This study aims to elucidate the role and mechanism of clematichinenoside AR(CAR) in protecting bone marrow mesenchymal stem cells(BMSCs) from hypoxia-induced apoptosis. BMSCs were isolated by the bone fragment method and identified by flow cytometry. Cells were cultured under normal conditions(37℃, 5% CO_2) and hypoxic conditions(37℃, 90% N_2, 5% CO_2) and treated with CAR. The BMSCs were classified into eight groups: control(normal conditions), CAR(normal conditions + CAR), hypoxia 24 h, hypoxia 24 h + CAR, hypoxia 48 h, hypoxia 48 h + CAR, hypoxia 72 h, and hypoxia 72 h + CAR. The cell counting kit-8(CCK-8) assay and terminal-deoxynucleoitidyl transferase mediated nick end labeling(TUNEL) were employed to measure cell proliferation and apoptosis, respectively. The number of mitochondria and mitochondrial membrane potential were measured by MitoTracker®Red CM-H2XRo staining and JC-1 staining, respectively. The level of reactive oxygen species(ROS) was measured with the DCFH-DA fluorescence probe. The protein levels of B-cell lymphoma-2 associated X protein(BAX), caspase-3, and optic atrophy 1(OPA1) were determined by Western blot. The results demonstrated that CAR significantly increased cell proliferation. Compared with the control group, the hypoxia groups showed increased apoptosis rates, reduced mitochondria, elevated ROS levels, decreased mitochondrial membrane potential, upregulated expression of BAX and caspase-3, and downregulated expression of OPA1. In comparison to the corresponding hypoxia groups, CAR intervention significantly decreased the apoptosis rate, increased mitochondria, reduced ROS levels, elevated mitochondrial membrane potential, downregulated the expression of BAX and caspase-3, and upregulated the expression of OPA1. Therefore, it can be concluded that CAR may exert an anti-apoptotic effect on BMSCs under hypoxic conditions by regulating OPA1 to maintain mitochondrial homeostasis.
Mesenchymal Stem Cells/metabolism* ; Apoptosis/drug effects* ; Mitochondria/metabolism* ; Animals ; Rats ; Cell Hypoxia/drug effects* ; Homeostasis/drug effects* ; Reactive Oxygen Species/metabolism* ; Rats, Sprague-Dawley ; Membrane Potential, Mitochondrial/drug effects* ; Saponins/pharmacology* ; Caspase 3/genetics* ; Male ; bcl-2-Associated X Protein/genetics* ; Bone Marrow Cells/metabolism* ; Cell Proliferation/drug effects* ; Protective Agents/pharmacology* ; Cells, Cultured

Sepsis is a systemic inflammatory response caused by severe infection or trauma, and is one of the common causes of acute lung injury(ALI) and acute respiratory distress syndrome(ARDS). Sepsis-acute lung injury(SALI) is a critical clinical condition with high morbidity and mortality. Its pathogenesis is complex and not yet fully understood, and there is currently a lack of targeted and effective treatment options. Pyroptosis, a novel form of programmed cell death, plays a key role in the pathological process of SALI by activating inflammasomes and releasing inflammatory factors, making it a potential therapeutic target. In recent years, the role of traditional Chinese medicine(TCM) in regulating signaling pathways related to pyroptosis through multi-components and multi-targets has attracted increasing attention. TCM may intervene in pyroptosis by inhibiting the activation of NLRP3 inflammasomes and regulating the expression of Caspase family proteins, thus alleviating inflammatory damage in lung tissues. This paper systematically reviews the molecular regulatory network of pyroptosis in SALI and explores the potential mechanisms and research progress on TCM intervention in cellular pyroptosis. The aim is to provide new ideas and theoretical support for basic research and clinical treatment strategies of TCM in SALI.
Pyroptosis/drug effects* ; Humans ; Sepsis/genetics* ; Acute Lung Injury/physiopathology* ; Animals ; Drugs, Chinese Herbal/therapeutic use* ; Medicine, Chinese Traditional ; Inflammasomes/metabolism* ; NLR Family, Pyrin Domain-Containing 3 Protein/genetics*

Objective: To investigate an outbreak of acute gastroenteritis at a vocational and technical school in Shaanxi Province in 2024, ao as to provide the reference for the handling of school outbreaks. Methods: The conducted case searches, individual case investigations, and on-site hygienic investigations were established in accordance with the Guidelines on outbreak investigation, prevention and control of Norovirus infection (2015). The potential risk factors were analyzed by case-control study. Anal swab samples from cases and all canteen staff, as well as environmental swab samples were collected to detect common intestinal pathogens. All reserved food samples in canteen were collected to test for common pathogenic bacteria. Results: From October 26 to November 5, 2024, a cumulative total of 53 cases were reported, with an attack rate of 1.47%. The main clinical symptoms included vomiting (83.02%), abdominal pain (56.60%), diarrhea (30.19%), and fever (26.42%). The epidemic curve suggested an intermittent common-source outbreak, with no obvious clustering characteristics in terms of the population and spatial distribution of cases. The case-control analysis revealed that having dinner at the rice-with-dishes-on-top stall on the first floor of the canteen on October 28 was a risk factor for illness (OR=11.025, 95%CI: 2.186-55.601). GⅡ norovirus was detected as positive in anal swab samples from 6 cases and 2 asymptomatic infected canteen staff, as well as in 3 environmental swab samples from the rice-with-dishes-on-top stall. The test results for common pathogenic bacteria in the reserved food samples were all negative. Conclusions This outbreak was caused by an acute gastroenteritis epidemic induced by GⅡ norovirus infection, with a transmission pattern consistent with an intermittent homologous outbreak. The possible source of infection was asymptomatic infected canteen staff mainly through foodborne trasmission, and having meals at the rice-with-dishes-on-top stall was the primary risk factor for this outbreak.

