BACKGROUND:There are more ways of internal fixation in treatment of elderly intertrochanteric fracture;however, how to choose a fixed way is the key issue of ensuring the efficacy. OBJECTIVE:To compare the therapeutic effect of proximal femoral anti-rotation intramedul ary nail and proximal femoral locking plate in the treatment of elderly femoral intertrochanteric fractures. METHODS:Total y 100 patients with femoral intertrochanteric fractures who received the treatment at Qionghai City People’s Hospital from December 2009 to December 2013 were randomly divided into locking plate and anti-rotation intramedul ary nail groups. Patients in the anti-rotation intramedul ary nail group underwent internal fixation using proximal femoral anti-rotation intramedul ary nail. Patients in the locking plate group underwent internal fixation using proximal femoral locking plate. RESULTS AND CONCLUSION:Compared with the locking plate group, the amount of bleeding, operation time, postoperative bed activity time and hospital stay in the anti-rotation intramedul ary nail group significantly reduced, the excel ent rate of Harris scores was significantly increased after 1 year of internal fixation and the incidence of complications and adverse reactions was significantly decreased. There was no host response to the material in these two groups.

Objective To investigate the regulation of miR-1 and miR-133 a on L-type calcium channel β2 subunit ( Cavβ2 ) and α1C subunit during rat cardiomyocyte hypertrophy .Methods Cardiomyocyte hypertrophy was in-duced by isoproterenol (ISO, 10μmol/L).The targets of miR-1 and miR-133a were predicted by online database microCosm and Targetscan , respectively .The 3′untranslated region sequences of Cavβ2 andα1C were respectively cloned into reporter vector and then transiently transfected into HEK 293 cells.The luciferase activities of samples were measured for demonstrating the expression of luciferase reporter vector .The protein expression of Cavβ2 andα1C were evaluated by Western blot .The expression levels of Cavβ2 andα1C were inhibited by RNAi to determine theeffectsofCavβ2andα1Concardiomyocytehypertrophy.Results 1)Cavβ2wasoneofpotentialtargetsof miR-1,α1C was the one of potential targets of miR-133a.2) The luciferase activities of HEK293 cells with the plasmid containing widetype Cavβ2 3′UTR sequence or α1 C significantly decreased ( P <0.05 , P <0.01 ) . 3 ) Upregulation of the miR-1 and miR-133 a by miR-1 mimic and miR-133 a mimic transfection suppressed pro-tein expression of Cavβ2 and α1C, respectively(P<0.01, P<0.05).4)Downregulation of Cavβ2 andα1C by RNAi could markedly inhibit the increase of cell surface area ( P<0.01 ) , mRNA expression of ANP andβ-MHC (P<0.05).Conclusions Cavβ2 is the target gene of miR-1 and α1C is the target gene of miR-133a.miR-1 and miR-133a can negatively regulate the expression of L-type calcium channel Cavβ2 andα1C subunit, inhibi-ting cardiomyocyte hypertrophy.

To investigate the CT findings of thoracic sarcoidosis and improve the understanding and diagnostic level of the disease. Retrospective analysis of the pathology or clinical treatment were observed in 20 patients with thoracic sarcoidosis accorded with the diagnostic standard of CT performance. There were 15 cases confirmed by pathology and 5 cases verified after clinical treatment. There were hilar or mediastinal lymph nodes in 90% cas-es, pulmonary mainly nodules in 60% case, pulmonary fibrosis in 20% cases, bronchovascular bundle thickening in 15%cases, pleural effusion in 10% cases, interlobular septal thickening in 15% cases, ground-glass opacity in 10% cases and pulmonary consolidation in 5% cases. CT findings of thoracic sarcoidosis may help improve the rate of its diagnosis.

