Abstract:Objective To investigate whether the reduction of bone strength is related to its microscopic energy dissipation in case of osteoporosis. Methods Femoral head specimens from 24 patients undergoing hip arthroplasty in the Orthopaedics Department of the Chinese PLA General Hospital between January 2016 and December 2016 were subjected in this study. Bone mineral density (BMD) and bone strength were measured for all the samples, and the samples with similar BMD but significant different mechanical properties were used to investigate the change of bone strength by Young′s modulus. SPSS statistics 23.0 was used to perform the statistical analysis. One way ANOVA was employed for comparison between groups. Results The samples No.1 and No.3 were selected as the objectives, and their BMD value was 322.29 and 327.12mg/cm³, and the energy required for fracture was (1.05±0.09) and (0.44±0.04) J, respectively. Their BMD values were quite similar, but the difference of energy required for fracture was statistically significant between the 2 samples (P<0.01). The Young′s modulus value of sample No. 1 distributed in a scattered manner, while that of the other sample distributed relatively uniform in the both side of a central vertical line as axis, and the modulus value at upper part was lower, and at lower part is higher. The Young′s modulus value was (12.17±0.94) and (13.55±0.72) GPa, respectively, for the samples No. 1 and 3. Conclusion Osteoporosis may lead to nanoscale heterogeneity changes in bone, and thus change energy dissipation and affect bone strength.

Abstract:Objective To investigate the clinical features of patients with cardiac amyloidosis and the factors affecting their long-term prognosis. Methods A retrospective study was conducted of 119 patients with clinically diagnosed cardiac amyloidosis by reviewing their clinical data, and survival obtained from follow-up telephone. Analysis was made of their clinical manifestations, electrocardiogram, echocardiogram and cardiovascular magnetic resonance and of their relationship with long-term prognosis, the primary end-point being all-cause mortality. SPSS statistics 17.0 was employed for data analysis. Results Symptoms of the 119 patients varied widely, featuring mainly shortness of breath and chest tightness followed by edema of lower limbs and fatigue. Cardiac function was mostly New York Heart Association (NYHA) Ⅲ-Ⅳ class. One-year mortality rate was 50%, and five-year mortality rate was 25%. Independent factors affecting all-cause deaths included N-terminal pro-brain natriuretic peptide (NT-proBNP), troponin T, carbohydrate antigen 125 (CA125), albumin, blood chloride, and immunoglobulin M (IgM). Conclusion Prognosis of cardiac amyloidosis is poor with a 1-year survival rate of only 50%. Independent factors affecting all-cause deaths include NT-proBNP, troponin T, CA125, serum albumin, blood chloride, and serum IgM.

Abstract:Objective To investigate the efficacy of gastrointestinal multifunctional therapeutic instrument combined with powder compound of polyethylene glycol electrolytes in elderly patients with functional constipation. Methods A total of 150 patients with functional constipation hospitalized from January 2018 to December 2018 were randomly divided into study and control groups, with 75 in each group. The control group was treated with powder compound of polyethylene glycol electrolytes, and the study group received additional treatment by Digital Music Electric Gastrointestinal Multi-functional Therapeutic Instrument. The two groups were compared in fecal trait scores, time to first bowel movement and each defecation duration, Wexner constipation score, self-assessment scale for quality of life, and mental status. SPSS statistics 22.0 was used for data analysis. Results With a Bristol type Ⅳ of 33.3% and type Ⅴ of 28.0 %, the study group presented significantly better stool status than control group. After treatment, the study group had better results than the control group in the respects of time to first bowel movement, each defecation duration and weekly bowel movements. Wexner′s constipation score obtained after the treatment was significantly lower in both groups than before the treatment, (7.75±1.53) for the study group and (9.12±1.68) for the control group, and the two groups differed significantly (P<0.05). Patients with depression were fewer, and the degree of depression was lower in the study group than in the control group, the differences being statistically significant (P<0.05). Conclusion Medication combined with Digital Music Electric Gastrointestinal Multi-functional Therapeutic Instrument is superior to medication only, contributing to the alleviation of functional constipation in the elderly patients.

