AIM To investgate the changes in the expression of CREB and p-CREB in the cortex of ethanol dependent rats. On other hand, the effects of fluoxetine on these changes were also studied. METHODS Ethanol was administered in drinking water at the concentration of 6% V/V, for 28 d. The expression of CREB and p-CREB in the rat cortex were measured by immunohistochemistry methods. RESULTS It was found that chronic ethanol treatment and its withdrawal did not modify the expression of CREB in the rat cortex. However, the levels of p-CREB in the frontal and piriform cortex of rats were significantly decreased during ethanol withdrawal, and respectively decreased 57.28%?55.84% compared to control rats at 24 h after ethanol withdrawal. When fluoxetine (ip, 10 mg?kg -1) were administried concurrently with ethanol, it can significantly dampen alcohol withdrawal symptoms and antagonize the down-regulation of the phosphorylation of CREB in the frontal and piriform cortex of rats at 24 h after ethanol withdrawal, the expression of p-CREB protein respectively increased 292 58%,128 44% compared with rats intaking ethanol. CONCLUSION CREB may be one of the substance of the signal transduction process for ethanol dependence. Fluoxetine can reverse the decreased p-CREB levels in rat cortex induced by ethanol withdrawal, which may be the part reason of fluoxetine dampening alcohol withdrawal symptoms.

To assess the efficiency and reliability safety of ganciclovir to herpes simplex virus keratitis.
●METHODS: All of the randomized controlled trials for the study of ganciclovir versus acyclovir in the treatment of herpes simplex virus keratitis were collected from Cochrane Library, EMbase, PubMed, Chinese Bio -medicine Database, China Journal Full-text Database, VlP Database and WanFang Database. Then the data were extracted and evaluated by two reviewers independently. Risk of bias assessment was evaluated by a tool recommended by Cochrane Library. Revman 5. 0 software was used for statistical analysis.
●RESULTS: Finally, 14 randomized controlled trials were included, 4820 patients totally. Subgroups were used according to the number of patients and diseased eyes as well as the difference of follow-up time. For and relapse rate, ganciclovir group was overmatch acyclovir group. There were statistical differences between the two groups [RR= 1. 22, 95%CI (1. 10-1. 36); OR = 4. 50, 95% CI (2. 02-10. 04); RR = 0. 23, 95% CI (0. 10-0. 52)]. Compared with acyclovir, ganciclovir had less side - effect. There were statistical differences between the two groups [RR = 0. 12, 95%CI (0. 03 - 0. 46)]. All of the side effects of the two groups can be relieved by themselves.
● CONCLUSlON: Current evidence suggests that the ganciclovir is more efficient and safe than acyclovir in the treatment of herpes simplex virus keratitis.

The accommodative function before and after laser in situ keratomileusis (LASIK) was observed, and the effect of LASIk on accommodation was investigated. In a prospective clinical trial, 48 myopic patients (96 eyes) subject to bilateral LASIK in Refractive Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (China) from March 2006 to June 2006 were selected and studied. Refractions, accommodative range, amplitude of accommodative response and high frequency component (HFC) of accommodative microfluctuations were measured with NEDIK-730A before and one week and 30 days after operation. Dominant and non-dominant eyes were determined by hole-in-card method. It was found that all of the operative eyes showed an uncorrected visual acuity of 0.8 or better one week postoperatively, and 1.0 or better 30 days postoperatively. Compared with those preoperatively, accommodative range and HFC had no significant difference at first week and 30th day after operation in both dominant eyes and non-dominant eyes (P>0.05), but there was a significant difference in the amplitude of accommodative response/accommodative stimulus ratio (A/S) after operation (P<0.01), and no significant difference was found in accommodation between one week and 30 days postoperation. No ocular dominance's change was noted. There was no significant difference in accommodative function between dominant eyes and non-dominant eyes. It was suggested that LASIK produced no significant effect on accommodation.
Accommodation, Ocular/*physiology ; Keratomileusis, Laser In Situ/*adverse effects ; Myopia/*physiopathology ; Myopia/*surgery ; Postoperative Period ; Prospective Studies ; Young Adult

