Objective:To systematically review the effect of fracture liaison service (FLS) in elderly patients with fragile hip fractures, so as to provide reference for clinical decision-making.Methods:By combining subject terms and free terms, electronic searches were conducted on China National Knowledge Infrastructure, WanFang Data, VIP, China Biomedical Literature Database, PubMed, Embase, Cochrane Library and Web of Science. The included references were manually retrieved using the snowball method. The retrieval time was from the establishment of the database to March 1, 2023. Two researchers screened articles based on inclusion and exclusion criteria, extracted data, and evaluated the quality of articles, using RevMan5.4 software for statistical analysis.Results:A total of 15 articles were included, totaling 4 333 patients with fragile hip fractures, with a follow-up time of ≥3 months. Meta-analysis showed that FLS could improve patient medication compliance [ RR=2.32, 95% CI (1.74, 3.11) , P<0.01] and hip function [ SMD=1.20, 95% CI (0.93, 1.47) , P<0.01] , reduce mortality [ RR=0.70, 95% CI (0.58, 0.84) , P<0.01] and the occurrence of refractures [ RR=0.44, 95% CI (0.32, 0.61) , P<0.01] , with statistical differences. Conclusions:Compared with routine nursing for fragile hip fractures, FLS can improve medication compliance and hip function, decrease mortality and the occurrence of refractures in patients with fragile hip fractures.

Objective:To investigate the emergency surgical effect of ruptured intracranial dural arteriovenous fistula (DAVF).Methods:Patients with ruptured intracranial DAVF underwent microsurgery in the Department of Neurosurgery, Nanping First Hospital Affiliated to Fujian Medical University from May 2013 to July 2022 were retrospectively included. The clinical, imaging and follow-up data were collected, and the clinical characteristics, selection of surgical methods and treatment effects of patients were summarized.Results:A total of 8 patients with DAVF were enrolled. Their age ranged from 11 to 60 years (average, 48 years). There were 7 males and 1 female. All 8 patients suffered from intracranial hemorrhage, manifested as headache and vomiting in 2 cases, simple conscious disturbance in 2 cases, conscious disturbance with cerebral hernia in 3 cases, and conscious disturbance with limb paralysis in 1 case. The fistula was located in the anterior fossa in 4 cases (including 2 cases with aneurysms), the middle fossa in 2 cases (including 1 case with moyamoya disease), the transverse sinus in 1 case, and the anterior 1/3 area of the sagittal sinus in 1 case. Cognard classification: 7 patients were type Ⅲ and 1 was type Ⅳ. After admission, all patients underwent emergency craniotomy and microsurgery to remove hematoma. Among them, 4 patients underwent decompressive craniectomy at the same time, 1 patient with moyamoya disease underwent dural turnover and temporalis muscle application at the same time, and 2 patients with aneurysms at the same location were clipped at the same time. Postoperative re-examination of head CT showed that the hematoma was cleared satisfactorily and the midline was no shift in all 8 patients. CT angiography (CTA) showed that the fistula disappeared within 2 weeks. Seven patients were followed up within 1-12 months after operation. CTA or digital subtraction angiography showed no recurrence of DAVF. Two patients with aneurysms did not have residual or recurrent aneurysms. All patients had no new neurological symptoms, and the Glasgow Outcome Scale score in 2 patients increased by 1 compared with that at discharge.Conclusion:Emergency microsurgery is an effective method for the treatment of ruptured intracranial DAVF, especially for patients with special parts or complicated hematoma, cerebral hernia, and other vascular diseases.

