BACKGROUND: Clinical studies have discovered heart rate variability (HRV) is closely correlated with autonomic nervous system, sub-health and sudden death. Medical studies have summarized some chaotic medical science and homeostasis relevance theory. But so far the combination could still not systematically explain the clinical manifestation or summarize the diagnostic standards for sub-health and effective index to prevent sudden death. OBJECTIVE: To elucidate the correlation among autonomic nervous system, sub-health and sudden death by using chaotic medicine and homeostasis, so as to provide theoretical basis for evaluating sub-healthy state using HRV and preventing sudden death HRV. RETRIEVAL STRATEGY: A computer-based online search of Pubmed was undertaken to identify the articles published in English between January 1995 and June 2007 with the keywords of "chaotic medicine, heart rate variability (HRV), Sudden death, Sub-health, homeostasis". Meanwhile, the Weblog and CNKI database were searched for relevant articles dated from January 1995 and June 2007 with the same keywords in Chinese. Fifty-six papers were searched. After the first trial, only articles ①closely correlated with chaotic medical science, sudden death and sub-health, and ②published recently or in authority magazine in same field were selected. Repetitive studies were excluded. LITERATURE EVALUATION: The review articles, basic and clinical experiments about chaotic medical science, HRV, sudden death, sub-health, and homeostasis as well as articles published in related weblogs were selected. DATA SYNTHESIS: ①In any individual composed of multi-cells and multi-system, there are at least three-level chaotic system: overall chaotic system, cardiovascular chaotic system maintaining the blood pressure and cell chaotic system. Healthy state is that the three chaotic systems are in normal condition. Disease and sub-healthy state is the sub-stable state of chaotic system caused by the overstress of central nervous system, overexcitation of autonomic nerves and HRV decrease when there is some cell or cardiovascular system malfunction, and the information is feedback to central nervous system. ②Based on the theory about chaotic medicine and homeostasis, there are four states in individual chaotic motion: health, disease, sub-health, and homeostasis border before sudden death. The health is the homeostasis of body; disease and sub-health are the sub-homeostasis and may develop from healthy state because various factors; they may transform each other and both of them may lead to sudden death for unsteady. ③The extreme tension of central nervous system and over-excitation of autonomic nerves result in the destabilizing overall chaotic motion. Stimulation induces system destabilizing and sudden death because the patient cannot maintain arterial blood pressure. CONCLUSION: Long-term healthy state is unpredictable, but we can forecast 1-2 days situations by short-term HRV testing for 512 times in the early morning of every day, and judge the healthy state after sleep, and the change tendency of healthy state. Accordingly, we could predict person is in healthy state, sub-healthy state or unsteady border state that could cause sudden death.

Objective To compare the effectiveness of enteral nutritional emulsion (TPF-D) and enteral nutritional emulsion (TP) in patients with chronic wound and diabetes (CWD). Methods Totally 20 CWD patients in Beijing Jishuitan Hospital from June 2008 to June 2010 were enrolled in this study. Enteral nutritional emulsion (TP) was used for the first 5 days ( TP group) and enteral nutritional emulsion (TPF-D) was used for the second 5 days (TPF-D group). Changes of mean amplitude of glycemic excursions (MAGE), insulin dosage, and prealbumin (PA) were compared between TPF-D group and TP group. The adverse effects and post-operational complications were also observed. Results The every-day MAGE was (2. 56 ±0. 35) mmol/L in TPF-D group, which was significantly lower than that in TP group [ (3.23 ± 0. 42) mmol/L] ( P = 0. 01 ). The mean insulin dosage was (9.6 ± 1.7) U in TPF-D group, which was significantly lower than that in TP group [ ( 12. 2 ± 2. 5 ) U ] ( P =0.03 ). The increase of PA showed no significant difference between TPF-D group [ ( 12.7 ± 3. 3) mg/L] and TP group [ ( 13.4 ± 2. 8 ) mg/L ] ( P = 0. 08 ). No enteral nutrition-related adverse effect or post-operation complication was noted. Conclusion Compared with TP, TPF-D is more suitable for the CWD patients.

