BACKGROUND:Currently,spinal endoscopic technology has become the mainstream technology in minimally invasive spinal surgery.The specifications of the instruments for different operating systems are different,and the choice of specific surgical protocols needs to be combined with the actual situation of the patient and the choice of the clinical surgeon. OBJECTIVE:To compare the early efficacy of percutaneous endoscopic interlaminar discectomy for L5-S1 disc herniation under the iLESSYS Delta System and Endo-Surgi Plus System. METHODS:Totally 80 patients with L5-S1 disc herniation were treated with percutaneous endoscopic interlaminar discectomy.Patients were divided into two groups based on the endoscopic system used.Among them,37 cases received the iLESSYS Delta System(Delta group)and 43 cases received the Endo-Surgi Plus System(Plus group).Patient demographic characteristics,perioperative indicators,and complications were analyzed between the two groups.Clinical outcomes were quantified using back and leg visual analog scale scores,Oswestry Disability Index,and Japanese Orthopaedic Association scores at 1 day,1,3,and 6 months after surgery.Patient satisfaction was assessed according to modified MacNab criteria at final follow-up. RESULTS AND CONCLUSION:(1)The operative time and number of arthroplasties in the Plus group were less than those in the Delta group,and the differences were statistically significant(P<0.05).(2)Compared with the preoperative period,the visual analog scale scores,Oswestry Disability Index,and Japanese Orthopaedic Association scores of patients in both groups improved at all follow-up time points,and the difference was statistically significant(P<0.001).(3)There was no statistically significant difference in the comparison of pain visual analog scale scores,Oswestry Disability Index,and Japanese Orthopaedic Association scores of patients in the two groups(P>0.05).(4)At 6-month follow-up after surgery,the MacNab standard excellent and good rates in the Delta group and Plus group were 81%and 79%,respectively,with no significant difference(P=0.823).(5)The incidence of complications was 3%in the Delta group and 2%in the Plus group,but there was no significant difference between the two groups(P=0.914).(6)It is concluded that both iLESSYS Delta and Endo-Surgi Plus surgical systems achieved satisfactory early clinical results in the treatment of lumbar disc herniation,with Endo-Surgi Plus surgical moulding being more efficient and safer.

Acute kidney injury (AKI) is one of the most common and severe nephropathy syndromes in clinical practice and also one of the most common serious complications after organ transplantation, with high incidence and fatality. Iron is an essential trace element in the body. Ferroptosis is a form of programmed cell death induced by the accumulation of iron-mediated lipid peroxidation, and its occurrence is closely related to iron metabolism, lipid metabolism, amino acid metabolism and multiple signaling pathways. Recent studies have shown that ferroptosis plays a key role in the occurrence and development of AKI and provides therapeutic targets for AKI. This article summarizes the regulatory mechanism of ferroptosis and its role in AKI, as well as the compounds that play an important role in the prevention and treatment of AKI by inhibiting ferroptosis, providing new ideas for the future treatment and research of AKI.

Objective:To analyze the efficacy and feasibility of performing a new surgical procedure, tunnel esophagogastrostomy, to perform proximal gastrectomy.Methods:The study cohort comprised 10 consecutive patients who had undergone esophagogastrostomy by the tunnel technique in Jiangsu Cancer Hospital between October 2019 and July 2022. All patients were male. Their average age was (64.2±8.1) years and body mass index (25.5±3.2) kg/m2. Nine had upper gastric body adenocarcinoma, the remaining one having signet ring cell carcinoma. TNM staging of the tumors showed that seven were Stage IA, one Stage IB, one Stage IIA, and one Stage IIIA. Briefly, tunnel esophagogastrostomy is performed as follows: After performing a proximal gastrectomy, a rectangular seromuscular flap (3.0 cm × 3.5 cm) is created. The posterior esophageal wall is sutured to the gastric wall at the orad end of the seromuscular flap 5 cm from the stump with three to four stitches. Next, the stump of the esophagus is opened, the posterior esophageal wall is sutured to the gastric mucosa and submucosa, and the anterior esophageal wall is sutured to the full layer of the stomach. Finally, the caudad end of the seromuscular flap is closed. Data on surgical safety, postoperative morbidity, and postoperative reflux esophagitis were analyzed. All enrolled patients completed endoscopic follow-up 1 year and 2 years after surgery.Results:All procedures were completed. They comprised four cases of laparoscopic assisted surgery, four of DaVinci robotic surgery, and two of open surgery. The mean operation time was 212.7±33.2 mins, mean anastomosis time (51.6±5.3) minutes, mean tunnel preparation time (20.0±3.5) minutes, and mean operative blood loss (90.0±51.6) mL. The time to first postoperative passage of flatus was (64.8±11.5) hours. The mean hospital stay after surgery was (9.2±1.7) days. There were no postoperative complications above Clavien-Dindo Grade II. The mean preoperative Reflux Disease Questionnaire score was (3.3± 0.4) before the surgery, (3.8±1.0) 1 month postoperatively, and (3.3±0.4) 12 months postoperatively. All patients underwent endoscopic follow-up; no anastomotic stenoses were found. However, one patient had Grade A reflux esophagitis 1 year after surgery and another Grade B reflux esophagitis 2 years after surgery.Conclusion:Esophagogastrostomy by the tunnel technique is a safe and feasible means of performing proximal gastrectomy.

