Objective:To evaluate systematically the outcomes of prevention of fragility fracture with alendronate use for 3 to 4 years.Methods:We searched CENTRAL, MEDLINE, EMBASE and CBM for relevant randomized controlled trials published before 16 July, 2020. The quality of included studies was evaluated according to the Cochrane tool for assessing risk of bias. Fix- or random-effects were taken for meta-analysis depending on the magnitude of heterogeneity. Sensitivity analysis was used for high risk studies to assess the robustness of results. The results were reported according to The PRISMA 2009 Check-list.Results:A total of 8 reports from 4 studies were included. Two reports from 2 studies were rated as high-risk while the other 6 reports from the other 2 studies as low-risk. The meta-analyses showed that use of alendronic acid for 3 to 4 years effectively prevented new vertebral fracture ( RR=0.54, 95% CI: 0.44 to 0.66, RD=-0.03), clinical fracture ( RR=0.82, 95% CI: 0.73 to 0.92, RD=-0.03), non-vertebral fracture ( RR=0.84, 95% CI: 0.75 to 0.95, RD=-0.02), clinical vertebral fracture ( RR=0.51, 95% CI: 0.34 to 0.76, RD=-0.01) and hip fracture ( RR=0.56, 95% CI: 0.37 to 0.87, RD=-0.01), but did not prevent wrist fracture ( RR=0.85, 95% CI: 0.67 to 1.09), serious adverse event ( RR=0.95, 95% CI: 0.80 to 1.14) or upper gastrointestinal adverse event ( RR=1.02, 95% CI: 0.96 to 1.07). By the sensitivity analysis of the 6 results from the high-risk reports, the HRs for clinical fracture, non-vertebral fracture, vertebral fracture, hip fracture, wrist fracture, and serious adverse event were, respectively, 0.81, 0.85, 0.49, 0.62, 0.94 and 0.94. Conclusions:Alendronate use for 3 to 4 years can effectively prevent fragility fractures in postmenopausal women with low bone mass or osteoporosis, leading to better prevention effect on vertebral fracture than on non-vertebral fracture.

Objective To investigate the effects of different processing methods on contents of main chemical components isoferulic acid in Cimicifuga heracleifolia. Methods Cimicifuga heracleifolia from the same batch were prepared by processing method. HPLC were used to determine the contents of isoferulic acid in crudes samples, wine-prepared samples, vinegar-prepared samples, and carbonized samples. Results The contents of isoferulic acid of crudes samples and the three different processed products were in the order as follows:carbonized samples (0.404 7%)>vinegar-prepared samples (0.302 3%)>wine-prepared samples (0.262 4%)>crudes samples (0.231 3%). Conclusion Different processing methods had certain effects on the content of isoferulic acid in Cimicifuga heracleifolia.

Objective To analyze the injury features of the wounded in the bullet train crash in July 23,2011 in Wenzhou of Zhejiang and explore treatment experience.Methods A total of 177 cases who were injured or died in the 7.23 Wenzhou bullet train crash were involved in the study.The age,gender,injury types,injury regions and injury severity were analyzed by using Trauma Database System V3.0 ( produced by China Trauma Data Center of Third Military Medical University). Results A total of 137 cases were admitted to our hospital within 24 hours after the bullet train crash in Wenzhou.There were 76 males and 61 females,with no significant difference.Of the 137 cases,136 survived and one died after medical treatment.The major injury types included impact injury,crush injury and heavy weight falling injury.Among the 136 survivors,108 cases were with multiple injuries,accounting for 79.4％.The most common injury region of the survivors was the chest,followed by the head and limb.The minimum trauma index (TI) was 5 points and the maximum 27 points.There were 4 cases(3.7％ )with TI ≤9 points,86 (79.6％) with 10-16 points and 18 (16.7％) with ≥ 17 points.Of all,78 cases (72.2％) had ISS score ＜ 16 points and 30 (27.8％) had ≥16 points.The minimum ISS was 3 points and maximum 75 points.There were 40 deaths including the one died after medical treatment,who were all with multiple injuries,with head injury the main cause.ConclusionsThe causes of the bullet train crashes are complicated,with high incidence of multiple injuries.The injury severity is varied,but the overall situation is not serious.Distribution of common injury regions is significantly different between the wounded and the dead.Injury triage,patient transfer and specialist treatment of the wounded should be carried out appropriately during the initial stage of medical rescue based on those injury features after the bullet train crashes.

