Influence of health literacy of rural junior middle school students on knowledge, attitudes and practices of COVID-19 protection in Jiangxi Province / 中国学校卫生

Objective@#To understand the influence of junior middle school students health literacy on knowledge, belief and behavior of COVID-19 in rural areas of Jiangxi Province, and to enhance junior middle school students ability to deal with public health emergencies.@*Methods@#Stratified cluster random sampling was used to investigate the health literacy, knowledge level and behavior of COVID-19 protection of 4 311 grade 7 to grade 8 students in rural areas of Jiangxi Province; Chi square test and Logistic regression analysis were used to analyze the correlation between junior high school students health literacy and COVID-19 protection knowledge, belief and behavior.@*Results@#The rate of health literacy of junior middle school students in rural areas was 18.21 %( n =785), the reported rate of intermediate level was high ( n =2 454, 56.92%), and the reported rate of junior high school students at a low level of health literacy was 24.87%( n =1 072). The rate of junior middle school students in rural areas with good COVID-19 protection knowledge was 63.49%, the rate of positive protection attitude was 74.25%, and the rate of good protection behavior was 85.36%; Rate of COVID-19 protection knowledge ( OR=4.85, 95%CI =3.80-6.18) and positive rate of protection attitude of high level health literacy ( OR=44.07, 95%CI =24.57-79.05), protective behavior possession rate ( OR=25.99, 95%CI = 19.67-34.35) were higher than those with low level of health literacy( P <0.01).@*Conclusion@#Health literacy is associated with COVID-19 protection knowledge, belief and behavior in rural junior high school students of Jiangxi Province, the findings provide direction for junior middle school students to improve their ability to deal with public health emergencies.

Silencing of SMAD family member 3 promotes M2 polarization of macrophages and the expression of SMAD7 in rheumatoid arthritis / 细胞与分子免疫学杂志

Objective To investigate the effect of SMAD family member 3(SMAD3) silenced by small interfering RNA (siRNA) on macrophage polarization and transforming growth factor β1 (TGF-β1)/ SMAD family signaling pathway in rheumatoid arthritis (RA). Methods RA macrophages co-cultured with rheumatoid arthritis fibroblast-like synoviocytes (RA-FLS) were used as a cell model. TGF-β1 was used to stimulate macrophages, and SMAD3-specific siRNA (si-SMAD3) and negative control siRNA (si-NC) were transfected into human RA macrophages co-cultured in TranswellTM chamber. The expression of SMAD3 mRNA was detected by real-time fluorescence quantitative PCR, and the expression of TGF-β1, SMAD3 and SMAD7 protein was detected by Western blot analysis. The contents of TGF-β1 and IL-23 in cell culture supernatant were determined by ELISA. Cell proliferation was detected by CCK-8 assay. TranswellTM chamber was used to measure cell migration. Results Compared with the model group and the si-NC group, the expression of TGF-β1, SMAD3 mRNA and protein in RA macrophages decreased significantly after silencing SMAD3. In addition, the secretion of IL-23 decreased significantly, and the cell proliferation activity and cell migration were inhibited, with high expression of SMAD7. Conclusion Knockdown of SMAD3 can promote M2 polarization and SMAD7 expression in RA macrophages.

Pro-oxidation status of rotator cuff tissue and expression of Beclin-1 and mTOR in patients with rotator cuff injury / 中国骨伤

OBJECTIVE@#To explore pro-oxidative state of rotator cuff tissue and expression levels of Beclin-1 and mam-malian target of rapamycin(mTOR) in patients with acute and chronic rotator cuff injury, and then analyzed relationship between rotator cuff injury and oxidative stress and autophagy.@*METHODS@#Forty patients with rotator cuff injury were seleceted from July 2019 to December 2020, and divided into male chronic injury group, male acute injury group, female chronic injury group, and female acute injury group, 10 patients in each group. All patients were performed rotator cuff repair under arthroscopy. The sample of tendon at the rotator cuff injury site of the patient was taken during operation, and total reactive oxygen species (ROS) and superoxide dismutase(SOD) were detected by detection kit;expression of Beclin-1 and mTOR mRNA were detected by reverse transcription-polymerase chain reaction (RT-PCR), and Western-blot was applied to detect protein expression of Beclin-1 and p-mTOR/mTOR.@*RESULTS@#There were no significant difference in expression of ROS, SOD, Beclin-1mRNA and mTOR mRNA between male and female chronic injury groups, and between male and female acute injury groups (P>0.05); ROS, SOD and Beclin-1mRNA in male chronic injury group were higher than those in male chronic injury group, while mTOR mRNAand protein decreased (P<0.05);ROS, SOD and Beclin-1 mRNA in female chronic injury group were up-regulated compared with female acute injury group, while mTOR mRNA was down-regulated (P<0.05).@*CONCLUSION@#Chronic rotator cuff injury is more likely to stimulate the pro-oxidation state of rotator cuff tissue than acute rotator cuff injury, which could up-regulating expression of autophagy factor Beclin-1 and down-regulating expression of mTOR. Therefore, patients with chronic rotator cuff injury may have higher levels of oxidative stress and autophagy.

