Objective To explore a 3D printing model of fracture restoration which can be used in preoperative planning and design for distal tibiofibular fractures.Methods A retrospective analysis was performed of the 35 patients with distal tibiofibular fracture who had been treated from October 2015 to September 2016 at our department.Bilateral tibiofibular CT scan was performed in all the cases to obtain Dicom data.Using Mimics 15.0 software,cross sections were created at 5 cm,10 cm and 15 cm above the knee joint at the bilateral upper tibiae and marked as PT5,PT10 and PT15.The long and short axles on the left and right sides were measured and compared (LL vs.RL;LS vs.RS).After the STL files for 3D models were generated using Mimics 15.0 software,a real-sized 3D model of the distal tibiofibular fracture and a mirror model of the contralateral tibiofibula were printed.The fracture lines were drawn and preoperative manoeuvre was performed on the mirror 3D printed model.The real operation used the implants preoperatively designed;the actual screw lengths were measured and compared radiographically with those designed in the preoperative manoeuvre.Results All the data were collected of the long and short axles on the 3 cross-sections (PT5,PT10 and PT15) of the left and right sides of the proximal tibia.The samples were paired into 6 groups.The correlation coefficients of paired samples were greater than 0.95,showing an extremely strong correlation.The differences between the left and right sides showed no statistically significance in paired samples of LR-RL and LS-RS groups on PT5,PT10 and PT15 cross-sections (P ＞ 0.05).All the 35 cases received surgical operation.The postoperative X-ray review showed fine agreement between actual surgery and preoperative design in terms of screw length and accuracy.The deviations were in an allowable range,leading to satisfactory internal fixation.Conclusions A mirror 3D model of the healthy side is of clinical value to some extent because it can serve as one for an anatomically reduced fracture which can be used for preoperative manoeuvre and preparation of implants.The contrasts between the long and short axles on the 3 cross-sections may simplify and facilitate comparisons of bilateral similarity,avoid the blindness in direct application of the health side mirror model for preoperative planning.

OBJECTIVE:To establish a method for the simultaneous determination of ornidazole and dexamethasone sodium phosphate in Compound ornidazole film. METHODS:HPLC was performed on the column of Inertsil ODS-3 with mobile phase of methanol-20 mmol/L phosphate buffer(pH was adjusted to 7.40 with glacial acetic acid)(55∶45,V/V)at a flow rate of 1.0 ml/min, column temperature was 30 ℃,detection wavelength was 242 nm and volume injection was 10 μl. RESULTS:The linear range were 1-100μg/ml for both ornidazole(r=0.999 7)and dexamethasone sodium phosphate(r=0.999 9);RSDs of precision,stabili-ty and reproducibility tests were lower than 2.0%;recoveries were 96.50%-99.80%(RSD=1.02%,n=9) and 96.50%-99.60%(RSD=0.99%,n=9). CONCLUSIONS:The method is specific with good precision and stability and high accuracy,and can be used for the simultaneous determination of ornidazole and dexamethasone sodium phosphate in Compound ornidazole film.

AIM: To investigate the relationship among MCP-1 and monocyte chemoattract protein activity (MCA) and pathogenesis of lung cancer. METHODS: 173 patients were involved in the study and divided into three groups: group A: lung cancer group (60 patients); group B: benign lung disease group (55 patients) and group C: healthy control group (58 patients). MCP-1 level and MCA in bronchoalveolar lavage fluid (BALF) were measured. RESULTS: The concentration of MCP-1 and MCA in BALF in group A were much higher than those in group B and group C (P

[ ABSTRACT] AIM:To explore the mechanisms of fluctuant high blood glucose-induced apoptosis of hepatocytes. METHODS:SD rats were randomly divided into normal control group ( N) , stable high blood glucose group ( S) , fluctu-ant high blood glucose group ( F) and insulin group ( I) .Diabetic rats were induced by intraperitoneal injection of strepto-zotocin (65 mg/kg) , and the fluctuant high blood glucose animal model was induced by intraperitoneal injection of ordinary insulin and glucose at different time points every day.The blood glucose fluctuation patterns of the animals in F group with-in 12 weeks were similar every day and no significant difference of the HbA1c concentration was observed compared with S group, indicating that the fluctuant hyperglycemia was successfully established in F group.The activity of superoxide dis-mutase ( SOD) and glutathione peroxidase ( GSH-Px) , and the content of malondialdehyde ( MDA) and nitric oxide ( NO) in the homogenate of the liver tissues were detected by colorimetry.The mRNA and protein levels of JNK, p-JNK, Bax and Bcl-2 were examined by RT-PCR and Western blot.RESULTS:After 12 weeks, the increases in the intakes of food and water, the urine output, and the abnormal liver function were observed in S group, I group and F group.Compared with N group, the MDA level was increased, the content of NO and the activity of SOD and GSH-Px were decreased, and up-regu-lation of JNK mRNA and p-JNK and Bax proteins, and down-regulation of Bcl-2 were also found in S group, I group and F group.The above effects were more obviously showed in F group.CONCLUSION:Oxidative stress activates JNK-MAPK signaling pathway, which is involved in fluctuant high glucose-induced apoptosis of hepatocytes.

