Objective AMI is a prevalent global health condition.This study assessed the effects of PLGF and VEGF in a rat model of post-AMI.Methods Wistar rats underwent LAD ligation and injection of VEGF,PLGF,VEGF + PLGF,antiVEGFR1,anti-VEGFR2,anti-VEGFR1 + anti-VEGFR2,IgG2α,or saline,into the infarct border zone.We also set up a pseudo-operation group.Two weeks later,heart function was detected by hemodynamic and geometry,then the hearts were dis sected and HE stained.We assessed vW factor and α-SMA by immunohistochemistry and cardiomyocyte apoptosis rate by TUNEL.Results Rats in the VEGF + PLGF group performed significantly well in cardiac function,had weaker LV remodeling and less cardiomyocyte apoptosis.There were no obvious changes in VEGF group.The use of VEGFR1/VEGFR2 antibody didnt deteriorate the rat's cardiac function.More new-born arteries were seen in PLGF and VEGF + PLGF rats,and change wasnt found in other groups.Lastly,the most angiogenesis,the least left ventricular remodeling and the best heart function were observed in VEGF + PLGF group.Conclusion Earlier intervention with PLGF or VEGF + PLGF can improve heart function in rats with AMI; VEGF alone didnt improve heart function.VEGFR1/VEGFR2 antibody didnt aggravate the rat's heart function.This indicates that left ventricular and coronary remodeling may involve other factors.

Objective To assess the efficacy of urethroplasty by using the mucosa of diverticulum as the distal urethral for the recurrence of urethral stricture.Methods We reviewed our experience about 6 cases from Jan.2007 to Oct.2012,including 5 hypospadias and 1 epispadias.The mean age of the patients was 28 ± 16 (12-45)month,range 12 to 45 months.The patients presenting urethral diverticulum should last for 6 months after urethroplasty,which should last for 6 months.The preoperative mean urinary flow rate was 5.1 ± 1.4 (range 3.1 to 7.3) ml/s.All the patients took the retrograde urethrography and cystoscopy to confirm the position and length of urethrostenosis.The positions of urethrostenosis were at the penis coronary in 5 cases and glans penis in 1 case.The mean length of stricture was 13.3 ±4.2(range 8.8 to 20.5) mm.The mean length of diverticulum was 37.5 ± 15.3 (range 21.8 to 55.2) mm.All patients received the urethral reconstruction by using the pedicel diverticulum mucosa.After resecting the stenosis urethra and exposed the whole diverticulum,we opened the diverticulum laterally and halved it.One was used for tabularized urethroplasty in situ,the other was flipped to the distal urethral as pedicel flap to remedy the defect of the urethral.Results Totally 6 cases received the procedure.The mean operating time was 133 ± 48 (range 84 to 192) min.Postoperatively,urethral catheter was remained 2 weeks.All the patients can urinate smoothly after removing the catheter.The postoperative mean urinary flow rate was 10o 9 ± 3.3 (range 6.3 to 15.9) ml/s.The mean follow-up time was 2.2 yrs(range 1 to 4 years).At the end point of follow-up,all patients had not experienced a recurrent diverticulum or stricture at the anastomotic site.Urethrocutaneous fistula in the coronary glan was reported in 2 patients,which were finally cured after 2nd repair.No complication was found in other 4 patients.Conclusions Urethroplasty by flipping the mucosa of diverticulum takes full advantage of urinary mucosa that already existing,which can be very useful in those patients who are lack of foreskin.This approach can also reduce the patient's pain by completing the urethroplasty in situ and avoiding staging operation.But up till now,it can only be applied to the urethral diverticulum secondary to urethrostenosis.It also demands flip flap skilled.And the long-term effects and complications still remain to be seen.

