Objective To investigate the role of phosphatidyl-inositol 3-kinase-Akt (PI3k-Akt) signal pathway in the attenuation of ischemia-reperfusion (I/R) injury by sevoflurane preconditioning in isolated rat hearts. Methods Ninety-six adult male SD rats weighing 220-280 g were randomly divided into 6 groups ( n = 16 each): sham operation group (group S); I/R group; sevoflurane preconditioning group (group SP); wortmannin group (group W); dimethyl sulfoxide (DMSO) group (group D) and sevoflurane preconditioning + wortmannin group (group SW) . Their hearts were excised and perfused in a Langendorff apparatus with K-H solution saturated with 95%O2-5%C02 at 37 ℃ . The hearts were continuously perfused for 180 min in group S. After 15 min of equilibration, the isolated hearts were subjected to 30 min of ischemia followed by 120 min of reperfusion in SP, W, D and SW groups. Croups SP, W, D and SW received 10 min of perfusion with K-H solution containing 2. 4% sevoflurane, 100 nmol/L wortmannin, 20 μmol/L DMSO, and 2.4% sevoflurane + 100 nmol/L wortmannin, respectively, followed by 5 min washout before I/R. Eight hearts in each group were selected and HR, left ventricular end-diabetic pressure (LVEDP), left ventricular developed pressure (LVDP), and ± dp/dtmax were recorded at the end of equilibration and at 15 min of reperfusion, Myocardial tissues were obtained at 15 min of reperfusion for determination of apoptosis (by TUNEL) and phosphorylated Akt (p-Akt) expression (by Western blot) . Another 8 hearts were selected at 120 min of reperfusion for determination of myocardial infarct size by TTC staining. Result Compared with group S, LVDP and ± dp/dt,^ were significantly decreased and LVEDP was significantly increased in groups I/R, SP, W, D and SW, and myocardial p-Akt expression was up-regulated in groups I/R, SP and D ( P ＜ 0.05). Compared with group I/R, LVDP and ± dp/dtmax were significantly increased, LVEDP and apoptosis index were significantly decreased, myocardial p-Akt expression was up-regulated, and myocardial infarct size was significantly reduced in group SP (P ＜0.05) . Conclusion Activation of PI3K-Akt signal pathway is involved in the attenuation of I/R injury by sevoflurane reconditioning in isolated rat hearts.

Objective To investigate the stability of 1% lauromacrogol foam sclerosant prepared with different liquid-to-air ratio in order to find out the optimal liquid-to-air ratio. Methods According to Tessari technique, two 10 ml disposable plastic syringes and one three-way plastic stopcock were used to mix 1%lauromacrogol with room air, and liquid-to-air ratios from 1∶1 to 1∶9 were separately employed to make the preparation of the foam sclerosant. Each kind of liquid-to-air ratio was used to separately make bubbles for 5 times, the foam half-life time (FHT), the foam drainage time (FDT) and the foam coalescence time (FCT) were recorded, and their mean values were calculated. The optimal liquid-to-air ratio was defined as the intermediate values of all the above measured indexes. Results When the liquid-to-air ratio was 1 ∶ 1, 1 ∶2, 1 ∶ 3, 1 ∶ 4, 1 ∶ 5, 1 ∶ 6, 1 ∶ 7, 1 ∶ 8 and 1 ∶ 9, the FHT of 1% lauromacrogol foam sclerosant was 184.8, 169.3, 135.9, 110.8, 111.5, 92.6, 76.3, 74.7 and 49.9 seconds respectively; the FDT was 10.6, 17.8, 14.6, 13.7, 13.0, 12.3, 10.7, 11.5 and 12.6 seconds respectively; while the FCT was 108.4, 79.8, 41.8, 20.3, 10.4, 0, 0, 0 and 0 seconds respectively. Conclusion Based on Tessari technique, the indoor air, two 10 ml disposable plastic syringes and one three-way plastic stopcock are used to prepare 1%lauromacrogol foam sclerosant, and the optimal liquid-to-air ratio is 1 ∶ 2.

