目的观察带锁髓内钉固定结合自体骨髓移植治疗长管状骨骨折和骨折不愈合的疗效。方法对12例股骨、胫骨长管状骨骨折和骨折不愈合患者行带锁髓内钉固定、复位,同时行自体骨髓移植治疗(每2周移植1次,共移植3—6次)。结果所有病例均未出现骨折延迟愈合或不愈合,于10—18个月时取出髓内钉,未出现断钉、关节功能障碍、骨密度明显降低等。结论带锁髓内钉固定结合自体骨髓移植是一种可行的治疗长管状骨骨折与骨折不愈合的有效方法。

Self-made molecule imprinting polymer-solid phase extraction column was used in extracting nerve agent degradation products in rice. The extraction was then examined by capillary electrophoresis. The method was simple, reliable and sensitive. The calibration curve showed a good linearity for the nerve agent degradation products in rice was in the concentration range of 0.2～5.0　μg/g and the detection limits were 0.05μg/g. The RSD of the method was less than 6.2%.

Objective To explore the basic reason of postpartum hemorrhage patients, and compare the differences of postpartum hemorrhage in the different delivery modes, in order to serve the clinical treatment. Methods The delivery modes in gynecological patients in our hospital were input to statistical analysis,the postpartum hemorrhage in cesare-an section and vaginal delivery were comparative study, the difference in bleeding frequency, hemorrhage cause,blood loss of two groups were compared. Results The blood loss of caesarean section was significantly higher than that of vaginal delivery (P<0.05). The difference of bleeding time in two delivery modes was not significant (P>0.05).The main reason for vaginal delivery of postpartum hemorrhage was uterine inertia,while the main reason for hemorrhage of cesarean section was operation factors or position. Conclusion Clinical analysis of postpartum hemorrhage in cesarean section and vaginal delivery situation and the reason of difference is helpful to the prevention and the control of mater-nal postpartum hemorrhage.

Objective To explore an ideal form of graft for pituitary transplantation, which could restore normal pituitary function and avoid hyperprolactinmia providing it is implanted outside the hypophysiotrophic area.Methods Pituitary cells, hypothalamic cells and nigral cells were obtained from human embryos (4-6 months gestation) during therapeutic abortion, and three different cultures were conducted: group P (n=38), half amount of pituitary cells per embryo; group PH (n=18), half amount of pituitary cells mixed with double amount of hypothalamic cells obtained from each embryo; and group PHN (n=20), half amount of pituitary cells mixed with double amount of hypothalamic and nigral cells acquired from each embryo. The histological changes of the cultured cells were observed and the secretive levels of growth hormone and prolactin indifferent medium were measured.Results All the monolayer cultured cells grew well throughout the 30-day culture period. Ultrastructurally, the cells in group P degenerated significantly at the 21st day of culture. However, in the PH and PHN groups, the cells kept well viability. The secretive level of growth hormone in culture medium declined steadily in group P, but kept at 20 ng/ml in both PH and PHN groups. Prolactin concentration decreased rapidly following an initial increase in group P, but kept at a high level in PH group. In PHN group, the prolactin level was valuable, remaining at about 15 ng/ml.Conclusions In the mixed culture of fetal pituitary-hypothalamic-nigral cells, the pituitary cells kept high viability in a long period and its hormone secretion remained at ideal levels. These indicate that the mixed fetal pituitary-hypothalamic-nigral cells are a good graft, which can be implanted outside the cranium while maintaining normal pituitary function with no increase in blood prolactin concentration.

