Fracture healing is regulated by a complex array of factors,of which calcitonin gene-related peptide(CGRP) has been shown to play an anabolic role in bone metabolism.It has been reported that CGRP-containing sensory nerve fibers increased apparently at bone fracture site.CGRP is an important sensory neuropeptides expressed in bone tissue,although the primary function of this neuropeptides is to induce vasodilatation and blood flow,substantial evidence has shown that targeted expression of CGRP to mouse osteoblasts increased bone density,stimulated cancellous bone formation in vivo,especially the presence of CGRP receptors on rat osteoblast provides further evidence for a direct role for CGRP in modulating the function and growth of bone.CGRP is also proved to be a neuropeptide with proinflammatory activities,it may play a direct role in initiating the local inflammatory cell infiltration in the fracture site.Although it has been recognized that CGRP plays an important role in bone repair and reconstruction,the mechanism of this activation still remains to be elucidated.

Asthma ; diagnosis ; Child ; Humans ; Perception

Sixty patients underwent surgery for malignant thoracic tumor were evenly randomized into control group (group A) and treatment group (group B).0.3 ml low-molecular-weight heparin was injected per 12 h for 3 d in group B from 24 h after surgery.Bilateral venous sonography of lower extremities were performed before and d1,d3 after operation.Blood coagulation marks PLT,PT,APTT,Fibrinogen (FIB)and D-dimer were determined at the same time.Diagnosis of calf vein thrombosis after surgery was confirmed by color Doppler sonography in 7 patients:1 in group B (3％) and 6 in group A (20％) (P ＜ 0.05 ).Thrombosis at calf intermuscular vein was found in 6 patients and thrombosis at posterior tibial vein in 1 patient.FIB and D-dimer had no significant difference on the dl ( P ＞ 0.05 ) between two groups,but significantly lower on the d3 after surgery in group B than that in group A ( P ＜ 0.05 ).Low-molecularweight heparin reduced blood hypercoagulation state and thrombosis.Color Doppler sonography can be a valuable method for detecting asymptomatic deep vein thrombosis in the early stage after surgery and monitoring the efficacy of thrombosis prevention.

Objective To investigate the effect of calcitonin gene-related peptide(CGRP) on early-stage bone fracture healing and on the expression of bone morphogenetic protein-2(BMP-2) in bone tissue of rats.Methods Totally 30 SD rats with tibial fracture were randomly and equally divided into 3 group and received normal saline(control group),CGRP or CGRP receptor antagonist injection intraperitoneally.In 1,2 and 4 weeks later,the fracture sites from the 3 groups were subjected to X-ray scanning,callus measurement and HE staining.The expression of the BMP-2 was detected by immunohistochemical method.Results There was no obvious difference on callus amounts among the 3 groups,but at 2 weeks after treatment,there were significantly more callus in CGRP group with enlargement in the fracture site than in the other 2 groups;The enlargement of CGRP group became minimized with fused cortex and almost normal morphology and size.So were the other 2 groups.Immunohistochemical results showed that exogenous CGRP significantly increased BMP-2 expression,but the expression was decreased significantly after administration of CGRP receptor antagonist.Conclusion Our results suggest that CGRP may participate in the regulation of bone fracture healing,and induce BMP-2 production,implying that BMP-2 may be related functionally with CGRP in the mechanism of bone metabolism.

