Objective To study the changes of urodynamics of middle-aged(35-55 years old)female patients with urinary incontinence and improve the diagnosis and treatment.Methods Analyze and compare the urodynamics between 56 cases of middle-aged female patients with urinary incontinence and 17 cases of normal control.Results Among the 56 patients,33 cases with stress incontinence(SUI group 58.93％),9 cases with urgency urinary incontinence(UUI group 16.07％),14 cases with mixed urinary incontinence(SUI/UUI group 25.00％).There was significant difference on maximum flow rate(Qmax[27.72 ± 5.21]ml/s vs[20.45 ±7.15]ml/s,P ＜0.05)between the SUI group and control group.The beginning of a sense of capacity(FS),normal urination feeling(ND),strong feeling of urination(SD)and urgent urination feeling(UD)were (135.65 ± 42.73)ml,(166.24 ± 51.42)ml,(315.75 ±42.34)ml,(320.24 ± 45.03)ml and(132.70 ±40.65)ml,(160.70 ± 50.44)ml,(320.75 ± 42.34)ml,(335.75 ± 51.98)ml in the UUI group and control group respectively.And there were significant differences on the four indexes between UUI group and control group(P ＜ 0.05).There was significant difference on ALPP([62.29 ± 25.40]cm H2O vs[88.30 ± 28.54]cm H2O,P ＜0.05)between the SUI group and SUI/UUI group.Pressure at maximum flow rate(Pdet-Qmax,[24.29 ± 6.24]cm H2O vs[34.45 ± 8.20]cm H2 O,maximum urethral pressure(M UP([68.20 ± 18.27]cm H2O vs[87.14 ± 17.26]cm H2O)and maximum urethral closure pressure(MUCP([74.24 ±35.75]cm H2O vs[90.66 ±30.10]cm H2O)in SUI group were significantly lower than those in control group(P ＜0.05)Conclusion There were large groups of middle-aged female urinary incontinence in patients and the classification is more complex.It shows important guiding significance for diagnosis and selecting proper treatments by detecting urodynamic.

Objective To compare the effects of propofol and ketamine on long-term memory and the expression of brain N-methylgroup-D-aspartate receptor 2B(NMDAR2B) and Gamma-aminobutyric acid receptor 1(GABAR1) in aged rats, and preliminary investigate the relation between the long-term memory and expression of neurotransmitter receptors in different cerebral areas. Methods The aged male rats were randomly divided into control group,propofol group and ketamine group. Morris water maze training was performed in all the rats of three groups for 5 days. On the 6th day, intraperitoneal injection of 50 mg?mL-1 propofol was administrated in propofol group,80 mg?mL-1 ketamine was intraperitoneally injected in ketamine group,and blank control group was given the same dose of saline.Seven days after the administration,space exploration experiment and navigation experiment test were performed to test the impact on the learning and memory ability of rats. After that, the expression levels of GABAR1 and NMDAR2B in temporal lobe and hippocampal CA1 region of the rat brain were detected by immunofluorescence and FISH technique. Results The results of Morris water maze showed there was no significant difference between propofol group (9.49±1.24) s and blank control group (8.82±2.22) s.There was statistically significant difference between ketamine group (12.04±2.67) s and blank control group (P<0.05),with longer latency time and less number of times of passing through target as compared with blank control group.By using immunohistochemistry and FISH technique,the expression of GABAR1 in temporal lobe and hippocampal CA1 region of the rat brain was not significantly different between propofol group and blank control group,but it was significantly up-regulated in ketamine group as compared with blank control group ( P<0.05) . The expression of NMDAR2B in temporal lobe and hippocampal CA1 region of the rat brain was not significantly different between propofol group and blank control group,but it was significantly down-regulated in ketamine group as compared with blank control group (P<0.05). Conclusion Propofol anesthesia alone had no effect on long-term learning and memory,but ketamine anesthesia can result in long-term learning and memory impairment. The mechanism may be related with down-regulation of the expression of NMDAR2B receptor and up-regulation of GABAR1 not only in CA1 region hippocampus,but also in temporal lobe.