Objective To evaluate the feasibility and outcomes of robotic-assisted laparoscopic pyeloplasty in children .Methods A retrospective study was performed in patients who underwent robotic-assisted laparoscopic pyeloplasty ( Anderson-Hynes ) at our institution between January 2014 to August 2014.Totally 6 boys were diagnosed as left ureteropelvic junction obstruction depending on the symptoms and radiographic studies .The mean age was 9 years ( range 4 -12 years ) .Results The procedure was performed successfully without conversion to open surgery in all of the cases .Mean operative time was 216 min (range 175-269 min), with a mean robotic anastomosis time of 45 min (range 30-60 min).Mean estimated blood loss was less than 15 ml.The mean hospitalization was 4.5 days.Mean follow-up period was 10 months ( range 7 -14 months ) .There were no perioperative complications , and recovery was uncomplicated (without recurrence, pyelonephritis, nephrarctia) in all of the patients.Conclusion Robotic-assisted laparoscopic pyeloplasty can be safely performed in children older than 4-year-old with ureteropelvic junction obstruction .

Objective:To investigate the current situation of emergency medical service (EMS) system and its effect on treatment of the acute stage and short- and long-term prognosis in patients with acute myocardial infarction in Hebei province.Methods:Totally 2 961 patients with acute myocardial infarction who were admitted to major tertiary and some representative secondary hospitals in Hebei province from January 2016 to December 2016 were collected. According to the pattern of arriving hospital, all the patients were divided into the EMS group and self-transport group. The general conditions, time from onset to treatment, treatment methods, in-hospital mortality rate and 3-year mortality rate were compared between the two groups.Results:Of the included 2 961 patients, 33.13% of them were transported through EMS and 66.87% of them by private transport. Patients with a history of hypertension and ST-segment elevation myocardial infarction were more likely to choose EMS, and the difference was statistically significant ( P<0.05). Moreover, patients in the EMS group were more likely to go to tertiary hospitals for treatment (88.58% vs 85.76%, P=0.033). The time from onset to treatment of the EMS group was significantly shorter than that of the self-transport group (160 min vs 185 min, P<0.01), and the proportion of patients in the EMS group from onset-to-door time in <3 h and 3-6 h was higher than that of the self-transport group (55.76% vs 49.14%, 21.41% vs 19.09%, P<0.01). Compared with the self-transport group, the EMS group has a higher rate of reperfusion therapy (67.48% vs 61.67%, P=0.002). Patients in the EMS group had a higher in-hospital mortality rate in the acute stage (7.03% vs 4.44%, P=0.003), but its 3-year mortality rate was lower than that of the self-transport group (17.31% vs 20.77%, P<0.05). Conclusions:EMS can shorten symptom-onset-to-arrival time, increase the rate of reperfusion therapy and improve long-term prognosis of patients with acute myocardial infarction.

