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简介：AbstractBackground:Geriatric hip fracture patients receiving clopidogrel are a surgical challenge. In China, most of these patients undergo delayed surgical treatment after clopidogrel withdrawal for at least 5 to 7 days. However, delayed surgery is associated with increased complications and mortality in the older adults. This retrospective paralleled comparison study investigated the safety of early surgery for geriatric hip fracture patients within 5 days of clopidogrel withdrawal.Methods:Acute hip fracture patients (≥65 years) who were hospitalized in the orthogeriatric co-management ward of Beijing Jishuitan Hospital between November 2016 and April 2018 were retrospectively reviewed. Sixty patients taking clopidogrel before injury and discontinued <5 days before surgery constituted the clopidogrel group. The control group constituted 60 patients not taking antiplatelet or anticoagulant drugs and matched 1:1 with the clopidogrel group for sex, fracture type, operative procedure, and time from injury to operation (±10 h). The primary outcome was perioperative blood loss and the secondary outcomes were transfusion requirement, complications, and mortality. The Student’s t test or Wilcoxon signed rank sum test was used for continuous variables and the Chi-square test was used for categorical variables.Results:Age, body mass index, American Society of Anesthesiologists score, and percentage undergoing general anesthesia were comparable between the groups (P > 0.050). The percentages of patients with coronary heart disease (61.7% vs. 18.3%; P < 0.001) and cerebrovascular disease (45.0% vs. 15.0%; P < 0.010) were significantly higher in the clopidogrel vs. control groups, respectively. The median clopidogrel discontinuation time before operation was 73.0 (range: 3.0-120.0) h. There was no significant difference in the estimated perioperative blood loss between the clopidogrel group (median: 745 mL) and control group (median: 772 mL) (P = 0.866). The intra-operative transfusion rate was higher in the clopidogrel group (22/60, 36.7%) than that in the control group (12/60, 20.0%) (P < 0.050). However, there was no significant difference in the blood transfusion rate during the entire perioperative period (26/60, 43.3% vs. 20/60, 33.3%; clopidogrel group vs. control group, respectively; P > 0.050). There was no significant difference in perioperative complications, and 30-day and 1-year mortality rates between the groups.Conclusions:Early hip fracture surgery is safe for elderly patients within 5 days of clopidogrel withdrawal, without increased perioperative blood loss, transfusion requirement, complications, and mortality compared with patients not taking antiplatelet drugs.

简介：采用针刺治疗56例癌症呃逆患者并与西药治疗58例相对照，结果治疗组有效率87．5％，对照组有效率32．8％。经Ridit分析，治疗组疗效明显优于对照组(P<0．01)。

简介：BACKGROUND:Asaginginelderlypeople,theirbraintissuehasdegenerationandbrainatrophyofdifferentseverity,andthevolumeofcranialcavityisrelativelyenlarged,ithasgreatercompensatoryabilitytothespaceoccupyinglesion,anditisdifficulttodetectthemeningiomabecauseitgrowstoexpandslowly,thetumorlocatesinnon-functionalregion,andthereareatypicalsymptomsanddeficiencyoflocalizationsigns.OBJECTIVE:Toinvestigatetheclinicopathologicfeaturesofsenilemeningiomas.DESIGN:Aretrospectiveanalysis.SETTING:AffiliatedHospitalofHebeiUniversity.PARTICIPANTS:Forty-nineelderlypatientswithmeningiomawereselectedfromtheDepartmentofNeurosurgery,AffiliatedHospitalofHebeiUniversityfromMay1999toMarch2005,including15malesand34females,60-74yearsofage,andtheywerealldiagnosedbyCTandMRI.METHODS:ThesitesoftumorswereidentifiedbyCTandMRIexaminationsinallthepatients.Thetumorswerepartiallyortotallyresectedaccordingtotheirownconditions.Thetypesoftheresectedtumorwerepathologicallyobserved.Theconditionsofpostoperativerecoverywereobservedafter1,3and6months,andwithoutnewneurologicaldysfunctionorcomplicationwasconsideredasgoodoutcome.MAINOUTCOMEMEASURES:①Sitesandpathologicaltypesofthetumor;②Postoperativeoutcomesandcomplications.RESULTS:Allthe49patientswereinvolvedintheanalysisofresults.①Thetumorshadwidedistributionswithamainlocationinbrainconvexity.Amongthe49casesofmeningioma,therewere25casesoffibrocystictype,12casesofmeningothelialtype,6casesofpsammomatoustype,4casesofangiomatoustypeand2casesofmicrocystictype.②Amongthe49patients,35hadgoodoutcome,8hadself-careability,4requiredcarebyothers,2(4.1%)diedpostoperatively.Nolong-termcomplicationrelatedtotheoperationwasobservedduringthefollow-uppostoperatively.CONCLUSION:Meningiomahasamainlocationinbrainconvexity,andits

