Abstract:Osteoporosis is a frequently seen metabolic bone disease characterized by reduced bone mass, reduced bone mineral density and bone micro-structure destruction. Patients with osteoporosis are prone to brittle fractures, and the incidence of osteoporosis is increased annually. The pathogenesis of osteoporosis is related to the imbalance between osteoblasts and osteoclasts. On one hand, the activity of osteoclasts is increased, with high bone resorption; on the other hand, the function of osteoblasts is attenuated, with low osteogenesis; and finally the two reasons lead to loss of net bone mass. Osteogenesis is closely related to the differentiation of bone marrow-derived mesenchymal stem cells (BMSCs). In osteoporotic patients, the adipogenic differentiation of BMSCs is increased and the osteogenic differentiation is decreased. The differentiation fate of BMSCs is regulated by BMP/Smad, Wnt, Notch, Hedgehogs and other signal pathways, involving microRNAs, transcription factors, epigenetic and other regulatory mechanisms, which is a focus in current research. The future studies need to focus on finding the key factors in determining the differentiation fate of BMSCs and BMSCs transplantation, so as to cast new lights on the treatment of osteoporosis.

Abstract:Objective To evaluate the therapeutic effect of novel β-catenin-binding drug SAHPA1 on postmenopausal osteoporosis animal models. Methods C57 female mice were selected and divided into 3 groups (n=5): Sham group, osteoporosis model group (OP group), and osteoporosis model treatment group (Treat group). The mice in the Sham group only underwent surgical incision exposing bilateral ovaries, while the mice in the OP and Treat groups underwent bilateral ovariectomy and the ovariectomized osteoporosis mouse models were established. Then the mice in the Treat group were immediately treated with SAHPA1 (10 mg/kg) by daily intramuscular injection, and those in the Sham and OP groups were injected with the same dose of saline daily. The morphology of trabecular bone in the femur metaphyseal bone in mice was observed and the morphometric analysis was performed by bone tissue sections with H-E staining and micro-CT. The therapeutic effect of SAHPA1 on osteoporosis in ovariectomized mice models was also evaluated. Results The bone mineral density (BMD), trabecular bone number (Tb.N) and trabecular bone thickness (Tb.Th) of mice in the OP group were significantly lower than those in the Sham group (P<0.05). The BMD and Tb.N of mice in the Treat group were significantly higher than those in the OP group (P<0.05), while there was no significant difference in Tb.Th between the two groups (P>0.05). Conclusion The novel β-catenin-binding drug SAHPA1 has a certain therapeutic effect on postmenopausal mice with osteoporosis.

Abstract:Objective To analyze the clinical data of 915 elderly patients with hip fractures (≥80 years old) receiving surgical treatment in our department over the past 10 years, so as to summarize the surgical strategies of hip fractures in elderly patients. Methods We included 915 patients with hip fractures aged 80 years and over from Jun. 2007 to Jun. 2016. Based on preoperative preparation and evaluation, the general condition and underlying diseases of patients were adjusted individually during the perioperation, and then the suitable anesthesia methods and reasonable internal fixation were selected and the surgery was performed as soon as possible. Active early functional exercise, specialist nursing and health education were conducted after surgery. The waiting time for operation, operation time, hospital stays, bleeding volume, postoperative systemic and local complications and 1-year mortality were analyzed. Results The mean operation time of the 915 patients was (69.5±34.2) min (range 50-120 min), the mean bleeding volume was (278.3±56.8) mL (range 150-440 mL), and the mean hospital stay was (5.6±3.2) d (range 5-31 d). There were 210 cases having systemic and local complications, with 117 cases of systemic complications and 93 cases of local complications. Fourteen patients died, accounting for 1.5% (14/915) of the total. The patients were divided into <2 d group, 2-7 d group and >7 d group according to the waiting time for operation. Our results showed that the waiting time for operation was longer, the mortalities and incidences of complications of patients were higher, with a significant difference found between the 3 groups (P<0.05). Conclusion Active preoperative preparation and evaluation, right anesthesia methods, reasonable internal fixation according to the fracture site and type, adjusting general condition and underlying disease drug during the perioperation, early surgery, active specialist nursing, preoperative health education and individualized diagnosis can all contribute to the treatment of elderly patients with hip fractures, improving the clinical efficacy and reduce the complications effectively.

