Objective To analyze the correlation between bone mineral density(BMD)and muscle mass and physical function level in middle-aged and elderly women,and to provide certain reference for the prevention and treatment of osteosarcopenia.Methods The clinical data of 111 female patients aged ≥45 years old who received the Affiliated Hospital of Nanjing University of Chinese Medicine from October 2021 to June 2023 were selected.Dual-energy X-ray absorptiometry(DXA)was used to detect the BMD of lumbar and appendicular muscle mass(ASM),appendicular skeletal muscle mass index(ASMI)was calculated as the index of muscle mass.The physical function level was measured by the timed up and go test(TUG).The groups were grouped according to age and BMD,and the differences in age,body mass index(BMI),ASMI,TUG and BMD among all groups were compared.The detection rate of low muscle mass in BMD groups was also compared.Pearson method was used to analyze the correlation between each index and BMD.Results BMD decreased with increasing age(P＜0.001),and the TUG increased with increasing age(P＜0.001).ASMI showed that 45-55 years old group was higher than over 66 years old group,and the difference was statistically significant(P＜0.05).There were no signifi-cant differences in BMI and ASMI among the different age groups(P＞0.05).The age and TUG of BMD groups increased with the de-crease of BMD,and the differences were statistically significant(P＜0.001),while ASMI(P＜0.001)decreased with the decrease of BMD.The BMI of normal bone mass group was higher than that of osteoporosis group,and the difference was statistically significant(P＜0.05).There was no significant difference in BMI among the different BMD groups(P＞0.05).Among the 111 patients,49.6％had osteoporosis,and 72.1％had low muscle mass.The detection rates of low muscle mass in different BMD groups were 85.5％,64.3％and 53.6％,respectively,and the difference was statistically significant(P＜0.05).BMD was negatively correlated with age(r=-0.328,P=0.002),TUG(r=-0.262,P=0.017),and positively correlated with BMI(r=0.224,P=0.042),ASMI(r=0.291,P=0.008).Conclusion Muscle mass and physical functional level are important factors affecting BMD in middle-aged and elderly women.Early intervention of muscle mass and improvement of physical functional level can delay bone loss and improve bone me-tabolism in middle-aged and elderly women.

Objective:To systematically review the effect of fracture liaison service (FLS) in elderly patients with fragile hip fractures, so as to provide reference for clinical decision-making.Methods:By combining subject terms and free terms, electronic searches were conducted on China National Knowledge Infrastructure, WanFang Data, VIP, China Biomedical Literature Database, PubMed, Embase, Cochrane Library and Web of Science. The included references were manually retrieved using the snowball method. The retrieval time was from the establishment of the database to March 1, 2023. Two researchers screened articles based on inclusion and exclusion criteria, extracted data, and evaluated the quality of articles, using RevMan5.4 software for statistical analysis.Results:A total of 15 articles were included, totaling 4 333 patients with fragile hip fractures, with a follow-up time of ≥3 months. Meta-analysis showed that FLS could improve patient medication compliance [ RR=2.32, 95% CI (1.74, 3.11) , P<0.01] and hip function [ SMD=1.20, 95% CI (0.93, 1.47) , P<0.01] , reduce mortality [ RR=0.70, 95% CI (0.58, 0.84) , P<0.01] and the occurrence of refractures [ RR=0.44, 95% CI (0.32, 0.61) , P<0.01] , with statistical differences. Conclusions:Compared with routine nursing for fragile hip fractures, FLS can improve medication compliance and hip function, decrease mortality and the occurrence of refractures in patients with fragile hip fractures.

