Objective To investigate the effects of surgical trauma on Toll?like receptor 4 ( TLR4) expression in the hippocampus of aged mice. Methods Ninety male Kunming mice, aged 16-18 months, weighing 30-40 g, were randomly divided into 3 groups ( n=30 each) using a random number table:control group ( group C), anesthesia group ( group A), and partial hepatectomy group ( group PH). Normal saline 0.1 ml∕10 g was injected intraperitoneally in group C. In group A, fentanyl 0.2 mg∕kg and droperidol 5 mg∕kg were injected intraperitoneally. In group PH, fentanyl 0. 2 mg∕kg and droperidol 5 mg∕kg were injected intraperitoneally, and the mice underwent partial hepatectomy. Cognitive function was assessed using Morris water maze test at 1, 3, and 7 days after anesthesia or surgery. After the end of the test, the hippocampus was immediately harvested for determination of the TLR4, tumor necrosis factor?alpha ( TNF?α) and interleukin?1 beta ( IL?1β) protein and mRNA expression by Western blot and real?time reverse transcriptase?polymerase chain reaction, respectively. Results Compared with group C, no significant changes were found in group PH in the escape latency, percentage of swimming distance in the target quadrant, and TLR4, TNF?α and IL?1β protein and mRNA expression at each time point after anesthesia in group A (P>0.05), and the escape latency was significantly prolonged, the percentage of swimming distance in the target quadrant was decreased, and the expression of TLR4, TNF?α and IL?1βprotein and mRNA was up?regulated at 1 and 3 days after surgery in group PH ( P<0. 05 or 0. 01 ) . Compared with group A, the escape latency was significantly prolonged, the percentage of swimming distance in the target quadrant was decreased, and the expression of TLR4, TNF?αand IL?1βprotein and mRNA was up?regulated at 1 and 3 days after surgery in group PH (P<0.05 or 0.01). Conclusion Surgical trauma can up?regulate the expression of TLR4 in the hippocampus of aged mice, which may be involved in the mechanism of surgical trauma?induced postoperative cognitive dysfunction.

Objective To observe the effectiveness and safety of oral anticoagulants and antithrombotic therapy in elderly patients with atrial fibrillation. Methods Patients were divided into anticoagulant group (warfarin) and antithrombotie group (aspirin or clopidogrel) based on the initial treatment. The prothrombin time (PT), activated clotting time (ACT), international normalized ratio (INR), activated partial thromboplastin time (APTT), fihrinogen (FIB), thrombin time (TT), coagulation factor Ⅱ,Ⅴ,Ⅶ,Ⅷ,Ⅸ, and Ⅹ,fibrin degradation product (FDP) and D-dimer were tested at baseline and after therapy in both groups. Results The average treatment period was 44.2±37.5 months in antithrombotic group and 39.0±61.5 months in anticoagulant group. There were six cases of isehemic stroke, one acute artery embolism in right lower limb and three gastrointestinal bleeding in antithrombotic group, while two gastrointestinal bleeding and two fatal hemorrhagic stroke in anticoagulant group. The results of PT, ACT, INR, APTT, FIB, TT, coagulation factor Ⅱ,Ⅴ ,Ⅶ, Ⅷ,Ⅸ,Ⅹ,FDP and D-dimer had no significant differences compared with the baseline in antithrombotic group. However, there were significant increase in PT and INR [(8.4±7.5)s and (0. 93±0. 83)s, both P<0. 05)], and significant decrease in ACT, coagulation factor Ⅱ,Ⅶ, Ⅸ and Ⅹ (all P<0. 05) in anticoagulant group. Conclusions Anticoagulant therapy may he effective in prevention of ischemic stroke in elderly patients with atrial fibrillation. However, it may slightly increase the hemorrhage incidence. The overall adverse events were not significantly reduced.