Abstract:Objective To analyze the epidemiological characteristics of 2 859 patients with hip fractures, so as to provide reference for the prevention and treatment of elderly patients with hip fractures. Methods The clinical data of 2 859 patients with hip fractures in Changhai Hospital, Second Military Medical University from Jan. 2004 to Dec. 2016 were collected, including age, gender, injury mechanism, fracture type, injury-operation time, hospital stays, bleeding volume and operation method. SPSS 16.0 software was used to analyze the epidemiological characteristics of elderly patients with hip fractures. Results (1) The total number of in-patients with hip fractures in our hospital increased annually, with the proportion of femoral neck fractures being the highest (1 602/2 859, 56.03%), followed by intertrochanteric fractures. (2) The age of the patients with hip fractures was 52-104 years old, and there was a significant difference in the age distribution (P<0.05), with the patients aged 71-80 years being the most majority, accounting for 37.39%(1 069/2 859). (3) The proportion of female patients with hip fractures (1 916/2 859, 67.02%) was higher than that of male patients (943/2 859, 32.98%). (4) The distribution of injury mechanism was significantly different (P<0.05). The number of fractures caused by walking falls was the highest, accounting for 87.65% (2 506/2 859). (5) The distribution of fracture types was significantly different in different genders (P<0.05). The proportion of femoral neck fractures was higher in female patients, while the proportion of intertrochanteric fractures was higher in male patients. (6) The incidences of hip fractures were the highest in patients with diabetes or cardiovascular disease, accounting for 26.76% (765/2 859) and 25.85% (739/2 859), respectively. Conclusion Femoral neck fractures and intertrochanteric fractures are the most common types in elderly patients with hip fractures. The distributions of age, gender, injury mechanism and complications of elderly patients have certain epidemiological characteristics, which provides clue to further improve the prevention and treatment of hip fractures.

Abstract:Objective To observe the application of the Green channel in the treatment of elderly patients with hip fracture, so as to provide a reference for the standardized treatment. Methods We retrospectively analyzed the clinical data of 115 elderly patients (≥75 years) with hip fractures treated in hospital from Jun. 2014 to Jun. 2015. The patients were treated through the Green channel (Green channel group, n=58) or received conventional treatment (normal group, n=57). The waiting time for operation, operation time, bleeding volume, hospital stay, and postoperative systemic and local complications during hospitalization were compared between the two groups. Results The waiting time for operation of patients in the Green channel group (median 43.6 h) was significantly shorter than that in the normal group (median 136.8 h, P<0.01), and the hospital stay of patients in the Green channel group ([4.3±1.2] d) was significantly shorter than that in the normal group ([8.5±2.5] d, P<0.05). There was no significant difference in the operation time or bleeding volume between the two groups (P>0.05). The incidence of complications of patients in the Green channel group (11/58, 19.0%) was significantly higher than that in the normal group (29/57, 50.9%; P< 0.01). The incidences of pulmonary infection and pressure sores of patients in the Green channel group were significantly lower than those in the normal group (3.4% [2/58] vs 14.0% [8/57], P<0.05; 3.4% [2/58] vs 15.8% [9/57], P<0.05). There was no significant difference in the incidences of pulmonary embolism, cerebral infarction, deep vein thrombosis, myocardial infarction, or incision infection between the two groups. Conclusion Application of the Green channel in the treatment of elderly patients with hip fracture can allow early surgery under suitable conditions, which is conducive to reduce hospital stay and postoperative complications, and can promote the recovery of hip function, indicating that the Green channel has an important significance for standardized treatment of eldery patients with hip fractures.

Abstract:Objective To explore the surgical technique and efficacy of intramedullary nails fixation in treatment of unstable femoral intertroehanteric fracture in elderly patients. Methods We retrospectively analyzed the data of 64 elderly patients with unstable intertrochanteric fractures who were treated with intramedullary nail fixation in our department from Jul. 2014 to Dec. 2015. There were 21 males and 43 females, with a mean age of (81.9±5.2) years old, ranging from 75 to 96 years. Thirty-one cases were type 31-A2.2, 23 were type 31-A2.3, and 10 were type 31-A3.3 according to AO classification.All patients were treated with intramedullary nail fixation and were divided into Group 1 (limited open reduction and temporary fixation by accessory appliances, n=19) and Group 2 (direct close reduction and fixation, n=45). The operation time, intraoperative blood loss, follow-up and fracture healing time, and Harris score of the hip at the last follow-up of patients were compared between the two groups. Results Compared with the Group 2, the intraoperative blood loss in the Group 1 was significantly higher ([365.8±81.2] mL vs [238.9±56.7] mL, P<0.05) and the operation time was significantly longer ([93.4±10.4] min vs [79.4±12.7] min, P<0.05). All patients were followed up for 12 to 18 months. There were no significant differences in the fracture healing time ([17.4±3.1] weeks vs [16.7±2.2] weeks) or the Harris score at the last follow-up (84.7±8.3 vs 86.4±7.4) between the two groups (P>0.05). There were no complications such as deep infection, avascular necrosis of the femoral head, hip varus deformity, femoral shaft fractures, implant failure or fracture in the two groups. Conclusion Unstable femoral intertrochanteric fractures is common in elderly patients. The limited open reduction combined with temporary fixation by accessory appliances is required for good reduction when the closed reduction is hard to reset. Although the technique will greatly increase intraoperative blood loss and operation time, it does not affect the overall clinical effectiveness.

