Humans ; Integrative Medicine ; Medicine, Chinese Traditional

Aim To investigate the effects of miR-122a on blood-spinal cord barrier after spinal cord ischemia-reperfusion injury in rats.Methods Thirty-six SD rats were randomly divided into three groups:group of sham(S group),group of control(C group)and group of miR-122a antagomir(M group).Rats in S group were subjected to exposure of aorta arch but without occlusion.Spinal ischemia-reperfusion injury was induced by clamping the aorta arch for 14 min in C group and M group.Rats in M group and C group were intrathecally injected with miR-122a antagomir or antagomir control daily for three times after injury.The miR-122a expression in injured spinal cord tissue was detected by real-time PCR.The occludin expression in injured spinal cord tissue was detected by Western blot.The permeability of blood-spinal cord barrier was examined using evans blue as a vascular tracer.The neurological motor function was evaluated by Basso Beattie Bresnahan score.Results Compared with S group,the expression of miR-122a was increased,the expression of occludin was decreased,the permeability of blood-spinal cord barrier was increased,and neurological motor function score was decreased significantly in C group(P<0.05).Compared with C group,the expression of miR-122a was decreased,the expression of occludin was increased,the permeability of blood-spinal cord barrier was decreased,and neurological motor function score was increased significantly in M group(P<0.05).Conclusion miR-122a can regulate the expression of occludin and change the permeability of blood-spinal cord barrier.

Objective To determine the 95 ％ effective target plasma concentration (EC95) of remifentanil for tracheal tube tolerance during the recovery period from anesthesia following cervical spine surgery.Methods Thirty ASA Ⅰ or Ⅱ patients,aged 18-60 yr,weighing 50-80 kg,scheduled for elective cervical spine surgery under total intravenous anesthesia,were enrolled in this study.Anesthesia was induced with iv injection of propofol,sufentanil and rocuronium.The patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with iv infusion of propofol and target-controlled infusion of remifentanil.The target plasma concentration (Cp) of remifentanil was set at 4-6 μg/L.BIS value was maintained at 40-60.Infusion of propofol was stopped at the end of surgery.Participants were allocated to a dose of remifentanil by 3-patient cohorts.Six Cps were selected from 1.0-3.5 μg/L before beginning and they were 1.0,1.5,2.0,2.5,3.0,3.5 μg/L.The Cp of remifentanil was 3.0 μg/L in the first cohort.After completion of the trial in each cohort,the posterior probability of each concentration was calculated according to the condition of sedation/analgesia and anterior probability of each concentration.The concentration with the posterior probability closest to 95 ％ was chosen as Cp in the next cohort.The concentration-probability curve was made according to the posterior probability of each concentration,and then EC95 and 95 ％ confidence interval of remifentanil were calculated.Results The EC95 and 95 ％ confidence interval of remifentanil were 2.77μg/L (2.65-2.83 μg/L) for tracheal tube tolerance during the recovery period from anesthesia following cervical spine surgery.Conclusion The EC95 of remifentanil for tracheal tube tolerance during the recovery period from anesthesia is 2.77 μg/L in patients undergoing cervical spine surgery.

OBJECTIVETo research the distribution characteristics of Chinese medicine (CM) syndrome and syndrome elements of chronic fatigue syndrome (CFS) by analyzing literature in recent 20 years.

METHODSRelevant literature on treating CFS by syndrome differentiation of CM at home were retrieved by computer and manual ways. Database were established by using EpiData 3.1 to conduct frequency analysis of syndrome and syndrome elements.

RESULTSThe most common clinical syndromes were Xin-Pi deficiency syndrome, Gan stagnation Pi deficiency syndrome, Gan-Shen yin deficiency syndrome, Gan qi stagnation syndrome, and Pi-Wei qi deficiency syndrome. Disease locations were sequenced as Pi, Gan, Shen, and Xin. The clinical pathogenesis of CFS was characterized by deficiency of vital energy, complicated with intermingled excess and deficiency. Asthenia of healthy energy was mainly manifested as qi deficiency, blood deficiency, and yin deficiency, while excess of sthenia was mainly manifested as qi stagnation, phlegm dampness, and static blood.

CONCLUSIONSResearch of CM syndrome starting from syndrome elements can better unify and standardize clinical syndrome differentiation. Results of literature analysis can provide reference for further studies.

