Objective:To evaluate any effect of transcranial direct current stimulation (tDCS) on cognitive impairment after an ischemic stroke (IS) using tract-based spatial statistics (TBSS).Methods:Fifty-one patients with mild or more serious cognitive impairment after an IS were divided into an electrical stimulation group (26 cases) and a control group (25 cases) using a random number table. In addition to conventional rehabilitation treatment, the electrical stimulation group was given tDCS, while the control group was given sham tDCS for 15 days. Before and after the treatment, both groups were evaluated using the Mini-mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Diffusion tensor imaging (DTI) was also performed. TBSS were computed for the differences in fractional anisotropy (FA) between the two groups before and after the treatment, and Pearson correlation analysis was applied to the pre-treatment and post-treatment FA differences within each group and the improvements in MMSE and MoCA scores.Results:After the treatment, the average MMSE and MoCA scores of both groups had improved significantly, but the improvement was significantly greater in the electrical stimulation group. After the treatment, the FA values among the electrical stimulation group had increased significantly in the bilateral genu of the corpus callosum, the bilateral inferior fronto-occipital fasciculus, the bilateral anterior thalamic radiation and the left superior longitudinal fasciculus. In the control group significant increases were recorded only in the left superior longitudinal fasciculus and the left anterior thalamic radiation. The FA change in the left superior longitudinal fasciculus of the electrical stimulation group was then positively correlated with the improvement in MMSE scores ( r=0.42), and that in the left anterior thalamic radiation was positively correlated with the improvement in MoCA scores ( r=0.45). Conclusions:tDCS can significantly improve the cognition of stroke survivors with cognitive impairment and promote the recovery of white matter fiber tracts. The FA values of the anterior thalamic radiation and the superior longitudinal fasciculus may be useful predictors and indicators of the recovery of cognitive function among such patients.

Objective:To evaluate any effect of transcranial direct current stimulation (tDCS) on cognitive impairment after an ischemic stroke (IS) using tract-based spatial statistics (TBSS).Methods:Fifty-one patients with mild or more serious cognitive impairment after an IS were divided into an electrical stimulation group (26 cases) and a control group (25 cases) using a random number table. In addition to conventional rehabilitation treatment, the electrical stimulation group was given tDCS, while the control group was given sham tDCS for 15 days. Before and after the treatment, both groups were evaluated using the Mini-mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Diffusion tensor imaging (DTI) was also performed. TBSS were computed for the differences in fractional anisotropy (FA) between the two groups before and after the treatment, and Pearson correlation analysis was applied to the pre-treatment and post-treatment FA differences within each group and the improvements in MMSE and MoCA scores.Results:After the treatment, the average MMSE and MoCA scores of both groups had improved significantly, but the improvement was significantly greater in the electrical stimulation group. After the treatment, the FA values among the electrical stimulation group had increased significantly in the bilateral genu of the corpus callosum, the bilateral inferior fronto-occipital fasciculus, the bilateral anterior thalamic radiation and the left superior longitudinal fasciculus. In the control group significant increases were recorded only in the left superior longitudinal fasciculus and the left anterior thalamic radiation. The FA change in the left superior longitudinal fasciculus of the electrical stimulation group was then positively correlated with the improvement in MMSE scores ( r=0.42), and that in the left anterior thalamic radiation was positively correlated with the improvement in MoCA scores ( r=0.45). Conclusions:tDCS can significantly improve the cognition of stroke survivors with cognitive impairment and promote the recovery of white matter fiber tracts. The FA values of the anterior thalamic radiation and the superior longitudinal fasciculus may be useful predictors and indicators of the recovery of cognitive function among such patients.

