Objective To investigate the association of gene polymorphism of cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) with ulcerative colitis (UC) in Chinese patients. Methods The A+49G transition polymorphism at position 49 (exon 1) and C-318T transition polymorphism at position -318 in promoter of the CTLA-4 gene were determined by polymerase chain reaction with sequence specific primers (PCR-SSP) method in 82 Chinese patients with UC and 204 healthy controls of Han nationality. Results No significant differences in the distribution of genotype and allele frequencies were observed between CTLA-4 C-318T and A+49G gene polymorphisms in UC patients and normal controls. How- ever , comparing with healthy subjects,the frequency of haplotype 2,3 (C -318 -G 49 /T -318 -A 49 ) in UC patients was significantly reduced (26% vs 41%, P

AIM: To investigate the effect and mechanism of 5-aminosalicylic acid (5-ASA) in topical treatment on trinitrobenzene sulfonic acid (TNBS)-induced colitis in rats. METHODS: Colitis was induced by intracolonic administration of TNBS and was treated with 5-ASA at the dose of 100 mg?kg -1 for 2 weeks. Normal control group was administrated with normal saline and TNBS control group was treated with TNBS, not with 5-ASA. Macroscopic damage, histological changes and myeloperoxidase (MPO) activity were evaluated. Superoxide dismutase (SOD) activity and malondialdehyde (MDA) level in colonic mucosa were detected by kits. The expression of interleukin-1? (IL-1?) and tumor necrosis factor-? (TNF-?) mRNAs in colonic mucosa was determined by a reverse transcription and polymerase chain reaction method. RESULTS: Compared with TNBS control group, the macroscopic and histological changes and MPO activity in 5-ASA treated groups were improved. SOD activity was increased and the level of MDA in colonic mucosa was reduced significantly. The expression of IL-1? and TNF-? mRNAs in colonic mucosa was also decreased significantly. CONCLUSION: 5-ASA enema can significantly ameliorate TNBS-induced colitis in rats via antioxidant mechanism and attenuation of proinflammatory cytokine expression.

OBJECTIVETo explore the clinical efficacy of the arthroscopic Mender II stapler for the treatment of patients with meniscus anterior horn injury needing meniscal suture repair.

METHODSAmong 47 patients with meniscus anterior horn injury, 29 patients were male and 18 patients were female, ranging in age from 12 to 31 years old, with a mean age of (20.53± 4.12) years old. The duration of disease ranged from 3 to 35 days, and the average duration was (12.43±5.74) days. The Mender II stapler was used to carry out arthroscopic suture from outside to inside. The Lysholm knee scoring system was used to evaluate and analyze preoperative and postoperative symptoms, such as pain, limping embolism and so on.

RESULTSForty-six patients were followed up, and the duration ranged from 12 to 48 months, with a mean of (20.53±4.12) years. The incision healed at the first stage without important vessels and nerves injuries. The symptoms of the locked knee joint disappeared, and symptoms such as pain, limp, swelling and limitation of activity improved. The Lysholm score increased from preoperative 52.33±7.31 to postoperative 86.74±6.92.

CONCLUSIONUsing Mender II stapler to treat patients with meniscus anterior horn injury who were treated with arthroscopic suture from outside to inside is effective to improve symptoms, and to obtain good short-term results.

Adolescent ; Adult ; Arthroscopy ; methods ; Child ; Female ; Humans ; Male ; Menisci, Tibial ; surgery ; Suture Techniques ; Tibial Meniscus Injuries

