Objective To investigate the change of expression of toll like receptor 4( TLR4)on peripheral blood monouclear cells( PBMC) and clinical significance of sepsis acute kidney injury( AKI) patients. Methods ICU admission diagnosis of sepsis patients from May 2012 to December 2013 in the Zhongxin Hospital of Handan were diagnosed AKI according to the KDIGO guidelines of 2012 and were divided into AKI group and non AKI. Meanwhile,patients with AKI were also divided into group Ⅰ(KDIGO Ⅰ period);group Ⅱ( KDIGO Ⅱ period)and group Ⅲ( KDIGO Ⅲ period)according to the AKI stages. Thirty cases health patients were elected as the control group. The expression levels of TLR4,human leucocyte antigen(HLA-DR)on PBMC with of sepsis patients were detected with the flow cytometry. The levels of interleukin-6(IL-6) and interleukin-10(IL-10)in serum were detected by enzyme linked immunosorbent assay(ELISA). The length of ICU stay,ICU mortality and the APACHE Ⅱ in 24 h were recorded. Results (1)The expression levels of TLR4 in sepsis AKI patients was(34. 45 ± 9. 54),higher than that in patients without AKI and control group ((26. 29 ± 6. 76,10. 72 ± 8. 82;F = 55. 351,P < 0. 01). The expression of TLR4 in sepsis AKI patients was higher than sepsis patients without AKI(P < 0. 05). There was significant difference among sub AKI groups in terms of TLR4(F = 13. 235,P < 0. 01),and it significantly lower in group Ⅲ among three groups.(P < 0. 05 or P < 0. 01).(2)The levels of IL-6,IL-10 in sepsis AKI group were(565. 81 ± 106. 27)ng/ L,(76. 78 ± 12. 33) ng/ L,higher than those in non AKI group and control group((321. 85 ± 76. 62)ng/ L,(38. 53 ± 9. 93)ng/ L;(84. 36 ± 36. 91)ng/ L,(17. 53 ± 6. 08)ng/ L;F = 264. 962,254. 398,P < 0. 01). While,the levels of IL-6,IL-10 in sepsis AKI group were higher than those in non AKI group(P < 0. 05). However,there was no significant difference among three sub AKI groups in terms of IL-6 levels. The IL-10 level in group Ⅲ was highest among three sub AKI groups(P < 0. 05).(3)ICU mortality in sepsis AKI group and non AKI group were 34. 8% and 14. 8%(χ2 = 3. 410,P = 0. 065). Meanwhile,ICU mortality in three sub-AKI groups were 20. 0% ,33. 3% , 57. 1% ,and there was no significant difference(P = 0. 120). The length of ICU stay in non ALI group was(4. 14 ± 1. 65)d,shorter than that in AKI group(10. 52 ± 3. 70)d;t = 8. 201,P = 0. 000). Meanwhile,The length of ICU stay in three sub-AKI groups were(8. 93 ± 1. 81)d,(10. 17 ± 2. 31)d,(14. 71. ± 2. 81)d,and the difference was significant(F = 19. 052,P = 0. 000). APACHE-Ⅱ in three sub-AKI groups Ⅰ,group Ⅱ,groupⅢ were 20. 20 ± 4. 07,21. 00 ± 3. 16,30. 57 ± 2. 44 respectively and the difference was significant(P < 0. 05 or P < 0. 01). Conclusion TLR4 mediated inflammation is involved in the sepsis AKI process. Because the damage degree of AKI is aggravating,immune factors also participate in the development of AKI. And with the decrease of HLA-DR,the probability of RRT increases.