OBJECTIVE: To observe the toxicokinetic parameters, absorption characteristics and pathomorphological damage in different parts of the gastrointestinal tract of rats poisoned with different doses of diquat (DQ). METHODS: Ninety-six healthy male Wistar rats were randomly divided into a control group (six rats) and low (115.5 mg/kg), medium (231.0 mg/kg) and high (346.5 mg/kg) dose DQ poisoning groups (thirty rats in each dose group), and then the poisoning groups were randomly divided into 5 subgroups according to the time after exposure (15 minutes and 1, 3, 12, 36 hours; six rats in each subgroup). All rats in the exposure groups were given a single dose of DQ by gavage. Rats in the control group was given the same amount of saline by gavage. The general condition of the rats was recorded. Blood was collected from the inner canthus of the eye at 3 time points in each subgroup, and rats were sacrificed after the third blood collection to obtain gastrointestinal specimens. DQ concentrations in plasma and tissues were determined by ultra-high performance liquid chromatography and mass spectrometry (UPHLC-MS), and the toxic concentration-time curves were plotted to calculate the toxicokinetic parameters; the morphological structure of the intestine was observed under light microscopy, and the villi height and crypt depth were determined and the ratio (V/C) was calculated. RESULTS: DQ was detected in the plasma of the rats in the low, medium and high dose groups 5 minutes after exposure. The time to maximum plasma concentration (Tmax) was (0.85±0.22), (0.75±0.25) and (0.25±0.00) hours, respectively. The trend of plasma DQ concentration over time was similar in the three dose groups, but the plasma DQ concentration increased again at 36 hours in the high dose group. In terms of DQ concentration in gastrointestinal tissues, the highest concentrations of DQ were found in the stomach and small intestine from 15 minutes to 1 hour and in the colon at 3 hours. By 36 hours after poisoning, the concentrations of DQ in all parts of the stomach and intestine in the low and medium dose groups had decreased to lower levels. Gastrointestinal tissue (except jejunum) DQ concentrations in the high dose group tended to increase from 12 hours. Higher doses of DQ were still detectable [gastric, duodenal, ileal and colonic DQ concentrations of 6 400.0 (1 232.5), 4 889.0 (6 070.5), 10 300.0 (3 565.0) and 1 835.0 (202.5) mg/kg respectively]. Light microscopic observation of morphological and histopathological changes in the intestine shows that acute damage to the stomach, duodenum and jejunum of rats was observed 15 minutes after each dose of DQ, pathological lesions were observed in the ileum and colon 1 hour after exposure, the most severe gastrointestinal injury occurred at 12 hours, significant reduction in villi height, significant increase in crypt depth and lowest V/C ratio in all segments of the small intestine, damage begins to diminish by 36-hour post-intoxication. At the same time, morphological and histopathological damage to the intestine of rats at all time points increased significantly with increasing doses of the toxin. CONCLUSIONS The absorption of DQ in the digestive tract is rapid, and all segments of the gastrointestinal tract may absorb DQ. The toxicokinetics of DQ-tainted rats at different times and doses have different characteristics. In terms of timing, gastrointestinal damage was seen at 15 minutes after DQ, and began to diminish at 36 hours. In terms of dose, Tmax was advanced with the increase of dose and the peak time was shorter. The damage to the digestive system of DQ is closely related to the dose and retention time of the poison exposure.
Animals ; Male ; Rats ; Diquat/toxicity* ; Gastrointestinal Diseases ; Intestines ; Poisons ; Rats, Wistar ; Toxicokinetics

Objective:To investigate the effects of diquat (DQ) on the expression of intestinal pyroptosis-related proteins and tight junction proteins in rats, and to analyze the role of pyroptosis in the intestinal injury of rats with acute DQ poisoning.Methods:A total of 36 Wistar male rats were randomly divided into control group, and 3 hours, 12 hours, 36 hours and 3 days exposure groups, with 6 rats in each group. Each exposure group was given 1/2 median lethal dose (LD50) of 115.5 mg/kg DQ by one-time gavage. The control group was given the same amount of normal saline by gavage. The control group was anesthetized at 3 hours after DQ gavage to take jejunal tissues; each exposure group was anesthetized at 3 hours, 12 hours, 36 hours, and 3 days after DQ gavage to take jejunal tissues, respectively. The general conditions of the rats were recorded. The pathological changes of jejunum tissue were observed by hematoxylin-eosin (HE) staining. The expression of intestinal pyroptosis-related proteins [NOD-like receptor protein 3 (NLRP3), cysteine aspartate-specific protease 1 (caspase-1), Gasdemin D (GSDMD)] in the intestinal tissues was observed by immunohistochemical staining. Western blotting was used to detect the expression of intestinal pyroptosis-related proteins and intestinal tight junction proteins (Occludin and Claudin-1).Results:Light microscopy showed that pathological changes occurred in jejunum tissue at the early stage of exposure (3 hours), and the injury was the most serious in the 12 hours exposure group, with a large number of inflammatory cells infiltrating in the tissue, and the damage was significantly reduced after 3 days exposure. Immunohistochemical results showed that NLRP3, caspase-1 and GSDMD were expressed in the jejunal mucosa of the control group and the exposure groups, and the positive cells in the control group were less expressed with light staining. The expression of the above proteins in the exposed group was increased significantly and the staining was deep. Western blotting results showed that compared with the control group, the expression of NLRP3 protein in jejunum tissues of all groups was increased, with the most significant increase in the 36 hours group (NLRP3/β-actin: 1.47±0.06 vs. 0.43±0.14, P < 0.01). Compared with the control group, the expression of GSDMD protein in the 3 hours, 12 hours and 36 hours exposure groups increased, and the expression of GSDMD protein in the 3 hours and 12 hours exposure groups increased significantly (GSDMD/β-actin: 1.04±0.40, 1.25±0.15 vs. 0.65±0.25, both P < 0.05). The expression of caspase-1 protein was increased in 36 hours exposure group compared with the control group (caspase-1/β-actin: 1.44±0.34 vs. 0.98±0.19, P > 0.05). Compared with the control group, the expression of Occludin and Claudin-1 proteins in each exposure group decreased, and the expression of Occludin proteins was significantly decreased in the 3 hours, 12 hours, and 36 hours exposure groups decreased significantly (Occludin/β-actin: 0.74±0.17, 0.91±0.20, 0.79±0.23 vs. 1.41±0.08, all P < 0.05). Although the protein expression of Claudin-1 decreased in each exposure group, the difference was not statistically significant. Conclusion:The intestinal injury caused by acute DQ poisoning may be related to the activation of pyroptosis pathway of small intestinal cells and the reduction of the density of intercellular junctions.

