Objective To evaluate the effects of different time courses and depths of acute normovolemic hemodilution (ANH) with hematocrit (Hct) on injury to the mucous membrane of small intestines in rabbits.Methods Thirty-two adult rabbits,weighing 2.0-2.5 kg,were randomly divided into 4 groups (n=8 each) using a random number table:control group (group C),Hct 18％ group (H1 group),Hct 15％ group (H2 group) and Hct 12％ group (H3 group).The animals were anesthetized with iv 20％ urethane 4 ml/kg,tracheostomized and mechanically ventilated.Blood samples were taken from the left femoral artery.Blood withdrawn from the femoral artery =2 ×body weight× body fluid per kilogram × (initial Hct-target Hct) ÷ (initial Hct+target Hct),and was simultaneously replaced with the equal volume of 6％ hydroxyethyl starch 130/0.4 infused over 30 min via the left femoral vein until the target Hct was achieved in H1,H2 and H3 groups.At 30 min of stabilization after puncture (T0) and 2,4 and 8 h after ANH (T1-3),blood samples were obtained from the superior mesenteric artery and vein for blood gas analysis and for determination of plasma concentrations of tumor necrosis factor-α (TNF-α) in the superior mesenteric vein.Oxygen extraction rate (ERO2) was calculated.Small intestinal mucosal tissues were obtained at T3 to observe the pathological changes with light microscope.Results Compared with those at T0,the plasma concentrations of TNF-α at T3 and ERO2 at T1-3 were significantly increased in H1 group,and the plasma concentrations of TNF-α at T3 and ERO2 at T1-3 were increased in H2 and H3 groups.The injury to the mucous membrane of small intestine was mild in group H1,and was severe in H2 and H3 groups.Conclusion ANH performed with 6％ hydroxyethyl starch causes injury to the mucous membrane of small intestine when Hct is 18％ and the time course ≥ 8 h,and when Hct ≤ 15％ and the time course ≥ 2 h in the rabbits.

Objective To evaluate the accuracy of auditory evoked potential index (AAI) in monitoring the anesthetic depth during isoflurane anesthesia.Methods Thirty ASA Ⅰ or Ⅱ patients aged 18-55 years and undergoing elective surgery under general anesthesia were enrolled in this study. The patients were unpremedicated. Anesthesia was induced with midazolam 0.05 mg/kg, fentanyl 3 μg/kg and propofol 1 mg/kg. Tracheal intubation was facilitated with recuronium 0.1 mg/kg. The patients were mechanically ventilated (VT:40 mm Hg. Anesthesia was maintained with isoflurane inhalation and intermittent intravenous boluses of vecuronium. Isoflurane was started with high-flow (FGF, 3 L/min) for 12 min followed by low-flow (LGF, 0.5 L/min). The inspired isoflurane concentration was set at 3%. The electrocardiogram (ECG), mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SpO2), end-tidal isoflurane concentration and AAI were continuously monitored during anesthesia and recorded before induction of anesthesia (baseline, To ), immediately after induction (T1), immediately before isoflurane inhalation (T2), at 3 min(T3), 6 min (T4), 9 min (T5) and 12 min (T6) during high-flow wash-in and at the end-tidal isoflurane concentrations of 0.8 MAC (T7), 1.0 MAC (T8) and 1.3 MAC (T9) during low-flow inhalation of isoflurane, respectively.Results AAI decreased gradually while the end-tidal isoflurane concentration increased during high-flow wash-in. And AAI was negatively correlated with the end-tidal isoflurane concentrations ( r = -0.896, P ＜ 0.01 ) during low-flow inhalation of isoflurane anesthesia.

Objective To compare the efficacy of different target concentrations of etomidate in combination with midazolam,fentanyl and rocuronium used to induce anesthesia for tracheal intubation.Methods Eighty ASA Ⅰ or Ⅱ and Mallampati Ⅰ or Ⅱ patients of both sexes,aged 25-50 yr,weighing 57-76 kg,scheduled for elective non-cardiac surgery under general anesthesia,were randomly allocated into 4 groups according to the target effect-site concentration of etomidate (n =20 each) ∶ 0.5 μg/ml group (group E0.5),0.7 μg/ml group (group E0.7),0.9μg/ml group (group E0.9) and 1.1 μg/ml group (group E1.1).The patients were unpremedicated.Anesthesia was induced with midazolam 0.05 mg/kg,fentanyl 3 μg/kg,rocuronium 0.6 mg/kg and etomidate given by target-controlled infusion.When the effect-site concentration of etomidate reached 0.5,0.7,0.9 or 1.1 μg/ml,endotracheal intubation was performed.Auditory evoked potential index was recorded before induction of anesthesia (baseline),immediately before intubation,during insertion of the laryngoscope,and at 1,3 and 5 min after intubation.Myoclonus,injection pain,the requirement for vasoactive agents and burst suppression (BS) were recorded during induction of anesthesia.Results Compared with group E0.5,the requirement for urapidil was significantly decreased in group E0.7,the requirement for esmolol and urapidil was significantly decreased and the incidence of BS was increased in group E0.9,the requirement for esmolol and urapidil was significantly decreased,and the requirement for atropine and ephedrine and incidence of BS were increased in group E1.1 (P ＜ 0.05).The incidence of BS was significantly higher in group E0.9,and the requirement for atropine and incidence of BS were significantly higher in group E1.1 than in group E0.7 (P ＜ 0.05).The incidence of BS was significantly higher in group E1.1 than in group E0.9 (P ＜ 0.05).There was no significant difference in auditory evoked potential index and incidences of myoclonus and injection pain among the four groups (P ＞ 0.05).Conclusion The optimum target concentration of etomidate is 0.7μg/ml when combined with midazolam,fentanyl and rocuronium used to induce anesthesia.

