ObjectiveTo establish steroid-induced osteonecrosis of the femoral head （SANFH） cell model by using dexamethasone （DEX）-induced bone marrow mesenchymal stem cells （BMSCs） and demonstrate that Gushing Granules （GSNs） exert an improving effect by activating the phosphatidylinositol-3-kinase/protein kinase B/B-lymphoma-2 gene related promoter （PI3K/Akt/Bad） signalling pathway. MethodsFirstly， SD rats were orally administered with drugs at a dose of 0.9 g·kg^-1 to prepare GSN-containing serum， and CCK-8 screening was used to determine the optimal dosage and duration of action. Then， BMSCs were cultured and treated with 1×10^-6 mol·L^-1 DEX， 10% GSN-containing serum， and inhibitor LY294002 of PI3K/Akt signalling pathway for 24 hours to model and group SANFH cells. Cell viability and proliferation were detected by using CCK-8 assay kit and EdU staining kit. Flow cytometry was used to detect cell apoptosis. An alkaline phosphatase （ALP） assay kit was employed to detect ALP expression. In order to detect the PI3K/Akt/Bad signalling pathway and protein and mRNA expression of apoptosis-related proteins such as apoptosis regulatory factors B-cell lymphoma-2 gene （Bcl-2）， and Bcl-2-associated X protein （Bax）， osteocalcin （OCN）， and Collagen Ⅰ， we used Western blot and Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. ResultsThe CCK-8 assay kit determined that the optimal dosage for GSN-containing serum is 10%， and the duration of action is 48 hours. After modelling and grouping the cells in each group， the detection results showed that the SANFH model group had significantly lower cell viability， cell proliferation， and ALP expression， as well as protein and mRNA expressions of PI3K， Akt， Bad， Bcl-2， OCN， and Collagen I compared to the blank group. The nucleic acid and protein levels of the Bax index and the cell apoptosis rate detected by flow cytometry significantly increased （P<0.05，P<0.01）. After treatment with GSN-containing serum， cell viability， cell proliferation， and ALP expression， as well as expressions of PI3K， Akt， Bad， Bcl-2， OCN， and Collagen Ⅰ nucleic acids and proteins were significantly increased， while the nucleic acid and protein levels of the Bax index and the cell apoptosis rate detected by flow cytometry significantly decreased（P<0.05，P<0.01）. Compared with the GSN drug-containing serum group， the simultaneous treatment with the inhibitor LY294002 and GSN drug-containing serum reversed the improvement effect of GSN. Specifically， the cell viability， cell proliferation， ALP expression， and the nucleic acid and protein levels of PI3K， Akt， Bad， Bcl-2， OCN， and Collagen Ⅰ were all significantly decreased， while the nucleic acid and protein levels of the Bax index and the cell apoptosis rate detected by flow cytometry were significantly increased （P<0.05， P<0.01）. ConclusionGSNs antagonize DEX-induced apoptosis of BMSCs by activating the PI3K/Akt/Bad signalling pathway， providing a scientific theoretical basis for the clinical treatment of SANFH with GSNs.

To promote the development of extracellular vesicles of herbal medicine especially the establishment of standardization, led by the National Expert Committee on Research and Application of Chinese Herbal Vesicles, research experts in the field of herbal medicine and extracellular vesicles were invited nationwide with the support of the Expert Committee on Research and Application of Chinese Herbal Vesicles, Professional Committee on Extracellular Vesicle Research and Application, Chinese Society of Research Hospitals and the Guangdong Engineering Research Center of Chinese Herbal Vesicles. Based on the collation of relevant literature, we have adopted the Delphi method, the consensus meeting method combined with the nominal group method to form a discussion draft of "Consensus statement on research and application of Chinese herbal medicine derived extracellular vesicles-like particles (2023)". The first draft was discussed in online and offline meetings on October 12, 14, November 2, 2022 and April and May 2023 on the current status of research, nomenclature, isolation methods, quality standards and research applications of extracellular vesicles of Chinese herbal medicines, and 13 consensus opinions were finally formed. At the Third Academic Conference on Research and Application of Chinese Herbal Vesicles, held on May 26, 2023, Kewei Zhao, convenor of the consensus, presented and read the consensus to the experts of the Expert Committee on Research and Application of Chinese Herbal Vesicles. The consensus highlights the characteristics and advantages of Chinese medicine, inherits the essence, and keeps the righteousness and innovation, aiming to provide a reference for colleagues engaged in research and application of Chinese herbal vesicles at home and abroad, decode the mystery behind Chinese herbal vesicles together, establish a safe, effective and controllable accurate Chinese herbal vesicle prevention and treatment system, and build a bridge for Chinese medicine to the world.

