Objective To study the effects of esmolol on fluid responsiveness and hemodynamic parameters in patients with septic shock.Methods A prospective self-control study was conducted.Fifteen septic shock patients undergoing mechanical ventilation admitted to Department of Critical Care Medicine of Yijishan Hospital from January 2015 to August 2015 were enrolled.All patients enrolled in this study were given the treatment based on American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) Consensus 2012.Esmolol was intravenously injected at a beginning rate of 6 mg·kg-1·h-1, and then the dose was adjusted to reduce heart rate by 10％ from baseline.The changes in hemodynamic and systemic oxygen metabolism indexes were monitored by pulse indicator continuous cardiac output (PiCCO) before and 2 hours after the esmolol administration, and the fluid responsiveness was evaluated by stroke volume variation (SVV).SVV ≥ 10％ was considered to be a positive fluid responsiveness.Results In 15 patients, 9 were male and 6 female, with an age of 65 ± 16.Among them 10 patients suffered from pulmonary infection, and 5 patients with abdominal infection.Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was 21 ±9;sequential organ failure score (SOFA) was 8 ±4.28-day mortality was 40.0％.SVV was significantly decreased after esmolol infusion as compared with baseline [(14 ± 5)％ vs.(17 ±7)％, t =2.400, P =0.031].Heart rate [HR (bpm): 100±4 vs.112±8, t =8.161, P =0.000], cardiac output [CO (L/min):6.13 ± 1.45 vs.7.88 ± 1.82, t =4.046, P =0.001], cardiac index [CI (mL·s-1·m-2): 51.51 ± 11.00 vs.66.18 ± 11.48, t =4.131, P =0.001], stroke volume index [SVI (mL/m2): 31.0 ± 6.4 vs.35.4 ± 6.5, t =2.577, P =0.020], the maximum rate of left ventricular pressure rise [dp/dt max (mmHg/s): 927±231 vs.1 194±294, t =3.775, P =0.002], global ejection fraction (GEF: 0.21 ±0.05 vs.0.24±0.06, t =3.091, P =0.008), cardiac function index (CFI: 5.03 ± 1.37 vs.6.59 ± 1.92, t =4.769, P =0.000) showed significant decrease during esmolol infusion.On the other hand, central venous pressure [CVP (mmHg, 1 mmHg =0.133 kPa): 9±3 vs.8±3, t =-3.617, P =0.003], diastolic blood pressure (DBP, mmHg: 69± 15 vs.66± 13, t =-2.656, P =0.019), systemic vascular resistance index (SVRI, kPa·s·L-1·m-2:206.8±69.8 vs.206.8±69.8, t =-3.255, P =0.006) were significantly increased during esmolol infusion.No significant difference was found in systolic blood pressure [SBP (mmHg): 120 ± 25 vs.123 ± 18, t =0.678, P =0.509],mean arterial pressure [MAP (mmHg): 86 ± 18 vs.85 ± 14, t =-0.693, P =0.500], global end diastolic volume index [GEDVI (mL/m2): 614 ± 84 vs.618 ± 64, t =0.218, P =0.830], extravascular lung water index [EVLWI (mL/kg):5.99±1.50 vs.5.73±1.14, t =-1.329, P =0.205], central venous oxygen saturation (ScvO2: 0.711±0.035 vs.0.704 ± 0.048, t =-0.298, P =0.773), arterial blood lactate [Lac (mmol/L): 3.1± 0.3 vs.3.0 ± 0.4, t =-0.997, P =0.345],and difference of central venous-arterial carbon dioxide partial pressure [Pcv-aCO2 (mmHg): 4.1 ± 0.9 vs.4.7 ± 0.5,t =1.445, P =0.182] as compared with those before esmolol treatment.Conclusion Heart rate control with esmolol infusion may reduce fluid responsiveness, cardiac function, heart rate and cardiac output without adverse effect on systemic perfusion in septic shock patients.

Training pathologist's ability of rapid intraoperative diagnosis of central nervous system tumors is of great importance to decide ranges of clinical operation and to promote pathological diagnosis level.Pathologist made frozen section,fully understood the clinical data and operation,mastered correct method of slice reading,learned comprehensive analysis,and exercised psychological quality thus to make rapid intraoperative diagnosis correctly.

