Abstract:Osteonecrosis of femoral head (ONFH), a kind of bone metabolic disease, is featured by reduced osteogenic activity of osteoblasts (OB), increased osteoclast activity of osteoclasts (OC), decreased bone marrow stromal cells (BMSCs) osteogenic differentiation with enhanced adipogenic differentiation, disrupted vascular endothelial cells, and dropped blood supply, resulting in a negative balance of bone metabolism in the femoral head. ONFH is closely related to the abnormal intercellular communication of bone tissue. Gap junction (GJ) is a membrane channel structure for intercellular communication between adjacent cells, and GJ plays an important regulatory role in substance exchange and signal transduction between bone tissue and cells. Communication of gap junction cell through GJ plays an important role to keep the dynamic balance of bone metabolism. Connexin 43 (Cx43) is an important component of GJ in bone tissue. Therefore, GJ-mediated intercellular communication is closely related to the occurrence of bone metabolic diseases such as ONFH. This paper reviews the research progress of GJ and Cx43 roles in the diseases of glucocorticoids-induced ONFH.

Abstract:Articular cartilage is the most common hyaline cartilage which has been studied the most. The solute transport of chondrocytes includes diffusion and convection. In the extracellular matrix, diffusion and convection of bioactive molecule plays an important role in physiologic adjustment and cytobiological response. For the last few decades, the interaction of subchondral bone and articular cartilage has been investigated, which is considered as an important aspect in the etiology of osteoarthritis. In this paper, we have reviewed studies of solute transport in articular cartilage and the interface of cartilage and subchondral bone, aiming to provide references to environmental pathophysiological function of articular cartilage and provide new thoughts for treating clinical ostearthritis.

Abstract:Spinal cord injury (SCI) is a common refractory disease and has been a focus of clinical research. It not only damages patients' physical and mental health, but also brings a heavy financial burden to their family and society. Although there are many researches on SCI, its exact mechanism still remains unclear. Therefore, effective treatments for SCI are in urgent needs. In recent years, relevant studies have shown that the inflammatory reaction caused by microglia polarization plays an important role in SCI. Therefore, this paper reviews the mechanism of microglia polarization in SCI, so as to provide new therapeutic strategies for SCI in the future.

Abstract:Objective:　To investigate the effect of extracorporeal shock wave (ESW) on repair of skeletal muscle injury, so as to provide theoretical basis for clinical application of ESW in the treatment of skeletal muscle disease. Methods:　A model of skeletal muscle blunt contusion was established, and the experiment was divided into the ESW group and the injury group. The ESW group were treated with ESW on the 1st day after injury, and the tissues in the injury area of the two groups were taken for HE staining on the 1st d, 4th d, and 7th d after treatment to observe the tissue morphology; immunohistochemistry was used to detect the expression of myostatin (Mstn), and the images analysis software was used to perform average optical density (AOD) analysis; Western blot was used to detect expression levels of Myod and Mstn protein. Results:　In the ESW group, the muscle fiber atrophy was gradually alleviated and the inflammatory cell infiltration was decreased. During this period, a large number of new muscle cells were seen and post-treatment muscle fiber was lined up in order. Results of immunohistochemistry showed that Mstn (1st d: 0.158±0.015, t=3.229, P=0.032; 4th d: 0.203±0.004, t=6.069, P=0.004; 7th d: 0.149±0.009, t=2.821, P=0.048) expression was lower than that in the control group (1st d: 0.190±0.006; 4th d: 0.242±0.189; 7th d: 0.171±0.011). Western blot results showed that the expression of Myod protein in the ESW group was firstly increased with increasing intensity and then decreased (F=50.074, P=0.000). And over time, the amount of expression also showed a trend of rising at first and then falling (F=46.217, P=0.000). With the concentration of 0.14 mJ/mm², expressions in the treatment group (1st d: 0.998±0.163; 4th d: 1.155±0.059; 7th d: 0.733±0.077) were higher than those in the control group (1st d: 0.410±0.115; 4th d: 0.560±0.194; 7th d: 0.250±0.103). With the increase of the impact strength, the expression of Mstn protein was gradually decreased (F=86.103, P=0.000). Expression at different time was risen at first and then decreased (F=32.380, P=0.000). With the concentration of 0.14 mJ/mm², expressions in the ESW group (1st d: 0.131±0.044; 4th d: 0.383±0.022; 7th d: 0.162±0.027) were lower than those in the control group (1st d: 0.388±0.060; 4th d: 0.829±0.192; 7th d: 0.508±0.112). Conclusion:　This experiment confirms that ESW can promote the repair of skeletal muscle injury in rats.

