Objective To explore the risk factors for peptic ulcer bleeding in elderly patients.Methods The 414 patients with upper gastrointestinal ulcer bleeding in Xuanwu Hospital from January 2001 to January 2006 were enrolled.The patients were divided into elderly group (≥ 60years,n= 183 ) and non-elderly group ( ＜ 60 years,n= 231 ).The coexisting diseases and hemorrhage causes were compared and analyzed.Results The detection rate of coexisting diseases was significantly higher in elderly group than in non-elderly group (68.9% vs.10.0% ).The hemorrhage causes included the taking of drugs for cardiovascular and cerebrovascular diseases or osteoarthropathy in elderly group.And the fatigue,stress and dietary upset were the main causes in non-elderly group.Helicobacter pylori infection rate was 35.0% in the elderly and 58.0% in young patients.Conclusions It is very important to promote rational use of anticoagulant drugs and analgesic agents in elderly patients for managing peptic ulcer complication.

Objective To compare the effect and survival period of endoscopic treatment group and non endoscopic treatment group of esophageal gastric varices bleeding in patients with hepatocellular carcinoma and portal vein tumor thrombus, in order to define the significance of endoscopic therapy for prolonging the survival period of patients. Methods 76 patients diagnosed as esophageal gastric varices bleeding with hepatocellular carcinoma and portal vein tumor thrombus from Jan. 2013 to Dec. 2015 were enrolled, of all these cases, 27 were non endoscopic treatment group and 49 were endoscopic treatment group. The medical records were analyzed retrospectively. Then compare the effect of emergency treatment, the main causes of death and survival time of the two groups. Results In the non endoscopic treatment group, 40.7% (11/27) patients died in one week after bleeding, 81.5% (22/27) patients died of esophageal gastric varices bleeding, the mean survival period was (42.03 ± 13.94) days; In the endoscopic treatment group, only 16.3% (8/49) patients died in one week (P < 0.05), 55.1% (27/49) patients died of esophageal gastric varices bleeding (P < 0.05), the mean survival time was (174.24 ± 34.42) days (P < 0.05). Conclusions Endoscopic therapy can effectively reduce the risk of death from acute hemorrhage and prolong the survival time in patients with hepatocellular carcinoma and portal vein tumor thrombus.

Objective To investigate the mechanism of the permeability change in the blood brain barrier(BBB)at early stage of infectious brain edema which was pretreated with LPS.Methods PMNs were isolated and purified.The concentration of Glu was measured in the supernatant without cells.The rat BMECs were primarily isolated and cultured.The permeability of BMECs waB evaluated by measuring the passing rate of 125 I-BSA via γ ray counter.The expression of NMDAR1 on BMECs was evaluated.Results The concentration of Glu in the LPS preconditioning PMNs subgroup at 5 rain time point was highest.In each group conditioned for 240 min,the permeability index of Bake average of the LPS preconditioning PMNs extract group was highest(P＜0.01).The expression of NMDARI increased in the LPS preconditioning PMNs extract group was more than that in other groups.Conclusions The research showed for the first time that the concentration of Glu increased after LPS preconditioning and the Glu excreted by PMNs can promote the permeability of BMECs and change the function of BBB,which possibly may be related the mechanism of NMDAR1 expression increased in BMECs.

Objective To investigate the effect of high mobility group box-1 protein (HMGB1) on inter-leukin-2 (1L-2) and interleukin-2 receptor α (IL-2α) expressions in human T lymphocytes and its potential regulat-ing mechanism in vitro. Method Human T lymphocytes were isolated and suspended, the cells were cultured with 20 μg/mL phytohemagglutinin (PHA) in 5% CO_2 at 37 ℃, recombinant human HMGB1 (rhHMGB1, 0, 10, 100, 1000 ng/mL) was added with the PHA and cultures were centrifuged at 12 and 48 hours for cell collect-ing. Reverse transcription polymerase chain reaction (RT-PCR) amplification was perfomed to determine gene ex-pressions of IL-2, IL-2Rα. IL-2, sIL-2R protein levels in cell culture supematants were measured by ELIZA. Re-sults After coincubated with rhHMGB1 (10, 100, and 1000 ng/mL) for 12 hours, IL-2 levels in cell culture su-pernatants respectively were 0 . 064 ± 0. 017 μg/L, 0.076±0.033 μg/L, and 0.061 ±0.02 μg/L, which were significantly higher compared with the untreated cells (0.045±0.011 μg/L, P < 0.05 or P < 0.01). Mean-while, IL-2 mRNA expression was markedly up-regulated following rhHMGB1 stimulation in various doses (F = 4.6872, P < 0.01). At 48 bourn, however, both IL-2 mRNA expression and protein production tended to de-crease along with an increased dose of dd-IMGB1 stimulationn. IL-2/sIL-2R ratio in 1000 ng/mL rhHMGB1 was markedly lower than that in 10 ng/ml rhHMGB1 (0.036±0.015 vs.0.055±0.017, P <0.05), together with down-regulation of IL-2Rα mRNA expression(P <0.01). Conclusions These data indieated that HMGBI could marked influence the IL-2/IL-2R expression in human T lymphocytes. With the increase in stimulating doses and prolongation of time, HMGBI might down-regulate T cell-mediated immune response of human lymphocytes.

