Objective To investigate the applicability of Stroop color-word test in Chinese eldly patients with sub-jective cognitive impairment. Methods 36 patients with subjective cognitive impairment and 35 normal elders,all accepted general information questionaire( including age,gender,education,ect) ,Chinese version Stroop color-word test,background neuropsychological tests(MMSE,ADL,GDS,ect). Analysis of indicators included: the number of errors,average response,Stroop interference effects ( SIE)-Time difference of the Color inconsistencies and consist-ent with the meaning of words. At last we analyse relationship between CWT results and age,education,et al. Re-sults There were no significant differences in neuropsychological tests. Compared with normal subjects,subjective cognitive impairment subjects spent more time and made more errors in doing this task. They made statistical signifi-cance. The linear regression analysis between reaction time, the number of errors and overall cognitive function ( MMSE) , age, memory ( digit span, delayed recall) showed:the numbers of errors and the average response time had significant positive correlation with age. SIE of SCI was significantly longer than the normal control, the differ-ence was significant (P<0. 05). And it had no significant correlation with age, overall cognitive function and mem-ory and other related inspection. Conclusion Stroop color-word test has a certain sensitivity in recognition of sub-jective cognitive impairment elders.

Antiplatelet therapy is commonly used for the secondary prevention of embolic stroke of undetermined source (ESUS). However, the embolic source of ESUS is extremely heterogeneous, and the effect of antithrombotic therapy is different. This article describes the etiology and secondary prevention research progress of ESUS, in order to provide reference for clinical diagnosis and treatment.

Objective To compare the clinical effect of remifentanil and dexmedetomidine on controlled hypotension during endoscopic sinus surgery. Methods Forty patients undergoing endoscopic sinus surgery were randomly divided into group R and group D, 20 in each group. All patients received controlled hypotension when the surgeons began to sterilize the nasal cavity for the purpose of maintaining the MAP at 60 ~ 70 mmHg. Group R received remifentanil 1μg/kg over 1 minute, followed by 0.2 to 0.4μg/kg per minute infusion during maintenance, whereas group D received dexmedetomidine 1μg/kg over 10 minutes, followed by 0.2 to 0.7μg/kg per hour during maintenance. At the moment of pre-induction(T0), incision(T1), 30 min(T2) and 60 min(T3) after incision and 10 min(T4) after end of controlled hypotension, MAP and HR were measured. Quality of the surgical field, blood loss and extubation time were recorded. Sedation and postoperative pain were assessed on arrival at the PACU. Results The goals for the MAP level were achieved and the surgical field quality was ideal in both groups. The MAP and HR values at T1~ T3 were significantly lower than those at T0 in both groups (P < 0.05). There were no significant differences in the MAP or HR values between the groups at each time point (P>0.05). No significant difference was founded between the groups in the Fromme operative field score and blood loss (P > 0.05). The extubation time was significantly shorter in group R than in group D(P<0.05). The sedation score in the PACU was significantly lower in group R than in group D(P<0.05), while there were no significant differences in postoperative pain between the groups(P<0.05). Conclusion Both remifentanil and dexmedetomidine are safe agents for controlled hypotension and are effective in providing satisfactory surgical fields during endoscopic sinus surgery. However , remifentanil is advantageous in time for extubation and complete consciousness from anesthesia and therefore it may have the advantage of fast track anesthesia.

Background and purpose: Preemptive analgesia is one of the strategies to treat postoperative pain by preventing the establishment of central sensitization. This study was designed to explore whether the method of flurbiprofen axetil injection combined with bilateral cervical plexus nerve block in thyroid carcinoma surgery as multimodal preemptive analgesia can serve as a better analgesia. Methods: Sixty patients with thyroid carcinoma were randomly divided into three groups. Patients in Group A were treated with flurbiprofen axetil injection combined with bilateral cervical plexus nerve block as multimodal preemptive analgesia. Patients in Group B were anesthetized with bilateral cervical plexus nerve block. General anesthesia alone was used in patients of Group C. The onset time of nerve block, operation time, extubation time and dosage of fentanyl were recorded. The VAS (visual analogue scale) was used to evaluate the pain level, the side effects of drugs were also analyzed. Results: The onset time of nerve block in Group A, Group B were (7.47±1.04) min and (8.75±1.36) min, repectively (P<0.05). The dosage of fentanyl n Group A, B and C were (0.36±0.04) mg, (0.40±0.06) mg and (0.45±0.07) mg, respectively (Group A vs Group B P<0.05; Group A vs Group C, P<0.01).VAS scores of patients in Group C were higher than both Group A and B at 4,8 h after operation. Moreover, patients in Group B got higher VAS scores than that of Group A at 8 h. The side effects of both Group A and B were much less serious than that of Group C. Conclusion: Flurbiprofen axetil injection combined with bilateral cervical plexus nerve block as multimodal preemptive analgesia during thyroid carcinoma surgery can supply better analgesia and opioid-sparing effects, with less side effects.

