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The study aimed to examine the effects of virtual reality (VR) technology-based phase I cardiac rehabilitation (CR) program in elderly coronary heart disease (CHD) patients after percutaneous coronary intervention (PCI). Thirty-six cases of elderly CHD patients who underwent PCI in the First Affiliated Hospital of Chongqing Medical University from June 2022 to April 2023 were recruited by convenience sampling method. The patients were randomly assigned by means of random digital table method to two study groups: control group (n = 18), which received conventional nursing intervention after PCI, and experimental group (n = 18), which received a combined program of conventional nursing intervention together with CR program based on VR technology. The 6 min walk test (6MWT), Simple Physical Performance Battery (SPPB), SF-36 scale, Hospital Anxiety and Depression Scale (HADS) and Impact of Events Scale-Revised (IES-R) were tested before and after rehabilitation. Moreover, the incidence of major adverse cardiovascular events (MACE) was recorded at 3 months after PCI. After VR-based CR, the 6MWT distance and SPPB scores of patients in the experimental group were higher than those in control group (P < 0.05). The HADS scores and IES-R scores of the patients in the experimental group were lower than those in control group (P < 0.01), and the difference in SF-36 scale scores was not statistically significant between two groups (P > 0.05). The incidence of MACE was not significantly different at 3 months after PCI (P > 0.05). These results suggest that VR-based phase I CR program mitigates the degree of PCI postoperative stress, anxiety, and depression in elderly CHD patients, however, enhances the resistance to fatigue and does not increase the risk of adverse cardiac events, suggesting it is a safe intervention.

Objective To observe the effect of calcified lymph nodes on video-assisted thoracoscopic surgery (VATS) lobectomy in the chronic obstructive pulmonary disease (COPD) patients with lung cancer. Methods A retrospective analysis was conducted on the COPD patients with lung cancer who underwent VATS lobectomy in the Department of Thoracic Surgery in the First Affiliated Hospital of Hebei North University from May 2014 to May 2018.The patients were assigned into a calcified lymph node group and a control group according to the presence or absence of calcified lymph nodes in CT,and the size,morphology,and calcification degree of the lymph nodes were recorded.The operation duration,intraoperative blood loss,chest tube retention time,hospitalization days,and overall complication rate were compared between the two groups. Results The 30 patients in the calcified lymph node group included 17 patients with one calcified lymph node and 13 patients with two or more calcified lymph nodes,and a total of 65 calcified lymph nodes were recorded.The calcified lymph nodes with the size ≤5 mm were the most common (53.8%),and complete calcification was the most common form (55.4%) in lymph node calcification.The mean operation duration had no significant difference between the calcified lymph node group and the control group ( t =-1.357, P =0.180).The intraoperative blood loss ( t =-2.646, P =0.010),chest tube retention time ( t =-2.302, P =0.025),and hospitalization days ( t =-2.274, P =0.027) in the calcified lymph node group were higher than those in the control group. Conclusion Calcified lymph nodes increase the difficulty and risk of VATS lobectomy in the COPD patients with lung cancer.The findings of this study are conducive to predicting the perioperative process of VATS lobectomy.

Mature biological phosphorus removal granules were inoculated into a SBR. The effect of the ammonia concentration on biological phosphorus removal granules system was investigated by increasing the concentration of ammonia in the influent. The ability of the system to withstand ammonia loading was determined. The results showed that when the influent ammonia concentration was below 45 mg·L -1 , the biological phosphorus removal granule system showed good performance. The TP removal efficiency was above 96%, the COD removal efficiency was over 89%. The effluent TP concentration and COD concentration were 0.4 mg·L -1 and 25 mg·L -1 respectively. The particle size was above 950 μm and the SVI was below 45 mL·g -1 . When the influent ammonia concentration was 60 mg·L -1 , the removal efficiency of TP was more than 95%. The effluent TP concentration was below 0.5 mg·L -1 , the particle size was 760 μm, and the SVI was 56 mL·g -1 . Furthermore, the biological phosphorus removal granules partially disintegrated and the metabolism and growth of PAOs began to be inhibited in the system. When the influent ammonia concentration reached 70 mg·L -1 , the removal efficiency of TP was 70%, the effluent TP concentration was about 3 mg·L -1 , the particle size was 570 μm, the SVI was 75 mL·g -1 , and the value of PN/PS was about 7.50. The biological phosphorus granules severely disintegrated and the metabolism and growth of PAOs was severely inhibited in the system. Moreover, as the influent ammonia concentration increased, the protein increased and polysaccharide decreased from the microbial secretion of biological phosphorus removal granules. Moreover, the value of PN/PS increased, the biological phosphorus removal granules disintegrated, the particle size decreased, the SVI increased, and the structure and function of the biological phosphorus removal granules were destroyed.