Objective: To investigate the prognostic value of pretreatment albumin to globulin ratio(AGR)in prostate cancer(Pca)patients treated with maximal androgen blockade(MAB). Methods: Clinical and pathological data of 210 Pca patients who underwent MAB as first-line therapy between January 2013 and June 2018 were retrospectively analyzed.The ages of patients in our cohort ranged from 61 to 90 years, with a mean of(77.0±6.5)years.According to the cut-off point for AGR calculated by the receiver-operating curve analysis, patients were categorized into two groups: the high-AGR group and the low-AGR group.Clinical and pathological features were compared between the groups.Independent factors affecting prognosis were analyzed by using univariate and multivariate analysis. Results: The median follow-up duration was 44.0 months.Of the 210 patients, 99 cases had castration resistance, 100 patients(47.6%)had disease progression and 67 patients(31.8%)died.The cut-off point for AGR calculated by the receiver-operating curve analysis was 1.56.There were 103 cases in the low-AGR group(AGR<1.56)and 107 cases in the high-AGR group(AGR≥1.56). Univariate analysis revealed that the progression-free survival(PFS), cancer-specific survival(CSS)and overall survival(OS)were lower in the low-AGR group than in the high-AGR group[1.773(1.298~2.442), 1.948(1.220~3.213), 1.965(1.217~2.996), all P<0.05]. Multivariate Cox regression analysis showed that Gleason score, regional lymph nodes and bone metastases and AGR were independent prognostic factors for PFS(P=0.007, 0.040 and 0.022, P=0.031), CSS(P=0.003, 0.035 and 0.041, P=0.009)and OS(P=0.003, 0.026 and 0.023, P=0.002). Conclusions Pretreatment AGR<1.56 is an independent predictor for poor prognosis in Pca patients treated with MAB.

Objective:To investigate the effect of lentivirus-mediated silencing of mitochondrial ribosomal protein L35 (MRPL35) gene on the growth of human esophageal cancer TE-1cells, and to clarify its mechanism.Methods:Three kinds of human esophageal cancer cells, TE-1, ECA109and KYSE150, were selected.The relative expression levels of MRPL35mRNA in three kinds of cells by real-time quantitative PCR.The esophageal cancer TE-1cells were divided into shMRPL35group and shCtrl group, and the cells were infected with si-RNA lentivirus and si-RNA lentivirus;the esophageal cancer cell line stably silenting the MRPL35gene was established.Real-time quantitative PCR and Western blotting methods were used to detect the efficiency of MRPL35gene silencing.The cell growth curves in various groups were detected by CCK-8method, and the apoptotic rates were detected by flow cytometry after AnnexinⅤ-PE/7AAD double staining.Results:Three kinds of esophageal cancer cells expressed MRPL35gene, and the expression levels were not statistically significant between them (P＞0.05) .The results of real-time quantitative PCR and Western blotting methods showed that the mRNA and protein levels of MRPL35in the TE-1cells in shMRPL35group were significantly lower than those in shCtrl group (P＜0.05) .Compared with shCtrl group, the cell growth speed in shMRPL35group was decreased (P＜0.05) , and the apoptotic rate was significantly increased (P＜0.01) .Conclusion:Silencing MRPL35gene can inhibit the proliferation of esophageal cancer TE-1cells and plays a role through the apoptotic pathway.

Objective To study the expression of Stat5,E-cadherin and Vimentin in thyroid carcinoma and the correlation among them. Method The expression of Stat5,E-cadherin and Vimentin in 149 cases of thyroid specimens(including 23 cases of nodular goiter and 126 cases of thyroid carcinoma)was detected by immunohisto-chemistry SP method and the correlation analysis was conducted with the main clinical pathological parameters. Results The positive rate of Stat5 and Vimentin in thyroid carcinoma was 85.71% and 77.78% respectively, which was significantly higher than that in nodular goiter(26.09%and 8.70%)(P<0.05)and the positive rate of E-cadherin in thyroid carcinoma was 25.40%,lower than that in nodular goiter(86.96%)(P<0.05). Three kinds of protein expression were not significantly correlated with gender and age (P > 0.05),but obviously with lymph node metastasis and pathological type(P<0.05). Stat5 was negatively correlated with the expression of E-cadherin (r=-0.335,P=0.000)but positively with the expression of Vimentin(r=0.218,P<0.05). Conclusion The high expression of Stat5 and EMT in thyroid carcinoma tissues indicate that Stat5 may be involved in the EMT process of thyroid carcinoma ,thus it can promote the invasion and metastasis of thyroid carcinoma.

