BACKGROUND:Total knee arthroplasty is the main therapeutic regimen for end-stage osteoarthritis.However,diabetes mellitus can affect the treatment effect and prognosis. OBJECTIVE:To explore the effect of diabetes mellitus on perioperative blood loss and postoperative pain in patients undergoing primary total knee arthroplasty. METHODS:A retrospective study was conducted on 154 patients who underwent primary total knee arthroplasty and met the inclusion criteria in the Osteonecrosis and Joint Reconstruction Ward of Xi'an Honghui Hospital Affiliated to Xi'an Jiaotong University from January to April 2021.Patients were divided into a non-diabetic group and a diabetic group according to their diagnosis,with 32 cases in the diabetic group,9 males and 23 females,aged 55 to 80(66.58±7.16)years and 122 cases in the non-diabetic group,34 males and 88 females,aged 44 to 83(66.69±6.63)years.Perioperative blood loss(including total blood loss,hidden blood loss,the falling value of hemoglobin and hematocrit)was calculated for both groups.Visual analog scale scores,hospital for special surgery knee score,and Caprini scores were recorded preoperatively and postoperatively. RESULTS AND CONCLUSION:(1)Total blood loss was significantly lower in the non-diabetic group(729.93±233.83 mL)than that in the diabetic group(853.69±184.91 mL)(P<0.05).Latent hidden blood loss was also significantly lower in the non-diabetic group(624.40±233.19 mL)than that in the diabetic group(749.08±179.49 mL)(P<0.05).(2)In the non-diabetic group,the visual analog scale scores preoperatively and 1 month postoperatively were significantly lower than those in the diabetic group(P<0.05).The differences in visual analog scale scores at 3 days and 3 months postoperatively between the non-diabetic group and the diabetic group were not statistically significant(P>0.05).(3)The hospital for special surgery knee score at 1 month postoperatively was significantly higher in the non-diabetic group than that in the diabetic group(P<0.05).There was no significant difference in hospital for special surgery knee score between the two groups at 3 months postoperatively(P>0.05).(4)There was no statistically significant difference in preoperative and postoperative Caprini scores between the two groups(P>0.05).(5)It is concluded that having diabetes increases total and occult hidden blood loss in primary total knee arthroplasty.In the short term after total knee arthroplasty,diabetes increases the patient's pain and affects the recovery of joint function,but the negative effects fade with time.

Objective: To describe an extended whole upper limb liposuction technique and evaluate its clinical effect. Methods: 34 patients who underwent upper limb liposuction from February 2018 to February 2019 were selected and the clinical data were retrospectively summarized. Patients were treated with upper arm ring/upper arm ring + forearm 1/3 rings/whole arm ring aspiration combined with accessory mammary gland, armpit, scapula and other adjacent aesthetic parts of extended liposuction. The preoperative and postoperative maximum circumference, thickness of the anterior and posterior subcutaneous tissue and skin laxity were measured and compared. analysis of complications, and evaluation of patients′ satisfaction through satisfaction questionnaire. Results: The arm shape of all patients was significantly improved, the maximum circumference of the arm was reduced (16.2±4.0)%, the distance of the upper arm was reduced (29.5±8.9)%, the thickness of the posterior subcutaneous tissue was reduced (56.6 ±6.2)%, and the thickness of the anterior subcutaneous tissue was reduced (44.7±9.6)%. There were three cases of mild anemia after operation, and no other serious complications occurred. Patient satisfaction was very high. Conclusions This is an innovative arm liposuction technique with hidden incision. The effect of improvement is remarkable. The patient′s satisfaction is high.

Purpose: The incidence rate of breast cancer (BC) has increased annually. Downstream neighbor of son (DONSON) critically affects cell cycle progression and maintains stable genomic properties; however, its relevant effects on BC growth and progression require indepth investigation. Methods: DONSON upregulation was validated in public databases. DONSON expression in matched BC and adjacent tissues and cell lines (MDA-MB-231, BT-549, and HS-578T) was determined using quantitative reverse transcription polymerase chain reaction. In vitro apoptosis, invasion, migration, and proliferation tests were performed to ascertain the functions of DONSON in BC cell lines. Then, using western blot analysis, the levels of DONSON downstream proteins were determined. Results: Compared to the control, DONSON was expressed at higher levels in BC tissues and cell lines. DONSON knockdown facilitated apoptosis and limited proliferation, migration, invasion, and S/G2 transition of BC cells In vitro. Furthermore, DONSON overexpression promoted BC cell proliferation and inhibited apoptosis In vitro. Moreover, DONSON knockdown reduced cyclin A1 and cyclin-dependent kinase 2 levels. Moreover, DONSON knockdown limited the progression of epithelial-mesenchymal transition. Conclusion DONSON critically affects BC growth and serves as a possible target and marker for the efficacy of subsequent therapies.

