Objective To evaluate the effects of mild hypothermia performed at different times on the levels of glutamate, Bcl-2 and Bax during global cerebral ischemia-reperfsusion (I/R) in rats. Methods Twenty-four male SD rats weighing 230-270 g were randomly divided into 4 groups according to the time at which mild hypothermia was performed ( n =6 each): group A, B, C and D. Global cerebral ischemia was produced by occlusion of 4 vessels (cauterization of bilateral vertebral arteries and occlusion of bilateral common carotid arteries) in the 4 groups. In group B, C and D, the nasopharyngeal temperature was reduced to 32.5-33.5 ℃ and maintained for 1 h. Ischemia was performed after termination of cooling in group B. While ischemia was performed, cooling was started in group C. While reperfusion was performed, cooling was started in group D. Rewarming was started after termination of cooling in group B, C and D. Samples of dialysate in hippocampal CA1 area were collected every 10 min during 100 min reperfusion for determination of glutamate concentrations by high-performance capillary electrophoresis with laser-induced fluorescence detection ( HPCE-LIF). The brain tissues were taken at 3 h of reperfusion for determination of the expression of Bax and Bcl-2 in hippocampal CA1 area, and the ratio of Bcl-2/Bax was calculated. Results Compared with group A, the glutamate concentrations were significantly decreased, the Bcl-2 expression was up-regulated, the Bax expression was down-regulated and the ratio of Bcl-2/Bax was increased in the other thee groups ( P ＜ 0.05). Compared with group B, the Bcl-2 expression was significantly down-regulated, the Bax expression was up-regulated and the ratio of Bcl-2/Bax was decreased in group C ( P ＜0.05). The glutamate concentrations were significantly increased, the Bax expression was up-regulated and the ratio of Bcl-2/Bax was decreased in group D compared with group C ( P ＜ 0.05 ). Conclusion The earlier cooling is performed, the better the cerebral protective effect is during global cerebral I/R in rats.

Objective To evaluate the effect of isoflurane on the apoptosis of SH-SYSY cells transfected with APPsw gene and the role of inositol 1,4,5-triphosphate (IP3) recepters.Methods The SH-SYSY ceils transfected with APPsw gene were seeded in culture flasks with the density of 1.2 × 104/cm2.The cells were randomly divided into 4 groups (n =6 each):control group (group C),IP3 receptor antagonist group (group Ⅹ),isoflurane group (group Ⅰ) and isoflurane + IP3 receptor antagonist group (group Ⅰ + Ⅹ).After the cells were cultured for 24 h and attached to the wall,the cells were cultured routinely in group C,and Xestospongin C 100 nmol/L (IP3 receptor antagonist) was added to DMEM culture medium in groups X and Ⅰ + X,and 30 min later the cells were exposed to 1.2 ％ sevoflurane for 8 h in groups Ⅰ and Ⅰ + X.The cells were collected for examination of the ultrastructure and for determination of cell apoptosis,intracellular free calcium ion concentration [Ca2 +] i (by flow cytometry) and expression of IP3 receptor protein (by Western blot).The apoptosis rate was calculated.Results Compared with group C,there was no significant change in the apoptosis rate,[Ca2 +]i or IP3 receptor protein expression in group Ⅹ (P ＞ 0.05),while the cell apoptosis rate and [Ca2 +] i were significantly increased and IP3 receptor protein expression was up-regulated in groups I and Ⅰ + Ⅹ (P ＜ 0.05 or 0.01).Compared with group Ⅰ,cell apoptosis rate and [Ca2+]i were significantly decreased and IP3 receptor protein expression was down-regulated in group Ⅰ + Ⅹ (P ＜ 0.01).The pathological changes of the cells happened in groups Ⅰ and Ⅰ + Ⅹ,and the pathological changes were severer in group Ⅰ than in group Ⅰ + Ⅹ.Conclusion Isoflurane can induce apoptosis of SH-SY5Y cells transfected with APPsw gene through increasing [Ca2+]i and up-regulating IP3 receptor protein expression.

