Objective Toinvestigatetheeffectoffolicacidonplasmahomocysteine(Hcy)levels and vascular endothelial function in elderly cerebral infarction patients with hyperhomocysteinemia. Methods Thisstudywasaprospectivecontrolledtrial.Atotalof112elderlylacunarinfarction patients with high hyperhomocysteinemia admitted to the Department of Neurology,Nanjing Municipal Government Hospital from November 2012 to October 2013 were enrolled. The patients were divided into two groups according to the method of random number table. The patients of both groups received the conventional drug treatment of ischemic stroke at the same time. Fifty-six patients were in group A,and they were treated with folic acid 20 mg,once a day;56 patients were in group B,and they did not treat with folic acid. The Hcy levels on admission and after 24 weeks treatment were measured. Brachial artery flow-mediated endothelium-dependent dilation (FMD)was measured by high resolution ultrasound,and nitric oxide (NO), nitricoxidesynthase(NOS),andendothelin(ET)weredetectedatthesametime.Results Twenty-four weeks after treatment,the plasma Hcy level in group A was significantly decreased as compared with prior treatment (12. 2 ± 4. 2 vs. 22. 6 ± 3. 7μmol/L;P<0. 05),moreover,it was lower than the level of group B at the same period (12. 2 ± 4. 2 vs. 21. 8 ± 4. 0μmol/L;P <0. 05 ). The FMD level of group A was significantly higher than that of prior treatment and group B (11. 2 ± 3. 6 vs. 9. 2 ± 3. 3,9. 3 ± 3. 3;P<0. 05). The NO and NOS levels of group A at 24 weeks after treatment were significantly higher than those of prior treatment and group B at the same period (76. 2 ± 9. 4 vs. 49. 2 ± 9. 0,50. 0 ± 9. 1μmol/L,47. 6 ± 9. 5 vs.38. 4 ± 7. 5,37. 8 ± 8. 8 kU/L;P<0.05). The ET level of group A was decreased as compared with that of prior treatment and group B at the same period (81. 3 ± 20. 5 vs. 105. 6 ± 25. 2,105. 3 ± 21. 8 ng/L;P<0.05).NoadversereactionwasfoundduringthetreatmentingroupA.Conclusion Alargerdoseof folic acid can significantly reduce the plasma Hcy level,decrease the FMD level,and ameliorate vascular endothelial function in elderly cerebral infarction patients with hyperhomocysteinemia.

Recently more and more ophthalmologists selected a multifocal intraocular lens (IOL) for their cataract patient in order to get good unaided reading vision. Although the design of IOL have made a great progress, we are still dissatisfied compared with our natural crystal lens. Understanding the design theory and improving our surgery technique are basic for better utilization the multifocal IOL. Does the multifocal IOL reduce contrast sensitivity? Should we implant the multifocal IOL in pediatric cataract surgery? How can we deal with the residual refractive error after multifocal IOL implantation? In this editorial, we try to clarify these problems to make us select and use multifocal IOL better.

Objective:To observe the efficacy and safety of Qingpeng ointment in the prevention and treatment of chemotherapeutic phlebitis. Methods:Totally 72 patients with non-small cell lung cancer undergoing chemotherapy after pneumonectomy were randomly divided into control and observation groups. The control group was treated with the conventional therapy to prevent phlebitis, and on the basis of conrentional therapy the observation group was treated with Qingpeng ointment at the injection site and along with the vein be-fore the chemotherapy, at the beginning of the chemotherapy, during the chemotherapy and after the chemotherapy in the same day and on the next day. The treatment course was 3 days. The incidence of phlebitis, hierarchical cases, VAS score and pain duration between the groups were compared, and the adverse drug reactions were observed. Results:The pain degree and duration induced by phlebitis showed no significant differences between the groups(P>0. 05), while the pain degree and duration in the observation group were de-creased when compared with those in the control group. The incidence of phlebitis in the observation group was obviously lower than that in the control group with statistically significant difference (P <0. 05). No adverse reactions were found with the external use of Qingpeng ointment. Conclusion:Qingpeng ointment has certain efficacy with high safety in the prevention of tumor-chemotherapeutic phlebitis, which can improve patients’ compliance, and is worthy of promoted application in clinics.

Objective Studying information disclosure at China' s public hospitals and recommending on information disclosure policies.Methods Collecting and analyzing the websites of 80 public hospitals in five main Chinese cities (Beijing,Shanghai,etc.).Results Information disclosure by these hospitals is found to be identical,with a slight difference in information publicity.By percentage,the information disclosure of hospital profile,department navigation,specialists characteristics,hospital news,health education,and doctor-seeking guidance,is 100.0％,98.3％,95.0％,93.3％,90.0％and 88.3％respectively.The disclosure is found to be lack of general planning,objectivity,timeliness and sufficiency.ConclusionEstablishing the information disclosure system based on mandatory information disclosure,stipulating the content,approach and timing for public hospitals information disclosure.

