Unsteadiness and falls in the elderly are a common complaint in primary care and their incidence is expected to increase as the population ages. These patients are physiologically less able to withstand traumatic forces than their younger counterparts and are thus more prone to morbidity and mortality. Aside from intrinsic and extrinsic risk factors, there may be more sinister pathologies underlying these events. We report a case of an elderly gentleman who presented with unsteadiness, clumsiness and recurrent falls. The patient’s son brought to our attention subtle suspicious findings which eventually led to further evaluation. The patient was found to have had bilateral acute on chronic subdural haemorrhages with associated mass effect, underwent emergent decompression surgery and showed marked functional recovery. We review the incidence and outcomes of recurrent falls in the elderly, as well as the incidence, risk factors and varied presentations of subdural haemorrhage in the primary care setting. The case also reminds clinicians of the tendency to overlook and undermanage such patients with seemingly “minor” falls, and the value of family members’ inputs during consultation. It highlights the need for a high index of suspicion and the necessity of lower referral thresholds for further evaluation if indicated.

years ago, Noma first applicated the patch\|clamp technique to CN\|treated mamammalian heart cells,evealed specific K + channels which were depressed by intracellular ATP at level greater than 1 mM.He suggested the ATP-sensitive channels are important for regulating cellular energy metabolism in the control of membrane exitability.Recent studies supported the hypothesis and suggested that ATP-sensitive channels play an important role in hypoxia,myocardial ischemia/reperfusion and is chemic preconditioning.

AIM: To determine the effects of phospholipase A 2 (PLA 2) and K ATP on rat ischemia/reperfusion(I/R)-induced arrhythmia. METHODS: Myocardial ischemia and reperfusion were produced by occlusion and reirregation of the left anterior descending artery(LAD). An inhibitor of PLA 2, 5,5-dithio-bis(2-nitrobenzoic acid) (DTNB) (16 mg /kg), a K ATP opener pinacidil (0.2 mg/kg), a K ATP blocker glibenclamide (0.3 mg/kg) was used 5 min prior to 10 min regional ischemia and 10 min reperfusion. RESULTS: DTNB (16 mg/kg) reduced the scores of arrhythmia, creatine kinase (CPK) and lactate dehydrogenase(LDH) (P

Objective To investigate the suicide behavior among middle school students in Kunming city and its relationship with family factors, and provide a theoretical basis for prevention and control of juvenile suicide behavior. Methods 1 164 junior to senior students in 5 middle schools in Kunming were investigated by anonymous self-administered questionnaire investigation, and the collected data were statistically analysed by using SPSS software. Results The total effective number of students was 1 163, including 548 boys, accounting for 47.1%, and 615 girls, accounting for 52.8%, with age of 11 and 18 years (15.17 ± 1.838) .Among them, 153 people considered suicide, accounting for 13.1%of the proportion. Family factors of suicide analysis found that family type, education level of the parents and the family economic situation had influences on the suicide behavior among middle school students. Conclusions The suicide behavior is more common in middle school students,and is influenced by the family factors including family type,cultural degree of parents and etc.,so we should strengthen the comprehensive intervention measures to prevent the occurrence of suicide behavior based on the influencing factors.

Purpose To analyze the relevance between magnetic susceptibility weighted imaging intratumoral susceptibility signal intensity (ITSS) and diffusion weighted imaging apparent diffusion coefficient (ADC) with different grade gliomas, and to explore the value of ITSS and ADC in the preoperative grading of gliomas. Materials and Methods Fifty-two cases of glioma patients underwent magnetic susceptibility weighted imaging and diffusion weighted imaging scans, all subjects were divided into low-grade glioma group (18 cases) and high-grade glioma group (34 cases) according to brain tumor grading standard, correlation between ITSS grade and ADC values with tumor grade was analyzed, and ROC curve was used to evaluate the diagnostic efficacy of ITSS and ADC values in the grading of brain glioma. Results Difference of ITSS grading was statistically significant (χ2=27.458, P<0.01) among different grade gliomas;difference of ADC values between different grade gliomas was also statistically significant (U=689.000, P<0.01); there was a significant positive correlation (r=0.727, P<0.001) between ITSS grading and pathological grading, ADC values were significantly negatively correlated (r=-0.622, P<0.001) with tumor grading, and ITSS grading was significantly negatively correlated (r=-0.617, P<0.001) with ADC values among different grade brain gliomas. With pathological grading as reference standard, the diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ITSS for preoperative glioma grading was 85.29%, 77.78%, 82.69%, 87.88%and 73.68%, respectively, while the diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ADC values for preoperative glioma grading was 97.06%, 88.89%, 94.23%, 94.29%and 94.12%, respectively. Conclusion There is a significant correlation between ITSS grading, ADC values and pathological grading of gliomas, the combination use of ITSS and ADC values can significantly improve the preoperative grading accuracy of brain glioma.

