Frailty is a complex age-related clinical condition characterized by a decline in physiological capacity across several organ systems, with a resultant increased susceptibility to stressors.The relationship between frailty assessment and elderly patients’ safety during perioperative period has received widespread attention.This paper reviews research progress of frailty assessment in elderly patients during perioperative period in the department of urology.

Purpose: Bone destruction and pain caused by cancer is one of the most devastating complications of cancer patients with bone metastases, and it seriously affects the quality of patients’ life. Extracellular matrix metalloproteinase inducer (EMMPRIN) is a cell adhesion molecule with increased expression in a variety of tumors. This study focused to clarify the specific function of EMMPRIN in bone metastasis of breast cancer. Materials and Methods: Adenovirus with shRNA-EMMPRIN was transfected into MRMT-1 rat breast carcinoma cells, and the MRMT-1 cells with different expression levels of EMMPRIN were implanted into the bone marrow cavity of rat tibia. Next, the effect of down-regulation of EMMPRIN was evaluated as follows: bone damage was detected by X-ray radiological and tartrate-resistant acid phosphatase staining; the tumor burden was evaluated by hematoxylin and eosin staining; the test of pain-related behaviors was assessed used the bilateral paw withdrawal mechanical threshold; and the levels of secretory factors in tumor conditioned medium were determined by using enzyme-linked immunosorbent assay. Results: We found that down-regulation of EMMPRIN in tumor cells can simultaneously reduce tumor burden, relieve cancer-induced bone destruction and pain. Conclusion: Materials and Methods EMMPRIN is expected to be a therapeutic target for relieving bone metastasis of breast cancer and alleviating cancerinduced bone destruction and pain. The method of targeting EMMPRIN may be a promising strategy for the treatment of cancer in the future.

Purpose: Bone destruction and pain caused by cancer is one of the most devastating complications of cancer patients with bone metastases, and it seriously affects the quality of patients’ life. Extracellular matrix metalloproteinase inducer (EMMPRIN) is a cell adhesion molecule with increased expression in a variety of tumors. This study focused to clarify the specific function of EMMPRIN in bone metastasis of breast cancer. Materials and Methods: Adenovirus with shRNA-EMMPRIN was transfected into MRMT-1 rat breast carcinoma cells, and the MRMT-1 cells with different expression levels of EMMPRIN were implanted into the bone marrow cavity of rat tibia. Next, the effect of down-regulation of EMMPRIN was evaluated as follows: bone damage was detected by X-ray radiological and tartrate-resistant acid phosphatase staining; the tumor burden was evaluated by hematoxylin and eosin staining; the test of pain-related behaviors was assessed used the bilateral paw withdrawal mechanical threshold; and the levels of secretory factors in tumor conditioned medium were determined by using enzyme-linked immunosorbent assay. Results: We found that down-regulation of EMMPRIN in tumor cells can simultaneously reduce tumor burden, relieve cancer-induced bone destruction and pain. Conclusion: Materials and Methods EMMPRIN is expected to be a therapeutic target for relieving bone metastasis of breast cancer and alleviating cancerinduced bone destruction and pain. The method of targeting EMMPRIN may be a promising strategy for the treatment of cancer in the future.

AIM: To investigate the clinical application value of trazodone combined with cognitive behavioral therapy on heroin addicts during the period of community detoxification. METHODS: A total of 140 heroin addictive patients treated by community detoxification management were randomly divided into four groups, 35 patients were given trazodone combined with cognitive behavioral therapy (T+P group), 35 patients were given a single trazodone therapy (T group), 35 patients were given a single cognitive behavioral therapy (P group), and 35 patients were only given community detoxification management (S group), the course of the treatment lasted for 12 weeks. At the time-point of baseline and the weekends 4, 8 and 12 after treatment, four groups were scored by Hamilton anxiety rating scale (HAMA), Hamilton depression rating scale (HAMD), Pittsburgh sleep quality index scale (PSQI), psychological craving rating scale (PCS), Chinese perceived stress scale (CPSS), and urine morphine positive rate. The safety was evaluated with Treatment Emergent Side-effect Scale (TESS) and laboratory test. RESULTS: A total of 125 patients completed the 12 weeks of treatment. HAMA, HAMD and PSQI scores of T+P group and T group on weekends 4, 8 and 12 were significantly reduced when compared with baseline, respectively (P< 0.05). HAMA and HAMD scores of P group on weekends 4, 8 and 12 were significantly decreased when compared with baseline, respectively (P< 0.05). PSQI scores of P group on weekends 8 and 12 were significantly decreased when compared with baseline, respectively (P< 0.05). HAMA, HAMD and PSQI scores of S group on weekend 12 were significantly reduced when compared with baseline, respectively (P< 0.05). There were significant differences on the PCS and CPSS scores between T+P group, T group, P group and S group on weekends 4, 8 and 12, respectively (P< 0.05). There also showed statistically significant differences on the urine morphine positive rates between T+P group and S group on weekends 4, 8 and 12, respectively (P< 0.05). There was no significant difference on the TESS score between T+P group and T group (P> 0.05). CONCLUSION: Trazolone combined with cognitive behavior therapy can significantly improve the negative emotions, sleep quality and other related mental symptom of heroin addiction patients in the community detoxification period, and play a positive role in improving the quality of community detoxification management.