Effect and mechanism of gerbeloid J from Gerbera piloselloides (L.) Cass. on cycle and apoptosis of breast cancer cells / 药学学报

Breast cancer has become the most prevalent malignant tumor among women, putting the health of women at serious risk. Screening for lead compounds in the active ingredients of plant that are effective and less toxic continues to be an important strategy for treating breast cancer. Gerbeloid J, a coumarin isolated from Gerbera piloselloides (L.) Cass., showed significant anti-cancer activity. But there is no report on the effect and mechanism of gerbeloid J on cycle and apoptosis of breast cancer. By using the CCK-8, clone formation, and PI staining assays, the effects of gerbeloid J on the proliferation of MCF-7 and MDA-MB-231 cells were assessed in this study. The effects of gerbeloid J on the apoptosis and mitochondrial function of MCF-7 and MDA-MB-231 cells were assessed using DAPI, Annexin V/TO-PRO-3, Rhod-2 AM, TMRM, DCFDA staining assays, and Western blot. The results demonstrated that gerbeloid J regulated the P21/CDC25C/CDK-1/cyclin B1 pathway and arrested the cell cycle at G2/M phase to suppressed the proliferation of MCF-7 and MDA-MB-231 cells. Additionally, gerbeloid J induced apoptosis through the stimulation of mitochondrial calcium excess, reduction of mitochondrial membrane potential, and promotion of ROS generation, and its mechanism was related to the activation of mitochondrial apoptotic pathway. In conclusion, by regulating the P21/CDC25C/CDK-1/cyclin B1 pathway and activating the mitochondrial apoptosis pathway, gerbeloid J could cause breast cancer cell cycle arrest and apoptosis, which might offer a promising candidate for the creation of new drugs against breast cancer.

Exploration on "Efficacy-toxicity" Association Mechanisms of Tripterygium wilfordii Polyglycoside Tablets Against Rheumatoid Arthritis Based on Multi-omics Integrated Regulatory Network / 中国实验方剂学杂志

ObjectiveTo explore the "efficacy-toxicity" association mechanisms of Tripterygium wilfordii polyglycoside tablets （TWPT） by establishing and analyzing an interaction network associated with the clinical efficacy of TWPT in the treatment of rheumatoid arthritis （RA） and TWPT-induced liver injury. MethodOn the basis of the TWPT efficacy-related gene expression profile and TWPT-induced liver injury-related protein expression profile which were both obtained from our clinical cohorts， the "efficacy-toxicity" association network of TWPT was constructed， and the key network targets were identified by calculating the topological values of the nodes， including the degree， closeness and betweenness. After that， the biological functions and pathways of the key network targets were investigated by enrichment analysis. ResultA total of 119 differentially expressed genes （58 up-regulated and 61 down-regulated） between RA patients with TWPT well and weak response were identified as TWPT efficacy-related genes by clinical transcriptomics， and 49 differentially expressed proteins （36 up-regulated and 13 down-regulated） were demonstrated to be TWPT-induced liver injury-related proteins by clinical proteomics. In addition， the clinical symptom enrichment analysis indicated that the TWPT efficacy-related genes were significantly associated with various clinical symptoms of arthralgia in traditional Chinese medicine and clinical phenotypes of modern medicine， and most of the TWPT-induced liver injury-related proteins were involved in digestive system abnormalities. Therefore， the aforementioned multi-omics data represented the main clinical symptoms of TWPT treating RA and inducing liver injury. Mechanically， the "efficacy-toxicity" association network revealed that both TWPT efficacy-related genes and TWPT-induced liver injury-related core proteins were involved in the "immune-inflammatory" imbalance， especially playing an important role in neutrophil degranulation， complement cascade reaction， and immune-inflammatory response mediated by protein post-translational modification. Notably， the above genes and proteins were also enriched in various signaling pathways related to cell proliferation and cell cycle regulation， such as RAS and mitogen-activated protein kinase （MAPK） signaling pathway， and in several liver functional processes， such as glycogen metabolism and redox reaction. ConclusionThis study systematically explained the "efficacy-toxicity" association characteristics and molecular mechanisms of TWPT by applying a research strategy integrating clinical phenomics， transcriptomics and proteomics， laying a good data foundation for exploring the "efficacy enhancing and toxicity-reducing" mechanisms of TWPT.

