[Analysis of correlation factors of hyponatremia in elderly patients with hip fracture during perioperative period].

Objective: To examine the risk factors of hyponatremia during perioperative period for elderly hip fracture patients. Methods: Clinical data of 1 001 patients with hip fracture over 60 years old who received surgical treatment at Department of Orthopedics,Seventh Medical Center,People's Liberation Army General Hospital from January 2012 to December 2016 were retrospectively analyzed.There were 327 males and 674 females with a median age of 81 years (range: 60 to 104 years).There were 584 cases(58.34%) intertrochanteric fractures and 417 cases(41.65%) femoral neck fractures.Hyponatremia was defined as serum sodium concentration <135 mmol/L,and patients were divided into admission hyponatremia and postoperative hyponatremia according to the occurrence time of hyponatremia.Postoperative hyponatremia was divided into early postoperative hyponatremia (within 24 hours after surgery) and discharge hyponatremia (within 48 hours before discharge or death).Patients with hyponatremia can be divided into three types according to their condition changes:persistent hyponatremia,transient hyponatremia (hyponatremia on admission,but normal blood sodium after operation),and new postoperative hyponatremia (normal blood sodium on admission,hyponatremia after operation).The incidence rate,occurrence time and type of perioperative hyponatremia in elderly patients with hip fracture were analyzed,and univariate and multivariate Logistic regression analysis was used to examine the related factors of admission and postoperative hyponatremia. Results: Among 1 001 patients,126 patients (12.69%,126/1 001) had hyponatremia on admission,161 patients (16.3%,161/987) had hyponatremia after operation,140 patients (14.6%,140/960) had early postoperative hyponatremia,128 patients (14.0%,128/916) had discharge hyponatremia.Among the 916 patients with complete perioperative blood sodium concentration data,52 patients(5.7%) had persistent hyponatremia,64 patients(7.0%) had transient hyponatremia.Seventy-seven patients(8.4%) had new onset hyponatremia.Univariate analysis showed that age,male,intertrochanteric fracture of femur,white blood cell count,hemoglobin and albumin level were correlated with hyponatremia at admission (all P≤0.05). Hyponatremia at admission,dementia,and general anesthesia were associated with postoperative hyponatremia.Multivariate analysis showed that male(OR=1.788,95%CI:1.196 to 2.674,P=0.005) and white blood cell count(OR=1.116,95%CI:1.041 to 1.195,P=0.002) were independent risk factors for admission hyponatraemia,and albumin level(OR=0.932,95%CI:0.891 to 0.982,P=0.004) were protective factors, admission hyponatremia (OR=6.481,95%CI:4.125 to 10.182,P<0.01) was an independent risk factor for postoperative hyponatremia,while general anesthesia (OR=0.614,95%CI:0.383 to 0.986,P=0.044) was a protective factor. Conclusions: The incidence of hyponatremia in elderly hip fracture patients is high.Male and high level of white blood cell counts are independent risk factors for admission hyponatremia.High level of albumin is a protective factor for admission hyponatremia.Admission hyponatremia is an independent risk factor for postoperative hyponatremia,and general anesthesia is a protective factor for postoperative hyponatremia.

[Clinical significance of hyponatremia in hip fracture in elderly patients].

