Objective To discuss the effect of early combined therapy of sertraline and psychotherapy on the rehabilitation of the patients with post-stroke depression (PSD)and observe its effect on plasma and platelet serotonin(5-HT). Methods All of 130 patients with PSD were divided into sertraline treatment group (65 cases) and routine treatment group (65 eases). Every patient was given routine treatment according to treatment guideline of cerebrovascular disease after admission. The sertraline treatment group received twelve-week sertraline treatment and psychotherapy, while the routine treatment group only received psychotherapy. Patients were evaluated by HAmilton rating scale for depression (HRSD) and serf-rating depression scale (SDS) before treatment and at the ends of the 4th and 8th week treatment, respectively. Meanwhile, the levels of plasma and playlet 5-HT of every patient were measured by the enzyme immunoassay methods. Results The scores of HRSD and SDS were lower in sertraline treatment group than those in routine tretment group at the ends of the 4th and 8th week. The rate of decrease of HRSD and SDS in sertraline treatment group was higher than that in routine treatment group at the end of the 8th week (Pall<0.01).The levels of platelet 5-HT in sertraline treatment group was lower at the ends of the 4th and 8th week than those before, treatment (P< 0.01).No significant change in plasma 5- HT level could be observed before and after treatment in two groups(P> 0.05). Conclusions Early treatment by sertraline can release the symptom of PSD and promote rehabilitation of PSD patients. The sertraline treatment can reduce the level of platelet 5- HT in PSD patients. However, the effect of plasma 5-HT value is not clear.

n clinic.

Objective To investigate the efficacy and safety spinal ropivacaine and fentanyl-epidural anes-thesia for the first stage of preclinical of childbirth.Methods 78 cases of full-term maternal were divided into the three groups randomly by using digital representation,each group had 26 cases.A group did not implement analgesia, B group was given analgesia in the first stage of incubation(ropivacaine and fentanyl epidural anesthesia),C group was given labor analgesia on the first line of the active phase.The labor time,mode of delivery,Apgar score,pain VAS score and the occurrence of adverse reactions of three groups were observed.Results The VAS pain scores of B group were (5.01 ±0.61)points,(2.30 ±0.32) points and (1.65 ±0.21) points after 5,10,30min of analgesia, which were significantly lower than those of before(t=6.59,9.62,10.73,all P<0.05) and A group(t=6.76, 9.80,11.02,all P<0.05);The VAS pain scores of C group were (4.92 ±0.57)points,(2.34 ±0.30)points and (1.61 ±0.23)points after 5,10,30min of analgesia,which were significantly lower than those of before(t=9.72, 9.55,10.91,all P<0.05) and A group( t=6.88,9.73,11.30,all P<0.05);The VAS pain scores of B group and C group showed no significant difference(t=2.22,2.08,1.99,all P>0.05) at each time point;The first stage of labor of B group and C group were (327.43 ±31.02)min and (335.62 ±30.18)min,respectively,which were significantly decreased compared with A group(t=7.21,6.90,all P<0.05);The natural birth rate of B group and C group was 80.77%and 84.62%,respectively,which were significantly higher than 57.69%of A group(χ2 =8.43, 8.81,all P<0.05);There was no significantly different among three groups in the incidence of adverse reactions (χ2 =2.23,2.23,all P>0.05).Conclusion Ropivacaine and fentanyl in epidural anesthesia had a preferable effect for the first stage of preclinical and active period of childbirth which can effectively reduce maternal labor pain and improve the natural birth rate and has a fewer adverse reactions.

Objective To validate cystatin (Cys C)-based equations for evaluation of residual renal function (RRF) in patients on continuous ambulatory peritoneal dialysis (CAPD).Methods Fifty patients on CAPD from our department were enrolled in the study.Eight patients with residual urine volume ≤ 100 ml/d and 42 patients with residual urine volume ＞ 100 ml/d were enrolled into anuria group and non-anuric group respectively.The clinical and laboratory status of each group were compared and equations (Hoek' s,Yang' s and abbreviated MDRD equations) were validated in the non -anuric group by comparing with the arithmetic average of residual renal creatinine clearance rate and residual renal urea clearance rate which was considered as the golden standard for RRF.Results (1) Anuric group had significantly higher serum Cys C than the non-anuric group [(7.73±1.13) mg/L vs (6.46± 1.15) mg/L,t =2.39,P =0.02)].(2) RRF estimated by each equation was correlated well with measured RRF (r =0.56,0.56 and 0.39,all P ＜ 0.05).(3) Yang' s equation [0.10 ml· min1· (1.73 m2)-1]was least biased,followed by Hoek' s equation [-0.73 ml· min-1 · (1.73 m2) 1] and abbreviated MDRD equation [3.15 ml· min-1 · (1.73 m2)-1].(4) The precision of Yang' s equation was equivalent to that of Hoek' s equation and both of them were better than abbreviated MDRD equation [6.2 and 6.1 vs 8.4 ml· min-1 · (1.73 m2)-1].(5) 50％ accuracy according to Yang' s equation and Hoek' s equation revealed an elevated results in comparison to that according to abbreviated MDRD equation (59.5％ and 54.8％ vs 23.8％,respectively,all P ＜ 0.01).Conclusions Serum Cys C-based prediction equations are better than the abbreviated MDRD equation in bias,precision and 50％ accuracy.For patients undergoing CAPD,the use of Cys C-based equation to estimate RRF may be a clinically acceptable alternative.

