Objective To discuss the indication, technical points and long-term effects of endovascular embolization for non-functioning renal graft with detachable coils, and to get further evaluation of its practical value.Methods Monitored by DSA, endovascular embolization with detachable coils was performed on 11 patients with non-functioning renal graft.Results Renal arteries all had been successfully blocked in 11 cases.Good recovery without any complication was obtained.Conclusion Endovascular embolization for non-functioning renal graft with detachable coils is safe, minimally invasive and convenient, and can be used as an alternative to the resection of the renal grafts.

Objective To study correlation of the retinal nerve epithelium layer thickness measured with different optical coher-ence tomography (OCT) in vivo with histological measurement. Design Experimental study. Participants 15 rabbit eyes. Methods The retina measurement position of 15 rabbit eyes were marked by laser, and then were scanned by OSE-1800 OCT and Stratus OCT. Reti-nal nerve epithelium layer thickness was measured in retinal histological shdes of rabbit eyes. The results measured with three methods were compared and linear regression analyses were done with SPSS11.5 software. Results The average retinal nerve epithelium layer thickness measured with OSE-1800 OCT, Stratus OCT and histological method were 119.5±7.4, 118.0±5.6, and 116.3±8.8μm respec-tively(P=0.292). Retinal nerve epithelium layer thickness measured with both OCT instruments had the best correlation (r=0.914, P= 0.000), and the thickness measured with Stratus OCT and histological method had the better correlation (r=0.872, P=0.001), and the thickness measured with OSE-1800 OCT and histological method had the significant correlation (r=0.833, P=0.002). Conclusions The retinal nerve epithelium layer thickness measured with different OCTs in vivo correlate well with histomorphometry, and the measure-ment of both OCT instruments are accurate. (Ophthalmol CHN, 2009, 18: 239-242)

OBJECTIVETo explore the therapeutic effect of diagnosis and treatment program of integrative medicine (IM) on level 2 hypertension in the young and middle-aged patients and their ambulatory blood pressure.

METHODSA randomized, placebo parallel and controlled, multi-center clinical trial was performed. Totally 199 young and middle-aged level 2 hypertension patients were randomly assigned to the treatment group (99 cases) and the control group (100 cases). All received combined hypotensive treatment program by taking Nifedipine Sustained Release Tablet and Hydrochlorothiazide as basic drugs. Patients in the treatment group additionally took Western medicine (WM) combined Jiangyabao serial drugs (0.31 g per tablet, 2 tablets each time, twice daily), while those in the control group additionally took WM combined simulative agents of Jiangyabao serial drugs (0.31 g per tablet, 2 tablets each time, twice daily). The treatment course was 8 weeks for all, and 24-week follow-ups performed. 24 h ambulatory blood pressure and casual blood pressure, and their efficacies were compared between the two groups, and safety assessed as well.

RESULTSCompared with before treatment in the same group, daytime and night casual blood pressure, as well as 24 h ambulatory blood pressure were all obviously improved in the two groups (P < 0.01). Average diastolic and systolic blood pressures at night decreased more in the treatment group than in the control group with statistical difference (P < 0.05). There was no statistical difference in total efficacies of daytime casual blood pressure or ambulatory blood pressure (P > 0.05).

CONCLUSIONJiangyabao serial drugs combined WM in treating young and middle-aged level 2 hypertension patients showed obvious effect in improving night blood pressure, especially for night diastolic blood pressure.

Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Hypertension ; diagnosis ; therapy ; Integrative Medicine ; Middle Aged ; Nifedipine

Objective To observe the expression of cAMP -response element binding protein (CREB) and N-methyl-D-aspartic acid receptor (NMDA ) after intracochlear electrical stimulation in the auditory cortex and inferior colliculus in infant rats with auditory deprivation .Methods Sixty six SD infant rats were randomly divided into 6 groups (11 rats each group):4 weeks ,and 6 weeks after injection of ototoxic drug ,the control group ,and 3 weeks and 5 weeks after injection of ototoxic drug with intra -cochlear electrical stimulation for one week .Gentami-cin sulphate (350 mg/kg body weight) and frusemide (200 mg/kg body weight) were injected subcutaneously in the skin folds on the lateral abdominal side and the dorsal neck area ,respectively .The expression of CREB and NMDAR1protein were detected by immunohistological staining .Results The results of immunohisto -chemistry revealed that protein expression of CREB and NMDAR1 in 4 week group of injection increased as compared to the control group ,while decreasing as compared to intracochlear electrical stimulation group ,significantly .However ,protein expression of CREB and NMDAR1 in 6 week group of injection decreased as compared to the control group and in-tracochlear electrical stimulation group ,significantly .Conclusion Auditory deprivation could result in the expres-sion of protein of CREB and NMDAR1 in auditory cortex and inferior colliculus increasing in an early stage and then de-creasing in infant rats .Intracochlear electrical stimulation could result in the expression of proteins of CREB and NMDAR 1 in auditory cortex and inferior colliculus increasing in infant rats .The dynamic variation of CREB and NMDAR1 expression in rat auditory cortex and inferior colliculus reflects synaptic plasticity in neurons of auditory pathway .

