Congenital clubfoot(CCF), which is also known as equines deformity, is a common congenital malformation that affect children′s life quality. However, its cause is still to be elucidated. Currently, polygenetic and environmental fac?tors are both believed to play important roles in CCF pathogenesis. Several genes including HOX, PITX1, NAT2, P63, DTDS and COL9A were shown to contribute to congenital clubfoot, but which is the most critical gene remains unclear. Several re?ports have revealed that Hox genes are closely related to the cause of CCF. Hox genes are regulators of body morphogenesis, and its mutation result in limbs and trunk deformity in human. Here, we systematically reviewed the latest literature that stud?ied the role of Hox genes in pathogenesis of Congenital clubfoot, with the prospect of laying a foundation for its future clinic treatment.

Objective To investigate the effect of pretreatment with parecoxib for postoperative analgesia in patients undergoing laparoscopic hernia repair. Methods Sixty patients undergoing laparoscopic hernia repair were assigned in two groups by random digits table with 30 cases each. The patients in pretreating group received parecoxib 40 mg intravenously before anesthesia, and in control group with the same capacity of normal saline. All patients were anesthetized with combined spinal epidural blockage and tranquilized with pethidine, droperidol and diazepam. Postoperative pain of the abdomen incision was assessed by visual analogue scale (VAS) and the pain of shoulder or back was judged by a 4 grade scale. Side-effects, supplement analgesic, passage of gas by anus 24 h after surgery were observed as well. Results The abdomen incision VAS at 4,8,12,24 h after surgery in pretreating group were lower than those in control group (P ＜ 0.05). And the incidence of pain of shoulder or back was lower in pretreating group (13.3% ,4/30) than that in control group (33.3% ,10/30)(P ＜0.05). While the cases needing supplement analgesic also decreased in pretreating group (13.3% ,4/30) compared with control group (40.0%, 12/30)(P ＜ 0.05). And the side effects and passage of gas by anus 24 h after surgery had no significant difference in two groups. Conclusion Pretreatment with parecoxib in patients undergoing laparoscopic hernia repair may relieve the postoperative incision pain and the pain of shoulder or back while reducing the analgesic supplement without side effects.

Objective To assess the current situation and quality of clinical randomized controlled trials(RCTs) designed for accessing the treatment of depressive neurosis with acupuncture and moxibustion. Methods Relative clinical research literatures published from year 1980 to 2008 were collected, and composed into "evaluation to all literature of acupuncture and moxibustion treating depressive neurosis message table", according to the clinical epidemic disease and EBM. The quality evaluation on these trails were performed. Results There were altogether 15 articles included in this study. Among them, 5 articles used the correct randomized controlled trials (33.3%), 10 articles used the diagnostic criteria (66.6%), 10 articles used excluded criteria (66.6%), 12 articles used the therapeutic evaluation criteria (80%), 4 articles used blind treals (26.7%), 5 articles reported quit cases (33.3%), and 9 articles reported the adopted statistical methods (60%)4 articles Conclusion The quality of RCT of acupuncture and moxibustion for depressive neurosis needs to be improved.

Objective Diagnosis related groups ( DRGs) is a system to classify hospital cases into groups , which is effective in the control of medical cost .The article was to explore the DRGs grouping method and quality control indexes of cerebrovascular dis -ease in Nanjing first-class hospitals at grade 3. Methods Polytomous logistic regression for ordinal response was used in the factor analysis of hospitalization cost .E -CHAID decision tree method was applied in the DRGs grouping of cerebrovascular patients . Results Totally 9095 cases were enrolled in this study with the average age was (64.52 ±14.85).The average of stay lengths and expenses were (11.77 ±9.26)d and (25921.04 ±23096.76)rmb respectively.Hospitalization expense was associated with neurologi-cal surgery, main diagnosis, interventional surgery, main complication and ICU days.Taking neurological surgery as the first forced variable, cerebrovascular cases could be divided into 14 DRGs groups. Conclusion The terminal quality control index , the step warning index and case maximum index of cerebrovascular disease established by the DRGs grouping method are suitable in the area .

