Objective To investigate the relationship among peroxisome proliferators - activated receptor gamma (PPAR-γ), pul-monary arterial systolic pressure(PASP) ,and insulin resistance in Chronic Obstructive Pulmonary Disease (COPD) patients. Methods A-mong 63 COPD patients, 30 patients with level of PASP above 40mmHg were enrolled in PAH group and other 33 patients were enrolled in COPD group. Twenty healthy medical examination subjects were enrolled in control group. The expression of PPAR-γ, mRNA was detected by real time fluorescent quantitative RT- PCR. Radioimmunoassay was used to measure the level of fasting plasma insulin (FIN). Fasting plas-ma glucose (FPG) was detected by glucose oxidase method. Results The expression of PPAR-γ mRNA was significantly decreased in PAH and COPD group, while FPG, FIN and IRI increased significantly. PAH group had more increased PASP, decreased expression of PPAR-γ and higher IRI than COPD group. Expression of PPAR-γ was negatively related to PASP and IRI. Conclusions The significantly down reg-ulated expression of PPAR-γ maybe explain the higher FPG and PASP.

Objective To explore factors associated with incision infection in elderly patients undergoing general surgery and thus provide a basis for its clinical prevention.Methods Retrospective clinical data of 2985 elderly patients who underwent routine surgical operation after admission to the Department of General Surgery from Feb.2009 to Dec.2013 were analyzed.Patients with incision infection following surgery were assigned into the infection group,while patients without incision infection served as the control group.Single factor analysis and multivariate Logistic regression analysis were conducted to identify factors responsible for incision infection.Results There were 91 cases with incision infection,constituting a rate of 3.0％.Compared with the control group,patients in the infection group showed an older average age [(67.3±5.8) years vs.(63.0± 5.6) years,t=1.906,P＜0.05],a longer average operating time [(2.13±0.26) hours vs.(1.87±0.24) hours,t=10.149,P＜0.001],and a longer average incision length [(8.14±2.62) cm vs.(7.59±2.14) cm,t=2.396,P＜0.01].In addition,compared with the control group,more patients in the infection group received prophylactic antibiotics (74.7％ vs.83.3％,x2 =4.819,P=0.032),exhibited malnutrition (20.9％ vs.10.0％,x2 =11.418,P=0.001),and had diabetes mellitus (11.0％ vs.5.1％,x2 =5.968,P=0.015).Therefore,independent risk factors for incision infection included age (OR=1.89),operating time (OR=3.32),nutritional status (OR=2.08) and diabetes mellitus (OR=3.18).Conclusions A few risk factors may contribute to incision infection.Clinicians should take necessary preventive measures accordingly to minimize its occurrence.

Objective To investigate the clinical effectiveness of procedure for prolapse and hemorrhoids(PPH)in the treatment of outlet obstructive constipation caused by moderate and severe recto-cele. Methods A total of 48 patients with moderate or severe rectocele were treated with PPH. Patients were followed up for 4 ~ 6 months. The preoperative and postoperative parameters from rectoanal manome-try were compared and analyzed. Results After the surgery,patients had loose stool for 1 ~ 2 times a day. Sense of defecation obstruction in all patients was obviously improved. After the surgery,there were no significant changes in rectum resting pressure,anal resting pressure and various rectal sensitivity( P >0. 05). However,the decrease of inside rectal pressure and residual anal pressure were significantly re-duced(P < 0. 05). Conclusion The subjective defecation feeling of postoperative patients with PPH is unblock. Objective results of rectoanal manometry is clearly improved and the function of the rectum and anal canal is obviously restored.

BACKGROUND:At present, the clinical application of intramedul ary nail in the treatment of tibial shaft fractures has achieved good results. However reamed and unreamed intramedul ary nail in repair of tibial fractures in adults remains controversial. OBJECTIVE:To evaluate clinical efficacy and safety of reamed versus unreamed intramedul ary nailing for the treatment of tibial fractures in adults. METHODS:The literature related to application of reamed or unreamed intramedul ary nailing for tibial fractures published from 1980 to 2015 were searched from Springer, PubMed, and Wanfang database. Related Chinese and English journals of orthopedics were hand-searched. Al randomized control ed trials were col ected. RevMan5.0 provided by Cochrane was used to analyze the data. RESULTS AND CONCLUSION:Seven randomized control ed trials were included according to inclusion criteria, including 1 331 patients. There were 682 cases in the reamed intramedul ary nailing group and 649 cases in the unreamed intramedul ary nailing group. Meta-analysis results showed that compared with the reamed intramedul ary nailing group, implant failure rate was significantly higher in the unreamed intramedul ary nailing group [MD=0.37, 95%CI (0.24, 0.57), P<0.000 01], and nonunion rate was significantly higher [MD=0.54, 95%CI (0.31, 0.93), P=0.03]. There was no significant difference in the incidence of compartment syndrome, the rate of malunion and postoperative infection rate. Results suggested that no difference in the incidence of compartment syndrome, the rate of malunion and postoperative infection rate was found in reamed and unreamed intramedul ary nailing in the repair of adult tibial fractures. Reamed intramedul ary nailing has advantages of low implant failure rate and nonunion rate.

