Objective To explore the effects of intraventricular administration of insulin on the expressions of Bcl-2,Bax mRNA and neuronal hippocampus apoptosis in rats after cardiopulmonary resuscitation (CPR).Methods This experiment was implemented in the animal Laboratory center of Xuanwu Hospital of Capital Medical University.Thirty male SD rats were randomly (random number)divided into three groups:control group (n=6),CPR group (n=12),insulin treated group ( n =12).CPR was performed at 6 minutes after ventricular fibrillation induced by transesophageal overdrive pacing.Resuscitation procedures lasted until restoration of spontaneous circulation (ROSC).ROSC was defined as the recovery of the supraventricular heart rates and the increase of mean arterial pressure (MAP) ＞ 60mmHg for more than 10 minutes.Ten minutes after ROSC in rats,12.5 μL ( 1 U) regular insulin was injected into the left ventricle in the insulin group,and 12.5 μL isotonic saline was injected the control and CPR groups at least 10 minutes.Real-time PCR was used to observe the expressions of Bcl-2,Bax mRNA in hippocampus CAI after reperfusion 24 h and 72 h.TUNEL staining was used to observe the neuronal apoptosis in all groups after reperfusion 7 days.Blood glucose was monitored in rats before and after CPR.Results ① The Bcl-2mRNA in insulin groups were significantly higher than those in the CPR group after 24 h and 72 h (P ＜0.01 ).The expression of Bcl-2 mRNA in 24 h insulin group were significantly higher than those in 72 h insulin group ( P ＜ 0.01 ) ; There were no significantly different in the Bax mRNA between insulin groups and the CPR and the control group after 24 h and 72 h ( P ＞ 0.05 ) ; ②After CPR 7 d,the apoptotic neurons of hippocampal CA1 area in the CPR group ( 124.75 ± 17.35 ) were significantly higher than those in the control group (5.12 ± 3.26) ( P ＜ 0.01 ) and the insulin group (92.79 ± 7.35 )(P ＜0.01 ); the apoptotic neurons in the insulin group were higher than those in the control group (P ＜0.0l ),and the differences were statistically significant.③There were no significant difference in venous blood glucose in the CPR and insulin groups (P ＞ 0.05).Conclusions Insulin may regulate Bcl-2mRNA expression in hippocampus,inhibit neuronal apoptosis and protect neurons after CPR in rats.

Objective To summarize experiences of microsurgical treatment of dumbbell tumors of the high cervical spine. Methods A series of 12 patients with dumbbell tumors of the high cervical spine were treated by using microsurgical techniques through posterior approach or antero-lateral approach. Results Complete resection was achieved in 10 patients. Postoperative neurological symptoms improved greatly in all. Conclusion The key points of treatment in dumbbell tumors of the high cervical spine are to analyze the preoperative image carefully and have knowledge about anatomy of high cervical spine as well as the experience of microsurgical technique.

Objective To summarize the perioperative clinical effect of extracorporeal membrane oxygenation (ECMO) technique in bilateral lung transplantation of patients with idiopathic pulmonary arterial hypertension.Methods Of 18 recipients with idiopathic pulmonary arterial hypertension receiving double lung transplantation,there were 11 cases of 11 grade Ⅲ (WHO cardiac function ratings) and 7 cases of grade Ⅳ.All patients were given ECMO technique after anesthetic induction,and the speed and volume of ECMO were adjusted according to oxygenation and cardiac function.At the end of the operation,the ECMO flow rate was decreased to 1 L·min-1 ·m-2.If the hemodynamics was stable and the oxygenation index was above 300,the ECMO could be removed.All data were Collected at 7 time points (preoperation,30 min after two lung ventilation,15 min after ECMO,the establishment of one lung ventilation,30 min after pulmonary artery occlusion,30 min after pulmonary artery open and at the end of the operation).The prognosis of the recipients was observed postoperatively.Results All patients successfully completed operation under the support of ECMO technique.As compared with preoperation,PaO2 and PaCO2 were significantly increased at 30 min after two lung ventilation (P＜0.05).As compared with 30 min after two lung ventilation,PaO2 was significantly elevated (P＜0.05),PaCO2 and PAP were reduced at 15 min after ECMO (P＜0.05).As compared with 15 min after ECMO,PAP was significantly increased at 30 min after pulmonary artery occlusion (P＜0.05).As compared with 30 min after pulmonary artery occlusion,PAP was significantly reduced at 30 min after pulmonary artery open (P ＜ 0.05).ECMO of 3 patients was removed after operation at once and of 15 patients were not removed until 3.3 ± 2.5 days in ICU.Tencases suffered from left cardiac insufficiency to varying degrees after removing ECMO (including 3cases whose ECMO was removed at once after operation),3 of them received ECMO bypass again and 7 of them were relieved after administration of cardiotonic,diuretics and vasodilators.Two cases sufferred from wound fat liquefaction and infection and 2 cases had moderate femoral artery thrombosis after postoperative ECMO.One case had renal failure 5 days after operation and thereafter died of multiple organ failure 2 weeks later after treatment with the continuous ECMO pipelines of hemofiltration,then 17 cases were cured.The pulmonary arterial pressure of all recipients was (30.79 ± 6.18) mmHg 2 months after operation and the cardiac function rating was significantly increased (P ＜0.01).Conclusion The application of ECMO technique in the lung transplantation patients with idiopathic pulmonary hypertension can reduce the pulmonary arterial pressure,improve the safety of operation and has obvious auxiliary effect on the perioperative cardiac function.

