Osteoporosis （OP） is a systemic metabolic bone disease. Amid population aging， OP has become a major health problem for the middle-aged and the elderly in China. Aging， iron load， and estrogen deficiency break the balance between oxidation and antioxidant systems， and the increase of reactive oxygen species mediates oxidative stress to damage DNA， lipids， proteins and other macromolecules， thus accelerating cell apoptosis and inducing OP， obesity， and neurodegenerative disorders. It has been found that oxidative stress is of great significance in the pathogenesis of OP. Oxidative stress regulates the signaling pathways， cytokines， and proteins related to the mesenchymal stem cells， osteoblasts， and osteoclasts， thereby weakening the osteogenic differentiation of mesenchymal stem cells， inhibiting osteoblast mineralization， and promoting the activation， proliferation， and maturation of osteoclasts. As a result， the dynamic imbalance between bone resorption and bone formation occurs， influencing bone remodeling and promoting the progression of OP. At the moment， anti-bone resorption drugs， bone formation-promoting drugs， and hormones are mainly used in clinical settings in western medicine. However， due to the long treatment cycle and the occurrence of serious gastrointestinal reactions， hypocalcemia， osteonecrosis， and others， patients show poor compliance and thus the effect is not as expected. Traditional Chinese medicine （TCM） demonstrates remarkable effect on OP attributing to the multi-pathway and multi-target characteristics. With low price and few adverse reactions， TCM is widely applied in clinical practice in comparison with western medicine. TCM has unique advantages in the treatment of OP by regulating oxidative stress. It exerts the therapeutic effect on OP by modulating different signaling pathways， providing new mindset for the treatment of this disease. Therefore， through literature research， this study summarized the research on mechanism of oxidative stress in OP and the treatment by TCM， which is expected to lay a foundation for further research.

OBJECTIVE: To establish a clinically applicable model of rapid identification of adverse drug reaction program (RiADP) for risk management and decision-making of clinical drug use. METHODS: Based on the theory of disproportion analysis, frequency method and Bayes method, a clinically applicable RiADP model in R language background was established, and the parameters of the model were interpreted by MedDRA coding. Based on the actual monitoring data of FDA, the model was validated by the assessing hepatotoxicity of lopinavir/ritonavir (LPV/r). RESULTS: The established RiADP model included four parameters: standard value of adverse drug reaction signal information, empirical Bayesian geometric mean value, ratio of reporting ratio and number of adverse drug reaction cases. Through the application of R language parameter package "phViD", the model parameters could be output quickly. After being encoded by MedDRA, it was converted into clinical terms to form a clinical interpretation report of adverse drug reactions. In addition, the evaluation results of LPV/r hepatotoxicity by the model were matched with the results reported in latest literature, which also proved the reliability of the model results. CONCLUSIONS In this study, a rapid identification method of adverse reactions based on post marketing drug monitoring data was established in R language environment, which is capable of sending rapid warning of adverse reactions of target drugs in public health emergencies, and providing intuitive evidence for risk management and decision-making of clinical drugs.
Databases, Pharmaceutical ; Decision Making, Computer-Assisted ; Drug Monitoring ; Drug-Related Side Effects and Adverse Reactions ; HIV Protease Inhibitors ; adverse effects ; pharmacology ; Humans ; Liver ; drug effects ; Lopinavir ; adverse effects ; toxicity ; Models, Statistical ; Reproducibility of Results ; Software ; standards

In the era of big data, hospital′s research data platform development is faced with challenges in how to strengthen the deep and efficient application of medical big data in their clinical research. The authors studied such problems of a tertiary hospital in Henan as low data value density, difficulty in structuring medical text language and mismatch between clinical research thinking and ability, in terms of the use of existing clinical data exploration system and effective use of data. Based on results of the study, they summarized relevant measures for effective use of medical data and considerations in the establishment of a clinical research big data center.For example, combination of " pre-structuring" and " post-structuring" in data collection for data quality control; exploration of deep mining of medical text data using machine learning technology based on unstructured text data, and perfection the intelligent analysis application function of clinical research big data; enhancement of talent training to promote clinicians′ capacity in using clinical big data; and enhancement of multi-disciplinary teambuilding and composite talent cultivation, for the purposes of more efficient use of medical big data and higher efficiency and quality of clinical research.

Objective To explore the effect of 3d digital reconstruction and printing technology on the teaching of complex orthopedics. Methods A total of 90 interns in the Second Affiliated Hospital of Inner Mongolia Medical University from September 2016 to September 2017 were selected as research subjects. According to the different teaching methods, they were divided into control group (n=45) and experimental group (n=45). The former received traditional teaching;the latter used three-dimensional digital reconstruction and printing technology to print out complex fracture models of patients, digitally reproduced fracture classification, developed scientific surgical plans through fracture models, and simulated surgical fixation methods. Examination was divided into clinical skills and written exam according to exam outline requirements; Self-cognitive ability score included professional interest, fracture understanding, etc. The satisfaction of the medical students in the experimental group was determined using self-made questionnaires. t test was used to compare data between groups. Results Experimental groups' scores for surgical skills (84.36 ±0.28) and theoretical knowledge (87.55 ±0.44) were higher than the control group, and the differences were statistically significant (P<0.05). The professional interest of the experimantal group was higher than that of the control group, and the difference was statistically significant (P<0.05). The students' classroom atmosphere was significantly better compared with the control group, and the difference was statistically significant (P<0.05). Conclusion Using 3 d digital reconstruction and printing technology to establish modes in complex orthopedics teaching process can effectively improve interns' surgical skills and theoretical knowledge, and promote student satisfaction.

