Objective To evaluate the effect of remifentanil on Toll-like receptor 2 (TLR2) mRNA expression during renal ischemia-reperfusion (Ⅰ/R) in rats.Methods Fifty-four male Sprague-Dawley rats,weighing 200-250 g,were randomly divided into 3 groups (n=18 each) using a random number table:sham operation group (group S),Ⅰ/R group and remifentanil group (group R).Renal Ⅰ/R injury was produced by clamping the bilateral renal arteries for 45 min followed by reperfusion in Ⅰ/R and R groups.Bilateral renal arteries were only exposed but not clamped in group S.Remifentanil 1.0 μg · kg-1 · min-1 was infused via the tail vein starting from 15 min before ischemia until 30 min of reperfusion in group R,while the equal volume of normal saline was given instead in S and Ⅰ/R groups.The animals were sacrificed at 15 min before ischemia and 6 and 24 h of reperfusion,and the renal specimens were obtained for examination of the pathological changes (with light microscope) and for determination of the contents of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) (by ELISA) and expression of TLR2 mRNA (by RT-PCR) and cell apoptosis (by double staining and flow eytometry).The apoptotic rate was calculated.Results Compared with group S,TLR2 mRNA expression was significantly up-regulated,and the contents of TNF-α and IL-6 and apoptotic rate were increased at 6 and 24 h of reperfusion in Ⅰ/R and R groups.Compared with group Ⅰ/R,TLR2 mRNA expression was significantly down-regulated,and the contents of TNF-α and IL-6 and apoptotic rate were decreased at 6 and 24 h of reperfusion in group R.The pathological changes were significantly attenuated in group R as compared with group Ⅰ/R.Conclusion The mechanism by which remifentanil reduces renal Ⅰ/R injury is related to down-regulation of TLR2 expression and decrease in TLR2 activity and inhibition of inflammatory responses in renal tissues and cell apoptosis in rats.

Objective To investigate the effect of remifentanil on protein kinase C (PKC) activity during renal ischemia-reperfusion (I/R) in rats.Methods Seventy-five male Sprague-Dawley rats,weighing 250-300 g,were randomly divided into 5 groups (n=15 each) using a random number table:sham operation group (group S),I/R group,remifentanil group (group R),naloxone group (group N),and naloxone + remifentanil group (group NR).Renal ischemia was induced by clamping the bilateral renal arteries for 45 min using an atraumatic clamp followed by reperfusion.In R and NR groups,remifentanil 1.0 μg · kg-1 · min-1was infused via the caudal vein starting from 15 min before ischemia until 30 min of reperfusion.In N and NR groups,naloxone 0.3 mg/kg was injected via the caudal vein at 20 min before ischemia and 35 min of ischemia,respectively.The rats were sacrificed at 24 h of reperfusion and the kidneys were removed for determination of the ultrastructure of the renal tubular epithelial cells (using transmission electron microscope),activity of PKC in renal tissues (by ELISA),and expression of the PKC in renal tissues (by immuno-histochemistry).Results Compared with group S,the activity of PKC in renal tissues was significantly increased in the other four groups,and the expression of the PKC in renal tissues was up-regulated in group R.Compared with group I/R,the activity of PKC in renal tissues was significantlyincreased,the expression of PKC in renal tissues was up-regulated,and the pathological changes were attenuated in group R.Compared with group R,the activity of PKC in renal tissues was significantly decreased,the expression of PKC in renal tissues was down-regulated,and the pathological changes were aggravated in N and NR groups.Conclusion The mechanism by which remifentanil attenuates renal I/R injury may be related to up-regulation of PKC expression and increase in PKC activity through activating opioid receptors in rats.

OBJECTIVE To explore the pro-apoptotic mechanism of juglone in SiHa cells and to in?vestigate its associated signal transduction pathways. METHODS SiHa cells were treated with juglone 20μmol·L-1 for 24,48 and 72 h. Cellular morphology was detected by inverted microscopy.The cell viability was detected by methyl thiazolyl tetrazolium (MTT) assay. After 24 h treatment with juglone 20μmol·L-1,the cell apoptosis was detected by flow cytometry while the expressions of apopto?sis-related protein BCL-2,BAX and cleave-caspase-3,PI3K/AKt pathway-related protein PTEN,AKT and pAKT were detected by Western blotting. RESULTS After treatment with juglone for 24, 48 and 72 h,the growth of SiHa cells was significantly inhibited. Compared with cell control group,cells in juglone treated gruop were sparse,slipped off the wall,became round and the cell proliferation inhibitory rate was 43.3%,63.0%and 73.1%(P<0.05,P<0.01),respectively. Twenty-four hours post treatment, the early apoptosis rate of juglone treated gruop cells was increased by(6.47±1.79)%(P<0.01)compared with cell control group. Western blotting results showed that the expression of BCL-2 decreased by 53.0%while the expression of BAX and caspase-3 increased by 85.5%and 183.3%,respectively. The expression of PTEN was increased by 75.0% but the pAKt was decreased by 45.8%(P<0.01). CONCLUSION Juglone can upregulate the expression of PTEN, thus inhibiting PI3K/AKt pathway and promoting apoptosis of SiHa cells.

