ObjectiveTo investigate the effect and mechanism of transplantation of human umbilical cord mesenchymal stem cell （hUC-MSC） with overexpression of the Numb gene in the treatment of cholestatic liver fibrosis （CLF）. MethodsThe technique of lentiviral transfection was used to induce the overexpression of the Numb gene in hUC-MSC （hUC-MSC^Numb-OE）， and hUC-MSC transfected with empty vector （hUC-MSC^OE-EV） was used as negative control. Bile duct ligation （BDL） was performed to establish a rat model of CLF， and then the rats were randomly divided into BDL group， hUC-MSC group， hUC-MSC^OE-EV group， and hUC-MSC^Numb-OE group， while a sham-operation group was also established. The rats in the intervention groups were given a single splenic injection of the corresponding cells after BDL， and samples were collected at the end of week 4. Related indicators were measured， including serum biochemistry， liver histopathology， the content of hydroxyproline （Hyp） in the liver， hepatic stellate cell activation， ductular reaction， liver regeneration， and the expression levels of key molecules in the Numb-p53 signaling axis. A one-way analysis of variance was used for comparison of continuous data between multiple groups， and the least significant difference t-test was used for further comparison between two groups. ResultsCompared with the BDL group， the hUC-MSC group and the hUC-MSC^OE-EV group had significant reductions in the levels of serum biochemical parameters （aspartate aminotransferase， gamma-glutamyl transpeptidase， total bile acid， total bilirubin， and direct bilirubin）， liver fibrosis markers （the content of Hyp and the expression levels of alpha-smooth muscle actin， tumor necrosis factor-α， and transforming growth factor-beta 1）， and ductular reaction markers （the expression levels of CK7 and CK19） （all P <0.05）， and compared with the hUC-MSC^OE-EV group， the hUC-MSC^Numb-OE group had significantly greater improvements in the above indicators （all P <0.05）. In addition， compared with the hUC-MSC^OE-EV group， the hUC-MSC^Numb-OE group had significant improvements in the expression levels of liver regeneration-related markers （albumin and hepatocyte nuclear factor 4α） and the molecules associated with the Numb-p53 signaling axis （Numb， pNumb， Mdm2， and p53） （all P <0.05）. ConclusionOverexpression of the Numb gene can enhance the therapeutic effect of hUC-MSC on CLF， possibly by activating the Numb-PTB^L-p53-HNF4α axis， promoting the hepatic differentiation of hUC-MSCs and subsequently enhancing liver regeneration.

OBJECTIVES: To assess the biomechanical performance of a novel bridging plate for treating Rockwood III acromioclavicular joint dislocation. METHODS: A novel bridging plate structure was designed based on CT data from a patient with Rockwood type III acromioclavicular joint dislocation, and a finite element model of the bridging plate-acromioclavicular joint interaction was constructed. The stress and deformation characteristics and biomechanical compatibility of the plate under post-reduction, normal loading, and impact loading conditions were analyzed to evaluate its fixation mechanism and clinical advantages. RESULTS: The stiffness of the bridging system was 27.78 N/mm, close to that of acromioclavicular joint ligaments (26.05 N/mm) and meeting the requirements for flexible deformation. Under normal loading, the maximum stress in the bridging system was 88.29 MPa to sustain physiological activities; under impact loading, the maximum stress reached 480 MPa, and the cable underwent plastic deformation to dissipate energy and effectively buffer local stress concentrations, thereby reducing the risk of rigid bone fractures. The high-stress regions in the bone primarily occurred at the edges of the C1-C4 screw holes. The maximum bone stress was 0.762 MPa under normal loading and 5.963 MPa under impact loading, accounting for 2.86% and 1.66% of the corresponding bolt stresses, respectively. CONCLUSIONS The novel bridging plate is better adapted to biomechanical characteristics of the acromioclavicular joint compared to traditional internal fixation. This fixation system provides sufficient stability while allowing physiological micromotion to facilitate postoperative rehabilitation. Significant flexible deformation can occur at the connection between the fixation ring and the cable, and brittle materials should not be used in this region. The issue of stress concentration at the C1-C4 screw holes requires special attention in its clinical application.
Acromioclavicular Joint/surgery* ; Humans ; Bone Plates ; Biomechanical Phenomena ; Finite Element Analysis ; Joint Dislocations/surgery* ; Fracture Fixation, Internal/methods*

