Objective:To explore feasible aeromedical evaluation methods and principles of obstructive sleep apnea (OSA) for Air Force by analyzing the diagnosis, treatment and assessment of cases of the military flying personnel at home and abroad.Literature resource and selection:Based on the journal papers and scientific reports published at home and abroad, we analyzed the evaluation methods and management of sleep disorders in United States Air Force (USAF) and the current situation of Chinese military flying personnel.Literature quotation:Forty-four related literatures, including 37 published articles, 2 medical standards, 3 monographs, 1 scientific report, 1 electric announcement, were cited.Literature synthesis:OSA related flight safety risk that induced by daytime sleepiness, cognitive impairment and emotional abnormalities is the importance of Aviation medicine concern. USAF’s diagnosis of OSA follows the criteria recommended by the American Academy of Sleep Medicine and is carried out by accredited professional sleep lab. Its treatment is conducted in conjunction with military deployment. The well-treated aircrew could be waivered but the special assessment and close follow-up of the treatment compliance are required. There are corresponding requirements in the medical selection of high-performance fighter pilots and armed helicopter pilots in China, but no provisions in physical standards for flying personnel. Inconsistencies exist among clinical diagnosis, treatment and medical assessment.Conclusions:It is necessary to formulate relevant physical examination standards of OSA for military flying personnel, improve the awareness of support departments at all levels, supplement OSA screening in regular physical examination, and assign accredited sleep health centers to undertake the diagnosis, treatment and medical assessment of OSA. Waiver could be considered to the flying personnel with good treatment compliance.

Objective:To explore feasible aeromedical evaluation methods and principles of obstructive sleep apnea (OSA) for Air Force by analyzing the diagnosis, treatment and assessment of cases of the military flying personnel at home and abroad.Literature resource and selection:Based on the journal papers and scientific reports published at home and abroad, we analyzed the evaluation methods and management of sleep disorders in United States Air Force (USAF) and the current situation of Chinese military flying personnel.Literature quotation:Forty-four related literatures, including 37 published articles, 2 medical standards, 3 monographs, 1 scientific report, 1 electric announcement, were cited.Literature synthesis:OSA related flight safety risk that induced by daytime sleepiness, cognitive impairment and emotional abnormalities is the importance of Aviation medicine concern. USAF’s diagnosis of OSA follows the criteria recommended by the American Academy of Sleep Medicine and is carried out by accredited professional sleep lab. Its treatment is conducted in conjunction with military deployment. The well-treated aircrew could be waivered but the special assessment and close follow-up of the treatment compliance are required. There are corresponding requirements in the medical selection of high-performance fighter pilots and armed helicopter pilots in China, but no provisions in physical standards for flying personnel. Inconsistencies exist among clinical diagnosis, treatment and medical assessment.Conclusions:It is necessary to formulate relevant physical examination standards of OSA for military flying personnel, improve the awareness of support departments at all levels, supplement OSA screening in regular physical examination, and assign accredited sleep health centers to undertake the diagnosis, treatment and medical assessment of OSA. Waiver could be considered to the flying personnel with good treatment compliance.

Objective To investigate the possibility of using maintenance of wakefulness test (MWT) as an objective tool in waiver certification for the flying personnel suffering from obstructive sleep apnea (OSA).Methods Epworth sleepiness scale (ESS) was performed in 18 male flying personnel with OSA diagnosed by polysomnography (PSG).Then they were monitored by PSG for one night.The severity of OSA was defined by apnea hypopnea index (AHI) as:mild AHI (5-15 events/h),moderate AHI (≥15 events/h and ≤30 events/h) and severe AHI (＞30 events/h).The 40-min maintenance of wakefulness test (MWT) was conducted for 4 times next day.The flying personnel were grouped by the medical evaluation results as medical waiver group and temporarily/permanently grounded group.ESS score,PSG data and MWT results of flying personnel were compared between different groups.The relationships between MWT mean sleep latency and ESS score,PSG data were also analyzed.Results ①In 18 flying personnel,5 were with mild AHI,5 were with moderate and 8 were with severe.② Medical waiver group had 8 flying personnel while temporarily/permanently grounded group had 10.ESS score,AHI,arousal index and breathing events related arousal index of temporarily/permanently grounded group were significantly higher than those of medical waiver group (t =2.308-3.779,P＜0.05).③Mean sleep latency in MWT showed negative correlation to ESS score,AHI,apnea hypopnea index of rapid eye movement sleep,apnea hypopnea index of non-rapid eye movement sleep,supine apnea hypopnea index,arousal index and breathing events related arousal index (r =-0.635-0.481,P ＜ 0.05).④ The mean sleep latency in MWT of medical waiver group [(10.62 ± 3.91) min] was significantly shorter than that of temporarily/permanently grounded group [(37.80±6.22) min] (t =11.333,P＜0.05).Conclusions MWT is applicable as an objective and reliable tool to evaluate alertness of the flying personnel with OSA.Further studies on finding the correlation between abnormal MWT results and flight operational capacity are still needed for obtaining higher safety reliability.

