Objective To evaluate cerebral autoregulation in cerebral vascular disease using transeranial Doppler(TCD)-CO_2 test and head-upright tilt test(HUTT).Methods Thirty-two patients with occlusive cerebral vascular disease (group A),28 cerebral infarction patients without stenosis (group B), and 26 controls were included.Cerebrovascular reactivity was calculated in terms of the breath-holding index (BHI) and vascular motor reactivity (VMR) by TCD-CO_2 test.Changes of cerebral blood flow velocity (CBFV),blood pressure (BP) and heart rate (HR) were detected during HUTT to assess the cerebral pressure-autoregulation.Results Compared with controls,VMR decreased in group A and B,being 0.18?0.02,0.26?0.04 respectively,and so did BHI,being 0.76?0.15,1.05?0.15 respectively with significance(P

Aged ; Blood Platelet Disorders ; complications ; therapy ; Coronary Artery Disease ; complications ; therapy ; Humans ; Male ; Stents ; Thrombosis ; etiology

BACKGROUND:Repeated hyperbaric oxygenation (HBO) preconditioning induces tolerance against ischemia in spinal cord. The confirmation of this phenomenon paves a new way in clinic to prevent and treat complications of spinal ischemia following thoracoepigastric aorta surgery. Probing into its mechanism of is chemic tolerance has provided basis for clinical application.OBJECTIVE: To investigate the changes of mitochondrial structure and ATPase activity during spinal cord ischemic tolerance induced by repeated HBO preconditioning in rabbits.DESIGN: Randomized and controlled trial.SETTING: Department of Anesthesiology, Xijing Hospital of Fourth Military Medical University of Chinese PLA.MATERIALS: The experiment was conducted in the hyperbaric oxygen chamber of the Department of Air Medicine; Experimental Animal Center of the Department of Anesthesiology, Xijing Hospital of Fourth Military Medical University of Chinese PLA, between March and June 2004. Totally 50 male New Zealand rabbits were selected.METHODS: Fifty male New Zealand rabbits were randomly divided into two groups: simple ischemia control group and HBO group with 25 rabbits in each group: 0.25 Mpa, 100% O2, one hour per day for 5 days. Spinal ischemia model was prepared 24 hours after the last preconditioning.Spinal cord ischemia (20 minutes)/reperfusion model was prepared by blocking the infrsrenal aorta. The motor function of hind-limbs was scored at 6 hours, 24 hours and 48 hours after reperfusion. The mitochondrial ATPase activity was measured and compared between two groups before ischemia, at 6 hours, 24 hours and 48 hours after reperfusion.MAIN OUTCOME MEASURES: ① The score of motor nerve function of the hind-limbs; ② The activity of mitochondrial ATPase; ③ Pathological evaluation.RESULTS: Totally 50 rabbits were involved for result analysis, and finally 25 rats in each group entered statistical analysis with no loss in the midway. ① The score of motor nerve function of the hind-limbs in HBO group at 6 hours, 24 hours and 48 hours after HBO preconditioning was significantly higher than that in control group (P ＜ 0.01). ② The activity of mitochondrial ATPase: the mitochondrial Na+, K+-ATPase activity and Ca2+, Mg2+-ATPase activity at each time point of the animals in the two groups after is chemia were significantly decreased; Na+, K+-ATPase activity in HBO preconditioning group at 6 hours, 24 hours and 48 hours of ischemia was significantly higher than that in control group (P ＜ 0.01); Ca2+, Mg2+-ATPase activity at 6 hours and 24 hours after ischemia was significantly higher than that in control group (P ＜ 0.01). ③ Pathological evaluation: The structure of mitochondria in control group was seriously damaged while it was found almost normal in spinal cord in HBO group animals at 48 hours after reperfusion.CONCLUSION: The mechanism of ischemic tolerance induced by hyperbaric oxygenation pretreatment may partly be related to the attenuation of mitochondria ATPase activity decrease after ischemia, thereby protecting the function of mitochondria.

Objective To explore clinicopathological features and prognosis of juvenile granulosa cell tumor (JGCT).Methods Patients were divided into JGCT group (n=10) and the adult granulosa cell tumor (AGCT) group (n=10).The tumor samples were examined by HE and immunohistochemical methods.Results Age of JGCT group ranged from 7-31 years (average 20.5 years);90% occurred before 30 years old.Diameter of the tumors ranged from 5.5 cm to 15.0 cm,average 9.8 cm.Characteristic features included nodular arrangement,irregular formation of follicles containing muein and luteinization, atypical hyperplasia of ceils and high mitotic activity.Nuclei grooved and Call-Exner bodies were absent or rare.Survival rate was 90% in 5 years.Age of AGCT group ranged from 14-74 years (average 45.1 years);AGCT occurred mostly in over 40 years old.Atypical hyperplasia of cell,mitotic activity and luteinization were absent or rare.Nuclei grooved and eall-Exner bodies were common.Survival rate was 100% in 5 years.Immunohistochemical staining were positive for p53 at 70%,PCNA at 90% in 10 cases of JGCT and p53 at 10%,PCNA at 20% in 10 cases of AGCT(P

