The process of exercise regulating bone metabolism is complicated, which involves a number of signaling pathways. A large number of studies in vitro have indicated that mechanical stress regulates bone metabolism by Wnt, bone morphogenetic protein (BMP), and osteoprotegerin (OPG)/receptor activator of NF-κB ligand (RANKL)/receptor activator of NF-κB (RANK) signaling pathways. Both the in-tensity and frequency of mechanical stress have varing impact on bone tissue and cells. Plenty of studies in vivo also have shown that exer-cise regulates bone metabolism by key factors in bone metabolism signaling pathways. This paper reviewed the effects of exercise on bone metabolism pathways and their mechanisms.

OBJECTIVETo verify the regulatory effects of acupuncture on exercise tolerance in patients with chronic obstructive pulmonary disease (COPD) at stable phase.

METHODSThirty cases of COPD were randomly divided into a treatment group (16 cases) and a placebo group (14 cases). Based on specified aerobic exercise, acupuncture was applied in the treatment group and placebo acupuncture was used in the placebo group. The acupoints included Danzhong (CV 17), Rugen (ST 18), Guanyuan (CV 4), Zhongwan (CV 12), Tianshu (ST 25) and so on. The needle did not penetrate into the skin for the placebo group. The treatment was required for 2 to 3 times per week for totally 5 weeks. The indices of exercise tolerance, including 6-min walking distance (6-MWD), exercise time, maximum oxygen uptake (VO2max) forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC), maximum ventilatory volume (MVV), St. George respiratory questionnaire (SGRQ) were observed in two groups before and after treatment.

RESULTS(1) Exercise tolerance: the differences of 6-MWD and exercise time were statistically significant between groups, which were more superior in the treatment group (both P<0.01); the VO2max was significantly increased after treatment in the treatment group (P<0.05), but there was no difference between two groups (P>0.05). (2) Pulmonary ventilation function: the differences of FEV1%, FEV1/FVC and MVV% were statistically significant between groups, which were more superior in the treatment group (P<0.05, P<0.01); (3) SGRQ: the SGRQ was significantly improved after treatment in the treatment group (P<0.05), but there was no difference between two groups (P>0.05).

CONCLUSIONThe acupuncture could improve the exercise tolerance in patients with chronic obstructive pulmonary disease at stable phase, and shorten the onset time of aerobic exercise. Besides, acupuncture combined with aerobic exercise could effectively improve the pulmonary function.

Acupuncture Points ; Acupuncture Therapy ; Aged ; Exercise Tolerance ; Female ; Humans ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; physiopathology ; therapy

Pulmonary vein isolation (PVI) is a new ,effective and radical method to cure atrial fibrillation .Within a period after radiofrequency ablation (RFA) ,coagulation system is activated in patients ,then thrombus incident such as cerebral embolism may happen .The present article made a review on its mechanism .

