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 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.

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 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 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 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.

BACKGROUND:At present,autogenous periosteum and artificial dura mater are usually applied as the substitute grafts for the dural defect by neurological surgery.However they do not accord with the developing trend of modern medicine,due to the limitations of material size and shape,operational complex and additional wound.OBJECTIVE:To observe and compare the evolution of a new type bio-artificial dura and autogenous periosteum in replacing orthotopic duraDESIGN:Controlled observation and trial.SETTING:Animal Testing Center in the 157 Hospital of Guangzhou City.MATERIALS:Nine New Zealand rabbits.aged 6 months and weighed 2-3 kg,either gender was selected.Twelve hybrid healthy dogs of both genders,aged 2 years and weighed 15-20 kg.New type dura mater(No.2006.3460627).METHODS:The experiment was carried out at the Animal Testing Center in the 157 Hospital of Guangzhou City from October 2003 to October 2005.After the general anesthesia and bilateral craniotomy,the bilateral dural defect and pia mater injury were induced partly,then dural neoplasty was performed using new type artificial dura and autogenous periosteum.MAIN OUTCOME MEASURES:At months 1,6,12 of modeling,each three rabbits were selected to isolate and expose the implanted materials,while each four dogs were selected at months 6,12,24 of modeling,died of disease or prior to death.General observation and microscopic assessment of samples were compared to analyze the development of implanted materials at difference stages.RESULTS:Except one experimental dog died during the anesthesia,9 rabbits and 11 dogs were involved in the final presented the extemal surface of adherence and separation with pedcranium,grew well with surrounding orthotopic dura.For the internal surface of materials,the new type artificial dura was more likely the orthotopic dura and did no adhere to pericranium, and filament-shaped adherence appeared occasionally, while there were filament-shaped even month 12 of grafting new type artificial dura into the experimental rabbits.inflammatory cellular reactions such as neutrophil and lymphocyte were not found,additionally no capsule wall formation occurred.The internal surface of artificial dura was covered with epithelial cells,which appeared fibroplasia,fibroblast proliferation,degradation of implants and obvious reduction of total cell amount.Moreover the blood capillary was also found.CONCLUSION:New type artificial dura can achieve the dural reconstruction through producing epithelial cells and being nibbled.degraded and substituted by autogenous tissue.And no adherence to cerebral tissues is found.New type artificial dura is superior to autogenous periosteum for repairing the dural defects.

ObjectiveTo investigate the relationship between ceruloplasmin expression and Down syndrome (DS). MethodsDifferential protein expression in serum of six mothers with DS fetuses and six mothers with healthy fetuses was detected by two-dimensional electrophoresis and matrix assisted laser desorption ionization-mass spectrum,the results were confirmed by Western blot.The levels of serum ceruloplasmin in 11 mothers with DS fetuses,10 mothers with healthy fetuses,11 DS newborns and 10 healthy babies were detected by enzyme-linked immunosorbent assay.The difference between the two groups was compared by two-independent samples t test. ResultsTwenty-nine differential proteins were found in the serum of the mothers with DS fetuses; among which ceruloplasmin increased significantly compared with that in mothers with healthy fetuese with density ratio of 5.43 (t=2.7102,P＜0.05).Western blot results showed that the expression of ceruloplasmin in maternal serum with DS fetuses (0.95 ± 0.24) was higher than that of normal mothers (0.37±0.14) (t=2.9521,P＜0.05) ; while the expression of ceruloplasmin in DS babies' serum (0.74±0.03) was lower than that of normal newborns (0.89±0.06)(t=-2.9515,P＜0.05).The expression of ceruloplasmin in serum of mothers with DS fetuses [(346.5± 111.8) ng/ml] was higher than that of normal mothers [(248.6478.3) ng/ml] (t=2.301,P＜0.05) ; while the expression of ceruloplasmin in DS babies' serum [(166.1 ±55.0) ng/ml] was lower than that of normal newborns [(244.0±36.0) ng/ml] (t=-3.873,P＜0.01). ConclusionsAbnormal maternal and neonatal serum ceruloplasmin level might relate to DS.

Objective To compare the efficacy of laryngeal mask airway-Advance (ALMA) and laryngeal mask airway-Supreme (S-LMA) in patients undergoing laparoscopic cholecystectomy.Methods Two hundred and forty ASA Ⅰ or Ⅱ patients,aged 18-64 yr,weighing 50-70 kg,undergoing laparoscopic cholecystectomy,were randomly divided into2 groups (n=120 each):group S-LMA (group S) and group A-LMA (group A).LMA was inserted after induction of general anesthesia with propofol 2.0-2.5 mg/kg,sufentanil 0.2 μg/kg and rocuronium 0.6 mg/kg.After LMA was placed,the rim was immediately inflated and positive pressure was applied to the reservoir bag of anesthesia machine circuit to check for leaks.The plateau pressure at which leaks occurred was recorded.BP,HR,SpO2,PErCO2 and Ppeak were monitored during operation.Fiberoptic bronchoscopy was performed and the placement was scored (0 =unable to see the vocal cords and the ventilation of the lungs was inadequate,4=vocal cords were clearly seen and ventilation was adequate).The rate of successful placement,placement time,the incidence of leaks during operation,duration of anesthesia and surgery,extubation time,emergence time,blood stain on the LMA after being removed,backflow after extubation and postoperatve complacations including sore throat,hoarseness and dysphagia were recorded.The efficacy for airway management and the difficulty of placement were scored.Results There was no significant difference in the rate of successful placement,difficulty of placement scores,blood stain on the LMA after being removed,incidence of backflow,sore throat,hoarseness and dysphogia,anesthesia time,duration of surgery,extubation time and emergence time between the two groups.The placement time was shorter in group S than in group A,but the airway sealing pressure,FOB scores and efficacy for airway management scores were significantly higher and the incidence of leaks during operation was significantly lower in group A than in group S.Conclusion Both A-LMA and S-LMA can provide adequate ventilation during laparoscopic cholecystectomy.The efficacy of A-LMA is better.