Objective To observe the change of learning and memory quality and the expression change of GABAR1 and NMDAR2B in aged SD rat cerebral temporal lobe by propofol injection and discuss the influence that may be caused by propofol.Methods Aged male sd rats were randomly divided into three groups,each group of 20.Propofol intraperitoneal injection was implemented to groups P1 and P7 according 50 mg/kg and maintained anesthesia for 3 hours.The same dose of emulsion was given to control group. Morris water maze test was done in the first days and the seventh days after intraperitoneal injection.Then the left temporal lobe was gathered and the mRNA transcription and protein expression of GABAR1 and NMDAR2B were detected by FISH and Immunofluorescence technique.Results Compared with control group,the latent time of group P1 was significantly prolonged and the numbers of passing through the target frequency were decreased significantly (P <0.05).Group P7 had no significant differences.The mRNA transcription and protein expression of GABAR1 in group P1 were increased significantly and the mRNA transcription and protein expression of NMDAR2B in group P1 were decreased significantly (P <0.05 ). Group P7 had no significant differences.Conclusion The short-term memory of brain declined after propofol was used.This may be related to the function of temporal lobe.The mechanism may be related to the up regulation of GABAR1 and the down regulation of NMDAR2B simultaneously.

Objective To evaluate the clinic effect of leaflet enlargement with autologous pericardium in repairing mitral valve disease and to describe the technique and discuss its indications. Methods Between July 2004 and June 2008, 45 pa-tients with isolated mitral valve disease, included stenosis in 10 and regurgitation in 35. The causes were congenital heart dis-ease in 8, rheumatic in 21, degenerative in 7 and endecarditis in 9. The procedures were: posterior leaflet enlargement with autologuus pericardium in 14, anterior leaflet enlargement in 8, both anterior and posterior leaflet enlargement in 23. In addi-tion, eye to eye technique was in 12, artificial chordal in 12, chordal transfer in 6, papillary muscle vepesitioning in 4. Mitral anuuloplasty was performed in all cases. Before and after surgery, cardiac function parameters were compared. Results No operative deaths occurred. One case wastransfered to mitral valve replacement due to regurgation, lntraoperative transesophageal echocardiography showed no mitral regurgitation in 38 and small regurgitation in 6 cases. The mean mitral valve effective orifice area(MVEOA) was (2.8±0.6) cm~2, with a mean gradient pressure of (6.21±1.34) mm Hg after operation. The mean followed up was ( 18.0±2.1 ) months. Echocardiography study showed that no mitral regurgitation in 35 cases, slight regurgi-tation in 9, mean mitral effective orifice area was (2.5±0. 8 ) cm~2, mean gradient pressure of (7.21±0. 45 ) mm Hg, no one need reoperation. Postoperative cardiac functions were significantly improved: the average left ventricular end-diastolic diameter (LVEDD) was (48±7) mm [ preoperative (56±6) nun, P <0.05], ejection fraction (EF) was 0.51～0.24( preoperative 0.45± 0.23, P < 0.05 ), the average left atrium diameter ( LA ) was ( 50±11 ) mm [ preoperative ( 62±23 ) mm, P <0. 05 ]. The function of mitral valves was well performed. Conclusion Leaflet enlargement with autologous pericardium com-bined with mitral annuloplasty was effective in repairing of diseased mitral valve. The advantages of the procedure including simplicity, good compatibility, avoiding foreign body and no need for anticoagulation.

AIM　To investigate the structures and immunomodulation activity of four homogeneous polysaccharides: LBP 1a-1, LBP 1a-2, LBP 3a-1 and LBP 3a-2 isolated from Lycium barbarum L. brought from Zhongning County, Ningxia Province. METHODS　Their molecular weights, sugar component (constituents) and their linkages were determined by gel permeation chromatography, acid hydrolysis, periodate oxidation and NMR spectrum. The activity of immunomodulation was evaluated with splenocyte proliferation by ［3H］-TDR incorperation, in vitro. RESULTS　Four polysaccharides with molecular weights 11.5×104, 9.4×104, 10.3×104 and 8.2×104, were shown to enhance splenocyte proliferation induced by ConA. LBP 1a-1 and LBP 1a-2 were α-(1→6)-D-glucans. LBP 3a-1 and LBP 3a-2 were found to be α-(1→4)-D-polygalacturonans. CONCLUSION　The four polysaccharides were first isolated from this plant. Polysaccharides with main chain of α-(1→4)-D-polygalacturonans showed stronger immunomodulation activity.