Objective To investigate the clinical features of neonatal invasive fungal infection(IFI) so as to guide diagnosis,prevention and treatment of IFI.Methods Seventy-six neonates with IFI admitted to the Neonatal Intensive Care Unit (NICU) at Children's Hospital of Fudan University from 2004 to 2014 were included in the study.Pathogens,clinical manifestation,risk factor exposure,laboratory findings,complications,and clinical outcome of neonatal IFI were analyzed.Results Seventy-six cases were diagnosed as IFI between 2004 and 2014,with an yearly increasing trend.Sixty-eight patients were premature infants (89.5％).Of the 76 cases,except one with unknown birth weight,11(14.7％),34(45.3％),20(26.7％)and 10 (13.3％) cases had birth weight ＜ 1 000 g,(≥ 1 000-＜1 500) g,(≥ 1 500-＜2 500) g and ≥ 2 500 g,respectively.The pathogens were mainly Candida (74/76,97.4％),including 26 cases of Candida albicans (34.2％).However,the incidence of non-Candida albicans infection was increasing.Candida guilliermondii was the most common in nonCandida albicans,accounting for 29.2％ (14/48).All Candida albicans were sensitive to fluconazole.One strain of Candida glabrata was resistant to fluconazole.The most common risk factors included use of broad-spectrum antibiotics(93.3％,56/60),parenteral nutrition(70.0％,42/60),central vein catheterization(53.3％,32/60),invasive ventilation(40.0％,24/60) and history of abdominal surgery(21.7％,13/60).Clinical manifestations of IFI included temperature instability,frequent apnea,increased requirement of respiratory support and feeding intolerance.Among all cases,six were diagnosed as central nervous system infection.Of the patients who received cranial MRI,46.8％(22/47) showed multiple abnormal signals in cerebral parenchyma.Fiftytwo patients were cured and seven patients died before discharge,including one death due to fungal infection.Conclusions There is an increasing trend of IFI cases in NICU,especially in premature infants.Non-Candida albicans has become the main pathogenic fungus.There are no specific clinical manifestations in neonatal IFI.Use of broad-spectrum antibiotics,parenteral nutrition and central venous catheterization are common risk factors,and preventive measures should be taken in high-risk infants.In addition,IFI in neonates may affect important organs such as central nervous system,thus early treatment is necessary in suspected patients.

OBJECTIVETo evaluate the diagnostic specificity of dynamic assessment and monitoring using a portable spirometer in diagnosis and differential diagnosis of asthma.

METHODSWe retrospectively reviewed the results of dynamic monitoring of spirometry in 145 symptomatic patients with physician-diagnosed asthma. Flow-volume curve and simultaneous symptoms and mood were measured in a fixed-time thrice-daily assessment schedule for 2 weeks. Patients were allowed to make additional measurements in case of symptom exacerbations.

RESULTSThe clinical data of 51 males and 94 females with a mean age of (39.1 +/- 13.0) years (ranged from 10 to 65 years) were analyzed. Duration of asthma before study was (6.7 +/- 9.9) years. Of 145 patients with physician-diagnosed asthma, 126 (87%) could be conclusively confirmed for a diagnosis of asthma. Asthma was misdiagnosed in 14 patients (9.7%). Overdiagnosis of asthma was observed in 5 patients (3.4%).

CONCLUSIONDynamic assessment and monitoring using a portable spirometer by revealing variability and reversibility of airway obstruction may provide an additional tool for diagnosis and differential diagnosis of asthma.

Adolescent ; Adult ; Aged ; Airway Obstruction ; Asthma ; diagnosis ; Child ; Diagnosis, Differential ; Diagnostic Errors ; Female ; Humans ; Male ; Middle Aged ; Peak Expiratory Flow Rate ; Spirometry ; methods ; Young Adult

OBJECTIVETo investigate the feasibility and effectiveness of laparoscopic radical trachelectomy and lymphadenectomy in the treatment of early-stage cervical cancer.

METHODSThe clinical data of 6 patients (stage 1a2 to 1b1), who underwent laparoscopic fertility-preserving radical operation for cervical cancer in our department from February 2009 to October 2010, were retrospectively analyzed in terms of operation duration, intra-operative blood loss, postoperative pathology, complications, and pregnancy.