Objective:To investigate impacts of paeoniflorin-6′-O-benzene sulfonate(CP-25)on proliferation and apoptosis of ovarian cancer cells through Toll-like receptor 4(TLR-4)/nuclear factor-κB(NF-κB)signaling pathway.Methods:CCK-8 assay was performed to measure the cell activity of human ovarian cancer cells A2780,SK-OV-3,HO8910 and normal ovarian cells HOSEpiC.A2780 cells were separated into control group(0.01%DMSO),CP-25 low(0.5 mg/ml CP-25),medium(1 mg/ml CP-25)and high(2 mg/ml CP-25)concentration groups and CP-25 high concentration+LPS group(2 mg/ml CP-25 and 0.1 μg/ml TLR-4 activator LPS).Cell proliferation was evaluated by CCK-8 and clone formation assays;cell apoptosis was analyzed by flow cytometry and TUNEL staining;proliferating protein Ki67,apoptosis-related proteins(Cleaved caspase-3,Caspase-3,Bax,Bcl-2),TLR-4,p-NF-κB p65,NF-κB p65 protein expression levels were analyzed by Western blot;protein expressions of TLR-4 and NF-κB p65 were observed by immunofluorescence staining.Results:Compared with HOSEpiC cells,viabilities of A2780,SK-OV-3 and HO8910 cells were reduced gradually with the increased of CP-25 concentration(P<0.05),and CP-25 had about 50%inhibitory effect on the growth of A2780 cells at low,medium and high concentrations,so A2780 cells were used for the experiments.Compared with control group,the clone formation rate of A2780 cells in low,medium and high concentration groups of CP-25 reduced obviously,while apoptosis rate and apoptosis index rose obviously,expression levels of Ki67,Bcl-2,TLR-4,p-NF-κB p65 and nuclear NF-κB p65 were reduced obviously,while expression of Cleaved caspase-3/Caspase-3 and Bax were increased obviously in a concentration-dependent manner(P<0.05).Compared with CP-25 high concentration group,cell viability and clone formation rate were significantly increased in CP-25 high concentration+LPS group,while apoptosis rate and apoptosis index were decreased significantly,expression levels of Ki67,Bcl-2,TLR-4,p-NF-κB p65 and nuclear NF-κB p65 were increased significantly,while expressions of Cleaved caspase-3/Cas-pase-3 and Bax were significantly decreased(P<0.05).Conclusion:CP-25 inhibits ovarian cancer cell proliferation and promotes apoptosis by inhibiting TLR-4/NF-κB signaling pathway.

Bosworth fracture and dislocation is relatively rare, accounting for about 1% of ankle fractures. It is characterized by the proximal fibula fracture embedded in the posterolateral distal tibia. Due to an insufficient understanding of this fracture, it is easy to cause missed diagnosis and misdiagnosis in clinical practice. Due to the insertion of the fracture, it is challenging to perform closed reduction, and improper treatment is easy to cause complications. Surgical treatment is recommended for this type of fracture. In order to improve the understanding of orthopedic surgeons about Bosworth fracture and dislocation, this paper reports the diagnosis and treatment of 2 cases of Bosworth fracture and dislocation, and reviews the literature on Bosworth fracture's mechanism, diagnosis, classification, complications, and treatment options in recent years.
Humans ; Ankle Fractures/surgery* ; Joint Dislocations/surgery* ; Fracture Fixation, Internal ; Fibula ; Tibia

