Objective To determine the specific effect of manual removal of the placenta in the third stage of labor in the prevention of postpartum hemorrhage.Methods We searched PubMed,EMBASE,EBSCOhost databases and Chinese Academic Journal et al(inception to October August 2015).Articles database of all published.Randomized controlled trials comparing manual removal of the placenta with hands-off management inthe third stage of labor were included.Two independent reviewers assessed the included studies and extracted data.RevMan4.2 software was used for Meta-analysis.Results Six randomized controlled trials involving a total of 2 435 participants were eligible.There were five cases of cesarean section,one case of natural childbirth,and four English literatures and two Chinese literatures.Significant difference was found between manual removal of the placenta and handsoff management groups with respect to the incidence of postpartum hemorrhage.Conclusion Routine manual removal of placenta at cesarean section significantly increases perioperative blood loss.However,the effect in vaginal delivery need further research.

Objective:To determine the influences of structural changes after valgus impacted femoral neck fracture on hip range of motion (ROM) so as to provide evidence for clinical judgment of whether reduction is necessary or not in the internal fixation of such fractures.Methods:1. 3D reconstructions of the CT hip scans were performed for the 73 patients who had been treated at Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University for valgus impacted femoral neck fractures from January 2019 to April 2019.The femoral neck-shaft angle, anteversion angle, femoral offset, axial alpha angle, lateral center edge angle (LCEA), anterior center edge angle (ACEA) and center displacement were measured and compared between the affected and healthy sides to determine the influences of the fracture on the above indexes. 2. Hip motions (flexion and MIR-90°) were simulated on bilateral sides to determine the influences of structural changes after fracture on hip ROM using stepwise regression and Logistic regression. 3. The distribution of femoral-acetabular contact points on the femoral side was observed in simulation of hip flexion to detect the potential area for femoracetabular impingement (FAI) induced by the fracture displacement.Results:1. The valgus impacted femoral neck fractures had significant influences on femoral neck-shaft angle, anteversion angle, femoral offset and axial alpha angle. Compared with the healthy side, on average, the femoral neck-shaft angle increased by 5.1°, anteversion angle decreased by 6.5°, femoral offset decreased by 8.2 mm and axial alpha angle increased by 9.7° on the affected side, showing significant differences ( P<0.05).The displacements of the femoral head center averaged 9.2 mm. There was no significant difference in LCEA or ACEA between the affected and healthy sides ( P>0.05). 2. Compared with the healthy side, on average, the simulated hip flexion decreased significantly by 27.0° and the hip MIR-90° decreased significantly by 20.3° on the affected side after fracture ( P<0.05). Regression analysis showed that femoral anteversion angle, ACEA and displacement of the femoral head center had a significant influence on hip ROM, especially the anteversion angle. When the anteversion angle decreased by more than 7.1°, the hip flexion would decrease by at least 20%. 3. The points of FAI distributed more widely on the fracture side. Compared with the healthy side, the impact points extended outward and upward in hip flexion and extended inwardly in hip MIR-90° on the affected side. Conclusions:After a valgus impacted femoral neck fracture, if the femoral anteversion angle has been decreased by more than 7.1°, the hip ROM can be greatly influenced and the points of FAI can be distributed more widely. Therefore, reduction should be recommended before internal fixation of the fracture.

Depression is a frequently-seen mental disorder that profoundly affects the survival and quality of life of individuals.Present clinical medicine therapies for depression are not fully efficacious and novel therapeutic agents and targets remain necessary.Bupleuri Radix-Paeoniae Radix(BR-PRA),an essential and crucial compo-nent of traditional antidepressant compound,possesses the beneficial effect of lowering toxicity and amplifying the antidepressant effect when utilized in combination.The underlying mechanisms of these synergistic effects may involve the suppression of inflammation and oxidative stress,the regulation of monoamine neurotransmitters,brain-derived neurotrophic factors,the modulation of the hypothalamus-pituitary-adrenal axis,and the metabolism of various amino acids and energy.This article summarizes the synergistic effects and antidepressant pharmacological effects of BR-PRA herb-pair,thereby providing valuable insights into the potential advantages of this combination and its potential mechanisms of antidepressant action.

AlM: To investigate the effect of C. sinensis extracts on HBx (Hepatitis B virus X protein) induced cell proliferation and extracellular matrix (ECM) accumulation and the underlying mechanism in cultured human mesangial cells (HMCs). METHODS: Human mesangial cells were stable transfected with pCMV-HBx to establish an HBx over-expression model, and a control group was transfected with an empty vector. Cell proliferation was determined by MTT assay and DNA synthesis assay. Western blotting was used to measure the expression of PI3K/Akt signaling pathway-related proteins and extracellular matrix. RESULTS: HBx transfection induced cell proliferation, matrix accumulation. HBx-transfected mesangial cells had increased activity of the PI3K/Akt pathways, and treatment with C. sinensis suppressed this effect. CONCLUSlON: C.sinensis attenuates the HBx-induced human mesangial cell proliferation and matrix production in human mesangial cells via inhibition of the PI3K/Akt pathways.