ObjectiveTo investigate the risk factors for pyogenic liver abscess （PLA） comorbid with sepsis by analyzing clinical features， and to construct a predictive model. MethodsA retrospective analysis was performed for 489 patients who were hospitalized and diagnosed with PLA in The Affiliated Hospital of Xuzhou Medical University from January 2019 to December 2023， and according to the presence or absence of sepsis， they were divided into sepsis group with 306 patients and non-sepsis group with 183 patients. Related data were collected， including general information， laboratory markers， and outcome measures. The patients were further divided into a training set of 342 patients and a validation set of 147 patients at a ratio of 7∶3， and the training set was used for screening of variables and construction of a predictive model， while the validation set was used to test the performance of the model. An LASSO regression analysis was used for the screening of variables， and a multivariate Logistic regression analysis was used to construct the predictive model and plot a nomogram. The calibration curve， the receiver operating characteristic （ROC） curve， and the decision curve analysis were used for the validation of the model， and internal validation was performed for assessment. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test was used for comparison of categorical variables between groups. ResultsThere were significant differences between the sepsis group and the non-sepsis group in pulse rate， mean arterial pressure， duration pf symptoms， comorbidity of liver cirrhosis or malignant tumor， leukocyte count， neutrophil count， lymphocyte count， platelet count （PLT）， activated partial thromboplastin time， fibrinogen， C-reactive protein， aspartate aminotransferase， alanine aminotransferase， albumin， total bilirubin （TBil）， creatinine， potassium， and prognostic nutritional index （PNI） （all P<0.05）. In the training set， the LASSO regression analysis identified four predictive factors of pulse rate， PLT， TBil and PNI， and the multivariate Logistic regression analysis showed that pulse rate （odds ratio ［OR］=1.033， 95% confidence interval ［CI］： 1.006‍ ‍—‍ ‍1.061， P=0.018）， PLT （OR=0.981， 95%CI： 0.975‍ ‍—‍ ‍0.987， P<0.001）， TBil （OR=1.086， 95%CI： 1.053‍ ‍—‍ ‍1.125， P<0.001）， and PNI （OR=0.935， 95%CI： 0.882‍ ‍—‍ ‍0.988， P=0.019） were independent influencing factors for the risk of sepsis in patients with PLA. The model constructed based on these factors showed a good predictive ability， with an area under the ROC curve of 0.948 （95%CI： 0.923‍ ‍—‍ ‍0.973） in the training set and 0.912 （95%CI： 0.848‍ ‍—‍ ‍0.976） in the validation set. The decision curve analysis showed that the model has a good net benefit within the range of 0.3‍ ‍—‍ ‍0.9 for threshold probability. ConclusionThe nomogram prediction model constructed based on pulse rate， PLT， TBil， and PNI has a certain clinical value and can well predict the risk of sepsis in patients with PLA.

Objective To explore the effect of virtual reality treadmill training on balance and gait in stroke patients. Methods From March,2022,to March,2023,40 stroke patients in Beijing Tiantan Hospital,Capital Medical University were randomly divided into control group(n = 20)and experimental group(n = 20).Both groups received rou-tine rehabilitation training.The control group received ordinary treadmill walking training,and the experimental group received treadmill walking training with virtual reality,for two weeks.They were assessed with Berg Bal-ance Scale(BBS)and Timed Up and Go Test(TUGT),and the envelope ellipse area,center of pressure(COP)av-erage speed of movement,step length,stride length and stride width were compared between two groups before and after treatment. Results After treatment,the scores of BBS and time of TUGT improved in both groups(|t|>3.508,P<0.01),and they were better in the experimental group than in the control group(|t|>3.019,P<0.01);there was no significant dif-ference in the envelope ellipse area,COP average speed,and stride width between two groups(P>0.05);howev-er,the step length and stride width improved in the experimental group(|t|>4.008,P<0.01). Conclusion Treadmill training with virtual reality can improve the balance and walking ability of stroke patients.

