[Objective]To study the role and the effect of establishing the plan of meeting emergency in the rehabilitation and reestablishment of high-octane body hurt.[Method]Eighty six patients of high-octane body hurt were collected from Shi He Zi people's hospital during 1998 to 2007.According to Gustilo-Anderson categorize of open fracture and mark of ISS,high-octane body hurt can be divided into three parts.Meanwhile,different part can be taken different methods to rehabilitate and reestablish.Therefore,we can analyze pertinence between cure principle and curative effect.[Result]Eighty three patients were observed during the period of fifteen and thirty-three months,the average were nineteen months.Five of them contracted double floating knee injury,and their knee joint appeared anchylosis,abnormality and function failure afterfracture healed up.We did one-off knee joint release while extracting internal fixation,and used CPM machine to assist exercise.Fortunately,the function of knee joint could be renewed.Another five patients' fracture did not heal up very well.However,after experiencing the apply of oneself bone autograft,fracture could be healed up perfectly.The time of allograft bone union ranged from five to sixteen months,the average time were 7.5 months.There are three patients contract paraplegia,and three patients dead.By autopsy,some of them belongs to multiple fracture and multiple viscera burst.Mortality was 3.48%.[Conclusion]By establishing the plan of meeting emergency of high-octane body hurt,using the Gustilo-Anderson categorize of open fracture and mark of ISS,we can systemic classify damage degree,and make scientific treatment by stages,therefore,attaining our goal of early diagnoses,early treatment,and decreasing mortality and decreasing the proportion of disabled.After all,the plan of meeting emergency plays an essential role in traumatie surgery.

Objective: To analyze Chinese elderly health policy documents from 2018 to 2022 based on policy tools, so as to provide insights into improving elderly health policies and promoting healthy aging. Methods: Elderly health policy documents were retrieved from “the magic weapon of Peking University”, the policy document database of the State Council and portal websites of relevant ministries and commissions using keywords “elderly”, “aging” and “elderly health”. The documents were encoded using content analysis and keywords were extracted. A two-dimensional analysis framework was constructed based on Rothwell and Zegveld's classification framework and dimension theory, and the use of policy tools was analyzed. Results: Totally 57 Chinese elderly health policy documents were collected from 2018 to 2022, including 44 notices, 7 opinions, one rule, one regulation, one law, one announcement, one letter and one joint declaration. There were 37 documents (64.91%) issued by National Health Commission and its departments and offices. The high-frequency keywords in the documents included “medical and healthcare institutions”, “elderly health”, “rehabilitation/nursing”, “community/grassroots/rural”, “pilot”, “traditional Chinese medicine”, “propaganda” and “standardization”. There were 413 document codes, and the supply-, environment- and demand-side policy tools accounted for 52.54%, 31.72% and 15.74%, respectively. Public health and medical services (19.61%) and science popularization (7.99%) were the most commonly used supply-side policy tools, law/regulations and administration systems (7.99%) was the most commonly used environment-side policy tools, while pilot/demonstration projects (5.33%) was the most commonly used demand-side policy tools. The external and internal indicators of the system dimensions accounted for 48.18% and 51.82%, and political system (17.19%) and technical system (16.46%) were the two most commonly used external indicators, while service system (35.60%) was the most commonly used internal indicator. Conclusions Chinese elderly health policies focused on supply-side policies from 2018 to 2022, such as public health and medical services. The use of demand-side policy tools is recommended to be increased and the internal composition of supply- and environment-side policy tools are recommended to be optimized.

