Objective To investigate the characteristics of clinical course in elderly patients and young-mid-dle-aged patients with upper gastrointestinal hemorrhage. Methods 417 hospitalized patients were divided into eld-edy group (≥60 yrs,198 cases) and young-middle-aged( <60 yrs,219 cases). All patients were diagnosed upper gastrointestinal hemorrhage by endoscopy. Results Endoscopy diagnosis included the first common cause to upper gastrointestinal hemorrhage was peptic ulcer, whereas more gastric ulcer were seen in elderly patients and more duo-denal ulcer were seen in young-middle-aged patients(23.7% vs 12.8%, 39.7% vs 21.7%, P <0.01). More eld-erly patients had a history of using Aspirin or NSMDs (17.1% vs 5.0%, P <0.01). The number of circulatory fail-ure and blood transfusion necessary were significantly increased, the mean duration of hospital stay was longer in eld-erly group than in young-middle-aged group(P<0.05). Conclusion The elderly patients have a more complicated clinical course than those young-mlddle-aged patients. Endoscopy is a necessary and effective method for both diagno-sis and treatment.

Objective To investigate the effects of aerosolized Dexamethsone inhalation on circulatory and respiratory function during lung injury (ALI) induced by hydrochloric acid (HCI) aspiration.Methods Twenty-four healthy pigs of either sex,weighting (15.5±2) kg were anesthetized with intraperitoneal injection of pentobarbital sodium 50mg/kg and intubated and mechanically ventilated (FiO2=1.0,VT=10-15 ml/kg,RR=16bpm,I:E=1:2).Anesthesia was maintained with infusion of Ketamine,procaine and succinylcholine.Femoral artery was cannulated for MAP monitoring and blood sampling.Swan-Ganz catheter was placed in the pulmonary artery via right inexternal jugular vein.Dilute HC1 (0.1mol/L) was instilled via trachea into lungs until PaO2 was＜13.3kPa.Arterial blood gases,MAP,MPAP and dynamic compliance were measured before induction of ALl (T0),when ALI was induced (T1) and 1,2,3 and 4(T2～5)there after.The pigs were then divided randomly into three groups according to the treatment they received:group A received IPPV alone,group B IPPV+PEEP(0.69kPa) ,group C IPPV+PEEP(0.69kPa)+aerosolized Dexamethasone (12.5ugokg-loh-I).Results MAP decreased significantly after induction of ALI in three groups hut there was no significant difference in MAP among the three groups (P＞0.05).MPAP increased significantly after induction of ALI in all groups and remained high during the period of T2～5 in group A and B (P＞0.05),hut decreased significantly from T2 in group C (P＜0.05 ).PaO2 increased significantly during the treatment in group B、C(P＜0.05),and was significantly higher in group C than that in group B (P＜0.05).PaCO2 in group A was highest in three groups (P＜0.05) and group C was lower in three groups (P＜0.05).Dynamic lung compliance decreased in all animals after induction of lung injury (P＞0.05),but was gradually increasing significantly during treatment(B、C group) (P＜0.05).Conclusion Aerosolized Dexamethasone inhalation can improve respiratory function during ALI induced by HC1 aspiration and reduce pulmonary hypertension,but dont impair MAP.Both have the same effects on the treatment of lung injuries.

OBJECTIVE: To understand the research on the development and application of non-fusion inter-spinous stabilization devices.DATA SOURCES: Using the key terms of "inter-spinous and low back pain", relevant articles on non-fusion inter-spinous stabilization devices and low back pain in English were retrieved from Medline between January 1966 and October 2004 and the Ovid database between January 2003 and June 2007.STUDY SELECTION: Titles and most abstracts of all articles on the types of non-fusion inter-spinous stabilization devices and action mechanisms of non-fusion inter-spinous stabilization devices were selected. Duplicated researches and meta analytic papers were excluded.DATA EXTRACTION: A total of 351 articles met the inclusion criteria and 322 were excluded. Among them, 29 papers were analyzed. The major exclusion factor was duplicate studies.DATA SYNTHESIS: Non-fusion inter-spinous stabilization devices can improve mechanism of low back pain and cause certain effects on the biodynamic environment of degenerative lumbar vertebrae, such as relieving loading of the posterior border of the anulus fibrosus of the intervertebral disc and opening the intervertebral foramen. At present,non-fusion inter-spinous stabilization devices, such as X-STOP, Wallis and DLAM, have been tested for a long time;therefore, the effects of their effectiveness, utility and risk of complications will be proved by clinical experiments as soon as possible.CONCLUSION: Non-fusion inter-spinous stabilization devices have good effects on the treatment of degenerative low back pain originating in the anulus fibrosus of the intervertebral disc and can reduce complications caused by the fusion technique.

