Objective:To observe the effect of ginsenoside Rd pretreatment on the expressions of N-methyl-D-aspartate(NMDA)receptor subunit NR2 B protein and endonuclease G(EndoG)in basal ganglia region after cerebral focal ischemia-reperfusion in rats and to investigate possible mechanism of ginsenoside Rd in the treatment of ischemic stroke.Methods:A rat model of middle cerebral artery occlusion(MCAO)was induced by intraluminal filament method.The expressions of NR2B and EndoG in basal ganglia region for focal cerebral iSChemia 1 hour,and 1,6,24 and 72 hours reperfusion were detected by immunohistochemical staining and image analysis method.The effects of ginsenoside Rd on the expressions of FaxioG and NR2B and the volume of cerebral infarction were evaluated.Results:The positive expression of NR2B in basal ganglia region on the ischemic side in ischemia-reperfusion group was increased significantly.The expression of EndoG in the nucleus was notable;the positive expressions of NR2B and EndoG at different reperfusion time points in ginsenoside Rd pretreatment group were decreased significantly(P<0.05 or P<0.01),and the volume of cerebral infarction was reduced significantly(P<0.01).Conclusions:The expressions of NMDA receptor subunit NR2B protein and apoptosis-inducing factor EndoG were increased significantly after cerebral focal ischemia reperfusion;ginsenoside Rd pretreatment may significantly reduce the expressions of NR2B and EndoG.It reduces the volume of cerebral infarction by inhibiting excitatory neurotoxicity and blocking neuronal apoptosis,and thus plays a role in neuroprotection.

BACKGROUND:In rabbit femur fracture model experiment, there are a few studies on whether quadriceps tendon wil affect the stability of the fixed device. OBJECTIVE:To analyze the effects of quadriceps tendon to the stability of external fixator in rabbit models of femur fracture. METHODS:The 48 New Zealand white rabbits were randomly divided into two groups. External fixator was used to make fracture model. In the experiment group, quadriceps tendon was cut. In the control group, quadriceps tendon was retained. 2 weeks later, X-ray examination was utilized to observe the number of failed external fixator in both groups from modeling to success. RESULTS AND CONCLUSION:(1) X-ray examination:2 weeks after model establishment, external fixation frame screw was free from femur in one rabbit of the experiment group, and seven rabbits in the control group. Of them, one screw was broken. Threaded portion retained in the femur. (2) External fixation failure rate:failed external fixator was found in one rabbit in the experiment group, resulting in a failure rate of 4%, and 12 rabbits in the control group, resulting in a failure rate of 50%(P<0.05). These findings suggested that cutting off the rabbit quadriceps tendon can effectively ensure the stability of the external fixator, and indirectly improve success rate of the experiment.

Septic shock is one of the most serious diseases threatening the critically ill patients in Intensive Care Unit.How to improve the survival rate has now been most concerned and directed by critical care doctors.For that case,it is necessary to summarize and investigate the clinical cases about how to manage elderly patients with septic shock.

Objective To study hepatic blood flow exclusion for the resection of liver tumors involving hepatic hilar region. Methods The clinical data of 16 cases of liver tumors involving hepatic hilar region from January 2005 to March 2008 were retrospectively analyzed. Liver tumors were resected by the technique combining hepatic portal control ( Pringle's maneuver) and normothermie total hepatic vascular exclusion (NHVE). The relation of liver tumors to major vessels, episodes and durations of hepatic blood flow exclusion, intraoperative blood loss and blood transfusion, postoperative complications were analyzed. Results The technique combining Pringle's maneuver and NHVE was used in 16 cases. The mean episodes and durations of Pringle's maneuver were (3.8±1.6) min and (46.6±28.8) min, respectively. The mean episodes and durations of NHVE were (1.6±0.4) min and (23.5±8.2) min, respectively. The mean amount of intraoperativ blood loss was (1250±320) ml, blood transfusion (860±245) ml. Major hepatic vessel injuried were repaired intraoperatively including inferior vena cave in 4 cases, main hepatic veins in 2 cases and portal veins in 2 cases. The serum alanine transaminase(ALT) and bilirubin raised in different degrees after operation, and recovered gradually to normal level. There was no postoperative mortality and serious postoperative complications. Conclusions Alternative use of hepatic blood flow exclusion combining Pringle maneuver and NHVE reduces the time of total hepatic vascular exclusion, improves safety for resection of liver tumors involving hepatic hilar region.

