Objective:To analyze the value of the modified 5-factor frailty index in assessing postoperative complications and mortality in elderly hip fracture patients.Methods:In this retrospective study, clinical data were collected of hip fracture patients aged 60 years and above surgically treated at Beijing Luhe Hospital affiliated to Capital Medical University between January 2015 and December 2019.Patients' group assignment was based on whether the modified frailty index score was ≤1 or ≥2, and a post-surgery follow-up was conducted for survival at 30 days, 1 year, 2 years, and 4 years, which was analyzed by the Kaplan-Meier method.Multivariate Cox regression analysis was used to identify factors affecting death in elderly patients.Results:A total of 1 208 patients were included, with 890 in the group with the index score ≤1 and 318 in the group with the index score ≥2.There was no difference in mortality at 30 days(1.6% or 14/890 vs.1.9% or 6/318, P=0.707), 1-year(11.3% or 99/874 vs.11.6% or 36/310, P=0.917), 2-years(19.7% or 168/852 vs.24.3% or 73/300, P=0.099)and 4-years(44.0% or 238/541 vs.51.5% or 106/206, P=0.071). The incidence of postoperative complications in the group with the score ≥2 was higher(14.8% or 47/318 vs.9.7% or 86/890, P=0.012), including the incidence of stroke(6.3% or 20/318 vs.1.8% or 16/890, P<0.001)and the incidence of postoperative pneumonia(6.0% or 19/318 vs.3.1% or 28/890, P=0.029), and the differences were statistically significant.Multivariate Cox regression analysis showed that age, being female, the Charlson comorbidity index score and low hemoglobin at admission were risk factors for 1-year, 2-year and 4-year mortality post-surgery(all P<0.05), while the modified frailty index score had no correlation with postoperative mortality. Conclusions:A modified frailty index ≥2 is predictive of increased risk of postoperative pneumonia and stroke in patients with hip fractures, but is not correlated with the risk of postoperative mortality.

Rosai-Dorfman disease (RDD) is a benign self-limited disease characterized by lymphadenopathy and phagocytosis of lymphocytes by histiocytes. A case of intracranial-extracranial non communicating RDD was reported in this paper. The patient was admitted to Shiyan Taihe Hospital in May 2020 because of "the left top scalp tumor was found for 4 months, and the right lower limb was numb for more than half a month". The plain scan and enhanced scan of the patient′s head magnetic resonance imaging (MRI) showed that the disease focus of the left parietal bone was slightly uneven enhanced, its internal and external soft tissues were significantly enhanced, and the local internal and external soft tissues were significantly thickened irregularly, with the size of about 3.2 cm× 4.7 cm, and adjacent brain parenchyma was compressed. After resection of left top mass and intracranial mass, pathological results showed spindle cell proliferation with inflammatory reaction, and immunohistochemical staining results supported the diagnosis of RDD. The neurological function of the patient recovered to normal basically 7 months after operation, and no recurrence of the disease was found in the MRI examination of the head. The treatment effect was satisfactory.

METHODS: Rat BMSCs were isolated, cultured and identified. The time-dependent expressions of TSP-2 and Sox9 in BMSCs under a dynamic mechanical pressure of 0–120 kPa at 0.1 Hz for 1 h were tested by qPCR and Western blotting. The role of TSP-2 in chondrogenic differentiation of BMSCs under mechanical pressure was validated by using small interfering RNA. The impact of TSP-2 and mechanical pressure on chondrogenesis were detected and the downstream signaling molecules were explored using Western blotting. RESULTS: Mechanical pressure stimulation of 0–120 kPa for 1 h significantly upregulated the expression of TSP-2 in BMSCs. The expression of the chondrogenesis markers Sox9, Aggrecan, and Col-II were all upregulated under dynamic mechanical pressure or TSP-2 stimulation. Additional exogenous TSP-2 may potentiate the chondrogenic effect of mechanical stimulation. After knock down TSP-2, the upregulation of Sox9, Aggrecan and Col-II under mechanical pressure was inhibited. The NF-jB signaling pathway responded to both dynamic pressure and TSP-2 stimulation, and the cartilage-promoting effect was blocked by an NF-jB signaling inhibitor. CONCLUSION TSP-2 plays an essential role in the chondrogenic differentiation of BMSCs under mechanical pressure. NF-jB signaling is involved in the mechano-chemical coupling of TSP-2 and mechanical pressure for the chondrogenic differentiation of BMSCs.

The psychological health problems of the disabled elderly in China are closely related to physical diseases. Through combing the opening of psychological care services in the pilot cities of long-term care insurance in China, it is revealed that the current pilot cities do not pay much attention to psychological nursing services, the evaluation of psychological nursing needs is absent, and the implementation regulations of psychological nursing services are not perfect. Pilot cities should strengthen psychological care services for the disabled elderly; develop an evaluation system compatible with psychological care services; improve and implement psychological care services; developing information systems that match the needs of psychological care services to ensure the linkage of data in the transition between long-term care and medical needs; and the clients and service providers should cooperate to jointly promote the sustainable development of long-term care insurance psychological care services.

