BACKGROUND:The pathogenesis of ligamentum flavum hypertrophy remains poorly understood, and the expression of transforming growth factor beta1 (TGF-β1) is increased notably. Reactive oxygen species (ROS) accumulation is associated with tissue degeneration, which may accelerate the progression of ligamentum flavum hypertrophy by upregulating TGF-β1 expression. OBJECTIVE:To clarify the effect and significance of ROS H2O2-mediated up-regulation of TGF-β1 and collagen type Ⅰ in the progress of ligamentum flavum hypertrophy. METHODS:Ligamentum flavum was removed from a case of acquired lumbar disc herniation with normal ligamentum flavum during lumbar posterior decompression surgery, and then separated and cultured in vitro to the 4-6 generations, followed by exposure to H2O2 at various concentrations (0, 50, 100, 150, 200μmol/L) for 72 hours. The mRNA and protein expression levels of TGF-β1 and collagen type Ⅰ were detected by real-time PCR and western blot assay, respectively. RESULTS AND CONCLUSION:Real-time quantitative PCR showed that the mRNA expression level of TGF-β1 was significantly increased in the 150 and 200μmol/L groups (P<0.05). The mRNA expression level of collagen type Ⅰ was significantly higher in the experimental groups than that in the control group, especially in the 200μmol/L group (P<0.05). Western blot assay revealed that the protein expression levels of TGF-β1 and collagen type Ⅰ were significantly increased in a dose-dependent manner (P<0.05). These findings indicate that H2O2 may accelerate the progression of ligamentum flavum hypertrophy by up-regulating the expression levels of TGF-β1 and collagen type Ⅰ.

Objective To observe the clinical efficacy of acupuncture plus activator method chiropractic technique (AMCT) in treating lumbar facet joint disorders.Method A total of 40 patients with lumbar facet joint disorders were randomized into a treatment group and a control group, 20 cases in each group. The treatment group was intervened by acupuncture plus AMCT, while the control group was treated with AMCT alone. The Visual Analogue Scale (VAS) and Japanese Orthopaedic Association (JOA) were observed in the two groups before and after 3 treatment sessions, and the clinical efficacies were compared between the two groups.Result The VAS score and JOA score were significantly changed right after the 1st treatment and after 3 treatment sessions in the two groups (P<0.05). Right after the 1st treatment and after 3 treatment sessions, there were statistically significant differences in the VAS score and JOA score between the two groups (P<0.05). The total effective rate was 90.0% in the treatment group versus 60.0% in the control group, and the difference was statistically significant (P<0.05). The relapse rate was 22.2% in the treatment group versus 50.0% in the control group 3 months after the treatment, and the difference was statistically significant (P<0.05).Conclusion Acupuncture plus AMCT is an effective approach in treating lumbar facet joint disorders.

Objective To find the mutation of disease-causing genes of sudden unexplained death syn-drome (SU D S ) in the young by whole exome sequencing in one case. Methods O ne SU D S case was found no obvious fatal pathological changes after conventional autopsy and pathological examination. The whole exome sequencing was performed with the Ion Torrent PGMTM Systemwith hg19 as reference se-quence for sequencing data. The functions of mutations were analyzed by PhyloP, PolyPhen2 and SIFT. A three-step bioinformatics filtering procedure was carried out to identify possible significative single nu-cleotide variation (SN V ), which was missense mutation with allele frequency <1% of myocardial cell. Results Four rare suspicious pathogenic SN V were identified. C ombined with the analysis of convention-al autopsy and pathological examination, the mutation MYOM 2 (8_2054058_G/A ) was assessed as high-risk deleterious mutation by PolyPhen2 and SIFT, respectively. Conclusion Based on the second genera-tion sequencing technology, analysis of whole exome sequencing can be a newmethod for the death cause investigation of SU D S. The gene MYOM2 is a newcandidate SU D S pathogenic gene for mecha-nismresearch.

