Objective:To understand the current status of depression in older people aged 65 and over in Henan Province, and to study its influencing factors, with a focus on depression in older adults in grandparent families.Methods:A multi-stage stratified cluster sampling method was used.Baseline data about older people aged 65 and over were collected by self-designed questionnaires, the 15-item Geriatric Depression Scale(GDS-15)was used to assess depression.Results:A total of 7673 valid questionnaires about older adults aged 65 and over were collected, and the rate of depression was 29.52%(2265). Logistic regression analysis showed that 15 factors, such type of parenting, religious belief, region, degree of self-care, affected depression in older people aged 65 and above.Compared with regular parenting, grandparenting alone was a protective factor for depression[ OR(95% CI)=0.613(0.499-0.755), P<0.01]; compared with religious belief, no religious belief was a risk factor for depression[ OR(95% CI)=1.281(1.102-1.488), P<0.01]; compared with income ≥￥4000, incomes between ￥1000-1999[ OR(95% CI)=0.638(0.464-0.877), P<0.01], between ￥2000-2999[ OR(95% CI)=0.567(0.432-0.744), P<0.01]and between￥3000-3999[ OR(95% CI)=0.584(0.448-0.761), P<0.01]were protective factors for depression, with higher income showing stronger protection; compared with retirement, working had a protective effect, but the protective strength decreased in the order of working as urban labor, [ OR(95% CI)=0.332(0.273-0.405), P<0.01], as farmers[ OR(95% CI)=0.391(0.296-0.516), P<0.01], and as professionals or managers[ OR(95% CI)=0.514(0.402-0.656), P<0.01]; living in rural areas[ OR(95% CI)=0.686(0.586-0.804), P<0.01]and female[ OR(95% CI)=0.820(0.734-0.917), P<0.01]were risk factors for depression. Conclusions:There is currently a high rate of depression in older people aged 65 and over in Henan Province.Its influence factors are complicated and variable.Intervention measures taken by institutions need to adapt to specific circumstances.

Objective To investigate the effects of Edaravone on cognitive dysfunction and on protein expression of the mitogen-activated protein kinase/extracellular signal-regulated protein kinase (MAPK/ERK)signaling pathway in elderly patients with acute ischemic stroke. Methods A total of 100 elderly patients with acute ischemic cerebral stroke admitted to our hospital from January 2011 to December 2015 were enrolled in this study.During the corresponding period ,100 healthy individuals receiving regular check-ups were selected as the control group. The effects of Edaravone on cognitive function in elderly patients with acute ischemic cerebral stroke were assessed.Serum proteins related to the MAPK/ERK signaling pathway were assayed. Results Elderly patients with acute ischemic stroke showed obvious cognitive dysfunction ,and scores on memory ,orientation ,attention ,calculation language and recall significantly decreased(P＜0.01)but returned to normal after Edaravone treatment (P＜0.01).Compared with the control group ,serum protein expression of rat sarcoma (Ras) ,rapidly accelerated fibrosarcoma(Raf) ,hypoxia inducible factor-1α(HIF-1α) ,connective tissue growth factor (CTGF),extracellular signal-regulated protein kinase(ERK1),ERK2 ,MAPK/ERK kinase(MEK), interleukin-1(IL-1) ,tumor necrosis factor-α(TNF-α) ,vascular endothelial growth factor (VEGF) , tissue inhibitor of metalloproteinase (TIMP) ,nerve growth factor (NGF)and its receptors was significantly downregulated(P＜0.01) ,while expression of leptin and its receptors was upregulated in elderly patients with acute ischemic cerebral stroke ( P ＜ 0.01 ). Expression levels of the above downregulated proteins clearly recovered after Edaravone treatment ( P ＜ 0.01 ). Conclusions Edaravone has favorable effects on cognition dysfunction in elderly patients with acute ischemic cerebral stroke ,which may be related to the regulation of the MAPK/ERK signaling pathway.