Objective:Based on the detection of CD4+IL17+Th17 and CD4+CD25+Foxp3+Treg cells in the peripheral blood of patients with human papilloma virus (HPV), the study analyzes the ratio of Th17 to Treg and compares the different expression of cytokine IL-17, IL-10, TGF-β, and IL-23 in the serum. Methods:From September 2014 to June 2016, 119 cases of untreated patients with cervical HPV in-fection were collected at the First Affiliated Hospital of Xinjiang Medical University, which include 46 cases of cervical cancer (CC), 43 cases with cervical intraepithelial neoplasia (CIN)Ⅱ-Ⅲ, and 30 with chronic cervicitis (CCS). The detection of HPV types classified 80 patients as high-risk and 39 as low-risk. Flow cytometry examined Treg and Th17 cells, and enzyme-linked immune sorbent assay was used to test related cytokines. Results:In the infection of high-risk cervical HPV, the rate of the CC group was 87%(40/46), which was higher than that of the CINⅡ-Ⅲgroup and the CCS group, which were 77%(33/43) and 23%(7/30), respectively. For the expression of Th17 and Treg cells in the peripheral blood and the related cytokine IL-17, IL-23, TGF-β, and IL-10 in the serum, the levels of CC group were also significantly higher than that of the other two groups, and the ratio of Th17 to Treg increased considerably with the se-verity of cervical lesions. The expression of Th17 and Treg cells in the peripheral blood of patients with high-risk cervical HPV were higher than that of patients with low-risk cervical HPV (P<0.05), which was the same for the expression of the related cytokine IL-17, IL-23, TGF-β, and IL-10 in the serum. The ratio of the Th17 to Treg of patients with high-risk cervical HPV increased remarkably (P<0.05). Conclusion:The expression of Treg and Th17 cells in high-risk patients exhibits an increasing trend, and the ratio of increased Th17 to Treg may directly participate in the process of HPV infection and immune evasion, which plays an important role in the occurrence and development of cervical cancer.

The blood concentrations of the pharmacodynamic substances of traditional Chinese medicines (TCMs) are usually very low. How can they exert pharmacological actions, in which forms (original form, metabolite or the both) do they exert the actions. To answer these questions, we proposed a new concept ofEffective Formsof pharmacodynamic substances of TCMs and a hypothesis of additive effect of multiple constituents of TCMs. The hypothesis includes that the aggregate or summation of Effective Forms of pharmacodynamic substances of TCMs is the core material base of the effi-cacy of TCMs, and the additive effect of the blood concentrations of different Effective Forms is one part of the action mechanism. The additive effect of the different Effective Forms of a TCMs means an additive effect of numerous con-stituents or/and metabolites on a same target, and therefore the efficacy brought by the addition of the concentrations of all these compounds, which different from the synergy effect of multi-constituents on multi-targets. Studies on the disposition of TCMs showed that a constituent can be biotransformed to many metabolites (up to more than 50 metabolites);different constituents can produce the same metabolites;many metabolites (up to 10 compounds for each metabolite) are isomers or homologues; some constituents can be converted to each other in vivo; and some metabolites are bioactive. These com-pounds having the similar structure are likely to have the same pharmacological effects on the same target, which could provide experimental evidences for the concept ofEffective Formsand the hypothesis ofAdditive Effect. We suggest that the Effective Forms and Additive Effects of the pharmacodynamic substances of TCMs should be extensively investi-gated in the future, and the results of such researches will help us further understand the pharmacodynamic substances and action mechanism of TCMs, and give a new explanation 'Toxicities Scattering Effect' for 'Why the toxicities of TCMs are low', and propose a new strategy for quality control of TCMs.

Many species of the genus Ephedra plants are used as Chinese traditional medicines, in Chinese which are known as "Mahuang" (Ephedrae Herba). In order to get a clear picture of resources distribution and varieties on Chinese markets of the crude drug Mahuang and provide scientific basis for their resource conservation and sustainable use, during recent years we conducted field investigations and market researches many times. The results showed that the most common species on the Chinese markets was E. sinica (33/38 commercial samples), followed by E. intermedia (5/38 commercial samples), which was also used in local clinics in Qing-hai, Gansu and Xinjiang province, no E. equisetina was found in the market. We noticed that the resources of both official and non-official plants of Mahuang, especially Zhong-Mahuang and Muzei-Mahuang, were seriously damaged in the past decade because of the ecological environment damage and over-digging. Zhong-Mahuang was distinguished in Ningxia and north Gansu, which was once one of the most distribution areas and contains more than 10,000 t Zhong-Mahuang. Muzei-Mahuang was distinguished in most places and distributed sparsely around Altay Mountains in northeast in Xinjiang. Thus, Cultivation of Mahuang, especially Zhong-Mahuang and Muzei-Mahuang should be greatly developed. At the same time, wild resources of Mahuang must be preserved strictly, i.e., proper method of cutting Ephedra plant could prevent the damage of the resource.
China ; Conservation of Natural Resources ; Drugs, Chinese Herbal ; classification ; supply & distribution ; Ephedra sinica ; classification ; growth & development

