Objective To observe the effect of enteral nutrition therapy on metabolic status and adiponectin levels in elderly patients with metabolic syndrome (MS) complicated with nonalcoholic fatty liver disease (NAFLD).Methods 92 elderly hospitalized patients with mild to moderate non-alcoholic fatty liver disease underwent enteral nutrition (EN,n=46) and total parenteral nutrition (TPN,n=46) for 2 months.Body mass index,triceps skin-fold thickness,waist hip ratio,serum high-molecular weight (HMW) form of adiponectin,fasting blood glucose,postprandial 2-hour blood glucose,glycosylated hemoglobin,plasma insulin,alanine aminotransferase,aspartate aminotransferase,γ-glutamyltransferase,total bilirubin,direct bilirubin,total cholesterol,triglyceride,low density lipoprotein cholesterol,high density lipoprotein cholesterol,the blood pressure and liver ultrasound test were detected.The insulin resistance (HOMA-IR) was used to assess insulin resistance.Results In pre-versus post-treatment,serum level of HMW adiponectin [(6.8 ± 4.0) μg/L vs.(7.1 ± 3.9) μg/L,P ＞ 0.05 in enteral nutrition],and [(6.8 ± 3.5) μg/L vs.(5.0 ± 1.1)μg/L(P＜0.05)] in parenteral nutrition were found.The significantly decreased body mass index in the obese patients (P＜0.05),significantly improved values of 2-hour blood glucose,glycated hemoglobin,liver function,triglycerides,low-density lipoprotein cholesterol levels (all P＜0.05),and no obvious change in HOMA-IR were found after two months of enteral nutrition treatment.There were no significant changes in indicators mentioned above in TPN group after 2 months of treatment.Conclusions Enteral nutrition therapy can improve the glucose metabolism,lipid metabolism,the non-alcoholic fatty liver disease and body mass index,affect the level of adiponectin in the elderly patients with MS and NAFLD.It is vital to body metabolism.

AIM: To prepare α-tricalcium phosphate (α-TCP)/calcium polyphosphate (CPP) fiber and to study the feasibility of CPP fiber to reinforce calcium phosphate bone cement composites. METHODS: Firstly,α-TCP powder was synthesized using chemical sediment method. Secondly, the α-TCP was mixed with CPP fiber according to different contents and lengths. Finally, bone cement was tempered with firming agent. Solidification time and mechanical property of the samples were measured. Microstructure of hardened sample was observed with scanning electron microscope. RESULTS: When the amount of CPP fibers was 10% and the length was 2 mm, the compressive strength reached 62.5 MPa and the rupture strength reached 12.4 MPa. Scanning electron microscope suggested that CPP fibers with great associativity were well distributed in bone cement. After immersing in Ringer fluid for two months, the CPP fibers did not biodegrade obviously and still had certain function to increase strength and toughness. CONCLUSION: To a certain extent, the CPP fiber can increase strength and toughness of bone cement. Furthermore, α-TCP/CPP composites have good mechanical properties and biocompatibility.

BACKGROUND:When bone cement solidifies fast,the bone cement consistency will be decreased.resulting in difficulty in molding.DESIGN,TIME AND SETTING:Open experiment,performed in the Laboratory of Department of Materials,Lanzhou Jiaotong University between March 2005 and August 2006.gelatin were mixed with citric acid to produce hardening liquid.Then bone cement power and hardening liquid were mixed to form a paste,I.e.,bone cement.METHODS:Setting time of bone cement was determined using a Vicat apparatus.The compressive strength of bone cement at different proportions was tested using MTS-810 material tester.After 2 months of physiological saline soaking at 37℃.the microstructure of solidified bone cement was observed using scanning electron microscope.MAIN OUTCOME MEASURES:Setting time and compressive strength of bone cement,pH value of hydrated bone cement and the microstructure.RESULTS:After adding chitosan and gelatin in the hardening liquid.the consistency of the concoction obviously increased,the setting time became a little longer and the water-resistance of samples was enhanced.therefore the samples could be easily molded.But the compressive strength of the bone cement decreased a little.The pH value of the hydrated bone cement increased gradually with time and was close to the pH value of physiological saline at hour 24.The compressive strength of bone cement was achieyed at 24 hours and it almost did not change after 48 hours.the drawback of ceramic HA,including sintering and difficulties in shaping.It has the characteristics of simple-producing,easy application and low heat energy.

