Introduction：Neonatal tetanus is a major cause of neonatal mortality in many developing countries and remains a major public health problem. This study aimed to determine risk factors associated with neonatal tetanus in Wenzhou, China.Methodology：Medical records of neonatal tetanus cases from 17 hospitals over a 13-year period (2000–2012) were reviewed for potential risk factors. Controls were selected from neonates with diseases other than tetanus who were admitted to the same facility during the same period. The potential risk factors of the neonatal tetanus group were compared with the control group using univariate analysis and an unconditional logistic regression model.Results：A total of 246 neonates with tetanus and 257 controls were included in this study. Univariate analysis showed that having untrained birth attendants, home delivery, an unsterile method of delivery and being a migrant to Wenzhou were significantly different between the two groups (P < 0.001). Logistic regression analysis revealed that the odds of having an untrained birth attendant, home delivery and an unsterile method of delivery were significantly higher in the tetanus group than the control group (odds ratio: 1371.0; 95% confidence interval: 206.0, 9123.5).Conclusion：This study identified that the main risks of neonatal tetanus in cases from Wenzhou were having an untrained birth attendant, home delivery and an unsterile method of delivery. Preventive measures directed to these risk factors may reduce the occurrence of neonatal tetanus in the studied area.

OBJECTIVETo evaluate the efficacy and safety of fast track surgery(FTS) in patients undergoing laparoscopic colorectal resection.

METHODRandomized controlled trials(RCT) or clinical controlled trials(CCT) on fast-track surgery in patients undergoing laparoscopic colorectal resection were obtained from databases including CNKI, Wanfang, PubMed, EMBACE, and Cochrane Library between January 2000 and March 2012. Meta-analysis was performed with RevMan 5.1.

RESULTThere were 6 RCTs and 7 CCTs including 1795 patients. There were 955 patients in the FTS group and 840 in the control group. The time to passage of flatus was shorter(WMD=-1.37, 95%CI:-1.55~-1.19, P<0.05), time to resumption of diet/drink was shorter(WMD=-2.62, 95%CI:-2.69~-2.55, P<0.05), length of postoperative hospital stay was decreased(WMD=-1.63, 95%CI:-1.92~-1.34, P<0.05) and the incidence of postoperative complications were less(OR=0.52, 95%CI:0.41~0.67, P<0.05) in the FTS group. However, there were no differences in readmission(P>0.05).

CONCLUSIONFast-track surgery in patients undergoing laparoscopic colorectal resection can promote bowel function recovery, decrease the incidence of postoperative complications and length of hospital stay.

Controlled Clinical Trials as Topic ; Digestive System Surgical Procedures ; Humans ; Incidence ; Laparoscopy ; Length of Stay ; Postoperative Complications

Adolescent ; Adult ; Biomarkers ; Female ; Hepatitis B, Chronic ; metabolism ; Humans ; Liver ; chemistry ; Liver Cirrhosis ; blood ; therapy ; Male ; Middle Aged ; Platelet-Derived Growth Factor ; analysis ; Proto-Oncogene Proteins c-sis

[Objective]To study the relationship between bridging septa thickening in the perinephric space and split renal function in acute unilateral upper urinary tract obstruction.[Methods]50 patients with acute unilateral upper urinary tract obstruction by calculus were analyzed retrospectively. According to the images of multi-slice spiral CT (MSCT)scanning,all cases were divided into thickened bridging septa group(n=25)and normal bridging septa group (n=25),The CT values of renal cortical in the plain(CTp)and renal cortical enhancing(CTe)phase were measured, the difference of increasement value(CTe-CTp)and the CT value ratio of the ipsilateral and opposite in renal cortical phase was analyzed by independent sample T test.[Results]The CT increasement value of bridging septa thickening and normal group were(103±30)HU and(128±24)HU respectively,the difference between the two groups was statistically significant(P<0.01);and CTac/CTuc were 0.81±0.13 and 0.96±0.06 respectively(P<0.01).[Conclusion]Thickening of bridging septa in the perinephric space with acute unilateral upper urinary tract obstruction will weaken the enhancement of renal cortical,and increased the likelihood of split renal function impairing.

