Osteoporosis can be induced by various factors including prolonged glucocorticoid usage, diminished estrogen levels, secondary hyperparathyroidism, and alterations in the microenvironment of bone tissue. The bone metabolism imbalance(osteogenic-lipogenic imbalance) plays a crucial role in the development of osteoporosis. This imbalance is primarily driven by an increase in the differentiation of bone marrow mesenchymal stem cells into adipocytes and a decrease in their differentiation into osteoblasts, thus forming the core of the osteogenic-lipogenic imbalance observed in osteoporosis. The bone morphogenesis protein(BMP) plays a crucial role in the regulation of the osteogenic-lipid balance in osteoporosis. This regulatory function is accomplished through both the Smad-dependent and Smad-independent pathways. This review centers on the Smad-dependent and Smad-independent pathways facilitated by BMP, offering a comprehensive overview of the potential mechanisms through which BMP-2, 4, 6, 7, and 9 contribute to the regulation of osteogenesis and lipid metabolism in osteoporosis via these pathways. In order to present novel insights for the identification of efficacious targets for clinical anti-osteoporosis medications.

BACKGROUND:Muscle weakness is a common symptom after coronavirus disease 2019(COVID-19)infection and affects the ability to perform daily activities in humans during recovery.Low-frequency pulsed magnetic field stimulation at a strength of 1.5 mT and a frequency of 3 300 Hz can enhance the maximal voluntary contraction and strength endurance of human skeletal muscle by inducing and activating classical transient receptor potential channel 1(TRPC1),which produces a series of pathological support effects on muscle tissue.It has not been studied whether this means will improve muscle weakness in patients recovering from COVID-19. OBJECTIVE:To select the low-frequency pulsed magnetic field for magnetic stimulation of lower limb muscle groups in patients with COVID-19,in order to observe the effect of this stimulation on the improvement of muscle weakness of lower limb muscle groups in patients with COVID-19 during the recovery period. METHODS:Fourteen patients infected with COVID-19(Omicron strain)positive for Innovita COVID-19 Ab Test(Colloidal Gold)and accompanied by muscle weakness were recruited and randomly divided into two groups:a test group receiving magnetic field stimulation and a control group receiving sham treatment,respectively.The total duration of the trial was 3 weeks.The test group was given low-frequency pulsed magnetic stimulation of the lower limbs every 48 hours and the control group was given the same intervention procedure as the test group but with sham stimulation.Patients in both groups were not informed whether the magnetic stimulation apparatus was running or not.Nine sessions were performed in both groups and the changes in the maximum voluntary contraction,explosive leg force and strength endurance of the local muscle groups of the lower limbs were subsequently observed in both groups. RESULTS AND CONCLUSION:Among the eight local muscle groups collected,seven local muscle groups in the test group showed an increase in the maximum voluntary contraction value after 3 weeks of low-frequency pulsed magnetic field stimulation.In the control group,there were only three muscle groups with improvement in the maximum voluntary contraction.The rate of improvement in the anterior and posterior muscle groups of the left leg in the test group was significantly higher than that in the control group.The longitudinal jump height and peak angular velocity of the knee joint in both groups were improved compared with the pre-test measurement,and the elevation rate of jumping height in the test group was higher than that in the control group.Under the fatigue condition,the decline rates of peak angular velocity of the knee joint and jumping height in the test group decreased significantly,while those in the control group did not change significantly.The above data confirmed that the low-frequency pulsed magnetic field stimulation with the intensity of 1.5 mT and frequency of 3 300 Hz could improve the muscle strength of more local muscle groups in the lower limbs of patients with COVID-19 during the recovery period compared with the human self-healing process,and the whole-body coordination ability and functional status based on explosive leg force of the legs could be significantly improved.Therefore,low-frequency pulsed magnetic field stimulation can be used as an effective,non-exercise rehabilitation tool to improve muscle weakness in the lower limbs of patients with COVID-19.

