BACKGROUND:Abnormal stress is an important factor causing intervertebral disc degeneration. To establish an ideal in vivoanimal model of intervertebral disc degeneration is of great significance for in-depth study on the related pathogenesis. OBJECTIVE:To develop anin vivo rabbit intervertebral disc model and to investigate the relationship between continuous tensile load and intervertebral disc degeneration. METHODS:Twenty-five New Zealand white rabbits aged 6 months old were randomly divided into three groups: blank control (n=5), sham (n=10) and experimental (n=10) groups. The blank control group received no intervention, and the L4/5 segments were removed at the 1st day. The intervertebral disc assistor was used to fix the L4 and L5 vertebral bodies in the experimental and sham groups, the L4/5 segments in the experimental group were loaded 1 MPa axial tensile force, and the L4/5 segments in both two groups were then removed at 14 and 28 days. The changes of L4/5 intervetebral space height and surrounding bone substance were observed by X-ray examination, the morphological changes of the intervertebral disc were observed by hematoxylin-eosin staining, the cell survival was detected by nitro blue tetrazolium staining and mRNA expression levels of aggrecan, collagen type Ⅱ and SOX9 in the intervertebral disc tissues were assessed by RT-PCR at each time point. RESULTS AND CONCLUSION:The radiological manifestations, histological changes, cell survival and mRNA expression levels of aggrecan, collagen type Ⅱ and Sox9 showed no significant difference between the blank control and sham groups. Comparied with the blank control group, in the experimental group, the L4/5 intervertebral space was narrowed with time, the articular surface was coarse, and the upper and lower corpus vertebrae edge appeared to have lip-shaped hyperplasia; the intervertebral disc cells distributed irregularly; the nucleus pulposus was in dehydration and deflation, annulus fibrosus arranged irregularly, and the vacuoles in notochord cells tended to disappear; the expression levels of aggrecan, collagen type Ⅱ and SOX9 were markedly downregulated. These findings suggest that the in vivo rabbit model of intervertebral disc is successfully established, in which continuous mechanical tensile load is further proved to directly cause intervertebral disc degeneration.

Objective To determine whether the adjustment of the pusher of GTF was useful to decrease the degree of tilting of the femoral Ginther Tulip filter (GTF) in an in vitro caval model. Methods The caval model was constructed by placement of a 25 mm × 100 mm and two 10 mm ×200 mm Dacron graft inside a transparent bifurcate glass tube. The study consisted of two groups: left straight group (GLS) (n =100) and left curved group (GLC) (n = 100). In the GLC, a 10° to 20° angle was curved on the introducer.The distance (DCH) between the caval right wall and the hook was measured. The degree of tilting (DT) was classified into 5 grades and recorded. Before and after the GTF being released, the angle (ACM1, 2)between the axis of IVC and the metal mount, the distance (DCM1) between the caval right wall and the metal mount, the angle (ACF) between the axis of IVC and the axis of the filter and the diameter of IVC (DIVC) were measured. The data were analyzed with Chi-Square test, t test, rank sum test and Pearson correlation test. Results The degree of GTF tilting in each group revealed a divergent tendency. In group LC, the apex of the filter tended to be grade Ⅲ compared in group LS (x2 value 37. 491 ,P ＜0.01).The differences of most variables between GLS and GLC were considered as statistical significance(16. 60° vs.3.05°, 20.60° vs. 3.50°, -3.90°vs. -0.40°, 2.98 mm vs. 10.40 mm, - 10.95° vs. -0.485°,13. 17 mm vs. 10.06 mm, - 1.70° vs. 0.70°, t or Z values - 12. 187, - 12. 188, -8.545, -51.834,-11. 395,9. 562, -3. 596, P ＜ 0. 01). There exist significant positive correlation between ACM1 and ACF,ACM1 - ACM2 and DCH1 - DCH2 in each group, respectively(r values 0. 978,0. 344,0. 879,0. 627 ,P ＜0. 01),while significant negative associations are detected between DCH1 and ACF in each group , ACP and ACF in group LC(r values -0.974, -0.322, -0.702,P＜0.01). Conclusion The technique of adjusting the orientation of filter pusher had minimized the incidence and extent of GTF filter tilting in vitro.

