BACKGROUND: Color Doppler flow imaging can exam the early myocardial disorder in type 2 diabetic patients. What does exercise tolerance test work for the examination of such disorder in combination with color Doppler flow imaging (CDFI) ?OBJECTIVE: To analyze in comparison the early evaluation on reduced diastolic function in left ventricle in patients with type 2 diabetes between the examinations of exercise tolerance test combined with color Doppler flow image and simple color Doppler flow imaging.DESIGN: Cases-controlled comparison and self-comparison.SETTING: Department of electrodiagnosis and department of Endocrinology in a municipal hospital.PARTICIPANTS: Thirty-six cases of inpatients with type 2 diabetes were selected from Department of Endocrinology of Shenyang Red Cross Hospital from March to December in 2004, of which, 25 cases were males and 11cases females. The diabetic patients included had no cardiac vascular complications and participated in the study in volunteer. Thirty-two patients who received annual routine health check at the same period were selected as the control, of which, 20 cases were males and 12 cases females.METHODS: Metronics treadmill exercise test equipment was used for exercise tolerance in two groups. Before exercise(at quiescent state) and after exercise tolerance, Vivid 4 CDFI was used to determine flow velocity at E and A peak values respectively, ratio between flow velocities at E peak value and A peak value as well as isovolumtric relaxation time (IRT).MAIN OUTCOME MEASURES: Comparison of cardiac functional indexes before and after exercise tolerance in two groups.RESULTS: Thirty-four diabetic patients accomplished exercise tolerance test, of which, 1 case presented frequent ventricular extrasystole, another one presented precordial pain and stopped the test. In the control, all of 32 cases ratio between flow rates of E peak value and A peak value was remarkably lower than that in the control (0. 90 ± 0. 25, 1.40 ± 0.30, P ＜ 0.05 ); IRT was remarkably longer than that in the control [ (112. 07 ± 20. 16),imental group, the ratio between flow rates of E peak value and A peak value was remarkably lower than that in the control (0.62 ±0. 12, 1.28 ±0.87, P＜ 0.01 ); IRT was remarkably longer than that in the control[ (138. 10± 19.21), (97.37±9.61) ms, P ＜0.01].CONCLUSION: CDFI can supervise and evaluate at early stage the cardiac functional changes in type 2 diabetic patients. Due to the induction of exercise tolerance, the combination of exercise tolerance test and CDFI provides more accurate, objective and valuable conclusions at early stage.

Objective To investigate the cause of non-union and delayed union of femoral and tibia] fractures and assess the clinical outcome after treatment with intramedullary compression interlocking nail (ICIN). Methods From February 1998 to December 2006, 21 patients with non-union and delayed union of femoral and tibial fractures (13 patients with femoral fractures and 8 with tibial fractures) were treated by ICIN. Bone grafting was performed in 18 patients, and the other three patients only rocoived reamed compression nailing. Five patients received bone grafting combined with knee adhesion release operation. Results All patients were followed up for 11.4-36 months (mean 13.6 months). Solid bone union was observed in all patients, with mean bone union time of 8.7 months and without malunion, infection or refracture. According to the Klemm grading, the clinical outcome was graded excellent in 19 patients and good in 2. Conclusions The main causes for non-union and delayed union of femoral and tibial fractures are improper indication selection and incorrect use of implants, which may result in bieenvironment disruption. ICIN shortens the time of functional recovery of knee and ankle joint. ICIN has advantages of stable fixation, early exercise of the knee and ankle as well as early weight loading and hence is one of effective alternatives in treatment of non-union and delayed union of femoral and tibial fractures. ICIN can accelerate the healing of bone and improves the function of knee joint when combined with bone grafting, reamed compression nailing and knee adhesion release.

Objective To study the expression and clinical significance of Mybl2 in Cervical tissues.Methods 74 cases of cervical tissues were obtained from the department of obstetrics and gynecology.The expression level of Mybl2 was detected by Elisa method,and the relationship with clinical pathology was analyzed.Results Elisa results showed that the expression of Mybl2 was significant among inflammation,CINⅠ,CINⅡ,CINⅢ and ICC groups (F=27.39,P＜0.05).The expression level of Mybl2 was higher in the older group that the younger one which were in the same clinical pathology degree,but it was not was significant(P＞0.05).Conclusion The expression levels of Mybl2 were related with the pathological changes of cervix.Disturb expression level of Mybl2 maybe induce the development of cervical cancer.

