Objective To investigate the neuroprotective effect of escitalopram on focal cerebral ischemia/reperfusion in rats and its possible mechanisms.Methods Seventy-five male Sprague-Dawley rats were randomly divided into three groups:sham operation,saline control and escitalopram intervention groups (n =25 in each group).A focal cerebral ischemia reperfusion model in rats was induced by the intraluminal suture method.The modified neurological severity scale was used to evaluate neurological deficit in rats (n =5 in each group).Laser confocal technology was used to observe the microvascular diameter,density,and total area in ischemic region (n =5 in each group).Enzyme-linked immunosorbent assay was used to detect the plasma concentration of vascular endothelial growth factor (VEGF) (n =5 in each group).Immunohistochemical staining (n =5 in each group) and Western blotting (n =5 in each group) were used to detect the expression of VEGF in the ischemic brain tissue.Results At day 14 after modeling,the neurological deficit improved more significantly in the escitalopram intervention group than that in the saline control group (4.39 ±0.92 vs.6.57 ± 1.13; P =0.015).The 3D confocal vascular imaging showed that capillary diameter in the escitalopram intervention group was significantly smaller than that in the saline control group (2.93 ± 0.19 μm vs.3.56 ± 0.22 μm; P ＜0.01); the vascular density was significantly higher than that in the saline control group (232.68 ±12.54/0.002 mm3 vs.176.26 ± 10.87/0.002 mm3; P=0.000); the total microvascular area was significantly greater than that in the saline control group (89 154± 3 298 μm2/0.002 mm3 vs.75 368.14± 3 519 μm2/0.002 mm3; P=0.000).Enzyme-linked immunosorbent assay showed that the plasma VEGF concentration in the escitalopram intervention group was significantly higher than that in the saline control group (50.35 ± 5.44 pg/ml vs.13.75 ± 4.12 pg/ml; P =0.000).Immunohistochemical analysis showed that the VEGF expression in ischemic brain tissue in the escitalopram intervention group was significantly higher than that in the saline control group (P =0.000).Western blotting showed that the VEGF expression in ischemic brain tissue in the escitalopram intervention group was significantly higher than that in the saline control group (0.94 ±0.18 vs.0.62 ±0.22; P =0.006).Conclusions Escitalopram may reduce neurological deficit in cerebral ischemia/reperfusion in rats.Its mechanisms may be associated with VEGF-mediated angiogenesis.

Objective To assess the dose reduction potential of adaptive statistical iterative reconstruction(ASiR)and model-based iterative reconstruction(MBIR)in pelvic CT with a standard male phantom.Methods A Fluke Biomedical RANDO standard male phantom was scanned with discovery CT750 HD using different tube currents.CT images were reconstructed with FBP,50％ASiR and MBIR.The CT value,the image noise and the contrast-to-noise ratio(CNR)for the sacral vertebra relative to muscle were measured.The volume CT dose indexes(CTDIvo1)and dose-length product(DLP)were recorded.Results Compared with FBP,using 50％ASiR and MBIR had significant reduced image noise and greater CNR.The effective minimal tube currents for displaying sacral vertebra were 250 mA(FBP),180 mA(50％ASiR),and 100 mA(MBIR).With the similar image quality using FBP,the dose was reduced by 28.0％ and 59.9％ using 50％ASiR and MBIR,respectively.Conclusions Using advanced iterative algorithms can reduce image noise,improve CNR,and reduce the radiation dose in pelvic CT examination.

Objective To investigate the risk factors of posttraumatic hydrocephalus (PTH) in patients with moderate to severe traumatic brain injury (TBI).Methods Aretrospective study was conducted for 183 patients with moderate to severe TBI (125 males,58 females;6-91 years of age,mean 48.23 years).According the presence of PTH,the patients were allocated into PTH group (n =34) and non-PTH group (n =149).Risk factors of PTh were assessed by univariate and logistic regression analysis,including gender,age,injury types,injury severity,intraventricular hemorrhage,subarachnoid hemorrhage,midline shift,subdural effusion,therapeutic strategies and skull defect.Association between the boundaries of skull defect and PTH was determined.Results Between-group differences were not significant regarding age,gender,injury types and intraventricular hemorrhage (P ＞ 0.05),but differed significantly in injury severity,subarachnoid hemorrhage,midline shift,subdural effusion,craniectomy and skull defect (P ＜ 0.05).Further Logistic regression analysis confirmed subarachnoid hemorrhage (OR =6.169),interhemispheric subdural effusion (OR =31.743),and unilateral (OR =17.602) and bilateral (OR =30.567) skull defects were risk factors of PTH.Of the patients with unilateral skull defect following decompressive craniectomy,the inferior limit ≤ 10 mm from the zygomatic arch also played a role in the development of PTH (OR =5.500,P ＜ 0.05).Conclusions Subarachnoid hemorrhage,interhemispheric subdural effusion and skull defect are risk factors of PTH.Unilateral skull defects with the inferior limit too close to the zygomatic arch can predispose to the development of PTH.

