TLR2 deficiency attenuates skeletal muscle atrophy in mice.

Oxidative stress and inflammation are associated with skeletal muscle atrophy. Because the activation of toll-like receptor (TLR) 2 induces oxidative stress and inflammation, TLR2 may be directly linked to skeletal muscle atrophy. This study examined the role of TLR2 in skeletal muscle atrophy in wild-type (WT) and TLR2 knockout (KO) mice. Immobilization for 2 weeks increased the expression of cytokine genes and the levels of carbonylated proteins and nitrotyrosine in the skeletal muscle, but these increases were lower in the TLR2 KO mice. Muscle weight loss and a reduction in treadmill running times induced by immobilization were also attenuated in TLR2 KO mice. Furthermore, immobilization increased the protein levels of forkhead box O 1/3, atrogin-1 and muscle ring finger 1 in the WT mice, which was attenuated in TLR2 KO mice. In addition, immobilization-associated increases in ubiquitinated protein levels were lower in the TLR2 KO mice. Immobilization increased the phosphorylation of Akt and p70S6K similarly in WT and KO mice. Furthermore, cardiotoxin injection into the skeletal muscle increased the protein levels of atrogin-1, interleukin-6, and nitrotyrosine and increased the levels of ubiquitinated proteins, although these levels were increased to a lesser extent in TLR2 KO mice. These results suggest that TLR2 is involved in skeletal muscle atrophy, and the inhibition of TLR2 offers a potential target for preventing skeletal muscle atrophy.

Arthroscopic suture anchor repair of posterior root attachment injury in medial meniscus: technical note.

A root attachment injury (root tear) of the meniscus can abolish the ability of the meniscus to bear hoop stress and predispose to increase articular contact stress which contribute to femorotibial degenerative changes. A pull out suture technique to repair the root tear has been described, but the procedure making the tibial tunnel may be difficult and troublesome. This article describes a repair technique using a suture anchor and posterior trans-septal portal.

Mechanism of Osteosarcopenia and Its Control by Exercise / 生物化学与生物物理进展

Osteosarcopenia (OS) is a multifactorial, multiaetiologic degenerative metabolic syndrome in which sarcopenia coexists with osteoporosis, and its influences are related to aging-induced mechanics, genetics, inflammatory factors, endocrine disorders, and irregular lifestyles. With the accelerated aging process in our country, osteosarcopenia has become a public health problem that cannot be ignored, with a higher risk of falls, fractures, impaired mobility and death. In recent years, scholars at home and abroad have conducted a lot of research on osteosarcopenia, but their pathogenesis is still unclear. Understanding the signaling pathways associated with osteosarcopenia is of great significance for further research on the pathogenesis of these disorders and for finding new targets for treatment. Studies have shown that activation of the PI3K/Akt signaling pathway promotes osteoblast differentiation as well as skeletal muscle regeneration, indicating that inhibition of thePI3K/Akt signaling pathway is closely related to the development of osteosarcopenia. Muscle factor-mechanical stress interactions can maintain osteoblast viability by activating the Wnt/β-catenin signaling pathway, suggesting that Wnt signaling is important in muscle and bone crosstalk. The Notch signaling pathway also plays an important role in improving bone and muscle mass and function, but different researchers hold different views, which need to be further validated and refined in subsequent studies. Exercise, as an existing non-pharmacological treatment with strong and sustained effects on physical function and muscle strength, also significantly increases bone density in osteoporosis patients, which may be mainly due to the fact that exercise induces changes in the form and function of bones, in the form of muscular pulling and indirectly improves the bone mass, and changes in the bone strength can also change the number, shape as well as the function of the muscles. At the same time, the mechanism of different exercise modalities focuses on different aspects, and there are differences in exercise time, exercise intensity, and therapeutic effects in the implementation of interventions. Aerobic exercise can improve the quality of skeletal muscle and increase the expression of osteogenesis-related genes by stimulating mitochondrial biosynthesis, as well as improve the quality and strength of bones and muscles through the Wnt/β- catenin and PI3K/Akt signaling pathways, effectively preventing and controlling the occurrence of musculoskeletal disorders. High-intensity resistance exercise has a significant effect on improving the quality of muscles and bone mineral density, but older people with osteosarcopenia suffer from a decline in muscle quality and strength, and a decline in bone mineral density, which makes them very susceptible to fracture, so they should select the intensity of the training in a gradual and orderly manner, from small to large. What kind of exercise intensity and exercise modalities are most effective in improving the occurrence and development of osteosarcopenia needs to be further investigated. Therefore, this paper mainly reviews the epidemiology of osteosarcopenia, diagnostic criteria, the related signaling pathways (PI3K/Akt pathway, Wnt/β-catenin pathway, Notch pathway, NF-κB pathway) that jointly regulate the metabolic process of myocytes and skeletal cells, as well as the interventional effects of different exercise modes on osteosarcopenia, with the aim of providing theoretical bases for the clinical treatment of osteosarcopenia, as well as enhancing the preventive capacity of the disease in old age.