Objective:To investigate the effects of Ginkgo diterpene lactone on depression-like behaviors in a rat model of chronic unpredictable mild stress (CUMS) and its mechanism.Methods:Forty SD rats were randomly divided into five groups, which were control group, CUMS group, CUMS+ low-dose Ginkgo diterpene lactone group (1.5 mg·kg -1·d -1), CUMS+ medium-dose Ginkgo diterpene lactone group (3 mg·kg -1·d -1) and CUMS+ high-dose Ginkgo diterpene lactone group (6 mg·kg -1·d -1). CUMS rat model was established by continuous stress for six weeks, and the rats were given corresponding treatment in the last three weeks. Sucrose preference test was performed during the stress and drug administration, and behavior tests were performed after the stress and drug administration. After behavior tests, hippocampus, hypothalamus and serum samples were collected to detect inflammatory factors and neurotransmitter. Results:Chronic stress caused depression-like behaviors in rats, while continuous treatment with Ginkgo diterpene lactone could effectively improve sucrose preference, forced swimming immobility time and open field test scores in CUMS rats. It was found that Ginkgo diterpene lactone could significantly improve the decreased secretion of IL-1β and IFN-γ in plasma, and significantly increase the secretion of IL-10 and IL-4 caused by CUMS. In addition, CUMS caused hyperfunction of the hypothalamic-pituitary-adrenal (HPA) axis in rats, which manifested as increased secretion of corticotropin releasing hormone (CRH), adrenocorticotropic hormone (ACTH) and cortisol (COR). The negative feedback of HPA hypermodulated the release of neurotransmitters in the hippocampus, causing the levels of 5-hydroxytryptamine (5-HT), 5-hydroxyindoleacetic acid (5-HIAA) and norepinephrine (NE) in the brain of CUMS rats to decrease. However, Ginkgo diterpene lactone could significantly inhibit HPA axis hyperfunction and increase neurotransmitter levels in the brain.Conclusions:Ginkgo diterpene lactone can effectively improve the depression-like behaviors of CUMS rats through regulating the immune environment, inhibiting the HPA axis hyperfunction and increasing neurotransmitter release.

Objective:To evaluate the nutritional status of elderly inpatients with heart failure, and to analyze risk factors for malnutrition.Methods:A total of 221 patients with heart failure in our hospital from January 2018 to March 2019 were enrolled in the study.The demographic characteristics and medical record data were collected.All patients received Nutritional Risk Screening 2002(NRS-2002)and a questionnaire survey relating to heart failure.We investigated the effects of risk factors on the detection rate of malnutrition by using Mann-Whitney U test or Chi-square test, and the independent risk factors for malnutrition were analyzed by multivariate Logistic regression analysis.Results:The detection rate of nutritional risk was 45.2% in 221 patients.The detection rate of nutritional risk increased along with lower degree of education and worse cardiac function( P<0.05). The detection rate of nutritional risk was higher in patients with peripheral vascular disease and osteoporosis than in patients without them( P<0.05), and in patients with the increased numbers of complication and drugs( P<0.05). Patients with nutritional risk had a higher degree of frailty and a worse quality of activities of daily living( P<0.05). Multivariate Logistic regression analysis indicated that great age, ejection fraction, B-type natriuretic peptide(BNP), NYHA classification, numbers of drugs and diseases, frailty, low quality of life were independent risk factors for nutritional risk, and Digoxin was the independent protective factor for nutritional risk( P<0.05). Conclusions:The great age, severity of heart failure, numbers of drugs and diseases, frailty, low quality of daily life may be the independent risk factors for nutritional risk in elderly patients with heart failure, and oral Digoxin may be the independent protective factor for nutritional risk.