BACKGROUND:For patients with rheumatoid arthritis and Kümmel ’s disease, how to effectively control back pain, to recover patient’s locomotor activity and to avoid a vicious cycle of disuse osteoporosis is a key therapeutic target. Kyphoplasty is a recently developed new technology of minimal y invasive spine surgery. Few reports concerned the kyphoplasty for rheumatoid arthritis and Kümmel ’s disease. OBJECTIVE:To assess the clinical outcome of bone cement kyphoplasty for the treatment of Kümmel ’s disease combined with rheumatoid arthritis. METHODS:From June 2012 to July 2013, 11 female patients at the age of 65.4±5.1 years with Kümmel ’s disease combined with rheumatoid arthritis, who suffered from severe back pain, were treated with bone cement vertebroplasty. Back pain and imaging indexes were compared and observed before surgery and during fol ow-up. Imaging indexes contained preoperative and postoperative anterior height of vertebral body after fractures, the ratio of anterior height to posterior height of the vertebral body, and local kyphosis angle (Cobb method). RESULTS AND CONCLUSION:No patients were lost to fol ow up. 11 patients were fol owed up for 6 to 12 months. Significant differences in fol ow-up and preoperative Visual Analogue Scale scores, anterior height of vertebral body after fractures, the ratio of anterior height to posterior height of the vertebral body, and local kyphosis angle were detected (P<0.05). Two patients experienced bone cement leakage. No severe complications appeared such as pulmonary embolism or neurological dysfunction. These data confirmed that bone cement vertebroplasty for rheumatoid arthritis combined with Kümmel ’s disease can effectively lessen back pain, partial y restore the height of vertebral body after fracture, rebuild spinal stabilization, reduce local kyphosis, and is a safe effective repair method.

Objective To explore the clinical and electrophysiological features and pulmonary function of 8 Chinese patients with Kennedy's disease (KD) and to enhance the understanding for the disease.Methods Eight patients with KD,admitted to out hospital from July 2010 to December 2013 and confirmed by gene examination,were chosen in our study; their clinical and electrophysiological features,and laboratory characteristics and pulmonary function were compared with those in the healthy volunteers.Results The average age of onset in the 8 patients was (45.13±17.47) years,and the average age of diagnosis was (55.63±12.11) years.The most common complaint was leg weakness.All patients presented hemifacial spasm,tongue muscle atrophy and fibrillation,amyotrophy and gynaecomastia; creatine kinase level was elevated and endocrine disorder appeared in different degrees.The electromyogram characteristics included widespread neurogenic changes accompanied with/without sensory or motor conduction abnormalities.The forced vital capacity,forced expiratory volume in first second,maximal voluntary ventilation and peak expiratory flow rate were significantly lower,and the residual volume in the KD patients was statistically higher than that in the healthy volunteers (P＜0.05).Respiratory muscle strength (maximum inspiratory pressure and maximum expiratory pressure) decreased in the KD patients.Conclusion KD is a degenerative disease with slow clinical progression which has its own characteristics of inheritance pattern and natural course; the age of onset,repeat number of CAG sequences,pulmonary function and respiratory muscle strength may be valuable for illness evaluation.