Objective To investigate the effects of siRNA mediated HMGA 1 silence on proliferation and the gene expression of HMGA1 ,α-SMA and E-cadherin in activated hepatic stellate cells and its mechanisms .Methods Synthetic HMGA1 siRNA was transfected into LX-2 cells to silence the HMGA1 gene .The expression level of HMGA1 ,α-SMA and E-cadherin was determined by RT-PCR and Western blot experiments .LX-2 cell proliferation was assessed by M TT assay .Results The best inhibited effect was HMGA1-siRNA-1 .Compared with control group ,the cell proliferation and the mRNA and protein expression of HMGA 1 ,α-SMA in TGF-β1 group and TGF-β1 + NC-siRNA group were significantly increased (P< 0 .05) ,without significant differences between the two groups (P> 0 .05) ,while the expression of E-cadherin in TGF-β1 group and TGF-β1 + NC-siRNA group were significantly decreased compared with control group (P< 0 .05) .Meanwhile ,the cells in TGF-β1 + HMGA1 siRNA group showed significantly decreased proliferation level ,down-regulated mRNA and protein expression of HMGA 1 ,α-SMA but up-regulated expression of E-cadherin compared with TGF-β1 group and TGF-β1 + NC-siRNA group(P< 0 .05) .Conclusion HMGA1 interference could signifi-cantly down-regulate the expression of HMGA1 in LX-2 cells cultured with TGF-β1 ,thus inhibiting the proliferation and activation of the cells .

Objective To understand the incidence of common geriatric syndromes in hospitalized patients,and analyze the relationship between different kinds of geriatric syndromes.Methods A crosssectional study was conducted by five well-trained investigators-300 patients were chosen from geriatric department and medical department within 3 top three hospitals in Chengdu.Results 300 copies of questionnaires were distributed in total,and 300 questionnaires were returned (response rate 100％).Among those,277 questionnaires were considered valid (valid response rate 92.3％).Among those elderly which were above 65 years old,having risk of falling accounted for 91.3％,feeling pain accounted for 79.1％,chronic constipation accounted for 59.2％,having risk of malnutrition accounted for 49.1％,malnutrition accounted for 28.2％,having risk of pressure ulcers accounted for 32.5％,incontinence accounted for 25.3％,and dysphagia accounted for 17％.The correlation among these syndromes was signifcant.Conclusions The overall incidence of geriatric syndromes in hospitalized patients is higher than that in the community.These syndromes are correlated with each other.One can be a risk factor of other geriatric syndromes and also could affect each other.

In current study,by means of analysis of client and administrator needs,we constructed "internal medical resource database" based on internet,which has 5 modules including database itself,communication on line,resource searching,recent updating and resource statistic.We hope the establishment of "internal medical resource database" can do a favor for the similar resource database.

Objective: To establish the evaluation of the chemial quality standard of Radix Astragali according to their contents of saponin, flavonoid and polyscaccharide. Methods: HPLC ELS was used to determine astragaloside Ⅳ content. RP HPLC was used to determine 10 hydroxy 3,9 dimethoxypterocarpan content. Sulfuric acid phenol method was used to determine total polysaccharide content. Results: Astragaloside Ⅳ, total flavonoid, 10 hydroxy 3,9 dimethoxypterocarpan and total polysaccharide content of Astragalus mongmolicus Fisch. were 0.710? 0.030mg/g, 45?4.243mg/g, 19.955?0.813?g/g, 73.310?0.962mg/g, respectively; Astragaloside Ⅳ, total flavonoid, 10 hydroxy 3,9 dimethoxypeterocarpan and total polysaccharide content of Astragalus membranacens Fisch. were 1.186?0.024mg/g, 46?1.414mg/g,84.640?3.069?g/g, 48.800?1.245mg/g, respectively. Conclusion: The method was practical and provided a new idea to study the chemical quality standard of traditional Chinese drug.

