ObjectiveTo explore the metabolic changes during the development of Tupaia belangeri breast tumors, to investigate the close relationship between the changes of serum metabolic substances and the occurrence and progression of tumors, and to screen for biomarkers reflecting the progression of breast tumors. MethodsBreast tumors in Tupaia belangeri were induced by orally administering 7,12-dimethylbenzoanthracene (DMBA) three times, with a 15-day interval between each administration, along with a high-fat and high-sugar diet. The DMBA-induced breast cancer group and the DMBA-inducedwithout breast cancer group were compared with the control group. Untargeted determination of serum metabolites was performed using gas chromatography-time-of-flight mass spectrometry (GC-TOFMS) in DMBA-induced Tupaia belangeri with breast cancer, DMBA-induced without breast cancer and the control group. Multidimensional statistical analysis including unsupervised principal component analysis (PCA), and orthogonal partial least squares analysis (OPLS-DA) were conducted. Furthermore, t-test was used for intergroup differential comparison. Differential metabolites were screened under VIP>1 and P<0.05 conditions, and significantly changing differential metabolites were identified using the HMDB online database. The Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway database was utilized to enrich metabolic-related gene regulatory pathways. ResultsThe incidence of breast tumors was 40% in DMBA-induced Tupaia belangeri. Compared with the control group, 30 metabolic differential products were detected in the serum of the group with breast cancer, with 18 down-regulated and 12 up-regulated (VIP>1, P<0.05). KEGG pathway analysis revealed significant changes in four metabolic pathways: glutamate metabolism, glyceride metabolism, citric acid cycle, and alanine metabolism. Compared with the group without breast cancer, 18 metabolic differential products were detected, with 7 down-regulated and 11 up-regulated (VIP>1, P<0.05). KEGG pathway analysis revealed significant changes in the citric acid cycle and glutamate metabolism. Compared with the control group, 31 metabolic differential products were detected in the serum of the groups without breast cancer, with 14 down-regulated and 17 up-regulated (VIP>1, P<0.05). KEGG pathway analysis revealed significant changes in three metabolic pathways: glutamate metabolism, glyceride metabolism, and citric acid cycle. ConclusionMetabolomics analysis can reveal the characteristics of changes in metabolites in the serum of breast tumors. The results suggest that glutamate metabolism, glyceride metabolism, citric acid cycle, and alanine metabolism pathways are associated with the occurrence and development of DMBA-induced breast tumors in Tupaia belangeri. It provides a foundation for further research into the biological mechanism of breast cancer.

As the National Health Commission changes the management of novel corona virus infection, the situation and preventive policies for controlling the epidemic have also entered a new stage in China. Perioperative care strategies for orthopedic trauma such as designated isolation and nucleic acid test screening have also been adjusted in the new stage. Based on the perioperative work experiences in the new stage of epidemic from the frontline anti-epidemic staff of orthopedics in domestic hospitals and combined with the literature and relevant evidence-based medical data in perioperative care of orthopedic trauma patients under the current anti-epidemic policies at home and abroad, Chinese Orthopedic Association and Chinese Society of Traumatology organized relevant experts to formulate the Guideline for clinical perioperative care of orthopedic trauma patients in the new stage of novel corona virus infection ( version 2023). The guideline summarized 16 recommendations from the aspects of preoperative diagnosis and treatment, infection prevention, emergency operation and postoperative management to systematically standardize the perioperative clinical pathways, diagnosis and treatment processes of orthopedic trauma in the new stage of novel corona virus infection, so as to provide a guidance and reference for hospitals at all levels to carry out relevant work in current epidemic control policies.

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

PURPOSE: Details of patients hospitalized for asthma exacerbation in mainland China are lacking. To improve disease control and reduce economic burden, a large sample survey among this patient population is indispensable. This study aimed to investigate the clinical characteristics and outcomes of such patients.METHODS: A retrospective study was conducted on patients hospitalized for asthma exacerbation in 29 hospitals of 29 regions in mainland China during the period 2013 to 2014. Demographic features, pre-admission conditions, exacerbation details, and outcomes were summarized. Risk factors for exacerbation severity were analyzed.RESULTS: There were 3,240 asthmatic patients included in this study (57.7% females, 42.3% males). Only 28.0% used daily controller medications; 1,287 (39.7%) patients were not currently on inhaled corticosteroids. Acute upper airway infection was the most common trigger of exacerbation (42.3%). Patients with severe to life-threatening exacerbation tended to have a longer disease course, a smoking history, and had comorbidities such as hypertension, chronic obstructive pulmonary disease (COPD), and food allergy. The multivariate analysis showed that smoking history, comorbidities of hypertension, COPD, and food allergy were independent risk factors for more severe exacerbation. The number of patients hospitalized for asthma exacerbation varied with seasons, peaking in March and September. Eight patients died during the study period (mortality 0.25%).CONCLUSIONS: Despite enhanced education on asthma self-management in China during recent years, few patients were using daily controller medications before the onset of their exacerbation, indicating that more educational efforts and considerations are needed. The findings of this study may improve our understanding of hospital admission for asthma exacerbation in mainland China and provide evidence for decision-making.
Adrenal Cortex Hormones ; Asthma ; China ; Comorbidity ; Disease Progression ; Education ; Female ; Food Hypersensitivity ; Hospitalization ; Humans ; Hypertension ; Inpatients ; Medication Adherence ; Mortality ; Multivariate Analysis ; Pulmonary Disease, Chronic Obstructive ; Retrospective Studies ; Risk Factors ; Seasons ; Self Care ; Smoke ; Smoking

