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    Translatinal medicine
    2016, 36 (12):  1677. 
    Abstract ( 294 )   PDF (3469KB) ( 548 )  
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    Journal of Shanghai Jiao Tong University (Medicine Science)
    2016, 36 (12):  1678. 
    Abstract ( 311 )   PDF (1160KB) ( 392 )  
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    Original article (Basic research)
    Expression, purification, and crystallization of recombinant rat α2 macroglobulin
    FENG Ling-ling, ZHOU Ai-wu
    2016, 36 (12):  1685. 
    doi: 10.3969/j.issn.1674-8115.2016.12.001

    Abstract ( 776 )   PDF (4953KB) ( 881 )  

    Objective · To obtain high purity rat α2 macroglobulin (Rα2M) and screen the protein crystals in order to collect high-resolution diffraction data for subsequent structural biology research. Methods · The gene for encoding Rα2M was cloned into the eukaryotic expression vector pCEP4. Recombinant Rα2M was expressed in HEK293EBNA cells using PEI-mediated transient transfection method. Rα2M was purified with anion exchange column and nickel affinity chromatography and purified Rα2M was crystallized, screened, and optimized. Results · The recombinant full length Rα2M protein with a relative molecular mass of about 180 000 was obtained after purification, as well as small and large fragments after slicing. Rα2M protein crystals were obtained after crystallization screening and optimization. Conclusion · The Rα2M crystals that can be used for crystal diffraction were obtained. This work lays a foundation for subsequent elucidation of the crystal structure of Rα2m.

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    Study on the inhibitory effect of Herba Selaginellae Uncinatae on renal interstitial fibrosis in rats with unilateral ureteral obstruction
    XU Jian, YUAN Hong-ling, NI Kai, ZHOU Xiao-ping, LI Rong, ZHOU Yan, GAO Min
    2016, 36 (12):  1689. 
    doi: 10.3969/j.issn.1674-8115.2016.12.002

    Abstract ( 528 )   PDF (9062KB) ( 598 )  

    Objective · To investigate the inhibitory effect of Herba Selaginellae Uncinatae (HSU) on renal interstitial fibrosis in rats with unilateral ureteral obstruction (UUO) and possible mechanisms. Methods · One hundred and eight Sprague-Dawley rats were randomly assigned to the sham-operation group, the model group, the low-dose HSU group, and the high-dose HSU group. The model of left ureteral obstruction was built in the latter three groups. The low-dose HSU group and the high-dose HSU group received lavage with 2 and 4 g/kg of HSU extract for 14 days, respectively. Renal tissue sections from nine rats in each group were prepared 3, 7, and 14 days,respectively, after the model was built. H-E staining and Masson staining were used to observe renal histopathological changes and renal fibrosis. Immunohistochemistry was used to measure the expressions of MCP-1, TGF-β1, and α-smooth muscle actin (α-SMA) in renal tissues. RT-PCR was used to quantitatively measure mRNA levels of TGF-β1, α-SMA, and MCP-1. Results · Renal pathological changes in the model group 3 days after operation were mainly inflammatory cell infiltration with tubular dilation, insignificant renal interstitial fibrosis, and normal glomeruli. Some renal tubules were atrophic with disorganized arrangement 14 days after operation. Diffuse inflammatory cell infiltration was observed in renal interstitium with severe fibrosis. Compared with the control group, two HSU groups had less inflammatory cell infiltration, renal tubular atrophy, and fibrosis. The immunohistochemical results showed that α-SMA, MCP-1, and TGF-β1 distributed in renal tubular interstitium and on small vessel walls. The normal saline group had the darkest staining 14 days after operation. The optical density was significantly lower in two HSU groups than in the control group (P<0.05). RT-PCR results showed that mRNA levels of TGF-β1, α-SMA, and MCP-1 in renal tissues were significantly lower in two HSU groups than in the control group (P<0.05). Conclusion · HSU can down-regulate α-SMA, TGF-β1, and MCP-1 levels in renal tissues of UUO rats, reduce inflammatory cell infiltration, and inhibit the progression of renal fibrosis.

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    Comparative study on cytocompatibility and osteogenic activity for silver-doped hydroxyapatite with different silver contents
    HE Qi, GONG Jing-jue*, YANG Lei, JIAO Ting
    2016, 36 (12):  1697. 
    doi: 10.3969/j.issn.1674-8115.2016.12.003

    Abstract ( 684 )   PDF (6061KB) ( 1032 )  

    Objective · To synthesize silver-doped hydroxyapatite (Ag-HAp) with different silver contents, explore their cytocompatibility and effects on the osteogenetic activity of rat bone marrow mesenchymal stem cells (BMSCs) in vitro, and determine the proper Ag content. Methods · Silver-doped hydroxyapatite with different silver contents (xAg0, xAg0.3, xAg0.5, and xAg0.7) was synthesized, characterized, and divided into the control group (xAg0 group) and experimental groups (xAg0.3, xAg0.5, and xAg0.7). The effects of Ag-HAp with different silver contents on cytocompatibility, expressions of genes related to osteogenesis, and secretion of alkaline phosphatase (ALP) in BMSCs were detected. Results · Characterization results confirmed that the synthesized product was silver-doped hydroxyapatite with silver contents of xAg0.7>xAg0.5>xAg0.3. The cytocompatibility test results showed that the xAg0.3 and xAg0.5 groups were qualified to be medical material and the xAg0.7 group had slight toxicity. Real-time PCR results indicated that compared with the control group, the xAg0.3 and xAg0.5 groups had elevated expressions of osteogenesis-related genes and the xAg0.7 group had comparable or decreased expressions of osteogenesis-related genes. ALP qualitative and quantitative tests showed that the xAg0.3 and xAg0.5 groups had higher ALP activity and the xAg0.7 group had lower ALP activity than the control group. Conclusion · Silver-doped hydroxyapatite with different silver contents can be synthesized by changing the quantity of added silver. When xAg is 0.3 or 0.5, the silver-doped hydroxyapatite is qualified to be medical material and can promote the expressions of
    osteogenesis-related genes and the secretion of ALP.

