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Study design Retrospective cross-sectional study. Objective To investigate the prevalence, characteristics, and risk factors of spine-related malpractice claims in China in a 2-year period. Methods The arbitration files of the Chinese Medical Association (CMA) were reviewed for spine-related malpractice claims. Descriptive statistics and correlation analysis were conducted on claim characteristics, clinical data, plaintiff’s main allegations, and arbitration outcomes. Results A total of 288 cases of spinal claims filed in the CMA between January 2016 and December 2017 were included. Most claims were found in lumbar degenerative disorders (59.4%), lumbar trauma (13.2%), and cervical degenerative disorders (11.8%). The most common adverse events (AEs) leading to claims were new neurologic deficit (NND) (47.6%), infection (11.5%), and insufficient symptom relief (10.4%). The most common patient allegation was surgical error (66.0%), although the main arbitrated cause of AEs was disease/treatment itself (49.0%), while providers were judged as mainly responsible in only 47.3% cases. In multivariate regression analysis, cervical spine, misdiagnosis/mistreatment, and unpredictable emergency correlated with more severe damage to patients; minimally invasive surgery was predictive of judgment in plaintiff’s favor, while claims in the eastern region and unpredictable emergencies were predictive of defendant’s favor; only NND was associated with being arbitrated as surgical error in surgical cases where surgeons accepted major liability. Conclusion The current study provided a descriptive overview and risk factor analysis of spine-related malpractice claims in China. Gaining improved understanding of the facts and causes of malpractice claims may help providers reduce the risk of claims and subsequent litigation.

Objective. To assess the effectiveness and safety of extracorporeal shockwave therapy (ESWT) for the treatment of chronic low back pain (CLBP). Methods. This was a systematic review and meta-analysis of randomized controlled trials (RCTs) designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement standard. We identified relevant studies by searching multiple electronic databases, trial registries, and websites up to April 30, 2021, and examining reference lists. We selected RCTs that compared ESWT, in unimodal or multimodal therapeutic approaches, with sham ESWT or other active therapies. Two investigators independently extracted data and assessed the risk of bias and quality of the evidence. The main outcomes were pain intensity and disability status, examined as standardized mean differences (SMD) with 95% confidence intervals (CI). The risk of bias was assessed by using Cochrane Back and Neck (CBN) Group risk of bias tool and Jadad score, and GRADE was applied to determine the confidence in effect estimates. Heterogeneity was explored using sensitivity analysis and meta-regression. Results. Ten RCTs, including a total of 455 young to middle-aged individuals (29.2–55.8 years), were identified. Compared with control, the ESWT group showed lower pain intensity at month 1 ( SMD = − 0.81 , 95% CI −1.21 to −0.42), as well as lower disability score at month 1 ( SMD = − 1.45 , 95% CI −2.68 to −0.22) and at month 3 ( SMD = − 0.69 , 95% CI −1.08 to −0.31). No serious shockwave-related adverse events were reported. Conclusion. The use of ESWT in CLBP patients results in significant and quantifiable reductions in pain and disability in the short term. However, further well-conducted RCTs are necessary for building high-quality evidence and promoting the application of ESWT in clinical practice.

Epigallocatechin-3-gallate (EGCG) is the most abundant and biologically active catechin in green tea, and it exerts multiple effects in humans through mechanisms that remain to be clarified. The present study used bioinformatics to identify possible mechanisms by which EGCG reduces the risk of ovarian cancer. Possible human protein targets of EGCG were identified in the PubChem database, possible human gene targets were identified in the National Center for Biotechnology Information database, and then both sets of targets were analyzed using Ingenuity Pathway Analysis (IPA). The results suggest that signaling proteins affected by EGCG in ovarian cancer, which include JUN, FADD, NFKB1, Bcl-2, HIF1α, and MMP, are involved primarily in cell cycle, cellular assembly and organization, DNA replication, etc. These results identify several specific proteins and pathways that may be affected by EGCG in ovarian cancer, and they illustrate the power of integrative informatics and chemical fragment analysis for focusing mechanistic studies.