Abstract:Objective:　To investigate the expression of matrix metalloproteinases 9 (MMP-9) in osteosarcoma tissues and the effect of MMP-9 on the progression of osteosarcoma and its clinical significance. Methods:　The expression of MMPs'family in 5 osteosarcoma specimens and 5 normal bone tissues was detected by real-time quantitative PCR. shRNA was used to knockdown the expression of MMP-9 in Saos2 cells. The proliferation, invasion and migration of the cells after transfection were detected for the effects of MMP-9 down-regulation. According to the expression of MMP-9 in osteosarcoma, 64 follow-up cases were grouped and analyzed for survival rate. Results:　Screening of MMPs'family revealed that the expression of MMP-9 in osteosarcoma tissues was significantly higher than that in normal bone tissues (t=12.040, P=0.000). In cell proliferation, invasion and scratch test, there was no significant difference between blank control group and negative control group. But compared with negative control group, down-regulation of MMP-9 in Saos2 cells markedly repressed cell proliferation, decreased invasion and migration (t=4.954, P=0.008; t=6.360, P=0.003; t=3.965, P=0.017). In addition, a survival analysis in 64 follow-up cases showed that the overall survival rate of the high-MMP-9 group was significantly lower than that of the low-MMP-9 group (χ²=4.169, P=0.041). Conclusion:　The high expression of MMP-9 in osteosarcoma tissue is closely related to the proliferation, invasion and migration of osteosarcoma, which has certain implication for the clinical prognosis of patients.

Abstract:Objective:　To investigate the role of Netrin-1-enhanced bone marrow mesenchymal stem cells (BMSC) on the treatment of osteoporotic fracture and its mechanism. Methods:　The apoptotic level of BMSC and the expression of human leukocyte antigen-G (HLA-G) were detected by flow cytometry. Mice models with osteoporotic fracture were built. Concentrations of alkaline phosphatase, tartrate resistant acid phosphatase (TRAP) and osteocalcin were detected by ELISA, and the number of human BMSC and macrophages in bone tissue was detected by immunohistochemistry. Results:　Flow cytometry showed that Netrin-1 was able to inhibit the apoptosis of BMSC induced by ischemia and hypoxia (F=27.311, P=0.000), and increase the expression of HLA-G (F=27.094, P=0.000). BMSC was able to reduce the concentration of alkaline phosphatase and TRAP in serum, and increase the concentration of osteocalcin in serum, the number of osteocytes in bone tissue and the bone mineral density. Netrin-1 was able to further enhance functions of BMSC. Compared with the BMSC group, the difference was statistically significant. Immunohistochemical results showed that the number of surviving BMSCs in the BMSC group was (10.401±1.392) /high-power field (HPF) and was (25.506±2.257) /HPF in the Netrin-1 group, with significant differences between two groups (t=5.694, P=0.000). The number of macrophages in the BMSC group was (21.900±4.458) /HPF, which was significantly different from that in the osteoporosis group. The number of macrophages in the Netrin-1 group was (11.500±3.808) /HPF, which was significantly different from that in the BMSC group (F=79.863, P=0.000). Conclusion:　Netrin-1 can enhance the therapeutic effect of BMSC on osteoporotic fracture through cell protection and regulation of inflammatory reaction.