Objective To improve the understanding to transposition of the great arteries with posterior aorta and decrease the clinic misdiagnosis by summarizing their echocardiography features . Methods Echocardiography images were retrospectively reviewed for 7 cases with transposition of the great arteries with posterior aorta who diagnosed in Anzhen Hospital ,and their echocardiography features were summarized .Results In 7 patients ,5 patients had operation ,including 3 for arterial switch operation ,1 for right GLEEN ,1 for right GLEEN and Fortan surgery ,and 2 patients were lost to follow‐up .The echocardiography characters:① Artery short view showed aorta and pulmonary artery existed the half‐surrounding relationship .The aorta was situated posteriorly and the pulmonary artery anteriorly .②Multiple views showed aorta was completely and mostly arised from the right ventricle ,while the pulmonary artery was came off the left ventricle .③ Ventricular septal defects were presented in all cases and aorta could ride the defect of ventricular septal .④ In most cases ,fibrous continuity between the aortic and mitral valve through a ventricular septal defect was found and there was no conus under the aorta .⑤ Some cases could combine the different degree stenosis of the outflow tract of subpulmonary valve and pulmonary valve . Conclusions The connection relationship between two arteries and ventricles can displayed clearly on the long axis view of double outflow tracts of two ventricles under xiphoid process .The acoustic window under the xiphoid process is the key for diagnosis and differential diagnosis of the disease .

Objective:To explore the curative effect and safety of febuxosta for the patients with primary gout complicated with mild to moderate renal insufficiency.Methods:60 male patients with primary gout complicated with mild to moderate renal insufficiency were enrolled in the affiliated Hospital of integrated traditional Chinese and Westem Medicine,Nanjing University of Chinese Medicine from January 2015 to August 2016 and randomly divided into two groups,the control group (n=30) was treated by allopurinol,and the study group (n=30) was treated by febuxosta treatment.The blood uric acid (BUA) and hepatorenal function were compared in the treatment period,and the incidence of adverse reactions and the recurrence of gout in post-treatment were compared.Results:At 1,2 and 3 month after treatment,the serum level of BUN in the study group was significantly lower than that of the control group (P＜0.05).The renal function of all patients were significantly improved compared with pre-treatment (P＜0.05),but the no significant difference was found between two groups at the same time(P＞0.05).The control group showed the adverse reactions with limb discomfort,drowsiness,nausea,abdominal distension,diarrhea and itch of skin,and the study group showed limb discomfort,drowsiness and abdominal distension,and one patients presenting allergic skin rash and discontinuation of allopurinol.The total incidence of adverse reactions in the study group was significantly lower than that of the control group (P＜0.05).Conclusions:Febuxosta could effectively and safely decrease the blood uric acid levels and improve the renal function of patients with primary gout complicated with mild to moderate renal insufficiency.

Objective To improve the prenatal echocardiographic diagnostic accuracy for fetus with isolated mirror-image right aortic arch which combined with vascular ring by analyzing and accumulating its echocardiographic features.Methods Echocardiographic signs were analyzed retrospectively and fetal echocardiographic features were accumulated in 16 cases with prenatal diagnosis of isolated mirror-image right aortic arch with left-side ductus arteriosus which formed vascular ring between January 2014 and February 2016.All cases were confirmed by neonatal echocardiography.Results The fetal echocardiography characters:① In 3-vessel and trachea view,fetal right aortic arch was demonstrated a Ushaped appearance of the great vessels,the right arm of the ‘ U’ represented the aortic arch and its left branch with ductal continuation.② In 3-vessel and trachea view or upper axial mediastinal transverse view,left innominate artery passed straightly to the left of the trachea.Left innominate artery and right-side ductus arteriosus were overlapped and the distance of two vessels was very close.③ In double arch view and longitudinal view for ductus,Left innominate artery did not connect to descending aorta or ductus arteriosus and did not involve in the formation of vascular ring.④ Color Doppler played an important role in diagnosis of this disease.Power Doppler or high-definition imaging easily showed color overflow and wrongly displayed the crossed relationship of left innominate artery with descending aorta as the anatomical connection,and caused the misdiagnosis of this disease as double aortic arch.Conclusions Isolated mirrorimage right aortic arch with vascular ring is not rare in the fetal period.Because ductus arteriosus is large and patent during the prenatal period,it is easily mistaken for the crossed relationship of left innominate artery with descending aorta as the anatomical connection and finally misdiagnoses this anomaly as double aortic arch.The keys to accurate diagnosis of the disease are clearly visualization of the innominate artery and its relationship with descending aorta and ductus arteriosus by scanning different views.

