Objective To investigate the epidemiological features of critical patients in our emergency rescue area.Methods The ages,genders,time distribution of entering and turning out,disease scores and mortality rates of 2987 critical care patients rescued in emergency department of our hospital in 2011 were retrospectively analyzed.Results Circulatory,neurological diseases and respiratory diseases were the top three critical diseases in the emergency department.More male cases were received than female cases.Senior citizens aged from 60 to 79 were the largest group needing rescue.The diseases contributed to the top three mortality rates were sudden death out of hospital,hematological diseases and respiratory diseases. Peak time of the rescuing were December and April of the year and 16:00 to 20:00 of the day.Conclusions Resuing critical care patients is the emphasis of the emergency department.Promptly solving fatal problems and sending patients to relevant units as soon as possible is the necessary.Given the main targets are elderly patients with cardiac or cerebrovascular diseases as well as respiratory diseases,emergency staff and resources should be arranged and assigned properly according to the distribution features of the critical patients.Rescue green channel of several fatal diseases could be built to establish cooperative teams and improve the success rate of rescuing.Health education should also be strengthened to promote the emergency treatment knowledge for the high risk population.

BACKGROUND:The number of complications after hip replacement, such as infection, implant loosening, fracture prosthesis wear, osteolysis, and recurrent dislocation, had drastical y increased. These complications would induce the increased occurrence of total hip revision.
OBJECTIVE:To analyze the causes and treatment measures of revision after total hip replacement. METHODS:The reasons for revision, the prosthesis selection, the treatment of bone defect and the postoperative rehabilitation were discussed in 33 cases after total hip replacement. The prosthesis for revision included general metal ring and lining (21 cases), large head and cup (8 cases), polyethylene cup (4 cases), general femoral components (15 cases, including 11 cases fixed by bone cement), and lengthening femoral components (18 cases, including 9 cases fixed by bone cement and 6 cases of combined components).
RESULTS AND CONCLUSION:Al 33 patients were fol owed up for 24-60 months, averagely 36.5 months. After revision, wound healed perfect, and the prosthesis was reliable. No case suffered from infection or dislocation. Hip joint function was greatly improved. Harris score was increased from 37.1 preoperatively to 91.3 postoperatively. Medium-or short-period clinical fol ow-up results demonstrated that if the indication of revision was right, bone defects were handled perfectly, prosthesis was chosen correctly, one-stage total hip revision can get a good clinical efficacy.

Objective To investigate the relationship of greyscale ultrasonographic signs and clinical pathological characteristics with axillary lymph node metastasis in invasive breast cancer.Methods Three hundred and thirty-five patients with pathologically confirmed breast cancer were retrospectively analyzed,which categorized into 2 groups,including lymph node metastasis group and lymph node non-metastasis group.The clinical and pathological characteristics included age,primary tumor size,histological grade,and molecular subtypes.The ultrasonographic features were examined including orientation,shape,margin,echo pattern,posterior acoustic feature,and calcification.Chi-Square test and Logistic regression analysis were performed to analyze the relationship of clinical pathological characteristics and greyscale ultrasonographic signs with axillary lymph node metastasis.Results Age (＜45 years),primary tumor size (≥2 cm),histological grade(Ⅲ grade),molecular subtype (Luminal B),and number of margin angulation (＞ 10) contributed to axillary lymph node metastasis in 335 cases,according to univariate analysis (P ＜0.05).Multivariate Logistic regression analysis showed age (OR =0.573,P =0.019),the primary tumor size (OR=2.359,P =0.001),histological grade (OR=0.529,P =0.008),and number of marginangulation (OR =1.889,P =0.031) were risk factors of axillary lymph node metastasis in breast cancer.Conclusions Univariate and multivariate analyses show the correlation between ultrasonographic features and axillary lymph node involvement.Combining with clinical pathological data,it can provide a predictor of axillary lymph node metastasis.

