Objective : To investigate the correlation between knowledge, self-efficacy and prevention management behaviour of osteoporosis among middle-aged and elderly community residents in Shanghai, based on the knowledge, attitude, and practice (KAP) theory. Methods ¡¤ By using convenient sampling, a cross-sectional study was conducted to obtain information of 2 058 residents from 20 communities in Shanghai, concerning socio-demographics, osteoporosis knowledge scale, osteoporosis self-efficacy scale and osteoporosis prevention management be-haviour scale questionnaires. The structural equation model was applied to correlation analysis and path analysis. Results ¡¤ A total of 2 001 valid questionnaires were collected, the average age being (62.12±12.08) years; female osteoporosis prevention self-management behaviour (17.25±5.35) was shown to be better men's (t=3.78, P<0.001). A higher score of prevention management behaviour in osteoporosis was obtained from residents of college education or higher (18.25±5.18), compared with those of primary school or lower (15.34±4.74), and high school (17.09±5.31) (F=26.93, P<0.001), respectively. Higher scores were revealed in groups with family history (18.13±4.73) compared with those without (16.89±5.33) (t=3.89, P<0.001). Higher income groups achieved higher scores (17.90± 4.52), compared with relatively lower income groups (F=8.66, P<0.001). Multiple factor analysis demonstrated that knowledge and self-efficacy were significantly correlated with prevention management behaviour (β=0.27, 95% CI 0.22-0.32; β=1.01, 95% CI 0.92-1.11). Path analysis showed that relevant knowledge (β=0.169, P<0.001) had direct effect on the prevention management behaviour, and could also be mediated by self-efficacy (β=0.410, P<0.001). Conclu-sion ¡¤ Male, low education, no family history of osteoporosis and low income are the risk factors for the decrease of osteoporosis prevention and management behaviour.

Objective • To evaluate the recurrence rate of atrial fibrillation (Af) and its related risk factors in aged patients with chronic diseases after cryoballoon ablation. Methods • With the method of convenient sampling, a total of 159 patients with Af after cryoballoon ablation were enrolled in the Department of Cardiology, Ruijin Hospital from Oct. 2016 to Jan. 2018. Self-rating depression scale (SDS) and CHA2DS2-VASc scores [congestive heart failure, hypertension, age ≥ 75 y (doubled), diabetes mellitus, stroke(doubled)-vascular disease, age 65-74 and sex category(female)] were used to assess the patients. Follow-up checks consisted of chief complaint, postoperative electrocardiogram (ECG), and 24 h Holter monitoring. Logistic regression models were performed to explore the independent risk factors of Af recurrence after cryoballoon ablation. Results • 152 patients (95.6%) completed the follow-up checks, with an average age of (61.9±8.9) years. The average time of follow-up period was (8.35±2.41) months. A total of 41 patients (27.0%) developed Af after cryoballoon ablation. Logistic regression analysis showed the number of chronic disease ≥ 2 (OR=2.466, 95% CI: 1.375-4.452), CHA2DS2-VASc scores ≥ 2 (OR=2.088, 95% CI: 1.142-5.557), irregular use of anti-arrhythmic drugs (OR=1.581, 95% CI: 1.351-2.125), hypertension (OR=1.317, 95% CI: 1.076-2.809), and body mass index (BMI) (OR=1.147, 95% CI: 1.009-1.174) were the independent risk factors of Af recurrence. Conclusion • There is still a certain percentage of recurrence in aged patients with chronic diseases after cryoballoon ablation. 2 and more chronic diseases, irregular use of anti-arrhythmic drugs, hypertension, CHA2DS2-VASc scores ≥ 2, and overweight may be potential risk factors of Af recurrence after cryoballoon ablation.