Objective To investigate the effect of Trimebutine maleate on reflux esophagitis in elderly patients.Methods A total of 160 elderly patients with typical esophageal reflux symptoms diagnosed as reflux esophagitis by gastroscope,with concomitant gastroesophageal disease confirmed by esophageal motility manometry and 24 h esophageal pH impedance monitoring acid reflux,were selected and retrospectively analyzed.All patients were treated with proton pump inhibitor(PPI) esomeprazole 20 mg tid,antecibum(AC)for 8 weeks,and randomly divided into four groups:group A (itopride hydrochloride 50 mg tid,AC),group B(citrate mosapride 5 mg tid,AC),group C (trimebutine maleate 200 mg tid,AC),group D(treated without prokinetic drugs).After 4 and 8 weeks of therapy,the symptom improvements were observed in the four groups.Endoscopy,esophageal motility manometry,24h esophageal pH impedance monitoring were performed in the 160 cases after 8 weeks of treatment.Results The total effective rate was 97.5％(39 cases),95.0％ (38 cases),92.5％(37 cases)and 77.5％(31 cases)in group A,B,C and D respectively after 8 weeks of treatment.Endoscopic examination showed that the cure rate was 70.0％ (28 cases),62.5％ (25cases),72.5％(29 cases),67.5％(27 cases),and the effective rate was 87.5％,(35 cases),92.5％(37 cases),87.5％(35 cases)and 87.5％(35 cases)in group A,B,C and D respectively after 8 weeks of treatment,without statistically significant differences in the cure rate and effective rate between the four groups.The results of esophageal motility manometry showed that the lower esophageal sphincter pressure(LESP),lower esophageal sphincter relaxation (LESR),lower esophageal peristaltic wave pressure(LEPP) and percentage of abnormal esophageal body contraction had significant difference before versus after treatment in group A and B,but not in control group.The improvements in the percentage of total time of pH＜4.0,the percentage of time of pH＜4 at standing position,the percentage of time of pH＜4 at supine position,supine reflux times,the times of supine reflux＞5 min,the longest reflux time(min)at supine position were more significant in group A,B and C than in group D.Compared with pre-treatment,the times of non-acid reflux were reduced significantly in group A,B and D(all P＜0.01),and there was a significant difference(P＜0.05)between the three (A,B,C)groups and group D(P＜0.05).There were significant differences in the times of reflux liquid and gas reflux between the group A,B and D(P＜0.05).The proximal reflux times were improved more significantly in group A,B and C after treatment than in control group(P＜0.05).Conclusions Prokinetic drugs combined with PPI therapy has better effect than single PPI application in improving the clinical symptoms and upper gastrointestinal motility in elderly patients with RE.Trimebutine maleate is safe and effective in the elderly,and has a similar effect on esophageal motility with mosapride citrate and itopride hydrochloride,which may be involved in selectively improving esophageal motility,lower esophageal sphincter pressure and gastric emptying function.

