Objective To observe the clinical efficacy and anticoagulant effects and safety of low-molecular-weight heparin (LMWH) on treatment of refractory nephrotic syndrome(NS).Methods 33 patients of primary NS complicated with hypercoagulability were randomly divided into two groups: the control and the treatment groups. The control group was treated with prednisolone(1mg/kg/d) plus oral cyclophosphamide (50mg bid) and methylprednisolone 0 5～1g(20mg/kg/time) in glucose 250ml(5%) intravenously by drip . While the treated group was administered, on the basis of the therapeutic scheme of the control group, with subcutaneous injection of LMWH (5000IU bid) for 4 weeks, the clinical symptom was observed in both groups before and after the treatment ,the 24h urine protein quantitative determination,renal function,anti thrombin III (AT-III) activity,fibrinogen(FIB),D-dimer(DD),plasma factor Xa( Fxa),plasma factor IIa(FIIa) were also tested, the side effects in two groups were observed at the same time. Results The 24h urine protein quantitative determination,blood urea nitrogen(BUN) and serum Cr were significantly decreased(P

Objective To investigate the effects of peroral endoscopic myotomy (POEM) on esophageal dynamics in patients with achalasia (AC) and appraise the role of high resolution manometry (HRM)in assessment of POEM therapy.Methods From July 2011 to September 2012,20 patients with achalasia underwent POEM in the department of gastroenterology,Tianjin Medical University General Hospital.Preoperation esophageal dynamics of all the patients were evaluated by high resolution manometry (HRM) system and one month after POEM operation the test was repeated.Data of lower esophageal sphincter (LES)and esophageal body were analyzed,with 15 healthy volunteers as a contrast study.Results Mter POEM,the LES pressure (LESP) and 4-second integrated relaxation pressure (4sIRP) significantly decreased:LESP [pre-operation (24.5 ± 13.1) mm Hg vs.post-operation (8.5 ± 3.1) mm Hg,P ＜ 0.05] ; 4sIRP [pre-operation (20.7 ± 6.8) mm Hg vs.post-operation (5.0 ± 3.4) mm Hg,P ＜ 0.05].The LES relax rate (LESRR) significantly elevated [pre-operation (12.7 ± 9.8) ％ vs.post-operation (39.6 ± 18.1) ％,P ＜ 0.05].However,the esophageal aperistalsis remained after POEM.The total of 20 patiems were all type Ⅰ achalasia and responded well to POEM therapy.Post-operation data on the symptom scores markedly decreased and a significant correlation was found between the decreasing level of symptom scores and LESP,as well as the scores 4sIRP in the 20 patients (LESP:r =0.751,P ＜ 0.05 ; 4sIRP:r =0.500,P ＜ 0.05).Conclusion POEM can significantly improve esophageal dynamics in patients with achalasia and the treatment outcome is definite.HRM plays an important role in evaluation of POEM therapy on achalasia.

Objective We aim to evaluate the value of the current serum creatinine reference interval ( RI ) provided by Industry Standard WS /T 404.5 in clinical practice.Methods The first time serum creatinine levels and urinary albumin /creatinine ratio were obtained from 67 605 adult patients ( <60 years old) who were treated in the First Hospital of China Medical University between October 1, 2014 and September 30, 2015 in this cross-sectional study.Estimated glomerular filtration rate ( eGFR ) calculated by chronic kidney disease epidemiology collaboration (CKD-EPI) equation and urinary albumin /creatinine ratio (ACR) were used to evaluate the clinical practical significance of current and old serum creatinine RIs as the criteria.Results 4.3% of normal subjects based on current RI were showed decreased eGFR, 98% of abnormal subjects based on the current RI were founded to have decreased eGFR . 1378 subjects were evaluated as increased based on current RI but as normal based on old RI , and 93.5% of these subjects were showed decreased eGFR .In addition, ACR was measured in 26 cases, and 18 out of 26 cases (69.2%) were confirmed to have elevated ACR (≥30 mg/g) and proteinuria.On the other hand of analysis, screening positive rates of declined eGFR were 43.6% by old RI and 61.9% by current RI in the subjects with eGFR under 90 ml(min ×1.73 m 2 ), and the performance of the current RI was obviously improved(χ2 =212.648,P <0.001).Conclusions The current reference interval of serum creatinine is favorable for the detection of renal dysfunction in patients .It is recommended that the current reference interval can be applied in the clinical laboratories as early as possible .