简介：目的将在ICU与多重损害为病人调查外科的治疗。病人们从2006年1月承认了到我们的医院的ICU到2009年1月的163多重损害的方法临床的数据回顾地被学习，包括118男性和45女性，与36.2年的吝啬的年龄(范围，5-67年)。包括的损害区域出发，颈(29个案例)，脸(32个案例)，胸(89个案例)，腹部(77个案例)，骨盆和手足(91个案例)和身体出现(83个案例)。有57个案例，与吃惊相结合。ISS价值从10～54变化了，18.42平均。病人们分别地在在内的ICU接受了外科的治疗24个小时(10个案例)，24-48小时(8个案例)，3-7天(7个案例)和8-14天(23个案例)。为163个病人，结果ICU停留的持续时间从2～29天，与7.56天的平均价值。在他们之中，143被治好(87.73%)，11由于严重出血性的吃惊(6个盒子)在医院(6.75%)里死了，craniocerebral损害(3个盒子)和多重机关失败(2个盒子)，并且9在自愿地从医院(5.52%)排出以后死了。全部的死亡率是12.27%。当多重损害病人在ICU被复活时，损坏控制原则应该被跟随的结论。外科的治疗策略活跃地包括控制出血，对待以前错过的损害和相关创伤或外科的复杂并发症并且动计划阶段手术。

简介：DuringGHtherapyfor2.3-9.6years,maleadult-onsetGH-deficientpatientswithadiagnosisofanonfunctioningadenomahavenoincreasedall-causemortality.However,womenwithadult-onsetGHdeficiency(GHD)arestillatslightlyhigherrisk.Thisgeneralimprovementinmortalityisduetoamorecontemporaryregimenofcardiovasculardrugs,arefinementofsurgicalprocedures,besidestheintroductionofGHtherapyimprovedhormonereplacementregimenswithloweredglucocorticoidreplacement,updatedapproachesofsexsteroidsforwomen,andlessuseofcranialradiotherapy.Theunderlyingdiseaseisthemostimportantpredictorformortality:eg,acraniopharyngioma,malignantcausesofhypopituitarism,previousCushing'sdisease,andthepresenceofdiabetesinsipidus/

简介：AbstractBackground:Leukocyte telomere length shortening is a characteristic of premature senescence, a process that can be accelerated by oxidative stress. In general, patients with end-stage renal disease undergoing regular hemodialysis (HD) are repeatedly exposed to oxidative stress. Patients undergoing HD tend to have cardiovascular diseases associated with oxidative stress and inflammation. Therefore, we assumed that telomere length is associated with HD vintage and the degree of vascular calcification.Methods:A total of 144 patients undergoing regular HD before kidney transplantation and 62 patients on hemodialysis, but not undergoing kidney transplantation, were enrolled. We measured common laboratory values, such as calcium, phosphate, and hemoglobin levels, and assessed the degree of vascular calcification in the patients. The leukocyte telomere length was measured using reverse transcription polymerase chain reaction, and Spearman correlation was used for correlation analysis.Results:The leukocyte telomere length was negatively associated with age (rho = -0.306, P <0.01); it was shorter in middle-aged patients than in young patients (13.48 ± 4.80 vs. 15.86 ± 4.51, P < 0.01). The telomere length was significantly different among patients aged 52-74 years in groups with different HD vintages. Additionally, the telomere length was positively associated with serum hemoglobin (Hb) levels in all patients (rho = 0.290, P < 0.01). There was a significant difference among patients divided into three groups according to the degree of anemia (17.09 ± 5.64 vs. 14.40 ± 4.07 vs. 13.99 ± 3.95, P < 0.01). Further, a significant difference was observed in the telomere length among patients with different degrees of vascular calcification (16.79 ± 4.91 vs. 13.61 ± 2.82 vs. 14.62 ± 3.63 vs. 10.71 ± 3.74, P < 0.01). The telomere length was shorter in the patients on hemodialysis who did not receive a kidney transplant than in the surgical patients (8.12 ± 1.83 vs. 14.33 ± 4.63, P < 0.01).Conclusion:This study demonstrated that the telomere length was significantly correlated with HD vintage in patients of a certain age group. The telomere length was shorter in patients on hemodialysis who matched for age and dialysis vintage with kidney transplant patients. It was also associated with vascular calcification and serum Hb levels in all patients undergoing HD.

