Objective To investigate the expression of Toll-like receptor 4 (TLR4)in peripheral blood monocytes and its correlation with TNF-α and IL-6 in type 2 diabetes (T2DM)patients with neuropathy. Methods Healthy volunteers (NC,n=44),T2DM without neuropathy (n=44)and T2DM with neuropathy (n=44)were recruited in the present study.The expression of TLR4 mRNA and protein in peripheral blood monocytes was detected by RT-PCR and flow cytometry. ELISA was undertaken to measure the plasma concentration of TNF-αand IL-6. Results The levels of HbA1 c[(9.09±1.62)%vs(8.36±1.10)% vs (5.30±0.89)%],the protein expression of TLR4[(42.02±9.69)% vs (31.27± 6.87)% vs (11.96±5.54)%],the mRNA expression of TLR4[(2.98±1.06)vs (1.74±0.47)vs (1.12 ±0.52)],TNF-α[(8.75±3.14 )vs (6.27±3.64)vs(3.19±1.17)pg/ml]and IL-6[(3.63±1.81)vs(2.60 ±1.14)vs(1.54±0.58)pg/ml]in patients with diabetic neuropathy significantly increased compared with T2DM and NC group;TLR4 showed a positive correlation with TNF-αand IL-6(r=0.631,P <0.0001;r=0.447,P =0.0023). Conclusion TLR4 of monocytes may take part in the occurrence of systemic inflammation and has a close relationship with the development of diabetic neuropathy.

BACKGROUND: Tissue engineering provides a new way for the repair of urinary tissue and organ defects.Urinary tissue engineering has shown a bright prospect.OBJECTIVE: To review the latest research on urinary tissue engineering at national and international level.METHODS: With the keywords of tissue engineering, urology, scaffold, vascularization in Chinese and in English,respectively, a computer-based search for articles published from January 2000 to January 2016 was performed in CNKI and PubMed databases. The articles addressing urology tissue engineering, scaffolds and vascularization were collected,summarized and analyzed.RESULTS AND CONCLUSION: The selection and cultivation of seed cells, scaffold material performance, tissue construction in vitro, and degree of vascularization all make an important influence on the repair of urinary injuries. As different seed cells hold different biological characteristics, we should make full consideration prior to choosing an appropriate seed cell, so as to pave a good foundation for urinary tissue engineering. Scaffolds with good three-dimensional structure can promote the cell growth and proliferation, tissue in-growth and vascularization.Tissue-engineered materials are superior to traditional repair materials, but still on initial stage, and further large scale trials will be necessary. Moreover, some problems needed to be solved, such as the regenerated tissue with incomplete function different from natural tissues, and regeneration failure caused by biological stent rejection.

Objective To study the clinical value of cerebrospinal fluid cytology(csfc)and specific stain in tuberculous meningitis(TBM)-purulent meningitis(PM)and cryptococcal meningitis(CM).Methods The csfc data of 179 patients with TBM,PM and CM were retrospectively analyzed.The samples collected from all of these patients were analyzed by csfc May-Grunwald-Giemsa(MGG)staining,aricine blue staining and Indian ink staining. And the cytospin smears from 70 TBM were simultaneously stained by the immunofluorescence(IF)and immunocytological method to demonstrate the presence of mycobacterial antigen.Results ①TBM group showed a mixed-cell response.At the early stage of disease,the proportion of neutrophilic granulocyte reached 80%,and then reduced gradually.Lyumphoidocyte reaction was the most obvious in 1～2 months.The immunofluorescence(IF)and immunocytological method present a sensitivity of 82.9%and 85.7%,respectively.②Neutrophilic granulocyte was the most cell at acute stage of PM,and it descended quickly once treated with effective antibiotics.③The positive rates to detect CM with csfc MGG,aricine and Indian ink staining were 83.3%,81.8%,and 76.5%,respectively.Conclusion Dynamic observation on cerebrospinal fluid cytology is helpful to boost the differential diagnosis of intracranial infection.

