BACKGROUND:Osteoarthritis is pathologically characterized by progressive degeneration of the articular cartilage and abnormal deformation of the subchondral bone.In recent years,with the deepening of medical research,it has been found that the mitogen-activated protein kinases(MAPK)signaling pathway has a regulatory role in inflammatory cell infiltration,inflammatory factor release,and chondrocyte proliferation,which is particularly important for the treatment of osteoarthritis.OBJECTIVE:To briefly review the main research progress in the mechanism of MAPK signaling pathway regulating osteoarthritis in recent years,aiming to provide new ideas for the treatment of osteoarthritis.METHODS:CNKI,WanFang and PubMed databases were searched for relevant literature using the search terms of"mitogen-activated protein kinases,osteoarthritis,extracellular signal-regulated MAP kinases,p38 mitogen-activated protein kinases,JNK mitogen-activated protein kinase"in Chinese and English.Relevant literature published from January 2019 to November 2024 was searched,and 108 articles were finally included for summary analysis.RESULTS AND CONCLUSION:(1)Various stimuli inside and outside the cells activate the MAPK signaling pathway,regulate gene transcription and protein synthesis,and promote the release of inflammatory factors,such as tumor necrosis factor-α,interleukin-1β,and interleukin-6.The release of these inflammatory factors aggravates the progression of osteoarthritis.(2)The active ingredients of traditional Chinese medicine,mainly saponins and flavonoids,as well as Chinese herbal formulas and preparations with the main effects of activating blood circulation and removing blood stasis,tonifying the liver and kidney,can play a therapeutic role in osteoarthritis by inhibiting the MAPK signaling pathway,regulating the release of matrix metalloproteinases,balancing the homeostatic state of osteogenesis and osteoblastogenesis,attenuating the synovial inflammation,decreasing the release of inflammatory factors and inflammatory vesicles,decreasing cellular pyroptosis,promoting autophagy,and ameliorating oxidative stress.(3)Although traditional Chinese medicine has become popular in the treatment of osteoarthritis by virtue of its own advantages of multi-components,multi-targets,multi-pathways,and low side effects,the use of MAPK signaling pathway to guide the treatment of individual osteoarthritis is the difficulty of the technology,which needs to be continuously researched and explored.(4)Therefore,further development of relevant herbal inhibitors that can modulate the MAPK signaling pathway may be a potential drug strategy for the treatment of osteoarthritis in the future.

BACKGROUND:Osteoarthritis is pathologically characterized by progressive degeneration of the articular cartilage and abnormal deformation of the subchondral bone.In recent years,with the deepening of medical research,it has been found that the mitogen-activated protein kinases(MAPK)signaling pathway has a regulatory role in inflammatory cell infiltration,inflammatory factor release,and chondrocyte proliferation,which is particularly important for the treatment of osteoarthritis.OBJECTIVE:To briefly review the main research progress in the mechanism of MAPK signaling pathway regulating osteoarthritis in recent years,aiming to provide new ideas for the treatment of osteoarthritis.METHODS:CNKI,WanFang and PubMed databases were searched for relevant literature using the search terms of"mitogen-activated protein kinases,osteoarthritis,extracellular signal-regulated MAP kinases,p38 mitogen-activated protein kinases,JNK mitogen-activated protein kinase"in Chinese and English.Relevant literature published from January 2019 to November 2024 was searched,and 108 articles were finally included for summary analysis.RESULTS AND CONCLUSION:(1)Various stimuli inside and outside the cells activate the MAPK signaling pathway,regulate gene transcription and protein synthesis,and promote the release of inflammatory factors,such as tumor necrosis factor-α,interleukin-1β,and interleukin-6.The release of these inflammatory factors aggravates the progression of osteoarthritis.(2)The active ingredients of traditional Chinese medicine,mainly saponins and flavonoids,as well as Chinese herbal formulas and preparations with the main effects of activating blood circulation and removing blood stasis,tonifying the liver and kidney,can play a therapeutic role in osteoarthritis by inhibiting the MAPK signaling pathway,regulating the release of matrix metalloproteinases,balancing the homeostatic state of osteogenesis and osteoblastogenesis,attenuating the synovial inflammation,decreasing the release of inflammatory factors and inflammatory vesicles,decreasing cellular pyroptosis,promoting autophagy,and ameliorating oxidative stress.(3)Although traditional Chinese medicine has become popular in the treatment of osteoarthritis by virtue of its own advantages of multi-components,multi-targets,multi-pathways,and low side effects,the use of MAPK signaling pathway to guide the treatment of individual osteoarthritis is the difficulty of the technology,which needs to be continuously researched and explored.(4)Therefore,further development of relevant herbal inhibitors that can modulate the MAPK signaling pathway may be a potential drug strategy for the treatment of osteoarthritis in the future.

