Ghrelin is a hormone produced by the stomach that regulates energy metabolism after acting on the central nervous system.Cocaine amphetamine-regulated transcriptional peptide(CART)neurons participate in the regulation of feeding behavior and energy balance.It is known that CART neurons are influenced by hormones to regulate energy homeostasis,but whether ghre-lin exerts its pro-appetite function by influencing CART neurons is unknown.Therefore,this study focuses on the role of VMHCART neurons in the regulation of feeding and relative body weight by ghrelin.Firstly,the whole brain expression of CART was determined by immunofluorescence.Then the effect of intraperitoneal injection of ghrelin on the expression of DMHCART neurons was evalua-ted.Finally,the ghrelin was delivered to DMH and the changes of food intake and relative body weight of mice were measured.CART immunoreactive neurons were detected in medial preoptic nucleus(MPA),arcuate nucleus(ARC),dorsomedial hypothalamic nucleus(DMH),thalamic pa-raventricular nucleus(PVT)and raphe nucleus(ROb).Compared with the control group,periph-eral injection of ghrelin significantly increased the expression of DMHC ART immunoreactive neurons(P=0.037 3).DMH long-term injection of ghrelin resulted in an increase in body weight(P=0.004 0)and feed intake(P=0.023 1).The results provide anatomical evidence for the whole brain distribution of CART,which proves that ghrelin affects feed intake and body weight of mice through CART neurons in DMH,suggesting that specific neuron types and regional specificity are involved in ghrelin regulation of feed intake and energy homeostasis.

Vesicular glutamate transporter 2(VGlut2)is expressed in the PVN of the hypothalamic paraventricular nucleus(PVNVG1ut2)as an excitatory neurotransmitter,which regulates food intake and energy metabolism and plays an important role in maintaining homeostasis.However,it is not clear that the upstream and downstream projection network of PVNVGut2 neurons hinders the anal-ysis of glutamatergic neuron circuit function.Anterograde and retrograde tracer viruses were injec-ted into the PVN of VGlut2 mice by stereotactic brain injection technique to find the input and output nuclei of PVNVGlut2 neurons.Anterograde tracing results showed that PVNVGlut2 neurons pro-jected to the downstream medial amygdala(MeAD)and arcuate nucleus(ARC).Retrograde trac-ing results showed that PVNVGlut2 received input from the prefrontal nucleus(Pr),the reticular tegmental nucleus(RtTg),and the hypoglossal nucleus(12N).In addition,VGlut2 was found to be co-expressed with neuronal nitric oxide synthase(nNOS)neurons in the PVN.The anatomical net-work of PVNVG1ut2 neurons was analyzed by virus tracking tool,which laid the anatomical founda-tion for further study on the functional regulation of PVNVGlut2.

【Objective】 To establish a predictive model for patients with hemorrhage after CT-guided coaxial core needle lung biopsy （CCNB） based on logistic regression. 【Methods】 A total of 489 patients who had undergone CCNB were retrospectively recruited. The potential risk factors of hemorrhage after lung biopsy were analyzed by univariate and multivariate logistic regression， through which we screened the independent risk factors and established a prediction model for hemorrhage. We evaluated the discrimination， calibration and clinical usefulness of the model. 【Results】 There were 141 cases （42.6%） of hemorrhage in the development group and 66 cases （41.8%） of hemorrhage in the validation group； there was no case of severe hemorrhage or hemothorax. Multivariate logistic regression analysis showed that fibrinogen degradation products， pulmonary interstitial fibrosis， largest diameter and puncture depth were independent predictive factors of hemorrhage. Hemorrhage prediction model was established and presented in the form of a nomogram. Discrimination of the model： the AUC was 0.837 in the development group and 0.777 in the validation group. The calibration curve showed good agreement between predicted probability and actual probability of hemorrhage. The unreliability test yielded a P value of 0.849 in the development group and 0.147 in the validation group. The DCA curve showed that the hemorrhage predictive model could increase the benefit of patients. 【Conclusion】 The predictive model of hemorrhage in patients after CCNB based on logistic regression can be used in clinical practice.