Objective T o observe the changes of cystathionine β-synthase (C B S ) expression in the cere-bral cortex after brain contusion at different tim es. Methods A n experim ental m odel of traum atic brain injury (T B I) in m ice w as established by an im proved w eight-drop device. T hen W estern blotting and im m unohistochem ical exam ination w ere used to detect the C B S expression in cerebral cortex around in-jury at different tim e points (1 h, 6 h, 12 h, 1 d, 2 d, 3 d, 7 d). Results T he results of W estern blotting revealed that the expression level of C B S w as dow n-regulated and reached its low est level at the 3rd days after injury, and then restored to norm al level after 7 days. T he results of im m unohistochem istry show ed that C B S w as present in the norm al brain cortex. C B S expression gradually decreased at the 3rd days after injury, and then restored to norm al level after 7 days. Conclusion C B S has the potential to be a reference index for tim e estim ation after brain contusion in forensic practice.

Objective To investigate the status and influencing factors of sleep in preterm infants at 1 month corrected age.Methods 130 preterm infants admitted to the NICU of 3 tertiary hospitals in Hubei Province were recruited as participants during May 2021 and March 2022.Sleep assessment of preterm infants was conducted at 1 month corrected age.Infants'sleep was assessed using the Brief Infant Sleep Questionnaire(BISQ).Multivariate linear regression model was used to analyze the influencing factors of sleep status(sleep latency,night awakenings,nocturnal sleep duration,daytime sleep duration,24 h sleep duration)of preterm infants.Results A total of 124 preterm infants completed the follow-up at 1 month corrected age.Multiple linear regression analysis showed that feeding patterns and sleep initiation patterns affected the sleep latency;gestational age,mechanical ventilation duration,maternal education level,and sleep initiation patterns were influencing factors of night awakenings;nocturnal sleep duration was influenced by mechanical ventilation duration and feeding patterns;daytime sleep duration and 24 h sleep duration were influenced by feeding patterns and maternal educational level.Conclusion The preterm infant sleep is influenced by gestational age,duration of mechanical ventilation,feeding patterns,maternal education level,and sleep initiation patterns.Neonatology staff should focus on the preterm infants discharged from NICU and develop targeted intervention plans based on the determined influencing factors to improve the sleep status of preterm infants.

Objective To compare the sensitivity and specificity of venereal disease research laboratory (VDRL) test versus several other laboratory tests in the diagnosis of neurosyphilis. Methods Lumber puncture was conducted to obtain cerebrospinal fluid (CSF) from untreated outpatients with latent syphilis (LS) or serofast outpatients with LS. Then, VDRL test, rapid plasma regain (RPR) test, Treponema pallidum particle agglutination (TPPA) assay, fluorescent treponemal antibody-absorption (FTA-ABS) test and protein quantification were performed on these CSF samples. The sensitivity, specificity, positive predictive value and negative predictive value were compared between VDRL test and four other laboratory tests in the diagnosis of neurosyphilis. Results Totally, 61 cases of latent syphilis were included in this study. The sensitivity, specificity,positive predictive value and negative predictive value were 93.44% (57/61), 99.32%(293/295), 96.61%(57/59), 98.65% (293/297)for CSF-RPR, respectively, 91.80% (56/61), 82.71% (244/295), 52.34% (56/107),97.99 (244/249) for CSF-TPPA, respectively, 93.44% (57/61), 82.71% (244/295), 52.78%(57/108), 98.39%(244/248) for CSF-FTA-ABS, respectively, and 49.18%(30/61), 97.29% (287/295), 78.95% (30/38),90.25% (287/318) for CSF protein quantification, respectively. Conclusions CSF-VDRL cannot be replaced by CSF-RPR, -TPPA, -FTA-ABS, or CSF protein quantification in the diagnosis of neurosyphilis. CSF-RPR shows a high sensitivity and specificity in the diagnosis of neurosyphilis, with an increased diagnostic capability (area under the receiver operating characteristic curve) compared with CSF-TPPA, CSF-FTA-ABS or CSF protein quantification.

