BACKGROUND:Pain after hip replacement is a difficulty for orthopedic surgeons,and revision surgery might result in severe wound for patients undergoing hip replacement.Extracorporeal shock wave(ESWT) is certificated effective for relieving pain.OBJECTIVE:To evaluate the effects of ESWT on the pain after hip replacement.DESIGN,TIME AND SETTING:Case self-control,double-blind evaluation.The experiment was performed at the Department of Orthopaedics,Zhongnan Hospital,Wuhan University between June 2004 and February 2008.PARTICIPANTS:Fifty-one cases(61 hips) undergoing total hip replacement with pain were selected,including prosthetic loosening(cemented:16 cases,20 hips;non-cement:12 cases,16 hips),ectopic ossification(8 cases,10 hips),acute infection(4 cases,4 hips),chronic infection(5 cases,5 hips),soft tissue aseprtic inflammation(4 cases,4 hips) and acetabulum dislocation(2 cases,2 hips).METHODS:These patients received sessions of ESWT(4 000 shocks,3 times/s),with an energy ranging from 0.54 to 1.06 MJ/mm2,once a week for 8-12 weeks.MAIN OUTCOME MEASURES:Visual analog scale(VAS),Harris hip scores,diversity of the sclerotin surrounding the prosthesis(X-ray).RESULTS:The 51 patients were followed up for 18-64 months(4.1years in average),and 2 died during this period.The scores of VAS in non-cement,chronic infection,ectopic ossification and soft tissue aseprtic inflammation groups were significantly decreased than before treatment(P

The number of clinical postgraduates is growing with the reform of educational mode of postgraduates.It is a particular concern for medical colleges to improve educational quality of postgraduates,especially to cultivate postgraduates with great ability of observational study.The ability of clinical thinking and observational study is a key objective throughout postgraduate teaching.A good teaching method plays an important role in improving the ability of observational study for clinical postgraduates.A teaching platform combining academic theories with clincal pratice is a basis for promoting quality of clinical postgraduates.The construction of tutor team is a key point in elevating clinical observational ability.Academic exchange is a shortcut to cultivate postgraduates with great observational ability in clinical work.

Objective To investigate the effection of Shenfu Injection (Ginseng-radix aconitum Injection)to the blood coagulation system and its prognosis in the patient of multiple trauma complicated with shock.Methods We prospectively studied 90 patients of multiple trauma complicated with shock,who came from the emergency center of the Second Affiliated Hospital of Medicine' s college of Zhe-Jiang University and emergency department of Lishui People' s Hospital from February 2007 to December 2011,and excluded those suffered with the dysfunction of coagulation system and uncontrolled ongoing bleeding before trauma.And then these eligible patients were randomly divided into two groups:treatment group ( 45 cases ) and control group (45 cases),the control group were received the routine treatment,the treatment group were received Shenfu Injection in early stage based on the routine treatment.The two groups were measured the platelet count (PLT),prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time (TT),fibrinogen (FIB) before treatment and 3,7 days after treatment.Results The differences of the PLT,PT,APTT,TT,FIB between the treatment group and control group at 3,7 d after the treatment was statistically significant (P ＜ 0.05 ). Conclusions Shenfu Injection has positive regulation to the coagulation system in the patient of multiple trauma complicated with shock.

OBJECTIVE To understand the status of gastroscope contamination.METHODS The bacterial(cultivation) of samples derived from inside and outside gastroscope after using was conducted.RESULTS There were heavy(contaminations) inside and(outside) gastroscope after using.Except for normal microbial populations(existing) on pharynx nasalis,many(conditional) pathogenic bacteria had been detected,such as Streptococcus pyogenes,Moraxella catarrhalis,and(nonzymocyte).CONCLUSIONS Many species of bacteria are detected inside and outside(gastroscope) after using.They are normal microbial populations in pharynx nasalis and some conditional pathogenic bacteria.It is (necessary) to strengthen regulation of gastroscope cleaning and disinfection. We should follow Technological Regulations of Disinfection(Ministry of Health,2004) to clean and disinfect endoscope strictly in order to avoid(hospital) acquired infection due to insufficient cleaning and disinfection.

