Objective To understand the current economical operation of public hospitals in Hubei province and its effect on their public welfare performance. Methods To collect data in field survey and to analyze the current economic situation of such hospitals in the province based on relevant statistics.Results Financial revenue and expenditure of these hospitals keep rising and achieving a balance in general; for the insufficient government financial subsidy, 90% of the revenue of such hospitals come from their medical services and drugs sold; the per capita revenue of these public hospitals maintains a yearly rising trend; their asset-liability ratio was relatively high. Conclusions The public welfare performance of these hospitals tends to be impeded by the reform on the macro economic system and health policy changes, on top of the attraction of economic interests. Improving the government subsidy mechanism for public hospitals and standardizing the financial management mechanism of public hospitals.

Objective To observe different effects of cyclic and continuous nutrition infusion on serum nutritional indicators, peripheral white blood cell counts (WBC), arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2) and acute physiology and chronic health evaluation Ⅲ (APACHE Ⅲ ) score in patients with mechanical ventilated respiratory failure (MVRF).Methods A cross-over and self-controlled trial was conducted in 48 patients with MVRF treated in a medical intensive care unit during December 2006 to June 2009, and continuous nutrition (group A) and cyclic nutrition (group B) were infused respectively for patients of the two groups.Serum levels of albumin (ALB), pre-albumin (PA), transferrin (TR), PaO2, PaCO2, WBC and APACHE Ⅲ score were measured for the patients with 24-hour continuous nutrition (group A) and 16-hour cyclic nutrition (group B)infusion.Effects of the two nutritional therapies were compared.Results After nutrition infusion, serum levels of ALB, PA and TR were (34±3)g/L, (196±28)mg/L and (2.1±0.3 ) g/L in group A, and (35 ±4) g/L, (198 ±25) mg/L and (2.0 ±0.4) g/L in group B, respectively; and PaO2 and PaCO2levels were (92 ± 12) mm Hg ( 1 mm Hg =0.133 kPa) and (42 ± 10) mm Hg in group A, and (91 ±9)mm Hg and (42 ± 10) mm Hg in group B, respectively.WBC and APACHE Ⅲ score were ( 11.8 ± 1.7) ×109/L and 38 ±7 in group A, and ( 12.6 ± 1.2) × 109/L and 40 ±6 in group B, respectively.Significant difference in serum levels of PA and TR was found between the two groups (PPA =0.019 and PTR =0.013),while there was no significant difference in other indictors between the two groups.Conclusions 24-hour continuous nutrition infusion for patients with MVRF can obviously improve their serum levels of PA and TR,but has no effect on serum level of ALB, PaO2, WBC and APACHE Ⅲ score in critical ill patients, as compared to those with 16-hour cyclic nutrition infusion.

Objective To investigate the effect of surgical trauma on the expression of COX-2 and PGE2in the hippocampus in aged rats. Methods Forty-five 18-month-old male SD rats weighing 500-600 g were randomly divided into 3 groups (n = 15 each): group Ⅰ control (group C); group Ⅱ anesthesia (group A) and group Ⅲ surgery + anesthesia (group S). Anesthesia was induced by intraperitoneal 1% pentobarbital sodium 50 mg/kg in group A and S. The animals underwent appendectomy and splenectomy under anesthesia in group S.Cognitive function was assessed by open field test and Y-mase test on the 1st, 3rd and 7th day after anesthesia and surgery (T1-3). The animals were sacrificed after behavior tests at T1.2.3 and the hippocampi were removed for determination of the expression of COX-2 mRNA (by RT-PCR) and PGE2 content (by ELISA). Results The time the animal spent in the central square was significantly prolonged, the number of crossing grid and standing on the back legs and the number of right response were decreased, the total reaction time was prolonged and the COX-2mRNA expression at T1 and PGE2 content in the hippocampus were increased at T1,2 in group S as compared with group C and A. There was no significant difference in the variables mentioned above between group C and A. Conclusion Surgical trauma can induce early postoperative cognitive dysfunction through up-regulation of COX-2 mRNA expression and by increasing PGE2 content in the hippocampus in aged rats.

