Comparison of 3 Treatment Methods for Distal Tibial Fractures: A Network Meta-Analysis.

BACKGROUND The choice of optimal internal fixation device for distal tibial fractures remains controversial. The purpose of our study was to evaluate the effectiveness and safety of open reduction and internal fixation, minimally invasive percutaneous osteosynthesis, and intramedullary nailing of distal tibial fractures in adults using network meta-analysis of data from clinical trials. MATERIAL AND METHODS The studies were abstracted from MEDLINE, EMBASE, CNKI, and the Cochrane Central Register of Controlled Trials. Randomized controlled trials meeting inclusion and exclusion criteria were selected. Statistical analyses were conducted using Stata software, version 13.0 (Stata Corporation, College Station, Texas, USA). RESULTS Eleven randomized controlled trials were included. The total number of participants was 710 and the studies were published between 2005 and 2017. There were no significant differences in rates of delayed union, nonunion, or malunion among the various treatments (all p>0.05). The intramedullary nailing group had a lower incidence of wound complications than did the open reduction and internal fixation group and minimally invasive percutaneous osteosynthesis technique group. The SUCRA probabilities were 28.6% for ORIF, 98.4% for IMN, and 22.9% for MIPPO. CONCLUSIONS Given the superior results for intramedullary nailing in terms of wound complications, we recommend this procedure for treatment of distal tibial fractures. More RCTs focused on distal tibial fractures are needed to support the current evidence.

Association of white matter hyperintensities with migraine features and prognosis.

BACKGROUND: White matter hyperintensities (WMHs) are frequently detected in migraine patients. However, their significance and correlation to migraine disease burden remain unclear. This study aims to examine the correlation of WMHs with migraine features and explore the relationship between WMHs and migraine prognosis. METHODS: A total of 69 migraineurs underwent MRI scans to evaluate WMHs. Migraine features were compared between patients with and without WMHs. After an average follow-up period of 3 years, these patients were divided into two groups, according to the reduction of headache frequency: improved and non-improved groups. The percentage and degree of WMHs were compared between these two groups. RESULTS: A total of 24 patients (34.8%) had WMHs. Patients with WMHs were significantly older (39.0 ± 7.9 vs. 30.6 ± 10.4 years, P < 0.001) and had a longer disease duration (median: 180.0 vs. 84.0 months, P = 0.013). Furthermore, 33 patients completed the follow up period (15 patients improved and 18 patients did not improve). Patients in the non-improved group had a higher frequency of WMHs (55.6% vs. 13.3%, P = 0.027) and median WMHs score (1.0 vs. 0.0, P = 0.030). CONCLUSIONS: WMHs can predict unfavorable migraine prognosis. Furthermore, WMHs may have a closer association with age than migraine features.

Migraine and percutaneous patent foramen ovale closure: a systematic review and meta-analysis.

BACKGROUND: The association between patent foramen ovale (PFO) and migraine with aura (MA) is well established. However, the benefits of PFO closure are less certain in patients with migraine without aura (MwoA). METHODS: We systematically searched Pubmed for pertinent clinical studies published from January 2000 to July 2015. The primary end-point was the elimination or significant improvement of migraine symptoms after PFO closure. RESULTS: Upon screening an initial list of 315 publications, we identified eight studies that included 546 patients. Overall, our analysis indicated a significant improvement of migraine in 81% of MA cases compared to only 63% of MwoA cases. The summary odds ratio was 2.5 (95% confidence interval 1.09-5.73), and the benefits of PFO closure were significantly greater for patients with MA compared to patients with MwoA (P = 0.03). CONCLUSIONS: The presence of aura provides a reference standard for the clinical selection of patients with migraine for PFO closure intervention.

Variance of Serum Lipid Levels in Stroke Subtypes.

