OBJECTIVE:To analyze the medico-ethical problems of epilepsy from Medi-ethics and its effect on improving the quality of life of the persons with epilepsy.DATA SOURCES:Articles were computer-searched from Chinese Journal of Medico-ethics, Chinese Journal of Clinical Neurology, Chinese Medical Journal, Chinese Journal of NeuroMed, Chinese Journal of Nerval Mental Disorder from January 1989 to December 2004 with the key words of "epilepsy, medico-ethics and social discrimination". And the language was restricted to Chinese. And we also selected two books, which were Bioethics written by Shen Ming-xian, and The Prevention and Therapy of Epilepsy written by Zhou Zheng-xin for reference.STUDY SELECTION: From all the preliminarily screened papers, 98 papers were obtained related to epidemiology, sociology and ethics.DATA EXTRACTION: Repeated and similar papers were excluded. 10 papers and books were selected from the 98 papers, which touched upon the problems of the epileptics and their life quality. The 10 papers have involved many cross discipline subjects, such as Bioethics, Medico-ethics,and Socio-ethics, which provided more concern about the epileptics from multiple directions.DATA SYNTHESIS: Ethics indicate the principles and guidelines for relationships between people. The ethics explored here refer to normative ethics. Generally, the basic ethical principles are: respect, beneficialness,balance and justice. Since some epileptic patients lack in the knowledge of epilepsy and proper treatment and suffer from discrimination in the health care, more untreated and non-proper treatment, doctors and nursing persons should take the attitude of being beneficial to the patients. Medication for the epileptics, especially the female patients at the first period of pregnancy, the incidence of the deformed children was high. Should the principle of beneficence be applied to mothers or children? The number of the operative treatment was more and more in patients with epilepsy, while surgery itself is a risk behavior .If there is no better method to choose, and all the available choices have their advantage and disadvantages. Physicians can only choose the better one from the two kinds of harm, trying to make the patientssuffer the least harm with the largest effect. Aggressive behaviors can be observed during seizure or unconsciousness state. Controlling the moving range of the patients with epilepsy consciously is in accord with the general ethical behavior, on the contrary, confinement disobeys the morals and the curative effect is not good. The extreme behavior of the patients with epilepsy is suicide and occurred more in unemployed, unmarried and living alone, male, and patients with mental disorders in epilepsy. The direct reasons of suicide are unemployment, low social status, and little understanding and care from their communities, families and friends.The sensible ethical principle for epileptics is to treat the patients as normal people in the society.CONCLUSION: Epileptic crowd need care from the society, family and other factors. Proper considering ethical principle in treating the population is the humane solicitude and to help the patients regain health and improve the life quality.

Objective To investigate the effect and underlying mechanisms of ghrelin in a rat model of renal fibrosis. Methods Male Sprague-Dawley rats were divided into 4 groups , including sham operation +saline or brain gut peptide treatment group , model + saline or brain gut peptide treatment group. Unilateral ureteral obstruction (UUO) was established by left ureteral ligation. 7 days and 14 days after operation, the rats were sacrificed , while the kidney tissue of obstruction side was harvested for pathlogical changes through Masson coloration. Expression of α-smooth muscle actin (α-SMA), transforming growth factor beta1 (TGF-β1) and phosphorylated Smad3 (p-Smad3) in renal tissues were analyzed through immunohistochemistry. Expression of α-SMA and TGF-β1 mRNA was detected by real-time-PCR. Apoptosis kidneys cells were marked with TUNEL. Results Ghrelin inhibited renal fibrosis by reducing the production of collagen , restraining extracellular matrix (ECM) deposition and decreasing the expression of α-SMA. Meanwhile, ghrelin inhibited the accumulation of myofibroblasts by blocking the transforming growth factor-β1/Smad3 (TGF-β1/Smad3) signaling pathway. Moreover, ghrelin could attenuate renal tubular cell apoptosis induced by UUO injury. Conclusion Ghrelin can reduce renal fibrosis and renal cell apoptosis induced by UUO , demonstrating that ghrelin is a potent antifibrotic agent that may have therapeutic potential for patients with obstructive nephropathy.