Objective:To explore the feasibility and optimization effect of modifying the Henry Ford Hospital (HFHS) RapidPlan model for stereotactic body radiation therapy planning based on local requirements.Methods:The following changes were made based on Henry Ford Health System(HFHS) Rapid Plan Lung SBRT model, taking the latest clinical guideline evidence and local clinical practice into account: Internal gross target volume(IGTV) and organ at risk(OAR) structure, lung, were added and set corresponding parameters.The upper value of planning target volume (PTV) was adjusted from 109% to 125%. The original training library was replaced with 73 local historical simultaneous integrated boosting plans, and statistical verification and outlier cleaning of the initial trained model were performed using Model Analytics software. Totally 10 cases not included in the model library were selected for independent verification, and automatic optimization result of the models before and after modifying were compared under the same beam condition. The following dosimetric parameters were compared after target dose normalization: conformal index (CI) of target volume, the mean doses, maximum doses and dose-volume parameters of OARs.Results:The " tail" of the PTV′s DVH and the " shoulder" and " tail" of the IGTV′s DVH of model M (local) validation plan (M (local)_P) performs higher than the original model HFHS (HFHS_P). The PTV_CI (1.07±0.13) of M local_P were significantly smaller than HFHS_P (1.25±0.24) ( Z=-2.497, P<0.05). Except for Heart_ D15 cm 3 and Heart_ Dmax, most of the M local_P dosimetric parameters of OARs were lower than HFHS_P, and the standard deviation was smaller. However, the difference of between two plans was no more than 3.06%. 10 HFHS_P plans don′t satisfy dose parameters requirement, two of which PTV_CI values are 1.52 and 1.74, far beyond the clinically acceptable range. Conclusions:Commercial model HFHS could be localized by replacing training library and adjusting parameters. Moreover, plans optimized by the modified model are local clinical acceptable in the aspects of target volume conformity and hotspots, and have a better performance in terms of OAR sparing and plan consistency.

Objective To compare the outcomes of homeopathic bidirectional-traction reduction device and traction table in surgical treatment of femoral intertrochanteric fractures.Methods A retrospective case control study was made on 94 cases of femoral intertrochanteric fractures treated from July 2015 to December 2015.There were 26 males and 68 females,aged 60-75 years.According to the Evans classification,the fractures were type Ⅱ in 24 cases,type Ⅲ in 32 and type Ⅳ in 38.Fifty-seven cases sustained chronic diseases.According to the random number table,the subjects were assigned to receive homeopathic bidirectional-traction reduction (homeopathic reduction group,48 cases) and traction table reduction (control group,46 cases).All fractures were fixed with proximal femoral nail antirotation.Operation time,reduction time,tluoroscopy time,blood loss and rate of closed reduced cases were recorded.Fracture union and rotation of the affected femur to the tibia were detected after operation.Functional outcome was evaluated using the Harris score at the final follow-up.Results All fractures were reduced closely in homeopathic reduction group,while 15 fractures in control group were reduced via a small-incision anterior approach.Operation time,reduction time and fluoroscopy time in homeopathic reduction group were (62.9 ± 12.1) min,(6.8 ± 1.5) min and (11.3 ± 5.6) s respectively,significantly less than the corresponding data in control group (all P ＜ 0.05).One month after operation,rotation of the affected femur to the tibia was (2.8 ± 1.2) ° in homeopathic reduction group,significantly less than that in control group [(11.5 ± 4.7) °] (P ＜ 0.05).Bone union was observed in all cases.At the final follow-up,Harris hip score was (92.6 ± 7.6)points in homeopathic reduction group,significantly higher than that in control group [(87.3 ± 6.5) points] (P ＜ 0.05).Conclusion For the elderly patients with intertrochanteric fractures,homeopathic bidirectional-traction device has advantages of high rate of closed reduction,shorter operation time,less radiological exposure and satisfactory function recovery of the affected hip joint.

Objective To investigate the effect of community comprehensive intervention on health behavior and self-rated health status among family caregivers of disabled elderly.Methods One hundredand twenty family caregivers of disabled elderly were selected from community health service centers of Beijing Dongcheng District,and were given 6 month-comprehensive community intervention (intervention group);121 family caregivers of disabled elderly from another community were selected as the control group.The knowledge and skills of caregiving,health behaviors (daily exercise time,daily relaxation time) and self-rated health status were evaluated before and 6 months after intervention.Results The knowledge and skill scores in intervention group were improved by 50.781 points,the daily exercise time and daily relaxation time were prolonged by 0.491 h and 0.837 h,respectively after the intervention (all P＜0.05).There was no significant difference in self-rated health status of two groups before and after intervention (P ＞0.05).Conclusion Community comprehensive intervention improves the knowledge and skills of caregiving,and the health behaviors among family caregivers of disabled elderly,but the intervention measures does not impact the self-rated health status of family caregivers.