BACKGROUND: An increasing number of epidemiological studies have identified a close relationship between dyslipidemia and atherosclerotic stroke. Indeed, lipid metabolism is significantly different among the different ischemic stroke subtypes. There are few studies available regarding risk factors for specific subtypes of ischemic stroke, and in particular, there is little evidence about the role of dyslipidemia. The aim of this study is to determine the relationship between acute ischemic stroke subtype and serum lipid level. METHODS: The levels of serum lipid including TC, TG, LDL-C, HDL-C, apoA, apoB, apoE, and LP (a) were tested in 362 ischemic stroke patients and 181 healthy controls. Lipid levels were analyzed in stroke subtypes according to the TOAST classification. RESULTS: Levels of TC, TG, LDL-C, apoA, apoB, apoE, and LP (a) were significantly higher and HDL-C levels were significantly lower in the patient group relative to control. The TC/HDL-C ratio, TG/HDL-C ratio, and LDL-C/HDL-C ratio were remarkably higher in the patient group. The levels of TC, TG, LDL-C, apoA, apoB, apoE, and LP(a) were markedly higher and HDL-C was markedly lower in the large-artery atherosclerosis stroke subtype relative to the cardioembolism subtype. Compared with the small-vessel occlusion group, the level of LP(a), TC, and TC/HDL-C were strikingly higher in the cardioembolism group. The TC/HDL-C ratio was different among subgroups, with the large-artery atherosclerosis group exhibiting the highest value. For TC, TG, LDL-C, apoA, apoB, apoE, LP(a), TC/HDL-C, TG/HDL-C, and LDL-C/HDL-C levels a statistically significant difference was found between the large-artery atherosclerosis group and the small-vessel occlusion group. CONCLUSIONS: We found that LDL-C and TC levels may be independent predictors for the occurrence of large-artery atherosclerotic stroke.

[Clinical observation of virtual reality technology combined with isokinetic strength training for patients after anterior cruciate ligament reconstruction].

OBJECTIVE: To explore application value and effectiveness of virtual reality technology combined with isokinetic muscle strength training in the rehabilitation of patients after anterior cruciate ligament (ACL) reconstruction surgery. METHODS: Forty patients who underwent ACL reconstruction surgery from December 2021 to January 2023 were selected and divided into control group and observation group according to treatment methods, 20 patients in each group. Control group was received routine rehabilitation training combined with isokinetic muscle strength training, including 15 males and 5 females, aged from 17 to 44 years old, with an average of (29.10±8.60) years old. Observation group was performed virtual reality technology combined with isokinetic muscle strength training, including 16 males and 4 females, aged from 17 to 45 years old with an average of (30.95±9.11) years old. Lysholm knee joint score, knee extension peak torque, and knee flexion peak torque between two groups at 12 (before training) and 16 weeks (after training) after surgery were compared. RESULTS: All patients were followed up for 1 to 6 months with an average of (3.30±1.42) months. There were no statistically significant difference in Lysholm knee joint score, peak knee extension peak torque, and peak knee flexion peak torque between two groups (P>0.05) before training. After training, Lysholm knee joint score, knee extension peak torque, and knee flexion peak torque of both groups were improved compared to before training (P<0.05);there were significant difference in Lysholm knee joint score, knee extension peak torque, and knee flexion peak torque between two groups(P<0.05). CONCLUSION: The application of virtual reality technology combined with isokinetic muscle strength training could promote recovery of knee joint function and enhance muscle strength in patients after ACL reconstruction surgery in further.

[The pharmacological mechanism of gastrodin on calcitonin gene-related peptide of cultured rat trigeminal ganglion].

