BACKGROUND:Bisphosphonates that can suppress osteoclast activity strongly is a powerful inhibitor for bone resorption, which has been reported to have good effects in the treatment of fibrous dysplasia.
OBJECTIVE:To evaluate the clinical effect of surgical treatment combined with bisphosphonate therapy in the treatment of fibrous dysplasia.
METHODS: Fifteen patients with fibrous dysplasia of the long bone were subjected to surgical treatment and oral bisphosphonate therapy postoperatively. Limb pain, limb function, local X-ray manifestations and blood alkaline phosphatase activity were observed before and at 3, 6, 12, 24 months after treatment. The therapeutic effects were evaluated using modified Macnab standards.
RESULTS AND CONCLUSION:Al the 15 patients were folowed up for more than 24 months, and their pain symptoms were significantly relieved after the combined treatment of surgery and bisphosphonates, excelent in 12 cases and effective in 1 case, and the total efficiency was 100%. X-ray films showed that the density slightly decreased in operation areas after 3 months, but at 6 months after treatment, the cortical bone was thickened and the marrow cavity density increased in the operation areas, and non-focal zone was continuously enlarged. No fractures and recurrence were found in al patients. At 6 months after treatment, the serum alkaline phosphatase activity decreased significantly (P < 0.05). The results suggest that surgical operation with bisphosphonate treatment for bone fibrous dysplasia can effectively inhibit the bone resorption, promote bone formation, increase the intensity of the lesion, reduce fractures and recurrence rate, so as to achieve a better therapeutic effect in clinic.

BACKGROUND: Treatment of large bone defects is an important problem faced by orthopedic physicians. Allogeneic bone transplantation is a classic method, but it has many restrictions. The membrane guided bone regeneration technique has become an important method for the research nowadays.OBJECTIVE:To compare the effects of self-made high strength biodegradable nano-hydroxyapatite/multi(amino acid) copolymer (n-HA/MACP) guided bone regeneration membrane tube and allograft bone graft segment in the repair of large segmental bone defect in goats. METHODS: The model of 30 mm large segment bone defect in the middle section of the femur in 32 adult goats was established. Experimental group used self-made n-HA/MACP tube to bridge defects following bone plate fixation. The control group was treated with allograft bone graft bone segments combined with plate fixation. The animals were sacrificed at 4, 8, 12 and 16 weeks after operation, and the bone callus growth was observed in the specimens. The X-ray and histological observations were performed at the same time. Biomechanical measurement of plate fixation of allograft cortical bone segment was done at 12 and 16 weeks after operation. RESULTS AND CONCLUSION: (1) After 4 to 16 weeks, gross and pathological results showed fibrous callus growth inside and outside of the membrane tube, and the fibrous callus gradually hardened into a bony callus. Additionally, the callus was larger in the experimental group than in the control group. X-ray films showed significantly increased lateral callus density in the experimental group as compared with the control group. (2) Maximum bending strength was significantly higher in the experimental group than in the control group at 16 weeks (P < 0.05). Overall, the n-HA/MACP membrane tube used for bridging large segment bone defects in goats can obtain similar repair effects to the allograft cortical bone, and further achieve the better mechanical strength of the new bone segment than the allograft bone.

Objective To evaluate the effect of environmental hypothermia exposure on hemodynamics and oxygen metabolism during general anesthesia in a pig model of hemorrhagic shock.Methods Twelve pathogen-free Bama miniature pigs of both sexes,weighing 20-24 kg,were divided into 2 groups (n=6 each) using a random number table:room temperature group (group RT) and environmental hypothermia group (group EH).The animals inhaled 2％ isoflurane for maintenance of anesthesia.The pigs were placed at room temperature (20-22℃) and at low temperature (-10 ℃) in group RT and group EH,respectively.Hemorrhagic shock was induced by withdrawing blood from the right femoral artery within 20 min (30 ml/kg).Before withdrawing blood (T1),immediately after the end of withdrawing blood (T2),and at 1,2,3,4 and 5 h of shock (T3-7),heart rate,mean arterial pressure,mean pulmonary artery pressure,cardiac index and systemic vascular resistance index were recorded.Blood samples were collected from the right femoral artery and internal jugular vein for blood gas analysis,and lactic acid concentrations,hemoglobin,arterial oxygen partial pressure,arterial oxygen saturation,and mixed venous oxygen saturation were recorded.Oxygen delivery index,oxygen consumption index and O2 extraction rate were calculated.Results Compared with group RT,heart rate at T3-7,cardiac index and oxygen delivery index at T5-7,oxygen consumption index at T1-7,O2 extraction rate at T2-6,and lactic acid concentrations at T5-7 were significantly decreased,and mean arterial pressure at T4,5,mean pulmonary artery pressure at T4-7,systemic vascular resistance index at T3-7,and mixed venous oxygen saturation at T2-6 were increased in group EH (P＜0.05).Conclusion Environmental hypothermia exposure inhibits cardiac compensatory responses,increases the peripheral vascular resistance,and aggravates oxygen dysmetabolism during general anesthesia in a pig model of hemorrhagic shock.

