Objective To investigate the effect of circadian rhythm on the duration of neuromuscular blockade (NMB) elicited by atracurium. Methods Sixty-one ASA Ⅰ or Ⅱ patients aged 18-55 yr with body mass index of 18-24 kg/m2 undergoing general anesthesia were enrolled in this study. Anesthesia was induced with fentanyl 2 μg/kg and propofol 2 mg/kg. Atracurium 0.75 mg/kg was injected iv as soon as the patients lost consciousness . NMB was assessed by TOF-stimulation of ulnar nerve using TOF-Watch(R) SX. Tracheal intubation was performed as soon as the first twitch (T1) disappeared. The patients were mechanically ventilation (VT 6-8 ml/kg, RR 12 bpm, I ∶ E 1.0 ∶1.5). PETCO2 was maintained at 35-45 mm Hg. Anesthesia was maintained with continuous infusion of propofol 6-8 mg·kg-1·-1·-1and remifentanil 0.25-0.50 μg·kg-1·min-1 . Anesthesia was performed at 5 time periods: (1) 8:00-11:00, (2) 11:00-14:00, (3) 14:00-17:00, (4) 17:00-20:00 and (5) 20:00-23:00. The duration of NMB produced by atracurium was defined as the interval between the end of atracurium injection and 3% recovery of T2 . The data were analysed using generalised linear models (GLMs) and cosinor method. Results Fifty-three cases completed the study. GLM analysis showed that the duration of NMB was longest at 20:00-23:00 (53 min (95% confidence interval 50-56 min)) and shortest at 11:00-14:00 (43 min (95% confidence interval 39-46 min)), suggesting that there is a significant diurnal variation in the duration of NMB elicited by atracurium. Cosinor method analysis showed that equation of the duration of NMB and time point of atracurium administration was y = 48.05 + 15cos( 15t + 52.66). Conclusion Circadian rhythm can affect the duration of NMB elicited by atracurium, which shows that the duration of NMB is longest at 20:00-23:00 and shortest at 11:00-14:00.

Objective To evaluate the differences of clinical features,neuroimaging,angiography and laboratory findings between different stroke subtypes according to TOAST criteria in elderly patients.Methods 91 patients (aged ≥ 80 years) with acute ischemic stroke were retrospectively reviewed in Departement of Neurology from April 2009 to August 2010.Subtypes of ischemic stroke were analyzed according to the classification of TOAST.Risk factors,clinical manifestations,complications,prognosis,neuroimaging,cerebrovascular lesions,and laboratory findings of different TOAST subtypes were compared.Results Large-artery atherosclerosis (LAA) (34/91) was the most common cause of acute ischemic stroke in elderly patients,and most criminal lesions (25/34) located at the intracranial arteries.In the LAA group,patients with intracranial (25/34) or extracranial (12/34) occlusive diseases were more than those in other groups.Patients with cardioembolism (CE) had lower lipid levels.In the CE group,patients with poor shortterm prognosis (7/15) were more than in the LAA or small-artery occlusion (SAO) group,and patients with severe cerebral edema (4/15) were more than those in other groups.In patients of the SAO group,complications occurred infrequently (4/20),and none had poor short-term prognosis.Conclusions There were some differences among different TOAST subtypes in clinical features,neuroimaging,cerebrovascular diseases,and laboratory findings.The clinical significance of our findings needs to be explored further.

Apoptosis ; drug effects ; Asparaginase ; pharmacology ; HL-60 Cells ; Humans ; K562 Cells ; U937 Cells

To investigate the clinical significance of serum soluble programmed cell death ligand-1 (PD-L1) in adult patients with community-acquired pneumonia (CAP). A total of 44 CAP patients, 54 severe CAP patients and 30 healthy volunteers were recruited in this study. Serum soluble PD-L1 were detected. Univariate and multivariate regression analyses were used to assess the influence of multiple clinical variables on prognosis. Serum soluble PD-L1 level in severe CAP group was 98.20(57.94, 128.90) ng/L, which was significantly higher than that in the CAP group [59.32(33.55, 92.58) ng/L] and healthy controls [20.44(12.15, 36.20) ng/L] (all P<0.001). PD-L1 level was positively correlated with CRUB-65( r=0.481, P<0.001) and the pneumonia severity index (PSI) score ( r=0.442, P<0.001). Univariate regression analysis showed that CURB-65 ( HR=2.544, 95% CI 1.324-4.889, P=0.005), PSI score ( HR=1.036, 95% CI 1.012-1.061, P=0.004), soluble PD-L1( HR=1.013, 95% CI 1.001-1.026, P=0.041) were risk factors of mortality during hospitalization. Multivariate regression analysis suggested that PSI score ( HR=1.042, 95% CI 1.012-1.073, P=0.005), soluble PD-L1 ( HR=1.011, 95% CI 1.002-1.071, P=0.020) were independent predictors for mortality risk in CAP patients. CAP patients with soluble PD-L1≥98.20 ng/L had a significantly lower survival rate than those with soluble PD-L1<98.20 ng/L ( P=0.033). In conclusion, this study indicates that serum soluble PD-L1 level in CAP patients is correlated with the survival prognosis.

