Objective:To investigate the relationship between serum osteopontin (OPN), bone morphogenetic protein 2 (BMP2), retinol binding protein 4 (RBP4) and renal function and bone mineral density in patients with diabetes nephropathy (DN).Methods:A total of 120 patients with DN diagnosed in the Affiliated Hospital of Jining Medical University from January 2020 to December 2021 were selected as the DN group, 60 patients with simple diabetes as the type 2 diabetes mellitus (T2DM) group, and 60 subjects with normal glucose tolerance test as the control group. The serum OPN, BMP2, RBP4, low bone mineral density (LBMD), femoral neck bone density (FNBMD) and renal function indicators of the three groups were compared. According to the urinary albumin excretion rate (UAER) of DN patients, the patients were divided into microalbuminuria DN group (71 cases) and massive albuminuria DN group (49 cases), and stratified comparison was made. The simple linear correlation analysis was used to analyze the OPN of DN patients. BMP2, RBP4, renal function and bone mineral density.Results:The fasting blood glucose (FPG), glycated hemoglobin (HbA 1c), serum creatinine (Scr), UAER, and cystatin (CysC) levels of DN group patients were significantly higher than those of T2DM group and control group, and the differences were statistically significant (all P<0.05); The FPG and HbA 1c in the T2DM group were higher than those in the control group, and the differences were statistically significant (all P<0.05); The OPN and BMP2 of DN group patients were higher than those of T2DM group and control group, while the RBP4, LBMD, FNBMD of DN group were lower than those of T2DM group and control group, and the differences were statistically significant (all P<0.05); The OPN and BMP2 of the T2DM group were higher than those of the control group, while RBP4 was lower than that of the control group, and the differences were statistically significant (all P<0.05); The levels of FPG, HbA 1c, Scr, UAER, and CysC in patients with macroalbuminuria DN were significantly higher than those in patients with microalbuminuria DN, and the differences were statistically significant (all P<0.05); The OPN and BMP2 of patients in the large albuminuria DN group were higher than those in the microalbuminuria DN group, while the RBP4, LBMD, and FNBMD of patients in the large albuminuria DN group were lower than those in the microalbuminuria DN group, and the differences were statistically significant (all P<0.05). The OPN of DN group patients was positively correlated with Scr, UAER, and CysC (all P<0.05), while BMP2 was positively correlated with UAER and CysC (all P<0.05); The OPN and BMP2 of DN group patients were negatively correlated with LBMD and FNBMD (all P<0.05), while RBP4 was positively correlated with LBMD and FNBMD (all P<0.05). Conclusions:OPN, BMP2, RBP4 are closely related to the degree of renal function impairment and bone loss in DN patients, and can to some extent reflect the degree of bone metabolism and osteoporosis in T2DM patients.

Objective To explore the clinical utility of endoclip papilloplasty in endoscopic retrograde cholangiopancreatography(ERCP).Methods A prospective study was conducted and selected 62 patients who underwent ERCP from November 2021 to November 2022.30 out of 32 patients who randomly underwent endoclip papilloplasty were successful.These patients were assigned to successful endoclip papilloplasty group(group A,n=30)or the duodenal papilla unclamping group(group B,n=30).The aim was to compare the difference in short-term and long-term complications between the two groups.Results The success rate of papillary plasty was 93.8%(30/32),with no statistically significant differences observed in the incidence of postoperative pancreatitis,postoperative hemorrhage after ERCP,and postoperative cholangitis between the two groups(P>0.05).The duodenal perforation rate was 0.There were no significant differences between the two groups in terms of total cholangitis incidence and recurrence rate of calculus of common bile duct within 1 year(P>0.05).However,there was a statistical difference in terms of total the incidence of cholangitis+calculus of common bile duct recurrence within 1 year(P<0.05).Conclusion The endoclip papilloplasty exhibits a high success rate and safety and feasibility procedure reducing long-term recurrence rate of cholangitis and calculus of common bile duct in endoscopic papillary large balloon dilation(EPLBD)procedure.

