Objective　To evaluate the effect of tamoxifen on the endometrium. Methods　Hysteroscopy and endometrial biopsies were performed in 26 patients with breast cancer receiving tamoxifen and having vaginal bleeding or endometrial thickness detected by ultrasound. In addition 78 women with postmenopausal bleeding without receiving tamoxifen underwent the same examination. Results　Thirteen (50.0%) patients receiving tamoxifen had endometrial or endocervical polyps, whereas 14 cases(17.9%) not receiving tamoxifen developed the polyps （P＜0.05）. Nine (34.6%) patients receiving tamoxifen had thyperplasias, which was significantly higher than that of women not receiving tamoxifen (P<0.05). Conclusions　The incidence of endometria disease in the patient with breast cancer receiving tamoxifen was increased. These patients should be closely monitored by transvaginal sonography and hysteroscopy.

Objective To evaluate the treatment and clinical outcome of pancreatic pseudocysts.Methods Clinical data of 53 pancreatic pseudocyst patients treated from Jan 2008 to Oct 2014 was retrospectively analyzed.Results 9 cases underwent CT-guided percutaneous catheter drainage,among them 3 cases underwent reoperation.8 cases underwent endoscopic ultrasonography-guided transmural drainage,including transgastric approach in 7,transduodenal approach in 1,Procedures in all these 8 cases were successful and pseudocyst disappeared completely without complication.Surgical procedures were performed in 36 cases,3 by external drainage,1 of the 3 underwent reoperation;11 cases underwent cystgastrostomy,with 2 suffering from postopertative gastrointestinal bleeding;3 cases underwent cystduodenostomy;19 cases underwent Roux-en-Y cystojejunostomy,with 1 suffering from postopertative gastrointestinal bleeding.Follow-up ranged from 4 months to 6 years,there was no cyst recurrence.Conclusion The treatment of pancreatic pseudocysts is diversified and should be individualized.Internal drainage is the mainstay of treatment,preferably through endoscopic ultrasonography-guided transmural drainage,leaving difficult cases to open cystojejunostomy.

Objective To investigate the process of apoptosis in lungs and liver induced by crushing hindlimbs of rat, and study the mechanismof crush injury. Methods The rat experimental model of hindlimbs crush injury was established. The cell apoptosis in lungs and liver was detected by TUNEL assay, and the expression of Bax, Bcl-2 and caspase-3 apoptin was examined by immunohistochemistry. Results C ompared with the control group, the partial muscle injury of rat’s hindlimbs was more serious with more apoptosis observed in lungs and liver (P<0.05). The expression of Bax was up-regulated and Bcl-2 was down-regulated, whereas caspase-3 expression was activated (P<0.05). Conclusion The cell apoptosis has increased significantly in lungs and liver after crush injury of hindlimbs in rat. The corre-lation factor released during tissue injury may mediate apoptosis process.

Objective To explore the role of the PI3K/Akt signaling pathway in the calvarial osteolysis induced by TCP wear particles in mice model.Methods Thirty-six male ICR mice were randomly divided into a sham group (n=12),TCP group (n=12)and a LY294002-treated group (n=12).A murine calvarial model of osteolysis was established through implanting 30 mg of TCP particles onto the surface of bilateral parietal bones following the removal of the periosteum.On the second postoperative day,LY294002 (5 mg·kg-1)was locally injected to the calvarium under the periosteum three times a week;mice in the sham group received local injection of normal saline (N.S.)in the calvarium,and the injection time was consistent with that of LY294002.Two weeks later,the calvaria and periostea were obtained after the mice were executed.The calvarial osteolysis,bone mineral density (BMD)and bone mineral content(BMC)were analyzed using Micro-CT,Hematoxylin-Eosin (HE)staining was conducted to observe the inflammatrory response and formation of osteoclasts.Real-time PCR was applied to detect the mRNA level of tartrate-resistant acid phosphatase (TRAP),the marker of osteoclasts formation,cathepsin K (CstK),receptor activator for nuclear factor-κB kigand (RANKL)and c-Fos.The release of tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6)and IL-1β were measured using enzyme-linked immumsorbent assay (ELISA).Results Micro-CT and histological analysis indicated that LY294002,the specific inhibitor of PI3K,significantly prevented TCP wear particles-induced osteolysis and osteoclastogenesis,and increased BMD and BMC in the calvaria of mice.Real-time PCR data revealed LY294002 significantly suppressed the increase in mRNA level of osteoclastogenic genes such as TRAP,CstK,RANKL and c-Fos in the calvaria of TCP wear particles-implanted group.ELISA assay showed that TCP wear particles-induced release of TNF-α,IL-1β and IL-6 was significantly inhibited by LY294002 treatment.Furthermore,LY294002 significantly attenuated TCP wear particles-triggered activation of Akt,and down-regulated the level of p-AktSer473 and p-AktThr308.Conclusion PI3K/Akt signaling pathway contributes to TCP wear particle-induced osteolysis,and can be developed as a new therapeutic target for the prevention and treatment of bone destruction diseases caused by wear debris.

