Vascular eognitive impairment (VCI) is a large class of syndromes from mild cognitive impairment to dementia, which are caused by the cerebrovascular risk factors (eg, hypertension, diabetes and hyperlipemia), obvious (eg, cerebral infarction and intracerebral hemorrhage) or unobvious cerebrovascular diseases (leukoaraiosis and chronic cerebral ischemia). Accurate early diagnosis provides the best treatment opportunity and slows down the progress of the disease. In recent years, the research on VCI has made a great progress. This article reviews VCI from the aspects of the etiology, clinical manifestation, neuropsychology, imaging, neuroelectrophysiology, biomarkers, and diagnostic criteria.

Objective:To explore the efficacy of nimodipine in treating cognitive impairment of cerebral small vessel disease (CSVD) and the value of magnetic resonance diffusion tensor imaging (DTI) in CSVD.Methods:A total of 80 patients with CVSD and cognitive dysfunction who admitted to Suzhou Municipal Hospital from February 2018 to February 2019 were selected, and the patients were divided into control group (40 patiengts) and observation group (40 patients) by random number table method. The control group received basic treatment and donepezil, and the observation group added nimodipine on the basis of control group. All patients were followed up for 12 months. Before treatment, 6 months after treatment and 12 months after treatment, the patients’Montreal cognitive assessment scale (MoCA) score, daily living ability scale (ADL) score, and Tinetti balance and gait analysis(TGA) were recorded. The levels of total cholesterol (TC), triacylglycerol (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C), homocysteine (Hcy) and high-sensitivity C-reactive protein (hs-CRP) before and after treatment were recorded. The changes of DTI data before and after 12 months′ treatment in the two groups were recorded.Results:The MoCA score, ADL score, and TGA score of the two groups were higher than those before treatment and at 6 months and 12 months after treatment, and those 12 months after treatment were higher than those at 6 months after treatment. There were significant differences ( P<0.05). The MoCA and ADL scores of the observation group were higher than those of the control group at 6 and 12 months after treatment at 6 months: (24.61 ± 2.54) scores vs. (22.21 ± 2.83) scores, (71.53 ± 6.25) scores vs. ( 69.51 ± 6.81) scores; 12 months: (26.39 ± 2.16) scores vs. (23.76 ± 2.64) scores, (78.39 ± 5.76) scores vs. (72.39 ± 6.12) scores, P<0.05. At 6 months and 12 months after treatment, the visual space and execution ability, delayed memory, and orientation scores were higher than those before treatment, and in the observation group 12 months after treatment was higher than those 6 months after treatment: (5.97 ± 1.37) scores vs. (5.36 ± 1.29) scores, P<0.05. The observation group′s visual space and executive ability, abstract thinking, delayed memory, and orientation score were higher than those in the control group at the same period ( P<0.05). The levels of TC, TG, LDL-C, Hcy and hs-CRP of the two groups after treatment for 6 and 12 months were lower than those before treatment, and the levels of these index at 12 months after treatment were lower than those at 6 months after treatment ( P<0.05). The levels of Hcy and hs-CRP in the observation group were lower than those in the control group at 12 months after treatment, and Hcy was lower than that in the control group at 6 months after treatment ( P<0.05). After treatment, the fractional anisotropy (FA) values of the center, frontal lobe, and parietal lobe of both sides of the two groups were higher than those before treatment, and the difference in the observation group before and after treatment was higher than that of the control group ( P<0.05). After treatment, the mean diffusivity (MD) values of both frontal lobe and parietal lobe of the two groups were lower than those before treatment, and the difference between the observation group before and after treatment was higher than that of the control group ( P<0.05). Conclusions:Nimodipine has a good effect on the treatment of CVSD, which can effectively improve the patients′ cognitive impairment and other symptoms. DTI can sensitively sense the white matter integrity and cerebral blood flow perfusion of patients, which has a positive significance for the prevention and treatment of CVSD.

Objective To observe the changes of extracellular matrix(ECM) production and hypertrophy of glomerular mesangial cells(GMCs) induced by high glucose(HG),and the inhibitory role of myriocin(ISP-1).Methods GMC cultured with normal glucose(5.6 mmol/L D-Glucose,NG),HG(25.2 mmol/L D-Glucose) and HG plus ISP-1(100 mg/L) for different durations(0,24,48,(72 h)).The sizes of GMC were indicated by forward scatter intensity,measured by flow cytometery,and the levels of fibronection(FN),collagen Ⅳ(Col Ⅳ),laminin(LN),precollagen Ⅲ(Pcol Ⅲ) and hyaluronic acid(HA) in the supernatant of cultured GMC were detec-(ted) by ELISA.Results Compared with NG,HG could induce GMC hypertrophy(P