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    Experimental study on the mechanical properties of polyurethane composite
    FAN Rui, LI Jing*, ZHENG Yuan-li
    2016, 36 (12):  1702. 
    doi: 10.3969/j.issn.1674-8115.2016.12.004

    Abstract ( 585 )   PDF (6232KB) ( 880 )  

    Objective · To investigate the mechanical properties of polyurethane composite containing polyphosphazene nanospheres. Methods · Test specimens were prepared with different materials, including polyurethane (the PU group), polyurethane containing 1% polyphosphazene nanospheres (the 1% PSZ group), polyurethane containing 5% polyphosphazene nanospheres (the 5% PSZ group), and self-curing silicone rubber soft liner material Sofreliner (the Sofreliner group). The microstructure of test specimens was observed using the scanning electron microscope (SEM). The tensile strength and tearing strength of test specimens were calculated after 0, 1 000, and 3 000 hot and cold cycles. Results · SEM observation showed that there were no nanoparticles aggregating on the surface of test specimens in the 1% PSZ and 5% PSZ groups. Depressions on the surface of test specimens were shallower in the 5% PSZ group than those in the 1% PSZ and PU groups. Before hot and cold cycling tests, the differences in tensile strength and tearing strength among the PU, 1% PSZ and 5% PSZ groups were not statistically significant, but tensile strength and tearing strength were significantly higher in the PU, 1% PSZ and 5% PSZ groups than those in the Sofreliner group (P<0.05). After hot and cold cycling tests, the tensile strength in the PU, 1% PSZ and 5% PSZ groups was slightly decreased, while the tearing strength was not significantly changed. Conclusion · The tensile strength and tearing strength of polyurethane composite are higher than those of Sofreliner and meet the clinical application standard. The surface properties of materials were improved by adding 5% polyphosphazene nanospheres to polyurethane compared with adding 1% polyphosphazene nanospheres, but the tensile strength and tearing strength were not significantly improved.

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    Effects of different intensity of extracorporeal shock wave combined with bone marrow mesenchymal stem cells transplantation on the repair of bone defect in rats
    JIA Lang, HUANG Rong-zhong, WANG Yu-le, JIA Gong-wei
    2016, 36 (12):  1706. 
    doi: 10.3969/j.issn.1674-8115.2016.12.005

    Abstract ( 692 )   PDF (9344KB) ( 680 )  

    Objective · To observe the effects of different intensity of extracorporeal shock wave (ESW) combined with bone marrow mesenchymal stem cells (BMMSCs) transplantation on the repair of bone defect in rats and explore the optimal stimulation parameters of ESW in this therapy. Methods · A total of 150 SD rats were randomly divided into 5 groups. The bone defect model was built by drilling a round hole in the femur middle segment with a dental drill. BMMSCs of SD rats were isolated and cultivated in vitro. The third generation of BMMSCs was implanted into the bone defects where ESW with different stimulation parameters was applied. Ten rats in each group were sacrificed 2, 4, and 6 weeks after treatment. X-ray examination and HE staining were respectively used for radiological and histological observations. Radiological and histological scores were evaluated. Expressions of osteogenic related proteins were measured using Western blotting. Results · ESW significantly promoted the local osteogenic activity of the bone defect model. The rats receiving ESW of 8.5 kV and 2 Hz generated calluses earlier and more than other rats. Histological staining showed that their new bones were more mature and Western blotting indicated that the increase in expressions of osteogenic related proteins (RUNX2, ALP, and Col I) was more significant as well. Conclusion · ESW combined with BMMSCs transplantation can promote the expression of osteogenic related proteins and accelerate the healing of bone defect. 8.5 kV and 2 Hz are the optimal stimulation parameters of ESW for the repair of bone defect in this study.

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    Experimental study on polyelectrolyte multilayer film-modified decellularized tissue engineered vascular grafts
    LIU Jun, ZHANG Xiao-ying
    2016, 36 (12):  1713. 
    doi: 10.3969/j.issn.1674-8115.2016.12.006

    Abstract ( 513 )   PDF (7873KB) ( 597 )  

    Objective · To find the best acellular reagent for the preparation of tissue engineered vascular grafts (TEVGs) and to modify decellularized vascular grafts with heparin -SDF-1α polyelectrolyte multilayer film and evaluate the biocompatibility of TEVGs. Methods · We decellularized rat aortas with PBS solutions containing 0.25% Triton-X100 and 0.25% SD (the TS group), 1% SDS (the SDS group), and 0.5% Triton-X100, 0.5% SD, and 0.5% SDS (the STS group) with untreated rat aortas serving as controls. The optimal acellular reagent was identified with HE staining, DNA quantification, and scanning electron microscope. After modifying decellularized vascular grafts with heparin -SDF-1α polyelectrolyte multilayer film, we used immunofluorescence to verify the binding of TEVGs on vascular surface. The biocompatibility of modified TEVGs was evaluated with migration assay in vitro and the platelet activation assay was used to measure the adhesion of rat bone marrow mesenchymal stem cells. Results · The STS group had the best aorta decellularization with good preservation of the three-dimensional structure of blood vessels. Heparin -SDF1α polyelectrolyte multilayer film could bind firmly on the surface of TEVGs. Heparin -SDF-1α polyelectrolyte multilayer film-modified TEVGs significantly reduced the adhesion and activation of platelet on the surface of TEVGs and greatly enhanced proliferation and migration abilities of rat bone marrow mesenchymal stem cells. Conclusion · The PBS solution containing 0.5% SD, 0.5% SDS, and 0.5% Triton-X100 was the best acellular reagent. The heparin -SDF-1 polyelectrolyte multilayer film can favorably bind on the surface of acellular vessels, which have good biocompatibility.

