Objective To explore the influence of different hemodialysis ways on cognitive function in the patients with end-stage renal failure(ESRF) in maintenance dialysis.Methods Choosing 68 ESRF patients who needed maintenance dialysis were divided into high flux dialysis group and normal flux dialysis group,34 cases in each group.The P300 lantency period(LP) and amplitude(Amp),mini-mental status examination(MMSE) scale were applied to examine the patients in the two groups before treatment,1 month and 6 months after treatment,respectively.Results The P300 LP and Amp in high flux dialysis group and low flux dialysis group were(398.6?38.5)ms,(7.3?1.21)?V vs(410.3?49.7)ms,(6.9?1.03)?V before the treatment;and(336.8?32.1)ms,(8.2?1.15)?V vs(342.6?35.8)ms,(7.9?1.01) ?V 1 month after treatment.There were no significantly differences between the two groups.6 months after treatment,the P300 LP and Amp of high flux dialysis group and low flux dialysis group were(320.6?31.9)ms,(8.5?1.02) ?V vs(390.6?42.8)ms,(6.5?1.12)?V.There were significantly differences between the two groups(all P

Objective To discuss the mechanism about exercise preconditioning (EP) protected myocardium by means of regulate NLRP3 inflammasome signal pathways on exhausted exercise rats. Methods The male Sprague-Dawley (SD) rats were randomly divided into four groups: normal control group (C group), no EP on exhausted exercise group (EE group), 3dEP + EE group, and 3wEP + EE group, with 12 rats in each group. In C group and EE group, the rats had not done exercise, while EE group took an exhausted swimming exercise with 3% heavy weight on tail at the end of 3 weeks; 3dEP + EE group and 3wEP + EE group exercised according to the standard of swimming for 60 minutes every day (swam 15 minutes, took a rest for 5 minutes, repeated 3 times), 6 days in a week, and were trained for 3 days and 3 weeks respectively, and took an exhausted swimming exercise on the last day. A light microscope and electron microscope were used to observe the myocardial histopathology and ultrastructure change, and enzyme linked immunosorbent assay (ELISA) was used to detect the levels of serum interleukin (IL-1β, IL-18, IL-6), hypersensitive C-reactive protein (hs-CRP), MB isoenzyme of creatine kinase (CK-MB), and brain natriuretic peptide (BNP). The protein expressions of NLRP3 and caspase-1 were detected by Western Blot. The correlations among all the parameters were analyzed by Pearson correlation analysis. Results Under the light microscope and electron microscope, the myocardial fiber morphological structure was normal, neatly, and no interstitial edema, muscle membrane damage or myocardial cell swellen was found in C group. In EE group, heart tissues were stained obviously uneven, a large number of myocardial fibers were fractured and messed, interstitial fibers were hyperplasiaed and edema moderately, much of myocardial cells were edema and necrosis, inflammatory cells were infiltrated, the number of average infiltration inflammatory cells was highest, mitochondria were edema seriously, part of the crest and a small number of membrane were blended together, fuzzy and crest were fractured, sarcomere were disordered; 3dEP + EE group and 3wEP + EE group heart tissues injuries were obviously alleviated, among the three groups, and the best results were in 3wEP + EE group. Compared with C group, the serum contents of IL-1β, IL-18, IL-6, hs-CRP, CK-MB, BNP and heart tissues protein expressions of NLRP3 and caspase-1 in EE group were significantly increased [IL-1β (μg/L): 18.77±1.28 vs. 12.00±1.55, IL-18 (μg/L): 236.79±15.73 vs. 150.74±7.09, IL-6 (μg/L): 59.31±9.17 vs. 34.65±2.89, hs-CRP (mg/L): 469.37±137.73 vs. 107.15±14.22, CK-MB (U/L): 15.57±0.91 vs. 7.40±0.40, BNP (ng/L): 532.08±63.44 vs. 386.96±34.77, NLRP3 protein (gray value): 0.66±0.07 vs. 0.16±0.06, caspase-1 protein (gray value): 0.96±0.08 vs. 0.48±0.06, all P < 0.01]. Compared with EE group, the above indicators in 3dEP + EE group and 3wEP + EE group were remarkably decreased, each index in 3wEP + EE group was lower than that in 3dEP + EE group except BNP [IL-1β (μg/L): 14.26±1.42 vs. 16.57±1.81, IL-18 (μg/L): 168.49±7.05 vs. 191.92±14.16, IL-6 (μg/L): 32.62±3.81 vs. 45.61±6.20, hs-CRP (mg/L): 207.06±41.68 vs. 339.56±89.65, CK-MB (U/L): 9.97±1.08 vs. 13.10±0.78, NLRP3 protein (gray value): 0.33±0.07 vs. 0.48±0.06, caspase-1 protein (gray value): 0.65±0.06 vs. 0.79±0.02, all P < 0.01; BNP (ng/L): 432.53±32.03 vs. 478.46±44.79, P > 0.05]. A positive correlation was shown among IL-1β, IL-18, IL-6, hs-CRP, BNP, CK-MB, NLRP3, and caspase-1 (all P < 0.01). Conclusions EP can reduce inflammatory reaction by regulating the NLRP3 inflammatory signal pathways, and protect the myocardial injury. The protection of the heart by long-term EP is more obvious than that of short-term EP.