Objective:To investigate the effect of hUCMSC-exos on the expression levels of HDAC in different isotypes of RA FLSs, and to elucidate the possible mechanism of hUCMSC-exos on the apoptosis of RA FLSs by regulating HDAC.Methods:hUCMSC and hUCMSC-Exos were isolated and identified. RT-qPCR was used to detect the changes in HDAC mRNA expression levels in FLSs after hUCMSC-Exos intervention, and the most affected HDAC types were identified. Western blot was used to detect the levels of FLS HDAC1 protein and the expression levels of NF-κB p65 and phospho-NF-κB p65 (Ser 536) in the blank control group, hUCMSC group, hUCMSC-Exos group, Trichostatin A (TSA) group and HDAC1 Inhibitor (Pyroxamide) group. To investigate the effects of hUCMSC-Exos on HDAC expression and NF-κB activity in FLSs. Flow cytometry was used to detect the effect of hUCMSC-Exos on the apoptosis of FLSs. ELISA was used to detect the effects of hUCMSC-Exos on the secretion of TNF-α, IL-6, IL-1β and IL-8 by FLSs. Flow cytometry and ELISA were used to detect the apoptosis level and pro-inflammatory cytokine secretion level of RA FLSs in the blank control group, NF-κB Inhibitor (pyrrolidine dithiocarbamate (PDTC) group, hUCMSC-Exos group and PDTC+hUCMSC-Exos co-intervention group. Whether inhibition of NF-κB affects the regulatory effect of hUCMSC-Exos on RA FLSs was further explored. All experimental data conforming to the normal distribution were compared by one-way ANOVA. LSD- t test was used for pin-group comparison, and independent sample t test was used for two-sample comparison. Results:Cultured primary hUCMSC were adherently grown spindle-shaped cells, and hUCMSC-Exos were saucer-shaped membranous vesicles, both of which met the identification criteria. hUCMSC-Exos reduced the expression level of HDCA1 mRNA [(0.932±0.091), t=2.19, P<0.001] and protein [(0.204±0.012), t=8.28, P<0.001] in RA FLSs, and the inhibitory effect was stronger than that of hUCMSC ( t=1.09, P=0.009) and HDAC1 ( t=11.29, P=0.013) Inhibitor. hUCMSC-Exos increased the apoptosis rate of RA FLSs [(48.68±0.84)%, t=12.33, P<0.001]. hUCMSC-Exos reduced the secretion levels of TNF-α [(29.6±1.0)pg/ml, t=10.78, P<0.001], IL-6 [(20.1±0.7)pg/ml, t=7.96, P<0.001], IL-1β [(9.28±0.23)pg/ml, t=6.14, P<0.001] and IL-8 [(108.0±3.8)pg/ml, t=1.21, P<0.001] in the supernatant of RA FLSs. hUCMSC-Exos reduced the expression level of p-NF-κB-p65/NF-κB-p65 in RA FLSs(0.351±0.024, t=17.67, P<0.001), and its inhibitory effect was stronger than that of hUCMSC (0.515±0.064, t=8.07, P=0.009) and HDAC1 inhibitor(0.411±0.033, t=2.44, P=0.04). After use of NF-κB inhibitors, hUCMSC-Exos weakened the promotion of apoptosis of RA FLSs [(29.0±0.5)%, t=10.63, P<0.001] and weakened the inhibitory effect of IL-8 secretion in the supernatant of RA FLSs [(125.5±3.2)pg/ml, t=2.63, P=0.002]. Conclusion:hUCMSC-Exos can mimic maternal cells to effectively inhibit the aberrant expression of HDAC1 in RA FLSs. hUCMSC-Exos may affect the apoptosis of RA FLSs and the secretion of pro-inflammatory cytokines by inhibiting the HDAC1/NF-κB pathway.