Objective To compare the clinical efficacy of anteroposterior approach (APA) versus anterior approach (AA) for decompression,fusion and fixation for single-level unstable thoracolumbar vertebrae fractures concomitant with incomplete neurologic symptoms and injury to posterior ligament complex (PLC).Methods From February 2006 to June 2012,55 patients were treated for single-level unstable thoracolumbar vertebrae fractures.Of them,27 were treated by only anterior decompression and lateral screw-rod instrumentation and 28 by anterior decompression and fusion combined with open posterior pedicle fixation of one to two segments above and below the fracture position.The 2 groups were compared at postoperative 3 and 12 months in terms of visual analogue scale (VAS),overall score of short-form health survey (SF-36),Japanese Orthopaedics Association (JOA) score of lower back,Oswestry disability index (ODI),loss ratio of anterior margin of vertebral height,endplate angle of kyphotic deformity of superior-inferior adjacent vertebrae,wedge angle of fractured vertebra via radiographic measurement and canal compromise rate.The neurologic functional recovery was analyzed using the American Spine Injury Association (ASIA) evaluation system at postoperative 12 months.Results There were no significant differcnces in operative time,amount of blood loss or postoperative drainage between the 2 groups (P ＞ 0.05).At postoperative 3 months,the VAS and JOA scores in the APA group were significantly better than those in the AA group (P ＜ 0.05).At 12 months after surgery,the VAS,kyphotic angle of adjacent vertebra,wedge angle of fractured vertebra and the ASIA improvements in the APA group were significantly better than those in the AA group (P ＜ 0.05).There were no significant differences between the 2 groups in the other indexes at postoperative 3 or 12 months (P ＞ 0.05).All the comparative indexes were significantly improved than the preoperative values in all the patients in the 2 groups at both 3 and 12 months (P ＜ 0.05).Conclusions Compared with the merely anterior approach,the combined antero-posterior approach may have advantages of better immediate and persistent reduction,steadily rebuilding fractured alignment,continuously maintaining injured biomechanical stability,and obviously improving neurological function.As the antero-posterior approach allows for combination of posterior auxiliary reduction and fixation with anterior definitive support and decompression,it may lead to a safe and effective treatment of unstable single-level thoracolumbar fracture concomitant with incomplete neurologic and PLC impairments.

Objective To investigate the clinical efficacy of anterior pelvic plating plus percutaneous lumbo-iliac rod/screw fixation in the treatment of pelvic fractures which are vertically and rotationally unstable and combined with unilateral sacral fracture of Denis type Ⅱ.Methods From January 2008 to November 2012,19 patients were treated for compound injury to the anterior and posterior pelvic rings complicated with sacral fracture of unilateral Denis type Ⅱ using anterior pelvic plating plus posterior percutaneous fixation of lumbo-ilium with screws.Their improvement in neurological function,reduction outcome and clinical effectiveness were evaluated by comparing preoperation and 2 years postoperation in terms of visual analogue scale (VAS),Japanese Orthopaedic Association (JOA) score for lower back pain,MOS Item Short-form health survey (SF-36 comprehensive scale),modified Roland-Morris Disability questionnaire (RDQ),Oswestry disability index (ODI),Gibbons overall scale,Majeed total score,sacral kyphosis abnormity,bias of sagittal/coronal vertical axis (SVA/CVA),pelvic incidence,pelvic tilt,lumbar lordosis,vertical displace,and leg length discrepancy.Results The differences respectively reached statistical significance for the aforementioned clinical and imaging parameters between preoperation and 2 years postoperation (P ＜ 0.05).By Majeed scoring,13 cases were rated as excellent,4 as good and 2 as fair.By Tometta/Matto scoring postoperatively,the fracture reduction was rated as excellent in 12 cases,as good in 6 and as fair in one.The complications of incision infection or necrosis,secondary neurovascular damage,implant failure or mal-union was not observed.Perfect nerve functional recovery and sufficient imaging reduction were achieved in all but one patient who had to receive decompression and release for sacral canals or foramens.According to Mohammad criteria,15 patients were engaged in the jobs with the same intensity and property as their pre-injury ones.Conclusions The simultaneous hybrid performance of anterior reconstruction plating combined with unilateral lumbar/sacral pedicle and iliac screwing may be a safe,reliable and satisfactory treatment for pelvic fractures of AO/Tile C1 type which involve unilateral sacral Denis type Ⅱ.

