Objective To investigate the protective effect of salvianolic acid A (SAA) on permanent focal cerebral ischemia in rats and its possible mechanisms. Methods Fifty-four adult male Sprague-Daw ley rats w ere randomly divided into a sham operation group, a cerebral ischemia group, and a SAA group ( n =18 in each group). A model of permanent middle cerebral artery occlusion w as induced by the intraluminal suture method.At 0 h and 6 h after modeling, the rats of the SAA groups w ere intraperitonealy injected SAA (3 mg/kg). The other groups w ere injected equal volume of saline. At 24 h after modeling, the neurological deficit scores w ere performed. 2,3,5-Triphenyl tetrazolium chloride (TTC) staining w as used to detect cerebral infarction volume. TUNEL staining w as used to detect cel apoptosis. Both immunohistochemical staining and Western blotting w ere used to detect the expressions of Wnt3a, β-catenin, and phosphor-glycogen synthase-kinase-3β(p-GSK-3β) in the ischemic cortex. Results The neurological deficit scores show ed that no neurological deficits w ere observed in the sham operation group (score 0). The neurological deficit score in the SAA group (median and interquartile range) w as significantly low er than that in the cerebral ischemia group (3 [2-3] vs.4 [3-5]; Z = -2.679, P =0.007). No infarcts w ere observed in the sham operation group. The infarct volume in the SAA group w as reduced significantly compared w ith the cerebral ischemia group (79.038 ±10.665 mm 3 vs.212.702 ±8.029 mm 3; t = 24.525, P < 0.001). Very few positive cels w ere observed in the sham operation group. The numbers of TUNEL -positive cels in the SAA group and the cerebral ischemia group w ere 29.667 ±1.366/HP and 63.333 ±0.894/HP, respectively. The former w as significantly less than the latter ( t = 14.115, P < 0.001). Immunohistochemical staining show ed that the number of Wnt3a positive cels in the sham operation group, the cerebral ischemia group, and the SAA group w ere 35.500 ±2.572/HP, 18.056 ±3.765/HP, and 29.000 ±2.376/HP, respectively. There w ere significant differences among the 3 groups ( F = 115.972, P < 0.001), and those in the SAA group w ere significantly more than the cerebral ischemia group ( P < 0.01). The numbers of p-GSK-3βpositive cels in the sham operation group, the model group, and the SAA group w ere 7.944 ±2.127/HP, 37.444 ±3.434/HP, and 11.222 ±1.734/HP, respectively. There w ere significant differences among the three groups (F =730.580, P < 0.001), and those in the SAA group w ere significantly less than the cerebral ischemia group ( P < 0.01). The numbers of β-catenin positive cels in the sham operation group, the cerebral ischemia group, and the SAA group w ere 26.722 ±26.722/HP, 16.556 ±1.854/HP, and 21.333 ± 1.940/HP, respectively. There w ere also significant differences among the 3 groups ( F < 33.385, P <0.01), and those in the SAA group w ere significantly more than the cerebral ischemia group ( P < 0.01). Western blot analysis show ed that Wnt3a expression levels in the sham operated group, the cerebral ischemia group, and the SAA group w ere 1.000 ±0.190, 0.800 ±0.185, and 1.198 ±0.262, respectively. There w ere significant differences among 3 groups ( F = 9.621, P < 0.001), and those in the SAA group w ere significantly higher than the cerebral ischemia group ( P < 0.01). The p-GSK-3βexpression levels in the sham operation group, the cerebral ischemia group, and the SAA group w ere 0.650 ±0.150, 1.290 ± 0.250, and 1.190 ±0.250, respectively. There w ere also significant differences among the 3 groups ( F =19.668, P < 0.001), and those in the SAA group w ere significantly higher than the cerebral ischemia group (P <0.01). The β-catenin expression levels in the sham operation group, the cerebral ischemia group, and the SAA group w ere 1.200 ±0.210, 0.500 ±0.120, and 1.100 ±0.220, respectively. There w ere significant differences among the 3 groups ( F = 33.385, P < 0.001), and those in the SAA group w ere significantly higher than the cerebral ischemia group ( P < 0.01). Conclusions SAA has certain protective effect on permanent cerebral ischemia injury in rats. Its mechanism may be associated w ith the up -regulation of the expression of Wnt3a and β-catenin and the dow n-regulation of the expression of p-GSK-3β.

