Objective To investigate the effect of intravenous midazolam on the response of parafascicular nucleus(Pf) to noxious stimuli in rats. Methods Twenty SD rats of both sexes weighing 260-300g were used in the study. The animals were anesthetized with intraperitoneal urethane(1.2 g/kg) . A hole was drilled in the skull. Under stereomicroscope micro-glass electrode was inserted into Pf nucleus and the characteristic discharge of nociceptive neurons was recorded. The experiment was then performed in four steps. The discharge was recorded in the basal state (A), when hind paw was pinched by a pair of strong forceps: noxious stimuli (B) , 2 min after midazolam 0.2 mg/kg was given intravenously , step B was repeated (C) and flumazenil 0.05mg was given iv and 2 min later step B was repeated (D) . There was a pause of 5 min after each step. Results The characteristic discharge of nociceptive neurons was recorded only in 9 animals and the data from 6 animals were complete and could be analyzed. Noxious stimuli induced significant increase in spike of discharge of nociceptive neurons. Midazolam significantly depressed the response of nociceptive neurons to noxious stimuli. There was no significant difference in the mean spikes of discharge of nociceptive neurons between step A and C. After flumazenil the mean spike of discharge increased again in response to noxious stimuli. Conclusion Midazolam can inhibit the activity of the nociceptive neurons located in Pf nucleus, probably through GABA-BZ receptor.

Ischemic stroke causes varying degrees of cognitive impairment, and its incidence is very high. Early diagnosis of cognitive impairment may provide the best intervention treatment opportunity, and slow disease progression. Therefore, it has attracted more and more attention. This article reviews the advances in etiology, pathogenesis, risk factors, diagnosis, prevention and treatment of cognitive impairment after ischemic stroke.

Objective To study the expression of LIVIN and PTEN in human gastric cancer and evaluate their clinical significance. Methods The expressions of LIVIN and PTEN were detected by immunohistochemical method in the tissues of 65 primary gastric cancer and 15 normal gastric mucosae. Results The positive expression rate of LIVIN in gastric cancer tissues was significantly higher than that in normal tissues [73.85%(48165) vs 26.67%(4/15)], and the positive expression rate of PTEN was obviously lower than that in normal tissues [30.77%(20/65) vs 66.67%(10/15)](P < 0.05). The positive expressions of LIVIN and PTEN were closely correlated with tumor depth of gastric cancer, histological differentiation grade, lymph node metastasis and TNM stage. The expressions of LIVIN and PTEN had a significant positive correlation (r = -0.362,P =0.003). Conclusion LIVIN and PTEN may play important roles in carcinogenesis of gastric cancer, which may be considered as reliable markers in clinical diagnosis and the prognosis of gastric cancer.

Objective To study the characteristics of lamivudine-resistant mutation associated chronic severe hepatitis B during lamivudine treatment.Methods Twenty-seven patients with lamivudine-resistant mutation associated chronic severe hepatitis B during lamivudine treatment were analyzed retrospectively.YMDD motif mutation was detected by gene chips or DNA sequencing.The pathological features of liver tissues from 8 patients undergoing liver transplantation were analyzed.The X2 test were used to perform the stafistical analysis.Results The YMDD motif mutations of 27 lamivudine-resistant patients were 5 cases of YVDD mutation,2 of YVDD+L180M,13 of YIDD mutation,4 of YIDD+L180M,1 of YVDD+YIDD mutations,2 of YVDD+YIDD+L180M,and there was no single L180 M mutation among patients.Twenty-seven patients were divided into cirrhotic group and noncirrhotic group according to whether they were diagnosed with cirrhosis before treatment.Compared to cirrhotic group,incidence of severe hepatitis was lower,prognosis was better,the age of patients was younger and hepatitis Be antigen(HBeAg)positive rate was higher in noncirrhotic group.There were two types of pathological features of liver tissues from 8 patients,which were active hepatic cirrhosis and massive or submassive hepatic necrosis with liver shrinking significantly.Conclusions Hepatic cirrhosis is a risk factor of lamivudine-resistant mutation associated chronic severe hepatitis B.There may be two mechanisms in lamivudine-resistant mutation associated chronic severe hepatitis B.

