Age-related white matter changes are common in the elderly and are considered as manifestation of arteriolosclerotic small vessel disease. Most recent studies have shown that the white matter changes are associated with cognitive impairment and dementia, urinary incontinence, gait disturbances, depression and increased risk of stroke and death. Although the clinical phenotypes of the white matter changes have been extensively studied, to date, only few clinical trials have been conducted in this area. In this review, we discussed the current understanding in the epidemiology, pathogenesis, imaging features, chemical biomarkers, clinical importance, and management of age-related white matter changes, with special emphasis in studies that were conducted among Asians.

Objective: To prepare betahistine dihydrochloride sustained-release matrix tablets. Methods: The tablets were pre-pared with water soluble HPMC matrix, and the release behaviors were investigated by single factor study. The formula and preparation procedures were optimized by orthogonal design. Results:The optimal technology was as follows:using 60% HPMC K15M as the ma-trix material, calcium hydrogen phosphate as the filler, 10% PVP in 90% alcohol as the bonding agent;wet granulation compression technique was used to prepare the tablets with the tablet weight of 500mg. The in vitro drug release fits a Higuchi equation and the drug can be sustained-released within 12 h. Conclusion:The preparation technology is simple and the tablets have sustainol release behav-ior.

Objective To analyze the risk factors for healthcare-associated pneumonia (HAP) in patients with orthopedic injury,provide the basis for making prevention and control measures.Methods HAP occurred in patients with orthopedic injury and admitted to the department of orthopedics of a hospital from June 2011 to May 2015 were investigated retrospectively,risk factors were analyzed by univariate and multivariate logistic regression methods.Results A total of 2 578 patients with orthopedic injury were investigated,92 patients developed HAI,incidence of HAP was 3.57％.107 strains of pathogens were detected,the major were Klebsiella pneumoniae (n =22,20.56％),Escherichia coli (n =14,13.08％),and Acinetobacter baumannii (n =13,12.15％).Risk factors for HAP in patients with orthopedic injury were length of hospital stay≥15 days,smoking history≥3 years,bedridden ≥7 days,associated with underlying diseases,complications,indwelling catheter≥7 days,surgical operation,mechanical ventilation,admitted to intensive care unit,open injury,blood sugar≥11 mmol/L,plasma albumin＜30 g/ L,hemoglobin concentration＜90 g/L,and use of glucocorticoid≥4 days (all P＜0.05).Multivariate logistic regression analysis showed that smoking,bedridden,surgery,mechanical ventilation,glucocorticoid use,and anaemia were independent risk factors for HAP in patients with orthopedic injury.Conclusion The occurrence of HAP in patients with orthopedic injury is related with multiple factors,the major are surgical operation,mechanical ventilation,glucocorticoid use,long term smoking,bedridden,and anaemia.

Humans ; Muscular Dystrophy, Duchenne ; Research ; trends

Objective To research the expression of mitofusin-2 (mfn2) and tumor metastasis suppressor genes (nm23)in bladder cancer cells and its correlation with clinical pathological feature. Methods Immunohistochemistry was used to measure the expression of mfn2 and nm23.Sixty-five cases of bladder cancer were sampled,which include fif-ty cases of male and fifteen cases of female. TNM stage:Forty-seven cases were in stage I;Ten cases were in stage II; Five cases were in stageⅢ; Three cases were in stageⅣ. Other fifteen cases were sampled from normal bladder or benign tumor of bladder as control . All cases were collected from department of pathology,affiliated Hospital of hebei union university. Results The positive expression rate of mfn2 in bladder cancer tissues was significantly higher than those in normal blad-der tissues and benign tumor of bladder(χ2=32.528,P<0.05);The positive expression rate of nm23 in bladder cancer tis-sues was significantly lower than those in normal bladder tissues and benign tumor of bladder (χ2=19.719,P<0.05);the high expression level of mfn2 in bladder cancer was associated with tumor differentiation and TNM stage(P<0.05),but not corre-lated with age,sex,lymph node metastasis and clinical grade. The low level of nm23 was associated with TNM stage,clinical grade and LN metastasis. Conclusion The positive expression rate of mfn2 was increased in bladder cancer. It indicated that there was a close relationship between mfn2 and the occurrence and development of bladder cancer;The expression rate of nm23 was decreased in bladder cancer,it may be a predictor for metastasis and prognosis of bladder cancer.