Objective To evaluate the safety and efficacy of QUILLTM self-retaining suture (QUILLTMSRS) in laparoscopie partial nephrectomy.Methods Sixty-three patients (39 males,24 females) with renal tumor accepted laparoscopic partial nephrectomy in Peking Union Medical Hospital from February 2012 to January 2013.The ages ranged from 38 to 75 years.The tumor sizes varied from 1.5 cm to 4.5 cm.According to the device of renorrhaphy,they were divided into 2 groups.Vicryl suture was used for renorrhaphy in 32 patients (Group 1),and QUILLTMSRS was used in 31 patients (Group 2).Renorrhaphy was performed in two layers for both groups,with a closure of deep vessels and the collecting system with 4-0 absorbable suture,followed by a running closure of the renal parenchyma and renal capsule.Demographical and perioperative parameters including age,body mass index,tumor size,R.E.N.A.L score,estimated blood loss,warm ischemic time,length of hospital stay were recorded and compared between the 2 groups.Results Renorrhaphy was successfully performed in all the 63 cases without conversion to open procedure or nephrectomy.The estimated blood loss and length of postoperative hospital stay were not significantly different between the 2 groups (P＞0.05).But warm ischemic time was significantly shorter in QUILLTM SRS group than that in Vicryl group (22.2 vs 26.7 min,P＜0.001).Conclusions QUILLTMSRS could be safe and effective for renorrhaphy in laparoscopic partial nephrectomy.It could make laparoscopic renorrhaphy easier and reduce warm ischemic time significantly.

Objective To study the role of heparin-binding protein (HBP) in sepsis-associated acute respiratory distress syndrome (ARDS),and to evaluate the prognostic value of HBP in ARDS.Method Sixty seven sepsis patients were enrolled in the prospective study.According to whether present ARDS,patients were divided into two groups:ARDS group and non-ARDS group.Blood samples were obtained within 2 hours after patients were diagnosed with sepsis.We measured the level of interleukin-6,interleukin8 and HBP by ELISA,counted the number of polymorphonuclear neutrophils (PMN),and calculated Acute Physiology and Chronic Health Evaluation Ⅱ score.We compared interleukin-6,interleukin-8,PMN and HBP between two groups by Student's t test.Correlation analysis was studied between HBP and other indicators by Spearman rank correlation coefficient.We also studied the early prognostic value on sepsisassociated ARDS by establishing receiver operating characteristic (ROC) curve.Results Interleukin-6 (t=4.25,P＜0.01),interleukin-8 (t=10.10,P＜0.01),PMN (t=3.47,P=0.0009) and HBP (t =0.0225,P =2.336,all showed significant difference between ARDS group and non-ARDS group.Interleukin-6 (r=0.535,P=0.002),interleukin-8 (r=0.419,P=0.017) and PMN (r=0.419,P =0.017) all had positive correlation with HBP.The area under curve (AUC) of HBP predicting ARDS was 0.796.Conclusions HBP level elevated in sepsis-associated ARDS patients and were correlated with interleuki-6,interleuki-8 and PMN.HBP show a high value on predicting emergence of sepsis-associated ARDS.HBP may play an important role in sepsis-associated ARDS pathological process.From this study we can conclude one of possible ARDS pathogenesis:inflammatory mediators,such as interleuki-6,interleuki8,activate PMN.Subseqoently PMN releases HBP.Then HBP resolts in vascolar leakage,which is one of the basic ARDS pathology.

