Objective To study effects of multimodal analgesia on postoperative delirium (POD)in elder patients with hip fracture.Methods One hundred and eight elder patients with hip fractures were gathered in a prospective study.Fifty-nine cases were included in the group of multimodal analgesia (25 males,34 females),with an average age of 72.91±5.42 years,and 35 were treated with hip replacements,the other 24 were internal fixations.Forty-nine cases were in the group of conventional analgesia (22 males,27 females),with an average age of 72.14±4.93 years,29 were treated with hip replacements,20 were internal fixations.Assessments of delirium were based on confusion assessment method.Local infiltrated anesthesia,patient control intravenous analgesia,and intravenous nonsteroid anti-inflammatory drug were applied in the group of multimodal analgesia.For the other group,morphine would be given only when patient complained pain or there was POD.Postoperatively,visual analogue scale (VAS),onset of delirium,other correlative data were recorded by an independent researcher.All patients underwent POD were managed with intensive pain management,and then reevaluated.Results VAS in multimodal analgesia group [Day1:2.10±1.43(resting),4.74±1.45 (active) and Day 3:1.01±0.92 (resting),3.31±1.36 (active)] were significandy lower than that in the other group [Day1:4.67±1.33 (resting),7.44±1.59 (active)and Day 3:2.24±1.39 (resting),5.06±1.46 (active)].PODs were detected in 15 (30.6％) in group of conventional analgesia; while in group of multimodal analgesia,there were 7 (11.9％).All POD were given intensive pain managements by injection of 10 mg morphine and achieved relief of deliriums.Conclusion Postoperative multimodal analgesia may reduce the incidence of POD.First aid of intensive pain management may help to control POD.

AIM: To study the effect of vascular endothelial growth factor(VEGF) on hematopoietic differentiation from mouse embryonic stem cells(ESC) in vitro.METHODS: ES-D3 was allowed to grow on mouse fetal fibroblast feeder layer,and then was developed into embryoid bodies(EB).EB cells were transferred into medium supplemented with different concentration of VEGF and VEGF+SCF for 1 week.Six groups,including.VEGF 5 ?g/L,VEGF 10 ?g/L,VEGF 20 ?g/L, VEGF 5 ?g/L+SCF,VEGF 10 ?g/L+SCF and VEGF 20 ?g/L+SCF,were designed.The group of spontaneous differentiation without cytokine(s) was used as control.Hematopoietic transcription factor GATA-2 and early hematopoietic differentiation genes(c-kit and ?-H1) were detected by RT-PCR.The content of CD34~+ cells in each group were measured by flow cytometry.The cells derived from ESC were incubated in semisolid methycellulose cultures.The numbers of total colony-forming units in culture(CFU-C) were counted by reverse microscope.RESULTS: ES-D3 grew and formed EB at day 4.VEGF had a stimulatory effect as a single factor on the expression of genes associated with early hematopoietic differentiation(GATA-2,c-kit and ?-H1),the generation of CD34~+ cells and CFU-C in EB.The effects of VEGF+SCF were the most potent in the experimental groups according to the percent of CD34~+ cells and the numbers of hematopoietic colonies.The most highest inducing efficacy was achieved in VEGF 20 ?g/L or VEGF 10 ?g/L combined with SCF.CONCLUSION: VEGF promotes the differentiation of ESC into hematopoietic cells in vitro.The strongest effect was achieved when VEGF was combined with SCF.

OBJECTIVETo explore the effect of arteriosclerosis obliterans (ASO) blood stasis syndrome (BSS) serum on vascular endothelial cell injury and to study the regulation of Taohong Siwu Decoction (TSD) on it.

METHODSUmbilical vein endothelial cell culture system was established. The serum endothelial cell injury model with ASO BSS was prepared. Low, medium, and high concentrations TSD containing serums were respectively added. The endothelial cell proliferation activity was observed by MTT method. Ultrastructures of endothelial cells were observed under transmission electron microscope. Changes of intracellular calcium ion concentration and the cytoskeleton were observed under laser confocal microscope. Contents of ET, NO, and transforming growth factor beta1 (TGF-beta1) in endothelial cell culture supernatant were detected by ELISA.

RESULTSIn ASO BSS serum group endothelial cell proliferation activities decreased, the cell structure was obviously destroyed, calcium ion concentration increased, contents of ET, NO and TGF-beta1 increased significantly (P < 0.01), and ET/NO ratio was imbalanced. After incubating with TSD drug containing serum, endothelial cell proliferation activities and injured cell structures were obviously improved; ET, NO and TGF-beta1 levels decreased (P < 0.05, P < 0.01), ET/NO ratios approximated to the normal level.

