Background and Aims:The repair of giant incisional hernia is challenging,as closing the significant defect in the abdominal wall can lead to life-threatening complications like abdominal compartment syndrome(ACS).Botulinum toxin type A(BTA)can temporarily relax the abdominal wall muscles,facilitating defect repair,while preoperative progressive pneumoperitoneum(PPP)can increase intra-abdominal volume,reducing intra-abdominal pressure caused by hernia content reintegration.Combining BTA with PPP for the preoperative preparation of giant incisional hernia repair may have a complementary effect.This study was conducted to evaluate the clinical value of combining BTA and PPP in the repair of giant abdominal incisional hernia. Methods:The clinical data of 213 patients with giant abdominal incisional hernia treated at the Sixth Affiliated Hospital of Sun Yat-sen University from December 2015 to December 2019 were retrospectively analyzed.Two weeks after receiving combined BTA and PPP treatment,changes in bilateral abdominal wall muscle,intra-abdominal adhesions,abdominal circumference,abdominal cavity volume,and hernia sac volume ratio were assessed using CT.Intraoperative details,incidence of complications,and postoperative follow-up outcomes were recorded. Results:Following combined BTA and PPP treatment,CT scan showed a significant extension of bilateral lateral abdominal wall muscles towards the midline in all 213 patients,with an average increase of 2.45(1.53-3.29)cm on the left side and 2.54(1.68-3.40)cm on the right side;muscle thickness was reduced by an average of 0.84(0.64-1.00)cm on the left and 0.82(0.62-1.05)cm on the right,the average distance between viscera and the abdominal wall increased to(7.52±1.78)cm,with a mean increase of 6.1(4.2-6.9)cm;the mean increase in abdominal cavity volume was 1 802(1 494.98-2 316.26)mL,and the hernia sac volume ratio decreased by an average of 9％(6％-12％),all changes were statistically significant(P＜0.05).Post-PPP CT scan revealed no abdominal adhesions in 18 patients(8.45％),while 195 patients(91.55％)had varying degrees of adhesions,including 39 cases(18.31％)of sheet adhesions and 156 cases(73.24％)of mixed adhesions.Adhesions mainly consisted of omentum and intestinal tissues in 59.15％of cases.There were 43 cases(20.19％)of grade Ⅰ complications during the BTA-PPP process,including abdominal pain(28 cases),shoulder pain(9 cases),subcutaneous emphysema(6 cases),and dyspnea(3 cases).Dyspnea improved with oxygen therapy,while other complications required no special intervention.All 213 patients successfully underwent laparoscopic incisional hernia repair without conversion to open surgery or organ resection for volume reduction.Fascial closure was achieved in 209 cases(98.12％),with 4 cases(1.88％)having incomplete defect closure.The average time for adhesiolysis was 28(11.00-44.50)min,with a total operative time of 178.0(132.50-255.00)min and an average blood loss of 20(10-30)mL.The median intra-abdominal pressure(IAP)after operation was between 10 mmHg(9.00-12.00 mmHg),Among them,47 cases(22.07％)had IAP exceeding 12 mmHg,and after implementing proactive measures such as diuresis and diachoresis to reduce intra-abdominal contents,the IAP in these patients decreased to below 12 mmHg.No severe complications such as skin flap necrosis or ACS were observed.There were no deaths within postoperative 30 d,and during a follow-up period of 26(16.50-33.00)months,13 cases(6.10％)had surgical site events,including infections in 5 cases(2.35％),seromas in 7 cases(3.29％),and hematoma in 1 case(0.47％),with no hernia recurrence. Conclusion:The combination of BTA and PPP not only aids in identifying abdominal wall adhesion areas,improving preoperative surgical planning and enhancing surgical safety,but also significantly increases abdominal cavity volume and extends lateral abdominal wall muscles,facilitating the closure of giant incisional hernia defects and reducing the incidence of severe postoperative complications like ACS.This approach is worthy of clinical promotion.