Objective: To investigate the outcome of hip fracture patients associated with hyponatremia. Methods: From January 2012 to December 2016, the data of 1 001 elderly patients with hip fracture treated in the Seventh Medical Center of PLA General Hospital were analyzed retrospectively. According to the level of serum sodium, the patients were divided into hyponatremia group (sodium<135 mmol/L) and non-hyponatremia group (sodium≥135 mmol/L), in which≥130-135 mmol/L was mild hyponatremia, ≥125-130 mmol/L was moderate hyponatremia, and<125 mmol/L was severe hyponatremia. The length of hospital stay, incidence of complications and mortality were compared between patient with hyponatremia and without; and the above three indexes between patients with mild hyponatremia and moderate severe hyponatremia were also analyzed. Results: There were 126 patients with hyponatremia, including 98 with mild hyponatremia (9.8%, 98/1 001), 18 with moderate hyponatremia (1.8%, 18/1 001), and 10 with severe hyponatremia (1.0%, 10/1001); of those patients, there were 53 males and 73 females, aged 82(78, 87) years. There were 875 patients in non-hyponatremia group, including 274 males and 601 females, and aged 81(75, 85) years. The mortality of 30 days, 1 year and overall were 9.5% (12/126), 26.2% (33/126) and 40.5% (51/126) in hyponatremia group, 3.5% (31/875), 14.2% (124/875) and 27.7% (242/875) in non-hyponatremia group, respectively; the differences between the two groups were all statistically significant (χ2=9.583, 12.031, 9.839, all P<0.05). After adjusting the age, sex, fracture type and coexisting diseases, hyponatremia was an independent risk factor for 30 days, 1 year and overall mortality, the OR(95%CI) was 2.744(1.331-5.654), 1.975(1.251-3.119), 1.637(1.099-2.440), respectively (all P<0.05). The 30 days, 1 year and overall mortality for mild hyponatremia were 6.1%, 24.5% and 37.8%, respectively; and those were 21.4%, 32.1% and 50.0% in patients with moderate and severe hyponatremia, respectively; only the difference for 30 days mortality was statistically different between two groups (χ²=4.278, P=0.039). The length of hospital stay for mild hyponatremia patients were 11 (9,16) d, and it was 12(10,18) d in patients with moderate and severe hyponatremia patients, and there was no significant difference between the two groups (Z=1.613, P=0.107). The incidence of complications was 22.9% (200/875) in non-hyponatremia group and 32.5%(41/126) in hyponatremia group, and there was significant difference between the two groups (χ²=5.649, P=0.017). Conclusions: Compared with non-hyponatremia, patients with hyponatremia have higher incidence of perioperative complications, longer hospital stay and higher mortality. With the increasing degree of hyponatremia, the above indicators tend to be serious.

Characterization of volatile compounds in fermented milk using solid-phase microextraction methods coupled with gas chromatography-mass spectrometry.

Lactic acid bacteria (LAB) are industrially important bacteria that are widely used in the fermented food industry, especially in the manufacture of yogurt. Characteristic flavors are produced by LAB during fermentation and storage that affect the quality and acceptability of fermented milk products. In this study, the volatile compounds in milk fermented by Streptococcus thermophilus IMAU80842 alone, Lactobacillus delbrueckii ssp. bulgaricus IMAU20401 alone, or both species together were identified using solid-phase microextraction methods coupled with gas chromatography-mass spectrometry. A total of 53, 43, and 32 volatile compounds were identified in milk fermented by S. thermophilus alone, L. delbrueckii ssp. bulgaricus alone, or both species together, respectively. The presence of some important flavor compounds was confirmed: acetic acid, acetaldehyde, acetoin, 2,3-butanedione, ethanol, and 1-heptanol. Our results demonstrate that the composition of the volatile compounds in fermented milk depends on the species of LAB used and whether they are used alone or in combination. This is important for the selection of appropriate starter cultures for the production of different types of fermented milk product with particular flavors.

Role of ERCC2 and ERCC3 gene polymorphisms in the development of osteosarcoma.

