Objection To investigate the effects of etomidate on aorta isolated from IR rats, and explore its underlying endothelium-related mechanism(s). Methods The IR animal model was made by feeding rats with high fructose diet for 8 weeks. Aortic rings were isolated and suspended in a tissue bath, and tensions were recorded isometrically. The effects of etomidate on provoked contractions of the rings were assessed in absence or presence of potassium channel blockers or NO-synthase inhibitors. Results Etomidate-induced relaxation in IR rings was greater than NC rings. NG-nitro-L-arginine methyl ester (L-NAME) or glibenclamide (Gli) inhibit significantly etomidate-induced relaxation in IR rings, and the inhibition of Gli was disappeared in endothelial-denuded aortic rings. Conclusion Etomidate cause vasodilation in IR rat aortas by an endothelial-dependent and independent manner. Impaired NO- and KATP channel-mediated relaxation and etomidate-induced increased availability of may involve in endothelial-dependent relaxation of etomidate in IR rat aortas.

Objectives To investigate the neuroprotective mechanism of vagus nerve stimulation ( VNS) by stimulating the vagus nerve in ischemic cerebral tissue in a rat model of transient focal cerebral ischemia. Methods Twenty-six adult male Sprague-Dawley ( SD ) rats were randomly divided into sham operation group (n=6),model group (n=10),and VNS-treated group (n=10) . The model of rat transient focal cerebral ischemia was induced by the intraluminal suture method. At 30 min after modeling,the right side neck VNS in the VNS-treated group was stimulated ( stimulus intensity 0. 5 mA, interval 0. 5 ms, frequency 20 Hz),once every 5 min within 1 h,and once for 30 s. The model group repeated the steps of the VNS-treated group,but did not stimulate. The sham operation group repeated the experimental steps,but it neither embolized the vessels nor stimulated nerves. The changes of cerebral blood flow were monitored with a laser Doppler flowmeter. The rats were sacrificed after 24 h. The expressions of interleukin 6(IL-6) and caspase-3 in brain tissue were determined by immunohistochemistry staining. The neuronal apoptosis was observed by the in situ end-labelling technique. Results ( 1 ) Compared with the sham operation group, the number of positive cells of IL-6,caspase-3,and the numbers of neuronal apoptosis in the model group were significantly increased (20. 7 ± 5. 0 cells/HP vs. 2. 3 ± 1. 0 cells/HP,44. 5 ± 9. 5 cells/HP vs. 0,30. 9 ± 9. 0 cells/HP vs.0).Thereweresignificantdifferences(P<0.05).(2)Comparedwiththemodelgroup,thenumber of positive cells of IL-6(10. 9 ± 3. 7 cells/HP),the caspase-3 (18. 9 ± 6. 7 cells/HP),and the numbers of neuronal apoptosis (14. 0 ± 5. 2 cells/HP) in the VNS-treated group decreased significantly. There were significant differences (P<0. 01). (3) Before and after modeling,there were no significant differences in cerebral blood flow in various periods between the model group and the VNS-treated group (P>0. 05). Conclusion The neuroprotective mechanism of VNS for cerebral ischemia may be associated with the inhibition of neuronal apoptosis and decreasing inflammatory response. It may not be associated with the changes of cortical cerebral blood flow.

ObjectiveTo observe the clinical efficacy of external application of sihuang-honey for aseptic inflammation after total knee arthroplasty.Methods 30 cases of total knee arthroplasty patients were recruited into two groups,of 15 cases in each group.The treatment group was treated with sihuang-honey (made of rhubarb,scutellaria,phellodendron,coptis according to the same proportion of powder with honey ),which was placed on a sterile plastic sheet,0.5 cm thickness.The sheet was applied on the knee of the highest skin temperature for 6 hours,removed it for 2 hours interval,and reapplied on it,for altogether 24 hours before changing another sheet.The control group were treated by continued covering ice on the knee every day,with the ice completely surrounded the knee.Both groups were treated for 2 weeks.Clinical efficacy was observed before the treatment,and 3 d,7 d,14 d after the treatment.ResultsAfter the treatment,compared with the control group,the treatment group was effective in terms of VAS score (4.12± 1.08) points in 3d,(3.34±0.61)points in the first 7 days; skin temperature (37.56±0.40) ℃,activity (98.56±3.24) ° in 3d,and the difference was statistically significant (P＜0.05).The degree of swelling in 3 d (5.80±2.00) ％,7 d (9.33±2.55)％,14 d (12.13 ± 2.70)％ in the treatment group were better than the control group (P＜0.05); The rate of pain relief of treatment group was 93.33％ and satisfaction was 66.67％,although better than 86.67％ and 46.67％ of the control group,the difference was not statistically significant (x2 were 1.33,3.04,P＞0.05).Conclusion Sihuang-honey was effective for the treatment of aseptic inflammation after the surgery of total knee arthroplasty.