Objective To investigate the effects of penehyclidine hydrochloride (PHCD) pretreatment on NF-κB mRNA expression and SOD activity in lung tissues in rats with acute lung injury (ALI) induced by LPS.Methods Thirty-two male SD rats, 2 months old, weighing 230-280 g, were randomly divided into 4 groups (n=8 each): control group (group C), ALI group, low dose PHCD group (group LP) and high dose PHCD group (group HP). ALI was induced by intravenous LPS 5 mg/kg via tail vein. Group LP and HP received intraperitoneal PHCD 0. 3 and 1 mg/kg respectively 30 min before LPS administration. The rats were killed at 6 h after LPS administration. The lungs were removed immediately for determination of W/D lung weight ratio, lung water content, NF-κB mRNA expression, TNF-α and MDA content, and SOD activity and microscopic examination. Results NF-κB mRNA expression, TNF-α and MDA content, W/D lung weight ratio and lung water content were significantly higher, while SOD activity was significantly lower in group ALI, LP and HP than in group C (P ＜ 0.05). NF-κB mRNA expression, TNF-α and MDA content, W/D lung weight ratio and lung water content were significantly lower, while SOD activity was significantly higher in group LP and HP than in group ALI and HP than in group LP (P ＜ 0.05). The LPS-induced changes were mitigated by pretreatment with low and high doses of PHCD in group LP and HP.Conclusion Pretreatment with PHCD attenuates LPS-induced ALI by downregulating NF-κB mRNA expression, decreasing local inflammatory response and enhancing anti-oxidant activity.

Aim To study clinical efficacy of valsartan,in comparison with amlodipine, in hypertentive patients with left ventricular hypertrophy. Methods 65 hypertentive patients with left ventricular hypertrophy is divided into two groups, with 33 cases in valsartan group and 32 cases in amlodipine group Valsartan 80～160mg and amlodipine 5～ 10 mg were taken by the patients in the two groups for 6 months respectively. 24 h ambulatory blood pressure monitoring ( 24 h ABPM) and color echocardiography were performed in the two groups before and after treatment. Results The parameters of 24 h ABPM ( 24 h SBP? 24 h DBP?dSBP?dDBP?nSBP?nDBP) and color echocardiography (IVST?PWT?LVMI)after treatment in the two groups were significant decreased compared with those before treatment respectively (P0.05). Conclusion Valsartan can lower significantly the blood pressure level and make left ventricular hypertrophy remarkably dispelled in hypertensive patients with left ventricular hypertrophy and has the effect similar to that of amlodipine.

OBJECTIVE: To investigate the clinical manifestations and diagnostic method of hyperparathyroidism due to parathyroid tumors and to evaluate the intra-operative detection of parathyroid hormone in surgical treatment. METHOD: Thirty-seven cases with functional parathyroid tumors from January 2003 to October 2012 were retrospectively analyzed. The clinical manifestation, examination and operation method, changes of parathyroid hormone before and after operation were collected. RESULT: All cases were definitely diagnosed before operation. The sensitivity and the positively predictive values of neck ultrasonography were 86.5% and 97.6% respectively, and the same data of Tc-99m-MIBI was 97.2% and 100.0%. The PTH levels declined by 84.9% ten minutes after tumor resecting compared with the level before operation. The serum calcium and PTH returned to normal levels and symptomatic relief occurred after operation. CONCLUSION Recurrent bone disease, long-term urinary calculus and obscure gastrointestinal symptoms were common symptoms of hyperparathyroidism due to parathyroid tumors. The neck ultrasonography and Tc-99m-MIBI were suitable for location of parathyroid tumors. Surgical operation was an effective treatment for parathyroid tumor. Intra-operative PTH assay would be able to ensure the radical excision and the operative safety for functional parathyroid tumors.
Adult ; Aged ; Female ; Humans ; Hyperparathyroidism ; etiology ; surgery ; Male ; Middle Aged ; Monitoring, Intraoperative ; Parathyroid Hormone ; blood ; Parathyroid Neoplasms ; complications ; surgery ; Retrospective Studies