Objective To observe the sedative effects and analyze the cost-benefit of dexmedetomidine and midazolam for severe patients undergoing mechanical ventilation (MV) in intensive care unit (ICU). Methods A prospective randomized controlled trial was conducted. Eighty patients undergoing MV (24 hours < time of MV < 72 hours) with tracheal intubation and necessity of analgesic therapy in ICU from January 2014 to October 2014 in Affiliated Hospital of Guiyang Medical College were divided into midazolam group (39 cases) and dexmedetomidine group (41 cases) by random numerical table method. Both groups used intravenous continuous pump infusion of fentanyl 0.7 - 1.5μg·kg-1·h-1 as an analgesic therapy. The analgesic goal was critical care pain observation tool (COPT) score kept at 0 - 3, and the score was taken once per hour; when COPT score > 4, 0.5μg/kg fentanyl was added, when the analgesic goal was reached, the sedative treatment was given. In midazolam group, the patients received midazolam whose loading dose was 0.05 mg/kg intravenous injection (IV) in 2 minutes, followed by continuous IV pump infusion 0.03 - 0.30 mg·kg-1·h-1. In dexmedetomidine group, the patients received dexmedetomidine whose loading dose was slowly intravenous pump infusion of 0.5 - 1.0μg/kg, followed by continuous pump IV infusion of 0.2 - 0.7μg·kg-1·h-1; the sedation goal was richmond agitation-sedation scale (RASS) at 0 - 2, the score being taken once per hour, and as RASS > 0 point, the dosage of sedative was increased, and as RASS < -2, the dosage of sedative was reduced or discontinued. During the course of study, the heart rate (HR), blood pressure, the amount of sedative and analgesic used, duration of MV, extubation time, ICU stay time, total costs of sedative and fentanyl drugs, total ICU treatment costs and adverse reactions of patients were observed.Results Compared with midazolam group, the total amount of sedative used (mg/kg: 0.03±0.01 vs. 3.35±1.39), the dose of sedative used per hour (μg·kg-1·h-1: 0.66±0.13 vs. 59.78±19.44), the dose of fentanyl used (μg·kg-1·h-1: 0.40±0.21 vs. 0.57±0.26), the total costs of fentanyl used per hour (yuan: 1.41±0.86 vs. 2.00±0.84), the total costs in ICU per hour (yuan: 264.42±99.55 vs. 297.80±138.70) in dexmedetomidine group were significantly less (allP < 0.05); compared with midazolam group, the total costs of sedative in dexmedetomidine group was significantly higher (yuan: 8.97±5.05 vs. 7.78±4.22); the duration of MV [hours: 43.58 (39.83, 53.58) vs. 58.58 (46.17, 65.50)], extubation time [hours: 1.00 (1.67, 0.58) vs. 3.67 (2.00, 5.50)] and the time for staying in ICU [hours: 57.25 (47.33, 67.37) vs. 75.58 (64.67, 90.83)] were significantly shorter in dexmedetomidine group (allP < 0.05); the incidences of adverse reactions in dexmedetomidine group were significantly higher [hypotension: 29.27% (12/41) vs. 7.69% (3/39), bradycardia: 24.39% (10/41) vs. 5.13% (2/39), bothP < 0.05]; the incidence of delirium in dexmedetomidine group was lower [2.43% (1/41) vs. 15.38% (6/39),P < 0.05].Conclusion For ICU patients, dexmedetomidine is an ideal effective sedative, as it may shorten the duration of MV, the time for extubation, the period staying in ICU, reduce the dosage of analgesic used and the cost of treatment in ICU.

