Objective To evaluate the relationship between fragile fracture sites in hospitalized geriatric and nutritional status.Methods On the basis of whether the fracture,293 cases were divided into fracture group(n =140)and normal control group(n =153),51 males(36.4%)and 89 females(63.6%)in 140 fracture patients. Results The age was (74.04 ±8.58)years in the fracture group,that in the normal control group was (74.77 ± 8.14)years,there was statistically significant difference between the two groups(t =-0.743,P >0.05).The femoral neck fracture was 51 cases(36.4%)and intertrochantetic fracture was 57 cases(40.7%),and other was 32 cases (22.8%).The patients were divided into the two groups according to the age:60 ~75 years group(n =62)and >75 years group(n =78),femoral neck fracture was 37.2%,and intertrochantetic fracture was 52.6% in the group that more than 75 years old,which were 35.5% and 25.8%,respectively in 60 ~75 years group,there was statistically significant difference between the two groups(χ2 =18.337,P <0.01).The hemoglobin,serum albumin weight,weight,BMI in the fracture group were (117.44 ±20.25)g/L,(34.96 ±4.95)g/L,(60.81 ±10.63)kg,(22.83 ±3.54)kg/m2 , and those in the normal control group were (136.99 ±17.10)g/L,(37.27 ±5.85 )g/L,(64.47 ±11.23)kg, (24.24 ±3.88)kg/m2 respectively.The commonly used nutritional indicators:hemoglobin(t =-8.908),serum albu-min(t =-3.619),weight(t =-2.837)and BMI(t =-3.218)were lower than the normal control group(all P <0.01 ),serum phosphate was lower than the normal control group,the difference was statistically singnificant (t =-2.047,P <0.05).The blood calcium(t =0.630)and ALP(t =-0.550)had no statistically singnificant differences between the two groups(all P >0.05).Conclusion The proportion of intertrochantetic fracture and femo-ral neck fracture were higher in hospitalized elderly patients,and malnutrition,such as lower hemoglobin,lower serum albumin,lower weight,and lower BMI were,important factors in the fragile fracture in the geriatric inpatients.

Objective To explore the clinical significance of the serum brain?derived neurotrophic factor( BDNF) level in severe neonatal hyperbilirubinemia. Methods One hundred and twenty term and birth weight>2500 g infants admitted to the Neonatal Intensive Care Unit of Bethune nternational Peace Hospital of People Liberation Army were divided into severe hyperbilirubinemia group and control group according to their total bilirubin concentration. Total bilirubin( TBIL) concentration,BDNF and albumin in serum were determined in two groups. In addition, craniocerebral MRI was performed in severe neonatal hyperbilirubinemia before discharge. The correlation of the BDNF, TBIL, B/A, MRI results between severe hyperbilirubinemia group and control group were compared. Results The serum BDNF levels in severe hyperbilirubinemia group was ( 8. 84 ±3. 26) μg/L,significantly higher than that in control group((6. 24±1. 71) μg/L,t=3. 88,P<0. 05). In severe hyperbilirubinemia group,BDNF level was positively correlated with B/A level(r=0. 429,P<0. 05),but there was no correlation between BDNF and total bilirubin level(r=0. 278,P>0. 05). The serum BDNF level with craniocerebral MRI abnormal was ( 9. 53 ± 2. 77 ) μg/L, higher than that with craniocerebral MRI abnormal ((7. 81±3. 76) μg/L),but there was no statistical difference between them(t=1. 439,P>0. 05). Conclusion In severe neonatal hyperbilirubinemia, the body can secrete BDNF increasely. BDNF level is positivelycorrelated with B/ A level. As a marker of brain damage,BDNF is sensitive than craniocerebral MRI.

