BACKGROUND:There are many treatment methods for knee osteoarthritis,among which electroacupuncture,as an important non-drug treatment,is effective in the treatment of knee osteoarthritis,but its exact mechanism is not clear. OBJECTIVE:Effect of electroacupuncture on the expression of p53 and P21 in articular cartilage and subchondral bone of aged rats with knee osteoarthritis. METHODS:Eight 6-month-old male Sprague-Dawley rats were included in the young group and sixteen 24-month-old male Sprague-Dawley rats were randomly divided into old group(n=8)and electroacupuncture group(n=8).The rats in the electroacupuncture group received electroacupuncture stimulation once a day,5 days a week,for 8 continuous weeks,and the other two groups did not do any treatment.Eight weeks later,the level of type Ⅱ collagen C-terminal peptide in peripheral blood was detected by ELISA,the morphology of left knee cartilage and subchondral bone was observed by safranin O-fast green staining,the degree of knee cartilage degeneration was evaluated by modified Mankin's score,the microstructure of left knee cartilage and subchondral bone was detected by micro-CT,and the expression levels of matrix metalloproteinase 13,P53,P21 Mrna and protein were detected by RT-PCR and western blot respectively. RESULTS AND CONCLUSION:Compared with the young group,the level of C-terminal peptide of type Ⅱ collagen in the peripheral blood was increased in the old group(P<0.05).The micro-CT results showed that the bone volume fraction,bone mineral density and the number of bone trabeculae were decreased in the old group compared with the young group(P<0.05),while the trabecular separation increased(P<0.05).Safranin O-fast green staining showed that in the old group,the surface layer of cartilage was uneven with fissures,the morphology of chondrocytes was irregular and stained unevenly,the boundary between the cartilage and subchondral bone was blurred,and the matrix loss was serious.The Mankin's score was higher in the old group than the young group(P<0.05).The expression of matrix metalloproteinase 13,P53,P21 at Mrna and protein levels increased in the old group compared with the young group(P<0.05).Compared with the old group,electroacupuncture decreased the level of C-terminal peptide of type Ⅱ collagen(P<0.05),increased the bone volume fraction,bone mineral density and the number of bone trabeculae(P<0.05),and decreased the trabecular separation(P<0.05).Safranin O-fast green staining showed that in the electroacupuncture group,the surface of cartilage was smooth and red staining was uniform,and the cell morphology and structure were between the young group and the old group.Following electroacupuncture treatment,the Mankin's score(P<0.05),matrix metalloproteinase 13 and P21 Mrna expression(P<0.05),and matrix metalloproteinase 13 and P53 protein expression decreased(P<0.05),while there was a decreasing trend of P53 Mrna and P21 protein expression,but with no statistical significance(P>0.05).To conclude,electroacupuncture may delay articular cartilage degeneration and subchondral osteoporosis in aged rats by inhibiting the expression of P53 and P21,so as to protect joints and delay joint aging.

Objective:To survey the status quo of family doctor work mode in Shanghai Xuhui district.Methods:Semi-structured and structured in-depth interviews were conducted in Shanghai Xuhui district from April to June 2021, 11 directors, 12 deputy directors in charge and 30 family doctors from 12 community health service centers participated in the survey and completed two stages and four sessions of interviews on the development of the integrated and high-quality family doctor work mode and the ways to realize and the challenges to face. The records of interviews were transcribed, sorted and analyzed using the Colaizzi 7-step analysis method.Results:The survey showed that the family doctor contracting was carried out in a large team mode in the whole district, mainly for the elderly, and most of contracted residents were not included in health management and follow-up services. The team was composed of family doctors and assistants, and the routine outpatient service was the main work pattern, and the regular services also included the chronic disease follow-up and health check-up for elderly. On the issue of how to output high-quality integrated services, the majority of doctors (12/13) believed that the contracted individual should be taken as the unit of fine service, carrying out overall health assessment, optimizing medication plan, lifestyle guidance, one-stop service in hospital, etc.; only one doctor suggested that the family should be the management unit. For upgrading the working mode and service quality, insufficient time and energy were the main obstacle. Public health work occupied a lot of working time, but it seemed not be transformed into favorable resources and conveniences in health management and services. The professional assistants should carry out some responsibility to save family doctor′s time. The survey suggests that informatization, service space, and sufficient drug supply are the keys for ensuring high-quality and high-efficiency integrated services.Conclusion:The organizational structure of the family doctor team in Shanghai Xuhui district is relatively mature, but the integrated and high-quality service output has not yet reached. It is necessary to make regional overall planning and increase efforts to achieve the integration of medical treatment and prevention, so as to gain time for family doctors to carry out high-quality services. At the same time, it is also necessary to cultivate effective family doctor assistants, provide an information work platform that matches the work attributes and goals of family doctors, open up an integrated health management service space, and ensure the full range supply of drugs.