OBJECTIVE:To explore an effective method to formulate management-related strategies for off-lable use of drugs by the evidence-based medicine. METHODS:The process of guideline formulation included seven procedures,i.g. establishment ofguideliesformulation workgroup;investigation and selection of the status quo on off-label drug use;identification of the clinical problems;retrieval and evaluation and comprehensing of evidence;applification of GRADE in evidence quality grading;formation of the recommendations consensus;peer review and result publication. And eventually guidelines were formed based on the steps. This study took off-label use of rheumatoid immunoprotective subjects as a case to explore. RESULTS & CONCLUSIONS:Based on the evidence evaluation system and above 7 steps,the methods and process of guideline formulation on off-label use of rheuma-toid immunoprotective subjects that integrated administration,law,clinical medicine,pharmacy subjects were made .The process of guideline formulation fully reflects multidisciplinary characteristics of the workgroup,the advanced nature of the process,the comprehensiveness of evidence ,the rigor of evidence quality grading,and the normalization of consensus. It provides reference in methodology for establishing a comprehensive evidence-based evaluation and management system of off-label use of drugs for all clinical specialist disease. Therefore,this scientific research results may promote the standardization and legalization of the off-label use of drugs management in China.

Objective: To study the diagnostic characteristics of cardiac amyloidosis (CA) by non-invasive electrocardiography (ECG) in relevant patients. Methods: We retrospectively analyzed 60 CA patients diagnosed in our hospital from 2008-08 to 2013-12 for their clinical and ECG characteristics. Results: There were 48 male and 12 female patients with the ratio of 4: 1. The ifrst time diagnosis rate was low and the average age for conifrmed diagnosis was at (54. 5±14. 2) years.①There were 32 (53. 3%) cases combining heart failure, 12 (20%) with pleural effusion, 20 (33. 3%) with atrial arrhythmia, 8 (13. 3%)with ventricular arrhythmia, 4 (6. 7%)with sino-atrial block, 15 (25%)with atrio-ventricular block, 4 (6. 7%) with left bundle branch block (LBBB), 5 (8. 3%)with RBBB and 8 (13. 3%)with intra-ventricular block.②There were 32 (53. 3%) cases with low voltage on limb leads, 52 (86. 7%) with pseudo-infarct pattern, 48 (60%) with ST-T abnormality and 30 (50%) combining low voltage on limb leads with pseudo-infarct pattern.③The patients combining pleural effusion and with pseudo-infarct pattern had the increased ratio of low voltage on limb leads, while there were still 22 (45. 8%) cases without pleural effusion had low voltage on limb leads.④ ECG characteristics for 60 CA patients were as follows: QRS duration (104±26) ms, QT interval (404±34) ms, QTc (462±35) ms; the R wave of avR 0. 17 mV, QRS wave 0.30 mV; the R wave of limb leads and V1-3 were all<0.5mV, the S wave of V1-3 were 0. 62mV, 1. 61mV, 1. 56mV; the R/S ratio of V1-3 were 0. 19, 0. 12, 0. 20 respectively. Conclusion: CA patients had the highest incidence of pseudo-infarct pattern; meanwhile, combining with low voltage on limb leads, pseudo-infarct with long Q or S wave and ST-T abnormality but normal QRS duration was helpful for differential diagnosis of CA in clinical practice.

Objective To observe effects of Huanglian Jiedu Decoction on fasting blood glucose (FBG), fasting insulin (FINS), abdominal aortic morphology and expression of HIF-1α in the abdominal aorta in rats with type 2 diabetes. Methods The rat model of type 2 diabetes was established by intravenous injection of streptozotocin and feeding with high sugar and high fat diet. Rats were randomly divided into blank group, model group, control group and treatment group. The blank group and model group were given normal saline by gavage, the control group was given metformin, and the treatment group was given Huanglian Jiedu Decoction. Six weeks later, the levels of FBG and FINS were determined. Immunohistochemical method was used to determine the expression of HIF-1α in abdominal aorta and HE staining method to observe the changes of abdominal aortic morphology. Results Compared with model group and control group, abdominal aorta of HIF-1α and FBG level of treatment group were significantly decreased (P <0.01), FINS significantly increased (P <0.01), and abdominal aortic endothelial cell injury was significantly improved. Conclusion Huanglian Jiedu Decoction has a protective effect on the injury of vascular endothelium, and its mechanism may be related with inhibiting the expression of HIF-1α.

