Objective To investigate the clinical effectiveness of dynamic hip screw (DHS) internal fixation and proximal femoral nail (PFN) internal fixation for intertrochanteric femoral fractures.Methods One hundred and sixty-five patients with intertrochanteric femoral fractures were randomly divided into 2 groups,85 patients were in DHS group and 80 patients were in PFN group.The clinical effectiveness,index in operative procedure and complications were compared between two groups.Results The fine rate of DHS group and PFN group was 75.3％(64/85 ) and 83.8％( 67/80 ) (P ＞ 0.05 ).The indexes of function recover time,fracture healing time,amount of bleeding in operation,operation time in PFN group were significant lower than those in DHS group [(54.3 ± 11.7 ) d vs.(92.6 ± 10.5 ) d,(63.8 ± 12.2) d vs.(71.3 ± 10.6) d,(453.3 ± 50.7) ml vs.(627.5 ± 46.8) ml,(77.9 ± 25.2) min vs.( 115.7 ± 32.8) min](P＜0.05 ).The rate of short-term complications was 16.2％ (13/80) in PFN group,and 12.9 ％ ( 11/85 ) in DHS group(P ＞ 0.05 ).The rate of long-term complications was 1.2％( 1/80 ) in PEN group and 4.7％(4/85 ) in plts group (P ＜ 0.05).Conclusions As the treatment of intertrochanteric femoral fractures,PFN internal fixation has less bleeding and better efficacy,and can improve function recovery.PFN internal fixation is a better method for unstable femoral fracture.

Objective To evaluate the feasibility and accuracy of the isovolumic contraction peak velocity (IVCv) of right heart function in patients with pulmonary hypertension (PH) by echocardiography and Doppler tissue imaging. Methods In 41 patients with suspected diagnosis of PH, IVCv at the tricuspid annulus were measured by echocardiography and Doppler tissue imaging. The right heart systolic function parameters such as tricuspid annular plane systolic excursion (TAPSE), peak systolic velocity (PSv) and right ventricular fractional area change (RVFCA) were also measured. The pulmonary artery pressure was detected by right-heart catheterization (RHC). According to different levels of pulmonary arterial systolic pressure, patients were classiifed into four groups to compare and analyze if any signiifcance could be found, including without PH group, mild PH group, moderate PH group and severe PH group. The sensitivity and speciifcity for diagnosing right heart impairment were assessed by ROC curves. Last, correlation analysis was performed. Results IVCv was signiifcantly and positively correlated with the right heart systolic function parameters, such as TAPSE (r=0.557, P<0.001), PSv (r=0.714, P<0.001) and RVFCA (r=0.341, P<0.05). Negative correlation existed between IVCv and PASP (r=-0.739, P<0.001). The average IVCv of without PH group, mild PH group, moderate PH group and severe PH group were (13.83±3.56) cm/s, (10.11±1.36) cm/s, (8.70±2.21) cm/s and (5.80±1.03) cm/s, respectively. The level of IVCv was obviously lower in severe PH group than those in without PH group, mild PH group and moderate PH group. The difference was signiifcant (P<0.05). The levels of IVCv increased obviously in without PH group than those in mild PH group and moderate PH group (P<0.01). There were no differences for IVCv between mild PH group and moderate PH group (P>0.05). Using the lower limit of right ventricular systolic function parameter obtained by common echocardiographic assessment as standard (TAPSE<16 mm, PSv<10 cm/s and RVFAC<35%), the sensitivities of IVCv<6.5 cm/s for diagnosing right ventricular systolic function reduction were 91%, 96%and 87%and the speciifcities were 70%, 53%and 77%, respectively. Conclusions IVCv obtained by Doppler tissue imaging is a new objective parameter for diagnosing right ventricular systolic function reduction. It is worth further study and application in clinic.

Six compounds were isolated from the dried leaves and tender branches of Rabdosia ma-crocalyx (Dunn ) Hara. Their structures were identified as excisanin A, excisanin B, rabdol-oxin B, ursolic acid, ?-sitosterol and palmitic acid.