Objective To investigate the changes in cyclophilin A (CyPA) signal pathway in rat myocardial tissue after cardiopulmonary resuscitation (CPR).Methods Sixty-eight healthy male Sprague-Dawley (SD) rats were randomly divided into sham operation group (n =8),instantancous CPR after cardiac arrest (CA),immediate CPR after CA (CRP),and 15,30,60 and 120 minutes after CPR groups,respectively,with 10 rats in each group.Asphyxia was simulated by occlusion of the tracheal tube at the end of exhalation.Mechanical ventilation,compression and epinephrine injection were given for restoration of spontaneous circulation (ROSC) in order to reproduce cardiopulmonary resuscitation after cardiac arrest (CA-CPR) models in rats.Hemodynamic changes were recorded at different time points.The blood was collected from abdominal aorta,and myocardial tissue was also harvested.The serum CyPA and CD147 levels were determined by enzyme-linked immunosorbent assay (ELISA).The protein positive cells and mRNA expression of CyPA and CD147 in myocardial tissue of the rats were determined by immunohistochemical and real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR).The protein expressions of matrix metalloproteinases (MMP-2,MMP-9) and myeloperoxidase (MPO) in rat myocardial tissue were determined by Western Blot.The neutrophil infiltration in rat myocardial tissue was assessed by hematoxylin and eosin (HE) staining.Results The heart rate of rat was lowered to 0 with arterial pressure lowered immediately after CA.Arterial pressure was elevated to normal range immediately after CPR.Heart rate was restored at about 30 minutes later,and the dose of epinephrine was 50-60 μg,and ROSC time was 1-4 minutes.Compared with those of the sham group,serum CyPA and CD147 levels were gradually increased along with elongation of ROCS time within 120 minutes,and peaked at 120 minutes,CyPA was increased from (786.11 ± 3.93) μg/L to (2 001.80 ± 10.61) μg/L,and CD147 was increased from (2.94±0.02) μg/L to (5.99±0.023) μg/L (P ＜ 0.05 or P ＜ 0.01).CyPA and CD147 mRNA expressions (A value) in rat myocardial tissue were gradually increased,and peaked at 120 minutes.Relative expression of CyPA at 120 minutes was 2.42 ± 0.05 when it was 1 in the control,and relative expression of CD147 at 120 minutes was 1.88 ±0.10 (both P ＜ 0.01).The immunohistochemical results under light microscope showed that the brown positive cells were gradually increased,which indicated that the expressions of CyPA and CD147 were increased.Expressions of MMP-2,MMP-9 and MPO (gray value) in myocardial tissue were also gradually increased,peaking at 120 minutes,and MMP-2 was increased from 0.396 ± 0.021 to 0.879 ± 0.020,MMP-9 was increased from 0.372 ± 0.009 to 0.819±0.012,and MPO was increased from 0.176±0.005 to 0.829±0.018 (P ＜ 0.05 or P ＜ 0.01).No obvious neutrophil infiltration in myocardial tissue was found with HE staining.Conclusion Expressions of CyPA and CD 147 were up-regulated in serum and myocardial tissue after CPR in rats,which may be the markers of inflammatory reaction.

Objective To investigate the relationship between 4G/5G polymorphism in the promotor of plasminogen activator inhibitor-1 (PAI-1) gene and pulmonary thromboembolism (PTE). And to detect whether it plays an important role in the pathogenesis of PTE. Methods The 76 patients with PTE, 74 gender and age matched healthy controls were recruited in this study. Genome DNA was extracted from whole blood using phenol-chloroform. Subjects were genotyped for the 4G/ 5G polymorphism of PAI-1 gene using polymerase chain reaction and restriction fragment length polymorphism analysis. Results Significant difference was found in the frequency of 4G/4G genotype between PTE group and control group (50.0% vs.24.3%,P<0.01). And there were no significant differences in 4G/5G and 5G/5G genotype between the two groups. The 4G allele frequency was higher in PTE group than in control group (72.4% vs. 55.4% , P<0.01) . The recessive allele model was informative and the odd ratio of 4G/4G genotype was much higher than of other two genotypes (OR=3.40, P<0.01). Further stratification showed 4G/4G genotype was associated with high risk of PTE for those individuals without traditional environment risk factors. Conclusions The 4G/5G polymorphism of PAI-1 gene is associated with PTE and 4G allele is recessive. 4G/4G genotype increases the risk of PTE for individuals who have no traditional risk factors of PTE.

