Objective To identify the clinical features and risk factors of early rheumatoid arthritis (RA)-associated osteoporosis in premenopausal women. Methods A total of 76 premenopausal women with early RA were randomly selected in the Department of Kidney and Rheumatology in the hospital. A total of 84 health cases were randomly selected in our hospital as controls. Bone mineral density (BMD) was determined using dual energy X-ray absorptiometry (DEX). Bone metabolism (CTX, PINP) and inflammatory cytokines (IL-17, IL-6, TNF-α) were examined with quantitative enzyme-linked immune-sorbent assay (ELISA). Quantitative data were expressed as x ±s deviation and the data were compared between groups using non- parametric test (Z value). Multi-group comparison was performed with variance analysis. Qualitative data were compared with Fisher's test. Logistic regression was used to investigate the risk factors. Results ①Compared with the control group, BMD in the premenopausal women with early RA group [neck: (0.802 ±0.193) g/cm2, GT zone: (0.923±0.033) g/cm2, L1: (0.862±0.011) g/cm2] was significantly decreased [(0.981±0.032) g/cm2, (0.771 ±0.023) g/cm2, (0.912 ±0.012) g/cm2, F=14.401, 19.860, 6.560, respectively, both P<0.05). The prevalence of osteoporosis in this group was 7%(5/76), which was higher than controls 1%(1/84). ② According to values of Bone meta-bolism [(CTX: (0.37±0.21) ng/ml] and inflammatory cytokines, TNF-α: (9.8±4.1) pg/ml, IL-6: (33.6±5.7) pg/ml and IL-17: (129±24) pg/ml were markedly increased in premenopausal women in early RA group [(0.24 ±0.09) ng/ml, (6.7 ±1.9) pg/ml, (1.5 ±0.4) pg/ml, (45 ±7) pg/ml, Z=2.722, 5.932, 7.501, 4.370, respectively, both P<0.05]. ③ The premenopausal women with early RA group with osteoporosis were signifi- cantly difference with controls in BMI [(9±3) kg/m2 vs (16±3) kg/m2], bone density of neck [(0.85±0.20) ng/ml vs (0.88±0.14) g/cm2], L2 [(0.75±0.23) g/cm2 vs (0.88±0.14) g/cm2], L3 [(0.87±0.07) g/cm2 vs (0.93±0.14) g/cm2], L4 [(0.92±0.12) g/cm2 vs (0.94±0.16) g/cm2], serum ESR [47.8(22.0, 76.0) mm/1 h vs 18.8(8.7, 35.2) mm/1 h] and DAS28-CRP (5.3 ±1.2 vs 3.8 ±1.2) F=0.68, 14.632, 26.114, 20.931, 36.582, Z=3.21, 6.58, respectively, both P<0.05. ④ Logistic regression showed that IL-6 (Wald χ2=5.78, P=0.021), PINP (Wald χ2=5.12, P=0.031), CTX (Wald χ2=9.17, P=0.003), ESR (Wald χ2=9.24, P=0.011), DAS28-CRP (Wald χ2=17.28, P=0.001) were significantly positively correlated with osteoporosis. Moreover, ordered unconditional Logistic regression analysis of the variables (IL-6, PINP, CTX, ESR, DSA28) described above showed that DAS 28-CRP score [OR=1.58, 95%CI: (1.10, 2.20)] was the most important risk factor for osteoporosis in premenopausal women with early RA. Conclusion The incidence of osteoporosis is high in premenopausal women with early RA than healthy cases. DAS 28-CRP score is the important risk factor for premenopausal women with early RA- associated osteoporosis. Measures relieve symptoms of RA can help to prevent and treatment osteoporosis.

BACKGROUND:Intramedul ary nail and traditional steel plate fixation have been widely used in the treatment of distal tibial (extra-articular) fractures, but these two kinds of methods have shortcomings. Some control studies attempt to answer the advantages and disadvantages of the issue on the treatment of extra-articular distal tibial fractures with intramedul ary nail and steel plate fixation, but the conclusions are different.
OBJECTIVE:To determine the efficiency and safety of intramedul ary nail and plate fixation in the treatment of extra-articular distal tibial fractures by Meta analysis.
METHODS:PubMed, Embase, Cochrane Library, CBMdisc, Weipu information database and Wanfang were searched by computer, and relevant Chinese and English orthopedic journals were hand-searched. Control ed trials related to intramedul ary nail and plate fixation in the treatment of extra-articular distal tibial fracture were included. The quality of trials was critical y assessed. RevMan 5.0 software was used for data analysis.
RESULTS AND CONCLUSION:Four articles were included. Meta analysis showed that compared with the plate fixation, the malunion rate of the intramedul ary nail for extra-articular distal tibial fractures increased. There was no statistical difference in the rate of nonunion rate, delayed fracture healing, and infection rate after operation. These indicate that intramedul ary nail and plate fixation both have good effects on fracture healing.

