Recent studies have found that the incidence of diabetes with cognitive impairment increases significantly.This article reviews the clinical manifestation of diabetic cognitive impairment and expounds its potential pathogenesis from 4 aspects,including the toxic effect of hyperglycemia,and the changes of cerebrovascular pathology,neurotrophic factor and neuromodulation.

Objective To make a nationwide external quality assessment of tests for isolation and identification of N.gonorrhoeae in medical and healthcare facilities at different levels,and to analyze current problems.Methods Lyophilized quality control samples were uniformly delivered to 252 medical and healthcare facilities providing sexually transmitted disease (STD) services at different levels.Test results were analyzed by the National Center for STD Control,China Center for Disease Control and Prevention,and evaluation results were fed back to participating laboratories.Results Finally,test results were received from 203 (80.56％) facilities.The comprehensive score averaged at 87.14,and facilities achieving a comprehensive score of 80 or greater amounted to 80.30％ (163/203).The coincidence rate was 53.69％ (109/203) for all of the 5 quality control samples,82.76％ (168/203) and 87.68％ (178/203) respectively for two quality control samples containing only N.gonorrhoeae,86.21％ (175/203) and 96.06％ (195/203) respectively for a sample containing Neisseria sicca and a sample containing Enterococcus faecalis,69.46％ (141/203)for a sample containing different species of Neisseria.Conclusion The external quality assessment reveals a disparity in the capability to isolate and identify Neisseria among medical and healthcare facilities providing STD services at different levels.

Objective To investigate the therapeutic effects of repeated transcranial magnetic stimulation (rTMS) at high and low frequency for the rigidity and tremors of Parkinson's disease (PD).Methods Sixty-nine patients with PD received rTMS at 5 Hz or 0.5 Hz.The efficacy was assessed using the unified Parkinson's disease rating scale (UPDRS),motor function tests and motor evoked potentials (MEPs).Results Thirty-two patients with rigidity from PD received 5 Hz rTMS therapy,and their UPDRS total scores decreased significantly.Their motor function test results improved significantly and their MEP relaxed motor thresholds were significantly elevated.Thirtyseven patients with tremors from PD received 0.5 Hz rTMS therapy,and their UPDRS total scores were significantly decreased.Their motor function test results improved significantly and their MEP relaxed motor thresholds were significantly elevated.Conclusion High frequency rTMS may improve the symptoms of patients with PD rigidity and low frequency rTMS may improve the symptoms of patients with PD tremors.

Objective To investigate the mechanisms of methylglyoxal(MG)-induced injury of hippocam-pal neurons. Methods Primary cultured of hippocampal neurons from 1-day-old Sprague-Dawley rats were incuba-ted with MG for different time and dose period. Cells proliferation were assayed by methyl thiazolyl tetrazolium (MTT),and apoptosis was quantified by flow cytometer using annexin V-FITC and propidium iodide (PI) stai-ning. The protein and mRNA levels of brain-derived neurotrophie factor (BDNF) and tyrosine kinase B(TrkB) were assayed with Western Blotting and real-time PCR. Results Treatment with MG resulted in a concentration-dependent (r=0.946, P < 0.01) and time-dependent (r=0.993, P < 0.01) decreasing neurons viability. Com-pared with Oh group(1. 633±0. 153)%, 100 μM MG treatment for 2h,6h, 12h and 24h,the cellular apeptosis rate were significantly increased ((2. 833±0. 153)%, (3. 367±0. 153)%, (4. 433±0. 404)% and (8. 833± 0. 306)% respectivdy,all P<0.01). MG also increased the BDNF mRNA and protein expression after 12h treat-ment (P<0.05 or P<0.01),but decreased the TrkB mRNA and protein expression in the cells after 6h treatment (P<0.05 or P < 0.01). Conclusion MG has direct toxic effect on hippocampal neurons and can impaire the BD-NF-TrkB signal pathway by inhibiting the expression of TrkB,and increasing the apoptosis of hippocampal neurons.

Objective To compare the effects of median nerve electrical stimulation on coma patients after traumatic brain injury with different settings. Methods From 2013 to 2015, 161 patients with traumatic brain injury were randomly divided into control group (n=40), experimental group 1 (n=41), experimental group 2 (n=39) and experimental group 3 (n=41). The control group received routine conscious-ness-promoted methods, and the experimental groups received median nerve electrical stimulation with 200μs and 30 Hz, 100 Hz and 50 Hz in sequence, 60 minutes a day for 90 days. They were assessed with Glasgow Coma Scale (GCS) and Coma Recovery Scale-Revised (CRS-R) before, 30 days and 90 days after treatment. Results There was significant difference in the scores of CCS and CRS-R, times of treatment, number of sobered patients and coma time among groups (P<0.01), that the experimental groups were better than the control group (P<0.05), and no significant difference was found between the experimental groups 1 and 2 (P>0.05). The experimental group 3 was better than the experimental groups 1 and 2 (P<0.05). Conclusion Median nerve electrical stimulation with 200μs, 50 Hz could promote co-ma patients to wake up optimally.

