Chronic rhinosinusitis is a common health problem of otorhinolaryngology head and neck surgery, and is characterized by persistent inflammation of the nasal and paranasal mucosal linings. In recent years, tissue remodeling has been demonstrated to play an important role in the development of chronic rhinosinusitis, and furthermore transforming growth factor-beta1 (TGF-beta1) may play a pivotal role in this progress. This review will summarize the current knowledge on the roles of tissue remodeling in chronic rhinosinusitis, therefore to offer reference to the research and help to make diagnosis and give treatment for this disease.
Airway Remodeling ; Chronic Disease ; Humans ; Inflammation ; Sinusitis ; metabolism ; pathology ; Transforming Growth Factor beta1 ; metabolism

Objective To study the mechanism of miR-548a-3p targeting MMP-2 inhibits the metastasis and invasion of gastric cancer cells.Methods Bioinformatics were used to search those miRNAs targeting MMP-2.The level of miR-548a-3p in gastric cancer tissues were detected by qRT-PCR and the expression of MMP-2 were detected by Western blot.The level of miR-548a-3p in three reconstructed gastric cancer cell lines were detected by qRT-PCR and the expression of MMP-2 were detected by Western blot.miR-548a-3p targeting the 3'-UTR of MMP-2 were detected by Luciferase reporter assay detected.And the changes of ability of metastasis and invasion were examined by Transwell experiment before and after transfection.Results There were high expression of miR217 and low expression of MMP-2 in human poorly differentiated gastric cancer cell line BGC-823.There were low expression of miR-548a-3p and high expression of MMP-2 in human middle and high differentiated gastric cancer cell line MKN-28 and SGC-7901 (P ＜ 0.05).The result of Luciferase reporter assay showed that miR-548a-3p can targeting the 3’-UTR of MMP-2.There were high expression of miR-548a-3p and low expression of MMP-2 in MKN28-miR-548a-3p mimics.There were low expression of miR-548a-3p and high expression of MMP-2 in others reconstructed three cell lines.There were smaller invaded cells in SGC-7901-miR-217 mimics than in others three cell lines (P ＜ 0.05).Conclusions miR-548a-3p can target the 3'-UTR of MMP-2 and down regulate its expression and inhibit the ability of invasion of gastric cancer cells.

OBJECTIVE:To analyze the effect of daptomycin on methicillin resistant Staphylococcus aureus(MRSA)infection patients with diabetic foot (DF). METHODS:179 patients with type 2 DF complicating with MRSA were randomly divided into daptomycin group (90 cases) and vancomycin group (89 cases),and both groups were included infection group. 80 DF patients without MRSA infection were included in non-infection group. All of them received DF routine treatment ;daptomycin group was additionally given intravenous injection of daptomycin 4 mg/kg,once a day,for 2 weeks;vancomycin group was additionally giv-en intravenous injection of vancomycin 4 mg/kg,once a day,for 2 weeks. RESULTS:After treatment,IL-6,IL-8,MMP-2 and MMP-9 of infection group were significantly decreased,while TIMP-1 levels increased significantly,with statistical significance, compared to before treatment (P<0.05). The effective rate of daptomycin group was 94.4%,which was significantly higher than that of vancomycin group(71.9%),with statistical significance(P<0.05). CONCLUSIONS:Daptomycin can effectively improve the inflammatory status in patients with DF complicated with MRSA infection,to restore the MMPs/TIMPs balance.