Objective To study the effect and its possible mechanism of p66shc on endothelial dysfunction induced by hydrogen peroxide(H2O2).Methods Human umbilical vein endothelial cells (HUVEC) were used and cultured.H UVEC cells were untreated(control group)or treated with four groups of H2O2,H2O2 plus protein kinase C (PKC) inhibitors,H2O2 plus PKC activator,H2O2 plus P38 inhibitor for 30 minutes respectively,and cells were collected after 24 hours.The apoptosis,viability,proliferation of HUVEC were detected with immune fluorescent staining,MTT and Ki-67 respectively.P66shc and ser36 p66shc (p-p66shc)protein expressions were assessed using Western blotting.P66shc mRNA expression was measured with real-time quantitative polymerase chain reaction (RT-PCR).Results H2O2 induced HUVEC dysfunction which decreased HUVEC proliferation and increased the apoptosis of HUVEC.The expressions of p66shc,p-p66shc protein and p66shc mRNA were significantly increased after treating with H2O2.PKC inhibitor inhibited a H2O2 induced HUVEC dysfunction through increasing HUVEC proliferation activity and reducing cell apoptosis.The expressions of p66shc,p-p66shc protein and p66shc mRNA were significantly decreased after treating with H2O2 plus PKC inhibitor.PKC activator enhanced H2O2-induced HUVEC dysfunction and increased the expressions of p66shc.P38 inhibitor had no obvious effect on H2O2-induced HUVEC dysfunction and the expressions of p66shc.Conclusions p66shc may play an important regulatory rote in endothelial dysfunction caused by H2O2.P66shc may regulate a H2O2-induced endothelial dysfunction through PKC signal pathway.

Objective:To investigate perioperative management of anesthesia for septic shock.Methods:Anesthesia performed on an elderly patient with septic shock who underwent emergency surgery in Beijing Hospital was analyzed and summarized, with a literature review.Results:Etomidate, Ketamine, cis Atracurium and Remifentanil are preferred for anesthesia induction, and Remifentanil and Sevoflurane are the first choices for anesthesia maintenance.Combined application with Dexmedetomidine may improve patients' prognosis.For septic shock patients with new-onset atrial fibrillation, β-blockers are preferred for perioperative anti-arrhythmia.If necessary, propafenone or amiodarone can be used for cardioversion.Perioperative ultrasound evaluation may be used to guide perioperative fluid therapy and vasoactive drug administration for septic shock in the future.Conclusions:Anesthesiologists should place a high value on and have a good command of the main aspects of perioperative management of anesthesia for septic shock.

Objective To investigate the prevalence,characteristics and risk factors of fatigue in a large cohort of subjects with early Parkinson's disease (PD).Methods A total of 391 individuals with PD,recruited in Linzhi trial,were re-screened.Early,non-depressed subjects [Center for epidcmiological survey depression scale (CES-D)＜16]underwent further fatigue assessment.Subjects who scored＞4 on fatigue severity scale (FSS) were classified as fatigue.Motor symptoms and PD severity were assessed using the unified Parkinson's disease rating scale (UPDRS) and Hoehn-Yahr scale.Other clinical measures,including sleep disorder by Pittsburg sleep quality index (PSQ-Ⅰ),mental function by Alzheimer's Disease assessment scale-cognitive sections (ADAS-Cog) and quality of life by medical outcomes study short form 36 (SF- 36) were also evaluated.Results Among 204 subjects who completed fatigue measures,82 (40.2％) were classified as fatigue.The fatigue group had significantly more neurological impairment by higher scores on each subsets of UPDRS including mentation (P＜0.05),activities of daily living (P＜0.01) and motor (P＜0.01),while the subjects with fatigue had worse scores on SF-36 (P＜0.01).Multiple regression analyses showed that motor subset of UPDRS was the variable that had the predictive value for FSS score.The full model explained 6.4％ of the variance of the FSSscore (β=0.039,95％CI:0.019-0.059).However,other factors,including levodopa dosage,PSQ-Ⅰ,and ADAS-Cog score did not significantly contribute to the model.Conclusions Fatigue is a frequent symptom in carly,non-depressed patients with PD,affecting over 40％ of the patients in this cohort.The small correlation between fatigue and motor score,and the lack of association with dosage of dopaminergic treatment suggest that dopaminergic pathways might be only moderately involved in pathogenesis of fatigue.

