Objective To observe the expression of core-binding factor ?1 (Cbf?1) in aging osteoblast, and try to provide new mechanisms of Chinese medicine on bone formation. Methods Rat osteoblast from different age donors (6 months and 16 months) were isolated and cultured by the tissue-fragment-migrating-growth method. The biological characteristic was observed by phase-contrast microscope and identified with mineralizing nodule staining. The expression of Cbf?1 was examined by RT-PCR and immunohistochemistry. Results RT-PCR and immunohistochemistry showed that the expression of Cbf?1 was upregulated by Gubenzhuanggu and Jinkuishenqi, and downregulated by Zhibaidihuang in aging osteoblast, but the effect was different on the Cbf?1 expression in Bushenyijing. Conclusion Buyang Chinese medicine among Bushen Chinese medicine promoted bone formation.

Objective To explore the effect of Rhodiola kirilowii Regel combined with calcium dobesilate in the treatment of early diabetic nephropathy.Methods 80 patients with early diabetic nephropathy were selected,and they were divided into treatment group and control group according to the digital table,40 cases in each group.The two groups were given diet control and appropriate exercise and positive controlled blood sugar,blood fat,blood pressure.The control group was given calcium dobesilate,based on this,the treatment group was given Rhodiola kirilowii Regel 10mL into 5％ glucose injection 250mL and 3 unit insulin to intravenous drip.The period of treatment was fifteen days.The UAER,Scr and BUN were compared between two groups before treatment and fifteen days after treatment.Results Before treatment,the Scr,BUN and UAER in the control group were (88.00 ± 18.19) μmol/L,(5.98 ± 1.92) mmol/L,(123.31 ± 60.01) μg/min respectively,which in the treatment group were (85.80 ± 18.31) μmol/L,(5.96 ± 1.94) mmol/L,(140.21 ± 62.92) μg/min respectively,there were no statistically significant differences between the two groups(t =-1.191,-0.016,0.432,all P ＞0.05).After treatment,the Scr,BUN and UAER in the control group were (84.61 ± 11.71) μmol/L,(6.30 ± 1.37) mmol/L,(97.81 ± 49.16) μg/min respectively,which in the treatment group were (75.60 ± 11.44) μmol/L,(5.25 ± 1.24) mmol/L,(39.81 ± 23.43) μg/min.There were no statistically significant differences in Scr and BUN of the two groups compared with before treatment (the control group:t =0.767,-0.657;the treatment group:t =1.947,1.219,all P ＞ 0.05).There was statistically significant difference in UAER of the two groups compared with before treatnent (t =2.850,5.402;P =0.046,0.006),but UAER of the treatment group after treatment decreased significantly.After treatment,there were no statistically significant differences in Scr and BUN between the two groups (t =-1.229,-1.236,all P ＞ 0.05),while there was statistically significant difference in UAER between the two groups (t =-2.394,P =0.044).The effective rate in the treatment group was 87.5 ％,which was higher than 57.5 ％ of the control group (x2 =9.028,P ＜ 0.05).Conclusion Rhodiola kirilowii Regel combined with calcium dobesilate can ameliorate protenuria and improve renal function of the patients with early diabetic nephropathy.

