BACKGROUNDAn apnea test is essential in the clinical determination of brain death. This study was conducted to analyse complications associated with the apnea test in the determination of the brain death.

METHODSOn 93 adult patients in coma in Zhejiang Province of China from January 2003 to December 2006, 179 apnea tests were performed as a part of the determination of brain death. Potential risk conditions and complications were analysed during apnea tests.

RESULTSDuring apnea, serious cardiac arrhythmia did not occur in all patients. Complications occurred in 37 of 179 (21%) apnea tests. Hypotension occurred in 30 patients (17%) and it was observed in 8/94 (9%) tests with baseline value of systolic arterial blood pressure not less than 120 mmHg, and 22/85 (26%) less than 120 mmHg (P < 0.05). Severe hypoxaemia occurred in 10 patients (6%) of which 3/138 (2%) tests with baseline value of arterial oxygen pressure not less than 200 mmHg, and 7/41 (17%) less than 200 mmHg (P < 0.05).

CONCLUSIONSThis study demonstrated that complications occurred mostly in patients with inadequate baseline systolic arterial blood pressure and preoxygenation. Adequate precautions during the apnea tests may reduce the risk of cardiovascular and oxygenation complication.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Apnea ; physiopathology ; Brain Death ; diagnosis ; Carbon Dioxide ; blood ; Female ; Humans ; Hypotension ; etiology ; Hypoxia ; etiology ; Male ; Middle Aged

Adult ; Diagnosis, Differential ; Humans ; Lung ; pathology ; Lung Diseases, Interstitial ; diagnosis ; drug therapy ; pathology ; Male ; Middle Aged

OBJECTIVETo explore the effect of Wnt signaling suppression on proliferation of non small cell lung cancer to gefitinib, and its related mechanisms.

METHODSPC9 and PC9/AB2 cells of both gefitinib sensitive and resistant were treated with different concentrations of gefitinib, and the proliferation index was measured using CCK8 kit. The members of Wnt signaling pathway were detected by Western blot. Dual luciferase reportor gene assay (TOP Flash) was used to document the transcriptional level of β-catenin. β-catenin siRNA was transfected into PC9/AB2 cells to suppress the Wnt signaling transcription, followed by treatment with different concentrations of gefitinib. Western blot was then used to detect the expression of EGFR and its downstream signaling after inhibit the expression of β-catenin.

RESULTSTreating with different concentrations of gefitinib, the resistance of PC9/AB2 cells to gefitinib was significantly increased (P < 0.05). The members of Wnt signaling expressed at higher level in PC9/AB2 cells than in PC9 cells (t = 24.590, P = 0.000). TOP Flash examination showed that the endogenous transcriptional activity of Wnt signaling was higher in PC9/AB2 cell than that in PC9 cell (t = 4.983, P = 0.008). Compared with the negative control group, apoptotic rate and sensitivity to gefitinib significantly increased in interfered group (P < 0.05). The expression of p-ERK1/2 significantly decreased after Wnt signaling suppression, although other proteins showed no significant alterations.

CONCLUSIONSuppressing the activity of Wnt signaling can partly reverse the celluar resistance to gefitinib in non small cell lung cancer.

Antineoplastic Agents ; administration & dosage ; pharmacology ; Apoptosis ; Carcinoma, Non-Small-Cell Lung ; metabolism ; pathology ; Cell Line, Tumor ; Cell Proliferation ; Dose-Response Relationship, Drug ; Drug Resistance, Neoplasm ; Humans ; Lung Neoplasms ; metabolism ; pathology ; Mitogen-Activated Protein Kinase 1 ; metabolism ; Mitogen-Activated Protein Kinase 3 ; metabolism ; Phosphorylation ; Quinazolines ; administration & dosage ; pharmacology ; Wnt Signaling Pathway ; drug effects ; beta Catenin ; metabolism