Objective A foundation for one of the biological components,Spirulina,to be applied in Controlled Ecological Life Support System(CELSS)would be laid with exploring effects of ionization radiation on the growth of Spirulina.Methods By using the ?-rays of ~(60)Co,Spirulina were irradiated.The dose of the ionization radiation covered 0,0.5,1.0,1.5,2.0,2.5,3.0 kGy.After irradiated,these Spirulina were cultured under the same conditions.The growth state,shape change,photodensity change,photosynthetic efficiency(O2 produced),and trophic physiological indexes of Spirulina or its solution,were observed,measured and analyzed.Its anti-irradiation ability was investigated.Results After irradiared with ~(60)Co ray,the growth rate,photosynthetic O2 produced efficiency,length of fila and other trophic physiological indexes were all affected in certain degree,but as compared to the higher plants,Spirulina have stronger radiation proof and self-rehabilitation capacity.Even if under high radiation condition(3.0 kGy),there was no complete death of cells,and the dose resulted in 50% death of the Spirulina was 2.0 kGy.Conclusion Spirulina has stronger ionization radiation proof and self-rehabilitation capacity,it can be considered as one of the key biological components in CELSS for future long-term space missions.

Objective To study the effect and safety of modified Valdivia position and prone position in percutaneous nephrolithotomy(PCNL) on renal calculi.Methods The clinical data of 94 patients with solitary renal calculi admitted in our hospital from September 2015 to November 2016 were enrolled to this study,who were divided into control group and study group by surgery methods and body position,47 cases in each group.The control group received PCNL with prone position,and the study group were treated by PCNL with modified Valdivia position.The operative condition,postoperative condition,stone clearance rate and incidence of adverse reactions between the two groups between two groups were compared,and the levels of diastolic blood pressure(DBP),systolic blood pressure(SBP) and heart rate(HR) between the two groups were observed.Results After position placement,DBP and SBP level decreased in both groups,the level of DBP and SBP in study group were lower than the control group,the difference was significant(P<0.01).There was no significant difference in the level of HR between two groups(P>0.05).The operative time,intraoperative blood loss,hospitalization time,reoperation rate and blood transfusion rate in the study group were lower than those in control group,the differences were significant(P<0.05),the removal rate of stones was significantly higher than that of control group(χ2=9.55,P=0.00).The rate of chest stuffy and dysphoria in the study group were higher than those in control group(P<0.05).The incidence of infection,hemorrhage,pleural injury and renal injury were slightly lower than those of the control group,but there was no significant difference between two groups(P>0.05).Conclusion PCNL with modified Valdivia position has high safety and significant effect on patients with kidney stones,which can effectively remove stones,reduce operation time.

Objective To investigate the immunological activity change of regulatory T cells (Treg) and discuss its significance in the outcomes of patients with multiple organ dysfunction syndrome (MODS) and severe burn. Methods A total of 106 patients with total burn surface area (TBSA) larger than 30% were included in the study and randomly divided into three groups according to the burn area: Group Ⅰ (TBSA of 30%-49%, n = 41), Group Ⅱ (TBSA of 50% -69%, n = 34) and Group Ⅲ (TBSA of 70%-99%, n = 31). According to the development of MODS, patients were divided into MODS group (n =21) and non-MODS group (n =85). The patients with MODS were further divided into non-survival group (n = 16) and survival group (n = 5) based on their outcomes. Healthy volunteers were served as normal control (n = 25). Peripheral blood samples were collected at days 1,3,7, 14 and 21 postburn. The immunomagnetic separation technique was applied to separate and purify CD4+ CD25+Tregs in peripheral blood, and phenotypes (CTLA-4) were analyzed by flow cytometry and the contents of interleukin-10 released in the supernatants were determined by ELISA. Results Expression of CTLA-4 and level of IL-10 were significantly increased in burn patients compared with normal control group, with statistical differences. The expression of CTLA-4 and level of IL-10 were significantly increased in patients with severe burns at all time points. The expression of CTLA-4 and level of IL-10 in MODS group were much higher than those in non-MODS group at days 3-21 postburn (P ＜ 0.01). Among the MODS patients, the expression of CTLA-4 and level of IL-10 in the survival group were obviously lower than those in the non-survival group at days 3-21 postburn (P ＜ 0.05 or P ＜ 0.01). Conclusions After severe burn injury, expressions of the markers on CD4 + CD25 + Treg surface and secretion of cytokines produced by CD4 + CD25 + Tregs show significant difference in patients with different born areas, MODS development and survival state. CD4 + CD25 + Treg may play an important role in the pathogenesis of immunoregulation, MODS and mortality of burn patients through secretion of inhibitory cytokines.

