Objective To investigate the prevalence of osteoporosis,osteopenia,fall and brittle fracture and their associated factors in men aged 80 years and over.Methods In a prospective study,184 study subjects with good self-care ability aged 80 years and over were enrolled.The questionnaire included living habits,falls,comorbidities,related symptoms and medicines.The bone mineral density,hand-grip strength,gait speed,timed up and go test(TUG),chair rising test(CRT),bone turnover markers and related hormones were measured.Binary Logistic regression model was used to analyze associated factors for osteoporosis,osteopenia,fall and brittle fracture.Results The prevalence of osteoporosis (OP)and osteopenia(OPA) were 12.5 ％ (23/184) and 45.1％ (83/184) respectively in this study.The height,weight and body mass index were lower,and serum levels of procollagen type 1 N terminal propeptide(P1NP)and C-telopeptides of type 1 collagen(s-CTx)were higher in osteoporosis group than in normal bone mass(NBM) group(P＜0.05,P＜0.01).The estradiol levels were lower in OP and OPA group than in NBM group(P＜ 0.05).The risk factors for OP and OPA included smoking(OR =3.607,P＜0.05),decreased body weight (OR=0.823,P ＜ 0.05) and elevated S-CTx level (OR =12.427,P ＜ 0.01).55.4％ (102/184) of study subjects had fall history after 80-year old.The prevalence of fragile fracture was 17.4％ (4/23),18.1 ％ (15/ 83)and 3.8％(3/78)in OP,OPA and NBM groups respectively,with total prevalence of 12.0％ (22/184).The risk factors for fragile fracture were a decreased total hip BMD(OR 0.017,P＜0.05)and fall history after 80-year-old(OR 13.126,P ＜ 0.05).Conclusions Based on associated factors of osteoporosis,osteopenia,falls and fragile fracture in male aged 80 years and over,the primary and secondary prevention of osteoporosis may need a comprehensive geriatric intervention including lifestyle adjustment,fall prevention and pharmacologic treatments.

The work aims to study the drug metabolizing enzymes involved in the metabolism of butylphthalide and evaluate the induction and inhibition activities of butylphthalide on CYP450 isoenzymes by using in vitro (liver microsome incubation system of rats and human) and in vivo (CYP induced model of rats) method. Butylphthalide was incubated with selective inhibitors of CYP450, and its metabolic rate was determined to identify the metabolizing isoenzymes of NBP in rat (normal and induced rats) and human liver microsomes. The in vitro inhibition effect of butylphthalide on 6 main liver microsomal CYP450 isoenzymes was evaluated by using probe drugs; the induction and inhibition activities in vivo of butylphthalide on CYP450 isoenzymes were evaluated by NBP ig dosing (160 mg x kg(-1)) and iv dosing (20 mg x kg(-1)) in rats. After adding the specific inhibitors of CYP2C11, 2E1 and 3A 1/2 for rat, CYP2C19, 2E1 and 3A4/5 for human, the metabolism of NBP in rat and human liver microsomes were reduced 38.8%, 86.2%, 78.4% and 51.0%, 92.0%, 58.9% of control, respectively. The metabolic rates of NBP in CYP2E1 and 3A 1/2 induced rat liver microsomes were increased 25.5% and 68.9%. High concentration of NBP (≥ 200 μmol x L(-1), in vitro) could inhibit the activities of CYP1A2, 2C6, 2C11 and 2D2 in rats, and high concentration of NBP ( ≥ 15 μmol x L(-1), in vitro) could inhibit the activity of CYP2C19 in human. All the results indicated that NBP should be mainly metabolized by CYP2E1, 2C11 and 3A 1/2 in rats and CYP2E1, 2C19 and 3A4/5 in human. High concentration of NBP could inhibit human CYP2C19 in vitro. No significant induction/inhibition effects of NBP were observed on rat liver CYP450 isoforms after ig 160 mg x kg(-1) NBP or iv 20 mg x kg(-1) NBP.

