ObjectiveTo investigate the clinical effects of posterior atlantoaxial fusion fixation in treatment of old atlantoaxial injury secondary to atlantoaxial dislocation.MethodsA retrospective analysis was carried out on 16 patients ( 14 males and 2 females) with old atlantoaxial injuries secondary to atlantoaxial dislocations managed with posterior atlantoaxial fusion fixation from March 2008 to March 2012.The time from injury to operation lasted for 3-36 months ( average 10.5 months).Posterior atlantoaxial transpedicular fixation was performed in 13 patients including 10 patients with old odontoid fractures and three with old traumatic transverse ligament disruptions of the atlas combined with atlantoaxial dislocations.Also,posterior atlantal arch transpediclar fixation combined with axial pedicle screw fixation was performed in three patients who had old odontoid fractures combined with atlantoaxial dislocations.All patients had simultaneous autogenous bone grafting between atlas and axis during reduction and fixation.The preoperative and postoperative Japanese Orthopaedic Association (JOA) scores were compared.Follow-up X-ray films and CT was performed to evaluate the atlantoaxial reduction and fusion.ResultsAll the patients were followed up for 9-18 months ( mean 13 months).None of the patients had spinal cord or vertebral artery injuries.Follow-up CT showed that two patients had partial penetration of one side axial pedicle screws into transverse foramen without nerve and blood vessel injuries.Clinical symptoms obtained different degree of improvement.The postoperative JOA scores ranged from 13 to 16 points ( mean 14.8 points) and the improvement rate of JOA was 71％-92％ ( mean 82％ ).The X-ray films and CT showed sound bone fusion,with good location of screws but with no signs of atlantoaxial instability or loss of reduction,or loosening or breakage of the screws.ConclusionPosterior atlantoaxial fusion fixation can effectively reconstruct atlantoaxial stability,improves neurologic function of spinal cord and has reliable curative effects.

Objective To identify the main etiologies of emergency room (ER) patients with chest pain or equivalent syndrome.Methods This was a prospective and cross-sectinal survey of ER patinets with chest pain or equivalent syndrome in 17 medical centre in Beijing,China from July to August 2009.Data was collected by structured interviews and medical record reviews.The mean follow up period was 30 days.Results A total of 5666 patients were enrolled in the study (2663 males and 3303 females) and the mean age was 58.1 ± 18.4years.Their final diagnoses were:coronary heart disease 1506 ( 27.4％ ),acute heart failure 149 ( 2.6％ ),pericarditis 4 ( 0.1％ ),pulmonary embolism 11 ( 0.2％ ),aortic dissection 8 ( 0.1％ ),acute cerebrovascular disease 431 ( 7.6％ ) and non-cardic chest pain 2538 ( 44.9％ ).Thirty-seven cased died and 275 cases hospitalized again 30 days later,4.9％ patients with cornary heart disease had symptoms at their presentation.Conclusion Special vigilance and thorough coronary artery evaluation are needed for all patients with chest discomfort or respiratory distress in the ER,even for patients without chest pain.

OBJECTIVETo construct a short hairpin (sh)RNA targeting aquaglyceroporin 9 (AQP9) that effectively silences gene expression in liver cells in order to investigate of the role of AQP9 in nonalcoholic fatty liver disease (NAFLD) pathogenesis using an in vitro cell model system.

METHODSSmall interfering (si)RNAs were designed against the human gene sequences encoding AQP9 (NCBI GenBank Accession No. AB008775) and unrelated control sequences, synthesized, annealed to form double-strands, and inserted into the pGenesil- 1 shRNA-expression plasmid. The silencing effects of the four pshRNA-AQP9 constructs (a-d) and the pshRNA-negative control construct were investigated by transfecting into the L02 human normal liver cell line and detecting expression of AQP9 mRNA and protein (relative to beta-actin) by reverse transcription-PCR and western blotting. The NAFLD cell model was established by treating L02 cells with oleic acid to induce fatty degeneration. After transfecting the NAFLD cell model with various constructs, the effects on NAFLD-related features were investigated by staining with Oil Red O (to detect lipid droplets) and performing enzymatic assays (to quantitate triglyceride (TG), free fatty acid (FFA) and glycerol content). The significance of intergroup differences was assessed by analysis of variance test.