Objective To analyze the function of let-7e in the carcinogenesis of non-small-cell lung cancer.Methods The microRNA let-7e expression levels in cancer tissues and adjacent normal lung tissues were detected by quantitative real-time reverse transcription-PCR from 35 non-small-cell lung cancer patients,U6 RNA as an actin.Results The expression of microRNA let-7e in cancer tissues was significantly higher than adjacent normal lung tissues (10.111±6.135,P ＜ 0.0001),there was a significantly different between squamous carcinoma group (9.635±8.300) and adenocarcinoma group (10.301 ±5.228,P ＜ 0.05),independently of sex,smoking history,stage,and histologic characteristics of the tumor.Conclusion The expression of microRNA let-7e in cancerous tissues is high,microRNA let-7e should play oncogene role in process of non-small-cell lung cancer,and would be an useful biomarker.

AIM: To study compatibility rationality of combination of Paeonia lacliflora and Glycyrrhiza uralensis. METHODS: The effective combination of paeoniflorin(44% purity),glycyrrhizic acid(50% purity) and liquorice flavones(52% purity),glycyrrhizic acid(50% purity) and liquorice flavones(52% purity) were respectively administered to rats.Pharmacokinetic change of these constituents in rat blood was studied. RESULTS: The pharmacokinetic parameters of these constituents in rat blood showed that the increases in AUC and C_(max) of effective combination group were more than that of glycyrrhizic acid group or that of liquorice flavones group.T_(max) of the former was extended with respect to the latters.Clearance of effective combination markedly slowed down. CONCLUSION: The effective combination of paeonia lacliflora and Glycyrrhiza uralensis have the advantage of either Paeonia lacliflora or Glycyrrhiza uralensis.

Background: Integrative traditional Chinese and western medicine may be a new approach to improve the eradication rate of Helicobacter pylori (Hp).Aims: To compare the efficacy and safety of Weifuchun tablet versus bismuth combined with standard triple regimen as the first-line therapy of Hp infection.Methods: A total of 141 patients with Hp infection and na(i)ve to treatment were randomly assigned into 3 groups receiving a 14-day eradication therapy.In standard triple therapy group, esomeprazole, amoxicillin and clarithromycin were given twice a day;while in Weifuchun group and bismuth group, Weifuchun tablet and bismuth potassium citrate were added, respectively, to the standard triple therapy.Hp eradication was assessed by 13C-urea breath test at least 6 weeks after the end of treatment.Hp isolates were tested for resistance to antibiotics.Results: One hundred and twenty-eight patients completed the study.Hp eradication rates in Weifuchun group, bismuth group and standard triple therapy group were 83.7%, 91.8% and 79.1%, respectively by ITT analysis and 88.4%, 97.8% and 84.6%, respectively by PP analysis.The eradication rate of Weifuchun group was lower than that of bismuth group and higher than that of standard triple therapy group, but the differences were not statistically significant (P>0.05).Only PP eradication rate of bismuth group was significantly higher than that of standard triple therapy group (P<0.05).The resistant rates of Hp to clarithromycin, amoxicillin and metronidazole were 33.3%, 2.9% and 70.5%, respectively.For eradication of clarithromycin resistant strains, bismuth group was superior to Weifuchun group and standard triple therapy group (100% vs.60.0% and 66.7%, P all <0.05).All three eradication regimens showed good compliance, and no significant difference in incidence of adverse events was found between the three regimens (P>0.05).Conclusions: Weifuchun tablet combined with standard triple regimen is safe and effective for use as first-line treatment for Hp infection, however, the eradication rate is relatively low in cases infected with clarithromycin resistant strains.Bismuth combined with standard triple regimen is a good alternative in areas with high clarithromycin resistance and regions where tetracycline is unavailable.

