[ ABSTRACT] AIM:To explore the effect of dexmedetomidine ( DEX) on the CCAAT/enhancer-binding protein-homologous protein ( CHOP) pathway during lung ischemia-reperfusion ( I/R) in mice.METHODS:C57BL/6J male mice were randomly divided into sham operation group ( sham group) , lung ischemia/reperfusion group ( I/R group) , ischemia/reperfusion +normal saline group ( I/R+NS group ) and ischemia/reperfusion+dexmedetomidine group ( I/R+DEX group) .Dexmedetomidine was infused intraperitoneally with 25 μg/kg for 30 min prior to the ischemia period in I/R+DEX group, the normal saline was administrated with the same volume of dexmedetomidine in I/R+NS group.After fini-shed the 3 h-reperfusion period , the left lung tissues were harvested to determine lung wet/dry weight ( W/D) , the total lung water content ( TLW) , and index of quantitative evaluation for alveolar damage ( IQA) .Morphological observation and terminal-deoxynucleotidyl transferase mediated nick end labeling ( TUNEL) were applied to evaluate the structure changes and the apoptosis index (AI) of the lung tissues.The expression of CHOP and glucose-regulated protein 78 (GRP78) at mRNA and protein levels in the lung tissues was detected by Western blot and RT-PCR.RESULTS:Compared with sham group, the W/D, TLW, IQA, AI, the mRNA and protein expression of CHOP and GRP78 obviously increased, and the left lung tissues structure were damaged more obviously both in I/R group and I/R+NS group.Compared with I/R group, the W/D, TLW, IQA, AI and the protein and mRNA expression of CHOP in I/R+DEX group decreased, the injury of the left lung tissue structures induced by I/R in I/R+DEX group were also alleviated .CONCLUSION:DEX alleviates the
lung I/R injury, which may be related to inhibition of apoptosis mediated by CHOP pathway.

BACKGROUND:Perioperative high hidden blood loss affects the recovery of joint function after total hip replacement. OBJECTIVE:To analyze the reliability of the Mini Nutritional Assessment on evaluating the nutritional status in elderly patients with femoral neck fracture on admission, and to investigate the effect of nutritional status variation on hidden blood loss after total hip replacement. METHODS:234 elderly patients with femoral neck fracture underwent total hip replacement. By using Mini Nutritional Assessment, patients were randomly divided into three groups:wel-nourishment group (n=52), malnourishment at risk group (n=92), and malnourishment group (n=90). The results were used to analyze the correlation of Mini Nutritional Assessment and serological nutrition indicators, and to hidden blood loss. RESULTS AND CONCLUSION:(1) Hidden blood loss:101 patients suffered from high hidden blood loss. Hidden blood loss, its proportion to total blood loss and incidence of high hidden blood loss gradual y increased with the deterioration of the nutritional status (P<0.05). (2) Mini Nutritional Assessment:Pre-operative Mini Nutritional Assessment score, and the incidence of hidden blood loss evaluated by albumin, prealbumin, transferrin, lymphocyte count, the percentage of lymphocytes and hemoglobin was significantly higher in patients with high hidden blood loss than those with low hidden blood loss (P<0.01). (3) Results of correlation analysis:High hidden blood loss was positively correlated with pre-operative Mini Nutritional Assessment, albumin, prealbumin, transferrin, the percentage of lymphocytes and hemoglobin (P<0.05). (4) These findings confirm that risk evaluation with Mini Nutritional Assessment is a reliable method to assess the nutritional status in elderly patients undergoing total hip replacement. Its combination with various serum nutrition indicators can determine high hidden blood loss and the prognosis.

Stress urinary incontinence (SUI) is closely related to pregnancy and delivery. With the implementation of the three-child policy and the increasing number of pregnant women at advanced age or with obesity, the prevalence of SUI during pregnancy and the postpartum period is increasing gradually. Risk factors of SUI that are associated with pregnancy and childbirth include delivery mode, advanced maternal age, overweight/obesity, macrosomia, prolonged second stage of labor, epidural anesthesia, and breastfeeding. Identification of such risk factors is crucial for early intervention for high-risk patients, which would be conducive to reducing the risk of long-term SUI.

