AIM:To investigate the effects of memantine(Mem),an N-methyl-D-aspartate(NMDA)recep-tor antagonist,on sevoflurane(Sev)anesthetic depth and perioperative neurocognitive disorders in mice,and to explore the possible mechanisms involved.METHODS:Mouse electroencephalogram(EEG)monitoring and cognitive disorder models were established.For EEG monitoring,male C57BL/6J mice were randomly divided into control group,Sev group,and Mem+Sev group.The EEG monitoring electrodes were implanted in the heads of the mice 7 d before anesthe-sia.On the day of anesthesia,the mice in Mem+Sev group received an intraperitoneal injection of 20 mg/kg Mem dissolved in normal saline,while those in control and Sev groups received intraperitoneal injection of an equivalent volume of normal saline based on body weight.Thirty minutes later,the mice in Sev and Mem+Sev groups were anesthetized with 400 mL/min O2+3%Sev for 5 h,while those in control group were treated with 400 mL/min O2 for 5 h.The EEG monitoring was ter-minated after the righting reflex was restored in Sev and Mem+Sev groups.The time of disappearance and recovery of the righting reflex was recorded,and changes in EEG burst suppression ratio and relative power of each frequency band were analyzed.For the cognitive disorder part,another batch of male C57BL/6J mice were selected and divided into the same groups as before.The mice underwent water maze spatial navigation training for 6 d before anesthesia.On the day of anes-thesia,the mice in Mem+Sev group received an intraperitoneal injection of 20 mg/kg Mem dissolved in normal saline,while those in control and Sev groups received intraperitoneal injection of an equivalent volume of normal saline based on body weight.Thirty minutes later,the mice in Sev and Mem+Sev groups were anesthetized with 400 mL/min O2+3%Sev for 5 h,and those in control group were treated with 400 mL/min O2 for 5 h.Spatial navigation and exploration tests were conducted 3 d after anesthesia.After the tests,the mice were sacrificed,and their hippocampal tissues were collected.The levels of interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α)and acetylcholine(ACh)in the hippocampal tis-sues were detected by ELISA.The concentration of Ca2+in the hippocampal tissues was measured using a calcium assay kit.Pathological changes in the hippocampal CA3 region were observed by HE staining,and the protein levels of NMDA receptor GluN1 subunit,GABAA receptor,amyloid β-protein(Aβ),and p-tau were detected by Western blot.RE-SULTS:Compared with control group,the mice in Sev group had increased burst suppression ratio at all time points dur-ing anesthesia and prolonged escape latency and reduced platform crossings 3 d after anesthesia(P<0.05).The levels of IL-1β and TNF-α in the hippocampal tissues increased,while the level of ACh decreased,and the concentration of Ca2+in-creased.The protein levels of GluN1 subunit,Aβ and p-tau were elevated(P<0.05).Compared with Sev group,the mice in Mem+Sev group had shortened anesthesia induction time and increased burst suppression ratio at all time points during anesthesia,with elevated relative power of slow waves and δ waves(P<0.05).The escape latency was shortened,and the platform crossings increased 3 d after anesthesia(P<0.05).The levels of IL-1β and TNF-α in the hippocampal tissues decreased,while the levels of ACh increased,and the protein levels of GluN1 subunit,Aβ and p-tau were reduced(P<0.05).There was no significant difference in anesthesia recovery time among the groups(P>0.05).CONCLU-SION:Memantine,in combination with Sev anesthesia,accelerates anesthesia induction and deepens anesthetic depth,which may be related to the increased relative power of δ EEG waves,but has no significant effect on recovery time.Me-mantine intervention alleviates Sev anesthesia-induced cognitive disorders by inhibiting the overexpression of NMDA recep-tors,Aβ and p-tau,and attenuating neuroinflammation.