OBJECTIVETo observe the protective effect of alcohol extract of Potentilla anserina against myocardial apoptosis induced by acute myocardial ischemia/reperfusion by arteria coronaria ligation and the effect on the expressions of Caspase-3 and Caspase-9 in myocardial apoptosis signal pathway.

METHODMale SD rats were randomly divided into the sham-operated group, the model group, the diltiazem group (30 mg x kg(-1)) and P. anserine alcohol extract intervention groups (0.9, 1.8, 3.6 g x kg(-1)). Rat acute myocardial ischemia/reperfusion model was established by ligating left anterior descending. Apoptosis of myocardial cells were detected by TUNEL (Terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling assay). The expressions of Caspase-3 and Caspase-9 mRNA were assayed by reverse transcription-polymerase chain reaction (RT-PCR). Semi-quantitative analysis was made for the expressions of Caspase-3 and Caspase-9 by immunohistochemistry.

RESULTAccording to TUNEL results, after I/R injury-induced myocardial apoptosis, the apoptotic index (AI) of model group was (31.5 +/- 3.6)%. All P. anserine alcohol extract intervention groups showed obvious inhibition of ischemia/reperfusion-induced myocardial apoptosis. In the model group, myocardial apoptosis caused increased expression of Caspase-3, Caspase-9 mRNA and proteins. After the administration of P. anserine alcohol extract, 1.8, 3.6 g x kg(-1) dose groups showed notable decrease in Caspase-9 mRNA (P < 0.05), while the 0.9 g x kg(-1) dose group showed no significant difference with the model group. Alcohol extract of P. anserina in all dosages showed inhibitory effect on the expression of Caspase-3 mRNA in myocardial cells compared with model group (P < 0.05). Immunohistochemistry showed that administration of all dosages of alcohol extract of P. anserina could significantly reduce Caspase-3 and Caspase-9 protein expressions after I/R injury (P < 0.05).

CONCLUSIONThe administration with alcohol extract of P. anserina can protect the myocardial tissue from apoptosis after acute myocardial ischemia and reperfusion injury in rats and inhibit the expressions of Caspase-9 and Caspase-3 mRNA and proteins.

Animals ; Apoptosis ; drug effects ; Caspase 3 ; metabolism ; Caspase 9 ; metabolism ; Ethanol ; chemistry ; Male ; Myocardial Reperfusion Injury ; drug therapy ; Plant Extracts ; chemistry ; therapeutic use ; Potentilla ; Rats ; Rats, Sprague-Dawley

Multiple system atrophy(MSA)is an adult-onset and progressive neurodegenerative disease,is clinically classified into two subtypes:MSA with predominant parkinsonism(MSA-P)and MSA with predominant cerebellar ataxia(MSA-C),characterized by dysautonomia and dyskinesia.The etiology of MSA is still unknown,multiple pathogenic factors are involved in the pathogenesis of this disease,therefore,in addition to limited symptomatic treatment,there is still a lack of disease modifying therapy to prevent the progress of the disease.Currently,animal and clinical studies targeting α-synuclein,neuroinflammation and neurotrophic supporting are being explored,so this article reviewed the latest progresses to improve the clinical understanding of treatment of MSA.

Objective: To study the level of squamous cell antigen (SCC?Ag) and cyclin E in cervical intraepithelial neoplasia ( CIN) and cervical cancer, and to explore the clinical significance. Methods: From Nov 2012 to Nov 2015, 308 patients with CIN or cervical cancer were chosen as research objects, and 170 patients with uterine leiomyoma or uterine gland muscle disease for hyster?ectomy and after pathological examination of the normalcases were chosen as control group. The SCC?Ag level, positive expression rate in blood, and positive expression of Cyclin E in cervical tissue for patients with different cervical lesions were compared. Results: The SCC?Aglevel , positive expression rate in blood, and positive expression of Cyclin E in cervical tissue for patients with cervical canc?er, CIN were higher that those in the control group ( P<0?05) . The SCC?Aglevel, positive expression rate in blood, and positive ex?pression of Cyclin E in different CIN grades and different stages of cervical cancer patient had significant difference ( P<0?05) . Con?clusion: Blood SCC?Ag level and positive expression, Cyclin E positive expression in the cervical tissue have a close relationship with occurrence and development of CIN and cervical cancer .

