Objective To assesses the value of the Pipkin fracture classification on the treatment and prognosis of Pipkin fracture. Methods A total of 71 patients with Pipkin fractures treated from January 2002 to January 2007 were followed up and the detailed information of 63 patients were obtained. The clinical and radiographic evaluation criteria of Thompson was employed to evaluate the outcome, analyze the results and discuss the correlation between Pipkin fracture type and prognosis and hence propose the significance of Pipkin classification on the prognosis. Results There was no statistical difference in aspect of the outcome between type Pipkin Ⅰ , Ⅱ injury and type Pipkin Ⅳ injury (types Pipkin Ⅰ and Ⅱ injury combined with minimum fracture, with fragment ＜ 1 cm,P＞0. 05). There showed statistical difference in outcome between types Pipkin Ⅰ , Ⅱ injury and type Pipkin Ⅳ injury (types Pipkin Ⅰ and Ⅱ injury combined with acetabular rim fracture, P ＜0. 05). Conclusions Pipkin fracture classification system needs a further improvement. The type Pipkin Ⅳ injury that is combined with types Pipkin Ⅰ , Ⅱ , Ⅲ injuries with minimum fracture (fragment ＜ 1 cm) of the acetabular rim should be incorporated into types Pipkin Ⅰ ,Ⅱ , Ⅲ injury. Type Pipkin Ⅳ injury refers to types Pipkin Ⅰ ,Ⅱ , Ⅲ injuries, with major fracture of the acetabular rim and the hip joint instability. In addition, the Pipkin fracture type involving the fracture line, femoral neck and intertrochanteric region is hard to treat clinically and has poor prognosis, suggesting that this type of injury should be considered as special type Pipkin Ⅲ injury.

Amyloidosis ; complications ; pathology ; Heart Diseases ; etiology ; pathology ; Humans ; Male ; Middle Aged

Objective:To investigate the changes of plasma ghrelin levels and insulin(INS) sensitivity of full-term infants small for gestational age (SGA) and the effects of breast feeding on it.Methods:Full-term SGA hospitalised in the Department of Neonatology, Wuhan Children′s Hospital from October 2014 to April 2019 were re-cruited as the SGA group (120 cases), with full-term infants appropriate for gestational age (AGA) born in the same period as the AGA group (96 cases) in this study with recorded birth weight and length.The levels of fasting blood glucose (FG), triglyceride (TG), low density lipoprotein (LDL), high density lipoprotein (HDL), INS and ghrelin were measured 7 days after birth.Homeostasis model assessment-insulin resistance (HOMA-IR) was calculated.The SGA group was subdivided into breast feeding group and formula feeding group.The above indexes were tracked and mea-sured in the 3 rd and 6 th month, respectively, and their growth parameters were recorded. Results:There were no diffe-rences in serum FG, TG, LDL and HDL levels between the SGA and the AGA group (all P>0.05). Compared with the AGA group, the serum INS[(4.21±0.83) mIU/L vs.(3.54±1.10) mIU/L], ghrelin levels[(0.80±0.23) μg/L vs.(0.69±0.19) μg/L] and HOMA-IR (0.85±0.25 vs.0.72±0.25) increased in the SGA group, the differences were statistically significant (all P<0.05). Serum INS, HOMA-IR and ghrelin levels changed with the duration of breast feeding, the differences were statistically significant( F=12.394, 9.810, 5.531, all P<0.05). Conclusions:The serum ghrelin levels of SGA infants increased and INS sensitivity decreased.Breastfeeding can decrease levels of serum INS, HOMA-IR and ghrelin, and can improve INS sensitivity of SGA infants.

