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Pulmonary artery hypertension (PAH) is a chronic vascular disease defined by the elevation of pulmonary vascular resistance and mean pulmonary artery pressure, which arises due to pulmonary vascular remodelling. Prior research has already established a link between the autonomic nervous system (ANS) and PAH. Therefore, the rebalancing of the ANS offers a promising approach for the treatment of PAH. The process of rebalancing involves two key aspects: inhibiting an overactive sympathetic nervous system and fortifying the impaired parasympathetic nervous system through pharmacological or interventional procedures. However, the understanding of the precise mechanisms involved in neuromodulation, whether achieved through medication or intervention, remains insufficient. This limited understanding hinders our ability to determine the appropriate timing and scope of such treatment. This review aims to integrate the findings from clinical and mechanistic studies on ANS rebalancing as a treatment approach for PAH, with the ultimate goal of identifying a path to enhance the safety and efficacy of neuromodulation therapy and improve the prognosis of PAH.

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Hipertensión Pulmonar , Hipertensión Arterial Pulmonar , Humanos , Arteria Pulmonar , Sistema Nervioso Autónomo , Sistema Nervioso Simpático

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Objective:To compare the survival outcomes in patients of small cell lung cancer (SCLC) with brain-single metastasis and brain with organs-multiple metastasis.Methods:Using the US surveillance, epidemiology and final results database, 5 520 SCLC patients with complete clinical information from 2004 to 2015 were selected. SCLC patients were adjusted, stratified or matched according to the metastasis site after the stratification or matching of the propensity scores, and the lung cancer-specific survival (CSS) rate and overall survival (OS) rate were compared between brain-single metastasis group and brain with organs-multiple metastasis group. In addition, the effects of chemotherapy and radiotherapy in CSS between brain-single metastasis group and brain with organs-multiple metastasis group were compared.Results:Of the 5 520 SCLC patients, 2 658 cases was in the brain-single metastasis group, and 2 862 cases was in brain with organs-multiple metastasis group. After the stratification or matching of the propensity scores, the median survival time in brain-single metastasis group was significantly longer than that in brain with organs-multiple metastasis group (6 months vs. 4 months), and there was statistical difference ( P<0.05). The fatality rate in brain-single metastasis group was significantly lower than that in brain with organs-multiple metastasis group (80.66% vs. 85.96%), and there was statistical difference ( P<0.01). Kaplan-Meier survival curve analysis result showed that the OS rate and CSS rate in brain-single metastasis group were significantly higher than those in brain with organs-multiple metastasis group (14.72% vs. 9.50% and 19.34% vs. 14.04%), and there were statistical differences ( P<0.05). Cox analysis result showed that age, race, T stage, gender, N stage, radiotherapy, chemotherapy, tumor diameter, marriage and metastasis were the influencing factors of CSS rate in SCLC patients with brain metastasis ( P<0.01 or <0.05). Multivariate Logistic regression analysis result showed that radiotherapy and chemotherapy can significantly improve the CSS rate ( HR = 0.668 and 0.671, 95% CI 0.570 to 0.783 and 0.573 to 0.786, P < 0.01). Conclusions:The survival rate in SCLC patients with brain-single metastasis is higher than that of SCLC patients with brain with organs-multiple metastasis; chemotherapy and radiotherapy can improve the survival rate in SCLC patients with brain metastasis.

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@#Objective　Our study aimed to investigate the relationship between post-stroke cognitive function and pre-stroke Chinese language input in patients with cerebral infarction,and to assess the writing function of patients with post-stroke cognitive impairment.Methods　(1)A total of 196 patients diagnosed with cerebral infarction were selected.Scores of various diagnostic scales,as well as writing,reading and use of electronic products before stroke were compared.The correlation between post-stroke cognitive function and pre-stroke Chinese language input,and the relationship between writing ability with cognition in various domains as well as the trend of changes were analyzed.(2)Chinese character writing training was used to analyze the prevention of post-stroke cognitive impairment and restoration of neurological function.Aphasia battery of Chinese (ABC) was used to assess the writing function of patients.Furthermore,the relationship between writing and cognitive functions,and the ABC scores were analyzed.(3)Patients’cognitive and neurological functions were evaluated again at 1st,3rd and 6th months after writing training to analyze the effect of writing training on the cognitive impairment and neurological function recovery.Results　(1)The total MMSE score and total MoCA score were significantly correlated with the writing and reading of Chinese characters in pre-stroke patients (all P<0.05),but were not significantly correlated with the use limit of electronic products.(2)Total score of MMSE was significantly correlated with transcribing,dictating,graph writing,and active writing (all P<0.05),while the total score of MoCA only had a significant positive correlation with the dictating, graph writing,and active writing (all P<0.05).(3)The total MMSE score at the 3rd and 6th months were significantly increased (both P<0.05).Conclusions　Pre-stroke writing and reading habits were associated with better post-stroke cognitive performance,whereas good pre-stroke writing and reading habits might have a protective effect on post-stroke cognitive function.There was a positive correlation between the level of post-stroke writing and the level of post-stroke cognitive function,suggesting that the post-stroke writing ability may affect the level of post-stroke cognitive function.Writing training might improve cognitive impairment after stroke.