Abstract:Objective To compare the clinical efficacy of proximal femoral nail antirotation (PFNA) and InterTan nail in the treatment of unstable femoral intertrochanteric fractures in elderly patients. Methods Totally 102 elderly patients (≥65 years old) with A2.2, A2.3 and A3 type unstable femoral intertrochanteric fractures were enrolled in this prospective study. The patients were divided into PFNA group (n=48, with a mean age of [75.6±6.7] years) and InterTan group (n=54, with a mean age of [75.3±6.6] years) according to the surgical method. During follow-up, the Harris hip score was recorded at the last outpatient review, and the survival information of patients was obtained by telephone interview and census register database. Results There was no significant difference in baseline characteristics of patients between the two groups. The operation time, intraoperative fluoroscopy time and bleeding volume of patients in the InterTan group were significantly higher than those in the PFNA group (P<0.05). There was no significant difference in hospital stays or postoperative spikes between the two groups (P>0.05). Screw cut-out occurred in 4 patients in the PFNA group, and the hospital death occurred in 3 (2.9%) patients in the two groups. There was no significant difference in the healing time and Harris hip score between the two groups during follow-up (P>0.05). The median survival time of patients in the PFNA group and the InterTan group was 33.9 and 27.4 months, respectively, with no significant difference between the two groups (P>0.05). Conclusion PFNA and InterTan nail have similar therapeutic effect on elderly patients with unstable femoral intertrochanteric fractures. PFNA is better in improving operation time, intraoperative fluoroscopy time and intraoperative bleeding volume, but has the risk of screw cutting-out.

Abstract:Objective To evaluate the clinical efficacy of proximal femoral nail antirotation (PFNA) internal fixtion combined with normalized anti-osteoporosis drugs in treating elderly patients with osteoporotic femoral intertrochanteric fractures. Methods Seventy-eight elderly osteoporosis patients (≥60 years old, 25 males and 53 females) with femoral intertrochanteric fractures were enrolled, who received PFNA operation from Jun. 2012 to Jun. 2014 and had complete follow-up data. Patients were divided into anti-osteoporosis treatment group and control group according to whether anti-osteoporosis treatment was given. Patients in anti-osteoporosis treatment group (n=40) were treated with PFNA and received salmon calcitonin and zoledronic acid for sequential therapy based on the supplementation of calcium and active vitamin D, while the control group (n=38) was treated with PFNA only. Bone healing was observed with X-ray and bone mineral density (BMD) was measured regularly by dual energy X-ray absorptiometry after surgery. Harris score was used to evaluate the function of hip joint, and the complications, adverse reaction and subsequent fragility fractures were recorded after surgery. Results All patients were successfully operated, without any complication such as infection and internal fixation failure. X-ray results confirmed that clinical bone healing was achieved in all cases. There were no significant differences in fracture healing time or Harris' hip functional score between the two groups. BMD of contralateral hip joint of patients in the anti-osteoporosis treatment group was significantly higher than that in the control group on the 6 months, 12 months and 18 months after surgery (P<0.05), while the subsequent fragility fracture rate was significantly lower (P<0.05). Conclusion Method for treating elderly patients with osteoporotic femoral intertrochanteric fractures by PFNA conforms to concept of minimally invasive, with simple operation and satisfactory effect. PFNA combined with normalized anti-osteoporosis drugs can increase BMD and reduce subsequent fragile fractures.

Abstract:Objective To explore the anti-osteoporosis effect of bisphosphonates on repairing injured vertebrae after thoracolumbar fracture internal fixation through a randomized controlled study. Methods Eighty-four patients with thoracolumbar fracture treated by orthopaedic internal fixation in Department of Orthopaedics, Nanjing General Hospital from Jun. 2014 to Jun. 2015 were included, and the patients were divided into the bisphosphonate treatment group (n=42) and control group (n=42) by random number method. The patients in both groups were given the routine anti-osteoporosis drugs such as calcitriol and calcium carbonate D3 after surgery; in addition, the patients in the bisphosphonate treatment group were also given alendronate sodium D3 tablets (each containing alendronate sodium 70 mg, 1 tablet per week), while the control group received a placebo. The bone mineral density (BMD) in thoracolumbar vertebral injury area of patients in the two groups was measured and compared at 1 month, 3 months, 6 months and 1 year after surgery. Results The BMD values of patients in two groups were significantly decreased immediately after reset compared with preoperation, and then they were increased continuously in follow-up. There was no significant difference in BMD between the two groups at 1 month or 3 months after sursery (P>0.05), while the BMD in the bisphosphonate treatment group was significantly higher than that in the control group at 6 months and 1 year after surgery (P<0.05). Conclusion Bisphosphaonate drugs can accelerate the repair of vertebral osteoporosis after thoracolumbar fracture internal fixation, showing a good clinical application value.