Objective To study the clinical characteristics and to summarize our experience in the diagnosis and treatment of ectopic splenic autotransplantation (ESAP) many years after splenic rupture and splenectomy.Methods The clinical data of 15 patients with ESAP who were treated in the People's Hospital of Zhengzhou from January 1998 to January 2013 were retrospectively analyzed.Results Of the 15 patients,2 patients presented with intestinal obstruction due to the ectopic splenic tissues and required partial resection of small intestine.In 5 patients,the ectopic splenic tissues were in the greater omentum which required resection of part or the whole of the greater omentum.In 4 patients,the ectopic splenic tissues were in the mesentery which required partial or total resection of the tissues.The ectopic tissues were in the pelvis in 3 patients and resection of the left fallopian tube was carried out in 2 patients and resection of the pelvic tissues in 1 patient.In 1 patient the diagnosis was made under laparoscopic biopsy,thus avoiding open surgery.Three patients had multiple implanted sites for these ectopic splenic tissues.Conclusions ESAP is an uncommon disease and it has no clinical characteristics.It is easy to confuse the condition with metastatic deposits.A diagnosis could be made only by combining the history with magnetic resonance imaging,or 99mTc study of red blood cells,or laparoscopic exploration and biopsy.

BACKGROUND: Apolipoprotein E (ApoE) gene polymorphism is associated with the onset of Alzheimer disease (AD), most of the researchers reported that ApoE ε4 allele accounts for familial AD as well as for sporadic AD.OBJECTIVE: This study was designed to validate the relationship between ApoE gene polymorphism and the sporadic AD in Aged Adults in Urumqi, and to evaluate the value of ApoE gene for prediction the risk of sporadic AD.DESIGN: Controlled comparative study based on patients.SETTING: It was conducted at the Institute of Clinical Medicine and the Neurological Department of Urumqi General Hospital of Lanzhou Military Area Command of Chinese PLA.PARTICIPANTS: From January 2001 to January 2003, 60 aged inpatients and outpatients at the Neurological Department of Urumqi General Hospital of Lanzhou Military Area Command of Chinese PLA and elderly in the Old People's Home were screened for AD. Of all these participants,28 were males and 32 were females, with an age from 52 to 91, in average of (74.2±19.5) years old, They had 0-16 years education, in average of 4.43 years, 28 were illiterate, 13 were at primary school educational level,12 were at junior middle school educational level, 4 were at high school educational level and 3 were at college educational level. From February to December 2002, 90 genetically unrelated individuals with healthy physical examination findings in Xinjiang area were selected into control group, 59males and 31 females, with an age from 50 to 101 years old, in average of (69.9±25.5) years old, have 0-16 year's education, in average of 7.96years. Of all the controls, 14 were illiterate, 23 were at primary educational level, 25 were at junior middle school educational level, 21 were at high school educational level and 7 were at college educational level. Informed consents were obtained from all the participants.METHODS: 5 Ml blood samples, anticoagulated with ethylene diamine tetraacetic acid (EDTA), were drawn from each participant. Then genome DNA was extracted from peripheral white blood cells using the phenolchloroform method. A fragment containing polymorphism site in exon 4 of ApoE were amplified using the polymerase chain reaction (PCR), were digested with Hha I and were identified using electrophoresis and silver staining. Then, ApoE genotypes and the frequency of ApoE alleles were compared between AD group and control group.MAIN OUTCOME MEASURES: ① ApoE genotypes and the frequency of ApoE alleles were measured in AD group and control group. ② The frequency of ApoE alleles were calculated in participants with different sex,age and educational level in AD group and control group.RESULTS: Sixty patients with AD and 90 healthy individuals participated this investigation. All of them entered the statistical analysis procedure.① The frequency of ε3/ε4 and ε4/ε4 alleles was higher in AD group than in control group (26.67%,11.11%; 3.33%, 1.11%; P ＜ 0.05). The frequency of e2/ε3 in AD group were lower than control group (5.00%,14.00%, P ＜0.05). ② The frequency of ApoE ε4 allele were higher in AD group as compared with control group (17.50%, 7.22%, P ＜ 0.05). The frequency of ApoE ε2 allele were lower in AD group (6.67%, 13.33%, P ＜ 0.05). ③ The frequency of ApoE ε4 allele in females were higher in AD group than in control group (20.97%, 5.00%, P ＜ 0.01). ④ In AD group, patients ≥ 75 years old have a lower frequency of ApoE ε4 allele compared to those less than 75 years (8.57%, 30.00%, P ＜ 0.01). And in individuals less than 75 years old, the frequency of ApoE ε4 allele were higher in AD group than that in control group (30.00%, 7.02%, P ＜ 0.01). ⑤ In illiterate persons and the individuals with only primary school educational level, the frequency of ApoE ε4 allele were higher in AD group than that in control group (10.00%, 0.56%, P ＜ 0.001; 5.00%,1.12%, P ＜ 0.01).CONCLUSION: ① It is proved that ApoE ε4 allele is significantly associated with sporadicAD in Urumqi and ε3/ε4 is the major genotype. ② ApoE ε2 allele has a protective effect on onset of AD. ③ Those individuals，female,less than 75,lower educational level or carrying ApoE ε4 allele take a higher risk of AD.

