Objective:To observe the sedative effect of epidural anesthesia assisted with target controlled infusion(TCI) propofol.Methods:45 ASA Ⅰ～Ⅱ patients,who would accept hysterectomy,were randomly allocated to group Ⅰ (without propofol),group Ⅱ(Target blood propofol concentration was set at 1.0?g/ml when epidural anesthesia level was confirmed) and group Ⅲ(Target blood propofol concentration was set at 1.5?g/ml).Heart rate and blood pressure were determined at the different moment from pre-operation to the end of the surgery.And the sedation degree was evaluated by the Observer's Assessment of Alertness/Sedation (OAA/S) Scale.At the same time,efficacy of antitraction response and perioperative awareness were investigated.Results:In three groups,blood pressure significantly decreased when epidural anesthesia level was confirmed.Goup Ⅱ and Goup Ⅲ showed significantly lower than group Ⅰ in 5 min after propofol infusion.HR gradually decreased with operative courses,and no difference was significantly found in the three groups.53.3% of patients fell asleep;53.3% had effective antitraction response and 33.3% were aware in group Ⅱ.And the patients in goup Ⅲ all fell asleep;86.7% could prevent traction response during operation but no perioperative awareness.Conclusion:Target controlled infusion of propofol as an adjuvant for epidural anesthesia is applicable and can prevent viscus traction response during surgical exploration.And the sedative effects of blood propofol concentration of 1.5?g/ml are better than 1.0?g/ml through OAA/S Scale.

Objective To investigate the incidence and the risk factors of the vascular disease in lower limbs of patients with type 2 diabetes(T2DM).Methods To retrospectively analyze 318 cases with T2DM patients.All the patients were checked on both lower limbs by color ultrasonic Doppler.The differences of ordinary and biochemical indicators between PVD group and non-PVD group were compared.Results There were 67.2％ (205/318) patients who had vascular disease in lower limbs with type 2 diabetes.Age,course of disease,HbAlC,TC,TG,SBP,DBP and BMI in PVD group were significantly higher than those in non-PVD group( P ＜ 0.01 ).Conclusion There was higher incidence of the vascular disease in lower limbs of patients with type 2 diabetes.And the independent risk factors were hypertension,hyperglycemia,hyperlipemia.It could help to prevent the development of lower limb blood vessel pathological changes in DM patients by controlling the levels of blood pressure,lipid and blood sugar strictly.

Objective To analyze the clinical effect of puerarin and lipoic acid in treatment diabetic peripheral neuropathy.Methods 80 type Ⅱ diabetes patients accompanied with peripheral neuropathy were selected.According to different therapy,they were divided into single drug treatment control group (lipoic acid) and combined treatment group (puerarin + lipoie acid).Total effective rate,MNCV,SNCV,FBG,HbAlc and sorbitol were evaluated after treatment.Results The total effective rate in the treatment group was higher than that in the control group (P ＜ 0.05).Compared with the control group,the recovery rates of MNCV and SNCV were faster in the treatment group(P ＜0.05).And the levels of FBG,HbAlc and sorbitol were significantly lower in the treatment group than in the control group(P ＜ 0.05).Concluslon The clinical effect of puerarin and lipoic acid in treatment diabetic peripheral neuropathy was significant.

There are multiple types of inhibitory immune cells in tumor. Among these cells, Treg (regulatory T cell) plays an extremely important role in tumor development and progression. Treg exihibits potent inhibitory effects on effector cells by a variety of mechanisms, which might be the the key factor for tumor immune escape. These mechanisms include inhibiting the effector cell function by inhibitory cytokines, killing effector cells by granzyme and profrin, interfering effector cell metabolism, and affecting Treg differentiation and proliferation by regulating the function of dendrtic cells, etc. The research on Treg has provided new strategies for tumor immunotherapy. Tumor immunotherapies targeting Treg and related immunosuppressive factors, such as deleting Treg nonsepcificlly or sepcificlly controling the numbers and functions of Treg, might have a bright future in clinical application.keyword regulatory T cell(Treg); neoplasms; immune escape; immunotherapy

Objective To observe the distribution and drug resistance of pathogenic bacteria causing pulmo-nary infections in cardiology department of general hospital ,and to provide advices for infection control and selection of drugs.Methods 110 sputum specimens of patients with pulmonary infections in cardiology department were col -lected.The distribution and drug resistance of pathogenic bacteria were analyzed .Results In the 110 sputum sam-ples,83 cases(75.5%) were infected by gram-negative bacterias,21 cases(19.1%) were infected by gram-positive bacterias,6 cases(5.4%) of fungal infection .The Escherichia coli and the Pseudomonas aeruginosa after the antibiot-ic resistance analysis were found a trend of multi resistance .Conclusion The major pathogenic bacterias causing pulmonary infections in cardiology department are gram-negative bacterias ,and they show a trend of multi resistance .

