Objective To investigate the associations between levels of perioperative biochemical markers of the liver,kidney,lung and heart and death within 3 months postoperatively in the senile patients with femoral intertrochanteric fracture.Methods A retrospective study was conducted on the 153 senile patients with femoral intertrochanteric fracture who had been treated at Nanfang Hospital from January 2010 to January 2012.They were 71 men and 82 women,with an average age of 83.1 years.There were 70 stable and 83 unstable fractures.At preoperation (within 24 h after admission),and 24 h,25 to 48 h and 72 h postoperation,all the patients had blood examinations of biochemical markers of the liver [alanine aminotransaminase (ALT)],kidney (creatinine and urea nitrogen),lung (PaO2) and heart [brain natriuretic peptide (BNP)].The levels of biochemical markers at all time points and clinical data were compared between the living patients and those who died within 3 months postoperatively.Univariate and multivariate logistic regression analyses were conducted to estimate the independent risk factors for mortality within 3 months postoperatively.Results Of the 153 patients,32 (20.9％) died within 3 months postoperatively,including 10 men and 22 women.In the dead and surviving patients,there were respectively 25 and 17 cases who were rated as level Ⅲ or Ⅳ by ASA (American Society of Anesthesiologists).The levels of ALT,creatinine,urea nitrogen,and BNP increased to different extents while the level of PaO2 decreased postoperatively in both the dead and surviving patients.The differences between the dead and surviving patients were statistically significant (P ＜ 0.05).Multivariate logistic regression analysis showed poor preoperative physical condition (ASA level Ⅲ or Ⅳ),increased creatinine level at 25 to 48 h postoperation,decreased PaO2 at 72 h postoperation,and increased BNP level at 24 h postoperation were independent risk factors for early mortality in senile patients with femoral intertrochanteric fracture.Conclusions Femoral intertrochanteric fracture in senile patients may lead to changes in the liver,kidney,lung and heart.Prompt and dynamic monitoring of the levels of PaO2,creatinine and BNP may provide timely prediction of the poor prognosis.

[Objective]To compare the expression of calcitonin gene-related peptide(CGRP) receptor in rat bone marrow mesenchymal stem cells(rBMSCs) and the induced osteoblasts.[Method]The rBMSCs were isolated using whole bone marrow adherence method,and classified into osteoblast-induced group and non-induced group.In the different periods of culturing(1,2,and 3 weeks),identification of osteoblasts was performed by immunohistochemistry and reverse transcriptase-polymerase chain reaction(RT-PCR),and expression of the CGRP receptor was detected by Western Blot and RT-PCR.[Result]RT-PCR test demonstrated that osteoblast-induced group had a higher expression of CGRP receptor than non-induced group at the same time point,expression of CGRP receptor was increased in a time-dependent manner in the osteoblast-induced groups.Western Blot test demonstrated that osteoblast-induced group had a higher expression of CGRP receptor than non-induced group at the same time point.Expression of CGRP receptor was increased in a time-dependent manner in osteoblast-induced groups.[Conclusion]According to the mRNA test and protein test,it is suggested that CGRP receptor exists in the rBMSCs.CGRP receptor expression increased in the progress of osteogenic differentiation.

Choroid neovascularization (CNV) is pathological proliferation of choroid vascular,accompanying with bleeding and leakage,is one of the major factors caused blindness,so CNV inhibitors have become a research hotspot.At present,researches on inhibitors of vascular endothelial growth factors and their receptors,endogenous angiogenesis factors,redox and inflammatory response related factors,etc,have achieved certain progresses.In addition,as drugs with multiple targets for treatment,many Chinese herbs also show inhibition effect on CNV.This article reviews the research advances in inhibitors for CNV.