BACKGROUND:Intramedul ary nails and locking plates are widely used for two-part proximal humerus fracture. Which is better for two types of implants in patients remains controversial. OBJECTIVE:To determine the clinical outcome of intramedul ary nails versus locking plates for two-part proximal humerus fracture according to Cochrane Meta analysis. METHODS:We searched PubMed, SCI, Embase, the Cochranel Library and CBMdisc, VIP information, Wanfang Database, and CNKI for randomized control ed trials and quasi-randomized control ed trials on intramedul ary nails and locking plates for two-part proximal humerus fracture. RevMan 5.2 software was used to analyze operation time, intraoperative blood loss, fracture healing time, postoperative complications (heterotopic ossification, pain, screw penetration, necrosis of humeral head), and Constant Score. RESULTS AND CONCLUSION:Six articles of clinical control ed trials were included with 259 patients. 131 patients received intramedul ary nails, and 128 patients received locking plates. Meta-analysis displayed that no significant difference in fracture healing time, heterotopic ossification, pain, necrosis of humeral head and Constant Score was detected between intramedul ary nails and locking plates for two-part proximal humerus fracture. Operation time, intraoperative blood loss, and screw penetration were significantly less in the fixation with intramedul ary nails than that in locking plates (P<0.05). These findings suggested that compared with locking plates, intramedul ary nails method for two-part proximal humerus fractures could reduce screw penetration.

Objective To investigate the technical requirements for the 3.0T multi-modal quantitative MR imaging of the rabbit liver.Methods A total of 8 rabbits were scanned and T1 mapping,T2 mapping,MT and Gd EOB-DTPA dynamic enhancement images were acquired.For the dynamic enhanced scanning,injecting contrast medium was followed by saline flush with different combinations of injection flow rate (1.5 mL/s and 2 mL/s) and injection volume(6 mL and 8 mL).The quality of the images was assessed and analyzed statistically.Results The total scanning time was about 20-25 min.High-quality images were acquired by T1 mapping,T2 mapping and MT sequences.There was no significant difference in image quality among different groups in Gd-EOB-DTPA dynamic enhanced scanning(P＞0.05).Two rabbits died when the combination of injection flow rate of 2 mL/s and injection volume of 8 mL was used.Conclusion 3.0 T multi-modal quantitative MR scanning of rabbit liver can be achieved successfully if scanning parameters are properly chosen.

Objective? To explore the effect of Smart Hand Hygiene Management System on hand hygiene compliance of Intensive Care Uni(t ICU) medical staff. Methods? Using convenience sampling method, 106 medical staff in the comprehensive ICU of Tianjin First Central Hospital were selected as the research objects. By deploying Smart Hand Hygiene Management System, medical staff's hand hygiene before and after contacts with patients in the ward were collected automatically, and compliance was calculated. By engineering means, the first month (July, 2018) data collected after removing the system's prompting function was taken as the baseline level, and the month after the system's acousto-optic prompting function was added and working principle training (August, 2018) was taken as the intervening stage. Compare the hand hygiene compliance of selected medical staff before and after intervention. Results? The hand hygiene compliance of medical staff was 85.62% after intervention, which was higher than 52.87% before intervention and the difference was statistically significant (P＜ 0.01). After intervention, the "pre-operation" compliance increased to 73.90%, and the "post-operation"compliance increased to 94.94%, which were all statistically different from those before intervention (P＜0.01). Conclusions? The application of Smart Hand Hygiene Management System has a significant effect on improving the compliance of hand hygiene performance of medical staff,and the initiatives of performing hand hygiene of medical staff have been greatly improved.

Objective To investigate the predictive value of serum ferritin(SF)in early gestation,pre-pregnancy body mass index(BMI)and gestational age for gestational diabetes mellitus(GDM).Methods A total of 260 pregnant women who had a routine prenatal examination in Wenzhou People's Hospital were collected from January 2021 to December 2022.Fasting venous blood was collected at the first prenatal examination(within 14 weeks'gestation)for SF.According to the results of 75 grams oral glucose tolerance test(OGTT)between 24 weeks and 28 weeks,they were divided into GDM group(n=62)and normal glucose tolerance(NGT)group(n=198).The general clinical data of the two groups were compared;Multivariate Logistic regression analysis was conducted to determine the independent risk factors of GDM.Receiver operating characteristic(ROC)curve was used to further analyze the predictive value of SF in early gestation,pre-pregnancy BMI and gestational age for GDM.Results Pregnant women in GDM group had higher SF,BMI and gestational age in early pregnancy than those of NGT group(P<0.05).Pre-pregnancy BMI,gestational age and SF increased in early pregnancy were independent risk factors for GDM(P<0.05).The area under the curve(AUC)of SF in early pregnancy as well as pre-pregnancy BMI and gestational age for predicting GDM were 0.612,0.691 and 0.664.The best tangent point values were 94.045ng/ml,21.125kg/m2 and 28.500 years old,respectively.The total AUC of ROC predicted GDM by SF in early gestation,pre-pregnancy BMI and gestational age was 0.750,the sensitivity and specificity were 66.1%and 79.3%,respectively.Conclusion SF in early gestation,pre-pregnancy BMI and gestational age are important factors in the development of GDM,the combined detection of SF in early pregnancy,pre-pregnancy BMI and gestational age has a certain predictive value for GDM.