AIM: To study the effect of VEGF on extracellular H2O2 production in HUVECs and the role of H2O2 in the VEGF-induced proliferation. METHODS: HUVECs was stimulated with 500 ?g/L VEGF. Products of extracellular H2O2 was detected by H2DCFDA staining. MTT method was used to value the influences of 3?106 U/L catalase and 5-20 mmol/L H2O2 to VEGF function. RESULTS: After treatment for 15 min with VEGF, HUVECs appeared fluorescence, and continued to become stronger, peaked at 45 min then decreased. HUVECs, which was treated simultaneity with VEGF and 3?106 U/L catalase, only appeared very faint fluorescence. The proliferation of HUVECs by VEGF was restrained when treated with 3?106 U/L catalase. The extrinsic H2O2 at concentration of 5-10 mmol/L promoted the proliferation of HUVECs but inhibited the proliferation effect of VEGF on HUVECs (P

Objective To explore the difference in short-term efficacy between peroral endoscopic myotomy (POEM) and pneumatic dilatation (PD) in achalasia patients.Methods A retrospective analysis was applied.From September 2010 to March 2015,patients with POEM or PD were enrolled and divided into POEM group (n=26) and PD group (n=40).High-resolution manometry (HRM) before and one month after treatment were compared between POEM group and PD group.Before and three months after treatment,Eckardt score and gastroesophageal reflux symptom was compared between groups (Eckardt score ≤ 3 as the standard for successful treatment).Wilcoxon signed rank test was performed for before and after treatment comparison in the same group.Mann-Whitney U test was used to compare between two groups and Fisher's exact test was used for rate comparison.Results The successful treatment rates at one and three month after POEM group were 92.3 ％ (24/26) and 96.2％ (25/26),respectively.The successful treatment rates at one and three month after PD were 87.5％ (35/40) and 75.0％ (30/40).At three month after treatment,the successful treatment rate of POEM group was higher than that of PD group (Fisher's exact test,P =0.02).At three months after treatment,the Eckardt score of POEM group was lower than that of PD group (1.35,0 to 4.00,vs2.73,0 to 6.00;U=-3.921,P＞0.01).By the end of three months after treatment,the rate of gastroesophageal reflux symptom of POEM group was higher than that of PD group (7/26,26.9 ％ vs 2/40,5.0％;Fisher's exact test,P=0.01).The postoperative 4 second integrated relaxation pressure (4s-IRP) and lower esophageal sphincter pressure (LESP) of POEM group were both lower than those of PD group (7.01 mmHg,3.48 to 10.40 mmHg vs 10.11 mmHg,5.75 to 12.91 mmHg,U=-4.541,P＜0.01;11.61 mmHg,4.21 to 14.64 mmHg vs 17.85 mmHg,8.39 to 24.57 mmHg,U=-6.142,P＜0.01).The analysis of achalasia subtypes indicated that the efficacy of POEM was better than that of PD both in type Ⅰ and type Ⅱ.Conclusion During short-term follow-up,the efficacy of POEM was better than that of PD in achalasia patients,however there was a higher incidence of post-operative gastroesophageal reflux after POEM.

