Objective To study the efficacy of Singhindex and fracture-type-based treatment strategy on inter-trochanter femoral fracture.Methods Sixty four patients who suffered from inter-trochanteric femoral fracture from 2007 to 2010 were recruited into this study.The pattern of fixation was determined according to the preoperative Singh index and fracture type.The efficacy of fixation was compared with that of the previously treated 127 cases in the same condition.Results The healing time of fracture in the study group was 10.5 ± 1.2 weeks,which was significantly shorter than 12.6 ± 2.4 weeks of the control group( t =4.27,P ＜ 0.05 ).Fixationrelated complications were observed in 3 cases in the study group and 17 cases in the control group,which was statistically different between the two groups ( x2 =5.74,P ＜ 0.05 ).The percentage of patients with excellent outcome in the study group was 91％ (58/64),significantly higher than 84％ ( 107/127 ) of the control group ( x2 =6.28,P ＜ 0.05 ).Conclusion Treating the inter-trochanteric femoral fracture according to Singh index and fracture type will create improved clinical efficacy.

The antagonistic effects of L-THP, Ver and Pap to contraction of isolated guinea pig trachea preparations induced by BaCl2 10-3mol/L ,KC1 3?10-2mol/L, 5-HT 2?10-5mol/L, Ach 2?10-5mol/L and His 2? 10-5mol/L were studied.The antagonistic effects of L-THP were different from Ver and Pap. The IC50 value of L-THP for contraction induced by BaCl2, KC1, 5-HT and His was 3 .5? 10-5mol/L , 4.5 ? 10-5mol/L , 2.5?10-3 mol/L and 8.9? 10-5mol/L respectively. It was showed that sensibility of several agonists to inhibition by L-THP was correlated with dependence of extracellular Ca2+. The potencies of L-THP on anti-KCl and anti-5-HT actions were similar. The results suggested that LTHP possesses anti-calcium and anti-5-HT action on guinea pig trachea.

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 feasibility,safety and efficacy of laparoscopic and endoscopic cooperative surgery (LECS) for elderly patients with gastric gastrointestinal stromal tumor (GIST).Methods 54 cases with GIST aged 65 years and over in Department of Gastrointestinal Surgery in Beijing Hospital from Dec.2008 to Dec.2012 were selected.31 cases underwent LECS and 23 cases underwent open surgery.Clinical data including operation time,intraoperative blood loss,complications,tumor size,length of incision,postoperative gastrointestinal function recovery time,postoperative in hospitalization and follow up data were retrospectively analyzed in patients.Results There were 17 males and 14 females in the LECS group,and the mean age was (72.8±5.9)years.29 patients underwent laparoscopic-assisted partial gastrectomy,and 2 cases underwent laparoscopicassisted endoscopic dissection in LECS group.All operations were successful with no conversion to open surgery and death.There were 13 males and 10 females in the open surgery group,and the mean age was(73.3±6.1)years.The mean operation time was longer in LECS group than in open surgery group [(120.6±32.8) min vs.(86.3±33.5) min].The mean intraoperative blood loss,mean tumor size,mean length of incision,mean time of gastrointestinal function recovery,mean postoperative hospitalization were less or smaller in LECS group than in open surgery group [(40±23.4) ml vs.(130±65.6) ml,(2.3±1.2)cm vs.(3.6 ±1.8)cm,(3.6±1.1) cm vs.(14.4±3.5) cm,(47.7± 10.4)h vs.(61.4±11.9)h,(5.1±2.3)d vs.(7.2±2.5)d,respectively,t=3.192,1.831,5.212,2.014,3.519,P=0.002,0.012,0.000,0.015,0.001].According postoperative tumor risk assessment,13 cases were at very low risk,15 cases at low risk and 3 cases at middle risk in LECS group; 4 cases were at very low risk,14 cases at low risk and 5 cases at middle risk in open surgery group.The risk degree was lower in LECS group than in open surgery group (x2 =5.63,P=0.017).During a follow-up of 5 53 months,death without GIST was found in 5 patients in LECS group and 4 cases in open surgery group.Hepatic metastasis was found in 1 case in open surgery group.Conclusions LECS is a safe and feasibility alternative approach for elderly patients with gastric GISTs.It has more minimal invasion,fast recovery and satisfaction with short term outcomes as compared with conventional open surgery.