CONCLUSIONThe main mechanism of TSD for treating ASO ASS lied in improving injured vascular endothelial cells and endocrine disorder.

Arteriosclerosis Obliterans ; Cell Proliferation ; Drugs, Chinese Herbal ; therapeutic use ; Endothelial Cells ; Humans ; Medicine, Chinese Traditional ; Serum ; Transforming Growth Factor beta1 ; metabolism ; Umbilical Veins

OBJECTIVETo observe the long-term results of midline partial glossectomy with uvulopalatopharyngoplasty (UPPP) in the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS).

METHODSTwenty-four severe OSAHS patients treated with midline partial glossectomy and UPPP from January 2003 to March 2004 were included in this study, the follow-up was 5 years. The median of preoperative lowest arterial oxygen saturation (LSaO(2)) of this group at night (the same below) 0.650, and AHI was 56.5 times/h, UPPP was performed under general anesthesia, no tracheotomy performed. Criteria of curative effects: AHI < 5 times/h was recovery, AHI < 20 times/h and decreased beyond 50% marked improvement, only AHI decreased beyond 50% improvement.

RESULTSPost-operation AHI (6 months, 1 year, 2 years and 5 years after surgery) decreased significantly compared to that before the surgery, and post-operation LSaO(2) was significantly higher than that of preoperative (Wilcoxon's signed rank test, the same below, P < 0.01). The LSaO(2) and AHI were significantly different between 1 year, 2 years, 5 years and 6 months post-operatively (P < 0.01). Six months after surgery, PSG results showed that 21 were recovery, marked improvement for the other 3 cases, the recovery rate was 87.5%. One year after surgery, 18 were recovery, marked improvement in 3 cases, the recovery rate 75.0%. Two years after surgery, 14 cases recovery, marked improvement in 4 cases, the recovery rate 58.3%. Five years after surgery, 6 were recovery, the recovery rate 25.0%. Among 5 cases with hypertension before the surgery, after surgery antihypertensive drugs were not necessary in 4 cases, and the dosage was decreased in 1 case.

CONCLUSIONThe midline partial glossectomy with UPPP surgery may be an effective treatment for the severe OSAHS, long-term effect is satisfactory.

Adult ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Otorhinolaryngologic Surgical Procedures ; methods ; Palate, Soft ; surgery ; Retrospective Studies ; Sleep Apnea, Obstructive ; surgery ; Tongue ; surgery ; Uvula ; surgery

The ZM-1 tissue microarrayer designed by our groups is manufactured in stainless steel and brass and contains many features that make TMA (tissue microarray) paraffin blocks construction faster and more convenient. By means of ZM-1 tissue microarrayer, biopsy needles are used to punch the donor tissue specimens respectively. All the needles with the punched specimen cylinders are arrayed into the array-board, with an array of small holes dug to fit the needles. All the specimen cylinders arraying and the TMA paraffin block shaping are finished in only one step so that the specimen cylinders and the paraffin of the TMA block can very easily be incorporated and the recipient paraffin blocks need not be made in advance, and the paraffin used is the same as that for conventional pathology purpose. ZM-1 tissue microarrayer is easy to be manufactured, does not need any precision location system, and so is much cheaper than the currently used instrument. Our method's relatively cheap and simple ZM-1 tissue microarrayer technique of constructing TMA paraffin block may facilitate popularization of the TMA technology.
Biopsy, Needle ; instrumentation ; Equipment Design ; Female ; Humans ; Immunohistochemistry ; Male ; Neoplasms ; enzymology ; Paraffin ; Tissue Array Analysis ; instrumentation

OBJECTIVETo observe changes of growth, body composition and biochemical markers associated with growth (IGF-1) in prepubertal children with obstructive sleep apnea syndrome (OSAHS).

METHODSThirty-one children aged 3-10 years with OSAHS were followed up for 1 year after the corresponding surgery. During the same period of time, 20 children of similar age without OSAHS (excluded any other diseases that could result growth retardation or hypoxemia) were also followed up for 1 year. PSG, height, weight as well as insulin-like growth factor-1 (IGF-1) were measured during the preoperative period, 3 months, 6 months and 1 year after surgery in patient group. The same indexes were measured before surgery, and only height and weight were recorded after surgery in the control group. Wilcoxon signed- rank test and Mann-Whitney U test are used to analyze the data.

