Objective To explore the influence of nicorandil and tirofiban on coronary microcircula-tion and myocardial remodeling in patients with acute myocardial infarction(AMI)after percuta-neous coronary intervention(PCI).Methods A total of 118 AMI patients undergoing PCI in our hospital from January 2020 to January 2024 were enrolled,and divided into nicorandil group(n=39,nicorandil on the basis of routine treatment),tirofiban group(n=37,tirofiban on the basis of routine treatment)and combined group(n=42,nicorandil and tirofiban on the basis of routine treatment)according to their treatment regimens.The levels of the coagulation-related factors,coronary microcirculation indicators,microvascular function,myocardial remodeling indicators,oxidative stress indicators and major adverse cardiovascular events were compared among the three groups.Results In 7 d after PCI,prothrombin time(PT)value,activated partial prothrom-bin time(APTT),left ventricular ejection fraction(LVEF)value and serum levels of von Wille-brand factor(vWF),tissue factor(TF)and superoxide dismutase(SOD)were increased,while in-dex of microcirculatory resistance(IMR),left ventricular end-systolic volume(LVESV)value,left ventricular end-diastolic volume(LVEDV)value and serum endothelin(ET)level were de-creased in the three groups when compared with the corresponding levels before surgery(P＜0.05).At the time point,the combined group had higher LVEF value and serum levels of vWF,TF and SOD,while lower IMR,LVESV and LVEDV values and serum ET level when compared to the nicorandil group and tirofiban group(P＜0.05).The incidence of reperfusion arrhythmia(2.38％vs 16.22％and 15.38％,P＜0.05),incidence of angina pectoris within 6 months after surger-y(2.38％vs 18.92％and 15.38％,P＜0.05),and readmission rate of heart failure(2.38％vs 16.22％and 17.95％,P＜0.05)were notably lower in the combined group than the other two groups(P＜0.05).Conclusion For AMI patients after PCI,combination of nicorandil and tirofi-ban can effectively improve the postoperative coronary microcirculation,promote myocardial re-modeling,improve body's oxidative stress status and vascular endothelial function,and reduce the occurrence of cardiovascular adverse events.

BACKGROUND:The blood-brain barrier is an important structure that protects the central nervous system,and the study of the effects of high glucose on the blood-brain barrier is important for the prevention of high glucose-induced damage to the central nervous system.OBJECTIVE:To investigate the potential effect of high glucose on the blood-brain barrier function of hCMEC/D3 human brain microvascular endothelial cells.METHODS:hCMEC/D3 cells were cultured in regular sugar medium(glucose concentration of 25 mmol/L)and high-sugar medium(glucose concentration of 55 mmol/L).The morphology of cells in each group was observed by light microscopy.CCK-8 assay was used to detect changes in cell viability.A monolayer blood-brain barrier model was established using hCMEC/D3 cell line with Transwell chamber device.Changes in cell transmembrane resistance were monitored daily.The permeability of cell monolayers was detected by phenol red permeability.Flow cytometry was used to detect the apoptosis rate of the cells.Western blot assay was used to detect the expression of Bcl-2,Bax,Caspase-3,ZO-1,Occludin,Claudin-1,and histone deacetylase 4.The levels of histone deacetylase in cell supernatant were detected by ELISA.The expression of histone deacetylase 4 in cells was detected by immunofluorescence.RESULTS AND CONCLUSION:(1)The cell viability of high sugar group was significantly lower than that of control group(P＜0.000 1).(2)The cells of the control group were in a good growth state,interwoven into a dense mesh,with interconnections between synapses.The cell growth of high glucose group was suppressed,and the connection of inter-cellular synapses was reduced.(3)Compared with the control group,the transmembrane resistance value of the high glucose group was reduced(P＜0.05);phenol-red permeability of the monolayer cell membrane was increased(P＜0.05);cell apoptosis rate was increased(P＜0.01);the expression of Bax protein was increased(P＜0.000 1);the expression of Caspase-3 protein had no significant change(P＞0.05);the expression of Bcl-2,ZO-1,Occludin,Claudin-1,and histone deacetylase 4 proteins was decreased(P＜0.01,P＜0.001,P＜0.01,P＜0.000 1,P＜0.01);the fluorescence expression of histone deacetylase 4 was decreased(P＜0.001)in the high glucose group.(4)The level of histone deacetylase 4 in the cell supernatant of the high glucose group was lower than that of the control group(P＜0.05).The results show that high glucose induces the increased apoptosis and enhances permeability of hCEMCE/D3 cells,and its mechanism may be related to the decreased expression level of histone deacetylase 4.

