BACKGROUND:Periprosthetic joint infection is the most common cause of early failure after total knee replacement.The current methods of preventing periprosthetic joint infection by improving the surface of the prosthesis have limitations to varying degrees.OBJECTIVE:To construct a coating material that can stably improve the surface of the implant,prevent the initial floating bacterial infection of periprosthetic infection,and regulate the bone transfer function around the implant.METHODS:(1)Material preparation:YGF polypeptide(which promotes bone formation),LL-37 polypeptide(with antibacterial properties)and YGF+LL-37 composite peptide were prepared by Fmoc solid phase peptide synthesis technology.The titanium-based materials were immersed in the three polypeptide solutions for 2 hours to obtain YGF coating,LL-37 coating and composite peptide coating coated titanium sheets.(2)In vitro experiment:Uncoated titanium sheets and coated titanium sheets were co-cultured with Escherichia coli(or Staphylococcus aureus)and the colonies were counted by plate method.MC3T3 cells were inoculated on the surface of uncoated titanium sheet and coated titanium sheet,respectively.Alizarin red staining was used to observe the calcium salt deposition on the surface of the material.Western blot assay was used to detect the protein expression of RUNX2,osteocalcin,osteopontin,and bone morphogenetic protein 2.(3)Animal experiment:24 SD rats were randomly divided into three groups:the blank group(n=8)was implanted with uncoated titanium nails in the femoral medullary canal;the control group(n=8)was implanted with uncoated titanium nails in the femoral medullary canal+intra-articular injection of Staphylococcus aureus suspension;the experimental group(n=8)was implanted with composite peptide coated titanium nails in the femoral medullary canal+intra-articular injection of Staphylococcus aureus suspension.After 5 weeks of implantation,micro-CT examination,hematoxylin-eosin staining and immunohistochemical staining of femur specimens were performed.RESULTS AND CONCLUSION:(1)In vitro experiment:Compared with uncoated titanium sheet and YGF coated titanium sheet,LL-37 coated and composite peptide coated titanium sheet could significantly inhibit the growth and reproduction of Escherichia coli and Staphylococcus aureus.Compared with uncoated titanium sheets and LL-37-coated titanium sheets,YGF-coated and composite peptide-coated titanium sheets could promote calcium salt deposition in osteoblasts and increase the protein expression of RUNX2,osteocalcin,osteopontin and bone morphogenetic protein 2.(2)Animal experiment:Micro-CT test showed that the control group had less bone mass than the blank group and the experimental group.Hematoxylin-eosin staining showed that there was a large amount of fibrous tissue around the nail channel in the control group,only a small amount of tissue fibrosis around the nail channel in the blank group,and only a small amount of tissue fibrosis around the nail channel in the experimental group.Immunohistochemical staining showed that the protein expression of interleukin 1β and tumor necrosis factor α in the control group was higher than that in the blank group and the experimental group,and the expression of osteocalcin,RUNX2 and osteopontin in the experimental group was higher than that in the blank group and the control group.(3)The results show that the titanium-based material coated with YGF+LL-37 composite peptide coating has good antibacterial ability and can promote bone transfer around the implant.