Objective To evaluate the effects of sevoflurane preconditioning on postoperative cognitive dysfunction in aged rats.Methods One hundred and twenty healthy male Sprague-Dawley rats,aged 18 months,weighing 400-450 g,were randomly divided into 3 groups (n =40 each) using a random number table:control group (group C),operation group (group O),and sevoflurane preconditioning group (group Sev).In group C,the rats were only anesthetized with pentobarbital sodium and did not undergo operation.In group O,the rats were anesthetized with pentobarbital sodium and underwent 30 min of exploratory laparotomy.In group Sev,the rats inhaled 2.4％ sevoflurane for 30 min and then inhaled air for 30 min,and the other procedures were similar to those previously described in group O.At 30 min before operation and on 1st,3rd,5th and 7th days after operation,Morris water maze test was performed to record the escape latency,time of staying at the original platform quadrant and frequency of crossing the original platform.At 30 min before operation and on 1st and 7th days after operation,10 rats in each group were sacrificed and hippocampi were isolated to detect the apoptotic rate and intracellular [Ca2 +] i (using flow cytometry) and the ultrastructure of hippocampal neurons was observed with transmission electron microscope.Results Compared with group C,the escape latency was significantly prolonged,the time of staying at the original platform quadrant was shortened,the frequency of crossing the original platform was decreased,and the apoptotic rate and intracellular [Ca2 +] i were increased after operation in O and Sev groups (P ＜0.05).Compared with group O,the escape latency was significantly shorten,the time of staying at the original platform quadrant was prolonged,the frequency of crossing the original platform was increased,and the apoptotic rate and intracellular [Ca2+]i were decreased after operation in group Sev (P ＜ 0.05).Microscopic examination showed no abnormality in the ultrastructure of hippocampal neurons in group C,and the pathological changes of the ultrastructure of hippocampal neurons were obvious in group O,and were significantly attenuated in group Sev.Conclusion 2.4％ sevoflurane preconditioning can reduce postoperative cognitive dysfunction in aged rats,and regulation of imbalance of calcium homeostasis and reduction of cell apoptosis are involved in the mechanism.

ObjectiveTo evaluate the short-term effectiveness of tension-free vaginal tapeobturator system(TVT-O) on the type Ⅰ,Ⅱ stress urinary incontinence(SUI) in the elderly female patients. Methods Elderly female patients (73 cases) with SUI type Ⅰ and Ⅱ were selected in 0.5-3.0 years after TVT-O surgical treatment,and they reached the age over 60 years before TVT-O.Difference of daily life and lower urinary tract symptoms before and after surgery were compared by the incontinence impact questionnaire ( Ⅱ Q-7) and the urogenital distress inventory (UDI-6) through telephone survey.Results Totally 73 patients were followed up successfully,aged 60 to 72 years (mean 64.0±4.5).Preoperative patients' daily life quality such as making housework,activities,entertainment,go-out,social contact and emotion had obviously been affected with a score of 9 to 25 by their own scoring (mean 17.0±6.7).Lower urinary tract symptoms including urgency,frequent urination,movement,leakage of urine volume,odynuria and dysuria were from 8 to 21 (mean 14.0±4.7) scores.Mild urinary frequency was 8.2％ (6 cases).Urinal pad usage was in 71 cases (97.3％)After TVT-O,patients' symptoms improved by their own scoring.The Ⅱ Q-7 scores were ranging from 2 to 13 (mean 6.4±3.2),and lower urinary tract symptoms scores from 1 to 9 (mean 5.4±3.2).Mild urinary frequency after surgery was 1.4 ％ (1 case).The urinary incontinence in 39 cases completely disappeared (53.4 ％ ),urinal pad usage were in 34 cases (46.6 ％ ).18 cases (24.7 ％ ) had suprapubic area pain or discomfort postoperatively.Conclusions TVT-O is an ideal choice for type Ⅰ and Ⅱ SUI in elderly female patients.

Objective To investigate the pathological features of blood vessel inflammation in facioscapulohumeral muscular dystrophy ( FSHD ) and the role of vasculitis on the pathogenesis of FSHD. Methods The clinical manifestations and myopathological features of 26 FSHD patients were retrospectively analyzed and summarized. All of the patients were divided into 2 groups; inflammatory infiltration group and non-inflammatory infiltration group. The latter was further divided into 3 subgroups;endomysial inflammation subgroup, perivasculitis subgroup and transmural vasculitis subgroup.Immunohistochemical staining were carried out in inflammatory infiltration group with anti-CD3, anti-CD4,anti-CD8,anti-CD20 and anti-SMA antibody. The control group was composed of 10 dermatomyositis ( DM)cases and 10 polymyositis ( PM) cases. Results The age of onset was (25. 2 ± 12. 6) years old and the average course was (7. 8 ±7. 3) years. The sex ratio of male to female was 1.6: 1. Five of them had family history. The main clinical features were progressive weakness and atrophy of facial, shoulder girdles and proximal upper limbs muscles. The lower distal limbs and (or) lower distal limbs and pelvic girdle muscles were involved in 18 cases. The main pathological features were shown as followed. Seventeen of them had focal inflammatory cell infiltration, including endomysial inflammation (4/17) , perivasculitis (7/17) , and transmural vasculitis (6/17). Immunohistochemical staining confirmed the major types of inflammatory cells were CD4* T lymphocytes and CD20B lymphocytes, which was familiar with DM. While in PM, CD8+ T lymphocytes were dominant The proportionality of residual muscle fibers obviously decreased in inflammatory infiltration group ( 48. 0% ± 23. 6% ) than non-inflammatory infiltration group ( 94. 3% ±3. 1% , T = 198. 000, P = 0. 000). As to CK levels, there were no significant deviation. Conclusions Obvious inflammatory cell infiltration can be seen in FSHD, the locations of inflammatory cells are endomyosium inflammation, perivasculitis and transmural vasculitis. Transmural vasculitis indicates vascular pathological factor may have something to do with pathogenesis of FSHD.