Objective To investigate the supply of iodized salt in non-excessive iodine counties and iodine-free salt in excessive iodine counties at household level in Jiangsu Province so as to provide a basis for the prevention and control of iodine deficiency disorders(IDD).Methods According to the National Iodine Deficiency Disorders Monitoring Program(Trial),county(city,district) was taken as a elementary sampling unit in Jiangsu Province.Townships(towns) and administrative villages were selected by systematic sampling and random sampling in every county and households were chosen by random sampling to collect their edible salt samples.The salt iodine content in non-and excessive iodine regions was detected by direct titration method and semi-quantitative method,respectively.Results All 30 840 salt samples were collected from 106 non-excessive iodine counties,and qualified iodized salt was 30 303 copies,iodine-free salt 199 copies.Weighted by the population of counties,the rate of iodine-free salt was 0.71％,the coverage rate of iodized salt accounted for 99.29％,out of which,98.93％ was qualified and the consuming rate of qualified iodized salt was 98.23％.All 1296 salt samples were collected in 5 counties with excessive water iodine content and the coverage rate of iodine-free salt was 98.99％ (1283/1295).Conclusions The national targets for preliminary elimination of IDD have been achieved in regions of nonexcessive and excessive iodine of Jiangsu Province.But it still should be strengthen the management work of iodinefree salt in excessive iodine counties and iodine saft in non-excessive iodine counties.

Acute Disease ; Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; China ; Humans ; Infant ; Inpatients ; Insecticides ; poisoning ; Middle Aged ; Organophosphorus Compounds ; Pesticides ; poisoning ; Poisoning ; etiology ; mortality ; therapy ; Risk Factors ; Survival Rate

Objective To investigate the expressions of transforming growth factor beta receptors (TGF beta R), receptor-activated Smads and common-partner Smad in condylomata acuminata. Methods Tissue samples were collected from 20 patients with condylomata acuminata and 15 normal human controls.EliVisionTM plus immunohistochemical technique was used to detect the distribution and expression of TGF beta R Ⅰ , TGF beta R Ⅱ, Smad1/2/3, phosphorylated Smad2/3 and Smad4 in condylomata acuminata and normal control skin. Results Positive immunohistochemical staining for TGFbeta R Ⅰ , TGFbeta R Ⅱ,Smad1/2/3, p-Smad2/3 and Smad4 was detected in the epidermis of normal control skin. The intensity of im-munohistochemical staining was significantly lower for TGFbeta R Ⅰ , TGFbeta R Ⅱ, Smad1/2/3, p-Smad2/3and Smad4 in the epidermis of condylomata acuminata than in that of normal control skin (P < 0.05 or < 0.01). Conclusion The expressions of TGF beta R, receptor-activated Smads and common-partner Smad are decreased or absent in the epidermis of condylomata acuminata, which might interfere with TGF be-ta/Smad signaling and contribute to the development of epidermal hyperplasia in condylomata acuminata.

Autopsy ; Fetus ; Heart Neoplasms ; pathology ; Humans ; Rhabdomyoma ; pathology ; Tuberous Sclerosis ; pathology

Human immunodeficiency virus(HIV) infection may result in serious impairment of the immune system in HIV-posi-tive patients. Both HIV productions and highly active antiretrovi-ral therapy (HAART) drugs can cause neuropathy, including the HIV associated neurocognitive disorders (HAND) and the peripheral neuropathy. Several animal models have been devel-oped in an attempt to study the mechanisms of HIV relative neu-ropathies. This review focuses on researching HIV-1 associated neuropathies by application of HIV-1 animal models.

We here investigated the effect of MS4A6D(the membrane spanning 4-domain subfamily A(MS4A)superfamily protein 6D),one of the tetraspanins which specifically expresses on the membrane of macrophages,on carrageenan(CGN)-induced mouse foot pad swelling and its possible mechanism.Male C57BL/6 wild-type(WT)and various gene knockout(including Ms4a6d-/-,Nlrp3-/-,Casp-1-/-and IlR1-/-)mice were recruited and injected with 100 μl 1%CGN(w/v)and 20 μl CaCl2(50 mmol/L)to establish the foot pad swelling model,and then the severity of foot pad swelling in WT and gene knockout mice were compared.H&E staining was performed to investigate the pathological changes,and immunofluorescence was used to detect the infiltration of F4/80+ macrophages in the foot pad tissue.Finally,Western blot was used to determine the protein expression of NLRP3,IL-1 β,TNF-α and IL-6.Data showed that the combined injection of 100 μl 1%CGN(w/v)and 20 μl CaCl2(50 mmol/L)significantly promoted the swelling of foot pads,while the degree of foot pad swelling in Ms4a6d-/-mice was significantly lower than that in WT littermates(P<0.05);Significant tissue damage and inflammatory infiltration as well as necrotic lesions were observed in the WT foot pads,whereas,the degrees from Ms4a6d-/-foot pads showed significantly reduced;The protein levels of Caspase-1 and IL-1β in the foot pad tissue of the WT model were significantly higher than those of the Ms4a6d-/-groups;Compared with WT controls,the degree of foot pad swelling in Nlrp3-/-,Casp-1-/-,and IlR1-/-mice induced by 1%CGN(w/v)and CaCl2(50 mmol/L)were also significantly reduced(P<0.05).Taken together,MS4A6D promotes the activation of NLRP3 inflammasome in macrophages and induces IL-1β secretion,by thus deteriorates CGN-mediated swelling of mouse foot pads.