Objective: To investigate the mental health status and its influencing factors among guardians of patients with severe mental disorders, so as to provide the evidences for improving mental health services among guardians. Methods: The first guardians of patients with severe mental disorders registered and managed in Zhujing Township, Jinshan District, Shanghai Municipality were enrolled. Participants' demographics, economic status, health status and relationships with patients were collected using self-designed questionnaires from January to June 2021. Participants' mental health was assessed with twelve-item General Health Questionnaire (GHQ-12), and factors affecting guardians' mental health were identified with a multivariable logistic regression model. Results: A total of 650 questionnaires were allocated, and 606 valid questionnaires were recovered, with an effective recovery rate of 93.23%. The participants included 356 men (58.75%), and had a mean age of (59.61±12.61) years. Among all participants, 256 were patients' spouse (42.24%), and 516 lived with patients (85.15%). The mean GHQ-12 score was (3.18±2.48), and there were 171 participants with mental health problems (28.22%). Multivariable logistic regression analysis identified educational level of junior high school and below (OR=2.715, 95%CI: 1.076-6.850), married (OR=0.374, 95%CI: 0.184-0.761), patients' parents (OR=0.303, 95%CI: 1.114-0.806), living with patients (OR=0.481, 95%CI: 0.237-0.974), having basic medical insurance for urban employees (OR=0.489, 95%CI: 0.254-0.942), receiving government subsidy (OR=3.788, 95%CI: 1.734-8.276), self-rated health status (good, OR=0.105, 95%CI: 0.037-0.299; average, OR=0.126, 95%CI: 0.049-0.325), considering that caring patients has an impact on family (OR=3.689, 95%CI: 1.807-7.531), being hopeful about the patient's future (OR=0.372, 95%CI: 0.139-0.994) and patients' need for accompanying/surrogate care (OR=1.606, 95%CI: 1.006-2.565) as factors affecting mental health among guardians of patients with severe mental disorders. Conclusion Mental health problems are found among 28.22% of guardians of patients with severe mental disorders, and the development of mental health problems is affected by educational level, economic status, health status and patient's need of caring.

Purpose To study the clinicopathological features of extraventricular neurocytoma. Methods 12 cases of extraventricular neurocytoma were retrospectively analyzed for their clinical information and histopathological features. Results The distribution of ex-traventricular neurocytoma was as follows: cerebral hemisphere (5 cases), right thalamus (2 cases), cerebellar vermis (2 cases), saddle area (2 cases), and spinal cord (1 case). The histological features were round uniform cells, round or oval nuclei, with peri-nuclear clearing commonly seen. Neuropil-like structure, ganglion cells or ganglion-like cells, perivascular rosettes, calcification, cap-illary wall thickening and hyaline degeneration and other pathological changes were also observed. All cases showed strong immunoreac-tivity for Syn. 7 cases exhibited Ki-67 labeling index of≤2%, and other 5 cases showed 3% ~8%. 3 cases were performed with fluo-rescence in situ hybridization ( FISH) to detect loss of chromosome 1p/19q, but no loss was detected. Postoperative follow-up for 4 months to 4 years showed one case had tumor recurrence and intracranial spread in postoperative 2 years. Conclusions Extraventricu-lar neurocytoma shares similar histological features with central neurocytoma, but often more complex. Ganglion cells or ganglion-like cells, calcification, capillary wall thickening and hyaline degeneration are more frequently seen, but neuropil-like structure is less seen. Extraventricular neurocytoma needs differential diagnoses from oligodendroglioma, ependymoma, dysembryoplastic neuroepitheli-al tumor and others. Immunohistochemistry and chromosome 1p/19q loss can help in the differential diagnosis. The treatment for ex-traventricular neurocytoma is grossly total resection, with post-operative radiotherapy for subtotal resection, atypical or recurrent cases.

