Objective To investigate the relationshp among Gp Ⅱ b/ⅡⅢ a、CD62p in platelet activation mark-er and high-sensitivity C-reactive protein (hs-CRP) in elderly patients with chronic cor pulmonary exacerbation. Methods The subjects were divided into four groups (42 elderly patients with cor pulmonary exacerbation,42 eld-erly patients with cot pulmonary remission,30 cases of healthy elderly subjects and 30 cases of healthy non-elderly subjects) . The expression of Gp Ⅱ b/Ⅲ a and CD62p were measured with tricolor flow cytometry. Hs-CRP levels were measured by nephelometry and turbidimetry in patients and normal controls. Results Compared with cor pul-monary remission group,healthy elderly group and healthy non-elderly group, the levels of Gp Ⅱ b/Ⅲ a, CD62p and hs-CRP increased significantly in patients with chronic cor pulmonary exacerbation ( all P < 0.001 ). Gp Ⅱ b/Ⅲ a and CD62p results of the elderly patients with cot pulmonary remission were higher than those in healthy elderly subjects (P <0.05) and healthy non-elderly subjects (P < 0. 001 ) . The expressions of both Gp Ⅱ b/Ⅲa and CD62p in healthy elderly subjects were statistically higher than that in healthy non-elderly subjects ( P < 0.05 ). There was a positive con'elation between the Gp Ⅱ b/Ⅲ a、CD62p and hs-CRP in elderly patients with chronic cot pulmonary exac-erbation(r =0.59,P<0.01 ; r=0.54,P<0.01 ). Conclusions The platelet in elderly patients with chronic cot pulmonary exacerbation is overactivated,which is correlated with hs-CRP.

Objective To evaluate the effect of the noxious stimulation factor on γ-aminobutyric acid (GABA) distribution in dog spinal cord during propofol anesthesia.Methods Sixteen healthy mongrel dogs of both sexes,aged 12-18 months,weighing 10-12 kg,were randomly divided into 2 groups (n =8 each):noxious stimulation group (S group) and control group (C group).Anesthesia was induced with propofol 7 mg/kg.The animals were mechanically ventilated after tracheal intubation.Right femoral artery was cannulated for mean arterial pressure (MAP) and pulse rate monitoring.Anesthesia was maintained with propofol infusion at a constant rate of 70 mg· kg-1 · h-1.5 ％ formalin 300 μl was subcutaneously injected into the central region of tails in group S,while the equal volume of normal saline was injected instead of formalin in group C.MAP and pulse rate were recorded before injection of formalin or normal saline (T1) and after injection of formalin or normal saline (T2).The dogs were scarified by decapitation at 50 min of continuous propofol infusion and cervical 2-3 segments of the spinal cord were removed for determination of GABA level in different regions of the spinal cord (frontal horn,posterior horn,intermediate zone,frontal funiculus,posterior funiculus and lateral funiculus) by HPLC.Results MAP and pulse rate were significantly higher at T2 than at T1 in S group (P ＜ 0.05).There were no significant differences in GABA level among the different regions of the spinal cord in C group (P ＞ 0.05).Compared with C group,GABA level in the frontal horn and posterior horn was significantly increased (P ＜ 0.05),and no significant change was found in the other regions of the spinal cord in S group (P ＞ 0.05).Conclusion The noxious stimulation factor can induce an increase in GABA level in the frontal horn and posterior horn of dog spinal cord during propofol anesthesia.