BACKGROUND:Many studies have demonstrated that restoration of femoral offset in revision total hip arthroplasty would contribute to the recovery of joint function.OBJECTIVE:To investigate the importance of restoration of femoral offset in revision total hip arthreplasty on the recovery of joint function.METHODS:An observational study was performed at the Department of Orthopedics,Third Affiliated Hospital of Guangzhou Medical University between February 2004 and May 2007.A total of 15 patients with the revision total hip arthroplasty,including 12 males and 3 females,aging 62 75 years,averaging 67 years old,were recruited into this study.Harris evaluation system was used to evaluate joint function.The femoral neck anteversion and the femoral offset were measured by the method of Sakai.The vertical distance from the teardrop line to the most prominent point of the lesser trochanter was measured from each radiograph.References were combined to investigate the effect of restoration of femoral offset in revision total hip arthroplasty on joint function.RESULTS AND CONCLUSION:All the 15 patients were recruited into this study.The duration of follow-up ranged from 24 months to 5 years.We measured the femoral offset on pre- and post-operative radiographs,and the results indicated that the femoral offset of 4 patients were above 4 mm.The femoral offset of 11 patients was restored.The femoral offset were 22-48 (32.21±0.64) mm pre- and 22-57 (36.13±0.82) mm post-operative radiographs,respectively.The mean difference in femoral offset post-operatively was significant (t=0.424,P=0.01 ).Harris scores were good in 4 cases,passable in 2 cases,and poor in 9 cases pre-operatively,and the scores were excellent in 8 cases,good in 4 cases,passable in 2 cases,and poor in 1 case post-operatively.The score of Harris evaluation system in the patient of restoration group and failed restoration group were 88.72±5.3 (80%) and 72.32±6.5 (27%) post-operative at 1 month respectively.The mean difference of the score was significant (χ~2=1.245,P<0.05).The 3 patients had complication,one was the dislocation of hip,and two had the pain of hip.All the patients with complication were in failed restoration of femoral offset,which was above 4 mm.The restoration of femoral offset contributes to the recovery of joint function and reduce complication occurrence after total hip arthroplasty revision.

Objective To study the doses and methods of F1 antigen(F1Ag) to immune Balb/c mice during the establishment of hybridoma cell strains. Secreting McAbs against F1Ag of Yersinia pestis. Methods Balb/c mice of seven to nine weeks old were randomly divided into six groups. The first four groups were 150, 100, 50 and 25 μg F1Ag inoculated group, having multipoint hypodermic inoculation of F1Ag of 150, 100, 50 and 25 μg followed by multipoint hypodermic inoculation of F1Ag of 100 μg for a second time and then intraperitoneal injection of 100 μg. Next, hypodermically inoculated group received F1Ag of 100 μg for three times in multiple points. Finally, the intraperitoneal injection group was intraperitoneally inoculated with F1Ag of 100 μg for three times. Emulsification liquid of F1Ag + Complete Frednd's adjuvant(CFA) of equivalence was used in the first inoculation, emulsification liquid of F1Ag + Incomplete Frednd's adjuvant(IFA) balanced mix in the second, F1Ag liquid in the third. One week afterwards, tail blood of the mice was collected to test antibody titers of anti-F1Ag by double antigens sandwich enzyme linked immunosorbent assay (DAgS-ELISA) and trace indirect hemagglutination assay(IHA). Results The levels of antibody of anti-F1Ag in 150,100,50 and 25 μg groups had statistics difference (DAgS-ELISA method: G = 12 173.87,13 440.37,15 024.19 and 4466.72, F= 3.11, P< 0.05;IHA: G = 19 972.32,18 089.40,23 170.47 and 4871.08, F = 4.11, P < 0.05). Immune effect of the 3 groups of 150, 100 and 50 μg was almost the same (P> 0.05), and excelled as compared with that in 25 μg group with statistics difference(DAgS-ELISA method: t = 2.18,2.39,2.73, P < 0.05;IHA: t = 2.54,2.73,3.13, P< 0.05). The titer of F1 antibody had an increasing trend from the 100 μg group to hypodermic group and intraperitoneal injection groups, but without statistics difference (DAgS-ELISA method: G = 8933.44, 9986.16, 13 440.37;IHA: G = 13 777.25,16 384.00, 18 089.40, F = 0.66,0.25, all P > 0.05). Conclusions Hyodermical inoculation of F1Ag with the first dose of 50 μg in multiple points for mouse is appropriate, and a strengthening dose of 100 μg in an intraperitoneal injection may shorten the immune period.

BACKGROUNDThe most appropriate surgical approach for patients with post-infarction left ventricular (LV) aneurysm remains undetermined. We compared the efficacy of the linear versus patch repair techniques, and investigated the mid-term changes of LV geometry and cardiac function, for repair of LV aneurysms.

METHODSWe reviewed the records of 194 patients who had surgery for a post-infarction LV aneurysm between 1998 and 2010. Short-term and mid-term outcomes, including complications, cardiac function and mortality, were assessed. LV end-diastolic and systolic dimensions (LVEDD and LVESD), LV end-diastolic and end-systolic volume indexes (LVEDVI and LVESVI) and LV ejection fraction (LVEF) were measured on pre-operative and follow-up echocardiography.