Clinical Efficacy of Compound Tripterygium wilfordii Preparation（Xinfeng Capsules） in Improving Immune Inflammation of Rheumatoid Arthritis Due to Spleen Deficiency and Dampness Exuberance Based on Apriori Algorithm and Random Walk Model / 中国实验方剂学杂志

ObjectiveTo investigate the effect of Xinfeng capsules on immunoinflammatory indicators in patients with rheumatoid arthritis （RA） due to spleen deficiency and dampness exuberance. MethodA total of 102 patients were randomly divided into control group and observation group according to the random number table method， with 51 cases in each group. All patients were treated with methotrexate tablets， while those in the observation group received additional Xinfeng capsules. The course of treatment in both groups was 12 weeks. The 28-joint disease activity score （DAS28）， visual analogue scale （VAS） scores， morning stiffness time， erythrocyte sedimentation rate （ESR）， high-sensitivity C-reactive protein （hs-CRP）， rheumatoid factor （RF）， anti-cyclic citrullinated peptide （anti-CCP） antibody， vascular endothelial growth factor （VEGF）， and serum amyloid A （SAA） of the two groups before and after treatment were compared. The efficacy and incidence of adverse events were compared between the two groups. The Apriori association rule model and random walk model were constructed to evaluate the effect of Xinfeng capsules in improving hs-CRP， ESR， RF， SAA， VEGF， and anti-CCP. ResultThere were no dropouts in this study. There was no statistical difference in the indicators between the two groups before treatment. After 12 weeks of treatment， the total effective rate in the observation group was 90.19% （46/51）， which was higher than 74.51% （38/51） in the control group （χ2＝4.320，P<0.05）. DAS28， VAS score， and morning stiffness time in the observation group were improved compared with those in the control group （P<0.05）. Apriori association rule model results showed that the application of Xinfeng capsules in the observation group had a strong correlation with the reduction of RF， ESR， hs-CRP， SAA， and VEGF. The results of the random walk model showed that the improvement coefficients of hs-CRP， ESR， RF， SAA， and VEGF in the observation group were all better than those of the control group， and the improvement coefficient of anti-CCP in the control group was better than that of the observation group. The improvement degree of hs-CRP， ESR， RF， SAA， and VEGF in the observation group was superior to that of the control group （P<0.05）. The incidence of adverse reactions in the observation group was lower than in the control group （χ2＝4.057，P<0.05）. ConclusionOn the basis of the treatment with methotrexate tablets， Xinfeng capsules can effectively improve the immunoinflammatory level in RA due to spleen deficiency and dampness exuberance and reduce the incidence of adverse reactions.

Research Progress of Age Estimation in the Living by Knee Joint MRI / 法医学杂志

Bone development shows certain regularity with age. The regularity can be used to infer age and serve many fields such as justice, medicine, archaeology, etc. As a non-invasive evaluation method of the epiphyseal development stage, MRI is widely used in living age estimation. In recent years, the rapid development of machine learning has significantly improved the effectiveness and reliability of living age estimation, which is one of the main development directions of current research. This paper summarizes the analysis methods of age estimation by knee joint MRI, introduces the current research trends, and future application trend.

Comparison of CT Values between Thrombus and Postmortem Clot Based on Cadaveric Pulmonary Angiography / 法医学杂志

OBJECTIVES@#To explore the difference in CT values between pulmonary thromboembolism and postmortem clot in postmortem CT pulmonary angiography (CTPA) to further improve the application value of virtual autopsy.@*METHODS@#Postmortem CTPA data with the definite cause of death from 2016 to 2019 were collected and divided into pulmonary thromboembolism group (n=4), postmortem clot group (n=5), and control group (n=5). CT values of pulmonary trunk and left and right pulmonary artery contents in each group were measured and analyzed statistically.@*RESULTS@#The average CT value in the pulmonary thromboembolism group and postmortem clot group were (168.4±53.8) Hu and (282.7±78.0) Hu, respectively, which were lower than those of the control group (1 193.0±82.9) Hu (P<0.05). The average CT value of the postmortem clot group was higher than that of the pulmonary thromboembolism group (P<0.05).@*CONCLUSIONS@#CT value is reliable and feasible as a relatively objective quantitative index to distinguish pulmonary thromboembolism and postmortem clot in postmortem CTPA. At the same time, it can provide a scientific basis to a certain extent for ruling out pulmonary thromboembolism deaths.