把社区康复纳入社区卫生服务是“人人享有康复服务”的重要保证,而社区卫生服务康复专业人员的规范化上岗培训是提高社区康复服务质量和可持续发展的关键。北京市在社区卫生服务康复专业人员规范化上岗培训方面已取得一定经验,要搞好此项工作,涉及培训的目的和职称、指导思想、师资队伍、培训基地、组织领导等方面的问题。

Nonalcoholic steatohepatitis (NASH) is an important pathological stage of nonalcoholic fatty liver disease characterized by hepatocyte fatty degeneration, liver injury, and liver inflammation and can further develop into liver cirrhosis and hepatocellular carcinoma. The NOD-like receptor family, pyrin domain-containing protein 3 (NLRP3) inflammasome is a multi-protein complex in cells and can induce cell apoptosis and expand inflammatory response by activating caspase-1 and releasing mature inflammatory factors such as interleukin-1β and interleukin-18. Recent studies have found that NLRP3 inflammasome may participate in the development and progression of NASH. Therefore, this article summarizes the role of NLRP3 inflammasome in NASH, so as to provide a theoretical basis for future research and treatment.

ObjectiveTo investigate the effect of Quzhi Ruangan decoction on the mRNA and protein expression of organic anion transporting polypeptide 2B1 (OATP2B1) in the small intestine of rats with nonalcoholic fatty liver disease (NAFLD). MethodsAfter 1 week of adaptive feeding, 36 male Sprague-Dawley rats were randomly divided into normal group, model group, simvastatin group, and high-, middle-, and low-dose Quzhi Ruangan decoction groups, with 6 rats in each group. Liver tissue was collected and HE staining was used to observe hepatic steatosis; an automatic biochemical analyzer was used to measure the serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), glucose (GLU), and cholesterol (CHOL); RT-PCR and Western blot were used to measure the mRNA and protein expression of OATP2B1 in the small intestine of rats. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups. Results There were significant differences in liver index, GLU, and CHOL between groups (F=10.814, 12.298, and 5.024, all P＜0.05), and there were also significant differences in the mRNA and protein expression of OATP2B1 in the small intestine (F=13.384 and 73.025, both P＜0.05). Compared with the normal group, the model group had significant increases in the mRNA and protein expression of OATP2B1 (both P＜0.05); compared with the model group, the simvastatin group and the high- and middle-dose Quzhi Ruangan groups had a significant reduction in the mRNA expression of OATP2B1 (all P＜0.05); compared with the simvastatin group, the middle- and low-dose Quzhi Ruangan groups had a significant reduction in the mRNA expression of OATP2B1 (both P＜0.05). Compared with the normal group, the model group had a significant increase in the protein expression of OATP2B1 (P＜0.05); compared with the model group, all treatment groups had a significant reduction in the protein expression of OATP2B1 (all P＜0.001); compared with the simvastatin group, the high-, middle-, and low-dose Quzhi Ruangan groups had a significant reduction in the protein expression of OATP2B1 (all P＜0.05). ConclusionQuzhi Ruangan decoction may alleviate the pathological changes of NAFLD by reducing the overexpression of OATP2B1.

To investigate the therapeutic effects of oral osthole on streptozotocin (STZ)-induced type 1 diabetes mellitus(T1DM) mice and explore its internal mechanism. METHODS: The diabetes model induced by STZ was established. Mice were randomly divided into control group, STZ model group, STZ+osthole group (20 mg/kg). Body weight, blood glucose, urine protein, blood urea nitrogen and creatinine were observed to detect renal function. The degree of renal tissue damage was detected by H&E staining and PAS staining, and the degree of renal fibrosis was detected by Sirius Red staining. CD68 and F4/80 immunofluorescence staining was used to observe the infiltration of macrophages in kidney tissue. The mRNA expressive levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) in renal tissue were detected by RT-qPCR. The protein expressive levels of phospho-NF-κB p65, NF-κB p65, IκBα, phospho-IκBα, phospho-p38 and p38 were detected by Western blot in renal tissue. RESULTS: Compared with the STZ model group, the levels of urinary protein, blood urea nitrogen, creatinine were significantly decreased after osthole treatment (P<0.05 or P<0.01). The renal structure disorder, mesangial matrix area, collagen fiber accumulation, and macrophage infiltration were significantly improved (P<0.05 or P<0.01). The expression of mRNA of pro-inflammatory cytokines TNF-α and IL-6 were significantly decreased (P<0.05 or P<0.001). The expression of phospho-NF-κB p65, phospho-IκBα and phospho-p38 were significantly down-regulated (P<0.05 or P<0.01), while the protein expression level of NF-κB p65, IκBα was up-regulated (P<0.05). CONCLUSION: Osthole has a protective effect on kidney injury caused by diabetes and inhibits NF-κB and p38/MAPK signaling pathway.