Abstract: Objective　To analyze the treatment outcomes of elderly patients with pulmonary tuberculosis in Chongqing, so as to provide reference for the prevention and control strategies of the epidemic of elderly pulmonary tuberculosis. Methods　The data of tuberculosis cases aged ≥65 years in Chongqing from 2015 to 2020 were collected from the National Health Insurance Information Project Disease Prevention and Control Information system. Descriptive statistical methods were used to analyze the data. Results The registration rates of elderly active pulmonary tuberculosis patients and etiological positive patients were 110.95/10-5and 32.25/10-5 in 2015 and 84.06/10-5 and 57.29/10-5 in 2020. The annual decline rate of active tuberculosis registration was 5.40%, and the annual increase rate of pathogenic-positive tuberculosis registration was 12.18%. The registration rates of active tuberculosis patients and etiological positive patients in the whole population were 70.75/10-5 and 17.63/10-5 in 2015 and 50.34/10-5 and 29.14/10-5 in 2020. The annual decline rate of active tuberculosis registration was 6.58%, and the annual increase rate of pathogenic-positive tuberculosis registration was 10.57%. From 2015 to 2020, a total of 25 931 cases of elderly pulmonary tuberculosis were registered, of which 21 374 (82.43%) cases were successfully treated and 4 010 (15.80%) cases had unfavorable outcomes. The proportion of cured and death patients showed an increasing trend year by year (χ2trend=313.853, 100.502, P<0.01). From 2015 to 2020, the average annual successful treatment rate of elderly pulmonary tuberculosis in the whole city was 82.43%, with the lowest rate in southeast Chongqing (74.23%), followed by urban areas (81.99%). The success rate of elderly pulmonary tuberculosis treatment in the whole city, west Chongqing, northeast Chongqing and southeast Chongqing showed a downward trend year by year (χ2trend=230.199, 35.278, 108.076, 112.130, all P<0.01), with annual decline rates of 2.77%, 2.26%, 3.0% and 4.12%, respectively. Among the registered elderly patients, female, 65-<75 years old, Han nationality, newly diagnosed, no complications, and negative for etiology (χ2=15.234, 255.910, 146.842, 179.998, 25.575, 131.170, P<0.01) had higher success treatment rates. Conclusions The prevalence of pulmonary tuberculosis in the elderly population in Chongqing City is declining, but the positive registration rate of etiology is increasing annually, and the success rate of treatment is decreasing. Therefore, it is necessary to strengthen the systematic management, publicity and education of elderly patients (especially those in southeast Chongqing, male, positive patients and severe patients) to effectively control the epidemic of tuberculosis in the elderly.