The Chinese herbal medicine Tianma (Gastrodia elata) has been used for treating and preventing primary headache over thousands of years, but the exact pharmacological mechanism of the main bioactive ingredient gastrodin remains unclear. In present study, the effects of gastrodin on calcitonin gene-related peptide (CGRP) and phosphorylated extracellular signal-regulated kinase1/2 (pERK1/2) expression were observed in rat trigeminal ganglion (TG) after in vitro organ culture to explore the underlying intracellular mechanism of gastrodin on primary vascular-associated headache. CGRP-immunoreactivity (CGRP-ir) positive neurons count, positive area, mean optical density and integrated optical density by means of immunohistochemistry stain were compared at different concentrations of gastrodin, which was separately co-incubated with DMEM in SD rat TG for 24 hours. Only at 5 or 10 mmol L(-1) concentration, gastrodin demonstrated significantly concentration-dependent reduction of CGRP-ir (+) expression and its action closed to 1.2 mmol L(-1) sumatriptan succinate. While at 2.5, 20, and 40 mmol L(-1) concentration, gastrodin did not show remarkable effects on CGRP-ir (+) expression. The optimal concentration of gastrodin (5 and 10 mmol L(-1)) similarly inhibited CGRP-mRNA expression level separately compared with 1.2 mmol L(-1) sumatriptan succinate and 10 micromol L(-1) flunarizine hydrochloride, which was quantitatively analyzed by real-time PCR (RT-PCR). pERK1/2 level was examined by Western blotting after co-cultured with optimal concentration of gastrodin and effective specific ERK1/2 pathway inhibitors PD98059, U0126. The result indicated that gastrodin significantly reduced pERK1/2 protein actions similarly to ERK1/2 pathway specific blockade. It suggests ERK1/2 signaling transduction pathway may be involved in gastrodin intracellular mechanism. This study indicates gastrodin (5 and 10 mmol L(-1)) can remarkably reduce CGRP-ir (+) neuron, CGRP-mRNA and pERK1/2 expression level in cultured rat TG, with its actions similar to the effective concentration of sumatriptan succinate, flunarizine hydrochloride and specific ERK1/2 pathway blocker. The intracellular signaling transduction ERK1/2 pathway may be involved in the gastrodin reducing CGRP up-regulation in rat TG after organ culture.

Safety and efficacy of remote ischemic postconditioning after thrombolysis in patients with stroke.

OBJECTIVE: To determine the effect of remote ischemic postconditioning (RIPC) on patients with acute ischemic stroke (AIS) undergoing IV thrombolysis (IVT). METHODS: A single-center randomized controlled trial was performed with patients with AIS receiving IVT. Patients in the RIPC group were administered RIPC treatment (after IVT) during hospitalization. The primary endpoint was a score of 0 or 1 on the modified Rankin scale (mRS) at day 90. The safety, tolerability, and neuroprotection biomarkers associated with RIPC were also evaluated. RESULTS: We collected data from both the RIPC group (n = 34) and the control group (n = 34). The average duration of hospitalization was 11.2 days. There was no significant difference between 2 groups at admission for the NIH Stroke Scale score (p = 0.364) or occur-to-treatment time (p = 0.889). Favorable recovery (mRS score 0-1) at 3 months was obtained in 71.9% of patients in the RIPC group vs 50.0% in the control group (adjusted odds ratio 9.85, 95% confidence interval 1.54-63.16; p = 0.016). We further found significantly lower plasma S100-ß (p = 0.007) and higher vascular endothelial growth factor (p = 0.003) levels in the RIPC group than in the control group. CONCLUSIONS: Repeated RIPC combined with IVT can significantly facilitate recovery of nerve function and improve clinical prognosis of patients with AIS. CLINICALTRIALSGOV IDENTIFIER: NCT03218293. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that RIPC after tissue plasminogen activator treatment of AIS significantly increases the proportion of patients with an MRS score of 0 or 1 at 90 days.

Effects of a new magnesium-rich artificial cerebrospinal fluid on contractile 5-hydroxytryptamine and endothelin receptors in rat cerebral arteries.

