ObjectiveTo explore the influence of fluvastatin on the levels of IL-6,MMP-1 and APN in patients with coronary heart diseases.Methods60 patients with coronary heart diseases were randomly divided into 2groups:40mg group and 80mg group treated by fluvastatin and 30 healthy persons were selected as control group,serum levels of IL-6,MMP-1 and APN were measured before and after treatmead.ResultsSerum levels of IL-6,MMP-1 were significantly increasd in the coronary heart diseases group (t =4.896,4.231,all P ＜ 0.05 ).Serum level of APN was significantly decreasd in the coronary heart diseases group( t =4.352,P ＜ 0.05 ).The serum levels of IL-6and M MP-1 were significantly decreasd after therapy (4.156,4.121、4.553,all P ＜ 0.05 ).The decrease of serum levels of IL-6,MMP-1 in 80mg group was more significant than those of 40mg group( t =3.786,3.690,4.10,all P ＜0.05).ConclusionSerum concentrations of IL-6 and MMP-1 increase,but APN decrease in patients with coronary heart diseases.Serum concentrations of IL-6,MMP-1 and APN had relationships with coronary plaque extent.Fluvastatin could decrease serum levels of IL-6 and MMP-1,increase serum level of APN in patients with coronary heart diseases,and have a beneficial effect on steadying the plaque.

Necrotizing enterocolitis ( NEC) is one of the most serious diseases of digestive system dur-ing neonatal period,which is one of the main cause of premature death. The components which maintain the in-testinal barrier function of newborns,especially the premature infants,are always underdeveloped,and easily to be damaged. Thus,the formation of tight junctions between epithelial cells is broken,the early intestinal peristal-sis established delayed,and the secretion of sIgA is reduced. These pathogenic factors induce serious complica-tions,such as intestinal barrier dysfunction,bacterial translocation and sepsis. Hypoxia ischemia,inflammation, infection can either cause intestinal mechanical barrier damage. The delay of micro ecological barrier establish-ment,the immature of immune barriers,intestinal microcirculation dysfunction are all involved in the occurrence of NEC. In addition,miRNA also plays an important role in the regulation of intestinal epithelial cell differentia-tion,structure and barrier function. Pathological changes of NEC are the result of intestinal barrier dysfunction, and the injury of intestinal barrier function will aggravate NEC pathological changes. Therefore, understanding the role of intestinal barrier dysfunction in the pathogenesis of NEC may improve the prevention and treatment of NEC.

Objective:To evaluate the efficacy of posterior subtotal vertebrectomy in the treatment of thoracolumbar vertebral refractures after vertebroplasty.Methods:A retrospective analysis was conducted in the 28 patients with refracture after percutaneous vertebroplasty(PVP) or percutaneous kyphoplasty(PKP) who had been treated at Department of Spinal Surgery, Henan Provincial People's Hospital from June 2017 to October 2019. They were 7 males and 21 females, with an average age of 62.4 years(from 61 to 76 years). A total of 28 vertebrae were involved, including 5 T11s, 9 T12s, 11 L1s and 3 L2s. Their previous operations were PKP in 17 cases and PVP in 11. After the spinous process, vertebral plate, articular process and transverse process were resected by posterior approach, the vertebral body, bone cement and upper and lower intervertebral discs were partially resected by trans-vertebral lateral approach. At the same time, nerve decompression was performed. Finally, the inter-vertebral support was fixated followed by the posterior screw-rod orthopedic fixation. The operation time and intraoperative bleeding volume were recorded. The cobb angles of kyphosis were compared on the X-ray films of the whole spine between preoperation and the last follow-up to evaluate correction. Functional improvement of the spine was evaluated by comparison of the visual analogue scale (VAS) and JOA(Japanese Orthopedics Association) scores between preoperation and the last follow-up.Results:The operation time averaged 182.1 min and intraoperative bleeding volume 996.2 mL. All the 28 patients were followed up for 8 to 29 months (mean, 19.8 months). No obvious neurological lesions or other serious complications were observed. The cobb angle was improved from preoperative 41.3°±10.3° to 6.4°±2.5° at the last follow-up, the VAS score from preoperative 7.3±1.8 to 2.5±1.0 at the last follow-up, and the JOA score from preoperative 8.4±2.3 to 21.3±2.5 at the last follow-up, showing a significant difference in all the comparisons ( P<0.05). Conclusion:The posterior subtotal vertebrectomy is effective for thoracolumbar vertebral refractures after vertebroplasty because it can remove bone cement, decompress the spinal canal, fuse the inter-vertebral graft and reconstruct the spinal stability in one stage.

