Objective To investigate the effects about Tetramethyl -pyrazine (TMP)to Bad, Caspases-1 protein relating with JNK signal transduction pathways on cultured rat hippocampal neurons after anoxia-reoxygenation. Methods Rat hippocampal neurons were cultured in vitro and observed respectively on 7 ~ 9 days. Neurons were exposed to TMP in three different concentration (60,200,800 μg/mL) and JNK inhibitors (10 μmol/L). Control/normal groups were set in each experiment, except for the normal group. After 1 hour of treatment, the rat hippocampal neurons were placed in an incubator with 90%N2 + 10% CO2 for 2 hours to induce anoxia. Then, the rat hippocampal neurons were placed in an incubator with 5% CO2+95%air to establish reoxygenation. Bad, Caspases-1 protein were examined by Western Blot. Results After neurons with 60,200, 800 μg/mL TMP and 10 μmol/L JNK inhibitors on damage induced by anoxia-reoxygenation , the Bad , Caspases-1 protein are lower than the control group. But the 200 μg/mL group is better than 60 800 μg/mL groups. Conclusions Through the JNK signal transduction pathways, the Caspases-1, Bad protein expressions are lower than the control group. So TMP has obvious inhibitory action to rat hippocampal neuronal damage induced by anoxia-reoxygenation.

The teaching methods in anesthesiology practice to traditional Chinese medicine students was discussed.Watching for the first step, then simulation and manipulation on patients should be abided by. Paying more attention to patients’ safety and avoiding any fault to patients should be emphasized . The one to one and hand by hand teaching method should also be used to train the students' clinic thought and practical ability.

Objective To investigate the assessment value of multimodal CT examination for collateral circulation after cerebral ischemia. Methods Within 3 days of admission,39 patients with ischemic stroke received multimodal CT examinations,including CT scan,CT perfusion (CTP)imaging,and CT angiography (CTA). The postprocessing software of the German SIEMENS 64-slice spiral CT system was used to evaluate the state of brain tissue perfusion and the conditions of head blood vessels of the subjects. The cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT),time to peak(TTP) and the score of the modified Rankin scale (mRS)in the 90 d after discharge were compared between the patients with good collateral circulation and poor collateral circulation. Results Among 39 patients, multimodal CT examination revealed that 2 patients were negative,one of them was followed up by head MR and was clinically proven as transient ischemic attack,and the other was lacunar infarction. Thirty-seven patients were positive. Multimodal CT examination found 24 patients had offending vessels occlusion and/or stenosis on the lesion sides,the collateral circulation formation in 11 of them was observed on the lesion sides;another 13 patients had poor collateral circulation on the lesion sides. The comparison of lesion sides and contralateral sides,the patients with good collateral circulation showed the CBF decreased (t= -5. 92),the MTT and TTP prolonged (t=4. 27 and 3. 17 respectively). There were significant differences (all P<0. 01). The CBV and CBF in patients with poor collateral circulation were decreased significantly (t= -14.27 and-14.82 respectively),MTT and TTP prolonged (t=7. 26 and 7. 54 respectively). There were significant differences (all P <0. 01). There were significant differences in CBF,CBV,and TTP on the lesion sides between the two groups of patients (t=3. 24,4. 11,and -2. 34,respectively;all P<0. 05). The 90 d mRS scores for patients with good collateral circulation and poor collateral circulation were 1. 3 ± 0.6 and 4. 0 ± 0. 9 respectively. There was significant difference (t = -8. 29,P <0. 01). The patients of having collateral circulation formation had good prognosis. Conclusion Multimodal CT examination has certain clinical significance for evaluation of cerebral perfusion state,understanding the establishment or patency of cerebral collateral circulation,and determining the clinical prognosis.

