Objective:To explore the mechanism of zoledronic acid (ZOL) affects osteogenic differentiation and bone formation through the regulation of sirtuin 3 (SIRT3) / P53 expression.Methods:Bone marrow mesenchymal stem cells (BMSCs) were induced to differentiate into osteogenic cells, the expression of SIRT3 in the cells was detected, and the targeting regulation relationship between SIRT3 and P53 was analyzed. The intracellular expressions of SIRT3 and P53 were intervened and ZOL was used to treat the cells. MTT method, Western blot method and kit were used to detect cell viability, osteogenesis-related genes Osteoprotegerin (OPG), runt-related transcription factor 2 (Runx2) expression, alkaline phosphatase (ALP) activity and alizarin red S (ARS) staining, respectively. Ovariectomy (OVX) was used to construct a rat model and explore the effect of ZOL on the progression of osteoporosis (OP) in vivo.Results:ZOL promoted osteogenic differentiation of BMSCs. The expression of SIRT3 was down-regulated in the serum of OP patients (0.78±0.23) compared with that of healthy subjects (1.00±0.26 vs. 0.78±0.23. t=3.85, P<0.001). During the osteogenic differentiation of BMSCs, the expression level of SIRT3 gradually increased with the prolonged induction of osteogenesis. Compared with the p53 protein expression and BMSCs activity in the control group, SIRT3 knockout could increase the expression level of p53 protein (0.59±0.05 vs. 1.01±0.11. t=6.02, P=0.004) but inhibited the activity of BMSCs (100.00±8.41 vs. 51.26±5.59. t=8.36, P=0.001). After ZOL treatment, the inhibitory effect of SIRT3 on cell viability (49.61±5.11 vs. 87.61±7.31. t=7.38, P=0.002) and osteogenesis was relieved, and the level of P53 was inhibited (1.10±0.10 vs. 0.69±0.04. t=6.59, P=0.003). P53 overexpression partially offseted the effects of ZOL on cell viability (84.61±6.52 vs. 66.54±5.47. t=3.68, P=0.021) and osteogenesis. Compared with the sham surgery group, the OVX group showed inhibition of osteogenesis in rats, and ZOL treatment significantly improved osteogenic inhibition. ZOL treatment increased the expression level of SIRT3 protein in bone tissue of OVX rats, but inhibited the expression level of P53. Conclusion:ZOL promoted osteogenic differentiation and bone formation of BMSCs by promoting the ubiquitination and degradation of P53 by SIRT3.

Objective:To explore the safety and feasibility of adrenal tumor resection under day surgery mode for the treatment of unilateral primary aldosteronism (UPA).Methods:The clinical data of 83 patients who underwent adrenalectomy for the treatment of UPA from January 2020 to January 2023 were retrospectively analyzed. There were 42 males (50.6%)and 41 females (49.4%), age (49.0±12.3)years old. Body mass index (25.4±3.6)kg/m 2. There were 17 patients with diabetes, 58 patients with preoperative hypertension, and the duration of hypertension was 8.2(1, 15)years. Systolic blood pressure was 151.8(137.0, 160.0)mmHg (1 mmHg=0.133 kPa), and diastolic blood pressure was 97.4(87.0, 107.0)mmHg. 20 cases had severe preoperative hypokalemia, with preoperative blood potassium levels of (2.9±0.6)mmol/L. The ratio of preoperative plasma aldosterone to renin activity was 54.1(13.0, 77.2). Tumors were located on the left side in 47 cases (56.6%)and on the right side in 36 cases (43.4%). The maximum diameter of the tumor is 1.5(1.0, 1.7)cm. Patients diagnosed with unilateral primary aldosteronism were included, and patients diagnosed with adrenal pheochromocytoma, adrenal malignancy, or severe cardiovascular disease that cannot tolerate surgery were excluded. The patient was admitted to the hospital on the same day, underwent surgery on the same day, and was evaluated after extubation within one day after surgery. The patient had no fever or lower back pain after surgery, was able to freely get out of bed, and had no obvious abnormalities in blood routine, electrolyte and other test indicators. The patient was discharged from the hospital and received continuous care outside the hospital. The patient was guided to undergo regular outpatient follow-up. Evaluate the efficacy using the Primary Aldosterone Hyperaldosteronism Surgical Outcome (PASO)criteria. Results:The patients had a mean length of hospital stay of 43.0(40.3, 44.6)hours, an operation time of 89.6(70.0, 103.0)minutes, and an operation cost of 23 820.2 (21 150.8, 24 948. 3)yuan. The postoperative free position time was 29.5(20.8, 39.7)hours, the postoperative time for fluid placement of the diet was 25.2(20.1, 27.8) hours, and 42.2(37.9, 41.9)hours of postoperative drain removal. The overall postoperative clinical remission rate was 85.5%. There were four postoperative complications, accounting for 4.8% of cases. These included two cases of interosseous vein thrombosis, one case of delayed healing, and one case of peritoneal rupture. No case of readmission was reported within 30 days.Conclusions:UPA adrenal tumour resection in ambulatory mode is safe and effective when strict inclusion and exclusion criteria are followed, adequate preoperative preparation is carried out, and expert physician assessment is provided.