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    Effects of d1-3-n-butylphthalide on the release of inflammatory mediators in lipopolysaccharide-activated microglia cells
    ZHI Nan, XU Qun
    2016, 36 (12):  1719. 
    doi: 10.3969/j.issn.1674-8115.2016.12.007

    Abstract ( 519 )   PDF (5990KB) ( 718 )  

    Objective · To investigate the effects of d1-3-n-butylphthalide (NBP) on inflammatory mediators released by microglia cells after being activated with lipopolysaccharide (LPS). Methods · Microglia cells and neurons were obtained from primary cultured rat cortices. Microglia cells were divided into five groups, including the blank control group, the LPS activated group, the solvent plus LPS group, the 0.01 mmol/L NBP plus LPS group, and the 0.1 mmol/L NBP plus LPS group. Microglia cells were pretreated with NBP 2 h before LPS stimulation. The morphology of microglia cells was observed under inverted microscope after being stimulated with LPS for 24 h. The levels of inflammatory factors, including tumor necrosis factor α (TNF-α), interleukin 1β (IL-1β), and interleukin 10 (IL-10), were measured with enzyme linked immunosorbent assay (ELISA) method and the content of carbon monoxide (NO) was measured using nitrate reductase method. The survival rate of neurons was detected by MTT method. Results · NBP pretreated microglia cells remained the activated form after LPS stimulation. NBP did not affect the release of TNF-α, IL-1β, and IL-10 by activated microglia cells, but inhibited the production of inflammatory mediator NO, thus improved the survival rate of neurons in a dose-dependent manner. Conclusion · NBP can attenuate the LPS-induced neuroinflammatory responses in microglia cells and show the dose-dependent neuroprotection.

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    Preparation and activity identification of human cyclophilin B
    ZHANG Qi, WU Jia-wei, ZHOU Ai-wu
    2016, 36 (12):  1723. 
    doi: 10.3969/j.issn.1674-8115.2016.12.008

    Abstract ( 550 )   PDF (4077KB) ( 610 )  

    Objective · To construct an expression vector for human cyclophilin B (hCypB) and prepare active CypB via the prokaryotic expression system. Methods · The DNA sequence enconding hCypB was amplified by PCR and inserted into expression vector pGEX-6P-1 by double enzyme digestion. hCypB was further purified with affinity chromatography and the activity of over-expressed hCypB was verified with GST-pulldown. Results · The recombinant CypB expression plasmid was successfully constructed and verified with DNA sequencing. GST-CypB fusion protein was purified to a purity of 90% by affinity chromatography with a yield of 26 mg of fusion protein from a liter of overnight E. coli culture. GST-pulldown further confirmed that this GST-hCypB fusion protein could form the ternary complex with prolyl 3-hydroxylase 1 (P3H1) and cartilage-associated protein (CRTAP). Conclusion · Large amount of active and highly purified hCypB can be obtained via this experiment method within short time period.

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    Original article (Clinical research)
    Metabolism-related high risk factors for obstructive sleep apnea hypopnea syndrome in adolescent obese patients
    ZHANG Yu-wen, SHI Juan, ZHANG Yi-fei, GU Wei-qiong, WANG Wei-qing, HONG Jie
    2016, 36 (12):  1726. 
    doi: 10.3969/j.issn.1674-8115.2016.12.009

    Abstract ( 621 )   PDF (7395KB) ( 643 )  

    Objective · To explore the high risk factors for obstructive sleep apnea hypopnea syndrome (OSAHS) in adolescent obese patients. Methods · A total of 199 adolescent obese patients were enrolled. All patients underwent polysomnography (PSG). The severity of OSAHS was assessed with apnea hypopnea index (AHI). The homeostasis model assessment-insulin resistance index (HOMA-IR) was calculated using steady-state model. Bergman mini-model technology and frequently sampled intravenous glucose tolerance test were used to calculate the insulin sensitivity index (SI). The abdominal fat distribution and content were measured with CT and specific software. Patients were stratified and compared by OSAHS and severity and regression analysis was used to predict the high risk factors for OSAHS in this population. Results · The OSAHS group had significantly larger neck circumference (NC) and higher visceral fat area (VAT), blood pressure, blood glucose, liver enzyme, and blood lipid than the non-OSAHS group (P<0.05). Among above factors, NC, VAT, and diastolic blood pressure (DBP) are independent risk factors for OSAHS. Conclusion · Larger NC and higher VAT and DBP are high risk factors for OSAHS in adolescent obese patients.

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    Value of angiotensin Ⅱ and aldosterone for the diagnosis of atrial fibrillation in patients with primary hypertension
    ZHAO Li-qun, LI Xu-guang, XIE Li-jun, WU Hai-qing, WANG Zhi-min, LIU Shao-wen
    2016, 36 (12):  1732. 
    doi: 10.3969/j.issn.1674-8115.2016.12.010

    Abstract ( 580 )   PDF (5555KB) ( 791 )  

    Objective · To explore whether plasma angiotensin Ⅱ(AngⅡ) and aldosterone (ALD) in patients with primary hypertension can be used as biomarkers for the occurrence of atrial fibrillation and to guide the treatment of atrial fibrillation. Methods · 179 atrial fibrillation patients were enrolled and assigned to the train group (n=72) and the verification group (n=107) and 189 primary hypertensive patients were enrolled and assigned to the train group (n=75) and the verification group (n=114). Plasma renin activity (PRA), Ang Ⅱ, and ALD levels were measured using radioimmunity and compared between groups. The efficacy of Ang Ⅱand ALD on the diagnosis of atrial fibrillation was analyzed using ROC curves. Results · The atrial fibrillation group had higher Ang Ⅱand ALD levels than the hypertensive group (P=0.000). ROC curve analysis showed that sensitivity, specificity, and cut-off value were 0.92, 0.80, and 58.00 pg/mL for Ang Ⅱand 0.93, 0.96, and 150.00 pg/mL for ALD. The differences in AngⅡand ALD distributions between two groups were statistically significant (P =0.000). Conclusion · The plasma Ang Ⅱand ALD can be used as biomarkers for predicting atrial fibrillation in patients with primary hypertension and as an important index for using RAAS system blockers for the treatment of atrial fibrillation.