In order to enhance the specificity of TNF-α monoclonal antibody to inflamed site, a bispecific antibody BsDb that targets TNF-α and the extra-domain B (ED-B) of fibronectin (FN) was constructed by covalently linking the anti-TNF-α single chain Fv antibody (TNF-scFv) and the anti-ED-B scFv L19 via a flexible peptide linker deriving from human serum albumin (HSA). ED-B is an antigen specifically expressed at the inflamed site. BsDb is expressed in E. coli, identified by immunoblot, and purified with affinity chromatography. This was followed by further examination of its bioactivities and pharmacokinetics. We demonstrated that BsDb retained the immunoreactivity of its original antibodies as it could simultaneously bind to TNF-α and ED-B and neutralize the biological action of TNF-α. In the collagen-induced arthritis mice model, BsDb selectively accumulate in the inflamed joint with a maximal uptake of (12.2 ± 1.50)% ID/g in a single inflamed paw and retain in the inflamed paw for at least 72 h. In contrast, BsDb showed a short serum half-life of (0.50 ± 0.05) h and a rapid clearance from normal tissues. The findings reported herein indicate that BsDb has good specificity to the inflamed site and low toxicity to normal tissues. BsDb is therefore likely to have greater clinical applications in the treatment of rheumatoid arthritis and other autoimmune diseases. This laid a stable basis for its preclinical study.
Animals ; Antibodies, Bispecific ; chemistry ; Antibodies, Monoclonal ; chemistry ; Arthritis, Experimental ; Escherichia coli ; Fibronectins ; chemistry ; Half-Life ; Humans ; Mice ; Single-Chain Antibodies ; chemistry ; Tumor Necrosis Factor-alpha ; chemistry

Objective:To evaluate the role of miR-146a in hippocampal inflammatory responses in postoperative cognitive dysfunction (POCD) in mice.Methods:One hundred and sixty clean-grade male C57BL/6 mice, aged 12-16 weeks, weighing 22-28 g, were divided into 5 groups ( n=32 each) using a random number table method: control group (group C), group POCD, miR-146a agomir group (group Ag), miR-146a antagomir group (group At) and negative control group (group NC). The mice were subjected to an intramedullary fixation for tibial fracture under 1.5% isoflurane anesthesia to establish POCD model.At 2 days before operation, miR-146a agomir 0.5 nmol (0.1 nmol/μl) was injected into bilateral hippocampi in group Ag, miR-146a antagomir 2.5 nmol (0.5 nmol/μl) was injected in group At, miR-146a negative control solution 2.5 nmol (0.5 nmol/μl) was given in group NC, and the animals in group C did not receive any treatment.At 1 day before operation and at 1, 3 and 7 days after operation, open-field test was performed to evaluate spontaneous motor activity, and contextual fear conditioning test was performed to evaluate cognitive ability 15 min later.At 1 and 3 days after operation, the animals were sacrificed and hippocampi was removed for determination of expression of CD11b (a marker for activation of microglia) in hippocampal CA1 region by immunofluorescence staining.At 6, 12 and 24 h after operation, the expression of miR-146a was detected by quantitative real-time polymerase chain reaction, the expression of interleukin-1 receptor-associated kinase 1 (IRAK1), tumor necrosis factor receptor-associated factor 6 (TRAF6), nuclear factor kappa B p65 (NF-κB p65) and tumor necrosis factor-alpha (TNF-α) was determined by Western blot and interleukin-1beta (IL-1β) and IL-6 contents were determined by enzyme-linked immunosorbent assay. Results:There was no significant difference in the total exploring distance in the open-field test or percentage of freezing time in tone-fear conditioning test at each time point among the five groups( P>0.05). Compared with group C, the percentage of freezing time in the contextual fear conditioning test was significantly decreased at 1, 3 and 7 days after operation, the expression of CD11b at 1 and 3 days after surgery and expression of miR-146a, IRAK1, TRAF6, NF-κB p65 and TNF-α were up-regulated and the contents of IL-1 β and IL-6 were increased at 6, 12 and 24 h after operation in group POCD ( P<0.05). Compared with group NC, the percentage of freezing time in the contextual fear conditioning test was significantly increased at 1, 3 and 7 days after operation, and the expression of CD11b was down-regulated at 1 and 3 days after surgery, and the expression of miR-146a, IRAK1, TRAF6, NF-κB p65 and TNF-α was up-regulated and IL-1β and IL-6 contents were decreased at 6, 12 and 24 h after operation in group Ag, and the percentage of freezing time in the contextual fear conditioning test was decreased at 1, 3 and 7 days after operation, the expression of CD11b at 1 and 3 days after surgery was up-regulated, the expression of miR-146a was down-regulated and IRAK1, TRAF6, NF-κB p65 expression was up-regulated at 6, 12 and 24 h after operation, TNF-α expression was up-regulated and IL-1β and IL-6 contents were increased at 12 and 24 h after operation in group At ( P<0.05). Conclusion:miR-146a is involved in the process of hippocampal inflammatory responses, and the mechanism may be related to the inhibition of IRAK1-TRAF6-NF-κB signaling pathway in mice.