Objective To investigate the relationships of serum angiopoietin-like protein 4(ANGPTL4)and fibroblast growth factor-23(FGF-23)levels with the severity and prognosis of patients with diabet-ic nephropathy.Methods A total of 120 patients(diabetic nephropathy group)with diabetic nephrop-athy were selected from July 2018 to July 2020 and divided into mild group(n=62)and severe group(n=58)according to the staging criteria of diabetic nephropathy;based on the prognosis within 3 years,they were also divided into good prognosis group(n=94)and poor prognosis group(n=26).Addition-ally,102 diabetic patients were enrolled as diabetic group,and 81 healthy volunteers were selected as control group.The serum levels of ANGPTL4 and FGF-23 in diabetic nephropathy patients were detected by enzyme-linked immunosorbent assay(ELISA).Logistic regression analysis was used to analyze the influencing factors of prognosis,and receiver operating characteristic(ROC)curves were drawn to ana-lyze the values of ANGPTL4,FGF-23 and their combination in assessing the severity and prognosis of diabetic nephropathy.Results The levels of ANGPTL4 and FGF-23 in the diabetic nephropathy group and simple diabetic group were significantly higher than those in the control group(P＜0.05);compared with the simple diabetic group,the levels of ANGPTL4 and FGF-23 in the diabetic ne-phropathy group were significantly increased(P＜0.05);the levels of ANGPTL4 and FGF-23 in the severe group were significantly higher than those in the mild group(P＜0.05);the ROC curve analysis revealed that the areas under the curve(AUCs)for assessing disease severity of ANGPTL4,FGF-23 and their combination were 0.748,0.781 and 0.858 respectively,and the combined diagnosis was significantly better than FGF-23(Z=2.149,P=0.032)and ANGPTL4(Z=2.886,P=0.004)alone;the levels of ANGPTL4 and FGF-23 in the good prognosis group were significantly lower than those in the poor prognosis group(P＜0.05);significant differences were observed in diabetes dura-tion,blood urea nitrogen(BUN),serum creatinine(Scr),fasting blood glucose(FBG),glycated hemoglobin(HbA1C),hypertension,ANGPTL4 and FGF-23 levels between diabetic nephropathy pa-tients with different prognoses(P＜0.05);the Scr,ANGPTL4 and FGF-23 levels were all risk factors affecting the prognosis of diabetic nephropathy(P＜0.05);the ROC curve analysis for prognosis as-sessment showed that the AUCs of ANGPTL4,FGF-23 and their combination were 0.774,0.795 and 0.874 respectively;the combined diagnosis was significantly better than FGF-23(Z=2.385,P=0.171)and ANGPTL4(Z=2.317,P=0.021)alone.Conclusion The serum levels of ANGPTL4 and FGF-23 are significantly increased in diabetic nephropathy patients,and they have certain refer-ence value for the clinical diagnosis and prognosis assessment of diabetic nephropathy patients.

Objective To investigate the relationships of serum angiopoietin-like protein 4(ANGPTL4)and fibroblast growth factor-23(FGF-23)levels with the severity and prognosis of patients with diabet-ic nephropathy.Methods A total of 120 patients(diabetic nephropathy group)with diabetic nephrop-athy were selected from July 2018 to July 2020 and divided into mild group(n=62)and severe group(n=58)according to the staging criteria of diabetic nephropathy;based on the prognosis within 3 years,they were also divided into good prognosis group(n=94)and poor prognosis group(n=26).Addition-ally,102 diabetic patients were enrolled as diabetic group,and 81 healthy volunteers were selected as control group.The serum levels of ANGPTL4 and FGF-23 in diabetic nephropathy patients were detected by enzyme-linked immunosorbent assay(ELISA).Logistic regression analysis was used to analyze the influencing factors of prognosis,and receiver operating characteristic(ROC)curves were drawn to ana-lyze the values of ANGPTL4,FGF-23 and their combination in assessing the severity and prognosis of diabetic nephropathy.Results The levels of ANGPTL4 and FGF-23 in the diabetic nephropathy group and simple diabetic group were significantly higher than those in the control group(P＜0.05);compared with the simple diabetic group,the levels of ANGPTL4 and FGF-23 in the diabetic ne-phropathy group were significantly increased(P＜0.05);the levels of ANGPTL4 and FGF-23 in the severe group were significantly higher than those in the mild group(P＜0.05);the ROC curve analysis revealed that the areas under the curve(AUCs)for assessing disease severity of ANGPTL4,FGF-23 and their combination were 0.748,0.781 and 0.858 respectively,and the combined diagnosis was significantly better than FGF-23(Z=2.149,P=0.032)and ANGPTL4(Z=2.886,P=0.004)alone;the levels of ANGPTL4 and FGF-23 in the good prognosis group were significantly lower than those in the poor prognosis group(P＜0.05);significant differences were observed in diabetes dura-tion,blood urea nitrogen(BUN),serum creatinine(Scr),fasting blood glucose(FBG),glycated hemoglobin(HbA1C),hypertension,ANGPTL4 and FGF-23 levels between diabetic nephropathy pa-tients with different prognoses(P＜0.05);the Scr,ANGPTL4 and FGF-23 levels were all risk factors affecting the prognosis of diabetic nephropathy(P＜0.05);the ROC curve analysis for prognosis as-sessment showed that the AUCs of ANGPTL4,FGF-23 and their combination were 0.774,0.795 and 0.874 respectively;the combined diagnosis was significantly better than FGF-23(Z=2.385,P=0.171)and ANGPTL4(Z=2.317,P=0.021)alone.Conclusion The serum levels of ANGPTL4 and FGF-23 are significantly increased in diabetic nephropathy patients,and they have certain refer-ence value for the clinical diagnosis and prognosis assessment of diabetic nephropathy patients.