BACKGROUND:Periprosthetic joint infection is the most common cause of early failure after total knee replacement.The current methods of preventing periprosthetic joint infection by improving the surface of the prosthesis have limitations to varying degrees.OBJECTIVE:To construct a coating material that can stably improve the surface of the implant,prevent the initial floating bacterial infection of periprosthetic infection,and regulate the bone transfer function around the implant.METHODS:(1)Material preparation:YGF polypeptide(which promotes bone formation),LL-37 polypeptide(with antibacterial properties)and YGF+LL-37 composite peptide were prepared by Fmoc solid phase peptide synthesis technology.The titanium-based materials were immersed in the three polypeptide solutions for 2 hours to obtain YGF coating,LL-37 coating and composite peptide coating coated titanium sheets.(2)In vitro experiment:Uncoated titanium sheets and coated titanium sheets were co-cultured with Escherichia coli(or Staphylococcus aureus)and the colonies were counted by plate method.MC3T3 cells were inoculated on the surface of uncoated titanium sheet and coated titanium sheet,respectively.Alizarin red staining was used to observe the calcium salt deposition on the surface of the material.Western blot assay was used to detect the protein expression of RUNX2,osteocalcin,osteopontin,and bone morphogenetic protein 2.(3)Animal experiment:24 SD rats were randomly divided into three groups:the blank group(n=8)was implanted with uncoated titanium nails in the femoral medullary canal;the control group(n=8)was implanted with uncoated titanium nails in the femoral medullary canal+intra-articular injection of Staphylococcus aureus suspension;the experimental group(n=8)was implanted with composite peptide coated titanium nails in the femoral medullary canal+intra-articular injection of Staphylococcus aureus suspension.After 5 weeks of implantation,micro-CT examination,hematoxylin-eosin staining and immunohistochemical staining of femur specimens were performed.RESULTS AND CONCLUSION:(1)In vitro experiment:Compared with uncoated titanium sheet and YGF coated titanium sheet,LL-37 coated and composite peptide coated titanium sheet could significantly inhibit the growth and reproduction of Escherichia coli and Staphylococcus aureus.Compared with uncoated titanium sheets and LL-37-coated titanium sheets,YGF-coated and composite peptide-coated titanium sheets could promote calcium salt deposition in osteoblasts and increase the protein expression of RUNX2,osteocalcin,osteopontin and bone morphogenetic protein 2.(2)Animal experiment:Micro-CT test showed that the control group had less bone mass than the blank group and the experimental group.Hematoxylin-eosin staining showed that there was a large amount of fibrous tissue around the nail channel in the control group,only a small amount of tissue fibrosis around the nail channel in the blank group,and only a small amount of tissue fibrosis around the nail channel in the experimental group.Immunohistochemical staining showed that the protein expression of interleukin 1β and tumor necrosis factor α in the control group was higher than that in the blank group and the experimental group,and the expression of osteocalcin,RUNX2 and osteopontin in the experimental group was higher than that in the blank group and the control group.(3)The results show that the titanium-based material coated with YGF+LL-37 composite peptide coating has good antibacterial ability and can promote bone transfer around the implant.

ObjectiveTo explore the potential mechanism of Weicanqing Formula （微残清方， WF） combined with chemotherapy in treating acute myeloid leukemia （AML） based on malic enzyme 2 （ME2）-mediated bone marrow immune-metabolic homeostasis and . MethodsSixty-five male C57BL/6N mice were randomly divided into control group， model group， WF group， chemotherapy group， and the combination group （WF plus chemotherapy）， with 13 mice per group. Except for the control group， mice were injected with C1498 cells （appro-ximately 1×10⁶ cells per mouse） via the tail vein on day 1 to establish an AML model. Starting from day 8， mice in the chemotherapy group and the combination group were administered with cytarabine at 30 mg/（kg·d） via subcutaneous injection， once daily for 3 consecutive days； WF group and the combination group received WF at 7.54 g/（kg·d） by gavage， once daily for 21 consecutive days. On days 1， 7， 14， 21 and 28， hemoglobin （Hb） and white blood cell （WBC） levels were determined in each group. On day 28， Giemsa staining was used to observe morphological changes in bone marrow cells. Flow cytometry was employed to detect the expression levels of bone marrow T lympthocyte subsets， including CD8⁺， CD4⁺， and regulatory T lymphocytes （Treg）. The contents of glutamine （Gln）， nicotinamide adenine dinucleotide phosphate （NADP⁺）， and reduced nicotinamide adenine dinucleotide phosphate （NADPH） in bone marrow were determined using visible spectrophotometry. Adenosine triphosphate （ATP） concentration in bone marrow was measured by chemiluminescence assay. The mRNA expression of malic enzyme 2 （ME2） in bone marrow was detected by RT-qPCR， and the protein expression level of ME2 was determined by Western blotting. ResultsCompared to the control group， the model group showed decreased Hb levels on day 14， 21， and 28， and increased WBC levels on day 7， 14， 21， and 28 （P＜0.05）. On day 28， bone marrow CD8⁺ and CD8⁺/CD4⁺ levels decreased， while Treg cells， ATP， Gln， NADP⁺， NADPH， ME2 mRNA， and their corresponding protein levels increased （P＜0.05）. Compared to the model group， the chemotherapy group and the combination group both exhibited reduced Hb level on day 14， 21 and 28， as well as the increased WBC level； the combination group showed increased CD8⁺ level， decreased Treg， ATP， Gln， and NADPH content， as well as reduced ME2 mRNA expression and protein levels （P＜0.05）. Compared to the chemotherapy group， the combination group showed significantly increased Hb level on days 21 and 28， and increased WBC level on day 28 （P＜0.05）. Bone marrow smear pathology revealed that， in the model group， myeloid blast cells exhibited cytoplasmic vacuoles indicative of abnormal metabolic activity. In contrast， both the chemotherapy group and the combination group showed large numbers of metamyelocytes and band neutrophils， with only a few immature granulocytic blast cells observed. ConclusionWF may improve the prognosis of AML when used as an adjunct to chemotherapy by modulating ME2 expression， inhibiting metabolic energy competition within the bone marrow microenvironment， and reshaping the distribution of T lymphocyte subsets in the bone marrow.