Objective:To investigate the incidence and risk factors of neonatal asphyxia in twin pregnancy.Methods:This study retrospectively recruited 2 035 women with twin pregnancy and their 4 070 twin neonates in the Obstetrics and Gynecology Hospital of Fudan University from January 2010 to December 2018. There were 211 cases suffered from neonatal asphyxia (asphyxia group) and 3 859 did not (non-asphyxia group). The demographic information of the women and their newborns and the incidence of perinatal complications were compared between the two groups by two independent samples t-test and Chi-square test. Multivariate logistic regression was used to analyze the risk factors of neonatal asphyxia in twin pregnancy. Results:The age of 2 035 women was (31.8±4.4) years old (17-52 years old). The gestational age of the twins at delivery was (35.2±2.2) weeks (25-40 weeks). There were 1 330 (65.4%) premature births, including 997 (49.0%) born at ≥34 weeks. Monochorionic diamniotic twin pregnancies accounted for 22.6% (460/2 035). The total incidence of neonatal asphyxia was 5.2% (211/4 070), 5.0% (102/2 035) in the first- and 5.4% (109/2 035) in the second-born twin infants, and the three figures were all decreased with the increase of gestational age ( χ2trend=1 601.965, 549.693 and 1 089.709, all P<0.001) as well as birth weight ( χ2trend=1 273.386, 437.906 and 848.007, all P<0.001). Univariate analysis showed that the asphyxia group had smaller gestational age and lower birth weight [(34.1±2.8) vs (35.3±2.1) weeks, t=6.279; (2 113.3±565.7) vs (2 339.6±478.7) g, t=5.700], but a higher ratio of male infants [58.3% (123/211) vs 48.5% (1 878/3 859), χ2=7.704], vaginal delivery [10.4% (22/211) vs 4.5% (173/3 859), χ2=15.493], monochorionic diamniotic twins [27.5% (58/211) vs 22.3% (862/3 859), χ2=7.714], special complications related to monochorionic diamniotic twin pregnancies [8.1% (17/211) vs 2.5% (95/3 859), χ2=23.403] and fetal distress [13.7% (29/211) vs 3.8% (148/3 859), χ2=47.222] than the non-asphyxia group (all P<0.05). After adjusting for the gestational age, birth weight and gender, multivariate logistic regression found that vaginal delivery ( OR=1.748, 95% CI: 1.069-2.861), special complications related to monochorionic diamniotic twin pregnancies ( OR=3.200, 95% CI: 2.056-4.982) and fetal distress ( OR=2.017, 95% CI: 1.073-3.791) were the risk factors for asphyxia in twin neonates (all P<0.05). Conclusions:The incidence of neonatal asphyxia is high in twins with small gestational age and low birth weight. Vaginal delivery, fetal distress and special complications related to monochorionic diamniotic twin pregnancies are the high-risk factors. Clinicians should be well prepared for resuscitation when encountering neonatal asphyxia.

Objective:To provide a normal reference range for anogenital distance (AGD) in full-term neonates and to investigate factors possibly affecting neonatal AGD.Methods:Neonates with gestational age ≥37 weeks who were delivered in the Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from November 2017 to March 2019 were enrolled.General information on mothers and newborns were collected and neonatal AGD were measured.The distance from the male anus center to the base of the scrotum was determined to be the male AGD, and the distance from the female anus center to the posterior labia was recorded as the female AGD.The effects of maternal and neonatal factors on neonatal AGD were analyzed.Results:A total of 1 078 newborns were included, including 586 males and 492 females.Male AGD [(22.90±3.80) mm] was significantly greater than female AGD [(11.80±2.10) mm] ( t=22.316, P<0.05). The AGD of singleton neonates was significantly greater than that of neonatal twins [males: (23.01±3.82) mm vs.(21.18±1.88) mm, females: (11.89±2.08) mm vs.(10.98±1.75) mm, t=26.185, 18.326, all P<0.05]. Neonatal gestational age, birth weight, head circumference and length were significantly associated with AGD (all P<0.05). Maternal factors (including age, height, weight, body mass index, gravidity, parity, occupation, etc.) were not significantly associated with neonatal AGD (all P>0.05). The AGD of 10 children with genital malformation was significantly smaller than that of males with normal genital appearance [(22.89±1.99) mm vs.(23.55±3.78) mm]( t=15.362, P=0.006). Conclusions:The reference ranges of AGD in full-term males and females in Shanghai are(22.90±3.80) mm and (11.80±2.10) mm, respectively.The neonatal gestational age, birth weight, head circumference and length may be the intrinsic factors affecting neonatal AGD.