We conducted a case-control study to investigate the role of common SNPs in ERCC2 (rs13181 and rs1799793) and ERCC3 (rs4150441 and rs4150506) in the development of osteosarcoma. A 1:2 matched case-control study was conducted. Between January 2012 and December 2013, 141 patients with pathologically diagnosed osteosarcoma and 282 controls were recruited in our study. Genotyping of ERCC2 rs13181 and rs1799793 as well as ERCC3 rs4150441 and rs4150506 were performed using polymerase chain reaction coupled with restriction fragment length polymorphism. The genotype distributions of ERCC2 rs13181 and rs1799793 as well as ERCC3 rs4150441 and rs4150506 showed no significant difference between patients with osteosarcoma and controls, as analyzed by c2 tests. Multivariate logistic regression analysis did not reveal significant associations between ERCC2 rs13181/rs1799793 or ERCC3 rs4150441/ rs4150506 gene polymorphisms and the development of osteosarcoma in codominant, dominant, and recessive models. In conclusion, we did not find any association between ERCC2 or ERCC3 gene polymorphisms and the development of osteosarcoma. Future studies with larger sample sizes may contribute in elucidating the impact of ERCC2 and ERCC3 gene polymorphisms on osteosarcoma risks.

Alterations of resting-state regional and network-level neural function after acute spinal cord injury.

OBJECT: The purpose of this study was to investigate functional alterations of the brain in the early stage of spinal cord injury (SCI) and further investigate how these functional alterations relate to SCI patients' sensorimotor functions. METHODS: Twenty-five patients with SCI and 25 matched healthy controls underwent imaging by using resting-state functional magnetic resonance imaging (fMRI). The amplitude of low-frequency fluctuations (ALFF) were used to characterize regional neural function, and the seed-based functional connectivity (FC) was used to evaluate the functional integration of the brain network. RESULTS: Compared to healthy controls, patients with SCI showed decreased ALFF in the bilateral primary sensorimotor cortex, and increased ALFF in the bilateral cerebellum and right orbitofrontal cortex (OFC). The ALFF value in the left cerebellum was negatively correlated with the clinical total motor score in patients with SCI. Furthermore, SCI patients mainly showed decreased inter-hemispheric FC between the bilateral primary sensorimotor cortex, as well as increased intra-hemispheric FC within the motor network, including the primary sensorimotor cortex, premotor cortex, supplementary motor area (SMA), thalamus and cerebellum. Subsequent correlation analyses revealed that increased FC within the primary sensorimotor cortex, SMA, and cerebellum negatively correlated with the total American Spinal Cord Injury Association (ASIA) motor score. CONCLUSIONS: Our findings provide evidence that SCI can induce significant regional and network-level functional alterations in the early stage of the disease. We hypothesized these alterations may be an adaptive phenomenon following SCI, reflecting a compensatory mechanism during the early stage of SCI.

Brain sensorimotor system atrophy during the early stage of spinal cord injury in humans.

Spinal cord injury (SCI) usually leads to severe sensory and motor deficits below the spinal lesion. Previous animal models have shown significant atrophic changes in the neural sensorimotor system following SCI. However, specific anatomical changes in the human brain following SCI remain poorly understood. The purpose of the present study was to investigate structural changes during the early stage of SCI, and to investigate further the association between the structural changes and patients' sensorimotor functions. The study participants included 20 patients with SCI and 30 matched healthy controls. The mean period post-SCI was 8.9±2.7weeks (range 4-12weeks). Voxel-based morphometry was used to investigate the regions with gray and white matter volume changes. Compared to healthy controls, patients with SCI showed significant gray matter atrophy in the primary motor cortex (M1), primary somatosensory cortex (S1), supplementary motor area (SMA), and thalamus, as well as white matter atrophy in the corticospinal tracts at the level of the bilateral cerebral peduncles. In addition, gray matter volume in the primary motor cortex was positively correlated with the total American Spinal Injury Association motor score in patients with SCI. In conclusion, our findings suggest that SCI causes significant anatomical changes in the human sensorimotor system, and that these anatomical changes may occur in the early phase of SCI. Future treatments that aim to restore sensorimotor functions following SCI need to attend to these anatomical changes in the brain.

Preliminary selection for potential probiotic Bifidobacterium isolated from subjects of different Chinese ethnic groups and evaluation of their fermentation and storage characteristics in bovine milk.