Objective:Based on the Janus kinase 2(JAK2)/signal transducer and activator of transcription 3(STAT3)signaling pathway,to explore the influences of Liyan syrup on pharyngeal tissue injury and pharyngeal mucosal repair in rats with chronic phar-yngitis.Methods:SD rats were randomly separated into control group,model group,Liyan syrup group,RO8191(JAK2/STAT3 acti-vator)group,Liyan syrup+RO8191 group,the model group and drug intervention group were treated with ammonia water to stimulate the pharynx to build a chronic pharyngitis model,while rats in control group were injected with an equal dose of normal saline into the pharynx.After the intervention of Liyan Syrup and RO8191,the general condition of rats and the apparent state of pharynx were detected,and the apparent state of pharynx was scored;the pathological changes of pharynx of rats were measured by HE staining;the proportions of CD4+T and CD8+T and the ratio of CD4+T/CD8+T in peripheral blood T lymphocyte subsets of rats were measured by flow cytometry;the levels of serum tumor necrosis factor alpha(TNF-α),IL-6,IL-10,malondialdehyde(MDA),reactive oxygen species(ROS)and total antioxidant capacity(T-AOC)were measured by kits;the expressions of JAK2/STAT3 pathway-related proteins in rat pharyngeal tissues were measured by immunoblotting.Results:Compared with control group,the pharyngeal tissue of model group showed obvious pathological morphological damage,the peripheral blood CD4+T proportion and CD4+T/CD8+T,IL-10 and serum T-AOC level decreased(P<0.05),the pharyngeal appearance state score,CD8+T ratio,serum TNF-α,IL-6,MDA and ROS levels,and pharyngeal tissue p-JAK2/JAK2 and p-STAT3/STAT3 levels increased(P<0.05);compared with model group and Liyan syrup+ RO8191 group,the pathological and morphological damage of the pharynx of rats in Liyan syrup group was alleviated,the peripheral blood CD4+T and CD4+T/CD8+T,IL-10,and serum T-AOC level all increased(P<0.05),and the pharyngeal appearance state score,CD8+T,serum TNF-α,IL-6,MDA and ROS levels,and pharyngeal tissue p-JAK2/JAK2 and p-STAT3/STAT3 levels all decreased(P<0.05);the change trend of each index in RO8191 group was opposite to that in Liyan syrup group.Conclusion:Liyan syrup can reduce inflammation and oxidative stress by inhibiting the activation of JAK2/STAT3 signal,enhance anti-inflammatory and antioxidant capacity,relieve throat tissue damage and repair pharyngeal mucosa in rats with chronic pharyngitis.

Taking the reform of DRG payment methods as the background,it discusses how the medical in-surance department uses information technology to achieve refined monitoring and management of medical institu-tions,so as to improve the quality and efficiency of medical services and control the unreasonable growth of medical expenses.The three stages of"precision monitoring-refined supervision-precision governance"of medical insurance DRG based on"refined theory"are proposed;taking Nanjing's"medical insurance high-speed railway"as an example,a DRG refined supervision and governance model framework is constructed,and its analysis is carried out monitoring elements and governance elements,and finally put forward implementation suggestions,including hori-zontal collaboration led by medical insurance,establishing a service and cost evaluation mechanism that combines in-ternal and external services.

