Objective To investigate the intervention effect of 1,25(OH)2D3 on serum level of parathyroid hormone,bone metabolic markers and muscle strength in the community elderly with low bone mass.Methods A total of 132 residents aged 60 years and over from Shanghai communities diagnosed as osteopenia or osteoporosis were enrolled and treated with 0.5 μg/d calcitriol for 3 months.Serum levels of parameters in blood biochemistry and bone metabolic markers were determined by Cobas Diagnosis System of Roche before and after treatment,and the handgrip strength of both left and right hands were measured at the same time.Results The average age of 132 patients was(66.1 ± 6.3) years,4 cases (all female) terminated their medication in advance,and 128 patients completed the treatment for three months.The baseline serum levels of 25 (OH)D and PTH were 19.6 ± 7.9 μg/L and 41.0 μg/L respectively.According to the median value of serum PTH before treatment,patients were divided into the two groups:the high PTH group and the low PTH group.Compared with the low PTH group,the serum levels of 25OHD and serum calcium were decreased in the high PTH group[(17.1 ± 7.0) μg/L vs.(22.1 ± 8.2) μg/L,2.4 mmol/L vs.2.5 mmol/L,P＜0.05].After 3 months of intervention,serum levels of creatinine,urine calcium and left handgrip were significantly elevated[(68.2 ± 13.8) μmol/L vs.(65.2 ± 13.4) μmol/L,(5.9 ± 2.8)mmol/24 h vs.(4.4 ± 2.0) mmol/24 h,23.8 kg vs.21.0 kg,all P ＜0.05],while serum levels of PTH,eGFR,phosphorus were significantly decreased[35.5 ng/L vs.42.0 ng/L,(87.0 ± 17.0) ml/min vs.(93.1±17.9) ml/min,1.2 mmol/L vs.1.3 mmol/L,all P＜0.05).There was a significant negative correlation between serum 25(OH)D and PTH before treatment(r=-0.312,P＜0.05),but the negative correlation between them was no longer significant after 3 months of treatment (r =0.042,P ＞ 0.05).A multivariate logistic regression analysis revealed that the increment of left handgrip strength greater than 25％ (OR =0.138,95％ CI:-0.002-8.383),the increment of serum calcium levels(OR =2.578,95％CI:1.0345-8.693)and age(OR =0.103,95％CI:0.035-0.345) were significantly correlated with the decrement of serum PTH levels greater than 30 ％ after three months of treatment.Conclusions Vitamin D diminution or deficiency is common in the elderly.The shortterm treatment of calcitriol can obviously reduce serum PTH,inhibit bone absorption and increase muscle strength.The effect of calcitriol on serum PTH is closely related to promoting calcium absorption and improving handgrip strength.

Based on the experiences in Quyang Community Health Service Center,and through focus group discussions and literature research,the home-based rehabilitation mode for stroke patients in community was developed.With the principles of safety and effectiveness,rehabilitation physicians and family physicians are responsible for rehabilitation program,while rehabilitation therapists and community nurses implement the rehabilitation program.The rehabilitation services are provided for patients and their families at home with the community service resources,including counseling services,rehabilitation aids and other cares according to their needs and demands.The definition and contents of the mode provide a basis for further clarification and operation of home-based rehabilitation for stroke patients in community.

Objective To explore and analyze the pathogen proifle and risk factors of infected diabetic foot ulcers, and propose appropriate prevention and intervention measures for early recovery of patients.Methods The data of 120 patients with diabetic foot ulcers treated in our hospital from February 2012 to May 2014 were retrospectively analyzed. These patients were classified into infection group (38 patients) and non-infection group (82 patients) based on whether their ulcer was infected or not. The pathogens and risk factors of infection in diabetic foot ulcer were analyzed.Results In this study, 43 strains of pathogenic bacteria were isolated from 38 cases of infection, of which gram positive bacteria accounted for 51.2 %, gram negative bacteria 41.9 %, and fungi 7.0 %.Staphylococcus aureus,Pseudomonas aeruginosa and Enterobacter cloacae were the top three pathogens, accounting for 16.3 % each. Univariate analysis showed that diabetic vascular complication, retinopathy, more than 2 foci of ulcer, osteomyelitis, and diabetic nephropathy were closely associated with infection (P<0.05). Multivariate logistic regression analysis showed that HDL-C, albumin, diabetic vascular complication, number of ulcers, osteomyelitis were independent risk factors for infection in patients with diabetic foot ulcer. Conclusions HDL-C, red blood cell, hemoglobin, diabetic complications, white blood cell, triglyceride, albumin, diabetic vascular complication and smoking are the risk factors for infection in patients with diabetic foot ulcer. These factors should be prevented and controlled to reduce the incidence of infection in diabetic foot ulcer.

