OBJECTIVETo explore the effect of recombinant human parathyroid hormone 1-34 [rhPTH(1-34)] on bone regeneration rabbit mandible during distraction osteogenesis (DO).

METHODS40 Japanese white rabbit (weight 2.0-2.5 kg) were randomly divided into control group and groups. The experimental groups were divided inito 12.5, 25 and 50 µg/kg group according to the dosage of rhPTH (1-34) in each group. Each group involved 10 rabbits, and unilateral DO models were established at the right mandible of the rabbits. From the first day of distraction to the day of execution, the rabbits in the experimental groups were injected subcutaneously rhPTH (1-34) of the corresponding dose respectively, and the rabbits in the control group were injected subcutaneously 2% heat inactivated rabbit serum 1 ml respectively.. Five rabbits in each group were executed respectively at 1 week and 3 weeks after completion of distraction, and the specimens of DO were harvested. The gross observation, X-ray examination, and histological study were performed.

RESULTSGross appearance: At the first week of consolidation, the dense and opaque white tissue was seen in the distraction gap of the 50 µg/kg group, and the white translucent tissue was seen in the distraction gaps of the rest groups. At the third week of consolidation, the greyish white tissue was seen in the distraction gap of the control group, while the cartilage-like tissue was seen in the buccal side of the distraction gap of the 12.5 µg/kg group, the color of new-formed tissues was close to that of normal bone tissue in the lingual side. The buccal tissue at the edge of the distraction gap of the 25 µg/kg group fitted together with the primary bone tissue in its two sides. It was difficult to distinguish the boundaries between the distraction gap and the bone tissues in its two sides in the 50 µg/kg group. X-ray findings: At the first week of consolidation, a sparse opaque image was seen in the distraction gap of the 50 µg/kg group, and a low-density image was seen in the distraction gap of the rest groups. At the third week of consolidation, a sparse bone image was seen in the control group, and the edge of the bone was not continuous. With the increase of the dose in the experimental groups, the image of the distraction gap became more and more opaque, and the image of the distraction gap in the 50 µg/kg group was close to that of the normal bone tissue. HISTOLOGICAL FINDINGS: At the first week of consolidation, few osteoblasts were present at the edge of the distraction gap of the control group. A large number of bone cells and bone trabecular were present in the distraction gap of the 12.5 µg/kg group, the network of the bone trabecula was present in the 25 µg/kg group, and a few new bones were found in the 50 µg/kg group. At the third week of consolidation, the network of the trabecular bone was present in the distraction gap of the control group, while the network of the bone trabecula was present in the 12.5 µg/kg group, a lot of bone-like tissues in the 25 µg/kg group, and near-mature bone in the 50 µg/kg group.

CONCLUSIONSrhPTH(1-34) can promote the formation of new bone in the distracted gap during mandibular DO in rabbits.

Animals ; Bone Density ; Bone Regeneration ; drug effects ; physiology ; Humans ; Mandible ; drug effects ; surgery ; Osteogenesis, Distraction ; methods ; Parathyroid Hormone ; pharmacology ; Rabbits ; Random Allocation ; Recombinant Proteins ; pharmacology

Objective To evaluate the relationship between fragile fracture sites in hospitalized geriatric and nutritional status.Methods On the basis of whether the fracture,293 cases were divided into fracture group(n =140)and normal control group(n =153),51 males(36.4%)and 89 females(63.6%)in 140 fracture patients. Results The age was (74.04 ±8.58)years in the fracture group,that in the normal control group was (74.77 ± 8.14)years,there was statistically significant difference between the two groups(t =-0.743,P >0.05).The femoral neck fracture was 51 cases(36.4%)and intertrochantetic fracture was 57 cases(40.7%),and other was 32 cases (22.8%).The patients were divided into the two groups according to the age:60 ~75 years group(n =62)and >75 years group(n =78),femoral neck fracture was 37.2%,and intertrochantetic fracture was 52.6% in the group that more than 75 years old,which were 35.5% and 25.8%,respectively in 60 ~75 years group,there was statistically significant difference between the two groups(χ2 =18.337,P <0.01).The hemoglobin,serum albumin weight,weight,BMI in the fracture group were (117.44 ±20.25)g/L,(34.96 ±4.95)g/L,(60.81 ±10.63)kg,(22.83 ±3.54)kg/m2 , and those in the normal control group were (136.99 ±17.10)g/L,(37.27 ±5.85 )g/L,(64.47 ±11.23)kg, (24.24 ±3.88)kg/m2 respectively.The commonly used nutritional indicators:hemoglobin(t =-8.908),serum albu-min(t =-3.619),weight(t =-2.837)and BMI(t =-3.218)were lower than the normal control group(all P <0.01 ),serum phosphate was lower than the normal control group,the difference was statistically singnificant (t =-2.047,P <0.05).The blood calcium(t =0.630)and ALP(t =-0.550)had no statistically singnificant differences between the two groups(all P >0.05).Conclusion The proportion of intertrochantetic fracture and femo-ral neck fracture were higher in hospitalized elderly patients,and malnutrition,such as lower hemoglobin,lower serum albumin,lower weight,and lower BMI were,important factors in the fragile fracture in the geriatric inpatients.