Objective To explore the role of somatosensory evoked potentials elicited by paraspinal stimulation in the detection of spinal cord lesions.Methods Patients with clinically suspected spinal cord lesions underwent somatosensory evoked potentials(SEPs)and spinal cord conduction velocity(SCCV)test using paraspinal stimulating method.96 patients aged 15 to 75 years old with suspected spinal cord lesions of various aetiologies were tested.36 patients had demyelinating disease of the spinal cord,26 had sub-acute combined degeneration of the spinal cord,19 had myelopathy,10 had acute myelitis,5 had spinal cord corhpression.Results Paraspinal stimulation elicited somatosensory evoked potentials were Performed on all 96 patients,68 of whom underwent spinal MRI as well.SEPs and SCCV were found abnormal in a high ratio in all kinds of spinal cord lesions ; in general,78 among the 96 patients had abnormal SEPs with a sensitivity of 81.25%.27 out of 36 with demyelinating disease of the spine had abnormal SEPs with a sensitivity of 75.00%,23 out of 26 with subacute combined degeneration of the spinal cord had abnormal SEPs with a sensitivity of 88.46%,8 out of 10 with acute myelitis had abnormal SEPs,15 patients with myelopathy having abnormal findings,all 5 patients with spinal cord compression had abnormal SEPs.42 of 68 patients undergoing MRI revealed to be abnormal,in which 35 patients also had abnormal SEPs.The other 26 patients had normal spinal MRI,in which 21 patients had abnormal SEPs.Conclusions Paraspinal stimulation somatosensory evoked potentials and spinal cord conduction velocity may objectively document the abnormalities of electrophysiology,which occurs earlier than those of anatomy and radiological finds, therefore it may detect the dysfunction of spinal cord at an early stage.It is even more useful in the detecting of the metabolic myelopathy,which can hardly be detected by MRI.This technique is simple,inexpensive, and maybe useful in the diagnosis for patients with suspected spinal cord lesions.

Objective To investigate the effect of manual operation on occupational therapy teaching. Methods 83 students were randomly divided into 2 groups: 41 students of general teaching group and the other 42 of manual operation teaching group, who received the ordinary classroom teaching and manual operation teaching respectively. After 4 h of study, they were measured with Canadian Model of Occupational Performance (CMOP). Results There were 37 and 41 questionnaires recalled from the general teaching group and the manual operation teaching group, and 2 and 3 questionnaires excluded as incomplete respectively. The scores of the classroom atmosphere, interesting stimulation, explanation of curriculum connotation, obtaining professional ideology, ability cultivated to solve practical problems, good relationship between doctors and patients developing, and thinking of discussion stimulating were more in the manual operation teaching group than in the general teaching group (P<0.01). Conclusion Manual operation is a new, effective, convenient, and low-cost mode of teaching for occupational therapy.

Objective To analyze the safety and efficacy of endovascular aortic repair (EVAR) for abdominal aortic aneurysm(AAA) with hostile aortic proximal landing anatomy. Methods The clinical and imaging data of 147 AAA patients [135 males, (68.7 ± 8.9) years old, range 43-85 years old] with hostile aortic proximal landing anatomy treated by EVAR from January 2012 to December 2014 in our center were retrospectively analyzed. The range of maximum aneurysm diameter was 45-100 mm; the length range of proximal aneurysm neck was 7-32 mm;the width range of proximal aneurysm neck was 15-30 mm, and the infrarenal angulation was 10°-90° . In addition, there were atherosclerotic changes in the proximal neck in 43 cases. Follow-up protocol consisted of evaluation of clinical symptoms and cTA at 3, 6 and 12 months and annually thereafter. Results The technical success rate was 100%. Different procedures were adopted among patients, with 113 cases of EVAR, 3 cases of fenestrated EVAR and 24 cases of chimney EVAR. The intra-operative type Ia endoleak was observed in 32 cases, in which 25 of them were successfully treated by balloon angioplasty and the other 9 patients were treated with Cuff extension. During the mean follow-up period of 18 months (6-42 months), the accumulative survival rate was 98.0%(144/147),the patency rate of stents was 99.3%(146/147), and the thrombosis rate of aneurysm was 97.3%(143/147). Two patients died because of aneurysm rupture, and another case died of unknown reason. Two patients underwent secondary intervention successfully for the treatment of thrombosis formation and lumen occlusion in unilateral iliac stent in 1 case, and type Ⅲ endoleak in another case. No other complications such as misplace of stent grafts, no bilateral limb ischemia and stent infection were observed during follow-up. Conclusions EVAR is a safe and effective option to treat AAA with hostile aortic proximal landing anatomy. Choosing the most suitable stent-graft, the combination of various interventional techniques and close postoperative follow-up are the key points for successful treatment.

