BACKGROUND: It was reported that the reason why the fracture healing become more and more difficult with the increasing age may be associated with the varied gene regulation of bone marrow mesenchymal stem cells differentiation into osteoblast and lipoblast. However, the exact mechanism under it remains poorly understood.OBJECTIVE: To explore the association of the age-related changes on expression of peroxisome proliferator-activated receptor γ (PPARγ) and core binding α1 (Cbfα1) with the age-relatad fracture healing impairment, we studied the expression changes of PPARγ and Cbfα1 during aging fracture healing.DESIGN, TIME AND SETTING: A randomized control animal trial was performed in the Third Xiangya Hospital of Central South University between October 2007 and Febuary 2008. MATERIALS: Six male SD rats of 3 months and the other six of 23 months, randomly-selected, were divided into two groups: the old experiment group (23 months) and the young control group (3 months). METHODS: Transverse osteotomies on the middle-upper parts of left tibiae were performed to the rats, with the self-made extemal mini-fixator implanted there simultaneously. Tractions were taken twice a day (0.2 mm/d) for 14 days from day 2 till day 15 post operation. On day 15 post operation, rats were sacrificed to harvest left tibea samples. MAIN OUTCOME MEASURES: Both imaging examination and histological observation were performed to the fractures of rats. The PPARγ and Cbfα1 expression were detected with reverse transcription-polymerase chain reaction (RT-PCR) technique. RESULTS: All samples were involved in the results analyses. The imaging examination showed that many osteotylus generated between the broken ends of fractures in the young control group; that the bone formation of the young control group was much better than that of the old experiment group. The histological observation showed that large amounts of osteotylus growth occurred to every animal in the young control group and their membrane bone formation was remarkable; comparatively, the osteotylus growth in the old group was weakened dramatically, and only fibrous joints were seen. The RT-PCR detection showed that differences of significance existed in both PPARγ and Cbfα1 mRNA expressions between the two groups, with the much higher Cbfol mRNA expression in the bone marrow of rats in the young group and the much higher PPARy mRNA expression in the bone marrow of rats in the old group.CONCLUSION: Rats of different ages show different fracture healing abilities, i.e. the higher ages, the lower fracture healing abilities. In addition, expressions of PPARγ and Cbfα1 in the bone marrow of rats alter with the increasing age, which indicates that there are certain associations between the changed expression level of the two factors and the fracture healing impartment.

Objective:To explore the safety of cyclophosphamide combined with taxane chemotherapy in triple-negative breast cancer patients with chronic renal failure and the management strategy of complications.Methods:Data of 8 patients with triple-negative breast cancer and chronic renal failure admitted to our hospital from Jun 2016 to Dec 2019 were retrospectively analyzed.Results:Eight patients received standard cyclophosphamide combined with taxane (TC regimen) chemotherapy after operation, 5 of which received docetaxel 75 mg/m 2 + cyclophosphamide 600 mg/m 2, and 3 received albumin paclitaxel 260 mg/m 2+ cyclophosphamide 600 mg/m 2, during chemotherapy, only leukopenia, hair loss and gastrointestinal reactions occurred in grades 3 to 4, and the incidence was 25%, 25% and 12%, respectively. Four patients adjusted the dosage due to adverse reactions. One patient quit, the remaining patients successfully completed 4 cycles of chemotherapy. The average serum creatinine before chemotherapy was (498±63) μmol/L, and after chemotherapy, it was (518±61) μmol/L ( t=-2.335, P>0.05). Conclusions:Combined with chronic renal failure is not a contraindication to postoperative chemotherapy for patients with breast cancer. It is safe to choose standard TC regimen and adjust the dose of adjuvant chemotherapy for patients with triple-negative breast cancer.

