Evaluation of fetal cardiac functions in the setting of maternal diabetes: Application of the global spherical index, global strain and fractional area change by the speckle tracking technique.

OBJECTIVE: To evaluate ventricular contractility and profile heart deformations in fetuses of hyperglycemic mothers using the Speckle tracking imaging (STI). The fractional area change (FAC), global longitudinal strain (GLS) and global sphericity index (GSI) of the 4-chamber view (4-CV) were computed. STUDY DESIGN: Dynamic 4-CV images of 60 fetuses exposed to maternal diabetes (MD) and 60 controls were retrospectively collected between 19 and 37 weeks of gestation. Speckle-tracking analysis was used to compute and compare GSI, GLS and FAC of the right ventricle (RV) and the left ventricle (LV) between the groups. By definition, GSI was the ratio of the epicardial basal-apical length in end-diastole (BAL) to the overall transverse length of RV and LV in end-diastole (TL). The FAC was calculated by dividing the difference between end-diastolic area and end-systolic area by the end-diastolic area. Similarly, the GLS of the RV and LV was obtained by dividing the difference between the endocardial length in end-systole and endocardial length in end-diastole to the endocardial length in end-diastole. Data for conventional echocardiographic parameters, standard biological measurements of fetus and maternal baseline characteristics were also recorded and compared between the groups. Linear regression analysis was performed to assess the association between age, BMI and the inter-ventricular septum thickness (IVST). RESULTS: Gestational age at the time of examination did not differ significantly between the control and gestational diabetes group (p = 0.74). In fetuses exposed to MD, the thickness of the IVS was higher while the FAC of RV, GLS of RV and the GSI were all significantly lower. The FAC and global strain of LV generally decreased with progress in gestation but the difference between the two groups was not statistically significant. Conventional echocardiography in fetuses exposed to MD revealed a lower mitral E/A ratio and a larger myocardial performance index (MPI) of the RV and LV. Although the annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE) and septal annular plane systolic excursion (SAPSE) were also lower in this group, the difference was not statistically significant compared to fetuses of the control group. No regression relationship between age, BMI and IVST were noticed in any group. CONCLUSION: This study found that diastolic dysfunction among fetuses of gestational diabetic mothers is accompanied by global cardiac deformation and functional decrease of the RV in systole in the second and third trimester. The GSI, global strain and FAC acquired by SRI can be used as convenient and reliable quantitative parameters in the assessment of cardiac function in fetuses exposed to gestational diabetes.

ATAS Acupuncture Reduces Chemotherapy Induced Fatigue in Breast Cancer Through Regulating ADROA1 Expression: A Randomized Sham-Controlled Pilot Trial.

OBJECTIVE: To investigate the feasibility and effectiveness of ATAS acupuncture (Acupoints-Time-Space Acupuncture) as a non-pharmacological intervention to prevent or relieve chemotherapy-induced fatigue in breast cancer patients undergoing taxane chemotherapy. METHODS: A pilot study in Kunming center with the aim of evaluating 40 patients randomized to 3 groups: ATAS, sham and non-acupuncture with an unequal randomization of 2:1:1. Participants with stage I-III breast cancer were scheduled to receive adjuvant EC4P4 chemotherapy. Participants in the ATAS and sham acupuncture arms received 20 sessions of acupuncture over 20 weeks, non-acupuncture arm received usual care. Evaluation scales, including VAS-F, MFI-20, HDAS, ISI, and blood samples were collected at four timepoints (T1-T4). mRNA sequencing was performed to detect the mechanism of acupuncture. RESULTS: A total of 581 sessions of acupuncture were performed on patients in the acupuncture group. There was no difference between the three groups in terms of clinical characteristics. Patients randomized to ATAS acupuncture had improved symptoms including fatigue, anxiety and insomnia during the whole process of chemotherapy compared with the other two groups. The VAS-F score of ATAS acupuncture group was decreased compared with non-acupuncture group (P=0.004). The score of MFI-20 in ATAS acupuncture group was kept at low level, while the other two groups' scores kept climbing during chemotherapy (P=0.016; P=0.028, respectively). The mechanism of ATAS acupuncture which reduced fatigue and depression may be related to ADROA1, by regulating cGMP/PKG pathway. CONCLUSION: This pilot study has demonstrated that ATAS acupuncture can significantly reduce fatigue induced by chemotherapy. TRIAL REGISTRATION: Chinese Clinical Trials Registry, ChiCTR-IPR-17,013,652, registered Dec 3, 2017. http://www.chictr.org.cn/. PROTOCOL VERSION: Version 3.2 dated from 2018/04/20.