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Hyperglycemia is common in patients with acute ischemic stroke and is associated with poor outcomes.International guidelines recommend that patients with acute ischemic stroke should maintain their blood glucose level within an appropriate range using the loose treatment.However,specific hypoglycemic measures are still inconclusive.This article reviews the research progress of hyperglycemia after acute ischemic stroke.

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Hyperglycemia is common in patients with acute ischemic stroke and is associated with poor outcomes. International guidelines recommend that patients with acute ischemic stroke should maintain their blood glucose level within an appropriate range using the loose treatment. However, specific hypoglycemic measures are still inconclusive. This article reviews the research progress of hyperglycemia after acute ischemic stroke.

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Bilirubin is a metabolic end product degraded under the action of heme oxygenase.It is an endogenous antioxidant and has the function of anti-atherosclerosis, clearing free radicals and protecting the tissues and organs of the body.This article reviews the metabolism and biological characteristics of bilirubin, and the correlations between bilirubin and vascular risk factors, as well as between bilirubin and ischemic stroke.

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Objective To explore the effect of preeclampsia on the expression of hypothalamic-pituitary-adrenal (HPA) axis related genesin the hippocampus of adolescent offspring rats.Methods The pregnant Sprague-Dawley rats were randomly divided into two groups to be given 125 mg · kg-1 ·d-1 L-NAME or 1 mL pure saline by daily injection from day 14 to delivery.Serum corticosterone (CORT) levels in neonatal offspring rats were detected by ELISA.The mRNA and protein levels of glucocorticoid receptor (GR),corticotropin releasing hormone (CRH),CRH receptor 1 (CRHR1) and IL-6 in the hippocampus of 8-week offspring rats were determined by real-time PCR and Western blot,respectively.Results Compared with normal neonatal rats,the serum CORT concentration of neonatal rats with preeclampsia was increased (P＜0.05).Compared with normal adolescent offspring,the levels of GR,CRH and CRHR1 mRNA and protein were increased in the hippocampus of adolescent rats with preeclampsia (P＜0.05),accompanied by increased IL-6 mRNA and protein (P＜0.05),as a downstream inflammatory gene of the GR.Conclusions We found that adolescent SD rats exposed to preeclampsia showed alteration in the expression of HPA related genes in the hippocampus,which played a role in the impairment of learning and memory in children.

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[Abstract ] Objective As an important metal element, iron is involved in a variety of life activities.This study was to inves-tigate the effect of iron deposition on the apoptosis of PC12 cells and the expression of glyceraldehyde de-3-phosphate dehydrogenase (GAPDH). Methods PC12 cells were incubated with FeCl3 at 50, 100, and 500 μmol/L for the establishment of an iron deposi-tion cell model.The proliferation of the PC12 cells was measured with the CCK-8 method, their apoptosis determined by TUNEL, the expressions of GAPDH mRNA and protein detected by quantitative real-time PCR and Western blot respectively, and the level of GAP-DH in the nuclei measured by immunofluorescence assay. Results Compared with the normal control group, the proliferation rate of the PC12 cells was decreased in the 50μmol/L FeCl3 group (100%vs [77.13 ±3.9]%, P>0.05) and significantly in the 100 and 500 μmol/L groups ([66.19 ±3.37]% and [13.84 ±0.43]%) (P0.05) and remarkably in the 100 and 500μmol/L groups (1.93 ±0.07 and 2.33 ±0.15) (P0.05) and markedly elevated in the 100 and 500 μmol/L groups ( 1.45 ±0.13 and 1.79 ±0.07 ) ( P<0.05) .After iron deposition, GAPDH transferred from the cytoplasm to the nuclei of the PC12 cells and nuclear accumulation was observed. Conclusion Iron deposition increases the apoptosis of PC12 cells, which may be related to the up-regulated expression of GAPDH in the nuclei.

