Older adults have decreased control of body balance with aging and are prone to fall. As the primary point of contact between human body and ground, footwear is critical for stability of older adults. The relationship between shoe characteristics and stability of older adults was systematically reviewed to determine the effect of footwear characteristics on stability of older adults. The results show that wearing shoes with shoelaces or velcro, low heels, wide outsole and appropriate soles, or using vibrating insoles and arch support insoles can help older adults improve their stability. Excessive sole spring and low sole hardness may have adverse effects on stability of older adults. This study can provide theoretical references for older adults to choose shoes reasonably and for the manufacturers to design and make shoes to prevent falls.

Objective:Using ultrasound imaging technology to evaluate the contraction characteristics of diaphragm in patients with chronic low back pain.Methods:Twenty nine patients with chronic low back pain and 26 healthy persons recruited from the rehabilitation department of the Third Affiliated Hospital of Sun Yat-sen University from November 2019 to April 2020 were selected and divided into the low back pain (LBP) group and the healthy control group. The thickness of the diaphragm (Tdi) of the subjects during deep breathing was evaluated by portable color Doppler ultrasound equipment under different body positions. The subjects were required to perform maximum inspiration for total lung capacity (TLC) and expiration for functional residual capacity (FRC) in the supine and standing position, respectively. The end-inspiratory diaphragm thickness (TdiTLC) and end-expiratory diaphragm thickness (TdiFRC) were recorded, and the diaphragmatic thickening fraction (DTF) was calculated. The general data of subjects with lower back pain and the correlation between Oswestry Dysfunction Index (ODI) and diaphragm function were analyzed; The diaphragm function of healthy control group and LBP group were compared; The receiver operating characteristic (ROC) curve of Tdi and DTF in the diagnosis of lower back pain were analyzed.Results:ODI lifting score was negatively correlated with standing TdiTLC ( r=-0.50, P<0.01). In intra-group comparison, the TdiTLC and TdiFRC values of healthy subjects in standing position were increased compared with those in supine position ( t=6.115, 7.314, all P<0.001); In standing position, TdiTCL and TdiFRC values in LBP group were increased compared with those in supine position ( t=2.834, 4.673, all P<0.01). In comparison between groups, TdiTLC values in supine and standing position of LBP group were significantly lower than those in healthy control group ( t=2.597, 3.338, all P<0.05); In standing position, TdiFRC of patients in LBP group was significantly lower than that of healthy control group ( t=2.098, P=0.041) and DTF value of patients in LBP group was significantly lower than that of healthy control group ( t=2.902, P=0.006). When TdiTCL≤3.3 mm in supine position was used to predict low back pain, the diagnostic sensitivity and specificity were 78.6% and 53.8%, respectively, and the area under the curve was 0.661. When TdiTCL≤4.5 mm in standing position was used to predict low back pain, the diagnostic sensitivity and specificity were 95.7% and 46.2%, respectively, and the area under the curve was 0.759. When DTF≤81.3% in standing position was used to predict low back pain, the diagnostic sensitivity and specificity were 52.2% and 84.6%, respectively, and the area under the curve was 0.698. Conclusions:It is found in our study that the diaphragm contractile function of patients with lower back pain is worse than that of normal subjects, and the difference was significant in standing position. We suggest that the right-side ultrasound image acquisition in the patient′s standing position is helpful to ensure the accuracy and objectivity of the measurement results. TdiTCL≤4.5 mm or DTF≤81.3% in standing position can be used as one of the reference indexes for the combined diagnosis of chronic low back pain.

In this study, sonography video urodynamic studies (SVUDS), which combined synchronically urodynamic studies with trans-perineal and trans-abdominal sonography, were used to detect female bladder outlet obstruction (FBOO). The dynamic changes of urethra and surrounding pelvic floor structure during storage and voiding phase were observed by SVUDS and the causes of FBOO were analyzed. And the findings were as follows: 13 patients showed organ prolapse, there was an urethral angulation deformity during urination; 5 cases had abnormal urination as the urethral opening was not good in the middle of urination period; 4 cases had urethral stricture, as the proximal end of the obstruction dilated during urination, and the obstruction site showed no relaxation; 1 case had primary bladder neck obstruction with an incomplete opening of the bladder neck during urination; 3 cases had idiopathic bladder outlet obstruction and the sphincter of bladder neck and urethra opened well during urination.