Objective To investigate the efficacy of dexmedetomidine combined with target-controlled infusion (TCI) of propofol and remifentanil for fiberoptic bronchoscopy in the elderly patients.Methods Forty ASA Ⅱ or Ⅲ patients,aged 65-75 yr,with body mass index of 20-30 kg/m2,scheduled for elective fiberoptic bronchoscopy,were randomly divided into 2 groups (n =20 each):control group (group C) and dexmedetomidine group (group D).In group D,a loading dose of dexmedetomidine 0.5/μg/kg was injected at 10 min before induction of anesthesia,followed by infusion at 0.5 μg· kg-1 · h-1 until the end of fiberoptic bronchoscopy.While the equal volume of normal saline was given instead in group C.Anesthesia was induced with TCI of propofol and remifentanil.The target effect-site concentration (Ce) of propofol was 3 μg/ml.When the plasma concentration and Ce were balanced,TCI of remifentanil (target Ce 4 ng/ml) was started.The fiberoptic bronchoscope was placed after consciousness was lost and then the Ces of propofol and remifentanil were adjusted to 1-3 μg/ml and 2-4 ng/ml,respectively.MAP,HR and OAA/S score were recorded before induction (T0),immediately after induction (T1),when the tip of fiberoptic bronchoscope reached the glottis (T2) and carina (T3),at the end of bronchoscopy (T4)and 10 min after the end of bronchoscopy (T5).The consumption of propofol and remifentanil,duration of bron-choscopy,emergence time,adverse cardiovascular events and side effects such as hyoxemia,nausea and vomiting,regurgitation and aspiration were recorded.Results Compared with group C,OAA/S score at T5 and the consumption of propofol and remifentanil was reduced,and emergence time was shortened,and the incidence of hypotension and hyoxemia was decreased in group D (P ＜ 0.05).No patients developed side effects such as hyoxemia,nausea and vomiting,regurgitation and aspiration in both groups.Conclusion Dexmedetomidine (infusion at 0.5 μg·kg-1 ·h-1 after a loading dose of 0.5 μg/kg) combined with TCI of propofol and remifentanil can be safely and effectively used for fiberoptic bronchoscopy in the elderly patients.

Objective To investigate the teaching effect of applying idea of ‘ integrating world with specialty' in teaching ward - round.Methods Totally 112 undergraduates from department of anesthesiology in Chongqing medical university were randomly divided into 2 groups:group C and group T.The students in group C and group T were received traditional method and teaching ward-round applying idea of ‘integrating world with specialty' respectively.The teching effects were compared.Results Constituent ratio of performance of written test and defence of case analysis in group C and group T were respectively as follow,excellent ( 12％,19％) vs.(31％,37％),good (25％,19％ ) vs.(50％,44％ ),middle (54％,50％ ) vs.( 19％,13％ ),bad (9％,12％ ) vs.(0,6％ ),and there were statistically differences between the two groups.Conclusion Teaching ward-round applying idea of ‘ integrating world with specialty' integrates medical knowledge with social skills and common sense of life,making it easier for medical students to understand and master professional knowledge,as a result of improving the students' ability of problem analysing and solving.

Objective To investigate the effect of KCNQ2/3 channel opener retigabine on the median effective dose (ED50) of bupivacaine and chloroprocaine for induction of convulsion in mice and the relationship between KCNQ2/3 channels and the neurotoxicity of local anesthetics.Methods Pathogen-free female Kunming mice,weighing 20-30 g,were used in the study.The experiment was performed in two parts.Part Ⅰ Sixty mice were randomly divided into 2 groups (n =30 each):control group (group C) and retigabine group (group R).The C and R groups were further divided into 3 subgroups with different doses of chlorprocaine (C + L1,C + L2 and C+ L3 groups,and R+ L1,R+ L2 and R+ L3 groups,n =10 each).In groups C and R,0.9％ normal saline 0.005 ml/g and retigabine 20 mg/kg were injected intraperitoneally,respectively,and chlorprocaine was injected intraperitoneally 20 min later.The doses of chlorprocaine were 150.0,172.5 and 198.4 mg/kg in C + L1,C + L2 and C + L3 groups,respectively,and 198.4,228.2 and 262.4 mg/kg in R+ L1,R+ 12 and R+ L3 groups,respectively.Part Ⅱ Eighty mice were randomly divided into 2 groups (n =40 each):control group (group C) and retigabine group (group R).The C and R groups were further divided into 4 subgroups with different doses of bupivacaine (C + B1,C + B2,C + B3 and C + B4 groups,and R + B1,R + B2,R + B3 and R + B4 groups,n =10 each).In groups C and R,0.9％ normal saline 0.005 ml/g and retigabine 20 mg/kg were injected intraperitoneally,respectively,and bupivacaine was injected intraperitoneally 20 min later.The doses of bupivacaine were 37.8,43.5,50.0 and 57.5 mg/kg in C + B1,C + B2,C + B3 and C + B4 groups,respectively,and 50.0,57.5,66.1 and 76.0 mg/kg in R + B1,R + B2,R + B3 and R + B4 groups,respectively.The ED50 and 95％ confidence interval (CI) of bupivacaine and chloroprocaine for induction of convulsion were calculated by Probit analysis.Results The ED50(95％ CI) of chloroprocaine was 165.3 (155.8-175.0) mg/kg,and the ED50(95％CI) of bupivacaine was 41.1 (36.7-44.5) mg/kg in C group.The ED50 (95％ CI) of chloroprocaine was 212.4 (200.2-224.3) mg/kg,and the ED5o (95％ CI)of bupivacaine was 51.5 (945.1-56.0)mg/kg in R group.Compared with group C,the ED50 of bupivacaine and chloroprocaine for induction of convulsion was significantly increased in group R (P ＜ 0.01).Conclusion KCNQ2/3 channel opener retigabine can significantly increase the ED50 of bupivacaine and chloroprocaine for induction of convulsion and reduce convulsion induced by bupivacaine and chloroprocaine in mice,indicating that the neurotoxicity of local anesthetics is related to inhibition of KCNQ2/3 channels.

