Objective To grasp the basic situation concerning visits by emergency outpatients to big urban hospitals before the implementation of reform in the medical insurance system in our city. Methods An investigation was made by means of profile survey questionnaires into the form of medical security of emergency outpatients, the sources of patients, referrals of patients, and the evaluation of doctors. Results Current emergency outpatient services in big urban hospitals have the following features: fairly great medical demands and attraction, widespread sources of patients, and pretty strong advantages in comprehensive clinical treatment. At the same time, before the implementation of reform in the basic medical insurance system, existing medical security setups, which are in the stage of transition, are characterized by a variety of types, a pretty narrow coverage in the provision of medical security and a rather high proportion of self-paying patients. Conclusion It is imperative to actively promote reform of the medical insurance system, formulate regional health plans that conform to the situation in our country, and expand the functions of community medical healthcare.

Objective To investigate the application of stroke volume variation (SVV) in directing management of elderly septic shock patients. Methods Patients who were diagnosed with elderly septic shock and supported with mechanical ventilation were in?cluded (n=28). They were divided into control group (n=13) and SVV group (n=15). Volume recovery was directed by CVP (central ve?nous pressure ) in control group and by SVV and CO (cardiac output) in SVV guoup respectively. Blood lactate, oxidation index, CVP , MVP, NT-proBNP, time of recovery, the length relying on mechanical ventilation and Vigileo parameters were compared after volume resuscition. During the period of treatment, the incidence of acute left ventricle dysfunction within 24 hours, MODS within 28 days and mortality rates of all causes were compared between these two groups. Changes in SVV, cardiac output (CO) and systemic vascular re?sistance (SVR) in SVV group before and after resustation were recorded. Results Blood lactate acid and NT-proBNP were significant?ly lower in SVV group compared with those in control group whereas oxidation index in SVV group were significantly higher than that of control group. The time of resuscitation and the duration relying on mechanical ventilation were shorter in SVV group than those in control group. On the contrary, the incidence of acute left ventricle dysfunction,MODS and all mortality rates were not significantly different between these two groups. There were significant differences between hemodynamic variables such as SVV, CO in SVV group before and after resuscitation. Conclusion SVV may direct volume resuscitation more effective in elderly septic shock than CVP does.

ObjectiveTo study the change of cholinergic neurons of hippocampus of vascular dementia rats after transplantation of the neural stem cells(NSCs) in hippocampus.MethodsAfter the vascular dementia model was reproduced,the rats were randomly divided into transplantation,dementia and pseudo-operative groups.8 weeks after operation,immunofluorescence was used to observe the survivors and migration of neural stem cells.Immunochemistry staining was used to observe the number of ChAT positive neurons in hippocampus.ResultsThe number of the ChAT positive neurons in the CA1 subfield of the hippocampus were more significantly increased in transplantation group than that in dementia group. ConclusionChAT positive neurons can be found in hippocampus area of vascular dementia rats after transplanting NSCs into the hippocampus, which seem to be cholinergic neurons.

OBJECTIVETo study the applied value of double joystick technique in reduction-internal fixation for femoral shaft fracture in adults.

METHODSThirty-four patients (24 males and 10 females) with femoral shaft fractures were treated with reduction assisted by double joystick technique and internal fixation with interlocking intramedullary nail from September 2010 to June 2013. The average age of the patients was 41 years old, ranged from 17 to 65 years old. The duration of the disease course ranged from 3 to 7 days, with a mean of 5 days. The fractures belonged to AO types 32A (5 cases), 32B (20 cases) and 32C (9 cases) and located in left femur for 18 patients and right femur for 16 patients. The patients were followed up, and fracture healing and complications were observed. The curative effect were evaluated according to Thorsen femur fracture evaluation standard.

RESULTSThe operative time ranged from 40 to 110 min (mean 75 min) and intraoperative blood loss ranged from 200 to 300 ml (mean 250 ml). All the patients obtained a good fracture reduction and were followed up for 12 to 24 months (mean 18 months) after the surgery. All the fractures united between 4 and 8 months with a mean of 5 months. No complications such as breakage of nail, infection, osteofascial compartment syndrome, refracture and fracture malunion were found. According to Thorsen femur fracture evaluation standard, 30 patients obtained an excellent result, 3 good and 1 fair.

CONCLUSIONIn surgery of reduction-internal fixation for femoral shaft fracture in adults, the use of double joystick technique obtains good reduction result, short operative time, less injury, high healing rate of bone fractures, less complications and good limbs function, so it is worthy of popularizing in clinic.

