In this article, two research cases are employed to show the rationale of the stepped-wedge design, under what situations that such a design is desirable, and how it can be implemented. Stepped-wedge design seems to suit to randomized controlled trials in which the entire study population will receive intervention programs as they would "provide more advantages than harm". When intervention can not be given to all the targets simultaneously due to limited resources, this design is particularly useful. The stepped-wedge design is also relevant when there is a hope to detect or control the time trend effect on the effectiveness of the intervention strategy. On the other hand, however, this design requires longer trial duration and presents a number of statistical challenges. Hence, careful planning and monitoring are essential to ensure that a robust evaluation is undertaken.

ObjectiveTo observe the effect of Tongxinfang on coronary collateral formation and stent-restenosis in patients with coronary artery disease after stenting.Methods61 patients with coronary artery disease were randomly divided into the treatment group (n=30), and control group (n=31). Patients of the treatment group were taking Chinese medicine Tongxinfang for six months, but cases of the control group only received basic treatment. Coronary collateral formation, stent-restenosis and ejection fraction (EF) of patients of two groups were assessed through aniograms and echocardiography before treatment and after six months.ResultsCoronary collateral formation and EF of patients of the treatment group improved significantly compared with cases of the control group (P<0.01 or P<0.05), but the minimal lumen diameter and percent of diamter stenosis were not significantly different between two groups (P>0.05).ConclusionTongxinfang can improve coronary collateral formation and EF.

ObjectiveTo observe the effect of Yiqihuoxue recipe on left ventricular remodeling after acute myocardial infarction (AMI).Methods40 patients with AMI were randomly divided into treatment group and control group with 20 cases in each group and received Yiqihuoxue recipe or fasinopril respectively for 6 months. Changes of clinical symptoms, the level of plasma angiotensin Ⅱ(ATⅡ), aldosterone (ALD), endothelin (ET) and echocardiographical indexes: left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI), ejection fraction (EF), left ventricular mass index (LvmassI), wall motion index (WMI), wall thick (WT), E/A were assessed before discharge, and in the end of 3rd and 6th month after AMI.ResultsClinical symptoms of patients of treatment group improved significantly (P<0.01). EF and E/A of all patients in two groups increased (P<0.01 or P<0.05), LvmassI and WT reduced (P<0.05), but there were no significantly differences between two groups in LVEDVI, LVESVI, EF, LvmassI, WMI, E/A and WT(P>0.05). The level of plasma ET decreased in treatment group (P<0.05), the level of plasma ATⅡ and ALD of control group decreased more than that of treatment group (P<0.05).ConclusionYiqihuoxue recipe can significantly improve clinical symptoms, cardic function, and left ventricular remodeling, showing a better clinical efficacy.

Objective To explore the effects of dehydroepiandrosterone (DHEA) on learning and memory ability and activities of choline acetyltransferase (ChAT),acetylcholinesterase (AchE),acetylcholine (Ach) in the frontal,temporal,hippocampal area of the aged rat.Methods Forty 24-month-old male SD rats were randomly divided into 4 groups (n=10,each group):control group,solvent group (intraperitoneal injection with equal volumes of DMSO),low-dose group (intraperitoneal injection with equal volumes of DHEA,1 mg/kg),and high-dose group (intraperitoneal injection with equal volumes of DHEA,5 mg/kg).The activities of ChAT,AchE,and Ach were measured by enzyme linked immunosorbent assay (ELISA) method.Learning and memory ability was detected by Morris water maze test.Results The levels of ChAT in frontal,temporal and hippocampal area were (118.5±1.3) U/mg,(120.6±1.5) U/mg,(130.8±1.5) U/mg,respectively in control group,(i39.5±1.6) U/mg,(137.4±1.4) U/mg,(141.46±1.9) U/mg,respectively in high-dose group,(131.8±1.9) U/mg,(132.4±1.2) U/mg,(139.9±1.3) U/mg,respectively in low-dose group.The levels of AchE in frontal,temporal and hippocampal area were (0.5±0.0) U/mg,(0.4±0.0) U/mg,(0.5±0.0) U/mg,respectively in control group,(0.4±0.0) U/mg,(0.4±0.0) U/mg,(0.4±0.0) U/mg,respectively in high-dose group,and (0.4±0.0) U/mg,(0.4±0.0) U/mg,(0.4±0.0) U/mg,respectively in low-dose group,and (0.5±0.0)U/mg.The Ach levels in frontal,temporal and hippocampal area were (26.0±0.8) U/mg,(24.5±1.4) U/mg,(30.1±0.8) U/mg respectively in control group,(28.7±0.9) U/mg,(28.9±1.3) U/mg,(35.9±1.4) U/mg,respectively in high-dose group,and (27.6±0.1) U/mg,(28.0±1.1) U/mg,(34.2± 1.0) U/mg,rcspectively in low dose group.The activities of ChAT in frontal,temporal and hippocampal area were higher in DHEA treatment group than in control group (P＜0.05).The activities of AchE in frontal,temporal and hippocampal area were much lower in DHEA treatment group than in control group (P＜ 0.05).The Ach levels in frontal,temporal and hippocampal area were much higher in DHEA treatment group than in control group (P＜0.05).There were significant differences in the activities of ChAT and AchE and Ach levels between low-dose group and high-dose group (P＜0.05).Compared with control group,the activities of ChAT and AchE and Ach levels had no significant differences in solvent group (P＞0.05).The escape latency was shorter in low-dose group and high-dose group than in control group (P＜0.05,P＜0.01,respectively),and there was a significant difference in escape latency between low-dose group and high dose group (P＜ 0.05).Conclusions DHEA administration can significantly increase the activity of cholinergic system,and improve the learning and memory ability in aged SD rats.

