Objective·To investigate the role and mechanism of CaMKKβ in RAW264.7 macrophage M2 polarization induced by interleukin-4 (IL-4).Methods·IL-4 induced RAW264.7 polarization was measured by RT-PCR and ELISA.Western blotting was used to analyze the total and phosphorylated protein levels of CaMKKβ,AMPK,JAK2 and STAT3 during polarization.A lentiviral vector carrying an shRNA targeting the CaMKKβ gene was successfully constructed.The expression of M1 and M2 markers and the expression of phosphorylated AMPK,JAK2,STAT3 were detected by RT-PCR and Western blotting respectively.The protein activity ofAMPK,JAK2 and STAT3 were selectively blocked,and then the effect of IL-4 on macrophage polarization was detected by RT-PCR.Results·IL-4 significantly polarized RAW264.7 cells towards M2 macrophages (P＜0.05),and the phosphorylated protein expression of CaMKKβ,AMPK,JAK2,STAT3 was significantly increased (all P＜0.05).The expression of M2 markers induced by IL-4 was decreased and the phosphorylation ofAMPK,JAK2 and STAT3 was also decreased after knockdown of CaMKKβ by shRNA (all P＜0.05).The polarization of macrophages to M2 was decreased after the activities of AMPK,JAK2 and STAT3 proteins were blocked respectively (all P＜0.05).Conclusion·CaMKKβ promotes IL-4 induced M2 macrophage polarization via activation of AMPK/JAK2/STAT3 pathway.

Objective To investigate the treatment of complicated upper urinary tract calculi. Methods 138 cases of upper urinary tract calculi were treated by the combination of extracorporeal shork wave lithotripsy (ESWL),ureteroscopic lithotripsy and minimally invasive percutaneous nephrolithotomy were reviewed.There were 110 cases of complex ureteral stone and 28 cases of complex kidney stone among the group.All cases had variable degree of hydronephrosis.The treatment program for complex upper urinary tract calculi was initially,ESWL and followed by ureteroscopy and pneumatic lithotripsy in 24 hours.For the complex kidney stone and upper ureteral stone,which was difficult for ureteroscopy lithotripsy.The program was firstly percutuneous minimal pyelostomy,ESWL after 5～7 days,then urteroscopy lithotripsy and lithotomy through the fistula in 24 hours. Results Total stone-free rate was 97.1%(134/138),in ureteral stone group was 100%(110/110),in kidney stone group 85.7%(24/28).Satisfactory result has been observed in all cases. Conclusions The endoscopic manipulation become easy and fast by means of endoscopic manipulation in the treatment of complex upper urinary tract calculi.This technique is minimally invasive and has less complications,it increases the stone-free rate.

Objective To recognize the factors which influence the therapeutic efficacy of transurethral resection of the prostate (TURP) and to improve the qualities of TURP. Methods The data of 600 patients with benign prostatic hyperplasia (BPH) were retrospectively studied based on the mastering of TURP.The patients’age ranged from 52 to 92 years,with a mean of 64.8 years.Preoperatively,the volume of the prostate was 16.3～210.4 ml,with a mean of 46.2 ml,measured by color Doppler B-ultrasound.The average maximum urinary flow rate (Qmax) was 8.4 ml/s,and average urinary flow rate (Qave) was 4.3 ml/s.The average residual urinary volume (RU) was 75 ml,and the average IPSS was 23. Results TURP was successfully performed on all the 600 patients.The average resected prostate tissue weight was 31.8 g.The average electric ablation time was 51 minutes.Intraoperative blood transfusion was performed in 38 cases. Aura of transurethral resection syndrome (TURS) occurred in 4 cases,but no TURS occurred.Of the 600 cases,508 cases (85%) were followed up for 1～32 months.Postoperative average Qmax increased to 16.9 ml/s,Qave increased to 10.8 ml/s and RU decreased to 15 ml.Compared with those of preoperation,the differences were statistically significant (P

Objective To assess the correlation between the pregnancy‐associated plasma protein A (PAPP‐A)level with gesta‐tional diabetes mellitus(GDM )in primiparous women .Methods The nonparametric test and Logistic regression analysis were used to retrospectively analyze 168 pregnant women of GDM and 273 normal pregnant women ,including age ,body weight ,PAPP‐A ,freeβ‐human chorionic gonadotropin(fβ‐hCG) .Results The age had significant difference between GDM group and control group(P<0 .01) ,the PAPP‐A concentration and corrected multiple of the median (MoM )of PAPP‐A in the GDM group were significantly lower than those in the control group(P<0 .01) .Conclusion Low level of PAPP‐A during early pregnant stage in primiparas is strongly associated with GDM and can be used as the risk factor of GDM .