Collagen is a major structural protein in the matrix of animal cells and the most widely distributed and abundant functional protein in mammals. Collagen’s good biocompatibility, biodegradability and biological activity make it a very valuable biomaterial. According to the source of collagen, it can be broadly categorized into two types: one is animal collagen; the other is recombinant collagen. Animal collagen is mainly extracted and purified from animal connective tissues by chemical methods, such as acid, alkali and enzyme methods, etc. Recombinant collagen refers to collagen produced by gene splicing technology, where the amino acid sequence is first designed and improved according to one’s own needs, and the gene sequence of improved recombinant collagen is highly consistent with that of human beings, and then the designed gene sequence is cloned into the appropriate vector, and then transferred to the appropriate expression vector. The designed gene sequence is cloned into a suitable vector, and then transferred to a suitable expression system for full expression, and finally the target protein is obtained by extraction and purification technology. Recombinant collagen has excellent histocompatibility and water solubility, can be directly absorbed by the human body and participate in the construction of collagen, remodeling of the extracellular matrix, cell growth, wound healing and site filling, etc., which has demonstrated significant effects, and has become the focus of the development of modern biomedical materials. This paper firstly elaborates the structure, type, and tissue distribution of human collagen, as well as the associated genetic diseases of different types of collagen, then introduces the specific process of producing animal source collagen and recombinant collagen, explains the advantages of recombinant collagen production method, and then introduces the various systems of expressing recombinant collagen, as well as their advantages and disadvantages, and finally briefly introduces the application of animal collagen, focusing on the use of animal collagen in the development of biopharmaceutical materials. In terms of application, it focuses on the use of animal disease models exploring the application effects of recombinant collagen in wound hemostasis, wound repair, corneal therapy, female pelvic floor dysfunction (FPFD), vaginal atrophy (VA) and vaginal dryness, thin endometritis (TE), chronic endometritis (CE), bone tissue regeneration in vivo, cardiovascular diseases, breast cancer (BC) and anti-aging. The mechanism of action of recombinant collagen in the treatment of FPFD and CE was introduced, and the clinical application and curative effect of recombinant collagen in skin burn, skin wound, dermatitis, acne and menopausal urogenital syndrome (GSM) were summarized. From the exploratory studies and clinical applications, it is evident that recombinant collagen has demonstrated surprising effects in the treatment of all types of diseases, such as reducing inflammation, promoting cell proliferation, migration and adhesion, increasing collagen deposition, and remodeling the extracellular matrix. At the end of the review, the challenges faced by recombinant collagen are summarized: to develop new recombinant collagen types and dosage forms, to explore the mechanism of action of recombinant collagen, and to provide an outlook for the future development and application of recombinant collagen.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.

