OBJECTIVE:To observe the efficacy and safety of paroxetine combined with buspirone in the treatment of geriatric depression with anxiety. METHODS:78 patients with geriatric depression with anxiety were randomly divided into control group (39 cases) and observation group (39 cases). Control group received 20-40 mg Paroxetine hydrochloride tablet,within half an hour after breakfast. Observation group additionally received 5-10 mg Buspirone hydrochloride tablet for 3 times. The treatment course for both groups was 8 weeks. Clinical efficacy,HAMD,HAMA and TESS before and after 2,4 and 8 weeks of treatment in 2 groups were observed. RESULTS:The total effective rate in observation group was significantly higher than control group,the difference was statistically significant(P<0.05). HAMD after 4 and 8 weeks,HAMA after 8 weeks in control group,HAMD and HAMA after 2,4 and 8 weeks in observation group were significantly lower than before,and it gradually decreased by time pro-longed,observation group was lower than control group,the differences were statistically significant (P<0.05 or P<0.01). And there was no significant difference in the TESS rating in 2 groups before and after treatment(P>0.05). CONCLUSIONS:The effi-cacy of buspirone combined with paroxetine is superior to paroxetine alone in the treatment of geriatric depression with anxiety, with better safety.

ObjectiveTo review the surgical technique and outcome of intracranial angiographically occult vascular malformations (AOVM) hemorrhage. Methods40 patients with spontaneous intracranial hemorrhage episodes and accepted microsurgery were analyzed retrospectively. ResultsAll AOVMs were successfully resected. No operative death occurred.36 patients were followed up for mean 28 months. CT and/or MRI revealed no residual lesions. Most neurological complications improved postoperatively. 1 case demonstrated rebleeding in surgical site 48 months after operation. Another case, a follow-up MRI scan revealed a contralateral denovo lesion 44 months after operation.ConclusionA current neurosurgical procedure is a satisfactory method to prevents AOVMs rebleeding. Long-term follow-up evaluation is necessary despite the lesion has been totally resected.

Objective Gasp was defined as a pathology respiration during cardiac arrest. This study was to investigate its effect on hemodynamics during CPR. Method Twelve domestic pigs, weighening (30 ± 1) kg,were anaesthetized. After tracheal intubation and mechanical ventilation, continuous respiratory variables were recorded. An artery catheter was inserted for reference blood samples and measuring aortic artery pressure (AOP).Right atrial pressure (RAP) and cardiac output (CO) were detected by Swan-Ganz catheter. Ventricular fibrillation (VF) was induced by programmed electrical stimulation instruments. After 4 minutes untreated VF, standard 30:2 CPR was done for 12 minutes and the parameters were recorded. Results pH, PaCO2 and lactic acid increased and PaO2 decreased progressively during CPR, whereas PaO2 was up to 50mmHg during the whole protocol. Gasps were observed in 10 animals, but weaken gradually; the left 2 animals with no gasp did not restore of spontaneous circulation (ROSC). Standard CPR could produce passive ventilation more than dead space (VD), but its tidal volume decreased gradually, which led to the percentage of rescue ventilation increased progressively. Positive correlations were found between CO, coronary perfusion pressure (CPP) and minute ventilation of gasps (MVg) (r was 0.736 and 0.721 respectively, both P ＜0.01); negative correlation were found between RAP and MVg (r= -0. 744, P ＜ 0.01). Conclusions Standard CPR could maintain 12 minutes oxygenation of body; compressions could produce enough passive ventilation more than VD; gasps were benefit to ROSC by increasing CO, CPP and decreasing RAP.

Objective To examine ultrastructural features of the arteriole responsible for intracerebral hemorrhage or the perforating branches artery around hematoma in patients with hypertensive intracerebral hemorrhage and explore the mechanism of hypertensive intracerebral hemorrhage. Methods Twelve hypertensive patients with CT proved intracerebral hemorrhage underwent operation. The small artery specimens were obtained through cortex fistula and their ultrastructures were observed under the electron microscope. Results Twelve specimens including 4 cases of duty arteriolae and 8 cases of perforating branch arteriolae were collected, Different degrees of degeneration were observed in three layers of the arteriola in all 12 specimens. Changes in endothelial cells included endothelial cell necrosis, collapse, or fallen of from endomembrane, accompanied by degeneration of internal elastic membrane, such as uneven thickness, absence of intermittent and medial smooth muscle cell necrosis. Myofilaments in the cytoplasm were condensed to form a high electron-dense cytoplasm. No micro-aneurysm was observed. Conclusions The pathological changes of cerebral small artery walls load-bearing layer in hypertensive patients include internal elastic layer rupture, smooth muscle layer of degeneration, decreased elasticity and increased fragility. Small artery walls may rupture, resulting in bleeding under the condition of rapid dynamic changes of blood flow.