BACKGROUND:Some studies indicate that PI3K/Akt signaling pathway is associated with the expression of glucose transporter 4 (GLUT4) and the function of cAMP response element binding protein (CREB) in skeletal muscle. However, it is stil unclear whether PI3K/Akt signaling pathway has the effects on CREB and GLUT4 in skeletal muscle of the rats with high-fat diet and treadmil exercise. OBJECTIVE:To investigate whether PI3K/Akt signaling pathway has the effects on CREB and GLUT4 in gastrocnemius muscle of the rats with high-fat diet and treadmil exercise. METHODS:A total of 70 rats were fed with normal diet for 2 weeks, and randomly divided into common feed group (n=20) and high-fat feed group (n=50). Rats in both groups were respectively fed with common feed and high-fat feed for 8 weeks. The rats in the common feed group were equaly assigned to common feed quiet group and common feed exercise group. 20 rats from the high-fat feed group whose body weight was 1.4 times of common rats were randomly and equaly assigned to obese quiet group and obese exercise group. Rats in the quiet groups did not do exercises. Rats in the exercise groups received adaptive sports for 1 week and medium-intensity treadmil exercise for 8 weeks. RESULTS AND CONCLUSION:(1) Impairments of PI3K/Akt signaling pathway appeared in obese rats, however, the quantity of GLUT4 expression did not change obviously in gastrocnemius muscles of obese rats. The reasons for the decrease of the nuclear protein CREB level of gastrocnemius muscles of obese rats might be related to the decrease of pAkt-Ser473 level. (2) The increase of the quantity of GLUT4 expression was accompanied by significantly up-regulated pAkt-Ser473 level by exercise intervention in gastrocnemius muscles of obese rats. Exercise intervention significantly increased the expression of nuclear protein CREB in gastrocnemius muscles of chow-fed rats and obese rats, which was consistent with the changes of pAkt-Ser473. These findings suggest that pAkt-Ser473 can play an important role in the effects of high-fat diet and exercise intervention on GLUT4 and CREB protein expression in gastrocnemius muscles of obese rats.

Objective To investigate the diagnostic value of hyperenhancement sign on ultrasound,CT and their combination in diagnosis of thyroid benign and malignant nodules.Methods The contrast-enhanced ultrasound and enhanced CT datas of 172 thyroid nodules in 144 cases confirmed by operation and pathology were retrospectively analyzed,including 97 benign nodules and 75 malignant nodules.According to the degree of enhancement,these nodules were divided into iso-or low-enhancement and hyperenhancement.The distributions of ultrasound hyperenhancement,CT hyperenhancement and both of them in thyroid benign and malignant nodules,adenomatoid lesions and nodular goiters were analyzed,followed byx2 test for statistical analysis.Results In 172 thyroid nodules,the proportions of ultrasound hyperenhancement,CT hyperenhancement and both of them in thyroid benign and malignant nodules were 53.6％(52/97) and 20.0％(15/75)(x2＝20.090,P＜0.05),34.0％ (33/97) and 4.0％ (3/75) (x2＝23.033,P＜0.05),31.0％ (30/97) and 0％ (0/75) (x2＝28.096,P＜0.05),respectively.Their sensitivity and specificity of diagnosing benign nodules were 53.6％ (52/97) and 80.0％ (60/75),34.0％ (33/97) and 96％ (72/75),30.9％ (30/97) and 100％ (75/75),respectively.The proportions of ultrasound hyperenhancement,CT hyperenhancement and both of them in adenomatoid lesions and nodular goiters were 96.9％(31/32) and 32.3％(21/65)0x2＝35.946,P＜0.05),65.6％(21/32) and 18.5％(12/65)(x2＝21.250,P＜0.05),65.6％(21/32) and 13.8％ (9/65)(x2＝26.912,P＜0.05).Their sensitivity and specificity of diagnosing adenomatoid lesions were 96.9％(31/32) and 67.7％(44/65),65.6％(21/32) and 81.5％(53/65),65.6％(21/32) and 87.2％(56/65).Conclusions Ultrasound hyperenhancement,CT hyperenhancement for diagnosing thyroid benign nodules are of significant value.Especially for adenomatoid nodules,ultrasound hyperenhancement has a higher sensitivity,while CT hyperenhancement has a higher specificity.Their combination can further improve the diagnostic specificity,thus reducing the unnecessary surgical trauma.

Objective:To study of change of Th17 cell and IL-17 caused by bacteria biofilm after infection.Methods: To detect biofilm formation ability of bacteria isolated from bronchus alveolus washing-water of patients;to detect expressing ratios of Th17 cells and IL-17 level in peripheral blood of patients and healthy person;to detect expressing ratios of Th17 cells and IL-17 level in bronchus alveolus washing-water of patients;to analyze the above data using SPSS17.0 software.Results: Expressing ratios of Th17 cells and IL-17 level in peripheral blood of patients infected by producing biofilm and non-producing biofilm bacteria and healthy person are respectively(0.59±0.18)%and(108.8±20.5)pg/ml,(0.58±0.18)%and(100.1±20.7)pg/ml,(0.55±0.17)% and(100.0± 21.4)pg/ml,they were not different among data from patients and healthy person,P>0.05,expressing ratios of Th17 cells and IL-17 level in bronchus alveolus washing-water of patients infected by producing biofilm and non-producing biofilm bacteria were respective (1.37±0.34)%,(157.4±30.8)pg/ml and(1.11±0.21)%,(136.2±24.3)mg/ml,the data between patients infected by producing biofilm and non-producing biofilm bacteria were distinctly different, P<0.05.Conclusion: Bacteria biofilm can cause Th17 cell expressing ratio and IL-17 level to become high in infected part,this may be mechanism that infection become chronic.