Objective To investigate the effect of dexmedetomidine on renal function during percutaneous nephrolithotomy under general anesthesia in the patients with renal calculus. Methods Thirty patients (male 25 cases,female 5 cases)with renal calculi,age 40-70 yr,with body mass index of 1 9-27 kg/m2 ,ASA physical status Ⅰ or Ⅱ,scheduled for elective percutaneous neph-rolithotomy under general anesthesia,were randomized into two groups (n =1 5 each):control group (group C)and dexmedetomidine group (group D).In patients of group D,dexmedetomidine 1 μg/kg were infused intravenously over 10 min before induction anesthesia,followed by infusion at a rate of 0.5 μg·kg-1 ·h-1 until the end of operation.The equal volume of normal saline was given in pa-tients of group C.Immediately before beginning of surgery (T0 ),at the end of surgery (T1 ),the first day after surgery (T2 )and the third day after surgery (T3 ),blood and urine samples were obtained. The serum and urine concentrations of urea nitrogen (BUN),serum creatinine (Scr),cystatin C (CYS-C),retinol binding protein (RBP),urinaryα1-microglobulin (α1-MG),urine micro-albumin,u-rinary transferrin,urinary immunoglobulin G was measured by automatic biochemical analyzer and Beckman specific protein analyzer.Results There was no difference in BUN and Scr at any time point between the two groups.Compared with T0 ,CYS-C and RBP at T1-T3 increased significantly in two groups (P <0.05).The levels of CYS-C and RBP in group D were lower than in group C at T1-T3 (P<0.05).There was no difference in urinary immunoglobulin G,urine micro-albumin after the start of surgery.Compared with T0 ,urinary α1-MG at T1-T3 increased significantly in two groups (P <0.05).The level of urinary α1-MG in group D was lower than in group C at T1-T3 (P < 0.05 ). Conclusion Dexmedetomidine(1 μg/kg infused intravenously before induction of anesthesia,followed by infusion at a rate of 0.5 μg·kg-1 ·h-1 until the end of operation)might provide renal protection to some extent during percutaneous nephrolithotomy under general anesthesia in the patients with renal calculi.

Objective To investigate the regulation of miR-939-5p on USP22 gene expression and its effect on liver cancer migration and proliferation.Methods The expression of miR-939-5p in hepatoma cell lines (HepG2,MHCC-97H,SMMC-7721,BEL-7404 and Huh7) and normal liver cell line LO2 was detected by realtime PCR (qPCR).The liver cancer cells with the lowest expression were used as experimental subjects,and transfected with miR-939-5p (Experimental group) or miR-NC (Control group).qPCR was used to detect the transfection efficiency of miR-939-5p.Transwell migration assay and MTT proliferation assay were used to detect the migration and proliferation of hepatoma cells after transfected miR-939-5p.Bioinformatics software predicted target genes for miR-939-5p.The dual luciferase reporter gene verified the interaction of miR-939-5p with the target gene.qPCR and Western blotting were used to detect the expression of target genes at mRNA and protein levels after over-expression of miR-939-5p.Measurement data were expressed as (Mean ± SD),and t test was used for comparison between groups.Results The expression of miR-939-5p was significantly lower in hepatoma cell lines than in normal hepatocytes (P ＜0.01),and the expression of miR-939-5p was the lowest in SMMC-7721 cells (P＜0.01).miR-939-5p was efficiently transfected into SMMC-7721 cells [(1.01 ±0.07) vs (20.12 ± 1.27),P ＜0.01].High expression of miR-939-5p inhibited the migration ability (P ＜ 0.01) and proliferative capacity of liver cancer SMMC-7721 cells (P ＜0.05).The USP22 gene may be a target gene of miR-939-5p.The luciferase reporter gene confirmed that miR-939-5p specifically binds to the 3'-UTR of USP22 mRNA (P ＜ 0.01).USP22 expression was decreased at mRNA and protein levels after high expression of miR-939-5p (P ＜ 0.01).Conclusions The expression of miR-939-5p was down-regulated in hepatocellular carcinoma cell lines,and miR-939-5p inhibited the migration and proliferation of liver cancer SMMC-7721 cells.The molecular mechanism was to interfere with the expression of USP22 gene.