The effect of aeration densities (3, 6, 12) on the CANON process start-up were investigated in R1, R2, and R3 inoculated mature anaerobic ammonium oxide granule sludge under the same conditions of aeration and aeration/anaerobic time ratio (1:1) at 25℃. The results showed that R1, R2, and R3 of the CANON process were initiated in 32, 29, and 23 d, respectively. A greater aeration density promoted the start-up of the CANON process. In the cycle test, the pH of R1, R2, and R3 decreased by 0.4, 0.55, and 1.06, respectively. R3 exhibited excellent denitrification performance due to its large aeration density and suitable time interval, which increased system efficiency in DO and better inhibited NOB activity. According to the denitrification route analysis, there were two denitrification pathways of ANA and SNA in the system. The proportion of SNA was 19.3%, 24.5%, and 33.6%, respectively. With the increase in aeration density, the contribution of SNA increased gradually.

Matured nitrosation granules were inoculated to an anoxic-aerobic continuous-flow reactor at room temperature (17-19℃). The startup and stabilization of nitrosation with granules were studied. The results show that the nitrosation of the continuous-flow was successfully achieved with an average nitrite accumulation rate (NAR) above 95%. With the increase of the dissolved oxygen (DO) content from (3±0.2) to (4.5±0.2) mg·L -1 in the aerobic zone, the NAR remained above 95%. The effect of the hydraulic retention time (HRT) of the continuous-flow reactor was investigated. The short HRT (8.4 h) sped up the circulation of the sludge particles in the continuous-flow system such that the broken granular sludge could not be integrated in time, resulting in the deterioration of granular sludge settling and the loss of sludge granules. The performance of the system was restored with the increase of the HRT to 12.2 h and the continuous-flow system stabilized. The ammonia removal efficiency and NAR were 86.7% and 96.2% on day 166, respectively.

Anaerobic ammonium oxidizing bacteria were stored under NH 4 + -N and NO 2 - -N conditions (addition ratio 1:1) at a substrate concentration of 0, 60, and 120 mg·L -1 at 15℃±1℃ for 15 days. The effect of different substrate concentrations on the short-term storage and recovery of anaerobic ammonia oxidation sludge was investigated. After a short period of storage, a recovery experiment was performed. The results show that the anaerobic ammonia oxidation activities in the reactors 1, 2, and 3 decrease by 41.8%, 17.4%, and 33.4%, respectively. Because of the excessive endogenous respiration and high substrate concentration, the activities of the bacteria in reactors 1 and 3 were inhibited, respectively. Therefore, the activities decreased greatly. Because the substrate concentration was relatively suitable in reactor No. 2, excessive endogenous respiration and high substrate concentration inhibition were avoided such that the activity of the bacteria species was maintained at the substrate concentration. Endogenous respiration occurred during the storage period. Subsequently, the organic matter in the three reactors was consumed. As a result, the EPS content decreased by 50.9%, 41.7%, and 23.7% and the particle size decreased by 31.6%, 16.7%, and 8.2%, respectively. This shows that endogenous respiration is maintained by the bacteria in the matrix-deficient period and the higher concentration of the substrate can to some extent delay the endogenous respiration. During the recovery period, the three reactors recover the denitrification performances after 15, 10, and 7 d respectively. This shows that the denitrification performance of the system has a faster recovery through enhanced strain activities compared with the proliferation of the strain.

In this study, the effect of COD loading on a biological phosphorus removal granule system under different phosphorus concentrations was investigated by changing the concentration of total phosphorus (TP) and COD in the influent. The lowest concentration of COD for good performance of the biological phosphorus removal system under different phosphorus concentrations was obtained. The results show that when the concentration of TP was 10 mg·L -1 in the influent, the lowest concentration of COD for good performance of the biological phosphorus removal system was 175 mg·L -1 . The concentration of TP in the effluent was below 0.5 mg·L -1 ; the particle size and SVI were 1020 μm and 36 mL·g -1 , respectively; and the contents of PN and PS (by MLSS) were 78 mg·g -1 and 39 mg·g -1 , respectively. Furthermore, the PN/PS was lower and the granules had good structure and performance. When the concentration of TP was 6 mg·L -1 in the influent, the lowest concentration of COD for good performance of the biological phosphorus removal system was 150 mg·L -1 . The concentration of TP in the effluent was below 0.3 mg·L -1 ; the particle size and SVI were respectively 960 μm and 35 mL·g -1 ; and the contents of PN and PS were 75 mg·g -1 and 35 mg·g -1 , respectively. Moreover, the PN/PS was lower and the granules had good structure and performance. The removal efficiency of COD was above 83% and the concentration of COD in the effluent was below 25 mg·L -1 throughout the operational process. Under different the influent phosphorus concentrations, the contents of PN and PS decreased, PN/PS increased, particle size decreased, SVI increased, and the structure and performance of the biological phosphorus removal granules deteriorated as the COD concentration decreased.

