Objective To evaluate the changes of platelet activity before and after anti-platelet treatment in pa?tients with coronary heart disease, and their responsiveness to clopidogrel through detecting the phosphorylation levels of va?sodilator stimulated phosphoprotein (VASP). Methods Twenty-eight cases of healthy people were selected as control group . Patients with chronic stable angina pectoris (CSA, n=95) were randomly divided into A (48 cases) group and B (47 cases) group,and were given clopidogrel 75 mg/d or 150 mg/d respectively;Patients with non ST segment elevation acute coronary syndrome (NST-ACS, n=67) were all given 300 mg loading dose of clopidogrel at the first time, then randomly divid?ed into C (33 cases) group and D (34 cases) group, and given clopidogrel 75 mg/d and 150 mg/d respectively. Blood were tak?en to examine the phosphorylation levels of serum VASP by ELISA before taking clopidogrel, at time point of loading dose and the fifth day of clopidogrel administration . Results Before treatment, phosphorylation levels of serum VASP were low?er in A, B, C, D groups than those in the normal control group(P<0.05). After treatment of clopidogrel for 5 days: ① In group A and group B ,phosphorylation levels of serum VASP did not change compared to that before treatment (P>0.05).②In group C and group D, phosphorylation levels of serum VASP were significantly increased at loading dose and the fifth day of clopidogrel administration than those before treatment (P<0.05), but there were no significant differences in phosphory?lation level of VASP was lower group between group C and group D after serum treatment (P > 0.05). Conclusion The phosphorylation level of serum VASP was lower in patients with coronary heart disease than that in normal control group. Clopidogrel can improve the phosphorylation level of serum VASP in NST-ACS patients .

Objective To explore the dosimetry of simplified intensity modulated radiotherapy (sIMRT)in the spinal component of craniospinal irradiation(CSI)compared with conventional plan(3D-CRT).Methods Five previously treated patients were adopted to generate 3D-CRT,3-and 5-field slMRT plans.The prescribed dose was 36 Gy to the planning target volume(PTV)in 20 fractions.The dose distributions of target volume and normal tissues,and homogeneity index(HI)were ananlyzed using the dose volume histogram.The total monitor units(MUs)were also analyzed to compare the delivery time indirectly.Results For 3D-CRT plans,the region of the neighbouring fields only received 70％ of the prescribed dose,and the maximum dose delivered in the normal tissues was increased to approximately 140％ of the prescribed dose.The homogeneity index(HI)of 3-and 5-field sIMRT were 0.09 ± 0.01 and 0.08 ±0.01,respectively,superior to that of 3D-CRT(0.18 ± 0.02,t=7.80,7.65,P＜0.05).The values of V10 for the heart of 3-and 5-field sIMRT were(8.4 ± 1.9)％ and(8.4 ± 2.0)％,respectively,lower than that of 3D-CRT((36.0 ± 6.0)％(t=13.3,13.0,P＜0.05).V20 for the thyroid gland were (12.4±1.5)％ and(12.4±1.6)％,respectively,lower than(69.4±5.7)％ of 3D-CRT(t=26.3,26.4,P＜0.05).V20 for the larynx were(17.2 ± 1.2)％ and(17.9 ± 1.5)％,respectively,lower than that of 3D-CRT[(89.4±7.0)％(t=25.5,26.5,P＜0.05)].V30for the NTwas(4.4±1.4)％,(4.9± 1.9)％,lower than that of 3 D-CRT[(31.9 ± 6.1)％(t=8.5,10.1,P＜0.05)].The averaged values of total MUs for 3-and 5-field sIMRT were 1100 ± 177 and 1160 ±204,respectively,higher than that of 3D-CRT(640 ± 151).Conclusions Compared with the 3D-CRT CSI technique,3-and 5-field sIMRT have better dose distribution and can improve target dose uniformity and protect the organs at risk.