Objective To investigate the possibility of using maintenance of wakefulness test (MWT) as an objective tool in waiver certification for the flying personnel suffering from obstructive sleep apnea (OSA).Methods Epworth sleepiness scale (ESS) was performed in 18 male flying personnel with OSA diagnosed by polysomnography (PSG).Then they were monitored by PSG for one night.The severity of OSA was defined by apnea hypopnea index (AHI) as:mild AHI (5-15 events/h),moderate AHI (≥15 events/h and ≤30 events/h) and severe AHI (＞30 events/h).The 40-min maintenance of wakefulness test (MWT) was conducted for 4 times next day.The flying personnel were grouped by the medical evaluation results as medical waiver group and temporarily/permanently grounded group.ESS score,PSG data and MWT results of flying personnel were compared between different groups.The relationships between MWT mean sleep latency and ESS score,PSG data were also analyzed.Results ①In 18 flying personnel,5 were with mild AHI,5 were with moderate and 8 were with severe.② Medical waiver group had 8 flying personnel while temporarily/permanently grounded group had 10.ESS score,AHI,arousal index and breathing events related arousal index of temporarily/permanently grounded group were significantly higher than those of medical waiver group (t =2.308-3.779,P＜0.05).③Mean sleep latency in MWT showed negative correlation to ESS score,AHI,apnea hypopnea index of rapid eye movement sleep,apnea hypopnea index of non-rapid eye movement sleep,supine apnea hypopnea index,arousal index and breathing events related arousal index (r =-0.635-0.481,P ＜ 0.05).④ The mean sleep latency in MWT of medical waiver group [(10.62 ± 3.91) min] was significantly shorter than that of temporarily/permanently grounded group [(37.80±6.22) min] (t =11.333,P＜0.05).Conclusions MWT is applicable as an objective and reliable tool to evaluate alertness of the flying personnel with OSA.Further studies on finding the correlation between abnormal MWT results and flight operational capacity are still needed for obtaining higher safety reliability.

OBJECTIVETo investigate the effect and its possible mechanism of interleukin-17 (IL-17) on invasion and metastasis of human colon cancer cells.

METHODSIL-17 was added into the culture media of human colon cancer cells SW480 and LOVO. Cells were divided into 4 groups: SW480 control group (SW480 cells), LOVO control group (LOVO cells), SW480 experiment group (50 μg/L IL-17+SW480 cells), and LOVO experiment group (50 μg/L IL-17+LOVO cells). Cell growth was measured by CCK-8 assay. The proliferation rate(%)=[(Aexperiment group-Ablank)/(Acontrol group-Ablank)]×100%). The ability of cell invasion and migration was measured by transwell assay. Real time-PCR was used to detect mRNA expression of VEGF and MMP-9. Western blot was performed to detect protein expression of STAT3, p-STAT3, VEGF and MMP-9. Enzyme-linked immunosorbent assay (ELISA) was applied to measure the protein content of VEGF and MMP-9 in the supernatant.

