Objective To explore the influence of WeChat platform rehabilitation guidance mode on refracture of osteoporotic fracture patients.Methods Totally 100 osteoporotic fracture patients admitted to the Department of Orthopedics of the hospital from 2018 to 2019 were selected and randomly divided into control group and experimental group with 50 patients in each group.The control group adopted the conventional discharge rehabilitation guidance mode,and the experimental group implemented WeChat platform rehabilitation guidance mode on this basis,including WeChat platform construction and detailed intervention mode.The changes of bone mineral density and the recurrence rate of osteoporotic fracture were compared between the two groups at admission and after 3 years of follow-up.Results There were 7 cases of lost follow-up in the experimental group,and there were 6 cases of lost follow-up in the control group.After 3 years,the bone mineral density of the experimental group was significantly higher than that of the control group,and the recurrence fracture rate was significantly lower than that of the control group(P<0.05).Conclusion The application of WeChat platform rehabilitation guidance mode can effectively improve bone density and reduce the incidence of refracture in osteoporotic fracture patients.

Objective To investigate the correlation between the expression of phospholipase Cβ1 (PLCβ1) and the clinical relevant parameters and prognosis in patients with hepatocellular carcinoma (HCC).Methods By using tissue microarray technique and immunohistochemical method,the expressions of PLCβ1 in tumor and pericancerous tissues were tested in 141 HCC patients.The relationship between the expressions of PLCβ1 and the clinical and pathological characteristics was analyzed.Colony formation assay and apoptosis experiments were used to check the effect of PLCβ1 on proliferation of HCC cells.KaplanMeier analysis and Cox multivariate regression model analysis were adopted to analyze the prognosis of HCC patients.Results The expression level of PLCβ1 in tumor tissues was obviously higher than that in pericancerous tissues,which was closely related to the tumor staging.Kaplan-Meier survival analysis indicated that the survival rate in HCC patients with high expression level of PLCβ1 was lower than that in HCC patients with low expression level of PLCβ1.Cox multivariate regression analysis revealed that high expression of PLCβ1 was an independent prognostic factor for HCC patients.Over expression of PLCβ1 in HCC cells could promote the proliferation of HCC cell and inhibit its apoptosis.Further investigation showed that activation of extracellular regulated protein kinase signaling pathway might be involved in PLCβ1-mediated HCC cell growth.Conclusion PLCβ1 can promote the progression of HCC,and the expression level of PLCβ1 can be regarded as an independent prognostic factor for HCC,and it is expected that PLCβ1 may become an ideal therapeutic target.

Objective To investigate the influence of sorafenib on the expressions of B7-H3 and B7-H4 proteins in different human hepatocellular carcinoma cell lines,including HepG2,Hep3B,BEL-7402,BEL-7404,BEL-7405,QGY-7701,QGY-7703,SMMC-7721,MHCC97H,MHCC97L,HCCLM3 and HCCLM6.Methods Western blotting and MTT assay were used to check the influence of sorafenib on the expressions of B7-H3 and B7-H4 proteins in different human hepatocellular carcinoma cell lines and to test the inhibitory effect of sorafenib on different human hepatocellular carcinoma cell lines.Results Compared with normal human liver cells (HL-7702),the expressions of B7-H3 and B-H4 proteins in different human hepatocellular carcinoma cell lines were significantly up-regulated (P＜0.01).The cytotoxic activity IC50 values of sorafenib to Hep3B,BEL-7404,MHCC97H,HCCLM3 and HCCLM6 were 14.56,9.14,9.46,17.21 and 9.29 μmol/L respectively.After treating Hep3B,BEL-7404,MHCC97H,HCCLM3 and HCCLM6 with sorafenib at the doses of 5,10 and 20 μmol/L separately,the expressions of B7-H3 and B7-H4 proteins were strikingly down-regulated when compared with the control group (P＜0.01).Conclusion The overexpressions of B7-H3 and B7-H4 proteins in different human hepatocellular carcinoma cell lines are a common finding,which can influence tumor immune escape.It may be a new target for prevention and treatment of liver cancer in future.

