Objective To establish the cardiac arrest-cardiopulmonary resuscitation model in rats, and to observe the effect of mild hypothermia on autophagy in hippocampal CA1 neurons after ROSC.Methods A total of 36 Wistar rats were randomly divided into two groups: normal temperature treatment group(NT group) and mild hypothermia treatment group(HT group).To establish the cardiac arrest-cardiopulmonary resuscitation(CA-CPR) model in rats by epicardial electrical stimulation induced ventricular fibrillation, and to sacrifice 3 animals in each group to obtain the brain cortex in 2nd and 4th hours after ROSC in order to observe the expression of p-AMPK by electron microscope and LC3 granules through Western blot.The neurological deficit score(NDS) was assessed in 24、48、72 hours respectively after ROSC.To sacrifice the animals so as to take the cerebrum in 72 hours after ROSC, then calculate the apoptotic index of the hippocampal CA1 neurons, which were dyed through TUNEL method.Results The expression of p-AMPK、Beclin-1 and LC3-Ⅱ/LC3-Ⅰratio in Normothermia group were all lower than the Mild hypothermia group(P<0.05), the neurons plasma of hippocampal CA1 area in the Hypothermia group demonstrated obvious LC3 granules formation, the NDS score of the Normothermia group and the Mild hypothermia group in ROSC24h、ROSC48h、ROSC72h were 320vs205、285vs140、266vs120, respectively.The apoptotic index of the hippocampal CA1 area in the Normothemia group in ROSC72h was higher than the Mild hypothermia group,(P<0.05).Conclusions Mild hypothermia after cardiopulmonary resuscitation promotes autophagy of the hippocampal CA1 area neurons in rats and reduce neuronal apoptosis.

Objective: The present study aimed to prospectively validate whether the single nucleotide polymorphisms (SNPs) in obesity-related genes were associated with change in body mass index (BMI) and obesity status during childhood. Methods: Based on the Beijing Child and Adolescent Metabolic Syndrome study (BCAMS), which was initiated between April and October in 2004, we conducted a follow-up study among 1 624 children aged 6 to 11 years old with genetic data in December 2010. A total of 777 children (246 obese and 531 non-obese) were reassessed for BMI. Z-score of BMI was used to standardize for age and sex. The changes in BMI Z-score during follow up were calcnlated SNPs were genotyped by quantitative Real-time PCR (rs9939609, rs6499640, rs7138803, rs1805081, rs17782313, rs6265, rs10938397, rs6235, rs29941, rs2844479, rs10913469 and rs4788102). Overweight and obesity were diagnosed by the age-and sex-specific BMI cutoffs recommended by the International Obesity Task Force. A multilocus genetic risk score for BMI was calculated as the simple sum of alleles of all the SNPs associated with BMI. Linear regression models and logistic regression models were performed to assess the associations of change in BMI Z-score and obese status with genotypes (assuming an additive model), respectively. Results: During 6 years of follow-up, 158 previously obese children remained obese as they aged into adolescence, and 88 transiently obese children were not obese during the second survey, 58 children were newly identified obese, and the other 473 children remained their non-obese state. BMI Z-score increased from 1.41±0.05 at baseline to 1.57±0.06 at follow up.The genotypes of the SNPs except rs6499640(P=0.033) and rs6265(P=0.041) were in Hardy-Weinberg equilibrium in each group (P>0.05). Each additional copy of the rs9939609 A allele was significantly associated with an increase in BMI Z-score (β=0.205, P=0.014) during follow up. Per C allele of rs17782313 was associated with an increase in BMI Z-score at baseline (β=0.268, P=0.003). As the non-obese reference, a significantly relative risk of obesity at follow up was observed for children carrying rs9939609 A-allele versus the T-allele carriers (OR=2.37, 95%CI: 1.45-3.88, P=0.001). Rs17782313 C-allele was significantly increase the risk of obesity only at baseline (OR=1.79, 95%CI: 1.24-2.60, P=0.002). Rs1805081 A-allele was significantly associated with durative of obesity (OR=1.45, 95%CI: 1.04-2.03, P=0.028). Each unit higher genetic risk score was associated with increases risk of 0.18 times (OR=1.18, 95%CI: 1.05-1.33) in childhood transient obesity, and 0.22 times (OR=1.22, 95% CI: 1.06-1.42) in incident obesity at follow-up. But it was not significantly associated with persisted obesity during 6 years of follow-up (OR=1.09, 95% CI: 0.99-1.20). Conclusion We confirmed that the change of BMI and obesity status in children was affected by different genetic factors. Individual who carries more risk alleles in obesity-related genes may increase the susceptibility to obesity.