A pot experiment was conducted to investigate differences in antioxidative defence and carbon–nitrogen metabolism between acid-tolerant (YJSM) and acid-sensitive (YHSM) rice cultivars under acid stress. Acid-tolerant and acid-sensitive rice were planted in both acidic soil (pH 4.21) and normal soil (pH 6.13). Forty-eight days after sowing, rice shoots and roots from four treatments were collected, and the other four replicates were harvested at seed maturity. The results revealed that the grain yield of acid-tolerant YJSM was significantly higher than that of acid-sensitive YHSM under acid stress. The activities of antioxidant enzymes (superoxide dismutase and catalase) and contents of non-enzymatic antioxidants (ascorbate and reduced glutathione) of acid-tolerant YJSM were both higher than those of acid-sensitive YHSM under acid stress. Moreover, the enzyme activities (nitrate reductase, glutamine synthetase, glutamate synthase and glutamate dehydrogenase) and product contents (soluble sugar and ...

Process tomography (PT) techniques have been developed rapidly for visualizing the internal behavior of industrial processes, e.g. multi-phase flow measurement. Most of tomography systems employ a single measurement technique, such as computerized tomography (CT), optical tomography (OT), electrical resistance tomography (ERT) or electrical capacitance tomography (ECT). It is now possible to fit two or more tomographic systems to an industrial process. Detailed information from different modalities can be gained by inspection of separate tomographs, and the advantage of the strongest features provided by each unit can be taken. A combined tomogram can be produced of superior quality to any of the separate tomograms. To maximize the information available from the combined tomographic system, data fusion is the better option. In this paper, a dual-mode tomography system based on capacitance sensor and gamma sensor was developed to capture oil–gas two-phase flow. The two modalities can work at the same time. Two fusion methods, namely image fusion method and data fusion method, are proposed. Both simulation and static experiments for oil–gas two-phase flow were conducted. The reconstruction results of different fusion methods and modalities were compared and discussed.

The expression of resistin protein in normal human abdominal, thigh, pregnant women abdominal, non-pregnant women abdominal subcutaneous adipose tissue and placenta and the relationship between obesity, type 2 diabetes mellitus (T2DM), pregnant physiological insulin resistance (IR) and gestational diabetes mellitus (GDM) was investigated. The expression of resistin protein in normal human abdominal, thigh, pregnant women abdominal, non-pregnant women abdominal subcutaneous adipose tissue and placenta was detected by using Western blotting method. Fasting serum glucose concentration was measured by glucose oxidase assay. Serum cholesterol (CHOL), serum triglycerides (TG), serum HDL cholesterol (HDL-C) and serum LDL cholesterol (LDL-C) were determined by full automatic biochemical instrument. Fasting insulin was measured by enzyme immunoassay to calculate insulin resistance index (IRI). Height, weight, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured to calculate body mass index (BMI) and body fat percentage (BF%). Resistin protein expression in pregnant women placental tissue (67 905±8441) (arbittary A values) was much higher than that in subcutaneous adipose tissue in pregnant women abdomen (40 718±3818,P

Background The pathogenesis of Monteggia injuries remains controversial. The current study biomechanically explored the pathological changes during Monteggia fractures using finite element analysis. Methods Two cadaveric forearm specimens underwent computed tomography in both the prone and supine positions. The images were imported to Mimics to construct three-dimensional images. The obtained models of the annular ligaments were assembled onto the bones. Two thin gaps were produced at the proximal third of the ulna to simulate a Monteggia fracture. The models were analyzed mechanically. The initial fracture process was simulated by constraining the distal portions of the radius and ulna and the dorsal fracture sites of the ulna. The mechanical changes of the annular ligament in the two positions were observed and compared. Results In the prone position, the maximum Z-axial displacement of the annular ligament was close to that along the Y-axis, although with a significant difference (P