Objective To observe the change of serum fibrinogen(FIB) ,procalcitonin(PCT) and hypersensitve C reactive protein (hs-CRP) in children with infectious pneumonia and its clinical significance .Methods One hundred and four cases of children with bacterial infectious pneumonia (bacterial group) ,109 cases with non-bacterial infectious pneumonia(non-bacterial group) and 110 healthy children under going physical examination (control group) were included into this study ,the serum FIB ,PCT and hs-CRP level were observed in each group .Results The FIB ,PCT and hs-CRP levels in the bacterial group were higher than those in the non-bacterial group and control group (P<0 .05);the FIB ,PCT and hs-CRP had no statistical difference among the virus group , mycoplasma group and chlamydia group had no atoctistical(P>0 .05) .The positive rate of combined detection of FIB ,PCT and hs-CRP in the non-bacterial group and bacterial group was significantly higher than that of single index detection (P<0 .05) .The FIB level in the bacterial group was positively correlated with PCT and hs-CRP(r=0 .445 ,0 .396 ,P<0 .05) .PCT and hs-CRP showed a positive correlation (r=0 .487 ,P=0 .021) .Conclusion The combined detection of FIB ,PCT and hs-CRP can effectively identify bacterial infection and non-bacterial infection and which has an important clinical significance for the diagnosis and treatment of pathogenic infection of pneumonia .

Objective To investigate the effects of bone marrow(BM)-sparing pelvic intensity-modulated radiotherapy(IMRT)after surgery for cervical cancer on radiation dose to the target volume,organs at risk(OAR),and hematologic toxicity. Methods Ten patients with cervical cancer who would receive postoperative radiotherapy were selected.BM-sparing pelvic IMRT and conventional IMRT were performed for the same image by the Varian planning system. The radiation dose to the pelvis,the dose distribution of the target volume,and the radiation dose to OAR were compared between the two plans. A total of 30 patients with cervical cancer who had received postoperative radiotherapy were selected to investigate the relationships of the radiation dose to the pelvis with the lengths of the pelvis in coronal axis,sagittal axis,and vertical axis and the pelvic volume. A total of 41 patients with cervical cancer who would receive postoperative radiotherapy were randomly divided into observation group and control group. The observation group was given BM-sparing IMRT,while the control group was given conventional IMRT.The incidence of grade ≥2 hematologic toxicity was compared between the two groups and the relationship between the hematologic toxicity and the radiation dose to the pelvis was investigated. Results Both groups showed excellent dose coverage to the clinical target volume. There was no significant difference in radiation dose to the OAR between the two groups(all P>0.05).However,the observation group had significantly lower D mean,V 10,V 20,V 40,and V 50of the pelvis than the control group(P=0.003-0.045).The Pearson correlation analysis showed that D mean,V 20,V 30,V 40,and V 50of the pelvis were negatively correlated with the length of the pelvis in coronal axis(P=0.008-0.038).The observation group had a significantly lower incidence of hematologic toxicity than the control group(P=0.019).The logistic regression analysis showed that the development of hematologic toxicity was significantly associated with V 20of the pelvis (OR=1.191,P=0.042). Conclusions BM-sparing IMRT after surgery for cervical cancer can reduce the radiation dose to the pelvis and the incidence of blood toxicity. The radiation dose to the pelvis is negatively correlated with the length of the pelvis in coronal axis. The development of hematologic toxicity is associated with V 20of the pelvis.

