[Objective] To investigate internal fixation with locked plate and bone cement in treatment of long bone pathologic fractures due to metastatic carcinoma. [Methods]From February 2005 to February 2008, 15 patients suffering from pathologic fractures caused by metastatic lesions of the humerus(3 cases), ulna(2 cases), radius(1 cases), femur(5 cases) and tibia(4 cases) have been surgically treated with internal fixation with locked plate and bone cement.[Results]All patients were followed up after operation for ranging from 24~46 months. Pain relief was achieved in 14 patients(93.3%). Thirteen(86.7%) patients got excellent Enneking scores at 2 weeks postoperatively. The quality of life had significant difference betwen before and after operation (P

Vascular dementia,an acquired,persistent syndrome of intelligent disorder,mainly caused by cerebrovascular disease is one of the main types of senile dementia.Its pathogenesis remains unclear.Brain-derived neurotrophic factor sustains multiple neuronic survival,development, differentiation,and repair following injury.It also induces and maintains the long-term potentiation of hippocampus and cortex,and changes the morphologic plasticity of hippocampal neuron by regulating hippocanoal synaptic transmission and synaptic plasticity.It participates in the processes of hippocampus-dependent learning and memory,and it may play an important role in the onset and development of vascular dementia.

Objective To evaluate the value of video-assisted thoracic surgery(VATS)for penetrating thoracoabdominal injuries.Methods Under general anaesthesia and double-lumen tracheal intubation,VATS was carried out to examine patients with chest injuries.Those who had mild injuries received VATS combined with mini-incision surgery.Electrocoagulation or suturing was employed to control intraoperative bleeding,and then blood clots were removed.Injured diaphragm muscles were repaired,and organs with hemorrhage or ruptures were sutured or resected.The seriously injured cases underwent open surgery and intra-abdominal exploration instead.Results A total of 18 patients received the operations.Among them,15 patients underwent VATS combined with mini-incision surgery(repair of the diaphragm was performed on 15,controlling intercostal arterial bleeding on 8,repair of the lung on 2,wedge resection of the lung on 2,and coagulated hemothorax removal on 2),the other 3 were converted to open surgery for repairing the diaphragm(3),heart(1),or esophagus(1),or lobectomy(2).Abdominal surgery via the thorax were performed on 13 cases,including repair of the liver in 1,lienectomy in 1,gastrorrhaphy in 1,repair of diaphragmatic hernia in 3,and intra-abdominal exploration in 7.Five patients received open surgery(pancreatic neoplasty in 1,repair of the liver in 1,lienectomy in 1,gastrorrhaphy in 2,and repair of the caul and mesenterium in 3).One patient who had multi-organ penetrating injuries died of hemorrhagic shock,circulatory failure,and DIC after open thoracic and abdominal surgeries.The mean operation time in this series was(125?44)minutes(ranged from 45 to 220),and the mean blood loss was(1089?582)ml(500 to 10 000 ml).Twenty-four hours after the operation,the mean volume of chest drainage was(234?75)ml(100 to 350 ml)in the first 24 hours after the operation.The chest drainage tube was withdrawn 2.5(2 to 5)days postoperation.The patients expelled gas in 1 to 4 days(mean,2 days).Totally,12 patients were followed up for 3 to 12 months(mean,6 months),during which none of them had trauma-related complications.Conclusion VATS combined with mini-incision surgery is safe and effective for patients with thoracoabdominal injuries,if the cases were carefully selected.

Objective To evaluate the outcomes of thoracoscopy-assisted mini-incision procedure in patients with lung cancer.Methods From January 2003 to June 2003,66 patients with non-small cell lung cancer were treated in our hospital by lobectomy combined with mediastinal lymph node resection using thoracoscopy-assisted mini-incision(36 patients,VATS Group)or traditional surgery(30 patients,traditional group).The clinical and follow-up data of the two groups were compared after the operation.Results No significant difference was found in the operation time between the VATS and traditional groups(114.6?47.4)min vs(123.3?43.9)min,t=-0.768,P=0.449],while the postoperative hospital stay of the VATS group was significantly shorter than that in the traditional group (9.2?1.4)d vs(10.5?1.7)d,t=-3.408,P=0.001].Log-rank test showed that the survival curve in the two groups was comparable(?2=0.270,P=0.605).Cox regression model indicated that the pathological characteristics(risk ratio:3.912,P=0.000),TNM stage(risk ratio:3.737,P=0.000),and lymph node metastasis(risk ratio:15.495,P=0.000)were independent,unfavorable prognostic factors for the disease;whereas,no relation was detected between the thoracotomy incision and prognosis(P=0.414).Conclusions Thoracoscopy-assisted mini-incision procedure is a safe and reliable approach for patients with lung cancer with satisfying outcomes.