Objective To investigate the protective effect of hypoxic-preconditioned bone marrow mesenchymal stem cells (BMSCs) on spinal cord tissue after ischemia reperfusion injury.Methods Healthy adult Sprague Dawley (SD) rats weighing 200 ～ 250 grams (g) were randomly divided into 3 groups with 6 animals in each group:The sham group received simple surgical manipulation without ischemia/reperfusion treatment;The spinal cord ischemia/reperfusion group (Control group) only received spinal cord ischemia/reperfusion surgery.The hypoxic preconditioned BMSC transplantation group (HP-MSCs group) was injected with hypoxic preconditioned BMSCs 2 days before ischemia/reperfusion.The control group,HP-MSCs group received spinal cord ischemia/reperfusion for 10 min and observed for 48 h.The permeability of the blood-spinal cord barrier was examined with Evans blue (EB),and the histomorphology changes were observed with hematoxylin and eosin (HE) staining.Results EB red fluorescence was significantly weakened in the HP-MSCs group than that in the Control group (P ＜ 0.05),and more intact motor neurons were found in the lumbar spinal cords in the HP-MSCs group than that in the Control group (P ＜0.05).Conclusions The hypoxic-preconditioned BMSCs could effectively attenuate spinal cord ischemia reperfusion injury,it may be associated with protective effect of the blood-spinal cord barrier integrity.

Objective To investigate the risk factors for postoperative cognitive dysfunction (POCD)induced by patient-controlled intravenous analgesia(PCIA)in elderly patients. Methods 95 patients with POCD and 97 cognitive normal controls were included in the study. The cases and controls were matched for gender, type of operation and PCIA volume dose. Cognitive function was assessed by Mini-Mental-State test and the relationship between POCD and various factors was analyzed by univariate and multivariate analysis. Results Univariate analysis revealed that the education level and visual analog scale (VAS) score had significant differences between the two groups. Multivariate analysis showed that the VAS score and education level were significantly related to POCD induced by PCIA, with the odds ratios of 2. 379 (95%CI:1.205～4.698) and 0. 292 (95%CI:0.157～0.543), respectively. Conclusions Lower VAS score is an independent risk factor and higher education level seems to be a protective factor for POCD induced by PCIA.

Objective To compare the application of two different radial artery puncture and cannulation methods in septic shock patients. Meth-ods A total of 80 septic shock patients who need emergency operation were enrolled in this study. The shock index was>1.0. The patients were randomly divided into two groups:ultrasound group(group U)and palpation group(group A),with 40 cases in each group. For the patients in group U,Sonosite S-Nerve ultrasound in the wrist was used to determine the location of the radial artery puncture. For the patients in group A ,pal-pation method was used to determine the location of the radial artery puncture. The heart rate,blood pressure,first puncture success rate,total suc-cess rate,number of punctures,puncture time and complication rate of the two groups were monitored. Results The success rate of first puncture and total success rate of group U were higher than those of group A ,the number of puncture was less than that of group A ,the puncture time was shorter than that of group A,and the incidence of complications was lower than that of group A(P<0.05). Conclusion The application of ultra-sound for radial artery puncture and catheterization in septic shock patients is accurate ,and with higher first success puncture rate and total success rate,less number of puncture,shorter puncture time,and lower incidence of complications compared with palpation method.

Objective The mononuclear cells(MNCs) were cultivated and expanded into mesenchymal stem cells(MSCs) from human umbilical cord blood,and the purpose of this study was to explore the biological characteristics and induced differentiation ability in vitro.Methods Human umbilical cord blood samples were obtained and the mononuclear cells were isolated from it,then inoculated the MNCs into 25-mm culture flasks containing DMEM/F12 medium.The morphology was observed under microscope.Nissl body staining was used,The passage 2,4,7 of the expanded MSCs were induced to differentiate to neuron-like cells.The expressions of nestin and neuron-specific enolase (NSE) on the treated cells were detected by immunocytochemical method.Results Nissl body staining was positive;Nestin expression was found in(51.2?3.2)% of the second,(34.6?2.7)% of the fifth,(11.3?3.3)% of the seventh passage of MSCs;NSE expression was found in(11.4?2.3)% of the second,(21.78?3.1)% of the fifth,(40.7?3.4)% of the seventh passage of MSCs.Conclusion Cord bloodMSCs possess some features of neural stem cells,and have the capacity to differentiate into neuron-like cells under proper conditions.

