Objective o investigate the prophylactic and therapeutic effects of montelukast,a cysteinyl leukotriene receptor-1 (CysLT1R) antagonist,on the delayed neuropsychological sequelae (DNS) in rat model of carbon monoxide (CO) poisoning and to explore the possible underlying mechanism.Methods A total of 90 rats were acclimated for one week prior to screening rat by Morris water maze test.Ten rats were randomly assigned to control group (Con group),and the remaining 80 rats were subjected to modified method of intraperitoneal injection of CO gas to establish animal model of acute CO poisoning,Thereafter,the survival rats randomized into CO poisoning group (Mod group),low-dose montelukast group (ML group),medium-dose montelukast group (MM group),high-dose montelukast group (MH group) (n =10 each).Montelukast was accordingly administered via intragastric tube at different intervals (30 min,4 h and 12 h) after CO poisoning,and then montelukast was administered every 12 hours for 7 consecutive days.The rats of control group and Mod group received equal volume of normal saline instead at given intervals.Twenty-one days after CO exposure,the average escape latency was measured by Morris water maze test to screen DNS rats followed by H-E staining to observe the pathological changes of cortex and hippocampal CA1 region and TUNEL was used to assess the apoptosis of neurons in cortex and hippocampal CA1 region after rats sacrificed.Results All CO-exposed rats exhibited cognition function lowered,and the escape latency (seconds) in Mod group (43.3 ± 15.5),ML group (31.5 ± 13.2) and MH groups (30.1 ± 12.2) was significantly prolonged compared with Con group (12.1 ± 3.0) (P ＜ 0.05),whereas the difference between MM group (15.0 ± 6.6) and Con group was statistically insignificant (P ＞ 0.05).Compared with Mod group,the escape latency in montelukast treatment groups was shortened,whereas the significant difference in escape latency only found between Mod group and MM group (P ＜ 0.05).Except for Con group,DNS was evident in CO-exposed groups,and the numbers of DNS rats in Mod,ML,MM and MH groups were 8,5,1,4,respectively,which made statistically significant differences to Con group (P ＜ 0.05) except MM group.The DNS incidence in MM group was lower than that in Mod group (P ＜ 0.05).Mod group exhibited severe histopathological injury to the brain,with evident apoptosis of neural cells,whereas in the groups with montelukast treatment,histopathological damage to the brain was mitigated and the number of apoptotic neuronal cells was diminished noticeably in MM group.Conclusion Montelukast can ameliorate the cognitive function of rats,decrease the incidence of DNS and reduce the apoptosis of neural cells as well as attenuate neuronal cell injury,thus exerting neuroprotection against DNS in rats with CO poisoning.

Objective To investigate the effect of high volume hemofiltration (HVHF) on expression of miRNA-146 in peripheral blood mononuclear cells in posttraumatic sepsis patients and its therapeutic mechanism.Methods Twenty-five cases of posttraumatic sepsis were included as HVHF group.Another 25 age-and gender-matched traumatic sepsis patients with similar APACHE-Ⅱ who received no HVHF treatment for some reasons were used as controls.Therapeutic measurements were the same of the two groups except for HVHF.At 0-,6-,12-,24-and 48-hour time points,the peripheral blood mononuclear cells were isolated from patients of both groups to detect level of miRNA-146.Peripheral blood mononuclear cells isolated at 24 hours were incubated with lipopolysaccharide (LPS) in vitro.At hours 4,8,12,24 and 48 after incubation,level of miRNA-146 in mononuclear cells was determined and levels of TNF-α,IL-6,and IL-10 in the substrate was detected by ELISA.Results (1) Level of miRNA-146 in HVHF group was decreased significantly over time as compared with that in sepsis group;(2) Before incubation and at 4-and 8-hour after incubation,miRNA-146 level was lowered significantly in HVHF group as compared with that in sepsis group.After LPS stimulation,mononuclear cell also presented a stronger inflammatory response in HVHF group than in sepsis group.Conclusions HVHF provides a definite effect on immune function recovery and a significant improvement in prognosis.Moreover,HVHF may attenuate the impact of miRNA-146 on mononuclear cell inflammatory factor release and enhance the cell ability to respond to external stimuli again via down-regulating miRNA-146,as may be one of the therapeutic mechanisms of HVHF for posttraumatic sepsis.

