Objective:To explore the assessment value of echocardiogram combined with serum high-sensitivity C-reactive protein(hs CRP)and N-terminal pro brain natriuretic peptide(NT proBNP)levels on cardiac function of patients with coronary heart failure.Methods:A total of 306 patients with coronary heart failure admitted to Beijing Daxing District People's Hospital from November 2021 to November 2022 were selected as the study group.Among of them,144 cases were grade Ⅱ,103 cases were grade Ⅲ and 59 cases were grade Ⅳ as the classification of New York Heart Association(NYHA)for cardiac function.A total of 108 healthy examinees who underwent physical examinations in our hospital during the same period were selected as the healthy control group.All examinees were classified as the NYHA for cardiac function,and left ventricular end diastolic volume(LVEDV),left ventricular end systolic volume(LVESV),left ventricular ejection fraction(LVEF),peak ejection rate(PER)and peak filling rate(PFR)of them were measured by echocardiogram.The NT proBNP and hs CRP levels of all examinees were measured.Receiver operating characteristic(ROC)curve was used to analyze the values of single LVEDV,LVESV,LVEF,PER,PFR,hs CRP and NT-proBNP,and the combination of them.Results:LVEDV(122.69±18.24)ml and LVESV(70.79±10.03)ml of the study group were significantly higher than(92.27±15.22)ml and(33.16±7.22)ml of the healthy control group,and the LVEF(42.26±5.13)％,PER(2.49±0.22)EDV/s and PFR(1.79±0.26)EDV/s of the study group were significantly lower than(69.34±5.27)％,(3.56±0.27)EDV/s,and(2.59±0.23)EDV/s of the healthy control group,with statistical significances(t=15.526,35.837,46.828,40.825,28.302,P<0.05),respectively.The levels of hs CRP and NT proBNP of the study group were significantly higher than those of the healthy control group,with statistical significance(t=88.000,29.099,P<0.05),respectively.The LVEDV and LVESV of grade Ⅱ/Ⅲ patients were significantly lower than those of grade Ⅳ patients,while LVEF,PER and PFR of grade Ⅱ/Ⅲ patients were significantly higher than those of grade Ⅳ patients,with statistically significant differences(t=53.391,92.658,32.140,240.474,116.921,P<0.05),respectively.The levels of hs CRP and NT proBNP of grade Ⅱ/Ⅲ patients were significantly lower than those in grade Ⅳ patients,with statistical significance(t=41.037,5.955,P<0.05),respectively.The results of ROC curve analysis showed that the sensitivities of single LVEDV,LVESV,LVEF,PER,PFR,hs CRP,NT proBNP and the combined examination of them were respectively 45.00％,50.00％,70.00％,70.00％,75.00％,70.00％and 90.00％,and the specificities of them were respectively 76.70％,57.00％,82.60％,44.20％,58.10％,52.30％and 96.50％.The area under curve(AUC)values of LVEDV,LVESV,LVEF,PER,PFR,hs CRP,NT proBNP and the combined examination of them were 0.592(95％CI:0.441-0.743),0.615(95％CI:0.468-0.761),0.766(95％CI:0.634-0.899),0.717(95％CI:0.575-0.860),0.674(95％CI:0.536-0.812),0.734(95％CI:0.592-0.876),0.581(95％CI:0.469-0.694)and 0.978(95％CI:0.947-1.000),respectively.Conclusion:The serum hs CRP,NT proBNP levels and function parameters of left heart in patients with coronary heart failure have occurred corresponding changes,and the above indicators have higher assessment value for the heart function of coronary heart failure,and the value of combined assessment is higher.

