Objective To explore the effect of Toll-like receptor 4 (TLR4) on the peripheral blood mononuclear cells(PBMCs) in the development of rheumatoid arthritis (RA) by inducing the differentiation of Th17 cells.Methods Forty two subjects were recruited to the study,including 22 patients with RA and 20 healthy controls (HC).The percentage of circulating Th17 cells were analyzed using flow cytometry.PBMCs were stimulated with LPS for two days.TLR4 mRNA of the PBMCs and the concentration of IL-6 and TNF-α in the supernatants were analyzed with the real-time qPCR and ELISA respectively.Supematants was then used for CD4+ cord blood mononuclear cells (CBMCs) culture,and IL-17 in the supernatants and the expression of IL-17 mRNA in cells were detected by ELISA and real-time qPCR respectively.The statistical analysis was carried out with t-test.Results The TLR4 mRNA expression in the PBMCs and the percentage of circulating Th17 ceils of RA patients were significantly higher than that of the HC group (P＜0.01).Stimulated by LPS,the expression of TLR4 mRNA increased 3.5 times in the RA group but decreased 0.11 times in the HC group.LPS also increased cytokines production in both groups,while PBMCs from RA patients produced more IL-6 and TNF-α than the cells from healthy subjects (P＜0.01).Compared to the HC group,the IL-17 mRNA expression and IL-17 secretion of CD4+ CBMCs induced by the supematants of RA patients' PBMCs stimulated with LPS was significantly higher(P＜0.01 ); but there was no significant difference between the RA group and the HC group without LPS stimulation (P＞0.05).Conclusion The expression of TLR4 on PBMCs from patients with RA and its response to LPS stimulation are increased,and it has demonstrated high capability in inducing the differentiation of Th 17 cells.

AimTo establish the model of adriamycin- induced nephritic syndrome in rats and its pathological change wasobserved. MethodsThe model of nephritic syndrome in rats was established by intravenous injection of adriamycin in the dose of 5mg · kg-1 and 3 mg · kg-1 respectively at the first day and 15 th day. The amount of urine protein was measured at the 1、2、3、4、6、8 and 12 th week and the serum biochemical pa rameters of TG, TCH, BUN, Cr, TP and ALB were detected at the 6 th and 12 th week. Results The urine protein and the serum biochemic parameters were increased significantly, except the TP and ALB, which were decreased. Pathological changes at the sixth week was similar to minimal changes in glomerulonephritis, and at the 12 th week, sclerosis of glomeruli of kidney could be found. ConclusionAfter first injection,the changes of kidney were like those inminimal change glomerulonephritis of human being. But after the second injection. The kidney had the changes of focal segmental glomeralosclerosis.

Seventy-one patients with variant angina (VA) admitted in the Cardiology Department from January 2003 to March 2011,were divided into non-stenosis group (stenosis ＜ 50％,n =43) and stenosis group (stenosis ≥50％,n =28) according to the degree of stenosis.The differences of the risk factors,clinical manifestations,electrocardiogram,echocardiogram and laboratory examinations between these two groups were compared.The average age of patients in stenosis group 58 ± 8 y was higher than that in non-stenosis group (52 ± 9 y,t =2.43,P =0.02).Other risk factors,including male gender,smoking,hypertension,diabetes mellitus and lipid disorder did not show any differences between the two groups.Percentage of patients with angina pectoris lasting less than 5 min was higher in stenosis group (x2 =5.98,P =0.02),while percentage of effort angina,seeking medical consultation ≤ 6 months of onset and hemodynamic disorders showed no difference.Laboratory examinations had no differences.It is difficult to determine whether the VA patient has fixed coronary stenosis by analyzing the risk factors,clinical manifestations and laboratory examinations; to determine the fixed coronary stenosis coronary angiography is necessary.

Objective:To evaluate the value of ultrasound-guided transperineal systematic prostate biopsy(SPB)and cognitive fusion multi-parameter magnetic resonance imaging(mpMRI) suspicious transperineal targeted biopsy(CFTB) in the prostate cancer with different serum prostate specific antigen(PSA) levels.Methods:A retrospective analyses were performed in 527 patients with suspected prostate cancer who underwent ultrasound-guided SPB from January 2018 to December 2019 in Shanghai Jiaotong University Affiliated 6th People′s Hospital. According to the PSA levels, they were divided into group A(PSA 4-10 μg/L) and group B(PSA>10 μg/L). All the patients underwent ultrasound-guided SPB, 376 patients with suspicious mpMRI had two additional targeted biopsies. The detection rates of ultrasound-guided SPB and CFTB in prostate cancer were tested by χ 2 test. Compared with pathological results, the sensitivity, specificity, accuracy of two methods were calculated and tested by χ 2 test, and a P<0.05 was defined as statistically significant difference. Results:Prostate cancer was detected in 319 of 527 patients(60.5%). One hundred and three cases of 198 patients in group A were diagnosed as prostate cancer, with an overall detection rate was 52.0%. Among them, ultrasound-guided SPB detected 72 cases of prostate cancer, the detection rate was 36.4%, sensitivity was 67.9%, specificity was 17.7%, accuracy was 26.5%, the detection rate, sensitivity, specificity and accuracy of CFTB were 39.9%, 75.6%, 91.6% and 88.8%, respectively. In this group, there were no statistically significant differences in the detection rate and sensitivity of the two methods in the diagnosis of prostate cancer (χ 2=0.525, 0.005, both P>0.05), and the differences in specificity and accuracy were statistically significant (χ 2=108.340, 79.829, respectively, both P<0.05). Two hundred and sixteen cases of 329 patients in group B were diagnosed as prostate cancer, with an overall detection rate was 65.7%. Among them, 160 cases of perineal prostate cancer were detected by ultrasound-guided SPB, with the detection rate was 48.6%, sensitivity was 78.2%, specificity was 37.6% and accuracy was 49.5%. A total of 189 cases of prostate cancer detected by CFTB, the detection rate was 57.4%, the sensitivity was 89.3%, the specificity was 90.6%, and the accuracy was 90.2%. All the differences were statistically significant in group B(χ 2=5.131, 4.391, 61.339, 38.982, all P<0.05). Conclusions:When PSA is greater than 10 μg/L, CFTB has a higher diagnostic efficiency than SPB.When PSA is 4-10 μg/L, there are no significant differences between the two methods in the detection rate and sensitivity of prostate cancer.