Flocculent sludge with good nitritation performance and MLSS and SVI values of 3500 mg ·L -1 and 162 mL ·g -1 , respectively, was inoculated in the R1, R2, and R3 groups of the same SBR reactors at room temperature (22-28℃). The effects of different anaerobic time and aeration time ratios (1:2, 1:1, and 2:1) on the formation of partial nitrification granular sludge were studied. The results showed that granules in three reactors were successfully formed at 103 d, 82 d, and 64 d. The nitrosation rate of R1, R2, and R3 were 86%, 98%, and 96%, respectively, and SVI decreased to 89, 75, and 58 mL ·g -1 and MLSS increased to 2314, 2781, and 2946 mg ·L -1 , respectively, at the 85 d. The larger ratio of anaerobic time and aeration time was more conducive to sludge granulation, better settling, and nitritation performance. When the anaerobic time and aeration time ratio was 1:2, the nitritation performance of the sludge decreased since the NOB could not be suppressed, and the settling performance of the sludge became better and then worse. In addition, at the larger ratio of anaerobic time and aeration time, there was more PN and PS from microbial secretion. The PN of R1, R2, and R3 was smaller at the end of the anaerobic phase compared to that of the aerobic phase in the early stage of granular formation, but were reversed in the stabilization stage. The PS of the anaerobic phase was larger than that of the aerobic stage over the entire process.

The different effects of additional aerobic granules (AGs) and phosphorus removal granules (PRGs) on the start-up and stable operation of partial nitrification granular sludge (PNGS) were compared at room temperature(22-28℃). The results showed that in the first stage (days 0-22), partial nitrification was accomplished on day 19 for the three reactors (R1, R2, and R3). In the second stage (days 23-56), 20% AGs and 20% PRGs were added to R2 and R3 to induce PNGS. The start-up of the granules of the three reactors was successfully achieved. The mean particle sizes of R1, R2, and R3 reached 412 μm at day 76, 468 μm at day 42, and 400 μm at day 56. In the third stage (days 57-108), because the influent ammonia load increased from 0.4 kg·(m 3 ·d) -1 to 0.5 kg·(m 3 ·d) -1 and the COD load increased from 0.2 kg·(m 3 ·d) -1 to 0.5 kg·(m 3 ·d) -1 , the mean particle sizes of R1 and R2 increased significantly. The average particle sizes of R1 and R2 reached 689 μm and 893 μm by the end of the operation (day 108), but sludge expansion occurred in R3. The inoculation of either AGs or PRGs could quickly achieve granulation, but the PNGS inoculated with the AGs could adapt to higher C/N and be more tolerable to shock loads and long-term stable operation.

Trace chemical constituents from the ethyl acetate extract of Red Yeast Rice were investigated. Four phenolic compounds were isolated by various column chromatographies, and their structures were identified on the basis of spectroscopic analysis including UV, MS, IR and NMR. The four compounds were identified as 2-methyl-5-(2'R-methyl-4'-hydroxy-butyl)-cinnamic acid(1), 5-(2'-hydroxy-6'-methyl phenyl)-3-methylfuran-2-carboxylic acid(2), daidzein(3), and genistein(4). Compound 1 was new and 2 was firstly discovered from the genus Monascus, while 3-4 were obtained from Red Yeast Rice for the first time., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Chinese Pharmaceutical Association.)

The experiment explored the effect of different seeding sludge on the rapid start-up of an anaerobic ammonium oxidation (ANAMMOX) reactor by seeding a single type of denitrified granular sludge and a mixed sludge composed of denitrified granular sludge and aerobic nitrification sludge (the volume ratio of the mixed sludge was 2:1) in two sequencing batch reactors (SBR), R0 and R1, respectively. The results indicated that R0 was started up successfully on day 64 with a nitrogen removal rate (NRR) of 0.26 kg·(m 3 ·d) -1 , while R1 was started up by day 47 with a NRR of 0.30 kg·(m 3 ·d) -1 , which was shorter than R0 by 17 d. In the enrichment stage, reddish sludge appeared in R1, and the characteristics of anaerobic ammonium oxidation of the system were more obvious than in R0. After the reactor was started up successfully, the stoichiometric ratio of R0 was 1.20 and 0.34, respectively, and the stoichiometric ratio of R1 was 1.26 and 0.21, which was closer to the theoretical values of 1.32 and 0.26. The mixed liquor suspended solids (MLSS) and mixed liquor volatile suspended solids (MLVSS) of R0 were restored to 51% (4.2 g·L -1 ) and 38% (2.3 g·L -1 )of the initial seeding sludge, respectively, while the MLSS and MLVSS of R1 were restored to 54% (4.4 g·L -1 ) and 42% (2.6 g·L -1 ),which was higher than R0. It can be speculated that the proliferation rate of AnAOB in R1 was faster than in R0. Seeding mixed sludge can accelerate the start-up process of anaerobic ammonium oxidation with more stable N-removal performance.