Objective To investigate the feasibility and clinical effect of percutaneous pedicle screw fixation in the treatment of ankylosing spondylitis (AS) with thoracolumbar fractures.Methods A retrospective case-series study was performed on 12 AS patients with thoracolumbar fractures admitted from January 2013 to January 2016.There were 9 males and 3 females,aged (42.7 ± 13.0) years (range,24-63 years).All patients received percutaneous minimally invasive pedicle screw fixation.The operation duration,intraoperative blood loss,length of incision,ambulation time,and time to basic life were recorded.Visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated before and after operation.Postoperative complications and bone fracture union were observed during the followup period.Results All patients were followed up for average 22 months (range,14-36 months).All patients underwent successful surgery,with operation duration and intraoperative blood loss of (178.0 ± 60.2) min and (116.7 ± 44.2) ml respectively.No serious complications such as blood vessel or nerve injury occurred during the operation.The incision length was 1.2-1.5 cm.All the patients were able to do exercise with the help of brace 2-3 days after the operation and returned to basic life after (23.4 ± 7.3)days postoperatively.At 1,3,6 and 12 months after operation,VAS and ODI differed significantly from the preoperative detections (P ＜ 0.05).During the follow-up,bone fracture union was observed in all patients,with no nail breakage or nail loosening occurred after operation.Conclusion For AS combined with thoracolumbar fractures,minimally invasive fixation can attain satisfactory curative effect,with advantages of minor lesion,little bleeding,fast recovery and sound bone union.

Given that the traditional algorithms for elimination of electrocardiogram(ECG)contamination have a poor performance on abnormal ECG signals,a denoising algorithm for diaphragmatic electromyogram(EMGdi)signals based on wavelet dual-threshold filtering is presented.The method constructs the detection threshold of R peak in QRS group wave based on wavelet coefficient for accurately locating the position of the R peak,and takes the average energy on both sides of one interference range as the threshold of this interference range for eliminating ECG contamination.Experimental results of eliminating ECG contamination from clinical EMGdi signals show that the proposed algorithm surpasses the traditional algorithms in interference removal,especially for weak EMGdi signals.

Objective To investigate the clinical efficacy and prognosis of lung transplantation in the treatment of cystic fibrosis (CF). Methods Clinical data of one patient with end-stage CF undergoing allogeneic bilateral lung transplantation were retrospectively analyzed. Clinical characteristics, diagnostic methods and treatment strategies of the CF recipient were summarized. Results The recipient had suffered from relevant symptoms since childhood including repeated cough and purulent sputum for 30 years, complicated with recurrent pulmonary infection combined with acute exacerbation, chronic sinusitis and extremely severe malnutrition. Prior to lung transplantation, the patient had to depend upon the invasive ventilator due to respiratory muscle weakness, and admitted to intensive care unit (ICU) for a long time. Imaging examination revealed multiple cystic columnar bronchiectasis accompanied with infection in bilateral lungs. The diagnosis of CF was further confirmed by sweat test and gene detection. The recipient underwent bilateral lung transplantation on August 17, 2017 and received rehabilitation treatment. The lung function was gradually restored to normal. The recipient had obtained the same quality of life to the healthy counterparts since the date of manuscript submission (over 2 years). Conclusions Lung transplantation is an efficacious treatment for end-stage CF, which can not only save patients' lives, but also significantly improve the quality of life of patients.

