ObjectiveTo unveil the mechanism of Jianpi Huogu prescription （JPHGP） in ameliorating the dyslipidemia of steroid-induced osteonecrosis of the femur head （SONFH） by oxylipidomics combined with transcriptomics. MethodsSixty SD rats were assigned into normal， model， low-， medium-， and high-dose （2.5， 5， 10 g·kg^-1， respectively） JPHGP， and Jiangushengwan （1.53 g·kg^-1） groups. Lipopolysaccharide was injected into the tail vein at a dose of 20 μg·kg^-1 on days 1 and 2， and methylprednisolone sodium succinate was injected at a dose of 40 mg·kg^-1 into the buttock muscle on days 3 to 5. The normal group received an equal volume of normal saline. Drug administration by gavage began 4 weeks after the last injection， and samples were taken after administration for 8 weeks. Hematoxylin-eosin staining was conducted to reveal the histopathological changes of the femoral head， and the number of adipocytes， the rate of empty bone lacunae， and the trabecular area were calculated. Micro-computed tomography was used for revealing the histological and histomorphometrical changes of the femoral head. Enzyme-linked immunosorbent assay was employed to measure the serum levels of triglyceride （TG）， total cholesterol （TC）， low-density lipoprotein （LDL）， high-density lipoprotein （HDL）， apolipoprotein A1 （ApoA1）， and apolipoprotein B （ApoB）. At the same time， the femoral head was collected for oxylipidomic and transcriptomic detection. The differential metabolites and differential genes were enriched and analyzed， and the target genes regulating lipid metabolism were predicted. The predicted target proteins were further verified by molecular docking， immunohistochemistry， and Western blot. ResultsCompared with the normal group， the model group showcased thinning of the femoral head， trabecular fracture， karyopyknosis， subchondral cystic degeneration， increases in the number of adipocytes and the rate of empty bone lacunae （P<0.01）， a reduction in the trabecular area （P<0.01）， decreases in BMD， Tb.Th， Tb.N， and BV/TV， and increases in Tb.Sp and BS/BV （P<0.01）. Compared with the model group， the JPHGP groups showed no obvious thinning of the femoral head or subchondroidal cystic degeneration. The high- and medium-dose JPHGP groups presented declines in the number of adipocytes and the rate of empty bone lacunae， an increase in the trabecular area （P<0.05， P<0.01）， rises in BMD， Tb.Th， Tb.N， and BV/TV， and decreases in Tb.Sp and BS/BV （P<0.05， P<0.01）. Compared with the normal group， the model group showcased raised serum levels of TG， TC， LDL， and ApoB and lowered serum levels of HDL and ApoA1 （P<0.01）. Compared with the model group， the JPHGP groups had lowered serum levels of TG， TC， LDL， and ApoB （P<0.05， P<0.01） and a risen serum level of ApoA1 （P<0.05， P<0.01）. Moreover， the serum level of HDL in the high-dose JPHGP group increased （P<0.01）. A total of 19 different metabolites of disease set and drug set were screened out by oxylipidomics of the femoral head， and 119 core genes with restored expression were detected by transcriptomics. The enriched pathways were mainly concentrated in inflammation， lipids， apoptosis， and osteoclast differentiation. Molecular docking， immunohistochemistry， and Western blot results showed that compared with the normal group， the model group displayed increased content of 5-lipoxygenase （5-LO） and peroxisome proliferator-activated receptor γ （PPARγ） in the femoral head （P<0.01）. Compared with the model group， medium- and high-dose JPHGP reduced the content of 5-LO and PPARγ （P<0.05， P<0.01）. ConclusionJPHGP can restore the levels of oxidized lipid metabolites by regulating the 5-LO-PPARγ axis to treat SONFH in rats. Relevant studies provide experimental evidence for the efficacy mechanism of JPHGP in the treatment of SONFH.

