Objective To observe the occurrence of myocardial apoptosis and discussing the mechanism of the effects of glucocorticoid on myocardial apoptosis in septic rats in order to provide the rationale for clinical strategy.Methods A total of 60 Wistar rats weighing 230-280 g were randomly (random number) divided into control group and experimental group (n =30 in each group).Cecal ligation and puncture (CLP) was performed in rats to induce sepsis,and Cefoperazone Sodium/Sulbactam Sodium (200 mg/kg) was injected into caudal vein 4 hours after CLP,twice a day.In addition,glucocorticoid was given to rats of experimental group.After rats sacrificed,their left ventricular myocardia were rapidly taken out and myocardial apoptosis rate was measured and the level of Bcl-2 was assayed at 6 h,24 h,and 72 h after CLP.Measured data were analyzed with independent-samples t-test and One-Way ANOVA.Results The rates of myocardial apoptosis in experimental group were obviously lower than those in control groups respectively (F=9.11,t=5.681,P＜0.01) (6ht=11.416,P＜0.01; 24ht=6.217,P＜0.01; 72 h t =3.76,P ＜0.01).The rates of myocardial apoptosis in 24 h in control and 72 h control groups were distinctively higher than those in 6 h control group,respectively (F =13.254,sig =0.000,P ＜0.01 ; sig =0.004,P ＜ 0.01).The rates ofmyocardial apoptosis in group 24 h control were higher than those in 72 h control group (sig =0.039,P ＜ 0.05).The rates of myocardial apoptosis make no difference among experimental group (F =2.488,6/24 h sig =0.132,P ＞ 0.05 ; 24/72 h sig =0.549,P ＞ 0.05 ; 6/72 h sig =0.053,P ＞ 0.05).Conclusions The rate of myocardial apoptosis is peaked at 24 h in sepsis rat,and the rate of myocardial apoptosis can be obviously decreased by administration of glucocorticoid.

Objective To explore the significance of shock index in the early assessment of patients with severe sepsis and septic shock.Methods A retrospective study of 100 patients with severe sepsis and septic shock admitted in the Emergency Department of the Beijing Friendship Hospital from September 2011 to August 2013 was carried out.According to the 28-day outcome,all patients were divided into survival group (n =48) and death group (n =52).Shock index of patients was calculated at admission (SI1) and 2 hours after resuscitation (SI 2).Results (1) The SI1 and SI2 (1.5 ± 0.05),(1.2 ± 0.04) in the death group were significantly higher than those (1.3 ± 0.08),(0.9 ± 0.05),in the survival group (P ＜ 0.01) ; (2) AUC of SI1 and SI2 of death group were 0.7075 and 0.8894,respectively.The SI2 showed higher sensitivity (80.3％) and specificity (78.4％) compared to SI1.The optimal cut-off point for SI2 was ≥ 1.Conclusions SI2 may potentially be utilized as a reliable predictor for death in patients with septic shock and severe sepsis in an emergency department.

Juvenile myoclonic epilepsy (JME) diagnosed with seizure history,semiology and electroencephalography is a syndrome of idiopathic generalized epilepsy.MRS can quantitatively detect the concentration of neurometabolites noninvasively,and assess the metabolic changes in brain.Currently,studies of pathogenesis of JME are focused on the dysfunction of thalamo-cortical network and the neurometabolites and imbalance of Glutamate and γ-aminobutyric acid in the network are alterted.Epilepsy is associated with the imbalance of the ratio of excitatory and inhibitory amino acid,and seizures lead to neuronal lesions which result in altered concentration of neuron related metabolites.This article reviewed MRS studies of JME by combining material metabolism,neural structure and function.

Objective To evaluate the efficacy of midazolam premedication for prevention of emergence agitation (EA) after sevoflurane anesthesia in children undergoing minor surgery.Methods One hundred and twenty ASA physical status Ⅰ or Ⅱ paediatric patients,aged 3-9 yr,weighing 15-35 kg,scheduled for elective tonsillectomy and adenoidectomy,were randomly divided into 4 groups (n =30 each):control group (group C) and midazolam 0.25,0.50 and 0.75 mg/kg groups (groups M1-3).The 10 ml mixture of midazolam 0.25,0.50 and 0.75 mg/kg and 10％ glucose was taken orally at 30 min before anesthesia in M1-3 groups,respectively,while 10 ml of 10％ glucose was taken orally in group C.Anesthesia was induced with inhalation of sevoflurane and maintained with iv infusion of remifentanil and inhalation of sevoflurane.EA was assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale.Results Compared with group C,the PAED scores and incidence of EA were significantly decreased in groups M2 and M3 (P ＜ 0.05),and no significant change was found in group M1 (P ＞ 0.05).Compared with group M1,the PAED scores and incidence of EA were significantly decreased in groups M2 and M3 (P ＜ 0.05).There was no significant difference in the PAED scores and incidence of EA between groups M3 and M2 (P ＞ 0.05).Conclusion Premedication with oral midazolam can prevent EA following sevoflurane anesthesia in children undergoing minor surgery and the optimum dose is 0.50 mg/kg.