Objective To study the effects of dexmedetomidine combined with ropivacaine for intercostal nerve block on pain and sleep in patients with multiple ribs fracture. Methods One hundred and seventy-eight patients with multiple ribs fracture were divided into two groups according to the random digits table method: control group (ropivacaine, 88 cases) and experimental group (dexmedetomidine combined with ropivacaine, 90cases). On the second day after admission, the patient underwent intercostal nerve block guided by ultrasound. Pain score of resting pain, cough pain and night pain at each time point and the sleep condition was compared after 3 days. Results In 4—7 ribs fracture patients, the resting pain score in the experimental group was significantly lower than that in the control group within 16 hours: (1.3 ± 0.6)scores vs. (1.7 ± 0.7) scores, (2.1 ± 0.4) scores vs. (2.2 ± 0.6) scores, (2.2 ± 0.3) scores vs. (2.3 ± 0.3)scores; while in the cough pain score, the experimental group was significantly better than the control group within 24 hours: (1.6 ± 0.8) scores vs. (2.5 ± 0.9) scores, (3.0 ± 0.7) scores vs. (3.3 ± 0.8) scores, (3.3 ± 0.7) scores vs. (4.0 ± 0.9) scores, (4.9 ± 1.0) scores vs. (5.4 ± 1.0) scores. The differences were statistically significant (P<0.05). In patients with more than 7 ribs fractures, the resting pain scoreand cough pain score ,the experimental group were significantly better than those in the control group within 12 hours (P<0.05). On the first day and the second day after the block, the insomnia scores in the experimental group were significantly lower than those of the control group: (2.5 ± 0.7) scores vs. (4.2 ± 1.6) scores, (2.8 ± 0.8) scores vs. (4.5 ± 1.5) scores. The difference was statistically significant (χ2＝7.374, 7.989, P < 0.05) . Conclusions For patients with multiple ribs fracture, the use of dexmedetomidine combined with ropivacaine for intercostal nerve block can improve the analgesic effect, prolong the analgesic time, and improve sleep quality.

Objective To investigate the neurons autophagy and apoptosis after cerebral ischemia reperfusion (I/R) injury in mice,and to explore the effect of mild hypothermia on neurons autophagy and apoptosis.Methods The global cerebral ischemia-reperfusion injury model in C57 mice was established with carotid artery ligation method.Ninety-six C57 mice were randomly (random number) divided into 8 groups (n =12 in each group),namely control group (C0),sham group,normal body temperature group (NT,37 ℃) after I/R 6 h (C6 h),normal body temperature group after I/R 12 h (C12 h),normal body temperature group after I/R 72 h (C72 h),mild hypothermia group (MH,34 ℃) after I/R6 h (C6 h +MH),mild hypothermia group after I/R12 h (C12 h + MH),mild hypothermia group after I/R 72 h (C72 h + MH).The protein expressions of Sirt1,P-FoxO1,Rab7,P53 and autophagy related genes such as Beclin1,LC3 were detected by Western blot at given intervals.The LC3 granules were assayed by immunofluorescence.The neurons apoptosis was detected by TUNEL.The software of SPSS13.0 was used for statistical analysis.Measurement data was expressed with mean ± SD,and comparison between two groups was carried out with Student's t test,One-way ANOVA was used for comparisons among groups,and P ＜ 0.05 was considered statistically significant.Results The global cerebral ischemia-reperfusion injury model in C57 mice was established successfully with bilateral carotid arteries ligation method.Compared with the control group,the protein expressions of Sirt1,P-FoxO1,Rab7,Beclin1 and LC3 Ⅱ / Ⅰ were gradually reduced,especially at 12 h after I/R in NT group (P ＜ 0.05),while