Environmental Exposure ; prevention & control ; Environmental Monitoring ; Humans ; Occupational Health Services ; organization & administration

Objective:To investigate the clinical significance of changes of platelet count after splenectomy in patients with cirrhosis and portal hypertension.Methods:In this study,from January 2002 to January 2006,the platelet count and liver function in 153 splenomegaly and hypersplenism due to cirrhosis patients who had been carried out splenectomy were selected.The change tendency of platelet count was observed,the relationship of changes of platelet count and liver function was analysed,and compared with patients of spleen trauma.Results:Postoperative platelet count was higher than preoperatively in most patients with cirrhosis,the portion did not elevate,even decreased.The change tendency of platelet count was correlated with the liver function.The change in cirrhosis patients is not more than patients of spleen trauma.Conclusions:The reason of thrombocytopenia in patients with cirrhosis may be correlated with the change of liver function besides the splenomegaly.

Objective To study the incidence and risk factors of infection caused by methicillinresistant staphylococcus aureus (MRSA) with a targeted surveillance at intensive care unit (ICU) acquired MRSA infection in Tianjin area.Methods A prospective multi-center observational analysis of consecutive patients admitted to 15 adult ICUs from March 1,2012 through March 31,2014 was carried out.The ICUs were divided into four groups according to the type of the ICU.All of the patients were cared for with routine MRSA surveillance.A number of risk markers and prognostic factors were recorded.The risk factors contributing to ICU acquired MRSA were evaluated using a logistic regression model.Comparison of survival between groups was analyzed with Kaplan-Meier method.Results A total of 1 787 patients were enrolled,and 144 cases of them were MRSA infections.The patients with MRSA infection were significantly older than those with non-MRSA infection (P =0.043),length of ICU stay,length of antimicrobial therapy,the history of repeated administration of antibiotics in recent days,history of operation in the past five years,history of MRSA infection or colonization,frequent application of and the overall length of time for mechanical ventilation and central venous catheter and catheter-associated infection were significantly higher than those with non-MRSA infection.The survival rate of patients with non-MRSA infection were higher than those with MRSA infection (x2 =9.23,P =0.004).The rate of MRSA infection and MRSA colonization in 2013 were significantly lower than that in 2012,because the rate of hand hygiene rule execution and bacterial clearance rate were significantly higher in 2013.Multivariate Logistic regression analysis demonstrated that advanced age (OR =1.05,95％ CI:1.009-1.086),length of ICU stay (OR =1.05,95％ CI:1.01-1.08),history of MRSA infection or colonization (OR =1.33,95％ CI:1.82 -3.27),glucocorticoid therapy (OR =2.85,95％ CI:1.18-6.91),antacid medicine (OR =4.92,95％ CI:1.18-20.58),history of recent or repeated application of antibiotics (OR =3.26,95％ CI:1.06-4.59) catheter-associated infections (OR =2.22,95％ CI:1.08-4.59) were associated with ICU acquired MRSA infections.Conclusions Performing the rule of hand hygiene strictly as well as strengthening prevention and control of MRSA infections can effectively reduce the incidence of ICU acquired MRSA infections.The advanced age,length of ICU stay,history of MRSA infection or colonization,glucocorticoid therapy,antacids medicine,history of recent or repeated application of antibiotics,catheterassociated infections were independent risk factors of ICU acquired MRSA infections.

Objective To evaluate the safety and effectiveness of multi-mode interventional therapy for complications occurring after renal transplantation.Methods The clinical data of 26 patients with complications occurring after renal transplantation were retrospectively analyzed.Vascular and non-vascular complications were treated with different interventional techniques,and the curative effects were analyzed.Results Vascular complications were observed in 19 patients and non-vascular complications were seen in 7patients.The technical success rate of interventional therapy was 100％.One week after the treatment,the total creatinine level (SCr) was significantly improved,which decreased from preoperative (372.7±295.5)μmol/L to postoperative (184.3±138.4) μmol/L (P＜0.001).No severe complications occurred.Further analysis indicated that no statistically significant differences in patient's general condition,kidney donor source,anastomosis method existed between vascular intervention group and non-vascular intervention (P＞0.05).However,the onset time of vascular complications was markedly earlier than that of non-vascular complications (1.8± 1.4 months vs.118.3 ±54.4 months),the difference was statistically significant (P＜0.001).During the follow-up period lasting for 4-55 months (mean of 18.6 months),3 patients developed recurrence of complications;interventional therapy had to be carried out in 2 patients and their creatinine level returned to normal after treatment,and transplanted renal artery embolization had to be performed in the other patient as whose pseudoaneurysm became enlarged.Conclusion For the treatment of complications occurring after renal transplantation,interventional therapy is less-invasive,rapidly-effective and safe,this technique can timely and effectively improve the renal function and save the transplanted kidney.