Iliac vein stenosis (IVS), known as iliac vein compression syndrome, refers to a series of diseases caused by iliac vein compression or intraluminal adhesions leading to lower extremity vein or pelvic vein drainage disturbance and other clinical manifestations which is quite common in vascular surgery. The vast majority of patients with symptoms of chronic venous insufficiency (CVI) have IVS. In clinical work, IVS does not typically appear as a single symptom, while often combining with other lesions, such as varicose veins of the lower extremities, skin pigmentation, ulcer formation. Studies on its aetiology and epidemiology have found a mean age of onset of 40 years, the age of onset in females is lower than that in males, and the average of stress in females is significantly higher than that in males. Typical IVS occurs mainly in the left lower extremity in young women of reproductive age, but exceptions remain. In summary, the importance of the diagnosis of IVS in clinical practical work can be seen. CVI is a general term for all diseases that affect the morphology and function of the venous system. Compared with chronic venous disease (CVD), CVI include venous system abnormalities without symptoms or signs. Thus, it more accurately describes the diagnosis and treatment of IVS that requires clinical guidance, so its concept is quoted. With the development and advancement of medical imaging, more and more techniques provide help in the diagnosis and treatment of IVS. Therefore, professionals in various specialties have made relevant studies about the benefits and drawbacks of imaging techniques for diagnosis, treatment modalities, and prognostic management of this disease, in order to improve the diagnostic efficacy. Consequently, this review is focused on the current situation of the diagnosis and treatment of IVS under multi-modal imaging, hoping to provide choices of medical imaging technologies for the different states, and to find a better and personalized plan for patients.

Objective:To investigate the risk factors for infection after cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS+ HIPEC), and observe the infection in patients who underwent this combined procedure, to explore the predictive value of postoperative white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT) and systemic immune inflammation index (SII) for postoperative infection.Methods:Clinical data of 106 patients who underwent CRS + HIPEC in the Fifth Medical Clinical College of Shanxi Medical University between July 2019 and July 2022 were retrospectively analyzed. These patients, including 61 males and 45 females, (58.93±10.65) years old, were divided into the infection group ( n=19) and the non-infection group ( n=87) according to the presence of postoperative infection. Risk factors were analyzed for patients in the infection group, and postoperative WBC, CRP, PCT and SII were determined for patients in both groups to determine their prognostic values. Risk factors for postoperative secondary infection in patients with CRS+ HIPEC were analyzed using univariate and multivariate logistic regression. Predictive values of WBC, PCT, CRP and SII for postoperative infection were evaluated by receiver operating characteristic (ROC) curve, and the optimal cutoff values of these variables were determined by Youden index and evaluated using sensitivity, specificity, positive predictive value, and negative predictive value as evaluation indexes. Nomogram prediction model was constructed using R software and samples were included in this model to calculate the total score of these patients. ROC curve analysis and calibration curve verification were then performed. Results:Univariate analysis showed significant differences in age, body mass index (BMI), postoperative fistulization, preoperative serum albumin, combined multiple organ resection, and operation duration between the infection and non-infection groups ( P<0.05). WBC, CRP, PCT and SII were compared between the infection group and the non-infection group on were compared on postoperative days 1, 3, 5 and 7, and the ROC curves were plotted accordingly. The area under the ROC curve (AUC) of the WBC, CRP, PCT and SII on postoperative Days 1, 3, 5 and 7, and their 95% CI, sensitivities and specificities were compared. It was found that the predictive values of the 5th postoperative day WBC and PCT, and the 7th postoperative day CRP were superior to those determined on other postoperative days, and SII was not significant in predicting postoperative secondary infection in patients who underwent CRS+ HIPEC. The cut-off values of the 5th postoperative day WBC and PCT and the 7th postoperative day CRP were 7.7×10 9/L, 2.068 ng/mL and 76.43 mg/L, respectively, and AUCs and their 95% CI were 0.754 and (0.625, 0.883), 0.830 and (0.717, 0.943), 0.715 and (0.584, 0.846), respectively, with sensitivities of 78.9%, 68.4% and 63.2%, respectively, and specificities of 70.1%, 96.5% and 75.9%, respectively. The predictive values of PCT on postoperative days 1, 3, 5 and 7 were superior to those of WBC, CRP and SII determined on each corresponding day. The cut-off values of the 5th postoperative day WBC and PCT and the 7th postoperative day CRP were used as the classification thresholds, and the results after classification as well as significant variables in univariate analysis, including age, BMI≥25 kg/m 2, postoperative fistulization, preoperative serum albumin≥35 g/L, number of organs resected and operation duration were included in multivariate logistic regression analysis. The results showed that BMI≥25 kg/m 2, combined multiple organ resection, WBC and PCT on the 5th postoperative day and, CRP on the 7th postoperative day were independent risk factors for secondary infection ( P<0.05). A Nomogram prediction model was then constructed. Points indicated the scores for each variable, and the corresponding scores were 70 when BMI was ≥25 kg/m 2, 80 when multiple organ resection was combined, 100 when the 5th postoperative day WBC was ≥7.7×10 9/L, and 79 when the 7th postoperative day CRP was ≥76.3. The sum of the scores for all variable was calculated and used as total score for the patient. The total score obtained from the Nomogram prediction model was used for ROC curve analysis and calibration curve verification. The ROC curve analysis showed that the AUC was 0.966, with a sensitivity of 0.895 and specificity of 0.966, indicating an excellent discriminative power of the model. The significance level of the calibration curve was 0.05, and the absolute error between the predicted and actual incidences of postoperative infection after CRS+ HIPEC was 0.038. Conclusions:The incidence of secondary infection after CRS+ HIPEC is related to factors such as BMI and combined multiple organ resection. Inflammation markers in peripheral blood, including PCT, CRP and WBC, can serve as predictors for postoperative secondary infection in patients with CRS+ HIPEC, and the fifth postoperative day WBC and PCT and the seventh postoperative day CRP among others have the highest diagnostic values for postoperative infections. In addition, the predictive value of combined diagnosis is superior to that of individual testing.