The Role and Possible Mechanisms of Exercise in Combating Osteoporosis by Modulating The Bone Autophagy Pathway / 生物化学与生物物理进展

Osteoporosis leads to an imbalance in bone remodelling, where bone resorption is greater than bone formation and osteoclast degradation increases, resulting in severe bone loss. Autophagy is a lysosomal degradation pathway that regulates the proliferation, differentiation, and apoptosis of various bone cells (including osteoblasts, osteoclasts, and osteoclasts), and is deeply involved in the bone remodelling process. In recent years, the role of autophagy in the progression of osteoporosis and related bone metabolic diseases has received more and more attention, and it has become a research hotspot in this field. Summarising the existing studies, it is found that senile osteoporosis is the result of a combination of factors. On the one hand, it is the imbalance of bone remodelling and the increase of bone resorption/bone formation ratio with ageing, which causes progressive bone loss. On the other hand, aging leads to a general decrease in the level of autophagy, a decrease in the activity of osteoblasts and osteoclasts, and an inhibition of osteogenic differentiation. The lack of oestrogen leads to the immune system being in a low activation state, and the antioxidant capacity is weakened and inflammatory response is increased, inducing autophagy-related proteins to participate in the transmission of inflammatory signals, excessive accumulation of reactive oxygen species (ROS) in the skeleton, and negatively regulating bone formation. In addition, with aging and the occurrence of related diseases, glucocorticoid treatments also mediate autophagy in bone tissue cells, contributing to the decline in bone strength. Exercise, as an effective means of combating osteoporosis, improves bone biomechanical properties and increases bone density. It has been found that exercise induces oxidative stress, energy imbalance, protein defolding and increased intracellular calcium ions in the organism, which in turn activates autophagy. In bone, exercise of different intensities activates messengers such as ROS, PI3K, and AMP. These messengers signal downstream cascades, which in turn induce autophagy to restore dynamic homeostasis in vivo. During exercise, increased production of AMP, PI3K, and ROS activate their downstream effectors, AMPK, Akt, and p38MAPK, respectively, and these molecules in turn lead to activation of the autophagy pathway. Activation of AMPK inhibits mTOR activity and phosphorylates ULK1 at different sites, inducing autophagy. AMPK and p38 up-regulate per-PGC-1α activity and activate transcription factors in the nucleus, resulting in increased autophagy and lysosomal genes. Together, they activate FoxOs, whose transcriptional activity controls cellular processes including autophagy and can act on autophagy key proteins, while FoxOs proteins are expressed in osteoblasts. Exercise also regulates the expression of mTORC1, FoxO1, and PGC-1 through the PI3K/Akt signalling pathway, which ultimately plays a role in the differentiation and proliferation of osteoblasts and regulates bone metabolism. In addition, BMPs signaling pathway and long chain non-coding RNAs also play a role in the proliferation and differentiation of osteoblasts and autophagy process under exercise stimulation. Therefore, exercise may become a new molecular regulatory mechanism to improve osteoporosis through the bone autophagy pathway, but the specific mechanism needs to be further investigated. How exercise affects bone autophagy and thus prevents and treats bone-related diseases will become a future research hotspot in the fields of biology, sports medicine and sports science, and it is believed that future studies will further reveal its mechanism and provide new theoretical basis and ideas.

AMPK activator, AICAR, inhibits palmitate-induced apoptosis in osteoblast.