OBJECTIVETo evaluate the methods of orthognathic treatment for mandibular asymmetry.

METHODS110 cases of mandibular asymmetry had been treated in past thirteen years. The type of deformity, the management of the cases, and the effects of orthognathic treatment were summarized in this paper. Orthodontic therapy was taken before and after operation to keep the treatment effect.

RESULTSAccording to the type of the asymmetry deformity, different methods were used. After treatment, all the patients obtained satisfactory facial appearances and oral function.

CONCLUSIONIt should be diagnosed before surgery whether the development of deformity is steady or not. If it is steady, the effects of orthognathic and orthodontic therapy will be satisfactory; if not, we should remove the affected condyles and simulataneously ameliorate facial appearance.

Facial Asymmetry ; surgery ; Humans ; Mandible ; abnormalities ; surgery ; Orthodontics ; Orthognathic Surgical Procedures

OBJECTIVETo investigate clinical features of disk displacement during the course of condylar fracture and to explore the techniques of disk reposition and suturation.

METHODS32 patients (10 females and 22 males) who had disk displacements with condylar fractures were followed up. Reduction and reposition of the dislocated disks simultaneously with fixation of fractures were performed. 7 patients underwent intermaxillary fixation with elastic bands for 1 to 2 weeks.

RESULTSThe occlusions were satisfactory in all cases but one for the reason of ramus height loss. No TMJ symptom was found when examined 3 months post operation.

CONCLUSIONSAnterior disk displacements were most occurred with high condylar process fractures. Surgical reposition and suturation of disk play an important role for the later TMJ-function.

Adolescent ; Adult ; Female ; Fracture Fixation, Internal ; Humans ; Joint Dislocations ; etiology ; surgery ; Male ; Mandibular Condyle ; injuries ; Mandibular Fractures ; complications ; surgery ; Middle Aged ; Temporomandibular Joint Disc ; pathology

Objective To investigate the number and distribution of un-repaired cleft lip/palate patients in Gansu province. Methods A census was conducted by staff members of the health system and Population and Family Planning Committee (PFPC) in Gansu province. Standardized -Questionnaires were administered to collect demographic, domestic and diagnosis-related information. Results In 2008, the total number of un-repaired cleft lip/palate patients was 4675,with a detection rate of 1.84/10 000 in Gansu province. Rates of detection were higher in males (2.11/10 000), young age group(4.86/10 000), rural areas(2.23/10 000),poor counties(2.19/10 000)than in females(1.43/10 000), medium (0,97/10 000)/old age group(0.68/10 000), township areas (0.62/10 000), or richer counties (1.35/10 000). Among all the cities and prefectures of Gansu,Baiyin city (2.7/10 000) had the highest while Jinchang city (0.7/10 000) had the lowest prevalence rates. Conclusion Un-repaired cleft lip/palate had been a disease burden to Gansu province,especially in the rural area and poorer counties.

OBJECTIVETo observe the changes of telomere length and telomerase activity in patients with aplastic anemia (AA), and relationship with immunosuppressive therapy (IST) efficacy, to explore the pathogenesis of AA and the role of telomere length in evaluating immunosuppressive therapy efficacy.

METHODS71 cases of AA patients between September 2010 and March 2013 were enrolled into this study. 3 ml peripheral blood specimens from this cohort of patients were collected to test the telomere length in peripheral blood mononuclear cell (PBMNC) with flow-FISH and detect telomerase activity with TRAP-PCR-ELISA method.

