OBJECTIVETo investigate a manipulating therapy for treatment of anterior shoulder dislocation in elderly.

METHODSFrom October 2011 to June 2012,27 elderly patients with anterior shoulder dislocation were treated by extorsion traction and pushing manipulation with fingers, including 7 males and 20 females aged from 65 to 86 years old with an average of 77. The course of disease ranged from 1 h to 1 d. The shoulder manifested square deformity, Dugus signs showed positive, and X-ray displayed anterior shoulder dislocation. Dugus fixation was applied for and removed external fixation at 3 weeks after operation and carried out shoulder functional exercise. Functional evaluation standard on shoulder joint injuries was used for evaluate clinical outcomes.

RESULTSAll patients were gained reduction for the first time, and followed up at 3 months after operation, no dislocation occurred. According to functional evaluation standard on shoulder joint injuries, 22 cases got an excellent result,2 cases good,and 1 case moderate.

CONCLUSIONExtorsion traction and pushing manipulating therapy for treatment of anterior shoulder dislocation in elderly, which has advantages of simple, convenient, less painful, and can avoid iatrogenic injury, is feasible to widespread.

Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Manipulation, Orthopedic ; Shoulder Dislocation ; physiopathology ; therapy ; Shoulder Joint ; physiopathology ; Traction ; Treatment Outcome

Breast Neoplasms ; therapy ; Humans ; Medicine, Chinese Traditional ; Yin Deficiency

Objective: To explore the influence of hydroxyethyl starch(HES) 130/0.4 on myocardial ischemia-reperfusion (I/R) injury in rats and the possible mechanism. Methods: Twenty-four SD rats were evenly randomized into four groups(n = 6): the sham operation group, the I/R(IR) group, albumin + I/R(A-IR) group, and HES+I/R(H-IR) group; rats in the latter three groups were made into I/R models and were treated respectively with 7.5 ml/kg saline, 5% albumin and HES 130/0.4 through femoral vein at 25 min of ischemia. At 180 min of reperfusion, animals were sacrificed and the pathological changes of myocardium were observed. Serum concentrations of TNF-α and IL-1β and the myocardial NF-κB activity were also measured. Results: Histological examination showed that the injury in H-IR group was ameliorated compared with those in IR and A-IR groups. NF-κB activity and TNF-α, IL-1β concentrations in the sham operation group were significantly lower than those of the other 3 groups (P<0.05); and the increases of the above parameters in H-IR group were smaller than those of the IR and A-IR groups (P<0.05). Conclusion: HES 130/0.4 can improve myocardial function and attenuate ischemia-reperfusion injury, and the mechanism might be related to the inhibition of myocardial NF-κB activity and reduction of proinflammatory factors.

Objective:To introduce several international long-term care insurance systems so as to provide references for building China's long-term care insurance system.Methods:Literature of International long-term care insurance system were reviewed to extract and summarize the content so as to provide suggestion and references for China's system construction.Results:It concluded 4 modes of systems for long-term care insurance including the private long-term care social insurance like Netherlands,the public long-term care social insurance like German and Japan,long-term care commercial insurance like America and national long-term care insurance like England.The advantages of different modes could be learned to form Chinese system.Conclusion:The long-term care insurance systems of Netherlands,German,Japan,American could be learned for our system construction,but they also had disadvantages.Therefore,on the basis of the foster strengths and circumvent weaknesses,the reasonable long-term care insurance system was formed.