BACKGROUND:Studies have shown that Schwann cells form a Bunger band in the basement tube and guide the extension of regenerating axons after peripheral nerve injury, but the exact mechanism remains to be explored.
OBJECTIVE:To explore the effect of Wal erian degeneration on biological characteristics and secretory function of Schwann cells in rats with sciatic nerve injury.
METHODS:A rat model of sciatic nerve injury was established and divided into two groups:sciatic nerve transection group and surgical control group. Schwann cells were isolated and cultured from sciatic nerve segments by one enzyme digestion. The cellmorphology was observed under light microscope and S-100 protein expression was determined by immunofluorescence staining. After subculture, the first generation of Schwann cells were chosen to draw the growth curve by the counting method within 14 days. The cellactivity was detected by MTT assay. The adhesion of Schwann cells was examined by acid phosphatase analysis and the concentration of nerve growth factor was detected by ELISA method.
RESULTS AND CONCLUSION:At 14 days after primary culture, a great number of Schwann cells were observed near the edges of nerve segments in the sciatic nerve transection group, but only smal number of Schwann cells scattered around nerve segments in the control group. Schwann cells in both groups showed S-100 positive expression. At 3 days after subculture, Schwann cells reached the logarithm proliferative phase, the cellnumber and proliferation absorbance values in both groups were increased along with time extension. Furthermore, the number of Schwann cells and absorbance value in the sciatic nerve transection group were significantly higher than those of control group (P<0.05). The adhesion ability in the sciatic nerve transection group was also significantly higher than those in the control group (P<0.05). ELISA results showed that, the concentrations of nerve growth factor in the sciatic nerve transection group were significantly higher than those in the control group at 4, 6, 8, 10, 12 and 14 days (P<0.05). After sciatic nerve injury, Wal erian degeneration can induce Schwann cells dedifferentiate into the precursors, significantly influence the biological function of Schwann cells, promote the proliferation of Schwann cells within the short term, secrete large amounts of neurotrophic factors, enhance celladhesion, and provide a suitable microenvironment for regenerated axons. In addition, it creates the necessary microenvironment for peripheral nerve regeneration.

Objective To evaluate the value of sonourethrography in the diagnosis of dysuria after bipolar transurethral plasmakinetic prostatectomy. Methods Sixty male patients with dysuria after bipolar transurethral plasmakinetic prostatectomy underwent sonourethrography and re-operation.The clinical data of these patients were reviewed. Results The sonourethrographic findings were similar with the operative findings in 57 cases.In the 60 cases,there were 11 cases with bladder neck closure,10 cases with bladder neck stricture,30 cases with urethral stricture (16 located at membranous urethra,12 located at pars cavernosa urethra and 2 in external orifice of urethra),5 cases with prostate remnant,1 case with calculi in prostatic urethra,2 cases with dysfunction of detrusor of bladder and 1 case with flap of internal urethral orifice,Conclusions Sonourethrography could be a reliable diagnostic method for dysuria after bipolar transurethral plasmakinetic prostatectomy.It may be helpful for clinical treatment.

