Objective To assess the clinical efficacy of modified split patella in the treatment of patellar fracture.Methods 56 patients with patellar fracture were selected,and they were divided into two groups according to the random number method.The regular group was treated with common split patella,while the improved group was treated with modified split patella.In both two groups,the aspects of split patella slip,model large and knee pain were recorded.Results The incidence rates of model large and knee pain in the improved group were 3.57%,7.14%, which were 25.00%,32.14%in the regular group,the differences were statistically significant(χ2 =5.250,5.543,P=0.022,0.019).The incidence rate of split patella slip in the regular group was 3.57%,that was 0.00% in the improved group,the difference was statistically significant(χ2 =1.018,P=0.313).Conclusion Modified split patella mini-mizes the incidence of split patella model large and patellofemoral osteoarthritis.Thus,it deserves further application.

Objective To study the technique of placemen t of Nitinol stent for relieving malignant pylorus or duodenal obstruction, and to assess its clinical effectiveness.Methods In this group the strictures were caused by gastric car cinoma at the antrum (n=2), anastomosis site of previous gastrojejunostomy (n=2 ), gastric carcinoma at the cardia (n=4), colon cancer (n=1), pancreatic cancer (n=3) and duodenal cancer (n=4). Under fluoroscopic guidance the Nitinol stent w as inserted into pylorus or duodenal obstruction sites via oral cavity in all ca ses. Complications and clinical status were investigated during the study period .Results Successful stent placement was achieved in 15 cases. Tw o patients had undergone double stent placement (pylorus stent and bile duct ste nt). The rate of improvement in abdominal distention and vomiting 1 week after p rocedure was 73 3% and 86 7% respectively. Procedure-related complications ne ver occurred.Conclusion Nitinol alloy network stent is a safe and efficaciou s method for palliating malignant pylorus or duodenal obstruction, and improves patient's living quality.

Objective To evaluate the short-term effects and complications of transoral endoscopic suturing in the treatment of gastroesophageal reflux diseases (GERD). Methods Sixteen patients with GERD, confirmed by gastroscopy, upper gastrointestinal barium meal examination, and esophageal pH value examination, received gastroesophageal suturing by using an endoscopic suturing device (manufactured by Bard Co.). The site of suturing was 1cm below the dentation line, with a suture interval of 1.5cm and a knot interval of 2.0cm. Symptom severity scoring, esophageal 24-hour pH monitoring and the degree of esophagitis before and 1 month after the operation were compared respectively. Results A total of 42 sutures and 21 knots were made in the 16 cases. The mean operation time was 30 min. The sum of heartburn scores and regurgitation scores before the treatment were 39 (mean, 2.44) and 32 (mean, 2.0), and those after the treatment were 11 (mean, 0.68) and 10 (mean, 0.63), respectively, with statistical significances between preoperation and postoperation ( ? 2 =19.5 and 16.33; P

Objective To explore the efficacy of endoscopic therapy for common bile duct stones in the elderly. Methods From July 2003 to June 2006,421 elderly patients with common bile duct stones were treated in the Danyang People's Hospital(112 cases) and the Second Affiliated Hospital of Nanjing Medical University(309 cases).The clinical data of the patients were retrospectively analyzed Results ERCP was completed in all the 421 patients,of which 27 was converted to a pre-cut sphincterotomy because of difficulties in the deep cannulation of the bile duct.The diagnosis of common duct stones was confirmed during the operation in all the cases,and 46 of them were found complicated with cholecystolithiasis.Of the patients,266 patients had one stone,107 had two,and 48 had three or more.The calculi were removed using basket directly in 283 patients,balloon catheter in 122,lithotrity in 10,and plastic stent placement without calculus removal in 6.The stones were removed completed at the first operation in 392 cases,and the other 23 cases received a second operation after endoscopic nasobiliary drainage.Errhysis occurred in 20 patients during the pre-cut sphincterotomy,and was healed by locally sprinkling or injecting noradrenaline(1:10 000),or electric coagulation.Six patients had hemorrhage from the incision on the duodenal papilla 48 hours after the operation,and were cured by using submucous injection of noradrenaline(1:10 000,4 cases) or titanium clipper(2 cases).34 patients had a transient increase of serum amylase without abdominal pain;10 patients developed mild pancreatitis and then was cured by fasting,inhibiting pancreatic secretion and pancreatic enzyme activities,anti-inflammation therapy,and rehydration;4 patients developed cholangitis,and was cured by anti-inflammation therapy.All the patients were discharged without complications.342 of the patients were followed up for 6-12 months,4(1.2%) of them had recurrence of stones and was treated with endoscopy,3(0.9%) had cholangitis and received anti-inflammation therapy.In the 6 patients with plastic stent,the stones were dissolved in 2 of them in half a year.Conclusions Endoscopic therapy is safe and efficient for common bile duct stones in the elderly and is associated with a low rate of complications.