Objective:To construct a rat model of hypothalamic obesity by two point electrical damage to the ventromedial hypothalamus and arcuate nucleus.Methods:Twenty adult male SD rats of SPF grade were randomly divided into experimental group and sham operation group.A 25GA (0.45 mm) solid iron needle was used, the needle was coated with an insulating layer, and the tip exposed a 0.5 mm conductive area.With reference to The Rat Brain in Stereotaxic Coordinates and using the stereotactic instrument (AP: -2.6 mm, ML: ± 0.6 mm, DV: -9.6 mm) as the coordinate, 1.5 mA current was continuously applied for 25 s, the ventromedial nucleus (VMH) and arcuate nucleus (ARC) of bilateral brain in SD rats was damaged.During the experiment, the body weight(BW), food intake(FI) and water intake(WI) of the two groups were recorded regularly.The rats were sacrificed on the 28th day after the operation, and the changes of periprenal fat mass and body length were measured.The changes of liver and adipose tissue were detected by HE staining method, leptin by ELISA, leptin receptor(LEPR) by Western blot.Results:(1) The body weight of rats in the experimental group ((427.5±17.7)g) and weight gain ((208.5±14.8)g) were significantly increased compared with the rats in the control group((349.2±17.7)g), ((136.2±21.4)g)on the 28th day after operation ( t=7.661, 6.806, both P<0.001). (2) The daily food intake of rats in the experimental group ((44.2±6.6)g) on the 28th day after surgery was significantly higher than that in the control group ((23.0±3.6)g) ( t=6.918, P<0.001). There was no significant difference of the daily drinking water of rats between experimental group((37.5±12.1)ml) and the control group ((35.0±11.8)ml) ( t=0.361, P=0.726). (3) Perikidney fat mass of experimental group rats ((13.4±2.7)g) significantly increased 28 days after operation compared with control group rats((6.3±0.9)g)( t=4.250, P<0.05). The naso-anal length of experimental group((21.8±0.4)cm) was significantly decreased compared with the control group ((23.4±0.2)cm) ( t=-6.788, P<0.01). The Lee index of the experimental group (348.9±8.5) was significantly higher than that of the control group(305.5±4.3)( t=7.898, P<0.01). (4) The serum leptin content ((8 324.10±159.00)μg/L) of the experimental group rats at 28 days after surgery was significantly higher than that of the control group((2 705.31±407.10)μg/L) ( t=25.712, P<0.001). The lateral hypothalamus area (LHA) LEPR protein expression (1.3±0.1) in the experimental group was significantly higher than that in the control group (0.9±0.1) ( t=4.932, P<0.01). Conclusion:Two-point electrical damage to bilateral VMH and ARC of rats can establish hypothalamic obese rat model.