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.

BACKGROUND:Steroid-induced femoral head necrosis is mostly caused by long-term and extensive use of hormones,but its specific pathogenesis is not yet clear and needs further study. OBJECTIVE:To screen out the differential miRNAs in osteoclast exosomes after the intervention of Panax notoginseng saponins,and on this basis,to further construct an osteogenic-related ferroptosis regulatory network to explore the potential mechanism and research direction of steroid-induced osteonecrosis of the femoral head. METHODS:MTT assay was used to detect the toxic effects of different concentrations of dexamethasone and different mass concentrations of Panax notoginseng saponins on Raw264.7 cell line.Tartrate resistant acid phosphatase staining and TUNEL assay were used to detect the effects of Panax notoginseng saponins on osteoclast inhibition and apoptosis.Exosomes were extracted from cultured osteoclasts with Panax notoginseng saponins intervention.Exosomes from different groups were sequenced to identify differentially expressed miRNAs.CytoScape 3.9.1 was used to construct and visualize the regulatory network between differentially expressed miRNAs and mRNAs.Candidate mRNAs were screened by GO analysis and KEGG analysis.Finally,the differential genes related to ferroptosis were screened out,and the regulatory network of ferroptosis-related genes was constructed. RESULTS AND CONCLUSION:(1)The concentration of dexamethasone(0.1 μmol/L)and Panax notoginseng saponins(1 736.85 μg/mL)suitable for intervention of Raw264.7 cells was determined by MTT assay.(2)Panax notoginseng saponins had an inhibitory effect on osteoclasts and could promote their apoptosis.(3)Totally 20 differentially expressed miRNAs were identified from osteoclast-derived exosome samples,and 11 differentially expressed miRNAs related to osteogenesis were predicted by target mRNAs.The regulatory networks of 4 up-regulated differentially expressed miRNAs corresponding to 155 down-regulated candidate mRNAs and 7 down-regulated differentially expressed miRNAs corresponding to 238 up-regulated candidate mRNAs were constructed.(4)Twenty-four genes related to ferroptosis were screened out from the differential genes.Finally,12 networks were constructed(miR-98-5p/PTGS2,miR-23b-3p/PTGS2,miR-425-5p/TFRC,miR-133a-3p/TFRC,miR-185-5p/TFRC,miR-23b-3p/NFE2L2,miR-23b-3p/LAMP2,miR-98-5p/LAMP2,miR-182-5p/LAMP2,miR-182-5p/TLR4,miR-23b-3p/ZFP36,and miR-182-5p/ZFP36).These results indicate that Panax notoginseng saponins may regulate osteoblast ferroptosis by regulating the expression of miRNAs derived from osteoclast exosomes,thus providing a new idea for the study of the mechanism of steroid-induced femoral head necrosis.

Objective To optimize the water extraction process of modified Wendan Formula.Methods The comprehensive scores of the content of naringin and neohesperidin as well as the extraction yields of solids were used as the evaluation indexes,the number of decoctions,the decoction time and the solid-liquid ratio as three factors were take into consideration,L9(34)orthogonal experiment was designed to optimize the water extraction process of modified Wendan Formula.Results Combining the orthogonal experiment with the principle of energy conservation and emission reduction in actual production,this study suggests that the optimized process was under the conditions of 1∶8 for the solid-liquid ratio,decoction were performed twice,the first time was 1.5 hours,and the second time was 1 hour.The average composite score of validation of three batches of modified Wendan Formula was 99.00％.Conclusion Such optimized process was stable,feasible and realizable,and it can be applied in water extraction process of modified Wendan Formula.