Objective To investigate the application of functional assessment to determine the needs of intermediate care services of elderly,and to analyze the needs of intermediate care services of elderly patients in different grades of hospital,different departments and different age.Method 2481 cases of patients aged over 60 years hospitalized due to acute diseases were collected.The ability of activities of daily living (ADL) scale (Barthel index) and limb function were determined in patients aged over 60 years within 1 week after admission as acute diseases.According to the clinical data and scoring scales,the patients were divided into three groups of self-care group without declined independent function of life with Barthel index ＞ 95 points;intermediate care group in whom the ability of daily activities was decreased due to the acute diseases,the function of the body was decreased,and Barthel index was between 45 ～ 95 points;and long-term care group with long term bed rest,severely declined autonomic function or complete dependence and Barthel index less than 45 points,and no opportunity of further recovery.A total of 382 elderly patients (195 male) were in intermediate care group.Analyzed were the intermediate care needs of elderly patients in different levels of hospitals,different departments (including respiratory,cardiovascular,emergency department,geriatrics) and different age.Results The proportion of needs of intermediate care services was 16.1％ (194/1205) in third grade hospitals,24.3％ (33/136) in grade 2 hospitals,38.1 ％ (91/239) in grade 1 hospitals,and 7.1％ (64/901) in community hospital.In general hospital the proportion of needs of intermediate care services were 24.5 ％ (13/53) in emergency department,12.1％ (4/33) in cardiology department,14.6％ (6/41) in respiratory department,and 10.4％ (7/ 67) in geriatric department.The proportion of needs of intermediate care services was 19.0％ (22/ 116) in age group of 60～69,42.2％ (62/147) in age groupof 70～79,and 28.6％ (34/119) in age group of over 80 years.Conclusion The needs of intermediate care services are different in different age groups.Patients aged 70 ～ 79 years have the highest needs of intermediate care services.The needs of intermediate care services are different in different grade levels of hospitals and in different departments.

Objective To study the effects of rehabilitation training on the synaptic ultrastructure of the brain cortex after cerebral ischemia.Methods Sixty rats were randomly divided into a sham operation group,a cerebral ischemia group and a rehabilitation training group.A model of focal cerebral ischemia was created in the rats of the cerebral ischemia and rehabilitation training groups.The rehabilitation training group was given balancing,grasping,rotation and walking training every day.The sham operation group and cerebral ischemia group were kept in normal cages,taking food and moving freely.Electron microscopy was used to observe the density and ultrastructure of the cortical synapses at days 1,7,14 and 21 after the operation.Results In the sham operation group there were numerous synaptic terminals in the cortical neuropil.The majority of synapses were Gray type Ⅱ,containing spherical synaptic vesicles in presynaptic elements.After cerebral ischemia,the number of synaptic terminals had decreased and the synaptic structure was damaged.The synaptic vesicles lessened and dissolved.The presynaptic and postsynaptic membranes became unclear.At 21d after ischemia,the synaptic vesicles had disappeared and the presynaptic and postsynaptic membranes were damaged so seriously that the typical synaptic structure disappeared.After rehabilitation training,the damaged synaptic terminals recovered.Conclusions The synaptic structure was damaged after cerebral ischemia,and the damaged synaptic terminals recovered after rehabilitation training.Rehabilitation training can enhance synaptogenesis in the brain's cortex after cerebral ischemia and promote the recovery of motor function,at least in rats.

Background and aim:The transcriptional co-activator Yes-associated protein-1(YAP1)has been impli-cated as an oncogene and is overexpressed in different kinds of human cancers,especially hepatocellular carcinoma(HCC).However,the role of YAP1 has not been reported in residual/recurrent HCC after transarterial chemoembolization(TACE).Our aim is to determine whether YAP1 is overexpressed in the residual/recurrent HCC after TACE. Methods:A total of 105 tumor tissues from 71 patients including 30 cases of primary HCC without prior treatment,35 cases of residual/recurrent HCC post TACE,and 6 cases of hepatoblastoma were included in the immunohistochemical study.YAP1 immunoreactivity was blindly scored as 0,1+,2+or 3+in density and percentages of positive cells. Results:About 33.3％(10/30)of primary HCC without prior treatment showed 2+of YAP1 immunore-activity.While 82.8％(29/35)of residual/recurrent HCCs after TACE treatment displayed 2-3+of YAP1 immunoreactivity,which was significantly higher compared to primary HCC without prior treatment(P=0.0002).YAP1 immunoreactivity was moderately to strongly positive(2-3+)in 100％ of the hep-atoblastoma,particularly in the embryonal components(3+ in 100％ cases). Conclusions:YAP1 is significantly upregulated in the residual/recurrent HCCs post TACE treatment,suggesting that YAP1 may serve as a sensitive diagnostic marker and a treatment target for residual/recurrent HCC post TACE.

