BACKGROUND:Elderly patients may suffer from cognitive dysfunction after arthroplasty, which easily leads to the emergence of various postoperative complications, and even leads to the death of the patient. Different methods of analgesia are used to reduce the incidence of cognitive dysfunction after lower limb arthroplasty in elderly patients. OBJECTIVE:To compare the incidence of early cognitive dysfunction in elderly patients with total knee arthroplasty under different analgesia. METHODS: A total of 82 elderly patients with total knee arthroplasty in the Liuzhou City People’s Hospital Affiliated to Guangxi University of Science and Technology from December 2013 to December 2014 were enroled in this study, equaly and randomly assigned to control group and observation group, which received general anesthesia and epidural anesthesia, respectively. At 3 days after arthroplasty, Mini Mental State Examination score, visual analogue scale score and incidence rate of postoperative cognitive dysfunction in the two groups were observed and compared. RESULTS AND CONCLUSION:No significant difference in Mini Mental State Examination score was detected between the two groups (P > 0.05), but visual analogue scale score and incidence rate of postoperative cognitive dysfunction were significantly lower in the observation group than in the control group (P < 0.05). Moreover, visual analogue scale score was an independent risk factor for postoperative cognitive dysfunction (P < 0.05). These findings suggest that regarding the effect in the early postoperative cognitive function, implementation of intravenous anesthesia or epidural anesthesia in elderly patients undergoing total knee arthroplasty does not have apparent difference. As for the incidence of postoperative analgesic effect and postoperative cognitive dysfunction, epidural analgesia is better. Through analysis, the pain is a risk factor for cognitive dysfunction after total knee arthroplasty in elderly patients.

The re-testing for postgraduate candidates is an important part in the work of enrollment.The article expounds the general development of re-testing for postgraduate candidates,especially in the new period(since 2003).After a series of reform taking place since 2003,the development of the re-testing for postgraduate candidates has a positive effect on enhancing the quality of enrollment.

BACKGROUND: Efficacy of gap arthroplasty (GA) versus interpositional arthroplasty (IA) for temporomandibular joint ankylosis (TMJA) is rarely reported, and the treatment efficacy is still under discussion. OBJECTIVE: To systematically review the efficacy of GA versus IA in the TMJA treatment and patient's prognosis. METHODS: A computer-based online research of the databases of WanFang, CqVip, PubMed, Ovid, Embase, Clinical Evidence, Cochrance Library combined with the manual search of relevant controlled trials that compared the resurrence postoperative maximal incision opening and/or recurrence of the two methods for TMJA published before October, 2015 was performed. According to heterogeneity results, the maximal incision opening index was analyzed by random-effect model, and the two groups were subdivided into temporomandibular myofascial flap and other material groups, and then MD and 95%CI were calculated; recurrence was analyzed through fixed effect model, and OR and 95%CI were calculated.RESULTS AND CONCLUSION: According to the inclusion and exclusion criteria, a total of 18 eligible articles involving 999 patients were enrolled, and the GA and IA were conducted in 656 and 343 cases, respectively. Meta-analysis results of the maximal incision opening were as followings: MD= -1.85, 95%CI: (-3.15, -0.55), Z=2.80, P=0.005, I2=55.4%; the temporomandibular myofascial flap subgroup: MD= -0.94, 95%CI: (-1.84, -0.04), Z=2.05, P=0.040, I2=0.0%; the other material group: MD= -3.36, 95%CI: (-6.66, -0.66), Z=2.39, P=0.017, I2=67.0%. Meta-analysis of the recurrence showed that OR=1.38, 95%CI: (0.87, 2.17), Z=1.37, P=0.170, I2=14.9%. Egger test manifested that there were no publication biases in the literatures. Sensitivity test showed that only one study influenced the total combined Meta-analysis results, and the others were steady. These results indicate that the IA can markedly increases the maximal incision opening in the TMJA treatment compared with the GA, but the two methods have the similar recurrence rate. Due to the limited quantity and quality of the included studies, the above conclusion needs to be verified by more high quality researchs.

