Objective Dickkopf-1 (DKK-1) is an antagonist of the Wnt signaling pathway of bone formation and it is the target gene of TNF.When DKK-1 is inhibited,osteoprotegerin (OPG) would increase,OPG can antagonize bone erosion caused by receptor activator of NF-κB ligand (RANKL).Detection the levelsof serum DKK-1,OPG,RANKL and TNF-α of patients with AS before and after applying TNF-α antagonist,the effects of anti-TNF-α treatment on signaling pathway of bone formation was explored.Methods Medical records and serum samples of 43 AS patients receiving TNF-α receptor-Ⅱ IgG Fc fusion protein for 12 weeks were collected and the levels of serum DKK-1,OPG,RANKL and TNF-α were detected by enzyme-linked immunosorbent assay.Paired t-test and Person's correlation analysis were used for data analysis.Results Disease activity indexes in AS patients with anti-TNF-α treatment,including VAS score,time of morning stiffness,BASDAI,BASFI,ESR and CRP,which were [(2.7±2.0) cm,(7±4) min,1.1±1.1,0.8±1.2,(10±9) mm/1 h and (16±26) mg/L] respectively,were reduced when compared with those before treatment,[(7.6±1.9) cm,(46±33) min,6.0±1.3,4.4±2.0,(39±29) mm/1 h and (76±43) mg/L] respectively,and the differences were statistically significant (P＜0.05).Serum levels of DKK-1,(3.3±1.5) μg/L vs (3.2±1.3) μg/L,OPG,(144±71) pg/ml vs (136±62) pg/ml,and RANKL,(71±37) pg/ml vs (68±30) pg/ml,were not changed (t=14.043,8.031,20.166,13.521,7.679,9.563,all P＞0.05).The levels of TNF-α increased from (1.9±1.3) pg/ml to (55.0±50.6) pg/ml (t=6.951,P＜0.05).There were no relations between DKK-1 and TNF-α,RANKUOPG,patient VAS,duration of morning stiffness,BASDAI,BASFI,ESR and CRP,allP＞0.05.Conclusion Clinical indicators are improved significantly by anti-TNF-α therapy; however,it should not be withdrawal suddenly.There is no relationship between serum levels of DKK-1 and level of inflammation in AS patients.

ObjectiveTo investigate the status medicine taking in rural schizophrenic patients.MethodsThe families of 217 schizophrenic patients in a town of Shaoxing rural area were investigated with self-made questionnaire.Results and Conclusion125 cases routinely took medicine(57.6%). The main reason caused patients to resist taking medicine was absence of family or family's care. The medicine were obtained from hospital, drugstore, free drugs from mental preventing organization, mail-order, half or more of them were free. Only 53.46% of the objects would like to receive free drugs. The most of the others want to give up. The objects suggested mental preventing organization to provide more kinds and costly free drugs, simplify procedures of obtaining drugs, permit to receive more drugs at a time and be more kindly.

