yin asthenia. Conclusion Characteristic of syndrome about type 2 diabetes mellitus affiliated metablic syndrome show that:extreme heat with yin asthenia, deficiency of both vital energy and yin, deficiency of vital energy and blood stasis, syndrome of blood stasis run through the whole course of disease. Incorporated syndrome show characteristic of versatility and individualization.

Objective To explore the incidence,clinical features,causes,treatment method and risk factors of 30-day readmission after bariatric and metabolic surgery.Methods The retrospective case-control study was conducted.The clinical data of 631 obese patients who underwent bariatric and metabolic surgery in the First Affiliated Hospital of Nanjing Medical University from May 2010 to May 2016 were collected.All the 631 patients underwent laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB).Patients were followed up by outpatient examination and telephone interview for 1 month to detect readmission of patients up to June 2016.Observation indicators:(1) 30-day readmission situations after bariatric and metabolic surgery:cases with readmission,readmission time,clinical features,causes and treatment of readmission;(2) risk factors analysis affecting 30-day readmission after bariatric and metabolic surgery.Measurement data with skewed distribution were described as M (range).The univariate analysis and multivariate analysis were respectively done using the chi-square test and Logistic regression model.Results (1) Thirty-day readmission situations after bariatric and metabolic surgery:among 631 patients receiving postoperative 1-months follow-up,21 had 30-day readmission,with an incidence of 3.33％ (21/631),including 13 males and 8 females;10 received LSG and 11 received LRYGB.The median readmission time of 21 patients was 12 days (range,4-30 days).Of 21 patients,nausea,vomiting and dehydration of the main manifestations were detected in 11 patients,gastrointestinal bleeding in 6 patients,high fever in 2 patients,bowel obstruction in 1 patient and abdominal pain in 1 patient.The causes of the readmission of 21 patients:8 had improper food intake including 5 with premature solid food intake,1 with premature semi-fluid food intake,1 with irritating food intake and 1 with swallowing whole tablets;3 had postoperative over-anxiety;1 had Petersen hiatal hernia;1 had anastomotic ulcer;1 had anastomotic edema;1 had abdominal abscess.Of 6 patients with uncertain causes,4 had gastrointestinal bleeding and didn't receive endoscopy;1 had postoperative unexplained abdominal pain and underwent laboratory and imaging examinations and gastroscopy,showing no trouble finding;1 had high fever,and no abnormality was detected by imaging examination.Of 21 patients,19 underwent conservative treatment (rehydration and acid suppression) and then discharged from hospital after improvement,without readmission;1 with abdominal abscess was cured after emergency debridement and drainage;1 with Petersen hiatal hernia was cured by emergency surgery.The median duration of hospital stay in 21 patients with readmission was 7 days (range,3-40 days).(2) Risk factors analysis affecting 30-day readmission after bariatric and metabolic surgery:the results of univariate analysis showed that gender,preoperative adephagia habit and duration of postoperative hospital stay were related factors affecting 30-day readmission after bariatric and metabolic surgery (x2 =5.330,6.498,4.574,P＜0.05).The results of multivariate analysis showed that male and preoperative adephagia habit were independent risk factors affecting 30-day readmission after bariatric and metabolic surgery (OR=2.489,2.912,95％ confidence interval:1.006-6.161,1.196-7.088,P＜0.05).Conclusions Nausea,vomiting and dehydration are common manifestations of patients with 30-day readmission after bariatric and metabolic surgery,and it might be associated with improper food intake.Male and preoperative adephagia habit are independent risk factors affecting 30-day readmission after bariatric and metabolic surgery.

