ObjectiveTo investigate the expression levels of the red blood cell surface receptors and oxidative stress of patients with hemodialysis,evaluate the immune function of the red blood cells,and identify the cause of infection and high prevalence of tumor in patients with hemodialysis.MethodsForty-five long-term hemodialysis patients from our blood purification center was chosen as the treatment group.Forty-five healthy individuals conducting physical examination at the same period was chosen as the control group.The flow cytometric method was used to detect CD35 surface receptors numbers of the red blood cell.The red blood cells wreath experiments were used to measure the adhesive function.The ELASA method was used to test the changes of oxidative stress index:SOD,MDA,CAT and GSH-PX.ResultsCompared to the normal control group,the treatment group had significantly lower levels of CD35 [ ( 28.62 ±6.95 ) AU vs.( 19.71 4.89) AU,t =5.441,P ＜0.01 ],impaired adhesive function red blood cells[ (0.63 ±0.07) vs.(0.44 ±0.04),t =0.41,P ＜0.05].For the levels of oxidative stress index,MDA [ ( 6.18 ± 0.16 ) μmol/L vs ( 13.47 ± 0.39 ) μmol/L ] was significantly higher in the treatment group than in the normal control group( t =13.14,P ＜ 0.05 ),and SOD( 34 202.00 ± 1634.00) U/( g · Hb),CAT ( 21.70 ± 0.84 ) U/ml and GSH-PX ( 444.00 ± 10.31 ) U/ml were significantly lower in the treatment group than in the normal control group [ SOD:(24 652.00 ± 2179.00)U/( g · Hb),CAT:( 14.80 ± 1.13 ) U/ml,GSH-PX:( 217.89 ± 13.70 ) U,t =20.246,9.496,27.195,P ＜0.05 ].ConclusionPatients with hemodialysis had lower numbers of red blood cell surface receptors CD35 and impaired immune function of adhesion,and higher oxidative stress levels.This may be the cause of infection and tumor of patients with hemodialvsis.

To summarize the accumulated successful experiences, defeated cases and lessons the recent year’s clinical studies, works and experiences of hip prosthesis combining the relevant status abroad and to analyze some questions such as the operations are not standardized; the indications are not strict; overemphasizing the navigation and mini-invasion; clinical techniques are irregular, and the patients should be educated, and so on. The above questions influence the good development of the Chinese joint prosthesis and reduce the clinical outcomes of the joint prosthesis. Taken together, these questions should be concerned and resolved. Relevant solutions are discussed.

In the clinical practice,critically ill patients are in great risk of delirium because of the impact of psychological,surroundings,illness,and medications,with the incidence rate as high as 45％-87％.Delirium could result in bad prognosis and clinical consequences of cognitive function in late stage.Dexmedetomidine (DEX) is a novel and highly selective 2-adrenoceptor agonist.It offers beneficial pharmacological properties and has been widely used in intensive care unit (ICU).In order to provide scientific and effective references for clinical practice,this paper reviewed the development of DEX intervention for the prevention of delirium in ICU both in China and abroad refereed to the pharmacological characteristics and the efficiency in clinic and the influence factors ofthe efficiency;and also discussed the possible mechanisms,such as modulating the neurotransmitters,and attenuating stress response and inflammation.

Objective To investigate the value of integrin αvβ3 targeted microSPECT/CT imaging with 99 Tcm-3P4-RGD2 as a radiotracer in tumor anti-angiogenesis therapy .Methods Animal models bearing glioma and prostate cancer xenografts were established by subcutaneously injecting tumor cells U87MG and PC-3 in nude mice.Anti-angiogensis therapy with Avastin was administered via intraperitoneal injection when the tumor diameter reached 6 to 7 mm while saline was served as control group . MicroSPECT/CT imaging was performed with 99 Tcm-3P4-RGD2 as radiotracer one day before and 3, 5, 10, 15 days after Avastin administration .Tumor volume and tumor uptake of 99 Tcm-3P4-RGD2 , expressed as percentage of injected dose (%ID) or %ID per gram (%ID/g) were measured and calculated based on microSPECT/CT.Mice basic condition was monitored and tumor xenograft was harvested in one tumor bearing nude mouse after its sacrifice at each imaging time point .Results Tumor volume of U87MG glioma in the administration group was significantly smaller than that of non-administration control group at 10 d after Avastin adminstration ( t=5.81, P<0.05), while no significance was observed between the administration group and its control group of PC-3 tumor (P >0.05).The uptake of 99Tcm-3P4-RGD2 (%ID/g) in U87MG group was higher than that in PC-3 group before Avastin administration ( t=10.48, P<0.05), and it decreased to a value less than control ( t =3.26, P <0.05) at 3 d after Avastin administration and continually reduced at longer time after administration .PC-3 tumor had less uptake of 99 Tcm-3P4-RGD2 in both Avastin administration group and its control group .The pathologic results revealed on that the decrease of tumor integrin β3 expression in U87MG treatment group was mainly on the endothelial cells of the neovessel .Linear relationship was verified between tumor uptake (%ID/g ) and integrin β3 expression (y=0.499 1x-0.243 8, R2 =0.811 7).Conclusions Complete inhibition of integrin is demonstrated early after Avastin administration .99 Tcm-3P4-RGD2 microSPECT/CT imaging, assessing the expression level of integrin αvβ3 level by quantification of tumor uptake of 99 Tcm-3P4-RGD2 , is probably an important method to reflect the early therapeutic effect of tumor anti -angiogensis .