OBJECTIVETo investigate the maturation of individual bones on the hand and wrist in children with central precocious puberty (CPP) and idiopathic short stature (ISS).

METHODSHand and wrist films of 25 children with CPP, 29 children with ISS and 21 normal controls were evaluated by conventional Greulich-Pyle (GP) atlas method and individual bone assessment method, in which all twenty bones of the hand and wrist were evaluated based on GP atlas, including 2 radius and ulna, 7 carpal bones, 11 metacarpal and phalangeal bones, the average bone age (BA) was calculated. The differences in groups were analyzed by independent samples t test. The differences between the two methods were analyzed by paired sample t test. The differences between BA and chronological age (CA) were analyzed by ROC with SPSS 17.0.

RESULTSCompared with the normal control group, the advance of BA in the CPP group was 0.70-2.26 y (1.48 ±0.78) by the GP atlas method, while that was 0.28-2.00 y(1.14 ±0.86) by the individual bone evaluation method. In all twenty bones, the advance of metacarpal and phalangeal BA was the greatest [0.34-2.06 y(1.2±0.86)]. In the ISS group,the delay of BA was 0.47-2.91 y(-1.69±1.22) by the GP atlas method, while that was 0.48-2.50 y (-1.49±1.01) by individual bone evaluation method.The delay of carpal BA was the greatest [0.59-2.73 y(-1.66±1.07)] in all twenty bones. In the ISS group and the normal control group, there were no statistic differences between the two methods. In the CPP group, statistic difference was found between two methods. There were no statistic differences for the areas under ROC curves between two methods.

CONCLUSIONThe advance of metacarpal and phalangeal BA is the greatest in CPP group and the delay of carpal BA is the greatest in ISS group.Both methods provide diagnostic information for bone age in CPP and ISS children.

Age Determination by Skeleton ; methods ; Carpal Bones ; diagnostic imaging ; Case-Control Studies ; Child ; Dwarfism ; diagnostic imaging ; Female ; Hand ; diagnostic imaging ; Humans ; Male ; Puberty, Precocious ; diagnostic imaging

Objective: To learn the epidemiological characteristics of family clusters of COVID-19 in Henan Province from January 23 to February 22, 2020, so as to provide reference for the prevention and control. Methods: The data of family clusters of COVID-19 in Henan Province from January 23 to February 22 was retrieved from Public Health Emergency Management System, the epidemiological characteristics of time, space, population distribution and clinical feasures were analyzed. Results: By February 22, there were 202 family clusters of COVID-19, with 546 cases reported in Henan Province, including 493 ( 90.29% ) confirmed cases and 53 ( 9.71% ) asymptomatic cases. There were 247 ( 45.24% ) imported cases and 299 ( 54.76% ) local cases. Most of the clusters were reported from January 25 to February 7, with 129 clusters accounting for 63.86% . The cases reported before February 5 were mainly imported ( 153 cases, 57.09% ) , after that local cases were predominant ( 168 cases, 68.29% ) . Eighteen cities in Henan Province all reported family clusters of COVID-19, with Xinyang, Zhengzhou, Nanyang, Zhumadian and Shangqiu as the top five. Most of the confirmed cases ( 430, 87.22% ) were mild. The median and longest incubation period was 8 and 17 days, respectively. The intergenerational distribution was dominated by first-generation and second-generation cases ( 537 cases, 98.35% ) . A total of 5 635 close contacts were tracked down, of whom 262 were secondary cases, with an incidence rate of 4.65%. The first cases of the family clusters were mainly imported from other provinces ( 149 cases, 73.76% ) . Conclusions The family clusters of COVID-19 in Henan Province were concentrated from January 25 to February 7. The source of infection mainly comes from other provinces. Most of the cases are first-and second-generation cases, with longer incubation period. Close contacts have higher incidence rate.