Osteoblast apoptosis reduces bone mineral density. Apoptosis can be induced in a variety of cells by palmitate, which is one of the most common saturated fatty acids in dietary fat. The AMPK activator, AICAR, has been shown to inhibit palmitate-induced apoptosis. However, the role of palmitate in osteoblast apoptosis is currently unknown. This study examined whether palmitate could induce apoptosis in osteoblasts, and if so, whether AICAR could alleviate palmitate-induced apoptosis. Palmitate reduced cell survival and induced apoptosis in a dose- and time-dependent manner in human fetal osteoblasts (hFOB) 1.19. While the long-chain acyl-CoA synthetase inhibitor, triacsin C, inhibited palmitate-induced apoptosis, anti-oxidants and ceramide synthesis inhibitors did not attenuate the apoptosis. AICAR prevented palmitate-induced apoptosis and the inhibition of AICAR-mediated increase in fatty acid oxidation by etomoxir did not affect the prevention of apoptosis by AICAR. Constitutively-active AMPK also inhibited palmitate-induced apoptosis. Treatment with an AMPK inhibitor (compound C) and a dominant-negative AMPK adenovirus suppressed the inhibitory effect of AICAR on apoptosis. Palmitate impaired the activation of ERK by fetal bovine serum, which was blocked by AICAR. Moreover, AICAR increased ERK activation, and ERK inhibitors, PD98059 and U0126, as well as a dominant-negative MEK1, abolished the inhibitory effect of AICAR on palmitate-induced apoptosis. AICAR also inhibited palmitate-induced apoptosis in osteoblastic differentiated cells from human bone marrow, which was accompanied by recovered ERK activity. These results suggest that palmitate induces apoptosis in osteoblasts through the impaired activation of ERK, and the activation of AMPK inhibits palmitate-induced apoptosis by activating ERK.

Research progress on tumor-associated macrophages in colorectal cancer / 细胞与分子免疫学杂志

Colorectal cancer is a common malignant tumor in gastrointestinal tract. Its onset and development are associated with its own characteristics as well as the tumor microenvironment (TME) in which tumor-associated macrophages (TAMs) are the most abundant immune cells. After being recruited to the tumor site and stimulated by different signals in TME, TAMs can grow into two different subtypes, namely M1 and M2. TAMs are mainly manifested as M1 macrophages in the early stage of colorectal cancer, mediating the immune response to inhibit tumor growth. In the late stage, TAMs mainly grow into M2 macrophages, showing the ability to suppress immunity, stimulate the proliferation of tumor cells and tumor angiogenesis, and promote the invasion and metastasis of tumor cells. It has been found that intervention in TAMs polarization can regulate its relationship with the onset and development of colorectal cancer.

Clinical correlation study of Naomai Jiejing decoction on aneurysmal subarachnoid hemorrhage / 中国药师

Objective To investigate the clinical correlation of Naomai Jiejing decoction with cerebrovascular hemodynamics,thromboelastography(TEG)and rehabilitation outcome in patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods A total of 160 patients with aSAH admitted to Zhongshan Traditional Chinese Medicine Hospital from January 2020 to December 2022 were selected as the study objects,and were divided into study groupand control group according to whether the patients used Naomai Jiejing decoction.The control group was treated with basic therapy combined with nimodipine,the study group was treated with basic therapy combined with nimodipine and Naomai Jiejing decoction(No.1)before surgery,and was treated with basic therapy combined with Nimodipine and naomai Jiejing decoction(No.2)after surgery.Chinese medicine symptom score,cerebrovascular hemodynamics indexes[systolic peak velocity(Vs),mean blood velocity(Vm),end-diastolic peak velocity(Vd),pulsatile index(PI)and resistance index(RI)]and TEG parameters[maximum amplitude(MA),α angle and coagulation index(CI)]were compared between the two groups before and after treatment.Finally,the short-term prognosis of the two groups was evaluated by glasgow prognostic score,and the short-term prognosis of the two groups was compared.Results A total of 160 aS AH patients were included,with 85 in the study group and 75 in the control group.After treatment,the Chinese medicine symptom scores in the study group were significantly lower than those in the control group(P＞0.05).After treatment,the indexes of cerebrovascular hemodynamics in the study group were better than those in the control group(P＜0.05).After treatment,the TEG parameters in the study group were significantly lower than those in the control group(P＜0.05).The overall prognosis of the study group was better than that of the control group,and the proportion of patients with good recovery was significantly higher than that of the control group(P＜0.05).Conclusion Naomai Jiejing decoction has a good treatment effect on aSAH patients,can improve cerebrovascular hemodynamics and TEG parameters,relieve clinical symptoms,and improve the short-term prognosis of patients.

