Objective:To study the risk of refracture after osteoporotic vertebral fracture with changes in blood calcium and bone metabolism.Methods:260 patients with osteoporotic vertebral fracture treated in our hospital from Feb. 2018 to Feb. 2020 were selected for study. All patients were treated with kyphoplasty. The clinical curative effect, blood calcium, PINP, and β-CTX level changes were observed, postoperative recurrence was followed up. Clinical data of fracture patients were collected, risk factors of osteoporotic vertebral fractures in patients with postoperative recurrence of fracture were analyzed, receiver-operating characteristic curve was drawn to analyze the predictive value of blood calcium, PINP, andβ-CTX in postoperative recurrence of osteoporotic vertebral fracture.Results:The total clinical response rate was 95.77% (249/260) after treatment. After treatment, serum calcium, PINP, and β-CTX decreased with time, and the difference was significant ( P<0.05) . All patients were followed up for 6 months. There were 81 cases (31.15%) suffering postoperative fracture and 179 cases (68.85%) without fracture. According to univariate analysis, there were no statistically significant differences in age, sex, BMI, history of trauma, underlying disease, site of surgical vertebral body, segment of surgical vertebral body, correction angle of sagittal kyphosis, or amount of bone cement injection between the two groups ( P>0.05) . Long-term history of glucocorticoid use, preoperative fractured vertebra number, surgical vertebra number, blood calcium, PINP, β-CTX, fracture compression rate, vertebra height recovery rate, reinforced vertebra number, and bone cement leakage were correlated with postoperative recurrence of fracture in patients with osteoporotic vertebral fracture ( P<0.05) . Multivariate Logistic analysis showed that long-term history of glucocorticoid use, preoperative number of fractured vertebrae, surgical vertebra number, fracture compression rate, vertebral height recovery rate, enhanced vertebral body number, bone cement leakage, blood calcium, PINP, and β-CTX were all independent risk factors for postoperative recurrence of osteoporotic vertebral fracture ( P<0.05) . ROC curve results showed that AUC, 95%CI and truncation value were 0.820, 0.770-0.871 and 2.12mmol/L vs 0.915, 0.873-0.957 and 45.51 ng/mL vs 0.973, 0.957-0.988, and 463.29 for serum calcium, PINP, and β-CTX respectively in predicting the recurrence of osteoporotic vertebral fracture. Conclusion:Kyphoplasty has a significant effect on osteoporotic vertebral fracture, and it can effectively improve the serum calcium, PINP, and β-CTX, which have a certain monitoring value for postoperative recurrence of fracture.

Objective:To investigate the diagnosis and clinical characteristics of five elderly patients with Chlamydia psittaci-caused severe pneumonia.Methods:Through retrospective analysis, diagnosis and treatment process and clinical characteristics of five elderly inpatients with severe pneumonia caused by Chlamydia psittaci were summarized in the Department of Critical Care Medicine, Quanzhou First Hospital East Street Branch Area, affiliated to Fujian Medical University between January to June 2021.Results:Five patients with severe pneumonia caused by Chlamydia psittaci were aged from 64 to 74 years, with various underlying diseases such as coronary heart disease, chronic heart failure, chronic obstructive pulmonary disease, etc.All patients had an established history of poultry exposure.These cases had high fever, cough, spitting, and dyspnea as the main clinical manifestations.Some of them also had systemic symptoms or weakness of the limbs as the prodromal symptoms.The disease progressed rapidly, with severe respiratory failure, acute kidney injury, and shock appearing soon, accompanied by different degrees of muscle injury, and damage to the heart, liver, blood coagulation, and immune systems at the same time.Laboratory examination showed that levels of inflammatory indicators were increased: at 3, 5, 7 d after admission, the level of C reactive protein was 214.6(153.9-256.3)mg/L, 199.2(115.8-333.8)mg/L, 151.0(11.19-173.7)mg/L, respectively; and interleukin 6 level was 1 241.0(912.1-6822.0)ng/L, 779.1(451.2-7122.0)ng/L, 631.2(7.0-4 321.0)ng/L, respectively.And monitoring results of nutritional index indicated a high metabolic state.The imaging examinations showed that consolidation and ground-glass shadows spreaded to both lungs, may accompany the miliary and nodular shadows, and may also involve pleural which caused pleural effusion.After the clinical use of metagenomic next-generation sequencing(mNGS), mNGS has been confirmed as an important method for the diagnosis of Chlamydia psittaci infection.The disease course and prognosis were related to the severity of the disease, advanced age, underlying diseases, and timely diagnosis and effective treatment.Conclusions:The progression of Chlamydia psittaci pneumonia to severe disease may be related to advanced age, more basic diseases such as chronic cardiopulmonary disease, smoking, and timely diagnosis and treatment.Generally, laboratory and imaging examinations have no diagnostic specificity, but mNGS is of great significance for early diagnosis, transition to target treatment and improvement of prognosis.