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简介：Objective:ToinvestigatethedynamicsofplasmacAMP/Cgmpinpatientsduringcardiacsurgery,anditsrelationshiptotraumaticstress.Methods:Sixteenpatients,aged19.31years±10.4years,whounderwentanopenheartoperationwithcardiopulmonarybypass(CPB)andhypothermiawereservedassubjects.Thearterialplasmaconcentrationsofcyclicadenosinemonophosphate(Camp)andcyclicguanosinemonophosphate(Cgmp)weremeasuredbyradioimmunoassay2hoursbeforeoperation,afterheparinization,20minutesfollowingCPB,attheendoftheoperation,and24and72hourspostoperatively,respectively.Thepatients'preoperativebloodsampleswereheparinizedandthevenousbloodsamplesof30healthyblooddonorsweretakentomeasurethelevelsofCampandcGMPasheparinandnormalcontrolsseparately.Results:Therewerenostatisticaldifferenceamongtheheparincontrol,preoperativelevelandnormalcontrol.ThepeakvaluesofCampandCgmpoccurredduringCPBandplasmaCamplevelschangedsynchronouslywithintensitiesofoperativestimulustohumanbody.HowevercGMPlevelwasmainlyrelatedtotheoperativestimulustotheheartandCPB.TheCampvaluewaspositivelycorrelatedwiththeCgmpvalue(r=0.6313,P＜0.001).Conclusions:Dynamicvariationofplasmacyclicribonucleotidecanbeconsideredasareferenceparameterforintensityoftraumaticstress.

简介：目的：探讨针刺对单纯性肥胖症患者胰岛素抵抗的调节作用与临床疗效。方法：采用“益气健脾，化痰消浊”法，取脐周八穴（天枢、滑肉门、外陵、阴交、水分）、关元、足三里等穴，配合耳穴贴压，并与同期30例健康体检者比较，观察针刺前后单纯性肥胖症患者FBG、INS、ISI、TC、TG、LDLC、HDLC变化；观察针刺前后单纯性肥胖症患者腰围、臀围、腰臀比、体重、BMI的变化，及其Ⅰ度肥胖、Ⅱ度肥胖的疗效差异。结果：治疗前单纯性肥胖症患者存在高胰岛素血症（HI），ISI显著下降（P〈0．01），治疗后腰围、臀围、腰臀比、体重、BMI明显下降职0．05，P〈0．01），同时FBG、INS、TC、TG、LDLC亦明显下降（P〈0．01，P〈0．05），ISI、HDLC明显上升（P〈0．05）。结论：针刺治疗不仅能有效改善单纯性肥胖症患者的体脂参数，同时也能调整单纯性肥胖症患者异常脂质代谢，改善胰岛素抵抗状态。

