Objective To study the mRNA expression of Toll-like receptor (TLR) 2 and 4 in human urinary tract epithelium. Methods The epithelial cells of nephric tubule, pelvis, ureter and bladder were cultured in vitro, and their mRNA expressions of TLR2 and TLR4 were measured by RT-PCR. Results The mRNA expression of TLR2 in nephric tubule, pelvis, ureter and bladder was 0.326, 0.589, 0.602 and 0.735, and that of TLR4 was 0.223, 0.327, 0.379, 0.365, respectively. The mean TLR2 mRNA copy was significantly higher than TLR4 in each tissue (P

Objective To observe the effect of Tung’s acupuncture on walk and balance function in patients with Parkinson’s disease (PD). Method Ninety-two eligible PD patients were randomized into a control group and a treatment group, 46 cases in each group. The control group was intervened by Levodopa, while the treatment group was additionally intervened by Tung’s acupuncture. The two groups were both treated for 20 d. Before and after the treatment, the walk and balance function were evaluated by the indices of NeuroCom Balance Master, including Walk Across (WLK), Step/Quick Turn (SNT), and Timed Up & Go Test (TUGT), and the results were compared between the two groups. Result The walk speed, step length, swing in turning, time-consumption in turning, and TUGT were improved after the intervention in both groups (P<0.05), and the improvements in the treatment group were more significant than that in the control group (P<0.05). Conclusion Tung’s acupuncture plus oral administration of Levodopa can markedly improve the walk and balance function in patients with PD.

Objective To explore the distribution of pathogens and the characteristics of the urine pH values in urinary tract infection (UTI),and provide a new idea for clinical prevention and treatment of UTI.Methods The data of 606 strains of pathogens and the infected urine pH values from urinary samples of patients with UTI from January 2007 to November 2009 in our hospital were obtained.The distribution of pathogens was detected,and these pathogens were divided into 3 groups according to the genus.Urine pH value of different pathogens was analyzed.Results Among 606 strains from UTI,the group of escherichia ranked the first with 186 strains (30.7%),and the infected urine pH by this bacteria ranged from 6.21 to 6.33.A total of 152 strains of candida were detected (25.1%),and the infected urine pH value was from 5.81 to 5.95.There were 86 strains of enterococcus detected (14.2%),and the infected urine pH was from 6.10 to 6.28.By contrasting the infected urine pH of these 3 groups,the infected urine pH by candida was acidic significantly (P

Objective To observe the clinical efficacy of extracorporeal shock wave (ESW) plus electroacupuncture in treating periarthritis of shoulder.Method Ninety patients with periarthritis of shoulder were randomized into an electroacupuncture (EA) group, an ESW group, and an ESW plus EA group, 30 cases in each group. The EA group was intervened by EA, the ESW group was treated with ESW, and the ESW plus EA group by ESW and EA. The three groups were treated once every 2 d, with successive 10 sessions as a treatment course. The Visual Analogue Scale (VAS) score and shoulder range of motion (ROM) score were evaluated before and after the treatment in the three groups. Result The VAS scores dropped significantly in the three groups after the intervention (P<0.05); there was no significant difference in comparing the VAS score between the EA group and ESW group after the intervention (P>0.05); the VAS score in the ESW plus EA group was significantly different from that in the EA group and ESW group after the treatment (P<0.05). The ROM scores were significantly improved in the three groups after the intervention (P<0.05); there was no significant difference in comparing the ROM score between the EA group and the ESW group after the intervention (P>0.05); the ROM score in the ESW plus EA group was significant different from that in the other two groups (P<0.05).Conclusion ESW plus EA can more significantly ease the pain and improve the shoulder ROM in treating periarthritis of shoulder compared with the two methods used separately.

