OBJECTIVE: To investigate the effect of electroacupuncture (EA) on neurological function in rats with cerebral ischemia-reperfusion injury (CIRI) by regulating adenosine monophosphate-activated protein kinase (AMPK)/mammalian target of rapamycin (mTOR)/Unc-51-like kinase 1 (ULK1) signaling pathway. METHODS: Thirty-three male SD rats were randomly divided into a sham-operation group, a model group and an EA group, with 11 rats in each group. The right middle cerebral artery occlusion/reperfusion (MCAO/R) model was prepared by thread occlusion method in the model group and the EA group. In the sham-operation group, no thread was inserted after vascular separation. After the success of modeling, in the EA group, EA was applied to "Baihui" (GV 20) and "Zusanli" (ST 36) on the affected side, with disperse-dense wave, the frequency of 2 Hz/15 Hz, for 20 min, once a day. EA was delivered continuously for 3 days. On day 1 and day 3 of operation, the score of the modified neurological deficit scale (mNSS) was evaluated. After intervention completion, the cerebral infarction area was measured by the thiazolyl blue tetrazolium chloride (TTC) method. Nissl staining was used to observe the damage of cortical neurons on the ischemic side in each group. Using transmission electron microscopy, the ultrastructure of cortical neurons on the ischemic side was observed. With the immunofluorescence method adopted, the positive expression of the related protein 1 light chain 3 (LC3) and benzyl chloroform (Beclin-1) on the ischemic side was detected. The protein expression of p-AMPK, AMPK, p-mTOR, mTOR, pS757-ULK1, ULK1 and chelating ligand 1 (p62) in the ischemic cortex was detected using Western blot method. RESULTS: ① Compared with the sham-operation group, in the model group, the mNSS score increased (P<0.01), the percentage of infarction area was increased (P<0.01); the cortical neurons on the ischemic side were loosely distributed, with karyopyknosis and vacuolization, and the number of neurons was reduced (P<0.01); the cells were swollen and ruptured, mitochondrial shrunk, electron density higher, and there were a large number of autophagic debris. The positive expression of LC3 and Beclin-1 was elevated (P<0.01), and p-mTOR/mTOR, pS757-ULK1/ULK1 and the protein expression of p62 dropped (P<0.01) in the ischemic cortex. ② Compared with the model group, in the EA group, the mNSS score was reduced (P<0.05). The percentage of cerebral infarction area was descreased (P<0.01); and the neurons were regularly distributed, the number of neurons increased (P<0.01), the structure of mitochondria was clearer, the crest fracture alleviated, and the damage of neurons attenuated. The positive expression of LC3 and Beclin-1 was dropped (P<0.01), and p-AMPK/AMPK reduced (P<0.05), and p-mTOR/ mTOR, pS757-ULK1/ULK1 and the protein expression of p62 increased (P<0.01) in the ischemic cortex. CONCLUSION EA at "Baihui" (GV 20) and "Zusanli" (ST 36) inhibits autophay, attenuates neurological deficit and cerebral pathological damage in CIRI rats to protect the nerves, which may be obtained by regulating AMPK/mTOR/ULK1 signaling pathway.
Animals ; Electroacupuncture ; Male ; Rats ; TOR Serine-Threonine Kinases/genetics* ; Rats, Sprague-Dawley ; Autophagy-Related Protein-1 Homolog/genetics* ; Reperfusion Injury/metabolism* ; Signal Transduction ; AMP-Activated Protein Kinases/genetics* ; Brain Ischemia/metabolism* ; Humans ; Acupuncture Points

