Selectins are a family of adhesion molecules,including P-,L-,E-selectins.The three adhesion molecules all participate in the inflammatory processes of ischemia-reperfusion injury of brain.P-selectin is expressed on activated platelets as well as on endothelial cells.E-selectin is only expressed on endothelial cells.P-and E-selectin mediate the adhesion of the leukocytes,platelets and endothelial cells.L-selectin is mainly expressed on leukocytes and mediates leukocytes rolling contact with microvascular endothelial cells.

Objective To investigate the effects of epidural administration of a mixture of betamethasone and lidocaine on nerve root inflammation and epidural space adhesion in rabbits. Methods Twenty-four adult male New Zealand white rabbits weighing 2.0-2.1 kg, were randomly divided into 2 groups ( n = 12 each): control group and treatment group. A catheter was inserted into epidural space at L2,3 interspace. Twenty-four hour after epidural catheter placement, talcum powder 0.5 mg/kg was injected into epidural space to make the model of nerve root inflammation and epidural space adhesion. Three days later a mixture of lidocaine 2.5 mg/kg and betamethasone 0.25 mg/kg was injected via the epidural catheter in treatment group, while the equal volume of normal saline was given in control group. At 21 days after administration of lidocaine and betamethasone, the spinal cord was removed, and dura mater and nerve root were checked with naked eye, light microscope and electron microscope.The neutrophil count in the dura mater was determined. Results There was nerve root inflammation and epidural space adhesion in control group. The nerve root inflammation and epidural space adhesion was not observed in treatment group. The neutrophil count was reduced in treatment group (21 ± 12) compared with control group (250 ±43) ( P < 0.01) . Conclusion Epidural administration of a mixture of betamethasone and lidocaine can alleviate nerve root inflammation and epidural space adhesion.

BACKGROUND:Tantalum rod implant technology is a new method of early osteonecrosis treatment. Current research on stress distribution before and after tantalum rod implant in different sizes of femoral head necrosis area is few. OBJECTIVE:To analyze the stress distribution before and after tantalum rod implantation in different sizes of necrotic femoral head area using three-dimensional finite element method. METHODS:Three-dimensional finite element models of normal femoral head and necrotic femoral head of 15, 20 and 30 mm diameterwere constructed. Eight measuring points were chosen on two tiers of each necrotic model to detect the stress distribution and its alteration before and after tantalum rod implantation. RESULTS AND CONCLUSION:(1) Stress concentration werefound on every necrotic femoral head, most pronounced on the one with 30 mm lesion. (2) Tantalum implant appeared to reduce the stress concentration generaly. Comparison of the peak points of these models indicated most significant benefit in 15 mm lesion, next in 30 mm lesion, last in 20 mm lesion. (3) Results indicate that larger lesion entails more concentrated stress distribution and more likely to colapse. Tantalum rod implantation can delay the development of necrosis of the femoral head, andismost effective in smal lesion.

OBJECTIVE:To observe the efficacy and safety of levofloxacin and capreomycin combined with chemotherapy regi-men in the treatment of multi-drug resistant tuberculosis(MDR-TB). METHODS:84 MDR-TB patients were randomly divided in-to observation group (42 cases) and control group (42 cases). Observation group received 0.75 g Capreomycin sulfate for injec-tion,addint into 100 ml 0.9% Sodium chloride injection,intravenous infusion,once a day+0.4 g Levofloxacin hydrochloride tab-let,orally,once a day+0.2 g Protionamide tablet,orally,3 times a day+0.3 g Pasiniazid tablet,orally,3 times a day+0.5 g Pyra-zinamide tablet,orally,4 times a day. Control group received 0.4 g Amikacin sulfate injection,adding into 100 ml 0.9% Sodium chloride injection,once a day,intravenous infusion+0.3 g Ofloxacin tablet,orally,twice a day+Protionamide tablet (the same dose with observation group)+Pasiniazid tablet (the same dose with observation group)+Pyrazinamide tablet (the same dose with observation group). All patient were given 0.1 g Glucuronolactone tablet,orally,3 times a day. The treatment course for both group was 12 months. Sputum negative conversion rate,negative conversion time,symptom improvement time,lesion absorption and lung cavity closing,and cell immune indexes (CD4+CD25+/CD4+,CD4+CD25+CD127low/CD4+),IL-17 level before and after treatment,and the incidence of adverse reactions in 2 groups were observed. RESULTS:The sputum negative conversion rate,ab-sorption rate,lung cavity closing and narrowing cases in research group after 3,6,9,12,18 months treatment were significantly higher than control group,sputum negative conversion time,symptom improvement time in observation group were significantly lower than control group,the differences were statistically significant(P<0.05). Before treatment,there were no significant differ-ences in CD4+CD25+/CD4+,CD4+CD25+CD127low/CD4+,IL-17 level in 2 groups(P>0.05). After treatment,CD4+CD25+/CD4+,CD4+CD25+CD127low/CD4+ in 2 groups were significantly lower than before,and observation group was lower than control group,IL-17 level was significantly higher than before,and observation group was higher than control group,the differences were statistically significant (P<0.05). And there was no significant difference in the incidence of adverse reactions in 2 groups (P>0.05). CON-CLUSIONS:Levofloxacin and capreomycin combined with chemotherapy in the treatment of MDR-TB,it can reduce T regulatory cells,increase IL-17 level,do not increase the incidence of adverse reactions.

