BACKGROUND: Hypertension is one of the most important risk factors for stroke, and brain focal renin-angiotensin system has been proved to play a vital role in the development of hypertension and stroke.OBJECTIVE: To observe the influence of long-term administration of losartan, an angiotensin-1 receptor antagonist, on the incidence of strokeprone spontaneous hypertension in rats.DESIGN: Randomized controlled experiment.SETTING: Renmin Hospital Affiliated to Wuhan University.MATERIALS: This experiment was carried out in Wuhan University between July 1999 and March 2001. Totally 26 six-week-old male rats with stroke-prone spontaneous hypertension and 8 Kyoto male Wistar rats were recruited in this experiment with the body mass of 144.5-182.1 g.METHODS: Totally 26 six-week-old male rats with spontaneous hypertension were randomized into stroke-Rrone spontaneous hypertension group (n=9) which received gastric perfusion of physiological saline at a dosage of 5 mL/d; losartan 10 mg/(kg·d) group of 9 rats which received gastric perfusion of losartan at a dosage of 10 mg/(kg ·d) and losartan 30 mg/(kg ·d)group of 8 rats which received gastric perfusion of losartan at a dosage of 30 mg/(kg·d). Rats in the three groups were provided with high-protein feed when entering the group, and drank 15 g/L salty water (5 mL/d) from the onset of week 2. At the same time, 8 six-week-old male Wistar rats were taken as normal controls to receive gastric perfusion of physiological saline at a dosage of 5 mL/d once a day; they took ordinary feed and drank running water. All rats lived with 12 hours' day-night alternation at room temperature of 18-20 ℃ and with humidity of 40%-50%. Totally 18weeks later, the incidence of stroke and BP changes were observed. The clinical manifestation of stroke was scored 1 if rats appeared few activities,with movements slightly reduced or excited; 2 score referred to very few activities, with movements obviously reduced or violently stimulated; 3score referred to inability to walk, lying motionless with melancholy symptoms; score 4 referred to paralysis and inability to stand, lateral or bilateral limb paralysis. Transmission electron microscope was used for histological observation of cell apoptosis in the brain.MAIN OUTCOME MEASURES: ① Observation of brain structure at week 18 when rats were decapitated. ② Results of nerve cell apoptosis detected with TUNEL technique. ③ Rat body mass, BP, as well as the incidence and changes of stroke were recorded.RESULTS: Totally 34 rats entered the result analysis. ① The incidence of stroke in the three groups: It was 100%, 22%, and 13%, respectively, in stroke-prone spontaneous hypertension group, losartan 10 mg/(kg·d) group,and losartan 30 mg/(kg·d) group. ② Score for stroke: The score was remarkably higher in stroke-prone spontaneous hypertension group than in losartan 10 mg/(kg·d) group and losartan 30 mg/(kg·d) group [(3.50±0.55,0.67±1.12, 0.38±0.74) minutes]. ③ Electron-microscopic observation: In stroke-prone spontaneous hypertension group, electron density was found increased in necrotic neurons; moreover, some nuclear membrane lost double-layer structure with ridges broken, even reduced or disappeared, displaying vacuolated changes. In losartan 30 mg/(kg·d) group and losartan 10 mg/(kg·d) group, most of neurons displayed basically normal morphology, with neuron chromatin evenly distributed and nuclear envelops regular, but there were still some neurons that had dense chromatin, with ridges broken and reduced. ④ Nerve cell apoptosis in the three groups: It was found obviously lower in normal group than in losartan 30 mg/(kg ·d)group, losartan 10 mg/(kg·d) group, and stroke-prone spontaneous hypertension group [(2.5±0.8, 13.9±4.3, 14.0±4.4, 52.0±16.7)%, P ＜ 0.05]. ⑤ BP changes: At week 18, BP was obviously lower in normal group than in losartan 30 mg/(kg·d) group, losartan 10 mg/(kg·d) group and strokeprone spontaneous hypertension group [(120.1±7.9, 169.4±10.1,216.7±8.3,225.5±6.8) mmHg (1 mm Hg=0.133 kPa), P ＜ 0.05]. ⑥ Changes of body mass: At week 18, body mass was obviously higher in normal group than in losartan 30 mg/(kg·d) group, losartan 10 mg/(kg·d) group, and stroke-prone spontaneous hypertension group [(313.3 ±10.1, 270.8 ± 10.4,258.7±12.7, 231.0±6.5) g, P ＜ 0.05].CONCLUSION: Losartan can obviously reduce the incidence of stroke and nerve cell apoptosis in rats with spontaneous hypertension, suggesting that losartan as an angiotensin-1 receptor antagonist may prevent and delay the onset of stroke through antagonizing angiotensin I receptor, thus exerting brain-protecting function.

