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The neurotoxin β-amyloid (Aβ) is the main hallmark of Alzheimer′s disease (AD). Recent evidence suggests that, in common sporadic or late-onset forms of AD, elevated brain Aβ levels are caused by impaired clearance rather than overproduction. The cell surface receptor′s low-density lipoprotein receptor-related protein-1 (LRP1) has been reported to not only play a role in Aβ endocytosis, but also exist in the blood-brain barrier system, peripheral blood, liver, kidney and other tissues and organs, and transport Aβ to the cerebrospinal fluid or blood system by passing through the blood-brain barrier or the blood-cerebrospinal fluid barrier effectively, and finally clear it out of the body through peripheral tissues and organs. In this review, the role of LRP1 in the peripheral transport and clearance of Aβ is described, and it may be a safe and effective way to reduce Aβ in the brain and even improve cognitive dysfunction.
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Objective:To establish an evaluation index system for training effect of order-oriented clinical medical students in Xinjiang by employers, so as to lay a foundation for training effect evaluation.Methods:On the basis of questionnaires and interviews with the training requirements of employers, Delphi method was used to determine the index system and weight.Results:The training requirements of employing units for the ability of free and directional medical students in autonomous regions were in turn competent for work, knowledge and practical ability, and good moral quality. The cultivation requirements for students' personal qualities of free and directional medical students were good interpersonal communication and moral quality. After three rounds of Delphi expert consultation, the evaluation index system was established, and three dimensions (knowledge, professional ability, professional ethics literacy), nine secondary indicators and 33 tertiary indicators were screened out, and the weights were determined.Conclusion:The evaluation index of training effect of directional clinical medical students established by Delphi expert consultation method needs further validation. Through the follow-up empirical application in directional clinical students, the evaluation index system can be constantly improved, which can also provide reference for the establishment of evaluation index system for other positions.
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Objective To explore the incidence rate of mild cognitive impairment (MCI) among the elderly which transferred to Alzheimer disease (AD) and to analyze the related influencing factors. Methods 10 urban communities were selected through stratified cluster sampling as the research sites where 361 patients with MCI were screened from 1 942 residents aged over 60 years old. Questionnaires and laboratory assays were used to collect data from subjects, including characteristics of demographic, life style, medical history, Alzheimer-associated neuronal thread protein,(AD7C-(NTP)), amyloid β-protein 42(Aβ42) and amyloid β-protein 40(Aβ40), etc. Patients with MCI were followed up for three years to determine whether they progressed to AD. Results 121 of 361 patients of MCI converted to AD, and the incidence rate of MCI to AD was 9.49% person-years. According to the results of Logistic regression analysis model, elder (80-89 years) (OR=3.651,95% CI:1.295-10.297, P<0.001),female (OR=2.603,95% CI:1.136-5.966, P<0.001), heavy drinking(OR=1.479,95% CI:1.343-1.627, P<0.001), increased ADL score (OR=1.790, 95% CI:1.443-2.220, P=0.031) and smoking (OR=1.157,95% CI:1.091-1.224, P<0.001) were the risky factors of the transition of MCI to AD. The increase of Moca score (OR=0.766,95% CI:0.681-0.861, P<0.001) was the protective factor of the transition. Conclusions We should strengthen our monitor on elder female MCI patients, and promote healthy lifestyles among the elders, encouraging them to actively participate in physical exercises and reading, in order to delay patients' transition of MCI to AD.
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Objective To compare the efficacy between percutaneous compression plate (PCCP) and cannulated compression screw for undisplaced femoral neck fracture among the elderly.Methods A retrospective case-control study was made on 46 elderly patients with undisplaced femoral neck fracture between August 2011 and September 2015.There were 14 males and 32 females,with the age of (76.9 ± 12.1) years (range,60-85 years).The fracture types included Garden Ⅰ in 12 patients and Garden Ⅱ in 34.These patients were divided into PCCP group (PCCP for undisplaced femoral neck fracture in 23 patients) and cannulated screw group (three cannulated compression screws for undisplaced femoral neck fracture in 23 patients),according to different surgical fixations.The following data were compared between two groups,namely,operation time,intraoperative blood loss,postoperative hemoglobin decline,postoperative length of hospital stay,postoperative partial time of weight-bearing and full weight-bearing,fracture healing time,Harris hip score (HHS) as well as postoperative complications.Results All 46 patients were followed up,with follow-up duration for (34.6± 15.3)months (range,12-60 months) in PCCP group and for (32.9 ±17.3) months (range,12-60 months) in cannulated screw group (P ＞ 0.05).There were no statistically significant difference between two groups in terms of operation time,intraoperative blood loss,postoperative hemoglobin decline,postoperative length of hospital stay,fracture healing time,and postoperative full weight-bearing time (P ＞ 0.05).The partial weight-bearing time of patients in PCCP group was earlier than that in cannulated screw group (P ＜ 0.05).The HHS of patients at postoperative 3 months in PCCP group was better than that in cannulated screw group (P ＜ 0.05),but the HHS at the final follow-up had no statistically significant difference between two groups (P ＞ 0.05).There was no statistically significant difference in the incidence of postoperative complications between PCCP group (9％) and the cannulated screw group (13％) (P ＞ 0.05).Conclusions Usage of PCCP or cannulated compression screw can obtain satisfactory clinical results for the undisplaced femoral neck fracture among the elderly.But PCCP has the advantages of earlier partial weight-bearing time and faster recovery.
