Osteoclast, a huge coenocytes,originates from mononuclear macrophages or monocytic series hematopoietic precursor cell, plays an important role in the progree of bone resorption. Formation and abnormal activity of osteoclast may cause osteoprosis, rheumatoid arthritis and aseptic loosening after arthroplasty. Therefore, osteoclast is the target for treating these disease. At present, a lot of study on formation of osteoclast were reported, but the study on how to identify and degradation of bone tissue is not yet reported. Bone mineral are seen as important component of identifing osteoclast, and the research suggested that bone matrix is not the essential ingredients of activiting osteoclast, petri dish covered by vitronectin also can make osteoclast occure certain form of bone resorption, vitronectin plays an significant role in activiting osteoclast. Otherwise, the research found that swallowing and secretion of bone matrix degradation products is benefit for differentiation of osteoclast and maintain of function, and this may be therapeutic target for treatment of musculoskeletal disorders.
Animals ; Bone Matrix ; metabolism ; Bone Resorption ; Humans ; Osteoclasts ; physiology

Adolescent ; Adult ; China ; epidemiology ; Female ; Hepatitis B ; epidemiology ; prevention & control ; Hepatitis B Vaccines ; immunology ; Humans ; Incidence ; Male ; Vaccination

Objective To evaluate the effects of medical residency training program in postgraduate-year-one (PGY-1) residents at Peking Union Medical College (PUMC) Hospital.Methods PGY-I medical residents at PUMC Hospital were surveyed by a self-administered questionnaire after they completed their first year residency.Results Forty-nine residents who completed their first year residency training participated in the survey with a 100％ response rate.Before training,only a few had bedside (n =18) and on-call experiences (n =10).At the end of the one-year-training,all the residents (100％) considered themselves being improved to certain degrees,especially in clinical practice capability,and passed all the examinations.However,53.1％ and 8.2％ of all the residents agreed that they need to improve their abilities in teaching (n =26) and doctor-patient communication (n =4),respectively.All residents hoped to get further improved by taking part in various forms of teaching activities,including experience summary/sharing and basic skills training.During the first year,95.9％ of them participated in all teaching activities in medicine actively.Conclusions The tradition and current models of medical residency training program at PUMC Hospital had a significant impact on professional development of the 1st year resident physicians.It is critical to focus on basic skill training and multi-level teaching to improve residents' clinical competency.

Chronic disseminated intravascular coagulation (DIC) is a rare but devastating complication of aortic aneurysm (AA).This study investigated the clinical manifestations,laboratory findings,and treatment of patients with AA-associated chronic DIC (AA-DIC) and explored the mechanisms,duration,and therapeutic response of AA-DIC.We retrospectively reviewed the medical records of 235 AA patients admitted at the Peking Union Medical College Hospital between September 2009 and January 2015.The patients were classified as those with DIC (AA-DIC) and those without DIC (non-DIC).The AA-DIC group showed a significantly higher proportion of female patients and a significantly longer AA disease course than the non-DIC group did.The AA-DIC patients presented mural thrombi,dissecting aneurysms,a family history of AA,and diabetes significantly more frequently than the non-DIC patients did.Furthermore,multiple regression analyses revealed that sex,mural thrombus,aneurysm type,diabetes,and stent surgery are possible independent risk factors for AA-DIC patients.Fifty-two (22.1％) patients presented AA-DIC.Among these patients,43 had non-typical DIC and 9 had typical DIC;the mortality rate of the latter was 22.2％.The mean age of the patients with typical DIC was significantly higher than of that of patients with non-typical DIC.The non-typical DIC patients also presented abnormal coagulation disorders of varying degrees.Furthermore,heparin or low-molecular-weight heparin improved the clinical symptoms and laboratory parameters in patients with AA and typical DIC.Thus,chronic DIC should be considered in patients with AA.

OBJECTIVETo study the intervention of astragalus injection in the kidney injury of infants with congenital heart disease after cardiopulmonary bypass, thus providing a new method for protection of the kidney injury in them.