Objective:To evaluate the associations of depression and anxiety statues with serum inflammatory biomarkers in elderly patients with chronic heart failure.Methods:From January 2018 to January 2020, 225 elderly patients with chronic heart failure were enrolled from our hospital. Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS) were performed in all patients to determine if the patients were with depression and anxiety statues and evaluate the degrees of depression and anxiety. The differences in demographic and clinical data, geriatric comprehensive assessment indicators, and serum inflammatory markers were compared among patients in the control group (without depression and anxiety), depression group, anxiety group, and depression and anxiety group (with both depression and anxiety). Spearman correlation test was used to analyze the correlation between the levels of serum inflammatory markers and the degrees of depression and anxiety in patients with depression and anxiety. Binary Logistic regression analysis was used to determine the independent influencing factors for depression and anxiety.Results:(1) As compared with those in the control group, patients in the depression group, anxiety group, and depression and anxiety group had significantly increased scores of Chinese version of Tilburg Frailty Indicator, statistically decreased Mini Mental State Examination (MMSE) scores, significantly increased Minnesota Living with Heart Failure Questionnaire (MLWHFQ) scores, increased proportions of patients with 2-4 kinds of diseases and those taking 2-4 kinds of drugs, and decreased Basic Activity of Daily Living (BADL) scores ( P<0.05); as compared with those in the depression group and the anxiety group, the changes of the above indicators in the depression and anxiety group were more obvious with significant differences ( P<0.05). As compared with those in the control group, patients in the depression group, anxiety group, and depression and anxiety group had significantly increased serum interleukin (IL)-6 and C-reactive protein (CRP) levels, patients in the anxiety group and depression and anxiety group had statistically elevated serum homocysteine (Hcy) level, and patients in the depression group and depression and anxiety group had significantly increased serum tumor necrosis factor α (TNF-α) level ( P<0.05); the serum levels of CRP, Hcy and TNF-α in patients from the depression and anxiety group were significantly higher than those in depression group ( P<0.05); the levels of IL-6, CRP, Hcy and TNF-α in the depression and anxiety group were significantly higher than those in the anxiety group ( P<0.05). As compared with that in the control group, the proportion of patients with nutritional risk in the depression and anxiety group was statistically higher ( P<0.05). (2) The serum levels of IL-6, CRP and TNF-α in depression patients were positively correlated with the depression degrees ( P<0.05); the serum levels of IL-6, CRP and Hcy in anxiety patients were positively correlated with the anxiety degrees ( P<0.05). (3) Results of binary Logistic regression analysis showed that IL-6 was an independent risk factor for depression in elderly patients with chronic heart failure ( OR=1.093, 95%CI: 1.049-1.139, P=0.000); Hcy was an independent risk factor for anxiety in elderly patients with chronic heart failure ( OR=1.114, 95%CI: 1.030-1.205, P=0.007); CRP, TNF-α, IL-6 and Hcy were independent risk factors for depression and anxiety in elderly patients with chronic heart failure ( P<0.05). Conclusion:The depression and anxiety degrees and expressions of inflammatory markers in elderly patients with chronic heart failure have synergistic effects.

Objective To explore the construction method and physicochemical properties of disulfide?bonded hyaluronic acid?functionalized sodium?meter probe for hepatocellular carcinoma, and its biological evaluation in vitro and feasibility of MRI. Methods Synthesis of hyaluronic acid?disulfide?bonded?poly ε?caprolactone (HA?SS?PCL) by disulfide?bonded alkynyl?terminated polycaprolacton (alkyne?SS?PCL) and azido?terminated hyaluronic acid (HA?N3) by clicking chemical reaction, then doxorubicin (DOX) and superparamagnetic iron oxide (SPIO) were encapsulated in HA?SS?PCL core by dialysis method.HA?SS?PCL@DOX/SPIO was prepared and its particle size,DOX and SPIO loading rate were measured. With PBS as control group, the safety of HA?SS?PCL on human hepatocellular carcinoma cells HepG2 and normal liver cells LO2 was evaluated by the methylthiazolyl tetrazolium (MTT) assay, and the cytotoxicity of HA?PCL@DOX/SPIO and HA?SS?PCL@DOX/SPIO on human hepatocellular carcinoma cells HepG2 was evaluated. Immunofluorescence and flow cytometry were used to observe the expression of CD44 receptor on the surface of HepG2 cells in HA?PCL@DOX/SPIO and HA?SS?PCL@DOX/SPIO groups. Through in vitro MRI, PBS was used as the control group to observe the changes of T2 signal intensity of HA?PCL@DOX/SPIO and HA?SS?PCL@DOX/SPIO groups when SPIO concentration was 10, 20, 40, 80 μg / ml. One way ANOVA test and t test were used. Results HA?SS?PCL@DOX / SPIO sodium?meter probes were successfully constructed. The particle size of HA?SS?PCL@DOX/SPIO was (126.9±6.3) nm,and they were spherical with uniform size. The loading rates of DOX and SPIO were 61.4% and 58.7%. MTT assay showed that the survival rate of HepG2 and LO2 cells was more than 80% even at 500 μg/ml of HA?SS?PCL, 66.6% in HA?PCL@DOX/SPIO group and 55.2% in HA?SS?PCL@DOX/SPIO group. Immunofluorescence and flow cytometry showed that HA?PCL@DOX/SPIO and HA?SS?PCL@DOX/SPIO groups all have strong fluorescence, and the latter has stronger fluorescence intensity the former fluorescence intensity was 139.70±8.52,less than the latter 245.06±13.21. In vitro MRI showed that the T2 signal intensity of HA?PCL@DOX/SPIO and HA?SS?PCL@DOX/SPIO was significantly lower than that of the control group (F values were 613.591 and 569.234,P=0.000), the latter decline rate was more significant. Conclusion The disulfide?bonded hyaluronic acid?functionalized sodium?meter probe for hepatocellular carcinoma has excellent physicochemical properties, good targeting and MRI functions on human hepatoma cell HepG2 at the cellular level in vitro.