Objectives Cerebral vasospasm after subarachnoid haemorrhage (SAH) is associated with cerebrovascular contractile receptor upregulation resulted from haemolysis in the subarachnoid space. This study developed a new magnesium-rich artificial cerebrospinal fluid (MACSF) formula and investigated its effects on receptor-mediated contraction in rat basilar arteries. Methods Clear and haemorrhagic cerebrospinal fluid (CSF) were collected from patients with hydrocephalus or SAH. MACSF was freshly prepared using clinical intravenous injections. Rat basilar arteries were segmented and incubated with clear CSF, haemorrhagic CSF or MACSF. The contractile responses were studied by myograph. The messenger ribonucleic acid (mRNA) and protein expression of 5-hydroxytryptamine 1B (5-HT1B), endothelin subtype B (ETB) and endothelin subtype A (ETA) receptors were evaluated by real-time polymerase chain reaction (PCR) and Western blot analyses. Results Haemorrhagic CSF exposure shifted the contractile curves induced by 5-hydroxytryptamine (5-HT), sarafotoxins 6c (S6c) and endothelin-1 (ET-1) leftward with increased maximal contraction values. Furthermore, mRNA and protein expression were markedly elevated for 5-HT1B, ETB and ETA receptors on arteries exposed to haemorrhagic CSF. However, the contractile responses to 5-HT, S6c or ET-1 and expression of 5-HT1B, ETB and ETA receptors in rat cerebral arteries exposed to MACSF remained unaffected compared to those exposed to clear CSF. Besides, unlike normal saline which can inactive in-vitro vessels, MACSF can maintain their physiological activity. Conclusion Haemorrhagic CSF induces upregulation of 5-HT1B, ETB and ETA receptors in rat cerebral arteries. However, MACSF can maintain in-vitro rat basilar arteries in good physiological activity and normal expression of contractile 5-HT and ET receptors.

[Preliminary analysis of the effect of different administration routes of tranexamic acid on blood loss after total hip arthroplasty for female femur neck fractures].

OBJECTIVE: To study curative effect of different administration routes of tranexamic acid (TXA) on blood loss of elderly female patients with femoral neck fracture in total hip arthroplasty. METHODS: From December 2015 to January 2018, 77 elderly women with femoral neck fractures undergoing total hip replacement were divided into four groups: group A, group B, group C, and group D. The group A (intravenous medication group) included 21 patients with an average age of (77.10±7.02) years old. The patients in group A received 15 mg/kg TXA intravenously 5 minutes before skin incision and intraoperative infusion of saline into the joint cavity. The group B(local medication group) included 18 cases, with an average age of (73.83±6.56) years old. The patients in group B received saline intravenously 5 minutes before skin incision and intraoperative infusion of 3 g TXA into the joint cavity. The group C (combined medication group) included 19 cases, with an average age of (74.26±6.04) year old. The patients in group C received 15 mg/kg TXA intravenously before operation and intraoperative infusion of 1.5 g TXA into the joint cavity. The group D (control group) included 19 cases, with an average age of (76.69±9.27) years old. The patients in group D received saline intravenously 5 minutes before skin incision and intraoperative infusion of saline into the joint cavity. The postoperative wound drainage volume, hemoglobin value, and the total blood loss calculated according to the height and weight and the hematocrit (HCT) before and after operation were observed and compared. RESULTS: In group A, the postoperative drainage was(111.91±35.02)ml; the change of hemoglobin was(26.86±12.99) g/L; and total blood loss was(628.60±306.78) ml. In group B, postoperative drainage was(108.89±36.61) ml; change of hemoglobin was(26.28±8.59) g/L; and the total blood loss was (584.41±250.86) ml. In group C, postoperative drainage was(102.63±47.36) ml; change of hemoglobin was (26.89±12.47) g/L; and total blood loss was(634.78±384.89) ml. In group D, postoperative drainage was(107.37±40.53) ml; change of hemoglobin was(40.95±12.48) g/L; and total blood loss was(1 005.24±483.37) ml. There were no significant differences among 4 groups in postoperative drainage volume (P>0.05). The hemoglobin and total blood loss in group A, B, and C were less than those in the group D(P<0.05), however, there were no significant differences among three groups(P>0.05). CONCLUSIONS: Application of TXA can effectively reduce blood loss during perioperative period of total hip arthroplasty for elderly women with femoral neck fracture. The best administration route and dosage should be further studied.