Objective To investigate the effect of tetramethylpyrazine pretreatment on the expression of cfos and heat shock protein (HSP70) during hypoxia-reoxygenation (H/R) in cultured fetal rat hippocampal neurons. Methods After the neurons were cultured and identified, they were randomly divided into 5 groups ( n = 24each): control group (group C), H/R group, and low, median and high concentration of tetramethylpyrazine pretreatment groups (group L, M and H). The neurons were exposed to 2 h of hypoxia followed by 24 h of reoxygenation. Tetramethylpyrazine was added with the final concentrations of 60, 200 and 800 μg/ml in group L, M and H respectively, and then the neurons were incubated for 1 h before H/R. The apoptosis rate, cell viability and expression of c-fos and HSP70 were detected. Results The cell viability was significantly lower, while the apoptosis rate was significantly higher in group A/R, L and H than in group C (P ＜0.01). The cell viability and HSP70expression were significantly higher, while the apoptosis rate and c-fos expression were significantly lower in group L, M and H than in group A/R, and in group M and H than in group L (P＜ 0.05). The cell viability and HSP70expression were significantly lower, while the apoptosis rate and c-fos expression were significantly higher in group H than in group M ( P ＜ 0.01 ).Conclusion The mechanism by which tetramethylpyrazine pretreatment inhibits the apoptosis in cultured fetal rat hippocampal neurons during H/R may be related to the dowm-regulation of c-fos expression and up-regulation of HSP70 expression.

Objective To explore the effect of different types of statins combined with donepezil in the treatment of Alzheimer disease(AD).Methods According to the digital table,90 patients with AD were randomly divided into the statins A group(atrovstatin combined with donepezil) 31 cases,statins B group(simvastatin combined with donepezil)27 cases,and donepezil group(only with donepezil) 32 cases.All patients were treated for one year.The blood lipid level (including cholesterol (CH) and low density lipoprotein cholesterol (LDL-C),mini-mental state examination(MMSE),activity of daily living(ADL) and global deterioration scale (GDS) were detected and compared respectively among groups before and after treatment.Results The MMSE,ADL and GDS scores of the donepezil group were (17.00 ± 2.99) points,(60.44 ± 14.57) points,(4.28 ± 1.22) points,respectively,which were worse than those of the statins A group [(19.90 ± 3.07) points,(71.61 ± 18.50) points,(3.39 ± 1.15) points] (t =0.218,P ＜ 0.05,t =2.669,P ＜ 0.01,t =2.562,P ＜ 0.01) and statins B group [(19.88 ± 6.66) points,(71.89 ± 19.61) points,(3.37 ±l.39)points](t=l.959,P ＜0.05,t=2.991,P ＜0.0l,t=2,265,P ＜0.01).Conclusion The combination of donepezil and statins can effectively improve cognitive function and daily living ability in patients with AD,and its effect is superior to single use of donepezil.

Objective To investigate the effect of ulinastatin on the postoperative immune function of effective T-lymphocytes (Teff cells) and regulatory T-lymphocytes (Treg cells) in the peripheral blood in patients undergoing laparoscopic operation.Methods Forty ASA physical status Ⅰ or Ⅱ patients,aged 20-40 yr,weighing 45-65 kg,scheduled for elective laparoscopic operation for infertility,were equally and randomly divided into 2 groups using a random number table:control group (group C) and ulinastatin group (group U).At 15 min before induction of anesthesia,ulinastatin 200,000 U (in 100 ml of normal saline) was infused intravenously in group U,while the equal volume of normal saline was infused instead in group C.Anesthesia was induced with iv injection of fentanyl,propofol,and cisatracurium and maintained with iv infusion of propofol and sevoflurane.Before surgery (T0),at the end of surgery (T1) and on 1st and 3rd days after surgery (T2.3),venous blood samples were collected from the peripheral blood for determination of the expression of Teff cells (CD4 + CD25-) and Treg cells (CD4 + CD25+) and serum interferon-γ (IFN-γ) and transforming growth factor-β (TGF-β) concentrations (by ILISA).Teff/Treg and IFN-γ/TGF-β ratios were calculated.Results Compared with the baseline value at T0,the expression of Treg cells was significantly up-regulated,and Teff/Treg ratio was decreased at T2 and T3 in group C,and the expression of Teff cells was up-regulated at T3 (P ＜ 0.05 or 0.01),while no significant difference was found in the expression of Treg cells and Teff/Treg ratio at T3 in group U (P ＞ 0.05).Compared with group C,the expression of Teff cells was significantly up-regulated at T3,the expression of Treg cells was down-regulated and Teff/Treg ratio was increased at T2 and T3,the concentration of serum TGF-β was decreased and IFN-γ/TGF-β ratio was increased at T2 and T3 in group U (P ＜ 0.05 or 0.01).No significant changes were found in the serum IFN-γ and TGF-β concentrations and IFN-γ/TGF-β ratio at each time point in the two groups (P ＞ 0.05).Conclusion Ulinastatin can enhance the immune function of Teff cells in the peripheral blood and decrease the immune function of Treg cells,thus maintaining the balance of the postoperative cellular immune function in patients undergoing laparoscopic operation.