Hemodynamic study of L-THP in anaesthetized rats showed that 6 mg/kg iv decreased only blood pressure (BP) significantly, and decreased left ventricular pressure ( LVP ) temporarily. At the dose of 18 mg/kg, L-THP lowered the BP, LVP, ? ( dP/dt ) max, ( dP/dt ) P-1 and HR. But the degrees o?diminutions of BP were greater than that of cardiac contractility. The inhibitory percentage of L-THP on DAP was greater than that of SAP. In addition, the extent of decrease of DAP was shown dose dependently. The results suggest that L-THP reduces the peripheral vessel resistance, and it inhibits the cardiac contractibility in high dosage.

Objective:To investigate the role of heme oxygenase-1(HO-1) in molecular mechanism of experimental allergic encephalomyelitis (EAE). Methods: Seventy-eight healthy female Wistar rats were randomly divided into 3 groups(n=26): rats in control group received no treatment; rats in EAE group were induced with complete Freund's adjuvant and Guinea pig spinal cord homogenate(CFA-GPSCH); and rats in pyrrolidine-dithiocharbamate (PDTC) group received PDTC (100 mg/kg), a specific inhibitor of NF-kB, 1 h before and after(once a day for 7 d) CFA-GPSCH treatment. HO-1 mRNA expression were analyzed with reverse transcription polymerase chain reaction(RT-PCR) on 1 d,7 d,14 d,and 21 d after EAE induction, respectively. The relationship between HO-1 and symptoms of EAE was also investigated. Results: The expression of HO-1 mRNA was very low in the brains of the control group (0.27?0.05), whereas enhanced gradually with onset and development of EAE in EAE group, peaked on d 7 (1.11?0.12), kept at a high level till d 14(1.06?0.18) and decreased on d 21 (0.37?0.1). HO-1 mRNA expression change was in parallel with severities of EAE. In PDTC group,the EAE symptoms were mitigated markedly and the expression of HO-1 mRNA reduced noticeably compared with that of EAE group. Conclusion: Brain HO-1 mRNA expression may play an important role in the pathogenesis of EAE,and application of some inhibitors of NF-kB may be one of the potential therapies for prevention and treatment of EAE.

