Clinical data of 448 patients aged ≥60 years with osteoporotic hip fractures admitted in Shanghai Huashan Hospital between January 2010 and December 2014 were retrospectively analyzed.Among 448 cases,there were 143 males and 305 females;196 cases aged 80-89 years (43.8％) and 137 cases aged 70-79 years (30.6％);304 cases of femoral neck fracture (67.9％) and 144 cases of intertrochanteric femoral fracture (32.1％);the fractures caused by fall in 328 cases (73.2％) and comorbidity with hypertension and diabetes mellitus in 415 cases (92.6％).Two hundred and sixty eight patients were followed up for 2 years,among whom re-fractures occurred in 17 cases.The study indicates that health education is important for prevention of osteoporotic fractures in elderly people.

Objective: To investigate the feasibility for reconstructing an aortic arch by a new integrated two-branched stent graft releasing in experimental canine thoracic aorta simulation system.
Methods: A new type of integrated two-branched stent graft was developed and placed in the canine thoracic aorta, the stent graft releasing in a simulated system was conducted under X-ray guidance to monitor the operating process and to explore the feasibility for invitro sent graft releasing.
Results: The new two-branched stent graft was successfully deployed in canine thoracic aorta simulation system. The releasing process was smooth, two small stent grafts were well landing, and all stent grafts were fully expanded and properly positioned.
Conclusion: Our new two-branched stent graft could successfully reconstruct the aortic arch in experimental canine. The thoracic aorta releasing system may better and truly simulate the whole process of endovascular aortic repairing, which provides a good foundation for further animal experiments.

With the development of natural products, the research activities on the solubilization methods of water-insoluble natural products have been carried out worldwide. Big molecular weight and poor solubility of most natural active ingredients lead to a very poor oral absorption and low bioavailability, which has extremely limited their development in pharmaceutical fields and clinical application. As a result, it is necessary to find out a suitable technique to improve the solubility and enhance the oral bioavailability of insoluble natural drugs. Based on the related references published in these years, this review introduced some new techniques to improve the solubility and bioavailability of natural drugs, including prodrugs, inclusion complex, solid dispersion, cocrystals, osmotic pump, liquisolid compacts, micronization, self-microemulsifying, nanosuspensions, lipsomes, polymeric micelles and so on, and summarized the theory, characteristics, application range, application examples, problems and development direction of each technique.
Administration, Oral ; Biological Availability ; Biological Products ; administration & dosage ; chemistry ; pharmacokinetics ; Chemistry, Pharmaceutical ; methods ; trends ; Solubility ; Technology, Pharmaceutical ; methods ; trends ; Water

Objective To investigate the value of drug intervention for difficult weaning from mechanical ventilation. Methods A prospective single-blind randomized controlled trial was conducted. 120 patients with difficult weaning from mechanical ventilation encountered in Department of Critical Care Medicine of Peking University Third Hospital from January 2008 to December 2013 were included,and the patients were divided into treatment group and control group according to random number table,with 60 cases in each group. Patients received furosemide therapy in the treatment group 3 days before weaning up to 48 hours after weaning in order to control negative liquid balance. Enema was given the day before weaning to reduce abdominal pressure. On the weaning day,all of the patients received nitroglycerin and beta blocker or cedilanid to prevent or control elevation of blood pressure and heart rate in the process of weaning. All patients in treatment group received anisodamine in small dosage 2 hours before extubation.The patients in control group received conventional treatment without drug intervention. Baseline indexes of two groups were compared,including the heart rate,respiration rate(RR),mean arterial pressure(MAP),pulse blood oxygen saturation(SpO2),blood gas,hemoglobin(HG),albumin(ALB)and creatinine(Cr). The main reasons of difficulty in weaning,sedative and analgesic drug selection,presence of abdominal discomfort before weaning,interval between sputum suction before extubation,liquid balance at the beginning of the investigation and at time of weaning,24 hours and 48 hours after weaning,failures of spontaneous breathing test(SBT),length of mechanical ventilation,length of ICU stay,and total length of mechanical ventilation and total length of ICU stay during hospitalization. Results There was no statistically significant difference in the heart rate,RR,MAP,SpO2,blood gas,HG,ALB,Cr at the beginning of the investigation between the two groups. The main reasons for difficult weaning in both groups of patients were respiratory dysfunction,cardiac insufficiency,and central nervous system dysfunction. The use of propofol combined dexmedetomidine in the treatment group was more frequent than the control group〔16.7%(10/60)vs. 1.7%(1/60),χ2=8.107,P=0.004〕,and there was no statistically significant difference in the use of other combinations of sedative drugs between the two groups. Abdominal discomfort before weaning was milder in treatment group as compared with control group〔10.0%(6/60)vs. 25.0%(15/60),χ2=4.675,P=0.031〕. The interval between sputum suction before extubation in the treatment group was significantly longer than that of the control group〔hours:1(1,2)vs. 1(1,1),Z=-2.209,P= 0.027〕. SBT failure was less frequent in treatment group compared with control group〔times:0(0,1)vs. 1(1,2),Z=-6.561,P=0.000〕. Liquid balance was better in the treatment group than the control group at time of weaning,24 hours and 48 hours after weaning〔at time of weaning:-567.71 (-755.95,-226.41)vs. 1 256.76(472.48,1 796.63),Z=-9.038,P=0.000;24 hours after weaning:-5.03 (-530.28,245.09)vs. 342.28(125.36,613.25),Z=-4.711,P=0.000;48 hours after weaning:115.50(-450.26, 485.00)vs. 330.00(16.25,575.25),Z=-1.932,P=0.053〕. Compared with control group,length of mechanical ventilation〔days:1.0(1.0,2.0)vs. 2.0(2.0,3.0),Z=-6.545,P=0.000〕,ICU stay time〔days:3.0(3.0,4.0) vs. 4.0(4.0,5.0),Z=-6.545,P=0.000〕,and total length of mechanical ventilation〔days:8.0(6.0,12.0)vs. 11.0(8.0,15.0),Z=-4.091,P=0.000〕and total length of ICU stay during hospitalization〔days:12.5(9.2,19.0) vs. 17.0(12.0,29.5),Z=-2.722,P=0.000〕were all significantly shorter in the treatment group. Conclusions Adjuvant drugs therapy is helpful in patients weaning from the mechanical ventilation,and can shorten length of mechanical ventilation and ICU stay time. Propofol,combined dexmedetomidine,is helpful for weaning.

