BACKGROUND: Alendronate has been recently used for treating osteoporosis by inhibiting the activity of osteoclasts, but further clinical observation is necessary to compare its therapeutic effect with exclusive use of calcium supplement.OBJECTIVE: To observe the therapeutic effect of oral alendronate (tianke tablet) on the clinical symptoms and bone mineral density (BMD) of middle-aged and elderly patients for comparison with calcium gluconate.DESIGN: A self-controlled study and controlled trial with concurrent patients.SETTING: Department of Orthopedics, Shenzhen Hospital, Peking UniversityPARTICIPANTS: Sixty-eight middle-aged and elderly patients with osteoporosis were admitted in the Department of Orthopedics, Shenzhen Hospital of Peking University between July 1999 and July 2000. From these patients 62 at the age over 45 years without secondary osteoporosis were selected for this study, who were randomly divided into oral alendronate group (n=32) and oral calcium gluconate group (n=30).INTERVENTIONS: On the basis of comprehensive therapies, the patients in the alendronate group were given 10 mg alendronate daily and those in calcium gluconate group had 20 mL oral calcium gluconate solution (containing 100 mg calcium gluconate, equivalent to 9 mg calcium in every 10 mL) three times daily for three months. According to bodily pain relief, occurrence of new fracture and improvement in BMD, the therapeutic effect was assessed in three grades.RESULTS: Thirty patients in the alendronate group and 26 in the calcium gluconate group completed the study. Alendronate treatment for 3months significantly increased BMD of the patients [(0.716±0.082) g/cm2in comparison with that before treatment [(0.667±0.083) g/cm2, t= 2.473,P ＜ 0.01], whereas the BMD underwent no obvious changes after treatment with calcium gluconate [(0.671±0.081) g/cm2 before vs (0.680±0.073) g/cm2after treatment, t=1.812, P ＞ 0.05]. Significant difference in BMD after treatment was noted between the two groups (t=2.384, P ＜ 0.01). The effective rate was significantly higher in alendronate group than in calcium gluconate group (X2=14.9, P=0.005), but 7 patients complained of abdominal discomfort in the former group and the patients in calcium gluconate group reported no adverse effects.CONCLUSION: Alendronate can inhibit bone absorption, promote the recovery of bone matrix, and increase the bone mass, producing better effect than exclusive use of calcium gluconate oral solution in treatment of the osteoporosis in the middle-aged and the elderly.

Objective To observe the effect of hyperbaric oxygen therapy (HBOT) on mineral density and biomechanics of new-formed bone in distraction gap.Methods The mandibles were subjected to osteotomy and distractors were placed bilaterly in 30 rabbits,which were divided randomly into 2 groups.After 5 days for latency,the mandibles were distracted at a rate of 0.8 mm/day for 10 days,and then for consolidation.After surgery,group A received HBOT with daily distraction,whereas group B only distracted without HBOT served as control group.The animals in groups A and B were sacrificed 1 wk,2 wk,4 wk of consolidation,respectively.The mandibles were harvested and subjected to examination for new bone formation,and bone mineral density (BMD) and biomechanics of newly formed bone in the distraction gap.Results At one week of consolidation,no significant differences were observed between the BMD of newly formed bone in the two groups (P＞0.05);however,at the other time points,BMD of newly formed bone in group A was significantly higher than that in group B (P＜0.05).Moreover,at 4 weeks of consolidation,the strength,maximum fragile energy and modulus of elasticity of newly formed bone in group A were significantly higher than those in group B (P＜0.05).Conclusions The results suggest that HBOT improves mineral density and strength of new formed bone in distraction gap.