Objective:To evaluate the clinical application effects of a domestic bone-level implant system for restoring single tooth loss, and provide clinical evidence for the promotion and application of domestic implants.Methods:A prospective, multicenter clinical trial was conducted from April 2018 to January 2020 in three institutions: Department of Oral Implantology, School & Hospital of Stomatology, Wuhan University, Department of Stomatology, The First Affiliated Hospital of Zhejiang University School of Medicine, and Department of Stomatology, The Third Hospital of Hebei Medical University. The trial planned to include 100 patients for single tooth implantation and restoration, followed up for 1 year, to evaluate the implantation success rate and other related outcomes.Results:This study screened a total of 142 patients and ultimately included 100, comprising 43 males and 57 females with age of (47.0±12.2) years. Ninety-eight out of 100 patients completed a one-year follow-up (98.0%), while 2 patients terminated the trial early due to implant loosening (2.0%). After a one-year follow-up, the implants of the 98 patients were all functioning successfully, with a success rate of 98.0% (98/100). The patients were satisfied with the overall restoration effect.Conclusions:This study indicates that the domestic bone-level implant system has achieved favorable short-term clinical outcomes for single-tooth implantation and restoration.

Background Heavy metals are widely present in the environment, difficult to degrade, and bioaccumulative. Children's physical development are not mature, and exposure to heavy metals which may cause irreversible harm to them. However, the current research conclusions are still inconsistent. Therefore, it is very important to pay attention to the impact of heavy metal pollutants on physical development. Objective To detect the level of heavy metal exposure of school-age children in Laizhou Wan, Shandong Province, and to explore the relationship between heavy metal exposure level and physical development indexes of school-age children. Methods The subjects of this study were 318 children born to pregnant women recruited from Laizhou Wan Birth Cohort in Shandong Province from September 2010 to December 2013. The school-age children at age 7 were followed up from July to September 2019. Their urine samples were collected and the levels of arsenic (As), cadmium (Cd), lead (Pb), and mercury (Hg) in urine were detected by inductively coupled plasma mass spectrometry (ICP-MS). At the same time, the height, weight, body mass index (BMI), waist circumference, and body fat percentage of the children were evaluate to analyze the relationship between the four heavy metals in children's urine and the indicators related to children's physical development. Results Among the 318 school-age children with an age (\begin{document}$\bar x \pm s $\end{document}) of (7.77±0.67) years, the median (P₂₅, P₇₅) levels of As, Cd, Pb, and Hg in urine were 73.98 (44.81, 124.61), 0.40 (0.27, 0.58), 1.20 (0.71, 1.72), and 2.38 (1.32, 4.80) µg·g⁻¹ (of creatinine), respectively. The children’s urinary Cd level was positively correlated with their weight, BMI, and waist circumference (P<0.05), and corresponding regression coefficients (b) and its 95% confidence intervals (CI) were 0.99 (0.14-1.83), 0.43 (0.06-0.81), and 1.35 (0.27-2.42), respectively; while the other heavy metals were not related to the above physical development indicators (P>0.05). After sex stratification, it was found that boys’ urinary Cd level was positively correlated with their height, weight, BMI, and waist circumference (P <0.05) with associated b (95%CI) of 1.73 (0.53-2.93), 2.03 (0.60-3.47), 0.75 (0.11-1.38), and 2.66 (0.85-4.47), respectively; such associations were not found in girls. After further stratification of boys’ BMI according to normal, overweight, and obesity, it was found that a higher urinary Cd level was correlated with an increased risk of obesity in boys (P<0.05), and the associated b (95%CI) was 2.34 (1.02-5.36). Conclusion The level of urinary Cd exposure of boys in Laizhou Wan, Shandong Province is positively correlated with their height, weight, BMI, and waist circumference, and may be related to obesity in boys.

Objective:To investigate the dynamic change of nutritional risk in hepatological surgical patients during hospitalization.Methods:Anthropometric measurement and laboratory examination were conducted within 24 hours both after admission and before discharge. NRS 2002 was used to assess patients' nutritional status. The correlation between nutritional status and clinical outcomes was also analyzed.Results:A total of 600 patients were included in the study, among whom 401 were with benign diseases and 199 with malignant tumors. Compared with those values at admission, patients' weight, BMI, grip strength, calf circumference and main serum protein indicators decreased significantly at discharge ( P<0.05). The incidence of nutritional risk at discharge was 57.3%, higher than that at admission ( χ 2=6.512, P=0.011). The incidence of nutritional risk showed a significant increase during hospitalization in hepatological surgery patients ( P<0.05). Conclusions:Hepatological surgery patients were at high nutritional risk, which increased during hospitalization. The whole-course nutrition management of surgical patients should be given more attention.

