Objective To evaluate the efficacy and safety of dexmedetomidine combined with propofol for gastroscopy in elderly patients.Methods Ninety ASA physical status Ⅰ-Ⅲ patients,aged 65-80 yr,weighing 45-80 kg,scheduled for elective gastroscopy,were randomized to receive either dexmedetomidine combined with propofol (group DP,n =45) or propofol (group P,n =45).In group DP,dexmedetomidine 0.4 μg/kg was infused over 5 min and propofol 1.0 mg/kg was injected intravenously 25 min later.Propofol 2.0 mg/kg was injected intravenously in group P.When body movement occurred during operation,additional propofol 0.2 mg/kg was given intermittently.Mean arterial pressure (MAP),heart rate (HR),pulse oxygen saturation (SpO2) and Narcotrend index were monitored during the whole procedures.The consumption of propofol and vasoactive agents,adverse cardiovascular events,and respiratory depression were recorded.Results Compared with group P,the consumption of propofol,incidences of respiratory depression and tachycardia,and degree of body movement were significantly decreased (P ＜ 0.05),Narcotrend index was increased during operation (P ＜ 0.01),and no significant change in the incidence of circulatory depression was found in group DP (P ＞ 0.05).Conclusion Small dose of dexmedetomidine 0.4 μg/kg combined with small dose of propofol 1.0 mg/kg provides good efficacy and safety for gastroscopy in elderly patients.

Objective To construct h n bone marrow mesenchymal stem cell line genetically modified with human proenkephalin gene. Methods The packaging cell line Phoenix-293T was transfected with the recombinant pBABE-PENK vector to aquire virus. The recombinant virus was then collected and used to infect hMSCs. Stable expression of proenkephalin gene and leucine enkephalin protein and the concentration of leucine enkephalin protein were detected by RT-PCR, immunofluorescence and ELISA respectively. Results The expression of proenkephalin gene and leucine enkephalin protein were significantly up-regulated in the hMSC-PENK cells, and the concentration of leucine enkephalin protein was also increased in the culture medium. Conclusion A human mesenchymal stem cell line that expresses proenkephalin gene and secrets enkephalin was successfully established.

Focal adhesion kinase is a non-receptor protein tyrosine kinase with molecular weight 125 ku and regarded as the foundmental molecule of integrin-dependent signal transduction pathway. Active focal adhesion kinase regulates cell adhesion, migration, proliferation and differentiation by interacting with Src family kinase, phosphatidylinositol-3 kinase, cytoskeletal proteins, Graf and adoptor proteins through the phosphorylated tyrosines and the proline-rich sequences.

Objective To investigate the analgesic effect of intrathecal(IT)human bone marrow mesenchymal stem cells(hMSC)genetically modified with human proenkephalin gene(PENK)in a rat model of neuropathic pain.Methods Forty male SD rats weighing 160-180 g in which IT catheters were successfully implanted without complication were randomly divided into 4 gorups(n = 10 each): group A normal control;group B neuropathic pain(NP);group C NP + hMSC-pBABE and group D NP + hMSC-PENK.Neuropathic pain was induced with chronic constrictive injury(CCI).Four loose ligatures were placed on the main stem of sciatic nerve with 4-0 chronic catgut.IT normal saline 10 μl,hMSC-pBABE cell suspension 10 μl(2 × 108-3 × 108/μl)and hMSCPENK cell suspension 10 μl(2 × 108-3 × 108/μl)were injected in group B,C and D respectively on the 3rd day after operation.Paw-withdrawal latency(PWL)to noxious thermal stimulation was measured before(baseline)and at 3,5,7,9 and 14 d after operation.The animals were killed on the 14th day after last PWL measurement.RNA was extracted from the spinal cord for determination of proenkephalin mRNA expression.Results PWL was significantly decreased after operation as compared with the baseline values before operation in group B,C and D.PWL was significantly longer at 7,9,14 d after operation in group D than in group B and C but there was no significant difference in PWL after operation between group B and C.PENK mRNA expression was significantly lower in group B and C than in group A,but was significantly higher in group D than in group B and C.There was no significant difference in PENK mRNA expression between group B and C.Conclusion Intratheccal human bone marrow mesenchymal stem cells genetically modified with human proenkephalin gene can relieve neuropathic pain in rats.

early lithagogue rate.