Abstract:Objective:　To explore the key pathogenic genes involved in osteoarthritis (OA) and potential therapeutic drugs for OA by bioinformatics. Methods:　The expression profiles of GSE55235, GSE12021 and GSE55457 were downloaded from the gene expression omnibus (GEO) database. The microarray data were integrated to obtain differentially expressed genes (DEGs) by R software. The gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG) pathway enrichments of DEGs were performed by DAVID online analyses. The protein-protein interaction (PPI) was analyzed by using STRING online database and visual editing by Cytoscape software. Finally, small molecule drugs with potential therapeutic OA were analyzed by connectivity map (cMap) database. Results:　A total of 67 DEGs were obtained, of which 18 genes were up-regulated and 49 genes were down-regulated. GO analysis showed that the biological process of DEGs focused on cell proliferation, cell adhesion, response to mechanical stimulus, osteoblast differentiation, and the regulation of cellular response to calcium ions. The main cell composition included extracellular space, endoplasmic reticulum membrane and cyclin-dependent protein kinase holoenzyme complex. The molecular functions included protein homodimerization activity, growth factor activity, transcription factor activity, RNA polymeraseⅡcore promoter proximal region sequence-specific binding, protein heterodimerization activity, peroxidase activity, and MAP kinase tyrosine/serine/threonine phosphatase activity. KEGG pathway analysis showed that these DEGs were mainly involved in the osteoclast differentiation, TNF signaling pathway, PI3K-Akt signaling pathway, MAPK signaling pathway, cytokine-cytokine receptor interaction and Jak-STAT signaling pathway. The top 10 hub genes IL-6, JUN, VEGFA, ATF3, DUSP1, MYC, PTGS2, JUNB, CDKN1A and CD44 were identified from the PPI network. Some potential small molecular drugs for the treatment of OA, such as estradiol and leflunomide, were also been screened. Conclusion:　The selected key genes may be the diagnostic markers and potential therapeutic targets of OA, and the selected small molecular drugs may be potential therapeutic drugs for OA treatment.

Abstract:Objective:　To establish and validate a finite element model of composite artificial femur. Methods:　A composite artificial femur of fourth generation SAWBONE and a normal human femur of cadaveric specimen were selected to conduct three-dimensional reconstruction of femur via computed-tomography scan. Two groups of composite artificial bone entity models including cortical bone, cancellous bone, and medullary cavity and three-dimensional model of normal human femur were reconstructed. A load case of axial compression during mid-stance gait of lower extremities was simulated while an identical boundary condition was applied to both groups of models. The model validation of composite artificial femur was conducted according to the comparison of biomechanical response among the two groups and the results from previous literature. Results:　Regarding to the peak stress distribution and the magnitude of displacement peak value, the finite element model of composite artificial femur presented relatively in good accordance with results from previous literature. Nevertheless, the biomechanical response of cadaveric femur presented significantly lower stress distribution comparing to that of the composite femur model. Conclusion:　The results of finite element analysis of composite artificial femur are in good agreement with previous literatures, which can be used for biomechanical research of femur and biomechanical evaluation of orthopedic implants, and has obvious advantages over cadaveric specimens in terms of material sources and individual anatomical differences.

Abstract:Objective:　To investigate the clinical effect of a new anatomic locking plate for posterior malleolus fracture. Methods:　Data of 22 patients (male of 14 patients and female of 8 patients; age from 21-57 years old, average of 42.5 years old) with ankle fractures (all the fractures involved the posterior ankle and the fracture area≥25%) that were admitted to our hospital from September 2017 to December 2018 were collected, including 20 patients suffered trimalleolar fracture (11 patients with type AO and B, and 9 patients with type C) and 2 patients suffered posterior malleolus fracture. All patients were treated with open reduction via the posterolateral approach and internal fixation with a new posterior malleolus anatomical locking plate after 3 days to 7 days (mean 5 days) of deswelling until the appearance of dermatoglyphic lines. Results:　After operation, 22 patients were followed up for 11 to 25 months (mean 16 months). The fracture healing time was 8 to 13 weeks, with an average of 11.8 weeks. There was no fracture delay healing and fracture non-healing. One patient had superficial skin infection, which was healed after dressing change. No traumatic osteaorthritis was occurred at the last follow-up. All patients were evaluated with the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale: excellent 20 cases and good 2 cases, with excellent and good rate of 100% and average score of 94.0 points. Conclusion:　The new anatomic locking plate of posterior malleolus has a good curative effect and is a good choice for fixing posterior malleolus fracture.