Objective : To investigate the effect of platelet particles on the extent of intestinal inflammation and in⁃ testinal mucosal permeability in mice with dextran sodium sulfate induced colitis. Methods : The experiment was divided into four groups : normal control group ( n = 10 , drinking sterile distilled water + intraperitoneal injection of 0. 9% sodium chloride solution) , PMPs group ( n = 10 , drinking sterile distilled water + intraperitoneal injection of PMPs) , DSS model group ( n = 10 , drinking DSS solution + intraperitoneal injection of 0. 9% sodium chloride solution) , and experimental group ( n = 15 , drinking DSS solution + intraperitoneal injection of PMPs) . Peripheral blood⁃derived PMPs suspension was collected from inflammatory bowel disease ( IBD) patients. A colitis model was constructed in mice by allowing them to freely drink a 5% DSS solution for 1 week , followed by continuous intraperitoneal injection of PMPs for 7 days. Disease activity index (DAI) scores was recorded daily and the severity of intestinal inflammation with histopathological scores (HI) was assessed by HE staining of colon samples at the end of the experiment. Myeloperoxidase (MPO) , neutrophil elastase (NE) , citrullinated histone H3 (citH3) , and free DNA levels were measured in colon homogenate , observe intestinal mucosal structure by transmission electron microscopy , and intestinal permeability was tested using fluorescein isothiocyanate⁃dextran (FITC⁃D) . Results: Compared with the normal control group , the colonic mucosa of mice in the PMPs group showed edema , severe destruction of epithelial structure , extensive aggregation of inflammatory cells , and increased overall HI score (P < 0. 01) ; the levels of inflammatory factors such as IL⁃1β and TNF⁃α in colonic tissue homogenates of mice in the PMPs group increased (P < 0. 05) , and the expression of NETs increased (P < 0. 05) ; the plasma FITC⁃D level of mice in the PMPs group significantly increased (P < 0. 05) , and the permeability of intestinal mucosa increased. Compared with the DSS group , the experimental group mice had higher plasma FITC⁃D levels ( P < 0. 05 ) and more electron microscopic colonic epithelial damage. Conclusion PMPs induces NETs formation in mice , promotes colonic inflammation in mice , increases intestinal mucosal permeability and aggravates intestinal inflammation in mice with DSS colitis.

Objective:To explore the effect of case three-dimensional teaching method (CTTM) combined with multimedia teaching on the practice teaching of liver infectious diseases.Methods:Twenty-five interns of liver infectious diseases received by The Second Hospital of Nanjing from May 2019 to January 2020 were taken as the control group, and 25 interns of liver infectious diseases received from February 2020 to October 2020 were taken as the observation group. The control group was given the conventional teaching mode including the conventional case teaching and the conventional multimedia teaching, while the observation group was given CTTM integrated with multimedia teaching method, and both groups were taught for 4 weeks. After teaching, the examination results of liver infectious disease related theory and practice, the changes of core competence before and after teaching, and the recognition of teaching were compared between the two groups. SPSS 25.0 was used for t test and chi-square test. Results:After teaching, the examination results of liver infectious disease related theory [(92.45±7.23) vs. (81.21±7.11)] and practice [(93.27±6.68) vs. (81.23±6.26)] in the observation group were higher than those in the control group. There was no significant difference in the scores of core competence between the two groups before teaching; after teaching, the scores of autonomous learning, problem analysis and solving, doctor-patient communication and teamwork ability of the two groups were higher than those before teaching, and the scores of observation group were significantly higher than those of the control group ( P<0.05). The recognition rates of interns in the observation group were higher than those in the control group in the improvement of learning initiative, the consolidation of theoretical knowledge, the enhancement of practical ability and the improvement of learning efficiency ( P<0.05). Conclusion:In the teaching of liver infectious disease interns, CTTM integrated with multimedia teaching method can not only improve the examination results, and enhance the core competence, but also improve the recognition of interns on the teaching mode.