Objective To evaluate the effect of bundles of care on the prevention of postoperative delirium among elderly patients with hip fractures.Methods A prospective randomized case control study was conducted on 80 patients (≥65 years old) with hip fractures from March 2017 to June 2017.The patients were divided into experimental group (n =43) and control group (n =37) according to the random number table method.The experimental group received bundles of care,while the control group received routine nursing.The patients in both groups were all surgically treated,and the confusion assessment method (CAM) was applied to diagnose delirium after surgery.Gender,age,fracture type,duration from injury to operation,internal fixation type,operation time,total amount of bleeding,visual analogue scale (VAS),incidence of delirium,complications,and adverse events were compared between the two groups.Results Among the 80 patients,there were 11 males and 69 females,aged averagely 79.3 years (range,65-95 years).No significant differences were found between experiment group and control group in terms of gender (male:6 cases vs.5 cases,females:37 cases vs.32 cases),age [(79.8 ± 7.8) years vs.(78.7 ± 8.9) years],cause of injury (traffic injuries:7 cases vs.4 cases;falling injuries:36 cases vs.33 cases),duration from injury to operation [(66.1 ±14.3)hours vs.(63.4 ±14.9) hours],fracture type (femoral neck:13 cases vs.10 cases;intertrochanteric:26 cases vs.24 cases;subtrochanteric:4 cases vs.3 cases),internal fixation type (artificial total hip:5 cases vs.5 cases;artificial femoral head:8 cases vs.5 cases;PFNA:29 cases vs.27 cases),operation time [(55.5 ± 16.8) minutes vs.(51.6 ± 17.0) minutes],total blood loss [(114.4 ± 73.9) ml vs.(108.1 ±72.0) ml] (P ＞ 0.05).After bundles of care intervention,the postoperative VAS [(2.2 ± 0.8) points vs.(4.3 ± 1.2) points],postoperative delirium incidence (9％ vs.32％),incidence of complications and adverse events (2％ vs.19％) in experimental group were significantly lower than those in control group (P ＜ 0.05).Conclusion Bundles of care can relieve the pain and effectively reduce the incidences of postoperative delirium,complications,and adverse events in elderly patients with hip fracture.

Cardiac disease is the general term of diseases, caused by damage to the structure or abnormal function of the heart. Its morbidity and mortality have remained high, seriously threatening the lives and health of people. The tyrosine kinase receptor ErbB2 (also known as EGFR2 or HER2) was originally discovered for its oncogenic activity, however, recent studies have found that ErbB2 have protective effects in various heart diseases. Therefore, this article reviews the role and underlying mechanism of ErbB2 in myocardial infarction, myocardial ischemia/reperfusion injury, cardiac hypertrophy, heart failure, doxorubicin-induced cardiotoxic injury and diabetic cardiomyopathy. Furthermore, this article also preliminarily discusses the application prospects, limitations and development directions of ErbB2 as a clinical diagnostic marker and therapeutic target for heart disease.

