Objective To investigate the concentration of monocyte chemoattractant protein-1 (MCP-1) and interleukin-18 (IL-18) in the urinary of children with primary nephrotic syndrome(PNS) at different time points,and to explore their correlation with occurrence,development,progression,and prognosis of PNS.Methods A total of 65 pediatric cases from our hospital was enrolled in this study,and was divided into three groups based on the retrospective the follow-up results including steroid-sensitive NS (SSNS) (n =35),steroid-resistant NS (SRNS) (n =15),and frequent-relapse NS (FRNS) (n =15) groups.Another 20 healthy children served as normal controls.Peripheral blood samples and urine specimen were collected at three time points (without glucocorticoids,treatment after 8 weeks,and treatment after 16 weeks or recurrence).The levels of MCP-1 and IL-18 in the urine were assayed by enzyme-linked immunosorbent assay (ELISA).The levels of blood urea nitrogen,creatinine,and 24-hour urinary protein excretion were assayed by full-automatic biochemical study appliance.Results (1)In SSNS group,the levels of urinary IL-18 before treatment and treated for 8 weeks were higher than the normal control group [before treatment:(160.30 ±27.29) pg/ml; treated for 8 weeks:(157.62 ±26.85) pg/ml; normal control group:(70.88 ± 14.43) pg/ul].However,after treated for 16 weeks,the levels of urinary MCP-1 and IL-18 were markedly decreased compared with that of control group and those before treatment and treated for 8 weeks [treated for 16 weeks:(20.98 ±4.53) pg/ml,and (79.09 ±7.23) pg/ml,P ＜0.05].(2)In SRNS group,the levels of urinary MCP-1 and IL-18 before treatment were remarkably higher than that of control group and that of SSNS group before treatment[SSNS group before treatment:(76.84 ± 5.58) pg/ml,and (252.37 ± 25.34)pg/ml,P ＜0.05],but no significant difference was found when it was compared with that treated for 8 weeks [treated for 8 weeks:(72.32 ±4.30) pg/ml,and (243.70 ±35.43) pg/ml,P ＞0.05] ; However,its level was markedly decreased after treated with immunosuppressants of CTX for 16 weeks when it was compared with those before treatment and treated for 8 weeks[treated for 16 weeks:(34.03 ± 2.56) pg/ ml,and (114.42 ± 21.33)pg/ml,P ＜ 0.05].(3)In FRNS group,the levels of urinary MCP-1 and IL-18 were no remarkable difference between control and SSNS groups [before treatment:(30.43 ± 4.61) pg/ml,and (156.65 ± 34.39)pg/ml; treated for 8 weeks:(29.41 ± 4.76) pg/ml,and (152.21 ± 34.73) pg/ml,P ＞ 0.05],but its level was markedly lower than SRNS group (P ＜ 0.05).When it was recurred,the levels of urinary MCP-1 and IL-18 were significantly increased compared with before treatment and treated for 8 weeks[recurred:(72.92 ±3.01)pg/ml,and (224.33 ±26.07)pg/ml,P ＜0.05].(4)No correlation was found between the levels of MCP-1 and IL-18 and the levels of blood urea nitrogen and creatinine (P ＞0.05).Positive correlation was found between the levels of MCP-1 and IL-18 and the 24-hour urinary protein excretion (r =0.706,0.556,P ＜0.01).There's a correlation between urinary MCP-1 and IL-18 (r =0.811,P ＜ 0.01).Conclusions For children with PNS,the detection of urinary MCP-1 and IL-1 8 contributed to the early prediction of children'sensitivity on glucocorticoid.The elevated levels of urinary MCP-1 and IL-18 in combination with clinical symptoms and proteinuria can be used as an important noninvasive marker to monitor PNS recurrence.