AIM:Cytochrome P450 epoxygenase 2J2 and epoxyeicosatrienoic acids ( EETs) are known to protect against cardiac hypertrophy and heart failure, which involve activation of 5′-AMP-activated protein kinase ( AMPK) and Akt.Although the functional roles of AMPK and Akt are well established , the significance of crosstalk between them in the development of cardiac hypertrophy and anti -hy-pertrophy of CYP2J2 and EETs remains unclear .Here, we investigated whether CYP 2J2 and its metabolites EETs protected against cardiac hypertrophy by activating AMPKα2 and Akt1.Moreover, we tested whether EETs enhanced crosstalk between AMPKα2 and phosphorylated Akt1 ( p-Akt1), and stimulated the nuclear translocation of p-Akt1, to exert their anti-hypertrophic effects. METHODS:The recombinant rAAV9 vector was coupled to CYP2J2 and the rAAV9-CYP2J2 construct was injected into the caudal vein of AMPKα2-/-and littermate control mice .AMPKα2 -/-and littermate control mice that overexpressed CYP 2J2 in heart were treated with angiotensin II (Ang II) for 2 weeks.Hemodynamic and cardiac functions were also evaluated after 14 days of infusion with Ang II or saline.RESULTS:Interestingly, the overexpression of CYP2J2 suppressed cardiac hypertrophy , including decreased heart size, cross sectional area of cardiomyocytes , markers of cardiac hypertrophy [ brain natriuretic peptide ( BNP) ,β-myosin heavy chain (β-MHC) and skeletal muscle α-actin (ACTA1)] and increased levels of atrial natriuretic peptide (ANP) in the heart tissue and plasma of wild-type mice but not AMPKα2 -/-mice.Measurement of left ventricular ejection fraction and fractional shortening showed that CYP2J2 overexpression prevented Ang II-induced ventricular systolic dysfunction in mice .Moreover, an Ang II-induced reduction in cardiac function, demonstrated by decreased dp/dtmax and dp/dtmin, was prevented by overexpression of CYP2J2.Mechanistically, the CYP2J2 metabolites 11,12-EET activated AMPKα2 to induce the nuclear translocation of p-Akt1, which increased production of ANP and thereby inhibited the development of cardiac hypertrophy .Furthermore , by co-immunoprecipitation analysis , we found that full-length Akt1 and an Akt1 fragment containing amino acids 150-408, which constitute the protein kinase domain , but not other frag-ments of Akt1, bind to the AMPKγ1 subunit.AMPKα2β2γ1 and p-Akt1 interact through the direct binding of the AMPKγ1 subunit to the Akt1 protein kinase domain.This interaction was enhanced by 11,12-EET.CONCLUSION:Our studies reveal a novel mechanism in which CYP2J2 and EETs enhanced Akt1 nuclear translocation through interaction with AMPKα2β2γ1 and protect against cardiac hy-pertrophy and suggest that overexpression of CYP 2J2 might have clinical potential to suppress cardiac hypertrophy and heart failure .

0.05).Conclusions Neither the new nor old SIRS diagnostic criteria had a high conforning rate with neonatal critical illnesses;There was no significant difference between them in each clinical item.It shows that the new SIRS diagnostic criteria is not superior to the old one,therefore we should improve the neonatal SIRS diagnostic criteria in the future.

Background Fibrin glue has been utilized to adhere the graft during the pterygium excision with conjunctival autografts.Several relevant clinical randomized controlled trial(RCT) and retrospective studies have been published abroad,but the samples for its effectiveness and safety issue of fibrin glue and suture are still underinvestigation.Objective Current study was to quantificationally assess the efficacy and safety of fibrin glue versus sutures in the application of pterygium excision with conjunctival autografts.Methods Based on established search strategy,a computerized literature search was conducted to identify all citations concerning the RCT for effectiveness and safety evaluation of fibrin glue and suture for the graft fixation during the pterygium excision with conjunctival autografts from MEDLINE ( from 2000 to October,2010 ),EMbase ( from 2000 to October,2010 ),Cochrane Central Register of Controlled Trials ( Issue 4,2010 ),CBMdisc ( 2000 to October 2010 ),CNKI ( 2000 to October 2010 ),and the relevant conference proceedings and references searched by hand was performed as supplement.The included literature was scored with Jadad table.The Cochrane Collaboration' s RevMan 5.0 software was used for the test of heterogeneity or test for overall effect.The effective indexes,such as operative duration,recurrence rate and complication,were evaluated by Meta analysis.Results Six RCTs involving 401 eyes of 377 participants were identified.These literatures were published with English in 2004-2010 from China,New Zealand,Sweden,Israel,Turkey and Malasia and the Jadad scores were 4-5.The quantitatively analysis revealed that fibrin glue appeared to short the operative time compared with suturing method (MD =14.23 ;95％ CI:- 16.18- 12.29;P=0.00) and drop the rate of recurrence ( RR =0.49,95％ CI:0.26 -0.95 ; P =0.03 ).No significant differences were found in the rate of postoperative graft dehiscence or absence (RR =3.41,95 ％ CI:0.85-13.68;P =0.08 ).Conclusions Fibrin glue shows the good effectiveness and easy application during the pterygium excision with conjunctival autografts.Long-term follow-up of multi-central RCTs with a larger number of cases are still needed to support this conclusion.