Objective To observe the influence of Shenkang injection with Irbesartan on urinary albumin excretion rate(UAER)in 24 hours,serum lipid and blood rheology in early diabetic nephropathy.Methods One hundred and fifty normotensive early diabetic nephmpathy were randomly divided into control group,Shenkang injection group and Shenkang injection with Irbesartan group.Three groups were treated with diabetic education,dietary regimen,suitable physical activity and oral anti-hyperglycemic agents till their fasting blood glucose(FBG)was less than 7.0 mmol/L and postprandial blood glucose(PBG)was less than 10.0 mmol/L.The control group was treated with oral anti-hyperglycemic agents or/and insulin.Shenkang injection group was additionally treated with Shenkang solution.Shenkang solution was mixed by Shenkang injection 100 ml,5% glucose 250 ml and insulin 2-3 U.Shenkang solution was intravenously guttaed once a day.Shenkang injection with Irbesartan group was additionally treated with Irbesartan 0.15 g,once a day,taken orally.A course was taken for 3 weeks.The levels of UAER,serum lipid and blood rheology were detected immediately and 9 weeks after treatment.Results In the Shenkang injection group,compared with those before treatment,them were significant difference in UAER (87.44 ±10.06)μg/min vs.(116.55 ± 33.42)μg/min),serum lipid( (4.22 ± 0.70)mmol/L vs.(4.88 ± 0.69 )mmol/L)and blood rheology( (5.77 ±0.53)mPa·s vs.(7.38 ± 0.41)mPa·s)(P ＜ 0.05).In the Shenkang injection with Irbesartan group,compared to those before treatment,there were also significant difference in UAER ( (61.90 ±28.02)μg/min vs.(123.37 ± 29.98)μg/min),serum lipid( (4.00 ± 0.14)mmol/L vs.(4.90 ± 0.12)mmol/L)and blood rheology( (5.11 ±0.41)mPa·s vs.(7.27 ± 0.44)mpa·s)(P ＜ 0.05).Whearas in the control group,no significant difference were found compared with those before treatment.Furthermore,the improvements in the Shenkang injection with Irbesartan group were better than those in the Shenkang injection group(P ＜ 0.05).Conclusions Shenkang injection can reduce UAER,decrease serum lipid and improve renal blood rheology.Iteffectively prevents diabetic nephropathy in earlier period and maybe have synergy with Irbesartan.

Objective To observe the therapeutic effect of Shenluo'an Decoction(SD) for the treatment of obese patients with early diabetic nephropathy and to explore the possible mechanism.Methods A total of 68 obese patients with early diabetic nephropathy were randomly assigned into control group and treatment group,34 cases in each group.Both groups were given conventional western medicine treatment including lifestyle regulation,dietary control,and medicine for lowering blood pressure,blood glucose and blood lipids.Additionally,the control group was given oral use of Irbesartan,and the treatment group was given oral use of SD combined with Irbesartan.Before and after treatment,we observed the traditional Chinese medical syndrome scores,body mass index(BMI),blood levels of cystatin C (Cys C),β2-microglobumin(β2-MG),homocysteine (Hcy) and fasting blood glucose (FBG),and urine parameters of urinary monocyte chemoattractant protein-1 / urinary creatinine (UMCP-1/UCR),urinary factor of regulated on activation in normal T cell expressed and secreted / urinary creatinine (URANTES/UCR),urinary albumin-to-creatinine ratio (UACR) and urinary albumin excretion ratio (UAER) before treatment and after treatment for 16 weeks.After treatment,the clinical efficacy and safety were also evaluated.Results (1) During the treatment,5 cases were dropped out,and a total of 63 cases (32 from the treatment group and 31 from the control group) completed the experiment.(2) The total effective rate of the treatment group(90.6％) was significantly higher than that of the control group(67.7％),the difference being significant(P ＜ 0.05).(3)BMI of the two groups after treatment was significantly lower than that before treatment (P ＜ 0.05).(4) After treatment,the traditional Chinese medical syndrome scores,blood parameters (Cys C,β2-MG,Hcy,FBG) and urine parameters (UMCP-1/UCR,URANTES/UCR,UACR,UAER) in the treatment group were decreased as compared with those before treatment and those in the control group after treatment(P ＜0.05).(5) A positive correlation was present among the parameters of UMCP-1/UCR,URANTES/UCR,UACR and UAER.(6) No abnormal changes took place in the blood and stool routine examination,hepatic function,or electrocardiography of the 63 cases.Conclusion SD combined with western medicine exerts certain therapeutic effect for obese patients with early diabetic nephropathy,and is effective on relieving clinical symptoms anddecreasing BMI,Cys C,β2-MG,UACR,UAER,UMCP-1 and URANTES.Its mechanism is probably related with the inhibition of chronic renal inflammation.