RESULTSOf the four pshRNA-AQP9 constructs, pshRNA-AQP9a produced the most robust silencing effect on AQP9 mRNA (25.1 - 1.2% vs. untransfected: 39.3 +/- 1.7% and pshRNA-negative control: 39.4 +/- 1.5%, P < 0.01) and protein (25.4 - 2.0% vs. untransfected: 35.1 +/- 1.9% and psh-RNA-negative control: 35.6 +/- 2.3%, P < 0.01). Oleic acid-induced L02 cells showed enhanced AQP9 mRNA and protein expression, and increased intracellular content of lipid, TG, FFA, and glycerol, which were significantly reduced by pshRNA-AQP9a transfection (all P <0.05).

CONCLUSIONThe new pshRNA-AQP9a construct can efficiently reduce AQP9 expression in cultured human liver cells and relieve steatosis-related features in an NAFLD cell model, pshRNA-AQP9a represents a novel tool for studying the role ofAQP9 in NAFLD pathogenesis and its potential as a gene therapy strategy.

Aquaporins ; genetics ; Cell Line ; Fatty Liver ; genetics ; Gene Expression ; Genetic Vectors ; Hepatocytes ; metabolism ; Humans ; Non-alcoholic Fatty Liver Disease ; Plasmids ; RNA Interference ; RNA, Messenger ; RNA, Small Interfering

OBJECTIVEMassive hemorrhage is life-threatening during armed conflicts. Tourniquets are important medical devices used to reduce severe bleeding in trauma. The aim of this study was to empirically evaluate the current tourniquets used in China and provide information to emergency nurses in selecting the appropriate tourniquet.

METHODSFive tourniquets were self-applied by 20 healthy participants. The blood flow distal to the tourniquet site was assessed using vascular Doppler ultrasound. Application time, pain, numbness, and other parameters were evaluated.

RESULTSThe bladder tourniquet and windlass tourniquet effectively occluded arterial blood flow with success rates higher than 75% in both the upper and lower extremities. The Cargo-strap was the fastest to apply, taking (7.22+/-2.30) s for the upper extremity and (6.48+/-2.40) s for the lower extremity. The rubber tube was the most painful, and the improvised tourniquet was the least efficient. The success rates were higher in the lower extremity than in the upper extremity (P less than 0.05, X(2) equal to 5.714).

CONCLUSIONSThe bladder tourniquet and the windlass tourniquet are efficient tourniquets, although the windlass is superior with respect to portability and pain. The Cargo-strap and rubber tourniquets have several disadvantages that reduce their suitability for field use. The improvised tourniquet is not recommended because of low efficiency and severe pain during implementation.

Adult ; China ; Emergency Medical Services ; Female ; Humans ; Male ; Tourniquets

Objective To investigate the influencing factors of the formation of intracranial collateral circulation in patients with anterior circulation chronic occlusion. Methods From January 2015 to December 2017,181 consecutive patients with unilateral internal carotid artery or middle cerebral artery chronic occlusion diagnosed by DSA and admitted to the Department of Neurology,Chinese People′s Liberation Army General Hospital were enrolled retrospectively. According to the American society for interventional and therapeutic neuroradiology/society of interventional radiology ( ASITN/SIR ) collateral circulation grading system, 68 patients were divided into poor collateral circulation group (grade 0-2) and 113 were divided into good collateral circulation group (grade 3-4). After admission,the patients completed the relevant examinations, including blood routine,blood uric acid,blood lipids,and DSA examination. The age,gender,basic diseases (hypertension,diabetes,hyperlipidemia, coronary heart disease, history of previous ischemic stroke) and history of smoking/alcohol of the patients were recorded. The formation of collateral circulation was used as the dependent variable. The factor of P<0. 05 in the univariate analysis was included in the multivariate logistic regression analysis. Results (1) The patients of the poor collateral circulation group were older than those of the good collateral circulation group (61 ± 9 years vs. 56 ± 12 years),and the proportion of hyperlipidemia was higher than that of the good collateral circulation group (26. 5%[18/68] vs. 13. 3%[15/113]). The differences were statistically significant between the groups (all P<0. 05). There were no significant differences in the proportions of gender,hypertension,diabetes,coronary heart disease,ischemic stroke,tobacco and alcohol history between the two groups ( all P>0. 05) . (2) Compared with the good collateral circulation group,the level of high density lipoprotein ( HDL) in the poor collateral circulation group was lower. The differences were statistically significant between the groups (1. 0 ± 0. 2 mmol/L vs. 1. 1 ±0. 3 mmol/L,P<0. 05). There were no significant differences in blood uric acid,triglyceride,cholesterol, low-density lipoprotein,and platelet count levels between the two groups (all P>0. 05). (3) After variable selection,age (from young to old) and HDL (from low to high) as independent variables and the formation of collateral circulation as dependent variables, they were included in multivariate logistic regression analysis. The results showed that increasing age increases the risk of poor collateral circulation (OR,1. 053, 95%CI 1.021-1.085,P <0.05);the elevated HDL level was a protective factor of the formation of collateral circulation (OR,0. 265,95% CI 0. 085-0. 825,P<0. 05). Conclusion With the increase of age,the risk of intracranial poor collateral circulation increases,and the increased HDL level is beneficial to the formation of collateral circulation.

