Toll-like receptor 4 (TLR4), the natural receptor of lipopolysaccharide(LPS), plays an important role in the regulation of acute inflammation, intracellular signal transduction and cell apoptosis. TLR4 over expresses in both acute inflammation and fibrotic tissues, which suggests that TLR4 may be essential in acute inflammation and subsequent fibrosis. Nowadays, some progress has been made in the exploration of TLR4 in pathogenesis and treatment of liver cirrhosis and pulmonary fibrosis. TLR4 may become a new target in the treatment of human fibrotic diseases including liver cirrhosis and pulmonary fibrosis. The research status of TLR4 in human fibrotic diseases and its future development are reviewed in this paper.

Objective To evaluate the safety and efficacy of three types of anesthesia methods in elderly patients with coronary heart disease undergoing unilateral lower extremity surgery.Methods Totally 65 patients with coronary heart disease of cardiac function Ⅰ-Ⅱ (NYHA),scheduled for undergoing unilateral lower limb surgery were randomly divided into three groups:local nerve block anesthesia of lumbar plexus plus the sciatic nerve (21 cases),general anesthesia (19 cases),epidural anesthesia (25 cases).Systolic blood pressure (SBP),heart rate (HR),pulse rate and blood oxygen saturation (SPO2) at 0 min,10 min,20 min,30 min,40 min after surgery at the end of the surgery were observed and recorded.The change of troponin Ⅰ (cTnI) at 3 day after surgery was observed.Visual analoguc scales (VAS) scores.movement reaction,the infortnation of muscle relax and corresponding management were recorded in order to detect anesthesia efficacy.Results The excellent and satisfactory rate of anesthesia efficacy of three groups were 17 cases (81.0％) and 4 cases (19.0％),17 eases (89.5％) and 2 cases (10.5％),22 cases (88.0％) and 3 cases (12.0％) (all P＞0.05).In epiduralgroup compared with other groups,SBP were decreased (both P＜0.05).cTnI in nerve stimulator group was decreased (all P＜0.05) at 1 and 3 day after surgery compared with general anesthesia group,and at 3 day after surgery,cTnI level in nerve stimulator group was lower than other two groups(all P＜0.05).Conclusions The nerve stimulator guided nerve block is the most safe method among general anesthesia and epidural anesthesia in elderly patients with coronary heart disease scheduled for lower extremity surgery.

Objective To analyze the detection rate of HBV serological makers in non-hepatic inpatients in the past six years. Methods Serum samples of 70 582 non-hepatic inpatients from three large hospitals were collected during 2003 to 2008. Serological markers of HBV ( HBsAg, anti-HBs, HBeAg, antiHBe and anti-HBc) were detected by the AxSYM MEIA system (Abbott Laboratories,Abbott Park,IL).Combining the test results of serological makers with other clinical data, several analysis models for this retrospective study were set up to evaluate the year-to-year changes in serological makers and the detection rates of each model. Results The order from high to low of detection rate of the 5 HBV serological markers was anti-HBc (55. 17% ), anti-HBs (49. 57% ), anti-HBe (28.42%), HBsAg ( 8. 92% ) and HBeAg (2. 12% ), and all of them had a downward trend in the past six years. The positive rate of HBsAg went down from 9. 30% (2003) to 8.70% (2008). The positive rate of HBsAg among people who were born after 1992 (2. 28% ) were significantly lower than that of the overall population (8. 92% ) and fell from 3.57%(2003) to 1.85% (2008). Each detection rate of all serological makers had male sexual side effect [HBsAg ( 12. 38%/7. 25% ), HBeAg ( 2. 72%/1.58% ), anti-HBc ( 56. 57%/53.43% ), anti-HBe (41.50%/28. 35% ) and anti-HBs (65.48%/50. 00% ), male/female]. The differences were statistically significant (Chi-square values of HBsAg, HBeAg, anti-HBc, anti-HBe and anti-HBs were 509.74,105.78, 69.66, 1 321.61 and 1 726.91, respectively; all P ＜ 0. 01).Twenty-six models of HBV serological makers from 70 582 inpatients were summed up, and 8 models had positive rates geater than or equal to 1%. The "All Negative" model ranked No. 1 and had no significant change from year to year. During the past six years, models representing "A11 Negative" and "anti-HBs Positive alone" were mainly in individuals younger than or equal to 20-year-old, while the models representing "anti-HBc and/or anti-HBe,anti-HBs Positive" were mostly in people older than 20-year-old. The distribution curve of models representing "HBsAg, HbeAg and anti-HBc Positive" and "HBsAg, anti-HBc, anti-HBe Positive"etc. showed a bell-shape, covering the population from 20-year-old to 70-year-old. Conclusions The slowlydescending tendency of the detection rates of HBV serological makers was observed during the past six years.The detection rates of HBV in the younger generation decreased significantly. However, the HBV infection rates of overall population is still high, so it is a high time that we made continuous improvement for the serum HBV screening technique in order to reduce the HBV infection ratess.