Objective To investigate the feasibility of ultrasound-guided interscalenus brachial plexus block used for the emergency surgery.Method From August to December 2007 80 patients from the Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou,ASA Ⅰ to Ⅲ,age 18 to 68 years old,weight 45 to 75 kg,without deformity on the shoulder or neck,without limb paresthesia,without contraindications of interscalenus brachial plexus block,were scheduled for emergency surgery of upper limb.They were randomly divided into two groups:interscalenus block guided by ultrasound group(group U,re =40)and nerve stimulator group(group N,re = 40).Patients of both groups received 20 mL mixture of 0.75%ropivacaine and 2%lidocaine.The onset time,and the analgesic efficacy of axillary nerve,lateral antebrachial cutaneous nerve,radial nerve,median nerve,median cutaneous nerve of arm,median antebrachial cutaneous nerve and ulnar nerve,and duration of anesthesia were observed.Statistical analysis was performed by t test,rank sum test and X2 test.Results The onset time of analgesia after nerve block was shorter in group U than that in group N(P＜0.01).The rate of perfect analgesia after nerve block in group U was higher than that in group N(100%vs.87.5%,X2 = 5.267,P = 0.027).The duration of anesthesia lasted in group U was(378 ± 151)minutes and that in group N was(365 ± 163)minutes(t= 0.363,P = 0.718).ConclusionsCompared with the method of nerve block guided by nerve stimulator,the ultrasound-guided interscalenus block offers faster onset and better analgesic efficacy.It is an ideal technique of brachial plexus block for the emergency surgery.

Objective To objectively evaluate the endpoint ot transcatheter arterial chemoembolization (TACE) using two dimensional color-coded digital subtraction angiography (2D-ccDSA).Methods Retrospective analysis of twenty-four patients diagnosed with hepatocellular carcinoma (HCC),treated by TACE and evaluated by post-processed 2D-ccDSA.All patients were examined by DSA before and after TACE procedure,all these DSA series were converted into color-code images,the time density curve (TDC) was derived from the 2D-ccDSA imaging.Time-to-peak (TTP) was measured for the ostia of the catheter,the origin of the tumor feeding artery (TFA) and the embolized site of the TFA; maximal TDC enhancement was measured for selected spots of the tumor parenchyma.The tumor blood supply time (TBST) for pre and post-TACE was calculated accordingly.Data were interpreted with paired t test using SPSS.Results The TTP of the ostia of the catheter and the origin of the tumor feeding artery (TFA) before TACE were (3.47 ± 0.96) and (4.09 ± 1.09) s,after the TACE were (3.49 ± 1.02) and (3.78 ± 1.05) s,respectively.There was no statistical difference between the pre-and post-procedural TTP of the two landmarks (t values were 0.10 and 1.15,P values were 0.92 and 0.26).TTP at the embolized site of the main TFA were [(4.62± 1.16) and (5.59± 1.57)s]for pre and post-TACE,the tumor blood supply time (TBST) was greatly delayed compared with that after the TACE procedure [(1.82± 1.10)s and (0.52±0.41)s].The mean maximal TDC enhancements of the tumor parenchyma areas were (3.03±0.88)units before TACE and (1.10±0.67)units after TACE.The differences were all statistically significant (t values were 3.32,6.04 and 8.93,respectively,P＜0.01) Conclusion It is feasible to use 2D-ccDSA to objectively assess the endpoint of TACE procedures.

Objective To investigate the effects of captopril on cardiac function and levels of energy-rich phosphates in pressure overload induced left ventricular hypertrophy rats. Methods One hundred and twenty SD rats were randomly divided into three groups: sham operation group (SH group, n=40),coarctation of abdominal aorta group (CAA group, n=40) and captopril treatment 1 mg· 1001·d-1) group (CAP group, n=40). Left ventricular end-diastolic pressure (LVEDP), left ventricular mass index (LVMI), levels of energy-rich phosphates and morphological changes of the myocardial mitochondria were compared at the 6th and 8th week after operation. Results At 6th week, in CAA group, LVMI and LVEDP were increased and ±dp/dtmax was decreased, while ATP and ADP were decreased and AMP was increased (P<0.01). These changes were much obvious at 8th week (P<0.01). Compared with those of CAA group, the parameters of heart function and energy-rich phosphates (ATP, ADP, AMP, TAN) in CAP group were improved significantly(P<0.01) at the 6th and 8th week. In CAP group, the parameters of heart function and energy-rich phosphates (ADP, AMP, TAN) were much better at 8th week than those at 6th week. The morphological change of mitochondria was less in CAP group than that in CAA group. Conclusion Captopril significantly improves myocardial energy metabolism in pressure overload rats and protects the function of myocardial mitochondria.

