BACKGROUND:Osteoporotic fracture is the most serious complication of osteoporosis.Previous studies have demonstrated that gut microbiota has a regulatory effect on skeletal tissue and that gut microbiota has an important relationship with osteoporotic fracture,but the causal relationship between the two is unclear. OBJECTIVE:To explore the causal relationship between gut microbiota and osteoporotic fractures using Mendelian randomization method. METHODS:The genome-wide association study(GWAS)datasets of gut microbiota and osteoporotic fracture were obtained from the IEU Open GWAS database and the Finnish database R9,respectively.Using gut microbiota as the exposure factor and osteoporotic fracture as the outcome variable,Mendelian randomization analyses with random-effects inverse variance weighted,MR-Egger regression,weighted median,simple model,and weighted model methods were performed to assess whether there is a causal relationship between gut microbiota and osteoporotic fracture.Sensitivity analyses were performed to test the reliability and robustness of the results.Reverse Mendelian randomization analyses were performed to further validate the causal relationship identified in the forward Mendelian randomization analyses. RESULTS AND CONCLUSION:The results of this Mendelian randomization analysis indicated a causal relationship between gut microbiota and osteoporotic fracture.Elevated abundance of Actinomycetales[odds ratio(OR)=1.562,95%confidence interval(CI):1.027-2.375,P=0.037),Actinomycetaceae(OR=1.561,95%CI:1.027-2.374,P=0.037),Actinomyces(OR=1.544,95%CI:1.130-2.110,P=0.006),Butyricicoccus(OR=1.781,95%CI:1.194-2.657,P=0.005),Coprococcus 2(OR=1.550,95%CI:1.068-2.251,P=0.021),Family ⅩⅢ UCG-001(OR=1.473,95%CI:1.001-2.168,P=0.049),Methanobrevibacter(OR=1.274,95%CI:1.001-1.621,P=0.049),and Roseburia(OR=1.429,95%CI:1.015-2.013,P=0.041)would increase the risk of osteoporotic fractures in patients.Elevated abundance of Bacteroidia(OR=0.660,95%CI:0.455-0.959,P=0.029),Bacteroidales(OR=0.660,95%CI:0.455-0.959,P=0.029),Christensenellacea(OR=0.725,95%CI:0.529-0.995,P=0.047),Ruminococcaceae(OR=0.643,95%CI:0.443-0.933,P=0.020),Enterorhabdus(OR=0.558,95%CI:0.395-0.788,P=0.001),Eubacterium rectale group(OR=0.631,95%CI:0.435-0.916,P=0.016),Lachnospiraceae UCG008(OR=0.738,95%CI:0.546-0.998,P=0.048),and Ruminiclostridium 9(OR=0.492,95%CI:0.324-0.746,P=0.001)would reduce the risk of osteoporotic fractures in patients.We identified 16 gut microbiota associated with osteoporotic fracture by the Mendelian randomization method.That is,using gut microbiota as the exposure factor and osteoporotic fracture as the outcome variable,eight gut microbiota showed positive causal associations with osteoporotic fracture and another eight gut microbiota showed negative causal associations with osteoporotic fracture.The results of this study not only identify new biomarkers for the early prediction of osteoporotic fracture and potential therapeutic targets in clinical practice,but also provide an experimental basis and theoretical basis for the study of improving the occurrence and prognosis of osteoporotic fracture through gut microbiota in bone tissue engineering.

