Objective:This study aims to evaluate the effect of an elevated preoperative neutrophil to lymphocyte ratio (NLR) on outcome after comprehensive staging laparotomy or optimal tumor debulking surgery for epithelial ovarian cancer (EOC) and determine the value of the NLR as an independent prognostic prediction marker. Methods:A total of 80 women with primary EOC and with complete clinical and pathological information documented at the time of surgery were selected for this study. The optimum cut-off value of the preoperative NLR was identified through receiver operator characteristic (ROC) curve, and the patients were then classified into two groups: low and high NLR group. Univariate and multivariate analyses were performed to assess the prognostic effect of the preoperative NLR patients who underwent comprehensive staging laparotomy or optimal tumor debulking surgery. The levels of expression of CD68 were measured through immunohistochemistry. Results:The optimal cut-off value of the NLR was 3.8. The preoperative NLR differed significantly in the FIGO stage between the low NLR group (NLR ≤3.8) and the high NLR group (NLR>3.8), but no discrimination was observed in other parameters. The mean follow-up time was 45 months, and the post-operative 1-and 3-year survival rates were 93.7%and 60.0%, respectively. The preoperative NLR>3.8 and stageⅢ/Ⅳwere all risk factors for poor overall and disease-free survival. Multivariate analysis revealed the patients with high NLR (P<0.05) and stage Ⅲ/Ⅳ (P<0.05) had prognostic significance for poor overall survival. The number of CD68-positive tumor-associated macrophages was significantly higher in the high NLR group than in the low NLR group (54.65 ± 8.78 and 41.78 ± 9.10, respectively; P<0.001). Conclusion: An elevated blood preoperative NLR indicates poor prognosis in patients with EOC. Preoperative NLR may function as an important independent prognostic factor for patients with EOC.

Objectives To determine the significance of serum total bile acid (TBA) in the diagnosis and treatment of infantile hepatitis syndrome. Methods Serum TBA and other liver function related items were determined with automatic enzymatic assay techniques in 67 with infantile hepatitis syndrome patients (age 26 days～7 months) and 100 normal infants (age 20 days～1 year). Results In the control group, the serum TAB level was 0～11.3 ?mol/L. TBA level was abnormal in 89.5% patients and the values were 0.5～226.0 ?mol/L ?s =(79 5?54.3) ?mol/L]. The difference was significant between the two groups. The TBA levels were well related to those of ALP, DBIL and ? GT and TBA was better than others in sensitivity and specificity. . The difference was significant between the two groups. The TBA levels were well related to those of ALP, DBIL and ? GT and TBA was better than others in sensitivity and specificity. Conclusion Serum TBA level is important in evaluating the diagnosis, treatment, and prognosis of infantile hepatitis syndrome.