Objective To investigate the clinical characteristics of hemodialysis (HD) patients complicated with arteriosclerosis obliterans (ASO) of lower extremity,and to discuss the factors that influence the curative prognosis of percutaneous transluminal angioplasty (PTA).Methods The clinical data of 211 patients with ASO of lower extremity receiving HD or not receiving HD,who were admitted to authors' hospital during the period from January 2008 to October 2015,were retrospectively analyzed.PTA was successfully accomplished in all patients.Results The median follow-up time was 2.24 years.Theamputation-free survival of HD group was significantly lower than that of non-HD group (P＜0.000 1),and the postoperative artery patency rate of HD group was also obviously lower than that of non-HD group (P＜0.000 4).The factors influencing the survival rate without amputation of the two groups were different.The independent influence factor in HD group was diabetes mellitus,while in non-HD group the independent influence factors were Fontaine stage and hyperlipidemia.The infection mortality of HD group was 55.5％ (10/18),which was higher than 22.2％(6/26) of non-HD group,the difference was statistically significant (P＜0.05).Conclusion In treating ASO of lower extremity,the curative effect of PTA is poorer in HD patients than in non-HD patients,and the presence of diabetes mellitus may be an independent factor influencing prognosis.

Objective To assess the validity and safety of arterial embolization with medical adhesive in treating peripheral artery pseudoaneurysms(PSA).Methods 25 cases of peripheral artery PSA embolized with Fuaile medical adhesive(FMA) were analyzed retrospectively.25 patients included 28 PSA.Super-selective transcatheter arterial embolization was performed in 19 patients (22 PSA) using 3F microcatheter and 6 PSA in 6 patients were embolized through puncturing directly.All the lesions were treated with mixtures of FMA and iodized oil (1：1) during the radiography.The clinical efficacy and complications were recorded.Results The success rate of embolization was 100% during the operation (28/28), and the average volume of FMA used was 1.8 mL(0.5-5.5 mL).One patient with PSA(d>2 cm) still have hematuria 2 days after the operation.The hematuria disappeared after embolization with micro-coil following re-angiography.Bleed stopped after the second embolization with FMA in one patient with brachial artery PSA.No one developed complications associated with therapy and occurred rebleeding in the follow-up period time (3 months).Conclusion The mixtures of FMA and iodized oil can be a useful alternative embolic agent for the treatment of peripheral artery pseudoaneurysm with high success rate, short operation time and definite clinical effect.

Objective To discuss the prognostic value of aspartate aminotransferase (AST) to neutrophils ratio index (ANRI) in patients with hepatocellular carcinoma (HCC) after receiving transarterial chemoembolization (TACE).Methods The clinical data of 107 HCC patients,who were admitted to authors' hospital to receive treatment during the period from January 2008 to June 2011,were retrospectively analyzed.TACE was successfully performed in all patients.Based on the 5-year overall survival rate,ROC curve was drawn and the cutoff value was determined.Preoperative ANRI,AST-lymphocytes ratio index (ALRI),AST-platelet count ratio index (APRI),neutrophil-lymphocytes ratio index (NLR),platelet count-lymphocytes ratio index (PLR) and other clinical pathological parameters were calculated.Univariate analysis,multivariate Logisitc regression analysis and Kaplan-Meier survival analysis were used to assess the value of the above indexes in prejudging the disease-free survival (DFS) and overall survival (OS).Results ANRI bore a close relationship to the presence of HBsAg,AST,presence of cirrhosis,tumor size,portal vein tumor thrombus (PVTT) and recurrence of tumor (P＜0.05).Univariate analysis showed that ANRI,ALRI,APRI,NLR and PLR were significantly correlated with DFS and OS in HCC patients after receiving TACE (P＜0.05).Logisitc regression analysis revealed that ANRI was independent factor influencing DFS and OS (P＜0.05).Kaplan-Meier survival analysis indicated that the prognosis after TACE was poor in patients whose preoperative ANRI ＞7.8.Conclusion Preoperative ANRI level is an independent and effective predictor for judging the prognosis of HCC patients.A high preoperative ANRI level usually suggests a poor prognosis after TACE.