Objective To investigate the effect of Ser473-Akt phosphorylation in the protection of atorvastatin to cerebral ischemia-re-perfusion (I/R) injury in rats. Methods Forty male Sprague-Dawley rats were randomly divided into normal group (n=10), sham group (n=10), I/R group (n=10) and intervention group (n=10). A model of cerebral ischemia-reperfusion in rats was establishied, with ischemia for 2 hours and reperfusion for 72 hours. The normal group and the sham group received no injury. I/R group was administered with normal saline only, and the intervention group received atorvastatin 10 mg/kg prepared with normal saline at palinesthesia, 24 and 48 hours after reperfu-sion. All rats were sacrificed 72 hours after reperfusion. HE staining and TUNEL staining were performed in the brain specimens. The ex-pression of Akt and Ser473-Akt in the prefrontal cortex of the brain were detected with Western blotting. Results Compared with I/R group, 72 hours after reperfusion, the damage of nerve cells significantly lessened in the intervention group;the apoptosis positive cells significant-ly reduced in the intervention group (t=-6.014, P<0.001). The expression of Ser473-Akt in prefrontal cortex was higher in I/R group than in the normal group and the sham group (t>20.327, P<0.001), and was higher in the intervention group than in I/R group (t=3.649, P=0.007). Conclusion The Ser473-Akt phosphorylation plays an important role in the protection of atorvastatin in nerve cell through anti-apoptosis of nerve cells, and reducing cerebral I/R injury.

[ ABSTRACT] AIM:To prove the purinergic signaling mechanism of the neuroprotective action of hydrogen sulfide by observing the effects of sodium hydrosulfide ( NaHS) , a donor of hydrogen sulfide, on the cell viability, intracellular Ca2+concentration ( [ Ca2+] i ) and the change of membrane permeability in the PC12 cells injured by adenosine triphos-phate ( ATP) .METHODS: PC12 cells in logarithmic growth phase were randomly divided into 4 groups.In control group, the cells were cultured without ATP treatment.In ATP group, the cells were treated with ATP after cultured for 24 h.In NaHS+ATP group, the cells were incubated with NaHS for 30 min before treated with ATP, and NaHS always exis-ted in the reaction system.In KN-62+ATP group, the cells were pretreated with KN-62 for 30 min, and the other treat-ments were as the same as those in NaHS+ATP group.The cell viability was assessed by MTT assay.The [ Ca2+] i was detected by Fura-2/AM staining.The membrane permeability was observed by staining with fluorescent dye YO-PRO-1. RESULTS:ATP at concentration of 0.3 mmol/L showed no injury effect on the cells.However, the cell viability was dropped gradually in a dose-dependent manner as the ATP at doses of 1, 3, 5 and 10 mmol/L.The decline of cell viability by ATP was obviously reversed by 200 μmol/L of NaHS in the PC12 cells (P<0.05), but exasperated by 800μmol/L of NaHS (P<0.05).At the same time, ATP evoked the increase in [Ca2+]i in a dose-dependent manner, which was inhib-ited by NaHS ( P<0.05) .Furthermore, the YO-PRO-1 uptake induced by ATP in a dose-dependent and time-dependent manner was also reduced by NaHS ( P<0.05) .CONCLUSION:Hydrogen sulfide has protective effect on the PC12 cells injured by ATP.The mechanism may be related to the reverse of the increased [ Ca2+] i and YO-PRO-1 uptake.

Objective To analyze the clinicopathological factors impacting on the prognosis of colorectal cancer liver metastases and to investigate how to improve patients' survival.Methods The clinical data of 103 patients who received radical resection for liver metastases from colorectal cancer from January 2005 to December 2011 were enrolled.The survival curve was drawn by Kaplan-Meier method,and the survival rates were analyzed by Log-rank test.Factors influencing survival were analyzed by Cox regression model.Results All patients were followed up from 10 to 60 months,The 1-,3-,5-year's survival rates were 90％,49％,39％,respectively.Univariate analysis revealed that number and size of liver metastases,distribution of liver metastases,serum CEA concentration,complications,postoperative chemotherapy were related to prognosis (x2 =24.732,9.461,9.568,25.948,25.370,5.701,P ＜ 0.05).Multivariate analysis identified number of liver metastases,serum CEA concentration,complications were as significant predictors of survival (Wald =7.974,12.051,11.547,P ＜ 0.05).Conclusions Number of liver metastases,serum CEA concentration,complication are important prognostic factors for liver metastases from colorectal cancer.Appropriate expansion of surgical indication,early diagnosis with intensive follow-up is crucial to increase the survival rate after hepatectomy for liver metastasis of coloractal carcinoma.