Objective To study the changes of ventilatory function of young soldiers coming from different regions during cold - tol-erance training. Methods The recruited young soldiers were divided into 2 groups:Group Ⅰ (50 coming from the northern region)and group Ⅱ (50 coming from the southern region) . According to the new training outline of cold -tolerance in winter,their ventilatory func-tions were tested before training and 60 days after training. Ventilatory functions were compared between smoking and non - smoking sub-jects. Results 25% forced expiratory flow (FEF25%) , 50% forced expiratory flow (FEF50%) and 75% forced expiratory flow (FEF75 %) were significant different between two groups before the course of training (P < 0.05). After 60 days, ventilatory functions of two groups were improved significantly as compared with that before training (P <0.01 ,P <0.05). There was no significant difference in ventilatory between two groups after 60 days of training (P > 0.05). There was significant difference in partial small airway function be-tween smoking and non - smoking subjects. Conclusion Cold air could decline the small airway function of soldiers coming from south-ern region before training. Cold -tolerance training has significant influence on soldiers' ventilatory function. Long- term and heavy smok-ing could decline the small airway function.

BACKGROUND:At present, it remains controversial whether open reduction plate fixation is needed for distal radius fracture in the elderly to restore anatomic reduction of imaging.
OBJECTIVE:To systematical y evaluate the curative effects of operative and nonoperative treatments for distal radius fractures in the elderly.
METHODS:We retrieved PubMed, Springer and Wanfang database using computer. Relevant English and Chinese journals of orthopedics were retrieved by hand. Al literatures on curative effects of operative and nonoperative treatments for distal radius fractures in the elderly were col ected. RevMan 5.0 software provided by Cochrane was used to statistical y analyze the data.
RESULTS AND CONCLUSION:Six literatures were included, including two of randomized control ed study and four of retrospective cohort study. Meta-analysis results displayed that there were no significant differences in both groups in range of motion of wrist joint extension [mean difference (MD)=-0.87, 95%confidence interval (CI) (-3.31, 1.58), P=0.49], range of motion of wrist joint flexion [MD=-2.79, 95%CI(-6.47, 0.88), P=0.14], range of motion of wrist pronation [MD=-0.08, 95%CI(-1.49, 1.64), P=0.92], range of motion of supination [MD=-0.7, 95%CI(-3.52, 2.12), P=0.63] and the occurrence of complication [MD=1.35, 95%CI(0.71, 2.56), P=0.36]. The length of radius in the surgery group was similar to that of normal [MD=2.46, 95%CI(1.78, 3.15), P<0.01]. Ulnar inclination [MD=3.73, 95%CI(2.97, 4.48), P<0.000 01] and palmar tilt angle [MD=6.81, 95%CI(3.72, 9.90), P<0. 000 1] in the surgery group were close to that of normal. There are no significant differences in extension, flexion, pronation and supination activities of wrist and posttreatment complication between two groups. Operative treatment result is superior to that of nonoperative treatment in anatomic reduction.

Objective To analyze the predictive value of platelet related indicators for patent ductus arteriosus (PDA) in extremely low birth weight infants (ELBW). Methods The data of 79 ELBW infants born from June 2013 to June 2016 were retrospective analyzed. There were 48 cases without PDA (nPDA group) and 31 cases with PDA (PDA group). Among 31 cases with PDA, there were 17 cases of non-haemodynamically significant PDA (nhsPDA group) and 14 cases of haemodynamically significant PDA (hsPDA group). The clinical feature and platelet related indicators among nPDA group, PDA group, nhsPDA group and hsPDA group were compared. Multivariate logistic regression was used to analyze the effects of various factors on the occurrence of PDA. ROC curve analysis was performed to evaluate the early predictive value of platelet related indicators for PDA. Results Compared with the nPDA group, the PDA group had a smaller gestational age, a higher proportion of male infants, and a smaller platelet distribution width (PDW), and there were statistically significant differences in all of those (P all<0.05). Multivariate logistic regression analysis indicated that the risk of PDA was increased as the PDW was decreased (OR=1.26, 95%CI: 1.05~1.52). The ROC curve analysis showed that the best diagnostic value of PDW was 13.4 GSD, and the sensitivity of early prediction of PDA was about 67.74%, and the specificity was 68.75%. Compared with nhsPDA group, hsPDA group had a smaller gestation age, lower cesarean section rate, and there were statistically significant differences (P all<0.05). There was no significant difference in platelet related indicators between hsPDA group and nhsPDA group (P>0.05). Conclusion PDW has certain early predictive value for PDA in ELBW. ELBW infants with PDW<13.4 GSD need to be watched closely for the occurrence of PDA.