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OBJECTIVE: To discuss a best predictive score index in predicting death in patients with severe trauma, death warning score, and to provide a simple score for clinical use. METHODS: The clinical data of 394 traumatic patients admitted to Department of Critical Care Medicine of Xi'nan Hospital of the Third Military Medical University, Daping Hospital of the Third Military Medical University, and Affiliated Hospital of Zunyi Medical College from January 2014 to December 2014 were retrospectively analyzed. The patients were divided into survival group (n = 330) and non-survival group (n = 64). The clinical data in two groups were recorded as following: gender, age; respiratory rate, heart rate, and systolic blood pressure at admission; the lowest values of serum creatinine (SCr), white blood cell count (WBC), platelet count (PLT), hematocrit (Hct), respectively, within 24 hours after admission; acute physiology and chronic health evaluation II (APACHE II) score, Glasgow coma scale (GCS) score, sequential organ failure assessment (SOFA), systemic inflammatory response syndrome (SIRS) score, injury severity score (ISS) within 24 hours of final diagnosis; the performance of emergency operation or intubation within 24 hours; incidence of sepsis, and clinical outcomes. Each observed indicator was analyzed by univariate analysis, and factors leading to death were further analyzed by logistic regression. Risk factors of severe trauma patients were sorted, from which the meaningful indicators were included to calculate the warning score of death. Receiver operating characteristic curve (ROC) was plotted to evaluate the predictive value of the warning score of death in severe trauma patients. RESULTS: Compared with the survival group, the age in non-survival group was older (years old: 51.50 ± 18.31 vs. 45.54 ± 14.70, t = -2.456, P = 0.016); SCr was increased (µmol/L: 94.18 ± 65.51 vs. 72.42 ± 28.22, t = -2.611, P = 0.011); APACHE II score (24.30 ± 6.23 vs. 16.38 ± 6.19, t = -9.353, P < 0.001) and SOFA score were higher (7.84 ± 3.68 vs. 4.43 ± 2.75, t = -7.049, P < 0.001); and the incidence of emergency intubation [79.7% (51/64) vs. 42.7% (141/330), χ² = 29.309, P < 0.001] and sepsis was also higher [48.4% (31/64) vs. 30.3% (100/330), χ² = 18.512, P < 0.001], but PLT count (X 109/L: 112.75 ± 59.85 vs. 144.12 ± 68.28, t = 3.428, P = 0.001) and GCS score (6.44 ± 4.20 vs. 11.02 ± 3.93, t = 8.449, P < 0.001) were significantly lower. There was no significant difference in gender, respiratory rate, heart rate, systolic blood pressure, WBC, Hct, SIRS score, ISS, or emergency operation between two groups. The indicators with statistically significant difference from the univariate analysis were further analyzed by multivariate logistic regression, and the indices included in the regression model were age ≥ 65 years [95% confidence interval (95%CI) = 0.176-1.974, P = 0.019], APACHE II score ≥ 21 (95% CI = 0.121-2.725, P = 0.032), GCS < 6 (95% CI = 0.201-3.221, P = 0.026), severe sepsis (95%CI = 0.421-2.735, P = 0.008) or septic shock (95%CI = 0.430-3.636, P = 0.013), with assigning scores of 1.0, 1.5, 1.5, 1.5, 2.0, respectively. Finally these five indicators were included into the warning score of death. It was shown by ROC curve analysis that the area under ROC curve (AUC) of warning score of death in predicting mortality in critically ill trauma patients was 0.867, which was significantly higher than that of the APACHE II score (AUC = 0.812, P = 0.022) and GCS score (AUC = 0.783, P = 0.001). When the cut-off value of warning score of death was 1.5, the sensitivity, specificity, positive predict value (+PV), negative predict value (-PV), positive likelihood ratio (+LR), negative likelihood ratio (-LR), and Youden index was 75.00%, 85.40%, 50.0%, 94.6%, 5.16, 0.29, and 0.605, respectively. CONCLUSIONS: Age ≥ 65 years, APACHE II score ≥ 21, GCS < 6, severe sepsis or septic shock were the risk factors of death in patients with severe trauma, and they can be considered as warning score of death in patients with severe trauma. With the score mortality can be better predicted than any other kind of score for patients with severe trauma.