A total of 29 strains of Bifidobacterium were isolated from 18 samples of human feces in different ethnic minority regions of China. All isolates were identified as Bifidobacterium longum (9 strains) and Bifidobacterium pseudocatenulatum (20 strains) based on 16S rRNA gene sequencing and phylogenetic analysis. These strains were preliminarily tested for their suitability to become probiotics by assessing their ability to survive adequately at low pH conditions and their tolerance of different concentrations of bile salts and simulated gastrointestinal juices. In vitro tests were sequentially used to predict the survival of these strains in the simulated conditions in the human gastrointestinal tract. These strains were first exposed to pH 2.5 for 3h, and 7 out of the 29 strains were discriminated from the others by their high survival rates. Out of these 7 strains, 4 were found to grow and survive well at an even lower pH of 2.0 and in high bile salt concentration. Apart from the gastrointestinal survival capacity, both fermentation efficiency and storage characteristics are important criteria for selecting for suitable potential probiotic strains. Therefore, the fermentation efficiency in bovine milk and the bacterial viability during the storage in the resultant fermented milk were also evaluated for these 4 selected strains. In this study, we isolated and identified 29 novel Bifidobacterium strains. Based on our initial evaluation, at least 4 of them may serve as valuable resources for further dairy probiotic strain selection.

A survey of the bacterial composition of kurut from Tibet using a culture-independent approach.

Kurut (fermented yak milk) made by natural fermentation is a very important dairy food for the local people in Tibet (China). It is important to fully understand the bacterial composition of kurut for quality improvement and industrial production. Because more than 99% of prokaryotes cannot be cultured and identified by methods currently used in taxonomy, we applied a culture-independent approach to explore the microbial biodiversity of this traditional food. In this study, a bacterial 16S rRNA gene clone library, including 460 clones, was constructed using total DNA extracted from 30 samples of kurut. After screening by restriction fragment length polymorphism (RFLP) analysis, 56 operational taxonomic units (OTU) with unique RFLP patterns were obtained. Then, 1 representative sequence of every OTU was sequenced and phylogenetically analyzed. The representative phylotypes were affiliated with 5 groups, including Lactococcus lactis ssp. lactis, Lactobacillus helveticus, Streptococcus thermophilus, Lactobacillus delbrueckii ssp. bulgaricus, and Acetobacter. In addition, nearly one-third of the representative clones (132 clones) had low similarity to species in GenBank (<97%), and these phylotypes were regarded as unknown bacteria. The characteristics of kurut are determined not only by lactic acid bacteria well known by the culture-dependent approach but also by bacteria that have not yet been identified.

Diversity of lactic acid bacteria associated with traditional fermented dairy products in Mongolia.

Spontaneous milk fermentation has a long history in Mongolia, and beneficial microorganisms have been handed down from one generation to the next for use in fermented dairy products. The objective of this study was to investigate the diversity of lactic acid bacteria (LAB) communities in fermented yak, mare, goat, and cow milk products by analyzing 189 samples collected from 13 different regions in Mongolia. The LAB counts in these samples varied from 3.41 to 9.03 log cfu/mL. Fermented yak and mare milks had almost identical mean numbers of LAB, which were significantly higher than those in fermented goat milk but slightly lower than those in fermented cow milk. In total, 668 isolates were obtained from these samples using de Man, Rogosa, and Sharpe agar and M17 agar. Each isolate was considered to be presumptive LAB based on gram-positive and catalase-negative properties, and was identified at the species level by 16S rRNA gene sequencing, multiplex PCR assay, and restriction fragment length polymorphism analysis. All isolates from Mongolian dairy products were accurately identified as Enterococcus faecalis (1 strain), Enterococcus durans (3 strains), Lactobacillus brevis (3 strains), Lactobacillus buchneri (2 strains), Lactobacillus casei (16 strains), Lactobacillus delbrueckii ssp. bulgaricus (142 strains), Lactobacillus diolivorans (17 strains), Lactobacillus fermentum (42 strains), Lactobacillus helveticus (183 strains), Lactobacillus kefiri (6 strains), Lactobacillus plantarum ssp. plantarum (7 strains), Lactococcus lactis ssp. lactis (7 strains), Leuconostoc lactis (22 strains), Leuconostoc mesenteroides (21 strains), Streptococcus thermophilus (195 strains), and Weissella cibaria (1 strain). The predominant LAB were Strep. thermophilus and Lb. helveticus, which were isolated from all sampling sites. The results demonstrate that traditional fermented dairy products from different regions of Mongolia have complex compositions of LAB species. Such diversity of LAB provides useful information for further studies of probiotic strain selection and starter culture design, with regard to the industrial production of traditional fermented milk.