Objective To investigate the effect of chronic intermittent hypoxia on blood pressure,sympathetic nerve activity and myocardial mitochondrial oxidative stress status in aged rats.Methods Chronic intermittent hypoxia(CIH)rat models were established.A total of 84 male Wistar rats(3-4 and 23-24 months old,respectively)were randomly and equally divided into four groups according to age:young control group,young CIH group,aged control group and aged CIH group.CIH exposure lasted for 3 weeks.The arterial blood pressure,the frequency of carotid sinus nerve action potential,the lung function,the levels of catecholamine,aconitase/fumarate ratio (A/F),plasma superoxide dismutase(SOD)in the plasma were measured and compared between four groups.Results The arterial blood pressure was significantly higher in young CIH group than in the young control group[(150.4 ±25.6)mmHg vs.(102.2±7.4)mmHg,P＜0.01].There was no significant difference in the arterial blood pressure between the aged CIH group[(132.8 ±16.2) mmHg] and the aged control group[(127.1 ± 26.8)mmHg].The minute volume ventilation was significantly lower in the aged control group than in young controlgroup[(331.7±53.5)ml· min-1 · kg-1vs.(554.8±111.9)ml· min-1 · kg-1P＜0.05].The min-1 · kg-1 ventilation showed no significant difference between the agedCIH group[(354.1±51.9)ml· min-1 · kg-1]and the aged control group[(331.7 ±53.5)ml· min-1 · kg-1].The rate of CSN frequency change by hypoxia stimulation was lower in the aged control group than in young control group[(6.2± 5.5)times vs.(11.8 ±6.6)times,P＜0.01],and was lower in the aged CIH group than in the young CIH group[(22.2 ± 13.5) times vs.(44.2± 12.1) times,P＜0.01].The levels of plasma norepinephrine and epinephrine were higher in the young CIH group than in the control group[(39.0±8.9)nmol/L vs.(20.8±10.6)nmol/L,(48.1±13.6)nmol/L vs.(26.7 ± 14.3)nmol/L,both P＜0.05].The levels of plasma norepinephrine and epinephrine showed no significant difference between the aged control group and the young control group,also no significant difference was found between the aged CIH group and the aged control group.The A/F ratio was lower in the young CIH group than in the young control group[(0.26±0.13)vs.(0.58 ±0.04),P＜0.01].The A/F ratio was lower in the aged control group than in the young control group [(0.29±0.02)vs.(0.58± 0.04),P＜0.01],but there was no significant difference in the A/F ratio between the aged CIH group and the aged control group.The level of SOD was significantly lower in the young CIH group than in the young control group [(5.30 ±± 0.90) NU/mgprot vs.(6.10 ± 1.73)NU/mgprot,P＜0.05].There was no significant difference in SOD level between aged control group and aged CIH group.Conclusions The effect of CIH on blood pressure in aged rats is different from the youth rats.This study shows adecreasedsympathetic nervous over activity and a reducedmitochondrial oxidative stress in aged rats.Aging probably suppresses two important pathogenic mechanisms,by which CIH affects blood pressure,therefore releases CIH induced blood pressure abnormality.