Since December 2019, novel coronavirus pneumonia (NCP) has been reported in Wuhan, Hubei Province, and spreads rapidly to all through Hubei Province and even to the whole country. The virus is 2019 novel coronavirus (2019-nCoV), never been seen previously in human, but all the population is generally susceptible. The virus spreads through many ways and is highly infectious, which brings great difficulties to the prevention and control of NCP. Based on the needs of orthopedic trauma patients for emergency surgery and review of the latest NCP diagnosis and treatment strategy and the latest principles and principles of evidence-based medicine in traumatic orthopedics, the authors put forward this expert consensus to systematically standardize the clinical pathway and protective measures of emergency surgery for orthopedic trauma patients during prevention and control of NCP and provide reference for the emergency surgical treatment of orthopedic trauma patients in hospitals at all levels.

Circular RNAs (circRNAs), covalently closed continuous RNA loops, are generated from cognate linear RNAs through back splicing events, and alternative splicing events may gener-ate different circRNA isoforms at the same locus. However, the challenges of reconstruction and quantification of alternatively spliced full-length circRNAs remain unresolved. On the basis of the internal structural characteristics of circRNAs, we developed CircAST, a tool to assemble alter-natively spliced circRNA transcripts and estimate their expression by using multiple splice graphs.Simulation studies showed that CircAST correctly assembled the full sequences of circRNAs with a sensitivity of 85.63％-94.32％and a precision of 81.96％-87.55％. By assigning reads to specific iso-forms, CircAST quantified the expression of circRNA isoforms with correlation coefficients of 0.85-0.99 between theoretical and estimated values. We evaluated CircAST on an in-house mouse testis RNA-seq dataset with RNase R treatment for enriching circRNAs and identified 380 cir-cRNAs with full-length sequences different from those of their corresponding cognate linear RNAs. RT-PCR and Sanger sequencing analyses validated 32 out of 37 randomly selected isoforms, thus further indicating the good performance of CircAST, especially for isoforms with low abundance. We also applied CircAST to published experimental data and observed substantial diversity in circular transcripts across samples, thus suggesting that circRNA expression is highly regulated. CircAST can be accessed freely at https://github.com/xiaofengsong/CircAST.

Objective To explore the clinical outcomes of treating unstable intertrochanteric fractures with proximal femoral locking plate (PFLP) in the elderly patients.Methods From January 2010 to June 2015,380 elderly patients with unstable intertrochanteric fracture were treated with PFLP and successfully followed up at our department.They were 171 men and 209 women,from 60 to 89 years of age (average,68.7 years).By AO classification,there were 58 cases of AO31-A2.2,87 ones of 31-A2.3,130 ones of 31-A3.1,63 ones of 31-A3.2,and 42 ones of 31-A3.3.Operation time,incision length,length of hospital stay,fracture healing time,postoperative complications and hip joint Harris scores were recorded.Results This cohort was followed up for an average of 13.3 months (range,from 8 to 21 months).Their operation time averaged 53.2 min,X-ray exposure 12.2 times,intraoperative blood loss 92.7 mL,incision length 12.6 cm,postoperative drainage volume 54.7 mL,and length of hospital stay 9.2 days.Pulmonary infection was observed in 3 cases,fixation loosening in 8,fixation breakage in 2,hip varus in 9,and fracture nonunion in 4,yielding a total complication rate of 6.8％ (26/380).No operative incision infection was observed.The average fracture healing time was 11.8 weeks (range,from 7 to 48 weeks) after operation.The average Harris score one year postoperation for the 380 patients was 86.3 ± 6.1,significantly higher than the preoperative value (43.6±4.4) (P ＜0.05).There were 96 excellent,231 good,42 fair and 11 poor cases,giving an excellent to good rate of 86.1％.Conclusion Since PFLP has advantages of limited invasion,blood loss and complications,a high rate of fracture healing,and good functional recovery of the hip,it may be a good treatment for unstable intertrochanteric fractures in the elderly patients.

