Objective To investigate the effect and safety of primary percutaneous coronary intervention (PCI) of acute ST-segment elevation myocardial infarction (STEMI) in elderly patients.Methods 103 consecutive patients with STEMI treated by primary PCI were divided into two groups according to the age:the elderly group [aged≥65 years,with a mean age of (75.7 ±6.2) years(n =49],the non-elderly group [aged＜65 years,with a mean age of (43.0±8.6) years(n =54].Clinical characteristics,complications related to PCI procedure and success rate were analyzed,and major cardiovascular events (MACE) were followed up for(5.7 ± 1.2) months.Results The proportion of female,patients with Killip ≥ Ⅲ,three vessels disease and higher level of serum brain natriuretic peptide were higher in elderly group than in non-elderly group (all P＜0.05).No significant difference was observed between the two groups in success rate and complications of PCI procedure (both P＞0.05).Patients were followed up for (5.7± 1.2) months.The in-hospital and one-month mortalities were higher in elderly group than in non-elderly group [8.2％ (4 cases)vs.0％ (0 case),10.2％(5 cases) vs.0 ％ (0 case),respectively,all P＜0.05].There was no significant difference in six-month mortality and MACE between the two groups.Multivariate logistic regression analysis showed that Killip ≥ Ⅲ was related with the increase of one-month mortality in patients with STEMI undergoing primary PCI,whereas age was not.Conclusions Primary PCI is effective and safe in elderly patients with STEMI.

OBJECTIVETo explore clinical efficacy of double Endobutto reconstituting coracoclavicular ligament combined with repairing acromioclavicular ligament in stage I in treating acromioclavicular dislocation with Rockwood type III - V .

METHODSFrom January 2010 to September 2013, 56 patients with Rockwood type III - V acromioclavicular dislocation were treated by operation, including 20 males and 36 femlaes, aged from 32 to 52 years old with an average of 38.5 years old. Twenty-five patients were on the left side and 31 cases on the right side. The time from injury to operation was from 3 to 14 days, averaged 7 days. All patients were diagnosed as acromioclavicular dislocation with Rockwood type III - V, and double Endobutto were used to reconstituting coracoclavicular ligament, line metal anchors were applied for repairing acromioclavicular ligament. Postoperative complications were observed, Karlsson and Constant-Murley evaluation standard were used to evaluate clinical effects.

RESULTSAll patients were followed up from 8 to 24 months with average of 11 months. According to Karlsson evaluation standard at 6 months after operation,42 cases were grade A, 13 were grade B and 1 was grade C. Constant-Murley score were improved from (42.80±5.43) before operation to (91.75±4.27) at 6 months after operation. All items at 6 months after operation were better than that of preoperative items. Forty-eight patients got excellent results, 7 were moderate and only 1 with bad result. No shoulder joint adhesion, screw loosening or breakage were occurred during following up.

CONCLUSIONDouble Endobutto reconstituting coracoclavicular ligament combined with repairing acromioclavicular ligament in stage I for the treatment of acromioclavicular dislocation with Rockwood type III - V could obtain early staisfied clinical effects, and benefit for early recovery of shoulder joint function.

Acromioclavicular Joint ; injuries ; surgery ; Adult ; Bone Plates ; Bone Screws ; Female ; Humans ; Ligaments, Articular ; injuries ; surgery ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; Shoulder Dislocation ; surgery ; Treatment Outcome

AIM: To study p42/p44 mitogen - activated protein kinases ( MAPK ) signal transduction pathway effect on vascular endothelial growth factor ( VEGF ) expression induced by elevated glucose concentration in cultured human retinal pigment epithelium ( hRPE) .
METHODS:hRPE cells were cultured and divided into four groups:normal glucose group (NG) (5. 6mmol/L), high glucose group ( HG1:15mmol/L D-glucose, HG2:20mmol/L D - glucose, HG3:30mmol/L D - glucose ), PD98059 group: hRPE cells were treated by an efficient and selective inhibitor PD98059 (20μmol/L) of p42/p44MAPK signal transduction pathway and solvent dimethyl sulfoxide group ( DMSO group) . The expression of VEGF and pigment epithelium derived factor ( PEDF ) mRNA was detected by RT-PCR. VEGF protein expression in cultured hRPE supernatants was detected by enzyme-linked immumosorbent assay ( ELISA) .
RUSULTS: VEGF mRNA and protein expression induced by elevated glucose concentration increased significantly. VEGF mRNA and protein expression were restrained in PD98059 group. Ratio of ( VEGF/β-actine)/( PEDF/β - actine ) in PD98059 group decreased significantly compare with that in high glucose group.
CONCLUSION: p42/p44MAPK signal transduction pathway might play a part in VEGF expression induced by elevated glucose concentration in cultured hRPE cells.