Objective To explore the effect of ginseng combined with transplantation of bone marrow mesenchymal stem cells(BMSCs)on functional recovery of rats with spinal cord injury(SCI). Methods Forty-eight female Wistar rats were randomly assigned to following four groups(n=12 per group):the sham operation group was treated by opening the vertebral lamina and exposing spinal cord without SCI;the SCI model group was reproduced by using improved Allen bump method and afterwards no treatment was given;methyl prednisolone(MP)group was treated by MP pulse treatment after SCI,including intravenous injection of MP 30 mg/kg immediately after SCI and 4 hours later the same injection was repeated,and then the same intravenous injection 2 times daily,3 days in total;The ginseng+BMSCs group was treated by orally taking ginseng ultra-microgranules 300 mg/kg after SCI,twice a day for 20 days and BMSCs 5μL(concentration 1×107 cell/μL)transplantation was carried out in SCI region on the 7th day after SCI. In the above 4 groups,the ethological observation(BBB scores)was done regularly and on the 30th day after operation,silver staining was applied to investigate the changes of spinal cord,and neuro-electrophysiological tests including somatosensory evoked potential(SEP)and motor evoked potential(MEP)were performed. Results In sham operation group,after surgery the movement of both hind limbs became temporarily sluggish and on the 7th day their functions recovered to approximately normal. In SCI model group,after injury paralysis of both hind limbs occurred,while in the MP group and ginseng+BMSCs group,different degrees of functional recovery of the injured limbs developed,and the recovery in ginseng + BMSCs group was more significant. Compared with sham operation group,after surgery the BBB score was reduced markedly at various time points in SCI model group;compared to the SCI model group,the BBB scores in MP and ginseng+BMSCs groups were increased significantly,especially more remarkable in ginseng+BMSCs group(all P<0.05),and beginning from the 12th day after operation,the difference became obvious (5.23±1.22 vs. 3.61±1.03, P<0.05). Histological detection showed that in sham operation group,the structure of spinal cord was complete,neurons distributed evenly in the gray matter and a large number of silver staining positive nerve fibers paralleled to each other and arranged regularly;in SCI model group,fragmented construction was present and the defects of gray and white matters were prominent. Compared with the SCI model group, the extents of tissue necrosis in MP and ginseng + BMSCs groups were ameliorated. The neuro-electrophysiological tests demonstrated that in SCI model group,the loss of normal wave form occurred. Compared with SCI model group,in MP and ginseng+BMSCs groups,after treatment latent periods(ms)were shortened prominently in different degrees of SEP and MEP,and their peak-to-peak values(mV)were increased obviously;the improvement in potential in ginseng+BMSCs group was greater than that in MP group〔SEP:latent period(ms):3.31±0.36 vs. 4.66±0.33, peak-to-peak value(mV):0.10±0.01 vs. 0.05±0.01,MEP:latent period(ms):3.40±0.13 vs. 4.24±0.31, peak-to-peak value(mV):41.12±0.56 vs. 16.46±2.83,all P<0.05〕. Conclusion A combined treatment of ginseng and BMSCs transplantation can effectively promote the recovery of neural function for rats with SCI.

Objective To investigate the clinical application value of Quadrant system combined with percutaneous pedicle screw fixation for treatment of lumbar degenerative disease.Methods The clinical data of 40 patients who sufferred from lumbar degenerative disease,were randomly divided into two groups:Quadrant system combined with percutaneous pedicle screw fixation to do discectomy and intervertebral bone graft fusion as invasive group (n =20),traditional posterior lumbar interbody fusion as conventional group (n =20).The operation time,length of incision,blood loss,postoperative drainage,JOA score of preoperation and postoperation,and effect (reforming Macnab standard) between two groups were recorded and compared.Results Operations were all well done in two groups.The operation time in invasive group was longer than that in traditional group [(147.3 ± 8.9) min,(136.7 ± 10.2) min,t =3.5,P ＜ 0.05].The length of incision [(3.65 ± 0.68) cm,(1 1.11 ± 1.29) cm,t =22.88,P ＜ 0.05)],blood loss [(205.00 ± 63.04) mL,(270.50 ± 77.58) mL,t =2.93,P ＜ 0.05],postoperative drainage [(90.3 ± 10.8) mL,(180.6 ± 1 3.9) mL,t =22.96,P ＜ 0.05] and days in hospital [(16.9 ± 2.0) days,(18.9 ± 2.1)days,t =3.05,P ＜ 0.05] in invasive group were all less.than those in traditional group (P ＜ 0.05).All cases had been followed up for 6-18 months,average of 13 months.There were no significant differences in excellent and good rate (reforming Macnab standard) between two groups in the last following up (P ＞ 0.05).There were no significant differences of JOA scores in preoperation [(12.0 ± 1.7) points,(11.0 ± 1.5) points,P ＞ 0.05],postoperative half a year [(22.0 ± 2.3) points,(21.0 ± 2.5) points,P ＞ 0.05],and postoperative one year [(23.0 ± 1.9) points,(22.0 ± 2.0) points,P ＞ 0.05].Conclusion Quadrant system combined withpercutaneous pedicle screw fixation is a safe,effective and minimally invasive surgical technique in treating lumbar degenerative disease.Compared with conventional group,invasive group has advantages such as less injury,less blood loss,simple operation,and good curative effect,which should be popularized.