Objective:To investigate the long-term effect of open reduction and internal fixation and one stage rotator cuff repair in treatment of proximal humeral fractures combined with rotator cuff tear.Methods:A retrospective case series study was performed on clinical data of 40 patients with proximal humeral fractures combined with rotator cuff tear admitted to Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2012 to December 2015. There were 24 males and 16 females, aged 52-93 years [(72.5±10.2)years]. According to Neer classification, there were 7 patients with two-part proximal humerus fractures, 27 with three-part proximal humerus fractures and 6 with four-part proximal humerus fractures. All patients received open reduction and internal fixation using locking plates and one stage rotator cuff repair. Functional shoulder exercises were carried out after operation. Fracture healing and wound healing were observed postoperatively. Shoulder active motion, visual analogue score (VAS) and University of California at Los Angeles (UCLA) shoulder rating scale were assessed and compared before operation and at the last follow-up.Results:All patients were followed up for 4.5-8.5 years [(6.2±1.2)years]. All wounds and fractures healed without infection or nonunion. At the last follow-up, the active forward elevation of affected shoulder was 100°-150° [(121.8±15.8)°], the external rotation with the shoulder in neutral position was 30°-80° [(47.0±15.9)°], the external rotation with the shoulder abduction was 60°-80° [(73. 5±6.2)°], the internal rotation with the shoulder abduction was 60°-80° [(70.5±7.1)°], showing significant differences compared to preoperative 30°-60° [(44.8±11.1)°], 0°-30° [(12.0±10.4)°], 0°-30° [(13.8±7.7)°], 30°-60° [(47.0±8.5)°], respectively (all P<0.01). The VAS was 1 (0, 1)points at the last follow-up, and was 6(5, 6)points before operation ( P<0.01). The UCLA shoulder rating scale was 28-35 points [(31.0±2.3)points] at the last follow-up, compared with preoperative 8-11 points [(10.3±0.8)points] ( P<0.01), and rated as excellent in 10 patients, good in 23 and poor in 7, with the excellent-good rate of 83%. Conclusion:For patients with proximal humeral fractures combined with rotator cuff tear, open reduction and internal fixation and one stage rotator cuff repair can significantly restore the shoulder motion, relieve the pain and recovery shoulder function, and the long-term therapeutic effect is satisfactory.

Objective: To investigate the clinical efficacy of arthroscopic irrigation combined with surgical debridement in the treatment of shoulder infection after arthroscopic rotator cuff repair. Methods: Data of 4 post-operative infected patients [(male 3 cases, female 1 case; 55 years (51-61 years)] after arthroscopic rotator cuff repair who underwent arthroscopic irrigation combined with surgical debridement from January 2016 to June 2019 were retrospectively analyzed. Less than 1 month after surgery, swelling, pain in the surgical area occurred and all patients had fever, abscess and sinus. Hematology and radiology were conducted immediately after admission. Antibiotic treatment was applied, and adjusted according to the culture results timely. All patients underwent arthroscopic irrigation combined with surgical debridement. Antibiotics continued accordingly after the operation. Blood routine, erythrocyte sedimentation rate, C-reactive protein, X-ray, etc. were rechecked regularly to evaluate the symptomatic relief of the infection and prognosis. Visual analogue scale (VAS) and American Shoulder and Elbow Surgeons (ASES) score were used to evaluate shoulder function during the pre-operative and post-operative follow-up period. Results: The surgery was successfully completed in all 4 patients. One was treated with VSD for vacuum suction and the wound was closed one week later. The results of microbial culture showed that 2 cases were Mycobacterium tuberculosis positive, 1 case Pseudomonas aeruginosa positive, and 1 case was Staphylococcus aureus positive. After treatment, the shoulder sinuses of all patients were healed, without swelling, pain, etc. The follow-up time was 3, 4, 32, and 33 months, respectively. There was no recurrence of infection until the latest follow-up. The joint mobility and scores were better than the situation of preoperative. The VAS score and ASES score of 2 patients with early debridement (< 1 month duration of infected symptoms) were respectively improved significantly from 5 and 40, 6 and 23 before operation to 1 and 80, 1 and 73 respectively at the latest follow up. The VAS score and ASES score of other 2 patients (> 6 months duration of infected symptoms) were respectively improved from 6 and 28, 6 and 32 to 1 and 62, 2 and 65 respectively. All patients were satisfied with the results. Conclusion Early arthroscopic irrigation combined with surgical debridement is an effective method to treat the post-operative infections after arthroscopic rotator cuff repair.

