Objective:To explore the placental expression of farnesoid X receptor( FXR) ,as well as the total bile acid (TBA) levels in maternal and umbilical cord serum in intrahepatic cholestasis of pregnancy (ICP) and normal late pregnancy. To evaluate the roles of placental FXR in the pathological mechanism of ICP. Methods:Maternal and umbilical cord blood as well as placentas were collected in gravidas of 33 ICP (ICP group) and 33 normal late pregnancy (control group). According to maternal serum TBA levels, ICP group was divided into mild and severe subgroup, the latter with TBA ≥40 μmol/L TBA levels were measured by velocimetry and the placental FXR mRNA expression were examined by real time nested RT-PCR. Results:①Comparing the rate of meconium -stain of amniotic fluid: The rate in ICP group was significantly higher than that in control group(χ~2=7.543,P=0.013); The rate in serve ICP group was significantly higher than that in mild ICP group(χ~2= 7.637,P=0.013). ②The expression of FXR mRNA in placentas: placental FXR mRNA expression was significantly higher in ICP group than that in control group (z = -2. 391, P = 0.017). Placental FXR mRNA expression was higher in severe ICP group than that in mild ICP group (z= -2.391 ,P=0.017).③ln ICP group, a positive correlation was found between the placental FXR mRNA expression and the maternal serum TBA levels as well as umbilical serum TBA levels(r_s =0.348,P=0.047; r_s =0.284,P=0.027). There were no significant correlations between maternal serum as well as umbilical serum TBA levels and placental FXR mRNA expression in control group ( r_s = - 0.068, P = 0.716; r_s = 0.010,P=0.959). Conclusions:Placental FXR mRNA expression is up regulated by increased bile acid levels in ICP, which may represent a compensatory (anti-cholestatic) mechanism of placenta in ICP.

Objective To investigate the quantitative abnormality of CD~+_5B lymphocytes in the bone morrow of the patients with autoimmunic hemocytopenia and its clinical significance.Methods The patients were referred to the Institute of Hematology & Blood Diseases Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College.Quantities of CD~+_5B lymphocytes in the bone morrow of 14 patients with autoimmune hemolytic anemia(AIHA)or Evans syndrome,22 immunorelated pancytopenia(IRP)patients and 10 normal controls were assayed by FACS.The correlation between their clinical and laboratory parameters with CD~+_5B lymphocytes was analyzed.Results The qutantity of CD~+_5B lymphocytes were significantly higher in AIHA and Evans and IRP patients than in normal controls;there was no significant difference between AIHA、Evans syndrome and IRP patients.The qutantity of CD~+_5B lymphocytes in the bone morrow of all cytopenic patients showed negative correlation with C_3 complement.In AIHA、Evans syndrome patients,the quantity of CD~+_5 B lymphocytes in their bone morrow showed positive correlation with IBIL.In Evans syndrome patients,the quantity of CD~+_5B lymphocytes in their bone morrow showed positive correlation with PAIgG and PAIgM.The qutantity of CD~+_5B lymphocytes in the bone marrow of all cytopenic patients showed negative correlation with treatment response,but no correlation with the yields of CFU-E、 BFU-E、CFU-F and CFU-GM cultured from their bone marrow mononuclear cells in vitro.Conclusion CD~+_5B lymphocytes in the bone marrow of the patients with autoimmunic hemocytopenia significantly increase and are related to the disease severity and clinical response.It is suggested that CD~+_5B lymphocytes might have important roles in the pathogenesis of autoimmunic cytopenia.

Objective To evaluate the clinical features and early management of combined thoracoabdominal injury (CTI).Methods A retrospective study was carried out in 29 cases with CTI treated surgically.There were 21 cases with penetrating injuries and 8 cases with blunt injuries.All cases were associated with penumothorax and/or hernothorax at various degrees and 13 cases complicated with shock.In this study thoracotomy was performed in 17 cases,laparotomy in 6 cases,thoracotomy plus laparotomy in 5 cases and combined thoraco-laparotomy in 1 case.Results The injury severity score in this series was (40.16±15.23) scores.Four cases were died from hemorrhagic shock (2 cases),pericardial tampenade(1 case) and multiple organ failure(1 case).Conclusions CTI has high mortality rate,and the most frequent cause of death is hypovolemic shock.The operative approach is based on individual injury condition.Early diagnosis and timely surgical intervention are key to improving the cure rate and reducing mortality in severe CTI.