Objective To study the influence of anti-Helicobacter pylori therapy on reflux esophagitis (RE) and Barrett's esophagus (BE). Methods Two hundred and sixty-two patients including 177 patients with RE and 85 patients with BE were divided into 2 groups: Group A,139 patients without Hp infection;Group B,123 patients with Hp infection, which was further divided into 2 groups (group B1 and group B2) randomly. The pa-tients in group A and B1 were treated with Losec 20 mg bid, domperidone 10 mg tid and colloidal bismuth pectin 100 mg tid for 8 weeks, group B2 were treated with 2 kinds of antibiotics which were chosen from 3 types of antibiot-ics including amoxicillin 500 mg bid, Clarithromycin 500 mg bid or tinidazole 500 mg bid for 2 weeks additional to the same treatment as group A and B1. Endoscopy, pathologic examination, 24 h esophagus pH value and bilirubin were measured before and after treatment. Results The overall rates of improvement on symptoms in the 3 groups were 95.0% (group A: 97.8% (136/139), group B1: 96.8% (60/62), group B2: 98.4% (60/61)), which was significantly different from that before treatment (P < 0.05). However, the overall effect rates were not significantly different among the 3 groups (P > 0.05). The overall effect rate based on endoscopy examination in the RE patients 92.9% (78/84),91.8% (45/49) and 88.6% (39/44) in group A,B1 and B2,respectively,and the differences were statistically significant among the 3 groups (P <0.05). The overall effect rates in the BE patients were about 35.0%,which showed non-significant effect compared to that before treatment (P >0.05). 24 hrs esophagus PH value and bilirubin were significantly improved in the 3 groups (P < 0.05), whereas the difference among the 3 groups were not significant (P > 0.05). Conclusions RE and BE patients with HP infection could be treated with anti-Helicobacter pylori therapy. However, systematic therapy of anti gastric acid, prokinetics and mucosa protector must be performed simultaneously. This might be effective in preventing the development of RE and BE in short term. The long term effect is still uncertain and large scale, long term clinical studies are needed.

Objective To investigate the relationship between the recurrence of Barrett esophagus (BE) and Helicobacter pylori (Hp) eradication therapy, according to endoscopic follow-up outcomes in the elderly patients with BE after endoscopic argon plasma coagulation (APC). Methods A total of 201 elderly patients were enrolled to be treated with APC, including 53 patients without Hp infection (control group) and 148 cases with Hp infection (infection group), then the infection group was randomly divided into two groups: infection group A (n=74) and infection group B (n=74). After APC, all patients were given acid suppression therapy with omeprazole infusion 40 mg twice daily for 7 days, then omeprazole capsules 20 mg twice a day orally, the overall time was 2months. The patients in infection group B received Hp eradication therapy with two of the following three kinds of antibiotics for 2 weeks: amoxicillin 500 mg twice a day, clarithromycin 500 mg twice a day and tinidazole 500 mg twice a day. All patients received reexamination of endoscopy and pathology, and underwent 24-hour esophageal pH test 1, 3, 6, 12 and 24 months after treatment.Results By APC treatment for an average of 2.4 times (1-3 times), 1 month after treatment, all BE epithelium disappeared and stratified squamous epithelium was repaired completely. Reflux esophagitis (RE) and BE in some cases were found in 3 groups 3 months after therapy. The relapse incidence of RE was significantly increased at 6 months after therapy [control group: 22.6%, infection group A:12.2o%and infection group B: 17. 6%, t = 2.21, 2.17 and 2.30,P＜0. 05]. At 12 months after therapy, the relapse incidence of BE was significantly increased [control group: 22.6%, infection group A: 18.9% and infection group B: 23.0%, t=2.11, 2.19 and 2.32, P＜0. 05]. All patients presented pathological gastro-esophageal reflux (DeMeester index＞14.72) before treatment. At 1 month after therapy, all patients returned to normal DeMeester index[control group: 14.5, infection group A: 15.2 and infection group B: 12.0, t=2.09, 2.22 and 2.15, P＜0. 05]. At 6 months after treatment, DeMeester index increased (t=2.29, 2.33 and 2.14, P＜0.05). But there were no significant differences among 3 groups (P＞0. 05). Conclusions The elderly BE patients with HP infection in gastric antrum can receive APC treatment plus Hp eradication treatment, but it has no significant effect on long-term prognosis for BE patients. APC treatment can completely remove BE epithelium, long-term acid suppression therapy may delay recurrence of BE.