In the present study, a risperidone loaded microsphere/sucrose acetate isobutyrate (SAIB) in situ forming complex depot was designed to reduce the burst release of SAIB in situ forming depot and to continuously release risperidone for a long-term period without lagime. The model drug risperidone (Ris) was first encapsulated into microspheres and then the Ris-microspheres were embedded into SAIB depot to reduce the amount of dissolved drug in the depot. The effects of different types of microsphere matrix, including chitosan and poly(lactide-coglycolide) (PLGA), matrix/Ris ratios in microspheres and morphology of microspheres on the drug release behavior of complex depot were investigated. In comparison with the Ris-loaded SAIB depot (Ris-SAIB), the complex depot containing chitosan microspheres (in which chitosan/Ris = 1 : 1, w/w) (Ris-Cm-SAIB) decreased the burst release from 12.16% to 5.80%. However, increased drug release rate after 4 days was observed in Ris-Cm-SAIB, which was caused by the high penetration of the medium to Ris-Cm-SAIB due to the hydrophilie of chitosan. By encapsulation of risperidone in PLGA microspheres, most drugs can be prevented from dissolving in the depot and meanwhile the hydrophobic PLGA can reduce the media penetration effect on the depot. The complex depot containing PLGA microspheres (in which PLGA/ drug=4 : 2, w/w) (Ris-Pm-SAIB) showed a significant effectiveness on reducing the burst release both in vitro and in vivo whereby only 0.64% drug was released on the first day in vitro and a low AUC0-4d value [(105.2± 24.4) ng.mL-1.d] was detected over the first 4 days in vivo. In addition, drug release from Ris-Pm-SAIB can be modified by varying the morphology of microspheres. The porous PLGA microspheres could be prepared by adding medium chain triglyceride (MCT) in the organic phase which served as pore agents during the preparation of PLGA microspheres. The complex depot containing porous PLGA microspheres (which were prepared by co-encapsulation of 20% MCT) (Ris-PPm-SAIB) exhibited a slightly increased AUC0-4d of (194.6±15.8) ng.mL-1d and high plasma concentration levels from 4 to 78 days [Cs(4-78d)=(7.8±1.2) ng.mL-1]. The plasma concentration on 78 day C78d was (9.0 2.5) ng.mL-1 which was higher than that of Ris-Pm-SAIB [C78d= (1.6 ± 0.6) ng.mL-1]. In comparison with Ris-Pm-SAIB, the AUC4-78d of Ris-PPm-SAIB increased from (379.0±114.3) ng.mL-1.d to (465.0 ±149.2) ng.mL-1.d, indicating sufficient drug release from the Ris-PPm-SAIB. These results demonstrate that the risperidone loaded porous PLGA microsphere/SAIB in situ forming complex depot could not only efficiently reduce the burst release of SAIB depot both in vitro and in vivo, but also release the drug sufficiently in vivo, and be capable to continuously release the drug for 78 days.
Chitosan ; Drug Carriers ; Lactic Acid ; Microspheres ; Polyglycolic Acid ; Risperidone ; chemistry ; Sucrose ; analogs & derivatives ; Technology, Pharmaceutical

OBJECTIVETo compare the efficacy and complication of tissue selecting therapy stapler (TST) and procedure for prolapse and hemorrhoids (PPH) in the treatment of severe hemorrhoids.

METHODSClinical data of 542 cases of severe hemorrhoids undergoing TST (258 cases) or PPH (284 cases) in The First Affiliated Hospital of Fujian Medical University from November 2010 to January 2012 were analyzed retrospectively. Operative parameters, efficacy and complication 3 months after operation were assessed and compared.

RESULTSNo significant difference in cure rate between TST and PPH (96.5% vs. 95.4%) was found, while the operation time and hospital stay after operation in TST group were significantly shorter urgency [(20.6±4.7) vs. (26.4±6.3) min, (2.9±0.5) vs. (3.5±0.7) d, both P<0.05]. Incidences of postoperative pain, bleeding, anal urgency and urinary retention in TST group were significantly lower than those in PPH group (all P<0.01). No anal stenosis was observed in TST group, and 5 cases developed anal stenosis in PPH group (P<0.05). Hemorrhoid recurrence did not differ significantly between the two groups.

CONCLUSIONSThe efficacy of TST and PPH is comparable for severe hemorrhoids patients, while TST is associated with faster postoperative recovery and less complications.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Hemorrhoids ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Surgical Stapling ; methods ; Treatment Outcome ; Young Adult

OBJECTIVE:To study the purification technology of 4 active components from Tripterygium wilfordii by macropo-rous resin. METHODS:The purification abilities of nine macroporous resins(ADS-5,ADS-8,HPD100,HPD300,HPD400, HPD450,HPD700,HPD722 and HPD750) were studied with the adsorption and desorption rates of triptolide,wilforlide,trip-tonide and tripterine as the index by static adsorption and desorption experiments for 4 active components from T. wilfordii,so as to screen optimal macroporous resins. Using transfer rate of active component as index,single factor test was used to investigate the effects of different sampling method,ratio of mixing sample to total resin quantity,ratio of resin to medicinal material,cleaning so-lution(type,amount and cleaning flow rate),diameter- height ratio of resins,eluant(volume,flow rate)on adsorption,so as to determine the optimal elution technology;validation test was also conducted. RESULTS:HPD722 macroporous resin was chosen as adsorption resin;ratio of diameter to height was 1∶10,resin-medicinal material ratio was 1∶2,and ratio of mixing sample to to-tal resin quantity was 1∶10;wet column installing and mixing resin for sample loading were adopted. The macroporous resin was washed with 12 BV 20%ethanol at the rate of 12 BV/h,and then eluted with 12 BV 95%ethanol at the rate of 6 BV/h. The verifi-cation test results showed that the total transfer rate of 4 active components from T. wilfordii was more than 90%(RSD=0.99%, n=3). CONCLUSIONS:The optimized technology is stable and feasible,and suitable for the purification of 4 active components from T. wilfordii.

