The condition and prognosis of ischemic cerebrovascular disease(ICVD)are closely associated w ith the w hole blood coagulation status and the reactivity of antiplatelet agents of patients. Thromboelastography ( TEG ) is a reliable means to detect the w hole blood coagulation and fibrinolytic capacity. Its overal results of the evaluation can be used in the coagulation monitoring, efficacy of antiplatelet therapy, and prognostic evaluation in patients w ith ischemic cerebrovascular disease. In recent years, the detection methods of TEG have been improved continuously. The research reports for its clinical application are gradual y increasing. This article review s the clinical application of TEG in the diagnosis, treatment, and prognostic evaluation in ischemic cerebrovascular disease.

Objective To explore the expression of matrix metalloproteinase-11 (MMP-11) gene in gastric cancer and its correlation with transcription factor Sp1.Methods The expressions of the MMP-11 and Sp1 in level of RNA and protein in 11 specimens from the gastric cancer patients s were detected by RT-PCR,differential PCR and Western-blot,respectively.Results Electrophoresis illustration showed MMP-11 mRNA expression had significant differences in eight pairs of gastric cancer tissues and normal tissues,including 7 pairs of over expressed in gastric cancer tissues and low or no expression in normal tissues,and 1 pair of low expression in cancer tissues but high in normal tissues.The relative molecular weight of Sp1 protein was mainly 95×103 in cancer tissue and 106×103 in normal tissues.Activated MMP-11 protein mainly was over expressed in gastric cancer tissues,and low or no expression in normal tissues,but degradable MMP-1 1 protein was not observed.The enzyme prototype of and activated type of MMP-11 protein were also associated with Sp1 protein.Conclusions The MMP-11 mRNA expression in gastric tissue is higher than that in the adjacent tissues.Sp1 protein and MMP-11 protein are expressed in gastric cancer,but are low or no expression in normal tissue.There is relationship between Spl and MMP-11.

Objective To observe the effect of Valpar 4 system on hand injury. Methods 40 patients with hand injury were randomly divided into control group and observation group with 20 patients in each group. Routine treatment was applied in both groups while Valpar 4 system was added in the observation group. Then total active motion (TAM) of finger joints, Disability of Arm Shoulder and Hand (DASH), and Upper Extremity Function Test (UEFT) were carried out before, 2 weeks and 4 weeks after treatment. Results The TAM improved significantly in the control group 2 weeks after treatment (P<0.001). The TAM, DASH and UEFT improved significantly in the observation group (P<0.001), and the DASH and UEFT were better in the observation group than in the control group (P<0.001). 4 weeks after treatment, the TAM and UEFT improved significantly (P<0.001) in the control group, the TAM, DASH, UEFT significantly improved in the observation group (P<0.001), and were better in the observation group than in the control group (P<0.05). Conclusion Valpar 4 system can effectively improve the TAM of fingers, function of hands and upper limb, especially in terms of activities of daily living of upper limbs.

Objective We investigated the expression profile of cancer related genes in hMSCs co-cultured with U251 glioma cells, to evaluate the risk of malignant transformation of hMSCs in glioma environment. Methods hMSCs were co-cultured with U251 glioma cells for 5 days and the expression profile of cancer-related genes were investigated by using microarray assay, followed by Real-time quantitative RT-PCR and Western blot. Results Of the 440 cancer-re?lated genes covered by Oligo GEArray Human Cancer Microarray OHS-802, SPINT2, TK1, STC1, MMP1, CCND1, SORT1, SEPT6, CDC20, SHB, CDK5, RELA, XRCC4, KIT, CTPS, CAPNS1 and ETV6 were significantly upregulated (>3-fold) whereas none was downregulated in hMSCs co-cultured with U251 glioma cells. The upregulation of oncogenes KIT, CAPNS1, TK1, MMP1, CCND1, CDC20, RELA and STC1 in co-cultured hMSCs were confirmed by Real-time quan? titative RT-PCR. The upregulation of protein expression of oncogenes KIT, MMP1, CCND1 and RELA were detected by Western blot. Conclusion The present study demonstrates that co-culture of hMSCs with human glioma cells leads to up?regulation of some important oncogenes in hMSCs, indicating the tumorigenic potential of hMSCs in glioma environment.