BACKGROUND:Sarcopenia is a comprehensive condition of aging induced decline in skeletal muscle mass and strength and represents a major health challenge for the elderly.Accumulating evidence suggests that mitochondrial dysfunction plays a key role in the pathogenesis of sarcopenia.OBJECTIVE:To summarize the mechanisms by which dysregulation of mitochondrial quality control leads to sarcopenia and to explore whether mitochondrial transplantation may be a potential target for the treatment of sarcopenia.METHODS:We searched PubMed and CNKI databases for relevant articles published from 2009 to 2023 using the keywords "sarcopenia,mitochondrial dysfunction,mitochondrial quality control,mitochondrial transplantation,limitations."RESULTS AND CONCLUSION:Given the key role of mitochondrial dysfunction in the pathogenesis of sarcopenia,mitochondrial transplantation may serve as a possible strategy for the treatment of sarcopenia by improving mitochondrial bioenergetics and modulating mitochondria related signaling pathways.Although some preclinical and clinical studies have confirmed the potential of mitochondrial transplantation for the treatment of various diseases,there are still some urgent questions regarding the specific details of mitochondrial transfer.

Objective Advances in synthetic DNA technology have made it much easier to fake human DNA samples.There are literature reports that fake human DNA can be synthesized by different methods and implanted in the field to confuse the investigation or mislead the trial.Therefore,distinguishing authentic human DNA from synthetic DNA and performing individual identification has become a critical scientific challenge.Methods We define a novel composite genetic marker(methylation-microhaplotype)by combining CpG sites stably hypermethylated or hypomethylated in natural human DNA and nearby immediately adjacent microhaplotype sites.A total of 19 locis were obtained according to the screening criteria,and a composite detection system for methylation-microhaplotypes was established using MPS technology.Random volunteer DNA samples were extracted and synthetic DNA samples were prepared based on whole genome amplification techniques.Population DNA samples were analyzed to evaluate forensic parameters and methylation variability of the methylation-microhaplotype markers.Comparative analyses of human and synthetic DNA were conducted to assess the markers'ability to discriminate between the two and to detect/type both components in mixed mixed samples.Results The composite detection system composed of 19 locis demonstrated high individual identification ability,achieving a cumulative individual identification probability of 0.999 999 999 996 86.12 hypermethylated locis and 7 hypomethylated locis had relatively stable methylation levels in 57 human DNA samples.According to the allele methylation rate(Ram)value,the system can effectively identify natural and synthetic DNA samples.Meanwhile,for mixed DNA samples,the presence of human and synthetic DNA samples can be found and genotyped.Conclusion Methylation-microhaplotype genetic markers,which can discover human DNA and synthetic DNA and can detect the presence and genotyping of them from mixed samples,is a potential useful tool for forensic DNA analysis.

Objective To investigate the angiographic manifestations and interventional treatment outcomes of inferior vena cava occlusion associated with dangerous collateral vessels in Budd-Chiari syndrome(BCS).Methods The data of 43 BCS patients with inferior vena cava occlusion and dangerous collateral vessels were retrospectively analyzed.All 43 patients underwent digital subtraction angiography(DSA)of the inferior vena cava and recanalization treatment of the occluded segment of the inferior vena cava.Results DSA in 43 patients showed that the inferior vena cava was occluded,and a total of 70 dangerous collateral vessels originated from the occluded end.All patients were successfully treated.DSA showed that the blood flow in the inferior vena cava was unobstructed and the dangerous collateral vessels disappeared.No complications,such as rupture or bleeding of the inferior vena cava,occurred during the interventional treatment.The 43 patients were followed up for 6-75 months after interventional treatment,and re-occlusion occurred in 6 cases.All patients made it through.Conclusion DSA can clearly show the dangerous collateral vessels originating from the occluded end of the inferior vena cava in BCS,and interventional treatment is safe and effective.