The number of investigator initiate trials(IIT)is increasing,and a detailed scientific clinical trial protocol is an important prerequisite for ensuring the success of clinical trials and obtaining reliable and accurate results.In this study,132 scien-tific research projects taken by the researchers of a tertiary hospital were reviewed to summarize and analyze the issues in the re-search designs.It was found the issues in common consisted of five aspects:research background,types of design,inclusion and exclusion criteria,outcomes,and sample size.Meanwhile,the causes of these problems were discussed and the countermeasures were proposed aimed at improving the efficiency of scientific review work and promoting the high-quality operation of IIT projects.

Objective:To analyze the efficacy and feasibility of performing a new surgical procedure, tunnel esophagogastrostomy, to perform proximal gastrectomy.Methods:The study cohort comprised 10 consecutive patients who had undergone esophagogastrostomy by the tunnel technique in Jiangsu Cancer Hospital between October 2019 and July 2022. All patients were male. Their average age was (64.2±8.1) years and body mass index (25.5±3.2) kg/m2. Nine had upper gastric body adenocarcinoma, the remaining one having signet ring cell carcinoma. TNM staging of the tumors showed that seven were Stage IA, one Stage IB, one Stage IIA, and one Stage IIIA. Briefly, tunnel esophagogastrostomy is performed as follows: After performing a proximal gastrectomy, a rectangular seromuscular flap (3.0 cm × 3.5 cm) is created. The posterior esophageal wall is sutured to the gastric wall at the orad end of the seromuscular flap 5 cm from the stump with three to four stitches. Next, the stump of the esophagus is opened, the posterior esophageal wall is sutured to the gastric mucosa and submucosa, and the anterior esophageal wall is sutured to the full layer of the stomach. Finally, the caudad end of the seromuscular flap is closed. Data on surgical safety, postoperative morbidity, and postoperative reflux esophagitis were analyzed. All enrolled patients completed endoscopic follow-up 1 year and 2 years after surgery.Results:All procedures were completed. They comprised four cases of laparoscopic assisted surgery, four of DaVinci robotic surgery, and two of open surgery. The mean operation time was 212.7±33.2 mins, mean anastomosis time (51.6±5.3) minutes, mean tunnel preparation time (20.0±3.5) minutes, and mean operative blood loss (90.0±51.6) mL. The time to first postoperative passage of flatus was (64.8±11.5) hours. The mean hospital stay after surgery was (9.2±1.7) days. There were no postoperative complications above Clavien-Dindo Grade II. The mean preoperative Reflux Disease Questionnaire score was (3.3± 0.4) before the surgery, (3.8±1.0) 1 month postoperatively, and (3.3±0.4) 12 months postoperatively. All patients underwent endoscopic follow-up; no anastomotic stenoses were found. However, one patient had Grade A reflux esophagitis 1 year after surgery and another Grade B reflux esophagitis 2 years after surgery.Conclusion:Esophagogastrostomy by the tunnel technique is a safe and feasible means of performing proximal gastrectomy.