Identification and characterization of the dominant lactic acid bacteria isolated from traditional fermented milk in Mongolia.

Five samples of Airag and 20 of Tarag (both in Mongolia) were collected from scattered households. One hundred strains of lactic acid bacteria (LAB) were isolated and identified from these samples according to phenotypic characterization and 16S rRNA gene sequence analysis. Eighty-five isolates belonged to the genus Lactobacillus, 15 being classified as coccoid LAB. All isolates belonged to 5 genera and 11 to different species and subspecies. Lactobacillus (Lb.) helveticus was predominant population in Airag samples, Lb. fermentum and Lb. helveticus were the major LAB microflora in Tarag.

Lumbar spinal fusion with a mineralized collagen matrix and rhBMP-2 in a rabbit model.

STUDY DESIGN: A new mineralized collagen matrix combined with or without growth factor was used for the posterolateral spinal fusion in the rabbit lumbar spine. OBJECTIVES: The availability of a new osteoconductive matrix with or without recombinant osteoinductive growth factors offers a possible alternative to the use of autogenous bone for grafting indications. This study evaluated the bone-forming activity of the biomimetic matrix: nano-hydroxyapatite/collagen/polylactic acid (nHAC/PLA) combined without or with recombinant human bone morphogenetic protein-2 (rhBMP-2) in a rabbit posterolateral spinal fusion. SUMMARY OF BACKGROUND DATA: Many bone grafting materials such as titanium alloy, ceramics, and polymers were used to repair bony defects. However, each has specific disadvantaged. The permanent implantation still has possibility to be eroded in vivo, which is caused by late breakdown and abscess formation. The acidic outcome of polymer biodegradation was also negatively affected in the later-stage results of bone repair. It needed a promising material for an alternative to the use of autogenous bone for grafting indications. MATERIALS AND METHODS: Sixty-four rabbits were randomly divided into four groups: autologous iliac crest bone group (ACB), nHAC/PLA composite group (nHAC/PLA), autologous iliac crest bone mixed with nHAC/PLA composite group (ACB + nHAC/PLA), nHAC/PLA composite with recombinant human BMP-2 group (nHAC/PLA + rhBMP-2). The lumbar intertransverse process fusions were assessed by manual palpation, radiographic, histologic, and mechanical strength, and scanning electronic microscopy (SEM) in a 10-week observation. RESULTS: Optimal formulations of the ACB + nHAC/PLA and nHAC/PLA + rhBMP-2 groups were shown to perform similar to ACB in both the fusion ratio and mechanical strength in the 6 and 10 weeks after surgery. From the microstructure analysis of the samples, there was no negative effect when the compound implanted this composite with autogenous iliac crest, and there was also new bone-like tissue formation implanted this composite without combined rhBMP-2 early at the second week after surgery. CONCLUSIONS: This study shows the effective results of nHAC/PLA in rabbit posterolateral spinal fusion combined with rhBMP-2. It is an alternative method to autograft by compounding this osteoconductive matrix with growth factors.

Evaluation and application of a bioluminescent bacterial genotoxicity test.