Objective To investigate the metabolism characteristics and the potetial biomarker candidates of osteonecro?sis of the femoral head (ONFH) using metabolomic technology. Methods The femoral head specimens from 23 ONFH patients (25 necrotic femoral heads) and 18 normal femoral heads from femoral neck fracture patients were collected for histopathological examination to confirm the diagnosis of all samples. All the metabolites of bone trabecula were extracted for ultra-high perfor?mance liquid chromatography-MS/MS analyzed. The measured variables was pretreat, and PCA (principal component analysis), PLS?DA (partial least squares?discriminant analysis) and OPLS?DA (orthogonal?partial least squares?discriminant analysis) models were employed to confirm the difference between these two groups after UPLC?MS/MS (ultra?high performance liquid chromatogra?phy?mass spectrometry/mass spectrometry) analysis. At last, the differential variables were screened out by PLS?DA and variate analysis (Kruskal?Wallis H test). The changed metabolites were confirmed by MS and MS/MS aligned in HMDB (human metabolo?mic database) and Massbank. The changed metabolites with the most obviously changed peak abundance, D?arginine, L?proline and L?glutamine, were picked out as the potential diagnostic biomarkers. After binary logistic regression analysis, the combined biomarkers candidates were further analyzed by receiver operating characteristic (ROC) curve to evaluate the significance of the combined biomarkers. Results Significant distinction of metabolites expression mode can be seen in PCA, PLS?DA and OPLS?DA models scoring plots between ONFH and control groups. Twelve changed metabolites in ONFH bone trabeculas were con?firmed by multi?variate statistical analysis and variate statistical analysis. Compared with the femoral neck fracture patients, the in?creased metabolites included D?arginine, L?proline, L?glutamine, creatine, uracil, uridine, LysoPC(20∶4(5Z, 8Z, 11Z, 14Z)), Ly?soPC(16∶0), PC(20∶1(11Z)/18∶3(6Z, 9Z, 12Z)) and PE(P?16∶0e/0∶0). The decreased metabolites were reticulataxanthin and β?cryptoxanthin. According to the change fold of peak abundance and variable weight projection in PLS?DA, the most obviously dif? ferential metabolites were picked out as the biomarker candidates of ONFH. The potential biomarkers candidates were identified as D?arginine, L?proline and L?glutamine. The area under the curve of D?arginine, L?proline and L?glutamine ROC were 0.873, 0.712 and 0.862. The area under the curve of ROC was 0.946 after combining D?arginine, L?proline, L?glutamine using binary lo?gistic regression analysis. Conclusion PCA, PLS?DA and OPLS?DA models were used to find out the differential variables in the metabolites of bone trabeculas in ONFH and femoral neck fracture patients. Twelve metabolites were identified by MS/MS, and 3 obviously changed metabolites, D?arginine, L?proline, L?glutamine, were indicated as biomarker candidates. These 3 obviously changed metabolites showed a good diagnostic significance.

Objective To assecess the role of CT in the diagnosis and the reasons of misdiagnosis of biliary duct carcinoma.Methods 23 cases with biliary duct carcinoma pathologically comfirmed were reviewed.Results 2 cases were peripheral type,10 cases were major intrahepatic biliary duct type,7 cases were extrahepatic type and 4 cases ampullar type.The masses within biliary duct were showed by CT in 16 cases.The obstruction of biliary duct was cut off abruptly in 18 cases and narrowing sharply in 5 cases.The intrahepatic biliary duct indicated mild or marked expansion,of them,17 cases were showed as vine and 6 as segmental.The extrahepatic biliary duct were dilated in 11 and gallbladder dilatation in 7.4 cases were misdiagnosed and leaked diagnosis was in one cases by CT preoperation.Conclusion CT is valuable in diagnosis of biliary duct carcinoma,but it still has some limitations.

AIM: To investigate the inhibitory effect of L-carnitine on high glucose-induced apoptosis of human aortic endothelial cells (HAECs) and the molecular mechanisms.METHODS: The apoptosis of HAECs was induced by high-glucose incubation.HAECs were treated with L-carnitine at different concentrations (50, 100 and 200 μmol/L).The cell viability was measured by MTT assay.The cell apoptosis was assessed by Hoechst 33258 staining and flow cytometry.Colorimetric method was employed to detect the caspase-3 activity in the HAECs.The protein expression and phosphorylation levels were determined by Western blot.RESULTS: High-glucose incubation dramatically decreased the cell viability and induced apoptosis.The protein kinase R-like endoplasmic reticulum kinase (PERK), inositol-requiring enzyme-1 (IRE1) and activating transcription factor 6 (ATF6) signaling pathways of endoplasmic reticulum stress were activated to induce cell apoptosis via down-stream caspase-4/3 cascade.However, L-carnitine treatment significantly attenuated the cell apoptosis and increased the cell viability in a concentration-dependent manner.L-carnitine also significantly suppressed endoplasmic reticulum stress and ATF6 signaling in high glucose-incubated HAECs without attenuating PERK and IRE1 signaling.The expression of site-1 protease (S1P) and site-2 protease (S2P) was inhibited by L-carnitine treatment, thus decreasing pro-apoptotic factor ATF6 p50 produced by ATF6 cleavage.CONCLUSION: L-carnitine inhibits high glucose-induced apoptosis of HAECs by inhibiting ATF6 signaling.