Objective To investigate the effects of reducing the auditory organ dose by limitation of sub regional auditory organ in IMRT plan. Methods Total 223 cases of nasopharyngeal carcinoma patients were divided into group A and group B. In group A, the IMRT plans of 114 patients were designed by limiting overall auditory organ dose. In group B, the IMRT plans of 109 patients were designed by limiting sub regional auditory organ dose. According to the Clinical prescription, the IMRT plans were designed. Paried t?test was difference between groups. Results By comparing the two groups of auditory organ dose, in all stages, the tympanic cavity Dmean average in group B decreased by T1 vs. 17?? 7%,T2 vs. 22?? 4%,T3 vs. 15?? 7% and T4 vs. 14?? 2% ( P= 0?? 000,0?? 000,0?? 000,0?? 000);cochlea Dmean average decreased by T1 vs. 11?? 0%, T2 vs. 20?? 1%, T3 vs. 10?? 0% and T4 vs. 9?? 0%(P= 0?? 004,0?? 000,0?? 007,0?? 036);vestibule Dmean average decreased by T1 vs. 22?? 6%, T2 vs. 31?? 8%, T3 vs. 20?? 6% and T4 vs. 21?? 4%, significantly less than in group A (P= 0?? 000,0?? 000,0?? 000,0?? 000). The bony portion of eustachian tube Dmean average in group B decreased were not significantly less than in group A (decreased by 3?? 4%,6?? 8%,3?? 6%,0?? 1%;P= 0?? 291, 0?? 006,0?? 155,0?? 963). Conclusions In IMRT plan, optimization on dose limitation of sub regional auditory organs were used to reduce the auditory organ dose and decrease the radiation damage to auditory organ.

Objective To investigate the prevalence of plasmid-mediated quinolone resistance (PMQR) genes among clinical isolates of Klebsiella pneumoniae (K.pneumoniae) in pediatrics.MethodsA total of 131 non-duplicate clinical isolates of K.pneumoniae were collected in the Affiliated Children′s Hospital of Capital Institute of Pediatrics from 2010 to 2012.PMQR genes [qnrA, qnrB, qnrS, aac(6′)-Ⅰb-cr and qepA], mutations in the quinolone resistance-determining region (QRDR) and extended spectrum β-lactamases (ESBLs) genes in those strains were analyzed by PCR.Minimum inhibitory concentrations (MIC) of different antibiotics against those K.pneumoniae strains were determined by broth microdilution method and E-test according to the guidelines issued by the Clinical and Laboratory Standards Institute (CLSI).Transferability of the PMQR genes was examined by conjugation test with the sodiumazide-resistant Escherichia coli J53.Results Among the 131 isolates, 9.92% were resistant to quinolone and 30.5% were positive for PMQR genes, including 6.87% harboring qnrB gene, 22.9% harboring qnrS gene and 4.58% harboring aac(6′)-Ⅰb-cr gene.Neither qnrA-positive nor qepA-positive strain was detected.Among these PMQR genes-positive isolates, 90% were ESBLs-producing strains and two presented mutations in gyrA and parC genes.Conjugation test showed that these PMQR genes could be transferred horizontally and the ciprofloxacin resistance increased 2 to 32 folds in transconjugants.Conclusion This study indicates that the PMQR gene-carrying rate is high in K.pneumoniae strains isolated in paediatrics in China.Most of the PMQR gene-positive strains are also ESBLs-producing strains.The PMQR genes could be transferred horizontally in bacteria.