AIM: To find new gene function associate with active lupus nephritis (LN) through study on the difference in gene expression of peripheral blood mononuclear cells between LN patients and healthy controls by gene chip. METHODS: The CSC-GE-80 chip containing 8 000 spots of cDNAs were used to investigate the difference of the expression. Both the total RNA from peripheral blood mononuclear cells of active LN patients and healthy donors were reversely transcribed to cDNA with the incorporation of fluorescent( cy3 and cy5) labeled dCTP to prepare the hybridization probes. After hybridization, the gene chip was scanned for the fluorescent intensity. The differentially expressed genes were screened. We repeated that in three groups of LN patients and healthy controls, respectively, and only the genes that have differential expression in all three chips were considered associated with LN. RESULTS: 75 genes were identified to be differently expressed in all three groups of LN patients as compared with healthy controls, including 42 up-regulated genes and 33 down-regulated ones. CONCLUSION: The present study represents a global view of gene expression of LN and provides important clues for further study of LN related genes. And it also suggests defensin ? 1, S100A8, S100A9 may be involved in the pathogenesis of LN.

Objective To examine the correlation of serum neutrophil gelatinase-associated lipocalin (NGAL) with dialysis adequacy,microinflammatory state and iron metabolism,and to assess the value of NGAL in identifying the dialysis adequacy in maintenance hemodialysis (MHD) patients.Methods A total of 150 MHD patients and 50 healthy control people were enrolled in the study.Clinical data were collected and serum NGAL,CRP,transferrin saturation,serum ferritin were measured.MHD patients were divided into adequacy group and non-adequacy group according to spKt/V value.Serum NGAL between two groups was compared and correlation of NGAL with spKt/V,inflammatory factors,and other clinical indexes was examined by Pearson,multivariate regression Logistic model and area under curve (AUC) of ROC.MHD patients were followed up for 3 months.Similar correlation analysis was carried out before and after follow up between two groups.Results Serum NGAL of MHD patients was higher compared to healthy people [(445.45±50.34) μg/L vs (50.02 ±6.45) μg/L].Among 150 MHD patients,95 were classified into adequacy group,while 55 into non-adequacy group according to spKt/V value.Serum NGAL was significantly higher in adequacy group as compared to non-adequacy group [(589.14±56.34) μg/L vs (360.13±46.23) μg/L,P＜0.05].Serum NGAL was positively correlated to spKt/V,CRP,TSAT [r=0.652,0.825,0.785,all P＜0.05],but not to serum ferritin.Serum NGAL was also correlated to spKt/V,CRP,TSAT by multivariate regression Logistic model.AUC showed that NGAL level could reflex the condition of dialysis adequacy.During the follow up,all adequacy patients remained the same adequacy status.Thirty-eight out of 55 non-adequacy patients were qualified for complete adequacy after intervention.The serum NGAL before and after intervention was (368.14±56.21) μg/L and (360.56±46.23) μg/L respectively without significant difference.Conclusions Serum NGAL is obviously higher in MHD patients with dialysis adequacy compared to those without dialysis adequacy.Serum NGAL is positively correlated to spKt/V,CRP,TSAT.NGAL can reflex the condition of dialysis adequate in MHD patients.

