Objective This study was designed to explore the effect of hyperglycemia on the expression of Toll-like receptor 4 (TLR4 ) in renal tubular epithelial cells and its significance in diabetic nephropathy. Methods In vitro cultured renal tubular epithelial cells ( NRK-52E) were divided into LG group (cultured in 5mmol / L glucose DMEM) and HC group (cultured in 25mmol / L glucose DMEM). Cells were harvested at different time points. Immunohistochemistry, Rt-PCR, Western Blot were used to detect TLR4 protein and mRNA expression, and the levels of IL-6 and TNF-α from the cell culture supernatant were determined by EL1SA assay. Results After 6 hours, there was increased expression TLR4 mRNA in HC group, which appeared to be maintained for 24 hours and began to decrease after 48 hours ( P < 0.05). TLR4 protein expression increased in HC group after 24 hours, and increased even further after 48 hours. Compared with LG groups, the difference had statistical significance ( P <0.05). In HG group, IL-6 and TNF-α expression in the supernatant from the NRK-52E culture were significantly increased ( P < 0.05) , and the expression of IL-6 and TNF-α was positive correlated with the expression of TLR4 protein ( r =0.799,0.820). Conclusion High glucose triggers an increase in expression of TLR4 in NRK-52E cells, itself leading to an increase in expression of inflammatory factors such as TNF-α and IL-6. In this way, TLR4 participates in the progress of diabetic nephropathy.

Aim To investigate the immunomodulatory effects of sea cucumber fucoidan ( SC-FUC) on macro-phage and the signaling pathways. Methods Cell via-bilities in response to different concentrations of SC-FUC were analyzed by MTT, phagocytosis ability was detected by neutral red,and nitric oxide ( NO) produc-tion was examined by Griess reaction kit. The mRNA expression levels of IL-6 , IL-10 , Toll-like receptors (TLRs) and related signal molecules MyD88, TRIF, NF-κB were assayed by real-time PCR. All the experi-ments were based on murine RAW264. 7 cell line. Re-sults SC-FUC could promote RAW264 . 7 cell prolif-eration, phagocytosis as evidenced by uptake of neutral red and release of NO. The effects were significant at the early stage (6 h and 12 h) . SC-FUC could up-reg-ulate the expression of IL-6 , IL-10 , TLR4 , TLR5 , TLR9. Moreover, mRNA expressions of TLRs signaling molecules were increased, as well as MyD88, TRIF, NF-κB. Conclusions SC-FUC could activate macro-phage, and then promote the immune function by pro-moting production or expression of NO, IL-6, IL-10. It is speculated to be relevant to activated cell surface re-ceptors in macrophage, including TLR4, TLR5, TLR9, and NF-κB signaling pathways.

Objective To investigate the relationship and clinical significance between circulating soluble low-density lipoprotein receptor family member 11 (sLR11) level,type 2 diabetes (T2DM) and carotid intima-media thickness (CIMT). Methods Newly diagnosed patients with T2DM (T2DM group,n=55)and healthy controls (NC group,n=55)were enrolled in this study. The sLR11 level was measured by ELISA. The level of sLR11,CIMT,age,blood lipid,and blood pressure were compared between the two groups. Another 165 patients with T2DM treated with conventional pharmaceutical medications were also selected in this study. The relationship between sLR11,CIMT and atherosclerosis were analyzed. The influences of sLR11 and FPG in the progress of CIMT were also evaluated. Results The sLR11 level and CIMT were higher in T2DM group than in NC group [(8.35 ± 2.65) vs (6.64 ± 1.99)ng/ml,P= 0.026;(0.87 ± 0.37) vs (0.73 ± 0.26) mm,P= 0.037]. In the 165 patients with T2DM,the level of sLR11 and CIM T were(9.79 ± 3.54)ng/ml and (0.79 ± 0.18)mm respectively. Correlation analysis showed that sLR11 levels were positively correlated with age,systolic blood pressure, LDL-C,fasting plasma-glucose (FPG),and HbA1c (r = 0.226,0.162,0.166,0.276,0.176). Multivariate linear regression analysis indicated that FPG was an independent risk factor for sLR 11 (β=0.175,P<0.05),and sLR11 was a independent risk factor of CIMT in the absence of age factor (β=0.008,P<0.05). Conclusion The sLR11 level may relate to blood glucose in T 2DM,and reflect the situation of CIM T and the pathological status of vessel intimal smooth muscle cells (SMCs).