Objective To compare the difference and effectiveness between Tetra-ataxiametry and Berg balance scale (BBS) in predicting the risk for fall in the elderly inpatients.Methods A total of 401 elderly inpatients were randomly selected using convenience sampling in a class III grade A hospital. Tetra-ataxiametry and BBS were used to monitor the risk for falls of elderly patients in two groups: group with or without fall histories.Results Fall histories were set as the standard. The area ratios under receiver operating characteristic (ROC) of Tetra-ataxiametry fall index (FI) and BBS were 0.762 and 0.705. Youden index showed that the predicted value, the sensibility and the specificity of Tetra-ataxiametry FI were 41, 80.5% and 60.2%; while those for BBS were 46, 67.1% and 65.8%. No statistically significant difference in the area under the curve (AUC) between Tetra-ataxiametry and BBS was observed(P=0.0587).Conclusions There is no statistically significant difference in predicting the risk for fall in the elderly inpatients between Tetra-ataxiametry and BBS, suggesting that Tetra-ataxiametry can replace BBS to evaluate the fall risk, and is better than BBS, since Tetra-ataxiametry has higher sensitivity in objective data provision, body weight and BMI (body mass index).

Objective To evaluate the short-term outcome of the Kelly procedure for bladder exstrophy-epispadias complex.Methods Kelly procedure was performed in 5 cases from December 2015 in our institute. Retrospective analysis was done including the surgery and follow up.Results Two bladder exstrophy boys had histories of primary bladder closure without bladder neck reconstruction during the neonatal period. Another three epispadias boys had sever urethral defects with full incontinence. All cases undertook Kelly procedure and were followed up for 7.8 months (2-12 months). No severe complications such as glanular necrosis, urethral stricture and urethrocutaneous fistula was observed. Four cases were fully continent and one epispadias case had stress incontinence.Conclusions Kelly procedure produced satisfactory urinary continence and phallic cosmetics in bladder exstrophy-epispadias complex in children. Proper identification of the pudendal neurovascular bundle and repair of the external sphincter by levatorplasty help improve the outcome.