Objective To compare transurethral enucleation of plasma chamber(TUERP)plasma and tran-surethral resection of the prostate(PKRP) treatment efficacy,security and the impact on sexual function.Methods 80 cases of BPH patients were randomly divided into two groups,TUERP and PKRP.Follow-up for 12 months,compared two groups maximum urinary flow rate(Qmax),residual urine volume(PVR),serum prostate-specific antigen(PSA) level,prostate volume(PV),international prostate symptom score(IPSS),quality of life score(QOL),the bladder prostate prominent(IPP)and other indicators and erectile dysfunction and retrograde ejaculation changing circum-stances were compared.Results In the weight of prostate surgery there were significant differences,in which removal of the weight of TUERP group significantly higher than PKRP group.After 12 months,32 cases of TUERP patients and 31 patients of PKRP group completed follow-up.After 1,3,6,12 months,Qmax,PVR,IPSS,QOL improved than that before surgery.Two groups were compared after a month,and there were significant differences in prostate volume,which TU/ERP group was significantly smaller than PKRP group.After3 months in the prostate volume and residual U-rine volume there were significant differences,both TUERP group Was significantly smaller than PKRP group.After 6 months and 12 months in the prostate volume,residual urine volume and there were significant differences in PSA,both TUERP group was significantly smaller than PKRP group.ED,and retrograde ejaculation occured after the rate of two between the two groups was no significant difference.Conclusion Transurethral enueleation of plasma chamber on sexual function in patients,but through the appropriate personalized treatment,sexual function in some patients was recoverable.

Objective To investigate the correlation between FA value,ADC value and limb muscle strength score measured by magnetic resonance imaging in patients with ischemic stroke,aims to to analyze the clinical value of magnetic resonance imaging in limb muscle strength.Methods Twenty patients with acute cerebral infarction and treated from June 2015 to Junly 2016 were recruited from This hospital,and the simplified Fugl-Meyer motor function score was observed for all patients within 3 days.Tensor imaging examination was conducted to observe the distribution of nerve fiber bundles,FA value,ADC value changes.Results The FA value and ADC value of the infarct side were significantly different from those of the contralateral side(t=8.70,t=-18.70,P＜0.05);There were significant differences in FA value and ADC value between the infarcted ventricle hind limbs and the contralateral side of the infarcted ventricle(t=-5.16,t=-5.08,P＜0.05).The FA value of the infarcted ventral hind limbs had positive correlation with the simplified Fugl-Meyer motor function score(R=0.863,P=0.013).Conclusion FA value and ADC value of acute infarct and internal hindlimb are lower than FA value and ADC value of contralateral normal white matter.The FA value of internal capsule hind limbs is closely related to the simplified Fugl-Meyer motor function score.

Objective To investigate the therapeutic effects of cystitis glandularis by TUR. Methods The clinical data of 40 patients with cystitis glandularis who were treated with TUR, transurethal plasma kinetic resection or postoperative mitomycin instillation of bladder in our hospital from January 2003 to December 2006 were retrospectively analyzed. Results Vesical perforation occurred in 2 patients,and the complications of urinary incontinence and vesical neck constriction were not observed postoperatively. 37 patients were followed up for an average of 1.8years, 32 patients were cured ,3 patients turned better, 2 patients reoccurred, and no cancer was observed. Conclusion The transurethra resection combined with mitomycin irrigation of bladder has satisfactory therapeutic effects on cystitis glandularis,and there are fewer adverse reaction and can be taken as the primary choice for treating cystitis glandularis.

BACKGROUND:With the increasing of aging, the incidence and mortality of osteoporotic hip fracture wil rise. It is of great significance to study the pathogenesis and preventing method. At present, finite element analysis can be used to judge fracture, only for the distribution trend of fracture failure in the starting point or section view, but it cannot completely reflect actual situation of fracture. OBJECTIVE:To build the fracture model of the femoral neck fracture caused by fal ing-induced external force based on the finite element analysis LS-DYNA software, and to evaluate the effect of rupture. METHODS:CT image data of one case of elderly femoral neck fracture were col ected. Using Mimics software, region growth of the contralateral area, cavity fil ing, editing, rebuilding the contralateral proximal femur model were conducted. Data were imported in Hypermesh and LS-DYNA software for meshing, and defining material properties. The failure parameters and interfacial properties were set. The load and force boundary constraints simulating the fal ing were simulated. The model of femoral neck fracture was calculated. Rupture effect was evaluated. RESULTS AND CONCLUSION:(1) The validity of contralateral proximal femur three-dimensional model was verified. Based on the finite element analysis software LS-DYNA, the femoral neck fracture model matched the actual fracture line to a degree of close to 83%. (2) Above results confirmed that based on the finite element analysis, LS-DYNA software can wel simulate the femoral neck fracture, which provides experimental basis to the exploration of femoral neck fracture classification mechanism caused by different fal ing-induced external forces.