Risk factors of infection with polymyxin resistant and carbapenemase-resistant Klebsiella pneumoniae / 中华临床感染病杂志

Objective:To investigate the risk factors of infection with polymyxin resistant and carbapenemase-resistant Klebsiella pneumoniae（PR-CRKP）. Methods:A total of 170 patients with CRKP infection admitted in the Third Affiliated Hospital of Soochow University from July 2020 to October 2023 were enrolled，including 123 cases of CRKP infection and 47 cases of PR-CRKP infection. The general conditions，exposure of antibacterial drugs 6 months before admission，laboratory test indicators at admission，antibacterial drug use when target bacteria were detected，length of hospital stay and time of invasive procedures in two groups were retrospectively analyzed. The risk factors of PR-CRKP infection were analyzed with univariate and multivariate logistic regression. SPSS 26.0 software was used to analyze the data.Results:Univariate analysis showed that compared with the CRKP group，the average age of patients in PR-CRKP group was older（ Z = -2.186， P = 0.029），the proportion of patients with exposure history to semisynthetic penicillins，carbapenems，polymyxins，and quinolones 6 months before admission was higher（ χ 2= 3.930，5.414，11.939，8.478，all P < 0.05），the proportion of infections diagnosed at admission and blood urea nitrogen levels（ χ 2= 7.268， Z = -2.406， P = 0.007 and 0.016）was higher，the hemoglobin level（ t = 2.641， P = 0.009）was lower，the length of hospital stay was longer，the rates of tracheal intubation，urinary catheter，and deep vein catheterization were higher（ Z = -4.243，-4.660，-5.341，-4.583，all P < 0.001），the duration of carbapenem and polymyxin B use was longer（ Z = -4.757，-7.554，both P < 0.001），the proportion of combined quinolone-resistant Escherichia coli（QREC）and carbapenem-resistant organism（CRO）infections and bloodstream infections，and the rate of admission to intensive care units was higher（ χ 2 = 33.737，42.041，5.426，12.991， P < 0.05 or < 0.01）. Multivariate analysis showed that time to polymyxin B use（ OR = 1.179， 95%CI 1.059-1.312， P = 0.003），combined QREC infection（ OR = 5.357， 95%CI 2.100-13.669， P < 0.001）and combined CRO infection（ OR = 3.302， 95%CI 1.146-9.514， P= 0.027）were independent risk factors for PR-CRKP. Conclusion:Prolonged use of polymyxin B is an independent risk factor for PR-CRKP，and mixed QREC and CRO infection can increase the risk of PR-CRKP.

Diagnostic value of a combined serology-based model for minimal hepatic encephalopathy in patients with compensated cirrhosis / 中华检验医学杂志

Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.

Study on rat small intestinal absorption characteristics of gallic acid based on single-pass perfusion model / 中国药理学通报

Aim To investigate the absorption characteristics of gallic acid in the intestine, and to provide a theoretical basis for improving the bioavailability of tannins. Methods Single-pass intestinal perfusion (SPIP) model was used for rat in situ and HPLC to determine the concentration of gallic acid. The absorption rate constant Ka and effective apparent permeability coefficient Peff of gallic acid in each intestinal segment were calculated. The effects of different intestinal segments, drug concentrations, pH value, P-glycoprotein (P-gp), and multidrug resistance protein2 (MRP2) on intestinal absorption were assessed. Results The absorption rate constant (Ka) of gallic acid decreased following the sequence of jejunum > duodenum > ileum ≈ colon. With the increase of drug concentration, there was no significant difference in the absorption of gallic acid. The acidic environment (pH 5. 5) was conducive to the absorption of gallic acid. After the addition of P-gp and MRP2 inhibitors, the absorption of gallic acid was significantly different from that without P-gp and MRP2 inhibitors (P < 0. 05). Conclusions Gallic acid can be well absorbed in the intestine of rats, and is best absorbed in jejunum. The absorption mechanism is determined to be passive diffusion. The gallic acid absorption process is affected by the efflux of P-gp and MRP2, which may be the P-gp and MRP2 substrates.

