Objective To investigate the clinical features and strategy of diagnosis and treatment of the abdominal trauma in eld er people. Methods Clinical data of 68 elderly patients w ith abdominal trauma were analyzed retrospectively.Results Diagnosis in 35 of 68 cases were confir med within 12 hours after trauma (51.5%). Fifty-eight cases in this group were treated surgically and 10 cases with non-surgical treament.The re were 7 death, the overall mortality was 10.3% . The cause of death was septic shock and multiple organ systemic failure. Conclusion The elder patient with abdominal tra uma has its speciality in clinical and pathophysiological characteristics and is less tolerant to trauma, which easily leads to misdiagnosis or maldiagnosis. T he principle of treatment is to choose positive surgery, to streng then the peri operative management, to protect the function of each important organ, and to pr event the occurrence of multiple organ dysfunction syndrome.

Objective To investigate the hemostatic effect of balloon compression on the puncture site in cancer patients with peripherally inserted central catheter (PICC) inserted by ultrasound-guided modified Seldinger technique (MST). Methods Between October 2015 to January 2016, 50 cancer patients who accepted PICC inserted by ultrasound-guided MST were assigned into test group and control group respectively according to the admission time.Each group contained 25 cases. Balloon compression method was used to stop bleeding of the puncture point in the test group, while bandage compression hemostasis adopted in the control group. Results The incidence of bleeding on puncture site in the last 24 h of PICC placement was 28% (7/25) in the test group, while 68% (17/25) in the control group, and there were statistical differences between the groups (Z=-2.653,P<0.01). The incidence of bleeding on puncture site in 24-72 h of PICC placement was 16% (4/25) in the test group, while 36% (9/25) in the control group, and the difference had statistical significance (Z=-1.679,P>0.05). The incidence of limb swelling or numbness in the test group was 8% (2/25),which was lower than 32% (8/25) in the control group, and the difference had statistical significance (χ2=4.5,P < 0.05). Conclusions Balloon compression method can reduce the bleeding ratio of puncture site in cancer patients with PICC inserted by ultrasound-guided MST,and can relieve limb swelling or numbness .It is simple and safe in operation and can be easily accepted by the patients .

BACKGROUND:Acute toxicity in vivo experiments in previous studies has been confirmed that the median lethal dose of chitosan microcapsules is higher than 2 000 mg/kg, but the specific pathogenic mechanism is unclear.
OBJECTIVE:To explore the influence of nano chitosan on MC3T3-E1 cellgrowth as a bone substitute material, as wel as the physiological function of rats.
METHODS:MC3T3-E1 cells were respectively cultured in Dulbecco’s modified Eagle’s medium with different concentrations of chitosan nanoparticles (0, 10 mg/L, 100 mg/L, 1 g/L, 10 g/L). The absorbance values were determined. Changes in MC3T3-E1 cellmorphology were observed by scanning electron microscope after 24 hours culture. 10 g/L nano chitosan suspension was prepared using PBS. Two different doses of nano chitosan suspension (166.67 and 16.67 mg/kg body weight) with PBS were injected intraperitoneal y into Sprague-Dawley rats, three times a week, for 4 weeks. The control group was injected with equal volume of physiologic saline. Serum biochemical markers were detected to analyze the functions of liver and kidney of rats. Moreover, histopathology slices were observed to evaluate the morphological changes of tissue and inflammatory infiltration.
RESULTS AND CONCLUSION:10 mg/L, 100 mg/L, 1 g/L, 10 g/L nano chitosan suspensions were found growth inhibition in MC3T3-E1 cells as compared with the control group (P<0.05). The reunion of chitosan was observed in the cytoplasm of MC3T3-E1 cells by transmission electron microscopy. On the cellsurface, pseudopodia formed, wavy undulating membrane, nucleus degeneration, fragmentation and condensation were found. Compared with the control group, blood urea nitrogen, Na+levels were significantly increased in rats injected with nano chitosan suspension at two dosages, but the K+level in the high concentration group was decreased significantly (P<0.05). cellapoptosis was found in the liver and renal tissue in a dose-dependent manner. It suggests that apoptosis may be the possible mechanism of nano chitosan toxicity, and normal physiological function may be impacted over a certain dose.

Objective To explore the risk factors and treatment of crush syndrome comlicated in earth-quake injury. Method The demographics and epidemiological characteristics, clinical treatment and the outcome of 35 cases with crush syndrome were reviewed and analyzed.The 35 patients were among 325 victims of "5·12" Wenchuan earthquake, who were admitted in Sichuan Provincial People's Hospital, Chengdu. Results Of 35 pa-tients with crush syndrome, 7 cases injured at forearm, 25 cases injured at cruse, and 3 cases injured at palm,and 3 cases were complicated with acute renal failure. The time from the occurrence of injury to transporting patients into the hospital was 6～92 hours, with mean time 49.3 hours. All the 35 patients had their wound cut open for de-compression,and 6 cases were cured, 2 had dysfunction, and 27 underwent amputation. Young patients under 14 years old had higher rate (25.8%) of crush syndrome than elder patients of 14～59 years old with rate of 8.0%.And patients admitted into hospital later (over 48 hour after injury) had higher incidence of crush syndrome (31.0 %) than those admitted earlier within 48 hours after injury (3.5 %). Conchusions Attaching great impor-tance to crush syndrome after earthquake injury, early diagnosis and treatment, and timely and complete surgical decompression are key points to the successful treatment and prevention of crush syndrome complicated in earth-quake injury. Because the longer interval between injury and rescue, delayed diagnosis and treatment, and the younger age of patients are all the risk factors of crush syndrome.