Objective To investigate the effects of stress hyperglycemia on prognosis in patients with severe cerebral vascular diseases.Methods A retrospective analysis was conducted.416 patients with severe cerebral vascular diseases confirmed by radiological imaging admitted to intensive care unit (ICU) of Guangdong General Hospital from December 2013 to June 2015 were enrolled.According to the values of randomise blood glucose (RBG) and glycosylated hemoglobin (HbA1c) and diabetes history,the patients were divided into euglycemia group (RBG ＜ 11.1 mmol/L,HbA1c ＜ 0.065,without diabetes history),diabetes group (RBG ≥ 11.1 mmol/L,HbA1c ≥ 0.065,with diabetes history),and stress hyperglycemia group (RBG ≥ 11.1 mmol/L,HbA1c ＜ 0.065,without diabetes history).The nosocomial infection rate,the length of ICU stay and 28-day mortality were compared among the three groups.Survival analysis was performed using Kaplan-Meier method,and multivariate Cox proportional hazard model was used to estimate the risk of death.Results Among 416 patients,there were 40 cases with stress hyperglycemia,46 with diabetes and 330 with euglycemia,with the incidence of stress hyperglycemia of 10.81％ (40/370).The nosocomial infection rates in the stress hyperglycemia group and diabetes group were significantly higher than those of the euglycemia group [55.00％ (22/40),52.17％ (24/46) vs.18.79％ (62/330),both P ＜ 0.01],and the length of ICU stay was significantly longer than that of the euglycemia group (days:16.53 ± 6.26,15.79 ± 8.51 vs.9.23 ± 4.29,both P ＜ 0.01).No significant differences in nosocomial intection rate and length of ICU stay were found between stress hyperglycemia group and diabetes group (both P ＞ 0.05).The 28-day mortality rate in stress hyperglycemia group was significantly higher than that of diabetes group and euglycemia group [47.50％ (19/40) vs.26.09％ (12/46),10.30％ (34/330),P ＜ 0.05 and P ＜ 0.01].It was showed by Kaplan-Meier survival analysis that 28-day cumulative survival rate in stress hyperglycemia group was significantly lower than that of euglycemia group and diabetes group (log-rank =6.148,P =0.043).It was showed by Cox death risk analysis that stress hyperglycemia was the risk factor of death in patients with severe cerebral vascular disease [hazard ratio (HR) =1.53,95％ confidence interval (95％CI) =1.04-1.26,P =0.001].Conclusion The patients with stress hyperglycemia may have a higher 28-day mortality and a poorer prognosis compared with those with diabetes and normal blood glucose in severe cerebral vascular diseases.

Objective To evaluate the clinical efficacy of noninvasive positive pressure ventilation (NPPV) in the treatment of patients with acute respiratory distress syndrome (ARDS), and to look for the predictors of failure of NPPV. Methods A retrospective observation was conducted. ARDS patients underwent NPPV admitted to emergency intensive care unit (EICU) of Guangdong General Hospital from January 2013 to December 2015 were enrolled. The patients were divided into success group and failure group according to the clinical efficacy. The condition of the patients in the two groups was evaluated, and ARDS classification and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score before treatment were recorded. Etiological composition of ARDS was analyzed. The parameters, including heart rate (HR), respiratory rate (RR), oxygenation index (PaO2/FiO2), arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2) and arterial oxygen saturation (SaO2), were recorded before and 2 hours after the treatment of NPPV. Multivariate logistic regression analysis was conducted for predicting the independent factors inducing the failure of NPPV treatment of patients with ARDS. Results The date of 137 patients with ARDS were collected, excluding the followed patients, 6 with coma, 18 with hemodynamic instability, 5 with severe hypoxia, and 5 with incomplete date. Finally, a total of 103 patients entered the statistics. There were 69 patients in NPPV success group, and 34 in failure group. Compared with success group, APACHE Ⅱ score in the failure group was higher (21.4±6.2 vs. 19.7±8.9), the ratios of patients with severe ARDS and those induced by pulmonary infection were higher [82.4% (28/34) vs. 5.8% (4/69), 32.4% (11/34) vs. 8.7% (6/69), respectively, both P < 0.05]. HR and RR before NPPV in the failure group were significantly higher than those of success group [HR (bpm): 124±13 vs. 117±12, RR (bpm): 39±5 vs. 33±4], and PaO2/FiO2, PaO2, PaCO2, and SaO2 were significantly lower than those of the success group [PaO2/FiO2 (mmHg, 1 mmHg = 0.133 kPa): 104±10 vs. 156±12, PaO2 (mmHg): 53±8 vs. 68±7, PaCO2 (mmHg): 31±5 vs. 37±7, SaO2: 0.83±0.07 vs. 0.91±0.05, all P < 0.05]. It was shown by logistic regression analysis that severe ARDS [odds ratio (OR) = 10.533, 95% confidence interval (95%CI) = 5.847-89.852, P = 0.000], pulmonary infection resulted ARDS (OR = 4.831, 95%CI = 1.688-13.825, P = 0.003) and PaO2/FiO2 < 140 mmHg 2 hours after treatment (OR = 7.049, 95%CI = 1.266-39.236, P = 0.026) were the independent risk factors of NPPV failure for the treatment of patients with ARDS. Conclusions Patients with severe ARDS and pulmonary infection derived ARDS were the risk factors of failure to NPPV in ARDS. Lack of improvement in oxygenation 2 hours after NPPV is the predictor of NPPV failure and change to invasive ventilation.