Objective: An isochronous substitution model was established to explore the association and substitution effect between college students 24 hour activity behavior and physical health, so as to provide specific activity behavior suggestions for college students to improve their physical health. Methods: A stratified random cluster sampling method was used to conduct physical fitness tests and 24 hour activity behavior surveys among 2 794 college students in 12 colleges and universities in Tianjin.Time spent on sedentary behavior(SB), light intensity physical activity(LPA), moderate to vigorous physical activity(MVPA) and sleep(SLP) time. The isochronous method of components was used to explore the relationship between 24 h activity behavior and physical health. Results: Except for 50 m running, MVPA was negatively correlated with BMI Z ( β =-0.62, P <0.05), but positively correlated with other physical fitness indexes ( β =0.34~274.23, P <0.05). LPA was not associated with lung capacity, sitting forward flexion and 50 m running, and negatively correlated with other physical fitness indexes ( β =-14.30- -0.19, P <0.05). SB was negatively correlated with most physical fitness indexes ( β =-11.57- -0.33, P <0.05), but positively correlated with BMI Z ( β =0.45, P < 0.05 ). In addition to lung capacity, SLP was positively correlated with BMI Z , total physical fitness score,1 minute sit-ups, pull ups, 800/1 000 m running, sitting forward flexion, and 50 m running ( β =0.27-11.21, P <0.05), but negatively correlated with long jump ( β =-0.10, P <0.05）. Isochronous substitution showed that the adverse effects of 30 min/d SB and LPA substitution of MVPA were much greater than the beneficial effects of MVPA substitution for corresponding behaviors (total physical score: SB, -0.58 vs 0.47 points; LPA, -0.50 vs 0.38 points). Conclusion MVPA and SLP have been found to have a positive effect on physical fitness among college students. Therefore, in the process of improving the physical health of college students, ensuring adequate sleep, improving MVPA and reducing SB as much as possible may be one of the effective methods.

Objective To compare the differences and clinical value of prognostic evaluation between American Joint Committee on Cancer (AJCC) TNM staging system 7th edition and 8th edition for gastric cancer (GC).Methods The retrospective case-control study was conducted.The clinicopathological data of 1 383 GC patients who were admitted to the First People's Hospital of Changzhou between January 2008 and August 2012 were collected.Distal gastrectomy,proximal gastrectomy + pyloroplasty or total gastrectomy were performed according to preoperative evaluation and intraoperative exploration.Observation indicators:(1) surgical and postoperative situations;(2) follow-up and survival situations;(3) T staging comparison between AJCC TNM staging system 7th edition and 8th edition;(4) N staging comparison of AJCC TNM staging system 8th edition;(5) prognostic analysis in N staging of AJCC TNM staging system 8th edition;(6) TNM staging comparison between AJCC TNM staging system 7th edition and 8th edition;(7) prognostic analysis in different TNM staging between AJCC TNM staging system 7th edition and 8th edition.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to October 2017.Measurement data with normal distribution were represented as x ± s.Measurement data with skewed distribution were described as M (range).The survival curve and survival rate were respectively drawn and calculated by the Kaplan-Meier method,and the Log-rank test was used for survival analysis.Results (1) Surgical and postoperative situations:1 383 GC patients underwent successful radical gastrectomy,including 923 with distal gastrectomy,165 with proximal gastrectomy and 295 with total gastrectomy.Of 1 383 patients,115 with postoperative complications were improved by symptomatic treatment,including 87 with surgical complications and 28 with non-surgical complications.Postoperative pathological examinations:total number of intraoperative lymph node dissection and number of lymph node metastasis were 25± 12 and 7±4;577 didn't have lymph node metastasis and 806 had regional lymph node metastasis;308 were in early GC and 1 075 in advanced GC.(2) Follow-up and survival situations:1 383 patients were followed up for 1-117 months,with a median time of 34 months.The 1-,3-and 5-year survival rates of 1 383 patients were respectively 90.5％,71.9％ and 61.1％.