Cerebral hyperperfusion syndrome (CHS) is one of the complications after stenting in patients with carotid stenosis.Although its incidence is lower,it may result in serious disability or death in patients.Full awareness and understanding of CHS and its related risk factors may contribute to its prevention and treatment.

Objective To investigate protective effects of the hydrogen saturated saline on acute lung injury and pulmonary fibrosis in rats with paraquat (PQ) poisoning. Method Forty-eight Sprague-Dawley rats were randomly divided into 3 groups, namely control group, PQ poisoning group and intervention group (n = 16 rats in each group) . Animals in PQ poisoning group and intervention group were fed with PQ in dosage of 50 mg / kg. Rats of control group were fed equivalent amount of distilled water instead. One hour after administration of PQ, rats of intervention group were treated with 5 ml / kg hydrogen saturated saline injected intra-peritoneally twice a day until the rats were sacrificed. The rats of poisoning group and control group were treated with intra-peritoneal injection of equivalent amount of normal saline. Arterial partial pressure of oxygen ( PaO2 ), 8-hydroxy-2' -desoxyguanosine (8-OHDG) and transforming growth factor β1 (TGF-β1) of lung tissue were measured on the 3rd and 21st day after PQ administration. Quantitative data was expressed as mean ±standard deviation (x-±s) . SPSS version 12. 0 package was applied for variance analysis and SNK-q test, and statistical differences were considered significant when P ＜ 0. 05. Results ① PaO2 decreased significantly in poisoning group (9. 34 ± 0. 47 kPa) and intervention group (10. 30±0.62 kPa) compared with control group (11.87 +/- 0.42 kPa) on the 3d (P ＜0.01), and as intervention group was compared with poisoning group, there was a significant difference ( P ＜ 0. 05 ) . On the 21st day, PaO2 was still lower in poisoning group (8. 36 ±0. 51 kPa) and intervention group ( 10. 14 ±0. 27 kPa) than that in control group ( 11.87 +0. 24 kPa) (P ＜0. 01 and P ＜0. 05, respectively), and as intervention group was compared with poisoning group, there was a significant difference ( P ＜ 0. 01 ) . ②The levels of 8-OHDG in lung tissue increased significantly in poisoning group (23.58±7. 18 ng/ml ) and intervention group (9. 49± 2. 45 ng/ml) on the 3rd day after PQ administration compared with control group (7.71 + 1.96 ng/ml) (P＜0. 01 and P＜0. 05, respectively), and as intervention group was compared with poisoning group there was a significant difference ( p ＜0. 01 ) . There were no significant differences in 8-OHDG level found among the groups on the 21st day after PQ administration (P ＞ 0. 05 ) . ③ The level of TGF-β1 (measured by mean optic density, MOD) in lung tissue of rats in poisoning group ( 10. 11±2.49 MOD) and intervention group (8. 14 + 1.58 MOD) exhibited in higher levels than control group (5.93 + 1. 98 MOD) on the 3rd and (5.97 + 2. 35 MOD) on the 21st day after PQ administration (P ＜0. 01 and P ＜0. 05, respectively), and however, a lower level of TGF-β1 was observed in intervention group on 3d and 21d compared with poisoning group (P ＜0. 05 and P ＜0. 01, respectively) . Conclusions Hydrogen saturated saline can alleviate oxidative stress, mitigate oxidative damage and inhibit pulmonary fibrosis of lung induced by PQ intoxication.

