Objective To investigate the variation in the position of conus medullaris in Chinese adult population in order to avoid hitting conus during spinal puncture. Methods Eight hundred patients suffering from back pain, aged 18-91 yr, were enrolled in this study. The position of conus medullaris was determined using Siemens 1.5 T magnetic resonance imaging system. According to the method described by Reimann, the vertebral body was used as mark of reference to the level of the end of conus. Results There were 190 patients in whom the position of the end of conus medullaris was lower than L1,2 . The incidence of the position of the end of conus medullaris lower than L1,2 was higher in patients 30-60 or older than in those under 30, and in those over the age of 60 than in those 30-60 (P ＜ 0.05). Conclusion Spinal puncture should be performed cautiously at L2,3. CT or MRI is recommended before operation for the patients to locate the position of conus medullaris and avoid injury to the spinal cord.

Objective To evaluate the effects of patient controlled analgesia(PCEA)on the perioperative changes of circulatory and pulmonary function of elderly with hypertensions after abdominal surgery.Methods Twenty-eight patients of ASAⅡ-Ⅲ aged more than 60 years undergoing uratomy were randomly divided into two groups:control group and PCEA group.Preoperative and postoperative circulatory and pulmonary functions were measured with noninvasion circulatory monitor and pocket lung function meter respectively.Results In control group,the systolic pressure,diastolic pressure,and heart rate increased by 19%,17% and 19%,respectively,as compared with preoperation.The percentage of forced vital capacity(FVC%),percentage of forced expiratory volume in first second to forced vital capacity(FEV1%) and percentage of maximal ventilatory volume(MVV%) of postoperation in control group were significantly decreased compared with preoperation(P

0.05),but it was significantly lower than that in LTP group (P

Objective To evaluate the role of alpha4 beta2 neuronal nicotinic acetylcholine receptor in the inhibition of synaptic long-term potentiation (LTP) by isoflurane in the CA1 area of rat hippocampal slices.Methods Hippocampal slices (400 μm thick) were prepared from the brains of adult male SD rats, 2 months old, weighing 200-250 g, anesthetized with ether and decapitated. The slices were incubated in artificial cerebrospinal fluid (aCSF) at room temperature for at least 2 h before use. Seventy slices were randomly divided into 10 groups ( n = 7 each): Ⅰ LTP group in which the slices were perfused with aCSF; Ⅱ , Ⅲ and Ⅳ group in which the slices were perfused with aCSF containing isoflurane 0.125, 0.25 and 0.5 mmol/L respectively (group Ⅰ1-3 );Ⅴ and Ⅵ group in which the slices were perfused with aCSF containing epibatidine 0.1 and 1.0 μmol/L respectively (group E1.2 ); Ⅶ group epibatidine 0.1 μmol/L + isoflurane 0.25 mmol/L (group E1 + I2 ); Ⅷgroup epibatidine 1.0 μmol/L + isoflurane 0.25 mmol/L (group E2 + I2); Ⅸ group DHβE 0.1 μmol/L (group D); Ⅹ group DHβE 0.1 μmol/L + isoflurane 0.125 mmol/L (group D + I1 ). Population spikes (PS) were recorded for at least 30 min before LTP in each group. For LTP induction, high-frequency stimulation (HFS) was applied to the Schaffer collateral-commissural pathway of hippocampus and maintained for 15 min using a stimulating electrode.The changes in PS amplitude were analyzed at 5, 10, 15, 20, 25, 30, 40, 50 and 60 min after HFS in each group. Results Compared with group LTP, the PS amplitude was significantly decreased after HFS in group I1 ,I2, I3 , D, D + I1 and E1 + I2 ( P ＜ 0.05), while increased after HFS in group E1 .2 ( P ＜ 0.05 ), but no significant change was found after HFS in group E2 + I2 ( P ＞ 0.05). The PS amplitude was significantly decreased after HFS in group D + I1 compared with group I1 (P ＜ 0.05). The PS amplitude was significantly increased after HFS in group E1 + I2 and F2 + I2 compared with group I2 ( P ＜ 0.01 ). Conclusion Isoflurane inhibits LTP induction via inhibiting the activation of alpha4 beta2 nicotinic acetylcholine receptor in rat hippocampus.