Objective To evaluate the correlation between impaired fasting glucose and the extent and severity of angiographic coronary artery disease( CAD ) in patients who underwent coronary angiography.Methods A total of 630 consecutivc patients who underwent coronary angiography were selected in the stndy.The extent and severity of angiographic CAD were diagnosed based on the followings:whether or not with CAD diagnosis by angiography,the number of diseased vessels,the CAD Gensini cumulative index.According to fasting plasma glucose ( FPG),all patients were divided into three group,group 1 ( FPG ＜5.6 mmol/L),group 2 ( 5.6 mmol/L ≤ FPC ＜ 6.1 mmol/L) and group 3 ( 6.1 mmol/L ≤ FPG ＜ 7.0mmol/L).The CHD risk factors and the lesion degree of coronary arteries were compared among three groups.The relation of FPG and CAD were analyzed by univariate and multivariate analyses.Results The incidence of CH and,the CAD Gensini cumulative index and the incidence of mult-vessel lesions were significantly different among the three subgroups ( all P ＜ 0.05 ).After adjusting other inffluencing factors,there were significantly positive correlation between the number of diseased vessels and the CAD Gensini cumulative index and FPG( P ＜0.05).The FPG had significant correlation with the diagnosis or not of CAD by angiography( OR =3.042,95％ CI:2.589 -6.275,P ＜0.01).Conclusions In prediabetic period,the extent and severity of angiographic coronary artery disease have significant correlations with the impaired fasting glucose,and the extent and severity can increase along with the increasing FPG.

This study investigated a nano drug delivery system built by one sort of modified trimethyl chitosan (TMC). The TMC was modified by cRGDyk, ligand of integrin receptor avβ3. Single factor screening was used to optimize the prescription in which the particle sizes of TMC nanoparticle (TMC NPs) and cRGDyk modified TMC nanoparticle (C-TMC NPs) were (240.3 ± 4.2) nm and (259.5 ± 3.3) nm. Electric potential of those two nanoparticles were (33.5 ± 0.8) mV and (25.7 ± 1.6) mV. Encapsulation efficiencies were (76.0 ± 2.2) % and (74.4 ± 2.0) %. Drug loading efficacies were (50.1 ± 2.1) % and (26.1 ± 1.0) %. Then the cellular uptake, uptake mechanism and transport efficacy of TMC NPs and C-TMC NPs were investigated using Caco-2 cell line. The uptake rate and accumulating drug transit dose of C-TMC NPs were 1.98 and 2.84 times higher than TMC NPs, separately. Mechanism investigations revealed that caveolae-mediated endocytosis, clathrin-mediated endocytosis and macropinocytosis were involved in the intercellular uptake of both TMC NPs and C-TMC NPs. What is more, free cRGDyk could remarkably inhibit the uptake of C-TMC NPs.
Biological Transport ; Caco-2 Cells ; Caveolae ; Chitosan ; chemistry ; Clathrin ; Endocytosis ; Humans ; Integrin alphaVbeta3 ; chemistry ; Nanoparticles ; Particle Size ; Pinocytosis

OBJECTIVETo study clinical effects of the over-articular external fixator combined with limited internal fixation for the treatment of Pilon fractures caused by high energy.

METHODSFrom September 2003 to April 2011, 36 patients with Pilon fractures caused by high energy were treated with the over-articular external fixator combined with limited internal fixator. There were 25 males and 11 females, ranging in age from 16 to 72 years old,with an average of 38 years old. The diagnoses of all patients were determined by conventional X-ray examination or three-dimensional spiral CT examination. The AOFAS scoring criteria was used to evaluate the therapeutic effects. The patients with comminuted fractures were treated with screw or Kirschner wire fixation without uncovering periost so as to enhance stability between fracture end and bone blocks,followed by the fixation with over-articular external fixators.

RESULTSAll the patients were followed up, and the duration ranged from 4 to 27 months, with an average of 13 months. Thirty-two patients got wound healing at the first stage. And the bone union duration ranged from 2 to 6 months, with a mean of 3 months. According to the AOFAS ankle-hindfoot subjective scoring standard, 13 patients got an excellent result, 20 good and 3 fair, with an score of 88.2 +/- 3.6. Twelve patients had infections at pinhole, 5 patients had pinhole pain. One patient had the fixator broken induced by over loading, who was cured after treatment. There were no complications such as nerve or vascular injuries, or osteomyelitis.

CONCLUSIONThe over-articular external fixation combined with limited internal fixation for the treatment of Pilon fractures caused by high energy is an ideal method, which has such advantages as reliable fixation, simple operation, coincidence with principles of biomechanical fixation, and benefit for fracture healing.

Adolescent ; Adult ; Aged ; Ankle Injuries ; diagnostic imaging ; surgery ; Ankle Joint ; diagnostic imaging ; surgery ; External Fixators ; Female ; Fracture Fixation ; Fracture Fixation, Internal ; Humans ; Internal Fixators ; Male ; Middle Aged ; Radiography ; Treatment Outcome ; Young Adult