SUMMARY Tuberculous aneurysm of the aorta is a very rare disorder. There have been only 50 reported cases of tuberculous aneurysm since 1895 till now, of which 88% were false aneurysms with majority being single in number. And only four were found to have multiple tuberculous aneurysms. The mean ages of the patients were 50?16 years. Treatment of tuberculous aortic aneurysm must be a combined medical and surgical approach. Once tuberculous aneurysm is identified, surgery must be performed promptly. The size of the aneurysm does not influence the need for surgery. A 70-year-old male with intermittent episodes of abdominal pain after receiving an inappropriate antitubercular therapy for pulmonary tuberculosis was diagnosed as multiple false tubercular aneurysm of abdominal aorta. An aneurysm of base 3.3 cm and greatest diameter 5 cm?6 cm was seen just above the opening of Coeliac trunk. Also at the dorsal aspect of abdominal aorta and superior mesenteric artery junction and ventral aspect of renal artery false aneurysms were seen, each with the size of 1 cm in diameter. Apart from antitubercular and antimicrobial treatment, first line surgery Endovascular Exclusion of Abdominal Aortic Aneurysm was performed for ruptured false abdominal aortic aneurysm. Even before the second line surgery, smaller abdominal aortic aneurysms got ruptured and the patient ’s party gave up further treatment. Finally the patient died of gastrointestinal haemorrhage.

Objective　To explore the development of endogenous CO and its mechanisms in asthma.Methods　50 guinea pigs were equally separated 5 groups.After the models of asthmatic guinea pigs were established in 4 groups,3 groups of them were treated with dexamethasone,the specific stimulator(hemin)and inhibitor(Sn-PP)of HO-1 respectively.The rest of groups were asthmatic one and normal control one(NCG).From all tested animals,the COHb in blood and lung HO-1 activity were examined,the lung tissues were pathologically observed and immunohistochemically stained.Results　In asthmatic and hemin stimulated groups,the levels of COHb with enhanced expression of lung HO-1 and their activity were significantly increased compared with NCG(t=4.43～9.97,P＜0.01).For example,the lung HO-1 activities in asthmatic group were (881±361)pmol/(mg*pro*h),COHb (4.94±2.15)% respectively.In dexamethason prevented and Sn-PP inhibited groups,however,all determined levels were markedly reduced compared with asthmatic group(P＜0.01).Conclusion　The increased HO-1 had resulted in the growth of endogenous CO in asthma.

Adolescent ; Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Joint Dislocations ; diagnostic imaging ; physiopathology ; therapy ; Male ; Manipulation, Orthopedic ; Middle Aged ; Recovery of Function ; Sacroiliac Joint ; injuries ; Tomography, X-Ray Computed

Objective To establish a method of microbial limit tests for compound Hongjingtian oral liquid and to per-form the validation of the method.Methods The validation on the microbial limit test method was conducted according to the counting method of bacteria,mycetes and yeasts and the control bacteria test method stated in the appendix of China pharmaco-poeia (2010 edition).Results The recoveries were over 70% when culture diluting method was used for staphylococcus aureus and routine test method was used for Escherichiacoli,Bacillus subtilis,Candida albicans and Aspergillus niger.In the test of positive control bacteria,the growth was detected,while the negative control was no growth detected.Conclusion The micro-bial limit test for compound Hongjingtian oral liquid is validated in this study.The amount of staphylococcus aureus can be de-termined using diluted culture method ;while the amounts of Escherichiacoli,Bacillus subtilis,Candida albicans,Aspergillus niger can be determined by conventional method.