Objective To explore the predictive value of the model for end-stage liver disease (MELD) score, energy metabolism and serum thyroid hormone levels on the severity and prognosis of patients with liver failure and their correlation. Methods This study collected clinicopathological data from 60 liver failure patients, e.g., end-stage liver disease (MELD) score, energy metabolism, and serum thyroid hormone levels. The χ 2 test was performed to analyze the categorical variables, while the Mann-Whitney U test and independent sample t test were performed to assess the continuous variables between the two groups. Spearman correlation coefficient test was used to evaluate correlation of each index. The receiver operating characteristic (ROC) curve was used to analyze the optimal cut-off points of serum total triiodothyronine (TT3) and free triiodothyronine (FT3) levels in predicting prognosis of the patients. Results The rates of low TT3 and FT3 levels in liver failure patients were 78.2% and 69.1%, respectively, whereas the low TT3 rates were 95.2% and 67.6% and the low FT3 rates were 90.5% and 55.9% in survival and non-survival groups of patients, respectively (both P < 0.05). Moreover, the MELD score was significantly higher in the non-survival patients than in survival patients [26.0(21.0-29.0) vs 21.0 (19.0-24.0), Z =-3.396, P =0.001], while TT3 and FT3 levels were significantly lower in the non-survival patients than in the survival patients [0.69(0.62-0.73) vs 0.83(0.69-0.94) and 2.17(1.99-2.31) vs 2.54(2.12-2.86), respectively; Z =-2.884、-2.876, all P < 0.01]. The MELD score was negatively associated with serum TT3, FT3, and thyroid stimulating hormone (TSH) levels and the respiratory quotient (RQ) ( r =-0.487、-0.329、-0.422、-0.350, all P < 0.01), whereas the RQ was associated with serum TT3 and FT3 levels ( r =0.271、0.265, all P < 0.05). The optimal cutoff values in predicting the severity and survival of patients was 0.75 nmol/L and 2.37pmol/L with the sensitivity values of 67.6% and 64.7% and the specificity of 90.5% and 81.0%, respectively. Conclusion Abnormal thyroid hormone levels and low respiratory quotient could be used to predict the severity and prognosis of patients with liver failure.

Objective:To investigate the clinical value of continuous increase of blood lactic acid (Lac) in prognosis evaluation of patients with sepsis.Methods:From January 2016 to December 2018, 84 patients with sepsis in the Department of Critical Medicine of Lanzhou First People's Hospital were retrospectively analyzed. According to the final outcome, the patients were divided into death group and survival group. The general condition, initial Lac, Lac at 6, 12, 18, 24 h, and the duration of Lac>2 mmol/L (T Lac>2) were compared between the two groups. Receiver operating characteristic curve (ROC) was used to analyze the sensitivity and specificity of gender, age, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), initial lac, 6, 12, 18, 24 h lac, T Lac>2 in evaluating the prognosis of patients with sepsis. At the same time, the relationship between these parameters and the prognosis of patients was analyzed by Cox regression analysis to evaluate the clinical value of the time of continuous increase of blood lactate in the prognosis of patients with sepsis. Results:There was no significant difference in age, gender, APACHE Ⅱ score and initial lac between the two groups ( P>0.05). The Lac of death group was higher than that of survival group at 6, 12, 18 and 24 h after treatment ( P<0.05), and T Lac>2 in death group was significantly longer than that in survival group ( P<0.05). Cox regression analysis showed that age, gender, APACHE Ⅱ score, initial Lac, 6, 12, 18, 24 h lac had no significant effect on the prognosis of sepsis patients, while T Lac>2 was significantly correlated with survival rate and death risk. The longer T Lac>2 was, the lower the survival rate and the higher the risk of death. At the same time, ROC curve analysis showed that gender, age, APACHE Ⅱ score and area under the curve (AUC) of initial lac showed that these indicators could not effectively evaluate the prognosis of patients ( P>0.05). The area under the curve of T Lac>2 was the largest, and the evaluation of prognosis was the best, followed by 24 h Lac and 18 h, 12 h and 6 h Lac. In addition, the sensitivity of T Lac>2, 24, 18, 12, 6 h for sepsis mortality risk assessment were 90.9%, 81.8%, 81.8%, 81.8%, 88.6%, and the specificity were 71.4%, 52.5%, 52.5%, 47.7% and 25.2%, respectively. Conclusions:Transient increase of lactic acid can not evaluate the prognosis of patients with sepsis, but the duration of lactic acid increase has a significant impact on the prognosis of patients with sepsis. The longer the increase of Lactic acid (T Lac>2) is, the lower the survival rate and the higher the risk of death. The sensitivity and specificity of lactic acid duration in evaluating the risk of death were higher than those of other parameters, and the prognostic efficacy was the best.