Objective To investigate the change of serum alkaline phosphatase (ALP) level in patients with acute cerebral infarction (ACI) and its clinical significance.Methods A total of 400 patients with ACI (ACI group) and 240 gender-and age-matched healthy controls during the same period were enrolled in this study.Serum ALP,total protein,alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and other indicators of liver function,serum creatinine (Cr),blood urea nitrogen (BUN) and other indexes of renal function were determined.ACI patients were divided into three subgroups according to the largest diameter of infarction slice on the diffusion weighted imaging (DWI):small area group (＜1.5cm),middle area group (1.5-4.0cm) and large area group (＞4.0cm).The degree of neurologic impairment at admission and the degree of nerve function recovery at discharge were assessed by National Institute of Health stroke scale (NHISS) and modified-Rankin Scale (mRS) in all patients.The relationship of serum ALP level with infarction area,NHISS score and mRS was analyzed.Results Serum ALP level was higher in ACI group than in control group [(80.1±24.4)U/L vs.(75.5±21.5)U/L,t=-2.471,P=0.014].Serum ALP level was elevated along with the increase of infarction areas in ACI group [(78.0 ± 23.3)U/L,(79.4±24.9) U/L vs.(87.7±26.0) U/L,F=4.374,P=0.013].The correlation analysis showed that serum ALP level was positively correlated with infarction area (r=0.118,P=0.019) and NHISS score (r=0.114,P=0.023),but no significant relationship was found with mRS (r=0.071,P=0.08).Multivariate regression analysis revealed that patients with high serum ALP level (＞86 U/L) had 1.691-fold higher risk for cerebral infarction than did those with low serum ALP level(＜67 U/L) (OR=1.691,95％CI:1.103～2.594) after adjusting for confounding variables including age,gender,hypertension,diabetic mellitus,heart disease (coronary heart disease and atrial fibrillation),et al.Receiver operating curves (ROC) analysis revealed that the area under the curve of serum ALP level for predicting ACI was 0.557 (95％CI:0.512～0.602,P=0.016),and its sensitivity and specificity were 43.1％ and 67.6 ％ respectively when serum ALP level was 81.5 U/L.Conclusions Serum ALP level is increased in ACI patients,which has positive correlations with cerebral infarction areas and NHISS scores.In the future,maybe,we could assess ACI by monitoring serum ALP levels or improve the prognosis of ACI patients by decreasing serum ALP levels in the future.

Objective In order to choose a suitable method in detecting MRS,the detection rate,sensitivity and specificity of Vitek-32 auto microbacteria indentity system,oxacillin agar dilution test,cefoxitin disk diffusion test and PCR for mecA gene are evaluated.Methods MRSA and MRCNS are detected by the four methods metioned above in 175 staphylococci,then comparing the postive detection rate by Chi-square test and calculating sensitivity and specificity of the other three methods based on PCR for meeA gene as a gold standard.Results The detection rate of four methods have no difference in detecting MRSA,but the detection rate of Vitek-32 auto microbacteria indentity system and oxacillin agar dilution test is better than that of PCR for mecA gene in detecting MRCNS.Sensitivity and specificity of Vitek-32 auto microbacteria indentity system,oxacillin agar dilution test and cefoxitin disk diffusion test in detecting MRSA are 100%、96.3%、96.3% and 88.2%、100%、100% respectively,the sensitivity of detecting MRCNS are all 100%,the specificity of detecting MRCNS are 50%、46.1% and 65.4% respectively.Conclusions Both mecA gene and the determination for MIC of Oxacillin should be considered in final decision for MRS,Furthermore.the MRS mediated by mecA gene and the MRS mediated by non-mecA gene should be treated differentially.

Liver cirrhosis in China can be caused by many causes of which the most important one is chronic viral hepatitis. Hemorrhage and ascites were the main manifestations of decompensated liver cirrhosis, and the main cause of hemorrhage is viral hepatitis. The pathological basis of hemorrhage is portal hypertension and its secondary pathophysiological changes. Additionally, the deficiency of coagulation factors and the imbalance of coagulation and fibrinolysis both of which caused by the hypofunction of liver are also important reasons. This article reviews the mechanism of hemorrhage in decompensated liver cirrhosis in order to provide help for further research.