Objective This work was to study the distribution of Acinetobacter baumannii and analyze the change in the trend of its resistance,so as to provide experimental basis for clinical rational drug usage.Methods The identification of isolates were car-ried out by using VITEK-2 compact automatic identification system,and drug susceptibility testing was performed by disc diffusion method,the results were carried out according to the Standard of CLSI 2014 version for interpretation,and data analysis was per-formed with WHONET5.6.Results A total of 981 strains of Acinetobacter baumannii had been isolated from the samples in 2013 to 2015,most of them were isolated from respiratory samples accounted for 80.4%,followed by the urines and other body secre-tion.The distribution of this kind of bacteria mostly was 30.1% in ICU,departments of Emergency observation(16.0%),respirato-ry diseases(15.7%)and senior cadres(10.8%).The drug resistance of this kind of bacteria to polymyxin B and cefoperazone/sul-bactam was to a minimum of lower than 5.0%,and has relatively high sensitivity to amikacin and minocycline(<30.0%).And the resistance to other antimicrobials were higher than 30.0%,and the resistance to Nitrofurantoin and cefotaxime were higher than 94.0%.The most drug resistance of Acinetobacter baumannii in 2014 were lower than those in 2013,but the most drug resistance of Acinetobacter baumannii in 2015 were increased significantly as well as strains had been isolated from the samples.Conclusion The main source for isolation of Acinetobacter baumannii in this hospital mainly comes from sputum specimens of patients in ICU, departments of emergency observation,respiratory diseases and senior cadres.The high prevalence of antimicrobial resistance of this kind of bacteria should be prevented and controlled in nosocomial infection,and rational application of antimicrobial agents in order to reduce the spread of drug-resistant strains.

Objective To understand the drug resistance situation of clinical common bacteria in hospital.Methods VITEK-2 was adopted to perform the identification and antimicrobial susceptibility test.The drug resistance data were analyzed by adopting the WHONET 5.5 software.Results 13 841 strains of bacteria isolated for the first time from the patient were collected from Jan-uary 2009 to December 2012,in which Gram positive bacteria accounted for 29.3% and Gram negative bacteria accounted for 70.7%.Meticillin-resistant Staphylococcus aureus (MRSA)and meticillin-resistant coagulase-negative staphylococci (MRCNS) accounted for 78.3% and 88.4% of staphylococci aureus and coagulase-negative staphylococci,respectively.No vancomycin and tigecycline resistant strains of staphylococci were found.4.3% of enterococcus faecalis and 7.5% of enterococcus faecium were re-sistant to vancomycin.The detection rates of E.coli and Klebsiella spp (Klebsiella pneumoniae +Klebsiella bacteria producing acid )producing extended spectrum beta-lactamases (ESBLs)were 58.5% and 24.4%,respectively.Enterobacteriaceae strains were still more sensitive to carbapenem antibiotics.The resistance rates of pseudomonas aeruginosa and Acinetobacter spp strains to imipenem were 24.9 % and 42.6%,respectively.Conclusion Bacterial drug resistance still constitutes a serious threat to the clini-cal anti-infection therapy.So the antibacterial agents should be rationally used for reducing the bacterial drug resistance.

Objective To detect the mutation frequency of EML4-ALK fusion gene in lung cancer patients, and to inves-tigate the distribution of mutation character for EML4-ALK fusion gene in Ⅰ stage lung cancer patients and clinical features as well as provide a reference for the individual treatment of lung cancer .Methods 256 fresh tumor tissue specimens of lung cancer patients were screened from the specimen bank of our hospital and all the patients had accepted the surgical treatment from February 2013 to December 2014.Total RNA was extracted and then be transcribed into cDNA, the amplification-refrac-tory mutation system(ARMS) was used to detect mutation of EML4-ALK fusion gene.The results according to the positive con-trol, negative control and RNA quality control for EML4-ALK fusion type were analyzed.Results During the 256 patients ofⅠ stage lung cancer, there were 17 patients(6.64%) had mutations in EML4-ALK fusion gene.In lung adenocarcinoma mu-tation rate(16/207, 7.73%) was higher than that of lung squamous cell mutation rate(1/39, 2.56%), lung adeno-squamous mutation rate(0/4, 0) and large cell carcinoma(0/5, 0) of the mutation rate;young lung cancer patients( <63 years) of the mutation rate(14/139, 10.07%) was significantly higher than the high age of lung cancer patients(≥63 years old) mutation rate(3/117, 2.56%), P =0.009.EML4-ALK fusion with tumor invasion and visceral pleura group incidence (9/80, 11. 25%) was significantly higher than that of non-invasive and visceral pleura group incidence rate(8/176, 4.55%), P =0.045.Conclusion The occurence of EML4-ALK fusion correlates with patients’ age as well as whether visceral pleura is in-vaded, type 1 EML4-ALK fusion was detected more in phase I lung cancer patients.