Abstract:Objective:　To study the changes and diagnostic value of peripheral serological indexes in knee osteoarthritis. Methods:　A total of 228 patients with knee osteoarthritis (KOA) admitted to our hospital undergoing total knee arthroplasty (TKA) from January 2013 to January 2018 and 120 healthy volunteers were enrolled in this study. They were divided into KOA group and healthy control group. Demographic parameters, blood neutrophil percentage (NEU%), monocyte count, lymphocyte count, red blood cell distribution width (RDW-CV), serum alkaline phosphatase (ALP), and serum uric acid (UA) of all participants were recorded, and the neutrophillymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR) were calculated and compared between the two groups. Then the receiver operating curve (ROC) was drawn to determine the diagnostic threshold. The HSS scores of knee joint at 1 day, 3 months, 6 months and 1 year after TKA were followed up, and the correlation between HSS scores and NLR and MLR was analyzed. Results:　Elevated blood NLR, MLR and RDW-CV were apparent features in KOA patients compared with healthy individuals (P<0.001) and NLR≥2.005, MLR≥0.165 and RDW-CV≥12.45 were the diagnostic thresholds for KOA based on the ROC characteristics. These blood indictors of only 26 patients with KOA were followed up for one year after TKA, and the results indicated that NLR and MLR were gradually reduced with the improvement of knee joint HSS scores, with significant correlation. Conclusion:　Our present results show that both NLR, MLR and RDW-CV are promising peripheral blood markers of KOA, and the NLR and MLR may be served as the serum markers to predict the prognosis of TKA.

Abstract:Objective:　To treat Denis type B lumbar burst fractures with symptoms of nerve injury by percutaneous pedicle screw fixation combined with the lateral iliocostalis approach for direct anterior decompression, and to evaluate the clinical effect and application value of this operation. Methods:　Twenty-eight patients with single-segmental Denis type B lumbar burst fractures underwent this operation, involving L1-3 segments. At first, the patients underwent percutaneous three-segment fixation and anterior direct decompression by reduction or/and removal of fragments in spinal canal. Then, the posterolateral intermuscular approach for anterior direct spinal canal decompression started from the lateral side of the iliocostalis, passed through the gap between the iliocostalis and quadratus lumborum, and reached the posterior part of injured vertebra at the level of the upper endplate through the intervertebral foramen. The patients were followed up for 18 months, and the imaging and clinical efficacy were observed and evaluated. Results:　All patients received the operation by this method. The mean operation time was (152.1±27.1) min, and the blood loss during the operation was (137.8±42.0) mL. According to the imaging makers, the Cobb angle of kyphosis recovered from (34.0°±6.2°) preoperatively to (9.7°±2.7°) 18 months after operation (P<0.05); the height ratio of the anterior edge of the injured vertebra, recovered from (43.3±9.4)% to (66.3±7.5)% (P<0.05); and the ratio of sagittal diameter of spinal canal, recovered from (54.7±8.3)% to (10.9±4.2)% (P<0.05). For the curative effect evaluation indexes, significant improvements in visual analogue scale (VAS) [(6.1±1.2) vs. (1.4±1.0), P<0.05], oswestry disability index (ODI) [(86.1±4.2) vs. (27.3±12.3), P<0.05], and American Spinal Injury Association (ASIA) scores were also notedly improved. Conclusion:　Posterior percutaneous pedicle screw fixation combined with lateral iliocostalis bypass for direct anterior decompression in the spinal canal is effective in the treatment of type Denis B lumbar burst fractures. The posterolateral intermuscular approach is minimally invasive and effective for anterior direct decompression of the spinal canal. This new operation has potential in clinical application.

