Clinical obstetrics practice is a very important process. According to our exploration on it on 7-year-systemmedical students in our hospital for nine years, we think that if you want high quality 7-year-system medical students,five concepts should be emphasized besides traditional basic knowledge, basic theory and basic skill, which are familyplanning and eugenics, loving infants, whole concept, new medical model and renewing knowledge.

[Objective]To investigate and compare the effects of standard gamma nail (SGN) and proximal femoral nail anti-rotation (PFNA) in the treatment of osteoporotic intertrochanteric fractures in the elderly.[Method]From May 2002 to September 2005,55 patients with intertrochanteric fractures were treated with SGN.Sixty-eight patients were treated with PFNA from November 2005 to June 2008.The effects of the two implants about perioperative complications,bone healing and the function of the operated hip joint were compared.[Result]No statistically significant difference was found between the two groups in blood loss,blood transfusion,infection,deep venous thrombosis and hospital stay.One patient developed femoral head avascular necrosis postoperatively in Gamma nail group.The incidence of postoperative hip pain in Gamma nail group was higher than that in the PFNA group,but there was no significant difference in the Harris score.[Conclusion]Gamma nail and PFNA nail are reliable methods to treat geriatric intertrochanteric fractures,with advantages of minimal iatrogenic injury,stable fixation and few complications.

Objective To investigate the treatment effect of the proximal humeral internal locking system (PHIL()S) on the elderly patients with displaced proximal humeral fractures.MethodsFrom Feb 2004 to Mar 2007, 36 patients (mean age: 72.2 years) with proximal humeral fractures were treated with PHILOS plate fixation which included 14 cases with 2-part, 17 cases with three-part and 5 cases with four-part fractures according to Neer classification.Operation time,intraoperative blood loss, blood transfusion, perioperative complications and function evaluation of the operated shoulder joint were calculated with 14.5 months follow-up at average.Results The average operation time and blood loss were (61.5± 11.6) min and ( 165.2±91.2) ml, respectively. 1 case with accidents of blood vessel and 1 case with pneumonia were found without neurovascular injuries. All fractures were radiographically healed in an average of 3-5 months.No necrosis of humeral head appeared and 30 (83.3％) cases were excellent or good according to Neer scoring system. Two part fracture and early operation ( within 3 days after operation) might improve the postoperative function of shoulder joint, but the patient's age, gender and ASA score were not statistically with Neer score.Conclusions PHILOS plate fixation is a suitable procedure for displaced proximal humeral fractures via stable fixation and early rehabilitation, especially for elderly patients combined with osteoporosis.

AIM: To investigate the protective effects and mechanisms of Tongqiao Huoxue Decoction on the rats of cerebral ischemia. METHODS: Cerebral ischemia madel was established on the basis of cerebral thrombus and at the same time ligaturing bilateral carotid arteries.These models were used to observe the protective effects of Tongqiao Huoxue Decoction on contents of CGRP、ET、IL-1?,TNF? in rats′ cerebral ischemica. RESULTS: The results showed that Tongqiao Huoxue Decoction decreased the contents of IL-1?、TNF-?、 ET,and increased the contents of CGRP. CONCLUSION: Tongqiao Huoxue Decoction had effects on anti-cerebral ischemia.The protective effects of Tongqiao Huoxue Decoction are related to decreasing the contents of IL-1?,TNF-?,ET,and increasing the contents of CGRP.

