Objective:To compare the similarities and differences of macrophage activation syndrome（MAS）combined with systemic juvenile idiopathic arthritis（sJIA）versus with juvenile onset systemic lupus erythematosus（JSLE）.Methods:The clinical data of 48 children with MAS admitted to the Department of Nephrology and Immunology in Children's Hospital of Hebei Province from May 2015 to January 2023 were retrospectively analyzed. The patients were divided into sJIA-MAS and JSLE-MAS group，and the clinical manifestations，laboratory indicators and treatment of the two groups were compared.Results:Among the 48 children（14 males and 34 females）with MAS，the average age of onset was 9.5（3.0，11.8）years. There were 28 cases（11males and 17 females）of sJIA-MAS and 20 cases（3 males and 17 females）of JSLE- MAS. All the 48 children with MAS had fever and hyperferinemia，and the fever with sJIA-MAS was mostly continued fever or remittent fever. Respiratory tract infection was the most common trigger in sJIA-MAS［15 cases（53.6%）］，and disease activity was the most common trigger in JSLE-MAS［13 cases（65.0%）］.Additionally，viral infections（EB virus and cytomegalovirus）were also one of the triggers in MAS［sJIA：7 cases（25%），JSLE：4 cases（20%）］.Compared with JSLE-MAS，the number of days with fever［15.0（12.0，21.0）days vs. 6.0（4.0，9.5）days， Z=-3.812， P=0.001］and the length of hospital stay［29.0（26.3，39.8）days vs.26.0（19.3，30.8）days， Z=-1.958， P=0.049］were longer in sJIA. Compared with JSLE-MAS，ALT［（685.32±561.67）U/L vs.（139.61±124.44）U/L， t=4.973， P=0.001］，AST［784.00（235.25，1 251.25）U/L vs.189.50（53.25，374.08）U/L， Z=-3.283， P=0.001］，CRP［11.48（3.56，28.89）mg/L vs.1.91（0.53，8.98）mg/L， Z=-3.200， P=0.001］，ferritin［32 167.0（12 384.8，65 963.8）μg/L vs.2 003.5（922.5，11 430.0）μg/L， Z=-4.130， P=0.001］，ferritin max/ESR min［1 353.35（355.75，4 342.53）vs.91.92（34.94，291.53）， Z=-4.120， P=0.001］were higher in sJIA.The decrease of CRP was greater in sJIA［80.04（45.64，143.71）mg/L vs.10.20（6.27，25.64）mg/L， Z=-4.433， P=0.001］.Compared with sJIA-MAS，peripheral white blood cell counting［4.05（2.90，7.73）×10 9/L vs.1.56（1.15，3.47）×10 9/L， Z=-3.577， P=0.001］and platelet counting［（162.68±92.19）×10 9/L vs.（110.10±72.99）×10 9/L， t=2.118， P=0.040］were lower in JSLE-MAS. Kidney involvement was more common in JSLE-MAS［10 cases（50%）vs.0 cases（0%）， χ 2=17.684， P=0.001］.There was no significant difference in the incidence of sJIA-MAS and JSLE-MAS meeting the criteria of hemophagocytic lymphohistiocytosis［6 cases（21.4%）vs.5 cases（25.0%）， χ 2=0.084， P=0.772］. Conclusion:Compared with JSLE-MAS，sJIA-MAS is more dangerous and difficult to control，while JSLE-MAS involves more organs，among which the blood system and kidney are more common.

Femoral acetabular impingement (FAI) syndrome is a motion-related clinical disorder of the hip joint, resulting in cartilage lesions frequently. The pattern and natural history of these cartilage lesions vary with types of FAI, each bearing unique gross appearance and injury mechanism. On the basis of available evidence, this paper reviews the progress of the FAI-related acetabular cartilage lesions in pathogenesis, diagnosis and treatment. Cam-type FAI is always closely associated with acetabular cartilage lesions and early-onset of hip osteoarthritis. However, the reason why acetabular cartilage developed into osteoarthritis in FAI of Cam-type is unknown. In addition to the direct mechanical impingement and the vulnerable anatomic base of chondrolabral junction, stress change from abnormal movement or anatomical morphology will lead to the change of biomechanical environment, causing a chronic-recurrent inflammation in articular cartilage. The preoperative diagnosis of acetabular cartilage lesions depends on a triad of symptoms, clinical signs and imaging findings. 1.5 T magnetic resonance arthrography and 3.0 T magnetic resonance imaging are equally valued in objectively diagnosing cartilage lesions. Final diagnosis relies on surgical exploration, however, there is no consensus on how cartilage lesions should be reported, including the description of extent, location, pattern and grade. Using Beck classification of clock-face method to describe lesions observed in surgery is recommended at present. Most treatment methods of FAI-related acetabular cartilage lesions are borrowed from treating cartilage lesions in knee joints. Conservative treatment includes rest, activity modification, nonsteroidal anti-inflammatory medications and physical therapy. Surgery is an option if conservative treatment of at least 6 months fails. The surgical procedures commonly include chondroplasty, microfracture and enhanced microfracture, autologous matrix-induced chondrogenesis, autologous chondrocyte implantation, matrix-induced autologous chondrocyte implantation, osteochondral transplantation and other cartilage repair techniques. However, there is no consensus on the standardized treatment of FAI-related acetabular cartilage lesions for lacking evidence-based guidance currently.

