Due to an overall high incidence of pulmonary tuberculosis (TB) and the emergence of drug-resistant TB, the role of surgical treatment is likely to be expanding. This review discusses the use of surgery in the treatment of TB, including surgical indications, timing of surgery and preoperative management, type of operations, and postoperative anti-TB treatment.

Objective To investigate the effects of antidepressant therapy on whole regulating function of OPG/RANKL/RANK system in ovariectomized (OVX) rat model with depressive disorder.Methods Forty sexually mature female SD rats were used as subjects.The rats were randomly divided into 8 groups as following:sham group(Sn),depression group(Dn),the OVX group (On),the OVX with depression group(ODn),OVX with depression +sertraline group (ODs),and OVX with depression + citalopram (ODx),OVX with depression + reboxetine group(ODr),OVX with depression + venlafaxine group (ODw).Bilateral oophorectomy was applied to establish the ovariectomized rats model.Chronic unpredictable mild stress(CUMS) was used to estalish depression model.Open-field test and sugar consumption experiment were applied before the experiment and the 28th day of the experiment.Immunohistochemistry and Quantitative Real-time PCR were used to observe the expression of OPG,RANKL and RANK.Results After chronic unpredictable mild stress the scores of horizontal motion,vertical motion and percentage of sugar consumption experiment in Dn group were decreased contrast to the in control Sn group (P＜0.05)and the scores in ODn group were decreased in contrast to the On group (P＜0.05).The protein and gene expression of RANK in Dn group and On group were increased in contrast to the Sn group (P＜0.05).The protein and gene expression of RANKL in Dn group and On group were increased in contrast to the Sn group (P＜0.05).The gene expression of OPG in ODs group(5.94±0.79),ODw group(5.99± 1.08) and ODr group(6.59±0.69) was decreased in contrast to the ODn group (4.96±0.51) (P＜0.05).The gene expression of RANK in ODs group (2.82±0.23),ODx group(3.03±0.04) was increased in contrast to the ODn group(3.44±0.18) (P＜0.05).The gene expression of RANKL in ODs group(4.82±0.94),ODx group(5.00±0.82) and ODw group(5.23±0.88)was decreased in contrast to the ODn group (3.69± 0.69) (P＜0.05).Conclusion The expression of RANK and RANKL in femoral neck is increased both in depressive disorder model rats and ovariectomized model rats.The antidepressant can up-regulate the expression of RANK,and down-regulate the expression of OPG and RANKL in the OVX with depression group.Of the effect,sertraline is the strongest,however reboxetine mesylate is the poorest.

Objective To study the clinical values of dynamic changes of yon Willebrand factor (vWF) and ADAMTS13 (a disintegrin and metalloprotease with thrombospondin repeats-13 ) in aneurysmal subarachnoid hemorrhage. Methods Twenty-nine patients with aneurysmal subarachnoid hemorrhage admitted to Department of Neurosurgery from April 2010 through April 2011 were enrolled for retrospective study.They could be categorized into 3 sets of grouping:delayed cerebral ischemia group ( DCI group) and non-delayed cerebral ischemia group ( no DCI group ),cerebral vasospasm group ( CVS group ) and no vasospasm group (no CVS group),and good prognosis group and poor prognosis group,and another 20 healthy subjects as control group.All patients were examined with CT,DSA,or/and CTA to identify the intracranial subarachnoid hemorrhage resulted from aneurysm rupture.The exclusion criteria included:(1)the time from onset to admission was longer than 72 hours or patient was in imminent danger of death; (2)patients had surgery,interventiona] or conservative treatment outside the hospital; (3) patients were under the treatment of antiplatelet medicine such as aspirin,clopidogrel,or other anticoagulants such as warfarin,etc ; (4) patients had blood diseases,impaired kidney or liver function,pregnant,or with recent infections.Venous blood were taken one day,4 days and 10 days after SAH to determine plasma concentrations of ADAMTS13 and vWF by using enzyme-linked immunosorbent assay (ELISA). Transcranial Doppler ultrasonography (TCD) was used to measure mean blood flow velocity of middle cerebral artery (VMCA).Glasgow outcome scale (GOS) score was measured before discharge. Data were analyzed by using SPSS version 13.0 software. Results The levels of vWF were significantly higher in DCI group,CVS group and poor prognosis group compared with those in the control group 1 day,4 days and 10 days after SAH.There were differences in vWF between DCI group and no DCI group 1 day and 4 days after SAH ( P ＜ 0.05 ).There were significantly differences in vWF between CVS group and no CVS group,and between good prognosis group and poor prognosis group 4 days and 10 days after SAH ( P ＜ 0.01 ).In DCI group and poor prognosis group,the level of plasma ADAMTS13 was significantly lower 1 day after SAH than that in the normal control group (P ＜0.01) and in the no DCI group (P ＜0.O1 ); and there were no differences in ADAMTS13 between CVS group and no CVS group.Conclusions In the early stage,the increase in plasma vWF and decrease in ADAMTS13 activity are associated with DCI,and the decrease in ADAMTS13 activity can be used to predict the outcome.