Objective ①Observing urinary neutrophil gelatinase-associated lipocalin (uNGAL)'s concentration variation under the intervention of sepsis; ②Evaluatingu NGAL' s diagnostic value for early acute kidney injury (AKI).Method Fifty-six SD (Sprague Dawley) rats were randomly (random number) divided into four groups,including 16 rats in model group (CLG),16 rats in Xuebijing group (XBG),16 rats in Huangqi and Chaihu injection jointly applied group (HCG),and 8 rats in sham operation group (SOG).The septic models in CLG group,HCG group and XBG group were established by cecal ligation and puncture (CLP).Then,the rats in HCG group was treated with intraperitoneal injectionby Huangqi and Chaihu injections; the XBG group was treated with intravenous injection by Xuebijing injection; the SOG group was treated with open surgery without CLP.After the CLP,serial urine and serum samples were obtained at baseline (just prior to operation),6 h,12 h,18 h,24 h,36 h,48 h,and 72 h,and were measured by sCr,uCr,uNa,and uNGAL.The line graph of uNGAL' s concentration variation was plotted,based on the time.Diagnostic characteristics of urinary NGAL in predicting AKI were assessed by calculating the area under the receiver operating characteristic curve (AUC).Results After the CLP,the uNGAL of sepsis model rats increased quickly within 6 hours.The time points of each group model reaching their peak were 6 hours after CLP in CLG groupand 24 hours after CLP in HCG group and XBG group.These groups' uNGAL all decreased quickly after the peak.The cuNGAL of sepsis model rats was increased quickly within 6 hours after CLP,reached its peak at 24 hours after CLP.In CLG group,the line graphs of uNGAL or cuNGAL were almost overlapped.There is little difference in the concentration of uNGAL or cuNGAL at each time point (uNGAL:6h,t=0.691; 12h,t=1.627; 18 h,t=0.511,cuNGAL:6h,t =0.371 ; 12 h,t =0.474; 18 h,t =-1.187.Statistical significance of all above value was P ＞0.05).InXBG group,the line graph of uNGAL and cuNGAL were not overlapped,but difference between uNGAL and cuNGAL concentration at each time point was not significant (uNGAL:6 h,t =1.222 ; 12 h,t =1.178 ; 18h,t=1.272; 24h,t=0.918; 36h,t =0.442.cuNGAL:6 h,t =1.482; 12 h,t =1.314; 18 h,t=1.280; 24 h,t =0.280; 36 h,t =0.467.Statistical significance of all above value was P ＞ 0.05).In HCG group,uNGAL of AKI rats were higher than non-AKI rats at each time points since 6 hours later (6 h,t =2.351,P＜0.05; 12h,t=3.086,P＜0.01; 18h,t=2.535,P＜0.05;24h,t=2.150,P＜0.05;36h,t =2.485,P ＜ 0.05),The average cuNGAL of AKI rats and non-AKI rats have statistical significance at 6h,18 h,and 24 h (6 h,t=3.013.P＜0.01; 18 h,t =4.804,P＜0.01; 24 h,t=2.682,P＜0.05).At 6 h,Uout can increase cuNGAL' s ability of predicting AKI' s occurrence in 24 hours (AUC increased from 0.839 to 0.900,P ＜ 0.05).Conclusions The intervention to the sepsis rats have influence on the secretion volume and secretion sequence of NGAL in rat urine.uNGAL and cuNGAL are good predictor of AKI occurrence in sepsis rats.

Objective To assess the capability of serum and urine neutrophil gelatinase-associated lipocalin (NGAL) in predicting acute kidney injury (AKI) in septic patients.Methods From July 1, 2014 through December 31, 2014, a prospective observational study of septic patients without AKI was carried out in Renmin Hospital, Tianjin Hospital, and Nankai Hospital, Tianjin.The patients with AKI which was developed after admission to intensive care unit (ICU) were assigned to AKI group and the patients without AKI were assigned to non-AKI group.Clinical data and serum and urine sample were collected at the admission, and at 12, 24, 36, 48, 60, 72 ,84 and 96 hours after admission for detecting creatinine and NGAL.The measurement data accorded with normal distribution were used for t test or variance analysis of repeated measures;comparison of measurement data in non-normal distribution was carried out using the Mann-Whitney U test or Fridman test;comparison of count data was performed using Fisher exact probability method.ROC curve of serum or urine NGAL was plotted and the diagnostic values of serum or urine NGAL in predicting AKI were assessed by calculation of the area under the receiver operating characteristic curve (AuROC).Results Fifty septic patients were included.Thirty-five patients were in AKI group and fifteen in non-AKI group.The median age of AKI group was 73 and the median age of non-AKI group was 60 (IQR, 47-82).The urine NGAL (uNGAL) concentration in AKI group was higher than that in non-AKI group at the every interval and serum NGAL (sNGAL) was higher in AKI group than that in non-AKI group at only first twointervals.The uNGAL showed the capability of prediction for AKI progression at the 48 hour (AuROC=0.83,95% CI:0.70-0.97), 36 hours (AuROC=0.75,95%CI:0.59-0.91), 24 hours (AuROC=0.83,95%CI:0.70-0.95), 12 hours (AuROC=0.73,95%CI:0.60-0.88) prior to AKI occurred.The sNGAL showed capability of prediction at the 48 hours (AuROC=0.69,95%CI:0.51-0.88), 36 hours (AuROC=0.69,95%CI:0.52-0.87) prior to AKI occurred.Conclusions The sNGAL and uNGAL both were useful biomarker that predicted development of AKI in early stage.But the performance of sNGAL was slightly inferior to that of uNGAL for predicting development of AKI.