Objective To evaluate the effect of ultrasound-guided quadratus lumborum block (QLB) on the efficacy of postoperative analgesia after caesarean section.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ parturients,aged 20-39 yr,weighing 50-80 kg,scheduled for elective cesarean section under subarachnoid block,were divided into 2 groups (n =30 each) using a random number table:QLB group (group Q) and control group (group C).Ultrasound-guided bilateral QLBs were performed at the end of surgery,the solution was injected into the compartment between quadratus muscle and psoas major muscles,and 0.25％ ropivacaine 1.25 mg/kg was injected to each side in group Q.The parturients in both groups received patient-controlled intravenous analgesia after surgery to maintain the visual analog scale score ≤ 3,and dezocine 5 mg was intramuscularly injected as a rescue analgesic when the visual analog scale score≥4.Bruggrmann comfort scale (BCS) and Ramsay sedation scores were evaluated at 2,4,6,12,24 and 48 h after operation.The consumption of sufentanil during patient-controlled intravenous analgesia,requirement for rescue analgesia,satisfaction score of analgesia,the number of successfully delivered doses (D1) and the number of attempts (D2) were recorded within 24 h after surgery.D1/D2 was calculated.The development of respiratory depression and over-sedation was recorded.The development of QLB-related adverse reactions and postoperative nausea,vomiting,chest tightness and pruritus was also recorded.Results Compared with group C,BCS scores were significantly increased,the consumption of sufentanil was reduced,D1/D2 was increased,the requirement for rescue analgesia was decreased,and the satisfaction score of analgesia was increased (P＜0.05),and no significant change was found in Ramsay sedation score in group Q (P＞0.05).Adverse reactions such as respiratory depression,over-sedation,nausea,vomiting,chest tightness and pruritus were not found in two groups.Adverse reactions such as hematoma and infection at the puncture site or local anesthetic intoxication were not observed after surgery in group Q.Conclusion Ultrasound-guided QLB can enhance the efficacy of postoperative analgesia after caesarean section,reduce postoperative consumption of opioids and raise the comfort degree for parturients.

Objective To evaluate the effect of ultrasound-guided continuous anterior quadratus lumborum block (QLB) on postoperative analgesia in total hip arthroplasty.Methods Fifty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes,aged 65-80 yr,weighing 45-80 kg,scheduled for elective total hip arthroplasty under subarachnoid block,were divided into 2 groups (n =25 each) using a random number table method:ultrasound-guided continuous anterior quadratus lumborum block group (group Q) and routine analgesia group (group R).Anterior QLB was performed at the end of operation in group Q.Patient-controlled intravenous analgesia was performed with sufentanil after operation in two groups.Dezocine was given as rescue analgesic.Ramsay sedation score and the maximum angle for hip flexion and abduction of hip joint were recorded after operation,and the total consumption of sufentanil,requirement for dezocine and occurrence of adverse reactions were recorded within 72 h after operation.The occurrence of QLB-related complications was also recorded.Results Compared with group R,Ramsay sedation score was significantly decreased and the maximum angle for hip flexion and abduction of hip joint were increased at each time point after operation,and the total consumption of sufentanil,requirement for dezocine and incidence of nausea and vomiting were decreased in group Q (P ＜ 0.05).No QLB-related complications were found in group Q.Conclusion Ultrasound-guided continuous anterior QLB can produce better postoperative analgesia and reduce postoperative consumption of opioids with fewer adverse reactions in the patients undergoing total hip arthroplasty.