AIM:To investigate the effects of memantine(Mem),an N-methyl-D-aspartate(NMDA)recep-tor antagonist,on sevoflurane(Sev)anesthetic depth and perioperative neurocognitive disorders in mice,and to explore the possible mechanisms involved.METHODS:Mouse electroencephalogram(EEG)monitoring and cognitive disorder models were established.For EEG monitoring,male C57BL/6J mice were randomly divided into control group,Sev group,and Mem+Sev group.The EEG monitoring electrodes were implanted in the heads of the mice 7 d before anesthe-sia.On the day of anesthesia,the mice in Mem+Sev group received an intraperitoneal injection of 20 mg/kg Mem dissolved in normal saline,while those in control and Sev groups received intraperitoneal injection of an equivalent volume of normal saline based on body weight.Thirty minutes later,the mice in Sev and Mem+Sev groups were anesthetized with 400 mL/min O2+3%Sev for 5 h,while those in control group were treated with 400 mL/min O2 for 5 h.The EEG monitoring was ter-minated after the righting reflex was restored in Sev and Mem+Sev groups.The time of disappearance and recovery of the righting reflex was recorded,and changes in EEG burst suppression ratio and relative power of each frequency band were analyzed.For the cognitive disorder part,another batch of male C57BL/6J mice were selected and divided into the same groups as before.The mice underwent water maze spatial navigation training for 6 d before anesthesia.On the day of anes-thesia,the mice in Mem+Sev group received an intraperitoneal injection of 20 mg/kg Mem dissolved in normal saline,while those in control and Sev groups received intraperitoneal injection of an equivalent volume of normal saline based on body weight.Thirty minutes later,the mice in Sev and Mem+Sev groups were anesthetized with 400 mL/min O2+3%Sev for 5 h,and those in control group were treated with 400 mL/min O2 for 5 h.Spatial navigation and exploration tests were conducted 3 d after anesthesia.After the tests,the mice were sacrificed,and their hippocampal tissues were collected.The levels of interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α)and acetylcholine(ACh)in the hippocampal tis-sues were detected by ELISA.The concentration of Ca2+in the hippocampal tissues was measured using a calcium assay kit.Pathological changes in the hippocampal CA3 region were observed by HE staining,and the protein levels of NMDA receptor GluN1 subunit,GABAA receptor,amyloid β-protein(Aβ),and p-tau were detected by Western blot.RE-SULTS:Compared with control group,the mice in Sev group had increased burst suppression ratio at all time points dur-ing anesthesia and prolonged escape latency and reduced platform crossings 3 d after anesthesia(P<0.05).The levels of IL-1β and TNF-α in the hippocampal tissues increased,while the level of ACh decreased,and the concentration of Ca2+in-creased.The protein levels of GluN1 subunit,Aβ and p-tau were elevated(P<0.05).Compared with Sev group,the mice in Mem+Sev group had shortened anesthesia induction time and increased burst suppression ratio at all time points during anesthesia,with elevated relative power of slow waves and δ waves(P<0.05).The escape latency was shortened,and the platform crossings increased 3 d after anesthesia(P<0.05).The levels of IL-1β and TNF-α in the hippocampal tissues decreased,while the levels of ACh increased,and the protein levels of GluN1 subunit,Aβ and p-tau were reduced(P<0.05).There was no significant difference in anesthesia recovery time among the groups(P>0.05).CONCLU-SION:Memantine,in combination with Sev anesthesia,accelerates anesthesia induction and deepens anesthetic depth,which may be related to the increased relative power of δ EEG waves,but has no significant effect on recovery time.Me-mantine intervention alleviates Sev anesthesia-induced cognitive disorders by inhibiting the overexpression of NMDA recep-tors,Aβ and p-tau,and attenuating neuroinflammation.