the expression of P53 was obviously increased (P ＜0.05).In MH group,the expressions of Sirt1,P-FoxO1,Rab7,Beclin1,LC3 Ⅱ / Ⅰ were higher than those in NT group (P ＜ 0.05).And the expression of P53 was lower than that in NT group (P ＜0.05).Immuno-fluorescence test showed that compared with the control group,the LC3 particles of neurons cells were decreased significantly in group C12 (at 12 h after I/R 6.0 ± 1.5 vs.18.1 ±2.5,P ＜0.05).Nevertheless,LC3 particles were increased in MH group compared with NT group (36.1 ± 4.5 vs.6.0 ± 1.5,P ＜ 0.05).The results of TUNEL test showed that compared with the control group,neurons cells apoptosis were significantly increased in C72 group (at 72 h after I/R,54.8％ ±7.5％ vs.5.5％ ±1.2％,P ＜ 0.05).However,compared with NT group,neurons apoptosis were decreased in MH group (28.8％ ±4.5％ vs.54.8％ ±7.5％,P＜0.05).Conclusions The neuron autophagy was significantly reduced and apoptosis was significantly increased after ischemia reperfusion injury (I/R) in mice.However,mild hypothermia could increase the expression of Sirt1,FoxO1,beclin1 and LC3,so as to promote neurons autophagy and reduce apoptosis,which would provide therapy target for neurons injury after hypoxia and provide soundly theoretical basis for mild hypothermia for clinical application.

Objective: To investigate the safety and feasibility of caudal-medial approach combined with "page-turning" middle lymphadenectomy in the laparoscopic right hemicolectomy. Methods: A descriptive cohort study was conducted. Clinical data of 35 patients who underwent laparoscopic radical right hemicolectomy using caudal-medial approach combined with "page-turning" middle lymphadenectomy at Department of Gastrointestinal Surgery, Guangdong Hospital of Chinese Medicine from April 2018 to May 2020 were retrospectively analyzed. All operations were performed consecutively by the same surgeon. The caudal-medial approach was used to dissect the right Toldt's fascia and the anterior pancreaticoduodenal space in a caudal-to-cranial and medial-to-lateral manner guided by the duodenum. The "page-turning" middle lymphadenectomy was used to dissect the mesocolon along the superior mesenteric vein with ileocolic vein, Henle's trunk and pancreas exposed preferentially. Results: All the 35 patients completed the operation successfully, and there was no damage and bleeding of superior mesenteric vessels and their branches. The operative time was (186.9±46.2) minutes, and the blood loss was 50 (10-200) ml. The first time to flatus was (2.1±0.6) days, and the time to fluid intake was (2.5±0.8) days. The postoperative hospital stay was 6 (3-18) d. The overall morbidity of postoperative complication was 8.6% (3/35), including grade II in 1 cases (2.8%) and grade IIIa in 2 case (5.7%) according to the Clavien-Dindo grading standard. The total number of lymph node dissected was 30.2±5.6, and the positive lymph node was 0 (0-7). Tumor staging revealed 5 cases of stage I, 18 cases of stage II, 11 cases of stage III, and 1 case of stage IVA. In this study, the median follow-up time was 15 (4-29) months. One patient died due to cerebrovascular accident 12 months after surgery, and no tumor recurrence or metastasis was observed in all other patients. Conclusions: Laparoscopic radical right hemicolectomy using caudal-medial approach combined with "page-turning" middle lymphadenectomy is safe and feasible. The anterior pancreaticoduodenal space is preferentially mobilized, which reduces the difficulty of central vascular dissection.
Cohort Studies ; Colectomy ; Colonic Neoplasms/surgery* ; Humans ; Laparoscopy ; Lymph Node Excision ; Retrospective Studies