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简介：Objective:ToelucidategeneralcharacteristicsofHIV/AIDSpatientsseekingcareatDitanHospitalinanattempttoguideearlydiagnosisinroutinemedicalcare.Materialsandmethods:Aretrospectiveanalysisof185HIV/AIDScasesfromJanuary1990toJune2002wascompletedusingSPSSstatisticalanalysis.Results:Maletofemaleratiowas1.8:1.Subjectsrangedinagefrom1yearoldto64yearsold.16caseswereyoungerthan20yearsoldwiththemedianageamongtheyoungersubsetat7.7years.169caseswereolderthan20yearsoldwithamedianageof36yearsold.29%ofthesubjectswerepeasants.Theremaining71%,wereofotherunspecifiedoccupations.90.8%ofindividualswereofHandescentwhile3.7%ofindividualswereofaminorityheritage.50.3%ofsubjectsweremarried;23.8%havenevermarried;8.1%weredivorced;andtheremaining17.8%wereofunknownmaritalstatus.Ofthoserepresentedinthisstudy,36.8%camefromtheHenanprovince;17.8%werefromBeijing;8.6%werefromShanxi;31.4%fromtheother20provincesofChina;and5.4%fromoutsideofChina.Modeoftransmission:40.0%(74/185)contractedHIVthroughunprotectedsexualcontact;29.2%(54/185)throughreceivingbloodorplasmatransfusions;21.1%(39/185)throughdonatingplasma;7caseswereintravenousdrugusers;7caseswereverticallytransmitted.Modeoftransmissionwasunknownin4cases.Clinicalcategories:Anincluded45cases;Bincluded85cases:Cconsistedof76cases.12casesweredeceased.Initialpresentation:39casespresentedwith_fever,coughanddiarrhea.37caseshadfeverandcoughonly-38casespresentedwithchronicdiarrhea.16caseswerediscoveredincidentallyattimeofoperation.8casespresentedwithfungalinfectionoftheoralcavityorinesophagus.ThecommonHIVassociatedsymptomsandopportunisticinfectionswere:weightlossanddiarrhea,respiratorydiseases,dermatologicdiseases,anemia,neutropenia.Diseasesofotherorgansystemswerelesscommon.Commonmisdiagnosesincluded

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简介：Inordertoacknowledgethemulti-infectiondataofSTDpatientsandimprovetheprophylaxisandtherapyforSTDs，297patientsand30healthypeoplewereexaminedusingtheHSV-2plasmaantibody．TheresultsshowedthatallkindsofSTDpatientswereinfectedbyHSV-2indifierentratios．thehighestratiooccurringinsyphilispatients．

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简介：AbstractBackground:The association between free triiodothyronine (FT3) and long-term prognosis in dilated cardiomyopathy (DCM) patients has not been evaluated. The purpose of this study was to determine whether the level of FT3 could provide prognostic value in patients with DCM.Methods:Data of consecutive patients diagnosed with DCM were collected from October 2009 to December 2014. FT3 was measured by fluoroimmunoassay. Other biochemical markers, such as free thyroxin (FT4), thyroid-stimulating hormone, red blood cell, hemoglobin, blood urea nitrogen, and serum creatinine, were tested at the same time. Follow-up was performed every 3 months. The primary endpoint was all-cause mortality. Pearson analysis was used to evaluate the correlation of FT3 and other lab metrics with DCM patients’ prognosis. The association of long-term mortality in DCM and FT3 was compared using Cox hazards model.Results:Data of 176 patients diagnosed with DCM were collected. Of them, 24 patients missed FT3 values and six patients were lost to follow-up. Altogether, data of 146 patients were analyzed. During the median follow-up time of 79.9 (53.5-159.6) months, nine patients lost, 61 patients died (non-survival group), and 85 patients survived (survival group). FT3 was significantly lower in non-survival group than that in survival group (3.65 ± 0.83 pmol/L vs. 4.36 ± 1.91 pmol/L; P = 0.003). FT3 also showed a significantly positive correlation with red blood cell and hemoglobin, negatively correlated with age, blood urea nitrogen and serum creatinine (P < 0.05), respectively. Patients in the group of lower FT3 levels (FT3 ≤ 3.49 pmol/L) suffered from a higher risk of all-cause mortality (P for log-rank = 0.001). In multivariate Cox regression analysis, FT3 level was significantly associated with all-cause mortality (hazard ratio: 0.70, 95% confidence interval 0.52-0.95, P for trend = 0.021).Conclusion:Low levels of FT3 were associated with increased all-cause mortality in patients with DCM.

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