Objective To compare the value of abdominal aorta occlusion and internal iliac artery ligation in preventing massive bleeding during surgical treatment of complex acetabular fractures.Methods The study enrolled 67 cases of complicated acetabular fractures,of which 35 had control of hemorrhage via abdominal aorta blockage and 32 via internal iliac artery ligation.Intraoperative bleeding and postoperative drainage volumes were compared of the two operations.Results Of the two operations to control hemorrhage,abdominal aorta occlusion was significantly different from internal iliac artery ligation with regard to amount of blood loss [(648.00 ± 170.20) ml vs (231.18 ± 21.90) ml,t =1.693,P ＜ 0.05],but there was no significant difference between abdominal aorta occlusion and internal iliac artery ligation in postoperative drainage volume [(1 631.50 ± 675.50) ml vs (236.00 ±23.80) ml].Conclusion During surgical treatment of complex acetabular fractures,abdominal aorta occlusion is superior to internal iliac artery ligation in preventing bleeding and can be safe and effective for the fact that the bilateral common iliac arteries are occluded completely for a clear operation field.

Objective To observe the histological features of muscular layers in different parts of esophagus of patients with achalasia (AC) and to explore the distribution and function of eosinophils in esophageal muscular layer in patients with AC.Methods From June 2015 to February 2016,21 patients diagnosed with AC by endoscopy,barium meal and esophageal high resolution manometry,accepted peroral endoscopic myotomy (POEM) were enrolled.At the same period,nine patients with esophageal carcinoma who received esophagectomy were selected as controls.Muscular tissues of lower esophageal sphincter (LES),distal esophagus (5 cm above LES) and middle esophagus (10 cm above LES) of patients with AC and controls were taken for regular haematoxylin-eosin (H-E) staining to analyze degree of eosinophils infiltration.Nonparametric analysis and Chi-square analysis were used for statistical analysis.Spearman correlation analysis was used for analyzing correlations.Results The results of H-E staining indicated that different degree of eosinophil infiltration was found in 18(85.7％) patients with AC,and eosinophil counts in muscular layer were over 15 per high power field in five patients with AC (23.8％,5/21).However,no eosinophils infiltration was found in esophageal carcinoma patients.Median numbers of eosinophil in muscular layer of LES,distal esophagus and middle esophagus were all higher than those of esophageal carcinoma group (4.0,2.0 to 10.0 vs 1.0,0 to 1.5;4.0,1.0 to 17.0 vs 1.0,0.5 to 1.5；6.0,0.5 to 15.0 vs 0,0 to 1.0),and the differences were statistically significant (Z=2.997,2.476 and 2.504,all P＜0.05).The distribution of eosinophils in muscular layer of LES,distalesophagus and middle esophagus between the two groups were statistically significant (x2=2.710,2.543and 2.313,all P＜0.05).The differences in eosinophils distribution in muscular layer of LES,distal esophagus and middle esophagus in patients with AC were not ststistically significant (x2 =0.110,P＞0.05).Additionally,number of eosinophils in muscular layer of different parts of esophagus was not correlated with age and disease course (r=0.434 and 0.639；P =0.282 and 0.088).Conclusion The wide distribution of eosinophils in muscular layer of esophagus in patients with AC may involve in the genesis and development of AC.

Sepsis,life-threatening organ dysfunction caused by a dysregulated host response to infection,is a major public health concern.To date,the mechanism of sepsis is not completely understood,which is still a huge task ahead of numerous clinical and laboratory researchers.Recently,increasing evidences show that deacetylase sirtuins play an important role in sepsis and the function of sirtuins are varied in different stages of sepsis.More importantly,the mechanism of sirutins is not fully understood.The sirtuins family is composed by sirtuin 1-7 members.Among them,sirtuin 1 is widely reported.In addition to sirtuin 1,other members of sirtuins are also involved in the regulation of inflammation or metabolism signaling following sepsis.Of note,the sirtuins may interact with each other and form a precious control mechanism.Herein,we tried to summarize the recent paper from PubMed,to explain the possible mechanism of distinct role of sirtuin 1/2,to generalize the downstream effects of sirtuin 3 action,and to describe the interactions among sirtuins members on sepsis,which might be helpful for our future research and potential clinical applications.