Objective To investigate the changes in skin microcirculatory perfusion during induction of general anesthesia and the effects oftwo fluid therapy regimens in patients undergoing abdominal surgery.Methods Thirty-six ASA Ⅰ or Ⅱ patients aged 18-64 yr scheduled for elective major abdominal surgery were randomized to receive either 6% hydroxyetlayl starch(130/0.4)7 ml/kg(HES group,n=18)or lactated Ringer's solution 7 ml/kg(RL group,n=18)for compensatory intravascular volultne expansion(CVE)before tracheal intubation.Meanwhile both groups received continuous intravenous infusion of RL at a of 8 ml·kg~(-1)·h~(-1).Tracheal intubation was performed at 40 min after the onset of infusion.Anesthesia was maintained with with sevoflurane,remifentanil and rocuronium.Operation was started at 20 min after tracheal intubation.The microcirculatory perfusion was measured on forehead skin by using Doppler perfusion imaging system(LDPI)PI)at the onset of fluid infusion(T_0,baseline),the end of endotracheal intubation(T_1)and the onset of skin incision(T_2).Rwsults The MAP,HR,blood gases and body temperature were within the normal during the experiment and there was no significant difference between the 2 groups.The skin microcirculatory perfusion and CVP at T_1 were significantly higher in group HES than in group RL(P<0.05 or 0.01).Compared with the baseline value at T_0,the skin microcirculatory perfusion at T_1 was significantly increased in group HES(P<0.01),but there was no significant change in the skin microcirculatory perfusion at T_1 in group RL(P>0.05),the skin microcirculatory perfusion at T_2 was singificantly decreased in both groups(P<0.01),and CVP and PaO_2/FiO_2 at T_(1.2) were significantly increased,while Hb at T_(1.2) was significantly decreased in both groups(P<0.05).The skin microcirculatory perfusion in both groups was significantly lower at T_2 than at T_1(P<0.01).Conclusion The infusion of 6% HES 130/0.4 can improve the skin microcirculatory perfusion and the effect is better than that of RL during induction of general anesthesia in patients seheduled for abdominal surgery.

Objective To determine the median effective doae (ED50) for motor block after intrathecal ropivacaine and bupivacaine. Methods Sixty ASA Ⅰ or Ⅱ patients, aged 18-64, weighing 46-75 kg, undergoing elective urological surgery under combined spinal-epidural anesthesia, were randomized into 2 groups ( n = 30each) receiving intrathecal 0.5% ropivacaine and 0.5% bupivacaine respectively. The ED50 was determined by up-down sequential allocation. The initial dose was 4 mg. Each time the dose increased/decreased by 1 mg. Efficacy was determined by the occurrence of any motor block in either lower extremity (modified Bromage scale > 0)within 5 or 10 min after the spinal injection. Results The intrathecal ED50 for motor block was 6.68 mg for ropivacaine (95% confidence interval 6.27-7.13 mg) and 4.07 mg for bupivacaine (95% confidence interval 3.56-4.47mg) . The relative motor blocking potency ratio was ropivacaine/bupivacaine 0.61. Conclusion The potency of intrathecal ropivacaine is lower than that of bupivacaine for motor block.