Objective To explore the effect of individual rehabilitation nursing guidance on the initiative of rehabilitation therapy of spinalcord injury patients. Methods 50 spinal cord injured patients were divided into conventional group (group A) and individualized group(group B). Group A was given conventional rehabilitation nursing guidance. Group B was given special rehabilitation nursing guidance consideringthe patients' and their families' requirement. Initiative of rehabilitation therapy was assessed between group A and group B beforeand 2 months after intervention. Results Group A had no significant increasing of initiative assessment score (P<0.05) 2 months, while theinitiative assessment score of group B increased significantly (P<0.01), even group B was better than group A (P<0.05) after the intervention.Conclusion Individual rehabilitation nursing guidance may facilitate to improve the initiative of SCI patients.

Objective To explore the effect of nursing intervention on the hyponatremia after cervical spinal cord injury. Methods 60 patients with the hyponatremia after cervical spinal cord injury were divided into a control group (n=30) and a nursing intervention group (n=30). The control group was just given a general treatment on hyponatremia, while the nursing intervention group was given a systematic nursing intervention of hyponatremia by the duty nurse concerned. The serum sodium value and the course of disease of the two groups were both analyzed a month after nursing intervention. Results Compared with the control group, the value of serum sodium in the nursing intervention group got a significant rise with a shorter course and a less relapsed cases (P<0.01). Conclusion Nursing intervention may improve the hyponatremia after cervical spinal cord injury.

Anniversaries and Special Events ; Pediatrics ; Periodicals as Topic

BACKGROUND: Encopresis after operation for congenital.ectopic anus can cause psychological, physiological and social ability disorders.OBJECTIVE: To treat the children with encopresis with biofeedback training so as to improve the function of post-operative defecation.DESIGN: A self-controlled trial.SETTING: Department of Pediatric Surgery, Second Clinical College of China Medical University.PARTICIPANTS: Totally 20 cases of encopresis after treatment with operation for ectopic anus,were recruited from the Department of Pediatric Surgery, Second Clinical College of China Medical University, between January 1998 and October 2004. Among them, there were 4 cases of complete encopresis, 7 cases of loose encopresis and 9 cases of blotch. All the cases were followed up. There were 9 cases of ectopic anus in the middle and lower parts, and 11 cases of ectopic anus at the high part.METHODS: The objective measuring methods of biofeedback training such as anorectal pressure and anus sphincter electromyography were used to train the patients with postoperative encopresis. After one-month self-directed training in anus contraction and defecation habit, the children received proper biofeedback training. ① Biofeedback training to strengthen the muscles around the anus twice per day. The portable biofeedback-training machine was taken home after the children patients could automically contract the muscles around the anus 3 weeks later. ② Biofeedback training to improve rectal sensitivity and coordination of anus sphincter, and repeated training in expanding saccus. A normal defecation reflex was established. Anus sphincter presented reflex contraction to prevent encopresis once the rectum expanded. ③ Defecation training was performed for 30 minutes after meals every day. ④ Electrostimulation combined with biofeedback training was performed for 10 minutes twice a day for 3 or 4 consecutive weeks.MAIN OUTCOME MEASURES: ① The maximum contraction anal pressure, vector volume, and electromyographic amplitude of external sphincter of anus; ② positive rate of anorectal contraction reflex of the children patients before and after training.RESULTS: According to actual treatment analysis, all the 20 children patients entered the result analysis. ① In middle and lower parts groups, the maximum contraction anal pressure increased from (11.87±5.61) kPa before training to (24.88±16.58) kPa after training; in high part group, they increased from (5.76±3.84)kPa to (18.18±13.71) kPa (P＜ 0.05). ② In middle and lower parts groups, the vector volume increased from (139.17±130.02) cm (cm Hg)2 to 608.10±131.06 cm·(cmHg)2, whereas in high group it increased from (117.01±74.35) cm(cm Hg)2 to (452.17±69.43) cm(cm Hg)2 (P＜ 0.05). ③ In middle and lower parts groups, the electromyographic amplitude of external sphincter of anus increased from (152.20±37.42) μV to (324.12±67.78) μV; in high part group, it rose from (114.08±51.41)μV to (266.18±49.38)μV (P ＜ 0.05). ④ The positive rate of anorectal contraction reflex improved from pretraining 55％ (11/20) to post-training 90％ (18/20).CONCLUSION: After biofeedback training, the maximum contraction anal pressure, anorectal sensitivity and the coordination of anus external sphincter, defecation habit, and contractibility of external sphincter of anus were all improved obviously, especially in those with ectopic anus in the middle or lower parts. Anus external sphincter function can be improved to the uttermost so as to cure encopresis.