Objective To investigate the clinical curative effect of“Qing Dynasty Palace manipulation” in combination with plaster immobilization and foot bath with traditional Chinese medicine for acute soft tissue sprain of the ankle.Method A total of 90 patients with acute soft tissue sprain of the ankle from emergency department of WangJing Hospital, CACMS were recruited from July 2013 to April 2014 and randomly divided into two groups with 45 patients in each. The patients in the treatment group were treated with the court manipulation, plaster and Chinese herbs washing, and those in the control group were only treated with cast immobilization. The clinical curative effect was evaluated using Baird-Jackson score system(excellent: 96-100; good: 91-95; fair: 81-90; poor: 0-80).Result At the second, third week after treatment, the excellent/good rates in the treatment group were significantly higher than those in the control group(at week 2: 73.3%vs. 44.4%;χ2=11.468,P<0.01; at week 3: 86.7%vs.60.0%;χ2=6.875,P<0.05). At week 2 and 3, Baird-Jackson scores in the treatment group(87.41±14.12, 93.16±9.51)and in the control group(76.32±11.41, 82.54±9.22)were significantly higher than those before treatment(treatment group: 72.11±12.61; control group: 71.67±13.12, allP<0.05); at week 3, Baird-Jackson score in the treatment group were significantly higher than that in the control group(P<0.05).Conclusion“Qing Dynasty Palace manipulation” in combination with plaster immobilization and foot bath with traditional Chinese medicine can increase Baird-Jackson score and aid recovery of the ankle function in patients with acute soft tissue sprain of the ankle.

Objective To compare the clinical effects of transurethral plasmakinetic resection(TUPR) with transurethral resection of the prostate(TURP) for benign prostatic hyperplasia.Methods From October 2003 to July 2006,a total of 127 patients with benign prostatic hyperplasia was divided the into the TURP Group(n=62) and the TUPR Group(n=61) according to random number table by computer.1 case of neurogenic bladder and 3 cases of TURP failure were ruled out the study.Results As compared with the RTRP Group,the TUPR Group had less intraoperative blood loss[(78.5?46.2)ml vs(115.0?43.5)ml,t=4.511,P=0.000] and more weight of resected prostate[(60.5?29.3)g vs(45.9?30.5)g,t=2.709,P=0.008].The operation time in the two groups was similar[(93.4?35.5)min vs(81.3?46.3)min,t=1.629,P=0.106].There were no statistic differences in international prostate symptom score,quality of life,Qmax,residual urine and complication rate(2/61 vs 5/62).Conclusions Compared with TURP,transurethral plasmakinetic resection of the prostate has the advantages of less blood loss and more entire resection of the prostate,so it might be more effective.

Tuberculous meningitis is an important global medical problem which gives rise to high morbidity and mortality. It is the most severe form of extrapulmonary Mycobacterium tuberculosis. Comprehensive prevention effort, prompt diagnosis and rational treatment are all keys to improving treatment outcomes; yet many unsolved problems remain. On the other hand, the new problems, such as HIV co-infection and drug-resistance are posing important challenges. This review outlines the epidemiology, pathogenesis, diagnosis, management and prognosis of tuberculous meningitis. We mainly focus on research carried out in the recent decades, giving special attention to the work done among the Asian populations
Tuberculosis, Meningeal

Recent in vitro and in vivo experiments have revealed that ellagic acid and its metabolites can inhibit the growth of digestive system malignant tumor cells by inhibiting tumor cell proliferation,inducing apoptosis,breaking DNA binding to carcinogens,blocking virus infection,disturbing inflammation,angiogenesis and drug-resistance processes required for tumor metastasis.Ellagic acid and its metabolites are potential chemoprevention and therapeutic drugs against human cancers.

Objective To assess the clinical outcomes in patients who underwent laparoscopic primary closure of common bile duct (CBD) with or without transcystic cholangiography and transcystic biliary drainage.Methods From June 2013 to March 2016,we operated on 46 patients who underwent primary closure of common bile duct after laparoscopic choledochotomy (group A).The results were compared with 51 patients who underwent primary closure of common bile duct after laparoscopic choledochotomy together with transcystic biliary drainage (group B) during the same study period.Results There was a significant difference in the incidence of postoperative bile leakage between the two groups.The risk in group A was sig nificantly higher than group B (8.7％ vs 0％,P ＜0.05).The duration of operation in group A was significantly shorter than in group B [(125.3 ± 28.3) min vs (131.3 ± 20.5) min].There were no significant differences in the duration of hospital stay between the two groups [(7.3 ± 2.4) days vs (7.8 ± 1.9) days,P ＞ 0.05].All patients were followed up (range 3 months to 29 months,average 8.4 months).B-ultrasound examination showed no residual bile duct stones and the liver functions were normal.Conclusions Laparoscopic primary closure of common bile duct was possible after choledochotomy.Transcystic cholangiography and transcystic biliary drainage after primary closure of common bile duct were safer and more reli able.