Objective To investigate clinical features and risk factors for recurrent syncope in children with orthostatic intolerance.Methods Patients with orthostatic intolerance and syncope admitted in the Second Hospital of Lanzhou University from January 2014 to June 2015 were retrospectively analyzed by using t test,Chi -square test,and Fisher′s exact probability method.According to frequency of syncope,all cases were divided into 2 groups,the occasio-nal syncope group and the recurrent syncope group.All risk factors including age,gender,body mass index(BMI),in-ducement,the history of motion sickness,family history,syncope -related injuries,performance of head -up tilt table test,and outcomes of head -up tilt table test were studied statistically and compared within 2 different groups.Results A total of 83 cases were enrolled in this study.Among these children,33 cases(39.76%)were assigned as occasio-nal syncope group,in which 17 cases were male and 16 cases were female and the age ranged from 6 to 18 years with the average age of (9.70 ±2.87)years;50 cases(60.24%)were assigned as recurrent syncope group,in which 27 ca-ses were male and 23 cases were female and the age ranged from 6 to 18 years with the average age of (11.24 ±2.83) years.Of all the investigated risk factors,the BMI and the history of motion sickness were significantly different between 2 groups[(18.84 ±3.49)kg/m2 vs (18.16 ±3.68)kg/m2 ,t =4.82,P =0.001;39.39%(13 /33 cases)vs 70.00%(35 /50 cases),χ2 =7.64,P =0.006].No significant difference was found in age distribution(6 -9 years,10 -14 years,15 -18 years)between 2 groups(P =0.428).There were no significant differences in gender (male /female), family history,or syncope -related injuries between 2 groups[17 /16 cases vs 27 /23 cases;3.03%(1 /33 cases)vs 10.00%(5 /50 cases);15.15%(5 /33 cases)vs 20.00%(10 /50 cases),all P >0.05].And no significant difference was found in inducement (prolonged standing,body posture change,emotional stress/emotional stimuli,muggy environ-ment,movement)between 2 groups [78.79% (23 /33 cases)vs 72.00% (36 /50 cases);9.09% (3 /33 cases)vs 14.00%(7 /50 cases);3.03%(1 /33 cases)vs 6.00%(3 /50 cases);12.12% (4 /33 cases)vs 10.00% (5 /50 cases);3.03%(1 /33 cases)and 12.00%(6 /50 cases),all P >0.05].And performances of head -up tilt table test (blurred vision/blacked out,nausea/vomiting,sweating,dizzy/headache,palpation,anhelation /chest tightness,hot, weak)between 2 groups showed no significant differences[18.18%(6 /33 cases)vs 12.00%(6 /50 cases);36.36%(12 /33 cases)vs 50.00%(25 /50 cases);24.24%(8 /33 cases)vs 26.00%(13 /50 cases);51.52%(17 /33 cases) vs 58.00%(29 /50 cases);6.06%(2 /33 cases)vs 16.00%(8 /50 cases);27.27%(9 /33 cases)vs 22.00%(11 /33 cases);33.33%(11 /33 cases)vs 32.00%(16 /50 cases);12.12%(4 /33 cases)vs 16.00%(8 /50 cases),all P >0.05].Also there were no significant differences in outcomes of head -up tilt table test between 2 groups(P =0.589). Conclusions The risk factors for recurrent syncope in children with orthostatic intolerance were low BMI and the his-tory of motion sickness for such children,and more positive and effective clinical intervention can improve the living quality of children with orthostatic intolerance to some extent.

Objective To elucidate cerebral cortical response to esophageal acid exposure in normal individuals by functional magnetic resonance imaging (fMRI) and the characteristics of activity. Methods Fifteen volunteers were received intraesophageal perfusion with either 0.9% of sodium chloride or acid (0.1 mmol/L HC1) solutions. The modified block-design model of fMRI scanning was performed simultaneously. All of 32 minutes were needed for resting (A, 8 minutes), 0.9% of sodium chloride perfusion (B,8 minutes), acid perfusion (C,8 minutes) and 0.9% of sodium chloride perfusion again (D,8 minutes). Each chunk was consisted of 160 scans and every scan contained 3 seconds. Six hundred and forty scans were collected in all. The clinical response to esophageal acid exposure was observed and the changes in the cerebral regions was statistically analyzed. Results After perfusion of 0.9% of sodium chloride or acid, 10 out of 15 volunteers had chemosensitive complaints, such as pain in pars laryngen pharyngis, heartburn and chest complaint. The initial active domains involved deutocerebrum, anterior part of callosal gyrus, left side of insula, two sides of amygdale and subiculum hippocampi, two outers of forehead cortex. The provoked regions of acid perfusion (C-A) and 0.9% of sodium chloride perfusion again (D-A) were as same as that of the activated domains by initial perfusion of 0.9% sodium chloride (B-A). The intensity and amplitude of most provoked regions increased gradually(D-A> B-A, P< 0.01). Conclusions The two different stimulations of saline and acid provoke similar cerebral regions that may act in the regulation of esophageal sensitivity. There are the evidences of the central mechanism of esophageal visceral hypersensitivity by acid perfusion.