[Analysis of normal tissues adjacent to the tumour-specific expressed genes in breast cancer].

Normal tissues adjacent to the tumour (NAT) are widely used as controls in comparative studies to search for cancer-associated genes. However, the gene expression profiles between NAT and non-tumour-bearing tissues are different. The presence of NAT-specific expressed genes often hinders traditional transcriptional profiles studies. Further, studies on the differences in gene expression profiles between NAT and tumour-free tissues are infrequently performed. In this study, we sequenced and analysed the transcriptomes of tumour tissues (T), matched NAT and contralateral breast normal tissues (CBN) of 14 breast cancer patients, and identified 102 differentially expressed genes (DEGs) between CBN and NAT. Gene enrichment and protein-protein interaction (PPI) analyses revealed that these DEGs are significantly enriched in TNF (tumour necrosis factor) signalling and EMT (epithelial-mesenchymal transition) gene sets closely associated with oncogenesis. Comparative analyses of the transcriptomic profiles between NAT and CBN, NAT and T identified 23 NAT-specific highly-expressed genes, namely tumour-adjacent speci?cally activated (TASA) genes. These genes were significantly enriched in TNF signalling gene set, and 15 of which have not been previously reported. The results indicate that TASA genes are common in adjacent tissues and are related to the TNF signalling in the immune system. The tumour-adjacent tissues harbour tumour-like expressed genes that could contribute to tumour initiation but are often missed in NAT-T pair-wise studies.

Genome-wide analysis of the three-way interplay among gene expression, estrogen receptor expression and chemotherapeutic sensitivity in breast cancer.

The expression of estrogen receptor α (ER) in breast cancers may be indicative of a favorable prognosis and most of these cancers respond to anti-estrogens or aromatase inhibitors. However, ER-positive (ER+) breast cancers receiving anti-hormone and/or chemotherapy sometimes lose their ER expression, which leads to the evolution of the disease to higher aggressiveness and drug resistance. In the present study, an ER-modified signature (EMS) was developed from the expression profile of a chemoresistant MCF-7 breast cancer cell line that lost ER expression during long-term treatment with a chemotherapeutic agent. The EMS could discriminate the ER-negative (ER-) breast cancer cells from the ER+ ones, which included seven pathways essential for the ER- cell development. Furthermore, the EMS indicated a more malignant subgroup of the ER- cells by discriminating the chemoresistant ER- cells from the chemosensitive ones. In addition, the classified chemoresistant ER- patients demonstrated worse prognosis. In conclusion, we developed a new method to discriminate subgroups of ER- breast cancer cells.

Genome-wide profiling of long non-coding RNA expression patterns in anthracycline-resistant breast cancer cells.

Long non-coding RNAs (lncRNAs) are involved in cancer progression. In the present study, we analyzed the lncRNA profiles in adriamycin-resistant and -sensitive breast cancer cells and found a group of dysregulated lncRNAs in the adriamycin-resistant cells. Expression of the dysregulated lncRNAs was correlated with dysregulated mRNAs, and these were enriched in GO and KEGG pathways associated with cancer progression and chemoresistance development. Among these lncRNA-mRNA interactions, some lncRNAs may cis­regulate neighboring protein-coding genes and be involved in chemoresistance. We then validated that the lncRNA NONHSAT028712 regulated nearby CDK2 and interfered with the cell cycle and chemoresistance. Furthermore, we identified another group of lncRNAs that trans-regulated genes by interacting with different transcription factors. For example, NONHSAT057282 and NONHSAG023333 modulated chemoresistance and most likely interacted with the transcription factors ELF1 and E2F1, respectively. In conclusion, in the present study, we report for the first time the lncRNA expression patterns in adriamycin-resistant breast cancer cells, and provide a group of novel lncRNA targets that mediate chemoresistance development in both cis- and trans-action modes.

