BACKGROUND:Stem cell transplantation is a new way to prevent and cure intervertebral disc degeneration.However,whether the transplanted stem cells can survive,proliferate,differentiate,and restore the function of nucleus pulposus cells after transplantation,is the key and difficult point to overcome. OBJECTIVE:To explore the effects of Bushenhuoxue decoction on survival,proliferation,and nucleus pulposus-like differentiation of adipose-derived stem cells. METHODS:A Transwell chamber was used to construct a co-culture model of human adipose-derived stem cells and human degenerative nucleus pulposus cells.The experiment was divided into control group,model group,drug-containing serum group,and drug-free serum group.Except for the control group,the co-culture system of other groups was treated with 50 μmol/L tert-butyl hydrogen peroxide for 24 hours.The drug-containing serum group and drug-free serum group were treated with DMEM low-glucose complete culture medium containing drug-containing serum of Bushenhuoxue decoction or drug-free serum with 20％volume fraction for 48 hours.The sublayer adipose-derived stem cells were taken.Toluidine blue staining was used to detect proteoglycan synthesis levels.Real-time PCR method was used to detect mRNA expression of type Ⅱ collagen,proteoglycan and SRY-box transcription factor 9.The protein expression of SOX9 was detected by western blot assay.Lactate dehydrogenase assay was used to detect cytotoxicity.Flow cytometry was used to detect reactive oxygen species,and β-galactosidase staining was used to detect cell senescence. RESULTS AND CONCLUSION:(1)Compared with the control group,the proportion of necrotic cells in the model group increased;toluidine blue staining became lighter,and the expression levels of type Ⅱ collagen,proteoglycan,SOX9 mRNA and SOX9 protein decreased(P<0.05).Compared with the model group,the drug-containing serum of Bushenhuoxue decoction could significantly reduce cell injury and promote the expression of type Ⅱ collagen,proteoglycan,SOX9 mRNA,and SOX9 protein(P<0.05),but the improvement in the drug-free serum group was not significant(P>0.05).(2)Compared with the control group,the contents of cytotoxicity,reactive oxygen species,and cell senescence in the model group were significantly increased.Compared with the model group,the microenvironment of the coculture system was significantly improved by drug-containing serum of Bushenhuoxue decoction(P<0.05),while drug-free serum had no significant effect on the microenvironment of the co-culture system(P>0.05).(3)The results show that Bushenhuoxue decoction can promote the survival,proliferation,and nucleus pulposus-like differentiation of adipose-derived stem cells.

Objectives:To evaluate the coronary microcirculatory function in patients with hypertrophic cardiomyopathy(HCM). Methods:Patients who diagnosed with HCM and underwent the measurement of index of microcirculatory resistance(IMR)using pressure-sensing guide wire from November 2021 to April 2023 were prospectively included.Coronary microcirculatory dysfunction(CMD)was defined as IMR≥25 U and patients were grouped accordingly to compare the clinical characteristics. Results:A total of 25 HCM patients were included.Mean age was(58.4±13.3)years,18 were men and mean body mass index was(26.7±3.6)kg/m2.Coronary microcirculatory function was successfully evaluated in all patients and the mean value of IMR was(30.5±15.3)U.There were 15 patients with CMD.Baseline clinical characteristics,laboratory examinations and medications were simialr between patients with and without CMD.The maximal left ventricular wall was significant thicker in patients with CMD compared with that in patients without CMD([20.2±2.8]mm vs.[16.9±2.3]mm,P=0.005).There was no significant difference in other echocardiographic parameters between two groups(all P>0.05).In the range of IMR value less than 50 U(n=22),there was a significant linear positive correlation between maximal left ventricular wall thickness and IMR(r=0.423,P=0.049).There was no significant difference in coronary flow reserve and fractional flow reserve between two groups. Conclusions:The severity of CMD is positively correlated with left ventricular wall thickness in HCM patients.