Objective To investigate the differences of risk factors for ischemic stroke between the Han and Uygur nationalities in Xinjiang China.Methods The data of demography,vascular risk factors,lifestyle as well as blood pressure,blood glucose and blood lipids on admission of 589 patients with stroke (Han 294 cases and Uygur 295 cases) in 5 hospitals from 2007 to 2009 in Xinjiang,China were collected.The exposure levels or the proportion of the risk factors for ischemic stroke between the 2 nationalities were compared.Results The proportions of smoking (18.0％ vs.11.5％,x2 =4.945,P =0.026) and alcohol consumption (37.8％ vs.21.5％,x2 =9.884,P =0.002) in the Han patients were significantly higher than those in the Uygur patients,while the body mass index in the Uygur patients with ischemic stroke was significantly higher than that in the Han patients with ischemic stroke (25.168 kg/m2 vs.24.443 kg/m2,t =2.515,P =0.012).Conclusions The onset of ischemic stroke of the Han people in Xinjiang China may be more associated with the exposure of smoking and alcohol consumption,while the Uighur people may be more associated with the high-fat and high energy intake caused obesity.

OBJECTIVETo investigate the effect of betulinic acid (BA) on the proliferation, migration, apoptosis and cell cycle of pancreatic cancer cells (BxPC-3) in vitro and elucidate the underlying.

METHODThe effect of BA on the proliferation of BxPC-3 was measured by using sulforhodamine B (SRB) assay. Migratory ability of BxPC3 cells were detected by wound healing assay, and the morphological change was observed with light microscope. The influence of BA on cell cycle of BxPC-3 cells was tested by flow cytometry (FCM). Apoptosis was analyzed by using Hochest33342-PI double staining. Western blot technologies were applied to detect the expression of Bcl-2 and Bax.

RESULTBA exhibited significant cell proliferation and migration inhibition, as well as its potency of inducing apoptosis in BxPC-3 cells in vitro in a dose-dependent manner. The IC50 value for 72 h was 16.54 mg x L(-1). Cell migration was significantly inhibited at 5 mg x L(-1) of BA. Cells treated with BA showed increased cell population in G0 phase, with decreased G2/M phase population. The expression of Bax and Bcl-2 was up and down-regulated respectively in BA-treated BxPC-3 cells in a dose-dependent manner.

CONCLUSIONBA exerted potent effect on growth inhibition, G0 cell cycle arrest and induction of apoptosis in BxPC-3 cells in vitro, possibly associated with the down-regulation of Bcl-2 and up-regulation of Bax expression. The potent antitumor capacity of BA suggested that it could be a promising new anticancer agent in human pancreatic cancer treatment.

Apoptosis ; drug effects ; Cell Cycle ; drug effects ; Cell Line, Tumor ; Cell Movement ; drug effects ; Cell Proliferation ; drug effects ; Drugs, Chinese Herbal ; pharmacology ; Gene Expression Regulation, Neoplastic ; drug effects ; Humans ; Pancreatic Neoplasms ; drug therapy ; genetics ; metabolism ; physiopathology ; Proto-Oncogene Proteins c-bcl-2 ; genetics ; metabolism ; Triterpenes ; pharmacology ; bcl-2-Associated X Protein ; genetics ; metabolism

Objective To introduce experience of using the new AO anterolateral distal tibia locking com-pression plate (LCP) for treatment of Pilon fractures. Methods Between February and August of 2009,8 closed Pi-lon fractures were treated by open reduction and internal fixation. The distal fibula was fixed with a one-third tubular plate or an recontruction plate via a straight incision posterior to the fibular crest. The distal tibia was approched by a straight incision over the ankle joint, and the fracture was stabilized using an anterolateral distal tibia LCP. Regular follow up was made to observe and evaluate the preliminary clinical outcomes. Results Seven of the 8 patients were availabe for follow up for 3 ～ 6 months (average 4.5 months). All incisions obtained primary healing, though one ex-perienced mild superficial inflammation,and none developed deep infections. Based on the Burwell and Charnley radi-ographic criteria,anatomical reduction was obtained in 5 cases,good in 1 ,and fair in 1. Among the 5 cases exceeding 5 months postsurgery,4 were evaluated as excellent and 1 us good according to Tometta' s clinically based criteria for Pilon fractures. Conclusion With good surgical timing,internal fixation with anterolateral LCP for Pilon fractures is reliable and warrants less complications.