Objective To evaluate the efficacy, advantages and shortcomings of micro-percutaneous nephrolithotomy in treatment of uncomplicated ureteral calculi.Methods Clinical data were collected from 126 patients with a failure treatment of history by ESWL (extracorporeal shock wave lithotripsy) and RIRS (retrograde intrarenal surgery) in treatment of upper ureteral calculi (< 3.0 cm) from June 2015 to May 2016. Antegrade percutaneous access was obtained by B-type ultrasound guidance. Micro-PCNL was done using YAG laser fiber or pneumatic through the ureteroscope (F4.5~F6.5、F6.0~F7.5, 315 mm) to disintegrate the stones. The calculi clearance rate, operation time, operative hemorrhage, length of hospital stay and complications of the patients were analyzed after operation.ResultsThe calculi clearance rate was 88.9%, the operation time was 15~75 min, the operative hemorrhage was 15~35 ml, the length of hospital stay was 5~10 d. Only one patient need the second stage surgery because of intraoperative hemorrhage affected the surgical ifeld. No patients occurred massive hemorrhage, pneumothorax, bowel and other complications such as organ damage.Conclusion Micro-PCNL had a good clinical curative effect and security in treatment of uncomplicated ureteral calculi, which was worthy of promoting clinically.

Objective To observe the role of α7 nicotinic acetylcholine receptor (α7nAChR) in the protection against delirium by the use of dexmedetomidine (DEX) in endotoxin derived delirium and its mechanism. Methods 100 male adult C57BL/6 mice were randomly divided into normal saline control group (NS group), DEX control group, lipopolysaccharide (LPS) induced endotoxemia model group (LPS group), DEX protection group (DEX+LPS group), and α-bungarotoxin antagonism group (α-BGT+DEX+LPS group), with 20 mice in each group. A model of endotoxemia was reproduced by intraperitoneal injection of LPS 20 mg/kg, and the mice in NS group and DEX control group were given equivalent sterile normal saline. The mice in DEX control group, DEX+LPS group, and α-BGT+DEX+LPS group were intraperitoneally injected with DEX 40 μg/kg 15 minutes before LPS injection. The mice in α-BGT+DEX+LPS group were intraperitoneally injected with α7nAChR inhibitor α-BGT 1 μg/kg 15 minutes before DEX injection. The mice in NS group were given equivalent sterile normal saline. Ten mice in each group were assigned for open field test before and 24 hours after model reproduction, and the mice were then sacrificed to obtain the specimens. The levels of tumor necrosis factor-α (TNF-α) and neuron-specific enolase (NSE) in serum were determined by enzyme-linked immune sorbent assay (ELISA). Western Blot method was used to determine the expression of choline acetyltransferase (ChAT) and acetylcholinesterase (AChE) in hippocampus. Another 10 mice were subjected to new object recognition test to observe the total exploration time during training period and preference index at 3 hours and 24 hours after LPS challenge. Results There were no significant differences in all parameters between NS group and DEX control group. ① It was shown by the open field test results that there were no significant differences in all parameters of open field test before model reproduction among all the groups. Twenty-four hours after model reproduction, when compared with NS group, the mice in LPS group showed that they had the ability of cognition of new environment, but learning and memory abilities were lowered, and tension was increased. DEX could significantly attenuate the degree of delirium, however, the protection of DEX from the delirious syndrome was antagonized partly by α-BGT. ② The new object recognition test results showed that compared with NS group, the ability of exploring new object was decreased in LPS group. DEX could significantly improve the exploration ability. However, DEX failed to control the delirious syndrome in α-BGT+DEX+LPS group. ③ The results of ELISA showed that the levels of TNF-α and NSE in serum were significantly increased in LPS groups as compared with that in NS group, and the levels of TNF-α and NSE were significantly decreased in DEX+LPS group. However, α-BGT could antagonise the protective effect of DEX [TNF-α (ng/L) in NS, LPS, DEX+LPS and α-BGT+DEX+LPS groups was 23.72±3.13, 808.78±87.86, 192.96±31.47, 829.99±80.98, respectively, and NSE (μg/L) was 8.70±0.74, 25.90±3.03, 18.10±2.14, and 23.12±2.21, respectively, all P < 0.01]. ④ The results of Western Blot showed that compared with NS group, the protein expression of ChAT in LPS group was significantly declined, and the protein expression of AChE was significantly increased. DEX could reverse the expressions of ChAT and AChT, however, α-BGT could reverse the protective effect of DEX [ChAT (gray value) in NS, LPS, DEX+LPS and α-BGT+DEX+LPS groups was 1.536±0.150, 0.381±0.138, 0.914±0.173, 0.628±0.088, respectively, and AChE (gray value) was 0.382±0.201, 1.843±0.325, 0.898±0.155, and 1.470±0.220, respectively, P < 0.05 or P<0.01]. Conclusions Delirium syndrome may occur in mice with endotoxemia. DEX could attenuate endotoxemia-associated delirium syndrome through transforming central neurotransmitter, and its mechanism maybe related with α7nAChR.