Objective:To evaluate the effect of active cycle of breathing techniques (ACBT) on respiratory muscle training in patients undergoing coronary artery bypass grafting (CABG) surgery.Methods:A quasi-experimental trial was performed. Patients were allocated to the control group or intervention group according to their time of admission. Patients who were admitted to hospital from January 2019 to April 2019 were assigned to the control group and patients admitted from May 2019 to October 2019 were allocated to the intervention group. The control group ( n=84) received routine perioperative care, and the intervention group ( n=82) received ACBT in addition to routine perioperative care. Patients in both groups were trained 3 to 5 times a day throughout their stay in the hospital. The primary outcome measure was maximum inspiratory pressure (MIP), peak of expiratory flow (PEF), forced vital capacity (FVC). Other outcomes included the postoperative pulmonary complications (PPC), days of postoperative hospital stay. Results:The MIP, PEF, FVC value of the control group 3 days after extubation were (64.77±9.80) cmH 2O (1 cmH 2O=0.098 kPa), (139.52±23.74) L/min, (1.07±0.20) L, the intervention group were (69.89±10.92) cmH 2O, (150.37±28.65) L/min, (1.15±0.22)L, the differences between the two groups were statistically significant ( t values were -3.177,-2.657,-2.409, P <0.05). The MIP, PEF, FVC value of the control group 5 days after extubation were (71.13±8.64) cmH 2O, (270.48±44.36) L/min, (2.02±0.29) L, the intervention group were (74.72±12.48) cmH 2O, (287.07±58.61) L/min, (2.21±0.35) L, the differences between the two groups were statistically significant ( t values were -2.161,-2.060,-3.605, P <0.05). The days of postoperative hospital stay of control group and intervention group were (8.15±0.98) and (7.80±1.23) d, there were significant differences ( t value was 2.021, P <0.05). Conclusions:ACBT is an effective and economical pulmonary rehabilitation method, it has effect on Respiratory Muscle Training in Patients Undergoing CABG surgery.

Objective To investigate the endoscopic ultrasound (EUS) features of distal biliary stricture (DBS), and to provide a clinical basis for the evaluation of DBS by EUS. Methods Related clinical data were collected from 175 patients with DBS who underwent EUS examination in The First Affiliated Hospital of Anhui Medical University from April 2016 to March 2020 to analyze their clinical manifestation, laboratory examination results, imaging findings, and EUS findings, and the patients were followed up to summarize the EUS features of DBS. The chi-square test was used for comparison of categorical data between groups, and the t -test was used for comparison of continuous data between groups. Results Among the 175 patients with DBS, 85(48.57%) had benign DBS and 90(51.43%) had malignant DBS. Compared with the patients with benign DBS, the patients with malignant DBS had a significantly longer length of stricture on EUS (14.1±3.0 mm vs 7.9±3.0 mm, t =13.358, P < 0.001) and significantly higher incidence rates of the characteristic changes on EUS such as hypoechoic space-occupying lesions in lumen (57.8% vs 34.1%, χ 2 =9.843, P =0.002), peripheral lymph node enlargement (26.7% vs 12.9%, χ 2 =5.147, P =0.023), and pancreatic duct dilatation (51.1% vs 28.2%, χ 2 =9.532, P =0.002). EUS combined with magnetic resonance cholangiopancreatography had a sensitivity of 70.6% in the diagnosis of benign DBS and a sensitivity of 92.2% in the diagnosis of malignant DBS. Conclusion The characteristic EUS features of DBS, such as long length of stricture, hypoechoic lesion, peripheral lymph node enlargement, and pancreatic duct dilatation, may help with the differential diagnosis of DBS in clinical practice.

