Objective To observe the effect of L-carnitine on plasma soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) protein in maintenance hemodialysis (MHD) patients.Methods Forty-six cases of MHD patients were enrolled as MHD group,and 40 cases of the same period healthy subjects were enrolled as control group.The levels of plasma sTWEAK protein,high-sensitivity C-reactive protein (hs-CRP),interleukin (IL)-6 and insulin-like growth factor (IGF)-1 were measured by enzyme-linked immunosorbent assay (ELISA).Twenty-six MHD patients with the levels of sTWEAK protein higher than control group mean value as treatment group,were treated for L-carnitine 1.0 g in 0.9％ sodium chloride solution 20 ml after hemodialysis by intravenous injection one time per week.Twenty MHD patients with the levels of sTWEAK protein lower than or equal to control group mean value as non-treatment group.The changes of sTWEAK protein,IGF-1,grip strength and protein energy waisting (PEW) were observed after 3 months treatment.Results The levels of plasma sTWEAK protein,IL-6 and hs-CRP in MHD group were higher than those in control group [(464 ± 102) ng/L vs.(346 ± 159) ng/L,(986.54 ± 123.12) ng/L vs.(407.12 ± 180.25) ng/L,(18.8 ± 2.9) mg/L vs.(1.0 ± 1.2) mg/L],there were significant differences (P＜ 0.05).Compared with non-treatment group,the levels of plasma sTWEAK protein,IL-6 and hs-CRP in treatment group after treatment of 3 months were decreased [(126 ± 92) ng/L vs.(243 ± 103) ng/L,(799.45 ± 105.34) ng/L vs.(966.04 ± 113.11) ng/L,(13.7 ± 1.9) mg/L vs.(26.8 ± 2.8) mg/L],IGF-1 was increased,grip strength was increased,PEW was improved,there were significant differences (P ＜ 0.01 or ＜ 0.05).The body mass index in treatment group was more than that in non-treatment group,but there was no significant difference (P ＞ 0.05).Conclusions L-carnitine can reduce the levels of plasma sTWEAK protein in MHD patients,reduce inflammatory reaction,improve the levels of IGF-1,increase strength,improve the PEW.

Objective hole.Research demonstrated that amnion promotes the proliferation of and its mechanism.Methodswhite rabbit.The cells were primarily cultured and passaged in DM/F12 with 10% fetal bovine serum and identified with glial fibrillary acidic using 0.25% trypsin and 0.05%EDTA and suspended in 10% fetal bovine serum+DMEM/F12.0.5 mL of the amnion supernatant was added to the medium for 12 hours.The expression of EGFR in the cells was detected by immunohistochemistry.The difference of EGFR expression with or without the amnion was evaluated.ResultsCultured cells showed a positive response for GFAP and S-100.The intermediate filaments with a length of 8-10 nm were exhibited under the transmission electron microscope.EGFR was fainly expressed in cultured hours,the expression of EGFR was obviously increased with a significant difference in the gray scale between the two groups(571 588.80±67 862.68 vs.1 000 352.00±98 386.22)(t=4.035,P＜0.01).Conclusion

Objective To investigate the relationship between soluble tumor necrosis factor-like weak inducer of apoptosis levels (sTWEAK) and cardiovascular events in patients with maintenance hemodialysis (MHD).Methods A prospective cohort study was conducted in 64 MHD patients(MHD group).The plasma level of sTWEAK was measured by enzyme-linked immunosorbent assay,N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitive C-reactive protein (hs-CRP) levels were measured by enzyme-linked immunofluorescence method,left ventricular end-diastolic diameter (LVEDd),left ventricular posterior wall thickness (LVPWT),end-diastolic ventricular septal thickness (IVST),left ventricular ejection fraction (LVEF) was determined by echocardiography.The general situation,clinical indicators and occurrence of cardiovascular events of MHD patients were recorded and followed up for 2 years.Fifty healthy people were selected as control group.Results The plasma level of sTWEAK was higher in MHD group than that in control group [(589 ± 122) ng/L vs.(346 ± 127) ng/L],and there was significant difference (P＜ 0.01).During the follow-up period,12 patients underwent cardiovascular events(3 patients died).The plasma level of sTWEAK in cardiovascular event patients was significantly higher than that in non-cardiovascular event patients (695 ng/L vs.458 ng/L),and there was significant difference (P ＜ 0.01).The plasma level of sTWEAK was positively correlated with NT-proBNP in MHD patients(r =0.698,P ＜ 0.05).Logistic repression analysis showed that sTWEAK was the predictor of cardiovascular events of MHD patients.Conclusion The plasma level of sTWEAK probably predicts the ocurrence of cardiovascular event in MHD patients.

Objective To investigate the therapeutic effect of integrated traditional Chinese and western medicine for acute severe traumatic brain injury.Methods The patients with acute severe traumatic brain injury were randomized into the treatment group(receiving integrated traditional Chinese and western medicine),control 1 group(receiving routine western medicine and blood-activating and stasis-removing herbs) and control 2 group(receiving routine western medicine).The therapeutic effect,neurological impairment score and complications were compared in the three groups after treatment for 3 weeks.Results In the treatment group,13 patients were markedly effective,5 effective,2 ineffective and the total effective rate was 90.0%;in control 1 group,8 patients were markedly effective,4 effective,8 ineffective and the total effective rate was 60.0%;in control 2 group,9 patients were markedly effective,6 effective,5 ineffective and the total effective rate was 75.0%.The therapeutic effect in the treatment group was superior to that in the two control groups(P

To compare the effectiveness and safety of spinal versus general anesthesia for arthroplasty with respect to deep vein thrombosis(DVT),pulmonary embolism (PE) and epidural hematoma.Randomized controlled trials involving spinal and general anesthesia for arthroplasty were searched.Quality assessment were analyzed according to the Cochrane Collaboration's rule.A total of 12 trials involving 1023 participants met the inclusion criteria,Meta-analyses showed that spinal anesthesia may reduce the incidence of DVT or PE after arthroplagty without anticoagulant.There is no difference in the incidence of DVT and PE when anticoagulant is used.Whether anticoagulant was used or not,no epidural hematoma was observed after using the two anesthesia methods.