Objective To identify the morphological parameters that are related to intracranial aneurysms (IAs) rupture using a case-control model. Methods A total of 107 patients with multiple IAs and aneurysmal subarachnoid hemorrhage between August 2011 and February 2017 were enrolled in this study. Characteristics of IAs location, shape, neck width, perpendicular height, depth, maximum size, flow angle, parent vessel diameter (PVD), aspect ratio (AR) and size ratio (SR) were evaluated using CT angiography. Multiple logistic regression analysis was used to identify the independent risk factors associated with IAs rupture. Receiver operating characteristic curve analysis was performed on the final model, and the optimal thresholds were obtained. Results IAs located in the internal carotid artery (ICA) was associated with a negative risk of rupture, whereas AR, SR1 (height/PVD) and SR2 (depth/PVD) were associated with increased risk of rupture. When SR was calculated differently, the odds ratio values of these factors were also different. The receiver operating characteristic curve showed that AR, SR1 and SR2 had cut-off values of 1.01, 1.48 and 1.40, respectively. SR3 (maximum size/PVD) was not associated with IAs rupture. Conclusions IAs located in the ICA are associated with a negative risk of rupture, while high AR (>1.01), SR1 (>1.48) or SR2 (>1.40) are risk factors for multiple IAs rupture.

This paper introduces the present application situation of medical consumable materials in consumption, use, quality control and computer management. It presents the concrete contents of standard management in quality guarantee, rules and regulations, and cost reduction.
Costs and Cost Analysis ; Disposable Equipment ; economics ; standards ; Quality Control

Objective To describe the techniques of fluoroscopy-guided foam sclerotherapy for lower extremity varicosities, and evaluate the feasibility, safety and curative effects of it. Methods From October 2008 to December 2009, a total of 21 legs in 16 patients with lower extremity varicosities received radiological-guided foam sclerotherapy. They were enrolled in this study. Sodium morrhuate was foamed with by the filling-defects technique under fluoroscopy guidance. Postoperative compression was maintained for 2 weeks. Clinical effect was assessed as full success, partial success and no success. Complications were classified as minor or serious. Results The technical procedure was successful in all foam sclerotherapies for 21 legs. And, a single sclerotherapy session was adequate for all legs. The median follow-up period was 6. 0 months after treatment, ranged from 3.0 to 17.0 months. In this period, Clinical effect was assessed as full success for 17 legs (81.0%) and partial success for 4 legs ( 19.0% ). All patients presented selflimiting minor complications, including cordlike subcutaneous indurations along the treated veins (21 cases), skin hyperpigmentation in 11 legs (8 cases), local pain in 7 legs (6 cases) and superficial thrombophlebitits in one leg ( 1 case). No serious complications or systemic events occurred. Conclusion Fluoroscopy-guided foam sclerotherapy was a feasible, safe and effective treatment for lower extremity varicosities.

Objective    To investigate the multidisciplinary management of patients with acute type A aortic dissection in late pregnancy. Methods    The clinical data of 3 patients admitted to the Second Affiliated Hospital of Army Medical University from 2018 to 2019 were analyzed. Their age ranged from 27 to 32 years, while gestational age was 34-37 weeks. Sudden chest pain was the main clinical symptom before operation. All 3 patients underwent Bentall surgery after cesarean section under general anesthesia, of whom 2 patients received total arch replacement (TAR) combined with frozen elephant trunk (FET) implantation and 1 received coronary artery bypass grafting (CABG) additionally. Results    No patient died during the perioperative period, and all the newborns were delivered successfully and survived healthily. The ICU stay was 3-5 d. The postoperative hospital stay was 15-18 d. The follow-up was 250-751 d. There was no recurrence or death. One patient who developed spontaneous pneumothorax and hydropneumothorax was cured in our center. Conclusion    The multidisciplinary diagnosis and treatment strategy plays a crucial role in saving the life of pregnant patients with acute type A aortic dissection.

AIMThe effects of angiotensin II on the changes of Ca2+ signal in cultured rat neonatal myocytes were investigated in order to reveal the localization and distribution of elementary Ca2+ signaling units.

METHODSThe cultured neonate rat myocytes were treated with angiotensin II, and calcium signal was detected using confocal laser scanning microscopy and fluo-4/AM calcium probe.

RESULTSThe propagation of Ca2+ waves was observed in rest and angiotensin II stimulated cardiac myocytes. Calcium fluorescent intensity oscillated slightly in myocytes and the average intensity was much higher in the nucleus than in the cytosol, all of which could be magnified significantly by AngII (10(-6) mol/L). Ca2+ oscillation induced by Ang II was completely blocked by NO donor sodium nitroprusside. AngII evoked Ca2+ sparks close to the cell surface membrane, and couldn't be abolished by sodium nitroprusside.

