Objective To study the effects of electroacupuncture (EA) on the elderly's postoperation cognitive dysfunction (POCD) after general anesthesia.Methods Patients who need to have surgical operation done for lumbar spinal stenosis were randomly divided into an observation group (electroacupuncture and routine intravenous anesthesia) and a control group (only routine intravenous anesthesia),and EA was administered to those in the electroacupuncture group for 30 minutes at an interval of 10 minutes,beginning at 30 minutes prior to routine intravenous anesthesia and lasted till the end of the surgery.The differences regarding intraoperative propofol and remifentanil dosage,cognitive function,the levels of serum interleukin-6(IL-6),interleukin-10 (IL-10) and S100-β were compared.Results The intraoperative propofol and remifentanil dosages in observation group were (6.54 ± 3.27) μg/(kg· h) and (3.67 ± 2.53) mg/(kg· h),respectively,while those in control group were (9.70 ± 4.82) μg/kg and (5.62 ± 1.73) mg/kg.The intraoperative propofol and remifentanil dosages in observation group were significantly lower than those in control group (P ＜ 0.05).At 72 hours post-operation the incidence of POCD in observation group was significantly lower than that in control group (1 case,2.5％ versus 8 cases,20％),while the MMSE score was higher in observation group than that in control group (25.7 ± 1.9 versus 23.2 ± 2.1).The post-operation level of serum IL-6,IL-10 and S100-β in observation group were significantly lower than that in control group (P ＜ 0.05).Conclusion Electroacupuncture could significantly improve the elderly's postoperation cognitive dysfunction after general anesthesia.It could inhibit the excessive expressions of IL-6,IL-10 and S100-β,alleviate the brain damage and reduce the incidence of POCD.

Melioidosis is a endemic infectious disease caused by Burkholderia pseudomallei, and is considered one of the major causes of fatal pneumonia and sepsis.This paper reports diagnosis and treatment course of one case pulmonary melioidosis, and reviews the related literatures, so to improve clinical workers'' understanding towards melioidosis, avoid misdiagnosis and missed diagnosis.

Objective To explore the feasibility of tibial nerve motor branches transfer to the deep fibular nerve in an anatomical study.Methods Twenty-three sides lower limbs from 12 adult cadavers which preserved in Formalin were used for dissection of the tibial nerve and its all motor branches,and the proximal deep and superficial fibular nerve.Experimental measurement were performed for the parameters of each branch such as length,diameter,the location of original point relative to the level of the fibular head.The diameter of proximal part of the deep fibular nerve was measured simultaneously.Finally,the length from original point of each branch to the fibular neck was also measured during simulation of nerve transfer procedure.Results The average length of motor branches to the flexor digitorum longus muscle,to the flexor hallucis longus muscle and the superficial branches to the soleus muscle were (95.70 ± 13.40)mm,(96.90± 13.60)mm and (73.60 ± 12.00)mm respectively.Their average diameter were (0.63 ± 0.16)mm,(0.65 ±0.20)mm and ( 1.56 ± 0.26)mm respectively.The average diameter of proximal deep fibular nerve was (2.54± 0.26)mm.Based on length,branches to the flexor digitorum longus muscle and flexor hallucis longus muscle were adequate for direct nerve transfer to the deep fibular nerve in all specimens without interpositional grafr.And in 22 specimens (95.7 percent),the superficial branches to the soleus muscle were long enough to directly transfer.Other branches of the tibial nerve were not adequate for direct nerve transfer Conclusion This study confirmed the anatomical feasibility of using motor branches from tibial nerve for direct transfer to restore the deep fibular nerve.The superficial branches to soleus muscle were the best donor nerve if considering the branches,length,diameter and the difficulty of surgical procedures.

Objective To study the optimum combination of orientation parameter of total hip prosthesis and acetabular safe zone on condition that the range of motion for activities of daily living (ADL) is fulfilled.Methods A three-dimensional generic parametric and visually kinematic simulation module of THA was developed.Range of motion ( ROM ) of hip flexion ≥ 110°,internal-rotation ≥30° at 90° flexion,extension ≥30° and external rotation ≥40° were defined as the normal criteria for ADL.ROM of hip flexion ≥ 120°,internal-rotation ≥45° at 90° flexion,extension ≥30° and external rotation ≥40° were as the severe criteria.The ranges of changes in general ratios (GRs) of head-neck,femoral neck antevemion ( FNA ),operative inclination (OI) and anteversion (OA) of acetabulur components were 2.0-2.92,0°-30°,10°-60°,and 0°-70° respectively.Within the limits of the upper two activity criteria,the synchronous OA of acetabulur components was calculated with every 5°change in OI of the cup,and the collodiaphyseal angle ( CDD ) was set as 135°.The safe-zone of combination of acetabulur operative anteversion (OA) and inclination (OI) was defined as the area that fulfilled the two mentioned criteria of ROM without cup-neck impingement.All parameters were analyzed by using SAS 6.12 software.Results The safe zone of acetabdar angle rose with the increase of GRs of head-neck and the safe zone of severe criteria was smaller than that of normal criteria.When the CDD angle was 135°,the sum of average aeetabular OA and acetahular OI plus 0.816 times of the FNA equaled to 84.76° innormal criteria; and the sum of average acetabular OA and acetabular OI plus 0.873 times of the FNA equaled to 92.04° in severe criteria.Conclusions A high GR of head-neck greatly increases the size of safe-zone of acetabular angle.The higher demand of ROM of hip joint requires the smaller safe zone of acetabular angle,as can be corrected by increasing the GR of head-neck.The optimum combination between the sum of average acetabular OA and acetabular OI ( Y) plus FA (X)in the normal criteria and severe criteria can be estimated by using the following formulae:Y1 =-0.816X1 + 84.76 (R2 =0.993 ),Y2 =-0.873X2 + 92.04( R2 =0.999) respectively.