OBJECTIVE To observe the neurotoxicity of 1-bromopropane(BP) and investigate the protective effects of edaravone(Edv) against BP-induced deficits of spatial learning and memory ability in rats by its anti-inflammatory mechanism. METHODS Adult male Wistar rats were ig given BP 800 mg·kg-1 to develop the model, followed by Edv 1, 3 and 5 mg·kg-1 ip treatment respectively 4 h later for consecutive 12 d. From the 7th day (d 7), all rats were subjected to the five-day place navigation in Morris water maze (MWM) to measure the escape latency and the total swimming distance. On d 6 of MWM, spatial probe test was performed and the crossing times of rats were recorded to evaluate the spatial memory ability. At the end of the behavioral experiment, four rats in each group were randomly selected and the frozen section of the whole brain was sliced for thionin staining and immunohisto?chemistry. The other eight sacrifced rat brains from each group were harvested for the determination of the tumor necrosis factor-α (TNF-α) and nitric oxide (NO) by ELISA and nitrate reductase method, respectively. RESULTS The results of MWM test showed that compared with control rats the escape latencies of rats in BP group were increased by 60.8%, 81.9%,124.0% and 323.3%, respectively, during the d 2-d 5 of MWM, and the total swimming distance increased by 47.0%, 66.4%, 106.0% and 277.6%, respectirely. All the differences between BP group and control group were significant (P<0.05, P<0.01). In the spatial probe trial, the crossing times of rats in BP group were significantly decreased, compared with the control rats (P<0.01). Morphologically, thionin staining and immunohistochemistry revealed significant microglia activation and neuron loss in the rat forebrains, accompanied by a 147.6% and 18.7% increase in NO and TNF-α levels in rats treated with BP respectively compared with control values (P<0.05, P<0.01). After co-treatment at different dosages of Edv with BP, the escape latencies of rats in BP+Edv 5 mg·kg-1 group were decreased by 38.4%and 44.3%(P<0.01), and the total swimming distance decreased 34.5%and 43.3%(P<0.05, P<0.01), respectively, compared with the BP treated rats on the d 4 and d 5 of MWM test. The microglia activation and neuron damage in the brain of rats induced by BP treatment were significantly alleviated in BP+Edv groups. In addition, the contents of NO and TNF-α were decreased in BP+Edv 1, 3 and 5 mg · kg-1 groups, with a decrease of 53.8%, 55.4% and 59.8% in NO, and 12.2%, 15.8% and 22.2% in TNF-α(P<0.05, P<0.01), respectively. CONCLUSION Edv could effectively protect against central neurotoxicity induced by BP via anti-neuro?inflammation.

BACKGROUND:Numerous diseases like cardiac hypertrophy and intervertebral disc degeneration are known to be implicated in the changes of mechanical stress acting on surrounding tissues or cells, and autophagy contributes to the pathogenesis of these diseases. OBJECTIVE:To review the effects of mechanical factors on autophagy in different tissues and the underlying molecular mechanisms, thereby providing references for the research of autophagy and the prevention and treatment of related diseases. METHODS:A search of Web of Science and PubMed databases was performed for the literatures addressing the effects of mechanical factors on autophagy using the English keywords ofautophagy, mechanicaland the articles were summarized systematically. Finally, 52 literatures were enrolled according to the inclusion and exclusion criteria. RESULTS AND CONCLUSION:Mechanical factors make great effects on autophagy of various cells, such as myocardial cells, endothelial cells, chondrocytes and skeletal muscle cells. Autophagy is a self-protective reaction, and the mechanical stress of physiological conditions induces autophagy to maintain cellhomeostasis, normal function and survival. The mechanism of autophagy induced by mechanical stress may involve PI3K-AKT-mTOR, oxygen free radical, AKT-FoxO and other pathways, and the definite mechanism needs to be further studied.

Aim To investigate the protective effects of echinacoside ( ECH ) on oxidative stress injury in vascular dementia rats. Methods Vascular dementia model was duplicated by means of permanent ligation of bilateral common carotid artery at two times intervals for three days. Biochemical methods was used to detect the GSH, NO, GSH-Px, NOS in each group rat’ s cor-tex and hippocampus. The change of the tissue struc-ture in CA1 area of hippocampus in each group was ob-served and analyzed by microscope after HE staining. Results Compared with sham group, the content of GSH and activity of GSH-Px in the rats of the model group were decreased significantly ( P<0. 01 ) , while the content of NO and activity of NOS were increased obviously (P<0. 05, P <0. 01). Meanwhile, in tis-sue structure of rat’ s hippocampal CA1 area, the num-bers of cells were reduced, cell arrangement was sparse and in disorder, cell form was not intact and cell struc-ture was not normal, cytoplasm, nucleus and cyto-plasm were blurry, nuclei were hyperchromatic and in contraction, and were changed to triangular or irregular shape, lacking nucleoli, and proliferation of glial cells appeared. Compared with the model group, the content of GSH and activity of GSH-Px in the rats of the treat-ment groups were increased significantly ( P<0. 05 , P<0 . 01 ) , while the activity of NOS was decreased ob-viously (P<0. 05, P<0. 01). Meanwhile, in rat tis-sue structure of hippocampal CA1 area, the rat cells in each treatment group were arranged in order, the form of structure was normal, the nuclei were less hyper-chromatic and contracted. Compared with Gal group and sham group, the rats of ECH high dosage group were not different in every part of experiment ( P >0. 05 ) . Conclusion ECH exerts protection on oxida-tive stress injury in vascular dementia rats.