OBJECTIVE: To investigate the mechanism by which doublecortin promotes the recovery of cytoskeleton in arginine vasopressin (AVP) neurons in rats with electrical lesions of the pituitary stalk (PEL). METHODS: Thirty-two SD rats were randomized into PEL group with electrical lesions of the pituitary stalk through the floor of the skull base (=25) and sham operation group (=7), and the daily water consumption (DWC), daily urine volume (DUV) and urine specific gravity (USG) of the rats were recorded. Four rats on day 1 and 7 rats on each of days 3, 7 and 14 after PEL as well as the sham-operated rats were sacrificed for detection of the expressions of β-Tubulin (Tuj1), doublecortin and caspase- 3 in the AVP neurons of the supraoptic nucleus using immunofluorescence assay and Western blotting. RESULTS: After PEL, the rats exhibited a typical triphasic pattern of diabetes insipidus, with the postoperative days 1-2 as the phase one, days 3-5 as the phase two, and days 6-14 as the phase three. Immunofluorescent results indicated the repair of the AVP neurons evidenced by significantly increased doublecortin expressions in the AVP neurons following PEL; similarly, the expression of Tuj1 also increased progressively after PEL, reaching the peak level on day 7 after PEL. The apoptotic rates of the AVP neurons exhibited a reverse pattern of variation, peaking on postoperative day 3 followed by progressive reduction till day 14. Western blotting showed that the expressions of c-Jun and p-c-Jun were up-regulated significantly on day 3 ( < 0.05) and 7 ( < 0.01) after PEL, while an upregulated p-JNK expression was detected only on day 3 ( < 0.05), as was consistent with the time-courses of neuronal recovery and apoptosis after PEL. CONCLUSIONS JNK/c-Jun pathway is activated after PEL to induce apoptosis of AVP neurons in the acute phase and to promote the repair of neuronal cytoskeleton by up-regulation of doublecortin and Tuj1 expressions.
Animals ; Apoptosis ; Arginine Vasopressin ; pharmacology ; Cytoskeleton ; metabolism ; MAP Kinase Signaling System ; Neurons ; cytology ; Pituitary Gland ; cytology ; injuries ; Proto-Oncogene Proteins c-jun ; metabolism ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Regeneration ; Tubulin ; metabolism

Objective:To analyze the incidence and epidemiological characteristics of traumatic spinal cord injury in China in 2018.Methods:Multi-stage stratified cluster sampling was used to randomly select hospitals capable of treating patients with spinal cord injury from 3 regions，9 provinces and 27 cities in China to retrospectively investigate eligible patients with traumatic spinal cord injury admitted in 2018. National and regional incidence rates were calculated. The data of cause of injury，injury level，severity of injury，segment and type of fracture，complications，death and other data were collected by medical record questionnaire，and analyzed according to geographical region，age and gender.Results:Medical records of 4，134 patients were included in this study，with a male-to-female ratio of 2.99∶1. The incidence of traumatic spinal cord injury in China in 2018 was 50.484 / 1 million （95% CI 50.122-50.846）. The highest incidence in the Eastern region was 53.791 / 1 million （95% CI 53.217-54.365）. In the whole country，the main causes of injury were high falls （29.58%），as well as in the Western region （40.68%），while the main causes of injury in the Eastern and Central regions were traffic injuries （31.22%，30.10%）. The main injury level was cervical spinal cord in the whole country （64.49%），and the proportion of cervical spinal cord injury in the Central region was the highest （74.68%），and the proportion of lumbosacral spinal cord injury in the Western region was the highest （32.30%）. The highest proportion of degree of injury was incomplete quadriplegia （55.20%），and the distribution pattern was the same in each region. A total of 65.87% of the patients were complicated with fracture or dislocation，77.95% in the Western region and only 54.77% in the Central region. In the whole country，the head was the main combined injury （37.87%），as well as in the Eastern and Central regions，while the proportion of chest combined injury in the Western region was the highest （38.57%）. A total of 32.90% of the patients were complicated with respiratory complications. There were 23 patients （0.56%） died in hospital，of which 17（73.91%） died of respiratory dysfunction. Conclusions:The Eastern region of China has a high incidence of traumatic spinal cord injury. Other epidemiological features include high fall as the main cause of injury cervical spinal cord injury as the main injury level，incomplete quadriplegia as the main degree of injury，head as the main combined injury，and respiratory complications as the main complication.