Adolescent ; Adult ; Aged ; Bone Nails ; Female ; Femoral Fractures ; physiopathology ; surgery ; Fracture Fixation, Intramedullary ; instrumentation ; methods ; Fracture Healing ; Humans ; Male ; Middle Aged ; Young Adult

Objective To investigate the effects of different afferent nerve injury on development of neuropathic pain and its relationship with brain-derived neurotrophic factor (BDNF) in spinal cord and dorsal root ganglion (DRG) in rats. Methods Twenty-four male SD rats aged 2 months weighing 200-250 g were randomly divided into 3 groups:group Ⅰ sham operation (group S); group Ⅱ sural nerve injury (group SUR) and group Ⅲ gastrocnemius-soleus nerve injury (group GS). Sural nerve and gastrocnemius-soleus nerve were transected in group SUR and GS respectively. Paw withdrawal threshold to von Frey filament stimulation was measured the day before and at day 3 and 7 after operation. The animals were killed at postoperative day 7 after the measurement of paw withdrawal threshold. The ipsllateral L5 DRG and L5 segment of the spinal cord were removed. BDNF expression in the spinal dorsal horn was determined. The percentage of BDNF positive neurons and ATF-3 positive neurons in the total DRG neurons and the percentage of BDNF positive neurons in the damaged neurons (ATF-3 positive) were calculated. Results Mechanical hyperalgesia developed after transection of gastrocnemius-soleus muscle in group GS. Mechanical pain threshold was sinificantly lower, while BDNF expression in the spinal dorsal horn and the percentage of BDNF positive neurons in total DRG neurons were significantly higher in group GS than in group S and SUR (P ＜ 0.01). There was no significant difference in all variables between group SUR and S (P＞0.05). There was no significant difference in the percentage of ATF-3 positive neurons in the total DRG neurons between group GS and SUR (P ＞ 0.05), but the percentage of BDNF positive neurons in the damaged neurons (ATF-3 positive) was significantly higher in group GS than in group SUR (P ＜ 0.05). Conclusion Transection of the afferent nerve innervating muscle can produce neuropathic pain through up-regulation of BDNF expression in spinal dorsal horn and DRG in rats, while transection of the afferent nerve innervating skin can not.

Objective To evaluate mini-percutaneous nephrolithotomy in treating superior segmental ureteral calculi. Methods Two Hundred and thirty-six patients underwent mini-percutaneous nephrolithotomy with holmium laser for superior segmental ureteral calculi from May 2005 to May 2008, 133 male and 103 female. Their age ranged from 17 to 76 years old with a mean of 47. 2 years. Of the 236 patients,141 compli-cated with calculi in the left side and 88 cases in the right side,7 in the both sides. The calculi diameter ranged from 0. 7 cm to 2.2 cm and the mean diameter was 1.4 cm. One hundred and ninety-three patients had undergone ESWL from 1～6 times. Results Of the 236 patients,217 were rendered stone-free at 1 pro-cedure. Residual calculi were found in 12 cases after operation and drugs were used for treatment. The resid-ual calculi were removed after 1 month. Seven cases with residual calculi were treated by ESWL and the cal-culi were removed. The total stone clearance was 91.9%. The mean operation time was 31.3 min(rang from 19～52 min), and the mean hospital stay was 9.5 days(rang from 6 to 12 days). The main complications following operation included: durative hematuria in 25 cases relieved by haemostasis and diuresis treatment within 24 to 48 hours,pnstoperative fever in 141 cases within 24 hours of which 103 were relieved by antiin-flammatory and fluid replacement treatment within 24 to 48 hours. Thirty-eight cases were relieved by anti-inflammatory treatwent depending on urine culture results within 3 to 7 days. The postoperative pain in all patients was light. Conclusion Minimally invasive percutaneous nephrolithotomy with holmium laser under ultrasound guidance is simple,safe and effective in treating proximal ureteral calculi.