Objective: To explore the effects of three-dimensional (3D) bioprinting gelatin methacrylamide (GelMA) hydrogel loaded with nano silver on full-thickness skin defect wounds in rats. Methods: The experimental research method was adopted. The morphology, particle diameter, and distribution of silver nanoparticles in nano silver solution with different mass concentrations and the pore structure of silver-containing GelMA hydrogel with different final mass fractions of GelMA were observed by scanning electron microscope and the pore size was calculated. On treatment day 1, 3, 7, and 14, the concentration of nano silver released from the hydrogel containing GelMA with final mass fraction of 15% and nano silver with final mass concentration of 10 mg/L was detected by mass spectrometer. At 24 h of culture, the diameters of inhibition zone of GelMA hydrogel containing final mass concentration of 0 (no nano silver), 25, 50, and 100 mg/L nano silver against Staphylococcus aureus and Escherichia coli were detected. Fibroblasts (Fbs) and adipose stem cells (ASCs) were isolated respectively by enzymatic digestion using the discarded prepuce after circumcision from a 5-year-old healthy boy who was treated in the Department of Urology of the Second Affiliated Hospital of Zhejiang University School of Medicine in July 2020, and the discarded fat tissue after liposuction from a 23-year-old healthy woman who was treated in the Department of Plastic Surgery of the Hospital in July 2020. The Fbs were divided into blank control group (culture medium only), 2 mg/L nano sliver group, 5 mg/L nano sliver group, 10 mg/L nano sliver group, 25 mg/L nano sliver group, and 50 mg/L nano sliver group, which were added with the corresponding final mass concentrations of nano sliver solution, respectively. At 48 h of culture, the Fb proliferation viability was detected by cell counting kit 8 method. The Fbs were divided into 0 mg/L silver-containing GelMA hydrogel group, 10 mg/L silver-containing GelMA hydrogel group, 50 mg/L silver-containing GelMA hydrogel group, and 100 mg/L silver-containing GelMA hydrogel group and then were correspondingly treated. On culture day 1, 3, and 7, the Fb proliferation viability was detected as before. The ASCs were mixed into GelMA hydrogel and divided into 3D bioprinting group and non-printing group. On culture day 1, 3, and 7, the ASC proliferation viability was detected as before and cell growth was observed by live/dead cell fluorescence staining. The sample numbers in the above experiments were all 3. Four full-thickness skin defect wounds were produced on the back of 18 male Sprague-Dawley rats aged 4 to 6 weeks. The wounds were divided into hydrogel alone group, hydrogel/nano sliver group, hydrogel scaffold/nano sliver group, and hydrogel scaffold/nano sliver/ASC group, and transplanted with the corresponding scaffolds, respectively. On post injury day (PID) 4, 7, 14, and 21, the wound healing was observed and the wound healing rate was calculated (n=6). On PID 7 and 14, histopathological changes of wounds were observed by hematoxylin eosin staining (n=6). On PID 21, collagen deposition of wounds was observed by Masson staining (n=3). Data were statistically analyzed with one-way analysis of variance, analysis of variance for repeated measurement, Bonferroni correction, and independent sample t test. Results: The sliver nano particles in nano silver solution with different mass concentrations were all round, in scattered distribution and uniform in size. The silver-containing GelMA hydrogels with different final mass fractions of GelMA all showed pore structures of different sizes and interconnections. The pore size of silver-containing GelMA hydrogel with 10% final mass fraction was significantly larger than that of silver-containing GelMA hydrogels with 15% and 20% final mass fractions (with P values both below 0.05). On treatment day 1, 3, and 7, the concentration of nano silver released from silver-containing GelMA hydrogel in vitro showed a relatively flat trend. On treatment day 14, the concentration of released nano silver in vitro increased rapidly. At 24 h of culture, the diameters of inhibition zone of GelMA hydrogel containing 0, 25, 50, and 100 mg/L nano silver against Staphylococcus aureus and Escherichia coli were 0, 0, 0.7, and 2.1 mm and 0, 1.4, 3.2, and 3.3 mm, respectively. At 48 h of culture, the proliferation activity of Fbs in 2 mg/L nano silver group and 5 mg/L nano silver group was both significantly higher than that in blank control group (P<0.05), and the proliferation activity of Fbs in 10 mg/L nano silver group, 25 mg/L nano silver group, and 50 mg/L nano silver group was all significantly lower than that in blank control group (P<0.05). Compared with the that of Fbs in 0 mg/L silver-containing GelMA hydrogel group, the proliferation activity of Fbs in 50 mg/L silver-containing GelMA hydrogel group and 100 mg/L silver-containing GelMA hydrogel group was all significantly decreased on culture day 1 (P<0.05); the proliferation activity of Fbs in 50 mg/L silver-containing GelMA hydrogel group was significantly increased (P<0.05), while the proliferation activity of Fbs in 100 mg/L silver-containing GelMA hydrogel group was significantly decreased on culture day 3 (P<0.05); the proliferation activity of Fbs in 100 mg/L silver-containing GelMA hydrogel group was significantly decreased on culture day 7 (P<0.05). The proliferation activity of ASCs in 3D bioprinting group show no statistically significant differences to that in non-printing group on culture day 1 (P>0.05). The proliferation activity of ASCs in 3D bioprinting group was significantly higher than that in non-printing group on culture day 3 and 7 (with t values of 21.50 and 12.95, respectively, P<0.05). On culture day 1, the number of dead ASCs in 3D bioprinting group was slightly more than that in non-printing group. On culture day 3 and 5, the majority of ASCs in 3D bioprinting group and non-printing group were living cells. On PID 4, the wounds of rats in hydrogel alone group and hydrogel/nano sliver group had more exudation, and the wounds of rats in hydrogel scaffold/nano sliver group and hydrogel scaffold/nano sliver/ASC group were dry without obvious signs of infection. On PID 7, there was still a small amount of exudation on the wounds of rats in hydrogel alone group and hydrogel/nano sliver group, while the wounds of rats in hydrogel scaffold/nano sliver group and hydrogel scaffold/nano sliver/ASC group were dry and scabbed. On PID 14, the hydrogels on the wound surface of rats in the four groups all fell off. On PID 21, a small area of wounds remained unhealed in hydrogel alone group. On PID 4 and 7, the wound healing rates of rats in hydrogel scaffold/nano sliver/ASC group were significantly higher than those of the other three groups (P<0.05). On PID 14, the wound healing rate of rats in hydrogel scaffold/nano sliver/ASC group was significantly higher than the wound healing rates in hydrogel alone group and hydrogel/nano sliver group (all P<0.05). On PID 21, the wound healing rate of rats in hydrogel alone group was significantly lower than that in hydrogel scaffold/nano sliver/ASC group (P<0.05). On PID 7, the hydrogels on the wound surface of rats in the four groups remained in place; on PID 14, the hydrogel in hydrogel alone group was separated from the wounds of rats, while some hydrogels still existed in the new tissue of the wounds of rats in the other three groups. On PID 21, the collagen arrangement in the wounds of rats in hydrogel alone group was out of order, while the collagen arrangement in the wounds of rats in hydrogel/nano sliver group, and hydrogel scaffold/nano sliver/ASC group was relatively orderly. Conclusions: Silver-containing GelMA hydrogel has good biocompatibility and antibacterial properties. Its three-dimensional bioprinted double-layer structure can better integrate with new formed tissue in the full-thickness skin defect wounds in rats and promote wound healing.
Male ; Rats ; Animals ; Humans ; Hydrogels/pharmacology* ; Bioprinting ; Metal Nanoparticles ; Rats, Sprague-Dawley ; Silver/pharmacology* ; Soft Tissue Injuries ; Anti-Bacterial Agents

