Objective To observe the changes of hippocampal NogoA-NgR1 signaling on postoperative cognitive function (POCD) in aged mice, and explore the potential underling mechanism.Methods Isoflurane anesthesia and laparotomy were applied to establish the POCD model.Forty aged male C57BL/6 mice were randomly divided into the following four groups (n=10): group O2+saline (group OS), group O2+NEP1-40 (group ON), group isoflurane anesthesia+laparotomy surgery+saline (group SS), and group isoflurane anesthesia+laparotomy surgery+NEP1-40 (group SN).Cannula placement was performed into lateral ventricle 7 days before the surgery.Animals were subjected to an administration of NEP1-40 (20 μg/2 μl) or isochoric saline via intracerebroventricular injection once daily for 8 consecutive days, injection was given from 2 h before isoflurane anesthesia to the last behavioral test.Open field test was performed at 5th d after operation.Contextual and cued fear conditioning training and testing were exhibited at 6th and 7th d after operation, respectively.The hippocampus was harvested 2 h after the behavioral test.Western blot was used to detect the expressions of NogoA, NgR1, RhoA, ROCK2 and GAP43.Golgi staining was applied to measure the changes of dendritic spines in hippocampal CA1 area.Results Compared with the groups OS and ON, the freezing time in the contextual fear conditioning test was significantly decreased, the contents of NogoA, NgR1, RhoA and ROCK2 were significantly increased, the content of GAP43 and the number of dendritic spine were significantly decreased in group SS (P<0.05).Compared with the group SS, the freezing time in the contextual fear conditioning test was significantly increased, the contents of RhoA and ROCK2 were significantly decreased, the content of GAP43 and the number of dendritic spine were significantly increased in group SN (P<0.05).Conclusion Over-activated of hippocampal NogoA-NgR1 signaling participated in the pathogenesis of POCD in aged mice.

ObjectiveTo evaluate the efficacy and safety of the angiotensin Ⅱ receptor blockers (ARB) in reducing portal hypertension ( PHT) in patients with cirrhosis.Methods PubMed,EMBASE,Web of Science,The Cochrane Central Register of Controlled Trials,Chinese BiomedicalDatabase,ChineseJournals Full-text Database and WanFang Digital Journal Full-text database were searched.Statistical analysis was performed by meta-analysis using RevMan4.2 software.ResultsAmong 8 randomized controlled trials ( RCT) including 282 patients met the inclusion criteria,4 trials were analyzed to compare the ARB with the placebo or no treatment and the other 4 trials were analyzed to compare the ARB with propranolol.Meta-analysis results were as follows.(1) The ARB resulted in more significant hepatic venous pressure gradient ( HVPG) reduction as compared with the placebo or no treatment [ WMD =1.87 mm Hg (1 mm Hg =0.133 kPa),95％CI ( 0.86-2.87 )mmHg,P =0.00003 ].Andthe ARB were similar to propranolol in reducing HVPG [ WMD =0.92 mm Hg,95％ CI ( - 0.41-2.26)mm Hg,P =0.17 ].(2)The ARB led to more significant reduction in mean arterial pressure than the placebo or no treatment [ WMD =8.89 mm Hg,95％ CI( 7.16-10.62)mm Hg,P ＜ 0.00001 ],but they were similar to propranolol had no significant difference.And the ARB had no significant effect on the heart rate of the patients,which was similar to no treatment group ( P ＞ 0.05 ).Whereas,propranolol could greatly decrease heart rate of the patients ( WMD =- 21.25,95％ CI - 25.83-16.68,P ＜ 0.000 01 ).( 3 ) No significant differences were found in serum bilirubin and creatinine levels between the ARB and the placebo or no treatment groups ( P ＞0.05).The rate of nonspecific adverse events was higher in the ARB groups than in the placebo or no treatment groups ( P =0.03 ),but it showed there was no difference between the ARB and propranolol groups (P =0.72).ConclusionThe ARB is effective in reducing portal hypertension in patients with cirrhosis,which is similar to propranolol.Their effects on mean arterial pressure is similar to propranolol without significant effects on hear rate,liver functionand kidney function,and with less nonspecific adverse events.The ARB could become a new choice for the treatment of portal hypertension.