Background:Tryptophan(TRP)is an essential amino acid,and can produce 5-hydroxytryptamine(5-HT)via 5-HT signal pathway and kynurenine( KYN)metabolic pathway under the catalysis of enzyme,thereby participating in the pathogenesis of visceral hypersensitivity in diarrhea-predominant irritable bowel syndrome(IBS-D). Aims:To investigate the relationship between visceral sensitivity and TRP metabolic pathway in patients with IBS-D. Methods:Thirty patients with IBS-D and 30 healthy controls from June 2012 to January 2014 at Guangdong Provincial TCM Hospital were enrolled. Score of gastrointestinal symptom rating scale( GSRS)was evaluated. Visceral sensitivity was measured by anorectal manometry. RT-PCR and Western blotting were used to detect mRNA and protein expressions of colon mucosal IDo, respectively. Serum 5-HT,5-HIAA,TRP,IDo,KYN,KYNA concentrations and IDo activity,KAT activity were determined by high performance liquid chromatography assay. Results:Compared with control group,GSRS score was significantly increased(P < 0. 05),initial perception threshold,defecation threshold,pain threshold were significantly decreased(P < 0. 05),anorectal constriction pressure was significantly increased( P < 0. 05),serum 5-HT,5-HIAA concentrations were significantly increased(P < 0. 05),mRNA and protein expressions of IDo were significantly increased (P < 0. 05),serum KYN was significantly increased(P < 0. 05),KYNA was significantly decreased(P < 0. 01),IDo activity was significantly incseased(P < 0. 01),and KAT activity was significantly decreased in IBS-D group(P < 0. 01). Correlation analysis showed that initial perception threshold,defecation threshold,pain threshold and anorectal constriction pressure were correlated with 5-HT,5-HIAA,TRP,KYN,KYNA,IDo activity and KAT activity in patients with IBS-D (P < 0. 05). Conclusions:TRP metabolic pathway is correlated with visceral hypersensitivity in patients with IBS-D.

OBJECTIVETo analyse the relationship between the electrical activity changes of nucleus accumbens (NAc) shell and the drug-seeking behavior by recording NAc shell electrical activity in conditioned place preference (CPP) rats induced by morphine.

METHODSForty SD rats were randomly divided into operation-only control group and the morphine-induced CPP group after stereotaxic electrode was buried on rats NAc shell and the latter group was used to establish the morphine CPP model(n = 20). A CPP video system combining with the technique of electrical activity wireless telemetry was used in the study. The NAc electrical activity from each group of rats was recorded by wireless telemetry respectively, which included staying in black or white chamber of video box, shuttling between black-white chambers and between white-black chambers. The electrical activity differences were analyzed by the percentage of each wave.

RESULTSWhen the morphine-induced rats staying in black chamber, compared with the operation-only control group, the NAc shell electrical activity showed that the percentage of 0 - 10 Hz was increased(P < 0.05), meanwhile, those of 10 - 20 Hz and 30 - 40 Hz were reduced(P < 0.05, P < 0.01); when the morphine-induced rats staying in white chamber, the NAc shell electrical activity showed that the percentage of 0 - 10 Hz and 30 - 40 Hz were increased(P < 0.05 , P < 0.01) , that of 10 - 20 Hz was reduced(P < 0.05 , P < 0. 01); when the morphine-induced rats in black- white shuttling status, the NAc shell electrical activity showed that the percentage of 0 - 10 Hz was increased(P <0.05, P <0.01), that of 10- 30 Hz was reduced( P <0.05); and in the white-black shuttling status, the electrical activity showed that the percentage of 0 - 10 Hz was reduced(P <0.05), that of 10 - 30 Hz was increased(P < 0.05) ; the electrical activity was further compared between staying status and shuttling status in the morphine-induced CPP group. There was no significant difference of electrical activity between the rats in white-black shuttling status and staying in white chamber. However, when rats in black-white shuttling status, compared with staying in black chamber, the electrical activity showed that the percentage of 0 - 10 Hz and 40 - 50 Hz were increased(P < 0.05), meanwhile, those of 10 - 20 Hz and 30 - 40 Hz were reduced(P <0.05).

CONCLUSIONThe electrical activity changes of NAc shell in morphine-induced CPP rats were different from those of the operation-only control group, and these changes might be associated to the rat's drug-seeking behavior.