Objective To explore the clinical features of patients with vertebrobasilar dolichoectasia (VBD).Methods Patients diagnosed with posterior circulation ischemia in our hospital from October 2008 to January 2012 were consecutively collected and were divided into the VBD group and the non-VBD (NVBD) group.Clinical manifestations,risk factors,hemodynamic parameters and neuroimaging features were collected.Results (1) Statistical difference was observed in dyslipidemia,hypertension and the history of diabetes in the two groups (P ＜ 0.05).(2) The cerebral hemodynamic features of the VBD patients were as the following:decreased peak systolic velocity of vertebral artery and basilar artery and decreased systolic/diastolic ratio.Statistical difference was showed in the average peak flow velocity(Vm),pulsatility index(PI) and resistance index(RI) (P =0.036,0.032,0.032,respectively).(3) The main clinical manifestations of VBD were ischemic cerebrovascular disease,hemorrhagic cerebrovascular disease,oppression,brain damage symptoms and hydrocephalus.(4) The diagnosis in most of the VBD patients was confirmed by neural imaging and MRI was the first choice.Conclusion The VBD patients have relative unique clinical features.MRI should be the first choice for neuroimaging.

Thirty-six cases of delayed tramatic intracranial hematomas are reported in this paper. Among them 9, 5, 10 and 12 cases were epidural, subdural, intracerebral and multiple hematomas, respectively. The initial CT scans showed normal or brain contusions accompanied by a Me hemorrhage in 23 patients, and delayed intracranial hematomas developed after the earlier neurosurgical operations for evacuations of another traumatic mass lessions for urgent decompressions in 13 patients. Delayed hematomas occurred mostly in the acute stage of head injuries and most patients were impacted occipitally. Deterioration of consciousness was the most important manifestation for diagnosis. The responsible mechanisms of delayed intracranial hematomas are investigated and the indications of repeat CT scans or surgery for its early diagnosis are Droposed.

0.05) between two groups in the above results.Disc agar diffusion test showed the sensitivity rates of overall clinical isolates to gatifloxacin and levofloxacin were 97.56% and 92.68%,respectively.The incidence of adverse drug reactions(ADR) of two groups were 23.91% and 43.75%,respectively.In 5 cases severe ADR were found. CONCLUSIONS Sequential therapy of gatifloxacin may get satisfactory results in lower respiratory tract infections of elder people.The irrational use of drugs is an important factor to increase ADR(including collateral damage).So we should pay attention to the ADR and grasp the indications strictly and use the drugs appropriately,especially for the elder patients.

Objective To study the effects of exogenous double-stranded DNA antigen on the immunophenotypic changes of dendritic cells (DCs) derived from stem cells in mouse bone marrow. Methods LinCD117 (c-kit)+ hemopoietic stem cells were obtained from the bone marrow of C57 mice by magnetic affinity cell sorting. Some cytokines, including granulocyte-macrophage colony-stimulating factor, interleukin-4, tumor necrosis factor-α and so on, were used to enhance the proliferation or differentiation of stem cells to obtain mature, semimature and immature DCs. The double stranded DNA of kinetoplast (kDNA) was isolated from Trypanosoma equiperdum, and added to the culture media to pulse DCs. The immunophenotypic and morphologic features of DCs were analyzed by using flow cytometry and laser confocal microscopy respectively. Results The expression rates of CD117 and CD11c in DCs showed no significant changes after kDNA pulse compared with those before the pulse. In unpulsed immature, semi-mature and mature DCs, the expression rate was 11.42% ± 2.56%, 27.08% ± 5.29% and 44.63% ± 10.37% for MHC Ⅱ, 8.54% ± 2.01%, 31.35% ± 6.40% and52.96% ± 10.34% for CD80, 10.22% ± 3.47%, 32.15% ± 6.83% and 64.72% ± 9.68% for CD86, respectively.After pulse with the kDNA antigen, the expression rate increased by 15.63%, 9.66% and 4.12% (t = 6.21,4.35, 2.82, P < 0.05) for MHC Ⅱ, by 9.63%, 7.09% and 4.09% for CD80, by 13.16%, 9.75% and 3.10% for CD86, respectively in immature, semi-mature and mature DCs, respectively. The increase of expression rate of these membrane antigens in decreasing order was observed in immature DCs, semi-mature DCs and mature DCs. Conclusions The exogenous DNA antigen could enhance the maturation of bone marrow-derived DCs,likely by upregulating the expression of certain immunophenotypic membrane proteins, and the lower the maturity degree, the more liable the DCs to be affected by the antigen.