Objective To explore the formation mechanism of peritumoral brain edema(PTBE)by vascular endothelial growth factor(VEGF).Methods 40 biopsies were obtained from 37 patients.Inmunohistochemical staining and Western blot were performed to detect the expression of VEGF protein.Reverse-transcriptase polymerase chain reaction(RT-PCR)was used to analyze the presence and quantity of VEGF mRNA.The extent of PTBE was estimated as an edema index(EI)based on preoperative magnetic resonance imaging.Results In VEGF-positive cases,a decreasing gradient of VEGF protein expression was observed with increasing distance from tumors(0.38±0.08,0.20±0.03,0.04±0.02).In meningiomas,the protein level and the mRNA level were congruent and the expression of both protein and mRNA had a significant correlation with EI(protein: r =0.892,RNA: r =0.875,P ＜ 0.05).However,in peritumoral areas,protein level were not consistent with the mRNA level.Protein results showed high correlation with EI(r =0.912,P ＜ 0.05),but mRNA almost was almost undetectable(0.06±0.02).Conclusion VEGF is impartant on PTBE.It is concluded that VEGF macromolecules are secreted by tumor tissue and enter peritumoral normal brain tissue to induce edemagenesis in meningiomas.

Aim To observe the protective effects of breviscapine against lung fibrosis and investigate its possible mechanism.Methods Effects of breviscapine on cell proliferation,activation and extracellular matrix secretion were examined in mouse embryonic lung fibroblast L929 cells in vitro.The mouse model of bleomycin-induced lung fibrosis was used to assess the protective effect of breviscapine against lung fibrosis.Results In vitro,breviscapine had no cytotoxicity directly on L929 cells,however,it could suppress cell proliferation,activation and secretion of laminin(LN) and collagen Ⅰ(ColⅠ) induced by transforming growth factor beta1(TGF-?1) in L929 cells.In vivo,breviscapine could prevent increase in serum TGF-?1 and decrease in superoxide dismutase(SOD),peroxidase(POD) and catalase(CAT) in mice with lung fibrosis caused by bleomycin.In addition,breviscapine was able to reduce pulmonary hydroxyproline,collagen,malondialdehyde(MDA)and TGF-?1 in lung fibrosis mice.Conclusion Breviscapine has protective effect against lung fibrosis and the possible mechanism is to enhance antioxidative defense activities and prevent TGF-? signal.

Objective To evaluate the diagnostic value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)for the differential diagnosis of the adenoid cystic carcinoma and pleomorphic adenoma of the head and neck.Methods Thirty-one pa-tients with histopathologically proved adenoid cystic carcinoma and pleomorphic adenoma were examined with DCE-MRI,in which 10 cases were benign and 21 cases were malignant.The data of the conventional 3.0T DCE-MRI were improved by the 3D fast spoiled gradient-echo sequence (FSPGR)method.Z-test was performed on the quantitative parameters for benign and malignant le-sions,including volume transfer constant (Ktrans ),rate constant (Kep )and extravascular extracellular space fraction (Ve ).The re-ceiver operating characteristic (ROC)curves were plotted to investigate the diagnosis.Results The mean Ktranss of the adenoid cystic carcinoma group and pleomorphic adenoma group were (0.266 ± 0.103 )min-1 and (0.1 55 ± 0.080)min-1 respectively,and the difference between them were statistically significant (Z =-2.699,P < 0.05).The difference between the keps of the aforementioned two groups was of statistical significance (Z =-2.263,P < 0.05),while that of the ves is without statistical significance (Z =-1.132, P >0.05).The areas under the ROC curves of the Ktrans and kep were 0.813 and 0.763 respectively.Choosing the optimal diagnostic cut-off points corresponding to the maximum Youden indexes 0.173 min-1 and 0.818 min-1 ,the sensitivities of Ktrans and kep for identifying the adenoid cystic carcinoma and pleomorphic adenoma were 90.9% and 81.8%,and the specificities were 77.8% and 66.7%.Ktrans was of the highest sensitivity and specificity for the identification of the adenoid cystic carcinoma and pleomorphic adenoma.Conclu-sion The dynamic contrast-enhanced parameter Ktrans plays a certain role in the differential diagnosis of the adenoid cystic carcinoma and pleomorphic adenoma of the head and neck.

