Objective To analyze the etiology and the clinical characteristis of fever in older patients in Wenzhou.Methods Totolly 87 cases admitted to the First Affiliated Hospital of Wenzhou Medical College from January 2001 to April 2004 were retrospectively analyzed;all cases displayed fever as the major clinical manifestation and met the criteria of fever well.Results The etiology of fever which was infectious disease was in 44 of the 87 cases,accounting for 50.6%,collagen-vascular diseases 4.6%,neoplasms 10.3% and miscellaneous diseases 5.7%.In 28.7% of the cases the etiology could not be found.And in the infectious disease the tuberculosis accounted for 13.6%(6/44). Ultrasonography ,X-rays,CT scan,MRI,the marrow puncture and biopsy contributed to the final diagnosis in 21.1%,16.9%,63%,0,16.7% and 57.1% of the cases,respectively.Conclusion Because the symptoms of the older patients'febrile diseases are atypical,the diagnosis is more difficult.Infectious disease still remains a major cause of the fever in the elderly.A thorough history of disease,full physical examination of the patient and routine laboratory studies,especially erythrocyte sedimentation rate,are very important in determining the etiology of febrile disease.Early and reasonable use of non-invasive imaging techniques and the essential invasive methods are helpful to diagnosis.

Objective To investigate early changes of angiopoietin-2(Ang-2)in multiple trauma patients and assess its clinical significance.Methods Forty-five multiple trauma patients aged 2060 years admitted to the hospital within one hour after injury were randomly divided into three groups according to injury severity score(ISS).Blood specimens were obtained immediately upon arrival in the emergency department and plasma samples were assayed for comparing changes of Ang-2,TNF-a and IL-6.Meanwhile,plasma level of Ang-2 was measured and analyzed under different oxygenation index,shock index and base deficit.Results Plasma level of Ang-2 was positively correlated with ISS(P ＜ 0.01)and was concordant with the plasma levels of TNF-a and IL-6(P＜0.01).Furthermore,plasma level of Ang-2 was elevated upon increase of shock index or decrease of oxygenation index(P ＜ 0.01).Plasma level of Ang-2 was elevated with the increase of base deficit(P ＜ 0.01).Conclusions High level of Ang-2 is a marker of endothelial activation and dysfunction early after trauma.Ang-2 is related tightly with the injury severity,inflammation factors,systemic oxygenation and tissue hypoperfusion and may have a tight relation with pathophysiological development and clinical outcome after trauma.

Objective To explore the effects of sole desensitization physical therapy on standing balance and walking function among recovering stroke patients.MethodsStroke patients who met the inclusion criteria were randomly assigned to the observation group (40 cases) or the control group (40 cases). All patients received traditional rehabilitation. In addition, the observation group received sole densensitization physical therapy. The total course of treatment lasted for 1 month. The Berg balance scale (BBS) and Holden's functional ambulation classification (FAC) were used to evaluate balance and walking ability before and after treatment. The Fugl-Meyer assessment (FMA) was used to assess the motor function of the affected ankle, and footprint analysis was used to measure and record any changes in time and distance walked and to analyze improvements in gait.ResultsAfter the sole desensitization training, the BBS (37.41 ± 8.14), FAC ( 3.91 ±0.92) and FMA motor function (6.42 ± 1.12) results of the observation group were all significantly better than before training. Walking time and distance also improved.ConclusionsSole desensitization can affect foot proprioception. As a result, stroke patients' soles adapt to the surroundings, recover their ability to provide physiological support and promote improved motor function of the ankle.Sole desensitization can thus improve the standing balance and walking of stroke patients.