Objective:To conduct health economic evaluation of Chinese population-based screening and opportunistic testing strategies for the prevention of Helicobacter pylori ( H. pylori)-related diseases. Methods:The Markov models of H.pylori infection caused non-ulcer dyspepsia, peptic ulcer (PU) and gastric cancer were established. The cost and effects of the population-based screening, opportunistic testing, and non-intervention strategies in 100 000 population of our country were simulation calculated. Wilcoxon signed rank test was used for statistic analysis. Single factor sensitivity analysis was performed to analyze the impact of single parameter uncertainty on cost-effectiveness. Probability sensitivity was used to analyze the impact of common uncertainty of all parameters on cost-effectiveness. Results:Compared with opportunistic testing strategy and non-intervention strategy, the total cost of population-based screening strategy was reduced by 0.43 million yuan(-6.63 million yuan to 7.19 million yuan) and 4.45 million yuan(-8.60 million yuan to 27.93 million yuan), quality adjusted life years (QALY), life years and asmptomatic months were prolonged by 888.00 (479.86 to 1 574.10) and 3 032.78 (1 756.04 to 5 007.84), 651.82 (294.73 to 1 211.94) and 1 868.64 (1 045.88 to 3 148.34), 28 381.91 (19 109.54 to 43 736.72)and 102 537.13 (58 649.18 to 176 868.77) respectively, gastric cancer, deaths from gastric cancer, deaths from PU and deaths from various causes were reduced by 115 cases(52 cases to 232 cases) and 464 cases(266 cases to 803 cases), 74 cases(33 cases to 148 cases) and 260 cases(149 cases to 453 cases), 46 cases(25 cases to 72 cases) and 369 cases(210 cases to 710 cases), 80 cases(42 cases to 126 cases) and 501 cases(331 cases to 772 cases) respectively, and the differences were statistically significant ( Z=1.99, 10.54, 27.39, 27.39, 27.37, 27.39, 27.39, 27.39, 27.21, 27.28, 27.22, 27.28, 27.38, 27.39, 27.39 and 27.39, all P<0.05). Compared with the non-intervention strategy, the opportunistic testing strategy reduced the total cost by 3.89 million yuan(-2.79 million yuan to 18.18 million yuan), QALY, life years and asymptomatic months were prolonged by 1 764.77 (888.70 to 3 406.62), 1 044.16 (524.46 to 1 912.75) and 62 568.69 (30 054.07 to 129 892.76) respectively, gastric cancer, deaths from gastric cancer, deaths from PU and deaths from various causes were reduced by 311 cases(164 cases to 563 cases), 164 cases (87 cases to 301 cases), 325 cases(162 cases to 644 cases) and 399 cases(234 cases to 684 cases) respectively, and the differences were statistically significant ( Z=14.20, 27.39, 27.38, 27.39, 27.25, 27.25, 27.39 and 27.39, all P<0.01). The results of singlefactor sensitivity analysis showed that the uncertainty of any parameter did not affect the cost-effectiveness of three strategies. The results of probability sensitivity analysis indicated that the probability of cost-effectiveness advantage of the population-based screening strategy was 100% and the common uncertainty of all parameters had no effect on cost-effectiveness. Conclusions:For preventing H.pylori-related diseases, the population-based screening strategy has the lowest average cost and the best average effect. However, non-intervention strategy has the highest average cost and the worst average effect. Population-based screening strategy is worthy of promotion throughout China, and opportunistic testing strategy has a higher clinical practical value.

Objective To confirm whether community management of hypertension could improve blood pressure control in Chongqing.Methods Cluster sampling method was used to select 5283 adults from 20 community healthcare centers in Chongqing.Matched t test was used to analyze the changes of blood pressure before and after the intervention.x2 test analysis was performed to compare the rate of normal blood pressure.Results The average age of 5283 participants was (60.5 ± 11.0) years old.Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly decreased after intervention (total population:t values were 16.98 and 13.80,respectively; male:t values were 12.58 and 10.66,respectively; female:t values were 11.60 and 9.10,respectively; all P ＜ 0.05).The most significant decrease in SBP was found in 50-59 y age group (t =15.29,P ＜0.05),followed by 40-49 y age group (t =9.22,P ＜0.05).The control rate of hypertension was increased by 5.3％ after 1 year's intervention (x2 =134.5,P＜0.05),except for 60-69 y age group and ≥70 y age group (x2 values were 2.5 and 1.7,respectively ; both P ＞ 0.05).Conclusion Our results show that standardized management of hypertension in communities can decrease the level of blood pressure and increase the control rate of hypertension.