Objective:To observe the curative effect and temperature safety management of ginger mud moxibustion of different thickness on ankylosing spondylitis patients with kidney yang deficiency type, and to explore the best curative effect combination and safety combination of ginger mud thickness in Du Meridian moxibustion.Methods:From March 2020 to March 2021, 90 patients with ankylosing spondylitis of kidney yang deficiency type who were treated with Du moxibustion in the Affiliated Hospital of Nanjing University of Chinese Medicine were selected. According to the thickness of ginger paste, they were randomly divided into 2 cm-thick ginger mud thickness group, 3 cm-thick ginger mud thickness group and 4 cm-thick ginger mud thickness group when the diameter and height of moxa wool were the same as 2 cm, 30 cases in each group. They were treated with Fu Yang Du moxibustion once a week for 60 minutes each time. Visual Analogue Scale (VAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), traditional Chinese medicine syndrome score were used to evaluate the curative effect of spinal function before and after the intervention for 6 weeks. The time when moxibustion temperature reached 43 ℃ and moxibustion temperature maintained at 43-45 ℃ were analyzed for safety evaluation.Results:After moxibustion, VAS scores of 2 cm-thick ginger mud thickness group, 3 cm-thick ginger mud thickness group and 4 cm-thick ginger mud thickness group were 2.89 ± 0.96, 2.01 ± 0.69, 2.93 ± 1.23, BASDAI scores were 3.51 ± 0.94, 2.69 ± 0.68, 3.13 ± 0.96 and BASFI scores were 1.71 ± 0.99, 0.99 ± 0.36, 1.61 ± 0.50, the traditional Chinese medicine syndrome scores were 15.97 ± 4.61, 12.08 ± 3.21, 13.79 ± 3.58. The scores of the three groups were statistically significant ( F values were 6.51-19.22, all P<0.05) . After the intervention, there were significant differences in the scores between 2 cm-thick ginger mud thickness group and 3 cm-thick ginger mud thickness group, 2 cm-thick ginger mud thickness group and 4 cm-thick ginger mud thickness group, 3 cm-thick ginger mud thickness group and 4 cm-thick ginger mud thickness group ( t values were -6.61-4.56, all P<0.05). Conclusions:Du moxibustion is an effective method to treat ankylosing spondylitis of kidney yang deficiency type. The best curative effect and safety combination is moxa velvet diameter height 2 cm, ginger mud thickness 3 cm.

Bacillus spp. are probiotics and can secrete a variety of natural antimicrobiol active substances, of which lipopeptides are an important class. Up to now, about 90 lipopeptides have been identified, and most of them are cyclic lipopeptides. surfactin, iturin, fengycin, bacillomycin and polymyxins are widely studied, and the first three have huge potential for application due to their properties of surfactants and anti-fungal, anti-bacterial, anti-viral, anti-tumor and anti-inflammatory functions. In this paper, the research progress in the structure, function, synthesis regulation, separation, purification and production of surfactin, iturin and fengycin was reviewed. Synthetic biology is a vital means to increase the yield of lipopeptides, and in the future, lipopeptides can be used in crop cultivation, animal farming, food, medicine and petroleum industries as well as environmental protection. Future research should be strengthened on the discovery of new lipopeptides, synthesis of high-activity lipopeptides, economical production of lipopeptides on a large scale and their safety evaluation.
Anti-Bacterial Agents ; Anti-Infective Agents/pharmacology* ; Bacillus ; Bacillus subtilis ; Lipopeptides/pharmacology* ; Peptides, Cyclic/pharmacology*

Objective:To investigate the effect of lentivirus-mediated silencing of mitochondrial ribosomal protein L35 (MRPL35) gene on the growth of human esophageal cancer TE-1cells, and to clarify its mechanism.Methods:Three kinds of human esophageal cancer cells, TE-1, ECA109and KYSE150, were selected.The relative expression levels of MRPL35mRNA in three kinds of cells by real-time quantitative PCR.The esophageal cancer TE-1cells were divided into shMRPL35group and shCtrl group, and the cells were infected with si-RNA lentivirus and si-RNA lentivirus;the esophageal cancer cell line stably silenting the MRPL35gene was established.Real-time quantitative PCR and Western blotting methods were used to detect the efficiency of MRPL35gene silencing.The cell growth curves in various groups were detected by CCK-8method, and the apoptotic rates were detected by flow cytometry after AnnexinⅤ-PE/7AAD double staining.Results:Three kinds of esophageal cancer cells expressed MRPL35gene, and the expression levels were not statistically significant between them (P＞0.05) .The results of real-time quantitative PCR and Western blotting methods showed that the mRNA and protein levels of MRPL35in the TE-1cells in shMRPL35group were significantly lower than those in shCtrl group (P＜0.05) .Compared with shCtrl group, the cell growth speed in shMRPL35group was decreased (P＜0.05) , and the apoptotic rate was significantly increased (P＜0.01) .Conclusion:Silencing MRPL35gene can inhibit the proliferation of esophageal cancer TE-1cells and plays a role through the apoptotic pathway.

