Objective To explore the value cerebral blood flow in prediction of motor recovery of stroke patients. Methods After evaluating the cerebral blood flow velocities of bilateral middle cerebral arteries with TCD during passive elbow movement, 68 patients with cerebral infarction were treated by rehabilitation therapy. The motor function of upper limbs was evaluated with Fugl Meyer before and after 6,12 weeks of treatment. The patients were divided into groups A and B according to the Fugl Meyer scales score of the paralytic upper limb at 12 weeks and the changes of cerebral blood velocities were compared between the two groups. Results The score of upper limb motor function were not different between group B and A before the treatment, but the score of group B was significantly higher than that of group A ( P

Objective To compare the effect of different positive end-expiratory pressures (PEEPs) on the efficacy of volume therapy guided by global end-diastolic volume index (GEDVI) and central venous pressure (CVP) in patients with septic shock.Methods Twenty-five patients with septic shock complicated with respiratory failure,of both sexes,aged 18-64 yr,were enrolled in the study.Their APACHE [[scores were 13-31.The patients were endotracheally intubated and underwent volume-controlled ventilation,PEEP was 5-15 cmH2O,and pulse oxygen saturation was maintained ＞ 90 ％.The patients were divided into low PEEP (5-10 cmH2 O) group and high PEEP (11-15 cmH2 O) group depending on the different PEEP levels.6 ％ hydroxyethyl starch (200/0.5)6 ml/kg was infused over 30 min for volume therapy.Right internal jugular vein or subclavian vein was cannulated for CVP monitoring,and GEDVI was continuously monitored by pulse indicator continuous output monitoring (PiCCO) technology.CVP and GEDVI were recorded before and after volume therapy and the changing rate was calculated.Results Compared with CVP and GEDVI before volume therapy,CVP and GEDVI were significantly increased after volume therapy in low PEEP group (P ＜ 0.05),and GEDVI was increased after volume therapy (P ＜ 0.05) and no significant change was found in CVP after volume therapy in high PEEP group (P ＞ 0.05).Compared with low PEEP group,the changing rate of CVP was significantly decreased (P ＜ 0.05),and no significant change was found in the changing rate of GEDVI in high PEEP group (P ＞ 0.05).Conclusion High PEEP can decrease the efficacy of volume therapy guided by CVP,while exerts no effect on the efficacy of volume therapy guided by GEDVI in patients with septic shock.

Objective To produce the biological calcium citrate cement with fresh oyster shells, and investigate its compressive strength and biocompatibility so as to provide the experimental basis for clinical application of the material.Methods The compressive strength of biological calcium citrate cement was measured and its surface morphology was observed by SEM.The calcium release curve and pH value were measured in the simulated body fluid.Last, its biocompatibility was detected by cytotoxicity test.Results Biological calcium citrate cement produced by 0.33mL/g liquid solid ratio had the maximum compressive strength, and the crystal structure of the material was uniform and orderly.The determination of pH value showed that the degradation and absorption of biological calcium citrate cement did not significantly change the pH value of the body fluid.With gradual degradation of the material, the concentration of Ca2+ in the solution increased gradually.Cytotoxicity test showed that this material had good biocompatibility and no cytotoxicity.Conclusion Biological calcium citrate cement possesses strong compressive strength and good biocompatibility, and it can form a microenvironment with low in alkaline and high in calcium.

Objective: To investigate the urban and rural differences in adverse outcomes of pulmonary tuberculosis (PTB) in patients with pulmonary tuberculosis-diabetes mellitus comorbidity (PTB-DM), so as to provide insights into improving the prevention and treatment measures for PTB-DM. Methods: Patients with PTB-DM who were admitted and discharged from 14 designated tuberculosis hospitals in Hangzhou City from 2018 to 2022 were selected. Basic information, and history of diagnosis and treatment were collected through hospital information systems. The adverse outcomes of PTB were defined as endpoints, and the proportions of adverse outcomes of PTB in urban and rural patients with PTB-DM were analyzed. Factors affecting the adverse outcomes of PTB were identified using a multivariable Cox proportional hazards regression model. Results: A total of 823 patients with PTB-DM were enrolled, including 354 (43.01%) urban and 469 (56.99%) rural patients. There were 112 (13.61%) patients with adverse outcomes of PTB. The proportions of adverse outcomes of PTB in urban and rural patients were 14.41% and 13.01%, respectively, with no statistically significant difference (P>0.05). Multivariable Cox proportional hazards regression analysis identified first diagnosed in county-level hospitals or above (HR=2.107, 95%CI: 1.181-3.758) and drug resistance (HR=3.303, 95%CI: 1.653-6.600) as the risk factors for adverse outcomes of PTB in urban patients with PTB-DM, while the treatment/observed management throughout the process (HR=0.470, 95%CI: 0.274-0.803) and fixed-dose combinations throughout the process (HR=0.331, 95%CI: 0.151-0.729) as the protective factors for adverse outcomes in rural patients with PTB-DM. Conclusions There are differences in influencing factors for adverse outcomes of PTB in urban and rural patients with PTB-DM. The adverse outcomes of PTB are associated with first diagnosed hospitals and drug resistance in urban patients, and are associated with the treatment/observed management and fixed-dose combinations throughout the process in rural patients.

