OBJECTIVE To investigate the mechanism of Xibining Ⅱ formula in alleviating synovial inflammation and fibrosis in knee osteoarthritis （KOA） rats based on Janus kinase 2 （JAK2）/signal transducer and activator of transcription 3 （STAT3） pathway. METHODS Seventy-five male SD rats were randomly divided into sham operation group （Sham group）， KOA group， Xibining Ⅱ low-dose group （XBNⅡ-L group， 4 g/kg）， Xibining Ⅱ high-dose group （XBNⅡ-H group， 8 g/kg）， and Xibining Ⅱ high-dose combined with STAT3 activator Colivelin trifluoroacetate （C-TFA） group [C-TFA group， 8 g/kg Xibining Ⅱ+ 1.0 mg/（kg·d） C-TFA]， with 15 rats in each group. Except for the Sham group， the KOA model was established by anterior cruciate ligament transection in the other groups. After successful modeling， each group was given corresponding drugs by intragastric administration and （or） intraperitoneal injection once daily for 28 consecutive days. After the last medication， the pathological changes of synovial tissue of knee joint in each group were evaluated and the indicators were calculated. The levels of serum inflammatory factors were detected. The positive expressions of phosphorylated JAK2 （p-JAK2） and phosphorylated STAT3 （p-STAT3） in synovial tissue of the knee joint were detected. The expressions of JAK2/STAT3 pathway-related proteins and mRNAs in synovial tissue were detected. RESULTS Compared with the Sham group， the synovial lining cells in the KOA group showed significant proliferation and disordered arrangement； the Krenn score， fibrosis ratio， positive area percentage of p-JAK2 and p-STAT3， p-JAK2/JAK2 and p-STAT3/STAT3， protein expression of Collagen-Ⅰ and α -smooth muscle actin， the mRNA expression of JAK2， STAT3， Collagen-Ⅰ and α -smooth muscle actin， as well as serum levels of interleukin-1β and interleukin-18 were significantly increased （ P ＜0.05）. Compared with the KOA group， the above pathological changes were significantly improved in each dose group of Xibining Ⅱ formula， and all indicators were significantly decreased （ P ＜0.05）， with the XBNⅡ-H group showing better effects than the XBNⅡ-L group （ P ＜0.05）. Compared with the XBNⅡ-H group， the above pathological damages were aggravated in the C-TFA group， and all indicators were significantly worsened （ P ＜0.05）. CONCLUSIONS Xibining Ⅱ formula can alleviate synovial inflammation and fibrosis in KOA rats， and its mechanism may be related to inhibiting the activation of JAK2/STAT3 pathway.

ObjectiveTo establish and evaluate different disease-syndrome combination mice models of knee osteoarthritis （KOA） with cold-dampness obstruction syndrome， and to identify the optimal modeling method. MethodsEighty mice were randomly divided into a control group， a treadmill plus climate chamber group， an anterior cruciate ligament transection （ACLT） plus climate chamber group， an ACLT group， a destabilization of the medial meniscus （DMM） plus climate chamber group， a DMM group， an intra-articular injection plus climate chamber group， and an intra-articular injection group， with 10 mice in each group. Mice in the ACLT group underwent surgical transection of the knee anterior cruciate ligament to establish the model， while those in the DMM underwent surgical transection of the medial meniscal tibial ligament of the knee， and those in the intra-articular injection group were modeled by an intra-articular injection of 50 μl of normal saline containing 1mg of monosodium iodoacetate （MIA） into the medial side of the patellar ligament. Mice in the ACLT plus climate chamber， DMM plus climate chamber， and intra-articular injection plus climate chamber groups were placed in an artificial climate chamber （relative humidity 60%， temperature 4 ℃， wind speed 6 m/s） simultaneously with aforementioned interventions， once daily for 2 h each time， for 14 consecutive days. Mice in the control group underwent sham surgery， involving only the incision of the skin and subcutaneous tissue at the knee joint to expose the articular cavity， followed by layer-by-layer suturing. Mice in the treadmill plus climate chamber group were placed on an animal treadmill starting on the 4th day after the sham operation， undergoing high-intensity treadmill exercise at a speed of 20 m/min， an inclination of 5°， for 30min