BACKGROUND:Toxic cytarabine is often used to prepare highly purified neurons in experimental studies addressing central nervous system diseases. However, the intervention time of cytarabine is little reported. OBJECTIVE:To determine the optimal intervention time of cytarabine(final concentration 10μmol/L) in primary culture of rat cortical neurons. METHODS:Rat primary cortical neurons were cultured in Neurobasal+B27 medium, and 10μmol/L cytarabine were added at 12, 24, 36 and 48 hours after culture, respectively. Half of the medium were changed every 48 hours. The morphology of neurons was observed under inverted microscope at 7 days. The purity and differentiation of neurons maturity were identified by immunocytochemistry method of neuron specific enolization enzyme staining. Morphometric analysis for all neuron-specific enolase positive cells was performed by Multifunction Computer Image Analysis System. RESULTS AND CONCLUSION:After addition of cytarabine at 24 hours of culture, the purity of neurons was more than 90%, well-differentiated cortical neurons accounted for 89.00%, and the area of neuronal body was the largest with the longest synapses. There were more neuron cells with transparent cytoplasm, and large nucleus. The cell body had good refraction and strong stereo sense. The neurons with 3-4 synapses and 3-4 bifurcates formed a good network structure. These results illustrate that although it willbe beneficial for the purity of neurons to add cytarabine early in neuron culture process, it will make obvious effect on neuronal differentiation. The highly purified and well-grown cerebral cortical neurons will be obtained after cultured in neurolbasal medium, which cytarabine is added to at 24 hours of culture.

Objective To observe the effect of electroacupuncture and nerve and tendon gliding exercises on mild to moderate carpal tunnel syndrome.Methods Forty patients with mild to moderate carpal tunnel syndrome were randomly divided into an observation group and a control group,each of 20.Both groups were given neurotrophic drugs.The observation group was additionally provided with electroacupuncture and nerve and tendon gliding exercises,while the control group was given routine health education for 4 weeks.The Boston carpal tunnel syndrome questionnaire (BCTQ),a visual analogue scale (VAS),thumb and middle finger to wrist motor conduction velocity (MCV),sensory nerve action potentials (SNAPs),median nerve distal motor latency (DML) and the amplitude of compound muscle action potential (CMAP) of the musculi abductor pollicis brevis were evaluated.Results There were no significant differences in any of the measurements between the two groups before the treatment.After four weeks of treatment,significantly better improvement was observed in the average SCV of the thumb and wrist,the SCV of the digitus medius and wrist,the SNAP of the thumb and wrist,the SNAP of the digitus medius and wrist,the DML of the nervus medianus and the CMAP of the abductor pollicis brevis in the observation group compared to before the treatment and compared to the control group.Moreover,there was a significant decrease in the observation group's average BCTQ symptom score and function score and in their VAS ratings.However,in the control group significant differences were only found in the average SCV of the thumb and wrist,the DML of the nervus medianus and in their VAS ratings.Conclusions Electroacupuncture and nerve and tendon gliding exercises can significantly relieve symptoms and restore hand function.They are worth applying in clinical practice.

