ObjectiveTo investigate the effects of hyperbaric oxygen therapy on T-lymphocytes 1 and cytokines including IL-6, IL-10 and TNF-α asindicators well representing immune function and inflammation in normal rats and rats with systemic inflammatory response syndrome. Methods Forty Sprague-Dawley male Rats were randomly ( random number) divided into five groups.Rats of group A were treated by saline solution (0.9 ％ NaCl,5 mL/kg),and served as control group; rats of group B were treated with saline solution and hyperbaric oxygen therapy three times; rats of group C were treated with zymosan (500 mg/kg) ; rats of group D were treated with zymosan and hyperbaric oxygen therapy once; and rats of group E were treated with zymosan and hyperbaric oxygen therapy three times.At 24 hours after saline or zymosan administration,rats were sacrificed and blood samples were collected from the portal vein.CD3 +,CD4+,CD8+ cells were counted by flow cytometer,and plasma levels of IL-6,IL-10 and TNF-αwere measured by ELISA.The results were analyzed by one - way ANOVA and LSD post-hoc test.Results CD4 T cell of normal rats was decreased by hyperbaric oxygen (P＜0.01 ),CD4/CD8 T cell ratio was also decreased ( P ＜ 0.05 ).Of rats with zymosan administration,CD4 T cells and CD8 T cells were both decreased on a parallel (P＜0.01 ).A single one HBO and HBO for three times both raised the percentage of CD4 T cells which was significantly decreased by zymosan administration ( P ＜ 0.01 and P ＜ 0.05 ).In rats without hyper- inflammation,hyperbaric oxygen therapy showed a pro-inflammatory effect by elevating TNF-α (P＜0.01),IL-6 (P＜0.05) and reducing 1L-10 (P＜0.05).ConclusionsHBO reduces CD4 T cells in normal rats.HBO reduces the production of TNF-α,IL-6 and IL-10 during hyper- inflammation.HBO is pro - inflammatory in normal rats and minor SIRS rats withourt appreciable hyper-inflammation in circulation.

Objective To analyse the failed total hip arthroplasty(THA) and to improve its long term results. Methods Thirty five patients(36 hips) undergone revision THA from November 1996 to April 1999, were grouped according to the different causes of the primary failed THA. Results Statistical analysis failed to show the factors related to the failures. In any one failed case, the causes were usually more then one item. The most common causes of failed surgery found in 24 cases were aseptic loosening and peri prosthetic osteolysis, wear out of acetabulum was seen in 7, malpositioned prostheses in 6 and postoperative dislocation in 3. Infection and fracture of femoral stem happened in 3 and 2 patients respectively. Conclusion THA has been extensively used as an effective procedure for the reconstruction of hip joint. Long term excellent clinical results are related to strict selection of indications, appropriate prosthesis, and finally the experience and surgical technique of the surgeon are also of importance to the final outcome.

Objective To study the correlation of serum hepcidin with residual renal function and micro-inflammation state in continuous ambulatory peritoneal dialysis (CAPD) patients.Methods Thirty-four stable CADP patients were involved in this study as observers (CAPD group),who had accepted CAPD treatment more than three months; twenty non-dialysis patients with stage 5 of chronic kidney disease were selected as control group.According to the level of high sensitivity Creactive protein (hs-CRP),CAPD patients were divided into two subgroups.There were 14 patients in the hsCRP elevated group (hs-CRP ＞ 3.00 mg/L) and 20 patients in the hs-CRP normal group.In addition,there had been 14 patients with residual renal function in CAPD group.Serum hepcidin was measured by ELISA.Serum Ferritin (FER),hs-CRP,routine blood and biochemistry were measured by routine methods.Calculated estimated glomerular filtration rate (eGFR).Pearson correlation and linear regression were used to assess the correlation of serum hepcidin with other laboratory parameters in CAPD patients.Results (1) Serum hepcidin was significantly higher in CAPD patients than control group,but eGFR was significantly lower (P ＜ 0.01).(2) Serum hepcidin levels of no residual renal function patients increased more significantly in CAPD group (P ＜ 0.05).(3) Serum hepcidin levels were higher in hs-CRP elevated group than hs-CRP normal group (P ＜ 0.05).(4) Pearson correlation analyses revealed that serum hepcidin was positively correlated with hs-CRP (r=0.501) and FER (r=0.847,all P ＜ 0.01),and was negatively correlated with Hb (r=-0.919),TRF (r=-0.751),TIBC (r=-0.532,all P ＜ 0.05).(5) Multiple linear regression analysis showed that ferritin and hs-CRP were closely associated with serum hepcidin level in CAPD.Conclusions Serum hepcidin level markedly elevate in CAPD patients,especially in the patients with no residual renal function and micro inflammatory state increased more significantly.

