ObjectiveTo evaluate the clinical efficacy of Huayu Tongluo Formula （化瘀通络方， HTF） in patients with mid-stage diabetic kidney disease of blood stasis syndrome and explore its potential mechanisms. MethodsA multi-center， randomized， double-blind， placebo-controlled clinical trial was conducted. Ninety patients of mid-stage diabetic kidney disease of blood stasis syndrome were divided into a control group of 46 cases and a treatment group of 44 cases. Both groups received conventional western medicine treatment， the treatment group additionally taking HTF， while the control group taking a placebo of the formula. The treatment was administered once daily for 24 weeks. The primary outcomes included 24-hour urine total protein （24 h-UTP）， serum albumin （Alb）， glycated hemoglobin （HbA1c）， and serum creatinine （Scr）.The secondary outcomes included changes in levels of endothelin-1 （ET-1）， nitric oxide （NO）， vascular endothelial growth factor （VEGF）， and traditional Chinese medicine （TCM） syndrome scores before and after treatment. Clinical efficacy was evaluated based on TCM syndrome scores and overall disease outcomes. Adverse reactions and endpoint events were recorded. ResultsIn the treatment group after treatment， 24 h-UTP， ET-1， and VEGF levels significantly decreased （P＜0.05）， Alb and NO levels significantly increased （P＜0.05）； while the TCM syndrome scores for edema， lumbar pain， numbness of limbs， dark purple lips， dark purple tongue or purpura， and thin， rough pulse all significantly decreased （P＜0.05）. In the control group， no significant changes were observed in any of the indicators after treatment （P＞0.05）.Compared with the control group， the treatment group showed significant reductions in 24 h-UTP， ET-1， and VEGF levels， and increases in Alb and NO levels （P＜0.05）. The TCM syndrome scores for edema， lumbar pain， dark purple tongue or purpura， and thin， rough pulse were all lower in the treatment group than in the control group （P＜0.05）. The total effective rate of TCM syndrome in the treatment group was 59.09% （26/44）， and the overall clinical effective rate was 45.45% （20/44）. In the control group， these rates were 15.22% （7/46） and 8.7% （4/46）， respectively， with the treatment group showing significantly better outcomes （P＜0.05）. A total of 7 adverse events occurred across both groups， with no significant difference （P＞0.05）. No endpoint events occurred during the study. ConclusionOn the basis of conventional treatment of Western medicine， HTF can further reduce urinary protein levels and improve clinical symptoms in patients with mid-stage diabetic kidney disease of blood stasis syndrome. The mechanism may be related to its effects on endothelial function.

OBJECTIVES: Oblique lateral interbody fusion (OLIF) has become a well-established treatment for lumbar spinal stenosis (LSS) due to its advantages of being minimally invasive, effective, and associated with fewer complications. However, relying solely on lateral fixation provides limited strength and uneven load distribution. Conventional posterior bilateral fixation after OLIF typically requires intraoperative repositioning, increases fluoroscopy frequency, and involves extensive dissection of posterior muscles and soft tissues, resulting in greater trauma, blood loss, and risks of dural tear, nerve root injury, and persistent postoperative low back pain. This study aims to compare the clinical efficacy of robot-assisted single-position OLIF with lateral plating and posterior unilateral fixation, OLIF with lateral fixation alone, and OLIF combined with posterior bilateral fixation for treating single-segment LSS, and to explore how to enhance fixation stability, reduce trauma, and achieve precise minimally invasive outcomes without changing patient positioning. METHODS: A retrospective analysis was conducted on the clinical data from patients treated for single-segment LSS between January 2020 and June 2023 at the First Affiliated Hospital of Kunming Medical University. Patients were divided into 3 groups: Robot group (robot-assisted single-position OLIF with lateral plate and posterior unilateral fixation, 33 cases), lateral group (OLIF with lateral fixation alone, 52 cases), and combined group (OLIF with posterior bilateral fixation, 45 cases). Surgical time, intraoperative blood loss, fluoroscopy frequency, hospital stay, pedicle screw placement accuracy, and complication rates were recorded. Pain visual analogue scale (VAS) scores and Oswestry disability index (ODI) scores were assessed preoperatively, postoperatively, and at the final follow-up. Radiological evaluations (X-ray, computed tomography, and magnetic resonance imaging) measured interbody disc height (IDH), intervertebral foraminal height (IFH), and cross-sectional area (CSA) of the dural