Objective:To investigate the relationship between the mechanism of clonidine preventing sevoflurane-induced neurotoxicity and Tau phosphorylation in neonatal mice.Methods:Seventy-two SPF healthy newborn C57BL/6 wild-type mice, aged 6 days, were divided into 4 groups ( n=18 each) using a random number table method: normal control group (C group), clonidine control group (CC group), sevoflurane-induced neurotoxicity group (S group) and prevention with clonidine group (SC group). Mice inhaled 3% sevoflurane for 2 h daily on postnatal days 6, 9 and 12, and normal saline or clonidine 1 mg/kg was intraperitoneally injected before anesthesia in S group and SC group. Six mice were randomly selected from each group after the end of anesthesia on postnatal day 12, and the hippocampal tissues were removed for determination of the expression of the phosphorylated Tau protein (AT8) and total Tau protein (Tau46) at Tau-PS202 and Tau-PT205 sites by Western blot. The ratio of AT8 expression to Tau 46 expression (AT8/Tau46 ratio) was calculated. Another 12 mice in each group underwent novel object recognition test on postnatal days 29-30 (the discrimination ratio of novel objects was observed), and the Morris water maze test was performed on postnatal days 31-37 (the escape latency and the times of crossing the platform were observed). After the end of the behavioral testing, the hippocampal tissues were harvested under anesthesia to detect the expression of postsynaptic density-95 (PSD-95) by Western blot. Results:Compared with group C, the expression of AT8 was significantly up-regulated, the ratio of AT8/Tau46 was increased, the expression of PSD-95 was down-regulated, and the number of crossing platforms and novel object discrimination ratio were decreased in group S ( P<0.05). Compared with group S, the expression of AT8 was significantly down-regulated, the ratio of AT8/Tau46 was decreased, the expression of PSD-95 was up-regulated, and the number of crossing platforms and novel object discrimination ratio were significantly increased in group SC ( P<0.05). There was no significant difference in the expression of Tau46 and escape latency among the four groups ( P>0.05). Conclusions:The mechanism by which clonidine prevents sevoflurane-induced neurotoxicity in neonatal mice is related to the inhibition of Tau phosphorylation.

Objective:To compare the quality of sleep and rehabilitation after routine surgery versus day surgery in pediatric patients with snoring.Methods:This was a prospective study.Seventy pediatric patients with snoring, aged 4-6 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, undergoing adenoidectomy and/or tonsillectomy in the Guangzhou Women and Children′s Medical Center from March to June 2023, were divided into routine surgery group (group R) and day surgery group (group D), with 35 cases in each group. A sleep-detecting bracelet was used to monitor the sleep status. The proportion of deep sleep, light sleep and rapid eye movement, sleep continuity score and the maximum and minimum heart rate were recorded on the night before surgery, the first and second night after surgery. Rehabilitation was assessed using Quality of Recovery-15 at 1 day before surgery and 24 and 48 h and 28 days after surgery.Results:Compared with group R, the maximum heart rate at the night before surgery was significantly decreased, the proportion of light sleep on the second night after surgery was increased, the proportion of rapid eye movement sleep on the second night after surgery was decreased, the scores for items on " getting support from hospital doctors and nurses", " feeling comfortable and in control", and " having a feeling of general well-being" and the total score of Quality of Recovery-15 were significantly decreased at 24 and 48 h after operation, and the score for items on " feeling rested" and " have had a good sleep" at 48 h after surgery was decreased in group D ( P<0.05). Conclusions:Pediatric patients with snoring have poor quality of early sleep and rehabilitation after day surgery compared with routine surgery.

