Objective To evaluate the predictive value of serum presepsin (sCD14-ST) for septic myocardial depression (SMD) in patients with severe sepsis or septic shock.Methods This was a prospective cohort study.A total of 84 patients with severe sepsis or septic shock were monitored by pulse indicator continuous cardiac output (PiCCO) system and divided into myocardial depression group (cardiac function index [CFI]<4.1 L/min, n=37) and non-myocardial depression group (CFI≥4.1 L/min, n=47) according to cardiac function index (CFI).Left ventricular ejection fraction (LVEF) was measured by doppler echocardiography at admission.The patients were divided into survival group (n=40) and non-survival group (n=44) based on 28-day mortality.Serum sCD14-ST,B-type natriuretic peptide(BNP), tumor necrosis factor-α(TNF-α), cardiac troponin Ⅰ (cTnⅠ) levels and hemodynamic parameters were observed dynamically at day 1,3,5 after admission.Quantitative data with normal distribution were analyzed using t-test and abnormal distribution data were analyzed using Mann-Whitney U test.Categorical data were analyzed using χ2 test.Results The serum levels of cardiac index (CI), global ejection fraction (GEF) and left ventricular contractility index (dPmax) in myocardial depression group were all significantly lower than those in non-depression group at day 1 after admission (all P<0.01).The serum levels of sCD14-ST, TNF-α and BNP in myocardial depression group were all significantly higher than those in non-depression group (all P<0.01).Serum sCD14-ST levels in 84 septic patients were positively correlated with both BNP and TNF-α (r=0.204, P<0.05 and r=0.516, P<0.01, respectively).The area under the receiver operating characteristics curve (AUC) of sCD14-ST was 0.782 for myocardial depression in patients with sepsis, with a sensitivity of 89.2% and a specificity of 78.0% at the cut-off point of 988 mg/mL.The predictive value of sCD14-ST was inferior to BNP and TNF-α (both P<0.05).The combination of sCD14-ST, TNF-α and BNP could provide better prediction value in septic myocardial depression.Logistic regression analysis showed that serum sCD14-ST was not the in dependent predictor for septic myocardial depression (P>0.05).There were 24 cases died in myocardial depression group.The mortality of myocardial depression group was significantly higher than that of non-depression group (64.9% vs 42.6%, χ2=4.132, P =0.042).The serum levels of sCD14-ST at day 1 and day 3 in myocardial depression group were significantly higher than those in non-myocardial depression group (both P<0.01).sCD14-ST levels in both groups showed downtrend.The serum level of sCD14-ST in non-survival group was significantly higher than that in survival group (P<0.01).Conclusions Myocardial depression is common in patients with severe sepsis and septic shock.High serum level of sCD14-ST is correlated with myocardial depression to some extent, but not an independent predictor.The combination of sCD4-ST, BNP and TNF-α can improve the predictive value for myocardial depression.

This study was to appraise safety and feasibility of laparoscopic approach and investigate the clinical effects of laparoscopic tension-free repair of esophageal hiatal hernia using mesh. From August 2006 to July 2009, 24 patients with esophageal hiatal hernia underwent laparoscopic repair. Twenty-three patients received laparoscopic tension-free repair using mesh, at the same time, Toupet or Dor partial fundoplication was performed. One patient was converted to open surgery. The average operating time was 90 min (70-210 min) and the blood loss was between 10-110 mL. There was no death. The mean postoperative hospital stay was 5 days (3-30 days). During a follow-up period of 12-20 months (mean 15 months), there was no recurrence of the hernia, and no complication with use of mesh. The present study suggested that laparoscopic approach was secure and minimally invasive operation for esophageal hiatal hernia and the use of mesh could reduce recurrence rate.

