Objective To evaluate the effects of ABO blood group factors on perioperative coagulation in patients following epidural anesthesia.Methods One hundred and twenty ASA I or Ⅱ patients,aged 30-50 yr,weighing 50-75 kg,scheduled for elective operations expected to cause small volume of blood loss during operation under epidural anesthesia,were divided into 4 groups according to the blood group (n =30 each):blood group A group (A group),blood group B group (B group),blood group AB group (AB group) and blood group O group (O group).Blood samples were taken from the central vein before anesthesia (baseline,T1),at 30 min after beginning of operation (T2),at the end of operation (T3),and at 1,8 and 24 h after operation (T4-6) for determination of prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen (Fib) concentration,thrombin time (TT),prothrombin activity (PTA),hematocrit (Hct),and platelet (Plt) count.Results The parameters of coagulation were within the normal range at T1-6 in each group.Compared with the baseline value at T1,Fib concentration was significantly decreased,and PT,TT and APTT were increased at T2-6 in O group (P ＜0.05),however,no significant change in all parameters was found at T2-6 in the other three groups (P ＞ 0.05).Fib concentration was significantly lower,and PT,APTT and TT were longer at T1-6 in O group than in A,B and AB groups (P ＜ 0.05 or 0.01).Conclusion Although perioperative coagulation is in the normal range under epidural anesthesia in patients of different ABO blood groups,the coagulation is decreased in patients of blood group O as compared with the other blood groups.

Objective To evaluate the role of Akt and nuclear factor (NF)-κB pathway in the development of chemoresistance in gastric cancer and the relation between Akt and NF-κB.Methods SGC-7901 cells were exposed to chemotherapeutic drugs (doxorubicin and etoposide ) or chemotherapeutic drugs combined with Wortmannin or MG-132.The cell growth was detected using MTT method.The apoptosis of SGC-7901 cells was measured by TUNEL and Annexin V/PI methods.The protein level of NF-κB was analyzed by immunocytochemical staining.Electrophoretic mobility shift assay (EMSA) was used to confirm the increased nuclear translocation of NF-κB/P65.chemotherapeutic drugs could obviously inhibit the growth of SGC-7901 cells in time-dose-dependent manner.Pretreatment of SGC-7901 cells with Wortmannin or MG-132 could promote this inhibitory κB in a dose-dependent manner.Wortmannin or MG-132 pretreatment could enhance the apoptosis of NF-κB was found in SGC-7901 cells stimulated with Wortmannin,but no activation of Akt was noted in those treated with MG-132.Conclusions The chemotherapeutic drugs can both induce apoptosis and activate Akt and NF-κB in SGC-7901 cells.The efficacy of chemotherapeutic drugs can be increased via inhibiting activation of Akt or NF-κB.

Objective To analyze the differences with the expression of glucocorticoids receptor isoforms ( GRα, GRβ, GRγand GR-P ) and cytokines [ IL-6, macrophage migration inhibitory factor (MIF), IFN-γand IL-10] between patients with systemic lupus erythematosus (SLE) and rheumatoid ar-thritis ( RA) , and to further understand their correlations with disease activities.Methods Fifty-five pa-tients with SLE, forty-nine patients with RA and thirty-eight healthy subjects were recruited in this study. All patients were steroid-naive.The expression of GRα, GRβ, GRγ, and GR-P in peripheral blood mononu-clear cells at transcript levels were determined by real-time PCR.Enzyme-linked immunosorbent assay was used to detect the expression of IL-6, MIF, IFN-γand IL-10 in serum samples.Results The percentages of GRαin all subjects were the highest among four isoforms of GR, followed by GR-P, GRγand GRβ.Com-pared with healthy subjects, patients with SLE or RA showed significantly decreased expression of GRα( P<0.05), but increased expression of GR-P (P<0.05).The percentages of GR-P in patients with RA were higher than those in patients with SLE (P<0.05).The expression of GRαwas negatively correlated with SLE disease activity index (SLEDAI) and disease activity score 28 (DAS28).SLE or RA patients with high disease activity showed lower expression of GRαthan those with low disease activity.The levels of IL-6, IFN-γand MIF in patients with SLE or RA were significantly higher than those in healthy subjects ( P<0.05).A negative correlation was observed between the expression of IL-6 and GRαin patients with SLE (P<0.05).The expression of IFN-γwas negatively correlated with GRαin patients with RA (P<0.05). Conclusion There were significant differences with the expression of GR isoforms among patients with SLE, patients with RA and healthy subjects, indicating the change of internal environment in patients might be in-volved in GR alternative splicing.GRαwas the predominant isoform and was negatively correlated with dis-ease activities.Oversecretion of cytokines resulted in a decreased expression of GRα.This study would be useful for the diagnosis of the disease status and for monitoring clinical treatment.