Objective To investigate the effect of general anesthesia with sevoflurane or intravenous propofol on anesthesia recovery period in obstructive jaundice patients. Methods Thirty ASA Ⅰ or Ⅱ and Child A obstructive jaundice patients were randomly divided into two equal groups (n=15 each). The patients in group S received inhalation anesthesia with sevoflurane and those in group P intravenous anesthesia with propofol during operation for obstructive jaundice. The patients were premedicated with intramuscular phenobarbital 100mg and atropine 0.5mg, anesthesia was induced with midazolam 0.05mg/kg, atracurium 0.5mg/kg, propofol 1.5-2.5mg/kg and fentanyl 4μg/kg. Maintained with TCI of propofol (target plasmaconcentration was set at 3.5mg/L) or sevoflurane inhalation (end-tidal sevoflurane concentration was 2%-3%) and intermittent i. v. boluses of fentanyl. EGG, HR, MAP, SpO<,2> and end-tidal sevoflurane concentration were continuously monitored during operation. Duration of anesthesia, the volume of infusion and fentanyl were recorded, awaking time, extubation and regained consciousness after operation were recorded. Results There were no significant differences between the two groups in average age, sex, body-weight, duration of anesthesia, the parameters of MAP and HR (P>0.05). The awaking time was (7.9±1.5) minutes in group S and (26.1±8.8) minutes in group P. The extubation time was (8.5±2.5) minutes in group S and (27.8±11.2) minutes in group P. The regained consciousness time was (13.1±4.4) minutes in group S and (33.7±12.5) minutes in group P. The incidence of lethargy, fidget were higher in group P than those in group S. Conclusion Both sevoflurane and propofol can provide satisfactory anesthesia for the operation of obstructive jaundice, but the recovery of influence caused by sevoflurane is faster and more steady than that caused by propofol.

Objective To evaluate the clinical effect of intervertional devascularization and surgical devascularization in treatment of patients with upper gastrointestinal hemorrhage .Methods Ninety-nine cases treated with intervertional devaacularization or surgical devascularization were retrospectively studied including 48 cases in intervertional group and 51 cases in surgical group.The postoperative resection, complications and rebleeding time were compared by X2 test and t test between two methods.Results The 12 months, 24 months and 36 months cumulative rebleeding rates after intervertional devascularization were 12.5% (6/47) ,24.5% (11/45), 27.9% (12/43) respectively.The rate after surgical devaacularization were 29.2% (14/48) ,44.7% (21/47), 48.9% (22/45) respectively.There were statistically significant differences between the intervertional and surgical groups (X2=3.843,4.150,4.083, P < 0.05).The complications of intervertional devascularization included fever 85.4% (41/48), bellyache 81.3% (39/48), portalvein thrombosis 4.2% (2/48), intraabdominal hemorrhage 2.1% (1/48), infection 2.1% (1/48) and death 2.1% (1/48).The complications of surgical devaacularization included fever 68.6% (35/51), bellyache 62.7% (32/51), generous hydroperitoneum 25.5% (13/51), portalvein thrombosis 37.3% (19/51), splenic vein thrombosis 11.8% (6/51), hepatic encephalopathy 3.9% (2/51), hepatorenal syndrome 2.0% (1/51), intraabdominal hemorrhage 2.0% (1/51), death 3.9% (2/51) and infection 15.7% (8/51).There were statistically significant differences of fever, bellyache, generous hydroperitoneum, portalvein thrombosis, splenic vein thrombosis between the intervertional and surgical groups(X2=4.174,3.098,16.199,6.011,5.536,14.085,P <0.05).Conclusions The intervertional devascularization procedure is simple, safe and effective method for treating upper gastrointestinal hemorrhage for portal hypertensive.The clinical effect is better than that of surgical devascularization.