Wet age-related macular degeneration (AMD),which is the leading cause of visual impairment in elderly people,significantly affects quality of life of millions worldwide.Currently,anti-VEGF is the first-line therapy for wAMD,bringing encouraging results in improving the vision.However,not all of the patients will response to this therapy,moreover,anti-VEGF may be associated with several issues,such as multiple injections,systemic adverse effects,delay or lack of response.With a deep understanding of the mechanism of wAMD,there are rapid developments of new approaches to more effective therapy.Ophthalmologists should pay attention to the advantages and disadvantages of these anti-VEGF drugs as well as the current advances of anti-VEGF drugs in order to provide better treating strategies for wAMD patients better.

Objective To investigate the feasibility and short-term efficacy of endplate reduction percutaneous pedicle screw (ERPPS) technique combined with short-segment percutaneous pedicle screw fixation for the treatment of AO type A3 thoracolumbar fractures.Methods A retrospective case control study was conducted to analyze the clinical data of 36 patients with type A3 thoracolumbar fractures without neurological symptoms and with comminuted endplates admitted to 903 Hospital of PLA from December 2015 to January 2018.Fifteen patients (Group A) were treated with ERPPS technique combined with short-segment percutaneous pedicle screw fixation,including 11 males and four females,aged (37.9 ±8.3)years.The injured segments were at T11 in 1 patient,T12 in 3,L1 in 6,L2 in 3 and L3 in 2.Simple short-segment percutaneous pedicle screw reduction and internal fixation was performed in 21 patients (Group B),including 14 males and seven females,aged (37.3 ± 9.5)years.The injured segments were at T~ in two patients,T12 in six,L1 in seven,L2 in four and L3 in two patients.The operation time,intraoperative bleeding and complications were recorded.The anterior vertebral body height ratioin (AVBHr),middle vertebral body height ratio (MVBHr),posterior vertebral body height ratio (PVBHr),Cobb angle of kyphosis and wedge angle of injured vertebrae were calculated based on the measurement by X-ray films taken before operation,during operation (after regular reduction),3 days after operation and 6 months after operation.Visual analogue scale (VAS) and Oswestry dysfunction index (ODI) were used to assess the pain and functional improvement.Results All patients were followed up for 11-30 months [(19.1 ± 5.0) months].The operation time was (62.8 ± 4.4)minutes in Group A and (60.1 ± 4.7)minutes in Group B (P ＞ 0.05).The intraoperative blood loss was (48.5 ± 5.1) ml in Group A and (48.0 ± 4.9) ml in Group B (P ＞ 0.05).All the incisions were healed by first intention without complications.The MVBHr of injured vertebra was (84.8 ± 4.4) ％ in Group A and (68.1 ±8.8)％ in Group B (P＜0.05).The MVBHr 6 months after operation was (81.3 ±4.9)％in Group A,significantly better than that in Group B [(63.6 ± 8.1) ％] (P ＜ 0.05).At 6 months after surgery,the kyphosis Cobb angle [(11.3 ± 3.2) °],the wedge angle [(10.5 ± 2.1) °] of the injured vertebra and the VAS [(1.1 ± 0.7) points] of Group A were significantly better than those of Group B [(13.4±2.3)°,(12.1 ±2.2) °and (1.9±1.1)points] (P＜0.05).There were no significant differences in AVBHr,PVBHr and ODI between the two groups (P ＞ 0.05).Conclusion For type A3 thoracolumbar fractures with endplate comminuted injury and without neurological symptoms,the ERPPS technique can effectively reduce the collapse of the central part of the upper endplate and improve the clinical results (less reduction loss and back pain) after short-segment percutaneous pedicle screw reduction and internal fixation under the premise of strict indications.

