ObjectiveTo investigate the changes of renin-angiotensin-aldosterone system (RAAS) and glomerular filtration rate (GFR) in epidurally-anesthetized patients undergoing gynecological laparoscopy with 15° head-down position and low insufflation pressure. MethodsTwenty gynecological patients(ASA grade I- Ⅱ )were studied during CO2 insufflation with an intra-abdominal pressure of 1012mmHg and 15° head-down position. Arterial blood samples were obtained for the measurements of serum concentrations of plasma renin activity(PRA), angiotensin Ⅱ (All), aldosterone(ALD) and β2-microglobulin(β2-MG)by radioimmunoassay at the following five time points: before insufflation, at 10min, 30min and 60 min after insufflation respectively and after desufflation. Arterial blood gas analysis was made in 10 of the cases simultaneously. ResultsCompared with preinsufflation, there was no significant decrease in the plasma levels of PRA, All ,ALD and β2-MG during CO2 pneumoperitoneum except for PRA at 10 min after insufflation(P ＜0.05). As the time of insufflation went on, the measurements above showed a tendency of slightly increase. The PaCO2 during peritoneal CO2 insufflation was increeseing ( P ＞ 0.05) and reached its maximum at 30 min after insufflation. The pH values of 30～60 min after insufflation were significantly decreased as compared with that of before insufflation. ConclusionThe epidural anesthesia may inhibit the response of RAAS to (CO2 insufflation pressure of 10-12mmHg and has no effect on GFR during gynecological laParoscopy.

Neuropathological, clinical epidemiology and animal models studies provide clear evidence for the activation of neuroinflammation in Alzheimer's disease (AD), and long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) is linked with reduced risk to develop the disease. But the clinical trials got a negative outcome with traditional NSAIDs treating AD. The therapeutic effects of NSAIDs on Alzheimer's disease are still not clear based on the present research. Profound study for anti-inflammatory mechanisms and standardized clinical trials are needed. As cause and effect relationships between neuroinflammation and AD are being worked out, the challenge is how to realize the effect of traditional NSAIDs on treating AD.

Objective To study the effects of rehabilitation training on the synaptic ultrastructure of the brain cortex after cerebral ischemia.Methods Sixty rats were randomly divided into a sham operation group,a cerebral ischemia group and a rehabilitation training group.A model of focal cerebral ischemia was created in the rats of the cerebral ischemia and rehabilitation training groups.The rehabilitation training group was given balancing,grasping,rotation and walking training every day.The sham operation group and cerebral ischemia group were kept in normal cages,taking food and moving freely.Electron microscopy was used to observe the density and ultrastructure of the cortical synapses at days 1,7,14 and 21 after the operation.Results In the sham operation group there were numerous synaptic terminals in the cortical neuropil.The majority of synapses were Gray type Ⅱ,containing spherical synaptic vesicles in presynaptic elements.After cerebral ischemia,the number of synaptic terminals had decreased and the synaptic structure was damaged.The synaptic vesicles lessened and dissolved.The presynaptic and postsynaptic membranes became unclear.At 21d after ischemia,the synaptic vesicles had disappeared and the presynaptic and postsynaptic membranes were damaged so seriously that the typical synaptic structure disappeared.After rehabilitation training,the damaged synaptic terminals recovered.Conclusions The synaptic structure was damaged after cerebral ischemia,and the damaged synaptic terminals recovered after rehabilitation training.Rehabilitation training can enhance synaptogenesis in the brain's cortex after cerebral ischemia and promote the recovery of motor function,at least in rats.

Aim To investigate the mechanism of high mobility group protein B1(HMGB1)and tumor necrosis factor α-induced protein-3(TNFAIP3)involved in cell proliferation in lupus nephritis(LN)patients and human mesangial cells(HMC).Methods Immunofluorescence and immunohistochemistry technique were employed to detect HMGB1,TNFAIP3 and IκBα expression levels in glomerular cells of type Ⅳ LN patients.BrdU incorporation technology was used to detect cell proliferation level in HMC after stimulated by recombinant HMGB1.TNFAIP3 and IκBα expression levels in HMC were detected after HMGB1 stimulation by Western blot.Results The expression levels of HMGB1 and TNFAIP3 were increased in LN patients,while IκBα was decreased.HMC proliferation levels increased significantly after HMGB1 stimulation.At the same time,30 minutes after HMGB1 stimulation,the expression level of TNFAIP3 was significantly increased(P<0.05),while IκBα decreased(P<0.05)and then p65 increased significantly(P<0.05),compared with control group.Conclusion HMGB1 and TNFAIP3 are probably involved in mesangial cell proliferation by activating of NF-κB signaling pathways in LN pathogenesis.