Objective: To investigate the status and influencing factors of disease uncertainty among caregivers of colorectal cancer patients receiving chemotherapy, so as to provide insights into psychological interventions among caregivers. Methods: Caregivers of colorectal cancer patients hospitalized in Hunan Cancer Hospital, the Third Xiangya Hospital and the Second Xiangya Hospital for chemotherapy from March 2020 to December 2021 were recruited. Caregivers' demographics, health status, medical and nursing support and social support, as well as patients' demographics, frequency of chemotherapy and disease stage were collected using questionnaire surveys. Caregivers' disease uncertainty was evaluated using Chinese version of the Uncertainty in Illness Scale for Family Members, and factors affecting caregivers' disease uncertainty were identified using a multivariable linear regression model. Results: A total of 318 caregivers were enrolled, including 115 men (36.16%) and 203 women (63.84%), with a mean age of (45.89±6.57) years, and there were 186 caregivers as patients' spouses (58.49%). The mean score of disease uncertainty was (86.65±10.82) points, and the scores of the unpredictability dimension, uncertainty dimension, complexity, and lack of information dimension were (3.21±0.35), (2.98±0.48), (2.84±0.49) and (2.36±0.59) points, respectively. There were 285 participants with a high level of disease uncertainty (89.62%), and multivariable linear regression analysis identified social support (β′=-0.199), medical and nursing support (β′=-0.118), patient's age (β′=-0.155) and stage Ⅲ and Ⅳ of colorectal cancer (β′=0.151) as factors affecting caregiver's disease uncertainty. Conclusion Caregivers of colorectal cancer patients with chemotherapy have a high level of disease uncertainty, which is affected by social support, medical and nursing support, patient's age and duration of disease.

ObjectiveTo investigate the clinical significance of inflammatory factors and adiponectin in type 2 diabetes milletus complicated with non-alcoholic fatty liver disease.Methods Two hundred and ten subjects aging from 25.0 to 65.0 years old,including 106 men and 104 women,were recruited into this study.They were divided into four groups: Forty cases of healthy control (NC),60 cases with newly-diagnosed type 2 diabetes (T2DM),65 cases with simple non-alcoholic fatty liver disease (NAFLD) and other 45 cases with newly-diagnosed T2DM complicated with NAFLD.The physical examination was performed for each patient.Serum levels of alanine aminotransferase (ALT),gamma-glutamyl transpeptidase (GGT),fasting plasma glucose (FPG),glycation hemoglobin A 1 c ( GHbA1c ),creatinine ( Cr),uric acid ( UA ),2 hours postprandic plasma glucose (2hPG),fasting insulin (FINS),lipid profiles were measured.Insulin resistance index (HOMAIR) was calculated.Tumor necrosis factor-α (TNF-α),high sensitive C-reactive protein (hs-CRP) and adiponectin were also detected.Results The serum levels of ALT and GGT,body mass index and waist/hip ratio were higher in the NAFLD,T2DM with NAFLD patient groups than that in T2DM and NC group ( P ＜0.05or P ＜0.01 ).The serum levels of TG and LDL-C were significantly higher in T2DM,NAFLD and T2DM with NAFLD groups than that of NC group.And serum TG levels in T2DM with NAFLD group were higher than that of T2DM group (P ＜ 0.05).FPG and GHbAl c were higher in T2DM and T2DM with NAFLD groups than that of NAFLD and NC groups.The serum levels of TNF-α,hs-CRP and HOMA-IR were higher in T2DM,NAFLD and T2DM with NAFLD groups than that of NC group.T2DM with NAFLD group had higher levels of TNF-α,hs-CRP and HOMA-IR compared with T2DM group.However,serum adiponectin levels of T2DM,NAFLD and T2DM with NAFLD groups were lower than that of NC group.And it was lower in T2DM with NAFLD group when compared with NC group ( P ＜ 0.05 ).Adiponectin was negatively associated with TNF-α,hs-CRP and HOMA-IR (r =-0.635,-0.668,-0.752 respectively,P ＜ 0.0l ).But HOMA-IR was positively associated with TNF-α,hs-CRP( r =0.667,0.706 respectively,P ＜ 0.01 ).ConclusionInflammatory factors and adiponectin may play important roles in the pathophysiology and progression of T2DM and NAFLD.The protective effects of adiponectin may come from its anti-inflammatory activity to relieve insulin resistance for NAFLD.

Objective To observe the efficacy and safety in the postoperative craniocerebral trauma elderly patients us-ing the layered method of sputum suction. Methods Senventy patients aged 60 and above with craniocerebral trauma were divided into the layered method group (group A) and the traditional method group (group B). The vital sign, mu-cosa damage frequency, the times of average daily sputum suction and the incidence of VAP were compared. Results Compared with group B, group A could reduce the vital signs change and the times of average daily sputum suction, with lower airway mucosa damage and the incidence of VAP, the difference was statistically significant(P<0.05). Con-clusion The layered method of sputum suction is safer and more effective than traditional method in treatment of the postoperative elderly patients with craniocerebral trauma.