AIM:To investigate the changes of histone modifications during the activation of primarily cultured rat hepatic stellate cells ( HSCs) and the relationship between histone modification patterns andα-smooth muscle actin (α-SMA) expression, and to explore the roles of histone modifications in the activation of HSCs.METHODS:The rat HSCs were isolated by in situ perfusion of collagenase combined with density gradient centrifugation, cultured in vitro and identi-fied by immunofluorescence staining.The morphological features of the cells were observed under inverted microscope.The changes of desmin and α-SMA during the activation of HSCs were detected by immunofluorescence staining and Western blotting.The levels of histone 3 lysine 4 dimethylation (H3K4me2), histone 3 lysine 9 dimethylation (H3K9me2), his-tone 3 lysine 9 acetylation (acH3K9) and histone 4 lysine 12 acetylation (acH4K12) in quiescent HSCs and activated HSCs were determined by Western blotting.RESULTS: The morphology of HSCs shifted from a quiescent phenotype to highly activated myofibroblast during the culture.Immunofluorescence staining and Western blotting showed that the expres-sion levels of α-SMA and desmin were increased over time and reached maximum at 15 d.According to the results of cell morphology and immunofluorescence staining, the cells cultured for 24 h and 15 d were quiescent and activated HSCs, re-spectively.Compared with quiescent HSCs, there were higher H3K4me2 and lower H3K9me2, acH3K9 and acH4K12 modification levels in activated HSCs ( P<0.01 ) .CONCLUSION: Histone modifications show anomalous expression during the activation of primarily cultured rat HSCs.Histone modifications may contribute to the transdifferentiation of HSCs and the development of hepatic fibrosis.

Objective To evaluate laparoscopic local resection for the treatment of gastric tumors. Methods The clinical data of 78 patients who received laparoscopic local resection at the PLA General Hospital from February 2006 to January 2010 were retrospectively analyzed. According to the tumor site and free range, total laparoscopic gastrectomy was applied to 45 patients, laparoscopic local resection was applied to 22 patients, laparoscopic and endoscopic tumor resection was applied to 11 patients. The efficacies of the surgical approaches were investigated. Results Laparoscopic local resection was successfully performed on the 78 patients without conversion to open surgery. The mean operation time and operative blood loss were 75 minutes (range, 45-120 minutes) and 60 ml (range, 35-90 ml), respectively. The mean diameter of the tumor was (2.5±1.3)cm (range, 0.7-4.8 cm). No mortality or morbidity occurred postoperatively. The bowel function recovery time and the duration of hospital stay were 35 hours (range, 25-42 hours) and 7.5 days (range, 6-9 days), respectively. The results of postoperative pathological examination verified that 63 patients were with gastric stromal tumor, 11 patients were with benign gastric diseases, including 5 with gastric heterotopic pancreas, 2 with inflammatory pseudotumor, 2 with hyperplastic polyp, 1 with schwannomas and one with angioma. Four patients were with carcinoid, 3 carcinoids were located in mucous layer and 1 invaded into muscular layer. The median time of follow-up was 26 months, and no anastomotic stenosis or port-site metastasis was observed. Of the 63 patients with gastric stromal tumor, 2 were treated with imatinib mesylate, 1 had tumor recurrence and received reoperation. Conclusion Laparoscopic local resection is safe and feasible for the treatment of benign gastric neoplasms, stromal tumor and early gastric tumors.

Objective To study the effect of a new mucA gene mutation on the biofilm formation process and the morphology of matured biofilm of Pseudomonas aeruginosa. Methods The mucA gene of PAO1 was cloned into the Pseudomonas aeruginosa expression plasmid pUCP20. The recombinant plasmid was transformed to mucoid PA17 which contained a new mucA mutation. Positive clones of the plasmids were identified by enzyme digestion and sequencing. The expression levels of algD in the positive clones were assessed by semi-quantitative RT-PCR. The modified plate culture method was used to establish the biofilm models of PA17, PA17 with recombinant plasmid and PAO1 in vitro. Results Transformation was identified by the decreased expression of algD in positive clones. The rate of biofilm formation of the positive clones was between those of PAO1 and PA17. The irreversible adhesion occurred after 8 h and the matured biofilm was observed on day 6. The morphologies of PA17, PAO1 and PA17 with recombinant plasmid were the same. Conclusion The mucA gene mutation of PA17 delays the formation of irreversible adhesion of PA17 biofilm, but it has no effect on the morphology of matured biofilm.

