Autophagy is a process for the degradation of long half-life proteins and organelles via the lysosome system. A large body of evidence indicates that the autophagic phenomena exist in the progressive atherosclerotic plaques. Vascular smooth muscle cells, macrophages, and endothelial cells treated with some stimulants that result in atherosclerosis formation in in vitro experiments, these cells show certain autophagic features, such as myelin-like structures, accumulation of ubiquitinated inclusions in the cytoplasm, and extensive vacuolization. However, although the interests in research on autophagy are increasing, the exact role of autophagy in atherosclerosis remains unclear. Therefore, understanding the underlying cellular and molecular mechanisms of autophagy will provide a new idea for studying the mechanisms and treatment of atherosclerotic disease.

Objective To study the clinical study of the effect of removing blood stasis and eliminating powder on the recovery of wrist function after distal radius fracture.MethodsA total of 82 patients with distal radius fractures were selected from September 2012 to October 2016.The random number table method was divided into study group and control group.The two groups were given intervention, and the study group (VAS score), the correlation index(swelling time, pain time, fracture healing time), clinical curative effect and the recovery of wrist function were observed and compared with the two groups.ResultsAfter treatment, the VAS scores of the two groups were significantly lower than those before treatment, and the VAS scores of the study group were significantly lower than those of the control group (P<0.05).After the treatment group, the swelling time, pain time (P<0.05).After treatment, the total effective rate was 87.80% higher than that of the control group (68.29%) (P<0.05).After treatment, the two groups were significantly higher than those in the control group (P<0.05), and the wrist function scores of the study group were significantly lower than those of the control group (P<0.05).ConclusionThe combined effect of removing blood stasis and eliminating powder is effective in the treatment of distal radius fractures, which can effectively reduce the pain and reduce the healing time of the fracture and promote the recovery of the wrist function.

Objective To assess the diagnostic value of various preoperative imaging examinations for the point of the lateral femoral circumflex artery perforators through the deep fascia,in order to provide reasonable evidence for the design of location and protocol of anterolateral thigh perforator flap.Mehtods From September,2013 to December,2013,23 patients (including 1 patient with bilateral anterolateral thigh perforator flap) preparing anterolateral flap surgery were randomly divided into 4 groups(every group was 6 side).The patients in different groups were using different imaging techniques respectively,such as handheld doppler (HHD),Color doppler sonography (CDS),MDCT angiography (MDCTA),CDS and MDCTA united image location technology.The flap sizes varied from 8 cm × 5 cm to 28 cm × 12 cm.Moreover the coincidence rate between preoperative and intraoperative location of the perforator vessel was evaluated.Results Ali flaps were survived after the operation.The donor site were primarily closed while partial skin grafting was performed in 8 cases.The appearance and functional resuhs were satisfactory with following up for 3 to 9 months.The rates of coincidence between the preoperative and intraoperative location of perforating branches were HHD 61.53％,CDS 87.50％,MDCTA 85.71％,CDS and MDCTA united image location technology 93.33％ respectively.The HHD group showed significant decrease compared with the other groups (x2 =7.92,P ＜ 0.01; x2 =6.15,P ＜ 0.05; x2 =12.54,P ＜ 0.01,respectively).The CDS group had no statistically difference with the MDCTA group (P ＞ 0.05).The united CDS and MDCTA group showed significant increase compared with the other groups (x2 =4.22,P ＜ 0.05; x2 =3.94,P ＜ 0.05).Conclusion CDS and MDCTA united image location technology are more accurate for perforator preoperative location in auterolateral thigh flap,and should be widely used.

Objective To investigate whether myeloid-derived suppressor cells (MDSCs) have a protective effect in septic mice. Methods The model of caecal ligation and puncture (CLP) was performed to induce polymicrobial sepsis in mice. The changes of MDSCs in spleens at different times after operation were studied. In order to observe the influence of MDSCs on the inflammatory factors and survival of septic mice, MDSCs were injected into the peritoneal cavities of mice after CLP. Results MDSCs accumulated in spleens of septic mice progressively. MDSCs could increase anti-inflammatory cytokine production, decrease the level of inflammatory factors, and improve the survival rate of mice with sepsis. Conclusion MDSCs can attenuate the inflammation and improve the survival rate of mice with sepsis, suggesting that intraperitoneal injection of MDSCs may provide a new direction for the treatment of sepsis.