Objective To evaluate the efficacy of comprehensive treatment for liver cancer recurrence and metastasis after liver transplantation, and investigate the risk factors affecting the lifespan of patients with liver cancer recurrence and metastasis. Methods Of 29 patients with liver cancer recurrence and metastasis after liver transplantation, 11 patients in the comprehensive treatment group were treated by TACE, microwave coagulation, radiotherapy or hepatectomy, and the remaining 18 patients were classified into chemotherapy group. The differences in efficacy between the 2 treatment modalities were compared, and the factors influencing the patients' lifespan were analyzed. Results Compared with patients in the chemotherapy group, patients in the comprehensive treatment group had significantly longer lifespan after liver cancer recurrence and metastasis (t = 5. 617, P < 0.01). TNM staging, pathological classification, time of postoperative recurrence and metastasis and treatment method were the factors that influence the lifespan of patients with liver cancer recurrence and metastasis after liver transplantation (t =2.843, 3.061,22.781,5.617, P <0.01). Conclusions Comprehensive treatment could prolong the lifespan of patients with liver cancer recurrence and metastasis after liver transplantation. The efficacy of comprehensive treatment is superior to that of the chemotherapy.

Specific to the existing problems of uneven distribution of resources in the medical industry,especially the shortage of grass-root high-quality medical resources,the paper introduces the construction objective,overall architecture and construction contents of regional medical collaboration,and normalizes the medical service process through informationalized technological means,in order to promote standardized construction of the regional medical information system and information interconnection and intercommunication.

BACKGROUND:The exact pathogenesis of ossification of ligamentum flavum has not been elucidated yet. And osteopontin may be an important factor involved in the ossification of ligamentum flavum. OBJECTIVE:To clarify the expression and significance of osteopontin and its receptors, CD44 and integrin-β3, in ligamentum flavum cels between normal controls and patients with ossification of ligamentum flavum.METHODS:Ligamentum flavum tissues were obtained from normal adult controls and adult patients with ossification of ligamentum flavum (n=8 per group) who underwent thoracic/lumbar posterior decompression surgery. Ligmentum flavum cels were separated, cultured and identifiedin vitro, and osteopontin, CD44, integrin-β3 were stained using immunocytochemistry method and observed under inverted phase contrast microscope. And the mRNA expressions of osteopontin, CD44, integrin-β3 were measured by RT-PCR. RESULTS AND CONCLUSION: Immunocytochemistry results showed that the stronger positive staining for osteopontin, CD44, integrin-β3 was observed in the ossification of ligamentum flavum group than the control group (P < 0.01). The mRNA expressions of osteopontin, CD44 and integrin-β3 were also higher in the ossification of ligamentum flavum group than the control group (P < 0.05). These findings indicate that osteopontin and its receptors, CD44 and integrin-β3, in ligamentum flavum cels may play an important role in ossification of ligamentum flavum.

Objective To investigate the relationship between sleep duration and the risk of stroke in Asian populations.Methods Using duration of sleep,stroke and cerebrovascular event as search terms,we searched the China National Knowledge Internet (CNKI),Wanfang,Chinese BioMedical Literature(CBM),Vip Citation Databases(VIP),PubMed,EMBASE and Science Citation Index databases from the time of database construction to April 1,2018.Observational studies including cross-sectional studies,case-control studies and cohort studies that aimed to investigate the relationship between sleep duration and the risk of stroke in Asian populations were collected.Two investigators independently screened the literature,extracted data and assessed the quality of included studies.All analyses were performed by using the Stata 12.0 software.Results A total of 18 studies,including 658 778 participants,were included in this meta-analysis.Pooled results showed that short sleep duration was not associated with increased risk of stroke(OR =1.08,95 ％CI:0.96-1.22,Z =1.27,P =0.205),but long sleep duration was associated with increased risk of stroke(OR =1.61,95 ％CI:1.42-1.83,Z =7.49,P ＜ 0.001).Subgroup analysis showed that short sleep duration was correlated with a high risk of stroke only in the Singaporean population while it was not the case in other Asian populations,and long sleep duration was correlated with a high risk of stroke in many studies except in pooled results of case-control studies and pooled research results concerning the Korean population.Conclusions Long but not short sleep duration is a risk factor for the incidence of stoke in Asian populations.