BACKGROUND:Valgus-varus constrained polyethylene insert is selected in strict accordance with the principle of“to obtain reliable stability using minimum restriction”. The stability of the prosthesis is elevated, but the restriction is not increased.
OBJECTIVE:To retrospectively analyze the application experience of constrained polyethylene insert in valgus and varus instability of primary total knee arthroplasty for older patients and to summarize the indications and clinical effects of this kind of implements.
METHODS:From March 2010 to March 2012, a total of 70 patients combined valgus and varus malfomation who accepted primary total knee arthroplasty were enrol ed in this study, including 56 varus patients (averagely 15°-30°) and 14 valgus patients (averagely 10°-20°). Constrained polyethylene insert was performed in 23 patients (25 knees) who stil had remaining unilateral valgus or varus<6 mm (18 patients were varus instability and 7 patients were valgus instability) when finished operation of standard osteotomy and soft tissue balancing. The bone cement knee prostheses in 23 cases were purchased from Smith&Nephew. The stem implant was not used in al cases. Cement or autografts were used in 11 valgus knees to fil the bone defects.
RESULTS AND CONCLUSION:Patients were fol owed up for 2 years on average (18-42 mouths). The knee pain symptoms of al cases disappeared. The joint stability was obviously improved. The lower limb power lines were correct. The Knee Society Score scores were improved from an average of 39.4 points preoperation to an average of 88.5 points postoperation. Al cases did not need the protection of knee braces. The maximum degree of flexion was 110°(96°-130°). The satisfaction degree of 36-Item Short Form Health Survey was 98%. No dislocation or infection happened. Results indicated that constrained polyethylene insert could be applied in the cases of less than 6 mm valgus and varus instability when finished operation of standard osteotomy and soft tissue balancing in total knee arthroplasty for older patients. This kind of implements can preserve bone mass, simplify operational process and have good clinical outcome in a short period.

Objective:To explore CT and MRI features of the endolymphatic sac tumor (ELST).Methods:The CT and MRI morphology confirmed by surgical pathology for 19 patients with ELST were retrospectively analyzed from June 2011 to May 2019 in Eye & ENT Hospital of Fudan University. The features of CT and MRI included location, size, adjacent structures invasion, CT values, bone destruction, features of T 1WI and T 2WI, enhancement distribution characteristics, dynamic enhancement curve morphology, DWI signal characteristics. The ADC values of the lesions and ipsilateral medial pterygoid muscles were compared using a paired t test. Results:Nineteen ELST patients (one with bilateral diseases) were included. Totally 20 ears (right 9 and left 11) of 13 females and 6 males were studied. The masses with slightly high-density and obscure boundary were located around the vestibular aqueduct at the posterior edge of the petrosal bone. Bone destruction involved mastoid process of the middle ear (16 ears), jugular foramen (11 ears), semicircular canal (10 ears), facial nerve canal (7 ears) and internal auditory canal (9 ears). A large amount of residual bone could be found in the interior of nineteen masses. The CT value was (78.6±21.9) HU. The lesion showed central iso-intensity and peripheral hyperintensity on T 1WI and T 2WI in 16 ears, while no obvious hyperintensity on T 1WI in the other 4 ears. The hyperintensity on T 1WI was around the margin of the lesion in 10 ears, situated at lateral side in 5 ears and all over the lesion in 1 ear. Flow voids signals could be seen in 9 ears as well. Liquid-liquid plane was seen on T 2WI in 2 ears. The solid mass portion which showed iso-intensity on both T 1WI and T 2WI presented marked enhancement on contrast-enhanced T 1WI, while other part of the mass no enhancement. DWI of 14 ears illustrates no evidence of restricted diffusion, and the ADC value [(1.25±0.08)×10 -3 mm 2/s] was slightly higher than that of the medial pterygoid muscles ( t=4.437, P=0.001). The style of time-signal intensity curves of the dynamic contrast-enhanced MRI was rapidly ascending followed by descending curves in 2 ears. Conclusion:Imaging findings of ELST have some characteristics, including located around the vestibular aqueduct at the posterior edge of the petrosal bone, bone destruction, peripheral hyperintensity on T 1WI and no restricted diffusion, which is helpful for its diagnosis.