OBJECTIVE: To investigate the selections of radionucide and vehicle and the indications, contraindications, complications and cautions of radiation synovectomy in clinical applications; meanwhile, to provide valuable references for clinical application of radiation synovectomy.DATA SOURCES: Of 277 articles which have the word "radiation synovectomy" or "radiosynovectomy" were searched out from PubMed database without limitations.STUDY SELECTION: All the titles and most abstracts of the articles were reviewed. A total of 58 articles were selected by the standard of having close relations with radionucide, vehicle and radiation synovectomy. Then the full texts were searched in other available databases, especially in "OVID" and "ScienceDirect".DATA EXTRACTION: The last articles and articles published in authority journals were chosen for further read, and 41 articles were obtained.DATA SYNTHESIS: Recently, the hot topic of radionucide is detailed as follows: Firstly, selection of vehicle. Till now, silicate, citrate, Ca oxalate, ferric hydroxide macroaggregate (FHMA), hydroxyapatite (HA), polylactic acid (PLA), sulfur colloids, microspheres, etc. Have been the most widely used vehicles. The usage of a good vehicle is to control the size and stability of the radiopharmaceutical, and decrease its leakage from the joint. Secondly, it should contain radiopharmaceuticals of nuclein and vehicle. An ideal radiolabeled radiopharmaceutical for radiation synovectomy should meet the following requirements: ① it should be sufficiently small to be phagocytized, but not so small that it might leak from the joint before being phagocytized, the appropriate size range is usually considered to be from 2 to 10 μm; ② the binding between the radionuclide and the vehicle should be irreversible throughout the course of the radiotherapy, which, in turn, is determined by the physical half-life of the radionuclide; ③ the radiolabeled particles should be distributed homogeneously in the joint without initiating an inflammatory response; ④ the half-life of the vehicle should be longer than that of the nuclide it combines,and the vehicle should be biodegradable, so that it can be eliminated out of the body after therapy; ⑤ good stability and low cost are also very important features. Thirdly, Radiation synovectomy is an effective method to treat chronic arthritis.CONCLUSION: With careful nuclide and indication selection and correct operation, radiation synovectomy is a clinically useful, safe, and cost-effective outpatient procedure in the treatment for many kinds of joint disease.

OBJECTIVE: Radiculopathy is a common disease in orthopedics,clinically manifested chiefly by pains in the regions innervated by the spinal nerve involved. Since the etiology is complex,either surgical or non-surgical interventions can be adopted accordingly. This study reviewed recent relevant reports to explore the etiology and therapy of radiculopathy.DATA SOURCES: A computer-based search were carried out in Medline database for related articles published between January 1999 and August 2004 using the key words of "nervi spinales,pain,therapy" with language of the text limited to English. A computer-based search of Chinese periodical database,Wanfang Digital Database was also conducted for articles published in Chinese between January 1999 and December 2004 with the same searching words in Chinese language.STUDY SELECTION: Original studies of the etiology,pathogenesis and treatment of radiculopathy.DATA EXTRACTION: Totally 22 articles related to the etiology,pathogenesis,surgical treatment,minimal invasive and interventional treatment,as well as non-surgical treatment for radiculopathy were collected.DATA SYNTHESIS: Cervical,lumbar and back pains are the most common clinical manifestations of radiculopathy,induced by mechanical compression and chemical stimulation due to different etiologies. In clinical practice,surgeries or alternative non-surgical treatment can be adopted according to the etiology,the choice of which depends on,therefore,a thorough knowledge of the etiology and therapy of radiculopathy.CONCLUSION: The key for achieving favorable outcome of the patients with radiculopathy lies in correct recognition of the etiology and proper therapeutic decisions.

MR appearance of brain metastases from 33 cases of lung carcinoma was reported. The lesions were mainly localized in the cerebrum associated with edema in varying degrees. Squamous cell carcinoma had a tendency to cystic degeneration and adenocarcinoma to bleeding. The low signal rings around the bleeding locus were irregular in T2WI imaging. Enhanced MR could find the lesions that noncontrast-enhanced MR could not. From the above, it was concluded that MRI had an important value in the imaging diagnosis of brain metastases from lung carcinoma.

With the increasing incidence of pelvic fractures, the concept of damage control was applied to the treatment of severe pelvic fractures, and the principle of phased treatment and indications were put for-ward. Meanwhile, the development of damage control surgery, which improves the survival rate and reduces the disability rate of patients, brings the treatments of pelvic fractures to a new stage.

DNA double-strand breaks(DSBs) repair protein XRCC4,plays an important role in the genesis and development of tumor,there are many different aspects in the tumor genesis and development.This paper reviews the molecular mechanism of XRCC4 in repairing DSBs,several theories of tumor genesis and development,and the relationship between XRCC4 gene's single nucleotide polymorphisms(SNPs) and tumor.

The efficacy and safety of pioglitazone in combination with insulin in type 2 diabetic patient were evaluated. CENTRAL, MEDLINE, EMBASE, CBM, CNKI(up to September 2014) were searched by computer. The quality of included randomized controlled trials(RCTs)was assessed according to the Cochrane Collaboration system review, and then meta-analysis was performed using Stata 12. 0. A total of 9 RCTs were included. The results of meta-analyses showed that HbA1C value was lower in the group taking pioglitazone plus insulin than in the group taking insulin without pioglitazone[standard mean difference -0. 48, 95% CI( -0. 55, -0. 40),I2 = 0. 0% ,P = 0. 531], but there were more patients with hypoglycaemic in the pioglitazone plus insulin groups than with insulin without pioglitazone[relative risk 1. 33, 95% CI(1. 21, 1. 46), I2 =75. 4% , P=0. 00].

Histone deacetylases inhibitors(HDACIs)are a group of compound regulating gene expression at transcriptional level.HDACIs can induce protein hyperacetylation and subsequently lead to chromatin remodeling,cell-cycle arrest,cell differentiation and apoptosis,and transcriptional activation and repression.HDACIs demonstrate promising antitumor activity and are presently tested in clinical studies for solid and hematologic malignancies.Cumulating evidence in animal models of immune disorders also suggests immunosuppressive properties of HDACIs,which provides us with new ideas for treating immune disorders and rejection after transplantation.This paper reviews the recent progress of immunosuppressive function induced by HDACIs from the following aspects:immune diseases,T lymphocytes,inflammatory cytokines and dendritic cells.