Objective To summarize and analyze the"Qiangzhi"drugs in Shennong's Classic of the Materia Medica,and to explore the effect and mechanism of improving memory impairment.Methods To screen the drugs with the effect of"Qiangzhi"in Shennong's Classic of the Materia Medica,and summarize their properties and tastes.By searching the common action targets of"Qiangzhi"traditional Chinese medicine through network pharmacology,it is speculated that it may be the basis for playing the role of"Qiangzhi".Animal experiments were carried out,and 80 mice were divided into blank group,model group,Radix Aucklandiae group,Radix Polygalae group,Eucommiae Cortex group,Rubi Fructus group,Euryale Semen group,Fructus Xanthii group,Epimedium group(0.06 g·d1)and Pilose Antler group(0.018 g·d1),with 8 mice in each group,and the corresponding dosage was given by gavage for 30 days.From the 23th day,scopolamine(2 mg·kg-1)was injected intraperitoneally in all groups except the blank group.On the 31th day,the platform test and water maze test were carried out on the mice in each group.After the experiment,the mice were killed and the materials were taken.The damage of neurons in the cortex and hippocampus of the mice was observed by LFB staining.According to the results of network pharmacology,Use ELISA kit to detect prostaglandin endoperoxide synthase 2(COX-2),monoamine oxidase A(MAOA),serotonin(5-HT),serotonin receptor 2A(5-HT2AR),acetylcholine(Ach),acetylcholinesterase(AchE),adenosine receptor A2a(A2aR)and adenosine receptor A1(A1R)in hippocampus of mice.Western blot was used to detect the expression of nuclear transcription factor-κB(NF-κB)and 5-HT transporter(SERT)in hippocampus of mice.Results There are eight kinds of drugs for"Qiangzhi"in Shennong's Classic of the Materia Medica,including Radix Aucklandiae,Cortex et Radix Polygalae,Eucommiae Cortex,Rubi Fructus,Euryale Semen,Fructus Xanthii,Herba Epimedii,and Cornu Cervi Pantotrichum.The main drugs are pungent and sweet,and the main drugs are warm,and most of them belong to the kidney meridian.According to the network pharmacology analysis,their common targets are COX-2,MAOA,5-HT2AR,AchE,A2aR,A1R.In the behavioral experiment,compared with the model mice,the latency of jumping off the platform was significantly increased,the number of jumping off the platform was significantly reduced,and the latency of water maze was significantly shortened(P＜0.05 or P＜0.01),and the mice in each Qiangzhi drug group were obviously more familiar with the swimming route.The results of LFB staining showed that each Qiangzhi drug could reduce the neuronal damage in cortex and hippocampus of mice.The results of ELISA showed that compared with the model group,the contents of COX-2,Ach,AchE,MAOA,A1R,A2aR in the hippocampus of mice in each Qiangzhi drug group were significantly decreased(P＜0.05 or P＜0.01),while the contents of 5-HT and 5-HT2AR were significantly increased(P＜0.01).Western blot method was used to detect the contents of NF-κB and SERT in hippocampus of mice in each"Qiangzhi"drug group,which was significantly lower than that in model group.Conclusion Eight"Qiangzhi"drugs all have the effect of improving memory impairment in different degrees.The mechanism of their"Qiangzhi"effect and improving memory impairment may be related to various ways,such as inhibiting NF-κB/COX-2 inflammatory pathway,reducing 5-HT hydrolysis and increasing 5-HT2A receptor content,stabilizing the contents of Ach and AchE,and reducing the contents of adenosine A1 and A2a receptors.