ObjectiveTo investigate the clinical feature, management, outcome and prognosis of chest pain during pregnancy.MethodsClinical data of 13 gravidas with chest pain admitted to the Fujian Medical University Union Hospital from January, 2013 to December, 2017 were analyzed retrospectively.Results Among the 13 cases, nine had acute chest pain (happen within 72 hours); two had chronic chest pain lasting over one month, and the other two had paroxysmal subacute chest pain (72 h to less than 30 d). Seven cases were complicated by cardiogenic disease/death including six with aortic dissection (patients No.1-6) and one with myocardial infarction (patient No.7). The remaining six cases were complicated by a variety of different non-cardiac conditions including transverse colon cancer (patient No.8), spontaneous pneumothorax (patient No.9), reflux esophagitis (patient No.11), intercostal neuralgia (patient No.12), acute leukemia (patient No.13) and idiopathic disease (patient No.10). Eight women underwent cesarean section, three delivered vaginally (patients No.8, No.10 and No.12), and two (patients No.7 and No.13) were aborted in the first trimester. Patient No.7 chose abortion in early pregnancy, 12 days after stent implantation, and was lost to follow up after discharge. Patient No.13 underwent induced abortion following two courses of chemotherapy against acute leukemia and was also lost to follow up. Patient No.2 died due to the septic shock and subsequent multi-organ dysfunction syndrome after cesarean section and aortic surgery. The remaining ten cases did not report any abnormalities during follow-up. Among the 11 neonates, seven were preterm infants. All of the 11 babies were normal in follow-ups except one preterm infant (case 8) showed growth retardation at 11 months old.ConclusionsChest pain during pregnancy may be caused by various reasons, and the severity varies greatly, and may even result in maternal and infant deaths in some circumstances. Early identification diagnosis and timely intervention are required to improve maternal and fetal outcomes.

Objective To study the effects of dichloroacetate (DCA) on cell colony-forming,cell invasion and cell migration of the bladder cancer cells and to study the underlying mechanism.Methods The bldder cancer cells T24 were randomly divided into two groups:the observation group and the control group.Cells in the observation groups were treated with 5 mmol/L,10 mmol/L and 20 mmol/L dichloroacetate,and the control group was treated with the same amount of dimethyl sulfoxide.Colony formation assays were detected with Giemsa staining.Cell wound scratch assay and Transwell assay were applied to evaluate the ability of the T24 cell invasion and migration.Realtime PCR and Western blot were applied to detect the expression of the epithelial-mesenchymal transition (EMT)-related marker,including E-cadherin,N-cadherin,vimentin,Snail and Slug.Results Compared with the control group,the colony formation assays of T24 cells constantly decreased along with the increased doses in the observation group(P ＜ 0.01).The cell wound scratch assay showed that the scratch width of the observation groups were significantly higher along with the increased doses and prolonged time than that in the control group (P ＜ 0.01).The transwell assay showed that the invasion ability of the observation groups were significantly discreased along with the increased doses than that in the the control group (P ＜ 0.01).The expression levels of E-cadherin mRNA and protein in combination the control group were higher than those in the the observation groups (P ＜ 0.05).However,the expression levels of N-cadherin,vimentin,Snail and Slug mRNAs and proteins in combination the control group were lower than those in the the observation groups (P ＜ 0.05).Conclusion Dichloroacetate can inhibit the colony-forming,invasion and migration of bladder cancer T24 cells,and its mechanism may inhibit the expression of epithelial mesenchymal transition in T24 cells by down-regulating the expression of nuclear transcription factor Snail and Slug.

Objective To discuss the establishment and application effects of secondary triage management system based on JCI standard in outpatient clinic of maternal and child health care hospital. Methods In July 2015,secondary triage mode was implemented and secondary triage management team was established in our hospital under the JCI standard basis. Nursing staff were trained. The secondary triage management system in outpatient clinic,job and responsibilities of nurses and work flow of secondary triage mode were developed. Satisfaction of patients and doctors in outpatient clinic and waiting time of patients before (January 2014 to June 2015) and after (July 2015 to October 2016) the implementation of secondary triage mode were compared.Results After the implementation of secondary triage mode,the satisfaction of patients increased from (85.76±15.24) to (96.38±12.91),while satisfaction of patients increased from 88.80% to 97.20%. The waiting time of patients decreased from (59.64±12.38) min to (40.55±10.96) min. The differences were statistically significant (t/χ2=15.634,13.550,9.915;P<0.001).Conclusions The secondary triage management model can reduce the waiting time of patients and improve their satisfaction.