ObjectiveTo recognize the cranial MRI appearance in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy(CADASIL). MethodsFive patients with CADASIL from two generations in a family underwent routine MRI and MRA examinations.Three patients with CADASIL were confirmed by the Notch3 genetic testing and the vascular pathological Resultsand one was diagnosed on basis of MR and clinical manifestations. The imaging data from 4 patients with CADASIL were analyzed.ResultsFour cases achieved preliminary diagnosis of CADASIL and one was excluded by MRI.In 4 patients with CADASIL,bilateral symmetrical,confluent white matter lesions in the subcortical and Deriventricular regions were seen frequently in the temporal,frontal and parietal lobes,but the occipital lobes were less involved.These lesions appeared as long T1 and long T2 signal.O'Sul]ivan sign was shown in all cases and subcortical lacunar lesions was seen in 2 cases. In the centrum semiovale,well-defined,round or oval cystic infarcts(black holes)were demonstrated in 3 cases and multiple tiny round enlarged perivascular spaces(pepperpot appearance)in all cases.The corpus callosum was involved in all cases,and it was evidently atrophic in 2 cases.The anterior part of internal capsule and external capsule were were present in the basal ganglia and brainstem. Only one case revealed a small infarct in the right cerebellum. Four Datients shared mild or moderate atrophy of brainstem, cerebellum and cerebrum. No marked abnorillalitv of large vessels was seen in all cerebral MRA. ConclusionsThe cranial MRI appearance in CADASIL shows some characteristics.MRI may give some infotznation in the preliminary diagnosis or exclusion of CADASIL.

When having completed the treatments of acute disease ,the hospitalized elderly patients are often not able to return home immediately due to poor physical and mental conditions. They need a period of integrated medical care for recovering independent living ability. Intermediate care provides appropriate treatment and intensive rehabilitation for elderly patients in a relatively short period after acute diseases to restore optimal health ,reduce readmission ,and return self-care ability as far as possible. Intermediate care can fill the gap between acute-term treatment and long-term care. This review is about the development of intermediate care ,the mode and the research of intermediate care in different countries ,equipment configuration and human resource allocation ,and the outlook for intermediate care.

Objective The multiple malformation of upper eyelid,including the excessive width of fold line,sunken and/or multiple folded upper eyelid are the common complications after blepharoplasty.The aim of this study was to investigate the clinical effect of orbital septum fat redistribution on correcting these deformities.Methods From September 2015 to September 2017,38 patients with multiple malformations of upper eyelid were treated.The incision of upper eyelid and the excessive skin was designed and resected.After completely relieving the scar adhesion zones,we set the lateral orbital septum fat free and transposed it to the inner side of orbital septum or superior border of tarsus with suturing fixation.Then we routinely completed the double eyelid operation.Results Thirty-eight patients with multiple malformations of upper eyelid were treated successfully.The patients were followed up for 6 months to one year,and the results were totally satisfactory.The operation was not performed again.Conclusions The orbital septum fat redistribution can successfully correct the multi ple malformation of upper eyelid.It should become a regular procedure in blepharoplasty.

Objective To investigate the expression and immune function of NOD2 signal in MyD88-/- mice. Methods MyD88-/- mice and wild-type C57 BL/6 mice were characterized by PCR. Mice model of pulmonary infection was constructed by tracheal instillation of BCG vaccine strain(attenuated strain of Mycobacterium). PBS tracheal instillation was used as negative control.Peripheral blood sample and lung tissue were collected aseptically 24 h after Mycobacterium challenge. Real-time PCR and Western blot were used to detect the expression of NOD2 gene and protein. IL-6 level in the peripheral blood was determined by enzymelinked immunosorbent assay. Results The expression of NOD2 protein in BCG infected mice was significantly higher than PBS negative control group. NOD2 protein expression in MyD88-/- mice was higher than in wild-type mice. BCG infection was associated with higher NOD2 protein expression than infection-free PBS control in both groups of animals. The IL-6 level in peripheral blood was significantly higher after BCG infection than PBS group in both MyD88-/- mice and wild type mice. Conclusions BCG can activate the NOD2 signaling pathway when MyD88-dependent pathway is deficient.

Objective:To construct an evaluation index system for the risk factors of peripheral venous indwelling catheter failure in adults.Methods:Through literature review, focus group interview method and Delphi method, an evaluation index system for risk factors of peripheral venous indwelling catheter failure in adults was established.Results:The recovery rate of the two round were both 100%; the authority coefficient was 0.939, the coordination coefficient was 0.452 and 0.315 respectively ( χ2=607.88, 502.45, P<0.05). Finally an evaluation index system for adult peripheral venous indwelling needle catheter failure risk factors including puncture factors, patient factors, indwelling needle placement factors, indwelling needle maitenance and withdrawal factors and 54 second-level indicators were formed. Conclusions:The construction of adult peripheral venous indwelling needle catheter failure risk factor assessment system is reasonable and comprehensive in content, which provides reference for clinical nurses to evaluate and prevent the failure of adult peripheral venous catheter failure.