Objective To compare the effects of smoking and non smoking on postoperative pain of laparoscopic cholecystectomy. Methods Sixty patients having underwent selective laparoscopic cholecystectom were divided into smoking group and non smoking group by random digits table with 30 cases each. In smoking group, 14 cases quitted smoking within 1 week before operation. The Fagerstrom test of nicotine dependence (FTND) was evaluated before operation in smoking group, and FTND ≥ 6 scores was in 11 cases. The visual analog score (VAS), Bruggrmarm comfort score (BCS), sedation-agitation score (SAS), immediately, 15 min, and 30 min after entering postanesthesia care unit (PACU) and leaving PACU was evaluated. The operation time, anesthesia time, wake up time, extubation time, PACU time, using rate of remedial measures and untoward reaction were recorded. Results There were no statistical differences in operation time, anesthesia time, wake up time, extubation time, SAS and incidence of untoward reaction between 2 groups (P>0.05). The PACU time and using rate of remedial measures in smoking group were significantly higher than those in non smoking group:(39.7 ± 5.1) min vs. (31.3 ± 6.1) min and 30.0% (9/30) vs. 0, and there were statistical differences (P<0.05). The VAS immediately, 15 min and 30 min after entering PACU and leaving PACU in smoking group was significantly higher than that in non smoking group: (2.90 ± 0.85) scores vs. (1.00 ± 0.83) scores, (2.70 ± 0.47) scores vs. (0.73 ± 0.69) scores, (2.60 ± 0.56) scores vs. (1.13 ± 0.73) scores, (2.23 ± 0.57) scores vs. (1.13 ± 0.73) scores; and the BCS was significantly lower than that in non smoking group:(1.80 ± 0.61) scores vs. (2.90 ± 0.99) scores, (1.90 ± 0.31) scores vs. (2.87 ± 1.00) scores, (2.10 ± 0.31) scores vs. (2.47 ± 0.82) scores, (2.17 ± 0.38) scores vs. (2.47 ± 0.82) scores, and there were statistical differences (P<0.05). The VAS immediately after entering PACU in patients of FTND ≥ 6 scores was significantly higher than that in patients of FTND<6 scores:(3.6 ± 0.7) scores vs. (2.5 ± 0.7) scores, the BCS was significantly lower than that in patients of FTND <6 scores:(1.5 ± 0.5) scores vs. (2.0 ± 0.6) scores, and there were statistical differences (P<0.05). The VAS immediately after entering PACU in patients of non- quit smoking was significantly higher than that in patients of quit smoking: (3.4 ± 0.7) scores vs. (2.4 ± 0.6) scores, and there were statistical differences (P<0.05). Conclusions Smokers have more severe postoperative pain in laparoscopic cholecystectomy and higher postoperative opioid requirement than nonsmokers. Quit smoking before surgery will reduce postoperative pain and related complications. Appropriate increase of analgesic drugs can prevent postoperative pain in patients with smoking.

Objective To study the genotypes of OXA-51-like carbepenemases in Aeinetobacter beumannii and its association with drug resistance. Methods The susceptibility of 174 Acinetobacter baumannii against ceftazidime, cefotriaxon, amikacin and ciprofloxacin were detected with disc diffusion method. The minimum inhibitory concentration (MIC) values for meropenem and imipenem were determined with an agar dilution method. VIM, IMP, OXA-23, OXA-24, OXA-51 and OXA-58 β-lactamase genes were determined by PCR. DNA sequencing and genotyping were performed against OXA-51 positivestrains. Results All 174 isolates were negative by PCR for genes OXA-24, OXA-58, IMP and VIM. OXA-23 and OXA-51were amplified in 15.5% (27/174) and 72.4% (126/174) isolates, respectively. Therewere 15.5% (27/174) isolates producing OXA-51-like and OXA-23 carbapenemase simultaneously. Among126 OXA-51-like carbapenemase producing strains, 82.5% (104/126)were OXA-66 genotype, whereas theremaining 17.5% (22/126) strains belong to other genotype. Eight novel OXA-51-like Genotype were foundin this study. Conclusions OXA-66 were the primary genotype of OXA-51-like carbapenemases in A.baumannii. OXA-66 were related to low-level carbapenems resistance and may be associated with resistanceof other drugs. We found new OXA-51-like genotype in clinic isolates of A. baumannii in this study.