Spinal fractures are a big challenge to orthopedists.Thoracolumbar Injury Classification and Severity Score (TLICS),a newly developed evaluation system for thoracolumbar fractures,has proved to be valid and reliable in the last decade.However,there have still been many problems in the clinical application of TLICS in China.We discussed nine issues about the clinical application of TLICS in this article,hoping to promote better understanding and application of TLICS in Chinese spinal surgeons in their daily practice.

Objective To compare the clinical effects of extensive or limited arthroscopic debridement in varying degrees of knees osteo-arthritis. Methods 32 cases with knees osteoarthritis who underwent extensive debridement under arthroscopy were selected as the observa-tion group, and 30 cases with knees osteoarthritis who underwent limited debridement were selected as the control group. The excellent rate of joint function, Lysholm and VAS scores were compared between the two groups. Results The excellent rate of joint function were 90. 0%and 91. 4% in observation group and control group respectively, without significant difference (P>0. 05). Lysholm scores of patients with grade Ⅱ osteoarthritis was much higher in observation group than that in control group after operation (P<0. 05). There was no significant difference in Lysholm scores between gradeⅠand gradeⅢosteoarthritis (P>0. 05). No statistically significant difference of VAS scores on 1 year after operation were found (P>0. 05). Conclusion Extensive debridement and limited debridement under arthroscopy have similar effects for knees osteoarthritis. Extensive arthroscopic debridement is an ideal treatment method for Ⅱ grade of knees osteoarthritis.

Objective To explore the correlation between serum growth differentiation factor‐15(GDF‐15) level and acute myocardial infarction(AMI) to provide a basis for the prognostic evaluation of AMI .Methods Totally 192 Han patients with AMI (AMI group) and non‐coronary heart disease (NCHD ,NCHD group) diagnosed in Chengde Municipal Central Hospital from Sep‐tember 2013 to January 2015 ,were selected and their clinical data were collected .The biochemical markers and serum GDF‐15 level were detected .Results Comparing the AMI group with the NCHD group ,differences in the patients′age ,smoking ,blood glucose (Glu) ,TC ,TG ,LDL‐C levels had statistical significance (P<0 .05);the serum GDF‐15 level in the AMI group was significantly higher than that in the NCHD ;serum GDF‐15 level was positively correlated with TC ,LDL‐C ,hs‐CRP and Glu in the AMI group . Conclusion The increase of serum GDF‐15 level is obviously correlated AMI ,therefore GDF‐15 can serve as an indicator for moni‐toring myocardial infarction .

Objective To investigate the mutations of BRCA genes in sporadic high grade serous ovarian cancer (HGSOC) and study its clinical significance. Methods Sixty-eight patients between January 2015 and January 2016 from the Affiliated Cancer Hospital of Zhengzhou University were collected who were based on pathological diagnosis of ovarian cancer and had no reported family history, and all patients firstly hospitalized were untreated in other hospitals before. (1)The BRCA genes were detected by next-generation sequencing (NGS) method. (2)The serum tumor markers included carcinoembryonic antigen (CEA), CA125, CA199, and human epididymis protein 4 (HE4) were detected by the chemiluminescence methods, and their correlation was analyzed by Pearson linear correlation. Descriptive statistics and comparisons were performed using two-tailed t-tests, Pearson′s chi square test, Fisher′s exact tests or logistic regression analysis as appropriate to research the clinicopathologic features associated with BRCA mutations, including age, International Federation of Gynecology and Obstetrics(FIGO)stage, platinum-based chemotherapy sensitivity, distant metastases, serum tumor markers (STM). Results (1) Fifteen cases (22%, 15/68) BRCA mutations were identified (BRCA1: 11 cases; BRCA2: 4 cases), and four novel mutations were observed. (2) The levels of CEA, CA199, and HE4 were lower in BRCA mutations compared to that in control group, while no significant differences were found (P>0.05), but the level of CA125 was much higher in BRCA mutation group than that in controls (t=-3.536,P=0.003). Further linear regression analysis found that there was a significant linear correlation between CA125 and HE4 group (r=0.494,P<0.01), and the same correlation as CEA and CA199 group (r=0.897,P<0.01). (3) Single factor analysis showed that no significant differences were observed in onset age, FIGO stage, distant metastasis, and STM between BRCA+and BRCA- group (P>0.05), while significant differences were found in CA125 and sensitivity to platinum-based chemotherapy between the patients with BRCA mutation and wild type (P<0.05). The multiple factors analysis showed that the high level of CA125 was a independent risk factor of BRCA mutations in sporadic HGSOC (P=0.007). Conclusion The combination of CA125 with BRCA have great clinical significance, the mutation of BRCA gene could guild the clinical chemotherapy regiments.

