Objective To investigate the timing for delivery in twin pregnancies to improve the perinatal outcome. Methods A multicentered and retrospective study was conducted on 655 women with twin pregnancies in 6 hospitals of Shanghai from Jan 1993 to Oct 2003. The average birthweight(BW) for both twins in different gestation, the incidence of small for gestational age (SGA) and severe neonatal asphyxia were analyzed. Results For the smaller babies in all twins, the 50 percentile of the birth weight was far behind the singletons throughout the pregnancy. But for the larger babies, it was similar to the singletons if delivered before 33 weeks, lighter than the singletons if after 33 weeks and remarkable difference was shown beyond 39 weeks. The largest BW of the larger babies was 3073 g presented at 39 weeks, while 2670 g for the smaller babies at 40 weeks after which the average BW was decreased. It reached 2555 g and 2303 g at 41 weeks for the larger and smaller babies, respectively (P

Objective:To study the role of rennin and angiotension Ⅱ in the developement of acute pancreatitis in rats.Methods:Forth-two Sprague-Dawley rats were divided into two groups randomly-control group,and acute pancreatitis group.Acute pancreatitis model was reproduced by closed duodenal loop technique.Plasma amylase.Plasma renin activity and angiotesion Ⅱ level were measured,pancreatic histopathology was examined with light microscopy. Results:In acute pancreatitis group,pancreatitis histopathology developed from edematous to bleeding and necrotizing pancreatitis,plasma amylase,plasma renin activity,and angiotesion Ⅱ level were increased as acute pancreatitis developed,but after 10h,the angiotesion Ⅱ level was increased sequentially and plasma renin activity was increased unsignificantly.Conclusion:Renin and angiotension Ⅱ played the important role in the developement of experimental acute pancreatitis.

BACKGROUND:Studies on high glucose exposure in human periodontal ligament cel s usual y focus on the biological behaviors, pathways and secretory factors, but whether the metabolic memory is involved is little known. OBJECTIVE:To investigate the metabolic memory of high glucose exposure in human periodontal ligament cel s. METHODS:Human periodontal ligament cel s were primarily cultured and identified. Cel s at 5-8 passages were selected and randomized into four groups. Group A (controls):DMEM containing 5.5 mmol/L glucose for 8 days;group B (5-day memory group):DMEM containing 35 mmol/L glucose for 3 days and DMEM containing 5.5 mmol/L glucose for 5 days;group C (3-day memory group):DMEM containing 35 mmol/L glucose for 5 days and DMEM containing 5.5 mmol/L glucose for 3 days;group D (8-day high glucose group):DMEM containing 35 mmol/L glucose for 8 days. The cel proliferation was detected by cel counting kit-8, the cel apoptosis was determined by flow cytometry, and the levels of total proteins and alkaline phosphatase were investigated using ELISA. RESULTS AND CONCLUSION:Compared with the control group, the cel proliferation in the other three groups was significantly reduced (P<0.05), the number of apoptotic cel s was significantly increased, while the levels of total proteins and alkaline phosphatase were significantly decreased (P<0.05). These results suggest that high glucose causes persistent changes in human periodontal ligament cel s by inhibiting cel viability, increasing the apoptosis and downregulating the levels of the total proteins and alkaline phosphatase

Objective To detect the expression and potential correlation of ERK1 and P16 in gastrointestinal stromal tumor group and in control group.Methods Tissue chip and immunohistochemistry Elivison were used to detect the expression of ERK1 and P16 in 40 cases of gastrointestinal stromal tumor and 40 cases of control tissues.Quantitative analysis of mean absorbent density of the expression of ERK1 and P16 was conducted with image analytic software.Results The expressions of ERK was higher in GIST group than that in control group(P

This study examined whether exposure to nitrate in drinking water is associated with increased risk for bladder cancer by conducting a comprehensive literature research. A meta-analysis was performed with and without adjustment for confounding factors. Three groups (reference, intermediate and high groups) were established in terms of different nitrate concentrations in each included study. Separate relative risk measures were calculated for intermediate and high groups. Heterogeneity was assessed by using the Q statistics. Publication bias was evaluated by Egger's and Begg's test. Quality assessment for studies was performed by using the Newcastle-Ottawa scale. Two cohorts, two case-controls, and one ecological study were included in this study. The adjusted data showed that the combined risk ratios (RRs) were 1.13 (95% CI: 0.81 to 1.57) and 1.27 (95% CI: 0.75 to 2.15) for intermediate and high groups respectively. For unadjusted data, the corresponding RRs were 1.18 (95% CI: 0.89 to 1.57) and 1.29 (95% CI: 0.81 to 2.07). Sensitivity test indicated that results were significantly underestimated when Ward's study was included. No significant publication bias was found. There was heterogeneity among studies. The results suggested that there was no sufficient evidence that nitrate in drinking water is associated with increased risks for bladder cancer.