Objective To investigate the effects of MG132 on diabetic nephropathy (DN) rats induced with streptozocin. Methods Seventy-two male SD rats were randomly divided into three groups: normal control group (NC, n=24), DN group (n=24) and DN treated with MG132 group (DN+MG132, n=24). At the end of 4, 8 and 12 weeks, 24 hour urinary protein excretion rate (UPER) was detected. Morphology of kidney was examined by special staining of periodic acid-schiff (PAS). Renal 26S proteasome activity was determined by quantifying the hydrolysis of S-LLVY-AMC in a fluorescence reader. Urinary malondialdehyde (MDA) level and renal SOD and GSH-PX activity were detected by commercial kits. Renal SOD, GSH-PX and p47phox mRNA expressions were determined by real-time fluorescence PCR. Renal p47phox protein expression wasdetermined by Western blotting. Results Compared with NC group, the DN group showed a significant increased of UPER at week 4, 8, 12 (all P<0.05), of mesangium proliferation and mesangial matrix expansion at week 12. In DN+MG132 group, UPER was significantly decreased compared with DN group at the end of 4, 8 and 12 weeks (P<0.05, respectively), and the glomeruler pathological alteration induced by diabetes was attenuated. Increased renal 26S proteasome activity in DN rats was significantly inhibited after MC132 administration (P<0.05). Moreover, renal p47phox mRNA expression in DN group was 155%, 149% and 120% more than those in NC group at 3 time points (all P<0.05), and so was the renal p47phox protein expression, 139%, 152% and 186% more (all P<0.05). Urinary MDA levels in DN group were 1.95-, 2.04-and 2.62-folds more than those in NC group (all P<0.05). In addition, compared with NC group at 3 time points, in DN group, renal SOD activity was decreased by 23.09%, 33.59% and 53.31% (all P<0.05); renal GSH-PX activity was decreased by 28.57%, 33.06% and 48.76% (all P< 0.05); renal SOD mRNA was decreased by 38.09%, 61.44% and 76.53% (all P<0.05); renal GSH-PX mRNA group was decreased by 29.16%, 37.26% and 62.40% (all P<0.05). Compared with DN group, renal p47phox mRNA and protein expression, and urinary MDA levels were significantly lower in DN+MG132 group (all P<0.05); renal SOD and GSH-PX activity as well as mRNA expression were significantly increased in DN+MG132 group (all P<0.05). Conclusions MG132 treatment can provide renoprotection for DN rats effectively maybe through enhancing renal anti-oxidative ability.

Objective To investigate the effect of 4-phenylbutyric acid(4-PBA)on the renal pathogenesis of rats with streptozotocin-induced diabetes and its mechanism. Methods Fifty-four male SD rats were randomly divided into three groups:normal control group(NC group,n=18),diabetic nephropathy group(DN group,n=18),diabetic nephropathy plus 4-PBA treatment group(4-PBA group,n=18).At the end of 4,8 and 12 weeks,index of kidney weight/body weight ratio(KI)were measured and calculated.Serum creatinine (Scr),blood urea nitrogen(BUN),urinary MDA levels,urinary SOD activity,and 24 hour urinary protein excretion ram(UAER)were detected by HITACHI automatically.Morphology of kidney wag examined by special staining of periodic acid-schitt (PAS).The p47phox and nitrotyrosine (NT) expression in kidney were determined by real-time fluorescence PCR and Western blotting. Results Compared with the NC group, the DN group rats showed a significant increase of KI(P＜0.05), UAER(mg/24 h) (4.92±0.70 vs 0.26±0.07, 5.29±0.83 vs 0.28±0.08, 5.54±0.81 vs 0.29±0.04,respectively, P＜0.05]for indicated time, mesangial cells proliferation and mesangial matrix expansion at 12 week. However,4-PBA treatment could significantly inhibit the increase of KI (P＜0.05), decrease UAER (mg/24 h) (3.71±0.37, 3.47±0.36, 3.28±0.40, respectively, P＜0.05]for indicated time, and prevent the glomeruler pathological alteration induced by diabetes. Moreover, the mRNA expression of p47phox in the kidney of DN group was 154.72%, 148.60% and 91.95% more than that of NC group (all P＜0.05) for indicated time. The protein expression of p47phox was 118.00%, 140.10% and 177.82% more than that of NC group (all P＜0.05), and the protein expression of NT was 45.29%,59.13% and 89.28% more than that of NC group (all P＜0.05). In addition, urinary MDA levels in DN group were 2.05-, 2.26- and 2.43- folds of NC group, and urinary SOD activities were decreased by 64.78%, 71.29% and 79.32% of NC group. Compared with the DN group, the mRNA and protein expression of p47phox, and protein expression of NT in 4-PBA group were decreased markedly (all P＜0.05) at the end of 8 and 12 weeks. The urinary MDA level was decreased, and the urinary SOD activity was increased significantly in rats with diabetes after 4-PBA treatment for indicated time (all P＜0.05). Conclusion 4-PBA treatment can significantly inhibit the renal pathogenesis of rats with diabetes through inhibition of oxidative stress.

