Objective To investigate the ability of the four-slice perfusion maps derived by multislice CT(MSCT)perfusion imaging (CTPI) to detect ischemic lesion in rabbit models with the middle cerebral artery occlusion(MCAO). Methods Sequential dynamic CT studies were performed at four slices in 2 control rabbits and another 8 with MCAO. The volume of critically ischemic lesions on CTPI maps at 1st,2nd and 3rd hour after operation and the volume of infarction measured by postmortem 2,3,5- triphenyltetrazolium chloride (TTC) staining were analyzed by analysis of variance with random blocks design and linear correlation. Results In 6 of 8 animals of the ischemia group, critically ischemia or infarction was visible on perfusion maps and TTC-staining,while appearing negative in 2 control rabbits. In four-slice CTPI maps, lesions were visualized in 2 of 4 slices at least. The results of analysis of variance demonstrated that the intergroup differences were discovered between 1st , 2nd and 3rd hour after operation, and between MTT map and other CTPI maps (P

Objective To give a summary of the current researches on hematopoietic stem cell niche.Methods Through extensive reviewing the related domestic and abroad literatures,the present summary reviews the compo- nents of hematopoietic stem cell niche,related cell factors and related cell signaling pathway participating in regula- tion of hematopoietic stem cell.Results The activities of hematopoietic stem cells are regulated by the niche(micro- environment),which is composed of hematopoietic stem cell and its surrounding cells.The regulation cannot be completed through one signaling pathway.Also,the self-renewal and differentiation of hematopoietic stem cell can- not be completed only through osteoblastic cells.Conclusion The niche regulates hematopoietic stem cells by differ- ent ways.With study in-depth,we will comprehensively understand the nature of stem cells and the study will pro- vide a broader space to stem cell-based therapy.

OBJECTIVETo discuss the curative effect of traditional treatment and combination therapy for senile hip fracture.

METHODSUsing prospective methods to choose 300 cases of elderly patients with hip fractures from February 2011 to December 2012, which were randomly divided into comprehensive treatment group and conventional treatment group. After screening, 148 case were in comprehensive treatment group,including 62 males and 86 females with an average age of (78.76 +/- 7.32) years old ranging from 60 to 88; 45 cases were intertrochanteric fracture of femur, 103 cases were fracture of neck of femur; Singh index > or = IV in 74 cases, < IV in 74 cases;preoperative Harris score was 39.90 +/- 2.28. There were 146 cases in conventional treatment group,including 60 males and 86 females with an average age of (80.00 +/- 7.06) years old ranging from 66 to 96; 50 cases were intertrochanteric fracture of femur, 96 cases were fracture of neck of femur; Singh index > or = IV in 75 cases, < IV in 71 cases; preoperative Harris score was 40.10 +/- 2.81. Preoperative general situation,leaving bed time and hospital stay, the incidence of postoperative 12 weeks Singh index > or = IV and DPD/Cr value, Harris score at 12 months after operation and the incidence of fracture again of two groups were observed and compared.

RESULTSIn comprehensive treatment group 140 patients were followed up for 12 to 18 months with an anverage of 14.80 +/- 1.85. In conventional treatment group 132 patients were followed up for 12 to 14 months with an average of 12.75 +/- 0.79. There were no significant differences in age, gender, the classification of fracture, preoperative Harris hip score, preoperative Singh index > or = IV level and DPD/Cr value between the two groups (P > 0.05). Comprehensive treatment group had shorter leaving bed time and hospital stay, smaller postoperative 12 weeks DPD/Cr value and higher postoperative Harris score, higher incidence of postoperative 12 weeks Singh index > or = IV level, lower incidence of fracture again than conventional treatment group, there was statistically significant difference between two groups (P < 0.05).

CONCLUSIONFor the anti-osteoporosis effect, the comprehensive treatment group has more advantage than traditional treatment group in elderly hip fracture, which can further improve the elderly hip fracture treatment and provide the reference of evidence-based medicine cooperate with rehabilitation department.

Aged ; Aged, 80 and over ; Case-Control Studies ; Female ; Hip Fractures ; surgery ; Humans ; Incidence ; Length of Stay ; Male ; Postoperative Complications ; epidemiology ; Prospective Studies