Objective To investigate the effects of bone marrow(BM)-sparing pelvic intensity-modulated radiotherapy(IMRT)after surgery for cervical cancer on radiation dose to the target volume,organs at risk(OAR),and hematologic toxicity. Methods Ten patients with cervical cancer who would receive postoperative radiotherapy were selected.BM-sparing pelvic IMRT and conventional IMRT were performed for the same image by the Varian planning system. The radiation dose to the pelvis,the dose distribution of the target volume,and the radiation dose to OAR were compared between the two plans. A total of 30 patients with cervical cancer who had received postoperative radiotherapy were selected to investigate the relationships of the radiation dose to the pelvis with the lengths of the pelvis in coronal axis,sagittal axis,and vertical axis and the pelvic volume. A total of 41 patients with cervical cancer who would receive postoperative radiotherapy were randomly divided into observation group and control group. The observation group was given BM-sparing IMRT,while the control group was given conventional IMRT.The incidence of grade ≥2 hematologic toxicity was compared between the two groups and the relationship between the hematologic toxicity and the radiation dose to the pelvis was investigated. Results Both groups showed excellent dose coverage to the clinical target volume. There was no significant difference in radiation dose to the OAR between the two groups(all P>0.05).However,the observation group had significantly lower D mean,V 10,V 20,V 40,and V 50of the pelvis than the control group(P=0.003-0.045).The Pearson correlation analysis showed that D mean,V 20,V 30,V 40,and V 50of the pelvis were negatively correlated with the length of the pelvis in coronal axis(P=0.008-0.038).The observation group had a significantly lower incidence of hematologic toxicity than the control group(P=0.019).The logistic regression analysis showed that the development of hematologic toxicity was significantly associated with V 20of the pelvis (OR=1.191,P=0.042). Conclusions BM-sparing IMRT after surgery for cervical cancer can reduce the radiation dose to the pelvis and the incidence of blood toxicity. The radiation dose to the pelvis is negatively correlated with the length of the pelvis in coronal axis. The development of hematologic toxicity is associated with V 20of the pelvis.

Objective To investigate the risk of death between older and non-older critical patients in intensive care unit (ICU) in Shuyang People's Hospital.Methods A retrospective cohort study was conducted. The critical patients who aged 15 or above, and admitted to ICU of Shuyang People's Hospital from January 2014 to December 2016 were enrolled, and all the data was collected from theregistration and electronic medical records in the ICU. The prevalence and causes of death in ICU critical patients during the study period were observed. The patients were divided into elderly group (65 years and older) and non-elderly group (15-65 years), and logistic regression analysis was performed for the risk of death in the two groups.Results During the study period, 2707 critical patients in emergency were admitted to the ICU of Shuyang People's Hospital, and patients not satisfied the inclusion criteria were excluded. Finally, a total of 2466 patients were enrolled in the analysis with the male and female ratio of 1.6 : 1, an average age of (61.8±17.3) years, a median Glasgow coma scale (GCS) score of 6 (4, 8), and with a median ICU stay of 3 (1, 6) days. In 2466 critical patients, the most common cause of critical state was spontaneous intracerebral hemorrhage (25.5%) and traumatic brain injury (17.0%), with a fatality rate of 46.0% and 39.5% within first 7 days respectively. Compared with the non-elderly patients (n = 1415), the incidences of death of the elderly patients (n = 1051) due to traumatic brain injury, cerebral infarction, heart failure/cardiovascularcrisis, and respiratory critically ill were significantly increased (9.4% vs. 4.7%, 2.9% vs. 0.8%, 5.0% vs. 2.1%, 2.5% vs. 1.0%, respectively), while the incidence of death for pesticide/drug poisoning in the elderly group was significantly lower than that in the non-elderly group (0.2% vs. 1.2%, allP < 0.01). Stepwise logistic regression analysis showed that traumatic brain injury [hazard ratio (HR) = 1.878, 95% confidence interval (95%CI) = 1.233-2.864,P = 0.003), cerebral infarction (HR = 0.435, 95%CI = 0.229-0.826, P = 0.011), heart failure/cardiovascular crisis (HR = 0.399, 95%CI = 0.238-0.668,P = 0.000), and respiratory critically ill (HR = 0.239, 95%CI = 0.126-0.453,P= 0.000) in the older patients were significantly high risk factors of death as compared with those in non-older patients.Conclusions In the general ICU, the most common cause is spontaneous intracerebral hemorrhage and traumatic brain injury in critical patients with a high fatality rate. The risk of death in elderly patients with severe traumatic brain injury, cerebral infarction, heart failure/cardiovascular crisis, respiratory critically ill is higher than that of the non-elderly patients.