Objective To analyze the impact of lymphocyte subsets on chemotherapy efficacy and long-term survival of patients with advanced non-small cell lung cancer(NSCLC).Methods Totally 125 NSCLC patients who had received first-line chemotherapy including paclitaxel and pemetrexed with/without platinum were enrolled in this study.Lymphocytes from peripheral blood were collected before and after two cycles of first-line chemotherapy.Flow cytometry was performed to determine the expressions of 21 fluorescence-labeled lymphocyte subsets.Based on the imaging findings,chemotherapy efficacy was evaluated,and impact of the lymphocyte subsets on progression-free survival(PFS)and overall survival(OS)were analyzed.Results The baseline peripheral lymphocyte subsets showed no significant difference among groups receiving different treatment protocols(all P>0.05).After 2 cycles of chemotherapy,the percentage of CD4CD29lymphocytes was(16.87±5.28)% in progressive disease group,which was significantly lower than those in complete remission+partial remission group [(22.42±7.88)%,P=0.013] and stable disease group [(21.88±6.81)%,P=0.009].The median PFS was 7.07 months and median OS was 23.00 months.Cox multivariable regression analysis showed that the percentages of HLA-DR(HR:1.03,95%CI:1.01-1.05,P<0.001) and CDHLA-DRlymphocytes (HR:1.05,95%CI:1.01-1.08,P<0.001)were positively correlated with OS.Conclusions The rise of CD4CD29T lymphocytes in patients after chemotherapy indicates good chemotherapy efficacy.Higher percentage of HLA-DRand CD3HLA-DRlymphocytes in peripheral blood before chemotherapy predicts favorable prognosis.

Objective To investigate the effect and significance of regulating endoplasmic reticulum stress on the expression of histone methyltransferases SET7/9 in the kidneys of db/db mice.Methods Db/db mice were randomly divided into two groups according to random number table method:diabetic nephropathy model group (DN group,n=18) and betaine treatment group (DN+B group,n =18),db/m mice were defined as normal control group (NC group,n =18).At the end of 4,8 and 12 weeks,the expression of GRP78,SET7/9,H3K4me2,and monocyte chemoattractant protein 1 (MCP-1) was determined by real-time fluorescence PCR and Western blotting.24-hour urinary protein excretion rate (UPER) and urine MCP-1 were measured by enzyme linked immunosorbent assay (ELISA).The dynamic changes of blood glucose(BG),serum creatinine (Scr),blood urea nitrogen (BUN) were tested by completely automatic biochemistry analyzer.The morphology of kidney was estimated by special staining of periodic acid-schiff (PAS).Results The levels of BG,BUN,UAER and MCP-1 were significantly higher in DN group than those in NC group (P ＜ 0.05),and were in time-dependent manner.Glomerular basement membrane thickening and mesangial cells proliferation began to emerge in DN group at the end of week 4 and mesangial matrix expansion was more obvious at the end of week 12.The mRNA and protein expression of GRP78 and SET7/9 were elevated significantly in DN group as compared to NC group.The H3K4me2 protein expression level was also increased in time-dependent manner.Compared with the DN group,in DN+B group glomerular lesions attenuated and the GRP78 and SET7/9 expression levels obviously decreased (P ＜ 0.05).Furthermore,the levels of BG,BUN,UPER,MCP-1,H3K4me2 in DN+B group were also reduced (P ＜ 0.05).Conclusion Endoplasmic reticulum stress may be the upstream mechanism of mediating the expression of SET7/9 in the kidneys of DN mice.

Objective To investigate the role of tet methylcytosine dioxygenase 2 (TET2) in the regulation of transforming growth factor-β1 (TGF-β1) expression in human glomerular mesangial cells induced by high glucose.Methods Cultured human glomerular mesangial cells were divided into normal control group (5.5 mmol/L glucose) and high glucose group (30.0 mmol/L glucose) which was cultured for 12 h to 72 h.The gene expression of TET2 in mesangial cells were inhibited by small molecule chemical called SC1,and which were divided into high glucose group (30.0 mmol/L glucose+ DMEM),DMSO group (30.0 mmol/L glucose+0.1％DMSO) and SC1 group (30.0 mmol/L glucose+3 μmol/L SC1).The mRNA and protein expression of TGF-β1,TET1 to 3 and α-smooth muscle actin (α-SMA) was detected by quantitative real-time PCR and Western blotting.Methylation of CpG islands in the regulation region of TGF-β1 was detected by bisulfite sequencing PCR (BSP).The activity of mesangial cell proliferation was assessed by colorimetry of thiazolyl blue (MTT).Results Compared with normal control group,the mRNA and protein expression of TET2 in mesangial cells induced by high glucose was increased significantly in a time-dependent manner (all P ＜ 0.05),but the expression of TET1 and TET3 was not affected.Meanwhile methylation rate of 4 CG sites from 24 h to 72 h were decreased in the first exon of TGF-β1 (P ＜ 0.01),but not in the promoter.Compared with high glucose group,when the expression of TET2 was inhibited by SC1,the methylation rate of TGF-β1 was recovered evidently (P ＜ 0.05),the mRNA and protein expression of TGF-β1 and α-SMA was suppressed,and the proliferation of mesangial cells was decreased (all P ＜ 0.05).Conclusions Demethylation of the CpG island mediated by TET2 may play an important role in the expression of TGF-β1 and mesangial cell phenotype transformation induced by high glucose.

