BACKGROUND:Periprosthetic fracture of the femoral of the knee after total knee arthroplasty is one of the common complications,and there is a lack of biomechanical research on the periprosthetic fractures of the femoral of the knee under different bone strength conditions.The three-dimensional finite element analysis can provide a biomechanical basis for clinical practice. OBJECTIVE:To investigate the biomechanical changes of anterior femoral notching after total knee arthroplasty under different bone strengths,and to provide a mechanical basis for the clinical prevention of supracondylar femoral periprosthetic fractures after knee arthroplasty. METHODS:The femoral CT data of healthy adults were obtained,and the three-dimensional model of femoral lateral replacement of the knee joint was established by Mimics,Geomagic studio,and Solidworks software.Anterior femoral notching models of different depths were constructed,and the models were imported into ANSYS software to analyze the changes of biological stress on the femoral condyle with different bone strengths and different anterior femoral notching depths.The stress changes of the femoral anterior condyle section after and before the filling of anterior femoral notching with bone cement were analyzed. RESULTS AND CONCLUSION:(1)Under any bone strength,the supracondylar stress increased with the depth of anterior femoral notching.In normal bone conditions,there was a stress abrupt change point when the anterior femoral notching depth was between 3 mm and 4 mm.In the case of osteoporosis,there was a stress abrupt point when the anterior femoral notching depth was between 2 mm and 3 mm.(2)When anterior femoral notching occurred during knee arthroplasty and the depth exceeded the thickness of the bone cortex,the supracondylar stress of the femoral gradually increased as the bone strength decreased.(3)The stress of the anterior femoral condyle section decreased when the model with an anterior femoral notching depth of 3 mm was filled with bone cement.(4)The results show that anterior femoral notching should be avoided during knee arthroplasty,especially in patients with osteoporosis.If anterior femoral notching occurs during surgery,bone cement can be used to evenly fill the anterior femoral notching to reduce the supracondylar stress of the femur and reduce the incidence of periprosthetic fractures of the femoral joint

Objective:To explore the effect of vaginal microbiota disorder on pregnancy outcomes in the first-time frozen-thawed embryo transfer (FET) patients and perinatal outcomes in single pregnancy live delivery patients.Methods:The clinical data of 2 299 cycles of FET patients in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from January 2021 to December 2022 were collected in a retrospective cohort study. According to the types of dominant bacteria in the vaginal microbiota before transplantation, they were divided into three groups: control group (dominant bacteria were Lactobacillus, which was Gram positive bacteria, 1 849 cycles), the Gram negative bacilli group (191 cycles), and the Gram positive cocci group (259 cycles). Baseline data and pregnancy outcomes were compared among the three groups. The perinatal outcomes of select single pregnancy live birth FET patients who met the inclusion criteria were further analyzed among the three groups. The main observation indicators were live birth rate, miscarriage rate, and preterm birth rate. A multivariate logistic regression model was used to control confounding factors in the main observation indicators, and to analyze the relationship between dominant bacterial types in the vaginal microbiota and live birth rate, miscarriage rate, and preterm birth rate.Results:The difference in endometrial thickness on the day of transplantation among control group, Gram negative bacilli group, and Gram positive cocci group was statistically significant [(9.38±1.58) mm, (9.56±1.70) mm, and (9.84±1.74) mm, respectively, P<0.001]. In the endometrium preparation methods, the proportion of down-regulation+artificial cycle patients in the Gram positive cocci group was higher than that in control group, and the difference was statistically significant [13.13% (34/259) and 7.46% (138/1 849), respectively, P<0.016 7]. In the pregnancy outcomes, there was a statistically significant difference in live birth rate among control group, Gram negative bacilli group, and Gram positive cocci group [49.86% (922/1 849), 49.21% (94/191) and 41.70% (108/259), respectively, P=0.048]. The live birth rate of the Gram positive cocci group was lower than that of control group, and the difference between the two groups was statistically significant ( P<0.016 7). There were no statistically significant differences in other pregnancy outcomes and perinatal outcomes of single pregnancy live birth FET patients (all P>0.05). The multivariate logistic regression model corrected for female age, infertility years, basal follicle stimulating hormone, anti-Müllerian hormone, proportion of single embryo transfer, proportion of single blastocyst transfer, endometrial thickness on transfer day, and endometrial preparation methods, Gram positive cocci were independent risk factors for live brith after FET transplantation (a OR=0.73, 95% CI: 0.55-0.95, P=0.021). Conclusion:The dominant bacteria in the vaginal microbiota before embryo transfer are Gram positive cocci, which may be related to a decrease in live birth rate in first-time FET patients, but not significantly related to the perinatal outcomes.