per session， 5 times per week for 28 consecutive days， while being housed in the artificial climate chamber. Cold pain thresholds of the mice in each group were compared using the cold plate test and the acetone low-temperature test before and after modeling. Following modeling， knee joint pathological changes were observed using HE and Safranin O-Fast Green staining， and quantified using Mankin and Osteoarthritis Research Society International （OARSI） scores. Serum levels of tumor necrosis factor-α （TNF-α） and interleukin-1β （IL-1β） were measured by ELISA. Protein and mRNA expression levels of pain-related markers， including calcitonin gene-related peptide （CGRP）， protein gene product 9.5 （PGP9.5）， and cellular proto-oncogene Fos （c-Fos）， and the cold hyperalgesia-related markers including transient receptor potential ankyrin 1 （TRPA1） and transient receptor potential melastatin 8 （TRPM8） in the dorsal root ganglion （DRG） tissues were detected by Western Blot and qPCR. TRPA1 and TRPM8 fluorescent intensity in the DRG was detected by immunofluorescence assay. ResultsCompared to the control group， the remaining groups showed decreased cold pain thresholds in the cold plate tese， increased cold pain thresholds in the acetone low-temperature test， elevated Mankin and OARSI scores， and increased serum TNF-α and IL-1β levels， upregulated protein and mRNA expression levels of CGRP， PGP9.5， c-Fos， TRPA1， and TRPM8 in the DRG， and increased immunofluorescence intensities of TRPA1 and TRPM8 in the DRG tissue （P＜0.05 or P＜0.01）， along with severe pathological damage and cartilage degeneration in the knee joints. Compared to the ACLT， DMM， and intra-articular injection groups， the ACLT plus climate chamber， DMM plus climate chamber， and intra-articular injection plus climate chamber groups exhibited more significant changes in all the aforementioned indicators （P＜0.01）. Furthermore， changes in the aforementioned indicators were more pronounced in the ACLT plus climate chamber group compared to the Treadmill plus climate chamber group， DMM plus climate chamber and intra-articular injection plus climate chamber group （P＜0.01）， exhibiting the most severe degree of pathological damage and cartilage degeneration. ConclusionThe combination of an artificial climate chamber can successfully establish a disease-syndrome combined animal model of KOA with cold-damp obstruction syndrome， with the ACLT combined with the artificial climate chamber being the optimal modeling approach.

ObjectiveTo establish and evaluate different disease-syndrome combination mice models of knee osteoarthritis （KOA） with cold-dampness obstruction syndrome， and to identify the optimal modeling method. MethodsEighty mice were randomly divided into a control group， a treadmill plus climate chamber group， an anterior cruciate ligament transection （ACLT） plus climate chamber group， an ACLT group， a destabilization of the medial meniscus （DMM） plus climate chamber group， a DMM group， an intra-articular injection plus climate chamber group， and an intra-articular injection group， with 10 mice in each group. Mice in the ACLT group underwent surgical transection of the knee anterior cruciate ligament to establish the model， while those in the DMM underwent surgical transection of the medial meniscal tibial ligament of the knee， and those in the intra-articular injection group were modeled by an intra-articular injection of 50 μl of normal saline containing 1mg of monosodium iodoacetate （MIA） into the medial side of the patellar ligament. Mice in the ACLT plus climate chamber， DMM plus climate chamber， and intra-articular injection plus climate chamber groups were placed in an artificial climate chamber （relative humidity 60%， temperature 4 ℃， wind speed 6 m/s） simultaneously with aforementioned interventions， once daily for 2 h each time， for 14 consecutive days. Mice in the control group underwent sham surgery， involving only the incision of the skin and subcutaneous tissue at the knee joint to expose the articular cavity， followed by layer-by-layer suturing. Mice in the treadmill plus climate chamber group were placed on an animal treadmill starting on the 4th day after the sham operation， undergoing high-intensity treadmill exercise at a speed of 20 