Objective To investigate the roles of fiberoptic bronchoscopy in diagnosis and treatment for infants with refractory and persistent wheezing. Methods From Jun. 2012 to Dec. 2013, 52 hospitalized children with age between four 4 months and 1 year old were recruited for ifberoptic bronchoscopy, who had been wheezing for at least four weeks and treated ineffectively with conventional anti-inlfammatory agents:budesonide and compound ipratropium bromide solution. Then, the pathogenesis of refractory and persistent wheezing was summarized based on clinical features, detection of CT imaging of three-dimensional airway reconstruction and cardiac CT, results of bronchoscopy inspection, and bronchoalveolar lavage lfuid culture. Results Among the 52 cases, 40 were with ground glass-like changes (76.92%) in pulmonary spiral CT testing, 4 with mosaic perfusion syndrome (7.69%), 8 with segmental pulmonary consolidation (15.38%), 8 with obstructive pulmonary emphysema (15.38%), and 1 with left primary bronchial foreign body. In addition, through bronchofibroscopy, there were 52 cases with imlfammation (100%),3 with tracheal stenosis (5.77%), 3 with left and/or right main bronchus stenosis of the external pressure, 18 with bronchomalacia(34.62%), 2 cases with foreign body (3.84%), one in trachea (1.92%), the other in left main bronchus (1.92%), 10 with bronchial mucus plug (19.23%), and 8 (15.38%) with congenital airway malformations (including 3 at tracheal bronchus, 1 at left upper lobe bronchial stenosis and 1 at bronchial Bridge). The culture of bronchoalveolar lavage lfuid were conducted for all patients. The positive rate of bronchoalveolar lavage lfuid was 9.62%(5/52 cases), including 2 cases with tip Escherichia coli, 2 with Haemophilus inlfuenzae, and 1 with Acinetobacter baumannii. Conclusions First, infection is the primary cause of refractory and persistent wheezing, which is persistent in airway resulted from multi-drug resistant bacteriua. Second, refractory and persistent wheezing is often caused by multi-factors including infection, congenital airway malformations, the endogenous and exogenous foreign body, cardiovascular malformation, etc. These factors often lead to dififcult wheezing control. The last, the diagnosis rate of the refractory and persistent wheezing can be improved by combination of ifberoptic bronchoscopy and lung spiral CT.

BACKGROUND: It is difficult to conduct the operation of ossification of ligamentum flavum (OLF) in thoracic spine, and the operation needs complecated operative skill, and unmerited disposal tends to worsen neurological dysfunction.OBJECTIVE: To analyze the operative method for OLF of thoracic spineand functional restoration.DESIGN: Case analysis.SETTING: Department of Orthopaedics, Changzheng Hospital, SecondMilitary Medical University of Chinese PLA.PARTICIPANTS: Totally 56 patients with OLF of thoracic spine, whowere treated at the Department of Orthopaedics, Changzheng Hospital fromAugust 1996 to August 2003.METHODS: The operative therapy was performed in all the patients, and the method was determined by the results of MRI and CT examination: ①The 19 patients, whose OLF in thoracic spine was focal type, and range of lesion did not exceed two segments, were treated with simple resection and decompres sion in posterior wall of vertebral canal. ②Fenestration and sledging-allocating manipulation in the whole piece unilateral lamina of vertebra were carried out in 29 cases involving more than 2 segments. ③If coplanar OLF in thoracic spine combined with protrusion of thoracic spine disc or ossification of posterior longitudinal ligament, decompression of posterior midline approach+posterior lateral approach was performed, totally 8 cases.MAIN OUTCOME MEASURES: Post-operation functional restoration was evaluated with Epstein standard, excellent: recovery of sensation and exercise was near to normal; good: spinal cord function was improved significantly, and permitted to walk with brace; fair: small partial restoration of sensory and motor function, unable to walk; bad: Inefficiency or becoming severe.RESULTS: A total of 55 cases were followed up for more than one year and 1 case only for two months after operation. ①Functional restoration: excellent: 39 cases; good: 8 cases; fair: 5 cases; bad: 4 cases. ②Symptom recovery after operation was confirmed by disappearance of tight sensation, reduction of muscular tension, relieving of numbness in order. ③The recovery was rapid for 3 to 6 months after operation. Part of patients' condition was still ameliorating during one year after operation, and rare advancement 2 years later. The recovery of complete paraplegics was bad, so was the severe paraplegia with long history. CONCLUSION: Compressive myelopathy caused by OLF in thoracic spine should be treated in an earlier period by operation. Resection and decompression of posterior wall of thoracic spine and decompression of posterior approach could be choosed according to different condition.