Objective To investigate the effects of minimal-flow sevoflurane anesthesia combined with a new CO2 adsorbent Amsorb Plus calcium lime on the hepatic and renal functions in patients.Methods Seventytow ASA Ⅰ or Ⅱ patients,aged 20-60 yr,scheduled for gastrointestinal surgery under general anesthesia,were randomized into 2 groups (n =36 each):middle-flow anesthesia group (group G1 ) and minimal-flow anesthesia group (group G2 ).Amsorb Plus calcium lime was added into the CO2 absorption canister and the core temperature of the calcium lime was continuously monitored and recorded.The patients were tracheal intubated after anesthesia induction and mechanically ventilated.The initial sevoflurane concentration was set at 4％ and the fresh gas flow of oxygen was set at 4 L/min.After the end-tidal concentration of sevoflurane reached 2.6％,the fresh gas flow of oxygen was adjusted to 2 L/min in group G1 or 0.5 L/min in group G2.The end-tidal concentration of sevoflurane was maintained at 2.4％-2.8％ during operation.Venous blood samples were taken 24 h before and 24 h after operation for determination of the serum concentrations of total bilirubin (TBIL),direct bilirubin (DBIL),blood urea nitrogen (BUN) and creatinire (Cr) and activities of alanine aminotransferase (ALT) and aspartate aminotransferase (AST).Urine samples were obtained at 24 h before and after operation to detect the concentration of glucose and protein.The urine glucose and protein positive patients were recorded.Results There was no significant difference in the core temperature of calcium lime at different time points between the two groups ( P ＞ 0.05 ).Compared with that at 24 h before operation,AST activity,TBIL and DBIL concentrations were significantly increased,BUN concentration was significantly decreased,but no significant change was found in the Cr concentration and the number of urine glucose and protein positive patients at 24 h after operation in group G1,and DBIL concentration was significantly increased,while BUN concentration was significantly decreased at 24 h after operation in group G2 ( P ＜ 0.05 ).There was no significant difference in the parameters of hepatic and renal functions between the two groups ( P ＞ 0.05).Conclusion The combination of minimal-flow sevoflurane anesthesia and Amsorb Plus calcium lime exerts no effect on the hepatic and renal functions,the effect is similar to that of middle-flow anesthesia,and it can be safely used in patients.

Objective To evaluate the effect of RNA interference in p53 gene on the expressions of genes involved in ultraviolet B (UVB)-induced premature senescence and photocarcinogenesis in human skin fibroblasts (HSFs).Methods A previously established HSF cell clone with repressed expression of p53,which was named as HSF-p53,was cultured and irradiated with a subcytotoxic dose (10 mJ/cm2) of UVB once a day for five consecutive days.The HSFs with normal expression of p53 served as the control.Subsequently,β-galactosidase (SA-β-gal)-staining was performed to estimate the degree of senescence,quantitative real-time PCR array was performed to determine the mRNA expressions of photocarcinogenesis-and senescence-associated genes,including p53,p21,p19,p16,pRb,fibronectin,osteonectin,smooth muscle 22 (SM22),bax,bcl-2,hypoxia-inducible factor-1 α (HIF-1α),vascular endothelial growth factor(VEGF),and human double minute-2 (hdm2).Statistical analysis was carried out by Student's t test using the software SPSS 10.0.Results The percentage of SA-β-gal-positive cells in irradiated HSF-p53 was 19.70％ ± 0.85％,significantly higher than that in unirradiated HSF-p53 (12.77％ ± 0.81％,t =6.45,P ＜ 0.05),but lower than that in irradiated control HSFs (50.48％ ± 5.30％,t =7.86,P ＜ 0.05),and similar to that in unirradiated control HSFs (18.50％ ± 0.45％,t =2.57,P ＞ 0.05).Compared with the control HSFs,the HSF-p53 showed decreased expressions of p21,p19,fibronectin,osteonectin,SM22 and bax genes (all P ＜ 0.05),but increased expressions of bcl-2,HIF-1α,VEGF and hdm2 genes (all P ＜ 0.05),and a similar expression of p16 gene (P ＞ 0.05); the repeated UVB radiation significantly promoted the expressions of p16 and pRb genes (both P ＜ 0.05),but had no obvious effect on the expressions of the other genes in HSF-p53 compared with unirradiated HSF-p53 (all P ＞ 0.05).Conclusions The inhibition of p53 expression may decelerate the UVB-induced premature senescence in HSFs,which may be involved in the p53-dependent tumor suppression.