Objective To summarize and analyze the"Qiangzhi"drugs in Shennong's Classic of the Materia Medica,and to explore the effect and mechanism of improving memory impairment.Methods To screen the drugs with the effect of"Qiangzhi"in Shennong's Classic of the Materia Medica,and summarize their properties and tastes.By searching the common action targets of"Qiangzhi"traditional Chinese medicine through network pharmacology,it is speculated that it may be the basis for playing the role of"Qiangzhi".Animal experiments were carried out,and 80 mice were divided into blank group,model group,Radix Aucklandiae group,Radix Polygalae group,Eucommiae Cortex group,Rubi Fructus group,Euryale Semen group,Fructus Xanthii group,Epimedium group(0.06 g·d1)and Pilose Antler group(0.018 g·d1),with 8 mice in each group,and the corresponding dosage was given by gavage for 30 days.From the 23th day,scopolamine(2 mg·kg-1)was injected intraperitoneally in all groups except the blank group.On the 31th day,the platform test and water maze test were carried out on the mice in each group.After the experiment,the mice were killed and the materials were taken.The damage of neurons in the cortex and hippocampus of the mice was observed by LFB staining.According to the results of network pharmacology,Use ELISA kit to detect prostaglandin endoperoxide synthase 2(COX-2),monoamine oxidase A(MAOA),serotonin(5-HT),serotonin receptor 2A(5-HT2AR),acetylcholine(Ach),acetylcholinesterase(AchE),adenosine receptor A2a(A2aR)and adenosine receptor A1(A1R)in hippocampus of mice.Western blot was used to detect the expression of nuclear transcription factor-κB(NF-κB)and 5-HT transporter(SERT)in hippocampus of mice.Results There are eight kinds of drugs for"Qiangzhi"in Shennong's Classic of the Materia Medica,including Radix Aucklandiae,Cortex et Radix Polygalae,Eucommiae Cortex,Rubi Fructus,Euryale Semen,Fructus Xanthii,Herba Epimedii,and Cornu Cervi Pantotrichum.The main drugs are pungent and sweet,and the main drugs are warm,and most of them belong to the kidney meridian.According to the network pharmacology analysis,their common targets are COX-2,MAOA,5-HT2AR,AchE,A2aR,A1R.In the behavioral experiment,compared with the model mice,the latency of jumping off the platform was significantly increased,the number of jumping off the platform was significantly reduced,and the latency of water maze was significantly shortened(P＜0.05 or P＜0.01),and the mice in each Qiangzhi drug group were obviously more familiar with the swimming route.The results of LFB staining showed that each Qiangzhi drug could reduce the neuronal damage in cortex and hippocampus of mice.The results of ELISA showed that compared with the model group,the contents of COX-2,Ach,AchE,MAOA,A1R,A2aR in the hippocampus of mice in each Qiangzhi drug group were significantly decreased(P＜0.05 or P＜0.01),while the contents of 5-HT and 5-HT2AR were significantly increased(P＜0.01).Western blot method was used to detect the contents of NF-κB and SERT in hippocampus of mice in each"Qiangzhi"drug group,which was significantly lower than that in model group.Conclusion Eight"Qiangzhi"drugs all have the effect of improving memory impairment in different degrees.The mechanism of their"Qiangzhi"effect and improving memory impairment may be related to various ways,such as inhibiting NF-κB/COX-2 inflammatory pathway,reducing 5-HT hydrolysis and increasing 5-HT2A receptor content,stabilizing the contents of Ach and AchE,and reducing the contents of adenosine A1 and A2a receptors.

Objective:To investigate the expression of forkhead box protein O3(FOXO3) in pancreatic cancer and its effect on the motility and proliferation of pancreatic cancer cells.Methods:The FOXO3 expression in pancreatic cancer and adjacent tissues was retrieved from LinkedOmics database. Western blotting and real-time quantitative polymerase chain reaction were used to detect FOXO3 expression in pancreatic cancer cells and human pancreatic stellate cells. PANC-1 and MIAPaCa-2 pancreatic cancer cells with low FOXO3 expression were selected to transfect FOXO3 overexpression plasmid and negative control plasmid, respectively. The motility and proliferation ability of pancreatic cancer cells were detected by colony formation assay, cell scratch assay, Transwell assay and flow cytometry.Results:In the LinkedOmics database, the relative expression of FOXO3 protein in the cancer tissues of 64 patients with pancreatic cancer was significantly lower than that in the adjacent tissues ( t=8.36, P<0.001). The number of clones in PANC-1 cell line was (30.0±6.6) after overexpressed FOXO3, which was lower than that in negative control cells (92.7±6.7), and the difference was statistically significant ( t=11.54, P<0.001). After overexpressed FOXO3 in PANC-1 and MIAPaCa-2 cell lines, the scratch repair rate was significantly decreased compared with the control group. In Transwell experiment, the number of cells in FOXO3 overexpressed group in PANC-1 cell lines was (21.0±6.6), which was lower than that of negative control groups (55.7±8.5), and the difference was statistically significant ( t=5.59, P=0.005). The results of MIAPaCa-2 cell line were consistent with that of PANC-1 cell line. After overexpressing of FOXO3 in PANC-1 and MIAPaCa-2 cell lines, the proportion of cells in the G0/G1 phase decreased, while the proportion in the S phase increased. Conclusion:The expression of FOXO3 was decreased in pancreatic cancer. Overexpression of FOXO3 could significantly inhibit the proliferation, migration and invasion of pancreatic cancer cells and induce cell cycle arrest, which is a potential target for the treatment of pancreatic cancer.

