ObjectiveTo study the effect of Bushen Huoxuetang on the apoptosis and the expression of B-cell lymphoma （Bcl-2）-associated X protein （Bax）/ Bcl-2 and cleaved cysteine-containing aspartate proteolytic enzyme-3 （cleaved Caspase-3） in the nude mouse model of bone metastasis of breast cancer， and explore the mechanism of Bushen Huoxuetang in inhibiting bone destruction. MethodThirty BALB/c female nude mice were randomly assigned into blank group （n=6） and model group （n=24）. The suspension of 4T1 breast cancer cells was injected into the tibia of mouse right lower limb to establish model of bone metastasis of breast cancer. The successfully modeled nude mice were randomly assigned into model group， Bushen Huoxuetang group， zoledronic acid group， and combined drug group， with 6 mice in each group. Bushen Huoxuetang was administrated at a dose of 36.67 g·kg^-1， once a day， and zoledronic acid was administrated by subcutaneous injection at a dose of 100 μg·kg^-1， twice a week. The combined drug group was administrated with the same doses of Bushen Huoxuetang group by gavage and zoledronic acid by subcutaneous injection. The mice in the blank group and the model group were administrated with the same volume of distilled water by gavage for 14 days. On the next day at the end of drug administration， the mice were sacrificed by cervical dislocation. The general situation and weight changes of the mice were examined. The right lower limb was collected， and X-ray scanning and hematoxylin-eosin （HE） staining methods were used for observation of pathological changes in the bone. The terminal deoxynucleotidyl transferase dUTP nick-end labeling （TUNEL） was employed to detect the apoptosis of bone tissue in nude mice， and Western blot to determine the expression of Bax/Bcl-2 and cleaved Caspase-3 in the bone tissue. ResultCompared with the blank group， the modeling reduced the body weight （P<0.01） and increased the right lower limb weight of the nude mice （P<0.01）. Compared with the model group， Bushen Huoxuetang， zoledronic acid， and their combination increased the body weight （P<0.01） and decreased the right lower limb weight （P<0.01）. Compared with the blank group， the other groups showed obvious tumor cell atypia， deep nuclear staining， and clear bone metastasis， and the model group showed obvious osteolytic damage in right lower limb and loss of proximal tibia and knee joint. Compared with the model group， Bushen Huoxuetang， zoledronic acid， and their combination reduced the osteolytic lesions in the right lower limb and recovered part of the bone structure， demonstrating an inhibitory effect on bone destruction. The TUNEL assay showed that the model group had lower apoptosis rate of bone metastatic tumor cells than the blank group， Bushen Huoxuetang group， zoledronic acid group， and combined drug group （P<0.01）. Compared with the blank group， the modeling down-regulated the expression of Bax and cleaved Caspase-3 （P<0.01） and up-regulated the expression of Bcl-2 （P<0.01）. Compared with the model group， Bushen Huoxuetang， zoledronic acid， and their combination up-regulated the expression of Bax （P<0.01） and cleaved Caspase-3 （P<0.05， P<0.01） and down-regulated the expression of Bcl-2 （P<0.05， P<0.01）. ConclusionBushen Huoxuetang may inhibit bone destruction in the nude mouse model of bone metastasis of breast cancer by up-regulating the expression of Bax， down-regulating the expression of Bcl-2， activating cleaved Caspase-3， and further inducing apoptosis.

Objective: To construct and determine the weight of Index System for Assessing Parent s Ability on Child Injury Prevention, and to provide the basis for childhood injury intervention in family. Methods: Twenty four experts majored in related fields were invited to participate in Delphi consultation. The final index system was constructed according to the consulting results and the weight of primary and secondary indicators were calculated. Results: The final index system consisted of 5 subscales corresponding to 5 age groups: 0,1-2,3-5,6-11 and 12-17 years old. Each scale included 4 primary indicators and 11 secondary indicators. The weight of primary indicators obtained by analytic hierarchy process is 0.28 for "environment", 0.16 for "product", 0.31 for "behaviors and skills", and 0.25 for "psychology". The highest weight of secondary indicators for "environment", "product" and "behaviors and skills" was "water area", while the top secondary indicators for "psychology" included "parental style""emotional control" "family atmosphere", with all indicators weighted higher than 0.2. Conclusion The Index System for Assessing Parent s Ability on Child Injury Prevention by Delphi consultation is comprehensive in content, and with the focus on parental behaviors and skills on injury prevention.