Objective: To evaluate the curative effect and surigical skills of reconstruction intramedullary nailing in the treatment of ipsilateral femoral neck and shaft fractures., Methods: From January 2007 to January 2013, 13 patients with ipsilateral femoral neck and shaft fractures were treated by reconstruction intramedullary nailing including 11 males and 2 females with an average age of 38.9 yeas old ranging from 25 to 53 years old. For femoral neck fractures,10 cases were basilar neck fracture, 3 were transcervical fractures and according to Garden classification,10 were type II, 2 were type III and 1 was type IV. For feormal shaft fracture, 5 were type I, 4 were type II, 3 were type III and 1 was type IV according to Winquist classification. The location of all 13 feormal shaft fractures were all in the uper 3/4 of the feormal shaft. Complications and postoperative function were recorded and evaluated., Results: Eleven patients were followed up for 23.45 months (12 to 36 months). Time from injury to operation was 5.9 days in average. Malunion of femoral neck fracture happened in 1 patient, nonunion of femoral shaft fracture happened in 2 patients. NO femoral head osteonecrosis, infection and malunion of femoral shaft fracture happened. According to Friedman-Wyman classification, 8 cases get good result, 2 get faii and 1 get poor., Conclusion: Reconstruction intramedullary nailing is a good choice for the ipsilateral femoral neck and shaft fractures with the advantages of less soft-tissue trauma and complications.

Objective: To investigate the effect of renal sympathetic denervation on left ventricular hypertrophy and inflammatory factors in spontaneously hypertensive rats., Methods: Thirty six spontaneously hypertensive rats (SHR) were divided into 3 groups with 12 animals in each group: SHR control group,operation group and sham operation group. Bilateral renal sympathectomy or sham operation were performed in operation and sham groups,respectively; another 12 WKY rats served as normal controls. The blood pressure and body weight were examined weekly. The animals were sacrificed at w1 and w6, rat hearts were collected and left ventricular mass index (LVMI) was calculated. The expression of TLR4,TNF-α and IL-6 in heart tissue were detected by immunohistochemistry and Western blot., Results: The systolic blood pressure [(201.67 ± 11.09) mmHg compared with (140.0 ± 10.86)mmHg,P<0.05],diastolic blood pressure [(144.50 ± 10.48)mmHg compared with (78.50 ± 7.32)mmHg,P<0.05], LVMI (2.44 ± 0.05 compared with 1.93 ± 0.05,P<0.05),the expression of TLR4 (0.298 ± 0.004 compared with 0.126 ± 0.004, P<0.05), NF-κB (0.249 ± 0.006 compared with 0.195 ± 0.005, P<0.05),TNF-α(0.323 ± 0.004 compared with 0.146 ± 0.004,P <0.05), IL-6 (0.283 ± 0.005 compared with 0.207 ± 0.006, P<0.05) in SHR control group were significantly higher than those in WKY group. Compared to sham operation group,the systolic blood pressure (157.30 ± 9.35 compared with 197.30 ± 11.5, P<0.05),diastolic blood pressure (112.50 ± 6.25 compared with 146.80 ± 7.6, P<0.05),LVMI (2.32 ± 0.04 compared with 2.57 ± 0.09, P<0.05, TLR4 (0.198 ± 0.006 compared with 0.317 ± 0.008, P<0.05), NF-κB (0.208 ± 0.006 compared with 0.332 ± 0.007, P<0.05), TNF-α(0.27 ± 0.009 compared with 0.375 ± 0.004,P<0.05), IL-6 (0.218 ± 0.004 compared with 0.376 ± 0.009, P<0.05) in operation group were all decreased at w1 after sympathectomy. Six weeks after the operation,there were no significant differences in systolic blood pressure (197.50 ± 12.13 compared with 208.83 ± 10.23,P>0.05) and diastolic blood pressure (150.33 ± 7.74 compared with 151.50 ± 8.22, P>0.05) between denervated and sham-operated SHRs; however,the LVMI (2.46 ± 0.07 compared with 2.81 ± 0.05,P<0.05) and the expression of TLR4(0.301 ± 0.009 compared with 0.567 ± 0.006, P<0.05), NF-κB (0.251 ± 0.004 compared with 0.476 ± 0.009,P<0.05),TNF-α(0.324 ± 0.005 compared with 0.535 ± 0.006, P<0.05,IL-6 (0.285 ± 0.009 compared with 0.549 ± 0.007, P<0.05) in operation group were still significantly lower than those in sham operation group., Conclusion: Renal sympathetic denervation can significantly delay the progression of LVH in SHR, which may associated with lowering blood pressure and decreasing expression of TLR4, NF-κB,TNF-α, IL-6 in myocardial tissue.