Abstract:Objective:　To establish a new prediction model combing the inflammatory markers including neutrophil/lymphocyte ratio (NLR) and red blood cell distribution width (RDW) with several hematological testing indicators to assess the prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods:　Clinical data and laboratory testing indicators of 577 patients from three hospitals were collected in this study. The model for end-stage liver disease (MELD) score was used to establish the new model cohort of 554 patients with MELD score between 9 points and 40 points. Univariate and multivariate COX regression analysis were used to identify the independent risk factor associated with the prognosis of patients with HBV-ACLF, so as to establish the prognostic assessment model. And ROC curves were applied to validate the new model in predicting the 90-day prognosis in patients with HBV-ACLF in three hospitals, respectively. SPSS 22.0 software was employed for data analyses. Results:　Multivate COX regression analysis showed that RDW, NLR, international normalized ratio (INR), and creatinine (Cr) and total bilirubin (TBIL) were independent factors of 90-day prognosis in patients with HBV-ACLF (P<0.05). The prediction model was established according to the multivariate Cox regression analysis, COX_RNTIC=0.073×RDW+0.027×NLR+0.004×TBIL+0.236×INR+0.005×Cr (P=0.000), with a cut-off value of 3.59 (sensitivity: 78.48%, specificity: 84.86%). ROC curve was used to detect the predictive ability and the results showed that RNTIC (0.864, 95%CI=0.837-0.903) was better than MELD score (0.737, 95%CI=0.698-0.773), NLR (0.705, 95%CI=0.665-0.743) and RDW (0.677, 95%CI=0.637-0.716) (P=0.000). In the validation cohort, RNTIC model demonstrated a better predictive value of death than RDW, NLR, and MELD score in three hospitals. Conclusion:　The short-term prognostic prediction model of HBV-ACLF which is established on the basis of inflammatory markers of RDW and NLR has a better predictive value when compared with MELD score, and is a reliable clinical predictive model.

Abstract:Objective:　To compare the safety and effectiveness of ultrasound-guided percutaneous peritoneal dialysis catheterization with multifunctional bladder fistulation paracentesis trocar and open abdominal catheterization. Methods:　A total of 242 patients who were diagnosed with end-stage renal disease (ESRD) and who voluntarily chose the peritoneal dialysis in the peritonea dialysis center of Yongchuan Hospital of Chongqing Medical University from June 2016 to July 2018 were selected as study objects. Among them, 93 patients were treated with ultrasound-guided percutaneous peritoneal dialysis catheterization with multifunctional bladder fistulation paracentesis trocar (group A), and 149 patients were treated with traditional open abdominal catheterization (group B). After surgery, all patients were followed up for one year; the success rate of clinical catheterization, incidence of early-and-late complications and one-year technical survival rate of catheter in two groups were retrospectively analyzed. SPSS 17.0 statistical software was used for data analysis. Results:　Gender, age and history of abdominal operation in two groups had no significant differences (P>0.05). Incision length and operation time in the group A were all shorter than those in the group B (P<0.05). Incidence of early peritonitis and incidence of advanced catheter-end and tunnel infection in the group A were lower than those in the group B (P<0.05). Success rate of clinical catheterization and one-year technical survival rate of catheter in the group A were higher than those in the group B (P<0.05). Intraoperative complications, catheter displacement, perivascular leakage, abdominal hernia and abdominal tube occlusion in two groups had no significant differences (P>0.05). Conclusion:　Ultrasound-guided percutaneous peritoneal dialysis catheterization with multifunctional bladder fistulation paracentesis trocar is safer and more effective, and can be used as an alternative to traditional open abdominal catheterization.