Background There is no effective preventing way for the posterior capsular opacification(PCO) after cataract surgery.Objective The aim of this study was to investigate the preventing effect of adenovirus-mediated herpes simplex virus thymidine kinase/ganciclovir(HSV-tk/GCV) system on PCO.Methods Twelve New Zealand white rabbits were divided into BSS+BSS group,BSS+GCV group,HSV-tk+BSS group and HSV-tk+GCV group at random.Phacoemulsification was performed in bilateral eyes of rabbits,and 0.1ml of BSS or adenovirus vector with HSV-tk gene were injected into lens capsular bag during the operation based on the grouping.In 12 hours after operation,0.1ml BSS was injected into the anterior chamber daily for 3 times in BSS+BSS group and HSV-tk+BSS group,and 0.1ml GCV was used in the same way in BSS+GCV group and HSV-tk+GCV group.The situations of the anterior segment and the posterior capsule were examined under the slit lamp postoperatively.All the wet weight of capsular bags was assessed using electronic balance.The capsular membrane was histopathologically examined in the 4th week after injection.PCO was graded according to the method of Couderc.Results Mild corneal edema and aqueous humor opacity were observed in all the eyes within 3 days and returned to normal level gradually within 2 weeks postoperatively.PCO scores were higher in BSS+BSS group,BSS+GCV group,HSV-tk+BSS group than the HSV-tk+GCV group,showing the significant differences between them(H=2.647,P=0.008;H=2.939,P=0.003;H=2.884,P=0.004).No obvious difference was seen in PCO score among BSS+BSS group,BSS+GCV group,HSV-tk+BSS group(P＞0.05).The wet weight of the capsular bags in HSV-tk+GCV group was reduced in comparison with BSS+BSS group,BSS+GCV group,HSV-tk+BSS group with the statistically significant difference between them(q=9.93,q=10.15,q=10.07,P＜0.05).Histopathological examination revealed that mild proliferation of lens epithelial cells(LECs) at the capsular equator and migration toward the posterior capsule to form a thin soemmering ring in the periphery of the capsular bags and thin fibromembrane at the center of the capsular bags without cells or cortices in HSV-tk+GCV group.However,in BSS+BSS group,BSS+GCV group and HSV-tk+BSS group,the proliferation and migration of LECs were more obvious to form a dense soemmering ring in the periphery of the capsular bags and thick fibromembrane in the center of capsular bags.Conclusion Adenovirus-mediated HSV-tk/GCV system can effectively prevent PCO.

Objective To study the preventive effect of small-dose fluconazol adiministered in low frequency on nosocomial fungal infectoin.Methods The condition of nosocomial fungal infection among 200 patients in pediatric intensive care unit (PICU)were observed,who were suffered with serious infection or basic diseases and underwent broad-spectrum or ultra-broad spectrum antibiotic and steroid hormones treatment.These patients were divided imto treatment and control group.And the patients in treatment group received fluconazol[5 mg/(kg?time)once every 2 days,total 3 times,after that,twice 1 week till improved] to prevent fungal infection .The control group were treated with fluconazol [6-10 mg/(kg?time),once everyday for 10-14 days] after fungal infection.Results The incidence rate of nosocomial fungal infectoin of control group was 58.3%(56 out of 96 cases,which were 44 cases of mouth,5 cases of respiratory tract ,5 cases of digestive tract and 2 cases of urethra ) and that of treatment group was 1.9%(2 out of 104 cases, which were 2 cases of mouth).In control group,37 cases were cured,17 cases improved and 2 cases were not effective.Mouth fungal infection in treatment group was gently and cured with 1 or 2 times of local treatment .The treatment group didn′t occured liver function damage or aggravation.Conclusion For PICU patients, adiministration of small-dose flucomazol in low frequency is an effective and relatively safety method to prevent against nosocomial fungal infectoin.

OBJECTIVE: Analyze the applications and challenges of guidelines for pharmacoeconomic evaluation (PE) in China. METHODS: Reviewing what Chinese health policy need from pharmacoeconomics; analyzethe applications and challenges of guidelines for PE in China; summarize the application and development of the guidelines for PE in the world. RESULTS: PE plays an important role in Drug development, pricing, reimbursement and evidenc-based clinical pathway. Since PE guidelineis not mandatory in healthcare policy decision making in China, and there are lack of high-quality, reliable database for PE, the guideline encountered many difficulties and challenges in practice and hasn't play its due role yet. CONCLUSION: Based on the experience from other counties and practical in China, we recommended that PEguideline shouldbe mandatory. It is recommended to set up national research institutions for PE, and update or supplementthe guidelines regularly. Moreover, the basic research should be strengthened, such as rational drug use, pharmacoepidemiology, quality of life.