Objective This study aimed to survey students' satisfaction and cognitive attitude of elaborate course of social medicine to provide a basis for exploring appropriate teaching mode. Methods Purposive sampling was used with questionnaire to survey 646 students who had learned social medicine in 5 universities in Guangdong province. The survey included the social medicine curriculum, teaching situation, students' satisfaction and cognitive attitude of elaborate course of so-cial medicine. Descriptive statistical analysis was used to describe the demographic characteristics and curriculum. The t test and one-way ANOVA were used to compare the means of students' satisfaction and cognitive attitude of elaborate course in different universities, using the test level of 0.05. Results The lecture-based learning was the main teaching mode. 335(52.7%) students thought it necessary to learn social medicine, but only 27.2%of the students(173 students) were interested in social medicine and 65(10.2%) students could take the initiative to read about extracurricular books. Overall satisfac-tion with using network resources of elaborate course in two universities that had university-level elab-orate course of social medicine were (2.78 ± 0.55) and (3.01 ± 0.30) respectively and the difference was statistically significant(t=-3.97,P<0.01). The cognitive attitude of the students in 5 universities with using network resources of elaborate course was (3.09±0.66) and the difference was statistically significant(F=3.70,P<0.01). Conclusion Social medicine teaching has been paid attention to in 5 universities, but there were some common problems: ①putting emphasis on theory and ignoring prac-tice in teaching mode; ②putting emphasis on credit and ignoring effectiveness in learning; ③and putting emphasis on construction and ignoring using in network resources of elaborate course of social medicine.

Objective To investigate and analyze oral health status of inpatients with schizophrenia.Method We selected 105 patients from Beijing Anding hospital included hospitalization length 1-5 years group (39 cases) and hospitalization length over 5 years (55 cases) were investigated with Self-made questionnaire and assessment guide for psychiatric care (OAG-PC).Results Tooth loss and oral health status of schizophrenia inpatients were both poor.There was significant difference in the number of people with tooth loss (x2 =7.68,P ＜ 0.05) and mean number of tooth loss (F =9.20,P ＜ 0.05) between two groups.The OAG-PC total score (F=11.1,P＜ 0.05),odour from the mouth (F=4.34,P＜ 0.05),saliva (F=3.93,P＜ 0.05),mucous membranes (F=5.64,P＜ 0.05),teeth or dentures (F=5.34,P＜ 0.05),calculus on teeth (F=15.34,P ＜ 0.05),looseness of teeth (F =14.14,P ＜ 0.05),and No.of teeth in the lower jaw (F =7.70,P ＜ 0.05) in the schizophrenia inpatients with hospitalization length 1-5 years group was better than those with hospitalization length over 5 years,there were significant difference between two groups.There were no significant difference in lips (F =0.69,P ＞ 0.05),tongue (F =0.65,P ＞ 0.05),gums (F =1.87,P ＞ 0.05),appearance of teeth (F=1.52,P＞ 0.05),and No.of teeth in the upper jaw (F=3.58,P ＞ 0.05) between two groups.Conclusions Patients with schizophrenia are special vulnerable people.The more course of the disease was longer,the more the oral health status was worse.Tooth loss,calculus,and looseness of teeth are much more serious and will influence chew function seriously.Society,medical institutions,and families should pay more attention to the oral health status of patients with schizophrenia.And taking the preventative measures against poor oral health can improve quality of life of patients with schizophrenia.

Objective To evaluate the effect of dexmedetomidine on acute lung injury induced by scalds in rats.Methods Seventy-five male Sprague-Dawley rats,weighing 200-220 g,were randomly divided into 5 groups (n =15 each) using a random number table:control group (group C),scald group (group S),dexmedetomidine group (group D),α-bungarotoxin (α-BGT) group,and dexmedetomidine+ α-BGT group (group D+α-BGT).About 30％ of the total body surface was shaved and then exposed to 98 ℃ water for 12 s in S,D,α-BGT and D+α-BGT groups.The back of rats was exposed to 37 ℃ water for 12 s in group C.Rats were resuscitated with lactated Ringer's solution injected intraperitoneally according to Parkland formula within 24 h after establishment of the model.In D,α-BGT,and D+α-BGT groups,dexrnedetomidine 40 μg/kg,α7 nicotinic acetylcholine receptor antagonist α-BGT 1 μg/kg,and α-BGT 1 μg/kg plus dexmedetomidine 40 μg/kg were injected intraperitoneally,respectively,at 15 min before establishnent of the model.At 24 h after establishment of the model,the rats were sacrificed,and lungs were removed for examination of the pathological changes and for determination of myeloperoxidase (MPO) activity,in terleukin-1beta (IL-1β),tumor necrosis factor-alpha (TNF-α),and IL-6 contents (by enzyme-linked immunosorbent assay),and nucleoprotein factor kappa B (NF-κB) (by Western blot).The lung water content [(wet weight-dry weight)÷wet weight× 100％] was calculated.Results Compared with group C,the lung water content,MPO activities,and contents of IL-1β,TNF-α and IL-6 were significantly increased,and the expression of NF-κB was up-regulated in S,α-BGT and D groups (P＜0.05).Compared with group S,the lung water content,MPO activities,and contents of IL-1β,TNF-α and IL-6 were significantly decreased,and the expression of NF-κB was down-regulated in D and D+α-BGT groups (P＜0.05),and no significant change was found in the parameters mentioned above (P＞0.05),and the pathological changes were significantly attenuated in group α-BGT.Compared with group D,the lung water content,MPO activities,and contents of IL-1β,TNF-α and IL-6 were significantly increased,the expression of NF-κB was up-regulated (P＜0.05),and the pathological changes were aggravated in group D + α-BGT.Conclusion Dexmedetomidine can mitigate scalds-induced acute lung injury in rats.