Objective To investigate the mechanisms of the inhibitory effects of peripheral electrical stimu- lation(PES)on chronic central pain(CCP)after spinal cord injury(SCI).Methods Twenty-four male Sprague- Dawley rats with CCP following SCI were randomly divided into three groups:a group without stainless steel needles implanted (NSSN group,n=8),a group with a stainless steel needle implanted but no peripheral electrical stimula- tion applied(NPES group,n=8)and a PES group(PES group,n=8).The rats' CCP was evaluated through ob- serving their response to nociceptive stimulation by means of the paw withdrawal pressure threshold(PWPT)and the paw withdrawal latency(PWL).Spontaneous pain behaviors including autophagia and scratching were observed at the same time.PES was applied via stainless steel needles inserted into standard acupoints on the hind limps and the back.The expression of the NMDA receptor 1(NR-1)subunit in the spinal cord horn was measured using immuno- chemical methods.Results Compared with the NSSN and NPES groups,CCP in the PES group was alleviated, PWPT and PWL were dramatically increased(P＜0.01)and the expression of NR-1 was obviously decreased (P＜0.01).Conclusion Peripheral electrical stimulation may alleviate chronic central pain after spinal cord injury in rats.

Objective To investigate the minimal and optimal concentration of ropivacain for epidural anesthesia in patients with breast cancer.Methods 103 patients with breast cancer ASA Ⅰ-Ⅱ undergoing elective radical mastectomy were conducted with epidural anesthesia.T2-3 were selected as a puncture site.A catheter was inserted into the epidural space in a cephalic direction for 3.5-4.0 cm.The concentration of ropivacain was produced by the test of up-down sequential allocation technique.20-25 ml of 0.20 ％ ropivacaine was given after a test of 0.20 ％ 5 ml ropivacaine.If the anesthesia was effective (VAS≤3),the next concentration was down 0.01％,while the VAS was more than 5,the next concentration was up 0.01％.The anesthesia effect and segments of block were measured with acupuncture.Blood pressure (NIBP),heart rates(HR),blood oxygen saturation (SPO2),blood gas and VAS were monitored during operation.Nasal catheter oxygen inhalation was used in routine method.Results The median effective concentration (EC50) of ropivacaine was 0.10 ％ determined by the formula of dixon and massey.The 95 ％ confidence intervals was 0.1022 ％-0.1065 ％.The least and the best analgesic concentration of ropivacaine for the upper thoracic epidural block was 0.14 ％ and 0.17 ％-0.18 ％ respectively.Conclusion The minimal and the optimal analgesic concentration of ropivacaine for the upper thoracic epidural block are 0.14 ％ and 0.17 ％-0.18 ％respectively,and which provides a safe and rational use of ropivacaine for the clinic.

Objective To summarize the methods of diagnosis and results of surgical treatment of pancreatic insulinoma. Methods The clinical data of 137 patients with insulinoma treated in our hospital during the past twenty-six years were reviewed retrospectively.Results There were 77 males and 60 females. All of them were characterized by the Whipple′s triad. The sensitivity of ultrasonography, CT and MRI for localization was 35.1%, 67.9% and 58.1% respectively. One hundred and tweenty-six patients underwent operation. Of them, 102 cases had tumor enucleation, 4 cases had pancreaticoduodenectomy, 16 cases had distal panreatectomy, and the other 4 cases had only laparotomy. Of the 122 patients, who underwent resection, the tumor was benign in 118(96.7%) and malignant in 4(3.3%). The diameter of the tumor was less than 2cm in 86.9% of cases. In 98.4% of cases the tumors were single and in 1.6% of cases were multiple. 13.1% of the tumors located in the head, 46.7% in the body, and 40.2% in the tail.Conclusions Whipple′s triad and the measurement of fasting glucose, IRI, IGR, C-peptide, and proinsulin levels contribute to the diagnosis of insulinoma. However, the preoperative tumor localization is still difficult. Tumor enucleation is the technique of choice when feasible. Patients in whom tumor localization is unsuccessful at operation should be carefully evaluated to be certain of the diagnosis, and in general should not undergo blind resection.