sac. Differences between pre- and postoperative imaging indices were statistically analyzed, and complication rates, fusion rates, and cage subsidence rates were recorded. RESULTS: All patients exhibited good positioning of internal fixation devices and cages, with significant symptom relief and no cases of spinal cord injury or symptom worsening. The follow-up time was (15.2±3.6) months. The operation time of the robot group was (70.62±8.99) min, which was longer than that of the lateral group (45.90±6.09) min and shorter than that of the combined group (110.12±8.44) min. The intraoperative blood loss of the robot group was (44.27±6.87) mL, which was more than that of the lateral group (33.58±9.73) mL and less than that of the combined group (79.19±10.35) mL. The number of intraoperative fluoroscopy times of the robot group was (9.49±2.25), which was comparable to that of the lateral group (7.45±2.02) but less than that of the combined group (12.24±4.25). The hospital stay of the robot group was (9.28±2.10) days, which was longer than that of the lateral group (7.95±1.91) days and shorter than that of the combined group (12.49±5.07) days. The screw placement accuracy of the robot group was 98.48%, which was higher than that of the combined group (90.55%). Postoperative and final follow-up VAS and ODI scores were significantly lower than preoperative scores in all 3 groups (all P<0.05), and there were no significant differences in preoperative VAS and ODI scores among the groups (all P>0.05). Radiologically, IDH, IFH, and CSA at the surgical segment were significantly increased postoperatively and at final follow-up compared to preoperatively and at final follow-up compared to preoperative values (all P<0.05), with no significant differences among the groups postoperatively (all P>0.05). Internal fixation remained stable during the follow-up period, and all cages achieved fusion at final follow-up. The intervertebral fusion rate of the robot-assisted group was 93.40%, which was similar to that of the combined group (95.56%) and higher than that of the lateral approach group (90.34%). The complication rate of the robot-assisted group was 6.1%, which was comparable to that of the combined group (8.9%) and lower than that of the lateral approach group (15.4%) (P<0.05). No cases of fixation loosening or breakage were observed throughout the follow-up period. CONCLUSIONS Robot-assisted single-position OLIF with lateral plate combined with posterior unilateral fixation effectively achieves indirect decompression and excellent spinal stability without the need for intraoperative repositioning. It provides high pedicle screw accuracy, reduces intraoperative blood loss, fluoroscopy times, and complication rates, offering a fully minimally invasive new treatment option for single-segment LSS.
Humans ; Spinal Stenosis/surgery* ; Robotic Surgical Procedures/methods* ; Lumbar Vertebrae/surgery* ; Spinal Fusion/instrumentation* ; Male ; Female ; Retrospective Studies ; Middle Aged ; Aged ; Treatment Outcome ; Bone Plates ; Minimally Invasive Surgical Procedures/methods* ; Adult

OBJECTIVES: To explore the expression profile of circular RNAs (circRNAs) and their potential roles in prognosis and progression of Wilms' tumor (WT). METHODS: Four pairs of WT and adjacent tissues were collected for high-throughput circRNA sequencing to identify the differentially expressed circular RNAs. RT-qPCR was used to verify the expression levels of the top 6 candidate circRNAs in the clinical samples. hsa_circ_0001900 was selected for analysis of its correlation with clinicopathological features and prognosis in 34 patients with WT. Sanger sequencing and RNase R digestion experiments were used to verify the cycling site and structural stability of hsa_circ_0001900 molecule. RESULTS: A total of 23 978 circular RNA molecules were identified in WT tissues by high-throughput circular RNA sequencing, and among them 614 were differentially expressed in WT. hsa_circ_0001900 showed the highest expression level among the differentially expressed circRNAs, which was consistent with the findings in clinical tumor samples and the sequencing results. Correlation analysis showed that hsa_circ_0001900 expression level was positively correlated with WT volume, and the children with high hsa_circ_0001900 expression had a lowered recurrence-free survival rate. The results of Sanger sequencing verified the circular splice site sequence of the molecule, and Rnase R digestion assay confirmed its stable covalent structure. CONCLUSIONS This study presents a comprehensive expression profile of circular RNAs in WT, and the expression level of hsa_circ_0001900 is related to the size of WT and the patients' prognosis, suggesting its possible role as a key driving gene in WT progression.