Objective To test the reliability and validity of the home care demand forecasting scale for fracture patients when they were before discharge. Methods This study was descriptive study. Convenience sampling was used and 412 patients with fracture from 5 comprehensive hospitals in Yanbian Korean Autonomous Prefecture were selected. Finally, the number of valid questionnaires is 398 which were used for testing. Results Five factors and 32 items were eventually determined. The split-half reliability coefficient was 0.910, and split-half coefficient in each dimension was over 0.75; the content validity showed scale level content validity index(S-CVI) was 0.948, and the index in each item′s item level content validity index (I-CVI) was between 0.76 to 1.00. The result of factor analysis included 5 factors and the cumulative contribution of variance was 59.181%. The result of construct validity χ2/df=1.554, root mean square error approximation (RMSEA)=0.037, goodness-of-fit index (GFI)=0.920. The total of scale′s Cronbach coefficient was 0.948, Each dimension′s Cronbach coefficient was between 0.797-0.875. Conclusions The home care demand forecasting scale was proved to be reliable and valid. It can be used to assess the home-care needs of fracture patients before they were discharge.

Objective To investigate the function of myeloid dendritic cells (mDCs) from severe aplastic anemia ( SAA ) patients in stimulating allogeneic T lymphocytes proliferation in vitro and then explore the immunopathogenesis of SAA. Methods Twenty-five SAA patients ( 15 untreated and 10 recovered after immunosuppressive therapy) and 12 normal controls were enrolled in this study. Their mature mDCs were induced from their bone marrow monocytes with recombined human interleukin-4 ( rhIL-4) , recombined human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) and recombined human tumor necrosis factor (rhTNF) in vitro. Then mDCs were co-cultured with allogeneic lymphocytes (mixture lymphocyte reaction, MLR) at a ratio of 1: 100 or 1: 50. The growth rate of lymphocyte was measured with methyl thiazolyl tetrazolium ( MTT) colorimetry.The concentrations of interleukin( IL) -12 and inlerferon -y (IFNγ) in MLR supernatant were measured with EL1SA. The correlation between the growth rate and the concentration of IL-12 or IFNγ was analyzed. Results When mDCs and lymphocytes were co-cultured at the ratio of 1: 100, the growth rates of lymphocytes stimulated with mDCs from untreated, recovered SAA patients and controls were (219. 8 ±94. 0)% , (159. 1 ±66. 0)% and (160. 1 ±91. 9)% respectively. The concentrations of IL-12 in MLR supernatant were (8. 2 ± 3. 6) ng/L, (6. 5 ± 2. 8) ng/L and (6. 1 ± 2. 6) ng/L and the concentrations of IFNγ were (21. 8 ± 8. 7) ng/L, (25. 5 ± 9. 1) ng/L and (22. 6 ± 7. 8) ng/L respectively. All of them had no statistical differences among the three groups ( P > 0. 05 ). When mDCs and lymphocytes were co-cultured at the ratio of 1: 50, the growth rate of lymphocytes stimulated with mDCs from untreated patients was (322. 1 ± 171. 1)% , which was higher than that of recovered patients [ (180. 9 ±79. 1)% and controls (192. 3 ±91. 9)% ]. The concentrations of IL-12 in MLR supernatant in the three groups were (12.6 ±4.4) ng/L, (9.4 ±3.3) ng/L and (8.5 ±3.7) ng/L, and the concentrations of IFNγ were (32. 3 + 9. 2 ) ng/L, ( 27. 4 ± 6. 5) ng/L and (24. 4 ± 7. 4 ) ng/L Both of the values in untreated cases were higher than those of the recovered cases or controls (P < 0. 05 ) , but there were no statistical difference between the recovered and control groups ( P >0. 05 ). The concentration of IL-12 in MLR supernatant correlated positively with the growth rate of lymphocyte (r=0. 529,P <0. 01) and so did the concentration of IFNγ (r = 0. 381, P < 0. 05). Conclusion The function of mDCs to stimulate T lymphocytes proliferation in SAA was enhanced; it might play an important role in the immunopathogenesis of SAA.

