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.

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.

There are multiple types of inhibitory immune cells in tumor. Among these cells, Treg (regulatory T cell) plays an extremely important role in tumor development and progression. Treg exihibits potent inhibitory effects on effector cells by a variety of mechanisms, which might be the the key factor for tumor immune escape. These mechanisms include inhibiting the effector cell function by inhibitory cytokines, killing effector cells by granzyme and profrin, interfering effector cell metabolism, and affecting Treg differentiation and proliferation by regulating the function of dendrtic cells, etc. The research on Treg has provided new strategies for tumor immunotherapy. Tumor immunotherapies targeting Treg and related immunosuppressive factors, such as deleting Treg nonsepcificlly or sepcificlly controling the numbers and functions of Treg, might have a bright future in clinical application.keyword regulatory T cell(Treg); neoplasms; immune escape; immunotherapy

Objective To analyze the clinical effect of puerarin and lipoic acid in treatment diabetic peripheral neuropathy.Methods 80 type Ⅱ diabetes patients accompanied with peripheral neuropathy were selected.According to different therapy,they were divided into single drug treatment control group (lipoic acid) and combined treatment group (puerarin + lipoie acid).Total effective rate,MNCV,SNCV,FBG,HbAlc and sorbitol were evaluated after treatment.Results The total effective rate in the treatment group was higher than that in the control group (P ＜ 0.05).Compared with the control group,the recovery rates of MNCV and SNCV were faster in the treatment group(P ＜0.05).And the levels of FBG,HbAlc and sorbitol were significantly lower in the treatment group than in the control group(P ＜ 0.05).Concluslon The clinical effect of puerarin and lipoic acid in treatment diabetic peripheral neuropathy was significant.

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.

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 observe the distribution and drug resistance of pathogenic bacteria causing pulmo-nary infections in cardiology department of general hospital ,and to provide advices for infection control and selection of drugs.Methods 110 sputum specimens of patients with pulmonary infections in cardiology department were col -lected.The distribution and drug resistance of pathogenic bacteria were analyzed .Results In the 110 sputum sam-ples,83 cases(75.5%) were infected by gram-negative bacterias,21 cases(19.1%) were infected by gram-positive bacterias,6 cases(5.4%) of fungal infection .The Escherichia coli and the Pseudomonas aeruginosa after the antibiot-ic resistance analysis were found a trend of multi resistance .Conclusion The major pathogenic bacterias causing pulmonary infections in cardiology department are gram-negative bacterias ,and they show a trend of multi resistance .

Objective To investigate the changes of platelet activating factor ( PAF) in serum from patients with hypertensive disorder complicating pregnancy .Methods The specimens from 138 women were obtained at Department of Obstetrics , Xinhua Hospital , School of Medicine , Shanghai Jiaotong Uni-versity, between June 2008 and March 2010.They were divided into two groups:women( n =63) with hy-pertensive disorder complicating pregnancy and normal pregnant women ( n =75 ) ( control group ) .All of them delivered until maturity .ELISA was used to detect the levels of PAF in those women's serum and in the umbilical cord serum .Results The levels of PAF in hypertensive disorder complicating pregnancy group (27.46 ±13.37 ) ng/ml were no significantly different from the control group (25.48 ±11.05 ) ng/ml( P >0.05 ) .With the hypertensive disorder complicating pregnancy more deteriorative , the levels of women ser-um PAF would be higher .The levels of women's serum PAF in hypertensive disorder complicating pregnancy group were significantly higher than the umbilical cord serum [0.00(0.00-8.83) ng/mL]( P <0.05). The levels of women's serum PAF in control group were also significantly higher than the umbilical cord ser -um[0.00(0.00-7.80)ng/mL]( P <0.05).Conclusion There are some relationships between PAF and hypertensive disorder complicating pregnancy .

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 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.