Objective To explore the prognosis related genes of pancreatic ductal adenocarcinoma (PDAC)and investigate the molecular regulation mechanism.Methods Gene expression data of 102 PDAC patients with complete clinical survival data were selected from gene expression database of National Center for Biotechnology Information.The 106 transcription regulation gene collection was collected from Transfac database.The 715 microRNA (miRNA)target regulation gene collection was selected according to PicTar and TargetScanS method.Biological pathway data obtained from the Kyoto Encyclopedia of Genes and Genomes (KEGG).The known cancer genes were collected from the cancer gene census (CGC) database.Univariate Cox proportional hazards model was used to analyze the correlation between gene expression data and survival time,then obtained survival related candidate genes from the whole genome. Then the enriched genes were analyzed by hypergeometric distribution algorithm from three databases. Multiple correction testing was performed by BH-FDR method (FDR < 0.05 ).Kaplan-Meier was performed for survival curve analysis of PDAC.Results The results of data of 102 PDAC patients analyzed by univariate Cox proportional hazards model indicated that 273 genes were significantly related to the survival time of patients (P <0.000 1 ).After 273 survival genes were enrichment analyzed in 106 transcription factor regulation gene collection,12 survival genes enriched transcription factor target gene sets were found.After 273 survival genes were enrichment analyzed in 715 miRNA target regulation gene collection,11 survival genes enriched miRNAs target sets were discovered.After 273 survival genes were enrichment analyzed in pathway data of KEGG,15 survival genes enriched pathways were obtained. Period circadian clock 2 (PER2 )was regulated by CCAAT/enhancer binding protein (CEBPA)at transcription level and regulated by miRNA-32 after transcription.The prognosis of PDAC was affected by circadian rhythm pathway.The 102 patients with PDAC were ranked according to the expression of PER2 from high to low,the first 51 cases were included in PER2 higher expression group and the left were included in PER2 lower expression group.Kaplan-Meier survival analysis indicated that PER2 was significantly correlated with prognosis of PDAC (P <0.01 ).Conclusion CEBPA/miRNA-32/PER2 and its related circadian clock pathway may be the target pathway in interfering the development of PDAC,and is correlated with the prognosis of PDAC.

Objective To observe the clinical efficacy and safety of compound glycyrrhizin tablets in the treatment of autoimmune hepatitis primary biliary cirrhosis with overlap syndrome (AIH-PBC).Methods Forty-six patients with AIH-PBC were randomly divided into control group and treatment group with 23 cases per group.Control group received 10 mg · kg-1ursodeoxycholic acid capsule,qd,orally + prednisone acetate tablet,orally,starting dose 0.5 mg · kg-1 · d-1,and gradually reduce to 5 mg · d-1 to maintain treatment + azathioprine tablets 50 mg · d-1,orally.Treatment group was given compound glycyrrhizin tablets 75 mg each time,tid,orally,on the basis of control group.Two groups were treated for 12 months.The clinical efficacy and adverse drug reactions were compared between two groups.Results After treatment,the total effective rates of treatment and control groups were respectively 91.30％ (21 cases/23 cases) and 60.87％ (14 cases/23 cases) with significant difference (P ＜ 0.05).The adverse drug reactions of treatment group were diarrhea,gastrointestinal discomfort and headache,which in control group were diarrhea and gastrointestinal discomfort.The incidences of adverse drug reactions in treatment and control groups were 17.39％ and 26.09％ without significant difference (P ＞ 0.05).Conclusion Compound glycyrrhizin tablets have a definitive clinical efficacy in the treatment of AIH-PBC,without increasing the incidence of adverse drug reactions.

Objective To investigate the effect of the bletilla striata polysaccharide on the expression of ovarian vascular endothelial growth factor(VEGF) and serum malondialdehyde(MDA)and endometrial morphology in rat during perimenopause period.Methods The animal model of perimenopause rats was established by unforced aging.A total of 40 female SD rats(12~14 months old)were randomly divid-ed into four groups:Chinese medicine low(0.5 g/kg),medium(1 g/kg),high(2 g/kg) dosage group and the elder model group.The rats were given with corresponding drugs for 8 weeks.The content changes of ovarian VEGF protein was detected by western blot;serum MDA con-tent was detected by thiobarbituric acid;the morphology of endometrium in rats was observed by HE staining.Results Eight weeks later, compared with the elder model group,the VEGF protein expression in Chinese medicine low,medium,high dosage group increased,the serum MDA content in Chinese medicine low,medium,high,dosage group reduced,the differences were statistically significant( P<0.01),with dose dependence.Endometrial thickening and glandular increasing with the increase of dose.Conclusion Bletilla striata polysaccharide can upregulate the expression of VEGF protein,and down regulate the level of serum MDA,which improves the uterine function so as to delay the process of perimenopause in rats.

Mitochondrial DNA (mtDNA) common deletion (CD) plays a significant role in aging and age-related diseases. In this study, we used D-galactose (D-gal) to generate an animal model of aging and the involvement and causative mechanisms of mitochondrial damage in such a model were investigated. Twenty 5-week-old male Sprague-Dawley rats were randomly divided into two groups: D-gal group (n=10) and control group (n=10). The quantity of the mtDNA CD in the hippocampus was determined using a TaqMan real-time PCR assay. Transmission electron microscopy was used to observe the mitochondrial ultrastructure in the hippocampus. Western blot was used to detect the protein levels of NADPH oxidase (NOX) and uncoupling protein 2 (UCP2). We found that the level of mtDNA CD was significantly higher in the hippocampus of D-gal-induced aging rats than in control rats. In comparison with the control group, the mitochondrial ultrastructure in the hippocampus of D-gal-treated rats was damaged, and the protein levels of NOX and UCP2 were significantly increased in the hippocampus of D-gal-induced aging rats. This study demonstrated that the levels of mtDNA CD and NOX protein expression were significantly increased in the hippocampus of D-gal-induced aging rats. These findings indicate that NOX-dependent reactive oxygen species generation may contribute to D-gal-induced mitochondrial damage.