Objective To investigate the risk factors of posttraumatic hydrocephalus (PTH) in patients with moderate to severe traumatic brain injury (TBI).Methods Aretrospective study was conducted for 183 patients with moderate to severe TBI (125 males,58 females;6-91 years of age,mean 48.23 years).According the presence of PTH,the patients were allocated into PTH group (n =34) and non-PTH group (n =149).Risk factors of PTh were assessed by univariate and logistic regression analysis,including gender,age,injury types,injury severity,intraventricular hemorrhage,subarachnoid hemorrhage,midline shift,subdural effusion,therapeutic strategies and skull defect.Association between the boundaries of skull defect and PTH was determined.Results Between-group differences were not significant regarding age,gender,injury types and intraventricular hemorrhage (P ＞ 0.05),but differed significantly in injury severity,subarachnoid hemorrhage,midline shift,subdural effusion,craniectomy and skull defect (P ＜ 0.05).Further Logistic regression analysis confirmed subarachnoid hemorrhage (OR =6.169),interhemispheric subdural effusion (OR =31.743),and unilateral (OR =17.602) and bilateral (OR =30.567) skull defects were risk factors of PTH.Of the patients with unilateral skull defect following decompressive craniectomy,the inferior limit ≤ 10 mm from the zygomatic arch also played a role in the development of PTH (OR =5.500,P ＜ 0.05).Conclusions Subarachnoid hemorrhage,interhemispheric subdural effusion and skull defect are risk factors of PTH.Unilateral skull defects with the inferior limit too close to the zygomatic arch can predispose to the development of PTH.

ObjectiveTo evaluate the clinical efficacy of micro-invasive thread-embedding in treating allergic rhinitis.Method Sixty eligible patients were randomized into a control group and a thread-embedding group. Thecontrol group was intervened by Budesonide nasal spray, while the thread-embedding group was by micro-invasive thread-embedding in addition to the nasal spray. The therapeutic efficacy was evaluated after 2-month treatment.ResultThe symptom score and symptom-sign global score were decreased significantly in both groups after intervention (P<0.05), the improvement of stuffy nose and running nose and the global score of the thread-embedding group were significantly superior to that of the control group (P<0.05); the quality of life scores were markedly improved in both groups after intervention (P<0.05), and the improvement of non-nasal/eye symptoms, actual symptoms, and nasal symptoms, as well as the global score in the thread-embedding group were superior to that in the control group (P<0.05); the total effective rate was 96.7% in the thread-embedding group, significantly higher than 66.7% in the control group (P<0.01).ConclusionMicro-invasive thread-embedding can produce a content efficacy in treating allergic rhinitis, and can enhance the quality of life.

Objective:To analyze the clinical characteristics of patients with femoral neck fracture in Tianjin Hospital.Methods:Data of femoral neck fracture patients discharged from Tianjin Hospital from January 1, 2016 to December 31, 2017 were retrospectively analyzed. The gender, age, fracture type, injury mechanism and treatment method were collected.Results:Total of 2,150 eligible patients including 736 males and 1414 females were selected. There were significant differences in the gender distribution in different age groups ( χ2=91.63, P<0.001). Among young patients, males were more than females, while among middle-aged and elderly patients, females were more than males. The main type of fracture was displaced type (75.56%, 1,646/2,150), the displaced rate was the lowest in young patients (55.17%, 64/116), while it was the highest in old patients (81.91%, 1,159/1,415). The main injury mechanism of the three age groups were falls [young 61.21% (71/116), middle 80.29% (497/619), eldly 91.24% (1,291/1,415)]. There was a significant difference in the treatment methods between different age groups ( χ2=1,057.11, P<0.001). The main treatment method for young and middle-aged patients was internal fixation, no matter whether the fracture was displaced or not. The proportion of undisplaced patients with internal fixation (86.22%, 169/196) was higher than that of displaced patients with internal fixation (62.88%, 266/423) in middle-aged group ( χ2=34.93, P<0.001). In the elderly, more patients used internal fixation in undisplaced group, while more patients used hemiarthroplasty in displaced group. The age of old femoral neck fracture (median age was 74) was older than that of fresh fracture (median age was 70) ( Z=-2.777, P=0.005). And the displaced rate of patients with old femoral neck fracture (92.41%, 73/79) was higher than that of the fresh ones (75.95%, 1,573/2,071)( χ2=11.48, P=0.001). The patients with old femoral neck fracture usually adopt total hip replacement, while the proportion of three kinds of operation (internal fixation, hemiarthroplasty, total hip replacement) were similar among the fresh ones, and the internal fixation was the most. Conclusion:Femoral neck fracture is the most common in elderly women. The patients with displaced fracture are more than that with undisplaced fracture. Falling is the main injury mechanism in both young and old people. Internal fixation is commonly used in young and middle-aged patients, while arthroplasty is often used in elderly patients.