Objective    To evaluate the value of myocardial perfusion change before and after coronary artery bypass grafting (CABG) in predicting postoperative major adverse cardiovascular events (MACE). Methods    A total of 70 CABG patients who received CABG completed by the same operator from January to November 2017 were selected, including 45 males and 25 females with an average age of 64.83±9.09 years. The patients were divided into two groups according to whether the patients had MACE after 1 year of the surgery, including a non-MACE group (group A, n=60) and a MACE group (group B, n=10). The clinical data of patients were compared. Results    There were statistical difference in the myocardial contrast echocardiography (MCE) score in the group A before and after surgery (P<0.05), and there were statistically significant differences in the left ventricular size and left ventricular ejection fraction (LVEF) value before and 1 year after surgery (P<0.001), but no statistically significant difference in the size of left atrium (P=0.075). There was no significant difference in the preoperative and postoperative MCE score, and preoperative and postoperative 1-year cardiac ultrasound score in the group B (P>0.05). Conclusion    The change of myocardial perfusion after CABG surgery is associated with postoperative MACE. The evaluation of myocardial perfusion before and after CABG surgery is of great significance for the prognosis evaluation of patients.

The fcl gene encodes GDP-fucose synthase, which catalyzes two-step differential isomerase and reductase reactions in the synthesis of GDP-L-fucose from GDP-D-mannose. It also participates in the biosynthesis of amino sugar and ribose sugar, and is one of the key enzymes to regulate the metabolism of sugar and nucleotides in organisms. The presence of fcl gene in Saccharopolyspora pogona was found through sequencing result of genome. The mutant S. pogona-fcl and S. pogona-Δfcl were constructed by gene engineering technology. The results showed that the gene had an effects on growth and development, protein expression and transcriptional level, insecticidal activity, and biosynthesis of butenyl-spinosyn of Saccharopolyspora pogona. The results of HPLC analysis showed that the yield of butenyl-spinosyn in S. pogona-Δfcl was 130% compared with that in S. pogona, which reduced by 25% in S. pogona-fcl. The results of determination of insecticidal activity showed that S. pogona-Δfcl had a stronger insecticidal activity against Helicoverpa armigera than that of S. pogona, while the S. pogona-fcl had a lower insecticidal activity against Helicoverpa armigera compared with S. pogona. Scanning electron microscopy (SEM) was used to observe the morphology of the mycelia. It was found that the surface of the S. pogona-Δfcl was wrinkled, and the mycelium showed a short rod shape. There was no significant difference in mycelial morphology between S. pogona-fcl and S. pogona. Aboved all showed that deletion of fcl gene in S. pogona hindered the growth and development of mycelia, but was beneficial to increase the biosynthesis of butenyl-spinosyn and improve insecticidal activity. Whereas the fcl gene over-expression was not conducive to the biosynthesis of butenyl-spinosyn and reduced their insecticidal activity. SDS-PAGE results showed that the difference of protein expression among the three strains was most obvious at 96 hours, which was identified by real-time fluorescence quantitative polymerase chain reaction, the results showed that there were significant differences of related genes in transcriptional levels among the three strains. Based on the results of the study, a network metabolic control map was constructed to analyze the effect of fcl gene on growth and the regulation pathway of butenyl-spinosyn biosynthesis, which provided an experimental basis for revealing the regulation mechanism of butenyl-spinosyn biosynthesis and related follow-up studies.
Bacterial Proteins ; Genetic Engineering ; Insecticides ; Macrolides ; Saccharopolyspora