Objective To investigate the main origin of IL-6 during acute rejection of renal transplantation and provide the experimental foundations for expounding the molecular pathogenic mechanism of acute rejective reaction of renal transplantation Methods 3'IL-6 probe with in situ hybridization technique was used to detect the IL-6mRNA expression in renal graft. Results (1) Renal graft expression of IL-6mKNA in acute rejection was higher than that in CsA toxicosis, stable transplantation and normal control. (2) Expression of IL-6mRNA in tubular epithe-lium of acute rejection graft was higher than that in glomerular cells ,vascular endotheli-um and interstitium. (3) The expression of IL-6mRNA in renal graft of CsA toxicosis was similar with that in stable transplantation and normal control. Conclusion Renal graft cells may produce IL-6 directly during acute rejection. The abnormal expression and activation of IL-6 in renal graft may play an important role in the mechanism of renal acute rejection. Graft tubular epithelium may play a more important role in the cause of immunorejection.

Objective To investigate the effect of ultrasound-guided transversus abdominis plane (TAP)block on the efficacy of postoperative analgesia in parturients undergoing selective cesar-ean delivery.Methods Eighty ASA Ⅰ or Ⅱ parturients recruited for selective cesarean delivery under combined spinal-epidural anesthesia were randomly divided into two groups(n =40 each):TAP group (group T)and control group(group C).After cesarean delivery,bilateral of ultrasound-guided TAP block were performed,20 ml of 0.5% ropivacaine was injected in each side in group T,while TAP was not done in group C.Both groups received patient-controlled intravenous analgesia (PCIA)after cesarean delivery.The resting and exercise visual analogue scale (VAS)scores,Ramsay sedation score and the Bruggrmann comfort scale(BCS)score were evaluated at 2,4,6,8 and 24 h after operation. The consumption of sufentanil within 24 h after operation,the number of successfully delivered doses (D1 )and the number of attempts (D2 )within 24 hr after operation were recorded.D1/D2 was calculated.The parturients satisfaction and the adverse reactions were also recorded.Each parturient was assessed postoperatively by a blinded investigator.Results The consumption of sufentanil within 24 hr after operation,the resting and exercise VAS scores at 2,4,6 hr after surgery were significant-ly lower,while the BCS score,the value of Dl/D2 and the degree of satisfaction were higher in group T than those in group C (P <0.05).There were no adverse reactions in both groups.Conclusion Ultra-sound-guided TAP block reduces the postoperative sufentanil consumption,enhances the efficacy of post-cesarean analgesia of the parturients.Comfort and satisfaction are achieved in the parturients of the group T.

Objective To investigate clinical manifestation and pathological changes and the expressions of Emerin protein and STA gene of Emery-Dreifuss muscular dystrophy (EDMD).Methods The clinical features and STA gene detection from one patient with EDMD were analyzed retrospectively. Results The onset age of this patient was in early childhood. The four limbs were progressive muscle weakness and muscular atrophy. There were joint contractures and cardiac involvement in the early stage. The serum muscle enzymes increased slightly. The pathological changes in muscles showed that the sizes of muscle fibers were different, the fibers became spherical and some fibers were replaced by fat. Because of normal spinal anterior horn cells and sural nerves, neurogenic muscular atrophy might be ruled out. Emerin protein could not be tested in striated muscle and cardiac muscle. No mutation of STA gene was found in this case. Conclusions Emery-Dreifuss muscular dystrophy is one particular type of muscular dystrophy. It is characterized with joint contractures and cardiac involvement in the early stage. Emerin protein is deficient in EDMD. There is no mutation of STA gene in sporadic EDMD.

Selective posterior rhizotomy was performed for the treatment of spastic limbs in patients with brain injury, and evoked potential and gait analysis were used to study its effect. The posterior roots of L 2～S 1 were separated from anterior roots and they were split into funiculi. Electric stimulation of the fumiculi was done.Those with low threshold were sectioned. Evoked potential and gait analysis were performed preoperatively and postoperatively. Selective posterior rhizotomy had been performed in 16 cases.They were followed up for 4 years. The result of the treatment was satisfactory.The rate of reduction in spasticity was 90 percent, and the rate of functional improvement was 80 percent.The study of evoked potential and gait analysis also showed that the effect of the operation was satisfactory.The results of selective posterior rhizotomy in the treatment of spastic limbs as a sequela of brain injury is promising,as judged by evoked potential and gait analysis.