A new agent developed by biotransformation of polyphyllin VII inhibits chemoresistance in breast cancer.

Biotransformation by the endophytes of certain plants changes various compounds, and this 'green' chemistry becomes increasingly important for finding new products with pharmacological activity. In this study, polyphyllin VII (PPL7) was biotransformed by endophytes from the medicinal plant Paris polyphylla Smith, var. yunnanensis. This produced a new compound, ZH-2, with pharmacological activity in vitro and in vivo. ZH-2 was more potent than PPL7 in selectively killing more chemoresistant than chemosensitive breast cancer cells. ZH-2 also re-sensitized chemoresistant breast cancer cells, as evidenced by the improved anti-cancer activity of commonly-used chemotherapeutic agent in vitro, in vivo, and in clinical samples. This anti-chemoresistance effect of ZH-2 was associated with inhibiting the epithelial-mesenchymal transition (EMT) pathway. Taken together, our findings are the first one to link biotransformation with a biomedicine. The results provide insights into developing new pharmacologically-active agents via biotransformation by endophytes.

Surveillance of antimalarial drug resistance in China in the 1980s-1990s.

Since the successful preparation of the microplates and the medium for field application, the resistance degree and its geographical distribution of chloroquine-resistant Plasmodium falciparum, the fluctuation of the resistance degree of P. falciparum to chloroquine, and the sensitivity of the parasite to commonly used antimalarial drugs were investigated between 1980 and 2003 by the in vitro microtest and the in vivo four-week test recommended by the World Health Organization (WHO). The results indicated that chloroquine-resistant falciparum malaria was present in all eight provinces/autonomous regions endemic for falciparum malaria in China, and the resistance was high and widely distributed in the Hainan and Yunnan provinces. When the use of chloroquine was stopped or administered in a decreased quanity, the drug resistance gradually decreased. In Hainan and Yunnan, P. falciparum was still highly resistant to chloroquine, amodiaquine and piperaquine, and sensitive to pyronaridine and artemisinin derivatives, but the sensitivity was gradually reduced. Based on these results, principles and therapeutic regimens for antimalarial drug use in China were formulated, the use of the antimalarials which had already developed resistance was stopped or reduced, and recommendations to use artemisinin derivatives or compound pyronaridine to promote a rational use of antimalarials and strengthen malaria control were made. The results showed that malaria incidence had declined, and endemic areas of falciparum malaria have been gradually reducing since the mid-1980s.

A novel MYB transcription factor, GmMYBJ1, from soybean confers drought and cold tolerance in Arabidopsis thaliana.

MYB transcription factors play important roles in the regulation of plant growth, developmental metabolism and stress responses. In this study, a new MYB transcription factor gene, GmMYBJ1, was isolated from soybean [Glycine max (L.)]. The GmMYBJ1 cDNA is 1296bp in length with an open reading frame (ORF) of 816 bp encoding for 271 amino acids. The amino acid sequence displays similarities to the typical R2R3 MYB proteins reported in other plants. Transient expression analysis using the GmMYBJ1-GFP fusion gene in onion epidermal cells revealed that the GmMYBJ1 protein is targeted to the nucleus. Quantitative RT-PCR analysis demonstrated that GmMYBJ1 expression was induced by abiotic stresses, such as drought, cold, salt and exogenous abscisic acid (ABA). Compared to wild-type (WT) plants, transgenic Arabidopsis overexpressing GmMYBJ1 exhibited an enhanced tolerance to drought and cold stresses. These results indicate that GmMYBJ1 has the potential to be utilized in transgenic breeding lines to improve abiotic stress tolerance.

Tetra-aqua-bis(1,10-phenanthroline)bis-[µ(2)-1H-pyrazole-3,5-dicarboxyl-ato(3-)]tricopper(II) dihydrate.

