Objective The various influencing factors in the process of nano-silver preparation were studied in order to prepare nano-silver that has uniformity particle size distribution and good crystallinity. Methods Through the method of liquid reduction at room temperature,the nano-silver powders were prepared directly using silver nitrate as raw material,water as the reactive medium,polyvinylpyrrolidone(PVP) as protecting agent and ammonium formate as reducing agent. By means of EDS and TEM(transmission electron microscopy),the prepared silver particles were characterized. The various influencing factors in the process of preparation were also discussed. Results With the increasing concentration of AgNO3,the particle diameter of nano-silver changed obviously. When the concentration of silver nitrate was 0.25-0.30 mol/L,the size of product is the smallest. With the increasing concentration of reductant,the diameter of nano-silver decreased gradually. While at the concentration of 0.70 mol/L HCOOH,the average diameter of nano-silver is not more than 10 nm. Smaller and more well-distributed silver powder could be prepared at ratio of concentration of PVP to AgNO3 with the value of 1.5-1.0,at which PVP presented effective protection. Conclusions This method can prepare particle of nano-silver which revealed well dispersed and uniform size. The process is stable and reliable,easy to operate,high yields and suitable for industrial production.

Objective To observe the effect of thymalfasin on non-operative treatment of cervical cancer.Methods Seventy-eight patients with advanced cervical cancer were divided into two groups according to the digital table,each group in 39 cases.The two groups were treated with concurrent chemoradiotherapy.The observation group was given 1.6 mg of thymalfasin subcutaneously each Monday to Friday.While the control group received no additional treatment.And then the two groups were compared in terms of curative effects,adverse reactions,immune states and cellular immune functions.Results The results showed that the differences of curative effects[there were 23 patients in the control group,as compared with 31 patients in the observation group,achieved a complete response(CR),x2=3.852,P<0.05],adverse reactions(grade Ⅲ or Ⅳ radiation-induced enteritis occurred in 4 patients in the observation group,and 12 patients in the control group,x2=5.032,P<0.05;Grade Ⅲ or Ⅳ leukopenia occurred in 16 patients in the observation group,and 25 patients in the control group,x2=4.165,P<0.05;Grade Ⅲ or Ⅳ nausea,vomit occurred in 6 patients in the observation group,and 14 patients in the control group,x2=4.303,P<0.05),immune states and cellular immune functions between the two groups were significant[the counts of CD+3(t=9.236,P<0.05),CD+4(t=7.445,P<0.05),CD+4/CD+8(t=7.445,P<0.05) and NK(t=9.256,P<0.05)]were significantly higher in the observation group after treatment.Conclusion In the treatment of advanced cervical cancer,concurrent chemoradiotherapy combined with thymalfasin can improve the curative effect,reduce the side effects,improve the quality of life and enhance the immunity.

[Objective]To evaluate the two plates internal fixation treating the distal humeral comminuted and complicated fracture.[Method]Twenty-eight patient with comminuted distal humeral fracture were treated with the double-plate internal fixation from April 2004 to April 2007.According to AO/ASIF classification method,all fractures were C types.There were 9 C1 types,15 C2 types,4 C3 types.All cases were taken from the middle of posterior elbow incision.The patients were treated with the open reduction and double plate internal fixation.Fifteen cases were done through the triceps tongue-shaped flap,13 cases were olecranon osteotomy (including one case with olecranon fractures with ipsilateral).Surgical steps included:the articular surface reduction of intra-articular fractures,small temporary Kirschner wire fixation,making the complete fractures into simple comminuted fractures of humerl condylar fractures,then resetting metaphysis.Internal fixation method used the restruction plate according to the size of fracture.The restruction plate was fixed in the back of the distal humeral radial column.One-third of a good-shaped tubular plate was used to fix the inner edge of humeral ulnar column,two 90 ? of each other into the plane separately fixed on the inner lateral humeral column.[Result]All cases were followed up for an average of 17 months(ranged,8-33 months).Fracture healing time ranged 8-16 weeks.Myositis ossificans was found in 1 case,joint space narrowing was found in 4 cases.No non-union and ulnar nerve injury were found.The final good-to-excellent rate was 82.1%.[Conclusion]The distal humeral comminuted fracture has complicated structure.The internal fixation with two plates and screws,and early functional exercise could improve the elbow function.It has satisfactory curative effect in clinic.