Objective To analyze the association of elevated carotid intima-media thickness(CIMT)with low-grade albuminuria in a community-based population. Methods A total of 10 375 participants aged 40 years or older were recruited using cluster sampling from Jiading district, Shanghai. Standardized questionnaires were adopted to collect information on health status and lifestyles. Anthropometric measurements including weight, height, and blood pressure, and biochemical tests for blood and urine were performed. CIMT was detected by B-mode ultrasound examinations. 9 523 subjects were included for final analysis. All these subjects were divided into 4 groups according to sex-specific urinary albumin to creatinine ratio ( UACR ) quartiles. CIMT≥upper decile of the population was defined as elevated CIMT and low-grade albuminuria was defined as UACR≥sex-specific upper quartile. The relationship between UACR and CIMT was investigated by multiple logistic regression analysis. Results The prevalence of elevated CIMT in this population aged 40 years or older with albuminuria in normal range was 21. 44%. Comparing to participants without elevated CIMT, those with elevated CIMT showed higher level of UACR (4. 79 vs 4. 51 mg/g, P<0. 01). The metabolic status was deteriorated with the increment of UACR level. The prevalences of elevated CIMT were 18. 99%, 19. 24%, 20. 20%, and 27. 33% from the lowest to highest UACR quartile, respectively(Ptrend<0. 01). After adjusting for some conventional cardiovascular risk factors, multiple logistic regression revealed that compared with the participants in the lowest quartile of UACR, those in the highest quartile had a 1. 25-fold risk of elevated CIMT. Conclusions This study shows that low-grade albuminuria is positively associated with elevated CIMT, independent of conventional cardiovascular risk factors in middle-aged and elderly adults.

OBJECTIVETo evaluate the efficacy of different modes of lymphadenectomies in the surgical treatment for early gastric cancer (EGC) in order to provide evidence for reasonable selection of lymphadenectomy for the ECG.

METHODSThe clinicopathological data of 325 EGC patients were reviewed. The lymph node metastasis (LNM) rate of different levels and the efficiency of different modes of lymphadenectomies were analyzed, and the correlation between LNM and clinicopathological features were analyzed either.

RESULTSThe overall LNM rate in the EGC was 14.8%, and the overall LNM degree was 3.0%. In the ECG located in the lower third of the stomach, the rate of first level nodal involvement was 14.5%, which was detected in the No. 3, No. 4, No. 5, No. 6 station of draining lymph nodes for the stomach; and it was 6.9% in the second level lymph nodes which were seen in the No.7 and No. 8a station. There was rare metastasis in the No. 1, No. 9, No. 11p, No. 12a and No. 14v station. In the ECG located in the middle third of the stomach, the rate of first level nodal involvement was 13.8% , which was found in the No. 1, No. 3, No. 5 and No. 6 station, and it was 6.9% in the second level nodes only seen in the No. 7 and No. 8a station. The LNM rate was significantly higher in the lesion larger than 3.0 cm in diameter, or having submucosa invasion, or being poorly differentiated, or with lymphatic involvement than that of the lesion smaller than 3.0 cm in diameter, without mucosa invasion or lymphatic involvement, or being well differentiated (P < 0.05).

CONCLUSIONBased on our data, it is suggested that the D1 or D1 + lymphadenectomy of the No. 7 station of lymph node may be suitable for the lesion smaller than 1.0 cm in diameter or only located in the mucosa; the D1 + lymphadenectomy of the No. 7 and No. 8a station of lymph nodes may be suitable for the lesion larger than 1.0 cm in diameter, or being depressed type or with submucosa invasion in the middle and/or lower third of the stomach. For the lesion larger than 3.0 cm in diameter, the No. 1 and No. 9 station lymph node should be dissected. It is also suggested that regular D2/ D3 lymphadenectomy should be avoided in the surgical treatment for the early gastric cancer whenever the tumor situation is suitable.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Lymph Node Excision ; methods ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Retrospective Studies ; Stomach Neoplasms ; pathology ; surgery ; Treatment Outcome

OBJECTIVETo investigate the feasibility of using adipose tissue derived stem cells (ASCs) to promote neovascularization and survival rate of free fat transplantation.

METHODSASCs were isolated from aspirates from human liposuction and cultured in vitro. The cells were incubated in adipogenic, osteogenic, and chondrogenic medium for 2-4 weeks to induce adipogenesis, osteogenesis and chondrogenesis, respectively. ASCs were labelled by DiI. ASCs (A group), Insulin (B group), Medium (C group) were respectively mixed with free fat graft from aspirates. The mixtures were injected subcutaneously at the three random points on the back of eighteen 4- 6-week-old nude mice. Transplanted fat tissue was harvested after 6 months. The grafts were assessed by morphological observation, HE staining and immunohistochemistry.

