Pituitary adenylate cyclase-activating polypeptide (PA CAP) which belongs to the secretin/glucagon/VIP family has been originally isola ted from the sheep hypothalamus on the basis of its ability to stimulate cAMP fo rmation in culture rat anterior pituitary cells. Post-translational processing of the PACAP precursor generates two biologically active molecular forms, PACAP -38 and PACAP-27. The primary structure of PACAP has been remarkably conserved during evolution. The sequence of PACAP-27 exhibits substantial similarities w ith those of vasoactive intestinal polypeptide (VIP), glucagon and secretin. The gene encoding the PACAP precursor is widely expressed in brain and various peri pheral organs, notably in endocrine glands, gastro-intestinal，uro-genital tra cts and respiratory system. In vivo and in vitro studies have shown that PACAP exhibits multiple activities especially a trophic activity during ontogen esis, notably in the adrenal medulla and the central nervous system. The biologi cal effects of PACAP are mediated through three distinct receptor subtypes which exhibit differential affinities for PACAP and VIP. The PAC1 receptor, which sho ws high selectivity for PACAP, is coupled to several transduction systems. In co ntrast, VPAC1 and VPAC2, which bind with the same affinity for PACAP and VIP, ar e mainly coupled to the adenylyl cyclase pathway. In conclusion, PACAP is neurop eptide, and it functions as a hypothalamic hormone, neurohormone, neuromodulator , vasodilator, neurotransmitter or trophic factor in the brain and the various o rgans.

Objective:To investigate the curative effect and prognosis of schizophrenia patients treated with paliperidone extended -release tablets.Methods:Totally 72 cases of patients with schizophrenia were divided into the observation group (n=35) and the control group ( n=37 ) according to the order of admission .The obsevation group was treated with paliperidone extended-release tab-lets, while the controll group was treated with risperidone tablets , and both groups were treated for 8 weeks.The positive and negative syndrome scale(PANSS) was used to assess the effect of the two groups , the social function defect scale (SDSS) and prognosis of the two groups were compared.Results: After the 2-week treatment, the PANSS score, positive symptom score, negative symptom score and general symptom score were all decreased in the two groups when compared with those before the treatment (P<0.05),and the scores in the observation group were lower than those in the controll group (P<0.05).After the treatment, the SDSS was significantly reduced in the two groups when compared with that before the treatment (P<0.05), and the reduction in the observation group was more notable than that in the control group (P<0.05).The total effective rate of the observation group was 94.3%, which was higher than that (67.6%) of the control group (P<0.05).The incidence of adverse reactions, such as anxiety and akathisia, and the total adverse drug reactions in the observation group were both lower than those in the control group (P<0.05).Conclusion:Paliperidone extended-release tablets can effectively relieve suffering from schizophrenia with quick effect , few adverse reactions , high safety and good effect , which is worthy of promotion in clinical use .

