Objective To investigate the effect of valsartan combined with ginkgo biloba extract (EGB) in the treatment of early diabetic nephropathy (DN). Methods All of 112 cases of early stage DN patients were randomly divided into treatment group (58 cases) and control group (54 cases). Two groups were given insulin to control blood gluoose and valsartan 80 mg/d. Meanwhile the treatment group was given EGB by intravenous infusion. The changes of urinary protein excretion rate (UAER), urinary β_2-microglobulin (β_2-MG), blood pressure, fasting glucose, serum creatinine (SCr), blood urea nitrogen (BUN), total cholesterol (TC), triglyceride (TG) were compared. Results There was no significant difference in UAER, β_2-MG, systolic blood pressure, diastolic blood pressure, FPG, BUN, SCr, TG and TC before treatment between two groups (P> 0.05). After treatment, they were improved in two groups compared with those before treatment(P < 0.05). Except for systolic blood pressure[(130 ± 13) mm Hg(1 mm Hg = 0.133 kPa) vs(129 ± 11) mm Hg], the improvement in treatment group was superior to that in control group(P<0.05). Conclusions Valsartan combined with EGB in treatment of early DN has significant synergies, and they can play roles with each other to prevent further deterioration of DN. This strategy is worthy to be popularized.

The human plasma lipoprotein-associated phospholipase A2 (Lp-PLA2) is secreted, by the mature macrophages and lymphocytes, which predominantly binds to low-density lipoprotein. Studies in recent years have demonstrated that Lp-PLA2 plays an important role in the process of atherogenesis. Its gene polymorphisms are associated with the occurrence of ischemic stroke, and its specific inhibitor has anti-atherogenic effects. Lp-PLA2 may be a novel independent risk factor and a therapeutic target for ischemic stroke.

Objective To evaluate the hypoxia selectivity of 99 Tcm O?labeld MAG3?nitroimidazole complexes with different spacers. Methods Four kinds of 99 Tcm O?labeled MAG3?2?nitroimidazole hypoxia imaging agents with different spacers were synthesized and radiolabeled. The stability and lipid solubility of BzMAG3?2NIEA(1), BzMAG3?2NIPA(2), BzMAG3?2NIHA(3) and BzMAG3?2NIUA(4) were measured. The uptake was investigated by biodistribution experiment using S180?bearing mice. Two?sample t test was used for statistical analysis. Results All 4 99 Tcm O?MAG3 complexes were stable and negatively charged, showing an increasing trend in fat solubility with the increase of spacer length. In biodistribution study, tumor uptake of 99TcmO?1 and 99TcmO?2 with medium? and short?carbon chain were (0.67±0.18) and (0?65±0.18) %ID/g 2 h post injection, which were (0.19±0.03) and (0.39±0.05) %ID/g for 99TcmO?3 and 99TcmO?4 with long?carbon chain (t=2.78-5.88, all P<0.05). Conclusion Molecular structure of spacers has a significant effect on the physicochemical properties and tumor targeting of 99 Tcm O?labeled MAG3?2?nitroimidazole hypoxia imaging agents, such that the medium?and short?carbon chain spacers show the best hypoxia?selective property.

This research mainly analysed the section of clinical experience in the reporl of"A panoramic snapshot of medical students'education at the beginning of the 21st century"and gave a brief introduction to the mainstream medical education in No,hem Amercia according to the literature.At last,the enlightment from the report and reformation of our clinical practice were put forward.

Objective To analyze the influence of different types of seizures and nonepileptic events on peripheral white blood cell (WBC)counts. Methods We prospectively collected blood samples from all patients and detered WBC count to evaluate the relation of each type of seizure,duration,frequencies,and ttme lapse between a seizure and collection of blood sample to peripheral WBC count. Results Peripheral WBC count was elevated in about 50% cases after a generalized seizure. The length of a seizures was positively associated, whereas its frequencies and the lapse time was negatively correlated with the increase in WBC counts. Conclusion Peripheral WBC counts increase significantly after a generalized seizure.

Chronic pancreatitis is a chronic inflammatory disease of the pancreas,whichcan lead to irreversible damage to the morphology and function of the pancreas ultimately.So the early diagnosis and treatment for chronic pancreatitis are very important.And the differentiation between mass-forming chronic pancreatitis and pancreatic cancer is also a difficult problem in clinic.MRI as a noninvasive and nonradiative examination with excellent soft tissue resolution,is very valuable for the diagnosis of chronic pancreatitis.And the combination of functional MRI and conventional MRI is very helpful for the differentiation between pancreatic carcinoma and mass-forming chronic pancreatitis,which is of great significance to the clinical management.The application and progresses of function MRI in the diagnosis and identification of chronic pancrea titis were reviewed in this article.