Objective To investigate the role of signal transduction of toll-like receptors(TLRs)in immunological pathogenesis in children with acute idiopathic thrombocytopenic purpura(ITP).Methods Thirty children with actue ITP and 30 age-matched healthy children were studied.Real-time fluorescent quantitative PCR was used to evaluate the levels of TLR 1-10 and signal transducing molecules,and cytokines associated with TLRs,such as IL-1?,granulocyte-macrophage colony-stimulating factor(GM-CSF),macrophage colony-stimulating factor(M-CSF)and IFN-?/? mRNA.Expressions of co-stimulatory molecules such as CD40,CD80 and CD86 in mo-nocyte/macrophage(MC)was analyzed by flow cytometry.Results Compared with healthy control group,the mRNA levels of TLR3,7,8 and 9 in ITP group were significantly up-regulated(Pa0.05).Transcription le-vels of MyD88-dependent and-independent pathway molecules such as MD-2,MyD88,IRAK-4,TRAF6,TAK1,TRIF,TRAM,TBK-1 and IFN-? were significantly up-regulated in acute ITP(Pa0.05).Conclusion Aberrant activation of toll-like receptors signaling may be one of the initiating factors of immune dysfunction in children with acute ITP.

Objective To establish a method for culture of rat pulmonary capillary pericytes.Methods Six male Sprague-Dawley rats,aged 6-7 weeks,weighing 200-220 g,were anesthetized and the chest was opened.The pulmonary capillary was isolated by type Ⅰ collagenase digestion and micropore filtration and cultured in highglucose DMEM/F12 1∶1 containing 10％ fetal bovine serum and 0.5％ mixture of penicillin and streptomycin.The morphology and growth of cells were observed with inverted phase contrast microscope.The positive cells of αsmooth muscle actin (α-SMA),desmin,neuron-glial antigen 2 (NG2),cluster of differentiation 31 (CD31) were counted by immunofluorescence.The percentage of positive cells was calculated.Results The microscopic examination showed cells of shuttle shape or star shape,mononuclear cells,binuclear cells occasionally,oval nucleus,rich cell plasma,growth in the shape of vortex or fence,and no contact inhibition.The percentage of positive cells ofα-SMA,desmin,NG2,and CD31 was (99.0± 1.2)％,(96.0±2.1)％,(99.0±0.7)％ and0,respectively.Conclusion The culture method for rat pulmonary capillary pericytes is successfully established.

Objective To investigate the role of negative-regulatory factors of toll-like receptors (TLRs)signal pathways in immunological pathogenesis of Kawasaki disease(KD).Methods Thirty-two chil- dren with Kawasaki disease and 16 age-matched healthy children were studied.Reverse-transcription PCR (RT-PCR)and real-time PCR were used to evaluate the mRNA expression levels of toll-like receptor 4(TLR4), MD-2,MyD88,IRAK-4,TRAF6,T1/ST2,IRAK-M,Triad 3A,and proinflammatory factors such as IL-1?, IL-6,IL-8 and TNF-?,in peripheral blood monocytes/macrophages(MC).The expression of TLR4 protein in MC was analyzed by flow cytometry.Results①Compared with the control group,the mRNA levels of TLR4, MD-2,MyD88,IRAK-4 and TRAF6 in KD group were up-regulated significantly(P＜0.01),and the expression level of TLR4 protein was also found to be up-regulated in KD group during acute phase.It was detected that expression levels of TLR4 protein in KD with coronary artery lesion(KD-CAL~+)was significantly higher than that of KD without coronary artery lesion(KD-CAL-)[flow cytometry:(6.5?1.7)% vs(11.9_+2.4)%,P＜0.01].②The expression level of negative-regulatory factors such as IRAK-M and Triad3A were significantly up-regulat- ed in acute phase of Kawasaki disease,while the mRNA levels of IRAK-M and Triad3A in KD-CAL~+ group was found to be significantly lower than those of KD-CAL~- group(P＜0.01).No difference of T1/ST2 mRNA expres sion level was detected among all groups(P＞0.05).③The expressions of proinflammatory eytokines such as IL-1?, IL-6,IL-8 and TNF-?in monoeytes/macrophages during acute phase of Kawasaki disease were higher than those of the control group(P＜0.01),and expression of proinflammatory cytokines in KD-CAL~+ group was significantly higher than that of KD-CAL~- group.Conclusion Relative insufficient expression of negative-regulatory factors, such as IRAK-M and Triad3A,maybe correlate with immunological pathogenesis of Kawasaki disease.

Objective To screen for the causative genes involved in the occurrence and development of minimal changes nephritic syndrome(MCNS) and to furtherly assist the genetic diagnosis and treatment of MCNS.Methods Human genome U133 Array Set from Affymetrix Inc was used to evaluate gene expression patterns in peripheral blood mononuclear cells(PBMC) isolated from 7 children with primary MCNS and 7 age-matched health volunteers.Reverse transcription-polymerase chain reaction(RT-PCR) and real-time PCR were performed to identify the findings of gene chip.Results Of 33 000 genes detected,969 genes showed significant difference between children with(MCNS) and healthy volunteers;552 genes were up-regulated,while 417 genes down-regulated significantly.Findings from RT-PCR and real-time PCR were consistent with those of gene chip.Conclusions Gene chip of expression patterns is a powerful method to detect expression difference of genes correlated with MCNS.Occurrence and development of MCNS can be a complicated process that many correlative genes may participate in.

