Objective:To explore the related risk factors contributing to re-fracture after hip surgery in elderly patients.Methods:This retrospective analysis was conducted on the clinical data of 2 415 elderly individuals who underwent surgical treatment for hip fractures and were discharged from Shanghai Sixth People's Hospital between January 2016 and December 2021.Patients were grouped into re-fracture and non-re-fracture cohorts based on whether a second fracture occurred within three years after surgery.Demographics, clinical data, and postoperative functional rehabilitation outcomes of the two groups were collected, and univariate and multivariate logistic regression analyses were applied to identify the independent risk factors for re-fractures after surgery.Results:A total of 2, 000 patients who completed follow-up were included in the final analysis, aged 60~91 years, with a mean age of (75.4±8.2) years.Among them, 855 were male(42.75%), and the postoperative re-fracture incidence was 28.25% (565/2 000). Univariate analysis indicated that advanced age, fracture type at first onset, lower Harris scores, insufficient rehabilitation training, osteoporosis, diabetes, cerebrovascular disorders, visual impairment, and syncope were all significantly associated with re-fracture (all P<0.05), while gender differences were not statistically significant ( P>0.05). Multivariate regression confirmed the following as independent risk factors: age ≥75 years, postoperative Harris score <80, non-standard rehabilitation training, combined osteoporosis, diabetes, cerebrovascular disease, visual impairment, and syncope ( OR、 RR>1). Conclusions:Elderly patients are prone to re-fracture after hip surgery, and its occurrence is closely related to advanced age, inadequate functional rehabilitation, osteoporosis, and multiple internal medical comorbidities.In clinical practice, attention should be paid to standardized postoperative rehabilitation, systematic anti-osteoporotic therapy, and active intervention of comorbidities to reduce the incidence of re-fracture and improve the long-term prognosis of patients.

BACKGROUND: P16 inactivation is frequently accompanied by telomerase reverse transcriptase ( TERT ) amplification in human cancer genomes. P16 inactivation by DNA methylation often occurs automatically during immortalization of normal cells by TERT . However, direct evidence remains to be obtained to support the causal effect of epigenetic changes, such as P16 methylation, on cancer development. This study aimed to provide experimental evidence that P16 methylation directly drives cancer development. METHODS: A zinc finger protein-based P16 -specific DNA methyltransferase (P16-Dnmt) vector containing a "Tet-On" switch was used to induce extensive methylation of P16 CpG islands in normal human fibroblast CCD-18Co cells. Battery assays were used to evaluate cell immortalization and transformation throughout their lifespan. Cell subcloning and DNA barcoding were used to track the diversity of cell evolution. RESULTS: Leaking P16-Dnmt expression (without doxycycline-induction) could specifically inactivate P16 expression by DNA methylation. P16 methylation only promoted proliferation and prolonged lifespan but did not induce immortalization of CCD-18Co cells. Notably, cell immortalization, loss of contact inhibition, and anchorage-independent growth were always prevalent in P16-Dnmt&TERT cells, indicating cell transformation. In contrast, almost all TERT cells died in the replicative crisis. Only a few TERT cells recovered from the crisis, in which spontaneous P16 inactivation by DNA methylation occurred. Furthermore, the subclone formation capacity of P16-Dnmt&TERT cells was two-fold that of TERT cells. DNA barcoding analysis showed that the diversity of the P16-Dnmt&TERT cell population was much greater than that of the TERT cell population. CONCLUSION P16 methylation drives TERT -mediated immortalization and transformation of normal human cells that may contribute to cancer development.
Humans ; Telomerase/genetics* ; DNA Methylation/physiology* ; Fibroblasts/cytology* ; Cyclin-Dependent Kinase Inhibitor p16/metabolism* ; Cell Line ; Cell Transformation, Neoplastic/genetics*

