Objective:To observe the effect of high-intensity interval training (HIIT) on diabetic rats with non-alcoholic fatty liver disease (NAFLD), and to explore the role of miR-122 in it.Methods:Forty Wistar rats were randomly divided into a healthy control group, a sedentary group, a high-intensity interval training (HIIT) group and a moderate-intensity continuous training (MICT) group using a random number table. All except the healthy control group had type 2 diabetes with NAFLD induced using a high-fat and high-fructose diet. The healthy control and sedentary groups were kept quiet in their cages, while the HIIT and MICT groups performed treadmill exercise of the corresponding intensity for 8 consecutive weeks. At 48h after the last training, plasma was collected to measure biochemical markers, and the livers were resected for histological observation using hematoxylin and eosin staining. miR-122 expression was measured using real-time fluorescent quantitative polymerase chain reactions, while the protein expressions of fatty acid synthase (FAS), acetyl-CoA carboxylase (ACC), sterol regulatory element binding protein-1c (SREBP1c) and peroxisome proliferator-activated receptor γ (PPARγ) were detected using western blotting.Results:Compared with the healthy control group, the average fasting blood glucose (FBG), triglyceride (TG), total cholesterol (TC), alanine aminotransferase (ALT), aspartate aminotransferase (AST), insulin and insulin resistance index (HOMA-IR) had increased significantly in the sedentary group. Compared with the sedentary group, the average FBG, TG, TC, insulin and HOMA-IR had decreased significantly in both the HIIT and MICT groups, and the average ALT and AST in the HIIT group had also decreased significantly. The average TG, TC, ALT and AST levels in the HIIT group were then significantly lower than in the MICT group. Compared with the sedentary group, the average liver steatosis score had decreased significantly in both the HIIT and MICT groups, with that of the HIIT group significantly lower than in the MICT group, on average. Compared with the healthy control group, the expression of miR-122 had decreased significantly, but that of SREBP1c, PPARγ, FAS and ACC had increased significantly in the sedentary group. And compared with the sedentary group, the expression of miR-122 had increased significantly in both the HIIT and MICT groups, on average, but that of SREBP1c, PPARγ, FAS and ACC had decreased significantly. Average miR-122 levels in the HIIT group were then significantly higher, and those of SREBP1c, PPARγ, FAS and ACC were significantly lower than in the MICT group.Conclusions:Either MICT or HIIT training can relieve NAFLD in rats modeling diabetes, but HIIT has a better therapeutic effect. Its therapeutic mechanism may be related to the upregulation of miR-122 in the liver.

Objective:To observe the effect of high-intensity interval training (HIIT) on diabetic rats with non-alcoholic fatty liver disease (NAFLD), and to explore the role of miR-122 in it.Methods:Forty Wistar rats were randomly divided into a healthy control group, a sedentary group, a high-intensity interval training (HIIT) group and a moderate-intensity continuous training (MICT) group using a random number table. All except the healthy control group had type 2 diabetes with NAFLD induced using a high-fat and high-fructose diet. The healthy control and sedentary groups were kept quiet in their cages, while the HIIT and MICT groups performed treadmill exercise of the corresponding intensity for 8 consecutive weeks. At 48h after the last training, plasma was collected to measure biochemical markers, and the livers were resected for histological observation using hematoxylin and eosin staining. miR-122 expression was measured using real-time fluorescent quantitative polymerase chain reactions, while the protein expressions of fatty acid synthase (FAS), acetyl-CoA carboxylase (ACC), sterol regulatory element binding protein-1c (SREBP1c) and peroxisome proliferator-activated receptor γ (PPARγ) were detected using western blotting.Results:Compared with the healthy control group, the average fasting blood glucose (FBG), triglyceride (TG), total cholesterol (TC), alanine aminotransferase (ALT), aspartate aminotransferase (AST), insulin and insulin resistance index (HOMA-IR) had increased significantly in the sedentary group. Compared with the sedentary group, the average FBG, TG, TC, insulin and HOMA-IR had decreased significantly in both the HIIT and MICT groups, and the average ALT and AST in the HIIT group had also decreased significantly. The average TG, TC, ALT and AST levels in the HIIT group were then significantly lower than in the MICT group. Compared with the sedentary group, the average liver steatosis score had decreased significantly in both the HIIT and MICT groups, with that of the HIIT group significantly lower than in the MICT group, on average. Compared with the healthy control group, the expression of miR-122 had decreased significantly, but that of SREBP1c, PPARγ, FAS and ACC had increased significantly in the sedentary group. And compared with the sedentary group, the expression of miR-122 had increased significantly in both the HIIT and MICT groups, on average, but that of SREBP1c, PPARγ, FAS and ACC had decreased significantly. Average miR-122 levels in the HIIT group were then significantly higher, and those of SREBP1c, PPARγ, FAS and ACC were significantly lower than in the MICT group.Conclusions:Either MICT or HIIT training can relieve NAFLD in rats modeling diabetes, but HIIT has a better therapeutic effect. Its therapeutic mechanism may be related to the upregulation of miR-122 in the liver.