Abstract:Objective To explore the safety of early minimally invasive surgery without stopping anti-platelet drugs in treatment of elderly patients with hip fractures. Methods Data of elderly patients with femoral intertrochanteric fractures treated with proximal femoral intramedullary nail between Jan. 2012 and Dec. 2013 were collected, in which 32 patients who took long-term oral anti-platelet drugs due to cardiovascular and cerebrovascular disorders received early closed reduction of minimally invasive intramedullary nail treatment without stopping anti-platelet drugs. Retrospective study was performed to analyze the clinical data of 32 patients, including gender, age, ASA score, fracture AO type, time from injured to surgery, pre- and post-operative hemoglobin, hospital stays, ICU stays, bleeding volume, post-operative blood transfusions, incision complications, systemic complications and intra-1-month and 1-year mortality. Results Thirty-two patients were aged 65-81 years old, with 11 males and 21 females. Twenty-five patients were taking only clopidogrel and 7 patients were taking both clopidogrel and aspirin. The mean time from injured to surgery was (4.8±2.5) d (range 2-13 d), and the mean operative time was (89.0±33.2) min. The mean inter-operation bleeding volume, post-operative drainage volume, post-operation hemoglobin and post-operative blood transfusions were (242.9±83.7) mL, (259.8±94.9) mL, (73±11) g/L, and (390.2±103.1) mL, respectively. The ICU stays was (1.7±0.9) d and the hospital stays was (12.5±2.5) d. Three patients experienced post-operative incision complications (9.4%), with 2 poor incision and 1 incisional hematoma. During the first month after surgery, acute cardiovascular event was found in 3 cases (9.4%), acute stroke in 2 cases (6.2%), pneumonia in 2 cases (6.2%), and pressure ulcer in 1 case (3.1%). Three patients (9.4%) died during the first month after surgery and 12 patients (37.5%) died in the first year. Conclusion Early minimally invasive surgery without stopping anti-platelet drugs in elderly patients with femoral intertrochanteric fractures will not increase the incidence of local and systemic complications within 1 year.

Abstract:Objective To compare the advantages and disadvantages of iliac fascia block (blocking femoral nerve, lateral femoral cutaneous nerve and obturator nerve simultaneously) composite laryngeal mask anesthesia with spinal anesthesia in elderly patients (≥80 years old) undergoing artificial femoral head replacement (not bone cement type), so as to explore the individualized anesthesia scheme for orthopedic elderly patients. Methods We retrospectively analyzed the anesthesia-related data of 98 elderly patients (≥80 years old) undergoing artificial femoral head replacement, including 44 cases with iliac fascia block composite laryngeal mask anesthesia in group G and 54 cases with spinal anesthesia in group S, with the American Association of Anesthesiologists (ASA) grade being Ⅱ-Ⅳ. Mean arterial pressure (MAP) and heart rate (HR) of patients were recorded before anesthesia induction, and after anesthesia induction for 5, 10, 15, 20, and 30 min. Visual Analogue Scale (VAS) score was recorded before surgery, immediately after surgery, and at 6 h, 24 h after surgery. The number of methamphetamine used, complications, incidence of side effects, length of hospital stay, and sleep quality before and 1 day after operation were recorded, and surgeon's satisfaction with the anesthesia scheme was investigated. Results There were no significant differences in age, gender or body mass index of patients between the two groups. The number of ASA Ⅳ patients in the group G was significantly larger than that in the group S (P<0.05). VAS score in the group G was significantly lower than that in the group S (P<0.01) at 6 h and 24 h after surgery, and the analgesic effect was satisfactory. There was no significant difference in hemodynamics between the two groups before and after anesthesia induction. The number of methamphetamine used in the group G was significantly higher than that in the group S (P<0.01). Incidence of postoperative urinary retention in the group S was significantly higher than that in the group G (P<0.05). There was no significant difference in length of hospital stay after surgery between the two groups (P>0.05). Conclusion Individualized anesthesia scheme for elderly patients undergoing hip arthroplasty should be considered. In selected patients, iliac fascia blockade composite laryngeal mask anesthesia has longer time of postoperative analgesia, and is safer and more feasible compared with spinal anesthesia.

Abstract:Hypoxia inducible factor (HIF) plays a key role in the cellular response to hypoxia, and is involved in a variety of pathological and physiological processes such as glucose metabolism, vascular remodeling and erythropoiesis. Growing research suggests that HIF has an important effect on osteogenesis, bone resorption and angiogenesis; while the deterioration of bone vascular structures and functions is closely related to the development and progression of postmenopausal osteoporosis. In this review, we summarized the relationship between HIF and postmenopausal osteoporosis based on the roles of HIF in osteogenesis, bone resorption and angiogenesis, hoping to evaluate its therapeutic prospect on postmenopausal osteoporosis.

Abstract:Objective To clarify the factors influencing long-term prognosis of patients with hepatocellular carcinoma (HCC) after hepatectomy, and to explore the value of preoperative plasma prealbumin (PA) in assessing the long-term prognosis. Methods We retrospectively analyzed the clinical and follow-up data of HCC patients who underwent hepatectomy in Eastern Hepatobiliary Surgery Hospital between Dec. 2011 and Mar. 2012. Univariate and multivariate Cox regression analyses were used to analyze the effects of preoperative factors on the overall survival time and recurrence of patients. According to the content of preoperative plasma PA, the patients were divided into high PA group (preoperative PA content was higher than 152 mg/L) and low PA group (preoperative PA content was lower than 152 mg/L); then the difference of prognosis between the two groups were compared by Kaplan-Meier methods. Results A total of 373 HCC patients undergoing hepatectomy were included in this study. The median survival time was 32.3 months and the median recurrence time was 20.5 months. Univariate and multivariate analysis showed that tumor size (P=0.003), TNM stage (P<0.001), preoperative PA content (P=0.034), and vascular invasion (P=0.027) were the independent risk factors for long-term overall survival time of patients after hepatectomy; while TNM stage (P<0.000 1), preoperative PA content (P=0.002), and vascular invasion (P=0.048) were the independent risk factors for recurrence of patients after hepatectomy. The median overall survival time and median recurrence time of patients in the high PA group were both significantly longer than those in the low PA group, respectively (median overall survival time: 41.3 months vs 31.7 months, P<0.000 1; median recurrence time: 28.8 months vs 14.4 months, P<0.000 1). Conclusion Low preoperative PA content is an independent risk factor for long-term overall survival and recurrence of HCC patients after hepatectomy.