Objective: This research explores the relationship between the immuno-suppression function of regulatory T cells (Treg) in the ascites of ovarian cancer (OC) patients, the clinico-pathologic features of these patients, and the correlation of the function of Treg with initial treatment and relapse status of the patients to further investigate the specific mechanism of immuno-regulatory func-tion of CD4+ CD25+ Treg in the ascites of OC. Methods: Immuno-magnetic activated cell sorting (MACS) was conducted to sort CD4+CD25+Treg and autologous CD4+CD25-Treg from the ascites of 28 OC patients. Carboxyfluorescein-diacetate succinimidyl ester (CFSE) was used to label the autologous CD4+CD25-Treg. These labeled cells were then used as controls and co-cultured with autologous CD4+CD25+Treg at the ratio of 1∶1 or 1∶2. The mean inhibition ratio of Treg in specimens to the proliferation of autolo-gous CD4+ CD25-Treg was calculated after the flow cytometry of the CFSE expression and Modfit software analysis of the CD4+CD25-Treg proliferation index (PI) were performed. Anti-IL-10 and/or anti-TGF-β1 antibodies were neutralized to investigate whether the CD4+CD25+Treg-mediated immuno-suppression escaped through the ascites can produce a marked effect by the inhibitory cyto-kine IL-10 or TGF-β1. Results: The mean inhibition ratio of CD4+ CD25- Treg in the ascites of stage Ⅲ to Ⅳ OC patients was (75.72±17.04)%, which is significantly higher than that of stageⅠtoⅡOC patients (59.61±16.97)%;P<0.05. In addition, Treg in the as-cites of OC patients with recurrent disease showed a significantly higher inhibition ratio than that of patients with primary disease;P<0.001. Moreover, Treg in groups added into neutralizing anti-IL-10 and/or anti-TGF-β1 antibodies displayed significantly lower depres-sant effect than the control group;P<0.05. Conclusion:The immuno-suppression of CD4+CD25+Treg in the ascites of OC patients is correlated with the tumor staging and status of the primary or recurrent diseases. Moreover, Treg may indicate a suppressor function by secreting cytokine IL-10 and TGF-β1.

Objective To investigate the expression of suppressor of cytokine signaling-3 (SOCS-3) gene in placenta,its role in the pathogenesis of pre-eclampsia and its effect on proliferation and migration of HTR-8/SVneo cells.Methods Fifteen women with severe pre-eclampsia hospitalized in the First Affiliated Hospital of Nanjing Medical University from October 2010 to March 2011 and t 5 normal pregnant women during the same time period were investigated.Cultured HTR-8/SVneo cells were transfected with SOCS-3 specific small interfering RNA (siRNA) or negative siRNA as the controls.The expression of SOCS-3 mRNA and protein in placenta and these cells was detected by real-time quantitative reverse transcription-polymerase chain reaction and Western blot.Cell proliferation was detected by methyl thiazolyl tetrazolium,cell cycle by flow cytometry and migration by the Transwell test.Two independent t tests were used for statistical analysis.Results The SOCS-3 mRNA and protein levels in the severe pre-eclampsia group were lower than those in the normal group (0.25±0.03 vs 0.71±0.08 and 0.21±0.05 vs 0.75±0.12,t=15.94 and 14.29,respectively,both P＜0.05).SOCS-3 mRNA and protein levels in the transfection group at 24 hours were lower than those in the negative control group (0.39±0.02 vs 1.00±0.04 and 0.003 7±0.001 4 vs 1.514 9±0.035 7,t=27.58 and 73.35,respectively,both P＜0.05).The integral absorbance values of cell proliferation in the transfection group at 48,72 and 96 hours after transfection were 0.23 ± 0.01,0.32±0.02 and 0.37± 0.02,respectively,which were lower than those in the negative control group (0.39± 0.02,0.55 ± 0.04 and 0.86± 0.04,t=2.60,6.64 and 42.44,respectively,all P＜0.05).The cell clonal formation was lower in the transfection group compared with the negative group (116± 15 vs 312±24,t=9.96,P＜0.05).The ratios of G1/G0 and S phase cells in the transfection group were (55.75±2.21) ％ and (31.59±0.83) ％,respectively,and were significantly different from those in the negative control group [(47.88± 1.87) ％ and (37.38± 1.34) ％,t=45.43 and 20.06,respectively,P＜0.05].After 48 hours,cell migration in the transfection group was lower than that in the negative control group (93 ± 11 vs 167± 17,t=21.36,P＜O.05).Conclusion SOCS-3 expression is probably involved in the pathogenesis of pre-eclampsia by being down-regulated and therefore impeding proliferation and migration of the trophoblast.