Objective To study the risk factors of MRI for the prediction of collapse in patients with avascular necrosis of the femoral head.Methods Twenty-two patients (39 hips) diagnosed avascular necrosis of femoral head by MR were enrolled in our study.The following MR appearances were evaluated:bone marrow edema,joint fluids,signal intensity and location of the lesion.The volume and surface area of the necrosis zone were calculated.The time of follow-up was 18-84 months (median,25 months).Logistic regression analysis was used to predict the risk factors by SPSS 13.0.The maximum value of Youden index was selected as the critical point to predict the collapse of femoral head and to define the sensitivity,specificity and accuracy.Results In the 39 hips with femoral head necrosis,21 hips had collapse.Bilateral collapse occurred in 5 cases.In 25 hips with the necrosis surface larger than 25％,collapse occurred in 21 (84％); In 8 hips with the volume of femoral head necrosis larger than 30％,collapse occurred in all cases; 1n 33 hips with the necrosis locating at the superolateral quadrant,collapse occurred in 21 (63.6％); In 22 hips with necrotic areas showing heterogeneous signal intensity,collapse occurred in 18(81.8％) ;In 25 hips with large amount of joint effusion,collapse occurred in 16 (64％) ;in 18 hips with bone marrow edema,collapse occurred in 13 (65％).Joint fluid,heterogeneous signal intensity and lesions in the superolateral quadrant,volume ratio,and area ratio were the high risk factors,while bone marrow edema was a relatively low risk factor.The area under ROC curves for area ratio of NASA was greater than that for volume ratio (0.987 vs 0.902).When the critical value for area ratio was 26.7％,the true positive rate was 95.2％,true negative rate was 94.4％,and Youden's index was 0.896.Conclusions The collapse of necrosis of femoral head may result from many factors.The femoral head was easy to collapse when it had large enough area of necrosis and mixed signal intensity,a large amount of joint effusion,bone marrow edema,and superolateral quadrant location.The critical value for area ratio to predict the collapse of femoral head was about 26.7％.The area ratio is more accurate than volume ratio in predicting the collapse of necrosis of femoral head.

Objective This study was undertaken to evaluate the ecological association between terrestrial natural radionuclide,indoor radon concentration,natural radioactivity and leukemia incidence among children under 18 years of age.Methods Data were gathered from the disease surveillance program and literature reading while software SPSS 13.0 was used to calculate the Spearman's correlation.Results The incidence rates of childhood(0-18 year)leukemia showed significant differences in different places with the highest as 3.13/105in Jiangmen area and the lowest as 0.42/105 in Maoming area.The incidence in Jiangmen was 7.45 times higher than that in Maoming.There was a rank correlation between the incidence of childhood leukemia and the mean concentrations of natural radio-nuclides in soll(226Ra and 232Th),with a Positive correlation observed for overall leukemia(rs=0.70,P=0.011;rs=0.66,P=0.02 for226 Raand 232Th respectively)and acute lymphoblastic leukemia(ALL)(rs=0.66,P=0.019;rs=0.64,P=0.025 for 226 Ra and 232Th respectively).Associations between the incidence of childhood leukemia and the indoor γ radiation dose rate,the total annual average effective dose equivalent from natural background radiation were also analyzed(both rs=0.59,P=0.042).Conclusion The natural radioactivity was likely to be a causative factor for childhood leukemia in Guangdong.

Objective To investigate the selection of operative method and peri operative managements for osteoporotic femoral intertrochanteric fracture in elderly patients aged over 75 years.Methods A total of 132 consecutive patients aged 75-91 years with osteoporotic intertrochanteric fractures from July 2009 to July 2012 were retrospectively analyzed.47 patients were treated with dynamic hip screw (DHS group),44 patients with proximal femoral nail anti-rotation (PFNA group) and 41 patients with Gamma Ⅲ nail (Gamma Ⅲ group).The peri-operative managements,operation circumstance,the time for fracture union,postoperative complications and the degree of functional recovery were analyzed and compared between the 3 groups.Results The mean surgical time was shorter in Gamma Ⅲ nail and PFNA groups than in DHS group [(68.7±9.1) min,(80.5±11.3) min vs (112.2±18.4) min,both P＜0.01].The mean blood loss was less in the Gamma Ⅲ nail and PFNA groups than in DHS group[(156.9±18.5) ml,(183.4±21.3) ml vs (296.2±29.6) ml,both P＜0.01].The mean time for fracture healing was shorter in Gamma [Ⅲ nail and PFNA groups than inDHSgroup [(12.6±2.4) weeks,(13.1±2.4) weeks vs (15.3±3.2) weeks,both P＜ 0.05],and it has no obvious difference between Gamma Ⅲ nail and PFNA groups (P＞0.05).There were significant differences in postoperative complications between Gamma Ⅲ nail,PFNA groups and DHS group (2 cases,3 cases vv 11 cases,P＜0.05,respectively).The mean Harris hip score had no significantly difference among DHS,Gamma Ⅲ nail and PFNA groups (87.4±11.6,90.2±13.0 vs 88.9±12.3,both P＞0.05).Conclusions The 3 operative methods for stable intertrochanteric fracture are feasible and effective in elderly patients,but for unstable intertrochanteric fractures,the treatment with Gamma Ⅲ nail and PFNA has advantages.