Abstract:Objective To explore whether heat acclimation can protect the structure and function of mitochondrion of cerebral cortex and myocardium in rats with moderate and high intensity exercise in hygrothermal environment, and to explore its protective mechanism. Methods Forty SD rats underwent swimming experiment bearing weight and 8 rats were eliminated due to too short-swim or long-swim time. The rest 32 rats were randomly divided into four groups (n=8): room-temperature activity (RA) group, room-temperature exercise (RE) group, high-temperature activity (HA) group and high-temperature exercise (HE) group. Rats in RA and HA groups were placed at room temperature ([24±1]℃) and high temperature ([32±1]℃) to have a free activity for 2 h/d. Rats in RE and HE groups were placed at room temperature ([24±1]℃) and high temperature ([32±1]℃) to have a free activity for 1 h/d and then were allowed to run at a constant speed on the animal treadmill for 1 h/d (slope: 0°, speed: 14 m/min). After 14 days the heat acclimation rat models were created. Rats in all groups underwent moderate and high intensity exercise in hygrothermal environment for 30 min on the 3^rd day. The body weight loss rate and rectal temperatures of rats were measured before and after high and medium intensity exercise in hygrothermal environment. The contents of plasma norepinephrine (NE), arginine vasopressin (AVP) and cortisol (Cort) in rats were detected by radioimmunoassay. The ultrastructure of the mitochondria of cerebral cortex and myocardium was observed by transmission electron microscopy. The contents of ATP synthase and reactive oxygen species (ROS) were detected by ELISA method and the total antioxidative capacity was measured by ABTS method. Results The rectal temperatures before and after stimulation and the ascending range of rectal temperatures of rats in HE group were significantly lower than those in the RA, RE and HA groups (P<0.05, P<0.01). After stimulation with moderate and high intensity exercise in hygrothermal environment, the body weight loss rate of rats in HE group was significantly higher than that in RA group (P<0.01), the contents of plasma Cort and ROS of rats in HE group were significantly lower than those in the RA, RE and HA groups (P<0.05, P<0.01), the content of ATP synthase in mitochondrion and total antioxidative capacity in tissue from cerebral cortex and myocardium of rats in HE group were significantly higher than those in the RA, RE and HA groups (P<0.01), and the mitochondrion and synaptic structures in the cerebral cortex and the structures of myocardium, Z line and transverse tubule in the myocardium in HE group were superior to those in the RA, RE and HA groups. Conclusion Heat acclimation can enchance the oxidative and respiratory function of mitochondria and reduce the level of cell oxidative stress and the content of plasma Cort, so as to protect the mitochondrial structure of cerebral cortical neurons and cardiomyocytes in rats with moderate and high intensity exercise in hygrothermal environment.

Abstract:Objective To investigate the social psychological factors influencing postpartum depression (PPD), and to explore its predictive value for PPD, so as to establish and evaluate the prediction model of PPD. Methods We randomly selected 371 pregnant women (pregnancy≥28 weeks), who received antenatal examination and would be hospitalized for delivery in the First Hospital, Jinshan Hospital, and University-Town Hospital Affiliated to Chongqing Medical University from Sep. 2014 to Jun. 2016. The social demographic questionnaire (self-define), the Eysenck Personality Questionnaire (EPQ), the Symptom Checklist-90 (SCL-90), the Hamilton Anxiety Scale/Hamilton Depression Rating Scale (HAMA₁₄/HAMD₂₄), and the Beck Anxiety Inventory/Beck Depression Inventory (BAI/BDI) were used to assess the prenatal social psychological factors of pregnant women, and the Edinburgh postnatal depression scale (EPDS) was completed on the 42^nd day after delivery. Then the evaluation of PPD was conducted to analyze and predict the social psychological factors influencing PPD. Multivariate stepwise logistic regression analysis was used to establish the prediction model, and receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the model. Results Sixty of the 371 cases met the diagnostic criteria of PPD (PPD group) according to the assessment results of PPD, while 311 cases did not meet (N-PPD group); the incidence of PPD was 16.17% (60/371). Univariate analysis results showed that there were significant differences in having a fixed work or not, the degree of education, emotional stability, HAMA₁₄ score, HAMD₂₄ score, BAI score, BDI score, and each single factor score (except somatization) of the SCL-90 between the two groups (all P<0.05). The above indexes were selected for multivariate logistic regression analysis, and the following mathematical prediction model was established: Logit (PI)=0.042×total score of SCL-90+1.005×having a fixed work or not+2.498×relative company+0.108×BDI score-1.319×the degree of education-8.028, with the area under the ROC curve being 0.833 (P<0.001, 95%CI: 0.772-0.894). When PI=0.141 was selected as cut-off point, the Youden index of the model was maximum, the sensitivity was 0.900 and the specificity was 0.533. Conclusion The total score of SCL-90, having a fixed work or not, family company and BDI score are independent risk factors of PPD, while low degree of education is an independent protective factor. The prediction model for PPD based on social psychological factors has been successfully established, which has a great predictive value and is worthy of further study.