Objective:To explore the effects of umbilical moxibustion combined with a multi-component exercise program on perioperative rehabilitation in frail elderly patients with intertrochanteric fractures so as to provide evidence-based basis for optimizing clinical rehabilitation nursing pathways.Methods:A quasi-experimental study design was used. Convenience sampling was applied to frail select elderly patients with intertrochanteric femoral fractures, who were admitted to Zhengzhou Orthopedic Hospital from January to October 2024. According to their admission time, the patients were divided into four groups: conventional nursing group, umbilical moxibustion group (conventional nursing+umbilical moxibustion), exercise group (conventional nursing+multicomponent exercise), and combination group (conventional nursing+umbilical moxibustion combined with multicomponent exercise), with 31 patients in each group. All the patients underwent internal fixation with proximal femoral nail antirotation under anesthesia. The umbilical moxibustion protocol focused on Shenque acupoint, combined with liver-kidney-nourishing Chinese herbal powder, with each session lasting 20 minutes. The multi-component exercise program was designed in phases, including resistance, balance, and aerobic training. The Harris hip score (HHS), Tilburg frailty indicator (TFI), falls efficacy scale-international (FES-I), and Chinese version of the short form-36 health survey (SF-36) scores were compared among the four groups preoperatively, at 1 month, 3 months postoperatively, and at the last follow-up.Results:A total of 124 elderly patients were involved, including 50 males and 74 females, aged 60-80 years [(71.8±5.0)years]. All the patients were followed up for 6 months. The results of generalized estimating equation showed that the HHS, TFI, FES-I, and SF-36 scores differed significantly in terms of group effect, time effect, and interaction effect among the four groups across all the time points ( P<0.05). Simple effect analysis indicated no significant differences in preoperative HHS, TFI, FES-I, or SF-36 scores among the four groups ( P>0.05). The HHS scores at 1 and 3 months postoperatively were (54.3±5.1)points and (65.7±6.3)points in the umbilical moxibustion group, (61.3±5.3)points and (74.5±6.8)points in the exercise group, and (66.5±5.2)points and (86.3±6.7)points in the combination group, which were all significantly higher than (50.2±4.5)points and (60.7±5.1)points in the conventional nursing group ( P<0.05), with the combination group showing higher scores than the umbilical moxibustion group and exercise group ( P<0.05). At the last follow-up, the HHS score was (77.3±6.0)points in the conventional nursing group and (77.0±5.9)points in the umbilical moxibustion group ( P>0.05); the score was (83.8±4.7)points in the exercise group and (91.4±3.5)points in the combination group, which were significantly higher than that in the conventional nursing group ( P<0.05), with the combination group showing higher score than those in the umbilical moxibustion group and exercise group ( P<0.05). At 1 month, 3 months postoperatively, and at the last follow-up, the TFI total scores were 5.0(3.0, 7.0)points, 3.0(1.0, 5.0)points, and 3.0(0.0, 4.0)points in the umbilical moxibustion group, 4.0(1.0, 6.0)points, 2.0(0.0, 5.0)points, and 2.0(0.0, 3.0)points in the exercise group, and 2.0(0.0, 5.0)points, 1.0(0.0, 2.0)points, and 0.0(0.0, 1.0)points in the combination group, which were all significantly lower than those in the conventional nursing group [7.0(5.0, 10.0)points, 7.0(5.0, 9.0)points, and 6.0(5.0, 8.0)points, respectively] ( P<0.05), with the combination group showing lower scores than the umbilical moxibustion group and exercise group ( P<0.05). The physical and social dimension scores of TFI at 1 month, 3 months postoperatively, and at the last follow-up were significantly lower in the umbilical moxibustion group, exercise group, and combination group than those in the conventional nursing group ( P<0.05), with the combination group showing the lower scores than those in the umbilical moxibustion group and exercise group ( P<0.05). At 1 month postoperatively, no statistically significant difference was observed among the four groups in the psychological dimension scores of TFI ( P>0.05). At 3 months postoperatively and at the last follow-up, the psychological dimension scores of TFI in the umbilical moxibustion group, exercise group, and combination group were all lower than those in the conventional nursing group ( P<0.05), with the combination group showing the lower scores than those in the umbilical moxibustion group and exercise group ( P<0.05). At 1 month, 3 months postoperatively, and at the last follow-up, the FES-I scores were (45.3±4.3)points, (40.9±3.9)points, and (33.9±2.8)points, respectively in the umbilical moxibustion group, (38.7±3.8)points, (32.9±3.6)points, and (30.3±2.2)points, respectively in the exercise group, and (34.2±3.6)points, (30.2±2.6)points, and (27.9±1.3)points, respectively in the combination group, which were all significantly lower than those in the conventional nursing group [(50.9±4.9)points, (50.0±4.9)points, and (40.7±4.2)points] ( P<0.05), with the combination group showing lower scores than those in the umbilical moxibustion group and exercise group ( P<0.05). At 1 month, 3 months postoperatively, and at the last follow-up, the SF-36 physical health scores were (60.6±3.7)points, (76.1±3.5)points, and (78.4±2.6)points, respectively in the umbilical moxibustion group, (57.6±3.7)points, (78.4±3.7)points, and (80.4±3.1)points, respectively in the exercise group, and (65.7±3.1)points, (85.9±2.9)points, and (87.4±2.2)points, respectively in the combination group, which were all significantly higher than those in the conventional nursing group [(47.5±4.6)points, (65.9±4.6)points, and (68.3±4.4)points] ( P<0.05), with the combination group showing higher scores than those in the umbilical moxibustion group and exercise group ( P<0.05). At 1 month, 3 months postoperatively, and at the last follow-up, the SF-36 mental health scores were (59.7±4.1)points, (74.5±3.6)points, and (76.2±3.0)points, respectively in the umbilical moxibustion group, (59.4±4.6)points, (74.1±3.8)points, and (74.4±3.9)points, respectively in the exercise group, and (66.9±4.1)points, (81.6±3.3)points, and (79.9±3.7)points, respectively in the combination group, which were all significantly higher than those in the conventional nursing group [(52.8±5.2)points, (64.0±4.9)points, and (65.3±5.1)points] ( P<0.05), with the combination group showing higher scores than those in the umbilical moxibustion group and exercise group ( P<0.05). Conclusion:For elderly patients with intertrochanteric femoral fracture combined with frailty, umbilical moxibustion combined with a multi-component exercise program can significantly improve hip function, reduce frailty and fall risk, and enhance quality of life.