Objective To investigate the association of C-reactive protein (CRP) gene polymorphisms and plasma hs-CRP level,and effect on the genetic susceptibility of ischemic stroke (IS).Methods A case-control study was conducted and 548 patients with acute ischemic stroke and 993 agematched controls from community-based population were included in this study.Epidemiological questionnaires were managed to collect for demographic information.Blood pressure was measured and blood glucose,triacylglycerol,cholesterol,and high sensitivity C-reaction protein (hs-CRP) were detected.Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used for genotyping of CRP gene in all participants.Results The levels of plasma hs-CRP and the proportion of elevated plasma hs-CRP (≥3.0 mg/L) in the ischemic stroke patients (3.534 ± 3.484) mg/L (43.1％) were significantly higher than those of controls (1.957 ±2.344) mg/L (16.6％),t =9.475,P ＜ 0.01,x2 =128.326,P ＜ 0.01.The results of association analysis indicated that rs3093059 and rs3091244 of CPR gene presented statistical associations with ischemic stroke.After correction for confounding factors,ORs (95％ CI) of additive model and dominant model of rs3093059 were 0.697 (0.528-0.921),0.671 (0.487-0.923) respectively.ORs 95％ CI) of dominant model of rs3091244 was 0.728 (0.536-0.988).Further analysis indicated the polymorphism of rs876537,rs3093059,rs3091244 of CPR genotyping were significantly associated with plasma hs-CRP elevation (≥ 3.0 mg/L) both in ischemic stroke patients and in controls (P ＜0.05).Conclusion The CRP genetic polymorphisms were negatively associated with ischemic stroke,and positively corrleted with plasma hs-CRP elevation.However,plasma hs-CPP was positively correlated with ischemic stroke.These results suggested that the plasma hs-CRP levels might be accompanied by ischemic stroke.

BACKGROUND:The homing ability of mesenchymal stem cells after transplantation can decrease along with culture and passage in vitro. And the decline of homing abilities can further influence the implantation of mesenchymal stem cells in the target tissue, thus seriously affecting the repair effect.
OBJECTIVE:To investigate the effect and its related mechanisms by which in vitro culture and passage affect the homing ability of mesenchymal stem cells.
METHODS:Mesenchymal stem cells were isolated from the bone marrow using Ficol density gradient centrifugation, and then purified using adhesion method. The mesenchymal stem cells were cultured into the seventh generations with the normal cultural condition, and the morphological features of the 3rd, 5th and 7th generations of mesenchymal stem cells were observed. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide chromatometry was used to detect the growth feature of the 3rd, 5th and 7th generations of mesenchymal stem cells, and the growth curve was drawn. Real-time PCR was used to detect the expression of CXCR4, CXCR6, CXCL12, CD44 in the 3rd, 5th and 7th generations of mesenchymal stem cells, 2-△△Ct was calculated to get the relative value of each target gene, and the differences in expression of CXCR4, CXCR6, CXCL12, CD44 between different generations were compared.
RESULTS AND CONCLUSION:Mononuclear cells could be obtained from the bone marrow by using Ficol density gradient centrifugation. High-purity mesenchymal stem cells could be obtained using adherent method. The ability of in vitro growing was strong, but fol owing the passage, the cellmorphology became wider and shorter. And the proliferation rate, the overal proliferated multiple and the expression of homing related factors decreased fol owing the passage. The expression of CXCR4, CXCR6, CXCL12 and CD44 of mesenchymal stem cells decreased fol owing the passage. The homing ability of mesenchymal stem cells was decreased fol owing the passage, and may be relevant with the lower expression of CXCR4, CXCR6, CXCL12 and CD44 in cultured mesenchymal stem cells.

OBJECTIVETo analyze effects of fracture of processus styloideus ulnae on prognosis in the treatment of distal radial fracture of type C according to AO classification.

METHODSThis was a retrospective case-control study, and the information was got ten through case evaluation and follow-up, including sex, age, patient satisfaction, Gartland & Werley score and radiographic score. There were 76 patient treated with open reduction and plate fixation in People's Hospital Affiliated to Peking University from July 2006 to July 2011. All the patients were divided into two groups: no combination with fracture of processus styloideus ulnae (group A, 56 cases), combination with fracture of processus styloideus ulnae (group B, 20 cases). The patients in group A and B were treated with open reduction and internal fixation; however the fracture of processus styloideus ulnae was not fixed. The indexes such as clinical data, bone grafting, joint movement, Gartland & Werley score and radiographic score were compared between two groups.