Objective:To investigate the safety, economic effect, and short-term clinical efficacy of ambulatory total hip arthroplasty (THA) in the treatment of hip osteopathy within.Methods:This study retrospectively reviewed patients who underwent 48-hour outpatient THA and conventional primary THA from July 2020 to July 2021. Gender, age, body mass index (BMI), clinical diagnosis, place of resident, length of hospital stay, duration of the surgery, hemoglobin, albumin, C-reactive protein (CRP) and D-dimer before and 1 day after surgery, the visual analogue scale (VAS) was obtained postoperative day 2, hip joint modified Harris score before and 1 month after surgery, readmission and reoperation within 1 month after operation as the data of evaluations were extracted and compared in this study.Results:A totally of 150 cases were involved in this study, which including 75 cases with 48-hour outpatient primary THA and 75 cases with conventional primary THA. There was no significant difference between the two groups in terms of age, sex, BMI, education level, preoperative diagnosis, and preoperative Harris score ( P>0.05), but a significant difference was found in term of residence (χ 2=6.29, P=0.043), that the patients in the outpatient group were all from Zhejiang Province and 48% (36/75) of them were from Hangzhou City. While, in the conventional group, 6 patients were from other provinces. The length of stay was 2.13±0.52 days and operation time was 59.73±18.91 minutes in the outpatient group, which were both shorter than those (6.71±1.44 days and 66.91±22.40 min) in the conventional group ( t=25.91, P<0.001 for the length of hospital stay; t=2.12, P=0.036 for operation time). Compared with the conventional group, outpatient group saved the average hospital cost (4.60±0.44 vs. 5.20±0.72 ten thousand yuan, t=6.16, P<0.001). The VAS on the second day after surgery 3.45±0.75 was higher in the outpatient group than in the conventional group (3.45±0.75 vs. 3.16±0.94 points, t=2.09, P=0.039). The modified Harris score was without statistical significance ( t=0.42, P=0.677) 1 month after surgery in both groups. 75 patients in the outpatient group, 7 patients delayed discharge (were not discharge within 48 hours), and the rate of delayed discharge was 9.3%. Reasons for delayed discharge included poor pain control in two cases, one case had postoperative nausea and vomiting, one case had failed to meet rehabilitation standards, hypotension in one case, the intraoperative infection in one case and postoperative fever within 48 hours in one case. Conclusion:Outpatient THA can reduce the length of hospital stay, operative time and total cost of hospitalization. It has similar safety and early clinical efficacy as conventional THA. However, a small proportion of patients would delay discharge.

Mild cognitive impairment (MCI) is a pre-clinical stage of Alzheimer's disease (AD). In recent years, transcranial direct current stimulation (tDCS), as a neuromodulation technique, has being applied in the field of cognitive intervention for MCI, but its effect is controversial because of many factors. In order to promote the application of tDCS in intervention for MCI, this study performed a systematic review of the previous studies that used tDCS to improve cognitive functions of MCI individuals. The results indicate that tDCS could improve episodic memory, working memory, and language of individuals with MCI, while there is a lack of strong evidence that supports a positive effect of tDCS on attention of individuals with MCI. The placement of electrodes, time course of treatment, and current intensity all affected the intervention effect of tDCS. Future studies should take brain networks underlying cognitive processes and personalized factors such as age and education level into consideration to design better stimulation protocols, and they should be conducted in combination with neuroimaging technologies to evaluate the intervention effect of tDCS more accurately and objectively and to discover the neural mechanisms of tDCS intervention.

Nonunion of femur is a common complication after intramedullary nail operation of femoral fracture, with an incidence of 1% to 12.5%. At present, the treatment of femoral nonunion is mainly divided into surgical treatment and non-operative treatment, and surgical treatment is the first choice. The gold standard for surgical treatment of femoral nonunion is replacement of intramedullary nail, but for non-isthmus femoral nonunion, larger diameter intramedullary nail could not solve the problem of rotation and angular displacement of the broken end of nonunion. For malnourished nonunion, atrophic nonunion and bone nonunion with large bone defect, the replacement of intramedullary nail and autogenous bone graft are not enough to eliminate the gap between the broken ends and increase the contact area between the broken ends. It cannot provide a good biological environment for the broken ends. Because the replacement of intramedullary nail does not expose the broken ends of bone nonunion, and the corresponding tissue cannot be taken for bacteriological culture, so it is difficult to judge whether the broken end sare complicated with infection. The double plate technique is to find the site of bone nonunion under direct vision, and two plates are placed with different angles. This paper reviews the literature related to the treatment of femoral nonunion with double plate technique published at home and abroad in the past 10 years, and concludes that double plate fixation combined with autogenous iliac bone graft provides a three-dimensional fixation model for the healing of nonunion. It has the characteristics of strong stability and plays an active role in improving the biological behavior and mechanical stability of the fracture ends. The operation is beneficial to the flexion and extension of the knee joint, with the characteristics of high healing rate, low complication rate, effective pain relief and so on.