Viral myocarditis (VMC) is normally caused by myocarditis virus infection. Currently, the Western medicine treatment is mainly about symptomatic supportive treatment, while TCM has remarkable efficacy for this disease. This article started from the 4 common mechanisms of VMC, and elaborated the effects of individual and compound preparation, such as antiviral, regulating immune, anti free redical, antioxidation, improving myocardial metabolism, protecting myocardial cells, with a purpose to provide experimental references for TCM application in clinic.

Objective: To explore the changes and signiifcance of serum level of salusins in patients with essential hypertension (EH), obstructive sleep apnea hypopnea syndrome (OSAHS) and OSAHS complicated hypertension.
Methods: Our research included 4 groups: EH+OSAHS group,n=50, EH group,n=60, OSAHS group,n=35 and Control group,n=31 healthy subjects. Blood pressure, AHI index, body weight, height and routine biochemical examination were conducted and recorded in all subjects, serum levels of salusin-α and salusin-β were detected by ELISA, the relationship between each variable and OSAHS complicated hypertension was studied by multivariate Logistic regression analysis.
Results:①Serum levels of salusin-α were reduced accordingly as in Control group (7.438±1.626) pg/ml, in OSAHS group (6.186±1.200) pg/ml, in EH group (5.938±1.287) pg/ml and in EH+OSAHS group (5.299±1.398) pg/ml; for difference between OSAHS group and EH group,P>0.05 and for differences between other groups, allP<0.01.②Serumlevels of salusin-βwere decreased accordingly as in Control group (10.575±1.791) pg/ml, in OSAHS group (10.279±0.530) pg/ml, in EHgroup (9.698±0.344) pg/ml and in EH+OSAHS group (9.070±0.586) pg/ml; for differences between OSAHS group and Control group, EH group, bothP>0.05 and fordifferences between other groups, allP<0.05.③Multivariate Logistic regression analysis showed that serum level of salusin-α was independently and negatively related to OSAHS complicated hypertension (OR=-0.736,P<0.05); serum level of salusin-β was independently and negatively related to OSAHS complicated hypertension (r=-0.731,P<0.05).
Conclusion: Low serum levels of salusin-α and salusin-β were related to OSAHS complicated hypertension.

Objective:To explore the effect of peer support system on social anxiety and resilience among new graduate nurses. Methods:Totally 36 new graduate nurses entry in 2014 who's Interaction Anxiousness Scale (IAS) score were ＞43 were selected as control group. Totally 39 new graduate nurses entry in 2015 who's IAS score were ＞ 43 were as experimental group. The control group accepted routine standardized training. The experimental group received peer support, which consisted on conduct group intervention and twining intervention (6 months). IAS and Connor-Davidson Resilience Scale(CD-RISC) were used to investigate the nurses'social anxiety and resilienceat 3 months and 6 months after intervention. The scores were analyzed by using repeated ANVOA Results: Repeated measures analysis of variance of IAS showed that, there were significant differences on the IAS scores for interaction between measure time and group processing (P ＜0.001). The differences between the two groups in the main effects of interaction and time on the total score of CD-Rescan its three dimensions score were all statistically significant (Ps ＜ 0.001). Separate analyses showed that at baseline, there was no significant difference between two groups in all variables (Ps ＞0.05). After 3 months and 6 months of intervention, the IAS scores were lower in the intervention group than in the control group (Ps ＜0.001), the CD-RISC total scores and the three dimensions scores were higher in the intervention group than in the control group (Ps ＜0.05). Conclusion: It suggests that the peer support system could improve the social anxiety and resilience of new graduate nurses.

OBJECTIVETo compare the efficacy and safety of recombinant human interferon α-2b (INFα-2b) monotherapy and combined therapy with entecavir (ETV) plus adefovir dipivoxil (ADV) in chronic hepatitis B patients with poor response to combined therapy with lamivudine and ADV.

METHODSA total of 161 patients with chronic hepatitis B refractory to to combined therapy with lamivudine (LAM) and ADV were randomized to receive INFα-2b monotherapy (5×10(6), three times a week) (group A) or combined therapy with entecavir (0.5 mg/day) plus adefovir (10 mg/day) (group B). Serum levels of HBsAg, HBeAg and HBV viral load were analyzed at 48 weeks using chemiluminescence assay and by real-time PCR as appropriate. The drug resistance genes in HBV was tested by direct DNA sequencing.