Objective: To investigate the clinical value of laparoscopic peritoneal dialysis catheter implantation in peritoneal chemotherapy for gastric cancer with peritoneal metastasis. Methods: From January 2019 to June 2019, the clinical data of 6 patients diagnosed as gastric cancer with peritoneal metastasis were retrospectively analyzed in the Gastrointestinal Surgery Department of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine. Five were male and 1 was female. The median age was 69.5 (28-77) years. The median body mass index (BMI) was 22.8 (19.6-23.5). All procedures were performed under general anesthesia with endotracheal intubation. The patient′s body position and facility layout in the operating room were consistent with those of laparoscopic gastrectomy. The operator′s position: the main surgeon was located on the right side of the patient, the first assistant stood on the left side of the patient, and the scopist stood between the patient′s legs. Surgical procedure: (1) trocar location: three abdominal trocars was adopted, with one 12 mm umbilical port for the 30° laparoscope (point A). Location of the other two trocars was dependent on the procedure of exploration or biopsy as well as the two polyester cuff position of the peritoneal dialysis catheter: Usually one 5 mm port in the anterior midline 5 cm inferior to the umbilicus point was selected as point B to ensure that the distal end of the catheter could reach the Douglas pouch. The other 5 mm port was located in the right lower quadrant lateral to the umbilicus to establish the subcutaneous tunnel tract, and the proximal cuff was situated 2 cm away from the desired exit site (point C).(2) exploration of the abdominal cavity: a 30° laparoscope was inserted from 12 mm trocar below the umbilicus to explore the entire peritoneal cavity. The uterus and adnexa should be explored additionally for women. Once peritoneal metastasis was investigated and identified, primary laparoscopic peritoneal dialysis catheter implantation was performed so as to facilitate subsequent peritoneal chemotherapy. Ascites were collected for cytology in patients with ascites. (3) peritoneal dialysis catheter placement: the peritoneal dialysis catheter was introduced into the abdominal cavity from point A. Under the direct vision of laparoscopy, 2-0 absorbable ligature was reserved at the expected fixation point of the proximal cuff (point B) for the final knot closure. Non-traumatic graspers were used to pull the distal cuff of peritoneal dialysis catheter out of the abdominal cavity through point B. The 5-mm trocar was removed simultaneously, and the distal cuff was fixed between bilateral rectus sheaths at the anterior midline port site preperitoneally. To prevent subsequent ascites and chemotherapy fluid extravasation, the reserved crocheted wire was knotted. From point C the subcutaneous tunnel tract was created before the peritoneal steath towards the port site lateral to the umbilicus. Satisfactory catheter irrigation and outflow were then confirmed. Chemotherapy regimen after peritoneal dialysis catheterization: all patients began intraperitoneal chemotherapy on the second day after surgery. On the 1st and 8th day of each 3-weeks cycle, paclitaxel (20 mg/m²) was administered through peritoneal dialysis catheter, and paclitaxel (50 mg/m²) was injected intravenously. Meanwhile, S-1 was orally administered twice daily at a dose of 80 mg·m^-2·d^-1 for 14 consecutive days followed by 7-days rest. To observe the patients′ intraoperative and postoperative conditions. Results: All the procedures were performed successfully without intraoperative complications or conversion to laparotomy. No 30 day postoperative complications were observed. The median operative time was 33.5 (23-38) min. The median time to first flatus was 1(1-2) days, and the median postoperative hospital stay was 3 (3-4) days, without short-term complications within 30 days postoperatively. The last follow-up was up to July 10, 2019, and the patients were followed for 4(1-6) months. No ascites extravasation was observed and no death occurred in the 6 patients. There was no catheter obstruction or peritoneal fluid extravasation during and after chemotherapy. Conclusion Laparoscopic peritoneal dialysis catheter implantation was safe and feasible for patients with peritoneal metastasis of gastric cancer. The abdominal exploration, tumor staging and the abdominal chemotherapy device implantation can be completed simultaneously, which could simplify the surgical approach, improve the quality of life for patients and further propose a new direction for the development of abdominal chemotherapy.

