Hypoxia inducible factor(HIF)is a key factor in the regulation of oxygen homeostasis, and its expression level is mainly influenced by oxygen concentration in the adaptation of the body to chronic hypoxia, with which many pediatric diseases are closely associated.The response to hypoxia can be altered by HIF and its mediated downstream signaling pathways, in addition to epigenetic modifications such as regulation of overall methylation or histone modification levels to adapt to hypoxic environments.Previous studies have shown that the transcriptional activity and stability of HIF are interrelated with various histone modifications including methylation/demethylation, hydroxylation, deacetylation, phosphorylation, and lactylation, which makes the study of epigenetic modification correlation deserves to be explored in depth as an important potential target for regulating HIF expression levels.

Objective:To compare the numerical rating scales (NRS) and Oswestry disability index (ODI) of denosumab in Chinese postmenopausal osteoporosis patients after 3 months, and analyze the early adverse reactions to provide reference for clinical diagnosis and treatment.Methods:Using a prospective study method, 260 patients with postmenopausal osteoporosis who were outpatients and inpatients in the Second Affiliated Hospital of Soochow University from September 2020 to October 2021 were selected, and general information, including age, height, weight, bone mineral density, history of fragility fractures, and use of anti-osteoporosis drugs. All subjects received denosumab 60 mg subcutaneously, and were given calcium and vitamin D at the same time. Pain was scored by NRS before treatment and 3 months after treatment, and functional improvement was assessed by ODI.Results:After 3 months of denosumab treatment in postmenopausal women with osteoporosis, among patients with different age groups, different degrees of osteoporosis, history of fragility fractures, and history of use of anti-osteoporosis drugs, NRS score and ODI score were lower than those before treatment, and the difference was statistically significant ( P<0.05). In addition, in patients with a history of fragility fractures (mainly vertebral fractures), the NRS scores and the ODI score decreased more significantly, and the difference was statistically significant ( P<0.05); the NRS score and ODI score decreased more significantly in patients with severe osteoporosis than in patients with osteoporosis, and the difference was statistically significant ( P<0.05); the BMD value of lumbar spine was negatively correlated with the reduction of NRS score before and after treatment ( P=0.042). In this study, 260 patients had musculoskeletal pain in 6 (2.3%), fatigue in 5 (1.9%), rash in 4 (1.5%), urinary tract infection in 2 (0.7%), and dizziness in 2 (0.7%), 2 case of fever (0.7%), 1 case of hypocalcemia (0.4%), a total of 22 cases of adverse reactions were reported, and the overall adverse reaction rate was 8.5%. Conclusion:Denosumab can improve pain symptoms and functional disability early in the clinical application of Chinese postmenopausal women with osteoporosis, and the incidence of adverse reactions is low. Especially for postmenopausal female osteoporosis patients with severe osteoporosis, low lumbar spine bone density, and a history of fragility fractures (mainly vertebral fractures), the application effect is more significant.

Acute lung injury is an inflammatory pulmonary disease with complex pathogenesis, frequently resulting in systematic hypoxia.As a central regulator modulating cellular oxygen levels, hypoxia reducible factor-1α affects the development of acute lung injury, which also has been gaining focus as a potential therapeutic target of acute lung injury.Therefore, hypoxia reducible factor-1α is a pivotal factor while understanding the pathogenesis and exploring the therapeutic approach of acute lung injury.