Objective:To analyze the association between air pollution, genetic susceptibility, and the risk of all-cause mortality and cardiovascular outcomes in patients with atrial fibrillation (AF).Methods:AF patients aged between 40-69 years old registered in the United Kingdom Biobank from 2006 to 2010 were included. After excluding those lost to follow-up or with incomplete data during follow-up, 5 814 subjects were analyzed. Long-term exposure to air pollution was estimated at the geocoded residential address of each participant. Genetic risk scores for all-cause mortality, cardiovascular disease, heart failure, myocardial infarction, and stroke were constructed separately for each object to assess the corresponding genetic susceptibility. The Cox proportional hazards model was used to analyze the association between air pollution, genetic susceptibility, and the risk of all-cause mortality and cardiovascular outcomes in AF patients.Results:During a median follow-up of 12.4 years, there were 929 of all-cause mortality (15.98%) and 1 772 of cardiovascular events (30.48%). Multivariable-adjusted analyses revealed that higher exposure to PM 2.5, PM 10, NO x, and NO 2 was associated with an increased risk of cardiovascular disease mortality, heart failure, myocardial infarction, and stroke, with hazard ratios ( HRs) ranging from 1.26 to 1.48. Specifically, for each interquartile range ( IQR) increase in PM 2.5 exposure, the HRs for the outcomes mentioned above were 1.33 (95% CI: 1.14-1.54), 1.42 (95% CI: 1.31-1.54), 1.46 (95% CI: 1.30-1.64), and 1.43 (95% CI: 1.27-1.61), respectively. Both NO x and NO 2 exposures were associated with a 9% increased risk of all-cause mortality per IQR increment, with corresponding HRs of 1.09 (95% CI: 1.02-1.17) and 1.09 (95% CI: 1.01-1.17), respectively. Individuals with high genetic susceptibility to AF had a higher risk of myocardial infarction and stroke compared to those with low genetic susceptibility, with corresponding HRs of 1.39 (95% CI: 1.04-1.87) and 1.46 (95% CI: 1.09-1.95), respectively. Compared to AF patients with low air pollution exposure, those with high air pollution exposure have adjusted population attributable fractions of up to 33.57% (95% CI: 17.87%-46.26%) for cardiovascular mortality, 28.61% (95% CI: 20.67%-35.75%) for heart failure, 33.35% (95% CI: 20.97%-43.79%) for myocardial infarction, and 42.29% (95% CI: 30.05%-52.71%) for stroke. Furthermore, there was an additive interaction between PM 2.5, NO x, and NO 2 exposure and high genetic susceptibility on the incidence of myocardial infarction. An additive interaction was also observed between NO x, NO 2 exposure, and high genetic susceptibility on the incidence of heart failure (all P<0.05). Conclusions:Both air pollution and genetic susceptibility increase the risk of all-cause mortality and cardiovascular outcomes in AF patients.

Fracture nonunion is the cessation of a normal reparative process of fracture healing. With an incidence of 2.5%-4.4%, it is one of difficult problem for orthopedics surgeons. Definition, classification, treatment and causes of fracture nonunion are reviewed in this article. The therapeutic principles and methods are introduced systematically combined with causes of fracture nonunion.
Fracture Healing ; Fractures, Ununited ; diagnosis ; therapy ; Humans

Acute cellular rejection (ACR) is a common complication after lung transplantation, which is mainly caused by the immune response of T lymphocytes recognizing the major histocompatibility complex on the cellular surface of grafts. It is currently considered as the main pattern of acute rejection. ACR is not only a direct cause of death of recipients, but also a high-risk factor for chronic rejection after lung transplantation. Nevertheless, it is a challenging task to deliver the diagnosis and treatment of ACR following lung transplantation. In this article, new progresses on the risk factors, pathogenesis, diagnosis and treatment of ACR in lung transplant recipients were summarized, aiming to improve the diagnostic and treatment efficiency of ACR and prolong the survival of recipients.