Objective:To study the safety and efficacy of hiatal hernia-endoscopic submucosal dissection (HH-ESD) for the treatment of giant hiatal hernia (>3 cm in length) complicated with refractory gastroesophageal reflux disease (GERD).Methods:Patients with giant hiatal hernia complicated with refractory GERD who voluntarily received HH-ESD at the Digestive Endoscopy Center of the Affiliated People's Hospital of Inner Mongolia Medical University from April 2018 to March 2020 were included in the clinical study. The completion of HH-ESD and the occurrence of complications were observed, and the changes of indicators before and after the treatment were observed, including gastroesophageal reflux disease-health related quality of life (GERD-HRQL) score, gastroesophageal reflux disease questionnaire (GERD-Q) score, endoscopy results, 24 h esophageal pH monitoring results, esophageal high-resolution manometry results and proton pump inhibitor (PPI) usage.Results:Data of 10 patients were collected during the study, with a medical history of 2-10 years. All patients successfully underwent HH-ESD treatment. No adverse events such as perforation and massive bleeding occurred during the operation, and the hospital stay was 6-12 days. Dysphagia occurred in 3 cases after the operation, which was relieved spontaneously within 3 or 6 months. The preoperative GERD-HRQL scores ranged from 19 to 29, which were reduced to 0-14 and 0-8 at 3 and 12 months after the operation, respectively. The preoperative GERD-Q score was 9-17, and the scores at 3 and 12 months after the operation were all 6-9, which were significantly lower than those before. Gastroscopy showed that esophagitis was improved in all patients, hernia sac was reduced, and Hill grade was reduced compared with that before. The preoperative DeMeester score was 30.3-247.1, and the postoperative 12-month score was 0.2-29.9, which was significantly lower than that before. The long diameter of hiatal hernia was 3.0-6.0 cm before the operation and 0-5.0 cm at 12 months after, which was smaller than that before. At 12 months of the follow-up, 7 patients had stopped PPI, and the remaining 3 had changed to intermittent oral PPI.Conclusion:Preliminary results show that HH-ESD is safe and effective for the treatment of giant hiatal hernia complicated with refractory GERD.

Objective:To design and manufacture mind maps of outpatient pre-examination triage and provide references for the training of outpatient triage nurses.Methods:The mind maps team was set up, and the content of outpatient pre-examination triage was prepared preliminarily by searching literature and combining with clinical practice. The first draft of mind map of outpatient pre-examination triage was established by drawing software, and the final draft was determined after consultation and verification by experts.Results:The final mind maps of outpatient pre-examination triage are composed of three parts: head, neck and chest symptoms, abdominal symptoms and other symptoms. The mind maps of head, neck and chest symptoms and abdominal symptoms both include six modules, and the mind map of other symptoms includes five modules. Each module contains different disease symptoms and departments.Conclusions:This mind map is comprehensive and easily mastering. Meanwhile it can regulate outpatient pre-examination triage and give guidance of nurse training.

OBJECTIVE：To systematically evaluate efficacy and safety of Shengxuening tablets in the treatment of cancer-related anemia （CRA），and to provide evidence-based reference for clinical drug use. METHODS ：Retrieved from the Cochrane Library ，PubMed，Embase，CJFD，CSJD，Wanfang database and CBM ，RCTs about Shengxuening tablets alone or combined with routine therapy （trial group ）versus routine therapy or blank control （control group ）in the treatment of CRA were collected from inception to July 2019. After literature screening and data extraction ，quality evaluation of included literatures with system evaluation bias risk evaluation tool provided by Cochrane intervention measure system evaluation manual 3.0.2， Meta-analysis of the included literatures was carried out by using Rev Man 5.3 software. RESULTS ：A total of 9 RCTs involving 681 patients were included. Results of Meta-analysis showed that red blood cell count [MD ＝0.62，95％CI（0.30，0.93），P＝0.000 1]， hematocrit level [MD ＝6.12，95％CI（4.97，7.27），P＜0.000 01]，hemoglobin level [MD ＝7.47，95％CI（5.29，9.66），P＜0.000 01]， white blood cell count [MD ＝0.31，95％CI（0.12，0.50），P＝0.001]，platelet count [MD ＝3.06，95％CI（0.84，5.28），P＝0.007]， KPS score [MD ＝5.15，95％CI（2.79，7.51），P＜0.000 1]，quality of life score [MD ＝28.27，95％CI（19.27，37.28），P＜0.000 01] after treatment in trial group were significantly higher than control group ，while the incidence of ADR [RR ＝0.14，95％CI（0.03， 0.76），P＝0.02] in trial group was significantly lower than control group. CONCLUSIONS ：Shengxuening tablets have good efficacy and safety in the treatment of CRA.