Objective To evaluate the etiology, pathogenesis, clinical manifestation, imaging features, treatments and factors related to prognosis of acute spinal spontaneous hematoma.Methods The clinical data of 38 patients with acute spinal hematoma treated in our hospital from 2011 till now were analyzed retrospectively.Duration of follow-up was 6 months.The factors influencing the prognosis were analyzed.Results Acute epidural hematomas (n=29) were much more common than subdural (n=5), subarachnoid (n=1) and intramedullary (n=3).Most hematomas were located in the cervical and thoracic vertebra regions.The etiology of acute spinal spontaneous hematoma was unknown in most patients.Twenty-nine patients were dealt with surgical intervention and 9 patients were treated conservatively.After 6-month follow up, recovery rate measured by JOA score in patients of spinal injury ASIA level A and B was (51.26 ±38.97), and level C, D and E was (80.33 ±25.83), P<0.05.Recovery rate in patients with hematoma discovered in less then 24 hours treated with surgical decompression was (64.79 ±36.10), and that in those with hematoma present over 24 hours was (34.54 ±30.17), P<0.05.Conclusions Acute spinal hematoma always caused by unknown etiology, and usually manifests itself in a sudden onset of pain and neurological deficits.The early diagnosis mainly depends on MRI.Patients presenting with severe neurologic dysfunction or showing signs of progressive deficit should have immediate surgical intervention. The status of neurological deficits before surgery and the length of interval between onset and surgical intervention are associated with recovery.

Objective To investigate the effect of methylprednisolone pretreatment on cardiopulmonary bypass(CPB)-induced intestinal barrier injury in patients undergoing cardiac surgery.Methods Ninety NYHA Ⅰor Ⅱ patients,aged 30-50 yr,weighing 50-75 kg,scheduled for elective cardiac surgery with CPB,were randomly divided into 3 gnoups(n =30 each):control group without CPB(group Ⅰ),control group with CPB(group Ⅱ)and administration of methylprednisolone before CPB group(group Ⅲ).Anesthesia was induced with midszolam,fentanyl,etomidate and rocuronium and maintained with intravenous infusion of propofol and intermittent iv boluses of fentanyl and rocuronium.The patients were mechanically ventilated after tracheal intubation.In group Ⅲ,methylprednisolone 10 mg/kg was injected intravenously before operation and CPB.While in groups Ⅰ and Ⅱ,the equal volume of normal saline was injected instead.The blood samples were taken from the central vein before induetion of anesthesia(T1),before CPB(T2),at 30 min after the beginning of CPB(T3),at 30 rin afier the end of CPB(T4)and at 120 min after operation(T5)for determination of the plasma endotoxin concentration.Infection was recorded within 7 days after operation.Results The plasma endotoxin concentrations at T1 were within the normal range in all groups,without significant difference among the three gnoups(P ＞0.05).The plasma endotoxin concentration at T3-5 and incidence of postoperative infection in group Ⅲ were significantly lower than those in group Ⅱ,while higher than those in group Ⅰ(P ＜ 0.05).Conclusion Methylprednisolone pretreatment can reduce CPB-induced impairment of the intestinal harrier function in patients undergoing cardiac surgery.

The effect of 131I therapy for primary and metastatic lesions of thyroid carcinoma depends on the ability of iodine uptake.The loss or down-regulation of iodine-metabolizing genes represents dedifferentiation of DTC,which results in the disability to take up and accumulate 131I and eventually leads to radioiodine-refractory DTC (RR-DTC).The management of RR-DTC is extremely difficult and the prognosis is poor.It is important for the treatment and prognosis of RR-DTC to investigate the mechanism of redifferentiation.The up-regulation of thyroid iodine-metabolizing genes expression,inhibition of the changes in epigenetic modifications and intervention of the abnormal activation of signaling pathways are reviewed in this article.