Objective: To explore the early diagnosis, therapeutic methods and efficacy for blunt cardiac injury (BCI). Methods: All BCI patients from September 2003 to August 2018 were studied retrospectively in respect of sex, age, cause of injury, diagnostic methods, therapeutic procedures, and outcome. The patients were divided into two groups: nonoperative group (n=305) and operative group (n=43). The two groups were compared and analyzed. Results: Totally 348 BCI patients accounted for 18.3% of 1 903 patients with blunt thoracic injury (BTI), and the mortality rate was 10.1%. The main cause of injury was traffic accident with an incidence of 48.3%. The diagnostic methods included electrocardiogram (ECG), enzymes and troponin I, echocardiography, and CT scanning, or confirmed by emergency thoracatomy. In the nonoperative group, patients were mainly myocardial contusion, with a mortality rate of 6.9%. In the operative group, patients were mainly cardiac rupture and pericardial hernia, and the mortality was 32.6%. The incidence of negative ECG between the two groups was not significantly different (16.7% vs 11.6%, P>0.05). The incidence of shock and mortality in the operative group were significantly higher than those in the the nonoperative group (P<0.01). The number of death directly resulted from BCI in the operative group was greater than that in the nonoperative group (P<0.05). Conclusions For BTI patients, BCI must be highly suspected, and necessary examinations should be given. To manage myocardial contusion without surgery, it is necessary to protect the heart, alleviate edema of myocardium, and control arrhythmia with drugs. To deal with those patients requiring operation, early recognition and expeditious thoracotomy are essential.

Objective: To explore early diagnosis, surgical intervention and efficacy for blunt cardiac injury. Methods: 43 patients with blunt cardiac injury treated operatively were studied retrospectively in respect of sex, age, cause of injury, preoperative diagnosis, operative time from injury, surgical procedures, and therapeutic efficacy. The study lasted for 15 years between September 2003 and August 2018. The main cause of injury is road traffic accident with a rate of 48.8%(21/43); and steering wheel injury accounted for 71.4%(15/21). Preoperative diagnosis was based on computer scaning, echocardiography in 26 cases. In remaining 17, initial judgement of cardiac wound was done because of obvious cardiac tamponade, or massive hemothorax with shock; and was proved during emergent thoracotomy. Surgical intervention was started within one hour in cases of 27.9%(12/43). Main procedures included pericardial decompression, clear off hemopericardium, and cardiorrhaphy in 36 cases; relief of pericardial herniation with strangulation of the heart in 3 cases, and repair of diaphragmatic hernia involving pericardium in 4 cases. Of all 43 cases, 7 cases underwent Emergent Department Thoracotomy(EDT) with a resuscitative rate of 42.9%(3/7). Results: Overall mortality rate was 32.6%(14/43); 4 cases died at EDT, 5 cases intraoperatively, and 5 cases postoperatively. The cause of deaths was directly related to BCI in 9 cases(associated with transected aorta in 1 case); and associated injuries in 5 cases including liver trauma(3 cases), brain trauma(1 case), and cervical spinal trauma(1 case). In 4 of 29 survivors, intracardiac injury was proved by echocardiography postoperatively, including mitral valve in 2 cases, tricuspid in 1 case, and ventricular septum in 1 case. Of these 4 cases 2 received valvuloplasty 2 weeks and 3 months after initial operation respectively; and other 2 restored spontaneously which were ensured by echocardiography. Postoperative complications included atelectasis in 3 and infectious endocarditis in 1 respectively. They were cured . All survivors were followed up from 6 to 36 months, with a normal cardiac function and healthy condition. Conclusion Early diagnosis and emergent thoracotomy in time are essential to improve survival rate. Preoperative massive transfusion and pericardiocentesis are not advocated. If it is necessary, EDT should be exercised decidedly.