Objective:To study the clinical characteristics and compliance of early-onset gout patients by case-control analysis.Methods:A total of 111 early-onset patients (onset age ≤35 years old) were included as Group A, and 111 non-early-onset patients (onset age >35 years old) with matched disease durationwere included as Group B. The differences ofclinical characteristics, causes of acute gout attack, dairy diet habits, compliance, and misunderstanding of the disease were compared.Results:Compared with the non-early-onsetgoutpatients, the early-onset patients had a higher proportion of obesity (63 cases vs 28 cases), family history (36 cases vs 20 cases) and tophus (39 cases vs 23 cases) and higher level of VAS scores (8.5±1.3 vs 7.6±1.7; χ2=22.988, P<0.01; χ2=5.749, P=0.016; χ2=5.729, P=0.017; t=4.639, P<0.01), lowerproportionof the first metatarsophalangeal joint involvement as the initial joint involvement (45.9%, 51 cases vs 59.4%, 66 cases; χ2=4.066, P=0.044), higher proportion of the ankle involvement as the initial joint involvement (34.2%, 38 cases vs 21.6%, 24 cases; χ2=4.386, P=0.036), higher proportion of alcohol drinkers and high fructose drinkers, which was more likely to relate to alcohol intake, strenuous exercise and high fructose intakeas trigger of the flare ( χ2=6.513, P=0.011; χ2=7.126, P=0.008; χ2=1.978, P=0.160), while the proportion of regular exercisers and on diet in the family was lower ( χ2=22.887, P<0.01; t=-4.917, P<0.01). The proportion of poor diet and medication compliance in Group A was higher than that in Group B(57.7%, 64 cases vs 38.7%, 43 cases; χ2=5.207, P=0.022; χ2=5.867, P=0.015). As for the reason for poor treatment compliance, early-onset gout patients were more worry about the side-effects of drugs than non-early onset patients ( χ2=4.190, P=0.041). There was no significant difference between the two groups in the main misunderstanding of gout. Conclusion:Although early onset gout patients are young, their condition is more serious, and compliance is poorer, this group of patients should be highly valued in clinical diagnosis and treatment.

Objective:To evaluate the efficacy and safety of oral anisodine hydrobromide tablets in the treatment of nonarteritic anterior ischemic optic neuropathy (NAION).Methods:A multicenter nonrandomized controlled trial was conducted.A total of 282 acute NAION patients (282 eyes) were recruited from 16 hospitals in China from July 2020 to May 2021.Patients were divided into two groups according to treatment methods, which were control group (124 cases, 124 eyes) receiving regular treatment including citicoline sodium plus Ginkgo biloba leaf liquid extract or Ginkgo biloba leaf extract tablets plus mecobalamin, and experimental group (158 cases, 158 eyes) receiving treatment in control group plus oral anisodine hydrobromide tablets 1 mg, twice daily for 2 to 3 months.Best corrected visual acuity (BCVA), visual field index (VFI), peripapillary retinal nerve fiber layer (pRNFL) and radial peripapillary capillary vessel density (RPC) were assessed at 1, 2, 3, and 6 months after enrollment using the standard decimal visual acuity chart, 750i Humphery visual field analyzer, Cirrus HD-OCT 4000/Cirrus HD-OCT 5000, RTVue-XR optical coherence tomography respectively.The primary outcomes were BCVA and VFI, and the secondary outcomes were pRNFL, RPC, and the side effects during the follow-up.The study adhered to the Declaration of Helsinki.All patients were fully informed about the treatment and purpose of this study and voluntarily signed the informed consent form.The study protocol was approved by Chinese PLA General Hospital (No.S2020-021-01). Results:In all, 242 patients (242 eyes) completed the follow-up of BCVA, and 98 patients (98 eyes) completed the VFI follow-up.In terms of visual function, BCVA and VFI improved significantly over time in the two groups, and BCVA and VFI were better in experimental group than in control group at various follow-up time points (all at P<0.05). In terms of structure, pRNFL gradually decreased in both groups with the extension of treatment, and pRNFL was significanthy thinner in experimental group than in control group at various follow-up time points (all at P<0.05). There was no significant difference in RPC between the two groups at the last follow-up ( P>0.05). There were two cases with side effects and one case was discontinued due to side effects 25 days after enrollment. Conclusions:Oral anisodine hydrobromide can improve visual acuity and visual field in NAION and accelerate the regression of optic disc edema, with good safety.