The incidence of diffuse gastric cancer is increasing year by year, comprehensive therapy is the main treatment. The main reason of surgical treatment failure is local recurrence, and the long-term curative effect is generally poor. Radiotherapy is an important part of comprehensive treatment for diffuse gastric cancer, which can reduce tumor stage before surgery and prevent recurrence and metastasis after surgery. Effective neoadjuvant radiotherapy is one of the approaches to improve surgical resection rate in patients with diffuse gastric cancer. In this paper, the clinical application of radiotherapy for diffuse gastric cancer will be reviewed, including the selection of reasonable radiotherapy system, precise location, dose setting, application of sensitization technology and mechanism of sensitization, in addition, the prevention and treatment of neoadjuvant radiotherapy and radiotherapy complications will be introduced.

Objective To investigate the effect of dexmedetomidine on excitatory aminoacid (EAA)and inhibition of amino acid(IAA)in cerebro-spinal fluid(CSF)of patients undergoing in-tracranial tumor surgery,and to explore the cerebral protective mechanism of dexmedetomidine in neurosurgery.Methods Sixty patients aged 18-64 years old,ASA Ⅰ or Ⅱ,weighing 50-90 kg un-dergoing elective intracranial tumor surgery were randomly divided into dexmedetomidine group (group D)and control group(group C).Dexmedetomidine 1 μg/kg was infused before anesthesia in-duction for more than 10 minutes and pumped continously with 0.2-0.7 μg·kg-1·h-1 in group D, while in group C midazolam 0.03-0.05 mg/kg was injected followed by intermittent administration of 0.03-0.05 mg/kg.BIS value was maintained between 40-50.MAP and HR was recorded at the time points before induction(T0 ),dura mater incision(T1 ),tumor resection(T2 ),at the end of the surgery (T3 ).And we collected CSF at T0 ,T3 ,6 hours after the surgery(T4 ),12 hours after the surgery (T5 ),24 hours after the surgery(T6 ),then the concentrations of EAA and IAA were determined with high-performance liquid chromatography (HPLC)at T0 ,T3 ,T4 ,T5 and T6 .Results The MAP and HR in group D at T1-T3 were much lower than that in T0 and in group C(P <0.05).Compared with T0 ,the Glu and Asp in CSF significantly increased in group C at T3-T6 and were much higher than those in group D (P < 0.05 ),GABA was significantly decreased and much lower than group D(P <0.05).Compared with T0 ,the Glu and Asp in group D at T3-T5 were increased and GABA was decreased, but without statistic significance. At T6 , the values recovered to the level at T0 . Conclusion Dexmedetomidine can be used to maintain hemodynamic stability in intracranial tumor surgery,and may play a role in cerebral protection through inhibiting expression of Glu and Asp (EAA).

Objective To investigate the expression of nestin, a type Ⅵ intermediate filament protein in the glomeruli with foot process effacement and the potential relationship between nestin expression in the kidney and the degree of proteinuria. Method Immunohistochemistry was used to determine the localization of nestin in the kidney samples obtained from needle biopsies of normal human and patients with minimal change disease (MCD). Puromycin aminonucleoside (PAN) nephrosis rat models were established by a single intraperitoneal injection of PAN. Both real time quatitative reverse PCR and Western blot methods were applied to evaluate the levels of nestin expression at day 1, 4, 10 and 20 after PAN injection. Results Immunohistochemistry showed that the expression of nestin in glomeruli of MCD patients was significantly reduced compared with normal samples (0.93±0.08 vs 1.65±0.12, P<0.05) . The mRNA and protein expressions of nestin in the rat kidney were transitorily increased by 1.23 folds and 1.48 folds of control group (NC) after 1 day of PAN injection (P<0.05), then decreased quickly in the following days. The mRNA levels of nestin in the kidney were 35.8% and 12.1% of NC after 4 days and 10 days of PAN injection, respectively, (P<0.01) as determined by real time PCR. After 20 days of PAN injury, nestin mRNA expression partly recovered to 65.8% of NC (P< 0.05 ). The protein levels of nestin detected by Western blot presented the similar trend, which were 77.0%, 58.0% and 83.4% of NC after 4 days, 10 days and 20 days of PAN injection, respectively (P<0.05). The degree of proteinuria in puromycin aminonucleoside nephrosis rats was negatively correlated with both mRNA and protein levels of nestin in the kidney(r=-0.667,P<0.05 and r=-0.621 ,P<0.05, respectively). Conclusions The expression of intermediate filament protein nestin is down-regnlated in the kidney characterized with foot process effacement and negatively correlated with the degree of proteinuria in puromycin aminonucleoside nephrosis rats. Nestin may play a potential role in modulating the structure and function of podocyte.