Vascular cognitive impaiment (VCI) refers to a large class of clinical syndromes caused by vascular risk factors,obvious or not obvious cerebrovascular diseases from mild cognitive impairment to dementia.Looking for a physiologically controllable and repeatable animal model is critical for the systematic research of the VCI pathophysiological processes and the evaluation of new treatment methods.

[Objective]To retrospectively analyze of functional and radiographic outcome of distal calvicle fractures (Neer type II) treated with coracoclavicular screw fixation.[Method]Fifteen patients with Neer type II distal clavicle fracture were treated surgically between March 2001 and March 2004.Operative treatment included open reduction and fixation of the proximal clavicular fragment to the coracoid process using a 6.5-mm cancellous screw and repair of the coracoclavicular ligaments.Perioperative radiographs were performed to ensure that the screw was introduced properly into the coracoid.Following the operation,the arm was placed in a sling for two weeks.After two weeks,the sling was discontinued and the patient was permitted to use the arm for daily activities except for lifting,pulling,and pushing for 6 weeks.The patient is instructed not to perform any heavy lifting,pushing,pulling or participate in contact sports for 3 months.Data were collected to allow scoring according to the American Shoulder and Elbow Surgeons shoulder index 6 months after operation.[Result]All the patients were followed up at an average of 16 months (range:9~26 months).Fracture union occurred at a mean of 7 weeks (range:6~9 weeks)postoperatively without any serious complications such as screw-migration,pseudarthrosis,infection,neurovascular damage,or skin necrosis.All patients returned to the pre-injury level of activity with no residual pain or dysfunction.The mean American Shoulder and Elbow Surgeons shoulder index was 97 points ( range: 90-100 points) 6 months after operation.Two patients showed radiologically ossification of the acromioclavicular joint with no clinical symptoms.[Conclusion]Coracoclavicular screw fixation is a relatively simple,reliable,and safe technique of open reduction and internal fixation of the type II distal clavicle fracture.

Objective: To investigate the effects of ginsenoside Rb1 on activation and proliferation of murine T lymphocytes in vitro and to elucidate the mechanism of the immunosuppressive effect of ginsenoside Rb1. Methods: Cell suspensions were prepared from murine lymph nodes. T lymphocytes were treated with different concentrations of ginsenoside Rb1 and stimulated with polyclonal activator concanavalin (ConA). Fluorescence conjugated monoclonal antibodies and flow cytometry were used to detect the expression of CD3/CD69 and CD4/CD25. After the staining with CFDA-SE, T lymphocytes were stimulated with polyclonal activator ConA. The proliferation of T lymphocytes, after stimulated by ConA, was detected using the method of MTT. The distribution of the cell apoptosis was analyzed by staining both DIOC and PI. Results: In a dose-dependent manner, ginsenoside Rb1 (5, 10, and 20 μmol/L) could significantly inhibit T lymphocytes activation index (P<0.01) stimulated by ConA and proliferation index (P<0.05) stimulated by ConA. Ginsenoside Rb1 could also reduce the apoptosis of T lymphocytes stimulated by H2O2. Conclusion: Ginsenoside Rb1 can effectively inhibit the activation and proliferation of murine T lymphocytes, and ginsenoside Rb1 is a potential effective immunoinhibitory agent.

Objective To investigate the influence of Zengshiling oral liquid on gastric emptying,plasma motilin (MOT) and small intestine propulsion of young rat. Methods Experiment animal were divided into five groups randomly:control group,large dose of Zengshiling oral liquid group,normal dose of Zengshiling oral liquid group,small dose of Zengshiling oral liquid group and Motilium group. The rats were gavaged by 0.9% of NaCl and corresponding drug. 7 days later,gastric emptying was assayed by phenol red,plasma MOT levels and carbon powder propelling rate of small intestine were also assayed. Results The rate of gastric emptying of Zengshiling oral liquid groups were significantly higher than control group (P