The cranial suture complex is made up of fibrous tissue with mesenchyme,an osteogenic front,the dura mater beneath,and an overlying periosteum.The dura mater is a layer of fibrous connective tissue that protects the brain and spinal cord,containing blood and lymphatic vessels.It is important for the progression of cranial osteo-genesis during early development,as well as the cranial morphology and the state of the cranial suture later in life.Cranial suture mesenchymal stem cells are primarily found in the cranial suture and can proliferate,differentiate in-to osteoblasts,generate cranial bone,and aid in the repair of cranial bone after injury.Understanding how cranial suture mesenchymal stem cells interact with the dura mater is critical for cranial growth and development,as well as the treatment of cranial diseases.This article reviews the roles of dura mater and cranial suture mesenchymal stem cells in cranial bone formation.

BACKGROUND:The dura mater and skull are physically and functionally related,although there have been few investigations on primary extraction of dura mater and cranial cells,as well as co-culture of the two.The use of primary cells to investigate the influence of the dura mater on the skull is novel,and it is hoped that it may give a theoretical foundation for therapeutic therapy. OBJECTIVE:Rat dura mater and cranial bone cells were retrieved in situ to observe the influence of dura mater on cranial bone proliferation and differentiation,as well as to get a basic knowledge of the involvement of Twist1 in this process. METHODS:The enzyme digestion method was used in conjunction with the tissue block method to extract dural cells and cranial osteoblasts from rats within three days of birth.Immunofluorescence staining was used to identify the extracted cells,and alizarin red staining was used to identify and evaluate cranial osteoblasts and their mineralization ability.After co-culturing dural cells and cranial osteoblasts,real-time PCR was utilized to identify the expression of genes associated to cranial osteoblast proliferation and osteogenesis,as well as Twist1. RESULTS AND CONCLUSION:(1)Morphology:The retrieved dural cells had morphological traits similar to fibroblasts,while the osteoblasts were spindle-shaped.(2)Cell identification:immunofluorescence staining revealed that extracted dural cells expressed high levels of vimentin and cranial osteoblasts expressed high levels of alkaline phosphatase;cranial osteoblasts were stained with alizarin red 28 days after osteogenic induction,and obvious mineralized nodules were observed.(3)Real time PCR detection showed that the co-culture group had higher levels of PCNA,alkaline phosphatase,and RUNX2 mRNA expression than the control group(P＜0.01);however,Twist1 mRNA expression was lower(P＜0.01).(4)The findings showed that the primary extracted cranial osteoblasts had a high mineralization capacity,and that the dura mater was a key factor in promoting cranial growth and development and osteogenic differentiation,with Twist1 playing a key role in this process.

AIM: To evaluate the safety and efficacy of accelerated corneal cross-linking(A-CXL)with application of isotonic riboflavin under pedicled corneal epithelial flap in the treatment of thin keratoconus(corneal thickness less than 400 μm after epithelial removal).METHODS: Retrospective study. A total of 46 patients(74 eyes)with keratoconus treated in the refractive surgery department of Ineye Hospital of Chengdu University of TCM from September 2017 to December 2020 were enrolled. According to the preoperative thinnest corneal thickness(TCT), the patients were divided into two groups: 16 patients(20 eyes)with TCT ranging from 400 to <450 μm underwent accelerated corneal cross-linking with application of isotonic riboflavin under pedicled corneal epithelial flap, and the surgical method involves creating a pedicled corneal epithelial flap and lifting it, applying isotonic riboflavin eye drops, repositioning the corneal epithelial flap, performing ultraviolet irradiation and then using corettage of corneal epithlial flap after irradiation. Another 30 patients(54 eyes)with TCT ≥450 μm underwent epithelial-off A-CXL surgery. After follow-up for 12 mo, the results of best corrected visual acuity(BCVA), Sirius three-dimensional corneal topography, and corneal endothelial cell density were collected before and after surgery.RESULTS: At 12 months post-surgery, patients in the pedicled corneal epithelial flap group showed no significant difference in Kmax compared with pre-surgery(P>0.005), while patients in the epithelial-off group showed a significant reduction in Kmax compared with pre-surgery(P<0.005). For both groups, there were no significant differences in BCVA(LogMAR), corneal anterior and posterior surface curvatures(K1, K2), and corneal endothelial cell density at 12 mo post-surgery compared with pre-surgery(all P>0.005). The comparisons of the changes in various parameters between 12 mo post-surgery and pre-surgery for both groups showed no significant differences(all P>0.05).CONCLUSION: Accelerated corneal cross-linking with application of isotonic riboflavin under pedicled corneal epithelial flap surgery is safe and feasible for patients with thin keratoconus, achieving similar control of keratoconus progression as epithelial-off A-CXL.