AIM:To explore and compare effect of coaxial micro-incision phacoemulsification and standard coaxial phacoemulsification in the treatment of cataract.
METHODS:A total of 88 patients(88 eyes) with senile cataract who underwent selective cataract ultrasonic emulsification resorption combined with intraocular lens implantation in the hospital from Aug. 2013 and Aug. 2015 were selected, they were divided randomly into the control group ( 44 cases, 38 cases completed, 6 cases dropped out ) and the observation group ( 44 cases, 40 cases completed, 4 cases dropped out ) . The control group received standard coaxial 3. 0mm small incision phacoemulsification, the observation group received coaxial 1. 8mm micro-incision phacoemulsification. All patients were combined with intraocular lens implantation. Intraoperative effective ultrasonic time, cumulative release energy, best corrected visual acuity before and after surgery in the two groups were recorded, corneal endothelium cell population, incision corneal thickness, percentage of cornea hexagon cell, corneal astigmatism changes before the operation, 1d, 7d, 30d after the operation were compared.
RESULTS: There was no significant difference in intraoperative effective ultrasonic time, cumulative release energy in the two groups(P>0. 05). There was no significant difference in postoperative best corrected visual acuity between the two groups(P>0. 05). Corneal endothelium cell population, percentage of cornea hexagon cell 1d, 7d, 30d after the operation in the two groups were significantly decreased compared with those before the treatment ( P < 0. 05 ), but there was no significant difference in the two groups ( P > 0. 05 ). Incision corneal thickness 30d after the operation in the observation group was significantly lower than the control group(P<0. 05). Degree of corneal astigmatism in the observation group 1d, 7d, and 30d after the operation were significantly lower than the control group (P<0. 05).
CONCLUSION: Coaxial micro - incision phacoemulsification and standard coaxial phacoemulsification can improve visual acuity of cataract patients, but the former can reduce degree of corneal astigmatism.

Objective To identify risk factors associated with repeat use of pulmonary surfactant ( PS) in the treatment of respiratory distress syndrome ( RDS ) in the term and near-term neonate. Methods There were 130term and near-term new borns with RDS who were treated with pulmonary surfactant were enrolled. These infants were categorized into two groups: single-dose group (85 cases) and repeat-dose group (45 cases). The differences in basic information were compared between the two groups, and logistic regression analysis was used to identify the risk factors for repeat use of pulmonary surfactant.Results TherepeatutilizationrateofPSwas34.6℅.The incidence of asphyxia,maternal gestational hypertension, X-ray RDS grade 3-4, the age of first dose PS,respiratory support time in the repeat-dose group was significantly higher than in the single-dose group (P<0. 05). PaO2/FiO2 and the cure rate in the repeat-dose group were significantly lower than in single-dose group ( P<0. 05 ) . The incidence of sepsis, pulmonary hemorrhage, shock and patent ductus arteriosus ( PDA) in the repeat-dose group was significantly higher than in the single-dose group ( P<0. 05). Further logistic regression analysis showed that birth asphyxia ( OR=5. 674 , 95℅CI 1. 378 -23. 354 , the age of first dose of PS (OR=1.092, 95℅CI 1.002 -1.191)and PDA(OR =23.499, 95℅CI 2.348 -235.152)were the independent risk factors for repeat use of pulmonary surfactant.Conclusions Birth asphyxia,the age of first dose PS and PDA are the risk factors for repeat use of pulmonary surfactant in the treatment of RDS in the term and near -term neonate.

