Objective To assess the efficacy of recoil of inflating syringe plunger in limiting laryngeal mask airway (LMA) cuff pressure.Methods Sixty ASA Ⅰ or Ⅱ patients aged 22-64 yr with body mass index of 18-30 kg/m2 undergoing elective surgery under general anesthesia with LMA were enrolled in this study.LMA Supreme (Laryngeal Mask Co.Singapore) size # 3 (for patients with body weight ≤50 kg) or # 4 (for patients with body weight ＞ 50 kg) was placed after induction of anesthesia.Correct position of LMA was confirmed by fiberoptic bronchoscopy.The LMA cuff was inflated to 60,80,100 and 120 cm H2O step by step using a 20 ml-syringe.The cuff pressure was measured with a monometer through a 3-way stopcock and maintained at each level for 10 seconds.The plunger was then allowed to recoil.The cuff pressure at the end of recoil (residual cuff pressure) was recorded.The patients were mechanically ventilated.The inspiratory pressure was limited to 30 cm H2 O.The airway pressure at which the air started to leak between LMA and larynx (leak pressure-Pleak) was recorded.Results The residual cuff pressure following the 4 inflating pressures was all ＜ 60 cm H2 O.The Pleak was ＞20 cm H2O.There was no significant difference in residual cuff pressure and Pleak between size # 3 and # 4.Conclusion Recoil of inflating syringe plunger can limit LMA pressure to safe level.

Objective To explore the mechanism ofHuanshuai Oral Liquid in the process of hypoxia-microvascular waste-renal interstitial fibrosis in mice with atherosclerosis renal artery stenosis.Methods The atherosclerosis renal artery stenosis model was established on Apoe-/- mice by high fat feed and uninephrectomy. After 2 weeks of renal ablation, model mice were randomly divided into TCM group (Huanshuai Oral Liquid) and model group. C57BL/6J mice were taken as the blank group. The mice of TCM group receivedHuanshuai Oral Liquid 0.01 mL/(g?d) for gavage, while the blank group and the model group received normal saline 0.01 mL/(g?d) for gavage. Renal function, atherosclerosis and renal interstitial fibrosis were assessed in the 12th week after taking medicine via immunohistochemical method to detect the expressions of the collagen typeⅣ, alpha smooth muscle actin (α-SMA) andⅧ factor related antigen (vWF), and via RT-PCR to detect the expressions of HIF-1α and TGF-β.ResultsCompared with the blank group, the model group suffered severe renal artery stenosis and renal fibrosis, and the expressions of HIF-1α, TGF-β, collagen typeⅣ andα-SMA significantly increased (P<0.05), while the expression of vWF decreased (P<0.05). Compared with the model group, the expressions of HIF-1α, TGF-β, collagen typeⅣ andα-SMA group, the expressions of HIF-1α, TGF-β, collagen typeⅣ andα-SMA significantly decreased in the TCM group (P<0.05), while the expression of vWF significantly increased (P<0.05).ConclusionHuanshuai Oral Liquid could significantly improve the renal function and the renal tubular-interstitial fibrosis. The mechanism might be associated with regulating the expressions of HIF-1α and TGF-β.

Objective To investigate the relationship among the late-life depression ( LLD ) , cognitive function and white matter lesions ( WML) , after excluding vascular risk factors and brain atrophy.Methods The depression and cognition status of 277 patients were assessed using a variety of neurological scales, and the actually enrolled patients were divided into LLD group ( 77 cases ) and the non-depressed group (103 cases).The independent samples t test and multivariate Logistic regression were used to analyze independent risk factors for depressive symptoms with the model Ⅰ of controlling age , sex, years of education and the model Ⅱof controlling age, sex, years of education, high blood pressure, diabetes and coronary heart disease.Under the premise of controlling mode Ⅱand brain atrophy , partial correlation was used to analyze the correlations of depressive symptoms and cognitive function and WML , and the correlation between depressive symptoms and cognitive items.Results The results showed that the proportion of high blood pressure (90.9%vs 74.7%, χ2 =6.342,P=0.046), cognitive scores (19.23 ±7.05 vs 22.99 ± 6.71, t=3.343,P=0.001), WML level 2 proportion (65.1% vs 34.9%, χ2 =7.373,P=0.025) and temporal lobe atrophy of hippocampal sulcus ratio (0.24 ±0.03 vs 0.22 ±0.03, t=-2.041,P=0.044) had statistically significant difference between the two groups.Multivariate Logistic regression showed that cognitive function was an independent risk factor for depression ( OR=1.63,95% CI 1.01 -2.80, P=0.030).Controlling for all risk factors , partial correlation analysis showed that depressive symptoms were correlated with cognitive function ( r=-0.239,P=0.004) and WML ( r=0.222,P=0.008) and the atrophy of temporal lobe and hippocampus ( r=0.173, P=0.040 ).Under the model Ⅱ, depressive symptoms correlated with attention (r=-0.175, P=0.040), memories (r=-0.140, P=0.050) and drawing clock test ( r=-0.186, P=0.029 ).Conclusions Excluding vascular risk factorts , brain atrophy and WML , cognitive impairment has significant correlation with depressive symptoms.Vascular risk factors are involved in the occurrence of depression , and WML may be the severity of cognitive impairment reserve marker.LLD patients showed hippocampal atrophy similar with early AD , manifesting the cognitive feature of memory and executive dysfunction and attention disorder .