Objective This study was designed to investigate the role of apoptosis-inducing factor on neonatal rat cardiomyocytes apoptosis induced by TNF-a,and to detect the effect of IL-10 on the apoptosis rate of cardio-myocytes apoptosis induced by TNF-α.Methods Neonatal rat cardiacmyocytes in primary culture were exposed to TNF-α( 100ng/ml)for 12 hours,18 hours,24 hours,TNF-α( 100ng/ml) for lohours pretreated by IL-10(50ng/ml) 1 hour,or IL-10(50ng/ml) for 19hours.Apoptotic cells were detected by flow cytometry and Hoechest 33258 dye; Western blot were used to determine the apoptosis-inducing factor protein expression.Results The apoptosis rate of cardiomyocytes increased in TNF-α 12 hours group than that of control[ Flow cytometry (5.08 ±0.79% ) vs ( 2.2± 0.77)% ,P <0.05],and reach the peak in TNF-α 18 hours group compared with control[ Flow cytometry(14.39± 2.31)%vs(2.2±0.77)%,P<0.01;Hoechst 33258 dyeing(18.936±2.791)% Vs(2.890± 1.326)% ,P< 0.01];also elevated in TNF-α 24 hours group vs control[Flow cytometry(4.61±0.84)% vs(2.2 ±0.77)% ,P< 0.05].AIF expression:Increased expression of AIF in the cells treated by TNF-α( 100 ng/ml) 12 hours,reached highest in TNF-α( 100 ng/ml) for 18 hours group and decreased in TNF-α( 100 ng/ml) 24 hours group compared with control;AIF expression is not decrease in TNF-α( 100 ng/ml) 18 hours pretreated by IL-10(50 ng/ml) for 1-hour group comparing with TNF-α( 100 ng/ml) 18hours group.Conclusion The study demonstrated that AIF contributed to TNF-α induced apoptosis of rat cardiomyocytes; IL-10 alleviated the apoptosis of rat cardiacmyocytes induced by TNF-α,and AIF may not its mechanism.

BACKGROUND:Alternative implants affect stability of prostheses,and freeze-dried bone allografts are most selected as implants.The crack between grafts and host bone is unavoidable,which would weaken the bone integration.Bone cement can fill the cracks quickly and completely,however,the effects of bone cement on the stress of prostheses and its own remains poorly understood.OBJECTIVE:To evaluate the effect of the different grafting for bone loss in the presence of the new acetabular component with wings at the time of acetabular revision.METHODS:The finite-element models of acetabular component with three wings and acetabulum with bone loss were established.Following prostheses implantation,the gaps were filled with bone cement and freeze-dried bone allograft,respectively,stress of the graft and its effect on prostheses were analyzed under 2 158 N and 426 N acetabular loads.RESULTS AND CONCLUSION:The finite-element analysis demonstrated that stress and strain at the interfaces of bone-shell and metal-polyethylene liner had the same direction of change but no significant difference between them.In the study,the result indicated increased contact stresses with an increased hip force and orientation.The stress of wings increased gradually from rim to root.Its peak stress was at the joint between the wing and the shell.The different grafts did not affect the stress of the acetabular component.But the stress of bone cement was significantly higher than that of particulate bone.The study demonstrated that change of the graft could not make remarkable effect on the stress of the acetabular component.But the stress of bone cement increased significantly.The result of the finite-element analysis indicated that particulate bone graft is benefit to improving itsstability and to minimize aseptic loosening rate of acetabular component.

Alternative designs have been explored in an attempt to improve the longevity of acetabular prostheses in revision surgery. Many studies had been designed to test the result of the extra-large uncemented hemispherical acetabular components used for acetabular revision in the presence of bone loss. A clinical study of a new acetabular component consisting of a porous metal shell with three wings and an all-polyethylene liner had attained a satisfying result. The purpose of this study was to evaluate the new acetabular component by comparison with the hemispherical acetabular component. The finite-element models of the two acetabular components and the acetabulum in the presence of bone loss were established to calculate the interface stresses during a normal gait cycle with use of the finite-element formulations. Results of the finite-element analysis demonstrated that stress and strain of the two acetabular components had the same direction of change, but the new component had higher stress at the root of wings. In the study, the result indicated reduced contact stresses with a reduced abduction angle of wings. The stress was lower in the new acetabular component of 15° angle of wings compared with the new acetabularcomponent of 30°of wings and hemispherical acetabular component (P < 0.05). The stress of acetabular component with wings showed no remarkable difference by comparison with the extra-large uncemented hemispherical acetabular component. Reducing abduction angle of wings seemed to be a viable means of reducing the stress of the acetabular component while improving its stability.

Objective To investigate the mechanism of Sut melanocytes growth inhibition in response to xCT -deficiency. Methods TTotal proteins were extracted from xCT-deficient Sut melanocytes and wild melanocytes, respectively, and were separated by 2-dimensional electrophoresis. Altered expression profile of proteins of Sut melanocytes was analyzed by PDQuest software and compared with that of wild melanocytes.Proteins with significant change were chosen to be identified by mass spectrometry and database query.Results Twenty proteins in Sut melanocytes altered significantly compared with wild melanocytes. Ten of the proteins were up-regulated, while the other tens were down-regulated. Four proteins from both up-regulated and down-regulated were identified respectively: up-regulated proteins were Tubulin alpha-1b, S100-A6,Nucleoside, S-formylglutathione, and down-regulated proteins were Calumenin,NDRG1 ,DPYSL2, 14kDa unknown protein. Conclusion The identification of the xCT-deficiency related proteins may provide supporting evidence for the mechanism research of Sut melanocytes' growth inhibition caused by xCT-deficiency.