Objective: To investigate the short-term outcome of patients with acute myocardial infarction complicating cardiogenic shock due to left main disease. Methods: A total of 24 patients with acute myocardial infarction complicating cardiogenic shock due to left main artery disease hospitalized in Fuwai hospital from June 2012 to May 2018 were included. The clinical data were analyzed,and the patients were divided into survivor group (11 cases) and death group (13 cases) according to survival status at 28 days post the diagnosis of shock. The patients were further divided into thrombolysis in myocardial infarction(TIMI) flow grade 0-2 group (11 cases) and TIMI flow grade 3 group (13 cases) according to TIMI flow grade after the procedure. The patients were then divided into non-three-vessel lesions group (14 cases) and three-vessel lesions group (10 cases) according to coronary angiography results. Results: Compared with survivor group, patients in death group presented with lower worst systolic blood pressure within 24 hours after admission (50(48, 70) mmHg (1 mmHg=0.133 kPa) vs. 73(70, 80) mmHg, P<0.01), lower worst diastolic blood pressure with in 24 hours after admission ((33.5±12.4) mmHg vs. (48.9±9.4) mmHg, P<0.01), higher respiratory rates ((27.3±2.5) times/min vs. (21.5±4.0) times/min, P<0.01), less 24 hours urine output ((422±266) ml vs. (1 680±863) ml, P<0.01), lower platelet counts ((161.9±81.9)×10⁹/L vs. (241.6±94.0)×10⁹/L, P=0.03), higher serum creatinine ((250.0±36.8) μmol/L vs. (132.7±34.2) μmol/L, P<0.01), higher alanine aminotransferase (288(76,846) IU/ml vs. 81(42, 109) IU/ml, P=0.04), lower artery pH (7.11±0.17 vs. 7.39±0.09, P<0.01), higher lactic acid ((10.29±3.62) mmol/L vs. (4.21±2.85) mmol/L, P<0.01), higher incidence of invasive ventilation (7/13 vs. 2/11, P=0.02), higher scores of acute physiology and chronic health evaluation (APACHE) Ⅱ (35.4±6.8 vs. 18.7±1.7, P<0.01) and simplified acute physiology score (SAPS) Ⅱ (73.5±17.4 vs. 47.0±4.3, P<0.01), and higher incidence of target vessel TIMI flow grade 0-2 (10/13 vs. 1/11, P<0.01). Kaplan-Meier survival curve analysis showed that survival rate at 28 days post the diagnosis of shock in TIMI flow grade 3 group was higher than that in TIMI flow grade 0-2 group (76.9% vs. 9.1%, log-rank test, P<0.01), and mortality rate was similar at 28 days post the diagnosis of shock between non-three-vessel lesions group and three-vessel lesions group (35.7% vs. 60.0%, log-rank test, P=0.14). Multivariate logistic regression analysis showed that compared with TIMI flow grade 0-2 group, the OR value of death at 28 days post the diagnosis of shock in TIMI flow grade 3 patients with acute myocardial infarction complicating cardiogenic shock due to left main disease was 0.030(95%CI 0.003-0.340, P<0.01). Conclusion Short-term outcomeof patients with acute myocardial infarction complicating cardiogenic shock due to left main disease remains poor, and final flow of TIMI grade 3 is confirmed as independent protective factor of death at 28 days post the diagnosis of shock in these patients.

OBJECTIVE: To explore the correlation between diabetic nephropathy (DN) and cognitive impairment through examining the cognitive function and the metabolism of the cerebrum in Type 2 diabetes mellitus patients at different stages of renal function.
 METHODS: Eighty six patients with Type 2 diabetes mellitus (T2DM) were enrolled for this study. According to the urinary albumin excretion rate (UAER), the patients were divided into a T2DM without DN group (DM group, n=33), an early DN group (DN-III group, n=26) and a clinical stage group (DN-IV group, n=27). Thirty healthy adults were selected as a control group (NC group). Biochemical indexes and UAER were measured, and glomerular filtration rate (GFR) was detected by single-photon emission computed tomography (SPECT). The cognitive function was measured by Montreal Cognitive Assessment (MoCA, Beijing version) and mini-mental state examination (MMSE). The peak areas of N-acetylasparte (NAA), creatine (Cr), choline-containing compounds (Cho) were detected by proton magnetic resonance spectroscopy (1H-MRS).
 RESULTS: 1) There was no statistical difference in MMSE scores between the DM group and the control group. The scores of MoCA in the DN-III group or in the DN-IV group were significant less than that in the NC group (F=3.66, P<0.05); 2) There was significant difference in left N-acetylaspartate (LNAA), left choline (LCho) among the diabetes groups. Compared with the DM group, the level of LNAA was decreased significantly (t=3.826, P<0.05) while the LCho was increased significantly (t=4.373, P<0.05) in the DN groups, with statistic difference between the 2 groups (t=3.693, P<0.05); 3) The MoCA scores of T2DM patients were negatively correlated with UAER (r=-0.285, P<0.05), while positively correlated with GFR (r=0.379, P<0.05); 4) Logistic regression analysis indicated that UAER and GFR were the major risky factors for diabetic cognitive impairment.
 CONCLUSION Diabetic cognitive impairment is closely correlated with the nephropathy in patients with Type 2 diabetes. With the decline in glomerular filtration function, the cognitive disorder tends to be aggravated. The hippocampal brain metabolism may have some changes in left side of Cho/Cr in patients with diabetic nephropathy.
Adult ; Aspartic Acid ; analogs & derivatives ; metabolism ; Case-Control Studies ; Cerebrum ; metabolism ; Choline ; metabolism ; Cognition ; Cognition Disorders ; epidemiology ; Creatine ; metabolism ; Diabetes Mellitus, Type 2 ; physiopathology ; Diabetic Nephropathies ; epidemiology ; Glomerular Filtration Rate ; Humans ; Neuropsychological Tests