Dura mater is a tough collagen connective tissue attached to inner surface of skull and wrapped around brain.As a buffer bridge between brain tissue and skull,its physiological function and role in skull development and repair have always been a focus of research.Recent studies have found that dura mater not only directly participates in skull development during skull growth,but also secretes a variety of cytokines that control the development of central nervous system.There are abundant material exchange and cell communication between the two.This article reviews the role of dura in development and repair of skull,and provides clues for further discovery of the relevant mechanisms of dura in development and repair of skull.

Objective:To analyze the prognosis and risk factors for complete common peroneal nerve injury after total hip arthroplasty (THA) and revision via the modified Hardinge approach.Methods:A retrospective study was conducted to analyze the clinical data of 11 patients (nerve injury group) who had developed complete common peroneal nerve injury after THA and revision via the modified Hardinge approach at Department of Joint Surgery, The Affiliated Hospital of Qingdao University from April 2016 to April 2022. There were 7 males and 4 females, with an age at the time of surgery of (59.5±10.1) years and a body mass index of (26.1±3.5) kg/m 2. In a 1∶5 ratio, another 55 patients were included in the nerve injury free group who had not developed common peroneal nerve injury after THA or revision and were matched in surgical year, surgical type, surgical approach, prosthesis fixation mode, and chief surgeon. The clinical data were compared between the 2 groups. Variables with P<0.05 were included in a multifactorial logistic regression model to analyze the risk factors for the complete common peroneal nerve injury after THA and revision via the modified Hardinge approach. The time for recovery of nerve function and functional recovery of the common peroneal nerve at the last follow-up were recorded in the nerve injury group. Results:The differences were statistically significant between the 2 groups in the comparisons of drainage tube placement, body mass index, operative time, and postoperative limb lengthening ( P<0.05). The multifactorial logistic regression analysis showed that absence of drainage tube placement ( OR=0.047, 95% CI: 0.003 to 0.680, P=0.025) and long operative time ( OR=1.063, 95% CI: 1.002 to 1.128, P=0.044) were the risk factors for complete common peroneal nerve injury after THA and revision. The 11 patients were followed up for (48.0±22.0) months after operation. The function of the common peroneal nerve recovered fully at postoperative 3, 21, and 24 months respectively in 3 patients, and began to recover at postoperative 2, 3, 10, and 48 months and recovered to muscle strength levels 3, 2, 2, and 1 at the last follow-up in 4 patients respectively. The neurological function of the common peroneal nerve did not recover in 4 patients whose feet drooped significantly during walking to seriously affect their daily life. Conclusions:Absence of drainage tube placement and long operative time are the risk factors for complete common peroneal nerve injury after THA and revision via the modified Hardinge approach. Once complete common peroneal nerve injury occurs, the prognosis is generally poor for the patients.

Objective:To analyze the prognosis and risk factors for complete common peroneal nerve injury after total hip arthroplasty (THA) and revision via the modified Hardinge approach.Methods:A retrospective study was conducted to analyze the clinical data of 11 patients (nerve injury group) who had developed complete common peroneal nerve injury after THA and revision via the modified Hardinge approach at Department of Joint Surgery, The Affiliated Hospital of Qingdao University from April 2016 to April 2022. There were 7 males and 4 females, with an age at the time of surgery of (59.5±10.1) years and a body mass index of (26.1±3.5) kg/m 2. In a 1∶5 ratio, another 55 patients were included in the nerve injury free group who had not developed common peroneal nerve injury after THA or revision and were matched in surgical year, surgical type, surgical approach, prosthesis fixation mode, and chief surgeon. The clinical data were compared between the 2 groups. Variables with P<0.05 were included in a multifactorial logistic regression model to analyze the risk factors for the complete common peroneal nerve injury after THA and revision via the modified Hardinge approach. The time for recovery of nerve function and functional recovery of the common peroneal nerve at the last follow-up were recorded in the nerve injury group. Results:The differences were statistically significant between the 2 groups in the comparisons of drainage tube placement, body mass index, operative time, and postoperative limb lengthening ( P<0.05). The multifactorial logistic regression analysis showed that absence of drainage tube placement ( OR=0.047, 95% CI: 0.003 to 0.680, P=0.025) and long operative time ( OR=1.063, 95% CI: 1.002 to 1.128, P=0.044) were the risk factors for complete common peroneal nerve injury after THA and revision. The 11 patients were followed up for (48.0±22.0) months after operation. The function of the common peroneal nerve recovered fully at postoperative 3, 21, and 24 months respectively in 3 patients, and began to recover at postoperative 2, 3, 10, and 48 months and recovered to muscle strength levels 3, 2, 2, and 1 at the last follow-up in 4 patients respectively. The neurological function of the common peroneal nerve did not recover in 4 patients whose feet drooped significantly during walking to seriously affect their daily life. Conclusions:Absence of drainage tube placement and long operative time are the risk factors for complete common peroneal nerve injury after THA and revision via the modified Hardinge approach. Once complete common peroneal nerve injury occurs, the prognosis is generally poor for the patients.