ObjectiveTo investigate effects of pamidronate on the proliferation and differentiation of osteoblasts of rats in vitro.MethodsOsteoblasts isolated from newborn rat calvaria were treated with various concentrations of pamidronate, the proliferation of osteoblasts was evaluated with the method of methyl thiazole tetrazolium (MTT) and activity of alkaline phosphatase (ALP) in medium was measured with kit of ALP detecting.ResultsThe proliferation of osteoblasts increased under the stimulation of Pamidronate range 10-6-M-10-12 M(P<0.05), but was inhibited at the concentration of high level (10-4 M). The activity of ALP decreased in the experiment.ConclusionPamidronate can act on the osteoblasts directly and increase the proliferation of bone cells, but inhibit the differentiation of the same cells.

Objective To identify the risk factors for progression of advanced chronic kidney disease(CKD) patients who were cared by nephrologists in a specific CKD outpatient management clinic.Methods A prospective monocentric cohort study was performed.CKD patients of stage 3, 4 and 5 without renal replacement treatment were followed up regularly by nephrologists in this specific CKD management clinic.Patients with established atherosclerotic renal artery stenosis(ARAS) and chronic tubulointerstitial nephritis, and those who had not been followed-up for at least 12 months before Jun.30, 2010 were excluded.Clinical and laboratory data including blood pressure (BP), proteinuria, hemoglobulin (Hb), calcium phosphate product (Ca×P) and serum creatinine were consecutively collected.The treatment regimen was also recorded.Estimated glomerular filtration rate(eGFR) was calculated with the formula modified for Chinese to evaluate the change of renal function.The progression of kidney disease was defined as initiation of renal replacement therapy, the annual decrease of eGFR＞4 ml·min-1·(1.73 m2)-1, and/or death associated with renal disease.Results A total of 138 patients were enrolled in the final analysis with 84 patients of CKD stage 3, 36 of CKD stage 4 and 18 of CKD stage 5, respectively.At the time of enrollment, patients had an average age of (56.5:±:16.7) years old with an average eGFR of (32.3±13.4) ml·min-1·(1.73 m2)-1.During a mean follow-up interval of (27.1±12.1) months, the patients were well-controlled with an average blood pressure of (126.5±12.4)/(76.4±7.9) mm Hg in 50.7％(70/138), less than or equal to 130/80 mm Hg, an average Hb of(123.8±17.1) g/L in 73.9％(102/138), above or equal to 110 g/L and an average Ca×P of (45.2±7.7) mg2/dl2 in 89.1％(123/138), less than or equal to 55 mg2/dl2.Sixty-two patients (44.9％) had progression of kidney disease. On univariate analysis, factors predicting progression were low eGFR at referral, high systolic pressure, low Hb level, high Ca×P and proteinuria during follow-up, and renin-angiotensin system inhibitors treatment did not affect the progression.After the adjustment, multivariate analysis revealed proteinuria and low Hb level were independent factors for the progression of kidney disease.Conclusions The co-morbidities of advanced CKD patients can be managed efficiently in specific CKD outpatient management clinic.Control of proteinuria and correction of anemia may be beneficial to prevent the progression of advanced CKD.

Cultivation of medical students' clinical practice is an important part of higher medical education.At present,the imbalance of teachers structure and the old and single teaching mode and method etc,have had a great impact on the clinical practice of medical students.Only by strengthening the construction of clinical teachers,establishing access and assessment system of clinical teachers,carring out diverse clinical education reform,such as Problem-Based Learning ( PBL )and Case-Based Learning ( CBL ),etc,and fully mobilizing the initiative of students and enthusiasm for learning to reach teaching and learning complement in virtuous circle.can we truly improve the quality of clinical practice.