Objective:Recent studies have shown that in contrast to decrease in distal gastric adenocarcinoma (DGA), incidence of adenocarcinoma of the esophagogastric junction (AEG) has increased noticeably in numerous counties. However, the reasons remain unclear. This study evaluated the possible differences in the expression of KLF4, SP1, and Cyclin D1 in AEG and DGA, and explored the potential carcinogenesis of AEG. Methods:Immunohistochemistry was performed on paraffin-embedded tissues to evaluate the pu-tative differences in the expressions of KLF4, SP1, and Cyclin D1 at protein level between AEG (n=58) and DGA (n=47). The patholog-ical significance of these markers between the two groups was also compared and analyzed. Results:The percentage of positive KLF4 expression was significantly lower in DGA than in AEG (P<0.05). Lower KLF4 expression was found both in well-or moderately dif-ferentiated cases and in poorly differentiated cases with DGA compared with their AEG counterparts (P<0.05). However, positive stain-ing for SP1 was significantly higher in DGA (P<0.05). No significant difference was found in the expression of Cyclin D1 between the two groups. Further analysis showed that in DGA, the positive expression of KLF4, SP1, and Cyclin D1 were significantly correlated with lymph node metastasis. In AEG, only Cyclin D1 expression was correlated with lymph node metastasis (P<0.05). No correlation was found among the expression of KLF4, SP1, and Cyclin D1 in AEG. In DGA, KLF4 was inversely correlated with SP1 and Cyclin D1 (r=-0.334 and r=-0.341, respectively, P<0.05), and SP1 was positively correlated with Cyclin D1 expression (r=0.340, P<0.05).Conclusion:Different expression patterns and clinicopathological significance of KLF4, SP1, and Cyclin D1 were observed between AEG and DGA, suggesting the putative difference in the carcinogenesis and progression of AEG and DGA.

Aim To study the vasodilation of MS23,a brand new phosphodiesteras inhibitor,on contractions induced by various stimuli in rings of arteries isolated from rat different organs.Method Tension of aortic and microvessel rings were recorded isometrically by PowerLab and DMT system respectively.Results MS23 concentration-dependently shifted the noradrenaline(NA)-induced concentration-contraction curves rightward in a non-parallel manner with the maximal contraction depressed by 74.7%.MS23 and aminophylline(Ami) produced concentration-dependent relaxation on KCl or NA-induced precontraction.Endothelium deprivation and NO synthesis inhibition induced by L-NAME failed to affect the relaxation.MS23 and Ami relaxed KCl-induced precontraction of rat coronary,middle cerebral,renal and mesenteric arterial rings in a concentration-dependent manner,and showed no organ preference in this respect.Conclusion MS23 antagonizes and relaxes contractions induced by various stimuli in the rings of arteries isolated from different organs of rat without marked preference among the organ origin of artery and stimuli.The vasorelaxation induced by MS23 is related neither to endothelium nor to nitric oxide synthesis.