ObjectiveTo evaluate the effects of Tongnaoyin on the blood-brain barrier status and neurological impairment in acute ischemic stroke （AIS） patients with the syndrome of phlegm-stasis blocking collaterals by dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI）. MethodsA total of 63 patients diagnosed with AIS in the Jiangsu Province Hospital of Chinese Medicine from October 2022 to December 2023 were enrolled in this study. According to random number table method，the patients were assigned into a control group （32 cases） and an observation group （31 cases）. The control group received conventional Western medical treatment，and the observation group took 200 mL Tongnaoyin after meals，twice a day from day 2 of admission on the basis of the treatment in the control group. After 7 days of treatment，the patients were examined by DCE-MRI. The baseline data for two groups of patients before treatment were compared. The National Institute of Health Stroke Scale （NIHSS） score and modified Rankin Scale （mRS） score were recorded before treatment and after 90 days of treatment for both groups. The rKtrans，rKep，and rVe values were obtained from the region of interest （ROI） of the infarct zone/mirror area and compared between the two groups. ResultsThere was no significant difference in the NIHSS or mRS score between the two groups before treatment. After 90 days of treatment，the NIHSS and mRS scores declined in both groups，and the observation group had lower scores than the control group （P<0.05）. After treatment，the rKtrans and rVe in the observation group were lower than those in the control group （P<0.01）. ConclusionCompared with conventional Western medical treatment alone，conventional Western medical treatment combined with Tongnaoyin accelerates the repair of the blood-brain barrier in AIS patients，thereby ameliorating neurological impairment after AIS to improve the prognosis.

BACKGROUND: To date, results on relationship between CYP3A4 gene polymorphism were limited and inconclusive, and no study focused on the influence of CYP3A4 gene-obesity interaction on breast cancer risk, especially in Chinese women. The purpose of this study was to evaluate the impact of four single nucleotide polymorphisms (SNPs) of CYP3A4 gene, the SNP-SNP and gene-environment interactions on the susceptibility to breast cancer in Chinese women. METHODS: Logistic regression was used to explore the relationship between four SNPs of CYP3A4 gene and the risk of breast cancer. Generalized multifactor dimensionality reduction (GMDR) was used to screen the best SNP-SNP and gene-abdominal obesity interaction combinations among four SNPs and abdominal obesity. Haplotype examination among 4 SNPs was conducted using the SHEsis web-based platform. RESULTS: Logistic regression analysis showed that carriers of rs2242480- T allele have significantly higher breast cancer risk, than those with rs2242480- CC genotype, adjusted OR (95%CI) was 1.68 (1.23-2.16) and 2.03 (1.53-2.58) for participants with CT genotype and TT genotype under additive model. We did not find any notable interactions between the four SNPs within the CYP3A4 gene. GMDR model found a significant association in a two-locus model involving rs2242480 and obesity, with a p-value of 0.018. Stratified analysis found that breast cancer risk was the highest in obese participants with rs2242480- CT or TT genotype, compared to those non-obese participants with rs2242480- CC genotype, OR (95%CI) was 3.02 (1.83-4.25). We found that all haplotype combinations were not correlated with breast cancer risk. CONCLUSIONS We found that the T allele of rs2242480 within the CYP3A4 gene and interaction between rs2242480 and obesity were associated with an increased risk of breast cancer. However, the results of this study were only applicable to the Han ethnic group and cannot be generalized to other ethnic groups in China, and more SNPs of CYP3A4 gene should been enrolled in the analysis in the future, to verify the results obtained in this study.
Adult ; Aged ; Female ; Humans ; Middle Aged ; Breast Neoplasms/etiology* ; China/epidemiology* ; Cytochrome P-450 CYP3A/metabolism* ; Gene-Environment Interaction ; Genetic Predisposition to Disease ; Haplotypes ; Obesity/epidemiology* ; Polymorphism, Single Nucleotide ; Risk Factors ; East Asian People