Objective To evaluate the effects and safety of closed tracheal suction system(CTSS)versus open tracheal suction system (OTSS) for mechanically ventilated patients.Methods All randomized controlled trials (RCTs) comparing CTSS with OTSS for mechanically ventilated patients home and abroad were identified via manual and computer retrieval.All related data were extracted.Meta analysis was conducted using the statistical software RevMan 5.1 on the basis of strict quality evaluation with the methods recommended by the Cochrane Collaboration.Results Fifty-one related papers were found and 12 RCTs involving 1205 patients in CTSS group and 1179 patients in OTSS group were included.The results of meta analysis showed that CTSS was associated with a significant reduction in the duration of mechanical ventilation (WMD =-0.73,95％ CI-1.07--0.40,P＜0.0001),but the incidence of ventilator associated pneumonia and microbial colonization,mortality and length of ICU stay exhibited no difference between the two groups (P ＞ 0.05).However,compared with OTSS,CTSS reduced the incidence of arrhythmia (RR =0.23,95％ CI 0.07-0.74,P =0.01) and minimized the disturbance to heart rate (WMD =-1.97,95％ CI-3.03--0.91,P =0.0003),mean arterial pressure (WMD =-2.01,95％ CI-3.02--1.01,P ＜ 0.0001) and oxygen saturation (SpO2) (WMD =-1.00,95％ CI-1.14--0.86,P ＜ 0.000 01).Conclusions Compared with OTSS,CTSS could reduce disturbance to respiratory and circulatory system by sputum suction and shorten the duration of mechanical ventilation.However,CTSS has no advantage in prevention of ventilator associated pneumonia or microbial colonization,nor does it shorten the length of ICU stay or improve the outcome of mechanically ventilated patients.

Objective To compare the difficult degree,differences in gastric pouch volume,the complications,and postoperative weight loss effect of two gastric pouch practices in laparoscopic gastric bypass for bariatrics.Methods We retrospectively analyzed laparoscopic gastric bypass surgery in 76 bariatrics cases from May 2010 to May 2012.Two methods were used to create gastric pouch,among which 39 cases were operated with the dissection landmark method (called dissection),and 37 cases with bougie airbags 30 ml (called the bougie).Parameters were compared between the 2 groups including operation time for gastric pouch,the amount of staple cartridges,intraoperative complications,blood loss,and postoperative excess weight loss percentage (EWL ％),the postoperative bleeding,obstruction,fistula and other complications.Results All patients were followed up for more than one month.The dissection group used longer time in creating gastric pouch than that in the bougie group [(58 ± 27) min,(42 ±21) min,P ＜ 0.01].The number of staple cartridges used were significantly different between the two groups [(6.2 ±3.0),(4.3 ± 2.0),P ＜ 0.01].There were 10 cases of complications in the dissection group (26％),and 3 cases in the bougie group (8％) (P ＜0.05).One month after the surgery,one each patient had transient hematochezia.There was no gastric pouch-related complications in the two groups postoperation.There was no difference in excess weight loss (P ＞ 0.05).Conclusions The two methods can achieve the same effect on excess weight loss.The bougie method used less time in creating the gastric pouch,less consumable materials,and less complications occurred in creating gastric pouch.

Objective To assess the risks of complications of loop colostomy and loop ileostomy.Methods The databases of Medline,Embase,Cochrane Library,Google Scholar and Wanfang were retrieved to identify the published studies comparing the advantages between loop colostomy and loop ileostomy.All the articles retrieved were published before April 15,2011.The incidence of complications was analyzed by Meta-analysis.The data were analyzed by the Z test and the heterogeneity of the data was analyzed by the Q test.Results Five randomized controlled trials and 8 non-randomized controlled trials with 1752 cases were included in the Meta-analysis.Compared with loop ileostomy,loop colostomy was associated with significantly increased risk of stoma prolapse ( OR =3.46,95％ CI:1.81-6.63,P ＜ 0.05 ).There were no significant differences in the incidences of stoma hemorrhage and stenosis,wound infection,stoma necrosis,parastoma dermatitis and hernia between patients who received loop ileostomy and those who received loop colostomy.Compared with loop ileostomy,loop colostomy was associated with increased risk of wound infection following stoma closure(OR =3.44,95％ CI:1.95-6.05,P ＜0.05).Compared with loop colostomy,loop ileostomy was associated with increased risk of postoperative bowel obstruction following stoma closure(OR =0.43,95 ％ CI:0.20-0.91,P ＜ 0.05 ).There was no significant difference in the risk of anastomotic leak between loop ileostomy and loop colostomy.Conclusion Compared with loop ileostomy,loop colostomy is associated with increased risk of stoma prolapse and wound infection after stoma closure,while a higher risk of bowel obstruction following stoma closure is observed after loop ileostomy.

Objective To investigate the expression of the genes correlated with interferon induced genes virus (MX1, OAS1, IFI44) in the peripheral blood leukocytes of patients with systemic lupus erythematosus (SLE), and to evaluate the relationships between the expression levels of these genes and diseaseactivity. Methods The clinical data of 100 SLE patients, 40 non-SLE patients with rheumatic diseases, and 40 normal controls were collected. Peripheral blood samples were collected. Total RNA was extracted and transcribed into cDNA. SYBR green dye based real-time quantitative PCR method was used to compare the expression levels (indicated as △CT value) of MX1, OAS1 and IFI44 in patients with SLE and those in the controls. Comparisons between groups were performed with ANOVA and Spearman correlations. Results ①The △CT value of MX1, OAS1 and IFI44 expression level of the SLE patients (3.4±1.8, 4.2±1.5, 8.8±2.2)was significantly higher than those of the non-SLE patients (2.4±0.4, 3.4±0.7, 5.4±2.1 ) and normal controls (2.3±1.1, 2.6±0.7, 5.2±2.0). ② The △CT value of OAS1 and IFI44 expression level of the SLE patients in severe disease was significantly higher than those of the SLE patients in mild disease and the SLE patients with stable disease. ③The ACT value of OASI and IFI44 were correlated with the SLEDAI scores (r=0.038,0.380). ④ The △CT values of MX1, OAS1 and IFI44 expression level of the SLE patients with arthritis were significantly higher than those of SLE patients without arthritis. ⑤ The △CT value of IFI44 expression level of the SLE patients with lupus nephritis (3.2±2.1,2.2±1.1) was significantly higher than that of the SLE patients without lupus nephritis. ⑥ There was correlations among these genes in SLE patients (P＜0.05). Conclusion The value of MX1, OAS1 and FFF44 expression level of SLE patients is up-regulated. The real time expression levels of OAS1, IFI44 genes are associated with SLE disease activity and there are close correlation among these genes with interferon induce virus-relationed genes (MX1, OAS1, IFI44) in SLE patients.