Objective To study the effects of rehabilitation training on learning and memory ability and the expression of growth-associated protein-43(GAP-43)in rats with vascular dementia.Methods Forty-four female Sprague-Dawley rats were randomly assigned to a rehabilitation group(n=20),an immobilization group(n=20),and a sham-operation group(n=4).The rats in the former 2 groups were operated on to establish the experimental vascular dementia model by repeatedly ischemia/reperfusion injury of brain induced by ligation of bilateral common carotid arteries and lowering of blood pressure induced by intraabdominal injection of sodium nitroprusside.The rats in rehabilitation group were administered with rotating bar and rolling cage exercises for 1 hour once daily,while those in the immobilization group were immobilized and without any exercise:the rats in sham-operation group could move freely in cage.Learning and memory tests were preformed by using step-down avoidance test at the 27th and 28th days after operation.Immunohistochemical staining was used to detect GAP-43 expression in hippocampus CA1 area at different time points after operation. Results The rats in rehabilitation group demonstrated better learning and memory ability than those in immobilization group(P<0.01),and more GAP-43 expression in hippocampus CA1 ar-ea than those in immobilization group and sham-operation(P<0.01).Conclusion Rehabilitation training can im-prove the learning and memory ability of rats with experimental vascular dementia,and the mechanism is probably re-lated to the increase of GAP-43 in hippocampus CA1 area.

Objective To investigate the effect of rehabilitation training on learning and memory ability and the expression of neural cell adhesion molecule(NCAM)in rats modeling vascular dementia.Methods Foay-five female Sprague-Dawley rats were randomly assigned to a rehabilitation group(20 rats),an immobilization group(20 rats),or a sham-operation group(5 rats).The experimental vascular dementia model was established by repeatedly clipping the common carotid artery to induce repetitive isehemia-reperfusion,and by reducing blood pressure with intra-abdominal injection of sodium nitroprusside.The rats' learning and memory were tested on the 27th and 28th days after the operation using a water-maze step-down avoidance test.A RT-PCR technique was used to detect NCAM expression around the hippocampal area at different times after the operation.Results The rehabilitation group rats showed significantly better learning and memory ability than those in the immobilization group.NCAM was also more strongly expressed in their hippocampi than in those of the immobilization group and sham-operation group.Conclusion Rehabilitation can accelerate recovery of learning and memory ability in rats,and the mechanism possibly is related to the increase of NCAM expression in the hippocampus.

Objective To investigate the characteristics of health related quality of life(HR-QOL) in Chinese patients with early Parkinson' s disease(PD), to identify the motor and non-motor factors that are associated with a poorer quality of life in patients with early PD. Methods All 391 patients with early PD were identified in a clinical-based study. Motor functions were measured by Unified Parkinson' s Disease Rating Scale (UPDRS) and Hoehn-Yabr Scale. Non-motor variables were assessed by Center of Epidemiological Survey Depression Scale (CES-D) for depressive symptoms, Pittsburg Sleep Quality Index (PSQI) for sleep disturbance, Fatigue Severity Scale (FSS) for fatigue, Alzheimer' s Disease Assessment Scale-Cognitive Sections (ADAS-Cng) for cognitive function, and Constipation Severity Scale for constipation. HR-QOL was measured by SF-36. Motor and non-motor variables were collected at the baseline assessment of a clinical trial and determined during a structured interview and by clinical examination by movement disorder specialists. The results were compared with those in healthy elderly people. Multiple regression analyses were used to determine which variables were strongly associated with lower levels of quality of life. Results Patients with early PD had a lower score on all dimensions of SF-36, except bodily pain dimension. Motor factors, particular physical disability and disease severity, contributed to decreased HR-QOL, but to a lesser extent. The motor score of the UPDRS (23. 8±11.8), Hoehn-Yahr stage(2. 0± 0.7), together with the rigidity score (4.4 ± 3.1), only accounted for 18.9 % (R2=0. 189) of the variance of SF-36 total score. The variables that most strongly predicted a low total SF-36 score were non-motor factors, particularly depressive symptoms, sleep disorders and fatigue. When the CES-D, FSS, and PSQI score were included in the model, the R2 increased from 0. 189 to 0.617, indicating that 61.7% of the variance in HR-QOL could be explained if additional CES-D, FSS and PSQI scores were known. Depressive symptoms, as measured by CES-D, had an overwhelming impact on HR-QOL. When CES-D score was included, the R2 change was 0.433, which indicated that additional 43.3% of the variability in HR-QOL could be explained by adding depressive symptoms. Conclusions PD has a substantial impact on HR-QOL, even if in its early stage. Depressive symptoms, sleep disorders and fatigue correlated strongly with lower quality of life. Depressive symptoms appeared to be the strongest determinant of HR-QOL in early PD patients. Every effort should be made to recognize and treat these conditions, thus improving all aspects of PD and giving these patients as good a quality of life as possible.