Objective To discuss the methods and experience of using short term left ventricular assist devices (LVADs) in patients after congenital heart disease(CHD) corrective surgery.Methods This study included 17 postoperative cases using short term LVAD support.The device used was a Maquet Rotaflow system, and the clinical patient data was collected and eval-uated retrospectively.Results The 17 patients were divided into two groups by the clinical outcome as follows: 6 cases in the early death group(Group D) and 11 cases in the survival group(Group S).The pre-support time[(9.00 ±9.95)h vs. (23.83 ±13.23)h, P＝0.042]and the lactate level values[(4.01 ±2.15)mmol/L vs.(9.30 ±4.90)mmol/L, P＝0.045] were significantly lower and more favorable in Group S.Patients in Group S also received a longer support time than patients in Group D.Conclusion Using the Maquet Rotaflow system is generally safe and efficient, when used as a short term LVAD in postoperative pediatric patients.The selection of patients, the timing of support, and reasonable management were the keys to patient survival.

Objective To discuss the surgical treatment of anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA) and the risk factors of postoperative recovery in infants and children.Methods A retrospective review of all patients who underwent surgical treatment of ALCAPA in Shanghai Children Medical Center(2003.1-2018.1) was conducted.Patients were divided into early surgery group (2003.1-2012.12) and late surgery group (2013.1-2018.1) according to the operation time,a preoperative left ventricular ejection fraction(LVEF) ＜0.35 was defined as severe group and LVEF≥0.35 as the control group in both surgery group.Meantime,and the clinical data among the groups were analyzed and compared.Results 102 patients were included in our study.According to the operation time and preoperative LVEF grouping:10 cases in the early severe group,early death in 4 cases(40％);28 cases in the early control group,and 3 cases died(10.7％)in hospital.Preoperative LVEF(0.29 ± 0.06 vs.0.53 ± 0.12),surgical age [(8.0 ± 7.9) months vs.(23.3 ± 27.7)months],and cardiopulmonary bypass time [(131.1 ± 39.6) min vs.(103.8 ± 29.8) min] were statistically different between the early two groups.The results of the late surgery had been improved:24 cases in the late severe group,4 cases died in hospital(16.7％);40 cases in the late control group,and early death in 2 cases (5％).In the late surgery groups,there was a statistically significant difference in preoperative LVEF(0.28 ±0.05 vs.0.59 ±0.12),left ventricular end-diastolic diameter(LVDD) Z-score(3.09 ±1.16 vs.2.11 ±0.95),and surgical age [(5.3 ±3.0) months vs.(24.8 ±30.5)months],clamping time [(67.1 ± 15.5) min vs.(82.7 ± 28.4) min].In the severe group,there was no significant difference in preoperative clinical data between early and late patients,and the early mortality decreased from 40％ in the early period to 16.7％ in the late period.In this study,13 cases(38.2％) of children with severe ALCAPA underwent mechanical circulation support(MCS).One patient died during MCS support and 2 died after weaning.Conclusion The early mortality severe ALCAPA remains high,which may be related to severe cardiac ischemia,left ventricular enlargement and age at surgical time.The modify of surgery technology and the use of MCS in the early clinical stage can improve the early survival rate.