The effects of somatic and visceral nociceptive stimulation on neurons of dorsal commissural nucleus in sacral spinal cord were studied in pentobarbitone anesthetized cats using extracellular recording techniques. The results indicated that all neurons deriving input from Aδ fibers of the pelvic nerve were either nociceptive specific or wide dynamic range neurons, and could be activated by mechanical or intense electrical stimulation of the respective receptive fields including perianal region. The above results suggest that the Aδ afferents innervation of the pelvic organ is important in nociception.

The modulatory effect of substance P (SP) on strychnine-sensitive glycine (Gly) response was examined in neurons acutely dissociated from the rat sacral dorsal commissural nucleus (SDCN) using nystatin perforated patch recording configuration under voltage-clamp conditions. Application of SP potentiated 30 μmol/L Gly-activated chloride current (IGly) in a concentration-dependent manner over the range of 1 nmol/L to 1 μmol/L at a holding potential of -40 mV. SP neither changed the reversal potential of Gly response nor affected the affinity of Gly to its receptor. The SP potentiation effect could be blocked by spantide as well as a selective NK1 receptor antagonist, L-668,169, but not by NK2 receptor antagonist, L-659,877. The facilitatory action of SP on IGly could also be abolished by pretreatment with chelerythrine or KN-62 in different neurons, a finding suggesting that protein kinase C (PKC) or Ca2+/calmodulin-dependent protein kinase Ⅱ (CaMKⅡ) possibly contributes to an intracellular pathway of SP in the augmentation of IGly. The results imply that SP may suppress nociception in the spinal cord by potentiating Gly response.

Objective To explore the inflammatory mechanisms of pulmonary embolism ( PTE ) and/or deep venous thrombosis ( DVT ) in elders secondary to chronic obstructive pulmonary disease ( COPD) exacerbation.Methods A total of 26 elders with acute exacerbation of high-risk COPD secondary PTE and/or DVT and 26 patients with low-risk COPD during stable phase diagnosed during the period of January 2008 to December 2012 were enrolled.The relevant parameters of routine blood examination , blood viscosity, D-dimer, fibrinogen ( FIB), arterial blood gas, blood cytokine, erythrocyte sedimentation rate ( ESR ) and C-reactive protein ( CRP ) were retrospectively analyzed.Results The major nonspecific symptoms were cough, sputum and dyspnea.The mean of neutrophile percentage (N%), D-dimer, FIB, interleukin-6 (IL-6), tumor necrosis factor (TNF), C-reactive protein (CRP), low and high shear blood viscosity in blood samples of patients with acute exacerbation of high-risk COPD secondary PTE and ( or ) DVT were higher than those of the control group ( t =3.339, 2.700, 2.207, 2.431, 2.257, 2.143, 2.223, 2.797, all P<0.05).However arterial partial pressure of oxygen ( PaO2 ) was lower than that of lower-risk COPD patients (t=4.312, P<0.05).IL-6 in blood of patients with acute exacerbation of high-risk COPD secondary PTE and ( or) DVT was positively correlated with low-shear blood viscosity , D-dimer and FIB (r=0.437, 0.624, 0.429, all P<0.05).TNF in blood of patients with acute exacerbation of high-risk COPD secondary PTE and ( or ) DVT was positively correlated to FIB , low and high cut blood viscosity ( r =0.624, 0.519, 0.513, all P <0.05 ).Plasma CRP in blood of patients with acute exacerbation of high-risk COPD secondary PTE and/or DVT was positively correlated with D-dimer, FIB, IL-6 and TNF ( r=0.478, 0.541, 0.533, 0.491, all P<0.05).Conclusions Inflammation may exist in elders with acute exacerbation of high-risk COPD secondary thrombotic disease.IL-6 and TNF may promote thrombosis secondary to acute exacerbation of COPD disease.Early screening and/or prophylactic anticoagulation are necessary for prevention.