Objective:To explore the effects of G protein-coupled receptor 55 (GPR55) antagonist CID16020046 on renal fibrosis in mice, and provide a new method and idea for the treatment of renal fibrosis.Methods:(1) GPR55 overexpression and GPR55 antagonist CID16020046 were used in renal fibroblasts (NRK-49F) of rats, respectively. Meanwhile,transforming growth factor-β1 (TGF-β1) was applied in the NRK-49F cells to observe the expression of fibrosis-related factors and inflammatory factors. (2) A mouse model of renal fibrosis with unilateral ureteral obstruction (UUO) was established in vivo. Eight-week-old male C57BL/6J mice (20-25 g) were randomly divided into three groups according to the random number table method: sham group ( n=6), model group (UUO group, n=7), model + CID16020046 drug (UUO+CID group, n=8). The drug CID16020046 (10 mg/kg) was intraperitoneally injected 1 day before modeling, on the day of modeling and every day after surgery in UUO+CID group, and the corresponding dose of 0.9% normal saline was injected intraperitoneally in sham and UUO groups.The mice were sacrificed for sampling 7 days after UUO surgery, and their renal function indicators, liver transaminase, and cardiac markers were examined. Western blotting and quantitative real-time PCR were used to detect the expression of renal fibrosis-related factors and inflammatory factors. Immunohistochemistry staining, Sirius red staining and Masson trichrome staining were used to detect the pathological changes of renal tissues. Results:(1) After NRK-49F cells were stimulated by TGF-β1, the mRNA and protein expression levels of GPR55 were significantly increased (both P<0.05). There was no statistically significant difference in the mRNA expression of fibrosis-related factors fibronectin and collagen Ⅰ, and inflammatory factors interleukin-1β and tumor necrosis factor-α between TGF-β1 group and TGF-β1 + GPR55 overexpression group (all P>0.05). Compared with the TGF-β1 group, the protein expression levels of fibrosis-related factors alpha-smooth muscle actin (α-SMA) and vimentin, and the mRNA expression levels of collagen Ⅰ and α-SMA were lower in the TGF-β1 + CID group (all P<0.05). (2) Compared with sham group, the mRNA and protein expression levels of GPR55 in UUO group were higher (both P<0.05). The serum creatinine in the UUO+CID group was lower compared to the UUO group ( P<0.05). There was no statistically significant difference in blood urea nitrogen, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase and creatine kinase isoenzyme between UUO group and UUO+CID group (all P>0.05). Compared with the UUO group, the protein expression levels of renal fibrosis-related factors fibronectin, collagen Ⅰ and vimentin, and the mRNA expression levels of fibronectin, collagen Ⅰ, collagen Ⅲ and α-SMA were lower in the UUO+CID group (all P<0.05). The degree of renal tubular dilation and interstitial collagen fiber deposition in the UUO+CID group was significantly reduced compared to the UUO group (all P<0.05). Conclusions:CID16020046 can reduce serum creatinine in UUO mice, protect renal function, and simultaneously decrease the expression of fibrosis-related factors in renal fibroblasts and mouse kidney tissues, thereby alleviating renal fibrosis.

Objective To investigate the effect of iTBS stimulation on walking function in patients with stroke.Methods Fifty patients with post-stroke walking dysfunction who met the inclusion criteria were selected for 3-week rehabilitation treatment,and were randomly divided into iTBS group(n=25)and sham group(n=25).The iTBS group was treated with conventional rehabilitation therapy combined with iTBS stimulation of contral-esional cerebellum,and the sham group was treated with conventional rehabilitation therapy plus iTBS stimulation of contralesional cerebellum.Relevant indicators were analyzed before treatment and at 21 days of treatment.Lower limb motor function scores of the two groups were compared before and after treatment.Fugl-Meyer motor function lower limb activity score,Berg Balance Scale score,Brunnstrom stage(lower limb),hamstring/quadriceps(H/Q)on the affected side,Modified Barthel index(MBI),gait analysis parameters,and TMS-MEP were used to evaluate the effectiveness of cerebellar iTBS in the rehabilitation of walking dysfunction after stroke.Results After 21 days of treatment,the improvements of Brunnstrom stage,Holden grade,Berg score,FMA score,6-minute walking dis-tance,NIHSS score and MBI score in iTBS group were significantly better than those in sham group(P<0.05).Af-ter treatment,the H/Q in iTBS group was significantly higher thanbefore(P<0.05),but there was no significant difference between the two groups(P>0.05).Stride speed,stride frequency,stride width,single support phase on the affected side and GDI score in iTBS group were significantly improved compared with sham group(P<0.05),and there was no significant difference in stride length between the two groups after treatment(P>0.05).The amplitude of MEP in the affected cerebral cortex of iTBS group was lower after treatment than before(P<0.05).Conclusion Contralesional cerebellar iTBS combined with routine rehabilitation could improve lower limb walk-ing function and daily living ability of stroke patients.