Objective To evaluate the clinical effect of the lung protective ventilation combining with Re-duning injection on the acute lung injury (ALI). Methods 59 patients with ALI were randomly divided into the lung protective ventilation group (control group, n =30) and the lung protective ventilation wmbined with Reduning injection group(experimental group,n = 29) ,and the changes of vital signs,RR,blood gas analysis,and so on were observed. The comparison between PaO2 and PaO2/FiO2 was carried out. The efficacy and the mortality rate were evaluated. Results Lung injury in 21 cases of experimental group were improved after applied Reduning treatment(72. 41%),there was a significant difference ( P < 0.05) with that of 14 cases in control group (46. 67% ) ; PaO2 increased, PaO2/FiO2 significantly increased in experiment group,there were significant difference compared with those of control group(P <0. 01). The mortality rate in the experimental group was 24.14% ,there was a significant differ-ence(P<0.05) compared with the mortality of 50. 00% in control group. Conclusion Reduning treatment could, improve the pulmonary function in lung protective ventilation to cure ALI,reducing the mortality rate as well.

Objective To study the anatomic features of surface vasa vasorum on longissimus in thoracolumbar segments,and its protection function during the internal fixation for thoracolumbar fracture via Wiltse approach.Methods From March 2010 to October 2012,a total of 97 patients with thoracolumbar fractures underwent posterior internal fixation with pedicle screw system.The trend and distribution of surface vasa vasorum on longissimus in thoracolumbar segments were observed in the operation,and the vessels were protected during the surgical procedures by using specific devices and techniques.Operative time and intra-operative blood loss were recorded.Visual analogue scale (VAS) values were evaluated after 3 days,1 month,6 months postoperatively,and 1 month after the removal of internal fixation.MRI images of longissimus in thoracolumbar segments were compared after preoperative and postoperative 6 months.Results Surface vasa vasorum distribution on 194 longissimus and 402 inter-pedicle areas of 97 patients were observed.In 402 areas,94.3％ of surface vasa vasorum presented sarciniform,while only 5.7％ of surface vasa vasorum presented tube shape.In 379 areas of sarciniform distribution,9.8％ of blood vessel bundles were located in vertebral pedicle area;76.0％ of blood vessel bundles were located in the upper inter-pedicle areas;12.4％ of blood vessel bundles were located in middle inter-pedicle areas;1.8％ of blood vessel bundles were located in lower inter-pedicle areas.In 379 areas,87.3％ of blood vessel bundles could be completely retained;12.7％ of blood vessel bundles were treated by electro coagulation and burning.Intra-operative blood loss was 21±9.3 ml.VAS values after 3 days,1 month,6 months postoperatively,and 1 month after the removal of internal fixation were 3.3± 1.6,2.1± 1.4,1.2±0.7 and 1.1±0.7.The longissimus treated with electro coagulation demonstrated pimelosis change on MRI after postoperative 6 months.Conclusion Surface vasa vasorum on longissimus in thoracolumbar segments are generally of sarciniform,and most of them are located in upper inter-pedicle areas.The protection of vasa vasorum can reduce the intra-operative lesion and postoperative pimelosis change of longissimus.

