AIM: To study the effects of tumor necrosis factor-α (TNF-α) on the transcriptional activity of nuclear factor-erythroid 2-related factor 2 (Nrf2) in pulmonary microvascular endothelial cells. METHODS: Rat pulmonary micro-vascular endothelial cells (PMVECs) were cultured by lung tissue block pasted methods, and identified immunocytochemically using Ⅷ factor-related antigen. The cells were treated with different doses TNF-α (prepared in serum-free medium) for 4 h. Subcellular localization and levels of Nrf2 in PMVECs were observed with immunocytochemical methods. Nuclear extract were obtained to assayed transcriptional activity of Nrf2 with EMSA. Total RNA were isolated to assay the mRNA expression of Nrf2 by RT-PCR. RESULTS: The protein level of Nrf2 in the nuclei and transcriptional activity increased dose-dependently in PMVECs after treated with TNF-α at concentrations of 2.5, 5.0 or 10.0 μg/L. However, the protein level of Nrf2 in nuclei and transcriptional activity decreased dose-dependently in PMVECs after treated with TNF-α at concentrations of 20 or 40 μg/L. No different mRNA expression of Nrf2 in PMVECs treated with TNF-α at all concentration above was observed. CONCLUSION: Transcriptional activity of Nrf2 increases in PMVECs treated with low or moderate doses of TNF-α and decreases in PMVECs treated with high doses of TNF-α.

Objective To study correlation of the retinal nerve epithelium layer thickness measured with different optical coher-ence tomography (OCT) in vivo with histological measurement. Design Experimental study. Participants 15 rabbit eyes. Methods The retina measurement position of 15 rabbit eyes were marked by laser, and then were scanned by OSE-1800 OCT and Stratus OCT. Reti-nal nerve epithelium layer thickness was measured in retinal histological shdes of rabbit eyes. The results measured with three methods were compared and linear regression analyses were done with SPSS11.5 software. Results The average retinal nerve epithelium layer thickness measured with OSE-1800 OCT, Stratus OCT and histological method were 119.5±7.4, 118.0±5.6, and 116.3±8.8μm respec-tively(P=0.292). Retinal nerve epithelium layer thickness measured with both OCT instruments had the best correlation (r=0.914, P= 0.000), and the thickness measured with Stratus OCT and histological method had the better correlation (r=0.872, P=0.001), and the thickness measured with OSE-1800 OCT and histological method had the significant correlation (r=0.833, P=0.002). Conclusions The retinal nerve epithelium layer thickness measured with different OCTs in vivo correlate well with histomorphometry, and the measure-ment of both OCT instruments are accurate. (Ophthalmol CHN, 2009, 18: 239-242)

Objective To explore the changes in serum plasminogen activator inhibitor 1(PAI-1),tissue factor(TF) and antithrombin Ⅲ(ATⅢ) in early period of severe limb injury,and their relationship with the occurrence of traumatic pre-DIC and DIC after trauma.Methods Thirty-five patients were divided into severe injury group(AIS score ≥3,20 cases),minor injury group(15 cases),and 10 healthy subjects served as control.The 35 patients with injury were divided again into pre-DIC group(10 cases),DIC group(3 cases),and others(22 cases).Fasting peripheral venous blood was collected on day 1,3,6 from the patients and healthy subjects.The changes in TF,ATⅢ and PAI-1 levels were detected and statistically analyzed.Results The PAI-1 levels were higher in minor injury group and severe injury group than that in control group on day 1(P

Hilar cholangiocarcinoma (HCC) is a rare tumor with a poor prognosis.With the development of high definition imaging technology,improvement of surgical instruments,optimization of perioperative surgical strategies and accumulation of surgical experiences,the radical resection rate of HCC is significantly improved.Operation is the main method of treatment for HCC,and radical resection is important for a long-term survival of HCC patients.The clinical data of 66 patients with HCC who were admitted to the Beijing Youan Hospital from April 2004 to April 2012 were retrospectively analyzed.The key points in surgical procedure and prognosis of patients were investigated.