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Objective To explore the effect of percutaneous kyphoplasty (PKP) combined with Xianling Gubao capsule on treatment of osteoporotic vertebral compression fractures(OVCF).Methods 118 postmenopausal women diagnosed as OVCF and meeting the standard were collected from Mar.2012 to Jul.2016 in our hospital.They were randomly divided into two groups:observation group and the control group.General information of the two groups were comparable.The patients of the control group received PKP combined with traditional anti-osteoporosis therapy.The patients of observation group received Xianling Gubao capsule on the basis of the control group.The lumbar bone density (BMD,greater trochanter BMD,femoral neck BMD,Ward triangle BMD,the Japanese orthopaedic association(JOA)score,the visual analogue score (VAS) score,the serum levels of osteoprotegerin (OPG),receptor activator of nuclear factor-κB ligand (RANKL)and adverse reactions were recorded during the treatment.Results The lumbar BMD,greater trochanter BMD,femoral neck BMD,Ward triangle BMD of observation group at 6-month after operation were higher than those before operation and those of control group (P＜0.05).The VAS score and JOA score of the observation group were superior to those of the control group at 6-month after operation (P＜0.05).The serum levels of OPG of observation group were higher than those of control group,while the serum levels of RANKL of observation group were lower than those of control group at 6-month after operation (P＜0.05).No severe adverse reactions occurred in the two groups during the treatment.Conclusion Xianling Gubao capsule can significantly improve bone metabolism of postmenopausal women with osteoporotic vertebral compression fractures after percutaneous kyphoplasty,increasing BMD,improving lumbar function,relieving pain,without increasing complication rates.
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Objective To investigate the change and clinical significance of blood D-dimer level during perioperative period in ad-vanced age hip fracture.Methods The blood D-dimer level in 60 patients aged over 80 years old with hip fracture was detected be-fore operation and after operation,which including at admission(T1 ),immediately preoperation(T2 ),immediately postoperation (T3 )and on postoperative 1 d (T4 ).Results The positive rates of D-dimer at T1 ,T2 ,T3 and T4 were 6.67%,16.45%,41.67%and 80.00% respectively;there were statistically significant differences between T3 ,T4 and T1 ,T2 ,between T3 and T4 (P 0.05).Conclusion The level of D-dimer in advanced age hip fracture has significant change before and after operation.The change of the D-dimer positive rate is an effective index for preven-ting lower limbs deep venous thrombosis and has the important clinical significance to dynamically monitor the D-dimer level during perioperative period in advanced age hip fracture.
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<p><b>OBJECTIVE</b>To explore the curative effects and complications of elastic intramedullary nail in treating children's bilateral femoral shaft fractures.</p><p><b>METHODS</b>Form February 2005 to March 2008, 7 patients with bilateral femoral shaft fractures were treated by closed reduction and internal fixation with elastic intramedullary nail. There were 5 males and 2 females. The age ranged from 3 to 13 years with the mean of 8.3 years. Six injuries caused by road accident and 1 injury caused by fall from high. Two cases associated with pulmonary contusion, 3 cases brain injuries, 1 case fracture of calcaneus and 1 case bladder injuries. All the cases were closed fractures without nerve and blood vessel injury. A cast external fixation had been used after operation for a month in two cases.</p><p><b>RESULTS</b>All the patients were followed up for 21-37 months with an average of 30.3 months. No infecton of incisional wound, displacement fracture, internal fixation fail, delayedunion and malunion were found. All fracture obtained healing for 7-12 weeks with an average of 8.7 weeks. Inequality of lower limb was found in 1 case (length differences was 5 mm). According to Flynn scoring,all fractures were excellent.</p><p><b>CONCLUSION</b>Treatment of femoral shaft fractures in children with elastic intramedullary nail according with biological principle. The method has little trauma, less complication, outstanding effect and it is a good way to treat bilateral femoral shaft fractures result from high-energy injuries.</p>
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Bone Nails , Elasticity , Femoral Fractures , General Surgery , Fracture Fixation, Intramedullary , MethodsABSTRACT
<p><b>OBJECTIVE</b>To compare the radiographic and functional outcomes of nonoperative and minimally invasive methods in treating femoral subtrochanteric fractures in children.</p><p><b>METHODS</b>Forty-five children (male 28, female 17) aging from 4- to 15-years-old with femoral subtrochanteric fracture were managed with traction and cast application (16 cases), and elastic intramedullary nailing (29 cases). Early and late radiologic outcomes were respectively evaluated by Beaty and Theologis criteria. The outcomes of clinical effect were evaluated with Sanders scoring system.</p><p><b>RESULTS</b>All patients were followed up from 26 to 62 months with an average of 39.5 months. The fractures united in 45 patients. Early (at 4th week after treatment) satisfactory radiologic outcomes were respectively 6 cases and 26 cases between two methods of nonoperative and minimally invasive. Late (at 2nd year after treatment) satisfactory radiologic outcomes were respectively 11 cases and 28 cases between two methods of nonoperative and minimally invasive. According to Sanders scoring, 12 cases were excellent, 4 good with nonoperative methods; and 28 excellent, 1 good with minimally invasive methods. There were significant differences between the two groups in aforesaid aspect.</p><p><b>CONCLUSION</b>Minimally invasive methods provided more satisfactory alignment of fractures as well as better functional outcomes than nonoperative methods. It is the first choice to treat femoral subtrochanteric fractures in children.</p>