Objective:To investigate the expression of Piezo1 in small intestinal mucosal epithelial cells of patients with Crohn′s disease (CD) and its clinical correlation with CD.Methods:From January 1st 2010 to November 30th 2020, the clinical data including age, gender, disease location and biological behavior, etc of 57 patients with CD (CD group) who underwent surgery at The First Affiliated Hospital of Anhui Medical University were retrospectively. And at same time the normal samll intestinal epithelial tissues of 10 healthy individuals who underwent colonoscopy were collected as the healthy control group. The expression of Piezo1 in small intestinal epithelial cells of CD patients with different disease sites, biological behavior and disease activity were detected by immunofluorescence staining and hematoxylin-eosin staining. The histological score system and intestinal fibrosis score were used to analyze the inflammation and fibrosis of the intestinal tissues of patients with CD. Semi-quantitative analysis of Piezo1 in small intestinal epithelial cells was analyzed by ImageJ software. And the correlation between Piezo1 expression and clinical characteristics and pathological features of small intestine was also analyzed. Independent sample t test and analysis of variance were used for statistical analysis. Results:In CD group, there were 37 males (64.9%) and 20 females (35.1%). The age was (39.1±14.2) years old, ranged from 18 to 71 years old, and the average duration of the disease was (26.5±24.1) months. There were 29 cases (50.9%)of ileal type, 26 cases (45.6%) of ileocolonin type and 2 cases (3.5%) of colonic type. There were 12 cases (21.1%) of non-penetrating non-stenotic type, 31 cases (54.4%) of stenotic type and 14 cases (24.6%) of penetrating type. There were 47 cases (82.5%) with moderate activity and 10 cases (17.5%) with severe activity. There were 17 cases (29.8%) of moderate intestinal inflammation, 40 cases (70.2%) of severe intestinal inflammation. The score of intestinal fibrosis in six cases (10.5%) was 1, 28 cases (49.1%) was 2, 18 cases (31.6%) was 3, five cases was 4. The relative expression level of Piezo1 in intestinal mucosal epithelial cells of CD group was higher than that of healthy control group (12.9±4.6 vs. 8.5±1.1), the relative expression of Piezo1 in intestinal mucosal epithelia cells of stenotic type and penetrating type CD patients were both higher than that of non-penetrating and non-stenotic CD patients (12.6±3.8 and 9.8±2.4 vs. 6.0±1.3), and the differences were all statistically significant ( t=3.00, -3.66 and -3.32, all P<0.01). The relative expression of Piezo1 in small intestinal epithelial cells of CD patients with severe intestinal inflammation was higher than that of CD patients with moderate intestinal inflammation (13.1±4.0 vs. 9.7±3.1), and the difference was statistically significant ( t=-2.65, P<0.05). The relative expression levels of Piezo1 in small intestinal epithelial cells of patients with intestinal fibrosis score of 4, 3, 2 and 1 were 17.6±5.2, 12.6±1.7, 9.1±2.1 and 5.8±1.1, respectively; the relative expression levels of Piezo1 in intestinal epithelial cells of patients scored 4 were higher than that of patients scored 3, 2 and 1, and that of patients scored 3 was higher than patients scored 2 and 1, and that of patients scored 2 was higher than that of patients scored 1, and the differences were all statistically significant ( t=-2.98, -5.10, -3.84, 4.60, 6.55 and 2.56, all P<0.05). The relative expression of Piezo1 in intestinal mucosal epithelial cells was related to the severity of intestinal inflammation and fibrosis. The more severe the intestinal inflammation and fibrosis, the higher the relative expression of Piezo1 in intestinal mucosal epithelial cells. Conclusions:The relative expression of Piezo1 in small intestinal epithelial cells is related to the biological behavior and the severity of intestinal inflammation and fibrosis of CD. It is speculated that the expression of Piezo1 in small intestinal epithelial cells may be clinically related to the process of intestinal wall fibrosis in CD to some extent, however whether it plays an important role in the process of intestinal wall fibrosis in CD and its specific mechanism need to be further studied.