Background and purpose: Epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) is of advantage in treating non-small cell lung cancer (NSCLC) patients with EGFR mutations. However, their clinical effects vary individually. This study aimed to evaluate whether the EGFR ligand, plasma transforming growth factor α (TGF-α), could act as a predictor for the EGFR-TKI treatment e?ciency in NSCLC patients with EGFR mutations and the association between TGF-α and prognosis in these patients. Methods: Seventy-five NSCLC patients with EGFR gene positive mutation were included in the current study from May 2012 to Jul. 2014 in Ruikang Hospital A?liated to Guangxi University of Chinese Medicine. Plasma TGF-α was measured using enzyme-linked immunosorbent assay (ELISA) in all of the patients before EGFR-TKI treatment. The radiographic evaluation was performed 2 months after the therapy. The association between TGF-α and clinical outcome and its prediction e?ciency were determined, followed by the further analysis of the association between TGF-α and overall survival (OS) as well as progression-free survival (PFS). Results: After EGFR-TKI treatment, there were 20 patients with partial response (PR), 25 with stable disease (SD) and 30 with progression disease (PD) in all 75 NSCLC patients harboring EGFR positive mutation. The disease control (DC) rate reached 60%. Patients in PD group presented statistically significant higher plasma TGF-αthan patients in the DC group (P<0.01). Multivariate COX model indicated that smoking status, lymph node metastasis and plasma TGF-α levels were independent risk factors for prognosis in these patients. The ROC analysis revealed that baseline plasma TGF-α showed good prediction e?ciency [area under the curve (AUC)=0.926] and the cut-off point of TGF-α was 16.75 pg/mL. Higher level of TGF-α (≥16.75 pg/mL) was associated with smoking history, clinical stage, lymph node metastasis and clinical outcome of the patients (P<0.05). In comparison to patients with low TGF-α, the patients with high TGF-α concentration presented significantly reduced median OS and PFS (log-rank P<0.05). Conclusion: Higher plasma TGF-α (≥16.75 pg/mL) had a predictive role in EGFR-TKI resistance and poor prognosis.

OBJECTIVE: To evaluate the efficiency of video-assisted thoracoscopic surgery for primary palm hyperhidrosis by T4 sympathicotomy plus bypass fiber resection, and to describe our experience regarding the prevention of related postoperative complications. METHODS: Clinical data for 32 cases of primary palmar hyperhidrosis in patients who underwent bilateral video-assisted thoracoscopic sympathictomy plus bypass fiber resection from October 2008 to June 2011 were analyzed retrospectively. RESULTS: The operation was performed successfully on all patients, and their palmar hyperhidrosis was completely alleviated after operation. No severe, surgery-related, postoperative complications occurred. CONCLUSION Video-assisted thoracoscopic sympathictomy is an effective, safe and minimally invasive procedure for primary palmar hyperhidrosis.
Adolescent ; Adult ; Female ; Hand ; Humans ; Hyperhidrosis ; etiology ; surgery ; Nerve Fibers ; Postoperative Complications ; prevention & control ; Sympathectomy ; methods ; Thoracic Surgery, Video-Assisted ; methods ; Young Adult

Objective:To investigate the efficacy and toxicity of oxaliplatin reintroduction combined with raltitrexed as second-line che-motherapy after the first-line oxaliplatin-based chemotherapy in advanced colorectal cancer patients. Methods:The 48 evaluable pa-tients with advanced colorectal cancer following disease progression prior to the first-line chemotherapy were treated with oxaliplatin and raltitrexed (raltitrexed 3 mg/m2 ivgtt d1, oxaliplatin 100-130 mg/m2 ivgtt d1, q21d). All 48 patients were divided into two groups:Group A, non-oxaliplatin-based regimens as the first-line chemotherapy, 20 cases;Group B, oxaliplatin-based regimens as the first-line chemotherapy, 28 cases. Each group was evaluated every two cycles. Results:The response rates (RR) of Groups A and B were 30.0%(6/20) and 32.1%(9/28), the disease control rates (DCR) were 80.0%(16/20) and 75.0%(21/28), the median progression free survival time (mPFS) was 6.5 and 7.0 months, and the median overall survival time (mOS) was 10 and 13 months, respectively. No statistical sig-nificance was observed between the two groups in their RR, CR, mPFS, and mOS (P=0.264, 0.514, 0.713, 0.788), respectively. The most common adverse effects observed wereⅠ-Ⅱgrades of bone marrow suppression, aminotransferase abnormality, and digestive toxici-ties. The incidence of neurotoxicity (Ⅰ-Ⅱgrades) between the two groups was similar. Conclusion:Instead of irinotecan combined with raltitrexed, oxaliplatin reintroduction combined with raltitrexed for second-line chemotherapy after the first-line oxaliplatin-based chemotherapy in advanced colorectal cancer patients is feasible.