Objective:To explore the related risk factors contributing to re-fracture after hip surgery in elderly patients.Methods:This retrospective analysis was conducted on the clinical data of 2 415 elderly individuals who underwent surgical treatment for hip fractures and were discharged from Shanghai Sixth People's Hospital between January 2016 and December 2021.Patients were grouped into re-fracture and non-re-fracture cohorts based on whether a second fracture occurred within three years after surgery.Demographics, clinical data, and postoperative functional rehabilitation outcomes of the two groups were collected, and univariate and multivariate logistic regression analyses were applied to identify the independent risk factors for re-fractures after surgery.Results:A total of 2, 000 patients who completed follow-up were included in the final analysis, aged 60~91 years, with a mean age of (75.4±8.2) years.Among them, 855 were male(42.75%), and the postoperative re-fracture incidence was 28.25% (565/2 000). Univariate analysis indicated that advanced age, fracture type at first onset, lower Harris scores, insufficient rehabilitation training, osteoporosis, diabetes, cerebrovascular disorders, visual impairment, and syncope were all significantly associated with re-fracture (all P<0.05), while gender differences were not statistically significant ( P>0.05). Multivariate regression confirmed the following as independent risk factors: age ≥75 years, postoperative Harris score <80, non-standard rehabilitation training, combined osteoporosis, diabetes, cerebrovascular disease, visual impairment, and syncope ( OR、 RR>1). Conclusions:Elderly patients are prone to re-fracture after hip surgery, and its occurrence is closely related to advanced age, inadequate functional rehabilitation, osteoporosis, and multiple internal medical comorbidities.In clinical practice, attention should be paid to standardized postoperative rehabilitation, systematic anti-osteoporotic therapy, and active intervention of comorbidities to reduce the incidence of re-fracture and improve the long-term prognosis of patients.

Objective To explore the clinical effect of endoscopic sclerosing agent and tissue glue injection combined with ligation in the treatment of rectal ectopic varices(EV)bleeding.Method A retrospective analysis was conducted on 60 patients with rectal EV bleeding who received endoscopic treatment from January 2017 to January 2022.According to the surgical method,the patients were divided into two groups,with 30 cases in the control group receiving endoscopic ligation treatment;30 cases in the observation group were treated with endoscopic scleroing agent and tissue glue injection combined with ligation.Follow up was conducted according to a cycle of 1,3,6 and 12 months after surgery,and the following indicators were compared between the two groups of patients:successful surgical hemostasis rate,incidence of postoperative complications,mortality rate,improvement of postoperative varicose vein diameter,and postoperative response rate.Result The success rate of surgical hemostasis in the observation group was 93.3%,significantly higher than 66.7%in the control group,the incidence of abdominal pain and fever in the observation group was 10.0%and 10.0%,respectively,significantly lower than 33.3%and 36.7%in the control group,there were 2 deaths in the observation group and 9 deaths in the control group,the mortality rate in the observation group was 6.7%,significantly lower than the 30.0%in the control group,the preoperative venous diameter of the observation group was(1.60±0.36)cm,and the postoperative diameter continued to decrease,at the 12th month after surgery,the diameter was(0.78±0.31)cm,while in the control group,the preoperative venous diameter was(1.52±0.26)cm,the postoperative diameter continued to increase,and at the 12th month after surgery,the diameter was(1.55±0.36)cm,the postoperative effective rate of the observation group was significantly better than that of the control group,the differences were statistically significant(P<0.05).Conclusion The combination of endoscopic scleroing agent and tissue glue injection combined with ligation for the treatment of rectal EV bleeding has a higher success rate and effective rate of surgical hemostasis,fewer postoperative complications,lower mortality rate during follow-up observation,and satisfactory clinical efficacy.It is worth further promoting and applying in clinical practice.

