[Epidemiological survey of mental disorders in the rural left behind elderly aged 60 years and older in Gansu].

Objective: To investigate the prevalence, demographic characteristics and social life function of mental disorders in the rural left behind elderly aged 60 years and older in Gansu. Methods: Between November 2017 and June 2018, a multi-stage stratified cluster sampling method was used to randomly select the rural left behind elderly aged 60 years and older in Gansu, and totally 6 000 elderly were enrolled. By using the extended general health questionnaire (GHQ-12) and the American Handbook for Diagnosis and Statistics of Mental Disorders (DSM-Ⅳ) Axis Ⅰ Disorders Formal Clinical Examination Patient Edition, all the included subjects were screened and diagnosed. Functional status was assessed by the Global Assessment Function scale (GAF). Statistical analysis of the prevalence of various mental illnesses, as well as the differences in the prevalence of different gender, marital status and age groups was performed. Results: Totally, 6 000 subjects completed the survey. The adjusted current prevalence of any mental disorder was 20.11% (95%CI 17.70%-22.85%). The six most prevalent specific disorders were major depressive disorder (9.20%), pain disorder (2.71%), mood disorder due to the body condition (2.08%), generalized anxiety disorder (1.99%), anxiety disorder not otherwise specified (1.15%) and dysthymic disorder (0.84%). The lifetime prevalence of mental disorders was 20.54% (95%CI 18.40%-23.39%). The overall current prevalence of mental disorders was higher in women (242.89‰) than in men (119.55‰), and the unmarried (248.37‰) was higher than those married (187.53‰). There was no significant difference in the prevalence of mental disorders among different age groups (P>0.05). The GAF score of mental disorders was 56±11, and 71.82% was moderate to severe functional impairment. Conclusions: The prevalence of mental disorders is high in rural left-behind population aged 60 years and over in Gansu Province. Major depression is a condition that deserves special attention.

A rat model designed for the continuous intraarterial infusion of cyclosporine.

BACKGROUND: Limb allotransplantation is not a life-saving treatment. However, large doses of immunosuppressive agents are needed. There is an urgent need to increase the selectivity and targeting of drugs. METHODS: We designed a rat model for intraarterial infusion of cyclosporine (CSA) based on the hindlimb replanted model to simulate the limb allotransplantation. To investigate whether intraartery infusion could improve the drug's distribution, we infused CSA 4.0 mg/kg per day continuously into either the superficial epigastric artery (IA group) or superficial epigastric vein (IV group) of Lewis rats. RESULTS: On day 10, CSA concentrations were measured in skin, muscle, and bone tissues of hindlimb. Samples were taken from different parts of the bilateral hindlimbs in the IA group and right hindlimb only in the IV group. Tissue concentrations of the perfusion side were much higher in IA group. Systemic concentrations of IA group were higher than IV group. CONCLUSIONS: These results warrant further research in our next limb allotransplantation model.

Serial monitoring of co-stimulating signals in double hand allograft: a case report.

AIMS: The aim of this study was to evaluate the clinical significance of serial monitoring of co-stimulating signals in double hand transplantation. METHODS: From September 2001 to December 2001, a patient who had double hand transplantation in our hospital was the subject of the experiment. Before the operation, a blood sample was collected before giving an immunodepressant and twice after giving the immunodepressant. A blood sample was also collected before arteriovenous connection during the operation, as well as once a day during the first week after the operation, once every other day in the second week, twice a week in the third and fourth week, followed by once a week for 2 months. The first week after operation was taken as the induction period with the other samples as the maintenance period. Then 2 mL peripheral venous blood collected from a healthy adult was anti-coagulated using EDTA of mass scores of 20 g/L. Flow cytometry was used for serial monitoring of T-cell surface co-stimulating molecules (CD28, CD54, and CD11a). RESULTS: The changes in the 3 co-stimulating molecules-CD28, CD54, and CD11a-were consistent with each other after double hand transplantation, displaying a decrement during induction compared with preoperatively: 9.84 +/- 5.28%, 55.50 +/- 3.62%; 71.03 +/- 5.33% versus 95.10 +/- 1.26%; 9.40 +/- 9.17%, 29.70 +/- 3.23% with low levels during maintenance 22.54 +/- 6.56%, 91.28 +/- 8.12%, 11.22 +/- 4.08%. CONCLUSION: The serial monitoring of the co-stimulating signals in the peripheral blood of limb allograft patients may be beneficial to evaluate postoperative immunologic reactions to guide immunosuppression as well as predict and diagnose postoperative immune rejection.

[The effects of dexamethasone on biological characteristics of bone marrow stromal cells].

OBJECTIVE: To investigate the effects of dexamethasone on the proliferation and differentiation of bone marrow stromal cells(MSC). METHODS: MSC were isolated and cultured in vitro. After treatment with different concentrations of dexamethasone (0, 10(-10), 10(-9), 10(-8), 10(-7) and 10(-6) mol/L), the proliferation and alkaline phosphatase (ALP) activity of MSC were measured to evaluate the effect of dexamethasone on the biological characteristics of MSC. RESULTS: Dexamethasone inhibited cell proliferation. With the increase of concentration of dexamethasone, the effect was enhanced, which was more significant when the concentration of dexamethasone was over 10(-8) mol/L. At the same time, dexamethasone promoted the activity of ALP. This effect was enhanced with the increase of concentration of dexamethasone, but the alteration was small when the concentration of dexamethasone was over 10(-8) mol/L. The effects increased with the time. The activity of ALP was enhanced 2 to 4 times with the dexamethasone for 6 days. CONCLUSION: Dexamethasone inhabit the proliferation of MSC, while induce them to differentiate into osteoblasts. The appropriate concentration of dexamethasone was 10(-8) mol/L.