Objective To investigate the clinical value of argon plasma coagulation (APC)trans-choledochoscopy in biliary tract complications following liver transplantation. Methods All 27 patients underwent T-tube-choledochoscopy or percutaneous transhepatic cholangioscope (PTCS).APC was used to burn the hyperplasia of bile duct stenosis and then expended the stenosis with bougienage. The bile duct foreign bodies were burnt by APC and then eliminated. The granulation tissues of bile duct were burnt by APC after biopsied. The sutures of anastomoses were burnt by APC and then eliminated. Results In general, the therapeutic achievement ratio of stenosis of bile duct in 25 cases of 28 locations was 78. 6% (22/28). The clearance ratio of bile duct foreign bodies was 85. 7% (6/7). The elimination ratio of granulation tissues was 100% (5/5), the same as the elimination ratio of sutures of anastomoses. There were no treatment-related complications about APC. The recurrence ratio of bile duct stenosis was respectively 4.5% (1/22) and 13. 6% (3/22)after follow-up for 3 and 6 months respectively. All the recurrent stenosis was non-anastomotic. The recurrence ratio of bile duct foreign bodies was respectively 16. 7% (1/6) and 33.3% (2/6) after follow-up for 3 and 6 months respectively. Conclusion APC trans-choledochoscopy in treatment of biliary anastomotic stenosis, mural foreign bodies, mural biliary cast, granulation tissues of bile duct and sutures of anastomoses following liver transplantion has a high success ratio and a sure long-term efficacy without treatment-related complications.

Objective To explore the technological and therapeutic value of endoscope for removal of hepatobiliary necrosis after liver transplantation.Methods Data of 36 patients with suspected hepatobiliary diseases,who underwent choledochoscopy or duodenoscopy to remove necrosis after liver transplantation,were reviewed.Liver function before and after the treatment were compared.Results Hepatobiliary necrosis located in common bile duct (n =6),intrahepatic bile duct (hilar bile duct included) (n =24) and intraand extra-hepatic duct (n =6).The total success rate was 72.2％ (26/36).Full clearance of bile duct necrosis was accomplished in 16 patients,partial clearance in 15 patients and the necrosis could not be removed in 5 others.The serum bilirubin and transaminase decreased significantly,compared with those before endoscopic treatment (P ＜ 0.05).No serious complications or death related to endoscopy occurred during the treatment.After 6-84 month follow-up,in 17 survivals,3 patients underwent a second liver transplantation with good prognosis.All the survivals had a life of good quality with no placed drainage tube except for one with drainage tube for four years with unstable serum bilirubin.Nineteen patients died from biliary tract related complications or other diseases during the long-term follow-up,among which eleven patients survived beyond four years.Conclusion Endoscopy for hepatobiliary necrosis removal,a minimally invasive method,is effective and safe.

Objective This study was performed to investigate the effect of high mobility group box-1 protein (HMGB 1) on immune function of human T lymphocytes in vitro and explore its potential role in cell-mediated immune dysfunction.Methods Fresh blood was obtained from healthy adult volunteers and peripheral blood mononuclear cells (PBMCs) were isolated,then rhHMGB 1 was added to PBMCs.Four-color flow cytometric (FCM) analysis was used for the measurement of intracellular cytokine including interleukin Results (1) Different stimulating time and dosage of rhHMGB 1 did not alter the number of IFN-a positive cells (Th 1).rhHMGB 1 stimulation provoked a dose-dependent and time-dependent increase in Th2 subset and decrease in ratio of Th 1 to Th2.(2) Compared with the untreated cells,when the cells were coincubated with rhHMGB 1 (10-100ng/ml) for 12 hrs,protein release of IL-2 and sIL-2R were significantly up-regulated.At 48 hrs,in contrast,protein production was relatively lower in cells after exposure to 100-1000 ng/ml rhHMGBI.Conclusions These findings demonstrated that HMGB1 has a dual influence on immune functions of human T lymphocytes.