(3) T staging comparison between AJCC TNM staging system 7th edition and 8th edition:T staging definition between AJCC TNM staging system 7th edition and 8th edition was identical.T staging of 1 383 patients:308,192,65,628 and 190 were respectively detected in T1,T2,T3,T4a and T4b stagings.(4) N staging comparison between AJCC TNM staging system 7th edition and 8th edition:N staging definition between AJCC TNM staging system 7th edition and 8th edition was identical.N staging of 1 383 patients:577,255,207,230 and 114 were respectively detected in N0,N1,N2,N3a and N3b stagings.N3a and N3b were classified as N3 staging of AJCC TNM staging system 7thedition,but they were classified as independent staging of AJCC TNM staging system 8th edition.(5) Prognostic analysis in N staging of AJCC TNM staging system 8th edition:5-year survival rate of patients in N0,N1,N2,N3a and N3b stagings was respectively 85.6％,76.5％,59.4％,45.2％ and 32.5％ based on AJCC TNM staging system 8th edition,with a statistically significant difference in survival (x2 =394.400,P＜0.05).There was a statistically significant difference between N0 and N 1 stagings (x2 =45.630,P＜0.05),between N 1 and N2 stagings (x2 =19.470,P＜0.05),between N2 and N3a stagings (x2 =7.602,P＜0.05) and between N3a and N3b stagings (x2=13.020,P＜0.05).(6) TNM staging comparison between AJCC TNM staging system 7th edition and 8th edition:TNM staging of 366 patients had changes,including 2 in T1N3b staging,2 in T2N3b staging,18 in T3N3b staging,120 in T4aN2 staging,149 in T4aN3a staging,34 in T4bN0 staging and 41 in T4bN2 staging;364 were detected in staging Ⅲ in 7th edition and 8th edition,and sub-staging of staging Ⅲ had a change;2 in T1N3b of ⅡB staging were redistricted into Ⅲ B staging based on AJCC TNM staging system 8th edition.(7) Prognostic analysis in different TNM staging between AJCC TNM staging system 7th edition and 8th edition:according to 7th edition,cases and 5-year survival rate were respectively 247,89.5％ in Ⅰ A staging and 147,83.7％ in Ⅰ B staging and 77,75.9％ in ⅡA staging and 207,70.5％ in ⅡB staging and 136,61.0％ in ⅢA staging and 236,37.5％ in Ⅲ B staging and 333,35.4％ in Ⅲ C staging,with a statistically significant difference in survival among sub-stagings (x2 =228.800,P＜0.05).There was a statistically significant difference in survival among Ⅰ,Ⅱ and Ⅲ stagings (x2=189.000,P＜0.05) and between ⅢA and ⅢB or ⅢC stagings (x2=22.710,18.010,P＜0.05).There was no statistically significant difference in survival between Ⅰ A and Ⅰ B stagings (x2=0.179,P＞0.05),between Ⅱ A and Ⅱ B stagings (x2 =0.265,P＞0.05),and between Ⅲ B and Ⅲ C stagings (x2 =1.550,P＞0.05).According to 8th edition,cases and 5-year survival rate were respectively 247,89.5％ in Ⅰ A staging and 147,83.7％ in Ⅰ B staging and 77,75.9％ in Ⅱ A staging and 205,70.7％ in Ⅱ B staging and 288,53.8％ in ⅢA staging and 258,37.3％ in ⅢB staging and 161,28.5％ in ⅢC staging,with a statistically significant difference in survival among sub-stagings (x2=234.900,P ＜ 0.05).There was no statistically significant difference in survival between Ⅰ A and Ⅰ B stagings (x2 =0.179,P＞0.05) and between Ⅱ A and ⅡB stagings (x2 =0.564,P＞0.05).There was statistically significant differences in survival between Ⅲ A and Ⅲ B or ⅢC stagings (x2 =29.790,43.060,P＜0.05) and between Ⅲ B and Ⅲ C stagings (x2 =7.494,P＜0.05).Further analysis showed that changes of TNM staging system between 7th edition and 8th edition were in T3N3b,T4aN2,T4aN3a,T4bN0 and T4bN2 stagings,5-year survival rate in above stagings was respectively 16.7％,35.8％,30.2％,47.1％ and 26.8％,with statistically significant differences in survival between T3N3b and T4aN2,T4aN3a,T4bN0 and T4bN2 stagings (x2 =19.590,8.039,12.070,3.853,P＜0.05),between T4aN2 and T4aN3a,T4bN2 stagings (x2 =6.529,3.859,P ＜ 0.05),between T4aN3a and T4bN0 stagings (x2 =10.400,P＜0.05) and between T4bN0 and T4bN2 stagings (x2=4.636,P＜0.05).There was no statistically significant difference in survival between T4aN2 and T4bN0 stagings (x2 =3.607,P＞0.05) and between T4aN3a and T4bN2 stagings (x2 =0.029,P＞0.05).Conclusions Compared with AJCC TNM staging system 7th edition,N3a and N3b stagings are classified as independent staging in AJCC TNM staging system 8th edition,and 8th edition is more accurate in prognostic evaluation of GC patients in stage Ⅲ.