Objective Proximal humerus fracture is the most common upper-arm osteoporotic fracture in elderly patients and the result of treatment directly affects the physiological function of the shoulder .This article discusses the clinical effect of the locking proximal humeral plate ( LPHP) combined with anti-osteoporosis drugs in the treatment of osteoporotic comminuted proximal humerus fractures in elderly patients . Methods This study included of 47 elderly osteoporotic patients with comminuted proximal humerus fractures treated from April 2009 to March 2012 and with complete follow-up data.According to the Neer classification , the patients were divided into groups A (LPHP treatment, n=23, including 13 cases of three-part fractures and 10 cases of four-part fractures) and B (LPHP+anti-osteoporosis drugs, n=24, including 13 cases of three-part fractures and 11 cases of four-part fractures). Results All the patients were followed up for 14 to 38 (mean 23.6) months.The postoperative healing time was significantly shorter in group B than in group A ([96.57 ±2.59]d vs [115.91 ±2.73]d, P<0.05), and the excellence rate was remarkably higher in B than in A (91.7%vs 78.3%,P<0.05). Conclusion With the advantages of short healing time and high excellence rate , LPHP+anti-os-teoporosis drugs is superior to simple LPHP in the treatment of osteoporotic comminuted proximal humerus fractures in elderly patients.

Objective To investigate the role of opioid receptors and vagus and sympathetic nerves in the remifentanil-induced cardiovascular depression in rabbits. Methods Forty 2-6 months old New Zealand white rebbits of both sexes weighing 1.5-2.5 kg were randomly divided into 5 groups (n = 8 each): group Ⅰ remifentanil (group R); group Ⅱ naloxone + remifentanil (group N+ R); group Ⅲ vagus nerve cut-off +remifentanil (group V+ R); group Ⅳ epidural block + remifentanil (group S+ R) and group V vagus nerve cutoff + epidural block + remifentanil (group V + S + R). The animals were anesthetized, tracheostomized and mechanically ventilated. PaCO2 was maintained at 35-45 mm Hg. Vecuronium 0.3 mg/kg was given iv every 40 min to keep muscle relaxed. Right carotid artery was cannulated for continuous MAP monitoring. ECG was continuously monitored. A bolus of remifentanil 5.0 μg/kg was administered iv in all 5 groups. In group N + R naloxone 40μg was given iv about 2 min before remifentanil. In group V + R bilateral vagus nerves were cut off through neck incision. After HR and MAP had stabilized for 30 min, remifentanil was given iv. In group S + R epidural block was performed at L6.7 interspace with 2% lidocaine to block cardiac sympathetic nerves. When HR and MAP decreased by 20% of the baseline values and stabilized for 30 min remifentanil was given iv. In group V + S + R bilateral vagus nerves were cut off first. Then epidural block was performed before remifentanil administration. MAP and HR were recorded at 1 min before iv remifentanil administration (T0 ), at 30 s (T1), 1,2, 3, 4, 5, 10, 15 and 20 min (T2-9 ) after remifentanil administration. Results Intravenous remifentanil 5.0 μg/kg significantly decreased HR at T1 and MAP at T1-7 as compared with those at T0 in group R. Pretreatmentwith naloxone 40 μg prevented remifentanil-induced decrease in MAP but did not affect remifentanil-induced decrease in HR in group N + R. Vagus nerve cut-off and sympathetic block induced by epidural anesthesia performed before iv remifentanil did not affect remifentanil-induced cardiac depression in group V + R, S + R and V + S + R. Conclusion Opioid receptors and vagus and sympathetic nerves are not related to remifentanil-induced decrease in HR. Remifentanil induces decrease in MAP by activating opioid receptors.