The title compound, [Cu(3)(C(5)HN(2)O(4))(2)(C(12)H(8)N(2))(2)(H(2)O)(4)]·2H(2)O, is a trinuclear copper(II) complex in which two centrosymmetrically related pyrazole-3,5-dicarboxyl-ate(3-) and 1,10-phenanthroline ligands bind three Cu(II) atoms, with one Cu(II) atom located on a center of symmetry. In each complex, there are four coordinated water mol-ecules and two solvent water mol-ecules, which participate in extensive hydrogen-bond patterns. These inter-actions, as well as π-π inter-actions between neighbouring 1,10-phenanthroline ligands [shortest atom-to-atom distance = 3.363 (3) Å], extend the crystal structure into a three-dimensional supra-molecular network.

Octa-aqua-bis(µ(2)-1H-pyrazole-3,5-di-carboxyl-ato)tricopper(II) tetra-hydrate.

In the trinucler Cu(II) complex mol-ecule of the title compound, [Cu(3)(C(5)HN(2)O(4))(2)(H(2)O)(8)]·4H(2)O, the central Cu(II) atom is located on an inversion centre and is coordinated in a distorted octa-hedral geometry. The equatorial sites are occupied by two N and two O atoms from two pyrazole-3,5-dicarboxyl-ate ligands and the axial positions are occupied by two water mol-ecules. The two other symmetry-related Cu(II) atoms are penta-coordinated and assume a square-pyramidal geometry. In the crystal structure, coordinated and uncoordinated water mol-ecules and carboxyl-ate O atoms are linked by O-H⋯O hydrogen bonds.

The functional roles of lipid rafts in T cell activation, immune diseases and HIV infection and prevention.

The first appearance of lipid rafts, or lipid rafts-like structure, was occasionally observed by cryo-electronic microscopy in 1980s as cavity, such as caveolae. However, the fully understanding of lipid raft was attributed by the studies of T cell activation, virus entry/budding, and other membrane events. During the interaction of T cell and antigen presenting cell, a highly organized structure is formed at the interface of the two cells, where cholesterol and sphingolipids are enriched, and form a liquid ordered phase that facilitates the signaling proteins on and off. Lipid rafts are also involved in virus entry and assembly. In this review, we will discuss cholesterol-sphingolipid floating microdomain, the lipid raft as a unique compartment of the plasma membrane, with biological functions that ensure correct intracellular traffic of proteins and lipids, such as protein-protein interactions by concentrating certain proteins in these microdomains, while excluding others. We also discuss the disruption of lipid rafts is related to different diseases and aging, and we especially exploit the lipid rafts as pharmaceutical targets for anti-virus and anti-inflammation, particularly a new approach to control HIV infection for AIDS prevention and protection by inhibition or disruption of lipid rafts.

Screening method for nonsteroidal antiinflammatory drugs based on the cyclooxygenase 2 pathway activated by serum-free stimulation in A549 cells.

Cyclooxygenase 2 (COX-2) pathway inhibitors were regarded as promising nonsteroidal antiinflammatory drugs (NSAIDs). We discovered that the COX-2 pathway in A549 cells, a human lung cancer cell line, was activated by serum-free stimulation, and a drug screening model for NSAIDs was established based on this principle with simple performance and sufficient reliability. The COX-2 pathway was activated by treating with serum-free medium for 12 h. The activated cells were incubated with NS398 (selective COX-2 inhibitor), SC560 (selective COX-1 inhibitor), acetyl salicylic acid (ASA) (nonselective COX inhibitor) at 37 degrees C for 15 min. Then the cells were incubated with 10 microM of arachidonic acid (AA) for another 30 min prostaglandin E2 and 6-keto-prostaglandin F(1alpha) were assayed in an enzyme immunoassay (EIA). The results showed that the COX-2 pathway was dominant in A549 cells whether activated by serum-free medium or not, and the COX-1 pathway could be ignored. The model accepted the positive inhibition threshold as NS398 2 microM; if a compound (10 microM) inhibited COX-2 pathway more than NS398 (2 microM), it was regarded as a hit. The COX-2 pathway inhibition experiment showed that the Z;-factor of the screening model was 0.62, which suggests that the model is suitable for COX-2 pathway inhibitor screening.