Objective To summarize and analyze the dynamic change of HBsAg levels in patients with chronic Hepatitis B (CHB) after receiving nucleos(t)ide analogues (NAs) as antiviral treatment.Methods Patients who were performed quantitative Hepatitis B surface antigen(qHBsAg) from July 30, 2012 to December 30,2016 in Peking Union Medical College Hospital were retrospectively enrolled.qHBsAg, HBV DNA, HBeAg were collected and analyzed at baseline and at 192-week follow-up every 24 weeks.qHBsAg and HBeAg were assessed with chemiluminesent microparticle immuno assay(CMIA).HBV DNA was assessed with PCR and COBAS Amplicor.Results 60 patients were included.Patients in HBeAg-positive group had higher HBV DNA than that in HBeAg-negative group (P<0.05)at baseline and the two groups both were under detection limit after 48 weeks.BaselineqHBsAg in HBeAg positive-group and negative-group were (3.43±0.73) log10 IU/mL, (3.08±0.47) log10 IU/mL respectively.qHBsAg in HBeAg-positive group was higher than that in HBeAg negative-group on all follow-ups(P<0.05) except 48weeks.However on 168 weeks and 192 weeks, difference between the two groups was statistically significant(P<0.05).In HBeAg-positive group,quantitative HBeAg dropped significantly during antiviral treatment.Conclusions HBV replication can be suppressed in the process of long-term NAs treatment in CHB patients.However qHBsAg decline is not so obvious, which indicates that HBsAg cleavence is difficult,and long-term NAs therapy is still necessary.

Intraoperative cell salvage (IOCS) has been widely used to reduce allogeneic blood transfusion and prevent blood transfusion related complications during surgery.However, due to the risk of transfusion related reaction, contamination, and immunological reaction, its use for tumor patients has been controversial and limited.To explore the feasibility of the application of IOCS in cancer patients, we reported 2 cases of renal cell carcinoma (RCC) with tumor embolism in IVC that underwent radical nephrectomy,and inferior caval venous thrombectomy receiving IOCS combined with leukocyte depletion filter (LDF) from August 2016 to November 2016 in our hospital.The cell saver blood salvage (Haemone-tics, 5+) was used for these 2 cases.The salvaged blood was filtered through the LDF before infusion.For case 1 (male 45-year-old) the total operation time was 505 min, and the estimated blood loss was 4 500 ml.A total of 1 000 mL autologous blood, 12 u allogeneic packed red blood cells (PRBC), 1 200 mL fresh frozen plasma (FFP) were infused during the procedure.The patient was discharged from hospital after 75 days without complications.The postoperative follow-up for 3 months showed no tumor recurrence or metastasis.For case 2 (a male patient, aged 51 years), the total operation time was 490 min, and the estimated (blood loss was 7 000 mL.the patient received 2 700 mL autologous blood transfusion, 12 u allogeneic packed red blood cells (PRBC), and 2 400 mL fresh frozen plasma (FFP).The patient was discharged from hospital after 86 days without severe complications.the postoperative follow-up for 6 months showed no tumor recurrence or metastasis for this patient.Other relevant retrospective studies with this technique showed that cell salvage could be used safely in many kinds of cancer patients, for example, bladder cancer, liver cancer and kidney cancer.Furthermore,numerous researches have proved the safety and efficacy of the combination of these two techniques, the intraoperative cell salvage technique and leucocyte depletion filter in cancer patients.Here we only reported two cases using IOCS and LDF.Further work is needed to determine whether the use of intraoperative cell salvage combined with leukocyte depletion filter can be used safely for patients with HCC.

OBJECTIVETo investigate the clinical and genetic characteristics of a patient with mixed gonadal dysgenesis.

METHODSClinical data was collected. The patient was subjected for serum hormone testing and G-banding chromosomal analysis. Sex-determining region of Y-chromosome (SRY) gene and azoospermia factor (AZF) a, b, c regions were analyzed with multiple polymerase chain reaction (PCR) and whole gene sequencing.

RESULTSAll serum hormone testing were normal. The karyotype of the patient was 45,X/46,X,Yqh-. PCR has proven the presence of SRY, ZFY and AZFa, and deletion of AZFb and AZFc regions. No mutation was detected in the sequence of the SRY gene. Abdominal computerized tomography has detected a huge mass in the pelvic cavity, which was positive for PLAP and CD117 on immunohistochemistry stain.