Objective To evaluate the effect of morphine on the growth of subcutaneous tumor of human gastric cancer cells in nude mice.Methods Thirty SPF male BALB/C nude mice,aged 4-5 weeks,weighing 15-20 g,in which the model of subcutaneous tumor of human gastric cancer cell line MGC-803 was established,were randomly divided into 3 groups (n=10 each) using a random number table:control group (group C),normal saline group (group N),and morphine group (group M).The mice in group C received no treatment.Morphine 20 mg/kg was intraperitoneally injected once a day for 14 consecutive days in group M,while normal saline 1.5 ml/kg was given instead of morphine in group N.The caliper was used to measure the tumor size every 2 days starting from 3 days after beginning of administration,and the relative tumor volume was calculated.The nude mice were sacrificed on 15th day,and the tumor tissues were obtained for determination of nuclear factor-kappa B activity and Bcl-2 and Bax protein and mRNA expression by real-time reverse transcriptase polymerase chain reaction and Western blot.Results Compared with group C,the relative tumor volume was significantly decreased,the activity of nuclear factor-kappa B in tumor tissues was significantly decreased,the expression of Bcl-2 protein and mRNA was significantly down-regulated,and the expression of Bax protein and mRNA was significantly up-regulated at each time point in group M (P＜0.05),and no significant change was found in each parameter mentioned above in group N (P＞0.05).Conclusion Morphine can inhibit the growth of subcutaneous tumor of human gastric cancer cells in nude mice,and the mechanism is associated with promotion of apoptosis in tumor cells.

Objctive:To investigate the immunohistochemical and morphological characteristics of the papillary thyroid microcarcinoma(PTM) ,and differential diagnosis of the related disease.Methods:The morphological characteristics of 223 patients with PTM were observed under light microscope.Seventy-four cases of PTM and 32 cases of proliferative lesion of thyroid were observed under light microscope with stains of hematoxylin and eosin and immunohistochemical staining.The antibody included CK19,MC,Galectin-3 and CD56.Results:Eighty-six cases were follicular-patterned and 31 cases nuclear features were untypical in 223 cases of PTM.The positive expression rates of CK19、MC、 Galectin-3、CD56 were 100.0%,98.6%,98.6% and 4.1% in 74 cases of PTM,and were 37.5%,12.5%,18.8%,68.8% in proliferative lesion of thyroid,respectively.Conclusion:Some cases of PTM show a follicular-patterned and the nuclear features.It is untypical compared with classical papillary thyroid carcinoma.It can be differentiated from proliferative lesion with absence of envelope,obviously various and unusually proliferated follicular cells,sclerotic stroma,neoplastic follicles among the collagen and normal follicles.The wide and intensive expression of CK19,Galectin-3,and the negative expression of CD56 are extremely useful in the diagnosis of PTM,four-marker panel with CK19,Galectin-3,MC and CD56 can improve the specificity and accuracy of the differential diagnosis of PTM.

Objective To evaluate the effect of dexmedetomidine on the activity of glycogen synthase kinase-3 beta (GSK-3β) during propofol-induced apoptosis in hippocampal nerve cells of newborn rats.Methods Sixty male 7-day-old Sprague-Dawley rats,weighing 10-15 g,were divided into 6 groups (n=10 each) using a random number table:normal saline group (group NS),fat emulsion group (group F),propofol group (group P) and different doses of dexmedetomindine groups (group D25,group D50 and group D75).Normal saline and fat emulsion 100 μl were injected intraperitoneally in group NS and group F,respectively.In group P,propofol 50 mg/kg was intraperitoneally injected,and an increment of propofol 50 mg/kg was added after righting reflex completely recovered,with the total amount of 100 mg/kg.In group D25,group D50 and group D75,dexmedetomidine 25,50 and 75 μg/kg were intraperitoneally injected,respectively,and 30 min later propofol 100 mg/kg was administered.At 2 h after emergence,the rats were sacrificed,their brains were removed for determination of apoptosis in hippocampal nerve cells (by TUNEL),and the hippocampi were isolated for detection of the expression of GSK-3β and phosphorylated GSK-3β (p-GSK-3β) by Western blot analysis.The apoptosis index (AI) and ratio of p-GSK-3β/GSK-3β were calculated.Results Compared with group NS,AI was significantly increased,the expression of p-GSK-3β was down-regulated,and the p-GSK-3β/GSK-3β ratio was decreased in P,D25,D50 and D75 groups (P＜0.05).Compared with group P,AI was significantly decreased,the expression of p-GSK-3β was up-regulated,and the p-GSK-3β/GSK-3β ratio was increased in D25,D50 and D75 groups (P＜0.05).Compared with group D25,AI was significantly decreased (P＜0.05),and no significant change was found in the expression of p-GSK-3β or ratio of p-GSK-3β/GSK-3β in D50 and D75 groups (P＞0.05).Compared with group D50,AI was significantly decreased (P＜0.05),and no significant change was found in the expression of p-GSK-3β or ratio of p-GSK-3β/GSK-3β in group D75 (P＞0.05).Conclusion The mechanism by which dexmedetomidine attenuates propofol-induced apoptosis in hippocampal nerve cells may be related to inhibition of GSK-3β activity in newborn rats.