Tumor microenvironment (TME) plays a key role in the development and progression of tumors, such as pro?moting local drug resistance, immune escape, and distal metastasis. According to the TME of different individuals, accurate evaluation and selection of clinical medication can effectively control the malignant transformation of carcinoma in situ and metastatic cancer. At present, the main method to treat cancer is chemotherapy, TME can regulate the reaction of the tumor cells to the standard chemotherapy and target drug therapy, so the combination of the targeted TME therapy and chemothera?py will achieve better clinical efficacy. In this review, we summarized the mechanisms of TME in breast cancer, including ex?tracellular matrix, carcinoma-associated fibroblasts, carcinoma-associated macrophages, regulatory T cells and bone marrow mesenchymal stem cells, which providing a theoretical basis for the development of TME targeted therapy.

Objective: To assess plantar arch index (AI) and prevalence of flat feet in school-age children (7-12 years old) in Shanghai and evaluate the relationship between flat feet with age, gender, weight status (BMI) and occurring sides, and to provide a reference for the prevention of flatfeet. Methods: Three-dimensional foot measuring instruments were used to measure bilateral foot length, medial arch height, AI and arch height ratio (AHR) in school-age children in Shanghai. Statistical analysis of these foot parameters was performed. Results: A total of 3 226 children between aged 7 and 12 in Shanghai were measured with AI of (0.27±0.05) and AHR of (3.02±1.89). Prevalence of flat feet in the group of 7 to 12 year old children was 56.1%. Prevalence of flatfeet decreased significantly with age: 72.6% at 7 years old and 37.9% at 12 years old. Boys had a significantly greater risk for flat feet than girls: the prevalence of flat feet was 62.9% for boys and 47.8% for girls (OR=1.81, 95%CI=1.57-2.10). This risk was independent of age but related to gender. The risk of flat feet in boys was always higher than that in girls at every age. For children aged 7-8, being overweight was not significantly related to the occurrence of flat feet. However, for children aged 9-12 who were overweight were more likely to have flat feet than those of normal weight. The OR increased with age: from 1.44 (95%CI=1.03-2.03) at 9 to 2.96 (95%CI=1.68-5.23) at 12. There was no difference on which side flat feet would occur (χ2=0.95，P=0.33). Conclusion This finding shows that prevalence of flat feet is influenced by age, gender and weight status. AI and prevalence of flat feet in children aged 7-12 decreases with age, and boys have significantly higher prevalence of flat feet than girls. Overweight children aged 9 or older have a higher risk of flat feet.

Objective:To compare the effect of O-arm assisted and free-hand pedicle screw placement in the treatment of AO type C thoracolumbar fracture.Methods:A retrospective cohort study was used to analyze the clinical data of 34 patients with type C thoracolumbar fracture admitted to Henan Provincial People′s Hospital from January 2018 to June 2021, including 23 males and 11 females; aged 42-63 years [(50.4±7.4)years]. The fracture was located at T 11 in 4 patients, T 12 in 10, L 1 in 12, L 2 in 6, T 11~12/L 1 in 1 and T 12/L 1 in 1. Posterior reduction and internal fixation was carried out for all patients, of whom 18 were treated with O-arm assisted pedicle screw placement (navigation group) and 16 with free-hand pedicle screw placement (free-hand group). The operation time, single screw placement time, intraoperative bleeding volume, operation mode and screw placement accuracy were compared between the two groups. The kyphotic Cobb angle, visual analogue score (VAS) and American Spinal Injury Association (ASIA) score were compared between the two groups before operation, at 1 week after operation, at 3 months after operation and at the last follow-up. Postoperative complications were observed. Results:All patients were followed up for 12-29 months [(16.8±6.1)months]. There was no significant difference between the two groups in the operation time, intraoperative bleeding volume and operation mode (all P>0.05). The single screw placement time was (9.4±1.6)minutes in navigation group, but was (10.8±1.5)minutes in free-hand group ( P<0.05). The screw placement accuracy was 97.4% in navigation group, but was 81.5% in free-hand group ( P<0.01). The kyphotic Cobb angle and VAS had no significant differences between the two groups before operation (all P>0.05). The kyphotic Cobb angle in navigation group and free-hand group was (4.3±1.1)° and (5.9±1.1)° at 1 week after operation, (4.4±1.2)° and (5.7±1.3)° at 3 months after operation, and (4.4±1.2)° and (6.8±0.9)° at the last follow-up, decreased significantly from that before operation [(21.8±3.1)°, (22.2±3.2)°] (all P<0.01). The kyphotic Cobb angle in navigation group was significantly lower than that in free-hand group at 1 week, 3 months after operation and at the last follow-up (all P<0.01). The VAS in navigation group and free-hand group was (3.2±0.7)points and (4.1±0.7)points at 1 week after operation, (2.4±0.6)points and (3.0±0.8)points at 3 months after operation, and (1.8±0.9)points and (2.6±0.7)points at the last follow-up, decreased significantly from that before operation [(8.4±0.8)points, (8.3±0.9)points] (all P<0.01). The VAS in navigation group was significantly lower than that in free-hand group at 1 week, 3 months after operation and at the last follow-up (all P<0.01). The ASIA score showed no significant difference within and between the two groups before operation, at 1 week, 3 months after operation and at the last follow-up (all P>0.05). Postoperative incision infection occurred in 1 patient in both groups ( P>0.05). Implant failure such as loosening or displacement was not observed in navigation group, and only occurred in 2 patients in free-hand group ( P>0.05). Conclusion:Compared with free-hand pedicle screw placement, O-arm assisted pedicle screw placement in the treatment of AO type C thoracolumbar fracture has advantages of rapid and accurate screw placement, good reduction and notable pain relief.