CONCLUSIONBased on clinical data and result of genetic testing, the patient was diagnosed with mixed gonadal dysgenesis. Pathological and immunohistochemistry analysis of the transformed gland has confirmed the diagnosis of seminoma. For patient with a karyotype of 45,X/46,X,Yqh-, the risk of seminoma may be related with the presence of SRY gene.

Chromosome Banding ; Chromosomes, Human, Y ; genetics ; Female ; Genes, sry ; Gonadal Dysgenesis, Mixed ; diagnosis ; genetics ; Humans ; Male ; Middle Aged ; Sex Determination Analysis

AIM: To investigate the effects of curcumin (Cur) on the expression of High mobility group box 1 protein (HMGB1), interleukin-1β(IL-1β), tumor necrosis factor-α(TNF-α) in amyloid-β(Aβ)-induced primary rat microglial cells.METHODS: Microglia were derived from the cerebral cortices of postnatal rat brains.The cells were i-dentified by immunocytochemistry using mouse anti rat Iba-1 monoclonal antibody.A cell model using primary rat microgli-al cells incubated with Aβ25-35 as an inflammation model of Alzheimer’s disease (AD) was set up.The morphological char-acters of primary rat microglial cells were observed.The concentration of Aβ25-35 and the treatment concentration of curcumin were selected by CCK-8 assay.Cultured primary rat microglial cells were divided into 5 groups: normal cell group, Aβ25-35 group, Cur group, Aβ25-35 +Cur group and Aβ25-35 +DMSO group.The expression of HMGB1, NF-κB, and receptor for advanced glycation end products (RAGE) was detected by Western blot.The levels of HMGB1, IL-1β, and TNF-αin the culture supernatant were measured by ELISA.RESULTS: The purity of primary microglias determined by Iba-1 immuno-fluorescence was more than 95%.The protein levels of HMGB1, RAGE and NF-κB were significantly increased after Aβ25-35 stimulation.After treatment with Cur, the protein levels of HMGB1, RAGE and NF-κB were significantly decreased (P <0.05).The levels of HMGB1, IL-1βand TNF-αin the supernatant were significantly increased after Aβ25-35 stimula-tion.Cur significantly decreased the level of HMGB1, IL-1βand TNF-αin the supernatant.CONCLUSION: Curcumin significantly inhibits neuroinflammation stimulated by Aβ25-35 in primary rat microglial cells.

Objective To evaluate the changes of left atrial structure and function in the patients with atrial fibrillation who accepted bi -polar radio frequency current ablation .Methods All patients in our study were divided into three groups including the ones who had accept -ed bipolar radio frequency current ablation because of atrial fibrillation ,the ones who refused to accept ablation operation in despite of atrial fibrillation and the ones who maintained sinus rhythm before operation .All patients accepted TTE before and after operation .Results The rate of transverse diameter change of ablation group (24.24 ±8.67)%was larger than those of other two groups (P<0.05).Left atrial chan-nel capacity volume change rate of ablation group (17.18 ±3.26)%were larger than the values of the group who were suffering atrial fibrilla-tion but refused ablation advice (0.86 ±0.26)(P<0.05).Left atrial total ejection fractions of ablation group (202.41 ±81.59)%were lar-ger than the values of the group who were suffering atrial fibrillation but refused ablation advice (109.53 ±60.91)%( P<0.05) .And its ac-tive ejection fractions(12.18 ±3.48)%,total ejection fractions(41.31 ±8.26)%and so forth were less than the group who maintained si-nus rhythm before operation(21.33 ±5.61)%,(45.05 ±7.37)%,respectively (P<0.05).Left atrial posterior wall center and cardiac basal segment strain(14.34 ±9.47)%,(13.20 ±8.38)%,respectively,and strain rate values after operation of ablation group were less than other segments .Conclusion Left atrial structure remodeling inversion was not obviously 3~6 months after bipolar radio frequency cur-rent ablation .And at the same time ,the improvement of left atrial storage function was not obviously compared with the group who refused ab -lation advice,left atrial channel function compensation degree descended obviously left atrial co -pumping function in ablation group increased obviously,left atrial posterior wall center and cardiac basal segment systolic and distolic function were less than other segments of left .