Objective:To investigate the association of time in range with metabolic associated fatty liver disease(MAFLD) and advanced liver fibrosis in patients with type 2 diabetes.Methods:This study was a retrospective study. A total of 494 type 2 diabetic patients were recruited in the Department of Endocrinololgy of Henan Provincial People′s Hospital from November 2019 to April 2022. Time in range(TIR) was calculated with continuous glucose monitoring data. Abdominal ultrasound scan was used to diagnose fatty liver. Liver stiffness measurement(LSM) by transient elastography was used to evaluate liver fibrosis. Pearson and multivariate linear regression analysis was used to evaluate the association between TIR and LSM. Multivariate logistic regression analysis was used to analyze the association of TIR with risk of MAFLD and advanced liver fibrosis.Results:Pearson correlation analysis showed that LSM was negatively correlated with TIR( r=-0.86, P<0.001) and was positively correlated with homeostasis model assessment for insulin resistance(HOMA-IR; r=0.48, P<0.001). After adjusting for confounding factors, multivariate linear regression analysis showed that TIR significantly negatively predicted LSM( β=-0.75, P<0.001), and HOMA-IR significantly positively predicted LSM( β=0.21, P=0.025). After adjusting for confounding factors, logistic regression analysis showed that compared with TIR Q4 patients, TIR Q1 patients had an increased risk of MAFLD( OR=1.96, 95% CI 1.07-3.62, P=0.027), advanced liver fibrosis( OR=3.82, 95% CI 1.17-12.50, P=0.027), and HOMA-IR was an independent risk factor for MAFLD( OR=1.22, 95% CI 1.04-1.43, P=0.005) and advanced liver fibrosis( OR=1.26, 95% CI 1.03-1.54, P=0.025). Conclusions:TIR and insulin resistance are independent risk factors for MAFLD and advanced liver fibrosis in patients with type 2 diabetes. TIR has a significant predictive value for MAFLD and advanced liver fibrosis.

Objective:To investigate the effect of hyperuricemia treatment on vascular endothelial function and blood pressure in patients with acute cerebral infarction.Methods:A total of 138 cases from the same center were enrolled in the study. 92 cases of acute cerebral infarction patients combined with hyperuricemia were selected. They were randomly divided into the experimental group (46 cases) and control group (46 cases). 46 cases of acute cerebral infarction patients with normal uric acid were selected in the same period. Patients in the experimental group received oral allopurinol for 3 months to treat hyperuricemia. Serum uric acid, blood lipid, and hs-CRP were tested before and after treatment in these populations. Blood pressure and body mass index (BMI) were also detected, and vascular endothelial function was evaluated using ultrasound non-invasive blood flow mediated vasodilation function (FMD). Comparison and statistical analysis were carried out in groups.Results:Uric acid [(479.7±49.0) μmol/L vs. (381.2±76.7) μmol/L]、hs-CRP[(8.1±6.7) mg/L vs. (5.1±4.6) mg/L]、systolic blood pressure [(124.7±26.3) mmHg vs. (97.4±13.5) mmHg] decreased significantly in the experimental group after 3 months of treatment with allopurinol ( P<0.05), and blood flow mediated vasodilation function [(7.6±3.5) vs. (11.2±3.9)]significantly increased ( P<0.05). The decrease of serum uric acid was positively correlated with the increase of FMD in the experimental group ( r=0.463, P<0.01). Multiple Regression analysis showed that serum uric acid was an independent predictor of FMD( β=-0.229, P=0.035). Conclusions:The treatment of hyperuricemia in patients with acute cerebral infarction can significantly improve the vascular endothelial function of patients, improve inflammation state and lower blood pressure. It is further confirmed that a higher uric acid level is related to worse endothelial function which may contribute to atherosclerosis.