This is to report the study of degradation of earthworm extracts prepared by wet superfine grinding in simulated gastrointestinal environment. Enzymatic reactions were terminated by adjusting the solution pH or using membrane bioreactor principle. Earthworm protein concentration change was detected by Bradford method, the degraded state of protein was described with SDS-PAGE technology, and the degraded state of small molecule substances was detected by HPLC. The results showed that earthworm protein degraded completely in artificial gastric juice. High molecular weight protein degraded greatly in artificial intestinal fluid, while low molecular weight protein was not significantly degraded. Small molecular substances degradation did not degrade in artificial gastric juice, while they degraded obviously in artificial intestinal fluid, there is even new small molecule substance appeared. Finally it is concluded that the substance that having therapeutic effects in vivo may be some degraded peptide, amino acid and stable small molecules existed in artificial intestinal fluid.

Objective:To evaluate the effects of increasing end-tidal concentrations of sevoflurane and increasing stimulation voltage on motor evoked potentials,so as to provide evidence in making anesthesia plan for intraspinal tumor surgery.Methods:In the study,48 patients scheduled to undergo intraspinal tumor surgery [American Society of Anesthesiology,(ASA)Ⅰ-Ⅱ,18-65 years old]were enrolled. After general anesthesia induction,the patients were assigned to receive sevoflurane anesthesia of increa-sing end-tidal concentration in the sequence of 0.0%,0.5%,1 .0% and 1 .5% respectively,under a background of propofol and remifentanil.All the observations were done before the important steps of sur-gery.Remifentanil infusion rate was 0.2 μg /(kg·min),while the propofol infusion rate was adjusted to maintain the bispectral index values within the range of 30-50.At each concentration,4 stimulation voltages of 300 V,400 V,500 V and 600 V were employed to elicit motor evoked potentials (MEPs). The amplitude and latency of each MEP were compared.The success ratio was also recorded.Results:The concentration of sevoflurane and the stimulation voltage had impacts on the amplitude and latency of MEPs.Under each stimulation voltage,the MEPs amplitude decreased following increasing end-tidal sevoflurane concentrations,and significant differences were found in comparing 1 .5% sevoflurane (left 20.50 μV,70.71 μV,135.97 μV,190.00μV ,right 14.29 μV,50.71 μV,73.10μV,77.50μV) with 0.0% sevoflurane (left 143.00 μV,388.10 μV,484.53 μV,500.00 μV,right 176.00 μV, 407.60 μV,384.35 μV,451.00 μV)and 0.5% sevoflurane (left 100.00 μV,362.57 μV,444.05μV,435.00 μV,right 115.00 μV,207.15 μV,258.34 μV,358.50 μV),left χ2 =27.46,P<0.01,right χ2 =60.49,P<0.01;left χ2 =20.73,P<0.01,right χ2 =55.05,P<0.01;left χ2 =34.25,P<0.01,right χ2 =33.58,P<0.01;left χ2 =28.61,P<0.01 ,right χ2 =49.04,P<0.01;while there were no statistical differences in the latency changes (P =0.26 ).Under each end-tidal sevoflurane concentration,the MEPs amplitude increased following increasing stimulation voltages,and significant differences were found in comparing 300 V (left 143.00 μV,100.00 μV,61.50 μV,20.50μV ,right 176.00 μV,115.00 μV,41.07 μV,14.29 μV)with 400 V (left 388.10 μV,362.57μV,198.81 μV,70.71 μV,right 407.60 μV,207.15 μV,89.00 μV,50.71 μV)and 500 V (left 484.53 μV,444.05 μV,216.24μV,135.97 μV,right 384.35 μV,258.34μV,187.50μV,73.10μV)and 600 V (left 500.00 μV,435.00 μV,344.00 μV,190.00 μV,right 451.00 μV,385.50μV,156.00μV,77.50μV),leftχ2 =45.55,P<0.01,rightχ2 =25.73,P<0.01;leftχ2 =46.67, P<0.01,right χ2 =55.30,P<0.01;left χ2 =47.36,P<0.01,right χ2 =47.82,P<0.01;left χ2 =38.67,P<0.01,right χ2 =45.87,P<0.01;while the latencies were decreased,and significant dif-ferences were found in comparing 300 V with 400 V and 500 V and 600V(left F=7.50,P=0.01 ,right F=13.33,P<0.01),but the differences had little clinical significance.The success ratio decreased by increasing end-tidal sevoflurane concentration,and significant differences were found in comparing 1 .5%sevoflurane (left 43.8%,70.8%,77.1%,81.3%,right 37.5%,60.4%,75.0%,66.7%)with 0.0%sevoflurane (left 79.2%,87.5%,95.8%,93.8%,right 75.0%,95.8%,95.8%,95.8%)and 0.5%sevoflurane (left 72.9%,89.6%,95.8%,95.8%,right 66.7%,89.6%,95.8%,97.9%);the suc-cess ratio increased by increasing stimulation voltage,and significant differences were found in comparing 300 V(left 79.2%,72.9%,62.5%,43.8%,right 75.0%,66.7%,60.4%,37.5%)with 400 V(left 87.5%,89.6%,77.1%,70.8% ,right 95.8%,89.6%,79.2%,60.4%)and 500 V(left 95.8%, 95 .8%,9 1 .7%,77 .1%,right 95 .8%,95 .8%,8 1 .3%,75 .0%)and 600 V (left 93 .8%,95 .8%, 89.6%,81.3%,right 95.8%,97.9%,89.6%,66.7%),but there were no statistical differences in the success ratio of MEPs between the group with stimulation voltage of 600 V ,end tidal sevoflurane concen-tration of 1 .5% and the group with stimulation voltage of 300 V,end tidal sevoflurane concentration of 0.0% (P=0.22).Conclusion:Sevoflurane inhibited MEPs in a dose-dependent manner.It can de-crease the amplitudes and prolong the latencies.But increasing stimulation voltage will facilitate MEPs monitoring and increase the success ratio.Sevoflurane can be used in larger parts of MEPs monitoring surgery by increasing the stimulation voltage.