Objective:To investigate the safety and efficacy of submucosal tunnel docking endoscopic resection (SDER) for the treatment of giant submucosal tumors in the cardia.Methods:A retrospective analysis was performed on data of patients with giant submucosal tumors in the cardia who were treated with SDER at the endoscopy center of Zhongshan Hospital, Fudan University and Xuhui District Central Hospital from January 2021 to January 2022. The surgical records, postoperative pathology, complications, hospitalization, and follow-up were analyzed.Results:A total of 6 patients were included. The mean long diameter of the lesions was 4.0 cm, all of which were located in the cardia. All patients successfully underwent SDER treatment with a surgical time of 23-42 min. Postoperative pathology revealed that 4 cases were leiomyomas and 2 cases were gastrointestinal stromal tumors. All lesions were completely resected. The postoperative hospital stay was 3-5 d, and no serious complications occurred after surgery. All patients recovered on follow-up gastroscopy at 3 and 6 months postoperatively.Conclusion:The preliminary conclusion is that SDER for the treatment of giant submucosal tumors in the cardia is safe, effective.

Objective:To evaluate the clinicopathological characteristics and prognosis of IgA nephropathy (IgAN) patients with microangiopathy lesions and with no hypertension.Methods:Adult IgAN patients without hypertension were selected from Peking University First Hospital. All kidney biopsies were independently reviewed by 2 investigators. Patients were divided into three groups (microangiopathy group, simple arterio/arteriolosclerosis group and normal vascular group) by renal arteriolar lesions. Composite kidney end point event defined as a ≥30% reduction in estimated glomerular filtration rate (eGFR) and end-stage kidney disease. Cox regression analysis was used to test the association between microangiopathy lesions and the outcomes.Results:A total of 420 patients were included in this study, of which 37(8.8%) patients had renal arteriolar microangiopathy lesions, 134 (31.9%) patients had simple arterio/ arteriolosclerosis, and the others had no vascular lesion. Compared with simple arterio/arteriolosclerosis group or non-vascular lesion group, patients with renal arteriolar microangiopathy lesions had more severe urine protein ( P=0.002), worse renal function ( P<0.001), higher proportion of segmental glomerulosclerosis and/or balloon adhesion (S1), tubular atrophy/interstitial fibrosis (T1/2), cellular/fibrocellular crescents (C1/2) (all P<0.05). During the follow-up, 20(54.1%) patients with microangiopathy lesions, 45(33.6%) patients with simple arterio/arteriolosclerosis and 82(32.9%) patients without vascular lesion reached the composite kidney end points ( χ2=6.491, P=0.039). In a multivariable Cox regression model, the presence of microangiopathy lesions was an independent risk factor for kidney disease progression in IgAN patients ( HR=1.872, 95% CI 1.044-3.357, P=0.035), and simple arterio/arteriolosclerosis was not a risk factor for kidney disease progression. Conclusion:It is not uncommon for non-hypertensive patients with IgAN having microangiopathy lesions, which suggests that hypertension is not the sole risk factor for microangiopathy lesions.