Objective To explore the role of BNP (B-type natriuretic peptide) in the early assessment of patients with acute pulmonary embolism (PE).MethodsEighty-six patients hospitalized in Beijing Friendship Hospital from November 2005 to June 2010 diagnosed as acute PE were studied retrospectively.The differences of BNP and other indicators and the relationship of BNP and right ventricular and right atrial pressure gradient value ( RV-RA PG) were compared between two groups divided by whether right ventricular dysfunction exists or not.imilarly,the differences of BNP and other indictors were compared between the two groups divided by complications exists or not.ResultsIn the right ventricular dysfunction group and control group,BNP was ( 1356.8 ±675.4) pg/ml and ( 103.8 ±51.4) pg/ml,respectively,and the differences are significant.BNP and RV-RA PG had a significant correlation (γ =0.824,P ＜0.01 ) by Linear correlation analysis.BNP had a reliable diagnostic power for right ventricular dysfunction ( AUC 0.907).In the group with complications and none -complication group,BNP value was ( 1356.8 ±675.4)pg/mlvs.(103.8 ±51.4) pg/ml,and pH value was (7.372 ±3.7) vs.(7.446 ±3.5),and the differences were all significant ( P ＜ 0.05 ). Conclusions BNP has important significance in early predicting the occurring,severity and prognosis of congestive heart failure caused by acute pulmonary embolism; pH of the early arterial blood gas has positive significance for early diagnose and treatment and predicting the severity and prognosis of patients suffering acute pulmonary embolism.

Objective:To investigate the clinical efficacy of gabapentin capsules( GBP)combined with amitriptyline and tramadol in the treatment of patients with postherpetic neuralgia( PHü)and anxiety. Methods:Totally 106 PHü patients with anxiety symptoms at different degree were selected and divided into group A(n=53)and group B(n=53). Group A was given GBP,amitriptyline and tramadol,while group was given GBP only. The anxiety,depression,quality of life and pain-relieving intensity( by VAS)of the pa-tients were determined before the medication( T1 )and in the first week( T2 )and the fourth week( T3 )after the medication. Follow-up was carried out regularly according to the requirements to evaluate the clinical efficacy. Results:The anxiety,depression and VAS scores in the two groups on T2 were statistically significant lower than the corresponding results on T1(P<0.05). On T3,however, there were statistically significant differences between the two groups(P<0. 05). The total adverse reaction rate of group A was signif-icantly lower than that of group B(P<0. 05). The total effective rate of group A was significantly higher than that of group B(P<0. 05). Conclusion:GBP combined with tramadol and amitriptyline in the treatment of PHü patients with anxiety can effectively con-trol the pain of the patients,significantly reduce the scores of VAS and improve the quality of life of the patients.

Objective To investigate the interventional treatment timing of patients with non-ST segment elevation myocar-dial infarction with ST segment elevation in lead aVR.Methods Totally 57 cases with non-ST segment elevation myocardial infarc-tion with ST segment elevation in lead aVR in our hospital from July 2010 to July 2013 were selected.They were divided into two groups,30 cases in group A and they were given emergency PCI treatment with in 12 hours of onset,27 cases in group B and they were given emergency PCI treatment within 12-24 hours of onset.Compare the therapeutic efficacy and adverse cardiovascular e-vents after discharge.Results Therapeutic efficacy of group A was better than group B after 1,6,12 month follow up and rate of adverse cardiovascular events of group A was shorter than group B.Conclusion Emergency PCI treatment within 12 hours can im-prove the prognosis of patients with non-ST segment elevation myocardial infarction with ST segment elevation in lead aVR.