The diversity in Tibetan kefir grains and dynamics of the microbial community during the fermentation of Tibetan kefir by PCR-DGGE fingerprinting technique were studied.The results showed that bacterial community of Tibetan kefir grains was more complex than that of yeast.The bacteria communities between different Tibetan kefir grains showed 78%～84% similarity, and yeast 80%～92%.Bands B, E and N of DGGE profiles of the microbial community during fermentation of Tibetan kefir were present throughout the fermentation.Analysis of sequence date showed the majority of the DGGE bands of bacteria community corresponded to LAB, and the most intense band (band E) was completely homology to Lactococcus lactis.

BACKGROUND:The risk of lower extremity deep venous thrombosis was high in patients with bone metastases. Major surgery is a major risk factor for thrombosis. There was no standard prophylactic regimen available.
OBJECTIVE:To investigate the efficacy and safety of low molecular weight heparins versus rivaroxaban in the postoperative prevention of lower extremity deep venous thrombosis in patients with bone metastases.
METHODS:From January 2010 to December 2013, a total of 73 patients with bone metastasis in spine, pelvis and lower extremities, who underwent open surgery in the Department of Musculoskeletal Tumor, Third Hospital, Hebei Medical University, China, were retrospectively analyzed. The patients were divided into low molecular weight heparins group (n=41) and rivaroxaban group (n=32) according to the prophylactic drugs after surgery.
RESULTS AND CONCLUSION:Nine cases (22%) in the low molecular weight heparins group were found lower extremity deep venous thrombosis, and six cases (19%) in the rivaroxaban group suffered from lower extremity deep venous thrombosis, showing no significant differences (χ2=0.11, P=0.74). The incidences of bleeding events in both groups were respectively 7.32%and 6.25%, showing no significant differences (correctionχ2=0.083, P>0.05). There were no significant differences regarding the levels of platelet, activated partial thromboplastin time and prothrombin time between both groups preoperatively or postoperatively (P>0.05). Therefore, the efficacy and safety of low molecular weight heparins and rivaroxaban in the postoperative prevention of lower extremity deep venous thrombosis were similar. Both could effectively reduce the incidence of deep venous thrombosis, with a relative low risk of bleeding.

AIM:To investigate the role of microRNA-486-5p (miR-486-5p) in the apoptosis of human bone marrow mesenchymal stem cells (hMSCs) induced by hydrogen peroxide (H2O2).METHODS: The hMSCs were cul-tured in vitro and exposed to serum-free medium and H2O2(10 mmol/L).The changes of miR-486-5p expression in oxida-tive stress-related apoptosis of hMSCs were measured by real-time PCR.The hMSCs were transfected with miR-486-5p mimic or inhibitor at concentration of 30 nmol/L by Lipofectamine RNAiMAX.The effect of miR-486-5p on H2 O2-induced decrease in cell viability was evaluated by MTT assay.Hoechst 33342 staining and flow cytometry were applied to determine the role of miR-486-5p in the apoptosis of hMSCs.The protein expression was evaluated by Western blotting.Caspase-3 ac-tivity was determined using a caspase-3 activity kit.RESULTS:Compared with control group, the expression of miR-486-5p significantly decreased after treated with H2O2(P<0.05).In addition, over-expression of miR-486-5p in the hMSCs reduced the cell viability, accelerated apoptosis, down-regulated Bcl-2/Bax ratio, caspase-3 enzyme precursor content and phosphorylation of Akt, and activated caspase-3 activity.Conversely, down-regulation of miR-486-5p significantly inhibited H2 O2-induced cell apoptosis and the caspase-3 activity, increased cell viability and up-regulated Bcl-2/Bax ratio and phos-phorylation level of Akt.CONCLUSION:Over-expression of miR-486-5p promotes H2 O2-induced hMSCs apoptosis, and repression of miR-486-5p protects hMSCs from H2 O2-induced cellular apoptosis, which may be mediated by regulating Akt signaling pathway.

Objective To explore the value of multislice computed tomography (MSCT) in diagnosis of vascular rings associated airway abnormalities in children. Methods CT image data were retrospective analysis in 159 cases of vascular rings, including multiplanar reconstruction (MPR), maximum and minimum density project reconstructions. The relationship between the vascular rings and airway had been observed. Results Of 159 cases of vascular rings as-sociated with airway stenosis in 101 cases, the main airway stenosis in 79 cases, left main bronchial stenosis in 14 cas-es, right main bronchus in 8 cases, tracheal bridge in 14 cases, tracheal bronchial in 11 cases, symmetry bronchial in 2 cases. Conclusions Vascular ring often causes compression of airway narrow and dysplasia. MSCT can clearly display vascular rings and its relationship with airway, providing help for surgical and reasonable treatment.