Effect of Kouyanqing granule combined with ornidazole on the expression of HMGB1, TNF-α, IL-17 and IL-23 in patients with chronic periodontitis / 中国基层医药

Objective:To investigate the effect of Kouyanqing granule combined with ornidazole on the expression of high mobility group protein B1 (HMGB1), tumor necrosis factor-α (TNF-α), interleukin-17 (IL-17) and interleukin-23 (IL-23) in patients with chronic periodontitis.Methods:From October 2018 to October 2019, 162 patients with chronic periodontitis admitted to the First People's Hospital of Xiaoshan District were divided into observation group (81 cases) and control group (81 cases) according to the random digital table method.The control group was treated with ornidazole, and the observation group was treated with Kouyanqing granules on the basis of the control group.The course of treatment in both two groups was 4 weeks.The changes of plaque index (PLI), probing depth of periodontal pocket (PD), bleeding index (BI), HMGB1, TNF-α, IL-17 and IL-23 and adverse reactions were compared before and after treatment.Results:The total effective rate of the observation group (91.36%) was higher than that of the control group (77.78%) (χ 2=5.723, P<0.05). The PLI(0.93±0.16), PD[(3.15±0.37)mm] and BI(1.35±0.24) in the observation group were lower than those in the control group [(1.42±0.24), (4.28±0.45)mm and (2.18±0.28)] ( t=15.289, 17.457, 20.256, all P<0.05). The levels of HMGB1 [(0.78±0.13)μg/L], TNF-α[(3.10±0.32)μg/L], IL-17[(368.19±24.31)ng/L] and IL-23[(7.63±0.89)ng/L] in the observation group were lower than those in the control group [(0.96±0.10)μg/L, (4.34±0.46)μg/L, (457.32±21.35)ng/L and (10.32±1.25)ng/L] ( t=9.877, 19.916, 24.793, 15.777, all P<0.05). The incidence of adverse reactions in the observation group (6.17%) was lower than that in the control group (17.28%) (χ 2=4.830, P<0.05). Conclusion:Kouyanqing granule combined with ornidazole is effective in the treatment of chronic periodontitis.It can reduce the levels of HMGB1, TNF-α, IL-17 and IL-23, and has few adverse reactions.

Treatment of thoracolumbar fracture.

The most common fractures of the spine are associated with the thoracolumbar junction. The goals of treatment of thoracolumbar fracture are leading to early mobilization and rehabilitation by restoring mechanical stability of fracture and inducing neurologic recovery, thereby enabling patients to return to the workplace. However, it is still debatable about the treatment methods. Neurologic injury should be identified by thorough physical examination for motor and sensory nerve system in order to determine the appropriate treatment. The mechanical stability of fracture also should be evaluated by plain radiographs and computed tomography. In some cases, magnetic resonance imaging is required to evaluate soft tissue injury involving neurologic structure or posterior ligament complex. Based on these physical examinations and imaging studies, fracture stability is evaluated and it is determined whether to use the conservative or operative treatment. The development of instruments have led to more interests on the operative treatment which saves mobile segments without fusion and on instrumentation through minimal invasive approach in recent years. It is still controversial for the use of these treatments because there have not been verified evidences yet. However, the morbidity of patients can be decreased and good clinical and radiologic outcomes can be achieved if the recent operative treatments are used carefully considering the fracture pattern and the injury severity.