Application of Wei nasal jet tube in painless gastroscopy in patients over age 60 / 中华消化内镜杂志

To investigate the clinical efficacy and safety of Wei nasal jet tube (WNJT) in painless gastroscopy in patients over age of 60, 80 patients aged 60 years or older scheduled for gastroscopy under propofol mono-sedation in Beijing Friendship Hospital were divided into WNJT group ( n=40) and nasal cannula group ( n=40) according to the random number table method from January to June 2021. The main observation indicator was the difference in the incidence of hypoxemia between the two groups, the secondary observation indicators included the lowest pulse blood oxygen saturation (SpO 2), interventions related to hypoxemia, adverse events such as body movement, cough, epistaxis, sore throat, and the satisfaction of physicians, anesthetists and patients. The results showed that the procedure time and total dosage of propofol were no significant differences between the two groups ( P>0.05). Compared with the nasal cannula group, the incidence of hypoxemia in the WNJT group was significantly lower [2.5% (1/40) VS 25.0% (10/40), χ2=8.538, P=0.003], the lowest SpO 2 was significantly higher (97.7%±2.5% VS 92.6%±5.8%, t=5.093, P<0.001), and the use of jaw lift was reduced [5.0% (2/40) VS 35.0% (14/40), χ2=11.250, P=0.001]. The adverse events were not significantly different between the two groups ( P>0.05), but no case of epistaxis and sore throat occurred in the nasal cannula group. The two groups were comparable in terms of the satisfaction of patients, anesthetists and physicians ( P>0.05). In conclusion, WNJT can be used safely during gastroscopy with propofol mono-sedation in patients over 60 years old, with less incidence of hypoxemia and the number of airway interventions. But violent operation should be avoided to reduce the incidence of epistaxis and sore throat.

The effect of different body positions after pars plana vitrectomy and inert gas filling for rhegmatogenous retinal detachment / 中华眼底病杂志

Objective:To compare and observe the curative effect of different body positions after pars plana vitrectomy (PPV) combined with inert gas filling for rhegmatogenous retinal detachment (RRD).Methods:A retrospective clinical study. From October 2019 to September 2021, 192 eyes of 192 RRD patients who were diagnosed and received PPV combined with inert gas filling in Qingdao Eye Hospital of Shandong First Medical University were included in the study. Best corrected visual acuity (BCVA), intraocular pressure, ultra-wide-angle fundus photography, optical coherence tomography, and B-mode ultrasonography were performed in all affected eyes. The BCVA examination was performed using a standard logarithmic visual acuity chart, which was converted into logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. According to the post-operative position requirements, the affected eyes were divided into the face-down positioning group and the adjustable positioning group, with 97 eyes in 97 patients and 95 eyes in 95 patients, respectively. Age ( Z=0.804), course of disease ( Z=-0.490), eye type ( χ2=0.175), logMAR BCVA( Z=-0.895), intraocular pressure ( Z=0.178), lens status ( χ2=1.090), number of detached clocks ( Z=0.301) and macular involvement ( χ2=0.219), number of holes ( Z=-1.051) and number of lower holes ( χ2=0.619) were compared, there was no significant difference ( P>0.05). The gender composition ratio was compared, and the difference was statistically significant ( χ2=5.341, P<0.05). The follow-up time after surgery was more than 3 months. The retinal reattachment rate in one operation, the improvement of BCVA and the incidence of complications were observed. The independent sample Mann-Whitney test was used for the comparison of continuous variables between groups; the χ2 test was used for the comparison of categorical variables. Results:In the face-down positioning group and the adjustable positioning group, retinal reattachment in one operation was performed in 92 (94.8%, 92/97) and 89 (93.7%, 89/95) eyes, respectively; logMAR BCVA was 0.45±0.34, 0.41±0.21. There was no significant difference in the retinal reattachment rate in one operation ( χ2=0.120, P=0.729) and logMAR BCVA ( Z=-0.815, P=0.416) between the two groups. After surgery, the intraocular pressure increased in 11 (11.3%, 11/97) and 5 (5.3%, 5/95) eyes in the face-down positioning group and the adjustable positioning group, respectively; the secondary epimacular membrane was 2 (2.1%, 2/97), 3 (3.2%, 3/95) eyes. There was no significant difference in the incidence of elevated intraocular pressure and secondary epimacular membrane between the two groups after surgery ( χ2=2.320, 0.227; P=0.128, 0.634). Conclusion:It is safe and effective to adopt adjustable positioning after PPV combined with inert gas filling for RRD, which is equivalent to the effect of face-down positioning.

Automatic Identification of Brain Injury Mechanism Based on Deep Learning / 法医学杂志

OBJECTIVES@#To apply the convolutional neural network (CNN) Inception_v3 model in automatic identification of acceleration and deceleration injury based on CT images of brain, and to explore the application prospect of deep learning technology in forensic brain injury mechanism inference.@*METHODS@#CT images from 190 cases with acceleration and deceleration brain injury were selected as the experimental group, and CT images from 130 normal brain cases were used as the control group. The above-mentioned 320 imaging data were divided into training validation dataset and testing dataset according to random sampling method. The model classification performance was evaluated by the accuracy rate, precision rate, recall rate, F1-value and AUC value.@*RESULTS@#In the training process and validation process, the accuracy rate of the model to classify acceleration injury, deceleration injury and normal brain was 99.00% and 87.21%, which met the requirements. The optimized model was used to test the data of the testing dataset, the result showed that the accuracy rate of the model in the test set was 87.18%, and the precision rate, recall rate, F1-score and AUC of the model to recognize acceleration injury were 84.38%, 90.00%, 87.10% and 0.98, respectively, to recognize deceleration injury were 86.67%, 72.22%, 78.79% and 0.92, respectively, to recognize normal brain were 88.57%, 89.86%, 89.21% and 0.93, respectively.@*CONCLUSIONS@#Inception_v3 model has potential application value in distinguishing acceleration and deceleration injury based on brain CT images, and is expected to become an auxiliary tool to infer the mechanism of head injury.

