BACKGROUND: Deposition of beta-amyloid protein is the main cause of Alzheimer disease. Overexpression of β-amyloid precursor protein gene (βAPP-gene) or mutation of it at certain part can be related with the attack of Alzheimer disease.OBJECTIVE: To observe the relationship of Alzheimer disease and β-amyloid protein with β APP-gene in Yimeng mountainous area.DESIGN: A case-control analysis study.SETTING: Department of Neurology, Linyi Municipal People's Hospital.PARTICIPANTS: Thirty-two Alzheimer disease inpatients were enrolled at the Department of Neurology, Linyi Municipal People's Hospital affiliated to Linyi Medical Professional College between January 2001 and December 2003. Thirty elderly patients who were treated with surgery of noncraniocerebral injury and were of the same sex and the similar age were regarded as the members of the control group [score of Mini Mental State Examination (MMSE) was over 27 points].METHODS: Level of β-amyloid protein in cerebrospinal fluid was detected with enzyme-linked immunoadsordent assay (ELISA). Expression of βAPP-gene was measured with the technic of fluorescent quantitative polymerase chain reaction.RESULTS: A total of 62 cases were involved in the result analysis. ①The level of β-amyloid protein in cerebrospinal fluid in the Alzheimer disease group was higher significantly than that in the control group[(13.63±9.34), (6.75±5.37)μg/L,t=3.354, P ＜ 0.01]. ② The expression ofβ APP in cerebrospinal fluid in the Alzheimer disease group was higher significantly than that in the control group [(1 624±298), (1275±269)copy/μL,t=4.42, P ＜ 0.01]. ③ The level of β-amyloid protein was posit ively correlated with the expression of β APP-gene in the Alzheimer disease group (r=0.44,P＜ 0.01).CONCLUSION: The level of β-amyloid protein and the expression of β APP-gene in cerebrospinal fluid of Alzheimer disease patients in the Yimeng Mountainous area increase. Besides, the higher the level of β-amyloid protein, the higher the expression of β APP-gene is, and the severer the degree of dementia is. It indicates that Alzheimer disease has closely relation with β-amyloid protein and β APP-gene. But the expression of the β APP-gene has no specificity in the diagnosis of Alzheimer disease.

Objective To investigate the changing and correlation between PaCO2 and PETCO2 during laparoscopic colorectal surgery. Methods Thirty ASA Ⅰ-Ⅱ patients scheduled for laparoscopic colorectal surgery were accepted general anesthesia and trachea cannula. Hemodynamic measurements, respiratory parameters and artery blood gas analysis were drawn at 5 min after intubating, 5 min, 30 min and 60 min after pneumoperitoneum, before the side-incisions were opened and the end of operations. Results The operation time was (216.1±39.1) min, pneumoperitoneum time was (117.3±11.5) min. Comparing to the data after pneumoperitoneum, there were differences among the parameters of circulating dynamics, but the values were acceptable, pH was decreasing with time, except 5 min after pneumoperitoneum, it was significantly decreased 30 min after pneumoperitoneum until the end of operations, compared with pre-intlation value (P<0.01), pH withdrawn a little at the end of the operations. The PETCO2 and PaCO2 at different times after pneumoperitaneum were significantly higher compared with pre-inflation value (P<0.05 or<0.01). They were increasing with the time of pneumoperitoneum, and withdrawn a little at the end of the operations. There was a good correlation between PETCO2 and PaCO2, although the correlation was worst after deflation. Conclusions The circulation dynamics are stable, the correlation of PETCO2 and PaCO2 is good during the laparoscopic colorectal surgery, PaCO2 may exceed the normal value after long-term of penumoperitoneum. It is necessary to monitor the blood gas analysis during such surgeries.

