Objective:To evaluate the relationship between preoperative frailty and postoperative pulmonary complications (PPCs) in elderly patients undergoing thoracoscopic lobectomy.Methods:The elderly patients with non-small cell lung cancer who underwent thoracoscopic lobectomy in the Affiliated Hospital of Jiangnan University were collected.The general data, frailty status, parameters of blood and operation-related parameters were recorded.The patients were divided into PPC group and non-PPC group according to whether PPCs occurred during hospitalization, and the differences between the parameters were compared.Logistic regression analysis was used to analyze the independent risk factors for PPCs.Stratification analysis and interaction test were used to further analyze the relationship between frailty and PPCs.Results:A total of 298 elderly patients with non-small cell lung cancer undergoing thoracoscopic lobectomy were included in this study, and the incidence of PPCs was 22.8%.Compared with non-PPC group, the albumin and FEV 1/FVC were decreased, and age, blood creatinine, ratio of diabetes mellitus, ratio of chronic obstructive pulmonary disease (COPD) and rate of preoperative frailty were significantly increased in PPC group ( P<0.05). The results of logistic regression analysis showed that COPD and preoperative frailty were independent risk factors for PPCs.After adjusting all the risk variables, the frail patients had a 171% increased risk of PPCs compared with non-frail patients ( OR value=2.71, 95%CI: 1.18-4.73, P<0.05). The results of subgroup analysis showed that body mass index and operation time had effect modification on the association between frailty and PPCs (interaction P<0.05). Conclusion:COPD and preoperative frailty are independent risk factors for PPCs in elderly patients undergoing thoracoscopic lobectomy, and the frail patients with obesity or long operation time are at higher risk of PPCs.

Objective To investigate the expressions of acid sensing ion channel 1a(ASIC1a) and activator protein-1 (AP-1) in hepatocellular carcinoma,and to analyze the relationship between expressions and clinical features.Methods At the transcription level,expression spectroscopy chips and bioinformatics were used to analyze the changes of signal pathways before and after ASICla interference in hepatocellular carcinoma cells.63 cases of HCC and 42 cases of tumor adjacent tissue samples were chosen from the Third People's Hospital of Wuxi,between January 2010 and December 2014.Immunohistochemical staining was utilized to detect the expressions of ASIC1 a,c-Jun,c-Fos.The relationships among the three were analyzed by the nonparametric Spearman rank correlation coefficient.Results After ASIC1a inhibition,the expression of AP-1 (c-Jun and c-Fox) decreased significantly.The expressions of c-Jun and c-Fox were greatly decreased in interference group compared with control group.The positive rates of ASIC1a,c-Jun and c-Fos in HCC tissues were significantly higher than that of the adjacent tissues,68.3％ vs.19.0％,55.6％ vs.11.9％,47.6％ vs.11.7％ (P ＜ 0.05).Correlation analysis showed that the expression of ASIC1a was positively correlated with c-Jun and c-Fos expression (r =0.404,0.309,P ＜ 0.05).The expressions of ASIC 1 a,c-Jun and c-Fos were not related to age,tumor diameter and gender (P ＞ 0.05),which were related to the clinical stage,AFP and lymph node metastasis of the tumor (P ＜ 0.05).Conclusion ASIC1a may.affect the development of hepatocellular carcinoma through the downstream gene AP-1.

The prevalence of inflammatory bowel disease (IBD) in China is increasing year by year, however, the efficacy and safety of commonly used therapeutic methods are limited.Granulocyte and monocyte adsorptive apheresis (GMA) is one of the effective methods for treatment of IBD used abroad, however, there is still lacking of such research in China.Aims: To investigate the efficacy and safety of GMA in IBD patients.Methods: A retrospective study was conducted in 21 cases of IBD patients [13 cases with ulcerative colitis (UC) and 8 with Crohn's disease (CD)] who accepted GMA treatment from May 2013 to July 2014 at the Shanghai Rui Jin Hospital.All the cases were poor responders to 5-aminosalycylic acid (5-ASA) or steroid-refractory.The clinical data were collected, and the clinical activity index (CAI), endoscopic activity index (EAI), laboratory parameters including serum albumin (Alb), hemoglobin (Hb), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), leukocyte count and percentage of neutrophils, as well as the adverse effects before and two weeks after the end of GMA treatment were analyzed.Results: After GMA treatment, both CAI and EAI were decreased significantly in UC and CD groups as compared with those before treatment (P all <0.05).Among laboratory parameters, Alb was increased in UC group and CRP was decreased in both UC and CD groups after treatment (P all <0.05).No significant differences were found in other laboratory parameters in both UC and CD groups before and after treatment (P all >0.05).The treatment was well tolerated with no severe adverse effects.Conclusions: GMA is safe and effective for ameliorating clinical symptoms, attenuating intestinal mucosal injury and controlling active inflammation in IBD patient that has not responded to 5-ASA or steroid treatment.Prospective clinical studies with large samples are needed to confirm these findings.

