Objective To explore the biomechanics mechanism of ATP6i gene-interference treating steroid-induced necrosis of the femoral heads(SINFH)in rats.Methods Forty SD rats were randomly assigned to four groups:blank control group,experimental control group,ATP6i SiRNA(+)group and ATP6i SiRNA(-)group,10 rats in each group.We established rat models of SINFH by injecting Escherichia Coli Endotoxin and prednisolone for 12 weeks,then cut along the inner side of the patella for about 1 cm and turn the patellar outside of the both knees of the experimental control group,the ATP6i SiRNA(+)group and the ATP6i SiRNA(-)group,and drill from the intercondylar until the femoral neck.Rats were treated by transfecting ATP6i small interference RNA(ATP6i SiRNA)into the osteoclasts of the femoral heads to interference the expression of ATP6i SiRNA(+),or by the ATP6i SiRNA(-)and same amount of saline.One month later,test the load,stress,modulus of elasticity,and axial stiffness of the right femoral heads of all four groups,and at the same time take the left femoral heads of all four groups for pathological study.Results The load,stress,modulus of elasticity,and axial stiffness of the ATP6i SiRNA(+)group were(307.01±27.34)N,(60.44±5.38)MPa,(125.29±11.16)MPa,(162.42±14.45)N/mm,respectively,which were much greater than the ATP6i SiRNA(-)group and the experimental control group(P＜0.05).In the pathological studies,we found that the trabecula of the femoral heads of the ATP6i SiRNA(+)group was much thicker than the ATP6i SiRNA(-)group and the experimental control group,but the degeneration,necrosis and breakage of the osteoepiphysis in each group had no statistically significant differences.Conclusion ATP6i gene-interference can inhibit the acid-secreting function of osteoclasts and improve the biomechanical property of the femoral heads of rats in treating the SINFH.

Objective To analyze the virulence genes expression and drug resistance situation of type three secretion system (TTSS) of pseudomonas aeruginosa in Zhongshan area to provide a basis for clinical anti-infection treatment .Methods Seventy-six clinically isolated strains of Pseudomonas aeruginosa were collected from the Zhongshan Municipal People′s Hospital from July to September 2016 .Four virulence genes exoU ,exoS ,exoT and exoY were isolated from the strains by PCR .The Vitek2 Compact au-tomatic microbiological identification instrument was used to detect the sensitivity of antibacterial drugs .The enumeration data were processed with chi-square test .Results The detection rates of gene exoS and exoY were highest ,which were 52 .6% (40/76) and 63 .2% (48/76) respectively ;genotype exoU(-)exoS(+ )exoT (-)exoY(+ ) were predominant and accounted for 59 .26% .The positive rates of 4 virulence genes had no statistical difference between the multiple resistant and non-multiple resistant strains of pseudomonas aeruginosa .The resistance rates in the TTSS positive group to 13 kinds of drugs were commonly lower than those in the TTSS negative group ,the difference was statistically significant .Conclusion The geographic difference exists in virulence genes carrier of pseudomonas aeruginosa .The virulence genes carrying situation in both the multiple resistant and non-multiple resistant strains of pseudomonas aeruginosa is similar .