BACKGROUND:In recent years, there are many animal studies and osteoblast studies on the anti-osteoporotic effects of puerarin, a kind of phytoestrogen. But few of them are reported on the effects of puerarin on osteoblasts in older patients with osteoporosis. OBJECTIVE: To observe the influence of puerarin on the proliferation ofin vitro cultured osteoblasts from older female patients with osteoporosis. METHODS:The older female patients with osteoporotic femoral neck fractures who underwent artificial femoral head replacement were included in this study. The femoral neck cancelous bone removed during the operation was colected. Primary cancelous bone osteoblasts were cultured using explant culture method. The cels were sub-cultured to the required amounts. Osteoblasts from the control group were cultured with culture medium without puerarin. Osteoblasts from the 0.01, 0.1, and 1 μmol/L puerarin groups were cultured with culture medium containing the corresponding concentrations of puerarin. After in vitro co-culture with different concentrations of puerarin for 1, 3, 5 days, the proliferation of osteoblasts was observed. RESULTS AND CONCLUSION:With the increase in the concentration of puerarin, the proliferative activity of
osteoblasts constantly increased at different time points (P < 0.05). At 3 days of culture, cel absorbance value in each group reached the peak level. These results suggest that 0.01, 0.1, 1μmol/L puerarin promotes the proliferation of osteoblasts in older patients with osteoporosis in a concentration-dependent manner.

OBJECTIVE:To investigate the effects of puerarin on bone mineral density around the femoral prosthesis of el-derly women after osteoporotic fracture artificial hip joint replacement. METHODS:99 elderly women after osteoporotic fracture artificial hip joint replacement were divided into control group(49 cases)and test group(50 cases)according to random number table. Control group received conventional treatment:calcium carbonate and vitamin D3+alendronate sodium+salmon calcitonin;test group was additionally given Puerarin injection 200-400 mg dissolved in Glucose injection 500 ml intravenously,qd,on the basis of control group. A treatment course lasted for 20 d,and both groups received 2 courses of treatment. The hip joint function score and bone mineral density around the femoral prosthesis of 2 groups were observed and compared after surgery,and the oc-currence of ADR was also observed. RESULTS:3 and 2 patients withdrew from control group and test group,respectively. 18 months after surgery,the patients with hip joint function score ranged 70-79 in test group was significantly less than in control group;the rate of excellent hip joint function score in test group was significantly higher than in control group,with statistical significance (P<0.05). 15 and 18 months after surgery,bone mineral density in R1-R5 range of Gruen range in test group was slightly higher than in control group,without statistical significance(P>0.05);bone mineral density in R6-R7 range was signifi-cantly higher than control group(89.58% vs. 69.57%),with statistical significance(P<0.05). The prosthesis loosening was not found in both groups,and ADR was also not found as fever,erythra,nausea,vomiting,headache,dizziness,etc. CONCLU-SIONS:For the use of puerarin in elderly women after osteoporotic fracture artificial hip joint replacement,puerarin can increase the periprosthetic femur bone mineral density with good safety.

Objective To compare the differences of prescription pattern, adverse events, economic burden and drug-use adherence between preferred mood stabilizers and preferred antipsychotics in patients with bipolar disorder. Methods We investigated 240 cases of patients with bipolar disorder from 39 mental health institutions in 11 cities in Hebei province. The self-made questionnaire was used to investigate the demographic information, disease characteris-tics, prescription pattern and medical expense. The clinical global impression scale-severity of illness (CGI-SI) was used to assess the disease severity. The treatment emergent symptom scale (TESS) was used to assess the adverse drug reac-tions. The medication adherence rating scale (MARS) was used to assess drug therapy compliance in patients. Results One hundred fifty-two patients (63.3%) used antipsychotics as the first choice (antipsychotics group), 88 patients (36.7%) used mood stabilizers as the first choice (mood stabilizers group). The number of patients in-patient (90.1%vs. 76.1%), patients with psychotic symptom (27.0%vs. 11.4%), incidences of adverse events (46.1%vs. 31.8%), drug daily cost (me-dians 12.00 yuan vs. 8.37 yuan) and drug total cost (medians 344.61 yuan vs. 144.64 yuan) were larger in antipsychotics group than in mood stabilizers group (P<0.05). There was no significant difference between two groups in pattern of pre-scription, severity of adverse events and total scores of MARS (P>0.05). Conclusion The bipolar disorder patients more frequently use antipsychotics as the first choice in Hebei province. The use of antipsychotics does not alter the combina-tion medication pattern. In addition, antipsychotics cause a higher incidence of adverse events and heavier economic bur-den compared with mood stabilizers, suggesting that mood stabilizers should be the first choice to bipolar disorder.