Cancer-related fatigue (CRF) belongs to the category of "consumptive disease" in TCM, and its occurrence is based on "internal deficiency" of the body causing by the tumor. Its nature is intermingled deficiency and excess. Its pathogenesis is the deficiency of qi, blood, yin and yang and zang-fu viscera dysfunction caused by disorders of "rise and fall of middle qi" and kidney origin depletion. The theory of "treating overstrain syndrome with warming methods" originates from Huang Di Nei Jing, which proposes that warming methods are the basic methods of treating consumptive disease. Therefore, starting from the cause and pathogenesis of CRF, this article sorted out the theoretical origin of "treating overstrain syndrome with warming methods", and discussed the clinical application of warming methods for the treatment of CRF combining with modern clinical research, with the purpose to provide references for clinical practice.

This article analyzes the limitations of traditional medical theory teaching, and proposes the strategies for cultivating medical students' autonomous learning ability, i.e., informatization-based flipped classroom, problem-oriented teaching, mind mapping training, semi-open book examination, exploitation of the clinical and scientific thinking, and practice activities of medical humanities. The strategies of "problem oriented teaching" and "mind mapping training" were integrated into the practice teaching of hematology. Compared with the traditional medical teaching mode, students' feedback after class showed that the teaching mode incorporating new cultivation strategies was more conducive to the improvement of students' self-learning ability ( P = 0.008), and their satisfaction with teaching mode, learning interest, and self-learning ability were all improved. Thus, the appropriate application of the above strategies can help improve students' autonomous learning ability and optimize the effect of medical theory teaching.

Objective:To investigate the mechanism of Xianglian Huazhuo Decoction in treating chronic atrophic gastritis (CAG) rats by detecting the protein and gene expressions of Wnt1, GSK-3β, β-catenin in Wnt signaling pathway.Methods:Totally 60 Wistar rats were randomly divided into blank group and model group. The CAG model was established by MNNG free drink combined with sodium salicylate gavage combined with abnormal hunger and satiety. After model establishment, the rats were randomly divided into model group, Xianglian Huazhuo Group and folic acid group. Folic acid group received the folic acid water solution 1.3 mg/kg for gavage; the Xianglian Huazhuo Group received Xianglian Huazhuo Decoction 15.5 g/kg for gavage; the blank group and the model group received the same volume of purified water for gavage. After 8 weeks of intervention, the general state and the atrophic degree of gastric mucosa were observed. The expressions of Wnt1, GSK-3β and β-catenin were detected by immunohistochemical method, and the mRNA expression of β-catenin expression was detected by real-time quantitative polymerase chain reaction PCR.Results:The general condition of rats in Xianglian Huazhuo group was improved, the atrophy of gastric mucosa was improved, and the effect was better than that in folic acid group. Compared with the model group, the positive area ratio of Wnt1 decreased in Xianglian Huazhuo group ( P<0.05), and the positive area ratio of β-catenin decreased in folic acid group and Xianglian Huazhuo group ( P<0.05 or P<0.01), the positive area ratio of GSK-3β increased ( P<0.05), and the β-catenin mRNA level of Xianglian Huazhuo group decreased ( P<0.05). Conciusion 　Xianglian Huazhuo Decoction may increase GSK-3β by downregulating abnormal expression of Wnt1, promoting β-catenin to degrade normally, thereby blocking the abnormal activation of the Wnt signaling pathway, delaying or reversing CAG carcinogenesis to a certain extent, and exerting therapeutic effects.