Objective To evaluate the clinical efficacy of invisible orthodontic appliances without brackets for the distal movement of maxillary molars to improve the ability of orthodontists to predict treatment outcomes.Methods Web of Science,Cochrane Library,Embase,PubMed,Wanfang Database,CNKI Database,and VIP Database were searched for studies investigating the efficacy of invisible orthodontic appliances for distal movement of maxillary molars in adult patients and published from database inception to August 1,2023.A total of three researchers screened the studies and evaluated their quality and conducted a meta-analysis of those that met quality standards.Results This study included 13 pre-and postcontrol trials with a total sample size of 281 patients.The meta-analysis revealed no sig-nificant differences in the sagittal or vertical parameters of the jawbone after treatment when compared with those before treatment(P＞0.05).The displacement of the first molar was MD=-2.34,95％CI(-2.83,-1.85);the displacement was MD=-0.95,95％CI(-1.34,-0.56);and the inclination was MD=-2.51,95％CI(-3.56,-1.46).There was a statistically significant difference in the change in sagittal,vertical,and axial tilt of the first molar before and after treatment.After treatment,the average adduction distance of the incisors was MD=-0.82,95％CI(-1.54,-0.09),and the decrease in lip inclination was MD=-1.61,95％CI(-2.86,-0.36);these values were significantly different from those before treat-ment(P＜0.05).Conclusion Invisible orthodontic appliances can effectively move the upper molars in a distal direc-tion and control the vertical position of the molars.When the molars move further away,there is some degree of com-pression and distal tilt movement,which is beneficial for patients with high angles.The sagittal movement of incisors is beneficial for improving the patient's profile.

Objective To explore the risk factors of orthostatic hypotension(OH)in patients with multiple system atrophy(MSA).Methods A total of 199 MSA patients were included,and they were divided into groups based on the severity of OH.The data differences between the groups were compared,and the risk factors for the occurrence of OH in MSA patients were analyzed from ordered Logistic regression.Results There were significant differences in gender,diabetes,disease grade,syncope,supine hypertension,fatigue and brain protective drugs among patients with different OH grades(all P＜0.05).Ordered Logistic regression analysis found that disease grade(probable MSA),syncope,supine hypertension,and fatigue were independent risk factors for the occurrence of OH in MSA patients(all P＜0.05).Conclusions OH is commonly present in MSA patients,and its severity is influenced by many factors.Disease grade(probable MSA),syncope,lying hypertension and fatigue are independent risk factors of OH in patients with MSA.

Objective:To investigate the effects of decorin (DCN) on the proliferation, migration and invasion of bladder cancer cells.Methods:Bladder cancer T24 cell line was used as the research object. MTT assay was used to detect the inhibitory effect of DCN at different concentrations (0, 5, 10, 20, 30, 40, 50 mg/L) on T24 cell proliferation at 24, 48, 72 and 96 h. The effects of DCN on T24 cell cycle and apoptosis were analyzed by flow cytometry. MTT assay, Transwell migration and invasion experiments were used to detect the effects of DCN on the adhesion, migration and invasion ability of T24 cells. The effects of DCN on TGF-β1 and P21 protein expression were detected by ELISA and Western blotting.Results:T24 cells were treated with 0, 5, 10, 20, 30, 40 and 50 mg/L DCN at 24, 48, 72 and 96 h, and there were statistically significant diffe-rences in cell proliferation activity ( F=168.64, P<0.001; F=165.81, P<0.001; F=291.02, P<0.001; F=148.93, P<0.001). T24 cells were treated with 0, 5, 10, 20, 30, 40 and 50 mg/L DCN for 72 h, and the cell proliferation activities were (60.71±3.03)%, (40.82±2.09)%, (37.24±1.63)%, (25.65±2.55)%, (23.00±2.67)%, (10.78±1.17)%, (11.04±0.96)%, respectively, and there was a statistically significant difference. At the concentration of 40 mg/L, the proliferation activity reached the lowest level, and the inhibitory effect on cell proliferation was the strongest. At concentrations of 40 and 50 mg/L, the cells in G 1 phase reached the peak value, while the cells in S phase reached the lowest value, and the cells in G 2 phase remained unchanged throughout the treatment process. T24 cells were treated with 0, 5, 10, 20, 30, 40 and 50 mg/L DCN for 72 h, and the apoptosis rates of cells were (12.18±1.17)%, (21.24±1.05)%, (19.80±1.20)%, (26.52±1.40)%, (30.86±1.40)%, (52.99±1.22)%, (43.04±2.16)%, respectively, and there was a statistically significant difference ( F=178.54, P<0.001). The differences between 5, 10, 20, 30, 40, 50 mg/L DCN and 0 mg/L DCN were all statistically significant (all P<0.001). When T24 cells were treated with 0, 40 mg/L DCN for 72 h, the cell adhesion rates were (37.14±1.35)% and (59.86±1.95)%, the numbers of migrated cells were 53.86±3.18 and 12.86±1.35, and there were statistically significant differences ( t=25.25, P<0.001; t=31.36, P<0.001). When DCN was applied to T24 cells for 48 h, the numbers of invasion at 0, 40 mg/L were 235.14±3.44 and 160.86±3.13, and there was a statistically significant difference ( t=2.27, P<0.001). When T24 cells were treated with 0, 5, 10, 20, 30, 40 and 50 mg/L DCN for 72 h, the relative expression levels of TGF-β1 were 85.67±3.35, 45.51±1.19, 49.93±4.15, 47.64±3.53, 46.05±3.18, 25.54±2.25, 33.44±4.05, and there was a statistically significant difference ( F=324.58, P<0.001). Compared with 0 mg/L DCN, 5, 10, 20, 30, 40 and 50 mg/L DCN could significantly inhibited the expression of TGF-β1 (all P<0.001). Compared with 0 mg/L DCN, P21 protein was upregulated 72 h after treatment with 40 mg/L DCN. Conclusion:DCN can inhibit proliferation and induce apoptosis of T24 cells in vitro, and has the effect of anti-metastasis of T24 cells.