Objective:To explore the correlation between single nucleotide polymorphisms (SNPs) in Homo sapiens longevity assur-ance homologue 2 (LASS2) gene 3′-untranslated regions (UTR) and susceptibility of bladder cancer among residents of Yunnan, China. Methods:A total of 105 bladder cancer patients (bladder cancer group) and 100 nonbladder cancer patients (control group) were se-lected. PCR method and sequence for LASS2-3′-UTR were performed to identify the SNPs correlated with bladder cancer. The relation-ships between the LASS2-3′-UTR polymorphisms and bladder cancer risk were analyzed. Results:An SNP (rs8444) was identified in LASS2-3′-UTR, and the T/C allele frequencies and genotype distributions of rs8444 largely differed between the bladder cancer and control groups (χ2=10.267, P=0.006;χ2=10.634, P=0.001). Individuals that carry the rs8444 C allele or CC genotype had a remarkably lower risk of bladder cancer compared with those that carry the T allele or TT genotype (OR=0.489, 95%CI:0.309-0.772, P=0.002;OR=0.258, 95%CI:0.081-0.827, P=0.023). No significant correlations were observed between the T/C allele frequencies and genotype distri-butions of rs8444 and TNM stage, as well as histological grade and distant metastasis in bladder cancer (P>0.05). Conclusion: The rs8444 C allele or CC genotype located within LASS2-3′-UTR can lower the susceptibility of bladder cancer among the residents of Yun-nan, China. However, it is not associated with the TNM stage, histological grade, and distant metastasis.

Objective To analyze and explore the clinical value of CYP2C19 genetic polymorphism in the treatment of refractory gastroesophageal reflux disease.Methods The CYP2C19 genetic polymorphism was detected and analyzed in 198 RGERD patients.According to genotyping,the patients were divided into extensive metabolism and poor metabolism.Each patient was filled in RDQ and LA Classification(from A to D) by endoscopy before and after 8 weeks of PPI treatment.Results There were 160 cases in EM group,mean age 53.23-± 14.52 years old.There were 38 cases in PM group,mean age 52.11 ± 12.13 years old.And all patients were treated with omeprazole 20 mg (twice daily).The mean score of RDQ in the PM group was significantly decreased after 8 weeks,and the esophageal mucosal lesion was significantly improved by endoscopy(P ＜ 0.05),but there was no significant difference in EM group with RDQ and LA (P ＞ 0.05).Conclusion The RGERD patients with poor metabolism group of CYP2C19 using proton pump inhibitors can achieve better efficacy.Theoretically,increasing the PPI dose can achieve the desired effect in the patients of EM group.So the clinician can be based on metabolic typing to achieve individualized medication and rationalization of medication.

Objective To study the correlation between morphological characteristics of coronary artery calcified plaques and luminal stenosis of local coronary artery segments with 64-slice computed tomography.Methods One hundred and eleven patients who had undergone 64-slice computed tomographic coronary angiography(CTCA)and conventional coronary angiography(CAG)were retrospectively analyzed.The calcified plaques were classified as punctate,nodular,strip-like and nubbly in long-axis view of coronary artery lumen,and were classified as crescent,semilunar,round moon and circinate in short-axis view.The morphologic characteristics of these calcified plaques on CTCA were retrospectively analyzed and compared with luminal stenosis of CAG results.Results Among 528 calcified coronary segments which were analyzed in 111 patients,there were 383(72.5%)punctate calcified plaque segments and 145(27.5%)of non-punctate plaques.There were 34(23.4%,34/145)non-punctate calcified plaques which caused severe stenosis(≥75%),including 4(11.8%)nodular,8(23.5%)stripe-like and 22(64.7%)nubbly calcified plaques on the long-axis view,and 0(0.0%)cresent,8(23.5%)semilunar,18(52.9%)round moon and 8(23.5%)circinate calcified plaques on the short-axis view.The ratios of different morphological coronary artery calcifications which caused severe stenoses were significantly different with each other(all P＜0.01).Conclusion Different figures of coronary artery calcified plaques demonstrate different degrees of stenoses of local coronary artery lumen.Severe stenoses were mostly caused by nubbly calcified plaque on long-axis view,round moon and circinate calcified plaque on short-axis view.