Objective To investigate the effect of mycophenolic acid on the proliferation of smooth muscle cells (SMCs) in rats' pulmonary arterial at cellular level. Methods Growth curve, MTT tests, and flow cytometry were used to detect the number of proliferative cells, the A-value of living cells and the DNA content of the control and drugs groups respectively and the number of cells in G1-phase, S-phase, G2M- phase and the proliferation index were calculated. Results Compared with the control group, the number of living cells in the mycopbenolic acid groups (with the concentration of 1, 10, 100 μmol/L) decreased, except the lowest dosage group (100 nmol/L). The difference was statistically significant (P<0.01). The living cells measured by MTT dose-dependently reduced in the mycophenolic acid groups. In the mycophenolic acid groups, the fraction of living cells in the S-phase and G2M-phase decreased respectively while that in G1- phase increased, and the proliferation index decreased. All these responses presented with a dose-dependent manner. Conclusion Mycophenolic acid can effectively inhibit the proliferation of rats' pulmonary arterial SMCs. This process happens mainly in ONA synthesis phase, and is dose dependent. In addition, these effective concentrations are all in the available range for clinical application.

Objective To detect the levels of serum uric acid(SUA),lipid and creatinine(SCr) of type 2 diabetes mellitus(T2DM),and discuss the correlation between them and diabetic nephropathy(DN).Methods One hundred and two cases of T2DM patients were selected and divided into three groups based on the level of urine microalbumin(mAlb)/creatinine(Cr):30 cases of N-UAlb group(urine mAlb/Cr＜30μg/mg),41 cases of M-UAlb group(30μg/mg≤urine mAlb/Cr＜300μg/mg)and 31 cases of C-UAlb group(urine mAlb/Cr≥300 μg/mg),detected the SUA,SCr,HbA1c,fasting insulin(FINS),triglyeride(TG)and calculated the creatinine clearance rate(CCr).Selected 40 healthy subjects as control group.Results The SUA level in C-UAlb group[(369.3±181.2)μmol/L]was significantly higher than the other groups [(248.6±109.4)μmol/L in control group;(228.7±104.8)μmol/L in N-UAlb group;(296.5±121.4)μmol/L in M-UAIb group](P＜0.01 or＜0.05),and increased with increment of urine mAlb/Cr.In the whole study population,the Pearson correlation coefficient of SCr,CCr,TG and SUA were 0.369,-0.389.0.525,respectively(P＜0.01).Multiple regression analysis showed that SUA levels in T2DM patients were positively correlated with TG(P＜0.05),and were negatively correlated with CCr(P＜0.05).Conclusions TG and CCr are independent risk factors of SUA.CCr correlates with SUA better than SCr.Diabetic hyperuricemia might affect the process of occurrence and development of DN.There is need for prevention and treatment.

Because of the high morbidity and mortality rate,cardio-cerebrovascular diseases,including cerebral embolism, cerebral hemorrhage,cerebral vasospasm and myocardial infarction,have become main diseases threatening human health. Tradition-al chinese medicine(TCM)holds that the basic pathogenesis is Qi imbalances,which could be improved by benefiting Qi and promot-ing blood circulation. The compatibility of Radix astragali and Radix salviae miltiorrhiae are particularly suitable for treating the car-dio-cerebrovascular system diseases by improving Qi deficiency and blood stasis. This paper focuses on the application of Radix astrag-ali,Radix s. miltiorrhiae and their compatibility for treating the cardio-cerebrovascular system diseases. Moreover,our research would offer valuable references for the development of new drugs related to the treatment of cardio-cerebrovascular system diseases.