Objective To measure the diameter of cochlear nerve(CN) in normal hearing children with different ages,and evaluate the diameter variations with age.Methods A total of 156 normal-hearing children were assessed with 3D-FIESTA sequence scanning of the inner ear.All the subjects were divided into 13 groups according to age,witha group of ≤6 months,a group of ≤1 year,and 11 groups from one year to 12 years.Each group had 12 cases,including 6 boys and 6 girls.The diameter of CN was measured at the entrance of the cochlea,the middle of internal auditory canal(IAC) and the fundus of IAC respectively on the axial and oblique sagittal images of 3.0 T MRI by two independent observers.The average values measured by them were the final results.The intraclass correlation coefficient was used to determine the consistency between the two independent observers.The t test was used to access differencesin CN diameter by sex and sides.One-way analysis of variance(ANOVA) and two-way ANOVA were used for comparisons among different groups.Spearman correlation coefficient was applied to find a correlation between the CN diameter and age.Results The diameters of normal-hearing children's CN at the middle of the IAC,IAC fundus and the entrance of the cochlea were (1.12 ± 0.08),(1.05 ± 0.06),(0.87 ± 0.14) mm respectively,and there was significant difference among the three measuring points (F=527.57,P＜0.05).The diameters of the CN had no significant differenc (P＞0.05) in age-groups,gender and sides(P＞0.05),and there was no correlation between the diameters of normal children's CN and age.Conclusions The diameters of normal-hearing children's CN change with different points of the IAC,of which the maximum value is at the middle of the IAC,followed by the IAC fundus,and the entrance of the cochlea is at the minimum,more over the normal size doesn't change with age.

Objective To explore the interaction of sleep quality and depression among patients with type 2 diabetes. Methods With multistage cluster sampling, all the participants were interviewed with self-designed questionnaire, diabetes-specific quality of life scale and self-rating depression scale, and Pittsburgh sleep quality index scale. Chi-square test was used for qualitative data. Risk factors were analyzed by means of multiple linear regression or logistic regression model. The indicator of interaction was calculated according to the delta method. Results There were 944 residents involved in the final analysis, including 365 males and 579 females. The average age was (64. 0 ± 10. 2) years. Compared with patients with type 2 diabetes mellitus( T2DM) who had good sleep quality and no depression symptoms, the risk of quality of life in those with good sleep quality but depression was 2. 75 (95% CI 1. 59-4. 77); and the risk of quality of life in those with poor sleep quality and no depression was 1. 55(95%CI 1. 03-2. 33). The risk of quality of life in those with poor sleep quality and depression was 4. 97(95% CI 2. 34-9. 63). Due to poor sleep quality and depression in patients with T2DM the combined interaction index was 2. 48 (95% CI 1. 44-4. 29), the relative excess risk was 3. 42(95% CI 2. 16-4. 67), and the attributable proportion was 0. 51(95% CI 0. 32-0. 70). Conclusion A combined interaction of poor sleep quality and depression in affecting the quality of life was found in type 2 diabetic patients. When both factors existed at the same time, the interaction effect of these 2 factors was greater than the single one.

Objective To explore the hypertensive vulnerability of residents living in Xuzhou City to provide evidence for effective intervention. Methods Based on multi-stage stratified randomized sampling methed,a total of 4980 residents aged 15 to 69 years from 9 counties of Xuzhou City were selected and completed a standard questionnaire. Hypertensive vulnerability was compared by using Chi-square test. Results The prevalence of hypertension was 13.62% among 15 to 69 years old participants. The residents who had no idea of normal level of blood pressure accounted for 45. 26%. The residents who thought it was unnecessary to measure blood pressure every year since 35 year-old accounted for 29. 68%. Those who did not know individual's salt intake per day accounted for 57. 23%. The participants who had no information on hypertension prevention or control accounted for 21.53% and 12. 05%, respectively. The higher hypertensive vulnerability was associated with lower educational level or monthly income per capita; higher hypertensive vulnerability of patients is less than normal crowed. The rates of current smoking, alcohol consumption,salt over-intake and non-blood pressure measurement were 16. 45%, 11.10% ,30. 00%, and 32. 05% respectively. The higher educational level, higher monthly income per capita or older age crowd ,the lower rate of non-blood pressure measurement, the higher rate of alcohol consumption ; salt over-intake was different in different education levels ( χ2 = 23.37, P＜0. 05 ) ; the older age group were in a higher proportion of current smokers;the behavior vulnerabilities were no difference between the patients and normal crowds. Conclusion Hypertensive vulnerability of residents living in Xuzhou City is high. Hypertension education and healthy living style should be improved to effectively prevent the development of hypertension.