Objective To evaluate the effect of malaria control in Shayang County from 1995 to 2014,so as to provide the evidence for the strategy revision of the elimination of malaria prevention and control. Methods The data of malaria surveil?lance were collected and analyzed in Shayang County from 1995 to 2014. Results During the 20 years,582 malaria patients(9 imported patients)were reported. The average annual incidence rate was 0.53/ten thousand. Through the comprehensive preven?tion and control measures,the incidence of malaria decreased from 2.30/ten thousand in 1997 to 0.02/ten thousand in 2010,and the decreasing rate was 99.13% . The proportion of malaria cases in the total infectious diseases cases also decreased from 21.23% in 1997 to 0.07% in 2010,and the decreasing rate was 99.67%. There were no local malaria patients from 2010 to 2014. However,the imported malaria patients were increased year by year during the recent years. Conclusions This county has reached the national malaria control and elimination standards,and the malaria control work has been transferred from the con?trol period to the elimination phase. We should implement the prevention and control measures and strictly control imported ma?laria,so as to consolidate the malaria control results.

OBJECTIVE:To observe the anesthesia effect and safety of hypoxia flow sevoflurane combined with propofol for el-derly abdominal tumor surgery in saturation. METHODS:128 elderly patients took abdominal tumor surgery under general anesthe-sia were randomly divided into observation group(64 cases)and control group(64 cases). After routine anesthetic induction,the oxygen flow was adjusted to 6 L/min,vaporizer was adjusted to 2%,10 minutes after inhalation,the observation group was adjust-ed to 0.5 L/min,and control group was 1.5 L/min,all received 0.5 mg/L propofol by target-controlled infusion,continuous infu-sion of remifentanil,intermittent bolus injection of vecuronium 1-2 mg/times based on the intraoperative muscle relaxation. Heart rate(HR),mean arterial pressure(MAP),oxygen saturation(SpO2),central venous pressure(CVP),inspired oxygen concentra-tion(FiO2),end-tidal carbon dioxide partial pressure [p(CO2)] in 10 min(T0),intraoperative 1 h(T1),intraoperative 2 h(T2), end of surgery(T3)in 2 groups were observed;sevoflurane dosage,recovery time,restlessness,and blood urea nitrogen(BUN), serum creatinine (Cr),alanine aminotransferase (ALT) levels,incidence of early cognitive dysfunction before and after surgery and the incidence of adverse reactions in 2 groups were recorded. RESULTS:There were no significant differences in the HR, MAP,SpO2,CVP,FiO2 and p(CO2)in 2 groups at different time points(P>0.05). The sevoflurane dosage,recovery time,the incidences of cognitive dysfunction postoperative 3 h and 6 h and adverse reactions in observation group were significantly lower than control group,the differences were statistically significant (P<0.05). And there were no significant differences in the cases with restlessness and incidence of cognitive dysfunction postoperative 1 d and 3 d(P>0.05). After surgery,ALT levels in 2 groups were significantly higher than before,the difference was statistically significant(P<0.05),but there was no significant difference between 2 groups (P>0.05). There were no significant differences in preoperative ALT and preoperative and postoperative BUN and Cr between 2 groups(P>0.05). CONCLUSIONS:Hypoxia flow sevoflurane combined with propofol shows obvious anesthe-sia effect for elderly abdominal tumor surgery in saturation,with stable hemodynamics,it can reduce sevoflurane dosage,shorten the recovery time and reduce the incidence of early postoperative cognitive dysfunction,with good safety.

OBJECTIVE To comprehend the changes in the spectrum of clinically isolated pathogenic bacteria and their drug resistance,and to analyze their tendency.METHODS Totally 5746 pathogenic bacteria isolated from clinical samples of the inpatients in our hospital during 1997-2004 and their drug resistance was statistically(analyzed).RESULTS Most of clinically isolated pathogenic bacteria were Gram-negative.The detected rate of Gram-positive bacteria tended to rise,while the detected rate of fungi obviously increased year after year.Gram-positive cocci and Gram-negative bacilli were resistant to commonly used antibacterials in different degrees,(especially) to ampicillin.The sensitive rate of Gram-positive bacteria was high to vancomycin,while the sensitive rates of Escherichia coli and Klebsiella pneumoniae to imipenem were high.CONCLUSIONS The structure of(nosocomial) infection(pathogens) and their drug resistance patterns are changing continuously.It should be(emphasized) to inspect(bacterial) tolerance in order to select antibacterial reasonably.