CONCLUSIONThere are spatiotemporal dynamics of Ca2+ signaling patterns such as Ca2+ wave, Ca2+ spikes, Ca2+ oscillation and the whole cell Ca2+ transients induced by angiotensin II, which might play very important roles in cellular cardiac function.

Angiotensin II ; pharmacology ; Animals ; Calcium ; metabolism ; Calcium Signaling ; Cells, Cultured ; Microscopy, Confocal ; Myocytes, Cardiac ; drug effects ; metabolism ; Rats

Objective To investigate the changes in oxygen delivery (D02) to the body and brain and its compensatory factors to acute hypoxia and their relation to acute mountain sickness (AMS). Methods One hundred and forty-seven participants were recruited from Chinese young men who had lived in plain all along arrived in Tibet by flight. All of them were asked to complete an AMS questionnaire within 48h after arrival. The resting heart rate (HR), blood pressure (BP), cardiac output (CO), oxygen saturation (Sa02), stroke volume (SV) and blood flow velocity in the middle cerebral artery (MCAv) were measured one week before departure from the plain and within 48h after arrival in Tibet. AMS was diagnosed according to Louis Lake Score System (LLS), and the results were then statistically analyzed. Results AMS was diagnosed in eighty-six subjects (58.5%). After exposure to hypoxia, Sa02 was decreased by 10% and was negatively correlated with AMS score. Systemic D02, CO and HR were increased by 19%, 32.5% and 31.7%, respectively, and were positively correlated with AMS, while the SV remained unchanged. MCAv accelerated by 10%, and that of AMS subjects was higher than of non-AMS ones. The cerebral D02 (D02C) was maintained because the MCAv matched with Sa02 changes. The middle cerebral artery resistance units (RMCA) decreased obviously with an increase in MBP, and RMCA in AMS subjects was lower than that in non-AMS ones. HR and MCAv, the key compensation factors of D02, were used as the objective evaluation indices, in collaboration of HR≥85 beat/min and MCAv≥66cm/s, could be a better means to evaluate AMS, with a positive predictive value of 82.4% and specificity of 90.2%. Conclusions D02 and its compensatory factors may play a key role in the regulation response to acclimatize to acute hypoxia. Among them, HR and MCAv may relate to the mechanism of AMS development, and indirectly reflect the compensation level to oxygen debt, implying that HR and MCAv are helpful in the assessment of AMS.

Objective To observe the changes in oxygen metabolism and sonic hedgehog (SHH) signaling pathway in soldiers returning to plains after being stationed and trained for 6 months in a plateau. Methods Eighty male officers and soldiers, aged 20-30 (22.3 ± 2.9) years, after being stationed and trained on plateau (altitude 3960m) for 6 months and returned to plain region (altitude 200m), were selected as subjects. Before their returning to plateau, 6 months after their station and training in plateau, and 2 days after their returning to plain, fasting venous blood samples were collected, the serum levels of superoxide dismutase (SOD), malondialdehyde (MDA) and Sonic Hedgehog (SHH) were determined by ELISA, the transcription of SHH mRNA was assayed by RT-PCR, and the expressions of SMO and nucleoprotein GLI2 were detected by Western blotting. All the data mentioned above were collected for statistical analysis. Results As the subjects entered and garrisoned in plateau for 6 months, the activity of SOD decreased and the content of MDA increased significantly (P<0.05). Both the protein expression and mRNA transcription of SHH were significantly higher after staying in plateau than in plain. When they returned to plain, both parameters decreased significantly, but were still higher than that when they lived in plain (P<0.01). The expressions of SMO and nucleoprotein LI2 showed a same tendency of changes. Conclusion High altitude environment may have a great influence on oxygen metabolism of organism and SHH signal pathway, and the hypoxic environment of high altitude region is one of the conditions in activating the SHH signal pathway.

Recent evidence suggests Toll-like receptor 4 (TLR4) and its accessory protein MD2 mediate endotoxin/lipopolysaccharide (LPS) signaling. LPS binds to LPS binding protein (LBP) in plasma and is delivered to CD14. Next, LPS is transferred to TLR4-MD2 complex. LPS activates several intracellular signaling pathways that include the NF-κB pathway and three mitogen-activated peotein kinase (MAPK) pathway: extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK) and p38. These signaling pathways in turn activate NF-κB and AP-1 (c-fos/c-jun), which coordinate the induction of many genes encoding inflammatory mediators. Targeting the signaling molecule in the pathway will develop new remedies for treatment of inflammatory disorder.