AIM: Using optical coherence tomography angiography (OCTA) to observe the changes and clinical significance of macular blood flow density in patients with diabetic retinopathy (DR).METHODS: Totally 47 eyes (28 patients) with diabetic retinopathy (DR) were enrolled in the DR group.According to the international clinical grading criteria of diabetic retinopathy, 30 eyes (19 patients) with non-proliferative diabetic retinopathy were classified as the NPDR group, and 17 eyes (11 patients) with proliferative diabetic retinopathy were classified as PDR group.A total of 46 (27 subjects) healthy eyes with matched age were enrolled in the control group.All the subjects underwent the 3mm×3mm scanning of macular retina by optical coherence tomography angiography (OCTA), obtaining 4 levels of macular blood flow density map.The macular blood flow density at 3 levels, including superficial retinal layer, deep retinal layer and choroidal capillaries layer, were measured.RESULTS: The macular blood flow density of superfical retinal layer, deep retinal layer and choroidal capillaries layer in DR group were 0.4963±0.0840, 0.4798±0.0801 and 0.5290±0.0528, respectively.Among them, the blood flow density of each layer were 0.5064±0.0843,0.4983±0.0766,0.5345±0.0529, respectively, for the NPDR group, and were 0.4786±0.0830, 0.4473±0.0778,0.5192±0.0526, respectively, for the PDR group.For the control group, the density of each layers were 0.5919±0.0704, 0.6301±0.0527, 0.5691±0.0169, respectively.The macular blood flow density was significantly different in the superficial retinal layer, deep retinal layer and choroidal capillary layer between the control group and the NPDR group, as well as the PDR group and the DR group (total P<0.001).Statistically significant difference was found between the NPDR group and the PDR group in the deep retina layer (P=0.029), but not in the superficial retina layer and choroid capillary layer (P=0.236, 0.268).CONCLUSION: Compared with the control group, the macular blood flow density of superficial retinal layer, deep retinal layer and choroidal capillary layer in the patients with diabetic retinopathy decreased significantly.It indicated that the macular ischemia existed in both retina and choroid.By quantitatively measurement of the macular blood flow, OCTA may be used for monitoring the progression of diabetes, and early detection of diabetic retinopathy.

Objective:To assess the safety and efficacy of riboflavin/ultraviolet-A-induced accelerated epithelium-off corneal collagen cross-linking (CXL) for teenagers with keratoconus.Methods:In this case series study, 25 eyes of 18 patients with primary keratoconus who underwent riboflavin/ultraviolet-A-induced accelerated epithelium-off CXL in Zhengzhou Second People's Hospital from January 2017 to February 2018 were included, and the average age of patients was (14.4±1.3) years.The uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), spherical equivalent (SE), maximum keratometry reading (K max), thinnest corneal thickness (TCT), posterior corneal elevation (PCE) and endothelial cell density (ECD) were measured before and after CXL.The patients were followed up for one year.The complications and adverse reactions were recorded.The study adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Zhengzhou Second People's Hospital (No.KY2017002). Written informed consent was obtained from each patient and their guardian prior to the surgery. Results:The mean UCVA (LogMAR) was 0.96±0.35 at baseline, which was significantly improved to 0.84±0.33 at 1 year postoperatively ( t=-5.765, P<0.01). The mean BCVA (LogMAR) was 0.45±0.22 preoperatively, which was significantly improved to 0.34±0.26 at 1 year postoperatively ( t=-4.843, P<0.01). The mean SE was (8.66±5.11)D at baseline, which was significantly higher than (8.07±5.21)D at 1 year postoperatively ( t=-3.253, P=0.003). The K max was reduced from (58.58±9.07)D preoperatively to (56.25±9.98)D at 1 year postoperatively, with significant difference between the two time points ( t=-4.357, P<0.01). The K max was reduced more than 1 D in 17 eyes (68%), was stable in 6 eyes(24%), and was increased more than 1 D in 2 eyes (8%). The TCT was reduced from (485.0±32.5)μm at baseline to (475.3±35.5)μm at 1 year postoperatively, with significant difference between the two time points ( t=-4.266, P<0.01). The differences of PCE and ECD between preoperative and postoperative 1 year were not statistically significant ( t=1.023, P=0.316; t=-1.424, P=0.167). There was one eye suffering peripheral sterile corneal infiltrate 2 days postoperatively, and favorable prognosis was achieved after the topical steroids application.No complication was encountered in other subjects. Conclusions:Riboflavin/ultraviolet-A-induced accelerated epithelium-off CXL is safe and effective in teenagers with keratoconus during the 1-year follow-up.The long-term effects need further observation.