Objective:To investigate the inhibitory effects of resveratrol (Res) on the apoptosis of retinal neurons of diabetic rats and ARPE-19 cells induced by high glucose.Methods:Streptozotocin was intraperitoneally injected to establish a diabetes model in 25 adult male SD rats, and 20 successful models were randomized into diabetic model group and Res-administered group according to random number table method.Another 10 matched normal rats were served as normal control group.Res was intragastrically given to the rats in the Res-administered group with the dose of 40 mg/(kg·d), and an equivalent volume of normal saline solution was used in the same way in the diabetic model group and normal control group.The body weight and blood glucose level were measured on the 0th, 4th, 8th, 12th week of administration.The rats were sacrificed on the 12th week by over-anesthesia and the eyeballs were enucleated.The ultrastructure of the retinal ganglion cells (RGCs) were examined under the transmission electron microscope.The terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling (TUNEL) assay was to assess the apoptosis of retinal neurons.ARPE-19 cells were divided into normal control group, high glucose group and Res-treated group and cultured for 48 hours in medium containing 5.5 mmol/L glucose, 30 mmol/L glucose, 30 mmol/L glucose and 10 mol/L Res, respectively.Apoptosis rate was detected by a flow cytometry.The distribution and expression of bax and bcl-2 in the cells was detected by immunofluorescence and Western blot assay, respectively.This study protocol was approved by an Experimental Animal Ethic Committee of Hubei University of Science and Technology, and the use and care of the animals complied with the Statement of ARVO.Results:Compared with the diabetic model group, the body weight was increased at 4-12 weeks and the blood glucose level was lowered at 8-12 weeks of Res administration in the Res-administered group (both at P<0.01). The chromatin condensation, mitochondrial swelling and vacuolation in cytoplasm were obviously slight and the apoptosis rate was reduced in the Res-administered group in comparison with the diabetic model group.The apoptosis indexes of the retinal ganglion cell layer cells and inner nuclear layer cells in the Res-administered group were (18.36±3.37)% and (23.67±8.98)%, respectively, which were significantly lower than (83.91±9.8)% and (64.26±10.66)% in the diabetic model group (both at P<0.01). The apoptosis rate of the ARPE-19 cells in the normal control group, high glucose group and Res-treated group was (3.11±0.26)%, (11.41±1.06)% and (5.38±0.58)%, respectively, and the apoptosis rate in the Res-treated group was significantly lower than that in the high glucose group (all at P<0.01). Immunofluorescence assay showed that the fluorescence of bax in the cell nucleus of Res-treated group was obviously enhanced in comparison with the normal control group and weaker in comparison with the high glucose group.The fluorescence of bcl-2 protein in the Res-interfered group was weaker in comparison with the normal control group and enhanced in comparison with the high glucose group.The relative expressions level of bax protein in the Res-treated group was 0.21±0.08, which was significantly higher than 0.15±0.06 in the normal control group and lower than 0.31±0.09 in the high glucose group (both at P<0.05). The relative expressions of bcl-2 protein was 0.66±0.25 in the Res-treated group, which was significantly lower than 0.80±0.14 in the normal control group and higher than 0.23±0.09 in the high glucose group (both at P<0.05). The bcl-2/bax ratio in the Res-treated group was significantly higher than that in the high glucose group ( P<0.01). Conclusions:Res can inhibit the apoptosis of RGCs of diabetic rats and high glucose-induced RPE cells in vitro.

OBJECTIVETo investigate the effect of tetrandrine (Tet) on the expression of bax, bcl-2, and transforming growth factor-β2 (TGF-β2) mRNA in cultured human fibroblasts of Tenon's capsules (TCFS) and explore its possible mechanism.