Objective:To explore the effect of vaginal microbiota disorder on pregnancy outcomes in the first-time frozen-thawed embryo transfer (FET) patients and perinatal outcomes in single pregnancy live delivery patients.Methods:The clinical data of 2 299 cycles of FET patients in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from January 2021 to December 2022 were collected in a retrospective cohort study. According to the types of dominant bacteria in the vaginal microbiota before transplantation, they were divided into three groups: control group (dominant bacteria were Lactobacillus, which was Gram positive bacteria, 1 849 cycles), the Gram negative bacilli group (191 cycles), and the Gram positive cocci group (259 cycles). Baseline data and pregnancy outcomes were compared among the three groups. The perinatal outcomes of select single pregnancy live birth FET patients who met the inclusion criteria were further analyzed among the three groups. The main observation indicators were live birth rate, miscarriage rate, and preterm birth rate. A multivariate logistic regression model was used to control confounding factors in the main observation indicators, and to analyze the relationship between dominant bacterial types in the vaginal microbiota and live birth rate, miscarriage rate, and preterm birth rate.Results:The difference in endometrial thickness on the day of transplantation among control group, Gram negative bacilli group, and Gram positive cocci group was statistically significant [(9.38±1.58) mm, (9.56±1.70) mm, and (9.84±1.74) mm, respectively, P<0.001]. In the endometrium preparation methods, the proportion of down-regulation+artificial cycle patients in the Gram positive cocci group was higher than that in control group, and the difference was statistically significant [13.13% (34/259) and 7.46% (138/1 849), respectively, P<0.016 7]. In the pregnancy outcomes, there was a statistically significant difference in live birth rate among control group, Gram negative bacilli group, and Gram positive cocci group [49.86% (922/1 849), 49.21% (94/191) and 41.70% (108/259), respectively, P=0.048]. The live birth rate of the Gram positive cocci group was lower than that of control group, and the difference between the two groups was statistically significant ( P<0.016 7). There were no statistically significant differences in other pregnancy outcomes and perinatal outcomes of single pregnancy live birth FET patients (all P>0.05). The multivariate logistic regression model corrected for female age, infertility years, basal follicle stimulating hormone, anti-Müllerian hormone, proportion of single embryo transfer, proportion of single blastocyst transfer, endometrial thickness on transfer day, and endometrial preparation methods, Gram positive cocci were independent risk factors for live brith after FET transplantation (a OR=0.73, 95% CI: 0.55-0.95, P=0.021). Conclusion:The dominant bacteria in the vaginal microbiota before embryo transfer are Gram positive cocci, which may be related to a decrease in live birth rate in first-time FET patients, but not significantly related to the perinatal outcomes.

Objective To discuss the relationships between regular pattern changes of plasma fibrinogen (Fib),D-dimer and fibrinogen degradation products (FDP) levels and the recent dissolution of thrombus in patients with pulmonary embolism (PE) in 14 days after treatment.Methods A prospective study was conducted.PE patients admitted to Departments of Respiratory Disease in 4 hospitals from January 2015 to March 2016 were enrolled and all of them were treated with thrombolysis and/or anticoagulation after admission.The computed tomographic pulmonary angiography (CTPA) was examined pre-treatment and 14 days post-treatment in PE patients.The pulmonary artery obstruction index (PAOI) was assessed according to the Mastora scoring method to estimate the thrombus load.The plasma Fib,D-dimer and FDP levels were measured before and on 1,2,3,5,7 and 14 days after treatment,and the relationships between the change regularities of these parameters and PAOI were also analyzed.Results A total of 42 PE patients were enrolled.The curve change of coagulation-fibrinolytic system parameters in 14 days after treatment showed that the Fib level was raised to its peak on the 3rd day after treatment and then decreased (g/L:4.24 ± 1.45 vs.3.83 ± 1.56),representing that its curve change was in accordance with the quadratic model (P =0.095).After treatment,the D-dimer and FDP levels were kept declining,they were reached the valley on 14th day [D-dimer (mg/L):1.58 ± 1.38vs.8.84 ± 6.35,FDP (mg/L):4.23 ± 3.63 vs.23.41 ± 16.54],and their curve changes were in accordance with the cubic model (F was 32.190 and 34.326,respectively both P =0.000).The PAOI variation before and 14 days after treatment [(18.77 ± 14.22)％] was not correlated with Fib variation [(1.20 ± 0.93) g/L,r =-0.194,P =0.219],but was positively correlated with D-dimer variation [(7.29 ± 7.10) mg/L] and FDP variation [(19.29 ± 18.67) mg/L,r was 0.556 and 0.460,respectively;P was 0.020 and 0.002,respectively].Conclusions The D-dimer and FDP levels are kept falling in PE patients after treatment,suggesting that the pulmonary artery embolus is being dissolved.