In this study, three methods for identification of E.coli were compared. The conventional method was employed to select and identify the suspicious E.coli isolates from a fecal sample. PCR based ARDRA analysis was then carried out to distinguish these E.coli isolates, E.coli MG1655 and other bacterial species. All the potential E.coli isolates and E.coli MG1655 had the identical ARDRA banding pattern while the other bacterial species showed the different patterns.The result indicated that the ARDRA analysis was consistent with the traditional method for identification of E.coli and could be the practical method for distinguishing E.coli from other intestinal bacterial species. The ERIC-PCR analysis provided abundant polymorphism between different E.coli isolates, and might be a powerful approach for elucidating the genetic diversity among isolates of the same species.

Objective To verify the application of anterior segment perfusion culture and trabecular meshwork (TM) organ culture for glaucoma study. Methods TM tissue was cultured by perfused anterior segment and TM organ culture, light microscopy was used to observe the TM cells and intercellular spaces.Results IOP of the porcine anterior segments perfused under constant flow at 0.1 mL/h could bekept in normal range(10～12 mmHg). The IOP was elevated with the increasing of perfusion rate, while the morphology and structure of the tissue were well preserved. TM cultured by TM organ culture could also reserve the tissues well, but the intercelluar spaces collapsed. Conclusion Anterior segment perfusion model could be a short-term high-pressure model and may simulate the normal physical state. Adequate perfusion was necessary for normal TM.

Objective To analyze the statistical correlation between 25-hydroxyl vitamin D and bone metabolism parameters in-cluding parathyroid hormone(PTH),N-terminal osteocalcin (N-MID),calcitonin(CT),bone alkaline phosphatase(BALP),and dis-cuss the significance in clinical diagnosis,prevention and treatment.Methods 411 cases of hospitalized patients were collected from January to September in 2014,including 316 women,95 men,age arranged from 37 to 96,the average age was(69.29±12.21).Use electro chemiluminescence immunoassay(ECLIA)method to detect the levels of 25-hydroxyl vitamin D,PTH,N-MID,CT,and BALP in hospitalized patients and explore the relationship of 25-hydroxyl vitamin D and serum bone markers in osteoporosis pa-tients.Results It was showed that vitamin D and PTH,BALP were negative correlation(P <0.05);There was no significant corre-lation between calcitonin and N-terminal osteocalcin(N-MID)(P >0.05 ).Regression analysis showed that regression equation for vitamin D and blood bone markers was:Y =19.02-0.066PTH-0.09BALP.Conclusion There was some correlation between 25-hydroxyl vitamin D and PTH,BALP in patients with osteoporosis.By taking a combination test of these markers,it can provide some basic data for clinical osteoporosis diagnosis,prevention and control.

The continuing education system at the Peking University Health Science Center for vis-iting scholars (Research program for young and middle-aged doctors) is a relatively advanced and compre-hensive medical continuing education system in China, among which, the tutorial system is a good method to guide the visiting scholars of continuing education. On this basis we conducted scholars learning effect questionnaire survey and combined with the feedback results, discussed the advantages and disadvantages of the current educational system of visiting scholars in China, and put forward some concrete suggestions on the development of the continuing education in China.

Objective To study the nutritional evaluation and clinical effects of perioperative enteral nutrition (EN) versus parenteral nutrition support (PN) in elderly patients undergoing gastrectomy for gastric carcinoma.The safety,feasibility and superiority were also compared between EN and PN.Methods Totally 50 cases (aged 65 years and over) undergoing gastrectomy for gastric carcinoma in Department of Gastrointestinal Surgery of Beijing Hospital were recruited and divided randomly into two groups of EN and PN (25 cases for each).NRS2002 nutritional assessment scoring system was used to evaluate the patients.The patients in EN group were given Rui Su at 2 d before surgery,then Wei wo,Bai pu li and Rui su were sequentially given from 12 h after the surgery.The patients in PN group were received total parenteral nutrition (TPN) via central venous for 7 days.Results The average absolute lymphocytes[(1.22±0.23) ×109/L and (1.31±0.27) ×109/L vs.(1.02±0.21) × 109/ L and (1.14 ± 0.23 × 10)9/L],pre-albumin[(151.442± 48.15) mg/ L and (167.38± 46.23) mg/ L vs.(115.22 ± 47.34) mg/L and (131.27 ± 43.58) mg/L] and transferring [(1.71±0.33)g /L and (1.83±0.31)g/L vs.(1.50±0.32)g/L and (1.65±0.32)g/L,all P＜0.05] levels after surgery of 3 d and 7 d in EN group were higher than those of PN group (P＜0.05).The CRP levels at 3 d and 7 d after surgery were increased in PN group compared with EN group [(63.71±35.26)mg/L and (41.58 ± 22.55)mg/L vs.(54.26±29.13)mg/L and (18.12 ±14.35)mg/L,P＜0.05].The blood sugar and insulin levels of EN group at 3 d and 7 d after surgery were (5.93±1.12) mmol/L and (5.61± 1.03)mmol/L,(6.72±5.14) U/L and (6.21±2.63) U/L,which were decreased compared to PN group (8.31 ± 2.62) mmol/L and (8.85 ± 2.92) mmol/L,(12.81±7.26) U/L and (15.21±8.24) U/L (P＜0.05).ALT in the PN group was (38.43±18.37) U/L at 7 d after surgery,higher than EN group (23.91± 14.82) U/L(P＜0.05).The perioperative average costs of EN group was (2714.5± 1391.7) yuan,lower than PN group (5041.6± 3007.7) yuan (P＜0.05).For the patients complicated with delayed gastric emptying after surgery,nutrition cost reduction was more evident.There were no significant difference between the two groups of patients in the liver and kidney function changes and postoperative complications.Conclusions It is safe and feasible for elderly gastric cancer patients with perioperative EN sequential therapy in view of its reduced stress response of surgical trauma and insulin resistance,improvement of hyperglycemia,reduction of medical costs compared with PN for elderly gastric cancer patients.