BACKGROUND:Functional recovery after joint arthroplasty is an important indicator to evaluate the effect and prognosis of total knee arthroplasty, and is affected by patients and many kinds of outside factors. OBJECTIVE:To investigate the influencing factors of functional recovery of knee in patients with knee osteoarthritis after total knee arthroplasty. METHODS:Clinical data of 76 osteoarthritis patients undergoing total knee arthroplasty in the Dongying People’s Hospital from August 2007 to August 2013 were retrospectively analyzed. Hospital for Special Surgery knee score, knee pain Visual Analogue Score, range of motion and posterior slop angle of tibial plateau were compared before and 6 months after surgery. Changes in anterior condylar offset were recorded before and after femoral prosthesis arthroplasty. SPSS 21.0 software was used to analyze the influential factors for Hospital for Special Surgery knee scores after arthroplasty. RESULTS AND CONCLUSION:(1) Hospital for Special Surgery knee score, knee pain Visual Analogue Score, and range of motion were significantly higher 6 months after arthroplasty than that before arthroplasty (P<0.05). (2) Pearson correlation analysis demonstrated that preoperative Hospital for Special Surgery knee score, preoperative knee pain Visual Analogue Score, preoperative range of motion, preoperative posterior slop angle of tibial plateau and preoperative and postoperative anterior condylar offset changes were positively correlated with postoperative Hospital for Special Surgery knee score (P<0.05). Body mass index and inversion deformity angle were negatively correlated with postoperative Hospital for Special Surgery knee score (P<0.05). (3) Multiple linear regression analysis showed body mass index was negatively correlated with postoperative Hospital for Special Surgery knee score (P<0.05). Preoperative Hospital for Special Surgery knee score, preoperative knee pain Visual Analogue Score and preoperative posterior slop angle of tibial plateau were positively correlated with postoperative Hospital for Special Surgery knee score (P<0.05). (4) These results indicated that total knee arthroplasty significantly improved knee joint function. Body mass index, preoperative Hospital for Special Surgery knee score, preoperative knee pain Visual Analogue Score, preoperative posterior slop angle of tibial plateau and preoperative and postoperative anterior condylar offset changes were correlated with the recovery of joint function after total knee arthroplasty.

Objective Assess the value of several biomarkers and disease severity scores for the prognostic assessment of sepsis.Methods The clinical data of adult patients, who met the diagnostic criteria for Sepsis-3 and admitted to the intensive care unit (ICU) of Affiliated Hospital of Guizhou Medical University from January 2015 to December 2016 were retrospectively analyzed. These patients were divided into survival group and death group. The levels of serum lactate (Lac), lactate clearance rate of 24 hours later (24 h LCR), procalcitonin (PCT), quick sequential organ failure assessment (qSOFA) score, SOFA score, simplified acute physiology score Ⅱ (SAPS Ⅱ), acute physiology and chronic health evaluation scoring system Ⅱ (APACHE Ⅱ) score were determined, and the receiver operating characteristic curve (ROC) were used to analyze the prognostic value of the indicators above.Results 110 of 152 sepsis patients survived, while the others died. Compared with survival group, serum Lac, PCT, SOFA score, qSOFA score, SAPS Ⅱ score, APACHE Ⅱ score of death group were increased, and 24 h LCR was decreased. SAPS Ⅱ[area under the ROC curve (AUC) = 0.877,P = 0.000, when threshold value was 41.50, sensitivity was 94.3%, specificity was 68.5%], 24 h LCR (AUC = 0.869,P = 0.000, when threshold value was 40.2%, sensitivity was 92.1%, specificity was 75.5%) and SOFA score (AUC = 0.815,P = 0.000, when threshold value was 7.60, sensitivity was 79.9%, specificity was 78.5%) showed better predictive value of sepsis. However, the predictive value of PCT (AUC = 0.759), Lac (AUC = 0.725), qSOFA (AUC = 0.701) and APACHE Ⅱ score (AUC = 0.680) were poorer (AUC = 0.6-0.8). For sepsis caused by abdominal cavity infection, the most accurate index was SOFA score (AUC = 0.889,P = 0.000, when threshold value was 9.50, sensitivity was 81.2%, specificity was 83.5%), and for sepsis caused by pneumonia, the most accurate index was PCT (AUC = 0.891,P = 0.001, when threshold value was 3.95 mg/L, sensitivity was 84.7%, specificity was 94.1%).Conclusion SOFA score and qSOFA score cannot take the place of traditional evaluation index for the evaluation of the prognosis of patients with sepsis.

