Objective To evaluate the effect of neuraxial and general anaesthesia for total joint arthroplasty by meta-analysis.Methods We searched online Pubmed,Web of science,Cochrane li-brary,CNKI,CBM and searched the literature of the Chinese series journals.All randomized controlled trials (RCT)that met their standards of neuraxial and general anaesthesia for total joint ar-throplasty were collected.The quality of trials was strictly assessed.RevMan 5.3 software was used for data analysis.Results Twenty-one RCTs involving 1 874 cases were included.Compared with general anaesthesia,the pooled data showed that the neuraxial anaesthesia significantly reduced blood loss (WMD=-97.52,95% CI = - 1 73.60-- 21.44,P = 0.01 ),associated with lower risk of deep vein thrombosis (RR=0.68,95%CI=0.48-0.95,P =0.02)and pulmonary embolism (RR=0.58, 95%CI=0.35-0.91,P =0.03),decreased the number of postoperative nausea and vomiting (RR=0.74,95%CI=0.60-0.92,P =0.008).Subgroup analysis showed that compared with general anaes-thesia,the neuraxial anaesthesia associated with lower risk of deep vein thrombosis (RR=0.5 1,95%CI=0.38-0.69,P < 0.000 01 )and pulmonary embolism (RR = 0.34,95% CI = 0.18-0.65,P =0.001)in patients who did not receive chemical antithrombotic prophylaxis.Conclusion Neuraxial anaesthesia seems to improve the outcome of patients undergoing total joint arthroplasty and reduce postoperative complications.

Objective To differential the biologic characteristics and multiple differentiation potential of mesenchymal stem cells in nucleus pulposus in (NP-MSC) scoliosis patient and patient with degenerative interverthral disc.Methods The human nucleus pulposus-mesenchymal stem cells were isolated and cultured with enzyme digestion from 2 patients of scoliosis and 2 patient with degenerative intervertbral disc separately.Cellular proliferation was detected with MTT assay and trypan blue.The immunophenotype expression of NP-MSC was detected by flow cytometry in scoliosis and degenerative group.The multiple differentiation ability of cells was assessed respectively using alizarin red dye,Oil red O dye and immunohistochemical staining.Results The primary cell morphology of scoliosis NP-MSC was the shape of spindle,while the degenerative NP-MSC was inhomogeneous.However,both of them became spindle shape after passages.The scoliosis NP-MSC was stronger than degenerative one in metabolic activity and proliferation.The percentage of positive antigen expression of CD44,CD105 and CD29 was 97％-100％ in scoliosis NP-MSC group,but 88.7％-97％ in the degenerative group.The expression of mature cell marker CD24 was negative in both groups.Furthermore,the MSC i.isolated from both groups differentiated along the osteogenic,chondrogenic but not adipogenic lineages.Conclusion The scoliosis and degenerative NP contains mesenchymal stem cells.Moreover the scoliosis NP-MSC had stronger ability of cell metabolic activity and proliferation.These cells have multiple differentiation potential with the exception of their adipogenic differentiation ability.

Objective To explore the indications of cervical artificial disc replacement (ADR) based on radiographic evaluation and different anterior decompression methods. Methods From January 2008 to July 2009, 175 patients with cervical spondylosis or disc herniation who underwent anterior decompression were involved in this study. Patients were distributed to different operative groups based on the preoperative radiographic evaluation. One hundred and forty-five cases were treated with fusion operation, and the others received ADR. Operative methods were as follows: 1) Anterior cervical discectomy and fusion (ACDF); 2)Anterior cervical discectomy and subtotal vertebrectomy; 3) Anterior subtotal vertebreetomy and fusion; 4)ProDisc-C ADR. The patients with single-level of cervical spondylotic myelopathy were divided into ACDF and ADR groups according to different operative methods. Clinical outcomes of two groups were evaluated by Japanese Orthopaedic Association (JOA) score. The range of motion (ROM) of the segment was recorded in ADR group at the 1st month, 3rd month, 6th month and 12th month postoperatively. Results The indication of ADR was cervical spondylosis with slight disc calcification or small vertebral posterior osteophytes. Under this condition, decompression could be obtained thorough intervertebral space and ADR be implanted. If cervical spondylosis was associated with vertebral posterior huge osteophytes, serious intervertebral narrow or fusion, serious disc calcification ,ossification of the posterior longitudinal ligament and extensive cervical spinal stenosis, subtotal vertebrectomy was necessary. The mean improvement rates of ACDF and ADR were 66.05% and 67.13%. There was no difference between two groups (P ＞ 0.05). No difference of ROM was found before and after surgery in ADR group (P ＞0.05). Conclusion Only decompression can be achieved thorough through the intervertebral space, and ADR is suitable for cervical spondylosis. ACDF and ADR have similar outcomes in treatment of single-level of cervical spondylotic myelopathy. But ADR has the advantage of maintaining ROM of the operative segment.