Objective To evaluate the reliability and validity of hepatocellular carcinoma (HCC)using the liver imaging reporting and data system (LI-RADS).Methods By using the LI-RADS v2013.1,two radiologists evaluated 1 62 patients with cirrhosis or with a risk of HCC according to an inclusion criteria.The Kappa value was used to evaluate the consistency between two different diagnoses and was compared with pathological and follow-up results.The accuracy of the LI-RADS was assessed including sensitivi-ty,specificity,positive predictive value,negative predictive value,positive likelihood ratio,negative likelihood ratio and accuracy rating.Results In all 1 62 patients,there were HCCs in 97 patients including 7 patients belonging to the LR3,benign diseases in 50,and other kinds of malignancy in 1 5.The Kappa value was 0.882 (P =0.000)between two observers on LI-RADS grading. The sensitivity,specificity and accuracy rating of LI-RADS grading in diagnosing HCC was 100.00%,91.30%,and 97.06%,re-spectively.Conclusion The LI-RADS has high consistency and stability in evaluation and diagnosis of HCC by enhanced CT.LR3 di-agnosis should be cautious because of a susceptible development to HCC,which can be improved through the combination of clinic and laboratory examination.

Objective To apply the model for end-stage liver disease(MELD)and the ChildTurcotte-Pugh(CTP)in predicting short-term prognosis of patients with severe chronic hepatitis B,and to evaluate their clinical value.Methods Data of 115 patients with severe chronic hepatitis B were retrospectively analyzed and all patients were divided into survival gnmp and fatal group by survival status at 3rd month of the treatment.The scores of MELD and CTP were obtained.The accuracies of MELD and CTP were evaluated by the receiver operating characteristic(ROC)curve.The difference between two systems was analyzed by Kaplan-Meier survival curve.Results MELD and CTP scores in fatal group were significantly higher than those in the survival group(t=4.891 and 3.949,P＜0.05),and two systems were significantly correlated(γ=0.500,P=0.000).MELD and CTP scores were good for predicting the fatality rate of patients with severe chronic hepatitis B within 3 months(C-statistic:0.765 and 0.834,respectively),and there was no significant difference between the two systems(Z=1.516,P＞0.05).Patients with CTP＜10.5 or MELD＜27.5 had longer survival time(Z:17.88 and 25.28,P=0.000)and higher survival rates(χ2=16.88 and 31.59.P=0.000)than those with CTP＞10.5 or MELD＞27.5.Conclusion MELD and CTP scores have similar predictive valHe for short-term prognosis of patients with severe chronic hepatitis B.and clinical data should be contained to better predict the short-term prognosis.

Objective:To investigate whether idebenone can improve behavioral disorders in mice with Parkinson disease (PD) by increasing PHB2 mediated mitophagy.Methods:In the first small experiment, thirty mice were randomly divided into normal control group, model group and treatment group according to the random number table method, with 10 animals in each group.The aim of this study was to observe the effect of idebenone on the behavior of Parkinson disease model mice. In the second experiment, 20 mice were randomly divided into blank control group, MPTP group, shRNA-PHB2 group and shRNA-PHB2+ MPTP group, with 5 mice in each group. The changes of tyrosine dehydrogenase (TH) in brain tissue were detected by immunofluorescence assay. In the third experiment, 30 mice were randomly divided into blank control group, shRNA-PHB2 group, MPTP+ idebenone group, shRNA-PHB2+ MPTP group, shRNA-PHB2+ idebenone group and shRNA-PHB2+ MPTP+ idebenone group, with 5 animals in each group. The aim of this study was to investigate the effect of idebenone on mitochondrial autophagy in mouse brain.C57BL-6 mice were intraperitoneally injected with MPTP to establish the animal model of chronic PD. Then 200 mg / kg idebenone was given by gavage for 21 days. And the expression of PHB2 in brain was inhibited by microinjection of adeno-associated virus 9 (AAV9) shRNA inhibin 2(PHB2) into lateral ventricle. The behavioral changes of the PD mice were detected by Morris water maze, and the changes of tyrosine dehydrogenase (TH) induced by inhibiting PHB2 were detected by immunohistochemistry. The protein expression of LC3 and PHB2 in substantia nigra of midbrain was detected by Western blot.The data were analyzed by GraphPad 7.0 and SPSS 22.0.Results:(1) In the water maze test data of the first small experiment, the repeated measurement ANOVA showed that the group-time interaction effects of latency of mice from 1 to 7 days were significant ( Ftime×group=20.51, P<0.05). Simple effect analysis showed that on the 5th, 6th and 7th day, the incubation period of the treatment group was significantly shortened (all P<0.05). Univariate analysis of variance showed that on the 7th day of the test, the differences between the control group and the model group, the model group and the treatment group, the control group and the treatment group were all statistically significant( t=-49.95, -21.81, 28.14; all P<0.01). In the third small experiment, repeated measurement analysis of variance showed that the interaction between time and group was significant ( Ftime×group=42.11, P<0.01). Simple effect analysis showed that compared with MPTP+ idebenone group, the latency of shRNA-PHB2+ MPTP+ idebenone group was significantly prolonged (all P<0.05). There were no significant difference between shRNA-PHB2+ MPTP+ idebenone group and shRNA-PHB2+ MPTP group except the 4th day ( P<0.05). On the 7th day, compared with MPTP+ idebenone group, the residence time of shRNA-PHB2+ MPTP+ idebenone group was significantly increased ( t=-34.36, P<0.001), but there was no significant difference between shRNA-PHB2+ MPTP group and shRNA-PHB2+ MPTP+ idebenone group ( t=2.94, P>0.05). (2)The results of immunofluorescence experiment showed that the relative expression of TH in the control group, model group, shRNA-PHB2 group and shRNA-PHB2+ MPTP group were (41.03±3.01), (24.20±4.18), (38.39±3.31) and (13.12±2.65), respectively. Compared with the control group, the expression of TH in the midbrain of the MPTP group was significantly down-regulated, the difference was statistically significant( t=7.98, P<0.01). Compared with the MPTP group, the expression of TH in shRNA-PHB2 group was down regulated ( t=-6.73, P<0.05). (3) Western blot results showed that the relative expression of LC3 in midbrain tissue of control group, shRNA-PHB2 group, MPTP+ idebenone group, shRNA-PHB2+ MPTP group, shRNA-PHB2+ idebenone group and shRNA-PHB2+ MPTP+ idebenone group were (0.86±0.07), (0.77±0.08), (0.42±0.05), (0.21±0.05), (0.66±0.09) and (0.27±0.07). The relative expression of PHB2 were (1.13±0.14), (0.56±0.11), (1.08±0.14), (0.27±0.07), (0.68±0.14) and (0.24±0.10). Compared with MPTP+ idebenone group, the relative expression of LC3 and PHB2 in shRNA-PHB2+ MPTP+ idebenone group was significantly decreased ( F=1.96, P<0.01). Conclusion:Idebenone can increase the level of mitophagy in PD mice through PHB2, thus improving the behavioral disorder.