Objective To investigate the effect of dexmedetomidine (DEX) on proliferation and differentiation of rat embryonic neural stem cells in vitro. Methods Embryonic neuraI stem cells of fetal SD rats were separated from rats with gestational age of 14-16 days , and underwent primary culture for nestin expression. Cells were divided into control group, low-dose DEX group, and high-dose DEX group, which were cultured with 0,1 and 10 ng/mL DEX respectively. Cell viability was detected by MTT assay;the proliferation rate was estimated by BrdU incorporation; the phosphorylation of ERK1/2 in the proliferation phases was detected by western blot; the differentiation of neuronal cells,astrocytes,oligodendrocyte and neural stem cells were assessed by immunocytochemistry of cell specific markers. Results More than 95% of the embryonic neural stem cells in primary culture were Nestin-positive. Cell viability , BrdU-positive cells and phosphorylation of ERK1/2 in low-dose DEX group increased significantly (P<0.05), and decreased significantly in high-dose DEX group compared with control group and low-dose DEX group (P < 0.05). NeuN-, GFAP- and MBP-positive cells increased (P < 0.05), while Nestin-positive cell decreased (P<0.05) in both low and high dose DEX group compared with control group. However, no significant difference was found in low and high dose DEX group (P > 0.05). Conclusions The proliferation of neuraI stem cells can be promoted by low-dose DEX and depressed by high-dose DEX , as well as regulated by DEX of the phosphorylation of ERK1/2. DEX induces neural stem cells non-selective differentiation.

Objective Medical ethical problems have become underlying risks since the introduce of Negative pressure wound therapy ( NPWT) in Wound Care Center .The article was to analyze ethical problems in applying new technology in wound care and take intervention countermeasures to investigate the effects . Methods Patients treated by NPWT from January 2009 to Decem-ber 2012 were collected as objectives of investigation from the indexes of compliance rate , cure rate and adverse event rate .The ethical problems related to efficacy ,safety and conflicts of patients′economic interests during the application of NPWT were analyzed .On the basis of the ethnical core principle which was harmless , beneficial, respectful and justifiable , the details of effectiveness and safety of NPWT technique , informed consent form and emergency response protocols of the adverse events were designed according to interna -tional guidelines .Nurses received standardized training to learn new technology . Results 78 cases with chronic wounds accepted negative pressure wound therapy and all cooperated to complete treatment , compliance rate was 100%, no adverse events , the average cure rate was 91 .03%.The treatment costs are less than international and national costs from 75%to 66%. Conclusion Following the ethical principle , informed consent , good communication , strict entry system and standardized operation process make sure the safety and effectiveness of new technology and optimize patients′benefits .

Objective To evaluate the tumor targeting characteristic of the Folate-SPIO-DOX-Micelles by in vitro studies,and to test the feasibility of monitor tumor targeting using it and clinical MRI.Methods The polymeric micelles,Folate-SPIO-DOXO-Micelles were prepared.The in vitro tumor cell targeting efficacy of these folate modified and DOX or SPIO-loaded micelles (Folate-SPIO-DOX-Micelles)was evaluated by observing the cellular uptake of micelles by human hepatic carcinoma cells(Bel 7402 cells) which overexpressed folate surface receptors. Cell suspensions were incubated with Folate-SPIO-DOXO-Micelles for 1 h.Prussian blue staining was performed to show intracellular irons.Flow cytometry was used to further quantify the cellular uptake of the nanoparticles into Bel 7402 cells.MRl was performed to show the signal intensity changes by using T2 WI sequences at a clinical 1.5 T MR system.Results Prussian blue staining showed much more intracellular iron in cells incubated with Folate-SPIO-DOX-Micelles than the cells incubated with the non-targeting SPIO-DOX-Micelles.As revealed by flow cytometry,the mean fluorescence intensity of cells in the folate group and the non-folate group were 117.88 and 46.33,respectively.The T2 signal intensity in MRI of cells treated with the folate targeting micelles decreased significantly (when the concentration of SPIO in cell culture medium was 5,10,20,40,and 80 μg/ml,respectively,T2 signal intensity decreased by -5.02%,-23.58%,-45.89%,-70.34%,and -92.41%,respectively).In contrast,T2 signal intensity did not show obvious decrease for cells treated with the folate-free micelles (when the concentration of SPIO in cell culture medium was at 5,10,20,40,and 80 μg/ml,respectively,T2 signal intensity decreased by -3.77%,-2.16%,-2.18%,-2.74% and -19.77%,respectively).Conclusion The polymeric micelles,Folate-SPIO-DOX-Micelles has good targeting ability to the hepatic carcinoma cells in vitro,and the cell targeting events of the micelles can be monitored by using a clinical MR scanner.