Objective To investigate the effect of mild hypothermia preconditioning against ischemia/ reperfusion (I/R) injury of cultured primary cortical rats neurons,and to compare the protective effect of mild hypothermia only and with its combination with drugs.Methods Cortical neurons of neonatal Sprague-Dawley (SD) rat within 24 hours after birth were harvested and cultured in vitro.On the 3rd day,the cells were cultured in a medium containing 2.5 mg/L cytosine arabinoside to inhibit the growth of glial cells and fibroblast.Having cultured for 6 days they were randomly divided into blank control group,glutamate damaged group (cultured with 200 μmol/L glutamate for 0.5 hour after washing),mild hypothermia preconditioning group (cultured under 33.5 ℃ for 24 hours before injury induced by glutamate),mild hypothermia combining with edaravone preconditioning group,and the hypothermia combining with propofol preconditioning group (medium containing 100 μmol/L edaravone and 3 mg/L propofol).They were cultured under 33.5 ℃ for 24 hours before injury induced by glutamate.After 24 hours of culturing in various medium,apoptosis ratio was observed by flow cytometry.Cell surviving rate was determined with methylthiazolete trazolium (MTT),c-fos protein expression was assayed,and morphologic change of cells with hematoxylin-eosin (HE) staining under the microscope,and uhrastructure changes were observed after uranyl acetate and lead citrate staining under transmission electron microscope.Results The apoptosis ratio and c-fos protein in glutamate damaged group were significantly higher than those in blank control group [apoptosis ratio:(9.85 ± 0.76)％ vs.(0.94 ± 0.20)％,c-fos (ng/L):6.96 ± 0.75 vs.1.65 ± 0.59,both P＜0.01],the cell surviving rate was significantly lower than that in blank control group [(0.20 ± 0.02)％ vs.(0.97 ± 0.03)％,P＜0.01].Mild hypothermia preconditioning reversed surviving rate,apoptosis ratio and c-fos protein,and the effect of hypothermia combining with propofol preconditioning was obviously better [cell surviving rate:(0.80 ± 0.04)％ vs.(0.20 ± 0.02)％,apoptosis ratio:(2.26 ± 0.54)％ vs.(9.85 ± 0.76)％,c-fos (ng/L):2.98 ± 0.46 vs.6.96 ± 0.75,all P＜0.01].The morphology of cortical neurons in blank control group was normal.Most of the cells in glutamate damaged group showed bluish black cytoplasm with pyknic nuclei,with crimpled axons and of them were fractured,and cell number was obviously decreased.In each pre-conditional groups,decrease in cell number was unconspicuous,and only a few cells showed apoptosis.Under transmission electron microscope,it was found that cell membrane,mitochondria and rough endoplasmic reticulum were intact in blank control group,but with reduction in organelles,severely swollen mitochondria,even with formation of vacuole or pyknosis,serious dilation of rough endoplasmic reticulum,with loss of cristac with loss of vacuoles or pyknosis,and marked dilatation of intemal reticular endoplasm,and loss of cristac with vacuolation and chromatin were observed under electron microscope in glutamate damaged group.Compared with the glutamate damaged group,these pathologic changes were markedly alleviated in protected groups.Conclusions Mild hypothermia preconditioning can inhibit glutamate-induced injury to cortical neurons.The protective effect of mild hypothermia combined with propofol is better.

Objective To investigate the clinical effects of the pulse indicator continuous cardiac output (PiCCO) in goal-optimized fluid management on patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with respiratory failure.Methods A total of 71 AECOPD patients with respiratory failure who were hospitalized in department of Critical Care Medicine in our hospital were selected from October 2010 to September 2013.The PiCCOtechnology was applied to monitor intrathoracic blood volume index (ITBI) and extravascular lung water index (ELWI).We compared the relationship of ELWI with ITBI and oxygenation index,and a simple correlation analysis was used for statistical analysis.Results A significantly negative correlation was found between ELWl and oxygenation index (r=-0.743,P＜0.01).ELWI =14 ml/kg was defined as the cutoff value for the subgroup analysis.A negative correlation still was found between ELWI and oxygenation index in the subgroup with ELWI ＜ 14 ml/kg,but it had no significant difference (r=-0.533,P=0.080),while a significantly negative correlation was found in the subgroup with ELWI≥14 ml/kg (r=-0.961,P＜0.01).There was no significant correlation between ELWI and ITBI (r=0.477,P=0.072).ITBI=1 000 ml/m2 was defined as the cutoff value for the subgroup analysis.There is no significant correlation between ELWI and ITBI in the subgroup with ITBI＜1 000 ml/m2(r=0.338,P=0.116),but in the subgroup with ITBI≥1 000 ml/m2,a significantly positive correlation between ELWI and ITBI was found (r=0.677,P＜ 0.01).Conclusions The results suggest that when ELWI is higher than 14 ml/kg,ELWI becomes an important influencing factor for oxygenation,which can be decreased to improve oxygenation in patients with AECOPD,and when ITBI≥ 1 000 ml/m2,ITBI can be reduced by decreasing ELWI.PiCCO has an important clinical significance on a goal-optimized fluid management in AECOPD patients with respiratory failure.