OBJECTIVES: To explore the efficacy of DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy for management of cancer pain and provide reference for its standardized clinical application. Methods and. RESULTS: Recommendations were formulated based on literature review and expert group discussion, and consensus was reached following expert consultation. The consensus recommendations are comprehensive, covering the entire treatment procedures from preoperative assessment and preparation, surgical operation process, postoperative management and traditional Chinese medicine treatment to individualized treatment planning. The study results showed that the treatment plans combining traditional Chinese with Western medicine effectively alleviated cancer pain, reduced the use of opioid drugs, and significantly improved the quality of life and enhanced immune function of the patients. Postoperative follow-up suggested good treatment tolerance among the patients without serious complications. CONCLUSIONS The formulated consensus is comprehensive and can provide reference for clinicians to use DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy. The combined treatment has a high clinical value with a good safety profile for management of cancer pain.
Humans ; Medicine, Chinese Traditional ; Cancer Pain/therapy* ; Drugs, Chinese Herbal/therapeutic use* ; Drug Delivery Systems ; Pain Management/methods* ; China

Objective To explore the feasibility of extracting and transplanting the live cells from burn scab tissue combined with artificial dermal scaffold coverage for the treatment of deep Ⅱ-degree burn wounds.Methods Four female Bama miniature pigs aged 7 to 8 months were successfully anesthetized and 3 square skin deep Ⅱ-degree burn wound models with a side length of 50 mm were established on each side of the spine(each wound is divided into four parts of a square with a side length of 25 mm).A total of 24 wounds were established.The ipsilateral wounds were divided into the dermis group and the combination group.After the live cells from the scabs were extracted and replanted on the wound surface of the combined group,an artificial dermal scaffold was covered.The wound surface of the dermis group was simply covered with an artificial dermal scaffold.On 7,14,21,28 d of the experiment,5 mm diameter tissues corresponding to the central part of each wound surface after anesthesia were successively and simultaneously cut by circular drilling.The HE staining was performed to observe the coverage rate of wound epidermis,the Masson staining was used to observe the tissue collagen content,Ki-67 antigen was used to observe the proliferation rate of wound cells,and CD31 count was used to observe the neovascularization of wound capillaries.Results On 7 d of the experiment,no wound epidermis coverage was observed in both groups.The wound coverage rate on 14,21,28 d in the combination group was higher than that in the dermis group,and the difference was statistically significant(P＜0.05),moreover,the wound coverage rate in the combination group was increased with the experimental time was extended(P＜0.05).The collagen content on 7 d of experiment in the combination group was higher than that in the dermis group,and the difference was statistically significant(P＜0.05).The Ki-67 expression level of the wound tissue on 7-28 d in the combination group was higher than that in the dermis group,and the difference was statistically significant(P＜0.05).There was no statistically significant difference in the CD31 expression level during 7-28 d of experiment between the two groups(P＞0.05).Conclusion The extraction and transplantation of live cells from deep burn scab tissue combined with artifi-cial dermal scaffolds coverage could partially repair burn deep Ⅱ-degree wound.