BACKGROUND: At present, the basic underlying molecular mechanism regulating the interactions among venous endothelial cells, platelets, leukocytes, and promoting local deep vein thrombosis microenvironment formation, still remains unclear, and there is no ideal method for early diagnosis of deep vein thrombosis. OBJECTIVE: To study the underlying role of nuclear factor kappa B1 and tissue factor in rats with deep vein thrombosis. METHODS: A total of 67 Sprague-Dawley rats were randomly divided into control group (n=10) and model group (n=57). Deep vein thrombosis model was established by a clamping and sewing method in femoral vein combined with cast fixation. The incidence and serious degree of thrombus were observed by dissecting rat femoral vein in different time points (2.5 and 25 hours after modeling). The model group was further divided into pre-thrombogenesis group (2.5 hours after modeling), thrombogenesis group (25 hours after modeling) and non-thrombogenesis group (25 hours after modeling). Then total RNA was extracted from the localized femoral venous endothelial tissue. The candidate genes, associated inflammation and thrombosis, were screened by a special gene chip. Then the gene expression of nuclear factor kappa B1 and tissue factor was further identified by real-time polymerase chain reaction. RESULTS AND CONCLUSION: Pre-thrombogenesis group had no thrombogenesis, while thrombogenesis group have 23 cases with thrombosis and non-thrombogenesis group have 22 cases without thrombosis. The results of gene chip hybridization analysis and real-time PCR found that the mRNA expression of nuclear factor kappa B1 and tissue factor in rat femoral vein endothelial tissue were significantly up-regulated at 2.5 hours after modeling (pre-thrombogenesis group was higher than control group) (P < 0.05), and continued up-regulating at 25 hours after modeling (thrombogenesis group was higher than the pre-thrombogenesis group, non-thrombogenesis group and control group) (P < 0.05). The results from present study indicate that up-regulating expressions of nuclear factor kappa B1 and tissue factor in local femoral venous endothelial tissue of rat deep vein thrombosis models may play a key role in initiating venous thrombosis.

BACKGROUND: The molecular mechanism and core regulatory network of deep vein thrombosis are not fully clarified yet.OBJECTIVE: To explore the roles of oxidative stress and Rac1/2 in rat deep vein thrombosis.METHODS: Deep vein thrombosis model in SD rats was established by a champing method femoral veins clamping combinedwith fixation of the lower extremity with plaster. The incidence and serious degree of thrombus were observed by dissecting ratfemoral vein at different time points (2.5 and 25 hours after modeling). The model rats were divided into pre-thrombogenesisgroup (2.5 hours after modeling), thrombogenesis group (25 hours after modeling) and non-thrombogenesis group (25 hours aftermodeling). Then total RNA and protein were extracted from the femoral venous wall tissues.RESULTS AND CONCLUSION: Colorimetry results showed that compared with the non-thrombogenesis group, theconcentration of malondiadehyde in rat femoral vein wall tissues of the thrombogenesis group was the highest (P < 0.05), followedby that of the pre-thrombogenesis group (P < 0.05). The concentrations of total superoxide dismutase and glutathione reductasein the thrombogenesis group were the lowest, followed by those in the pre-thrombogenesis group (P < 0.05). The results of genechip hybridization analysis and real-time PCR showed that compared with the non-thrombogenesis group, the expressions ofRac1 and Rac2 in rat femoral vein wall tissues of thrombogenesis group increased the most, followed by that of thepre-thrombogenesis group (P < 0.05). These findings indicate that the up-regulation of malondialdehyde and Rac1/2 as well asthe activity decrease of total superoxide dismutase and glutathione reductase may lead to the formation of deep venousthrombosis.

OBJECTIVE: To evaluate the recovery of patients with end-stage renal disease (ESRD) receiving kidney transplant from cardiac death donors, and to assess graft survival in China from this type of donor. METHODS: A total of 48 cases of patients with ESRD have received the kidneys from cardiac death donors in our hospital between February 2010 and March 2012. We retrospectively analyzed data on the preoperative and postoperative serum creatinine concentrations, on the survival of recipients and allografts with a view to investigating prognoses after this type of kidney transplant. RESULTS: Primary non-function (PNF) did not occur in any of the 48 recipients. Delayed graft function (DGF) occurred in 18 of 48 (37.5%) of kidneys from cardiac death donors, but the occurrence of DGF did not adversely influence patient's survival (P=0.098) or graft survival (P=0.447). Seven of 48 (14.6%) recipients lost their graft. Over a median follow-up period of 8 months (range 0.5-23 months), 39 of 41(95.1%) recipients' graft function had fully recovered. The actuarial graft and patient's survival rates at 1, 3, 6 and 12 months after transplantation were 95.7%, 93.0%, 90.0%, 87.5%, and 100%, 94.9%, 90%, 87.5%, respectively. CONCLUSION As the legislation of donation after brain death (DBD) has not been ratified in China, the use of kidneys from cardiac death donors might be an effective way to increase the number of kidneys available for transplantation here. Our experience indicates good short- and mid-term outcomes with transplants from cardiac death donors.
Adult ; Brain Death ; Cadaver ; Death, Sudden, Cardiac ; Delayed Graft Function ; epidemiology ; Female ; Graft Survival ; Humans ; Kidney Transplantation ; Male ; Middle Aged ; Tissue Donors ; statistics & numerical data