Objective: To compare the outcome of surgical high-risk elderly patients with severe aortic stenosis(SAS) treated by different therapy procedures, including transcatheter aortic valve implantation(TAVI), surgical aortic valve replacement(SAVR), and drug therapy. Methods: We retrospectively analyzed the clinical data of 242 surgical high-risk elderly (age ≥65 years old) SAS patients hospitalized in Fuwai Hospital between September 2012 and June 2015. According to the treatment method, patients were divided into TAVI group (81 cases), SAVR group (59 cases) and drug therapy group (102 cases). The primary end point was all-cause mortality at 1 year post procedure, and secondary end point included cardiac function class(NYHA), vascular complication, valvular function, non-fatal myocardial infarction, new atrial fibrillation, stroke, bleeding, pacemaker implantation, acute renal failure, and readmission. We used the Kaplan-Meier method to estimate survival function based on follow up data and survival was compared between groups with the use of the log-rank test. Results: (1) In the baseline data, there were statistically significant difference among 3 groups for the age, left ventricular ejection fraction, cardiac function class Ⅲ and Ⅳ, rates of combined diabetes, chronic renal failure, mild and moderate mitral regurgitation (P<0.01 or 0.05). The risk score of the Society of Thoracic Surgeons(STS) was 7.28±4.98 in the TAVI group, and 5.67±3.49 in the SAVR group(P=0.036). (2) The perioperative rates of pacemaker implantation(11.3%(9/81) vs. 0, P=0.025) and mild paravalvular regurgitation(29.6%(24/81) vs.1.7%(1/59), P<0.001) were significantly higher in TAVI group than in SAVR group.(3)The rate of rehospitalization was significantly lower in TAVI group than in SAVR group(3.0%(2/67) vs. 22.7%(10/44) P=0.005) and the rate of pacemaker implantation was significantly higher in TAVI group than in SAVR group(17.5 (12/67) vs. 0, P=0.008) after 1 year. The rates of death from any cause in the TAVI (5.8%(4/67)) and SAVR group (11.4%(5/44)) were significantly lower than that in the drug therapy group (54.9%(50/91), both P<0.05) after 1 year and was similar between TAVI group and SAVR group(P=0.622). (4) The rates of cardiac function classⅠandⅡ increased and Ⅲ and Ⅳ decreased in TAVI and SAVR group after 1 year when compared with base line(P<0.001). The rates of cardiac function class Ⅱ, and Ⅲ increased , class Ⅰ and Ⅳ decreased in drug therapy group after 1 year compared with base line (P=0.020). (5)The survival rates after 1 year were significantly higher in the TAVI group and SAVR group than in the drug therapy group(log-rank test, P<0.001), and the difference was similar between TAVI group and SAVR group (log-rank test, P=0.062). Conclusion In surgical high-risk elderly patients with SAS, the prognosis of drug therapy was poor, and TAVI and SAVR were associated with similarly improved rates of survival after 1 year, although there were significant differences in periprocedural complications between TAVI and SAVR groups.

BACKGROUNDDespite its severity, coronary artery ectasia (CAE) is still poorly understood. High-sensitivity C-reactive protein (hs-CRP) has been recognized as a prognostic factor in some cardiovascular diseases but not assessed in CAE. The aim of this observational study was to investigate the prognostic value of hs-CRP in CAE.

METHODSOur analysis evaluated the effect of the baseline hs-CRP on cardiovascular events (CVs) (cardiac death and nonfetal myocardial infarction) in consecutively enrolled stable CAE patients. We used the Cox proportional hazards regression models to examine the association between baseline hs-CRP level and follow-up CVs in CAE. The net reclassification improvement and integrated discrimination improvement (IDI) of hs-CRP were also assessed.

RESULTSWe obtained the follow-up results of 540 patients over a median follow-up period of 36 (37.41 ± 15.88) months. The multivariable Cox analysis showed that the hs-CRP was a significant predictor of adverse outcomes in CAE (hazard ratio [HR]: 2.99, 95% confidence interval [CI]: 1.31-6.81, P = 0.0091). In Kaplan-Meier analysis, the group with hs-CRP >3 mg/L had a lower cumulative 66-month event-free survival rate (log-rank test for trend, P = 0.0235) and a higher risk of CVs (HR = 2.66, 95% CI: 1.22-5.77, P = 0.0140) than the group with hs-CRP ≤3 mg/L. Hs-CRP added predictive information beyond that given by the baseline model comprising the classical risk factors (P value for IDI = 0.0330).

CONCLUSIONSA higher level of hs-CRP was independently associated with cardiac death and nonfatal myocardial infarction in CAE patients. The hs-CRP level may therefore provide prognostic information for the risk stratification of CAE patients.

Aged ; C-Reactive Protein ; metabolism ; Coronary Artery Disease ; metabolism ; pathology ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Proportional Hazards Models