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Objectives To study the effect of bone mineral density measurement on the diagnosis and treatment of osteoporosis in patients with fragility hip fracture.Methods A retrospective analysis was conducted on 560 cases of elderly patients with fragility hip fracture in our hospital from January 2010 to December 2012.They were divided into two groups with and without the bone mineral density measurement,and compared to study the bone turnover markers detection and osteoporosis treatment.Results Among the 80 cases with the DXA bone mineral density detection,36 cases received the bone turnover markers detection(45.0%),and the rate of osteoporosis treatment in hospital was 70.0%,while the rate of osteoporosis treatment after discharge was 57.5%.Among the 480 cases without DXA bone mineral density detection,none received bone turnover markers detection,and the rate of osteoporosis treatment in hospital was 42.1%,while the rate of osteoporosis treatment after discharge was 36.7%.Conclusions The detection rate of bone mineral density and the diagnosis and treatment rate of osteoporosis are low in patients with fragility hip fracture.DXA bone mineral density measurement is helpful to improve the detection rate of bone turnover markers and the treatment rate of osteoporosis.
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Objective To investigate the effects and possible mechanisms of nicorandil on lung injury of the collapsed lung in one-lung ventilation.Methods Twenty-four clean Japanese big-ear rabbits were randomly divided into sham group (group S) (two-lung ventilation + thoracotomy),negative control group (group C) (one-lung ventilation + thoracotomy + saline),nicorandil group (group N) (one-lung ventilation+thoracotomy+nicorandil) and antagonist group (group J) (onelung ventilation+ thoracotomy+ nicorandil+ glyburide) equally.Mechanical ventilation was implemented through self-made double-lumen endotracheal tube after intravenous induction through ear marginal vein.Intravenous maintenance medicine was infused by trace injection pump after anesthesia induction.Thoracic surgery was simulated through one-lung or two-lung ventilation determined by auscultation,bubble test and direct observation.Then wet and dry weight ratio (W/D) and content of MDA were measured after non-ventilatory lung was processed and preserved.The expression of Akt,p-Akt and NF-κB protein in non-ventilatory lung tissue were detected by Western-blot in all groups.Results In respects of W/D and content of MDA,the other three groups had significant differences compared with group S (P ＜ 0.05).It was significantly lower in group N than in group C (P ＜0.05),and it was significantly higher in group J than in group N (P＜0.05).The expressions of pAkt protein and p-Akt/Akt in group N were significantly higher than those in group S and group C (P＜0.05).Those of group J were significantly lower than group N (P＜0.05).Compared with group S,the expression of NF-κB protein in group C was significantly higher (P＜0.05).That of group N was significantly lower than that of group C (P＜0.05).But that in group J was higher than that in group N (P ＜ 0.05).Conclusion Nicorandil has a protective effect on the collapse and inflation of non-ventilatory lung in rabbits under one-lung ventilation,acting on mitoKATP through PI3K/Akt,and down-regulating NF-κB to reduce IR-induced lung injury.
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BACKGROUND:StageIorIIKummel’s diseaseisusualy suggested to be treated with percutaneous vertebroplasty (PVP) orpercutaneous kyphoplasty (PKP). Stage IIIKummel’s diseasewith neurologic deficit is treated with open decompression, cement-augmented combined with internalfixation. However, surgical options for stage IIIKummel’s diseasewithdural saccompression butwithnonervous symptoms arein disputeand rarely reported. OBJECTIVE:To investigatethesurgical options of Kummel’s disease with vertebral posterior walcolapse. METHODS:Fourteen patients with Kummel’s disease with vertebral posterior wal colapse wereenroled as experimental groupandtreated with PVP or PKP based on the degree of postural reduction.Another28 patients with osteoporotic vertebral fracture as control group were treated with PKP. Thenalpatients were folowed up to observe vertebralheight, Cobb angle, visual analog scale and the Oswestry disability index. RESULTS AND CONCLUSION:After folowed up for 10 to 42 months, therestoredvertebralheight, Cobb angle, visual analog scale and Oswestry disability index were significantly improved inthetwo groups (P 0.05). These data suggest that based on the degree of postural reduction, individualizedPVP or PKP for Kummel’s disease with vertebral posterior wal colapsecanattain satisfactoryoutcomes.