OBJECTIVE: To investigate the feasibility and clinical outcomes of emergency reconstruction of traumatic dynamic muscle defects using functional superficial vastus lateralis chimeric perforator flap based on descending branch of lateral femoral circumflex artery. METHODS: A retrospective analysis was conducted of 10 patients with traumatic dynamic muscle defects treated between March 2020 and April 2024. There were 8 males and 2 females, aged 23-52 years (mean, 36.7 years). Injuries included 7 cases of Gustilo type ⅢB forearm trauma (2 with flexor muscle group defects, 3 with extensor muscle group defects, and 2 with combined flexor and extensor muscle group defects), 1 case of right first metacarpal defect with concomitant thenar muscle and skin defect, 1 case of complete transection of the right upper arm musclecutaneous nerve extracted from the biceps brachii muscle, and 1 case of Gustilo type ⅢC lower-limb trauma with extensor hallucis longus and toe extensor defects. Soft tissue defects ranged from 10 cm×8 cm to 36 cm×11 cm. Preoperative musculoskeletal ultrasound of the contralateral side was used to measure cross-sectional area, length, and pennation angle of the target muscles. Based on these parameters, anterolateral thigh flaps combined with one or two superficial vastus lateralis muscle segments were designed and transplanted to the recipient sites. The grafts were used to cover wounds, reconstruct major missing muscle groups, and were fixed in place. Vascular and neural anastomoses were performed simultaneously with repair of bone and soft tissue injuries to restore limb perfusion and function. Postoperative evaluation included musculoskeletal ultrasound, electrophysiology, and dynamic assessment of muscle strength during follow-up. RESULTS: All transplanted muscles and flaps survived primarily without vascular or neural complications. All the 10 patients were followed up 10-38 months, with an average of 22.8 months. The muscle strength recovery reached M₅ in 6 cases, M₄ in 3 cases, and M3+ in 1 case. Patients achieving M₄ or above regained their original work capacity; limb contours were symmetrical, with no joint deformities, and patients achieved effective ranges of motion; functional recovery included the ability to push or lift weights of 2-30 kg, perform opposition, and achieve grasping function. All flaps were soft and lustrous, and the protective sensation restored in all patients. There was no discomfort in the donor site and knee joint. Musculoskeletal ultrasound showed that the average cross-sectional area of the transplanted muscles increased by 4%-66% in 10 cases at 1 month after operation, and the ratio of the average cross-sectional area of the transplanted muscles in contraction and relaxation was 1.37±0.16 in 7 cases at 6 months after operation. Electrophysiological examination showed that motor potential could be detected in 8 cases at 2 months after operation, and then the amplitude increased gradually, and 2 cases were not detected. CONCLUSION Emergency reconstruction of traumatic dynamic muscle defects using functional superficial vastus lateralis chimeric perforator flap based on descending branch of lateral femoral circumflex artery achieves near-normal muscle strength recovery and effective joint motion. This technique allows for reconstruction of one or two major muscle groups as clinically required.
Humans ; Male ; Adult ; Female ; Perforator Flap/blood supply* ; Plastic Surgery Procedures/methods* ; Retrospective Studies ; Soft Tissue Injuries/surgery* ; Middle Aged ; Quadriceps Muscle/transplantation* ; Femoral Artery/surgery* ; Young Adult ; Muscle, Skeletal/surgery* ; Treatment Outcome ; Forearm Injuries/surgery*

Objective To investigate the influence of repeated open field tests， novel object recognition tests， and Barnes maze behavioral tests within a short term on cognitive and anxiety assessment in 3xTg-AD mice.Methods Four groups of 3xTg-AD mice， aged 12 months， were obtained using different pretreatment regimens， and the mice in the experimental groups 1-3 were treated with different drugs， while those in the control group were treated with normal saline. The open field test， the novel object recognition test， and the Barnes maze test were performed on mice successively. A behavioral video analysis system was used to record the locomotor trajectories of the mice and analyze the parameters such as time spent in the central area， exploration time for novel versus familiar objects， and latency to reach the target hole. After one session of complete tests， three sessions were performed repeatedly， and all tests were completed within one month.Results With the increase in the number of repeated tests， there was a significant reduction in the time spent in the central area in the open field test （P<0.05）； in the novel object recognition test， there was an increase in the coefficient of variation for object recognition index and a reduction in exploratory behavior towards both the new environment and the novel objects； in the Barnes maze test， there was no significant difference in the latency to reach the target hole across the four tests， suggesting good reproducibility.Conclusion Repeated tests within a short term can interfere with the evaluation of anxiety status in 3xTg-AD mice in the open field test and their preference for novel objects in the novel object recognition test， but it has no obvious influence on the latency to reach the target hole in the Barnes maze test. Whether behavioral tests can be performed repeatedly in 3xTg-AD mice should be determined based on different tests.