Objective:To evaluate the shoulder arthroscopic treatment of avulsion fracture of humeral greater tuberosity with double-row suture bridge.Methods:Retrospectively analyzed were the 13 avulsion fractures of humeral greater tuberosity which had been treated by shoulder arthroscopic double-row suture bridge at Bone and Joint Department, Guangzhou Liwan District Orthopedic Hospital from March, 2018 to March, 2020. There were 6 males and 7 females, with an average ages of 52.3 years (from 35 to 69 years). According to the Mutch classification, all the fractures of humeral greater tuberosity were attributed to the avulsion type. Of them, 3 were simple avulsion fractures of humeral greater tuberosity and 10 were complicated with shoulder anterior dislocation which was reduced manually before operation. There were 3 obsolete avulsion fractures of humeral greater tuberosity. Regular clinic and X-ray follow-ups were carried out. At the final follow-up, the pain, range of motion (ROM) and stability of the shoulder joint were assessed using visual analogue scale (VAS), American shoulder elbow scores (ASES), and Korean shoulder scores (KSS).Results:All the patients were followed up for an average of 12.3 months (from 10 to 16 months) postoperatively. No infection or shoulder instability was observed. At the final follow-up, the abduction and elevation averaged 164.6° (from 135° to 180°), the lateral external rotation 62.7° (from 40° to 80°), the internal rotation touch back test T10 level (from L2 to T6), the VAS 0.65 (from 0 to 2.5), the ASES 90.5 (from 78 to 100), and the KSS 91.5 (from 84 to 100).Conclusion:Shoulder arthroscopic treatment of avulsion fracture of humeral greater tuberosity with double-row suture bridge is minimally invasive and allows for repair of combined injury, leading to quick postoperative recovery.

Objective:To evaluate the effect of nitric oxide on epidermal hyperplasia in mice with impaired barrier function.Methods:Fifteen SKH1 hairless mice were divided into 4 groups by using a random number table: normal control group (3 mice) , S-nitroso-N-acetyl-DL-penicillamine (SNAP) group (4 mice) , barrier-impaired group (4 mice) , SNAP-treated barrier-impaired group (4 mice) . Fifteen C57BL/6J mice were randomly and equally divided into 3 groups: normal control group, barrier-impaired group and sodium nitroprusside (SNP) -treated barrier-impaired group. Mice in the two normal control groups were both topically treated with propylene glycol-ethanol mixtures on the back; those in the SNAP group were topically treated with SNAP solution alone; those in the two barrier-impaired groups were both treated with repeated tape peeling followed by topical application of propylene glycol-ethanol mixtures on the back twice a day; those in the SNAP-or SNP-treated barrier-impaired group were treated with repeated tape peeling followed by topical application of 10-mmol/L SNAP or SNP solution on the back twice a day. After 4 consecutive days of treatment, all the mice were sacrificed on day 5, and skin tissues were resected from the back of mice followed by preparation of paraffin sections. Hematoxylin-eosin (HE) staining was performed to measure the epidermal thickness, and proliferating cell nuclear antigen (PCNA) staining was conducted to detect proliferating cells in the epidermis. Two-way analysis of variance and one-way analysis of variance were used for comparisons among groups, and least significant difference- t test was used for multiple comparisons. Results:No significant difference in the epidermal thickness or number of PCNA-positive cells was observed between the SNAP group and normal control group ( t=0.33, 1.25, P=0.748, 0.246, respectively) . Compared with the corresponding normal control groups, the barrier-impaired groups showed significantly increased epidermal thickness and number of PCNA-positive cells (all P < 0.01) . Compared with the corresponding barrier-impaired groups, SNAP-treated barrier-impaired group and SNP-treated barrier-impaired group both showed significantly increased epidermal thickness (SKH1: 127.5 ± 12.0 μm vs. 50.4 ± 5.4 μm; C57BL/6J: 78.1 ± 7.6 μm vs. 45.9 ± 3.7 μm; both P < 0.001) and number of PCNA-positive cells (SKH1: 120.0 ± 5.0 cells/mm vs. 87.3 ± 3.8 cells/mm; C57BL/6J: 285.0 ± 15.0 cells/mm vs. 232.0 ± 19.3 cells/mm; both P < 0.01) . Conclusion:Topical nitric oxide donors did not affect normal epidermis, but could aggravate epidermal hyperplasia in barrier-impaired skin, suggesting that skin condition affects the effect of topical nitric oxide donors on epidermal hyperplasia.

