Objective To evaluate the short term results of shoulder hemi-arthroplasty. Methods Twenty-one patients with comminuted intra-articular fracture of proximal humerus underwent Neer type (Link, Germany) humeral head replacement from August 2000 to January 2004, which involved 5 males and 16 females,with an average age of 70 years (range, 64-76 years). According to AO M?ller classification, 3 cases were of C1 type, 8 C2 type, and 10 C3 type. The important steps of the procedure included insertion of the prosthesis in 40 degree retroversion and reconstruction of the rotary cuff of shoulder. The rehabilitation training course was divided into three stages. The patients were trained passively in the first stage (1 day-6 weeks); The muscles around the shoulder undertook isometric contraction once the bone fusion of greater and lesser tuberosity were obtained on X-ray for the second stage (7 -12 weeks); The improvement of the muscle strength and ROM of the shoulder were targeted throughout the third stage (13-24 weeks). All cases were followed up with Neer's scoring system comprising the symptoms, function, range of motion (ROM) of shoulder, and position of the prosthesis. Results The follow-up was performed twice a month within one year postoperatively, and one time three months after that.The mean duration of follow-up was 34.5 months (range, 14 to 55 months). Only slight pain was complained occasionally in 4 cases. No difficulty in active daily life was found in 21 cases .The average ROM of shoulder was flexion 115?(range, 65?-165?),extension 42.5?(15?-70?),abduction 85?(50?-120?), adduction 32.5?(20?-45?), external rotation 40?(20?-60?),and internal rotation 50?(10?-90?). No dislocation or subluxation of shoulder occurred in all cases. Assessed by Neer's scoring system, 8 cases were rated as excellent, 9 as good, 3 as fair and 1 as poor. The excellent and good rate was 80.9%. The patients' satisfactory rate was 90%. Conclusion The shoulder hemi-arthroplasty show good short term results for comminuted intra-articular fractures of the proximal humerus. The key points to improve the postoperative results are presented as follows: less invasive technique, appropriate retroversion angle for humeral head prosthesis, very solid reconstruction for rotary cuff of shoulder, and correct consecutive physical therapy after surgery.

Objective To investigate the relationship between the differential expressing characters of metastasis-relating genes in the nasopharyngeal primary cancerous tissues of untreated nasopharyngeal carcinoma (NPC) cases and the patterns in the terms of Traditional Chinese Medicine (TCM) manifested by these patients. Methods Forty one untreated NPC cases included were differentiated for their own patterns respectively at first and biopsys were made to take tissue samples from the nasopharyngeal mass of them for histopathological diagnosis. Furthermore, expressing level determination of metastasis-relating genes nm23-H1 and VEGF165 was carried out among these samples to analyze the correlation of expressing activity of these genes with their firstly differentiated patterns respectively. Results The expressing level of nm23-H1 was significantly lower in the biopsied tissue samples of nasopharyngeal primary focus among the untreated NPC cases with a pattern of dual deficiency of Qi and Yin than those with the other two kinds of pattern, while the expressing level of VEGF165 was in a reverse way to that of nm23-H1 in its activity expression among these cases with the same kind of pattern (P

The establishment of fingerprint system and the study of spectrum-effect relationship have become a very important development trend in quality evaluation of Chinese materia medica (CMM). It is based on the research of index components and can be used to evaluate the authenticity, quality and stability of crude drug, pieces and patent medicines of CMM. However, it is affected by many unstable factors and lacks of relevance to traditional Chinese medicine theories. Quality marker, in due course, provides an enlightening thought and way for the fingerprint system and spectrum-effect relationship studies. Taking Lonicerae Japonicae Flos as an example, this paper explores the researching ideas and establishes methods for fingerprinting research on CMM based on the characteristics of Q-markers.