Objective: To study the biomechanical property and histocompatibility of acellular porcine fascia so as to supply a new substitute material for tissue repair. Methods: Samples of normal porcine fascia, acellular porcine fascia and normal human fascia were prepared for histological and biomechanical examination. Xenogeneic fresh porcine fascia, acellular porcine fascia and allogeneic rabbit fascia were implanted into the back of rabbit. Tissues were taken for HE staining and histocompatibility test. Results: Histological examination showed that the cellular components which elicit immune rejections had been removed in the acellular porcine fasciam, with the complete extracellular matrix reserved. Arrangement of collagen fiber was loose in the acellular porcine fascia. The biomechanical performance test of the three samples showed that there was no significant difference in the extreme tensile strength (4.47±0.54) MPa, (4.49±0.91) MPa, (4.79±1.35) MPa for acellular porcine fascia, normal porcine fascia and normal human fascia respecively, P>0.05). There was no significant difference between acellular porcine fascia extracellular matrix and porcine fascia with the cell in breaking elongation (501.83%±52.01%, 661.17%±200.28%, P>0.05). However, there was a significant difference in the breaking elongation between human fascia (98.08%±26.02%)and the other 2 kinds of porcine fascia (P<0.01). Histocompatibility test showed the local reactions of the acellular porcine fascia group were weaker than the normal porcine fascia group. Conclusions With sound preparativemethod, the acellular porcine fascia has good biomechanical property and histocompatibility and may serve as a good alternative material for tissue repair.

OBJECTIVETo assess the clinical outcomes of brachiocephalic artery-sparing aortic arch repair combined with stent-graft elephant trunk technique for treatment of Stanford type A aortic dissection.

METHODSTwenty-three patients with Stanford type A aortic dissection requiring arch replacement underwent brachiocephalic artery-sparing aortic arch repair combined with stent-graft elephant trunk technique. The operations were performed within 72 h (20 cases) or 3-14 days (3 cases) after the onset of aortic dissection.

RESULTSThere was no perioperative death in these cases. The mean extracorporeal circulation time was 209∓52 min, the aortic cross clamp time was 85∓21 min, and the mean chest tube output within the first 24 h after the operation was 570∓263 mL; none of the patients required chest reopening for management of bleeding. Postoperative acute renal failure requiring hemodialysis occurred in 3 cases, transient neurologic dysfunction in 2 cases, paraplegia in case and hematosepsis in 1 case. No such complications as permanent neurologic deficit or postoperative visceral malperfusion occurred in these cases. All the patients survived and were discharged from hospital without experiencing severe complications in the follow-up for 6-18 months.

CONCLUSIONBrachiocephalic artery-sparing aortic arch repair combined with stent-graft elephant trunk technique is a safe and simple procedure with controllable bleeding and can serve as an optional procedure for aortic arch replacement.

OBJECTIVETo investigate the effects of immature dendritic cells (imDC) expressing chemokine receptor-7 (CCR7) on acute graft-versus-host disease (aGVHD) in allogeneic bone marrow transposed (allo-BMT) mouse model.

METHODSWe constructed the lentiviral vectors carrying mouse CCR7 gene and infect imDC effectively in vitro. GVHD model was established with C57BL/6(H-2b) donor mice and BALB/c (H-2d) recipient mice. After irradiation, recipients were injected with donor bone marrow and spleen cells along with CCR7-modified dendritic cells. Mice were randomized into irradiation, transplant control, pXZ9-imDC (empty vector control) and CCR7-imDC groups. Survival, GVHD score, histopathological analysis and plasma levels of inflammatory cytokines were observed.