Objective To study the relationship between the cerebral artery stenosis and the carotid artery elasticity in the ischemia stroke patients by echo-tracking technique.Methods Ninety-two ischemia stroke patients were divided into both the mild cerebral arteries stenosis and moderate-severe cerebral arteries stenosis groups.CT angiography was performed to evaluate the stenosis of cerebral artery.The changes of the carotid diameter during cardiac cycles were obtained by echo-tracking technique and the quantitative parameters of pressure-strain elastic modulus (Ep),stiffness (β) and arterial compliance (AC) were calculated automatically. Results①There were significant differences (P＜0.05) between the ischemia stroke patient group and the normal adults group in β，Ep and AC.② There were significant differences (P＜0.05) between the mild cerebral arteries stenosis groups and the moderate-severe cerebral arteries stenosis groups in β and Ep.AC was lower in patients with the mild cerebral arteries stenosis groups than that in the moderate-severe cerebral arteries stenosis groups.Conclusions The carotid artery elasticity in ischemia stroke patients were significantly different from normal adults.In the ischemia stroke patients,the stiffer the carotid artery was,the higher the likelihood of moderate-severe cerebral stenosis was.

Objective To systematically review the efficacy of dexmedetomidine or midazolam for sedation in critically ill patients. Methods We searched the PubMed, EMBaes, Cochrane Library, Wanfang Database,CNKI and VIP for all randomized controlled trials (RCTs) about the efficacy of dexmedetomidine versus midazolam for sedation in severe cases. The quality of the studies was evaluated by the method recommended by Cochrane Collaboration. Meta-analysis was conducted using the Cochrane Collaboration's RevMan 5.0 software. Results Six RCTs involving 613 patients were included in our Meta-analysis. The results of Meta-analysis showed that the length of ICU stay was significantly shorter in group dexmedetomidine than in group midazolam. There were no significant differences in the duration of mechanical ventilation, incidences of bradycardia, hypotension and delirium and mortality rate between the two groups. Conclusion Dexmedetomidin can shorten the length of ICU stay and is beneficial for the outcome in critically ill patients.

Objective To evaluate the analgesic efficacy of thoracic paravertebral block (PVB) in patients after lobectomy performed via video-assisted thoracoscope (VAT) .Methods Fifty ASA Ⅰ or Ⅱ patients of both sexes aged 20-76 yr weighing 45-90 kg undergoing elective lobectomy via VAT were randomly divided into 2 groups (n = 25 each): patient-controlled intravenous analgesia (PCIA) group and thoracic PVB group. PVB was performed according to the method described by Jamieson et al and Richardson et al. Paravertebral catheter was placed at T7-8 after induction of anesthesia and tracheal intubation. A loading dose of 0.5% ropivacaine 20 ml was administered via PVB catheter at 30 min before the end of operation. PVB was then controlled by the patients with 0.2% ropivacaine (bolus dose 8.0 ml, lockout interval 30 min). In PCIA group a loading dose of sufentanil 0.1 μg/kg was given iv at 30 mln before the end of operation. Sufentanil 1.0 μg/ml was used. PCIA included a bolus of 2 ml with a 15 min lockout interval and background infusion 2 ml/h. Numeric rating scale (NRS) (0=no pain, 10 = most severe pain) was used to assess the intensity of pain. NRS score, MAP, HR and SpO2 were recorded before operation (T0 ,baseline), 30 min after withdrawal of chest tube (Ti) and at 24, 48 and 72 h after operation (T2, T3, T4). Forced vital capacity (FVC) and forced expiratory volume first second (FEV1.0) were measured and FVC/FEV1.0 ratio was calculated after chest tube was withdrawn. Blood cortisone and glucose concentrations were determined at To, T1 and T4. Requirement for rescue analgesics and side effects were recorded. Results There was no significant difference in MAP, HR, SpO2 and NRS at rest between the 2 groups.NRS at coughing and blood cortisone and glucose concentrations were significantly lower and the postoperative FEV1.0 was significantly higher in PVB group than in PCIA group. The requirement for rescue analgesics and side effects were comparable between the 2 groups. Conclusion Thoracic PVB can provide better postoperative analgesia with little side effects.