Animals ; Conditioning (Psychology) ; Drug-Seeking Behavior ; Morphine ; pharmacology ; Nucleus Accumbens ; drug effects ; physiology ; Rats ; Rats, Sprague-Dawley ; Telemetry

Coronary Sinus ; abnormalities ; Humans ; Male ; Middle Aged ; Subclavian Vein ; Vena Cava, Superior

Objective To investigate the association between chronic kidney dysfunction and the complexity of coronary artery disease in elderly patients.Methods A prospective study was conducted on 1380 consecutive patients underwent coronary angiography for the first time in our hospital and with angiographically diagnosed coronary artery disease from January 2011 to June 2012.The complexity of coronary artery disease were classified according to the American College of Cardiology/American Heart Association (ACC/AHA) grading system as types A,B1,B2,and C.Estimated glomerular filtration rate (eGFR) was calculated by the simplified Modification of Diet in Renal Disease(MDRD)equation.Patients were classified into 3 stages according to eGFR as follows:normal renalfunction(n=234,eGFR≥90 ml· min-1 · 1.73 m-2),mild renaldysfunction(n=881,60≤eGFR＜90 ml · min-1 · 1.73 m-2,and moderate or severe renaldysfunction(n=265,eGFR＜60ml · min-1 · 1.73 m-2).Ordinal logistic regression was used to analyze the association between chronic kidney dysfunction and the complexity of coronary artery disease.Results Patients with mild,moderate or severe renal dysfunction were older (F=56.82,P＜0.001),more predominantly female (x2 =66.29,P＜ 0.001) and more likely to have history of hypertension (x2 =17.57,P ＜ 0.001),diabetes (x2=20.97,P＜0.001) and hyperlipidemia (x2=10.48,P 0.005) than those with normal renal function.The percentage of lesions of types B2 or C in moderate or severe renal dysfunction group was higher than that in normal renal function group (x2=175.03,P＜0.001).The ordinal logistic regression showed that age,male,hypertension,diabetes,C-reactive protein and eGFR were independent risk factors for the ACC/AHA lesion classification.Conclusions Age,male,hypertension,diabetes,C-reactive protein and eGFR are independent risk factors for the complexity of coronary artery disease.

Objective To evaluate the medium-term outcomes of minimally invasive percutaneous nephrolithotomy in patients with renal function impairment.Methods Data of 811 patients who underwent minimally invasive percutaneous nephrolithotomy between Jan.2009 and Dec.2011 were retrospectively collected.Seventy-eight patients had a preoperative estimated GFR of 30-59 ml/(min · 1.73m2).The minimum follow-up was 1 year.Patients were divided into group 1 (improved or stable disease) and group 2 (worsened disease).Patient age was (42.8 ± 16.3) and (45.3 ± 14.2) separately,with male patients 41 and 7,female patients 25 and 5 respectively.Body mass index were (24.3 ± 4.1) kg/m2 and (25.4 ±5.2) kg/m2,history of open surgery or ESWL were 19 and 4.Mild hydronephrosis were 22 and 4.Staghorn stone were 22 and 5.Multiple access were 13 and 2.Operative time was (78.2 ± 30.4) min and (80.3 ±32.3) min.Stone-free rate 1 month postoperatively were recorded.Multiple regression analysis was used.Results The stone free rate at 1 month postoperatively was 85％ by CT scan.Preoperative eGFR was (38.4±12.8) ml/(min · 1.73m2),and 1 ycar postoperative eGFR was (45.1 ±15.8) ml/(min · 1.73m2)in 78 patients.Renal function had improved in 31％ of patients,but it remained the same or deteriorated in 54％ and 15％,respectively at 1 year follow-up.On multivariate regression analysis,diabetes was associated with the deterioration of renal function.Conclusions At medium-term follow-up,renal function was maintained or improved in 85％ of patients with chronic kidney disease who underwent minimally invasive percutaneous nephrolithotomy.Minimally invasive percutaneous nephrolithotomy could be an effective and safe option for the patients with chronic renal function impairment.Diabetes mellitus was independent predictive factor of renal function impairment.Therefore,patients with diabetes should be followed up carefully.Medical management is needed if necessassry.