Efficacy of acupuncture-moxibustion on peripheral facial paralysis at different time points: a Meta-analysis / 中国针灸

OBJECTIVE@#To systematically evaluate the efficacy and safety differences between acupuncture-moxibustion at acute stage and non-acute stage for peripheral facial paralysis.@*METHODS@#The clinical trials regarding acupuncture- moxibustion for peripheral facial paralysis published before May 31st 2019 were searched in databases of CNKI, WF, VIP, SinoMed, PubMed, Cochrane Library and Google Scholar. The information of included studies was extracted and the quality was assessed by two independent researchers. The Meta-analysis was performed by using RevMan 5.3 software.@*RESULTS@#A total of 11 trials were included, involving 1741 patients. The Meta-analysis results showed that: (1) the curative rate of acupuncture-moxibustion at acute stage was higher than that at non-acute stage (=2.45, 95%: 1.91-3.14, =7.06, <0.01); (2) the average curative time of acupuncture-moxibustion at acute stage were shorter than that of non-acute stage (=5.26, 95%: 3.44, 7.08, =5.67, <0.01); (3) the incidence rate of sequelae in 6-month follow up of acupuncture-moxibustion at acute stage were lower than that of non-acute stage (=2.71, 95%: 1.26, 5.84, =2.56, <0.05); (4) one study reported that there were no adverse reactions during treatment in both treatment group and control group.@*CONCLUSION@#Based on current evidence, the efficacy of acupuncture-moxibustion at acute stage is superior to non-acute stage, which could promote the recovery of the disease and shorten the course of treatment, and reduce the occurrence of sequelae. More high-quality, large-sample randomized controlled trials are needed for further verification.

Swirl sign and black hole sign on CT scanning in predicting early hematoma expansion in intracerebral hemorrhage: a comparative study / 中华神经医学杂志

Objective To compare the predictive values of swirl sign and black hole sign on CT scanning in early hematoma expansion in spontaneous intracerebral hemorrhage (SICH) patients.Methods Two hundred and ten firstly diagnosed SICH patients,admitted to our hospital from January 2012 to December 2018,were enrolled in the study.All patients were divided into hematoma expansion and non-hematoma expansion group according to whether early hematoma expansion appeared;and they were also divided into positive imaging sign group and negative imaging sign group according to whether imaging signs appeared;the clinical and imaging data were compared between these groups,respectively.The accuracies of swirl sign and black hole sign in predicting early hematoma expansion were analyzed using receiver operator characteristic (ROC) curve.Multivariate Logistic regression analysis was performed to determine the independent risk factors for early hematoma expansion.Results (1) In the 57 patients with early hematoma expansion,21 (36.8％) had swirl sign,and 17 (29.8％) had black hole sign;in the 153 patients without hematoma expansion,12 (7.8％) had swirl sign and 22 (14.4％) had black hole sign;the differences between the two groups were statistically significant (P＜0.05).As compared with those in the non-hematoma expansion group,the admission systolic blood pressure increased significantly and number of patients with intraventricular hemorrhage was significantly larger in the hematoma expansion group (P＜0.05).(2) There were no statistical differences in clinical and imaging data between the patients with swirl sign (n=33) and patients without swirl sign (n=177,P＞0.05);the hematoma volume in patients with black hole sign (n=39) was significantly increased as compared with that in patients without black hole sign (n=171,P＜0.05),and there were no statistical differences in other clinical and imaging data between patients with and without black hole sign (P＞0.05).(3) The areas under ROC curve of swirl sign,black hole sign,and "swirl sign combined with black hole sign" were 0.645,0.577,and 0.570,respectively.(4) Multivariate Logistic regression analysis showed that admission systolic blood pressure,swirl sign and black hole sign were independent risk factors for early hematoma expansion (P＜0.05).Conclusion In comparison to black hole sign and "swirl sign combined with black hole sign",the swirl sign has higher predictive value in early hematoma expansion in ICH patients.

Age-associated changes in the frequency of naïve, memory and effector CD8+ T cells.

We investigated age-associated changes in the frequency of CD8+ T cell subsets with different functions. Based on expression of CD45RA and CCR7, naïve (CD45RA+ CCR7+), central memory (CM, CD45RA- CCR7+), effector memory (EM, CD45RA- CCR7-) and effector (CD45RA+ CCR7-) CD8+ T cells were identified in peripheral blood from healthy young (n = 17) and elderly (n = 17) people using flow cytometry. The elderly had a decreased frequency of naïve and an increased frequency of EM and effector CD8+ T cells compared to the young. However, both groups had a similar frequency of CM cells. These findings suggest that age-associated changes in CD8+ T cell subsets occur, which could be a potential explanation for altered CD8+ T cell function in the elderly.