Objective:To investigate the image characteristics of woven coronary artery (WCA)on intravascular ultrasound(IVUS) and optical coherence tomography(OCT).Methods:Thirty-seven patients suspected of WCA on coronary angiography were enrolled from Teaching Hospital of Chengdu University of Traditional Chinese Medcine, Zhengzhou Cardiovascular Disease Hospital and Zhongshan Hospital of Fudan University from January 2013 to July 2020. The intraluminal imaging features of WCA were analyzed using IVUS and OCT.Results:Of the 37 patients admitted at the cardiology service, 9 patients had WCA. All the patients underwent coronary angiography, IVUS and OCT, of which 6 lesions were located on the right coronary artery, 2 lesions were located on the left anterior descending artery and 1 patient had WCA on the circumflex artery. The mean length of WCA lesions was 2.2 cm(ranged from 1.2 cm to 4.5 cm). The angiographic appearance of WCA was numerous small tortious channels origined form the main lumen. The channels appeared to be " doughnut" like pattern and they merged to normal artery again after the anomalous segment. Flow limitation was rare unless there was coronary atherosclerosis. OCT and IVUS showed multiple spiral channels in the anomalous segment, which were independent of each other and each channels had a relatively complete three-layers vascular structure.Conclusions:With typical image characteristics, IVUS and OCT are able to screen out WCA and guide the treatment decision making.

Objective To investigate the experience and effect of emergency cosmetic surgery for maxillofacial trauma.Methods From April 2011 to March 2017,256 patients with maxillofacial trauma in emergency cosmetic surgery in the People's Hospital of Lezhi County were selected in the study.The causes,locations,treatment methods and clinical effects were analyzed.Results In 256 cases,125 cases of traffic accident injury,68 cases of agricultural and industrial injury,48 cases of accidental injury,13 cases of asfights,2 cases of animal bites;of which 121 cases of lower face,73 cases of midface,39 cases of midface and lower face together,23 cases of upper face;98 cases of maxillofacial region fracture;105 patients had different degree of soft tissue defect.All patients the wound healed in primary healing,after stitches the wound healing in good contraposition,surface leveling,scar slender,facial features did not change significantly,no complications were observed.After 3-6 months of follow-up,the scar was not obvious and the appearance was satisfactory.Conclusion The clinical effect of emergency cosmetic surgery for maxillofacial trauma is satisfactory.Emergency cosmetic surgery can be used as an emergency treatment for maxillofacial trauma in primary hospital.

Objective To investigate the correlation of right ventricular (RV) to left ventricular (LV) volume ratio (RVv/LVv) measured by chest CT with pulmonary arterial pressure estimated by echocardiography before lung transplantation.Methods We reviewed 104 cases of lung transplant.According to the mean pulmonary arterial pressure (mPAP) exceeding 25 mmHg by right heart catheterization,hypertensive group (n =74) and normotensive group (n =30) were set up.Risk factors were assessed individually and adjusted for confounding by a multivariable logistic regression analysis.The area under the curve (AUC) for predicting pulmonary hypertension on chest CT and echocardiography was calculated.Results RVv/LVv and echocardiography-derived ptlmonary arterial systolic pressure (PASP) were significantly different between the two groups (P ＜ 0.05).In the hypertensive group,there was strong correlation between the RVv/LVv and PASP from catheterization (R =0.82,P＜0.001),also between the P ASP from echocardiography and catheterization (R =0.60,P＜ 0.001).The ROC curve displayed that with 0.85 as the cutoff for RVv/LVv,the sensmitivity,specificity and accuracy rate for predicting mPAP over 25 mmHg were 87.5％,91.8％ and 90.9％,respectively.The ROC curve also displayed that based upon an echocardiography-derived PASP of 35 mmHg as the cutoff point,the sensitivity,specificity and accuracy rate for predicting mPAP over 25 mmHg were 91.2％,90.8％ and 88.4％,respectively.Conclusion RV/LV volume ratios on chest CT and echocardiographic evaluation correlate well with PASP assessed by right heart catheterization and can be used to predict pulmonary hypertension with high sensitivity and specificity.