Objective To learn the clinical efficacy and adverse effects of nimodipine combined with riva stigmine in the treatment of senile vascular dementia,and to provide effective treatment for the disease.Methods 151 elderly patients with senile vascular dementia were randomly divided into observation group (78 cases) and control group (73 cases) by using the random number table method.The control group was given nimodipine,and the observation group was given nimodipine combined with rivastigmine.The cognitive function was assessed by mini mental state examination(MMSE) scale,clinical dementia rating (CDR) scale was used to evaluate the degree of dementia,and activity of daily living (ADL) scale was used to evaluate the ability of daily activities.P300 test was performed before and after treatment for 12 weeks,and latency period (P300-PL) and amplitude (P300-A) of P300 were determined.The adverse drug reactions of the two groups were observed during the treatment period.Results After 12 weeks of treatment,the MMSE scores of the two groups were higher than before treatment,the CDR,ADL scores of the two groups were significantly lower than before treatment (t =8.353,18.289,6.627,2.463,10.681,5.201,all P ＜ 0.05).After 12 weeks of treatment,the MMSE score of the observation group [(23.17 ±3.95) points] was significantly higher than that of the control group [(19.88 ± 4.43) points],the ADL,CDR scores of the observation group were (1.47 ± 0.26) points and (39.87 ± 7.43) points,which were significantly lower than (1.80 ± 0.34) points,(41.16 ± 6.40) points of the control group (t =4.823,6.725,5.278,all P ＜ 0.05).After 12 weeks of treatment,the P300-PL of the two groups were lower than those before treatment,the P300-A of the two groups were significantly higher than those before treatment (t =12.051,6.429,2.477,2.104,all P ＜ 0.05).After 12 weeks of treatment,P300-PL of the observation group [(321 ± 39)ms] was significantly lower than that of control group [(356 ± 44) ms] (t =5.180,P ＜ 0.05).In the course of treatment,the incidence rate of adverse reaction of the control group was 9.59％,that of the observation group was 11.54％,there was no statistically significant difference (x2 =0.151,P ＞ 0.05).Conclusion Nimodipine combined with rivastigrnine can effectively treat senile vascular dementia,improve cognitive function,degree of dementia and daily activity ability of patients,the incidence rate of adverse drug reaction is low,and the therapeutic method is well tolerated with good clinical application value.

Objective To analyze the risk factors in the patients with type 2 diabetes mellitus(T2DM ) complicating carotid ath-erosclerosis plaque to provide the scientific basis for effectively preventing and controlling the occurrence and development of carotid atherosclerotic plaque .Methods 109 cases of T2DM were selected and divided into the plaque group(A) and the non-plaque group (B) according to the ultrasonic diagnostic results .The age ,course of disease ,body mass index(BMI) ,blood pressure(BP) ,fasting blood glucose(FBG) ,glycosylated hemoglobin(HbA1c) ,blood uric acid(SUA) and blood lipid were detected and analyzed in the two groups .Results There was statistically significant differences in the age ,BMI ,FBG ,HbA1c ,systolic blood pressure(SBP) , TC ,TG ,LDL-C ,SUA between the group A and B(P<0 .05);the logistic analysis showed that the age ,SBP ,LDL-C and SUA were the independent risk factors for the occurrence of carotid atherosclerosis plaque in T 2DM patients .Conclusion The age ,SBP ,LDL-C and SUA play the important role in the occurrence and development of T 2DM complicating carotid artery plaque .

The important works for blood coagulation laboratory are providing evidences for diagnosing bleeding and thrombosis diseases.Besides to establish enough test items,the doctors of laboratory should follow pathways of lab test and clinical analysis to find the reasons for bleeding and thrombosis.In generally,screening test should be done first,such as prothrombin time,activated partial thromboplastin time,fibrinogen,fibrin/fibrinogen degradation product,D dimer,platelet count and platelet function test.Then the diagnostic tests are selected according to the screening test results and clinical condition.The last diagnosis can be two forms,one is diagnosis of disease,another one is diagnosis of targets such as malfunction of endothelial cell,blood coagulation factor,anticoagulation factors,fibrinolysis proteins and platelet count and function.

Objective Triterpene glycosides were expected to be isolated from the sea cucumber Holothuria nobilis.Methods The crude saponins of sea cucumber were desulfated with pyridine-dioxane(1∶1),the desulfated products were separated by multi-chromatography to afford two compounds.Results On the basis of chemical methods and spectral evidences,especially 2D NMR and ESI-MS technologies,these two compounds were identified as 3-O-(3-O-methyl-?-D-glucopyranosyl(1→3)-?-D-quinovopyranosyl(1→4)-?-D-quinovopyranosyl(1→2)-?-D-xylopyranosyl)-holosta-9-ene-3?,12?,17?,25?-tetraol(Ⅰ),named as nobiliside 1a;3-O-(3-O-methyl-?-D-glucopyranosyl(1→3)-?-D-xylopyranosyl(1→4)-?-D-quinovopyranosyl(1→2)-4′-O-sulfate-?-D-xylopyranosyl)-holosta-22,25-epoxy-9-ene-3?,12?,17?,25?-triol(Ⅱ),named as nobiliside 2a.Conclusion Two compounds are new triterpene glycosides.