The image segmentation method we use for leucocytes is based on image distance transformation, combining the region and edge approach, taking full advantage of image information. According to the shape, texture and color appearance of cells, we select 22 feature values and measure them. The classifier is designed on the statistical classification. A test for recognizing 831 leucocytes in 560 images shows that the classification accuracy is 96%. Clinical experts confirm this system; for it can automatically recognize leucocytes by pattern recognition technique, and it is demonstrably valid in practice.
Algorithms ; Artificial Intelligence ; Humans ; Leukocytes ; cytology ; Pattern Recognition, Automated ; methods

Objective To investigate the effect of specific cGMP-dependent protein kinase G (PKG) inhibitor (D)-DT-2 on the contractile function of rat vascular rings after being exposed to lipopolysaccharide (LPS).Methods The experiment was performed in 2 parts.Part Ⅰ:The Sprague-Dawley rat thoracic aortic rings were randomly divided into 3 groups (n =5 each):KH group,DT-2 group and (D)-DT-2 group.KH,DT-2 and (D)-DT-2 were added to the aortic ring after being dilated with 8-Br-cGMP 50 μmol/L for 25 min and the changes in tension of vascular rings were measured.Part Ⅱ:The rat thoracic aortic rings were randomly divided into 4 groups (n =5 each):control group,LPS group,LPS-DT2 group and LPS-(D)-DT2 group.After being incubated with LPS for 3 h in vitro.The Emax and EC50 were compared among the 4 groups.Results Part Ⅰ:Both DT-2 and (D)-DT-2 could contract the vascular rings dilated with 8-Br-cGMP and the Emax was significantly higher in (D)-DT-2 group than DT-2 group (P ＜0.05).Part Ⅱ]:Both DT-2 and (D)-DT-2 significantly improved the contractile function of vascular ring after being exposed to LPS.Emax was significantly higher,while EC50 was lower in groups DT-2 and (D)-DT-2 than in LPS group (P ＜0.01).Emax was significantly increased,while EC50 was decreased in LPS-(D)-DT-2 group as compared with LPS-DT-2 group (P ＜ 0.05).Conclusion PKG inhibitor can improve the contractile function of the vascular rings incubated with LPS and the efficacy of (D)-DT-2 is better than DT-2 in recovering the vascular reactivity.

Objective To investigate the safety, feasibility and results of laparoscopic assisted distal radical gastrectomy for gastric cancer. Methods Twenty-three cases of gastric cancer were subjected to laparoscopic assisted distal radical gastrectomy, D_(1+α)/D_(1+β) lymphadenectomy on 3 cases and D_2 lymphadenectomy on 20 cases. All cases received Billroth I reconstruction. Results Laparoscopic assisted distal radical gastrectomy was carried out in all cases successfully. The mean operative time was (205 ±38 )min, mean blood loss was (105 ± 66) ml and mean number of lymph nodes dissected was 19.7 ± 6.2 each case. The mean postoperative time of recovery of bowel function was (3.5 ±1.2) d,mean postoperative time of liquid intake was (4.9 ±0.9) d and mean hospitalization was (10.2 ± 2.7) d. No postoperative death or anastomotic fistula was found. Postoperative upper gastrointestinal bleeding occurred in 1 case and was cured by conservative treatment. Follow-up for 1-12 months revealed no recurrence or metastasis. Conclusions Laparoscopic assisted distal radical gastrectomy is a safe and feasible procedure with satisfactory short-term outcomes.Moreover,the short-term outcomes may be improved if the patients are treated under the notion of fast track surgery.

Objectives To investigate the changes of cystatin C in the serum of patients with acute kidney injury ( AKI) or end-stage renal disease ( ESRD), and study its significance in the early diagnosis of AKI and its correlation with the degree of renal function injury. Method The cases in Xiangya hospital were enrolled in this study according to the RIFLE criteria, including 20 cases of slight acute kidney injury, 30 cases of medium-severe acute kidney injury, 48 cases of victims of the 5. 12 wenchuan earthquake, 32 cases of end-stage renal disease and 20 healthy patients. The microparticle-enhanced immunoturbidimetry method was used to detect serum cystatin C, and the colorimetric method was used to detect urine N-acetyl-beta-D-glucosaminidase (NAGase). The enzymic method was used to detect serum creatinine. The correlation between serum cystatin C and serum creatinine was analyzed, and the sensitivity and specificity of serum cystatin C were evaluated with the receiver operator characteristic curve (ROC curve). Results Compared with healthy control group, the serum cystatin C increased obviously in acute kidney injury group and ESRD group( P <0. 05 and P <0. 01). The serum cystatin C was positively correlated with serum creati-nine( P <0.01). The serum cystatin C in the 5. 12 wenchuan earthquake injured group was also higher than that in healthy control group ( P <0.05), an the serum cystatin C had an AUC - ROC of 0.931 ( P <0. 01). Conclusion Compared to the conventional biomarkers, the earlier emergence of serum cystatin C can contribute better to early clinical diagnosis of AKI. The serum cystatin C is positively correlated with renal function, and reflect changes in renal function accurately.