Objective To approach the evaluative effect of respiratory variation of superior vena cava peak flow velocity measured using transthoracic echocardiography (TTE) on fluid responsiveness in patients with mechanical ventilation.Methods A prospective cohort study was conducted.All mechanical ventilated critically ill patients whose fluid therapy was planned due to hypovolemia in Department of Critical Care Medicine of Beijing Tongren Hospital of Capital Medical University from April 2011 to April 2013 were enrolled.Volume expansion was performed with 500 mL Linger solution within 30 minutes.Patients were classified as responders if pulse pressure variation (PPV) increased ≥ 13％ before volume expansion.The respiratory variation in superior vena cava peak velocity was calculated as the difference between maximum and minimum values of velocity in peak A,peak S and peak D over a single respiratory circle,and their variations (ΔA,ΔS,ΔD) were also calculated.The receiver operating characteristic curve (ROC curve) was plotted to assess the evaluative effect of respiratory variation of superior vena cava peak velocity on fluid responsiveness.Results Twenty-seven patients were enrolled in this study.Volume expansion increased PPV ≥ 13％ happened in 14 patients (responders).The velocity of superior vena cava in peak A,peak S,peak D was significantly increased after volume expansion compared with that before volume expansion in responders [peak A (cm/s):34.6 ± 2.2 vs.31.3 ±2.1,t=-2.493,P=0.027; peak S (cm/s):39.1 ± 1.3 vs.35.3 ±2.1,t=-2.564,P=0.024; peak D (cm/s):28.1 ± 1.2 vs.23.3 ± 1.4,t=-4.995,P=0.000],but there was no significant difference in ΔA,ΔS and ΔD between before and after volume expansion.The ΔA,ΔS and ΔD were positively correlated with PPV (r＝0.040,P=0.854; r=0.350,P=0.074; r=0.749,P=0.000).The area under ROC curve (AUC) of peak S was 0.36 [95％ confidence interval (95％CI):0.11-0.52],but the AUC of ΔS was 0.68 (95％CI 0.47-0.89),the AUC of peak D was 0.41 (95％CI 0.19-0.63),but the AUC of ΔD was 0.95 (95％CI 0.86-1.00),so the aberration rate of superior vena cava in respiration was better than the flow rate in superior vena cava.When the cut-off value of ΔS was 20.7％ for predicting fluid responsiveness,the sensitivity was 78.6％ and the specificity was 61.5％.When the cut-off value of ΔD was 12.7％ for predicting fluid responsiveness,the sensitivity was 92.0％ and the specificity was 92.3％.Conclusion Respiratory variations in superior vena cava peak velocity measured by TTE could assess fluid responsiveness in patients with mechanical ventilation.

Objective To analyze the prognostic factors and their influences on breast cancer patients with local-regional recurrence.Methods From Jan.1st,1998 to Dec.30th,2007,66 breast cancer patients with local-regional recurrence were treated at Breast Center of Peking University People's Hospital.The overall survival of the patients was analyzed using Kaplan Meier survival analysis and the prognostic factors such as primary tumor status,initial treatment,location of recurrence and treatment strategy after local recurrence were analyzed using Cox regression model.Results The median follow-up was 111 months.The median survival for the 66 patients with recurrence was 99 months,ranging from 3 to 188 months and 5-year survival rate was 60％.Kaplan-Meier analysis revealed statistically significant better survival for patients with unifocal primary tumor,undergoing initial breast conservation surgery,with local recurrence only and undergoing radical local treatment after local recurrence (P =0.003,P =0.017,P =0.050,and P =0.000 respectively).COX regression analysis showed that age at initial diagnosis and radical local treatment after recurrence had influences on post-recurrence survival of patients without distant metastasis (P =O.004 and 0.000 respectively).Conclusion The clinical and pathological features of primary tumor,initial surgery,site of recurrence and treatment strategy after recurrence have influences on prognosis of breast cancer patients with local-regional recurrence.

The effect of pioglitazone on mRNA expression of advanced glycosylation end products(AGE) receptor(RAGE)was observed in renal cortex of streptozotocin-induced diabetic rats.The RAGE mRNA expression was significantly raised in diabetic control group as compared with that in the normal control group(P

Objective To explore the feasibility and safety of early ambulation in patients with acute deep ve-nous thrombosis. Methods The literatures about early ambulation for acute venous thrombosis were collected and the quality of the literature was evaluated by two investigators independently. Results Thirteen published studies were recruited for systematic review,including 10 RCTs and 3 CCTs. The meta-analysis showed that compared with bed rest,early ambulation did not increase the incidence of secondary pulmonary embolism in patients with acute DVT[early activity:22/1408;bed rest:34/1417;RR=0.62,95%CI(0.37,1.03),and the incidence of DVT progression [early activity:48/1523;bed rest:45/1525;RR=0.85,95%CI(0.58,1.24)]. There were no statistically significant differ-ences in mortality,swelling,and pain relief in acute DVT patients. Conclusion Early ambulation did not increase the incidence of thrombus progression and secondary pulmonary embolism in patients with acute DVT compared with bed rest. Besides,early ambulation cannot relieve symptoms of swelling and pain in DVT patients. However,it can relieve the acute pain of DVT patients with moderate to severe pain.