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    Clinicopathologic characteristics and prognostic factors for hepatocellular carcinoma patients with diabetes mellitus
    LUO Cui-song, LIN Yun, ZOU Wei-bing, SHI Jun
    2016, 36 (12):  1736. 
    doi: 10.3969/j.issn.1674-8115.2016.12.011

    Abstract ( 556 )   PDF (5874KB) ( 902 )  

    Objective · To analyze the clinicopathologic characteristics and prognostic factors for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) patients with diabetes mellitus (DM) receiving radical resection. Methods · Clinical data of 250 HCC patients with DM receiving radical resection in the First Affiliated Hospital of Nanchang University from January 2000 to December 2013 were retrospectively analyzed. Basic clinical data and prognostic factors were summarized and analyzed. Results · 230 male patients (92.0%) and 20 female patients (8.0%) were enrolled with an average age of (53.15±8.73) years. The preoperative median course of DM was 36 months and there were 42.0% (105/250) of patients with DM for more than 5 years. Edmondson grade III was the main pathological type of HCC, accounting for 65.6%. The multivariate analysis revealed that the number of tumors, hemoglobin level, and treatment after recurrence were prognostic factors for HBV-related HCC patients with DM. Conclusion · This kind of HCC frequently occurs in overweight or obese male liver cirrhosis patients with a chronic hepatitis B history and a DM course of more than 3 years. Monitoring should be enhanced for these patients. The comprehensive treatment after recurrence is helpful for improving their prognosis.

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    Investigation of the normal ranges of thyroid function indexes based on the TPOAb positive value
    GUO Ai, LIU Chun
    2016, 36 (12):  1740. 
    doi: 10.3969/j.issn.1674-8115.2016.12.012

    Abstract ( 998 )   PDF (7457KB) ( 669 )  

    Objective · To investigate the normal ranges of thyroid function indexes in pregnancy through the positive values of autoimmune antibodies. Methods · 730 pregnant women were recruited. Levels of serum thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TGAb) were measured with chemiluminescence immunoassay. The values of each index in the normal ranges were assigned to the respective low, medium, and high groups. The differences in the positive rates of TPOAb and TGAb between groups were analyzed. Results · The differences in the positive rate of TPOAb between TSH low, medium, and high groups in each trimester of pregnancy were statistically significant. Comparison between groups showed that the TSH high group was more likely to develop abnormal TPOAb level than TSH low and medium groups. There was a significant positive correlation between the normal TSH value and the TPOAb positive value in first trimester of pregnancy (r=0.661, P=0.038). Conclusion · The high TSH level in normal range is more likely to be associated with abnormal TPOAb level in each trimester of pregnancy, which provides an idea for determine the normal ranges of thyroid function indexes. Screening and follow-up for thyroid function and autoimmune antibodies of pregnant women should be enhanced to avoid adverse pregnancy outcomes.

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    Study on the effects of drug treatment on the behavioral inhibition/activation systems in patients with obsessive-compulsive disorder
    GAO Rui, FAN Qing, ZHANG Zong-feng, CAO Xuan, CHEN Yong-jun, BAI Yan-le, ZHANG Hai-yin
    2016, 36 (12):  1745. 
    doi: 10.3969/j.issn.1674-8115.2016.12.013

    Abstract ( 775 )   PDF (7102KB) ( 545 )  

    Objective · To investigate the effects of drug treatment on the behavioral inhibition system (BIS) and behavioral activation system (BAS) in patients with obsessive-compulsive disorder (OCD). Methods · A total of 35 patients with OCD and 35 healthy controls were enrolled. The Yale-Browan obsessive compulsive scale (YBOCS) and behavioral inhibition system and behavioral activation system scale (BIS/BAS) were used for baseline assessment. OCD patients received drug treatment for three months. Then YBOCS and BIS/BAS were used again for follow-up assessment. The differences in BIS and BAS between the OCD and control groups, before and after drug treatment, and different efficacy groups were compared. Results · The BIS in the OCD group was significantly different from that in the control group (F=34.255, P=0.000). There was a significant difference in BIS before and after drug treatment (t=-2.302, P=0.028). Also there was a significant difference in the main effect of behavioral activation system scale-fun seeking (BASF) between different efficacy groups when controlling the basic YBOCS score before and after drug treatment (F=4.868, P=0.035). The main effect of efficacy on the BIS was significant (F=4.500, P=0.019). Conclusion · The activity of BIS in OCD patients was poorer than that of healthy controls. With the change of severity of OCD symptoms, the inhibition function of OCD changed as well. There was a significant difference in the BASF in different efficacy groups before and after drug treatment.