Objective To study the effect of precise locating technique of C?arm fluoroscopy in order to reduce the radia?tion exposure during the surgical procdure for thoracolumbar fracture. Methods From March 2010 to Octorber 2012, a total of 92 cases with thoracolumbar fracture underwent postierior internal fixation procdures with pedicle instrumentation. C?arm fluoros?copy was used in 44 cases with precise locating technique, while in 48 cases with traditional methods. In precise locating group,C?arm fluoroscopy was used after anesthesia. Once an ideal view was got, the position parameters of C?arm fluoroscopy machine were recorded. The machine was positioned according to the recording for the secondary fluoroscopy. Pre?operative and intra?operative number of times of exposure, length of exposure time, time for fluoroscopy and total operating time were recorded and compared be?tween two groups. Results Pre?operative number of times of exposure, exposure time, and time for fluoroscopy in precise locating group were (5.51±2.47), (2.26±1.05) s and (9.83±3.67) min,which were higher than those of (4.02±2.42), (1.78±0.98) s and (8.29± 3.52) min in traditional group. However, intra?operative number of times of exposure, exposure time, and time for fluoroscopy in precise locating group were (5.26±3.64), (2.24±1.24) s and (10.39±4.82) min,which were lower than those of (9.74±4.38), (4.21± 2.38) s and (24.69±6.35) min in traditional group,and total number of times of exposure, exposure time, time for fluoroscopy and total operating time in precise locating group were(10.77±4.16), (4.50±1.83) s, (20.22±5.03) min and(70.52±18.33)min,which were also lower than those of (13.76±5.31), (5.99±3.27) s , (32.98±7.83) min and(81.86±21.57)min in traditional group. Conclu?sion Precise locating technique of C?arm fluoroscopy reduces the radiation exposure during the surgical procdure for thoracolum?bar fracture.

Long noncoding RNA (lncRNA) is a class of RNA molecules that longer than 200 nucleotides.lncRNA is lack of functional open reading frames and has no protein coding ability.Recently, accumulating evidences indicate that lncRNA plays active roles in tumor carcinogenesis and progression.The aberrant expression of lncRNA is significantly correlated with the growth,metastasis,and therapy-resistance of digestive system tumors.Thus,lncRNA may be served as new targets for the diagnosis,treatment,and progno-sis of patients with digestive system tumors.

Objective: To analyze the risk factors of acute kidney injury (AKI) after isolated heart valve prosthesis implantation (HVPI) in relevant patients. Methods: We retrospectively studied 400 patients who received isolated HVPI in our hospital. The demographic characteristics and pre-, intra-, post-operative information were collected to conduct uni- and multi-variantanalysis. Results: The pre-operative serum creatinine level in 400 patients was 85.0 (72.0, 98.0) μmol/L and post-operative level was 104.5 (80.0, 146.3) μmol/L, the elevation was 20.9% (1.6%, 57.9%),P<0.05. Multi Logistic regression analysis indicated that age>50years (OR=2.12, 95% CI 1.13-3.95),hypertension history (OR=4.07, 95% CI1.23-13.47), cardiopulmonary bypass time>180 minutes (OR=5.38, 95% CI 1.63-17.77), post-operative hemoglobin<70 g/L (OR=0.20, 95% CI 0.06=0.74), serum glutamic-pyruvic transaminase>100 u/L (OR=12.10, 95% CI 2.28-64.23), pleural fluid drainage at the day of operation> 500 ml (OR=2.12, 95% CI 1.13-3.95), extubation after 24 hours of operation (OR=3.94, 95% CI 2.07-7.52), combining low cardiac output syndrome (OR=4.64, 95% CI 1.06-20.29) were the independent risk factors for AKI occurrence in patients after HVPI, allP<0.05. Conclusion: Post-HVPI AKI was associated with many factors. At prior operation, it was mainly related to the age and hypertension; during theoperation, it was mainly related to cardiopulmonary bypass time; at post-operation, it was mainly related to delayed extubation, low cardiac outputsyndrome, anemia, increased pleural lfuid drainage and serum glutamic-pyruvic transaminase.

Objective To investigate the basic data of risk estimation of lung cancer among non-uranium miners in China.Methods 2836 workers from 24 mines in 9 provinces/regions were face-to-face interviewed to collect information including age at exposure,exposure duration,cigarette smoking among others.Results Age of the investigated non-uranium miners ranged from 17 to 72(36.9±8.0)years.The miners received low and poor education,3% of them were illiterate,58% with primary and middle school education,only 7% with junior college and higher education.Seventy-five percent of the uranium miners are migrant rural workers.Ethnic minority miners accoungted for 16% of all the investigated miners.Among the migrant rural workers age at initial exposure was estimated to be 29.6±8.0 years.By the time of the investigation,46.7% of the miners had worked in the mine for five years and longer,working years in the mine was 6.7±6.8 years with a median of 4.1years.3.4% of the non-uranium miners began the initial radon exposure in mines before their 18 years of old.17.5% of the investigated miners reported working more than 8 h every working day.Among the males,58.0% were current smokers with a median of 16 cigarettes per day.Age to begin the cigarette smoking was 20 years on average.Current smoking rate was age-dependent,the rate as high as 69.2% for the males aged 15-19 years.Current smoking rate was significantly statistically lower in coal mines than that in other mines,49.0% vs 62.5%.Compared with other miners,more frequent mechanical ventilations were reported by coal miners,Conclusions In China non-uranium mines,75% were migrant rural workers,by the time of the investigation about half of them had worked in the mines for at least five years.Non-uranium miners began their mining at 30 years on average,with a very small percentage of 3%,exposed to the mining radon before their 18 years.Current cigarette smoking rate in non-uranium male miners was the same as the general male population in China.