RESULTSThe lowest oxyhemoglobin saturation of the patient group (0.88) is significantly lower than that of the control group (0.98), and was found increased at the 6 months post-op follow up (0.97, U = 238.5, P > 0.05), no significant change was found at the 1 year follow up. The post-op AHI (6 months after surgery) of the patient group (6.0/h) decreased to the similar level of the control group (0/h, U = 240.0, P > 0.05), and was similar to 1 year after surgery. Height of the patient group (116 cm), which was lower than the control group (U = 127.0, P < 0.001), significantly increased 1 year (138 cm) after the corresponding surgery (Z = 3.726, P < 0.01), and reached the similar levels of the control group (137 cm) 1 year after the surgery (U = 123.5, P > 0.05). The serum IGF-1 levels of the patient group (33.7 ng/ml), which were significantly lower than those of the controls preoperatively (44.1 ng/ml, U = 206.0, P < 0.05), increased to similar levels with the controls 6 months after the operation (50.3 ng/ml, U = 261.0, P > 0.05), and the 1 year post-op follow up was similar to the control group too (48.6 ng/ml, U = 163.0, P > 0.05).

CONCLUSIONSThe cure of OSAHS could accelerate growth in prepubertal children, and the serum IGF-1 levels increases at the same time. The growth retardation is presumed in children with OSAHS.

Body Height ; Body Weight ; Case-Control Studies ; Child ; Child, Preschool ; Female ; Growth Disorders ; etiology ; Humans ; Insulin-Like Growth Factor I ; metabolism ; Male ; Sleep Apnea, Obstructive ; blood ; therapy ; Treatment Outcome

OBJECTIVETo assess the diagnostic value of 8 equations using different variables for determining the estimated glomerular filtration rate (eGFR) in patients with cardiovascular diseases.

METHODSGFR was estimated in 208 patients with cardiovascular diseases by (99m)Tc-DTPA dynamic renal imaging, and the eGFR was derived from 8 equations using different variables.

RESULTSIn patients with chronic kidney disease (CKD) stages 1-3, the eGFR calculated suing serum creatinine (SCr)-based equation was better correlated to GFR estimated by (99m)Tc-DTPA renal imaging than that derived from cystatin C (Cys C)-based equations, whereas in patients with CKD stages 4 and 5, the estimates by the latter equation showed a better correlation to GFR. Compared with (99m)Tc-DTPA renal imaging, MDRD-based equation and simple MDRD equation resulted in a higher eGFR in patients with CKD stages 4 and 5, the Rule equation had a lower eGFR in CKD stages 1 and 2, the Macisaac equation yielded a higher eGFR in CKD stages 2-5, and the Tan equation showed a higher eGFR in CKD stages 2 and 3. In patients with mild renal dysfunction, the Scr-based equation had a higher AUC(ROC) than Cys C-based equation, which was reversed in patients with severe renal dysfunction; the AUC(ROC) of the two equations were comparable in patients with moderate renal dysfunction. Compared with (99m)Tc-DTPA renal imaging, the modified MDRD equation and Arnal-Dade equation showed no significant difference in the eGFR in patients with CKD stages 1-5.

CONCLUSIONModified MDRD equation (or simple MDRD equation) and Arnal-Dade equation are superior to other calculation methods for estimating the GFR in Chinese patients with cardiovascular disease.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cardiovascular Diseases ; physiopathology ; Child ; Chronic Disease ; Creatinine ; blood ; Cystatin C ; blood ; Female ; Glomerular Filtration Rate ; physiology ; Humans ; Kidney Diseases ; physiopathology ; Male ; Middle Aged ; Young Adult

ZM-1 tissue microarrayer designed by our group is manufactured in stainless steel and brass. It features an easier and faster preparation for tissue microarrays. By means of it, a group of biopsy needles are used to punch the donor tissue specimens respectively, and all the needles with the punched specimen cylinders are arranged into the array-board, where small holes have been digged to fit the needles. All the specimen cylinders arraying and the tissue microarray block's shaping are finished simultaneously. ZM-1 tissue microarrayer with a lower cost of manufacture, is capable of preparing the tissue microarrays conveniently, efficiently and quality-controllably.
Equipment Design ; Tissue Array Analysis ; instrumentation

OBJECTIVETo investigate the protective effect and mechanism of Shenqi Compound on diabetic angiopathy modeled rats.