Humans ; RNA, Circular ; Wilms Tumor/pathology* ; Prognosis ; High-Throughput Nucleotide Sequencing ; Kidney Neoplasms/genetics* ; Sequence Analysis, RNA ; Male ; Female

In order to explore the effects of Coptis detoxification powder on immune suppression and inflammatory response caused by heat stress in animals,Bama pigs were used as experimental animals to establish an animal model of heat stress,and the effects of Coptis detoxification powder on transcriptional activation of TLRs mRNA in PBMC induced by heat stress and its mediated ex-pression of inflammatory factors were studied in vivo.The animal model of heat stress was estab-lished by artificial climate greenhouse,Chinese medicine"Coptis detoxification powder"was pre-pared,and its inhibitory effect on heat stress and inflammation was studied by preventive and therapeutic administration.Real-time fluorescence quantitative PCR was used to determine the transcriptional changes of HSP70,TLRs and IL-17 mRNA,and ELISA was used to determine the dynamic changes of serum IL-2,IL-6 and TNF-α.Western blot and indirect immunofluorescence(IFA)were used to determine the nuclear translocation and protein expression of p65 phosphoryl-ated protein in NF-κβ inflammatory factor pathway.The transcription of PBMC TLRs mRNA and its mediated inflammatory factor expression and function in Bama pigs under heat stress were sys-tematically analyzed.The results showed that the experimental animal model of Bama pigs under heat stress was successfully established,and heat stress significantly up-regulated the mRNA tran-scription levels of HSP70,TLR2,TLR4 and inflammatory factor IL-17,resulting in significantly enhanced expressions of serum inflammatory factors IL-2,IL-6 and TNF-α.The NF-κβ pathway significantly promoted the level of p65 nuclear phosphorylation and the expression of cytoplasmic protein.The Chinese medicine"Coptis detoxification powder"could significantly reduce the upreg-ulation effect of heat stress conditions on the transcription levels of HSP70 and TLRs mRNA,thus inhibiting the mRNA transcription of inflammatory factor IL-17 and the expression of IL-2,IL-6 and TNF-α in serum,and significantly antagonizing the transcriptional activity of NF-κβ caused by heat stress.It showed good anti-heat stress effect.The anti-inflammatory effects of Chinese veteri-nary medicine prescription"Coptis detoxification powder",its pathway of action and its effectors were investigated,the expression and secretion levels of the regulatory factors related to the path-way associated with TLRs mRNA inhibition were analyzed,and the functional effects and mecha-nism of its clinical anti-heat stress and anti-inflammatory effects were clarified,which laid a data foundation for the promotion and application of this prescription and related mechanism research.