OBJECTIVE:To observe the protective effect of the traditional Chinese medicine Yiqimingmu oral solution on photochemical damage of retina in rats. METHODS:SD rats were divided into four groups randomly:negative control group, model group, low dose Yiqimingmu oral solution group and high dose Yiqimingmu oral solution group. All the groups except the control one were continually exposed to Lux (1 900?106.9) green fluorescent light for 24 hours to establish retinal photochemical damage model. The low dose and high dose groups were administered intragastrically with Yiqimingmu oral solution (15mL?kg-1?d-1 and 30mL?kg-1?d-1) 7 days before light expose. Normal saline solution was administered intragastrically in control and model group. At 6 hours and 6, 14 days after light expose, the content of malandialdehyde (MDA) and activity of SOD in rats' retina were measured. The histopathologic changes were observed by transmission electron microscopy and light microscopy. RESULTS:At 6 and 14 days after light expose, the activity of SOD in Yiqimingmu solution high dose group were higher than in the model control group(P

Background Stem cell transplantation represents a promising treatment option for patients suffering from degenerative disorders.Accumulating evidences indicate that mesenchymal stem cells (MSCs) are able to differentiate into retinal pigment epithelial (RPE)-like cells.However,MSCs are difficult to obtain.Human adipose mesenchymal stem cells (ADSCs) are proved to have similar properties to MSCs,but relevant study is less.Objective This study was to assess the feasibility of human ADSCs differentiating into RPE-like cells and the safety of its application in vivo.Methods The third generation of human ADSCs were incubated into 6-well plate,and 100 ng/ml epithelial growth factor,50 μ mol/L taurine and 5×10-7 mol/L retinoic acid were added into the medium 12 hours after cultured to induce the cells,and conventional cultured cells were used as the control group.Induced cells were traced with PKH26,and Pan-cytoke ratin (Pan-CK) monoclonal antibody was used to identify the cells under the fluorescence microscope.Induced RPE-like cell suspension of 1 μl was intravetreally injected in the right eyes of 6 BALB/c mice,and equal volume of PBS was used in the same way in another 6 mice.The animals were sacrificed 1 month after injection,and the retinal morphology was examined by histopathology under the optical microscope.The ultrastructure of retinal ganglion cells (RGCs) was examined by the transmission electron microscope.The use and care of the animals complied with Regulations for the Administration of Affair Concerning Experimental Animals by State Science and Technology Commission.Results Cultured human ADSCs grew well with the slender polygone shape.Cell membranes showed the red fluorescence for PKH26 after induced.In addition,Pan-CK was expressed in the cell membranes with the red fluorescence in the induced cells,but the response was absent in the control cells.One month after intravitreal injection,induced cells located on the retinal surface,and the retinal morphology was clear under the optical microscope.No abnormality in RGCs was seen under the transmission electron microscope.Conclusions Human ADSCs can differentiate into RPE-like cells after induction.PKH26 can mark induced cells well.There is no adverse effect of induced cells on retina after intravitreal injection in a short-term duration in mice.

BACKGROUND:The adhesion between muscle tendon and surrounding tissue after tendon restoration is one hot topic in clinic.
OBJECTIVE:To construct a deep flexor tendon transection model in the third toe of female Leghorn chicken and to explore the effect of peritenon transplantation on the prevention of tendon adhesions.
METHODS:After the transection models were successful y established, the third toe of left claw was taken as experimental group A. The transected tendon was sutured, the tendon anastomosis end was wrapped with the peritenon of the deep flexor tendon from the ipsilateral fourth toe (experimental group B). The third toe of right claw served as control group A, the transfected tendon was sutured and restored with the peritenon. The fourth toe of right claw was taken as control group B. Gross observation and histological observation of the tendon were performed.
RESULTS AND CONCLUSION:At 28 days postoperatively, gross observation and histological observation of Leghorn chicken were performed and compared using the Kruskal-Wal isH and Nemenyi test, respectively. The results showed that, the therapeutic effect was better in experimental group A than in control group A (P<0.05), but slightly poorer compared with control group B and experimental group B (P<0.05). The postoperative effect was better in experimental group B than in control group A (P<0.05) and showed no significant difference between experimental group B and control group B (P>0.05). The flexor function was evaluated and compared with the least significant difference t-test. The results showed that the postoperative effect was better in experimental group A than in control group A (P<0.05), but slightly poorer compared with control group B and experimental group B (P<0.05). The postoperative effect was better in experimental group B than in control group A (P<0.05) and showed no significant difference compared with control group B (P>0.05). Peritenon transplantation can effectively prevent tendon adhesions and has little impact on normal tendon sliding.