Objective: To investigate the effect of transurethral resection of bladder tumor (TURBt) combined with gemcitabine intravesical instillation in the treatment of superficial bladder cancer. Methods: From May 2011 to January 2016, 112 patients with superficial bladder cancer were treated in the Seventh Hospital of Ningbo.According to the digital table, the patients were randomly divided into two groups: A group was treated by TURBt, and B group was treated by TURBt combined with gemcitabine.The postoperative complications, postoperative recurrence and quality of life were compared between the two groups. Results: The operation time, indwelling catheter time and hospitalization time between the two groups had no statistically significant differences (all P>0.05). The postoperative complications of the two groups were frequent urination, dysuria and hematuria.The incidence rate of complications of A group was 39.29%, which was significantly higher than that of B group (χ²=36.597, P<0.05). The recurrence rate of B group was significantly better than that of A group (χ²=8.617, P<0.05). After treatment, the quality of life of the two groups was significantly improved compared with that before treatment, and compared with that of A group, the psychology, physiology, independence, social environment, quality of life scores of B group increased more significantly (t=29.217, 25.446, 19.517, 24.339, 36.001, all P<0.05). Conclusion Transurethral resection of bladder tumor combined with gemcitabine intravesical instillation in the treatment of superficial bladder cancer can ensure the treatment effect, at the same time, it can effectively reduce the postoperative complications and the emergence of various risk, reduce postoperative recurrence and improve the quality of life of patients, it has great significance and is worthy of promotion.

OBJECTIVE:To provide reference for storage management of injection drugs protected from light in inpatient phar-macy of hospital. METHODS:From Jan. to Mar. 2016,the storage items of injection drugs protected from light in inpatient phar-macy of our hospital and the current storage situation were surveyed,the quality management tool PDCA circulation was adopted to improve storage situation and evaluate the effect of PDCA. RESULTS:For improper storage of injection drugs protected from light caused by employees lacking knowledge in photophobic knowledge,unfamiliar to the list of injection drugs protected from light, no packaging in returned drugs,after developing and carrying out corresponding countermeasures,including reinforcing staff train-ing,studying characteristics of the new-coming drug timely,renewal photophobic knowledge and the list of injection drugs protect-ed from light,and ameliorating working procedure,the light storage pass rate was increased from 96.5% to 100% in 310 injection drugs protected from light in inpatient pharmacy. CONCLUSIONS:Appling PDCA can effectively improve the storage management of injection drugs protected from light and provide reliable protection for the drugs'safe and effective application.

This study was aimed to make clear the origin and clinical applications of the Tibetan medicine "Bangga".Based on the systematical consultation of the Tibetan medical literature documents and the Chinese version,such as The King's Medicine,The Four Medical Tantras,Jing Zhu Materia Medica,the herbal textual research was made on the name,based source,origin and harvesting season,function,indication and etc.of Tibetan medicine "Bangga".The results showed that Tibetan medicine "Bangga" comes from the whole dried plant of Aconitum naviculare Stapf or A.tanguticum (Maxim) Stapf of Ranunculaceae plants.It was concluded that the research on the origin of Tibetan medicine "Bangga" can provide a basis for the application and promotion of quality standards of "Bangga".

AIM:To investigate the potential effect of all-trans retinoic acid (ATRA) on the proliferation of human breast cancer MCF-7 cells and its underlying mechanism.METHODS:Human breast cancer MCF-7 cells were in-cubated in DMEM supplemented with 10%fetal bovine serum and 1%penicillin/streptomycin.Western blot was performed to detect the protein expression and its phosphorylation.MTT assay and bromodeoxyuridine ( BrdU) incorporation, and TUNEL staining were carried out to determine the cell proliferation and apoptosis, respectively.Lentivirus carrying shRNA sequences targeting the gene of docking protein 1 ( DOK1 ) was used to silence DOK1 expression.The activity of peroxi-some proliferator-activated receptor gamma ( PPARγ) was measured using a PPARγtranscription factor assay kit.RE-SULTS:ATRA treatment suppressed the proliferation and promoted the apoptosis of MCF-7 cells.ATRA was also found to induce DOK1 expression in a time-dependent manner.Silence of DOK1 mitigated anti-cancer effect of ATRA evidenced by recovered the cell proliferation and reduced the cell apoptosis.In addition, DOK1 knockdown inhibited PPARγexpression and activity.Furthermore, inhibition of PPARγwith its specific inhibitor GW9662 attenuated impacts of ATRA on the cell proliferation and apoptosis.CONCLUSION: ATRA suppresses MCF-7 cell survival through inhibiting cell proliferation and promoting cell apoptosis, which is mediated by DOK1-activated PPARγ.

