Objective To investigate the clinical efficacy of nicergoline combined with donepezil hydrochlo-ride in the treatment of mild vascular dementia and its influence on cognitive function.Methods 66 patients with mild vascular dementia from neurology were divided into two groups by random numbers,33 cases in each group.On the based of the routine symptomatic treatment,the control group were given nicergoline,the observation group were treated with nicergoline combined with aricept.Four weeks was a course,both groups were continuously treated for 3 courses.Results The MMSE scores of the observation group after treatment was (36.7 ±5.7)points,which was significantly increased compared with before treatment(t =10.137,P <0.05)and the control group(t =11.236,P <0.05);The ADL score was(35.8 ±16.2)points,which was significantly lower compared with before treatment(t =10.825,P <0.05)and the control group(t =11.415,P <0.05);The total effective rate of the observation group was 78.9%,which was higher than 54.5% of the control group(χ2 =9.24,P <0.05).Conclusion Nicergoline com-bined with donepezil hydrochloride in the treatment of mild vascular dementia can significantly improve cognitive func-tion scores,and it is a significant effect,safe and reliable method.

Objective To investigate the efficacy and influence of motor function and activities of daily living of hexose ganglioside sialic four single(GM1)combined with rehabilitation in treatment of cerebral infarction(ACI). Methods 110 patients with ACI were divided into the two groups in random number table,they were all treated with routine treatment,the patients of the control group(n =55)were given citicoline on the base of those addition,the patients of the observation group(n =55)were given hexose ganglioside sialic four single combined with rehabilitation. The efficacy and influence of motor function and activities of daily living of the two groups were observed and compared.Results The total efficiency of the observation group was 90.91%,which was significantly higher than 76.36% of the control group(χ2 =10.33,P <0.05);The bathel index and the FMA points after treatment of the two groups were significant increased compared with before treatment,the difference was statistically significant(t =7.11, 9.83,8.66,10.27,all P <0.05);The bathel index and the FMA points after treatment of the observation group were (60.79 ±5.64)and(64.34 ±7.83),which were significantly higher than the control group(t =8.89,9.45,all P <0.05).Conclusion Hexose ganglioside sialic four single combined with rehabilitation in treatment of cerebral infarc-tion had significant clinical effect,it can effectively improve motor dysfunction,improve their daily living skills,with a high clinical value and was worth to appliy.

Objective To explore the curative effect of the treatment for minor-size tissue defect of forefoot by pedicle fibular side flap of the hallux.Methods The data of 12 patients with minor-size tissue defect of forefoot was retrospectively analyzed who were repaired with fibular side flap of the hallux from September 2003 to June 2012.There were 9 males and 3 females,with an average of 27 years (range,19-55 years).Among them,4 injured on the left,8 on the right side; 3 on the dorsal side and 9 on the plantar.There were 4 cases of traumatic wound,4 of tumor,2 of ulcer,and 2 of scar.Sizes of tissue defect were 1.3 cm×0.5 cm-2.5 cm×2.0 cm,the minimal flap size was 1.5 cm×0.8 cm,and the maximal flap size was 3.0 cm×1.5 cm.All flaps were elevated with fibular side artery and nerve of the hallux,and with width less than 1.5 cm,so wound of donor site could be sutured directly.The postoperative curative effect was assessed from five respects including flap healing,the sensation of the flaps,the flap appearance,the scar and weight-bearing walking.Results This kind of flap all survived successfully in the 12 cases,with satisfying cosmetic effect and sensory,without skin necrosis and blood vessel crisis.Nine patients were followed up for 3-96 months (average,12 months).The flaps were covered with soft and intact normal colored skin,no abrasion or wearing out happened and no subsequent reshaping was needed in the last follow-up.The minor-sized donor site wound could be sutured up directly.Since donor site was selected from non-weight-bearing area,walking and weight-bearing function of the patients were nearly unaffected at all.Sensory of the flaps were normal,with two-point discrimination ranging between 4-10 mm.Conclusion Due to the advantages of thinness,nerve nourishing,constant anatomical position and hidden position of donor site,anterograde fibular side flap of the hallux can be an ideal choice in repairing minor-size tissue defect of forefoot.