Objective To explore the safety and feasibility of controlled hypotension with urapidil and nitroglycerin esmolol-three drugs combination in endoscopic surgery. Methods Forty patients who were received endoscopic surgeries were randomly divided into two groups, 20 cases in each group, urapidil-esmolol-nitroglycerin controlled hypotension group (A group) and non controlled hypotension group (B group). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded at the following points: before anesthesia (basal, T1), immediate before surgery (T2), 30 minutes after the start of surgery (T3), end of the operation (T4), 10 minutes after the end of surgery (T5). We recorded blood loss, operative time, transfusion volume, urine. At last the parameters were compared between the two groups. Results The difference of SBP, DBP, MAP at the points of T2, T3, T4 in the two groups was statistically significant (P < 0.05) comparing with the control group (group B). The vital signs of patients during anesthesia in A group had more stable than that of the B group , and the operation time of the A group was significantly shorter than that of the B group. Meanwhile, the blood loss in A group was significantly decreased(P < 0.05). Conclusion It has synergistic antihypertensive effect, and can reduce both side effects and the risk of anesthesia and surgery for us to use urapidil-esmolol-nitroglycerin three antihypertensive drugs in combination. It is a safe and reliable method for clinical application.

Objective To investigate the influence of electroacupuncture(EA) in different points combined with spinal anesthesia on acute stress response and mechanisms related with expression of spinal c-fos protein. Methods Fifty adult male Sprague-Dawley rats were randomly divided into 5 groups:groupⅠwere normal rats receiving only 50μL saline intrathecal IT injection;groupⅡwere docked rats receiving IT with 50 μL saline;groupⅢ were docked rats receiving IT injection of 50 μL, 2.5 μg fentanyl; group Ⅳwere docked rats receiving IT injection of fentanyl 50μL and EA at′zu-san-li′;groupⅤwere docked rats receiving EA at′er xue′and IT fentanyl. Serum corticosterone (CORT) and adrenocorticotropic hormone (ACTH) levels were measured by ELISA. Determined the c-fos protein expression levels of L4-6 spinal by western blotting. Result GroupⅡACTH, CORT levels and c-fos expression was significantly higher than those in groupⅠ(P<0.01). Compared with groupⅡ, groupⅢ,ⅣandⅤhad higher ACTH and CORT levels (P<0.05). However, c-fos expression in the spinal cord between groupⅡandⅢshowed no difference (P>0.05). Between groupⅢandⅣ, no differences in serum hormone levels (P > 0.05) were detected. In group Ⅴ the c-fos expression was lower than that of the Ⅳ group (P < 0.01). Conclusion Body acupuncture and auricular electrical stimulation combined with intrathecal anesthesia were effective to reduce pain in rats with acute stress reactions. Under intrathecal anesthesia, auricular stimulation played a better role of non-nerve block region, and the mechanism may be due to the release of neurotransmitters induced c-fos protein in spinal cord.

BACKGROUND:Recent studies have demonstrated that Niacinamide is capable of promoting the proliferation of intervertebral cells and improving intervertebral disc degeneration.Overloading is thought to the main cause of intervertebral disc degeneration.However,the protective effects of Niacinamide in loading induced intervertebral disc degeneration remains uncertain,OBJECTIVE:To investigate the protective effects of Niacinamide against axial loading induced degeneration of rabbit lumbar disc.DESIGN,TIME AND SETTING:A randomized controlled experiment was carded out in the Central Laboratory and the Laboratory of Department of Orthopaedics,Union Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology from November 2008 to April 2009.MATERIALS:Twenty-four Japanese white rabbits (4 months old,weighing 2.0 kg).Niacinamide was supplied by Tianjin Damao Chemical Reagent Factory.METHODS:Twenty-four Japanese white rabbits were randomly divided into 6 groups.The controllable axial loading induced rabbit lumbar disc degeneration model was adopted to impose 98N pressure on the rabbit discs to induce degeneration.Various doses of Niacinamide were given intragastrically to the rabbits in different groups:2 rabbits in group 1,the loading device was installed without pressing,and no Niacinamide was given;2 rabbits in group 2,given 50 mg/kg Niacinamide for 1 week;5 rabbits in group 3,loaded with 98N for 1 week;5 rabbits in group 4,loaded with 98N for 1 week,then the pressure was released for another week's recovery;5 rabbits in group 5,loaded with 98N and given 50 mg/kg Niacinamide for 1 week;5 rabbits in group 6,loaded with 98N for 1 week and then the pressure was released for another week's recovery,50 mg/kg Niacinamide was continually given during the 2 weeks.MAIN OUTCOME MEASURES:Magnetic resonance image and Thompson's grading system were used to assess degeneration degree of the discs;hematoxylin and eosin staining,immunohistochemical staining for type Ⅱ collagen,and Safranin O staining were used to evaluate histological changes;immunohistochemical staining for P161NK4A was used to evaluate cell proliferation and senescence.RESULTS：①According to the Thompson's grading system，there was no disc exhibited degeneration in group 2；5 rabbits graded Ⅱ in group 3；4 rabbits graded Ⅱ and 1 rabbit graded Ⅲ in group 4；2 rabbits graded Ⅰ and 3 rabbits graded Ⅱ in group 5；3 rabbits graded Ⅰ and 2 rabbits graded Ⅱ in group 6.MRI results revealed the alleviated degeneration in Niacinamide given groups.②The content of type Ⅱ collagen of annulus fibrosus of group 6 was 53.2% higher than that of group 4 (P＜0.01).③Safranin O-Fast Green staining density of group 2 was higher than that of group 1；The staining density of nucleus pulposus and annulus fibrosus of groups 5 and 6 was higher than the corresponding parts of group 4，especially that of nucleus pulposus (P＜0.01，P＜0.01)，and group 6 exhibited slightly increased levels than group 5.④P16INK4A positive staining rates decreased with the extension of Niacinamide administration time.CONCLUSION：Niacinamide can help to alleviate overloading-caused damage to intervertebral disc，and can benefit the recovery of damaged intervertebral disc.