Objective To investigate the risk assessment,guiding role,and clinical value of Vaso CT image features for recanalization of vertebrobasilar junction occlusion. Methods From January 2016 to May 2017,14 patients with vertebrobasilar junction occlusion admitted to the Department of Neurology, Chinese PLA General Hospital were analyzed retrospectively. Preoperative cerebral angiography confirmed vertebrobasilar junction occlusion. Vaso CT was used to measure the length of the occluded vessels and vascular direction at both ends. According to these results, the operative risks were evaluated and the recanalization of vertebrobasilar junction occlusion were guided. Results The length of vertebrobasilar junction occlusion was 2. 56-19. 09 mm (mean 4. 5 ± 2. 1 mm) in 14 patients,and 13 of them were treated with the recanalization of vertebrobasilar artery occlusion,the blood vessels of 12 cases were successfully recanalized and stent placement was performed after the recanalization,among them,8 Solitaire stents and 4 Wingspan stents were implanted;One patient did not perform recanalization because of longer length of occlusion (19. 09 mm). All patients operated did not have any perioperative complications, and the neurological symptoms were significantly improved after procedure. Conclusion Vaso CT can accurately determine the surgical risk of the recanalization of vertebrobasilar junction occlusion,and can guide the surgical pathways,reduce the incidence of perioperative complications,and improve the success rate of the operation.

Objective To improve the knowledge of Kaposi sarcoma and the relationship between Kaposi sarcoma and human immunodeficiency virus (HIV) infection,and to improve the ability to diagnose and treat Kaposi sarcoma and acquired immune deficiency syndrome (AIDS).Methods Symptoms,signs and results of 121 patients encountered in the department of otorhinolaryngology head and neck surgery in Tanzania,who was diagnosed as Kaposi sarcoma actually with HIV infection and AIDS,were retrospectively analyzed in this study.Results There were 46 males and 75 females with age ranged from 5 to 65 years,medium 30 year.The mucous membranes and skin lesions was the most commonly seen clinical manifestation in 121 cases,these lesions appeared as raised blotches or lumps that might be purple,brown,or red,early stages typical lesions began as flat or slightly raised colored spots.Among the cases reported here,25 patients(20.66％)showed progressive nose blockage and nose bleeding and the purple-red new-grows were found in the nose of these patients.Fifteen patients (12.40％) had fiat or slightly raised colored spots in their mucous membrane of mouth (palate or tongue),and in other 7 patients,purple small lumps were found in the gums of the patients.There were same lesions in their pharynx in 9 cases.In 10 patients (8.26％),Kaposi sarcoma was found in tonsil looked like tonsillitis with enlarged tonsils by two to three degree.Twelve patients(9.92％) had masses in the neck with no pain.Thirty-five patients(28.92％)had lesions of purple black nodules,including 10 patients who had the same lesions with ulcer formation in the nodules.All patients had been followed-up for at least two-years.Eighty-five patients passed away in one year,survival rate of one year was 21.48％ (26/121),only 12 patients survived from the disease over two years,two years' survival rate was 9.92％ (12/121).Conclusions Kaposi sarcoma is the characteristic disease for AIDS,mainly found on the membranes and skin.These lesions appears as raised blotches or lumps that may be purple,brown,or red,early stages typical lesions begin as fiat or slightly raised colored spots.Patients who had kaposi sarcoma often died in a short-time without treatment.