Objective To analyze the clinical significance of four kinds of microalbuminuria detection in early diagnosis of iodinated contrast agent damage to kidney by studying four elements in the patients' urine:microalbumin (mAlb),immunoglobulin G (IgG),α1-microglobulin (α1-MG) and β2-microglobulin (β2-MG).Methods 106 patients who have received percutaneous coronary interventional therapy were chosen and divided into group A(angiography dose ＜ 100ml,n =51) and group B (angiography dose ≥ 100ml,n =55) according to the amount of contrast agent used.Changes in the amount of mAlb,IgG,α1-MG and β2-MG levels,serum creatinine(Scr),endogenous creatinine clearance rate(eGFR) in the urine of the patients before and after the surgery were observed.Results Postoperative α1-MG and β2-MG levels in the urine of group A higher than before surgery (t =-6.748,-11.173,all P ＜0.0 5).2 4 hours after the surgery,mA1b,IgG,α1-MG and β2-MG levels in group B were elevated than before surgery,and the differences were significant(t =-6.223,-3.518,-11.532,-10.773,all P ＜ 0.05).Two groups had significant differences in terms of mAlb,IgG,α1-MG and β2-MG levels after the surgery (F =27.306,4.704,5.118,19.011,all P ＜ 0.05).Conclusion Four kinds of microalbuminuria detecting are conducive to early diagnosis of iodinated contrast agent damage to kidney and assessing the damage degree.The contrast agent damage to kidney first occurs as the renal tubular damage.When the contrast agent was used at a dosage of more than 100ml,glomerular damage occurred.

Objective To understand the molecular characteristics of human-derived non-O157 Shiga toxin-producing Escherichia coil (STEC) strains circulating in five regions of China.Methods Twenty-seven non-O157 STEC strains isolated in five geographic regions were investigated by serotyping, stx1/stx2 subtyping and PCR screening for adhesion and other virulence genes.A multilocus sequence typing (MLST) scheme provided by E.coil MLST database were performed to amplify and sequence seven housekeeping genes (adk, icd, fumC, rgyrB, purA, mdh and recA) in those strains.Results Twenty-seven non-O157 STEC strains were typed into 16 O∶H serotypes.Among those strains, 11 harbored stx1a, 12 harbored stx1c, two harbored stx2e and the other three strains respectively harbored stx1a+stx2b, stx2d and stx2g.Positive rates of eae, efa1, saa, paa, toxB, astA and ehxA genes were 18.5%, 18.5%, 29.6%, 22.2%, 11.1%, 11.1% and 25.9%, respectively.The 27 strains were typed into 16 different sequence types (STs) based upon MLST.Conclusion Human-derived non-O157 STEC strains circulating in five regions of China are heterogeneous in their serotypes, stx1/stx2 subtypes and virulence gene profiles.

ObjectiveTo explore the protective effect of low molecular dextran combined with salvia miltiorrhiza injection against kidney damage from contrast agent after percutaneous coronary intervention(PCI) and the effect of preventing kidney damage.Methods120 patients who underwent PCI were randomly divided into two groups:the treatment group( low molecular dextran combined with salvia miltiorrhiza treatment) and the control group,each group 60 cases.The control group was given the conventional treatment,and the treatment group was treated with 250ml low molecular dextran and 16ml salvia miltiorrhiza injection for 7d on the basis of conventional treatment.The levels of blood urea nitrogen ( BUN ),serum creatinine ( SCR),β2 microglobulin ( β2-MG),24h urine protein were detected before and 1 d,6d after surgery.ResultsAt one day after application of contrast agent,the levels of BUN,SCR,β2-MG,24h urine protein were increased,and returned to baseline level at 6th day.The levels of BUN,SCR,β2-MG,24h urine protein of the treatment group were significantly lower than those of the control group at 6th day ( P ＜ 0.05 ).ConclusionThe low molecular dextran combined with danshen injection treatment in the perioperative period could effectively reduce the kidney impairment from contrast agent and the incidence of renal insufficiency.