Objective To explore the fraction risk in patients with osteoporosis and effects of antiosteoporosis therapy on fracture healing.Methods All the recruited subjects were senile patients with fracture in lower extremity and were treated in the Department of Orthopaedics in Shandong Qianfoshan Hospital from Aug.2006 to Feb.2011.In the total 15 cases,10 were female and 5 were male,aged from 53 to 65 years (average 56.7 years old).After surgical reduction and internal fixation,all the 15 patients did free-weight and continous passive motion (CPM) functional exercise and received anti-osteoporosis treatment.X-ray was taken to show the preoperative and postoperative lumbar vertebrae and fracture position.Meanwhile,bone mineral density and blood calcium level and phosphate level were measured.Results Thirteen out of 15 patients were healed for bone fracture after a 3-month treatment,meeting the clinical standards of the fracture healing.The clinical fracture healing rate was 86.67％.Blood calcium level,phosphate level and the bone mineral density were significantly different between that before and after the treatment ( P ＜ 0.05 ).Conclusion Osteoporosis not only increases the risk of fracture,but also has an adverse effect on the bone healing.Anti-osteoporosis therapy has a positive role to the fracture healing in the senile patients with osteoporosis.

Objective To sum up the experience of diagnosis and treatment of paraduodenal hernia. Methods The clinical data of 18 cases of paraduodenal hernia treated by surgery were analyzed retrospectively. Results The average age of the patients was 34 years old.There were 15 cases with left paraduodenal hernia and 3 cases with right paraduodenal hernia.Ten patients usually had no clinical symptoms,while acute abdominal pain occurred after full food in 7 cases,and after vigorous movement in 10 cases respectively.Abdominal X-ray revealed complete or incomplete intestinal obstruction in 16 cases,while abdominal CT revealed abnormal cystic loops of small intestine between the pancreas and the stomach in 10 cases.All 18 cases underwent surgical operation,recovered 10-15 days after operation.After 2-8 years follow-up,there was no hernia recurrence.Conclusion Paraduodenal her-nia is difficult to diagnosis before operation,and the key to correct diagnosis and treatment is to explore the positive exploratory laparotomy.

ObjectiveTo analyze the perioperative risk factors of right heart failure (RHF) in human heart transplantation, and to summarize the efficacy of targeted agent especially on pulmonary hypertension.Methods Patients underwent heart transplantation were selected by exclusion criteria : (1) acute heart or other organ failure, or supported by mechanical assist device ; (2) the difference between the body weight of donor and recipient was ＞ 20％ ; (3) the ischemic time of donor was＞ 6 h; (4) acute rejection episode after transplantation; (5) perioperative death.The clinical data of 96 patients were collected, including gender, age, body weight, protopathy, history of heart failure, preoperative systolic pulmonary arterial pressure (SPAP), left ventricle end diastolic diameter (LVEDD), preoperative ejection fraction(LVEF), preoperative blood creatinine, donor ischemic time and preoperative application of 5-PDEs.The diagnosis standard of RHF was established.The risk factors were analyzed through Logistic Regression.Patients were divided into two groups according to the systolic pulmonary arterial pressure (SPAP).In group A, SPAP was ＜40 mm Hg, and in group B with SPAP≥40 mm Hg.The correlation between two groups was tested byχ2 test.ResultsIn the multivariable analysis, age, history of valve disease, length of heart failure,and preoperative SPAP were the risk factors of RHF with the coefficient of 1.051, 1.351, 1.712 and 6.725, respectively.SPAP seems to be the most important risk factor.Coronary artery disease and preoperative application of 5-PDEs-I were the favorable factors with the coefficient of 0.056 and 0.034, respectively.Parameters regarding age, history of valve disease, length of heart failure between the two groups were significantly different.There were no significant differences in gender, body weight, diagnosed as dilated cardiomyopathy or coronary artery disease and other etiologies, preoperative LVEDD, preoperative EF, preoperative blood creatinine, isehemic time and RHF, though the incidence of RHF in group B was higher than in group A (67.6％ vs 45.8％).There was also no statistic difference in using of ECMO and the mortality rate between two groups.ConclusionPreoperative PAP was the main risk factor of the RHF after heart transplantation.Although there was no statistic difference, the incidence of RHF in patients with SPAP≥40 mm Hg was higher than in patients with SPAP ＜40 mm Hg .The application of targeted agent therapy and ECMO may be helpful in treating RHF after heart transplantation.