Logistic Regression Analysis of the Mechanism of Blunt Brain Injury Inference Based on CT Images / 法医学杂志

OBJECTIVES@#To study the correlation between CT imaging features of acceleration and deceleration brain injury and injury degree.@*METHODS@#A total of 299 cases with acceleration and deceleration brain injury were collected and divided into acceleration brain injury group and deceleration brain injury group according to the injury mechanism. Subarachnoid hemorrhage (SAH) and Glasgow coma scale (GCS), combined with skull fracture, epidural hematoma (EDH), subdural hematoma (SDH) and brain contusion on the same and opposite sides of the stress point were selected as the screening indexes. χ2 test was used for primary screening, and binary logistic regression analysis was used for secondary screening. The indexes with the strongest correlation in acceleration and deceleration injury mechanism were selected.@*RESULTS@#χ2 test showed that skull fracture and EDH on the same side of the stress point; EDH, SDH and brain contusion on the opposite of the stress point; SAH, GCS were correlated with acceleration and deceleration injury (P<0.05). According to binary logistic regression analysis, the odds ratio (OR) of EDH on the same side of the stress point was 2.697, the OR of brain contusion on the opposite of the stress point was 0.043 and the OR of GCS was 0.238, suggesting there was statistically significant (P<0.05).@*CONCLUSIONS@#EDH on the same side of the stress point, brain contusion on the opposite of the stress point and GCS can be used as key indicators to distinguish acceleration and deceleration injury mechanism. In addition, skull fracture on the same side of the stress point, EDH and SDH on the opposite of the stress point and SAH were relatively weak indicators in distinguishing acceleration and deceleration injury mechanism.

Analysis of factors related to rheumatoid arthritis in elderly patients with concurrent anemia / 中华老年医学杂志

Objective:To analyze factors related to rheumatoid arthritis and anemia in elderly people.Methods:Clinical data of 58 elderly patients with rheumatoid arthritis(RA)admitted to the Department of Rheumatology, the First Affiliated Hospital of Anhui Medical University from May 2019 to May 2020 were retrospectively analyzed.Patients were divided into the anemia group and the non-anemia group based on the hemoglobin(Hb)index.Laboratory test results and general clinical data were compared between the two groups.Factors related to RA with concurrent anemia were analyzed by binary Logistic regression analysis.Association rules analysis was conducted using SPSS Clementine to identify strong correlations between red blood cells(RBC)and objective clinical parameters.Results:There was no significant difference in general clinical data between the two groups(all P>0.05). There were significant differences between the two groups in laboratory test results of high-sensitivity C-reactive protein(hs-CRP), platelet-to-lymphocyte ratio(PLR), low-density lipoprotein cholesterol(LDL-C), total cholesterol(TC), apolipoprotein B(ApoB), albumin(Alb), superoxide dismutases(SOD), erythrocyte sedimentation rate(ESR), Fe, mean corpuscular hemoglobin(MCH)and mean hemoglobin concentration(MCHC)(all P<0.05). Binary Logistic regression analysis showed that PLR( OR=3.718, 95% CI: 1.119-8.742, P=0.022)and LDL-C( OR=2.319, 95% CI: 1.026-3.061, P=0.038)were independent risk factors for RA with concurrent anemia.Association rules analysis showed that decline in RBC was strongly correlated with changes in PLR, hs-CRP and LDL-C. Conclusions:RA with concurrent anemia in elderly patients is closely correlated with levels of molecules related to lipid metabolism and the inflammatory response.Close monitoring of lipid metabolism and inflammation is recommended during clinical treatment.