BACKGROUND:Tranexamic acid is a synthetic anti-fibrinolytic drug, and can effectively control blood loss after total knee arthroplasty through vein. OBJECTIVE:To evaluate the effectiveness and safety of tranexamic acid in reducing blood loss after primary unilateral total knee arthroplasty. METHODS:From 2014 to 2015, 100 patients from the Department of Lower Limb, Sichuan Orthopaedic Hospital underwent primary unilateral total knee arthroplasty, and randomly divided into test group which used tranexamic acid and control group which used tranexamic acid, with 50 cases in each group. 1 g tranexamic acid was infused into the vein at 10 minutes before total knee arthroplasty in the test group, but tranexamic acid was not given in the control group. RESULTS AND CONCLUSION:The amount of total blood loss, postoperative wound drainage in 24 hours, and the amount of blood transfusion were significantly less in the test group than in the control group (P < 0.05). No significant differences in intraoperative blood loss and the number of patients receiving blood transfusion were found between the test and control groups. No significant difference in preoperative hemoglobin levels was detected before surgery, but hemoglobin levels were decreased after surgery between the two groups. Postoperative hemoglobin levels were apparently higher in the test group than in the control group after surgery. At 24 hours after surgery, no significant difference in coagulation was detectable between the two groups. At 6 days, double lower limb vein color Doppler ultrasound examination did not reveal deep vein thrombosis in both groups. These findings verify that treatment with tranexamic acid in the vein before primary unilateral total knee arthroplasty can evidently diminish the amount of perioperative blood loss and blood transfusion, reduce the risk and cost of blood transfusion, which is good for rehabilitation and does not increase the risk of deep vein thrombosis.

Objective To investigate the extent of pancreatic and liver function damage of acute necrotizing pancreatitis (ANP) rats under altitude hypoxia environment,and to provide a reference for better diagnosis and treatment of severe acute pancreatitis (SAP) in the plateau region.Methods Ninety-six specific pathogen free (SPF) Wistar male rats were involved in 1 500 meters,3 300 meters and 4 300 meters altitude.The model of ANP was established by using pancreatic capsule injection of sodium taurocholate (NaTc).In the sham operation group,the rats' belly was opened and closed after only flipping its pancreas several times.Rats in sham group were sacrificed at 6 h,and ANP group were sacrificed at 6,12,24 h after modeling.Serum amylase activity was measured,and pancreas and liver tissue were harvested for pathological examination and score.Results Serum amylase activity in sham operation group rats was not remarkably changed,and pathological changes of pancreas and liver were not obvious.At same altitude,serum amylase activity,pancreas and liver pathology score of ANP rats at each time point were significantly higher than those in the sham operation group;and serum amylase activity,pancreas and liver pathology scores of ANP 12,24 h group rats were significantly higher than those of ANP 6h group;and the difference was statistically significant (P ＜ 0.05).At 3 300 meters,4 300 meters altitude,the pancreas and liver pathology scores of ANP rats at each time point were significantly higher than those at 1 500 meters altitude,and the differences were statistically significant (P ＜ 0.05),but the difference in serum amylase activity was not statistically significant.Conclusions With the increase of altitude,pancreatic and liver pathological damage of ANP rats shows continuing aggravation.

Objective To compare the effects of peripatellar peripheral nerve partially and totally depolarized in total knee arthroplasty (TKA). Methods 66 TKA patients were divided into partially depolarized group (A, 42 knees) and totally depolarized group (B, 38 knees). The scores of knee-joint, Feller and Visual Analogue Scale were recorded. Results There was no significant difference in all the scores between 2 groups before operation (P>0.05). All the scores improved after operation (P<0.05), however, there was still no significant difference between 2 groups (P>0.05). Conclusion Patellar peripheral nerve partially depolarization technique can reduce postoperative knee pain, which has the same effect with totally depolarization.

Objective To investigate the effects of general anesthesia and hard epidural anesthesia on the incidence of postoperative cognitive dysfunction (POCD),serum S-100β and Aβ1-42 protein in elderly patients with transurethral resection of the prostate (TURP).Methods 120 cases of elderly male patients who wanted to implement TURP were enrolled in this study.From March 2014 to August 2016,60 patients underwent general anesthesia (general anesthesia group) and 60 patients underwent epidural anesthesia (hard epidural Group).The effects of two anesthesia methods on the cognitive function,serum S-100 β and Aβ1-42 protein were compared.Results There was no significant difference in mini-mental state examination (MMSE) score in preoperative,postoperative 12 h,postoperative 24 h,postoperative 72 h,and postoperative 1 week between hard epidural group and general anesthesia group (P ＞ 0.05).The MMSE scores at 12 h,24 h and 72 h after operation in both groups were significantly lower than those before operation in both groups (P ＜0.05).There was no significant difference in clock drawing task (CDT) score in preoperative,24 h after operation,72 h after operation and one week after operation (P ＞ 0.05).The CDT scores of both groups at 12 h,24 h,72 h after operation were significantly lower than those before operation (P ＜0.05).There was no significant difference in serum S-100β levels between the two groups at preoperative and 12 h,72 h after operation (P ＞0.05).Serum S-100β levels at 12 h and 72 h after surgery in both groups were significantly higher than those before surgery (P ＜ 0.05).There was no significant difference in preoperative and postoperative 12 h,postoperative between hard epidural group and general anesthesia group (P ＞ 0.05).Serum Aβ1-42 levels at preoperative,12 h and 72 h after operation in both groups were significantly lower than those before operation (P ＜ 0.05).There was not statistically significant in the incidence of POCD between hard epidural group [28.33 ％ (17/60)] and general anesthesia group [35％ (21/ 60)] (P ＞ 0.05).Conclusions There was no significant difference in the incidence of POCD between general anesthesia and hard epidural anesthesia group in elderly patients with TURP.The incidence of POCD in elderly patients was related to the decrease of serum S-100β and the decrease of Aβ1-42.