OBJECTIVE: To investigate the effects of Wenyang Huoxue Recipe (WRHXR), a compound traditional Chinese herbal medicine for warming yang and promoting blood flow, on the expression of angiopoietin mRNA in rats with chronic aristolochic acid nephropathy induced by Caulis Aristolochia Manshuriensis (CAM) decoction, and to explore the protection mechanism of WYHXR against kidney damage. METHODS: Twenty-eight male SD rats were randomly divided into normal control group, CAM group and WYHXR-treated group. Rats in the normal control group (n=8) and CAM group (n=10) were intragastrically administered with normal saline 10 ml/(kg.d) or CAM decoction 10 ml/(kg.d) respectively. Rats in the WYHXR-treated group (n=10) were intragastrically administered with WYHXR 30 g/(kg.d) and CAM decoction 10 ml/(kg.d). The expressions of Ang-l and Ang-2 mRNAs were detected by real-time reverse transcription polymerase chain reaction (RT-PCR) after 20-week treatment. RESULTS: Compared with the normal control group, the expression of Ang-l mRNA was significantly decreased, and the expression of Ang-2 mRNA was significantly increased in the CAM group (P<0.01). Compared with the CAM group, the expression of Ang-l mRNA was increased in the WYHXR-treated group (P<0.01). The expression of Ang-2 mRNA had no significant difference between the CAM group and the WYHXR-treated group (P>0.05). Renal pathology showed that renal damage in WYHXR-treated group was significantly reduced as compared with the CAM group. CONCLUSION: WYHXR can up-regulate the expression of Ang-l mRNA, which may be its action mechanism in protecting the kidneys.

BACKGROUND: Pterygium is associated with local chronic inflammatory responses and chronic stimulation from external factors such as. sunlight and wind dust. Presently. there are various theories concerning the onset mechanism of pterygium, but these theories are not generally accepted.OBJECTIVE: To investigate histopathological chractefistics of pterygium and analyze the mulfipotent stem cell effects on the onset of pterygium DESIGN: An open experiment.SETTING: Zhongshan Ophthalmic Center of Sun Yat-sen University.MATERIALS: Experiments were performed at the State Key Laboratory of Ophthalmology, Sun Yat-sen University from September 2006 to January 2007. 218 pterygial paraffin specimens following clinical and pathological diagnosis were obtained from Pathology Lab of Zhongshan Ophthalmic Center, Sun Yat-sea University.METHODS: Pterygial specimens harvested from clinical operations received morphology, immunohistochemistry and immunofluorescence under a confocal microscope.MAIN OUTCOME MEASURES: Morphology of ptorygium and expressions of CD34, vimentin (VIM), smooth muscle acfin (SMA), S- 100 in pterygium.RESULTS: Changes in morphology: Fibroplasia and neovascularization were the main changes in pterygium. Fibroplasia wasdiverse in different regions, and two main phenomena were observed. First, the tissues arranged tightly like the scleral fiber.Secondly, in some loose region, some of spindle-shape, polygonal, asteroid fibroblast-like cells, arranging loosely, could be seen only. No apparent collagen fibers were identified between them. Immunohistochemistry were positive for CD34 in some region where the fibroblast actively proliferated, whereas fibrocytes in mature fibrous tissue were negatively stained.Immunohistochemisu'y was positive for VIM in a large fraction of fibrocytes, vascular endothelial cells, vessel wall and perithelial cells. SMA staining was positive in basophilous small blocks, spindle or irregular cell cluster. Of the 218 cases, 56 cases had smooth muscle. S-100 staining demonstrated that neurofilament protein and adipocytes were positive. Of the 218 cases, 44 cases had adipose tissue, Immunofluorescence showed that proliferative active cells were positive and stained green under a confocal microscope.CONCLUSION: The fibrous tissues in pterygium originate from mesenchymal stem cells, and can differentiate into smooth muscle and adipose tissue.