The lifelong teaching and learning abilities based on training the core competency of ophthalmology residents is a new hot spot in the curriculum design of ophthalmological standardized residency training. In the standardized residency training base of Xiangya Hospital of Central South University Ophthalmic Center, a graded lecturer training curriculum with residents as core has been designed to train the critical thinking, active learning, summarizing and presenting skills of residents at all levels. According to the different tasks, the residents can present themselves through online and offline platforms so that they can gradually grow into different levels of lecturers. Through the graded training of lecturers from low level to high level, step by step, the residents are trained as active learners from the thinking mode, become student-instructors or lecturers from the teaching ability, and be more competent for future study and work.

Objective: To explore the effect of taurine on the activity of SOD, MDA, Na⁺ -K⁺ -ATP enzyme and Bax/Bcl-2 in skeletal muscle of rats after exhaustive exercise. Methods: Thirty male SD rats(6 months old) were randomly divided into normal group, control group and taurine group, with 10 rats in each group.The normal group was given routine feeding for 1 week, adaptive training for 3 days, without applying other measures.The control group was given routine feeding for 1 week, after adaptive training for 3 days underwent exhaustive exercise for 2 days.The taurine group was given 200mg/kg taurine gavage daily on the basis of the control group.The activity of SOD, MDA, Na⁺ -K⁺ -ATP and Bax/Bcl-2 were measured in the skeletal muscle after 2 days exhaustive exercise. Results: After 2 days exhaustive exercise, the SOD concentration in skeletal muscle of the control group was (146.58±13.42)U/mg prot, which was lower than that in the taurine group[(143.81±15.93)U/mg prot] (t=2.519, P<0.05). The MDA concentration in the skeletal muscle of the control group was (1.97±0.20)nmol/mg prot, which was higher than that in the taurine group [(1.22±0.19)nmol/mg prot] (t=2.356, P<0.05). The ratio of SOD/MDA in the control group was (60.86±20.38), which was lower than that in the taurine group [(120.87±23.51)] (t=4.071, P<0.05). The activity of Na⁺ -K⁺ -ATP in the control group was (2.42±0.67)U/mg prot, which was lower than that in the taurine group [(5.74±1.15)U/mg prot] (t=3.905, P<0.05). The ratio of Bax/Bcl-2 in the control group was (1.62±0.17), which was higher than that in the taurine group [(0.96±0.14)] (t=3.419, P<0.05). Conclusion Taking taurine before exhaustive exercise can increase the ability of scavenging free radicals, reduce the production of oxidative stress products and protect the activity of Na⁺ -K⁺ -ATP enzyme.It is benefit for maintain the stability of cell environment and prevent skeletal muscle injury.