ObjectiveTo explore the effects of the Tai Chi training on bone density， bone turnover markers， and heart rate variability for people with high-risk osteoporosis， and to provide evidence for the prevention of osteoporosis at early stage. MethodsSixty-six cases of people with high risk of osteoporosis were included， and they were divided into 33 cases each in the intervention group and the control group using the random number table method. The control group received osteoporosis health education three times a week， and the intervention group received Tai Chi training under the guidance of a trainer three times a week for 40 mins each time on the basis of the control group， and both groups were intervened for 12 weeks. Dual-energy X-ray absorptiometry was used to measure the bone density of L₁~L₄ vertebrae， bilateral femoral necks and bilateral total hips in the two groups before and after the intervention； enzyme-linked immunosorbent assay was used to determine bone turnover markers before and after the intervention， including pro-collagen type Ⅰ pro-amino-terminal prepropyl peptide （P1NP） and β-collagen type Ⅰ cross-linking carboxy-terminal peptide （β-CTX）. Seven cases with good compliance in the intervention group were selected. After wearing the heart rate sensor， they successively performed Tai Chi training and walking activities recommended by the guideline for 20 mins each， and the heart rate variability （HRV） during exercise was collected， including time-domain indexes such as standard deviation of normal sinus intervals （SDNN）， root-mean-square of the difference between adjacent RR intervals （RMSSD）， frequency-domain metrics such as low-frequency power （LF）， high-frequency power （HF）， and low-frequency/high-frequency power ratio （LF/HF）， as well as nonlinear metrics such as approximate entropy （ApEn）， sample entropy （SampEn）. ResultsFinally， 63 cases were included in the outcome analysis， including 30 cases in the intervention group and 33 cases in the control group. After the intervention， the differences of L₁~L₄ vertebrae， bone density of bilateral femoral neck and bilateral total hip in the intervention group were not statistically significant when compared with those before intervention （P＞0.05）， while the bone density of all parts of the control group decreased significantly compared with that before intervention （P＜0.05）， and the difference in the bone density of the L₁~L₄ vertebrae， bilateral femoral neck， and the right total hip before and after the intervention of the intervention group was smaller than that of the control group （P＜0.05）. The differences in P1NP and β-CTX between groups before and after intervention was not statistically significant （P＞0.05）. Compared with walking exercise， LF decreased， HF increased and LF/HF decreased during Tai Chi exercise （P＜0.05）； the time domain indexes and non-linear indexes between groups had no statistically significant difference （P＞0.05）. ConclusionTai Chi exercise can maintain lumbar， hip， and femoral bone density and improve sympathetic/parasympathetic balance in people at high risk for osteoporosis， but cannot significantly improve bone turnover markers.

