Objective To observe the effects of general anesthesia and combined spinal epidural anesthesia in elderly patients with lower limb fracture surgery, and to evaluate the effect of postoperative cognitive function and pain score.Methods Retrospective analysis, screening of intraoperative anesthesia, postoperative change lost invalid cases, from November 2012 to October 2015 in our hospital accepted surgical treatment of 180 patients with lower limb fracture surgery were selected according to different patients with different anesthesia methods can be divided into treatment group and control group, 90 cases each group of patients.Patients in the treatment group were treated with combined spinal epidural anesthesia , while the control group received general anesthesia.The incidence of cognitive dysfunction and postoperative pain scores were compared between the two groups. Results the incidence of cognitive dysfunction after surgery in 90 cases of observation group was lower than that of the control group , and the difference was statistically significant (P<0.05).The evaluation of two groups of postoperative chronic pain for 3 days, 6 days, 10 days, 15 days, the incidence rate of VAS score and the character, whether the impact on the daily life and the rest, the patients in the treatment group pain scores were significantly lower than the control group, the difference was significant (P <0.05).Conclusion After lumbar epidural anesthesia in elderly lower limb fracture surgery effect on cognitive function in patients with small, and can reduce the pain of patients, in the actual work according to the actual situation of different specific problems in different specific analysis.

Objective To explore the effect of anterior cruciate ligament (ACL) rupture on the biomechanics of medial collateral ligament (MCL). Methods Six fresh human knee joints were fixed on the self-made fixture and flexed 90°. ACL was divided into a normal group, an anteromedi-al bundle(AMB) break group, and an ACL complete break group. 800N burden was loaded, and the MCL strain data were compared among the 3 groups. Results The MCL strain was significantly increased in the AMB break group and the ACL complete break group than that in the normal group (P<0.05). There was no significant difference in the MCL strain between the AMB break group and the ACL complete break group (P>0.05). Conclusion ACL rupture may cause significant changes in the MCL biomechanics, but the effect of AMB break and ACL complete break on MCL has no significant difference.

BACKGROUND:In high-intensity exhaustive exercise process, the body must bear the exercise intensity decreasing splanchnic blood flow“ischemia”, at the same time, along with the movement of energy and material consumption, metabolite accumulation and oxidative stress in the body cause pathological damage, leading to a decline in exercise capacity. Thus, what is the impact on kidney filtration barrier? How to adapt to the change of renal tissue? Houttuynia cordata has the functions of heat clearing and detoxifying, dieresis for treating strangurtia, hemostatic, expel ing phlegm to arrest coughing and analgesia, if it has a protective effect on the renal injury caused by acute exhaustive exercise and its mechanism has not been reported in the literature. OBJECTIVE:To explore the effect of acute exhaustive exercise on kidney filtration barrier in rats and the intervention effect of Houttuynia cordata.METHODS:After resting and watching for 3 days, Sprague-Dawley rats received adaptive running for 15 minutes at a speed of 10 m/min on a 0° treadmil . A total of 24 rats, which can finish the running, were selected. They were divided into normal control group, exhaustive exercise group and dosed exhaustive exercise group according to the weight of layer (n=8). Rats in the exhaustive exercise group and dosed exhaustive exercise group on the 10° treadmil received once exhaustive exercise. Dosed exhaustive exercise group received intraperitoneal injection of sodium houttuyfonate 10 mL/kg at 30 minutes before exercises. The normal control group did not do any exercise. RESULTS AND CONCLUSION:Compared with the normal control group, serum urea nitrogen, serum creatinine, urine protein content, malondialdehyde concentration, renal cellapoptosis and apoptosis index were significantly increased, but nitric oxide content and nitric oxide synthase activity in the renal tissue were significantly deceased in the exhaustive exercise group (P<0.05 or 0.01). Glomerular filtration epithelial cells, the kidney filtration barrier of basement membrane and podocyte damage were obvious, showing abundant cellapoptosis, occasional y necrosis. Compared with the exhaustive exercise group, urine protein content, serum creatinine, malondialdehyde concentration, renal cellapoptosis and apoptosis index were significantly reduced, but nitric oxide content and nitric oxide synthase activity were significantly increased in the dosed exhaustive exercise group (P<0.05). No obvious pathological changes were detected, but apoptosis was visible. These findings confirmed that houttuynine made a reduction in renal cellinjury induced by exhaustive exercise and possibly significantly reduced apoptosis, increased nitric oxide synthase content, decreased malonaldehyde, and apparently increased superoxide dismutase activity, and final y protected injured renal tissue induced by exhaustive exercise.