ObjectiveTo screen out the transcriptomes related to the intervention of Wuzi Yanzongwan on the spermatogenic function of semi-castrated male mice， and to explore its potential mechanism in the intervention of the progress of low spermatogenic function. MethodBalb/c mice were randomly divided into sham-operated group， model group， testosterone propionate group（0.2 mg·kg^-1·d^-1， intramuscular injection） and Wuzi Yanzongwan group（1.56 g·kg^-1·d^-1， intragastric administration） according to body weight， with 12 mice in each group. The right testicle and epididymis were extracted from the model group and the drug administration group to construct the semi-castrated model of low spermatogenic function， while the fur and the right scrotum of the sham-operated group were only cut and immediately sterilized and sutured. At the end of the intervention， hematoxylin-eosin（HE） staining was used to observe the histopathology of testis， enzyme-linked immunosorbent assay（ELISA） was used to detect the levels of serum testosterone（T）， luteinizing hormone（LH） and follicle stimulating hormone（FSH）. The sperm count and motility of epididymis were measured by automatic sperm detector of small animal. Transcriptomic microarray technology was used to detect the mRNA expression level of testicular tissue in each group， the transcriptome of genes related to the regulation of Wuzi Yanzongwan was screened， and three mRNAs were selected for Real-time fluorescence quantitative polymerase chain reaction（Real-time PCR） to verify the transcriptome data. Through the annotation analysis of Gene Ontology（GO） and the signaling pathway analysis of Kyoto Encyclopedia of Genes and Genomes（KEGG）， the related functions of drugs regulating transcriptome were analyzed. ResultCompared with the sham-operated group， the testicular tissue of mice in the model group showed spermatogenic injury， contraction and vacuolization of the seminiferous tubules， reduction of spermatogenic cells at all levels， widening of the interstitial space， obstruction of spermatogonial cell development and other morphological abnormalities， and serum T significantly decreased， LH significantly increased（P<0.01）， and FSH elevated but no statistically significant difference， the count and vitality of epididymal sperm significantly decreased（P<0.01）. There were 882 differentially expressed mRNAs in the testicular tissues， of which 565 were up-regulated and 317 were down-regulated. Cluster analysis showed that these differentially expressed mRNA could effectively distinguish between the sham-operated group and the model group. Compared with the model group， the damage to testicular tissue in the Wuzi Yanzongwan group was reduced， the structure of the seminiferous tubules was intact， vacuolization was reduced， and the number of spermatogenic cells at all levels was significantly increased and arranged tightly. The serum T significantly increased， LH significantly decreased（P<0.01）， and FSH decreased but the difference was not statistically significant. The count and vitality of sperm in the epididymis were significantly increased（P<0.01）. Moreover， Wuzi Yanzongwan could regulate 159 mRNA levels in the testes of semi-castrated mice， of which 32 were up-regulated and 127 were down-regulated， and the data of the transcriptome assay was verified to be reliable by Real-time PCR. GO and KEGG analysis showed that the transcriptome functions regulated by Wuzi Yanzongwan were involved in the whole cell cycle process of sperm development such as sex hormone production of interstitial cells in testis， renewal， differentiation， metabolism， apoptosis and signal transduction of spermatogenic cells， and were closely related to the biological behaviors of signaling pathways such as spermatogenic stem cell function， endoplasmic reticulum protein processing and metabolic program. ConclusionWuzi Yanzongwan can effectively improve the low spermatogenic function of semi-castrated male mice， and its mechanism may be related to the regulation of testicular transcriptional regulatory network， the synthesis of sex hormones in testicular interstitial cells， the function of spermatogenic stem cells， the whole cell cycle process of spermatogenesis， as well as the expression of endoplasmic reticulum protein processing and metabolic program related genes transcription.

