Objective To explore the effect of donepezil combined with memantine in ameliorating the cogni-tive function and psychological behavior of patients with Alzheimers'disease(AD).Methods 214 AD patients were randomly divided into the control groupand observation group.The control group were treated with memantine,and the observation group were treated donepezil combined with memantine.Before and after treatment,MMSE and WHO -UCLA AVLT,BEHAVE -AD were utilized to assess the cognitive function,psychological behavior,respectively.The adverse effects were observed using TESS and laboratory examination.Results The scores of MMSE and its subitem, WHO -UCLA AVLT(Immediate memory,short -term memory and long -term memory)after treatment significantly increased as compared with those before treatment in the control group and the observation group(P <0.01 or P <0.05),while the cases of psychological behavior,the score of BEHAVE -AD and its subitem decreased(P <0.01 or P <0.05).The observation group showed statistically significant difference in the increasion of the scores of MMSE and its subitem,WHO -UCLA AVLT,and the decreasion of the cases of psychological behavior,the score of BE-HAVE -AD and its subitem comparison with the control group(t =-1.742,-1.431,-1.626,-2.173,-1.448,-1.026,-1.016,-1.279,-1.971,χ2 =12.295,7.609,8.917,t =0.778,1.139,2.004,1.153,0.822,1.944, P <0.01 or P <0.05).The total effective rate of the observation group was 90.65%,and 71.96% of the control group,there was a significant difference between the two groups(χ2 =12.299,P <0.01).There was no obvious side effects during the treatment in both groups.Conclusion Donepezil combined with memantine can significantly improve the cognitive function and psychological behavior of AD patients,and there are fewer adverse events.

Objective To compare the serum microelement changes between patients aged ≥80years and adults aged ＜ 60 years,and to compare the levels of serum microelement,total protein,albumin,hemoglobin between the long term in-bed and non in-bed oldest patients.Methods Beijing Bohui BH5100 type atomic absorption spectrometer was used to determine serum microelement.Total protein,albumin,hemoglobin were also determined.Results The amounts of ferrum,zinc,calcium,copper,magnesium were (7.21 ± 1.21) mmol/L,(93.29 ± 10.96)mmol/L,(1.63 ± 0.21)mmol/L,(17.31±3.61)mmol/L,(1.49±0.20)mmol/L in people aged over 80 years,(8.91±1.25)mmol/L,(121.85±11.24)mmol/L,(1.51±0.23)mmol/L,(15.89±3.87)mmol/L,(1.51±0.21)mmol/L in people aged less than 60 years,respectively.The ratios of Ferrum deficiency were 42.9 ％,zinc deficiency 14.3％,calcium deficiency 21.4％,copper deficiency 14.3％ in oldest-old,whereas were 9.1％,13.6 ％,31.8％,27.3％ in people aged less than 60 years.The amount of ferrum was significantly lower in people aged over 80 years than in people aged less than 60 years (P＜0.01).Proportion of ferrum deficiency was higher in patients aged over 80 years (P＜0.01).The amount of calcium and copper was markedly lower in people aged less than 60 years than in people aged over 80 years (P＜0.01).The proportions of calcium,copper deficiency were higher in people aged less than 60 years (P＜0.01).The amounts of ferrum,zinc,total protein,albumin,hemoglobin of the patients aged over 80 years in long-term in-bed group were significant decreased as compared with those of people in non long-term in-bed group [(6.44±0.89)mmol/L vs.(8.16±1.16)mmol/L,(84.48±8.98)mmol/L vs.(103.62±10.31)mmol/L,(62.8±3.9)g/L vs.(66.3±1.7)g/L,(33.7±2.6)g/L vs.(36.7±l.8)g/L,(109.0±12.5)g/L vs.(132.0±5.2)g/L,all P＜0.01].The amount of calcium of people in none long-term group was much lower [(1.57±0.23)mmol/L vs.(1.71±0.19)mmol/L,P＜0.01].Ferrum,zinc,calcium and copper deficiencies were 60.9％,18.8％,13.0％,13.0％ in long-term in-bed group,21.1％,8.8％,31.6％,15.8％ in non long-term in-bed group.Proportion of ferrum deficiency was higher in long term in-bed group than non long-term in-bed group (P＜0.01).Proportion of calcium deficiency was higher in non long-term in-bed group than long-term in bed group (P＜0.01).There was no significant difference in the amount of copper between people in long term in bed group and non long-term in-bed group (P＞0.05).There was no absence of magnesium in both two groups.Conclusions There is more absence of ferrum,zinc,total protein,albumin,hemoglobin in the patients aged 80 years and over in long-term in-bed.There is more calcium and copper absence of people aged less than 60 years.So it is necessary to supply high ferrum food and nutrients in order to get well sooner,especially to patients aged over 80 years.