To study the curative effect of selective posterior rhizotomy for spastic limbs after spinal cord injury, and to study the histochemistry of nerve roots. The posterior nerve roots of L 2～S 1 were separated from anterion roots and splited into rootlets. The lower threshold rootlets were sectioned after electrical stimulation. The sectioned rootlets were studied with histochemistry. The resalt showed that the selective posterior rhizotomy was performed on 29 cases who were followed up for 3 years. The treatment was satisfactory. The rate of reducing spasticity was 90% and the rate of functional improvement was 80%. The Ache reaction of sectioned rootlets was positive. The result suggest that it is a successful way to treat spastic limbs after spinal cord injury with selective posterior rhizotomy. Electrical stimulation is necessary in selective posterior rhizotomy.

Objective:To explore the expression and biological functions of miR-346 in nasopharyngeal carcinoma.Methods:63 cases nasopharyngeal carcinoma tissue and 34 cases nasopharyngeal non-cancer tissues were collected,the miR-346 expression were detected by Real-time PCR between nasopharyngeal carcinoma tissue and nasopharyngeal non-cancer tissues,6 strains of human nasopharyngeal carcinoma cell lines and 1 strain of normal nasopharyngeal epithelial cell immortalized NP69.Two cell lines with middle expression levels in human nasopharyngeal carcinoma cells lines were selected,and transfected into miR-346 inhibitor,the control group (NC group) were with negative control plasmid transfection,miR-346 expression in two groups were detected by Real-time PCR,the proliferation,apoptosis were detected by Brdu-ELISA and flow cytometry,the migration and invasion were detected by Transwell Chambers experiments.Results:Compared with the nasopharyngeal non-cancer tissues,the miR-346 expression in nasopharyngeal carcinoma tissues was significantly increased (P =0.000);compared with the normal nasopharyngeal epithelial cells NP69.the miR-346 expression in human nasopharyngeal carcinoma cell lines was significantly increased (P＜0.05).The CNE-1 and CNE-2 were chose,after the miR-346 inhibitor transfection,the miR-346 expression were significantly lower compared with NC group,the difference was statistically significant (P＜0.05).The proliferation of two kinds of nasopharyngeal carcinoma cell CNE-1 and CNE-2 were restrained after transfection,the difference showed statistically significant 3 days after transfection (P ＜ 0.05).The apoptosis increased significantly,and the migration cell numbers and invasion cell numbers decreased significantly compared with NC group,the differences were statistically significant (P＜0.05).Conclusion:miR-346 is overexpression in nasopharyngeal carcinoma,down-regu-lation of miR-346 inhibits the proliferation,migration,invasion,promotes the apoptosis,miR-346 may act as a oncogene and play an important role in the pathogenesis of nasopharyngeal carcinoma.

Objective:To analyze the clinical characteristics of functional esophagogastric junction outflow obstruction (EGJOO) and to improve the knowledge of functional EGJOO.Methods:From January 2015 to December 2019, at the Gastrointestinal Motility Center of The First Affiliated Hospital with Nanjing Medical University, 91 patients who underwent high resolution esophageal manometry (HREM) and met the EGJOO criteria of Chicago Classification for esophageal motility disorders, 3rd edition and excluded organic diseases by examination such as gastroscopy or upper gastrointestinal radiography were collected. The clinical manifestations, treatment methods, effect and clinical outcome of patients with functional EGJOO, the HREM parameters of patients with different clinical manifestations as well as symptoms and HREM parameters of patients with different treatments were analyzed. Least significant difference test or Tamhanes T2 test, Mann-Whitney U or Wilcoxon test, chi-square test or Fisher exact test were used for statistical analysis. Results:The most common symptom of 91 functional EGJOO patients was dysphagia (34/91, 37.4%). The lower esophageal sphincter pressure (LESP) and the intrabolus pressure during relaxation of the lower esophageal sphincter (IBP LESR) of patients with dysphagia were both higher than those of patients without dysphagia (30.95 mmHg (26.27 mmHg, 39.37 mmHg) (1 mmHg=0.133 kPa) vs. 27.35 mmHg (24.60 mmHg, 34.87 mmHg); (8.25±4.64) mmHg vs. (5.69±4.65) mmHg), and the differences were statistically significant ( Z=2.076, t=2.539; P=0.038, 0.013). Thirty patients (33.0%) had no special treatment, 52 patients (57.1%) were treated with medication, and nine patients (10.0%) underwent peroral endoscopic myotomy (POEM). The incidence of dysphagia before treatment and maximum intrabolus pressure of patients who underwent POEM were both higher than those of patients without special treatment and medication treatment (8/9 vs 43.3%, 13/30 and 25.0%, 13/52; 21.80 mmHg (15.45 mmHg, 28.95 mmHg) vs. 12.20 mmHg (10.00 mmHg, 18.10 mmHg) and 13.70 mmHg (11.07 mmHg, 17.82 mmHg)), and the differences were statistically significant (Fisher exact test, Fisher exact test; Z=2.814, 2.390; P=0.023, P<0.01, P=0.005, 0.017). The incidences of delayed esophageal emptying or esophageal dilation of patients who underwent POEM, without special treatment and with medication treatment was 6/9, 5/14 and 3/18, respectively, and the differences were statistically significant among three groups (Fisher exact test, P=0.039). Among them, the incidence of delayed esophageal emptying or esophageal dilation of patients received POEM before treatment was higher than that of patients with medication treatment (Fisher exact test, P=0.026). The symptoms of 24.2% (22/91) was spontaneously relieved, and two patients (2.2%) developed type Ⅱ achalasia during follow-up. Conclusions:The main manifestation of patients with functional EGJOO is dysphagia. Patients with significantly increased LESP and IBP LESP are more likely to have dysphagia. Patients with obvious signs of esophageal gastric junction obstruction are more inclined to choose POEM treatment. Some patients with functional EGJOO can relieve themselves, and a few patients can develop achalasia.