Objective:To explore the potential mechanism of Tianshui Dichang Decoction in the treatment of ulcerative colitis through network pharmacology and experimental verification.Methods:The active components and targets of Tianshui Dichang Decoction were screened by TCMSP. The related targets of ulcerative colitis were screened by OMIM, GeneCard and TTD databases, and the effective component targets of Tianshui Dichang Decoction were intersected with the potential targets of ulcerative colitis. The PPI network was constructed by STRING database to screen the core targets, and the "Chinese materia medica-disease-active components-target" network was constructed by Cytoscape 3.8.0 software. GO function and KEGG pathway enrichment analysis were carried out using Metascape database. 48 mice were divided into control group, model group, mesalazine group (0.3 g/kg) and Tianshui Dichang Decoction low-, medium-, and high-dosage groups (7.5,15 and 30 g/kg) according to random number table method, with 8 mice in each group. Except the control group, the ulcerative colitis model was established in other groups. After 7 days of intervention with corresponding drugs, the disease activity index (DAI) was scored, the pathological changes of colon were observed by HE staining, and the expressions of IL-6, STAT3mRNA and protein in colon tissue were detected by PCR and Western blot methods.Results:Totally 127 active components in Tianshui Dichang Decoction and 560 targets of ulcerative colitis were obtained. 89 intersecting targets of Tianshui Dichang Decoction and ulcerative colitis were obtained, and the core targets included IL6, TNF, IL1B, AKT1, TP53, VEGFA, JUN, PTGS2, CXCL8, CCL2, STAT3, MMP9 and so on. Oxidative stress response, lipopolysaccharide metabolism, bacterial response, signal transduction and other biological processes were mainly involved, mainly through the cancer pathway, IL17, TNF, MAPK and other signal pathways to play a role in the treatment of ulcerative colitis. The results of experimental verification showed that the DAI score, the expressions of IL-6 and STAT3 protein in colon tissue of Tianshui Dichang Decoction medium- and high-dosage groups.decreased ( P<0.05). The levels of IL-6 and STAT3 mRNA in colon tissue decreased in the Tianshui Dichang Decoction low-, medium- and high-dosage groups.groups ( P<0.05). Conclusion:Tianshui Dichang Decoction has a certain therapeutic effect on UC through component-multitarget-signal pathway, and its mechanism is related to regulating IL-6/STAT3 signal pathway and inhibiting intestinal mucosal inflammation.

ObjectiveTo explore the effect of tetramethylpyrazine （TMP） on the vascular mimicry （VM） of non-small cell lung cancer A549 stem cell-like cells （CSLCs） in hypoxic state， and on the expression of hepatocyte growth factor （HGF）/mesenchymal-epithelial transition factor （c-Met）. MethodSerum-free sphere culture method was used to separate and enrich A549 CSLCs， and flow cytometry to detect the expression of stem cell marker CD44⁺/CD24^-/low. CoCl₂ was employed to induce hypoxia model. Cell counting kit-8 （CCK-8） assay was employed to examine the influence of 100， 200， 400， 800， 1 600， and 3 200 μmol·L^-1 TMP on the viability of A549 CSLCs. The low， medium， and high concentration （100， 200， 400 μmol·L^-1） of TMP that did not significantly affect the viability of A549 CSLCs was selected for subsequent experiments. Tube formation assay was used to detect the effect of different concentration of TMP on the formation of A549 CSLCs VM under hypoxia condition， and Western blot was applied to measure the expression of HGF/c-Met. ResultThe CD44⁺/CD24^-/low expression ratio of the isolated and enriched CSLCs was （80.3±0.21）%， which was significantly higher than that of the A549 group （P<0.01）. Compared with the control group， TMP groups showed increase in the inhibition rate of CSLCs， particularly the 24 h TMP （800， 3 200 μmol·L^-1） groups and the 48 h TMP （1 600， 3 200 μmol·L^-1） groups （P<0.05）. Compared with blank group and Bevacizumab （Bev） group， each concentration of TMP decreased the number of tubes formed and intersections （P<0.01）. The number of tubes formed and intersections decreased in TMP groups compared with that in the SU11274 group， particularly the 200 μmol·L^-1 TMP group （P<0.05） and 400 μmol·L^-1 TMP group （P<0.01）. Levels of HGF and c-Met in all TMP groups were down-regulated compared with those in the blank group （P<0.05， P<0.01）. ConclusionTMP can inhibit the formation of VM in A549 CSLCs in vitro under hypoxia condition which may act by regulating HGF/c-Met related signaling pathways.