Objective To study the effect and molecular mechanism of vitamin D(VitD)on Tfh cells of MRL/lpr lupus mice.Methods C57/B6 mice and MRL/lpr lupus mice were transfected with siRNA to construct VDR knockout mouse models.Splenic Tfh cells of C57/B6 mice and MRL/lpr lupus mice were divided into control group,lupus group and VDRsiRNA lupus group(treated with vitamin D 0,1 and 10 nmol·L-1,respectively)by siRNA transfection.The percentage of Tfh cells was detected by flow cytometry.MRL/lpr lupus mice Peyer node Tfh cells were randomly divided into 7 groups,blank control group,vitamin D dose groups of 1 and 10 nmol·L-1,paricalcitol group(VitD 10 nmol·L-1+PA),VDRsiRNA control group,VDRsiRNA group(VitD 10 nmol·L-1),CaN inhibitor group(VitD 10 nmol·L-1+CsA),and incubated for 72 h.The concentration of calcium ions in Tfh of each group was detected.The expressions of AT1R,NFAT,CaN and P-CaN in Tfh cells were determined by Western blotting.Results The percentage of Tfh cells decreased significantly with the increase of vitamin D dose.Vitamin D CaN reduce the intracellular calcium concentration of Tfh,up-regulate the expression of AT1 protein in Tfh cells,and down-regulate the expression of CAN,P-CaN and NFAT protein in a dose-dependent manner,and the effect is more obvious when combined with PA.Conclusion Vitamin D may regulate the activation of follicular T helper cells in MRL/lpr mice via the Ca-CaN-NFAT pathway.

Objective To investigate the clinical characteristics,diagnosis and treatment of ileal injury secondary to percutaneous nephrolithotomy percutaneous nephrolithotomy(PCNL).Methods The diagnosis and treatment of a patient were reviewed,and relevant literature were retrieved.Results The patient was a 41-year-old male,who underwent stage PCNL(initial percutaneous nephrostomy,followed by secondary PCNL)due to right ureteral calculi with severe hydronephrosis.On postoperative day 1,he developed abdominal distension and pain.Abdominal X-ray revealed subdiaphragmatic free gas,and CT showed pelvic and abdominal fluid and gas accumulation,suggesting peritonitis due to intestinal perforation.Emergency exploratory laparotomy identified a 3 mm×3 mm ileal perforation approximately 30 cm from the ileocecal valve,which was repaired surgically.The patient recovered well and was discharged after one week,with no discomfort reported during a 6-month follow-up.Conclusion The clinical features of ileal injury secondary to PCNL include early postoperative abdominal distension,pain and peritonitis.Diagnosis relies on clinical manifestations,abdominal X-ray and CT,with surgical exploration if necessary.Conservative management under vigilant observation can be cautiously adopted for localized injuries,while surgical repair is required for peritonitis or failed conservative therapy.

Hypercoagulable state (HCS) after kidney transplantation is one of the common and serious complications in kidney transplant recipients, which has attracted increasing attention in recent years. HCS refers to the abnormal and excessive activation of blood coagulation function, leading to the increased risk of thrombosis. After kidney transplantation, the combined effects of hemodynamic changes, surgical trauma and severe rejection increase the incidence of HCS, not only raising the risk of thrombosis but also potentially causing graft failure and affecting the postoperative survival rate of patients. This article reviews the influencing factors, clinical manifestations, diagnostic methods and preventive strategies of HCS after kidney transplantation, aiming to provide a theoretical basis for optimizing perioperative management and improving the prognosis of patients.