Objective The study was designed to compare the pharmacodynamics of rocuronium administered by continuous infusion and intermittent bolus injection Methods Fifty ASAⅠ Ⅱ patients without any neuromuscular disease undergoing elective surgery under general anesthesia were randomly divided into two groups of 25 patients each In groupⅠ patients received rocuronium by intermittent bolus injection and in group Ⅱ by continuous infusion The responses of adductor pollicis to train of four (TOF) stimulation of ulnar nerve were monitored The onset time, the time of maximal neuromuscular blockade, the spontaneous recovery from paralysis and the total dose of rocuronium were recorded Intravenous anesthesia was used for both induction and maintenance of anesthesia, no patient received reversal of block Neuromuscular blockade monitoring ended when TOF ratio(T 4/T 1)≥70% The patients were extubated when ventilation was satisfactory Results The two groups were comparable with regard to age, sex, weight and duration of operation The mean onset time after rocuronium bolus(0 6mg/kg) was (78 18?15 44) s In group Ⅱ the mean infusion rate was (6 31?1 93)?g?kg -1 ?min -1 which was not significantly different from the amount of rocuronium administered per minute (5 43?1 46)?g?kg -1 ?min -1 in groupⅠ The mean interval between two bolus injection in group Ⅰwas (29 24?6 26) min, and no significant difference was seen between intervals The spontaneous recovery from neuromuscular block was significantly faster in group Ⅱ than that in group Ⅰ Conclusions Rocuronium has no cumulative effect There was no significant difference in the amount of rocuronium administered per unit time between the two groups The spontaneous recovery from neuromuscular block is faster by continuous infusion than that by intermittent bolus injection

OBJECTIVE To evaluate the relationships between antimicrobial usage and the isolated rate of ESBLs-KPN and ESBLs-ECO.METHODS We monitored the data on the yearly patient-days and the yearly consumption(defined daily dose(DDD) per 1000 patient days) frequent antibiotics and the isolated rate of ESBLs-KPN and ESBLs-ECO causing nosocomial infections from Jan 2004 to Dec 2007 was analyzed.RESULTS The yearly patient-days of our department significantly increased from 64 203 days in 2004 to 74 442 days in 2007(P

Objective To evaluate the change of extended spectrum β-lactamase (ESBLs) Producing Klebsiella Pneumoniae (ESBLs-KPN) and Escherichia coli (ESBLs-ECO) causing nosocomial infection after antimicrobial intervention. Methods We regularly monitored the data on the yearly consumption [defined as daily dose (DDD) per 1 000 patient-days] of frequently used antibiotics from Dec. 2004 to Dec. 2007. From Jan. 2005 to Dec. 2007, we monitored the resistance of frequently used antibiotics and the timely integrative antimicrobial intervention was based on the outcome of antimicrobial resistance. We also monitored the isolation rate of ESBLs-KPN and ESBLs-ECO causing nosocomial infection. The departments studied were the experimental group and other comparable medical departments were the control group(ICU was excluded).Results The isolation rate of ESBLs-KPN ((43.90%)) and ESBLs-ECO (45.83%) in the experimental group was higher than that in the control group (28.04% and 24.90%, respectively) before the intervetion (P＜0.05). The isolation rate of ESBLs-KPN decreased (from 26.47% to 17.65%) in the experimental group and that in the control group increased ( ESBLs-KPN: from 34.18% to (52.94%;) ESBLs-ECO: from 47.13% to 63.78%) from 2005 to 2007 (P＜0.05). The isolation rate of ESBLs-KPN and ESBLs-ECO in the experimental group was lower than that in the control group after the antimicrobial intervention (P＜0.05). Usage of ceftazidime and cefoperazone/sulbactam and imipenem was reduced and the consumption of cefepime was increased in the experimental group ((P＜0.05)). Consumption of ceftazidime and cefoperazone/sulbactam and cefepime was increased. Conclusion The prevalence of ESBLs-KPN and ESBLs-ECO may be decreased after the integrative antimicrobial intervention.

Objective To investigate the clinical operating skills of the ultrasound-guided percutaneous transhepatic bile duct puncture drainage(PTCD),and improve the success rate.Methods 60 cases of tumor-induced obstructive jaundice underwent ultrasound-guided percutaneous transhepatic bile duct puncture drainage were retrospectively analyzed and summarized.Results 60 cases were all punctureed successfully,and the success rate was 100％.A puncture needle patients which was successfully accounted for 88％ (53 cases).No obvious puncture complications were found.Conclusion Preoperative fully prepared for surgery the appropriate action can improve the ultrasoundguided percutaneous bile duct through the success rate of bypass,there is helpfal to reduce the puncture complications.