Objective The aim of this study was to evaluate the clinical factors contributing to the operative effects in patients with acetabular fracture.Methods A total of 129 cases of patients with acetabular fracture were retrospectively analyzed from Jun 2006 to Jan 2011 in The Second Hospital of Shaoxing.Of the 129 acetabular fracture patients,96 cases were in the superior group and 33 patients in the inferior group according to Merled'Aubigne-Postel methods.The potential clinical factors related to the operative effects in acetabular fracture patients were evaluated by the method of logistic regression analysis.Results The superior rate was 74％ in this study.Single factor analysis demonstrated that the diaplastic quality(x2=21.53,P ＜0.01),the femoral cartilage defect(x2 =17.50,P ＜0.01),the inra-aticular free bone(x2=12.18,P =0.0005),the type of fracture (x2 =7.24,P =0.0071) and the timing of operation (x2 =4.36,P =0.037) were correlated with operative effects in acetabular fracture patients.The binary logistic regression analysis indicated that non-anatomic diaplastic (OR =4.17,P =0.01)and the femoral cartilage defect(OR =3.11,P =0.03) were independent risk factors for operative effects in patients with acetabular fracture.Conclusions The prognosis of patients with acetabular fracture,which was complex,was affected by multiple factors.And introperatively,the anatomic reestablishment should be performed in order not to affect the post operative hip function.

Objective To evaluate the alexithymia in the continuous ambulatory peritoneal dialysis (CAPD) patients in our peritoneal dialysis center,and determine the factors affecting alexithymia in CPAD patients.Methods The patients with end-stage renal disease treated by CAPD were divided into alexithymia group (total score≥61)and non-alexithymia group(total score≤51),according to the Toronto Alexithymia Scale(TAS-20).Risk factors for alexithymia were analyzed by Logistic regression statistical model.Results (1)The TAS-20 score was(55.8±9.2) in 86 cases of patients with CAPD.Among them,TAS-20 scores of 38 cases were ≥61 points with an average score (64.5 ±4.4),and the scores of 30 cases were ≤ 51 points with an average score (48.9±5.3),which had a significant difference(t=10.1,P＜0.01).(2) There were significant differences in the pay-way and the residual urine volume between the two groups(P＜0.01).There were significant correlations of alexithymia with the pay-way and the residual urine volume(P＜0.01).(3) The level of serum albumin was significantly lower in alexithymia groups than that in non-alexithymia(P＜0.01).The level of serum calcium,phosphorus and parathormone were significantly higher in alexithymia group than that in non-alexithymia group(P＜0.05).There were significant negative correlations of alexithymia with the level of serum albumin(P＜0.01) and positive correlations of alexithymia with the level of serum calcium,phosphorus and parathormone(P＜0.05).(4) There were significant differences score in SF-36 total score,Physical Function,Bodily Pain,General Health,Vitality,Social Function,Role-Emotional and Mental Health (P＜ 0.01);There were significant negative correlations of alexithymia with SF-36,Physical Function,Bodily Pain,General Health,Vitality,Social Function,Role-Emotional and Mental Health (P＜ 0.05).(5) The Kt/v was 1.65±0.47 in alexithymia group and 2.13±0.69 in non-alexithymia group.There were significant differences in the two groups(t=2.5,P=0.017).There were significant negative correlations of alexithymia with Kt/v(r=-0.417,P=0.007)by Pearson correlation analysis.Logistic regression analysis showed that the level of serun albumin,SF-36 scores,residual urine volume,the pay-way and Kt/v were the risk factors for alexithymia.Conclusion The incidence rate of alexithymia is higher.The level of serum albumin,SF-36 scores,residual urine volume,the pay-way and Kt/v are the risk factors for alexithymia.

Objective To improve the detail of the surgery for cicatricial ectropion,and the the effect was investigated. Methods Based on 46 patients withⅡ,Ⅲdegree cicatricial ectropion admitted to our department,choose the junction of normal skin and scar tissue as the incision line according to the degree of ectropion and local situation,and to reserve and recover the orbicularis oculi muscle as possible. The released areas exceeded separately the external canthus and reached the level of eye fissure,take advantage of full-thickness skin graft to correct the parallel lines and make fixation to the eyelid ectropion fusion skin graft on external canthal ligament. Results After followed up for 6 months to 2 years,46 cases of eyelid skin grafts survived completely and eyelids were in good reduction,with none case of incomplete eyelid closure. Conclusion Choose the surgical incision and the released areas in a proper way to reserve the structural integrity of orbicu-laris muscle and make skin graft fixation to inner and external canthal skin can prevent effectively the recurrence of ectropion and improve surgical progress.