RESULTSAt 48 weeks of treatment, HBV DNA decreased significantly in groups A and B to 2.06∓1.15log10 copies/ml and 1.77∓1.28log10 copies/ml, respectively. The rates of viral response, serological response, and biochemical response in groups A and B were 48.15% (39/81) vs 53.75% (43/80), 61.70% (50/81) vs 53.75% (43/80), and 49.38% (40/81) vs 60.00% (48/80), showing no significant differences between the two groups (P>0.05). The drug resistance gene mutation rate was significanty higher in group B (64.86%, 24/37) than in group A (30.95%, 13/42, P<0.05).

CONCLUSIONChronic hepatitis B patients refractory to lamivudine combined with ADV have a good response to INFα-2b monotherapy and combined therapy with entecavir and ADV , and interferon treatment is preferred to reduce potential drug resistance gene mutations.

Adenine ; analogs & derivatives ; therapeutic use ; Antiviral Agents ; therapeutic use ; Drug Resistance, Viral ; Drug Therapy, Combination ; Guanine ; analogs & derivatives ; therapeutic use ; Hepatitis B virus ; drug effects ; Hepatitis B, Chronic ; drug therapy ; Humans ; Interferon-alpha ; therapeutic use ; Lamivudine ; Mutation ; Organophosphonates ; therapeutic use ; Real-Time Polymerase Chain Reaction ; Recombinant Proteins ; therapeutic use

Objective:To investigate the effect and mechanisms of lateral ventricular injection of interferon-alpha (IFN-α) on electrophysiological activity in central nervous system.Methods:Twenty male Kunming mice were selected and subjected to auditory cortical electrode implantation and lateral ventricle intubation under general anesthesia. After one week of recovery, all mice were randomly divided into IFN-α group ( n=10) and normal saline group ( n=10). IFN-α and saline were administered by lateral ventricle injection for 7 consecutive days, and the auditory steady-state response(ASSR) in auditory cortex were recorded. Then the brain tissue was perfused, and the changes of microglia and astrocytes in the hippocampus were observed by immunohistochemical staining. Results:There was no significant difference in the average intensity of ASSR between the saline group and the IFN-α group((3.22±0.87)dB vs (3.49±0.56)dB; t=0.84, P=0.41) before administration.After administration, the average intensity of ASSR in IFN-α group was significantly lower than that before administration ((3.22±0.87)dB vs (1.59±0.44)dB, t=5.27, P<0.01), while the ASSR in saline group did not change before and after administration((3.49±0.56)dB, (3.46±0.61)dB; t=0.12, P=0.90). Immunohistochemistry revealed that the number of astrocytes and microglia in hippocampal CA1, CA3, and DG regions in the IFN-α group was higher than that of the saline group. Obvious morphological changes were also observed in the astrocytes and microglia. Conclusion:IFN-α can induce the activation of glial cells in the hippocampus and lead to the abnormal electrophysiological activity in the cortex. ASSR can reflect IFN-α induced brain dysfunction, which may be a potential indicator for early diagnosis.

This paper summarized the operation cooperation and management of the first case of bilateral lung transplantation assisted with double extracorporeal membrane oxygenation (ECMO) for the recipient with novel coronavirus pneumonia (COVID-19) in the world. The bilateral lung transplantation assisted by double ECMO had been accomplished successfully on a recipient with COVID-19, who was supported by ventilator and ECMO, with other organs function basically normal. The operation took 405 min and went smoothly. The cooperation and management guidelines of the operation room included the following: setting up of COVID-19 emergency operation group quickly; listing and preparing of the detailed operation supplies; transferring of the whole system of lung transplantation operating room in Wuxi People's Hospital to the Wuxi No.5 People's Hospital (isolation hospital); reconstruction of a negative pressure operating room for lung transplantation; formulating and strictly implementing the guidelines and management process for the operation of patient with COVID-19.

Objective To translate the Self-Stigma Scale (SSS )into chinese version and check its reliability and validity. Methods The Chinese version of Self-Stigma Scale was translated by Brislin method, the reliability and validity was tested in 750 diabetes patients. Results The Chinese version of Self-Stigma Scale includs 28 items three dimensions. Total scale Cronbach′s α :0.949, all subscales>0.8, Retest reliability coefficient:0.873.The scale average validity index (S-CVI/Ave) was 0.944. Confirmatory factor analysis results show that the GFI: AGFI: 0.833, 0.805, RMSEA: 0.065 the fitting indicators show that the fitting is good. Conclusions The revised Chinese SSS has good reliability and validity. It can be a suitable tool to evaluate stigma level of diabetes patient.