Objective : To examine the association between acute exposure to traffic-related air pollutants (TRAP) NOX and NO2 and outpatient visits of pediatric respiratory diseases. Methods : Data regarding outpatient visits to Department of Respiratory Diseases of Beijing Children's Hospital from 2015 to 2020 were collected, and the concentrations of nitrogen oxides (NOX), nitrogen dioxide (NO2) and other TRAP were collected from the surveillance sites assigned by the Peking University Health Science Center. A time-stratified case-crossover design was employed, and a conditional logistic regression model was created to examine the association between NOX and NO2 acute exposure and outpatient visits of pediatric respiratory diseases. Results : The daily mean outpatient visits of pediatric respiratory diseases were 571 (interquartile range, 554) person-times among children at ages of 0 to 14 years in Beijing Children's Hospital from 2015 to 2020, and the daily mean outpatient visits for upper respiratory tract infections (URI), bronchitis, and pneumonia were 265 (interquartile range, 282), 143 (interquartile range, 178) and 128 (interquartile range, 120) person-times, respectively. The daily mean concentrations of atmospheric NOX and NO2 were 67.8 (interquartile range, 50.7) and 49.3 (interquartile range, 30.7) μg/m3, respectively. Conditional logistic regression analysis showed the largest lagged effect of NOX and NO2 on pediatric respiratory diseases at cumulative lags of 0 to 7 days. An increase in NOX concentrations by an interquartile range resulted in the excess risks of URI, bronchitis and pneumonia by 6.87% (95%CI: 6.37%-7.38%), 7.25% (95%CI: 6.51%-7.99%), and 5.51% (95%CI: 4.69%-6.33%), and an increase in NO2 concentrations by an interquartile range resulted in excess risks of URI, bronchitis and pneumonia by 5.71% (95%CI: 5.12%-6.31%), 5.32% (95%CI: 4.51%-6.14%), and 4.83% (95%CI: 3.91%-5.75%), respectively. NOX and NO2 presented a more remarkable effect on outpatient visits of pediatric respiratory diseases among children at ages of over 5 years. Conclusion NOx and NO2 acute exposure may increase the outpatient visits of pediatric respiratory diseases.

Objective To investigate the effects ofendothelin-1 (ET-1) and endothelin-3 (ET-3) on the expression of transformation growth factor-beta 1 (TGF-β1) and phosphorylation of Smad 3 in malignant melanoma cell line, A375. Methods Cultured A375 cells were classified into 5 groups, i.e. control group (no stimulation), ET-1 group (stimulated with ET-1), ET-1+BQ123 group (treated with ET-1 and BQ123),ET-1 + BQ788 group (treated with ET-1 and BQ788), ET-3 group (stimulated with ET-3), to receive different stimulation. The working concentrations were 0, 0.1, 1, 10, 100 nmol/L for ET-1 and ET-3, 10 μmol/L for BQ123 and BQ788. After another 12- and 24-hour culture, ELISA, RT-PCR and Western blot were used to detect the expression of TGF-β1 protein and mRNA as well as phosphorylated Smad 3 (P-Smad 3). Results The expression of TGF-β1 in A375 cells was up-regulated by ET-1, but down-regulated by ET-3, and both of the effects were in a concentration-dependent manner. Under the stimulation with ET-1 and ET-3 of 100 nmol/L, the level of TGF-β1 reached 1289.38 ± 89.42 ng/L per 105 cells and 85.09 ± 9.37 ng/L per 105 cells, respectively, significantly different from that in unstimulated cells (both P < 0.05). BQ123 signifi-cantly blocked the up-regnlatory effect of ET-1 on the expression TGF-β1 protein(P < 0.05), but BQ788 had no significant influence on the effect, so was the case with TGF-β1 mRNA. Western blot revealed that ET-1significantly elevated the expression of P-Smad 3 in A375 cells (P <0.05), and the elevation was significantly inhibited by BQ123, but not by BQ788. The expression of P-Smad 3 was statistically decreased by ET-3 in A375 cells (P <0.05). Conclusions The expression of TGF-β1 could be enhanced by ET-1, but suppressed by ET-3. It is likely that endothelin receptor A mediates the phosphorylation of Smad 3 induced by ET-1.