Abstract:Objective To compare the efficacy and prognosis of minimally invasive drilling drainage (MIDD) and small bone window cranial hematoma clearance (SBWCHC) in patients with moderate cerebral hemorrhage in hypertensive basal ganglia. Methods From May 2016 to May 2018,84 patients with moderate intracerebral hemorrhage in hypertensive basal ganglia were selected, who were treated in the Department of Neurosurgery of Xiangzhou People′s Hospital of Guangxi Province. The patients were rando-mized into the MIDD (study) group and the SBWCHC (control) group, with 42 in each group. The two groups were compared statistically in the operation time, intraoperative bleeding volume, hematoma clearance rate, postoperative complications, and rebleeding. Glasgow outcome score (GOS) and Glasgow coma score (GCS) at 3 weeks, activity of daily life (ADL) rating and mortality at 3 months were recorded. SPSS statistics 22.0 was used to analyze the data, and depending on data type, t test or Chi square test was used for the comparison between groups. Results Compared with control group, the operation time, amount of bleeding, incidence of pulmonary infection and gastrointestinal bleeding in the study group were significantly reduced (P<0.05). But no significant difference was observed between the two groups in the clearance rate of hematoma (P>0.05), GOS [(3.4±0.6) vs (3.1±0.9), P=0.347], and GCS [(11.6±1.3) vs (11.2±1.7), P=0.539] at 3 weeks, and fatality rate [4.76%(2/42) vs 2.38%(1/42), P=0.557] andADL excellence rate [78.57%(33/42) vs 88.09%(37/42), P=0.242] at 3 months. Conclusion Small bone window cranial hematoma clearance and minimally invasive drilling drainage are both effective in moderate cerebral hemorrhage in hypertensive basal ganglia and are able to effectively remove hematoma, but drilling drainage requires relatively shorter operation time and results in fewer complications, whose application is preferred.

Abstract:Objective To analyze the correlation between frailty and depression in the elderly inpatients and to evaluate different screening scales for frailty and depression for better management of the elderly patients with frailty. Methods A retrospective analysis was performed of the inpatients(≥ 65years)who were consecutively admitted to the Department of Geriatrics of Peking Union Medical College Hospital between 2017 and 2018. Frailty was assessed using the Fried phenotype and Frail scale, and depression using Self-Rating Depression Scale(SDS)and Short Form Geriatric Depression Scale(GDS-15). SPSS statistics 22.0 was used to analyze the data.Results Of 438 hospitalized patients, frailty was identified in 25.8% on Fried phenotype and 25.6% on Frail scale; and depression in 30.1% on SDS and 41.6% on GDS-15. On SDS and Fried phenotype, 49.2% of the patients with frailty and 40.9% with pre-frailty were depressed. After controlling for confounding factors, the risk of depression in those with frailty (OR=13.833,95%CI 6.962~27.487) and those with pre-frailty (OR=4.272,95%CI 2.209-8.260) was higher than that in those without frailty. Conclusion The detection rates of frailty and depression were high in the elderly inpatients. The self-assessed Frail scale has good consistence with Fried phenotype. There is a clear positive correlation between frailty and depression, an obvious increase in the detention rate of frailty coexisting with an obvious increase in risk of depression. For the elderly patients, it is advisable to provide routine evaluation of frailty and depression and to adopt a holistic approach to their management and intervention.