The brains from four newborns were used in this study. After continuous artery-vein injection with coloured materials, the brains were embedded in nitrocellulose. and coronal sections of 500?m, 100?m and 30?m in thickness were prepared in alternative and successive sequence. The 500?m sections were cleared in wintergreen oil and mounted, and the 100?m and 30?m sections were stained with thionin. The diameter and density of capillaries in thalamus and its adjacent structures were measured by means of Leitz MPV-Tasplus multifunction image analyser. All the data were dealt with variance and correlation analysis statistically. The capillary density of the thalamus and its adjacent structures varied obviously. The value in putamen, cellular layers of lateral geniculate body, anterior thalamic nucleus and subthalamic nucleus was the highest; while the value in dorsomedial nucleus, ventral lateral nucleus, pulvinar nucleus, ventral posterior lateral nucleus, lateral posterior nucleus, centromedian nucleus, medial geniculate body, ventral anterior nucleus and internal medullary lamina was the intermediate; however, the value in internal capsule and fibrous layers of lateral geniculate body was the lowest. The capillary diameter of ventral anterior nucleus and internal capsule was the widest; that of putamen and cellular layers of lateral geniculate body was the smallest; the rest was the intermediate. In the same measured structures, negtive correlation was shown between the capillary diameter and density.

The course, distribution of the intrathalamic vessels on 8 sides of newborn brains were studied by means of the continuous artery-vein infusion, Spalteholz's clearing and Nissl's staining. The brains were all cut into the coronal sections of 500 ?m, 100?m and 30?m thickness in alternate and successive order. The main arteries supplying thalamic nuclei were: 1. The thalamoperforating artery; 2. The geniculothalamic artery; 3. The medial posterior choroidal artery; 4. The medial inferior pulvinar artery; 5. The lateral ventricular choroidal artery. The thalamic veins opened respectively into the internal cerebral vein, the veins of the lateral ventricle, the veins of the interpeduncular fossa and the basal vein. There were three patterns of course relation between thalamic arteries and veins. They were solitariness, accompanying and one vein surrounded by several arteries.

Objective:To analyze the failure factors in root canal therapy(RCT)by analysis of the failed cases.Methods:215 teeth of 206 patients were analyzed according to former treatment records,clinical examination,pretreatment radiographs,and root canal exploration during endodontic retreatment.Results:67.9% of failed teeth showed apical radiolucency,12.6% showed under-filled canal material without apical radiolucent area,and 8.4% involved coronal leakage.When examined with X ray,84.2% of teeth indicated under-filling,and most canals of premolars and molars had poor taper.Most missed root canals were found in maxillary first molars and premolars.18.1% of teeth had complications such as ledge and apical transportation.Conclusions:The factors associated with RCT failure involve cleaning,obturation and poor seal of root canal system resulted from inadequate shaping.Coronal leakage and missed canals also contribute to the endodontic treatment failure.

Objective To compare the clinical outcomes of 2 different catheter ablation strategies for patients with chronic atrial fibrillation(CAF).Methods One hundred and thirty four consecutive patients(77 males,mean age 56.8?12.3 yrs)were randomized into 2 groups of different catheter ablation strategies.All the patients suffered from frequent attacks(more than 3 times per month),drug refractory and symptomatic CAF.One group received circumferential pulmonary rein ablation(CPVA group,n=68)and the other group received complex fractionated electrogram ablation additional to CPVA(CPVA+CFEA group,n=66).All ablation was guided by 3 dimensional mapping system(CARTO).Follow-up ECG,Holter and clinical outcomes of the 2 groups within 6 months after the procedures were analyzed.Results The baseline characteristics were comparable between the 2 groups.The mean procedure time in the CPVA+CFEA group was longer than that in the CPVA group but the mean fluoroscopy time between two groups had no significant difference.After the first procedure,60%of patients in the CPVA group and 77% of patients in the CPVA +CFEA group were free from symptomatic atrial tachycardia without any use of antiarrhythmic drugs for at least 3 months(P