Objective:To evaluate the role of silent information regulator 1 (SIRT1)/nuclear factor E2 related factor 2 (Nrf2) signaling pathway in sleep deprivation-induced cognitive dysfunction in rats.Methods:Thirty-six adult male Sprague-Dawley rats, aged 54-56 weeks, weighing 600-750 g, were divided into 3 groups ( n=12 each) using a random number table method: control group (group C), sleep deprivation group (group SD) and sleep deprivation+ SIRT1 agonist Srt1720 group (group SD+ Srt). Sleep deprivation model was established by modified multi-platform water environment method.Srt1720 10 mg/kg was injected intraperitoneally every 12 h starting from 24 h before establishing the model in group SD+ Srt, while the equal volume of 0.9% normal saline was injected intraperitoneally in C and SD groups.After the end of sleep deprivation, Morris water maze test was performed to evaluate the cognitive function.Animals were then sacrificed, and their hippocampi were removed for determination of neuronal degeneration rate in hippocampal CA1 region (using HE staining), the apoptosis rate in hippocampal CA1 (using TUNEL assay ), the expression of SIRT1 and Nrf2 in hippocampal CA1 (by immunohistochemistry) and the contents of reactive oxygen species (ROS) and superoxide dismutase (SOD) (by microplate method). Results:Compared with group C, the escape latency was significantly prolonged, the time of staying at the platform quadrant was shortened, and the frequency of crossing the platform was decreased on 2-4 days, the apoptotic rate and neuronal degeneration rate were increased, the expression of SIRT1 and Nrf2 was down-regulated, ROC content was increased, and SOD content was decreased in SD and SD+ Srt groups ( P<0.05). Compared with group SD, the escape latency was significantly shortened, the time of staying at the platform quadrant was prolonged, and the frequency of crossing the platform was increased on 3 and 4 days, the apoptotic rate and neuronal degeneration rate were decreased, the expression of SIRT1 and Nrf2 was up-regulated, ROC content was decreased, and SOD content was increased in group SD+ Srt ( P<0.05). Conclusions:Sleep deprivation can induce oxidative stress response in hippocampus by inhibiting the activation of SIRT1/Nrf2 signaling pathway, leading to cognitive dysfunction in rats.