m/min， an inclination of 5°， for 30min per session， 5 times per week for 28 consecutive days， while being housed in the artificial climate chamber. Cold pain thresholds of the mice in each group were compared using the cold plate test and the acetone low-temperature test before and after modeling. Following modeling， knee joint pathological changes were observed using HE and Safranin O-Fast Green staining， and quantified using Mankin and Osteoarthritis Research Society International （OARSI） scores. Serum levels of tumor necrosis factor-α （TNF-α） and interleukin-1β （IL-1β） were measured by ELISA. Protein and mRNA expression levels of pain-related markers， including calcitonin gene-related peptide （CGRP）， protein gene product 9.5 （PGP9.5）， and cellular proto-oncogene Fos （c-Fos）， and the cold hyperalgesia-related markers including transient receptor potential ankyrin 1 （TRPA1） and transient receptor potential melastatin 8 （TRPM8） in the dorsal root ganglion （DRG） tissues were detected by Western Blot and qPCR. TRPA1 and TRPM8 fluorescent intensity in the DRG was detected by immunofluorescence assay. ResultsCompared to the control group， the remaining groups showed decreased cold pain thresholds in the cold plate tese， increased cold pain thresholds in the acetone low-temperature test， elevated Mankin and OARSI scores， and increased serum TNF-α and IL-1β levels， upregulated protein and mRNA expression levels of CGRP， PGP9.5， c-Fos， TRPA1， and TRPM8 in the DRG， and increased immunofluorescence intensities of TRPA1 and TRPM8 in the DRG tissue （P＜0.05 or P＜0.01）， along with severe pathological damage and cartilage degeneration in the knee joints. Compared to the ACLT， DMM， and intra-articular injection groups， the ACLT plus climate chamber， DMM plus climate chamber， and intra-articular injection plus climate chamber groups exhibited more significant changes in all the aforementioned indicators （P＜0.01）. Furthermore， changes in the aforementioned indicators were more pronounced in the ACLT plus climate chamber group compared to the Treadmill plus climate chamber group， DMM plus climate chamber and intra-articular injection plus climate chamber group （P＜0.01）， exhibiting the most severe degree of pathological damage and cartilage degeneration. ConclusionThe combination of an artificial climate chamber can successfully establish a disease-syndrome combined animal model of KOA with cold-damp obstruction syndrome， with the ACLT combined with the artificial climate chamber being the optimal modeling approach.

Objective·To evaluate the effects of normally positioned flap(NPF)and coronally advanced flap(CAF)techniques on clinical results after epulis excision.Methods·A total of 55 patients with epulis who visited the Department of Periodontology,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine from August 2022 to December 2023 were included.The patients were divided into the NPF group and the CAF group.After epulis excision,the surgical area was closed using NPF or CAF technique.The following parameters were recorded:baseline epulis width(EW)and epulis height(EH);papilla width(PW)and papilla height(PH)at 6 months post-surgery;probing depth(PD),attachment loss(AL),and keratinized gingiva width(KGW)at both baseline and 6 months post-surgery.The esthetic outcomes were evaluated using a visual analog scale(VAS)by 2 periodontal specialists.t test was used to compare the differences in periodontal indices between baseline and 6 months post-surgery,as well as between the 2 flap techniques.Results·At 6 months post-surgery,PD of the CAF group was(1.68±0.79)mm,significantly lower than at baseline(P<0.001),but not significantly different from that in the NPF group(P=0.365);the AL in the CAF group was(1.26±1.18)mm,not significantly different from baseline(P=0.746),but significantly lower than in the NPF group(P<0.001).At 6 months post-surgery,PH of the CAF group was(3.74±0.62)mm,significantly higher than that in the NPF group(P<0.001),and the VAS score of the CAF group was significantly higher than that of the NPF group(P<0.001).Conclusion·Compared with NPF,CAF could effectively improve post-surgical KGW and reduce AL,which could prevent periodontal soft tissue defects,and improve esthetic outcome after epulis excision.