Objective To investigate the influence of CO2 pneumoperitoneum on the adhesive and invasive ability of gastric cancer cells based on the expression of adhesive and invasive molecules. Methods With an artificial CO2 pneumoperitoneum model in vitro, human gastric cancer cells MKN-45, SGC-7901 and MKN-28 were exposed to 3 different CO2 gradients: 9 mm Hg, 15 mm Hg and control group (0 mm Hg). The expression of E-cadherin, ICAM-1, MMP-2 and VEGF-A were measured at 2 and 4 hours exposure by using RT-PCR, CytoMatrixTM kit and ECMatrixTM kit. The pretreated gastric cancer cells were injected into abdominal cavity of nude mice(2×106 cells per mouse). Five mice in each group were sacrificed 4 weeks later to record the number of tumor nodules in abdominal cavity. The remaining mice were kept for observation of survival time. Results The expression of E-cadherin (MKN-45: from 2.26 to 2.19, SGC-7901 :from 2.16 to 2.09、MKN-28 :from 2.06 to 1.99), ICAM-1 (MKN-45 : from 2.20 to 2.28、SGC-7901: from 2.10 to 2.18、MKN-28: from 2.00 to 2.08), MMP-2 (MKN-45:from 2.05 to 2.13、SGC-7901: from 1.95 to 2.03、MKN-28: from 1.85 to 1.93) and VEGF-A(MKN-45 : from 2.10 to 2.16、SGC-7901 :from 2.00 to 2.06、MKN-28: from 1.90 to 1.96) didn't change significantly with increasing pressure and time (P>0.05). The expression of adhesive and invasive molecules didn't change significantly between the experimental groups and the control group. There was no statistical significance of tumor metastasis in abdominal cavity of nude mice(MKN-45:from 22 to 23、SGC-7901 :from 20 to 22、MKN-28:from 21 to 22) and survival time(MKN-45 :from 23 to 21、SGC-7901 :from 22 to 21、MKN-28 :from 22 to 21) among all the groups. Conclusion Under low pressure and short time of CO2 exposure, the adhesive and invasive capacity of gastric cancer cells did not change significantly hence did not increase the possibility of neoplasm metastasis.

Objective To evaluate the role of multidetector CT(MDCT) and high magnetic field MRI in diagnosis of small cystic-solid renal mass. Methods Fifty-two cases with small renal cystic-solid mass(≤3 cm) were consecutively collected,including small cystic-solid renal cell carcinoma(n=25),carcinoid(n=1),complex cysts(n=16),small angiomyolipoma(n=7) and benign cystic nephroma(n=3).All were examined by both 1.5T MRI and multidetector CT at intervals between 3 days and 2 months. Results All cases were proved by pathology.Multi-planar reconstruction techniques were useful for MDCT in differentiating small cystic-solid renal mass,with the sensitivity of 98.1%,which was as high as MRI.However,the accuracy for MDCT was 71.2%,significantly lower than that of MRI(90.4%)(P=0.001).MRI helped to identify the components and structure of renal masses,and behaved better in the detection of pseudo-capsule of renal cell carcinoma(57.7%).Conclusion High magnetic field MRI may play an important role in the diagnosis of small renal cystic-solid masses,and it may be feasible as a noninvasive examination when CT can not make the ultimate determination.