Objective:To investigate the safety and feasibility of the domestic single-port serpentine-arm robotic surgical system for pyeloplasty in children with congenital ureteropelvic junction obstruction(UPJO).Methods:Data of UPJO patients who underwent pyeloplasty using a domestic single-port ser-pentine-arm robotic surgical system(Beijing Surgerii Robotics Co.,Ltd.)in Beijing Children's Hospital from November 2023 to February 2024 were retrospectively collected.The patients who were not receiving surgical treatment for the first time,had hydronephrosis caused by other reasons(such as ureterovesical junction obstruction,posterior urethral valve,urinary tract stones,vesicoureteral reflux,ureterocele,etc.),had other urinary tract malformations(such as duplicated kidneys,congenital renal dysplasia,etc.),had severe atrophy of the affected kidney,severe urinary tract infection or severe renal insufficien-cy were excluded.All the surgeries were performed through the umbilicus and abdominal cavity,and the operation time,number of intraoperative incisions,incision size,intraoperative blood loss,and peri-operative complications were recorded.Statistical analysis was performed to compare changes in the an-teroposterior pelvic diameter(APD)and renal cortical thickness before surgery and 6 months postopera-tively.Results:A total of 10 patients were included(8 males and 2 females),with an average age of(10.20±3.12)years.Nine patients were on the left side and one patient was on the right side.The average height was(142.0±17.8)cm and the average weight was(37.6±17.9)kg.All the patients underwent surgery using the domestic single-port robotic surgery system,and no patient was converted to open pyeloplasty.The total operation time was(237±96)min,and the operation time on the operating table was(162.0±69.3)min.The intraoperative blood loss was 5.00(2.25,5.00)mL.No compli-cations,such as bleeding,urine extravasation,fever,and poor wound healing occurred during the perioperative period.Compared with the preoperative measurements,the APD was significantly shortened postoperatively(P=0.005),and the renal cortical thickness significantly increased(P=0.011).Con-clusion:The domestic single-port serpentine arm robotic surgical system is safe and feasible for UPJO pyeloplasty in children,with good surgical results,and can be promoted and applied in most domestic medical centers.

Objective To develop an assessment scale for post-intensive care syndrome in pediatrics(PICS-p)and evaluate its reliability and validity,aiming to provide a scientifically sound and feasible tool for clinical assessment.Methods Based on the PICS-p conceptual framework,combined with literature review,semi-structured interviews,and Delphi expert consultation,a preliminary scale was developed.From June to December 2023,a survey was conducted among 330 pediatric patients who were discharged from a tertiary children's hospital in Hangzhou,followed by a two-week retest with 30 children to assess the reliability and validity of the scale.Results Finally 304 children completed the survey.The Post-Intensive Care Syndrome Scale for Children consists of 4 dimensions of physical dysfunction,cognitive dysfunction,psychological dysfunction and social dysfunction,with a total of 29 entries,with a cumulative variance contribution of 61.705％.The content validity index for individual items ranged from 0.800 to 1.000,and the content validity index for the scale as a whole was 0.98.The dimensions of the scale showed positive correlations with the Functional Status Scale(r=0.438-0.581,P＜0.001).The overall Cronbach's α coefficient of the scale was 0.847;the split-half reliability was 0.868;the test-retest reliability was 0.832.Conclusion The scale demonstrates good reliability and validity,and it is suitable for assessing the severity of PICS-p in pediatric patients discharged from the PICU.