Objective To identify the level of functional immunity as measured by the ImmuKnow assay in Chinese stable liver transplant recipients and to correlate these values with the dose and the trough levels of immunosuppressant, and with other clinical parameters of these patients. Methods Functional immune response was assessed by the ImmuKnow assay in 46 blood samples taken from 46 stable liver transplant recipients from Beijing Youan Hospital, Capital Medical University Liver Transplantation Center. Results The average ATP value in these stable liver transplant recipients was 203±114 ng/ml (range: 38.47 ATP ng/ml to 524.06 ATP ng/ml) at 22± 15 month post liver transplantation. There was no correlation either between ImmuKnow ATP values and the tacrolimus trough levels, or between ImmuKnow ATP values and the liver function (P<0. 05). Stepwise multiple regression analysis identified WBC and CD3+, CD3+ CD4+ as independent predictors of ImmuKnow assay levels when age, gender and underlying diagnosis were taken into account (P<0. 05). Five patients who were detected to have active HCV infection had lower ImmuKnow ATP values (<61 ng/ml). Conclusions The Cylex ImmuKnow assay ATP values were lower in Chinese stable liver transplant recipients compared with American patients. Further investigation is required to determine the role of the ImmuKnow assay in tailoring immunosuppressant therapy in liver transplant recipients.

Objective To investigate the value of modified T staging system in the diagnosis and treatment of hilar cholangiocarcinoma (HCCA).Methods The clinical data of 95 patients with HCCA who were admitted to the Memorial Sun Yat-Sen Hospital from December 1995 to January 2010 were retrospectively analyzed.Based on the results of imaging examination,preoperative staging was determined according the modified T staging system.The prognosis of the patients in difference T stages were compared.The data were analyzed by using the chi-square test and Fisher exact test.The survival curve was drawn by Kaplan-Meier method and the survival rate was compared by using the Log-rank test.Results The diagnostic rates of ultrasound + magnetic resonance cholangiopancreatography (MRCP),ultrasound + computed tomography (CT) or spiral CT were 93％ (37/40) and 66％ (23/35),respectively.The diagnostic rates of ultrasound + CT or spiral CT and endoscopic retrograde cholangiopancreatography (ERCP),ultrasound + CT or spiral CT and MRCP were 14/15 and 15/15,respectively.Of the 95 patients,44 received operation (including 28 cases of radical resection and 16 cases of palliative resection),16 received exploratory laparotomy,and 35 received simple internal or external drainage.For patients in T1,T2 and T3 stages,the resection rates were 71％ (30/42),50％ (12/24) and 7％ (2/29),respectively,with significant differences (x2 =30.182,P ＜0.05).The negative rates of the resection margins of patients in T1 and T2 stages were 77％ (23/30) and 5/12,respectively,2 patients in T3 stage were found with tumor residuals at the resection margin.There was a significant difference in the radical resection rate among patients in different T stages (x2 =8.204,P ＜ 0.05).Of the 44 patients who received surgical treatment,30 (68％) received concomitant partial hepatectomy.The ratios of patients in T1 and T2 stages who received concomitant partial hepatectomy were 70％ (21/30) and 9/12,respectively,with no significant difference (x2 =0.101,P ＞ 0.05).Fourteen (32％) patients received tumor resection.The incidences of complications and perioperative mortalities were 53％ (16/30) and 10％ (3/30) for patients who received concomitant partial hepatectomy,and 5/14 and 1/14 for patients who received tumor resection,with no significant differences between the 2 groups (x2 =1.188,0.094,P ＞ 0.05).The median survival time of patients who received concomitant partial hepatectomy was 29 months,which was significantly longer than 19 months of patients who received tumor resection (x2 =11.317,P ＜0.05).Eighty-six patients were followed up,and the median time of follow up was 15.6 months (range,3-70 months).The 1-year cumulative survival rates of patients in T1,T2 and T3 stages were 73.8％,58.0％ and 9.2％,respectively,and the 3-year cumulative survival rates of patients in T1,T2 and T3 stages were 33.5％,12.1％ and 0,respectively.The median survival time of patients in T1,T2 and T3 stages were 24,16 and 7 months,respectively.The prognosis of patients was getting poor as the increase of the T stages (x2 =37.07,P ＜ 0.05).Conclusions The modified T-staging system is beneficial to preoperative evaluation of patients with HCCA.Concomitant partial hepatectomy could improve the radical resection rate and prolong the median survival time of HCCA patients.