Abstract:Objective To explore the effect of Astragalus polysaccharides (APS) on the function and quantity of islet β cells in rats with type 2 diabetes mellitus (T2DM). Methods SD rats were randomly divided into normal control group, T2DM model group and APS treatment group, with 8 rats in each group. The T2DM rats in the T2DM model group was induced by the combination of high fat diet and streptozotocin, and the rats in the APS treatment group was treated with APS (700 mg·kg^-1·d^-1, content of APS being 70%). The rats were sacrificed after 8 weeks of drug intervention, and the serum samples were collected to measure fasting blood glucose (FBG), triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and fasting insulin (FINS), and to calculate insulin secretion index (HOMA-β value). Pancreas tissues were extracted and stained with Hematoxylin-Eosin to observe the pancreatic histopathological characteristics, and the quantity of islet β cells was observed and calculated with immuno-histochemical method. Results (1) Compared with the normal control group, the rats in T2DM model group had significant increases in the FBG, TG and LDL-C, and significant decreases in the HDL-C, FINS and HOMA-β (P<0.05); compared with the T2DM model group, the rats in APS treatment group had significant decreases in the FBG, TG and LDL-C (P<0.05), and significant increases in the FINS and HOMA-β (P<0.05). (2) Compared with the normal control group, the rats in T2DM model group showed a significant atrophy of the islet accompanied by loss of granular and vacuolar degeneration, and the number of the islet β cells was significantly reduced (P<0.05); compared with the T2DM model group, the rats in APS treatment group showed a significant increase in the islet volume accompanied by improvement of islet degranulation and vacuolar degeneration, and had a significant increase in the number of islet β cells (P<0.05). Conclusion APS can improve the glucose and lipid metabolisms of the T2DM rats, which may be caused by increasing insulin secretion through the protective effect on pancreatic islet β cells.

Abstract:Objective To establish a transgenic breast cancer mouse model with human Her2 overexpression and to identify the mouse model. Methods The purified exogenous plasmid pMD18T-MMTV-huHER2-EGFP was constructed and injected into C57BL/6J mouse fertilized eggs by prokaryotic microinjection method. Then the embryos were transplanted into the fallopian tubes of pseudopregnant mice in estrus simultaneously, and the offspring mice were obtained. The genomic DNA of offspring mice was identified by PCR method. The expression of Her2 protein in the breast tissue of offspring mice was detected by Western blotting analysis. The pathological changes of breast tissue in transgenic mice were observed by histopathological section. Results Her2 transgenic mice were detected by PCR method. Western blotting analysis showed that, compared with wild-type mice, the expression of Her2 protein in the breast tissue of F2 generation positive mice was significantly higher. Histopathological sections showed that the breast tissue of F2 generation positive mice of 25 weeks old had an obvious carcinogenic tendency. Conclusion The transgenic breast cancer mouse model with human Her2 overexpression has been successfully established, with stable genetic and spontaneous formation of breast cancer. The biological characteristics and pathological changes of the model are similar to human breast cancer, indicating that it can be used as an animal model to study the development and progression of breast cancer.

Abstract:Liver stem cells are primitive cells with self-renewing capacity and bidirectional differentiation potential to differentiate into mature hepatocytes or biliary epithelial cells. Liver stem cells not only play roles in the homeostasis maintenance, injury repair and regeneration of liver, but also have huge potential applications in cell therapy of liver diseases, construction of bioartificial liver and liver-oriented gene therapy. In this review, we summarized the major types of liver stem cells, as well as their origins and molecular markers.

Abstract:Debridement is an indispensable step in repairing of burn wounds. Hydrosurgery system is an advanced instrument for debridement. Compared with the conventional debridement instruments, the hand-piece of hydrosurgery system is more facile and easy to be controlled, which is helpful for the debridement of wounds with irregular shape and uneven surface; besides, hydrosurgery system combines necrotic tissue resection and wound perfusion simultaneously, and its debridement process is highly tissue-selective, which is helpful to improve the wound-bed and to create favorable conditions for skin grafting and wound healing. Hydrosurgery system has been used in burn wounds debridement for more than 10 years. It is widely used abroad and has been introduced to China in recent years. Due to the complexity of burn wounds, there are also many different opinions about the clinical use of hydrosurgery system for different wounds, including debridement efficiency, effect, cost and the amount of bleeding. In this paper, we systematically summarized the effect of hydrosurgery system on the debridement of burn wounds,so as to provide reference for clinicians.