Objective To evaluate the effectiveness of intravenous immunoglobulin (IVIG) in critical hand-foot-mouth disease (HFMD).Methods The data from PubMed, MEDLINE, EMBASE, EBSChost, Cochrane Library, Cochrane Central Register of Controlled Trials, Ovid, China Biology Medicine disc, Wanfang Data, China National Knowledge Infrastructure, Chinese Citation Database, and other references and grey literatures were retrieved, screening out all those related to clinical trials on treating critical HFMD by IVIG.Standard methods of the Cochrane Collaboration were employed to evaluate the methodological quality of the trials.Meta analysis was performed with Rev man 5.3 software.Results Eleven trials including 967 cases were investigated.The meta analysis showed that IVIG had significantly clinical efficacy (OR =6.84,95％ CI:3.74-12.52 ,P ＜ 0.05).IVIG could significantly decrease duration of fever (MD =-1.94,95％ CI:-3.07--0.81 ,P ＜0.05) ,hospitalization time (MD =-4.56,95％ CI:-8.95--0.17,P ＜0.05).There was no significant difference in duration of fever (MD =-0.28,95 ％ CI:-0.59-0.03, P ＞ 0.05), duration of herpes (MD =0.18,95％ CI:-0.22-0.59, P ＞ 0.05), hospitalization time (MD =-0.12,95％ CI:-0.47-0.23, P ＞ 0.05) when the dosage of injection was adjusted.Conclusions IVIG is recommended for treating critical HFMD because it is effective in decreasing the duration of fever and hospitalization.Well designed studies with more sample in multi-center are required in further study to explore the efficacy and safety of IVIG on critical HFMD.

Objective To characterize the clinical manifestations and to evaluate the value of the electrophysio-logical examination in patients with peripheral nerves injuries caused by neurobrucellosis. Methods Electrophysiology examination was conducted in 32 patients with peripheral nerve injuries caused by neurobrucellosis and 32 normal controls who had equivalent age and gender. The results were further statistically analyzed. Results There were sig-nificant difference between patients and healthy control group in distal motor latency (DML), compound motor active potentials (CMAP) amplitude, motor nerve conduction velocity (MCV), sensory nerve action potential latency(SL),senso-ry nerve action potential (SNAP) amplitude and sensory nerve conduction velocity (SCV) ( P﹤0.05). Electrophysiology examination revealed peripheral nerve damage of limbs involving, both sensory nerve and motor nerves, of which sen-sory and motor nerve injuries accounted for 55.47% and 16.80%, respectively. Median and sural nerve injuries were most frequently affected in upper (64) and lower limbs (16). Motor and sensory nerve conduction velocity was delayed in 43 nerves (16.80%) of 256 examined motor nerves and in 142 nerves (55.47%) of 256 examined sensory nerves. The damage of the sensory nerves was more severe than those of the motor nerves and damage of nerves in the upper limbs was more severe than those in the lower limbs. Conclusion Electrophysiologoical examination provides objective basis for the diagnosis of peripheral nerve injuries in neurobrucellosis.