Objective:To review and analyze the clinical experience of children with aortic valve stenosis and/or insufficiency treated with autologous pulmonary valve for aortic valve replacement procedure(Ross operation) with ePTFE artificial valve for right ventricular outflow tract reconstruction.Methods:From 2015 to 2020, 8 cases of aortic stenosis and/or aortic insufficiency treated by Ross operation in our center were collected, with an age of 0.5-13.2 years old. 4 cases of aortic stenosis were diagnosed preoperatively, 3 cases of aortic stenosis with aortic insufficiency, and 1 case of infective endocarditis involving the aortic valve. The operation was carried out in three steps: Harvest autologous pulmonary valve; the diseased aortic valve was resected and autologous pulmonary valve was transplanted to the aorta by aortic root transplantation; the right ventricular outflow tract was reconstructed by a handmade ePTFE artificial flap blood vessel.Results:In 6 cases, the right ventricular outflow tract was reconstructed by hand-sewn ePTFE trileaflets, and artificial univalve in 2 cases, no death occurred during operation; all patients were cured and discharged. The patients were followed up for 1 to 36 months, with mean of(12.63±12.19) months. There was no long-term death or valvular complications. During follow-up echocardiography indicated 1 case of moderate aortic regurgitation, 1 case of mild-moderate regurgitation, and moderate regurgitation was found in 2 patients with artificial single pulmonary valve. For the remaining patients, they were mild aortic regurgitation, and a trivial or mild pulmonary artery regurgitation with hand-sewn three-leaflets ePTFE artificial vessel; All patients were followed up at the last time with a peak pressure of(6.63±3.46) mmHg(1 mmHg=0.133 kPa) across the aortic valve. The left ventricular outflow tract and aortic annulus shrank slightly after surgery(the diameter of one patient with Ross-Konno operation increased), but the annulus diameter increased with age. There was no need for further intervention.Conclusion:The Ross operation is safe for the treatment of aortic valve disease, it has good hemodynamic effect, and the autologous pulmonary artery has growth potential, especially suitable for children and young patients. Hand-sewn ePTFE with trileaflet vessels for reconstruction of right ventricular outflow tract performs well in anti-regurgitation function in the short term or may be used as a replacement material for the homograft/heterograft vessel, but longer follow-up and more cases are needed.

Objective:To investigate the expressions of miR-1254 and its target gene colony-stimulating factor-1 (CSF-1) in glioma tissues and glioma cells, and the effects of miR-1254 and CSF-1 on the proliferation and invasion of glioma cells.Methods:The clinicopathological specimens and paracancerous tissues of 30 patients with glioma who underwent surgical treatment in Shiyan Taihe Hospital of Hubei Province from April 2017 to May 2019 were collected. Quantitative real-time fluorescent PCR (qRT-PCR) was used to detect the expression levels of miR-1254 and CSF-1 mRNA in glioma tissues, paracancerous tissues, U87 cells and human brain normal glial cells HEB. The glioma U87 cells were divided into blank control group, mimic NC group, miR-1254 mimic group, and siRNA NC group, CSF-1 siRNA group. The expression levels of miR-1254 and CSF-1 mRNA were detected by qRT-PCR. The protein expression levels of CSF-1 in each group were detected by Western blotting. Dual luciferase reporter gene assay was used to verify the targeting relationship between miR-1254 and CSF-1 gene. CCK-8 method and Transwell invasion experiment were used to detect the proliferation and invasion ability of cells.Results:The relative expression of miR-1254 mRNA in glioma tissues was 0.44±0.16, that in adjacent tissues was 1.15±0.28, and there was a statistically significant difference ( t=12.914, P<0.001). The relative expression of CSF-1 mRNA in glioma tissues was 1.96±0.27, that in adjacent tissues was 0.98±0.22, and there was a statistically significant difference ( t=14.970, P<0.001). The relative expression of miR-1254 mRNA in glioma cells U87 was 0.39±0.11, that in human brain normal glial cells HEB was 1.03±0.02, and there was a statistically significant difference ( t=10.113, P=0.008). The relative expression of CSF-1 mRNA in glioma cell U87 was 1.02±0.03, that in human brain normal glial cell HEB was 0.32±0.13, and there was a statistically significant difference ( t=9.037, P=0.009). The expression levels of CSF-1 mRNA and protein decreased with the increase of miR-1254 after transfection of miR-1254. The results of dual luciferase reporter gene assay showed that compared with the mimic NC group (1.04±0.12), the fluorescence activity of CSF-1-WT cells in the miR-1254 mimic group (0.31±0.02) was significantly reduced ( t=10.430, P<0.001). The difference in cell proliferation ability among the blank control group (0.71±0.01), mimic NC group (0.68±0.04) and miR-1254 mimic group (0.35±0.01) was statistically significant 48 h after transfection ( F=252.651, P<0.001). The difference was statistically significant between miR-1254 mimic group and blank control group ( P<0.001), and the difference was also statistically significant between miR-1254 mimic group and mimic NC group( P<0.001). The difference in cell proliferation ability among the blank control group (0.71±0.01), siRNA NC group (0.68±0.04) and CSF-1 siRNA group (0.25±0.01) was statistically significant ( F=320.309, P<0.001). The difference was statistically significant between CSF-1 siRNA group and blank control group ( P<0.001), and the difference was also statistically significant between CSF-1 siRNA group and siRNA NC group ( P<0.001). Invasion experiments showed that the difference of transmembrane cells number among the blank control group (365±27), mimic NC group (388±24) and miR-1254 mimic group (83±15) was statistically significant ( F=173.915, P<0.001). The blank control group (365±27), siRNA NC group (404±32) and CSF-1 siRNA group (87±14) had statistically significant difference in the number of transmembrane cells ( F=141.294, P<0.001). Conclusion:The expressions of miR-1254 in glioma tissues and glioma cells U87 are significantly decreased, and the expressions of CSF-1 in glioma tissues and glioma cells U87 are significantly increased. Overexpression of miR-1254 may inhibit the proliferation and invasion of glioma U87 cells by reducing the expression of CSF-1 targetedly.