Objectives:To investigate the effects of morning blood pressure on vascular endothelial function and chronic inflammatory response in the elderly.Methods:349 elderly people aged ≥60 who underwent 24-hour ambulatory blood pressure monitoring in Gaomi Municipal Hospital from April 2018 to October 2019 were selected to detect brachial artery flow mediated vasodilation (FMD) and chronic inflammatory factors [high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor-α (TNF-α) and interleukin (IL)-17] levels. According to the results of 24-hour ambulatory blood pressure monitoring, the subjects were divided into normal blood pressure group ( n=108), simple morning hypertension group ( n=114) and hypertension group ( n=127). The clinical data, 24-hour ambulatory blood pressure parameters, vascular endothelial function and inflammatory factors of the three groups were compared. The correlation between 24-hour ambulatory blood pressure parameters and FMD and inflammatory factors was analyzed by partial correlation. Results:Compared with the normal blood pressure group, the simple morning hypertension group and the hypertension group had lower FMD (all P<0.05), higher serum hsCRP and TNF-α , IL-17 levels (all P<0.05). Compared with the simple morning hypertension group, the hypertension group had lower FMD ( P<0.05), higher serum hsCRP, TNF-α and IL-17 levels (all P<0.05). After controlling for age, sex, smoking history, drinking history, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting blood glucose and 24 h average blood pressure, the morning systolic blood pressure was negatively correlated with FMD ( P<0.05), and positively correlated with serum hsCRP and TNF-α and IL-17 levels (all P<0.05); the morning diastolic blood pressure was negatively correlated with FMD ( P<0.05) and positively correlated with serum hsCRP and TNF-α levels (all P<0.05). Conclusions:Morning blood pressure level is closely related to vascular endothelial function and chronic inflammation level, and is independent of 24-hour average blood pressure. The increase of morning blood pressure may be an important risk factor for endothelial dysfunction and chronic inflammation in the elderly.

OBJECTIVETo observe the clinical effect and the influences of Shuxuetong injection on serum neuron-specific enolase (NSE) level, the neurological deficit and activities of daily living in patients with acute cerebral infarction.

METHODThe 80 patients with acute cerebral infarction were randomly divided into Shuxuetong treatment group (40 cases) and routine control group (40 cases), both received routine treatment, while Shuxuetong injection was given additionally to treatment group. The serum NSE level, the National Insitute of Health Stroke Scale (NIHSS) scores and the clinical effect were observed pre-and post-treatment. The Barthel Index (BI) was evaluated after one month.

RESULTThe serum NSE level and NIHSS scores in two groups of post-treatment decreased obviously than those of pre-treatment, and after treatment in Shuxuetong treatment group the serum NSE level and NIHSS scores were significantly lower than those in control group, the differences were significant (P<0.05). Effective rate of Shuxuetong treatment group was 87.5%, and control group was 65%, the difference of the clinical effect between the two groups was significance (P<0.05). After one month BI of post-treatment in two groups improved than those of pre-treatment, and Shuxuetong treatment group was significantly better compared with control group (P<0.05).

CONCLUSIONShuxuetong injection has the remarkable neuronal protective effect, can decrease the serum level of NSE after acute cerebral infarction, promote recovery of nerve function, reduce disability rate, and improve quality of life and prognosis of patients with acute cerebral infarction.

Aged ; Aged, 80 and over ; Cerebral Infarction ; blood ; drug therapy ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Injections ; Male ; Middle Aged ; Phosphopyruvate Hydratase ; blood ; drug effects ; Prognosis ; Prospective Studies ; Recovery of Function ; drug effects ; Treatment Outcome