Objective:To investigate the effect of Jiawei Zhuyu Decoction combined with oxytocin on uterine involvement and residual of placenta in postpartum patients.Methods:A total of 91 patients with postpartum placenta residue admitted to Baoji Central Hospital from January 2023 to January 2024 were selected as the study objects. According to random number table method, the patients were divided into observation group (45 cases) and control group (46 cases). The control group was treated with oxytocin, and the observation group was treated with Jiawei Zhuyu decoction. Treatment effect, Traditional Chinese Medicine (TCM) symptom score, Visual Analogue Scale (VAS) score, SF-36 score, uterine reversion, uterine residual area, levels of beta human chorionic gonadotropin (β-HCG), progesterone (P), estradiol (E 2), duration of vaginal bleeding, length of hospital stay and adverse reactions were compared between the two groups. Results:The total effective rate of the observation group was higher than that of the control group [95.6%(43/45) vs 78.3%(36/46), χ 2=5.943, P=0.015]. After treatment, TCM syndrome scores, VAS scores and SF-36 scores of 2 groups were significantly improved (all P<0.05), and TCM syndrome scores and VAS scores of observation group were lower than those of control group, and SF-36 scores were higher than those of control group (all P<0.05). After treatment, the sum of three diameters of uterus, endometrial thickness and area of uterine residue in both groups decreased (all P<0.05), and the sum of three diameters of uterus, endometrial thickness, rate of uterine decline and area of uterine residue in the observation group were smaller than those in the control group (all P<0.05). After treatment, the levels of β-HCG, P, E 2 in 2 groups were improved compared with before (all P<0.05), and the levels of β-HCG and P in observation group were lower than those in the control group, and E 2 levels were higher than those in the control group (all P<0.05). The duration of vaginal bleeding and hospitalization in the observation group were shorter than those in the control group (all P<0.05). The incidence of adverse reactions in the observation group was lower than that in the control group [6.67%(3/45) vs 21.7%(10/46), χ 2=4.220, P=0.040]. Conclusions:Jiawei Zhuyu Decoction combined with oxytocin has a good effect on postpartum placenta residue, can effectively reduce the intrauterine placenta residue, promote uterine involution, and accelerate the recovery of patients.

Objective:To investigate the molecular characteristics, drug resistance rate and virulence genes harboring status of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) associated with skin and soft tissue infections (SSTIs), and provide epidemiological basis for clinical antibiotic usage and infection prevention and control. Methods:The Staphylococcus aureus associated with SSTIs in Quzhou People′s Hospital from 2014 to 2018 were retrospectively analyzed. A total of 72 CA-MRSA isolates were screened, and molecular typing was performed by multilocus sequence typing (MLST). K-B method and micro broth dilution method were used to analyze the antibiotic susceptibilities of those strains. The virulence genes screened including fibronectin binding protein genes (fnbA, fnbB),hemolysin genes (hla, hlb), enterotoxin genes (sec, seh) and leukocidin gene (PVL) were detected by polymerase chain reaction (PCR).Statistical analysis of differences between drug resistance rates and virulence genes carrier rates between ST59 and non-ST59 groups used were Chi-square test or Fisher exact test. Results:ST59 type was the main epidemic clone in skin and soft tissue infection CA-MRSA in Quzhou area with account for 55.56% (40/72). All isolates had higher resistance rates to erythromycin (90.28%, 65/72), clindamycin (68.06%, 49/72) and tetracycline (41.67%, 30/72). The nitrofurantoin, daptomycin and linezolid were all sensitive. The resistance rate to clindamycin of sequence type 59 (ST59) was (85.00%, 34/40). The resistance rate of ST59 to clindamycin was significantly higher than that of other clone types (χ 2=11.886, P<0.01). There was no significant difference in the resistance rates of other antibiotics. All 72 isolates exhibited carriage of virulence genes as follows, hla (97.22%, 70/72) , hlb (33.33%, 24/72) , fnbA (50.00%, 36/72) , fnbB (48.61%, 35/72) , PVL (63.89%, 46/72) , sec (4.17%, 3/72) , seh (4.17%, 3/72) . The carrier rate of PVL gene in ST59 type was (77.50%, 31/40). ST59 showed higher rates of PVL genes compared with other clone types (χ 2=7.227, P<0.01). Conclusions:The main clone of CA-MRSA associated with SSTIs in Quzhou was ST59, which was similar to other parts of the Country. The carrying rate of PVL gene of ST59 isolate was significantly higher than that of other isolates. CA-MRSA associated with SSTIs has a high resistance rate to erythromycin and clindamycin, which should not be used as the first choice in treatment.

