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 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.

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 analyze the clinical features and mutation patterns of HBV polymerase gene in patients with chronic hepatitis B(CHB) after the emergence of drug-resistance during Lamivudine(LAM) therapy.Methods LAM-resistant mutations were detected by direct sequencing of the HBV polymerase gene in hospitalized patients and outpatients of CHB with LAM-resistance in Changhai Hospital from Dec.2005 to Dec.2007.Clinical features after the emergence of LAM-resistant mutations were retrospectively analyzed.Results Two hundred and fifteen patients with CHB were diagnosed as LAM-resistant.Among them 192 patients were found to have LAM-resistant-associated mutations in the HBV polymerase gene.The mean value of serum HBV DNA was 6.25?1.31(log10copies/ml),the mean value of alanine aminotransferase(ALT) was 75U/L(ranged 19-821 U/L).ALT elevation and hepatitis recrudescence were found in 139 among 192(72.4%) patients.99.0%(190/192) patients had YMDD mutations.Four major mutation patterns of LAM-resistant HBV were identified as rtM204I(33.9%),rtL180M+rtM204V(26.0%),rtL180M+rtM204I(21.9%) and rtV173L+rtL180M+rtM204V(11.5%).The rtM204V mutation was accompanied more frequently by the rtL180M mutation compared with the rtM204I mutation(P0.05).Conclusions YMDD is the major mutation pattern of HBV polymerase gene after emergence of LAM-resistance.The mutation patterns of HBV polymerase gene are possibly not related to the clinical severity of CHB patients during LAM therapy.

Objective To evaluate the efficacy and safety of adefovir dipivoxil(ADV) monotherapy and ADV lamivudine(LAM) combined therapy for patients with LAM-resistant chronic hepatitis B.Methods 124 chronic hepatitis B patients with LAM-resistant mutations were enrolled in the present study.74 patients were treated with ADV combined with LAM therapy,and other 50 patients subjected to ADV monotherapy.There were no differences between the two groups in patients' baseline characteristics.Sequencing of the HBV polymerase gene was performed to determine LAM and ADV mutations occurred at baseline or during therapy.All patients were monitored with clinical examinations and routine laboratory tests during the therapy.Results The reduced logarithmic values of serum HBV DNA after 12-week and 24-week treatment were 1.99?0.64 and 2.61?0.80 in ADV group,obviously lower compared with those in ADV+LAM group(2.55?0.74 and 3.19?0.82,respectively,P

Objective To investigate the synergistic effects of pirarubicin (THP) combined with hyperthermia on proliferation and invasive potential of gastrointestinal cancer cells in vitro and to discuss the underlying mechanisms. Methods Gastric cancer cell line MGC-803 was established, and they were divided into 4 groups: control group (37℃), high temperature group (43℃), drug group (37℃+THP), and drug and high temperature group (43℃+THP). After THP and hyperthermia treatment, cell proliferative ability was determined by soft agar clonogenic assay, cell nuclear antigen PCNA was detected by flow cytometry, cyclin E mRNA level was assessed by reverse transcription PCR (RT-PCR). Cell invasion assay was assessed by using transwell chamber model. Results Strong synergistic inhibitory effects on clonogenic ability of MGC-803 cells were observed after MGC-803 cells were treated with pirarubicin in combination with hyperthermia (P