Objective To improve the understanding of pulmonary mucormycosis by analyzing the clinical manifestations,imaging features,diagnosis,treatment and prognosis of this disease.Methods The clinical data of eight patients diagnosed as pulmonary mucormycosis by histopathologic examination were retrospectively analyzed.Results Eight patients included six males and two females with age from 36 days to 66 years.Underlying conditions covered diabetes (n =4),renal transplantation (n =3),premature (n =1) and long-term corticosteroid treatment in two cases.Imaging manifestations revealed multiple irregular lumps or nodules in three cases,multiple cavities with thick wall in three cases,diffuse lung infiltrate in one case and lung opacities in one case.The diagnoses of seven patients were confirmed by percutaneous needle lung biopsy and the remaining one was diagnosed with fiberoptic bronchoscopy biopsy.Surgery combined with amphotericin B liposome(60 mg/d for three weeks)was applied to one patient who was cured with no recurrence after a 22 month follow-up.Three cases were given amphotericin B liposome (a newborn with 7mg/d for 62 days,the other two 60 mg/d for 31 days and 70 mg/d for 71 days respectively).All had achieved marked response with follow up from 8 to 29 months,but one patient relapsed and died of recurrent lung mucormycosis.The other three patients were treated with itraconazole 400-200 mg/d from 21 days to 1 year with duration of follow up from 1 month to 20 months.One patient was not evaluable due to missing.Two patients relapsed and one died.Conclusion Pulmonary mucormycosis is difficult to diagnose and treat with a high mortality.Percutaneous tranthoracic lung biopsy is a useful diagnostic method.Amphotericin B liposome or itraconazole may be active against mucus.Early control of causes is essential to improve the prognosis and reduce the recurrence in patients with pulmonary mucormycosis.

Objective To investigate the clinical value of transumbilical endoscopic thoracic sympathectomy on women patients with palmar hyperhidrosis.Methods A total of 25 consecutive women patients with palmar hyperhidrosis underwent transumblical thoracic sympathectomy with ultra-thin endoscope.The operative data,including duration of operation,intra-operative and postoperative complications were recorded.Results The procedure was performed successfully in all 25 patients with a mean operative time of 64 min(58-113 min).No umbilical hernia,diaphragmatic hernia,Horner's syndrome or hemothorax were observed.Minor pneumothorax was found in postoperative chest X-ray in 3 patients,all of which were completely resolved with conservative treatment.All patients recovered to their normal life at 1 week after discharge.The scar was small and hidden in umbilical with no visible incisions.After a follow-up of 4 to 12 months,all patients' hands sweating symptoms completely disappeared,axillary sweat symptoms completely resolved in 6 patients,significantly improved in 4 and mildly improved in 1.Conclusion Transumbilical thoracic sympathectomy with ultrathin flexible endoscope is a safe and effective option for women patients with severe palmar hyperhidrosis,which provides excellent cosmetic outcomes.

Objective To compare the clinical efficacy of seretide (50 μg/500 μg salmeterol/fluticasone propionate) with seretide (50 μg/250 μg salmeterol/fluticasone propionate) in single inhaler in the treatment of patients with stable status moderate to severe chronic obstructive pulmonary disease (COPD)Methods Sixty patients with COPD were randomly divided into the treatment and the control groups.Baseline treatments were similar in all patients,patients in the treatment group received seretide (50 μg/500 μg) while the control group received seretide (50 μg/250 μg) inhalation once every 12 hours for 24 weeks Before and after the therapeutic course,tests for lung function in patients of the two groups were conducted and compared with each other.Clinical symptoms and physical signs were graded by questionnaire.Results There was no significant difference on indexes of lung function between the two groups at baseline (P ＞ 0.05).After treatment,the score of clinical symptoms and signs in the treatment group was lower than that in the control group ((4.0 ± 0.5) vs.(4.8 ± 0.3),t =2.63,P ＜ 0.05).Six minutes walking distance was longer in the treatment group than that in the control group ((451.6±22.9) meter vs.(401.2 ±25.4) meter,t =2.51,P ＜0.05).The levels of forced exhaled gas volume 1 (FEV1),FEV1/forced vital capacity (FVC) and FEV1/pred in the treatment group were higher than those in the control group ([FEV1:(2.18 ± 0.38) L vs.(1.78 ± 0.45) L;FEV1/pred:(63.19 ±9.08)％ vs.(57.19 ±9.25)％; FEV1/FVC％:(73.8 ±5.6)％ vs.(67.3 ± 11.5)％ ;P ＜ 0.05).Conclnsion High dosage of seretide had better effect in the treatment of stable moderate and severe COPD,and can obviously improve patients' lung function,clinical symptoms and quality of life.