Objective To investigate the risk factors associated with delayed encephalopathy (DE)occurrence in carbon monoxide (CO) poisoning.Methods The clinical data of 249 patients with CO poisoning were retrospectively reviewed.Potential risk factors associated with occurrence of DE,including gender,age,duration of exposure to CO,time interval between onset and arrival in hospital,mental status after onset,oxygen therapy approach,were evaluated by univariate analysis of x2 test and multivariate Logistic regression analysis.Results Age and duration of exposure to CO was significandy related with occurrence of DE in patients with CO poisoning.The occurrence of DE in patients with CO poisoning with age 60-75 years was 3.236 times and 2.119 times as much as that with age 3-17 years and 18-59 years respectively.Occurrence of DE was 4.338 times in patients with duration of exposure to CO ≥12 hours compared to that ＜ 12 hours.Conclusions Age ≥ 60 years and duration of exposure to CO ≥ 12 hours are independent risk factors for developing D E.Old patients have a inclination to develop D E.To evacuate patients from CO environment timely is important for preventing from DE.

This study was aimed to analyze the clinical features of paroxysmal kinesigenic dyskinesia (PKD) and extend the understanding of this disease. From August, 2008 to October, 2010, 9 patients were diagnosed with PKD in the Department of Neurology of the First Affiliated Hospital of Zhejiang University, China. The data involving clinical demographic characteristics, somatosensory evoked potentials, results of electromyography, video electroencephalography (EEG), brain magnetic resonance imaging (MRI) and computerized tomography (CT) were collected. All PKD patients exhibited unilateral or bilateral recurrent episodic dyskinetic attacks triggered by sudden voluntary movements. The duration of the attacks ranged from several seconds to one minute. The attack frequency ranged from approximately once in several months to more than 10 times in a day. Patients suffered from no conscious disorders during the attack, and no neurological signs were found during the period between attacks. No abnormal somatosensory evoked potentials were found. Routine EEG, video EEG monitoring or brain imaging showed normal findings. Classical treatment for anti-epilepsy, including carbamazepine and topiramate, was administered to the patients and proved to be effective. It was concluded that PKD is characteristically triggered by sudden voluntary movement; no abnormal electroneurophysiological findings are observed in PKD, and antiepileptic drugs are effective in treating the disorder.

OBJECTIVE: To study the effectiveness of repairing nearly circumferential defect with the submental flaps after resection of laryngeal function unpreserved hypopharyngeal cancer. METHOD: All the cases were treated with the submental flaps after resection of hypopharyngeal cancer with laryngeal function unpreserved. RESULT: All 13 flaps were alive. Hypopharyngeal fistula occurred in 2 cases. All patients had normal swallowing function. The patients were followed up 6-42 months. Of 13 cases,3 had recurrence at neck Lymph node, but no local hypopharyngeal recurrence was found. Seven cases were followed up more than 3 years, and only 3 of them survived. CONCLUSION Submental flap is an ideal tissue flap submental flap in repairing of approaching circumferential defects after hypopharyngeal cancer ablation with laryngeal function unpreserved for the repairment of after approaching circumferential defects after hypopharyngeal cancer ablation with laryngeal function unpreserved, For it is close to the defect region, safe, easy-to-obtain and easy-to-survive.
Fistula ; pathology ; Humans ; Hypopharyngeal Neoplasms ; surgery ; Hypopharynx ; pathology ; surgery ; Larynx ; Lymphatic Metastasis ; Neck ; Neoplasm Recurrence, Local ; Reconstructive Surgical Procedures ; Surgical Flaps