Carotid Plaque Stiffness Measured with Supersonic Shear Imaging and Its Correlation with Serum Homocysteine Level in Ischemic Stroke Patients.

Objective: To ascertain the feasibility of using shear wave velocity (SWV) in assessing the stiffness of carotid plaque by supersonic shear imaging (SSI) and explore preliminary clinical value for such evaluation. Materials and Methods: Supersonic shear imaging was performed in 142 patients with ischemic stroke, including 76 males and 66 females with mean age of 66 years (range, 45-80 years). The maximum, minimum, and mean values of SWV were measured for 129 carotid plaques. SWVs were compared between echolucent and echogenic plaques. Correlations between SWVs and serum homocysteine levels were investigated. Based on neurological symptom, the surrogate marker of vulnerable plaque (VP), binary logistic regression was performed and area under curve (AUC) of homocysteine only and homocysteine combing SWVmean was calculated respectively. Results: Echogenic plaques (n = 51) had higher SWVs than echolucent ones (n = 78) (SWVmin 3.91 [3.24-4.17] m/s vs. 1.51 [1.04-1.94] m/s; SWVmean, 4.29 [3.98-4.57] m/s vs. 2.09 [1.69-2.41] m/s; SWVmax, 4.67 [4.33-4.86] m/s vs. 2.62 [2.32-3.31] m/s all p values < 0.01). Pearson correlation analysis showed that stiffness of plaques was negatively correlated with homocysteine level. R values for SWVmin, SWVmean, and SWVmax were -0.205, -0.213, and -0.199, respectively. Binary logistic regression analysis showed that sex (p = 0.008), low-density lipoprotein (p = 0.015), triglycerides (p = 0.011), SWVmean (p = 0.004), and hyper-homocysteinemia (p = 0.010) were significantly associated with symptomatic ischemic stroke. Receiver operating characteristic curves revealed that SWVmean combing serum homocysteine level (AUC = 0.67) presented better diagnostic value than serum homocysteine only (AUC = 0.60) for symptomatic ischemic stroke. Conclusion: Supersonic shear imaging could be used to quantitatively evaluate stiffness of both echolucent and echogenic carotid plaques. More importantly, SWVs of plaques were not only correlated to serum homocysteine level, but also associated with symptomatic ischemic stroke, suggesting that SSI might be useful for understanding more about VP.

Role of endothelin­1 and its receptors in cerebral vasospasm following subarachnoid hemorrhage.

Cerebral vasospasm (CVS) is a severe complication of subarachnoid hemorrhage (SAH), and endothelin­1 (ET­1) may be involved in its pathogenesis. The present study aimed to investigate the expression of ET­1 in cerebrospinal fluid (CSF) in patients with SAH and to analyze rat arterial contractility and the expression levels of ET­1 receptors in vitro. CSF samples were collected from 28 patients and the expression levels of ET­1 were measured. Rat cerebral basilar arteries were isolated and incubated with hemorrhagic or clear CSF. Contractility, as well as ETA and ETB mRNA expression were measured. ET­1 levels in CSF increased and reached a peak within the initial 5 days after SAH onset and then gradually subsided. After 12 or 24 h, the contraction of arteries incubated in hemorrhagic CSF was substantially stronger than those in clear CSF. The mRNA expression levels of endothelin receptor type A and B in arteries incubated in hemorrhagic CSF were significantly higher than those in clear CSF. ET­1 and its receptors may be involved in the pathogenic mechanism of CVS following SAH. ET­1 expression in CSF may be used as a marker in CVS and its receptors may provide novel therapeutic targets in CVS.

Up-regulation of alpha1A-adrenoceptors in rat mesenteric artery involves intracellular signal pathways.