BACKGROUND:Tendon adhesions after tendon repair have been one of the problems difficult to solve in clinical practice. OBJECTIVE:To introduce the current situation and progress of the prevention of postoperative tendon adhesions. METHODS: A computer-based search of CNKI, Wanfang, PubMed databases for articles related to prevention of tendon adhesions published from January 1971 to May 2014 using the keywords of “tendon injury; tendon adhesions; progress” in Chinese and English, respectively. Repetitive content and irrelevant articles were excluded, and finaly 40 articles were included in result analysis. RESULTS AND CONCLUSION: In this paper, we analyze the characteristics of tendons and causes of tendon adhesions, summarize the methods for prevention of tendon adhesions and the therapeutic effects, and thereby analyze the pros and cons of various methods and materials for prevention of tendon adhesions. Prevention of tendon adhesions after tendon repair involves various aspects: thorough debridement, better surgical approach, microsurgical repair of tendon tissues, applications of drugs and barrier materials, physical therapy as wel as appropriate functional exercise after tendon repair. The integrated use of these means can be done to prevent the occurrence of postoperative tendon adhesions.

BACKGROUND:There are a variety of treatments for femoral head necrosis,but their efficacy is not confirmed and unified.How to improve the differentiation ability of osteoblasts in the femoral head and improve the biomechanical support after the repair of the femoral head is an urgent problem to be solved.OBJECTIVE:To explore the clinical outcome of stem cells combined with vascularized iliac bone flap and tantalum rod implantation for the treatment of osteonecrosis of the femoral head (ONFH).METHODS:Totally 28 cases (36 hips) of non-traumatic ONFH admitted at the Zhongshan Hospital of Dalian University from January 2010 to January 2011 were enrolled.Bone marrow samples were extracted from each patient to isolate bone marrow stromal stem cells which were cultured in vitro for 2 weeks.Tantalum rod implantation with vascularized iliac bone graft was conducted to restore the femoral head shape,and then,prepared stem cell suspension were injected into the iliac bone flap and into the subchondral space of the femoral head.RESULTS AND CONCLUSION:All the 28 cases (36 hips) were followed up for 6-20 months (average 12 months),and their Harris hip scores and visual analogue scale scores at postoperative 6 and 12 months were significantly higher than the baseline (P ＜ 0.05).The Harris hip score at postoperative 12 months was significantly higher than that at postoperative 6 months (P ＜ 0.05),but there was no significant difference in the visual analogue scale scores at 6 and 12 months postoperatively (P ＞ 0.05).At the end of 12-month follow-up,clinical outcomes were excellent in 13 hips,good in 15 hips,fair in 4 hips,and poor in 4 hips,with an excellent and good rate of 90％.These findings indicate that autologous bone marrow stromal stem cell transplantation with vascularized iliac bone flap and tantalum rob implantation is an effective method with high clinical success rate for the treatment of ONFH.