BACKGROUND: Brain ischemia-reperfusion (IR) injury is closely connected with the activity of Kinesin. Previous research believes that reduced activity of Kinesin, a mierotubule based motor protein, is an early mark for nerve cell death induced by brain ischemia. Erigeron breviscapus can prevent brain IR-induced proteinase C activation, reduce calcium overload, and reduce ischemic infarctional volume, thus attenuating brain IR injury. However, it still remains less reported at present whether the neuroprotective role of erigeron breviscapus is related to Kinesin activity.OBJECTIVE: To observe the effect of erigeron breviscapus on the activity of Kinesin, a microtubule based motor protein, in hippocampal pyramidal cells during brain IR.DESIGN: Randomized controlled study.SETTING: Anesthesia Department, Affiliated Hospital of Jining Medical College; Anesthesiology Key Laboratory, Affiliated Hospital of Xuzhou Medical College.MATERIALS: This experiment was carried out in the Anesthesiology Key Laboratory, the Affiliated Hospital of Xuzhou Medical College, between February and August 1999. Totally 35 male gerbils were included.METHODS: Gerbils were randomized into sham-operation group (n=5), ischemia-reperfusion control group (n=15) and erigeron breviscapus group (n=15), the latter two of which were further divided into three subgroups according to reperfusion time, namely reperfusion group Ⅰ (reperfusion of 6 hours), reperfusion group Ⅱ (reperfusion of 48 hours) and reperfusion group Ⅲ (reperfusion of 96 hours) with 5 in each subgroup. Gerbils in IR group and erigeron breviscapus group were subjected to IR model preparation before experiment by brain arterial occlusion for 10 minutes, while gerbils in sham-operation group had only bilateral common carotid artery isolated without occlusion. Gerbils in erigeron breviscapus group were pretreated 15 minutes before ischemic inducement with intraperitoneal injection of breviscapine (its effective component is erigeron breviscapus) at a dosage of 45 mg/kg, which was replaced with the same volume of isometric normal saline in sham-operation group and IR group. IHC staining was used to detect hippocampus microtubule based motor protein-Kinesin activity with the assistance of computer imaging analysis technology. MAIN OUTCOME MEASURES: Activity and changes of Kinesin of animals in each group.RESULTS: Totally 35 animals were enrolled in this experiment and all entered the result analysis with no one lost during the experiment. In hippocampal CA1 region, Kinesin activity in IR group was found to descend to 58%, 38% and 12% respectively of that in sham-operation group at IR 6 hours, 48 and 96 hours (P < 0.01). In erigeron breviscapus group at IR 6 hours, 48 hours and 96 hours it was 81%, 61% and 21% of that in shamoperation group, and was obviously higher than that in IR control group (P < 0.05). However, the changes of Kinesin activity were not obviously different in hippocampal CA2, CA3 and CA4 regions.CONCLUSION: Erigeron breviscapus can exert brain-protecting function by reducing hippocampal CA1 Kinesin activity during brain IR injury.

Objective:To investigate the clinical efficacy of levodopa combined comprehensive therapy on the children with ametropic amblyopia.Methods:One hundred three patients (180 eyes) with ametropic amblyopia admitted into our hospital from April 2013 to March 2016 were randomly divided into the control group and the study group.Fifty-two patients (90 eyes) in the control group were treated with comprehensive therapy,and fifty-one patients (90 eyes) in study group were treated with levodopa combined comprehensive therapy.After six months of treatment,the treatment efficacy,pattern visual evoked potential (P-VEP),visual sensitivity,and visual function of patients were observed and compared between the two groups,and the adverse reaction were recorded and compared.Results:At six months after treatment,the effective rate of study group was 90.00％,which was significantly higher than that of control group (68.89％,P＜0.05).The wave amplitude ofP-VEP Pl00 of both groups showed a remarkable increase,which was much higher in the study group (P＜0.05);the incubation period in both groups were obviously decreased,while they were markedly lower in the study group (P＜0.05).The visual acuity under 100％,25％,10％ and 5％ of spatial frequency were conspicuously higher than those of control group (P＜0.05).And correction convergence range,and correction separation range in study group were much higher than those of control group,and corrected near stereo vision was markedly lower than that of control group (P＜0.05).Additionally,no significant difference was found in the incidence of adverse reactions between the two groups (P＞0.05).Conclusion:Levodopa combined comprehensive therapy had a good ability of improving function of visual central neurons,visual acuity and binocular stereo vision functions.

ObjectiveTo investigate the pathogens and prognostic factors of AIDS-associated severe pneumonia. MethodsClinical data were collected from 95 patients with AIDS-associated severe pneumonia admitted to Guangzhou No. 8 People' s Hospital from January 2005 to December 2008. The pathogens of pulmonary infections were investigated. Univariate analysis and multivariate logistic regression analysis were performed to study the relationships between the outcome and influencing factors. Results The most prevalent pathogen was Pneumocystis jirovecii (64/95, 67.4％ ), followed by bacteria (61/95, 64.2％ ),fungi ( 50/95, 52. 6％ ), mycobacterium tuberculosis ( 27/95, 28. 4％ ) and cytomegalovirus ( CMV ) (25/95, 26.3％ ). Among 95 cases, monocontamination was detected in 15 cases ( 15.8％ ), while mixed infection in 80 cases (84. 2％ ). Logistic regression analysis showed that mechanical ventilation, higher serum lactic dehydrogenase (LDH) level and severe underlying diseases were risk factors for the death of AIDS-associated severe pneumonia, and higher serum albumin level was the protective factor. Conclusion Pneumocystis jirovecii, bacteria and fungi are the main pathogens for AIDS-associated severe pneumonia, and mixed infection is popular.