Objective To study the effect of blood glucose fluctuations on the prognosis of thrombolytic therapy in patients with acute cerebral infarction. Methods A total of 83 consecutive patients with acute cerebral infarction admitted to the Department of Neurology,General Hospital of Beijing Military Command ( the Affiliated 81st Brain Hospital ) from January to November 2013 were enrolled retrospectively. They were divided into cerebral infarction with type 2 diabetes mellitus group (DMCI group,n=47) and cerebral infarction without type 2 diabetes mellitus group (NDMCI group,n=36) according to whether they had diabetes mellitus or not and the results of oral glucose tolerance test at day 7 after admission. Continuous glucose monitoring system ( CGMS) was used to monitor glucose for 72 hours at day 7 after admission. The mean blood glucose, standard deviation of blood glucose level, mean blood glucose fluctuation,and hemorrhagic transformation during the follow-up period,as well as vascular recanalization were observed and compared. At day 90,the modified Rankin scale (mRS) score was used to evaluate the prognosis of the patients. Results ( 1 ) Comparing the dynamic glucose parameters of the patients with acute cerebral infarction in both groups,the mean blood glucose,standard deviation of blood glucose level,mean blood glucose fluctuations at 24 hours in patients of the DMCI group were higher than those of the NDMCI group ( 8 . 3 ± 2 . 6 mmol/L vs. 5 . 8 ± 1 . 3 mmol/L,2. 1 ± 0. 4 mmol/L vs. 1. 6 ± 0. 6 mmol/L,4. 3 ± 0. 8 mmol/L vs. 3. 6 ± 0. 5 mmol/L). There were significant differences (t=31. 419, 15.537,and 15. 372,respectively;all P<0. 01). (2) Four patients (8.5%) in the DMCI group had hemorrhagic transformation during the follow-up period,17 cases (36. 2%) had good recanalization,and 15 cases (31.9%) had good prognosis (the mRS score < 2 at day 90);1 patient (2.8%) in the NDMCI group had hemorrhagic transformation,21 patients (58. 3%) had good recanalization,and 21 cases (58. 3%) had good prognosis. There was significant difference between the recanalization after thrombolysis and the prognosis in patients of both groups (P<0. 05). Conclusion The great fluctuations of blood glucose in acute cerebral infarction patients with type 2 diabetes mellitus may be an important factor of affecting its prognosis of thrombolytic therapy.

Objective To evaluate the role of mitochondria-mediated apoptosis in hippocampal neurons in sevoflurane anesthesia-induced cognitive dysfunction in aged rats.Methods Sixty healthy male Sprague-Dawley rats,aged 20 months,weighing 550-600 g,were randomly divided into 2 groups (n =30 each) using a random number table:control group (group C) and sevoflurane anesthesia group (group S).Animals inhaled pure oxygen and 3 ％ sevoflurane for 4 h in C and S groups,respectively.Ten rats were chosen at 1 and 6 days after anesthesia and hippocampal tissues were obtained for detection of cell apoptosis and mitochondrial membrane potential (MMP) (using flow cytometry) and expression of cytochrome c (Cyt c) in cytoplasm and activated caspase-3 in hippocampal neurons (by Western blot).The apoptotic rate was calculated.Results Compared with group C,the escape latency was significantly prolonged,the frequency of crossing the original platform,the percentage of time of staying at the original platform quadrant and MMP were decreased,the apoptotic rate was increased,and the expression of activated caspase-3 and Cyt c in cytoplasm was up-regulated in.group S.Conclusion The mechanism by which sevoflurane anesthesia induces cognitive dysfunction is related to the activation of mitochondria-mediated apoptosis in hippocampal neurons of aged rats.