Objective To observe the changes of plasma lipoprotein concentrations after an oral glucose tolerance test and research their relation to insulin resistance in Type 2 diabetic patients.Methods The age,duration of diabetes,sex,waist circumference,hip circumference,waist-hip ratio,height,body weight,body mass index ( BMI ),systolic blood pressure,diastolic blood pressure,fasting plasma glucose,HbAl C,fasting insulin,and fasting and 60-,120-,180-minute post-load plasma glucose,plasma insulin,triglycerides ( TG),high-density lipoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol(LDL-C) and total cholesterol(TC) after a 75-g oral glucose tolerance test were measured in 26 Type 2 diabetic patients.Comparison of plasma fasting lipoprotein concentrations and postload lipoprotein concentrations was made,and the relation between fasting and post-load lipoprotein concentrations and Homa-IR was researched.Stepwise multiple regression analysis was applied to investigate the areas under the lipoproteins' curves over 180 minutes.Results The declination of post-load lipoprotein concentrations after the 75-g glucose tolerance test was statistically significant( all P ＜0.01 ).Plasma TG concentration both in fasting and post-load state was positively related to Homa-IR( all P ＜ 0.05 ),and plasma HDL-C concentration in fasting and post-load state was negatively related to Homa-IR( all P ＜ 0.05 ).However,the correlation between both fasting and post-load state LDL-C and TC concentration and Homa-IR had no statistical significance.Moreover,stepwise multiple regression analysis revealed Homa-IR was the independent factor capable of modulating the area of HDL-C curve over 180 minutes after the 75-g glucose tolernce test ( P ＜ 0.05 ).Conclusion There was a significant declination of plasma lipoproteins after a 75-g glucose tolerance test,and plasma fasting and post-load TG and HDL-C concentrations were related to insulin resistance.Insulin resistance should play a significant role in the post-load HDL-C concentration after 75-goral glucose tolerance test.

Acupressure ; Acupuncture, Ear ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Middle Aged ; Phytotherapy ; Postmenopause ; Premenopause ; Syndrome

Objective To evaluate the effects of dexmedetomidine used to supplement analgesia with sufentanil on the stress response and inflammatory response after cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Forty-four patients of both sexes,aged 18-64 yr,with body mass index of 18-30 kg/m2,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ (New York Heart Association Ⅱ or Ⅲ),scheduled for elective cardiac valve replacement with CPB,were randomly divided into sufentanil analgesia group (group S,n =20) and dexmedetomidine supplementing sufentanil analgesia group (group DS,n=24) using a random number table.After induction of general anesthesia,the patients were endotracheally intubated and mechanically ventilated.Combined intravenous-inhalational anesthesia was used to maintain anesthesia.Dexmedetomidine was infused at 0.3 μg · kg-1 · h-1 from closure of the chest to the end of surgery in group DS,while the equal volume of normal saline was given instead in group S.The patient-controlled intravenous analgesia (PCIA) was used for postoperative analgesia.PCIA solution contained sufentanil 2 μg/kg in 100 ml of normal saline in group S,or sufentanil 2 μg/kg plus dexmedetomidine 3 μg/kg in 100 ml of normal saline in group DS.The PCIA pump was set up with a 0.5 ml bolus dose,a 5 min lockout interval and background infusion at a rate of 1.5 ml/h.Visual analogue scale score was maintained ≤ 3.When visual analogue scale score ≥ 4,morphine 0.1 mg/kg was injected intravenously.The occurrence of analgesics-related respiratory depression,bradycardia and hypotension was recorded.At the end of surgery (T0),and 12,24,48 and 72 h after surgery (T1-4),blood samples were collected from the central vein for determination of serum cortisol,β-endorphin,C-reactive protein,interleukin-2 (IL-2),and IL-6 concentrations by enzyme-linked immunosorbent assay.Results No analgesics-related adverse events were detected in the two groups.Compared with group S,the requirement for morphine was significantly decreased,the serum cortisol concentration was decreased at T2-4 and the serum β-endorphin,C-reactive protein concentrations were decreased at T1-4,the serum IL-2 concentrations were increased at T1-4,and the serum IL-6 concentrations were increased at T3 in group DS (P＜0.05).Conclusion Dexmedetomidine used to supplement analgesia with sufentanil can alleviate the stress response and inflammatory response after cardiac valve replacement with CPB.