BACKGROUND: Common complication of traditional joint replacement is hip joint dislocation and large head joint implant can effectively solve this problem. OBJECTIVE: To investigate the preliminary efficacy of large head metal-on-metal implants for patients undergoing total hip arthroplasty. DESIGN, TIME AND SETTING: Prospective cohort study. The patients were selected from Department of Joint Surgery, Xinjiang Hospital of Traditional Chinese Medicine between February 2007 and January 2008. PARTICIPANTS: A total of 65 patients (71 hips) undergoing large head metal-on-metal implantation in Xinjiang Hospital of Traditional Chinese Medicine were selected, including 21 females and 44 males with an average age of 54.6 years (ranging 19 to 77 years). Of them, there were 28 cases of necrosis of the femoral head, 24 of hip osteoarthritis, 9 of femoral neck fracture and 4 of acetabular dysplasia. METHODS: According to age, sex, cause of disease and preoperative joint function, the patients were divided into traditional prosthesis (n=30, 33 hips, metal-on-polyethylene implant) and large head M-O-M group (n=35, 38 hips, ASR/XL prosthesis, DePuy, Motech, Warsaw, IN, USA). MAIN OUTCOME MEASURES: The pre and postoperative Harris scores for the hip, range of motion, periprosthetic radiolucency, leg-length inequality and complications were recorded and compared. RESULTS: All patients were followed-up. The traditional group was followed up for 20 months (ranging 13-28 months), and the large head M-O-M group was followed up for 17 months (ranging 10-26 months). The mean Harris score was 89 points (ranging 59-98) in traditional group, and 94 points (ranging 71-100) in large head M-O-M group (P=0.014). The range of motion of hip was improved, and the large head M-O-M group (34?) was superior to traditional group (26?, P=0.004) at 6 months after surgery; the range of motion was improved 27? in traditional group and 37? in large head M-O-M group (P=0.009) over 1 year of follow up. The leg-length inequality was 4 mm (2-11 mm) in large head M-O-M group and 7 mm (5-16 mm) in traditional group (P=0.005). Both groups exhibited periprosthetic radiolucency (≤1 mm, 2 cases in traditional group and 3 cases in large head M-O-M group). One patient in the traditional group suffered dislocation. CONCLUSION: The large head M-on-M implants in total hip arthroplasty has excellent short-term effects on patients compared with traditional prosthesis. They offer the more stability and better restoration of hip articulation function and biomechanical reconstruction.

[Objective]To summarize Professor CHU Haoran's understanding and treatment experience on diarrhea type irritable bowel syndrome(IBS-D).[Methods]Through clinical study with teachers,consulting ancient books and combining modern literature research,summarize the understanding and treatment ideas of Professor CHU for IBS-D,clarify the basic diagnosis and treatment rules of the disease,and provide a clinical medical case as evidence.[Results]Professor CHU believes that disordered movement of Qi in the middle-Jiao is the core pathomechanism of IBS-D.He advocates for the treatment principle of"ascending Qi mechanism,regulating the middle-Jiao,and nourishing vital energy".The acupoint Tianshu(ST25)is considered the focal point,complemented by Zhongwan(CV12),Zhangmen(LR13),Shangjuxu(ST37),Dachangshu(BL25),and Zusanli(ST36)to regulating the middle-Jiao.This is paired with the needling technique of"Dragon and Tiger battle"to assist in facilitating the flow of Qi in the middle-Jiao.A key selection is"Baihui(DU20)-Neiguan(PC6)"to regulate the clear Qi,comb the mind and spirit located in the head,and elevate the overall movement of Qi.Additionally,"Guanyuan(RN4)-Zusanli(ST36)"are used to firm the foundation and cultivate the primal Qi,supplementing the innate vital energy.In a case study,the patient was diagnosed with syndrome differentiation of spleen and stomach deficiency,with concurrent restlessness of the heart spirit and signs of deficient Yang Qi.Professor CHU treated the patient by using the method of raising the clear Qi,managing the middle-Jiao,and nourishing vital energy,supplementing the postnatal to nourish the prenatal while calming the spirit,resulting in significant effects.[Conclusion]In clinical practice,Professor CHU modifies acupoints according to syndrome differentiation.By integrating groups of acupoints,he facilitates the beneficial ascent and descent of Qi within the middle-Jiao,creating a distinctive"regulating the middle and restoring the vital energy"diagnostic and treatment system for IBS-D,which provides a new approach to the clinical treatment of IBS-D.