Objective To observe the clinical features and evaluate the risk factors affecting prognosis in patients with secondary sepsis of gastrointestinal perforation (GIP). Methods A retrospective cohort study was conducted, and the patients with GIP admitted to the Department of General Surgery of Affiliated Shuyang People's Hospital of Xuzhou Medical University from January 1, 2014 to April 30, 2017 were enrolled, according to the presence or absence of sepsis occurrence, they were divided into GIP with and GIP without sepsis groups. The difference of gender, age, the time between the onset of GIP and the occurrence of sepsis, infection situation, body temperature, heart rate, respiratory frequency, white blood cell count (WBC), systemic inflammatory response syndrome (SIRS) in accord with standard, C-reactive protein (CRP), blood sugar, mean arterial pressure (MAP), lactic acid, number of cases having undergone laparoscopic surgery, sequential organ failure score (SOFA) and quick sequential organ failure score (qSOFA), Glasgow coma score(GCS), length of stay in intensive care unit (ICU), the total length of stay in hospital were compared;the status of survival and prognosis was assessed on day 30 by the Glasgow Outcome Scale (GOS). The indicators with statistical significance in the two groups were brought into the Cox regression model to analyze the independent risk factors affecting the prognosis of the patients. Results Fifty-eight patients with GIP were enrolled in this study. Among them, 22 cases developed secondary sepsis (GIP with sepsis group, there were 50.0% cases with single organ failure and 50.0% cases with multiple-organ failure, cases only in accord with 0-1 SIRS criteria accounting for 81.8%, and the mortality of secondary sepsis being 31.8%). No sepsis occurred in 36 patients (GIP without sepsis group). In GIP with sepsis group, the age, blood glucose, lactic acid, SOFA score, qSOFA, and the length of stay in ICU were significantly higher than those of GIP without sepsis group [age (years): 68.7±15.9 vs. 56.1±17.2, blood glucose (mmol/L): 6.9±2.3 vs. 5.9±1.2, lactic acid (mmol/L): 2.9±1.3 vs. 1.2±0.7, SOFA score: 5.6±3.2 vs. 0.5±0.4, qSOFA score: 1.0±0.9 vs. 0.3±0.1, the length of stay in ICU (days): 1.0 (0-4.0) vs. 0.1 (0-2.0), all P < 0.05], while MAP, GCS, and GOS scores in GIP with sepsis group were significantly lower than those in GIP without sepsis group [MAP (mmHg, 1 mmHg =0.133 kPa): 83.6±18.7 vs. 100.0±14.3, GCS score: 12.8±3.5 vs. 14.5±0.5, GOS score: 3.5±1.9 vs. 4.9±0.2, all P < 0.01]. Cox multivariable regression analysis showed: only low MAP and low GCS score were the independent risk predictors of death outcome for GIP with sepsis, the relative risk (RR) was 0.896 [95% confidence interval (CI) = 0.815-0.984, P = 0.022] and 0.585 (95%CI = 0.395-0.866, P = 0.007) respectively. Conclusion Patients with secondary sepsis following GIP have relatively high morbidity and much more risk factors, but only low MAP and low GCS score are closely associated with its high risk of death.

Objective To explore the microsurgery methods in patients with early intracranial aneurysm rupture. Methods Sixty-seven patients with early intracranial aneurysm rupture received the emergency microsurgery after releasing cerebrospinal fluid from improved Paine point via pterion craniotomy. Thirty-nine patients received surgery within 1 d after intracranial aneurysm rupture, and the other 28 patients were within 1-3 d. Results The therapeutic effect was evaluated by Glasgow outcome score (GOS) at discharge. Among the 45 patients with Hunt-Hess Ⅰ-Ⅲ grade, cure was in 41 cases, improved in 4 cases. Among the 22 patients with Hunt-HessⅣ-Ⅴgrade, cure was in 6 cases, improved in 6 cases, moderate disability in 4 cases, severe disability in 1 case, and death was in 5 cases. Conclusions The microsurgery of clipping aneurysm directly via pterion approach is still by far the most reliable treatment. And releasing cerebrospinal fluid from improved Paine points can effectively reduce the acute brain swelling of early operation, which will make it an effective adjuvant therapy to emergency microsurgery of clipping aneurysm.

Objective To study the ability of human embryonic stem cells to integrate into mouse liver and to repair chronic liver injury of the recipient.Methods On day 1,day-7 and day-15 after human embryonic stem cells were induced to differentiate into hepatocyte-like cells and were transplanted into mice with chronic liver failure,liver histopathology,liver function,liver tissue regeneration and mature hepatocytes of mice were tested respectively.Results Hepatic tissue pathology of mice significantly improved after transplantation and necrotic foci diminished,hemorrhage and congestion of hepatic cells relieved,and liver function improved.It was observed that human embryonic stem cells survived,proliferated,integrated with host liver,and differentiated into mature hepatocytes.Conclusions Human embryonic stem cells xenotransplanted into mice can participated liver tissue regeneration to some extent,and differentiated into functional liver cells.