Objective To investigate the role of ERCP in geriatric population (≥70 yr) with biliary obstruction.Methods 218 geriatric patients (≥70 yr) and 189 non-geriatric ones ( ＜70 yr) admitted during 2001.1～2007.12 who had undergone biliary drainage by ERCP were retrospectively studied.Results The mean ages in geriatric and non-geriatric group were 79±9 and 56±7 yr,respectively.The success rates of biliary drainage were 96.8% (211/218) and 97.4% (184/189) in geriatric and non-geriatric group,respectively.The procedure time of ERCP was (55±30)rain and (58±34)min in geriatric and non-geriatric group,respectively.The complication rates were 16.1% (35/218) and 13.8% (26/189),respectively.The mortality rates were 1.83% ( 4/218 ) and 1.06% ( 2/189 ),respectively.There were no statistically significant differences between the two groups.However,the re-intervention rates were 16.1% (35/218) in geriatric group,which was significantly higher than that of 5.8% (11/189) in non-geriatric group.Conclusions ERCP was a less invasive,safe and effective treatment option for geriatric patients with bile duct obstruction.

Objective To study the effects of marrow mesenchymal stem cells on heart functions and ventricular remodeling after myocardial infarction in rats. Methods Myocardial infarction model was established by ligation of the left anterior descending coronary artery (LAD) in adult SD rats. 4 and 8 weeks after MMSCs implantation,hemodynamic evaluations,left ventricular weight/body weight ratio and heart weight/body weight ratio were determined. HE staining was performed for counting microvasculars and Van Gieson staining was used for measurements and calculation of the myocardial fibrillar collagen. Then we investigated the migration and evolution of MSCs in vivo by fluorescent microscope. Results HR was significantly decreased in transplantation MMSCs group. Eight weeks after transplantation,body weight in transplantation MMSCs group reached that of control group. At the same time,SBP,DBP and MBP were significantly increased in transplantation MMSCs group. HR was significantly decreased in transplantation MMSCs group. Secondly,left ventricular weight/body weight ratio and heart weight/bodyweight ratio were significantly decreased 4 weeks after transplantation MMSCs. Then the ratio was significantly decreased 8 weeks after transplantation MMSCs. Thirdly density of microvasculars was increased at the boundary of infarction site in the animals transplanted MMSCs. Finally,total volume of the myocardial fibrillar collagen was reduced in the MMSCs treated groups after MI. Conclusion Transplanting MMSCs can improve the ventricular remodeling and heart functions in acute MI rat models.

Objective To study the effects of marrow mesenchymal stem cells on heart functions and ventricular remodeling after myocardial infarction in rats. Methods Myocardial infarction model was established by ligation of the left anterior descending coronary artery (LAD) in adult SD rats. 4 and 8 weeks after MMSCs implantation, he-modynamic evaluations, left ventricular weight/body weight ratio and heart weight/body weight ratio were determined. HE staining was performed for counting microvasculars and Van Gieson staining was used for measurements and calculation of the myocardial fibrillar collagen. Then we investigated the migration and evolution of MSCs in vivo by fluorescent microscope. Results HR was significantly decreased in transplantation MMSCs group. Eight weeks after transplantation, body weight in transplantation MMSCs group reached that of control group. At the same time, SBP, DBP and MBP were significantly increased in transplantation MMSCs group. HR was significantly decreased in transplantation MMSCs group. Secondly, left ventricular weight/body weight ratio and heart weight/body weight ratio were significantly decreased 4 weeks after transplantation MMSCs. Then the ratio was significantly decreased 8 weeks after transplantation MMSCs. Thirdly density of microvasculars was increased at the boundary of infarction site in the animals transplanted MMSCs. Finally, total volume of the myocardial fibrillar collagen was reduced in the MMSCs treated groups after MI. Conclusion Transplanting MMSCs can improve the ventricular remodeling and heart functions in acute MI rat models.

Commonly, the interbacterial transfer of circular plasmids is initiated by nicking at an internal sequence, oriT, followed by transferring one strand as single-stranded DNA through a type Ⅳ secretion channel on cell membrane. In contrast, Streptomyces conjugative linear plasmids, containing a free 3'-end but a protein-capped 5'-end, can potentially undergo cell-to-cell transfer by transfer of non-nicked DNA. It was reported that circular derivatives of the Streptomyces lividans linear plasmid SLP2, as well as the parental linear plasmid itself can transfer efficiently. And the genetic requirements for such transfer was described. Efficient transfer of plasmid requires six co-transcribed SLP2 genes, encoding a Tra-like DNA translocase, cell wall hydrolase, two cell membrane proteins that interact with an ATP binding protein, and a protein of unknown function. Reduced transfer efficiency of plasmid from SalⅠ R-/M-to Sal Ⅰ R/M hosts argues that transfer of both the circular and linear forms of the plasmid involves double-stranded DNA. These results suggest that conjugal transfer occurs by a similar mechanism for SLP2-derived linear and circular plasmids, and cellular membrane/wall functions in the transfer process.