Objective:To explore the application effect of multidisciplinary team (MDT) nursing model in enteral nutrition support for patients in intensive care unit (ICU) .Methods:The convenient sampling method was used to select 76 patients undergoing enteral nutrition in ICU of Taizhou Hospital in Zhejiang Province from August 2020 to August 2022 as the research objects. A total of 37 patients admitted from August 2020 to August 2021 were set as the control group, and 39 patients admitted from September 2021 to August 2022 were set as the intervention group. Patients in the control group received routine nursing, while patients in the intervention group received MDT nursing model. The start time of enteral nutrition after admission to ICU, the compliance rate of enteral nutrition at 7 days after feeding, the rate of feeding interruption and the incidence of complications were compared between the two groups.Results:After intervention, the start time of enteral nutrition after admission to ICU in the intervention group was shorter than that in the control group, the compliance rate of enteral nutrition at 7 days after feeding was higher than that in the control group, and the feeding interruption rate and incidence of aspiration, nausea, vomiting and diarrhea were lower than those in the control group ( P<0.05) . Conclusions:The MDT nursing model can improve the effect of enteral nutrition support for ICU patients and reduce the incidence of enteral nutrition complications.

Objective:To explore the feasibility and effectiveness of the construction of urban unmanned aerial vehicle (UAV) blood distribution system, and to provide a novel way for the distribution of emergency blood.Methods:The study was completed in Hangzhou from April 2019 to January 2021, and the main participants were from the Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province Blood Center and Hangzhou Fast Ant Network Technology Co., Ltd. Firstly, an unmanned aircraft delivery system was built for urban emergency blood and a special blood storage box for drones were developed. The drone was used to deliver blood products from Zhejiang Province Blood Center to Binjiang Campus, the Second Affiliated Hospital of Zhejiang University School of Medicine, and the following indicators were obtained: (1) flight time of the drone blood delivery; (2) real-time temperature of blood products during transportation; (3) Baidu map software was used to measure the blood delivery time of road traffic, which was compared with the flight time of the drone.Results:The urban drone blood delivery system consists of intelligent logistics drones, cryogenic blood storage tanks, unmanned logistics hub stations, and cloud-based operation control platforms. The drone route distance from Zhejiang Provincial Blood Center to Binjiang Campus, the Second Affiliated Hospital of Zhejiang University School of Medicine was 2.36±0.06 km, and the ground distance was 5.8 km, with 27 flights from April 12, 2019 to January 29, 2021, and the drone flight time was, shorter than the road travel time for a round trip [(6.37±0.35) min vs. (17.00±1.94) min]. At different time points of the day, UAV blood delivery could save 15.98-4.28 min, with an average saving of 10.62±1.87 min. Conclusions:Urban UAV blood delivery systems have the advantages of being fast, unaffected by ground traffic conditions, and can ensure the safety of blood products during transportation, and are worthy of further exploration.

Objective:To investigate the clinical features of Epstein-Barr virus associated lymphoproliferative disease in children and to improve the understanding of this disease.Methods:This study included the children with Epstein-Barr virus associated lymphoproliferative disease admitted to the First Affiliated Hospital of College of Medicine of Zhejiang University from January 2014 to December 2018.Data of these children were collected, including age, clinical manifestations, laboratory results, treatment and outcome.The clinical features and therapeutic effects were analyzed.Results:A total of 114 cases(mean age 6 years, 0~17 years)were enrolled in this study, including 53 males and 61 females.There were 107 cases(93.86%) in the mild group (38 cases of EBV infection and 69 cases of infectious mononucleosis) and 7 cases in the severe group (6.14%). Six cases of the severe group were T cell or NK cell proliferation.Compared with the mild group, the load of EBV-DNA was higher in the severe group, but there was no significant difference( χ2=0.957, P>0.05). The IgM in severe group was significantly lower( Z=-2.041, P<0.05). But the differences in the level of immune function including IgA, IgG, CD4 + cell and CD8 + cell between the severe group and the mild group were not significant.The cases in the mild group had improved after antiviral treatments.Among the severe group, 3 cases survived after treatment, another 1 case was diagnosed as hydroa vacciniforme-like EBV-related proliferative disease (HV-like LPD). After antiviral treatment, the effect was not good, then after high-dose IVIG treatment and Bortezomib combined with methylprednisolone treatment, the EBV-DNA load decreased and the condition improved.While 1 case lost to follow-up, there were 2 cases with EBV-associated hemophagocytic syndrome and 1 case with EBV-associated lymphoma died after chemotherapy or transplantation. Conclusion:EBV-associated lymphoproliferative disease may manifest as a condition similar to infectious mononucleosis.High IgE, low IgM or high DNA load may indicate poor prognosis.Immune function after EBV infection may have different effects on prognosis.When the infected lymphocyte types are NK or T cells, it may indicate poor prognosis.The efficacy of transplantation and chemotherapy in severe cases is still uncertain.

