as well as in overall RT and accuracy(Z=-1.385,-0.699,all P＞0.05).Conclusions These results suggest that there are selective impairments of the orienting and executive networks in patients with the frontal lobe and the parietal lobe injury,while the alerting network is spared.Furthermore,the frontallobe plays a key role in the executive control.meanwhile,the orienting network is closely related with the parietal lobe.

Objective To investigate clinical manifestations,histopathological features and treatment of ulcerative colitis (UC) complicated by pyoderma gangrenosum (PG).Methods Data on clinical manifestations,auxiliary examination findings,treatment and prognosis were collected from 8 inpatients with UC complicated by PG in Peking Union Medical College Hospital between July 2009 and July 2016,and analyzed retrospectively.Results Of the 8 cases,5 were male,and 3 were female.Theaverage age of onset was 30.6 years and 35.1 years in males and females respectively.All the patients developed intestinal symptoms of UC before the onset of PG with an average time interval of 5 years.Moreover,all the patients had active total colonic type UC at the onset of PG,including 6 with moderately active UC and 2 with mildly active UC.PG manifested as painful ulcers in 8 patients,and affected lower limbs in 7 patients.Histopathological examination of skin lesions showed typical characteristics of vasculitis in 5 patients.Five patients were complicated by arthralgia.All the patients were treated with glucocorticoids and 5-aminosalicylic acid agents as the basic therapy,3 patients received extra treatment with immunosuppressive agents or minocycline,and 2 with infliximab.Conclusions PG is a severe skin manifestation of UC,commonly occurs in patients with total colonic type UC in the active stage,and mostly affects the lower limbs,with typical histopathological features of vasculitis.

BACKGROUND:Xenogeneic ligament is readily available, which has ligament scaffold structure and is conducive to tissue ingrowth and creeping substitution. After processing, the xenogeneic ligament, with the presence of good growth scaffold function, can be completely eliminated antigenicity that can cause immune rejection. OBJECTIVE:To study the feasibility of biological xenogeneic ligament graft instead of alogeneic ligament graft for reconstruction of goat anterior cruciate ligament. METHODS: Twenty-four healthy adult goats were randomly divided into A, B, C groups, and then, the left knee joints of goats were removed to establish animal models of anterior cruciate ligament injury in the three groups. After the establishment of the tibia and femoral bone tunnel, groups A, B, C were respectively transplanted with biological xenogeneic ligament graft combined with bone marrow mesenchymal stem cels, biological xenogeneic ligament graft alone, and alogenic ligament. RESULTS AND CONCLUSION: After implantation, no rejection but good biocompatibility was found in the group A, in which, the transplanted ligament as a functional scaffold for anterior cruciate ligament reconstruction, and new tissues in-grew and replaced the scaffold under intraarticular environment to form the new ligament with good bone tendon healing. However, there were no differences in histology, immune response, biomechanical findings between groups A and C. Additionaly, in the group A, the host tissues were found to grow into the scaffold and establish a micro-circulation. These findings indicate that xenogeneic ligament combined with bone marrow mesenchymal stem cels can accelerate the establishment of micro-circulation and promote the growth of ligaments, especialy improve the ligament revascularization significantly, but has no influence on the biological characteristics of the ligament.