Objective To compare the effectiveness of controlling blood loss in the treatment of complex acetabular fracture between temporary occlusion of abdominal aorta by interventional balloon (TOAAIB),temporary occlusion of common iliac artery by interventional balloon (TOCAIIB) and internal iliac artery ligation (IIAL).Methods Included for this study were 113 complex acetabular fractures which had been treated at Department of Orthopaedic Trauma,Shaoguang Hospital Affiliated to Southern Medical University from January 2000 through January 2017.There were 68 males and 45 females,aged from 23 to 61 years (average,42.3 years).According to the Letournel classification,all of them belonged to complex fractures,including 10 T-type,24 double-column,16 posterior column & posterior wall,46 transverse & posterior wall and 15 anterior & posterior half-transverse ones.They were all treated by open reduction and internal fixation but differed in surgical hemostasis techniques:TOAAIB was used in 37cases,TOCAIIB in 31 and IIAL in 45.Fracture reduction was evaluated by Matta criteria.Intraoperative bleeding and postoperative wound drainage,fracture union and complications related to interventions were recorded.Hip function was evaluated by Modified d'Aubigne & Postal clinical grading system after fracture healing.Results The 3 groups (TOAAIB,TOCAIIB and IIAL) were comparable because there were no significant differences in gender,age,time from injury to surgery,Letournel classification or surgical approaches between the patients in the 3 groups (P ＞ 0.05).Anatomical reduction was achieved in 91.15％ of the patients (103/113) and satisfactory reduction in 8.85％ (10/113).Intraoperative hemorrhage was 1,631.5 ±675.5 mL in the HAL group,892.6 ±217.7 mL in the TOCAIIB group and 648.0 ± 170.2 mL in the TOAAIB group,showing significant differences between the 3 groups (P ＜ 0.05).One case of femoral artery thrombosis occurred in the TOAAIB group at the end of operation but was cured by symptomatic treatment of anticoagulation.There were no interventional complications in the other 2 groups.There were no significant differences between the 3 groups in postoperative wound drainage,fracture union time,hip function score or complications (P ＞ 0.05).Conclusions In controlling intraoperative bleeding in the surgery for complex acetabular fracture,TOAAIB may be the best,followed by TOCAIIB,and IIAL may be the worst.However,choice of a proper surgical hemostasis technique should also depend on the specific intraoperative condition of a specific patient.

Objective:To investigate the evaluation value of optical coherence tomography (OCT) for carotid atherosclerotic plaques.Methods:Patients with carotid atherosclerotic stenosis underwent digital subtraction angiography (DSA) and OCT in the Affiliated Hospital of Jining Medical College from January 2020 to January 2022 were retrospectively enrolled. The demographics, baseline clinical data, DSA and OCT imaging data of the symptomatic group and the asymptomatic group were compared. Multivariate logistic regression analysis was used to determine the independent risk factors for symptomatic carotid atherosclerotic stenosis. Results:A total of 39 patients were enrollded, including 21 in the symptomatic group and 18 in the asymptomatic group. The detection rate of fibrous plaque in the symptomatic group was significantly lower than that in the asymptomatic group (38.1% vs. 77.78%; P=0.023), while the detection rate of plaque rupture (38.1% vs. 5.56%; P=0.023) and macrophage infiltration (42.86% vs. 11.11%; P=0.037) was significantly higher than that in the asymptomatic group. Multivariate logistic regression analysis showed that plaque rupture (odds ratio 6.982, 95% confidence interval 1.068-45.660; P=0.043) and macrophage infiltration (odds ratio 6.480, 95% confidence interval 1.009-41.625; P=0.049) were significantly independently associated with the symptomatic carotid atherosclerotic stenosis. Conclusions:OCT is of value in evaluating the plaque characteristics of carotid atherosclerotic stenosis. Plaque rupture and macrophage infiltration are the independent risk factors for symptomatic carotid atherosclerotic stenosis.