Objective To assess the efficacy and safety of memantine for domestic patients with Alzheimer's disease(AD). Methods Randomized controlled trials carried in China,which compared memantine with placebo or other medicines in patients with AD,were searched from the electronic bibliographic databases,references listed in articles and journals.A systematic review was conducted based on the methods recommended by the Cochrane Collaboration.Results Nine trials involving 1273 patients were included,of which two were placebo-controlled trials and seven non-placebo-controlled trials(piacetam and donepezil).Two placebo-controlled trials,in which neurological changes were assessed by some neuropsychometric questionnaires,showed that there were significant differences in mini-mental state examination(MMSE),Severe Impairment Battery(SIB),Alzheimer's Disease Cooperative Study-Activities of Daily Living Inventory(ADCS-ADL_(19)) and Alzheimer's Disease Assessment Scale-Cognitive Subscale(ADAS-Cog) scores between two groups(P0.05),and there was no significant difference in Neuropsychiatric Inventory(NPI) score(P0.05) although memantine group had better score than placebo group.Six donepezil-controlled trials showed that there was no significant difference in MMSE,ADAS-Cog,Activities of Daily Living Scale(ADL),Blessed-Roth,NPI and Clinician's Interview Based Impression of Change-Plus Caregiver Input(CIBIC-Plus) scores between two groups(P0.05).One piacetam-controlled trial showed that there were significant differences in MMSE and Barthel Index(BI) scores between two groups (P0.05).One blank-controlled trial showed that there were significant differences in MMSE and ADL scores between the two groups(P0.05).Adverse reactions associated with medicines were reported in seven trials,including doze,fatigue,dizziness, confusion,deliria,agitation,anorexia,nausea,etc.However,no severe adverse reaction was reported.Conclusions Memantine can improve the general condition of patients with AD,including the cognitive function,daily life ability,mental behavior and global function.It has better therapeutic effects than piacetam,and at least equal tharapeutic effects to donepezil.It is safe for patients with AD.

Objective To investigate the association of oral chlorhexidine rinse with incidence of ventilator-associated pneumonia(VAP).Methods We searched PubMed as well as references lists from publications to collect randomized controlled trials comparing oral chlorhexidine with placebo in their effects on incidence of VAP.Meta analysis was performed using software Review Manager 5.0.Results Nine randomized controlled trials were included.Oral chlorhexidine rinse resulted in a reduced incidence of VAP(OR=0.44,95%CI 0.32 - 0.62).There was no difference in mortality rate between patients receiving oral chlorhexidine rinse and placebo(OR=1.04,95%CI 0.79-1.83).Conclusion The available evidence indicates that oral chlorhexidine rinse can reduce incidence of VAP.

Approximately 20%of human tumors are associated with mutations of ras genes.Ras proteins control cellular signaling pathways responsible for cell proliferation,differentiation,survival and apoptosis.Ras proteins belong to the large family of small GTPases,which are activated in response to various extracellular stimuli.RASAL1,as a ras GTPase activating protein,inhibits ras activation. Regulation of ras and RASAL1 activities may lead the direction of target treatment of tumors.Detection of ras and RASAL1 activities can provide more relevant information about diagnosis and prognosis of gastrointestinal tumors.In this paper,we reviewed the structure,the biochemical properties of ras proteins,and the role of its mutations in tumors.We further discussed the inhibitive effects of RASAL1 on ras activities.Finally,we commented the correlation of ras and RASAL1 with gastrointestinal tumors.

Objective To investigate the effects of valsartan on sarcoplasmic reticulum calcium adenodine triphosphatase expression and function in a rabbit model of heart failure.Methods Twenty-seven rabbits were divided into sham-operated,heart failure and valsartan groups,with 9 in each group.The rabbit model of heart failure was prepared by volume overload plus pressure overload.After 7 weeks,left ventricular function,hemodynamic parameters,and expression and function of SERCA2 were observed. Results Compared with sham-operated rabbits,left ventricular mass index(LVMI)and left ventricular end diastolic pressure (LVEDP)were significantly increased in heart failure rabbits[(1.32±0.06)vs(3.61 + 0.09)g/kg and(-0.50±1.05)vs(23.00±2.37)mmHg respectively, P0.05],but the left ventricular shortening fraction and left ventricular ejection fraction(LVEF)were significantly decreased in heart failure rabbits[(37.83±3.58)%vs(17.38±3.13)%;(72±5)%vs(38±6)%,P0.05].Compared with heart failure rabbits,LVMI and LVEDP were significantly decreased in valsartan rabbits[(2.07±0.14)g/kg and(2.17±0.72)mmHg respectively, P0.05],but their left ventricular shortening fraction and LVEF were increased[(33.8±2.9)%and(65±4)%respectively,P0.05]. Expression and function of SERCA2 were remarkably lower in heart failure rabbits than in sham-operated rabbits[(0.69±0.04)vs (1.02±0.02)and(54.4±7.9)%vs(95.5±2.1)%respectively,P0.05],while compared with heart failure rabbits,they were significantly higher in valsartan rabbits[(0.91±0.02)and(81.7±4.9)%respectively,P0.05)].Conclusion Valsartan can improve cardiac function,probably owing to its roles in upregulating expression and function of SERCA2 in the prevention of heart failure.