AIM:To investigate the roles of ClC-3 chloride channels in the regulation of cell cycle and the re-lationship between ClC-3 chloride channels and the cell cycle regulators , such as cyclin D1, cyclin-dependent kinase (CDK)4, CDK6, P21 and P27 in the HeLa cells.METHODS:ClC-3 genes were silenced by the siRNA technique in the HeLa cells.The transfection efficiency of ClC-3 siRNA was detected by real-time PCR.The cell cycle distribution was ana-lyzed by the flow cytometry .The protein expression of ClC-3, P21, P27, CDK4, CDK6 and cyclin D1 was determined by Western blot .RESULTS:ClC-3 was knocked down by ClC-3 siRNA in the HeLa cells .Transfection of the cells with ClC-3 siRNA arrested the cells at G0/G1 phases, decreased the expression of cyclin D1, CDK4 and CDK6, and increased the expression of P21 and P27.CONCLUSION:ClC-3 plays an important role in the cell cycle of HeLa cells through the G 1-S transition point.ClC-3 may regulate the cell cycle progression by up-regulation of cyclin D1, CDK4 and CDK6 expression and/or by down-regulation of P21 and P27 expression.

Objective To study the safety and feasibility of tubeless percutaneous nephrostolithotomy by hemostasis gel closure of mini-percutaneous renal-channel.Methods Eighty patients after conventional percutaneous nephrostolithotomy are selected and divided into two groups according to the principle of randomization.Control group adopts conventional percutaneous nephrostolithotomy calculi lithotripsy with renal pelvis drainage tube placement whereas the experimental group adopts tubeless percutaneous nephrostolithotomy by hemostasis gel closure of mini-percutaneous renal channel.Both experimental group and control group will be scientifically and statistically analyzed via the incidence and the dose of using sedative for alleviating pain after operation,hospital stay,level of hemoglobin,and the occurrence of complications such as continuate hemorrhage,infection,urinary extravasation,etc.Results The operation of both groups are successful in phrase Ⅰ.The incidence and the dose of using sedative in control group are obviously higher than that in experimental group(45％ vs 20％).However,the incidence of postoperative complications like infection and hemorrhage and hospital stay between two groups are undifferentiated in statistics(P ＞ 0.05).Neither the experimental group nor the control group has perinephric hematoma,and seven cases of control group have urinary leakage after remove of fistula.Conclusion Tubeless percutaneous nephrostolithotomy by hemostasis gel closure of mini-percutaneous renal-channel is safe and feasible and it can reduce the incidence of postoperative pain and avoid urinary leakage.

Objective To compare proximal femoral nail(PFN)introduction by percutaneous K-wire through a small incision with conventional PFN introduction protocol in the treatment of intertrochanteric fractures. Methods From January 2004 to March 2005,51 patients with intertrochanteric fractures were randomly dis- tributed into a minimally invasive treatment group(group MI)and a conventional treatment group(group C).All the fractures were closely reduced.In group MI a K-wire was percutaneously inserted through the tip of the greater troehanter into the center of medullary canal of the pruximal femur before the PFN was inserted under the guidance of K-wire through a small incision made along the K-wire while in group C the PFN was introduced according to the conventional procedure.The operation time,intra-operative blood loss,length of incision,X-ray exposure,duration of in-patient stay and time of bone union in both groups were recorded and compared.Results The mean oper- ation time,mean intraoperative blood loss and mean length of incisions in group MI were 77.20 min,104.20 mL and 5.12 cm respectively and significantly lower than those in group C(P＜0.01).The X-ray exposure and the reduction time in group MI lasted longer than in group C(P＜0.01).The mean time of bone union and in-patient stay in both groups were nearly equal(P＞0.05).At the latest tollow-up,all the fractures united in both groups without nonuuion or delayed union.Conclusion Compared with the conventional protocol,introduction of PFN by a pereutaneuus K-wire inserted into the central medullary canal of the proximal femur is much more minimally in- vasive and effective.

Isolation of high-quality genomic DNA from dried and processed crude drug is the key for the DNA identification of Dendrobii Caulis. The DNA extract of Dendrobii Caulis was firstly compared using different method to isolate genomic DNA from dried and processed crude drug, including commercial DNA extracted kit and CTAB method. Using modified CTAB method (extracted from large samples), the genomic DNA was successfully isolated from Dendrobii Caulis, including Huangcao and Fengdou. The ITS regions were amplified using the purified DNA as template, and then cloned and sequenced. These ITS sequences were compared with data from Genbank database and our lab, 14 Dendrobium species and five similar species were identified from "Huangcao" and "Huangcao" slice, while six species and three similar species from "Fengdou" according to their sequence similarity. The study demonstrated that the dried Dendrobii Caulis could be identified using DNA molecular method, which could overcome deficiencies and limitations of traditional identification method and has a certain application prospects.
DNA, Intergenic ; genetics ; DNA, Plant ; genetics ; Dendrobium ; classification ; genetics ; Sequence Analysis, DNA