Objective Geriatric medicine has become an important medical subspecialty,and will have broad prospects for development.By reviewing the brief history of geriatric medicine,it displays its emergence,birth,concept and scope under different background of social civilization and culture between western and eastern countries.Moreover,it presents the development courses of geriatric medicine in terms of clinical medicine,nursing,education,disciplinary development,academic organization,management and innovation among different countries.As the world's population ages,geriatric medicine is facing both great challenges and opportunities.Only by learning the knowledge and experience from the history and renewing ideas,healthcare professionals can promote the comprehensive development of geriatric medicine,which will be full of vigor and vitality.

Objective To explore the feasibility of nasolabial sulcus flap transfer with autologous free skin graft to repair the alar defects after malignant tumor resection.Methods From January 2012 to January 2015,9 patients with malignant tumor were treated in the hospital.After complete tumor removal,the defect area being reconstructed was 1.5 cm × 1.3 cm to 2.5 cm × 2.5 cm.The defects of 9 patients were all restored with nasolabial sulcus flap combined with autologous free skin graft.Results The 9 patients were followed up for 6-18 months postoperatively.The nasolabial sulcus flap and autologous free skin graft were survived completely in all cases.Symmetrical alae were noted with slight edema within nasal cavity but without difficult ventilation.Scar was repaired in phase-two surgery.Conclusions Nasolabial sulcus flap combined with autologous free skin graft is an optional way in alar defects restoration.Further with secondary morphologic plasty,satisfactory surgical outcome can be achieved.

Objective To analyze and investigate dopamine combined with milrinone treatment effect on elderly patients with intractable heart failure and N-terminal B-type natriuretic peptide level and cardiac function.Methods 80 cases of elderly patients with heart failure according to the number table method randomly divided into two groups: control group and experimental group, and control group was given conventional drugs.The patients in experimental group were received dopamine +Milrinone on the basis of control group.Clinical efficacy, N-terminal pro-B-type natriuretic peptide levels ( NT proBNP ) and heart function condition between two groups are compared and analyzed.Results The total effective rate of experimental group (95.00%) was higher than that of control group (70.00%) (P<0.05).NT-proBNP(2013.31 ±295.84)ng/L、LVEDD(61.48 ± 10.11)mm、LVEF(59.69 ±8.44)% in the experimental group was significantly better than the control group(P <0.05).Conclusion Dopamine combined with milrinone in the treatment of elderly patients with intractable heart failure is remarkable, can relieve the level of NT proBNP, and promote the recovery of cardiac function.

Objective To evaluate antimicrobial activity of fosfomycin combined with tigecycline against Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae and study the mechanism of drug resistance to fosfomycin. Methods Broth microdilution method was used to independently determine the minimum inhibitory concentrations (MIC)of fosfomycin and tigecycline against 42 Klebsiella pneumoniae isolates (including 20 KPC-producing and 22 KPC non-producing isolates).Checkerboard design method was applied to evaluate combined effect of different concentrations on antimicrobial susceptibility and calculate the fractional inhibitory concentration index (FICI).FICI=MICfosfomycin joint/MICfosfomycin monotherapy +MICtigecycline joint/MICtigecycline monotherapy .Related interpretation criteria were as following:FICI≤0.5 means synergy;0.5 2 means antagonism.The fosfomycin resistant genes in KPC-producing Klebsiella pneumoniae isolates were screened.The data were analyzed by t test.Results Antimicrobial susceptibility testing results indicated the fosfomycin and tigecycline susceptibility rates in KPC-producing isolates were 35 .0%(7/20)and 70.0% (14/20 ),respectively.The susceptibility rates of drug combination increased to 50.0% (10/20 )and 95 .0% (19/20 ),respectively,with both MIC decreased.MIC of tigecycline decreased significantly after combination therapy and showed a statistical significance compared with the MIC of monotherapy (t = - 2.596,P = 0.013 ),whereas there was no significant difference between single and combined therapy of fosfomycin (t=-1 .274,P =0.211).FICI indicated that a total of 60.0%isolates showed synergy and additive effects between two antimicrobial agents,followed by indifference (40.0%),but there was no antagonism effect.Among 22 KPC non-producing isolates,there were 54.5 %showing indifference effects,followed by additive (31 .8%)and synergy (13.6%)effects.No antagonism effect was found.The study also identified two isolates with fosA resistant gene which located on the same plasmid as well as the bla KPC gene.The plasmid sizes in the two isolates were 138.9 kb and 104.5 kb, respectively.Conclusions KPC-producing Klebsiella pneumoniae are more susceptible to tigecycline. Combined use of two antimicrobial agents mainly exerts synergy and additive effect rather than antagonism,which may suggest the combination therapy strategy could inhibit the activity of KPC-producing Klebsiella pneumoniae .