OBJECTIVE：To provide method reference for scientifically eva luating the rationality of the use of saxagliptin . METHODS：Based on the drug instructions ，clinical guidelines ，clinical pathways ，related references ，clinical endocrinology department and pharmaceutical experts of a hospital jointly discussed and formulated the evaluation criteria for the rationality of the use of saxagliptin. AHP method was used to assign weights to various indexes of evaluation criteria ；TOPSIS method was used to analyze the use of saxagliptin of 106 cases in the hospital during Nov. 2018-Apr. 2019 retrospectively and evaluate rational drug use. RESULTS ：A total of 6 primary indicators and 12 secondary indicators were established. The first three indicators with a relatively high index weight were indications （with a weight of 0.25），dose and adjustment of administration （with a weight of 0.21）and frequency of administration （with a weight of 0.15）. Among 106 cases，39.6％ of drug use were reasonable ，51.0％ were basically reasonable and 9.4％ were unreasonable. Evaluation results made by weighted TOPSIS were consistent with the actual situation. CONCLUSIONS ：TOPSIS method weighted by AHP is reasonable and feasible for evaluating the rationality of saxagliptin use.

Objective: To investigate the value of Cytomegalovirus(CMV) DNA real-time quantitative-polymerase chain reaction(RT-PCR) in different body fluids for diagnosing CMV pneumonia in immunocompetent infants. Methods: The clinical data of immunocompetent infants with CMV pneumonia who were treated in Pediatric Intensive Care Unit of Guangdong Women and Children′s Hospital from January 1^st, 2016 to February 5^th, 2018 were retrospectively analyzed.The clinical data included CMV DNA load of bronchoalveolar lavage fluid(BALF), urine, blood and cerebrospinal fluid(CSF); blood immunoglobulin(Ig)M CMV, alanine aminotransferase (ALT), X-ray and CT test of chest, combined infection, clinical manifestation and treatment. Results: Nine hundred and twenty-six infants received bronchoalveolar lavage by bronchoscope, and 34 cases were diagnosed as immunocompetent with CMV pneumonia.The infants with CMV pneumonia: the positive percentage of urine CMV DNA, blood CMV DNA, blood IgM CMV and ALT elevation were 100.0%(34/34 cases), 61.8%(21/34 cases), 52.9%(18/34 cases) and 20.6%(7/34 cases), respectively.There was no difference in positive percentage between blood CMV DNA and blood IgM CMV (χ²=0.5, P>0.05). Both the positive percentages of blood CMV DNA and blood IgM CMV were lower than those in the urine CMV DNA, and the differences were statistically significant (χ²=16.1, 20.9, all P<0.05). The positive percentages of ALT elevation were lower than those in the positive percentage of urine CMV DNA, blood CMV DNA and blood IgM CMV, and the differences were statistically significant (χ²=44.8, 11.9, 7.7, all P<0.05). Ten patients′ CSF CMV DNA were tested, and they were all negative.The median load of CMV DNA in BALF, urine and blood was 170.0×10⁵ copies/L, 130.0×10⁵ copies/L and 6.0×10⁵ copies/L.There was no difference in median load between BALF and urine (U=561, P>0.05). BALF CMV DNA load and blood CMV DNA load had a weak positive correlation (r=0.35, P<0.05), BALF CMV DNA load and age had a negative correlation (r=-0.42, P<0.05), and urine CMV DNA load and blood CMV DNA load had a positive correlation (r=0.52, P<0.05). No matter whether blood IgM CMV was positive, BALF CMV DNA load had no differences (U=92, P>0.05). The main radiographic signs were pulmonary interstitial lesions.Thirty-four immunocompetent infants with CMV pneumonia, 18 patients (52.9%) with symptoms lasted for over 2 weeks, 20 patients (58.8%) had complicated infections.They all received inductive treatment of Ganciclovir, 55.9%(19/34 cases) patients′ urine CMV DNA turned to be negative.When patients got combined infections by bacteria or mycoplasma, antibiotics were used.All discharged patients had symptoms relieved and signs improved. Conclusions BALF RT-PCR is instant, sensitive and distinctive method to diagnose CMV pneumonia.Urine RT-PCR gets specimens conveniently and safely, its positive percentage and DNA load are present well according to BALF, and is suitable for screening and monitoring CMV infection.Blood CMV DNA load and blood IgM CMV indicate viral dissemination and immunocompetence, but it is not recommended for diagnosing CMV pneumonia solely.