BACKGROUND: Studies have reported that Niacinamide is capable of promoting the proliferation of intervertebral cell and protecting intervertebral disc (IVD) against interleukin-1 β-induced degeneration. However,the mechanism of Niacinamide underlying protecting IVD degeneration remains uncertain. OBJECTIVE: To investigate the regulatory effect of Niacinamide on interleukin-1 β-induced cell apoptosis and energy metabolism related gene in IVD in vitro. DESIGN, TIME AND SETTING: Experiments were performed in the Central Laboratory of Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from November 2007 to May 2008. MATERIALS: Fifty-six IVDs from L16 lumbar spine often Japanese white rabbits,aged 3-4 months and weighing 1.5-2.0 kg,were harvested and cultured in alginate gel for further experiments. METHODS: IVD cultured models were randomly divided into 4 groups: normal control group (with the absence of drags), Niacinamide group (administrating 0.5 g/L Niacinamide), degeneration group (administrating 10 μg/L interlenkin-1β),treatment group (administrating 10 μg/L interleukin-1β and 0.5 g/L Niacinamide).After 2 weeks of culture,TUNEL staining and immunohistochcmical staining for FAS,Bcl-2, Caspase-3, hypoxia induced factor 1a, glucose transporter-1 and vascular endothelial cell growth factor were used to detect alternated cell apoptosis and expression of energy metabolism related genes. MAIN OUTCOME MEASURES: The positive cell rates of TUNEL staining and immunohistochemical staining in each group. RESULTS: The rate of TUNEL positive-staining cells of degeneration group was higher than normal control group (P=0.001). The rate of FAS positive-staining cells of degeneration group was obviously higher than normal control group (P＜0.01). The rate of Bcl-2 positive-staining cells of Niacinamide group was higher than normal control group (P=0.004). The rate of Caspase-3 positive-staining cells of treatment group was lower than degeneration group significantly (P=0,024).The rate of hypoxia induced factor- 1α positive-staining cells of Niacinamide group was lower than normal control group (P＜0.01),and the rate of degeneration group was higher than normal control group (P＜0.01 ). The rate of glucose transporter-1 positive-staining cells of treatment group was higher than normal control group(P＜0.01). CONCLUSION: Niacinamide can inhibit interleukin-1β-induced IVD cell apoptosis and alleviates interleukin-1β induced disturbance of energy metabolism.

Objective There is a lack objective methods for the diagnosis of postoperative cognitive dysfunction (POCD).This study aimed to investigate the influence of propofol or etomidate anes-thesia on the postoperative cognitive function and serum S 100βprotein level in infants . Methods This study included 100 hernia infants aged 1-3 years treated by laparoscopic herniorrhaphy under propofol (n=50) or etomidate anesthesia (n=50).At 1 day before and 3 days after surgery, we assessed the cognitive function of the patients using Bayley Scales of Infant and Toddler Development ( BSID-Ⅲ) and further divided each group into a POCD and a non-POCD sub-group based on the results of diagnosis made according to the Z-scores.Using ELISA, we measured the levels of the serum S100βpro-tein in the iliac venous blood drawn preoperatively ( T0 ) and before PACU ( T1 ) and compared them between the POCD and non-POCD groups. Results At 3 days after operation, POCD was observed in 10 cases (20.0%) in the propofol group and 9 cases (18.0%) in the etomidate group, with no statistically significant differences between the two (P>0.05).The level of the serum S100βprotein was markedly elevated in both the propofol and etomidate groups at T 1 as compared with that at T0(P<0.05), and so was it in the POCD in comparison with that in the non-POCD group (P<0.05), with no statistically significant differences between the two groups at T1(P>0.05).A significant correlation was found between the postoperative S 100βlevel and POCD at 3 days after surgery in both the propofol (r=0.842, P=0.001) and the etomidate group (r=0.821, P=0.001). Conclusion Propofol and etomidate anes-thesia can induce different degrees of postoperative decline of cognitive function in 1-3 years old infants .The post-anesthesia elevation of the serum S100βprotein level is positively correlated with early postoperative POCD and indicates various degrees of brain damage .