Objective:To construct a new thrombus risk assessment model and evaluate its predictive ability for venous thromboembolism(VTE)in the patients with malignant tumors,and to provide the basis for the early predition of the malignant tumor patients with high risk for VTE.Methods:A total of 128 untreated malignant tumor patients were included,of which 40 were diagnosed with VTE within 2 months of malignant tumor diagnosis and categorized as VTE group.A total of 88 patients who did not develop VTE were categorized as non-VTE group.The clinical risk factors and laboratory indicators of the patients in two groups were compared and analyzed;the types of thrombotic events of the patients were analyzed;the diagnostic values of thrombin-antithrombin-complex(TAT),α2-plasmin inhibitor-plasmin complex(PIC),D-dimer(D-dimer),and fibrin degradation products(FDP)in malignant tumors complicated by VTE were assessed using receiver operating characteristic(ROC)curve analysis;Multivariate Logistic regression analysis was used to analyze the correlations of the clinical risk factors and biomarkers with the malignant tumors complicated with VTE.A new thrombus risk assessment model was constructed,consisting of TAT≥0.70 μg·L-1,poor differentiation,and cardiovascular risk factors.The predictive probability of the model for malignant tumors complicated by VTE was evaluated based on the significance,goodness of fit,calibration curve,and C value of the model.The clinical application value of the new thrombus risk assessment model,COMPASS-CAT risk score(CRS),and Khorana risk score(KRS)in assessing malignant tumor patients complicated by VTE was compared using the C value and decision curve analysis(DCA).Results:The plasma levels of TAT(P＜0.001),PIC(P＜0.001),D-dimer(P＜0.05),and FDP(P＜0.01)of the patients in VTE group were higher than those in non-VTE group.Compared with the patients without cardiovascular risk factors,poor differentiation,and lymphatic metastasis,the malignant tumor patients with cardiovascular risk factors(P＜0.001),poor differentiation(P＜0.001),and lymphatic metastasis(P＜0.05)were more likely to develop VTE.Most VTE events(65％)were isolated deep vein thromboembolism(DVT).The ROC curve analysis showed that the area under the curve(AUC),sensitivity,and specificity of TAT and PIC were higher than those of D-dimer and FDP.TAT≥0.70 μg·L-1(P＜0.05),poor differentiation(P＜0.01),and cardiovascular risk factors(P＜0.01)were the independent risk factors for VTE in the malignant tumor patients.A new thrombus risk assessment model consisting of TAT≥0.70 μg·L-1,poor differentiation,and cardiovascular risk factors was constructed.The new risk assessment model had a high goodness of fit(P=0.805)and good predictive ability during internal validation(x2=75.266,P＜0.001).The ROC curve analysis results showed that the C values for the new thrombus risk prediction model,CRS,and KRS were 0.908,0.676,and 0.541,respectively.The DCA curve analysis results showed that the new thrombus risk assessment model had a higher net benefit rate compared with CRS and KRS.Conclusion:TAT and PIC have greater diagnostic efficiency than D-dimer in the early prediction of the malignant tumor patients with high-risk VTE.For the patients included in this study,the new thrombus risk assessment model,constructed from TAT≥0.70 μg·L-1,poor differentiation,and cardiovascular risk factors,has superior diagnostic efficiency and clinical predictive value compared with CRS and KRS.

According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.

Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.

Ankylosing spondylitis (AS) combined with lower cervical fracture is often categorized into unstable fracture, with a high incidence of neurological injury and a high rate of disability and morbidity. As factors such as shoulder occlusion may affect the accuracy of X-ray imaging diagnosis, it is often easily misdiagnosed at the primary diagnosis. Non-operative treatment has complications such as bone nonunion and the possibility of secondary neurological damage, while the timing, access and choice of surgical treatment are still controversial. Currently, there are no clinical practice guidelines for the treatment of AS combined with lower cervical fracture with or without dislocation. To this end, the Spinal Trauma Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate Clinical guidelines for the treatment of ankylosing spondylitis combined with lower cervical fracture in adults ( version 2024) in accordance with the principles of evidence-based medicine, scientificity and practicality, in which 11 recommendations were put forward in terms of the diagnosis, imaging evaluation, typing and treatment, etc, to provide guidance for the diagnosis and treatment of AS combined with lower cervical fracture.