Objective To evaluate the effect and safety of glucocorticosteroids in prevention of post-ERCP pancreatifis(post-endo- scopic retrograde cholangiopancreatography pancreatitis,PEP).Methods The database of Cochrane Library(issue 4,2006),Medline (1966-2007.1),EMBASE(1986-2007.1)and CBM(1978-2007.1)were searched.The cited literature of obtained articles and some core English and Chinese medical journals(July,2006-Jan,2007)relevant to gastro-enterolngy were also searched by hand.All random- ized controlled trials(RCT)comparing glucocorticosteroids to placeboes in prevention of PEP were included.Data collection and literature evaluation were performed by two reviewers independently.RevMan 4.2.8 was used for statistical analysis.Result Six RCTs were includ- ed in meta-analysis which showed no statistical difference for the incidence of overall PEP between the glucocorticosteroids group and place- bo group(RR=1.11,95%CI 0.89-1.39).Stratified by severity of PEP,four trials were included.Meta-analysis showed no statistical difference for the incidence of mild to moderate PEP and severe PEP between the two groups(RR=1.17,95%CI 0.91-1.51 for mild- moderate PEP;RR=1.79,95%CI 0.69-4.65 for severe PEP).Stratified by therapeutic ERCP,three RCTs were included.Meta-analy- sis showed no statistical difference for the incidence of PEP between the two groups(RR=1.24,95%CI 0.91-1.67).3 trials as to inter- im-analysis were excluded by sensitive analysis.Meta-analysis also showed no statistical difference for the incidence of PEP between the two groups(RR=0.73,95%CI 0.44-1.20).Conclusion Based on current evidence,glucocorticosteroids is not beneficial in preventing the occurrence of PEP.Further high quality study is needed to disclose the efficacy of glucocorticosteroids in prevention of PEP.

Twenty-six total intravenous anesthesia was performed in 23 ASAⅡorⅢpatients with various advanced malignancies undergoing whole body hyperthermia (WBH). Their age ranged from 32 to 67 yrs and body weight between 42 and 77 kg. The patients had no hypertension, coronary artery disease or diabetes mellitus. Anesthesia was induced with midazolam 5-10 mg, fentanyl 0.1 mg, propofol 1.5-2.5 mg?kg-1 and vecuronium 0.12 mg?kg-1 and maintained withⅣinfusion of midazolam (0.08-0.16 mg?kg-1?h-1), remifentanil (0.05-0.15?g?kg-1?h-1) and vecuronium (0.08-0.15 mg?kg-1?h-1). The patients were mechanically ventilated (VT = 8-12 ml?kg-1, RR= 10-18 bpm, FiO2 = 1.0) after tracheal intubation. PETCO2 was maintained at 35 mm Hg. ECG, MAP, HR, CVP, SpO2 , PETCO2 , peak airway pressure, VT, RR, minute ventilation (MV), urine output, core temperature (lower esophageal and naso-pharyngeal) and surface temperature were continuously monitored. Swan-Ganz catheter was placed in 15 patients. MPAP, PCWP and cardiac output (CO) were measured and Qs/Qt, cardiac index (CI) and stroke index (SI) were calculated. WBH was induced in an ultra-red radiation hyperthermic cabin (type ET-SpaceTM-1) and was divided into 3 phases:Ⅰwarming phase (lower esophageal temperature increased gradually to 41.8℃) ;Ⅱhyperthermic phase (lower esophageal temperature was maintained at 41.8℃for 1 h) andⅢcooling phase (core temperature was gradually decreased to 38.5℃without any cooling measures). Blood samples were taken from artery and Swan-Ganz catheter 15 min after induction of anesthesia (baseline), at 39℃, 40℃, 41℃and 41.8℃during warming phase, at the late hyperthermic phase and at 40℃and 38.5℃during cooling phase for blood gas analysis, determination of blood electrolytes and sugar. As the temperature was increasing, HR, CI, SI, CVP, MPAP, PCWP, Qs/Qt and peak airway pressure were gradually increased while MAP, PaO2 , pHa, BE and blood glucose and K+ were decreasing during warming phase (Ⅰ). These changes reached the peak levels at the late period of hyperthermic phase (Ⅱ) and then gradually returned to baseline during cooling phase (Ⅲ) . Vasoactive drugs and fluid infusion including crystalloid and colloid were needed to maintain hemodynamic stability in 69% patients. Acidosis had to be corrected in 54% patients. Severe hypotension and pulmonary edema occurred in 4 patients. Continuous hemodynamic monitoring, respiratory support, maintenance of circulatory stability and correction of acidosis and hypokalemia were the key factors in the management of patients during WBH.

Objective To compare the difference between intermittent epidural bolus(IEB) combined with patient controlled epidural analgesia(PCEA)and continuous epidural infusion(CEI)combined with PCEA mode in labor analgesia. Methods It was a retrospective cohort study ,which subjects were assigned to CEI+PCEA and IEB + PCEA group. Correlated data were collected to compare the effect of the two analgesic mode on perinatal events. Results There were less consumption of ropivacaine and sufentanil per hour ,less PCEA request and actual bolus in IEB + PCEA group. There were no significant difference between the delivery mode and the percentage of low Apgar score in neonates. Conclusion IEB+PCEA mode has better analgesic effect ,meanwhile doesn't disturb the delivery mode has no effect on the neonate outcome.