Objective To investigate the distribution and etiological characteristics of Yersinia en-terocolitica in Henan province between 2011 and 2017 and to analyze the homology among pathogenic strains. Methods A total of 12728 samples, including stool specimens from patients with diarrhea and domestic animals, flies, and smear specimens from raw and cooked meat products, were collected. Cold enrichment method was used to isolate Yersinia enterocolitica. The isolated strains were analyzed by biochemical identifi-cation, biotyping, serotyping and virulence gene detection with PCR. Pulsed-field gel electrophoresis ( PFGE) was performed for molecular typing of pathogenic strains. Results There were 390 strains of Yersinia enterocolitica isolated from the 12728 specimens with a detection rate of 3. 06％, including 13 hu-man strains and 377 animal strains. Most of the strains were isolated from pig and chicken feces and both ac-counted for 25. 13％ (98/390). The predominant biotype was 1A and the serotypes of the strains were main-ly O : 5 and O : 8. Results of the virulence gene analysis showed that 21 strains of O : 3 serotype were path-ogenic, including one human strain and 20 pig strains. After NotⅠdigestion, these pathogenic strains were divided into three band types with a band similarity of 94％-100％. Conclusions Yersinia enterocolitica ex-isted in both human population and many kinds of animals in Henan province. Pig was the main host of path-ogenic strains and there was a high homology among these strains.

Objective: In this study, we analyze the regulation mechanisms of the expression of ampD in AmpC β-lactamase and the regulation mechanism of β-N-acetylglucosaminidase (NagZ) in Yersinia enterocolitica. Methods: We construct the mutation strains of Yersinia enterocolitica AmpD (AmpD1-3) gene (ampD1-3), Low-Molecular-Mass Penicillin-Binding Proteins (LMM PBPs) gene (pbp4, pbp5a, pbp5b, pbp7), NagZ gene (nagZ), and ampR gene by deleting and complementing genes, and induce them by cefoxitin. We determined the activity of AmpC β-lactamase activity (U) of mutant strains (basal level and induce level) by using cephalothiophene hydrolysis method, the promoter activity of AmpC β-lactamase ((relative light unit (RLU)) was detected by the luxCDABEreporter system, and the activity of β-N-acetylglucosaminidase (nmol/L) was determined by by using 4-nitrophenyl N-acetyl-β-D-glucosaminide as the chromogenic substrate. Results: AmpD1 (Basal level: (3.29±1.58) U; Induced level: (4.08±1.75) U) was the most potent one. The YEΔ5b, YEΔ4Δ5b, YEΔ5aΔ5b and YEΔ5bΔ7 of ampC promoter activity increase significantly, whichYEΔ4Δ5b is the highest one (Basal level: (106 903.16±61 910.61) RLU; Induced level: (205 427.45±45 352.17) RLU). The YEΔ4Δ5bΔ7 of ampC promoter activity is the highest among triple mutant strain (Basal level: (304 108.04±99 274.53) RLU; Induced level: (531 440.21±68 891.02) RLU). Quadruple deletion strain YEΔ4Δ5aΔ5bΔ7 have the highest ampC promoter activity (Basal level: (1 013 810.99±260 955.96) RLU; Induced level: (1 230 214.59±205 526.79) RLU). After the deletion of nagZ gene, there is no significant change in β-lactamase activity of YEΔD1D2D3ΔZ, while β-lactamase activity of YEΔ4Δ5aΔ5bΔ7ΔZ shows a significant decrease (Basal level: (0.30±0.20) U; Induced level: (0.29±0.21) U), which basically drops to the wild strain level. Conclusion This is the first report of ampC multi-step upregulation mechanism driven by three AmpD homologues in Yersinia enterocolitica. The AmpC regulation mode with the function of single PBP4, PBP5a or PBP7 is relatively low, which work in coordination with PBP5b. Yersinia enterocolitica have both NagZ-depend and NagZ-independent mechanisms for β-lactamase expression.