Abstract:Objective:　To investigate the expression of blood urea nitrogen in differentiated thyroid cancer and benign thyroid tumors, so as to evaluate the difference of urea cycle dysregulation between them. Methods:　A total of 218 patients with diagnosis of differentiated thyroid cancer were enrolled in the group A and 193 patients with benign thyroid tumors in the group B. Blood urea nitrogen levels were measured 1-3 days before surgery.T test was used to analyze differences of urea nitrogen levels in two groups and two-way ANOVA analysis of variance was used to assess the effects of age, gender and tumor properties on urea nitrogen levels. The expression of genes related to urea cycle was evaluated by GEPIA database. Results:　After excluding chronic lymphocytic thyroiditis, the urea nitrogen level in the group A was significantly higher than that in the group B (P>0.05). Males' age>55 years old was the factor for elevating nitrogen levels, while the metastasis status of lymph node was not an influencing factor. The expression of TP53 and MDM2 in the cancer tissue was higher, without significant differences. Conclusion:　Males older than 55 years old are more likely to have dysregulation of urea metabolism.

Abstract:Objective:　To investigate the risk factors of necrotizing enterocolitis (NEC) in very low birth weight infants (VLBWI). Methods:　A retrospective study of VLBWI admitted to the Children's Hospital of Chongqing Medical University from January 2011 to October 2019 was conducted. Infants were assigned into two groups: NEC group (Bell stage≥Ⅱ) and non-NEC group. The data were measured with the Student's t-test, Kruskal-Wallis test, chi-square or the Fisher's exact test. Logistic regression analysis was used to identify independent risk factors associated with NEC. Results:　Of 497 VLBWI enrolled, 30 infants developed NEC. There were no significant differences in gender, gestational age, birth weight, and admitted age between the two groups. Higher incidences of in vitro fertilization and embryo transfer (IVF-ET) (P=0.025), intrauterine growth retardation (IUGR) (P=0.015), atrial septal defect (P=0.014), cardiac dysfunction (P=0.041), renal dysfunction (P=0.012), liver dysfunction (P=0.003), hypoalbuminemia (P=0.002), electrolyte disorder (P=0.041), and sepsis (P=0.000) were found in infants with NEC compared with those without NEC. Logistic regression analysis revealed sepsis (OR=13.24, 95%CI=4.04-43.36, P=0.000), hypoalbuminemia (OR=4.22, 95%CI=1.14-15.58, P=0.031), IUGR (OR=3.46, 95%CI=1.18-10.14, P=0.024) and IVF-ET (OR=4.85, 95%CI=1.50-15.68, P=0.008) were the risk factors of VLBWI with NEC. Conclusion:　We should keep an eye on sepsis, hypoalbuminemia, IUGR and in IVF-ET among VLBWI, which are the risk factors of NEC.

Abstract:Objective:　To retrospectively analyze the clinical characteristics of acute appendicitis (AA) and outcomes after appendectomy in≤5-year-old children. Methods:　The clinical data of 538 children with AA aged five years or younger were collected retrospectively. According to the intraoperative findings and postoperative pathological examination, they were divided into complex appendicitis (CA) group (n=326) and simple appendicitis (SA) group (n=212). Clinical data of the two groups were compared and analyzed. Results:　①The median age of children in CA group was lower than that in SA group (3.4 years old vs.4.3 years old, P=0.000), while the admission temperature (38.4℃vs.38.1℃, P=0.000) and symptom duration (26 h vs.24 h, P=0.000) in CA group were higher than those in SA group, and the incidences of vomiting, diarrhea, rebound tenderness and abdominal distension in CA group were higher than those in SA group (all P<0.05).②The levels of white blood cell count, neutrophil count, lymphocyte count and procalcitonin level in CA group were higher than those in SA group before operation (P<0.05). In addition, white blood cell count was more effective in predicting CA, and the area under the ROC curve was 0.738 (95%CI=0.695-0.781).③The hospitalization time and postoperative antibiotic use time in CA group were longer and the intraoperative blood loss of children in CA group were greater than those in SA group (all P<0.05). Conclusion:　The clinical manifestations of AA in children aged five years or younger are not typical. There were some differences in clinical manifestations, assay indicators and clinical outcomes between CA and SA children.