"The Expert Group on Tumor Ablation Therapy of Chinese Medical Doctor Association, The Tumor Ablation Committee of Chinese College of Interventionalists, The Society of Tumor Ablation Therapy of Chinese Anti-Cancer Association and The Ablation Expert Committee of the Chinese Society of Clinical Oncology" have organized multidisciplinary experts to formulate the consensus for thermal ablation of pulmonary subsolid nodules or ground-glass nodule (GGN). The expert consensus reviews current literatures and provides clinical practices for thermal ablation of GGN. The main contents include: (1) clinical evaluation of GGN, (2) procedures, indications, contraindications, outcomes evaluation and related complications of thermal ablation for GGN and (3) future development directions.
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To investigate cerebral autoregulation(CA)in patients with severe unilateral carotid artery stenosis by near infrared spectroscopy. Thirty patients who underwent general anesthesia in our hospital from January 2015 to February 2017 were enrolled in this study.The stenosis group included 15 patients with severe unilateral internal carotid artery stenosis,and the control group included 15 patients without carotid artery stenosis.Both groups were matched in sex and age.Cerebral tissue oxygenation index(TOI)and mean arterial pressure were recorded continuously under stable general anesthesia.The Pearson correlation coefficient()was calculated to judge the CA status. TOI was not significantly different between the stenosis side and the non-stenosis side in the stenosis group(66.52±6.50 65.23±4.50;=0.93, =0.368)or between the stenosis side in the stenosis group and the stenosis side in the control group(66.52±6.50 64.22±3.87;=1.18, =0.248).The values of stenosis side and non-stenosis side in the stenosis group were 0.36±0.12 and 0.17±0.11,respectively,and the values of the stenosis side in the stenosis group and the stenosis side of the control group were 0.36±0.12 and 0.13±0.08,respectively.In the stenosis group,5 patients had transient ischemic attack and 2 patients had a history of stroke within 3 months before operation.When an value of 0.342 was used as the judgment point of CA abnormality,the sensitivity and specificity were 0.625 and 0.909,respectively. Within the range of normal blood pressure fluctuation,cerebral blood flow is linked to blood pressure at the stenosis side in patients with severe unilateral carotid artery stenosis.
Blood Pressure ; Carotid Stenosis ; Cerebrovascular Circulation ; Homeostasis ; Humans ; Ischemic Attack, Transient

Objective:To explore the application and value of metagenomic next-generation sequencing (mNGS) in refractory infection after organ transplantation.Methods:A case report discussed about a patient with lumbar spine infection after kidney transplantation and the relevant literature was reviewed. The recipient was a 63-year-old man with low back pain after kidney transplantation. Lumbar spine magnetic resonance imaging showed lumbar spine infection. Multiple operations plus antibacterial and antituberculosis treatments were ineffective. Before and after treatment, numerous tests of traditional pathogenic microorganisms failed to detect any positive bacteria.Results:The detection of lumbar secretion by mNGS suggested aspergillus infection. The symptoms improved after dosing of voriconazole.Conclusions:The incidence of fungal infection of lumbar spine is low. The imaging manifestations are non-typical so that it is easy to misdiagnose. mNGS helps to timely diagnose and guide treatment. With a review of the literature, mNGS has some application value for some difficult and rare infectious diseases.