Objective: To explore the impact of ticagrelor on myocardial microcirculation in patients of non-ST elevation myocardial infarction (NSTEMI) after percutaneous coronary intervention (PCI). Methods: A total of 80 NSTEMI patients treated in our hospital from 2015-03 to 2015-12 were enrolled. All patients received coronary angiography (CAG) and PCI, they were randomly divided into 2 groups: ticagrelor (TA) group and clopidogrel (CA) group, n=40 in each group. The baseline condition, PCI related parameters, plasma levels of SOD, MDA at pre- and 24h, 72h post-PCI were compared, the incidence of major adverse cardiac events (MACE) within 30 days after PCI was also compared between 2 groups. Results: The baseline condition, proportion of infarction-related vessels, average length and diameter of implanted stents were similar between 2 groups, all P>0.05. Compared with CA group, TA group had the less post-operative CTFC in LAD and RCA, P<0.05; while CTFC in LCX was similar between 2 groups, P>0.05. The ratios of acute pre-operative, post-operative TIMI grade 3 and slow flow incidence were similar between 2 groups, P>0.05. The peak values of CK-MB and cTnI in TA group were lower than CA group, P<0.05. Compared with baseline condition, MDA levels at 24h and 72h post-operation were increased in both groups, all P<0.001; compared with CA group, TA group had the lower MDA level at 24h post-operation, P=0.023, MAD was further reduced at 72h post-operation in TA group, P=0.043. Compared with baseline condition, SOD levels at 24h and 72h post-operation were decreased in both groups, all P<0.001; compared with CA group, TA group had the higher SOD level at 24h post-operation, P=0.013, SOD was elevated at 72h post-operation in both groups, the elevation was more obvious in TA group, P=0.049. The incidence of MACE was similar between 2 groups within 30 days of PCI,. Conclusion: Ticagrelor could improve myocardial microcirculation in NSTEMI patients after PCI; it was safe and without obvious adverse effects.

Objective To explore the relationship between serum uric acid and fasting blood glucose ( FBG) in newly-diagnosed type 2 diabetes in regard to different genders. Methods In 282 patients of newly diagnosed type 2 diabetes(208 males and 74 females), detection of serum FBG, uric acid, creatinine, transaminases, blood lipids, etc were determined. FBG<7. 0 mmol/L was found in 118 cases (89 males and 29 females);7. 0 mmol/L≤FBG≤9. 0 mmol/L in 114 cases ( 88 males and 26 females ); FBG>9. 0 mmol/L in 50 cases ( 31 males and 19 females). Results (1)Serum uric acid showed statistically significant difference in regard to sex[Male:(325. 82±92. 26)μmol/L, Female:(292. 26±76. 19)μmol/L, P<0. 01]. (2) FBG and serum uric acid were negatively related(r=-0. 316, P<0. 01). (3) FBG and serum uric acid were negatively related both in male(r=-0. 320, P<0.01)andinfemale(r=-0.291,P<0.05). (4)Multiplestepwiseregressionanalysisshowedthatthethreegroups of FBG and serum uric acid showed regression relationship in male and female patients(P<0. 01). Conclusion With the increased FBG, serum uric acid was decreased in both males and females. Therefore, serum uric acid might serve as a potential biomarker of glucose metabolism.