Objective:To explore the feasibility and effect of applying spherical fitting technology in CT three-dimensional reconstruction in preoperative planning of the resection range of Cam-type femoral acetabular impingement (FAI).Methods:46 Cam-type FAI patients who underwent arthroscopic femoroplasty in the Department of Sports Medicine in the Third Affiliated Hospital of Southern Medical University from July 2020 to June 2022 were enrolled in the spherical fitting group, including 26 females and 20 males, with an average age of 38.4±15.2 years (range of 24-53 years). The preoperative planning was performed using spherical fitting technology in CT three-dimensional reconstruction. Another 42 Cam-type FAI patients who underwent arthroscopic femoroplasty from July 2018 to June 2020 were enrolled in the observation group, including 25 females and 17 males, with an average age of 43.6±18.4 years (range 24-61 years). The preoperative planning was performed using CT three-dimensional reconstruction observation method. This study evaluated the impact of femoroplasty planned by spherical fitting technique on patients' prognosis though comparing the differences of postoperative α angle, femoral head-neck offset ratio, modified Harris hip score (mHHS), and visual analog score (VAS) at 3, 6, 9, and 12 months between two groups.Results:The average follow-up time was 11.8±0.6 months in spherical fitting group and 11.3±0.8 months in observation group. There was no significant difference regarding α angle, femoral head-neck offset ratio, mHHS, and VAS between two groups preoperatively ( P>0.05). The mHHS in two groups increased gradually, while VAS decreased sequentially at 3, 6, 9, and 12 months postoperatively. The postoperative mHHS and VAS were significantly better than those before surgery ( P<0.05). The mHHS was 83.2±14.8 vs. 70.5±11.2 in spherical fitting group and observation group at the followup of 9 months with significant difference ( t=4.471, P=0.007). It was 85.7±13.3 vs. 73.2±12.5 at the followup of 12 months with significant difference ( t=4.596, P=0.008). No significant difference was found in α angle, femoral head-neck offset ratio or mHHS at 3 and 6 months postoperatively ( P>0.05), and no significant difference was found in VAS at 3, 6, 9, and 12 months postoperatively between two groups. Conclusion:The spherical fitting technology in CT three-dimensional reconstruction could assist surgeons with planning of the resection range of Cam deformity preoperatively, and achieve a smooth progress of arthroscopic femoroplasty intraoperatively; after short term follow-up, we found that patients who underwent femoroplasty using this technology achieved satisfactory outcomes.

This article summarizes the domestic and international research progress of recombinant human follicle stimulating hormone(rFSH).According to relevant guidelines and application cases,the general requirements and common problems for non-clinical evaluation of rFSH are summarized.The clinical development prospects of long-acting rFSH products which is a hot research topic in recent years are analyzed and corresponding suggestions are given in order to provide reference for related work.

The breakage pattern of unit particles during the production of oral solid dosage forms (OSD) is closely related to the quality of intermediate or final products. To accurately characterize the particles and study the evolution law of particle breakage, the Bonding model of the discrete element method (DEM) was used to investigate the breakage patterns of model parameters, particle shape and process conditions (loading mode and loading rate) on the dynamic breakage, force-time curve, breakage rate, maximum breakage size ratio and fracture strength of particles. The results showed that the particle breakage force was positively correlated with normal strength and bonded disk scale, negatively correlated with normal stiffness per unit area and tangential stiffness per unit area, and weakly correlated with tangential strength. The particle breakage rate was negatively correlated with the aspect ratio of the particles, and the maximum breakage size ratio was positively correlated with the aspect ratio of the particles; among the three loading modes, the breakage rate of compression breakage model was the largest, the breakage rate of shear breakage model was the second largest, and the breakage rate of wear breakage model was the smallest; the maximum breakage size ratio was positively correlated with the loading rate, the loading mode and the loading rate had no mutual influence on particle breakage rate, but had mutual influence on the maximum breakage size ratio. The research results will provide a theoretical basis for the shift of OSD from batch manufacturing to advanced manufacturing.