Objective To establish a cisplatin (DDP)-resistant HepG-2 cell line,and to explore the role of Wnt/β-catenin signaling pathway on multidrug resistance in human hepatocellular carcinoma.Methods The HepG-2 cells were exposed in a gradually increasing dose of DDP to establish a cisplatin ( DDP)-resistant HepG-2 cell line.MTT assay was used to detect the cytotoxic activity of DDP against HepG-2 and HepG-2/DDP cells.The mRNA expression of β-catenin was determined by Real-time PCR assay.The small interfering RNA was used to specifically knockdown β-catenin expression in HepG-2/DDP cells.The protein expression was detected by western blot analysis.Results The DDP-resistant cell line HepG-2/DDP was established by gradient DDP induction successfully.The IC50 values of DDP against HepG-2 and HepG-2/DDP cells were (2.29 ± 0.14) μmol/L and ( 20.51 ± 0.84 ) μmol/L,respectively ( t=95.68,P＜0.01 ),HepG-2/DDP cells was 8.96 times than HepG-2 cells on the resistance of cisplatin.The result of real time PCR showed that 2-△Ct value of β-catenin in HepG-2 cells and HepG-2/DDP cells were (0.323±0.065) and (0.674 ±0.097) (P＜0.01 ).And the protein expression of cisplatin in HepG-2/DDP cells was also significantly higher than that in the HepG-2 cells.The expresssion of β-catenin was significantly and specifically depleted by siRNA duplexes(P＜0.01 ).The IC50 values of cisplatin against HepG-2/DDP cells were (21.02 ± 1.64) μmol/L in cisplatin control group,(6.23 ± 0.68 ) μmol/L in SiRNA targeting interference group and ( 20.44 ± 1.26 ) μmol/L in SiRNA negative interference group,and there was significant difference between control group and SiRNA targeting interference group ( P＜0.01 ).Conclusion The Wnt/β-catenin signaling pathway was activated on the cisplatin(DDP)-resistant HepG-2 cell line and down regulation of β-catenin increased the chemosensitivity of HepG-2/DDP cells against cisplatin.It provided a theoretical basis for finding the new targets of multidrug resistance in liver cancer.

Objective:To determine the effect of standardized patients in medical international students' graduation practice assessment.Methods:The students were divided into two groups ofstandardized patient assessment and traditional assessment,the theoretical and professional performance was compared and analyzed after the assessments.All the students were investigated using questionnaire.Result:The students assessed using standardized patients reported higher skill scores than those with traditional assessments,and the difference was statistically significant.However,no difference was observed in theoretical scores.Gorcltusion:The introduction of standardized patient to medical international students' graduation practice assessment alleviates the status that emphasizes theory but ignores practice due to the lack of clinical resources,eliminates the obstacles in the communication between students and patients,and is conducive to the cultivation of humanistic quality and adaptability of the students.It is worthy popularizing in international students' graduation practice assessment.

Objective To investigate the prevalence of abnormal glucose regulation (AGR) in patients with coronary artery dis-ease (CAD) in the department of cardiology of Tianjin Medical University General Hospital. Methods Sixty seven patients with CAD in the department of cardiology of Tianjin Medical University General Hospital were consecutively recruited from Jun 1, 2005 to Aug 31, 2005. Patients were asked to perform oral glucose tolerance test (OGTT) to characterize the glucose regulation status except for those with previously known diabetes mellitus (DM). Results Most of patients with CAD in the study had abnormal glucose regulation. The prevalence of AGR was 88.1%. The prevalence of DM and IGT were 56.7% and 31.3%, respectively. Without OGTT, 42.5% DM and 48% IGR and 85% AGR would remain undiagnosed by fasting plasma glucose (FPG) detection alone. Conclusion A majori-ty of patients with CAD in the study have AGR and OGTT is needed to promptly and accurately disclose these patients.