Background Glaucoma is primarily characterized by the damage of retinal ganglion cells in the inner layer.Whether the outer retinal layers are involved is controversial.Although the functional abnormality of the outer retinal layers have been determined,structural studies present difierent outcomes.Objective This study measured and compared photoreceptor layer thickness between normal and glaucomatous eyes using spectral domain optical coherence tomography(OCT). Methods A case-control study was designed.The macular area of 38 eyes from 38 normal volunteers and 48 primary open-angle glaucomatous eyes(POAG)were imaged by spectral domain OCT(SD OCT).The outer nuclear layer(ONL)and inner and outer segments(IS/OS)layer thicknesses in fovea and parafovea(1.5 mm from the fovea) were measured by a single masked observer using an image analysis software (SigmaScan Pro version 5.0).Retinal nerve fiber layer(RNFL)thicknesses of the 86 eyes were measured by Stratus OCT.The photoreceptor layer thicknesses between normal and glaucomatous eyes were compared.The correlation of photoreceptor with RNFL thicknesses was evaluated with linear and non-linear regression models. Results The outer nuclear layer(ONL)thickness in the fovea in normal and glaucomatous eyes were 96.7±10.7μm and 103.7±13.3 μm,respectively,with a significant difference(P=0.011).The inner and outer segments(IS/OS)layer thicknesses in the fovea in the two groups were 59.3±5.5 μm and 59.5±5.5μm,respectively,without significant difference(P=0.890).The outer nuclear layer(ONL)thicknesses in the parafovea in normal and glaucomatous eyes were 70.9±14.0μm and 68.7 ±10.7μm,respectively,(P=0.410).The inner and outer segments(IS/OS)layer thicknesses in the parafovea in the two groups were 45.2±6.4 μm and 43.6±5.5μm,respectively(P=0.228).The relationship between ONL and RNFL thickness was best described with a second order polynomial regression model assoeiation(Y=-0.019X2+2.73X+10.34,R2=0.211,P=0.005). Conclusion The foveal ONL thickness is increased in glaucomatous eyes.The alteration of foveal ON L thickness is associated with the severity of the disease.

Background Fundus photography is a traditional method for detecting local retinal nerve fiber layer (RNFL) defects,but the evaluation of its result depends on the observer's experience.The spectral domain optical coherence tomography (OCT) exhibit the defects of RNFL very clearly.Objective This study was to evaluate the diagnosis value and correlation between topographic profiles of localized RNFL defects determined by spectral domain and time domain OCT with fundus photography.Methods Forty-one normal eyes of 41 subjects and 55 eyes of 55 glaucomatous patients with localized,wedge-shaped RNFL defects identified by two glaucoma specialists in fundus photographs were enrolled in the clinical study.The angular location and width of RNFL defects determined on the images of fundus photography,Cirrus HD-OCT and Stratus OCT were analyzed respectively using Pearson's correlation coefficient and linear regression analysis.This study followed the Helsinki declaration and was approved by Ethic Committee of Shenzhen Eye Hospital.Written informed consent was obtained from each individual before the clinical examination.Results Seventy-five RNFL defects were identified in 55 eyes by two glaucoma specialists unanimously with the defect position at superior-temporal and inferior-temporal quadrants.The sensitivity of Cirrus HD-OCT and Stratus OCT to determining RNFL defects were 88.0% and 69.3% respectively and their specificities were 92.7% and 97.6% respectively.The angular locations of RNFL defects by Cirrus HD-OCT and Stratus OCT were highly correlated with those by fundus photography(r=0.993,r=0.992,P＜0.001);while the angular widths of RNFL defects by Cirrus HD-OCT and Stratus OCT were moderately correlated with those by fundus photography(r=0.420,r=0.432,P=0.019,P=0.002).No significant differences were found in the defect width of RNFL between Cirrus HD-OCT or Stratus OCT and fundus photography(Cirrus HD-OCT:P=0.114;Stratus OCT:P=0.074),and significant difference was found in that between Cirrus HD-OCT and Stratus OCT(P=0.002).Conclusion Spectral domain OCT and time domain OCT can localize RNFL defects with high sensitivity and specificity.The measure value of Cirrus HD-OCT and Stratus OCT for RNFL defects shows a good diagnostic agreement with fundus photography.