RESULTSAfter cultivation for 24, 48 and 72 hours, CCK-8 assay revealed that the proliferation rate of SW480 was 1.18%±0.07%, 1.42%±0.09%, and 1.62%±0.08%; the proliferation rate of LOVO was 1.13%±0.02%, 1.32%±0.05% and 1.73%±0.02% in experiment group. Transwell experiments showed that after cultivation with IL-17 for 24 hours, number of invasion cell in experimental groups (SW480: 34.00±0.45, LOVO: 41.60±0.51) was higher as compared to corresponding control groups (SW480: 4.53±0.14; LOVO: 3.67±0.33) with significant differences (SW480: t=-76.026, P=0.001; LOVO: t=-81.580, P=0.005). The number of migration cell in experimental groups (SW480: 36.40±0.51, LOVO: 46.40±0.68) was higher as compared to corresponding control groups (SW480: 7.83±0.69; LOVO: 6.67±0.48) with significant differences (SW480: t=-51.542, P=0.003; LOVO: t=-49.265, P=0.005). Real-time PCR results revealed that after cultivation with IL-17 for 24 hours, VEGF and MMP-9 mRNA relative expression levels in experimental groups (SW480: VEGF:1.53±0.12, MMP-9: 2.44±0.23; LOVO: VEGF: 2.96±0.35, MMP-9: 3.38±0.55) were higher than those in control groups (both 1) with significant differences (VEGF: t=3.799, P=0.043; MMP-9: t=5.254, P=0.039). Western blot illustrated that after cultivation with IL-17 for 24 hours, STAT3, p-STAT3, VEGF and MMP-9 proteins relative expression levels in experimental groups were significantly higher that those in control groups (SW480:STAT3: t=3.233, P=0.023; p-STAT3: t=3.954, P=0.032; VEGF: t=3.201, P=0.025; MMP-9: t=3.154, P=0.029; LOVO: STAT3: t=3.788, P=0.012; p-STAT3: t=2.662, P=0.040; VEGF: t=4.118, P=0.035; MMP-9: t=4.268, P=0.030). ELISA indicated that content of VEGF and MMP-9 in the supernatant of experimental groups (SW480: VEGF 5 491.41±63.22, MMP-9: 21.43±1.35. LOVO: VEGF: 8 631.46±129.59, MMP-9: 178.32±3.20) were higher than those in control groups (SW480: VEGF:4 456.32±87.56, MMP-9:18.57±2.44. LOVO: VEGF: 8 122.38±108.66, MMP-9: 163.22±6.89) with significant differences (SW480: VEGF: t=6.993, P=0.037; MMP-9: t=5.587, P=0.040. LOVO: VEGF: t=7.013, P=0.044; MMP-9: t=6.762, P=0.043).

CONCLUSIONIL-17 may be able to activate STAT3 signal transduction pathway in vitro through up-regulation of VEGF and MMP-9 expression, thereby enhancing the invasion and migration of colon cancer SW480 and LOVO cells.

Cell Cycle ; Cell Line, Tumor ; Cell Movement ; Cell Proliferation ; Colonic Neoplasms ; pathology ; Humans ; Interleukin-17 ; pharmacology ; Matrix Metalloproteinase 9 ; metabolism ; Neoplasm Invasiveness ; Real-Time Polymerase Chain Reaction ; STAT3 Transcription Factor ; metabolism ; Signal Transduction ; Up-Regulation ; Vascular Endothelial Growth Factor A ; metabolism

Objective:To evaluate the safety and clinical effect of holmium laser enucleation of the prostate (HoLEP) for pati-ents with benign prostatic hyperplasia (BPH) .Methods:A total of 40 patients with BPH from Jan 2015 to Jul 2015 were underwent HoLEP.Pre-and postoperative complication were recorded and the differences of the clinical parameters were also compared, including peak urinary flow rate (Qmax), residual urine volume (PVR), International Prostate Symptom Score (IPSS), quality-of-life (QOL) .Results:A total of 34 patients were included after operation and 6 patients lost to follow-up. Qmax, PVR, IPSS, QOL after three months postoperatively were improved significantly compared with that of preoperative (P<0.01) .Complications included intraoperative bladder injury (1 case), postoperative stress incontinence (2 cases), urethral stricture (1 case) .No patients experienced the sign of TUR syndrome and blood transfusion for severe bleeding.Conclusion:HoLEP has the advantage of good therapeutic effects,wide scope of application,better safety performance,smaller risk and it’s worth popularizing in primary hospitals.