Objective To explore differences of drug resistance of temozolomide(TMZ) on different CD133 immune prototype of glioma cells and study on the changes of their sensitivity to TMZ through increased PUMA. Methods CD133+-U87MG cells sorted by CD133 magnetic beads were cultured in serum-free stem cell medium respectively. The cells were infected with recombinant adenovirus, Ad-PUMA, diluted in cell culture medium with or without TMZ intervention.The inhibitory rate of cell proliferation was detected by MTT assay and 50 ％ inhibition concentration of TMZ was calculated. Apoptosis rates of CD133+-U87MG cells were assessed by flow cytometry (FCM) before and after intervention of exogenous PUMA and TMZ.Results The TMZ IC50 values of CD133+glioma cells were higher than that of CD133- glioma cells. There were significant differences in apoptosis rate between CD133+ glioma cell and CD133- glioma cell (all P＜0.05).Conclusion AdPUMA joint TMZ can promote glioma stem cells apoptosis, thus improve the sensitivity to chemotherapy of glioma.

Objective ToexploretheprognosticvalueoftroponinT(cTnT)concentrationinpatientswithacuterespiratorydis-tress syndrome(ARDS) .Methods 82 patients from January 2008 to June 2011 were enrolled ,and admission blood samples were obtained for cTnT measurement .A variety of clinical and laboratory variables were recorded .With 28 days as end point ,the cTnT concentration ,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ ) score ,and Murray lung injury score(LIS) were compared respectively between survivors and non-survivors .The association between the concentration of cTnT and 28-day mortali-ty was assessed .Results 43 patients died during the 28-day observation period among 82 patients .cTnT concentration among non-survivors were significantly higher than those of survivors ,(0 .048 ± 0 .03)ng/mL vs .(0 .027 ± 0 .014)ng/mL(P<0 .01) .The con-centration of cTnT showed positive correlation with APACHE Ⅱ score and LIS(r1 =0 .509 ,r2 =0 .314 ,both P<0 .01) .cTnT con-centration had an area under the receiver operating characteristic (ROC) curve(AUC) of 0 .734 for predicting 28-day mortality ,with 95% confidence interval(95% CI) 0 .627 -0 .841 ;the optimal cTnT cut point for predicting 28-day mortality was 0 .034 ng/mL . cTnT concentration higher than 0 .034 ng/mL ,APACHE Ⅱ score higher than 17 .5 and LIS higher than 1 .65 were the independent risk factor of 28-day mortality .Conclusion cTnT concentration is an independent predictor of 28-day mortality in patients with ARDS .cTnT concentration shows a high predictive value in patients with ARDS ,similar to APACHE Ⅱ score and LIS .

Objective To observe the influence of p53-upregulated modulator of apoptosis (PUMA) on the growth of human brain glioma cell lines U251 (p53 mutant) and SHG-44 (p53 wild type),and to explore its possible mechanism.Methods Construct the adenovirus PUMA (Ad-PUMA) and vector of adenovirus (AdDsRed) which were respectively transfected into glioma cell lines U251 and SHG-44.Cells proliferation rates were measured with cell counting kit-8 (CCK-8).The apoptotic ratios were detected by flow cytometry.The expression of PUMA and apoptosis associated proteins (bcl-2,Bax) were determined with Western blot analysis.Caspase-3,Caspase-8,Caspase-9 activity were measured by Caspase activity assay kit.Results Compared with vector group and blank control group,Ad-PUMA transfected group showed strong cell proliferating inhibition effects [the inhibition rates were (50.89±4.73) ％ and (44.45±5.33) ％ respectively,P ＜0.05] and pro-apoptotic effects [apoptotic rates were (44.89±5.08) ％ and (31.67±7.32) ％,P ＜ 0.05] in different p53 glioma cell lines U251 and SHG-44.Western blot analysis showed that PUMA protein expression increased after Ad-PUMA transfection,accompanied by the reduced expression of the anti-apoptotic protein bcl-2 and the increased expression of pro-apoptotic protein Bax.The activity of Caspase testing results showed that the Caspase-3,Caspase-9 activity increased significantly,while the Caspase-8 activity changed little.Conclusion No matter how p53 phenotype,PUMA can inhibit glioma proliferation,promote apoptosis,and its mechanism may be through the mitochondrial apoptotic pathways,upregulation of Bax and inhibition of bcl-2 expression,which activated Caspase-9.Ad-PUMA is expected to become a new target for gene therapy of gliomas.