AIM:To observe the effects of normal mesenteric lymph (NML) on the lung, heart and liver inju-ries and the phosphorylation levels of p 38 mitogen-activated protein kinase ( MAPK) , extracellular signal-regulated kinase (ERK) 1/2 and c-Jun N-terminal kinase (JNK) in the mice with endotoxic shock (ES).METHODS: The NML was drained form health male BALB/c mice for the intervention of ES after the removal of cellular constituent .Lipopolysaccha-ride (LPS, 35 mg/kg) was intraperitoneally injected into the mice for the establishment of ES model .After 60 min of LPS injection, the administration of NML (1/15 of whole blood volume) was performed through the femoral artery in NML +ES group.Meanwhile, the mean arterial pressure (MAP) was monitored during the experiment .At 6 h after intraperitoneal in-jection of LPS or the corresponding time point , blood samples were harvested from the heart through apical centesis for de-termination of the biochemical indexes to reflect myocardial and hepatocyte injuries .Simultaneously , the lung , heart and liver tissue specimens from a fixed location were harvested for the observation of histomorphology and the measurement of phosphorylation levels of p38 MAPK, ERK1/2 and JNK.RESULTS:Compared with sham shock (SS) group, MAP in ES group and NML+ES group remarkably decreased at multiple time points after intraperitoneal injection of LPS .However, MAP in NML+ES group at 80 min, 90 min, 190 min, 210 min, 240 min, 250 min, 340 min, 350 min, and 360 min were significantly increased compared with ES group .There were normal structures in the lung , liver and myocardium of the mice in SS group, while the morphological damages of these tissues appeared in ES group .Meanwhile, the damages were attenuated in the mice of NML +ES group.The activities of AST , ALT and CK-MB in the plasma in ES group were remark-ably higher than those in SS group .The CK-MB activity in NML+ES group was also increased compared with SS group , and the activities of AST and LDH-1 were lower than those in ES group .At 6 h after LPS injection , the phosphorylation levels of p38 MAPK, ERK1/2 and JNK in the lung tissues were remarkably increased .Meanwhile , no statistical difference of these indexes between the myocardial and hepatic tissues was observed .NML intervention decreased the phosphorylation levels of p38 MAPK in the lung tissues , and p38 MAPK, ERK1/2 and JNK in the myocardial tissues .CONCLUSION:The NML administration alleviates multi-organ injuries and reduces the phosphorylation level of p 38 MAPK in the lung tis-sues in the mice subjected to ES .

PURPOSE: We investigated the effects of different stimulation frequencies on the inhibition of bladder overactivity by sacral neuromodulation (SNM) in pigs. METHODS: Implant-driven stimulators were used to stimulate the S3 spinal nerve in 13 pigs. Cystometry was performed by infusing normal saline (NS) or acetic acid (AA). SNM (pulse width, 210 µsec) at frequencies ranging from 5 to 50 Hz was conducted at the intensity threshold at which observable perianal and/or tail movement was induced. Multiple cystometrograms were performed to determine the effects of different frequencies on the micturition reflex. RESULTS: AA-induced bladder overactivity significantly reduced the bladder capacity (BC) to 34.4%±4.7% of the NS control level (354.4±35.9 mL) (P<0.05). During AA infusion, SNM at 5 Hz did not significantly change the BC (48.1%±6.9% of the NS control level) (P>0.05), but SNM at 15, 30, and 50 Hz significantly increased the BC to 54.5%±7.1%, 55.2%±6.5%, and 57.2%±6.1% of the NS control level (P<0.05), respectively. No significant differences were found among the results obtained using frequencies of 15, 30, and 50 Hz (P>0.05). CONCLUSIONS: This study demonstrated that 15 Hz was an appropriate frequency for SNM and that frequencies higher than 15 Hz did not lead to better surgical outcomes.
Acetic Acid ; Reflex ; Spinal Nerves ; Swine* ; Tail ; Urinary Bladder* ; Urinary Bladder, Overactive ; Urination

Purpose: To investigate the video-urodynamic and pelvic floor electrophysiological characteristics in patients with traumatic spinal cord injury (SCI). Methods: This retrospective reviewed the clinical records, urodynamic and pelvic floor electrophysiological data of 647 patients with traumatic SCI and out of spinal shock. Patients were classified based on American Spinal Injury Association (ASIA) Impairment Scale and urodynamic findings. Results: Of the 647 patients, detrusor overactivity (DO) with or without detrusor sphincter dyssynergia (DSD) was found in 79.5%, 61%, 35.2%, 35%, and 19.2% of patients with cervical, thoracic (T1–9), thoracic (T10–12), lumbar, and conical cauda injury, respectively. Other patients manifested detrusor areflexia (DA). Patients with DO and/or DSD had a longer duration of SCI at each injury level than patients with DA. In suprasacral injury patients with DA, 63.0% (58 of 92) had a normal bulbocavernosus reflex (BCR) response. Compared with patients without bladder sensation (BS), bladder capacity during urine leakage was far higher in those with BS. The manifestation of BCR and somatosensory-evoked potential (SEP) was associated with the level of injury. Conclusions This study showed a significant correlation between the level of SCI and video-urodynamic findings, but clinical examination cannot by predict bladder function; urodynamic testing is also necessary. In addition, the role of BCR and SEP for guiding bladder management is limited. Moreover, BS is important for urinary control in patients with traumatic SCI.