BACKGROUND:Recently, a neuroprotective effect of granulocyte colony-stimulating factor was reported in a model of cerebral infarction and a model of acute spinal cord injury. However, the applied animal model was not established by impact method, different from pathophysiological process of human.
OBJECTIVE:To observe effects of granulocyte colony-stimulating factor on motor function in a rat model of spinal cord injury induced by Al en’s method.
METHODS:Wistar rats were used to establish spinal cord injury at T 10 level using modified Al en’s method. They were randomly assigned to two groups, granulocyte colony-stimulating factor group, treated with granulocyte colony-stimulating factor, and vehicle group, treated with equal volume of PBS. The motor function was evaluated with Basso-Beattie-Bresnahan score and modified Rivlin loxotic plate test monitored at 1, 7, 14, 21, 28 and 35 days, and four-limb muscle strength was assessed using Grid walk test at 7, 14, 21, 28 and 35 days post-operatively.
RESULTS AND CONCLUSION:Hind limbs paralysis occurred in al animals postoperatively. Scores of Basso-Beattie-Bresnahan and modified Rivlin loxotic plate test were greater in granulocyte colony-stimulating factor group compared with vehicle group at 7, 14, 21, 28 and 35 days (P<0.05-0.01);mean Grid walk test errors were less in granulocyte colony-stimulating factor group compared with vehicle group at 14, 21, 28 and 35 days (P<0.05-0.01). Results indicate that motor function and four-limb muscle strength were improved fol owing granulocyte colony-stimulating factor therapy compared with vehicle group, indicating that granulocyte colony-stimulating factor has a positive effect on spinal cord injury.

Objective To explore the causes and risk factors affecting early death in patients with traumatic cervical spinal cord injury (SCI). Methods Clinical data of 553 patients with traumatic cervical SCI were analyzed retrospectively to discuss the related factors affecting early death of patients with traumatic cervical SCI by using univariate analysis and multivariate logistic regression analysis. Results The early mortality of the patients with traumatic cervical SCI was 4.0% ( 22/553 ). The main causes of the early death were respiratory failure in nine patients (40.9%) and electrolyte disorders in five (22.7%). Univariate analysis showed that age, cervical spinal cord injury severity, complications in respiratory, cardiovascular, digestive systems and electrolyte disturbance as well as tracheotomy were considered statistically significant for early death in patients with traumatic cervical SCI ( P < 0, 05 ). Multivariate logistic regression analysis showed that age, cervical SCI severity, complications in respiratory,cardiovascular system and electrolyte disturbance as well as tracheotomy. Conclusion Severe cervical SCI, combined respiratory, cardiovascular system and electrolyte disorder complications as well as tracheotomy are high risk factors for the early death in patients with traumatic cervical SCI.

Objective To compare the clinical outcome of external fixation device with Kirschner wire or fragment fixation pin with mini plate and screw fixation in treatment of metacarpal and phalangeal articular fracture dislocation. Methods From October 2002 to March 2008, 106 patients with metacarpal and phalangeal articular fracture dislocation were randomly divided into A and B group. The 53 patients in A group were treated with external fixation device with Kirschner wire or fragment fixation pin. There were thumb injury in 24 cases, fracture-dislocation of proximal interphalangeal joint(PIP) in 36 cases, fracture-dislocation of metacarpophalangeal joint (MP) in 17 cases. The 53 patients in B group were treated with mini plate and screw fixation. There were thumb injury in 22 cases, fracture-dislocation of PIP in 30 cases, fracture-dislocation of MP in 23 cases. Duncan rating criteria were used to compare finger range of motion. Results The mean follow-up of 16.8 and 17.5 months in A group and B group. According to Duncan rating criteria, there were excellent in 33 cases, good in 16, fair in 3, and poor in 1 case. The excellent and good rate was 92.5% in A group. There were excellent in 30 cases, good in 17, fair in 5, and poor in 1 case. The excellent and good rate was 88.7% in B group. In A group, 1 case of wound infection was found. The average arc of motion of thumb joint was 134°±21° while the average arc of motion of other fingers was 248°±19°. In B group, no wound infection occurred. The average arc of motion of thumb joint was 122°±18° while the average arc of motion of other fingers was 225°±17°. Conclusion External fixation device with Kirschner wire or fragment fixation pin was better than the application of mini plate and screw fixation in treatment of metacarpal and phalangeal articular fracture-dislocation.