Objective To explore the relation between vitamin D deficiency and susceptibility to spinal tuberculosis. Methods A total of 163 hospitalized patients with untreated spinal tuberculosis in Tianjin Haihe hospital were enrolled in this study from June 2013 to May 2016. A total of 170 individuals participated in health examination program at the same period were enrolled as the control group. The serum level of 25-hydroxyvitamin D [25(OH)D] was measured by enzyme linked immunosorbent assay. The 25(OH)D grading included serious deficiency group (<25 nmol/L), deficiency group (≥25 nmol/L and <50 nmol/L), insufficiency group (≥50 nmol/L and <75 nmol/L) and sufficiency group (≥75 nmol/L). Histopathological classification was confirmed by intraoperative findings. Results The serum level of 25(OH)D was significantly lower in patient group [23.99(20.55,29.54)nmol/L] than that of control group [42.94(35.68,51.04) nmol/L] (P<0.01), and which was also significantly lower in four seasons than that of controls (P<0.05). The serum levels of 25(OH)D were significantly higher in summer group than those of winter group in both patient and control groups (P<0.008 3). The proportion of patients with serious deficiency of 25(OH)D was significantly higher in spring and winter groups in patient group, which was significantly lower in summer group (P<0.01). There was no significant difference in patients with serious deficiency of 25(OH)D between four seasons (P<0.01). For control group, there was a higher proportion of cases with deficiency of 25(OH)D in four seasons, and there was no significant difference in the distribution of seasons (P>0.05). In patient group, there were 107 cases of caseous necrosis type, 56 cases of hyperplasia type, and the proportion of caseous necrosis type was significantly higher in the severe deficiency group (79.17%, 76/96) than that of deficiency group (46.27%, 31/67, P<0.01). Conclusion Excluding the effect of season, vitamin D deficiency is associated with susceptibility to spinal tuberculosis and histopathologic classification.

Objective To investigate the prognosis of children with acute kidney injury(AKI)treated with peritoneal dialysis(PD)following cardiopulmonary bypass.Methods A retrospective study of 46 children aged under 14 years old with AKI treated by using PD following cardiopulmonary bypass from Jan.2006 through Dec.2010.All of them were divided into three groups,namely group A(AKI Ⅰ),group B(AKI Ⅱ)and group C(AKI Ⅲ)according to the stratification of RIFLE criteria.The timing of PD was depended on the phase of AKI.The ICU length of stay,total duration of mechanical ventilation,total amount of peritoneal dialysate and the length of PD were compared among three groups.Their APACHE Ⅱ score,sequential organ failure assessment(SOFA)score,serum interleukin-6(IL-6),oxygenate index,serum creatinine,and mean arterial pressure were also compared between before PD and after PD for 48 hours.One-way ANOVA was used for statistical analysis between different phases of AKI.Data got before PD and after PD for 48 hours were analyzed with paired Student' s t-test.Results The APACHE Ⅱ score,SOFA score and serum IL-6 before PD were higher in patients with phase Ⅲ of AKI than those in patients with phases Ⅰ and Ⅱ of AKI(P ＜ 0.01).There were no significant differences in APACHE Ⅱ score and SOFA score between patients with phases Ⅰ of AKI and patients with phase Ⅱ of AKI before PD(P ＞0.05),but serum IL-6 before PD,ICU length of stay,total duration of mechanical ventilation,total amount of peritoneal dialysate and the length of PD in patients with phase Ⅱ of AKI were higher or longer than those in patients with phase Ⅰ of AKI(P ＜ 0.01).After PD for 48 hours,APACHE Ⅱ score,SOFA score,serum IL-6,oxygenate index,serum creatinine and mean arterial pressure improved insignificantly in patients with phase Ⅲ of AKI(P ＞0.05),but those were improved significantly in patients with phases Ⅰand Ⅱ of AKI(P ＜ 0.05),while serum IL-6 in patients with phase Ⅱ of AKI was still higher than that in patients with phase Ⅰ of AKI(P ＜ 0.01).Conclusions Therapeutic effect of PD on children with AKI following CPB is better if PD is started in the phases Ⅰ and Ⅱ of AKI,especially in the phase Ⅰ of AKI.The RIFLE criteria and IL-6 are useful guidance to the assessment of patients' illness.