Objective To investigate the effect of glutamine (GLN) treatment on neurobehavioral outcome,brain edema and inflammatory response in rats after traumatic brain injury (TBI),and to find out the role played by autophagic response in this effect.Methods Rat models with TBI in this study were established using Feeney's method.One hundred healthy male SD rats were randomly divided into five groups (n =20) to receive sham operation (group Sham),TBI (group TBI),TBI and glutamine treatment (group TBI+GLN),TBI amd autophagy inhibitor 3-methyladenine (group TBI+ 3-MA),and TBI,GLN and autophagy inhibitor (group TBI+GLN+3-MA).We measured the rats' behavioral outcomes by modified neurologic severity score (mNSS) tests at day 1,3,7 and 14 after intervention.Brain water content was measured with wet-dry weight method.The serum levels of tumor necrosis factor-α (TNF-ct),interleukin (IL)-1 and IL-4 were tested using enzyme linked immunosorbent assay.The expressions of autophagy-related factors (LC3-Ⅱ,Beclin-1) in TBI cerebral cortex were tested with Western blot.Results Compared with the Sham group,the other four groups had significantly increased levels of brain edema,mNSS,serum inflammatory factors and cerebral LC3-Ⅱ and Beclin-1 (P=0.00).Compared with the TBI group,the TBI+GLN group had less severe brain edema and improved mNSS,lower levels of TNF-α [(57.71 ±9.69) pg/ml vs.(83.37± 12.81) pg/ml,P=0.01] and IL-1 [(39.46±8.60) pg/ml vs.(69.04± 10.48) pg/ml,P=0.00],higher levels of IL-4 [(68.72± 11.18) pg/ml vs.(35.75 ± 8.40) pg/ml,P =0.04],and upregulated expressions of LC3-Ⅱ and Beclin-1 (P=0.01).Compared with the TBI+GLN group,the TBI+GLN+3-MA group had severer neurofunctional impairment,brain edema and inflammation (P＜ 0.05).Conclusions Treatment with GLN markedly reduced brain edema and improved neurobehavioral outcomes in rats with TBI by inhibiting inflammatory response in the central nervous system.The mechanism might have been the activation of the autophagic response.

Objective To investigate the association between ten single nucleotide polymorphisms (SNPs) in the peroxisome proliferator-activated receptors and pulse pressure (PP) as well as the relationships between gene-gene interaction between PPARα/δ/γ genes and PP.Methods A total of 820 subjects,with 550 females and 270 males,were recruited from a cohort study of “Prevention of Metabolic Syndrome and Multi-metabolic Disorders in Jiangsu Province of China Study (PMMJS)”.Ten SNPs of PPARα/δ/γ genes were selected.GMDR software (version 1.0.1) was used to evaluate the gene-gene interactions among PPARs SNPs associated with PP.Results The mean levels of PP in people with mutant genotype of rs1805192 in PPARγ genes (PA+AA) showed a significant increase by 1.341 mmHg (95％CI:0.431-2.252 mmHg) when compared to the persons with wild genotype (PP).In the subgroup of subjects with more than 30 mmHg levels of PP,a six-locus model comprised rs135539 of PPARα,rs2016520 of PPARδ,rs10865710,rs1805192,rs709158 and rs3856806 of PPARγshowed a highest level of prediction accuracy (0.577) and displayed a better cross-validation consistency (10/10).In the subgroup of subjects with less than 40 mmHg levels of PP,a two-locus model was statistically associated with PP with 0.628 of prediction accuracy and 10/10 of cross-validation consistency.Conclusion PPARγrs1805192 was associated with the occurrence of PP.Gene-gene interactions among rs135539 of PPARα,rs2016520 of PPARδ,rs10865710,rs1805192,rs709158 and rs3856806 of PPARγ were all significantly related to PP.

Objective To explore the influence factors for femoral head necrosis after treatment of femoral neck fractures with dynamic hip screw (DHS) and anti-rotation screw.Methods A retrospective case series analysis was made on the clinical data of 106 cases of femoral neck fractures who had undergone fixation with DHS and anti-rotation screw between May 2010 and May 2015.There were 59 males and 47 females,with an average age of 57.0 years (range,27-76 years).By Garden classification,there were 27 cases of type Ⅱ,51 cases of type Ⅲ and 28 cases of type Ⅳ.All cases were divided into femoral head necrosis group (18 cases) and none-necrosis group (88 cases) according to the radiographs of the fractured hip at the follow-up.Univariate analyses and a multivariate logistic regression analysis were made to test whether the following factors were significantly associated with femoral neck necrosis:sex,age,Garden classification,Pauwels classification,Singh index,injury-to-surgery time interval,reduction methods,reduction quality,complete weight-bearing time,implant removal and the time cost of implant removal surgery.Results All the 106 patients obtained a mean follow-up of 49 months (range,26-76 months).Femoral head necrosis occurred in 18 cases (17.0％).In univariate analyses,Garden classification,reduction quality,implant removal and long time of the implant removal surgery were significantly associated with femoral head necrosis (P ＜ 0.01).In multivariate logistic regression analysis,high level of Garden classification(95％ CI 0.008,0.998,P ＜ 0.05),implant removal and long time of the implant removal surgery (95％ CI 0.000,0.143,P ＜ 0.01) were found to have a significant effect on femoral head necrosis development.Conclusions Fracture displacement,removal of internal fixation and broadening the screw canal,which cand hinder the blood supply of femoral head,will enhance the rate of femoral head necrosis.As a result,it needs prudent consideration to remove internal fixation after internal fixation with DHS combined with anti-rotation screw for femoral neck fractures.When it is difficult to remove the anti-rotation screw,it is better to give up,rather than to force a removal.