Objective To observe the effectiveness of dexamethasone combined with azasetron for the prevention of postoperative nausea and vomiting(PONV) in patients after laparoscopic cholecystectomy(LC).Methods A total of 150 ASA(Ⅰ~Ⅱ) patients undergoing an elective LC were randomly divided into three groups with 50 patients in each group: Group D+A was given intravenous dexamethasone 5mg and azasetron 10mg(2ml) at the end of surgery,Group A received intravenous azasetron 10mg(2ml) at the end of surgery,and Group C received normal saline(NS) 2 ml as the control.Episodes of nausea and vomiting were recorded for 24 h following the surgery.Results The incidence of nausea was 4% in the Group D+A(2/50),which was significantly lower than in the Group A(16%,8/50) and the Group C(34%,17/50)(?~2=4.00 and 14.62;P=0.046 and 0.000).The incidence of vomiting was 2% in the Group D+A(1/50),which was significantly lower than in the Group A (14%,(7/50)) and the Group C(32%,16/50)(?~2=4.89 and 15.95;P=0.027 and 0.000).The incidences of nausea and vomiting were significantly lower in the Group A than in the Group C(?~2=4.32 and 4.57;P=0.038 and 0.033).Conclusions Use of a low dose of dexamethasone in combination with azasetron is more effective than azasetron prophylaxis alone for a successful control of PONV after LC.

Objective To evaluate the accuracy of systolic pressure variation (SPV) in monitoring blood volume in patients.Methods Twenty-two ASA Ⅱ or Ⅲ patients (17 male,5 female),aged 49-79 yr,with body height 153-173 cm,weighing 55-89 kg,scheduled for elective coronary artery bypass grafting under cardiopulmonary bypass,were studied.Stroke volume variation (SVV) was monitored based on the arterial pressure wave and SPV measured based on the invasive arterial pressure wave after changing the title.After the chest was closed,the volume load test was immediately carried out.6％ hydroxyethyl starch 130/0.4 50-80 ml/min was infused via the jugular vein until cardiac index (CI) increased by 10％.HR,mean arterial pressure (MAP),SPV,CI,SVV,stroke volume index (SVI),systemic vascular resistance index (SVRI),central venous pressure (CVP),and pulmonary capillary wedge pressure (PCWP) were recorded in supine position (T1),at 30° head-down tilt before skin incision (T1'),before (T2) and after opening the chest in supine position (T2'),before (T3) and after the volume load test in supine position after closing the chest (T3'),in supine position after skin closure (T4),and at 30° head-down tilt after skin closure (T4').The difference in SPV and SVV (△SPV and △SVV) was calculated.The receiver operator characteristic curve for △SVV and △ SPV in determining blood volume changes was plotted.Results MAP,CVP,PCWP,CI,and SVRI were significantly increased,while SVV and SPV were decreased at T1' compared with those at T1 (P ＜ 0.05).HR was significantly increased,while CVP was decreased at T2' compared with those at T2 (P ＜ 0.05).MAP,CVP,PCWP,and CI were significantly increased,while SVV and SPV were decreased at T3' compared with those at T3 (P ＜ 0.05).MAP,CVP,and PCWP were significantly increased,while SVV and SPV were decreased at T4' compared with those at T4 (P ＜ 0.05).The area under receive operator characteristic curve for △SVV and △SPV in determining blood volume changes was 0.603 and 0.616 respectively,and there was no significant difference (P ＞ 0.05).Conclusion SPV can accurately monitor the blood volume in patients.

Objective To evaluate the safety and efficacy of early carotid artery stenting in treating cerebral watershed infarction patients with carotid artery stenosis. Methods A total of 33 patients with acute cerebral watershed infarction complicated by carotid artery stenosis received carotid artery stenting within one week after the onset of the disease. The clinical safety and efficacy were evaluated. Results The carotid artery stenting was successfully accomplished in all 33 patients with a success rate of 100%. After the procedure, different degree of bradycardia and hypotension was seen in 23 patients, which restored to normal after prompt medication with atropine, dopamine, etc. During the procedure, one patients developed cerebral embolism due to dislodgment of emboli, resulting in contralateral hemiparalysis, and the contralateral limb muscle strength returned to preoperative status after proper treatment. After the treatment, no ipsilateral hemisphere excessive perfusion or cerebral hemorrhage occurred. Thirty days after the treatment, NHISS scores of the patients were obviously improved, which were significantly different from those determined before the treatment (P<0.05). Conclusion For the treatment of acute cerebral watershed infarction, early carotid artery stenting to relieve carotid artery stenosis is quite safe and it may improve the prognosis as well.

Objectiye To explore the expression of COX-2 and VEGF and its clinical significance in non-Hodgkin lymphoma (NHL). Methods The expression of COX-2 and VEGF were detected by immunohistochemistry in 42 cases of NHL and 20 cases of lymph node with benign pathological change. Results The positive rate of COX-2 and VEGF was 45.24% and 73.81% in NHL respectively. The expression rate of VEGF was positively correlated with that of COX-2 in tissues of NHL ( x2 = 4. 63, P ＜ 0. 05).The expression of COX-2 was related to clinical stage and histopathologic grade of NHL ( x2 = 5.43, P ＜0. 05), but it had no association with gender, age, B symptoms, and IPI. The expression of VEGF was significantly related with aggression, B symptoms and IPI ( x2 =8. 979, 8. 893,6. 434, P ＜0. 05), but it had no association with age, gender and clinical stages. Conclusion COX-2 and VEGF may be involved in NHL tumorgenesis, and COX-2 may accelerate angiogenesis by increasing VEGF expression. Specific COX-2 inhibitors may be a novel therapeutic approach for NHL.