BACKGROUND: Dihydrolycorine (DL) can inhibit the peripheral release of catecholamine from sympathetic nerve ending and block α, β adrenalinergic receptor. It has multiple pharmacological actions, such as vascular dilation, hypotension, anti-hypoglycemia and anti-ischemia.OBJECTIVE: To investigate the selective effect of DL on basilar artery,thoracic aorta and ventricular papillary muscle of rabbit by means of observing the vasoconstriction induced by noradrenaline bitartrate and KCl.DESIGN: Observation of comparative experiment.SETTING: Pharmacological Department of Yunyang Medical College.MATERIALS: This study was carried out at Pharmacological Department of Yunyang Medical College between March and July 2001, and 46 adult healthy New Zealand rabbits were selected.METHODS: New Zealand rabbits were put to death by intravenous injection of 10 mL air from the vein of aural edge, and soon after death, brain,thoracic aorta and heart were obtained. Basilar artery and thoracic aorta was linked into 4.0-5.0 mm vascular rings; meanwhile, ventricular papillary muscle were separated and connected with tension transducer. Obserdose of noradrenaline bitartrate or KCl: Sub-maximal constriction of thoracic aorta was induced by 0.1 mmol/L noradrenaline bitartrate or W60 mmol/L KCl, and when constriction curve became stable, DL or nimodipine of different dosage was added. Basilar artery was exposed to 0.1 mmol/L noradrenaline bitartrate or 60 mol/L KCl, and rinsing fluid was changed once every 20 minutes and thrice in all when vasocontratcion reached the peak level, then different dosage of DL or nimodipine was added 20 minutes later, and the changes of vasoconstriction curve due to administration of single dose of noradrenaline bitartrate or KCl were obconstriction of ventricular papillary muscular induced by electro-stimulation: Electro-stimulation was used to stimulate the ventricle papillary muscular synchronized constriction with the frequency of once per second,wavelength of 3 ms and threshold voltage of 120%; when constriction curve became stable, DL or nimodipine was administered in a accumulative way.ence of DL or nimodipine on the half-effective concentration of noradrenaline bitartrate or KCl that contributed to the vascular ring constriction of rabbit.RESULTS: Basilar artery, thoracic aorta and ventricular papillary muscle Resting tension of basilar artery was increased by DL but decreased by niof basilar artery and thoracic aorta induced by noradrenaline bitartrate and KCl can be relaxed by DL in a dose dependant manner, and the half-effective concentration was (6.69±3.12)×10-4, (3.41±1.52)×10-3mmol/L for basilar artery, and (1.49±0.59)×10-3, (2.91±0.99)×10-3 mmol/L for thoracic aorta, displaying stronger inhibition on the constriction of basilar artery induced by noradrenaline bitartrate than on the contraction induced by KCl.On the contrary, nimodipine showed stronger depression on KCl-induced constriction than on the constriction induced by noradrenaline bitartrate.ventricle papillary muscular induced by electro-stimulation in a dose-dependant manner, and the half-effective concentration of DL on the contraction of ventricle papillary muscle induced by electro-stimulation was significantly higher than that induced by noradrenaline bitartrate.CONCLUSION: DL displays obvious selective effect on basilar artery of rabbit, the possible existence of constrictive α1 receptor subtype and dilating β receptor on basilar artery might be correlated with the selective function of DL, which benefit, for the improvement of blood supply in the ischemic region.

Objective To investigate causes and treatments for a fracture of the contralateral femoral neck in the elderly with prosthetic replacement for femoral neck fractures.Methods A retrospective analysis was conducted on 85 cases undergone prosthetic replacement for femoral neck fractures between March 2005 and May 2012,including 12 cases in secondary replacement group due to fractures of the contralateral uninjured femoral neck after primary prosthetic replacement and 73 cases in primary replacement group.Variables were compared between the two groups including causes of injury,age,sex,bone density,complications,quality of life,Harris score of the contralateral hip joint,surgical choice.Refracture reasons were evaluated and treatment plans were proposed.Results Immediate cause of injury in all cases was falling.Primary and secondary replacement groups showed mean age of (68.82 ± 5.18) yearsvs (76.83 ± 3.64) years (P＜0.05),male to female ratio of 0.66:1 vs 0.09:1 (P＜0.05),and bone mineral density of (0.507 ± 0.062) g/cm2 vs (0.461 ± 0.095) g/cm2(P ＜0.05).Moreover,cases in the two groups suffered from the associated complications (hypertension,diabetes mellitus,cataract,stroke,rheumatoid arthritis,and Parkinson' s disease).Except for the diabetes mellitus,incidence of the other five basic diseases presented significance differences between the two groups (P ＜ 0.05).Of primary and secondary replacement groups,quality of life was (76.26 ±14.17) points vs (67.86 ± 16.74) points (P ＜ 0.05) ; Harris score of the contralateral hip was (98.66 ±1.39) points vs (90.75 ± 5.39) points (P ＜ O.05).For treatment choice,32 total hip arthroplasty (THA) and 41 femoral head arthroplasty (FHA) with cement fixation in 44 cases and cementless fixation in 29 cases were performed in primary replacement group; two total hip arthroplasty and 10 femoral head arthroplasty with cement fixation in 11 cases and cementless fixation in one were performed in secondary placement group (P ＜ 0.05).Conclusions Fall remains the immediate cause of the contralateral fractures following prosthetic replacement of femoral neck fractures in the elderly.Aging,females,bone density reduction,high-incidence of complications,decreased quality of life,and joint function impairment after the primary prosthetic replacement are unfavorable factors.Prosthetic replacement is still the preferred choice of treatment and surgical procedure is more likely to be the simple cemented FHA.