BACKGROUND:The risk of lower-extremity deep venous thrombosis was high in patients with the osteoporotic hip fracture. The aged age and hip fracture surgery are major risk factors for thrombosis. No study concerned the critical point in time course to the lower extremity deep venous thrombosis in the osteoporotic hip fracture patients.
OBJECTIVE:To analyze the incidence of the perioperative deep venous thrombosis of lower extremity limb at different time slots in senile osteoporotic intertrochanteric fracture patients repaired by proximal femoral nail antirotation fixation.
METHODS:From June 2012 to January 2016, 220 cases diagnosed as osteoporotic intertrochanteric fracture and performed closed reduction and proximal femoral nail antirotation fixation were selected from the Department of Orthopedics, the Affiliated Hospital of Chengde Medical Col ege in China. Based on administered low-molecular-weight heparins (LMWH) or not after trauma, there were two groups:LMWH group and the non-LMWH group. Vascular Doppler ultrasound was conducted at 1, 3 and 5 days after trauma, more than 5 days after trauma, 2, 5, 7 and 14 days after surgery. The total number of cases and incidence of thrombosis were recorded and compared between the two groups. The number of cases and the incidence of new thrombosis were recorded at different time points in both groups. Frequency distribution table was used to analyze the time of suffering thrombosis after injury and surgery.
RESULTS AND CONCLUSION:(1) Among 220 cases, 18 cases in the LMWH group (n=154) affected thrombosis, with an incidence of 12%, and 15 cases in the non-LMWH group (n=66) experienced deep vein thrombosis, with an incidence of 23%. Significant differences in the incidence of thrombosis were detected between the two groups (P=0.041). (2) Peak time of thrombus was 3 days before injury and 1 day after surgery in both groups. (3) Results suggested that the incidence of deep vein thrombosis was high in proximal femoral nail antirotation fixation for intertrochanteric fracture. The peak time of deep vein thrombosis was 3 days before injury and 1 day after surgery. The prevention of deep vein thrombosis should begin from injury. Prophylactic anticoagulation after injury can dramatical y decrease the incidence of deep vein thrombosis.

Objective To investigate the image quality and radiation dose of automatic spectral imaging mode selection and adaptive statistical iterative reconstruction (ASIR) at abdominal CT with low contrast agent dose. Methods One hundred cases with the arterial-phase (AP) and portal venous phase (PVP) contrast-enhanced abdominal CT scanning were analyzed prospectively. Patients were randomly assigned to the study group and control group (n=50 each). In the study group, automatic spectral imaging mode selection and contrast agent dose of 300 mg/kg were used and spectral monochromatic images(40 to 60 keV) were reconstructed using either filtered back-projection (FBP) (group A) or ASIR (group B). In the control group, the fixed tube potential of 120 kVp and contrast agent dose of 450 mg/kg were used with images reconstructed using FBP (group C). Quantitative parameters (image noise and contrast-to-noise ratio of the liver, pancreas, aorta and portal vein) and qualitative visual parameters (overall image quality as graded on a 5-point scale) were compared among the groups by using One-way ANOVA or Kruskal-Wallis H test. Two sample t tests were used compare the radiation dose difference. Results There had no significant difference in CTDIvol[both (12±5) mGy] and DLP[(364±142) mGy·cm versus (377±131) mGy·cm] between the study group and control group(t=-0.408 and-0.428,P>0.05). During the AP and PVP, at the energy level of 40 keV, group B showed higher CNRs than group A and group C, lower image noise[ (29±6) HU in AP, (24±6) HU in PVP] than group A[(43±11) HU, (44±10) HU] but higher image noise than group C[ (18± 4) HU, (18±4) HU], lower overall image quality scores[(3.0±0.2) point, (2.9±0.3) point] than group C[(3.6± 0.4) point , (3.6±0.5) point] but similar scores to group A[(2.9±0.4) point,(2.8±0.4)point]. At the energy level of 50 keV, group B showed higher CNRs than group A but higher than or similar CNRs to group C, lower image noise[ (20±5) HU, (20±4) HU] than group A[(31±8) HU, (31±7) HU] but similar image noise to group C, higher overall image quality scores[(3.6±0.4) point, (3.5±0.4) point]than group A[(3.3±0.3) point,(3.3±0.3) point] but similar scores to group C. At the energy level of 60 keV, group B showed lower image noise[(14±4) HU, (14±3) HU], higher CNRs and overall image quality scores[(3.9±0.4) point,(3.9±0.3) point] than group A[(19 ± 5) and (20 ± 5)HU in image noise, (3.7 ± 0.4) and (3.7 ± 0.3) point in overall image quality scores ]and group C. Except for monochromatic images at 40 keV, the overall image quality scores in group B were all greater than 3 point and met the clinical diagnostic level. Conclusions The radiation dose of CT spectral imaging and conventional 120 kVp CT scan is equivalent with the use of automatic spectral imaging mode selection. By combining ASIR technique, monochromatic images at 50 and 60 keV can improve CNR and reduce contrast agent dose while maintain or improve overall image quality.