Objective To compare and the advantages and disadvantages of 3 methods of bone grafting in the posterior treatment of thoracolumbar burst fracture.Methods A retrospective analysis was conducted of 258 thoracolumbar burst fractures treated with posterior short-segment fixation from March 2013 to March 2015 at Orthopedic Department One,Foshan Hospital of Traditional Chinese Medicine.Of them,87 were treated with transpedicular bone grafting (group A),87 with laminar and intertransverse process bone grafting (group B) and 84 with small joint turnover plus bone grafting (group C).The 3 groups were compared in terms of cobb angle,loss of correction,bony fusion,internal fixation failure,and Oswestry disability index (ODI).Results The 3 groups were comparable due to insignificant differences in the preoperative general data between them (P ＞ 0.05).The cobb angles in the 3 groups at one week after operation (4.9° ± 1.0°,4.8° ± 0.6° and 4.8° ± 0.6°) and at the final follow-up (6.1 o ± 1.5°,14.5° ± 3.7° and 15.3° ± 4.1 °) were significantly smaller than those before operation (27.5° ± 4.9°,27.6° ± 4.6° and 27.6° ± 4.2°) (P ＜ 0.05).The cobb angles in groups B and C at the final follow-up were significantly larger than those at one week after operation (P ＜0.05).At the final follow-up,both the cob angles and the loss of kyphoplasty correction in groups B and C were significantly larger than in group A (P ＜ 0.05).The fusion rate in group A (100％) was significantly larger than in group B (80.5％) and C (76.2％).There were no significant differences between the 3 groups in the rate of internal fixation failure (0,1.1％ and 2.4％) (x2 =2.108,P=0.348).The ODI for the 3 groups at 6 months after operation (28.5 ± 4.1,28.7 ± 3.9 and 28.8 ± 3.7) and at the final follow-up (10.7 ± 2.6,11.0 ± 2.7 and 11.4 ± 3.1) were all significantly lower than the preoperative values (94.3 ± 0.7,94.4 ± 0.9 and 94.4 ± 0.8) (P ＜ 0.001).In all the patients,the ODI at the final follow-up was significantly lower than that at 6 months after operation(P ＜ 0.001).Conclusions In the treatment of thoracolumbar burst fractures,all the posterior approach plus transpedicular bone grafting,posterolateral bone grafting and reversed bone grafting plus short segmental internal fixation can effectively restore vertebral height and result in a high rate of fusion.Although the latter 2 methods of bone grafting are effective,they may be disadvantageous in leading to long-term loss of vertebral height and kyphosis correction.

Objective To discuss the effects and the possible mechanismof curcumin on pulmonary functions and expression of TGF-β1 and NF-κB in paraquat-induced pulmonary fibrosis of rats.Methods SPF Wistar rats were randomly (random number) divided into three groups:paraquat-poisoned group (PQ group,with PQ 50 mg/kg by gavage),Curcumin-treatment group (PC group after 30,with curcumin (200 mg/kg) by intraperitoneal injection),and Blank group (B group,with same volume of sterile saline at the same time).After 14 d,the lung function of rats was observed,and the expression of TGF-β1 and NF-κB protein were detected by immunohistochemistry.Results The survival rates of mice significant difference in the PC and PQ groups with (70.83％ vs.41.67％,P ＜0.05).Compared with the B group,lung function index (Te,PIF,PEF,EF50,TV,F) of PQ group significantly decreased (P ＜ 0.05,P ＜ 0.01).Compared with the PQ group,lung function index (Te,PEF,TV,F) of PC group significantly increased (P ＜ 0.05 or P ＜ 0.01).There are some expression of lung tissues of rats with TGF-β1,NF-κB in B group.Compared with B group,PQ group significantly enhanced (P ＜0.01or P ＜0.05).Compared with the PQ,PC group significantly decreased (P ＜ 0.01 or P ＜ 0.05).Conclusions Curcumin can relieve paraquat-induced pulmonary fibrosis by inhibiting the over expression of TGF-β1,NF-κB in lung tissue of rats.