ObjectiveTo unveil the mechanism of Jianpi Huogu prescription （JPHGP） in ameliorating the dyslipidemia of steroid-induced osteonecrosis of the femur head （SONFH） by oxylipidomics combined with transcriptomics. MethodsSixty SD rats were assigned into normal， model， low-， medium-， and high-dose （2.5， 5， 10 g·kg^-1， respectively） JPHGP， and Jiangushengwan （1.53 g·kg^-1） groups. Lipopolysaccharide was injected into the tail vein at a dose of 20 μg·kg^-1 on days 1 and 2， and methylprednisolone sodium succinate was injected at a dose of 40 mg·kg^-1 into the buttock muscle on days 3 to 5. The normal group received an equal volume of normal saline. Drug administration by gavage began 4 weeks after the last injection， and samples were taken after administration for 8 weeks. Hematoxylin-eosin staining was conducted to reveal the histopathological changes of the femoral head， and the number of adipocytes， the rate of empty bone lacunae， and the trabecular area were calculated. Micro-computed tomography was used for revealing the histological and histomorphometrical changes of the femoral head. Enzyme-linked immunosorbent assay was employed to measure the serum levels of triglyceride （TG）， total cholesterol （TC）， low-density lipoprotein （LDL）， high-density lipoprotein （HDL）， apolipoprotein A1 （ApoA1）， and apolipoprotein B （ApoB）. At the same time， the femoral head was collected for oxylipidomic and transcriptomic detection. The differential metabolites and differential genes were enriched and analyzed， and the target genes regulating lipid metabolism were predicted. The predicted target proteins were further verified by molecular docking， immunohistochemistry， and Western blot. ResultsCompared with the normal group， the model group showcased thinning of the femoral head， trabecular fracture， karyopyknosis， subchondral cystic degeneration， increases in the number of adipocytes and the rate of empty bone lacunae （P<0.01）， a reduction in the trabecular area （P<0.01）， decreases in BMD， Tb.Th， Tb.N， and BV/TV， and increases in Tb.Sp and BS/BV （P<0.01）. Compared with the model group， the JPHGP groups showed no obvious thinning of the femoral head or subchondroidal cystic degeneration. The high- and medium-dose JPHGP groups presented declines in the number of adipocytes and the rate of empty bone lacunae， an increase in the trabecular area （P<0.05， P<0.01）， rises in BMD， Tb.Th， Tb.N， and BV/TV， and decreases in Tb.Sp and BS/BV （P<0.05， P<0.01）. Compared with the normal group， the model group showcased raised serum levels of TG， TC， LDL， and ApoB and lowered serum levels of HDL and ApoA1 （P<0.01）. Compared with the model group， the JPHGP groups had lowered serum levels of TG， TC， LDL， and ApoB （P<0.05， P<0.01） and a risen serum level of ApoA1 （P<0.05， P<0.01）. Moreover， the serum level of HDL in the high-dose JPHGP group increased （P<0.01）. A total of 19 different metabolites of disease set and drug set were screened out by oxylipidomics of the femoral head， and 119 core genes with restored expression were detected by transcriptomics. The enriched pathways were mainly concentrated in inflammation， lipids， apoptosis， and osteoclast differentiation. Molecular docking， immunohistochemistry， and Western blot results showed that compared with the normal group， the model group displayed increased content of 5-lipoxygenase （5-LO） and peroxisome proliferator-activated receptor γ （PPARγ） in the femoral head （P<0.01）. Compared with the model group， medium- and high-dose JPHGP reduced the content of 5-LO and PPARγ （P<0.05， P<0.01）. ConclusionJPHGP can restore the levels of oxidized lipid metabolites by regulating the 5-LO-PPARγ axis to treat SONFH in rats. Relevant studies provide experimental evidence for the efficacy mechanism of JPHGP in the treatment of SONFH.