Objective:To explore the prognostic differences and influencing factors between pancreatic cancer originated from intraductal papillary mucinous neoplasm (IPMN)-termed IC-Ds-and pancreatic cancer concomitant with IPMN (C-PDACs).Methods:Clinical data of 382 patients with pathologically confirmed IPMN who underwent surgical resection in the Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Naval Medical University from January 2016 to January 2022 were collected. According to pathological diagnosis, patients were divided into the IC-Ds group ( n=288) and the C-PDACs group ( n=94). The IC-Ds group was further divided into the colloid carcinoma subgroup and the ductal adenocarcinoma subgroup based on pathological typing. Data including age, gender, preoperative CA19-9 level, surgical margin status, lymph node metastasis, pathological grade, T stage, postoperative adjuvant chemotherapy, and survival follow-up were recorded. The median follow-up time was 35.00 months for IC-Ds patients and 29.00 months for C-PDACs patients. Clinicopathological characteristics and prognostic factors were compared between the IC-Ds and C-PDACs groups, as well as between the colloid carcinoma and ductal adenocarcinoma subgroups. Kaplan-Meier curves for overall survival were generated. Results:There were no significant differences in age, gender, R1 resection margin between the IC-Ds group and the C-PDACs group. However, in the C-PDACs group, 70 cases (74.47%) had elevated preoperative CA19-9, 40 cases (42.55%) had lymph node metastasis, 25 cases (26.60%) were pathologically confirmed as poorly differentiated carcinoma after surgery, and 54 cases (57.45%) received postoperative adjuvant chemotherapy; the proportions of all these indicators were higher than those in the IC-Ds group (90/288, 31.25%; 72/288, 25.00%; 32/288, 11.11%; 105/288, 36.46%). In contrast, the proportion of T1 stage in the IC-Ds group was higher (40.97% vs 20.21%), and all these differences were statistically significant (all P value <0.05). Among the 288 patients in the IC-Ds group, 97 cases (33.68%) were colloid carcinoma and 191 cases (66.32%) were ductal adenocarcinoma. There were no significant differences in age, gender, R1 resection margin, proportion of poorly differentiated carcinoma between the two subgroups. However, in the ductal adenocarcinoma subgroup, 67 cases (35.08%) had elevated preoperative CA19-9, 56 cases (29.32%) had lymph node metastasis confirmed by postoperative pathology, and 80 cases (41.88%) received postoperative adjuvant chemotherapy; all these proportions were significantly higher than those in the colloid carcinoma subgroup (23/97, 23.71%; 16/97, 17.02%; 25/97, 26.60%). In addition, the ductal adenocarcinoma subgroup had higher proportions of T2 and T3/T4 stages, while the proportion of T1 stage in the colloid carcinoma subgroup (60/97, 61.86%) was significantly higher than that in the ductal adenocarcinoma subgroup (58/191, 30.37%), with all differences being statistically significant (all P value <0.05). The median survival time was 47.00 months (95% CI 42.91-51.09) in the IC-Ds group and 34.00 months (95% CI 29.67-38.33) in the C-PDACs group. For the IC-Ds subgroups, the median survival time was 59.00 months (95% CI 50.79-67.21) in the colloid carcinoma subgroup and 42.00 months (95% CI 35.15-48.85) in the ductal adenocarcinoma subgroup. Significant differences in median survival time were observed between the IC-Ds and C-PDACs groups, between the colloid carcinoma and ductal adenocarcinoma subgroups, and between the ductal adenocarcinoma subgroup and the C-PDACs group (all P value <0.01). Conclusions:IC-Ds has a better prognosis than C-PDACs, and there is significant heterogeneity within IC-Ds, indicating different biological behaviors between the two types, which requires the development of targeted diagnosis and treatment strategies.

Objective To evaluate the impact of different methods of harvesting palatal connective tissue on patients' postoperative pain at the palatal donor site.Methods A total of 30 patients were included.The control group was de-epithelialized free gingival graft technique group,and the experimental group was the single-incision technique group.The keratinized gingival width of the recipient site,number of vertical incisions,number of teeth,donor site mucosa thickness,graft width,graft length,graft thickness,operation time and amount of anesthetic were recorded.The postoperative quality of life rating scale and visual analog scale were completed and statistical analysiswas performedon the results by SPSS 26.0.Results The postoperative quality of life score of the experimental group was significantly lower than that of the control group,and there was no significant difference in the total VAS score of the donor site.In terms of the total postoperative pain level after mucogingival surgery,the number of vertical incisions and graft thickness were positively correlated with the pain.Palate mucosal thickness was negatively correlated with postoperative pain levels.Conclusion In mucogingi-val surgery,the degree of postoperative pain in the donor palatal region of the patient is independent of the choice of de-epithelialized free gingival graft technique or single-incision technique to obtain subepithelial connective tissue.The surgeon should also give compre-hensive considerationsto the anatomical factors of the patient's donor site,surgical technical level and experience,and aesthetic require-ments when selecting the surgical method.