Objective:To explore the brain function changes in patients with cervical vertigo using functional MRI.Methods:Twenty-two patients who were diagnosed with cervical vertigo were recruited in this study for functional MRI (fMRI) analysis, while 25 age- and sex-matched adult healthy individuals were chose forhealthy controls. The Visual Analogue Scale(VAS) and Dizziness Handicap Inventory (DHI) were used to access the severity of cervical vertigo, and the six-point categorical rating scale was used to measure the frequency of vertigo. Functional MRI was used to investigate the regions with brain functional changes between the cervical vertigo group and the control group. All the data was analyzed using low-frequency oscillation amplitude (ALFF) to explore local brain function changes. The ALFF values between the two groups were tested by two independent samples t-tests. Finally, the ALFF values in abnormal brain regions were extracted using the REST software package and correlated with the diseaseduration of cervical vertigo and thevertigo scores (VAS and DHI) using Pearson correlation analysis. P <0.05 was considered statistically significant. Results:Compared to healthy controls, patients with cervical vertigo haddecreased ALFF valuesin the left superior temporal gyrus (voxel=45, t=-3.36), right superior temporal gyrus (voxel=32, t=-2.82) and left supramarginal gyrus (voxel=57, t=-4.85), and increased ALFF values in the left and right cerebellum (voxel=41, t=4.26; voxel=33, t=4.57; respectively)(AlphaSim Rest, all P values >0.05). The ALFF values of left and right superior temporal gyrus were negatively correlated with the disease duration of vertigo (left R2=0.437, right R2==0.259), the VAS score (left R2==0.453, right R2==0.341) and DHI score (left R2=0.553, right R2=0.594), respectively, and there were significant differences (all P values < 0.05). The ALFF values of left and right cerebellum were positively correlated with the disease duration of vertigo (left R2==0.555, right R2=0.490) and the VAS score (left R2=0.307, right R2=0.282) and DHI score (left R2=0.632, right R2=0.591), respectively, and the differences were significant (all P values < 0.05). Conclusion:Patients with cervical vertigo have reduced spontaneous nerve activity in bilateral Vestibular cortex, and increased spontaneous nerve activity in the bilateral cerebellum. The brain functional changes were correlated with the disease duration and the severity of vertigo.

Guided bone regeneration (GBR) barrier membranes are of great significance for the reconstruction of the health and function of different periodontal tissues. Biocompatibility, spatial maintenance, closure, controllability and biological activation are the main criteria that should be met by these membranes. Artificial barrier membrane biomaterials can be divided into synthetic polymer materials, natural polymer materials and metals. According to their degradation characteristics, these membranes can be divided into two categories, absorbable and nonabsorbable membranes. GBR used for horizontal bone increments can be used to treat various types of bone defects, including the treatment of bone fenestration and bone cracking. The use of a non-absorbable e-PTFE membrane or absorbable collagen membrane can achieve the expected effect. However, for incremental or vertical bone growth at the alveolar crest, the use of this membrane is very challenging and requires good strength to maintain the osteogenic space. This space can be enhanced with e-PTFE or d-PTFE membranes with stable morphology, or absorbable membranes can be covered with titanium plates or meshes to achieve vertical bone increments. Currently, bioactive membranes, digital 3D-printed titanium membranes and piezoelectric active biological membranes are research hotspots. In future research, the biological activation of these membranes will be further improved, which will promote the development of artificial membranes in the next stage.

Objective To observe the effect of Tomatis converted auditory training on the executive functioning of breast cancer patients undergoing chemotherapy.Methods Eighty breast cancer patients with the executive dysfunction who were undergoing chemotherapy were divided into a control group and an experimental group,each of 40.The experimental group was given Tomatis high and low frequency auditory training,while the control group was given ordinary music training.The patients in both groups were treated in 4 stages,each of 5 consecutive days with intervals of 21 days.The Chinese Version of the Behavioral Assessment of Dysexecutive Syndrome (BADS) was used to evaluate both groups before and after the intervention,including rule transformation ability,problem solving ability,planning ability,supervising ability and organizing ability.Results After the intervention,the experimental group had a significantly higher average score than before the intervention in the rule-switching card test,the action planning test,the key-finding test,and the modified six-element test.Their average BADS score was also significantly improved.The control group showed a significantly better average score only in the key-finding test and in its average BADS total score.After the intervention,the experimental group had a significantly higher average score than the control group in the rule-switching card test and the action planning and six-element tests.Its average BADS rating was also significantly better.Conclusion Tomatis high and low frequency auditory training can improve the executive function of patients undergoing chemotherapy for breast cancer.Its effect is better than that of ordinary music training.