Objective To study the pathogens and drug resistance profiles of pulmonary infection in patients with AIDS. Methods The pathogens and their drug susceptibility of pulmonary infection diagnosed by fibrobronchescopy-induced brunchoalveolar lavage fluid (BAI.F) culture and/or transbronchial biopsy in 116 AIDS cases were analyzed. Results Monopathogenic infection in lungs were detected in 18 cases(15.5%) and mixed infection in 98 cases ( 84.5%). Of the 116 cases, bacteria were present in 91 patients, fungi in 62, tubercle bacillus in 49, pneumocystis jiroveci in 29, and cytomegalovirus in 11.Ninety-five bacterial strains were isolated from BALF, mainly including Streptococci (34), coagulase negative Staphylococcus (20), Klebsiella pneumoniae (10) and Escherichia (7). The isolated bacteria were resistant to β-lactam, macrolides, quinolones and aminoglycosides, of which were 14 methicillin-resistant Streptococci (MRS) strains and 12 extended spectrum β-lactamases (ESBL) strains. Sixty-eight fungal strains were isolated, including 36 Candida mycodermas, 19 Penicilliums, 6 Aspergilli and 5 Mold fungi;they were sensitive to amphotericin B but resistant to fluconazol (5.6% -50. 0% ) and itraconazole( 10. 5%-60. 0% ). Conclusion Pneumonia in AIDS patients are usually caused by multiple pathogens,predominantly consisting of multiresistant bacteria and fungi. Therefore, antibiotics should be rationally chosen according to drug susceptibility test.

Objective To evaluate the effects of dexmedetomidine pretreatment on extracellular sig?nal?regulated kinase ( ERK) pathway during acute lung injury in a rat model of liver transplantation. Meth?ods Sixty male Sprague?Dawley rats, weighing 235-250 g, were divided into 4 groups ( n=15 each) u?sing a random number table: sham operation group (group S), liver transplantation group (group LT), low?dose dexmedetomidine pretreatment group ( group LD ) and high?dose dexmedetomidine pretreatment group ( group HD) . In LT, LD and HD groups, the model of orthotopic liver transplantation was estab?lished, and the operation time was about 4 h. Dexmedetomidine 2?5 and 5?0μg·kg-1 ·h-1 were intrave?nously infused for 1 h starting from 1 h prior to clipping the hepatic artery and portal vein in LD and HD groups, respectively. The rats were sacrificed after the end of operation, and the lungs were removed for determination of wet to dry weight ratio ( W∕D ratio) , cell apoptosis and expression of ERK mRNA, ERK, phosphorylated ERK ( p?ERK) , Bcl?2 and Bax in lung tissues and for examination of the pathological chan?ges ( with light microscope) and ultrastructure of lung tissues ( with transmission electron microscope) . The
injured alveolus rate ( IAR) , apoptosis index ( AI) and ratio of Bcl?2 to Bax expression ( Bcl?2∕Bax ratio) were calculated. Results Compared to group S, the W∕D ratio, IAR, AI, expression of ERK?1 mRNA, ERK?2 mRNA, p?ERK, Bcl?2 and Bax and Bcl?2∕Bax ratio were significantly increased in LT, LD and HD groups ( P<0?05) . Compared to group LT, the W∕D ratio, IAR and AI were significantly decreased, the expression of ERK?1 mRNA, ERK?2 mRNA, p?ERK and Bcl?2 and Bcl?2∕Bax ratio were significantly increased, and the expression of Bax was significantly down?regulated in LD and HD groups (P<0?05). Compared to group LD, the W∕D ratio, IAR and AI were significantly decreased, the expression of ERK?1 mRNA, ERK?2 mRNA, p?ERK and Bcl?2 and Bcl?2∕Bax ratio were significantly increased, and the ex?pression of Bax was significantly down?regulated in group HD ( P<0?05) . The pathological changes of lung tissues were significantly attenuated in LD and HD groups as compared with group LT, and in group HD as compared with group LD. Conclusion The mechanism by which dexmedetomidine pretreatment mitigates cell apoptosis during acute lung injury is related to activation of ERK pathway in a rat model of liver trans?plantation.