Objective To investigate the expression of Rac 1 in the guinea pig cochlea of gentamicin-induced ototoxic damage and prevention with antioxidant sodium salicylate , and to explore the roles of Rac 1 in the ototoxic mechanism of aminoglycoside antibi-otics.Methods Thirty healthy male guinea pigs were involved in this study .All the guinea pigs were randomly divided into 3 groups and received intraperitoneal injections according to their arranged group .Group I (control) was treated with normal saline for 7 days. Group II [Gentamicin (GM)] was treated with gentamicin alone for 7 days.Group III [GM+sodium salicylate(SA)] was treated with gentamicin in combination with sodium salicylate for 7 days.Paraffin-embedded cochlear section with immunohistochemical stai-ning was used for evaluation of Rac 1 expression in the cochlea .The protein was extracted from the cochlea tissues , and Rac1 protein levels in the cochlea were detected by Western blot assay .Results Immunohistochemistry showed a slightly positive reaction for Rac 1 staining found in the cochlea of the control group was mainly shown in the cytoplasm and cytomembrane of ganglion and organ of Corti ;a highly positive expression was shown in GM group;and the extent of Rac 1 expression of GM+SA group was between the control and GM groups.Image analysis showed that the differences in Rac1 expression between each two groups were statistically significant ( P <0.05).Western blot assay showed that expression of Rac 1 protein was highest in GM group and decreased in GM +SA group, while the intensity of Rac1 protein expression in GM +SA group was between the control and GM group .Statistics analysis showed that the expression between each two groups had significant difference ( P <0.05 ) .Conclusions A slightly positive reaction for Rac 1 stai-ning was found in the cochlea of guinea pigs , and mainly observed in the cytoplasm and cytomembrane of spiral ganglion and organ of Corti.With the administration of gentamicin , Rac1 protein expression was upregulated in the cochlea .Simultaneous administration of antioxidant sodium salicylate could significantly decrease the expression of Rac 1 protein.These results indicated that Rac1 might play an important role in the processes of gentamicin-induced oxidative damage of cochlea .

Objective Toinvestigatetheeffectoffolicacidonplasmahomocysteine(Hcy)levels and vascular endothelial function in elderly cerebral infarction patients with hyperhomocysteinemia. Methods Thisstudywasaprospectivecontrolledtrial.Atotalof112elderlylacunarinfarction patients with high hyperhomocysteinemia admitted to the Department of Neurology,Nanjing Municipal Government Hospital from November 2012 to October 2013 were enrolled. The patients were divided into two groups according to the method of random number table. The patients of both groups received the conventional drug treatment of ischemic stroke at the same time. Fifty-six patients were in group A,and they were treated with folic acid 20 mg,once a day;56 patients were in group B,and they did not treat with folic acid. The Hcy levels on admission and after 24 weeks treatment were measured. Brachial artery flow-mediated endothelium-dependent dilation (FMD)was measured by high resolution ultrasound,and nitric oxide (NO), nitricoxidesynthase(NOS),andendothelin(ET)weredetectedatthesametime.Results Twenty-four weeks after treatment,the plasma Hcy level in group A was significantly decreased as compared with prior treatment (12. 2 ± 4. 2 vs. 22. 6 ± 3. 7μmol/L;P<0. 05),moreover,it was lower than the level of group B at the same period (12. 2 ± 4. 2 vs. 21. 8 ± 4. 0μmol/L;P <0. 05 ). The FMD level of group A was significantly higher than that of prior treatment and group B (11. 2 ± 3. 6 vs. 9. 2 ± 3. 3,9. 3 ± 3. 3;P<0. 05). The NO and NOS levels of group A at 24 weeks after treatment were significantly higher than those of prior treatment and group B at the same period (76. 2 ± 9. 4 vs. 49. 2 ± 9. 0,50. 0 ± 9. 1μmol/L,47. 6 ± 9. 5 vs.38. 4 ± 7. 5,37. 8 ± 8. 8 kU/L;P<0.05). The ET level of group A was decreased as compared with that of prior treatment and group B at the same period (81. 3 ± 20. 5 vs. 105. 6 ± 25. 2,105. 3 ± 21. 8 ng/L;P<0.05).NoadversereactionwasfoundduringthetreatmentingroupA.Conclusion Alargerdoseof folic acid can significantly reduce the plasma Hcy level,decrease the FMD level,and ameliorate vascular endothelial function in elderly cerebral infarction patients with hyperhomocysteinemia.

Objective To investigate the possible role of eukaryotic initiation factor 6(eIF6)in the development of kidney inter-stitial tissue fibrosis in a mouse model of unilateral ureteral obstruction(UUO).Methods (1)UUO model was set up in eIF6+/-and eIF6+/+ mice.(2)HE and Masson staining were used to histologically assess the interstitial deposition of collagen in mouse kidney.Immunohistochemistry and image analysis were applied to analyze the expression of α-SMA and TGF-β1 in mouse kidney as well as eIF6 in human kidney samples.Results 10 days after unilateral ureteral obstruction,more kidney interstitial fibrosis tissues were found in eIF6+/- mice than that in eIF6+/+ mice.TGF-β1 andα-SMA were expressed more intensive in tubular epithelial cells of eIF6+/- mice than that of eIF6+/+ mice in the UUO model.Expression of eIF6 is lower in the region of fibrosis than that in non-fibrotic area.Conclusion eIF6 might be involved in the development of kidney interstitial tissue fibrosis by regulating the expres-sion of TGF-β1 .