Objective To investigate the effect of local injection of human umbilical cord mesenchymal stem cells(hUC-MSCs)combined with sodium hyaluronate gel in the treatment of intrauterine adhesion in rats and its possible mecha-nisms.Methods Twenty-five specific pathogen-free female Sprague Dawley rats were divided into a blank control group,an intrauterine adhesion group,a sodium hyaluronate group,an hUC-MSCs group,and an hUC-MSCs+sodium hyaluronate group according to the random number table method,with 5 rats in each group.The rats in the blank control group received no treatment,while the rats in the rest four groups were injected with 950 mL·L-1 ethanol to prepare intrauterine adhesion models.One week following the establishment of the intrauterine adhesion models,100 μL of 1 × 1010 L-1 hUC-MSCs suspension was injected into the bilateral uterine horns of rats in the hUC-MSCs group and hUC-MSCs+sodium hyaluronate group;and 100 μL of normal saline was injected into the bilateral uterine horns of rats in the intrauterine adhesion group and sodium hyaluronate group.Subsequently,300 μL of sodium hyaluronate gel was injected into the bilateral uterine horns of rats in the sodium hyaluronate group and hUC-MSCs+sodium hyaluronate group;while,the same amount of normal saline was injected into the bilateral uterine horns of rats in the intrauterine adhesion group and hUC-MSCs group.After three days of intervention,all female rats in the five groups were combined with mature male rats possessing reproductive ability at a ratio of 1∶2 and then mated.The vaginal plugs of the female rats were observed for seven days to confirm successful mating.The abdominal aortic blood from pregnant rats in the five groups was extracted,and the serum levels of interleukin-6(IL-6)and interleukin-8(IL-8)were determined by using enzyme-linked immunosorbent assay.After blood collection,the rats were euthanized with excessive anesthesia,and subsequently,the uterus was removed and rinsed with normal saline.Firstly,the quantity of gestational sacs was counted;then,the endometrial tissues were meticulously separated,and the expression levels of matrix metalloproteinase-9(MMP-9)and transforming growth factor β,(TGF-β1)in the endometrial tissues of the rats were detected by using Western blot.Results The number of gestational sacs in rats in the intrauterine adhesion group,sodium hyaluronate group,hUC-MSCs group,and hUC-MSCs+sodium hyaluronate group was significantly fewer than that in the blank control group,the number of gestational sacs in rats in the sodium hyaluronate group,hUC-MSCs group,and hUC-MSCs+sodium hyaluronate group was significantly more than that in the intrauterine adhesion group,and the number of gestational sacs in rats in the hUC-MSCs+sodium hyaluronate group was significantly higher than that in the sodium hyaluronate group and the hUC-MSCs group(P＜0.05);there was no significant difference in the number of gestational sacs in rats between the sodium hyaluronate group and the hUC-MSCs group(P＞0.05).The serum IL-6 and IL-8 levels of rats in the intrauterine adhesion group,sodium hyaluronate group,hUC-MSCs group,and hUC-MSCs+sodium hyaluronate group were significantly higher than those in the blank control group,the serum IL-6 and IL-8 levels of rats in the sodium hyaluronate group,hUC-MSCs group,and hUC-MSCs+sodium hyaluronate group were significantly lower than those in the intrauterine adhesion group,and the serum IL-6 and IL-8 levels of rats in the hUC-MSCs+sodium hyaluronate group were significantly lower than those in the sodium hyaluronate group and the hUC-MSCs group(P＜0.05);there was no significant difference in the serum IL-6 and IL-8 levels of rats between the sodium hyaluronate group and the hUC-MSCs group(P＞0.05).The relative expression level of TGF-β,in the endometrial tissues of rats in the intrauterine adhesion group,sodium hyaluronate group,hUC-MSCs group,and hUC-MSCs+sodium hyaluronate group was significantly higher than that in the blank control group,while the relative expression level of MMP-9 was significantly lower than that in the blank control group(P＜0.05).The relative expression level of TGF-β,in the endometrial tissues of rats in the sodium hyaluronate group,hUC-MSCs group,and hUC-MSCs+sodium hyaluronate group was significantly lower than that in the intrauterine adhesion group,while the relative expression level of MMP-9 was significantly higher than that in the intrauterine adhesion group(P＜0.05).The relative expression level of TGF-β,in the endometrial tissues of rats in the hUC-MSCs+sodium hyaluronate group was significantly lower than that in the sodium hyaluronate group and the hUC-MSCs group,while the relative expression level of MMP-9 was significantly higher than that in the sodium hyaluronate group and the hUC-MSCs group(P＜0.05).There was no significant difference in the relative expression levels of TGF-β,and MMP-9 in the endometrial tissues of rats between the sodium hyaluronate group and the hUC-MSCs group(P＞0.05).Conclusion The combined injection of hUC-MSCs and sodium hyaluronate gel may up-regulate the expression level of MMP-9 protein and reduce the levels of TGF-β1 and inflammatory factors IL-6 and IL-8 in the endometrial tissues of rats with intrauterine adhesion,thereby repairing the damaged endometrium and increasing the number of gestational sacs.