Objective:To develop a luminescent oxygen channeling immunoassay for pregnancy associated plasm a protein A.Methods:The monoclonal antibody of PAPP-A was labeled with biotin ,the polyclonal antibody of PAPP-A was coated on receptor particles.The LOCI reagents also contained sensitizer particles coated with streptavidin.The optimal test conditions and analytical per-formance of the method were studied.Results:The within-run and the between-run coefficients of variation were 5.91%-7.94% and 6.14%-9.69%,respectively;the analytical sensitivity was 2.8 mU/L and the function sensitivity was 4.6 mU/L,good linear in 2.8 mU/L-8 000 mU/L range;the recovery rate was 96.7%-100.3%.The interference rate of hemolysis , icterus and triglycerides were less than 10%; there is no Hook effect of PAPP-A concentrations up to 8 000 mU/L;the correlation coefficient between clinical samples detection results and Time resolved fluoroimmunoassay analysis results was 0.974.Conclusion:This LOCI can be used for the quantitative of serum PAPP-A,and detection performance in line with the requirements of clinical diagnostic reagents .

Objective To investigate the expression of Toll-like receptor 4 (TLR4) of peripheral blood mononuclear cell (PBMC) in the different prognosis of patients with severe sepsis and its relation with endotoxin-tolerant.Methods Thirty-five patients with severe sepsis (severe sepsis group) and 15 healthy volunteers (control group),respectively stayed in ICU 24 h and physical examination in the day measured TLR4 expression of PBMC by flow cytometry and measured the serum of tumor necrosis factor (TNF)-α and interleukin (IL)-10 by enzyme-linked immunosorbentassay.Simultaneous separation of peripheral blood of PBMC,addition of 40 μ g/ml lipopolysaccharide (LPS) cultured for 24 h,and TLR4 expression of PBMC was measured in the same manner and the culture supernatant of TNF-α and IL-10.Results Thirty-five patients with severe sepsis survivor 25 cases (survivor group) and death 10 cases (death group),28 d death rate was 28.6％ (10/35).The TLR4 expression of PBMC in severe sepsis group was significantly lower than that in control group [(11.09 ± 8.90) MFI vs.(33.72 ± 12.59) MFI,P ＜ 0.01],the serum TNF-α and IL-10 in severe sepsis group were significantly higher than those in control group [(96.66 ± 45.33) ng/L vs.(2.53 ± 1.21) ng/L,(149.79 ± 67.15) ng/L vs.(34.56 ± 19.08) ng/L,P ＜ 0.01].There was no significant difference in TLR4 expression of PBMC between survivor group and death group (P ＞ 0.05).The TLR4 expression of PBMC in control group after LPS stimulation was significantly higher than that before LPS stimulation [(50.22 ± 19.23) MFI vs.(33.72 ± 12.59) MFI,P ＜ 0.05],survivor group and death group after LPS stimulation were significantly lower than those before LPS stimulation [(4.55 ± 2.30) MFI vs.(11.21 ±7.92) M FI and (5.46 ± 3.44) M FI vs.(10.15 ± 9.70) MFI,P ＜ 0.01].The culture supernatant of TNF-α,IL-10 in survivor group and death group were significantly lower than those in control group [(22.34 ± 8.27)and (19.49 ±5.35) ng/L vs.(88.70 ±34.21) ng/L,(54.29 ±32.89) and (98.04 ±40.26) ng/L vs.(146.56 ± 52.18) ng/L,P ＜ 0.01],but the culture supernatant of IL-10 in death group was significantly higher than that in survivor group (P ＜ 0.05).Conclusion Different prognosis of patients with severe sepsis have endotoxin tolerance and different inflammatory cytokine secretion abifity.

Objective To study the effect of intercostal bronchial artery embolization(BAE) with gelatinum sponge(GS) or polyvinyl alcohol(PVA) in treating acute massive hemoptysis.Methods Fifty-two patients with acute massive hemoptysis underwent selective bronchial arteries angiogaphy first,then superselective bronchial arteries embolization using 3F SP catheter with GS in group A(n=24) and with PVA in group B(n=28).Results In group A,immediate control of hemoptysis was achieved in 16 patients(66.67%),marked reduce in bleeding was seen in 7 patients(29.17%),the effective rate was 95.83%.In group B,immediate control of hemoptysis was achieved in 24 patients(85.71%),marked reduce in bleeding was seen in one patients(14.29%),the effective rate was 100%(P﹥0.05).All patients were followed-up for one year.The recurrent rate was 25%(6 cases) in group A and 3.57%(1 case) in group B(P﹤0.05).Conclusion BAE with PVA is effective and safe method in treating serious hemoptysis.