Objective To explore the relationship between gene MTDH expression and its role in promo-ting gastric carcinoma metastasis .Methods We collected clinical specimens and cultured gastric carcinoma cell lines.By Western blotting and Real -time PCR methods,protein and mRNA levels in tissues and MTDH relation-ship with EMT were detected .Results There was 86%of patients who expressed MTDH positively and 13%of normal gastric mucosa was positive expression .The results showed that the expressive level of MTDH gene in gas-tric carcinoma was higher than in the normal tissues .The expression of MTDH was correlated with TNM stage、mi-crovascular invasion、recurrence and metastasis .The expressive level of MTDH was correlated with two epithelial mesenchymal transition markers ( E-cadherin and N-cadherin ) .Conclusion MTDH may promote gastric car-cinoma metastasis through the induction of EMT process and may be a candidate biomarker for therapeutic target .

Objective To investigate the value of the bedside index for severity in acute pancreatitis (BISAP),Ranson's,APACHE Ⅱ and computed tomography severity index (CTSI) scoring system in evaluating the severity of acute pancreatitis.Methods The clinical data of 385 patients with acute pancreatitis who were admitted to the Zhongnan Hospital of Wuhan University from 2005 to 2011 were retrospectively analyzed.The values of 4 scoring systems including BISAP,Ranson's,APACHE Ⅱ and CTSI in predicting the incidences of severe acute pancreatitis,local complications and death were investigated by Chi-square test and receiver operating characteristic curv e.Odds ratio (OR) was calculated.The differences of areas under the curves (AUC) were analyzed using the Z test.Results The incidences of severe acute pancreatitis,local complications and mortality of patients with BISAP score ≥ 3 were 64.4％ (56/87),16.1％ (14/87) and 8.0％ (7/87),which were significantly higher than 13.4％ (40/298),6.4％ (19/298) and 0.3 ％ (1/298) of patients with BISAP score ≤ 2 (x2 =93.4,8.1,19.7,P ＜ 0.05).The incidences of severe acute pancreatitis,local complications and mortality of patients with Ranson's score≥3 were 52.7％ (48/91),22.0％ (20/91) and 7.7％ (7/91),which were significantly higher than 16.3％ (48/294),4.4％ (13/294) and 0.3％ (1/294) of patients with Ranson's score ≤2 (x2 =49.2,27.3,18.5,P ＜0.05).The incidences of severe acute pancreatitis,local complications and mortality of patients with APACHE Ⅱ score ≥ 8 were 46.6％ (27/58),20.7％ (12/58) and 8.6％ (5/58),which were significantly higher than 21.1％ (69/327),6.4％ (21/327) and 0.9％ (3/327) of patients with APACHE Ⅱ score≤7 (x2 =17.0,12.8,14.4,P ＜0.05).The incidences of severe acute pancreatitis,local complications and mortality of patients with CTSI score ≥4 were 51.4％ (19/37),51.4％ (19/37),16.2％ (6/37),which were significantly higher than 22.2％ (77/347),4.0％ (14/347),0.6％ (2/347) of patients with CTSI score≤3 (x2 =15.1,95.3,40.1,P ＜ 0.05).The sensitivity,specificity,positive and negative predictive values of BISAP were 58％,89％,64％,86％,respectively,and the AUC was 0.848,which were significantly higher than the other 3 systems (Z =2.02,4.22,4.78,P ＜ 0.05).The sensitivity,specificity,positive and negative predictive values of CTSI were 58％,95％,51％ and 96％,respectively,and the AUC was 0.926,which was significantly higher than the other 3 systems (Z =3.99,3.24,4.06,P ＜ 0.05).The sensitivity,specificity,positive and negative predictive values of BISAP were 88％,79％,8％ and 100％,respectively,and the AUC was 0.855,with no significant difference compared with the other 3 systems (Z =0.81,0.03,0.14,P ＞ 0.05).Conclusions The accurate rate of BISAP in predicting the severe acute pancreatitis is higher than Ranson's,APACHE Ⅱ and CTSI.The accurate rate of CTSI in predicting the incidence of local complications is higher than the other 3 systems.There is no significant difference of the 4 systems in predicting the mortality.The BISAP scoring system is helpful in early diagnosis of severe acute pancreatitis,and making the individualized treatment plan,thus improving the prognosis of patients.