The aim of the present study was to investigate if there is an altered expression of alpha-adrenoceptors during organ culture of rat mesenteric artery segments by using a sensitive pharmacological method and molecular biological techniques. Noradrenalin (NA) induced contraction via alpha1-adrenoceptors. The contraction and alpha1A-adrenoceptor mRNA levels were elevated during organ culture. Transcriptional inhibitor actinomycin D, translational inhibitor cycloheximide, protein kinase C inhibitors (staurosporine and RO31-8220) and mitogen-activated protein kinase (MAPK) pathway inhibitors (SB386023, U0126 and SB239063) prevented the increase in NA-induced contractions. The amount of alpha1A-adrenoceptor mRNA was significantly lower in the artery segments cultured for 1 day in the presence of specific MAPK extracellular signal-regulated protein kinase1/2 pathway inhibitor SB386023 than that of the cultured controls. SB386023 did not affect alpha2-adrenoceptor mRNA level. Our results suggest that the up-regulation of alpha1A-adrenoceptors involves transcription and intracellular signal transduction via the protein kinase C and the ERK 1/2 pathways.

[Hypersensitization of alpha-adrenoreceptor of artery smooth muscle in hypertensive rats and hypertensive patients].

AIM: To investigate the hypersensitization of alpha-adrenoreceptor of artery smooth muscle in hypertensive patients and rats and the mechanisms concerned. METHODS: Isometric tension of artery ring segments was recorded by a sensitive myograph system in vitro and the relative amount of alpha-adrenoreceptor mRNA was quantified by a real-time PCR. RESULTS: Noradrenaline (NA)-induced concentration-contraction curve of mesenteric artery segments in spontaneously hypertensive rats (SHR) was more potent than that in Wistar-Kyoto (WKY) rats. The E(max) of NA in SHR was 1.82 times of that of WKY. The concentration-contractile curve induced by NA in great omental arteries of hypertensives significantly shifted toward left and the pD2 value of NA was larger than that of normotensives. After organ culture, the concentration-contractile curves of SD rat mesenteric artery induced by NA shifted toward left with significantly increased E(max). The relative amounts of mRNA for alpha1-adrenoreceptor was increased, but mRNA level for alpha2-adrenoreceptor did not change. CONCLUSION: The sensitivity of alpha1-adrenoreceptor of artery smooth muscle in hypertensive man and rat is enhanced, suggesting alpha1-adrenoreceptor is upregulated.

[ERK1/2 pathway involved in the expression of ETB receptors of the culturing smooth muscle cells of rat mesenteric artery].

AIM: To determine the involvement of extracellular signal-regulated kinase 1/2 (ERK1/2) pathway in the expression of endothelin receptor type B (ETB) during culture. METHODS: SB386023, a specific inhibitor for ERK1/2 pathway, was used to define the intracellular signaling pathway for the upregulation of ETB receptors and sarafotoxin 6c (S6c), a selective agonist for ETB receptors, induced contraction in isolated rat superior mesenteric arteries. The contraction was recorded by a sensitive in vitro myograph and the receptor mRNA was quantified by a real-time PCR. The phosphorylated ERK1/2 proteins were analyzed by phosphoELISA assay. RESULTS: S6c induced strong contractile responses of the artery after culture for 24 h, while there was no response to S6c in fresh vessel segments. The enhanced contractile response to S6c paralleled with an increase of mRNA for ETB receptors. The phosphorylated ERK1/2 proteins significantly increased after culture for 3 h. After co-culture with SB386023 for 24 h, S6c-induced contractions significantly decreased with reduction of Emax from (217 +/- 14) % to (127 +/- 23) % (P <0.01). This response paralleled with a decreased level of ETB receptor mRNA. CONCLUSION: ERK1/2 pathway was involved in the up-regulation of ETB receptors on smooth muscle cells isolated from rat mesenteric arteries during culture.