Objective To explore the expression of antigen activated of macrophages ( MΦ) of bone marrow and its clinical significance in pancytopenia patients with positive bone marrow mononuclear cells (BMMNC)-Coombs test ( immunorelated pancytopenia, IRP) . Methods Sixty-one IRP patients, 10 severe aplastic anemia (SAA) patients and 13 healthy controls were enrolled in this study. The categories of auto-antibodies(IgG, IgM) on BMMNC(CD_(34)~+/CD_(15)~+/GlycoA~+ hematocytes), the quantity (CD_(68)~+/CD_(45)~+)% and expression of antigen activated ( CD_(69) ) of MΦ ( CD_(68)~+ CD_(69)~+/CD_(68)~+ ) % in bone marrow of all cases and controls were measured by fluorescence activated cell sorting( FACS). Results The quantity and expression ratio of activated antigen of bone marrow ( BM ) MΦ in IRP patients [ ( 0. 57 ± 0. 30 ) % and ( 40. 30 ± 18.49)%] were respectively significantly higher than those in SAA [ (0.46 ± 0. 08)% and ( 32. 44 ± 19.37)%] and healthy controls [ (0. 44 ± 0. 69)% and (29.71 ± 11. 67 )% ] ( both P < 0. 05 ). The quantity presented high-positive correlation with the expression ratio of activated antigen of BM MΦ ( r = 0.89, P<0. 01). Patients with IRP were classified into two subgroups according to the quantity of MΦ: Group A (MΦ≥0. 5% , 34 cases) and Group B ( MΦ <0. 5% , 27 cases). Thirty-two cases (94. 12%) were with auto antibody ( IgG) in Group A, while only 2 (7. 41% ) with auto antibody ( IgG) in Group B. There was significant difference in expression ratio of activated antigen of BM MΦ between Group A (49. 19 ± 16. 63) % and Group B (29. 11 ± 14. 30) % ( P < 0. 05 ) , but no difference was found between Group B and the control group (P >0. 05). Total curative rates at 3 and 6 month (47. 06% and 79. 41% ) of Group A were better than those of Group B (22.22% and 51.85%). Thirty-four IRP patients with autoantibody ( IgG) ( + ) were divided into two subgroups according to the quantity of MΦ: high level group ( >0. 75% , 9 cases) and low level group( <0. 75% , 25 cases) , 24 cases (96% ) in MΦ low level group were found auto-antibody (IgG) on one hemotopoietic cell lineage, 1 on two lineages, while 8 (88. 89% ) in MΦ high level group were detected auto-antibody (IgG) on two cell lineages, and 1 on three cell lineages. Expression ratio of activated antigen (56. 12 ± 15. 11) % was much higher in MΦ high level group than that in MΦ low level group (44. 58 ± 18. 16)% (P < 0. 05 ). The count of red blood cell concentration of hemoglobin and platelet in peripheral blood in MΦ high level group were respectively lower than those in MΦ low level group, while the percentage of Ret, the level of total bilirubin and indirect bilirubin, the ratio of erythroid of sternal bone marrow in MΦ high level group were higher than those in MΦ low level group. Conclusion The expression of activated antigen of BM MΦ was enhanced in IRP especially with autoantibody (IgG) , which might be involved in damage process of hemotopoietic cell.

Purpose: To explore the effect of intravesical electrical stimulation (IVES) on urinary adenosine triphosphate (ATP) and nitric oxide (NO) in rats with detrusor underactivity (DU) induced by bilateral pelvic nerve crush (bPNC), and to determine the underlying peripheral mechanism. Methods: Twenty-four female Sprague-Dawley rats were equally divided into 3 groups: sham; bPNC; and IVES. Rats in the IVES group began to receive IVES treatment 10 days after bPNC (20 minutes per day for 14 consecutive days). After the 14th IVES, rat urine was collected and cystometry was performed. The serum creatinine, blood urea nitrogen, and urinary ATP and NO levels were measured, and a routine urinalysis was performed. Results: The maximum cystometric capacity (MCC), maximum changes in bladder pressure during filling (∆FP), and postvoid residual urine (PVR) in the IVES group were significantly lower than the bPNC group, and the maximum changes in bladder pressure during voiding (∆VP) was significantly higher than the bPNC group. Compared with the sham group, the MCC, ∆FP and PVR were significantly increased, and the maximum voiding pressure (MVP) and ∆VP were significantly decreased in the bPNC group. After bPNC, urinary ATP was significantly decreased, and urinary NO was significantly increased. In IVES-treated rats, urinary ATP was significantly higher than the bPNC group, and NO was significantly lower than the bPNC group. In addition, the ATP-to-NO ratio of the rats in the bPNC group was significantly lower than the sham and IVES groups. Correlation analysis showed that the ATP and NO were not correlated with the MCC, ∆FP, MVP, ∆VP, and PVR. Conclusions Promoting the release of urothelial ATP and inhibiting the release of urothelial NO may be one of the peripheral mechanisms underlying IVES in the treatment of DU. Specifically, IVES may shift the balance between excitation and inhibition toward excitation.