BACKGROUND:The need for bone graft and its substitutes has dramatically increased during the past decade. Either bio-derived graft materials or synthetic materials cannot satisfy this need. Study of composite bone graft has become a focused field.OBJECTIVE: To develop a novel porous poly (lactic-acid) (PLA)/bone matrix gelatin (BMG) bioactive composite material by means of supercritical carbon dioxide fluid technique (SC-CO2) and evaluate the bone forming potential in vitro.DESIGN: A comparative study and observation.SETTING: Research Center of Tissue Engineering, Southern Medical University; Institute of Biomaterials and Pharmaceutical Technique, China Institute for Radiation Protection.MATERTALS: Mouse osteoblast-like MC3T3-E1 cells were obtained from RIKEN Cell Bank in Japan. PLA was supplied by the Institute of Bio-technique of Jinan University. Alkaline phosphatase (ALP) kit was the product of Nanjing Jiancheng Bio-engineering Institute. MC3T3-E1 cells were cultured in Dulbecco's modified eagle medium (DMEM) (Gibco Laboratories, USA) supplemented with 10% fetal bovine serum (FBS, Si Ji Qing, China), 100 mg/L penicillin and 100 U/L streptomycin in a 37℃ humidified atmosphere. The cells were passaged with 0.25% trypsin (Gibco Laboratories, USA).METHODS: The experiment was carried out in the Research Center of Tissue Engineering, Southern Medical University from October 2005 to July 2006. The porous PLA/BMG composite biomaterials and PLA were prepared with SC-CO2 technique, and then macroscopic and microscopic observations were performed. The MC3T3-E1 cells were co-cultured with PLA and PLA/BMG in vitro, and DMEM was taken as the blank control group. Each well was pictured with digital camera.The percentage of the stained area, standing for the calcification deposition, was determined with an image processing and analysis software. The ALP activity and calcium content were determined with the method of ultrasonic cell lysis.MArN OUTCOME MEASURES: ① Macroscopic and microscopic observation of PLA/BMG; ③ Quantitative measurement of the calcification area; ② ALP activity and calcium content.RESULTS: ① Macroscopic and microscopic observation of PLA/BMG: The PLA/BMG showed good homological porosity with the size of 50-150 μm and connectivity: There were many holes with the size of 5-10 μm in the PLA/BMG walls. The PLA and BMG were mixed uniformly. ② Calcification areas: The percents of calcification area were significantly different among the PLA/BMG group, PLA group and blank control group [(42.98±4.44)%, (9.55±1.94)%, (0.86±0.41)%, P ＜ 0.01]. ③ Results of calcium content and ALP activity: The ALP activities were significantly different among the PLA/BMG group, PLA group and blank control group [(5 427.58±1173.57), (1 060.54±500.27),(40.01±24.50) nkat/g, P ＜ 0.05-0.01]; The calcium content in the PLA/BMG group was higher than those in the PLA group and blank control group [(3.51±1.64), (1.04±0.21), 0.70±0.24] mmol/g, P ＜ 0.01].CONCLUSTON: The PLA/BMG prepared by means of SC-CO2 has a good osteoinductive activity and it is worth studying further as bone biomaterial and bone tissue engineered scaffold.