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Objective To investigate the correlation of incident pneumonia and serum 25-hydroxyvitamin D[25(OH)D] levels in elderly patients with fragility hip fractures.Methods 132 patients with fragility hip fractures were divided into the pneumonia group [n=43,14 males and 29 females,aged 63-97 years,a mean age of (83.8±7.1) years] and the non-pneumonia group [n=89,28 males and 61 females,aged 60-93 years,a mean age of (77.1±8.1) years].Fasting venous blood samples were taken on the second day after admission.Serum 25 (OH)D levels were measured by radioimmunoassay.Results Vitamin D deficiency was found in 90.7％ of the patients in the pneumonia group,52.8％ in the non-pneumonia group (x2=24.953,P＜0.05).The age and smoking rate were higher in the pneumonia group than in the non-pneumonia group (t=4.661,P＜ 0.05;x2 =4.459,P=0.035).Logistic regression analysis showed that serum 25(OH)D levels,age and smoking were independent impact factors for pneumonia.When serum 25(OH)D levels were less than or equal to 20 g/L,the incidence of pneumonia was increased and the risk of pneumonia was 8.66 times higher than that for patients with normal 25 (OH)D levels.Conclusions The risk of pneumonia in patients with brittle hip fractures is correlated with age,smoking and the serum 25-hydroxyvitamin D level,with the latter as a major risk factor.Patients with brittle hip fractures should be supplemented with vitamin D as early as possible in order to reduce the risk of incident of pneumonia.
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Objective To observe the mortality of fragile hip fractures and evaluate the death-associated risk factors.Methods 100 men and 186 women aged 50 to 97 (mean,77.09± 10.65) years old who had fragile hip fracture over 50 years old from 2010 to 2012 were followed up,and the clinical data were retrospectively analyzed.Three months,one year and the total mortality of following time were calculated.Mortality-related risk factors were evaluated including age,gender,and surgery,duration from injury to operation,pulmonary infection,number and kind of complications.Results The 286 patients were followed up between 6 months and 42 months,with 21.42±9.88 months in average.The three month mortality was 7.69％,the patients who were followed up over one year were 231 cases,the one year mortality was 16.02％,and the total mortality of following time was 17.48％.The mortality was associated with age,gender,surgery,duration from injury to operation,number of complications,pre-injury cardiovascular disease and respiratory system diseases,and pulmonary infection.A Binary Logistic Regression analysis revealed that the independent risk factors affecting the mortality included age (OR=5.385,P=0.003),surgery (OR=21.217,P=0.000),number of complications (OR=9.038,P=0.000),pre-injury cardiovascular disease (OR=3.201,P=0.041).Conclusion The early mortality of fragile hip fractures was high and was associated with many risk factors.Age,surgery,number of complications and pre-injury cardiovascular disease were the independent risk factors affecting the mortality of fragile hip fractures.The positive treatment with complications,early surgery in condition allowed,can lower the early mortality.
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Objective To study the change of pancreatic hemocirculation in patients with acute pancreatitis by magnetic resonance perfusion (MRP) and to explore its relationship with pancreatic severity. Methods With a prospective investigation method, APACHEⅡscores, systemic inflammatory response syndrome (SIRS) scores, Binder scores and C-reactive protein (CRP) values were recorded within 72 h in patients with severe acute pancreatitis (SAP,n=15) and mild acute pancreatitis (MAP,n=17), while other 19 volunteers were as controls. MRP were performed on 32 patients and 19 controls. Patients in SAP group were evaluated by above criteria after two-weeks treatment and MRP were performed in 12 of them. All cases with bolus injection of Gd-DTPA (0.2 mol/kg) were scanned by transversal same slice and fast spoil phase gradient echo. Three groups datum of MIR and MSR were gained by ROI time-signal graphy of pancreatic head, body and trail which were calculated by Perfxproject software. Results ① The rates of MIR and MSR in SAP group were lower than MAP group (P0.05).Conclusion MRP is an objective imaging technique, which can reflect the hemocirculatory variety in acute pancrea-titis.It may have a considerable value in evaluating the severity of acute pancratitis.