RESULTSASCs can be easily harvested from liposuction aspirates and differentiate into adipogenic, osteogenic, chondrogenic lineages. The wet weight of transplanted fat tissue in ASCs group was (165.97 +/- 5.51) mg, significantly higher than that in the insulin group (93.42 +/- 5.12) mg and control group (67.64 +/- 5.09) mg (P = 0.000). The rate of fibrosis and steatonecrosis in ASCs group was( 152.2 +/- 9.8)/10HF, significantly lower than that in the Insulin group (743.9 +/- 20.4)/10HF and control group (892.2 +/- 16.5)/10HF (P = 0.000). DiI labelled ASCs were found between adipocytes and in the connective tissue in free transplanted fat tissue, and some of these cells were immunopositive for antihuman CD31 and FITC, suggesting differentiation into vascular endothelial cells.

CONCLUSIONSASCs can differentiate into vascular endothelial cells and contribute to angiogenesis in free transplanted fat tissue. ASCs can increase the survival rate and decrease the rate of fibrosis and steatonecrosis of free transplanted fat tissue. These findings suggest that ASCs-assisted transplantation may be an ideal cell therapy.

Adipocytes ; cytology ; Adipose Tissue ; cytology ; transplantation ; Adult ; Animals ; Cell Differentiation ; Cells, Cultured ; Feasibility Studies ; Female ; Graft Survival ; Humans ; Mice ; Mice, Nude ; Neovascularization, Physiologic ; Stem Cells ; cytology ; Tissue Scaffolds

OBJECTIVETo evaluate the status of lymph node metastasis (LNM) and reasonable procedure in early gastric cancer (EGC).

METHODSTwo hundred and ninety-two patients with histologically proven mucosal or submucosal gastric cancer who underwent gastrectomy/lymphadenectomy were included in this study. The numbers of total dissected lymph node were all above 15 in all patients. The clinical characteristics, pathologic features, and LNM were assessed by univariate and multivariate analysis.

RESULTSLNM were observed in 43 of 292 cases (14.7%), and 6.4% in mucosal lesions and 22.4% in submucosal lesions. The LNM was identified in 12.7% at the first level, 7.2% at the second level and 0.34% at the third level. The LNM frequency was found in the 6, 3, 4, 1, 5 lymph node (from high to low) consequently at the first level and the 7, 8a lymph node at the second level. The EGC with nodal involvement and the tumors < 2.0 cm in diameter were all depressed type. The diameter of elevated type with LNM was no less than 3.0 cm in this series. The depth of invasion and lymphatic vessel involvement were independent influencing factors in LNM on multivariate analysis (P<0.05).

CONCLUSIONSLess extensive surgery might be considered for the elevated type EGC, and tumors 3.0 cm in diameter. With respect to the depressed type EGC/tumors > 3.0 cm in diameter, gastrectomy with D2 lymphadenectomy is proper.

Adult ; Aged ; Aged, 80 and over ; Female ; Gastrectomy ; methods ; Humans ; Lymph Node Excision ; methods ; Lymph Nodes ; pathology ; surgery ; Lymphatic Metastasis ; Male ; Middle Aged ; Multivariate Analysis ; Retrospective Studies ; Stomach Neoplasms ; pathology ; surgery

OBJECTIVETo study the effects of experimentally created unilateral anterior crossbite prosthesis on the expression of parathyroid hormone-related peptide (PTHrP) and parathyroid hormone receptor-1 (PTH1R) in mandibular condylar cartilage of SD rat.

METHODSIn experimental groups, the unilateral anterior crossbite metal prosthesis was cemented to the left incisors of the maxilla and mandible of 6-week-old SD rats, respectively. Animals were sacrificed at 2, 4, 8 weeks. Hematoxylin-eosin (HE) staining were carried out for studying the morphological changes of the condylar cartilage. Immunohistochemical staining and real-time polymerase chain reaction (PCR) analysis were performed to detect the levels of expression of PTHrP and PTH1R in the condylar cartilages.

RESULTSThe obvious degenerative changes were found in the condylar cartilages in experimental group at 8 weeks. Comparing to the control group, the expression of PTHrP mRNA (P < 0.01) and protein(P < 0.01) in the experimental group were increased, whereas PTH1R mRNA (P < 0.01) and protein (P < 0.01) levels were decreased.

CONCLUSIONThe expression of PTHrP was increased in the condylar cartilage of rat with unilateral anterior crossbite metal prosthesis but its effects might be limited because of decreased expression of PTH1R in the condylar cartilage. The low level expression of PTH1R should be a part of the constitution of the molecular pathomechanism of temporomandibular joint osteoarthritis (TMJOA)-like lesion.

Animals ; Cartilage ; Cartilage, Articular ; Incisor ; Malocclusion ; Mandible ; Mandibular Condyle ; Osteoarthritis ; Parathyroid Hormone-Related Protein ; Prostheses and Implants ; Rats ; Rats, Sprague-Dawley ; Receptor, Parathyroid Hormone, Type 1 ; Temporomandibular Joint