BACKGROUND: Aromatic polyester can not be used alone as degradable material due to its poor biodegradation. In the School of Materials Science and Engineering, Nanchang University, aromatic/aliphatic copolyesters, a new kind of degradable biomaterial is synthesized by melt co-polycondensation and transesterification of terephthalyl chloride, bisphenol A, hexanediol as well as low lacticacid polymer, which has been patented. OBJECTIVE: To study the biocompatibility between aromatic/aliphatic copolyesters and bone marrow mesenchymal stem cells (BM-MSCs) in rats. DESIGN, TIME AND SETTING: An in vitro cellular-materials experiment. The experiment was performed at the Institute of Urology, the First Affiliated Hospital of Nanchang University between April 2006 and April 2007. MATERIALS: Five healthy, adult, male, Sprague Dawley rats were provided by the experimental animal center of Jiangxi University of Traditional Chinese Medicine. The bio-degradable polyester was aromatic/aliphatic copolyesters prepared by our group. METHODS: A new degradable biomaterial poly (4,4'-isopropylidenediphenyl terephthalate)-co-poly(hexylene terephthalate)-co-polylactide (PBHTL) was prepared into biomembrane by casting method. Simultaneously, polyvinyl chloride biomembrane was prepared with the same method. The leaching liquor of biomembrane was collected when the biomembranes were sterilized and immersed in culture medium. The BM-MSCs of rats with the 3~(rd) or 4(th) passage were incubated at the 96-well plates with density of 2×10~7/L and at 24-well plate with 1.3×10~5 per well. The experiment divided into 3 groups. In the negative control group, cells were cultured with DMEM. In the experimental group, 12.5%, 25%, 50%. 100% material leaching liquor were additional added based on DMEM. In the positive group, polyvinyl chloride leaching liquor was added except DMEM. MAIN OUTCOME MEASURES: The cytotoxicity of material was evaluated by neutral red uptake assay, basic fuchsin staining and MTT method. Growth of BM-MSCs on aromatic/aliphatic copolyesters membrane was estimated by electron microscope. RESULTS: The cell viability and metabolic capability were decreased 11%-16% in the positive control group at days 1, 3, 5, and 7 after culture. The absorbance value of the experimental group was significantly different from the positive control group (P < 0.001), which increased cell viability and metabolic capability with time prolonged (1%-4%). However, there was not obviouslydifference between the experimental group and negative group in absorbance value (P> 0.05). Acridine orange/ethylene dibromide staining showed that the BM-MSCs attached and grew in spindle-like manner on the surface of aromatic/aliphatic copolyesters biomembrane, which increased cell number with decreased apoptosis rate with time prolonged. CONCLUSION: The results demonstrated that aromatic/aliphatic copolyesters membrane has no eligible cytotoxicity to cell growth with good cell compatibility, which meets the requirements for applied biomaterials.

Objective To observe the infection prevention, wound healing effect and safety of nanometer silver in treatment of Ⅱ degree burn wound. Methods The patients with 6%-10% TBSA Ⅱ degree burn wound ( deep or superficial) were randomly divided into test group ( treated with nanome-ter silver, n =35) and control group (treated with 1% sulfadiazine silver, n =35). Each group was reg-ulated to change dressing and medication one time a day for seven days on 5% superficial Ⅱ degree burn wound. Then, 1% iodophors and gauze were used for change dressing. Before and after change dressing, bacterial culture was done in two groups to observe the time for wound healing. The blood collected before change dressing and at days 1,7 and 14 after change dressing and urine within 24 hours were employed for detecting serum silver level and mean silver level in urine by using inductively coupled plasma mass-spec-trum ( thermoelectricity of American Ⅹ Series Ⅱ ). In the meantime, the liver and renal function was e-valuated at days 7 and 14. Results Positive rate of bacterial culture in test group and control group was 3% and 3.1% respectively after treatment, which showed a decrease compared with the levels before treatment (12. 1% and 15.6% respectively), with no statistical difference. The wound healing time of test group was (9. 18 ± 1.9) days, which was shorter than ( 12.9 ± 1.3 ) days in control group, with sta-tistical difference (P<0.01). Before treatment, the silver level of blood was ( 1.55 ± 1.26) μL and ( 1.54 ± 1.28 ) μg/L respectively in test group and control group, and silver level of urine within 24 hours was ( 1.67 ± 1.05 ) μg and ( 1.87 ± 1.37) μg respectively test group and control group, with no statistical difference (P > 0. 05 ). Silver medication could elevate the serum silver level ( P < 0.01 ), with lower level in test group than control group (P <0. 01 ). Average silver level of urine within 24 hours showed similar change with that in the serum. The patients showed normal renal function, with no abnormal change of ALT. Conclusions For Ⅱ degree burn wound, nanometer silver can more significantly short-en wound healing time compared with sulfadiazine silver. Moreover, nanometer silver has higher degree of safety on silve metabolism and is an ideal medcation for burn wound.