Objective To study the roles of ethyl pyruvate ( EP ) in spinal cord edema after spinal cord injury ( SCI ) and in spinal cord astrocytic swelling after oxygen-glucose deprivation and reoxygenation ( OGD/R) in vitro in rats. Methods After SCI models were established in adult Sprague-Dawley ( SD ) rats, an intraperitoneal injection of EP was conducted to inhibit high mobility group box-1 ( HMGB1 ). Effects of EP on spinal cord edema, HMGB1 expression and astrocyte activation ( glial fibrillary acidic protein ( GFAP ) expression) in SCI rats were analyzed. Spinal cord astrocytes were cultured in post-natal SD rats and incubated under OGD/R procedure. Effects of EP on cell swelling, expression of HMGB1, aquaporin-4 ( AQP4 ) and toll-like receptor 4 ( TLR4 ) , and nuclear expression of nuclear factor-kappa B ( NF-κB ) in spinal cord astrocytes were observed. Results The water content in the spinal cord was increased significantly more at 1 d after SCI than at 12 h and 3 d ( P ＜0.05 ). Intraperitoneal injection of EP at 50 mg/kg reduced spinal cord water content, HMGB1 expression and astrocyte activation ( GFAP expression ) in SCI rats signif-icantly more than that at 25 mg/kg or 100 mg/kg ( P ＜0.05 ). The volume of spinal cord astrocytes cultured in vitro after OGD 6 h/R 24 h was significantly greater than that after OGD 6 h/R 6 h or OGD 6 h/R 12 h ( P ＜0.05 ). EP at 12 μmol/L reduced cell swelling, decreased expression of HMGB1, AQP4 and TLR4, and downgraded nuclear expression of NF-κB in spinal cord astrocytes after OGD/R significantly more than EP at 6 μmol/L( P ＜0.05). Conclusion EP may reduce early spinal cord edema after SCI, attenuate spinal cord astrocyte swelling and decrease AQP4 expression after OGD/R in vitro by inhibiting HMGB1 in rats.

Objective:To investigate the effect of heme oxygenase-1 (HO-1) modified rat bone marrow mesenchymal stem cells (BMSCs) on fibrotic rats.Methods:110 male SD rats aged 6-8 weeks were selected randomly divided into model group, BMSCs group and HO-1/BMSCs group with 11 rats in each group after intraperitoneal injection of CCl 4, PBS, BMSCs and HO-1/BMSCs were injected respectively. Another 11 rats were selected as control group. After 4 weeks of intervention, tracer experiment was used to detect the location of BMSCs. Rats in each group were executed, and liver function were detected by biochemical analyzer, liver fibrosis indexes were detected by ELISA, liver histopathology were detected by HE and Sirius red staining. Immunohistochemistry, Western blot and RT-PCR were used to detect the protein and mRNA expression of E-cadherin and Vimentin. Results:The rat fibrosis model was successfully established. Tracer experiment showed that BMSCs were implanted in rat liver after transplantation. Compared with the model group, the liver function and liver fibrosis indexes of BMSCs group and HO-1/BMSCs group were improved, and Ishak score and stage were significantly decreased, and HO-1/BMSCs group was superior to BMSCs group. The expression of E-cadherin in HO-1/BMSCs group (0.92±0.21), (0.84±0.03) were higher than those in BMSCs group [(0.54±0.16), (0.53±0.04)] and model group [(0.49±0.06), (0.11±0.06)] both at protein and mRNA level, while protein and mRNA level of Vimentin (1.21±0.23), (3.82±0.80) were lower than that in BMSCs group [(1.32±0.17), (6.39±0.75)] and model group [(1.41±0.18), (16.94±1.30)]. The difference was statistically significant ( P<0.05). Conclusion:HO-1/BMSCs can improve liver function and liver fibrosis in fibrotic rats more effectively than BMSCs alone. The mechanism was possibly through inhibiting liver epithelial mesenchymal transition.