Objective To study the clinical effect of transpedicular vertebral osteotomy spine shortening in treating spinal kyphosis com-plicated with spinal cord nerve dysfunction. Methods A total of 80 patients with spinal kyphosis complicated with spinal cord nerve dys-function in our hospital from May 2013 to June 2014 were enrolled and randomly divided into observation group(n=40) and control group (n=40). The observation group received transpedicular vertebral osteotomy,and the control group received lamina and facet osteotomy. The situation of surgery,vertebral healing and spinal cord function condition,treatment effect between two groups were compared. Results The operation time and postoperative ambulation time of observation group were shorter than those of control group [(76. 52 ± 9. 1) vs (113. 46 ± 13. 44) min,(3. 28 ± 0. 43) vs (5. 67 ± 0. 68) d]. The postoperative bleeding volume,postoperative drainage volume of observation group were less than those of control group [(36. 14 ± 4. 28) vs (55. 23 ± 7. 15) mL,(17. 92 ± 2. 12) vs (29. 64 ± 4. 28) mL]. The Cobb angle and residual urine volume,initial and strong urinary bladder capacity,maximum urinary output of observation group were significantly less than those of control group [(6. 12 ± 0. 68) vs(9. 78 ± 1. 21) mL,(241. 45 ± 28. 56) vs(335. 54 ± 36. 86) mL,(456. 56 ± 51. 78) vs (586. 35 ± 63. 12) mL,(63. 78 ± 7. 24) vs (96. 32 ± 10. 22) mL]. The intervertebral height of observation group was higher than that of control group [(12. 62 ± 2. 81) vs (8. 41 ± 1. 32) mm]. The excellent rate of observation group was significantly higher than that of control group(97. 50%vs 82. 50%). Conclusion Transpedicular vertebral osteotomy spine shortening is helpful to reduce operation wound, pro-mote postoperative recovery,correct kyphotic deformity and improve neurological functionin,improve therapeutic effect.

Objective To explore the relationships between serum adiponectin,IL-6 and hypoxic-ischemic encephalopathy(HIE) degree in newborn infant.Methods Enzyme-linked immunoabsorbent assay was used to detect the serum adiponectin and IL-6 in 58 neonatal HIE and 26 neonates without HIE.And all the data were processed by SPSS 10.0 software.Results The level of serum adiponectin in moderate and severe HIE at acute stage were significantly lower than that of mild and control groups(Pa0.05).The level of serum IL-6 in moderate and severe HIE at acute stage were significantly higher than that of the mild and control groups(Pa0.05).The level of adiponectin were significant negative correlation with IL-6(r=-0.852 P

Objective To review the experience of perioperative management and effect of valve replacement combined with renal dysfunction.Methods 536 cases of valve replacement.According to preoperative glomerular filtration rate(GFR),renal dysfunction was classified as normal in 322 cases,mild in 162,moderate in 40 and severe in 12.Logistic regression analysis was used to assess the effect of preoperative renal dysfunction on operative mortality and morbidity.Results Patients with a lower GFR were older and more likely to have hypertention.They also tended to have larger left ventricular end-diastolic diameter and worse left ventricular ejection factor.Operative mortality rose inversely with declining renal function,from 2％ for those with normal renal function to 17％ for patients with severe renal dysfunction.Renal dysfunction was significantly associated with a large blood transfusions,re-intubation,longer mechanical ventilation,intensive care unit stay and hospital stay.Conclusion Preoperative renal dysfunction is an important factor of postoperative mortality and morbidity for valve replacement.We must pay more attention to perioperative management.

OBJECTIVETo explore the scavenging action of tenuigenin (TEN) on intracerebral amyloid β protein (Aβ) aggregation and the abnormal phosphorylated tau protein and its mechanism in Alzheimer's disease (AD) rats' brain.

METHODSAβ1-40 was injected into the right CA1 region hippocampus to establish the AD model. Successfully modeled rats were divided into the model group, the low, middle, high TEN group. Rats were administered with TEN (18.5, 37.0, 74.0 mg/kg) by gastrogavage. Besides, a sham-operation group was set up. Expression levels of Aβ1-40 and Tau p-Ser262 were detected by immunohistochemistry. Expression levels of ubiquitin (Ub) and Ub-protein ligase E3 were measured by Western blotting.The content of 26S proteasome was detected by ELISA.

RESULTSImmunohistochemical results showed that the number of Aβ and Tau p-Ser262 positively reacted neurons significantly increased in model group, when compared with the sham-operation group (P < 0.01). Results of Western blot showed expression levels of ubiquitinated protein were up-regulated and those of Ub-protein ligase E3 were down-regulated in the model group (P < 0.01). ELISA results showed that the content of 26S proteasome significantly decreased in AD rats' brain (P < 0.01). Compared with the model group, expression levels of Aβ1-40, Tau p-Ser262, and Ub significantly decreased; expression levels of Ub-protein ligase E3 apparently increased; the content of 26S proteasome significantly increased in each TEN treatment group (P < 0.05, P < 0.01). Best effect was shown in 37.0 mg/kg and 74.0 mg/kg TEN groups.

