ObjectiveTo explore the potential mechanism of Zuogui Jiangtang Jieyu Formula （左归降糖解郁方， ZJJF） for diabetic rats with depression. MethodsSixty rats were randomly divided into normal group， model group， wingless MMTV integration site family member 5a （Wnt5a） agonist group， ZJJF group， and ZJJF plus Wnt5a inhibitor group， with 12 rats in each group. Except for the normal group， the rats were fed with high-fat chow， streptozotocin injection， and chronic mild unpredictable stress combination， to establish model of diabetes mellitus complicated with depression. After successful modelling， rats in the Wnt5a agonist group were given bilateral hippocampal stereotactic injections of Wnt5a agonist Foxy-5 with 5 μl each for 7 consecutive days； rats in ZJJF group were given 20.52 g/（kg·d） of ZJJF by gavage； rats in ZJJF plus Wnt5a inhibitor group were given the drug by gavage， and bilateral hippocampal stereotactic injections of Wnt5a inhibitors Box5， with the same dosage and injection method as above. The normal group and model group were given 10 ml/（kg·d） of normal saline by gavage. All groups were gavaged for 4 consecutive weeks. At the end of the intervention， the depression-like behaviour of rats was evaluated using the forced swimming experiment （immobility time） and the absent field experiment （number of activities）； the blood glucose and insulin levels of rats were measured and the insulin resistance index was calculated； the dendritic morphology of dentate gyrus neurons in the hippocampus was observed using Golgi staining； the level of dentate gyrus neuron proliferation was measured using 5-bromodeoxyuracil nucleoside （Brdu） injection and immunofluorescence； RT-qPCR and Western blot were used to detect the mRNA and protein expression of Wnt5a， Ras homologue genomic member A （RhoA） and Rho homologue-associated coiled-coil protein kinase 1 （ROCK1） in the dentate gyrus. ResultsCompared with the normal group， rats in the model group had significantly higher blood glucose， insulin and insulin resistance indices， longer immobility time， fewer activities， lower Brdu integral optical density values and Wnt5a， RhoA， ROCK1 protein and mRNA expression in the dentate gyrus of the hippocampus （P＜0.05 or P＜ 0.01）； the dendritic branches of rat hippocampal dentate gyrus neurons could be seen to be significantly reduced or broken， and their length shortened. Compared with the model group， the blood glucose， insulin and insulin resistance indices of rats in ZJJF group and the ZJJF plus Wnt5a inhibitor group significantly reduced （P＜0.05 or P＜0.01）； the immobility time of rats in the Wnt5a agonist group and ZJJF group was significantly shortened， the number of activities increased， the Brdu integral optical density values elevated， and the Wnt5a， RhoA， ROCK1 protein and mRNA expression elevated （P＜0.05 or P＜0.01）， and the number of dendritic branches of hippocampal dentate gyrus neurons significantly increased， the length lengthened， and the complexity of dendrites increased. Compared with the Wnt5a agonist group， rats in the ZJJF group showed significant decrease in blood glucose， insulin and insulin resistance indices， prolongation of immobilisation time， reduction in the number of activities， and reduction in the Brdu integral optical density value； except for the Wnt5a mRNA in ZJJF group， Wnt5a， RhoA， ROCK1 protein and mRNA expression reduced in both ZJJF group and ZJJF plus Wnt5a inhibitor group （P＜0.05 or P＜0.01）. Compared with ZJJF group， Wnt5a， RhoA， ROCK1 protein and mRNA expression were reduced in ZJJF plus Wnt5a inhibitor group （P＜0.05 or P＜0.01）. ConclusionZJJF can improve hyperglycemia and depressive-like behaviours in rat models of diabetes with depression， and its antidepressant effects may be related to the activation of hippocampal Wnt5a/RhoA signaling and promotion of dentate gyrus neuron dendritic growth.

Orthopedic joint replacement patients include a significant proportion of elderly individuals.Due to the physiological characteristics of the elderly,the incidence of patient harm during the diagnosis and treatment process is relatively high.Consequently,orthopedic joint replacement is also an area with a high rate of medical disputes in both domestic and international healthcare.The courts often hold the medical side more responsible in their judgments of such disputes.A retrospective analysis of 24 cases of orthopedic joint replacement dispute judgments was conducted to explore and summarize the causes of these cases,and to propose corresponding countermeasures and suggestions with the aim of reducing the incidence of such medical disputes.