Objective To evaluate the clinical efficacy of Chu-Needle Therapy combined with Kang'ai Injection in treating cancer-related fatigue(CRF)in colorectal cancer patients with qi-blood deficiency syndrome.Methods Eighty patients diagnosed with colorectal cancer accompanied by CRF and qi-blood deficiency syndrome were enrolled from the inpatient and outpatient departments of Guangdong Second Traditional Chinese Medicine Hospital between January 2023 and March 2024.Participants were randomly divided into an observation group(n=40)and a control group(n=40)using a random number table.The control group received Kang'ai Injection alone,while the observation group received additional Chu-Needle Therapy.Treatment courses lasted 7 days each,with two consecutive courses administered.After two weeks,clinical efficacy was evaluated by comparing Revised Piper Fatigue Scale scores,traditional Chinese medicine(TCM)syndrome scores,as well as red blood cell count(RBC),hemoglobin(HGB),and albumin(ALB)levels,and immune markers(CD3+,CD4+,CD8+,NK cells)before and after treatment.Safety and adverse reactions were also assessed.Results(1)After treatment,both groups showed significant improvements in all Piper Fatigue Scale(PFS)scores,including behavioral,sensory,affective,and cognitive dimensions,as well as total scores(P＜0.05).The observation group demonstrated significantly greater improvements in all PFS subscales and total scores compared to the control group,with statistically significant differences(P＜0.05).(2)After treatment,both groups exhibited marked reductions in TCM syndrome scores,including fatigue,palpitations,shortness of breath,pale complexion,dizziness,spontaneous or night sweating,limb numbness,poor appetite,pale nails,and total scores(P＜0.05).The observation group showed significantly better improvement in all TCM syndrome scores than the control group,with statistically significant differences(P＜0.05).(3)The total effective rate was 82.5％(33/40)in the observation group versus 40.00％(16/40)in the control group,indicating significantly superior therapeutic efficacy in the observation group,with statistically significant differences(P＜0.05).(4)After treatment,both groups demonstrated significant improvements in RBC,HGB,ALB levels(P＜0.05),with the observation group showing significantly greater improvements in these hematological parameters compared to the control group,with statistically significant differences(P＜0.05).(5)After-treatment,both groups showed significant changes in immune markers CD3+,CD4+,CD8+,or NK cells compared to baseline(P＜0.05).The observation group exhibited significantly better modulation of CD3+,CD4+,CD8+,and NK cell levels than the control group,with statistically significant differences(P＜0.05).(6)The incidence of adverse reactions was 5.00％(2/40)in the observation group versus 22.50％(9/40)in the control group,indicating significantly better safety profile in the observation group,with statistically significant differences(P＜0.05).Conclusion Chu-Needle Therapy combined with Kang'ai Injection significantly alleviates fatigue,improves clinical symptoms,enhances nutritional status and immune function,and elevates quality of life in colorectal cancer patients with CRF and qi-blood deficiency syndrome,demonstrating notable clinical efficacy.

Pyridaben is a broad-spectrum acaricide widely used in agriculture, accidental or self-administration of large doses of pyridaben can cause multiple organ failure in patients. Due to its damage to multiple organs and no specific antidote, the mortality rate is high. This paper reports two patients who took a large amount of pyridaben, developed severe metabolic acidosis, hyperlactatemia, toxic encephalopathy, and liver, kidney, heart and digestive tract damage. After timely gastric lavage, catharsis, organ support andblood purification treatment, the condition improved and discharged. It is expected to provide clinical ideas for the treatment of pyridaben poisoning.

Objective:To measure the overall and lobulated volume of the liver with different degrees of liver fibrosis and to further observe pathological changes such as liver microvasculature, hepatocyte apoptosis, and regeneration in order to understand the macroscopic volume changes of the liver during liver fibrosis and its relationship with liver tissue microscopic pathology in patients with chronic liver disease.Methods:53 patients with chronic hepatitis B, alcoholic fatty liver disease, autoimmune liver disease, nonalcoholic fatty liver disease, and drug-induced chronic liver disease who underwent both liver biopsy tissue and abdominal magnetic resonance imaging were collected. Patients were divided into early (F1-2), middle (F3-4), and late (F5-6) in accordance with the Ishak fibrosis stage and Masson stain. The liver and spleen volumes were measured using ITK-SNAP software. CD31 immunohistochemical staining was used to reflect intrahepatic angiogenesis. Ki67 and HNF-4α multiplex immunohistochemical staining were used to reflect hepatocyte regeneration. GS staining was used to determine parenchymal extinction lesions. TUNEL staining was used to observe hepatocyte apoptosis. Spearman correlation analysis was used to analyze the relationship between liver volume changes and liver histopathological changes.Results:As liver fibrosis progressed, the total liver volume and right lobe liver volume gradually decreased ( P<0.05), while the spleen volume gradually increased ( P<0.05). The expression of CD31 and GS gradually increased ( P<0.05), and the expression of Ki67 first increased and then decreased ( P<0.05). The positivity rate of CD31 was negatively correlated with the right lobe liver volume ( r=-0.609, P<0.001) and the total liver volume ( r=-0.363, P=0.017). The positivity rate of Ki67 was positively correlated with the right lobe liver volume ( r=0.423, P=0.018), while the positivity rate of apoptotic cells was significantly negatively correlated with the total liver volume ( r=-0.860, P<0.001). The positivity rate of GS was negatively correlated with the right lobe liver volume ( r=-0.440, P=0.002), and the number of PELs was negatively correlated with RV ( r=-0.476, P=0.013). The CD31 positive staining area was negatively correlated with the Ki67 positive staining area( r=-0.511, P=0.009). Conclusion:As liver fibrosis progresses, patients with chronic liver disease have a depletion in total liver volume and right lobe liver volume, and this is mainly in correlation with fewer liver cells and liver tissue microvasculature disorders.