Objective To determine the distribution and antibiotic resistance of hospital - associated pneu-monia(HAP) in senile patient,and the high risk factors of HAP,pathogenic bacterium and prognosis,so as to instruct the clinic prevention and treatment. Methods Patients with age over 60 years old,who were diagnosed of HAP with confirmed pathogens. Pathogens were identified, then the antibiotic resistance was determined by Kirty-Baucer disk dif-fusion assay. High risk factors of HAP, pathogenic bacterium and prognosis were analyzed by Logistic regression analy-sis. Results The first 10th pathogens of HAP patients were pseudomonas aeruginosa( 16.1% ),staphylococcus au-reus( 14.6% ) ,klebsiella pneumonia( 10.2% ), escherichia coil (8.8%) ,staphylococcus hemolyticus (7.3%). MR-SA accounted for 90% in staphylococcus aureus. The drug resistance of pseudomonas aeruginosa to imipenem was 29.5%. The high risk factors of HAP were acute brain accident, hypoalbuminemia, tracheal intubation or mechanical ventilation, rennal failure,COPD, gastric tube, anaemia,liver disfunction,long length of stay ( all P < 0.05 ). The mor-tality of senile HAP was 29.2%. Conclusion There are high antibiotic resistance and high mortality of HAP in se-nile patients. Measures should be taken to modify the risk factors.

OBJECTIVETo explore the relationship between the needling sensation of catgut embedding therapy and the depth of embedded catgut so as to improve the safety of the needle insertion and catgut implantation of the therapy.

METHODSTwenty healthy adults were selected. Under the ultrasound, the structure of the cervical Jiaji (EX-B 2) was observed. In the ultrasound guidance, the catgut was embedded. The two-dimensional imaging method was adopted to observe the anatomic structure and the procedure of needle insertion at the cervical Jiaji (EX-B 2). The high-frequency ultrasound was used to collect the images at Jiaji (EX-B 2) of C5 and determine the depths from the skin surface to the different layers of the point. Additionally, the visual analogue scale (VAS) was adopted to score the needling sensations when the needle inserted at different layers. The persistent sensation duration in the local area was followed continuously.

RESULTSUnder the ultrasound, the anatomic structure and tissue layers of cervical Jiaji (EX-B 2) were displayed clearly. The difference was significant in the average depth from the skin surface to the subcutaneous tissue, trapezius, splenius capitis, semispinalis capitis, semipinalis cervicis, multifidus and vertebral arch between the males and females (all P<0. 01). During the needle insertion, the sensations were apparently different when the implantation went to different layers. The qi arrival presented when the catgut was embedded to the trapezius, splenius capitis, semispinalis capitis, semipinalis cervicis and multifidus. But the distending pain was the most significant when in the myofascial. Commonly, the embedded catgut 2. 5 cm in length may be implanted deeply to the multifidus and the local needling sensation lasted averagely for (72. 0 ± 10. 2) h. Conclusion Under the ultrasound guidance, the depth of embedded catgut is clearly displayed at cervical Jiaji (EX-B 2). The needle insertion and the implanted material are visible, and the relationship between qi arrival and the layer of needle insertion is determined. The accuracy and safety of minimally invasive catgut embedding therapy is improved in the treatment of cervical spondylosis.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Catgut ; utilization ; Female ; Humans ; Male ; Middle Aged ; Neck Muscles ; anatomy & histology ; diagnostic imaging ; Qi ; Sensation ; Spondylosis ; diagnostic imaging ; therapy ; Ultrasonography

OBJECTIVETo explore the relationship between the therapeutic effect of minimally invasive embedding therapy and the implanted depth for cervical spondylosis.