Chimeric antigen receptor (CAR)-T cell therapy has achieved remarkable success in the treatment of hematological malignancies. Based on the immunomodulatory capability of CAR-T cells, efforts have turned toward exploring their potential in treating autoimmune diseases. Bibliometric analysis of 210 records from 128 academic journals published by 372 institutions in 40 countries/regions indicates a growing number of publications on CAR-T therapy for autoimmune diseases, covering a range of subtypes such as systemic lupus erythematosus, multiple sclerosis, among others. CAR-T therapy holds promise in mitigating several shortcomings, including the indiscriminate suppression of the immune system by traditional immunosuppressants, and non-sustaining therapeutic levels of monoclonal antibodies due to inherent pharmacokinetic constraints. By persisting and proliferating in vivo, CAR-T cells can offer a tailored and precise therapeutics. This paper reviewed preclinical experiments and clinical trials involving CAR-T and CAR-related therapies in various autoimmune diseases, incorporating innovations well-studied in the field of hematological tumors, aiming to explore a safe and effective therapeutic option for relapsed/refractory autoimmune diseases.

Objective To investigate the clinical value of laparoscopic peritoneal dialysis catheter implantation in peritoneal chemotherapy for gastric cancer with peritoneal metastasis. Methods From January 2019 to June 2019, the clinical data of 6 patients diagnosed as gastric cancer with peritoneal metastasis were retrospectively analyzed in the Gastrointestinal Surgery Department of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine. Five were male and 1 was female. The median age was 69.5 (28?77) years. The median body mass index (BMI) was 22.8 (19.6?23.5). All procedures were performed under general anesthesia with endotracheal intubation. The patient′s body position and facility layout in the operating room were consistent with those of laparoscopic gastrectomy. The operator′s position: the main surgeon was located on the right side of the patient, the first assistant stood on the left side of the patient, and the scopist stood between the patient′s legs. Surgical procedure: (1) trocar location: three abdominal trocars was adopted, with one 12 mm umbilical port for the 30°laparoscope (point A). Location of the other two trocars was dependent on the procedure of exploration or biopsy as well as the two polyester cuff position of the peritoneal dialysis catheter: Usually one 5 mm port in the anterior midline 5 cm inferior to the umbilicus point was selected as point B to ensure that the distal end of the catheter could reach the Douglas pouch. The other 5 mm port was located in the right lower quadrant lateral to the umbilicus to establish the subcutaneous tunnel tract, and the proximal cuff was situated 2 cm away from the desired exit site (point C).(2) exploration of the abdominal cavity: a 30°laparoscope was inserted from 12 mm trocar below the umbilicus to explore the entire peritoneal cavity. The uterus and adnexa should be explored additionally for women. Once peritoneal metastasis was investigated and identified, primary laparoscopic peritoneal dialysis catheter implantation was performed so as to facilitate subsequent peritoneal chemotherapy. Ascites were collected for cytology in patients with ascites. (3) peritoneal dialysis catheter placement: the peritoneal dialysis catheter was introduced into the abdominal cavity from point A. Under the direct vision of laparoscopy, 2?0 absorbable ligature was reserved at the expected fixation point of the proximal cuff (point B) for the final knot closure. Non?traumatic graspers were used to pull the distal cuff of peritoneal dialysis catheter out of the abdominal cavity through point B. The 5?mm trocar was removed simultaneously, and the distal cuff was fixed between bilateral rectus sheaths at the anterior midline port site preperitoneally. To prevent subsequent ascites and chemotherapy fluid extravasation, the reserved crocheted wire was knotted. From point C the subcutaneous tunnel tract was created before the peritoneal steath towards the port site lateral to the umbilicus. Satisfactory catheter irrigation and outflow were then confirmed. Chemotherapy regimen after peritoneal dialysis catheterization: all patients began intraperitoneal chemotherapy on the second day after surgery. On the 1st and 8th day of each 3?weeks cycle, paclitaxel (20 mg/m2) was administered through peritoneal dialysis catheter, and paclitaxel (50 mg/m2) was injected intravenously. Meanwhile, S?1 was orally administered twice daily at a dose of 80 mg·m-2·d-1 for 14 consecutive days followed by 7?days rest. To observe the patients′ intraoperative and postoperative conditions. Results All the procedures were performed successfully without intraoperative complications or conversion to laparotomy. No 30 day postoperative complications were observed. The median operative time was 33.5 (23?38) min. The median time to first flatus was 1(1?2) days, and the median postoperative hospital stay was 3 (3?4) days, without short?term complications within 30 days postoperatively. The last follow?up was up to July 10, 2019, and the patients were followed for 4(1?6) months. No ascites extravasation was observed and no death occurred in the 6 patients. There was no catheter obstruction or peritoneal fluid extravasation during and after chemotherapy. Conclusion Laparoscopic peritoneal dialysis catheter implantation was safe and feasible for patients with peritoneal metastasis of gastric cancer. The abdominal exploration, tumor staging and the abdominal chemotherapy device implantation can be completed simultaneously, which could simplify the surgical approach, improve the quality of life for patients and further propose a new direction for the development of abdominal chemotherapy.