Objective To analyze the distribution and antimicrobial resistance of pathogenic strains in wound infec-tion,and provide scientific evidence for rational use of antimicrobial agents in treatment of wound infection as well as reducing the emergence of drug-resistant organisms.Methods Data about pathogenic strains isolated from wound specimens of patients with wound infection in a hospital between June 2011 and April 2014 were analyzed retrospectively.Results A total of 965 pathogenic strains were isolated from wound specimens,the main infection sites were limbs(50.47%);infected patients mainly distributed in department of orthopaedic surgery(44.97%);trauma and incisional wound infection were the major infection types(47.98%,36.48%,respectively).Among iso-lated pathogens,gram-positive bacteria,gram-negative bacteria,and fungi accounted for 37.20%,59.59%,and 3.21 % respectively.The main gram-positive bacteria were highly susceptible to vancomycin,teicoplanin,and linezolid,the main gram-negative bacteria were highly resistant to most commonly used antimicrobial agents except cefoperazone/sulbactam,piperacillin/ tazobactam,imipenem,and meropenem.Conclusion Patients with wound infection are mainly distributed in department of orthopedics,the main infection types are trauma and surgical site infection,antimicrobial resistant rates of the major gram-positive and gram-negative bacteria are both high.Sur-geons,especially orthopedics surgeons,should pay attention to the culture of pathogens and monitoring of antimi-crobial susceptibility,use antimicrobial agents rationally,and strengthen the prevention and control of surgical site infection,so as to reduce the infection incidence and occurrence of drug-resistant organisms.

Objective To compare the efficacy of different doses of ropivacaine for ultrasound-guided axillary brachial plexus block in children.Methods One hundred and twenty ASA Ⅰ or Ⅱ children,aged 5-12 yr,scheduled for elective surgery for hand injury,were equally and randomly divided into 4 groups according to the doses of ropivacaine:0.35,0.3,0.25 and 0.20 ml/kg groups.The children received oral midazolam 30 min before surgery.Propofol was given by target-control infusion after admission to the operating room.When the pediatric patients lost consciousness and had no response to verbal command,axillary brachial plexus block was performed under the guidance of ultrasound.0.25 ％ ropivacaine 0.35,0.3,0.25 and 0.20 ml/kg were injected to block the radial,median,ulnar,musculocutaneous and medial antebrachial cutaneous nerves.Additional ketamine was given when needed during operation.The duration of block and consumption of general anesthesia and complications were recorded.The degree of sensory block of the region innervated by each nerve and effectiveness of block were assessed.Results The rate of effective block of the radial nerve,median nerve and musculocutaneous nerve was significantly lower,the number of patients requiring ketamine was larger and the duration of block was shorter in group 0.2 ml/kg than in 0.35,0.30 and 0.25 ml/kg groups (P ＜ 0.05).There was no significant difference in the parameters mentioned above between 0.35,0.30 and 0.25 ml/kg groups (P ＞ 0.05).No pediatric patients developed block-related complications in each group.Conclusion Ultrasound-guided axillary brachial plexus block with 0.25 ％ ropivacaine 0.25 ml/kg can provide better block in children.

Objective To analyze the results of treatment of complicated tibial plateau fractures with open reduction and internal fixation with bilateral plates .Methods 29 elder patients with C type tibial platform fractures underwent internal fixation with bilat-eral plates and bone grafting .Fixation with bilateral plates was performed during operation with dynamic compression plate or 1/3 Tubular steel plate placed medially and the dissection plate or LISS system ones inserted laterally after the underlying separation . Meanwhile ,sufficient bone grafting during operation could effectively support reduction of articular surface .Results All patients were followed up of an average of 13 .8 ± 2 .43 months .According to Rasmussen score standard ,the excellent and good rate was 82 .7% .There was significant difference of TPA and PA between postoperation and postoperation one year later .Conclusion It is a simple and effective method to treat complicated elder tibial platform fractures with bilateral plates .It will improve the effect and re-duce complications significantly to perform sufficient bone grafting intraoperatively ,and make the drainage unobstructed and do the early functional exercises postoperatively .

Objective To investigate the inhibitory effect of recombinant LIGHT-Fe gene on the proliferation of human esophageal carcinoma cell line Eea109. Methods LIGHT-Fc expression vector was transfected into human esophageal squamous carcinoma cell line Eca109 by using DOTAP liposomal transfection reagents. The effects of LIGHT-Fc gene on the proliferation of esophageal carcinoma cell line Eca109 in vitro were detected by cell growth curve and MTr assay. Forty-five nude mice were equally divided into Eea109/Wt group, Eca109/neo group and Eca109/LIGHT group. Carcinogenesis and pathological expression of the esophageal carcinoma tissues were observed. Results The expressions of LIGHT receptors were detected in Eca109 cells. The proliferation of Eca109 cells was inhibited after trasfecting LIGHT-Fc gene into Eca109 cells. The numbers of tumors generated in Eea109/Wt group, Eca109/neo group and Eca109/LIGHT group were 12, 11 and 5, with statistical significance between Eca109/LIGHT group and the other two groups (X2 =6.652, 4.821, P <0.05). The result of histopatholagical examination indicated that the tissue necrosis appeared significantly in tumors derived from Eea109/LIGHT cells. Conclusions The growth of esophageal squamous carcinoma cell line Eca109 can be suppressed by LIGHT-Fc gene whether in vitro or in vivo.