Objective To investigate the risk factors and treatment for infections after spinal internal fixation surgery. Methods The clinical data of 472 patients who underwent spinal internal fixation surgery from January 2012 to December 2012 was analyzed retrospectively, an average age of 50. 6 years (38~78 years). All cases were underwent posterior procedures. All infected patients received emergency opera-tion of wound debridement, drainage and sensitive antibiotic treatment. The mean follow-up time was 11 months (8~19 months). Risk fac-tors and treatment for infections were summarized and discussed. Results Of 472 patients,postoperative infections occurred in 9 cases with the infection rate of 1. 91%. The operation time,intraoperative blood and postoperative drainage was 100~325 min,200~1500 mL and 65~1350 mL,respectively,which were greater than the similar surgeries of same period. The initial signs of wound infection was observed at 10 d (6~16 d) after surgery. CRP,ESR and WBC were significantly increased in 4~7 d after surgery,and maintained at high level at least for 14 d. Bacterial culture results showed infection bacteria were mainly common skin flora. One infection recurred during followed-up and subse-quent treatment was successful. Conclusion Wound infection after internal fixation mainly occurred in the posterior procedure of spine, which were deep infection. The main clinical manifestation was the wound exudate and local deep tenderness,fever and wound surface swelling were relatively rare. Increased intraoperative bleeding,postoperative drainage volume,operation time were the risk factors,which lead to perio-perative malnutrition and subsequent infections. Debridement,drainage,and intravenously sensitive antibiotics could obtain an ideal outcome for most cases. It was not necessary to remove the internal fixation instrument and bone grafting.

Objective To investigate the role of polymorphisms of scavenger receptor class B gene CD36 in affecting the progress of subclinical atherosclerosis (AS) and the associated factors affecting the expression of CD36 on the surface of peripheral blood monouclear cells (PBMC) and the association between CD36 expression and progress of subclinical AS in type 2 diabetic patients.Methods CD36 polymorphisms (CD36-rs1984112, CD36-T620C) were typed by PCR-RFLP in 470 cases of type 2 diabetes mellitus and 220 non-diabetic controls of Hans in Hunan area.The genotypes and allele frequencies were compared between cases and controls.Fluorescence intensity of CD36 on the surface of PBMC was analyzed in 102 cases of type 2 diabetes mellitus by flow cytometry and was compared between the patients without AS and the patients with subclinical AS.Multiple linear regression was applied to evaluate the relevant factors contributing to CD36 expression.Results The genotypes and allele frequencies of CD36-rs1984112 in type 2 diabetes mellitus were not significantly different between cases and controls (P＞0.05), either did CD36-T620C (P＞0.05).The mean florescence intensity (MFI) of CD36 in type 2 diabetics with subclinical AS was higher than that without AS (1 382±659 vs 1 173±340, P＜0.05).Factors affecting the CD36 expression were: age (P=0.005), gender (P=0.021), systolic blood pressure (SBP) (P=0.027), standardized coefficients Beta was 0.28, 0.31 and -0.21, respectively.Age contributed to the CD36 expression level in males (P=0.002) and diastolic blood pressure in females (P=0.001) respectively.Conclusion CD36-rs1984112 and T620C seem not to be a functional polymorphism sites in Hans of Hunan, southern China.CD36 expression level is higher in type 2 diabetics with subclinical AS in contrast with those without AS.CD36 expression on PBMC surface is higher in aged males with lower SBP.