Objective:To examine the effects of Zishenwan Prescription on bile acid metabolism in mice with diabetic encephalopathy; To explore its mechanism of improvement of diabetic encephalopathy.Methods:Male C57BL/6J mice were used to replicate the mouse model of type 2 diabetes mellitus by using high-fat chow and a single intraperitoneal injection of streptozotocin (120 mg/kg). The mice were screened for diabetic encephalopathy by using the Morris water maze test after 8 weeks of continuous stimulation with hyperglycemia, and were divided into model group and Zishenwan Prescription group according to random number table method, with 12 mice in each group. The mice in the Zishenwan Prescription group were treated with the crude extract of Zishenwan Prescription (9.36 g/kg) by gavage, and the normal group and the model group were treated with the same volume of distilled water once a day for 8 weeks. At the end of the treatment, Morris water maze test was used to investigate the cognitive function of diabetic encephalopathy mice; cresyl violet staining was used to detect the number of granule neurons in the hippocampus; serum and feces were collected to detect the content of bile acids by liquid-liquid coupling; hepatic bile acid synthase CYP7a1 and CYP27a1, farnesol X receptor (FXR), fibroblast growth factor 15 (FGF15), fibroblast growth factor receptor 4 (FGFR4), and ileocecal apical sodium-dependent bile acid transporter protein (ABST) mRNA levels were detected by using fluorescence quantitative PCR assay.Results:Compared with the model group, mice in the Zishenwan Prescription group had shorter evasion latency time ( P<0.05 or P<0.01), decreased time to first reach the platform ( P<0.01), increased number of times to traverse the platform ( P<0.01), and reduced neuronal cell damage in hippocampal area; mice in the Zishenwan Prescription group showed decreased serum and fecal total bile acid content ( P<0.05 or P<0.01); the liver CYP7a1 and CYP27a1 mRNA expressions increased ( P<0.01), and FXR and FGF15 mRNA expressions decreased ( P<0.01); ileal ABST mRNA expression decreased ( P<0.01). Conclusion:Zishenwan Prescription may regulate bile acid metabolism, inhibit FRX-FGF15/FGFR4 signaling and ABST expression to promote new bile acid synthesis and conjugated bile acid reabsorption, and thus improve cognitive function in diabetic encephalopathy mice.

Objective:To evaluate the diagnostic efficacy and practicality of the Jaundice color card (JCard) as a screening tool for neonatal jaundice.Methods:Following the standards for reporting of diagnostic accuracy studies (STARD) statement, a multicenter prospective study was conducted in 9 hospitals in China from October 2019 to September 2021. A total of 845 newborns who were admitted to the hospital or outpatient department for liver function testing due to their own diseases. The inclusion criteria were a gestational age of ≥35 weeks, a birth weight of ≥2 000 g, and an age of ≤28 days. The neonate′s parents used the JCard to measure jaundice at the neonate′s cheek. Within 2 hours of the JCard measurement, transcutaneous bilirubin (TcB) was measured with a JH20-1B device and total serum bilirubin (TSB) was detected. The Pearson′s correlation analysis, Bland-Altman plots and the receiver operating characteristic (ROC) curve were used for statistic analysis.Results:Out of the 854 newborns, 445 were male and 409 were female; 46 were born at 35-36 weeks of gestational age and 808 were born at ≥37 weeks of gestational age. Additionally, 432 cases were aged 0-3 days, 236 cases were aged 4-7 days, and 186 cases were aged 8-28 days. The TSB level was (227.4±89.6) μmol/L, with a range of 23.7-717.0 μmol/L. The JCard level was (221.4±77.0) μmol/L and the TcB level was (252.5±76.0) μmol/L. Both the JCard and TcB values showed good correlation ( r=0.77 and 0.80, respectively) and agreements (96.0% (820/854) and 95.2% (813/854) of samples fell within the 95% limits of agreement, respectively) with TSB. The JCard value of 12 had a sensitivity of 0.93 and specificity of 0.75 for identifying a TSB ≥205.2?μmol/L, and a sensitivity of 1.00 and specificity of 0.35 for identifying a TSB ≥342.0?μmol/L. The TcB value of 205.2?μmol/L had a sensitivity of 0.97 and specificity of 0.60 for identifying TSB levels of 205.2 μmol/L, and a sensitivity of 1.00 and specificity of 0.26 for identifying TSB levels of 342.0 μmol/L. The areas under the ROC curve (AUC) of JCard for identifying TSB levels of 153.9, 205.2, 256.5, and 342.0 μmol/L were 0.96, 0.92, 0.83, and 0.83, respectively. The AUC of TcB were 0.94, 0.91, 0.86, and 0.87, respectively. There were both no significant differences between the AUC of JCard and TcB in identifying TSB levels of 153.9 and 205.2 μmol/L (both P>0.05). However, the AUC of JCard were both lower than those of TcB in identifying TSB levels of 256.5 and 342.0 μmol/L (both P<0.05). Conclusions:JCard can be used to classify different levels of bilirubin, but its diagnostic efficacy decreases with increasing bilirubin levels. When TSB level are ≤205.2 μmol/L, its diagnostic efficacy is equivalent to that of the JH20-1B. To prevent the misdiagnosis of severe jaundice, it is recommended that parents use a low JCard score, such as 12, to identify severe hyperbilirubinemia (TSB ≥342.0 μmol/L).