Objective:To describe the secular trends of premarital medical examination ( PME ) in China during 1996 and 2013 and to assess the impacts of national health policies on the PME rate. Methods:The information on marriage and PME for districts and counties in 31 provinces of China was annually collected by the Office for National Maternal & Child Health Statistics of China, and the infor-mation on the health policies was from official governmental websites. According to the main health poli-cies, the calendar years were categorized into 3 periods:1996 to 2003 was mandatory PME period;2004 to 2008 was encouraged voluntary PME period; and 2009 to 2013 was free-paid voluntary PME period. Results: During the 18-year period, 284 242 719 people were registered for a marriage in which 107 198 795 were examined, giving the PME rate of 37. 7%. During the mandatory PME period, the rate ranged 52 . 7% -67 . 7% with an average of 60 . 9% ( urban 71 . 5%, and rural 51 . 7%) . In 2004 , the first year when the PME became voluntary, the rate was abruptly dropped to 2. 6%, and thereafter gradually increased to 11 . 5% in 2008 . As the policies of the free-paid voluntary PME were subsequently issued, the rate was quickly increased to 52. 3% (urban 49. 8%, and rural 54. 6%) in 2013. The in-creasing trend was consistently observed both in urban and rural areas, and across East, Middle, West, and Northeast economical regions. However, the rates differed greatly among provinces. In 2013, 5 pro-vinces had rates of >90% ( Guangxi 97 . 5%, Fujian 96 . 0%, Ningxia 95 . 4%, Zhejiang 93 . 4% and Anhui 90. 1%), whereas some provinces were stuck at a low rate, including developed and underdeve-loped provinces/cities. The PME rate in 2013 was 27. 4% for Shanghai, 25. 5% for Guangdong, 12. 4%for Chongqing, 5. 8% for Beijing and 4. 6% for Tianjin. Underdeveloped provinces were Guizhou (6. 4%) and Qinghai (1. 8%). Conclusion:As various national policies to promote voluntary PME were issued, the PME rate was significantly increased after a sharp decline, though it varied greatly by provinces. For provinces with high PME rate, PME-related health benefits need to be evaluated;for provinces with low rate, it is of important practical significance to explore a cost-effective health service model that is likely incorporated with pre-pregnancy examination.

Objective To explore the effect of dexmedetomidine on phosphoinositide 3-kinase/protein kinase B (PI3K/Akt ) pathway in hippocampus of propofol anesthetized neonatal rats. Methods Eighty Sprague-Dawley male rats,aged 7 days,weighing 10-1 5 g,were randomly divided into 8 groups (n= 10 each):normal saline group (group N),DMSO group (group D),intralipid group (group I),propofol group (group P),dexmedetomidine 25 μg/kg,50 μg/kg and 75 μg/kg +propofol 100 mg/kg groups (groups PD25 ,PD50 and PD7 5 ),LY294002 25 μg + dexmedetomidine 75μg/kg + propofol 100 mg/kg group (group LYPD).The hippocampus of rats in all groups were taken 2 h after the animals fully awake.The ultrastructure of hippocampal neurons was observed by transmission electron microscope.The pAkt-(ser473 )protein and Akt protein in the hippocampus were evaluated by Western blot analysis.Results There was no significant difference in the expression of Akt protein among the eight groups.Compared with group N,the expression of pAkt (ser473)protein was significantly down-regulated in groups P,PD25 ,PD50 ,PD7 5 and LYPD (P <0.05).Compared with group P,the expression of pAkt (ser473)protein was increased significantly in groups PD7 5 and LYPD (P <0.05).Compared with group PD7 5 ,the expression of pAkt (ser473) protein was significantly down-regulated in group LYPD (P <0.05 ).The structure of hippocampal neurons was normal in groups N,I and D.Nuclear nuclei swelling,chromatin decreasing and mito-chondrion vacuolar degeneration were observed in group P while improved gradually with dexmedeto-midine in a dose-dependent manner in groups PD25 ,PD50 and PD7 5 .Neurons karyopyknosis,partial dissolution of nuclear membrane,chromatin condensation,mitochondria vacuolar degeneration were observed in group LYPD.Conclusion Dexmedetomidine pretreatment provides neuroprotection against propofol-induced hippocampal destruction by preserving PI3K/Akt pathway activity in the de-veloping brains.