Objective: To setup a custom-made gait simulator, and to provide an efficient tool for biomechanics research of ankle and foot. Methods: From November 2017 to April 2018, a total of 6 fresh frozen specimens of the foot and ankle were collected. The donated specimens, free of diseases in the foot and ankle part, were from the Department of Anatomy, Shanghai Medical College of Fudan University. Donors were 3 males and 3 females, aged from 48 to 69 years old, with an average age of 58.8 years old. The nine tendons in the foot were divided into 4 bundles, including anterior group comprised of tibialis anterior (TA), extensor hallucis longus (EHL) and extensor digitorum longus (EDL). Posterior group comprised of Achilles's tendon (AT). Medial group comprised of tibialis posterior (TP), flexor hallucis longus (FHL), and flexor digitorum longus (FDL). Lateral group comprised of peroneus brevis (PB) and peroneus longus (PL). A custom-made gait simulator was set up by using four independent electro motors to actuate 4 bands of tendons in the foot and another six motors to control tibia to achieve 6 degree-freedom parallel mechanism. And a hydraulic machine was used to provide axial pressure along tibia. Gait cycle of six fresh frozen cadaver feet was reproduced using this machine, and the kinematics data of ankle movement and ground reaction force (GRF) data was collected. By comparing the data above with the normal human gait data, the simulation results were analyzed to explore the clinical usage of this machine. Results: On the sagittal plane, the ankle appeared to plantarflexion at the beginning of gait, and then turned to dorsiflexion after the max plantar flexion (about 10°) at 18% of gait cycle. At the 40% gait cycle, ankle joint was in neutral position and reached its max dorsiflexion (about 22°) at 83% gait cycle. On the coronal plane, ankle joint appeared inversion at the beginning and eversion afterwards with 10° range of change. On the horizontal plane, movement of ankle joint was small. Results showed that the first peak of vertical ground reaction force can reach to 1.1-1.3 times of bodyweight at 25% of gait cycle and the second peak appeared little lower at 70% of gait cycle. The GRF in posterior direction reached its peak at 30%, and then turned to anterior with its peak at 83% gait cycle. The GRF had small variation at the internal to external direction.All of the coefficients of multiple correlations (CMC) of GRF and ankle joint movements were close to or greater than 0.90. Conclusion This custom-made gait simulator has good gait simulation ability with high intra repeatability in respect of ankle rotation and ground reaction force, and can satisfy the request for ankle and foot biomechanics research.

Objective:To analyze the distribution of clinically isolated fungal strains and their resistance to common antifungal drugs in Shandong province.Methods:Through the Shandong Children’s Bacterial & Fungal Drug Resistance Surveillance and Research Collaborative Network, a total of 1 030 fungi were collected in 46 hospitals of Shandong province from January 1 to December 31, 2018. The source and type of strains were analyzed, and antifungal drug sensitivity tests were performed by using the micro-dilution method. Whonet 5.6 and SPSS 22.0 were applied to analyze the data.Results:The overall main strains were Candida albicans (38.74%, 399/1 030), Candida tropicalis (16.99%, 175/1 030) and Candida parapsilosis (16.41%, 169/1 030); the main fungi strains in child patients were C. albicans (52.50%, 63/120), C. parapsilosis (12.50%, 15/120) and C. tropicalis (9.17%, 11/120); the main fungi strains in adult patients were C. albicans (36.37%, 331/910), C. tropicalis (17.03%, 155/910) and C. parapsilosis (15.27%, 139/910). The isolation rate of main Candida strains from January to March and August to December was much higher than that of other months. The drug resistance rates of C. albicans to fluconazole and voriconazole were 7.14% and 7.43%, respectively, and the drug resistance rates to itraconazole were 50.44%. The resistance rates of C. tropicalis to fluconazole, voriconazole and itraconazole were 29.05%, 23.29% and 48.65%, respectively. The sensitivity rates of C. parapsilosi to fluconazole, voriconazole and itraconazole were 93.06%, 93.75% and 94.44%, respectively. Candida glabrata showed a dose-dependent sensitivity rate of 2.33% to fluconazole. Analysis of 244 blood fungi strains showed that non-candida albicans bacteremia accounted for 70.08%. In the pathogen spectrum covering 92.22%, fluconazole was sensitive to 64.65% of the pathogens, voriconazole was 68.88%, and amphotericin B was 88.75%. After quantification, the effective rates of fluconazole, voriconazole and amphotericin B in the clinical treatment of fungal bacteremia were 70.10%, 74.69% and 96.23%, respectively. Among them, the sensitivity rate of voriconazole to C. tropicalis was lower than that of fluconazole. Conclusions:Candida is the main clinical fungus isolates in hospitals of Shandong province. The resistance rate of C. tropicalis to azole antifungal drugs is on the rise, and the sensitivity of other Candida species to clinically used antifungal drugs is basically stable.