METHODSForty infants undergoing cardiac surgery with cardiopulmonary bypass were randomly assigned to the test group and the control group, twenty in each group. Astragalus Injection (at the dose of 2 mL/kg) was added in the perfusion fluid before giving to infants in the test group before bypass, while the normal saline of the same volume was added in the perfusion fluid before giving to infants in the control group (P < 0.01). The concentrations of serum tumor necrosis factor-alpha (TNF)-alpha, interleukin-6 (IL-6), cystatin C (CysC), and N-acetyl-beta-D-glucosaminidase (NAG) were detected with ELISA at the following time points, i.e., before bypass (T1), by the end of the surgery (T2), 2 h after surgery (T3), 6 h after surgery (T4), and 24 h after surgery (T5).

RESULTSThe serum CysC concentrations were not significantly higher after CPB (P > 0.05). The urinary NAG level increased significantly in the control group after surgery (P < 0.05), but no obvious increase of the urinary NAG level was found in the test group after surgery (P > 0.05). It was obviously lower than that of the control group (P < 0.05). After CPB serum TNF-alpha and IL-6 levels increased significantly in the control group (P < 0.05), while they were lower in the test group than in the control group (P < 0.01).

CONCLUSIONSCPB may result in the renal tubular injury in infants with congenital heart disease. The application of Astragalus Injection before the CPB plays a role in protecting renal tubular functions.

Acetylglucosaminidase ; urine ; Astragalus Plant ; Cardiopulmonary Bypass ; adverse effects ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Heart Defects, Congenital ; blood ; drug therapy ; urine ; Humans ; Infant ; Interleukin-10 ; blood ; Kidney Function Tests ; Male ; Phytotherapy ; Postoperative Period ; Tumor Necrosis Factor-alpha ; blood

BACKGROUND: Deep venous thrombosis and blood loss are common complications after total hip arthroplasty in elderly patients. Thus, it needs to pick valid treatments to reduce the harm in the clinical treatment. OBJECTIVE: To compare and observe the effects of rivaroxaban and low molecular heparin on preventing deep venous thrombosis and blood loss after total hip arthroplasty in elderly patients. METHODS: 196 cases in Department of Orthopedics, General Hospital of Shuicheng Mining Group of Guizhou Province treated by unilateral total hip arthroplasty were enrolled between January 2015 and January 2017. They were randomly divided into observation group (98 cases) and control group (98 cases). The observation group was treated with oral rivaroxaban 6 hours after surgery for 2 consecutive weeks. The control group was subcutaneously injected with low molecular heparin injection 6 hours after surgery for 5 consecutive weeks. The coagulation index was measured by automatic coagulation analyzer at preoperative, 1 day, 1 and 2 weeks after surgery. Deep venous thrombosis was evaluated in the two groups. The caliber sizes of superficial femoral vein and popliteal vein were measured by color Doppler ultrasound before surgery, 1, 2, 3 and 4 weeks after surgery. Blood loss was recorded in the two groups. RESULTS AND CONCLUSION: (1) The difference in serum D-dimer levels was statistically significant 1 and 2 weeks after surgery in both groups (P < 0.05). Serum D-dimer levels were lower in the observation group than in the control group. (2) The incidence of deep venous thrombosis was lower in the observation group than in the control group (P < 0.05). (3) The caliber size of superficial femoral vein and popliteal vein was significantly different 1, 2, 3 and 4 weeks after surgery in both groups (P < 0.05). The caliber size of superficial femoral vein and popliteal vein was larger in the observation group than in the control group. (4) Hidden blood loss and total blood loss were significantly different between the two groups (P < 0.05). The hidden blood loss and total blood loss were higher in the observation group than in the control group. (5) Results suggest that rivaroxaban has a positive meaning for prevention of deep venous thrombosis after total hip arthroplasty in elderly patients. However, hidden blood loss is worthy of attention.

Osteoclast,a huge coenocytes,originates from mononuclear macrophages or monocytic series hematopoietic precursor cell,plays an important role in the progree of bone resorption. Formation and abnormal activity of osteoclast may cause osteoprosis,rheumatoid arthritis and aseptic loosening after arthroplasty. Therefore,osteoclast is the target for treating these disease. At present,a lot of study on formation of osteoclast were reported,but the study on how to identify and degrada-tion of bone tissue is not yet reported. Bone mineral are seen as important component of identifing osteoclast ,and the research suggested that bone matrix is not the essential ingredients of activiting osteoclast ,petri dish covered by vitronectin also can make osteoclast occure certain form of bone resorption ,vitronectin plays an significant role in activiting osteoclast. Otherwise , the research found that swallowing and secretion of bone matrix degradation products is benefit for differentiation of osteoclast and maintain of function,and this may be therapeutic target for treatment of musculoskeletal disorders.