Objective To establish a human HepG2 cell growth model under the low oxygen environment induced by cobalt chloride in order to observe the impacts of human HepG2 cell proliferation,cellular cycles and apoptosis,namely cellular growth conditions,under the low oxygen environment induced by cobalt chloride with different concentrations and to study the HepG2 cell growth mechanism under the low oxygen environment induced by cobalt chloride.Methods The human HepG2 cells in the logarithmic phase were randomized grouping as control group and CoCl2 experimental group with different concentrations (50 μm/L,100 μm/L,150 μm/L and 200 μm/L).① HepG2 cell proliferation was tested by MTT assay to calculate cell's suppression rate and draw HepG2 cell growth inhibition curves.② The move ability of HepG2 cells was observed by scratch test.③ The cellular apoptosis and periodic changes were detected using the flow cytometer Annexin-V FITC/PI double-staining and PI single staining methods.④HepG2 cell's Glyceraldehyde-3-phosphate dehydrogenase (GAPDH) and Bcl-2 protein expression were detected by Western Blot.Results ① The test results obtained via MTT assay showed that CoCl2 suppressed the human HepG2 cell proliferation within a certain amount of time and concentration and presented a time-dose dependent relation.② Scratch damage trial suggested that the cobalt chloride suppressed the HepG2 cell migration and wound repair capacity and presented a concentration dependent relation.③ Flow cytometer' s test results revealed that the apoptosis rates (％) in control group and experimental group with different concentrations (50 μm/L,100 μm/L,150 μm/L and 200 μm/L) were 3.42,7.74,13.07,20.56,28.53 and 44.45 (P ＜0.05),respectively.The apoptosis rate of the experimental group was significantly increased compared with the control group,as well as showing a concentration dependency.The results of cellular cycles revealed that the cobalt chloride significantly suppressed the HepG2 cell's periodic changes along with increases of concentration,as well as blocked the cell cycle staying in phase G1,thereby suppressing cell proliferation.④Western Blot test:Compared with the control group,the Bcl-2 protein expression was significantly decreased in the experimental group after treatment of cobalt chloride with different concentrations.Conclusion Within a certain range,CoC12-indiuced low oxygen environment can suppress the human HepG2 cell proliferation and healing migration capacity,induce apoptosis and present a time-dose dependent relation.The mechanism is likely associated with decreases of Bcl-2 protein expression.

Objective To discuss the correlation between serum uric acid (SUA) level and the severity of coronary borderline lesions in acute coronary syndrome (ACS) and the prognosis of percutaneous coronary intervention (PCI).Methods The 192 patients who were diagnosed as coronary borderline lesions in ACS and PCI were measured.All Patients were divided into two groups:hyperuricemia group and normal SUA group.The severity of coronary arterial lesions and flow in PCI was compared.The cardiac function changes and incidence of major adverse cardiovascular events (MACE) were recorded.Results The results of correlation analysis showed the positive correlation of SUA level and Gensini score (r =0.710,P ＜ 0.05).Patients with hyperuricemia group had a significantly higher prevalence of no-reflow on angiography,in-hospital and six-month prevalence of MACEs compared with the normal SUA group (P ＜ 0.05).The UA on admission has an independent association with coronary slow flow following primary PCI and in-hospital MACEs among patients with ACS (P ＜ 0.05).Conclusion The patients has higher the level of SUA of ACS borderline lesions patients will has more serious the coronary arterial lesions.The risk of coronary slow flow increased in the patients complicated with hyperuricemia who underwent PCI.

Objective To observe neurophysiological changes and pulmonary function in obstructive sleep apnea syndrome (OSAS) and analyze their inter-relationship. Methods Sixty OSAS patients were studied. Their lung function and phrenic motor nerve conduction (PNC) were examined. Thirty cases without respiratory disorder served as controls. The lung function tests included percentage of the predicted value of vital capacity ( VC% ), percentage of the predicted value of maximal voluntary ventilation ( MVV% ), percentage of the predicted value of forced expiratory volume in one second ( FEV1% ), inspiratory capacity ( IC), and expiratory reserve volume (ERV). The phrenic nerve was stimulated electrically, and the latent period and the diaphragmatic compound muscle action potential (dCMAP) were recorded. Results The VC%, MVV%, FEV1% , IC and ERV of the patients with OSAS were significantly lower than those of the controls. There was no significant difference between the patients and the controls with regard to their PNC latency. In the OSAS patients the amplitude ratio of their dCMAPs was positively correlated with VC% , MVV% , FEV1% , IC and ERV, and negatively with an apnea hypopnea index (AHI).Conclusions PNC examination can provide valuable information for evaluating diaphragmatic dysfunction in those with abnormal lung function. Decreased dCMAP might be associated with abnormal lung function.