Objective To investigate the optimal time and molecular mechanism of gene therapy for promoting distraction osteogenesis by observing the effect of gene transfecting at different time on expression of cyclins in mandibular distraction area.Methods Forty eight New-Zealand rabbits were employed.After accomplishing bilateral mandibular distraction osteogenesis model,the rabbits were randomly divided into the group A,B,C and D.The group A,B and C were transfected by recombinant plasmids pIRES-hBMP2-hVEGF165 2 μg(0.1 μg/μL)at the distraction area instantly after operation,on postoperative 4,14 d and given local electroporation stimulation.The four groups entered the consolidation stage after 10 d continuous traction at a rate of 1 mm/d on postoperative 4 d.Three rabbits in each group were respectively sacrificed on 7,14,28,56 d of the consolidation stage.The expression of cyclin A,D1,and E of fresh bone tissue in distraction area were detected by immunohistochemical staining.Results Cyclin A,D1,and E were strongly expressed in the traction gap on 7,14 d of consolidation stage found,which was strongest on 7 d,moreover the group A,B and C were stronger than the group D.The expression in each group was weakened on 28,56 d.The expression on 7 d in the group B was stronger than that in the4 group A,C and D(P<0.05),the expression had no statistical difference between the group A and C(P>0.05),but all were stronger than the group D(P<0.05);the expression in the group B and C on 14 d was stronger than that in the group A and D,but the expression had no statistical difference between the group B and C and between the group A and D(P>0.05).Conclusion The high expression of cyclin A,D1 and E can promote the cellular division,proliferation and differentiation in distraction area,thus accelerates the new bone formation in the distraction area,prompting that the distraction period is the best time for distraction osteogenesis under gene therapeutic intervention.

Objective To analyze the effect of the rhinoplasty on body image in the patients receiving cosmetic surgery,to investigate the change of postoperative body image disturbance(BDD)and to analyze the influencing factors of preoperative BDD in order to provide a basis for the psychological health management and reference for the diagnosis and treatment of plastic surgery.Methods A prospective study was performed on 84 patients with rhinoplasty admitted to the Affiliated Friendship Aesthetic Plastic Surgery Hospital of Nanjing Medical University from January 2015 to March 2016.The general data were investigated.The Plastic Psychological State Self-rating Scale was adopted to evaluate the patient′s body image situation,which was reexamined at postoperative 1-3 months.Results The preoperative non-BDD accounted for 60.71％,the occurrence rate of BDD was 19.05％,the other mental disorders,mental diseases or nervous system disease which had no relation with the BDD accounted for 20.24％;the occurrence rate of postoperative BDD was significantly lower than that of preoperative BDD(P＜0.05),moreover the patients with non-BDD had no postoperative BDD occurrence.The scores of question 1-10 before operation in the BDD group were higher than those in the non-BDD group,the scores of question 1-4 after operation in the non-BDD group were decreased,the scores of question 1-4,6-10 in the BDD group were decreased,while the scores of question 1,7,9-10 in the BDD group were higher than those in the non-BDD group(P＜0.05).The proportion of preoperative rhinoplasty and plastic surgery in the BDD group was higher than that in the non-BDD group,the difference was statistically significant(P＜0.05).Conclusion The occurrence rate of BDD in the patients with rhinoplasty is higher,operation is conducive to lessen the BDD,moreover operation itself will not result in new BDD.

Objective To investigate the clinical efficacy of autologous fat transplantation in augmentation mammoplasty with two different methods of purification treatment .Methods Selected 86 patients undergoing autologous fat granule replant mammaplasty .They were randomly and equally divided into the centrifuge group and the static group .After extracting the body fat in the centrifuge group ,obtained the high purity granular fat by using the Centrifugal technique;After the extraction of autologous fat in the static group ,obtain the purified particle fat by using the natural static suspension and physiological saline washed the im‐purities .Respectively ,the processed fat was injected the breast of two groups with multi tunnels and multi layers .After 6 months compared the clinical efficacy of two groups by evaluating the survival rate of autologous fat in augmentation mammoplasty and pre‐operative and postoperative breast volume ,the change of breast shape and patient satisfaction .Results Two groups of patients were successfully completed surgery ,and postoperative wound healed well .After 6 months ,in the centrifuge group and the static group the survival rate of autologous fat was 74 .42 ± 6 .35 and 65 .12 ± 5 .83 (P<0 .05) ,the satisfaction rate was 88 .37% and 76 .74%(P<0 .05) ,respectively .Conclusion The augmentation mammoplasty by injecting autologous fat granules in will not produce im‐mune rejection and surgical scar ,the breast shape is good and can be repeated without satisfactory ,until the desired effect is a‐chieved .The Centrifugal autologous fat can increase the survival rate of fat and patients′satisfaction ,which is suitable for clinical application .