[Establishment of in vitro microtest for determining sensitivity of Plasmodium falciparum to pyronaridine].

OBJECTIVE: To establish an in vitro microtest for determining the sensitivity of Plasmodium falciparum to pyronaridine. METHODS: Pyronaridine-coated plate and culture medium which is easy to use in the field were prepared. P. falciparum parasites from in vitro continuous passage culture (FCC1/HN) were used for experimental tests in the laboratory. When they were proved stable and reliable through repeated determinations, field trials were made in Hainan and Yunnan Provinces during the malaria transmission season with blood samples from clinical falciparum malaria cases. A 4-week in vivo test was carried out as a control. RESULTS: The pyronaridine-coated plate and culture medium were proved to be stable. The effective period of pyronaridine-coated plate, the ampule sealed liquid culture medium and the bottled lyophilized culture medium, all stored at 4 degrees C was 6 months, 2 months and 2 years respectively. Through several years field determinations, the baseline data of pyronaridine-sensitivity of P. falciparum in the country were collected and the sensitivity of P. falciparum to pyronaridine was also revealed to have decreased gradually. The mean drug concentration for in vitro complete inhibition of schizont formation raised by 2-4 times although the clinical therapeutic efficacy of pyronaridine was still satisfactory at the present time. CONCLUSION: The developed in vitro microtest can be used for determination of the sensitivity of P. falciparum to pyronaridine, and it is more convenient and sensitive than the 4-week in vivo method.

Chemical characterization of fine particles from on-road vehicles in the Wutong tunnel in Shenzhen, China.

Vehicle populations in China have been increasing sharply since 1990s. Vehicle emissions including various gaseous pollutants and particulate matter cause deterioration of air quality. However, measurements of particulate mater from on-road vehicles in China are scarcely reported, and thus the chemical compositions of particles emitted from vehicles in China are unknown. In this research, tunnel experiments were performed to measure PM2.5 in the Wutong tunnel, Shenzhen, China. Detailed PM2.5 chemical compositions, with organic compounds determined by GC/MS, in the tunnel were presented. Elemental carbon and organic matter composed 63% and 34% of the total PM2.5 mass in the Wutong tunnel, respectively. Alkanes, PAHs, hopanes, fatty acids, and dicarboxylic acids were the major identified organic compounds, and their source profiles in the PM2.5 in the Wutong tunnel were characterized. The comparisons of our measurements with those in the literature were also made to demonstrate the characteristics of the vehicle source profiles in the Wutong tunnel. The experimental results in this paper can improve understanding of particulate matter emitted from vehicles in China.

[Clinical study on the rotational deformity after interlocking nailing in femur shaft fracture].

OBJECTIVE: To explore the approach to accurately judge the degree of rotational deformity in femur shaft fracture. METHODS: 110 patients with femur shaft fracture were divided into 3 groups: Group A (n = 62) with the distal end of the fractured femur at the traumatic side at neutral position so as to fix the fracture, Group B (n = 27), with both the distal and proximal ends of the fractured femur at the neutral position so as to fix the femur at an antiversion angle of 15 degrees d, and Group C (n = 21), with the degree of antiversion angle to be controlled to that on the intact side. X ray examination and CT scanning were conducted 3 days after intramedullary nailing to measure the degree of the antiversion angle on both sides. The difference between the degrees of antiversion angle at the 2 sides was considered the rotational deformity of the femur shaft after the nailing. The antiversion angles of the femurs at both sides of 11 healthy persons were measured as controls. RESULTS: The biggest value of antiversion angle was 26 degrees , the smallest value was 8 degrees , the average value at the left side was 12.8 degrees , and the average value at the right side was 12.45, and the biggest difference between the 2 side was 7 degrees in the control group. The average antiversion angle of the femur was 14.67 degrees , the biggest value was 51 degrees , and the smallest value was -24 degrees at the traumatic side; and the average antiversion angle of the femur was 14.27 degrees , the biggest value was 40 degrees , and the smallest value was -23 degrees at the intact side in the treatment groups. 53% and 52% of the patients in Groups A and B showed a rotational deformity < 10 degrees , and 9% and 11% of them showed a rotational deformity > 20 degrees , significantly different from those in the control group (all P < 0.05). The rotational deformity was < 10 degrees in all patients of Group C, not significantly different from that of the control group (P > 0.05). CONCLUSION: Clinically about half of the femur shaft fractures are fixed in the position of rotational deformity > 10 degrees after nailing. The rotational deformity of femur shaft fracture should be prevented by comparing the antiversion angle on the intact side so as to achieve more reliable adequate reduction.