Objective To observe the effect of amniotic homogenate on closing holes in experimental rhegmatogenous retinal detachment and investigate its mechanism.Methods Forty rabbits were randomly divided into group A,B,C and D with 10 rabbits in each group.Group A and C were the treatment groups,and group B and D were the control groups.All eyes of rabbits underwent pars plana vitrectomy,retinectomy,and fluid-air exchange.The surface of the breaks was treated with 0.1 ml amniotic homogenate in experimental groups and 0.1 ml PBS in control groups.At the end of operation,20% SF6 was tamponaded and the retina reattaced.The animals were executed 14 (group A and B) and 28 days (group C and D) after the surgery.The tissue sections were observed by light microscope,electron microscope and immunocytochemistry method.Results Fourteen days after the surgery,the retina reattached in 6 eyes in group A (60%) and 2 eyes in group B (20%) (P=0.021),Twenty-eight days after the surgery,the retina reattached in 8 eyes in group C (80%) and 3 eyes in group D (30%) (P=0.046).The difference of the rate of retinal reattachment among the 4 groups were statistical significant (P<0.05).Light postoperative inflammation of ocular anterior segment was observed,which was controlled 3-5 days after treated with topical steroids.The result of light microscopy showed that the eyes in treatment groups had multilayer of fibroblast like cells around the retinal breaks,adhering to the choroid and retinal pigment epithelial cells.The proliferative cells around the retinal breaks obvious less in control groups than that in the treatment groups,and the retina could not adhere to the choroid.The results of electron microscopy were the same as that of light microscopy.Immunohistochemistry staining of the fibroblast-like cells revealed positve glial fibrillary acidic protein,which suggested that the proliferative cells around the retinal breaks were retinal glial cells.Conclusions Amniotic homogenate helps to seal retinal breaks and promote retinal reattachment by stimulating the proliferation of retinal glial cells around the breaks.

Tunneling nanotubes(TNT) are cellular communication and transport mechanism discovered recently. TNTs play important role in immunological response and viral spread, also may involve embryonic development, regulation of gene expression and carcinogenesis. However, it was not easy to study TNT for clinical samples since intricate assay method for TNT. We suggested using histochemical assay PAS staining in cell drip to show TNT in leukemia and lymphoma samples.

ObjectiveTo investigate the effect of remifentanil on hepatic ischemia-reperfusion (I/R) injury in rats with liver cirrhosis.MethodsThirty male SD rats weighing 260-300 g were randomly divided into 3 groups (n =10 each):group liver cirrhosis (group C); group liver cirrhosis + hepatic I/R (group I/R) and group remifentanil (group R).Liver cirrhosis was produced in all animals in the 3 goups.I/R injury was induced by 20 min occlusion of the hepatic artery and portal vein entering the middle and left lobes of the liver followed by 4 h reperfusion at 1 week after establishment of hepatic cirrhosis in I/R and R groups.In group R remifentanil was infused iv at 1 μg·kg-1 ·min-1 starting from 10 min before ischemia until the end of 4 h reperfusion.Venous blood samples were taken from inferior vena cava at the end of 4 h reperfusion for measurement of serum ALT and AST activities.The animals were then sacrificed and liver specimens were taken from middle lobe for determination of Bcl-2 and Bax expression (by immuno-histochemistry) and hepatocyte apoptosis (by TUNEL) and microscopic examination.Apoptosis index (percentage of apoptotic cells) was calculated.ResultsI/R significantly increased serum ALT and AST activities,Bax expression and apoptosis index and decreased Bcl-2 expression in group I/R as compared with group C.Remifentanil significantly attenuated the I/R-induced changes in serum ALT and AST activities,Bax and Bcl-2 expression and apoptosis in group R as compared with group I/R.Remifentanil also ameliorated I/R-induced liver damage.ConclusionRemifentanil can auenuate hepatic I/R injury in rats with liver cirrhosis by up-regulating Bcl-2 expression and down-regulating Bax expression and inhibiting apoptosis.

Objective To explore the training demand among clinical medical postgraduate students.Methods Focus Group Discussions and a research interview,two of the qualitative study methods were applied among medical students of a hospital.Results Different clinical medical postgraduate students need different levels training.The demand status related to the students' training styles.Students had desire to receive kinds of help of hospital administrative authority.Conclusion Training guide is importance during the growth of clinical medical postgraduate students.Hospital administrative authority should afford manifold ways to satisfy the demand of students for their training.

A retrospective analysis was made on clinical manifestations and autopsy results of 5 sudden deaths from aortic dissecting (AD).Sudden deaths from AD were almost induced by type Ⅰ and Ⅱ of DeBakey Typing.Most patients had a history of hypertension and prodromal symptoms of either chest pain,abdominal pain or back pain.Most common cause of death was cardiac tamponade induced by rupture of the ascending aorta.The clinicians should further recognize of AD so as to achieve the objective of early diagnosis and early treatment.