Objective To assess the safety of esophageal and gastric endoscopy for elderly patients with coronary heart disease (CHD) by monitoring the changes of their vital signs during operation process.Methods A total of 60 patients over 60 years old accepting esophageal and gastric endoscopy were divided into CHD group(with mild ST-T change or history of angina or old myocardial infarction but without respiratory diseases) and control group(without heart diseases),with 30 in each group.The heart rate,blood pressure,oxygen saturation(SpO_2) and electrocardiogram during performance of esophageal and gastric endoscopy were compared between the two groups.Results Heart rate was significantly increased during operation in both groups(P0.05),and the variation in CHD group was greater than that in control group(P0.05).Blood pressure was also increased in both groups(P0.05) and there was no significant difference between two groups(P0.05).SpO_2 was significantly decreased in CHD group(P0.05) during operation but with no significant difference compared with control group(P0.05).Arrhythmia,but no dangerous arrhythmia, occurred in both groups during operation.In addition,there were 6 cases with ST-T changes in CHD group and all cases recovered to normal after operation.Conclusion With full preparation before operation and electrocardiographic monitoring if necessary during operation,esophageal and gastric endoscopy is safe for elderly patients with CHD.

Genetic factors play important roles in the development of Alzheimer's disease(AD).We mainly introduced some genes, which has been reported in recent years,predisposing to different aspects of AD.Besides,from the aspects of epigenetics,gene or drug therapy,we also discussed how to block the expression pathway of some predisposing genes,so as to inhibit or delay the development of AD.Except several genes related to familial AD and apolipoprotein E,some other predisposing genes related to sporadic AD remains controversal.Racial diversity and sample size might explain the disagreement of various researches.Therefore,further studies are needed for better diagnosis and gene therapy of AD.

Objective To investigate the relationship between the prolonged QTc interval and the multi-cardiovascular risk factors in patients with type 2 diabetes mellitus(T2DM).Methods Medical data of 3940 T2DM patients were analyzed.After patients who had coronary heart diseases,arrhythmia,myocardial infarction,which may cause abnormal QTc,were excluded,a total of 3426 T2DM patients who had underwent diabetic complication assessment and 12 standard electrocardiogram(ECG) recording were enrolled.They were divided into normal QTc interval group(QTc0.44 s,n=2157) and prolonged QTc interval group(QTc≥0.44s,n=1269).The multi-cardiovascular risk factors were compared between the two groups and further analyzed.Results Compared with normal QTc interval group,the patients in prolonged QTc interval group were older[(55.6±11.0) vs(54.6±10.9) years],had longer diabetes duration[36(12,96) vs 36(6,84)months,median(P25,P75)],more females(51.5%vs 41.5%),shorter body height[(1.64±0.08) vs(1.65±0.08) m],bigger body mass index(BMI)[(26.2±3.6) vs(25.8±3.2) kg/m~2],bigger waist circumference[(89.7±9.6) vs(88.2±9.5) cm],bigger hip circumference[(95.4±7.3) vs(94.4±6.6)cm],higher waist hip ratio(WHR)[(0.94±0.07) vs(0.93±0.08)],higher blood pressure[(134.8±20.3) /(76.9±10.2) vs(130.1±19.1) /(74.5±9.6)mmHg], increased heart rate[(82.9+10.2) vs(70.7±10.1 )beats/min],higher HbA1c[(8.0±2.0)%vs(7.7±1.9)%],higher post-meal glucose[(13.7±5.1) vs(12.8±4.8)mmol/L],higher fasting insulin[(9.4±8.6) vs(8.2±7.5)IU/ml],increased total cholesterol[(5.1±1.1) vs(5.0±1.1)mmol/L],higher triglyceride[(2.4±2.6) vs(2.2±2.5)mmol/L],and higher urine albumin/creatinine(A1b/Cr)[15(8, 36) vs 12(7,27)mg/g,median(P25,P75)].All these indices were significantly different between the two groups(P0.05).Logistic regression analysis showed that factors including age,sex,BMI,waist circumference,WHR,heart rate and Cr,were significantly associated with prolonged QTc interval.Conclusions More than one third of T2DM patients present with prolonged QTc interval and more severe multi-cardiovascular risk factors.

Objective To determine the roles of heart rate variability(HRV) in evaluating cardiac autonomic nerve function of patients with vascular dementia.Methods Totally 124 patients with vascular dementia and 102 control subjects received 24h dynamic Holter monitoring to perform frequency domain measures,time domain measures and non-linear analysis of HRV. The following HRV spectral parameters were considered:total frequency power(TF),low frequency power(LF),high frequency power(HF),standard diviation of normal-to-normal intervals(SDNN),square-root of mean squared differences of successive NN intervals(RMSS),and standard deviation of SDNN(SDSD).Poincare plot descriptors included vector angle index(VAI) and vector length index(VLI).Results The time domain measures(SDNN,RMSS,SDSD),frequency domain measures(TF,LF,HF),VAI and VLI were significantly lower in patients with vascular dementia than in control subjects[SDNN:(78±28) vs(129±30)ms,RMSS: (20±8) vs(24±8)ms,SDSD:(17±7) vs(22±8)ms,P0.01;TF:(1432±621) vs(1962±583) ms~2/Hz,LF:(934±347) vs (1309±371)ms~2/Hz,HF:(473±174) vs(601±247)ms~2/Hz,P0.01;VAI:(0.54±0.14) vs(0.67±0.13)ms,VLI:(154±19) vs(194±25)ms,P0.01].There were less patients who had Poincare scatter grams in shape of comet in patients with vascular dementia than in control subjects.Conclusion We recommend to perform HRV analysis,a noninvasive mehtod,for patients with vascular dementia to evaluate the cardiac autonomic nerve function.