Objective:To evaluate the efficacy of ultrasound-guided superior laryngeal nerve block(SLNB) combined with intravenous anesthesia for improving pediatric fiberoptic bronchoscopy.Methods:Forty pediatric patients of either sex, aged 3-6 yr, of American Society of Anesthesiologists Physical Status classificationⅠor Ⅱ, with body mass index of 18-24 kg/m 2, undergoing fiberoptic bronchoscopy in Cangzhou Central Hospital in 2022, were divided into 2 groups ( n=20 each) by a random number table method: ultrasound-guided SLNB plus intravenous anesthesia group (group A) and topical anesthesia plus intravenous anesthesia group (group B). After sedation with dexmedetomidine and esketamine, ultrasound-guided bilateral SLNB was performed with 1% lidocaine 0.5 ml (for each side)in group A, and topical anesthesia was performed with 1% lidocaine in nasal and pharyngeal cavities in group B. After completion of the surgery procedure, propofol was continuously infused at 5 mg·kg -1·h -1 until completion of diagnosis and treatment. An increment of propofol 1 mg/kg was intravenously given if severe bucking or body movement occurred during operation. Mean arterial pressure (MAP), heart rate (HR) and SpO 2 were recorded on admission to the operating room (T 0), immediately after sedation (T 1), immediately after bronchoscopy entering the glottis (T 2), 5 min after start of treatment (T 3) and at the end of examination (T 4). The occurrence of intraoperative hypoxemia, HR <60 bpm, and MAP <50 mmHg were recorded, and the additional dose of propofol was recorded. The venous blood samples were collected at T 0 and T 4 to determine plasma cortisol concentrations by chemiluminescence.The surgeon′s satisfaction score was recorded. The complications of SLNB were also recorded within 2 h after operation in group A. Results:Compared with group B, HR was significantly decreased at T 2 and T 3, SpO 2 was increased, the intraoperative additional dosage of propofol and incidence of hypoxemia were decreased, and the surgeon′s satisfaction score was increased, and the concentrations of cortisol were decreased at T 4 in group A ( P<0.05). No HR<60 bpm and MAP<50 mmHg were found in two groups. No SLNB-related complications were observed after operation in group A. Conclusions:Ultrasound-guided SLNB combined with intravenous anesthesia is safer for pediatric fiberoptic bronchoscopy and can improve the analgesic effect and is more helpful in inhibiting intraoperative stress responses when compared with conventional anesthesia.

Berberine is a natural isoquinoline alkaloid that was initially used as a broad-spectrum antibacterial agent in clinical treatment of enteritis,peptic ulcers,chronic gastritis,pneumonia,and other diseases.In recent years,in-depth study of the pharmacological effects of berberine has provided increasing evidence that berberine has neuroprotective effects on ischemic stroke.In this review,we introduce the effect of berberine on risk factors of ischemic stroke and discuss the neuroprotective effects of berberine on various mechanisms of ischemic stroke in detail to provide a reference for clinical and basic research in this field.

AIM:To explore the protective effect of Xiaoxuming decoction(XXMD)on synaptic plasticity in the context of cerebral ischemia-reperfusion injury following ischemic stroke.METHODS:An oxygen-glucose depriva-tion/reoxygenation(OGD/R)model was employed in vitro using mouse hippocampal neurons(HT22 cells)to simulate ischemia-reperfusion injury.Cell viability was assessed using a CCK-8 assay to determine the optimal XXMD concentra-tion.The HT22 cells were divided into two groups:control and model(OGD/R).Cellular morphological changes were ob-served using an inverted microscope.The levels of IL-1β,IL-6 and TNF-α in the supernatant were quantified by ELISA.Ultrastructural changes were examined by transmission electron microscopy.Immunofluorescence staining was used to de-tect neuron markers NeuN and synaptic proteins NF200 and MAP2.The protein levels of NF200 and MAP2 were analyzed by Western blot.RESULTS:The highest cell survival rate occurred at an XXMD concentration of 100 mg/L(P<0.05).Compared with control group,the cells in model group exhibited round shape and shrinkage,mitochondrial swelling or vacuolization,and a marked decrease in survival rate.There were significant increases in IL-1β,IL-6 and TNF-α levels(P<0.05).Immunofluorescence intensity and protein levels of NeuN,NF200 and MAP2 were notably reduced(P<0.05).Treatment with XXMD improved cell morphology,ultrastructure and survival rate(P<0.05),and decreased in-flammatory factor levels(P<0.05).Compared with model group,the cells in OGD/R+XXMD group showed significantly increased immunofluorescence intensity and protein levels of NeuN,NF200 and MAP2(P<0.05).CONCLUSION:Xiaoxuming decoction may mitigate OGD/R-induced injury,potentially by inhibiting inflammatory responses and enhanc-ing synaptic plasticity.