Objective This study has explored the role of antibody against annexin A2 in patients with antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE). Methods Using purified recombinant annexin A2, IgG anti-annexin A2 antibody was measured by ELISA in 101 APS patients, 41 SLE patients with thrombosis, 124 SLE patients without thrombosis and 120 healthy controls. Results The positive rate of IgG anti-annexin A2 antibody in APS patients and SLE patients with thrombosis was 21.8%, 26.8%, respectively, they were all significantly higher than in SLE patients without thrombosis (6.5%). IgG anti-annexin A2 antibody was associated with thrombosis and/or pregnancy morbidity (P<0.01). Conclusion Anti-annexin A2 antibody is associated with thrombosis and/or pregnancy mnrbidity. It suggests that anti-annexin A2 antibody may be helpful in identifying in some potential AIRS.

BACKGROUND:Absorbable bio-glass injection composed by bio-glass and calcium phosphate bone cement can be tightly combined with bone tissue by a strong chemical bond to improve the stability of the bone-implant interface.
OBJECTIVE:To investigate the effect of absorbable bio-glass injection to support the vertebral body of osteoporosis mice and its mechanism of osteogenic induction.
METHODS:Osteoporosis models were prepared in 30 female Sprague-Dawley rats undergoing bilateral ovariectomy. After modeling, model rats were randomly divided into three groups, and given polymethylmethacrylate, injectable calcium phosphate bone cement and absorbable bio-glass injection into L3-5 vertebral bone defects, respectively. L3-5 segments were removed at 12 weeks after implantation to detect the biomechanical and degradation properties, levels of calcium and phosphate, alkaline phosphatase activity, bone mineral density, levels of bone morphogenetic protein 2 and transforming growth factor β, as wel as histological observation.
RESULTS AND CONCLUSION: In the absorbable bio-glass injection group, the degradation properties, compressive strength, surface hydroxyapatite deposition amount and bone mineral density were significantly higher than those in the other two groups(P< 0.05); trabecular bone relative volume, thickness and number were significant higher than those in the other two groups (P < 0.05); serum levels of calcium, alkaline phosphatase, bone morphogenetic protein 2 and transforming growth factor β were significantly higher than those in the other two groups(P < 0.05); but the level of serum phosphate was lower than that in the other two groups(P < 0.05). These results show that the absorbable bio-glass injection can enhance the support for the osteoporotic vertebral body and induce osteogenesis, probably by increasing bone morphogenetic protein 2 and transforming growth factor β levels.

Objective To analyze and evaluate neoadjuvant chemotherapy's value and significance in combining with surgical treatment for limited small cell lung cancer(LD-SCLC).Methods A total of 94 LD-SCLC patients underwent complete resections combined with chemotherapy between January 2000 and January 2011 in Shanghai Pulmonary Hospital.Among these cases,initial two cycles of neoadjuvant chemotherapies were performed for all pathologically confirmed patients (Group A),and initial operations followed by adjuvant chemotherapy were administered to patients without pathology (Group B).The survival rate was analyzed by log-rank test and Kaplan-Meier method.Multivariate analysis of the prognostic factors was performed using Cox's regression model.Results Group A included 43 cases and Group B included 51 cases.The mean age was (56.37 ± 10.18) years.According to the 6th edition of Tumor,Node,Metastasis(TNM) classification of lung cancer,54 cases were at stage Ⅰ or Ⅱ,40 cases were at stage Ⅲ.Overall 5-year survival(5-YS) was 27％.The 5-YS for patients with stage Ⅰ-Ⅱ was notably better than that of stage Ⅲ (34％ vs 20％,P =0.033).For patients with stage Ⅲ,the 5-YS of Group A was significantly better than that of Group B(34％ vs 12％,P =0.020),besides median overall survival for Group A and Group B were 46 and 15 months(P =0.009).Furthermore,the results of multivariate analysis showed that neoadjuvant chemotherapy,surgery and histopathology of SCLC were independent factors that strongly affected survival and prognosis.Conclusion In combined surgical treatment for LD-SCLC,neoadjuvant chemotherapy obviously improved the prognosis of patients with stage Ⅲ.Therefore,it was very important and necessary that pre-surgical neoadjuvant chemotherapy was administered to resectable stage Ⅲ LD-SCLC patients.