Objective To explore the differences of the joint function and the patient's satisfaction between two different methods to reconstruct limb length for unilateral Crowe Ⅳ developmental dysplasia of the hip (DDH).Methods The clinical controlled study were used.21 cases with unilateral DDH Crowe Ⅳ treated with total hip arthroplasty were divided into 2 groups randomly.The patients in the first group were reconstructed the limb with the compensatory length and those in the second group were did with the real length.The patients were followed up 10 years.Two independent sample t-test was used to compare these two operations.Harris scores and SF-36 scores were used in the test.Survival analysis with Kaplan-Meier method was involved in the survival of the prosthesis and then test with Log-rank test.X-ray films of different period were compared to confirm the prosthetic loosening.Results Seventeen patients were followed up 8-10 years.There were no significant differences both in Harris score and most of the SF-36 scores at the median follow-up of 10 years.The item mental healthy of SF-36 expressed significant difference.Five patients required revision.There were 10 cases suffered with polyethylene wear,6 cases with severe osteoporosis in greater trochanter,and 3 cases with osteolytic reaction.Conclusion There are no significant differences between the two surgical method in the survival rate of prosthesis and the joint function in the median follow up.The satisfaction of the control groups is lower than the trial groups both at the early stage after the operation and the median follow up.The revision rate between the two groups is similar but the reason is different.

Objective To explore the radiosensitivity of berberine on esophageal cancer cells under hypoxia condition.Methods MTT assay and clonogenic survival assay were used to evaluate the effect of berberine on proliferation inhibition and radiosensitivity of esophageal cancer cells,respectively.Immunofluorescence was employed to examine the expression of HIF-1.The change of cell cycle distribution and cell apoptosis was assayed by flow cytometry.The expression of HIF-1 was measured by Western blot.DNA damage was detected by γ-H2AX Foci counting.Results With a clear dose and time effect,berberine inhibited cell proliferation and enhanced cell radiosensitivity(t =3.69,P＜0.05)with a sensitizing enhancement ratio(SER)of 1.42.Berberine caused a dose-dependent decrease in HIF-1 protein expression and also significantly increased the cell apoptosis in ECA-109 population(t=4.74,P＜0.05).Compared with the radiation alone group,berberine enhanced X-ray induced DNA double chain breaks(DSB).Conclusions Berberine can increase the radiosensitivity of esophageal cell line ECA-109,which may be associated with decrease of HIF-1 expression and induction of apoptosis in ECA-109 cells.

BACKGROUND: The increasing prevalence of diabetes mellitus has been become one of the diseases which threaten the heath of human being in the 21st century. Islet transplantation is considered to be the most effective approach to cure type Ⅰ diabetes mellitus. However, lack of donor tissue limits the application of this therapy. However, recent progress of stem cell research shows that stem cell therapy may be a potential means to solve this problem.OBJECTIVE: To take activin A and all-trans retinoic acid (AR) in inducing the differentiation of bone marrow mesenchymal stem cells (MSCs) and explore its possibility DESIGN: A randomized controlled experiment.SETTING: Institute of Biotechnology, Academy of Military Medical SciencesMATERIALS: This experiment was conducted at the Institute of Biotechnology, Academy of Military Medical Sciences from November 2004to June 2005. Six male Sprague-Dawley rats, with body mass of 150-160g, were provided by the Experimental Animal Center of Academy of Military Medical Sciences.METHODS: Femoral bone marrow of the rats was extracted under aseptic condition. Bone marrow mesenchymal stem cells (MSCs) were isolated with density gradient centrifugation. Passaged MSCs were randomly divided into 4 groups: high concentration of glucose (HG), AR, beta-mercaptoethanol (ME) and negative control groups. MSCs were induced to differentiate into IPCs with conditional medium containing high concentration glucose, activin A, RA and ME etc. After induction, phenotypes of differentiated cells were examined by immunocytochemistry and reverse transcription-polymerase chain reaction (RT-PCR).MAIN OUTCOME MEASURES: Expression of insulin and glucagon of differentiated cells were examined by immunocytochemistry. Insulin-1 mR-NA expression of differentiated cells was detected by RT-PCR.RESULTS: After bone marrow mesenchymal stem cells were induced,there were scattered insulin-and glucagon-positive cells in the HG group,many insulin-and glucagon-positive cells in the AR and ME groups, and these cells formed insulin-like structure. The expression of insulin-1mRNA could be observed in the HG, AR and ME groups. Insulin-and glucagonpositive cells and the expression of insulin-1mRNA were not observed in the negative control group.CONCLUSION: We adopt an induction scheme based on AR and other matured factors, and successfully make bone marrow mesench.ymal stem cells induce and differentiate into insulin positive reaction cells and form insulin-like structure, but its induction efficiency needs further improvement.