Objective To investigate the effect of nitric oxide (NO) on the scratching behavior evoked by substance P (SP) in mice. Methods Forty BALB/c mice were randomly divided into 5 groups to receive intradermal injection of different doses of SP (0, 20, 40, 80, 160 nmol/site) into the rostral part of the back to establish the acute itch model. Another 40 mice were randomly allocated to model, spantide, L-arginine,L-NAME and aminognanidine groups injected intracutaneously with normal saline (NS), spantide, L-arginine,L-NAME and aminoguanidine, respectively, 10 minutes before SP (80 nmol/site) injection. Subsequently,the scratching behavior was observed, iNOS expression and NO level in the injected skin were detected by immunohistochemical staining and nitrate reductase assay, respectively. Results The scratching bouts per hour induced by intradermal NS and SP of 20, 40, 80 and 160 nmol/site were 4.38±4.07, 5.38±3.78,12.75±6.52, 23.50±7.84 and 42.38±15.84, respectively, and only SP at higher doses (40 - 160 nmol/site)elicited a dose-dependent scratching response in mice (P < 0.01 or 0.05) compared with NS. The scratches over 1 hour in SP, L-arginine, spantide, L-NAME and aminognanidine group were 67.13±32.79, 70.75±34.80, 10.75±8.14, 29.00±21.19 and 35.38±22.83, respectively; of them, pretreatment with spantide,L-NAME and aminognanidine significantly inhibited SP-induced scratching (P < 0.01 or 0.05), but L-arginine showed no inhibitory effect (P > 0.05). Compared with SP, the pretreatment with spantide, L-NAME and aminoguanidine significantly downregulated the iNOS expression and NO content (P < 0.01 or 0.05) in the injected skin other than L-arginine (P > 0.05 ). Conclusion Intradermal SP could increase NO synthesis by neurokinin 1 receptor activation, resulting in the scratching behavior in BALB/c mice.

OBJECTIVE To evaluate the clinical efficacy of piperacillin/tazobactam for acute exacerbation of chronic obstructive pulmonary disease(AECOPD) with pulmonary encephalopathy.METHODS Seventy three cases of AECOPD with pulmonary encephalopathy were randomized into piperacillin/tazobactam group and ceftazidime group,and sputum culture was underwent for each case before and after treatment.RESULTS The total efficacy rates and bacterial clean rates in piperacillin/tazobactam group and ceftazidime group were 91.67% and 88.89%,75.68% and 57.89%,respectively,and the differences between the two groups were statistically significant.CONCLUSIONS It suggested that piperacillin/tazobactam be a more effective drug for AECOPD with pulmonary encephalopathy.

Objective To investigate the intervention of Chinese herb Shengjiang San(SJS)for the imbal-ances of serum Th1/Th2 cells and related regulatory factors in sepsis patients. Methods Fifty-five sepsis patients were randomly divided into two groups:conventional treatment group of 27 cases and SJS group of 28 cases. Nine cases of healthy volunteers were enrolled as control group in the study. Cases of conventional group were treated with western medicine only and cases of SJS group were treated with both western medicine and Chinese herb SJS (100 mL twice one day). The therapy course of both groups was 3 days. Score of Chinese medical syndromes ,se-rum level of leukocyte count,C reactive protein(CRP)and procalcitonin(PCT),serum T-bet,GATA-3,Th1&Th2 cells in the proportion of whole CD4+Th cells and Th1/Th2 ratio were compared respectively in each group be-fore and after treatment. Results There were significant differences between SJS group and conventional group in score of Chinese medical syndromes,serum level of leukocyte count,T-bet,GATA-3,Th1&Th2 cells in the pro-portion of whole CD4+Th cells and Th1/Th2 ratio(P<0.05 or P<0.01). There were no significant differences be-tween the two groups in serum level of CRP,PCT and GATA3. Compared with control group,there were signifi-cant differences in all indicators except GATA3 of the two groups(P<0.01). Conclusion Chinese herb Shengji-ang San has an effective benefits to Chinese medical syndromes,inflammatory reaction,the imbalance of serum Th1/T2 and related regulatory factors(T-bet&GATA-3)in sepsis patients.

AIM: To study the determination of 5 kinds of cholic acid content. METHODS: Using single standard substitue (SSS), we assayed 5 kinds of cholic acid, such as cholic acid, deoxycholic acid, hyodexycholic acid, chenodeoxychoilc acid and ursodeoxycholic acid by HPLC/ELSD. and studied the influence of the additive substitutes (such as rabbit Serum, urine and Qingkailing extract) on the measure values. RESULTS: By using any one of the 5 kinds of cholic acid standard, the content in all the 5 kinds of cholic acid could be determined. CONCLUSION: Simply as well as credibly, the SSS method could be used in quality analysis, especially in complex matrix. Also, it proved a feasible way in quality control and research of fingerprint chromatography of TCM.