Objective To discuss the diagnostic value of 3D-ultrasound for cord entanglement in monoam-niotic twins. Methods From November 2013 to March 2016,a total of 65 monoamniotic twinsunderwent routine obstetric ultrasonography to screen fetal abnormalities in our hospital. The cord was meticulously observedusing a systematic continuous sequence approach. Fetuses who showed cord entanglement by 2-D ultrasound or 3-D flow Doppler were all recruited. The gestational weeks,fetal malformation,ultrasonic image feature of cord entangle-ment,and clinicaloutcome were recorded and analyzed retrospectively. Results 4 monoamniotic twins showed cord entanglement. Three-dimensional color Doppler clearly delineated thefeatures of entanglement. At following-up of 8 fetuses,3 fetuses were found intrauterine fetal death and 3 fetuses with structural abnormalities except for 2 well infants.Conclusion Cord entanglement may threaten the safety of fetusesin monoamniotic pregnancies.In aid of 2-D ultrasound or 3-D flow Doppler in monoamniotic twins can help to find it in time ,monitor it carefully and provide evidence for obstetric treatment .

Objective To evaluate the effect of tirofiban injection in coronary artery occlusion by suction catheter on the opening time of the coronary artery occlusion , the improvement of the blood flow and the incidence of adverse events in 30 days. Methods A total of 97 patients with acute myocardial infarction in recent 4 years were included , whose culprit vessels were subtotal occlusion or total occlusion by angiography and were randomly divided into thrombus aspiration group (group A) and tirofiban injection in occlusion and thrombus aspiration group (group B). The opening time of the coronary artery, the improvement of the blood flow and the incidence of adverse events in 30 days were compared between two groups. Results The opening time of the coronary artery occlusion in group A was shortened when compared with group B but the blood flow arriving TIMI III grade in group B was shorter (P < 0.05). No-reflow incidence in group B was lower while the proportion of blood flow arriving TIMI III grade was higher than that in group A in early phase (P < 0.05). The incidence of adverse events in 30 days was decreased in group B when compared with group A ,but the difference wasn't statistically significant (P > 0.05). Conclusion Direct tirofiban injection in coronary artery occlusion could effectively shorten the opening time of the coronary artery occlusion reduce no-reflow incidence , and improve coronary perfusion but could not decrease the incidence of adverse cardiovascular events in 30 days.

BACKGROUND:Tranexamic acid is extensively used in the primary total knee replacement, but there are many different methods. OBJECTIVE:To explore the efficacy and safety of the intra-articular injection of tranexamic acid with pressurization in reducing the blood loss of primary total knee replacement. METHODS:Total y 56 patients undergoing unilateral total knee arthroplasty were enrol ed and randomly divided into two groups. Patients were given the intra-articular injection of 100 mL of saline solution dissolving 2.0 g of tranexamic acid with large pad pressure bandaging the knee, and 4-hour drainage tube close, and then underwent negative pressure suction (experimental group);differently, the controls were given the normal pad bandage group. The drainage tube was removed within 48 hours after replacement. The patient blood routine examination was performed at the 3rd day, and at the same time, the volume of drainage was recorded;and the color Doppler ultrasound in ipsilateral lower extremity veins was conducted to observe the incidence of thrombosis at 4-5 days. RESULTS AND CONCLUSION:(1) The total blood loss, postoperative dominant blood loss, and hidden blood loss in the experimental group were significantly less than those in the control group (P<0.05). (2) No significant difference was found in the incidence of postoperative thrombosis between two groups (P>0.05). (3) These results indicate that the intra-articular injection of tranexamic acid with pressurization can significantly reduce the postoperative blood loss in the primary total knee arthroplasty, without increasing the risk of deep vein thrombosis.

Objective To study the effect of chloride channel blocker(niflumic acid,NFA) on pulmonary hypertension induced by high pulmonary blood flow in rats.Methods Fifty male or female Sprague-Dawley rats were randomly divided into 5 groups:normal group,sham group,model group,drug 1 group,and drug 2 group,with 10 rats in each group.After subjected to an abdominal aorta-inferior vena cava shunt,all the rats were reared under the same condition for 11 weeks.Then,mean pulmonary artery pressure(mPAP) and right ventricular hypertrophy index(RVHI) of each rat were measured.In addition,arterial wall area/vessel area (W/V) and arterial wall thickness/vessel external diameter(T/D) of each rat were also measured.Results 1.The mPAP of model group [(25.79 ± 4.03) mmHg,1 mmHg =0.133 kPa] was significantly higher than those of normal group [(16.48 ± 1.70) mmHg],sham group [(17.03 ± 2.01) mmHg],drug 1 group [(21.78 ± 2.77) mmHg] and drug 2 group [(20.31 ± 2.15) mmHg] (F =18.983,P ＜0.01).Although the mPAP of drug 1 group was a little higher than drug 2 group,there was no significant difference (P ＞ 0.05).Compared with normal group and sham group,the mPAP of drug 1 group and drug 2 group increased(P ＜0.01,respectively).2.The W/V and T/D of model group were significantly higher than those of normal group,sham group,drug 1 group and drug 2 group (F =26.135,15.527,all P ＜ 0.001).The W/V and T/D of two drug groups showed no significant difference,but they were higher than those of normal group and sham group (P ＜ 0.01,respectively).Conclusions Chloride channel blocker NFA partly decrease mPAP of pulmonary hypertension indnced by high pulmonary blood flow in rats,and inhibit proliferation of vascular smooth muscle cells.These results suggest that NFA had part of therapeutic effect to pulmonary hypertension induced by high pulmonary blood flow.