BACKGROUND: Femoral prosthesis malrotation will lead to various complications, such as femoro-tibial and patellofemoral instability, and maladjustment of patellar movement trajectory, further affecting the recovery of the knee function.OBJECTIVE: To evaluate the influence of the rotation angle of the femoral prosthesis on the knee joint function after total knee arthroplasty (TKA).METHODS: Totally 146 patients (186 knees) undergoing TKA in the Department of Joint Surgery, Zhenjiang First People's Hospital from January 2010 to January 2014 were selected. Afterwards, the femoral condyle torsion angle was measured on CT to evaluate the rotational position of the femoral prosthesis. According to the condyle torsion angle, all the patients were divided into three groups: normal group (n=74, extorsion angle 3°-intorsion angle 3°), intorsion group (n=15, intorsion angle > 3°) and group (n=58, extorsion angle > 3°). All the patients were followed up for 3 years.RESULTS AND CONCLUSION: (1) The order of the activity function score was as follows: the normal group > extorsion group > intorsion group (P < 0.05). The standard activity, free activity and senior activity scores were highest in the normal group, followed by the extorsion group, and lowest in the intorsion group (P < 0.05). However, the standing and walking scores, as well as the satisfaction and expected scores did not differ significantly among groups. (2) That is to say, the rotational position of the femoral prosthesis influences the long-term knee joint function after TKA, so we should pay attention to the femoral prosthesis malrotation.

Objective To compare the short-term therapeutic effects of reconstruction plate versus locking compression plate in the treatment of comminuted fracture of midshaft clavicle in the aged patients.Methods A retrospective analysis was performed of the 64 aged patients who had been treated from March 2009 to April 2015 for comminuted fracture of midshaft clavicle with reconstruction plate or locking compression plate.They were divided into 2 groups according to their treatment methods.There were 30 patients in the reconstruction plate group,14 males and 16 females with an average age of 67.9±5.6 years;there were 34 patients in the locking compression plate group,15 males and 19 females with an average age of 67.1 ± 5.3 years.The 2 groups were compared in terms of operation time,blood loss,fracture healing time,internal fixation failure and shoulder functional recovery.Results The reconstruction plate and locking compression plate groups were followed up for 13.2 ± 3.2 and 12.4 ± 2.9 months,respectively.For the 2 groups,respectively,the average operation time was 62.2 ± 10.7 min and 58.1 ± 11.4 min,the average amount of blood loss during operation 35.2 ± 10.7 mL and 30.4 ±9.6 mL,the average fracture healing time 4.7 ±0.7 months and 4.5 ± 0.7 months,and the excellent to good rate of shoulder function 86.7％ (26/30) and 91.2％ (31/34),showing no significant difference between the 2 groups (all P ＞ 0.05).Five cases (16.7％) reported plate breakage,screw loosening or delayed union due to fixation failure in the reconstruction plate group but none reported fixation failure in the locking compression plate group,showing a significant difference (P ＜ 0.05).There were no significant difference between the 2 groups in fracture nonunion,malunion,neurovascular injury or acromioclavicular arthritis (P ＞ 0.05).Conclusion Since locking compression plate may lead to a lower incidence of fixation failure compared with reconstruction plate,it is recommendable for elderly patients with comminuted fracture of midshafi clavicle.