Based on the conservation of nucleotides at splice sites, the characteristics of base composition and base correlation in the adjacent segment sequences, the distance between alternative donor or acceptor splice sites and the content of GC and TC near splice sites, the donor and acceptor splice sites for alternative and constitutive introns are predicted by use of the method of diversity measure combined with quadratic discriminant analysis. For alternative splice sites the total prediction accuracies are 87.9% and 89.9% for donors and acceptors respectively (with the chosen threshold -2). For constitutive splice sites the total accuracy are 92.8% and 94.3% for donors and acceptors respectively (with the chosen threshold -1).

Based on the characteristic of nucleotide distribution in nucleosome positioning and inhibiting sequences, the method of Increment of Diversity with Quadratic Discriminant (IDQD) was applied to the classification of these two types of sequences. The mean area under ROC curve archives 0.958. By using this model, the nucleosome formation potential was analyzed in the regions around the splice sites (GT/AG). The results show that coding regions have a high potential to form the nucleosome and the primary RNA transcripts are rigid, while DNA sequences corresponding to the splice sites and their adjacent intron regions tend to be nucleosome free and the primary transcripts from these regions are relative flexible. Moreover, the negative correlation between nucleosome positioning/inhibiting of DNA sequences and RNA flexibility/rigidity is demonstrated around the splice sites, providing a mechanism for understanding the correlation between the nucleosome positioning of DNA and the splicing of transcribed RNA sequences.

Objective To study serum IL-22 levels in patients with pulmonary tuberculosis and diabetes mellitus (PPTDM) and to analysis their clinical significance.Methods ELISA was used to detect serum IL-22 levels in 30 cases PPTDM pa-tients,30 cases pulmonary tuberculosis (PTB)patients,30 cases diabetes mellitus (DM)patients and 30 cases healthy vol-unteers (HV).Results Serum IL-22 levels of PPTDM patients (54.4±4.81 pg/ml)were significantly lower than those in diabetes mellitus (DM)patients (72.36±5.12 pg/ml)and healthy volunteers (HV)(68.32±3.08 pg/ml)(t=2.557,P =0.013;t=2.437,P =0.018),respectively.There was no significantly different of serum IL-22 levels between PPTDM and PTB patients (t=1.190,P =0.239).Serum IL-22 levels of diabetes mellitus coincident with pulmonary tuberculosis (DM-PTB)patients (64.62±8.59 pg/ml)were significantly higher than those in pulmonary tuberculosis coincident with diabetes mellitus (PTB-DM)patients (44.21±2.68 pg/ml)(t=2.267,P =0.031).Conclusion IL-22 may play an important role in PPTDM development.

ObjectiveTo analyze whether association of edge to edge valve repair to artificial ring annuloplasty would result in better results in patients with severe tricuspid regurgitation (TR).MethodsFrom April,2001 to May,2010,41 patients underwent tricuspid valve repair to treat severe TR were studied.Twenty-one patients were done artificial ring annuloplasty alone (group R) and twenty patients were done artificial ring annuloplasty associated with edge to edge valve repair ( group E).All the patients received echocardiography before surgery,before discharge and in mid and long-term follow-up.The ratio between TR jet area (TRA) and right atrial area (RAA) was used to quantitatively evaluate the seriousness of TR.Movement of tricuspid valve leaflets,tricuspid valve orifice area,pulmonary artery pressure ( PAP),left ventricular ejection fraction ( LVEF) were obserbed to evaluate heart function.ResultsAt discharge in group R,no or trivial TR was presented in 7 patients,mild TR in 12 patients and moderate TR in 2 patient.Bad apposition of the free edges of anterior and septal leaflets was observed in paients with mild and moderate TR.While in group E,no or trivial TR was presented in 13 patients and mild TR in 7 patients.The follow-up ranged from 6 months to 100 months[average (54.8 ±26.7) months].In group R,no or trivial TR was present in 5 patients,mild TR in 11 patients,moderate TR in 4 patients and severe in 1 patient.Bad apposition of the free edges of anterior and septal leaflets was observed in paients with mild to severe TR.Redo tricuspid valve repair was done in one patient in group R for recurrent severe TR and the edge-to-edge valve repair was utilized.In group E,no tricuspid stenosis was found.No or trivial TR was presented in 10 patients,mild TR in 9 patients and moderate TR in 1 patient.The ratio of TRA/RAA of group R was significantly higher than that of group E (0.25 ±0.16 vs.0.13±0.10,P < 0.01).ConclusionAssociation of edge-to-edge valve technique to artificial ring annuloplasty was safe and effective for treatment of severe tricuspid regurgitation due to bad apposition of free edges of tricuspid leaflets and dilatation of tricuspid annulus,.It could decrease the incidence of residual tricuspid regurgitation and prevent the recurrence of severe tricuspid regurgitation.