Objective:To analyze the demographic and clinical characteristics of elderly inpatients with osteoporotic femoral neck fractures(OFNF).Methods:Clinical data of 1 227 patients with OFNF treated at the department of orthopedics of Beijing Hospital from January 2010 to December 2019 were analyzed retrospectively, including 377 male and 850 female patients.Ten-year trends in the OFNF constituent ratio, patient age, average length of stay and hospitalization expenses were examined, and differences in demographic and clinical characteristics between different genders were analyzed.Results:From 2010 to 2017, the constituent ratio of OFNF patients increased each year, and the number of OFNF patients decreased slightly in 2018 and 2019.The age of onset in both male and female patients was the highest at the ages of 80-89(46.8% or 574/1 227). In the distribution of educational level, people with no education made up the highest proportion(36.7% or 450/1 227). The seasonal distribution of the disease was the highest in autumn(27.8% or 341/1 227). The constituent ratio of urban areas was higher than that of rural areas(54.6% or 670/1 227 vs.45.4% or 557/1 227). In the distribution of fracture types, the constituent ratio of 31-B2 fractures was the highest in both male and female patients.Of the causes of injury, the constituent ratio of falls and indoor activities was the highest.Hypertension, spinal degenerative diseases and knee and hip osteoarthritis ranked in the top three of concomitant diseases.The constituent ratio of previous fractures in females was significantly higher than that in males.In the past ten years, the average hospitalization length of OFNF patients showed a downward trend, and the change in average hospitalization cost showed abrupt fluctuations.From 2009 to 2016, the hospitalization cost showed an upward trend, with the highest in 2016, and then decreased year by year. Conclusions:In the past ten years, the number and constituent ratio of OFNF patients increased steadily in the first eight years, but decreased slightly or reached a plateau in the past two years.The education level, history of bone fractures, hypertension, spinal degenerative diseases and knee and hip osteoarthritis of OFNF patients were correlated with sex, while age distribution, seasonal distribution, urban and rural distribution, cause of injury, fracture classification and other concomitant diseases were not correlated with sex.In the past ten years, the average hospitalization length of OFNF patients trended downward, the average hospitalization cost showed an upward trend from 2009 to 2016, and decreased year by year after 2016.The medical policy reform in 2016 played a significant role in controlling medical expenses.

Objective:To compare the minimally invasive transforaminal lumbar interbody fusion (MTLIF) with open transforaminal lumbar interbody fusion (OTLIF) in treatment of lumbar degenerative disease.Methods:Clinical data of 63 patients with single segment lumbar degenerative disease treated in Department of Orthopedics of Beijing Hospital from November 2015 to September 2016 were retrospectively analyzed, among whom 30 cases received MTLIF and 33 cases received OTLIF. The operative time, intraoperative X-ray exposure times, intraoperative blood lose, postoperative drainage,perioperative fever, adjacent segment degeneration, loosening of internal fixation and cage collapse were observed in two groups 4 years after operation, and the visual analog scale (VAS) score of the lower back and the leg, the Oswestry disability index (ODI) score were compared between two groups.Results:The operation time [(191.6±50.5) min] and radiation exposure times [(15.5±6.4) times] in MTLIF group were significantly more than those in OTLIF group [(105.8±23.1) min, (7.2±1.4)times, t=17.210, t=10.850,all P<0.01]. The intraoperative blood loss [(150.4±70.4) ml], postoperative drainage [(90.4±30.7)ml], VAS score (2.4±0.7) and ODI score (24.5±3.7) 2 weeks after surgery in MTLIF group were significantly lower than those in OTLIF group [(250.7±43.9)ml,(216.3±67.8)ml,(4.5±1.6),(30.6±4.6), t=-12.830, t=-14.070, t=-6.890, t=-5.805,all P<0.01]. There were no significant differences in the incidence of fever [1 case(3.3%) vs. 4 cases(12.1%),χ2=-1.661, P=0.20], VAS score[(1.2±0.7) vs. (1.3±0.6), t=-0.628, P=0.53], ODI score[(14.2±2.7) vs. (14.7±2.5), t=-0.756, P=0.45], fusion rate of Bridwell grade Ⅰ [86.7%(26/30) vs. 84.8%(28/33),χ2=0.042, P=0.84] 1 year after surgery; and the adjacent segment degeneration [0 case(0) vs. 1 case(3.0%),χ2=0.924, P=0.34], internal fixation loosening [1 case(3.3%) vs. 1 case(3.0%),χ2=0.005, P= 0.95] and cage collapse 4 years after surgery [1 case(3.3%) vs. 1case(3.0%),χ2=0.005, P=0.95] between MTLIF group and OTLIF group. Conclusion:Compared with OTLIF, MTLIF has longer operation time and more radiation exposure, but it can achieve full decompression, the same fusion rate, less bleeding, less trauma, faster recovery, fewer complications and satisfactory long-term effect.

