Objective To investigate the level of soluble interleukin 7 receptor (sIL-7R) in serum of lupus nephritis(LN)patients and evaluate its clinical significance. Methods sIL-7R level in serum of LN patients and healthy controls were measured by ELISA , while total 24 hours urinary protein and complement C3 of LN patients were measured by BN ProSpec. The level of sIL-7R correlation with SLEDAI, total 24 hours urinary protein and complement C3 were analyzed respectively. Results The levelof sIL-7R was higher in serum of LN patients than healthy controls (P < 0.01). Moreover, its expression in serum was increased in LN patients in active stage than in LN patients in stable stage (P < 0.05). The level of sIL-7R was positively assosicated with SLEDAI, total 24 hours urinary protein(P < 0.01, P < 0.05) and negatively with complement C3 (P < 0.05). Conclusion The level of sIL-7R is upregulated in serum in LN patients and correlated with disease activity and progression, so it may be expected to become a potential marker of disease in prediction.

Objective To observe neurophysiological changes and pulmonary function in obstructive sleep apnea syndrome (OSAS) and analyze their inter-relationship. Methods Sixty OSAS patients were studied. Their lung function and phrenic motor nerve conduction (PNC) were examined. Thirty cases without respiratory disorder served as controls. The lung function tests included percentage of the predicted value of vital capacity ( VC% ), percentage of the predicted value of maximal voluntary ventilation ( MVV% ), percentage of the predicted value of forced expiratory volume in one second ( FEV1% ), inspiratory capacity ( IC), and expiratory reserve volume (ERV). The phrenic nerve was stimulated electrically, and the latent period and the diaphragmatic compound muscle action potential (dCMAP) were recorded. Results The VC%, MVV%, FEV1% , IC and ERV of the patients with OSAS were significantly lower than those of the controls. There was no significant difference between the patients and the controls with regard to their PNC latency. In the OSAS patients the amplitude ratio of their dCMAPs was positively correlated with VC% , MVV% , FEV1% , IC and ERV, and negatively with an apnea hypopnea index (AHI).Conclusions PNC examination can provide valuable information for evaluating diaphragmatic dysfunction in those with abnormal lung function. Decreased dCMAP might be associated with abnormal lung function.

Objective:To explore the diagnostic value of motion pain induction test for early knee osteoarthritis.Methods:A cross-sectional study was conducted and the data came from The Project of Health Management of Knee osteoarthritis in Community in Hangzhou in 2018, and a total number of 1 816 people were included which were divided into normal group ( n=530), early group ( n=534) and middle-late group ( n=752) by not sick, sick while Kellgren-Lawrence (KL) ≤Ⅱ and sick while KL>Ⅱ starting, squatting, walking up and down stairs and doing housework were included in the test, and the statistical indicators included age, gender and pain scores (visual analogue scale, VAS). Receiver operating characteristic (ROC) curves were mapped after the correlation analysis to obtain the cut-off points and compare their values of area under the curve (AUC). The confounders which included age and gender were corrected by propensity score matching (PSM) and the balance test is consistent with P>0.05 after the PSM. The Kappa analysis was used to verify the consistency of two diagnostic methods. Results:The age of normal, early and medial-late groupwas 67.39±7.43, 67.41±9.52, 71.55±9.87. And the gender distribution of three groups was (238 male, 292 female), (209 male, 325 female), (357 male, 395 female). There was no heterogeneitybetween the normal group and early group in distribution ( P>0.05) while there was heterogeneity between the early and medial-late group ( t=-0.034, P<0.05; χ2=8.80, P<0.05). The VAS scoresof starting pain in three groups was 0.16±0.37,2.70±1.69, 3.68±2.10. The VAS scoresof squatting pain was 0.42±0.49, 2.88±1.44, 4.01±2.08. The VAS scoresof up and down stair pain was 0.47±0.50, 2.87±1.38, 3.82±1.98. The VAS scoresof housework pain was 0.14±0.35, 2.15±1.40, 3.45±2.09. The VAS scoresofmaximum pain was 0.51±0.50, 3.59±1.48, 4.68±2.01. And there was significant difference between normal and early groupin all kinds of pain ( t=-33.81; t=-37.25; t=-37.66; t=-32.07; t=-45.41; P<0.05). The difference between early and medial-late group in all type of pain was significant ( t=-8.93; t=-10.84; t=-9.56; t=-12.52; t=-10.64; P<0.05). The results were similar after adjusting for confounders except for the pain of starting ( P>0.05). The results of ROC curve between normal and early group showed the maximum pain's AUC point was 0.98 and larger than others, and its cut-off point was 1. After adjusted, the results of ROC curve between early and medial-late group showed the maximum pain's AUC point was 0.72 which was larger than others and cut-off point was 4. For the AUC of ROC curve between early and medial-late groupwas lower, Kappa-test was used, and the Kappa point of two diagnostic methods was 0.41 ( P<0.05). Conclusion:The maximum of pain score in pain dimension>1 and ≤ 4 could be preliminarily diagnosed as early KOA. It had high value in separating early KOA from normal people and approximately similar to X-ray, and the value of identifying early and mid-late KOAwas moderateas well as the moderate consistency with KL stage. Comprehensive judgment of imaging examination should be improved when conditions are available.