Objective To analyze the changes of hematological parameters and coagulatory function in sever fever with thrombocytopenia syndrome (SFTS) in Zhoushan island.Methods Automated blood analyzer and automatic coagulation analyzer were used to measure hematological parameters and coagulatory function in SFTS patients before and after ten days treatment.Results The counts of white blood cells (WBC),neutrophils and lymphocytes and platelets of the 27 cases with SFTS were significantly lower than those of normal controls (P ＜ 0.05) ; Moreover,the counts of platelets was significantly higher in the cases who recovered as compared with those who died (P ＜ 0.05).Prothrombin time (PT),activated partial thromboplastin time (APTT) and thrombin time (TT) of SFTS patients before treatment were longer than normal controls,whereas fibrinogen (FIB) was lower (P ＜ 0.05).Pearson correlation analysis showed that APTT and platelet (PLT) of SFTS patients before treatment had significantly negative correlation (P ＜ 0.05),as well as PT,APTT and TT were negatively correlated with PLT of SFTS patients with 10 d treatment.Conclusion Paying close attention to the hematological parameters and coagulation function,especially PLT and APTT,has important clinical significance in diagnosis and monitoring of disease progression in patients with SFTS.

Objective To compare the dosimetric difference in planning target volume(PTV)and organ at risk(OAR)with conventional and the three-dimensional treatment planning for limlted-stage small cell lung cancer.Methods Ten patients with limited-stage small cell lung cancer were chosen in the present study.Two treatment planning were designed twice respectively with the Cadplan R 3.1.2 treatment planning system for each patient in two-course.The total radiation dose was 50 Gy.The dosimetric parameters were assessed with dose volume histograms in PIT and OAR.Results For the first course,the dose homogeneity indices(HI)of PTV1,conformal indices(CI)of PTV2,contralateral lung V3o and eontralateral mean lung dose in the three-dimensional treatment planning were better than that in the conventional treatment planning.For the second course,the HI,CI and mean dose of PTV1,CI and mean dose of PTV2 in the three-dimensional treatment planning were better than that in the conventional treatment planning.Conclusions By comparison with conventional treatment planning,the three-dimensional conformal treatment planning could meet the demands of dosimetrie requirements well for limited-stage small cell lung cancer with three-dimensional conformal radiotherapy,but with no significant dnsimetric differences in the OAR.

Objective To study the pathogenesis of acute intravascular hemolysis following copper needle electrothrombosis for treating a huge cavernous hemangioma. Methods (1) The full course of severe intravascular hemolysis in a patient with huge cavemous hemangioma treated by copper needle electrontrombosis was observed. (2)In vitro experiment, a copper needle, an iron needle and a stainlss-steel needle were put in citrated anticoagulant healthy blood specimens respectively. The needles were electrified with 3～6 voltages DC for 30 minutes. Then the free hemoglobin of the specimens was tested before,during and after electrfication. The red cell morphology was observed under a light microscope. Results Severe intravascular hemolysis occurred in twice treatments with copper needle electrothrombosis. In vitro experiment showed that erythroclasis occurred after needle electrifying with obvious increasing of free plasma hemoglobin of the specimens. The higher the voltage and the longer the electrification of the needle, the more severe the hemocytocatheresis. Conclusions Severe intravascular hemolysis may happen during copper needle electrothrombosis for treating huge cavernous hemangioma. Red blood cell injury directly caused by electrification is the main factor of intravascular hemolysis.

Objective To study the pathogenesis of acute intravascular hemolysis following copper needle electrothrombosis for treating a huge cavernous hemangioma. Methods (1) The full course of severe intravascular hemolysis in a patient with huge cavemous hemangioma treated by copper needle electrontrombosis was observed. (2)In vitro experiment, a copper needle, an iron needle and a stainlss-steel needle were put in citrated anticoagulant healthy blood specimens respectively. The needles were electrified with 3～6 voltages DC for 30 minutes. Then the free hemoglobin of the specimens was tested before,during and after electrfication. The red cell morphology was observed under a light microscope. Results Severe intravascular hemolysis occurred in twice treatments with copper needle electrothrombosis. In vitro experiment showed that erythroclasis occurred after needle electrifying with obvious increasing of free plasma hemoglobin of the specimens. The higher the voltage and the longer the electrification of the needle, the more severe the hemocytocatheresis. Conclusions Severe intravascular hemolysis may happen during copper needle electrothrombosis for treating huge cavernous hemangioma. Red blood cell injury directly caused by electrification is the main factor of intravascular hemolysis.