CONCLUSIONSUb proteasome pathway (UPP) participated in the occurrence of AD. TEN could obviously reduce intracere- bral Aβ1-40 accumulation and abnormal tau phosphorylation.

Alzheimer Disease ; metabolism ; Amyloid beta-Peptides ; Animals ; Drugs, Chinese Herbal ; pharmacology ; Hippocampus ; metabolism ; Neurons ; metabolism ; Phosphorylation ; Proteasome Endopeptidase Complex ; metabolism ; Rats ; Ubiquitin-Protein Ligases ; metabolism ; Ubiquitins

OBJECTIVETo investigate the expression of transcription factors (TF) T-bet and GATA-3 mRNA in peripheral blood mononuclear cells and its correlation with immune status in esophageal cancer patients.

METHODSSixty patients were divided into two groups according to the clinical data: group A consisting of stage I and II, group B including stage III and IV. The gene expression of T-bet and GATA-3 in 60 esophageal cancer patients and 30 healthy controls was detected by reverse transcription-polymerase chain reaction (RT-PCR). The expression of IFN-gamma and IL-4 was measured by enzyme linked immunosorbent assay (ELISA).

RESULTSExpression of T-bet mRNA in esophageal cancer patients (stage I and II: 0.27 +/- 0.05 ng/L, stage III and IV: 0.12 +/- 0.02 ng/L) was significantly lower than that in the healthy controls (1.35 +/- 0.14 ng/L), but the expression of GATA-3 mRNA in esophageal cancer patients (stage I and II: 0.45 +/- 0.06, stage III and IV: 0.55 +/- 0.03) was significantly higher than that in the healthy controls (0.09 +/- 0.10). The plasma level of Th1 cytokine IFN-gamma in the patients [stage I and II: (12.12 +/- 1.48) ng/L, stage III and IV: (8.44 +/- 0.90) ng/L] was significantly lower than that in the healthy controls, while the level of Th2 cytokine IL-4 in the patients [stage I and II: (18.64 +/- 0.77) ng/L, stage III and IV: (25.28 +/- 2.02) ng/L] was significantly higher than that in the healthy controls. However, neither in the expression of T-bet and GATA-3, nor in the plasma level of IFN-gamma and IL-4, showed a significant difference between group A and B.

CONCLUSIONIn the peripheral blood of esophageal cancer patients, the expression of T-bet decreased, while GATA-3 increased, Th1/Th2 balance is broken, and the Th2 is dominant. T-bet and GATA-3 play a part role in the regulation of Th1/Th2 balance.

Adult ; Aged ; Aged, 80 and over ; Enzyme-Linked Immunosorbent Assay ; Esophageal Neoplasms ; immunology ; metabolism ; pathology ; Female ; GATA3 Transcription Factor ; genetics ; metabolism ; Humans ; Interferon-gamma ; blood ; Interleukin-4 ; blood ; Leukocytes, Mononuclear ; metabolism ; Male ; Middle Aged ; Neoplasm Staging ; RNA, Messenger ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; T-Box Domain Proteins ; genetics ; metabolism ; Th1 Cells ; metabolism ; Th2 Cells ; metabolism

Atractylodis Macrocephalae Rhizoma and Atractylodis Rhizoma were widely used in strengthening spleen under different disease conditions, and were easily and often misused each other. Therefore, DNA barcode was used to distinguish Atractylodis Macrocephalae Rhizoma and Atractylodis Rhizoma from their adulterants to ensure the safe use. The sequence lengths of ITS2 of Atractylodes macrocephala, Atractylodis Rhizoma (A. lancea, A. japonica and A. coreana) were both 229 bp. Among the ITS2 sequences of A. macrocephala, only one G/C transversion was detected at site 98, and the average GC content was 69.42%. No variable site was detected in the ITS2 sequences of A. lancea. The maximum K2P intraspecific genetic distances of both A. japonica and A. coreana were 0.013. The maximum K2P intraspecific genetic distances of A. macrocephala, A. lancea, A. japonica and A. coreana were less than the minimum interspecific genetic distance of adulterants. The ITS2 sequences in each of these polytypic species were separated into pairs of divergent clusters in the NJ tree. DNA barcoding could be used as a fast and accurate identification method to distinguish Atractylodis Macrocephalae Rhizoma, Atractylodis Rhizoma, from their adulterants to ensure its safe use.
Atractylodes ; classification ; genetics ; DNA Barcoding, Taxonomic ; methods ; DNA, Plant ; genetics ; DNA, Ribosomal Spacer ; genetics ; Drug Contamination ; prevention & control ; Drugs, Chinese Herbal ; chemistry ; classification ; Molecular Sequence Data ; Phylogeny ; Quality Control ; Rhizome ; classification ; genetics