Objective To evaluate the surgical therapy on dislocated fracture of talus. Methods Retrospective analysis was mode in 21 patients with dislocated fracture of talus collected from Jan. 2004 to Jan.2010, which were treated with open reduction, cannulated screw fixation, and kept neutral position plaster fixation with no weight loading, to do functional exercise depending on the Ⅹ film demonstrations. Results All the patients were followed up from 6 months to 3.8 years post-operation, and according to the evaluation standard by American Foot-Ankle Surgery Society, good rate was 61.91%. Conclusion Treating dislocated fracture of talus with emergency operation, anatomical reduction, valid internal fixation and no weight loading plaster fixation post-operation, shows good effect with low rate of complication.

Objective To study the clinical characteristics, diagnostic methods and therapeutic efficacy of pneumocystis pneumonia (PCP) in patients with acquired immunodeficiency syndrome (AIDS). Methods Sixty-nine AIDS cases of PCP were diagnosed according to the criteria of USA Centers for Disease Control and Prevention revised in 1993. The clinical symptoms and signs of the patients were observed. The peripheral blood lymphocyte counts, blood gas analysis and bronchoalveolar lavage fluid (BALF) were checked and transbronchoscopic lung biopsy was performed. Results All studied patients were in the late stage of AIDS. The main clinical manifestations included fever (100.0%), cough (97.1%), and dyspnea (92.80%). Pulmonary rales could be heard in 42 cases (60.9% ). Peripheral CD4+ T lymphocyte counts ranged from 1 × 106 -88 × 106/L. Fifty-two cases (75.4% ) had low arterial partial pressure of oxygen value of less than 10.7 kPa (1 kPa = 7.5 mm Hg). Sixty-one cases (88.4 %) had elevated serum lactate dehydrogenase (LDH) level. Bilateral diffused interstitial change (46.4%) and ground-glass shadow (29.0%) were the most common abnormal chest radiological findings. Pneumocystis organisms were detected in the BALF from 2 patients and in the transbronchial biopsy (TBB) tissue from 35 patients. All patients were treated with compound sulfamethoxazole. Thirty-three were treated with corticosteroid simultaneously and 27 were assisted with mechanical ventilation. Fifty patients recovered or got improved, eleven died, and eight left hospital because of deteriorated condition. Conclusions When an AIDS patient represents with fever, cough, dyspnea, hypoxemia, elevated serum I.DH level, CD4+ T lymphocyte count below 100 × 106/L, and interstitial pneumonia or ground-glass shadow in chest images, the diagnosis of PCP could be made presumptively. It is difficult to make a nosogenic diagnosis of PCP, but TBB considerably increases the positive rate of pneumocystis. Compound sulfamethoxazole is recommended as the first selected drug. In severe cases, corticosteroid and assisted mechanical ventilation combined with compound sulfamethoxazole could remarkably improve the prognosis of PCP.

Objective To investigate gene polymorphisms of drug targets and mutations associated with drug resistance in Pneumocystis jiroveci (P.jiroveci) isolates.Methods Among 148 samples isolated from human immunodeficiency virus (HIV)infected patients with pneumonia in Guangdong,mitochondrid larg subunit rRNA (mtLSUrRNA) gene was amplified from 51 samples.Dihydropteroate synthase (DHPS),dihydrofolate reductase (DHFR) and Cytochrome b (CYB) genes of P.jiroveci were detected by gene sequencing,and compared with the reference sequences in GenBank to evaluate gene polymorphisms.Results P.jirovecii DHPS,DHFR and CYB genes were all successfully amplified from 51 samples.For DHPS gene,48 (94.1％) were wild-type and 3 (5.9％) had gene mutation associated with drug resistance.For DHFR gene,30 were wild-type,and 21 had a synonymous mutation at position 312,and 1 nonsynonymous mutation at position 188.There were no mutations associated with drug resistance.For CYB gene,polymorphisms of were detected at 5 sites,4 of which were synonymous mutations,1 was non-synonymous mutation.No mutation associated with drug resistance was found.Based on the gene polymorphism of CYB6,the strains can be classified into 6 genotypes,and 2 were first detected,including 25 CYB1,13 CYB2,2 CYB5,4 CYB8,as well as newly detected 4 CYB10 and 3 CYB11 strains.Conclusions The mutations associated with drug resistance in P.jiroveci isolates in Guangdong remain uncommon.CYB gene shows gene polymorphisms and can be selected as one of targeted genes for multilocus sequence typing.