Objective To observe the effect of yin-tonifying and fire-removing prescription on IL-10 and IL-18 in systemic lupus erythematosus patients with syndrome of internal heat due to yin deficiency.Methods A total of 86 systemic lupus erythematosus patients with syndrome of internal heat due to yin deficiency were enrolled and randomly divided into control group and research group,43 cases in each group.The control group was treated with conventional western medicine,while research group was treated with yin-tonifying and fire-removing prescription on basis of control group.The TCM symptom score,serum IL-10 and IL-18 levels and the incidence rate of adverse reactions were compared between the two groups.The clinical efficacy of the two groups was evaluated.Results Mter treatment,the levels of IL-10 and IL-18 in both group decreased significantly,and the levels in research group were significantly lower than control group (P ＜ 0.05).The total effective rate was 95.35％ in research group,which was significantly higher than 69.77％ in the control group (P ＜ 0.05).The incidence rate of adverse reactions was 6.98％ in the research group,whichwas similar to 9.30％ in the control group (P ＞ 0.05).Conclusion For systemic lupus erythematosus patients with syndrome of internal heat due to yin deficiency,yin-tonifying and fire-removing prescription can significantly improve the clinical efficacy,alleviate clinical symptoms,and will not increase the incidence rate of adverse reactions.

Objective To observe the effect of yin-tonifying and fire-removing prescription on IL-10 and IL-18 in systemic lupus erythematosus patients with syndrome of internal heat due to yin deficiency.Methods A total of 86 systemic lupus erythematosus patients with syndrome of internal heat due to yin deficiency were enrolled and randomly divided into control group and research group,43 cases in each group.The control group was treated with conventional western medicine,while research group was treated with yin-tonifying and fire-removing prescription on basis of control group.The TCM symptom score,serum IL-10 and IL-18 levels and the incidence rate of adverse reactions were compared between the two groups.The clinical efficacy of the two groups was evaluated.Results Mter treatment,the levels of IL-10 and IL-18 in both group decreased significantly,and the levels in research group were significantly lower than control group (P ＜ 0.05).The total effective rate was 95.35％ in research group,which was significantly higher than 69.77％ in the control group (P ＜ 0.05).The incidence rate of adverse reactions was 6.98％ in the research group,whichwas similar to 9.30％ in the control group (P ＞ 0.05).Conclusion For systemic lupus erythematosus patients with syndrome of internal heat due to yin deficiency,yin-tonifying and fire-removing prescription can significantly improve the clinical efficacy,alleviate clinical symptoms,and will not increase the incidence rate of adverse reactions.

Ipsilateral femoral neck and shaft fractures are rare injuries,which are often caused by high-energy trauma and combined with multiple injuries,such as thoracic and abdominal injury,head injuries,and fractures of other sites.Delayed or missed diagnosis of the ipsilateral femoral neck fracture often occurs.When patients with femoral shaft fractures caused by high-energy trauma are admitted into hospital,physical examination should be conducted carefully.In addition to femoral shaft fractures,radiographs of the ipsilater hip and knee joints should been taken,simultaneously taking into consideration the potential effect of anteversion angle on the demonstration of femoral neck fracture.Computed tomograph and magnetic resonance imaging are advised to perform if necessary to facilitate early and accurate diagnosis of ipsilateral femoral neck fracture.Comprehensive evaluation should be done based on age,physical condition,associated injuries as well as fracture site,classification and injury severity.Accordingly,proper and reasonable surgical plan is made.During the operation,anatomical reduction of the fractures,especially femoral neck fractures,should be achieved,and then fixed with appropriate internal implants.Besides,attention should also be paid to the treatment of associated injuries as well as the prevention and management of complications.

Ipsilateral femoral neck and shaft fractures are rare injuries,which are often caused by high-energy trauma and combined with multiple injuries,such as thoracic and abdominal injury,head injuries,and fractures of other sites.Delayed or missed diagnosis of the ipsilateral femoral neck fracture often occurs.When patients with femoral shaft fractures caused by high-energy trauma are admitted into hospital,physical examination should be conducted carefully.In addition to femoral shaft fractures,radiographs of the ipsilater hip and knee joints should been taken,simultaneously taking into consideration the potential effect of anteversion angle on the demonstration of femoral neck fracture.Computed tomograph and magnetic resonance imaging are advised to perform if necessary to facilitate early and accurate diagnosis of ipsilateral femoral neck fracture.Comprehensive evaluation should be done based on age,physical condition,associated injuries as well as fracture site,classification and injury severity.Accordingly,proper and reasonable surgical plan is made.During the operation,anatomical reduction of the fractures,especially femoral neck fractures,should be achieved,and then fixed with appropriate internal implants.Besides,attention should also be paid to the treatment of associated injuries as well as the prevention and management of complications.