Phosphoinositide-3 kinase/protein kinase-B/mammalian target of rapamycin (PI3K/Akt/mTOR) signaling pathway is involved in many important biological processes such as cell metabolism, growth, proliferation, and angiogenesis. And its high-level activation is closely related to the development and progression of many malignant tumors. In this paper, mTOR and PI3K/Akt/mTOR signaling pathway are introduced, and their action mechanisms in the development and progression of hepatocellular carcinoma, cholangiocellular carcinoma, cholangiocarcinoma, and gallbladder carcinoma are expounded, and then the role of mTOR inhibitors in the treatment of malignant hepatobiliary tumors is briefly described. It is thought that the PI3K/Akt/mTOR signaling pathway provides new therapeutic targets for malignant hepatobiliary tumors in advanced stage and the constant development of new mTOR inhibitors provides some new hope for the patients with malignant hepatobiliary tumors in advanced stage.

BACKGROUNDAutophagy has been found to be involved in animal and cell models of atherosclerosis, but to date, it lacks general observation in human atherosclerotic plaques. Here, we investigated autophagy in smooth muscle cells (SMCs), endothelial cells (ECs), and macrophages in human atherosclerotic plaques via transmission electron microscopy (TEM), western blotting, and immunohistochemistry analysis.

METHODSThe histopathologic morphology of these plaques was observed via hematoxylin and eosin staining. The ultrastructural morphology of the SMCs, ECs, and macrophages in these plaques was observed via TEM. The localization of microtubule-associated protein 1 light chain 3 (MAP1-LC3), a relatively special maker of autophagy, in plaques was observed by double fluorescent immunochemistry and western blotting.

RESULTSAll of these human atherosclerotic plaques were considered advanced and unstable in histologically observation. By double fluorescent immunochemistry, the expression of LC3-II increased in the SMCs of the fibrous cap, the macrophages, and the microvascular ECs of the plaque shoulders. The protein level of LC3-II by western blotting significantly increased in plaques compared with normal controls. In addition, TEM observation of plaques revealed certain features of autophagy in SMCs, ECs, and macrophages including the formation of myelin figures, vacuolization, and the accumulation of inclusions in the cytosol. These results indicate that autophagy is activated in SMCs, ECs, and macrophages in human advanced atherosclerotic plaques.

CONCLUSIONSOur study is to demonstrate the existence of autophagy in human atherosclerotic plaques by different methods, which may contribute to the development of pharmacological approaches to stabilize vulnerable and rupture-prone lesions.

Atherosclerosis ; metabolism ; physiopathology ; Autophagy ; physiology ; Endothelial Cells ; pathology ; Humans ; In Vitro Techniques ; Microscopy, Electron, Transmission ; Microtubule-Associated Proteins ; metabolism ; Myocytes, Smooth Muscle ; pathology ; Plaque, Atherosclerotic ; metabolism ; physiopathology ; ultrastructure