Objective To study the reliability and feasibility of video-assisted thorascopic lymphadenectomy for complete resection of non-small cell lung cancer(NSCLC).Methods From May 2007 to October 2008,31 patients with NSCLC underwent video-assisted thorascopic radical lobectomy combined with systemic lymphadenectomy in our hospital.The patients were divided into video-assisted thorascopic surgery(VATS) group(n=14) and video-assisted mini-thoracotomy(VAMT) group(n=17).The numbers of removed and metastatic lymph nodes were counted.The results and the follow-up outcomes were compared between the two groups.Results No patient dead or showed serious perioperative complications in both the groups.No significant differences were found between the VATS and VAMT groups in the operation time [(193?92) min vs(188?101) min,t=0.143,P=0.887],blood loss [(592?123) ml vs(648?120) ml,t=-1.297,P=0.211],number of removed lymph nodes [(14.6?7.5) vs(15.2?4.5),t=0.262,P=0.795],or 1-year rate of recurrence or metastasis [21.4%(3/14) vs 13.3%(2/15),P=0.651].Conclusion For patients with NSCLC,no significant difference exists between the outcomes of video-assisted thorascopic surgery and video-assisted mini-thoracotomy.

ObjectiveTo assess the degree of pain in elderly patients with mechanical ventilation in ICU using critical-care pain observation tool(CPOT) and to choose the correct sedative and analgesic method.Methods 110 elderly patients in ICU after neurosurgery were divided into three assessment stages,every stage had two record points and total six points (T1-T6):the first stage (intubation and unconsciousness,T1-T2),the second stage (intubation and consciousness,T3T4 ) and the third stage(extubation and consciousness,T5-T6 ).Among them T1,T3and T5were nonnocuity assessment points of every stage,while T2,T4 and T6 were nocuity assessment points of every stage.The assessment time was one minute at every point.After recorded at every point in second and third stages,patients were asked to use the pain intensity descriptive scale (PIDS) themselves.CPOT,heart rate and mean arterial pressure (MAP) from T1 to T6 were recorded as well as PIDS from T3 to T6 in second and third stages.Results In the three stages,CPOT〔(26.8 vs.0.54,3.36 vs.1.20,2.78 vs.0.68) scores〕,HR〔(95 vs.85,94 vs.82,94 vs.84)beat/min〕 and MAP〔(95 vs.85,95 vs.87,94 vs.87)mm Hg〕 at T2,T4and T6 were higher than T1 (t=-42.89,-55.95,-55.38),T3 (t =- 5.52,- 11.33,- 11.78) and T5 ( t =- 5.54,- 9.95,- 11.33 ) ( P＜ 0.05 ).The PIDS at T4 and T6were higher than at T3and T5in the second and third stages 〔(2.52 vs.1.69,2.12 vs.1.44)scores〕 (P＜0.05).The correlation coefficient between CPOT and PIDS at T3 and T4 in the second stage were 0.49 and 0.58,respectively (P＜0.05),and between CPOT and PIDS at T5 and T6 were 0.52 and 0.59 in the third stage,respectively (P ＜ 0.05),and they both reached moderate correlation.ConclusionsCPOT may be an effective way to assess the degree of pain in elderly patients with mechanical ventilation at present.

Objective To investigate the feature of pathogenic bacteria in central venous catheter related infection (CVC-RI)and risk factor in the emergency intensive care unit (ICU).Methods One hundred and three patients were checked out bacteria from January 2006 to December 2008 in the ICU who were central venous catheter and corresponded with diagnostic criteria for CVC-RI.They were analyzed retrospectively.Results The ratio between Gram-postive bacteria (37.9%,39/103)and Gram-negative bacteria (42.7%,44/103)were not statistically significant,however,CVC-RI was related to applying duetal number,duct keeping on time and elect location.Duct staying in subclavian vein had the fewest chance.Conclusions It would be better to choose duct staying in subclavian vein.control remaining time and luminal number,and monitor changing pathogenic bacteria strictly.Main measures are taken to evade the pollution on the ental and external lumina.

