Objective To evaluate the effect of preoperative intravenous drip of tranexamic acid(TXA) on perioperative bleeding in proximal femoral nail anti-rotation(PFNA) operation of elderly intertrochanteric fracture.Methods A total of 115 elderly patient with intertrochanteric fracture undergoing PFNA internal fixation were selected and divided into the treatment group(58 cases) and control group (57 cases).The treatment group was intravenously dripped with 20mg/kg TXA before operation,while the control group had no special treatment.Hemoglobin (Hb) and hematocrit(Hct) were recorded before operation and on postoperative 1,3 d.The total amounts of perioperative blood loss were calculated by using the Gross equation and Nadler equation.The blood transfusion rate and thromboembolic complications occurrence situation in the two groups were performed the statistics.Results The total amounts of perioperative blood loss were (872.21±312.53) mL in the treatment group and (1 162.41±368.64) mL in the control group,the difference was statistically significant(P<0.01).The blood transfusion rate was 3.45% in the treatment group and 17.5% in the control group,the difference was statistically significant (P<0.01).No deep vein thrombosis and pulmonary embolism occurred in both groups.The occurrence rate of venous thrombus was 5.1% in the treatment group and 7.0% in the control group without statistical difference(P>0.05).Conclusion Preoperatively intravenous drip of 20mg/kg TXA in PFNA internal fixation of elderly intertrochanteric fracture can effectively decrease perioperative blood loss without increasing the risk of thrombus formation.

Objective:To observe the expression of miR-30c-5p and Toll-like receptor 4(TLR4) in colon cancer tissues and cells, and to explore their relationship with clinicopathological features.Methods:As a prospective study, 30 cases of colon cancer surgical specimens and matched normal tissue samples were selected from the Cancer Hospital of China Medical University from May 2016 to may 2017.The expression of miR-30c-5p mRNA was detected by quantitative real-time polymerase chain reaction(qRT-PCR), and the expression of TLR4 Protein was detected by western blot (WC). The expression differences of miR-30c-5p mRNA and TLR4 protein in different TNM stages, differentiation degrees and diameters were observed.The correlation between the expression of miR-30c-5p and TLR4 Protein was analyzed by Pearson Rank method.Results:The expression of miR-30c-5p was lower in colon cancer tissues(0.311±0.147) than in adjacent normal colon tissues(0.881±0.266)( t=10.613, P<0.001). TLR4 protein was higher in colon cancer tissues(0.729±0.274) than in adjacent normal colon tissues(0.361±0.168)( t=6.310, P<0.001). Expression of miR-30c-5p was lower in colon cancer cell lines(0.394±0.045, 0.435±0.098, 0.533±0.092, 0.272±0.069) than in normal colon epithelial cell line(1.371±0.101)( t value were 6.744, 6.432, 6.865 and 6.201, respectively; P<0.001). The expression of TLR4 protein was higher in colon cancer cell lines(1.108±0.169, 1.035±0.177, 1.114±0.253, 1.116±0.157) than in normal colon epithelial tissues(0.358±0.094)( t value were 5.789, 4.799, 5.311 and 5.292, respectively; P<0.001). Pearson rank correlation showed that miR-30c-5p was negatively correlated with TLR4 protein expression( r=-0.487, 95% CI: -0.721--0.154, P<0.01). MiR-30c-5p was decreased with TNM stage increasing( F=31.406, P<0.001), pathological differentiation degree decreasing( F=9.960, P<0.001), tumor diameter increasing( F=10.267, P<0.001). TLR4 was increasing with TNM stage increasing( F=37.634, P<0.001). TLR4 increased with the decrease of tumor differentiation( F=38.027.35, P<0.001). TLR4 increased with tumor diameter ( F=20.717, P<0.001). Conclusion:The low expression of mir-30c-5p and high expression of TLR4 in colon cancer were correlated with TNM stage and tumor volume.

Objective To evaluate 99Tcm-MIBI imaging in patients with hyperparathyroidism and its correlation with serum intact PTH level. Methods Seventy patients with suspicious hyperparathyroidism underwent 99Tcm-MIBI imaging and serum intact PTH measurement. Abnormal increased uptake lesion appeared at early phase and even more clearly at delayed phase was considered as the positive by 99Tcm-MIBI imaging. A cut-off value of PTH ＞ 88 ng/L was taken as the criteria for hyperparathyroidism diagnosis. The diagnostic efficacy of 99Tcm-MIBI imaging combined with serum PTH measurement was assessed according to post-surgical histopathology or clinical follow-up. For those operated patients, Pearson correlation coefficient between serum PTH and the gland volume was calculated. Results Hyperparathyroidism was confirmed in 38 patients by histopathology (n = 36) or follow-up (n = 2). The overall diagnostic accuracy of 99Tcm-MIBI imaging was 90.0% (63/70), in which the accuracy was 80.0% (12/15) for patients with normal serum PTH and 92.7% (51/55) for those with elevated serum PTH. False positive 99Tcm-MIBI imaging were found in 3 patients with normal serum PTH. The diagnostic accuracy of abnormally high serum PTH combined with 99Tcm-MIBI imaging was 94.3% (66/70). There was a positive correlation between serum PTH level and the volume of pathologic parathyroid glands (r = 0.782, P ＜ 0.001 ). Conclusions Serum PTH measurement may help to improve the diagnostic accuracy of 99Tcm-MIBI imaging in patients with hyperparathyroidism.