Objective To evaluate the efficacy of laryngeal mask airway (LMA) Guardian for airway management in the patients requiring insertion of nasogastric tube before laparoscopic cholecystectomy.Methods Sixty patients of both sexes,aged 26-64 yr,weighing 48-95 kg,of American Society of Anesthesiologists physical status Ⅰ-Ⅲ,with Mallampati grade Ⅰ-Ⅲ,scheduled for elective laparoscopic cholecystectomy under general anesthesia,were divided into group Ⅰ and group Ⅱ (n =30 each) using a random number table.In group Ⅰ,the nasogastric tube was inserted through the drain tube of LMA Guardian.In group],the nasogastric tube was inserted through the nostril before operation,and after successful LMA Guardian placement,another nasogastric tube was inserted through the drain tube of LMA Guardian.The hemodynamic parameters,SpO2,end-tidal pressure of carbon dioxide and peak airway pressure (Ppeak) were monitored during operation.The fiberoptic laryngoscopy scores were assessed after successful LMA placement,and the nasogastric tube displacement was recorded.The LMA placement time,success rate of LMA placement at first attempt,airway sealing pressure,occurrence of air leakage of LMA and nasogastric tube drainage were recorded.The bloodstains and gastroesophageal reflux were observed after removal of the LMA.The pH values were tested at the tip of LMA and on the dorsal and ventral sides of the body of LMA using pH test papers.The development of adverse reactions in the oropharynx was recorded within 24 h after operation.Results The hemodynamics was stable,the SpO2 and Ppeak were within the normal range during operation,and Ppeak was lower than airway sealing pressure in the two groups (P＞0.05),and there was no significant difference between the two groups.There was no significant difference between the two groups in the LMA placement time,success rate of LMA placement at first attempt,airway sealing pressure,score for exposure of oropharynx,development of adverse reactions in the oropharynx,consumption of anesthetics,development of bloodstains within the body of LMA and gastroesophageal reflux,and pH values at the tip of LMA and on the dorsal and ventral sides of the body of LMA (P＞0.05).Nasogastric tube drainage:the rate of nasogastric tube drainage through the LMA Guardian was 67％ in group Ⅰ;the rate of nasogastric tube drainage through the nostril was 40％,and the rate of nasogastric tube drainage though the LMA Guardian was 50％ in group Ⅱ.No nasogastric tube displacement was found after operation in group Ⅱ.Conclusion For the patients requiring insertion of nasogastric tube before laparoscopic cholecystectomy,insertion of LMA Guardian is easy,and LMA Guardian can assure good airway sealing and adequate ventilation and can be safely and effectively used for airway management in this type of patients.

Objective To investigate the accuracy of functional magnetic resonance imaging(fMRI) and contrast-enhanced ultrasound on evaluation of the breast cancer patients after neoadjuvant chemotherapy.Methods Forty-eight patients with breast cancer who were confirmed by biopsy,undergoing 4 cycles weekly dose-concentrated programs (wPC) neoadjuvant chemotherapy,evaluated the efficacy by fMRI and contrastenhanced ultrasound.Results In pathology,complete remission was 12 cases (25.0％,12/48),non remission was 13 cases (27.1％,13/48).In contrast-enhanced ultrasound,complete remission was 20 cases (41.7％,20/48),non remission was 10 cases (20.8％,10/48).In fMRI,complete remission was 17 cases (35.4％,17/48),non remission was 11 cases (22.9％,11/48).The P values more than 0.05 showed no statistically significant among three methods,the Kappa test showed that fMRI were superior to contrastenhanced ultrasound on evaluating the efficacy of neoadjuvant chemotherapy.Conclusions fMRI and contrast-enhanced ultrasound can be used in evaluating the efficacy of neoadjuvant chemotherapy,however,the data shows fMRI is superior to contrast-enhanced ultrasound.Contrast-enhanced ultrasound must be as the supplementary method.