Objective To evaluate the effect of preconditioning with nimodipine on postoperative cognitive dys function of aged rats.Methods Ninety healthy male Sprague-Dawley rats,aged 18 months,weighing 400-500 g,were randomly divided into 3 groups (n =30 each) using a random number table:nimodipine control group (group N),surgery group (group S),and nimodipine + surgery group (N+ S group).In N and N + S groups,nimodipine 1 mg/kg was intraperitoneally injected,while the equal volume of normal saline was given instead in S group.30 min later,group N inhaled pure oxygen for 2 h,and S and N + S groups inhaled 1.8 ％ isoflourane for 2 h when splenectomy was performed.Morris water maze test was performed on 1 day before operation and 1st,3rd and 7th days after operation.After the end of Morris water maze test at 1 day before operation and 1st and 7th days after operation,10 rats were sacrificed and brains were removed and hippocampi were isolated for determination of apoptosis in hippocampal neurons,intracellular [Ca2+] i in cytoplasm,and hippocampal Bcl-2 and Bax mRNA expression and for examination of ultrastructure of hippocampal neurons.Results Compared with the value before administration,the escape latency was significantly prolonged,the frequency of crossing the original platform was decreased,apoptotic rate and [Ca2+]i were increased,Bcl-2 mRNA expression was down-regulated,and Bax mRNA expression and Bax/Bcl-2 mRNA ratio were up-regulated at each time point after operation in S and N + S groups,and no significant changes were found in the parameters mentioned above in N group.Compared with group S,the escape latency was significantly shortened,the frequency of crossing the original platform was inecreased,apoptotic rate and [Ca2+]i were decreased,Bcl-2 mRNA expression was up-regulated,and Bax mRNA expression was down-regulated at each time point after operation in group N + S.Pathological changes were found in S and N + S groups and the damage was severer in S group than in N + S group.Conclusion Nimodepine preconditioning can prevent postoperative cognitive dysfunction of aged rats,and inhibition of calcium overloadinduced apoptosis in hippocampal neurons may be involved in the mechanism.

Objective To access the effectiveness of withdrawing iodized salt on correcting the iodine excess in the population living in high iodine areas.Methods Before withdrawing iodized salt,2 twons were selected from each of 5 cities with water-borne iodine excess areas in Hebei province.All the selected towns were divided into 7 groups according to their iodine content in drinking water.Two villages wereselected from each group where urine samples of children aged 8 to 10 years old were collected to investigate the change of urinary iodine content of these children before and after withdrawing iodized salt.The urinary iodine content was determined using the method for determination of ammonium persulfate digestion arsenic cerium catalytic spectrophotometry (WS/T 107-2006).Correlation between children's urinary iodine and drinking water iodine was analyzed.Results Before and after withdrawing iodized salt,744 and 771 urine samples were collected from the examined children aged 8-10 years respectively.The overall median urinary iodine content (MUIC) of the examined children after withdrawing iodized salt (350.1 μg/L) decreased significantly than that of before withdrawing iodized salt (460.8 μg/L,U =3 127.8,P ＜ 0.05).After withdrawing iodized salt,the MUIC of the children decreased significantly in 8 of 12 villages (P ＜ 0.05).Before and after withdrawing iodized salt,the percentage of urine samples with iodine content above 300 μg/L was 76.7％ (571/744),58.5％ (451/771) respectively,with significant statistical difference (x2 =57.7,P ＜ 0.05).After withdrawing iodized salt,Children's MUIC also decreased significantly across gender and age (boys:558.5,351.6 μg/L,U =960,P ＜ 0.05; girls:522.9,355.5 μg/L,U =698,P ＜ 0.05; 8 years old:536.0,295.5 μg/L,U =529.5,P ＜ 0.01; 9 years old:386.2,323.2 μg/L,U =753.5,P ＜ 0.01; 10 years old:525.5,368.8 μg/L,U =521.5,P ＜ 0.05).The children's MUIC correlated positively with the median water iodine contert (MWIC) in the villages where they lived (r =0.951,P ＜ 0.01).Analyzed by linear regression,approximately 89％ of the variability in MUIC was associated with variability in MWIC.Conclusions Withdrawing iodized salt could only correct the iodine excess caused by consuming iodized salt in the population living in the areas with MWIC below 100 μg/L.In the areas with water iodine above 100 μg/L,intervention should be focused on seeking water with proper iodine content.

