BACKGROUND:Prosthesis restricted selection,soft tissue release,patellar trajectory recovery,and bone defect reconstruction were need to be optimized in total knee arthroplasty for moderate and severe valgus knee.The medial parapatellar approach has disadvantages in the treatment of valgus knee,such as aggravating the medial soft tissue relaxation.In recent years,it has been found that the lateral parapatellar approach has advantages in the treatment of valgus knee,such as exposure and release. OBJECTIVE:To observe the efficacy of the lateral and medial parapatellar approach in total knee arthroplasty for moderate and severe valgus knee,and to explore a more suitable surgical approach for moderate and severe valgus knee. METHODS:Totally 56 patients with moderate and severe valgus knee underwent total knee arthroplasty and would take turns performing surgery through the medial and lateral parapatellar approach according to the order of admission.The lateral group(n=28)underwent total knee arthroplasty through lateral parapatellar approach,and the medial group(n=28)through medial parapatellar approach.Posterior stablized knee prosthesis was used in all patients.The restricted types of prosthesis,thickness of polyethylene,operation time,amount of blood loss,femoro-tibia angle,patellar tilt angle,range of motion,Hospital for Special Surgery score,Western Ontario and McMaster Universities Arthritis Index(WOMAC)score,and complications were collected as observation indexes for statistical analysis. RESULTS AND CONCLUSION:(1)The utilization rate of condyle-restricted prosthesis in the lateral group was significantly lower than that in the medial group.The average thickness of polyethylene liner was lower,and the operation time was shorter in the lateral group compared with the medial group.There were significant differences between the two groups(P<0.05),and there was no significant difference in the amount of surgical bleeding.(2)56 patients were followed up for an average of 2-5 years.There were no signs of prosthesis loosening or bone resorption in all patients.The average patellar tilt angle and femoral tibial angle of the lateral group were lower than those of the medial group,and the average Hospital for Special Surgery score and WOMAC score of the lateral group were higher than those of the medial group,with significant differences(P<0.05).There was no significant difference in the range of motion of the knees between the two groups.(3)Incision fat liquefaction and calf intermuscular venous thrombosis occurred in one case in each group.No infection,poor incision healing,incisional hematoma,prosthesis dislocation,iatrogenic nerve injury,ectopic ossification,or periprosthesis fracture occurred during follow-up.(4)In conclusion,the treatment of moderate and severe valgus knee by lateral parapatellar approach can better protect the tension of the medial soft tissue of the knee,use less condylar restrictive prostheses,and have a more friendly patellar trajectory and higher postoperative function score.

Nuclear receptor corepressor (NCoR1) interacts with various nuclear receptors and regulates the anabolism and catabolism of lipids. An imbalance in lipid/energy homeostasis is also an important factor in obesity and metabolic syndrome development. In this study, we found that the deletion of NCoR1 in intestinal epithelial cells (IECs) mainly activated the nuclear receptor PPARα and attenuated metabolic syndrome by stimulating thermogenesis. The increase in brown adipose tissue thermogenesis was mediated by gut-derived tricarboxylic acid cycle intermediate succinate, whose production was significantly enhanced by PPARα activation in the fed state. Additionally, NCoR1 deletion derepressed intestinal LXR, increased cholesterol excretion, and impaired duodenal lipid absorption by decreasing bile acid hydrophobicity, thereby reversing the possible negative effects of intestinal PPARα activation. Therefore, the simultaneous regulatory effect of intestinal NCoR1 on both lipid intake and energy expenditure strongly suggests that it is a promising target for developing metabolic syndrome treatment.

Objective:To investigate the physical and mental health of trainees receiving standardized residency training of anesthesiology in four large teaching hospitals in Wuhan, China, as well as related risk factors.Methods:The trainees who received standardized residency training of anesthesiology in four large general teaching hospitals in Wuhan were selected as subjects, and Symptom Checklist-90 (SCL-90) and Eysenck Personality Questionnaire were used to investigate mental health and personality state. SPSS 22.0 was used to perform the independent samples t-test, a one-way analysis of variance, and the chi-square test, and Logistic regression was used to analyze the influencing factors for SCL-90. Results:A total of 328 questionnaires were distributed and 326 valid questionnaires were collected, with a recovery rate of 99.39%. Among these trainees, 68 (20.86%) were found to have abnormal mental status (SCL-90 score >160), with a relatively high proportion of the trainees with obsessive-compulsive symptoms or depression. The trainees with abnormal mental status showed the personality characteristics of tendency neuroticism and tendency psychoticism, and compared with the trainees with normal mental status, the trainees with abnormal mental status showed a higher proportion of trainees with abnormal personality characteristics. The univariate analysis showed that the grade of residency training, scientific research pressure, monthly on-duty frequency, and personality characteristics were associated with abnormal mental status, and the multivariate analysis showed that a monthly on-duty frequency of >5 times ( B=0.997, odds ratio [ OR]=2.709, 95%CI: 1.051-6.986, P=0.039), great pressure of scientific research ( B=3.235, OR=25.412, 95%CI: 3.239-199.363, P=0.002), emotional instability ( B=2.015, OR=7.504, 95%CI: 3.529-15.954, P<0.001), and psychosomatic abnormalities ( B=1.640, OR=5.154, 95%CI: 2.510-10.581, P<0.001) were risk factors for psychological abnormality in trainees, while extroversion personality ( B=-2.758, OR=0.063, 95%CI: 0.019-0.215, P<0.001) was a protective factor against abnormal mental status. Conclusions:The positive rate of psychological abnormality is 20.86% among trainees receiving standardized residency training of anesthesiology in four large teaching hospitals in Wuhan, and possible influencing factors include monthly on-duty frequency, scientific research pressure, work pressure, and different personality characteristics.