Objective To systematically review the changes in the intensity of postoperative pain under ketamine anesthesia in children.Methods We searched the Cochrane Library,PubMed,OVID,EMBASE,and Chinese Biomedical Database for prospective randomized controlled trials involving the changes in the intensity of postoperative pain under ketamine anesthesia in children.The quality of the studies was evaluated by the method recommended by Cochrane Collaboration.Evaluation indexes included pain score and analgesic consumption during 6 h after operation,pain score and analgesic consumption during 6-24 h after operation,duration of sensory block (caudal block),side effects during 24 h after operation (postoperative nausea and vomiting and psycho-mimetic manifestations).Meta-analysis was conducted using the Cochrane Collaboration's RevMan 5.0 software.Results Fifteen prospective randomized controlled trials involving 955 patients were included in our Meta-analysis.The patients were divided into 2 groups:control group ( n =455) and ketamine group ( n =500).The pain score and analgesic consumption during 6 h after operation were significantly decreased after general anesthesia with ketamine.The pain score during 6-24 h after operation and analgesic consumption during 6 h after operation were significantly decreased after local anesthesia with ketamine.The duration of sensory block was prolonged and the analgesic consumption during 6 h after operation was significantly reduced after caudal block with ketamine.There was no significant difference in the incidence of postoperative nausea and vomiting and psycho-mimetic manifestations between the two groups.Conclusion The intensity of pain and analgesic requirement during 6 h after operation are significantly reduced under ketamine anesthesia in children.

Objective To evaluate the effectiveness of using the anterolateral thigh flap and splitthickness skin grafting to repair large skin defect secondary to the excision of massive penoscrotal Paget's disease.Methods Clinical data of 6 patients with massive penoscrotal Paget's disease were retrospectively reviewed.The patients were admitted to our institute from Feb.2005 to Oct.2010 with mean age of 64 (55-68) years.No other neoplasm and enlarged inguinal lymph node were detected on physical examination,ultrasonography and CT scan.All cases underwent wide local excision of skin lesion which was taken 2 cm beyond the boundary under epidural anesthesia.An anterolateral thigh flap was used to reconstruct the scrotum,and the skin defect of penis was repaired by split-thickness skin grafting.Results Operation was uneventful for the 6 patients,with mean skin defect of 185 (150-210) cm2.The mean operative duration was 270 (210-300) min,and the mean blood loss was 75 (35-150) ml.Negative surgical margins were confirmed on postoperative pathology.Five patients recovered smoothly with satisfying cosmetic appearance,and one patient demonstrated partial necrosis of the flap which was repaired on secondary surgery.The mean follow-up was 37 (10-60) months,and no relapse was found.Conclusions It is an effective method to use anterolateral thigh flap and split-thickness skin grafting to repair large skin defect secondary to excision of massive penoscrotal Paget's disease.

Humans ; Lichen Planus, Oral ; psychology

Objective To express and purify the killer immunoglobulin-like receptor KIR3DL1 extracelluar domain.Methods pUC57-KIR3DL1 was used as template,KIR3DL1 extracelluar domain was amplified by polymerase chain reaction(PCR)and cloned into pGEM-T vector with A-T cloning technique.After DNA sequence analysis,the target fragment was inserted into the prokaryotic expression vector pET28a-DsbA to construct the recombinant vector pET28a-DsbA /KIR3DL1.The recombinant plasmid was transformed into E.coli BL21(DE3),and induced with IPTG.Bacterial pellets were resuspended in 8M urea and centrifuged to remove the insoluble material.The crude extract was purified by passing over a Ni-NTA-agarose column.After the inclusion body flowing through the Ni-NTA-agarose affinity chromatography was refolded successfully,it was purified by Superdex75 gel filtration and the purification effects of the fusion protein were identified by SDS-PAGE and western blot.Result Some fusion proteins were expressed in the supernatant,and the others were expressed in the form of inclusion bodies.The purity of fusion protein was over 95% after purification under denaturing condition.Conclusion The highly efficient expression of KIR3DL1 extracelluar domain laid the foundation for the further studies on exploration of the mechanism of immunization recognition between KIR3DL1 and its ligand.

