AIM: The relationship between muscle force (MF) and bone mass (BM)has become one of the pivotal aspects in research of cause, prevention and treatment of primary osteoporosis. This paper is to probe into the mechanism by which estrogen influences the relationship between MF and BM.METHODS: We searched for the relative papers on the relationship between muscle force and bone mass and the effect of estrogen on relationship between muscle force and bone mass. Combining the literatures with our previous results, we discussed the effects of estrogen on relationship between muscle force and bone mass.RESULTS: Muscle force, which determines bone structure and bone mass,makes bone strength adaptable to work load. Estrogen adjustes adaptability of muscle force and bone mass, mainly by the influence on threshold of bone strain. Estrogen therapy could maintain muscle force, partially by which estrogen exerts the beneficial effects on bone.CONCLUSION: Estrogen could influence the relationship between muscle force and bone mass, and estrogen therapy could have the beneficial effect on muscle force.

Objective To summarize our preliminary experience and evaluate the clinical value of laparoscope diagnosis and treatment for annular pancreas in neonates.Methods A retrospective review of laparoscope diagnosis and treatment for annular pancreas in 9 children from September 2009 to January 2013 was performed.Among them,5 were male,4 were female.The age was ranging from 1 to 13 d.A lowerpressure pneumoperitoneum of 5 ～ 8 mm Hg (1 mm Hg =0.133 kPa) was used.Eight cases of diamond duodenal anastomosis were performed under laparoscope after the diagnosis was established,and 1 case underwent procedure through slightly enlarged umbilical port site.Results Eight cases of diamond duodenal anastomosis were performed under laparoscope,and the operation time was 80 ～ 140 min (mean 105 min),in 1 case it was performed through umbilical port incision,the operation time was 64 min,and the length of incision was about 2.5 cm.Feedings were started at postoperative day 4 to 7 (mean 5 d),and patients were discharged at postoperative day 8 to 14 (mean 10 d).The cases were followed-up for 3 ～ 20 months (mean 6.7 months),and I case complicated with anal atresia died of pneumonia 6 months later.Other cases were uneventfully recovered and symptoms were alleviated with normal gastroenterological function,no preoperative symptoms recurred,and the nutrition and growth status was excellent.Conclusions Annular pancreas can be diagnosed through laparoscopy.Laparoscope diagnosis and treatment for annular pancreas has the advantages of small incision,micro-invasion and faster recovery,can be safely performed in neonatal period.

events were associated with promestriene use. Conclusion The premestriene capsule was safe and effective in the treatment of postmenopausal atrophic vaginitis.

Objective To evaluate the prevalence and risk factors of progressive liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD).Methods A total of 2 054 subjects who underwent health check up and were diagnosed as NAFLD in 9 institutions were included in the study.Blood routine and biochemical findings were collected to calculate aspartate aminotransferase-to-platelet ratio index (APRI).Subjects were divided into three groups according to diagnostic threshold of liver fibrosis:APRI ＜0.43 group,APRI 0.43-0.53 group and APRI ≥ 0.54 group.The correlation between APRI and biochemical variables was analyzed,and the risk factors of progressive fibrosis were also analyzed.Results Among 2 054 subjects (male/female 1 598/456) there were 61 cases with APRI ≥ 0.98 (2.97％,progressive fibrosis),318 with APRI ≥0.54 (15.48％),1 475 with APRI ＜ 0.43 (71.81％),261 with APRI 0.43-0.53 (12.71％).Logistic stepwise regression analysis showed that TG (P =0.002,OR =1.095,95％CI:1.033-1.161),2 hPG(P =0.000,OR =1.103,95％ CI:1.058-1.151,BUN(P =0.034,OR =1.215,95 ％ CI:1.014-1.454) were risk factors,and H DL-C (P =0.034,OR =0.353,95 ％ CI:O.135-0.924) was a protective factor for the progression of fibrosis.Conclusion The progressive fibrosis in patients with NAFLD is closely associated to blood glucose and lipid metabolism disorder.