Objective·To evaluate the effects of normally positioned flap(NPF)and coronally advanced flap(CAF)techniques on clinical results after epulis excision.Methods·A total of 55 patients with epulis who visited the Department of Periodontology,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine from August 2022 to December 2023 were included.The patients were divided into the NPF group and the CAF group.After epulis excision,the surgical area was closed using NPF or CAF technique.The following parameters were recorded:baseline epulis width(EW)and epulis height(EH);papilla width(PW)and papilla height(PH)at 6 months post-surgery;probing depth(PD),attachment loss(AL),and keratinized gingiva width(KGW)at both baseline and 6 months post-surgery.The esthetic outcomes were evaluated using a visual analog scale(VAS)by 2 periodontal specialists.t test was used to compare the differences in periodontal indices between baseline and 6 months post-surgery,as well as between the 2 flap techniques.Results·At 6 months post-surgery,PD of the CAF group was(1.68±0.79)mm,significantly lower than at baseline(P<0.001),but not significantly different from that in the NPF group(P=0.365);the AL in the CAF group was(1.26±1.18)mm,not significantly different from baseline(P=0.746),but significantly lower than in the NPF group(P<0.001).At 6 months post-surgery,PH of the CAF group was(3.74±0.62)mm,significantly higher than that in the NPF group(P<0.001),and the VAS score of the CAF group was significantly higher than that of the NPF group(P<0.001).Conclusion·Compared with NPF,CAF could effectively improve post-surgical KGW and reduce AL,which could prevent periodontal soft tissue defects,and improve esthetic outcome after epulis excision.

Objective To evaluate the impact of different methods of harvesting palatal connective tissue on patients' postoperative pain at the palatal donor site.Methods A total of 30 patients were included.The control group was de-epithelialized free gingival graft technique group,and the experimental group was the single-incision technique group.The keratinized gingival width of the recipient site,number of vertical incisions,number of teeth,donor site mucosa thickness,graft width,graft length,graft thickness,operation time and amount of anesthetic were recorded.The postoperative quality of life rating scale and visual analog scale were completed and statistical analysiswas performedon the results by SPSS 26.0.Results The postoperative quality of life score of the experimental group was significantly lower than that of the control group,and there was no significant difference in the total VAS score of the donor site.In terms of the total postoperative pain level after mucogingival surgery,the number of vertical incisions and graft thickness were positively correlated with the pain.Palate mucosal thickness was negatively correlated with postoperative pain levels.Conclusion In mucogingi-val surgery,the degree of postoperative pain in the donor palatal region of the patient is independent of the choice of de-epithelialized free gingival graft technique or single-incision technique to obtain subepithelial connective tissue.The surgeon should also give compre-hensive considerationsto the anatomical factors of the patient's donor site,surgical technical level and experience,and aesthetic require-ments when selecting the surgical method.

