Objective:To observe the sedative effect of epidural anesthesia assisted with target controlled infusion(TCI) propofol.Methods:45 ASA Ⅰ～Ⅱ patients,who would accept hysterectomy,were randomly allocated to group Ⅰ (without propofol),group Ⅱ(Target blood propofol concentration was set at 1.0?g/ml when epidural anesthesia level was confirmed) and group Ⅲ(Target blood propofol concentration was set at 1.5?g/ml).Heart rate and blood pressure were determined at the different moment from pre-operation to the end of the surgery.And the sedation degree was evaluated by the Observer's Assessment of Alertness/Sedation (OAA/S) Scale.At the same time,efficacy of antitraction response and perioperative awareness were investigated.Results:In three groups,blood pressure significantly decreased when epidural anesthesia level was confirmed.Goup Ⅱ and Goup Ⅲ showed significantly lower than group Ⅰ in 5 min after propofol infusion.HR gradually decreased with operative courses,and no difference was significantly found in the three groups.53.3% of patients fell asleep;53.3% had effective antitraction response and 33.3% were aware in group Ⅱ.And the patients in goup Ⅲ all fell asleep;86.7% could prevent traction response during operation but no perioperative awareness.Conclusion:Target controlled infusion of propofol as an adjuvant for epidural anesthesia is applicable and can prevent viscus traction response during surgical exploration.And the sedative effects of blood propofol concentration of 1.5?g/ml are better than 1.0?g/ml through OAA/S Scale.

The change of T cell subsets of peripheralblood were tested in 12 patients with prematureovarian failure (POF), among them 10 patients superoxide dismutase (SOD) activity in erythrocytewas also tested. The results showed that the num-ber of T_3, T_4 cells T_4/T_8 ratio and SOD activitywas significantly lower in patients with POF thanin normal controls, which indicated that the func-tion of proliferation and differentiation of T lym-phocyte was inhibited, the immunoregulation wasinbalanced and the ability of resistance to lipid per-oxidation was lower in patients with POF. There-fore, the results suggests that T cell subsets andSOD activity testing in patients with POF have val-ue in the investigation of the cause of the deseaseas well as in the diagnose and treatment.

At present,there are many problems in the cultivation for the young clinicians including lack of subjective initiative,insufficient innovation education.This paper analyzed the current status of the academic and charactersfic training of the young clinicians then put forward new training methods which can be used for reference.Developing prominent features and novelty is the most important way to implement the aforementioned training methods.

Objective To investigate the incidence and the risk factors of the vascular disease in lower limbs of patients with type 2 diabetes(T2DM).Methods To retrospectively analyze 318 cases with T2DM patients.All the patients were checked on both lower limbs by color ultrasonic Doppler.The differences of ordinary and biochemical indicators between PVD group and non-PVD group were compared.Results There were 67.2％ (205/318) patients who had vascular disease in lower limbs with type 2 diabetes.Age,course of disease,HbAlC,TC,TG,SBP,DBP and BMI in PVD group were significantly higher than those in non-PVD group( P ＜ 0.01 ).Conclusion There was higher incidence of the vascular disease in lower limbs of patients with type 2 diabetes.And the independent risk factors were hypertension,hyperglycemia,hyperlipemia.It could help to prevent the development of lower limb blood vessel pathological changes in DM patients by controlling the levels of blood pressure,lipid and blood sugar strictly.

MELAS syndrome(mitochondrial myopathy encephalophathy with lactic acidosis and stroke-like episodes),as one of the most common diseases in mitochondrial encephalomyopathies,is characterized by highly variable manifestations.So,more and more people come to realize the importance of molecular basis of MELAS.This review took the commonest mtDNA point mutation(A3243G) for example to overview its molecular biological mechanism,test strategy and recent progress of study on MELAS syndrome.

Objective To study effect of triple viable bacterium of bacillus (small peifeikang) on the intestinal microflora and inflammation factors in patients with infectious diarrhea.Methods From October 2010 to October 2014, 120 patients with infectious diarrhea were chosen as study objects, 30 cases of health examination were selected as healthy control group, All patients were divided into 2 groups:60 patients in small peifeikang group and 60 patients in control group.The therapeutic effect and the change of intestinal microflora and inflammation factors were compared between two groups.Results The effective rate of small peifeikang groupwas 100.00%, while that of control group was 96.67%,the difference had statistical significance (χ2 =5.52,P<0.05).The symptom disappearance time of diarrhea, vomiting and fever had statistical difference between two groups (P<0.05), that of dehydration had no statistical significance.After treatment, in small peifeikang group and control group, the number of bifidobacterium, lactobacillus, and B/E value had decreased significantly (P<0.05), and the number of intestinal bacteriahad increased significantly(P<0.05).The distribution of intestinal flora in small peifeikang group was better than that of control group, and the difference had statistical significance(P<0.05).After treatment, in small peifeikang group and control group, the level of endotoxin, IL -6, TNF-αand CRP had decreased significantly( P <0.05).The extent of decreasing in small peifeikang group was more significant than that of control group, and the difference had statistical significance ( P <0.05 ) . Conclusion The triple viable bacterium of bacillus can promote the recurrence of patients with infectious diarrhea by adjusting the distribution of intestinal microflora, and by its immune regulation function.