AIM: To investigate the role of ubiquitin-proteasome system ( UPS) in adipocyte differentiation. METHODS:Differentiation of 3T3-L1 preadipocytes into adipocytes was induced by treatment with insulin, 3-isobutyl-1-methylxanthine and dexamethasone.Western blot and immunoprecipitation were performed to detect the protein abundances and association, respectively.Oil red O staining was used to determine the intracellular lipid of 3T3-L1 adipocytes.The levels of mRNA were measured by reverse transcription polymerase chain reaction ( RT-PCR) .RESULTS:UPS inhibitor bortezomib (BZM) suppressed the differentiation of 3T3-L1 pre-adipocytes, evidenced by reduced intracellular content of triglyceride, and decreased mRNA expression of adipogenic marker proteins such as adiponectin and adipocyte protein 2.In contrast, administration of sildenafil (SDN), an activator of protein kinase G which was also found to activate UPS, promo-ted adipocyte differentiation.In addition, BZM treatment decreased the expression of heat shock protein 90 (HSP90) and peroxisome proliferator-activated receptor gamma ( PPARγ) in the soluble fraction and reduced association of HSP90 and PPARγ.Furthermore, HSP90-specific N-terminal inhibitor geldanamic mitigated SDN-induced increase in PPARγlevel and 3T3-L1 cell differentiation.CONCLUSION:UPS modulates HSP90-dependent PPARγstability, thus leading to pro-motion of adipocyte differentiation.

The resource of rare and endangered medicinal plant Swertia mussotii Franch. in Tibet, Qinghai and Sichuan province were surveyed by ways of documents, interview, quadrat and market investigation. The results indi-cated that Swertia mussotii Franch. mainly distributed in Zuogong and Mangkang of Tibet, Yushu of Qinghai province, Shiqu, Daofu, Kangding, Maerkang, Jinchuan and Xiaojin of Sichuan province. According to the height above sea level, the distribution altitude was from 2 300 m (Kangding of Sichuan province) to 3 900 m (Mangkang of Tibet). There are distributions of Swertia mussotii Franch. within the scope of 2 600 m. The illumination, water, soil, temperature and altitude had significant influence on the distribution, growth and reserve of Swertia mussotii Franch. from different angles. In recent years, there was huge increase of market requirement in Swertia mussotii Franch. which were used in Tibetan medicine Zangyinc he n. Excess collection was the primary cause of rapid decreasing in resource of Swertia mussotii Franch.. It was suggested to strengthen the management of rational collection, as well as to accelerate the development of cultivation and production.

Background and purpose:It was reported that nuclear factor of activated T cells (NFAT) is closely related with carcinomas. Esophageal squamous cell carcinoma (ESCC) is one of the most common carcinomas in China. The present study investigated the expression and clinical significance of NFAT isoforms in ESCC. Methods:The expression of NFAT isoforms and the differences in different pathological levels of ESCC were detected in 104 specimens of human ESCC tissues and normal esophageal tissues by immunohistochemistry. Results:This study found that the positive rates of NFAT1 (53.8%), NFAT2 (10.6%), NFAT3 (26.9%), NFAT4 (45.2%) expression were significantly higher in tumor tissues than in adjacent normal esophageal tissues (P<0.001), respectively. The positive rate of NFAT1 expression was significant-ly higher in drinkers (62.3%) than nondrinkers (37.1%, P=0.01), and also higher in patients with lymph node metastasis (68.4% vs 5.5%, P=0.002) and with late stage (58.7% vs 36.2%, P=0.02). Multivariate analysis showed that NFAT1 expression was correlated with lymph node metastasis. The positive rate of NFAT3 was significantly higher in patients with lymph node metastasis (39.4%) than in those without lymph node metastasis (19.7%, P=0.03). Conclusion:These results suggest that the overexpression of NFAT1 and NFAT3 is associated with lymph node metastasis in ESCC.