Objective To evaluate the effecof bilateral ovariectomy combined with hormone injection on the bone mineral density and biomechanical property of sheep proximal femu.Method16 healthy adulsheep were divided into the sham operation group (n=8) and the experimengroup (n=8) randomly .Bilateral ovariewere only exposed in the sham operation group .The ex-perimengroup waperformed bilateral ovariectomy (OVX) and began to conducthe intramusculainjection of methylprednisolone (0 .45 mg · kg -1 · d-1 ) aftepostoperative 1 month fo10 month.The bone density (BD) of all sheep proximal femuwameas-ured before OVX and in postoperative 1 yea.The compression tesand the axial pullouteswere performed to evaluate biome-chanical property of postoperative 1 yeaproximal femu.ResultBD of proximal femubefore surgery had no statistically signifi-candifference between the two group,and which in the sham operation group had no statistically significandifference between before and aftesurgery (P＞0 .05) .BD of proximal femuin postoperative 1 yeain the experimengroup wasignificantly de-creased and significantly lowethan thain the sham operation group (P＜0 .05) .The maximal compression stresand the energy absorption value in the experimengroup were significantly lowethan those in the sham operation group with statistically signifi-candifferences(P＜0 .05);the maximal axial pulling force and the energy absorption value in the experimengroup were signifi-cantly lowethan those in the sham operation group with statistically significandifference (P>0 .05) .Conclusion The method of bilateral ovariectomy combined with hormone injection can significantly decrease BD and biomechanical intensity of sheep proximal femu.

Objective To compare of the effect of intravenous zoledronic acid and calcitonin on the elderly with osteoporotic intertrochanteric fractures.Methods From June 2009 to November 2012,610 patients with osteoporotic intertrochanteric fractures were treated with closed reduction and internal fixation.543 consecutive patients were grouped sequentially according to the admission time.From June 2009 to April 2011,control group (n=325)received calcitonin for osteoporosis (male 107,female 218,mean age 75.02±5.65 years).The number of Evans-Jensen type Ⅰ,Ⅱ,and Ⅲ type patients were 87,136,and 102,respectively.Average lumbar bone mineral density (BMD) and hip BMD were 0.737±0.08 g/cm2 and 0.725±0.05 g/cm2,respectively.From May 2011 to November 2012,218 patients (male 82,female 136,mean age 74.71±5.32 years) received zoledronic acid for osteoporosis.The number of Evans-Jensen type Ⅰ,Ⅱ,and Ⅲ type patient were 62,91 and 65,respectively.Average lumbar BMD and hip BMD were 0.738±0.05 g/cm2 and 0.722±0.06 g/cm2,respectively.All patients received once-yearly intravenous zoledronic acid in one week after operation.The BMD during hospitalization and one year after operation were compared between the two groups.Harris score and VAS score were applied to evaluate the function and pain degree of the operated hip joint.Results The average follow-up time were 12.8 months (range,5 to 22 months) in control group and 12.5 months (range,4 to 19 months) in treatment group.The average fracture union time,Harris score,VAS score were 14.25±1.38 weeks,68.88±5.71 points,and 0.36±0.55 points respectively in treatment group and 14.39± 1.12 weeks,69.47±4.60 points,and 0.33±0.48 points respectively in control group.There were no statistical differences between two groups in fracture union time,Harris score and VAS score.The average lumbar BMD and hip BMD were 0.76±0.06 g/cm2 and 0.75±0.04 g/cm2 in treatment group,which were 0.75±0.07 g/cm2 and 0.74± 0.07 g/cm2 in control group one year after operation,respectively.Compared with the baseline,the BMD of lumbar spine and hip one year after operation slightly increased without statistically significant difference in control group.The BMD increased significantly in treatment group.Conclusion Early administration of intravenous zoledronic acid does not influence bone healing and it could increase BMD one year after closed reduction and internal fixation.

