Objective To investigate the effect of acupuncture plus astragalus polysaccharide on the expression of Bcl-2 protein in pancreatic islet b cells in db/db mice. Method C57BL/Ksj-db/db mice as an animal model of spontaneous type 2 diabetes were selected for this experiment. Five-week-old db/db mice were randomized into model, acupuncture, medication and acupuncture+medication groups. Meanwhile, db/m mice were selected as a normal group. The acupuncture group received acupuncture at points Housanli (equivalent to Zusanli, ST36), Neiting(ST44) and Yishu(Extra) and the medication group, an oral gavage of astragalus polysaccharide (1400 mg/kg). Both groups were treated once daily, for 12 consecutive weeks. After the end of experiment, blood glucose, insulin and resistin were measured, and the expression of Bcl-2 protein in islet b cells was determined by immunohistochemical method. Result Blood glucose, insulin and resistin levels were significantly lower in the acupuncture+medication, acupuncture and medication groups than in the model group. They were significantly lower in the acupuncture+medication group than in the acupuncture and medication groups and significantly lower in the acupuncture group than in the medication group. The expression of Bcl-2 protein in islet b cells was higher in the medication, acupuncture and acupuncture+medication groups than in the model group; there was a statistically significant difference (P<0.01). The expression of Bcl-2 protein was higher in the acupuncture+medication groups than in the medication group (P<0.01) and it was basically the same in the medication group as in the acupuncture group; there was no statistically significant difference (P>0.05). Conclusion Acupuncture plus astragalus polysaccharide can significantly reduce blood glucose and serum insulin and resistin levels and increase the expression of Bcl-2 protein in islet b cells to effectively inhibit apoptosis in islet b cells in db/db mice. Its effect is better than that of acupuncture alone or medication.

Objective: To investigate the potential role and our experience of perioperative nutritional support in the management of patients with Crohn's disease (CD).Methods: 150 CD patients (male to female=101:49) performed with operation and from the year 1997 to 2007 were analyzed retrospectively. Their nutritional index, Crohn's Disease Activity Index (CDAI), sites of lesion, causes and procedures of operation, usage of nutritional support pre-operatively and post-operatively, and operation-related complications were all recorded.Results: Malnutrition, as indicated as BMI<18.5 kg/m2 or decrease of body weight>10% over the recent 3 months,occurred in 130 patients (88.67%)on admission.After aggressive nutritional support,patients' nutritional index, such as blood haemoglobin, serum albumin, pre-albumin, transferrin and lymphocytes counts all increased significantly pre-operatively and on discharge compared with on admission, while the change of BMI was not significant. For 53 patients receiving home enteral nutrition after discharge, their BMI increased significantly on last follow-up compared with on admission (19.24 vs 17.64, P<0.001). Operation-related complications occurred in 14 patients (9.33%), and two of them died due to severe intra-abdominal infections. Two patients with severe retroperitoneal infection on admission were successfully treated using the damage-control surgery.Conclusion: Malnutrition is a common complication in CD patients receiving surgery, and aggressive perioperative nutritional support may have a positive effect on the morbidity and mortality in such patients. Long-term maintenance therapy with enteral nutrition may delay the postoperative recurrence of the Crohn's disease and should be considered. For critically ill CD, damage-control surgery may get a better outcome than conventional treatment procedures.

Objective To evaluate analgesic effect of dexmedetomidine (DEX) combined with ropivacaine in single sciatic nerve block after total knee arthroplasty (TKA) with continuous femoral never block.Meth ods One hundred and twenty patients,ASA physical status Ⅰ ～ Ⅱ,who underwent unilateral TKA were randomly allocated into two groups:group D (DEX with ropivacaine);group R (ropivacaine only).Both groups experienced spinal-epidural anesthesia.Continuous femoral nerve block was performed after operation.Rest and movement visual analogue score (VAS),Ramsay sedation scores were recorded.In addition to the date of the analgesia drug dose,the pressed times of PCA,the mobility of knee joint and the force of quadriceps femoris were obtained at different points of time.Results Rest Pain scores (RVAS) of the group D were lower at time point 8,12,24,36,48 h and Ramsay sedation scores were higher at time point 4,8,12 h than that in the group R (P ＜ 0.05).The analgesia drug dose and the pressed times of PCA reduced in the group D.The range of motion (ROM) was better in the group D at 1 d,2 d after operation (P ＜ 0.05).There was no significant difference in the force of quadriceps femoris in both groups.Conclusion Dexmedetomidine combined with ropivacaine in single sciatic nerve block after TKA provided better analgesia when continuous femoral nerve block was performed.Meanwhile,analgesia lasted longer and did not increase the motor nerve blockade.

Objective To evaluate the efficacy of transfrontal neuroendoscopic surgery in the treatment of chronic subdural hematoma.Methods Analysis of clinical data of 80 cases of chronic subdural hematoma.According to the surgical method,40 cases were divided into traditional external drainage of parietaltuber,40 cases were divided into transfrontal neuroendoscopic small bone window hematoma removal.The treatment efficiency,hematoma recurrence rate,operation time and intraoperative blood loss were compared between the two groups.Results Treatment efficiency of neuroendoscopic group was 95.0%,significantly higher than drainage group 75.0%,hematoma recurrence rate one month after surgery of neuroendoscopic group was 5.0%,significantly lower than that in drainage group 25.0%,operation time of neuroendoscopic group was(54.1±7.5)min,longer than that of drainage group(40.7±9.4)min,the differences were statistically significant(P<0.05).The intraoperative blood loss of neuroendoscopic group was(30.1±4.5)mL,compared with(27.1±6.4)mL in the drainage group,the difference was not statistically significant(P>0.05).Conclusion Transfrontal neuroendoscopic surgery can significantly improve the efficacy of chronic subdural hematoma,and hematoma recurrence rate is extremely low.It is worthy of clinical application.