Objective To assess the therapeutic efficacy of low-intensity focused ultrasound(LIFU)on knee arthrofibrosis in rats and explore its underlying mechanisms.Methods Fifteen male SD rats(8 weeks old,weighing 250～300 g)were randomly divided into a blank control group,a model group,and an ultrasound treatment group,with 5 animals in each group.Rat model of knee joint stiffness was established in the model and ultrasound treatment group.The rats in the ultrasound group received LIFU intervention(frequency:1 MHz,power:1.5 W,20 min per session,5 times/week)for 4 weeks.The knee ranges of motion(ROM,flexion and extension)were measured in all 3 groups at 0,14 and 28 d after intervention.Histological analysis was conducted for the morphological changes in the posterior capsular area of the knee.After the synovial fibroblasts were primary isolated from rat knee joints,the cells were divided into blank control,LIFU,TGF-β(10 ng/mL),and TGF-β+LIFU groups.Changes in fibrosis-related indicators and the TGF-β/Smad signaling pathway were assessed in each group.Results In the animal experiments,LIFU intervention for 14 d resulted in significantly improved flexion-extension ROM in knee joints when compared with the rats in the model group(P<0.05),and the improvement was more obvious at 28 d after intervention(P<0.05).After 28 d of LIFU intervention,the fibrosis of the posterior capsule of the knee joint was notably improved in the ultrasound group than the model group,and the expression levels of fibrosis-related indicators(α-SMA,TGF-β)were decreased(P<0.05).In the cellular experiments,the TGF-β group exhibited remarkable up-regulation of fibrosis-related molecules(α-SMA,COL1A1,COL3A1)at both protein and mRNA levels(P<0.05),and activation of the TGF-β/Smad signaling pathway when compared to the blank control group.While LIFU intervention inhibited the expression of TGF-β-induced upregulation of fibrotic indicators(α-SMA,COL1A1,COL3A1)and the activation of TGF-β/Smad signaling pathway(P<0.05).Conclusion LIFU can effectively improve knee arthrofibrosis in rats,which potentially through the inhibition of fibroblast activation and modulation of the TGF-β/Smad signaling pathway.

Objective:To investigate the distribution of pathogens and the risk of urinary tract infection for hospitalized spinal cord injury (SCI) patients.Methods:A total of 152 hospitalized SCI patients with a urinary tract infection were randomly divided into a complicated infection group (77 cases) and an uncomplicated infection group (75 cases) according to the diagnostic criteria for urinary tract infection. Univariate analysis quantified any correlation of urinary tract infection with gender, age, etiology, course of disease, injury level, injury degree, indwelling catheter use, diabetes history, hypoproteinemia, pressure ulcers, bladder compliance, maximum bladder manometric volume, maximum detrusor pressure during urine storage and detrusor overactivity during urine storage. Multivariate logistic regressions were evaluated to determine the independent risk factors.Results:A total of 124 pathogens were found in the subjects′ urine cultures. They included 83 gram-negative (G-) bacteria (66.94%), 31 gram-positive (G+ ) bacteria (25.00%), 9 fungi (7.26%) and 1 mycoplasm. The most common G- pathogen was Escherichia coli (42, 50.60%) with Enterococcus faecium (6, 19.35%) the most common G+. Overall, the five most common pathogens were Escherichia coli (42 strains, 33.87%), Klebsiella pneumoniae (10 strains, 8.06%), Proteus mirabilis (8 strains, 6.45%), Acinetobacter baumannii (7 strains, 5.65%), and Enterococcus faecium (6 strains, 4.84%). The univariate analysis showed that the etiology, injury level, injury degree, an indwelling catheter, pressure ulcers, maximum cystometric capacity, maximum detrusor pressure and detrusor overactivity in the storage phase were predictors of infection. The multivariate logistic regression analysis revealed that complete injury, an indwelling catheter, and increased maximum detrusor pressure in the storage phase were the independent risk factors.Conclusions:Escherichia coli is the most common pathogen causing urinary tract infection among SCI patients undergoing rehabilitation during hospitalization. Complete injury, an indwelling catheter, and increased maximum detrusor pressure in storage phase may be independent risk factors for urinary tract infection among such patients.