The rates of chronic obstructive pulmonary disease ( COPD) and lung cancer morbidity in Xuanwei city of Yunnan province are among the highest nationwide , and COPD is an major risk factor for lung cancer .The concur-rence of COPD and lung cancer is a common disease .There are common causative environmental risk factors and pathogenic processes between the two diseases , which provides new ideas for the research , prevention and treatment of both diseases .Additionally the discussion of the relationship between COPD and lung cancer can provide refer -ences for further studies of both diseases .

BACKGROUND:There is a close relationship between epilepsy and apoptosis. The appearance of epilepsy can lead to the loss of neurons in the hippocampus, triggering a series of programmed cel death. OBJECTIVE:To investigate the effect of bone marrow stromal stem cel transplantation on apoptosis in epilepsy. METHODS:After modeled to be of epilepsy 45, Sprague-Dawley model rats were randomly divided into three groups, fol owed by given no intervention (moldel group), normal saline (normal saline group) or bone marrow stromal stem cel transplantation (transplantation group). At 1, 2 and 4 weeks after modeling, the number of Bax-positive cel s, Bcl-2-positive cel s and Bax/Bcl-2 were detected by immunohistochemistry. RESULTS AND CONCLUSION:The number of Bax-positive cel s, Bcl-2-positive cel s and Bax/Bcl-2 presented no obvious changes in the normal saline group at different time points. However, the number of Bax-positive cel s and Bax/Bcl-2 in the transplantation group was significantly decreased, while the number of Bcl-2-positive cel s significantly increased compared with the other two groups at 1, 2 and 4 weeks after modeling (P<0.05). Moreover, the above indicators varied significantly in the transplantation group at different time points after modeling (P<0.05). These results show that bone marrow stromal stem cel transplantation can affect the apoptosis and effectively reduce the apoptosis in rats with epilepsy by up-regulating the number of Bax-positive cel s and down-regulating the number of Bcl-2-positive cel s.

Objective To discuss the reason of skin flap necrosis caused by vascular crisis of reverse island flap of forearm posterior interosseous artery.Methods Eight-six patients who were underwent reverse island flap of forearm interosseous posterior artery for deep tissues and skin defect on the back of hand between March,2002 and April,2014 were analyzed in this study.Eleven patients had occurred skin flap necrosis,include 5 cases had completely flap necrosis caused by circulation crisis,and 6 cases had partial necrosis at the distal of the flap.Among the necrosis cases,5 cases were injured by the machine injury,4 cases by the heavy crush and 2 cases by the traffic accident.The cause of circulation crisis was analyzed.Results In the series,75 skin flaps survived completely and 11 cases had occurred necrosis,included completely necrosis with 5 cases.The reasons of flap crisis were as follows:for the completely necrosis,2 cases with variation of perforating branch of posterior interosseous artery,1 case with absence of posterior interosseous artery,1 case with vessel pedicel entrapment in subcutaneous tunnel,and 1 case with misconduct venous congestion caused by the reverse perfusion of superficial vein.The reason of circulation crisis of completely necrosis were as follows:2 cases with artery crisis and 3 of them with distortion of entrapment at pedicel and vein crisis.One case was cured through debridement,change of medical prescription and skin grafting;and 4 cases were cured with other flap repair technique.For the partial necrosis,2 cases with variation of perforating branch of posterior interosseous artery,1 case with excessively narrow entrapment at pedicel in subcutaneous tunnel,1 case with folding vessel pedicel entrapment of skin at the back of wrist,1 case with misconduct of superficial vein trunk and 1 case with intraoperative side-injury.The symptoms of circulation crisis of completely necrosis were as follows:2 cases with artery crisis and 4 of them with distortion of entrapment at pedicel and vein crisis.Four cases were cured through debridement and skin grafting,1 case was cured by the vacuum-sealing drainage (VSD) and 1 case with skin flap repair at pedicle of abdomen.Conclusion The anatomic variation of perforator vessel of reverse island flap of forearm posterior interosseous artery;narrow entrapment at pedicel in subcutaneous tunnel and distortion of entrapment at pedicel;venous congestion caused by the reverse perfusion of superficial vein;intraoperative side-injury of the pedicel of the flap;excessively folding vessel pedicel entrapment of skin at the back of wrist after surgery will cause the circulation crisis of reverse island flap of forearm posterior interosseous artery and induce the necrosis of the skin flap.