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Heridas y Lesiones/diagnóstico , Heridas y Lesiones/mortalidad , APACHE , Creatinina/sangre , Cuidados Críticos , Enfermedad Crítica , Hematócrito , Humanos , Puntaje de Gravedad del Traumatismo , Recuento de Leucocitos , Modelos Logísticos , Recuento de Plaquetas , Curva ROC , Estudios Retrospectivos , Sensibilidad y Especificidad , Sepsis/diagnóstico , Choque Séptico/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico

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ObjectiveTo compare the predictive value of anatomic scoring system, physiological scoring system, and the combination of two systems in death prediction of patients with severe trauma in intensive care unit (ICU). Methods A retrospective analysis of patients with severe trauma admitted to department of critical care medicine of Daping Hospital, the Third Military Medical University, and Zunyi Medical University from January 2011 to December 2014 was conducted. The patients meeting the following criteria were enrolled: over 16 years old, admitted to hospital shorter than 24 hours after trauma, length of ICU stay≥48 hours, and injury severity score (ISS)≥16. Patients were divided into two groups: survivors and non-survivors. The data of anatomic scoring system, including ISS and new injury severity score (NISS), and physiological scoring system, including acute physiology and chronic health evaluationⅡ(APACHEⅡ) score were collected. The predictive power for death of the scoring system alone or combination in patients with severe trauma was evaluated.Results A total of 614 patients with severe trauma were enrolled, and there were 153 deaths with a mortality rate of 24.9%. ISS, NISS, APACHEⅡ, ISS+ APACHEⅡ, NISS+ APACHEⅡ of non-survivors were significantly higher than those of survivors (ISS: 29.15±7.75 vs. 24.31±6.50, NISS: 41.96±12.01 vs. 29.64±8.19, APACHEⅡ: 23.71±6.58 vs. 17.02±5.49, ISS+ APACHEⅡ: 52.86±10.00 vs. 41.33±8.70, NISS+ APACHEⅡ: 65.67±13.46 vs. 46.66±10.43, allP< 0.01). The area under receiver operating characteristic curve (AUC) of ISS, NISS, APACHEⅡ, ISS+ APACHEⅡ, NISS+ APACHEⅡ was 0.687, 0.792, 0.782, 0.809, and 0.860, respectively. Both of ISS+ APACHEⅡ and NISS+ APACHEⅡ had higher AUC than that of ISS, NISS or APACHEⅡ alone; and the AUC of NISS+ APACHEⅡ was significantly larger than that of ISS+ APACHEⅡ(allP< 0.05). NISS+ APACHEⅡ showed the largest AUC in death prediction of severe trauma patients. The cut-off value, sensitivity, specificity, positive predict value (+PV), negative predict value (-PV), positive likelihood ratio (+LR), negative likelihood ratio (-LR), and Youden index of NISS+ APACHEⅡ, which had the greatest AUC, were 56, 75.2%, 82.0%, 58.1%, 90.9%, 4.17, 0.30, and 0.572, respectively.Conclusion The combination of anatomic scoring system and physiological scoring system is better than single scoring system for death prediction in patients with severe trauma in ICU, and it may be considered to be a new method for early identification of death risk in patients with severe trauma.

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Objective To investigate the efficacy of CT guided radioactive 125I seed implantation on elderly patients with advanced malignancies.Methods 78 cases of elderly patients with malignant were collected and divided into two groups.41 cases of the treatment group were treated with CT guided radioactive 125I seed implantation.Particle activity was 29.6 MBq.The prescription dose was 90-110 Gy.37 cases of the control group were treated with optimized supportive care.Data from all of patients were to review and followup observation in short term efficacy,quality of life and side efforts.Results The total effective rate was 92.7 ％(38/41)and the disease control rate was 97.6 ％(40/41)in the treatment group.The control group was in the effective rate and 16.2 ％(16/37)in the disease control rate.The quality of life of the treatment group was higher than those in the control group(P＜0.05).And there is no obviously side efforts.Conclusion The treatment of elderly patients with advanced malignant tumors by 125I seed implantation was a safe and effective method.It can improve the quality of patients' life.