Objective To investigate the feasibility and clinical value of medical history and clinical manifestation-based protocol(MHCMP) for the diagnosis of spontaneous coronary artery dissection(SCAD)using intravascular ultrasound (IVUS).Methods Based on the MHCMP designed in our centre,intraoperative sequential analysis was performed in patients with acute coronary syndrom and clinical tip of SCAD,SCAD and its classification were defined according to the result of IVUS.Results Of the 37 patients admitted with ACS at the Cardiology Service,29 patients had SCAD as the cause(78.4 ％).All the patients underwent coronary angiography and IVUS,of which 9 patiens were type I (24.3 ％),15 patients were type Ⅱ (40.5％) and 5 patients were type Ⅲ (13.5％).The left anterior descending artery was the most frequently affected (16 patients),followed by the the right coronary artery (7 patients),while 5 patients had dissection of the circumflex artery and 1 patient had dissection of the left main coronary artery.Type I (evident arterial wall stain):this was the pathognomonic angiographic appearance of SCAD with contrast dye staining of the arterial wall with multiple radiolucent lumens.Type Ⅱ (diffuse stenosis of varying severity):this angiographic appearance was not well appreciated and was often missed or misdiagnosed.SCAD commonly involved the mid to distal segments of coronary arteries,and could be so extensive that it reached the distal tip.There was an appreciable (often subtle) abrupt change in arterial caliber,with demarcation from normal diameter to diffuse narrowing.This diffuse and usually smooth narrowing could vary in severity from inconspicuous mild stenosis to complete occlusion.Type Ⅲ (mimic atherosclerosis):this appearance was the most challenging to differentiate from atherosclerosis and most likely to be misdiagnosed,while IVUS was helpful for the differential diagnosis.Conclusions MHCMP is able to screen out all kinds of SCAD and guide the treatment decisions making.

Objective:To observe the influence of valsartan combined with Bailing capsules on urinary albumin excretion rate in early stage of type 2 diabetic nephropathy ( DN) , and explore its protection in early DN. Methods:Sixty patients with early DN were randomly divided into two groups. On the basis of diet control and blood glucose regulation, the control group (n=30) was given valsartan 160 mg, qd, while the prevention group (n=30) was treated by valsartan (160 mg·d-1) combined with Bailing capsules (2. 0g, po, tid), and the treatment course was 12 weeks. The urinary albumin excretion rate ( UAER) , mean arterial blood pressure ( MAP) , serum creat-inine ( Scr) and hemoglobin A1c ( HbA1c) were measured and compared before and after the treatment in the two groups. Results:UAER in the two groups was significantly reduced after the treatment compared with that before the treatment (P<0. 01), and that in the prevention group was obviously lower than that in the control group (P<0. 01). MAP in the two groups was significantly decreased after the treatment as well (P<0. 01), while there was no significant difference between the two groups. Scr and Hb Alc in the two groups showed no significant changes before and after the treatment (P>0. 05). Conclusion:Valsartan combined with Bailing capsules shows certain effects in the treatment of early stage of type 2 diabetic nephropathy by decreasing the urinary albumin excretion.

Objective To determine the changes of heart structure and function in early stage after lung transplant and to study the relationship between decreased pulmonary artery pressure and changes of heart structure and function.Methods 45 cases of lung transplant recipients were included in the study,their preoperative and postoperative echocardiography data were reviewed,and the postoperative early changes of cardiac structure and function were analysed.Then,the Pearson correlation analysis was used to compare the relationships between the decrease of pulmonary artery pressure and the changes of cardiac structure and function.Results After lung transplant,pulmonary artery systolic pressure(PASP) decreased significantly [(62.3 ± 27.2) vs (36.20 ± 7.8)mm Hg,P ＜0.01],and right ventricular dimensions zoomed down,tricuspid valve and pulmonary valve regurgitation reduced,left atrial diameter (LAD) and left ventricular end-diastolic diameter (LVDD) were enlarged,stroke volume (SV) increased [(43.85 ± 14.78) vs (58.68 ± 13.85)],but left ventricular ejection fraction (LVEF) was decreased [(69.31 ± 7.50)％ vs (62.82 ± 8.12) ％],those differences above were statistically significant (P ＜ 0.05) compared with preoperative echocardiography date.Pearson linear correlation analysis show that after lung transplantation the more decreased PASP,the more increased LAD and LVDD,and the more decreased LVEF (P ＜0.05).Conclusions In early stage after lung transplant,the structure of right ventricular was quickly normalized,the function of right ventricular improved,LAD enlarged,SV increased,but left ventricular function reduced,there were a linear correlation between those changes and PASP reduced.Echocardiography has good reference value for early lung transplant patient.