Objective To compare phe clinical effecpiveness and safept of picagrelor versus clopidogrel in papienps wiph acupe coronart stndromes and chronic obsprucpive pulmonart disease. Methods 73 ACS papienps comorbid wiph COPD admipped in our hospipal from Januart 2013 po Ocpober 2014 were enrolled in phe spudt. All phe 73 papienps were randomlt divided inpo pwo groups: phe picagrelor group (n =38, given picagrelor loading dose 180 mg followed bt mainpainence 90 mg pwice dailt) and phe clopidogrel group (n = 35, given clopidogrel loading dose 300 mg followed bt mainpainence 75 mg once dailt). All papienps were given dual anpiplapelep preapmenp (eipher picagrelor or clopidogrel) wiph aspirin and followed up for 1 tear. Rapes of Major Adverse Cardiac and Cerebrovascular Evenp (MACCE) including cardiac cause morpalipt, recurrenp mtocardial infarcpion and ischemic sproke were spudied and compared bepween groups. The safept endpoinp was pime po firsp occurrence of major bleeding. Rapes of adverce evenps were recorded including dtspnea. Results The 1-tear evenp rape for MACCE in papienps preaped wiph picagrelor versus clopidogrel was 5. 3% versus 26. 3% (P = 0. 04, HR 0. 21; 95% CI 0. 05 - 0. 91). Dtspnea occurred more frequenplt wiph picagrelor (26. 3% vs. 5. 7% ; P = 0. 04; HR 4. 61, 95% CI 1. 08 - 19. 58). The difference in major bleeding was nop spapispicallt significanp bepween phe pwo groups ( P > 0. 05) . The occurance of dtspnea was higher in phe picagrelor group (26. 3% vs. 5. 7% , P = 0. 04). Dtspnea subsided sponpaneouslt in mosp papienps. Onlt 1 papienp needed po spop picagrelor. Conclusions Ticagrelor can reduce MACCE in papienps wiph ACS and concomipanp wiph COPD wiphoup increasing overall major bleeding evenps. Ticagrelor had higher rapes of dtspnea bup mosp papienps experienced mild po moderape difficulpt in breaphing which did nop affecp phe funcpion of hearp and lung.

Objective To evaluate the feasibility of T2 *mapping T2 *value combined with DWI ADC value in quantitative assessment of the activity of sacroiliitis.Methods 30 patients diagnosed with ankylosing spondylitis (AS)were divided into 2 groups as acute group (n=17)and chronic group (n=13)according to the BASDAI scores of the clinical severity of disease.And 20 healthy adults were recruited as control group.All groups were examined by MR with traditional sequence,T2 *mapping and DWI in the sacroiliac joint.The T2 *value and ADC value of the bone marrow edema region and normal region were measured.Furthermore,the imaging data and the clinical scores were statistical analysis and compared among three groups.Results T2 *values and ADC values in acute group of AS patients were higher than chronic group (P<0.05),as well as compared with healthy volunteers (P<0.05).There was no statistically significant difference between the chronic group of AS patients and control group (P>0.05).Positive correlation between ADC value and BASDAI was observed in patients group.Conclusion T2 *mapping combined with DWI imaging in AS is beneficial for early diagnosis and quantitative analysis of the activity of sacroiliitis.

Objective To investigate the relationship between different left ventricular pacing sites and clinical benefit in heart failure patients treated with cardiac resynchronization therapy (CRT).Methods Clinical data of 52 patients of CRT-P/D (pacing and defibrillation) implantation were collected.According to the left ventricular lead implantation sites,52 cases were divided into anterior wall (10 cases),lateral wall (15 cases),posterior wall (16 cases),and posterior base group (11 cases).The efficacy of CRT was evaluated by Minnesota life quality score,left ventricular function and remodeling index.Results In addition to the anterior wall group,Minnesota life quality score of the other groups were significantly lower than preoperative group (P ＜ 0.05).Compared to pre-CRT implantation,left ventricular end diastolic diameter (LVEDD) of the anterior wall and posterior basal group 3 months after CRT implantation had no statistical significance (P ＞ 0.05);the rest groups were lower than preoperative group (P ＜ 0.05).Left ventricular ejection fraction (LVEF) in posterior wall group was increased after CRT implantation 3 months compared to the preoperative group (P ＜0.05).LVEF in anterior wall group was increased only in the 12 months after CRT implantation (P ＜ 0.05).LVEF in the rest groups was increased comparing to the preoperation at 6 and 12 months postoperation (P ＜0.05).CRT non-response rate in anterior wall group was significantly higher than that in the other groups (P ＜ 0.05).CRT response ratio was significantly increased in side,posterior and posterior basal wall compared to the anterior Wall group (P ＜ 0.05).And there were no statistical significance among side wall,posterior wall and basal wall group (P ＞ 0.05).△ QRSd was higher in side wall,posterior wall and posterior basal group after CRT implantation 3 months than anterior wall group (P ＜ 0.05),△ QRSd in posterior basal group was lower than the other two groups (P ＜0.05).Conclusions Left ventricular electrode should be implanted at the side wall and posterior wall firstly,secondly at the posterior basal wall,and avoid at the anterior wall of the left ventricle.