Microvascular architecture of the oviduct was observed by SEM in 20 adult female Wistar rats which were not pregnant. The oviduct was supplied by 2-4 tubal branches (0.2-0.3mm in diameter) which were derived from the ovarian artery. The tubal branches entered the wall of oviduct and divided into numerous meandering arterioles (0.02-0.07mm in diameter). Intrinsic microvasculature of the oviduct might be divided into three layers: (1) the subserosal vascular plexus which appeared tortuous and formed reticulate anastomosis, (2) a parallel branching vasculature in the muscle coat, and (3) the subepithelial capillary network. The latter arised from the arterioles which ramified terminally near the apex of mucosal folds and broke up into very dense capillaries. Subepithelial capillary density in the fimbriae was markedly higher than that in the isthmus and uterine part. Intrinsic venules of oviduct were less tortuous and less closely accompanied with the arterioles. In mesoviduct, veins were in closely accompanied with the corresponding arteries. In the wall of oviduct, some capillaries and venules drained to the small veins directly and vertically.

Objective To investigate the distribution and antimicrobial resistance of pathogens from lower respira-tory tract in patients in intensive care unit (ICU),so as to provide reference for clinical treatment.Methods Distri-bution and antimicrobial susceptibility of pathogens isolated from ICU patients’sputum obtained through fiberbron-choscope between 2011 and 2014 were analyzed retrospectively.Results A total of 3 454 pathogenic strains were isolated between January 1 ,2011 and December 31 ,2014,the percentage of gram-negative bacteria,gram-positive bacteria,and fungi were 84.11 %,14.50%,and 1 .39% respectively.The detection rates of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella spp .in 2011 -2014 were 38.46% -73.33% and 26.95% -37.06% respectively. Enterobacteriaceae strains had low resistance rates to imipenem and meropenem (<20.00%);resistance of Acinetobacter baumannii was higher than Pseudomonas aeruginosa ,both had low resistance rates to amikacin(3.32%-37.16%);vancomycin-and linezolid-resistant strains were not found among Staphylo-coccus .In 2011 - 2014,detection rates of methicillin-resistant Staphylococcus aureus (MRSA)were 42.86% -61 .22%,methicillin-resistant coagulase-negative staphylococcus (MRCNS)were 86.96% - 91 .67%;resistance rates of Enterococcus faecium was higher than Enterococcus faecalis ,vancomycin-resistant strains were not found among Enterococcus faecalis and Enterococcus faecium ;the major fungus was Candida albicans .Conclusion Anti-microbial resistance of pathogens isolated from lower respiratory tract is getting more serious,clinicians should pay attention to non-antimicrobial infection control strategies in addition to rational use of antimicrobial agents.

Objective To evaluate the status of self-efficacy and its influencing factors in adult patients with low vision,then explore an effective approach to improve their self-efficacy levels.Methods Seventy adult patients with low vision were sampled by random number table method.General social-demographic questionnaire and self-efficacy questionnaire were used to investigate these patients' general information and self-efficacy.Seventy pieces of questionnaires were issued and returned with the valid rate of 100％.Results The total score of self-efficacy in seventy adult patients with low vision was(16.25:±:1.93) points,92％ of patients had a low level of self-efficacy.The influencing factors of self-efficacy in adult patients with low vision were the attitude toward disease,mental status and gender.Conclusions The selfefficacy in patients with low vision was affected by many factors at different levels,so we should focus on main influencing factors to adopt corresponding nursing measures in order to improve self-efficacy of adult patients with low vision.

Objective To investigate the characteristics of the executive function and working memory in patients with mild cognitive impairment (MCI), and the relations between working memory and executive function and the effects of working memory on patient' s daily functioning.Methods Thirty patients with MCI and 30 healthy elderly subjects were tested with a wide neuropsychoingical battery of tests including those of executive function, working memory and other cognition domain tests.Executive function was evaluated by using the verbal fluency test (VFT), color trail test (CTT), digital span (DS).Results The results showed the presence of significant executive function and working memory impairment in MCI patients as compared with the healthy controls.The scores of executive function test in MCI patients were decreased significantly in CTT (130.8±58.2 vs 52.0±13.5), CTT-B (210.2±81.8 vs 121.0±33.4),DS (3.4±0.9 vs 4.2±1.1), VFT (8.9±5.4 vs 16.4±5.4) and visuo-objective working memory (0.73±0.12 vs 0.85±9.18) respectively (t = 7.108, 5.159,-2.544,-4.879, and-4.351, all P <0.01 or P < 0.05) .In the stepwise liner regression analysis objective working memory test made a significant independent contribution to ADL (β =-0.720, t =-3.571, P < 0.01).Conclusion The patients with MCI have the deficit in executive function and working memory.Visuo-objective working memory is closely correlated with general cognitive function such as daily function, resulting in daily function decline.