Objective: To analysis the epidemiological characteristics of overweight and obesity among middle school students in Taizhou from 2013 to 2020, to provide support for prevention and control efforts. Methods: Through stratified sampling, one primary school, one junior middle school and one senior high school were randomly selected from nine counties (cities and districts) in Taizhou, and continuous monitoring was conducted in all participants Height, weight and other variables were assessed and body mass index was calculated. The epidemic characteristics were analyzed according to the detection rate, fixed base ratio, sequential growth ratio and average growth rate. Results: From 2013 to 2020, the overall overweight rate among primary and middle school students in Taizhou was 14.5%(36 592/252 583), and the obesity rate was 11.2%(28 256/252 583). The rates of overweight and obesity increased, with average annual growth rates of 1.9% and 5.5%, respectively; thus, the rate of obesity increased more rapidly. The obesity rate was higher among boys (13.2%) than girls (9.0%)( χ 2=1 119.57, P <0.01), and the average annual growth rate was higher among girls than boys (6.1%, 5.2%, respectively). The rate of overweight among boys (17.6%) was higher than that among girls (10.9%)( χ 2=2 307.35, P <0.01). The average annual growth rate of overweight in girls was 2.3% and 1.7%, respectively. The obesity rate among primary school students (17.5%) was higher than that among middle school (9.7%) and high school (4.9%) students( χ 2=7 291.33, P <0.01). The average annual growth rate in students in middle school was fastest, followed by those in high and primary schools (6.5%, 3.9% and 2.6%, respectively). The rate of overweight in primary school students ( 15.8 %) was higher than that in middle school students (15.3%), and both were higher than that in high school students(12.2%)( χ 2=521.06, P <0.01). The average annual growth rate was also fastest in students in middle school, followed by high and primary schools (2.4%, 2.2% and 0.6%, respectively). Conclusion The detection rate of overweight and obesity among primary and middle school students in Taizhou is high and increasing rapidly, indicating high pressure on prevention and control. Boys and primary school students are the key target groups for prevention and control. Comprehensive prevention and control strategies should be adopted specifically.

Objective To explore the effect of early virtual reality training in the rehabilitation of stroke patients with hemiplegia.Methods From June 2015 to May 2016, 60 cases of stroke patients from the Department of Rehabilitation of the First Affiliated Hospital of Wenzhou Medical University were randomly divided into observation group and control group, 30 cases in each group. The patients of control group received routine rehabilitation training program, and patients of the observation group received routine rehabilitation and virtual reality training. The two groups were trained for 6 weeks. The walking function, activities of daily living and mental status of the patient before and after training were evaluated by functional ambulation category scale (FAC), modified Barthel index (MBI), hospital anxiety and depression scale (HAD).Results Before training, FAC, MBI and HAD scores had no significant difference between patients of two groups (P>0.05). After 6 weeks of training, the scores of FAC, MBI and HAD in the two groups were better than those before training (P<0.05); After training, except for HAD (D), the indexes in the observation group were better than those in the control group (P<0.05).Conclusions Early virtual reality training can effectively improve the walking function and activities of daily living in stroke patients with hemiplegia, and relieve the patients' unhealthy psychological emotion.