Objective To build the screening model for population with Impaired Glucose Regulation (IGR)in community, and to evaluate its validity by using the model in general population. Methods Based on the epidemiological survey of DM in the community population in 2006, the analysis of the risk factors and the risk factors scoring method were used to build the screening model for IGR in community which was then used to screen for IGR in 2 120 general population in community to evaluate its validity. Result When the screening model was built with the accumulative score of risk factors ≥5, the sensitivity and specificity for identifying undiagnosed IGR were 68.2% and 61.7%, Youden's index was 0.299 and the positive predictive value was 14.2%. When 2 120 general population used the screening model, only 974 (45.9% of them)had to take OGTT test, and 124 (68.9%) IGR were identified. Conclusion The screening model with the accumulative score of risk factors ≥5 is an easy, effective and economic tool for IGR screening, and it can be tried to use in the screening for IGR in community, further research is needed.

Diabetic cardiomyopathy(DCM) is a disease independently related with coronary artery atherosclerotic heart disease, hypertensive heart disease, valvular heart disease, congenital heart disease and other heart diseases that are uniquely associated with diabetes mellitus, and the pathological manifestations of DCM are mainly myocardial hypertrophy, interstitial fibrosis, necrosis and apoptosis.Endoplasmic reticulum is the central location of many important cellular functions, and endoplasmic reticulum swelling and functional disorder in diabetic cardiomyocytes, high blood sugar can cause endoplasmic reticulum stress, suggesting that endoplasmic reticulum stress(ERS) may be involved in the pathogenesis of diabetic cardiomyopathy and development.Based on this, this paper summarizes the progress of ERS in diabetic cardiomyopathy from the pathogenesis of diabetic cardiomyopathy, unfolding protein reaction and the related role of ERS in DCM.

Objective To evaluate the pharmacokinetic parameters and bioavailability of Cyclobuxine D in transdermal patch in Newzealand rabbits by determining concentration-time curve and by comparing with the pharmacokinetics of Cyclobuxine Dinjection and suspension.Methods Precolumn derivatization RP-HPLC was used to detect the concentration of Clovirobuxine D in rabbits plasma at different time,and software 3p87 was used to analyze the pharmacokinetics parameter.Results In contrast to oral delivery,relatively steadily sustained blood concentration with minimal fluctuation and prolonged peak time were presented in the rabbits over a long period after transdermal administration.The absolute bioavailability of Cyclobuxine D was 30.472 %.Conclusion Cyclobuxine D Patch exhibits good controlled-release properties and maintains appropriate blood concentration for a prolonged time.

Objective To study the chemical constituents of Peperomia dindygulensis. Methods Chromatography was used to isolate and purify the chemical constituents, their structures were identified by spectral analyses. Results Eight compounds were isolated and identified as bis-(2-methoxy-4, 5-methylenedioxy)-benzophenone (Ⅰ), peperomin B (Ⅱ), peperomin C (Ⅲ), 5-hydroxy-4′, 7, 8-trimethoxy flavone (Ⅳ), 5-hydroxy-3′, 4′, 7, 8-tetramethoxy flavone (Ⅴ), 5, 3′-dihydroxy-4′, 7, 8-trimethoxy flavone (Ⅵ), ?-sitosterol (Ⅶ), hexadecanoic acid (Ⅷ). Conclusion Compound Ⅰ is a new compound named as dindygulensin. All compounds, except Ⅴ, are isolated from P. dindygulensis for the first time.

Objective To explore the feasibility of laparoscopic Ladd’s procedure and its indications for intestinal malrotation accompanying midgut volvulus. Methods Laparoscopic Ladd’s procedure was performed in 15 children from July 2002 to March 2006. The procedure was performed using three trocars. Under laparoscopic visualization, the midgut volvulus was untwisted by grasping and pulling the intestine, the Ladd’s band was divided and broadened, the duodenum and the small intestine were mobilized, and finally an appendectomy was performed through an abdominal wall port. Results Laparoscopic Ladd’s procedure was completed successfully in the 15 children. Of them, 1 patient with duodenal web, 1 patient with paraduodenal hernia, and 1 patient with ectopic pancreas also had a concomitant procedure. The operative time was 45~150 min (mean, 75 min). The patients began to take food on 1~3 postoperative day. There was no surgical complications. The length of postoperative hospital stay ranged 4~6 days (mean, 5 days). Follow-up observations in 12 patients for 1~42 months (mean, 21 months) showed normal development and free of symptoms.Conclusions Laparoscopic Ladd’s procedure is a safe and effective technique. It can be performed in neonates and applicable subacute midgut volvulus, but may be unadvisable for acute volvulus with abdominal distention.