ObjectiveTo observe the effect of nursing interventions on improvement of psychological actions and quality of life of patients with Alzheimer disease. Methods50 patients with senile dementia diagnosed in our hospital were chosen.They were divided into the observation group and the control group with 25 patients in each group.All patients were taken with AD routine nursing care after admission.The observation group was taken with rehabilitation nursing interventions based on AD routine nursing care.The mini-mental state examination (MMSE)and the daily life ability scale (ADL)were used to evaluate the quality of life after nursing intervention. ResultsThe patients' MMSE score in the observation group was significantly higher than the control group,the difference was statistically significant.The ADL score of the observation group was significantly lower than the control group,the difference was statistically significant. ConclusionsThe use of integrated care intervention can significantly improve the cognitive function in AD patients,and improve daily living ability and quality of life significantly.

Objective To observe the stressor characteristic of patients with maintained hemodialy-sis (MHD). Methods The Chinese version of bemodialysis stressor seale(HSS) was adopted among 436 bemodialysis participants and the results underwent analysis. Results Among 436 patients psychological stressors> physiological stressers > social stressors, the most severe stressors included the requirement of long-term dialysis, the rest showed sequence from high to low: medical cost, concerning about the future,changes in family responsibility and decrease in sexuality. The slightest stressors included decreased ability to procreate, being limited in some styles of clothing, arterial and venous stick, reversal in family role with the children and changes in body appearance. Significant differences existed in patients with different age,gender, education background, working status and economic status, it manifested as follows: the more elder-ly, the more severity of stress, male patients had more severe stress than the female, patients with higher e-ducation background showed lower stress level, patients who kept working had lower level of stress, pa-tients who had better economic status showed lower stress level. Conclusions MHD patients often expe-rience high stress levels. Some measures should be taken to help MHD patients to cope better with stress.

Objective To analyse the clinical features and risk factors of interstitial lung disease in primary SjSgren's syndrome (pSS).Methods A retrospective study was employed.All 130 pSS patients who were hospitalized during 2004 to 2006 were enrolled into this study.Thirty-seven clinical and laboratory variables were used as the research factors and interstitial lung involvement as the related factor.The data were analyzed with the Logistic regression model.Results of 130 patients,22(16.9%) had interstitial lung involvement.Twelve patients were asymptomic when pulmonary involvement was detected.Variables in the univariate analysis which were significantly associated with lung fibrosis were age,exocrine glands(including parotid,sublingual gland and submandibular gland) swelling,oral ulceration and fever.Positive rate of antiU1RNP antibody in group of lung damage was significantly higher than non-lung damage group [5/22(22.7%)vs 6/108 (5.6%),P=0.021].In the Logistic regression model.variables which were significantly associated with pulmonary involvement were exocrine glands swelling (OR=3.739,95%CI 1.069～16.079,P＜0.05).oral ulceration (OR=3.739,95%CI 1.069～16.079,P＜0.05)and fever (OR=3.067,95%CI 1.198～20.067,P＜0.05).Conclusions This study indicates that some of the pulmonary damages of pSS are subclinical.Exocrine glands swelling,oral ulceration and fever are the risk factors for interstitial pulmonary involvements in pSS.

Objective To explore the ultrasonographic, clinical and histopathological characteristics features of primary uterus lymphoma. Methods The clinical, sonographic and histopathological characteristics of nine patients who were pathologically comfirmed as primary uterus lymphoma were analyzed. Results Among the nine cases of primary uterus lymphoma, three lesions were found in the uterine bodys and 6 were found in the cervixes. Two patients with uterine body lymphoma had painless pelvic masses and six patients with cervix lymphoma had contact bleeding, including irregular vaginal bleeding in four patients. In sonograms, six lesions showed remarkable hypoechogenicity with homogeneous internal echogenicity;the margins of most lesions were circumcribed;all lesions had posterior enhancement. In color Doppler lfow imaging, abundant vascularities were detected in eight lesions. In the cases of uterine body lymphoma, all of the uterine bodys showed diffuse symmetrical enlargement without disruption of the endometria, while in ifve cases of cervix lymphoma, the tumors showed the shape of lobule. The pathological examination showed that all tumors were diffuse B-cell type non-Hodgkin lymphoma. Conclusions Primary uterus lymphoma has some clinical and ultrasonic features, including contact bleeding or irrgular vaginal bleeding, diffuse symmetrical enlargement of uterine body, complete endometria, remarkable hypoechogenicity, homogeneous echogenicity and posterior enhancement. Final diagnosis depends on the histopathology.