BACKGROUND:Analgesia in different ways can be selected for the elderly in hip and knee arthroplasty. Considering the actual situation of the elderly patients, choice of anesthesia should be reasonable in order to achieve fast acting, long lasting time and good analgesic effect. OBJECTIVE:To explore the analgesic effect of ropivacaine of lumbar epidural anesthesia on elderly knee arthroplasty. METHODS:A total of 78 elderly patients aged 80-96 years, who were treated with hip and knee arthroplasty in the Shenyang Orthopaedic Hospital from September 2011 to September 2014, were enrol ed in this study. They were equal y and randomly assigned to control group and observation group, and separately administered continuous epidural anesthesia and lumbar epidural anesthesia with ropivacaine. The excel ent and good rate, onset time, anesthetic induction, frequency of use of Duffing mixture, and adverse reactions were compared between the two groups. RESULTS AND CONCLUSION:The excel ent and good rate of analgesic effect was higher in the observation group (97%) than in the control group (87%) (P<0.05). Onset time was significantly shorter, the dose of anesthetic was significantly less, frequency of use of Duffing mixture was significantly less in the observation group than in the control group (P<0.05). The difference was not significant in adverse reactions between the two groups (P>0.05). Above results indicated that lumbar epidural anesthesia of ropivacaine obtained good analgesic effects during elderly knee arthroplasty.

Objective To investigate the efficacy of laparoscopic surgery for intestinal atresia in neonates.Methods A perspective study,from February 2002 to November 2006,a series of 61 newborns with intestinal atresia were randomly divided into laparoscopic and open surgery groups.The intra-and post-operative records of the two groups were compared.Results The survival rate and postoperative complications of the two groups were similar (29/31 vs 28/30,x~2=0.001,P=0.973;and x~2=1.298,P= 0.862).In the laparoscopic group,the intestine was pulled out through the umbilical trocar and then resected;the umbilical area was normal after intestinal anastomosis;no scars or only small scars were observed on the abdomen after the operation.The two groups were followed up for 6 to 18 months.During the period,3 patients showed enterocolitis (2 in the laparoscopic group and 1 in the open surgery group);3 patients developed adhesive intestinal obstruction (1 in the laparoscopic group and 2 in the open surgery group), both the complications were cured by conservative therapies.Conclusions Laparoscopic surgery is simple,safe,and effective for intestinal atresia in newborn.

Objective To explore a suitable mode of prenatal ultrasound diagnosis of fetal malformations with early neonatal surgical treatment. Methods Nine fetus with surgical malformations diagnosed prenatally by ultrasound in our hospital from Mar. 1998 to Dec. 2000 were analysed. Results There were two cases diagnosed in the second trimester, 7 in the third trimester, including 1 duodeneal atresia with annular pancreas, 1 abdominal wall defect, 1 congenital diaphragmatic hernia, 1 huge omphalocele, 1 high imperforate anus, 4 hydronephrosis (2 mild and 2 severe). Six cases were operated in neonatal period, two were treated conservatively, and one did induced abortion. All cases recovered except 1 death. Conclusions The mode of prenatal ultrasound diagnosis with surgery in early neonatal period is a suitable way in China before the fetal surgery is applied. It is important to make effort to increase sensitivity of sonographic diagnosis of fetal malformation and to get early treatment in perinatal period.