BACKGROUND:There is no consensus on the choice of elastic stable intramedulary nailing or plate fixation for the treatment of humeral fractures in children.Current research is limited to smal-sample studies,and it is difficult to carry out a large-sample multicenter analysis.OBJECTIVE:To evaluate the efficacy and safety of elastic stable intramedulary nailing and plate fixation for the treatment of humeral fractures in children with meta-analysis.METHODS: The PubMed database,EMbase database,CBM database,CNKI database,VIP database and Wangfang database were searched with computer to colect the controled trials of elastic stable intramedulary nailingversusplate fixation for humerus fractures in children,and related journals were manualy searched.The searching time ranged from the date of database establishment to August 2014.The trails were selected,the data were extracted and the quality was evaluated by two investigators independently.RESULTS AND CONCLUSION: Two randomized controled trials and three retrospective controled trials were included in the meta-analysis.The Meta-analysis results showed that the postoperative functional recovery Constant score of the elastic stable intramedulary nailing group was higher than that of the plate fixation group (P＜0.01).The bone union time,operation time,incision length,intraoperative blood loss and the hospital stay of theelastic stable intramedulary nailing group were less than those of the plate fixation group (P＜0.01).There were no significant differences in incidence rate of complications,nonunion,wound infection and malunion between two groups (P＞0.05).Based on the current evidence,elastic stable intramedulary nailing for the treatment of humeral fractures in children is superior to the plate fixation in the efficacy.There is no significant difference in incidence rate of complications between elastic stable intramedulary nailing and plate fixation.But al the studies were smal-sample,and high-risk original study.Clinical trials with adequate samples,rational design and strict execution shal be carried out to provide more reliable evidence.

Objective To measure tricuspid annular displacement by two-dimensional speckle tracking echocardiography in pulmonary hypertension (PH) patients,and compare with the right ventricular function parameters,finally discuss the clinical application value of this technology in evaluating the right ventricular function in PH.Methods A total of 58 patients diagnosed or suspected diagnosed as PH were divided into PH group and control group according to pulmonary arterial systolic pressure measured by echocardiography.The right ventricular function parameters included:tricuspid annular plane systolic excursion (TAPSE),right ventricular fractional area change (FAC),tissue Doppler-derived tricuspid lateral annular systolic velocity (s') and right ventricular index of myocardial performance (RIMP).The parameters of tricuspid annular displacement included:the peak systolic tricuspid annular displacement at right ventricular free wall (TMAD1),the peak systolic tricuspid annular displacement at interventricular septum (TMAD2),the peak systolic tricuspid annular displacement at midpoint of tricuspid annulus (TMADm) and the right ventricular longitudinal shortening (TMADm％).Results ① There were significant statistical differences between two groups in TAPSE,RIMP,FAC and s' (P ＜0.01),TMAD1 (P＜0.05),and TMAD2,TMADm and TMADm％ (P ＜0.01).② Area under ROC curve indicated that parameters of tricuspid annular displacement had moderate predictive value in predicting the decline of right ventricular function in PH patients (P ＜0.01).③ Setting 15.5％ as cut-off value for TMADm％ to assessment FAC＜35 ％,TAPSE＜17 mm,RIMP＞0.54 and s'＜9.5 cm/s,their sensitivities were 81.8％,84.4％,85.7％ and 72.3％ respectively,and their specificities were 72.0％,73.1％,70.3％ and 100％ respectively.Conclusions The tricuspid annular tissue displacement parameters can predict the decrease of right ventricular function in patients with PH,and provide a new diagnostic index for clinical treatment and prognosis.

This study was aimed to detect the heavy metal residues of medicinal leeches, in order to understand the current market circulation situation of medicinal leeches, and to analyze possible factors which may cause heavy metal pollution, and to provide references for the standardized safe cultivation of medicinal leeches. Inductively coupled plasma mass spectrometry (ICP-MS) technique was applied to detect heavy metal residues in medicinal leeches. The results showed that medicinal leech samples tested for heavy metal content severely exceeded the standard, which caused a great threat to the safety of medication. It was conclude that more attentions should be paid on factors for causing heavy metal accumulation within medicinal leeches during the breeding process. The related department should also list safety limits explicitly and separately for animal drugs such as medicinal leech during the development of quality standards of Chinese materia medica.