Objective:To investigate the interventional effect of bone marrow mesenchymal stem cell (BMMSC) transplantation with different doses of X-ray irradiation induced hepatic injury in mice.Methods:Eighteen female C57BL/6J mice were randomly divided into 0, 2, and 3 Gy irradiation groups and 0, 2, and 3 Gy transplantation groups. The irradiation group was used as the control and injected with an equal volume of culture medium. The mice in the transplantation group were irradiated with different doses of X-ray irradiation, and BMMSCs were intravenously infused into the bone marrow. The mice were sacrificed for sampling at the end of the 21st day. Mice body weight changes were recorded daily. The changes in the content of peripheral blood lymphocytes, red blood cells, platelets, and hemoglobin were detected by an automatic blood tester. The morphological changes in mice liver tissues were observed by hematoxylin-eosin staining. The serum activities of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were detected by a biochemical analyzer. The reduced glutathione contents in liver tissue were detected by the microplate method. The malondialdehyde content in liver tissue was detected by thiobarbituric acid. The content of total superoxide dismutase (T-SOD) in liver tissue was detected by the hydroxylamine method. The expression of the F4/80 protein in liver tissue was detected by the immunohistochemistry method. The protein expression of nuclear transcription factor erythroid 2 related factor 2 (Nrf2) and heme oxygenase 1 (HO-1) in liver tissue was determined by the western blotting method. The mRNA expression of NLRP3, IL-6, and Nrf2 in liver tissue was detected by a real-time quantitative polymerase chain reaction. The multiple-group comparisons were analyzed by factorial analysis of variance. The inter-group comparisons were analyzed by the LSD method for statistical analysis.Results:The contents of peripheral blood lymphocytes, erythrocytes, platelets, and hemoglobin were significantly decreased in the 3 Gy irradiation group than the 0 Gy irradiation group ( P<0.05), while the activities of serum ALT and AST were significantly increased ( P<0.05). The malondialdehyde content, F4/80 protein expression level, nucleotide-binding domain and leucine-rich repeats, nucleotide oligomerization domain-like receptor family, pyrin domain containing 3 (NLRP3), and interleukin 6 mRNA expression levels were significantly increased in liver tissue, while the contents of T-SOD and glutathione, Nrf2 and HO-1 protein expression levels, and Nrf2 mRNA expression level in liver tissue were significantly decreased ( P<0.05). The contents of peripheral blood lymphocytes, red blood cells, platelets, and hemoglobin were significantly increased in the 3 Gy transplantation group than the 3 Gy irradiation group ( P<0.05), while the activities of serum ALT and AST were significantly decreased ( P<0.05). The malondialdehyde content, F4/80 protein expression level, NLRP3 and interleukin-6 mRNA expression levels in liver tissue were significantly decreased ( P<0.05), while the content of T-SOD and glutathione, Nrf2 and HO-1 protein expression levels, and Nrf2 mRNA expression level in liver tissue were significantly increased ( P<0.05). Conclusion:X-ray irradiation at a dose of 3 Gy can induce liver oxidative damage in mice. BMMSC transplantation can improve X-ray irradiation-induced liver oxidative damage in mice, and its mechanism of action may be related to the regulation of the Nrf2/HO-1 pathway.