Objective To investigate the effect of Salvianolic Acid B(Sal B)on vascular function of db/db mice and reveal the potential mechanism. Methods 20 male db/db mice were divided into 2 groups,the con-trol group(n=10)and Sal B group(n=10). 10 age-matched male C57BL/KsJ mice were used as the wild type control. Mice in Sal B group were given Sal B ,100 mg/(kg · d)by tube. Mice in db/db control group and in wild type control were given the same volume of saline. Body weight,tail blood pressure,heart rate and fasting blood glucose level were measured every week. After 6-weeks treatment ,thoracic aorta was obtained and used to detect the levels ofsuperoxide anion and NO,vascular function,eNOS,p-eNOS,AMPK and p-AMPK. Results Sal B could reduce the body weight and fasting blood glucose level of db/db mice ,but had no effect on blood pressure. Sal B could decrease the level of superoxide inon,increased NO level,and improved endothelium-dependent but not endothelium- independent diastolic function. Sal B could increase phosphorylation levels of eNOS and AMPK. Conclusion Sal B can reduce the oxidative stress ,increases NO level in vasculature ,and improves the endo-thelium-dependent vasodilation in the diabetic mice ,which may be associated with the promotion of AMPK phos-phorylation.

OBJECTIVE To study the improvement effect and possible mechanism of N-butylphthalide on inflammatory injury of bone marrow mesenchymal stem cells （BMSCs） in rats. METHODS BMSCs of rats were divided into control group， model group， N-butylphthalide low-concentration， medium-concentration and high-concentration groups （10， 20， 50 μmol/L）. BMSCs were cultured in vitro and lipopolysaccharide （the final concentration of 10 mg/L） was used to establish the inflammatory injury model. After the intervention of N-butylphthalide， the survival rate， apoptotic rate， the contents of tumor necrosis factor α （TNF- α）， interleukin 1β （IL-1β） and IL-6 in cell culture medium， the mRNA expression of nuclear factor-κB（NF-κB） p65， and the protein expressions of caspase-3， B-cell lymphoma 2 （Bcl-2）， Bcl-2 related X protein （Bax） and NF-κB p65 in cells were detected. RESULTS Compared with control group， the survival rate and protein expression of Bcl-2 were decreased significantly in model group （P＜0.05）； the apoptotic rate， contents of TNF-α， IL-1β and IL-6， the mRNA expression of NF-κB p65， and the protein expressions of caspase-3， Bax and NF-κB p65 were increased significantly （P＜0.05）. Compared with model group， above indexes were significantly reversed in all concentration groups of N-butylphthalide （P＜0.05）， in concentration-dependent manner. CONCLUSIONS N-butylphthalide can ameliorate the inflammatory injury of BMSCs induced by lipopolysaccharide， and its mechanism may be related to the inhibition of NF-κB signaling pathway.

TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.

Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.

Objective    To investigate the effectiveness and safety of totally endoscopic transmitral myectomy (TETM) for hypertrophic obstructive cardiomyopathy (HOCM), comparing with traditional sternotomy modified Morrow procedure (SMMP). Methods    Thirty-eight patients with HOCM who needed surgical intervention were selected from our hospital in 2019, including 14 males and 24 females, with an average age of 56 (44-68) years. According to the operation method, they were divided into a TETM group (n=18) and a SMMP group (n=20). Appropriate patients  were screened by propensity matching scores. Finally, the clinical data of two matched groups were compared and

Objective    To determine the clinical efficacy of transapical transcatheter mitral valve-in-valve treatment for patients with deteriorated mitral bioprosthesis after aortic-mitral double valve replacement. Methods    The clinical data of 9 patients who underwent transapical transcatheter mitral valve-in-valve implantation after aortic-mitral double valve replacement due to mitral bioprosthesis deterioration from May 2020 to January 2021 in our hospital were retrospectively analyzed, including 4 males and 5 females with a mean age of 72.44±7.57 years. Results    Surgeries were performed successfully in all patients with no conversion to median sternotomy. The mean procedural time was 101.33±48.49 min, the mechanical ventilation time was 23.11±26.54 h, the ICU stay was 1.89±1.05 d and the postoperative hospital stay was 6.11±2.02 d. Residual mild mitral regurgitation was only observed in 1 patient. Only 1 patient needed postoperative blood transfusion. No major complications were observed in all patients. There was no death in postoperative 90 days. Conclusion    For patients with deteriorated mitral bioprosthesis after aortic-mitral double valve replacement, transapical transcatheter mitral valve-in-valve implantation achieves good clinical results and effectively  improves the hemodynamics without increasing the risk of postoperative left ventricular outflow tract obstruction. The surgery is feasible and effective.

Objective    To determine the clinical efficacy of transcatheter aortic valve replacement (TAVR) for severe aortic regurgitation (AR) combined with severe mitral regurgitation (MR). Methods    The clinical data of 13 patients who underwent TAVR due to severe AR combined with severe MR from March 2018 to September 2021 in our hospital were retrospectively analyzed, including 10 males and 3 females with a mean age of 72.54±2.35 years. The echocardiographic findings of all patients were compared preoperatively and postoperatively. Results    Surgeries were performed successfully in all patients without intraoperative death or conversion to sternotomy. The operation time was 118.15±11.42 min, intraoperative blood loss was 100.00 (75.00, 250.00) mL, and the length of hospital stay after surgery was 9.00 (4.50, 11.00) d. The mean follow-up duration was 10.00 (6.50, 38.50) months, during which there were 2 patients with mild to moderate AR, 6 with mild AR, and 5 with no AR; meanwhile, severe MR decreased significantly (P=0.001) even without active intervention, including 4 mild to moderate MR and 9 mild MR patients. Compared to preoperative indexes, the left atrial diameter [46.00 (41.00, 52.50) mm vs. 35.00 (34.00, 41.00) mm, P<0.001], left ventricular end-systolic diameter [45.00 (36.00, 56.00) mm vs. 35.00 (28.00, 39.00) mm, P=0.002] and left ventricular end-diastolic diameter (62.62±2.40 mm vs. 51.08±2.49 mm, P<0.001) showed a decreasing trend during the follow-up. Conclusion    In selected patients with severe AR combined with severe MR, TAVR alone improves AR and combined MR at the same time.