Objective Tricuspid regurgitation is often associated in patients with congenital heart disease. Significant morbidity and mortality are related to tricuspid valve replacement. Tricuspid valve plasty is still a preferred choice. This report deals with our surgical experience in using edge-to-edge valve plasty technique to correct severe tricuspid regurgitation in patients with congenital heart disease. Methods From April 2001 to Mar. 2010, severe tricuspid regurgitation was corrected with a flexible band anuloplasty and edge-to-edge valve plasty technique in 14 patients with congenital heart disease. The age ranged from 7 years to 62 years [average (31.2 ± 16.1 ) years]. Congenital cardiac anomalies include: atrioventricular canal in 5 cases, secundum atrial septal defect in 6 cases, secundum atrial septal defect with mitral valve regurgitation in 2 cases and cor triatriatum in 1 case. Results No hospital death or postoperative morbidity occurred. No or trivial tricuspid regurgitation was present in 11 cases and mild tricuspid regurgitation in 3 cases at discharge. The follow-up ranged from 3 month to 97 months [average (51.6 ± 26.8 ) months]. No tricuspid stenosis was found. No or trivial tricuspid regurgitation was present in 5 cases. Mild tricuspid regurgitation was present in 8 cases, and moderate tricuspid regurgitation in 1 case at the latest followup. Conclusion Edge-to-edge valve plasty is an easy, effective and important procedure to correct severe tricuspid regurgitation in patients with congenital heart disease.

Objective:A study was conducted to determine the expression of acetyl-coa carboxylase product of phosphorylation (P-ACC) and an enzyme called cyclooxygenase 2 (COX-2) in non-small cell lung cancer (NSCLC) tissue, as well as the relationship and correlations between tumor size, lymph node metastasis, clinical stage, and pathological type. Methods: Sixty-two patients with NSCLC lung cancer tissues were included in the patient group, whereas 20 patients who underwent lobectomy for other reasons and had normal lung tissues were included in the control group. Immunohistochemical streptavidin peroxidase method was used to detect the expression of P-ACC and COX-2 in lung cancer and normal lung tissues. Results:The positive expressions of P-ACC and COX-2 in NSCLC lung cancer and normal lung tissues were significantly different (P<0.05). In NSCLC tissues, the positive expression of P-ACC was significantly associated with tumor size (P<0.05), but was not significantly associated with lymph node metastasis, clinical stage, and pathological type. We found no correlation between the positive expression of COX-2 and tumor size, lymph node metasta-sis, clinical stage and pathological type. Further analysis revealed that the positive expression of P-ACC and COX-2 in NSCLC was sig-nificantly and negatively correlated (r=-2.37, P=0.032). Conclusion:The positive expression of COX-2 in NSCLC greatly increased compared with that of P-ACC, and a significantly negative correlation was observed between them. We propose that the positive expres-sion of P-ACC reduction may activate the positive expression of COX-2 and promote the occurrence, development, invasion, and metas-tasis of NSCLC.

Objective To investigate the morbidity,clinical manifestations,and imageology characteristics,and the influencing factors of severe cyclosporine A(CsA)-related neurotoxicity(SNCT)in the patients after allogenic hematopoietic stem cell transplantation(allo-HSCT).Methods Finding of SNCT was carried out in 164 allo-HSCT recipients from January 2003 to June 2006.Clinical characteristics were analysed,including precursory symptoms and clinical manifestations.Associations between the onset of SNCT with blood CsA levels,age,transplant types,human leucocyte antigen(HIJA)matching,conditioning regimens,antihuman thymocyte globulin(ATG)used in the prevention and treatment for graft-versus-host disease(GVHD)and intravenous corticosteroid used for acute GVHD were analyzed.Statistical analysis was performed with Binary Logistic Regression using SPSS/PC version 11.0.Results Thirteen patients(7.93%)were identified to have SNCT,including seizures(n=8,4.88%),paralysis(n=6,3.66%),coma(n:2,1.22%),cerebllar ataxia(n=3,1.83%)and chondrioid encephalomyopathy (n=1,0.61%).All the patients had precursory symptoms prior SNCT including headache(n=8),agitation(n=4)and hypertension(n=6).Magnetic resonance imaging(MRI)performed in twelve patients after SNCT showed that eleven patients had signal abnormalities in cerebral cortex and cerebral white matter.Six patients examined with computerized tomography(CT)had no abnormal findings.After extenuation or withdrawal of CsA.ten patients had complete recovery.two had partial recovery and one died of SNCT.Simple effect analysis of Binary Logistic Regression showed that the associations between the onset of SNCT with blood CsA levels.transplanta types.HLA matching.ATG used in the prevention and treatment for GVHD and intravenous corticosteroid used for acute GVHD were of statistical significance.The multiple effect analysis of Binary Logistic Regression showed that the associations of the onset of SNCT with blood CsA levels and ATG used had statistical significance and the odds ratio(OR)was 1.007(P=0.006) and 6.727(P=0.030),respectively.Conclusions 91.67%of the allo-HSCT recipients with SNCT have MRI abnormalities.High blood CsA levels and the use of ATG Call elevate the risk of the occurrence of SNCT.