RESULTSThe mean survival in irradiation, transplantation, pXZ9-imDC and CCR7-imDC groups were (8.20±1.48)d, (12.20±2.78)d, (20.70±6.01)d and (27.5±7.55)d respectively. The survival in CCR7- imDC group was significantly improved compared with other groups (P<0.05). GVHD scores in transplantation, pXZ9-imDC and CCR7-imDC groups were (6.90±1.66), (5.60±0.97) and (4.10±1.79) respectively. CCR7-imDC group had significantly lower GVHD score and minor tissue damages shown by histopathological analysis than the other groups. Plasma IFN-γ level increased and reached the peak at +10 day in transplant group, while it gradually decreased in pXZ9-imDC and CCR7-imDC groups, and then reached the nadir at +20 day post-allo-BMT, with the lowest level in CCR7-imDC group (P<0.01). Plasma IL-4 decreased in transplant group, while it gradually increased in pXZ9-imDC and CCR7-imDC groups and reached the highest level at + 10 day in CCR7- imDC group (P<0.01). The 95%-100% of H-2b positive cells in recipient mice on + 30 day post-allo-BMT demonstrated the complete donor- type implantation.

CONCLUSIONGenetically modified immature DC by CCR7 gene could alleviate damages by GVHD and prolong survival of recipient mice after allo-BMT.

Animals ; Bone Marrow Transplantation ; adverse effects ; Dendritic Cells ; cytology ; Genetic Vectors ; Graft vs Host Disease ; prevention & control ; Male ; Mice ; Mice, Inbred BALB C ; Mice, Inbred C57BL ; Receptors, CCR7 ; genetics ; Transplantation, Homologous

OBJECTIVETo study the therapeutic effect of Weicao Capsule (WCC) on gout.

METHODSTwo hundred gout patients were assigned to two groups. The treated group was treated with WCC and the control group was treated with Tongfengding Capsule. Both groups were given the respective treatments orally 3 times a day, 2 capsules each time with 2 weeks as one course and all patients received 2 successive courses of treatment. Changes of blood beta(2)-microglobulin (beta(2)-M), hemoglobin (Hb), 24 h urinary protein (24 h UP), pH value of urine and blood uric acid (BUA) as well as kidney function were observed.

RESULTSAfter treatment, level of beta(2)-M got lowered significantly, Hb and 24 h UP, blood urea nitrogen, serum creatinine and the clearance rate of creatinine, as well as blood lipids all improved obviously in the treated group (all P<0.01), while these parameters remained unchanged in the control group (P>0.05). The pH value of urine was improved in both groups showing an insignificant difference between them (P>0.05). BUA was decreased in both groups with a decrease to a larger extent in the treated group (P<0.01). The total effective rate was 87% in the treated group, which was superior to that in the control group (62%, P<0.05).

CONCLUSIONWCC has a favorable therapeutic effect on gout and its mechanism of action for improving renal function and reducing urinary protein could be related with the lowering of blood beta(2)-M, BUA and lipids.

Adult ; Aged ; Capsules ; Drugs, Chinese Herbal ; adverse effects ; therapeutic use ; Female ; Gout ; blood ; drug therapy ; physiopathology ; Hemoglobins ; analysis ; Humans ; Hydrogen-Ion Concentration ; Kidney Function Tests ; Lipids ; blood ; Male ; Middle Aged ; Proteins ; analysis ; Treatment Outcome ; Uric Acid ; blood ; beta 2-Microglobulin ; blood

BACKGROUNDThe loss of cardiac myocytes is one of the mechanisms involved in acute myocardial infarction (AMI)-related heart failure. Autophagy is a common biological process in eukaryote cells. The relationship between cardiac myocyte loss and autophagy after AMI is still unclear. Carvedilol, a non-selective alpha1- and beta-receptor blocker, also suppresses cardiac myocyte necrosis and apoptosis induced by ischemia. However, the association between the therapeutic effects of carvedilol and autophagy is still not well understood. The aim of the present study was to establish a rat model of AMI and observe changes in autophagy in different zones of the myocardium and the effects of carvedilol on autophagy in AMI rats.

METHODSThe animals were randomly assigned to a sham group, an AMI group, a chloroquine intervention group and a carvedilol group. The AMI rat model was established by ligating the left anterior descending coronary artery. The hearts were harvested at 40 minutes, 2 hours, 24 hours and 2 weeks after ligation in the AMI group, at 40 minutes in the chloroquine intervention group and at 2 weeks in other groups. Presence of autophagic vacuoles (AV) in the myocytes was observed by electron microscopy. The expression of autophagy-, anti-apoptotic- and apoptotic-related proteins, MAPLC-3, Beclin-1, Bcl-xl and Bax, were detected by immunohistochemical staining and Western blotting.