Objective To investigate the current situation of emergency rescue patient retention in Jianyang People's Hospital and explore its causes.Methods A retrospective analysis was conducted on the data of 4 834 patients rescued in the emergency room of Jianyang People's Hospital in 2022.They were divided into retention group and non retention group based on whether the emergency detention time exceeded 6 hours.With detention as the dependent variable and factors that may lead to emergency detention as the independent variable,binary logistic regression method was applied to screen for factors related to emergency detention.Results The median retention time for emergency rescue patients was 4.84 hours,with 3 721 cases(76.98%)having a retention time≤6 hours and 1 113 cases(23.02%)having a retention time＞6 hours;the main influencing factors for emergency detention included age,visit time,visit season,admission method,involving two or more departments,diversion direction,and treatment compliance(P＜0.05).Conclusion Emergency patients aged≥41 years old,treated from 17:00 to＜08:00 the next day,visited in winter,admitted on their own,involving two or more departments,diverted to hospitalization,and with average or poor treatment compliance are prone to emergency detention.Therefore,the emergency department of the hospital should develop appropriate management measures based on the above factors to reduce emergency detention time.

ObjectiveTo investigate the effect of transplantation of bone marrow mesenchymal stem cells （BMSCs） co-cultured with bone marrow-derived M2 macrophages （M2-BMDMs）， named as BMSC^M2， on a rat model of liver cirrhosis induced by carbon tetrachloride （CCl₄）/2-acetaminofluorene （2-AAF）. MethodsRat BMDMs were isolated and polarized into M2 phenotype， and rat BMSCs were isolated and co-cultured with M2-BMDMs at the third generation to obtain BMSC^M2. The rats were given subcutaneous injection of CCl₄ for 6 weeks to establish a model of liver cirrhosis， and then they were randomly divided into model group （M group）， BMSC group， and BMSC^M2 group， with 6 rats in each group. A normal group （N group） with 6 rats was also established. Since week 7， the model rats were given 2-AAF by gavage in addition to the subcutaneous injection of CCl₄. Samples were collected at the end of week 10 to observe liver function， liver histopathology， and hydroxyproline （Hyp） content in liver tissue， as well as changes in the markers for hepatic stellate cells， hepatic progenitor cells， cholangiocytes， and hepatocytes. A one-way analysis of variance was used for comparison of continuous data between multiple groups， and the least significant difference t-test was used for further comparison between two groups. ResultsCompared with the N group， the M group had significant increases in the activities of serum alanine aminotransferase （ALT） and aspartate aminotransferase （AST） （P<0.01）； compared with the M group， the BMSC and BMSC^M2 groups had significant reductions in ALT and AST （P<0.01）， and the BMSC^M2 group had significantly better activities than the BMSC group （P<0.05）. Compared with the N group， the M group had significant increases in Hyp content and the mRNA and protein expression levels of alpha-smooth muscle actin （α-SMA） in the liver （P<0.01）； compared with the M group， the BMSC and BMSC^M2 groups had significant reductions in Hyp content and the expression of α-SMA （P<0.05）， and the BMSC^M2 group had a significantly lower level of α-SMA than the BMSC group （P<0.01）. Compared with the N group， the M group had significant increases in the mRNA expression levels of the hepatic progenitor cell markers EpCam and Sox9 and the cholangiocyte markers CK7 and CK19 （P<0.01） and significant reductions in the expression levels of the hepatocyte markers HNF-4α and Alb （P<0.01）； compared with the M group， the BMSC and BMSC^M2 groups had significant reductions in the mRNA expression levels of EpCam， Sox9， CK7， and CK19 （P<0.05） and significant increases in the mRNA expression levels of HNF-4α and Alb （P<0.05）， and compared with the BMSC group， the BMSC^M2 group had significant reductions in the mRNA expression levels of EpCam and CK19 （P<0.05） and significant increase in the expression level of HNF-4α （P<0.05）. ConclusionM2-BMDMs can enhance the therapeutic effect of BMSCs on CCl₄/2-AAF-induced liver cirrhosis in rats， which provides new ideas for further improving the therapeutic effect of BMSCs on liver cirrhosis.