Objective To compare the dosage characteristics between three-dimensional conformal radiotherapy (3DCRT)plan and simplified inverse dynamic intensity modulated radiotherapy (IMRT)in patients with early-stage breast cancer after breast-conserving surgery.Methods 3DCRT and IMRT treament plans were designed for 14 female patients with early-stage breast cancer after breast-conserving surgery,4 of whom were left breast cancer cases.A dose of 50 Gy in 25 fractions to the whole ipsilateral breast was delivered using 6 MV photons for 3DCRT or IMRT.For 3DCRT plans,tangential field irradiation was adopted.While for IMRT,reverse dynamic intensity modulated technology was done through two pairs of tangential-likely fields, and 10 Gy was boosted to the tumor bed concomitantly in 25 fractions.The conformity index (CI),heterogenei-ty index (HI),dose and volume of organs at risk were evaluated by dose volume histograms (DVH).Results Compared with 3DCRT plans for ipsilateral lung,the high dose volumes were reduced and the low dose volumes were increased in IMRT plans.The same phenomenon was also observed for the heart of the patient with left breast cancer.The crosspoint doses of 3DCRT DVH and IMRT DVH for lung or heart were (25.16 ±9.11) Gy,(28.63 ±10.41 )Gy respectively.There was no difference between the two plans in the V10 of contra-lateral breast [IMRT(4.13 ±5.17)%∶3DCRT(1.99 ±2.43)%,t=2.11,P>0.05],but the D30 and mean of IMRT plan were higher than that of 3DCRT [(2.23 ±1.77)Gy ∶(1.20 ±0.46)Gy,t=2.58,P<0.05;(2.35 ±1.59)Gy ∶(1.54 ±0.88)Gy,t=3.15,P<0.01].The difference in HI between the two plans was not observed [IMRT(1.25 ±0.10)∶3DCRT(1.23 ±0.11),t=1.25,P>0.05].While the CI of IMRT plans were improved compared with 3DCRT [(0.75 ±0.07)∶(0.62 ±0.09),t =5.68,P<0.000 1]. Conclusion Compared with 3DCRT plan in patients with early-stage breast cancer after breast-conserving surgery,the main advantages of four fields simplified inverse dynamic IMRT are concomitant tumor boosting, decreasing the high dose volumes of ipsilateral lung,and improving the CI of planning target volume at the same time,but the HI is not improved.The IMRT plan is a simple,rational and feasible design scheme.

OBJECTIVE: To examine the expression of HIF-1alpha and CD34 in nasopharyngeal carcinoma and nasopharyngitis tissues, evaluate the role of HIF-1alpha and microvessel density (MVD) in nasopharyngeal carcinoma, probe the relationship between HIF-1alpha and MVD. METHOD: The expression of HIF-1alpha was detected in 58 cases with nasopharyngeal carcinoma and 20 samples of nasopharyngitis tissues by immunohistochemical staining SABC methods and SP methods. MVD in tumor was counted by immunostaining with CD34 and analyzed with clinicopathologic parameters. RESULT: The positive rate of HIF-1alpha was 79.31% and 10.00% respectively in nasopharyngeal carcinoma and nasopharyngitis tissues, there was significant difference between them (P<0.01). MVD was 39.74+/-7.41 and 18.43+/-3.24 respectively in nasopharyngeal carcinoma and nasopharyngitis tissues, there was significant difference between them (P<0.01). The expression of HIF-1alpha and MVD were significantly higher in nasopharyngeal carcinoma and in lymph node metastasis group than in no-metastasis group. In different clinical stage, the expression of HIF-1alpha (P<0.05) and MVD (P<0.01) was different. The expression of HIF-1alpha was positively correlated with MVD (P<0.01). CONCLUSION HIF-1alpha may be involved in carcinogenesis, invasion and metastasis of NPC. Visualization plays a key role in invasion and metastasis of NPC. The expression of HIF-1alpha was positively correlated with tumor visualization in NPC. HIF-1alpha is likely to be a potential target of anticancer therapy.
Adolescent ; Adult ; Aged ; Antigens, CD34 ; metabolism ; Female ; Humans ; Hypoxia-Inducible Factor 1, alpha Subunit ; metabolism ; Male ; Microvessels ; Middle Aged ; Nasopharyngeal Neoplasms ; blood supply ; metabolism ; pathology ; Neoplasm Staging ; Neovascularization, Pathologic ; Young Adult