Objective To evaluate the clinical efficacy of interventional occlusion of ventricular septal rupture (VSR) complicating acute myocardial infarction (AMI). Methods Six patients with VSR complicated after AMI underwent transcatheter interventional occlusion in Chinese PLA General Hospital between May 2009 to May 2015 were retrospectively analyzed. Their clinical features, interventional treatment protocols, and occurance of postoperative complications were studied. Results Among the 6 patients, VSR were successfully occluded in 5 patients. One patient failed the operation due to instability of occluder after it was deployed and the occluder was retrieved. The paitents died of heart failure 6 months later. Among the 5 patients with successful closure, 4 patients presented mild residual shunt after occlusion and acute left heart failure occurred in 1 patient after operation. Two patients died during hospital stay after operation. Between them, one patient died 3 hours after operation because of cardiac tamponade and the other patient died of cardiogenic shock after withdrawal from IABP. Three patients were followed up until now and follow up echocardiography showed satisfactory cardiac function without heart failure. Conclusions Transcatheter occlusion was a reliable therapy for patients with ventricular septal rupture complicated in acute myocardial infarction which could improve cardiac function and reduce mortality.

Objective To investigate the relationship among stressful life events ,social support and depression through researc‐hing a large number of Chinese army men ,then discovered the social psychological mechanism of the depression .Methods 11 ,400 officers and soldiers were tested with three scales ,the center for epidemiologic studies depression scale ,life events scale and social support scale .The differences between groups were determined with the variance ,SPSS 18 .0 software and AMOS7 .0 were used to analyse and build model .In addition ,we built the path model of life events and social support on depression with AMOS 7 .0 soft‐ware .Results (1)There is a significant positive correlation between Chinese soldiers depression levels and life events (r=0 .382 , P<0 .01) .(2) There is a significant negative correlation between Chinese soldiers depression levels and the social support (r= -0 .379 ,P<0 .01) .(3) It was established the path model of life events ,the social support and depressive symptom level .Con‐clusion Depressive symptom is related to the military life events ,which may predict the occurrence of the depression .Moreover ,so‐cial support ,a protective factor for mental health ,can relieve the depression of officers and men .

OBJECTIVETo appraise the significance of extravascular lung water index (EVLWI), pulmonary vascular permeability index (PVPI), and intrathoracic blood volume index (ITBVI) in the differential diagnosis of the type of burn-induced pulmonary edema.

METHODSThe clinical data of 38 patients, with severe burn hospitalized in our burn ICU from December 2011 to September 2014 suffering from the complication of pulmonary edema within one week post burn and treated with mechanical ventilation accompanied by pulse contour cardiac output monitoring, were retrospectively analyzed. The patients were divided into lung injury group ( L, n = 17) and hydrostatic group (H, n = 21) according to the diagnosis of pulmonary edema. EVLWI, PVPI, ITBVI, oxygenation index, and lung injury score ( LIS) were compared between two groups, and the correlations among the former four indexes and the correlations between each of the former three indexes and types of pulmonary edema were analyzed. Data were processed with t test, chi-square test, Mann-Whitney U test, Pearson correlation test, and accuracy test [receiver operating characteristic (ROC) curve].

RESULTSThere was no statistically significant difference in EVLWI between group L and group H, respectively (12.9 ± 3.1) and (12.1 ± 2.1) mL/kg, U = 159.5, P > 0.05. The PVPI and LIS of patients in group L were respectively 2.6 ± 0.5 and (2.1 ± 0.6) points, and they were significantly higher than those in group H [1.4 ± 0.3 and (1.0 ± 0.6) points, with U values respectively 4.5 and 36.5, P values below 0.01]. The ITBVI and oxygenation index of patients in group L were respectively (911 197) mL/m2 and (136 ± 69) mmHg (1 mmHg = 0.133 kPa), which were significantly lower than those in group H [(1,305 ± 168) mL/m2 and (212 ± 60) mmHg, with U values respectively 21.5 and 70.5, P values below 0.01]. In group L, there was obviously positive correlation between EVLWI and PVPI, or EVLWI and ITBVI (with r values respectively 0.553 and 0.807, P < 0.05 or P < 0.01), and there was obviously negative correlation between oxygenation index and EVLWI, or oxygenation index and PVPI (with r values respectively -0.674 and -0.817, P values below 0.01). In group H, there was obviously positive correlation between EVLWI and ITBVI (r = 0.751, P < 0.01) but no obvious correlation between EVLWI and PVPI, oxygenation index and EVLWI, or oxygenation index and PVPI (with r values respectively -0.275, 0.197, and 0:062, P values above 0.05). The total area under ROC curve of PVPI value for differentiating the type of pulmonary edema was 0.987 [with 95% confidence interval (CI) 0.962-1.013, P < 0.01], and 1.9 was the cutoff value with sensitivity of 94.1% and specificity of 95.2% . The total area under ROC curve of ITBVI value for differentiating the type of pulmonary edema was 0.940 (with 95% CI 0.860-1.020, P < 0.01), and 1,077. 5 mL/m2 was the cutoff value with sensitivity of 95.2% and specificity of 88.2%.