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    Application of residual cholesterol to the assessment of patients with acute coronary syndrome
    WANG Ping, MAO Jian-hong, LU Yi-wen, SHEN Li-song
    2016, 36 (12):  1750. 
    doi: 10.3969/j.issn.1674-8115.2016.12.014

    Abstract ( 863 )   PDF (4758KB) ( 652 )  

    Objective · To investigate the clinical application of serum remnant cholesterol (RC) to the assessment of patients with acute coronary syndrome (ACS). Methods · We enrolled 293 patients with stable angina (SA), 115 patients with non-hypertensive ACS, 72 patients with hypertensive ACS, 91 patients as controls, and 152 healthy controls. Levels of total cholesterol (TC), HDL- cholesterol (HDL-Ch), and LDL-Ch were measured with biochemistry method. RC was given by subtracting LDL-Ch and HDL-Ch from TC and non-HDL-Ch was given by subtracting HDL-Ch from TC. The correlations of RC with TC, LDL-Ch, HDL-Ch, and non-HDL-Ch were analyzed. ROC curves were used to analyze the application of RC, LDL-Ch, HDL-Ch, and non-HDL-Ch for differentiating SA and ACS. Results · The RC level was significantly higher in the ACS group and the hypertensive ACS group than in the SA group (P<0.05). Correlations of RC with TC, LDL-Ch, HDL-Ch, and non-HDL-Ch were statistically significant (P<0.01). The ROC curve analysis showed that RC was the best for differentiating SA and ACS, followed by non-HDL-Ch, LDL-Ch, TC, and HDL-Ch. Conclusion · Remnant cholesterol is significantly elevated in the patients with ischemic heart disease and can be used for differentiating ACS and stable angina.

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    Assessment of a perioperative feeding behavioral intervention protocol for neonates undergoing arterial switch procedure
    LUO Wen-yi, GUAN Yong-mei, YAO Yi-wei, WANG Yun, FANG Wen-wen
    2016, 36 (12):  1754. 
    doi: 10.3969/j.issn.1674-8115.2016.12.015

    Abstract ( 532 )   PDF (6231KB) ( 786 )  

    Objective · To formulate and assess a perioperative feeding behavioral intervention protocol for neonates undergoing arterial switch procedure. Methods · Congenital heart disease neonates (n=140) undergoing arterial switch procedure and their mothers (n=140) were enrolled and assigned to the intervention group (the experimental group) and the conventional method group (the control group) according to perioperative feeding behaviors. The outcome of feeding behaviors and mothers’ satisfaction, self-efficacy, and depression were compared and analyzed. Results · Analysis of the outcome of feeding behaviors showed that the experimental group had shorter gastric usage time and greater oral motor ability than the control group (P<0.05). Mothers’ satisfaction, self-efficacy, and depression in the experimental group were significantly improved compared with the control group (P<0.01). Conclusion · A reasonable and scientific nursing intervention protocol can significantly improve the outcome of feeding behaviors and the quality of life for neonates undergoing arterial switch procedure in perioperative period and facilitate improving maternal feeding skills and maintaining emotional stability.

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    Analysis of the efficacy of rosuvastatin calcium for different HRCT phenotypes of COPD
    ZHOU Xi, YAN Jun-hai, ZHAO Chun-liu, HUANG Zhuo-qiong, ZHANG Bai-ying
    2016, 36 (12):  1759. 
    doi: 10.3969/j.issn.1674-8115.2016.12.016

    Abstract ( 546 )   PDF (5921KB) ( 705 )  

    Objective · To investigate the efficacy of rosuvastatin calcium for different high-resolution CT (HRCT) phenotypes of COPD. Methods · Fifty COPD patients were randomly selected and stratified into 3 types, i.e. A, E, M according to emphysema and bronchial wall thickening using HRCT. Based on conventional treatment, patients received 5 mg/d of rosuvastatin calcium for 2 years. Chest HRCT and type stratification were performed prior to treatment. Plasma IL-6 and IL-8 levels and lung function were measured before and after treatment. Results · There were 10 cases of A type, 17 cases of E type, and 23 cases of M type. Differences in IL-8, IL-6, FVC, and FEV1 before and after treatment between 3 types of patients were statistically significant (P < 0.05). Univariate variance analysis showed that differences in the decrease of IL-6 and IL-8 were statistically significant (P = 0.035, P = 0.006), which in A type patients decreased most. The differences in the decrease of FVC and FEV1 were not statistically significant (P=0.154, P = 0.453). Conclusion · Rosuvastatin calcium had efficacy for systemic inflammatory response in COPD patients with different HRCT phenotypes, but was unable to improve pulmonary function. The efficacy for different phenotypes varied.

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    Measurement and analysis of indexes of mandibular three-dimensional shape in patients with hemimandibular elongation
    HU Hong-tao, WANG Chao, HE Jin-long, MI Huan, CHEN Yao-di, WANG Tao
    2016, 36 (12):  1763. 
    doi: 10.3969/j.issn.1674-8115.2016.12.017

    Abstract ( 533 )   PDF (6693KB) ( 727 )  

    Objective · To analyze the morphological characteristics of mandibula for patients with hemimandibular elongation using the indexes of mandibula three-dimensional shape (IM3DS) and calculate reference ranges for normal and abnormal mandibula. Methods · 46 patients with hemimandibular elongation (the disease group) and 46 normal controls (the control group) were included in this study. Cone-beam computed tomography (CBCT) data were stored according DICOM medical digital image communication standard. Mandibula three-dimensional reconstruction was performed using Mimics 15.0. The location marks were used to measure line distance and volume of mandibula, and the results were statistically analyzed. Results · There was no statistical difference in measurements between two groups (P>0.05). For the disease group, the lesion side had significantly greater measurements of WC, WN, HC, LAR, LHR, HM1, HAC, VT, VC, VAR, VB2, and VB3 than the normal side (P<0.05). The differences in other indexes were not statistically significant (P>0.05). Obtained reference ranges for normal mandibula with IM3DS between 1 and 6 were 0.579 7-0.827 1, 0.532 3-0.708 7, 0.137 7-0.200 0, 0.140 5-0.189 5, 0.138 7-0.142 7, and 0.060 6-0.080 2. Reference ranges for abnormal mandibula were 0.386 2-0.709 2, 0.335 1-0.658 1, 0.016 6-0.304 0, 0.100 2-0.190 0, 0.096 8-0.160 4, and 0.091 4-0.141 6. Conclusion · The increase in the volume of mandibula in patients with hemimandibular elongation is mainly at mandibular ascending branch and back of mandibular body with the same development trend as normal mandibula. IM3DS can rapidly and effectively evaluate mandibular shape for patients with hemimandibular elongation, so as to clarify lesion range and degree and provide references and guidance for clinical diagnosis and treatment.