Objective To investigate the effect of ultrasound-guided paravertebral nerve block on stress reaction in patients undergoing esophageal resection. Methods Eighty patients scheduled to do the operation of esophageal resection were randomly divided into two groups with 40 cases in each group. The patients in group A were given the general anesthesia combined with ultrasound-guided paravertebral block, and the patients in group B were given the general anesthesia only. Both of two groups received postoperative patient controlled intravenous analgesia (PCIA). The amount of propofol and remifen-tanil used were recorded. The data of blood pressure, heart rate (HR) and pulseoxygen saturation (SpO2) before anesthesia (T1), before induction (T2), after intubation (T3), in 2 h of surgery (T4), after surgery (T5), 1 h after surgery (T6), 8 h after surgery (T7), 24 h after surgery (T8), 48 h after surgery (T9)were recorded. The analgesic effect was measured by VAS scores and Ramsay sedation scores were also recorded at T6-T10. The levels of blood glucose, epinephrine (E), norcpincphrinc (NE) and dopamine (DA) were also detected at T1, T4, T5, T9. Results The amount of propofol and remifentanil used in group A were lower than those in group B: (960.0 ± 216.9) mg vs. (1 242.5 ± 200.2) mg, (1.5 ± 0.4) mg vs. (2.3 ± 0.4) mg, P<0.05. The patients in two groups successfully completed surgery, and intraoperative vital signs was stable. The quiet and active VAS scores at T6-T9 in group A were significantly lower than those in group B (P<0.05). The Ramsay sedation scores at each time point in two groups had no significant differences (P>0.05). The levels of blood glucose and NE at T9 were significantly higher than those at T1, T4 or T5 of same group, P<0.05.The level of E at T4 and T5 was significantly lower than that at T1 and T9 of same group, P<0.05. The level of DA at T9 was significantly higher than that at T1, T4 and T5 in group B (P<0.05). The levels of blood glucose, NE, E and DA at T9 in group B were significantly higher than those in group A (P<0.05). Conclusions General anesthesia combined with ultrasound-guided paravertebral nerve block could offer favorable anaesthesia effect. It could decrease stress reaction and anesthetics requirements in patients undergoing esophageal resection.

Objective To assess the therapeutic effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) combined with neuromuscular electrical stimulation (NMES) on poststroke dysphagia.Methods A total of 90 patients with poststroke dysphagia were enrolled.They were randomly divided into either a NMES + rTMS group or a NMES + sham rTMS group (n =45 in each group).The Kuhota water drinking test and Standardized Swallowing Assessment (SSA) were used to assess the swallowing function.Results The scores of Kuhota water drinking test (F=82.001,P＜0.001) and the SSA (F =33.743,P ＜0.001) before treatment,treatment of one course,treatment of two courses,and at 3 months after treatment in the NMES + rTMS group had significant differences.Compared with before treatment,they were improved significantly for treatment of one course (P ＜0.01 and P ＜0.05,respectively),two courses (all P＜0.01),and at 3 months (all P＜0.01) after treatment.The scores of Kuhota water drinking test (F =53.647,P＜0.001) and the SSA (F=19.178,P＜0.001) in the NMES + sham rTMS group also had significant difference.Compared with before treatment,they had significant improvement for treatment of one course (all P ＜0.05),two courses (P ＜0.05 and P ＜0.01,respectively) and at 3 months (all P＜0.01)after treatment.The scores of Kuhota water drinking test for treatment of one course,two courses,and at 3 months after treatment (treatment of one course:t=2.217,P=0.02;treatment of two courses:t =2.406,P =0.019;at 3 months after treatment:t =2.128,P =0.037) and the SSA (treatment of one course:t =2.196,P =0.030,treatment of two courses:t =2.425,P =0.016;at 3 months after treatment:t =2.512,P=0.013) in the NMES + rTMS group were significantly better than those in the NMES + sham rTMS group.Conclusions High-frequency rTMS combined with NMES may significantly improve the swallowing function in patients with stroke.Its efficacy is superior to NMES.