Objective To study the efficacy and safety of estradiol and drospirenone tablets (Angeliq)in treatment of menopausal symptoms among postmenopausal Chinese healthy women.Methods Total 244 postmenopausal Chinese healthy women who had moderate to severe hot flushes were randomly assigned for 16 weeks in this randomized multi-center double-blind placebo-controlled study.During the trial.the follow-up visits were conducted at week 4,8,12,16 of treatment and 2 weeks after treatment respectively.Height,weight,vital signs,hot flushes,other relevant menopausal symptoms and vaginal bleeding were observed in each follow-up visit,while the clinical global impression scale Was assessed at 16 weeks as well.Results It showed that hot flushes were reduced significantly more in observation group than that in placebo group ( P＜0.01 ), although both treatments were effective. The absolute values of mean severity index of total hot flushes decreased by - 0. 6± 0. 5 in observation group and - 0. 4 ± 0. 4 in placebo group from baseline respectively, which reached significant difference ( P ＜ 0. 05 ). However, the absolute values of mean severity index of moderate to severe hot flushes decreased by - 0. 6± 0. 8 in observation group and -0. 3± 0.6 in placebo group from baseline respectively, which had no significant difference (P ＞ 0. 05 ).After 16 weeks treatment, it also showed that estradiol and drospirenone had significant better efficacy than placebo on moderate to severe sweating, vaginal dryness and clinical global impression scale (P ＜0. 01 ).During the trial, blood pressure in observation group was stable. The rate of vaginal bleeding in observation group was higher than that in the placebo group, especially during the week 4 to week 8 when 48. 9% (87/178) in observation group and 10. 7% (6/56) in placebo group of patients bled. Although the cumulative amenorrhea rate of observation group was lower than that of placebo group in each cycle (28 days), it increased gradually along with duration of the treatment. The commonest adverse event in observation group was breast tenderness which accounted for 12.0% (22/183 ). The level of serum potassium was in the normal range in observation group mostly. Meanwhile, the other adverse events rate was low. Serious adverse events reported in this trial were assessed as not study drug related or as unlikely study drug related. Conclusion Estradiol and drospirenone tablets which could effectively alleviate menopausal symptoms in postmeuopausal Chinese healthy women is a novel hormone replacement therapy regimen with high safety and efficacy.

OBJECTIVETo investigate the feasibility and efficacy of laparoscopic procedure in the diagnosis and treatment of congenital intestinal atresia and stenosis in neonates and infants.

METHODSBetween September 2009 and September 2013, 55 cases with intestinal atresia and stenosis underwent laparoscope-assisted procedures in our department. There were, 32 males and 23 females, Twelve cases were diagnosed as duodenal atresia and stenosis and 43 as intestinal atresia and stenosis. The age at hospitalization was 7 minutes to 7 months(mean 9.88 d). After the diagnosis by multiport or transumbilical single-site laparoscopic exploration, cases with duodenal atresia and stenosis and part of the cases with proximal jejunum were treated by laparoscopic operations to remove the septum and restore intestinal continuity. In other cases with intestinal atresia and stenosis, laparoscopic inspection was performed to make diagnosis and then the proximal and distal ends of the atresia were exteriorized through the umbilical port site for end-to-oblique anastomosis.

RESULTSAll the 55 cases underwent this minimally invasive approach, and no case was converted to open surgery. The operative time of laparoscopic procedure for duodenal atresia and stenosis (n=12) ranged from 80 to 145 min(mean, 110 min). During the follow-up of 3-34 months, one case had recurrent postoperative vomiting induced by giant duodenal expansion above anastomotic stoma and died the second day after operation. The operative time of laparoscopic surgery for intestinal atresia and stenosis (n=43) ranged from 35 to 70 min (mean 46 min). During the follow-up of 3-36 months, 3 cases complicated with meconium peritonitis had postoperative short bowel syndrome and died. One case died of intestinal perforation at 3 month postoperatively. One case died of intestinal adhesion at 7 month postoperatively. The rest of cases had favorable outcomes.

CONCLUSIONLaparoscopic surgery for the diagnosis and treatment of intestinal atresia and stenosis has advantages of small incision, less trauma, and rapid recovery.

Female ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn ; Intestinal Atresia ; surgery ; Laparoscopy ; methods ; Male ; Retrospective Studies ; Treatment Outcome

Objective:To explore the initial experience of thoracoscopic repair with simplified mattress sutures in the treatment of diaphragmatic hernia in neonates without posterolateral rim of diaphragm.Methods:A retrospective review of the new simplified technique in 10 cases from March 2015 to October 2017 was performed.Of the patients, 6 cases were male, 4 cases were female.The age was 10min-1d, 7 cases were term newborns, and 3 cases were premature.The mean weight was 2.88 kg(ranged 2.3-3.5kg). All the 4 cases were left-sided.Two to three primary suture sites were taken from the relative intercostal region of the body surface projection of the defect.A snip incision about 1 mm of the skin was done.Two 2-0 non-absorbable sutures round the rib were inserted between the front edged of the defect and the diaphragm muscle through a syringe needle.The first thread was brought out of the body by the ring of the second thread and knot tying was made extracorporally.The posterolateral defect was closed; the knot was under the skin of intercostals space.Results:Ten neonates with CDH were repaired successfully using this new simplified technique.The mean operative time was 37.5min(ranged 25-60min) for each CDH repair.No cases required conversion to open surgery, blood loss was minimal.The 10 cases were followed up for 16.5 months(ranged 5-24 months), with no death and no recurrence.One neonate complicated with subcutaneous emphysema postoperatively and healed in one week.Conclusion:The new technique of thoracoscopic repairing with simplified mattress sutures when no posterolateral rim of diaphragm exists has all the advantages of thoracoscopy in neonates combined with the advantages of reduced operative time, simplicity, feasibility and definite curative effect and has the value of clinical popularization.