Objective:To explore the application effect of pressure relief double knee pad in pressure injury in critically ill patients.Methods:A total of 635 patients who were admitted to Intensive Care Unit of Taizhou Hospital in Zhejiang Province from June 2020 to April 2021 were selected as the research objects by the convenient sampling method. They were divided into the control group ( n=315) and the experimental group ( n=320) by the random number table method. On the basis of the conventional lying position, patients in the control group placed the R-shaped pads on the back of the shoulder to the top of the pelvis, while patients in the experimental group slightly bent their lower limbs on the basis of the control group and placed it on the self-designed pressure relief double knee pad. The incidence of pressure injury, pressure index of sacrum and heel skin, the non-displacement rate of support appliances and the incidence of deep vein thrombosis (DVT) in the two groups were evaluated. Results:The incidence of pressure injury of patients in the experimental group was 0.63% (2/320) , which was lower than 3.17% (10/315) in the control group, and the difference was statistically significant ( P<0.05) . The pressure indexes of the sacrum and heel of the experimental group were respectively (66.10±13.43) and 0 mmHg, which were lower than (75.08±12.03) and (22.26±6.20) mmHg of the control group, and the differences were statistically significant ( P<0.05) . The non-displacement rate of support appliances in the experimental group was 89.62% (190/212) , which was higher than 52.63% (100/190) in the control group, and the difference was statistically significant ( P<0.05) . There was no statistically significant difference in the incidence of VTE between 2 groups ( P>0.05) . Conclusions:The use of pressure relief double knee pads can reduce the incidence of pressure injuries, the pressure of the skin of the sacrum and heel and increase the non-displacement rate of support appliances, which is worthy of clinical application.

Premature ovarian insufficiency(POI), previously known as premature ovarian failure(POF), is defined as the occurrence of premature ovarian failure in women under the age of 40 who may present with delayed puberty, primary or secondary(for 4 months or more)amenorrhea with two times and more of abnormal serum hormonal levels(low estradiol and raised gonadotrophins). And POI is not common in children and adolescents.It is generally believed that the etiologies of POI may be genetic, immunological, iatrogenic, etc.Hormone replacement therapy(HRT)is the primary treatment of POI in children and adolescents, and evaluation of therapeutic strategies to POI including cardiovascular, skeletal and emotional health is needed as well.Recently, the incidence of POI in children and adolescents has increased, therefore, early diagnosis and active treatment are urgent and necessary.Thus, this review will mainly be focused on the etiology and treatment of POI in children and adolescents.

Objective:To investigate the application value of three-dimensional morphological measurement in the treatment of displaced intra-articular calcaneal fractures in the elderly.Methods:A retrospective case series study was conducted to analyze the clinical data of 44 patients with displaced intra-articular calcaneal fractures admitted to East Hospital Affiliated to Tongji University from January 2015 to January 2018. There were 33 males and 11 females, aged 60-88 years (mean, 67.2 years). According to Sanders classification, 35 patients were with type II fractures and 9 with type III fractures. All patients were evaluated with digital technology and received open reduction and internal fixation. The operation time, intraoperative blood loss, intraoperative fluoroscopy frequency and complications were recorded. Three-dimensional morphological parameters of calcaneal fractures were compared before and at latest follow-up, including horizontal length of the calcaneus, height of the posterior articular facet, height and length of the anterior process, Gissane angle, and B?hler angle. The visual analogue scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot function score were also compared.Results:All patients were followed up for 12-30 months (mean, 17.1 months). There were 31 patients with posterior articular facet depression more than 2 mm, and 13 patients showed the back shift of the whole or part of posterior articular facet more than 3 mm and varying degree of fracture of the upper or lateral wall part of calcaneus body. The operative time was 55-105 minutes (mean, 85.1 minutes). The intraoperative blood loss was 30-130 ml (mean, 74.9 ml). The intraoperative fluoroscopy frequency was 5-8 times (mean, 6.5 times). During the operation, the internal fixation was not changed. Two patients suffered from skin incision infection after operation. At latest follow-up, the horizontal length of the calcaneus, height of the posterior articular facet, Gissane angle and B?hler angle were significantly improved from that before operation [(76.9±4.1)mm vs. (75.5±5.2)mm, (24.2±2.1)mm vs. (22.5±2.9)mm, (29.0±6.2)° vs. (18.3±5.5)°, (124.8±7.2)° vs. (107.6±8.5)°, respectively] ( P<0.01). No significance was found in the height and length of the anterior process ( P>0.05). At latest follow-up, the VAS and AOFAS ankle-hind foot function score were also significantly improved compared to preoperation [(1.1±0.9)points vs. (4.4±0.9)points, (86.4±6.2)points vs. (49.9±6.3)points, respectively] ( P<0.01). AOFAS ankle-hind foot function score was excellent in 13 patients, good in 26, fair in 5, with the excellent and good rate of 87%. Conclusion:Three-dimensional morphological measurement can fully evaluate the damage of calcaneal fractures and provide data reference for the preoperative planning of open reduction and internal fixation in the elderly, so as to restore the calcaneus structure, relieve pain and improve ankle function.