Objective To evaluate the value of the RIFLE criteria of acute kidney injury (AKI) for predicting the incidence and prognosis in critically ill patients and to identify the risk factors associated with the outcomes of those patients.Methods All ICU patients admitted over three years and 6-month period were retrospectively studied at Subei People's Hospital.Based on RIFLE criteria,AKI patients were diagnosed and classified into four groups:NAKI (non-AKI),R (risk),I (injury),F (failure)groups.Results (1) AKI occurred in 404 of the 2472 patients (16.3％) during their ICU stay.The mean age of the patients was (61.4 ± 17.4) years.Infectious disease,pulmonary disease,neurological disease and trauma were the major cause of AKI.(2) Mortality in the ICU was much higher in patients with AKI than in patients without AKI (47.3％ vs.23.0％,P ＜ 0.05).The mortality rate was 35.6％ in R group,48.9％ in I group and 60.6％ in F group.(3) The logistic regression suggested that MODS and septic shock were the independent risk factors of AKI,but continuous renal replacement therapy (CRRT) are the independent protective factor of AKI.Conclusions In these ICU patients,AKI is associated with increased hospital mortality.The RIFLE classification is a simple and useful diagnosis tool to detect and stratify the severity of AKI and aid in predicting outcome of patients.

Objective To evaluate the role ofpleth variability index (PVI) by passive leg raising (PLR) test in volume responsiveness and volume status prediction in patients with septic shock.Methods A prospective randomized controlled trial (RCT) was conducted.Eighty-seven patients suffering from septic shock undergoing mechanical ventilation in Department of Critical Care Medicine of Subei People's Hospital from June 2012 to September 2014 were enrolled.The hemodynamic changes before and after PLR were monitored by pulse indicated continuous cardiac output (PiCCO) and PVI monitoring.Responsive group:positive fluid response was defined as an increase in cardiac index (CI) ≥ 10％ after PLR.Unresponsive group:negative fluid response was defined as an increase in CI ＜ 10％ after PLR.The hemodynamic parameters,including heart rate (HR),mean arterial pressure (MAP),central venous pressure (CVP),stroke volume variation (SVV),CI and PVI,and the changes in cardiac parameters (△ HR,△ MAP,△ CVP,△ SVV,△ CI,and △ PVI) before and after PLR were determined.The relations between hemodynamic parameters and their changes with △ CI were analyzed by the Pearson analysis.The role of the parameters for volume responsiveness prediction was evaluated by receiver operating characteristic (ROC) curves.Results 145 PLRs in 87 patients with septic shock were conducted,with 67 in responsive group and 78 in unresponsive group.There were no statistically significant differences in HR,MAP,CVP and CI before PLR between the responsive and unresponsive groups.SVV and PVI in responsive group were significantly higher than those in the unresponsive group [SVV:(16.9± 3.1)％ vs.(8.4±2.2) ％,t =9.078,P =0.031; PVI:(20.6±4.3)％ vs.(11.1 ±3.2)％,t =19.189,P =0.022].There were no statistically significant differences in HR,MAP,CVP,SVV,and PVI after PLR between the responsive group and unresponsive group.CI in the responsive group was significantly higher than that in the unresponsive group (mL·s-1·m-2:78.3±6.7 vs.60.0±8.3,t =2.902,P =0.025).There were no statistically significant differences in △HR,△MAP,△ CVP between responsive group and unresponsive group.△ SVV,△ CI and △ PVI in responsive group were significantly higher than those in the unresponsive group [△ SVV:(4.6 ± 1.5)％ vs.(1.8 ± 0.9)％,t =11.187,P =0.022;△ CI (mL·s-1·m-2):18.3 ± 1.7 vs.1.7 ± 0.5,t =3.696,P =0.014; △ PVI:(6.4 ± 1.1)％ vs.