Objective To explore the related risk factors for diabetic nephropathy(DN) and discuss the value of diabetic dermopathy (DD) screening for DN.Methods A total of 188 patients with type 2 diabetes mellitus (T2DM) were studied,which included 78 patients with DN (DN group) and 110 cases without DN (non-DN group).The sex,age,duration of diabetes mellitus,smoking,DD,body mass index (BMI),systolic blood pressure (SBP),diastolic blood pressure (DBP),fasting blood glucose (FBG),2hours postpradial glucose(2 h PG),triglyceride (TG),total cholesterol (TC),glycosylated hemoglobin A1c (HbA1c),fasting C-peptide(FC-P) were recorded.Multiple factor Logistic regression was applied in patients with DN and non-DN.Results The incidence of DD and DN in T2DM patients was 47.34％(89/188) and 41.49％ (78/188) respectively.The ratio of DD in DN group was 79.49％(62/78),in non-DN group was 24.55％ (27/110),and the difference was significant (P ＜ 0.05).The age,duration of diabetes mellitus,SBP,FBG,2 h PG,HbA1c in DN group was higher than that in non-DN group [(52.83 ± 6.43) years old vs.(50.35 ±6.48) years old,(10.51 ±4.36) years vs.(6.48 ±3.25) years,(137.42 ± 14.17) mmHg(1mmHg =0.133 kPa) vs.(132.57 ± 15.38) mmHg,(11.95 ±2.83) mmol/L vs.(10.28 ± 1.98) mmol/L,(15.07 ± 3.16) mmol/L vs.(13.51 ± 2.75) mmol/L,(9.62±2.17)％ vs.(8.63 ± 2.08) ％],FC-P was lower than that in non-DN group [(1.76 ± 0.89) μ g/L vs.(2.01 ± 0.72) μ g/L],and the difference was significant (P ＜ 0.05).Multiple factor Logistic regression analysis showed that duration of diabetes mellitus,DD and FPG were still related to DN in T2DM (OR =4.841,3.209,3.368,P ＜0.01).Conclusions DD is correlated with DN in T2DM.DN should be screened in T2DM patients with DD.

Colonoscopy has been accepted as the standard method for evaluation of colon and rectum,its success rate depends on the quality of bowel preparation. Aims:To evaluate the cleanliness and tolerance of fractionated dose versus single dose polyethylene glycol electrolyte solution( PEG-ES) bowel preparation regimens for colonoscopy. Methods:A total of 427 consecutive asymptomatic individuals undergoing colorectal cancer screening were enrolled and randomly assigned into 2 groups. Subjects in group A drank 1. 5 L PEG-ES on the eve and 4 hours before colonoscopy, respectively;subjects in group B received a single dose of 3 L PEG-ES 5 hours before colonoscopy. Score and degree of Boston bowel preparation scale(BBPS)and PEG-ES related adverse effects of the two groups were assessed and compared. Results:There were no significant differences in gender,age and cecal insertion rate between group A and group B(P ﹥ 0. 05). Score of BBPS was significantly higher in group A than in group B(P ﹤0. 01). Both regimens met the requirement of conventional colonoscopy,however,the cleanliness of colon was graded as excellent in more subjects of group A( P ﹤ 0. 01),and less subjects of group A complained PEG-ES related nausea(P ﹤0. 05). Logistic regression analysis revealed that the PEG-ES drinking pattern was associated with cleanliness of colon and occurrence of nausea( P ﹤ 0. 05). Conclusions:Fractionated dose PEG-ES regimen provides a better colonic cleansing quality and tolerance for bowel preparation of colonoscopy,which is superior to that of single dose regimen.