Objective This study evaluates the prevalence and factors related to high-risk human papilloma virus (HR-HPV) infection in Nanning adult women.Methods A total of 431 women who presented cervical cancer screening in (gynecological clinic, maternal and child health hospital of the Guangxi Zhuang Autonomous)were selected as subjects,from January to June,2014.A standardize questionnaire regarding demographic characteristics and possible risk factors of cervical cancer was filled by each partici-pant.Routine gynecological examination,microbial detection of reproductive tract,cervical cell HC2 test,cervical cytological and HPV DNA testing were applied to all participantes.Individuals who were suspicious for cervical intraepithelial neoplasia or cervical cancer received colposcopy biopsy and histopathological diagnosis.The date were analyzed in SPSS 1 9.0.Results Out of the total number of 431 samples.54 (12.53%)subjects were positive for HR-HPV.Among women with cervical abnormalities,82.50%had HR-HPV infection compared to 9.64% of those women with healthy cervix (P <0.01.Analysis for risk factors of HPV infec-tion showed that extramarital sexnal behaviors and maltiple sexual partners would increase the risk of HPV positivity.For vaginal micro ecological environment of multi-factor analysis showed that pathogen infection and bacterial vaginal disease are risk factors of HPV infection.Conclusion Among women with cervical abnormalities,HR-HPV positivity was significantly higher than that a-mong women with normal cervix.extramarital sexnal behaviors,multiple parity,pathogen infection and bacterial vaginal disease in-crease the risk of HPV infection.

Objective:To evaluate the radiologic and clinical outcomes of supramalleolar dome osteotomy in the treatment of varus-type ankle arthritis.Methods:From June 2018 to December 2019, 13 patients with varus-type ankle arthritis underwent supramalleolar dome osteotomy at Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital. Of them, 13 (5 males and 8 females) were included in the study. Their average age at surgery was 47.2 years (range, from 16 to 65 years). By the modified Takakura staging for arthritis, 3 cases were stage 2, 4 cases stage 3a and 6 cases stage 3b. Comparisons were made between preoperation and the last follow-up in ankle-hindfoot score of American Orthopedic Foot and Ankle Society (AOFAS), foot function index (FFI), visual analogue scale (VAS), Takakura staging, dorsal extension, plantar flexion, range of motion (ROM), tibial anterior surface angle (TAS), tibial lateral surface angle (TLS), and talar tilt (TT).Results:This cohort were followed up for 12 to 29 months (average, 17.2 months). At the last follow-up, AOFAS score (86.5±8.0), FFI (14.5±1.6), VAS score (1.5±1.0), Takakura staging (2.7±1.3), ROM (39.4°±8.0°), TAS (92.4°±6.0°), TT (3.7°±4.4°) were significantly improved than the preoperative values (68.3±14.4, 43.7±3.0, 4.2±1.4, 3.2±0.8, 43.3°±7.6°, 78.2°±8.3° and 7.0°±5.1°), and dorsal extension (10.9°±4.4°) was significantly smaller than the preoperative value (13.6°±5.1°) (all P<0.05). There were no significant differences between preoperation and the last follow-up in plantar flexion (29.7°±4.6° versus 28.5°±5.2°) or TLS (77.8°±4.5° versus 78.1°±5.3°) ( P>0.05). Conclusions:Supramalleolar dome osteotomy has shown promising short-term clinical efficacy in the treatment of varus-type ankle arthritis. It can significantly relieve pain, improve function, substantially correct deformity and retard progression of arthritis, but it may affect dorsal extension.