Objectives To evaluate the effect of thyroid hormone therapy with low dose of thyroxin on cardiac function in elderly patients with heart failure and sick euthyroid syndrome. Methods Forty-seven patients (33 males and 14 females, mean age 85.9+4.6 years,ranging from 80 to 99 years) with chronic heart failure (NYHA Ⅱ-Ⅳ) and low triiodothyronine (T3) state were randomly allocated to the treatment group or control group. The treatment group patients received oral administration of levothyroxine sodium (Euthyrox) 25-50mg/d in addition to conventional therapy of heart failure, whereas patients in control group were given conventional therapy only. Serum level of total T3 (TT3), free T3 (FT3), total thyroxine (TT4), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) were determined. For both groups, left ventricular ejection fraction (LVEF) and stroke volume (SV) were assessed by two-dimensional echocardiography before and at 8 weeks after treatment. The changes of these parameters after the treatment were evaluated by adjusting heart rate in the two groups. Results The reduced serum T3 level in the treatment group was corrected after thyroid hormone therapy,and these patients had a significant improvement in cardiac function after treatment. By contrast, in the control group only changes of serum TT3 and TT4 levels and SV and LVEF after treatment were statistically significant. The heart rate-adjusted mean SV and LVEF in both groups were also increased, which was significantly greater in the treatment group than in the control group. Conclusion In the elderly patients with heart failure and sick euthyroid syndrome, addition of thyroxine at a low dosage to the conventional treatment could effectively improve the low T3 state and cardiac function independent of changes of heart rate.

BACKGROUND: After internal fixation is applied to femoral shaft fracture with medial cortical defect, the fixation device is often bended and broken due to the stress on it. So far, reliable methods have not been found to solve this problem in clinic.OBJECTIVE: To evaluate the biomechanical stability of the allograft bone plate after a bony defect of the medial cortex is reconstructed with allograft bone plate.DESIGN: A randomized controlled experimental study.SETTING: This trial was conducted in the Department of Orthopaedics, the 175 Hospital of Chinese PLA, and Laboratory of Biomechanics, First Military Medical University of Chinese PLA.PARTICIPANTS: This trial was conducted in Laboratory of Medical Biomechanics, First Military Medical University. MTS858 Biomix biomaterial testing machine was used to simulate model of femoral shaft fracture on 3male adult femurs donated voluntarily by their relatives, aged 23, 24 and 28years old.INTERVENTIONS: The fracture model of medial cortical defect was made in the femurs. Different kinds of fixation were applied and the results were compared between fixated femurs and the normal ones. The fixations included steel plate fixation(fixation for group 1 ), steel plate with allograft bone plate fixation(fixation for group 2), steel plate with allograft bone plate fixation and reduction of the medial cortical fragment(fixation for group 3).MAIN OUTCOME MEASURES: The vertical compression displacement under 500 N load, three-point bending strength under 10 N and anti-torsional angle under 300 N load are all measured.RESULTS: The vertical compression displacement and three-point bending strength of the control group were insignificantly different from those of the fixation group 3 ( P ＞ 0.05), but significantly different from those of the fixation group 1 and 2 ( P ＜ 0.05). The anti-torsional angle of the control group was significantly different from that of the three fixation groups( P ＜ 0. 05) . The result of fixation in fixation group 1 was the worst, better in fixation group 2and the best in fixation group 3.CONCLUSION: When there is a medial cortical defect in the femur, reconstruction with a bone plate can recover the integrity of the femoral medial cortex, and the successful rate of the plate internal fixation is increased.