Objective To compare the effects of nasogastric tube and spiral nasointestinal tube on patients with severe brain injury. Methods Pa?tients receiving enteral nutrition with spiral nasointestinal tube or nasogastric tube were collected and investigated to evaluate the two schemes of en?teral nutrition from aspects of coma score,nutrition improvement,and catheter complications and so on. Results Detection of levels of total protein and prealbumin were conducted for all patients at 7 and 15 days after intubation. Each index was higher in the spiral nasointestinal tube group than in the nasogastric tube group. The reflux and aspiration rate was lower in the spiral nasointestinal tube group than in the nasogastric tube group. The dif?ferences were significant(P<0.05). Conclusion Using spiral nasointestinal tube to give enteral nutrition in patients with severe brain injury can improve the nutritional status,reduce complications,which is more contributory to the recovery.

[Objective]To evaluate several abdominal skin flaps used for treatment of whole-finger degloving injury of multiple fingers.[Method]Since 2000, 45 patients with whole-finger degloving injury of multiple fingers except the thumb were treated with transfer of abdominal skin flaps. Among these patients,10 were treated with random abdominal tubed pattern flaps,15 with pedicle skin flaps with thoraco-umbilical perforator artery,12 with pedicle skin flaps with superficial iliaccircumflex artery,and 8 with embedding with abdominal flaps.At the second-stage operation,fingers were dissected with pedicels or with abdominal flaps before fingerweb plasty and flap plasty were carried out for many times.[Result]All the skin flaps survived. Three fingers of 3 cases had distal cutaneous necrosis after finger web plasty.Follow-up from 5 to 36 months showed the active motion of metacarpophalangeal joints averaged 60?, and interphalangeal articulations averaged 30?.Sensation recovery reached S3 in fingers with remanent palmar digital nerve, but poor in other fingers. All fingers could perform grasping. The contour of fingers was fine except for the 3 cases of necrosis.[Conclusion]Treatment of whole-finger degloving injury of multiple fingers except the thumb with suitable abdominal flaps can restore the shape and function of hand to the greatest extent and is still a practical, safe and convenient operative method.

The human bone morphogenetic protein 7 (hBMP 7) gene was reconstructed in retroviral vector and transferred into incasing cells PT67 by liposome mediated method.The clones of the cells transferred with BMP 7 were selected by G418, and targeted rabbit bone marrow stem cells were infected with the virus granules which secreted from PT67 cells and also selected by G418. The mRNA and protein of BMP 7 gene in transferred cells were analyzed with hybridization in situ and immunohistochemistry. BMP 7 retrovirus vetor was successfully reconstructed. Cells transferred by PLNCX 2 hBMP 7 expressed abundant human BMP 7 mRNA and protein in the cytoplasm. However positive findings were not found in those cells that were not transferred. It may be used to increase the osteogenic capability of BMSc in the study of bone tissue engineering.

Objective To investigate the effect of a kind of tissue engineered bone implants on healing of segmental bone defects. Methods A 15 mm bone defect experimental model at the right radius of New Zealand white rabbit was made. 24 animals of this model were divided into three groups at random. PLGA scaffords loaded with 5 mg BMP and about 1?106 BMSCs were implanted in Group 1(n=10); PLGA scaffords loaded with 2.5 mg BMP and about 1?106 BMSCs were implanted in Group 2(n=7); PLGA scaffords loaded with 1 mg BMP and about 1?106 BMSCs were implanted in Group 3(n=7). The osteogenesis at the defect area was observed by regular roentgenography and X-ray analysis, histological changes at the bone defects at 4th, 8th, 12th weeks after operation were studied and the new bone formation was measured by image analysis. Biomechanical analysis was done 12 weeks after operation. Results A large quantity of callus was found in all the 3 groups 4 weeks after repair. At the 12th week, the complete bone healing rate was 7/8, 3/5, 3/5, respectively in Group 1, 2 and 3. Group 1 had the largest quantity of new bone measured by histopathological study and X-ray analysis, and at the 12th week, the medullary cavity in this group became united. The compress stiffness, torsion stiffness and the maximal load in Group 1 were better than those in other groups. Conclusion The tissue engineered bone contructed by PLGA scaffords that are loaded with 5 mg BMP and BMSCs is capable of repairing segmental bone defects.