Objective To analyze the effect of ultrasound-guided glucocorticoid injection on different pathologies of the shoulder retrospectively.Methods Clinical data were collected describing 75 patients with shoulder pain who received ultrasound-guided glucocorticoid injection and finished 3 month follow-ups in the rehabilitation clinic of the Third Affiliated Hospital of Sun Yat-sen University between April and September of 2017.The patients were divided into three groups based on their different injection sites:group 1 was injected at the subacromial bursa alone,group 2 was injected at both the subacromial bursa and the coracoid bursa,while group 3 was injected at the subacromial bursa and the long head of the tendon sheath of the biceps brachii.A shoulder pain and disability index (SPADI) was used to quantify the pain and disability of each patient before and after the injection.Results Significant improvement was observed in the average pain and disability scores of all groups at 1 week,1 month and 3 months after the injection.Moreover,significant and continuous improvement was observed in the average pain and disability scores of groups 1 and 3,as well as the average disability score of group 2 from right after the injection until the last follow-up.However,no significant differences were found in the average pain score between one and three months after the injection.There was no significant difference among the 3 groups in the average pain and disability scores before and immediately after the injection.Conclusion Ultrasound-guided glucocorticoid injection is effective and persistent for treating shoulder pain with different pathologies.

Objective To observe the curative effect of nourishing kidney,activating blood and expelling toxin method Chinese medicine on chronic kidney disease (CKD) ratsand influence on cellular apoptosis.Methods The UUO animal model was adopted.SD male rats were divided into the sham operation group,UUO model group,Chinese medicine low dose group and high dose group.The renal function was measured by the automatic biochemical analyzer,the renal histopathologic change was observed by HE staining,the renal tissue apoptosis rate was observed by TUNEL as well as the protein expression levels of Bcl-2 and Bax were detected by Western blot.Results Compared with the UUO model group,the levels of serum creatinine(Scr) and urea nitrogen(BUN) in Chinese medicine various doses groups were significantly decreased(P＜0.05).In the UUO pathologic observation,renal tubular epithelial cells apoptosis,necrosis,exfoliation,inflammatory cells infiltration were found in the model group,the renal damage in the Chinese medicine various doses groups were slighter compared with the UUO group(P＜0.05).The TUNEL method detection showed that the cellular apoptosis number in the UUO group was significantly increased compared with the sham operation group,the Chinese medicine various doses groups could significantly decrease the apoptosis number(P＜0.05).Compared with the UUO model group,the level of Bcl-2 in the Chinese medicine treatment groups was markedly up-regulated,the Bax level was down-regulated,and the ratio of Bcl-2/Bax was increased(P＜0.05).Above results all showed the dose dependent manner.Conclusion The nourishing kidney,activating blood and expelling toxin method Chinese medicine can obviously down-regulate serum Scr and BUN levels,inhibits the renal cells apoptosis in UUO rat and regulates the Bcl-2 and Bax levels.