ObjectiveTo assess the differential diagnostic value of serum intestinal fatty acid binding protein (I-FABP)in distinguishing intestinal ischemia patients from acute abdomen patients.MethodsA total of 151 patients with acute abdomen and 17 healthy controls from the PLA General Hospital were enrolled from November,2009 to August,2011. Serum I-FABP levels were measured by ELISA.According to the ROC curve,the cut-off value,sensitivity,specificity,positive likelihood ratio (PLR),negative likelihood ratio ( NLR),positive predietive value (PPV) and negative predictive value (NPV) were calculated. ResultsOf the 151 acute abdomen patients,there were 24 intestinal ischemia patients and 127 without intestinal ischemia.Serum I-FABP level in intestinal ischemia group [( 109.67 ±48.82) μg/L]was significantly higher than those in patients without intestinal ischemia [(36.78 ± 11.25) μg/L]and healthy controls[(8.33 ±6.25) μg/L]( all P values ＜0.01 ).The serum I-FABP cut-off value for the diagnosis of intestinal ischemia was 87.52 μg/L.Serum I-FABP was efficient in terms of sensitivity (0.762),NPV(0.963),PLR(3.05) and NLR (0.24) in the diagnosis of intestinal ischemia.ConclusionI-FABP is potentially useful for discriminating intestinal ischemia from acute abdomen.

Objective To analyze the medium and long-term results of tricuspid valve replacement (TVR)and summarize the operative experience for tricuspid valve disease.Methods Clinical data of 27 patients with severe tricuspid valve disease from September 2005 to May 2010 were retrospectively reviewed.Biological valve prosthesis was replaced in 23 patients,while mechanical valve prosthesis was replaced in 4 patients.Accompanying procedures included mitral valve replacement in 8 cases,mitral valve replacement and aortic valve replacement in 4 cases,and repair of atrial septal defect in 4 cases.Results The operative mortality was 11.1％(3/27),among these patients,2 cases died of serious low cardiac output syndrome,1case died of muhiorgan failure on the 7th day after operation,1 case who underwent reoperation for hemorrhage postoperative was improved after treatment.During follow-up,1 patient died of biological valve prosthesis dysfuncion 3 years after operation,1 patient died of cerebral embolism 19 months after operation.Six cases were in New York Heart Association(NYHA)class Ⅰ,and 14 cases in NYHA class Ⅱ during the period of follow-up.Conclusions Because operative and follow-up mortality is high,TVR is the last selection for the treatment of tricuspid valve disease.Appropriate operative technique and perioperative therapy are the key for clinical success.For those older than 50 years,follow-up inconvenience and reproductive-age female patients,biological valve prosthesis should be recommended as a preferential choice.

OBJECTIVE To investigate the pertinency between acute physiology and chronic health evaluation Ⅱ scores(APACHEⅡ)and nosocomial infection.METHODS The clinical data from 1 007 ICU patients were evaluated with APACHEⅡ scores system,and made a prospective survey of nosocomial infection.RESULTS Along with the increase in APACHEⅡ scores,nosocomial infection rate and mortality showed rising trend and they were in linear relationship.CONCLUSIONS APACHEⅡ scores system not only can appraise the degrees of severity of illness,evaluate medical treatment,and estimate the prognosis,but also forecast nosocomial infection.