Objective To analyze the clinical charactaristics of acute symptomatic the ureteropelvic junction obstruction (UPJO) in children,who present abdominal pain as the primary symptom.Methods Retrospective analysis was performed in children of UPJO,who claimed abdominal pain as the primary symptom in our hospital from January 2009 to December 2016.Totally 48 cases were included.40 boys,8 girls.38 cases were dignosed as left UPJO,the others were right.The mean age was 7.2y (range 2.0-15.6y).Most patients are school age children.Renal ultrasonography was repeated to record the changes from the symptomatic to the asymptomatic stage.Diuretic renogram examination (ECT) was used to confirm UPJO and assess DRF(differential renal function)in all patients.Results 30 cases (62.5％) presented sole abdominal pain,while the other 18 cases (37.5％) had combined symptoms,such as nausea and vomiting,and hematuria.9 cases (20.5％) had abdominal pain only once,while the other 39 (79.5％) cases had recurrent abdominal pain.All cases showed significant differences in renal pelvis dilation and renal parenchyma thickness between the period of occurrence of abdominal pain[(35.5 ± 17.1) mm,(7.2 ± 4.9) mm] and normal condition [(23.4 ± 18.4) mm,(8.9-± 5.6) mm] (P ＜ 0.05).All patients underwent preoperative ECT,and DRF were ≥40％ in 31 cases (64.6％) and ＜40％ in 17 cases (35.4％).48 cases underwent unilateral dismembered pyeloplasty.48 cases underwent unilateral dismembered pyeloplasty.During the operation,sole ureteropelvic junction stenosis were diagnosed in 28 cases,aberrant vascular compression in 9 cases,polyps in 6 cases,high ureteral insertion in 2 cases,and multi-factors in 3 cases.The average DRF caused by aberrant vascular compression or polyps was ＞ 40％.All patients were followed up for 45.6 months,no abdominal pain was ever reported.Conclusions Acute symptomatic UPJO in children is more common in school-age children.The abdominal pain is intermittent,recurrent.It may happen with other symptoms.There is a significant increase in renal pelvis dilation and a decrease in renal parenchyma thickness on ultrasonography when the abdominal pain occures.US performed during the onset of abdominal pain and non-abdominal pain is an important method for the diagnosis of acute symptomatic UPJO in children.

OBJECTIVE：To study the compositi on of the volatile oil from Compound chaihu guizhi decoction ，and to evaluate its in vitro anti-proliferative activity on human lung adenocarcinoma A 549 cells. METHODS ：The volatile oil from Chaihu guizhi decoction was extracted according to the steam distillation method of general rules 2004 in the 2015 edition of Chinese Pharmacopoeia（part Ⅳ）. The volatile oil components were analyzed by GC-MS combined with Kováts index ，and the relative content of each component was calculated by peak area normalization method. Using different concentrations of cisplatin （4，8， 16，32，64 mg/L）as positive control ，MTT assay was used to detect the inhibitory effects of different concentrations of volatile oil from Chaihu guizhi decoction （25，50，100，200，400 mg/L）on in vitro proliferation of A 549 cell after 48 h of treatment. Negative control group （with cells but without drugs ）was set up. RESULTS ：A total of 71 chemical components were isolated from the volatile oil ，among which there were 59 compounds identified ，sum of peak areas accounting for 84.99％ of the total peak area. The compounds with relatively high content included ar-curcumene （17.65％），β-bisabolene（9.57％），β-ocimene（7.05％）， α-curcumene（5.35％），2，5-dimethylbenzaldehyde（4.24％），linalyl isobutyrate （2.70％），α-cedrene（2.48％），δ-cadinene （2.07％）. Compared with negative control group ，the proliferation rate of cells were decreased significantly in 4-64 mg/L cisplatin groups and 25-400 mg/L volatile oil from Chaihu guizhi decoction groups （P＜0.05）. IC 50 of cisplatin and volatile oil from Chaihu guizhi decoction to in vitro proliferation of A 549 cells were 10.150 and 73.526 mg/L. CONCLUSIONS ：The volatile oil from Chaihu guizhi decoction mainly includes ar-curcumene ，β-bisabolene，β-ocimene，α-curcumene，which shows certain inhibitory effect on in vitro proliferation of A 549 cells.