Objective To determine the contents of fluoride and tea polyphenols in brick-tea and to understand the utilization ratio of qualified brick-tea in fluorosis regions in Inner Mongolia.Methods The investigation was carried out in Chenbaerhuqi Country and Eweukeqi Country.Seventy-two households of four villages in Chenbaerhuqi and 11 households of three villages in Ewenkeqi were selected as study subjects.The brick-tea in each household was sampled.The contents of fluoride and tea polyphenols were determined by using fluoride selective electrode method and Forint-Ciocalteu oxidation method,respectively.T test and linear correlation were used to analyze the data.Results The fluoride content in qualified brick tea ranged from 114.82 mg/kg to 290.23 mg/kg with an average value of 171.78 mg/kg,while tea polyphenols content was between 56.15 g/kg and 132.18 g/kg with an average value of 95.44 g/kg.In unqualified brick-tea,the average fluoride content was 459.86 mg/kg with the range from 304.71 mg/kg to 660.76 mg/kg and the average of tea polyphenols was 67.48 g/kg with the range from 36.03 g/kg to 102.15 g/kg.The content of tea polyphenols of qualified brick tea was significantly higher than that of unqualified brick tea (P ＜ 0.05).The content of tea polyphenols was negatively correlated with fluoride content(r =-0.636,P ＜ 0.05).The content of tea polyphenols was 396 times more than that of fluoride in brick tea.The utilization ratio of qualified brick-tea in the investigation areas was 53.0％(44/83).Conclusion The fluoride content in qualified brick-tea was less than unqualified brick-tea,and the tea polyphenols of qualified brick-tea was higher than the unqualified brick-tea.The utilization rate of qualified brick tea is not high and further actions are needed to be taken to supply more qualified brick-tea for controlling of drinking brick-tea type fluorosis.

Objective To observe the effect of propofol on phosphorylation of a-amino-3-hydroxy-5-methyl-4-isoxa-zolep-propionate receptors (AMPARs) GluR1 subunit and long-term potentiation (LTP) in cultured hippocampal neurons in aged rats.Methods A total of 30 18-month-old rats were decapitated,the brains were rapidly removed and hippocampal slice were prepared.The slices were randomly divided into control group (perfused with artificial cerebrospinal fluid,n=10),propofol-treated group (perfused with propofol in artificial cerebrospinal fluid,n=10)and propofol+ phorbol-12-myristate-13-acetate (PMA)-treated group (perfused with propofol and phorbol ester in artificial cerebrospinal fluid,n=10).Extracellular excitatory postsynaptic potentials (EPSP) were recorded from the CA1 region of hippocampal slices.After perfusion for 20 min,LTP was induced using higher-frequency stimulation (HFS,100Hz,400 pulse) by the Schaffer-collateral pathway.The phosphorylation of AMPA-GluR1 subunit was assayed in cultured rat neurons by Western blot.Results The value of EPSP in propofol-treated group (105.50 ± 3.77) was much lower than in control group (242.10±14.68) and in propofol+ PMA-treated group (239.40±8.98) (F=2.90,P＜0.05),and there was no significant difference in the value of EPSP between control group and propofol+ PMA-treated group (P＞0.05).The level of P-Glu1/Glu1in propofol-treated group (0.68±0.15) was much lower than in control group (1.67±0.20) and in propofol+PMA-treated group (1.57±0.18) (F=6.84,P＜0.05),while there was no difference in the level of P-Glu1/Glu1 between control group and propofol + PMA-treated group (P ＞ 0.05).There was no difference in the value of GluR1/β-actin among the three groups (F=0.31,P＞0.05).Conclusions Propofol possesses the ability to inhibit LTP induction and attenuate AMPA receptor GluR1 subunit phosphorylation through modulation of PKC pathway.

Objective To study the reliability and validity of the Chinese version of an instrument for assessing quality of life after traumatic brain injury (QOLIBRI).Methods A total of 49 patients with traumatic brain injury were studied.The test-retest reliability of the instrument was examined by computing intraclass correlation coefficients and its internal consistency was examined using Cronbach's α statistic.Its criterion-related validity was examined using reference instruments such as the HADS,SF-36 and Glasgow outcome scale-extended (GOSE).The Kaiser-Meyer-Olkin measure and Barlett's test of sphericity as well as factor analysis were used for construct validity testing.Results The test-retest reliability of the QOLIBRI subscales was stable,with Pearson's correlation coefficients ranging from 0.906 to 0.987.Good internal consistency was demonstrated by the Cronbach's αs ranging from 0.498 to 0.921.The Kaiser-Meyer-Olkin measure of QOLIBRI was 0.813.Factor analysis yielded four factors,and their cumulative contribution was 68.4％.The QOLIBRI scores were highly negatively correlated with HADS scores,moderately correlated with GOSE scores and positively correlated to SF-36 scores.Conclusions The Chinese QOLIBRI instrument has good reliability and validity.