Objective To investigate the clinical characteristics of septicemia in type 2 diabetes mellitus,to enhance prevention level and decrease death rate.Methods A retrospective study was carried out,the data were collected from 58 cases of type 2 diabetes mellitus complicated by septicemia in our hospital in the past 13 years.Results The pathogenic invasive pathways included:19 cases of urinary tract,17 cases of respiratory tract,7 cases of intravenous catheter detain,7 cases of biliary tract,1 case of skin breakage,and 7 cases of unclear origin.Twenty-three of 58 cases were from nosoeomial infection (39.7%),among which 10 cases of urethral detain,7 cases of intravenous catheter detain,and 6 cases of respiratory tract infection.Pathogenic distribution was as following:24 cases of klehsiella pneumoniae,16 cases of escherichia coli,10 cases of staph aureus,2 cases of staphylococcus cohnii cohnii,2 cases of staphylococcus epidermidis,2 cases of pseudomonas putida,2 cases of candida glabrata.Among the 24 cases of llehsiella pneumoniae,12 cases showed migrating hepatapostema (50.0%),and 15 showed pneumatosis phenomenon in the intrahepatie bile (62.5%).Two cases originated from fungal septicemia.Among 56 cases under antibacterial therapy 15 cases developed fungal septicemia (26.8%).Fifty-eight cases were treated with insulin for forcing down serum glucose,56 cases of bacterial septicemia were treated with the third generation cephalosporins and fluoroquinolones.Two cases of pseudomonas putida septicemia were treated with intravenous injection of fluconazole.Seven cases died (12.1%).Conclusions Gram-negative bacilli were the major pathogens of septicemia in type 2 diabetes mellitus.Migrating hepatapostema and pneumatosis phenomenon in the intrahepatic bile often showed klebsiella pneumoniae septicemia.The important risk factors for septicemia were intravenous catheter detain and urethral detain.Therefore,strictly aseptic operation and removing vessel detain in time is very important.It is key points to make an early diagnosis,have a strong antibiosis therapy and treat the migrating pathogenic focus.And it is important to intensify serum glucose monitoring and strengthen supportive treatment.

Objective To investigate the polymorphism of glutathione S-transferease P1 gene(GSTP1) and the association between the mutation and susceptibility in childhood asthma.Methods The distribute frequency of Ile105/Ile105,Ile105/Val105 and Val105/Val105 ge-notype in GSTP1 of 51 children with asthmatic and 40 normal children were studied with polymerase chain reaction-restriction tragment length polymorphism(PCR-RFLP).Results The frequencies of Ile/Ile Ile/Val,Val/Val genotype were 66.7%,27.4% and 5.9%,the frequencies of Ile,Val allele were 80.4% and 19.6% in the asthmatic group.But the frequencies of Ile/Ile,Ile/Val,Val/Val genotype were 90.0%,7.5% and 2.5%,the frequencies of Ile,Val allele were 93.8%,6.2% in control group.The frequencies Ile/Val,Val/Val genotype and Val allele in asthmatic group were more than that in control group.A significant difference was found in the frequency distribution of GSTP1 genotypes between two groups(?2=6.947 P

Objective To investigate the quality of life and metal stress of breast cancer patients'spouses in the perioperative period,and analyze the relationship between them.Methods Self-made General Information Questionnaire (WHOQOL-BREF) aud relative stress scale (RSS) were used to investigate 110 breast cancer patients' spouses during the perioperative period,in order to analyze the relationship betweeu quality of life and metal stress.Results A total of 110 copies of questionnaires were gave out,102 valid questionnaires,effective recovery was 92.73％.The scores of quality of life in physiology,psychology,social relationship and environment were (13.34 ± 1.88),(13.95 ± 2.63),(13.61 ± 2.45) and (12.22 ± 2.47)respectively and the score of RSS was (11.16 ±4.69).There was a negative correlation between the scores of WHOQOL-BREF and the RSS,the metal suffering as well as the confusion of life (P ＜ 0.05).Only the scores of psychology and social relationship were negatively related to the negative emotions because of the patients (P ＜ 0.05).Conclusions The quality of life of breast cancer patients' spouses during perioperative period is negatively affected by their metal stress.