Mechanism of Xinfeng Capsules improving rheumatoid arthritis based on CD19~+B cells regulating FAK/CAPN/PI3K pathway / 中国中药杂志

To observe the effect of Xinfeng Capsules on rheumatoid arthritis (RA) B lymphocytes,inflammatory mediators,FAK/CAPN/PI3K pathway,in order to explore the mechanism of Xinfeng Capsules in improving clinical symptoms of RA.Joint and systemic symptoms of RA patients were observed,and laboratory indicators[hemoglobin (HGB),platelet count (PLT),erythrocyte sedimentation (ESR),immunoglobulin (Ig) G,Ig A,Ig M,rheumatoid factor (RF),anti-cyclic citrulline antibody (CCP-AB),C-reactive protein (CRP)]were detected.ELISA was used to detect serum interleukin (IL)-1β，IL-10,IL-33,chemokine 5 (CCL5),and vascular endothelial growth factor (VEGF).CD3~-CD19~+B cells were measured by flow cytometry.Western blot was used to detect FAK,p-FAK,CAPN,PI3K protein.The results showed that Xinfeng Capsules could significantly alleviate RA joint and systemic symptoms and improve clinical efficacy.And Xinfeng Capsules could increase HGB,decrease PLT,CCP-AB,CRP,ESR index,upregulate IL-10 expression,and down-regulate IL-1β，IL-33,CCL5,VEGF,CD3~-CD19~+B cells,FAK,p-FAK,CAPN,PI3K expressions (P<0.01).Based on the above results,Xinfeng Capsules may reduce the expression of CD3~-CD19~+,regulate the balance of inflammatory cytokines and chemokines,inhibit abnormal activation of FAK/CAPN/PI3K pathway,and improve clinical symptoms of RA.

Intraoperative incision combined with local anesthesia to improve postoperative pain after laparoscopic live donor nephrectomy / 国际外科学杂志

Objective:To evaluate the effect of intraoperative incision combined with local anesthesia in improving postoperative pain after retroperitoneal laparoscopic living donor nephrectomy.Methods:Using retrospective research methods, 28 donors who underwent hand-assisted retroperitoneal laparoscopic living donor nephrectomy at the Beijing Friendship Hospital, Capital Medical University from January 2018 to December 2020 were selected as the research group. Before the wound was sutured during the operation use 0.2% ropivacaine 20 mL+ 5 mg dexamethasone to block the transverse abdominis fascia and subcutaneously for infiltration anesthesia. The other 1∶1 matched 28 donors who had the same operation method but used on-demand systemic opioid analgesia after the operation as the control group. The demographic indicators (age, gender, body mass index, length of donor kidney), intraoperative conditions (intraoperative blood loss, operation time, warm ischemia time), 2, 12, 24, and 48 hours pain visual analogue scales(VAS) after operation were compared between the two groups of patients, postoperative systemic opioid demand rate, postoperative exhaust time, time to return to the ground, complication rate (postoperative bleeding, lung infection, lymphatic fistula, wound infection, intestinal obstruction), postoperative length of hospitalization and other information. Measurement data were expressed as mean±standard deviation ( Mean± SD), and independent sample t-test was used for comparison between groups; Chi-square test or Fisher exact probability method was used for comparison of count data between groups. Results:The pain VAS of the donors in the research group were significantly lower than those in the control group at 2 h, 12 h, 24 h, and 48 h after surgery (2 h: 1.6±1.0 vs 3.9±1.1; 12 h: 1.9±0.7 vs 3.1±1.0; 24 h: 1.6±0.5 vs 2.9±0.8; 48 h: 1.2±0.5 vs 2.3±0.8; P<0.05). The donors in the research group postoperative morphine requirement rate was also significantly lower than that of the control group (0 vs 21.4%), and the postoperative recovery time was significantly earlier than that of the control group [(25.7±4.5) h vs (30.6±6.6) h], the difference was statistically significant ( P<0.05). Lymphatic fistula was the main postoperative complication. There was no statistically significant difference between the research group and the control group (14.3% vs 25.0%) ( P>0.05). Conclusion:Intraoperative incision transversus abdominis fascia and subcutaneous combined local block anesthesia can effectively reduce the pain after laparoscopic donor nephrectomy, reduce the use of opioids, promote early postoperative activities of the donor, and will not increase postoperative complications incidence rate.

The influence of age on the safety of propofol mono-sedation gastroscopy for adult patients / 中华消化内镜杂志