Aim Tostudytheeffectsofechinacoside on striatal and hippocampus extracellular fluid of mono-amine neurotransmitter in Parkinsonˊs disease rat, and discuss the possible mechanism of the ECH effect on brainprotection.Methods Doublepointinjectionof 6-hydroxy dopamine damaged was adopted to make PD model, the corresponding drugs or normal saline were intraperitoneally injected for 4 consecutive weeks, mi-cro-dialysis program in double targets was taken after treatment, the dialysate was injected into HPLC-EDC, and striatal and hippocampus extracellular fluid of DA, DOPAC, HVA, NA, 5-HT levels of each group were measured. Results Compared with control group, striatal and hippocampus extracellular fluid of DA, DOPAC, HVA, NE, 5-HT levels were significantly re-duced in model group ( P <0. 01 ); compared with model group, striatal and hippocampus extracellular fluid of DA, DOPAC, HVA, NE, 5-HT levels were significantly increased in treatment group ( P <0 . 05 , P<0. 01 ) , and the content of five kinds of substances in ECH high dose group was similar to that in MD group.Conclusion ECHcouldincreaseextracellular monoamine neurotransmitters in striatum and hippo-campus, ECH has a therapeutic effect on PD, and echinacoside is possible mechanisms of the brain pro-tective effect of PD rats.

Aim To investigate the effects of echina-coside ( ECH ) on the learning and memory capacities and brain level of oxygen free radicals of rats with de-mentia induced by amyloid β-peptide. Methods Six-ty Sprague Dawley rats, weighing (300±10) g, were randomly divided with 10 rats pergroup into 6 groups:sham operated group, model, ECH high dose (40 mg ·kg-1·d-1), ECH middle dose (20 mg· kg-1· d-1), ECH low dose (10 mg·kg-1·d-1) and Hup A (Huperzine A, 0. 02 mg·kg-1·d-1) group. Mor-ris maze tests were conducted for evaluating the learn-ing and memory ability. Content of malondialdehyde (MDA), nitric oxide (NO) and activities of superox-ide dismutase ( SOD) and NO synthase ( NOS) in the hippocampus and cortex were detected. ResultsAβ25-35 induced significant learning and memory im-pairment in the rats. Compared with the rats in model group, those treated with ECH at different doses all manifested alleviation of learning and memory impair-ment ( P<0 . 01 , P<0 . 05 ) . Cotents of MDA of ECH treatment group were obviously decreased, while SOD activities were obviously increased, and significantly reduced the release of NO and NOS in the hippocam-pus and cortex brain tissue ( P <0 . 01 , P <0.05 ) . Conclusion ECH can enhance the learning and mem-ory ability in rats with AD, which is presumably relat-ed to accelerating the cleaning of oxygen free radicals and reducing oxidative stress in brain of AD rats.

Background and purpose:Neoadjuvant chemotherapy with docetaxel was gaining more attention in the treatment for locoregionally advanced nasopharyngeal carcinoma (NPC). The prediction of the sensitivity to neoadjuvant chemotherapy with docetaxel could enable clinicians to individualize treatment protocols for NPC. Recently we found that 99mTc-MIBI imaging in NPC could predict tumor response to chemotherapy with cisplatin plus 5-FU. However, there was no study to support similar findings in NPC patients receiving chemotherapy containing docetaxel. This study was to evaluate the value of double-phase 99mTc-MIBI SPECT/CT in predicting response to neoadjuvant chemotherapy with docetaxel-based regimen for nasopharyngeal carcinoma. Methods:Thirty-one nasopharyngeal carcinoma patients participated in this prospective study. Before treatment, early and delayed single-photon emission computed tomography/compute tomography (SPECT/CT) images were obtained instantly and 2 hours after an intravenous injection of 25-30 mCi 99mTc-MIBI. All patients received neoadjuvant chemotherapy consisting of docetaxel, cisplatin plus 5-FU for two cycles. The relationships between efficacy of neoadjuvant chemotherapy and the early uptake ratio, late uptake ratio and washout rate of 99mTc-MIBI were evaluated.Results:According to the MRI, the early uptake of 99mTc-MIBI (2.67±0.83) in the lesions which were sensitive to chemotherapy was significantly higher compared with that (1.69±0.46) in the insensitive lesions(P=0.003). The difference of the late uptake between the sensitive(1.46±0.39) and the insensitive (1.06±0.62) was also statistically significant (P=0.026). However, the washout rate of 99mTc-MIBI was not significantly different between the two groups (P=0.23). Through ROC curve analysis, the AUC for early uptake of 99mTc-MIBI and late uptake were 0.84. The sensitivity, specificity, positive predictive value and negative predictive value were 74.2%, 87.5%, 95.8%and 46.7%for early uptake when the cut off value of 1.97 was used. Conclusion:The uptake of 99mTc-MIBI in both early phase and late phase could predict the efficacy of neoadjuvant chemotherapy with docetaxel-based regimen.