Objective To investigate the effect of intravenous infusion of hyper-oxygenated solution (HOS) on small intestinal ischemia-reperfusion (I/R) injury in rabbits.Methods Twenty-four rabbits of both sexes,weighing 2.5-3.2 kg,were randomly divided into 3 groups ( n =8 each):sham operation group (group S),I/R group,and HOS group.Small intestinal I/R was produced by clamping the superior mesenteric artery (SMA) for 1 h followed by 2 h of reperfusion in I/R and HOS groups,while the SMA was only clamped in group S.HOS was infused intravenously at a rate of 20 ml· kg-1 ·h -1 via the auricular vein starting from the time immediately after clamping the SMA in group HOS and the equal volume of normal saline was infused instead of HOS in group I/R.Blood samples were obtained from the inferior vena cava at 2 h of reperfusion to detect the concentration of serum lactic acid.The animals were then sacrificed and the small intestine was removed for determination of the malondialdehyde (MDA) content,and activities of superoxide dismutase (SOD),catalase (CAT) and glutathione peroxidase (GSH-Px) in intestinal tissues and for microscopic examination.The pathological changes of the intestinal epithelia were observed and the damage.to the mucous membrane was scored.The internal organs were removed and bacterial translocation from gut to the internal organs was observed.Results Compared with group S,the level of MDA and lactic acid,and rate of bacterial translocation were significantly increased,and the activities of SOD,CAT and GSH-Px were significantly decreased in groups I/R and HOS ( P ＜ 0.05).Compared with group I/R,the level of MDA and lactic acid,rate of bacterial translocation,and activities of SOD,CAT and GSH-Px were significantly decreased in group HOS ( P ＜ 0.05).Conclusion Intravenous infusion of HOS can reduce small intestinal I/R injury in rabbits.

Objective To explore the necessity and function of the sustentaculum tali screw placement for the treatment of Sanders type Ⅱ calcaneal fracture.Methods The data of Dicom that CT scan with bone was input into Mimics 12.0 software and Ansys 13.0 software for construction of calcaneus three-dimensional finite element model.Then,this model was imported into Solidworks 2010 software.Type Ⅱ calcaneal fracture model was established according to Sanders type cutting of calcaneus.Geometric parameters of AO calcaneal plate and screws were imported to the Solidworks 2010 software.Two internal fixation simulations were established based on the calcaneal model.In one model,the steel was placed on the outside with bone and the cancellous' bone screws were infiltrated respectively into the vertical bone since two screw holes which under the articular surface behind the steel plate,two screw holes which rear of the steel plate,a screw hole of the below calcaneus,two screw holes which in front of steel plate.In another model,a cortical bone screw was infiltrated into the sustentaculum tali through the bottom screw hole of articular surface of the steel plate.The two internal fixation models were loaded under the same condition,and non linear finite element analysis was carried out.The stress distribution in the two internal fixation models was calculated respectively.Results The maximum principal stress focused on the cortical bone of sustentaculum tali in both of the models under the same condition of loading.Bone joint displacement,maximum principal stress of calcaneal and internal fixation system in the model with sustentaculum screw fixation were smaller than that in the model without sustentaculum screw fixation.The stress in the model with sustentaculum screw fixation was more dispersed.Conclusion The placement of sustentaculum tali screw is essential for fixation of type Ⅱ calcaneal fracture to achieve the biomechanical stability and can be used in clinical.