Abstract:Objective:　To compare the correlation between endoscopic and pathological diagnosis of chronic atrophic gastritis (CAG), and to explore how to improve the coincidence rate of these two diagnostic methods. Methods:　This study included in 192 cases of CAG diagnosed by endoscopy combined with pathologic biopsy, and the coincidence rate between the endoscopic and pathological diagnosis of CAG was retrospectively studied by analyzing the correlation between endoscopic findings and pathological examination results. Results:　Among 192 patients with CAG diagnosed by endoscopy, only 56 cases were also confirmed by pathological diagnosis at the same time, with coincidence rate of 29.17%. The atrophic gastritis under the endoscopy showed red and white mucosa, thin mucosa folds or some exposed and transparent blood vessels, mucosa with rough and/or granular or nodular performance and mucosa with these all four characteristics. The coincidence between them was 33.7%, 24.8%, 32.8%, 42.7%, respectively, without significant difference between them (P=0.293). The coincidence rate about endoscopic biopsy location of gastric antrum, gastric angle and gastric body was 25.9%, 39.5% and 47.5%, respectively, with statistical significance (P=0.019). The CAG coincidence rates of 1, 2, 3 and 4 biopsy specimens were 26.6%, 34.5%, 66.7% and 100.0%, respectively, among which the CAG coincidence rates of 1 biopsy specimen between those of more than 1 (2-4) biopsy specimen were not statistically significant (P=0.089).Helicobacter pylori (HP) infection rate of the patients with CAG diagnosed by both endoscopy and pathology was 52.0%, and that of the non-chronic atrophic gastritis cases diagnosed pathologically was 45.5%, with no significant difference between them (P=0.455). There were 50 patients pathologically diagnosed with CAG and they underwent¹³C breath test. They were divided into A (red and white gastric mucosa, or/and mainly white), B (thin gastric mucosa, exposed and transparent blood vessels) and C (mucosa with rough and/or granular or nodular performance) types according to different microscopic manifestations, and the HP infection rates of the three were 48.5%, 37.5% and 29.2%, respectively, without statistical differences (P=0.594). Conclusion:　There are misdiagnosis and missed diagnosis of the CAG through endoscopic examination alone, the awareness of the diversified manifestations under endoscopy and the endoscopy and pathology should be combined to improve the diagnosis rate of the CAG.

Abstract:Objective:　To study the role of vancomycin plasma concentration determination in treating patients with peritoneal-dialysisrelated peritonitis, so as to provide theoretical basis for peritonitis treatment. Methods:　Clinical data of patients with peritoneal-dialysisrelated peritonitis from January 1, 2016 to December 31, 2018 in our hospital were collected and retrospectively analyzed. Patients were divided into the low concentration group (<15 μg/mL) and the high concentration group (≥15 μg/mL) according to the blood concentration of vancomycin. Differences in gender, onset characteristics, age, dialysis age, various routine biochemical indicators, urine volume, dropout rate, body mass index (BMI) and hospitalization day between two groups were analyzed. Factors influencing the blood concentration of vancomycin were detcetd by logistic regression analysis. Results:　A total of 106 cases of peritoneal dialysisrelated peritonitis occurred in the last three years, with an average incidence of 0.19 times/year. Among them, 72 cases (67.92%) were positive for bacteria culture of permeable bacteria, among which 39 strains (54.17%) were gram-positive bacteria. Among the grampositive bacteria, Staphylococcus epidermidis and Staphylococcus aureus were the most common, and were sensitive to vancomycin. BMI, urine volume, and hospitalization time between two groups had significant differences. Logistic regression analysis showed that low-density lipoprotein (OR=2.240, P=0.038), BMI (OR=1.981, P<0.001) and urine volume (OR=13.749, P=0.010) were the main factors affecting vancomycin concentration. Conclusion:　The determination of vancomycin plasma concentration is of great clinical significance to provide a more reasonable drug regimen for treating peritoneal-dialysis-related peritonitis.

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