Objective To assess the clinical usefulness and value of the 5 models for the prediction of acute kidney injury (AKI),severe AKI which renal replacement treatment was needed (RRT-AKI) and death after cardiac surgery procedures in Chinese patients.Methods One thousand and sixty-seven patients who underwent cardiac surgery procedures in the department of cardiac surgery in the Zhongshan Hospital,Fudan University between May 2010 and January 2011 were involved in this research.The predicting value for AKI (AKICS),RRT-AKI (Cleveland,SRI and Mehta score) and death (EURO score) after cardiac surgery procedures was evaluated by Hosmer-Lemeshow goodness-of-fit test for the calibration and area under receiver operation characteristic curve (AUROC)for the discrimination.Results The incidence of AKI was 20.34％(217/1067),and 63.13％ of their renal function recovered completely.The incidence of RRT-AKI was 3.56％(38/1067) and the mortality of AKI and RRT-AKI was 9.68％ (21/217) and 44.73％ (17/38) respectively.The total mortality was 3.28％ (35/1067).The discrimination and calibration for the prediction ofAKI of AKICS were low.For the prediction ofRRT-AKI,the discrimination and calibration of Cleveland score were high enough,but the predicated value was lower than the real value (1.70％ vs 3.86％).The discrimination of Mehta score and the calibration of SRI were low.The discrimination and calibration for the prediction of death of EURO score was low.Conclusion According to the 2012 KDIGO AKI definition,none of the 5 models above is good at predicting AKI after cardiac surgery procedures.Cleveland score has been validated to have a proper impact on predicting RRT-AKI after cardiac surgery procedures,but the predicting value is still in doubt.EURO score has been validated to have an inaccurate predicting value for death after cardiac surgery procedures.

Objective:To test the effects of natural lactobacillus bio-products on lipid metabolism and intestinal microflora.Method:A hyperlipidemia mouse model system was developed.30 hyperlipidemia mice were randomly divided into three equal groups,i.e,saline water (control treatment),lactobacillus cocktail,and simvastatin.Mice were injected daily with saline water,lactobacillus (L.plantarum,L.acidophilus and L.casei,mixture in equal volume),and simvastatin solution,respectively.Result:Significant lower total cholesterol (TC),triglyceride (TG),and low-density lipoprotein cholesterol (LDL-C) were found in the blood serum from mice treated with lactobacillus and pharmaceutical simvastatin.CFUs (colony forming unity) of lactobacillus were much higher (P ＜ 0.05),whereas CFUs of Escherichia coli and Enterococcus faecalis were much lower (P＜ 0.05 and P＜ 0.05,respectively) in mice feces of treated by lactobacillus compared to pharmaceutical simvastatin.Conclusion:Lactobacillus probiotics reduced levels of cholesterolemia,increased CFUs of lactobacillus and reduced CFUs of E.coli and E.faecalis in gut.