Abstract:Objective To detect the expression of hepatic function indices and autoantibodies in patients with chronic hepatitis B patients, patients with autoimmune liver disease and patients with chronic hepatitis B combined with autoimmune liver disease, and to evaluate the clinical significance of autoantibodies and hepatic function indexes in the early diagnosis of chronic hepatitis B combined with autoimmune liver disease.Methods A total of 109 healthy controls (HC), 72 patients with chronic hepatitis B (CHB), 74 patients with autoimmune liver disease (AILD), and 24 patients with chronic hepatitis B combined with autoimmune liver disease (CHB+AILD) in the Fifth People’s Hospital of Suzhou from 2013 to 2021 were enrolled in this study. Basic information and the value of admission hepatic function indexes and autoantibodies were collected for all enrolled samples, while no autoantibody test was performed for healthy volunteers. All data were processed using GraphPad Prism and SPSS software.Results There were no significant differences in age and gender among the four groups. The detection rates of anti-mitochondrial antibody M2 (AMA-M2) and anti-soluble acidic phosphorylated nuclear protein antibody (anti-SP100 antibodies) in CHB+AILD group [29.2%(7/24), 17.4%(4/23)] were significantly higher than those in CHB group [5.1%(3/59), 0(0/59)], suggesting that the detection of these two autoantibodies is helpful to the differential diagnosis of CHB and CHB+AILD. In addition, eight hepatic function indexes displayed significant differences among the four groups. The levels of total bilirubin and direct bilirubin in CHB+AILD group were significantly higher than those in CHB and AILD groups, while the levels of total protein and albumin were significantly lower than those in CHB and AILD groups. Alkaline phosphatase and glutamyltranspeptidase in AILD group and CHB+AILD group were significantly higher than those in CHB group. The logistic regression analysis showed that total bilirubin, direct bilirubin, albumin, alanine aminotransferase and alkaline phosphatase could form a promising prediction model, which was useful for clinicians in the differential diagnosis of CHB and CHB+AILD (area under the curve, AUC=0.902).Conclusion The combination of autoantibody and hepatic function index detection can be helpful for clinicians in the differential diagnosis of CHB, AILD and CHB+AILD, thus contributing to the early and correct diagnosis of CHB+AILD and providing theoretical basis for patients to obtain reasonable treatment and clinical cure earlier.

Thirty nine compounds in the volatile oils of the flowerbuds of Panax quinquefolium L.cultivated in China were isolated and identified with gas chromatography/mass spectre metry. To our great surprise,β-famensene,a sesquiterpene compound of them,alone account for 48.67% of the total volatile oils contents. This experimental result was contrasted with the volatile oils components of the different parts of Panax quinquefolium L.and Panax ginseng,anidentical genus plant,on chemical components and relative quantities.It was discovered that the only one common component is β-famensene in them and it is the highest value in determined relative contents. Above result provides scientific basis for biological synthesis of triterpenoid saponins.

Objective: To investigate the changes of osteoprotegerin ( OPG) and receptor activator of nuclear factor kappa B ligand ( RANKL) level in perio-implant crevicular fluid ( PICF) and to monitor the development of the stability of Straumann ? tissue-level implants by resonance frequency analysis ( RFA) during the early phases of healing .Methods: A total of 35 implants ( length 10 mm ) were placed.PICF samples were collected with filter paper strips at baseline , 1, 2, 3, 4, 6, 8, and 12 weeks post-surgery, respectively.The OPG, RANKL levels were determined by ELISA method .At the same time points, the implant stability quotient (ISQ) values were determined with Osstell TM mentor.Results:During healing , PICF-OPG levels increased significantly 2 weeks after surgery when compared with the 4th-, 6th-, 8th-and 12th-week reevaluation (P<0.05).The OPG/RANKL ratio in PICF was significantly higher ( P<0 .05 ) than that in gingival crevicular fluid at 1 week post-surgery .ISQ slightly fluctuated within the first 4 weeks after installation .Following this, the ISQ values increased steadily for all the implants and up to 12 weeks.Significant differences were noted between the mean ISQ values at the 12th-week and other observation time points .Conclusion: The PICF-OPG levels may be effective in monito-ring the process of osseointegration .All the ISQ values indicated the stability of Straumann ? implants over a 12-week healing period .RFA is a reliable and effective assistant to monitor implant stability .

Objective To evaluate the suitability of cognitive behavioral therapy (CBT) techniques for obsessive-compulsive disorder (OCD),and analyze the domestic application status of CBT techniques for OCD and lay a foundation of standard CBT in China.Methods Delphi method was adopted to evaluate 30 CBT techniques on four dimensions,including operability,frequency,contribution of treatment and acceptability,and calculated the final scores of all techniques on different dimension and their comprehensive rank.Results After two rounds of experts consulting,Kendall coefficients of four dimensions were 0.249,0.269,0.234,0.250 (P＜0.01),coefficient of variation ranged from 0.05 to 0.31 of each technology on different dimension.The operability score of thought stopping,cost-benefit analysis and pie chart belonged to general suitability.The frequency and treatment contribution score of thought stopping and pie chart belonged to occasional use and small.The acceptation score of socratic question,thought stopping,in vivo exposure and behavior prevention belonged to partial acceptation.Weight coefficients of four dimensions were 0.26,0.18,0.27,0.29 and techniques ranking in the top three were information collection and evaluation,therapeutic alliance foundation and psychological education.Conclusion Most CBT techniques for OCD are suitable in China but some techniques still need to be improved.