Objective: To evaluate the methods and therapeutic effects of the posterior cruciate ligament (PCL) reconstruction with remnant preservation and no preservation., Methods: From January 2006 to January 2011,45 patients received arthroscopic PCL reconstruction by using hamstring tendon autograft fixed with bioabsorbable interference screw. Twenty-five patients were treated with PCL reconstruction with remnant no preservation, including 19 males and 6 females. During the operation, remnant PCL was not preserved, double-screws and whole-bone-tunnel technique was used to fix the tibial side. Twenty patients were treated with PCL reconstruction with remnant preservation, including 15 males and 5 females. Although the fixation technique was similar to the remnant no preservation group, the remnant was preserved. All the patients were followed up with a mean period of 18 months. Each patient was evaluated using the following variables: posterior laxity on KT-2000, Lysholm knee score, International Knee Documentation Committee (IKDC) knee score and grade., Results: At the latest follow-up, the results of mean side-to-side differences in posterior tibial translation, Lysholm knee score and IKDC score were (4.2 +/- 2.1) mm, 84.3 +/- 10.5 and 64.5 +/- 8.8 in the remnant no preservation group separately, and (3.9 +/- 1.8) mm, 86.5+/- 8.9 and 68.6 +/- 7.9 in the remnant preservation group separately. There were no statistical differences of above results between the two groups. However, IKDC objective grade differed significantly between the two groups and the result in remnant preservation group was better than that of remnant no preservation group., Conclusion: Remnant preservation in PCL reconstruction can provide better activity-related outcomes than remnant no preservation.

Objective: To explore the feasibility and effect of percutanuous cannulated pedicle screw AF system fixation for the treatment of thoracolumbar flexion-distraction fracture without neurologic impairment., Methods: From June 2008 to June 2010,21 patients with thoracolumbar flexion-distraction fracture were treated with percutanuous cannulated pedicle screw fixation. There were 16 males and 5 females with the mean age of 32.7 years ranging from 23 to 55 years. Injured levels 5 cases was in T12, 13 was in L1, 3 was in L2. According to classification of AO, B1 was in 13 cases, B2 was in 8 cases. ASIA grade of all the patients were grade E. The mean operative time, bleeding volume, lengths of stay were evaluated. All the patients took the X-ray and three-dimensional CT reconstruction to observe the fracture healing and to measure the height of the anterior border of fracture vertebral body and the Cobb angle of kyphosis. The visual analogue scales (VAS) were compared preoperation and postoperation. The clinical effects were analyzed according to Oswestry Disability Index (ODI) from 10 aspects, including pain intensity, personal care, lifting, walking, sitting, standing, sleeping, sex life, social life, traveling., Results: All the operations were successful and the mean time was (109.0+/-16.0) min, blood loss was (90.0+/-15.0) ml, lengths of stay was (7.7+/-2.3) d. No postoperative neurological deficits or wound infection occured. One case occurred subcutaneous fluid of incision and 1 case occurred delayed healing of incision. Fifteen patients were followed up with an average of 16.7 months (12-33 months). The VAS score improved from preoperative 8.3+/-1.7 to 1.8+/-1.2 at final follow up (P<0.05). The ODI of last follow-up was (10.0+/-1.2)%. Three-dimensional CT reconstructions and X-rays showed the height of vertebral body increased from preoperative (54.0+/-17.1)% to (82.7 - 3.5)% at 12 months after operation (P<0.05). Cobb angle of kyphosis changed from preoperative (23.0+/-13.1) to (6.9+/-5.1) degrees at 12 months after operation (P<0.05). The healing time of fracture was (4.7+/-0.3) months. There were no significant loss of vertebral height or kyphosis correction between postoperative 1 months and last follow-up (P>0.05). There were satisfactory fracture reduction and good position of internal fixation,and no loss of reduction within 12 months and no fixation failure in follow-up., Conclusion: The minimally invasive percutaneous cannulated pedicle screw fixation technique is feasible in treatment of thoracolumbar flexion-distraction fracture without neurologic impairment. This technique can avoid re -injury of posterior ligaments and bone structure, and may rebuild posterior tension band structure with the advantages of less trauma, less bleeding,shorter operative time, rapid postoperative recovery and so on.

Objective: To investigate the effect of liver X receptor agonist T0901317 on transforming growth factor-β1 (TGF-β1)-induced expression of α-smooth muscle actin (α-SMA) in normal human lung fibroblasts., Methods: Primary normal human lung fibroblast isolated from the lung specimens of lung cancer patients by explant culture technique were identified with immunostaining for vimentin and keratin. The cells in passages 4 to 10 were treated with T0901317 and/or TGF-β1, and RT-PCR, Western blotting and immunofluorescence assay were used to detect α-SMA expression in the fibroblasts., Results: Lung fibroblast expressed vimentin but not keratin. The results of RT-PCR, Western blotting and immunofluorescence assay all showed that normal human lung fibroblasts constitutively expressed α-SMA under baseline condition, and TGF-β1 at 5 ng/ml induced a significant upregulation of α-SMA both at the mRNA and protein levels. Liver X receptor agonist T0901317 (5 µg/ml) significantly inhibited TGF-β1-induced upregulation of α-SMA expression., Conclusion: Liver X receptor agonist T0901317 can inhibit the upregulation of α-SMA in normal human lung fibroblasts induced by TGF-β1, suggesting the potential value of liver X receptor agonist in the treatment of lung fibrosis.