Objective To observe the effect of stress caused by neuropathic pain on serum cortisol concentration and expres-sion of 11β-hydroxysteroid dehyarogenase 1(11βHSD1)and investigate the action mechanism of curcumin for alleviating neuropathic pain. Methods The 72 male SD rats were randomly divided into 4 groups with 18 rats in each group:sham operation group(Sham), chronic constrictive injury group(CCI),solvent contrast group(SC)and curcumin treated group(Cur100). Curcumin(100 mg/kg/d) was given after the operation in Cur100 group. Paw thermal withdrawal(PTWL)and paw mechanical withdrawal threshold(PMWT)of rats were measured on 2 pre-operative and 1,3,5,7,10,and 14 post-operative days. The animals were deeply anesthetized,the blood was taken from the heart,and the L4-L5 dorsal root ganglion(DRG)of the operated side was removed. The change of cortisol was measured by ELISA and the change of 11βHSD1 expression in spinal cord and DRG was determined by immunochemistry and Western blot. Results Compared with sham group,PTWL and PMWT decreased significantly after operation in CCI group(P<0.01),serum cortisol concentration was significantly increased(P<0.01)and the expression of 11βHSD1 was significantly increased in CCI group(P<0.01). Compared with CCI group,the PMWT and PTWL was increased in CCI group(P<0.05),the serum cortisol concentration was decreased(P<0.05)and the expression of 11βHSD1 was inhibited in Cur100 group(P<0.05). Conclusion Stress caused by neuropathic pain triggered the release of cortisol to the blood and increased the expression of 11βHSD1 at the same time. Cur-cumin could alleviate thermal hyperalgesia and mechanical hyperalgesia induced by CCI and could also inhibit the serum cortisol con-centration and the expression of 11βHSD1 in spinal cord and DRG,which was likely to be related to pathogenesy and maintenance of neuropathic pain.

Most of the current medical humanities education focuses on the moral aspects without good theoreti-cal basis and specific practices on the medical institution and daily life.The article dates back to the origins of So-cial Science based on the concept caregiving put forward by the medical anthropologist Arthur Kleinman,and states that the ultimate purpose of Social Science is to make response to the social suffering and provide caregiving for it.Caregiving as moral experience is response to social suffering and attracts much importance,because it pro-vides both the theoretical basis and practical means for the current medical humanities education.Its characteristics of caregiving as moral experience to social suffering and caregiving as reciprocity meet the demands of current notion of Big health in China.

Objective To comparatively complete clinical effectiveness of laparoscopic and open-bifemoral bypass in the treatment of advanced atherosclerosis.Methods During January 2008 to January 2013,according to the treatment method,a total of 60 patients with advanced atherosclerosis patients were divided into group A and group B,and there were 30 cases in each group,and group A was treated with open master bifemoral bypass surgery,and group B was treated with laparoscopic totally master bifemoral bypass surgery,to compare the general information of the two groups,surgery related indicators,clinical efficacy and survival rate,and to analyze the effect of surgical treatment on the prognosis of patients by COX model.Results The operation time of patients in group B (365.3 ±41.3) min and aortic clamping time (59.5 ± 18.3) min were significantly higher than that of group A,(294.3 ±35.5) min and(26.5 ± 19.3) min (P ＜0.05),bleeding amount (400.0 ± 145.3) ml and length of hospital stay (10.5 ± 2.1) d of group B patients was significantly lower than that of group A (1 002.3 ± 324.3) ml and (16.4 ± 4.3) d (P ＜ 0.05);postoperative mortality,thrombosis rate and the incidence of serious complications of patients in group B were significantly lower than group A (P ＜ 0.05);survival rate at different time of group B was significantly higher than that of group A (P ＜ 0.05);COX model analysis show that the surgical methods affect the postoperative mortality,thrombosis and the occurrence of severe complications.Conclusions Completely laparoscopic master bifemoral bypass can significantly decreased advanced main iliac artery occlusion disease mortality,and has small surgical trauma,less postoperative complications,rapid recovery and other advantages,especially for elderly critically ill patients,and it was worthy of clinical application.

Inverse agonist is a new type of drug acting on receptors.Its research has experienced several stages, including discovery of ethylβ-carboline 3-carboxylate,activity study,proposal of the concept,two-state model,and constitutive activity theory in succession.Most G protein-coupled receptors possess constitutive activity,i.e.a proportion of receptors are in active state and can produce effects without any agonist.Inverse agonist has an affinity to receptors,but no intrinsic activity,so it cannot activate receptors.However,it can antagonize the constitutive activity of receptors,and produce an opposite effect on the corresponding agonist.Both agonist and inverse agonist can produce their effect alone with different mechanisms.Agonist activates its receptors,but inverse agonist antagonizes them.Both inverse agonist and antagonist can antagonize receptors.However,inverse agonist and antagonist antagonize the constitutive activity of receptor and the agonist’s effects,respectively.Inverse agonists can be used to treat diseases with enhanced constitutive activity,up-regulate and sensitize receptors with constitutive activity.Moreover,endogenous inverse agonists can maintain a specific physiological function.The study on inverse agonist has a theoretical significance in perfecting receptor theory as well as a clinical value in diagnosis and treatment of diseases with enhanced constitutive activity.