ObjectiveTo investigate the risk factors for syncope in children with orthostatic intolerance (OI).Methods The clinical data from 136 children with OI were retrospectively analyzed. The children were divided into syncope group and non-syncope group based on the existence of syncope. Results Among the 136 children, 77 children (56.62%) had syncope and 59 children (43.38%) did not have syncope. The differences in BMI, prevalence of inducement of prolonged standing, prevalence of accompanied symptoms of blurred vision/ blacking out, cold sweating and pallor, prevalence of the history of motion sickness and blood flow velocity of MCA were statistically significant between two groups (P<0.05). Conclusions Children with OI who has low BMI, inducement of prolonged standing, accompanied symptoms of blurred vision/ blacking out, cold sweating and pallor, the history of motion sickness, and fast blood flow velocity of MCA, are prone to syncope.

Objective To detect the influence of miRNA-34a (miR-34a) on the proliferation of osteosarcoma and the mechanisms responsible for miR-34a regulation.Methods The osteoblastic cell line MG-63 and Saos-2,human osteoblastic cell line hFOB 1.19,10 osteosarcoma tissues and 10 normal bone tissues were selected.The expression of miRNA-34a in osteosarcoma cells and tissues was detected by quantitative real-time polymerase chain reaction (qPCR).Next,a eukaryotic expression vector named pcDNA/miR-34a was constructed.Then,osteosarcoma cells were transfected with this eukaryotic expression vector and the effects of miR-34a overexpression on the proliferation and growth of osteosarcoma were measured using CCK-8,colony formation and xenograft model of nude mice.Finally,Western blot analysis was used to detect the expression of ether-à-go-go 1 (Eag1) gene in osteosarcoma cells after transfected with pcDNA/miR-34a or a miR-34a inhibitor miR-34a-2'-O-Methyl antisense oligoribonucleotide (miR-34a-2'-O-Me).Results Compared with normal bone tissues and osteoblastic cell line,miR-34a was down-regulated in osteosarcoma cell lines and tissues.Compared with the blank group and the control group,the cell survival rates of miR-34a group of the two cell lines were significantly lower [MG-63 72 h:blank group (40.05±4.82) ％,control group (36.88± 4.66) ％,miRNA-34a group (26.24±6.22) ％;MG-63 96 h:blank group (83.55±5.95) ％,control group (80.13± 4.48) ％,miRNA-34a group (30.21±7.26) ％;Saos-2 72 h:blank group (46.45±8.15) ％,control group (43.33± 6.89) ％,miRNA-34a group (26.81±3.17) ％;Saos-2 96 h:blank group (84.79±4.10) ％,control group (80.14± 3.11) ％,miRNA-34a group (31.77±5.17) ％].The similar results were obtained from colony formation assay (MG-63:blank group 83.40±3.29,control group 80.00±3.06,miR-34a group 24.40±2.71;Saos-2:blank group 85.00±3.32,control group 80.60±3.29,miR-34a group 30.40±4.94).The tumor volumes of osteosarcoma xenograft in the miR-34a group was significantly smaller than that in the blank group and control group after 21 days treatment (all P ＜ 0.001).Overexpression of miR-34a could decrease Eag1 expression in osteosarcoma cell lines while inhibition of miR-34a induced the of expression Eag1 (P ＜ 0.001).Conclusion MiR-34a plays a tumor suppressor role in osteosarcoma and could suppress the proliferation and growth of osteosarcoma through the regulation of Eag1.Moreover,it may be a novel target for osteosarcoma therapy.

The construction of featured specialties is the current development strategy of community health service institutions to improve the service scope and to meet the health needs of residents. The rehabilitation medicine has undergone 12 years of development and become a relatively mature featured specialty in Fenglin Community Health Service Center. Based on the Fenglin′s experience, this article discusses the development status and restriction bottlenecks of general practice, and the development status and trend of rehabilitation medicine in the community; and also explores the integrated development model of community-featured specialty with general practice.