Objective To determine whether it is better to carry out laparoscopic cholecystectomy (LC) immediately or 3 days after endoscopic sphincterotomy (EST) in patients with common bile duct stones and gallbladder stones.Methods A retrospective study was conducted on 160 patients who had common bile duct stones and gallbladder stones treated from July 2013 to July 2015 in the First People's Hospital of Huizhou.These patients were divided into a control group and an observation group,with 80 patients in each group.The control group underwent LC immediately after EST,while the observation group underwent LC 3 days after EST.The levels of blood amylase before LC,operation time,intraoperative bleeding volume,postoperative time to first flatus,postoperative complication after EST,postoperative hospitalization stay,total hospitalization stay and total hospital costs and incidences of postoperative complication after LC were compared between the two groups.Results The time periods of total hospitalization stay in the observation group and the control group were (18.2 ±3.5) d and (12.3 ±3.0) d,respectively (P＜0.05).The total costs in the two groups were (32 164 ±9 125) RMB and (22 375 ±7 860) RMB,respectively (P ＜ 0.05).The overall incidences of postoperative complication [patients (％)] were 5 (6.3) and 9 (11.3),respectively (P ＜ 0.05).The differences on preoperative serum amylase levels,LC operative time,blood loss,postoperative time to first flatus and postoperative hospitalization stay were not significantly different (P ＞ 0.05).Conclusion LC carried out on day 3 after EST to treat common bile duct stones and gallbladder stones was clinically more efficacious.

Objective To study the clinical results of patients with gallbladder stones and common bile duct stones treated either by laparoscopic cholecystectomy followed by endoscopic sphincterotomy (EST + LC) or laparoscopic cholecystectomy + common bile duct exploration (LC + LCBDE) in the elderly patients.Methods A retrospective study was conducted on 96 patients who had common bile duct and gallbladder stones treated from January 2012 to January 2016.The patients were divided into the control group and the observation group.46 patients were in the observation group who underwent LC three days after EST,while the remaining patients were in the control group who underwent LC and LCBDE.The serum amylase levels before LC,operation time,intraoperation bleeding volume,postoperative time to first flatus,total hospitalization stay and total hospitalization costs and incidences of postoperative complication were compared.Results The total operation time was (95.0 ±7.0) minutes and (125.0 ± 18.0) minutes,respectively,(P＜0.05).The total costs in the two group were (39515.0 ±4 135.0) yuan and (28287.0 ± 2 254.0) yuan (P ＜ 0.05),respectively.Postoperative complications were observed in 5 (6.1％) and 10 (13.2％) patients (P ＜ 0.05),respectively.The preoperative serum amylase levels were (97.6 ± 48.5) IU/L and (131.4 ± 68.7) IU/L,respectively.The blood loss was (35.7 ± 8.5) ml and (31.8 ± 7.3) ml,respectively.The postoperative time to first flatus was (1.7 ± 0.5) days and (1.9 ± 0.4) days,respectively.The total hospitalization stay was (16.3 ±2.8) days and (15.2 ±3.7) days.There were no significantly differences (P ＞ 0.05).Conclusions LC carried out on day 3 after EST to treat elderly patients with cholecystolithiasis and choledocholithiasis was safe and efficacious and the treatment had the advantages of minimal trauma,short operative time,rapid recovery and low complication rates.This should be recommended in clinical practice.

Objective To investigate the effects of total anthraquinone in rheum on aquaporin 2 and aquaporin 4 expression in rat kidney and explore its diuresis mechanism.Methods Thirty-two SD rats were randomly divided into control group,low dose group,medium dose group and high dose group.Total anthraquinone in rheum was administered to rats at different doses.Urinary volume of 24 h,Na+ concentration and osmolality were detected.Rats were sacrificed 5 days later.Blood samples were taken from the abdominal aorta to detect blood biochemical indicators. Kidneys of rats were removed to detect AQP2, AQP4 expression through immunohistochemistry,Western blot,and RT-PCR. Results Compared with control group,there were significantly increased 24 h urine output of rats in medium and high dose group[(16.21±1.96),(18.16±1.8) ml vs(13.85±1.25)ml,P＜0.05].24 h urine output in low-dose group did not change significantly.AQP2 protein and mRNA expression were significantly decreased in rats'kidneys of medium and high dose group (P＜0.01),The AQP4 protein and mRNA expression was significantly down-regulated in high dose group (P＜0.01).In medium does group,the AQP4 protein expression was down-regulated (P＜0.01),without significant decrease in the mRNA expression.Protein and mRNA expression of AQP2 and AQP4 did not significantly change in low dose group.Conclusion Total anthraquinone in rheum can reduce the expression level of AQP2 and AQP4 in rat kidney,which is probably one mechanism of diuresis caused by rheum.