Objective To observe the influence of Kuailvning capsule(KLN)and its drug serum on the concentration of Ca2 + in rat ventricular muscle cells.Methods SD rats were randomly divided into five groups:the control group,serum control group,KLN high -dose group,KLN medium -dose group and KLN low -dose group,six mice in each group.The rat ventricular myocytes were separated by enzymatic hydrolysis.The influence of KLN and its drug serum on the concentration of Ca2 + in rat ventricular muscle cells were observed by Fluo -3 /AMprobe.Results The mean fluorescence intensity of cytosolic Ca2 + in the KLN high -dose group,KLN medium -dose group and KLN low -dose group after 50s,100s,150s,200s,250s were [(18.75 ±1.55),(16.69 ±0.93),(17.76 ±1.26)], [(25.47 ±1.118),(17.86 ±1.49),(17.81 ±1.13)],[(29.05 ±1.31),(20.14 ±1.73),(18.26 ±1.37)], [(35.21 ±1.33),(23.19 ±0.97),(18.18 ±1.46)],[(41.08 ±1.21),(26.34 ±1.69),(17.91 ±1.01)], which were higher than those in the control group(F =5.556,7.007,8.816,10.208,12.232,all P <0.01 ).The mean fluorescence intensity of cytosolic Ca2 + in the KLN high -dose group after 50s,100s,150s,200s,250s were (17.85 ±1.69),(18.95 ±1.73),(21.85 ±1.39),(23.01 ±1.48),(24.07 ±1.42),which were higher than those in the serum control group(t =3.642,4.406,6.074,7.402,8.625,all P <0.01 ).The mean fluorescence intensity of cytosolic Ca2 + in the KLN medium -dose group after 100s,150s,200s,250s were (18.01 ±1.42), (18.76 ±1.22),(19.73 ±1.37),(21.04 ±1.16),which were higher than those in the serum control group(t =3.902,4.033,4.126,4.326,all P <0.01).There were no statistically significant difference between the KLN low -dose group and the serum control group(P >0.05).Conclusion KLN drug serum can promote myocardial cell spon-taneous extracellular calcium influx,the mechanism of KLN antiarrhythmic effect may be related to the Ca2 + channel.

Primary biliary cholangitis (PBC) is an autoimmune liver disease with unclear pathogenesis.The amino acid composition and sequence in the complementarity-determining region 3 of T cell receptor (TCR) and B cell receptor (BCR) are highly diverse, which forms a large antigen recognition receptor repertoire, i.e., immune repertoire.In recent years, second-generation sequencing techniques combined with multiplex PCR or amplicon rescue multiplex PCR have been used to study the features of immune repertoire in PBC patients, and it has been found that PBC patients have clonal expansion of specific CD4+ T lymphocytes, clonal diversity of B lymphocytes, somatic hypermutation, and reduction in class switch, as well as increase in clonal diversity after treatment with ursodeoxycholic acid.These findings need to be confirmed by large-scale in vivo and in vitro studies and different immune repertoire research strategies.

Objective To investigate the risk factors and treatment of postoperative delirium in patients with benign prostatic hyperplasia(BPH). Methods　For 256 postoperrative BPH patients in our department,the clinical parameters including age,hypoxemia,preoperative infection,postoperative pain,and introvert were analyzed,and the treatment were summarized. Results　The incidence of postoperative delirium was higher in patients aged≥75 years than＜75 years[17.4%(19/109)vs.5.4%(8/147),X2=8.307,P=0.0043,higher in patients with preoperative infection (pulmonary or urinary)versus without the infection[15.0%(17/113)vs.7.0%(10/143),X2=4.337,P=0.037],higher in patients with hypoxia versus without hipoxia[16.5%(16/97).vs.6.9%(111159),X2=4.885,P=0.027]and higher in patients with post-operative pain versus without the pain(16.9%(10/59)vs.1.2%(1/85),X2=10.146,P=0.0014].Hematocrit and hemoglobin in patients with postoperative delirium were lower after operation versus pre-operation[(0.29±0.04)vs.(0.42±0.04),t=12.2314,P＜0.001;(102.39±6.58)g/L vs.(114.58±8.36)g/L,t=5.9537,P＜0.001].All delirium patients were recovered after sedation treatment,improving the quality of sleep,controlling the infection and correcting electrolyte turbulence. Conclusions　Advanced age,hypoxemia,preoperative infection,postoperative pain are important risk factors for delirium.