Objective: To investigate the clinical effect of posterior unilateral short segment screw fixation and bone graft fusion in the treatment of special upper cervical spine injuries. Methods: A retrospective case series study was conducted to analyze the clinical data of 15 patients with upper cervical spine injury admitted to Shanxi Bethune Hospital from July 2012 to May 2017. There were nine males and six females, aged 10-69 years [(41.9±20.9)years]. There were eight patients with traumatic atlantoaxial dislocation, one with congenital atlantoaxial dislocation, two with atlantoaxial dislocation with nonunion of odontoid process, three with Anderson type II odontoid process fracture, and one with old odontoid process fracture. All patients had cervico-occipital pain to different degrees, slender unilateral pedicle and distinct stenosis of vertebral artery. All patients were treated with posterior unilateral screw fixation and bone graft fusion. The injury of spinal cord and vertebral artery, operation time and intraoperative blood loss were recorded. Visual analogue scale (VAS) was used to evaluate pain before and after operation, and Japanese Orthopaedic Association (JOA) score was used to evaluate spinal cord function and postoperative improvement rate before and at the last follow-up. The position of internal fixation and fusion of bone graft were observed by X-ray after operation. Results: All 15 patients were followed up for 6-36 months [(20.4±8.6)months]. All the screws were implanted successfully at the first time, without spinal cord or vertebral artery injury. The operation time was 100-210 minutes [(131.3±32.0)minutes], and the intraoperative blood loss was 100-450 ml [(203.1±104.0)ml]. Preoperative VAS score was (7.9±0.9)points, and postoperative VAS score was (3.7±0.8)points (P<0.01). Preoperative JOA score was (12.1±4.4)points, and the JOA score at postoperative follow-up was (16.1±1.4)points, with the improvement rate of 68%. Postoperative X-ray showed good recovery of cervical spine sequence. One patient developed loosened internal fixation after the neck brace protection was removed one month after surgery, and the patient recovered after timely second surgical fixation and fusion. The remaining 14 patients did not have loosened internal fixation, fracture or loss of reduction, with bone fusion 6-12 months after surgery. Conclusion Posterior cervical unilateral short-segment screw fixation and bone graft fusion can restore cervical stability, relieve pain, and improve function recovery, which can be used as a complementary procedure to treat upper cervical spine injury with anatomic structure variation.

Objective:To investigate the effects of heme oxygenase-1 (HO-1)-modified rat bone marrow mesenchymal stem cells (BMMSCs) on T lymphocyte subsets in cirrhotic rats.Methods:A rat model of liver cirrhosis was established by intraperitoneal injection of carbon tetrachloride (CCL 4) in 110 rats. These rats were randomly divided into three groups, model group, BMMSCs group and HO-1/BMMSCs group, and injected with PBS, BMMSCs and HO-1/BMMSCs through dorsal penile vein, respectively. Another 10 rats were selected as control group. All rats were executed four weeks after intervention. Pathological changes in liver tissues were observed with HE and Sirius red staining. Serum albumin (ALB) and alanine aminotransferase (ALT) were detected by biochemical analyzer. Serum hyaluronidase (HA) and collagen type Ⅳ (Ⅳ-C) were detected by ELISA. T lymphocyte subsets in peripheral blood and spleen were detected by flow cytometry. Results:The rat model of cirrhosis was successfully established. Compared with the model group and BMMSCs group, the HO-1/BMMSCs group had significantly lower Ishak score and disease stage ( P<0.05), increased serum ALB level and CD4 + T/CD8 + T cell ratio ( P<0.05), and decreased serum ALT, HA and Ⅳ-C levels and Th17/Treg ratio ( P<0.05). Conclusions:HO-1/BMMSCs could improve liver function and liver fibrosis in cirrhotic rats more effectively than BMMSCs alone. The mechanism was possibly through regulating the immunomodulatory function of T lymphocyte subsets in cirrhotic rats.