METHODSThe third passage of TCFS cultured in vitro were exposed to 1×10(-5) mol/L Tet for 24 h, and real-time fluorescence quantitative PCR was used to detect the changes in the expressions of bax, bcl-2, and TGF-β2 mRNA.

RESULTSThe expression level of bax mRNA was obviously higher, while bcl-2 and TGF-β2 mRNA levels were significantly lower in Tet-treated TCFS than those in the control cells (P<0.05).

CONCLUSIONTet can inhibit the proliferation of TCFS possibly by reducing the expressions of bcl-2 and TGF-β2 mRNA, enhancing the expression of bax mRNA and inducing cell apoptosis, suggesting its potential in preventing fibrous scar formation after glaucoma filtration surgery.

Apoptosis ; Benzylisoquinolines ; pharmacology ; Cell Proliferation ; drug effects ; Cells, Cultured ; Cicatrix ; metabolism ; prevention & control ; Fibroblasts ; cytology ; drug effects ; metabolism ; Humans ; Proto-Oncogene Proteins c-bcl-2 ; genetics ; metabolism ; RNA, Messenger ; genetics ; metabolism ; Tenon Capsule ; cytology ; Transforming Growth Factor beta2 ; genetics ; metabolism ; bcl-2-Associated X Protein ; genetics ; metabolism

Objective To observe the effect of resveratrol(Res)on the expression of Bcl-2 and Bax in the retina of streptozotocin(STZ)induced diabetic rats.Methods Among 35 adult healthy male SD rats,10 were ran-domly divided into normal control group(Control),25 were used for the diabetic animal model with STZ.Success-fully modeled 20 rats were randomly divided into diabetes mellitus group(DM group)and resveratrol treated group (DM+Res group)equally. The DM+Res group were administrated with intragastric Res daily. After 12 weeks of Res administration,the eyes of three groups were dissected. Retinal histology was examined,and the thickness of the retina was measured.And the expression of Bcl-2 and Bax in the retinal tissues was determined by immunohisto-chemical staining. Results Compared with the control group,the thickness of the retina in DM group significant-ly decreased(P < 0.01),while the thickness of the retina in DM+Res group significantly increased(P < 0.05) compared with the DM group.Consistent with these effects,Res treatment increased the Bcl-2 level and decreased Bax expression level,at the same time,increased the ratio of Bcl-2-to-Bax(P<0.01). Conclusion Res is able to reduce apoptosis in retinal neurons caused by diabetes through up-regulating Bcl-2 expression and inhibiting Bax expression,as a result of increasing the ratio of Bcl-2-to-Bax.

Objective:To examine the application value of alternative pancreatic fistula risk score system(a-FRS) for patients with clinically relevant postoperative pancreatic fistula(CR-POPF) after laparoscopic pancreaticoduodenectomy(LPD).Methods:Clinical data of 400 patients who underwent LPD at Department of Hepatobiliary and Pancreatic Surgery,Jilin University First Hospital,from April 2015 to August 2019 were retrospectively analyzed.There were 217 males and 183 females, with age of ( M( Q R)) 58 (53) years (range:26 to 93 years) and body mass index of (23.0±2.7) kg/m 2 (range:19.4 to 27.1 kg/m 2).Preoperative CA19-9 was (171.6±212.7) U/ml (range:32.1 to 762.6 U/ml), and preoperative CA125 was (18.6±22.9) U/ml (range:9.0 to 112.3 U/ml).Univariate analysis and multivariate Logistic regression analysis were implemented to find independent risk factors in CR-POPF.According to 3 indicators of a-FRS system(pancreatic texture,main pancreatic duct diameter,and body mass index),receiver operator characteristic curve was used to prospectively analyze the clinical value of CR-POPF. Results:CR-POPF occurred in 60 patients(15.0%) among the 400 LPD patients,including 54 patients(13.5%) with grade B pancreatic fistula and 6 patients(1.5%) with grade C pancreatic fistula.Univariate and multivariate Logistic regression analysis results showed that soft pancreas,diameter of main pancreatic duct ≤3 mm,and body mass index>23 kg/m 2 were the independent risk factors for CR-POPF after LPD.The incidence of CR-POPF was 1.9% in the group with low pancreatic fistula risk(0 to 5%),5.9% with moderate pancreatic fistula risk(>5% to 20%),and 80.7% with high pancreatic fistula risk(>20%).a-FRS prospectively predicted the sensitivity and specificity of CR-POPF after LPD was 76.7% and 96.8%,positive predictive value was 80.7%,negative predictive value was 95.9%,positive likelihood ratio was 23.66,negative likelihood ratio was 0.24,and area under the curve was 0.735(95% CI:0.668-0.799). Conclusion:a-FRS system has great clinical application value in predicting CR-POPF after LPD,which can provide basis for early risk prediction of CR-POPF and timely related clinical intervention.

