Purpose Recently the incidence of bone and joint degeneration is increased,with the increasing of cardiovascular disease complication.This study aims to utilize realtime three-dimensional echocardiography (RT-3DE) in evaluating left ventricular remodeling index (LVRI),to guide treatment and improve the survival rate.Materials and Methods Fifty-seven cases of healthy volunteers (normal control group) and sixty-seven patients with bone and joint degeneration (research group) were respectively divided into two subgroups according to the age.Both groups underwent conventional echocardiography and RT-3DE.The LVRI,left ventricular end diastolic volume index (LVEDVI),left ventricular mass index (LVMI),left ventricular end systolic volume index (LVESVI) and left ventricular ejection fraction (LVEF) measured by different methods were analyzed,and the differences and correlations between groups and within each group were compared.Results The age of normal control group and research group was not significantly different (P＞0.05).The LVMI and LVRI in research group were significantly higher than those in the normal control group with same age (P＜0.05).The LVEDVI,LVMI and LVRI measured by two-dimensional echocardiography and M-mode echocardiography were higher than those measured by RT-3DE,and the difference was statistically significant (P＜0.05).Bland-Altman agreement analysis showed good agreement of measured LVRI using 2D echocardiography and RT-3DE.Conclusion Patients with bone and joint degeneration have left ventricular remodeling.RT-3DE can accurately assess LVRI with the advantages of convenience and lack of radiation,which can be widely used in clinic.

Objective To investigate the resistance mechanisms and epidemiology of Enterobacteriaceae isolated from clinical with reduced susceptibility to imipenem or meropenem.Methods 18 strains of Enterobacteriaceae with reduced carbapenem susceptibility were collected during January to August in 2010.The MICs of these strains were determined using automated microbial identification system.ESBLs,AmpC and KPC were tested using the agar dilution method.PCR amplification and DNA sequence were performed to analyze the KPC genes,PFGE was used to examine the molecular epidemiology.Results All 18 strains were detected ESBLs and AmpC,14 strains were detected KPC-2.3 strains with EDTA paper method positive may produce other metal carbapenem,in which 2 strains harbor KPC-2.PFGE types indicate that there were six genotypes among 15 strains of Klebsiella pneumoniae.Conclusion Plasmid-mediated KPC-2 was the main reason which makes Enterobacteriaceae reducing carbapenem susceptibility and causes short-term epidemic in hospital.Clinical strains harboring KPC-2 gene may carry multiple resistance genes meanwhile.

AIM: To investigate the immunologic mechanism of CXC chemokine ligand 10(CXCL10) and its receptor CXC chemokine receptor 3 (CXCR3 ) involved in the process of endometriosis (EM). METHODS: Serum samples were collected from 3 groups; EM patients without operation (n = 76) , EM patients with operation (n = 10) and the normal control persons (n =76). CXCL10 and CA12S concentrations were detected by means of ELISA and chemilumino-metry. Cell surface antigens on the activated PBMC - CD3 and CXCR3, as well as CXCR3 subgene - CXCR3A and CX-CR3B were tested by flow cytometry (FC) and RT - PCR when PBMC was separated from women with EM ( n = 10) and without EM (n = 10), and then activated. RESULTS: Serum CXCL10 concentrations between three groups were signifi-canly different (P < 0.05). Compared to normal control group, although the supernatant CXCL10 concentration and CD3~+ /CXCR3~+ PBMC number in EM group has no significant difference (P >0.05) , highly expressed CXCR3B in EM group rather than CXCR3A was observed. CONCLUSION: CXCL10 in women with EM is low, indicating that it plays a vital role in the process of EM and immune system of the women with EM is defected and impaired. The immunoreactivity of PBMC from both EM patients and normal person is same to activated signal, but the productions are different: PBMC in EM group mainly express CXCR3B but PBMC in normal person mainly express CXCR3A after activation, which may be one of the immune mechanisms that EM escapes from immunological lethal effect of the infected host.

Objective:To study effects of neuroligin (NLG) on the proliferation and apoptosis in human neuroblastoma SH-SY5Y cells.Methods:The SH-SY5Y cells were cultured in vitro for 24 hours,and then transfected with NLG siRNA at dose of 50,100,200 μmol/L,respectively.MTT procedure was used to detect the cell proliferation,and expression levels of apoptosis gene including Bax or Bcl-2 and Bcl-xl were measured by RT-PCR.Results:Compared to control groups proliferation of SH-SY5Y cells were distinctly inhibited after NLG siRNA transfection accompany with a dose-dependent,which was caused by activation of apoptosis.Conclusions:NLG protect neuron by inhibiting apoptosis.