Objective To evaluate the effect ofcytochrome P450 isoenzyme subfamily 2C19 (CYP2C19)gene polymorphism on the clopidogrel antiplatelet therapy in cirrhosis patients after receiving transjugular intrahepatic portosystemic shunt (TIPS).Methods The clinical data of 171 cirrhosis patients,who were treated with TIPS during the period from January 2013 to December 2014,were retrospectively analyzed.During operation both the portal vein and the elbow vein blood samples were collected and sent for CYP2C19 gene testing.After TIPS,clinical follow-up checkup was made once every 3 months.The gene detection results and clinical follow-up findings were comparatively analyzed.Results A total of 110 patients,who had not received blood transfusion before TIPS and who had regularly taken clopidogrel antiplatelet therapy after TIPS were enrolled in the study.The mean time to take clopidogrel was 192.4 days (31-517 days),and the gene detection results of portal vein and elbow vein were quite consistent.CYP2C19 genotype of *1/*1 was found in 49 patients (44.5％),CYP2C19 genotype of *1/*2 in 27 patients (24.6％),CYP2C19 genotype of *1/*3 in 18patients (16.4％),CYP2C19 genotype of *2/*2 in 11 patients (10.0％),CYP2C19 genotype of *2/*3 in 3patients (2.7％),and CYP2C 19 genotype of *3/*3 in 2 patients (1.8％).Following-up examinations showed that the incidence of shunt dysfunction in patients carrying slow metabolic gene was 87.5％ (14/16),which was significantly higher than that in patients carrying moderate metabolic gene (20.0％,9/45;x2=22.9,P=0.006)as well as in patients carrying fast metabolic gene (8.2％,4/49;x2=37.91,P=O.O00 1).Multivariate analysis of Cox regression model indicated that CYP2C19 slow metabolic gene variation was an important predictive factor for shunt dysfunction (95％CI:1.80-9.03,P=O.O00 7).Conclusion CYP2C19 slow metabolic gene variation,including genotype of *2/*2,*2/*3 and *3/*3,is an important factor that can influence the efficacy of clopidogrel treatment after TIPS.Preoperative CYP2C19 gene detection results can provide useful information,which is very helpful in making an effective and reliable anti-platelet treatment plan for patients after TIPS.

Objective To compare the technical success ,complication rates and comfort of the radiologic placement of central venous ports(CVP) via the internal jugular vein ,subclavian vein via subclavian region ,subclavian vein via supraclavicular region un‐der DSA guidance .Methods We retrospectively reviewed 188 CVP patients implanted at hospitals between December 2012 and De‐cember 2013 .The patients were divided into three groups according to the different catheter implantation sites ,internal jugular vein (group A) ,subclavian vein via subclavian region (group B) and subclavian vein via supraclavicular region (group C) .Intraoperative pain score ,technical success rates ,peri‐procedural ,as well as early and late complication rates were recorded based on the image fol‐low‐up and patient medical records .Results The technical success rate was 100 .0% without any lethal complications .The CVP re‐lated infections were occurred in each group with 1 patient ,but there was no statistics significant different(P>0 .05) .Subclavian vein thrombosis were occurred 2(2 .1% ,2/96) in group B ,which was recanalized after thrombolytic therapy ,and 1(1 .7% ,1/60) in group C ,which was completely occluded .The higher rate of catheter migration and kinking of catheter were occurred in group A and group C .The rate was statistically significant difference among the three groups (P<0 .01) .The late complication rates were statistically higher in group A and C compared with group B (P<0 .05) .The punch‐off was just occurred in group B (n=2) .There were no significant differences about catheter fracture ,port rotation and wound dehiscence among the three groups(P>0 .05) .Con‐clusion In DSA radiologic placement of a CVP via the subclavian vein via subclavian region is safe and efficient with more comfort‐able and lower complication rates ,which could be chosen priority .

Objective To evaluate the safety and effectiveness of different anesthesia methods in performing percutaneous radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). Methods The clinical data of 102 HCC patients, who were admitted to authors’ hospital during the period from January 2010 to October 2014 to receive percutaneous RFA, were retrospective analyzed. According to the anesthesia method used for RFA, the patients were divided into 3 groups. Group A: control of breathing and general intravenous anesthesia; group B: general intravenous anesthesia with spontaneous breathing; group C: local anesthesia with monitoring. The vital signs, perioperative adverse reactions and procedure-related complications were analyzed. Results The operation time of group A and B was longer than that of group C (P<0.02); the time of waking up after the operation in group A was longer than that in group B (P<0.03). During the performance of RFA the patient’s vital signs in group A and B were more stable than those in group C (P<0.01);during the performance of RFA the blood oxygen saturation in patients of both group A and B remained above 95%(from the placement of oxygen masks to the end of operation), although the blood oxygen saturation of group B was lower than that of group A (P<0.05), and the blood oxygen saturation of group C was lower than that of both group A and B (P<0.01). The incidences of adverse reactions such as involuntary limb activity, tears, need of anesthesia machine-assisted respiration, etc. in group A were significantly lower than those in group B and C (P<0.01). The postoperative complications such as subcutaneous emphysema, pneumothorax or need of thoracic drainage in group B and C were significantly higher than those in group A (P<0.05). Conclusion General intravenous anesthesia can reduce the operation time of RFA for HCC, which can create a safe and comfortable surgical environment for patients. The use of general intravenous anesthesia together with the control of breathing is the safest method with lower incidence of perioperative adverse reactions and procedure-related complications; it might be a relatively optimal anesthesia method for RFA of HCC.