Objective To investigate the prevalence of HBV infection and the risk of hepatitis B virus (HBV) reactivation in patients with inflammatory arthritis receiving tumour hecrosis factor alpha (TNFα) inhibitors.Methods The liver function,serology of HBV and viral loads (HBV DNA) were tested before using TNFα inhibitors,at 3 months and 6 months.Patients with chronic hepatitis B (CHB) infection (HBV DNA ＞ 1 × 103copies/ml) were eliminated.Results A total of 162 patients were investigated including 156 patients who finished the study.Eleven (7.05％) patients were HBsAg-positive.Two patients with HBV DNA ＞ 1 × 103copies/ml were eliminated before starting anti-TNFα therapy.Among HBsAgpositive patients,HBV reactivation was documented in only one of the 11 patients.This patient with rheumatoid arthritis developed elevation of glutamic-pyruvic transaminase (ALT) and HBV DNA copies three months after infliximab therapy.Therefore lamivudine was given for three months,which translated into the fall of ALT and HBV DNA copies back to normal level.After follow-up for six months,the virology and serology remained stable.In contrast,none of the other 155 patients had demonstrated evidence of HBV infection or HBV reactivation.Conclusion The kinetics of HBV viral loads should be carefully monitored in patients with inflammatory arthritis and HBsAg-positive during anti-TNFα therapy.HBV reactivation should be treated with antiviral medicine through out the period of anti-TNFα therapy.

OBJECTIVETo investigate the effect of subanaesthetic dose of ketamine on mechanical stimulus on brain regions.

METHODSTotally 13 healthy male volunteers were enrolled in this study, in whom 0 and 100 ng/ml ketamine were administrated by target controlled infusion system in pilot study. After von Frey filaments (vFFs) 300 g were used as mechanical stimuli, Visual Analogue Scale scores were evaluated. Functional magnetic resonance imaging (fMRI)was taken 1 week after pilot study at the following sequences: structure imaging + functional imaging (stimulus sequence with 300 g vFFs, ketamine sequence); stimulus sequence = 6×(20s on + 20s off), with target concentration of ketamine at 0,100 ng/ml.fMRI result was processed by SPM2 and Metlab 7.01 software package.

RESULTSPosterior cerebellum lobe and corpus callosum were inhibited at 100 ng/ml under vFFs stimulus, whereas cingulate gyrus, middle frontal gyrus, inferior parietal lobule, occipital lobe, and posterior cerebellum lobe were activated at 100 ng/ml under vFFs stimulus.

CONCLUSIONSKetamine 100 ng/ml exerts its effect on pain related brain regions. It can both activate and inhibit these brain regions, with the activating effect being the primary effect.

Adult ; Analgesics ; administration & dosage ; pharmacology ; Brain ; drug effects ; physiopathology ; Humans ; Ketamine ; administration & dosage ; pharmacology ; Magnetic Resonance Imaging ; Male ; Pain ; physiopathology ; Pilot Projects

Objective To explore the value of quantitative measurement of carotid intima-media thickness and elasticity for evaluating the degree of coronary heart disease by radio frequency ultrasonography. Methods From February 2011 to June 2012, a total of 142 subjects in cardiovascular internal medicine of the fourth military medical university Tangdu hospital with suspected CAD were enrolled in this study and were divided into non CAD group (n=35), atherosclerosis group in which coronary stenosis rate was less than 50%and no hemodynamic changes were detected (n=33), single artery involved group in which coronary stenosis rate was more than 50% (n=36) and multi-artery involved group in which coronary stenosis rate was more than 50%(n=38) based on the results of the coronary angiography (CAG). Measure the left common carotid artery intima-media thickness (IMT) and blood vessel elasticity index including the left common carotid artery pulse wave velocity (PWV) and stiffness index (β). Receiver operating characteristic (ROC) curves were used to calculate and compare the degrees of coronary heart disease, area under the curve of the left carotid artery elasticity parameters, cut-off value,sensitivity, speciifcity and Youden's index. Results LIMT, LPWV and Lβhad statistical signiifcance differences among four groups (F=3.621, 4.769 and 4.756, all P<0.05). The maximum values of parameter area under ROC curve were all observed in multi-artery involved groups and were 0.759 (LIMT), 0.770 (LPWV) and 0.764 (Lβ). The maximum value of Youden's index of the left common carotid artery intima-media thickness was observed in the coronary atherosclerosis group and was 0.513. The maximum value of Youden's index of the left common carotid artery pulse wave velocity and stiffnessβwere both observed in the multi-artery involved group and were 0.524 and 0.469. For diagnosing multivessel lesions, the sensitivities of LIMT, LPWV and Lβwere 71.0%, 77.4%and 71.0%, and the speciifcities were 73.4%, 74.7%and 75.9%. Conclusions The carotid elastic parameters have better predictive value for multivessel lesions. LPWV and Lβhave higher predictive value for coronary arterial disease than LIMT.