Objective To explore the association between diabetes mellitus type Ⅱ (DM) and deglutition function of amyotrophic lateral sclerosis (ALS) patients.Methods Seventy-five ALS patients older than 45 years and admitted to our hospital from August 2008 to November 2015 were selected into this study;67 of them were without DM and 8 were with DM.Water swallow test,amyotrophic lateral sclerosis severity scale-swallow (s-ALSSS),amyotrophic lateral sclerosis functional rating scale (ALSFR-R) and videofluoroscopic swallow study (VFS) were performed to evaluate the deglutition functions of these ALS patients with or without DM,and the results of the two groups were compared.Results (1) Patients with DM had significantly higher s-ALSSS scores,ingurgitation part in ALSFRS-R scores and in parts of VFS scores,such as transportation to pharyngeal,pharyngeal transit,flow into pharyngeal before reflexion,epiglottic vallecula residue,and piriform sinus residue than patients without DM (8.88±1.34 vs.7.54±1.47,3.50±0.54 vs.2.96±0.77,2.88±0.35 vs.2.16±0.69,2.75±0.46 vs.2.09±0.69,2.88±0.35 vs.2.42±0.56,2.88±0.35 vs.2.39±0.58,P＜0.05).(2) Scores of Kubota drinking test,ALSFRS-R,VGF (including oral phase,pharyngeal phase and aspiration degree) in patients without DM were 2.15±1.12,7.18±1.41(1.78±0.69,1.69±0.60 and 3.72±0.65),and those in patients with DM were 1.88±1.34,8.00±0.93(2.13±0.64,2.00±0.53 and 4.00±0.00);no significant differences were noted between the two groups (P＞0.05),but there was a trend showing that DM patients had higher scores in these evaluations.Conclusion As compared with ALS patients without DM,ALS patients with DM get more mildly impaired deglutition function.

Asari Radix et Rhizoma （AR） is a traditional Chinese medicine with a history of more than 2 000 years of medication and has been included in ancient herbal works in the past dynasties. It is effective in releasing the exterior， dispersing cold， dispelling wind， relieving pain， opening orifices， warming the lung， and resolving fluids， and is still widely used in the clinical treatment of influenza， coronavirus disease-2019 （COVID-19） pneumonia， asthma， allergic rhinitis， eye pain， headache， toothache， oral ulcer， eczema， etc. Modern pharmacological studies have shown that AR has antipyretic， anti-inflammatory， analgesic， antibacterial， antiviral， relieving cough and asthma， anti-allergy， and other effects. AR contains a variety of chemical components， in which essential oil is not only associated with functions such as dispelling cold， relieving heat， relieving pain， and resisting inflammation and allergy， but is also toxic. AR also contains lignans， flavonoids， amides， phenanthrenes， alkaloids， and other non-volatile oil components， which play an important role in immunity regulation， anti-inflammation， pain relief， heart strengthening， and blood vessel expansion. The phenanthrene compounds are mainly aristolochic acid analogues， such as aristolochic acid Ⅳ_a and aristolochic lactam Ⅰ. Aristolochic acid Ⅳ_a has been proven to have a significant anti-inflammatory effect. The toxicity of AR is related to safrole， aristolochic acids and their analogues， and is also affected by many factors， such as preparation method， dosage， origin， collection time， medicinal part， and decocting time， which should be comprehensively considered in clinical application. Based on the relevant literature in China and abroad， the present study reviewed the correlation of chemical composition and pharmacological and toxicological effects of AR， and the safety of AR， aristolochic acid， safrole， and other components to provide a new perspective for an objective understanding of AR safety， as well as references for rational clinical application， production risk prevention and control， and drug scientific supervision of AR.

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease affecting both upper and lower motor neurons in the brain and spinal cord. One important aspect of ALS pathogenesis is superoxide dismutase 1 (SOD1) mutant-mediated mitochondrial toxicity, leading to apoptosis in neurons. This study aimed to evaluate the neural protective synergistic effects of ginsenosides Rg1 (G-Rg1) and conditioned medium (CM) on a mutational SOD1 cell model, and to explore the underlying mechanisms. We found that the contents of nerve growth factor, glial cell line-derived neurotrophic factor, and brain-derived neurotrophic factor significantly increased in CM after human umbilical cord mesenchymal stem cells (hUCMSCs) were exposed to neuron differentiation reagents for seven days. CM or G-Rg1 decreased the apoptotic rate of SOD1^G93A-NSC34 cells to a certain extent, but their combination brought about the least apoptosis, compared with CM or G-Rg1 alone. Further research showed that the anti-apoptotic protein Bcl-2 was upregulated in all the treatment groups. Proteins associated with mitochondrial apoptotic pathways, such as Bax, caspase 9 (Cas-9), and cytochrome c (Cyt c), were downregulated. Furthermore, CM or G-Rg1 also inhibited the activation of the nuclear factor-kappa B (NF-κB) signaling pathway by reducing the phosphorylation of p65 and IκBα. CM/G-Rg1 or their combination also reduced the apoptotic rate induced by betulinic acid (BetA), an agonist of the NF-κB signaling pathway. In summary, the combination of CM and G-Rg1 effectively reduced the apoptosis of SOD1^G93A-NSC34 cells through suppressing the NF-κB/Bcl-2 signaling pathway (Fig. 1 is a graphical representation of the abstract).
Humans ; NF-kappa B/metabolism* ; Ginsenosides/pharmacology* ; Amyotrophic Lateral Sclerosis/genetics* ; Culture Media, Conditioned/pharmacology* ; Superoxide Dismutase-1 ; Neurodegenerative Diseases ; Neurons/metabolism* ; Apoptosis