Objective To investigate the effect of the third party evaluation on improving the quality of medical service as well as the degree of patient trust in hospital.Methods Discharge patients from a two-level hospital in Minhang District was enrolled to evaluate their trust for medical service.Telephone follow-up were implemented in group A by the third party evaluation team.Group B was evaluated by the in-patient department when they left the hospital.These two evaluation methods were compared for the effects.Results During the first evaluation,1 073 people in group A,the equipartition satisfaction was 3.83 ± 0.57,the satisfaction rate was 54.99％.While in group B of 1 480 people,the equalization satisfaction was 3.83 ± 0.49,the satisfaction rate was 57.03％ (P＞0.05).At the fourth evaluation,1 233 people in group A and 1 512 people in group B were evaluated.Regarding group A,the patient satisfaction scores was 4.18 ± 0.33,patients satisfaction rate was 84.43％,the equipartition of patients referral was 3.44 ± 0.83,the equipartition of patients recommends the physician was 3.52 ±0.88,the equipartition of the doctor and patient had a quarrel was 4.33 ± 0.60,the equipartition of patients will find another doctor for diagnosis was 3.31 ± 0.72,the equipartition of patients expressed fully in accordance with the doctor's order of medication was 3.45 ± 0.72,group A were better than groupB (P＜0.05).Of the28 entries in the level of trust related to medical services,15 entries of group A were higher than group B (P＜0.05).In group A,the equipartition of moderate intensity activity was 3.62 ± 0.81,the equipartition of emotional coordination refers to 3.71 ± 0.76,the equipartition of family coordination was 3.69 ± 0.58,the equipartition of friends coordination was 3.73 ± 0.74,the equipartition of overall health was 3.31 ± 0.77,all were superior to group B (P＜0.05).Conclusions The third party evaluation is a supplementation for hospital management,which has positive effects on improving medical service quality of medical institutions,the hospital performance appraisal system,patients' experiences and trust degree.

OBJECTIVETo investigate the risk factors for anastomotic infectious complications after bowel resection in patients with Crohn disease.

METHODSClinical data of 124 patients with Crohn disease undergoing bowel resection between January 1990 and October 2012 were analyzed retrospectively. The risk factors were identified by χ(2) test and Logistic regression.

RESULTSFourteen patients (12.3%, 14/114) developed anastomotic infectious complications in the postoperative period, including anastomotic leak (n=7), intra-abdominal abscess (n=6), and enterocutaneous fistula (n=1). Crohn disease activity index (CDAI)>150 (OR=2.185, 95%CI:1.098-6.256, P=0.040), steroid usage (OR=2.674, 95%CI:1.118-8.786, P=0.027), and the presence of preoperative abscess/fistula (OR=3.447, 95%CI:1.254-10.462, P=0.014) were identified as independent risk factors of anastomotic infectious complications. In the absence of these 3 risk factors, the rate of anastomotic infectious complication was 5.7% (3/53), which increased to 11.4% (4/35) when one risk factor was present, 21.1% (4/19) when two risk factors were present, and 42.9% (3/7) when all the 3 risk factors were present.

CONCLUSIONSCDAI>150, steroid usage and preoperative abscess/fistula are associated with higher rates of anastomotic infectious complications following bowel resection for Crohn disease. A prudent management should be carried out if risk factors can not be eliminated preoperatively.

Abdominal Abscess ; pathology ; Adolescent ; Adult ; Aged ; Anastomosis, Surgical ; adverse effects ; Anastomotic Leak ; pathology ; Chi-Square Distribution ; Colectomy ; adverse effects ; Crohn Disease ; surgery ; Female ; Humans ; Intestinal Fistula ; pathology ; Logistic Models ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Steroids ; therapeutic use ; Surgical Wound Infection ; etiology ; surgery ; Young Adult

To identify the predictors of prolonged mechanical ventilation in patients undergoing surgery for stanford type A acute aortic dissection. Methods 202 patients who underwent surgery for acute aortic dissection type A from May 2009 to May 2016 were divided into two groups based on their mechanical ventilation time after surgery, including 70 patients with mechanical ventilation 48 hours or more(group A), 132 patients with mechanical ventilation less than 48 hours (group B). Univariate and multivariate analysis(logistic regression) were used to identify the predictive risk factors. Results The mechanical ventilation time was(146. 8 ±78. 5)h and(21. 7 ±9. 5)h in group A and group B respectively. Overall inhospital mortality was 8. 6％ and 2. 3％. Multivariate logistic analysis showed that BMI(OR = 5. 956, 95％ CI: 2. 585 - 13. 723, P =0. 000), CPB time(OR =1. 108, 95％CI: 1. 052 -1. 166, P =0. 000), DHCA(OR =4. 562, 95％ CI: 1. 250 - 16. 640, P =0. 022), red blood cell transfusion intraoperative and in 24 hours postoperatively(OR =2. 625, 95％ CI: 1. 515 -4. 549, P =0. 001) were the independent predictors for prolonged mechanical ventilation. Conclusion The incidence of prolonged mechanical ventilation is high after surgery for stanford type A acute aortic dissection. It can be predicted based on above factors, for patients with these risk factors, more perioperative care strategies are needed in order to shorten the mechanical ventilation time.