CONCLUSIONSEVLWI, PVPI, and ITBVI have an important significance in the differential diagnosis of the type of burn-induced pulmonary edema, and they may be helpful in the early diagnosis and management of burn-induced pulmonary edema.

Blood Gas Analysis ; Blood Volume ; Burns ; complications ; Capillary Permeability ; Diagnosis, Differential ; Extravascular Lung Water ; Humans ; Lung ; blood supply ; Lung Injury ; physiopathology ; therapy ; Monitoring, Physiologic ; Pulmonary Edema ; diagnosis ; etiology ; ROC Curve ; Respiration, Artificial ; Retrospective Studies

Background: Femoral neck fractures (FNFs) comprise a large proportion of osteoporotic fractures in Asia. However, the full range of prognostic variables that affect prognosis remains unclear. Here, we aimed to determine whether the severity of bone defects at the fracture site and other variables impact the prognosis of displaced FNFs. Methods: We evaluated the incidence of FNF internal fixation failures at regular intervals after surgery in data collected retrospectively. Digital Imaging and Communications in Medicine (DICOM) magnetic resonance imaging data of the displaced FNFs of 204 patients (> 20 years old; mean age, 52.3 years; men, 55.4%) who underwent internal fixation were used to construct threedimensional (3D) virtual models of the femoral neck region. We calculated the position and volume of bone defect (VBD) using our independently developed algorithm and Mimics software. Each participant was followed up for at least 24 months; complications were noted and correlated with VBD and demographic and clinical variables. Results: On the basis of VBD values calculated from virtual reduction models, 57 patients were categorized as having a mild defect, 100 as having a moderate defect, and 47 as having a severe defect. Age (p = 0.046) and VBD (p < 0.001) were significantly correlated with internal fixation failure. Multivariate analysis revealed that severe bone defects were associated with internal fixation failure (adjusted odds ratio [aOR], 23.073; 95% confidence interval [CI], 2.791–190.732) and complications (aOR, 8.945; 95% CI, 1.829–43.749). In patients with a severe defect, bone grafting was inversely associated with internal fixation failure (aOR, 0.022; 95% CI, 0.002–0.268) and complications (aOR, 0.023; 95% CI, 0.002–0.299). Conclusions Bone defect severity was associated with internal fixation failure and other complications. For young adults with large VBDs, bone grafting of the defect can reduce the risk of internal fixation failure. These results provide useful new quantitative information for precisely classifying displaced FNFs and guiding subsequent optimal treatments.

OBJECTIVETo observe the role of Kupffer cells in the postburn production of TNFalpha, IL-1beta and IL-6 in severely scalded rats.

METHODS(1) The production of TNFalpha, IL-1beta and IL-6 from rat Kupffer cells stimulated by burn serum was observed. (2) The postburn change in the expression of cytokine mRNA from rat Kupffer cells was monitored. (3) The change in the plasma cytokine contents in scalded rats was determined after the application of gadolinium chloride, a specific inhibitor of Kupffer cells.

RESULTSKupffer cells could be stimulated by burn serum to release cytokines TNFalpha, IL-1beta and IL-6. The mRNA expression of TNFalpha, IL-1beta and IL-6 from rat Kupffer cells increased significantly after injury. But the postburn plasma levels of TNFalpha, IL-1beta and IL-6 decreased obviously to 34.71%, 36.99% and 33.7% of those in scalding group, respectively, after the Kupffer cell activity was inhibited.