Objectives To explore the effect of transient continuous subcutaneous insulin infusion (CSII) on β cell function, insulin resistance and vascular endothelial injury in newly diagnosed type 2 diabetic patients and its potential mechanism. Methods Ten patients with newly diagnosed type 2 diabetes mellitus (T2DM) accepted CSII for two weeks. Intravenous glucose tolerance test (IVGTT) and hyperinsulinemia euglycemia clamp test were performed before and after CSII. Serum soluble E-selectin (sE-selectin) was used to evaluate the injury of vascular endothelial cell, while serum high sensitivity C reactive protein (hsCRP) and soluble CD_(14) (sCD_(14)) were both used to assess inflammatory condition. Results (1) Compared with those before treatment, the blood glucose levels of IVGTT, the area under the curve of the blood glucose, glycosylated hemoglobin, TC and LDL-C in the patients were decreased after CSII (P < 0. 05 or 0. 01). (2) Compared with those before treatment, the insulin levels of IVGTT (except the fasting insulin), the area under the curve of insulin and acute insulin response were all increased after CSII(P < 0.05 or 0.01). (3) Compared with that before treatment, the glucose infusion ratio in the clamp test [(3.46±1.66)mg·kg~(-1)·min~(-1) increased to (7.14±2.37)mg·kg~(-1)·min~(-1)]and HOMA-β elevated, while HOMA-IR declined (P <0. 05 or 0. 01 in all). (4) Compared with those before treatment, the levels of serum sE-selectin, sCD_(14) and hsCRP were decreased (P < 0. 01, except for hsCRP) . Conclusion Transient intensive insulin therapy in patients with newly diagnosed T2DM is useful to restore 13 cell function, attenuate insulin resistance, repair vascular endothelial injury and improve the disorder of blood sugar and lipid. The mechanism may be related with the inhibition of inflammation in patients.

Objective:To evaluate the value of dual-energy CT (DECT) mixed images CT in predicting hemorrhagic transformation (HT) after endovascular therapy (EVT) of acute ischemic stroke (AIS).Methods:From October 2018 to January 2020, the immediate dual-energy CT images of intracranial high attenuation (HA) regions in patients with AIS after endovascular treatment in Wuhan No.1 Hospital were retrospectively analyzed. According to the diagnostic criteria of CT or diffusion weighted image in 72 hours of follow-up, they were classified into HT group and non-HT group. The CT value of mixed images, contrast media, and virtual non-enhancement (VNC) and iodine concentration in the highest attenuation areas were measured. Intragroup correlation coefficient was used to evaluate the consistency among the readers; Mann-Whitney U test was used to compare the difference between the two groups of quantitative parameters; Spearman correlation analysis was uesd for evaluating correlation between mixed images CT value and contrast media CT value, VNC CT value, and iodine concentration. The receiver operating characteristic curve was used to analyze the quantitative parameters to predict the diagnostic efficacy of HT. Results:A total of 154 cases were enrolled, with 65 cases in the HT group and 89 cases in the non-HT group. The intraclass correlation coefficient of CT values of mixed images was 0.861 ( P<0.05). Comparing the non-HT group and the HT group,the CT value of mixed images [59.40(54.84, 63.05) HU vs 100.10(79.90, 122.40) HU, Z=-10.87, P<0.001],contrast agent CT value [24.90(20.75, 30.05) HU vs 66.60(47.10, 84.15) HU, Z=-10.85, P<0.001] and iodine concentration [1.10(1.00, 1.30) mg/ml vs 2.90(2.05, 3.65) mg/ml, Z=-10.85, P<0.001] both increased in the HT group, but there was no significant difference in VNC CT values between the two groups [33.60(31.80, 35.70) HU vs 34.30(30.90, 38.00) HU, Z=-0.50, P=0.62]. There was a highly significant correlation between the CT value of mixed images and iodine concentration ( r=0.99, P<0.01). Using CT value>72.60 HU as the diagnostic cutoff value for predicting HT, the sensitivity and specificity were 89.23% and 95.51%, respectively. Conclusions:The CT value of DECT mixed images after EVT can be used to predict HT within 72 hours. When DECT was not available, conventional CT scan′s intracranial HA density over 72.60 HU can be selected as the cutoff value for predicting HT.