BACKGROUND: Thymoma is the most common malignant tumor in anterior mediastinum, and its specific pathogenesis is still unclear. This limits the study of targeted drugs for thymoma. The aim of the study is to investigate the genes and signal pathways of thymoma, and provide help for the research of thymic tumor pathogenesis using the technology of second-generation genechip to analyze thymoma. METHODS: From January 2015 to December 2017, we analyzed 31 cases of thymoma by CapitaBio mRNA expression profile genechip technology, and then confirmed the genes by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: We found some genes with different expression levels between thymoma and surrounding thymus tissue. Among them, six driving genes (FANCI, CAPD3, NCAPG, OXCT1, EPHA1 and MCM2) were significantly abnormal in thymoma. Some specific genes affected by copy-number variation were detected: E2F2, EphA1, CCL25 and MCM2 were significantly up-regulated, while IL-6, CD36, FABP4, SH2D1A and MYOC genes were significantly down-regulated. KEGG database analysis showed that the expression of 10 signaling pathway genes was generally up-regulated or down-regulated, such as systemic lupus erythematosus, viral oncogenes, primary immunodeficiency, cell cycle genes and p53 signaling pathway, which may be related to occurrence of thymoma. CONCLUSIONS We found a variety of genes abnormally expressed in thymoma, which will provide reference for the study of pathogenesis and biomarkers of thymoma in the future.

Objective To evaluate the prevalence of full thickness rotator cuff tear in patients with proximal humeral fractures,and the relationships between different risk factors.Methods Data of 113 patients with proximal humeral fractures from January 2014 to January 2016 who underwent surgical treatment were retrospectively analyzed.The general characteristics of patients (age,sex,cause of injury) were recorded and the rotator cuff was evaluated preoperatively on MRI and explored intra-operatively.We calculated and compared the incidence rate of age,sex in patients with and without rotator cuff tear.And the incidence rate of rotator cuff tear in different types of fracture according to Neer classification was calculated.Results The full thickness ro tator cuff tear were indentified in 28 patients (24.8％),and 21 of them had been confirmed by MRI preoperatively.Statistical significant difference was found between patients with rotator cuff tear group (average of 75.11± 10.89 years old) and without rotator cuff tear group (64.68± 13.43) for the age of the patient.Full thickness rotator cuff tear was most common in Neer 3 GT fracture (33.3％,8/54),followed by Neer 2 GT (26.67％,4/15) and Neer 2 SN (17.65,6/34),however,no full thickness rotator was found in Neer 4 type fracture.There were 4 patients with total rotator cuff tear who had symptom of shoulder before the operation.The other 24 patients had no symptom of shoulder.Conclusion Patient age was found as a risk factor for full thickness rotator cuff tear in humeral proximal fractures with the rate of 24.8％.Full thickness rotator cuff tear was most common in Neer 3 GT fracture.

OBJECTIVE: To systematically evaluate the clinical effect of cultured milk products as adjunctive therapy in the anti- Helicobacter pylori (H. pylori) treatment.
 METHODS: The randomized controlled trials (RCT) and Quasi-randomized controlled clinical trials (Quasi-RCT), which were used to evaluate the efficacy and safety of eradicating H. pylori by fermented milk-based routine treatment, were searched and collected in Pubmed, Embase, CNKI (China National Knowledge Infrastructure), CBM (Chinese BioMedical Literature Database), Wangfang Database, VIP (VIP Citation Database) from establishment of these database to February 2015. The combined relative risk (RR) of H. pylori eradication rate and the rate of side effects were analyzed. Sub-group and sensitivity analysis was performed, and the publication bias was also tested. 
 RESULTS: A total of 9 studies including 1 644 cases were identified. The H. pylori eradication rate was 79.5% in fermented milk products combined with routine therapy, and 67.0% in routine therapy. The combined RR of H. pylori eradication rate was 1.186 (95% CI 1.118-1.257), and the combined RR of total side effects was 0.706 (95% CI 0.373-1.340).
 CONCLUSION Cultured milk products as adjunctive therapy is effective in improving the eradication rate during eradication therapy for H. pylori. However, it could not effectively decrease the risk of side effects.
Animals ; China ; Combined Modality Therapy ; Fermentation ; Helicobacter Infections ; Helicobacter pylori ; Humans ; Milk ; Randomized Controlled Trials as Topic