Objective: To investigate child injury prevention practice and associated factors among parents of primary school students. Methods: Parents of 2 577 students were selected from three primary schools in three administrative regions of Shanghai by multi stage sampling method between May and June in 2021. Questionnaire survey was administered to parents based on the Index System for Assessing Parent s Ability on Child Injury Prevention, which was developed previously by the present research group. Results were converted into standardized scores for descriptive analysis, and the original scores were analyzed by multiple linear regression model. Results: The standardized scores of parents on environment safety, product safety, behaviors and skills and psychological safety were (0.91±0.08)(0.93±0.08)(0.97±0.04)(0.95±0.05), respectively. The standardized score of general ability was (0.95±0.04). The standardized scores on knowledge, attitude and practice of injury prevention were (0.99±0.03)( 0.97± 0.05)(0.89±0.10), respectively. Mothers performances were generally better than fathers . Parents with higher education performed better than those with lower education. Parents with "being a parent" in mind performed better on child injury prevention. Conclusion There is a gap between practice with the knowledge as well as attitude towards child injury prevention among parents of primary school students. Parenting role, educational background and parental awareness of the importance of parental role are primary factors that affect child injury prevention practice.

Extraskeletal Ewing sarcoma is a rare event, and extraskeletal Ewing sarcoma of the thyroid gland is even rarer. It has non-specific clinical manifestation and difficulty in early diagnosis. The diagnosis mainly depends on histology and immunohistochemistry. It possesses the features of high malignancy, high rate of local recurrence, and distant metastasis. Currently, the aggressive multimodal treatment contains surgery, chemotherapy, and radiotherapy. This study presented a case of extraskeletal Ewing sarcoma arising in the thyroid gland of a 30-year-old woman, who presented with supraclavicular mass and sense of dysphagia obstruction in Department of Otolaryngology, Head and Neck Surgery, Second Xiangya Hospital, Central South University in 2018. Imaging studies demonstrated a cystic-solid mass in inferior of the left leaf of thyroid gland and in the posterior of the trachea and esophagus. The patient underwent localized tumor resection. The pathological diagnosis revealed that it was a small round cell tumor, and the immunohistochemistry results were considered to be extraskeletal Ewing sarcoma. Subsequently, the patient was given chemotherapy and local radiation therapy. There was no evidence of tumor recurrence or metastasis.
Adult ; Combined Modality Therapy ; Female ; Humans ; Immunohistochemistry ; Neoplasm Recurrence, Local ; Sarcoma, Ewing/therapy* ; Thyroid Gland

Predicting the protein binding rate of drugs in plasma is helpful to us in understanding the pharmacokinetic characteristics of drugs, with much value of reference for early research on drug discovery. In this study, plasma protein binding rate information of 2 452 clinical drugs were collected.Two pieces of software, Molecular Operating Environment (MOE) and Mordred, were used to calculate molecular descriptors, which were used as input features of the model.Extreme gradient boosting (XGBoost) algorithm and random forest (RF) algorithm were then used to build a machine learning model.The results showed that, compared with MOE, the prediction performance of the constructed model was better using the molecular descriptor calculated by Mordred as the input of the model.The prediction performance results of the model constructed using the XGBoost algorithm and the RF algorithm were similar, and the R2 of the optimal model were both 0.715.According to the research results, it can be concluded that the drug plasma protein binding rate is closely related to some physical and chemical properties of the drug molecule, such as water solubility, octanol/water partition coefficient and conjugated double bonds.Using these parameters to predict the plasma protein binding rate of drugs has the advantages of convenience and efficiency, which can provide reference for related pharmacokinetic studies.

Objective To study the influence of GM1 on hyperbilirubinemia-induced brain injury in neonatal rats and its possible mechanism.Method A total of 120 7-day-old Sprague-Dawley (SD) rats were randomly assigned into normal control group (n =40),hyperbilirubinemia group (n =40) and GM1 group (n =40).According to the different duration of hyperbilirubinemia,each group was further assigned into 5 subgroups,6 h,12 h,24 h,48 h and 72 h group (n =8).The model of neonatal rat with hyperbilirubinemia was established injecting bilirubin solution (100 μg/g) intraperitoneally.GM1 (10 mg/kg) was injected intraperitoneally immediately after the model was established in GM1 group.Immunohistochemical method was used to determine the expression of Bax in hippocampus.TUNEL method was used to measure the neural cell apoptosis index (AI) in the brain.Result Six hours after the hyperbilirubinemia model was set up,the expression of Bax and AI in hyperbilirubinemia group and GM1 group were examined.The median of AI were 33.5％ and 15.4％ respectively and the average grey value of Bax positive cells were 157.4 ± 2.8 and 162.9 ± 2.3.Both apoptosis cells and the expression of Bax were gradually increasing,and peaked at 72 h after the model was established.The median of AI were 55.5％ and 35.5％ respectively,and the average grey value of Bax positive cells were 127.8 ± 3.6 and 141.5 ±2.7 in hyperbilirubinemia group and GM1 group.And the expressions of Bax and AI in the control group were nearly undetectable.The expression of Bax and AI in GM1 group were lower than hyperbilirubinemia group,but higher than the control group,the differences were statistically significant (P ＜ 0.001).Conclusion Brain cells apoptosis is influenced by hyperbilirubinemia-induced brain injury and Bax may be involved in the process.GM1 may reduce the brain damage by inhibiting the expression of Bax to reduce the apoptosis of the brain cells.