(1.3 ± 0.2)％,t =19.563,P =0.013].No significant correlation between HR,MAP or CVP before PLR and △ CI was found.SVV (r =0.850,P =0.015) and PVI (r =0.867,P =0.001) before PLR were correlated with △ CI.It was shown by ROC curve that the area under ROC curve (AUC) for SVV fluid responsiveness prediction was 0.948,and cut-off of SVV was 12.4％,the sensitivity was 85.4％,and specificity was 86.6％.The AUC for PVI fluid responsiveness prediction was 0.957,and cut-off was 14.8％,the sensitivity was 87.5％,and specificity was 84.8％.It was higher than other hemodynamic parameters (HR,MAP,CVP).Conclusions PVI and SVV can better predict fluid responsiveness in mechanically ventilating patients with septic shock after PLR.PVI as a new continuous,noninvasive and functional hemodynamic parameter has the same accuracy as SVV.

AIM:To evaluate the effect of microRNA-155(miRNA-155) on the regulation of angiogenesis in diabetic rats with cerebral ischemic injury .METHODS: Adult male Sprague-Dawley rats were randomly divided into 5 groups:sham group, cerebral ischemia group , diabetic cerebral ischemia group , diabetic cerebral ischemia +miRNA-155 inhibitors group and diabetic cerebral ischemia +scramble group .Diabetes model was made by injection of streptozocin and permanent cerebral ischemic model was developed by suture-occluded method .The scores of neurological deficit and infarct volume were estimated at 24 h after cerebral ischemia .miRNA-155 level was detected by real-time polymerase chain reaction.The expression of platelet endothelial cell adhesion molecule-1 ( PECAM-1/CD31 ) and vascular endothelial growth factor ( VEGF) was detected by Western blotting .RESULTS:miRNA-155 inhibitor significantly reduced miRNA-155 levels in the ischemic cortex (P<0.05), improved the scores of neurological deficit , reduced infarction size and up-regulated the levels of CD31 and VEGF (P<0.05).CONCLUSION:miRNA-155 has a critical role in the regulation of angiogenesis in diabetic rats with cerebral ischemia .Down-regulation of miRNA-155 using miRNA-155 inhibitor attenuates brain infarct injury in diabetic rats .

Objective To explore the correlations of extravascular lung water index (ELWI),oxygenation index and intrathoracic blood volume index (ITBI) in patients with acute exacerbation chronicobstructive pulmonary disease (AECOPD) and examine the significance of ELWI in fluid management.Methods A total of 63 hospitalized AECOPD patients with respiratory failure were recruited from our hospital from October 2010 to April 2013.Pulse indicator continuous cardiac output (PiCCO) technology was employed to monitor ITBI and ELWI.We compared the relationship of ELWI,ITBI and oxygenation index.And simple correlation analysis was used for statistical processing.Results Significant negative correlation existed in ELWI and oxygenation index (r =-0.741,P ＜ 0.01).ELWI 14 ml/kg was defined as a cutoff value for subgroup analysis.A negative correlation existed between ELWI and oxygenation index in the subgroup with ELWI ＜ 14 ml/kg,but there was no significant difference (r =-0.524,P =0.080) ; in the subgroup with ELWI ≥ 14 ml/kg,there was significant negative correlation (r =-0.952,P ＜ 0.01).No significant correlation existed between ELWI and ITBI (r =0.477,P =0.072).ITBI 1 000 ml/m2 was defined as a cutoff value for subgroup analysis.No significant difference existed in the subgroup with ITBI ＜ 1 000 ml/m2 (r =0.332,P =0.117).However,significant positive correlation existed in the subgroup with ITBI≥ 1 000 ml/m2 (r =0.677,P ＜ 0.01).Conclusion Excessive extravascular lung water is an important factor for acute exacerbation of COPD leading to respiratory failure.