Objective To investigate the clinical characteristics and prognosis of patients with high level of plasma procalcitonin (PCT > 100 μg/L), and to improve the clinician's understanding, diagnosis and treatment of this kind of patients. Methods A retrospective study was conducted. The clinical data of patients with plasma PCT over 100 μg/L within 48 hours of admission admitted to Second Affiliated Hospital of Zhejiang University School of Medicine from February 2013 to December 2016 were collected, and the clinical characteristics were analyzed. The patients were divided into survival and death groups according to 28-day prognosis. The general data and laboratory parameters including vital signs, 24-hour urine output, routine blood test, blood biochemical tests, coagulation parameters, myocardial enzymes and arterial blood gas analysis were collected. The risk factors of mortality were analyzed using multi-logistic regression analysis. Results 188 patients with high level of plasma PCT were enrolled. There were 128 male patients (68.1%) with the average age of 62 (49, 75) years. Most patients were admitted in intensive care unit (ICU, 70.7%, 133/188). Major diagnosis was sepsis (91.0%), followed by multiple organ dysfunction syndrome (MODS, 57.4%), post large operation of thorax and abdomen (20.7%), trauma/burns (13.8%) and post-cardiopulmonary resuscitation (CPR, 6.4%). Of all the 188 patients, 115 patients survived and 73 died with a mortality of 38.8%. The parameters in the death group, including the percentages of MODS (84.9% vs. 40.0%), trauma/burns (26.0% vs. 6.1%), post-CPR (13.7% vs. 1.7%), ventilator support (82.2% vs. 40.9%) and shock (100.0% vs. 60.0%), the numbers of principal diagnosis [2.0 (2.0, 3.0) vs. 2.0 (1.0, 2.0)], acute physiology and chronic health evaluation Ⅱ score [APACHE Ⅱscore: 24 (19, 28) vs. 14 (10, 16)] and sequential organ failure assessment (SOFA) score [16.0 (12.5, 18.0) vs. 9.0 (6.0, 12.0)], as well as liver function, coagulation parameters, myocardial enzymes and lactic acid (Lac) levels were significantly higher than those in the survival group, but the platelet (PLT) count in the death group was significantly lower than that in the survival group [×109/L: 62.00 (21.50, 111.00) vs. 93.00 (53.00, 136.00), all P < 0.05]. The parameters with statistical significance in the univariate analysis were enrolled in the multiple factor logistic regression analysis, which showed that patient with a high score of APACHE Ⅱ [odds ratio (OR) = 1.290, 95% confidence interval (95%CI) = 1.121-1.484, P = 0.000] or the occurrence of MODS (OR = 7.264, 95%CI = 1.762-29.941, P = 0.006) at admission had a poor prognosis. Conclusions The primary patients with high levels of plasma PCT (> 100 μg/L) were diagnosed with sepsis, MODS, trauma and post-CPR, complicated with respiratory and circulatory insufficiency. These factors of trauma, MODS and cardiac arrest, and some laboratory parameters including PLT, Lac, liver function, coagulation spectrum, and cardiac enzymes were correlated with the prognosis of the patients with high levels of plasma PCT. High APACHE Ⅱ score and the incidence of MODS might be independent predictors of poor prognosis in the patients with high levels of plasma PCT.

Objective To discuss the method, safety and clinical value of biliary stenting combined with 125I seed implantation intracavitary irradiation in treating malignant obstructive jaundice. Methods A total of 36 patients with malignant obstructive jaundice were enrolled in this study. PTCD was carried out in all patients, which was followed by biliary stenting combined with 125I seed implantation intracavitary irradiation treatment. The results were analyzed. Results During the interventional management, displacement of the stent and 125I seeds were observed in two cases, and the displaced stent and 125I seeds were replaced to the right position with the help of biliary biopsy forceps. The technical success rate was 100%, and the remission rate of the jaundice was 100%. All the patients were followed up for 1-23 months. No radioactive particles leaking or complications such as radiation enteritis occurred. No in-stent obstruction due to tumor recurrence was observed although slight dilatation of intrahepatic bile duct was detected in 25%of patients, which was resulted from intimal hyperplasia at the stent mesh and/or biliary stone formation. The median survival time was 10.9 months. Conclusion For the treatment of malignant obstructive jaundice, biliary stenting combined with 125I seed implantation intracavitary irradiation is safe, reliable and effective. This technique can prolong stent patency time as well as the patient’s survival time.

Aluminum salts are the most popular adjuvants applied in human vaccines currently. However,they can′t achieve satisfying results in the development of novel vaccines because of the cellular immune responses induced by them are weak and their adjuvant activities for some novel vaccines are poor, especially in vaccination against peptide antigens with small molecular weight. cGAMP (cyclic guanosine monophosphate-adenosine monophosphate) has recently been known as a mammalian second messenger, which plays an important role in the innate immune signaling pathway and is capable of boosting the immuno-genicity of vaccines,activating antigen-presenting cells and enhancing specific T cell responses. cGAMP is expected to become a new generation of vaccine adjuvants against infectious diseases and cancer. In this re-view,we summarize the application and current situation of vaccine adjuvants, describe the discovery of cGAMP and its mechanism as a vaccine adjuvant,and focus on the advances in using cGAMP in the fields of vaccination against infectious diseases, intradermal immunization and tumor immunotherapy. Finally, it is also pointed out that cGAMP,as a novel vaccine adjuvant,will have a broad prospect of application in areas such as anti-tumor,anti-virus,anti-inflammatory and vaccines.