[Objective] To research the sedative effect of intranasal dexmedetomidine and sufentanil for pediatric sedation for stomatological operation of outpatient department.[Methods] 60 children undergoing stomatological operation of outpatient department,age 3 ～ 7 years,weighing 10 ～ 32 kg,of ASA physical status Ⅰ ～ Ⅱ,were divided into the three groups (n =20) randomly using a random number table:group dexmedetomidine and sufentanil (group DS),group dexmetomidine (group D),group sufentanil (group S).Recorded the children's behavior using the Ohio State University behavior rating score (OSUBRS),the University of Michigan Sedation Score (UMSS),SBP,HR and side-effects when entry,during and leave operation and in post-anesthesia care unit,side-effects,the satisfaction of stomatological doctors and parents.[Results] The OSUBRS of group DS when entry,during operation were lower than group D (P ＜ 0.01).The UMSS of group DS were higher than group D and group S when entry and during operation (P ＜ 0.05).The success rate of group DS was higher than group D and group S (P ＜ 0.01).There was no different of mean percentage change in systolic blood pressure and heart rate from baseline between group DS and group D (P ＞ 0.05).There were no instances of respiratory depression,hypotension and bradycadia.[Conclusion] Intranasal dexmedetomidine and sufentanil provides satisfactory pediatric sedation for stomatological operation of outpatient department without side effects such as respiratory depression,bradycadia and hypotension.

Objective To investigate the effect of edaravone on the JAK2/STAT3 signaling pathway after ischemia-reperfusion injury in donor rat liver under different cold ischemia times. Methods A total of 102 SD rats were randomly divided into sham operation group,control group and experimental group. Six rats were in sham operation group with free liver operation and no transplantation. Forty-eight rats were in control group and experimental group respectively, and divided into subgroups according to the different cold ischemia times (30 min, 6 h, 12 h and 18 h). There were 6 donors and 6 recipients in each group. The rat model of orthotopic liver transplantation was established by modifiedtwo cuff method. All the donors were perfused by abdominal aorta and the warm ischemia time was 3-5 min. After different cold ischemia times, the experimental group was treated with edaravone (3 mg/kg) at 5 min before the opening of the new hepatic artery, and control group was injected with 3 mg/kg saline. Recipients of each group were sacrificed after 6 h. Finally, real-time fluorescence quantitative PCR was used to analyze the relative expression of JAK2/STAT3 mRNA of donor liver. Results The GAPDH gene and JAK2/STAT3 were well amplified. Under the same cold ischemia time, compared with the control group, the relative expression of JAK2/STAT3 was significantly decreased in the experimental group (P<0.05). With the prolongation of cold ischemia time, the relative expressions of JAK2 and STAT3 mRNA showed a decreasing trend in control group and experimental group, while the relative expression of JAK2 mRNA increased first and then decreased in the experimental group (P<0.05). Conclusion Edaravone has a protective effect on transplanted donor liver during different cold ischemia times, and extends the cold ischemia time for 18 h, which may be related to the inhibition of JAK2/STAT3 signal transduction pathway.

Objective To observe the effects of dredging collaterals and activating blood worm Chinese materia medica on angiogenesis related factors of lung cancer in hypoxic environment. Methods The lung cancer A549 cells were cultured in vitro to simulate tumor hypoxia microenvironment by the hypoxia workstation, and different concentrations of Scorpio, Scolopendra and Gecko medicated serum were added. MTT method was used to detect cell proliferation and screen the best medicine concentration and duration of action. Lung cancer A549 cells were administrated by the three kinds of medicated serum, and cells were collected and supernatant was cultured. Contents of VEGF, TGF-β1, and bFGF were detected by ELISA. Results Three kinds of medicated serum had the inhibitory effect on both added normoxia and hypoxia in cultured A549 lung cancer cells. 7.5% concentration of medicated serum was selected, and 24 h later were used in later experiments. Scorpio, Scolopendra and Gecko medicated serum can more reduce the contents of VEGF, TGF-β1 and bFGF in the supernatant of A549 cell compared with the control group (P<0.05, P<0.01). Conclusion Dredging collaterals and activating blood worm Chinese materia medica had inhibitory effect on cancer cells and the regulation of angiogenesis related cytokines in the condition of normoxia and hypoxia.