Objective To explore the pancreatic kininogenase enteric-coated tablets in the treatment of diabetic retinopathy (DR) patients and its effect on the optic disc and macula retinal hemodynamics. Methods 86 cases (140 eyes) of DR patients were randomly divided into pancreatic kininogenase group and normal group with 43 cases in each group, two groups were treated with basic therapy, pancreatic kininogenase group were combined with pancreatic kininogenase treatment. The best corrected visual acuity and the clinical effect of optic disc and macula retinal hemodynamic changes were compared between two groups. Results After treatment, the best corrected visual acuity (BCVA) in pancreatic kininogenase group was greater than the normal group (P<0.05), the retinal neovascularization and fluorescein leakage area in pancreatic kininogenase group was less than the normal group (P<0.05). The disc vascular and macular retinal blood flow volume (VOL), blood flow velocity (FLW)values in pancreatic kininogenase group were larger than those of normal group, and the clinical curative effect of pancreatic kininogenase group was better than that of normal group (P<0.05). Conclusion Pancreatic kininogenase enteric-coated tablets in the treatment of DR patients can improve the optic disc and macular retinal hemodynamic parameters, improve visual acuity and reduce the retinal neovascularization and fluorescein leakage area, so as to improve the clinical treatment effect.

BACKGROUND: The degree of neurofilament (NF) phosphorylation is closely correlated with the occurrence of Alzheimer disease (AD), and apolipoprotein E4 (apoE4) is a generally acknowledged liability factor for AD, but the effect and mechanism of apoE4 on the NF phosphorylation in neurons are not very clear. It has been reported that in the neurons cultured in vitro and in brain tissue of AD patients, the amino acid residues of apoE4 protein C terminal (272-299) could be truncated by hydrolysis,and produce truncated-apoE4 fragment. The latter interacts with the NF phosphorylation in neurofibrillary tangles (NFTs), which are the characteristic pathological changes of AD.OBJECTIVE: To observe the effect of truncated-apoE4 overexpression on the NF phosphorylation in the cultured neurons.DESIGN: A non-randomized controlled observation.SETTING: Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Tongji Medical College, Huazhong University of Science and Technology.MATERIALS: The experiment was carried out in the Laboratory of Biochemistry and Molecular Biology, Tongji Medical College, Huazhong University of Science and Technology in December 2005. The mice neuroma cell strain N2a was provided by Dr. Xu.METHODS: The truncated-apoE4(△272-299) cDNA was subcloned into pEGFP-c3 to form pEGFP-T-apoE4 recombinant. Then pEGFP-c3, pEGFP-apoE4 and pEGFP-T-apoE4 were transfected into N2a cells by lipofectamine2000 respectively. NF phosphorylation was detected by Western blot assay. The activities of glycogen synthase kinase-3 (GSK-3) and cyclin-dependent kinase 5(CDK-5) were measured.MAIN OUTCOME MEASURES: The degree of NF phosphorylation and the activities of GSK-3 and CDK-5 were mainly observed.RESULTS: In the transfected groups, the contents of phosphorylated NF were significantly increased, the GSK-3 activities were significantly increased, which were the most significant in the pEGFP-T-apoE4 transfected group (P＜0.05), but the CDK-5 activities were not significantly different from that in th e control group (P＞0.05).CONCLUSION: These results indicate that in vitro overexpression of truncated-apoE4(△272-299) can lead to NF hyperphosphorylation by activating of GSK-3 but not CDK-5, which may be the underline mechanism of AD induced by truncated-apoE4(△272-299).

Objective To study the relationship between oxidative stress and endothelial cell apoptosis in patients with obstructive sleep apnea-hypoventilation syndrome (OSAHS). Methods Sixth-seven patients definitely diagnosed by potysomnography (PSG) as OSAHS were divided into three groups according to their apnea-hypoventilation index (AHI), 14 in mild group (5 < AHI≤20), 21 in moderate group (20 < AHI≤40) and 32 in severe group (AHI 40). And, 18 healthy persons (AHI <5) were recruited as controls. Blood samples were obtained form all of them after PSG performance for measuring apoptotic endothelial cells (CD146AnnV+) and serum levels of superoxide dismutase (SOD) and malondialdehyde (MDA). Results Serum level of MDA and CD146AnnV+ in moderate and severe OSAHS group were significantly higher than those in control group (all P < 0.05). Serum level of SOD in moderate and severe OSAHS group was significantly lower than that in control group (P < 0.05). CD146AnnV+ correlated positively with AHI, the longest apnea time (LAT) and oxygen desaturation index (ODI) (r = 0.778, 0.609 and 0.689, respectively, all P < 0.05) and correlated reversely with saturation of arterial blood oxygen at night (SaO2min) (r =-0.635, P < 0.01). CD146AAnnV+ correlated positively with serum level of MDA (r = 0. 698, P < 0.01), and correlated reversely with serum level of SOD (r =-0.705, P < 0.01). Results of linear multivariate regression analysis showed that AHI, serum levels of SOD and MDA were independent risk factors for endothelial cells apoptosis in patients with OSAHS. Conclusions There existed oxidative stress due to intermittent hypoxia in patients with OSAHS, which could be one of the major causes in exacerbating endothelial damage.