Objective:To investigate the effect of miR-106a on osteoarthritis.Methods:Twenty-four S-D female rats were randomly divided into three groupsaccording to the random number table: the sham operation group, the osteoarthritis (OA) group and the miR-106a mimic group. Eightweeks after operation, all rats were killed and articular cartilage was separated from the medial tibial plateau of each rat. Histopathology was used to observe the morphological changes and denatured quantity of chondrocytes, the level of inflamm-atory cytokines [interleukin (IL)-1, IL-6, tumor necrosis factor (TNF)-β 1], the expression of apoptosis receptor p65, DR6 protein and the expression of mir-106a RNA. The mean between groups was compared by one-way analysis of variance (ANOVA), and the least significant difference (LSD)- t test was used for the comparison between the two groups. Results:Histopathological staining results showed that the articular surface and synovium of rats in the sham operation group were intact, the chondrocytes were arranged horizontally, and the articular cartilage edge was smooth.In the OA group, the articular cartilage edge was seriously damaged and the arrangement of chondrocytes was disordered.In the miR-106a simulation group, the cartilage structure tended to be normal, occasionally uneven, and the articular cartilage surface was not smooth. Compared with sham operation group, the expression of miR-106a in OA group was significantly decreased ( F=918.02, P<0.01); the expression of inflammatory mediators (IL-1, IL-6, TNF-β) in OA group was also signifi-cantly increased ( F=41 914.86, P<0.01; F=64 85.16, P<0.01; F=8 873.31, P<0.01). The expression levels of DR6 and p65 in OA group were higher ( F=2 319.338, P<0.01; F=1 253.882, P<0.01). Compared with OA group, the levels of inflammatory mediators (IL-1, IL-6, TNF-β) in miR-106a mimetic group were significantly decreased (1.270±0.020, 6.040±0.170, 5.690±0.080), and the expressions of DR6 and p65 were decreased (1.53±0.09, 0.41±0.04). Conclusion:miR-106a can reduce the inflammatory changes and the degeneration of chondrocytes in osteoarthritis rats.

Objective To explore the clinical characteristics of pleural effusion associated with peripherally inserted central catheters (PICCs) in neonates. Method The clinical data of pleural effusion caused by PICCs in two neonates were retrospectively analyzed. Results Both 2 cases were preterm female infants. Case 1 was delivered at 26+5 weeks, with a birth weight of 800 g. Dyspnea aggravated 8 hours after the PICC placement. Bedside chest radiograph indicated a large amount of pleural effusion on the right side. PICC was removed, puncture and drainage were performed, and pleural effusion was cured after 6 days of closed thoracic drainage. Case 2 was delivered at 29+3 weeks with a birth weight of 1240 g. Three days after placement of PICC, dyspnea became worse. Bedside chest radiograph showed bilateral pleural effusion, which was cured after PICC removal, puncture and drainage. According to the routine and biochemical indexes of pleural effusion, combined with the medical history, case 1 was consistent with the diagnosis of chylothorax and case 2 was considered as fluid exudation. Conclusion Neonatal PICC-associated pleural effusion is rare, but the etiology is varied and progress is rapid. Vigilance and active treatment is needed in clinic.

Objective To analyze the dosimetric and delivery efficiency differences between IMRT plans based on Halcyon and Trilogy Accelerator for left side breast cancer.Methods A total of 10 patients with left side breast cancer based on the Trilogy platform were retrospectively analyzed.For each patient,plan based on Halcyon was redesigned using Eclipse Version 15.1 TPS.In order to evaluate plan quality,dose coverage of target and dose to organs at risk,monitor unit efficiency,segment size and delivery time were compared.Results Halcyon treatment platform could meet the clinical objective.Dose distribution of the target volume had no significant difference with the Trilogy plans (P＞0.05).Volumes receiving 10 Gy,20 Gy and D of the left lung were significantly reduced(Z=-2.22--1.78,P＜0.05).V5 of heart for Halcyon and Trilogy was(27.80±7.66)％ and (23.18±8.19)％,respectively(Z=-0.71,P＜0.05),while D was (7.03± 1.8)Gy and(7.11±2.40)Gy,respectively(P＞0.05).Halcyon increased the monitor unit from 1 526.2±227.7 by Trilogy to 1 770.5±383.9(Z=-0.71,P＜0.05),but decreased the delivery time from (12.38± 1.49) min by Trilogy to (3.01 ±0.28) min (Z =-3.42,P＜ 0.05).Conclusion Halcyon treatment platform can meet the clinical requirements,reduce dose to normal tissue with high delivery efficiency.