Enhanced transcription of contractile 5-hydroxytryptamine 2A receptors via extracellular signal-regulated kinase 1/2 after organ culture of rat mesenteric artery.

5-Hydroxytryptamine (5-HT) has been found to elicit enhanced contractile effects in some vascular disorders. The present study was designed to examine if vascular 5-HT2A receptors are up-regulated during organ culture and if the extracellular signal-regulated protein kinase 1/2 (ERK1/2) pathways are involved. Compared with fresh rat mesenteric artery ring segments, the contractile responses to 5-HT were significantly increased in the segments cultured for 6, 24 or 48 hr (P<0.05, P<0.01, P<0.01, respectively). The 5-HT-induced contraction occurred via 5-HT2A receptors, since the selective 5-HT2A antagonist ketanserin blocked the 5-HT-induced contraction in the fresh segments with a pA2 value 9.5 (slope was 0.98 with 95% confidence intervals from 0.8 to 1.1). A similar result was obtained in the segments cultured for 24 hr with a pA2 value of 9.43 (slope=0.91 and 95% confidence intervals between 0.45 to 2.3). In addition, the enhanced 5-HT2A receptor contraction occurred with a significant increase of 5-HT2A receptor mRNA (P<0.05). Organ culture of the mesenteric artery was found to activate ERK1/2 already within 1 and 3 hr. It is likely that the ERK1/2 pathways were involved as a initial switch, since the selective ERK1/2 pathway inhibitor SB386023 abolished both up-regulation of 5-HT2A mRNA transcription and the enhanced contractile response to 5-HT. These data reveal a role of ERK1/2 in up-regulation of 5-HT2A receptors and suggest a possibility to inhibit the enhanced responses to 5-HT by inhibition of the ERK1/2 pathway.

[Case-control study on effects of vacuum drainage on perioperative blood loss after total hip arthroplasty for the treatment of femoral neck fractures].

OBJECTIVE: To compare postoperative blood loss under different negative pressures of drainage after total hip arthroplasty for the treatment of femoral neck fractures. METHODS: From January 1st to December 30th 2013, 74 patients with femoral neck fractures treated with total hip arthroplasty were randomly divided into two groups: high negative pressure drainage group and low negative pressure drainage group. In high negative pressure drainage group, there were 34 cases including 10 males and 24 females, with a mean age of (75.94 ± 9.02) years old, and the patients were treated with 60 kPa negative pressure of drainage. In the low negative pressure drainage group, there were 40 cases including 13 males and 27 females, with an average age of (74.93 ± 8.90) years old, and the patients were treated with 30 kPa negative pressure of drainage. The amount of total drainage, total blood loss, and hemoglobin change were compared between these two groups. RESULTS: All the patients got primary healing without infections. In high negative pressure drainage group,the change of hemoglobin was (41.74 ± 15.69) g/L, total blood loss was (1,217.73 ± 459.50) ml and the drainage volume was (312.94 ± 103.44) ml; while in low negative pressure drainage group,the results were (34.90 ± 12.90) g/L, (904.01 ± 381.58) ml and (129.25 ± 44.25) ml separately. All the results in high negative pressure drainage group were higher than those in the other group. Three days after operation, the change of hemoglobin was (46.00 ± 13.29) g/L and total blood loss was (1,304.72 ± 421.75) ml; while in low negative pressure drainage group, the changes of hemoglobin was (43.87 ± 11.39) g/L and total blood loss was (1,196.78 ± 344.20) ml; there were no statistically significant differences between two groups. CONCLUSION: When placing drainage devices after total hip arthroplasty for the treatment of femoral neck fractures, the level of negative pressure should be chosen according to preoperative level of hemoglobin and HCT in patients. For old patients with femoral neck fracture, low negative pressure is more suitable.

Leptin receptor expression in the basolateral nucleus of amygdala of conditioned taste aversion rats.