The aim of the present study was to investigate the effects of exosomes derived from bone marrow mesenchymal stem cells (BMSCs) on the polarization of M1/M2 microglia/macrophages in rats with acute cerebral ischemia.Ultrahigh-speed centrifugation was employed to isolate and identify exosomes; a middle cerebral artery occlusion (MCAO) model was prepared in rats using the intraluminal filament technique; Longa scoring and corner tests were used to evaluate the neurological function of rats; 2, 3, 5-triphenyltetrazole chloride (TTC) staining was used to assess the infarct volume in rat brains; immunofluorescence double-labeling of CD16/32/Iba1 and CD206/Iba1 was performed to detect M1/M2 phenotypes of microglia/macrophages; RT-qPCR was employed to measure the mRNA expression of CD86, inducible nitric oxide synthase (iNOS), tumor necrosis factor-alpha (TNF-α), arginase-1 (Arg-1), interleukin-10 (IL-10), and transforming growth factor beta (TGF-β) in the ischemic penumbra of rat brains.The experimental results showed that BMSC-Exos reduced the number of CD16/32+/Iba1+ positive cells in the ischemic penumbra (P < 0.01) while increasing the number of CD206+/Iba1+positive cells (P < 0.01), and decreased the mRNA expression of iNOS, CD86, and TNF-α, while increasing the mRNA expression of Arg-1, TGF-β, and IL-10 (P < 0.05 or P < 0.01).This research suggests that BMSC-Exos can regulate M1/M2 polarization of microglia/macrophages in rats with acute cerebral ischemia, alleviate neuroinflammation, and improve ischemic brain injury.

Objective: To evaluate the immunogenicity of high-dose inactivated quadrivalent influenza serial vaccines (split virion) for elderly people. Methods: Immunogenicity assays on mouse as research animal model with inactivated quadrivalent influenza serial vaccines (split virion) were carried out. Then rates of seroconversion and geometric mean hemagglutination inhibition titers (GMTs) at day 21 after the last vaccination among those who received high-dose (HD) A+ B influenza vaccine, were compared with those who received other vaccines by hemagglutination inhibition (HAI) test. Results: The result of HAI test showed in HD serial vaccine groups, GMTs for all kinds of HA in the two HD serial vaccine groups were significantly different from that of the two SD serial vaccine groups, respectively (P<0.0001), but not the titers for A3 in one B dose first group. Further- more, GMTs for strain A in one B dose first groups were significantly higher than that of one B dose first groups in both HD and SD groups, and vice versa in the GMTs for strain B. The result of the assay of the impact of different immunization intervals of HD serial influenza vaccine on immunogenicity indicated that the immunity responses in 7 or 10 d groups were higher than that in 3 d group. Conclusions It is a new method to prevent the flu for elderly by HD A+ B serial influenza vaccine, whose HA dose per immunization was reduced into two injections, worked best when the immunization interval was 7-10 d. The protective immunity can be improved by selecting immune procedure of the serial vaccine according to the epidemic type surveillance of influenza virus A and B strains.

With the rapid development of cell biology and biological materials, the dentine-pulp complex regeneration research has gone further. Scaffolds play important roles in the construction of tissue engineered dentine-pulp complex. At present, scaffolds used in dentine-pulp complex regeneration include not only natural biological materials and synthetic biomaterials, but also various composite materials and cell- or body-based carrier materials. In this paper, the latest research status of various scaffolds for dentine-pulp complex regeneration were reviewed. The advantages and problems of these scaffolds were analyzed. The future development direction was predicted.

Teaching of Critical Care Medicine faces several challenging issues includingcomprehensive intensive or specialist intensive, approach of curriculum, tralning of team working ability, building of teaching platform and teaching staff. Critical care medical education requires the concept of viewing the discipline as a whole. Under its guidance and with the opportunity of critical care medical subspecialties building, critical care medical education should focus on bothcompre-hensive critical care and specialist critical care, and have rational planning of Critical Care Medicine course. Through the construction and integration of ICU, we should create a comprehen-sive clinical practice platform of critical care medicine to carry out clinical practice and team work tralning. Meanwhile, construction of quality critical care medicine faculty should be based on its pro-fessional features.

Objective To assess the association between killer cell immunoglobulin-like receptor (KIR) gene polymorphisms and the risk of hypertension in autoimmune mechanism.Methods We conducted a case-control study including 205 hypertensives and 205 controls matched with sex and age,from a community-based population.KIR genes of all subjects were genotyped by polymerase chain reaction with sequence-specific primers (PCR-SSP).Conditional logistic regression model and generalized multifactor dimensionality reduction (GMDR) method were used to estimate the association among KIR gene polymorphisms and the risk of hypertension.Results The genotypic frequencies of KIRs were not significantly different between the hypertensives and the control groups (P＞0.05).Among all the models of GMDR concerning the association between interactions of KIR genes and essential hypertension,the testing accuracy of the interaction between K/R2DS2 and KIR2DS3 was the highest (55.13％),with cross-validation consistency as 10/10 (P=0.054).Results from the conditional logistic regression showed that individuals with KIR2DS2 +:KIR2DS3-were significantly associated with an increased risk on hypertension (OR=2.555,95％CI:1.203-5.429,P=0.015).However,individuals with KIR2DS2 +:KIR2DS3 + were significantly associated with a reduced risk of hypertension (0R=0.268,95％ CI:0.088-0.815,P=0.020).Individuals with KIR2DS2-KIR2DS3 + did not seem to be associated with the risk of hypertension (0R=1.602,95％ C I:0.785-3.266,P=0.195),when compared to the KIR2DS2-KIR2DS3-group.Interactions between KIR2DS2 and KIR2DS3 were significantly associated with the risk of hypertension,after adjusted for BMI,smoking,drinking and family history of hypertension (OR=0.065,95％CI:0.013-0.317,P=0.001).Conclusion Individuals with KIR2DS2 and no KIR2DS3 were associated with the increased risk of hypertension.KIR2DS2 that coexisted with KIR2DS3 were associated with the reduced risk of hypertension.Antagonism between KIR2DS2 and KIR2DS3 might serve as a protect factor for hypertension.