The Mutatox test (commercial name for the bioluminescent bacterial genotoxicity test) has been shown to be a good alternative to the Ames test. The test uses dark mutants of luminous bacteria (Vibrio fischeri) and determines the ability of various genotoxic agents to restore the luminescence by inducing mutation. It provides a rapid screening test which can be used to assay the genotoxicity of large numbers of pure and complex compounds. The test is completed in 1 day, and by serially diluting the compound, dose response data plus toxicity data can be generated for a number of samples simultaneously. For the direct assay (without exogenous metabolic activation), the positive controls selected were 3,6-diaminoacridine (proflavine) and N-methyl-N-nitro-nitrosoguanidine. For the S-9 assay, which incorporated the microsome fraction (S-9) from rat liver as an exogenous metabolic activation system, the positive controls selected were aflatoxin B1 and benzo(a)pyrene. This study also indicated that methyl-imidazo-quinoline and tryptophan pyrolysates were genotoxic in the presence of S-9 activation, aflatoxin B1 epoxide and fumonisin B1 showed direct genotoxic activity, and aflatoxin B2 and ochratoxin A were not genotoxic.

[Motor evoked potentials for the determination of experimental spinal cord injuries].

In testing the clinical use of motor evoked potentials (MEP), optimal responses were obtained while using a stimulus with an intensity of 1100 V. The studies of spinal cord lesion revealed that MEP was dependent primarily on anterolateral column pathways. MEP was shown to be produced in the muscle and was not the result of volume conduction. On the spinal cord injury, the studies revealed that MEP was a reliable indicator of the initial extent of injuries. No adverse effects from transcranial stimulation were identified by either histological examination of animal brains or EEG after stimulation of animal. During neurosurgery, motor evoked potentials can be use for monitoring and also for detecting the effects of different drugs in treating spinal cord injury.

Efficacy of hepatitis B immune globulin for prevention of perinatal transmission of the hepatitis B virus carrier state: final report of a randomized double-blind, placebo-controlled trial.

A randomized double-blind, placebo-controlled efficacy trial of hepatitis B immune globulin (HBIG) for prevention of the mother-to-infant transmitted HBsAg carrier state was conducted in Taiwan where the carrier rate in the general population is 15 to 20%. HBIG was given immediately after birth to infants of e antigen positive HBsAg carrier mothers, and all infants were followed for at least 15 months. Among 61 placebo recipients, the carrier rate was 92%; compared with 26% among 57 infants who received 0.5 ml HBIG at birth, 3 months, and 6 months, and 54% among 67 infants who received a single 1.0 ml dose of HBIG at birth only. Efficacy was 71 and 42%, respectively, for the two treatment schedules. The most common response of HBIG-treated infants was passive-active immunization which was 27% in the single-dose group and 61% in the three-dose group. Some of the infants who became carriers were probably infected as HBIG protection waned, and we expect that higher efficacy can be achieved by hepatitis B vaccine in conjunction with HBIG.

HBIG prophylaxis for perinatal HBV infections--final report of the Taiwan trial.

A randomized double blind placebo controlled efficacy trial of hepatitis B immunoglobulin (HBIG) for prevention of the mother to infant transmitted HBsAg carrier state was conducted in Taiwan where the carrier rate in the general population is 15% to 20%. HBIG was given immediately after birth to infants of e antigen positive HBsAg carrier mothers and all infants were followed for at least 15 months. Among 61 placebo recipients the carrier rate was 92%; compared with 26% among 57 infants who received 0.5 ml HBIG at birth, three months and six months and 54% among 67 infants who received a single 1.0 ml dose of HBIG at birth only. Efficacy was 71% and 42% respectively for the two treatment schedules. The most common response of HBIG-treated infants was passive-active immunization which was 27% in single dose group and 61% in three doses group. Some of the infants who became carriers were probably infected as HBIG protection waned and we expect that higher efficacy can be achieved by HB vaccine in conjunction with HBIG.