Objective To investigate the expression and clinical significance of P-selectin (CD62P) in bone marrow hematopoietic stem cells of patients with acute leukemia (AL). Methods The CD62P expression in bone marrow mononuclear cells of 15 healthy donors and 56 untreated patients with AL, were examined by flow cytometry. Results The average rate of CD62P expression was (6.72±7.64) % in hematopoietic stem cells (CD+45 CD+34 CD-38) of the 38 patients with acute myeloid leukemia (AML), was (3.46±2.51) % in hematopoietic stem cells (CD+45 CD+34 CD+19) of the 12 patients with B-acute lymphoblastic leukemia (B-ALL), and was (6.23±4.95) % in hematopoietic stem cells (CD+45 CD+34 CD+7) of 6 patients with T-acute lymphoblastic leukemia (T-ALL). The expression rates in those AL patients were higher than that in the healthy controls (1.04 ±1.23) % (t = 2.847, 3.284, 3.091, respectively, P ＜0.01), while there was no difference between the control group and the group who reach CR after routine treatment (t =1.932, P ＞0.05). Furthermore, the leukocyte,hemoglobin and platelet count in CD+62P patients with AML and T-ALL were significantly higher than CD-62P ones (t =4.153, 8.095, 8.289, 7.235, 8.692, 9.832, respectively, P ＜0.05), but there was no significant difference between CD+62P and CD-62P patients with B-ALL (t =0.340, 1.142, 0.019, respectively, P ＞0.05).Conclusion The CD62P is one of the markers of platelet activation, and its expression varies in different types of AL. The CD62P in hematopoietic stem cells of AL could be regarded as a new sign for the leukemic stem cells, as well as a helpful prognostic indicator in treatment response assessment.

Objective To test plasma levels of uPA,uPAR,D-dimer,IL-6 and TNF-α,and observe the relationships between uPA,uPAR and D-dimer,IL-6,TNF-αin patients with SIRS.Methods A prospective,clinical case-control study was adopted.Cases were collected from our hospital in January 2008 to January 2010,and all were ＞ 55 years of age.Venous blood samples were collected via routine venipuncture.Eighty-five patients were divided into two groups according to diagnostic criteria of SIRS:SIRS group collected from Intensive Care Unit ( n =50) and non SIRS group collected from medical ward ( n =35).The control group comprised 30 unrelated healthy blood donors who visited the General Health Checkup Division at our hospital.Patients with (1) pregnant women; (2) cancer; (3) died after admitted into ICU in 7 days; (4) after cardiopulmonary resuscitation ; ( 5 ) with previous blood system diseases; (6) patients with SIRS before admitted into ICU were excluded from the study.uPA,uPAR,D-D,IL-6 and TNF-α in blood were detected by commercial enzyme-linked immunosorbent assay (ELISA) kits.The data was analyzed using SPSS version17.0.Data accorded with normal distribution of measurement was expressed as mean ± standard,and analyzed by independent-samples t test; non-normal distribution of measurement data,expressed by median,was analyzed with Mann-Whitney test.Relationships between plasma levels of uPA,uPAR and D-dimer,IL-6 TNF-α were analyzed using Spearman rank correlation test.To compare with blood level of uPA,uPAR,IL-6 and TNF-α in SIRS patients in the application of diagnostic value of MODS,we constructed the receiver operating characteristic curve ( ROC curve) for blood levels of uPA,uPAR,IL-6 and TNF-α in 24 h.Results The plasma levels of uPA,uPAR,D-dimer,IL-6 and TNF-αin patients of SIRS were obviously higher compared with non-SIRS and normal controls ( all P ＜ 0.01 ).Correlation analysis showed that there was positive correlation between uPAR level and IL-6 level (r =0.395,P =0.004) ; there was positive correlation between uPAR level and TNF-αlevel ( r =0.606,P ＜0.01 ).There was no correlation between uPAR levd and D-dimer level ( r =- 0.069,P =0.632).There was no correlation between uPA level and D-dimer,IL-6 or TNF-α ( all p ＞ 0.05).There ROC curve were made based on the abilities of uPAR,D-dimer,IL-6 and TNF-αlevels in 24 hours to diagnose MODS,and the ROC areas under the curves were 0.76,0.58,0.86,0.83 respectively.Conclusions These results demonstrate that uPA and uPAR play a major contributory role in patients with SIRS in the process of coagulation disorders,but the mechanism in SIRS is not the same.uPAR may play a central rolein the development of SIRS to MODS.