Objective:To assess the influence of age on the safety of propofol mono-sedation for adult patients undergoing painless gastroscopy.Methods:A retrospective study was conducted on data of 321 patients scheduled for painless gastroscopy with propofol mono-sedation. According to the age, patients were divided into youth group (116 cases, 18-44 years), middle-aged group (103 cases, 45-59 years) and elderly group (102 cases, 60-80 years). The procedure time, the total dosage of propofol, the occurrence of airway obstruction or hypoxemia, the use of airway interventions including airway opening maneuvers and facemask ventilation, lowest SpO 2, adverse cardiovascular events (including hypertension, hypotension, tachycardia, and bradycardia), and the use of ephedrine during painless gastroscopy were observed. Results:There was significant difference regarding the total dosage of propofol among youth group (173.2±47.0 mg), middle-aged group (158.8±41.3 mg) and elderly group (137.8±26.3 mg) ( F=21.761, P<0.001). The total dosage of propofol was significantly lower in the elderly group compared with the middle-aged group ( P<0.017) and youth group ( P<0.017), and that in the middle-aged group was significantly lower than that in the youth group ( P<0.017). The incidence of hypoxemia was 12.9% (15/116) in the youth group, 15.5% (16/103) in the middle-aged group and 25.5% (26/102) in the elderly group, with significant difference among three groups ( χ2=5.711, P=0.017). Moreover, the incidence of hypoxemia was significantly higher in the elderly group compared with the middle-aged group ( P<0.017) and youth group ( P<0.017). The incidences of hypotension, bradycardia and total adverse cardiovascular events were 5.2% (6/116), 4.9% (5/103) and 11.8% (12/102), 1.7% (2/116), 2.9% (3/103) and 7.8% (8/102), and 11.2% (13/116), 10.7% (11/103) and 20.6% (21/102) respectively in youth, the middle-aged and the elderly group. There were no significant differences in the above indicators among the three groups ( P>0.05). However, compared with those of the young and the middle-aged patients, the occurrence of hypotension, bradycardia and total adverse cardiovascular events in the elderly patients were on the rise. There were no significant differences among the three groups in other indices( P>0.05). Conclusion:Total dosage of propofol may need to be decreased gradually with the increase of age of patients undergoing gastroscopy with propofol mono-sedation. Compared with young and middle-aged patients, elderly patients have a significantly higher incidence of hypoxemia, with a tendancy of total adverse cardiovascular events increase, so the safety of painless gastroscopy is reduced for these patients.

Surgical choice of posterior osteotomy way for senile osteoporotic thoracolumbar fracture with kyphosis / 中国骨伤

OBJECTIVE@#To investigate the surgical choice of posterior osteotomy way by the observation of clinical outcome of Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO) and vertebral column re-section (VCR) for senile osteoporotic thoracolumbar fracture with kyphosis.@*METHODS@#From June 2015 to August 2017, an amount of 8 elderly patients with thoracolumbar kyphosis caused by osteoporotic vertebral fracture underwent osteotomy approach for posterior osteotomy. All patients were old osteoporotic vertebral fracture more than 6 months and received invalid conservative treatment for 3 months including nonsteroidal anti-inflammatory and analgesic drugs, anti-osteoporosis drugs and acupuncture, etc. There were 3 males and 5 females, with an average age of 73.4 years (66 to 83 years), with an average course of the disease of 34.6 months (8 to 60 months). Eight patients had a total of 8 vertebral fractures, and fracture segment was in T of 1 case, T of 1 case, T of 3 cases, L of 2 cases, L of 1 case. Eight patients showed kyphosis caused by wedge deformation of single segmental vertebral fractures. The thoracolumbar kyphosis and symptoms were progressively developing into central sagittal imbalance. SPO osteotomy was performed in 3 cases, PSO osteotomy in 3 cases, and VCR osteotomy in 2 cases. Orthopaedic effects were analyzed by imaging measurements, including pre- and post-operative kyphosis Cobb angle, localized kyphosis (LK), thoracic kyphosis (TK), lumbar lordosis (LL), sacral tilt angle (ST) and sagittal vertical axis (SVA). Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the pain and lumbar function.@*RESULTS@#All the eight patients were followed up from 8 to 24 months with an average of 13.5 months and all the symptoms of low back pain have significantly reduced or disappeared. The VAS score decreased from 5-8 points (mean 6.5 points) before surgery to 1-4 points (mean 1.88 points) at the final follow-up, and the score was significantly improved. The ODI score decreased from 36-78 points (mean 60.25 points) before surgery to 10-32 points (mean 20.38 points) at the final follow-up, and the functional score improved significantly. During the follow-up period, X-ray examination showed that some patients had a slight decrease in the height of the intervertebral fusion, and the bone graft was healed. There was no obvious corrected degree loss and internal fixation loosening, and the thoracolumbar kyphosis was significantly improved. The mean Cobb angle of T-L was reduced from 25.3° to 2.8° with corrected rate of 89.3% ; LK was reduced from 43.4° to 7.1° with corrected rate of 86.2% ; TK was reduced from 49.9° to 30.6°, LL was reduced from 43.6° to 30.8°, and ST was changed from 24.0° to 32.1°, SVA was changed from 6.23 cm to 2.40 cm.@*CONCLUSION@#For the different pathological features and deformities of senile osteoporotic thoracolumbar fracture combined with kyphosis, SPO, PSO or VCR can achieve good orthopedic effect and clinical efficacy.