Objective:To investigate the distribution of pathogens and the risk of urinary tract infection for hospitalized spinal cord injury (SCI) patients.Methods:A total of 152 hospitalized SCI patients with a urinary tract infection were randomly divided into a complicated infection group (77 cases) and an uncomplicated infection group (75 cases) according to the diagnostic criteria for urinary tract infection. Univariate analysis quantified any correlation of urinary tract infection with gender, age, etiology, course of disease, injury level, injury degree, indwelling catheter use, diabetes history, hypoproteinemia, pressure ulcers, bladder compliance, maximum bladder manometric volume, maximum detrusor pressure during urine storage and detrusor overactivity during urine storage. Multivariate logistic regressions were evaluated to determine the independent risk factors.Results:A total of 124 pathogens were found in the subjects′ urine cultures. They included 83 gram-negative (G-) bacteria (66.94%), 31 gram-positive (G+ ) bacteria (25.00%), 9 fungi (7.26%) and 1 mycoplasm. The most common G- pathogen was Escherichia coli (42, 50.60%) with Enterococcus faecium (6, 19.35%) the most common G+. Overall, the five most common pathogens were Escherichia coli (42 strains, 33.87%), Klebsiella pneumoniae (10 strains, 8.06%), Proteus mirabilis (8 strains, 6.45%), Acinetobacter baumannii (7 strains, 5.65%), and Enterococcus faecium (6 strains, 4.84%). The univariate analysis showed that the etiology, injury level, injury degree, an indwelling catheter, pressure ulcers, maximum cystometric capacity, maximum detrusor pressure and detrusor overactivity in the storage phase were predictors of infection. The multivariate logistic regression analysis revealed that complete injury, an indwelling catheter, and increased maximum detrusor pressure in the storage phase were the independent risk factors.Conclusions:Escherichia coli is the most common pathogen causing urinary tract infection among SCI patients undergoing rehabilitation during hospitalization. Complete injury, an indwelling catheter, and increased maximum detrusor pressure in storage phase may be independent risk factors for urinary tract infection among such patients.

Objective:To observe any effect of photodynamic therapy (PDT) mediated by curcumin (CUR) on the proliferation of vascular smooth muscle cells (VSMCs) induced by platelet-derived growth factor-BB (PDGF-BB) through the phosphatidylinositol 3-kinase (PI3k)/serine threonine protein kinase (AKT) signaling pathway and explore its possible mechanism.Methods:Twenty μg/L of PDGF-BB was used to induce proliferation of VSMCs in A7R5 rat aortic smooth muscle cells and mouse aortic smooth muscle cells. Well-cultured VSMCs were randomly divided into a normal group, a PDGF-BB group, a curcumin group, and a low-dose PDT group (irradiated for 60s), a medium-dose PDT group (irradiated for 120s), and a high-dose PDT group (irradiated for 180s). The normal group was not given any intervention, and the PDGF-BB group was starved overnight and then stimulated for 24h by adding fresh medium containing 20μg/L of PDGF-BB. The curcumin group was first given the same intervention as the PDGF-BB group, and then placed in a medium containing 20μmol/L of curcumin for 6h. The PDT groups were first given the same intervention as the curcumin group, and then irradiated using a 425nm laser after removal of the medium. A CCK8 cell counting kit was used to detect the survival rate of VSMCs in the PDT groups after irradiation with the different laser doses. VSMC proliferation was detected using 5-ethynyl-2′-deoxyuridine (EDU) positive labeling. The cell cycle was observed using flow cytometry, and the expression levels of related phosphorylated proteins of the PI3K/AKT pathway and proliferating cell nuclear antigen were detected using western blotting.Results:The CCK-8 counts suggested that 120s was the optimum irradiation dose. The cell survival rates in the medium-dose and high-dose PDT groups were significantly different from the PDGF-BB group′s average. The proportion of proliferating cells in the PDT groups was significantly lower than in the PDGF-BB group. The proportion of cells in the G0 or G1 phase was significantly lower in the PDT group than in the normal group, while that in the G2 or M phase was significantly higher than in the normal and PDGF-BB groups. The expression of proliferating cell nuclear antigen and the phosphorylated proteins of the PI3K/AKT pathway had decreased significantly in the PDT group compared with the PDGF-BB group.Conclusion:CUR-mediated PDT inhibits PDGF-BB-induced proliferation of vascular smooth muscle cells, probably by down-regulating the expression of phosphorylated proteins related to the PI3K/AKT pathway.