OBJECTIVE To investigate the choise of operation approach for chronic otitis media surgery. METHODS Auditory and high resolution computed tomography (HRCT) assessment were carried out prior to the operation in 160 ears with otitis media. Tympanoplasty or mastoidectomy and tympanoplasty were performed. RESULTS Thirty-one patients received tympanoplasty and 129 patients received mastoidectomy and tympanoplasty. Closed and opened surgery were performed in 49 and 80 cases respectively. The ear-drying time ranged from 7 to 51days with an average of 23 days. Mean hearing increased by 15dB. CONCLUSION Assessing the HRCT scan prior to the surgery can help us choose a reasonable approach in chronic otitis media surgery.

Objective To investigate the protective effects and mechanism of Pentoxifylline(PTX) on rats with renal interstitial fibrosis following unilateral ureteral obstruction(UUO).Methods The rats were randomly divided into 5 groups: Sham operation group(group A),UUO group(group B),Enalapril group(group C),PTX group(group D) and PTX plus Enalapril group(group E).On the 3th,7th and 14th day after operation,5 rats of each group were sacrificed by exsanguinations,respectively.The concentration of hydroxyproline was measured,and the ratio of collagen and renal weight was tested.The expressions of transforming growth factor-?1(TGF-?1),tissue inhibitor of metalloproteinase-1(TIMP-1),vascular endothelial growth factor(VEGF),bone morphogenetic protein-7(BMP-7),NF-?B and CD34 were measured by immunohistochemistry.The peritubular capillary index(PCI) was regarded as the expression of CD34.Results The ratio of collagen and renal weight in the rats of group B was higher than that of other 4 groups(P

Objective To investigate the influence of electroacupuncture on the expression of neuropeptides in fibroeartilage callus tissue after femoral fracture. Methods Forty male Wistar rats were randomly divided into a fracture group and an electroacupuncture group. Femoral fracture models were established in both groups, and the rats in the electroacupuncture group were given electroacupuncture. Rats were sacrificed on the 4th, 7th, 14th and 28th days after surgery. The calluses were stained immunohistochemically to detect the expression of calcitonin gene-related peptide (CGRP) and substance P (SP). Results CGRP and SP levels increased rapidly after eleetroacu-puncture, with neuropeptides expressed strongly in callus cell tissue. The optical density (OD) in the electroacu-puncture group was significantly higher than that in the fracture group ( P≤0. 05 ). Conclusion Electroaeupune-ture can significantly increase the expression of neuropeptides in rats after femoral fracture. Electroaeupuneture can promote fracture healing through regulating neuropeptides.

Objective To stuay the serum levels of sCD40L,hsCRP,ICAM-1 and VCAM-1,and the expression of CD40L of the CD4+T cells in patients withacute coronary syndrome(ACS),and to explore the relationship between CD40L and inflammatory factors and the effects of CD40/CD40L on ACS.Method Thirty-two coronary heart disease patients without history of other discernible systemic disease and medicine of steroids or immunosuppressants taken were divided into acute myocardial infarction group(AMI,n=11),unstable angina pectoris group(USP,n=14)and stable angina pectoris group(SAP,n=7).The control group was composed of eight healthy volunteers(CON group).Theexpression of CD40L Was determined by flow cytometry(FCM).Serum sCD40L.ICAM-1 and VCAM-1 were determined by using ELISA.The serum hsCRP was assayed by using immunoturbidimetry.Data were analyzed with SPSS 11.0 software for windows.Results The expression percentage(%)of CD40L of the CD4+T cells,and the serum levels of sCD40L,hsCRP,ICAM-1 and VCAM-1were sifnificantly higher in patients of AMI group than those in patients of other groups(P＜0.05 or P＜0.01).Similarly,those biomarkers in patients of UAP group were usually higher than those in patients of CON or SAP groups(P＜0.05).There Was a positive correlation between the expression of CD40L and the serum level of VCAM-1 in paients of AMI group(P＜0.05),and likewise,a positive correlation also existed between the serum level of sCD40L and other factors,hsCRP,ICAM-1 as well as VCAM-1,in patients of AMI group(P＜0.05).Conclusions The enhanced expression of CD40L of the CD4+T cells and high serum level of sCD40L are present in patients with acute coronary syndrome.The hsCRP,ICAM-1 and VCAM-1 play roles in the pathogenesis of ACS,and they have correlation with enhanced expression of CD40L and high serum level of sCD40L.Therefore,CD40L and sCD40L may be used as indicators of risk in coronary heart disease.