Abstract Frailty is a clinical state characterized by increased vulnerability due to the decline of multiple organ functions. It is clinically manifested as slow movement, reduced activity, low energy level and involuntary weight loss. Frailty heightens the risk of disability, long-term hospitalization and mortality in the elderly when they face stressful events. Early assessment of frailty and personalized interventions can prevent and delay its progression, thereby reducing the occurrence of adverse events. This article reviews the literature on frailty published both domestically and internationally from January 2015 to January 2024. It provides an overview of the tools for assessing frailty in the elderly, such as the Clinical Frailty Scale, Frailty Index, Fried Frailty Phenotype, FRAIL Scale, and biological markers, and the management of frailty, including exercise, nutritional interventions, oral health management, and medication management, so as to provide the evidence for early assessment and intervention of frailty.

Objective To study the quantification of MDR1 and WT1 gene expression in patients with de novo acute myeloid leukemia(AML)and to explore the role of these two genes in clinical drug resistance and their correlation with risk stratification. Methods A real time quantitative reverse transcriptase polymerase chain reaction method was established for detecting MDR1 and WT1 gene expression levels in 63 de novo AML patients.Resuits The expression of WT1 and MDR1 was significantly higher in de novo AML patients than in normal controls (P＜0.001).WT1 levels were significantly correlated with corresponding levels of MDR1 gene in de novo AML patients(P=0.004).Expression levels of WT1 and MDR1 gene were not associated with FAB subtype and risk stratication(P＞0.05).AML patients with FLT3-ITD mutations had a significantly higher WT1 expression level as compared to with those without(P＜0.05),on the contrary MDR1 expression was not associated with FLT3-ITD mutations(P＞0.05).Patients with co-expression of high levels of WT1 and MDR1 had a significantly lower complete remission rate after induction therapy than those with low levels(P＜0.05).Conclusion There is a positive correlation between MDR1 gene expression and WT1 gene expression in AML.Quantification of the two gene expression together is more effective for judgement of prognosis in AML.

Objective To evaluate the usefulness of real-time three-dimensional transesophageal echocardiography(RT-3D-TEE)in cardiac valvular diseases.Methods Preoperative and postoperative RT-3D-TEE studies were performed in 32 patients who had undertaken cardiac valve repair or valvular replacement using Philips iE33 with X7-2 probe,and quantitative analysed the mitral structure in cases of mitral valve prolapse by using online QLAB7.0 quantitative analysis software.Results RT-3D-TEE can demonstrate the anatomicsl structure clearly,evaluate the function of cardiac valves precisely,and reveal details of type,position and extent of lesions vividly in surgical view.RT-3D-TEE helped correct misdiagnose in 2 cases,revised surgical plans in 3 cases,and guided implementation of remedial surgery in 1 case.Conclusions RT-3D-TEE can present images lively,and it can provide adequate information for preoperative diagnosis,aid the formulation of surgical plan and evaluate surgical effect.

Objective To set up a multiplex real time quantitative PCR method to detect the expression of WT1 and MDR1 gene simultaneously in acute leukemia patient. Methods Total RNA was extracted from k562 cell line and was reverse transcribed to cDNA by the outer primers of WT1 and MDR1 respectively. The cDNA of WT1 and MDR1 were purified and digested by Bam H Ⅰ and Bgl Ⅱ , and then the two fragments were ligated to form the recombinant fragment WT1 + MDR1. The outer forward primer of WT1 and outer reverse primer of MDR1 were used to amplify the recombinant fragment WT1 + MDR1. The PCR product was purified and cloned into pMD18-T vector, and then transferred into E. coli DH-5α. A new kind of WT1-MDRl-contained standard plasmid was obtained from the positive colony. The recombinant plasmid was verified by digestion with restriction enzyme and PCR amplification. A multiplex real time quantitative PCR method was set up with FAM-labeled MDR1 probe and VIC-labeled WT1 probe in one reaction tube. The WT1 and MDR1 gene expression was detected in forty-seven AL patients and thirty-two controls by this method. Seven patients were followed-up to elucidate the relationship between the gene expression levels and clinical prognosis. Results The recombinant plasmid was confirmed by EcoR1 digestion and PCR amplification. The multiplex real time quantitative PCR technique could reach the sensitivity of WT1 and MDR1 gene up to 102 copy/μl. The standard curve slopes were 0. 999 and 0. 998. The WT1 [ 37 000( 163-6 370 000 )copies/μg RNA ] and MDR1 [ 76 200( 179-18 000 000 )copies/μg RNA ]expression levels of AL patients were significantly higher as compared to the controls [ 258( 0-643 ) copies/μg RNA and 333( 0-779 )copies/μg RNA ]( Z= 6. 755,6. 736, P ＜ 0. 01 ). Following up seven patients with similar regimen of chemotherapy, the WT1 and MDR1 expression correlated to the clinical course. Three AL patients with WT1 and MDR1 expression levels (2 170 and 86 900, 1 130 and 5 860, 1 170 and 586 copies/μg RNA )significantly decreased after chemotherapy and kept in the low range ( 370 and 560,138 and 980, 150 and 690 copies/μg RNA ), and had a favorable outcome. Three AL patients with WT1 and MDR1 expression levels ( 1 600 and 11 800, 24 800 and 968, 48 200 and 1 100 000 copies/μg RNA )decreased after initial chemotherapy, but increased significantly afterwards (20 314 and 25 660,184 364 and 31 530, 15 680 and 878 000 copies/μg RNA ),and suffered clinical relapse. One patient with high WT1 and MDR1 expression levels ( from 81 600 and 1 200 000 copies/μg RNA to 124 100 and 7 632 400 copies/μg RNA )showed the persistence of disease. Conclusions A multiplex real time quantitative PCR method to detect WT1 and MDR1 gene simultaneously is constructed successfully. The expression of WT1 and MDR1 may provide useful information for AL patients prognosis.