Objective:To explore the protective effect and mechanism of scutellarin (Scu) on sepsis associated-acute kidney injury (SA-AKI).Methods:① In vivo experiment: 36 male C57BL/6 mice were divided into normal saline (NS) control group, lipopolysaccharide (LPS) induced SA-AKI model group (LPS group), 20 mg/kg Scu control group (Scu 20 control group), and 5, 10, 20 mg/kg Scu pretreatment groups by random number table with 6 mice in each group. The SA-AKI model was reproduced by intraperitoneal injection of 10 mg/kg LPS. The NS control group was injected with NS intraperitoneally. The Scu pretreatment groups were intraperitoneally injected with different doses of Scu every day before LPS injection for 1 week. Scu 20 control group was injected with 20 mg/kg Scu for 1 week. After 24 hours of LPS treatment, mice in each group were sacrificed, kidney tissues were collected, and kidney injury was detected by hematoxylin-eosin (HE) staining. Western blotting was used to detect the protein expression levels of nuclear factor-κB (NF-κB) signaling pathway related molecules, apoptosis-related proteins and cysteine-rich protein 61-connective tissue growth factor-nephroblastoma overexpressed gene 1 (CCN1). ② In vitro experiment: human renal tubular epithelial cell line HK-2 was cultured in vitro and used for experiment when the cells fused to 80%. In the cells without LPS treatment and after 100 g/L LPS treatment, pcDNA3.1-CCN1 and small interfering RNA (siRNA) CCN1 sequence were transfected to overexpress and inhibit CCN1 expression, respectively, to observe whether CCN1 was involved in NF-κB signaling pathway activation and apoptosis. In addition, 100g/L LPS and 20 μmol/L Scu were added into HK-2 cells transfected with and without CCN1 siRNA to investigate the mechanism of protective effect of Scu on LPS-induced HK-2 cells injury. Results:① The results of in vivo experiment: the renal function of SA-AKI mice induced by LPS was significantly decreased, and had kidney histological damage and severely damaged renal tubules. Scu could alleviate renal function and histological damage in a dose-dependent manner. Western blotting results showed Scu could reduce the protein expression of NF-κB signaling pathway related molecules and CCN1 in the renal tissue, and had a significant alleviating effect on apoptosis, indicating that CCN1 was involved in NF-κB signaling pathway activation and apoptosis. ② The results of in vitro experiment: in HK-2 cells not treated with LPS, CCN1 overexpression had no effect on apoptosis related protein and pro-inflammatory factors of NF-κB signaling pathway. In HK-2 cells treated with LPS, overexpression of CCN1 significantly inhibited the mRNA expressions of interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α) and monocyte chemoattractant protein-1 (MCP-1), with significant differences as compared with cells stimulated only by LPS [IL-1β mRNA (2 -ΔΔCT): 3.20±0.57 vs. 4.88±0.69, TNF-α mRNA (2 -ΔΔCT): 2.99±0.44 vs. 5.00±0.81, MCP-1 mRNA (2 -ΔΔCT): 2.81±0.50 vs. 5.41±0.75, all P < 0.05], and the apoptosis-related protein was significantly down-regulated. However, when siRNA was used to inhibit the expression of CCN1, the mRNA expressions of pro-inflammatory factors were significantly increased as compared with cells stimulated only by LPS [IL-1β mRNA (2 -ΔΔCT): 6.01±1.13 vs. 4.88±0.69, TNF-α mRNA (2 -ΔΔCT): 5.15±0.86 vs. 5.00±0.81, all P < 0.05], and apoptosis-related protein was significantly up-regulated. In the LPS-induced HK-2 cells, the mRNA expressions of pro-inflammatory factors were significantly down-regulated after Scu treatment as compared with cells stimulated only by LPS [IL-1β mRNA (2 -ΔΔCT) : 2.55±0.50 vs. 6.15±1.04, TNF-α mRNA (2 -ΔΔCT): 2.58±0.40 vs. 3.95±0.52, MCP-1 mRNA (2 -ΔΔCT): 2.64±0.44 vs. 6.21±0.96, all P < 0.05], and apoptosis-related protein was also significantly reduced. When the expression of CCN1 was inhibited by siRNA, the protective effect of Scu on cells was weakened, which showed that the mRNA expressions of pro-inflammatory factors in cells was significantly up-regulated compared with the cells without inhibition of CCN1 expression [IL-1β mRNA (2 -ΔΔCT): 5.34±0.76 vs. 2.55±0.50, TNF-α mRNA (2 -ΔΔCT): 3.66±0.54 vs. 2.58±0.40, MCP-1 mRNA (2 -ΔΔCT): 5.15±0.79 vs. 2.64±0.44, all P < 0.05], and the expression of apoptosis related protein was also significantly up-regulated. Conclusions:Scu could protect the renal function in SA-AKI mice, and the protective effect is associated with NF-κB signaling pathway and CCN1. Thus, Scu could alleviate LPS-induced kidney injury by regulating the NF-κB signaling pathway.