Objective To analyze the effect of different areas of paries medialis defect of femoral trochanter on the stability of fracture ends after percutaneous compression plating for femoral intertrochanteric fracture.Methods Thirteen preserved cadaveric specimens of adult femur were used in this experiment.The age of death ranged from 30 to 50 years.Oblique osteotomy was conducted under the same condition using a wire saw to create experimental models of fracture of Evans-Jensen type Ⅳ.The ratios of the area of paries medialis defect to the projected area of lesser trochanter in the specimens 1 to 13 were set respectively as 0,10.0％,14.5％,20.2％,23.4％,30.6％,45.8％,56.8％,76.8％,88.7％,99.8％,121.3％ and 149.4％.All the fractures were fixated by standard percutaneous compression plating.Cyclic load was applied on each specimen using Instron 2000 universal material tester.A vertical load of 600 N was applied for respectively 1,10,100 and 1,000 times to measure the displacements of proximal and distal fracture ends.Results When the ratio of the area of paries medialis defect to the projected area of lesser trochanter was 30.6％,the average displacements of the proximal and distal ends were 0.14 cm and 0.10 cm.When the ratio was 45.8％,the average displacement of the proximal end was 0.53 cm,278.6％ greater than that for 30.6％;the average displacement of the distal end was 0.41 cm,310.0％ greater than that for 30.6％.When the ratio was 149.4％,the average displacement of the proximal end was 0.93 cm,564.3％ greater than that for 30.6％;the average displacement of the distal end was 0.65 cm,550.0％ greater than that for 30.6％.Conclusions When the ratio of the area of paries medialis defect to the projected area of lesser trochanter reaches ＞ 45.8％,the area of paries medialis defect will have a significant effect on the stability of fracture ends after percutaneous compression plating for femoral intertrochanteric fracture.The displacement will increase linearly under the same compression with the increase in defect area.

Objective To determine the effect of high temperature denervation in back pain relief during percutaneous kyphoplasty (PKP) for vertebral osteoporotic fracture.Methods Fifty-six patients undergone PKP for single vertebral osteoporotic fracture were randomly divided into cooling group and normal group with 28 patients per group according to whether the temperature reducing measures were provided during the polymerization process of polymethyl methacrylate (PMMA).Data recorded were operation time, amount of PMMA injected into each vertebral body, visual analogue scale (VAS), Oswestry disability index (ODI), and anterior vertebral height.Results All the data revealed no significant differences between cooling and normal groups: operation time [(45.6 ± 7.3)min vs (43.6 ± 5.8)min], PMMA injected into each vertebral body [(2.8 ±0.3)ml vs (2.7 ±0.4)ml], VAS [(3.8 ± 0.7) points vs (3.2 ± 0.7) points], ODI [(36.6 ± 8.2) points vs (30.4 ± 6.0) points] and height restoration of anterior vertebral body [(85.3 ± 6.1)％ vs (83.9 ± 7.3)％] (P ＞ 0.05).Conclusion High temperature denervation contributes a little to the relief of back pain during PKP, as may be due to the vertebral augmentation and stabilization.

Objective To compare the efficiency of explants adherent after enzymatic pre-digestion and traditional typeⅡ?collagenase digestion methods for culturing human nucleus pulposus cells from degenerated intervertebral discs.Methods Human nucleus pulposus tissues collected from patients'degenerated intervertebral discs were divided into Groups A and B.In Group A,the nucleus pulposus tissues were cultured using explants adherent method directly after 0.025 ％ typeⅡ?collagenase digestion for 30 minutes.In Group B,the tissues were firstly digested with 0.025 ％ typeⅡ?collagenase for five hours,and then underwent filtration,centrifugation and inoculation successively Success rate and primary cell fusion time of the two culture methods were compared.Cell morphology and expressions of sex determining region Y-box 9(Sox-9),collagenⅡ?and aggrecan were observed by HE staining,toluidine blue staining and immunofluorescence cell staining.Results There was no significant difference in the successful culture rate between the two groups(P＞0.05).However,the average fusion time of primary passage in Group A was significantly shorter than that in Group B(P＜0.01).In Group A,the nucleus pulposus cells could be stained as azure by toluidine blue and immunofluorescence cell staining showed positive expressions of Sox-9,collagenⅡ?and aggrecan.Conclusions Compared with traditional typeⅡ?collagenase digestion,explants adherent method after typeⅡ?collagenase pre-digestion for the culture of human nucleus pulposus cells from degenerative intervertebral discs has a high success rate and obtains a large number of cells in a short time.Meanwhile,the cells have strong expressions of Sox-9,collagenⅡ?and aggrecan.

Echinococcosis is a zoonotic parasitic disease caused by infection of Echinococcus granulosus and Echinococcus multilocularis in the human body,which may endanger the health and life of patients.Surgical treatment is presently the main method for the treatment of echinococcosis,with drug therapy as a subsidiary measure.The paper summarizes the advances in the treatment of echinococcosis.

Acid-sensing ion channels(ASICs) are a novel class of ligand-gated cation channels activated by extracellular acidification and belong to the epithelial sodium channels(DEG/ENaC) superfamily.Their biological functions have recently been found not only in the central nervous system but also relevant to the physiology and pathology of non-neuronal tissues such as taste buds, cardiovascular system and bones.This review concerns the latest research on the expression and functions of ASICs in non-neuronal tissues so as to promote the understanding of their physiological and pathological functions.