As the comprehensive reform of public hospitals enters a more challenging phase,the conventional extensive operation management no longer fulfills the requirements of high-quality development.This article investigates the current challen-ges in hospital operation management under the DIP payment system,proposes an optimized pathway as well as an outline for practical implementation.The proposed pathway suggests implementing a closed-loop resource allocation strategy integrating budg-et and performance based on disease groups and scores,establishing a cost management mechanism for enhancing resource effi-ciency,and development of a performance distribution system for stimulating self-management motivation among personnel.Addi-tionally,the article suggests the establishment of a Management Information System,aiming to provide practical references for en-hancing operational management capabilities in public hospitals under the DIP payment mode.

Objective: To evaluate the caries preventive effect and economic outcome of an oral health promotion model in rural primary schools in Guangxi Zhuang Autonomous Region. Methods: In November 2015, a baseline survey was conducted on the caries prevalence of rural first graders in program areas, and then a program intervention was carried out on the first graders of target primary schools. The intervention methods included the distribution of oral health care products, oral health education, teacher training, etc. In 2020, the method of cluster random sampling was adopted to include the sixth graders who received the program intervention as first graders and were still available in 2020 as the intervention group. During this period, the sixth graders transferred from foreign schools who failed to receive the program intervention as first graders were included in the non-intervention group. The caries preventive effect was evaluated by analyzing the caries epidemiological data of 2 652 children aged 11-13 years, comparing the intervention and non-intervention group. The cost of the program was estimated by the structural analysis method. A decision tree model was established by TreeAge pro2019 and incorporated into the effect parameters and cost parameters for cost-effectiveness analysis and sensitivity analysis. Results : The prevalence of caries in the intervention group was 54.8%, and the mean DMFT was 1.36 ± 1.64, both of which were lower than those in the non-intervention group. The difference in prevalence and mean DMFT between the two groups was statistically significant (P < 0.05). It costs CNY 319.83 per child to reduce suffering from caries. The number of patients with caries in the intervention group was the most sensitive indicator of an economic effect. The probability of a cost-effectiveness advantage for the program was 92.2%. Conclusion This oral health promotion model used in rural schools demonstrated a caries preventive effect that was very likely economically advantageous. It is of practical significance to improve and promote this model in the Guangxi Zhuang Autonomous Region.

OBJECTIVE: To assess the geometrical matching of a new anatomical adaptive titanium mesh cage (AA-TMC) with the endplate and its effect on cervical segmental alignment reconstruction in single- and two-level anterior cervical corpectomy and fusion (ACCF) and compare the compressive load at the endplate between the AA-TMC and the conventional titanium mesh cage (TMC). METHODS: Twelve cervical cadaveric specimens were used to perform single- and two-level ACCF. The interbody angle (IBA), interbody height (IBH) and the interval between the AA-TMC and the endplate were evaluated by comparison of the pre- and postoperative X-ray images. The maximum load at the endplate was compared between the AA-TMC and TMC based on American Society for Testing and Materials (ASTM) F2267 standard. RESULTS: No significant differences were found between the preoperative and postoperative IBA and IBH in either single-level ACCF (11.62°±2.67° 12.13°±0.69° and 23.90±2.18 mm 24.23±1.13 mm, respectively; > 0.05) or two-level ACCF (15.63°±5.06° 16.16°±1.05°and 42.93±3.51 mm 43.04±1.70 mm, respectively; > 0.05). The mean interval between the AA-TMC and the endplate was 0.37 ± 0.3 mm. Compared to the conventional TMC, the use of AA-TMC significantly increased the maximum load at the endplate in both single-level ACCF (719.7±5.5 N 875.8±5.2 N, < 0.05) and two-level ACCF (634.3±5.9 N 873±6.1 N, < 0.05). CONCLUSIONS The use of AA-TMC in single-level and two-level ACCF can significantly increase the maximum load at the endplate to lower the possibility of implant subsidence and allows effective reconstruction of the cervical alignment.
Biomechanical Phenomena ; Cervical Vertebrae ; Humans ; Prostheses and Implants ; Spinal Fusion ; Surgical Mesh ; Titanium ; Treatment Outcome