Objective To observe the effects of total flavone from litchi chinensis sonn (TFL) on the liver function in-cluding p16 protein, pro collagen type 3 (PC3) and pro collagen typeⅠ(PCⅠ) in model rats with liver fibrosis induced by bile duct ligation. Methods Forty rats were randomly divided into four groups:sham operation (SO) group, bile duct liga-tion (BDL) group, TFL group and silibinin (SIL) group. Rats were gavaged with saline (5 mL·kg-1·d-1) in SO and BDL group, rats were gavaged with TFL (200 mL·kg-1·d-1) in TFL group and rats were gavaged with SIL (5 mL·kg-1·d-1) in SIL group for four weeks. The serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin direct (BILD) and bilirubin total (BILT) were detected in four groups. The liver tissues were stained by HE and Masson methods. The ex-pression levels of p16, PC3 and PCⅠin liver tissues were determined by Western blot assay. Results The serum levels of ALT (44.6 IU/L±8.0 IU/L), AST (103.8 IU/L±18.1 IU/L), BILD (0.76 μmol/L±0.28μmol/L) and BILT (1.48μmol/L±0.35μmol/L) were lower in SO group. There was a higher level of ALT in BDL group (147.4 IU/L±86.3 IU/L) than that of TFL group (92.9 IU/L±47.3 IU/L). The serum level of ALT was higher in AST group (362.7 IU/L±106.6 IU/L) than that of TFL group (290.1 IU/L ± 171.7 IU/L) and SIL group (250.2 IU/L ± 54.9 IU/L). The serum level of BILD was lower in BDL group (99.71μmol/L±40.87μmol/L) than that of SIL group (137.01μmol/L±38.86μmol/L). The serum levels of BILD and BILT were significantly lower in TFL group (81.48μmol/L±47.50μmol/L, 106.64μmol/L±61.04μmol/L) than those of SIL group (P<0.05). There were small amount of new bile duct and no obvious cells degeneration, small amount of infiltration of in-flammatory cells and collagen deposition in TFL group. The liver fibrosis improved significantly in TFL group than that of BDL group. There were more new bile duct in hepatic portal area in SIL group than those of TFL group. The expression levels of p16, PC3 and PCⅠwere significantly higher in BDL group than those of TFL group. The expression level of PC3 was significantly lower in BDL group than that of SIL group. The expression level of PCⅠwas significantly higher in BDL group than that of SIL group (P<0.05). There was no significant difference in the expression level of p16 between BDL group and SIL group. The expression levels of PC16 and PC3 were significantly lower in TFL group than those of SIL group (P<0.05). There was no significant difference in the ex-pression level of PCⅠbetween TFL group and SIL group. Conclusion TFL can improve the liver function in model rats with choles-tatic liver fibrosis and reduce liver fibrosis, which may be related with inhibitory effects on the expressions of p 16, PC3 and PCⅠ.

DNAzymes, screened through in vitro selection, were artificial nucleic acids with catalytic function . They could cleave specific substrates in the presence of cofactors with unique characteristics, such as high catalytic activity, high specificity for cofactors, excellent stability, and easy to synthesize and modify. The combination of DNAzymes with nanomaterials could retain the DNAzyme activity and realize the functional integration of recognition and signal transduction, promoting rapid development of biosensors. In the current paper, we mainly reviewed the recent progress in DNAzyme-nanomaterial based biosensors, and the nanomaterials included gold nanoparticles, graphene, quantum dots, magnetic nanomaterials, and so on.

BACKGROUND: Ossification of intervertebral disc, and ossification of spinal ligament and fibrous tissues are still uncertain.OBJECTIVE: To observe osteogenic potential of fibrous ring in the cervical intervertebral disc during bone fusion.DESIGN, TIME AND SETTING: The comparative observation was performed at the Experimental Animal Center of Second Military Medical University and Shanghai Institute of Orthopedics in October 2006.MATERIALS: Ten healthy goats, including 6 males and 4 females; titanium alloy cervical hollow threaded columnar internal fixator (CHTF) for goat, simulated human used internal fixator by Kanghui Medical Innovation Co., Ltd., Changzhou.METHODS: Every goat underwent conventional anterior cervical decompression and internal fixation. Two adjacent intervertebral spaces among C2-6 were selected and implanted with 2 CHTFs for each space. Of the 4 CHTFs, 3 were filled with cancellous bone alone, cancellous bone plus fibrous ring, and fibrous ring alone, respectively; the other one filled with nothing served as blank control.MAIN OUTCOME MEASURES: Implant location and fusion condition on anteroposterior and lateral radiographs and CT plain scanning at 6 and 12 weeks postoperatively; bone graft fusion and regional tissue reaction by histology.RESULTS: Radiographs and CT showed that CHTF was in the position during the whole experimental procedure with no loosening, displacement or dislocation. At 6 weeks, bone tissue was found surrounding CHTF and the vertebral body, and bone bridge formed in the connection site of CHTF and the vertebral body. New cartilage and bone trabecula formation were found in the CHTF filled with cancellous bone alone, accompanied by necrotic original bone graft; in the CHTF filled with cancellous bone and fibrous ring, necrotic fibrous tissue and newly formed cartilage accumulation surrounding original bone trabecula and fibrous ring were found; 6 weeks after surgery, there were fibrocartilage in fibrous tissue of CHTF filled with fibrous ring alone, and at 12 weeks postoperatively, newly formed cartilage was observed. In blank control group, only few newly formed cartilages were found at 12 weeks postoperatively. CONCLUSION: Enchondral ossification of fibroblast may be the osteogenic pattern of fibrous ring of cervical intervertebral disc.