Objective To investigate inhibitory effect and mechanism of extract from taraxacum mogonon (ETM) on human poorly differentiated gastric cancer MKN45 cells and their model nude mice tumors. Methods Human poorly differentiated gastric cancer MKN45 cells cultured in vitro were divided into the control group and the experimental group. The experimental group was treated with different concentrations of ETM, while the control group was treated with phosphate buffered saline (PBS). The tumor cell growth was examined by methyl thiazolyl tetrazolium(MTT).Cell apoptosis was detected by flow cytometry (FCM). The expression of Survivin mRNA was detected by reverse transcription polymerase chain reaction (RT-PCR), and the protein expression of Survivin was detected by Western blot. The nude mouse model with poorly differentiated gastric cancer was established with MKN45 cells. Successful models of nude mice were divided into the experimental group and the control group according to random number table. ETM 0.4 ml (100 mg/ml) was injected into abdominal cavity of the nude mice in the experimental group, while only equal dose of 0.9 % NaCl solution was injected in the control group, every 3 days for once, 42 days in total. The weight and volume changes of transplantable tumors were observed. The protein expression of Survivin in transplantable tumors was examined by immunohistochemistry(IHC) method. Results ETM could inhibit the cell proliferation and promote apoptosis of MKN45 cells in a dose-dependent and time-dependent way when its concentration reached 0.2 μmol/L (P< 0.05). The expression of Survivin mRNA and Survivin protein was down regulated in a dose-dependent way in the experimental group. Survivin mRNA expression in the experimental group with 0.1,0.2,0.4,0.8, 1.6 μmol/L of ETM and in the control group was 0.18±0.04, 0.14± 0.03, 0.11±0.01, 0.08±0.04, 0.06±0.02 and 0.19±0.03 respectively (F = 132.35, P< 0.05); Survivin protein expression in the experimental group in 0.1, 0.2, 0.4, 0.8, 1.6 μmol/L of ETM, and in the control group was 0.86±0.03, 0.60±0.05, 0.43±0.01, 0.22±0.01, 0.14±0.03 and 0.92±0.06 respectively (F= 76.57, P< 0.05). The difference of experimental group was statistically significant when concentration of ETM reached 0.2 μmol/L or above compared with the control group (P< 0.05). Nude mouse experiment showed that the tumor inhibition rate was (60.3±3.2) % in the experimental group. The volume and weight of transplantable tumor in the experimental group was(326± 27)mm3and(0.31±0.13)g,which was obviously lower than that in the control group[(843±14) mm3and (0.78±0.25) g]. The difference was statistically significant (t= 3.94,P =0.043;t= 3.27,P = 0.037). IHC experiment results showed that positive cell count of Survivin protein in the experimental group was obviously less than that in the control group(28±11 vs.152±20;t =4.32,P =0.029). Conclusions ETM has an obvious inhibitory effect on human poorly differentiated gastric cancer MKN45 cell and its nude mouse tomor model. The mechanism may be related with down-regulation of Survivin expression caused by ETM.