Objective To observe the immunostaining of endothelin-1(ET-1) and von Willebrand factor(vWF) in pulmonary vascular of ventricular septal defect(VSD) with pulmonary hypertension(PH),and the possible roles of ET-1 and vWF in the development of PH and remodeling in pulmonary artery.Methods VSD with non-PH were choosed as control group,20 cases with VSD with PH were divided into Ⅰgroup and Ⅱgroup according to mean pulmonary artery pressure. The specimens from middle lobe of right lung was obtained and stained by immunohistochemical technique.The degree of immunoreaction was measured with light density.Results The light density of ET-1 and vWF in small pulmonary arteries had significant statistical difference between every group,and Ⅱgroup was higher than those of Ⅰgroup,but no difference in small pulmonary veins.In every group,the light density of ET-1 and vWF had significant difference between small pulmonary arteries and pulmonary veins.There were statistical correlation among mean pulmonary pressure,VSD/A,ET-1 and vWF.Conclusions ET-1 and vWF are concerned with the development of PH and mediate pulmonary vascular remodeling.The data of small pulmonary veins suggest that the main origin of ET-1 in pulmonary tissue is small pulmonary artery.

Objective To investigate the stimulative effects of CollagenⅠon the increased adhesion of rabbit bone marrow stromal cells (BMSCs), cytoskeleton actin organization and intracellular free Ca~(2+) concentration. Methods The third generation BMSCs isolated from mature rabbits were cultured at different initial concentrations on cover-slice coated by collagenⅠin RPMI1640 containing 10% fetal calf serum, and cultured on the same kind of cover-slice untreated with collagenⅠas control. The cells adhesive behavior at different times was assessed. Cellular actin organization was described as either typeⅠor typeⅡcells. In general, typeⅠcells are round and represent a preliminary stage of actin assembly, while typeⅡcells are elongated with organized actin fiber network. At the same time intracellular free Ca~(2+) concentration was measured by using calcium fluorescent probe Fluo-3/AM and laser confocal microscope. Results We found more typeⅡcells in BMSCs cultured with collagen typeⅠsix hours after culture than in the control group. At 12 hours 89% of the BMSCs were typeⅡcells, while only 55% were typeⅡcells in the control group. This indicated active cellular actin organization after being modified by collagen typeⅠ. We also found that the BMSCs cultured with collagen typeⅠincreased intracellular free Ca~(2+) concentration in monolayer culture. Conclusions CollagenⅠis effective in promoting the cellular adhesion, which suggests that a kind of internal relationship or cross-talk may exist between cellular actin organization, intracellular free Ca~(2+) concentration and cell adhesion. Further study, however, is needed.

Objective To evaluate the correlation between environmental estrogen and incidence of hypospadias.Methods Medline,Web of Science (ISI),EMBASE,the Cochrane Library,EBSCO Host,Elsevier Science Direct,Chinese Biomedicine (CBMdisc),and China National Knowledge Infrastructure(CNKI) databases,had been searched and secondary manual search for library was also conducted.Case-control and cohort studies,reporting odds ratio (OR) or relative risk (RR) of environmental estrogen exposure before or during pregnancy and their 95％ confidence interval (CI) for the occurrence of hypospadias and published from January 1990 to July 2011,were included.Review Manager 5.2 software were used for data analysis.Results Altogether,18 studies were finally recruited including two cohort studies (only diethylstilbestrol was involved) and 16 case-control studies.While the 16 case-control studies showed significant heterogeneity (P=0.002),and the pooled OR (95％CI) calculated by random effect model was 1.35(1.08-1.70).For the three case-control studies on diethylstilbestrol exposured during pregnancy,no heterogeneity was found (P=0.250) and the pooled OR (95％CI) with fixed effect model was 2.12(1.18-3.80).For the three case-control studies on oral contraceptives and the other three on exposure to dichlorodiphenyltrichloroethane (DDT) or DDT-derived materials,the pooled OR (95％CI) were 1.01 (0.81-1.27) and 1.04 (0.61-1.74) respectively with fixed effect model as no heterogeneity was found (P=0.450 and 0.980).There were two case-control studies on phytoestrogens and two on phthalates,and both showed significant heterogeneity (both P=0.020).The pooled OR (95％CI) with random effect model were 1.88 (0.52-6.79) and 1.68 (0.47-5.94),respectively.The pooled OR (95％CI) of case-control studies in Europe (11 studies) and North America(five studies) were 1.51 (1.13-2.03) and 1.13(0.86 1.53) with the random and fixed effect model,separately (heterogeneity test P values were 0.002 and 0.110,respectively).Among those 11 studies in Europe,there were three from Holland and three from England with the pooled OR (95％CI) of 1.47(0.90-2.38) and 2.14(0.74-6.18) with fixed and random effect model (heterogeneity test P values were 0.400 and 0.000),respectively.For the two cohort studies,the pooled RR (95％CI) was 6.19 (0.39-99.55) (heterogeneity test P value was 0.002).Analysis of sensitivity and bias of publication found that publications with positive results were more than those with negative results.Conclusions Environmental estrogens may have effect on hypospadias with geographical differences.Maternal exposure to diethylstilbestrol during pregnancy increases the risk of hypospadias in the offspring.