Abstract: To report on two patients with Coronavirus Disease 2019 (COVID-19) combined with diffuse connective tissue disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection followed for nearly 3 years, in order to understand the long-term effects on the patients' immune system. Both patients were male, aged 81-82 years, and were hospitalized with fever on January 29, 2020 and February 10, 2020, respectively. Both were diagnosed with COVID-19 after positive SARS-CoV-2 polymerase chain reaction (PCR) tests. After receiving anti-infection treatment, cough suppressants, ex‐pectorants, and symptomatic supportive treatment, their body temperature returned to normal and two consecutive PCR tests were negative for SARS-CoV-2, and they were discharged from hospital. However, due to recurring fevers and varying degrees of rheumatic disease-related symptoms, both patients were readmitted to the hospital, indicating the presence of positive auto‐ antibodies and organ involvement. One patient recovered from COVID-19 with recurrent fever, joint pain, muscle aches and subcutaneous nodules, and was subsequently diagnosed with undifferentiated connective tissue disease. The other patient developed recurrent fever, mouth ulcers and rash after recovery from COVID-19 and was subsequently diagnosed with anti neutro phil cytoplasm antibody (ANCA)-associated vasculitis (AAV). The patient was treated with glucocorticoids and immunosuppres sive drugs and the symptoms resolved rapidly and subsequent laboratory and imaging examinations showed stable condition. However, due to self-termination of medication, their symptoms quickly relapsed, and further treatment with glucocorticoids and immunosuppressive agents resulted in sustained stability of their condition. The erythrocyte sedimentation rate and hyper‐sensitive C-reactive protein remained within normal limits, and lung CT scans showed stable lesions with partial absorption.SARS-CoV-2 infection may have long-term effects on patients' immune systems, leading to abnormal immune responses and diffuse connective tissue disease. This suggests that regular follow-up observation of immune system-related diseases may be necessary for elderly patients with COVID-19.

Objective To evaluate the incidence and mortality of acute kidney injury (AKI) in coronary care unit (CCU),and to identify the risk factors of the incidence of AKI and the mortality of CCU patients.Methods A total of 414 patients in CCU from January 1,2014 to June 1,2015 at Zhongnan Hospital of Wuhan University were enrolled.Based on the KDIGO-AKI criteria,these patients were classified into two groups:NAKI group (patients without AKI) and AKI group.Clinical characteristics and laboratory data of two groups were compared.The risk factors of the incidence of AKI and the mortality of CCU patients was analyzed by logistic regression,and then the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of these risk factors.Results (1) Among 414 patients,136(32.9％) patients fulfilled the criteria for AKI,and 14.0％ patients in AKI stage 1,10.9％ in AKI stage 2 and 8.0％ in AKI stage 3.(2) The total CCU mortality was 15.0％.Mortality of AKI patients in the CCU was 33.3％,higher than 6.1％ in patients without AKI (OR=7.735,95％CI 4.215-14.196,P ＜ 0.001).The mortality worsened with increasing severity of AKI (22.4％ for AKI stage 1 group,37.8％ for AKI stage 2 group,45.4％ for AKI stage 3 group).(3) Anemia (OR=8.274,95％ CI 4.363-15.689),history of chronic illness (OR=2.582,95％ CI 1.400-4.760),APACHE]Ⅱ seores (OR=1.813,95％CI 1.739-1.895),male (OR=3.666,95％CI 1.860-7.226) were the independent risk factors for AKI,while the normal mean arterial pressure (MAP) (OR=0.292,95％CI 0.153-0.556) and normal estimated glonerular filtration rate (eGFR) (OR=0.166,95％CI 0.090-0.306) are the protective factors for AKI (all P ＜ 0.05).(4) AKI was the most powerful independent factor associated with the mortality of CCU patients (OR=7.050,95％ CI 2.970-16.735,P ＜ 0.001).Other independent risk factors for CCU mortality included history of chronic illness,ejection fraction and APACHE Ⅱ ≥ 15 scores (all P ＜ 0.05),while the normal MAP and normal eGFR were the protective factors (all P ＜ 0.05).(5) For predicting AKI,eGFR displayed an excellent areas under the ROC curve (AUC=0.815,P ＜ 0.001),and for CCU mortality,APACHE Ⅱ scores had the highest overall correctness of prediction (AUC=0.757 P ＜ 0.001).Conclusions CCU patients have high morbidity of AKI,which is the most powerful independent factor associated with the increased CCU mortality.The eGFR is the best predictor for AKI,and then through the evaluation of eGFR for CCU patients,we can evaluate high-risk groups,make early interventions and then improve the prognosis of CCU patients.