Objective To investigate the clinical value of laparoscopic peritoneal dialysis catheter implantation in peritoneal chemotherapy for gastric cancer with peritoneal metastasis. Methods From January 2019 to June 2019, the clinical data of 6 patients diagnosed as gastric cancer with peritoneal metastasis were retrospectively analyzed in the Gastrointestinal Surgery Department of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine. Five were male and 1 was female. The median age was 69.5 (28?77) years. The median body mass index (BMI) was 22.8 (19.6?23.5). All procedures were performed under general anesthesia with endotracheal intubation. The patient′s body position and facility layout in the operating room were consistent with those of laparoscopic gastrectomy. The operator′s position: the main surgeon was located on the right side of the patient, the first assistant stood on the left side of the patient, and the scopist stood between the patient′s legs. Surgical procedure: (1) trocar location: three abdominal trocars was adopted, with one 12 mm umbilical port for the 30°laparoscope (point A). Location of the other two trocars was dependent on the procedure of exploration or biopsy as well as the two polyester cuff position of the peritoneal dialysis catheter: Usually one 5 mm port in the anterior midline 5 cm inferior to the umbilicus point was selected as point B to ensure that the distal end of the catheter could reach the Douglas pouch. The other 5 mm port was located in the right lower quadrant lateral to the umbilicus to establish the subcutaneous tunnel tract, and the proximal cuff was situated 2 cm away from the desired exit site (point C).(2) exploration of the abdominal cavity: a 30°laparoscope was inserted from 12 mm trocar below the umbilicus to explore the entire peritoneal cavity. The uterus and adnexa should be explored additionally for women. Once peritoneal metastasis was investigated and identified, primary laparoscopic peritoneal dialysis catheter implantation was performed so as to facilitate subsequent peritoneal chemotherapy. Ascites were collected for cytology in patients with ascites. (3) peritoneal dialysis catheter placement: the peritoneal dialysis catheter was introduced into the abdominal cavity from point A. Under the direct vision of laparoscopy, 2?0 absorbable ligature was reserved at the expected fixation point of the proximal cuff (point B) for the final knot closure. Non?traumatic graspers were used to pull the distal cuff of peritoneal dialysis catheter out of the abdominal cavity through point B. The 5?mm trocar was removed simultaneously, and the distal cuff was fixed between bilateral rectus sheaths at the anterior midline port site preperitoneally. To prevent subsequent ascites and chemotherapy fluid extravasation, the reserved crocheted wire was knotted. From point C the subcutaneous tunnel tract was created before the peritoneal steath towards the port site lateral to the umbilicus. Satisfactory catheter irrigation and outflow were then confirmed. Chemotherapy regimen after peritoneal dialysis catheterization: all patients began intraperitoneal chemotherapy on the second day after surgery. On the 1st and 8th day of each 3?weeks cycle, paclitaxel (20 mg/m2) was administered through peritoneal dialysis catheter, and paclitaxel (50 mg/m2) was injected intravenously. Meanwhile, S?1 was orally administered twice daily at a dose of 80 mg·m-2·d-1 for 14 consecutive days followed by 7?days rest. To observe the patients′ intraoperative and postoperative conditions. Results All the procedures were performed successfully without intraoperative complications or conversion to laparotomy. No 30 day postoperative complications were observed. The median operative time was 33.5 (23?38) min. The median time to first flatus was 1(1?2) days, and the median postoperative hospital stay was 3 (3?4) days, without short?term complications within 30 days postoperatively. The last follow?up was up to July 10, 2019, and the patients were followed for 4(1?6) months. No ascites extravasation was observed and no death occurred in the 6 patients. There was no catheter obstruction or peritoneal fluid extravasation during and after chemotherapy. Conclusion Laparoscopic peritoneal dialysis catheter implantation was safe and feasible for patients with peritoneal metastasis of gastric cancer. The abdominal exploration, tumor staging and the abdominal chemotherapy device implantation can be completed simultaneously, which could simplify the surgical approach, improve the quality of life for patients and further propose a new direction for the development of abdominal chemotherapy.