RESULTSBoth radical resection of cervical and pelvic lymph node dissection were completed under laparoscopy, and only the cervical and vaginal cuffs were closed from vagina. The operation duration ranged 155-210 min (mean: 185 min) and the intra-operative blood loss was approximately 60-120 ml(mean: 105 ml). The average length of hospital stay was 18 days without complications, postoperative infection, and bleeding. Postoperative pathology showed no lymph node metastasis, and no ligament, blood vessels, vaginal cutting margin, or upper part of cervix was invaded by tumor cells. During the 8-20-month follow-up, 1 patient had become pregnant for 4 months and no case experienced tumor recurrence.

CONCLUSIONLaparoscopic fertility-preserving lymphadenectomy and radical trachelectomy is feasible for patients with early-stage cervical cancer who have strong wish to have a child.

Adult ; Female ; Fertility Preservation ; Follow-Up Studies ; Humans ; Hysterectomy ; methods ; Laparoscopy ; Retrospective Studies ; Treatment Outcome ; Uterine Cervical Neoplasms ; surgery ; Young Adult

Medically unexplained dyspnea refers to a group of patients presenting marked dyspnea without structural alterations of organs/systems after thorough examinations. This clinically neglected group of patients accounts for about 14% of patients with dyspnea in secondary health care. They appear very difficult to manage clinically. In this paper an organized approach used to diagnose medically unexplained dyspnea is presented. Breathing re-training is recommended as a therapy for those "difficult to treat patients".
Breathing Exercises ; Diagnosis, Differential ; Dyspnea ; diagnosis ; psychology ; therapy ; Humans ; Psychophysiologic Disorders ; diagnosis ; therapy

Scoliosis is a common disease in children that causes deformity of spine and thoracic cage. The deformity not only affects the appearance, but also leads to irreversible impairment of lung function and respiratory failure in severe cases. This systematic review on publications over past 50 years demonstrates that scoliosis impairs growth and development of lungs, limits chest wall movement, and results in restrictive ventilation defect and gas exchange dysfunction. Respiratory failure occurs primarily in early-onset scoliosis and/or during latter half of gestation. Surgery corrects deformity and may slow down its progression. However, invasive procedure itself impairs lung function. Non invasive procedures prevent the deterioration of lung function rather than promoting growth and development of lungs. As a consequence, reserve of pulmonary function is recommended when surgical intervention is considered.
Humans ; Lung ; physiopathology ; Respiration ; Retrospective Studies ; Scoliosis ; physiopathology

BACKGROUNDThere are few researches for the healing of metaphyseal fractures; moreover, the animal models to study the metaphyseal fractures are usually made by the oscillating saw osteotomy without reliable fixation, which is not in accordance with our current clinical practice. In this study, we established a new model to observe the healing process of metaphyseal fractures.

METHODSEighteen New Zealand rabbits were used in the study. The fracture model was created by splitting the medial tibial plateau in rabbits, then reset, and fixed with compression screws. At 1, 2, 3, 4, 6, and 8 weeks postoperatively, the tibial specimens were collected; firstly, a general observation and an X-ray examination of the specimens was done, and then they were embedded in methylmethacrylate and cut into sections with hard tissue slicer. The sections were stained with Giemsa reagent and examined under light microscopy.

RESULTSThere was no fracture displacement in the tibial specimens of all time points, except for one showing a collapse. No external callus formation could be observed by X-ray and general examination. After 1 week of the operation, the fracture gap was filled by mesenchymal tissue; 2 weeks postoperatively, a large number of woven bones were formed; from the third week onwards, the woven bone began to turn into lamellar bone, and new trabecular structure began to form. In all of the slices, no obvious chondrocytes formed in fracture areas; thus, there was no endochondral ossification.

CONCLUSIONSThis model was an ideal fracture animal model and suitable for the study of metaphyseal fracture healing. The X-ray and histological images demonstrated that metaphyseal fracture healing was a process of direct bone healing through intramembranous bone formation under the conditions of minor trauma, good reduction, and firm fixation.

Animals ; Fracture Healing ; physiology ; Fractures, Bone ; diagnostic imaging ; pathology ; Rabbits ; Radiography