BACKGROUND:At present,there are few reports on the postoperative efficacy of arthroscopic coracoid tunnel-free suspension fixation and coracoid single tunnel fixation in the treatment of acromioclavicular joint dislocation at home and abroad.The specific clinical efficacy of the two procedures and whether there are other risks need to be explored. OBJECTIVE:To compare the short-term postoperative clinical efficacy of arthroscopic TightRope band plate fixation with single tunnel fixation of the coracoid process and tunnel-free suspension fixation of the coracoid process in the treatment of acute type Ⅲ-Ⅴ acromioclavicular joint dislocation. METHODS:A retrospective analysis was performed in 45 patients with acromioclavicular joint dislocation who met the inclusion criteria admitted to the Sixth Affiliated Hospital of Xinjiang Medical University from June 2019 to September 2022,and were divided into coracoid single tunnel fixation group(20 cases)and coracoid tunnel-free suspension fixation group(25 cases)according to the surgical treatment plan.Operation time,incision length,blood loss,Constant-Murley score,visual analogue scale score,the American Shoulder and Elbow Surgeons(ASES)score and intraoperative and postoperative complications of the shoulder joint before operation,3 months after surgery and the last follow-up were compared between the two groups. RESULTS AND CONCLUSION:All patients successfully completed the operation,and there was no important nerve or blood vessel damage during the operation.The operation time of the coracoid tunnel-free suspension fixation group was significantly shorter than that of the coracoid tunnel-free suspension fixation group(P<0.05).There was no significant difference in intraoperative blood loss and incision length between the two groups(P>0.05).All patients were followed up for 12 to 24 months,with an average of(15.29±2.73)months.In the coracoid single tunnel fixation group,at 3 months after operation and the final follow-up,the visual analogue scale score was significantly lower than the preoperative score(P<0.05);Constant-Murley score and ASES score were significantly increased compared with the preoperative values(P<0.05).In the coracoid tunnel-free suspension fixation group,at 3 months after operation and the final follow-up,the visual analogue scale score was significantly lower than the preoperative score(P<0.05);the Constant-Murley score and the ASES score were both significantly higher than the preoperative scores(P<0.05).At 3 months after operation,the Constant-Murley score of the coracoid tunnel-free suspension fixation group was higher than that of the coracoid single tunnel fixation group(P<0.05),while there was no significant difference in visual analogue scale and ASES scores between the two groups(P>0.05).There was also no significant difference in the visual analogue scale,Constant-Murley,and ASES scores between the two groups at the corresponding time points before surgery and at the final follow-up(P>0.05).Intraoperative and postoperative complications:In the coracoid single tunnel fixation group,there was one case of coracoid cortical rupture and fracture during the tunnel drilling during the operation,and one case of a loss of reduction at 3 months after operation,which was repositioned and fixed with hook plate transposition of the coracoacromial ligament.All patients had good acromioclavicular joint function recovery and no re-dislocation at the final follow-up.All patients in the coracoid tunnel-free suspension fixation group did not suffer from coracoid fractures,loss of reduction and other complications during surgery,postoperatively and at the last follow-up.To conclude,these two arthroscopic treatments for acute type Ⅲ-Ⅴ acromioclavicular joint dislocation have the advantages of less trauma,reliable reduction and fixation,and good recovery of shoulder joint function after operation.However,compared with the coracoid single tunnel technique,the coracoid tunnel-free suspension fixation requires shorter time,faster recovery of shoulder joint function in the short term,and avoids the establishment of bone tunnels on the coracoid process,which reduces the probability of iatrogenic fracture of the coracoid process during operation and provides a higher degree of safety.

Objective To explore the molecular mechanism of autophagy mediated by the protein kinase B(AKT)/mammalian target protein of rapamycin(mTOR)pathway in the rehabilitation of muscle atrophy associated with rotator cuff tears(RCTs).Methods Forty male C57BL/6J mice were randomly assigned to the following four groups:sham group,RCTs group,RCTs+exercise group,and RCTs+exercise+rapamycin group,with 10 mice in each group.On the eighth week after grouping,healing of the bone-tendon interface and muscle cell atrophy were analyzed by histology.The mRNA expression levels of muscle-atrophy-related genes(Atrogin-1,Bnip 3,MuRF-1)in supraspinatus muscle tissue were measured by real-time quantitative reverse transcription polymerase chain reaction.The expression of LC3 and AKT/mTOR signal pathway proteins in the supraspinatus muscle tissue of the groups was detected by Western blot,and the degree of autophagy in each group was analyzed by transmission electron microscope.Results Compared with the sham operation group,in RCTs group's maturity score for the bone-tendon interface at the supraspinatus tendon anchorage and the cross-sectional area of the supraspinatus muscle fibers decreased significantly(P＜0.001),while muscle loss and the expression of Atrogin-1,Bnip 3,and MuRF-1 increased significantly(P＜0.001).Compared with the RCTs group,the RCTs+exercise group showed a significant increase in bone-tendon interface maturity score and cross-sectional area of the supraspinatus muscle fibers(P＜0.01)and a decrease in muscle loss and the expression of Atrogin-1,Bnip 3,and MuRF-1(P＜0.01).Compared with the sham group,the RCTs group's LC3Ⅰ/LC3Ⅱ and degree of autophagy in the supraspinatus muscle increased significantly(P＜0.001),while p-AKT/AKT and p-mTOR/mTOR expression decreased significantly(P＜0.01).Compared with RCTs group,the RCTs+exercise group's LC3Ⅰ/LC3Ⅱ and degree of autophagy decreased significantly(P＜0.01)and p-AKT/AKT and p-mTOR/mTOR expression increased significantly(P＜0.001).The addition of rapamycin significantly reversed the rehabilitation effect of exercise in the RCTs group.Conclusions This study confirmed the anti-atrophy effect of exercise rehabilitation in RCT diseases and showed that its mechanism is related to AKT/mTOR signal activation,which inhibits autophagy.