Objective To investigate the expression and clinical significance of H1 receptor in kidney and bladder tissue of rats after long term ketamine intraperitoneal injection.Methods This study was conducted from May 2012 to December 2012.Sixty male 2-month-old SD rats,weighted (200±10) g,were randomly divided into Group A and Group B.Each group concluded 30 rats.In the Group A,Ketamine (100 mg/kg) was given as intraperitoneal injection every other day,while normal saline (100 mg/kg) was given in Group B.The dosage was adjusted every week according to the weight of rats.After 2,4 and 6 months,10 rats from each group were randomly chosen.First,the micturition number during 2 h was recorded.Then,urine samples over a 24 h period were collected and the content of Na+ and K+ were determined.Finally,the blood samples were obtained from the apex of heart for the creatinine determination.The kidneys and bladders were harvested after the rats were sacrificed.HE staining was conducted on all the tissues.Immunohistochemical S-P method was used to detect the expression of H1 receptor in the bladder and kidney tissues from Group A and Group B.The average optical density (A Value) in each group was separately calculated by Imagepro-plus 6.0 software.All the parameters,mentioned above,were carefully compared.Results The successive rate of establishing rats model was 90％ (9/10),according to the pathological result after 6 months injection.The urine volume of 24 h in group A and B were (15.9±1.3) and (10.1±0.8) ml,respectively.Micturition frequency during 2 hours in group A and B were (6.9±1.4) and (3.0±0.5) times.The urine volume of 24 h and micturition frequency during 2 hours were significantly increased in group A (P＜ 0.05).The urine sodium within 24 h in group A was (1.7±0.1) mmol,which is increased significantly than that in group B (1.0±0.1 mmol).While the urine potassium was less in group A (1.1±0.1 mmol/d) than in group B (2.6±0.1 mmol/d) (P＜0.05).But the serum creatinine level were (60.5±6.8) and (58.1± 3.9) μmol/L in group A and B,which had no difference between the two groups (P＜0.05).The expression of H1 receptor in kidneys and bladder in group A was significantly raised compared with group B (P＜0.05).In the group A,the expression of H1 receptor level in kidney was 0.008±0.001,0.016±0.001,0.023±0.004 after 2,4 and 6 months drug used.The expression level in group A were significantly difference than that in group B (0.003±0.001,0.004±0.002,0.003±0.001) (P＜0.05) and goes up with prolonging the drug using.While in the bladder tissue,the level of H1 receptor expression was 0.017±0.006,0.031±0.012,0.036±0.007 in group A and 0.015±0.007,0.016±0.005,0.016±0.004 in group B,which could be noticed a significantly increasing in group A (P＜0.05).In 4 and 6 months,the H1 receptor expression level significantly raised than that in 2 months (P＜0.05).Conclusions Long term ketamine addiction exerts toxicity not only on the bladder but also on the kidney.The increased expression of H1 receptor in rats' kidney and bladder tissues of group A indicates that H1 receptor may be related to the ketamine-associated urinary system dysfunction.The urine sodium and potassium within 24 h may be a sensitive index for the assessment of degree of kidney damage in the early stage of ketamine-induced dysfunction than serum creatinine.

Acupuncture Therapy ; Administration, Inhalation ; Aged ; Aged, 80 and over ; Cerebral Infarction ; drug therapy ; therapy ; Combined Modality Therapy ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Male ; Middle Aged ; Oxygen Inhalation Therapy