Objective:To explore the effects of medical support program on local diagnosis,treatment and prognosis of acute myocardial infarction(AMI).Methods:Department of Cardiology,Zhongshan Hospital,Fudan University launched medical support program for Fuyuan People′s Hospital in Mar 2010.A total of 103 AMI patients admitted to Fuyuan People′s Hospital during Mar 2010 and Apr 2014 were enrolled.And 5 1 patients admitted during Mar 2010 and Nov 2012 were allocated to group A,while 52 patients admitted during Dec 2012 and Apr 2014 were allocated to group B.The treatment strategy,hospital stay, medication and prognosis were compared between the two groups.Results:Among the 103 AMI patients,male smoking pro-portion was significantly higher than female one(P <0.05).Only 21 patients with ST segment elevation myocardial infarction (STEMI)arrived hospital within 12 h.The thrombolytic therapy rate of patients with STEMI in group B was higher than that in group A(P <0.05).The usage rate of adenosine diphosphate(ADP)receptor antagonist(clopidegrel)during hospitalization in group B was higher than that in group A (P <0.05 ).Only 57 patients were followed up.And only 1/3 of these patients re-ceived consecutive coronary angiography and percutaneous coronary intervention(PCI).After discharge from hospital,the pre-scription rates of ADP receptor antagonist,β-receptor blockers and angiotension converting enzyme inhibitor (ACEI)all de-creased obviously and there was no significant difference between the two groups(P >0.05).There was no significant difference regarding the incidence rates of endpoint events between the two groups(P >0.05).Conclusions:Medical support program im-proves the rates of diagnosis and standardized treatment of AMI during hospitalization.However,the delay before admission has not been shortened yet.Furthermore,there was no standardized secondary prevention and treatment after discharge.Thus,apart from improving the ability of diagnosis and treatment during hospitalization,more attention should be paid to the health education for patients and the training for primary medical staff,and enhance the regional cooperation.

OBJECTIVETo compare the inter- and intra-observer reliability of the GATA and SMU classification systems for spinal tuberculosis and assess the clinical value of SMU classification.

METHODSOne hundred patients with spinal tuberculosis treated in our hospital from January 2004 to December 2011 were randomly selected for analysis, including 54 males and 46 females with a mean age of 45 years (range, 16-68 years). All the patients had X-ray, CT and MRI examinations. Five observers experienced in spinal tuberculosis independently assigned the classification using the GATA and SMU classification systems, and the assignment was repeated 3 months later to test its reproducibility. Kappa value was used to determine the intra- and inter-observer reliability.

RESULTSFor GATA and SMU classification systems, the inter-observer percentage of agreement averaged (59.9∓4.84)% (κ=0.412∓0.058) and (81.6∓6.06)% (κ=0.753∓0.068), and the intra-observer percentage of agreement was (75.6∓5.27)% (κ=0.624∓0.078) and (89.8∓2.28)% (κ=0.862∓0.037), respectively.

CONCLUSIONThe SMU classification system of spinal tuberculosis has a higher inter-observer and intra-observer reliability than the GATA classification system, but its clinical value needs to be further tested in future clinical trials.

Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Observer Variation ; Reproducibility of Results ; Tuberculosis, Spinal ; classification ; diagnosis ; Young Adult

ObjectiveTo evaluate the value of MR imaging(MRI)in diagosing of obstetrical brachial plexus.MethodsBetween September 2006 to September 2011,eighteen cases (12 males and 6 females)of obstetrical brachial plexus injury had being used for investigation,aging from 2 month to 3 years, average of 10.6 month. Eight left side and 10 right side. Tassin Ⅰ was 4 cases,Tassin Ⅱ was 6 eases, Tassin Ⅲwas 5 eases, Tassin Ⅳ was 4 cases. All cases were performed to MRI test before operating and the result compare with finding during operating. ResultsFindings of MRI:pseudomeningocele was in 13 of the 18cases while 10 of the 15 patients had multiple pseudomeningoceles. Displacement of spinal cord was in 6 cases; Normal was 2 cases; thickening of nerve root was in 2 cases.ConclusionMR imaging is an effective tool for demonstrating lesions of the brachial plexus worthy of surgical exploration.