【Objective】 In this study， reactive oxygen species （ROS） scavenger N-acetyl-L-cysteine （NAC） was used to explore the inhibitory effect and mechanism of artesunate （ART） on pancreatic carcinoma （PC） cells. 【Methods】 Different concentrations of ART interfered with 3 PC cell lines CFPAC-1， Capan-2 and BxPC3. Cell viability was measured by CCK8； cell migration ability was measured by Transwell method， and the expressions of migration-related proteins E-cadherin， N-cadherin and Vimentin were measured by Western blotting. ROS probe DCFH-DA was used to measure intracellular ROS； LC3 cell immunofluorescence （IF） was used to detect the formation of intracellular autophagosomes. After adding NAC or autophagy inhibitor 3-MA， the cell viability was tested again by CCK8， and the expressions of p-AMPK/ AMPK， p-mTOR/mTOR， p62 and LC3Ⅱ/Ⅰ were detected by Western blotting. 【Results】 ART inhibited the growth of CFPAC-1 and Capan-2 in a time- and dose-dependent manner. After treatment of CFPAC-1 and Capan-2 cells with 200 μmol/L of ART for 48 h， the expression of E-cadherin was upregulated， while N-cadherin and Vimentin were downregulated， and the cell migration ability was significantly reduced. ART significantly upregulated intracellular ROS level and promoted the formation of autophagosomes. NAC could reduce the inhibitory effect of ART on CFPAC-1 and Capan-2 cells， upregulate p-AMPK/AMPK， P62 and LC3Ⅱ/Ⅰ， downregulate the expression of p-mTOR/mTOR， and intensify autophagy. 3-MA could not reverse the inhibitory effect of ART on PC cells. 【Conclusion】 ART is dependent on ROS， but not on autophagy， in exerting an anti-pancreatic carcinoma effect. NAC attenuates the inhibitory effect of ART on PC cells by activating protective autophagy through AMPK/mTOR signaling pathway.

0.05) in the presence of ApoE ?4 allele.In all four ApoE ?4/4 homozygote patients,one female patient presented a transient delirium status three days before surgery,another male patient presented serious fluctuated delirium symptoms from the second to 17th days after operation.Conclusion The presence of ApoE ?4 allele seems not a predictator of postoperative delirium.ApoE ?4/4 homozygote patients may be more indulgent to delirium than others.