OBJECTIVE: To explore the effect of decoction (DGNTD) on cell apoptosis and TNF receptor super family 6 (Fas)/caspase-8 pathway in rheumatoid arthritis (RA) fibroblast-like synoviocytes (FLS). METHODS: FLS isolated from the synovial tissue of RA patients were cultured and identified using immunofluorescence staining. The cells were treated with 10% blank serum (blank control group), 10% sera containing low, moderate or high doses of DGNTD, or 20 μmol/mL KR-33493 (a Fas inhibitor) combined with 10% serum containing high-dose DGNTD. MTT assay was used to detect the proliferation of the cells after the treatments. Apoptosis of the cells was detected at 48 h in each group using Hoechst 33342 staining and flow cytometry with annexin V-FITC/PI staining. The mRNA and protein expressions of Fas, FADD, caspase-8 and caspase-3 in the cells at 48 h were detected using qPCR and Western blotting. RESULTS: Immunofluorescence staining identified the cultured cells as FLS. Treatment with DGNTD-containing sera significantly inhibited the proliferation of FLS, and the inhibitory effects were enhanced as the dose and intervention time increased ( < 0.05). Hoechst 33342 staining and flow cytometry showed that the sera containing different doses of DGNTD significantly promoted apoptosis of FLS ( < 0.05). The expression levels of Fas, FADD, caspase-8, and caspase-3 at both mRNA and protein levels were significantly increased in the cells after treatment with different doses of DGNTD-containing sera ( < 0.05). The application of KR-33493 obviously reversed the effects of DGNTD on the FLS ( < 0.05). CONCLUSIONS DGNTD can induce apoptosis of the FLS by activating Fas/caspase-8 signaling pathway.
Apoptosis ; Arthritis, Rheumatoid ; Caspase 8 ; Cell Proliferation ; Cells, Cultured ; Fibroblasts ; Synovial Membrane ; Synoviocytes

Objective To evaluate the value of imaging examinations in the treatment of lymphangioleiomyomatosis (LAM) with chylothorax by thoracic duct extremity exploration.Methods Data of 34 LAM with chylothorax confirmed by pathology and clinical diagnosis were retrospectively analyzed.All patients underwent 99Tcm-DX lymphoscintigraphy and CT lymphangiography (CTL).Thoracic duct lesion types of 99Tcm-DX lymphoscintigraphy were type Ⅰ (abnormal concentration pattern),type Ⅱ (ectopic drainage pattern),and type Ⅲ (without image or transient image pattern).The type Ⅰ and type Ⅱ were diagnosed as thoracic duct abnormalities.Thoracic duct lesion types of CTL were type Ⅰ (dilatation pattern),type Ⅱ (distal obstruction pattern),type l (truck constriction pattern),type Ⅳ (ectopic drainage pattern),and type Ⅴ (no-display pattern).Type Ⅰ-Ⅳ were diagnosed as thoracic duct abnormalities.Consistency of displaying thoracic duct abnormalities between 99Tcm-DX lymphoscintigraphy and CTL was evaluated.Results The thoracic duct abnormalities in 99Tcm-DX lymphoscintigraphy were 58.82％ (20/34;type Ⅰ in 17,type Ⅱ in 3,type Ⅲ in 14),and in CTL were 73.53％ (25/34;type Ⅰ in 15,type Ⅱ in 3,type Ⅲ in 5,type Ⅳ in 2,type Ⅴ in 9).The consistency of CTL and 99Tcm-DX lymphoscintigraphy for detecting thoracic duct abnormalities was good (Kappa=0.679).In CTL thoracic duct types,type Ⅰ and Ⅱ were operated by thoracic duct-venous anastomosis or thoracic duct extremity release operation,type Ⅲ was operated by thoracic duct adhesion or compression band release operation,operative approach and method were chosen according to the abnormal thoracic duct flow path in type Ⅳ,type Ⅴ was took conservative treatment.Conclusion CTL is superior to 99Tcm-DX lymphoscintigraphy,which can clearly display the type of thoracic duct lesion and provide imaging informations to choose operation methods in thoracic duct exploration treatment for LAM with chylothorax.

The antimicrobial activity of nitropropane compound 791224 against several phytopachogenic fungi and Fusarium was studied in vitro. Its inhibitory effect on mycelial growth of Fusarium oxysporum f. sp. vasinfectum (Atk.) Snyder et Hansen and Fusarium graminearum Schwabe showed a much stronger than that on the other phytopathogenic fungi tested. The inhibition of 791224 on all tested Fusarium showed excellent. Its inhibitory effect values ranged from 54.2 to 100% at 5 ppm for 12 tested Fusarium whereas the respective values of carbendazim ranged from 0 to 27.3%. The inhibitory effect of 791224 at 5 ppm on Fusarium lateritium Nees reached to 100% whereas for carbendazim it was 0, i.e.100 times lower than that of 791224. In green house, the control efficiency of 791224 on Fusarium solani sothora japonico H. has been tested and showed a promising result.