Objective To establish mild cognitive dysfunction (MCI) models in elderly rats,and to investigate the pathophysiological features.Methods Totally 40 SD rats (14 to 18-month-old) were randomly divided into 2 groups:the model group (n=20) and the sham operation group (n=20).Bilateral carotid artery stenosis was prepared in the model group while bilateral carotid artery was seperated with no bilateral narrowing in the sham operation group.30 days after the operation,Morris water maze test was performed,pathomorphological and electron microscopic observations of the cerebral tissue were examined and the expression of G protein-coupled receptor kinase 2(GRK2) in hippocampus tissue w detected by reverse transcription polymerase chain reaction (RT-PCR) and Western blottin.Results The mortality in model group was only 10％.Pathological morphology and ultrastructure showed that hippocampal tissue structure was almost normal in sham operated group,but in model group group,hippocampal CA1 pyramidal cells were in ischemic demyelination,arranged loose,and part of the cells showed nucleus pyknosis,deeply stained; there was no obvious infarct in white matter,part of the white matter fiher hecame thinner and disorder,nucleolus became smaller and steped aside,cytoplasmic electron density increased,lipofuscin appeared occasionally.Rough endoplasmic reticulum and Golgi were expanded,cytosolic free ribosomes increased,part of mitochondria became swelled,vacuolated.Morris water maze test results showed that the average escape latency in model group was longer than in sham group (P＜0.05).In spatial probe test,the average time of crossing the first original platform in model rats was significantly longer than the sham operated group [(36.80±7.68) s vs.(20.87±6.16)s,P＜0.05].The average number of crossing the original platform in 60 seconds in model group was significantly less than in sham group(1.43±0.51 vs.3.10±1.45,P＜0.05).The expressiones of GRK2 mRNA and protein in the hippocampus were significantly increased in model group rats than in sham group (P＜0.05).Conclusions The model of severe CCA stenosis in elderly rats can be applied for MCI animal models with good stability and repeatability.Compared with sham group,the cells morphology and ultrastructure in model group appeare more obvious pathological changes and mild impairments in cognitive function.GRK2 may play an important role in the development of MCI.

Objective To study the changes of circulating triglyceride (TG) in the obese elderly, and to investigate the effect of hypertriglyceridemia on the development of insulin resistance. Methods A total of 82 subjects were divided into simple obesity group, obesity with IGT group, obesity with T2DM group and normal control group. The body height, body weight, blood pressure, fasting plasma glucose (FPG) and insulin(FPI), circulating TG and total cholesterol (TC) were measured. The homeostasis model assessment-insulin resistance (HOMA-IR) was calculated. Results The levels of serum TG were significantly higher in the simple obesity group ( 1.3 ± 0. 6) mmol/L, obesity with IGT group (1.9 ± 0.9)mmol/L and obesity with T2DM group (2.1±0.7) mmol/L than in the normal controls [(1.0±0.2)mmol/L, all P<0. 05], Furthermore, the levels of TG, FPG, FPI, HOMA-IR and systolic pressure were significantly higher(all P<0. 05) in obesity with IGT group and obesity with T2DM group than in simple obesity group. There were significantly positive correlations between TG and body mass index (BMI), FPG, HOMA-IR, TC, systolic pressure respectively (all P < 0.05). Multiple linear regression analysis indicated that FPG and HOMA-IR were the independent factors affecting TG (both P < 0. 05 ). Conclusions Hypertriglyceridemia may play an important role in the development of insulin resistance.

OBJECTIVE:To optimize the preparation technology for enteric-coated changbiqing granules.METHODS:The concentration of acrylic resin and the four factors like the quantity of castor oil,pulvis talci and methylsilicone oil on the yield of changbiqing enteric-coated granules were determined by orthogonal test design;The effects of the enteric-coated granule plasticizer on the quantity of castor oil and the weight increment of the coating were determined by the release rate test.RESULTS:The optimized formula of the coating solution was described as follows:the concentration of acrylic resin was5%,the relative amount of castor oil to acrylic resin was35%,the dosages of pulvis talci and methylsilicone oil were3%and1%,respectively,the weight increment of the coating was30%.CONCLUSION:Changbiqing enteric-coated granules pre?pared on the optimized technology are in line with the quality requirements and which have ideal enteric soluble drug releasing characteristics.