Objective To compare the efficacy of laparoscopic or open surgery for gastrointestinal stromal tumors (GISTs) and investigate effects of different risk level on prognosis.Methods The retrospective cohort study was adopted.The clinical data of 192 patients with GISTs who were admitted to Zhongshan Hospital of Fudan University from January 2008 to December 2013 were collected.Among the 192 patients,88 undergoing laparoscopic surgeries were allocated into the laparoscopic surgery group,104 patients undergoing open surgeries were allocated into the open surgery group.The following indicators were observed:(1) operative status:surgical procedure,operation time,volume of intraoperative blood loss.(2) Status of postoperative recovery:time of gastrointestinal function recovery,time of drainage tube removal,complications and duration of hospital stay.(3) Follow-up status.(4) Prognosis of patients in different risk level.The follow-up using outpatient examination and telephone interview was performed to assess patients' survival,tumor recurrence and metastasis until June 2015.Measurement data with normal distribution were presented as (x) ± s and comparison between groups was evaluated by the t test.Comparison of count data was analyzed by the chi-square test.The Kaplan-Meier method was used to draw survival curve and calculate the overall survival rate and relapse-free survival rate.Results (1) Operative status:of the 88 patients in the laparoscopic surgery group,1 underwent laparoscopic wedge gastrectomy + cholecystectomy + appendectomy,6 underwent laparoscopic wedge gastrectomy + cholecystectomy,14 underwent laparoscopic assisted partial gastrectomy,67 underwent laparoscopic wedge gastrectomy.Of the 104 patients in the open surgery group,1 underwent partial gastrectomy + splenectomy,2 underwent partial gastrectomy combined with distal pancreatectomy + splenectomy,2 underwent total gastrectomy,7 underwent distal subtotal gastrectomy,7 underwent wedge gastrectomy + partial or total adjacent organ resection,8 underwent proximal subtotal gastrectomy,8 underwent wedge gastrectomy + cholecystectomy,69 underwent wedge gastrectomy.The operation time and volume of intraoperative blood loss were (105 ± 33)minutes and (43 ± 16)mL in the laparoscopic surgery group,(121 ± 52)minutes and (199 ± 81) mL in the open group,respectively,with statistically significant differences between the 2 groups (t =-2.104,2.632,P ＜ 0.05).(2) Status of postoperative recovery:the time of gastrointestinal function recovery,time of drainage tube removal and duration of hospital stay were (4.6 ± 1.8) days,(5.8 ± 2.2) days,(7.1 ± 2.9) days in the laparoscopic surgery group and (5.2 ± 1.6) days,(7.1 ± 2.8) days,(8.7 ± 4.3) days in the open surgery group,respectively,with statistically significant differences between the 2 groups (t =-2.783,-3.891,-3.078,P ＜ 0.05).Wound infection,gastric emptying delay,anastomotic leakage,lung infection and bleeding were detected in 1,3,0,0,0 patients in the laparoscopic surgery group and in 0,2,2,2,1 patients in the open surgery group,respectively,with no statistically significant difference between the 2 groups (x2=0.421,P ＞ 0.05).(3) Follow-up status:Of the 192 patients,149 received follow-ups.Of 88 patients in the laparoscopic surgery group,68 were followed up for an average time of 39 months.Of 104 patients in the open surgery group,81 were followed up for an average time of 51 months.During the follow-up,tumor recurrence rate in the laparoscopic surgery group and open surgery group was respectively 8.8％ (6/68) and 21.0％ (17/81),with no statistically significant difference between the 2 groups (x2=1.888,P ＞0.05).Postoperative 1-,3-,5 year survival rates were 98.5％,92.9％,87.4％ and 91.7％,85.2％,76.9％ in the laparoscopic surgery group and open surgery group,respectively,with no statistically significant difference between the 2 groups (x2 =1.967,P ＞ 0.05).(4) Prognosis of patients in different risk level:of the 149 who received the follow-up,the tumor recurrence rate of patients in low,intermediate and high recurrence risk was 7.0％ (5/71),13.6％ (6/44) and 35.3％ (12/34),respectively,with a statistically significant difference among the above indexes (x2 =14.637,P ＜ 0.05),showing statistically significant differences between low risk and high risk patients and between intermediate risk and high risk patients (x2=13.263,6.279,P ＜ 0.05),while no statistically significant difference between low risk and intermediate risk patients (x2 =0.894,P ＞ 0.05).Five-year relapse-free survival rate of low,intermediate and high risk patients was 94.2％,80.0％ and 61.8％ respectively,with a statistically significant difference (x2=13.547,P ＜ 0.05),showing statistically significant differences between low risk and high risk patients,intermediate risk and high risk patients (x2 =4.357,12.336,P ＜ 0.05),while no statistically significant difference between low risk and intermediate risk patients (x2 =0.696,P ＞ 0.05).Conclusions Compared to open resection,laparoscopic GISTs resection offers better short-term outcomes,however,the two surgical techniques offer equal long-term outcomes.Patients of high risk have poor prognosis.