BACKGROUNDOptic neuritis (ON) is often the first symptom of multiple sclerosis (MS) and neuromyelitis optica (NMO) while there has been very little research reported on ON combined with Sjögren's syndrome (SS). The aim of this study is to provide different treatments and services for and NMO patients combined with SS.

METHODSTwenty-seven patients with ON combined SS were divided into two groups: corticosteroid group (C group, methylprednisolone sodium succinate, 14 patients) and corticosteroid+ immunosuppressant group (C+I group, leflunomide, 13 patients). ON relapse times in 1 year after treatment, number of patients who relapsed to NMO/MS in 1 years, visual acuity and retina nerve fiber layer (RNFL) thickness were measured. Mann Whitney-Wilcoxon test was used to compare continuous variables and Chi-square test or Fisher's exact test was to compare proportions.

RESULTSON combined with SS patients had higher incidence rates in middle-aged women who have binocular damage and heavier visual function damage or when there is an easy relapse, and the patients are often hormone dependent. The patients are more likely anti-aquaporin-4 IgG seropositive (70.4%). They are liable to form a centrocecal scotoma and tubular vision. The times of relapse decreased in patients who used immunosuppressant, and a significant difference was found between immunosuppressant and non-immunosuppressant groups in visual acuity recovery during 6-month follow-up period (P < 0.05); however, the RNFL thickness at the four quadrants was not significantly different.

CONCLUSIONSThe effect of immunosuppressant plus corticosteroid on the early onset of ON combined with SS was to provide ON remedy and to prevent recurrence in clinics. This study provides a significant reference for the prevention and treatment of ON on the basis of immunosuppressant and corticosteroid.

Adolescent ; Adrenal Cortex Hormones ; therapeutic use ; Adult ; Aged ; Female ; Humans ; Immunosuppressive Agents ; therapeutic use ; Magnetic Resonance Imaging ; Male ; Methylprednisolone Hemisuccinate ; therapeutic use ; Middle Aged ; Optic Neuritis ; drug therapy ; Sjogren's Syndrome ; drug therapy ; Visual Acuity ; drug effects ; Young Adult

Background The diseases of neuro-ophthalmology are common,which can influence the quality of patients' life seriously.The 39-item National Eye Institute Visual Function Questionnaire (NEI VFQ-39) is an instrument to assess self-reported visual impairment in studies of vision.However,until now,no studies have been performed to specifically assess the vision-related quality of life in persons with diseases of neuro-ophthalmology.Objective To evaluate vision-related quality of life for neuro-ophthalmology inpatients through the NEI VFQ-39,for the better treatment and nursing for them.Methods Ninety-seven neuro-ophthalmology inpatients were scheduled in research from June 1 to September 30,2012,and we collected all the clinical datas and the Chinese version NEI VFQ-39.The NEI VFQ-39 subscale item scores were compared among subgroups divided by monocular or binocular incidence,diseases and best corrected visual acuity(BCVA),and correlation analysis of the NEI VFQ-39 scores and BCVA for better-seeing and worse-seeing eyes was performed.Results The mean age of scheduled patients was (36.6±14.4)years,with no difference in gender.The mean composite score of VFQ-39 was 57.36(46.50,73.38),mental health subscale score was lowest [45.00 (35.00,60.00)].In the four eye diseases groups,except for eye pains,degree of dependence,periphery vision,anterior ischemic optic neuropathy (AION) group had lower scores compared with the other three groups,but there were no statistical significances among the four groups (all at P＞0.05).Except for eye pains,patients with monocular incidence had better scores than those with binocular incidence,with statistical significant significances between them(all at P＜0.05).Patients with BCVA in the better-seeing eye ＞ 20/32 had better scores than the other two groups,compared with the BCVA in the better-seeing eye ＜20/200 group,except for overall health and eye pains,cornpared with the 20/200 ≤ BCVA in the better-seeing eye ＜20/23 group,except for eye pains,social activity and color vision,and the rest subscale scores had significant differences among the three groups(all at P＜0.05).NEI VFQ-39 scores had positive correlations with the BCVA for better-seeing and worse-seeing eyes,and had strong correlations with the BCVA for better-seeing.Conclusions Neuro-ophthalmology diseases have serious influences on patients' visual function and quality of life.The quality of life has direct correlation with BCVA,so improving their visual function is helpful to their quality of life.

Targeted therapy means transporting drugs to certain tissue,aiming at increasing the utilization of drugs as well as reducing cytotoxicity.Chemotherapy drugs carried by carbon nanotube have high pharmaceutical activity and tumor control rate,compared with drugs alone.Carbon nanotube combined with immunotherapy drugs and nucleic acid can treat tumors at immunology and gene level.