Objective To explore the effects of quality improvement in delivery room resuscitation on very/extremely low birth-weight infants (VLBWI/ELBWI). Methods A retrospective analysis was performed to analyze the clinical data of VLBWI/ELBWI who were admitted to the Neonatal Intensive Care Unit (NICU) of Nanjing Maternity Hospital Affiliated to Nanjing Medical University from January to December 2015 (pre-improvement group, n=176) and of those who were admitted from January to December 2016 after the implementation of quality improvement program on delivery room resuscitation (post-improvement group, n=199). Several parameters were monitored, including resuscitation modalities [continuous positive airway pressure (CPAP) , peak inspiratory pressure (PIP)+positive end expiratory pressure (PEEP) with T-piece resuscitator and intubation rate in delivery room], neonatal body temperature and pH on NICU admission, respiratory outcomes, morbidity from intraventricular hemorrhage, necrotizing enterocolitis, retinopathy ofprematurity and hospitalization. Chi-square (or Fisher's exact test), t or rank Sum test was used for statistical analysis. Results There was no significant difference in gestational age, birth weight, gender proportion, delivery mode and Apgar scores between the two groups (all P>0.05). After implementing the quality improvement program, there was an increased overall usage of CPAP [85.9% (171/199) vs 66.3% (112/176), χ2=19.881, P<0.01] and PIP+PEEP with T-piece resuscitator [33.8% (67/199) vs 10.8% (12/176), χ2=19.819, P<0.01], but a decreased usage of balloon catheter ventilation [6.0% (12/199) vs 39.3% (44/176), χ2=53.682, P<0.01]. No significant change in intubation rate was observed(P>0.05). The average admission temperature increased after launching the quality improvement program [M (P25-P75), 36.2 (35.8-36.5) vs 35.6 (35.4-35.7)℃ , Z= - 9.681, P<0.01]. The morbidities of pulmonary hemorrhage within one week after birth [1.5% (3/199) vs 5.1% (9/176),χ2=3.921] and grade Ⅲ / Ⅳ intraventricular hemorrhage [1.1% (2/199) vs 11.9% (21/176), χ2=33.885] decreased along with the improvement in delivery room resuscitation (both P<0.05). The duration of invasive ventilation decreased as well [3 (1-6) vs 4 (2-9) d, Z= - 2.286, P<0.05]. Conclusions Quality improvement in delivery room resuscitation measures standardizes the management of delivery room resuscitation and improves the clinical outcomes of VLBWI/ELBWI.

Objective To explore post-effect of acupuncturing ST36 (Zusanli) on brain functional connectivity. Methods Twelve healthy volunteers participated in this experiment. The fMRI data taken before and 25 minutes after removed acupuncturing stimulation were analyzed, while posterior cingulated cortex were chosen as seed points. Results At 25 minutes after removed acupuncturing stimulation, new increased functional connectivity were found in the left paracentral lobule, right superior parietal lobule and right postcentral gyrus. After acupuncture, there was intensity functional connectivity greater than in primary brain regions. Conclusion Post-effect of acupuncture can increase functional connectivity in healthy volunteer's brain.

Objective To evaluate the effects of asymptomatic arteriovenous fistula closure on left ventricular morphology and function in renal transplant recipients.Methods Between March 2007 and March 2011,a total of 60 patients undergoing consecutive kidney transplantation with asymptomatic arteriovenous fistula were divided randomly into two groups: arteriovenous fistula closure group,and non-arteriovenous fistula closure group.By using echocardiography,the changes in CO,CI,EF,LVEDV and LVMI were analyzed.Results At 12th month after transplantation,the values of CO,LVEDV and LVMI were significantly lower than those before transplantation (P＜0.05).The value of CI also showed a tendency to decrease (P＞0.05),and the value of EF was increased significantly (P＜0.05).At 6th month after arteriovenous fistula closure (18 months after transplantation),the values of CO,CI,LVEDV and LVMI were significantly lower than those before arteriovenous fistula closure (12 months after transplantation) (P＜0.05),and the value of EF was increased significantly (P＜0.05),but the values of CO,CI,EF,LVEDV and LVMI remained unc(b)anged in controls (P＞0.05).At 18th month after transplantation,the values of CO (4.4 ±0.8 L/min),CI [3.0 ± 0.8 L·min-1·m-2],LVEDV (110.0 ± 17.4 ml) and LVMI (114.7 ± 42.5g/m2) in trial group were significantly lower than the values [CO: 5.1 ± 0.9 L/min,CI: 3.5 ± 1.0L·min-1·m-2,LVEDV: 121.4±19.3 mL,LVMI: 138.4±44.1 g/m2] in controls (P＜0.05),and the value of EF (75.2％ ± 7.4％ vs.70.5％ ± 8.2％) significantly higher (P＜005).Conclusion In both groups,kidney transplantation benefits significantly the regression of cardiac mass,cardiac index and left ventricular dimensions,but closure of asymptomatic AVF induces more significant regression.