RESULTSOverall in-hospital mortality was 4.12%, and major morbidity showed no significant differences between the two groups. Multivariate analysis identified preoperative left ventricular end diastolic pressure > 20 mmHg, low cardiac output and aortic clamping time > 2 hours as risk factors for early mortality. Follow-up revealed that LVEF improved from 37% pre-operation to 45% 12 months post-operation in the patch group (P = 0.008), and from 44% pre-operation to 40% 12 months postoperation in the linear group (P = 0.032). In contrast, the LVEDVI and LVESVI in the linear group were significantly reduced immediately after the operation, and increased again at follow-up. However, in the patch group, the LVEDVI and LVESVI were significantly reduced at follow-up. And there were significant differences in the correct value changes of LVEF and left ventricular remodeling between linear repair and patch groups.

CONCLUSIONSPersistent reduction of LV dimensions after the patch repair procedure seems to be a procedure-related problem. The choice of the technique should be tailored on an individual basis and surgeon's preference. The patch remodeling technique results in a better LVEF improvement, further significant reductions in LV dimensions and volumes than does the linear repair technique. The results suggest that LV patch remodeling is a better surgical choice for patients with post-infarction LV aneurysm.

Aged ; Female ; Heart Aneurysm ; etiology ; mortality ; surgery ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; complications ; mortality ; surgery ; Ventricular Remodeling

Objective To investigate uncertainty in illness state and its influential factors in patients with lung cancer. Methods A total of 280 hospitalized patients with lung cancer were evaluated with the scales of the demographic data and the Mishel's Chinese version of uncertainty in illness. Results Totally 280 qualified questionnaires were obtained, and the rate for response was 93. 3%. The total score of the uncertainty in illness was (105.15?2. 66); There was a significant difference of the score of the uncertainty in illness among different occupation groups, smoking status, self-uncomfortable level of disease groups, self-knowing of suffering from lung cancer groups, different treatment groups, different degree of social support groups, different religious belief groups; Religious beliefs influent the sense of uncertainty in illness in Patients with Lung Cancer. Conclusions There is a high degree of uncertainty in illness in patients with lung cancer; Lung cancer patients with different features have different levels of uncertainty in illness; Religious beliefs influent the sense of uncertainty in illness in Patients with Lung Cancer.

In this article, we presented the rationale and calculation procedures of the propcnsity score matching (PSM), and its application in the designing stage of an cpidcrniological study. Based on existing observational data, PSM can be used to select one or more comparable controls for each subject in 'treatment' group according to the propensity scores estimated by 'treatment' variable and main covariates. The results of an example analysis showed that the bias for main confounders between the treated and control samples declined more than 55% after PMS. Conclusion: PSM can reduce most of the confounding bias of the observational study, and can obtain approximate study effect to the randomized controlled trials when used in the designing of thc cpidcmiological study.

BACKGROUND: This study was undertaken to validate the use of the modified early warning score (MEWS) as a predictor of patient mortality and intensive care unit (ICU)/ high dependency (HD) admission in an Asian population. METHODS: The MEWS was applied to a retrospective cohort of 1024 critically ill patients presenting to a large Asian tertiary emergency department (ED) between November 2006 and December 2007. Individual MEWS was calculated based on vital signs parameters on arrival at ED. Outcomes of mortality and ICU/HD admission were obtained from hospital records. The ability of the composite MEWS and its individual components to predict mortality within 30 days from ED visit was assessed. Sensitivity, specificity, positive and negative predictive values were derived and compared with values from other cohorts. A MEWS of ≥4 was chosen as the cut-off value for poor prognosis based on previous studies. RESULTS: A total of 311 (30.4%) critically ill patients were presented with a MEWS ≥4. Their mean age was 61.4 years (SD 18.1) with a male to female ratio of 1.10. Of the 311 patients, 53 (17%) died within 30 days, 64 (20.6%) were admitted to ICU and 86 (27.7%) were admitted to HD. The area under the receiver operating characteristic curve was 0.71 with a sensitivity of 53.0% and a specificity of 72.1% in addition to a positive predictive value (PPV) of 17.0% and a negative predictive value (NPV) of 93.4% (MEWS cut-off of ≥4) for predicting mortality. CONCLUSION: The composite MEWS did not perform wel in predicting poor patient outcomes for critical y il patients presenting to an ED.

Bone remodeling is balanced by bone formation and bone resorption as well as by alterations in the quantities and functions of seed cells, leading to either the maintenance or deterioration of bone status. The existing evidence indicates that microRNAs (miRNAs), known as a family of short non-coding RNAs, are the key post-transcriptional repressors of gene expression, and growing numbers of novel miRNAs have been verified to play vital roles in the regulation of osteogenesis, osteoclastogenesis, and adipogenesis, revealing how they interact with signaling molecules to control these processes. This review summarizes the current knowledge of the roles of miRNAs in regulating bone remodeling as well as novel applications for miRNAs in biomaterials for therapeutic purposes.