Objective To investigate the clinical significance of neutrophil gelatinase-associated lipocalin (NGAL),monocyte chemoattractant protein-1 (MCP-1) and tumor necrosis factor-like apoptosis weak inducer (TWEAK) level in body fluids of lupus nephritis (LN) patients..Methods Levels of NGAL,MCP-1 and TWEAK in the serum and urine of 51 patients with SLE,including 27 LN cases and 24 non-LN cases,were detected by enzyme-linked immunosorbent assay; and the clinical data were collected.Student's t test,Mann-Whitney U test,Pearson's correlations and Spearman's rank correlations were used for statistical analysis.Results (①) The level of serum NGAL in the LN group (122±70) ng/ml was higher than that in the non-LN group (56 ± 34) ng/ml (P＜0.01).There was a positive correlation (r=0.408,0.431,0.339,0.403 and 0.585,P＜0.05) between the serum NGAL and general SLEDAI score,extra-renal SLEDAI score,renal SLEDAI score,the levels of 24-hour urine protein and serum creatinine.There was a negative correlation (r=-0.396,P＜0.01) between the serum NGAL and serum C3 level.There was a positive correlation (r=0.719,P＜0.01) between urinary NGAL levels and chronic index (CI).② The level of serum MCP-1 in the LN group (284 ± 113) pg/ml was higher than that in the non-LN group (173± 69) pg/ml,(P＜0.01).The level of urinary MCP-1 in the LN group (M=1154,P75 41 178,P25 341) pg/mg creatinine was higher than that in the non-LN group (M=456,P75 714,P~ 114) pg/mg creatinine (P＜0.01).There was a positive correlation (r=0.340,0.416,0.385,0.574 and 0.654,P＜0.05) between the serum MCP-1 level and the overall SLEDAI score,extra-renal SLEDAI score,renal SLEDAI score,24-hour urinary protein excretion level and serum creatinine levels.There was a negative correlation (r=-0.458,P＜0.01) between the serum MCP-1 level and serum C3 levels.There was a positive correlation (rs=0.448,0.429,0.459,0.412,0.375 and 0.419,P＜0.05) between urinary MCP-1 level and total SLEDAI score,extra-renal SLEDAI score,renal SLEDAI score,serum ds-DNA antibodies,24-hour urinary protein excretion level and serum creatinine levels.There was a significant positive correlation (r=0.689,P＜0.01) between urinary MCP-1 levels and CI.(③) TWEAK was detected in the urine of 6 cases of LN.Conclusion The urinary NGAL and MCP-1 levels are elevated in patients with chronic damage,which suggestes chronic renal injury.It can be used to monitor the LN disease activity.The blood levels of NGAL and urine MCP-1 are significantly higher in LN.The clinical significance of TWEAK needs further study.

Objective To investigate the association of single nucleotide polymorphism (SNP) rs13333226 in uromodulin (UMOD) gene with diabetic kidney diseases (DKD) in Han population in Tianjin,China.Methods A total of 210 type 2 diabetes (T2DM),90 normal controls (NC) and 280 DKD patients were recruited.According to the level of estimated glomerular filtration rate (eGFR),the DKD subjects were further subdivided into three groups:GFR≥90 ml/min group (n=105),60 ml/mim≤GFR ＜ 90 ml/min group (n=84) and GFR ＜ 60 ml/min group (n=91).Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used for UMOD rs13333226C genotyping.Results The frequencies of AA,GA,GG genotype were 27.8％,58.9％,13.3％ in NC group and 41.0％,48.6％,10.5％ in T2DM group and 54.3％,36.1％,9.6％ in DKD group.The frequency of G allele was 42.8％ in NC group,34.8％ in T2DM group and 27.7％ in DKD group.The genotype distribution of UMOD was statistically significant between NC group and DKD group,and between T2DM group and DKD group (P ＜ 0.05).G allele of UMOD was an independent protective gene polymorphism of DKD in Logistic regression (B=-0.248,Wald=8.012,P=0.021,OR=0.780,95％ CI 0.612-0.968).Conclusion The G allele of UMOD gene may be an independent protective factor of DKD in Han population in Tianjin,China.