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    Observation of the clinical efficacy of modified calcaneal plate for the treatment of intra-articular calcaneus fracture
    REN Ke-wei, WEI Shan, JIANG Xue-feng, HUANG Guo-wei, SHEN Jian-guo
    2016, 36 (12):  1768. 
    doi: 10.3969/j.issn.1674-8115.2016.12.018

    Abstract ( 517 )   PDF (5159KB) ( 785 )  

     Objective · To observe the clinical efficacy of sinus tarsi approach using modified calcaneal plate for the treatment of intra-articular calcaneus fractures. Methods · Clinical data and related indexes (wound healing, B.hler’s angles before and after operation and after healing, AOFAS scores, and complications) of 35 patients with intra-articular calcaneus fracture who underwent sinus tarsi approach using modified calcaneal plates from June 2012 to October 2014 were collected and retrospectively analyzed. Results · 35 cases were followed up for an average of 20.1 months (6-32 months). One of them developed superficial necrosis at the wound edge. The B.hler’s angles of all patients were significantly improved after operation. No significant loss of reduction and lateral impingement after operation until fracture healing were found. The excellent and good rates of AOFAS scores were 87.5%. Conclusion · The sinus tarsi approach using modified calcaneal plate for the treatment of intra-articular calcaneus fractures has fewer surgical traumas and wound complications with reliable fixation and satisfactory efficacy.

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    Analysis of clinical characteristics and death risk factors of patients with heterotaxy syndrome
    LIU Chun-jie, LI Ting-ting, LI Fen, XU Rang
    2016, 36 (12):  1772. 
    doi: 10.3969/j.issn.1674-8115.2016.12.019

    Abstract ( 1146 )   PDF (6500KB) ( 1030 )  

    Objective · To analyze the risk factors for the death of patients with heterotaxy syndrome. Methods · The clinical data of 56 patients with clear diagnosis of heterotaxy syndrome were collected. Clinical characteristics and risk factors for death were analyzed. Results · 47 patients were right isomerism and 9 patients were left isomerism according to anatomical classification. Patients with right isomerism had more severe cardiovascular malformation than those with left isomerism. Of 56 patients, 6 (10.7%) with right isomerism died, in which 5 (83.3%) had moderate to severe atrioventricular valve regurgitation. Results of Mann-Whitney test and Chi-squared test showed that the differences in incidences of moderate to severe atrioventricular valve regurgitation and postoperative low blood oxygen saturation ( ≤80%) were statistically significant (P=0.033 6, P=0.041 7). Univariate Logistic regression analysis showed moderate to severe atrioventricular valve regurgitation was a risk factor for the death of patients with heterotaxy syndrome [OR (95% CI): 11.666 (1.254-108.557), P=0.030 9]. Conclusion · Moderate to severe atrioventricular valve regurgitation is an important risk factor for the death of patients with heterotaxy syndrome.

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    Preliminary study on the measurement uncertainties and permissible ranges of the eight biochemical indexes
    XU Run-hao,ZHANG Jie
    2016, 36 (12):  1777. 
    doi: 10.3969/j.issn.1674-8115.2016.12.020

    Abstract ( 685 )   PDF (8087KB) ( 605 )  

    Objective · To explore the measurement uncertainties and the allowable ranges of the eight biochemical indexes, including serum Na, K, Ca, Phos, Glu, Crea, BUN, and Uric. Methods · Refer to the technical report "Medical Laboratory -Evaluation And Expression of Uncertainty in Measurement" by China National Accreditation Service for Conformity Assessment (CNAS) and Nordtest guideline, continuous accumulated data from internal quality control (IQC) and external quality assessment (EQA) of National Center for Clinical Laboratories (NCCL) were used to calculate the laboratory measurement reproducibility and offset, which were then introduced as the components of the measurement uncertainty. Based on the allowable imprecision and the allowable bias derived from the 95% CI of the measurement project, the measurement uncertainties and permissible ranges of 8 biochemical indexes were calculated and then further evaluated by the quality index models. Results · The measurement uncertainties of the 8 biochemical indexes, i.e. Na, K, Ca, Phos, Glu, Crea, BUN, and Uric, were 2.04%, 4.43%, 4.29%, 4.28%, 4.44%, 7.33%, 6.28%, and 6.25%, respectively. The allowable measurement uncertainties were 2.67%, 5.41%, 4.32%, 5.88%, 6.04%, 6.97%, 7.54%, and 7.48%, respectively. The measurement uncertainties and the permissible ranges of K, Phos, Glu, Crea, BUN, and Uric met the requirements of quality index grade 2 model and Na and Ca met the requirements of the model 3 of the quality index inder. Conclusion · The measurement uncertainties and permissible ranges of K, Phos, Glu, Crea, BUN, and Uric met the requirements of the model 2 of the quality index grade. Currently the methodology and operational techniques for Na and Ca in our laboratory can't meet the rigorous quality standards. We should communicate with the clinicians to understand their decision needs for Na and Ca. Reasonable measurement uncertainties and allowable ranges should be determined by both the laboratory and clinicians.

