Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Osteosarcoma (OS) is the most common primary malignant bone tumor in clinic. It has high mortality and disability rate. Effective neoadjuvant chemotherapy combined with limb salvage surgery can improve the 5-year survival rate of OS patients. Drug resistance or low sensitivity of tumor cells is the most common cause of postoperative local recurrence and metastasis. Therefore, the sensitivity of OS cells to chemotherapy drugs is of great value to the prognosis of the patients. In recent years, traditional Chinese medicine has been widely used because of high efficiency and low toxicity. A large number of studies have confirmed that part of traditional Chinese medicine can reverse the chemotherapy resistance of OS cells by regulating the ABC transmembrane transport protein system. This article gives an overview of its related mechanisms and latest developments.

Objective To compare the clinical effect of proximal femoral nail anti-rotation(PFNA) and dynamic hip screw(DHS) internal fixation in the treatment of femoral intertrochanteric fracture.Methods 80 patients with femoral intertrochanteric fracture were selected as research subjects.They were divided into PFNA group and DHS group by random number table,40 cases in each group.The operation time,intraoperative blood loss,postoperative wound drainage,postoperative weight-bearing time,healing time,complication rate,Harris hip function score between two groups were compared.Results The operation time of the PFNA group was lower than that of DHS group(t=22.66,P＜0.05),the amount of bleeding in operation was less than that in the DHS group(t=54.85,P＜0.05),the postoperative wound drainage volume was less than that of the DHS group(t=16.85,P＜0.05),the weight-bearing time after operation was shorter than that in the DHS group(t=20.18,P＜0.05),and the healing time was shorter than that in the DHS group(t=22.00,P＜0.05).The excellence rate of Harris hip function score in the PFNA group was 95.00％,which was significantly higher than 80.00％ in the DHS group,the difference was statistically significant(χ2=4.11,P＜0.05).The incidence rate of complication of the PFNA group was 7.50％,which was significantly lower than 25.00％ of the DHS group(χ2=4.50,P＜0.05).Conclusion Compared with DHS,PFNA internal fixation has the advantages of less operation time,less intraoperative blood loss,shorter healing time and low complication rate in the treatment of femoral intertrochanteric fracture.It is worthy to be promoted clinically.

OBJECTIVE: To explore new hallmarks affecting the prognosis of patients with laryngeal squamous cell carcinoma (LSCC) via investigating the expression of CyclinE and p27 in LSCC tissues. METHOD: The expression of CyclinE and p27 was detected via Elivision immunohistochemical staining in 160 LSCC tissues and 20 normal laryngeal tissues (NLT). The relationship between CyclinE/ p27 and LSCC/ NLT was analyzed via Log-rank analysis. The relationship of CyclinE and p27 protein was statistically analyzed by spearman correlation analysis. The relationship between CyclinE/p27 and clinical-pathology-factors of patients with LSCC, such as age, gender, tumor site, diameter, differentiation, lymph node metastasis and PTNM stage were analyzed by Chi-square test. The relationship between clinical-pathology-factors, CyclinE, p27 and overall survival time of patients with LSCC was analyzed via Cox multiplicity and Kaplan-Meier survival analysis. A significant difference was recognized by P<0.05. RESULT: In LSCC the positive rates of CyclinE and p27 protein was 62.50% and 41.25% respectively (P<0.05). In NLT the positive rates of CyclinE and p27 protein was 35% and 70% respectively (P<0.05). The expression of CyclinE or p27 protein was closely correlated with lymph node metastasis, PTNM stage of patients with LSCC (P<0.05). The expression of CyclinE and p27 had no significant correlations with patients' gender, age and tumor site, diameter differentiation (P>0.05 for all). A negative correlation was found between the expression of CyclinE and p27 protein, r= -0.767(P<0.05). Kaplan-Meier survival analysis showed that the overall survival rate of patients with LSCC was 36.9% (P<0.05). The 5-year survival rate in positive group of CyclinE was 8%, in negative group was 80% (P<0.05). On the contrary, the 5-year survival rate of patients with LSCC in positive group of p27 protein was 77.27%, the rate was 5.32% in negative group (P<0.05). Cox multivariate regression analysis revealed that lymph node metastasis, PTNM stage, CyclinE and p27 were independent risk factors of prognosis for patients with LSCC. CONCLUSION It is the molecular basis underlying the development and invasion/ metastasis of LSCC that activation of CyclinE gene accompanying inactivation of p27 gene. It is very important of co-detecting CyclinE and p27 protein to predict the prognosis of patients with LSCC.
Carcinoma, Squamous Cell ; metabolism ; pathology ; Cyclin E ; metabolism ; Cyclin-Dependent Kinase Inhibitor p27 ; metabolism ; Female ; Head and Neck Neoplasms ; metabolism ; pathology ; Humans ; Laryngeal Mucosa ; metabolism ; pathology ; Laryngeal Neoplasms ; metabolism ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Oncogene Proteins ; metabolism ; Prognosis ; Squamous Cell Carcinoma of Head and Neck ; Survival Rate