Objective To explore the effects of preoperative transcatheter arterial chemoembolization(TACE)on early postoperative recurrence in the China liver cancer(CNLC)staging Ⅰb-Ⅱa patients with primary hepatocellular carcinoma.Methods The data of patients with CNLC Ⅰb-Ⅱa stage hepatocellular carcinoma who underwent curative liver resection in Xiangyang Central Hospital from May 2017 to May 2022 were retrospectively analyzed.A total of 76 patients were included,patients were divided into preoperative TACE group(n=32)and surgery group(n=44)according to whether they underwent preoperative TACE.Observe the postoperative recovery of patients.Combined with the postoperative pathological results,adjuvant TACE treatment is performed.Regular reexamination and follow-up are conducted after discharge.The Kaplan-Meier method was used to estimate survival time,calculate 95％CI,and plot the Disease-free(DFS)survival curve.The Cox proportional risk model was used for univariate and multivariate analysis.Results The 1-year disease-free survival rate in the preoperative TACE group was higher than that in the direct surgery group(96.9％vs.84.1％,P＞0.05).The 2-year disease-free survival rate in the preoperative TACE group was higher than that in the direct surgery group(90.6％vs.70.5％,P＜0.05).The disease-free survival of the preoperative TACE group was higher than the direct surgery group(23.03 months vs.20.14 months,P＜0.05).The incidence of treatment-related adverse events after surgery in the preoperative TACE group was higher than that in the direct surgery group(34.4％vs.20.5％,P＞0.05).Multivariate Cox regression analysis showed that different treatment methods,tumor number ≥ 2,and tumor microvascular invasion were prognostic factors affecting tumor recurrence.No severe adverse reactions occurred in either group,and no deaths caused by adverse reactions were observed.Conclusion Compared with direct surgery,preoperative TACE can help improve early postoperative recurrence,prolong patients'disease-free survival,and do not lead to serious adverse events.

Objective:To explore the safety and efficacy of camrelizumab combined with tegafur gimeracil oteracil potassium (S-1) and albumin-bound paclitaxel in the treatment of initially unresectable cholangiocarcinoma.Methods:From October 2022 to August 2024, 17 patients with unresectable intrahepatic cholangiocarcinoma and 4 patients with hilar cholangiocarcinoma were admitted to Xiangyang Central Hospital. They received treatment with camrelizumab combined with S-1 and nab-paclitaxel. Their short-term efficacy and adverse reactions were evaluated, and their long-term survival was followed up.Results:Of the 21 patients, 2 were in complete remission, 6 were in partial remission, 12 had stable disease, and 1 had progressive disease. The objective remission rate was 38.10% (8/21), and the disease control rate was 95.23% (20/21). Five patients were converted to resectable cholangiocarcinoma, with a conversion success rate of 23.81%,2 patients had complete postoperative pathological remission, and 3 patients had major pathological remission. The median progression-free survival time was 11 months (95% CI: 8.37-13.62), and the 1-year progression-free and overall survival rates were 28.57% and 95.23%, respectively. The overall adverse event rate was 90.48% (19/21), and the grade 3 adverse event rate was 28.57% (6/21). Conclusion:The combination of camrelizumab with S-1 and nab-paclitaxel for initially unresectable cholangiocarcinoma has favorable short-term efficacy, tolerable adverse reactions, and improved long-term survival for patients.

Objective To observe the value of PET/CT radiomics for predicting Ki-67 expression level of non-small cell lung carcinoma(NSCLC).Methods 18F-FDG PET/CT data of 139 NSCLC patients were retrospectively analyzed.The patients were divided into high-expression group(≥40%,n=75)and low-expression group(＜40%,n=64)according to Ki-67 expression level of NSCLC.CT,PET and PET/CT data were divided into training set and test set at a ratio of 7∶3 and make the distribution of Ki-67 expression levels balanced between sets,respectively.CT,PET and PET/CT radiomics features of NSCLC were extracted,and the optimal radiomics features were screened,then random forest(RF),categorical boosting(CatBoost)and extreme gradient boosting(XGBoost)algorithms were used to construct models,respectively.Receiver operating characteristic curve was plotted,and the area under the curve(AUC)was calculated to screen the radiomics model with the highest efficacy for predicting Ki-67 expression level of NSCLC.Results RF models had the highest performance among radiomics models constructed based on CT,PET and PET/CT.The efficacy of RFCT,RFPET and RFPET/CT models for predicting Ki-67 expression level of NSCLC in test set increased sequentially,with AUC of 0.830,0.870 and 0.940,respectively(all P＜0.05),and RFPET/CT was the best radiomics model.Conclusion PET/CT radiomics could be used to effectively predict Ki-67 expression level of NSCLC,and RFPET/CT model had the best performance.