Objectives:To investigate the nursing effect of perioperative enhanced recovery after surgery（ERAS）management model in elderly patients with hip fracture.Methods:A retrospective case-control study was conducted to analyze the clinical data of 94 elderly patients with hip fracture admitted to Second Affiliated Hospital of Soochow University from July 2017 to June 2018，including 24 males and 70 females aged 76-98 years［（83.7±5.4）years］. There were 54 patients with intertrochanteric fracture and 40 patients with femoral neck fracture. Surgical method was proximal femoral nail antirotation（PFNA）fixation or artificial hip arthroplasty. A total of 44 patients were managed by ERAS（enhanced recovery group）and 50 patients by traditional nursing（traditional rehabilitation group）. The off-bed time was compared between the two groups from aspects of different fracture sites，bone mineral density and causes of injury. The visual analogue scale（VAS）was tested preoperatively and at postoperative days 1，3 and 7. The complications were recorded at postoperative 1 month. The activity of daily living（ADL）score was assessed preoperatively and at postoperative 1 week，1 month and 3 months. The Harris hip score was assessed at postoperative 1 week，1 month，3 months and at the last follow-up. The length of hospital stay and death at postoperative 3 months and at the last follow-up were recorded.Results:All patients were followed up for 12-24 months［（17.7±6.2）months］. In enhanced recovery group，the off-bed time of patients with different fracture sites（femoral neck，femoral intertrochanter），bone mineral density（>-2.5 SD，≤-2.5 SD）and causes of injury（falls，traffic accidents and others）were markedly shortened as compared with traditional rehabilitation group（ P<0.01）. There was no significant difference in VAS between the two groups before operation（ P>0.05）. However，the VAS in enhanced recovery group was（3.4±0.9）points，（2.7±0.5）points，（1.7±0.6）points at postoperative days 1，3 and 7，significantly lower than that in traditional rehabilitation group［（4.3±1.1）points，（3.5±0.5）points，（2.7±0.9）points］（ P<0.01）. One month after operation，the incidence of pulmonary infection was 0% in enhanced recovery group and 28%（14/50）in traditional rehabilitation group（ P<0.01）. While there showed no significant differences in incidences of cardiovascular system，nervous system，urinary tract infection，lower limb deep vein thrombosis，impaired liver and kidney function，anemia，electrolyte disorder or hypoalbuminemia between the two groups（ P>0.05）. There was no significant difference in preoperative ADL score between the two groups（ P>0.05）. The ADL score in enhanced recovery group was（37.0±6.6）points，（70.1±8.4）points，（86.2±9.3）points at postoperative 1 week，1 month and 3 months，significantly higher than that in traditional rehabilitation group［（26.5±10.4）points，（50.1±11.4）points，（70.7±9.0）points］（ P<0.01）. The Harris hip score in enhanced recovery group was（80.9±8.6）points at postoperative 1 month，significantly higher than that in traditional rehabilitation group［（71.1±9.2）points］（ P<0.01）. There were no significant differences in Harris hip score between the two groups at postoperative 1 week，3 months and at the last follow-up（ P>0.05）. The length of hospital stay was（4.7±2.4）days in enhanced recovery group，significantly shorter than（7.8±3.9）days in traditional rehabilitation group（ P<0.01）. The enhanced recovery group showed no death within 3 months after operation and 2 deaths［5%（2/44）］at the last follow-up，while the traditional rehabilitation group revealed 4 deaths［8%（4/50）］within 3 months after operation. There was no significant difference in the mortality between the two groups until the last follow-up（ P>0.05）. Conclusion:For elderly patients with hip fracture，perioperative ERAS management model can effectively shorten periods in bed，relieve postoperative pain，reduce incidence of postoperative pulmonary infection，accelerate recovery of hip function，improve quality of life，shorten length of hospitalization and promote early recovery.

Recurrent respiratory tract infection affects children all over the world, but its causes and pathogenesis still remain unknown.In recent years, the scientific community has been focusing on its correlation with the gut microbiota, that has been paid significant interest on in the field of pediatrics.In this review, we summarized the mechanism of how gut microbiota influence the body and the lung, the connection between recurrent respiratory tract infection and gut microbiota, and the advances of treatment using probiotics, which would provide a reference for further studies.

Objective:To explore the feasibility and effect of using free-style perforator pedicled propeller flap to repair the wound after extended resection of skin malignant tumor on the shoulder and back.Methods:From December 2017 to June 2019, 9 patients (7 males and 2 females, aged from 51 to 84 years, with an average age of 67.5 years) with skin malignant tumor of the shoulder and back were treated in the Department of Plastic and Reconstructive Surgery of Ningbo First Hospital.The etiologies included squamous cell carcinoma( n=4), basal cell carcinoma( n=3), skin juga fibrosarcoma( n=1) and malignant melanoma( n=1). Color Doppler ultrasound was used to detect and mark the perforating vessels before operation. After extended resection was performed, intraoperative frozen section identified pathological diagnosis, while also ensured margin and base being tumor-free. The defect size ranged from 3.0 cm×7.0 cm to 8.0 cm×9.0 cm. According to the wound size and shape, the perforator pedicled propeller flap ranged from 3.0 cm×10.0 cm to 8.0 cm×12.0 cm was designed to repair the wound. The donor area was closed directly. Results:All 9 flaps survived with primary wound healing in donor and recipient areas. Follow-up for 5-20 months showed no tumor recurrence and there was no obvious bulky and scar formation. The movement of left shoulder joint was smooth.Conclusions:The blood supply of the shoulder and back is extensive, and the skin perforating vessels are abundant. Free-style perforator pedicled propeller flap on the shoulder and back is a simple technique. It is an ideal flap to repair the wound defect after extended resection of skin malignant tumor on the shoulder and back.

Objective:To explore the feasibility and effect of using free-style perforator pedicled propeller flap to repair the wound after extended resection of skin malignant tumor on the shoulder and back.Methods:From December 2017 to June 2019, 9 patients (7 males and 2 females, aged from 51 to 84 years, with an average age of 67.5 years) with skin malignant tumor of the shoulder and back were treated in the Department of Plastic and Reconstructive Surgery of Ningbo First Hospital.The etiologies included squamous cell carcinoma( n=4), basal cell carcinoma( n=3), skin juga fibrosarcoma( n=1) and malignant melanoma( n=1). Color Doppler ultrasound was used to detect and mark the perforating vessels before operation. After extended resection was performed, intraoperative frozen section identified pathological diagnosis, while also ensured margin and base being tumor-free. The defect size ranged from 3.0 cm×7.0 cm to 8.0 cm×9.0 cm. According to the wound size and shape, the perforator pedicled propeller flap ranged from 3.0 cm×10.0 cm to 8.0 cm×12.0 cm was designed to repair the wound. The donor area was closed directly. Results:All 9 flaps survived with primary wound healing in donor and recipient areas. Follow-up for 5-20 months showed no tumor recurrence and there was no obvious bulky and scar formation. The movement of left shoulder joint was smooth.Conclusions:The blood supply of the shoulder and back is extensive, and the skin perforating vessels are abundant. Free-style perforator pedicled propeller flap on the shoulder and back is a simple technique. It is an ideal flap to repair the wound defect after extended resection of skin malignant tumor on the shoulder and back.