Background: Autologous fat grafting has gained popularity in breast augmentation. Various methods can be used to estimate the volume retention rate. This systematic review aimed to establish whether the type of method used for measuring breast volume is a factor that influences the reported volume retention rate. Methods: Studies were identified using the electronic databases PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science from inception of the database up to February 2019. Articles describing autologous fat grafting for breast augmentation were selected based on pre-determined inclusion and exclusion criteria. The characteristics of the included studies were summarized, and the reported volume retention rate from the studies was compared. A quality assessment of all included articles was performed using the methodological index for non-randomized studies criteria. Results: A total of 618 articles were identified, of which 12 studies, with a total of 1337 cases, were eligible. The retention rate of injected adipose tissue varied when the method of fat grafting and volume analysis used were both the same, as well as when the method of fat grafting was the same but the method of volumetric evaluation used was different. Conclusions Currently, the tools available for estimating the volume retention rate come with limitations. In order to objectively evaluate the percentage of graft retention, a standard protocol that applies to the different methods should be established in the future.

The present study was designed to investigate the antimalarial activity of synthetic hepcidin and its effect on cytokine secretion in mice infected with Plasmodium berghei. The mice were infected with P. berghei intravenously and treated with hepcidin according to 4-day suppression test and Rane's test. The serum levels of interleukins (IL-1β, IL-2, IL-6, IL-10, IL-12p70, and IL-17A), tumor necrosis factor-α (TNF-α), and interferon-γ (IFN-γ) in the experimental mice were determined using a cytometric bead array (CBA) kit. The survival rate of the infected mice was also registered. Additionally, the serum iron, alanine transaminase (ALT), aspartate transaminase (AST), and total bilirubin (BIL) were detected to evaluate liver functions. Hepcidin exerted direct anti-malarial function in vivo and increased survival rate in a dose-dependent manner. In addition, the secretion of T helper cell type 1 (Th1), Th2, and Th17 cytokines, TNF-α, and IFN-γ were inhibited by hepcidin. In conclusion, our results demonstrated that synthetic hepcidin exerts in vivo antimalarial activity and possesses anti-inflammatory function, which provides a basis for future design of new derivatives with ideal anti-malarial activity.
Animals ; Antimalarials ; chemical synthesis ; pharmacology ; Disease Models, Animal ; Drug Evaluation, Preclinical ; Hepcidins ; chemical synthesis ; pharmacology ; Humans ; Interleukin-10 ; immunology ; Interleukin-17 ; immunology ; Malaria ; drug therapy ; immunology ; mortality ; parasitology ; Male ; Mice ; Plasmodium berghei ; drug effects ; genetics ; metabolism