Objective:To study our initial experience on feasibility and safety of magnetic compression anastomosis in laparoscopic pancreaticoduodenectomy(LPD).Methods:A retrospective analysis was conducted on the data of 7 patients who underwent LPD with laparoscopic magnetic compression choledochojejunostomy (LMC-CJ) or pancreaticojejunostomy (LMC-PJ) at the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi’an Jiaotong University from May 2018 to September 2019. There were 6 males and 1 female. The median age of patients was 63 (56-83) years. Data analyzed included the model of the magnetic anastomosis device, operation time of the LMC-CJ or LMC-PJ, other operation-related parameters, postoperative complications, time to perform magnetic anastomosis, and time of discharge of the magnet from patients’ body.Results:All 7 patients completed LPD successfully, including 7 LMC-CJ and 2 LMC-PJ. The median operation time was 340 (310-450) minutes. The median diameter of the biliary-enteric magnetic anastomosis ring used was 10 (9-12) mm, and the median time of the biliary-enteric magnetic anastomosis was 11 (8-16) min. The diameter of the pancreaticojejunal magnetic anastomosis ring was 5 mm in the two anastomoses, and the times taken were 12 min and 15 min. Complications occurred in 4 patients, including 1 patient each for grade A and grade B pancreatic fistula, 2 patients with abdominal infection, 2 patients with postoperative gastric emptying disorder, and 1 patient with abdominal hemorrhage. All patients responded to conservative treatment. There was no biliary or pancreatic fistula at the magnetic anastomoses. Pancreaticojejunostomy functioned at 24 and 30 days after operation. The median time for the magnets to pass out from the body of all patients was 50 (40-170) days. The median follow-up was 11 (4-18) months. No biliary-enteric or pancreaticojejunostomy stenosis was detected.Conclusion:Magnetic compressive anastomosis was simple, feasible, and safe for choledochojejunostomy or pancreaticojejunostomy in LPD.

Surgical treatment for bone and soft tumors of pelvis and sacrum presents a big challenge, because of the complex anatomy of sacropelvic region, large tumor volume at presentation, rich blood supply to the tumor and visceral involvemen, et al. Therefore, surgical excision and reconstruction are technically difficult for sacropelvic tumors. Extensive intraoperative haemorrhage could be life-threatening, and this issue remains a major concern. How to effectively control bleeding during surgery is critical for successful operation and patient's favorable prognosis. Some previous attempts, such as interventional selective internal iliac artery embolization or manual ligation through an additional anterior approach, were tested to be ineffective. Inspired by the success of resuscitative endovascular balloon occlusion of the aorta (REBOA) which resemble an endovascular tourniquet for traumatic hemorrhagic shock, some researchers have applied this techinique to control surgical bleeding during pelvic or sacral tumor resection.The authors have performed REBOA for more than 1 500 sacropelvic tumr surgeries since 2003 in Peking University People's Hospital. The patient age, the diameter of femoral artery and aorta, atherosclerosis, as well as tumor location, volume and expansion and blood suppy, have to be thoroughly evaluated prior to REBOA administration. Admittedly, the application of REBOA do reduce intraoperative bleeding, shorten the operation duration, improve the safety of surgery, yet some complications were observed including local hematoma at the puncture site, acute arterial thrombosis, femoral artery pseudoaneurysm or occlusio, et al. The purpose of this study is to review the literature on REBOA administration in pelvic and sacral tumors excision, with the focus on its indications, performing procedure, the safety and efficacy, and complications. Moreover, in order to popularize the clinical application of aortic balloon occlusion in the future, we summarize our experience of abdominal aortic balloon occlusion over 10 years.

Objective To estimate the application value of a standard operating procedure (SOP) in the detection of syphilitic anticardiolipin reagin. Methods Clinical laboratories from 9 local hospitals in Shanghai participated the program. Quality control samples with unknown target value were qualitatively and quantitatively examined according to the uniform SOP in these laboratories with the same reagent and facility of horizontal reaction. External quality assessment (EQA) was carried out by using seven serum samples with no, or low (1∶ 128 dilution) to high (1∶1 dilution) concentrations of target before and after the implementation of SOP. The test results were statistically analyzed and the reasons for the detecting error were assessed. Results A total of 388 tests were performed in the 9 clinical laboratories. The total accuracy rate was 93.0%, including 40.2% in the detection of samples with 1 ∶ 8 dilution of target, 49.2% in the detection of samples with 1 ∶ 16 dilution of target, and 3.6% in the detection of samples with 1 ∶ 32 dilution of target. No forward bias was observed in these tests. There was a significant difference in the accuracy rate between the two times of EQA before and after the implementation of SOP (x2 = 4.17, P < 0.05). Conclusions The improved standard procedure for nontreponemal antigen test is beneficial to the decrease of testing error, and may provide a basis for the establishment of SOP and implementation of internal quality assessment.