Objective:To summarize the ultrasound characteristics of incarceration of gravid uterus (IGU) for improving the diagnostic accuracy of IGU.Methods:Three cases of IGU patients were diagnosed in Peking University Third Hospital from May 2018 to May 2020. CNKI, Wanfang Data, China Science and Technology Journal Database and PubMed were searched using the search terms "incarcerate uterus" or "uterine incarceration" and "gravid" through January 2000 to July 2020, 53 IGU cases were found. The ultrasound data and outcomes of the 56 IGU patients were retrospectively analyzed. The display rate of various ultrasonic features were counted. Relevant literatures were reviewed and the experience were summarized.Results:Of the 56 cases with IGU, 45 cases (80.4%) had positive results, of which 34 cases (60.7%) were found abnormal cervix(elongated anteriorly and superiorly displaced cervix or poorly visualized cervix), 27 cases (48.2%) were found retroversion of the gravid uterus, 12 cases (21.4%) were found that the fundus of the uterus lay deeply in the Douglas pouch, 4 cases (7.1%) were found anteriorly and superiorly displaced bladder. There was statistically significant difference between the displaying rates of abnormal cervix and retroversion of the gravid uterus(χ 2=5.452, P<0.05). Conclusions:Abnormal cervix was the most common feature of IGU by ultrasound. Correct identification of the cervix is helpful to improve the detection rate of IGU.

Cardiac Catheterization ; Heart Septal Defects, Ventricular ; therapy ; Humans ; Prosthesis Implantation ; instrumentation ; Septal Occluder Device

BACKGROUND:Al ogeneic hematopoietic stem cel transplantation is currently recognized as the first-line therapy for severe aplastic anemia. However, with the popularity of the one-child families, the source of ful y matched hematopoietic stem cel transplantation is limited, so haploidentical hematopoietic stem cel transplantation is favored. OBJECTIVE:To retrospectively compare and analyze the clinical efficacy and safety of haploidentical al ogeneic hematopoietic stem cel transplantation and ful y matched hematopoietic stem cel transplantation for the treatment of severe aplastic anemia. METHODS:Clinical data of 15 patients with severe aplastic anemia (treatment group) who underwent haploidentical al ogeneic hematopoietic stem cel transplantation in the Department of Hematology General Hospital of Beijing Military Region from January 2013 to January 2015 were retrospectively analyzed. Pretreatment regimen was cyclophosphamide, fludarabine, Busulfex, combined with anti-human lymphocyte immune globulin. Donors received granulocyte colony-stimulating factor, and the transplantation method was bone marrow mobilization combined with peripheral blood stem cel transplantation. Combined immunosuppressive agents including cyclosporine A, methotrexate, tacrolimus, were adopted for prevention of graft versus host disease. Another 15 cases of severe aplastic anemia undergoing ful y matched hematopoietic stem cel transplantation served as control group over the same period. Complications and survival of the two groups were statistical y analyzed. RESULTS AND CONCLUSION:By the end of July 2015, the median fol ow-up time of the treatment group was 20.7 months (6-30 months), and hematopoietic reconstruction was achieved in al cases, including four cases of graft versus host disease, five cases of pulmonary infection, three cases of sepsis, and one case died of pulmonary infection, one cases died of sepsis, and two cases died of graft versus host disease. In the control group, the median fol ow-up time was 19.7 months (5-28 months), hematopoietic reconstruction was achieved in al cases. There were three cases of graft versus host disease, four cases of pulmonary infection, one case died of pulmonary infection, and two cases died of graft versus host disease. The total survival rates of the two groups were 73%and 80%respectively, with no significant difference (P=0.67). The haploidentical al ogeneic hematopoietic stem cel transplantation for severe aplastic anemia is safe and effective, and the clinical efficacy is comparable to the ful y matched hematopoietic stem cel transplantation.