BACKGROUND:Long non-coding RNA(LncRNA)plays an important role in nervous system development and neurological diseases.Previous studies by the research team have demonstrated that human umbilical cord mesenchymal stem cells overexpressing erythropoietin(EPO-MSCs)under ischemic and hypoxic conditions have better neuroprotective functions and significantly activate the expression of LncRNA XIST.Research suggests that XIST is related to the pathogenesis of hypoxic-ischemic encephalopathy,but the role and mechanism of its regulation by EPO-MSCs in protecting ischemic-hypoxic neurons remain unclear.OBJECTIVE:To explore the new mechanism by which LncRNA XIST,in response to EPO-MSC signaling,affects the apoptosis of ischemic-hypoxic SH-SY5Y cells.METHODS:(1)SH-SY5Y cell lines with knockdown of LncRNA XIST(sh-XIST)and negative control(NC-XIST)were constructed through lentiviral transfection.Oxygen-glucose deprivation was used to induce ischemic-hypoxic injury in the cells.Transwell chambers were used to create a non-contact co-culture system with EPO-MSCs,sh-XIST,and NC-XIST ischemic-hypoxic SH-SY5Y cells.Cell proliferation ability was detected using the CCK-8 assay.Cell migration ability was assessed using the scratch assay,and cell apoptosis was measured by flow cytometry.(2)RNA-seq bioinformatics analysis was performed to screen for differentially expressed genes and pathways between sh-XIST and NC-XIST cell lines.Dual-luciferase experiments were used to verify the relationship between miR-124-3p and the target genes XIST and GRIN1.qRT-PCR was conducted to validate the expression levels of downstream miR-124-3p and GRIN1 genes.(3)miR-124-3p inhibitors and mimics were added to verify phenotypic changes in SH-SY5Y cells after ischemic-hypoxic injury and co-culture with EPO-MSCs.RESULTS AND CONCLUSION:(1)Compared with the NC-XIST group,SH-SY5Y cells in the sh-XIST group showed reduced proliferation and migration abilities and increased apoptosis after ischemic-hypoxic injury and co-culture with EPO-MSCs.(2)Dual-luciferase experiments showed that miR-124-3p interacted with the target gene XIST.SH-SY5Y cells transfected with miR-124-3p mimics and co-cultured with EPO-MSCs showed decreased apoptosis after ischemic-hypoxic injury,while SH-SY5Y cells transfected with miR-124-3p inhibitors showed increased apoptosis after co-culture with EPO-MSCs.(3)Transcriptomic sequencing and bioinformatics analysis of sh-XIST revealed significant downregulation of the neuroactive ligand-receptor pathway and the key receptor gene GRIN1 for central nervous system development.(4)Dual-luciferase experiments showed that miR-124-3p interacted with GRIN1.GRIN1 expression was significantly downregulated in the sh-XIST group after ischemic-hypoxic injury compared with the NC-XIST group.These findings indicate that LncRNA XIST promotes GRIN1 expression by upregulating miR-124-3p,thereby reducing cell apoptosis after ischemic-hypoxic injury and co-culture with EPO-MSCs and enhancing proliferation and migration.sh-XIST can block this protective function.

Aim To elucidate the underlying mecha-nism by which total triterpenoids extracted from Hove-nia dulcis(H-TP)enhance the sensitivity of A549/DDP cells to cisplatin.Methods The ARE-Nrf2 lu-ciferase reporter assay was applied to investigate the impact of H-TP on Nrf2 expression.Western blot was used to detect the protein levels of Keap-1/Nrf2/HO-1,Nrf2-GPX4 signaling pathway,apoptosis-related proteins of Bcl-2 and Bax.Further validation of its effects on Nrf2 was conducted by using Nrf2 activator/inhibitor.Results H-TP could enhance the sensitivi-ty of A549/DDP cells to cisplatin by modulating the expression of apoptosis-related proteins Bax and Bcl-2,inhibiting the Keap-1/Nrf2/HO-1/GPX4 signating pathway in A549/DDP cells,and inducing ferroptosis.Conclusion H-TP enhances the sensitivity of A549/DDP cells to cisplatin by inducing the Nrf2-mediated ferroptosis pathway.