CONCLUSIONThe plasma cytokines, i.e. TNFalpha, IL-1beta and IL-6, were primarily produced from Kupffer cells after injury in scalded rats, initiated by TNFalpha, IL-1beta and IL-6 mRNA transcription.

Animals ; Burns ; immunology ; metabolism ; Gadolinium ; pharmacology ; Interleukin-1 ; biosynthesis ; genetics ; Interleukin-6 ; biosynthesis ; genetics ; Kupffer Cells ; physiology ; RNA, Messenger ; analysis ; Rats ; Rats, Sprague-Dawley ; Tumor Necrosis Factor-alpha ; biosynthesis ; genetics

Objective To explore the association between urinary microalbumin-to-creatinine ratio (ACR) and brachial-ankle pulse wave velocity (baPWV) in hypertensive patients.Methods A total of 877 primary hypertension patients were enrolled in this trial from September 2009 to December 2012,and were randomly recruited and patients were divided into normal ACR group (ACR ＜ 30 mg/g,n =723),microalbuminuria group (30 mg/g ≤ ACR ＜ 300 mg/g,n =136) and macro-albuminuria group (ACR ≥300 mg/g,n =18).baPWV was measure by automatic pulse wave velocity measuring system.Results The baPWV values in patients of micro-albuminuria group and macro-albuminuria group were significantly higher than in the normal ACR group (all P ＜ 0.05).The baPWV value of macro-albuminuria group was significantly higher than in the micro-albuminuria group (P ＜ 0.05).Linear correlation analysis revealed that ACR was positively correlated with baPWV (r =0.413,P ＜ 0.01).Multiple linear regression analysis showed that ACR independently correlated with baPWV in patients with primary hypertension (β =0.29,R2 =0.112,P ＜ 0.01) after adjusting for age,sex,body mass index,systolic blood pressure,diastolic blood pressure,blood glucose,total cholesterol,low density lipoprotein,high density lipoprotein and triglyceride.Using ACR ＜ 30 mg/g and ACR ≥ 30 mg/g as dichotomous variable,binary logistic regression analysis showed that ACR≥30 mg/g was also a risk factor of the ascending baPWV in primary hypertension patients (OR:1.73,95％ CI:1.62-2.98) after adjusting the traditional cardiovascular risk factors.Conclusion ACR is positively correlated to baPWV in primary hypertension patients,and the ascending baPWV is a risk factor of early renal dysfunction in primary hypertension patients.

OBJECTIVETo investigate the characteristics of the intra- and extra-hepatocyte sodium ions distribution in scalded rats during early postburn stage,with the aim of improving burn shock resuscitation regime and the resuscitation effects.

METHODSAdult Sprague-Dawley rats were randomly divided into sham scalding (C, n = 12) and scalding (S, n = 7) groups. The rats in S group were subjected to 40% TBSA III degree scalding on the back and were catheterized via jugular vein for fluid resuscitation. The rats in C group were catheterized via jugular vein without fluid infusion and were sham scalded by warm water in temperature of 37 degrees. The changes in the intra- and extra-hepatocyte sodium ion contents were determined in vivo by (23)Na-magnetic resonance spectrum technology, while the existing state of the intra- and extra-hepatocyte sodium ion was determined by detecting (23)Na-magnetic resonance horizontal delaying time (T(2)).

RESULTSThe extra-hepatocyte sodium content in S group at 24 postburn hours (PBHs) was 17% less than that in C group. In addition, the T(2f) (fast T(2)) in S group remained stable but maintained a higher ratio during the observation time. This suggested that the sodium binding sites in extra-hepatocyte matrix increased relatively and that intra-hepatocyte sodium content increased by 57%. But the T(2) and the fast and slow parts of the T(2) kept stable, which implied that intra-hepatocyte catabolizing products were increased. This led to an increase in the sodium ion binding sites within intra-hepatocyte matrix in proportion to the sodium ion content.

CONCLUSIONDuring early postburn stage, the extra-hepatocyte sodium in a remote organ such as the liver exhibited relative deficiency due to its ingress into hepatocyte cytoplasm and to the increase of sodium combining sites.

Animals ; Binding Sites ; Burns ; metabolism ; Hepatocytes ; metabolism ; Magnetic Resonance Spectroscopy ; Rats ; Rats, Sprague-Dawley ; Sodium ; metabolism