Objective:To evaluate the accuracy of ultrasound-measured airway indicators in predicting difficult laryngoscopy.Methods:A total of 104 American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 18-70 yr, undergoing elective operation under general anesthesia, were selected.The airway was evaluated before induction of anesthesia, body mass index (BMI), neck circumference, mouth opening, thyromental distance and modified Mallampati classification were recorded, and mandibular condylar mobility, distance from skin to under surface of tongue, hyomental distance and distance from skin to epiglottis were measured by ultrasound.Anesthesia induction was performed after the end of measurement, and direct laryngoscopy was performed after mask pressure ventilation.Cormack-Lehane (CL) grade was recorded, and difficult laryngoscopy was defined as CL grade≥2b.The patients were divided into non-difficult laryngoscopy group (group NDL) and difficult laryngoscopy group (group DL) according to the view obtainable during laryngoscopy.The factors of which P values less than 0.05 would enter the logistic regression analysis.The accuracy of each index in predicting difficult laryngoscopy was evaluated using the area under the receiver operating characteristic curve (AUC) and 95% confidence interval (CI). The critical value was determined according to Youden index, and the sensitivity and specificity were calculated. Results:Compared with NDL group, BMI, depth of epiglottis and the incidence of modified Mallampti≥grade Ⅲ were significantly increased, and the mouth opening and thyromental distance were decreased in goup DL ( P<0.05). The AUC (95%CI) of modified Mallampti classification and the depth of epiglottis for difficult laryngoscopy prediction were 0.728 (0.619-0.836) and 0.833 (0.743-0.924), respectively.When the critical value of depth of epiglottis was 2.125 cm, the sensitivity and specificity of predicting difficult laryngoscopy were 65.71% and 89.86%, respectively. Conclusion:Ultrasound-measured depth of epiglottis can accurately predict the difficult laryngoscopy.

Objective:To analyze the clinical characteristics of hereditary diffuse leukoencephalopathy with spheroids (HDLS).Methods:A retrospective analysis was performed. The clinical data of 2 patients with genetically conformed HDLS, admitted to our hospital in August 2020 and October 2021, were collected; and a literature search was conducted in domestic and foreign databases from January 2012 to January 2022 (enrolling a total of 48 patients with HDLS caused by colony-stimulating factor-1 receptor [ CSF1R] gene mutation). The population, clinical, imaging and gene mutation characteristics of these patients were summarized and analyzed. Results:(1) In these 50 patients, 20 were male and 30 were female, with onset age of (40.72±11.27) years; 40 patients (80.0%) had been misdiagnosed. (2) The most common first symptom and sign were progressive cognitive impairment (74.0%) and progressive dementia (80.0%). The patients in the middle and old aged group (≥40 years old, n=31) had significantly higher incidences of progressive cognitive impairment and Parkinson's-like symptom, and statistically lower incidence of muscle weakness as compared with those in the youth group (<40 years old, n=19, P<0.05). (3) The highest incidence of abnormal imaging findings was white matter lesions (100.0%), followed by cerebral atrophy (84.0%), ventricular enlargement (84.0%) and corpus callosum atrophy (60.0%). DWI examination was completed in 28 patients, and all patients showed persistent limitation of diffusion (100.0%). The most affected areas of white matter lesions were around the lateral ventricles, followed by the frontal-parietal occipital lobe, and corpus callosum. The incidence of abnormal signal of central semiovale in youth group was statistically higher than that in middle and old aged group ( P<0.05). (4) A total of 36 CSF1R gene mutations or possibly pathogenic mutations were identified in 50 patients, 21 of which were novel mutations reported for the first time. Of the 47 patients whose mutations were described in detail, 8 (17.0%) and 5 (10.6%) probands carried c. 2381T>C/p. I794T and c.2345G>A/p.R782H, respectively. Conclusions:The clinical manifestations of HDLS are diverse and lack of specificity. The most common first symptom and sign are progressive cognitive impairment and progressive dementia; however, the symptom spectrum and MRI imaging changes of white matter damage are related to age. MRI follow-up and targeted gene testing help reduce misdiagnosis and missed diagnosis of HDLS.