AIM:To investigate the effect of activation of retinoid X receptor (RXR) on transforming growth factor β1 (TGF-β1) induced collagen synthesis under hypoxic environment in rat cardiac fibroblasts (CFs) and underlying molecular mechanisms .METHODS: CFs were cultured using myocardial tissue with dry method .Hypoxic environment was established for CFs by continuous nitrogen supplement .Type I and type III collagens in supernatants were detected by ELISA.Nuclear and cytoplasmic extractions were prepared using NE-PER nuclear and cytoplasmic extraction reagents .The protein levels of Smad2 and p-Smad2 were determined by Western blot and immunocytochemical staining .RESULTS:Un-der hypoxic condition , TGF-β1 (0.01~10 μg/L) increased the synthesis of type I and type III collagens in a dose-de-pendent manner in the CFs .At the concentration of 5μg/L, the synthesis of collagen I and III was significantly increased as compared with control group (P<0.01).RXR agonist 9-cis-retinoic acid (9-cis-RA;10 -9 ~10 -6 mol/L) decreased TGF-β1 (5μg/L)-induced synthesis of type I and III collagens in a dose-dependent manner in the CFs under hypoxic con-dition.The synthesis of type I and type III collagens was significantly inhibited by 9-cis-RA (P<0.01).Smad2 inhibitor ( 20 nmol/L) showed similar inhibitory effect on the synthesis of type I and III collagens induced by TGF -β1 under hypoxic condition.Compared with TGF-β1 intervention group, the cytoplasmic level of p-Smad2 in the CFs was significantly in-creased in TGF-β1+9-cis-RA group, but the nuclear p-Smad2 level was significantly decreased (P<0.05).CONCLU-SION:Retinoid X receptor agonist 9-cis-RA inhibits TGF-β1-induced synthesis of type I and type III collagens in the CFs by repressing p-Smad2 nuclear translocation under hypoxic condition .

Objective:To study the effect of continuous blood purification on inflammatory state and immune response in patients with multiple injury and sepsis.Methods:88 patients with multiple injury and sepsis who were treated in our hospital from January 2015 to May 2016 were selected as the research object,they were divided into the control group (n=44) and observation group (n=44) according to random number table method.The control group was given conventional treatment,and the observation group was given continuous blood purification treatment.The acute physiology and chronic health conditions Ⅱ (APACHE Ⅱ)score was observed in two groups Ⅱ at 3 d after treatment.The serum content of Interleukin-2(IL-2),Interleukin-4(IL-4),Interleukin-10(IL-10) and interferon-γ (IFN-γ) were detected by ELISA method.The levels of CD3 +,CD4 +,CD8 + and NK cell were analyzed by flow cytometry.The urea nitrogen (BUN),serum creatinine (Scr),prothrombin time (PT),thrombin time (TT),activated partial blood coagulation time (APTT) were tested by automatic biochemical analyzer.Results:The APACHE Ⅱ score,BUN and Scr levels in observation group were lower than the control group (P＜0.05).The content ofIL-2,IL-4,IL-10 and IFN-γ in observation group were lower than the control group (P＜0.05).The levels of CD3+,CD4+,CD8+ and NK in observation group were higher than the control group (P＜0.05).The levels ofPT,TT and APTT in observation group were lower than the control group (P＜0.05).Conclusion:Continuous blood purification in patients with multiple injury and sepsis had better clinical curative effect,can reduce inflammation,improve immune function and the function of blood coagulation.