With the transformation of the concept and model of mental health service in China,the participation of social work in multidisciplinary team cooperation in mental health has become an important development trend.In order to explore the mode and path of multidisciplinary treatment involving social work in mental health,this study selected two typical wards of Shanghai Mental Health Center as typical cases through the double-case study method,and conducted in-depth interviews and participatory observation of the medical teams in the wards.The results show that medical social workers can participate in multi-disciplinary comprehensive treatment through the path of"service embedding-relationship embedding-system embedding".In this process,the"resource-demand"response mode,power acquisition,daily interaction,discourse integration,and service mecha-nism reconstruction are important action strategies to achieve the service embeddedness of social workers.Different strategies de-termine the final different service modes.In the future,the participation of medical social work in multidisciplinary comprehen-sive treatment mode should not only strengthen micro-practice,but also form macro-institutional guarantee.

Objective To investigate glycemic control,changes of inflammatory factors and their clinical significance in severe sepsis patients.Methods One hundred and three severe sepsis patients with abnormal hyperglycemia were randomly divided into the two groups and receive intensive insulin therapy (IIT) and conventional insulin therapy (CIT) respectively.According to glycosylated hemoglobin level,the two groups were further divided into stress hyperglycaemia and diabetes mellitus subgroups.The mortality and incidence of hypoglycemia were compared between the groups and subgroups.Enzyme linked immunosorbent assay was used to detect TNF-α,IL-6 levels before treatment,3 and 7 days after treatment.Results In IIT group,the mortality in diabetes mellitus subgroup was significantly higher than that in stress hyperglycaemia subgroup (66.7％ vs.30.8％,P ＜ 0.05),while the mortality in stress hyperglycaemia subgroup significantly higher than that in diabetes mellitus subgroup (54.1％ vs.25.0％,P ＜ 0.05) in CIT group.Multivariate Logistic regression analysis revealed IIT increased the risk for death in diabetes mellitus subgroup (OR =1.221,95％ CI:1.075-1.434),while decreased the risk for death in stress hyperglycaemia subgroup (OR =0.872,95％ CI:0.714-0.975).The incidence of hypoglycemia was significantly higher in IIT group than that in CIT group (13.7％ vs.1.9％,P ＜0.05).Before treatment,the levels of TNF-α,IL-6 in stress hyperglycaemia patients were significantly higher than those in diabetes mellitus patients.After 7 day treatment,The levels of TNF-α,IL-6 decreased significantly in stress hyperglycaemia patients (P ＜ 0.01),and decreased more significantly in IIT group than that in CIT group.Conclusion Severe sepsis patients with stress hyperglycaemia can attain better glycemia control and inhibition of inflammatory factors,and clinical benefit from IIT.

Objective To explore the efficacy of retropubic midurethral synthetic sling(RMUS)in relieving urgency and urge urinary incontinence(UUI)symptoms in patients with mixed urinary incontinence(MUI).Methods Clinical data of 44 female MUI patients treated with RMUS during Jan.2018 and Dec.2020 in Shanghai Renji Hospital were retrospectively analyzed.All patients had positive results in stress test and Marshall-Marchetti test before operation,and 27 of them completed ICIQ-FLUTS-LF questionnaire.Urodynamic(UDS)tests suggested that 9 patients(20.5％)presented detrusor overactivity(DO).During RMUS procedure,the tension of the sling was adjusted based on the anatomical landmarks.The postoperative efficacy and improvement of urinary incontinence were analyzed.Results The patients aged(58.59±9.08)years,with a body mass index of 24.71±2.77.Among the 40 patients who completed telephone interview 2 years after surgery,the subjective cure rate was 85.0％(34/40).Among the 27 patients with records of questionnaires before and after surgery,there were significant differences in the incidence of urine leakage[100％(27/27)vs.18.5％(5/27)],stress urinary incontinence(SUI)[100％(27/27)vs.18.5％(5/27)]and UUI[70.4％(19/27)vs.29.6％(8/27)](P＜0.05).However,no statistical differences were found regarding nocturia voiding episode(≥1 times),urgency,dysuria,hesitancy,strain to void,intermittent stream and enuresis(P＞0.05).Based on preoperative UDS test,there were significant differences regarding the subjective cure rate in patients with or without preoperative DO[55.6％(5/9)vs.93.5％(29/31)],incidence of SUI[66.7％(4/6)vs.4.8％(1/21)],and UUI[66.7％(4/6)vs.19.0％(4/21)](P＜0.05),while there was no statistical difference regarding urgency[66.7％(4/6)vs.33.3％(7/21)](P＞0.05).Conclusion RMUS is effective in treating MUI patients with positive stress test and Marshall-Marchetti test results,which can relieve SUI and UUI symptoms,but has no effects on urgency symptoms.DO on preoperative urodynamics results in poorer subjective outcomes.