BACKGROUND:Mangiferin is a biphenylpyridone compound extracted from mango leaves,bark and roots.Previous studies have shown that mangiferin can exert anti-systemic inflammatory effects through the activation of transcription factors such as NF-κB and JAK/STAT. OBJECTIVE:To investigate the effects and mechanisms of mangiferin on proliferation,migration and inflammatory factor release of rheumatoid arthritis fibroblast-like synovial cells(RA-FLS). METHODS:RA-FLS were divided into blank group,R848(TLR7/8 agonists)stimulated group,mangiferin low-,medium-,high-dose groups(2,4 and 8 μg/mL)and positive control group(Cu-CPT8,TLR8 pathway inhibitor).The cytotoxic effect of different mass concentrations of mangiferin was detected using cell counting kit-8 method and the final cellular dosing mass concentration was screened.The proliferation ability of RA-FLS was detected by cell clone formation assay,the migration ability of RA-FLS was detected by scratch assay and Transwell migration assay,and the expression of interleukin 1β,interleukin 6 and tumor necrosis factor α mRNA in RA-FLS was detected by qRT-PCR. RESULTS AND CONCLUSION:Compared with the blank group,the viability of RA-FLS was inhibited after treatment with mangiferin at 2-10 μg/mL,but there was no significant difference among groups(P>0.05),indicating that the toxic effect on RA-FLS was minimal.Compared with the R848-stimulated group,mangiferin decreased the number of cell clones,the scratch healing rate and the number of migrating cells in all dosing groups(P<0.01);and the expression of interleukin 1β,interleukin 6 and tumor necrosis factor α mRNA was also reduced in the mangostin medium-and high-dose groups(P<0.01).Compared with the R848-stimulated group,the number of cell clones,the scratch healing rate and the number of migrating cells as well as the expression levels of interleukin 6 and tumor necrosis factor α mRNA were significantly reduced in the positive control group(P<0.05,P<0.01).But there was no significant difference in the expression level of interleukin 1β.To conclude,mangiferin may exert its anti-rheumatoid arthritis effects through the TLR7/8 signaling pathway by inhibiting RA-FLS proliferation,migration,and inflammatory factor release.

Objective: To obtain the serotype diversity and antimicrobial resistance of Salmonella isolates recovered from retail chicken carcasses for sale in six regions of China. Methods: From August 2010 to March 2012, each month 20 retail chicken carcasses including freshly slaughtered, chilled and frozen samples were collected from supermarkets and farmer's markets in 7 monitoring sites in Beijing, Jilin province, Inner Mongolia Autonomous, Shanxi province, Jiangsu province and Guangdong province, respectively. Samples were routinely collected for 12 months for each site. 1 680 chicken carcasses were collected in total and 2 629 Salmonella strains were isolated by PCR and biochemical method. Luminex xMAP method and classical slide agglutination method were carried out to determine isolates' serotypes. Minimal inhibitory concentrations (MICs) of 10 classes of antimicrobials including 14 agents were determined using broth micro-dilution method. Mocular methods were used to determine antimicrobial resistance genes of CIP-CTX-CT co-resistant isolates. Results: In all, 2 629 Salmonella isolates, there were 17 seorgroups and 58 serotypes, B and D1 were the dominant serogroups with rates of 34.7% (n=913) and 31.0% (n=815), Enteritidis (30.8%, n=810), Indiana (17.6%, n=463), Infantis (10.6%, n=278) were the top three serovars. We found 224 CIP-CTX co-resistant S. Indiana containing 3 colistin resistant strains, one of them carrying mcr-1 gene and being ESBLs positive, which demonstrated a nine multi drug resistance against 11 antimicrobials tested. Conclusion These data began to describe the complicated serovar diversity and heavy antimicrobial resistance of Salmonella isolates recovered from retail chicken carcasses in six regions of China. The findings highlight the emergence of ciprofloxacin and cefotaxime co-resistant S. Indiana and also a mcr-1 positive S. Indiana with heavy multi drug resistance.