BACKGROUND:Jumonji domain-containing histone demethylase (JMJD) can promote osteoblast differentiation, and estrogen-related receptor alpha (ERRα) can promote osteoblast differentiation and increase bone formation. However, little is reported on the association between postmenopausal osteoporosis andJMJD and ERRα. OBJECTIVE: To study the changes in the JMJD2 family expression in patients with postmenopausal osteoporosis. METHODS: Postmenopausal patients with osteoarthritis of the hip scheduled for total hip arthroplasty, aged 50-70 years, were enroled, including 10 postmenopausal osteoporosis patients (experimental group) and 10 patients with no postmenopausal osteoporosis (control group). During the arthroplasty, the cancelous bone specimens from the femoral head were colected. Then, immunohistochemistry and western blot assay were used to detect expression of histone demethylase (JMJD2A, JMJD2B), histone methylation (H3K9me3, H3K36me3) and ERRα. RESULTS AND CONCLUSION:In the experimental group, the expressions of JMJD2A, JMJD2B and ERRαwere from weakly positive to positive; these expressions were significantly lower in the experimental group than the control group (P < 0.05). The expressions of H3K9me3 and H3K36me3 were significantly higher in the experimental group than the control group (P < 0.05). These findings indicate that the expression of JMJD2A and JMJD2B is consistent with the expression of ERRα in the patients with postmenopausal osteoporosis, and JMJD is likely to serve as an antagonistic enzyme of osteoporosis.

BACKGROUND: Heterotopic ossification (HO) is common following primary total hip arthroplasty (THA) in patients with ankylosing spondylitis (AS), which may cause certain influence on functional recovery.OBJECTIVE: To explore the risk factors for HO after primary THA in AS patients.METHODS: The clinical and radiological data from 87 patients (132 hips) with AS undergoing primary THA between June 2011 and December 2015 were retrospectively analyzed, and followed up for more than 6 months. The radiological information included preoperative and postoperative hip anteroposterior and lateral radiographs. The presence of HO surrounding the prosthesis was evaluated on the radiographs at the last follow-up and graded according to the Brooker classification. Risk factors for HO were divided into invariable factors (age, sex, course and with or without ankylosed hip) and variable factors (preoperative C-reactive protein level, preoperative erythrocyte sedimentation rate, intraoperative blood loss, operation time, prosthesis types and anesthesia methods) to determine the pertinent risk factors.RESULTS AND CONCLUSION: (1) Totally 43 hips (32.6%) were found to have developed into HO. (2) Invariable risk factors including male (P=0.029), preoperative ankylosed hip (P < 0.001), and course (P=0.029) increased the prevalence of HO. Among the variable risk factors, prolonged operation time (P=0.031) and general anesthesia (P=0.003)were associated with the increased occurrence of HO. Age, preoperative C-reactive protein level and erythrocyte sedimentation rate, intraoperative blood loss, and prosthesis types had no obvious correlation with HO. (3) These results suggest that to prevent the formation of HO following THA in AS, efforts to reduce the operation time and avoid general anesthesia should be considered.

Objective To study correlation between biochemical markers of bone metabolism and postmenopausal osteoporot-ic vertebral fractures.Methods The clinical data of 100 cases with postmenopausal osteoporotic were study retrospectively.Fifty patients were postmenopausal osteoporotic,the rests were postmenopausal osteoporotic vertebral fractures.Lumbar spine,hip BMD,serum P1NP,β-CTX,N-MID,25-(OH)VitD and Ca2 + were recorded.Results There was a significant difference among ser-um P1NP,β-CTX and 25-(OH)VitD(P <0.05 ).There was positive correlation between postmenopausal osteoporotic vertebral fracture with serum P1NP (P <0.05),and negative correlation with serum 25-(OH)VitD (P <0.05),but had no correlation with serumβ-CTX (P >0.05).Conclusion Serum P1NP and 25-(OH)VitD could predict risk of postmenopausal osteoporotic vertebral fractures.Biochemical markers of bone metabolism combined with BMD could reduce postmenopausal osteoporosis fractures.