Objective To evaluate the efficacy of preoperative femoral nerve block on preemptive analgesia in the elderly patients undergoing total knee arthroplasty under general anesthesia.Methods Sixty ASA physical status Ⅰ-Ⅲ patients of both sexes,aged 65-75 yr,scheduled for elective total knee arthroplasty,were randomly divided into 3 groups (n =20 each) using a random number table:control group (group Ⅰ),preoperative femoral nerve block group (group Ⅱ) and postoperative femoral nerve block group (group Ⅲ).Single-injection femoral nerve block was performed with 0.375％ ropivacaine 20 ml injected around the nerve under thc guidance of ultrasound immediately before induction of anesthesia and at the end of surgery in Ⅱ and Ⅲ groups,respectively.Patient-controlled intravenous analgesia (PCIA) with sufentanil (background infusion 2 ml/h,bolus dose 2 ml,lockout interval 15 min) was used until 2 days after surgery,and VAS score was maintained ≤ 3.When VAS score＞3,flurbiprofen axetil 50 mg was injected intravenously as rescue medication.The consumption of sufentanil per hour,requirement for rescue medication,and development of adverse reactions were recorded within 24 h after surgery.Sufentanil-sparing degree was calculated.Results Compared with group Ⅰ,the consumption of sufentanil per hour,requirement for rescue medication and the incidence of nausea and vomiting were significantly decreased within 24 h after surgery in Ⅱ and Ⅲ groups.The consumption of sufentanil per hour,requirement for rescue medication and the incidence of nausea and vomiting were significantly lower within 24 h after surgery in group Ⅱ than in group Ⅲ.The consumption of sufentanil per hour was decreased by 35％ in group Ⅱ as compared with group Ⅰ,and decreased by 18％ in group Ⅱ as compared with group Ⅲ.Conclusion Preoperative femoral nerve block can provide good preemptive analgesia in the elderly patients undergoing total knee arthroplasty under general anesthesia.

Objective To analyze the clinical feature and pathological characteristics of oral submucous fibrosis (OSF) coexisted with oral leukoplakia (OLK) or oral lichen planus (OLP),and summarize both the common and each clinical and pathological characteristics of two kinds of diseases.Methods The clinical and pathological data of 74 patients with OSF coexisted with OLK and 57patients with OSF coexisted with OLP were retrospectively reviewed.Results Most of patients with OSF coexisted with OLK or OLP were mainly young and middle-aged male patients,and all had the habit of eating betel quid chewing.Most of them had the habit of smoking and alcohol drinking; while their limitation of mouth opening were not obvious.Patients coexisted with unilateral OLK or OLP all had a unilateral mastication of chewing betel nut;the prevalence rate of erosive OLP was lower in the patients with OSF coexisted OLP than that of OLP patients never chew betel nut.The pathology of both OSF coexisted with OLK or OLP was with the respective characteristics of OLK or OLP on the basis of OSF,and the epithelium was thickened more than atrophic.No relationship was found between the degree of epithelial hyperplasia and the severity of fibrosis in patients with OSF coexisted with OLK.Conclusions OSF coexisted with OLK and OSF coexisted with OLP were the occurrence of OLK or OLP on the basis of OSF,which were not a simple superposition of two diseases,but combination with their own characteristics of OSF coexisted with OLK or OLP.