Objective To determine the value of acute phase protein in the early diagnosis of recurrence after curative gastric cancer surgery. Methods Acute phase serum protein level was measured before and after the gastric cancer surgery in 120 patients,and was compared with that of the control group. At 1, 3, 6, 9, 12 months after the operation in 87 patients undergoing curative gastric cancer surgery, the levels of acute phase proteins were measured. They were followed up for at least 12 months or until death. Results The levels of serum C reactive protein(CRP), ?1 antitrypsin (?1 AT) and ? acid glycoprotein (? AG) in gastric cancer group were significantly higher than those in the control group (P0.05). In patients who underwent curative gastric cancer surgery in a certain period after the operation, the serum levels of CRP, ?1 AT and ? AG were significantly lower than those before the surgery(P0.05).There were significant difference in CRP,?1 AT and ? AG between the recurrence groups and nonrecurrence group before and after the operation (P

Objective:To investigate the pathophysiology,clinical manifestation and neuroimaging characteristics and therapeutic experiences for hemichore associated with non-ketotic hyperglycemia (HC-NH).Methods:Clinical data of three patients with HC-NH from Xiangya Hospital,Central South University were analyzed retrospectively,and the related literature was reviewed.Results:The core clinical features of HC-NH were characterized by acute/subacute onset of hemichorea with non-ketotic hyperglycemia in the elderly females.Radiologic findings associated with HC-NH were characterized by hyperattenuation on computed tomographic (CT) scans and hyperintensity on Tl-weighted magnetic resonance imaging (MRI) at unilateral basal ganglion region.Blood glucose control was the foundation of treatment.Dopamine receptor antagonists and benzodiazepine sedative were helpful in controlling hemichorea.Conclusion:Hemichorea-hemiballismus is a rare complication of nonketotic hyperglycaemia in elderly type 2 diabetes.It is associated with contralateral striatal radiological abnormality and typically T1 hyperintensity on MRI.The pathophysiology of HC-NH is not clear.The prognosis of HC-NH is favorable.Antidiabetic drugs combined with dopamine receptor antagonists can effectively relieve the hemichorea symptoms.

OBJECTIVETo analyze potential mutations of the NOTCH3 gene in two Chinese families featuring cerebral autosomal dominant arteriopathy with subcortical infarct and leucoencephalopathy (CADASIL).

METHODSThe two probands and related family members and 100 healthy controls were recruited. Potential mutations of the NOTCH3 gene were screened by PCR and direct sequencing. PolyPhen-2 and SIFT software were used to predict the protein function.

RESULTSThe conditions of both probands were adult-onset, with main clinical features including recurrent transient ischemic attacks and/or strokes, cognitive impairment. MRI findings suggested multiple cerebral infarcts and severe leukoencephalopathy. A heterozygous mutation c.328C>T (p.Arg110Cys), which was located in exon 3 of the NOTCH3 gene and known as a causative mutation, was identified in proband 1. A novel heterozygous mutation c.1013 G>C (p.Cys338Ser) located in exon 6 of the NOTCH3 gene was identified in the proband 2, which was not reported previously. The same mutations were not detected among the 100 unrelated healthy controls. Function analysis suggested that heterozygous mutation c.1013G>C can severely affect the functions of NOTCH3 protein.

CONCLUSIONTwo heterozygous missense mutations in the NOTCH3 gene have been identified in two families affected with CADASIL. The novel heterozygous Cys338Ser mutation in exon 6 of the NOTCH3 gene probably underlies the CADASIL.

Adult ; Brain ; diagnostic imaging ; CADASIL ; diagnostic imaging ; genetics ; Female ; Heterozygote ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Mutation ; Receptor, Notch3 ; genetics

Pulmonary arterial hypertension (PAH) is an abnormal remodeling of the pulmonary vascular wall due to various causes, resulting in severe cardiovascular disease characterized by increased pulmonary vascular resistance and pressure. The mortality and morbidity of pregnant women with PAH are extremely high. This article reports a woman with severe PAH associated with connective tissue disease who developed cardiac arrest, PAH crisis, and right heart failure during her two consecutive pregnancies without regular prenatal examination. After multidisciplinary consultation and extracorporeal membrane oxygenation, effective cardiopulmonary support was timely, and the patient was finally discharged from the hospital in stable condition. After ten months of follow-up, the mother and child both had good outcomes. Although the mother and her child were survived, severe PAH is a contraindication for pregnancy due to its severely harmful effect on endangering maternal and fetal health.

Objective? To explore the clinical effects of evidence-based psychological intervention on nursing care for middle-aged patients with ischemic stroke. Methods? Totally 120 patients aged 45-59 years who were hospitalized in the Department of Neurology, Cangzhou People's Hospital between February and July were selected, and stratified into intervention (n=60) and control (n=60) groups. Patients in the control group received conventional nursing care, while patients in the intervention group received psychological intervention based on conventional nursing care. Self-Depression Scale (SDS) was used to assess the status of patients in the two groups. Results? After 4 weeks, the SDS score of the intervention group was (52.37±4.38), whereas the SDS score of the control group was (58.81±3.44). The SDS score was lower in the intervention group than in the control group, and there was statistically significant difference between the two groups (P＜ 0.01). Conclusions? The evidence-based psychological intervention model helps to ameliorate the depression in middle-aged patients with ischemic stroke, which is worthy applying and promoting in clinical practice.