[Psychology during the process of human hand allograft].

OBJECTIVE: To study the psychology and its management during the process of hand allograft. METHODS: One psychologist participated through the whole process of the present hand allograft. 12 potential candidates of hand transplant were interviewed during the selection of patients to evaluate the state of psychiatry and their abilities to manage stressors like cooperation with medical workers and medical interventions, waiting for donors, adaptation to a new hand and post operation depression. The psychological state of 11 patients were believed to be able to receive hand transplant, and they are further prepared psychologically by the psychologist while waiting for a donor. Two lucky candidates were decided by tissue typing and received hand allograft simultaneously. After the operation, the two patients psychotherapy assisted with effective analgesia, supporting from family and environmental improvement. RESULTS: One out of 12 patients was found not suitable for the transplantation because of psychiatric problem. One week postoperation, the 2 patients were anxious, lack of patience, and horrified at seeing the long-expected grafted hand. After 1 week of treatments and adapation the patients managed to settle with the new hand, and accepted the hand as a whole 1 month postoperation. With the recovery of the hand sensation and motion 4 to 5 months postoperation, the patients held the hand as his own. CONCLUSION: Psychologists are required in the hand transplantation team during the pre-transplant selection of patients and post-transplant rehabilitation.

[Functional assess for reconstruction of tendon in finger amputation].

OBJECTIVE: To evaluate the function of injured hand after repair of finger stump and reconstruction of digit tendon attachment in finger amputation. METHODS: From 1992 to 1998, 20 cases with amputation of the 2nd to the 5th fingers were investigated, of which reconstruction of digit tendon attachment in 10 cases (group A) and routine operation without reconstruction of digit tendon attachment in other 10 cases (group B). After 6 months of operation, the tension test, fatigue test the sense of stability in motion and the perimeter of forearm in injured hand and the corresponding healthy hand were compared. RESULTS: The differences were remarkable (P < 0.01) between group A and group B in the tension test of injured finger, the fatigue test, the sense of stability in motion and the perimeter of injured arm. CONCLUSION: The digit of injured finger should be reconstructed in finger amputation in order to furthest maintain the function of injured hand.

[Development of biodegradable polymer scaffolds for bone tissue engineering].

OBJECTIVE: To investigate the selection and manufacture of ideal extracellular matrix materials in bone tissue engineering. METHODS: The recent literatures about biodegradable polymers served as culture scaffolds of osteoblasts were widely reviewed, the advantages and disadvantages of biodegradable synthetic polymers and natural polymers were analysed. RESULTS: The ideal extracellular matrix material in bone tissue engineering should be made up of inorganic materials, synthetic polymers and natural polymers, which possesses morphological structure of three-dimensional foam with self-mediated drug slow delivery system of bone growth factors. CONCLUSION: The design and manufacture of combined extracellular matrix materials in bone tissue engineering is a very important and urgent challenge.

[Biocompatibility studies on bioactive glass ceramics and polylactic acid combined with cultured bone marrow stromal cells in vitro].

OBJECTIVE: To study the biocompatibility on bioactive glass ceramics (BGC) and polylactic acid (PLA) combined with cultured bone marrow stromal cells (BMSCs) in bone tissue engineering. METHODS: BMSCs were cultured combined with BGC and PLA in vitro, and the morphological characters, cell proliferation, protein content, and alkaline phosphatase activity were detected. RESULTS: BMSCs could be attached to and extended on both BGC and PLA, and normally grown, proliferated, had active function. BGC could promote cell proliferation. CONCLUSION: The results show that both BGC and PLA have good biocompatibility with BMSCs, they can be used as biomaterials for cell transplantation in tissue engineering.

Reconstruction of the penis after severe injury.

Since 1986, five cases of one-stage reconstruction of the injured penis using microsurgical techniques have been successfully carried out. A piece of ilium based upon the deep circumflex iliac vessels is used to form the penis prop and a skin flap of the forearm is transferred to form the urethra and foreskin to encircle the prop. Then the vessels and nerves of the skin flap of the forearm are anastomosed with the vessels and nerves of the thigh. Postoperative follow-up showed the constructed penis to be satisfactory in contour, allow free flow of urine, provide cutaneous sensory recovery and satisfactory sexual function in four married patients. Radiography showed the bony structure of the penis prop to be normal. This method has advantages over the one-stage procedure in terms of contour, urinary flow, satisfactory sexual function and long-term benefits. Most of all it has solved the problem of poor blood supply into the reconstructed penis prop.

Replantation of multi-level hand severances.

Since 1990, the replantation of hands severed at multiple levels has been carried out successfully for 22 patients. In each case the motor and sensory functions of the hand were recovered satisfactorily. We suggest that such wounds should be named 'multi-level severances' and should be classified into five groups according to the wound localities. In order to shorten ischaemic time, debridement should be carried out simultaneously by several groups. The main technical points of the operation are: (1) The order of replantation for multiply severed fingers is that the most distant section should be reattached first, and then the more proximal part. (2) High quality blood vessel anastomosis must be ensured. (3) Avoid taking the blood vessels, nerves and tendons from severed region. (4) During the operation, care should be taken to ensure that the replanted fingers' segments are protected from collision and stretching. In the early stages following the operation correct functional exercise is very important.