Objective:To discuss the anti-fatigue effect of Wujia Shengmai Yin,and to clarify its mechanism.Methods:Thirty-six male ICR mice were randomly devided into control group(equivalent volume of distilled water),Shengmai Yin group(500 mg·kg?1 of Shengmai Yin),and Wujia Shengmai Yin group(600 mg·kg?1 of Wujia Shengmai Yin).The body weights of the mice in various groups were detected every 7 d,and the mental states were observed.The rotating rod test and exhaustive swimming test were used to detect the duration on the rod and the swimming time to exhaustion of the mice in various groups,respectively;the levels of urea nitrogen(BUN)and lactate(LA),and the activities of lactate dehydrogenase(LDH)in serum,the levels of liver glycogen(LG),muscle glycogen(MG),and malondialdehyde(MDA),and activities of glutathione peroxidase(GSH-Px)and superoxide dismutase(SOD)in muscle tissue of the mice in various groups were detected by kits;the expression levels of glucose metabolism-related proteins in liver tissue of the mice in various groups were detected by Western blotting method.Results:Compared with before experiment,the body weights after experiment of the mice in various groups showed a increasing trend but the differences were not statistically significant(P>0.05).The rotating rod test results showed that compared with control group,the duration on the rod of the mice in Wujia Shengmai Yin group was significantly increased(P<0.01).The exhaustive swimming test results showed that compared with control group,the swimming time to exhaustion of the mice in Shengmai Yin group and Wujia Shengmai Yin group was significantly increased(P<0.01).Compared with control group,the levels of BUN in serum of the mice in Shengmai Yin group and Wujia Shengmai Yin group were significantly decreased(P<0.01),and the activities of LDH were significantly increased(P<0.01);the level of LA of the mice in Wujia Shengmai Yin group was significantly decreased(P<0.01).Compared with Shengmai Yin group,the levels of BUN and LA in the serum and LDH activity of the mice in Wujia Shengmai Yin group were significantly decreased(P<0.01).Compared with control group,the levels of LG in liver tissue and the levels of MG in muscle tissue of the mice in Shengmai Yin group and Wujia Shengmai Yin group were significantly increased(P<0.01);compared with Shengmai Yin group,the level of LG in liver tissue and the level of MG in muscle tissue of the mice in Wujia Shengmai Yin group were increased(P<0.01).Compared with control group,the activities of GSH-Px and SOD in muscle tissue of the mice in Shengmai Yin group and Wujia Shengmai Yin group were significantly increased,and the levels of MDA in Shengmai Yin group and Wujia Shengmai Yin group was significantly decreased(P<0.01);compared with Shengmai Yin group,the activities of GSH-Px and SOD in muscle tissue of the mice in Wujia Shengmai Yin group were significantly increased and the level of MDA was decreased(P<0.01).The Western blotting results showed that compared with control group,the expression levels of phosphorylated phosphoinositide 3-kinase(p-PI3K),phosphorylated protein kinase B(p-AKT),phosphorylated glycogen synthase kinase 3 beta(p-GSK3β),and glycogen synthase(GS)proteins in liver tissue of the mice in Shengmai Yin group and Wujia Shengmai Yin group were significantly increased(P<0.05 or P<0.01);compared with Shengmai Yin group,the expression levels of p-PI3K,p-AKT,p-GSK3β,and GS proteins in liver tissue of the mice in Wujia Shengmai Yin group were significantly increased(P<0.01).Conclusion:Wujia Shengmai Yin enhances the anti-fatigue effect by activating the phosphoinositide 3-kinase(PI3K)/protein kinase B(AKT)/glycogen synthase kinase 3 beta(GSK3β)signaling pathways,and improves the body's antioxidant capacity,and increases the glycogen synthesis.