Objective To explore the application and efficacy of autogenous septal cartilage in the correction of cleft lip nasal deformity.Methods A total of 31 patients with secondary nasal deformity of cleft lip were involved in this study.After autologous nasal cartilage was released,the dislocation of nasal cartilage was corrected,nasal septum cartilage was used as substitute to raise the alar collapse,to reshape the nasal tip cartilage structure and correct the nasal deformity.Results Postoperative incision was primarily healing.For cartilage donor area there was no serious complications,and incision scar was concealed and unobvious; after 6 months to 2 years follow-up,there was no cartilage absorption deformation,the tip of the nose was flat,crack side nosewing collapses,and nasal columella skew was totally corrected,with stable rhinoplasty effects.Conclusions For secondary nasal deformity of cleft lip,the use of nasal septum cartilage to repair nose deformity can not only solve the cartilage source,but also give septal straightening and at the same time the correction effect of external nasal deformity is good.

Objective To investigate the relationship between corneal basal nerve change and type 2 diabetic retinopathy based on confocal laser microscopy.Methods Together 118 patients with type 2 diabetes (T2D) were collected in our hospital from February 2016 to February 2017,including 57 patients with diabetic retinopathy (DR group) and 61 patients without DR (NDR group).For comparison,60 healthy volunteers were selected as the control group.And all the subjects were examined by corneal confocal laser microscopy to analyze the relationship between the morphological parameters of the corneal nerve and clinical variables.Results Corneal nerve fiber density,corneal nerve branch density and corneal nerve branch length in DR group were (20.03 ±4.22) · mm-2,(22.01 ± 7.05) · mm-2 and (9.50 ± 1.76) mm ·mm-2,significantly less than those of the control group and NDR group (all P ＜ 0.05);and corneal nerve fiber curvature was (0.30 ± 0.03),significantly higher than that of the control group and NDR group (all P ＜ 0.05);In DR patients,phase Ⅲ patients had smaller the corneal nerve fiber density,corneal nerve branch density and corneal nerve branch length,but the larger corneal nerve fiber curvature than the phase Ⅰ and Ⅱ patients (all P ＜ 0.05);course of disease of DR group was (12.04 ± 2.48) years,which was significantly higher than that of NDR group (P ＜ 0.05),while fasting C peptide and fasting insulin were (1.41 ± 0.58) μg · L-1 and (20.05 ± 7.91) mU · L-1,respectively,significantly lower than those of NDR group (all P ＜ 0.05);The duration of T2D was negatively correlated with the corneal nerve branch density and corneal nerve branch length (r =-0.322,-0.317,all P ＜0.05);Fasting C peptide was positively correlated with the corneal nerve branch density (r =0.298,P ＜ 0.05),and negatively correlated with the corneal nerve curvature (r =-0.311,P ＜ 0.05).Conclusion Patients with T2D retinopathy have abnormal morphology of corneal nerve.And confocal laser scanning microscopy is conducive to the early detection of microvascular disease in T2D patients with a longer course of disease or a low level of fasting C peptide.

Objective To conclude the results of electrophysiological (EP) mapping and ganglianated plexis (GPs) ablation during the minimally invasive atrial fibrillation (AF) surgery.Methods During the period of Sep 2007 to May 2010 to-tally 185 paroxysmal atrial fibrillation cases were recruited receiving the minimally invasive AF surgery with video assistance.The EP mapping was used to test the dual direction block after ablation and the distribution of GPs was recorded.The sinus rhythm rate was followed up after surgery.Results All the minimally invasive surgery were performed successfully withoutdeath in the hospital.There was no permanent pacemaker implant and other serious complications.EP mapping results showed92％ pulmonary vein (PV) potential to the left atrium (LA) could be isolated with the dual direction block for the paroxysmal atrial fibrillation cases.And there were 89％ GPs positive,higher rate than the persistent AF.There were more GPs positive in the right PV area than the left and 86％ GPs lied at the LA domain,not the PV orifice.At least 5 or 6 ablation lesions were needed to get the dual direction block and denervation of the GPs.The sinus rhythm rate after surgery after 3,6,12 and 24months is 83.7％,82.4％,85.4％ and 83.9％.The 12 months follow up data showed the cases with more GPs positive (＞6) had 81.3％ sinus rate and the less GPs positive (≤2) group with 52.6％.Conclusion The EP mapping and GPsablation techniques during the minimally invasive AF ablation surgery could get good sinus rhythm rate during the long term follow up.