A phospholipid-based injectable gel was developed for the sustained delivery of leuprolide acetate (LA). The gel system was prepared using biocompatible materials (SPME), including soya phosphatidyl choline (SPC), medium chain triglyceride (MCT) and ethanol. The system displayed a sol state with low viscosity in vitro and underwent in situ gelation in vivo after subcutaneous injection. An in vitro release study was performed using a dialysis setup with different release media containing different percentages of ethanol. The stability of LA in the SPME system was investigated under different temperatures and in the presence of various antioxidants. In vivo studies in male rats were performed to elucidate the pharmacokinetic profiles and pharmacodynamic efficacy. A sustained release of LA for 28 days was observed without obvious initial burst in vivo. The pharmacodynamic study showed that once-a-month injection of LA-loaded SPME (SPME-LA) led to comparable suppression effects on the serum testosterone level as observed in LA solution except for the onset time. These findings demonstrate excellent potential for this novel SPME system as a sustained release delivery system for LA.

OBJECTIVETo examine the main effect of 10 Peroxisome proliferators-activated receptor (PPAR) SNP in contribution to non-HDL-C and study whether there is an interaction in the 10 SNPs.

METHODSParticipants were recruited within the framework of the PMMJS (Prevention of Multiple Metabolic Disorders and Metabolic Syndrome in Jiangsu province) cohort-population-survey, which was initiated from April 1999 to June 2004, and 5-year follow-up data from total 4 582 subjects were obtained between March 2006 and October 2007. A total of 4 083 participants received follow-up examination. After excluding subjects who had experienced stroke or exhibited cardiovascular disease, type 2 diabetes or a BMI <18.5 kg/m(2), a total of 820 unrelated individual subjects were selected from 3 731 subjects on October of 2009. Blood samples which were collected at the baseline were subjected to PPARα, PPARδ and PPARγ 10 SNPs genotype analysis. Logistic regression model was used to examine the association between 10 SNPs in the PPARs and non-HDL-C. Interactions within the 10 SNP were explored by using the Generalized Multifactor Dimensionality Reduction (GMDR).

RESULTSA total of 820 participants (mean age was 50.05±9.41) were included in the study and 270 were males and 550 were females. Single-locus analysis showed that after adjusting gender, age, smoking, alcohol consumption, physical activity, high-fat diet and low-fiber diet factors, rs1800206-V and rs3856806-T were significantly associated with higher non-HDL-C levels. V allele (LV + VV genotype) carriers of rs1800206 have a average non-HDL-C levels on (3.15 ± 0.89)mg/L (F = 15.01, P = 0.002); T allele (CT+TT genotype) carriers of rs3856806 have a average non-HDL-C levels on (3.03±1.01) mg/L (F = 9.87, P = 0.005). GMDR model analysis showed that after adjusting the same factors, two-locus model, five-locus model, six-locus model and seven-order interaction models were all statistically significant (P<0.05), and the seven-locus model (rs1800206, rs3856806, rs135539, rs4253778, rs2016520, rs1805192, rs709158) was the best model (P = 0.001), the cross-validation consistency was 10/10 and testing accuracy was 0.656.

CONCLUSIONRs1800206 and rs3856806 were significantly associated with non-HDL-C. And there was an gene-gene interaction among rs1800206, rs3856806, rs1800206, rs135539, rs4253778, rs2016520, rs1805192, rs3856806 and rs709158 which could influence the non-HDL-C levels.

Alleles ; Cardiovascular Diseases ; Cholesterol ; Diabetes Mellitus, Type 2 ; Female ; Genetic Phenomena ; Genotype ; Humans ; Logistic Models ; Male ; Middle Aged ; Overweight ; PPAR alpha ; PPAR delta ; PPAR gamma ; Peroxisome Proliferator-Activated Receptors ; Polymorphism, Single Nucleotide ; Stroke