Objective To explore and summarize the choices of pedicle skin flaps in repairing cutaneous defect of foot and ankle.Methods Defects of forefoot,pedal dorsum,pedal plantar and ankle were repaired with pedicle skin flaps such as dorsal pedal flap,medial plantar flap,plantar metatarsal flap,fibular hallux flap,tibial flap of 2nd toe,anterior tibial artery flap,posterior tibial artery flap,sural nerve flap,lateral tarsal artery flap,anterior ankle artery flap peroneal artery flap etc.Results Except for necrosis of 2 cases of flap,the other 249 flaps all survived.Blood vessel crisis was induced in 5 patients on 1st postoperative day,and in 2 cases on 2nd postoperative day,by tight package of transplanted skin,which was treated by emergent explorative operation.Finally 135 cases got 3 to 96 months' followed up(average of 16 months).There were 4 cases of medial pedal flap and 3 cases of plantar metatarsal flap received secondary reshaping for treating skin wear out.Nine cases of posterior tibial artery flap,and 6 cases of sural nerve flap were reshaped secondarily to improve bulk shape.Other flaps did not need secondary reshaping.Among them,in medial pedal flap,fibular-side flap of hallux,and tibialside flap of 2nd toe,sensory nerve were all transferred together with the flap,and normal sensory was got,with 4-10 mm two point discrimination.Condusion In covering tissue defects on heel or plantar side of forefoot,medial plantar artery flap is ideal.For defects on plantar side of forefoot,plantar metatarsal flap,fibular hallux flap,tibial flap of 2nd toe have the advantages of wear resistance and nerve innervation.While dorsal pedal flap,anterior tibial artery flap,posterior tibial artery flap,sural nerve flap,lateral tarsal flap,anterior ankle artery flap,and peroneal artery perforator flap have the advantages of large size,thinness,similar color with recipient site,and constant anatomical position,they are feasible for repairing defects on dorsum of foot or near ankle.

Objective To analyze the distribution and pulsed-field gel electrophoresis (PFGE)of pathogenic bacteria causing infectious diarrhea in a district of Beijing from 2011 to 2013,and provide basis for tracing infection sources.Methods A total of 1 179 stool specimens of infectious diarrhea from patients in a diarrhea outpatient department from January 2011 to December 2013 were collected,all isolated pathogens were identified by serotyping and PFGE analysis.Results 330 enteric pathogens were isolated from 1 179 specimens,the top 4 bacteria were Shi-gella spp .(28.18%,n=93),Salmonella spp .(20.91 %,n=69),Vibrio parahaemolyticus (13.33%,n =44),and diarrheagenic Escherichia coli (3.33%,n = 11 ).18 Shigella sonnei isolates were identified as 8 PFGE patterns, clustering similarity was close to 88%;69 Salmonella spp .strains belonged to 18 serotypes and 41 PFGE patterns, Salmonella senftenberg and Salmonella enteritidis had dominant patterns;no dominant PFGE patterns were obviously identified among 23 strains ofVibrio parahaemolyticus .Conclusion The serotypes and PFGE patterns of pathogenic bacteria in infectious diarrhea in past three years showed a wide distribution characteristics,the dominant PFGE patterns of Salmonella spp .and Shigella spp .need to be paid more attention,and outbreak of infectious diarrhea caused by Salmonella spp .and Shigella spp .should be alerted.