Objective To compare and analyze the epidemiological features of adult patients with scapular fracture between eastern and western areas in China from 2010 to 2011. Methods The data of adult patients with scapular fracture who had been treated from January 2010 to December 2011 in 63 hospitals in the eastern and western areas in China were collected through the PACS system and case reports checking system. The data from the eastern 35 hospitals were classified as group A and those from the 28 western hospitals as group B. The analytic items included gender, age and AO classification. Results A total of 2, 063 cases were collected. The median age was 44 years ( interquartile range, from 33 to 56 years ) and gender ratio 3. 50:1 in Group A of 1, 376 cases; the median age was 41 years ( interquartile range, from 31 to 51 years ) and gender ratio 3. 09:1 in Group B of 687 cases. There was a significant difference between the 2 groups in median age ( Z= -3. 798, P=0. 000 ) . There was no significant difference between the 2 groups in gender ratio or constituent ratio of fracture peak age ( P > 0. 05 ) . The proportions of patients from 16 to 20 and from 31 to 40 years old in group A were significantly lower than in group B ( P <0. 05 ) . The proportion of middle-aged patients was significantly higher and that of young patients significantly lower in group A than in group B. The proportion of AO type 14-A fractures in group A ( 66. 49％) was significantly higher than in group B ( 55. 60％) while the proportion of AO type 14-C fractures was significantly lower ( 21. 37％) in group A than in group B ( 29. 55％) . Conclusions Most scapular fractures occurred in male patients. The proportion of young patients in the eastern area was lower than in the western area, but the proportion of middle-aged patients was higher in the eastern area than in the western area. The proportion of AO type 14-A fractures in the eastern area was significantly higher than in the western area while the proportion of AO type 14-C fractures in the eastern area significantly lower than in the western area.

Objective To compare the outcomes of homeopathic bidirectional-traction reduction device and traction table in surgical treatment of femoral intertrochanteric fractures.Methods A retrospective case control study was made on 94 cases of femoral intertrochanteric fractures treated from July 2015 to December 2015.There were 26 males and 68 females,aged 60-75 years.According to the Evans classification,the fractures were type Ⅱ in 24 cases,type Ⅲ in 32 and type Ⅳ in 38.Fifty-seven cases sustained chronic diseases.According to the random number table,the subjects were assigned to receive homeopathic bidirectional-traction reduction (homeopathic reduction group,48 cases) and traction table reduction (control group,46 cases).All fractures were fixed with proximal femoral nail antirotation.Operation time,reduction time,tluoroscopy time,blood loss and rate of closed reduced cases were recorded.Fracture union and rotation of the affected femur to the tibia were detected after operation.Functional outcome was evaluated using the Harris score at the final follow-up.Results All fractures were reduced closely in homeopathic reduction group,while 15 fractures in control group were reduced via a small-incision anterior approach.Operation time,reduction time and fluoroscopy time in homeopathic reduction group were (62.9 ± 12.1) min,(6.8 ± 1.5) min and (11.3 ± 5.6) s respectively,significantly less than the corresponding data in control group (all P ＜ 0.05).One month after operation,rotation of the affected femur to the tibia was (2.8 ± 1.2) ° in homeopathic reduction group,significantly less than that in control group [(11.5 ± 4.7) °] (P ＜ 0.05).Bone union was observed in all cases.At the final follow-up,Harris hip score was (92.6 ± 7.6)points in homeopathic reduction group,significantly higher than that in control group [(87.3 ± 6.5) points] (P ＜ 0.05).Conclusion For the elderly patients with intertrochanteric fractures,homeopathic bidirectional-traction device has advantages of high rate of closed reduction,shorter operation time,less radiological exposure and satisfactory function recovery of the affected hip joint.

Policy background and stakeholder theory were elaborated.It could be concluded that the key stakeholders of the policy were residents,training hospitals,healthcare administrators,primary healthcare institutions and patients of such institutions.Through analysis of these stakeholders,effects on the interests of all parties were investigated and strategies to improve feasibility of the policy were put forward.Two key points were suggested for such policy goals.First,top-level policies should be designed and be effectively implemented.Second,conversion of the residents from permanent hospital employees to “contractors”or“ freelancers”.

Objective To analyze the feasibility of the policy that “Residents service or employment at primary care institutions after standardized training”.Methods Analyzing the feasibility of this policy by using questionnaire survey and in-depth interview.Results Constituent ratios of overall feasibility were 58.3％ (532/912)and 66.1％(603/912)for specialist and general practitioner respectively; percentage of feasibility of in-depth interview was 46.7％ (7/15).Conclusion The policy has feasibility,if government formulates and implements perfect complement policies effectively,and makes this policy to be impassable stage to resident.