Objective To explore the interactive effect of vitamin D and triglyceride(TG)/high-density lipoprotein cholesterol(HDL-C)on the time to achieve glycemic control in hospitalized patients with type 2 diabetes mellitus(T2DM).Methods A retrospective cohort study was conducted on 82 T2DM patients admitted to Henan Hongli Hospital from March 2021 to December 2023.Patients were categorized into two groups based on the time it took for their blood glucose to reach target levels during their hospitalization:the≤7 d group and the>7 d group.The baseline data,vitamin D levels,and TG/HDL-C ratios of both groups were compared.The relationship between vitamin D,TG/HDL-C levels,and the time it took for blood glucose to reach target levels was analyzed.Further-more,the TG/HDL-C levels of patients with varying vitamin D levels were compared,and the relative risk(RR)and receiver operating characteristic(ROC)curve were used to analyze the interactive effect and predictive value of vitamin D and TG/HDL-C levels on the time it took for hospitalized T2DM patients to achieve target blood glucose levels.Results The hospitalization duration of the group with a duration of>7 days was longer than that of the group with a duration of≤7 days.The fasting blood glucose,glycosylated hemoglobin,and TG/HDL-c levels were higher in the former group,while the vitamin D level was lower.The proportion of patients with vitamin D deficiency and severe deficiency was higher in the former group compared to the latter group(P<0.05).Pearson correlation analysis revealed that vitamin D level was negatively correlated with the time to achieve glycemic control(r=-0.733,P<0.001),while TG/HDL-C level was positively correlated with the time to achieve glycemic control(r=0.830,P<0.001).After adjustment,logistic regression analysis indicated that vitamin D(95%CI:0.482～0.694)and TG/HDL-C level(95%CI:1.053～1.392)remained independent factors influencing the time to achieve glycemic control in hospitalized T2DM patients(P<0.05).Patients with insufficient,deficient,and severely defi-cient vitamin D had higher TG/HDL-C levels compared to those with sufficient vitamin D(P<0.05).The relative risk(RR)of patients with vitamin D deficiency and elevated TG/HDL-C coexisting resulting in a hospitalization duration of>7 days for T2DM patients was 15.867,indicating a synergistic effect.The area under the receiver operating characteristic(AUC)curve for predicting the time to achieve glycemic control in hospitalized T2DM patients using a combination of vitamin D and TG/HDL-C was 0.929,which was greater than that of vitamin D and TG/HDL-C alone(Z=3.849,3.526,P<0.05).Conclusion The vitamin D and TG/HDL-C levels in hospitalized T2DM patients are closely related to the time of reaching glycemic targets.The simultaneous exposure of both factors can affect the time of achieving glycemic targets,and the combined prediction of vitamin D and TG/HDL-C has good reference value for predicting the time of achieving glycemic targets in hospitalized T2DM patients.

Objective To analyze the clinic-pathological data and peritubular capillary (PTC) injuries of malignant nephrosclerosis (MN) patients and their correlations with the long term renal survival.Methods This was a retrospective cohort study of 52 MN patients in Peking Union Medical College Hospital from January 2003 to March 2012.Their clinical data and renal biopsy samples were carefully studied.CD34 staining was performed to evaluate the PTC area,using Benign nephrosclerosis (BN,n=17) patients and glomerular minimal lesions (GML,n=19) patients as controls.Multivariate Cox proportional hazard model was used to identify the potential independent risk factors for long term renal survival.Results Fifty-two MN patients were enrolled.The sex ratio of male to female was 12:1 and the average age was (34.0±8.2) years.The maximum blood pressure (SBP/DBP) was (230.4 ± 25.0)/(156.4 ± 20.6) mmHg,companied with significant loss of eGFR and proteinuria.Glomerular sclerosis index,tubular atrophy and interstitial fibrosis correlated with eGFR and proteinuria (P ＜ 0.05).After aggressive treatment,BP control rate improved significantly (76.9％ vs 3.7％,P ＜0.01),Scr [(376.4±263.8) μmol/L vs (486.8±375.7) μmol/L,Wilcoxon test,P＜ 0.01] and proteinuria [(1.10±0.70) g/24 h vs (2.04± 1.26) g/24 h,P ＜ 0.01,n=21] also improved.PTC area in MN patients was significantly lower than those in BN patients and GML patients,and it correlated well with Scr (r=-0.553,P=0.001) and eGFR (r=0.476,P=0.004).The median follow-up time was 74 months,the cumulative renal survival rate at 1 year,5 year and 10 year was 90％,64％ and 23％,respectively.Kaplan-Meier analysis showed that the patients with higher PTC area had longer renal survival time [(114.8± 12.4) months vs (63.0±8.3) months, x2=5.312,P ＜ 0.05].Univariate Cox proportional hazard model found that unsatisfied BP control,eGFR ＜ 30 ml · min-1 · (1.73 m2)-1 upon discharge,lower PTC area,severer tubular-interstitial damage and anemia were associated with poor renal outcome.Multivariate Cox model showed that unsatisfied BP control (RR=3.89,95％ CI 1.75-8.65,P=0.001),eGFR ＜ 30 ml · min-1 · (1.73 m2)-1 upon discharge (RR=4.27,95％ CI 1.40-13.09,P=0.011) were independent risk factors for long-term renal survival.Conclusions The correlation between PTC area and renal functions in MN patients are much better than that of classic vascular changes.Unsatisfied BP control and eGFR ＜ 30 ml · min-1 · (1.73 m2)-1 upon discharge are independent risk factors for long-term renal survival.