Objective: To evaluate the value of ultrasound-guided fine needle aspiration(US-FNA) combined with detection of BRAF V600E and thyroid imaging reporting and data system(TI-RADS) in diagnosis of benign and malignant thyroid nodules. Methods: In this study, 123 operative thyroid nodules from 114 patients who underwent US-FNA and detection of BRAF V600E were enrolled. TI-RADS was apply for the classification of each nodule before surgery. Specimens from each nodule were subjected for hematoxylin and eosin (HE) staining and cytological diagnosis and detection of BRAF V600E mutation. Results: ①BRAF V600E mutation was found in 71 (71/123) nodules with histologic confirmation of papillary-thyroid carcinoma, 58 of which were cytologically diagnosed as carcinoma and 13 were indeterminate. Compared with the postoperative pathological results, US-FNA combined with BRAF V600E could improve the sensitivity and accuracy of diagnosis to thyroid nodules compared with individual US-FNA, and the difference was statistically significant(P<0.001). ②The mutation rate of BRAF V600E was associated with thyroid capsular invasion(χ²=8.44, P=0.004), and combined with TI-RADS could indicate the high-risk of this invasion. ③Among 123 operative nodules, 18 nodules were BRAF V600E negative and cytologically diagnosed as indetermination, 10 of which were TI-RADS 3b or above. After thyroidectomy, 6 nodules were confirmed as papillary-thyroid carcinoma, 1 nodule was thyroid follicular carcinoma, and 3 nodules were benign ones. Conclusions US-FNA combined with detection of BRAF V600E and TI-RADS can improve the diagnostic accuracy and decrease the misdiagnosis in indeterminate nodules.

Objective To explore the value of high frequency ultrasound in differential diagnosis in dorsal thyroid (including gland dorsal or posterior) nodules.Methods Ultrasonographic features of 101 patients with ultrasonography suspected or misdiagnosed nodules in the dorsal area of the thyroid gland,which were then confirmed by pathology or hyaluronography/gastroscopy,were retrospectively analyzed.Ultrasonographic homogeneity (other nodules with similar ultrasonographic features were found in the ipsilateral gland),parenchyma homology (nodule parenchyma was continuous with glandular parenchyma) and blood homology (blood flow signals in nodules were continuous with those in glandular parenchyma) were applied as indicators for determinng thyroid nodules.Double-line sign or vascular arch sign at the edge of nodules served as an indicator for determining parathyroid nodules.Results Of the 101 cases,there were 46 thyroid nodules,35 parathyroid nodules,7 enlarged lymph nodes;6 esophageal diverticulum,6 esophageal cancer,1 cleft cyst.The determination of thyroid nodules by at least one of ultrasonographic homogeneity,parenchyma homology and blood homology showed sensitivity of 73.5 ％,specificity of 96.5 ％ and accuracy of 85.8％.In the determination of parathyroid nodules by double-line sign or vascular arch sign at the edge of nodules,sensitivity,specificity and accuracy was 54.1％,85.5 ％ and 74.5 ％,respectively.Conclusions Nodules in the dorsal area of the thyroid gland have different sources,and the understanding of corresponding characteristic ultrasonographic appearances is helpful for improving the differential diagnosis of these nodules.

Objective To explore the correlation between NF-κB signaling pathways activated by IL-18 in CD4+ T cells and the pathogenesis of PBC.Methods We detected the expression of IL-18 mRNA in PBMCs,IL-18 level in plasma,receptor IL-18R on surface of CD4+ T cell,proliferation rate of CD4+T cell and its NF-κB signaling pathway protein IκBα and NF-κB p65 by qRT-PCR,ELISA,flow cytometry,MACS and Western blot on 32 cases of patients with PBC (PBC group) and 32 healthy people (control group) in Guizhou provincial people′s hospital.Results The level of IL-18 in PBC group was significantly higher than that in control group (P<0.05).The relative expression of IL-18 mRNA in PBC group was significantly higher than that in control group (P<0.05).The percentage of CD4+T cells expressing IL-18Rα in PBC group was higher than that in control group (P<0.05).The proliferation rate of CD4+T cells stimulated by IL-18 in PBC group was significantly higher than that in healthy control group (P<0.01).The relative expression levels of NF-κB p65 protein were up-regulated in IL-18,and the expression of IκBα protein in each group was significantly increased,especially in PBC group (P<0.01).Conclusion IL-18 can activate NF-κB signal pathway in CD4+ T cells and participate in the pathogenesis of primary biliary cirrhosis.