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    Effects of transforming growth factor β1 on epithelial-mesenchymal transition in pleural mesothelial cells in patients with tuberculous pleurisy and relevant mechanisms
     
    WANG Tao, HAN Na
    2016, 36 (12):  1784. 
    doi: 10.3969/j.issn.1674-8115.2016.12.021

    Abstract ( 444 )   PDF (6637KB) ( 882 )  

    Objective · To investigate the effects of transforming growth factor β1 (TGF-β1) on epithelial-mesenchymal transition (EMT) in pleural mesothelial cells in patients with tuberculous pleurisy and relevant mechanisms. Methods · 35 patients with tuberculous pleurisy were enrolled and underwent thoracoscopy test. Pleural effusion specimens were collected and pleural mesothelial cells (PMCs) were Isolated and purified. The PMCs were cultured and divided into different groups, i.e. the blank control group (containing only cell culture medium), the TGF-β1 treatment group (adding 5 μg/L of recombinant human TGF-β1), the PD150606 treatment group (adding 20 mg/L of PD150606), and the combined group (adding 5 μg/L of recombinant human TGF-β1 and 20 mg/L of PD150606). The gene and protein expressions of calpain-1, CK8, E-cadherin, vimentin, and α-SMA were measured using real-time PCR and Western blotting 48h after culture. Results · EMT was induced in PMCs in the TGF-β1 treatment group with typical characteristics of mesenchymal cells compared with the blank control group. Adding calpain inhibitor PD150606 could block the TGF-β1 induced EMT in PMCs. The TGF-β1 treatment group had higher gene and protein expressions of calpain-1, lower gene and protein expressions of CK8 and E-cadherin, and higher gene and protein expressions of vimentin and α-SMA than the blank control group. The combined group had lower gene and protein expressions of calpain-1, higher gene and protein expressions of CK8 and E-cadherin, and lower gene and protein expressions of vimentin and α-SMA than the TGF-β1 treatment group after adding PD150606. The differences in gene and protein expressions of calpain-1, CK8, E-cadherin, vimentin, and α-SMA between the blank control group and the combined group were not significant, as well as between the PD150606 treatment group and the blank control group. Conclusion · TGF-β1 might induce EMT in PMCs in patients with uberculous pleurisy through up-regulation of calpain-1.

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    Original article (Public health)
    Study on the operational efficiency and variation trend of municipal-level public hospitals in Chongqing based on DEA and SFA analyses
    ZHENG Wan-hui, LONG Chang, SUN Hong
    2016, 36 (12):  1789. 
    doi: 10.3969/j.issn.1674-8115.2016.12.022

    Abstract ( 819 )   PDF (8662KB) ( 648 )  

    Objective · To explore the operational efficiency and the variation trend of 16 municipal-level public hospitals in Chongqing after the new health care reform and to provide quantitative evidence for overall advance of urban public hospital reform in 2017. Methods · Data of main business indicators from 16 public hospitals (2009-2015) were collected. The mean and sample values of overall efficiency, pure technical efficiency, and scale efficiency were calculated with a BC2 model of the data envelopment analysis (DEA) and the input redundancy and output deficit were analyzed. The mean and sample values of productivity and cost effectiveness were calculated using the Cobb-Douglas production model of the stochastic frontier approach (SFA). The values were verified with the maximum likelihood method. The effects of productivity and cost effectiveness on total output and total cost were determined according to coefficients. Results · DEA analysis showed that average overall efficiency, pure technical efficiency, and scale efficiency were efficient in 16 public hospitals (0.852-0.991), but the optimal value (1.000) for above 3 indicators was only obtained in 3 public hospitals. There were irregular differences in the above 3
    indicators, as well as input redundancy and output deficit. SFA analysis showed that the average cost-effectiveness was efficient in 16 public hospitals (0.8891.000), while the average productivity was moderate to efficient (0.665-0.782) with large differences among the hospitals. Some indicators negatively influenced the productivity, including the number of outpatients and emergency patients, actual available bed days, and fixed assets medical income per
    hundred yuan. Conclusion · The government should pay more attention to efficiency estimation and variation trend, reasonably solve problems in allocating limited medical resources, and enhance the effect of efficiency in quantitative input when evaluating the public hospitals.

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    Review
    Exploration and practice of chronic disease management in Danish medical security system
    ZHOU Jian-zai, DAI Bao-zhen, WU Bing-xi
    2016, 36 (12):  1796. 
    doi: 10.3969/j.issn.1674-8115.2016.12.023

    Abstract ( 547 )   PDF (6676KB) ( 767 )  

    High medical expenditure for chronic diseases threatens the sustainability of Chinese medical security system. The chronic disease management in Danish medical security system has achieved favorable results. Detailed planning for implementation methods and service content of chronic disease management, strictly regulating the process, and reasonably formulating related evaluation system and compensation standards are main reasons to success. This article systematically summarizes the exploration and practice of chronic disease management in Danish medical security system and provides reference for establishing chronic disease management in Chinese medical security system.

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    Role of sirtuins in chronic inflammatory diseases
    MO Xing-xing, GE Qin-min
    2016, 36 (12):  1800. 
    doi: 10.3969/j.issn.1674-8115.2016.12.024

    Abstract ( 752 )   PDF (6743KB) ( 1119 )  

    Silent information regulators (SIRTs) belong to classⅢhistone deacetylase family dependent on nicotinamide adenine dinucleotide (NAD+). SIRTs play important roles in regulating oxidative stress, inflammatory mechanisms, and senescence, etc. A large amount of proinflammatory cytokines will be produced under various internal and external stimuli and anti-inflammatory and immunologic mechanisms will be activated. But if inflammatory cytokines persistently exist in circulating system, they will eventually cause multi-organ chronic inflammation and tissue damage. As a deacetylation cofactor for SIRTs, NAD+ may reduce the production of inflammatory cytokines through regulating histones or transcription factors such as NF-κB. Knockout of SIRTs will aggravate inflammatory invasion. So SIRTs may be a potential target for the treatment of chronic inflammatory diseases. This article reviews the role of SIRTs in the occurrence of different chronic inflammatory diseases and related signaling molecules with the aim to provide novel ideas for the treatment of chronic inflammatory diseases.