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OBJECTIVE To investigate and control the risk factors about nosocomial infection in cerebral hemorrhage patients.METHODS Totally 986 hospitalized patients with cerebral hemorrhage in our hospital from Jan 2002 to Dec 2005 were studied retrospectively.RESULTS It showed that the incidence of nosocomial infection rate was 32.05%,case infection rate was 44.62%.The nosocomial respiratory tract infection was the highest(66.36%),the second one was the urinary tract(20.68%).We also found that the risk factors prone to nosocomial infection were aging,long hospitalization,respiratory machine application,respiratory tract inicison,indwelling catheter and coma.CONCLUSIONS Nosocomial infection is still a high frequent complication in cerebral hemorrhage.It is suggested that there be urgent need for treating the underlying disease and reducing the risk factors,then can reduce the development of infection in patients with cerebral hemorrhage.

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Objective To investigate the effect and significance of batroxobin on the levels of neuron-specific enolase(NSE) and endothelin(ET) in plasm of patients with transient ischemic attacks(TIAs).Methods 120 cases of carotid territory TIAs(

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Objective To explore the relationship between the dynamic change of plasma tissue-type plasminogen activator(t-PA)and its inhibitor-1(PAI-1)levels and infarct size in patients with acute cerebral infarction.Methods There were 100 patients with acute cerebral infarction,22 cases of large area infarction,36 cases of small area infarction,42 cases of lacunar infarction.The levels of plasma t-PA or PAI-1 in 24 h,2 d,14 d,21 d after cerebral infarction were detected by chromogenic substrate method,compared with normal control and the level of blood plasma t-PA or PAI-1 in patients with different size of cerebral infarction.Results Compared with normal control,levels of plasma t-PA at 24 h,2 d,14 d after acute cerebral infarction decreased significantly,and plasma PAI-1 level increased significantly(all P0.05).The plasma t-PA level in patients with large size of infarction was lower obviously than that in patients with small area infarction and lacunar infarction,small size of infarction was lower than that in lacunar infarction(all P0.05).Conclusion The plasma t-PA level decreased and PAI level increased in patients with acute cerebral infarction.The the size of infarction area is larger,the plasma t-PA level is lower,but there is no relationship between the plasma PAI-1 level and infarction area.

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Objective To determine the dynamic changes of plasma endothelin (ET), calcitonin gene related peptide (CGRP) and atial natriuretic peptide (ANP) in elderly patients with acute cerebral infarction and explore the pathological role of ET, CGRP and ANP in the development of acute cerebral infarction.Methods The concentrations of ET, CGRP and ANP in plasma were determined with radioimmunoassay in 78 elderly patients with acute cerebral infarction and 60 normal controls.Results (1)The levels of ET and ANP in patient group were significantly higher than those in control group ( P3 cm) and small area infarct group (1.5～3.0 cm) were significantly higher (all P

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Object To investigate the effects of Heart-benefitting Recipe (HBR) on the histopathological changes of Alzheimer's disease (AD) rats after unilateral amyloid-?_ 25-35 protein (A?_ 25-35 ) injection into the amygdala. Methods The experimental rat models with dementia,spatial learning,and memory impairment were induced by unilateral amyloid ?_ 25-35 protein (A?_ 25-35 ) injection into the amygdala of rats. The spatial learning and memory ability and the function of cholinergic system were observed by the means of Morris water maze and radioligand binding assay. The protein expression of A?_ 1-40 ,AT_8 was estimated with immunohistochemistry. The expression of mRNA related to APP was observed by RT-PCR. Results HBR significantly alleviated the spatial learning and memory impairment induced by A?_ 25-35 and remarkably increased the activity of ChAT and Rt of M-receptor binding sites of these models. The expressions of A?_ 1-40 protein and APP mRNA in cortex and hippocampus of AD rats were decreased remarkably by HBR. The results of immunohistochemistry showed that the expression of hyperphosphorilated tau AT_ 8 in cortex and hippocampus of AD rats was inhibited significantly by HBR. Conclusion HBR can effectively improve the spatial learning and memory impairment,decrease the deposition of A?_ 1-40 ,and alleviate the hyperphos-phorylation of tau of AD rats induced by A?_ 25-35 .

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0.05).The scores of MMSE increased significantly(all P