Objective To compare the efficacy and safety of intravenous thrombolysis on cardiogenic cerebral infarction and noncardiac infarction by recombinant tissue plasminogen activator (rt-PA). Methods Comparations of NIHSS, mRS and adverse events before and after treatment were made between the cardiogenic group and the noncardiac group. Results No significant differences in the NIHSS and mRS were found between the two groups. The incidence of brain hernia and dermatorrhagia in the cardiogenic group was higher than that in the noncardiac group. Conclusion Rt-PA therapy in cardiogenic cerebral infarction was effective and safe in spite of higher incidence of hemorrhage and brain hernia.

Objective To investigate the incidence and the related factors of the depression in Parkinson's disease. Methods 52 cases with idiopathic Parkinson's disease were included in this study. Such scales as Hamilton depression scale-24 item (HAMD-24), Non Motor Symptoms Scale for Parkinson's disease (NMSS), 39-item Parkinson's Disease Questionnaire (PDQ-39), unified Parkinson's disease rating scale (UPDRS), revised Hoehn-Yahr rating scale (H-Y), revised Schwab and English daily life event scale (S-E), Minimum Mental State Examination (MMSE), etc. were applied and underwent Spearman correlation analysis. Results Thirty-six patients with Parkinson's disease (69.23%) met the criteria for depression. The spearman rank correlation analysis showed that MMSE (r=-0.294, P=0.036) and S-E (r=-0.506, P<0.001) had negative correlation with depression in Parkinson's disease, and the course of the disease (r=0.274, P=0.049), UPDRS (r=0.485, P<0.001), H-Y (r = 0.459, P = 0.001), NMSE (r = 0.729, P < 0.001) and PDQ-39 (r = 0.619, P < 0.001) had positive correlation with depression in Parkinson's disease. Conclusions The patients with Parkinson's disease had high incidence of depression. The depression in Parkinson's disease is associated with many factors and affected the quality of life of the patients.

Objective To investigate the changes in plasma very long chain fatty acids (VLCFAs),and to explore its relationship with obesity-related index in obese children.Methods One hundred and sixty-six obese children aged 7 to 12 years old were investigated and 148 health children matched with age and sex were selected as control group.Their height,weight,and waist circumference (WC) were measured.The percentage of body fat (PBF) was tested by dual-energy X-ray absorptiometry.Fasting blood triglycerides (TG),total cholesterol (TC),high density lipoprotein-cholesterol (HDL-C),low density lipoprotein-cholesterol (LDL-C) levels,fasting plasma glucose,and fasting insulin (FINS) were determined.The body mass index (BMI),BMI-Z score,waist to height ratio (WHtR),and homeostasis model assessment for insulin resistance (HOMA-IR) were calculated.The plasma VLCFAs were analyzed by gas chromatography-mass spectrometry.Results (1) Compared with normal control children,body weight,BMI,BMI-Z score,WC,WHtR,PBF,TG,TC,LDL-C,FINS,and HOMA-IR in obese children were increased (all P ＜ 0.05),and the level of HDL-C was decreased (P ＜ 0.05).(2) The plasma levels of docosamonoenoic acid (C22 ∶ 1 n-9) and arachidonic acid (C20 ∶ 4n-6) were decreased while the levels of arachicacid (C20 ∶ 0) and eicosapentaenoic acid (C20 ∶ 5n-3) increased in obese children compared to non-obese children.(3) The linear correlation analysis showed that PBF was positively correlated with C20 ∶ 0 and C20 ∶ 5n-3,and negatively correlated with C20 ∶ 4n-6.WHtR was negatively correlated with C22 ∶ 1 n-9 and positively correlated with C20 ∶ 0 (4) The multiple stepwise regression analysis showed that C20 ∶ 0 was the main factor for PBF,and C22 ∶ 1 n-9 and C20 ∶ 0 were the main factors for WHtR.Conclusion The metabolic abnormality of plasma very long chain fatty acids exists in obese children.The changes in C20 ∶ 0,C22 ∶ 1 n-9,and C20 ∶ 5n-3 may be associated with obesity in children.