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    Application of proteomics to the study on Candida albicans
    LIU Jin-yan, SHI Ce, WANG Ying, LI Wen-jing, ZHAO Yue, ZHU Wei-wei, XIANG Ming-jie
    2016, 36 (12):  1804. 
    doi: 10.3969/j.issn.1674-8115.2016.12.025

    Abstract ( 448 )   PDF (8424KB) ( 554 )  

    Candida albicans (C.albicans) is the most common opportunistic human fungal pathogen causing invasive candidiasis, which is one of factors resulting in increasing morbidity and mortality in immunocompromised patients. Currently, limited types of antifungal drugs for clinical application, increased drug resistance, and slow progress of new drug development lead to more and more challenges in clinical treatment. Recently developed proteomics can provide a novel effective technology platform and has been applied to the study of C.albicans, including pathogenic factors, resistance mechanism, immune response, action mechanism of antifungal drugs, etc. In this paper, new development of proteomic technology and its application to the study on C.albicans were reviewed.

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    Research progresses of the association of changes of membrane lipids with Aβ abnormality in Alzheimer’s disease
    LI Qin-jie, ZHONG Yuan
    2016, 36 (12):  1809. 
    doi: 10.3969/j.issn.1674-8115.2016.12.026

    Abstract ( 600 )   PDF (4970KB) ( 992 )  

    Membrane lipids mainly include sphingolipid, glycerophospholipid, and cholesterol, which are abundant in brain. Currently, lots of researches have indicated that metabolic disturbance of membrane lipids in body is associated with pathophysiology in Alzheimer’s disease (AD), especially with abnormalities of amyloid β (Aβ) and its relevant metabolic enzyme. This article aims to review studies on the association of changes of membrane lipids with Aβ abnormality and provides new views and ideas for studies on the pathogenesis of AD from the perspective of membrane lipids metabolism.

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    Application of mTOR inhibitor everolimus for the treatment of renal cell carcinoma
    ZHANG Lin-yuan, ZHANG Ming, DA Jun
    2016, 36 (12):  1812. 
    doi: 10.3969/j.issn.1674-8115.2016.12.027

    Abstract ( 722 )   PDF (7955KB) ( 931 )  

    The efficacy of mTOR inhibitor everolimus for targeted first-line, second-line, and sequential treatments of renal cell carcinoma is investigated and adverse reactions are summarized through introducing the PI3K/AKT/mTOR signaling pathways and their roles in renal cell carcinoma. It has been shown that everolimus alone has poor efficacy in first-line treatment, supporting the strategy mentioned in renal cell carcinoma treatment guidelines that everolimus can be used in second-line treatment after unsuccessful treatment with anti-angiogenic tyrosine kinase inhibitors. First-line treatment with everolimus plus other drugs requires further investigation. Everolimus has generally good tolerance, but the problem of high rate of grade 3-4 adverse reactions still needs to be solved.

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    Brief original article
    Analysis of pulmonary function in patients with severe obstructive sleep apnea-hypopnea syndrome
    TANG Zhi-jun, WEI Zhong-hui, WU Yong-de, WEN Fei, TIAN Chuan
    2016, 36 (12):  1817. 
    doi: 10.3969/j.issn.1674-8115.2016.12.028

    Abstract ( 646 )   PDF (3921KB) ( 859 )  

    Objective · To investigate the changes in pulmonary function for patients with severe obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods · Snoring patients who reached severe OSAHS by whole night polysomnogram (PSG) monitoring were enrolled and volunteers with normal PSG results were selected as controls. Both groups underwent pulmonary function tests. Research indexes included FVC, FEV1, FEV1/FVC, ratio of TLC measured value to predicted value, ratio of PEF50 measured value to predicted value, ratio of MMEF measured value to predicted value, ratio of R5 measured value to predicted value, and ratio of DLCO measured value to predicted value. The differences in indexes between two groups were compared. Results · The differences in FVC, FEV1, FEV1/FVC, ratio of TLC measured value to predicted value, ratio of DLCO measured value to predicted value, and ratio of R5 measured value to predicted value were not statistically significant. The differences in ratio of MMEF measured value to predicted value (P=0.036) and ratio of PEF50 measured value to predicted value (P=0.043) were statistically significant. Conclusion · Early pulmonary function damage in patients with severe OSAHS is mainly small airway disease. Small airway function should be monitored to avoid further aggravation of pulmonary function.

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    Case report
    Interventional therapy for pulsatile tinnitus caused by sigmoid sinus diverticulum: a case report
    PENG Jia-li, ZHAO Rong, LI Ge-fei, WU Yi-lan, SHI Yan-hui, LIU Yi-Sheng, ZHAO Ying, YAO Qian, ZHANG Qi-ting, WANG Shuo, FANG Jie, PAN Hui,
    2016, 36 (12):  1820. 
    doi: 10.3969/j.issn.1674-8115.2016.12.029

    Abstract ( 2412 )   PDF (5096KB) ( 2074 )  

    Sigmoid sinus diverticulum is one of important reasons for causing pulsatile tinnitus. Although the incidence of pulsatile tinnitus caused by sigmoid sinus diverticulum is low, it can lead to serious symptoms requiring diagnosis and treatment in time. This reported patient developed continuous and pulsatile tinnitus at left side without any precipitating factors. The tinnitus was blowy-like with the same rate as heartbeat and disappeared when pressing the left jugular vein, which were typical symptoms of venous pulsatile tinnitus. The cerebral angiography suggested that there was a big and complex sigmoid sinus diverticulum at left side. The patient’s tinnitus symptom was improved remarkably after undergoing the endovascular interventional treatment with coil embolization. It indicated that interventional therapy can provide a new option for the treatment of venous sinus origin pulsatile tinnitus.

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