Objective To study the effect of the cord blood stem cell transplantation therapy in patients with severe hepatitis. Methods Forty patients with severe hepatitis were randomly divided into control groups (n=20) and observed group (n=20). The patients in two groups were treated with the conventional liver protective therapy respectively, such as compound glycyrrhizin and glutathione. The patients in observed groups were performed with the cord blood stem cell trans-plantation therapy. After isolation and purification, the cells were transplanted into the liver via hepatic artery and then were transplanted via peripheral veins. The biochemical indices of albumin (ALB), prothrombin activity (PTA),alpha-fetoprotein (AFP)and clinical symptoms were detected at different times after therapy. Results After 4-week therapy, the levels of PTA (%)and AFP(μg/L)were significantly increased in observed group compared with those of control group (53.56 ± 5.15 vs 48.26±5.53,92.16±9.09 vs 43.57±11.33,P＜0.01). After 8-week therapy, the levels of alanine aminotransferase (ALT), total bilirubin (TBIL) and AFP were significantly decreased in observed group than those of control group. The level of PTA was sig-nificantly higher in observed group than that of control group (62.61±4.35 vs 54.95±3.01,P＜0.05 or P＜0.01). There were no significant differences in levels of ALB and blood ammonia between two groups (P>0.05). There were no serious complications and adverse reactions in two groups of patients. There was no significant difference in mortality between two groups ( 20%vs 35%,χ2=0.818,P>0.05). Conclusion Cord blood stem cell therapy has a good effect on treating severe hepatitis, which is safe and no significant adverse reactions, and can be used as a new method for treating the severe hepatitis.

AIM: To explore the long-term efficacy of Q-factor guided laser epithelial keratomleusis ( LASEK ) for myopia and astigmatism with positive Q-factor.
METHODS: There were 158 eyes which were myopia and astigmatism with positive Q- factor taken in two groups randomly: 86 eyes accepted Q - factor guided LASEK as observation group and 72 eyes accepted routine LASEK as control group. The difference between the two groups about all data was similar. The uncorrected visual acuity ( UCVA ) and the best corrected visual acuity ( BCVA ) as well as diopter, ocular tension, corneal topography, Keratometry value K, aspherical factor Q, Higher-order aberrations ( HOA ) , corneal thickness by ultrasound and, contrast sensitivity ( CS ) , Haze were examined and compared before and after surgery. All the cased were followed up for 14d, 1, 3, 6, 12mo. And there were no statistical difference among the data before surgery.
RESULTS: After 12mo there were no statistical difference between the two groups about UCVA and BCVA. But the safety index of observation group was 1.10, that of control group was 1. 07. The validity index of observation group was 1. 06, that of control group was 0.99. The HOA of observation group was 0. 45±0. 17μm, and that of control group was 0. 72±0.25μm, there was statistically significant difference (t=-8. 193,P=0. 000). Q factor of observation group was 0. 41±0. 17, that of control group was 0. 77±0. 22, there was significant difference (t=11. 377,P = 0. 028). The contrast sensitivity of 3mo post surgery of patients in the observation group returned to the level of before surgery. But in the control group the contrast sensitivity of the patients did not returned until 6mo.
CONCLUSION:Q-factor guided LASEK for myopia and astigmatism with positive Q-factor is stable, safe and effective. The operation allow for reducing the high order aberrations, maintaining the most asphericity of cornea, saving more in corneal tissue, which cause faster recovery of contrast sensitivity, less haze and better visual quality.

Administration, Intranasal ; Humans ; Mucociliary Clearance ; drug effects ; Nasal Mucosa ; drug effects

Adult ; Aged ; Female ; Humans ; Jaundice ; Liver Cirrhosis ; pathology ; therapy ; Male ; Middle Aged ; Moxibustion

Objective To study the methods and effects by using thrombolytic catheter in interventional treatment for patients with acute lower limb arterial thrombosis or embolism. Methods One hundred and twelve patients suffered acute lower limb arterial thrombosis or embolism. There were 85 cases of acute lower limb arterial embolism induced by atrial fibrillation in coronary or rheumatic heart disease,other 27 cases of arterial thrombosis caused by different reasons. Interventional treatment by inlying thrombolytic catheter was applied and continuous perfusion was received locally in all patients. Results Complete recanalization was got in 77 cases (68.8%) of 112 cases. Partial re canalization was got in 23 cases (20.5%), and ischemia limbs were saved in spite of chronic limb ischemia(chronic spasmodic limb) occurring in the later follow-up. Nine cases (8.0%) were amputated as a result of irreversible limbs necrosis, 3 cases (2.7%) died from acute renal failure resulting from reperfusion injury or recurrent cerebral embolism.Conclusion Interventional treatment by inlying thrombolytic catheter is a safe and effective method with lower amputation rate for acute lower limb arterial thrombosis or embolism in patients.