Objective To investigate the impact of new-onset atrial fibrillation(AF)on all-cause mortality in elderly patients with hypertension having no previous history of AF.Methods A retrospective study was conducted on 1352 elderly hypertensive inpatients who had no history of AF and received long-term follow-up in Chinese PLA General Hospital from January 2014 to June 2017.According to having newly developed AF or not,they were divided into a new-set AF group(191 cases)and a control group(1161 cases).Kaplan-Meier survival curve was plotted for survival analysis and multivariate Cox survival analysis was performed to identify risk factors for all-cause mortality.Results Compared with the control group,the new-onset AF group exhibited significantly advanced age,higher urea level,lower diabetes ratio,and decreased hemoglobin level(P＜0.05,P＜0.01).Kaplan-Meier survival curve analysis showed that the cumulative mortality of the new-onset AF group was significantly higher than that of the control group(P＜0.01).Multivariate Cox regression analysis revealed that age＞75 years(HR=4.562,95％CI:3.104-6.705,P＜0.01),anemia(HR=2.543,95％CI:1.939-3.334,P＜0.01),new-onset AF(HR=1.494,95％CI:1.185-1.884,P＜0.01),eGFR＜60 mL/(min·1.73 m2)(HR=1.729,95％CI:1.389-2.151,P＜0.01),and heart failure(HR=1.539,95％CI:1.173-2.019,P＜0.01)were risk factors for all-cause mortality in elderly hypertensive patients without a history of AF.Conclusions New-onset AF is closely associated with an increased risk of all-cause mortality in elderly hypertensive patients without a previous history of AF.

Objective:To investigate the prognostic and predictive value of tertiary lymphoid structures (TLS) in gastric cancer patients undergoing immunotherapy.Methods:Clinical and pathological data, along with tumor tissue samples, were collected from 33 gastric cancer patients who received immunotherapy at Zhongda Hospital, Southeast University from January 2020 to December 2024. The density of tertiary lymphoid structures (TLS) and expression patterns of CD3, CD20, PNAd, and BCL6 were systematically evaluated using hematoxylin-eosin (H&E) staining and immunohistochemical (IHC) analysis. Statistical analyses were performed to determine the associations between TLS characteristics and clinical outcomes, including objective response rate (ORR), disease control rate (DCR), and progression-free survival (PFS).Results:Patients in the TLS-high infiltration group (TLS High) demonstrated significantly better outcomes compared to that of the TLS-low group (TLS Low), with higher ORR (58.8% vs 18.8%, P=0.019), DCR (94.1% vs 37.5%, <0.001), and markedly prolonged median PFS (276 vs 67 days, P＜0.000 1). Similarly, the BCL6-high expression group (BCL6 High) showed superior treatment responses versus the BCL6-low group (BCL6 Low), with significantly higher ORR (64.7% vs 12.5%, P=0.002), DCR (100.0% vs 31.3%, P＜0.001), and extended PFS ( P＜0.001). Univariate and multivariable Cox regression confirmed TLS infiltration level as an independent favorable prognostic factor for gastric cancer patients receiving immunotherapy ( HR=0.147, 95% CI: 0.022-0.964, P=0.046). Receiver operating characteristic (ROC) curve analysis revealed excellent predictive accuracy for both TLS infiltration [area under the curve (AUC)=0.885, P＜0.001] and the BCL6 scoring model (AUC=0.890, P＜0.001) in anticipating immunotherapy response. Conclusion:TLS density and BCL6 expression may serve as dual predictive and prognostic biomarkers for gastric cancer immunotherapy, highlighting their clinical utility in patient stratification and treatment guidance.