0bjective To determine the optimal contrast protocols for 64.slice spiral CT coronary angiography in order to reduce the volume of contrast injection.Methods One hundred fifty pailents scheduled to undergo 64-slice spiral CT coronary angiography were prospectively randomized into the following five groups with different injection protocols:group l:uniphasic injection without a flush;group 2:biphasic injection with a flush;group 3,group 4 and group 5:triphasic injection with a diluted contrast material with 3:7.5:5.7:3 contrast/saline ratio respectively.Attenuation was measured in the right atrium,right ventricle,left atrium,left ventricle,ascending aorta,fight coronary artery and left coronary artery and analyzed with single factor variance test(ANOVA).The quality the coronary artery images was evaluated and compared using person Chi-Square.Results The total contrast material vohme were (67.0±5.3)ml,(59.9±4.9)ml,(62.9±3.2)ml,(69.2 4±5.7)ml and(70.9 4-4.6)ml in five groups respectively(F=27.43,P<0.01).Image quali～scores of coronary arteries were significant different among five groups(X2=18.81,P<0.05).There were signiflcandy differences in artifacts of the superior vena cava among five groups(X2=31.44,P<0.01).The artifacts in the superior vena cava in group 1 was the most,and in group 2 was the least.The mean enhancement values of right and left coronary arteries in group 2 were significantly greater than those in other groups(F=2.47 and 4.10,P<0.05).The visualization of both left ventricle and right ventricle cavities W88 the best in group 3.Conclusion Biphasic injection and triphasic injection are better than uniphasic injection for 64-slice spiral CT coronary angiography and triphasic injecfion is better than biphasic injection for the visualization of both left ventricle and right ventricle cavities.

Objective To compare the clinical effect of 2D and 3D laparoscopic radical prostectomy and summarize surgical experience of laparoscopic radical prostectomy of early prostate cancer.MethodsThe clinical data of 34 cases of prostate cancer treated in our institute from November 2015 to April 2016 were collected and analyzed retrospectively. The patients in observation group (11 cases) were treated by 3D laparoscopic radical prostectomy, while those in control group (23 cases) were given 2D laparoscopic radical prostectomy. The operation time, intraoperative bleeding volume, postoperative drainage time, quantity of drainage fluid within 24 hours postoperatively, indwelling catheter time, hospital time, positive surgical margin rate, potence rate, 30d-urinary continence rate and complications were compared between the two groups.Results All operations were successfully performed. There were no signiifcant differences in operation time, intraoperative bleeding volume, postoperative drainage time, quantity of drainage lfuid within 24 hours postoperatively, indwelling catheter time, hospital time, positive surgical margin rate, potence rate, 30d-urinary continence rate and complications between the two groups (P > 0.05). In observation group, the operation time was (153.52 ± 30.47) min and the potence rate was 50.0 %, 4 cases with uroclepsia (36.4 %), 1 case with urine leakage (9.1 %), no patient had urethral stricture or positive surgical margin, the 30d-urinary continence rate was 72.7 %. In control group, the operation time was (164.73 ± 28.65) min and the potence rate was 38.9 %, 13 cases with uroclepsia (56.5 %), 4 cases with urine leakage (17.4 %), 1 case with urethral stricture (4.3 %), 2 cases with positive surgical margin (8.7 %), 30d-urinary continence rate was 60.9 %.ConclusionLaparoscopic radical prostectomy is a safe, effective and less invasive method for treating early prostate cancer patients. Also 3D laparoscopic radical prostectomy play the similar functional results compared with 2D laparoscopic radical prostectomy, but 3D laparoscopic has the advantage in three dimensions space sense and accurate operation, it is worthy of promoting clinical application.