BACKGROUND:Seed cells and scaffold are two key factors for cartilage defects after osteonecrosis of femoral head using tissue-engineered method. OBJECTIVE:To explore the feasibility of Bio-gide col agen membrane combined with dog bone marrow mesenchymal stem cells into chondrocytes. METHODS:Bone marrow mesenchymal stem cells were isolated from beagle dogs by whole bone marrow blood centrifugation method and adherence screening method in vitro and cultured. Morphological changes in cells were observed, and identification was done using cellsurface antigens. Bone marrow mesenchymal stem cells of passage 3 were induced by chondrocyte induction medium to differentiate into chondrocytes (experimental group). cells cultured in normal medium were considered as control group. 3-(4, 5-Dimethylthiazol-2-yl) 2, 5-diphenyl tetrazolium bromide assay was used to measure growth curve of chondrocytes. cells underwent typeⅡcol agen immunohistochemistry and toluidine blue staining. The coculture of bone marrow mesenchymal stem cells at passage 3 and Bio-gide col agen membrane were observed under an inverted phase contrast microscope and scanning electron microscope. RESULTS AND CONCLUSION: Bone marrow mesenchymal stem cells with high purity and high viability were obtained by whole bone marrow blood centrifugation method and adherence screening method. cells grew wel and had strong amplified ability, and successful y differentiated into chondrocytes. Numerous bone marrow mesenchymal stem cells adhered on the Bio-gide col agen membrane, showing a tendency of multi-layer growth. cells and Bio-gide col agen membrane seem to blend into an integrant part. Cel processes appeared and connected each other and gradual y wrapped the Bio-gide col agen membrane, with the presence of obvious cel matrix secretion. These results suggested that bone marrow mesenchymal stem cells can grow and differentiate into chondrocytes on the Bio-gide col agen membrane.

Objective : To analyze the survival of patients with malignant mesothelioma, so as to provide insights into the management of malignant mesothelioma. Methods : Totally 36 patients with malignant mesothelioma admitted to Cixi Third People’s Hospital from October 2012 to January 2021 were enrolled, and the demographic features, exposure to asbestos, and diagnosis and treatment were retrospectively reviewed. The survival rate and median survival time were calculated with the life-table method, and the factors affecting the survival rate of malignant mesothelioma were identified using the Kaplan-Meier estimate and log-rank test. Results : The 36 patients with malignant mesothelioma included 6 men ( 16.67% ) and 30 women ( 83.33% ), and had a median age of 61 ( interquartile range, 14 ) years. There were 30 cases with pleural malignant mesothelioma ( 83.33% ) and 6 cases with peritoneal malignant mesothelioma ( 16.67% ), 32 cases ( 88.89% ) with a history of occupational exposure to asbestos, and 26 cases ( 72.22% ) receiving palliative treatment. The 1-, 2- and 3-year cumulative survival rates were 30%, 15% and 3%, respectively, and the median survival time was 0.71 years. In addition, there were no significant differences in the survival period among patients with malignant mesothelioma in terms of gender, age, route of asbestos exposure, duration of asbestos exposure, pathogenic site and treatment regimens ( P>0.05 ). Conclusion The 36 patients with malignant mesothelioma had a median survival period of 0.71 years, and no association was found between the survival period and asbestos exposure or pathogenic site.

AIM: To investigate the properties of human retinal microvascular endothelial cells (RMECs) at two different age groups. METHODS: Human RMECs with high affinity were isolated from donors at two age groups: 30 d (group A) after birth and 40 - 60 years of age (group B). The RMECs were characterized for expression and localization of endothelial cell markers by immunofluorescence staining of CD31, yon Willebrand factor(vWF) and uptake of acetylated low - density lipoprotein. The ability of tube formation was assessed on Matrigel, and vWF distribution in- cells was ob-served by confocal immunofluorescence microscope and Western blotting analysis, respectively. RESULTS: High purity RMECs can be obtained readily from each group with modified methods. At 6 hours, cells from both groups formed tube structures successfully, but there was a significantly higher incidence of branching in RMECs of infant group (group A) by 27.2%±2.2% compared with adult group (group B) at 12 h (P<0.05). Group A maintained intact structure even at 30h, but group B partially lost the basic tube structure. In addition, vWF was translocated from cytoplasm to nucleus with aging. CONCLUSION: Human RMECs at different ages have specific properties. Cell properties related with age of the donors should be considered in in vitro studies.