Osteoporotic proximal humeral fracture (OPHF) is one of the common osteoporotic fractures in the aged, with an incidence only lower than vertebral compression fracture, hip fracture, and distal radius fracture. OPHF, secondary to osteoporosis and characterized by poor bone quality, comminuted fracture pattern, slow healing, and severely impaired shoulder joint function, poses a big challenge to the current clinical diagnosis and treatment. In the field of diagnosis, treatment, and rehabilitation of OPHF, traditional Chinese and Western medicine have accumulated rich experience and evidence from evidence-based medicine and achieved favorable outcomes. However, there is still a lack of guidance from a relevant consensus as to how to integrate the advantages of the two medical systems and achieve the integrated diagnosis and treatment. To promote the diagnosis and treatment of OPHF with integrated traditional Chinese and Western medicine, relevant experts from Orthopedic Expert Committee of Geriatric Branch of Chinese Association of Gerontology and Geriatrics, Youth Osteoporosis Group of Orthopedic Branch of Chinese Medical Association, Osteoporosis Group of Orthopedic Surgeon Branch of Chinese Medical Doctor Association, and Osteoporosis Committee of Shanghai Association of Integrated Traditional Chinese and Western Medicine have been organized to formulate Expert consensus on the diagnosis and treatment of osteoporotic proximal humeral fracture with integrated traditional Chinese and Western medicine ( version 2024) by searching related literatures and based on the evidences from evidence-based medicine. This consensus consists of 13 recommendations about the diagnosis, treatment and rehabilitation of OPHF with integrated traditional Chinese medicine and Western medicine, aimed at standardizing, systematizing, and personalizing the diagnosis and treatment of OPHF with integrated traditional Chinse and Western medicine to improve the patients ′ function.

Objective:To discuss the inhibitory effect of Schisandrin B on the proliferation of pancreatic cancer Pan02 cells,and to clarify the mechanism.Methods:CCK-8 method was used to detect the proliferation rates of the Pan02 cells after treated with different concentrations(0,0.78,1.56,3.12,6.25,12.50,and 25.00 mg·L-1)of Schisandrin B to select the optimal concentration and treatment time of Schisandrin B.The mouse pancreatic cancer Pan02 cells were divided into control group(0 mg·L-1 Schisandrin B),2.5 mg·L-1 Schisandrin B group,5.0 mg·L-1 Schisandrin B group,and 10.0 mg·L-1 Schisandrin B group.The morpholoy of Pan02 cells invarious groups was observed with light microscope;5-ethynyl-2'-deoxyuridine(EdU)staining assay was used to detect the positive expression rates of the Pan02 cells in various groups;flow cytometry was used to detect the percentages of the Pan02 cells at different cell cycles and the apoptotic rates of the cells in various groups;Western blotting method was used to detect the expression levels of cell cycle and apoptosis-related proteins in the cells in various groups.Results:The CCK-8 method results showed that after treated with Schisandrin B for 48 and 72 h,compared with 0 mg·L-1 Schisandrin B,the proliferation rates of the Pan02 cells after treated with different concentrations of Schisandrin B were decreased(P<0.01),especially at 72 h.0.25,5.0,and 10.0 mg·L-1 Schisandrin B were selected to treat the Pan02 cells,and 72 h was the treatment time.In control group,the Pan02 cells had a spindle shape,with good condition,and grew closely adhered to the wall with normal organelles and cytoplasm,in 2.5 and 5.0 mg·L-1 Schisandrin B groups,the cell volume was decreased,the intercellular adhesion was disappeared,and the cell membrane was intact but more permeable;the cytoplasm shrank and vacuolar structures appeared inside the cells,with some fragmented and floating on the surface of the solution;in 10.0 mg·L-1 Schisandrin B group,the Pan02 cells exhibited notable apoptotic bodies,indicating an apoptotic state.The EdU staining results showed that compared with control group,the rates of EdU positive cells in 2.5,5.0,and 10.0 mg·L-1 Schisandrin B groups were significantly decreased(P<0.01).The flow cytometry results showed that compared with control group,the percentages of the cells at S phase in 2.5,5.0,and 10.0 mg·L-1 Schisandrin B groups were significantly increased(P<0.01),while the percentages of the cells at G2/M phase were significantly decreased(P<0.01),and the percentages of the cells at G0/G1 phase in 5.0 amd 1.0 mg·L-1 Schisandrin groups were decreased(P<0.01);compared with control group,the apoptotic rates of the cells in 2.5,5.0,and 10.0 mg·L-1 Schisandrin B groups were significantly increased(P<0.01).The Western blotting results showed that compared with control group,the expression levels of p27,B-cell lymphoma 2(Bcl-2)associated X protein(Bax),cleaved cysteine aspartic acid protease-3(cleaved Caspase-3),and cleaved poly adenosine diphosphate(ADP)ribose polymerase(cleaved PARP)proteins in the cells in 2.5 mg·L-1 Schisandrin B group were significantly increased(P<0.05 or P<0.01),the expression levels of cyclin A2,cyclin E2,and Bcl-2 proteins in the cells in 5.0 and 10.0 mg·L-1 Schisandrin B groups were significantly decreased(P<0.05 or P<0.01),while the expression levels of p27,Bax,cleaved Caspase-3,and cleaved PARP proteins in the cells in 5.0 and 10.0 mg·L-1 Schisandrin B groups were significantly increased(P<0.01).Conclusion:Schisandrin B has an inhibitory effect on proliferation of the pancreatic cancer Pan02 cells,and its mechanism may be related to the activation of the cysteine aspartic acid protease-3(Caspase-3)pathway to induce the apoptosis and activating p27 protein to induce the arrest of cell cycle at S phase.

Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.

Objective:To explore the clinical and pathological characteristics and prognostic factors of gastric neuroendocrine carcinoma(G-NEC)and gastric mixed adenoendocrine carcinoma(G-MANEC).Methods:Retrospective analysis was conducted on the clinical data of 67 patients with G-NEC and G-MANEC who underwent surgical treatment at Heping Hospital Affiliated to Changzhi Medical College from May 2015 to May 2023.The study included an analysis of the pathological characteristics distinguishing G-NEC from G-MANEC.Results:Com-pared to gastric adenocarcinoma,patients with G-NEC and G-MANEC in the stomach showed a higher incidence of gastric cancer in the male gastric cardia and were diagnosed at a later age.Tumors with larger diameters increase susceptibility to anemia,low albumin levels,and in-vasion of nerves and vasculature.Deeper tumor infiltration is associated with increased local lymph node metastases,later TNM staging,and a higher likelihood of distant metastasis post-surgery.The prognosis of G-NEC and G-MANEC is worse than that of gastric adenocarcinoma(P=0.001).However,there is no statistically significant difference in the pathological characteristics(P>0.05)and prognosis analysis(P=0.212)between G-NEC and G-MANEC.Univariate survival analysis identified age,preoperative albumin,preoperative CEA,number of lymph node metastases,TNM staging,and postoperative distant metastasis as risk factors affecting patient's overall survival(OS).In the multivariate ana-lysis,age,preoperative albumin,TNM staging,and postoperative distant metastasiswere identified as independent risk factors for OS.Con-clusions:There is a significant difference in clinical characteristics between G-NEC,G-MANEC,and gastric adenocarcinoma,often diagnosed at an advanced stage,which is prone to distant metastasis post-surgery.Poor prognosis is observed in patients aged over 60 years,with pre-operative albumin<40g/L,TNM stage Ⅱ/Ⅲ,and postoperative distant metastasis.

Objective:To analyze the epidemiological characteristics of geriatric acetabular fractures in western China.Methods:A retrospective case series study was made on data of geriatric patients with acetabular fracture hospitalized in 4 grade A hospitals in western China from 2015 to 2020. The investigation content included gender, age, incidence rate, injury mechanism, combined injuries, comorbidities, fracture types and treatment plans.Results:A total of 299 geriatric patients with acetabular fractures were included, including 203 males and 96 females, aged 60-97 years [(68.6±7.6)years]. The mean age of the patients was increased from 67.5 years to 71.1 years. The incidence rate was increased from 36 cases per year to 64 cases per year. The injury mechanism was mainly traffic accidents (42.47%), followed by falls (30.44%). Thoracic injury was the most common type of combined injuries (39.81%). Hypertension was the main comorbidity (28.76%). The most common fracture type was anterior column posterior hemitransverse fracture (31.32%). Of 299 patients, 210 received surgical treatment, with the surgery rate of 70.23%.Conclusions:Geriatric acetabular fracture is characterized by gradually increased age and incidence rate, traffic accidents as the main cause of injury, thoracic injury as the main combined injury, hypertension as the main comorbidity, anterior column posterior hemitransverse fracture as the main fracture type and surgery as the main treatment option.