Objective To study the efficacy of transcutaneous prostaglandin E 1( PGE 1) cream in relaxing the vascular spasm in rabbits, to find an ideal vascular dilation drug. Methods Sixty rabbits were randomly divided into six groups:experiment group 1(using 0.1% transcutaneous PGE 1 cream),experiment group 2(using 0.2% transcutaneous PGE 1 cream),experiment group 3(using 0.4% transcutaneous PGE 1 cream), experiment group 4( using 0.8% transcutaneous PGE 1 cream),PGE 1 control group (without using transcutaneous PGE 1 cream, but using PGE 1 cream only),control group(withous using PGE 1). 0.1% adrenlin was injected to the root of the rabbite ear to induce a model of vascular spasm. After a typical vascular spasm appeared,transcutaneou PGE 1 cream or PGE 1 cream was used on the skin of the ear. The vascular diameter and blood folw rate of the ear were determined before adrenalin injection, 10min after vascular spasm and 10,15,30,60,90 and 120 min after the drugs were used. Results The vascular diameters and blood flow rate were recovered to the levels of before adrenalin injection in experimental group 3, 4 after topical used of transcutaneous PGE 1 cream, and those parameters were significamly increased compared with other 4 groups(P0.05). Conclusions Tramscutameou PGE 1 cream can effectively relax the vascular spasm caused be adrenalin injection.The effect of vascular dilation is related to the dosage of the drug. Transcutaneous PGE 1 cream as a topical vascular dilation drug has advantages snch as wide indications,taking effect quick and enduring, and less side effect. So it might be a new simple, safe and effective drug for the treatment of vascular spasm.

Objective To investigate early changes of angiopoietin-2(Ang-2)in multiple trauma patients and assess its clinical significance.Methods Forty-five multiple trauma patients aged 2060 years admitted to the hospital within one hour after injury were randomly divided into three groups according to injury severity score(ISS).Blood specimens were obtained immediately upon arrival in the emergency department and plasma samples were assayed for comparing changes of Ang-2,TNF-a and IL-6.Meanwhile,plasma level of Ang-2 was measured and analyzed under different oxygenation index,shock index and base deficit.Results Plasma level of Ang-2 was positively correlated with ISS(P ＜ 0.01)and was concordant with the plasma levels of TNF-a and IL-6(P＜0.01).Furthermore,plasma level of Ang-2 was elevated upon increase of shock index or decrease of oxygenation index(P ＜ 0.01).Plasma level of Ang-2 was elevated with the increase of base deficit(P ＜ 0.01).Conclusions High level of Ang-2 is a marker of endothelial activation and dysfunction early after trauma.Ang-2 is related tightly with the injury severity,inflammation factors,systemic oxygenation and tissue hypoperfusion and may have a tight relation with pathophysiological development and clinical outcome after trauma.

Objective To summarize the clinical features,diagnostic and treatment experience of severe hand,foot and mouth disease(HFMD) cases receiving mechanical ventilation from Jan 1 to Sep 6,2009 in our hospital and provide reference for reducing the occurrence of neurogenic pulmonary edema(NPE) and mortality. Methods 147 severe HFMD who received mechanical ventilation were analyzed by a retrospective investigation. Results 85.0% children were less than 3 years old and 100% patients had a fever. The mechanical ventilation occurred within 1 to 4 days after fever (3.06 ± 1. 02) d. Neurological complications presented as bad spirit,easy surprised, involuntary movement of the extremities and lethargy. Respiratory system complication presented as polypnea, hypepnea and irregular rhythm. Circulatory system complication presented as heart rate increase or decrease, hypertension or hypotension, piebald skin and low limb temperature.Some of the children had high white blood cell counting,glucose and lactic acid of the blood. The EV71-PCR positive rate was 34. 7% for throat swabs,and 42. 2% for anal swabs. Chest X-ray presented as increased broncho vascular shadows, exudation or nonapparent abnormality. Only three children were dead, fatality rate was 2. 0%. Conclusion The HFMD cases in this outbreak are relatively more serious,and change rapidly. It's difficult to treat as soon as NPE appeared,and it has high fatality rate. Early recognition of critical patients,timely giving mechanical ventilation,and the comprehensive treatment can reduce NPE incidence and the mortality.

This article analyzes and summaries the problems and difficulties existing in the first-aid medicine's clinical teaching.Combined with his own teaching experience,the author has made some exploration on the teaching time,the way of teaching and inspection form,which has got a good teaching effect.It provids the reference and development for the clinical teaching of first-aid medicine.

The correlation between pulmonary endothelin receptors and alveolar-arterial oxygen gradient (A-aDO2) in rats with hepatopulmonary syndrome was investigated. Animals were divided into 2 groups: Sham-operated (Sham) group and common bile duct ligation (CBDL) group. Arterial blood gas was evaluated by a blood gas analyzer. The concentrations of ET-1 in blood and lung tissue sample were evaluated by radioimmunoassay. The distribution and expression of two kinds of subtype receptor of ET-1, ETRA and ETRB were examined by in situ hybridization. The results showed that the level of A-aDO2 was higher in CBDL group than that in Sham group (P < 0.05). The levels of plasma and pulmonary ET-1 in CBDL group were both higher than in Sham group (P < 0.05). There was no significant difference in average A of ETRA between two groups by imaging analysis (0.21 +/- 0.06 vs 0.22 +/- 0.08, P > 0.05), while that of ETRB was higher in CBDL group than in Sham group (0.58 +/- 0.16 vs 0.28 +/- 0.07, P < 0.05). The expression of ETRB in lung was positively correlated with A-aDO2 (P < 0.05). It was concluded that the widened A-aDO2 may be related with enhancement of the expression of ETRB in lung.
Endothelin-1/metabolism ; Hepatopulmonary Syndrome/*metabolism ; Lung/*metabolism ; Oxygen/*metabolism ; Pulmonary Alveoli/*metabolism ; Rats, Wistar ; Receptor, Endothelin A/metabolism ; Receptor, Endothelin B/*metabolism