METHODSNinety patients of cervical spondylosis of nerve root type were randomized into a shallow-layer embedding group (subcutaneous layer), a middle-layer embedding group (semispinalis capitis muscle layer) and a deep-layer embedding group (multifidus muscle layer), 30 cases in each one. Jiaji (EX-B 2) of C5 and C6 on the affected side and Dazhui (GV 14) were selected. Under the guide of ultrasound, the catgut was implanted to the corresponding tissue layers. The treatment was given once a week, continuously for 3 weeks in the three groups. The symptoms and physical signs were observed before and after treatment. The pain rating index (PRI), visual analogue scale (VAS) and present pain index (PPI) were assessed. The neck disability index (NDI) was compared.

RESULTSThe score of symptoms and function after treatment was increased apparently in the deep-layer embedding group (P < 0.05), which was increased more apparently as compared with those in the shallow-layer embedding group and the middle-layer embedding group (both P < 0.05). PRI, VAS and PPI after treatment were all reduced apparently as compared with those before treatment in the deep-layer embedding group and the middle-layer embedding group (all P < 0.05), which were reduced more remarkably than the shallow-layer embedding group (all P < 0.05). After treatment, the scores of NDI in the deep-layer embedding group and the middle-layer embedding group, were reduced apparently as compared with those before treatment (both P < 0.05), and that in the deep-layer embedding group was reduced more remarkably as compared with the shallow-layer embedding group and the middle-layer embedding group after treatment (both P < 0.05).

CONCLUSIONIn the acupoint embedding treatment of cervical spondylosis of nerve root type, the efficacy is different apparently in terms of the implantation depth. The deep-layer implantation, meaning to the multifidus muscle layer is more conductive to the treatment of cervical spondylosis.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Catgut ; Female ; Humans ; Male ; Middle Aged ; Pain Measurement ; Spondylosis ; diagnostic imaging ; therapy ; Treatment Outcome ; Ultrasonography

Objective To explore the risk factors affecting T-tube sinus tract formation after common bile duct exploration and T-tube drainage by spiral computed tomography (SCT)examination.Methods The clinical data of 465 patients undergoing common bile duct exploration and T-tube drainage at the Affiliated Hospital of Youjiang Medical College for Nationalities from May 2011 to December 2013 were retrospectively analyzed.The residual stones and biliary stricture were detected by T-tube cholangiography,and the T-tube sinus tract formation in all the patients was detected by SCT examination at postoperative week 2.The factors affecting sinus tract formation were analyzed,including gender,age,albumin (Alb),C-reactive protein,alanine transaminase (ALT),total bilirubin (TBil),hemoglobin (Hb),surgical method,effusion around T tube,reoperation,diabetes.Univariate analysis was done using the chi-square test.Multivariate analysis was done using the Logistic regression.Results T-tubes of 465 patients were clear without residual stones.T-tube in the 397 patients was removed when the sinus tract formation was confirmed by CT examination at postoperative week 2.T-tubes in other patients were removed when the sinus tract formation was detected by CT reexamination at postoperative week 4.In univariate analysis,Alb,surgery method,effusion around T-tube and diabetes were important factors affecting T-tube sinus tract formation (x2 =50.750,7.671,19.022,15.373,P ＜ 0.05).Alb ＜ 30 g/L,laparoscopic surgery,effusion around T-tube and diabetes were independent risk factors affecting T-tube sinus tract formation in multivariate analysis [Odds ratio =1.135,0.493,0.262,0.363; 95％ confidence interval:1.061-1.214,0.280-0.865,0.104-0.658,0.156-0.843,P ＜ 0.05].Conclusions The T-tube removal is determined according to the sinus tract formation by CT examination at week 2 after common bile duct exploration and T-tube drainage.Alb ＜ 30 g/L,laparoscopic surgery,effusion around T-tube and diabetes are independent risk factors affecting T-tube sinus tract formation.