Abstract:Objective To analyze the mental health status and its influencing factors of navy crews during long-term sailing. Methods Totally 172 crews with long-term sailing were collected by random sampling method. The mental health status of the crews was assessed by Eysenck Personality Questionnaire (EPQ) and Symptom Checklist-90 (SCL-90) at 1 week before the long-term sailing (first assessment). The psychological measurement and investigation of crews was conducted by SCL-90, Fatigue Scale-14 (FS-14) and Assens Insomnia Scale (AIS) after 4-month long-term sailing (second assessment). The differences in the total score of SCL-90 and each factor scores of crews between the first assessment, the second assessment and the military norm were analyzed to determine the influence of long-term sailing on the mental health status of crews. The relationship between the total score of SCL-90 and each factor scores (second assessment) and AIS, FS-14, and EPQ were used to analyze the correlation of the mental health status of crew with sleep, fatigue and personality traits. The major factors influencing the mental health status of crews during long-time sailing were explored by multivariate linear regression analysis with the SCL-90 score as the dependent variable. Results The mental health status of crews after 4-month long-term sailing was significantly lower than that before the sailing, with significant difference in SCL-90 scores (P<0.01). The mental health status of crews was moderately correlated with personality traits, sleep, and fatigue (r>0.4, P<0.01). Multivariate linear regression analysis showed that neuroticism, seasickness, total score of sleep, total score of fatigue, working pressure, mental quality and ship adaptability were the major factors influencing the total score of SCL-90. Conclusion The long-time sailing on the sea has a bad influence on the mental health of navy crews. The seasickness, personality traits, working pressure, sleep, fatigue, and ship adaptability are the major factors influencing the mental health of crews.

Abstract:Objective To investigate the feasibility and efficacy of the first stage anastomosis using perineal ring-shaped flap in the treatment of anterior urethral defect after bladder-preserving urinary continence anterior urethral resection in female patients with early urethra carcinoma. Methods Tweenty-nine female patients with early urethra malignant tumor diagnosed in Changhai Hospital, Second Military Medical University from Jan. 2013 to Jan. 2016 were enrolled in this study. The average age of the patients was (61.4±14.4) years old, the clinical stages were type Ⅰ and the lesions were limited to half of the urethra. All patients underwent bladder-preserving urinary continence anterior urethral resection. After the resection of tumor, a free 30-40 mm long ring-shaped flap from the perineal vestibule was anastomosed inline to the end of the urethra. The clinical feasibility and safety of the operation were evaluated. Results The operation time was 0.45-1.50 h, with an average of (0.51±0.30) h. The postoperative urethral orifice shape of patients was close to the physiological shape with unobstructed urination, and the maximum urination rate was 12.8-33.0 mL/s, with an average of (19.3±8.7) mL/s. The success rate of one-stage operation was 100%, without any urethral stricture or urinary incontinence. All patients were followed up for 12-48 months with an average of (32.6±3.5) months. During follow-up, 1 case (1/6) with squamous cell carcinoma had a positive left inguinal lymph node metastasis in the first 2 years after surgery, and died of extensive lung metastasis 3 years after surgery; 1 case diagnosed with metastatic squamous cell carcinoma by postoperative pathological report developed regional swollen lymph nodes in the groin 13 months after surgery, and then ilioinguinal lymphadenectomy was perform to dissect the lymph nodes. No other recurrence was found during follow-up. Conclusion The first stage anastomosis surgury using perineal ring-shaped flap is safe and effective in the treatment of anterior urethral defect after bladder-preserving urinary continence anterior urethral resection in female patients with early urethra carcinoma.

Abstract:Objective To investigate the curative effects of hematoma evacuation (HE) combined with external ventricular drainage (EVD) and simple EVD in the treatment of patients with intraventricular hemorrhage secondary to hypertensive intracerebral hemorrhage (HICH). Methods We retrospectively analyzed the clinical data of 70 patients who were diagnosed with HICH from Jun. 2012 to Jun. 2015 in Changzheng Hospital of Second Military Medical University. The patients were divided into EVD combined with HE group (EVD+HE group, n=31) and EVD group (n=39) according to the different choices of operation. The Glasgow Coma Scale (GCS) score, length of neurointensive intensive care units (NICU) stays, in-hospital mortality, incidences of lung infection, intracranial infection and rebleeding, and modified Rankin Scale (mRS) scores and Glasgow Outcome Scale (GOS) scores after 6 months were compared between two groups. Then we screened the patients with supratentorial hematoma volume greater than 30 mL in the EVD+HE group (n=20) and EVD group (n=13), and compared the above clinical indicators between two groups. Results The in-hospital mortality rate of patients in the EVD+HE group was significantly higher than that in the EVD group (29.0% vs 5.1%, P=0.008). The survival patients were included in the subsequent research, including 22 cases in the EVD+HE group and 37 in the EVD group. The improved GCS (ΔGCS) scores of survival patients in the EVD+HE group was significantly higher than that in the EVD group (3.9±3.5 vs 1.2±3.3, P<0.05). The length of NICU stays, incidences of lung infection, intracranial infection and rebleeding, and mRS scores and GOS scores after 6 months of survival patients were not significantly different between the EVD+HE group and EVD group (P>0.05). After screening, the patients with supratentorial hematoma volume greater than 30 mL in the EVD+HE group had significantly higher improved GCS (ΔGCS) scores (3.8±4.0 vs 1.1±2.4, P=0.044), lower 6-month mRS scores (4.2±1.6 vs 5.3±0.7, P=0.025) and higher 6-month GOS scores (3.1±2.0 vs 1.7±0.7, P=0.030) than those in the EVD group. The length of NICU stays, incidences of rebleeding, lung infection and intracranial infection of patients were not significantly different between the EVD+HE and EVD groups (P>0.05). Conclusion For patients with supratentorial hematoma volume greater than 30 mL, HE combined with EVD is superior to simple EVD in treating intraventricular hemorrhage secondary to hypertensive intracranial hemorrhage.