Objective To investigate the change of dynamic expression of t-PA and PAI-1 during early venous crisis after free perforator flap transplantation.Methods Thirty healthy New Zealand white rabbits weighed 2.5-3.0 kg were chosen and randomly divided into experimental group (n =15) and control group (n =15).Free transplantation of superficial epigastric artery perforator flap (SEAPF) was implemented in all rabbits firstly.Then the model of venous crisis was established by ligating the anastomosis vein in order to interrupt venous blood outflow in experimental group.The blood supply of all flaps was monitored by observing their color,swelling degree and the filling reaction of the capillaries after operation.Peripheral blood was drawn from femoral artery at different time point for measuring the concentration of t-PA and PAI-1 by Elisa.Partial flap tissue was harvested for pathological examination at corresponding time point.Data analysis was performed by using SPSS 17.0 statistical software.P ＜ 0.05 was considered statistically significant.Results One rabbit died of anesthesia,and the venous congestion was observed in 1 rabbit in control group.The models of free transplantation of SEAPF and venous crisis were established successfully in the remaining rabbits.No significant appearance change was observed within 1 h after the outflow vein being ligated,while typical appearance of venous crisis could be observed 2 hours after the outflow vein being ligated.Compared with the control group,the concentration of t-PA was lower,but the concentration of PAI-1 was higher in experimental group at 2 hours,4 hours,6 hours,8 hours after the outflow vein being ligated(P ＜ 0.05).However,there was no obvious differences between two groups at other time points (P ＞ 0.05).The pathological examination showed the red cells gradually got together and adhered to the venous wall,eventually the microcirculation had been blocked completely and theflap became necrosis after venous crisis being occurred.Conclusion t-PA and PAI-1 can't be used to diagnose early venous crisis of perforator flap transplantation.

Objective To explore the safety and efficacy of policosanol in elder patients with high on-treatment platelet reactivity ( HPR) after drug-eluting stent ( DES) implantation. Methods This study was a prespecified subgroup analysis of the multicenter, randomized SPIRIT trial,in which there were a total of 169 elder patients (≥60 years old) with HPR. Among these patients, 30 patients were in group A ( given clopidogrel 75 mg/d for one year) , 75 patients in group B ( given clopidogrel 150 mg/d for 30 days followed by 75 mg/d until one year ) and 64 patients in group C ( given policosanol 40 mg/d for 6 month and clopidgrel 75 mg/d for one year ) . All patients were treated with aspirin at the same time. The primary endpoint was the reversion rate of HPR at 30 days (reversion was defined as platelet aggregation ﹤65%). The secondary endpoint was 2-year major adverse cardiac events ( MACE ) rate, which included cardiac death, non-fatal myocardial infarction and ischemic symptoms driven target vessel revascularization. The safety endpoint was any bleeding as defined by the Bleeding Academic Research Consortium ( BARC ) definition. Results At 30 days, the reversion rate of HPR in group C was numerically higher as compared with group A ( 42. 9% vs. 23. 3. 0%, P=0. 068 ) , and similar with group B ( 42. 9% vs. 49. 3%, P=0.447). MACE occurred in 4 (13.3%), 5(6.7%) and 3(4.7%) patients in group A, B and C respictively ( P=0. 352). Bleeding events in group A and group C were both markedly lower in comparison to group B (3. 3% vs. 17. 3% vs. 1. 6%, P=0. 001). At the 24-month follow-up, the MACE-free survival rates were not significantly different (95. 3% vs. 93. 3% vs. 86. 7%, P=0. 146). Conclusions For elder patients with HPR, policosanol reduced platelet reactivity to a similar extent in comparison of high maintenance dose of clopidogrel without increasing bleeding risk.

[ ABSTRACT] AIM: To investigate the influence of advanced glycosylation end products-modified bovine serum albumin (AGE-BSA) on mammalian target of rapamycin complex 1 (mTORC1), urokinase-type plasminogen activator re-ceptor ( uPAR) , and cell mobility in the podocytes, and to further explore the probable relationship.METHODS: The conditionally immortalized mouse podocyte cell line was cultured in vitro.MTT assay and immunofluorescence were used to analyze the cell viability and cytoskeleton of the podocytes treated with the stimuli and intervention agents.The activity of mTORC1 and the expression level of uPAR in normal podocytes and podocytes treated with control BSA or AGE-BSA were detected by Western blotting.The migration ability of the podocytes was determined by would-healing assay.Rapamycin was added to inhibit the activity of mTORC1 along with the addition of AGE-BSA to observe the changes of uPAR and the motility of podocytes.RESULTS:No significant difference of the cell viability or cytoskeleton in the podocytes treated with the stimuli and intervention agents was observed.AGE-BSA up-regulated the activity of mTORC1 and the expression of uPAR, and induced the high mobility of the podocytes.Rapamycin obviously reduced the high expression level of uPAR and the increase in the migration ability of podocytes caused by AGE-BSA treatment.CONCLUSION: AGE-BSA might cause the high migration of podocytes through the mTORC1/uPAR signaling pathway.