OBJECTIVE： To investigate the analgesic and anti-inflammatory effects of ethanol extract from Arenga pinnata in mice/rats after intragastric administration. METHODS： The mice were randomly divided into A. pinnata ethanol extract group  and solvent control group （distilled water）， with 20 mice in each group. Maximal dosage method was used to observe the acute toxicity of ethanol extract from A. pinnata with intragastric administration. The mice were randomly divided into A. pinnata ethanol extract high-dose， medium-dose and low-dose groups [6.5， 3.25， 1.625 g/kg （by ethanol extract， similarly here in after）， i.g.]， positive control group （0.005 g/kg morphine， i.p.） and blank control group （distilled water， i.g.）. The analgesic effect was evaluated by hot plate method， and the licking latency was compared 30， 60 and 90 minutes after administration. The mice were randomly divided into A. pinnata ethanol extract high-dose， medium-dose and low-dose groups （6.5， 3.25， 1.625 g/kg， i.g.）， positive control group （loxoprofen sodium 0.023 g/kg， i.g.） and model control group （distilled water， i.g.）. The analgesic effect was evaluated by acetic acid writhing method. The writhing times within 20 minutes were compared and the writhing inhibition rate was calculated. The mice were randomly divided into A. pinnata ethanol extract high-dose， medium-dose and low-dose groups （6.5， 3.25， 1.625 g/kg， i.g.）， positive control group （morphine 0.005 g/kg， i.p.）， model control group （distilled water， i.g.）. The analgesic effect was evaluated by formalin-induced pain method. The total licking time was compared between 0-5 min and 10-40 min after formalin administration； the inhibition rate of licking was calculated. The mice were grouped according to acetic acid writhing test. The mice were given relevant medicine once a day for consecutive 3 days. The mice were given xylene to induce inflammation model， and the degree of ear swelling was compared. Rats were randomly divided into A. pinnata ethanol extract high-dose， medium-dose and low-dose groups （4.5， 2.25， 1.125 g/kg， i.g.）， positive control group （losoprofen sodium 0.016 g/kg， i.g.）， model control group （distilled water， i.g.） and blank control group （distilled water， i.g.）， once a day， for consecutive 3 days. The rats were given Freund’s complete adjuvant to induce inflammation model and then given relevant medicine for consecutive 7 d. The degree of paw swelling was compared before inflammation and within 7 days after inflammation. The number of mice/rats in each group was 8 to 14 in the analgesic and anti-inflammatory tests. RESULTS： Compared with solvent control group， the body weight of mice had no significant increase in A. pinnata ethanol extract group； no drug-induced toxicity was found. Compared with blank control group， licking latency in mice was significantly prolonged in A. pinnata ethanol extract high-dose group 30 and 60 minutes after medication （P＜0.01）. Compared with model control group， the times of writhing， total licking time and the degree of ear swelling of mice were decreased significantly in A. pinnata ethanol extract high-dose， medium-dose and low-dose groups （P＜0.05 or P＜0.01）. Compared with model control group， the degree of paw swelling began decrease significantly in A. pinnata ethanol extract high-dose group 4 h after inducing inflammation， and the effect lacted until the 7th day （P＜0.01）. CONCLUSIONS： A. pinnata ethanol extract has no significant acute oral toxicity， and possesses significant analgesic and anti-inflammatory effects.