Objective:To compare the efficacy of bilayer artificial dermis graft plus single layer dermal template and bilayer artificial dermis graft only in repairing lower extremity wounds with large area of exposed bone.Methods:A retrospective case-control study was conducted to analyze the clinical data of 34 patients with 37 wounds of the lower extremity involving large area of exposed bone admitted to Beijing Jishuitan Hospital from November 2009 to November 2020. There were 27 males and 7 females, aged 9-67 years [35.5(29, 45)years]. The exposed bone in the lower leg, ankle and foot was greater than 10 cm 2 in size (the shortest distance from edge to edge of bony exposure was more than 2 cm). At the first stage, the wounds were grafted with bilayer type artificial dermis only for 21 wounds of 20 patients in Group A, and grafted with bilayer type artificial dermis plus single layer dermal template for 16 wounds of 14 patients in Group B. At the second stage, the auto-skin graft was performed in the two groups. The wound healing rate was observed in all patients, and was compared between the two groups at 2 weeks and 2 months after the second stage operation. At the same time, the interval between first stage and second stage surgery was measured. The Vancouver Scar Scale (VSS) was used to evaluate the scar in the skin grafting area in the two groups at 5-6 months after the second stage operation. Results:All patients were followed up for 1 to 24 months [5(2, 7.5)months]. The total excellent and good wound healing rate in all patients was 81%(30/37) at 2 weeks and 97%(36/37) at 2 months. There was no significant difference between the Group A and Group B in the excellent and good wound healing rate at 2 weeks [(76%(16/21) vs. 88%(14/16)] and at 2 months [95%(20/21) vs. 100%(16/16)] ( P>0.05). In Group A, the bilayer artificial dermis was grafted into 4 wounds again to complete exposed bone coverage. However, all wounds in Group B were covered initially without re-grafting. The interval between the two-stage operation was 20(16, 21)days in Group A after the 4 patients who underwent secondary artificial dermal transplantation were excluded, showing no significant difference from 21(21, 23)days in Group B ( P>0.05). At 5-6 months after the second stage operation, the VSS score in Group B [(8.0±1.2)points] was significant less than that in Group A [(9.2±1.1)days] ( P<0.05). In the sub-index of VSS, the score of color and softness of scar in Group B [(2.0±0.6)points, (1.6±0.5)points] were significantly improved compared to those in Group A [(2.5±0.5)points, (2.2±0.7)points] ( P<0.05). Conclusions:The artificial dermis grafting is effective in treatment of lower extremity wounds with large area of exposed bone. However, the bilayer artificial dermis graft plus single layer dermal template can avoid artificial dermal re-graft in repair of large area of exposed bone, and the interval between two-stage operation is not significantly prolonged. Moerover, the color and texture of scar after skin grafting and wound repair efficiency and quality are improved.

Objective To explore the application of 3D printing technology in clinical apprenticeship teaching in spinal surgery. Methods 38 eight-year clinical medical students admitted to the Department of Spine Surgery were randomly divided into experimental group (19 patients) and control group (19 patients). Taking odontoid fracture as an example. The traditional method is used for teaching, and the experimental group is taught with traditional teaching method combined with 3D printing technology . After the apprenticeship, the students of the two groups were tested in theory and simulated operation to evaluate the teaching effect. SPSS 17.0 was used for statistical analysis. The measurement data was expressed as mean ± standard deviation, and the t-test was used to compare the measurement data between two groups. Results The results showed that the scores of immediate examination and one month after class in the control group were (82.23 ±7.52) and (72.36 ±6.39) points respectively. The scores of immediate examination and one month after the class in the experimental group were (85.58 ±6.32), (80.87 ±6.23). The scores of the two examinations in the experimental group were significantly higher than those in control group , and the differences were statistically significant (P<0.05). Conclusion The 3D printing technology can significantly improve the teaching effect in the clinical apprenticeship teaching of spine surgery, and it has a bright prospect for application.