Objective To evaluate the value of positive 99Tcm-MIBI tumor imaging for thyroid cancer diagnosis. Methods Fifty four suspected thyroid cancer patients underwent 99Tcm-O4 and 99Tcm-MIBI combined imaging procedure. The imaging data were confirmed by pathological findings. Results All the 54 cases had single throid nodules, and 25 of which were pathologically malignant. Fifty two cases of nodules were detected by the 99Tcm O4 thyroid static imaging, including 2 hot nodules,4 warm nodules, 10 cool nodules and 36 cold nodules;2 cases were negative by the imaging. Of the 25 malignant thyroid nodules, 16 nodules were visible by 99Tcm-MIBI uptake and were cold nodules;29 exhibited benign thyroid nodules,of which 15 could be seen by 99Tcm-MIBI uptake,including 1 warm nodules,2 cool nodules and 12 cold nodules. The sensitivity, specificity of the combined imaging of 99Tcm O4 and 99Tcm-MIBI were 64. 00% ( 16/25 ) and 48. 28% (14/29). No significant difference was found for the positivity between benign nodules and malignancy nodules by 99Tcm-MIBI tumor imaging ( χ2 = 0. 83, P ＞ 0. 05 ). Conclusion 99Tcm-MIBI tumor imaging is not specific for the diagnosis of thyroid malignancy.

BACKGROUND: Traditional scaphotrapeziotrapezoid limited intercarpal arthrodesis contains Kirschner wire, U-shaped nail, AO/ASIF steel plate and so on. Long-term plaster external fixation was needed following surgery. USA-designed arthrodesis apparatus is mainly suitable for European and people from USA, but not fit for Asian.OBJECTIVE: To simulate scaphotrapeziotrapezoid limited intercarpal arthrodesis, and to test the stability of the novel arthrodesis apparatus developed by the group according to anatomic form of dorsal joint fovea of Chinese scaphotrapeziotrapezoid.DESIGN, TIME AND SETTING: The observational study was performed at the Laboratory of Biomechanics of the Department of Orthopaedics, Nantong University from April 2006 to March 2007.MATERIALS: A total of 40 fresh forearm samples of corpses that were not subjected to antiseptic treatment were used for this study. Radiograph verified that these samples did not develop wrist joint affection or abnormal alinement.METHODS: The cadaver models were imitated limited intercarpal instability before scaphotrapeziotrapezoid arthrodesis used circular plate. Then, simulated flexion 50°, extenion 35°, ulnar deviation 30°, radial deviation 10° ultimate activities (50000).CT scan and 3-D reconstruction should be taken before and after motion.MAIN OUTCOME MEASURES: The index of the radial-scapho angle (RSA), radial-scapho distance (RSD), scapho length(SL), trapezium-trapezoid inclination (TTI), trapezium-trapezoid width (TTW) were measured.RESULTS: Prior to motion RSA, RSD, SL, TTW and TTI were (38.725±2.230) °, (18.988±1.216) mm, (1.686±0.191) cm,(27.360±1.571) mm and (114.975±2.293) °. Following motion RSA, RSD, SL, TTW and TTI were (38.800±2.388) °,(19.215±1.443) mm, (1.683±0.209) cm, (27.718±1.910) mm, (115.300±3.023) °. No significant difference in above-described indexes was determined before and after motion (P > 0.05).CONCLUSION: The novel STT limited intercarpal arthrodesis apparatus shows confidential stability. Thus, wrist joint can do exercises in an early stage at the range of 35 dorsal extension, 50 palmar flexion, 10 radial deviation and 30 ulnar deviation.