Objective:To analyze the expression and clinical significance of human papillomavirus (HPV) 16/18E6 in lung adenocarcinoma tissues and adjacent specimens.Methods:Sixty patients with pathologically confirmed lung adenocarcinoma treated with surgical resection were included in the study. To determine the expression of HPV16/18 E6, carcinoma specimens and adjacent tissues were collected and detected using immunohistochemistry. The χ 2 test was used to analyze the relationship between HPV16/18 E6 expression and the clinical features of lung adenocarcinoma. Using the cell transfection technique, the A549 lung adenocarcinoma cell line with high HPV16/18E6 expression was established, and the differences in cisplatin resistance between the E6, control (Ctl), and A549 groups were compared using the MTT assay. Results:Of the 60 cases, 29 (48%) were male and 31 (52%) were female, with an average age of (55.5±2.4) years. In lung adenocarcinoma specimens, the positive expression rate of HPV16/18 E6 was 48% (29/60), which was higher than that observed in adjacent tissues (18%; 11/60), demonstrating a statistically significant difference (P<0.05 ); the differences between the positive expression rate of HPV16/18E6 and TNM stage, age, gender, smoking, and tumor size were not statistically significant. In the E6 A549 lung adenocarcinoma group, cisplatin resistance was higher than that in the Ctl and A549 groups, demonstrating a statistically significant difference (P<0.05 ). Finally, the half-maximal inhibitory concentration (IC 50) of cisplatin in E6 (111 mg/L)was higher than that in Ctl(75 mg/L) and A549(79 mg/L) groups, demonstrating a statistically significant difference (P<0.05 ).Conclusions:High-risk HPV16/18E6 has a higher positive expression rate in lung adenocarcinoma, independent of TNM stage, age, gender, smoking, and tumor size, and may influence resistance to chemotherapy drugs.

Objective: To evaluate the effect on communication and listening ability of newly graduated nurses while outpatient guidence training. Method: According to the ratio of 1:1, a total of 102 new nurses who were recruited from 2015 to 2016 and met the criteria were divided into observation group and the control group by envelope method. Nurses in the two groups were rotated into the guiding post and clinical department, and all nurses participated in the training for 12 months. Evaluated the communication and listening ability of the two groups nurses before and after the training. Results: After the training, the total scores of communication and listening ability of nurses were 93.36±9.00 and 78.66±7.26 respectively in observation group, 86.84±9.67, 71.38±8.48 respectively in control group, the differences between the two groups were significant(t=3.61, 4.60, all P=0.00). After the training, correlation analysis showed that communication ability of observation group nurses was correlated with age, only-child and nursing professional attitude in the general situation factors (r=0.20-0.24, P<0.05). Conclusions The rotational training of guidance post can significantly improve the communication and listening abilities of nurses, and it will be helpful to the future career path of these nurses. Through training, we can understand the main factors that affect the communication and listening ability of nurses by the two training methods, and provide useful reference for future training.

Objective To explore the clinical efficacy of radical resection with individualized surgical approach for borderline resectable pancreatic head carcinoma.Methods The retrospective descriptive study was conducted.The clinicopathological data of 54 patients with borderline resectable pancreatic head carcinoma who underwent radical resection with individualized surgical approach in the West China Hospital of Sichuan University from January 2015 to January 2018 were collected.There were 37 males and 17 females,aged from 37 to 73 years,with a median age of 59 years.For venous type borderline resectable pancreatic head carcinoma,surgery for pancreatic head carcinoma and (or) pancreatic head and neck carcinoma was performed via inferior mesenteric vein,and surgery for pancreatic uncinate process carcinoma was performed via inferior colon artery.For arterial type borderline resectable pancreatic head carcinoma,surgery for pancreatic head carcinoma and (or) pancreatic head and neck carcinoma was performed via medial uncinate artery,and surgery for pancreatic uncinate process carcinoma was performed via left posterior artery.Observation indicators:(1) surgical situations;(2) postoperative complications;(3) postoperative pathological examination;(4) follow-up.Patients were followed up by outpatient examination or telephone interview once every 3 months to detect survival up to March 2019.Measurement data with normal distribution were represented by Mean ± SD.Measurement data with skewed distribution were represented by M (range),and count data were represented by absolute numbers or percentage.Kaplan-meier method was used to draw the survival curve and calculate the survival rate.Results (1) Surgical situations:all the 54 patients underwent expanded pancreatoduodenectomy combined with superior mesenteric vein/portal vein (SMV/PV) resection,including 15 via inferior mesenteric vein,20 via inferior colon artery,12 via medial uncinate artery,and 7 via left posterior artery.The operation time was (320± 83)minutes,and the volume of intraoperative blood loss was (865±512) mL.(2) Postoperative complications:of 54 cases,28 had postoperative complications,including 13 with grade 1 Clavien-Dindo complications,12 with grade 2 ClavienDindo complications,3 with grade 3 or above Clavien-Dindo complications.One of the 28 patients with postoperative complications died and 27 were improved after symptomatic and supportive treatment.(3) Postoperative pathological examination:of 54 patients,31 had R0 resection and 23 had R1 resection.In the 23 patients with R1 resection,5 underwent surgery via the inferior mesenteric vein (4 with involvement of pancreatic anterior surface,1 with involvement of both pancreatic anterior and posterior surface),9 underwent surgery via the inferior colon artery (2 with involvement of both pancreatic anterior and posterior surface,2 with involvement of superior mesenteric artery margin,2 with involvement of pancreatic posterior surface,2 with involvement of pancreatic anterior surface,1 with involvement of superior mesenteric artery margin and pancreatic posterior surface),5 underwent surgery via the medial uncinate process artery (2 with involvement of superior mesenteric artery margin,2 with involvement of both pancreatic anterior and posterior surface,1 with involvement of pancreatic neck transected margin),and 4 underwent surgery via the left posterior artery (3 with involvement of superior mesenteric artery margin,1 with involvement of both pancreatic anterior and posterior surface).Of 54 patients,16 had no positive lymph nodes,26 had 1-3 positive lymph nodes,and 12 had 4 or more positive lymph nodes.The tumor diameter was (3.20±0.14)cm.There were 48 of 54 patients with nerve infiltration,41 with superior mesenteric vein and/or portal vein infiltration,and 11 with vascular thrombus.There were 17 of 54 patients with high differentiation and medium differentiation,and 37 with low differentiation and undifferentiation.(4) Follow-up:54 patients were followed up for 1-42 months,with a median time of 19 months.The 1-,3-year overall survival rate was 78.0％,11.4％.Condusion As for the borderline resectable pancreatic head cancer,individualized and customized surgical approach according to the location of tumor and the relationship with blood vessels is helpful to standardize the radical resection and avoid R2 resection.