Objective To research the efficiency of short time intermittent veno-venous hemofiltration (SIVVH)on acute respiratory distress syndrome(ARDS). Methods Totally 95 patients suffered ARDS between January 2014 and October 2016 in the emergency intensive care unit(EICU)were divided to SIVVH group(n =37)and control group(n = 58). The SIVVH group received traditional therapy and SIVVH therapy,and control group traditional therapy. Vital signs,oxygenation index,APACHEⅡ scores between two groups before the treat-ment were compared. Vital signs,oxygenation index,APACHEⅡ scores,time of mechanical ventilation,length of stay of EICU and 28 day mortality between two groups after the treatment were compared. Results In two groups,vital signs,oxygenation index and APACHEⅡscores before the treatment showed no significant difference (P > 0.05). In SIVVH group ,heart rate and respiratory frequency on the 24th ,48th ,72nd and 120th hour were descended significantly when compared with those in control group(P < 0.05);body temperature on the 24th and 48th hour were descended obviously when compared with those in control group(P < 0.05);the oxygenation index on the 24th,48th,72nd and 120th hour were raised(P < 0.05);APACHEⅡ scores on the 72nd and 120th hour were lower than those in control group(P<0.05). There were shorter time of mechanical ventilation and length of stay of ICU in SIVVH group when compared with control group(P<0.05),but the 28 day mortality in SIVVH group was not lower when compared with that in control group(P>0.05). Conclusions SIVVH can improve the function of lung in ARDS,decrease the time of mechanical ventilation and the length of stay of ICU,and possible becomes an important adjunctive therapy.

Community health institutions have entered a new development stage of featured specialty construction. After 12 years of development, rehabilitation medicine now is the featured specialty of Fenglin Community Health Service Center. This article presents the train of thought and key points of specialty construction in primary care institutions based on the Fenglin′s experience. The positioning of featured specialty should be based on the community. The construction process should include 7 elements, namely, the standard operation procedure(SOP)of service system construction, the detailed publicity and implementation of the collaboration of specialists, prevention and control knowledge promotion for general practitioners, prevention and control knowledge education for community residents, service list, clinical efficacy evaluation, and clinical database. In the later iterations, the head of the department should always focus on the service system construction SOP and clinical database construction, and the rest parts can be assigned to the relevant team members.

Objective To compare the effectiveness and safety of ketamine and etomidate for rap-id sequential intubation.Methods Randomized controlled trials and cohort studies with ketamine and etomidate for RSI in patients with acute and critical illnesses published by China National Knowledge Infrastructure,Wanfang Data,VIP Network,PubMed,Embase,Cochrane Library and Clinicaltrials.gov from the date of database creation to May 1,2023 were searched by computer.The literatures were screened according to inclusion and exclusion criteria,and the data of literatures were also extracted for quality assessment.Meta-analysis was performed by RevMan 5.3 software.Results A total of 15 literatures with 20 839 patients were included,including 3 RCT studies and 12 cohort studies.Meta-a-nalysis showed that there were no significant differences in the success rate of primary intubation(RR=0.99,95％CI,0.98 to 1.00,P=0.10),incidence of cardiac arrest(RR=1.00,95％CI,0.62 to 1.62,P=0.99),time of mechanical ventilation(MD=0.33,95％CI,-0.34 to 1.01,P=0.33),and mortality rate(RR=1.05,95％CI,0.95 to 1.16,P=0.31)between the ketamine group and the etomidate group,but the incidence of adrenal insufficiency(RR=0.54,95％CI,0.41 to0.70,P＜0.001)and ICU stay(MD=-0.44,95％CI,-0.70 to-0.18,P=0.001)in the etomidate group were significantly lower and shorter than those in the ketamine group,while the inci-dence of hypoxemia was significantly higher in the etomidate group(RR=1.50,95％CI,1.27 to 1.79,P＜0.001).Conclusion During the process of RSI with sufficient preoxygenation,ketamine is a safe and effective alternative drug,and compared with etomidate,it has a lower incidence of adrenal insufficiency and shorter ICU stay.