Objective:To explore the effect of low intensity pulsed ultrasound(LIPUS)on inhibiting the abnormal cell phenotype of fibroblast-like synoviocytes in rheumatoid arthritis(RA-FLS)and possible mechanism. Method:Synoviocytes were isolated by using enzyme digestion,and the morphology of cells was observed un-der microscope.At the same time,the expression of Vimentin protein was detected by immunofluorescence method to identify RA-FLS.Cells cultured in vitro were divided into four groups:control group,LIPUS group,tumor necrosis factor(TNF-α)group and TNF-α+LIPUS group or three groups:control group,interleu-kin-6(IL-6)group and IL-6+LIPUS group.The effects of LIPUS on RA-FLS cell viability and proliferation were detected by CCK8 and EDU assay respectively,and the effects of LIPUS on RA-FLS migration were ob-served by scratch test and Transwell migration assay.RT-qPCR was used to detect the gene expression of im-portant cytokines,chemokines and matrix metalloproteinases(MMPs)in RA-FLS.ELISA was used to further detect the effect of LIPUS on the expression of IL-6,a key effector of RA-FLS,and the effects of LIPUS on mitogen-activated protein kinase(MAPK)signaling pathway in RA-FLS were detected by Western Blot. Result:Purified RA-FLS were obtained.Firstly,LIPUS could suppress the cell activity(P＜0.00l)and prolifer-ation(P=0.007)induced by TNF-α in RA-FLS cultured in vitro.However,the migration and the transcription levels of MMPs related to migration(MMP2 and MMP9)were not significantly different between groups(P＞0.05).LIPUS could inhibit the high expression of IL-6 and interleukin-8(IL-8)at the mRNA level in the in-flammatory environment induced by TNF-α(P＜0.001),but there was no significant difference in the suppres-sion of interleukin-1β(IL-1β),MMP1 and MMP13(P＞0.05).In addition,compared with untreated group,LI-PUS could inhibit the secretion of IL-6 in RA-FLS induced by TNF-α(P＜0.001),and also inhibited the pro-liferation of RA-FLS induced by IL-6(P-0.003).Finally,LIPUS could inhibit the phosphorylation of p38 MAPK and c-Jun N-terminal kinase(JNK)in MAPK signaling pathway(P=0.033),but the effect on the phosphorylation of extracellular signal-regulated kinas 1/2(ERK1/2)was not significantly(P＞0.05). Conclusion:LIPUS could reduce the abnormal proliferation of RA-FLS in inflammatory state without affecting its migration,which might be related to the inhibition of p38/JNK-IL-6 signaling pathway.

Objective:To explore the effect of case-based learning (CBL) guided by ICF (International Classification of Functioning, Disability and Health) in rehabilitation practice teaching.Methods:Fifty-eight rehabilitation undergraduates who had practiced in the Department of Rehabilitation Medicine in The First Affiliated Hospital of Chongqing Medical University from February 2019 to December 2019 were randomized into observation group and control group. The observation group adopted ICF-guided CBL method for practice teaching, while the control group adopted traditional teaching methods. At the end of the internship, all the students were assessed in terms of their theoretical knowledge, case analysis and clinical practice ability. At the same time, questionnaires were used to conduct a satisfaction survey on the teaching method, and the results of the two groups were compared and analyzed by ttest and rank-sum test through SPSS 25.0. Results:The scores of the observation group were higher than those of the control group, with statistical significance ( P<0.05) . In the satisfaction survey, the observation group was superior to the traditional teaching method in terms of self-thinking ability and learning initiative, with statistical significance ( P<0.05). Conclusion:ICF-guided CBL method can strengthen students' independent thinking ability and learning initiative, and improve the students' clinical comprehensive ability of rehabilitation treatment.