Objective To optimize the optimal doses of histamine and 4-aminopyridine (4-AP) in the establish-ment of guinea pigs models of itching, and to establish a new guinea pig model of itching. Methods The central composite design-response surface method was used to arrange the experiment. In the experiment different pruritus agents were hypo-dermically injection of 0. 5 mL in the depilated area, and the scratching incubation period and scratching number in 30 mi-nutes were counted after the injection. The guinea pig itching model was evaluated by observing the behavioral changes of guinea pigs and measuring the levels of histamine and interleukin-6 in the blood. Results The behavioral experiments found that the scratching frequency in the the combination group was significantly higher than the histamine group and 4-AP group (P<0. 01). The itching latency of the combination group was significantly shorter than that of the histamine group and 4-AP group (P<0. 01). Compared with the control group, the histamine concentrations of the combination group and histamine group were significantly increased ( P<0. 05 or P<0. 01 ) , and the level of the combination group was lower than that of the histamine group (P<0. 05). Compared with the control group, the serum IL-6 concentrations of histamine group, 4-AP group and combination group were significantly higher (P<0. 01 or P<0. 05), and those in the combination group were significantly higher than the histamine and 4-AP groups. Compared with the control group, pathologic examina-tion showed proliferation of inflammatory cells in all model groups, and the reaction of the combination group was more ob-vious. Conclusions The optimal conditions used in this experiment are easy to achieve and have good reproducibility in the establishment of a guinea pig model of itching.

Objective To investigate the psychological status of patients with brain concussion. Methods A total of 186 patients with brain concussion were evaluated using Symptom Check-List 90 (SCL-90) and the scores were compared with the norms. Results The general scores (137.71±39.48), total mean scores (1.53±0.44) and positive object number (32.90±19.41) of SCL-90, as well as the factor scores ofsomatization(1.57±0.52), compulsion(1.79±0.50), anxiety disorder(1.50±0.49), hostility(1.63± 0.57), phobic anxiety(1.57±0.51), paranoid ideation(1.62±0.51) and psychoticism ( 1.49±0.43) in the patients with brain concussion were all higher than the normal ones (129.96±38.76, 1.44±0.43, 24.92± 18.41, 1.37±0.48, 1.62±0.58, 1.39±0.43, 1.48±0.56, 1.23±0.41, 1.43±0.57, 1.29±0.42, respectively)(P< 0.05). The scores of interpersonal sensitivity (1.67±0.54) were also significantly higher than that of normal (P>0.05). Conclusion Brain concussion may lead to psychological disturbance, for which early interventions should be administered.

Objective To study the correlation between the changes of serum neuron specific enolase (NSE) level and psychological statuses in patients with cerebral concussion.Methods Forty patients with cerebral concussion,admitted to our hospital from January 2012 to December 2012,were chosen in our study as experimental group,and other 40 healthy controls performed physical examination in our Physical Examination Center at the same period were chosen.The serum NSE level in the two groups was determined by enzyme-linked immunosorbent assay (ELISA); Symptom Checklist 90 (SCL-90) scale was performed in 40 patients at different times after injury,and these data were compared with those from the national norm; the correlation between the changes of serum NSE level and SCL-90 scores was analyzed.Results The serum NSE level in the experimental group 1 d after the injury was obviously higher than that in the control group (P＜0.05); 3 and 7 d after the injury,the serum NSE level in the experimental group was close to normal level,which showed no significant differece as compared with that in the control group (P＞0.05).The SCL-90 scores in the experiemtal group 1,3 and 7 d after injury was signficantly higher than that of the national norm (P＜0.05).Positive corelation was noted between serum NSE level and SCL-90 scores 1 and 3 d after injury (r=0.498,P=0.001; r=0.418,P=0.007);however,negative corelation was noted btween the two 7 d after injury (r=0.213,P=0.186).Conclusion Different corelation can be noted between serum NSE level and SCL-90 scores at different time points;combined application of serum NSE level and SCL-90 scores can promote the diagnosis and treatment of patients with brain concussion.

A 44-year old male patient was admitted to the First Affiliated Hospital, Zhejiang University School of Medicine with left ptosis and pain on the left head and neck for 20 days.Brain MRI showed subacute cerebral infarction on left parietal lobe and intramural hematoma on left internal carotid artery. CT angiography showed stenosis line on the C1 segment of left internal carotid artery. Digital subtraction angiography showed dissection on the C1 segment of left internal carotid artery.The condition of patients was improved after anticoagulant therapy.
Adult ; Aneurysm, Dissecting ; complications ; diagnosis ; Carotid Artery, Internal ; pathology ; Cerebral Infarction ; pathology ; Horner Syndrome ; complications ; diagnosis ; Humans ; Magnetic Resonance Imaging ; Male