BACKGROUND:Foreign studies have found that the magnesium alloy stent is safe and effective, but there are few studies on the degradation performance of magnesium alloy stents in China.OBJECTIVE:To investigate the degradation of degradable AZ31 magnesium alloy stent in the rabbit abdominal aorta and the effect of degradation process on vascularization.METHODS:Twenty-eight rabbits were enrolled, and the degradable AZ31 magnesium alloy stent was implanted into the rabbit abdominal aorta. Postoperative abdominal aortic X-ray examination and histological observation were done at 30, 60, 90, 120 days after implantation.RESULTS AND CONCLUSION:(1) X-ray examination: 30 days after implantation, the stent expanded completely with structural integrity; 60 days after implantation, the stent deformation, partial stent fracture, and lose of support were found; 90 days after implantation, only a small amount of support rod residues were found, and the majority of the stent was degraded; and 120 days after implantation, there was no support rod residual, and the stent was degraded completely. (2) Histological observation: 60 days after implantation, the number of residual support rods was less than that 30 days after implantation (P< 0.05), the number value at 90 days after implantation was lower than that at 30 and 60 days after implantation (P< 0.05), and the number value at 120 days after implantation was lower than that at 30, 60, 90 days after implantation (P < 0.05), indicating that the number of residual support rods was negatively correlated with post-implantation days. The time for complete stent degradation was 124.8 days. The intimal area at 90 days after implantation was higher than that at 30, 60, 120 days after implantation (P < 0.05), while the lumen area was smaler than that at 30, 60, 120 days after implantation (P < 0.05). There was no significant difference in the intimal area and lumen area at latter three time points after implantation. To conclude, the degradation of the degradable AZ31 magnesium alloy stent in the rabbit abdominal aorta can be completed within 124.8 days, and at 90 days after the stent is implanted, vascular intimal hyperplasia and lumen stenosis are most serious, and then gradualy reduced.

Objective To observe the changes of learning function and neuron-specific enolase (NSE)protein of both brian and serum in rats after intermittent hypoxia,and explore the relation between NSE protein and learning and memory function.Methods Male Wistar adult rats(n=48)were randomly divided into control group (UC group) and 7.5％ chronic intermittent hypoxia group (7.5％CIH group).7.5％ chronic intermittent hypoxia model in rats were simalated by using the self-made cabin of intermittent hypoxia.At the 2nd,4th,6th,and 8th week respectively,learning and memory function in rat was tested by Morris water maze in two groups.The level of NSE protein in hippocampal CA1 region was detected by immunohistochemical method,and was detected in serum of rats by using enzyme-linked immunosorbent adsorption method.Results Compared with the control group,7.5％ CIH group at the 2nd,4th,6th,and 8th week in rats from the second week of the escape latency time was 44.13± 2.84) s,(50.35 ± 1.96) s,(57.47 ± 1.66) s,(62.85 ± 1.80) s,and across the target quadrant time was 48.81 ± 2.09) s,(42.04± 1.84) s,(36.82± 2.07) s,(31.81 ± 1.68) s.From the first two weeks,the longer the hypoxia time prolonged,the longer the rat's escapedlatency (P＜0.05) and the shorter the rats acrossed the target quadrant (P ＜0.05).7.5％ CIH group of hippocampal CA1 neurons NSE protein at the 2nd,4th,6th,and 8th week was (9.69±1.37),17.10± 1.87),(24.79± 3.51),(34.16±5.35),respectively,and serum NSE protein at the 2nd,4th,6th,and 8th week respectively was (6.03±0.91) μg/L,(11.04± 1.89) μg/L,(16.39± 1.00) μg/L,(24.22±3.73) μg/L,both of which were more than the control group.The difference was statistically significant (P＜0.05).7.5％ CIH group of hippocampal CA1 neurons and serum NSE protein expression were significant time differences,and gradually increased over time.The difference was statistically significant (P＜0.05).Positive NSE protein expression in hippocampal CA1 region relative NSE and serum protein expression values were positively correlated (r=0.94,P ＜0.01).But in control group NSE protein expression did not exist time difference (P＞0.05).Conclusion Intermittent hypoxia can cause NSE levels significant increase in serum and brain tissue,and the dynamic changes of them can reflect severity of learning and memory impairement in rat.