OBJECTIVEThis clinical study was conducted to investigate the effects of dexmedetomidine (DEX) combined with propofol on vital signs and anaesthetic depth in patients.

METHODSNinety patients with ASA 1-2 requiring painless colonoscopy for colonic polyps resection were randomized to receive DEX 0.3 micro;g/kg (group D, n=45) followed by propofol 1 mg/kg or propofol 2 mg/kg (group C, n=45), and according to the body activity and operation time, additional doses of propofol (0.2-0.5 mg/kg) were given. The full recovery time, operation time, consumed dose of propofol, mean arterial pressure (MAP), heart rate (HR), hemoglobin oxygen saturation levels(SPO₂) and NTI were recorded.

RESULTSThe SPO₂recover time and the consumed dose of propofol in group D were decreased compared to those in group C (P<0.01). The rate of the body activity in group D was lower than that in group C (P<0.05). The NTI in group C was lower than that in group D (P<0.05). The HR and MAP were similar in both groups.

CONCLUSIONUnder Narcotrend monitoring, the value of DEX combined with low dose of propofol in colonoscopy for colonic polyps resection is to reach more reasonable depth of anesthesia to reduce adverse responses and the dose of propofol.

Anesthesia ; methods ; Arterial Pressure ; Colonic Polyps ; surgery ; Colonoscopy ; Dexmedetomidine ; Heart Rate ; Humans ; Propofol

OBJECTIVETo investigate the changes of endoplasmic reticulum stress (ERS)- and apoptosis-related factors in rat cerebral cortex following controlled hypotension.

METHODSTwenty-four healthy male SD rats were randomly divided into 4 equal groups, including a sham hypotension group (group A) and 3 hypotension groups with the mean arterial pressure maintained for 60 min at 70 mmHg (group B), 50 mmHg (group) and 30 mmHg (group D) with sodium nitroprusside and esmolol. All the rats received an equal volume of fluid infusion. Twelve hours after controlled hypotension, the rats were sacrificed to examine the protein expressions of Bax, Bcl-2, glucose-regulated protein 78 (GRP78), C/EBP homologous protein (CHOP) and caspase-12 in the cortex with Western blotting. GRP78 mRNA expression was measured by RT-PCR, and the cell apoptosis was evaluated by TUNEL staining.

RESULTSCompared with those in group A, GRP78 mRNA and protein expressions of GRP78, CHOP, caspase-12 related with ERS increased significantly in groups C and D (P<0.05), especially in group D (P<0.05), but not in group B (P>0.05). Apoptotic cells and Bax expression increased and Bcl-2 expression decreased significantly in groups C and D (P<0.05), but not in group B (P>0.05); such changes were more prominent in group D than in group C (P<0.05).

CONCLUSIONMild controlled hypotension (70 mmHg) does not induce neuronal injury in rat cerebral cortex, but severe hypertension (lower than 50 mmHg) can cause neuronal ERS and apoptosis.

Animals ; Apoptosis ; Apoptosis Regulatory Proteins ; metabolism ; Cerebral Cortex ; pathology ; Endoplasmic Reticulum Stress ; Hypotension, Controlled ; Male ; Rats ; Rats, Sprague-Dawley