Objective:To evaluate the efficacy and safety of cell sheets containing allogeneic keratinocytes and fibroblasts in the treatment of partial-thickness burn wounds.Methods:The cell sheets containing allogeneic keratinocytes and fibroblasts were constructed using polyurethane biofilm as carrier. Then gross observation and histological observation were conducted. From April 2016 to December 2017, Changhai Hospital of Naval Medical University recruited patients with acute partial-thickness burn wounds that met the inclusion criteria for this prospective and positively self-controlled clinical trial. Recruitment of 40 acute partial-thickness burn wounds were planned with each selected single wound being not smaller than 10 cm×10 cm and not more than 5% total body surface area (TBSA). Each wound was equally divided into two areas, which were recruited into cell sheet group and conventional treatment group according to the random number table. The wounds in cell sheet group were covered by cell sheet and then sterile gauze as secondary dressings. Depending on the wound healing and exudation, the sterile gauze was replaced every 1 to 3 day (s) after the treatment was started, and the cell sheet was replaced every 7 days (namely dressing changing). The wounds in conventional treatment group were covered by sulfadiazine silver cream gauze and then dressed with sterile gauze, with the dressings changed every 2 to 3 days depending on wound exudation. On treatment day 5, 7, 10, and 14, the wound healing rates in the two groups were calculated. The complete wound healing time, the total number of dressing changes, and the status of wound infection during treatment were recorded. The Visual Analogue Scale was used to score the pain at the first dressing change. Scar formation of patients was followed up for 6 to 12 months after injury. Safety indicators including vital signs, laboratory examination indexes, and adverse reactions during treatment were observed. Data were statistically analysed with Wilcoxon rank sum test and Bonferroni correction.Results:(1) Each prepared cell sheet had a diameter of about 8 cm and was about 49 cm 2 in size, containing 2 or 3 layers of keratinocytes and fibroblasts. (2) A total of 43 patients were enrolled, of whom 3 patients dropped out of the study. Of the 40 patients who completed the treatment, there were 22 males and 18 females who were aged 1 to 57 year (s), with total burn area of 2% to 26% TBSA. (3) On treatment day 5, 7, 10, and 14, the wound healing rates in cell sheet group were significantly higher than those in conventional treatment group ( Z=4.205, 4.258, 3.495, 2.521, P<0.05 or P<0.01). The complete wound healing time in cell sheet group was 7 (6, 8) days, which was significantly shorter than 11 (7, 14) days in conventional treatment group ( Z=4.219, P<0.01). The total number of wound dressing changes in cell sheet group was 1 (1, 2) times, which was significantly less than 6 (4, 7) times in conventional treatment group ( Z=5.464, P<0.01). (4) The wounds in cell sheet group in 31 patients healed before the first dressing change. The pain score of wounds in the first dressing change in cell sheet group of 9 patients was 1 (0, 1) point, while the pain score of wounds in the first dressing change in conventional treatment group of 40 patients was 2 (1, 3) points. There was no obvious infection in the wounds in both groups of 40 patients before the wound healing. Nine patients completed the follow-up after the trial. In 6 patients, no scar formation was observed in cell sheet group or conventional treatment group. The color of wounds in cell sheet group was consistent with normal skin, and there was only a small amount of pigment deposition in the wounds of conventional treatment group. Three patients developed pigment deposition only in the wounds of cell sheet group but obvious scars in conventional treatment group. (5) The abnormal fluctuations of vital signs including body temperature, blood pressure, heart rate, respiratory rate, and laboratory examination indexes of all patients during treatment were alleviated through the process of burn wound healing. No obvious adverse reactions or abnormalities related to the treatment were observed. Conclusions:The cell sheet containing allogeneic keratinocytes and fibroblasts can reduce the number of dressing changes, accelerate wound epithelialization, shorten wound healing time, reduce pain during dressing change in the treatment of partial-thickness burn wounds, and it may reduce scar hyperplasia after wound healing because of accelerating wound epithelization. Its clinical application is simple, safe, and effective.