Objective To investigate and analyze the current status of adult unplanned endotracheal extubation in China,understand the preventive strategies of unplanned endotracheal extubation,and supply reference for future research.Methods All publications concerning unplanned endotracheal extubation from CBMdisc,CNKI and Wangfang Database were analyzed by establishing the reference manage and appraisal databases with Noteexpress and SPSS software.Results The publications concerning unplanned endotracheal extubation grew steadily year by year.The major study type was case series report(36.4％)followed by review(16.7％) and experience introduction(14.6％).Most literature focused on risk factors,preventing strategies,patients' outcomes and so on.Lacking of effective physical restraint and patients' anxious were the most common factors leading to unplanned endotracheal extubation.Conclusions Unplanned endotracheal extubation has got much attention from the clinical faculties recently.However,the domestic researchers focused on this topic lacked strict research design and efficient statistical methods.So it is imperative to develop the best practice information sheet for preventing unplanned endotracheal extubation by evidenced-based and scientific method.

Objective To investigate the incidence and risk factors of acute kidney injury (AKI)in hepatitis B virus (HBV)related acute-on-chronic liver failure (ACLF)patients,and to explore the impact of AKI on the prognosis of ACLF.Methods The medical records of 227 patients who were diagnosed with HBV-related ACLF at the Department of Infectious Diseases in the First Affiliated Hospital of Nanchang University from January 2015 to August 2016 were retrospectively reviewed.Patients were divided into AKI group and non-AKI group based on the AKI criteria published by International Club of Ascites in 2015 .Demographic and clinical data were compared between groups.The AKI incidence and its impact on patients’prognosis were analyzed.The comparison of continuous variables was done by t test or rank-sum test.The comparison of categorical variables was done byχ2 test or Fisher exact test.AKI risk factors were analyzed by using logistic regression.Results There were 66 (29.1 %)cases were diagnosed with AKI among 227 ACLF patients,among which,45 patients (68.2%)were stage Ⅰ,14 (21 .2%) were stage Ⅱ and 7 (10.6%)were stage Ⅲ.Age,cirrhosis,concentrations of total bilirubin and albumin,international normalized ratio (INR),percentage of neutrophils,MELD scores and spontaneous peritonitis rate (SBP)were all statistically different between AKI group and non-AKI group (all P <0.05).The binary logistic regression analysis revealed that only INR (OR=3.132,P =0.001 )and SBP (OR=4.204,P =0.001 )were the independent risk factors of AKI.The optimal cut-off value for INR was 2.025 with AUROC of 0.609 (P =0.01),sensitivity of 59.1 % and specificity of 62.1 %.The 30-day mortality of AKI group was significantly higher than non-AKI group (χ2= 18.324,P < 0.01). Conclusions AKI is relatively common in patients with ACLF.The risk factors of AKI are INR and SBP. AKI has significant impact on the short-term survival rate of ACLF.Therefore,physicians should pay attention to patients with INR of ACLF at admissions and SBP during the management so as to prevent the occurrence of AKI and to reduce the fatality of ACLF.

Objective: To observe the incidence of unreasonable use of high beam at nighttime among motor vehicle drivers, so as to provide the evidence for the prevention and control of road traffic injury. Methods: Four roads into city and five urban roads were selected in Yongkang of Zhejiang Province. An automatic recording system was used to collect the unreasonable use of high beam among motor vehicle drivers on the selected roads from 19:00 to 5:00 on Monday, Wednesday, Friday and Sunday during a week in July 2020. The regression tree model was used to analyze the relationship of the unreasonable use of high beam with road, time and traffic flow. Results: A total of 89 989 motor vehicles were observed, and 2 419 motor vehicle drivers had unreasonable use of high beam, with an incidence rate of 2.69%. The incidence rate of the unreasonable use of high beam was 3.14% in the roads into city, which was higher than 2.30% in the urban roads ( P<0.05 ). The incidence rates of the unreasonable use of high beam in the roads into city and in the urban roads were 5.15% and 2.90% on Wednesday, which were higher than those on Monday ( 2.89% and 2.34% ), Friday ( 2.90% and 1.92% ) and Sunday (2.06% and 2.12%). The highest incidence rate of the unreasonable use of high beam in the roads into city was 6.07% between 4:00 and 5:00, and in the urban roads was 4.50% between 2:00 and 3:00. The results of regression tree classification analysis showed that the highest incidence rate was 8.13% on the roads into city in the east, west and south directions, and on the urban roads in the east and north directions with less than 317 vehicles per hour on Wednesday. Conclusion It is more likely for motor vehicle drivers to use high beams unreasonably at nighttime on the roads into city with less traffic flow.