RESULTSAVs were not observed in necrotic regions of the myocardium 40 minutes after ligation of the coronary artery. A large number of AVs were found in the region bordering the infarction. Compared with the infarction region and the normal region, the formation of AV was significantly increased in the region bordering the infarction (P < 0.05). The expression of autophagy- and anti-apoptotic-related proteins was significantly increased in the region bordering the infarction. Meanwhile, the expression of apoptotic-related proteins was significantly increased in the infarction region. In the chloroquine intervention group, a large number of initiated AVs (AVis) were found in the necrotic myocardial region. At 2 weeks after AMI, AVs were frequently observed in myocardial cells in the AMI group, the carvedilol group and the sham group, and the number of AVs was significantly increased in the carvedilol group compared with both the AMI group and the sham group (P < 0.05). The expression of autophagy- and anti-apoptotic-related proteins was significantly increased in the carvedilol group compared with that in the AMI group, and the positive expression located in the infarction region and the region bordering the infarction.

CONCLUSIONSAMI induces the formation of AV in the myocardium. The expression of anti-apoptosis-related proteins increases in response to upregulation of autophagy. Carvedilol increases the formation of AVs and upregulates autophagy and anti-apoptosis of the cardiac myocytes after AMI.

Adrenergic beta-Antagonists ; pharmacology ; Animals ; Apoptosis ; Apoptosis Regulatory Proteins ; analysis ; Autophagy ; drug effects ; Beclin-1 ; Carbazoles ; pharmacology ; therapeutic use ; Immunohistochemistry ; Male ; Microscopy, Electron, Transmission ; Myocardial Infarction ; drug therapy ; pathology ; Myocardium ; ultrastructure ; Propanolamines ; pharmacology ; therapeutic use ; Rats ; Rats, Wistar ; Vacuoles ; drug effects

BACKGROUNDThe mammalian target of rapamycin (mTOR) pathway, a key cellular signaling pathway associated with various cellular functions, has distinct roles in the inflammatory process. In this study, the mTOR inhibitor rapamycin (Rapa) was used to test whether inhibition of mTOR activation attenuates lipopolysaccharide (LPS)-induced acute lung injury (ALI) in a murine model.

METHODSMice pretreated with Rapa or vehicle were given LPS intratracheally. Local cell numbers and inflammatory cytokines present in the bronchoalveolar lavage fluid (BAL), wet-to-dry weight ratio, histopathology of the lungs, and survival were evaluated.

RESULTSThe phosphorylation of S6, a major downstream target of mTOR, had a 3-fold increase in lung tissue after LPS stimulation, but the increase was blocked by Rapa. Rapa reduced the levels of TNF-α (LPS vs. LPS + Rapa, (1672.74 ± 193.73) vs. (539.17 ± 140.48) pg/ml, respectively; P < 0.01) and IL-6 (LPS vs. LPS + Rapa: (7790.88 ± 1170.54) vs. (1968.57 ± 474.62) pg/ml, respectively; P < 0.01) in the BAL fluid. However, Rapa had limited effects on the overall severity of ALI, as determined by the wet-to-dry weight ratio of the lungs, number of neutrophils in the BAL fluid, and changes in histopathology. In addition, Rapa failed to reduce mortality in the LPS-induced ALI model.

CONCLUSIONSWe confirmed that mTOR was activated during LPS-induced ALI and strongly inhibited by Rapa. Although Rapa reduced the levels of the mediators of inflammation, the overall severity and survival of the ALI murine model were unchanged.

Acute Lung Injury ; chemically induced ; drug therapy ; Animals ; Lipopolysaccharides ; Mice ; Mice, Inbred C57BL ; Phosphorylation ; Sirolimus ; pharmacology ; therapeutic use ; TOR Serine-Threonine Kinases ; drug effects