Objective To compare the clinical curative effect and the pros and cons of microwave intracavitary minimally invasive treatment and traditional operation for varicose veins in lower extremities.Methods(Treatment) group:The varicosities of greater saphenous vein were treated by microwave coagulation intracavitary treatment together with injection coagulation treatment of its tributaries. Control group:The varicosities of(greater) saphenous vein were treated by traditional operation.Results Treatment group was better than control group in improvement of symptoms,cosmetic effect of diseased limb,operation time,amount of blood loss,length of hospital stay,and complications of operation.Conclusions Microwave coagulation intracavitary treatment of varicose veins in lower extremities has more advantages,such as minimally invasive,little pain,quick recovery,good cosmetic effect,better result,fewer complications,and simplicity of operation.

OBJECTIVETo compare the difference in depression relief in the treatment of depressive disorder at the acute stage between the combined therapy of acupuncture and 5-HT (5-hydroxytryptamine) selective serotonini reuptake inhibitors (SSRIs) and the single application of SSRIs and explore the impact on the imbalance of 5-HT and TH1/TH2.

METHODSNinety cases of depressive disorder at the acute stage were randomized into a combined therapy group and a medication group, 45 cases in each one. In the medication group, SSRIs were prescribed forl oral administration, once or twice a day, continuously for 4 weeks. In the combined therapy group, on the basis of treatment as the medication group, acupuncture was combined. The main acupoints were Baihui (GV 20), Yintang (GV 29), Shenting (GV 24), Fengchi (GB 20), Dazhui (GV 14) and Sishencong (EX-HN 1), once every two. days, continuously for 4 weeks. Before treatment, and after the 1st, 2nd and 4th weeks of treatment, the Hamilton depression scale (HAMD) was used to evaluate the depression severity. Separately, before and after the 4 weeks of treatment, the levels of serum 5-HT, interleukin-1 beta (IL-1β), interleukin-6 (IL-6), interleukin-4 (IL-4) and interleukin-10 (IL-10) were determined and compared with those in 45 cases of the healthy group.

RESULTSHAMD score was reduced in the 1st, 2nd and 4th weeks of treatment as compared with that before treatment in the combined therapy group (all P<0 01). HAMD score was reduced in the 2nd and 4th weeks of treatment as compared with that before treatment in the medication group (all P<0. 01). HAMD scores in the combined therapy group were lower than those in the medication group in the 1st, 2nd and 4th weeks of treatment (all P< 0. 01). Before treatment, in the combined therapy group and the medication group, the levels of serum 5-HT, IL-4 and IL-10 were all lower than those in the healthy group (all P<0. 01); the levels of IL-1β and IL-6 were higher than those in the healthy group (all P<0. 01). In the combined therapy group and the medication group, the levels of 5-HT, IL-4 and IL-10 in 4 weeks of treatment were all increased as compared with those before treatment (all P<0. 01), and the levels of IL-1β and IL-6 were lower than those before treatment (all P<0. 01). In the combined therapy group, the levels of IL-1β and IL-6 in 4 weeks of treatment were lower than those in the medication group, and the levels of 5-HT, IL-4 and IL-10 were higher than those in the medication group (P<0. 01, P< 0. 05).

CONCLUSIONThe combined therapy of acupuncture and SSRIs achieves much quicker and more effective re-' sult for relieving depression in the patients of depressive disorder as compared with simple oral administration of' SSRIs, and much more contributes to adjust the imbalance of serum 5-HT and TH1/TH2.

Acupuncture Points ; Acupuncture Therapy ; Adolescent ; Adult ; Antidepressive Agents ; administration & dosage ; Combined Modality Therapy ; Depressive Disorder ; blood ; drug therapy ; therapy ; Female ; Humans ; Interleukin-10 ; blood ; Interleukin-1beta ; blood ; Interleukin-4 ; blood ; Interleukin-6 ; blood ; Male ; Middle Aged ; Serotonin ; blood ; Th1 Cells ; metabolism ; Th2 Cells ; metabolism ; Young Adult