Objective To evaluate the efficacy of anesthesia with etomidate administered by TCI in combination with continuous iv remifentanil infusion titrated to maintain BIS values at 40-60 for non-cardiac surgery in a prospective randomized single-blinded multicenter controlled clinical study.Methods Two hundred and forty-four ASA Ⅰ or Ⅱ patients of both sexes aged 20-60 yr undergoing non-cardiac surgery lasting less than 3 h were randomly allocated into 2 groups:etomidate group (group E,n =123) and propofol group (group P,n =121 ).The patients were unpremedicated.A bolus of midazolam 0.03 mg/kg was injected iv immediately before induction of anesthesia.Anesthesia was induced with sufentanil 0.3-0.4 μg/kg and TCI of etomidate (effect-site concentration (Ce) =0.5-1.0 μg/ml) or propofol (Ce =3-4 μg/ml).Tracheal intubation was facilitated with rocuronium 0.9 mg/kg.The patients were mechanically ventilated (VT 8-10 ml/kg,RR 10-12 bpm,FiO2 =1 ).PETCO2 was maintained at 35-40 mm Hg.Anesthesia was maintained with TCI of etomidate ( Ce =0.3-0.8 μg/ml ) or propofol ( Ce =3-4 μg/ml) in combination with continuous iv infusion of remifentanil at 0.1-1.0 μg· kg-1 ·min-1 and intermittent iv boluses of rocuronium.BIS values were maintained at 40-60 during operation.Sufentanil 0.1 μg/kg was administered iv before skin closure.Ce at loss of consciousness,during maintenance of anesthesia and at emergence,the consumption of remifentanil and vasoactive agents,the emergence time and extubation time were recorded.The incidences of injecton pain,post-operative nausea and vomiting (PONV) and emergence agitation were measured.Results Ce of etomidate at loss of consciousness,at emergence and during maintenance of anesthesia was (0.50 ± 0.22),(0.16 ± 0.09) and 0.22-0.39 μg/ml respectively.The incidence of injection pain and the consumption of vasoactive agents were significantly lower but more remifentanil was needed in group E than in group P (P ＜0.05 or 0.01).There was no significant difference in emergence time and extubation time between the 2 groups (P ＞ 0.05).The incidence of PONV and emergence agitation were significantly higher during recovery in group E than in group P ( P ＜ 0.05 ).Conclusion The hemodynamics is stabler during operation,but the incidence of PONV and emergence agitation are significantly higher during recovery in group E than in group P.Etomidate induces little injection pain.

Objective The purpose of this study is to investigate the factors associated with incisional surgical site infection (SSI) in colorectal cancer. Methods We retrospectively analyzed impacting factors of SSI including age, gender, BMI, diabetes mellitus, operation, albumin levels, hemoglobin levels, tumor staging, and length of stay post-operation in 327 colorectal patients from 2001 to 2005. Results The incidences of SSI and fat liquefaction were 2. 4%(8/327) and 12. 2%(40/327) respectively. The incidences of SSI in patients with obesity and diabetes mellitus increased significantly (16. 8% vs. 10. 0% ,28. 6% vs. 13. 7%). The length of stay in patients with SSI prolonged significantly (29.0 d vs. 15.8 d). Conclusion Obesity and diabetes mellitus are the most important factors associated with SSI in colorectal cancer patients.