OBJECTIVE： To study the improvement effect and mechanism of Chuanju zhitong capsules （CZC） on migraine model rats. METHODS： SD rats were randomly divided into normal group， model group， chemical drug positive control group （Zolmitriptan tablet， 0.004 05 g/kg）， TCM positive control group （Compound yangjiao capsule， 4.32 g/kg）， CZC high-dose， medium-dose and low-dose groups （1.6， 0.8， 0.4 g/kg）， 10 rats in each group. All rats were relevant medicine intragastrically once a day， for successive 5 days. 30 min after last medication， except for normal group， rats in other groups were given glyceryl trinitrate subcutaneously （10 mg/kg） via head and neck to induce migraine model. The behavior changes of rats were evaluated using the times of scratching head as indexes within 2 h after modeling （30 min as a period of time）. 4 h after modeling， hemorheological parameters as whole blood viscosity （low-shearing， medium-shearing， high-shearing）， plasma viscosity， erythrocyte aggregation indexes and erythrocyte rigidity indexes were determined by automatic hemorheology instrument. The levels of NO， NOS， ET-1， CGRP in serum and the levels of  5-HT， 5-HIAA， DA and NE in cerebral tissue were determined by ELISA. RESULTS： Compared with normal group， the times of scratching head was increased significantly in model group at different periods （P＜0.01）. The serum levels of NO， NOS and CGRP were increased significantly （P＜0.01）， while ET-1 level was decreased significantly （P＜0.01）. The levels of 5-HT， DA and NE in cerebral tissue were decreased significantly （P＜0.01）， while 5-HIAA level was increased significantly （P＜0.01）. Whole blood viscosity （low-shearing）， plasma viscosity， erythrocyte aggregation index and erythrocyte rigidity indexes were increased significantly （P＜0.05），plasma viscosity were decreased significantly （P＜0.05） . Compared with model group， the times of scratching head were decreased significantly in TCM positive control group （0-120 min）， TCM positive control group （60-90 min）， CZC high-dose （30-120 min） and medium-dose （60-90 min） groups （P＜0.05 or P＜0.01）. The whole blood viscosity （low-shearing） and erythrocyte aggregation indexes of TCM positive control group， CZC high-dose and medium-dose groups were decreased significantly （P＜0.05 or P＜0.01）； the serum levels of NO， NOS and CGRP in chemical drug positive control group and CZC high-dose and medium-dose groups were decreased significantly （P＜0.05 or P＜0.01）， while the serum level of ET-1 was increased significantly （P＜0.01）； the levels of 5-HT， DA and NE were increased significantly in cerebral tissue （P＜0.05 or P＜0.01）， while the level of 5-HIAA was decreased significantly （P＜0.05）. CONCLUSIONS： The improvement effect of CZC on migraine model rats is associated with decreasing the serum levels of NO， NOS and CGRP and increasing the levels of 5-HT， DA and NE in cerebral tissue.

Objective Indoxyl sulfate (IS) is associated with endothelial damage, NF-κB activation and induces the development of atherosclerosis. The purpose of this study was to investigate the relationship between serum IS levels and the severity of coronary artery stenosis and the relationship among IS and various cardiovascular risk factors. Methods Serum IS concentrations were measured using ultra performance liquid chromatography in 191 consecutive patients presenting with stable angina. The associations between serum IS levels and angio-graphic indexes of the number of diseased vessels, modified Gensini scores and calcium scores were determined. Results Patients with significant coronary artery stenosis were found to have higher serum IS levels than those with normal coronary arteries. Multivariate analysis showed that serum IS levels were found to be independently associated with the presence and severity of coronary artery disease (CAD). Furthermore, statistically significant correlation was observed between the serum IS levels and age, Agatston calcium score, volume calcium score, modifed Gensini score, coronary lesions, coronary disease and Framingham-10 year risk score. Conclusions Se-rum IS levels are significantly higher in the presence of CAD and correlate with the severity of the disease and coro-nary atherosclerosis scores,which suggests that increased serum IS may be involved in the pathogenesis of coronary atherosclerosis.

Objective To compare the effects of different anesthesia techniques on early prognosis in patients undergoing hip joint replacement. Methods The demographic, preoperative and postoperative data of 478 patients, aged 18-95 yr, of American Society of Anesthesiologists physical statusⅠ-Ⅳ, who underwent elective unilateral hip joint replacement in Tongji Hospital from May 2014 to December 2016, were retrospectively analyzed. Patients were divided into general anesthesia group (group GA, n=197), peripheral nerve block group ( group PNB, n=147) and peripheral nerve block combined with general an-esthesia group ( group PNB+GA, n=134) . The amount of crystalloid solution and colloid solution infused, consumption of sufentanil and requirement for vasoactive agents were recorded during operation. The dura-tion of anesthetic recovery room stay, length of hospital stay before and after operation and total length of hospital stay were recorded. The development of complications within 48 h after operation, therapy after ad-mission to intensive care unit and in-hospital fatality were also recorded. Results Compared with group GA, the intraoperative consumption of sufentanil was significantly decreased in group PNB+GA, and the a-mount of crystalloid solution infused, urine output, consumption of sufentanil, requirement for vasoactive agents and incidence of postoperative hypoxemia, pulmonary infection and acute cerebral infarction were significantly decreased in group PNB+GA ( P<0. 05) . Compared with group PNB+GA, the consumption of sufentanil, requirement for vasoactive agents and incidence of postoperative hypoxemia, pulmonary infec-tion and acute cerebral infarction were significantly decreased in group PNB (P<0. 05). Conclusion Compared with general anesthesia or with peripheral nerve block-general anesthesia, peripheral nerve block is more helpful in improving early prognosis in patients undergoing hip joint replacement.