Dual antiplatelet therapy has been widely used for the secondary prevention in patients with minor stroke and high-risk transient ischemic attack (TIA). Currently, the commonly used antiplatelet drugs are aspirin and clopidogrel. The therapeutic effect of antiplatelet drugs varies among individuals, namely platelet resistance. Among them, aspirin resistance is often caused by poor drug compliance, while clopidogrel resistance is often associated with CYP2C19 allele mutations. Patients with minor stroke and high-risk TIA carrying CYP2C19 loss-of-function alleles have poor preventive effects when using clopidogrel. Early screening of the CYP2C19 loss-of-function alleles and targeted measures can benefit such patients. This article reviews the research progress on the selection of antiplatelet therapy for minor stroke or high-risk TIA patients carrying the CYP2C19 loss-of-function alleles.

The cerebral venous system plays an important role in maintaining cerebral blood flow homeostasis. Research has shown that cerebral venous drainage is associated with collateral circulation status and outcomes after endovascular treatment in patients with acute ischemic stroke. There are currently multiple methods for evaluating cerebral veins based on different imaging techniques. This article reviews the imaging evaluation methods for cerebral venous drainage and their application in patients with acute ischemic stroke undergoing endovascular treatment.

Stroke has a high morbidity,disability and mortality.Early identification and intervention of carotid atherosclerotic plaque can prevent the occurrence of stroke.Studies have shown that atherosclerotic plaques are closely related to immune-mediated inflammation,and targeted inflammation therapy is expected to become a new method for the treatment of atherosclerotic plaques.This article systematically reviewed the role of immune regulatory mechanisms of different cells in the inflammatory response of atherosclerotic plaques,as well as potential targeted anti-inflammatory drugs,in order to provide reference for the clinical treatment of atherosclerosis related diseases.

Objective To investigate the effect of alogliptin on albuminuria in patients with early type 2 diabetic kidney disease (DKD) and the related mechanism.Methods One hundred patients with early DKD admitted in our hospital from May 2016 to May 2017 were randomly divided into two groups with 50 cases in each group.Patients in the control group were given metformin and gliclazide,while those in study group were given metformin and alogliptin,the treatment lasted for 24 weeks.The changes of urinary albumin-to-creatinine ratio (UACR),stromal cell-derived factor-1α (SDF-1α) and the fasting plasma glucose (FPG),2-h postprandial plasma glucose (2 hPPG),glycosylated hemoglobin(HbA1c) were measured before and after the treatment in two groups.Results There were no significant differences in HbA1c [(8.17± 0.46)％ vs.(8.29±0.48)％],UACR[(109±53) vs.(105±48)mg/g],SDF-1α [(1.21±0.3 9) vs.(1.17±0.35)μg/L] levels before treatment between two groups (t=0.343,0.464,0.075,all P＞0.05).After treatment,the HbA1c levels were significantly decreased in both groups (t=2.293,2.302,all P=0.03) and there was no significant difference between two groups[(6.82±0.75)％ vs.(6.93 ±0.79)％,t=0.295,P=0.77];the UACR levels were significantly reduced in both groups,but the level of study group was significantly lower than that of control group [(82±38) vs.(94±47) mg/g,t=3.320,P＜0.01];the SDF-1α levels were significantly increased in both groups,but the level of study group was significantly higher than that of control group[(3.01 ±0.38) vs.(2.76±0.42)μg/L,t=5.474,P＜0.01].There was no significant difference in the incidence of adverse reactions between the two groups [13％ (6/46) vs.12％ (6/48),x2=0.002,P＞0.05].Conclusion Alogliptin can effectively control the blood glucose,reduce urine albumin excretion and protect renal function in patients with early type 2 diabetic nephropathy,which is associated with the increased SDF-1α levels.