Objective: To evaluate the value of modified physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) scoring system in predicting mortality and morbidity for the intertrochanteric fracture in elder patients., Methods: A retrospective study was conducted over a period of nearly 2 years from January 2007 to December 2008. Complete data from 119 patients were analyzed to compare the mortality and morbidity predicted by the POSSUM and the observed mortality and morbidity. POSSUM risk was calculated using the original POSSUM equation., Results: POSSUM predicted 11(9.2%) deaths, which had no statistical significance with the observed mortality 5 (4.2%) (chi² = 2.412, P = 0.120). The estimated incidence of postoperative complications was 42 (35.3%), which also has no statistical significance with the observed morbidity 39 (32.8%) (chi² = 0.168, P = 0.682)., Conclusions: The modified POSSUM scoring system can predict accurately postoperative mortality and morbidity for the patients underwent intertrochanteric fracture and it predict more accurately in high risk band. The physiological score can be used to evaluate the physiological conditions preoperative and the pulmonary disease is the most important factor lead to death of the elder patients underwent intertrochanteric fracture.

Objective: To report the clinical outcome of the treatment of compound ankle fractures by vacuum sealing drainage and spanning external fixator., Methods: From April 2005 to April 2009, 19 cases of Gustilo type III compound ankle fractures were treated, with type IIIA in 10 cases, Type IIIB in 7 and Type IIIC in 2. All cases underwent emergency debridement, and had the fractures fixed with spanning external fixator following indirect reduction, the wound closed with vacuum sealing drainage and repaired through direct suture, split-thickness skin graft or flap transposition., Results: In this series, following VSD of 5.0 to 18.0 d (mean 10.3 d), 2 cases had their wounds closed by direct suture, 12 by skin graft and 3 by flap transposition. The other 2 cases had repeated wound debridement and multiple use of VSD, and had their wounds repaired by flap transposition. All the 19 cases were followed up for 8 to 36 months with an average of 26 months. All the fractures united 3.0 to 10.0 (mean 3.8) months. At the final follow-up functional evaluation of the affected ankle joints was performed only to find excellent in 9 cases, good in 5, fair in 4 and poor in 1., Conclusion: Gustilo type III compound ankle fracture can effectively be treated with VSD and spanning external fixator.

Objective: To study the effects of ketamine combined with penehyclidine hydrochloride on the learning and memory abilities and the expression of synaptophysin in the hippocampus CA3 region in the brain of neonatal rats., Methods: Eighty seven-day-old Sprague-Dawly rats were randomly intraperitoneally injected with 50 mg/kg of ketamine (K group), 2 mg/kg of penehyclidine hydrochloride (P group), 50 mg/kg of ketamine plus 2 mg/kg penehyclidine hydrochloride (PK group) or normal saline (control group). The rats were trained and tested in a Morris water maze 14 days after administration. The immunhistochemical method was used to ascertain the expression of synaptophysin in the hippocampus CA3 region 24 hrs, 14 days and 28 days after administration., Results: In the Morris water maze training, the rats in the PK group performed worst, followed by the K group. The rats from the P and NS groups performed well. Compared with the NS group, the expression of synaptophysin in the K and the PK groups decreased significantly 24 hrs and 14 days after administration (p<0.05). The PK group had lower synaptophysin expression than the K group 24 hrs and 14 days after administration (p<0.05). Up to 28 days after administration, the synaptophysin expression increased in all of the four groups and there were no significant differences between groups., Conclusions: Ketamine combined with penehyclidine hydrochloride may inhibit more significantly learning and memory abilities and the synaptophysin expression in the hippocampus CA3 region than ketamine alone in neonatal rats. Penehyclidine hydrochloride alone has no effect on learning and memory abilities and the synaptophysin expression. The synaptophysin expression may increase to a normal level by training and with increasing age.

Objective: To evaluate the safety and efficiency of treating the senile intertrochanteric fractures with cannulated compression screws (CCS) with across solid frame in femur head via biomechanical tests and clinical application., Methods: Biomechanical tests: the fracture model was made in 31-A1.3 style, 6 pairs of flesh and embalmed cadaveric femurs were mechanically tested in a single-limb stance configuration. A material testing machine was used to apply vertical loads onto the femoral head. Both stiffness and reverse turn were recorded. Clinical application: from 1998 to 2006, According to damage control orthopedics (DCO) and American Society of Anesthesiologists (ASA) and the Evans classification, 51 patients received treatment with CCS with across solid flame in femur head. All the cases were followed up for 12 to 36 months (mean: 18 months)., Results: the differences between two groups in BMD (bone mineral density) were of statistical significance. And tensile rigidity and torsional rigidity of CCS were strong enough to bear weight. The CCS group had a lesser amount of blood loss or transfusion and lower treatment expenses., Conclusion: Cannulated compression screw with across solid flame is strong enough to be employed as an effective method to treat aged intertrochanteric hip fractures with the advantages of simple procedure, minimal invasion, stable fixation and weight bearing.