Objective To investigate the role of the neuropsychological tests and functional imaging in differentiation between multiple system atrophy parkinsonism-predominant (MSA-P) and multiple system atrophy predominant cerebellar ataxia (MSA-C) or idiopathic Parkinson' s disease (PD).Methods We collected three groups of patients including MSA-P (n =8),MSA-C (n =13),idiopathic PD (n =13),and control group (n =13) between December 2012 and November 2013 in General Hospital of People's Liberation Army.We then compared the scores of neuropsychological assessment and parameters obtained from diffusion tensor imaging (DTI) examination among the four groups.Results (1) MSA-P group had longer time-consuming of trail-making test((103.7 ± 25.9) s) and lower graphic symbol test scores (20.9 ±6.1) than that of the MSA-P group ((80.9 ± 29.1) s ; 28.1 ± 7.4) and PD group ((72.0 ± 19.6) s ;29.0 ± 9.4 ; all P ＜ 0.05).(2) Mean diffusivity (MD) in both putamen (8.01 ± 0.76,7.91 ± 0.74) and the left substantia nigra (8.31 ± 0.43),thalamus (8.30 ± 0.69),external capsule (8.12 ± 0.32) of MSA-P group was significantly different from that of MSA-C group (7.27 ± 0.42,7.34 ± 0.3 1,7.58 ±0.81,7.81 ±0.34,7.70 ±0.44) and PD group (7.35 ±0.43,7.45 ±0.43,7.66 ±0.45,7.72 ±0.40,7.56 ± 0.37) ; Significantly higher MD in both middle cerebellar peduncle (8.54 ± 0.74,8.28 ± 0.71),medulla oblongata (8.32 ± 0.61) was demonstrated in MSA-C group than that of MSA-P group (8.54 ±0.74,8.28 ±0.71,8.32 ±0.61),PD group (7.25 ±0.70,7.30 ±0.66,7.65 ±0.50) and control group (6.94±0.39,7.08 ±0.32,7.44 ±0.41; all P＜0.01).(3) Fractional anisotropy (FA) in the left external capsule (0.45 ± 0.35) and right thalamus (0.28 ± 0.27),occipital lobe (0.47 ± 0.87) in MSA-P group was significantly different from that in MSA-C group (0.48 ± 0.36,0.23 ± 0.24,0.49 ± 0.49 ; P ＜0.05) ; FA in the left occipital lobe (0.46 ± 0.10) in PD group was significantly different from that in MSAP group (0.56 ± 0.82 ; P ＜ 0.01).Conclusion Trail-making test,graphic symbol test and DTI can be used to differentiate MSA-P type from MSA-C type or PD.

AIM: To investigate the effect of exercise stress on chronic cigarette smoking-induced downregulation of expression of large-conductance calcium-activated potassium channel (BK_(Ca)) and voltage-dependent delayed rectifier potassium channel (Kv1.5) in rat bronchial smooth muscle cells. METHODS: Rats were divided into 3 groups: normal control, smoking control and smoking plus exercise training group. The alteration of airway responsiveness and plasma cortisol level were detected, and potassium channel expression and pathological changes in lung tissue were determined with HE staining, immunohistochemistry, in situ hybridization and Western blot techniques. RESULTS: (1) Cigarette smoking induced an increase in airway responsiveness, smoking plus exercise lead to a decrease in airway responsiveness in contrast to smoking control group; (2) Plasma level of cortisol determined immediately after exercise was higher than that determined before exercise; (3) HE staining showed that there was severe chronic pulmonary inflammatory response in smoking control group, which was slight in the smoking plus exercise group; (4) The protein and mRNA expression of BK_(Ca) in cigarette smoking group were less than that in control group in BSMC, the mRNA expression of BK_(Ca) in exercise group were higher than that in smoking group; (5) The protein and mRNA expression of Kv1.5 in smoking group were less than that in control group in BSMC, and expression of Kv1.5 in exercise group was higher than that in smoking group in bronchioli. CONCLUSION: Proper exercise training can increase the expression of potassium channel BK_(Ca) and Kv1.5, and increase the cortisol secretion, which may contribute to the decreasing of airway hyperresponsiveness induced by cigarette smoking. [

Aim To study the anti-stress depression effect of Jiaweisinisan(JWSNS)and it's mechanism of N-methyl-D-aspartate(NMDA)receptor channel in hippocampus.Methods Chronic mild unpredictable stress(CMUS)was adopted to establish the rat depres-sion model.Before and after model establishing,the sucrose consumptions and the weight of rats were detected.TTC dyeing of hippocampus brain slices ex vivo were used to detect the situation of hippocampus neuron damage and the protective effect of serum containing components of JWSNS.The opening probability and the average opening time of NMDA receptor channels were detected by attach on cell patch clamp,the Ca2+ concentrations in single cell of hippocampus neurons were detected by Tillvis ION software.Results CMUS could decrease the sucrose preference and the weights of rats(P