AIM: To determine whether serum leptin level and the leptin receptor (OB-R) expression in the basolateral amygdala (BLA) change following conditioned taste aversion (CTA) formation. METHODS: The serum leptin concentration was measured by rat leptin RIA kit, long and short forms of leptin receptor (OB-Rb and OB-Ra) mRNA in the brain sections were examined by in situ hybridization (ISH) and the expression of OB-R was assessed by immunohistochemistry ABC method with a highly specific goat anti-OB-R antibody. RESULTS: The level of serum leptin didn't show significant difference between CTA and control group. Comparing with the control group, the CTA group had an increase on count of OB-R immunohistochemistry positive-stained cells in the BLA (127+/-12 vs 48+/-9 per 1 mm(2)). The OB-Rb mRNA expression level enhanced by 11.9 % in the BLA, while OB-Ra mRNA level increased by 7.4 % on the choroid plexus in CTA group. So BLA was supposed to be a region where interactions between gustatory and vagal signals take place. CONCLUSION: BLA is one of the sites, which are responsible for CTA formation in the brain. Leptin and OB-R maybe involved in neuronal communication for CTA. So leptin and its receptors probably take part in CTA and integration of autonomic and extroceptive information.

Early predictors of hematoma resorption rate in medically treated patients with spontaneous supratentorial hemorrhage.

Spontaneous intracranial hemorrhages are associated with a relatively high mortality rate, and there is no effective treatment so far. Hematoma resorption speed after intracranial hemorrhage (ICH) is believed to correlate with clinical outcome. However, little is known about hematoma resorption rates following spontaneous ICH. The aim of this study is to identify factors that can influence the rate of hematoma resorption in patients with spontaneous supratentorial ICH. We studied 80 patients admitted at the First Affiliated Hospital of Xi'an JiaoTong University from November 2008 to April 2012. The rate of hematoma resorption was calculated for each patient by measuring the variation in the volume of the hematoma (mL) from two computerized tomography brain scans divided by the time factor (days) separating the respective scans. Non-parametric and standard multiple linear regression methods were used for statistical analysis. The size of the hematoma was identified as a predictor of the rate of hematoma resorption. For supratentorial hematomas with a maximum volume of 45 mL, the larger the volume, the greater the rate of resorption. Non-hypertensive patients had a more favorable rate of hematoma resorption than those who were hypertensive. A low serum high-density lipoprotein (HDL) level (<0.83 mmol/L) was associated with a slower hematoma resorption rate. Therefore, a spontaneous ICH hematoma of less than 45 mL, a history of chronic hypertension, and a lower level of HDL were found to be the predictors of the hematoma resorption rate in the first 7-day period following ICH onset.

[The incidence of dementia among elderly people in Xi' an, China].

OBJECTIVE: To explore the incidence of dementia among elderly people in Xi'an and its related risk factors. METHODS: Subjects that had been studied on the prevalence of dementia were follow-up, and the incidence of dementia, Alzheimer disease (AD) , and vascular dementia (VD) were counted by person-years. The clinical diagnosis on dementia,AD and VD were based upon the 3rd Edition of Diagnostic and Statistical of Manual of Mental Disorder, Revised version (DSM-III-R) and NINCDS-ADRDA criteria. RESULTS: 2197 subjects of non-dementia being identified in 1998, were re-surveyed in 2001. Out of them, 47 new cases of dementia including 37 cases of AD and 8 cases of VD were identified, with an annual incidence rates of dementia, AD and VD as 0.68%, 0.54% and 0.12% among those of 55 years and over and 0.89%, 0.69% and 0.17% in 65 years and over, respectively. Analysis from single factor logistic regression showed that age and education but not gender were closely related to the occurrence of AD. On the contrary, age, hypertension and stroke were closely related to the occurrence of VD. CONCLUSION: The incidence of dementia in the "Xi' an cohort" was similar to that being reported from other countries. AD and VD were an age-related diseases but education seemed to have had great protective effect while lack of formal education served as risk factor to AD.