Abstract:Objective To investigate the feasibility of substituting iodinated contrast with intravenous ultrasound (IVUS) during the procedure of percutaneous coronary intervention (PCI) in chronic renal insufficiency patients suffering from angina pectoris. Methods A total of 51 angina pectoris patients with chronic renal insufficiency admitted in our hospital from January 2018 to December 2019 were enrolled in the study. They were randomly divided into conventional treatment group (n=30) and IVUS guidance group (n=21). Iodinated contrast was used in the conventional treatment group, and PCI was performed conventionally. For the IVUS guidance group, PCI was performed according to the results of IVUS examination, and iodine contrast was disallowed in the procedure. The primary end point was the success rate of procedure in 2 groups, and the secondary end point was the changes of renal function, incidence of complication and relief of angina pectoris. SPSS statistics 18.0 was used to analyze the data.Results PCI was successfully performed in both groups, and no significant differences were seen in the PCI and procedure success rates between them. Before the treatment, there were no statistical differences in estimated glomerular filtration rate [eGFR, (46.3±20.4) vs (39.7±13.2)L/(min·1.73m²), P=0.201] and serum creatinine [(SCr, (167.2±57.4) vs (156.3±44.3)μmol/L, P=0.469] between the two groups. In 24h after the treatment, the conventional treatment group had obviously increased SCr level [(210.3±100.9) vs (167.2±57. 4)μmol/L, P=0.002] and higher incidence of contrast-induced nephropathy (CIN) when compared with the IVUS guidance group (37% vs 0%, P<0.001). The SCr level was notably lower in the IVUS guidance group in 24h after treatment than the conventional treatment group [(144.6±41.9) vs (210.3±100.9)μmol/L, P=0.007]. Conclusion In angina pectoris patients with chronic renal insufficiency, it is feasible to use IVUS instead of iodine contrast during the procedure of PCI if indications are suitable.

Abstract:Objective To compare the anticoagulant efficacy and safety of bivalirudin and heparin during percutaneous coronary intervention (PCI). Methods A total of 100 consecutive patients hospitalized in our center due to unstable angina from December 1st to 31st, 2018, and undergoing elective PCI were enrolled in this study. They were randomly divided into bivalirudin group (n=50) and heparin group (n=50). Their activated coagulation time (ACT) was monitored at 15,30, 60min after administration and at the end of the operation, and the occurrence of perioperative bleeding events and major adverse cardiovascular events (MACE) were observed. SPSS statistics 20.0 was used for data analysis.Results After 15min of administration, the ACT were up to the standard time in both groups. The ACT levels remained stable in the bivalirudin group [15min:(280.5±12.5)s; 30min:(279.5±5.5)s; 60min:(282.1±6.8)s; end of operation:(275.3±9.9)s], while those of heparin group continued to decline [15min:(276.6±6.1)s; 30min:(258.1±3.0)s; 60min:(241.8±8.6)s; end of operation:(234.9±7.9)s]. Significant difference was seen in ACT between the 2 groups from 30 min after administration (P＜0.001). There were no obvious differences in the prevalence of hemorrhagic events and thrombotic events between the 2 groups (P＞0.05). Conclusion Both bivalirudin and heparin are efficient and safe anticoagulants during PCI, and the former can obtain more stable ACT. While, for the latter, ACT should be monitored every 15 min due to its obvious fluctuation during the whole operation.

Abstract:Objective To investigate the underlying mechanism of miR-200c reversing the drug resistance of lung cancer cells to cisplatin (DDP). Methods After transfection of miR-200c mimics into lung cancer A549 cells, the expression of miR-200c was detected by real-time PCR. MTS assay was employed to measure the cell viability to observe the tolerance of A549 cells to DDP. Flow cytometry was used to measure the apoptosis rate of the cells, and Western blotting was applied to test the expression of survivin and Bcl-2 protein. After bioinformatics analysis showed that TUBB3, the downstream target molecule of miR-200c, was expressed differentially, luciferase reporter vectors containing wild type and mutant TUBB3 3′UTR were constructed, and the regulation effect and binding site of miR-200c to TUBB3 was studied by double luciferase reporter assay. The regulatory effect of miR-200c on the expression of TUBB3 protein, and on the expression of survivin and Bcl-2 protein were detected by Western blotting. SPSS statistics 19.0 was used to perform the statistical analysis. Results Compared with the control group, miR-200c transfection significantly increased the sensitivity of lung cancer cells to cisplatin [IC₅₀:(37.3±3.1) vs (15.3±3.3)μmol/L, P<0.01]. And the overexpression of miR-200c also resulted in the increased apoptosis rate of expression of A549/DDP cells (P<0.01), and decreased expression of survivin and Bcl-2 protein. The expression of TUBB3 at protein and mRNA levels was down-regulated in A549/DDP cells transfected with miR-200c mimics (P<0.01). Double luciferase reporter assay showed that miR-200c could regulate the expression of TUBB3 (P<0.01). All these results confirmed that TUBB3 was the downstream target gene of miR-200c. After pcDNA-TUBB3 plasmid was transfected, the expression of survivin and Bcl-2 protein in A549/DDP cells with miR-200c overexpression was up-regulated than that in the cells transfected with miR-200c mimics. Conclusion miR-200c can reverse the drug resistance of DDP-resistant lung cancer cells by down-regulating TUBB3 expression.