Zi goose is a small local variety with high fecundity,good meat quality,roughage resist-ance,strong adaptability and excellent down quality.It is an excellent female parent for cross breeding among varieties.With the rapid development of goose industry,the variety of Zi goose has not been well protected,the variety is hybrid and degraded seriously,and the number of pure Zi goose is decreasing day by day.This paper reviewed the research progress on the breeding distribu-tion and preservation status of Zi goose and the variety characteristics of Zi goose,in order to pro-vide reference for the research,protection and utilization of germplasm resources of Zi goose and the stable development of goose industry.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To investigate the clinical manifestations, pathological, and gene mutation characteristics of ABCB4 gene variant-associated cholestatic liver disease in adults. Methods:Eight adult cases of ABCB4 gene variant-associated cholestatic liver disease who were hospitalized in the Department of Hepatology, Fifth Medical Center of the People's Liberation Army General Hospital from May 2010 to December 2022 were enrolled in this study. The clinical manifestations, pathological features, gene variant features, and prognostic conditions were analyzed. Patient gene testing and biological information analysis were performed using whole-exome next-generation sequencing. SPSS 19.0 software was used to conduct descriptive analysis. Results:Among the eight adult cases of the ABCB4 gene variant, there were three males and five females, with a median age of onset of 24 (20, 37) years. There were three cases with a compound heterozygous variant in ABCB4, and the clinical phenotypes included two cases of progressive familial intrahepatic cholestasis type 3 and one case of intrahepatic cholestasis of pregnancy overlapping with low-phospholipid-associated cholelithiasis syndrome. There were five cases with a single heterozygous variant in ABCB4, and the clinical phenotypes included two cases of intrahepatic cholestasis of pregnancy overlapping with drug-induced liver injury and three cases of low-phospholipid-associated cholelithiasis syndrome. Imaging of all eight cases showed liver fibrosis, and six cases already had cirrhosis. All patients underwent liver histopathological examination, which mainly showed cholestasis and portal fibrosis in eight cases, small bile duct hyperplasia in seven cases, copper deposition in three cases, and cirrhosis in five cases. ABCB4 screening revealed 11 different mutations, including eight new mutations. The pathogenicity assessment showed that c.2394+82C>T (intron) was a benign mutation, and the rest were deleterious mutations. Ursodeoxycholic acid was the treatment for all patients, with a follow-up time of 7.5 (0.5, 12.7) years. One case died of end-stage liver disease, two cases developed cholestatic cirrhosis, and five cases were in stable condition. Conclusion:The adult ABCB4 gene variant-associated cholestatic liver disease are mostly single heterozygous mutations, the clinical phenotypes are diverse and overlapping, the disease is more severe in those who carried non-functional mutations.

Objective To explore the relationship between the expression of Toll like receptor 4(TLR4)and Janus protein tyrosine kinase 3(JAK3)genes and the imbalance of helper T cell 17(Th17)/regulatory T cells(Treg)in peripheral blood mononuclear cells(PBMCs)of patients with ankylosing spondylitis(AS).Methods A total of 101 AS patients were selected as the AS group.According to the AS Disease Activity Index(BASDAI)score,patients were divided into the AS stable phase(ASS)group(＜4 points,42 cases)and the AS active phase(ASA)group(≥4 points,59 cases).Additionally,50 healthy volunteers who underwent physical examinations at our hospital during the same period were selected as the control group(health group).Real-time fluorescence quantitative polymerase chain reaction(RT-qPCR)was used to determine the mRNA expression of TLR4 and JAK3 in PBMCs,and the proportion of serum Th17 and Treg was measured and Th17/Treg levels were calculated.Results The levels of TLR4 mRNA and JAK3 mRNA in PBMCs of peripheral blood were higher in the AS group than those in the health group(P＜0.05).The levels of Th17,proportion and Th17/Treg in peripheral blood were higher in the AS group than those of the health group(P＜0.05).Higher levels of TLR4 mRNA,JAK3 mRNA,Th17,and Th17/Treg were risk factors for AS,while higher level of Treg was protective factors for AS.TLR4 mRNA and JAK3 mRNA in AS patients were positively correlated with Th17 ratio and Th17/Treg ratio,and negatively correlated with Treg ratio(P＜0.05).Conclusion TLR4 and JAK3 genes are highly expressed and Th17/Treg is unbalanced in PBMC of AS patients.The high expression of TLR4 and JAK3 genes is closely related to Th17/Treg imbalance in AS patients.