Objective To assess the prevalence of Campylobacter in the children with acute bacterial diarrhea in Shanghai.Methods Epidemiological survey.Totally 6 641 children with acute bacterial infectious diarrhea from outpatients and inpatients in Children′s Hospital of Fudan University were submitted to the investigation during January 2011 to December 2012.The Campylobacter was isolated from stool samples collected from subjects in micro aerobic environment and identified by both multi-PCR and matrix-assisted laser desorption ionization-time-of-flight mass spectrometry ( MALDI-TOF MS ) .Antimicrobial susceptibility tests were assayed by disk-diffusion method according to EUCAST standard.The isolates molecular typing was done by PFGE.SPSS16.0 was used to analyze the results.Results A total number of 6 641 subjects were enrolled, among them, 305 patients were infected with Campylobacter.The prevalence rate was 4.6%(305/6 641).Among the infected patients, 240 patients were infected with Campylobacter jejuni and 65 patients were infected with Campylobacter coli, the infectious rates of these two pathogenic bacteria were 3.6%and 1.0%, respectively.The peak infectious rate in patients older than 1 year of age was 6.2%(209/3 385) which was higher than that in children under 1 year of age (2.9%, 96/3 256),χ2 =35.98,P<0.001.The infectious rate in winter and spring (6.8%, 138/2 040) was higher than that in the other seasons ( 3.6%, 167/4 601 ) ,χ2 =28.59, P <0.001.Antimicrobial susceptibility test results showed that 91.5%( 279/305 ) isolates were resistant to ciprofloxacin and 11.8%( 36/305 ) isolates were resistant to erythromycin.A total of 9 genotypes of Campylobacter were found by PFGE cluster analysis.The similarity were ranged from 65.1%-100.0%for type A, 67.6%-100.0%for type B, 61.7%-100.0%for type C, 59.0%-100.0%for type D, 71.4%for type F, 80.0%for type H, 54.4%-90.9%for type I, and only one strain was classified as type E and G.Conclusions Campylobacter is a major pathogenic bacteria associated with acute bacterial infectious diarrhea in children especially in children older than 1 year of age in Shanghai.The prevalent pattern of this pathogen was sporadic and the sharp peak was in winter and spring.The isolates are highly resistant to ciprofloxacin but still sensitive to erythromycin.

ObjectiveTo investigate the effect of NGF on apoptosis of HSC in vitro and explore the possible mechanism.MethodsHSC was incubated with different concentrations of NGF.HSC apoptosis was identified by FCM.The expressions of apoptosis-regulating proteins Caspase-3,p53 and Bcl-2 of HSC after apoptosis induced by NGF were examined by immunohistochemical staining.Expressions of NGF and p75NTR were detected by immunofluorescence.ResultsApoptosis index of HSC was higher than that of control group [(22.36±9.51)％ vs (5.88±1.36)％] after treated with NGF (100 ng/ml) (P＜0.05).After incubating with 100 ng/ml NGF for 24 h,the positive expression rates of p53 and Caspase-3 of HSC increased significantly than those of control group [(78.41±4.00)％ vs (34.96±3.84)％,(39.26±1.57)％ vs (9.27±1.01)％,P ＜0.05].The positive expression rate of Bcl-2 protein of HSC significantly decreased compared with that of control group (18.12±1.38)％ vs (91.53±2.98)％ (P＜0.05).When HSC was stimulated with 100 ng/ml NGF for 24 h,the average optical density of NGF increased significantly than control group (6.53±1.40 vs 1.77±0.17) (P＜0.05),while the expression of p75NTR was not significantly changed (3.52±0.36 vs 4.24±0.38) (P＞0.05).ConclusionsThe mechanism of NGF to induce HSC apoptosis may be associated with the up-regulating expression of Caspase3,P53 and down-regulating expression of Bcl-2 on HSC.NGF could be used as an initiating factor and effect factor to increase the expression of NGF on HSC,but it had no significant effect on p75NTR expression.