[The point mutations in Pfcrt and Pfmdr1 genes in Plasmodium falciparum isolated from Hainan Province].

OBJECTIVE: To evaluate the point mutations in Pfcrt and Pfmdr1 genes in Plasmodium falciparum isolated from Hainan Province. METHODS: Nested polymerase chain reaction and restriction fragment length polymorphism were used to detect the point mutations at codon 76 of Pfcrt and at codon 86, 1246 of Pfmdr1 in P. falciparum isolates. Chloroquine resistance was measured by the in vitro microtest recommended by WHO. RESULTS: In 36 samples tested, 28 were successfully amplified for Pfcrt, 64.3% of them carried mutant allele at codon 76, 21.4% with wild allele K76 and 14.3% with mixed allele mutation. While for Pfmdr1, 3.4% isolates displayed the 86Y mutation, 89.7% with wild allele N86 and 6.9% with the mixed alleles in 29 isolates which were amplified successfully for N86Y. No point mutation in Pfmdr1 at codon 1246 was found in 13 isolates from the total 36 samples. By the in vitro test, 72.2% (26/36) showed resistance to chloroquine. The 76T and 86Y mutant alleles were present in both in vitro susceptible and resistant isolates. There was a significant difference between susceptible and resistant isolates carrying 76T mutant codon (P < 0.05), but no significant difference was found in Pfmdr1 (P < 0.05). CONCLUSION: There is a significant difference of the 76T prevalence in Pfcrt gene between the susceptible isolate and resistant one of P. falciparum to chloroquine in vitro. The Pfcrt 76T may be used as a predictive marker for chloroquine resistance surveillance.

[Fluctuation in the resistance of Plasmodium falciparum to chloroquine in China].

OBJECTIVE: To investigate whether chloroquine-resistance of Plasmodium falciparum had changed after stopping or reducing the use of chloroquine as an antimalarial in Hainan and Yunnan provinces. METHODS: WHO standard in vitro microtest and 4-week in vivo test were used, assays were carried out in different time after stopping or reducing the use of chloroquine. RESULTS: In vitro test in Hainan indicated that the rate of chloroquine-resistant P. falciparum was 97.9% in 1981, and dropped to 26.7% in 1997 (P<0.01). The mean concentration of chloroquine for complete inhibition of schizont formation was 10.46 +/- 7.14 pmol/microl blood in 1981, decreased to 1.63 +/- 1.47 pmol/microl blood in 1997 (P<0.01). The proportion of samples taken from malaria cases that required high concentration (>6.4 pmol/microl blood) of chloroquine for complete inhibition of schizont formation was 83.3% in 1981 and only 6.7% in 1997 (P<0.01). In the 4-week in vivo test, the rate of chloroquine-resistant P. falciparum decreased from 84.2% in 1981 to 18.4% in 1997 (P<0.01). RIII cases accounted for 53.1% of the total resistant cases in 1981, and for 14.3% in 1997 (P<0.01). In vitro test in Yunnan revealed that the rate of chloroquine-resistant P. falciparum, the mean concentration of chloroquine for complete inhibition of schizont formation and the proportion of samples taken from malaria cases that required >6.4 pmol/microl blood of chloroquine for complete inhibition of schizont formation were 97.4%, 17.2 +/- 12.6 pmol/microl blood and 58.9% in 1981 respectively, and dropped to 70.4% (P< 0.01), 4.0 +/- 3.3 pmol/microl blood (P<0.01) and 16.6% (P<0.01) in 2002 respectively. CONCLUSION: The resistance of P. falciparum to chloroquine declined progressively after its use had been stopped or reduced in Hainan and Yunnan provinces.