Objective: To investigate the clinical manifestations, laboratory test, treatment and outcome of neuropsychiatric (NP) involvement in pediatric systemic lupus erythematosus (SLE) patients., Methods: Seventy-seven patients with NP syndromes of SLE (NPSLE) seen from 1987 to 2007 were retrospectively reviewed. The relationship between the relative factors and the relapse of NPSLE was analyzed with logistic regression model., Results: NPSLE was found in 17.3% of the SLE patients and 75% of the NPSLE patients the NP involvements occurred in the first 2 years of the onset of SLE. The most frequent NP manifestations were headache (31.8%) and seizure disorder (29.1%). In the active phases, the levels of Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores of the 92.2% patients were higher than 15 and belonged to severe lupus. The patients were accompanied frequently with fever (88.3%) and rash (84.4%). The most frequently involved organs were kidney (76.6%) and blood system (67.5%). In the active phases, the ANA was positive (98.7%), the level of ESR increased (86.3%), the level of complement profile decreased (72.7%). The cerebrospinal fluid (CSF) study, the CT, the MRI and the EEG were abnormal (90.1%, 60.7%, 54.8%, 73.9%, respectively). All the patients received glucocorticoids and immunodepressant treatment in which 79.2% received IV high-dose methylprednisolone (MP), 51.9% received intrathecal (IT) methotrexate (MTX) and dexamethasone (DXM), 26.0% received IVIG, 2 patients received autologous peripheral blood stem cell transplantation. The mortality was 9.0%. The rate of relapse was 22.0% and in 75.0% of relapsed patients the relapse occurred within 24 months from the onset of NPSLE. The SLEDAI scores related to the relapse of the NPSLE (chi(2) = 3.987, P = 0.0459, OR = 1.172, 95% CI 1.003 and 1.370)., Conclusion: SLEDAI scores were significantly helpful in predicting recurrence of NPSLE.

The paper introduces the Change Data Capture based on change-track-table implementation in hospital information system. It improves efficiency of the change data capture and distribution in the data flat.

This paper introduces a data warehouse model for outpatient payments, which is designed according to the requirements of the hospital financial management while dimensional modeling technique is combined with the analysis on the requirements. This data warehouse model can not only improve the accuracy of financial management requirements, but also greatly increase the efficiency and quality of the hospital management.

Objective: To evaluate the effects of tibial shaft fractures treatment with plate-screw or intramedullary interlocking nail., Methods: Thirty-five fractures were treated with intramedullary interlocking nail. Tape A, B and C were 11, 18 and 6 cases respectively according to AO classification. Forty-five fractures were treated with plate-screw system. Type A,B and C were 10,22 and 13 cases respectively. The mean time between injury and operation was 3 days and 3.5 days respectively. The patients were evaluated with operation time,range of motion,time of bone union,and complications after a mean followup of 13 months(range 8 to 26 months)., Results: The mean operation time and the mean range of motion of the ankle and knee were found similar in both groups. The average dorsiflexion angle of ankle was 13 Degrees (0 degrees to 20 degrees) in locked intramedullary nailing group and 11 degrees (0 degree to 20 degrees) in plate group. The average plantar flextion angle of ankle was 41 degrees (30 degrees to 50 degrees) in locked intramedullary nailing group and 47 degrees (30 degrees to 50 degrees) in plate-screw group. The mean time of bone union was 3.3 months with intramedullary nailing and 3.5 months with plate-screw fixation. Length discrepancy occurred in only two patients (2 and 2.5 cm) with intramedullary interlocking nail. One patient treated by intramedullary interlocking nail for a type III open fracture occured osteomyelitis. Plain radiographs showed rotation in two patients with intramedullary interlocking nail and angulation in 3 patients with plate-screw fixation, which were distal-third tibial fractures., Conclusion: Plate-screw osteosynthesis could attain satisfactory results in uncomminuted tibia shaft fractures, and locked intramedullary nailing is more appropriate in comminuted fractures.