Objective:To analyze the efficacy of arthroscopic release of the lateral patellofemoral retinaculum (LPR) combined with medial patellofemoral ligament (MPFL) compression for the treatment of moderate to severe patellofemoral arthritis.Methods:A prospective study method was used to select 101 patients with moderate to severe patellofemoral arthritis who were admitted to the Jinzhou Medical University Shanghai Fengxian District Central Hospital from January 2021 to December 2023. They were randomly divided into group A (50 cases, LPR release surgery under knee arthroscopy) and group B (51 cases, LPR release surgery combined with MPFL compression surgery under knee arthroscopy). Perioperative indexes, pain degree of patellofemoral joint, patellofemoral trajectory correction, knee joint function and patellofemoral joint function were compared between the two groups before and 6 months after surgery.Results:During the study period, both group A and group B were excluded or separated, and ultimately 47 and 49 patients were enrolled in group A and group B, respectively. The operation time of group B was longer than that of group A: (35.27 ± 3.09) min vs. (25.64 ± 2.66) min, with statistically significant differences ( P<0.05). Six months after surgery, both groups experienced a reduction in pain, with group B being milder than group A: no pain 75.51% (37/49) vs. 44.68% (21/47), mild pain 24.49% (12/49) vs. 38.30% (18/47), moderate pain 0 vs. 14.89% (7/47), and severe pain 0 vs. 2.13% (1/47). The difference was statistically significant ( P<0.05). Six months after surgery, the patellofemoral adaptation angle, patellofemoral tilt angle, and patellofemoral lateral displacement distance in both groups decreased, and group B was smaller than group A: (8.02 ± 1.62)° vs. (10.35 ± 1.54)°, (8.71 ± 1.08)° vs. (10.85 ± 0.75)°, 1.00 (1.00, 1.00) mm vs. 1.00 (1.00, 1.00) mm, with statistically significant differences ( P<0.05). Both groups showed an increase in Lysholm knee score scale and patellar Kujala score, with group B being higher than group A: (89.92 ± 4.02) points vs. (84.21 ± 5.65) points and (89.18 ± 2.57) points vs. (87.40 ± 3.38) points, with statistically significant differences ( P<0.05). Conclusions:Arthroscopic release of LPR combined with MPFL compression surgery is more effective in treating moderate to severe patellofemoral arthritis than arthroscopic release of LPR. It can improve the correction of patellofemoral trajectory, reduce pain, and facilitate the recovery of knee and patellar joint function.

Abstract In recent years, the prevalence of overweight and obesity among children and adolescents has risen rapidly, posing a serious threat to their physical and mental health. To provide scientific, systematic, and standardized weight management guidance for overweight and obese children and adolescents, the study focuses on the core concept of healthy lifestyle intervention, integrates multidisciplinary expert opinions and research findings,and proposes a comprehensive multidisciplinary intervention framework covering scientific exercise intervention, precise nutrition and diet, optimized sleep management, and standardized psychological support. It calls for the establishment of a multi agent collaborative management mechanism led by the government, implemented by families, fostered by schools, initiated by individuals, optimized by communities, reinforced by healthcare, and coordinated by multiple stakeholders. Emphasizing a child and adolescent centered approach, the consensus advocates for comprehensive, multi level, and personalized guidance strategies to promote the internalization and maintenance of a healthy lifestyle. It serves as a reference and provides recommendations for the effective prevention and control of overweight and obesity, and enhancing the health level of children and adolescents.

Biomaterials provide a reliable and safe treatment for the repair of ear defects,especially microtia.With the continuous promotion of interdisciplinary research,the types and properties of materials used in auricle reconstruction have been greatly expanded and improved.In this paper,the latest research progress of polymer materials and tissue engineering scaffolds in the field of auricle reconstruction was reviewed,and the physical and chemical properties and clinical application effects of these scaffolds in vitro and in vivo were discussed.However,despite significant progress in ear stent research,there are still some challenges and limitations in the application of current polymer materials,such as the hydrophobicity of high-density polyethylene and the uncontrolled differen-tiation of stem cells in tissue engineering.Therefore,this paper discusses the research and clinical application of new modified materials,especially emphasizing the importance of surface modification technology and innovative synthesis strategies,so that the properties of modified materials are infinitely close to the characteristics of human ear cartilage.In addition,this paper also summarizes the control methods of stem cell differentiation in ear carti-lage tissue engineering.The application performance and biocompatibility of different ear scaffolds were reviewed in order to provide guidance for auricle reconstruction.