BACKGROUND: The proliferation of peripheral blood stem cells among peripheral blood mononuclear cells (PBMCs) invitro remains unclear. There is no optimal marker for tracing PBMCs transplanted in vivo.OBJECTIVE: To observe the degree of PBMC proliferation in stem cell medium by EdU labeling and to explore thefeasibility of EdU-labeled peripheral blood stem cells.METHODS: New Zealand rabbit PBMCs were isolated and cultured for 1 to 5 days in stem cell medium supplementedwith EdU. The cells were observed and counted at 0, 1, 2, 3, 4 and 5 days in culture. The cells were harvested at eachtime point and stained with EdU fluorescent reagents. Then, confocal microscopy and flow cytometry were used to detectEdU-labeled cells.RESULTS AND CONCLUSION: (1) Freshly isolated rabbit PBMCs were rounded and showed clear outline. After 1 dayculture, most of the cells were suspended in the medium, spherical or round. There were also a few cell clusters andadherent cells scattered in a triangle or polygon shape; after 2 days culture, more cell debris were observed, and mostcells were round; when cultured for 3-5 days, increased cell debris, smaller cell mass and decreased cell densitysignificantly were observed. (2) With the prolongation of culture time, the cell count decreased gradually. (3) Whencultured for 1 day, EdU labeled cells in red were scattered. The number of cells marked with EdU red label increasedsignificantly at day 2 and remained unchanged after 3 days of culture. At 5 days of culture, the number of red cellsmarkedly decreased; the highest positive rate of EdU-labeled cells was (2.38±0.10)% at 2 days after culture. To conclude,these results showed that the proportion of proliferating cells in rabbit PBMCs was very low. EdU is capable of labelingproliferative cells among PBMCs.

Objective To study the pulmonary interstitial changes in pulmonary hypertension induced by high pulmonary blood flow.Methods Sixty-five male or female Sprague-Dawley rats (180-230 g) were used and randomly divided into 3 groups:normal group (n =20) ; sham group (n =20),only exposing the abdominal aorta and inferior vena cava about 10-20 minutes;model group(n =25),rats in this group were subjected to an abdominal aorta-inferior vena cava shunt to create animal models of high pulmonary.After operation,all the rats were reared under the same conditions for 11 weeks.Then,the systolic pulmonary artery pressure (sPAP) and mean pulmonary artery pressure (mPAP) of every rat were determined by means of homemade right heart catheterization.After that,the right ventricle (RV) was separated from the left ventricle (LV) and septum (S),then weighed.And right ventricular hypertrophy index (RVHI) was measured by the ratio of RV to LV + S [RV/(LV + S)].In addition,the morphological changes of pulmonary interstitial of rats were observed under optical microscope by means of hematoxylin-eosin (HE) staining.In the end,single pulmonary artery smooth muscle cell (PASMC) was isolated through acute enzyme separation.Then membrane capacitance (Cm) was recorded through in the method of patch clamp technique.Results 1.Compared with sham group and normal group,the sPAP,mPAP and RVHI of model group increased significantly(F =17.293,16.259,12.878,all P ＜ 0.01).2.In contrast to sham group and normal group,arterial wall area/vessel area(W/V) and arterial wall thickness/vessel external diameter(T/D) in model group increased significantly(F =85.717,22.795,all P ＜0.01).3.The membrane capacitance of model group was bigger than that of sham group and normal group(F =8.704,P ＜ 0.01).4.mPAP was positively correlated with W/V,T/D and Cm (r =0.669,0.662,0.663,all P ＜ 0.01).Conclusions Shunts from abdominal aorta-inferior vena cava in SD rats caused high pulmonary blood flow-induced pulmonary hypertension,and these rats appeared with pulmonary smooth muscle cells hypertrophy,pulmonary vascular wall thickening and inflammatory cells infiltration.

Objective:To evaluate the safety and effectiveness of incision and drainage with Holmium laser under flexible ureteroscope in the treatment of parapelvic cysts.Methods:The clinical data of 21 patients with parapelvic cysts in Beijing Friendship Hospital, Capital Medical University from January 2018 to December 2022 were retrospectively analyzed, including 10 males and 11 females. The average age was (62.86±5.38) years, and median age was 63.0 years, aged from 36-72 years. The maximum diameter of the cyst was 33-71 mm, with an average of (53.46±9.68) mm. There were 15 cases with homolateral hydronephrosis and 6 cases with homolateral renal calculus. The patients included in the study were treated with incision and drainage with Holmium laser under flexible ureteroscope. The double J ureteral catheter was removed and the urinary system ultrasound was repeated one month after surgery. CT on bilateral kidney was repeated every 6 months until 12 months after surgery. Subsequently, ultrasound on bilateral kidney was reviewed regularly every year. Prognostic indexes sunch as operation time, postoperative hospital stay, postoperative time of getting out of bed, intraoperative blood loss, recurrence and shrinkage of renal cysts were recorded.Results:Of the 21 patients who underwent incision and drainage with Holmium laser under flexible ureteroscope, 9 cases (42.9%) underwent the one-stage operation and 12 cases (57.1%) underwent the two-stage operation. The mean operative time was (41.57±10.86) min, the mean postoperative hospitalization time was (2.90±1.06) d, the mean time of getting out of bed was (0.53±0.30) d, and the mean intraoperative blood loss was (6.52±2.15) mL. No significant recurrence of cysts was observed in all patients after 6-60 months of follow-up, and the cysts disappeared completely or shrank significantly.Conclusion:Incision and drainage with Holmium laser under flexible ureteroscope is safe and reliable in patients with parapelvic cysts, with short operation time, minor blood loss, rapid postoperative recovery and low recurrence rate, which is one of the ideal treatment options for parapelvic cysts.