Objective:To investigate the relationship between procalcitonin(PCT) and insulin resistance in diabetic foot infection.Methods:Sixty patients with diabetic foot infection hospitalized in the Fifth People's Hospital of Datong from March 2015 to March 2017 were selected and divided into three groups according to the value of PCT: slightly elevated group(L group, n=18), moderately elevated group(M group, n=21), highly elevated group(H group, n=21). Another 20 patients with type 2 diabetes mellitus were collected as control group.The PCT, C-reactive protein(CRP), white blood cell count(WBC), fasting and postprandial blood glucose, fasting insulin and insulin resistance index(HOMA-IR) were calculated and compared. Results:In the control group, the levels of PCT, HOMA-IR, CRP and WBC were (0.14±0.12)μg/L, (17.70±8.86), (32.90±24.19)mg/L, (8.01±2.21)×10 9/L, respectively, which in the L group were (0.31±0.14)μg/L, (20.42±9.71), (50.85±27.81)mg/L, (9.95±3.35)×10 9/L, respectively, which in the M group were (1.11±0.52)μg/L, (24.08±14.09), (64.31±40.21)mg/L, (10.86±2.25)×10 9/L, respectively, which in the H group were (5.31±3.04)μg/L, (31.73±14.13), (72.29±50.26)mg/L, (12.51±5.51)×10 9/L, respectively, and there were statistically significant differences among the four groups( F=50.744, 5.195, 4.303, 5.252, all P<0.01). With the increase of PCT, the levels of WBC, CRP and HOMA-IR were increased, and HOMA-IR was positively correlated with PCT( r=0.265, P=0.017). Conclusion:Serum level of PCT has correlation with infection degree of diabetic foot and is positively correlated with insulin resistance.

Objective:To investigate the clinical effect of bridging fixation with locking plate for the Seinsheimer type V subtrochanteric femoral fracture. Methods:From March 2009 to September 2014,18 cases of Seinsheimer type V sub-trochanteric femoral fracture were treated by open reduction and bridging fixation with locking plate through proximal and distal approach including 16 males and 2 females with an average age of 41 years old ranging from 22 to 67 years old. Among them , 12 cases caused by traffic accident,5 cases by falling,1 case by heavy aboving. All cases were fresh and closed fractures. Time between injury and operation was from 4 to 9 days with an average of 6.2 days. Of them ,11 cases were fixed with reverse LISS and the other 7 cases were fixed with anatomical locking plates of proximal femur. Results:The mean time of operation was 110 min (ranged from 90 to 155 min). The mean blood loss during operation was 425 ml (ranged from 350 to 650 ml) and 16 cases got blood transfusion which was meanly 300 ml. The mean hospital time was 14 days (ranged from 12 to 18 days). The mean duration of followed up was 11.8 months (ranged from 8 to 22 months). The mean time of bone union was 6.6 months (ranged from 5 to 8 months). There was not any complication such as infection,implant failure,hip varus,external rotation deformity of low limb or fat embolism. The Sanders hip scores were 53.22±6.48,the result was excellent in 12 cases and good in 6 cases at the last follow up. Conclusion:Under the principle of biological osteosynthesis ,treatment of Seinsheimer type V sub-trochanteric femoral fracture with bridging locking plate fixation has such advantages as high mechanism ,less interference of blood supply,stable fixation and little complication. It is a safe and idea way for the treatment of the Seinsheimer type V sub-trochanteric femoral fracture.

Objective: To study the clinical effect of fasudil plus cattle encephalon glycoside and ignotin injection in treating diabetic deafness and tinnitus. Methods: From January 2016 to December 2016, 60 patients with diabetic deafness and tinnitus in the Fifth People's Hospital of Datong were selected and randomly divided into two groups according to the digital table, with 30 cases in each group.The treatment group received fasudil injection plus cattle encephalon glycoside and ignotin injection (iv gtt), and the control group received cattle encephalon glycoside and ignotin injection.The effective rate after treatment for 10 days and 20 days were compared between the two groups. Results: Compared with the control group, the effective rate of hearing in the treatment group was not higher at 10 days after treatment (26.7% vs.16.7%, χ²=0.884, P=0.347), while it was higher in the treatment group at 20 days after treatment (53.3% vs.26.7%, χ²=4.444, P=0.035). The effective rate of tinnitus in the treatment group at 10 days after treatment was not higher compared with the control group (30.0% vs.20.0%, χ²=1.491, P=0.222), while it was higher in the treatment group at 20 days after treatment (56.7% vs.30.0%, χ²=4.344, P=0.037). As far as hearing threshold: there were no statistically significant differences between the control group and the observation group before treatment and 10 days after treatment(all P>0.05). The hearing threshold of the observation group was significantly better than that of the control group at 20 days after treatment (t=-2.511, P=0.02). Conclusion The combination therapy of fasudil injection plus cattle encephalon glycoside and ignotin injection has better efficacy for diabetic deafness and tinnitus.