[Research on the expression of some immune markers after reamed and unreamed femoral nailing].

OBJECTIVE: To investigate on the expression of some cytokines and other immunity makers right after the operation, the effect of femoral nailing on systemic immunity and sought to differentiate any differences between reamed and unreamed IMN. METHODS: Fifty-nine patients presenting with acute femoral fractured including 55 male and 4 female, 32.1 years old on average, are divided into 2 group depend on ISS. All patients were treated by close reduction and intramedullary nail for fixation. In group 1, 23 reamed and 23 unreamed; in group 2, 7 reamed and 6 unreamed. Venous blood samples were taken at 24 hr pre-operationally, and 1 hr, 24 hr, 48 hr post operationally. Serum TNF, IL-6, IL-8, IL-10 were measured by enzyme-linked immunosorbent assay. CRP was measured by protein assay apparatus. We also collected venous samples from 22 healthy uninjured volunteers, which formed control group. RESULTS: All immune marks were elevated post operation, for IL-6, IL-8, IL-10, this elevation began at 1 hr after operation, reached to the peak at 24 hr, and then down but never to the normal at 48 hr. For TNF and CRP, the level were raised at 24 hr, and then fallen at 48 hr. All mediators were raised significantly above the control group (< 0.05). Between reamed and unreamed patients both in group 1 and group 2, Although there was a trend towards higher levels of TNF, IL-6, IL-8, IL-10 and CRP in RFN than in the URFN, no significant difference was found except that there was a greater release of serum IL-10 in RFN than in URFN at 24 hr post operation (P = 0.047). Two patients have become SIRS, but the markers have shown no significant difference with those that have no SIRS symptoms. CONCLUSIONS: To the patient not injured severely, using IMN for treatment will make the inflammatory mediators re-released on higher level than normal, which will be balanced by immunity itself soon, so IMN won't make any damage severely. And no significant difference were found between reamed and unreamed nail. But the changing of IL-10 show us that after IMN, especially the reamed nailing, the level of anti-inflammatory mediators will show the difference more apparently between RFN and URFN while the patient got injured more severely. Under this condition, the RFN will aggravate the restrain of immunity.

[Surgical treatment of shotgun injuries of the sciatic nerve].

OBJECTIVE: To explore the clinical characteristics and the effect of surgical therapy for shotgun injuries of the sciatic nerve. METHODS: From 1996 to 2000, 19 sciatic nerve injuries resulted from shotgun were observed. Among 19 cases of shotgun sciatic nerve wounds, the gluteal wound was in 2 cases, thigh wound in 15 cases, and knee wound in 2 cases. The firing distance was between 0.5-9 m. According to Shermen classification of shotgun injury, 4 cases belonged to type I injury, 11 cases type II, 4 cases type III. The time from injury to admission was between 2 months-14 months except 1 patient who underwent emergency operation 4 hours after injury, and 1 patient was treated with debridement and epineurial neurorrhaphy, 7 cases with nerve trunk grafting, 6 cases with nerve cable grafting, 4 cases with neurolysis, 1 case with arthrodesis of ankle. RESULTS: Nineteen cases were followed-up for 0.8-3.5 years (mean, 19 months). The excellent and good nerve functional recovery was found in 52.6% according to MCRR. CONCLUSIONS: Shotgun injuries of the sciatic nerve are very severe and complicated, and injuries in most patients were usually complicated by open fracture, vascular injury, soft-tissue loss and infection; the character of nerve injury was classified as 4-5 degree according to Sunderland Standard, nerve transfer is effective in the treatment of shotgun injuries of the sciatic nerve, but outcome is poor; the recovery of the sciatic nerve should be observed continually after injury; selecting correct initial treatment after injury, strict minimally invasive surgical procedure, physical therapy and reasonable preoperative and postoperative medication can improve the surgical results.