Objective:To investigate the effects of 3-methyladenine(3-MA)on extracellular matrix deposition in early diabetic nephropathy(DN)and its mechanism.Methods:A streptozotocin(STZ)-induced type 1 diabetes mouse model was used, and the mice were divided into vehicle control group, diabetes group(STZ group), 3-MA group, and chloroquine(CQ)group, 8 mice in each group. After 6 weeks of intervention, both kidneys were harvested, and the kidney-to-body weight ratio was recorded. Western blotting was performed to detect protein expressions of renal cortex fibronectin, α-smooth muscle actin(α-SMA), LC3, Beclin 1, p62, and vascular endothelial growth factor(VEGF). Immunohistochemistry was used to observe kidney fibronectin staining. Bioinformatics analysis was conducted on shared genes between diabetic nephropathy(DN)gene targets and 3-MA predicted gene targets.Results:Both 3-MA and CQ exhibited certain hypoglycemic effects in diabetic mice. Compared to the STZ group, the kidney-to-body weight ratio decreased in the 3-MA group( P<0.05). Western blotting showed that 3-MA reduced the expression of renal cortex matrix-related proteins fibronectin and α-SMA in diabetic mice( P<0.05 or P<0.01). Immunohistochemistry also revealed that 3-MA reduced fibronectin staining in the kidneys of diabetic mice. Both 3-MA and CQ inhibited the protein expression of renal cortex Beclin 1 in diabetic mice(both P<0.05), while 3-MA increased the expression of renal cortex p62( P<0.05). Bioinformatics analysis indicated a connection between shared genes of DN gene targets and 3-MA predicted gene targets with the VEGF signaling pathway. Western blotting results further showed that 3-MA reduced renal cortex VEGF expression in diabetic mice( P<0.01). Conclusion:3-MA can alleviate extracellular matrix deposition in the kidneys of early DN mice by inhibiting the VEGF signaling pathway.

Objective To analyze the distribution characteristics of 9 hypertension drug related gene polymorphisms in the population of essential hypertension(EH)in Xi'an area,providing an objective basis for personalized treatment.Methods A total of 306 EH patients who visited the Shaanxi Provincial Armed Police Force Hospital from January 2022 to December 2023 were selected as the research subjects.The PCR melting curve method was used to detect 9 hypertension drug related gene polymorphisms,their genotype and allele distribution frequency were analyzed,and the correlations of gene polymorphism among patients of different genders,ages,and hypertension grading groups were compared.Results Among 306 patients,the distribution frequencies of each gene were consistent with Hardy Weinberg equilibrium(x2=0.153～2.941,all P＞0.05).Mutation rates of various gene were as follows:SLCO1B1 c.388A＞G,ADRB1 c.1165G＞C,MTHFR C677T,ADD1 c.1378G＞T,CYP2D6 c.100C＞T,ACE I/D,CYP3A5 c.806-4288C＞T,SLCO1B1 c.521T＞C,AGTR1 c.1166A＞C and CYP2C9 c.1075A＞C were 77.29％,73.20％,56.54％,48.37％,50.82％,35.13％,29.41％,11.76％,7.68％and 3.43％,respectively,and CYP2C9 c.403C＞T had no mutation.Comparing with patients of different genders,the mutation rate of SLCO1B1 c.388A＞G genotype and allele mutations in male group were higher than those in the female group(x2=5.221,8.237),the mutation rate of CYP2D6 c.100C＞T genotype and allele in the female group were higher than those in the male group(x2=5.093,9.661),the mutation rate of ACE I/D allele in the male group was higher than that in the female group(x2=6.118,8.032),with significant differences(all P＜0.05).The mutation rates of CYP2C9 c.1075A＞C,SLCO1B1 c.388A＞G,CYP2D6 c.100C＞T genotypes and alleles in the middle-aged and young age group were higher than those in the elderly group,and the differences were statistically significant(x2=11.683,10.243;9.003,9.803;10.617,9.931,all P＜0.05).There was no significant difference in the comparison of other genotypes and alleles among different gender and age groups and in the frequency of genotype and allele mutations among different hypertension grading groups(x2=1.321～7.733,1.031～5.198,all P＞0.05).Conclusion The distribution of gene polymorphisms related to antihypertensive drugs in the Xi'an area was related to the gender and age of EH patients.Thus,the genotype testing of antihypertensive drugs may have important guiding significance for personalized medication treatment of EH patients.