Objective:To explore the clinical significance of anti-Crohn′s disease antibody binding polypeptide (anti-CABP) in the diagnosis of inflammatory bowel disease (IBD) .Methods:Clinical data of 190 IBD patients diagnosed in the First Affiliated Hospital of Anhui Medical University from June 2017 to December 2019 were analyzed prospectively, including 103 patients with Crohn’s disease (CD) and 87 patients with ulcerative colitis (UC) . And 107 patients with gastrointestinal polyposis were set as control group. The serum level of anti-CABP, anti- Saccharomyces cerevisiae antibodies (ASCA) and perinuclear anti-neutrophil cytoplasmic antibodies (pANCA) were detected in CD, UC and control groups by using ELISA. The differences in the serum level and positive rates of anti-CABP, ASCA and pANCA among the three groups were analyzed statistically. The diagnostic value of anti-CABP was evaluated by using receiver operating characteristic (ROC) analysis. The correlation between anti-CABP and clinical characteristics of IBD was analyzed. Results:The levels of anti-CABP IgA[14.46 (7.77, 34.71) U/ml vs. 10.22 (5.71, 14.98) U/ml and 6.60 (5.04, 8.38) U/ml, both P<0.01], anti-CABP IgG [11.12 (4.48, 42.31) U/ml vs. 5.26 (3.28, 10.02) U/ml and 2.85 (2.41, 3.52) U/ml, both P<0.01] and ASCA IgG[5.59 (2.68, 11.36) U/ml vs. 2.63 (1.42, 6.40) U/ml and 2.19 (1.20, 4.03) U/ml, both P<0.01] of CD patients were significantly higher than those of UC patients and control group. The pANCA level in UC patients was significantly higher than that of CD and control groups [8.55 (4.06, 19.98) U/ml vs. 2.91 (2.09, 3.99) U/ml and 1.65 (1.24, 2.23) U/ml, both P<0.01]. The positive rate of anti-CABP was 45.63% in CD patients, which was obviously higher than 4.60% in UC patients ( P<0.01) . Anti-CABP could effectively distinguish CD from non-CD patients (AUC 0.840) , and the diagnostic efficacy of anti-CABP was better than that of ASCA (AUC 0.708) . The combined use of three antibodies (anti-CABP, ASCA and pANCA) significantly improved the diagnostic value and the AUC was 0.892. The positive rate of anti-CABP IgA was not related with the clinical characteristics of IBD (all P>0.05) , while the positive rate of anti-CABP IgG was significantly different in the disease locations of CD patients ( P = 0.016) . Conclusion:The positive rate of anti-CABP in CD patients is significantly higher than that in UC patients, which suggests that the anti-CABP can be used as a serological marker to assist diagnosis and differential diagnosis of CD.

Objective:To explore the clinical significance of anti-Crohn′s disease antibody binding polypeptide (anti-CABP) in the diagnosis of inflammatory bowel disease (IBD) .Methods:Clinical data of 190 IBD patients diagnosed in the First Affiliated Hospital of Anhui Medical University from June 2017 to December 2019 were analyzed prospectively, including 103 patients with Crohn’s disease (CD) and 87 patients with ulcerative colitis (UC) . And 107 patients with gastrointestinal polyposis were set as control group. The serum level of anti-CABP, anti- Saccharomyces cerevisiae antibodies (ASCA) and perinuclear anti-neutrophil cytoplasmic antibodies (pANCA) were detected in CD, UC and control groups by using ELISA. The differences in the serum level and positive rates of anti-CABP, ASCA and pANCA among the three groups were analyzed statistically. The diagnostic value of anti-CABP was evaluated by using receiver operating characteristic (ROC) analysis. The correlation between anti-CABP and clinical characteristics of IBD was analyzed. Results:The levels of anti-CABP IgA[14.46 (7.77, 34.71) U/ml vs. 10.22 (5.71, 14.98) U/ml and 6.60 (5.04, 8.38) U/ml, both P<0.01], anti-CABP IgG [11.12 (4.48, 42.31) U/ml vs. 5.26 (3.28, 10.02) U/ml and 2.85 (2.41, 3.52) U/ml, both