Objective To observe the therapeutic effect of consciousness-restoring needling combined with comprehensive rehabilitation training on motor function and the activities of daily living of poststroke patients with hemiplegia. Methods Sixty qualified patients were evenly randomized into observation group and control group. All of the patients were given conventional medicine treatment and conventional rehabilitation training, and the treatment group was given consciousness-restoring needling additionally. The therapeutic effects were compared at the end of first session of treatment for 4 weeks and 12 weeks after the first session of treatment. The Fugl-Meyer motor assessment scale (FMA), modified Barthel Index (MBI) and Stroke-Specific Quality of Life Scale ( SS-QQL) were taken as the main evaluation indexes. Results The differences of FMA, MBI and SS-QOL scores were insignificant between the two groups before treatment ( P>0.05). At the end of treatment for 4 weeks, FMA, MBI and SS-QOL scores were increased in the two groups (P<0.05), and the increase was more obvious in the observation group (P<0.05). The results of follow-up till the 12th week showed that FMA, MBI and SS-QOL scores were still higher than the baseline level ( P<0.05). Conclusion Consciousness-restoring needling combined with comprehensive rehabilitation training has better effect on improving motor function and the activities of daily living of poststroke hemiplegia patients than comprehensive rehabilitation training alone.

Objective To investigate the effects of remote ischemic postconditioning (RIPoC) on global cerebral ischemia-reperfusion (I/R) injury in rats.Methods One hundred and twenty-eight male adult SD rats weighing 200-250 g were randomly divided into 4 groups ( n =32 each):sham operation group (group S),group I/R,group I/R + RIPoC and remote I/R group (group RI/R ).Global cerebral I/R was induced by four-vessel occlusion.Group I/R + RIPoC received 3 cycles of 15 min reperfusion followed by 15 min ischemia in bilateral femoral arteries at the beginning of cerebral reperfusion.The rats were sacrificed at 24 and 48 h of cerebral reperfusion,and brains were removed for determination of neuronal apoptosis (by TUNEL method) in hippocampal CA1 region and the parietal cortex,Bcl-2 and Bax expression (by Western blot) in hippocampal CA1 region.The superoxide dismutase (SOD) and catalase (CAT) activity and malondialdehyde (MDA) content in hippocampal CA1 region and the parietal cortex were also measured at 48 h of cerebral reperfusion.Morris water maze task was used to test the learning and memory function at 4 d of cerebral reperfusion,and the rats were sacrificed at 7 d of cerebral reperfusion,and brains were removed for determination of neuronal density in hippocampal CAl region and the parietal cortex.Results Cerebral I/R significantly increased the number of apoptotic neurons and MDA content,upregulated Bcl-2 and Bax expression,decreased neuronal density,SOD and CAT activity and learning and memory function in group I/R as compared with group S.RIPoC significantly attenuated these cerebral I/R-induced changes.Conclusion RIPoC could protect brain against global cerebral I/R-induced injury,and the mechanism may be related to inhibiting lipid peroxidation,regulating the balance between Bcl-2 and Bax and inhibiting apoptosis.

Objective: To investigate the effects of different processing methods(steeping, boiling) and different adjuvants(alum, ginger, bile) on contents of amino acid and part of inorganic elements in Arisaema amurense Maxim.. Methods: The amino acid was determined by HPLC, and the inorganic elements were determined by AAS. Results: The total content of amino acid was the highest in raw Arisaema amurense Maxim. and the lowest in Arisaema amurense Maxim. processed with bile, wherease it was similar to other processed samples. The inorganic element content changed after it was processed. Conclusion: The long rinse is the key factor of losing amino acid in Arisaema amurense Maxim. after being processed. The content of inorganic element in adjuvants is the key factor of their content changes in Arisaema amurense Maxim. after it is processed.