Abstract:Objective To study the effect of Xiaotan Jieyu (XTJY) Decoction on PI3K/Akt signal pathway of MCF-10AT cells of breast precancerous lesion and the ralated mechanism. Methods The MCF-10AT cells were randomly divided into following groups: XTJY group, PI3K/Akt inhibitor LY294002 (LY) group, XTJY+LY group and control (CON) group. After corresponding drug intervention, CCK-8 method was used to observe the MCF-10AT cell proliferation and growth inhibition at 24 h and 48 h, flow cytometry was used to detect the changes of cell cycle at 48 h, and the expression changes of PTEN, PI3K and Akt protein were detected by Western blotting analysis at 48 h. Results The proliferation of MCF-10AT cells were significantly inhibited at 24 h and 48 h in XTJY, LY and XTJY+LY groups, and the inhibitory rate of MCF-10AT cells in XTJY+LY group was significantly higher than those in XTJY and LY groups (P<0.05). Compared with CON group, the percentages of G₀/G₁ phase cells in XTJY, LY and XTJY+LY groups were significantly increased at 48 h (P<0.05), while the percentages of S phase and G₂/M phase cells were significantly decreased (P<0.05); besides, there were significant differences between XTJY+LY group and the other two groups (P<0.05). Compared with CON group, the expressions of PI3K and p-AKT protein in XTJY, LY and XTJY+LY groups were significantly decreased at 48 h (P<0.05), and the expression of PTEN protein was significantly increased (P<0.05). Conclusion XTJY prescription may exert inhibitory and apoptotic effect on MCF-10AT cells through inhibiting the PI3K/Akt signal pathway.

Abstract:

Abstract:Objective:A patient with L3-5 lumbar disc herniations and right spinal recess stenosis at L4-5 level associated with type IIB lumbosacral nerve anomaly(LSNA) at right side according to Neidre and Macnab classification system missed preoperatively and initially misdiagnosed as type IIA intraoperatively was reported. The reasons leading to missed diagnosis preoperatively and misdiagnoses intraoperatively were analyzed. Methods: A 62-year-old female was admitted to our hospital for intermittent radiating pain and claudication to the right lower extremity for about 20 years, radiating pain to the left lower extremity for 2 weeks. Physical examination found the left L5 nerve and right L4 and L5 nerves were impinged. CT and MR scannings revealed L3-4 disc herniation at right side, L4-5 disc herniation at central and left side with severe lateral recess stenosis at right L4-5 level. Image examinations failed to find a nerve root anomaly preoperatively. Following failed conservative treatment, the patient accepted decompression operation initially at left side. Left L5 nerve compressed by the herniated L4-5 disc was found firstly, which was liberated by discectomy. When doing decompression exploration at right side, it was found that two lumbar nerve roots exited L4-5 intervertebral foramen while the upper one was compressed by the herniated L3-4 disc which was liberated by discectomy and the lower one was free of compression. With exposing the right side and partly unroofing of stenosed right L4-5 lateral recess , no typical L5 nerve root was found passing over the posterior surface of the herniated L4-5 disc except that there was a slim membrane-like structure covering it. The patient was initially considered as type IIA LSNA skeptical according to Neidre and Macnad Classification. But detailed observation of the axial CT and MR sequences at L4-5 lateral recess space and sagittal CT and MR sequences at L5S1 intervertebral foramen found there was nerve-like structure, which was further confirmed to be the L5 nerve root by total unroofing of stenosed lateral recess. The membrane-like structure covering the L4-5 disc was confirmed to be the flattened right L5 nerve root compressed by herniated L4-5 disc and stenosed lateral recess, which emerged from the dura’s ventral-lateral side just above the L4-5 disc, the L5 nerve was stripped and pushed medially from its lateral boundary meticulously, L4-5 discectomy was done at right side. Intervertebral cages were inserted after L3-4 and L4-5 disc spaces preparation, following pedicle screw system fusion. Results: No nerve damage occurred intraoperatively. The patient was free of radiating pain to the left lower extremity the day after operation, two weeks later the radiating pain to the right lower extremity alleviated after temporary aggravating. Conclusion: type II lumbar nerve anomalies were not easily to be detected by CT or MR images preoperatively, that closer distance between the conjoined nerves existing the L4-5 foramen and careless observation was responsible for missed diagnosis preoperatively. That the flattened right L5 nerve covering the L4-5 disc was difficult to be recognized intraoperatively for losing its typical contour and color was responsible for misdiagnosing type-IIB anomaly as IIA LSNA.. The operators should be alert and observed carefully in case of misdiagnosing.