Abstract:Objective To analyze the data obtained from treadmill echocardiography (TESE) of myocardial microcirculatory injury in patients with primary hypertension and to investigate the relationship between myocardial microcirculatory injury and TESE parameters in those patients and its possible mechanism. Methods A total of 47 patients with clinically diagnosed primary hypertension were enrolled from June 2018 to June 2019. All patients underwent TESE within one week. At the same time, myocardial microcirculation perfusion was evaluated in combination with myocardial contrast echocardiography (MCE). According to imaging of myocardial microcirculation, hypertensive patients were divided into normal group and abnormal group. An analysis was done of the correlation between myocardial microcirculatory injury and TESE parameters in patients with primary hypertension and its possible mechanism. SPSS statistics 23.0 was used for data analysis. Results In patients with primary hypertension, there was no significant difference in the association between the severity of hypertension and myocardial microvascular injury (P>0.05). In the abnormal group, higher peak systolic blood pressure, lower metabolic equivalents (METs), lower cardiac dysfunction index, shorter exercise time, thicker interventricular septum thickness (IVST) and left ventricular posterior wall (LVPWT), and lower peak left ventricular ejection fraction (LVEF) than in the normal group (P<0.05). Multivariate analysis showed that, in patients with hypertension, myocardial microcirculatory injury was negatively correlated with chronotropic function and peak LVEF (OR=0.002,95%CI 0.000-0.981, P=0.049; OR=0.000, 95%CI 0.000-0.028, P=0.002) and positively correlated with LVPWT (OR=3.745,95%CI 1.301-10.774, P=0.014). Conclusion TESE can evaluate cardiac structure and functional status before and after exercise, and exercise tolerance in patients with hypertensive myocardial microcirculatory injury, which is worthy of clinical application. Myocardial microcirculatory injury inpatients with primary hypertension is associated with cardiac chronotropic function, suggesting that autonomic dysfunction may be involved in the pathogenesis of myocardial microcirculatory injury in patients with primary hypertension.

Abstract:Objective To compare the clinical effect of proximal femoral nail antirotation (PFNA) and Inter Tan (an intertrochanteric antegrade proximal femoral nailing system) in the treatment of intertrochanteric fracture in the elderly. Methods The clinical data of 49 elderly patients with intertrochanteric fracture of femur admitted to our department from February 2014 to February 2019 were collected and analyzed retrospectively. According to the treatment, the patients were divided into PFNA group (n=24) and Inter Tan group (n=25). The operation time, bleeding volume, fracture healing time, hospitalization time and complication rate, and Harris score and quality of life (QOL) score after 6 months′ follow-up were compared between the 2 groups. SPSS statistics 13.0 was used for data analysis. Student′s t test or Chi-square test was employed for comparison between the 2 groups. Results No screw loosening or breakage was observed in both groups. The PFNA group had significantly shorter operation time [(43.04±6.25) vs (72.58±6.49)min] and less bleeding volume [(124.5±18.8) vs (238.9±25.6)ml], but obviously higher incidence rates of postoperative complications (16.0% vs 4.2%) when compared with the Inter Tan group (all P<0.05). There were no statistical differences in Harris score [(89.0±2.5) vs (91.5±1.8)] and QOL score [(53.9±3.5) vs (51.2±3.7)] between them at 6 months after operation (P>0.05).Conclusion Both Inter Tan and PFNA have good clinical efficacy in the treatment of intertrochanteric fractures in the elderly. Each of them has its own advantages and disadvantages, and clinical selection should be based on the actual situation of patients.