Objective:To explore the prognostic differences and influencing factors between pancreatic cancer originated from intraductal papillary mucinous neoplasm (IPMN)-termed IC-Ds-and pancreatic cancer concomitant with IPMN (C-PDACs).Methods:Clinical data of 382 patients with pathologically confirmed IPMN who underwent surgical resection in the Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Naval Medical University from January 2016 to January 2022 were collected. According to pathological diagnosis, patients were divided into the IC-Ds group ( n=288) and the C-PDACs group ( n=94). The IC-Ds group was further divided into the colloid carcinoma subgroup and the ductal adenocarcinoma subgroup based on pathological typing. Data including age, gender, preoperative CA19-9 level, surgical margin status, lymph node metastasis, pathological grade, T stage, postoperative adjuvant chemotherapy, and survival follow-up were recorded. The median follow-up time was 35.00 months for IC-Ds patients and 29.00 months for C-PDACs patients. Clinicopathological characteristics and prognostic factors were compared between the IC-Ds and C-PDACs groups, as well as between the colloid carcinoma and ductal adenocarcinoma subgroups. Kaplan-Meier curves for overall survival were generated. Results:There were no significant differences in age, gender, R1 resection margin between the IC-Ds group and the C-PDACs group. However, in the C-PDACs group, 70 cases (74.47%) had elevated preoperative CA19-9, 40 cases (42.55%) had lymph node metastasis, 25 cases (26.60%) were pathologically confirmed as poorly differentiated carcinoma after surgery, and 54 cases (57.45%) received postoperative adjuvant chemotherapy; the proportions of all these indicators were higher than those in the IC-Ds group (90/288, 31.25%; 72/288, 25.00%; 32/288, 11.11%; 105/288, 36.46%). In contrast, the proportion of T1 stage in the IC-Ds group was higher (40.97% vs 20.21%), and all these differences were statistically significant (all P value <0.05). Among the 288 patients in the IC-Ds group, 97 cases (33.68%) were colloid carcinoma and 191 cases (66.32%) were ductal adenocarcinoma. There were no significant differences in age, gender, R1 resection margin, proportion of poorly differentiated carcinoma between the two subgroups. However, in the ductal adenocarcinoma subgroup, 67 cases (35.08%) had elevated preoperative CA19-9, 56 cases (29.32%) had lymph node metastasis confirmed by postoperative pathology, and 80 cases (41.88%) received postoperative adjuvant chemotherapy; all these proportions were significantly higher than those in the colloid carcinoma subgroup (23/97, 23.71%; 16/97, 17.02%; 25/97, 26.60%). In addition, the ductal adenocarcinoma subgroup had higher proportions of T2 and T3/T4 stages, while the proportion of T1 stage in the colloid carcinoma subgroup (60/97, 61.86%) was significantly higher than that in the ductal adenocarcinoma subgroup (58/191, 30.37%), with all differences being statistically significant (all P value <0.05). The median survival time was 47.00 months (95% CI 42.91-51.09) in the IC-Ds group and 34.00 months (95% CI 29.67-38.33) in the C-PDACs group. For the IC-Ds subgroups, the median survival time was 59.00 months (95% CI 50.79-67.21) in the colloid carcinoma subgroup and 42.00 months (95% CI 35.15-48.85) in the ductal adenocarcinoma subgroup. Significant differences in median survival time were observed between the IC-Ds and C-PDACs groups, between the colloid carcinoma and ductal adenocarcinoma subgroups, and between the ductal adenocarcinoma subgroup and the C-PDACs group (all P value <0.01). Conclusions:IC-Ds has a better prognosis than C-PDACs, and there is significant heterogeneity within IC-Ds, indicating different biological behaviors between the two types, which requires the development of targeted diagnosis and treatment strategies.

Objective To describe the outcomes of extracorporeal membrane oxygenation (ECMO) for patients after aortic surgery and to summarize the experience. Methods The clinical data of patients who received ECMO support after aortic surgery in Fuwai Hospital from 2009 to 2020 were retrospectively analyzed. The patients who received an aortic dissection surgery were allocated into a dissection group, and the other patients were allocated into a non-dissection group. The in-hospital and follow-up survival rates were compared between the two groups, and the causes of death were analyzed. Results A total of 22 patients were enrolled, including 17 patients in the dissection group [13 males and 4 females, with a median age of 54 (46, 61) years] and 5 patients in the non-dissection group [3 males and 2 females, with a median age of 51 (41, 65) years]. There was no statistical difference in the age and gender between the two groups (P>0.05). The in-hospital survival rate (11.8% vs. 100.0%, P=0.001) and follow-up survival rate (11.8% vs. 80.0%, P=0.009) of the patients in the dissection group were significantly lower than those in the non-dissection group. The causes of death in the dissection group included massive bleeding and disseminated intravascular coagulation (3 patients), ventricular thrombosis (1 patient), irreversible brain injury (2 patients), visceral malperfusion syndrome (4 patients) and irreversible heart failure (5 patients). Conclusion ECMO after aortic dissection surgery is associated with high mortality, which is related to the pathological features of aortic dissection and severely disrupted coagulation system after the surgery. For these patients, strict indication selection and optimal management strategy are important.