Objective By comparing and analyzing the etiological monitoring results of influenza in Xicheng District general hos-pital and children′s Hospital ,to explore the epidemic regularity of influenza in children ,so as to provide the basis for developing in-fluenza prevention and control measures .Methods A total of 40 swabs of influenza samples were collected every week from two sentinel hospitals ,and the virus RNA was extracted and detected by RT-PCR method .Results There was a statistically significant difference in positive rate of influenza pathogen surveillance between general hospitals and children′s hospitals (21 .8% vs .14 .9% ) (P<0 .001) .In the general hospital ,the positive rate was highest in people aged ≥60 years old(31 .3% ) .In the children′s hospital , the positive rate was highest in people aged >4—14 years old(26 .7% ) .Both hospitals had an epidemic peak of influenza from No-vember to December of next year ,it was typical influenza epidemic of the North area .But the children′s hospital had a epidemic trough in January and February .In both hospitals ,the circulating strains were H3 ,H1N1 ,type B ,the predominant type was H3 and type B .Conclusion Taking the general hospital as a reference ,the quality of influenza surveillance in the children′s hospital was relatively stable and reliable .Lack of the people aged >24— <60 years old and aged ≥60 years old in children′s hospital ,is the key reason of the statistically significant difference of the positive rate ,between the general hospital and the children′s hospital .Chil-dren′s influenza vaccination rate is higher than the other age group ,and the protective effect of vaccine is better .

AIM:To study the expression of glucose transporters(GLUTs)and silent information regulators(SIRTs/sirtuins)in the liver of diabetic rats and human hepatocytes(LO2 cells)treated with high glucose.METHODS:(1)Twenty male SD rats were randomly divided into normal control(NC)group and diabetes mellitus(DM)group.The rats in DM group were given single intraperitoneal injection of streptozotocin(STZ,60 mg/kg)to establish the DM model,while the rats in NC group were intraperitoneally injected with equal volume of solvent once.Fasting blood glucose(FBG)and body mass were measured every 2 weeks.After 12 weeks of rearing,the blood and liver tissues of the rats were ob-tained after anesthesia with 1%sodium pentobarbitone,the biochemical indicators of blood were detected,and the liver in-dex was calculated.Hematoxylin-eosin(HE)staining and periodic acid-Schiff(PAS)staining were used to observe liver histopathological changes.Lipid accumulation in liver tissues was detected by oil red O staining.The expression levels of GLUTs and SIRTs family member proteins were detected in rat liver tissues.(2)The LO2 cells were treated with different concentrations of glucose for 48 h.The viability of the cells in each group was measured by CCK-8 assay,and Western blot was used to detected the protein expression levels of GLUTs and SIRTs in the cells.RESULTS:(1)Compared with NC group,the rats in DM group were depressed,lost weight,and the FBG and liver index were significantly increased(P＜0.05).The results of HE staining showed that the hepatic sinuses were dilatated and congested near the central vein in DM rats,and mild edema and scattered infiltration of inflammatory cells were found in liver cells.The results of oil red O staining showed the red fat droplets were diffusely scattered within liver cells in DM group.The results of PAS staining showed that there were numerous diffuse light purple circular droplets in the cytoplasm of the liver cells in the central ve-nous area of the DM rats.Western blot showed that the protein levels of GLUTs were higher and the protein levels of SIRTs were lower than those in NC group(P＜0.01).(2)The results of CCK-8 assay showed that the viability of LO2 cells was increased in 50 mmol/L glucose group(P＜0.01),without significant difference in 75,100 and 125 mmol/L glucose groups(all P＞0.05),and decreased in 150,175 and 200 mmol/L glucose groups(all P＜0.01).Later,150 mmol/L glu-cose was used as the high-glucose intervention condition.Western blot showed that the protein levels of GLUTs and SIRTs in LO2 cells under high glucose intervention were consistented with the results in animal experiments.CONCLUSION:High concentration of glucose can cause liver damage in SD rats and reduce the viability of human hepatocytes(LO2 cells).It can also increase the expression of GLUTs and decrease the expression of SIRTs in rat liver tissues and LO2 cells.Therefore,GLUTs and SIRTs family members may be the target proteins of diabetes-induced liver injury.