Objective To explore the effects of extract of Gingko biloba leaves (EGb) on learning, memory and hippoeampal heine oxygenase-1 (HO-1) expression in diabetic rats.Methods The behaviors of streptozotoein-induced diabetic rats were observed by Morris water maze for learning and memory after 6 months of diabetes.The HO-1 mRNA expression and protein expression in hippocampus of diabetic rats were detected by RT- PCR and immunohistochemistry respectively.Results The escape latency time in Morris water maze of diabetic rats was prolonged markedly.HO-1 mRNA and HO-1 protein expressions in hippocampus of diabetic rats were increased (1.635?0.326 vs 0.978?0.214,7.2?1.7 vs 1.9?0.5,respectively,both P＜0.01).The escape latency times in EGb (100,50 mg/kg) treated groups were shortened.HO-1 mRNA and HO-1 protein expressions in hippocampus were decreased at the same time as compared with diabetic group (100 mg/kg:0.954?0.144,2.0?0.8;50 mg/kg:0.988?0.154,2.5?0.6,all P＜0.01).Conclusion EGb can significantly inhibit HO-1 expression in hippocampus and improve learning and memory dysfunction in diabetic rats.

Objective To investigate the methods and effects of posterior fixation and fusion in treatment of complete thoracolumbar fracture and dislocation.Methods The study enrolled 8 cases of complete thoracolumbar fracture and dislocation treated by posterior fixation and fusion with pedicle screwrod system between January 2006 and December 2012.There were 7 males and 1 female,at mean age of 31.9 years (range,19-49 years).Mean time interval between injury and surgery was 8.1 days (range,4-12 days).Fracture-dislocation classification was AO type C,Denis three-column injury,and Meyerding grade V.According to American Spinal Injury Association (ASIA),there 5 cases at grades A,1 at grade B,1 at grade C 1 at grade E.Fracture-dislocation segments included T5-T6 in 1 case,T12-L1 in 3,L1-L2 in 2,L3-L4 in 1 and L4-L5 in 1.Results Mean duration of surgery was 220.6 minutes (range,135-335 minutes) and mean intraoperative blood loss was 1 150 ml (range,500-2 400 ml).Seven cases sustained dural laceration during the operation,which were sutured or covered with autologous fat grafts,but 3 of them were subjected to cerebrospinal fluid leakage and healed after conservative therapy.Anatomic reduction was achieved in 6 cases,partial reduction in 1 and non-reduction in 1.Mean Cobb angle improved from 29.3 ° (range,8 °-51 °) preoperatively to 1.9 ° (range,-5°-10 °) postoperatively.After a mean follow-up of 39.3 months (range,2-76 months),2 cases were recovered from preoperative ASIA grade A and B to C respectively and 6 cases (4 A,1 C,1 E) revealed no significant improvement.There was no implant loosening or breakage.One case was died of lung-related complications at postoperative 4 years.One case sustained lumbar deep infection at postoperative 3 weeks and managed by debridement,irrigation,drainage and implant retention.Conclusion Posterior fixation and fusion is the general treatment principle for complete thoracolumbar fracture and dislocation,but the degree of reduction depends on severity of the injured spinal cord.

Objective To evaluate the effect of acupressure on chemotherapy-induced digestive tract reaction of malignant tumor patients.Methods We searched Pubmed,Medline,Embase,AMED,Cochrane Library,Cancerlit and Cinabl,China Biology Medicine disc (CBM),China National Knowledge Infrastructure (CNKI),VIP database (VIP)and Wanfang database,the databases were searched from the establishment of the database to March 2014.We identified randomized controlled trials (RCTs) and of acupressure on chemotherapy-induced digestive tract reaction for malignant tumor patients.Results In total,8 RCT,959 patients were included.Meta-analysis showed that compared with the no implementation of acupressure,acupressure could effectively reduce the frequency,duration and severity of chemotherapy-induced nausea,vomiting and retching.Meanwhile,acupressure could decrease anti-emetic medication dosage,but could not increase quality of life.Conclusions Acupressure can improve the digestive tract reaction of malignant tumor patients,alleviate the suffering of patients.Meanwhile acupressure couldn't increase the medical burden and mental burden of patients.More attention should be paid to the effect of acupressure on baseline level of state anxiety,functional state and more items.