Transmembrane emp24 domain (TMED) gene is closely related to immune response, signal transduction, growth and disease development in mammals. However, only the Drosophila TMED gene has been reported on insects. We identified the TMED family genes of silkworm, Tribolium castaneum, tobacco moth and Italian bee from their genomes, and found that the TMED family gene composition patterns of one α-class, one β-class, one δ-class and several γ-classes arose in the common ancestor of pre-divergent Hymenoptera insects, while the composition of Drosophila TMED family members has evolved in a unique pattern. Insect TMED family γ-class genes have evolved rapidly, diverging into three separate subclasses, TMED6-like, TMED5-like and TMED3-like. The TMED5-like gene was lost in Hymenoptera, duplicated in the ancestors of Lepidoptera and duplicated in Drosophila. Insect TMED protein not only has typical structural characteristics of TMED, but also has obvious signal peptide. There are seven TMED genes in silkworm, distributed in six chromosomes. One of seven is single exon and others are multi-exons. The complete open reading frame (ORF) sequences of seven TMED genes of silkworm were cloned from larval tissues and registered in GenBank database. BmTMED1, BmTMED2 and BmTMED6 were expressed in all stages and tissues of the silkworm, and all genes were expressed in the 4th and 5th instar and silk gland of the silkworm. The present study revealed the composition pattern of TMED family members, their γ class differentiation and their evolutionary history, providing a basis for further studies on TMED genes in silkworm and other insects.
Animals ; Bombyx/metabolism* ; Genes, Insect/genetics* ; Moths/metabolism* ; Insecta/metabolism* ; Drosophila ; Insect Proteins/metabolism* ; Phylogeny ; Mammals/genetics*

Objective: To investigate the function of FAK / Twist1 signaling pathway during craniosynostosis closure. Methods: Ten days old rats were divided into a control group (n = 50) and a rotation group (n = 50) . Both of them were made a approximately 0. 5 cm circle bone window at the midpoint of the lambdoid suture of the rat.The bone flaps were left free without damaging the dura mater. The bone flaps in the control group were repositioned in situ , and the bone flaps in the rotation group were rotated 180 ° and repositioned 3 weeks later. Then the experiments were performance as followed :open field test , measurement of body weight , head circumference , bone flap area , and thickness of bone flap in the two groups , observation of cranial suture closure by microscopy and HE staining , FAK / Twist1 expression determined by Western blot , real⁃time PCR , and immunohistochemical staining in the bone flap and dure , respectively. Results: The cranial sutures was completely closed in the rotation groupand that was open in the control group through detecting by microscopic examination and HE staining. The thickness of the bone flap in the derotation group was greater than that in the control group , with statistical significance (P < 0. 01) . There were no significant differences between two groups in head circumference , weight , bone flap area , and operative area. The results of behavioral test showed that after the closure of cranial suture , the acsion of FAK was significantly increased in the calvaria and dura as well as Twsit1 was significantly decreased in the dura in rotating group measuring by Western blot , real⁃time PCR , and immunohistochemical staining (P < 0. 05) . Conclusion FAK/Twist1 may play an important role in craniosynostosis after rotation.