Objective Discusstheinfluence of early diagnosis of myocardial damage and heart-type fatty acid binding protein(h-FABP)on patients with severe head injury after rehabilitation.Methods The sorum h-FABP was detected using enzyme-linked immunosorbent one-step quantitative detection,cTnI using solid-phase enzyme-linked immunosorbent assay(ELISA),CK-MB using the method of immunosuppressive.Results The sorum levels of h-FABP,cTnl and CK-MB in severe head injury patients levels were significantly higher than that of healthy control group(P<0.01),the positive serum h-FABP in severe head injury patients Was significantly higher than cTnI,CK-MB or ECG(P<0.01);8 cases died in47 cases of severe head injury patients,the mortalisty rate was 17.02%(8/47),the mortality rate of abnormal sentrum h-FABP,cTnI and CK-MB group was significantly higher than the normal group(P<0. 01);The serum h-FABP in predicting the death of severe head injury patients was high in sensitivity and negative predictive value,but lower in specificity and accuracy.Condusiom The serum h-FABP quantitative assay as a high-sensitive indicators to minor myocardial dsmage can be used an objective indicators forjudging severity ofacute severe head injury,evaluating incidence of accidents.

Objective To investigate the influence of irbesartan taken before bedtime on morning blood pressure surge and urine microalbuminuria in elderly patients with essential hypertension. Methods Ninety-two patients with uncontrolled hypertension were recruited in this study and their 24-hour ambulatory blood pressure monitoring profiles were collected for analysis. After irbesartan taken before bedtime, its influence on general blood pressure, morning blood pressure surge and urine microalbuminuria was observed. Results Before irbesartan treatment,the average 24-hour ambulatory blood pressure was(140.1 ± 12. 7)mm Hg, the morning blood pressure surge was (45.6 ± 10.8) mm Hg, urine microalbuminuria level was (58.6 ± 3.7) mg/L. After irbesartan treatment,the average 24-hour ambulatory blood pressure decreased to (129. 5 t 11.8) mm Hg (t = 3.18, P ＜ 0.05), the morning blood pressure surge decreased to(14. 2 ±4. 1)mm Hg(t =5.74,P ＜0.01) ,urine microalbuminuria level decreased to(31.7±3.1)mg/L(t =5.24,P＜0.01).Conclusions Irbesartan can effectively reduce the peak morning blood pressure,improve achievement ratio of blood pressure control, decrease urine microalbuminuria level in elderly patients essential hypertension.

Objective To describe the method and clinical result of super sural neuromusculocutaneous flap grafting plus catheter irrigation in the treatment for chronic lateral malleolus osteomyelitis. Methods From March 2000 to March 2008, 17 cases, male 14, femal 3, 21 to 75 years old (average 43-year-old),were underwent reversed saphenous musculocutaneous island flap after wide excision of lateralmalleolus lesion. The cause of lateral-malleolus lesions was trauma. The smallest flap was 5 cm× 6 cm and the largest was 7 cm × 11 cm. Catheter irrigation was used in all cases. Results Follow-up ranged from 12 to 96 months, average 49 months. After operation, the wounds were irrigated with sensitive antibiotics 1 to 2.5 months(average 49 days), and all flaps were survived. Except 2 cases, the other 15 were healed in 1 month.The 2 cases were not healed at first stage. According to the lab result,we changed the antibiotic, and in 2.5 months, we took off the catheter. Conclusion To deal with the chronic traumatic lateral-malleolus osteomyelitis, super sural neuromusculocutaneous flap grafting plus catheter irrigation is approprite and effective.