Aim: To study the pharmacokinetic effects of salvianolic acid B( Sal B) on danshensu( DSS) in Danshen injection in rats. MGthod: Following the intravenous administration of Danshen injection and Danshen injection added with Sal B to rats, the plasma kinetic study, tissue distribution and urine excretion were studied. The plasma kinetic study was also investigated by giving DSS and DSS in combination with Sal B to rats. Plasma, tissue and urine drug levels of danshensu were analyzed by LC-MS. Results: Compared with danshensu given alone, no significant difference of the pharmacokinetic behavior of danshensu was found when danshensu was given in combination with salvianolic acid B. However, compared with Danshen injection given alone, the pharmacokinetic behavior of danshensu changed remarkably when Danshen injection was given in combination with salvianolic acid B which might be caused by the decrease of DSS in kidney distribution and urine excretion. Conclusion: The pharmacokinetic effects of salvianolic acid B on danshensu depend on the existence of multiple components in Danshen injection. Results suggest that the pharmacokinetic interactions of the multiple components are closely related to the integrity of herbal medicines.

Objective To investigate the feasibility and efficacy of iliofemoral endovascular therapy for the treatment of chronic ischemia of lower extremities due to arterial atherosclerosis. Methods During the period of September 2005-January 2009 percutaneous endovascular angioplasty and stent implantation were performed in 15 consecutive patients with CTA-proved chronic occlusive iliofemoral artery disease. The patients included 11 males and 4 females with a mean age of (72.1 ± 5.9) years (ranged from 61 to 82 years). Before the procedure, all patients underwent clinical and imaging assessments, including Fontaine classification, ankle-brachial pressure index (ABI), and lower limb computed tomography angiography (CTA). According to the length, morphology and location of the occlusive segment, different types of stents were employed together with pereutaneous transluminal angioplasty (PTA) to treat the occluded lilac or superficial femoral artery. At the end of the procedure, distal angiogram was performed to assess the success of the procedure and to exclude thromboembolism or dissection complications. After PTA, the residual stenosis < 30% and/or pressure gradient < 10 mmHg were defined as technical success. Clinical success was identified when patient's clinical symptoms were improved by one or more grade according to Fontaine classification. Results Technical success was totally achieved in all patients with no occurrence of complication. Recanalization of the occluded artery was performed preferably by retrograde ipsilateral femoral artery approach in 5 patients and by contralateral access using the crossover aorta technique in 10 patients. PTA was performed in all patients after stent release to open the occluded vessel to its normal diameter. The mean length of the lilac arterial segment covered with 8 stents was (7.6 ± 1.4) cm (ranged from 6 cm to 10 cm). The mean diameter ± SD of the iliac stents was 9.5 mm ± 1.4 mm (ranged from 8 mm to 12 mm). The mean length of 5 superficial artery implanted stents was (4.5 ± 1.1) cm (ranged from 4 cm to 6 cm). The mean ABI before treatment and six months after treatment was 0.64 (range 0.41 to 0.89) and 0.76 (range 0.50 to 0.95), respectively. The difference in ABI between pre-interventional and post-interventional procedure was statistically significant (t = -4.64, P < 0.01). Clinical improvements according to Fontaine classification were obtained in all patients, in whom technical success was achieved (100%). Conclusion Endovascular interventional procedure is a safe and effective treatment for iliofemoral arterial occlusive disease due to arterial atherosclerosis. PTA combined with subsequent stent implantation can well improve the patient's quality of life as well as the hemodynamics of lower extremities, which is very important for preserving the diseased limb for a long period of time.

Objective To explore the relationship between vitamin D receptor(VDR)gene polymorphisms and bone mineral density(BMD)in patients with type 2 diabetes mellitus(DM)and to better understand the pathogenesis of osteoporosis.Methods Ninety seven patients with type 2 DM were recruited for this study.BMD was measured by single photon absorptiometry at the lower one third of the nondominant radius and ulna.Polymorphisms of the VDR gene were analyzed by DNA amplification with polymerase chain reaction(PCR)and endonuclease digestion with Bsm Ⅰ.Results The respective frequencies of VDR genotypes were BB 18.6%,Bb 27.8% and bb 53.6%.The Z scores of the three groups were - 1.57 ± - 0.60,- 1.45 ± - 0.67 and - 1.41 ± - 0.81,respectively.Although the BMD of the Bb genotype DM patients was higher than that of BB genotype DM patients and lower than that of bb genotype DM patients,there were no significant differences.Conclusion These findings suggest a small influence of VDR gene polymorphism on the BMD of patients with type 2 DM.Further study on the value of VDR genotypes in the pathogenesis of osteoporosis in diabetes mellitus is still needed.