Objective To explore the clinical application effects of Chen's pancreatojejunostomy in laparoscopic pancreaticoduodenectomy.Methods Clinical data of 176 patients who underwent laparoscopic pancreaticoduodenectomy in Xiangyang Central Hospital from January 2019 to December 2024 were retrospectively analyzed.According to the methods of intraoperative pancreatojejunostomy,the patients were divided into two groups,the research group(102 cases)using Chen's pancreatojejunostomy,and the control group(74 cases)using duct-to-mucosa pancreatojejunostomy.The two groups were compared on clinical indicators,including operation time,pancreatojejunostomy time,intraoperative blood loss,incidence of postoperative complications,length of hospital stay,and 30-day postoperative mortality rate.Results All 176 patients successfully underwent laparoscopic pancreaticoduodenectomy.There were no statistically significant differences between the two groups in intraoperative blood loss,biochemical leakage,abdominal bleeding,upper gastrointestinal bleeding,delayed gastric emptying,bile leakage,abdominal infection,and 30-day postoperative mortality rate(P＞0.05).The pancreatojejunostomy time[(22.33±5.95)min]and operation time[(334.60±66.42)min]in the study group were significantly shorter than those in the control group[(30.70±5.50)min]and[(414.46±60.96)min],with statistically significant differences(P＜0.05).Two groups of patients did not develop grade C pancreatic fistula.The incidence of grade B pancreatic fistula in the study group(5.88％)was significantly lower compared to the control group(16.22％),and this difference was statistically significant(P＜0.05).Additionally,The postoperative hospital stay of the study group patients[(17.10±6.89)days]was significantly shorter than in the control group[(20.88±8.40)days],with a statistically significant difference(P＜0.05).Conclusion Chen's pancreatojejunostomy is a feasible,safe,and effective procedure in laparoscopic pancreaticoduodenectomy,which can shorten the pancreatojejunostomy time,reduce the incidence of postoperative pancreatic fistula,and decrease the length of hospital stay.

Objective To investigate the clinical efficacy of wrapping the hepatic artery with the hepatogastric ligament for preventing bleeding of the hepatic artery and its branches following pancreaticoduodenectomy(PD).Methods 194 patients who underwent PD in Xiangyang Central Hospital from January 2017 to November 2024 were enrolled and categorized into two groups based on whether the hepatic artery was enwrapped with the hepatogastric ligament during the operation.The wrapped group consisted of 95 cases where the hepatic artery was wrapped,while the non-wrapped group had 99 cases without such wrapping.Intraoperative parameters(intraoperative blood loss and operative time)and postoperative complications(pancreatic fistula,abdominal cavity infection,biliary fistula,delayed gastric emptying,postoperative bleeding,and bleeding of the hepatic artery and its branches)were compared between the two cohorts.Univariate and multivariate Logistic regression analyses were conducted to identify the independent risk factors for postoperative bleeding.Results PD was accomplished successfully in both groups.There was no remarkable difference in intraoperative indices like blood loss and operative time between the two groups(P＞0.05).Similarly,no significant disparities were noted in postoperative complications such as pancreatic fistula,abdominal infection,biliary fistula,and delayed gastric emptying(P＞0.05).Nevertheless,the incidence of postoperative bleeding in the wrapped group was lower than that in the non-wrapped group(3.16％vs.12.12％,P=0.019),and the incidence of bleeding of the hepatic artery and its branches after surgery was also significantly decreased in the wrapped group(0 vs.10.10％,P=0.004).Logistic regression analysis revealed that the operation time(OR=1.013,P=0.011),pancreatic fistula(OR=9.006,P=0.006)and celiac infection(OR=7.930,P=0.014)are independent risk factors of postoperative bleeding,Hepatogastric ligament encapsulation of hepatic artery was an independent protective factor for postoperative hemorrhage of PD(OR=0.084,P=0.006).Conclusion Wrapping the hepatic artery with the hepatogastric ligament reduces PD postoperative bleeding,especially that of the hepatic artery and its branches,without adding other complications.