Objective: To compare the outcome of postoperative adjuvant chemotherapy and surgery alone for stage pT1b-3N0M0 squamous cell carcinoma (SCC) of the thoracic esophagus. Methods: Two hundred and thirty-eight patients who underwent esophagectomy for stage pT1b-3N0M0 SCC of the thoracic esophagus in Department of Thoracic Surgery, Fourth Hospital, Hebei Medical University between January 2008 and February 2011 were analyzed retrospectively. These included postoperative adjuvant chemotherapy for 118 patients and surgery alone for 120 patients. In postoperative adjuvant chemotherapy arm, 3 or 4 cycles of taxol+ cisplatin (TP, n=33) or fluorouracil+ cisplatin (FP, n=85) regimens were given commencing from 4 to 6 weeks after surgery. Survival analysis was performed using Kaplan-Meier method. Univariate analysis for prognostic factors was performed by Log-rank test and multivariate by Cox regression model. Results: The 3- and 5-year disease-free survival (DFS) rates were 57.9% and 53.8%, respectively for postoperative adjuvant chemotherapy patients, compared to 40.4% and 32.5% for patients who underwent surgery alone (χ²=11.973, P=0.001). The 3- and 5-year overall survival (OS) rates were 64.4% and 55.9% in postoperative adjuvant chemotherapy patients, and 46.7% and 33.5% in surgery alone patients (χ²=13.110, P=0.000). Stratification analysis showed that there was significant difference in stage T3 patients (χ²=7.895, P=0.006), but not in stage T1b (χ²=0.762, P=0.383) and T2 (χ²=1.259, P=0.262) patients between adjuvant chemotherapy and surgery alone. Both DFS rate (χ²=1.748, P=0.186) and OS rate (χ²=2.200, P=0.138) of TP group were similar with FP group. Conclusion In lymph node negative esophageal SCC patients, postoperative adjuvant chemotherapy shows survival benefits in stage T3 patients.

As one of notable works of HUANG Yuanyu， a renowned physician from the Qing Dynasty， The Indications of Classics by Four Medical Sage emphasize the theoretical paradigm of “one qi circulation” with a particular focus on the middle qi. Building upon disease differentiation and treatment， HUANG Yuanyu attaches great importance to understanding the underlying cause of the disease. It is believed that the imbalance of the six climatic factors is the fundamental cause of diseases. The concept of mutual interaction between the physiological and pathological aspects of the six climatic factors is proposed to grasp the basic pathogenesis. Based on the individual's specific condition of six climatic factors， excess or deficiency， specific prescriptions are formulated. The diagnosis and treatment system can be summarized as a “differentiation of diseases → disease etiology → differentiation of the condition of six climatic factors → individualized pathogenesis of traditional Chinese medicine （TCM） → prescription of TCM” model based on the holistic view. HUANG Yuanyu' s diagnosis and treatment system is highly practical and can provide reference for clinical diagnosis and treatment of diseases in TCM.

Objective:To investigate the effectiveness of a hierarchical teaching model guided by "residency-specialty integration" in residency training and specialty training of oral and maxillofacial surgery with the training base of oral and maxillofacial surgery in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, as the research subject.Methods:A total of 144 trainees receiving residency training and 32 receiving specialist training were enrolled from June 2022 to April 2023 and were divided into experimental group and control group, with 72 trainees receiving residency training and 16 receiving specialist training in each group. Clinical and learning tasks were designed using the traditional model for the control group and the hierarchical teaching model guided by "residency-specialty integration" for the experimental group, and the performance of trainees in theoretical assessments and self-evaluations was recorded. SPSS 23.0 was used to perform the t-test. Results:The hierarchical teaching model guided by "residency-specialty integration" achieved a significant effect in both theoretical assessments and self-evaluations of the trainees. As for the trainees receiving specialty training, there was a significant difference in the score of theoretical assessment between the experimental group and the control group (84.56±4.05 vs. 81.13±2.78, P<0.05), and as for the trainees receiving residency training, there was also a significant difference in this score between the experimental group and the control group (84.74±4.85 vs. 82.10±4.34, P<0.01). The results of self-assessment questionnaire showed that compared with the control group, the experimental group had a higher proportion of trainees giving positive evaluations of various indicators. Conclusions:This study suggests that the hierarchical teaching model guided by "residency-specialty integration" provides an effective teaching model for residency training and specialty training of oral and maxillofacial surgery, and this model may help to enhance disciplinary interests and promote clinical practice abilities, thereby providing valuable insights for future medical education in China.

Amyloid beta-peptides (Aβ) are known to undergo active transport across the blood-brain barrier, and cerebral amyloid angiopathy has been shown to be a prominent feature in the majority of Alzheimer׳s disease. Quercetin is a natural flavonoid molecule and has been demonstrated to have potent neuroprotective effects, but its protective effect on endothelial cells under Aβ-damaged condition is unclear. In the present study, the protective effects of quercetin on brain microvascular endothelial cells injured by fibrillar Aβ 1-40 (fAβ 1-40) were observed. The results show that fAβ 1-40-induced cytotoxicity in human brain microvascular endothelial cells (hBMECs) can be relieved by quercetin treatment. Quercetin increases cell viability, reduces the release of lactate dehydrogenase, and relieves nuclear condensation. Quercetin also alleviates intracellular reactive oxygen species generation and increases superoxide dismutase activity. Moreover, it strengthens the barrier integrity through the preservation of the transendothelial electrical resistance value, the relief of aggravated permeability, and the increase of characteristic enzyme levels after being exposed to fAβ 1-40. In conclusion, quercetin protects hBMECs from fAβ 1-40-induced toxicity.