Objective To investigate the feasibility and efficacy of laparoscopic procedure in the diagnosis and treatment of congenital intestinal atresia and stenosis in neonates and infants. Methods Between September 2009 and September 2013, 55 cases with intestinal atresia and stenosis underwent laparoscope-assisted procedures in our department. There were, 32 males and 23 females, Twelve cases were diagnosed as duodenal atresia and stenosis and 43 as intestinal atresia and stenosis. The age at hospitalization was 7 minutes to 7 months (mean 9.88 d). After the diagnosis by multiport or transumbilical single-site laparoscopic exploration , cases with duodenal atresia and stenosis and part of the cases with proximal jejunum were treated by laparoscopic operations to remove the septum and restore intestinal continuity. In other cases with intestinal atresia and stenosis, laparoscopic inspection was performed to make diagnosis and then the proximal and distal ends of the atresia were exteriorized through the umbilical port site for end-to-oblique anastomosis. Results All the 55 cases underwent this minimally invasive approach, and no case was converted to open surgery. The operative time of laparoscopic procedure for duodenal atresia and stenosis (n=12) ranged from 80 to 145 min (mean, 110 min). During the follow-up of 3-34 months, one case had recurrent postoperative vomiting induced by giant duodenal expansion above anastomotic stoma and died the second day after operation. The operative time of laparoscopic surgery for intestinal atresia and stenosis (n=43) ranged from 35 to 70 min (mean 46 min). During the follow-up of 3-36 months, 3 cases complicated with meconium peritonitis had postoperative short bowel syndrome and died. One case died of intestinal perforation at 3 month postoperatively. One case died of intestinal adhesion at 7 month postoperatively. The rest of cases had favorable outcomes. Conclusion Laparoscopic surgery for the diagnosis and treatment of intestinal atresia and stenosis has advantages of small incision, less trauma, and rapid recovery.

Objective To investigate the feasibility and efficacy of laparoscopic procedure in the diagnosis and treatment of congenital intestinal atresia and stenosis in neonates and infants. Methods Between September 2009 and September 2013, 55 cases with intestinal atresia and stenosis underwent laparoscope-assisted procedures in our department. There were, 32 males and 23 females, Twelve cases were diagnosed as duodenal atresia and stenosis and 43 as intestinal atresia and stenosis. The age at hospitalization was 7 minutes to 7 months (mean 9.88 d). After the diagnosis by multiport or transumbilical single-site laparoscopic exploration , cases with duodenal atresia and stenosis and part of the cases with proximal jejunum were treated by laparoscopic operations to remove the septum and restore intestinal continuity. In other cases with intestinal atresia and stenosis, laparoscopic inspection was performed to make diagnosis and then the proximal and distal ends of the atresia were exteriorized through the umbilical port site for end-to-oblique anastomosis. Results All the 55 cases underwent this minimally invasive approach, and no case was converted to open surgery. The operative time of laparoscopic procedure for duodenal atresia and stenosis (n=12) ranged from 80 to 145 min (mean, 110 min). During the follow-up of 3-34 months, one case had recurrent postoperative vomiting induced by giant duodenal expansion above anastomotic stoma and died the second day after operation. The operative time of laparoscopic surgery for intestinal atresia and stenosis (n=43) ranged from 35 to 70 min (mean 46 min). During the follow-up of 3-36 months, 3 cases complicated with meconium peritonitis had postoperative short bowel syndrome and died. One case died of intestinal perforation at 3 month postoperatively. One case died of intestinal adhesion at 7 month postoperatively. The rest of cases had favorable outcomes. Conclusion Laparoscopic surgery for the diagnosis and treatment of intestinal atresia and stenosis has advantages of small incision, less trauma, and rapid recovery.

Objective To explore the clinical value of portal exposure in laparoscopic treatment of children with type Ⅲ biliary atresia (BA).Methods From June 2013 to October 2017,30 infants with type Ⅲ BA who treated with laparoscopic portoenterostomy in Huai'an Women and Children's Hospital were selected.A percutaneous suture was used to snare the round ligament and retract the liver,other percutaneous stay sutures were then introduced and fundus and neck of gallbladder were sutured to elevate the liver to expose the portal hepatis.The fibro cord and hepatic vessels were mobilized,and then two rubber bands were put around the left and right portal veins and hepatic arteries.The portal hepatis was exposed by laterally stretching the two elastic rubber bands.The fibro cord was removed and then laparoscopic portoenterostomy was accomplished.In 20 cases,the liver was enlarged,part of hepatic lobus quadratus was removed laparoscopiclly for exposure of the portal hepatis.Results There were 30 cases in this group,2 cases were converted to open surgery by a micro transverse incision.There was no surgical death.Time of laparoscopic procedure varied from 210 to 280 min.All cases survived the surgery without any intraoperative complications.Blood loss during operation was minimal,without necessity for blood transfusion.One case died of respiratory failure one week after surgery.Two cases were lost follow-up.Twenty-five cases were followed up for 3～51 months(mean 22.4 months).Three cases died because of repeated cholangitis and liver failure at 10,16,35 months postoperatively.Nineteen patients' total bilirubin had dropped to normal,three others' bilirubin levels dropped significantly after surgery.Conclusion The technique of laparoscopic hepatic porta exposure can help to complete hepatic portoenterostomy successfully,reduce the conversion rate of laparoscopic surgery,and improve the surgical effect.