Objective: To report the clinical results of hemiprosthesis for unstable intertrochanteric fractures in elderly patients., Methods: 86 cases (male 35 and females 51) of unstable intertrochanteric fractures in elderly patients were treated with hemiprosthesis arthroplasty in our hospital. The average age was 87 years old (range from 80 to 98 years old). According to the Evans classification of intertrochanteric fractures, there were 31 cases in type IIIA, 35 cases in IIIB and 20 cases in type IV. Most of the patients fell in the room and fractured, with concomitant diseases. After admitted to the hospital, the patients were consulted and treated for the concomitant diseases, and after the general conditions got stable and no absolute contraindications were found, the hemiprosthesis arthroplasty was performed. Almost all of the patients were operated on within 3 days with general anesthesia under the multi-function monitoring. The greater trochanter was reconstructed with figure of 8 wire fixation, the lesser trochanter with figure of 8 wire fixation, the lesser trochanter was fixed with circular wire around proximal femur. The defect within the femoral calcar was filled with bone cement and in a part of the patients, the intertrochanteric fracture was transformed into femoral neck fracture and the femoral calcar was fixed with femoral prosthesis stem., Results: All operations were successful and the duration of the operation was 45 to 70 minutes with an average of 55 minutes. Blood was transfused in 73 patients during the operation between 400-800 ml with an average 450 ml. The patients got out of the bed within 3 days in 33 cases, 4-7 days in 43 cases, more than 8 days in 8 cases, and 2 patients couldn't get out of the bed. The period of hospitalization was between 13 to 27 days with an average of 16.8 days., Complications: 2 patients got slight deep phlebitis, 5 patients showed psychological disorders, and disorders in bacterial spectrum appeared in 3 patients, and after appropriate treatments, the complications gradually recovered and had no effect on the function of the affected extremity. 2 cases died of multiple organ failure during the hospitalization. 59 patients were followed up for 6 to 48 months with an average 16 months. The result was excellent in 17 cases who resumed their activities as before they got fractured, good in 35 cases who could walk with walking aid, fair in 5 cases who could walk with others help, and poor in 2 cases who could not walk. 1 patient died of other diseases 5 months after discharged. No dislocation, loosening or late infections occurred. 88.1% showed excellent or good result., Conclusion: It's an effective method to treat the unstable intertrochanteric fractures in elderly patients with hemiprosthesis arthroplasty. The result was satisfactory. It can decrease the complications, reduce the mortality, improve the patient's the living quality, and reduce the burden of the patient's family.

Objective: To analyze the clinical diagnosis and treatment of hepatic hydatid disease and its epidemiological characteristics in Yili river valley., Methods: Retrospective investigation was carried out on 2049 cases collected in 1993-2003. Clinical diagnosis was made by ways of intradermal test, serological test, ultrasound, X-ray, CT and/or MRI, majority of them received surgical operation., Results: Among the 2049 cases, cystic hydatidosis occupied 96% (1965/2049), while 4% (84/2049) were alveolar hydatidosis. 99% (2034/2049) accepted surgery including hepatolobectomy, endocystomy and hydatidostomy in 302 cases (14.7%) without relapses. 754 cases (36.7%) received chemotherapy (praziquantel, albendazole) after surgical operation. The disease distributed in agri-pastoral areas along the valley. Local residents from different minorities had a close contact with dogs, 54% of the cases were females and 48% of the cases were in the group of 25-49 years old. The incidence tends to decline in the years., Conclusion: Hydatidosis is still an important health problem in the region. Further practices for improving treatment especially surgical intervention and for epidemiological investigation are needed.

Objective: To introduce a method by reversed ulnar fasciocutaneous flap incised form the ulnar side of the fifth metacarpal area for repairing the soft tissue defect of the fifth finger., Methods: From May 2001 to September 2001, ten patients with the soft tissue defects of the thenar side, dorsal side or ulnar side of the fifth finger were treated with the reversed ulnar fasciocutaneous flap incised from the fifth metacarpal area. The axial line of the flap was the line from ulnar side of the head of the fifth metacarpal bone to the pisiform level. The revolving point of the flap pedicle was 0.5-1 cm near the proximal end of the metacarpal-phalangeal joint.The area of the flap was form 5.0 cm x 3.5 cm to 1.5 cm x 1.0 cm., Results: All flaps of the ten cases were alive. 5-7 months followed-up show that, after operation, the flap present sensation in 6-12 mm, with soft texture and good appearances., Conclusions: The advantages of this operative method were as follows: the reversed ulnar fasciocutaneous flap of the fifth metacarpal area have reliable blood supply, it was easily dissected and with good texture. So far this kind of flap is a good choice in repairing the soft tissue of the fifth finger.

The Chinese traditional patent medicine Niuhuang Jiedu Pian was analyzed by three dimensional HPLC. The results show that some of the Chinese herbal drugs contained in Niuhuang Jiedu Pian can be identified and the content of the marker substances can be determined. According to the results of determination, the content of baicalin, sennoside A and glycyrrhizin in Niuhuang Jiedu Pian was 4.21, 0.59 and 1.03 (mg/tablet), respectively. The RSD was 1.6, 2.8 and 1.4%, respectively.

A Chinese traditional patent medicine Xiaoyao Wan was analysed by three dimensional HPLC. The result shows that the Chinese traditional medicines involved in Xiaoyao Wan were identified excellently and the content of marker substances can be determined accurately. According to the results of determination, the content of saikosaponin b1, b2, glycyrrhizin, paeoniflorin and atractylenolide III in Xiaoyao Wan was 0.43, 0.53, 5.22, 3.95 and 0.16 (mg/g), respectively; The RSD was 1.2, 0.8, 0.4, 0.3 and 1.0 (%) respectively.