OBJECTIVETo evaluate the safety of Ivor-Lewis procedure for middle and lower esophageal carcinoma in the elderly.

METHODSFrom June 2009 to June 2010, 232 cases aged over 60 years were diagnosed as esophageal carcinoma. These cases were randomly divided into two groups using table of random digits. One group underwent abdominal and right chest approaches for middle and lower esophageal carcinoma (Ivor-Lewis procedure, n=116). The other group underwent posterolateral left thoracal incisions(Sweet procedure, n=116). Intraoperative and postoperative parameters were compared.

RESULTSThe radical resection rates in Ivor-Lewis and Sweet procedure were 95.7% and 92.2% respectively(P>0.05). The time required for opening the thorax was(47.2 ± 5.2) min and (105.4 ± 9.3) min(P=0.000), respectively. The respiratory failure rates were 1.7% and 6.9%(P=0.049). The incidences of supraventricular tachyarrhythmia were 3.4% and 10.3%, respectively. The overall complication rates were 22.4% and 34.5%(P=0.004). The perioperative mortalities were 1.7% and 3.4%(P>0.05). The postoperative ambulation time was (4.0 ± 2.0)d and (4.8 ± 3.7)d(P=0.046). The postoperative time in hospital was (11.5 ± 4.7)d and (13.7 ± 7.8)d(P=0.008).

CONCLUSIONSIvor-Lewis procedure is associated with little damage to diaphragm, shorter intrathoracic operative time, minimal influence on cardiopulmonary function, less postoperative complications, and quicker recovery. This procedure should be considered as the first choice for middle and lower esophageal carcinoma in the elderly.

Aged ; Esophageal Neoplasms ; pathology ; surgery ; Esophagectomy ; methods ; Esophagus ; pathology ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Treatment Outcome

Objective To compare the clinical significance of peripheral blood neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in predicting prognosis of patients with hepatocellular carcinoma (HCC).Methods The clinical data of 661 patients with HCC were retrospectively analyzed.Routine peripheral blood test results were used to calculate the NLR and PLR,and the receiver operating characteristic (ROC) curves were drawn.Using the thresholds of NLR and PLR,the patients were divided into the low NLR group and the high NLR group,and the low PLR group and the high PLR group.Overall survival (OS) and disease free survival (DFS) were evaluated by the Kaplan-Meier method.Independent prognostic predictors were determined by the Cox proportional hazard model.Results The NLR and PLR thresholds were 2.790 and 99,respectively.Analysis of the ROC curves showed higher NLR and PLR were significantly associated with poorer OS and DFS (all P ＜ 0.05).Multivariate analysis showed that NLR was an independent risk factor of OS and DFS (both P ＜ 0.05).The results remained unchanged when the NLR was further analyzed by applying different cut-off values of 2.810 and 3.In subgroup analysis,NLR remained an independent factor of Barcelona Clinical Liver Cancer staging system (BCLC) 0/A/B (P ＜ 0.05 for all measurements).Conclusion An elevated preoperative NLR could be a better prognostic predictor for HCC patients in comparison with PLR,especially for BCLC 0/A/B patients.

OBJECTIVETo find an effective therapy for periarthritis of shoulder.

METHODSSixty cases were divided into two groups, 30 cases in each group. They were treated by acupuncture at pain point combined with moxibustion at Zusanli (ST 36) and routine acupuncture, respectively. Pain of the shoulder and movement functions of shoulder joints were used as indexes of therapeutic effects and their therapeutic effects were compared.

RESULTSThe total effective rate was 96.7% in the treatment group and 90.0% in the routine group with no significant difference between the two groups (P > 0.05); the cured rate in the two groups were 46.7% and 20.0% respectively with a significant difference between the two groups (P < 0.05). There were statistically significant differences between the two groups in improvement of movement function of shoulder joints and alleviation of pain (both P < 0.01).

CONCLUSIONAcupuncture at pain points combined with moxibustion at Zusanli (ST 36) in increase of the cured rate and alleviation of pain, and improvement of movement function of shoulder joints is better than the routine acupuncture and moxibustion for treatment of periarthritis of shoulder.

Acupuncture Therapy ; Humans ; Moxibustion ; Pain ; Periarthritis ; therapy ; Shoulder