Objective In order to study the biological characteristics of macrophages and provide the materials to study the survival mechanism of intracellular parasites, we conducted this study to establish a high-purity alveolar macrophage isolation and culture method.Methods Goat lungs were lavaged with normal saline in sterile environment several times, and cells were collected and then goat alveolar macrophages were purified by density gradient centrifugation using peripheral blood mononuclear cells (PBMC) solution.The isolated goat alveolar macrophages were cultured in cell culture medium containing 10% fetal bovine serum and cell morphology was observed under an inverted microscope every day,and the phagocytic activity of the cells was detected by chicken red blood cell phagocytosis test.Flow cytometry was used to detect CD14, a characteristic monocyte-macrophage surface marker.Results The adherent cells were characterized by typical macrophage morphology, pseudopodia and protrusions, showing round and irregular shape, rich cytoplasm, and large cell body.Of the cultured macrophages, 54.5% could phagocytize chicken erythrocytes and showed good phagocytic activity.After one month of in vitro culture, 93.7% of the cells were able to express CD14 antigen, which had a macrophage-specific immunophenotype.Conclusions The alveolar macrophages obtained in this study have high purity and good bioactivity, thus provide a cell model for studying the immune mechanism of intracellular parasites.

ObjectiveTo observe the clinical effect of Kangxiuke apozem in the treatment of severe bum shock.Methods40 patients of severe burn shock were randomly divided into a treatment group and a control group,with 20 patients in each group.All the patients were treated by the same route of counter-shock therapy,and the treatment group was additionally given Kangxiuke apozem (nasal feeding,qd,150 ml/d).Level of blood lactic acid,heart rate and urinary volume were evaluated by time.Main shock symptoms,including restlessness,hydrodipsia,perspiration and coldness,were observed.ResultsThe treatment group was significantly superior to the control group in the amelioration of blood lactic acid,heart rate and urinary volume ( t =10.485、3.219、7.429,P＜ 0.01 ).The symptomatic extinction of restlessness,hydrodipsia,perspiration and coldness in the extremities in the treatment group were significantly superior to those in the control group (x2=10.16、7.37、5.63、4.29,P＜0.05).ConclusionAt the same time of routine counter-shock therapy,thereby prompt burn patients to smoothly go through shock period and decreas late complications.

Objective To establish a porcine model of penetrating-suture pancreaticojejunostomy.Methods Ten domestic pigs were selected,and after general anesthesia they underwent laparotomy and the pancreas was visualized.Then the pancreas was dissected at the level of superior mesenteric vascular,and the proximal pancreatic stump was sewed up.The anastomosis between the distal pancreatic stump and the intestinal wall adopted penetrating-suture pancreaticojejunostomy; the digestive tract was reconstructed by Roux-en-Y.Results The anastomosis with penetrating-suture pancreaticojejunostomy was successful in ten domestic pigs.The mean pancreatic stump diameter was 2.5 cm,and the mean pancreatic duct diameter was 1.5 mm,the mean time for operation was 1.0 ～ 2.5 h,and the average time of pancreaticojejunostomy was 8 minutes.The mean blood loss was 25 ml.After operation,diarrhea occurred in 2 pigs and wound infection occurred in 1 pig,and all were cured with appropriate management.No pig died intra-operatively,and no pancreatic fistula or death occurred after operation.Conclusions A porcine model of penetrating-suture pancreaticojejunostomy is successfully established.

Objective To analyze the massive explosions and burn at Tianjin Port in 2015 resulted in a mass casualty event,and the entire course of response of a hospital to deal with such major sudden accident in order to find a rational strategy for optimal use of medical resources and reduce the critical mortality.Methods This study was done by a retrospective analysis of data from one trauma center at an academic hospital.Data including outcome,triage,severity and pattern of injuries,patient flow,and medical resources used were obtained by the review of hospital records.Results This disaster caused 165 deaths,8 missing contact,and 797 non-fatal casualties.The Pingjin Hospital admitted 298 casualties,and 29 of them were seriously injured referred to by Tianjin Emergency Medical Center.Excessive triage rate made after transfer to another hospital was 62.07% with 11 of the 29 severely injured patients.Maximum (also the first)surge had 147 injured patients arrived around one hour after incident,the second surge had 31 seriously injured patients occurred around 4 hours after incident.Of them,17 patients needed surgery and 17 patients were admitted to the intensive care unit.Conclusions These data showed that the number of casualties in the first surge was substantially larger than predicted and those casualties had less severe trauma,whereas the number of the injured in the second surge was less but the trauma was more severe.In order to maintain the hospital surge capacity,an effective re-triage and a hospital-wide damage control principle can be used to deal with.