BACKGROUND:Conventional serological, imaging and laboratory diagnosis methods for diagnosing periprosthetic infection are difficult to achieve ideal sensitivity, specificity and accuracy. In particular, the differential diagnosis of septic loosening and aseptic loosening in late stage after prosthetic replacement lacks of commonly accepted diagnostic criteria. The combination of preoperative, intraoperative and postoperative diagnostic methods is of great significance in the identifying infection diagnosis and formulating renovation strategy.
OBJECTIVE:To diagnose periprosthetic hip joint infection by combined use of preoperative 99Tcm triplephase bone scanning and intraoperative neutrophil count in frozen section analysis, and to compare with conventional diagnostic tools.
METHODS:Between April 2008 and May 2013, 44 hip revision cases were enrol ed. Combined with clinical symptoms and serological examination, 18 cases whose erythrocyte sedimentation rate and C-reactive protein increased were considered as clinical y suspected infection group;26 cases with normal serological examination were considered as clinical y suspected aseptic loosening group. 99Tcm triplephase bone scanning was performed in al patients, and combined with intraoperative frozen section analysis. If both results were negative, the diagnosis was aseptic loosening and did one-stage revision surgery;otherwise, periprosthetic infection was detected and two-stage revision surgery was conducted. By postoperative fol ow-up serological indexes and surgery outcomes, statistics of work curve of subjects was used to evaluate the diagnostic values of 99Tcm triplephase bone scanning and frozen section analysis.
RESULTS AND CONCLUSION:In 18 cases of clinical y suspected infection group, 16 cases of preoperative 99Tcm triplephase bone scanning and intraoperative frozen section results were positive, so two-stage revision surgeries were performed;2 cases with negative results received one-stage revision surgery after excluding infection. In 26 cases of clinical y suspected aseptic loosening group, 25 cases of preoperative 99Tcm three-phase bone scanning and intraoperative frozen section results were negative, and diagnosed as aseptic loosening, so one-stage revision surgery was performed. One patient affected infection of staphylococcus aureus in one-sample of the three samples in postoperative microbiological pathogen detection, and diagnosed as periprosthetic infection, so one-stage revision surgery was carried out. After combined use of 99Tcm triplephase bone scanning and intraoperative frozen section analysis, performance curve area increased from 0.906 to 0.972, sensitivity of diagnosis of infection increased from 89%to 94%, specificity of diagnosis of infection increased from 92%to 100%. However, no significant difference was detected in diagnostic methods. These data indicated that adding the method of 99Tcm triplephase bone scanning and intraoperative frozen section analysis technique, on the basis of serological and other conventional diagnostic tools, can differentiate infections from aseptic loosening of hip prosthesis. Negative results of 99Tcm triplephase bone scan showed high correlation between the diagnosis of aseptic loosening of the prosthesis and good diagnostic value to exclude infection. Combining with intraoperative frozen section method has a very good clinical value for the revision surgery.

Objective To raise risk exposure awareness for spreading pathogenic microorganisms in anesthesia procedures and normalize aseptic technique of anesthesiologists,thus minimizing postoperative infection.Methods Choose 45 cases of general anesthesia.Respectively before anesthesia induction (Time0),five minutes after induction (Time1) and two hours after anesthesia (Time2),make bacteriological tests on seven spots vulnerable to contamination,including the three-way stopcock,screwtype hose coupling,oxygen flux knob,pressure-release valve surface,exhaled breath entry of the anesthesia machine,oxygen intake of the breathing loop of the anesthesia machine,and operating desktop of the anesthesia cart.Results Contamination risk exposure of the stopcock extends with the operative time.At Time 0,it is sterile; at Time 1,84.4％of the 45 cases are found with bacteria growth,with colony count of 1～2CFU/ml; at Time2,colony counts at various monitoring points range 7～21 CFU/ml,of which the differences between Timel group and Time0,as well as Time2 and Time0 are statistically significant(P＜0.05).Colony counts at other monitoring points comply with the regulations.Conclusion Three-way stopcocks are highly vulnerable to contamination during operative anesthesia.Regular sterile operations can effectively prevent and lower postoperative infection of the patients.