This study aims to investigate the effects of fibroblast growth factor 21 (FGF-21) on learning and memory abilities and antioxidant capacity of D-galactose-induced aging mice. Kunming mice (37.1 +/- 0.62) g were randomly divided into normal control group, model group and FGF-21 high, medium and low dose groups (n = 8). Each group was injected in cervical part subcutaneously with D-galactose 180 mg x kg(-1) x d(-1) once a day for 8 weeks. At the same time, FGF-21-treated mice were administered with FGF-21 by giving subcutaneous injection in cervical part at the daily doses of 5, 2 and 1 mg x kg(-1) x d(-1). The normal control group was given with normal saline by subcutaneous injection in cervical part. At seventh week of the experiment, the learning and memory abilities of mice were determined by water maze and jumping stand tests. At the end of the experiment, the mice were sacrificed and the cells damage of hippocampus was observed by HE staining in each group. Reactive oxygen species (ROS), malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase (CAT) and total antioxidant capacity (T-AOC) in the brain of mice were determined. The results showed that different doses of FGF-21 could reduce the time reaching the end (P < 0.01 or P < 0.05) and the number of touching blind side (P < 0.01 or P < 0.05) in the water maze comparing with the model group. It could also prolong the latency time (P < 0.05) and decrease the number of errors (P < 0.01 or P < 0.05) in the step down test. The result of HE staining showed that FGF-21 could significantly reduce brain cell damage in the hippocampus. The ROS and MDA levels of three different doses FGF-21 treatment group reduced significantly than that of the model group [(5.58 +/- 1.07), (7.78 +/- 1.92), (9.03 +/- 1.77) vs (12.75 +/- 2.02) pmol (DCF) x min(-1) x mg(-1), P < 0.01 or P < 0.05], [(2.92 +/- 0.71), (4.21 +/- 0.81), (4.41 +/- 0.97) vs (5.62 +/- 0.63) nmol x mg(-1) (protein), P < 0.01]. Comparing with the model group, the activities of SOD, GPx, CAT and T-AOC of the three different doses FGF-21 treatment groups were also improved in a dose-dependent manner. This study demonstrates that FGF-21 can ameliorate learning and memory abilities of D-galactose induced aging mice, improve the antioxidant abilities in brain tissue and delay brain aging. This finding provides a theoretical support for clinical application of FGF-21 as a novel therapeutics for preventing aging.

Objective To observe the pathologic type and degree of traumatic recurrent anterior dislocation of the shoulder by means of arthroscopy and discuss clinical results of modified Bristow method and arthroscopic Bankart reconstruction so as to provide refeFences for selecting operation methods.Methods A retrospective study was done off 62 patients(62 shoulders,44 males and 18 females.at av-erage age of 39.8 years.ranging from 21 to 67 years)with anterior recurrent dislocation of shoulder (mean duration of 87 months)admitted into our hospital from July 1997 to Oetcher 2007.All patients un-derwent preoperative arthroscopic examination that showed pathologic changes including injury of shoulder and humerus head,Bankart injury severity and laxitas of humerus glenoid ligament of articular capsule,which were used as referenee of surgical procedures.Modified Bristow's method or arthroscopic suture anchor Bankart reconstruction were performed according to arthroscopic results(pathologic change).The patients were assessed with the University of California at Los Angeles(UCLA)shoulder rating scale.Results There were 45 patients treated with modified Bristow,s method and 17 with arthroscopic suture anchor Bankart reconstruction.The follow.uD for mean 64.2 months showed that pre-and post-operative mean UCLA scores were(22.6±4.4)points and(29.8±4.2)points respectively(P＜0.01),the mean forward flexion(136.8±14.2)°and(156.6±17.8)°respectively(P＜0.01)and the mean ex-ternal rotation in 90°abduction(52.5±16.4)°and(72.4±11.3)°(P＜0.01).There were no redis-location at final follow-up,but there were 6 patients(9.6%)with positive apprehension test.Of all,60 patients(97%)returned to their pre-injury.work. Conclusions Observation of pathologic change of surgical procedure.Both modified Bristow's method and arthruscopic Bankart reconstruction are good methtxts for treatment of recurrent anterior shoulder dislocation under conditions of successful management of pathologic change of shoulder, restoration of normal anatomic structure of shoulder ioint and strict indi-cation control.