Objective To evaluate the effects of different concentrations of chloroprocaine on KCNQ2/Q3 channel currents in HEK2936 cells.Methods Human embryonic kidney (HEK293) cells served as an expression system.KCNQ2 and KCNQ3 cDNAs and green fluorescent protein were transfected into HEK293 cells by using lipofectamine.The KCNQ2/Q3 currents were recorded by using the whole-cell patch-clamp technique.Part Ⅰ The transfected HEK293 cells were randomly divided into 4 groups (n =11 each):control group,and 1,10 and 100 mmol/L chloroprocaine groups.The KCNQ2/Q3 channel currents produced by different concentrations of chloroprocaine were recorded under different holding potentials (-40,0 and 40 mV) and the action time was 1 min.Part Ⅱ The transfected HEK293 cells were randomly divided into 2 groups (n =5 each):control group and 10 mmol/L chloroprocaine.The KCNQ2/Q3 channel currents were recorded under different holding potentials (-80-30 mV)and the action time was 1 min.Different test potentials were normalized and fitted to Boltzmann function,and KCNQ2/Q3 channel Ⅰ-Ⅴ curve was then obtained.The activation and deactivation currents were both fitted to a single exponential function and the time constants for current activation and for current deactivation were calculated.Results Part Ⅰ When the holding potential was 40,0 and-40 mV,the suppression rate of KCNQ2/Q3 channel currents in HEK293 cells was higher in 1,10 and 100 mmol/L chloroprocaine groups than in control group (P ＜0.05 or 0.01).Part Ⅱ Compared with control group,the time constant for the current activation at 0 mV of holding potential was prolonged,the time constant for the current deactivation was shortened when the holding potential was-80 mV,and the half-activation voltage of KCNQ2/Q3 channels was increased,the activation curve shifted to the depolarized potentials,and KCNQ2/Q3 channel Ⅰ-Ⅴ curve slope was decreased in 10 mmol/L chloroprocaine group (P ＜ 0.05).Conclusion Chloroprocaine concentration-dependently suppresses KCNQ2/Q3 channel currents in HEK2936 cells.The KCNQ2/Q3 channel is closed in advance due to KCNQ2/Q3 channel opening delay induced by chloroprocaine thus decreasing the activity of KCNQ2/Q3 channels.

Totally, 102 general practitioners (GPs) from 40 community health-care service centers in a district of Beijing were investigated for their awareness of diagnosis, treatment and prevention for chronic hepatitis B and evaluating effectiveness of their training with self-designed questionnaire before and after professional training.Before training, higher awareness of knowledge about prevention for hepatitis B had been achieved in GPs, such as "hepatitis C is communicable" (78/102, 76.5% ), "hepatitis B can be prevented by protective antibody" ( 76/102, 74.5% ), whereas only 3.9% ( 4/102 ) of GPs knew indications of antiviral therapy for chronic hepatitis B, 4.9% (5/102) could describe complications of decompensated cirrhosis and 19.6% (20/102) knew methods for screening primary hepatocellular carcinoma.After training, their awareness increased significantly to 93.1% (95/102), 49.0% (50/102)and 86.3% (88/102), respectively (all P ＜0.01 ).Now, GPs' knowledge about diagnosis and treatment for hepatitis B is still insufficient at community health-care centers and professional training can improve their awareness.It is an important assurance for patients with chronic hepatitis B to be better managed in both of specialized hospitals and community health-care centers by enhancing professional training for GPs indiagnosis and treatment for hepatitis B.