Objective:To investigate the therapeutic effect and possible mechanism of low intensity pulsed ultrasound（LIPUS）on painful gait in mice with Achilles tendon injury.Methods:Male C57BL/6 mice were selected to establish the Achilles tendon injury model by surgically full-thinkness tear of the right Achilles tendon. The mice were divided into Achilles tendon injury group and Achilles tendon injury+LIPUS group according to the random number table method，with 7 mice per group. The Catwalk gait analysis system was used to evaluate the gait function of the mice by measuring the following five parameters 14 days after operation，including print area，standing time，step cycle，max intensity and stride length. Morphological changes of the Achilles tendon were observed by HE staining. Immunofluorescence staining was used to detect the expression level of nitric oxide synthase（iNOS）in the Achilles tendon tissues. At the same time，Achilles tendon cells were isolated and cultured in vitro. The cells were induced by 100 ng/ml lipopolysaccharide（LPS）for 12 hours to establish in vitro model（LPS group），and treated with LIPUS（LPS+LIPUS group）. The control group was set as well（without any treatment）. The nuclear translocation of nuclear transcription factor-κB（NF-κB）P65 was detected by immunofluorescence staining，and the expression of iNOS and phosphorylation（p）-NF-κB p65 protein was detected by Western blotting. Results:Compared with Achilles tendon injury group［（0.14±0.10）cm 2］，the print area of the affected limb in Achilles tendon injury+LIPUS group［（0.28±0.13）cm 2］was increased（ P<0.05）. Compared with Achilles tendon injury group［（0.11±0.04）seconds］，the standing time of the affected limb in Achilles tendon injury+LIPUS group［（0.21±0.03）seconds］was increased（ P<0.05）. Compared with Achilles tendon injury group［（0.25±0.05）seconds］，the step cycle of the affected limb in Achilles tendon injury+LIPUS group［（0.40±0.05）seconds］was increased（ P<0.05）. There was no significant difference in the max intensity and stride length between Achilles tendon injury group and Achilles tendon injury+LIPUS group（ P>0.05）. HE staining showed obvious hyperplasia of Achilles tendon tissues in Achilles tendon injury group，with loosely and randomly arranged fibers，accompanied by neovascularization and inflammatory cell infiltration. Achilles tendon injury+LIPUS group showed more orderly arranged fibers in Achilles tendon tissues，and the degree of neovascularization and inflammatory cell infiltration were reduced. Compared with Achilles tendon injury group［（5.70±0.81）%］，the expression level of iNOS in Achilles tendon injury+LIPUS group［（2.84±0.94）%］was decreased 14 days after operation（ P<0.05）. Immunofluorescence results of Achilles tendon cells showed that NF-κB p65 protein entered the nucleus in LPS group compared with control group，and that LIPUS treatment inhibited nuclear translocation. In control group，Western blotting showed that iNOS was not expressed，and that the expression of phosphorylated NF-κB p65 was 0.63±0.16. Compared with control group，the expression levels of iNOS（0.99±0.22）and p-NF-κB P65（1.02±0.19）in LPS group were significantly increased（ P<0.05）. Compared with LPS group，the expression levels of iNOS（0.62±0.10）and p-NF-κB P65（0.65±0.21）in LPS+LIPUS group were decreased（ P<0.05）. Conclusion:LIPUS treatment can alleviate pain gait in mice with Achilles tendon injury and inhibit iNOS expression in vivo and in vitro，which may be related to inhibition of NF-κB signaling pathway.

According to characteristics of gait-assisted training, exoskeleton-based lower limb rehabilitation robot can be classified into treadmill-based exoskeleton robot and over-ground exoskeleton robot. Both kinds of exoskeleton-based lower limb rehabilitation robot have been applied in stroke rehabilitation, both in subacute and chronic stages, that may do something in gait training, balance improvement and lower limb motor function recovery.

Background and purpose:Adenosine triphosphate-binding cassette superfamily G member 2 (ABCG2), which has been found over-expressed in a variety of cancer cells, takes part in the drug resistance of cancer through effux of anticancer drugs. The purpose of this study was to investigate the mechanisms of human glioblastoma cells sensitivity to pyropheophorbide-a methyl ester (MPPa)-mediated photodynamic therapy (PDT) eradicating tumour cells and its relationship to ABCG2.Methods:U87 and A172 glioma cell lines in the logarithmic growth phase were selected and exposed to the treatment of MPPa-PDT and MPPa-PDT+fumitremorgin C (FTC) respectively. The cell viability was measured with the use of CCK-8 assay. The expression of ABCG2 was detected by Western blot. The intracellular contents of MPPa in each group without illumination were tested by lfow cytometry. Flow cytometry with AnnexinⅤ-FITC/PI double staining was used to detect the cell apoptotic rate. DCFH-DA staining was used to assess the generation of intracellular reactive oxygen species (ROS).Results:The MPPa-mediated PDT could eradicate A172 and U87 cancer cells in an energy-dependent manner. The light energy density in A172 was 8 times of that in U87 when the cell viability reached median lethal dose after MPPa-mediated PDT. The high expression of ABCG2 in A172 cells affected the accumulation of intracellular MPPa. Inhibition of ABCG2, not only could enhance the eradicating effect of MPPa-PDT on A172 cells, but also could increase the yield of ROS triggered by MPPa-PDT and the accumulation of intracellular MPPa.Conclusion:The human glioblastoma cell line A172 is insensitive to MPPa-mediated PDT. The mechanism may relate to ABCG2, which decreases the MPPa content in cancer cells through effux of MPPa, resulting in decline of cytotoxicity.

The practice of general practice emphasizes that the general practitioner is the backbone, and the primary health institution is the main body, which solves the main health problems of the commu-nity and meets the basic health service needs of the residents. Rehabilitation medicine occupies a prominent position in the community health service, and its related knowledge and skills are the important part of the whole medical education. However, rehabilitation medicine has more teaching contents, less training time and out-of-date teaching model, which have made the effect of rehabilitation medicine teaching not good. In the rehabilitation medicine teaching for training general practitioners, by strengthening the concept of reha-bilitation, elaborating teaching content, optimizing teaching ward-round, and outstanding ability as well as reforming evaluation way, we try to exercise the students' clinical thinking and improve clinical skills, to cultivate outstanding qualified general medical practitioners for community rehabilitation ultimately.