Objective To establish an osteoporosis model in tree shrews by bilateral ovariectomy.Methods One hundred healthy 6-24 month old female tree shrews were used in this study.The diagnosis and treatment of osteoporo-sis in the model tree shrews was assessed according to the Interpretation of the Clinical Practice Guideines for Primary Oste-oporosis 2011 released by the Chinese Medical Association of Osteoporosis and Bone Mineral Salt Disease Branch.① Ac-cording to the human natural life span, sexual maturation time and peak bone mineral density ( PBMD) and the tree shrew natural life span and sexual maturation time, we estimated the PBMD of tree shrew in the age of months.Six 6-, 12-, 18-and 24-month old tree shrews in each group were randomly taken for measurement of BMD, and compared the differences between groups to verify the PBMD age of tree shrews.②We chose 62 6-month old tree shrews from the rest of tree shrews to measure their BMD to determine the mean and standard deviation of BMD.Then we divided them into study group ( n =32) and control group (n =30).Bilateral ovariectomy was performed in the study group, while omentectomy was done in the control group.BMD was measured at 3, 6, 9, 12 months after the surgery, 6 animals from each group.The animals which met the criteria of guideline were taken for pathological examination.Results ①The PBMD of 6-, 12-, 18-, 24-month old tree shrews was 0.138 ±0.012, 0.143 ±0.010, 0.141 ±0.009, and 0.139 ±0.009) g/cm2 , respectively, showing no significant differences among them (P>0.05).②The mean PBMD of the tree shrews was 0.143 ±0.016 g/cm2 .③In the model groups, the number of tree shrews whose BMD met the criteria of guideline was 0, 5, 4, 5, respec-tively.The pathological examination of the proximal tibia from the model group showed sparse and some disrupted trabecu-lae and enlarged inter-trabecular space.In the control group, the tibia tissues showed normal histology of bone structure and no one tree shrew showed a BMD value which met the criteria of diagnosis of osteoporosis.Conclusions An osteopo-rosis model in tree shrews can be established at 6 months after bilateral ovariectomy, showing similar manifestation of osteo-porosis in postmenopausal women.The success rate of this modeling method is high and the model is stable.

Objective To explore the expression of Ang -2 and CD105 in breast cancer and their po-tential associations with the cancerization and progression of breast cancer .Methods Thirty patients with breast cancer ( cancerous tissue ) ,15 intraductal papilloma cases ( precancer tissue ) and 15 normal breast tissue were col-lected for each group ,respectively .Immunohistochemistry ,western blot and RT-PCR techniques were used to ex-amine the expressions of Ang -2 and CD105 in cancerous breast tissue ,precancer breast tissue and normal breast tissue at both protein and mRNA levels .The possible correlations of Ang -2 and CD105 expression with clinico-pathological characteristics of the breast cancer were analyzed .Results The expressions of CD105 and Ang-2 in cancer and precancer tissues were higher than in normal tissues at both protein and mRNA levels ,and the trend of their expressions was increased from normal to precancer ,and cancer tissue .The expressions of CD 105 and Ang-2 protein and mRNA were positively correlated with tumor size ,invasion,lymph node metastasis,and negatively correlated with the differentiation of the cancer .Conclusion CD105 and Ang-2 are involved in the canceriza-tion and pregression of breast cancer .These two biomarkers can serve as two useful indicators in assisting diagno-sis and prognosis of breast cancer .

Objective To evaluate the effect of pitavastatin on blood glucose in patients with hypercholesterolemia,and to investigate the efficacy of pitavastatin in diabetic patients combined with hypercholesterolemia.Method This study was a 12-week,multi-center,open-label,without parallel-group comparison,phase Ⅳ clinical trail.Results Contrasting to baseline,the prevalences at week 4 and 12 post-treatment of abnormal fasting plasma glucose (FPG) and glycosylated hemoglobin Alc (HbA1c)( FPG:14.2％ vs 14.1％ and 11.0％ ; HbA1c:14.3％ vs 15.1％ and 16.1％ ) in the safety set subjects without diabetes mellitus (DM),as well as in those with DM but not taking glucose-lowering drugs (FPG:7/7 vs 4/7 and 5/7; HbAlc:5/5 vs 4/4 and 5/5) had no significant changes (all P vaules ＞0.05).Contrasting to baseline,the levels of TC [ (6.51±0.94) mmol/L vs (5.12 ±0.93) mmol/L and (4.54 ±1.00) mmol/L],LDL-C [(4.11 ±0.79)mmol/L vs (3.02 ±0.81) mmol/L and (2.51 ±0.70)mmol/L] and TG [2.10(1.53,2.54) mmol/L vs 1.62(1.26,2.00) mmol/L and 1.35(1.10,1.86)mmol/L]at week 4 and 12 post-treatment in the per protocol set 55 subjects with DM were significantly reduced (all P values ＜ 0.05 ) ; 33.3％ of subjects at high risk and 10.0％ of subjects at very high risk had achieved a TC target value; 55.6％ of subjects at high risk and 40.0％ of subjects at very high risk had achieved a LDL-C target value.Conclusion Pitavastatin has a safe effect on blood glucose and it could be used to treat diabetic patients combined with hypercholesterolemia in China.