Objective To determine the relationship between neuronuscular block induced by cisatracurium for tracheal intubation during anesthesia induction and types of myasthenia gravis (MG).Methods Sixty-five patients of both sexes with MG,aged 20-75 yr,weighing 53-92 kg,with body height of 155-185 cm,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,undergoing elective videoassisted thoracoscopic thymectomy,were enrolled in the study.Among the 65 patients,there were 8 patients with ocular MG (type Ⅰ),19 patients with mild generalized MG (type]Ⅱ a),33 patients with subacute generalized MG (type Ⅱ b),2 patients with acute MG (type Ⅲ) and 3 patients with late severe MG (type Ⅳ).Neuromuscular monitoring was initiated when the patients lost consciousness after induction of anesthesia.Cisatracurium was administrated with the initial dose of 0.05 mg/kg,and if T1 depression was less than 95％ within 6 min,cisatracurium 0.015 mg/kg was intravenously injected until T1 depression was more than 95％.The patients were then tracheally intubated.The amount of cisatracurium consumed for intubation,onset time (from the beginning of cisatracurium injection to T1 depression ＞95％) and recovery time (recovery of T4/T1 to 25％ of control height) of neuromuscular block were recorded.T1 depression ＞ 95％ within 6 min after administration of 1-fold ED95 cistracuriun was defined as sensitivity to muscle relaxants.The requirement for cistracurium ＞ 1-fold ED95 when T1 depression ＞ 95％ was defined as insensitivity to muscle relaxants.The proportion of sensitivity/insensitivity was calculated.Results There was no significant difference in the amount of cisatracurium consumed for intubation and onset time and recovery time of neuromuscular block between patients with type Ⅰ and those with type Ⅱ a (P＞0.05).Compared with patients with type Ⅰ and type]Ⅱ a,the amount of cisatracurium consumed for intubation was significantly decreased,the proportion of sensitivity/insensitivity was increased,the onset time was shortened,and the recovery time was prolonged in patients with type Ⅱ b (P＜0.05).Conclusion With the severity of MG,the consumption of cisatracurium is gradually decreased when used for tracheal intubation during anesthesia induction,and the sensitivity is gradually increased in the patients with MG.

Objective To investigate the data of outpatient children,survey on the clinical characteristics of vertigo and provide baseline information for clinical diagnosis and treatment.Methods The questionnaires and clinical tests data of 553 children with vertigo were retrospectively analyzed.Results All the children and their parents received interviews,otological examinations and clinical audiological tests. Their ages were between 4 and 15,with the average at 9.51?2.83. ①The males were 341(61.66%) and female 212 (38.34%),with the gender ratio of male to female as 1.61:1. ②The peak of the age curves of treatment and the first onset of vertigo was 9.51 and 8.62-year-old,respectively. ③20.98% of children with vertigo had normal results with peripheral vertigo more common in the rest.④The semicircular canals were more likely to dysfunction if their relatives had vertigo or car sickness.Conclusion The age of children mostly with vertigo is between 6 and 11 years with more males than females. Vertigo itself can be a symptom but on the other hand,some show no positive signs even with vertigo.

ObjectiveTo investigate the changes in the expression of T-cell death-associated gene 8(TD- AG8) in spinal cord in rats with bone cancer pain.MethodsTwo hundred and twenty-four female rats weighting 150-180 g were randomly divided into 3 groups:normal control group(group Ⅰ,n ＝ 64),normal saline group (group Ⅱ,n ＝ 64),bone cancer pain group(group Ⅲ],n ＝ 96).Bone cancer pain was induced by inoculating Walker256 mammary gland carcinoma cells into the tibia medullary cavity.Mechanical withdrawl threshold(MWT)was measured at 1 d before(baseline)and 1,3,6,9,12,15 and 18 d after inoculation.Sixteen rats were sacrificed at 1 day before(baseline)and 6,9,12,15 and 18 d after inoculation in group Ⅲ and 18 d after inoculation in groups Ⅰ and Ⅱ.The L4-6 spinal cord were removed,and the number of TDAG8 positive cell was counted,and the expression of TDAG8 mRNA was measured by RT-PCR.ResultsCompared with baseline value and group Ⅰ,MWT was decreased,and the number of TDAG8 positive cells and the expression of TDAG8 mRNA in spinal cord were increased at 6-18 d after inoculation in group Ⅲ ( P < 0.01 ).ConclusionThe expression of TDAG8 in spinal cord is up-regulated in rats with bone cancer pain,which may be involved in the mechanism of the development of bone cancer pain.