Objective To systematically review the clinical effects of Shuxuetong and Low-molecular-weight Heparin(LMWH)in patients with deep vein thrombosis (DVT)in lower limbs.Methods The CNKI,Wanfang,VIP,SinoMed,PubMed,EMBASE,and ISI Web of Science databases were electronically searched from inception to February 3th,2017,to collect the randomized clinical trials on the clinical effects of Shuxuetong and LMWH on DVT in lower limbs.Two investigators independently screened the literatures,extracted data and assessed the quality of enrolled studies.All analyses were performed using the Stata 11.0 software.Results Twenty studies involving 1 515 patients were finally included.The meta-analysis results showed that the total effective rate was significantly higher in Shuxuetong group than in LMWH drug control group(RR =1.22,95 ％ CI:1.13-1.32,P ＜ 0.001).The subgroup analysis showed that there was no significant difference in total effective rate between the Shuxuetong alone group and LMWH alone control group(RR =1.05,95％ CI:0.98-1.12,P =0.136).However,the total effective rate was significantly higher in Shuxuetong combined with LMWH group than in LMWH alone control group(RR =1.30,95％CI:1.18-1.44,P ＜ 0.001).Conclusions Shuxuetong combined with LMWH has better clinical effects than do LMWH alone group in treating patients with DVT in lower limbs.

OBJECTIVETo establish a reasonable protocol for interventional treatment of hepatocellular carcinoma (HCC).

METHODSThe data of 1 000 HCC patients treated by different kinds of interventional treatment were reviewed with their results of biochemistry, imaging, pathology and survival rate evaluated. The value as well as the pros and cons of these various kinds of interventional treatment were compared in order to find an optimum protocol.

RESULTSSegmental-transcatheter oil chemoembolization (S-TOCE) was much effective eradicate the tumor yet inflicting less damage on the noncancerous hepatic tissue and giving much higher survival rate than the conventional transcatheter oil chemoembolization (C-TOCE). Percutaneous ethanol injection (PEI) played an important role in eradicating the residual tumor and improving the survival rate without damaging the noncancerous hepatic tissue. The survival quality or survival rate could be improved by choosing different ways of interventional treatments to cut down the complications.

CONCLUSIONThe selection of different interventional treatments should be done according to the size and type of HCC. Active management is indicated for different complications presenting along with HCC.

Carcinoma, Hepatocellular ; mortality ; therapy ; Chemoembolization, Therapeutic ; Humans ; Liver Neoplasms ; mortality ; therapy ; Retrospective Studies ; Survival Rate

Objective TodiscusstheevaluationeffectivenessofADCofMR DWIinneoadjuvantchemotherapy (NAC).Methods ThirtyGninepatientswithlocallyadvancedbreastcancerwereenrolledinthisstudy.Allthesepatientswerediagnosedbypuncture biopsyandtreatedwithNAC.DWIwasperformedbeforechemotherapyandafter4cyclesofchemotherapyrespectively.Radicalresectionof breastcancerwasperformedwithinoneweekaftertheendof4cyclesofNAC.Accordingtotheclinicalefficacyorpathologicalresponse,the changesoftumorvolumeandtumorcelldensitybeforeandafterchemotherapyweremeasured.Theresponseoftumorwasdividedas clinicallyeffective,completeremission (CR)+partialremission(PR)andclinicalineffectiveness,stabilizationdisease(SD)+progression disease(PD)ormajorhistologicalresponse (MHR)andnonGmajorhistologicalresponse (NMHR),respectively.Toevaluatethe practicalutilityofneoadjuvantchemotherapy,theADCvaluesweremeasuredinallgroupsandanalyzedstatistically.Results Before NAC,therewasnosignificantdifferenceinADCvaluebetweenCR+PR (0.96±0.22)andSD+PD (0.93±0.14)orMHR (1.05±0.22), NMHR (0.99±0.14).TheratiosofCR+PRand MHR were56.4%and66.7%respectivelyattheendoftreatment,andtheADC valuesinallpatientswerehigherthanthatbeforechemotherapy.However,Therewasnosignificantdifferencebeforeandafterchemotherapy intheSD+PD (1.02±0.19)andNMHR (1.08±0.20)groups (P＞0.05),whileCR+PR (1.47±0.16)and MHR (1.62+0.13) groupsweresignificantlydifferentbeforeandafterchemotherapy(P＜0.05).Therateoftumorvolumechangewaspositivelycorrelated withΔADC (r＝0.539,P＜0.05).Conclusion TheADCvalue canbeusedtoevaluatethevolumeandpathologicalgradeof tumorafterNACbasedon MRIplainscananddynamicscan, whichishelpfulfortimelyandeffectivepredictiveevaluationof chemotherapyeffect.ADCvaluecanbeusedasearlyevaluationofNACforbreastcancerandprognosticindicators.