Objective: To analyze the etiological characteristics of infectious diarrhea among people under 5 years old in Dongcheng District, Beijing. Methods: The age, time of infection, clinical symptoms and laboratory test results of the cases who didn't used antibiotics within 3 days in the second maternal and child health care hospital were collected from 2012 to 2015, through the information management system of infectious disease monitoring technology platform. To compare the detection rate of virus and bacteria in children with different sex, time and age,and the difference of clinical characteristics between virus detection group and bacteria detection group by chi square test. Results: 1 977 cases of infectious diarrhea were collected, the median of the month age (P₂₅, P₇₅) was 14.19 (8.31, 23.15) months. The virus detection rate was 34.3% (679 cases); the bacterial detection rate was 14.6% (288 cases). The difference of virus detection rate in children with different months was statistically significant (χ²=72.38, P<0.001), the virus detection rate of 24-60 months (40.9% (188/460)) was the hightest, and the detection rate of 0-5 months (15.3% (48/314)) was the lowest. The difference of bacteria detection rate was also statistically significant (χ²=32.67, P<0.001), and the detection rate of 12-17 months (19.0% (81/426)) was the highest, the detection rate of 0-5 months (6.7% (21/314)) was the lowest. The proportion of vomit and water sample in the virus detection group was 22.2% (136 cases) and 73.3% (449 cases), respectively, which were higher than those in bacteria detection group (8.1% (18 cases) and 57.2% (127 cases)), the difference was statistically significant (χ² values were 125.92 and 19.60; P values were both<0.001); the proportion of mucus stool and fever was 0.8% (5 cases) and 14.0% (86 cases), respectively, which were lower than those in bacterial detection group (4.1% (9 cases) and 18.5% (41 cases)), and the difference was statistically significant (χ² values were 8.50 and 23.01; P values were 0.004 and <0.001). Conclusion The virus detection rate of infantile infective diarrhea is higher than that of bacteria in Dongcheng district of Beijing, and the clinical characteristics are significantly different.

Objective To investigate the clinical significance of serum chemokine and hs-CRP levels in patients with type 2 diabetes mellitus with asymptomatic subclinical atherosclerosis.Methods The clinicpathological and follow-up data of 55 patients with Type 2 diabetic from 2012.1 to 2015.12 were collected and reviewed.At the same time,55 patients with non type 2 diabetes were taken as control.Determination of FPG,HbA1c,HDL-C,TC,TG,LDL-C,INS and other indicators by automatic biochemical analyzer,the application of color Doppler ultrasound equipment measurement C-IMT.Correlation using Pearson correlation analysis,risk factor analysis using multiple linear stepwise regression analysis.Results Compared with the control group,the two groups in BMI,WHR,systolic blood pressure,ankle brachial index,FPG,HbA1c,HDL-C,hsCRP,C-IMT,HOMA2-IR and serum chemokines were significantly different,with statistical significance (t =-6.31 ～5.79,P≤0.01 ～ 0.03).In 110 cases of experimental group and control group,the levels of serum chemokines were positively correlated with WHR,HOMA2-IR,C-IMT and hs-CRP (r=0.24～0.29,P=0.01～0.04).C-IMT and age,WHR,systolic blood pressure,diastolic blood pressure,FPG,HbA1c,diabetes duration,hs-CRP was positively correlated (r=0.15 ～0.68,P≤0.01～0.0.04),and the ankle brachial index was negatively correlated (r=-0.32～0.29,P≤0.01).Hs-CRP was positively correlated with HbA1c,HOMA2 IR,serum chemokine,C-IMT (r=0.25～0.32,P≤0.01～0.04),and was negatively correlated with TC and HDL-C (r=-0.27～-0.25,P all 0.02).Cox proportional hazard regression model for multivariate analysis showed that high serum chemokines,hs-CRP and HbA1c were the risk factors of C-IMT (β=0.026～0.658,SE=0.015～0.033,t=2.532～3.421,P≤0.01～0.04).Conclusion High serum levels of chemokines and hs-CRP are the risk factors of C-IMT,and it has important clinical significance for the diagnosis of asymptomatic subclinical atherosclerosis in patients with type 2 diabetes mellitus.