Abstract:Objective To determine the effect of ropivacaine-assisted dezocine anesthesia on recovery and stress responses during the period in patients undergoing supratentorial tumor resection. Methods Sixty patients undergoing supratentorial tumor resection in our hospital from March 2017 to May 2019 were recruited in this study. They were randomly divided into study group (n=30) and control group (n=30). All groups were treated with general anesthesia. The patients of the control group received 20 ml of saline infiltration in 10min before incision, and intravenous injection of 10mg dezocine in 30min before the end of surgery. While, those of the study group received ropivacaine infiltration and 10mg dezocine at the same time points, respectively. The heart rate (HR), diastolic blood pressure (DBP), systolic blood pressure (SBP), levels of agonistic indices, including epinephrine (E), norepinephrine (NE), cortisol (Cor), glucose (Glu) before anesthesia (T₀), end of the operation (T₁), extubation immediately (T₂), and 30min after extubation (T₃) were compared between the 2 groups. The incidence rate of hypotension, usage of vasoactive drugs, anesthesia recovery, incidence of adverse reactions, anesthesia recovery sedation-agitation scale (SAS), pain degree score (visual analogue scale, VAS) were also recorded and compared. SPSS statistics 23.0 was used for analysis. According to the data types, Student′s t test or Chi-square test was applied forcomparison between two groups. Results At T₀, there were no significant differences in HR, DBP, SBP, and levels of E, NE, Cor and Glu between the 2 groups (P>0.05). At T₁, T₂ and T₃, the above indices in the study group were lower than those in the control group (P<0.05). Compared with T₀, no significant changes were observed in the above indices at T₁, T₂ and T₃ in the study group (P>0.05), but obvious changes were seen in the control group (P<0.05). The incidence of hypotension was 20.00%(6/30) in the control group and 6.67%(2/30) in the study group, though no significant difference between them (Chi-square=1.298, P=0.255). The cases taking vasoactive drugs such as NE, dopamine and ephedrine were 4,4 and 10 cases respectively in the control group, and 0,2 and 2 cases in the study group. There were significant differences in the proportion of taking vasoactive drugs between them (Chi-square=6.667, P=0.010). The study group had significantly shorter time of tracheal extubation [(15.41±3.20) and (24.02±4.93)min, t=8.024, P<0.001] and time of anesthesia recovery [(10.67±3.38) and (15.24±4.26)min, t=4.603, P<0.001], longer duration of analgesic effect [(11.73±1.59) and (7.91±1.28)h, t=10.250, P<0.001], decreased SAS score [(3.82±0.41) and (5.06±0.50), t=10.504, P<0.001) and VAS score [(2.25±0.21) and (4.30±0.36), t=26.941, P<0.001], and lower incidence of adverse reactions [10.00%(3/30) and 33.33%(10/30), Chi-square=4.812, P=0.028]during the recovery period when compared with the control group. Conclusion Ropivacaine-assisted dezocine anesthesia for supratentorial tumor resection can promote recovery after anesthesia, stabilize hemodynamics and reduce stress responses during recovery period, improve sedative and analgesic effects, and reduce adverse reactions.