The expression of c-met stimulated by high glucose in human renal tubular epithelial cells and the role of HGF/c-met system in diabetic nephropathy were examined. The proximal tubular epithelial cells were cultured in vitro under different conditions. MTT was used for the detection of cellular proliferation and RT-PCR was employed for measurement of c-met mRNA level. Our results showed that under different conditions, there were no significant differences in the proliferation of proximal tubular epithelial cells 12 h and 24 h after the culuture (P0.05). The proliferation of proximal tubular epithelial cells showed a significant change 96 h after the culture and the cellular proliferation induced by hepatocyte growth factor (HGF) was very active (P0.05). Moreover, no significant difference in the expression of c-met mRNA was found 12 h after the culture under different conditions (P0.05), while 24 and 96 h after the culture, a persistent and significantly higher expression of c-met mRNA was found in HGF-induced proliferation. It is concluded that addition of exogenous HGF could inhibit the apoptosis induced by high-level glucose, promote the proliferation of proximal tubular epithelial cells, and induce the expression of c-met. Our study suggests that local up-regulation of HGF/c-met system plays an important role in the repair of renal damage in diabetic nephropathy.

The effects of heparin on the expression of transforming growth factor-β1 (TGF-β1) and two extracellular matrix components laminin (LN) and fibronectin (FN) in diabetic rat glomeruli were investigated. Twenty-six rats were randomly divided into control group (C,n=8), diabetic group (D,n=9), and diabetes+heparin group (DH,n=9). After 8-week therapy of heparin (200 U once daily by abdominal injection), TGF-β1, LN and FN expression in glomeruli was detected by immunohistochemical method. The results showed that the expression levels of TGF-β1, LN and FN were higher in group D than in group C. It was found that heparin could reduce 24-h urinary albumin excretion and inhibit overexpression of TGF-β1, LN and FN in glomeruli of diabetic rats. It suggested that the inhibitory effect of heparin on diabetic glomerular sclerosis was at least partly related with the inhibition of TGF-β1 expression.

Three steroidal constituents having the rare cis-B/C ring junctions (8-alpha-OH, 9-alpha-H), named amalogenin A, amaloside A and amaloside B, were isolated from the vine of Amalocalyx yunnanesis. The structures were deduced by precise NMR studies and confirmed by X-ray diffraction for amaloside A. The structures were shown to be 3-beta,8-alpha-dihydroxy-8-alpha,9-alpha,14-beta,17-beta,20(R)-pregn-5-ene-14,20-epoxy-13-carboxylic-20-lactone (amalogenin A) amalogenin A 3-O-beta-D-diginopyranoside (amaloside A) and amalogenin A 3-O-beta-D-glucopyranosyl(1-4)-beta-D-diginopyranoside (amaloside B).

Human cathepsin K, matrix metalloproteinase 9, and alpha(V)beta(3) integrin are the key regulators in osteoclast-mediated bone resorption. In this paper, we found natural inhibitors 1-10 for them by enzyme inhibition assays. Inhibitors 1-7, 8-9, and 10 are novel inhibitors of human cathepsin K, matrix metalloproteinase 9, and alpha(V)beta(3), respectively. (c) 2006 Elsevier Ltd. All rights reserved.

Seven constituents were isolated from the ethyl acetate extract of the rhizome of Cynanchum otophyllum Schneid (Asclepiadaceae). Their structures were determined as 1-(4-methoxy-3-(6-methoxy-3-acetylphenylperoxy)phenyl)ethanone (1), 1-(3-hydroxy-7-acetylnaphthalen-2-yl)ethanone (2), 1-(3,4-dihydroxyphenyl)ethanone (3), 1-(2,4-dihydroxyphenyl)ethanone (4), 1-(3-(3,6-dihydroxy-2-methylbenzoyl)-2,4-dihydroxyphenyl)ethanone (beishouwubenzophenone) (5), N,N-dimethylethanamine (6), and 2-oxo-2-phenylacetic acid (7), respectively, by spectral methods. Among them, 1 and 2 were new compounds; 1 had antifungal activity.