Application value of non-flapping technique in immediate implant prosthesis in aesthetic area of anterior teeth / 中国基层医药

Objective@#To explore the application value of non-flapping technique in immediate implant prosthesis in aesthetic area of anterior teeth.@*Methods@#From March 2016 to September 2017, 104 patients who received immediate implant restoration of anterior teeth in the First Hospital of Jiaxing were divided into observation group (53 cases) and control group (51 cases) according to random number table method.The control group was treated with conventional flap immediate implantation, while the observation group was treated with non-flap immediate implantation.The red aesthetic index (EPS), alveolar bone resorption and patients' satisfaction were compared between the two groups.@*Results@#The PES scores of the observation group were (6.17±1.21)points, (5.94±1.03)points and (5.12±0.85)points, respectively after repair 3 months, 6 months and 12 months, which were significantly higher than those of the control group [(5.38±0.96)points, (4.79±0.76)points, (4.05±0.70)points] (t=3.679, 6.459, 6.993, all P<0.05). At 3 months, 6 months and 12 months after restoration, the alveolar bone resorption in the observation group was(0.29±0.04)mm, (0.63±0.12)mm, (1.07±0.17)mm, respectively, which was significantly lower than that in the control group [(0.36±0.07)mm, (0.95±0.24)mm, (1.28±0.26)mm] (t=6.291, 8.649, 4.893, all P<0.05). At 12 months after repair, the satisfaction rate of patients in the observation group was 98.11% (52/53), which was significantly higher than 84.31% (43/51) in the control group (χ2=4.637, P<0.05).@*Conclusion@#The application of non-flapping technique in immediate implant prostheses in aesthetic area of anterior teeth has good effect, which can obtain better aesthetic effect, reduce alveolar bone absorption and improve patients'satisfaction with prostheses.However, in clinical work, it is necessary to strengthen preoperative examination and measurement of patients, accurately grasp the direction of implants and avoid the occurrence of bone wall perforation during operation.

Expression and clinical significance of receptor for activated C kinase 1 and β-catenin in cervical cancer tissues / 临床与实验病理学杂志

Purpose To investigate the expression and clinical significance of receptor for activated C kinase 1 (RACK1) and β-catenin in cervical cancer tissues. Methods The expression of RACK1 mRNA and β-catenin mRNA in 126 cases of cervical cancer and adjacent normal tissues was detected by RT-PCR, and the expression of RACK1 and β-catenin protein was detected by SP immunohistochemistry. The correlation between the expression of RACK1 and β-catenin protein and clinicopathological data and prognosis was analyzed. Results The relative expression of RACK1 mRNA in cervical cancer tissues was lower than that in adjacent normal tissues, while the relative expression of β-catenin mRNA in cervical cancer tissue was higher than that in adjacent normal tissues. There was a significant difference between the two groups (P < 0.05) . The positive expression rate of RACK1 in cancer tissue group was lower than that in adjacent tissue group (19.0％ vs 63.5％) , while the positive expression rate of β-catenin was higher than that in adjacent tissue group (69.0％ vs 31.0％) (P < 0.05) . The higher the TNM stage, the lower the differentiation and the lower the RACK1 positive expression rate with lymph node metastasis, the higher the positive expression rate of β-catenin (P < 0.05) .There was a negative correlation between RACK1 and β-catenin protein expression (r = 0.404, P < 0.05) . The survival rates of the patients with strong positive expression of RACK1 protein and weak positive expression of β-catenin protein were higher (42.8％ vs 33.3％, 42.8％ vs 36.4％) , but the difference was not statistically significant (P> 0.05) . There was a significantly difference in the median survival time between the two groups (57.2 vs 34.0, 44.2 vs 29.8, P < 0.05) . Weak positive expression of RACK1 protein and strong positive expression of β-catenin were risk factors for poor prognosis in patients with cervical cancer (HR were 9.654 and 8.882 respectively, P < 0.05) .Conclusion The abnormal expression of RACK1 and β-catenin may be related to the occurrence, development and prognosis of cervical cancer, and affect the lymph node metastasis of cervical cancer.