Background Laser in situ keratomileusis (LASIK) is frequently performed to reduce or eliminate myopic refractive error.Some patients complain of a loss of visual function after surgery even when they have 20/20 visual acuity.One of the reasons is the change of asphericity of the cornea.Objective This study attempts to investigate the short-term changes of the anterior and posterior corneal asphericity after LASIK.Methods One hundred and seven myopic eyes of 54 subjects with the equivalent spherical diopter of -1.30 to -7.50 D who have received LASIK were enrolled in this prospective study.The Q-values of the posterior corneal surface for different corneal diameters (6mm,7mm,8mm and 9mm) were measured with Pentacam preoperatively and 1 month postoperatively.The correlations between Q-value,Q change (△Q),and the mean preoperative spherical equivalent refraction (SE),central corneal thickness (CCT),central ablation depth (AD) and residual bed thickness were investigated.Written informed consents were obtained from all the subjects prior to the clinical trial.Results The Q-values of the anterior and posterior corneal surfaces gradually decreased to negative values with the increase of corneal diameter in myopic eyes.Weak correlations were found between the asphericity of the anterior and posterior corneal surfaces from diameters of 6mm,7mm,8mm and 9mm (r=0.227,0.288,0.303,0.389;P=0.019,0.003,0.002 and 0.000,respectively).No statistically significant correlation was found between Q-value and the diopter of refractive error (P＞0.05).Both the anterior and posterior corneal Q-values varied toward the positive direction except that in the 9mm area of the posterior corneal surface at postoperative 1 month(t=-1.495,P=0.138).The increase of the anterior corneal asphericity (△Q) was more obvious than that of the posterior corneal surface and showed a positive correlation with ablation depth and a negative correlation with residual bed thickness.However,no statistically significant correlation was seen between △Q and these two parameters in the posterior corneal surface (P＞0.05).Conclusion The shape of the anterior and posterior corneal surface shows more prolateness as the increase of corneal diameter in myopic eyes.Both the anterior and the posterior corneal surfaces have an oblate shift within the ablation zone 1 month after LASIK.

Guangxi Medical University had taken a lot of measures to construct systematic general medicine education system consisting of medical college education, post graduation education and continuing medical education. These measures included constructing the organization, modifying the personnel training program, training rural-order directional medical students, standardizing resi-dent training, providing on-the-job training and postgraduate degree education for general practitioners.

Objective To evaluate the effect of wire-reinforced polyurethane epidural catheters on the success rate of epidural catheterization in the patients undergoing caesarean section.Methods A total of 182 pregnant patients,aged 25-43 yr,with body height of 145-178 cm,weighing 51-100 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective caesarean section under combined spinal-epidural anesthesia,were divided into 2 groups using a random number table:polyvinyl chloride epidural catheter group (group Ⅰ,n =94) and wire-reinfnrced polyurethane epidural catheter group (group 11,n=88).Spinal or epidural puncture was performed at L2,3 or L3,4 interspace,and the corresponding epidural catheter was inserted in each group aficr succcssful puncturc.Thc dcvclopment of difficult insertion,intravascular catheter insertion or paresthesia during puncture or insertion was defined as a failure of epidural catheterization.The occurrence of failed epidural catheterization was recorded.Results The failure rate of epidural catheterization was significantly lower in group 1Ⅱ than in gronp Ⅰ (P＜0.05).Conclusion Wire-reinforced polyurethane epidural catheters can raise the success rate of epidural catheterization in the patients undergoing caesarean section.