Objective To investigate the changes of platelet activating factor ( PAF) in serum from patients with hypertensive disorder complicating pregnancy .Methods The specimens from 138 women were obtained at Department of Obstetrics , Xinhua Hospital , School of Medicine , Shanghai Jiaotong Uni-versity, between June 2008 and March 2010.They were divided into two groups:women( n =63) with hy-pertensive disorder complicating pregnancy and normal pregnant women ( n =75 ) ( control group ) .All of them delivered until maturity .ELISA was used to detect the levels of PAF in those women's serum and in the umbilical cord serum .Results The levels of PAF in hypertensive disorder complicating pregnancy group (27.46 ±13.37 ) ng/ml were no significantly different from the control group (25.48 ±11.05 ) ng/ml( P >0.05 ) .With the hypertensive disorder complicating pregnancy more deteriorative , the levels of women ser-um PAF would be higher .The levels of women's serum PAF in hypertensive disorder complicating pregnancy group were significantly higher than the umbilical cord serum [0.00(0.00-8.83) ng/mL]( P <0.05). The levels of women's serum PAF in control group were also significantly higher than the umbilical cord ser -um[0.00(0.00-7.80)ng/mL]( P <0.05).Conclusion There are some relationships between PAF and hypertensive disorder complicating pregnancy .

Objective To observe the effect of stress caused by neuropathic pain on serum cortisol concentration and expres-sion of 11β-hydroxysteroid dehyarogenase 1(11βHSD1)and investigate the action mechanism of curcumin for alleviating neuropathic pain. Methods The 72 male SD rats were randomly divided into 4 groups with 18 rats in each group:sham operation group(Sham), chronic constrictive injury group(CCI),solvent contrast group(SC)and curcumin treated group(Cur100). Curcumin(100 mg/kg/d) was given after the operation in Cur100 group. Paw thermal withdrawal(PTWL)and paw mechanical withdrawal threshold(PMWT)of rats were measured on 2 pre-operative and 1,3,5,7,10,and 14 post-operative days. The animals were deeply anesthetized,the blood was taken from the heart,and the L4-L5 dorsal root ganglion(DRG)of the operated side was removed. The change of cortisol was measured by ELISA and the change of 11βHSD1 expression in spinal cord and DRG was determined by immunochemistry and Western blot. Results Compared with sham group,PTWL and PMWT decreased significantly after operation in CCI group(P<0.01),serum cortisol concentration was significantly increased(P<0.01)and the expression of 11βHSD1 was significantly increased in CCI group(P<0.01). Compared with CCI group,the PMWT and PTWL was increased in CCI group(P<0.05),the serum cortisol concentration was decreased(P<0.05)and the expression of 11βHSD1 was inhibited in Cur100 group(P<0.05). Conclusion Stress caused by neuropathic pain triggered the release of cortisol to the blood and increased the expression of 11βHSD1 at the same time. Cur-cumin could alleviate thermal hyperalgesia and mechanical hyperalgesia induced by CCI and could also inhibit the serum cortisol con-centration and the expression of 11βHSD1 in spinal cord and DRG,which was likely to be related to pathogenesy and maintenance of neuropathic pain.

Objective To comparatively complete clinical effectiveness of laparoscopic and open-bifemoral bypass in the treatment of advanced atherosclerosis.Methods During January 2008 to January 2013,according to the treatment method,a total of 60 patients with advanced atherosclerosis patients were divided into group A and group B,and there were 30 cases in each group,and group A was treated with open master bifemoral bypass surgery,and group B was treated with laparoscopic totally master bifemoral bypass surgery,to compare the general information of the two groups,surgery related indicators,clinical efficacy and survival rate,and to analyze the effect of surgical treatment on the prognosis of patients by COX model.Results The operation time of patients in group B (365.3 ±41.3) min and aortic clamping time (59.5 ± 18.3) min were significantly higher than that of group A,(294.3 ±35.5) min and(26.5 ± 19.3) min (P ＜0.05),bleeding amount (400.0 ± 145.3) ml and length of hospital stay (10.5 ± 2.1) d of group B patients was significantly lower than that of group A (1 002.3 ± 324.3) ml and (16.4 ± 4.3) d (P ＜ 0.05);postoperative mortality,thrombosis rate and the incidence of serious complications of patients in group B were significantly lower than group A (P ＜ 0.05);survival rate at different time of group B was significantly higher than that of group A (P ＜ 0.05);COX model analysis show that the surgical methods affect the postoperative mortality,thrombosis and the occurrence of severe complications.Conclusions Completely laparoscopic master bifemoral bypass can significantly decreased advanced main iliac artery occlusion disease mortality,and has small surgical trauma,less postoperative complications,rapid recovery and other advantages,especially for elderly critically ill patients,and it was worthy of clinical application.

Most of the current medical humanities education focuses on the moral aspects without good theoreti-cal basis and specific practices on the medical institution and daily life.The article dates back to the origins of So-cial Science based on the concept caregiving put forward by the medical anthropologist Arthur Kleinman,and states that the ultimate purpose of Social Science is to make response to the social suffering and provide caregiving for it.Caregiving as moral experience is response to social suffering and attracts much importance,because it pro-vides both the theoretical basis and practical means for the current medical humanities education.Its characteristics of caregiving as moral experience to social suffering and caregiving as reciprocity meet the demands of current notion of Big health in China.

MELAS syndrome(mitochondrial myopathy encephalophathy with lactic acidosis and stroke-like episodes),as one of the most common diseases in mitochondrial encephalomyopathies,is characterized by highly variable manifestations.So,more and more people come to realize the importance of molecular basis of MELAS.This review took the commonest mtDNA point mutation(A3243G) for example to overview its molecular biological mechanism,test strategy and recent progress of study on MELAS syndrome.