Objective To report 6 cases of hydroa vacciniforme-like cutaneous lymphoma,and to inves- tigate the relationship between this disorder and Epstein-Barr virus(EBV)infection.Methods Pathological and immunohistochemical examinations were performed in the biopsy specimens obtained from all 6 patients. Skin lesions were subjected to EBV encoded RNA(EBER)detection by in situ hybridization.Serological assay and quantification of EBV DNA were performed.Results All the 6 patients had recurrent papules, papulovesicles,necrosis and variola-like scar with chronic intermittent fever;four of the patients also presented with edema of the face,hands and feet.Pathologically,there were multilocular vesicles in the epidermis,and large numbers of infiltrating lymphocytes through the dermis.The cells were atypical with mitotic figures. Immunohistochemical staining of the lesions of 4 patients showed large quantities of cells expressing CD56, scattered cells expressing CD3 and CD45RO,and cells expressing grazyme B and T cell intracellular antigen-1 (TIA-1);a diagnosis of hydroa vacciniforme-like cutaneous NK/T lymphoma was made in these 4 cases. In the lesions of another 2 patients,the cells expressing CD3 and CD45RO,but not CD56,were observed; the diagnosis of hydroa vacciniforme-like cutaneous T-cell lymphoma was made in them.EBER was detected in the tumor cells of all the 6 patients.The IgG titers of anti-Epstein-Barr viral capsid antigen increased in all patients(1:5120 in 2 cases,1:2560 in 2 cases,1:1280 in 2 cases).The copies of EBV DNA were increased in the peripheral blood of both the two detected cases.A chronic active EBV infection was confirmed in all patients.Conclusions Hydroa vacciniforme-like cutaneous lymphoma is clinically characterized by edema of face,hands and feet,vesicular eruptions and variola like scars;histologically,it is characterized by infiltrates of atypical cells consistent with lymphoma,and necrosis in the center of vessels.NK/T is the primary immunophenotype of this disease.There is a close association between chronic active EBV infection and hydroa vacciniforme-like cutaneous lymphoma.

AIM:To observe the influence of erythropoietin (EPO) on eryptosis and production of reactive oxygen species (ROS) in erythrocytes under stimulation of hydrogen peroxide (H2O2),.and to explore its related mecha-nism. METHODS:The erythrocyte suspension (1%) was cultured in vitro and divided into 3 groups:control group (C group,the culture medium was PBS),H2O2group (H group,the culture medium was PBS containing H2O2at final con-centration of 100 μmol/L) and EPO group (E group,the culture medium was PBS containing H2O2at final concentration of 100 μmol/L and EPO at final concentration of 2×104U/L). The erythrocytes were collected at 24 h and 60 h. The eryptosis was detected by flow cytometry with Annexin V staining. The production of ROS and intracellular calcium ion con-centration (Ca2+]i) were also analyzed by flow cytometry. RESULTS:The eryptosis in C group was increased as the in-cubating time extended. The eryptosis in H group was higher than that in C group (P<0.01),while that in E group was lower than that in H group(P<0.01). Meanwhile,ROS production andCa2+]iwere higher in H group than those in C group (P<0.01), but those were lower in E group than those in H group (P<0.05 or P<0.01). CONCLUSION:EPO inhibits eryptosis induced by H2O2and its mechanism may be related to antioxidant effect and change of Ca2+]i.

Objective To evaluate the methods and consequences of surgical technique in the treatment of Stanford A aortic dissection.Methods 108 patients with type Standford A aortic dissection underwent surgery in our study,including urgent surgery in 53 and selective surgery in 55.The operation was performed under deep hypothennic circulatory arrest (DHCA) in 85 cases.Surgical procedures included ascending and semi arch replacement or total arch replacement (some cases combined with stented graft implanted into the descending aorta),"elephant trunk" procedure.Concomitant procedures included repair of intimal tear in arch or descending aorta,Bentall procedure,aortic valve replacement,Cabrol or modified Cabrol procedure,aortic valvuloplasty,mitral valvuloplasty or mitral valve replacement,tricuspid valvuloplasty and CABG.Results In-hospital mortality was 6.5% (7 of 108 patients).The mor- tality was 7.5% (4 of 53 patients) in urgent surgery group and in elective surgery group was 5.4% (3 of 55 patients).Ninety six percent survived patients were followed up for 1 month to 13.3 years [mean (3.2?1.3) years] and 2 deaths occurred during the fel- low-up period.3 patients underwent re-operatian.Conclusion The choice of surgical procedures depend on the location of intimal tear for Stanford A aortic dissection.The better operative effects can be expected with proper surgical indication,perfecting surgical technique,and enhancing postoperative treatment.