Objective: To compare the clinical features, ultrasonic imaging manifestations and therapeutic evaluations between elderly onset rheumatoid arthritis (EORA) and EORA with osteoarthritis (OA). Methods: Eighty-eight patients with rheumatoid arthritis were divided into two groups: group EORA (n=36) and group EORA+OA (n=52). The onset age of all patients was 60 years or older. General conditions, joint involvement distribution, ultrasonic manifestations and disease activity scores (DAS28-3) of patients in the two groups were analyzed. The χ² test/Fisher's exact probability test and the Student's t test/Mann-Whitney U test were used to analyze data. Results: There was no significant difference in the proportion of male and female patients and erythrocyte sedimentation rate (ESR) between the two groups (P>0.05). The onset age of patients in group EORA+OA [(68±4) years old] was higher than that in group EORA [(65±4) years old], and the difference was statistically significant (t=-3.465, P=0.001). Duration of the disease and body mass index in group EORA+OA were significantly higher respectively than those in group EORA. Joint involvement in the two groups was mainly found in shoulder, wrist, Metacarpophalangeal joint (MCP)2, MCP3, proximal inter-phalangeal joint (PIP)2, PIP3, PIP4, and knee joint (34.7%-86.5%). The percentage of MCP2[36.5%(38/104), 70.8%(51/72); χ²=20.02, P<0.01], MCP3[33.7%(35/104), 59.7%(43/72); χ²=11.72, P=0.001], MCP4[4.8%(5/104), 22.2%(16/72); χ²=12.28, P<0.01], PIP2[69.2%(72/104), 83.3%(60/72); χ²=4.51, P=0.034] and PIP3[53.8%(56/104), 70.8%(51/72); χ²=5.15, P=0.023] in the EORA+OA group was lower while the percentage of MCP1, DIP 2, DIP3, DIP4 and knee joints were higher than that in the EORA group (P<0.05). In group EORA+OA, the synovial thickness of the wrist joints [(4.2±0.5) mm] and knee joints [(7.7±0.8) mm] were significantly thicker than those in group EORA [(3.2±0.9) mm; (6.3±0.8) mm, t=-5.82, P<0.01; t=-7.22, P<0.01]; The proportion (70.0%) of level 2 and 3 of patients' wrist joint synovium pannus blood flow and knee joint synovium pannus in group EORA+OA were increased than group EORA (51.9%; 52.3%), the difference between the two groups was statistically significant (χ²=4.64, P=0.031; χ²=4.43, P=0.035). There was no significant difference in DAS28-3 scores between the two groups before patients received treatment. After 2 weeks and 12 weeks of glucocorticoid treatment, DAS28-3 scores in group EORA [3.62(2.88, 4.03); 2.35(2.26, 2.62) points] were significantly lower than group EORA+OA [5.01(4.68, 5.26); 3.38(2.28, 3.83) points] (Z=-7.766, P<0.01; Z=-3.461, P<0.01). Conclusion Compared with patients of EORA alone, patients of EORA with OA have more obvious joint symptoms, MCP1, DIP and knee joint are susceptible to the co-involvement among them, longer duration of disease, and were prone to synovial hyperplasia and pannus flow formation. The therapeutic effects of glucocorticoid on joint inflammation in patients of EORA alone are superior to those patients of EORA with OA.

Objective Idiopathic pulmonary fibrosis, the fibrosis score (i.e., the combined extent of reticulation and honeycombing) is associated with worse survival. The aim of this study was to identify high-resolution computed tomography (HRCT) patterns and patient characteristics that could predict poor prognosis in rheumatoid arthritis-related ILD (RA-ILD). Methods We retrospectively analyzed 130 patients with newly diagnosed RA-ILD from 2011 to 2017 at Shanxi People's Hospital. The Pearson correlation analysis was used for the correlation between the fibrosis score and the worse survival of RA-ILD, and Using Cox regression analysis was used to identify the associations with mortality. A value of P less than 0.05 was considered statistically significant. Results During a median follow-up of 65 months, 32/130 (24.6％) patients died. Univariate analysis identified 6 significant poor prognostic factors: lower baseline ％ predicted forced vital capacity [HR=0.97, 95％CI(0.94, 0.99);P=0.008], total interstitial disease score [HR=1.06, 95％CI(1.03, 1.08);P<0.01], reticulation score [HR=1.07, 95％CI (1.04, 1.09); P<0.01], traction bronchiectasis score [HR=2.04, 95％CI (1.21, 3.40);P=0.008], fibrosis score [HR=1.07, 95％CI (1.01, 1.13);P<0.01], and definite UIP pattern [HR=4.18, 95％CI (1.40, 12.51); P=0.010]. Fibrosis score remained to be an independent significant poor prognostic factor of survival on bivariate analysis [HR=8.136, 95％CI (2.87, 28.35); P=0.001]. Patients with a fibrosis score>20％ had high mortality. Conclusion This study has shown that fibrosis score is strongly associated with worse survival in RA-ILD, and patients with fibrosis score>20％ have a 8.136-fold increased risk of mortality.