Objective To systematically evaluate the effectiveness of different nursing interventions for female overactive bladder, and to provide evidence- based evidence for nursing intervention for overactive bladder in women. Methods PubMed, Cochrane Library, Embase, ScienceDirect and CNKI,Wanfang database and CBM comprehensively by computer and included in the literature of nursing intervention for female overactive bladder patients. Results Four randomized controlled trials were included, a total of 426 participants were in, the intervention group was 214 participants, control group was 212 participants, the results of the study showed that pelvic floor muscle training,health education,psychological nursing intervention can improve patients with overactive bladder symptoms and enhance the quality of life. Conclusion Nursing intervention for women with overactive bladder is an effective way to control symptoms such as frequent micturition and urgency,improve bladder overactivity symptoms and enhance quality of life.

Objective:To explore the clinical features of recurrence after choledocholithotomy and to analyze the risk factors.Methods:The clinical data of 730 patients with choledocholithiasis who were treated in our hospital from January 2005 to July 2016 were analyzed retrospectively,550 cases who were received choledocholithotomy were defined as laparotomy group,30 cases with laparoscopic common bile duct exploration (LCBDE) were defined as the LCBDE group,and 150 cases with endoscopic sphincterotomy (EST) were defined as EST group.The recurrence rate of the three groups were compared.The patients of three groups were divided into recurrence group (n=227) and non recurrence group (n=503) according to the recurrent situation,then the clinical features and risk factors of recurrent patients were analyzed by univariate and multivariate Logistic regression analysis.Results:The recurrence rate of EST group was 38.67％,which was significantly higher than that of LCBDE group with 26.67％ and the laparotomy group with 29.27％,and there was statistical difference (P＜0.05).The results of univariate analysis showed that there were statistically significant differences in age,history of HBV infection,jaundice,abnormal total bilirubin,peripapillary diverticulum,biliary infection,biliary stricture,papillary stenosis,sphincter of Oddis dysfunction,history of biliary surgery,cholecystectomy,bile duct diameter ≥ 15 mm,bile duct angle ≤120°,operation type,stone quantity ≥ 2 grains,stone diameter ≥ 10 mm,with or without gallstones (P＜0.05).The results of Logistic multivariate regression analysis showed that age,having peripapillary diverticulum,having history of biliary surgery,bile duct diameter ≥ 15 mm,stone quantity ≥ 2grains and EST operation type were the independent risk factors of the recurrence after choledocholithotomy (P＜0.05).Conclusion:There are many risk factors of recurrence after choledocholithotomy,and operation method should be based on the size and the number of the stones,and the constitution of patients.Preventive measures should be strengthened to control the recurrence after choledocholithotomy.