Objective To evaluate the structure and stiffness of the common carotid artery (CCA) in patients with obstructive sleep apnea syndrome (OSAS) by RFQIMT and RFQAS technology and analyze the relationships between the parameters of CCA and cardiovascular risk factors.Methods 113 participants with habitual snoring suspected OSAS were divided into control group,mild,moderate and severe OSAS groups according to apnea hypopnea index(AHI)＜5,5-20,20-40,＞40 event/hour respectively.Carotid parameters included intima-media thickness (IMT),diameter (D),distension (Dis),distensibility coefficient (DC),compliance coefficient (CC),pulse wave velocity (PWV),stiffness index α and β were collected by RFQIMT and RFQAS.Multivariate linear regression analysis was applied to analyze the relationships between CCA parameters and cardiovascular risk factors.Results ①The clinical characteristics:blood pressure had significant difference among the four groups (P ＜0.05).SO2,SO2 min decreased and T90,ODI increased significantly in mild,moderate and severe group (P ＜0.05).②The structure parameters of CCA:IMT,D and plaques had no significant difference among the four groups (P ＞0.05).③The elasticity parameters of CCA:Compared with control group,Dis increased significantly in mild group (P ＜0.05).PWV,α,β increased significantly in moderate group (P ＜ 0.05).Compared with mild group,PWV,α,β increased significantly in moderate group (P ＜0.05).Compared with moderate group,α,β increased significantly in severe group (P ＜0.05).④By multivariate linear regression analysis,age was an independent predictor of IMT,Dis,D,CC,PWV,α,β(P ＜0.05).A blunted nocturnal fall was an independent predictor of D,DC,CC,PWV (P ＜0.05),SBP,DBP and PP of daytime had an important effect on D (P ＜0.05).SO2 was independently correlated with PWV (P ＜0.05).PP was an independent predictor of PWV,α,β (P ＜0.05).Smoking was an independent predictor of plaque (P ＜0.05).Conclusions ①Stiffness is damaged earlier than morphology of CCA in patient with OSAS.②PP,a blunted nocturnal fall and SO2 are correlated with stiffness of CCA significantly.It indicates that abnormal circadian blood pressure rhythm and hypoxia are associated significantly with stiffness of CCA in patient with OSAS.

Objective To study the relationship between reactive oxygen species (ROS) as well as total antioxidant capacity ( TAC ) within follicle fluid and body mass index ( BMI ) in patients with polycystic ovary syndrome (PCOS).Methods All patients enrolled in this study were infertile women receiving in vitro fertilization-embryo transfer (IVF-ET) treatment.55 PCOS patients were divided into over-weight group ( n =23 ) and non-over-weight group ( n =32 ).Another 55 age-matched non-PCOS women were also divided into control group ( n =30) and overweight group ( n =25 ).Plasma sex hormone,triglycerides,and total cholesterol were determined.On oocyte retrieval day after ovarian stimulation,ROS and TAC in follicular fluid were assayed.Results Subjects in over-weight and PCOS over-weight groups had higher triglycerides than those in control and PCOS non-over-weight groups [ ( 1.9 ±1.1,1.7 ± 0.9,1.0 ± 0.5,1.2 ± 0.7 ) mmol/L,respectively,all P＜0.05],so did total cholesterol [ ( 4.8 ± 1.2,5.2 ± 1.1,4.0 ± 0.6) mmol/L,respectively,all P＜0.05].In PCOS over-weight group,ROS and ROS/TAC within follicular fluid were ( 35.4 ± 6.7 ) RLU/S and 39.8 ± 22.0,both were higher than those in the other 3 groups ( all P＜0.05).TAC [ (0.8 ± 0.5 ) Mm] was lower in PCOS over-weight group than that among the other 3 groups( all P＜0.05 ).ROS/TAC was higher in PCOS non-over-weight group than that of control group ( 26.5 ± 14.5 vs 14.2 ± 12.5,P＜0.05 ).Univariate analysis showed that both ROS and ROS/TAC within follicular fluid in PCOS patients were positively correlated with BMI ( r =0.34 and r =0.32,both P＜0.05 ).Conclusion Abnormal oxidative stress exists in follicular fluid of PCOS patients,and the oxidative stress parameters show positive correlation with BMI.