METHODSTotally 18 SD rats were randomized into 3 groups, i.e., the normal control group, the diabetic mellitus (DM) group, and Shenqi Compound group, 6 in each group. The DM rat model was established by feeding high-fat diet (to induce hyperlipidemia) +intraperitoneal injection of small dose streptozotocin (STZ). Shenqi Compound was given to rats in the Shenqi Compound group at the daily dose of 2 g/kg. Equal volume of normal saline was given to rats in the model group and the normal control group by gastrogavage. All treatment was lasted for 12 weeks. Then 2-D and ultrasonic integrated backscatter technique were used to evaluate structural and functional changes of abdominal aorta in the progression of diabetic macroangiopathy. The fibrosis degree of the aorta vessel and myocardium capillaries were observed by using HE and Masson trichrome staining. The tension of the aortic vascular ring was determined. The transforming growth factor beta (TGF-beta) mRNA expression was detected by real time PCR (RT-PCR). The protein expression of TGF-beta, collagen I, collagen III, connective tissue growth factor (CTGF), and phosphorylation P38 MAPK were detected by Western blot.

RESULTSCompared with the normal control group, abdominal aortic systolic inner diameter, diastolic inner diameter, Peterson elastic modulus, stiffness index, and backscatter integral significantly increased; the rangeability of integral backscatter and the extension coefficient of cross section significantly decreased in the DM group (all P < 0.05). After 12 weeks aforesaid indices were obviously improved in the Shenqi Compound group (P < 0.05). Results of HE and Masson staining showed that the fibrosis degree of the aorta vessel and myocardium capillaries was obviously alleviated in rats of the Shenqi Compound group (P < 0.05). Results of the aortic vascular ring tension showed that acetylcholine induced vasodilatation and maximum diastolic percent were obviously elevated in the Shenqi Compound group (P < 0.05). Compared with the normal control group, the mRNA expression of TGF-beta, and the protein expression of TGF-beta, collagen I, and collagen III, and phosphorylation of P38 MAPK all significantly increased in the DM group (P < 0.05). Compared with the DM group, the mRNA expression of TGF-beta, and the protein expression of TGF-beta, collagen I, and collagen III, and phosphorylation of P38 MAPK all decreased (P < 0.05).

CONCLUSIONSShenqi Compound could effectively improve the arterial function in diabetic marcoangiopathy and microvascular dysfunction. The mechanism might be due to the down-regulating the expression of TGF-beta, and further suppressing the phosphorylation of P38 MAPK, reducing the synthesis of collagen I and collagen III, therefore, ameliorating arterial and myocardial interstitial fibrosis.

Animals ; Collagen Type I ; metabolism ; Collagen Type III ; metabolism ; Diabetes Mellitus, Experimental ; drug therapy ; Diabetic Angiopathies ; prevention & control ; Drugs, Chinese Herbal ; pharmacology ; Male ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Transforming Growth Factor beta1 ; metabolism ; p38 Mitogen-Activated Protein Kinases ; metabolism

OBJECTIVETo study the approaches for making acute-on-chronic hepatic failure model in rat.

METHODSSD rats were intraperitoneally injected with 50% CCl4 (Carbon tetrachloride) olive solution every three days for 6 or 10 weeks. Then they were divided into two groups randomly and injected with D-galactosamine (D-gal) at a dose of 2 g/kg, lipopolysaccharide (LPS) at a dose of 100 pg/kg and D-gal at a dose of 0.5 g/kg BW respectively. The levels of serum ALT, AST and TBil were detected,and histopathological changes were observed to evaluate these two models.

RESULTSAfter injection of 50% CCl4 olive solution intraperitoneally for 6 weeks, liver fibrosis happened in SD rats, 10 weeks, cirrhosis happened. Pelleta necrosis and massive or submassive necrosis was seen administration of two reagents mentioned above.

CONCLUSIONBy injecting of 50% CCl4 olive solution intraperitoneally, acute-on-chronic liver failure model could be induced by D-gal, LPS/D-gal in rats.

Alanine Transaminase ; metabolism ; Animals ; Carbon Tetrachloride ; adverse effects ; Disease Models, Animal ; Galactosamine ; adverse effects ; Humans ; Lipopolysaccharides ; adverse effects ; Liver Failure, Acute ; chemically induced ; enzymology ; mortality ; pathology ; Male ; Random Allocation ; Rats ; Rats, Sprague-Dawley