Objective:To explore the diagnostic value of motion pain induction test for early knee osteoarthritis.Methods:A cross-sectional study was conducted and the data came from The Project of Health Management of Knee osteoarthritis in Community in Hangzhou in 2018, and a total number of 1 816 people were included which were divided into normal group ( n=530), early group ( n=534) and middle-late group ( n=752) by not sick, sick while Kellgren-Lawrence (KL) ≤Ⅱ and sick while KL>Ⅱ starting, squatting, walking up and down stairs and doing housework were included in the test, and the statistical indicators included age, gender and pain scores (visual analogue scale, VAS). Receiver operating characteristic (ROC) curves were mapped after the correlation analysis to obtain the cut-off points and compare their values of area under the curve (AUC). The confounders which included age and gender were corrected by propensity score matching (PSM) and the balance test is consistent with P>0.05 after the PSM. The Kappa analysis was used to verify the consistency of two diagnostic methods. Results:The age of normal, early and medial-late groupwas 67.39±7.43, 67.41±9.52, 71.55±9.87. And the gender distribution of three groups was (238 male, 292 female), (209 male, 325 female), (357 male, 395 female). There was no heterogeneitybetween the normal group and early group in distribution ( P>0.05) while there was heterogeneity between the early and medial-late group ( t=-0.034, P<0.05; χ2=8.80, P<0.05). The VAS scoresof starting pain in three groups was 0.16±0.37,2.70±1.69, 3.68±2.10. The VAS scoresof squatting pain was 0.42±0.49, 2.88±1.44, 4.01±2.08. The VAS scoresof up and down stair pain was 0.47±0.50, 2.87±1.38, 3.82±1.98. The VAS scoresof housework pain was 0.14±0.35, 2.15±1.40, 3.45±2.09. The VAS scoresofmaximum pain was 0.51±0.50, 3.59±1.48, 4.68±2.01. And there was significant difference between normal and early groupin all kinds of pain ( t=-33.81; t=-37.25; t=-37.66; t=-32.07; t=-45.41; P<0.05). The difference between early and medial-late group in all type of pain was significant ( t=-8.93; t=-10.84; t=-9.56; t=-12.52; t=-10.64; P<0.05). The results were similar after adjusting for confounders except for the pain of starting ( P>0.05). The results of ROC curve between normal and early group showed the maximum pain's AUC point was 0.98 and larger than others, and its cut-off point was 1. After adjusted, the results of ROC curve between early and medial-late group showed the maximum pain's AUC point was 0.72 which was larger than others and cut-off point was 4. For the AUC of ROC curve between early and medial-late groupwas lower, Kappa-test was used, and the Kappa point of two diagnostic methods was 0.41 ( P<0.05). Conclusion:The maximum of pain score in pain dimension>1 and ≤ 4 could be preliminarily diagnosed as early KOA. It had high value in separating early KOA from normal people and approximately similar to X-ray, and the value of identifying early and mid-late KOAwas moderateas well as the moderate consistency with KL stage. Comprehensive judgment of imaging examination should be improved when conditions are available.

The incidence of fragility fractures of the pelvis (FFP) in elderly patients has been gradually increased. FFP has become another type of injury that threatens the lives of elderly patients because of high disability rate and mortality. The special physical condition of the elderly patients such as osteoporosis, chronic medical diseases and disability determines the specialty in diagnosis and treatment of FFP. The perioperative treatment is more difficult than other patients. FFP in elderly patients is different from the high violent mechanism of pelvis fractures in young patients, and its fracture morphology and classification are also varied. Surgical treatment is to stabilize the mechanical transmission structure of the pelvic ring, improve clinical symptoms, reduce long-term bed-related complications and restore painless daily self-care. In recent years, the surgical treatment of the pelvic fractures has made significant progress. However, there still remains controversy in treating FFP in elderly patients. The authors discuss the perioperative hot issues on FFP in elderly patients, hoping to realize the standard management of FFP.