The aim of the study is to investigate the effect of salvianolic acid B (SalB) on blood-brain barrier (BBB) in rats after cerebral ischemia-reperfusion, and to illustrate its possible mechanisms. Cerebral ischemia-reperfusion was induced by middle cerebral artery occlusion in rats. The break-down of BBB was indicated by extravasations of immunoglobulin (IgG) monitored with immunohistochemistry. The expression of MMP-9 and NOS2 in the brain was determined by immunohistochemistry, and the expression of p-p38 and p-ERK1/2 was detected by Western blotting. It was shown that on day 2 after ischemia-reperfusion the IgG accumulated around the vascular boundary zone, suggesting the break-down of BBB, and the expression of MMP-9 and NOS2 up-regulated at the same time. The result of Western blotting suggested that the expression of p-p38 and p-ERK1/2 increased. On day 7 after ischemia-reperfusion the. expression of MMP-9 and NOS2 was about the same level as day 2, the expression of p-p38 was higher than that on day 2 and the expression of p-ERK1/2 was slightly lower than that on day 2. SalB (1 and 10 mg x kg(-1)) significantly alleviated the extravasations of immunoglobulin induced by cerebral ischemia-reperfusion (P < 0.05). On day 2 and day 7 SalB attenuated the expression of MMP-9 and NOS2 (P < 0.05). SalB (10 mg x kg(-1)) reduced the expression of p-p38 and p-ERK1/2 apparently on day 2 and 7 after ischemia-reperfusion (P < 0.05). SalB (1 mg x kg(-1)) inhibited the expression of p-p38 on day 7 after ischemia-reperfusion (P < 0.05). The results indicate that SalB protects blood-brain barrier in rats after cerebral ischemia-reperfusion by inhibiting the MAPK pathway.

Objective To explore the clinical features and feasibility of renal transplantation for end-stage renal disease (ESRD) following hematopoietic stem cell transplantation (HSCT).Method A retrospective study was done in one case of renal transplantation for ERSD following HSCT.Clinical manifestations were summarized and prognosis was described.The 22-year-old male recipient had received HLA allele matched related bone marrow transplantation from his sister in 2001 and accepted renal transplantation 14 years after HSCT because of delayed renal dysfunction.Donor was a cardiac death patient,the preoperative Panel Reactive Antibody Testing was negative and there were 1.5 HLA antigen mismatches of 6 HLA-A,B,DR antigens of donor and recipient.The recipient received immunosuppressive therapy of tacrolimus + mycophenolate mofetil + steroid after renal transplantation.Result The patient's renal function remained stable and serum creatinine level was 65 μmol/L.The outcome of the patient was fairly good during the follow-up period of short-term.Conclusion Renal transplant is a feasible alternative for patients with ESRD following HSCT.If the transplanted kidney and abbr.hematopoietic stem cells are from different donors,irnmunosuppressive treatment is essential after renal transplantation.Long-term follow-up and adjustment of immunosuppression treatment are needed to prevent and treat postoperative complications.

Aim To explore the protective roles of lic-ochalcone A ( LA) on mice with cigarette smoke-medi-ated acute lung injury and the related mechanisms. Methods In vivo: Mice were exposed to cigarette smoke ( CS) to establish acute lung injury model. The bronchoalveolar lavage fluid ( BALF ) was conducted for cell counting. The mRNA and protein expression of keratinocyte-derived chemokine ( KC ) , tumor necrosis factor alpha ( TNF-α) , interleukin 1β ( IL-1β) and matrix metalloproteinases ( MMP)-9 in lungs were de-termined. The myeloperoxidase ( MPO ) , superoxide dismutase ( SOD ) activities and glutathione ( GSH ) levels in lungs were quantified. The paraffin sections of lungs were prepared and stained with HE. In vitro:Human lung epithelial cells (BEAS-2B) were exposed to cigarette smoke extract ( CSE ) , which induced cell injury. The releases of interleukin 8 (IL-8) and MMP-9 were assessed. The phosphorylation of mitogen-acti-vated protein kinases ( MAPKs, including ERK1/2, p38 and JNK ) and nuclear factor-κB ( NF-κB ) p65 protein were analyzed by Western blot. Results In vi-vo: The accumulation of inflammatory cells was lower in LA groups than that in model group. In comparison with normal control group, the mRNA and protein lev-els of KC, TNF-α, IL-1βand MMP-9 were significant-ly increased in model group. Following treatment with LA, the above indicators were significantly decreased as compared to model group. In the CS-exposed mice, the MPO activity in lungs was significantly increased, meanwhile the SOD activity and GSH level were signif-icantly decreased compared with the air-exposed ani-mals. CS-induced activity of MPO was significantly in-hibited, which were accompanied by increases in SOD and GSH levels by LA. In vitro: CSE-induced mRNA levels of IL-8 and MMP-9 were significantly inhibited by LA at 2 . 5 and 5 μmol · L-1 . The CSE-induced phosphorylation of ERK1/2 and nucleus NF-κB p65 protein expression were prevented by pretreatment with LA. Conclusions LA has protective effects on CS-ex-posed acute lung injury in mice by preventing CS-in-duced pulmonary inflammation, oxidative stress and protease rise. The exploration of the mechanisms sug-gests that LA exerts protective effects via suppressing ERK1/2/NF-κB pathways.