Abstract:Objective To investigate the effect of nicotinamide mononucleotide (NMN) in treatment of cardiac fibrosis in mice and the underlying mechanism. Methods A total of 40 male C57/BL6J mice (8 weeks old) were randomly divided into cardiac fibrosis model group (model group), normal control+normal saline group (control group), model+NMN group and normal control+NMN group, with 10 mice in each group. Mouse model of cardiac fibrosis was established by peritoneal injection of 1.6mg/(kg·d) angiotension Ⅱ (Ang Ⅱ) through subcutaneously implanted Alzet 1004 micropump, and the mice of the control group was pumped with the same amount of normal saline. The changes of echocardiography, blood pressure, cardiac HE staining and Masson staining were observed, and the expression of cardiac fibrosis related genes and proteins in mice were detected by real-time quantitative PCR and Western blot analysis. Results Compared with the control group, the mice in the model group had declined cardiac function and severer cardiac fibrosis, while NMN treatment improved the ejection fraction and attenuated myocardial fibrosis. The expression of SIRT6 was significantly decreased in the model group, and NMN administration up-regulated the expression of the molecule. Conclusion NMN can inhibit the cardiac fibrosis induced by Ang Ⅱ in mice, which may be associated with its up-regulation of SIRT6 expression.

Abstract:Heart failure (HF) is a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill or eject blood and affects the function of multiple organs, including the brain, through diverse and complex mechanisms. In recent years, increasing emphasis have been put on bi-directional feedback interactions between the heart and the brain in the research of HF-associated diseases, and HF-related cognitive impairment (CI) has received great clinical attention. Although several studies have suggested that HF patients complicated with CI is associated with prolonged in-hospital stay and increased mortality, screening for CI in HF patients is not conducted routinely in the current practice, which contributes to misdiagnoses and thus affects the prognosis of patients. Therefore, this articles reviews the recent progress in pathophysiological mechanisms, clinical research, screening tools, and treatments of HF-related CI, which may warrant special attention in HF practice.

Abstract:Long non-coding RNA plays an important role in the occurrence and development of cancer. Taurine up-regulated gene 1 (TUG1) has different expression levels and possesses different mechanisms of action in different cancers, but its role in glioma still remains controversial. TUG1 can regulate transcription factors by epigenetic means, and also regulate the expression of post-transcriptional genes through competitive endogenous RNA. TUG1 regulates the occurrence and development of glioma, which probably be associated with tumor self-renewal, cell cycle, apoptosis, chromatin stability, blood tumor barrier and angiogenesis. This article reviews the mechanism of TUG1 in gliomas, summarizes the current research results of TUG1 in glioma, and predicts its clinical application.

Abstract:Age is an independent risk factor for frailty. Accelerated aging of the population results in an increasing number of frail people.The incidence of coronary heart disease increases with age, and about 11 million Chinese are suffering from the condition. Studies have found that frailty is closely related to the incidence and prognosis of coronary heart disease. This article mainly introduces the incidence of, assessment tools for, and risk factors for frailty, explores the mechanism of frailty and coronary artery disease and the progress in clinical research both at home and abroad with a view of providing basis for improving the prognosis of patients with frailty and coronary artery disease.

Abstract:Tranexamic acid (TXA) is an anti-fibrinolytic agent with better antifibrinolytic activity than its counterparts. It is widely used for hemorrhages caused by fibrinolysis in reproductive, urinary, nervous, and athletic systems. For intraoperative and post-operative blood loss, preoperative and postoperative TXA can be used in addition to conventional blood management such as intraoperative autologous blood transfusion, controlled hypotension, and low temperature anesthesia. TXA is increasingly recognized by surgeons for its remarkable hemostasis and safety.

Abstract:Metastatic encephaloma is the most common malignant tumor in the brain, and most primary tumors originate in the lungs. Brain metastasis of lung cancer results in poor prognosis and high mortality rate, with a natural survival of about 1-2 months and median survival of only 4-12 months even after active treatment. Current studies have shown that the prognosis of lung cancer patients with brain metastasis is closely related to imaging technology, radiotherapy technology, and surgical modality. With the improvement of radiotherapy technology and surgical methods, and the continuous development and utilization of targeted drugs in recent years, the survival of the patients has been largely prolonged, and the life quality has been significantly improved. This paper reviews systematically the research progress in brain metastasis of lung cancer in the aspects of radiotherapy, chemotherapy, surgical treatment and small molecule targeted treatment.