OBJECTIVETo observe the effectiveness of xenogenic(porcine) acellular dermal matrix grafting with thin autogenic skin on deep wounds with good wound-bed.

METHODS52 cases of patients with deep wounds were transplanted with xenogenic(porcine) acellular dermal matrix grafting and thin autogenic skin by two step method from Jan. 2000 to Feb. 2002.

RESULTS37 cases of patients achieved complete take(71.1%) and 15 cases got 95 percent take (28.9%) with none needing grafting again. 3-6 months' following up showed that skins of complex grafting had well-acceptable color and quality compared to nearby skin.

CONCLUSIONThis kind of xenogenic(porcine) acellular dermal matrix can be widely used on deep wounds with good wound bed as complex graft.

Adolescent ; Adult ; Animals ; Child ; Child, Preschool ; Dermatologic Surgical Procedures ; Dermis ; transplantation ; Female ; Humans ; Infant ; Male ; Middle Aged ; Skin ; injuries ; Skin Transplantation ; methods ; Swine ; Transplantation, Autologous ; Transplantation, Heterologous ; Wound Healing ; Wounds and Injuries ; surgery

Objective:To search, evaluate and integrate the best evidence for lactation maintenance of very low birth weight infant(VLBWI) mothers, and to provide evidence for lactation maintenance.Methods:Up to Date, BMJ best practice, Newborn Services Clinical Guidelines, ABM, NICE, OVID evidence-based database, NGC, Joanna Briggs Institute Library, Cochrane Library, Web of Science, PubMed, CNKI, CBM and Wanfang Data were retrieved by computer on the Maintenance of Mother′s Lactation in VLBWI: Guidelines, Systematic Evaluation, Expert Consensus/Opinions, Evidence Summary Literature screening, quality evaluation, evidence extraction and integration of documents which met the requirements.Results:A total of 10 articles were included, including 3 guidelines, 4 systematic reviews, 1 expert consensus and 2 expert opinions. A total of 41 evidences were summarized from 9 aspects, including lactation support, lactation initiation, lactation monitoring and the application of lactating agents.Conclusion:The evidence of lactation maintenance of VLBWI mothers is sufficient, which can provide a basis for medical staff to make clinical decisions.

Tyrosine kinase inhibitor(TKI) combined with surgical treatment is the optimal strategy for gastrointestinal stromal tumors(GIST). However, there is no systemic report about the complicated GIST(recurrence or metastasis, peritoneal dissemination, combined resection of multiple organs), except the cases review and experimental studies. Tyrosine kinase inhibitor combined with surgery may increase the overall survival of complicated GIST. This article will describe the definition, clinical features, surgical and drug therapy, and prognosis, in order to provide reliable theoretical basis and experience for clinical doctors, prolong patient survival and improve the quality of survival.
Gastrointestinal Neoplasms ; Gastrointestinal Stromal Tumors ; Humans ; Peritoneum ; Prognosis ; Protein Kinase Inhibitors

OBJECTIVE To study the mechanism of drug-resistance of multi-resistant Pseudomonas aeruginosa,and provide the guideline for treatment and control of P.aeruginosa infection in hospital.METHODS Fifty strains of multi-resistant P.aeruginosa were selected with K-B susceptibility method.The three-dimensional method was taken to differentiate the various beta-lactamases.The relative drug-resistance gene was detected by polymerase chain reaction(PCR).RESULTS Among 50 strains of multi-resistant P.aeruginosa,there were 2 strains(4%)producing ESBLs,20 strains(40%)producing AmpC beta-lactamases,and 11 strains(22%) producing ESBLs and AmpC beta-lactamases at the same time.There were 8 positive genes in the detected drug-resistance gene,the most common sources of gene were CTX(56%),OprD(60%) and aac(6′)-Ⅱ(60%),respectively.CONCLUSIONS The main beta-lactamases are AmpC beta-lactamases and the main genotype is CTX in the multi-resistant P.aeruginosa cultured in our area.The main course of imipenem-resistance was deletion of outer membrane proteins,and the aminoglycoside modifying enzyme gene and disinfectant-resistance gene in multi-resistant P.aeruginosa are acquired.In order to reduce the drug-resistance strains and control the infection of P.aeruginosa,antibiotics should be used reasonably according to drug susceptibility testing clinically.