Objective To assess the value of internal medicine residency training program at Peking Union Medical College Hospital (PUMCH),and the feasibility of applying revised Milestones evaluation system.Methods Postgraduate-year-one to four (PGY-1 to PGY-4) residents in PUMCH finished the revised Milestones evaluation scales in September 2017.Residents' self-evaluation and faculty-evaluation scores were calculated.Statistical analysis was conducted on the data.Results A total of 207 residents were enrolled in this cross-sectional study.Both self and faculty scores showed an increasing trend in senior residents.PGY-1 residents were assessed during their first month of residency with scores of 4 points or higher,suggesting that residents have a high starting level.More strikingly,the mean score in PGY-4 was 7 points or higher,proving the career development of residency training program.There was no statistically significant difference between total self-and faculty-evaluation scores.Evaluation scores of learning ability and communication ability were lower in faculty group (t=-2.627,-4.279,all P＜0.05).The scores in graduate students were lower than those in standardized training residents.Conclusions The goal of national standardized residency training is to improve the quality of healthcare and residents' career development.The evaluation results would guide curriculum design and emphasize the importance and necessity of multi-level teaching.Self-evaluation contributes to the understanding of training objectives and personal cognition.

OBJECTIVETo analyze the failure factors treating femoral shaft fracture with interlocking intramedullary nailing, and to offer the measures for prevention.

METHODSFrom April 1999 to September 2002, among the 213 cases of femoral shaft fracture treated by interlocking intramedullary nailing, 18 were failure. The data of these cases were analyzed.

RESULTSThe failure cases were divided into 6 types: 3 cases with nail break-down, 7 with distal screw backing out, 3 with proximal screw backing out, 3 with fibrous ankylosis of knee, 2 with late infection. Failure relative factors were regarded to operation technique, incorrect rehabilitation choice of operative indication, quality of interlocking intramedullary nailing.

CONCLUSIONSAn appropriate indication should be chosen as using interlocking intramedullary nailing for femoral shaft fracture. The skills should be mastered well. The suitable materials should be chosen carefully. And the rehabilitation exercises should be directed properly. All these are important measures for prevention.

Adult ; Aged ; Bone Nails ; Female ; Femoral Fractures ; surgery ; Fracture Fixation, Intramedullary ; instrumentation ; methods ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Failure

OBJECTIVETo study kidney injury in infants with congenital heart disease (CHD) who underwent cardiac surgery with cardiopulmonary bypass (CPB).

METHODSForty CHD infants undergoing cardiac surgery with CPB from October 2009 to July 2010 were enrolled. The concentrations of serum tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), cystatin C (CysC) and urinary N-acetyl-beta-D-glucosaminidase (NAG) were detected using ELISA before bypass, at the end of surgery, and 2 hrs, 6 hrs and 24 hrs after surgery. Serum concentrations of creatinine (Cr) and urea nitrogen (BUN) were measured with conventional biochemistry technique before and after surgery.

RESULTSThe concentrations of serum Cr and BUN were normal before and after surgery. After CPB, the concentrations of serum TNF-α and IL-6 and urinary NAG increased significantly (P<0.05). Serum TNF-α was positively correlated with urinary NAG and serum CysC (r=0.195, 0.190, respectively; both P<0.05). Serum IL-6 was positively correlated with urinary NAG (r=0.278, P<0.01). The positive rate in kidney injury was detected by serum CysC and urinary NAG were significantly higher than by serum Cr or BUN (both P<0.01).

CONCLUSIONSCPB can cause acute kidney injury in infants, which may be correlated with the increase in the concentrations of serum TNF-α and IL-6. Serum CysC and urinary NAG may be used as sensitive markers for reflecting the changes of renal function.

Acetylglucosaminidase ; urine ; Acute Kidney Injury ; etiology ; Cardiopulmonary Bypass ; adverse effects ; Child ; Child, Preschool ; Cystatin C ; blood ; Female ; Heart Defects, Congenital ; surgery ; Humans ; Interleukin-6 ; blood ; Male ; Tumor Necrosis Factor-alpha ; blood