Objective To explore the changes of mineral and bone metabolism before and after renal transplantation as well as the effect of preoperative parathyroid hormone (PTH) level on postoperative mineral and bone metabolism.Methods In this retrospective analysis,we recruited 82 cases of renal transplant recipients with normal renal function and receiving kidney transplantation in our hospital from January 2011 to January 2015.All of these patients had intact PTH (iPTH) level ＞300 pg/mL.We chose 26 cases of recipients whose preoperative iPTH was more than or equal to 800 pg/mL as very high PTH group,and 56 cases of recipients whose preoperative iPTH was between 301-799 pg/mL as high PTH group.We monitored and performed analysis of the total serum calcium (Ca),serum inorganic phosphorus (P),25-(hydroxyl) vitamin D3 (25 OHD),serum alkaline phosphatase (ALP),Beta C-terminal telopeptide (β-CTX),N-terminal/midregion (N-MID) pre-and 1 month,4 months,1 year,2 years,3 years post-kidney transplantation.Results Serum total calcium in the two groups was gradually increased,returned to normal range 1 month post-transplantation and reached the plateau 4 months post-transplantation.The incidence of hypercalcemia in very high PTH group was statistically significantly higher than in high PTH group.Serum phosphorus in the two groups showed a trend of gradual decline after renal transplantation,and returned to the normal range 1 month post-transplantation.The serum phosphorus level in very high PTH group reached the plateau 4 months post-transplantation,and that in high PTH group 1 month post-transplantation.Compared with high PTH group,very high PTH group has greater The incidence of long-term hypophosphatemia after renal transplantation was significantly higher in very high PTH group then in high PTH group.iPTH,ALP,β-CTX and N-MID in the two groups showed a downward trend after renal transplantation.At first month post-transplantation,iPTH,ALP,β-CTX and N-MID levels were reduced most significantly.The average levels of the three mentioned indicators in very high PTH group were higher than in high PTH group at every time point after surgery with the difference being significant during the early post-transplantation period.The anomalies of iPTH and β-CTX levels persisted to long term after transplantation in very high PTH group.25-OHD levels in these two groups showed rising trend after renal transplantation,reached the plateau 4 months posttransplantation,but failed to achieve the ideal reference level,and no significant difference was found between two groups at any time point monitored.Conclusion The anomalies of mineral and bone metabolism after renal transplantation could persist a long time.Conclusion hyperparathyroidism in the renal transplantation plays an important role in mineral and bone metabolism.Preoperative severe HPT could continue to post-transplantation period and increase the incidence of hyperphosphatemia and hypocalcemia long term after transplantation,which may aggravate bone turnover and this effect can last a long time after transplantation.

Objective: To analyze the hints role of surveillance cultures of Carbapenem-resistant Enterobacteriaceae (CRE) by perianal swabs in patients with hematological diseases, and seek risk factors of CRE bloodstream infection. Methods: The resistance of CRE from 2 914 patients with hematological diseases who cultured perianal swabs, CRE bloodstream infection and risk factors were analyzed during January 2016 to December 2017. Results: In this study, perianal swabs from 2 914 patients with hematological diseases were cultured, 74 patients were CRE positive, and bloodstream infection with CRE was found in 13 of these patients. A total of 87 CRE strains were isolated (The same patient only keep the first one for the same location), including 31 Klebsiella pheuminiae, 43 Escherichia coli, 8 Enterobacter cloacae and 6 other Enterobacteriaceae. The resistance rates to piperacillin / tazobactam, imipenem, meropenam, amikacin, levofloxacin, tigecycline were 91.9%, 74.4%, 98.8%, 17.6%, 74.4% and 8.0%, respectively. Resistance to carbapenem, aminoglycoside, quinolones and tegacycline were highly consistent between two sites from 13 patients, whose both perianal swabs and blood were positive in CRE cultures. Febrile neutropenic time, digestive tract symptoms and perianal infection were independent risk factors for bloodstream infection in patients with perianal swabs positive results, the odds ratios (OR) were 1.10 (P=0.029), 1.13 (P=0.005) and 1.23 (P=0.016), respectively. Conclusion Perianal swabs surveillance cultures of CRE can be hints for CRE bloodstream infection in patients with hematological diseases, and also can provide suggestions for antibiotics. Long time of febrile neutropenic, digestive tract symptoms and perianal infection can be the early warning for CRE bloodstream infections.

Objective:To systematically evaluate the psychological experience of cancer bereaved, so as to provide basis for bereavement care and intervention.Methods:Qualitative studies on the emotional experiences of cancer bereaved were searched in PubMed, Embase, Cochrane Library, CINAHL, China National Knowledge Infrastructure, WanFang Data, VIP, and China Biomedical Database. The search period was from database establishment to July 2023. The quality evaluation was conducted using the 2020 version of the quality evaluation criteria for qualitative research of the Joanna Briggs Institute Evidence-Based Health Care Center, and the results were integrated using the Meta-synthesis.Results:A total of 11 studies were included, 44 research results were extracted, and 8 new categories and 3 integrated results were summarized, namely the differences in grief emotions after bereavement, grief coping, and support needs after bereavement.Conclusions:The psychological experience of bereaved is relatively complex, and their grief emotions vary. Medical and nursing staff should pay attention to the grief response of the bereaved, guide them to self-adjustment, attach importance to the needs of the bereaved, and provide social support to assist them in returning to society as soon as possible.