ObjectiveTo investigate the expression of heme oxygenase-1 (HO-1) in lung tissue of mice with acute paraquat poisoning, and discuss its pathological mechanism.Methods Fifty-eight healthy male mice were randomly divided into control group (n = 8) and poisoned group (n = 50). The mice in poisoned group were lavaged with 20% paraquat (50 mg/kg), and those in control group with equal amount of normal saline. The mice were sacrificed on the day of experiment in control group, and those in poisoned group at 6 hours and 1, 3, 7, 14 days after poisoning. The lung tissue was harvested to observe the changes in pathology of lung with hematoxylin and eosin (HE) staining. The positive expression of HO-1 was determined with immunohistochemistry, and the protein expression of HO-1 was determined with Western Blot. The contents of superoxide dismutase (SOD) and malonaldehyde (MDA) were determined.Results The mice showed shortness of breath and signs of exhaustion 1 hour after poisoning, getting worse on 3-5 days, but returned to normal 14 days after poisoning. Under the light microscope, it showed that the control group had no significant pathological changes in lung tissue. One day after the ingestion, pulmonary alveolar structure disorder, obvious hemorrhage, edema and infiltration of inflammatory cells were found. At 3 days, the pathological changes in the lung tissue were more pronounced. They were less pronounced on 7 days, and inflammatory changes disappeared on 14th day, but alveolar structure disorder remained. Immunohistochemical test showed that HO-1 was seldom expressed in the lung tissue, and a little amount was expressed in the mucosal epithelial cells of the airway in control group. It was shown that inflammatory cell and endothelial were mainly distributed in the mucosal epithelial cells of airway 1 day after poisoning followed by a gradually decrease tendence, and came to normal level of control group 7 days after poisoning. It was shown by Western Blot that HO-1 (gray value) in lung tissue increased 6 hours after poisoning (2.438±0.467 vs. 0.475±0.167,P< 0.01), peaked at 1 day (9.200±0.940 vs. 0.475±0.167,P< 0.01), continued to increase till 7 days after poisoning, and it lowered to normal level thereafter (0.825±0.260 vs. 0.475±0.167,P> 0.05). The SOD activity (μU/L) in lung tissue was lowered 6 hours after poisoning, and it was significantly lower than that of control group (649.681±13.951 vs. 1 167.051±15.744,P< 0.01), and it continued to decrease up to 14 days after poisoning (859.733±121.079 vs. 1 167.051±14.744,P< 0.01). MDA content (μmol/L) in the lung tissue homogenate was elevated 6 hours after poisoning with significant difference compared with that of the control group (4.542±0.266 vs. 3.705±0.176,P< 0.01). It peaked on day 1 (5.956±0.281 vs. 3.705±0.176,P< 0.01), then it declined and reached normal level 3 days after poisoning (4.134±0.168 vs. 3.705±0.176,P> 0.05).Conclusion HO-1 expression was increased significantly in lung tissue of mice with acute paraquat poisoning, which may be considered as an important protection mechanism against paraquat poisoning.

Objective To investigate the role of PI_3 K/Akt signal pathway in Ephrin-Al gene mediated invasion,metastasis of Huh-7 cells.Methods Western blot was used to test the protein expression of phosphatidylinositol 3-kinase(PI_3 K)and mitogen-activated protein kinase(MAPK)after Huh-7 cells were treated with Ephrin-A1/Fc fusion protein.According to the protein expression,LY294002 was used to block PI_3 K/Akt pathway specifically,then p-Akt protein expression,mobility and invasive ability of Huh-7 cells were examined.Results In Huh-7 cells actived by Ephrin-Al/Fc fusion protein,p-Akt expression was higher than that in control group(t=4.564,P＜0.05),but there was no difference of p-p38MAPK expression between Ephrin-Al/Fc fusion protein group and IgG/Fc fusion protein group(P＞0.05).PI_3 K/Akt pathway was specifically blocked by LY294002,the p-Akt protein expression decreased in Huh-7 cells,and the mobility and invasive ability mediated by Ephrin-Al in Huh-7 cells decreased(P＜0.05).Conclusions PI_3 K/Akt pathway effects an important role in mobility and invasive ability of Huh-7 cells mediated by Ephrin-A1.

Objective To investigate the expression and clinical significance of four histamine receptors:H1R, H2R, H3R and H4R in urinary bladder of patients with ketamine-induced cystitis. Methods Immunohistochemical S-P method was used to detect the expression levels of histamine receptors:H1R, H2R, H3R and H4R in bladder tissues of 10 patients with ketamine-induced cystitis (experimental group) and distal tissue away from bladder tumors of 10 patients with cystectomy (control group). The average optical density (OD) values of four kinds of different histamine receptors were separately calcu-lated by Imagepro-plus 6.0 in two groups. At the same time, mast cells were marked by toluidine blue special dyeing and were counted. Results Comparing with control group, the expression levels of H1R, H2R, and H4R were significantly in-creased in experimental group (P＜0.05). Mast cells diffused interstitial bladder infiltrates (P＜0.05). There was no signifi-cant difference in the expression of H3R in two groups. Conclusion Mast cells, H1R, H2R, and H4R are closely related to the ketamine-induced cystitis, which may be new diagnostic indicators and new treatment targets of ketamine-induced cysti-tis.