Objective To evaluate the clinical effectiveness of double balloon dilation in percutaneous kyphonplasty on curing vertebral?compression fractures. Methods From January 2009 to September 2013, 84 patients (94 vertebral bodies) with vertebral compression were treated by percutaneous kyphonplasty. All were fresh fractures and were injured or obvious low back pain 1 month, accompanied by local tenderness, kowtow attack painful, lumbar mobility, but no lower extremity injury numbness, activities and defecation disorders. After randomization, the double balloon dilation in percutaneous kyphonplasty method was used to treat 44 patients (49 vertebrae). In the process of performing percutaneous unilateral pedicle puncture and balloon dilata?tion of the vertebral body, the balloon has been moved some distance in the vertebral body. Then completed the perfusion of bone cement, vertebral body forming. 40 cases (45 vertebrae) were used conventional unilateral percutaneous kyphonplasty to vertebtal compression fractures. Recorded the operation time, amount of bleeding, bone?cement injection volume. Used visual analogue scale (VAS), the height of the vertebral body and Cobb angle to evaluated the curative effect. Results All 84 patients completed the operation, follow?up time was 22 months (18-24 months). In two mobile open expansion group, the operation time was about 48 min. The amount of bleeding was 8-15 ml. The average bone?cement injection volume was 5.1 ml. No patients quit the study and no bone cement?leakage cases or other side effects were observed , and no clinical accidents occurred. In a single stretching group, 40 cases (45 vertebrae) completed conventional vertebroplasty, the time of 44 min, bone cement average injection rate 3.2 ml, bleeding 10-15 ml. In two mobile open expansion group, the VAS score was 8.5 points, the height of the vertebral body height was 2.1cm, and the Cobb angle was 34°. After operation, the VAS score 2.9 points, the height of the vertebral body 2.8 cm, and Cobb 20° . In the other group, the pain was significantly relieved and the relief was satisfactor after operation.Vertebral height of 2 cm turned to the last follow?up of 2.4 cm. The Cobb angle was 32°, and the last follow?up was 27°. The VAS score, operation time and bleeding volume of the two groups were not statistically significant, and a statistically significant difference of the average bone ce?ment injection volume, postoperative vertebral height and cobb angle improved with statistical significance. A single open group were 2 cases of bone cement leakage and leakage, 1 cases of bone cement tail, the complication rate was 5.6%. Conclusion The application of double balloon dilation in percutaneous kyphonplasty to vertebral?compression fractures improve relocation of verte?bral compression fractures, increase recovery of vertebral height, and more effectively strengthen and stiffen pathological vertebral bodies, while improving kyphosis. Moreover, it can reduce pressure during bone?cement injections, minimizing the chance of over?flow and leakage, as well as the related side effects, but it will also result in an increase of bone cement?injection volume.

OBJECTIVETo investigate the expression profile of interleuki-1β (IL-1β) in rat myocardium at different time points during hypoxia/reoxygenation(H/R)transition.

METHODSThe isolated Langendorff perfused rat heart model was established.Forty SD rats were randomly divided into sham group (A group) and hypoxia/reoxygenation group (H/R group). The H/R group rats were subdivided into H/R 0.5 h group(B group), H/R 1 h group(C group), H/R 2 h group(D group)according to reoxygenation time. The left ventricular development pressure(LVDP), maximal rates of increase/decrease of the left ventricular pressure(±dp/dtmax) were continuously recorded. The concentration of interleukin-1β(IL-lβ) and creatine kinase-MB (CK-MB) in myocardium was measured by ELISA. The mRNA expression of IL-lβ in myocardium was determined by RT-PCR. Microstructure of myocardium was observed under light microscopy.

RESULTSThe value of LVDP and ±dp/dtmax in hypoxia/reoxygenation group rat were significantly lower than that in sham group(P < 0.05). The expression of IL-lβ and CK-MB at protein level and the expression of IL-1β at mRNA level in hypoxia /reoxygenation group were higher than that in sham group(P < 0. 05). There were significant differences of the above parameters among H/R 0.5 h, 1 h, 2 h group(P <0.05). The concentration of IL-1β and CK-MB, the mRNA expression of IL-1β were higher in H/R 2 h group than that of other groups(P < 0.05).

CONCLUSIONThe high expression of IL-Iβ in myocardium after myocardial hypoxia /reoxygenation in rats might lead to. ischemia/reperfusion injury.

Animals ; Creatine Kinase, MB Form ; metabolism ; Disease Models, Animal ; Hypoxia ; metabolism ; pathology ; Interleukin-1beta ; metabolism ; Myocardial Ischemia ; metabolism ; Myocardium ; metabolism ; pathology ; Rats ; Rats, Sprague-Dawley