Objective To investigate the association of T help (Th) lymphocyte and heart rate variability (HRV) in congestive heart failure (CHF) patients. Methods Ninety-six patients with CHF and thirty healthy persons were enrolled in the study. Time-domain HRV analysis was performed based on 24 hour Holter Electrocardiogram (ECG) monitoring. Interferon-γ (IFN-γ) was used as markers for the differentiation of Th1 subsets and interleukin-10 (IL-10) for the Th2 subsets. IFN-γand IL-10 in CD4 + T lymphocytes were quantified by 3-color flow cytometry. Results The frequency of IL-10-Producing T Cells in the CHF group was significantly lower than those in the healthy control ( ( 16.4 ± 5.8 ) % vs. ( 26.8 ± 3.7 ) %, t = 9. 243, P ＜ 0. 001 ). The frequency of IFN-γ in the CHF group ( ( 18.4 ± 7.3 )% ) was significantly lower than that in the healthy controls ( (7.3 ±4.6) % ,t =7. 917, P ＜ 0. 001 ). The following index of HRV in the CHF groups were all significantly lower than those in the healthy controls: (98. 6 ± 21.3) ms vs. ( 145. 1 ± 42. 6) ms for SDNN, (83. 9 ± 22.4) ms vs.(136.5 ±39.6)ms for SDANN, (40.6 ± 14.5) ms vs. (55.8 ± 17.9) ms for SDNNI, (20. 7 ± 12.9) ms vs.(29.1 ± 12.6) ms for RMSSD, (5.6 ± 3.7 ) % vs. ( 11.8 ± 4.4) % for PNN50 ( Ps ＜ 0.05 ). In CHF patients, the frequency of IL-10 were positively associated with SDNN, SDANN, SDNNI, RMSSD and PNN50 ( r = 0. 49,0. 57,0. 58,0.47 and 0. 52 ,respectively,Ps ＜ 0.01 ). In the CHF patients, the frequency of IFN-γand IFN-γ/IL-10 ratio were negatively associated with SDNN ,SDANN ,SDNNI, RMSSD and PNN50 ( r = - 0. 49, - 0. 54, - 0. 57, - 0.52,- 0.53, - 0. 52, - 0.64, - 0.57, - 0. 58, - 0. 67, Ps ＜ 0. 01 ). Conclusions Autonomic nervous system is involved in the regulation of the balance of Th1/Th2 in patients with CHF. Sympathetic nerve system enhances the effect of Th1 ,whereas parasympathetic nervous system enhances the effect of Th2.

Objective To investigate the risk factors for mild cognitive impairment (MCI) in elderly people in Beijing.Methods Using multistage cluster random sampling,129 elderly people aged 60-80 years living around Dongzhimen communities were interviewed by mini-mental state examination (MMSE) and National Institute of Neurological and Communicative Diseases and Stroke/ Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria for screening MCI and Alzheimer's disease (AD).Results Thirty-seven cases (28.7%) had amnestic MCI (aMCI),thirty-six cases (27.9%) had AD,and fifty-six cases (43.4%) were with normal cognitive state (NCS).The age was older in aMCI patients or AD patients than in NCS[(67.6±7.5)y vs.(62.5±7.9)y,(67.6±7.5)y vs.(62.5±7.9)y,both P<0.01],Andthe aMCI or AD patients had low level of education (P<0.05).The blood pressure was higher in the patients suffered from aMCI or AD than in people with NCS more or less (P<0.05).The prevalence of aMCI was related to the body mass index (BMI) (P<0.05),while that of AD had no significant relation with BMI (P>0.05).The prevalence of aMCI or AD was not significantly different between male and female or between different birth months.(all P>0.05).Conclusions The prevalence of aMCI increases with age,lower level of education,higher level of blood pressure and BMI,while it has no significant relations with gender or birth month.