Objective:To investigate the clinical characteristics, changes in lactate dehydrogenase (LDH) levels, and prognosis in cases of Amanita oberwinklerana poisoning.Methods:A retrospective analysis was conducted on the clinical data of 12 patients who were diagnosed with Amanita oberwinklerana poisoning at Xiangya Changde Hospital between January 2019 and December 2022. The analysis included an assessment of clinical manifestations, renal function changes, LDH levels, and patient prognosis. All statistical analyses were performed using SPSS25.0 Comparisons of ratios between groups were performed using the t test, correlation analyses were performed using scatter diagram and Pearson correlation method, P<0.05 was considered statistically significant. Results:The latency period for symptom onset ranged from 6 to 18 hours, with early symptoms primarily consisting of nausea and vomiting. Three patients developed anuria in the early stage. All patients experienced acute kidney injury (AKI) accompanied by mild liver injury. LDH levels were significantly elevated compared to other types of mushroom poisoning cases ( P < 0.01), with a mean peak value exceeding 2000 U/L. While no correlation was found between LDH levels and kidney injury severity, a positive correlation was observed between LDH levels and length of the course. All 12 patients recovered following dialysis treatment, with recovery periods ranging from 20 to 60 days. No cases of chronic renal failure or mortality were reported. Conclusions:Amanita oberwinklerana poisoning primarily causes acute renal injury. A significant elevation in LDH levels may serve as a potential marker for this type of poisoning. LDH levels did not correlate with kidney injury severity, while positively corrected with the length of the course. All patients in this study achieved good prognosis with full renal recovery.

Objective:To examine the application value of alternative pancreatic fistula risk score system(a-FRS) for patients with clinically relevant postoperative pancreatic fistula(CR-POPF) after laparoscopic pancreaticoduodenectomy(LPD).Methods:Clinical data of 400 patients who underwent LPD at Department of Hepatobiliary and Pancreatic Surgery,Jilin University First Hospital,from April 2015 to August 2019 were retrospectively analyzed.There were 217 males and 183 females, with age of ( M( Q R)) 58 (53) years (range:26 to 93 years) and body mass index of (23.0±2.7) kg/m 2 (range:19.4 to 27.1 kg/m 2).Preoperative CA19-9 was (171.6±212.7) U/ml (range:32.1 to 762.6 U/ml), and preoperative CA125 was (18.6±22.9) U/ml (range:9.0 to 112.3 U/ml).Univariate analysis and multivariate Logistic regression analysis were implemented to find independent risk factors in CR-POPF.According to 3 indicators of a-FRS system(pancreatic texture,main pancreatic duct diameter,and body mass index),receiver operator characteristic curve was used to prospectively analyze the clinical value of CR-POPF. Results:CR-POPF occurred in 60 patients(15.0%) among the 400 LPD patients,including 54 patients(13.5%) with grade B pancreatic fistula and 6 patients(1.5%) with grade C pancreatic fistula.Univariate and multivariate Logistic regression analysis results showed that soft pancreas,diameter of main pancreatic duct ≤3 mm,and body mass index>23 kg/m 2 were the independent risk factors for CR-POPF after LPD.The incidence of CR-POPF was 1.9% in the group with low pancreatic fistula risk(0 to 5%),5.9% with moderate pancreatic fistula risk(>5% to 20%),and 80.7% with high pancreatic fistula risk(>20%).a-FRS prospectively predicted the sensitivity and specificity of CR-POPF after LPD was 76.7% and 96.8%,positive predictive value was 80.7%,negative predictive value was 95.9%,positive likelihood ratio was 23.66,negative likelihood ratio was 0.24,and area under the curve was 0.735(95% CI:0.668-0.799). Conclusion:a-FRS system has great clinical application value in predicting CR-POPF after LPD,which can provide basis for early risk prediction of CR-POPF and timely related clinical intervention.