P<0.01] and ASCA IgG[5.59 (2.68, 11.36) U/ml vs. 2.63 (1.42, 6.40) U/ml and 2.19 (1.20, 4.03) U/ml, both P<0.01] of CD patients were significantly higher than those of UC patients and control group. The pANCA level in UC patients was significantly higher than that of CD and control groups [8.55 (4.06, 19.98) U/ml vs. 2.91 (2.09, 3.99) U/ml and 1.65 (1.24, 2.23) U/ml, both P<0.01]. The positive rate of anti-CABP was 45.63% in CD patients, which was obviously higher than 4.60% in UC patients ( P<0.01) . Anti-CABP could effectively distinguish CD from non-CD patients (AUC 0.840) , and the diagnostic efficacy of anti-CABP was better than that of ASCA (AUC 0.708) . The combined use of three antibodies (anti-CABP, ASCA and pANCA) significantly improved the diagnostic value and the AUC was 0.892. The positive rate of anti-CABP IgA was not related with the clinical characteristics of IBD (all P>0.05) , while the positive rate of anti-CABP IgG was significantly different in the disease locations of CD patients ( P = 0.016) . Conclusion:The positive rate of anti-CABP in CD patients is significantly higher than that in UC patients, which suggests that the anti-CABP can be used as a serological marker to assist diagnosis and differential diagnosis of CD.

Objective:To explore the clinical significance of anti-Crohn′s disease antibody binding polypeptide (anti-CABP) in the diagnosis of inflammatory bowel disease (IBD) .Methods:Clinical data of 190 IBD patients diagnosed in the First Affiliated Hospital of Anhui Medical University from June 2017 to December 2019 were analyzed prospectively, including 103 patients with Crohn’s disease (CD) and 87 patients with ulcerative colitis (UC) . And 107 patients with gastrointestinal polyposis were set as control group. The serum level of anti-CABP, anti- Saccharomyces cerevisiae antibodies (ASCA) and perinuclear anti-neutrophil cytoplasmic antibodies (pANCA) were detected in CD, UC and control groups by using ELISA. The differences in the serum level and positive rates of anti-CABP, ASCA and pANCA among the three groups were analyzed statistically. The diagnostic value of anti-CABP was evaluated by using receiver operating characteristic (ROC) analysis. The correlation between anti-CABP and clinical characteristics of IBD was analyzed. Results:The levels of anti-CABP IgA[14.46 (7.77, 34.71) U/ml vs. 10.22 (5.71, 14.98) U/ml and 6.60 (5.04, 8.38) U/ml, both P<0.01], anti-CABP IgG [11.12 (4.48, 42.31) U/ml vs. 5.26 (3.28, 10.02) U/ml and 2.85 (2.41, 3.52) U/ml, both P<0.01] and ASCA IgG[5.59 (2.68, 11.36) U/ml vs. 2.63 (1.42, 6.40) U/ml and 2.19 (1.20, 4.03) U/ml, both P<0.01] of CD patients were significantly higher than those of UC patients and control group. The pANCA level in UC patients was significantly higher than that of CD and control groups [8.55 (4.06, 19.98) U/ml vs. 2.91 (2.09, 3.99) U/ml and 1.65 (1.24, 2.23) U/ml, both P<0.01]. The positive rate of anti-CABP was 45.63% in CD patients, which was obviously higher than 4.60% in UC patients ( P<0.01) . Anti-CABP could effectively distinguish CD from non-CD patients (AUC 0.840) , and the diagnostic efficacy of anti-CABP was better than that of ASCA (AUC 0.708) . The combined use of three antibodies (anti-CABP, ASCA and pANCA) significantly improved the diagnostic value and the AUC was 0.892. The positive rate of anti-CABP IgA was not related with the clinical characteristics of IBD (all P>0.05) , while the positive rate of anti-CABP IgG was significantly different in the disease locations of CD patients ( P = 0.016) . Conclusion:The positive rate of anti-CABP in CD patients is significantly higher than that in UC patients, which suggests that the anti-CABP can be used as a serological marker to assist diagnosis and differential diagnosis of CD.