Objective To investigate the safety and feasibility of robotic nephrectomy,work bench surgery with robotic kidney autotransplantation in the treatment of complex renal tumors.Methods The clinical data of 5 patients with renal tumors admitted from January 2018 to July 2018 were analyzed retrospectively.There were 4 males and 1 females.The median age was 49 years old,ranging 32-66 years.The median body mass index was 25.6 kg/m2,ranging 21.1-27.8 kg/m2.Serum creatinine level was 87.2 μmol/L,ranging 78.0-88.9μmol/L before bench surgery.5 patients had multiple bilateral renal tumors and had undergone laparoscopic or robotic partial nephrectomy on the contralateral kidney.For bench surgery kidney,4 cases were on the left side and 1 case was on the right side.Each kidney has more than 2 separate tumors,combined with complete endophytic tumors,tumors larger than 7 cm in diameter or hilar tumors.5 patients were all performed robotic nephrectomy,work bench partial nephrectomy with robotic kidney autotransplantation under general anesthesia.The patient was first in a lateral decubitus position for robotic nephrectomy,and the kidney was removed through a median 6 cm periumbilical incision.After kidney removal,kidney tumors were resected and kidney was reconstructed on a hypothermic working table.Then the kidney was packed in a plastic bag,filling with ice slush.The corresponding parts of the plastic bag were cut to expose the renal artery and vein.Finally,the patient was moved to lithotomy position with Trendelenburg tilt of 20°,and the autologous kidney wrapped in the plastic bag was placed through the previous periumbilical incision into the abdominal cavity for robotic kidney autotransplantation.The renal artery and vein were anastomosed end-to-side with the right external iliac artery and vein.The ureter and bladder were anastomosed.Autologous kidneys were placed in abdominal cavity in 4 cases,and placed in right iliac fossa with retroperitonealization in 1 case.Ice slush on the surface of the autologous kidney did not completely melt before the blood supply was restored during the operation,and the autologous kidney immediately urinated after the blood supply was restored.Results All surgeries were performed successfully without conversion to open surgeries.The total operation time was 460 min,ranging (415-645 min),the time of robotic nephrectomy was 120 min,ranging (74-300 min),the time of robotic kidney autotransphntation was 135 min,ranging(103-163 min),the warm ischemia time was 3 min,ranging (1.5-6.0 min),the cold ischemia time was 182 min,ranging(135-210 min),the rewarming time was 50 min,ranging(45-55 min),the estimated blood loss during operation was 100 ml,ranging(50-300 ml),and the hospital stay was 6 d,ranging(5-9 d).The number of resected tumors was 4,ranging(2-6).The pathology reveals clear cell carcinoma in 3 cases and chromophobe cell carcinoma in 2 cases.The surgical margins were all negative.The serum creatinine levels were 111.1 μmol/L (87-217.6 μ mol/L) and 106.1 μmol/L (87.1-172 μmol/L) on the 7th and 30th day after operation,respectively.One month after operation,CT showed that the function and morphology of the autologous kidneys were fine.No recurrence or metastasis was found in 5 patients during a median follow-up of 7 months,ranging (5.4-11.7 mon).Conclusions For patients with complex renal tumors who cannot undergo in situ partial nephrectomy,robotic nephrectomy,work bench surgery with robotic kidney autotransplantation can completely remove the tumors,maximize the preservation of renal function and minimize the trauma of patients,making the ultimate means of nephron-sparing surgery for patients with complex renal tumors more minimally invasive and safe.