Objective: To explore the advantages of endoscopy combined with contrast fistulography in the clinical diagnosis and treatment of chronic wound with sinus tract adjacent to body cavity. Methods: Thirty-two patients (14 males and 18 females, aged 17 to 87 years) of chronic wounds with sinus tracts adjacent to body cavity, who underwent endoscopy combined with contrast fistulography (CT or magnetic resonance imaging) for the diagnosis and treatment in the Outpatient Department of Wound Healing Center of our hospital from October 2017 to March 2019, were enrolled in the study. Their diagnosis and treatment results were retrospectively analyzed. The following data were calculated. (1) The incidence rates of sinus wound involving body cavity or fistula. (2) The detection rates of sinus wound involving body cavity detected by routine examination and by endoscopy combined with contrast fistulography. (3) The detection rate of pathological features at deep part of wound by routine examination and by endoscopy combined with contrast fistulography. (4) The proportion of patients who benefited from routine examination and from endoscopy combined with contrast fistulography. Data were processed with paired chi-square test and Fisher′s exact probability test. Results: (1) The incidence rate of sinus wound involving body cavity was 43.75% (14/32); the incidence rate of fistula was 0. (2) The detection rate of sinus wound involving body cavity detected by endoscopy combined with contrast fistulography was 43.75% (14/32), which was obviously higher than that by routine examination [12.50% (4/32), χ²=32.0, P<0.01]. (3) The detection rate of pathological features at deep part of wound by endoscopy combined with contrast fistulography was 37.50% (12/32), which was obviously higher than that by routine examination (0, P<0.01). (4) The proportion of patients who benefited from endoscopy combined with contrast fistulography was 71.43% (20/28), which was obviously higher than that from routine examination [12.50% (4/32), χ²=21.6, P<0.01]. Conclusions Compared with routine examination, endoscopy combined with contrast fistulography is more accurate in detecting chronic wound with sinus tract adjacent to body cavity. The diagnosis and treatment of chronic wound with sinus tract adjacent to the body cavity can benefit from this joint examination.

Objective: evaluate the efficacy of a single medial locking plate and lag screws based on computer-assisted pre-operation plan (CAPP) for the treatment of pilon fractures. Methods: Between 2013 and 2016, data of 27 patients with pilon fractures who were treated using a single medial locking and lag screws based on CAPP were retrospectively analyzed. All the cas-es were AO/OTA 43-C type pilon fractures. According to the Rüedi-Allgöwer classification, there were 5 cases of type Ⅱ and 22 cases of type Ⅲ. Among 27 patients, 19 patients had fibula fracture. CAPP was performed for all fractures, including simulated re-duction, virtual surgery, and implantation of internal fixation. The time of CAPP, intraoperative realization of preoperative plan, op-eration time, intraoperative blood loss, and pre- and post-operative range of motion of ankle were recorded. Functional outcomes at final follow up were assessed using American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scale, visual analogue scale (VAS). Results: The mean time of CAPP was 25.8 minutes (range, 14-30 minutes). The average operating time was 138.5 minutes. The average intraoperative blood loss was 225.9 ml. All the twenty-seven patients were followed up for an average period of 18.6 months. The average AOFAS score, VAS score at the final follow-up was 82.9, 2.7 points respectively, which was signifi-cantly improved compared with those before operation (t=-19.358, 7.720; all P< 0.001). Conclusion CAPP system is convenient and efficient, which can facilitate the treatment of type C pilon fractures with a single medial locking plate and lag screws. In addi-tion, satisfactory clinical outcomes can be obtained.