The total effective rate for clinical symptomstreated with oral decoction with Weiweikang(benefit-ting atrophic stomach)granules and Huoli(vitality)Bolus guided by the principle of invigorating Qi,warming the interior,activating circulation and elimi-nating blood stasis,was 91.8%,while that for thechronic atrophic gastritis with metaplasia and atypicalhyperplasia of intestinal epithelium was 87.5% and74.4% respectively.After treatment,the volume ofblood flowing was markedly increased(P

Objective To analyze the effects of five proteins secreted by Chlamydia trachomatis on the phagocytosis of macrophages and dendritic cells derived from bone marrow cells of C3H/HeJ mice. Methods Glutathione S-transferase ( GST)-CT311, GST-GIgA, GST-cHtrA, GST-OmcBc and GST-Pgp3 proteins were prepared through an Escherichia coli prokaryotic expression system and purified by GST Mag-Beads. Chlamydia membrane protein GST-IncA was also prepared as a control. Proteins of interest were ob-tained by cleaving off GST-tag with PreScission protease. Macrophages (MΦ) and dendritic cells (DC) were prepared from bone marrow cells of C3H/HeJ mice and pretreated with either 100 μg/ml or 500 μg/ml of the above proteins. LPS was used as a control to testify the specificity of the proteins' functions. Four hours after pretreatment,fluorescent beads were added to culture media to evaluate the changes in phagocytosis with direct immunofluorescence assay. Results LPS and low concentration (100 μg/ml) of these proteins had no significant influence on the phagocytosis of DC and MΦ,while high concentration (500 μg/ml) of Pgp3, cHtrA and CT311 could significantly promote the phagocytosis of DC and MΦ. Conclusion Pgp3, cHtrA and CT311 can promote the in vitro phagocytosis of DC and MΦ,which may facilitate the in vivo dissemina-tion of Chlamyida trachomatis.

Objective To detect the expressions of transcription factor Snail,E-cadherin(E-cad)and N-cadherin(N-cad)in non-small cell lung cancer(NSCLC),and explore their correlations.Methods The expression patterns of Snail,E-cad and N-cad in human lung tissues were detected by immunohistochemistry,from 59 untreated NSCLC patients in Affiliated Cancer Hospital of Xinjiang Medical University from January 2014 to December 2015 for whom clinical data were available,with adjacent tissues and 31 benign lesions as control.The expression patterns of Snail,E-cad,N-cad and clinicopathological factors were analyzed.Results The positive rate of Snail and N-cad in NSCLC was significantly higher than those in the control tissues [81.4％(48/59)vs.37.3％(22/59)vs.12.9％(4/31),χ2=9.782,P <0.05; 76.3％(45/59)vs.33.9％(20/59)vs.12.9％(4/31),χ2= 7.445,P< 0.05].The positive rate of E-cad in NSCLC was significantly lower than those in the control tissues [20.3％(12/59)vs.55.9％(33/59)vs.93.5％(29/31),χ2= 45.107,P< 0.01].The expressions of Snail and E-cad were related to lymph node metastasis and TNM stage [snail: 97.5％(39/40)vs.47.4％(9/19),χ2=7.734,P <0.05; 12.5％(1/8)vs.81.0％(17/21)vs.100.0％(30/30),χ2=7.723,P<0.05; E-cad: 95.0％(38/40)vs.36.8％(7/19),χ 2=7.190,P<0.05; 100.0％(8/8)vs.19.0％(4/21)vs.0(0/30),χ 2= 12.311,P < 0.01].The expression of N-cad was related to lymph node metastasis,histological grade and TNM stage [97.5％(39/40)vs.47.4％(9/19),χ2=11.231,P <0.01; 28.6％(2/7)vs.63.6％(14/22)vs.96.7％(29/30),χ2=9.564,P <0.05; 12.5％(1/8)vs.85.7％(18/21)vs.86.7％(26/30),χ 2= 11.664,P<0.01].The positive correlation was found between Snail and N-cad(r=0.373,P<0.01),the negative correlation was found between the expression of Snail and E-cad,N-cad and E-cad(r =-0.667,P= 0.00;r=-0.297,P=0.01).Conclusion Snail,E-cad and N-cad are involved in the development,progression and metastasis of NSCLC,and combined detection can predict tumor invasion,metastasis and prognosis.