Objective To investigate the effect of terlipressin on hepatic and renal function in cirrhotic patients undergoing hepatectomy.Methods Aanlyze the clinical data of 57 patients following irregular hepatectomy for hepatocellular carcinoma with cirrhosis,according to whether use terlipressin or not after operation,which were divided into terlipressin group (A group,n =27) and control group (B group,n =30).Liver function parameters (ALT,AST,TB),ascites,urine volume and renal function parameters (Cr,BUN) preoperatively and on postoperative day(POD) 1,3,5 and 7 were compared between the two gruops.Results Compared with those of POD 1,the levels of ALT,AST and ascites on POD 3,5,7 were significantly lower in two groups (P ＜ 0.05),urine volume was significantly increased (P ＜ 0.05),Cr of POD 7 was significantly lower (P ＜0.05),but it is more remarkable in group A than group B.The levels of ALT in terlipressin group on POD 5,7 were (144.9 ±76.3) U/L,(100.5 ±61.5) U/L,which were lower than those of (267.2±91.2) U/L,(199.3 ±70.5) U/L in control group.On POD 3,5,7,the levels of AST,BUN,Cr and peritoneal fluid in terlipressin group,which were respectively(211.1 ±99.8) U/L,(80.4 ±54.6) U/L,(50.6 ±46.5) U/L,(6.6 ± 1.9) mmol/L,(6.5 ± 1.7) mmol/L,(6.3 ± 2.1) mmol/L,(74.3 ± 10.9) μmol/L,(71.5 ± 8.9) μmol/L,(58.7 ±4.1) μmol/L,(247.6±60.3) ml,(58.8±54.3) ml,(40.2±31.8) ml,were significantly lower than those in control group which were (298.7 ±131.2) U/L,(201.1 ±93.4) U/L,(114.7 ±70.3) U/L,(7.3 ± 1.9) mmol/L,(7.2±1.8) mmol/L,(7.1±1.7) mmol/L,(79.5±15.1) μmol/L,(76.9±16.2) μmol/L,(69.4±11.4) μmol/L,(275.2±88.1) ml,(191.7±71.6) ml,(93.2±50.2) ml.while urine volume of (2232.3±409.8) ml,(2270.5 ±395.8) ml,(2179.0±301.4) ml was much more than that of (1921 ± 510.4) ml,(2019.1 ±411.2) ml,(1978.7±323.7) ml in the control group,the differences in the two groups were statistically significant (P ＜ 0.05).There were 11 (36.7％) patients with hepatic and renal dysfunction and hepatorenal syndrome after operation in group B,while only 2 (7.4％) patients in group A.Conclusions The use of terlipressin after partial liver resection has a protective effect on hepatic and renal function in patients with cirrhosis,and can reduce postoperative ascites and prevent hepatorenal syndrome.

Objective: To compare the efficacy and side effects of patient-controlled intravenous morphine with epidural single bolus morphine in postoperative pain relief. Method: Sixty patients undergoing gynecological procedures under epidural anesthesia were randomly assigned to epidural morphine(EPI)group or patient-controlled intravenous analgesia (PCIA) group. In the EPI group,2 mg of morphine was injected into epidural space at the end of operation. In PCIA group, 1 mg of morphine as a demand dose would be injected intravenously by the patient through a patientcontrolled analgesic delivery system until the pain relieved. The patients were followed up at 4, 8, 12, 24 h after operation,and the degree of pain,sedation, nausea and vomiting were assessed. Result: The total dosage of morphine was higher in the PCIA group(19.08?5.0 mg)than that in the EPI group(2mg,P

Objective To investigate whether apolipoprotein E (ApoE) genotypes is associated with postoperative delirium in aged noncardiac surgical patients. Methods Two hundreds and twelve inpatients over 65y, undergoing selective noncardiac surgeries were enrolled in the study. The patients were frequently interviewed and evaluated prospectively for delirium with the Confusion Assessment Method (CAM) during the first three postoperative days. APOE genotype was determined using multiplex amplification refractory mutation system pelymerase chain reaction (multi-ARMS PCR) technique. Results Delirium occurred in 45 patients during the first three postoperative days. Of the 212 patients, 18 (8.5%) possessed one or two ApoE 84 allele. There was no significant difference between delirious patients and non-delirious patients(6.7% : 9.0%, P >0.05) in the presence of ApoE ε4 allele. In all four ApoE ε4/4 homozygote patients, one female patient presented a transient delirium status three days be-fore surgery, another male patient presented serious fluctuated delirium symptoms from the second to 17th days after operation. Conclusion The presence of ApoE ε4 allele seems not a predictator of postoperative delirium. ApoE ε4/4 homozygote patients may be more indulgent to delirium than others.