Objective To explore the effect of ulinastatin on coagulation function of elderly patients after hip replacement.MethodsTotally 120 patients undergoing elective hip replacement in our hospital were chosen.According to the stratified randomization method, all patients were divided into observation group and control group with 60 in each.The control group received oral Xarelto combined with other conventional treatment, while the observation group received ulinastatin on the basis of the treatment regimen of the control group.The coagulation parameters and clinical manifestations were compared between two groups.ResultsTwo days after operation, the TT, APTT, PT, DD and FIB between the two groups showed statistically significant difference (t=-5.300,-2.319,-2.409,-2.325,-3.567;P<0.05).The hospital stay,CRP,TXB2 and total drainage volume in observation group 5d after operation were lower than those in control group, between the two groups showed statistically significant difference (t=-2.529,-2.082,-3.388,-2.887;P<0.05).The patients with elevated blood urea and serum creatinine in observation group were obviously less than that of control group, but the patients with nausea in observation group were obviously higher than those in control group,between the two groups showed statistically significant difference (χ2=5.217,5.926,8.571;P<0.05).The patients with deep vein thrombosis in observation group were obviously higher than those in control group,between the two groups showed statistically significant difference (χ2=8.571, P<0.05).ConclusionUlinastatin can significantly improve the hypercoagulable state of patients after hip replacement and reduce the incidence of deep vein thrombosis, and plays an important role in promoting wound healing and immunity recovery.

Objective To study the significance of detecting the mutations of K-ras gene in faecal for diagnosis colorectal carcinoma.Methods 36 cases suffering from colorectal carcinoma,24 cases from colorectal benign diseases and 24 cases from healthy subjects,all cases had been diagnosed by enteroscope. K-ras gene mutation at the codon 12 was detected by PCR-RFLP,DNA was taken from faecal in modified method.Results K-ras mutation rate in colorectal carcinoma was 77.8 %,colorectal benign diseases was 25.0 %,healthy cases was 8.3 %.Conclusion Detecting the mutations of K-ras gene in faecalmay improve the rate of diagnosing colorectal carcinoma.

CD46 is not only identified as a complement regulatory protein which protects host cells from complement attack, but also a new co-stimulatory molecule for human T cells. CD3/CD46 co-stimulation can induce a T-regulatory 1 cell (Tr1)-specific cytokine phenotype in human CD4(+) T cells. However, the role of CD46 as a co-stimulatory molecule in the modulation of the acquired immunity, such as transplant immunology, remains unclear. In this study, CD4(+) T cells were isolated from human CD46-transgenic C57BL/6 mice by magnetic-activated cell sorting, and further induced by anti-CD3, anti-CD28 and anti-CD46 antibodies respectively, and anti-CD3/anti-CD28 antibodies, anti-CD3/anti-CD46 antibodies, or the monoclonal antibody panel against CD3/CD28/CD46. The levels of interleukin-2 (IL-2), gamma-interferon (gamma-IFN), interleukin-10 (IL-10) and transforming growth factor-beta (TGF-beta) were detected in the supernatants of different groups. Suppression of allogeneic T cell proliferation were assessed by using mixed lymphocyte reaction (MLR) assay, in which monoclonal antibodies against CD46 were added to the culture. The results showed that CD3/CD28, CD3/CD46 and CD3/CD28/CD46 co-stimulation could significantly induce stronger proliferation of T cells than CD3 stimulation (P<0.05), and CD3/CD28/CD46 co-stimulation significantly increased the proliferation of T cells when compared with CD3/CD28 or CD3/CD46 co-stimulation (P<0.05 for each). IL-2 and gamma-IFN levels were much higher in CD3/CD28 co-stimulation group than in CD3, CD28, CD46 and CD3/CD46 groups (P<0.05 for each). IL-10 and TGF-beta levels were dramatically increased in CD3/CD46 co-stimulation group as compared with those in the CD3, CD28, CD46 and CD3/CD28 groups (P<0.05 for each). CD3/CD46 co-stimulation significantly inhibited the T cell proliferation and allogenic immune responses through the secretion of IL-10 and TGF-beta in MLR (P<0.05). These results suggested that CD3/CD46 can induce Tr1 cells to modulate allogenic immune responses, and it may become a novel target for the development of new therapeutic approach for T-cell-mediated diseases. CD46 plays an important role in regulating the T cell-mediated immune responses by bridging innate and acquired immunity.