BACKGROUND: With an aging population increasing, the incidence of senile femoral intertrochanteric fractures is on a rise because of osteoporosis. Due to the aged usually accompanied with systematic diseases, conservative treatment will lead to high mortality after long-term bedridden. Thereafter, early surgery is recommended. OBJECTIVE: To investigate the incidence of femoral intertrochanteric fractures and its epidemiological features. METHODS: The digital radiography data and basic information of 179 patients (over 50 years of age) with femoral intertrochanteric fractures admitted in the General Hospital of Tianjin Medical University from 2013 to 2015 were analyzed retrospectively. The data including age, gender, injury causes, fracture types, complications, treatment procedures, and hospitalization time were recorded and compared. RESULTS AND CONCLUSION: All the 179 cases of femoral intertrochanteric fractures were enrolled, including 66 (36.9%) males and 113 (63.1%) females. The mean age was (76.98±9.73) years, and the number of patients aged 80-90 years was the most (n=71, 39.7%). With the age increasing, the incidence of fall-induced hip fractures was increased. By AO classification, type 31-A1 was the most common fracture type (46.4%), and type 31-A3 was the least common type (22.9%). By Evans classification, type I was the most common type (50.3%), and type V was the least common type (2.2%). There were 93.3% patients underwent surgical treatment (167/179), and 6.7% received conservative treatment (12/179). In the age group of 51-60 years, the male patients were more than females; in the age group 61-70 years, the male patients were more than females except in 2013; in the age groups of 71-80, and 81-90 years, the female patients were more than males; in the age group of over 90 years, there was no significant difference between female and male patients. These results manifest that the majority of hip fracture patients are the elderly, and slipping and osteoporosis are the leading causes. In spite of accumulating operative risks with aging, surgical treatment remains the predominant management strategy. Besides, the incidence of femoral intertrochanteric fractures shows a trend of increase yearly, with the highest incidence in the age group of 71-90 years, especially in females.

BACKGROUND: Decrease of regional cerebral blood flow (rCBF) perfusion of different degree exists in depressive patients, but the decreased ranges were different, different cerebral cortical and subcortical regions are involved.OBJECTIVE: To observe the types of abnormal rCBF perfusion in patients with depressive disorder.DESIGN: A diagnosis-based case-control analysis.SETTINGS: Department of Nuclear Medicine, Ruijin Hospital Affiliated to the Medical College of Shanghai Jiaotong University; Staff Room of Biomedical Engineering, Medical College of Shanghai Jiaotong University;Putuo District Mental Health of Shanghai City.PARTICIPANTS: The patients with depressive disorder were selected from the Putuo District Mental Health Center from January 1999 to December 2000, and 19 normal subjects matched by age were selected from the medical staff of the hospital as normal controls.METHODS: The patients with depressive disorder and healthy subjects were examined by single photon emission computerized tomography (SPECT), ethyl cysteinate dimmer (99Tcm-ECD) was performed, and the images were analyzed with the statistical parametric mapping (SPM). All the SPECT images were converted into DICOM format or ANALYZE-7 format at first, and then the images were standardized by taking MRI template as the template and smoothed, and the significantly different regions were evaluated by the statistical analysis and inferences with the Gaussian random theory.MAIN OUTCOME MEASURES: The differences of the cerebral blood flow perfusion in specific region and the changes of average rCBF images were mainly observed in the depressive disorder group and normal control group.RESULTS: All the 12 patients with depressive disorder and 19 normal healthy subjects entered the analysis of results. The SPM showed that the blood flow perfusion was decreased in bilateral frontal lobes, left superior temporal gyrus, left Brodmann area 20, left mamillary body of thalamus,right cingulated gyrus and right putamen in the patients with depressive disorder. The blood flow perfusion was increased in the right central frontal gyrus, right superior temporal gyrus, right occipital lobe and left central frontal gyrus.CONCLUSION: The rCBF is obviously changed in the frontal lobe, temporal lobe and limbic system of patients with depressive disorder.