Objective To analyze the image quality of coronary arteries by dual-source computed tomography (DSCT) in children with congenital heart disease(CHD). Methods Image quality of coronary arteries were scored by two radiologists with an ordinal grading system. Score 3 or 4 was considered to be good image quality and diagnostic. Score differences among 3 groups of various baseline heart rate levels, 3 groups of various age levels and 4 coronary branches were analyzed by using ANOVA. Multiple linear regression analysis was used to test the effects of age, heart rate, tube voltage, tube current, pitch, contrast volume, contrast injection rate on the coronary image scores. Results A total of 72 consecutive patients were enrolled. 71.2% (205/288) of coronary artery branches was good enough for diagnosis. Image quality of left main coronary artery (LM, score 3.64±0.49), left anterior descending (LAD, score 2.97±0.40), right coronary artery (RCA, score of 2.82±0.70), left circumflex (LCX, score 2.76±0.73) were in a descending order (F=29.00, P<0.01). Image scores of age groups of 0--1 years old (2.80±0.65), >1--3 years old (2.81±0.74), >3--14 years old (3.58±0.52) were in an ascending order (F= 20.16,P<0.01). Image scores of heart rate groups of<100 bpm (3.54±0.56),100--150 bpm (2.86± 0.70) and >150 bpm (2.81±0.63) were in a descending order (F=16.72, P<0.01). Multiple linearregression analysis demonstrated that multiple impact factors affected image quality of LM, LAD, LCX and RCA. Age(r=0.013 ,P<0.01)and contrast volume(r=0.292, P<0.01)had positive correlation with LM score. Age(r=0.509, P<0.01) and voltage (r=0.292, P=0.011) had positive correlation with LAD score. Heart rate(r= -0.179, P<0.05) had negative correlation with LAD score. Age (r=0.063, P< 0.01) had negative correlation with LCX score. Age (r=0.486,P<0.01) and voltage (r=0.220, P<0.05) had positive correlation with RCA score. Conclusions Dual-source CT could clearly shows coronary arteries of children with CHD over the age of 3 or with heart rate less than 100 bpm. Limitations of Dual-source CT coronary angiography for CHD children included young age and fast heart rate.

Telomere assumes intra-molecular G-quadruplex that is a significant drug target for inhibiting telomerase maintenance of telomeres in cancer. Metal cations have been recognized as playing important roles in stabilizing G-quadruplex, but their binding processes to human telomeric G-quadruplex remain uncharacterized. To investigate the detailed binding procedures, molecular dynamics simulations were conducted on the hybrid [3 + 1] form-one human telomeric intra-molecular G-quadruplex. We show here that the binding of a potassium ion to a G-tetrad core is mediated by two alternative pathways. Principal component analysis illustrated the dominant concerted motions of G-quadruplex occurred at the loop domains. MM-PBSA calculations revealed that binding was energetically favorable and driven by the electrostatic interactions. The lower binding site was found more constructive favorable for binding. Our data provide useful information on a potassium-mediated stable structure of human telomeric intra-molecular G-quadruplex, implicating in ion disorder associated conformational changes and targeted drug design.
Binding Sites ; G-Quadruplexes ; Humans ; Molecular Dynamics Simulation ; Movement ; Potassium ; metabolism ; Principal Component Analysis ; Substrate Specificity ; Telomere ; chemistry ; metabolism ; Thermodynamics

Objective:To investigate microRNA-20a (miRNA-20a) expression in bladder cancer and its potential mechanism. Methods:MiRNA-20a expression was examined using quantitative reverse-transcription polymerase chain reaction (qRT-PCR) in human bladder cancer tissues and the paired adjacent non-tumor bladder tissues of 96 patients. The target gene of the miRNA-20a was predicted and validated using bioinformatics analysis and reporter gene assay, respectively. The mRNA or protein expression of the target gene in bladder cancer T24 and J82 cells transfected with miRNA-20a mimic or negative control (NC) mimics was detected via qRT-PCR, West-ern blot analysis, and cell immunofluorescence. CCK-8, Transwell chamber, and wound-healing assays were applied to test the prolifer-ation, migration, and invasion of T24 cells after miRNA-20a over-expression in vitro. Results:MiRNA-20a expression significantly in-creased in bladder cancer tissues compared with those in corresponding adjacent non-tumor tissues. High miRNA-20a expression in bladder cancer tissues was closely related to aggressive tumor phenotype, such as high histological grade, poor TNM stage, lymph node invasion, distant metastasis, and tumor recurrence (all P<0.001). Dual-luciferase reporter assay confirmed that miRNA-20a can di-rectly bind to the 3'-untranslated region (3'-UTR) of Homo sapiens longevity assurance homologue 2 (LASS2). Transfection with miRNA-20a mimics significantly inhibited mRNA and protein expression of LASS2 in T24 and J82 cells (all P<0.01) and promoted T24 cell prolif-eration, migration, and invasion in vitro. Conclusion:MiRNA-20a is highly expressed in bladder cancer tissues. MiRNA-20a enhances cell migration as well as proliferation and acts as an oncogene in bladder cancer because of the targeted inhibition of LASS2 expression.