Objective To evaluate the different methods of blood purification for acute septic renal injury (AKI) in respect of outcome by using RIFLE(risk,injury,failure,loss and end-stage renal disease)criteria and A-PACHE Ⅱ score. MethodData of 96 patients with ASRI admired to ICU of Tianhe Hospital, Tianjin, from March 2004 to September 2006 were analyzed. Including criteria: 2001 International Sepsis Definitions Conference and 2004 RIFLE criteria of AKI. The methods of blood purification used continuous renal replacement therapy (CRRT, n=54) and imermittent hemodialysis (IHD, n=42).The patients of CRRT group could be classified into stages Ⅰ, Ⅱ and Ⅲ referred to RIFLE criteria. Excel was evaluated to set up clinical data base from documented material. Data were analyzed with SPSS version 11. 5 software. Physical signs, laboratory findings, variation of APACHE Ⅱ score and outcomes of patients were documented evaluated. Data of two groups compared using indepent samples T test, before and after the treatment compared using paired-samples T test, rate compared using chi-square test. Results①There were no statistical differences in APACHE Ⅱ score and creatinine (Cr) between CRRT group and IHD group before treatment (P>0.05). The mortalities of CRRT group and IHD group were 51.9％ and 52.4％, respectively (P>0.05), but the recovery rates of renal function in CRRT group and IHD group were 92.3％ and 65.0％ ,respectively (P< 0.05).②Mean arterial pressure (MAP),oxygen saturation (SpO2) of CRRT group were lower than those of IHD group (P<0.05) and they increased to some extent after treatment (P< 0.05). ③In the patients of stag Ⅰ ,the survival rate was 78.6％, APACHE Ⅱ score was 25.4± 2.5 before treatment, renal function recovery rate was 90.9％ ,and APACHE Ⅱ changed - 13.6 ± 4.3, while those relevant markers in the patients of stage Ⅲ were 38.1％, 36.1 ± 5.7,62.5 ％ and - 7.1 ± 4.2, respectively (P<0.05). ConclusionsThe RIFLE criteria has guiding significance for the early diagnosis and prognosis of ASRI,and the RIFLE and APACHE Ⅲ score may help to choose the optimum opportunity of treatment and the early CRRT as soon as possible after diagnosis can improve the outcome of patients with acute septic renal injury.

Objective To explorethe long-term prognosis of the triangular resectionvalvuloplasty for posterior mitral valve prolapse and provide a reference for the clinical treatment.Methods We retrospectively analyzed the clinical data of 61 pa-tients with posterior mitral valve prolapse underwent the mitral valvuloplasty in our hospital from Match 2008 to December 2016.30 patients who underwent triangular resection for posterior mitral valve prolapse.31 patients who underwentstandard quadrangular resection.The cardiac functional parameters and condition of mitral regurgitation were compared among the period of preoperation,discharging and follow-up.Results The mean follow-up period was 42 ±34(3-106)months.left atrium and left ventricular diameter were decreased(P<0.05).Inresrarch group,there was 1 patient who have moderate regurgitation,ar-rhythmia is one.In control group,there was arrhythmia in 1 cases,moderate regurgitation in 2 cases and death in 1 cases.Rate of freedom from reregurgitation was(97 ±6)% in research group and was(97 ±4)% in control group.There was no SAM in two groups.There were no significant differences of survival or risk of reoperation.There was a statistic difference of NYHA classification of cardiac function in the phase of follow-up than that of discharging(P<0.05).Conclusion Triangular resec-tion of a prolapsed posterior mitral leaflet is a simplified,reliable, reproducible, and durable procedure,like quadrangular re-section of a prolapsed posterior leaflet.