Background and objectiveRadiofrequency ablation (RFA) has become one of the local treatment for inoperable early stage non-small cell lung cancer (NSCLC). hTis study observes effectiveness and safety of computed tomog-raphy (CT) guided RFA followed intratumoral chemotherapy (RFA-ITC).MethodsFrom 2005 to 2015, our group perspec-tively enrolled inoperable early stage NSCLC underwent RFA-ITC duo to poor cardiopulmonary function or with other dis-eases or patient can't tolerate or reject surgery. RFA was performed by a directive apparatus assisted CT guided semi real-time and step-by-step puncture method, conformal umbrella-shaped electrode and single or multiple targets ablation. While the plan ifnished and CT showed normal lung tissue around the tumor present ground-glass opacity (GGO), the procedure ended, then 200 mg of carboplatinum were injected into the tumor via the electrode needle. Safety and effectiveness were evaluated byfollow-up.Results Technical success rates of 125 RFA-ITC treatments of 110 patients were 100%. hTe median survival was 48.0 months, overall survival (OS) was 55.4 months, progression-free survival was 55.1 months, 1, 2, 3, 5-year OS rates were 100%, 90.7%, 62.7%, 21.9%, respectively. Survival of GGO presence or not was 68.3 months and 40.1 months, respectively (P=0.001). hTe survival rates of the N1 staging and tumor size was no signiifcant difference. No perioperative deaths occurred, the main complicationsi.e. pneumothorax, pulmonary hemorrhage, pleural effusion, fever, intraoperative chest pain, subcuta-neous emphysema, intraoperative cough were slight and tolerable.ConclusionCT guided RFA-ITC provides a good method for treatment of inoperable early stage NSCLC with better survival, less complication and small damage.

Aim To investigate the renoprotective effect of berberine in diabetic nephropathy rat model. Methods The rat model of DN was induced by intra-peritoneal injection of streptozotocin ( STZ ) after fed with high sugar and high fat diet for six weeks. The rats were divided into 5 groups randomly, i. e. normal control group, model group, BBR ( 50 mg · kg-1 ) , BBR ( 100 mg · kg-1 ) and BBR ( 200 mg · kg-1 ) treatment group. The fasting blood glucose ( FBG) was evaluated at 2, 4, 6,8 week respectively. The patho-logical changes in the kidney were determined by PAS staining. The expression of vascular endothelial growth factor ( VEGF) was detected by immunohistochemistry and Western blot respectively. Results Compared with normal control group, the value of FBG, SCr, BUN and UTP of model group were sharply increased.
Compared with model group, the value of FBG in ber-berine different dosage treatment groups were signifi-cantly decreased to various degrees, and berberine dif-ferent dosage treatment could decrease the levels of SCr, BUN and UTP in different degree. Berberine could surpress the alterations of pathological changes in the kidneys and downregulate the expression levels of VEGF in the kidney of diabetic rats with nephropathy. Conclusion Berberine could significantly ameliorate the biochemical indicators and renal injury of the model rats through affecting the abnormal expression levels of VEGF in the kidney.

Aim To investigate the effect of berberine on the expression of nephrin, podocin and intergrinα3β1 in diabetic nephropathy ( DN ) rat model, and further probe in to the renoprotective effects of berber-ine and its potential mechanisms. Methods The rat model of DN was induced by intraperitoneal injection of streptozotocin ( STZ ) after fed with high-sugar and high-fat diet for six weeks. The rats were assigned into 6 groups randomly: normal control group, DN model group, BBR (50,100 and 200 mg·kg-1 ) treatment group and enalaprilat positive control group ( 1 mg · kg-1 ) . The distribution and expression of kidney podocyte related proteins nephrin, podocin and interg-rinα3β1 were detected by immunohistochemical meth-od following electron microscopy observation ( × 1000 ) and high magnification observation( × 400) and West-ern blot. Results The podocyte related protein neph-rin, podocin and intergrin α3β1 were mainly distribu-ted in podocyte, but slightly different. Compared with normal control group, the expresion of podocyte related protein nephrin, podocin and intergrin α3β1 was de-creased obviously; compared with model group, BBR (100 and 200 mg·kg-1 ) treatment group could sig-nificantly suppress the abnormalities of pathological changes of the kidney and upregulate the expression levels of podocyte specific protein nephrin, podocin and intergrin α3β1 in the kidney of diabetic rats with nephropathy. Conclusions Berberine could alleviate the abnormalities of kidney pathological changes and proteinuria production in the DN model rats, which may be related to the upregulation of the expression of the podocyte proteins nephrin, podocin and intergrinα3β1.