RESULTSTelomere length and age showed negative correlation (b=-0.387, P=0.001) in normal control, NSAA and SAA + VSAA groups, telomere length became shorter with the growth of age, and normal control group telomere length decreased along with the age growth slightly greater than the other two groups (NSAA, SAA+VSAA). Besides the effect of age on telomere length, no significant difference was observed between NSAA and SAA+VSAA groups (P=0.573), and NSAA, SAA+VSAA (30.957 ± 4.502,29.510 ± 5.911)groups were significantly shorter than normal control group (51.086±10.844) (P<0.01). Telomere length in NR group (25.357±4.848)was significantly lower than normal control group (51.086 ± 10.844) (P=0.005), telomere length in CR(32.808 ± 4.685)/PR groups (30.334±4.464) compared with normal control group had no significant difference (P=0.517, P=0.254). Telomere length below 29.21% obviously decreased outcomes of IST. Telomerase activity had significant difference (χ²=20.385, P<0.01). The telomerase activity had no significant difference in terms of age and gender in three groups, multiple comparison found that telomerase activities in SAA + VSAA (0.324±0.178) (P<0.01), and NSAA (0.234±0.175) groups (P=0.002) were significantly higher than normal control group (0.107±0.083).

CONCLUSIONTelomere length of PBMNC in AA patients was significantly shortened than normal control group with telomerase activity increased, and telomere shorted more apparently in NR group, these patients should adjust the treatment as early as possible. Telomeres could predict the curative effect of IST.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anemia, Aplastic ; enzymology ; therapy ; Case-Control Studies ; Child ; Female ; Humans ; Immunosuppression ; Leukocytes, Mononuclear ; metabolism ; Male ; Middle Aged ; Telomerase ; metabolism ; Telomere ; metabolism ; Treatment Outcome ; Young Adult

OBJECTIVETo monitor and analyze the arthroplasty related infection situations of Drum Tower Hospital, so as to provide evidences for the prevention of infection after arthroplasty.

METHODSMonitoring of infection situations of nine arthroplasty operations were carried out from July to August in 2008. Five sampling methods were used to monitor the air of the 30 m2 surgery for 4 times. Through the cotton swab sampling, hands of 14 surgeons and 76 samples of surgical instruments (forceps, surgical scissors, retractors) were collected and then for bacterial culture.

RESULTSThe average amount of the total number of free-floating bacteria in our surgery was 88.2 cfu/m3. For the germiculture, 8 samples of hand detections were positive; 11 samples of surgical instruments including those used and unused and exposed at different times were positive.

CONCLUSIONIn the surgery of arthroplasty, all operation personnels should protect the air cleanliness degree, obey the surgical hand-washing rules and diminish the exposed time of aseptic table.

Aged ; Air Microbiology ; Arthroplasty, Replacement ; adverse effects ; Bacterial Infections ; diagnosis ; prevention & control ; Equipment Contamination ; Female ; Hand Disinfection ; Humans ; Male ; Middle Aged

BACKGROUNDGastric cancer (GC) is one of the most common types of cancer in the world. A change in the metabolism of lipids in tumor cells could lead to the pathogenesis of cancer. In this study, we investigated fatty acid and fatty acid amide metabolic perturbations associated with GC morbidity.

METHODSGas chromatography/mass spectrometry (GC/MS) was utilized to analyze fatty acids (FAs) and fatty acid amides (FAAs) of GC tissues and matched normal mucosae from 30 GC patients. Acquired lipid data was analyzed using non parametric Wilcoxon rank sum test to find the differential biomarkers for GC and diagnostic models for GC were established by using orthogonal partial least squares discriminant analysis (OPLS-DA).

RESULTSA total of 13 FAs and 4 FAAs were detected using GC/MS and 5 differential FAs as well as oleamide were identified with significant difference (P<0.05). The OPLS-DA model generated from lipid profile showed adequate discrimination of GC tissues from normal mucosae while the OPLS-DA model failed to separate GC specimens of different TNM stages. A total of 8 variables were obtained for their most contribution in the discriminating model (Variable importance in the projection (VIP) value>1.0), five of which were detected with significant difference (P<0.05).

CONCLUSIONSFA and FAA metabolic profiles have great potential in detecting GC and helping understand perturbations of lipid metabolism associated with GC morbidity.

Amides ; metabolism ; Fatty Acids ; metabolism ; Female ; Gas Chromatography-Mass Spectrometry ; Humans ; In Vitro Techniques ; Male ; Metabolic Diseases ; physiopathology ; Stomach Neoplasms ; metabolism ; pathology