Objective:To investigate the safety and feasibility of the domestic single-port serpentine-arm robotic surgical system for pyeloplasty in children with congenital ureteropelvic junction obstruction(UPJO).Methods:Data of UPJO patients who underwent pyeloplasty using a domestic single-port ser-pentine-arm robotic surgical system(Beijing Surgerii Robotics Co.,Ltd.)in Beijing Children's Hospital from November 2023 to February 2024 were retrospectively collected.The patients who were not receiving surgical treatment for the first time,had hydronephrosis caused by other reasons(such as ureterovesical junction obstruction,posterior urethral valve,urinary tract stones,vesicoureteral reflux,ureterocele,etc.),had other urinary tract malformations(such as duplicated kidneys,congenital renal dysplasia,etc.),had severe atrophy of the affected kidney,severe urinary tract infection or severe renal insufficien-cy were excluded.All the surgeries were performed through the umbilicus and abdominal cavity,and the operation time,number of intraoperative incisions,incision size,intraoperative blood loss,and peri-operative complications were recorded.Statistical analysis was performed to compare changes in the an-teroposterior pelvic diameter(APD)and renal cortical thickness before surgery and 6 months postopera-tively.Results:A total of 10 patients were included(8 males and 2 females),with an average age of(10.20±3.12)years.Nine patients were on the left side and one patient was on the right side.The average height was(142.0±17.8)cm and the average weight was(37.6±17.9)kg.All the patients underwent surgery using the domestic single-port robotic surgery system,and no patient was converted to open pyeloplasty.The total operation time was(237±96)min,and the operation time on the operating table was(162.0±69.3)min.The intraoperative blood loss was 5.00(2.25,5.00)mL.No compli-cations,such as bleeding,urine extravasation,fever,and poor wound healing occurred during the perioperative period.Compared with the preoperative measurements,the APD was significantly shortened postoperatively(P=0.005),and the renal cortical thickness significantly increased(P=0.011).Con-clusion:The domestic single-port serpentine arm robotic surgical system is safe and feasible for UPJO pyeloplasty in children,with good surgical results,and can be promoted and applied in most domestic medical centers.

Pediatric urological non-Hodgkin lymphoma is relatively rare.When a single renal or ureteral tumor with multiple lymph node or bone metastases is present, it is very easy to be misdiagnosed as urinary tumor with metastasis, resulting in unnecessary radical nephrectomy. This paper reports two cases of non-Hodgkin lymphoma presenting with single urinary nodules. Case 1 was diagnosed with a 4.5cm tumor in the right kidney due to fever and fatigue. CT and PET-CT showed multiple bone destruction and lymph node metastasis. Renal biopsy was performed and ALK-positive anaplastic large cell lymphoma was diagnosed. Chemotherapy was effective for 6 months. Case 2 was diagnosed with left hydronephrosis due to intermittent low back pain for 2 weeks. Ultrasound examination revealed ureteral dilation with left hydronephrosis and low echo occupying of the lower ureter. The patient had sudden blurred vision before surgery. MRI examination revealed space occupying in the right optic nerve frame, and PET-CT found multiple bone, lymph nodes and nerve invasion. A lymph node biopsy was performed and Burkitt lymphoma was diagnosed. After 6 months of chemotherapy and radiotherapy, the tumor shrank significantly.

Pediatric urological non-Hodgkin lymphoma is relatively rare.When a single renal or ureteral tumor with multiple lymph node or bone metastases is present, it is very easy to be misdiagnosed as urinary tumor with metastasis, resulting in unnecessary radical nephrectomy. This paper reports two cases of non-Hodgkin lymphoma presenting with single urinary nodules. Case 1 was diagnosed with a 4.5cm tumor in the right kidney due to fever and fatigue. CT and PET-CT showed multiple bone destruction and lymph node metastasis. Renal biopsy was performed and ALK-positive anaplastic large cell lymphoma was diagnosed. Chemotherapy was effective for 6 months. Case 2 was diagnosed with left hydronephrosis due to intermittent low back pain for 2 weeks. Ultrasound examination revealed ureteral dilation with left hydronephrosis and low echo occupying of the lower ureter. The patient had sudden blurred vision before surgery. MRI examination revealed space occupying in the right optic nerve frame, and PET-CT found multiple bone, lymph nodes and nerve invasion. A lymph node biopsy was performed and Burkitt lymphoma was diagnosed. After 6 months of chemotherapy and radiotherapy, the tumor shrank significantly.