Objective To investigate the association between the single nucleotide polymorphisms (SNPs) rs894278 and rs11931074 of α-synuclein (SNCA) and non motor symptoms in Parkinson' s disease (PD).Methods One hundred and twenty PD patients and 100 healthy controls enrolled from Tonglu Hospital Affiliated to Ruijin Hospital and Ruijin Hospital,Shanghai Jiaotong University School of Medicine from 2012 to 2014 were recruited and the motor subscale of the Unified Parkinson' s Disease Rating Scale Ⅲ (UPDRS-Ⅲ) was used to evaluate motor function.The Mini-Mental State Examination (MMSE),17-item Hamilton Rating Scale (HAMD-17),the Rapid Eye Movement Behavior Disorder Screening Questionnaire (RBDSQ) and the ROME-Ⅲ criteria for chronic constipation were used to evaluate non motor symptoms.SNCA SNPs (rs894278,rs11931074) were genotyped by direct sequencing.Results There was no statistically significant difference in age,sex,non motor symptoms scores among the three genotypes of the two SNPs in control group.There was no statistically significant difference in age,sex,UPDRS-Ⅲ scores and Hoehn-Yahr stage among the three genotypes of the two SNPs in PD group.The results demonstrated that there was no association between the two SNPs and RBDSQ scores,HAMD-17 scores,MMSE scores and constipation in PD patients.However,additional analysis showed that patients with GG rs894278 had a greater proportion of clinical probable RBD than those with GT and TT types (GG 52.2％,12/23;GT 18.2％,10/55;TT 21.4％,9/42;x2 =9.254,P=0.002;x2 =6.424,P=0.005).In Logistic regression analyses adjusting for age and sex,we observed that rs894278 GG genotype could increase the risk of RBD in PD patients (OR =5.367,95％ CI =1.607-17.925,P =0.006).There was no association of RBD with allelic and genotypic distributions of SNCA rs11931074.Conclusion The results indicate that the rs894278 polymorphism correlates with RBD,while rs11931074 does not.

Objective To investigate the effect of gene therapy which was mediated by electroporation on the expression of basic fibroblast growth factor (bFGF) duning mandible distraction.Methods Bilateral mandibular osteotomies were performed in New-Zealand rabbit.After a latency of 3 days,the mandibles were elongated using distractors with a rate of 0.8 mm/d for 7 days.The rabbits were randomly divided into 5 groups:2 μtg recombinant plasmids pIRES-hVEGF165-hBMP2,pIRES-hBMP2,pIRES-hVEGF165,pIRES and normal saline (NS) were injected into the distraction area of groups A,B,C,D and E,after completion of distraction,respectively.The lengthened mandibles were harvested and processed for immunohistochemical detection of bFGF,and the mean optic densities and integral optical density of bFGF positive cells were measured by computerized image analyzer.Results bFGF mainly located in fibroblasts,giant monocytes,polynuclear phagocytes,osetocytes,and osetoblasts in the connective tissue around bone tissue.The strongest expression was observed at the 7th day,and weakened at 14th day of consolidation stage,there were no significant difference among groups A,B and C,at the 7th day of consolidation.However,there were significant differences between gene therapy groups (A,B and C) and control groups (D and E) (P＜0.01).Conclusions Gene therapy can enhance and prolong the expression of bFGF in distraction gap,which promotes the cell differentiation and proliferation,extracellular matrix synthesis and new bone formation during distraction osteogenesis.This is probably one of the molecular mechanisms of the gene therapy promoting new bone formation in distraction gap.