Two new C-21-steroidal glycosides having hepta-saccharide residue were isolated from the rhizome of Cynanchurn otophyllum Schneid. Their structures were determined to be caudatin 3-omicron-alpha-L-cymaropyranosyl-(l -> 4)-alpha-D-oleandropyranosyl-(1 -> 4)-alpha-L-cymaropyranosyl-(1 -> 4)-beta-D-glucopyranosyl-(1 -> 4)-alpha-D-oleandropyranosyl-(1 -> 4)-beta-D-oleandropyranosyl-(1 -> 4)-beta-D-diginopyranoside (1), and caudatin 3-omicron-beta-D-cymaropyranosyl-(1 -> 4)-alpha-D-oleandropyranosyl-(1 -> 4)-alpha-L-cymaropyranosyl-(1 -> 4)-beta-D-glucopyranosyl-(1 -> 4)-beta-D-oleandropyranosyl-(1 -> 4)-beta-D-cymaropyranosyl-(1 -> 4)-beta-D-diginopyranoside (2) by spectral methods, respectively.

In order to investigate the effect of tumor necrosis factor-alpha (TNFalpha) on resistin expression in 3T3-L1 adipocytes, and further explore its mechanisms, the differentiated 3T3-L1 adipocytes were incubated with 0, 1, 10, 100 ng/mL TNFalpha respectively for 24 h, and then the expression of resistin was determined. The differentiated 3T3-L1 adipocytes were incubated with 100 ng/ mL TNFalpha for 3, 6, 24 h respectively, and then the expression of resistin mRNA was analyzed. 3T3-L1 adipocytes were induced to differentiate into mature adipocytes. The cells were randomly divided into 4 groups for culture. In the control group, no drugs were added. Cells of TNFalpha group were treated with 100 ng/mL TNFalpha. In Ro-31-8220 group, 5 micromol/L protein kinase C inhibitor Ro-31-8220 was added. With TNFalpha+Ro-31-8220 group, 100 ng/mL TNFalpha were added 1 h after the addition of 5 micromol/L Ro-31-8220. All adipocytes were cultured for 24 h. Reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting were employed to detect the expression of resistin gene. Our results showed that resistin protein and mRNA in 3T3-L1 adipocytes were inhibited by TNFalpha at different concentrations (P0.01), and the inhibitory effect increased with the concentration (P0.01). At the same concentrations, the inhibitory effect increased with time (P0.01). Ro-31-8220 could inhibit its expression and the inhibitive effect remained unchanged with addition of TNFalpha (P0.05). It was concluded that TNFalpha could inhibit the expression of resistin in 3T3-L1 adipocytes. The mechanism may be that the expression of resistin is partly controlled by protein kinase C signal conduction pathway.

The structures of three new steroids, amaloside C, amaloside D and amalogenin B, isolated from Amalocalyx yunnanensis, were deduced from their NMR spectra. They all have a characteristic cis-B/C-ring junction and an 18-carboxylic-20-lactone in the aglycones.

Aging is the major risk factor for many human diseases and degeneration. Thus, clinically effective medicine could delay the process of aging and aging-related diseases are desperately wanted. In traditional Chinese medicine (TCM), some were claimed to slow down aging. Qingyangshen (Cynanchum otophyllum schneid) is such a TCM. Here, we assayed the longevity effect of compound Otophylloside B (Ot B), a C-21 steroidal glycoside isolated from Qingyangshen, in Caenorhabditis elegans, which is a popular model for aging research. Our results showed that Ot B could modestly extend the lifespan of C. elegans, delay the age-related decline of body movement and improve the stress resistance. Further investigating the molecular mechanism of lifespan extension effect revealed that Ot B could activate the FOXO transcription factor DAF-16. Ot B could not further extend the lifespan of long-lived mutant of insulin/IGF-1-like receptor (daf-2). In addition, Ot B also requires SIR-2.1 and CLK-1 which is an enzyme in ubiquinone synthesis, for lifespan extension. Electronic supplementary material The online version of this article (doi:10.1007/s13659-015-0064-4) contains supplementary material, which is available to authorized users.