Objective To evaluate the efficacy of arthroscopic capsular release of frozen shoulder.Methods Twenty-five patients with frozen shoulder were treated arthroscopically from October 2001 to October 2003 in this hospital.The operation was performed under general anesthesia.The arthoscope was inserted through a posterior approach and the radiofrequency electrotome was inserted via an anterior approach.The synovitis of the biceps tendon and the rotator interval was thermo-coagulated.The superior glenohumeral ligament,the middle glenohumeral ligament,and the intra-capsular part of subscapularis tendon were cut to release the capsule.The combination manipulation was performed to release the residual contracture.The range of motion of the shoulder and the American Shoulder & Elbow Surgeons(ASES) scores were recorded at 3 and 6 postoperative months,respectively.Results The operative time was 75~95 min(mean,85 min).No intraoperative complications were found.As compared with preoperative conditions,the motion of inward rotation revealed no significant improvement at 1 week after operation(?~2=8.558,P=0.073) and other shoulder motions were significantly improved at different postoperative stages(P0.05).Conclusions Arthroscopic release for the treatment of frozen shoulder may obviously shorten the period of the disease and obtain good curative effects.

Objective To evaluate the T lymphocyte functions in elderly patients following major orthopedic operation. Methods From May 1998 to Feb 1999, 39 elderly patients (65 95 years old) hospitalized for orthopedic operation were studied. The patients' peripheral blood samples in the experimental group were obtained on days 1, 3, 7 and 14 postoperation, respectively. At the same days, blood samples were taken from 15 elder patients without trauma and operation (65 80 years old) within 6 months as controls. T lymphocyte subpopulations were differentiated by means of quantitative assay with autocounting method of FCM. Results CD3 T cell count was significantly decreased on day 1(54 4?11 3)% and day 14(58 5?12 6)%, compared with controls (63 9?8 3)% ( P

Objective To determine the sensitivity and accuracy of CT do ub le-contrast arthrography (CTA) in detecting underlying soft-tissue and bony abno rmalities of recurrent anterior glenohumeral dislocations. Methods From March 19 90 to May 2003, 31 patients with the signs and symptoms of recurrent anterior in stability, which were 23 males and 8 females with an average age of 26.7 years ( ranging, 22 to 46 years), were recruited for the study. All patients suffered fr om more than three times of glenohumeral dislocations, underwent CT arthrography after intraarticular injection of air and radiographic contrast medium before o peration. The surgical procedures included open Bristow operation in 25, Bankart operation in 3, Putti-Platt operation in 2, and a combination of Bankart and ca psular tightness operation by arthroscopy in 1. Each patient also underwent arth roscopy or open surgery and the observations were compared with CTA. Results Les ions of labrum and capsulo-ligamentous complex were the two most common abnormal ities demonstrated by surgical findings, which were respectively found in 28 and 20 patients at surgery. Anterior glenoid labral abnormalities, including of tea r, detachment, degeneration, were detected on CTA in 26 of 28, 2 of glenoid labr al degeneration were undetected on CTA, and the accuracy rate diagnosis on CTA w as 93.5%, while the sensitivity of CTA was 92.8%. Capsular lesions, including of marked medial scapular insertion, glenoid marginal stripping, and loss of inter vening scapular marginal soft tissues, were detected on CTA in 19 of 20, 1 of ca psular glenoid marginal stripping was undetected on CTA, and the accuracy rate d iagnosis on CTA was 87.1%, while, the sensitivity of CTA was 95%. Subscapularis tendon abnormalities, including of tears and irregularities, were visualized in 7 cases on CTA, but only 4 of which were identified during surgery. Furthermore, all of 15 Hill-Sachs defects, 6 Bankart bony defects, and 1 rupture of supraspi natus tendon suggested by CTA, were identified during surgery. For 26 of the pat ients with above kinds of lesion resulting in recurrent anterior glenohumeral di slocation, the accuracy rate of diagnosis was 83.7%. Conclusion The utilization of CT double-contrast arthrography can improve the understanding of multiple les ions associated with recurrent shoulder dislocation, it is contributed to select proper operative procedure.