OBJECTIVETo conduct health economic evaluation of the prevention of mother-to-child HIV among pregnant women in Dehong prefecture, Yunnan province, China from 2004 to 2013.

METHODSData on cost were collected mainly from the annual prevention of mother-to-child transmission (PMTCT) reporting system of Dehong prefecture, and supplemented by HIV PMTCT-related resource allocation data from local health bureau. Effectiveness indexes were from local continuous HIV surveillance system and annual reported data. Cost-effectiveness and cost-utility analysis were used to conduct the health economic evaluation.

RESULTSFrom 2004 to 2013, 283980 pregnant women were screened for HIV, 2 059 were detected as positive, and the HIV positive rate was 0.73%. The total cost of the PMTCT program was 14 227 000 RMB after discounting, and the unit cost of positive case finding was 4 200 RMB. A total of 26 cases of adults and 325 infants were avoided HIV infection, and the cost-effectiveness ratio (CER) was 40 500 RMB/case. The total obtained quality adjusted life years (QALY) from the program was 8 911.5, each one of which cost 1 600 RMB/QALY. If the feeding pattern were breast feeding, CER would be 42 800 RMB/case and each one of QALY would cost 2 200 RMB.

CONCLUSIONBased on the cost-effectiveness and cost-utility analysis, the HIV PMTCT of Dehong prefecture had economic value, which indicates that continued investment is needed to strengthen local HIV PMTCT work.

Acquired Immunodeficiency Syndrome ; Adult ; Child ; China ; Cost-Benefit Analysis ; Costs and Cost Analysis ; Female ; HIV Infections ; Health ; Humans ; Infant ; Infectious Disease Transmission, Vertical ; Mothers ; Pregnancy ; Quality-Adjusted Life Years

Objective:To investigate the effect of preoperative use of diuretics on cardiac surgery-associated acute kidney injury(CSA-AKI)in elderly patients.Methods:In this single-center retrospective study, 1 638 patients aged ≥60 years and undergone cardiac surgery(including coronary artery bypass grafting, valve replacement and valvuloplasty)in the Department of Cardiovascular Surgery, Linyi People's Hospital between January 2015 and December 2022 were recruited.The last preoperative serum creatinine(SCr)level was taken as the baseline value, and AKI was diagnosed according to the Kidney Disease Improving Global Outcomes(KDIGO)criteria.Patients were divided into an AKI group and a non-AKI group according to whether AKI occurred after surgery.The clinical characteristics of the two groups were compared, and the effect of preoperative use of diuretics on CSA-AKI was evaluated by multivariate Logistic regression analysis.Results:Of 1638 patients enrolled in the study, 284 patients(17.3%)developed CSA-AKI.Compared with the non-AKI group, there were higher proportions of patients in the AKI group receiving furosemide(62.7% or 178/284 vs.46.2% or 626/1 354, χ2=25.397, P<0.001), spironolactone(70.1% or 199/284 vs.49.9% or 676/1 354, χ2=38.284, P<0.001), and hydrochlorothiazide(8.1% or 23/284 vs.3.5% or 47/1354, χ2=12.288, P<0.001). The number of diuretics in the AKI group was higher than in the non-AKI group[2(0, 2) vs.1(0, 2), Z=-6.381, P<0.001], and the proportion of patients using ≥2 diuretics was higher in the AKI group than in the non-AKI group(70.1% or 199/284 vs.49.0% or 664/1354, χ2=41.652, P<0.001). Multivariate Logistic regression analysis showed that, after adjusting for hypertension, diabetes mellitus, hypoalbuminemia, NYHA functional class Ⅲ/Ⅳ, cardiopulmonary bypass during surgery, operative duration≥6 h, postoperative blood transfusion>600 ml, postoperative use of >3 vasoactive drugs and other variables, preoperative use of ≥2 diuretics remained an independent risk factor for CSA-AKI in elderly patients( OR=1.580, 95% CI: 1.042-2.396, P=0.031). Conclusions:AKI is a common complication after cardiac surgery in elderly patients.Preoperative use of ≥2 diuretics used may be an independent risk factor for CSA-AKI.