Objective:To study the clinical effect of internal combined with external fixation in the treatment of pelvic fracture and its effect on the serum alkaline phosphatase (ALP),tumor necrosis factor-a (TNF-α) and transforming growth factor-β (TGF-β).Methods:Eighty-six patients with pelvic fractures admitted in our hospital from August 2014 to July 2015 were selected and divided into the observation group and control group according to the admission order.Conventional internal fixation was used in the control group,and the internal combined with extemal fixation was performed in the observation group.The clinical curative effect,operative time,blood loss,fracture healing time and incidence of complication were compared between two groups.The levels of serum ALP,TNF-α and TGF-β in the two groups were compared before and after treatment between two groups.Results:The excellent rate of observation group was significantly higher than that of the control group [81.40％ (35/43) vs 41.86％ (18/43)] (P ＜0.05).The operative time,blood loss and fracture healing time in the observation group were significantly shorter or less than those of the control group (P＜0.05).There was no significant difference in the serum ALP,TNF-α and TGF-β levels between the two groups before treatment (P＞0.05).After treatment,the serum ALP levels in the two groups were significantly higher than before treatment (P＜0.05).The levels of TNF-α and TGF-β were significantly lowe than those before treatment(P＜0.05),the ALP levels in the observation group was significantly higher than that of the control group (P ＜0.05),and the levels of TNF-c and TGF-β were significantly lower than those of the control group 0.05).The incidence of complications of observation group was significantly lower than that of the control group [0.00％ (0/43) vs 11.63％ (5/43)] (P ＜0.05).Conclusion:Internal and external fixation was effective and safe in the treatment of pelvic fractures,which could significantly increase the serum ALP level and reduce the levels of TNF-α and TGF-β.

Objective To investigate the comparison of clinical effects between two models of alimentary reconstruction after total gastrectomy in the elderly patients with gastric cancer.Methods 70 patients receiving alimentary tract reconstructions of Orr-type Roux-en-Y reconstruction (Orrtype,40 cases) and modified Brawn Ⅰ (30 cases) from January 2007 to December 2012 were retrospectively analyzed.The operative time,amount of bleeding,early postoperative complications and mortality,food intake,nutritional status and alimentary tract function were compared at 6 months after surgery.Results There were no significant differences between the two methods in the operative time [(198.8±14.0)min vs 233.5±30.7)min,t=-l.697,P＞0.05)],amount of bleeding [(420 ± 43) ml vs (340 ± 25) ml t =-1.956,P ＞ 0.05],and early postoperative complications [(17.5％ vs 16.7％),x2 =0.008,P＞0.05].However,times of liquid diet intake and semi liquid diet intake of the Orr-type reconstruction method was comparatively shorter than that of the modified Brawn Ⅰ [(4.8±2.1) d vs (7.6±2.4) d,and (9.5±3.6) d vs (11.5±3.7) d,t=-5.192,P＜0.05)].Nutritional status (weight,hemoglobin,total serum proteins and serum albumin) at 6 months after operation showed no significant differences between the two methods.But constituent ratio of Visick scores Ⅰ-Ⅱ of Orr-type was bigger than that of modified Brawn Ⅰ (86.7％ vs 62.5％,x2 =5.063,P＞0.05).Conclusions Orr-type Roux-en-Y reconstruction method can avoid reflux esophagitis,and the procedure is more simple than the modified Brawn Ⅰ method.Therefore,Orr-type Roux-en-Y reconstruction should be recommended as an adoptable method of digestive reconstruction after total gastrectomy for gastric cancer in the elderly patients.