RESULTSThe ulnaris pain of patients in group B was more obvious than that in group A. The local VAS, palmar and dorsal flexion degree of wrist joint, motion VAS, patients satisfaction score, radial and ulnar deviation degree, pronation and supination of forearm degree, Gartland & Werley score and radiographic score were separately 0.1 ± 0.1, (51.1 ± 1.9)°, (60.2 ± 1.9)°, 0.6 ± 0.1 (23.1 ± 0.9)°, (28.7 ± 1.3)° (81.5 ± 2.6)°, (68.2 ± 2.7)° 1.9 ± 0.3, 89.6 ± 12.3 in group A; and separately 0.3 ± 0.3, (51.4 ± 2.3)°, (66.6 ± 1.7)°, 0.5 ± 0.2, (24.5 ± 2.0)°, (26.9 ± 1.8)°, (80.3 ± 2.5)°, (70.3 ± 3.7)°, 1.2 ± 0.4, 92.5 ± 7.5 in group B; there were no statistical differences in above indexes between two groups.

CONCLUSIONWhether the distal radial fracture with a concomitant unrepaired ulnar styloid fracture or not exerts no influence on mainly outcomes including function, radiography and motion of the wrist.

Bone Plates ; Case-Control Studies ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Prognosis ; Radius Fractures ; surgery ; Retrospective Studies ; Ulna Fractures ; surgery

Objective To investigate the feasibility of pancreatic DWI at a 3T MR imager and its value for the qualitative diagnosis of pancreatic tumors. Methods For 20 normal healthy volunteers and 47 patients with pancreatic tumors [21 pancreatic carcinoma (PC), 7 mass-forming chronic pancreatitis (MFCP)and 19 cystic lesions), routine pancreatic MRI and pancreatic DWI using b values (500 and 1000 mm2/s)were obtained, the DWI signal intensity (SI) and apparent diffusion coefficient (ADC) value of pancreatic lesions and adjacent tissue was measured. Results In the b = 500 and 1000 mm2/s DWI images, there was no significant difference in ADC value between different parts of normal pancreas. But PC and MFCP were shown as hyperintensity mass, in addition, the related SI1000 of PC at b = 1000 mm2/s DWI was significantly higher than that of MFCP (1.238 +0.448 vs. 0.371 +0.293, P＜0. 01). Compared with normal pancreas,beth PC and MFCP presented as decreased ADC500 and ADC1000 value. The ADC1000 of PC was significantly lower than that of MFCP [ ( 1. 087 + 0. 175 ) mm2/s vs. ( 1. 279 ± 0.213 ) mm2/s]. Pancreatic cystic lesions were shown as hyperintensity in DWI at b = 500 mm2/s, but were depicted as iso-intense signal or low-signal lesions in DWI using b = 1000 mm2/s. Both ADC500 and ADC1000 of pancreatic cystic lesions were higher than that of normal pancreas. Conclusions 3T-MR DWI is helpful to differentiate pancreatic lesions. High b value DWI is more valuable for the qualitative diagnosis of pancreatic mass.

Objective To study the value of the diameters of fetal umbilical artery and umbilical vein in early prenatal screening program for thalassemia by ultrasound.Methods A total of 120 cases of singleton pregnant with thalassemia at 12- 28 gestational weeks were detected by ultrasound,328 cases of normal singleton pregnant at 12 - 28 gestational weeks were selected as controls.The diameters of fetal umbilical artery and umbilical vein were tested and compared between the two groups.The diagnostic values were evaluated by ROC curve.Results At 12 - 15+6 gestational weeks,the diameters of umbilical artery and umbilical vein of thalassemia group were larger than those of control group(P ＜0.05).At 16 - 19+6 gestational weeks, the diameter of umbilical vein of thalassemia group was larger than that of control group,the differences were significant (P ＜0.05).The cutoff threshold of the diameter of fetal umbilical artery was 1.80 mm,the diameter of fetal umbilical vein was 2.95 mm at 12 - 15+6 gestational weeks,the diameter of fetal umbilical vein was 3.80 mm at 16- 19+6 gestational weeks,which were obtained by ROC analysis.The sensitivity of this cutoff threshold to identify thalassemia were 83.3％, 83.3％, 47.8％,respectively, while the specificity were 90.5 ％, 95.2 ％, 85.4％, respectively.Conclusions The diameters of fetal umbilical artery and umbilical vein detected by ultrasound have great value on early prenatal screening of thalassemia, these indexes can be used as an important factors in early prenatal screening of thalassemia.