Objective To construct the murine allogeneic acute GVHD model.Methods C57BL/6 (H-2b) mice were used as the donors and Balb/c (H-2d) mice as the recipients in allogeneic bone marrow transplantation (BMT).Groups were set as total body radiation (TBI) control group (n =4),GVHD group (n =10),simple BM transplantation group (n =10) and normal control group (n =4).For TBI control group,mice were subjected to TBI but did not receive BMT after radiation.For GVHD group,5 days before TBI,gentamycin (320 mg/L) and erythromycin (250 mg/L) were added into the drinking water,and on the day of transplantation,mice received one total dose of 8.0 Gy 60Coγ TBI,and within 5 h,2 × 106 C57BL/6 BM cells and 1 × 107 C57BL/6 spleen cells were transfused per mouse via the tail vein.For simple BMT group,the pretreatment was the same as GVHD group,and mice received only 2 × 106 C57BL/6 BM cells per mouse via the tail vein.The mental status,activity,posture,fur,weight,and stool were observed after transplantation.Survival time of each mouse was recorded,survival rate was calculated,and survival curve was drawn.Pathological examination was done for the liver,skin,small intestine and BM on the brink of death.Results The median survival time (MST) in TBI control group,GVHD group and BMT group was (9.0 ± 0.7),(32.0 ± 3.2) and ( 17.5 ± 1.6) days respectively,and there was significant difference between every two groups (P ＜ 0.01 ).Pathological examination in TBI control group showedhematopoiesis exhaustion.GVHD group showed acute GVHD symptoms 10-13 days after allo-BMT,and the pathological changes of the skin,liver and small intestine corresponded to those of Ⅰ to Ⅱ degree of GVHD.Simple BMT group also showed acute GVHD symptoms 10-13 days after alloBMT,but their GVHD manifestation and histological changes were less serious and only 0 to Ⅰ degree of GVHD could be seen.ConclusionStable acute GVHD model can be constructed by transfusion of allogeneic BM cells and spleen cells into Balb/c mice after lethal TBI.

OBJECTIVETo summarize the experiences and advantages of laparoendoscopic single-site (LESS) surgery for neonatal intestinal atresia and stenosis.

METHODSTwenty patients of neonatal intestinal atresia and stenosis were treated with LESS procedure in Huai'an Women and Children's Hospital of Jiangsu Province between October 2010 and April 2012. The clinical data were retrospectively analyzed.

RESULTSAmong these patients, 13 were male, 7 were female. Age at admission ranged from 10 min to 1 d. Four cases were premature, and 3 were born with low birth weight (<2500 g). One was diagnosed with duodenal atresia, 1 with duodenal stenosis, 9 with jejunal atresia, 2 with jejunal stenosis, and 7 with ileal atresia. Laparoscopic exploration was performed in all the cases by transumbilical procedure, the proximal and distal ends were exteriorized from the umbilical port site for anastomosis. Twenty neonates with intestinal atresia and stenosis were performed using this new minimally invasive approach, with no cases converted to open operation or standard laparoscopy. The operative time was 35-60 (mean, 40) min. The intraoperative bleeding was 3-5 ml. Two cases were given up treatment by their parents on the second postoperative day. For the other 18 patients, oral intake started on postoperative day 5-10 (mean, 7), and discharged from hospital on the postoperative day 10-20 (mean, 13). The follow up ranged from 1 to 11 months, during which 1 case died, 3 cases were managed with conservative treatment for diarrhea or malnutrition. The other 14 cases grew up healthily.

CONCLUSIONThe technique of LESS in the treatment of neonatal atresia and stenosis is simple and the outcomes are satisfactory.

Constriction, Pathologic ; surgery ; Female ; Humans ; Infant, Newborn ; Intestinal Atresia ; surgery ; Laparoscopy ; methods ; Male ; Retrospective Studies