The association of Vitamin D levels with lipid metabolism during pregnancy / 中华预防医学杂志

Vitamin D deficiency is common in pregnant women, and it is associated with multiple gestational complications, fetal intrauterine dysplasia, and maternal and infant health in postpartum period. Vitamin D involved in lipid metabolism may affect maternal-fetal health during pregnancy through this biological pathway. This review provides an overview of three main aspects, including, the effect of vitamin D on the mechanism of lipid metabolism, the relationship between vitamin D and lipid metabolites in pregnant women and women with pregnancy complications. An association between vitamin D status and lipid metabolism at different stages of pregnancy has been justified in most current studies, and the underlying mechanism has also been partly elucidated. Given some gestational complications, such as gestational diabetes and pre-eclampsia, pregnant women with these conditions are often associated with abnormal lipid metabolism and vitamin D deficiency. There is no doubt that the studies on the vitamin D supplementation and lipid metabolism improvement could have crucial clinical significance for this population. More randomized controlled trials with multi-center, large sample and multi-dose interventions are needed in the future to provide scientific evidence for clinical practice.

Construction and practice of multi-disciplinary team information management system in the hospital / 中华医院管理杂志

Multi-disciplinary team(MDT) is a new mode of medical diagnosis and treatment service. Multidisciplinary discussion could provide patients with a scientific, standardized and effective individualized diagnosis and treatment plan to avoid over-treatment. This article is based on the application experience of the MDT information management platform designed by the First Affiliated Hospital of Zhejiang University during the past five years. It discussed how to build a MDT management system which could fit the medical environment of large general hospitals in China. The MDT management system simplifies the MDT process, improves the efficiency of MDT work, and enhances the overall medical quality of hospitals. Meanwhile, it also contributes to strengthen the disciplinary collaboration in such aspects as disease diagnosis and treatment, personnel training, and scientific research innovation, ultimately forming a new multi-disciplinary collaboration system in hospitals.

Association between vitamin D level and lipid metabolism during second trimester / 中华流行病学杂志

Objective@#To explore the relationship between the vitamin D levels and lipid metabolism during second trimester.@*Methods@#A total of 1 875 pregnant women who were in the second trimester and had antenatal care in 3 hospitals in Hefei of Anhui province from March 2015 to February 2018 were included. Baseline questionnaire survey was performed, and fasting venous blood samples were collected from the pregnant women to detect serum 25(OH)D, cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) levels. Cubic non-linear model and linear regression model were used to analyze the linear relationship between vitamin D levels and lipid metabolism indicators in the second trimester.@*Results@#The vitamin D deficiency rate was 75.3% (1 412/1 875) in the pregnant women. The mean levels of lipid metabolism indicators TC, TG, HDL-C and LDL-C were (233.22±38.87), (226.24±83.88), (79.04±12.77), and (109.54±25.95) mg/dl respectively. Multivariate linear regression model results showed, compared with Q5 of the 25(OH)D, the TC and TG levels of Q1-Q4 groups significantly increased, and the LDL-C of Q1 and Q2 groups significantly increased. The highest difference between TC, TG and LDL-C was observed in Q1 group. (TC: β=16.88, 95%CI: 10.50-23.26; TG: β=34.92, 95%CI: 21.32-48.53; LDL-C: β=9.06, 95%CI: 4.77-13.35). No significant differences in HDL-C level among the 5 groups were observed. When stratified with vitamin D deficiency the results showed that, when 25(OH)D was <50 nmol/L, TC, TG and LDL-C levels decreased by 3.53 (95%CI: 1.30-5.75), 7.42 (95%CI: 2.41 to 12.44) and 2.08 mg/dl (95%CI: 0.60-3.57) along with a 10 nmol/L increase of 25(OH)D, the difference was statistically significant, and when 25(OH)D was ≥50 nmol/L, no significant correlation was found between 25(OH)D level and TC, TG and LDL-C levels. No significant relationship between 25(OH)D level and HDL-C level was observed regardless of vitamin D deficiency.@*Conclusions@#There was a nonlinear relationship between vitamin D levels and lipid metabolism indicators in the second trimester. There was a significant negative correlation between 25(OH)D level and lipid metabolism indicators only in the deficiency of vitamin D.