OBJECTIVEKawasaki disease (KD) is an acute febrile, multi-system endangeitis, which is mainly found in early childhood. Its etiology is still unknown. A great deal of clinical evidence and epidemiologic data suggest that KD is correlated with an acute immune dysfunction caused by infection. Many evidences in the past suggested that over-expression of proinflammatory cytokines, co-stimulatory molecules and chemokines, which were observed in KD, may contribute to the pathologic lesion of vascular endothelial cells. But the causative factors are still unknown. Toll-like receptor is a type I trans-membrane protein which could recognize ligands of pathogenic microbes, induce interferon beta (IFN-beta) and promote gene transcription of proinflammatory cytokines, co-stimulatory molecules and chemokines. This study was designed to investigate the role of MyD88-independent signal transduction of Toll-like receptor 4 in immunological pathogenesis of KD.

METHODSThirty-two children with KD and 16 age-matched healthy children were studied. Reverse-transcription PCR (RT-PCR) and real-time PCR were used to evaluate the mRNA levels of Toll-like receptor 4 and the molecules such as Toll-IL-1-receptor domain containing adaptor inducing IFN-beta (TRIF), TRIF-related adaptor molecule (TRAM), TANK-binding kinase 1 (TBK-1), IFN-beta, interferon-gamma-inducible protein 10 (IP-10), regulated on activation normal T cells expressed and secreted (RANTES), inducible nitric oxide synthase (iNOS) and suppressor of cytokine signaling 1 (SOCS-1) in monocytes/macrophages (MC), which participate in MyD88-independent signal transduction of toll-like receptors. Expression of costimulatory molecules such as CD40 in MC was analyzed by flow cytometry. Methylation-specific PCR was performed to analyze the methylation status of cytosine-phosphate-guanine (CpG) motif in SOCS-1 gene.

RESULTS(1) Compared with healthy controls, transcription levels of the molecules such as TLR4, TRIF, TRAM, TBK-1 and IFN-beta, were significantly up-regulated during acute phase of KD (P < 0.05), and down-regulated after treatment with intravenous immunoglobulin therapy. (2) Expression of iNOS and chemokines such as IP10 and RANTES in MC during acute phase of KD was remarkably elevated (P < 0.05), and down-regulated to some extents after treatment with intravenous immunoglobulin therapy. (3) Expression of costimulatory molecule CD40 in MC increased significantly during acute phase of KD [(6.19 +/- 2.25)% vs. (2.00 +/- 1.37)%, P < 0.05], while the protein levels of CD40 in KD-coronary artery lesion (CAL)(+) group was found to be significantly higher than that of KD-CAL-group [KD-CAL, (9.63 +/- 2.96)% vs. (4.12 +/- 1.91)%, P < 0.05]. (4) Expression levels of SOCS-1 mRNA were significantly up-regulated during acute phase of KD [(4.31 +/- 0.83) x 10(-3) vs. (1.09 +/- 0.23) x 10(-3), P < 0.05], and the levels of SOCS-1 gene in KD-CAL(+) group was found to be significantly lower than that of KD-CAL(-) group [(5.73 +/- 1.04) x 10(-3) vs (1.94 +/- 0.46) x 10(-3), P < 0.05]. (5) The CpG island of SOCS-1 DNA in KD patients was remarkably demethylated [(26.9 +/- 8.6)% vs (5.9 +/- 1.4)%, P < 0.05], and demethylation levels of SOCS-1 in KD-CAL(-) group were higher than that in KD-CAL+ group [(35.1 +/- 10.3)% vs. (13.2 +/- 3.7)%, P < 0.05].

CONCLUSIONAberrant activation of MyD88-independent pathways of Toll-like receptor 4 may be one of the factors causing disturbed immunological function in KD.

Child ; Humans ; Interleukin-1 ; metabolism ; Macrophages ; drug effects ; pathology ; Nitric Oxide Synthase Type II ; metabolism ; Pyrimidinones ; pharmacology ; Signal Transduction ; drug effects ; physiology ; Thiazoles ; pharmacology ; Toll-Like Receptor 4 ; metabolism ; Toll-Like Receptors ; deficiency ; drug effects ; metabolism

The article puts forward the treatment of irritable bowel syndrome through regulating heart vitality since it is held that the pathological factors of the disease lay in dysfunction of heart and intestines as well as disorder of qi circulation. At the same time, the internal-external relationship between the heart the small intestine is discussed from the theory of Brain-gut Axis in modern medicine, which provides theoretical base of modern medicine for the treatment of irritable bowel syndrome through regulation of the heart functions.
Acupuncture Therapy ; Adult ; Female ; Heart ; physiopathology ; Humans ; Intestines ; physiopathology ; Irritable Bowel Syndrome ; physiopathology ; therapy ; Middle Aged