Adolescent ; Adult ; Aged ; Arrhythmias, Cardiac ; diagnosis ; etiology ; Child ; Child, Preschool ; Ebstein Anomaly ; complications ; pathology ; Humans ; Infant ; Middle Aged ; Young Adult

BACKGROUNDPatients with persistent or permanent atrial fibrillation (AF) often need direct current cardioversion after radiofrequency ablation. The aim of this study was to investigate the effectiveness and safety of ibutilide for cardioversion of persistent or permanent atrial fibrillation after radiofrequency ablation and the factors related to conversion.

METHODSPatients with persistent or permanent atrial fibrillation were treated with combined ablation strategy including circumferential pulmonary vein isolation, linear ablation and CAFÉ potential ablation. If AF was not terminated after ablation, ibutilide was used for cardioversion (1 mg, intravenous injection in 10 minutes). These patients were divided into a conversion group and a non-conversion group according to whether AF was converted to sinus rhythm within 30 minutes after administration. ECG monitoring was performed during the injection of ibutilide. Atrial waves recorded by coronary sinus electrodes were measured for calculating average wavelength of AF waves in six seconds. The QT interval was measured immediately after conversion and 2 hours after injection of ibutilide.

RESULTSForty patients whose AF was not converted to sinus rhythm after radiofrequency ablation were given an intravenous injection of ibutilide. Of the 40 patients, 29 cases were converted to sinus rhythm, with a conversion rate of 72.5%. The average conversion time was (13.2 ± 5.5) minutes. Compared with the conversion group, patients in the non-conversion group had a longer history of AF (9.4 ± 5.3) years vs. (4.3 ± 2.8) years, P < 0.05), and a markedly enlarged left atrium (47.3 ± 2.9) mm vs. (42.1 ± 4.5) mm, P < 0.05). There were no significant differences in gender, age, body mass index and left ventricular function between the two groups. Ibutilide significantly prolonged the average wavelength of the AF wave (171.8 ± 29.5) ms vs. (242.0 ± 40.0) ms, P < 0.001). Two hours after ibutilide treatment, the QT interval was significantly shortened (421.0 ± 24.7) ms vs. (441.0 ± 37.4) ms, P < 0.05). No cases of serious arrhythmias or other adverse reactions were found.

CONCLUSIONSA single dose of ibutilide for conversion of persistent or permanent AF after radiofrequency ablation is safe and effective.

Adult ; Anti-Arrhythmia Agents ; therapeutic use ; Atrial Fibrillation ; drug therapy ; therapy ; Electric Countershock ; methods ; Female ; Humans ; Male ; Middle Aged ; Sulfonamides ; therapeutic use ; Treatment Outcome

OBJECTIVETo investigate the prevalence of chronic obstructive pulmonary disease (COPD) and its risk factors in population over 40 years old in northern part of Guangdong province.

METHODSUsing uniform scheme, procedures and questionnaire, a cluster-randomized-sampling survey for the population aged over 40 years in a rural area of Shaoguan in the northern part of Guangdong province was performed. Spirometry was performed for every participant, followed by a bronchodilatation test when bronchial obstruction was present.

RESULTSThere were 1468 cases with complete data from 1498 people aged >or= 40 years including 640 males, 828 females with an average age of 54.3 years old. The total prevalence of COPD was 12.0%. The prevalence of COPD in males was significantly higher than that in females (18.3% vs. 7.1%, P < 0.01). Only 80.7% of the patients with COPD presented one or more symptoms as cough, phlegm, or dyspnoea. Underdiagnosis of COPD would be quite serious. Only 26.1% of the cases was previously diagnosed to have chronic bronchitis, emphysema, or COPD. Smoking was an important risk factor to COPD and 78.4% of the patients with COPD were smokers. However, relation of biomass and COPD called for further investigation.

CONCLUSIONPrevalence of COPD was much higher than expected in the northern part of Guangdong while smoking was an most important risk factor of COPD. Lung function test seemed to be of great importance to COPD diagnosis, especially in the earlier period of COPD.

Adult ; China ; epidemiology ; Female ; Humans ; Male ; Mass Screening ; Middle Aged ; Prevalence ; Pulmonary Disease, Chronic Obstructive ; epidemiology ; Risk Factors ; Sex Factors ; Smoking ; adverse effects ; Surveys and Questionnaires