Objective: To compare the clinical effects of surgery within and over 48 hours for hip fractures in elderly patients. Methods: From May 2017 to April 2018, 47 patients over 75 years old with hip fracture were operated in our hospital and met with inclusion criteria. The patients were divided into two groups: within 48-hour group and over 48-hour group according to study design. In the within 48-hour group, there were 22 patients including 5 males and 17 females, aged from 76 to 97 years, with an average age of 83.6±5.0 years, and there were 10 femoral neck fractures (3 total hip arthroplasty, 7 hemiarthroplasty) and 12 femoral intertrochanteric fractures (proximal femoral intramedullary nail fixation). There were 25 patients (7 males and 18 females) in the over 48-hour group, aged from 76 to 98 years, with an average age of 83.8±5.8 years, and there were 10 femoral neck fractures (2 total hip arthroplasty, 8 hemiarthroplasty) and 15 femoral intertrochanteric fractures (proximal femoral intramedullary nail fixation). At the end of the follow-up period, the clinical data of the two groups were compared. The differences in the length of stay, cost of stay (excluding implants), postoperative complications within 1 month, hip function score (Harris score) within 1 month and 3 months, and mortality within 3 months and at the end of follow-up were analyzed. Results: Both groups were followed up for 12 to 24 months, with an average of 17.7 months. The hospitalization time (7.9±3.0 d), hospitalization expenses (16 627.5±6 428.8 yuan), the incidence of early complications after operation (59.1%) and Harris score (80.9±8.6) in the within 48-hour group were significantly better than those in the over 48-hour group (12.3±4.1 d, 23 799.0±9 785.3 yuan, 88.0%, 71.1±9.2, respectively). At 3 months after operation, there was no significant difference in Harris score between the two groups (83.9±7.3 in within 48-hour group and 82.3±8.9 in over 48-hour group; t=0.668, P=0.507). Within 3 months, there was no death inwithin 48-hour group, but 2 in over 48-hour group; and 1 in within 48-hour group at the last follow-up. Conclusion Elderly patients with hip fracture benefit significantly from surgery within 48 hours after admission.

Objective To investigate the initial effect of LARS artificial ligaments arthroscopically in reconstruction of ipsilateral anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL).Methods A total of 21 patients (13 males and 8 females,at average age of 31.5 years) received ACL and PCL restoration using LARS artificial ligaments since June 2006.Preoperative MRI exactly confirmed them as ACL and PCL ruptures.Lysholm score on knee joint was (47.6 ±6.7) points.Surgery had reconstruction of PCL prior to ACL under arthroscope.Results All patients were followed up for average 42 months (range,36-49 months),which showed no infection,ligament rupture,ligament loosening,or other postoperative complications.At postoperative 3 years,Lysholm score was (90.8 ± 3.7) points and International Knee Documentation Committee (IKDC) score was normal in 14 patients,near normal in six,and abnormal in one,with excellent-good rate of 95％.Conclusions LARS artificial ligaments can attain anatomical reconstruction and stability of the knee joint in treatment of ACL and PCL ruptures.Meanwhile,arthroscopic surgery shows superiorities of micro-wound,rapid recovery and satisfactory curative effect.

Objective To investigate the key points of treating elder patients with hip fractures by hemiarthroplasty.Methods Clinical data of 138 elder patients with hip fractures undergone hemiarthroplasty between January 2008 and December 2010 were analyzed retrospectively.There were 43 males and 95 females at mean age of 82.8 years(range,75-103 years).Injury causes included fall from height(n=98),contusion(n=32)and sprain(n=8).There were 84 patients with femoral neck fractures(33 patients with Garden type Ⅲ,51 with type Ⅳ)and 54 patients with intertrochanteric fractures(three patients of Jensen-Evans type Ⅱ,six with type Ⅲ,25 with type Ⅳ,18 with type V,two with type R).Follow-up evaluation was performed using Harris scoring system.Results The ambulation period was average 4.5 days(range,3-12 days).Follow-up was average 24.4 months(range,10-45 months),which presented no loosening,subsidence or infection of prostheses.Due to additional trauma postoperatively,one patient suffered from prosthesis dislocation and two from fractures of distal prosthetic femoral shaft.Harris score at six months postoperatively was average 86.8 points(range,52-100 points),with excellent results in 42 patients,good in 59,fair in 19 and poor in five,with excellence rate of 80.8％.Conclusion With full accomplishment of peri-,intra-and post-operative measures,hemiarthroplasty is a suitable choice for treating hip fractures in the elderly patients.