Objective:To investigate the effect of resveratrol on the expression of inflammatory cytokines and related genes in human SZ95 sebocytes induced by benzo (a) pyrene.Methods:Human SZ95 sebocytes were cultured in vitro, and divided into 4 groups: control group treated with 1‰ dimethyl sulfoxide for 27 hours, resveratrol group treated with 1 × 10 -5 mol/L resveratrol for 24 hours, benzo (a) pyrene group treated with 1 × 10 -5 mol/L benzo (a) pyrene for 3 hours, resveratrol+benzo (a) pyrene group treated with 1 × 10 -5 mol/L resveratrol for 24 hours followed by 1 × 10 -5 mol/L benzo (a) pyrene for 3 hours. Real-time fluorescence-based quantitative PCR was performed to determine the mRNA expression of interleukin (IL) -1α, IL-6, aryl hydrocarbon receptor (AhR) , cytochrome P4501A1 (CYP1A1) and cytochrome P4501B1 (CYP1B1) in SZ95 sebocytes in the above groups; Western blot analysis was conducted to determine the phosphorylation level of p38 mitogen-activated protein kinase (p38 MAPK, expressed as the ratio of phosphorylated to total p38 MAPK) and AhR protein expression; enzyme-linked immunosorbent assay (ELISA) was conducted to detect levels of IL-1α and IL-6 in the cell culture supernatant in each group. One-way analysis of variance was used for comparison of means among multiple groups, and least significant difference- t test was used for multiple comparisons. Results:The mRNA and protein expression of IL-1α in SZ95 sebocytes significantly differed among the control group, resveratrol group, benzo (a) pyrene group and resveratrol+benzo (a) pyrene group (mRNA: 2.045 ± 0.272, 2.058 ± 0.154, 3.124 ± 0.094, 2.185 ± 0.337, protein: 9.132 ± 1.181, 9.429 ± 0.771, 20.361 ± 0.907, 9.917 ± 0.897, F=14.662, 101.705, P < 0.01, < 0.001, respectively) , and were significantly lower in the resveratrol+benzo (a) pyrene group than in the benzo (a) pyrene group (both P < 0.01) . In addition, the phosphorylation level of p38 was significantly higher in the benzo (a) pyrene group than in the control group, resveratrol group and resveratrol+benzo (a) pyrene group ( F=303.129, P < 0.000 1) . The mRNA expression of AhR, CYP1A1 and CYP1B1 was significantly lower in the resveratrol+benzo (a) pyrene group than in the benzo (a) pyrene group ( t=10.64, 33.599, 18.327, respectively, all P < 0.001) . The benzo (a) pyrene group showed significantly decreased protein expression of AhR compared with the resveratrol+benzo (a) pyrene group ( P < 0.001) . Conclusion:Resveratrol can inhibit the environmental pollutant benzo (a) pyrene-induced expression of inflammatory factor IL-1α in SZ95 sebocytes, which is likely mediated by the AhR and p38MAPK pathways.