Objective To investigate the incidence and the prognosis of acute kidney injury (AKI) and to find out the risk factors associated with the outcome for better understanding and preventing AKI among inpatients. Methods All the hospitalized patients were screened by Lab Administration Network of Renji Hospital,Shanghai Jiaotong University School of Medicine from Jan.to Dec.2009.Study cohort was comprised of all the patients with AKI defined by Acute Kidney Injury Network (AKIN) and with complete clinical data recorded.The incidence,etiology and distribution characteristics, prognosis of AKI in hospitalized patients were retrospectively analyzed.Logistic regression analysis was used to investigate the risk factors of patients and renal outcome. Results A total of 934 patients with AKI were enrolled.The incidence of AKI in hospitalized patients was 2.41％ (934/38 734).The ratio of male to female was 1.88∶1.Age was (60.82±16.94) years old.Increasing incidence could be seen with age rising.There was 63.4％ AKI found in surgical department,35.4％ in internal medicine department and 1.2％ in obstetric and gynecologic department.Pre-AKI,acute tubular necrosis (ATN),acute glomerular and renal vascular injury (AGV),acute interstitial nephritis (AIN) and post-AKI were accounted for 51.7％,37.7％,3.8％,3.5％ and 3.3％ of the causes of AKI,respectively.On day 28,the survival rate was 71.8％,complete renal recovery rate was 65.7％,partial renal recovery rate was 16.9％ and renal loss rate was 17.4％ among all the patients with AKI.The mortality of AKI with stage Ⅰ,Ⅱ and Ⅲ among inpatients was 24.8％,31.2％ and 43.7％ respectively.Multivariate Logistic regression analysis showed that renal injury drugs [odds ratio (OR)=2.313],hypotension (OR=4.482),oliguria (OR =5.267),the number of failure organs except kidney (OR =1.376) and requiring renal replacement therapy (RRT)(OR=4.221) were independent risk factors for death among AKI patients.The number of failure organs except kidney (OR=1.529) and RRT (OR=2.117) were independent risk factors for kidney loss. Conclusions AKI is one of the most common complications in hospitalized patients.The mortality is high and renal outcome is poor after AKI.The prognosis is closely associated with the severity of AKI.Renal injury drugs,hypotension,oliguria,the number of failure organs except kidney and requiring RRT are independent risk factors for death among AKI patients,while the number of failure organs except kidney and requiring RRT are independent risk.factors for renal loss.

Objective To elucidate the association of fibroblast growth factor 23 (FGF23)with coronary artery calcification in patients with moderate and advanced stage chronic kidney diseases (CKD). Methods Serum intact FGF23 levels in 150 patients with CKD stage 3 to 5 and 25 age- and sex-matched healthy controls were measured by ELISA.The association between FGF23 and coronary artery calcification was studied. Results Serum FGF23 levels in CKD patients were significantly higher than those in healthy controls [196.46 (83.09,355.02) ng/L vs 27.17 (21.63,51.20) ng/L,P＜0.01].The levels of FGF23 were significantly higher in dialyzed patients than those in non-dialyzed patients (P＜0.01),and hemodialysis patients had higher levels as compared to peritoneal dialysis ones [6048.29 (1129.08,34807.45) ng/L vs 1625.80 (602.83,7521.78) ng/L,P＜0.01].The incidence of coronary artery calcification was relatively high in patients with moderate and advanced stage CKD (74/130,56.9％ ).Serum FGF23 level was positively correlated with coronary artery calcification score (CaS) (r=0.177,P＜0.05).Logistic regression analysis showed that age (β=0.091,OR=1.095,P＜0.01),duration of dialysis (β=2.013,OR=7.483,P＜0.05) and FGF23 level (β=0.838,OR=2.311,P＜0.05) were independent risk factors for coronary artery calcification in patients with moderate and advanced stage CKD.ROC curve of coronary artery calcification revealed that area under curve (AUC) of FGF23 was 0.705 (P＜0.01).With the cut-off value of FGF23 as 786.73 ng/L,the diagnostic sensitivity and specificity in coronary artery calcification were 62.5％ and 75.9％.ROC curve of coronary artery calcification showed that AUC of alkaline phosphatase (AKP) was 0.626 (P=0.017).With the cutoff value of AKP as 79.75 U/L,the diagnostic sensitivity and specificity in coronary artery calcification were 84.5％ and 41.5％.There was no diagnostic value of serum phosphorus in coronary artery calcification. Conclusions Serum FGF23 level is correlated with coronary artery.calcification in patients with moderate and advanced stage CKD.The sensitivity of FGF23 is lower and the specificity is higher than those of AKP for the diagnosis of coronary artery calcification.