AIM:To investigate the effects of pioglitazone on the quantity and function-related factors of regu-latory and effector T cells ( Treg and Teff ) of uremic apolipoprotein E knockout mice in vitro with or without the stimulation of atherosclerotic plaque-specific antigen oxidized low-density lipoprotein ( oxLDL) .METHODS:Uremic apolipoprotein E knockout mouse model was established by 2-step surgical procedure.After intervention with different concentrations ( 2μmol/L and 20μmol/L) of pioglitazone and PPARγantagonist GW9662 (5μmol/L) on splenocytes of uremic mice for 12 h in the presence or absence of oxLDL (2 mg/L), the levels of CD4 +CD25 +Foxp3 +Treg and IFNγ+CD4 +Teff were de-termined by flow cytometry.The mRNA expressions of Foxp3 and IFNγwas detected by real-time fluorescent quantitative PCR.RESULTS:In vitro, oxLDL induced a Treg/Teff imbalance in splenocytes from the uremic mice.Pioglitazone up-regulated the level of Treg and mRNA expression of Foxp3 in the presence of oxLDL, which was not antagonized by GW9662.Meanwhile, pioglitazone downregulated the level of Teff and mRNA expression of IFNγin the presence or ab-sence of oxLDL, which was reversed by GW9662.CONCLUSION:oxLDL induces a Treg/Teff imbalance in uremic apo-lipoprotein E knockout mice.Pioglitazone modulates the Treg/Teff imbalance probably through PPARγ-independent and-dependent mechanisms.

OBJECTIVETo introduce different surgical treatment for gyncomastia at different grades.

METHODS37 cases with gynecomastia were divided into three grades as: grade I with fat as main tissue, grade II with proliferated fibro-gland as main tissue, grade III with big and ptosis breasts and sagging skin. Different surgical methods were chosen according to the different grades of gyncomastia. These include liposuction, subareolar fibroglandular tissue removing, combined technique of the two methods, and breasts resection with free transplantation of nipple-areola complex.

RESULTSAll patients were satisfied for the appearance of post-operative flat male chest. Complications, such as scar, numbness of nipple and areola were acceptable for them.

CONCLUSIONSDifferent surgical methods should be chosen for the gynecomastia at different grades. It can improve both the physical and psychological problems for patients.

Adolescent ; Gynecomastia ; classification ; surgery ; Humans ; Lipectomy ; Male ; Mammaplasty ; methods ; Nipples ; transplantation ; Retrospective Studies

Objective To explore the imaging features of external iliac artery-related postpartum hemorrhage, and to discuss its interventional therapy measures. Methods The clinical data and imaging findings of one patient with external iliac artery-related postpartum hemorrhage was retrospectively analyzed. The patient received interventional therapy at the intervention department of Shanxi provincial people ’s hospital. The relevant academic papers published in medical literature were reviewed. The common features of this condition were summarized, and the imaging features and the interventional therapy measures were discussed. Results A total of 4 patients, including authors’ case, with external iliac artery- related postpartum hemorrhage were reported in China. Of the 4 case , right external iliac artery-related postpartum hemorrhage was seen in 2 and bilateral external iliac artery-related postpartum hemorrhage was seen in other two. Embolization therapy of three abnormal branches of deep circumflex iliac artery that participated in the uterine blood supply was carried out. Immediately after the embolization the bleeding stopped. Conclusion For the treatment of postpartum hemorrhage, uterine arterial embolization should be followed by abdominal aorta angiography so as to check the external iliac artery. When recurrent bleeding occurs after uterine arterial embolization, the possibility that the abnormal branches of external iliac artery participates in the uterine blood supply should be considered. In performing the embolization of abnormal branches of external iliac artery, the catheter should be inserted to the distal end of the target vessel. Under DSA monitoring the embolic agent should be slowly injected into the targeted artery and the patient should be kept under close observation for blood reflux. Usually, the embolization of abnormal branches of external iliac artery will not cause ischemic symptoms of the pelvis and distal limbs.