Objective To explore the relationships between the alterations of cervical sagittal parameters and clinical outcomes after anterior cervical discectomy and fusion (ACDF).Methods From January 2010 to December 2015,a total of 227 patients with cervical spondylosis who undelwent ACDF in Dongfang Hospital affiliated Tongji University were analyzed in this study.There were 109 male and 118 female,with an average age of 52.2± 10.7 years (ranged from 34 to 78 years).The average duration of follow-up after revision surgery was (21.1 ±9.0) months (12-60 months).Comparing with Japanese 0rthopaedic Association (JOA) score and its improvement rate (IR),visual analogue scale (VAS) scores and neck disability index (NDI) between preoperation and 1 year follow-up.Cervical alignment was assessed with the following 3 parameters:T1 slope (T1S),Cobb's angle of C2 to C7 and C2-7 sagittal vertical axis (SVA).And compared the changes of sagittal parameters and clinical efficacy.Results At 1 year follow-up,T1S was increased from 25.4°±8.5° to 27.9°±8.2°,Cobb's angle was increased from 12.7°±8.5° to 15.3°±9.5°,SVA was increased from (21.0± 12.3) mm to (24.30± 11.4) mm,and the differences were statistical significant (P＜ 0.001).JOA score was increased from (8.5±4.0) points to (13.0±2.4) points at 1 year follow-up,however,VAS score was decreased from 2.7± 1.8 points to 0.2±0.4 points,and NDI was decreased from 48.2％±8.2％ to 27.1％± 11.1％,and the differences were statistical significant (P ＜ 0.001).Preoperatively,T1S had positive correlations with both Cobb's angle and SVA before operation (r=0.311,0.213;P=0.000,0.001),but Cobb's angle had negative correlation with SVA (r=-0.246,P=0.000).At 1 year follow-up,T1S had positive correlations with Cobb's angle and SVA (r=0.390,0.392;P=0.000,0.000),and Cobb's angle had negative correlation with SVA (r=-0.131,P=0.048).At 1 year after operation,the change value of Cobb's angle had positive correlation with the change of JOA (r=0.294,P=0.000),but negative correlation with the change of NDI (r=-0.141,P=0.034).Conclusion ACDF is effective in the treatment of cervical spondylosis which the cervical sagittal alignment remains relatively stable,and there were significant correlation between the alteration of cervical sagittal parameters and clinical outcomes after ACDF.

Objective To observe the value of 3.0T multimodal MRI for preoperative evaluation of T stage and therapeutic efficacy of neoadjuvant for rectal cancer.Methods 3.0T multimodal MRI data,including T1WI,T2WI/diffusion weighted imaging(DWI),dynamic contrast enhanced MRI(DCE-MRI)and intravoxel incoherent motion DWI(IVIM-DWI)of 150 patients with rectal cancer were retrospectively analyzed,and the value of different sequences for evaluating T stage and therapeutic efficacy of neoadjuvant for rectal cancer were assessed.Results The sensitivity,specificity and accuracy of T1WI,T2WI/DWI,DCE-MRI and IVIM-DWI for evaluating T1-T2 and T3-T4 stage rectal cancer were all significantly different(all P＜0.05).The diagnostic efficacy of DCE-MRI and IVIM-DWI were all higher than that of T1WI and T2WI/DWI(all P＜0.05).Combination evaluation of DCE-MRI and IVIM-DWI for T stage of rectal cancer had good consistency with pathological results(Kappa=0.943,P＜0.05).Significant differences of volume transfer constant(Ktrans),true diffusion coefficient(D)and apparent diffusion coefficient(ADC)were found among different T stage rectal cancers(all P＜0.05).Totally 80 patients received neoadjuvant therapy,and significant differences of Ktrans,D and ADC were noticed between patients with good(n=32)or poor efficacy(n=48)(all P＜0.05).The area under the curve(AUC)of Ktrans,D and ADC for evaluating therapeutic efficacy of neoadjuvant for rectal cancer was 0.774,0.837 and 0.758,respectively,of the combination of above three was 0.929,higher than that of single indexes(all P＜0.05).Conclusion Combination of 3.0T DCE-MRI and IVIM-DWI was helpful for preoperative evaluating T stage and therapeutic efficacy of neoadjuvant for rectal cancer.

In recent years, the prevalence rate of nonalcoholic fatty liver disease (NAFLD) has increased significantly and NAFLD has gradually become one of the common chronic liver diseases in China. Patients with NAFLD-related end-stage or deteriorative liver diseases have become one of the main populations for liver transplantation. The increasing prevalence rate of NAFLD and the severe outcomes of nonalcoholic steatohepatitis (NASH) make it necessary to use effective methods to identify NAFLD. Therefore, this article summarizes the current serological methods for the diagnosis of NAFLD, including steatosis, NASH, and liver fibrosis, and discusses their advantages and disadvantages. Although most of the serum markers have limited clinical value, serum marker models have a good application prospect in the diagnosis of hepatic steatosis, the evaluation of fibrosis degree, and preliminary screening. Since a combination of different serological models can improve the accuracy of diagnosis, multi-angle and multicenter joint diagnosis will be a research hotspot in the future.