Platelet-rich plasma combined with hollow screw fixation for femoral neck fractures / 中华创伤骨科杂志

Objective:To study the curative effect of platelet-rich plasma (PRP) combined with internal fixation with hollow screws on femoral neck fractures.Methods:The clinical data of 160 patients with femoral neck fracture were retrospectively analyzed who had been treated by internal fixation with hollow screws at Orthopedic Department Ⅲ, The Second Affiliated Hospital to Luohe Medical College from May 2012 to May 2018. According to whether PRP was used or not to assist their internal fixation, they were divided into a PRP group ( n=80) and a control group ( n=80). In the PRP group, there were 46 males and 34 females with an age of 52.3 years±7.6 years, and one case of type Ⅰ, 5 cases of type Ⅱ, 57 cases of type Ⅲ and 17 cases of type Ⅳ by the Garden classification. In the control group, there were 41 males and 39 females with an age of 50.6 years ± 7.3 years, and 2 cases of type Ⅰ, 7 cases of type Ⅱ, 51 cases of type Ⅲ and 20 cases of type Ⅳ by the Garden classification. The 2 groups were compared in terms of fracture healing time, nonunion, femoral head necrosis and Harris hip scores. Results:The 2 groups were comparable because their preoperative general data showed no significant differences ( P>0.05). The 160 patients obtained follow-up for 12 to 36 months. The PRP group showed significantly shorter fracture healing time (4.3 months ± 1.0 months), significantly lower incidences of nonunion [0% (0/80)] and avascular necrosis of femoral head [3.8% (3/80)] than the control group [7.3 months ± 1.3 months, 7.5% (6/80) and 15.0% (12/80), respectively] (all P< 0.05). The Harris scores at 6 and 12 months after operation for the PRP group (88.7±5.3 and 94.2±4.8) were significantly higher than those for the control group (81.4±4.6 and 84.2±5.2) (both P<0.05). Conclusion:In the treatment of femoral neck fractures, compared with internal fixation with hollow screws alone, platelet rich plasma combined with internal fixation with hollow screws can significantly shorten fracture healing time, reduce incidence of avascular necrosis of the femoral head and improve functional recovery of the hip joint.

Huangqin Qingre Chubi Capsules in improving oxidative stress of patients with ankylosing spondylitis via activating PPARγ mediated AMPK/FOXO3a pathway / 中国中药杂志

To investigate the efficacy of Huangqin Qingre Chubi Capsules(HQC) in patients with ankylosing spondylitis(AS) and its effect on oxidative stress, and to explore its possible mechanism. Fifty-eight cases of AS patients were randomly divided into HQC group and salazosulfapyridine(SASP) group. Another 30 healthy people were employed as a control group. Superoxide dismutase(SOD), total antioxidant capacity(TAOC), malondialdehyde(MDA), lipid peroxidatio(LPO), interleukin-1β(IL-1β), IL-10, IL-4, and tumor necrosis factor-α(TNF-α) were detected by ELISA. The mRNA expression levels of AMP-activated protein kinase(AMPK-α), forkhead box O3a(FOXO3a), manganese superoxide dismutase(MnSOD), and peroxisome proliferator-activated receptor gamma(PPARγ) were detected by Real-time fluorescence quantitative polymerase chain reaction(RT-qPCR). The protein expression levels of AMPK-α, FOXO3a, p-FOXO3a, MnSOD, and PPARγ were detected by Western blot. A questionnaire was used to evaluate the disease activity score and observe the clinical efficacy of HQC in AS patients. The levels of MDA, LPO, TNF-α, and IL-1β were significantly increased in the peripheral blood of AS patients, and SOD, TAOC, IL-4, IL-10 levels were significantly decreased. After HQC treatment, scores of disease active indexes were all decreased, and its clinical efficacy was significantly higher than that in SASP group. After HQC treatment, TAOC, SOD, IL-4, IL-10 were increased and MDA, LPO, TNF-α, IL-1β were decreased; mRNA levels of AMPK-α, FOXO3a, MnSOD, PPARγ and protein levels of AMPK-α, FOXO3a, p-FOXO3a, MnSOD, PPARγ were increased(P<0.01 or P<0.05). HQC can effectively improve the clinical symptoms and oxidative stress of AS patients, and its mechanism may be related to activating PPARγ and up-regulating AMPK/FOXO3a signal pathway.

Research Status of Postmortem MSCT Angiography in Forensic Science / 法医学杂志

Virtual autopsy is a new technique for investigating the morphological changes of cadaveric tissues and organs by medical imaging technology. It has been widely used in the identification of causes of death. Multislice spiral computed tomography （MSCT） has become a routine inspection method in some identification institutions, although it cannot completely replace traditional autopsy, it plays a key auxiliary or substitute role in the identification of certain abnormal causes of death. Plain MSCT scan cannot visualize cadaveric vessels, but can perform cadaveric angiography to determine vascular injury or disease. This technology has entered a rapid development period in recent years, and has made a considerable progress in contrast agent, perfusion methods and imaging methods. This article summarizes several common cadaveric MSCT angiography methods, such as systemic angiography, angiography through cardiopulmonary resuscitation, targeted angiography, and angiography by cardiac puncture, and analyzes and compares the application prospects.