OBJECTIVE: Utilize high-resolution chromosome analysis and microarray detection to determine the genetic etiology of infertility of a 32-year old female patient. METHODS: The peripheral blood of the patient was cultured for high-resolution chromosome G and C banding karyotype analysis, and then 750K SNP-Array chip detection was performed. RESULTS: Karyotype analysis results showed that the patient's karyotype was 45,XX,-13 [7]/46,XX,r(13) (p13q34) [185]/46,XX,dic r(13;13)(p13q34;p13q34) [14]/ 47,XX,+der(13;13;13;13) (p13q34;p13q34;p13q34; p13q34), dic r(13;13) [1]/ 46,XX [3]. The microarray results showed that the patient had a 3.3 Mb deletion in the 13q34 segment of chromosome 13, which may be related to infertility. CONCLUSION Infertility of the patient reported in this article may be related to the deletion of chromosome segment (13q34-qter).
Adult ; Chimera ; Chromosome Banding ; Chromosome Deletion ; Chromosome Disorders/genetics* ; Dacarbazine ; Female ; Humans ; Infertility/genetics* ; Ring Chromosomes

ObjectiveTo investigate the current status of knowledge， attitude and practice of nurses in mental health hospitals on the prevention and control of nosocomial infections， and to analyze the influencing factors. MethodsFrom June to August 2020， 402 clinical nurses from 8 mental health hospitals in a city were enrolled using simple random sampling method， and were assessed using a self-compiled knowledge-attitude-practice questionnaire related to the nosocomial infection prevention and control， thereafter， the influencing factors were screened. ResultsThe scores of knowledge， attitude and practice dimensions in relation to the nosocomial infection prevention and control among the nurses were （8.43±1.84）， （76.01±5.70） and （57.42±3.75）， respectively. Univariate analysis showed that the knowledge dimension score demonstrated significant difference among nurses of different types of hospital， grades of hospital， professional titles， education levels， and emphasis degrees of hospital and individual on nosocomial infection （P<0.05 or 0.01）. The attitude dimension scores yielded significant difference among nurses of different types of hospital， position， grades of hospital， and emphasis degrees of hospital and individual on nosocomial infection （P<0.05 or 0.01）. The practice dimension scores manifested significant difference among nurses of different types of hospital， grades of hospital， professional titles， emphasis degrees of hospital and individual on nosocomial infection， and training frequency （P<0.05 or 0.01）. Multiple linear regression analysis showed that professional titles and individual emphasis on nosocomial infection entered the regression model of nurses' knowledge dimension of nosocomial infection prevention and control （P<0.05 or 0.01）. Individual emphasis on nosocomial infection， hospital types and position entered the regression model of attitude dimension （P<0.05 or 0.01）. Individual emphasis on nosocomial infection， hospital types， professional titles， and hospital emphasis on nosocomial infection entered the regression model of practice dimension （P<0.05 or 0.01）. ConclusionNurses in mental health hospital have a positive attitude towards nosocomial infection prevention and control， but their knowledge base needs to be strengthened.

Objective To investigate the role of autophagy in contrast-induced acute kidney injury(CI-AKI)in rats and to explore its possible mechanism.Methods SD rats were randomly divided into control group,acute kid-ney injury model group(intravenous injection of contrast medium ioversol via tail vein;model),rapamycin(RAPA)group and hydroxychloroquine(HCQ)group.Blood urea nitrogen(BUN)and serum creatinine(Scr)con-tents were measured and the potential change foun in renal pathology was detected by HE staining and microscopy.Transmission electron microscopy was used to observe auto-phagy-related changes in ultrastructure.Western blot was used to observe the expression of microtubule-associated protein 1 light chain 3(LC3)Ⅱ/LC3Ⅰ,ubiquitin-binding protein p62 and Histone deacetylase 4(HDAC4).The expression of HDAC4 was also observed by RT-qPCR.Results Compared with control group,the level of BUN,Scr and HDAC4 expression in the model and HCQ group was increased(P＜0.01),the proximal tubules of the kidney were significantly damaged.In the model group,auto-phagososomes and autolysosomes increased,accompanied by an increase of LC3Ⅱ/LC3Ⅰ and a decrease in the p62 level(P＜0.05,P＜0.01);Compared with model group,there were more autophagosomes and autolysosomes were found in RAPA group(P＜0.01),accompanied by increased LC3Ⅱ/LC3Ⅰratio and decrease in the p62 and HDAC4(P＜0.05,P＜0.01).In contrast,the number of autophagy related structures decreased in HCQ group(P＜0.01),accompanied by the simultaneous increase of LC3Ⅱ/LC3Ⅰ,p62 and the increase of HDAC4(P＜0.01).Conclusions Ioversol may induce autophagy activation,while enhancing autophagy by RAPA alleviates CI-AKI induced renal dysfunction.The mechanism is potentially atributed to the regulation of HDAC4.