Objective:To assess the occurrence, prognosis and possible early risk factors of jaundice in polytrauma patients.Methods:This study was a single-center, prospective study. Polytrauma patients (age>18 years) admitted to Tongji Trauma Center from October 2020 to January 2023 were enrolled. The patients with liver, biliary tract or pancreatic traumatic injury, previously suffered from chronic liver disease were excluded. The clinical characteristics of patients, laboratory test results, imaging examination results, Injury Severity Score (ISS), Glasgow Coma Score and APACHEⅡ score were collected. The incidence of jaundice, the classification of jaundice or the severity of jaundice after multiple injuries, the mortality rate of polytrauma patients with jaundice, and the early independent risk factors of jaundice in polytrauma were analyzed. The differences between the groups were compared by Student’s t test or χ2 test. The independent risk factors of jaundice were analyzed by Logistic regression analyzed. Results:A total of 742 polytrauma patients were included, 34.09% polytrauma patients were accompanied by jaundice, and the ratio of both moderate and severe jaundice were as high as 32.41%. The main type of jaundice was intrahepatic cholestatic jaundice (47.03%). The mortality rate of polytrauma patients accompanied by jaundice was significantly higher than that of polytrauma patients without jaundice (12.25% vs. 3.47%, P<0.001). Logistic regression analysis showed that ISS score ( OR=3.405, 95% CI: 1.962-7.438, P=0.026), plasma lactate ( OR=2.216, 95% CI: 1.203-4.862, P=0.017), interleukin-6 levels ( OR=2.431, 95% CI: 1.424-3.793, P=0.007), the overall duration of parenteral nutrition ( OR=3.011, 95% CI: 1.624-5.041, P=0.022), and the total duration of mechanical ventilation ( OR=3.572, 95% CI: 1.497-4.601, P=0.031) were the early independent risk factors for jaundice in patients after polytrauma. Conclusions:Polytrauma patients are prone to developing jaundice after injury, which is more harmful, especially for intrahepatic cholestatic jaundice after injury. Early identification and early intervention of risk factors associated with jaundice after injury should be strengthened.

Objective To identify the key genes differentially expressed in Wilms tumor and analyze their potential impacts on prognosis and immune responses of the patients. Methods High-throughput RNA sequencing was used to identify the differentially expressed mRNAs in clinical samples of Wilms tumor and paired normal tissues, and their biological functions were analyzed using GO, KEGG and GSEA enrichment analyses. The hub genes were identified using STRING database, based on which a prognostic model was constructed using LASSO regression. The mutations of the key hub genes were analyzed and their impacts on immunotherapy efficacy was predicted using the cBioPortal platform. RT-qPCR was used to verify the differential expressions of the key hub genes in Wilms tumor. Results Of the 1612 differentially expressed genes identified in Wilms tumor, 1030 were up-regulated and 582 were down-regulated, involving mainly cell cycle processes and immune responses. Ten hub genes were identified, among which 4 genes (TP53, MED1, CCNB1 and EGF) were closely related to the survival of children with Wilms tumor. A 3-gene prognostic signature was constructed through LASSO regression analysis, and the patients stratified into with high- and low-risk groups based on this signature had significantly different survival outcomes (HR=1.814, log-rank P=0.002). The AUCs of the 3-, 5-and 7-year survival ROC curves of this model were all greater than 0.7. The overall mutations in the key hub genes or the individual mutations in TP53/CCNB1 were strongly correlated with a lower survival rates, and a high TP53 expression was correlated with a poor immunotherapy efficacy. RT-qPCR confirmed that the key hub genes had significant differential expressions in Wilms tumor tissues and cells. Conclusion TP53 gene plays an important role in the Wilms tumor and may potentially serve as a new immunotherapeutic biomarker as well as a therapeutic target.