Objective To study the expression of PTEN and its significance in doxorubicin-treated gastric cancer cells. Methods (1) Gastric cancer BGC-823 cells were treated with doxorubicin. Cell proliferation and apoptosis were evaluated by MTF and flow cytometry. The expression of PTEN at the mRNA and protein level were determined by RT-PCT and Western blot, respectively. (2)The gastric cancer xenografts model was constructed. The apoptosis of gastric cancer xenografts cells was determined by TUNEL. The expression of PTEN at the mRNA and protein level were detected using RT-PCR and Western blot, respectively. (3) BGC-823 cells were transfected with PTEN siRNA before addition of doxorubicin. The proliferation and apoptosis of these cells as well as the expression level of PTEN protein were determined. Results (1) After administration of doxorubicin, the proliferation of BGC-823 cells was inhibited in a time-dependent manner. (2) Doxorubicin significantly induced apoptosis of BGC-823 cells. (3) Doxorubicin treated BGC-823 cells showed a significant increase in the expression of PTEN at the mRNA and protein level in a time-dependent manner. TUNEL assay also showed a significant increase of apoptosis rate in gastric cancer xenografts treated with doxorubicin compared with control group [(28. 11± 1.05) % vs (2. 78 ± 1.63) %]. The expression of PTEN at the mRNA and protein level in the gastric cancer xenografts were significantly increased after administration of doxorobicin (0. 5667 ± 0. 0043 vs 0.2217±0.0063,0.14±0.26 vs 0.04±0.15,P <0.05). (4) After treated with doxorubicin, the expression of PTEN in siRNA-transfected BGC-823 cells was significantly higher than that in non-transfected BGC-823 cells (P < 0. 0001). The apoptosis of PTEN siRNA-transfected BGC-823 cells was significantly decreased compared with non-transfected BGC-823 cells [(10. 35 ± 1.04) % vs (31.37 ± 3.58) %, P < 0. 05]. Conclusion Doxorubicin can effectively inhibit the growth and induce the apoptosis of BGC-823 gastric cancer cells. Increasing PTEN protein may be one of the main mechanism involved in this effect.

Objective To explore the clinical design and therapeutic effect of total root avulsion of brachial plexus by contralateral C_7 nerve transfer for directly repairing C_8T_1 via prespinal route combined with functioning gracilis transplantation. Methods Twelve cases of total roots avulsion of brachial plexus were operated at 1 month to 3 months after injury.The contralateral C_7 nerve was successfully transferred to directly repair avulsed C_8T_1 roots or lower trunk via prespinal route.At 2nd operation stage after 4 to 8 months,the functioning gracills transplantation was preformed to reconstruct the elbow flexion and fingers extension. Results Follow-ups were carried out in all 12 cases who had been discharged for 9 to 36 months after the first operation.The positive Tinel signs of ulnar or median nerves were located in the proximal arm at 3 months after 1st operation,in the elbow or proximal forarm at 6 months,and in the wrist or distal forarm at 9 months.At 12 months the positive Tinel signs were found in the plam or fingers in 9 cases.The contraction of sternocostal part of pectoralis major was found at 9 mooths in 7 cases.There were the restoration of the taction-pain sensation in the palm, finger, and medial side of forearm and the contraction of flexor carpi ulnaris and flexor digitorum(M_3)in 5 cases at 15 to 18 months after 1st operation.In 7 patients the flexion of elbow and extension of fingers and thumb restored at 9 to 12 months after the 2nd operation.Their elbow flexion was 90°-120°and M_3(Highet's method),and their finger and thumb extension M_3. Conclusion There is the possibility of the operative design and clinical application of total root avulsion of brachial plexus by contralateral C_7 nerve transfer for directly repairing C_8T_1 via prespinal route combined with functioning gracilis transplantation.There are not only the restoration of sensation and flexion of wrist and fingers,but also the restoration of elbow flexion and fingers extension.