Objective To investigate the distribution and evolvement of resistance profiles of the pathogens isolated from children diagnosed with urinary tract infection (UTI).Methods The pediatric patients who were diagnosed with UTI in Children's Hospital of Fudan University from January 2001 to December 2010 were enrolled in this retrospective study.The clean catch midstream urine samples were collected and the pathogens were isolated by culture.Bacterial susceptibility test was performed by following a protocol of the standardized Kirby Bauer (KB) method.The enumeration data were analyzed by chi square test and the tendency of drug resistant rate was analyzed by curvilinear regression.Results A total of 10 686 pathogen strains were isolated during the past 10years.The major pathogen was Escherichia coli which counted for 38％ -56％ of the isolates.However,the proportion of Enterococcus faecalis (0 - 17％,F =34.075,P =0.000) and Enterococcus faecium (3 ％ - 15 ％,F =7.139,P =0.028) increased rapidly.The resistant rates of Escherichia coli to cefazolin,cefuroxime sodium,cefotaxime and ceftazidime were 35.8％- 62.3％(F=215.735,P=0.000),33.1％ -57.0％(F=70.674,P=0.000),19.0％ -56.5％(F=52.355,P=0.000) and 2.1％-23.5％(F=16.807,P=0.003),respectively.The resistant rate of Escherichia coli to ciprofloxacin was 23.4％ - 33.8 ％ (F=0.989,P=0.349),while the resistant rate of Escherichia coli to amikacin and cefoperozone/sulbactam were both less than 7％.There was no Escherichia coli isolate showing resistant to imipenem.The resistant rates of Enterococcus faecium to ampicillin and ciprofloxacin were higher than 60.0％ and 50.0％,respectively,while the resistant rate of Enterococcus faecalis to these two antibiotics decreased from 40.0％ to 9.6 ％ (F =17.497,P =0.009) and 60.0％ to 21.6％ (F=12.826,P=0.009),respectively.The resistant rate of Enterococcus faecium to nitrofurantoin decreased from 32 ％ (in the year of 2002) to 9.4％ (in the year of 2010,F=34.075,P=0.000) and the resistant rate of Enterococcus faecalis decreased from 9.2％ (in the year of 2005) to 1.4％ (in the year of 2010,F=7.139,P=0.028).The resistant rates to erythromycin were both higher than 75.0％ in both Enterococcus in recent 10 years.There was no Enterococcus isolates showing resistant to vancomycin.Conclusions Escherichia coli,Enterococcus faecalis and Enterococcus faecium are the most common pathogens associated with UTI in children.The proportions of Enterococcus faecalis and Enterococcus faecium among the pathogens of UTI are increasing.The antimicrobial activity of ampicillin to Enterococcus faecalis keeps at a high level.However,there are few drugs can be used for treating Enterococcus faecium infection.

Objective To observe therapeutic effects of HuGanJieXian decoction on rats hepatic fibrosis induced by tetrachloride. Methods Rat models of hepatic fibrosis were constructed by intraperitoneal injection of tetrachloride.HuGanJieXian decoction composed of low, middle, and high dose curcumin were given to these rats respectively at the same time. Sho-saiko-to compound treatment group and Fufangbiejiarangan Tablets treatment group were made as positive control groups. After twelve weeks, all rats were executed. Serum samples were kept for measuring serum levels of PC-Ⅲ, LN, and HA. Left livers were extirpated for pathologic examination including H.E and Masson stainings. Grade of hepatic fibrosis were evaluated according to SSS system. The levels of superoxide dismutase (SOD) and malondialdehyde (MDA) of supematant centrifugated from hepatic tissue homogenate were detected. Results Serum levels of PC-Ⅲ, LN, and HA were depressed obviously in decoction groups compared with those of fibrotic group (P<0.05) , especially in the low-dose curcumin group.HuGanJieXian Decoction could increase the level of SOD and decrease the level of MDA (P<0.05) , especially in the low-dose curcumin group. Staining of H. E and Masson showed that degrees of hepatic fibrosis in decoction groups were improved obviously compared with that of the fibrotic group. Conclusion HuGanJieXian Decoction can improve rat hepatic fibrosis, the mechanism of this effect may be associated with protecting hepatic cell membrane and anti- peroxidative damage.