Objective: To evaluate the differential diagnosis of idiopathic granulomatous mastitis (IGM) and invasive ductal carcinoma. Methods: The ultrasonographic data of 37 IGM patients and 50 cases of IDC were analyzed retrospectively. The shape, growth direction, margin, internal echo, posterior echo, calcification, Adler blood flow classification, PSV(peak sestolic velocity), RI (resistance index)and elasticity scores were analyzed by χ² test and independent sample t test. The optimal cutoff values of age, PSV and RI were calculated by receiver operating characteristic (ROC) curve. Logistic regression analysis was used to calculate the odds ratio (OR) of ultrasonic variates in the diagnosis of both diseases. Results: There were no significant differences in the shape, margin, internal echo and blood flow grading between the two groups. The age, lesion growth direction, posterior echo, calcification, PSV, RI and elasticity were statistically different. The cut-of value of Age, PSV and RI were 38.5 years old, 13.20 cm/s, and 0.655. Logistic regression multi-variated analysis revealed that elastic score (OR=9.806) had the best value of the differential diagnosis, as well as calcification (OR=6.937), posterior echo decay (OR=4.613), RI (OR=3.257), lesion growth orientation (OR=3.198), and PSV (OR=1.202). Lesion shape, margin, internal echo, and Adler blood flow classification did not help in differential diagnosis. Conclusion Ultrasound multi-parameter analysis has high value in IGM and IDC differential diagnosis.

Objective To explore the sample type and drug resistance characteristics of Streptococcus pneu-monia(Spn)isolated from pediatric patients in Guangzhou district,and their age distribution to offer instruc-tions for prevention and clinical treatment.Methods Spn isolates were cultured and identified according to the national standard procedure for clinical laboratory operation,followed by analysis of sample type and age dis-tribution of pediatric patients with positive isolates of Spn in Guangzhou Women and Children′s Medical Cen-ter from 2013 Jan 1st to 2015 Dec 31st,drug resistance status was determined by MIC test.Results Totally, 1 243 strains of Spn were isolated,which were mainly from pediatric patients under 1 year old(42.80%).Spn isolates were mainly isolated from respiratory tract(72.81%),ear secretions(15.37%),blood(5.63%),cere-brospinal fluid(3.06%)and hydrothorax(2.01%).For all Spn isolates,the resistance rate to erythromycin, tetracycline and sulfamethoxazole was especially high as 94.93%,85.76%,73.53% respectively,with relative high resistance to penicillin G(24.70%),amoxicillin(39.59%),ceftriaxone(24.05%),meropenem(22.85%) and cefotaxime(19.89%),low resistance to quinolone antibiotics(<10.00%),and no resistance to vancomycin and linezolid.Conclusion The major age group of children with Spn infection is infants under one year old in Guangzhou,clinicians should be serious about the high resistant rate of Spn to erythromycin,tetracycline and sulfamethoxazole,the significantly increased resistant rate to penicillin,amoxicillin and ceftriaxone.Clinicians should choose antibiotics rationally according to the characteristics of drug sensitivity for better treatment.

Objective To investigate the status of self-management in patients with chronic heart failure (CHF) in Zhejiang province, and to explore the relationship between the self-management level and medical coping styles. Methods From March to September 2016, using the convenient sampling method, a total of 450 aged patients with chronic heart failure from 5 Class Ⅲ Grade A hospitals in 3 districts including Ningbo, Pinghu and Jiaxing of Zhejiang province, who were hospitalized in the Cardiovascular Department, were recruited as research subjects. The Self-Management Scale of Heart Failure Patients and Medical Coping Modes Questionnaire (MCMQ) were applied in the investigation to carry out the correlation analysis. Results A total of 450 questionnaires were distributed, and 437 valid questionnaires were collected. The Self-Management Scale of Heart Failure Patients in the 437 patients were (51.48±10.77) in total score, (18.90±3.10) in facing coping style, (16.12±2.18) in avoiding coping style and (11.85±1.82) in yielding coping style. Pearson correlation analysis showed that the total score of self-management was positively correlated with facing coping style (r=0.303, P＜0.01), negatively correlated with yielding (r=-0.157, P＜0.01), and positively correlated with avoiding coping style (r=0.117, P＜0.01). Multiple linear stepwise regression analysis showed that family monthly income, self-care ability and marriage were the main factors affecting self-management of patients with chronic heart failure. Conclusions Self-management level in patients with chronic heart failure in Zhejiang province is relatively low, and effected by family income, self-care ability, marriage and other factors. Nursing staff should understand different characteristics of different patients to provide personalized health education, improve their self management level, and promote the patients more actively face the disease, reduce and avoid negative medical coping.