BACKGROUND:Developed by the esteemed Chinese medicine master Wei Guikang,Tongan Decoction has proven highly effective in treating knee osteoarthritis.However,the mechanism of action is yet unclear.OBJECTIVE:To elucidate how Tongan Decoction modulates synovial macrophage polarization as a therapeutic strategy for knee osteoarthritis in a rat model.METHODS:(1)We employed high-throughput microRNA sequencing and polymerase chain reaction to analyze the differentially expressed miRNA in synovial macrophages of normal and knee osteoarthritis rats.Predicted target genes of miR-27a were identified using bioinformatics databases,with subsequent validation through luciferase assays.A total of 68 Sprague-Dawley rats were randomly divided into normal control group(n=16),model group(n=16),miR-27a overexpression group(n=12),Tongan Decoction group(n=12),and Tongan Decoction+miR-27a inhibition group(n=12).The miR-27a overexpression group and the Tongan Decoction+miR-27a inhibition group were injected with miR-27a mimic and miR-27a inhibitor in the right knee joint cavity,respectively,once daily for 5 continuous days.On the 15th day after modeling,the Tongan Decoction group and the Tongan Decoction+miR-27a inhibition group were given Tongan Decoction by gastric lavage,and the other three groups were given saline by gastric lavage,once daily for 14 continuous days.After administration,behavioral tests,X-rays,hematoxylin-eosin staining of synovial and cartilage tissues of the knee joint and immunofluorescence staining of synovial tissues of the knee joint,RT-PCR,and Western blot were performed.RESULTS AND CONCLUSION:High-throughput sequencing of miRNA showed low expression of miR-27a in synovial tissues of rats with knee osteoarthritis.The target gene of miR-27a was nuclear factor κB,and luciferase assay showed that the two could bind to each other.Behavioral assays showed that miR-27a overexpression or Tongan Decoction alleviated joint dysfunction in rats with knee osteoarthritis,and miR-27a inhibition antagonized the effect of Tongan Decoction.X-ray films and hematoxylin-eosin staining showed that miR-27a overexpression or Tongan Decoction reduced the degree of knee osteoarthritis and miR-27a inhibition weakened the therapeutic effect of Tongan Decoction.The results of RT-PCR and western blot assay showed that compared with the normal control group,the expression of interleukin 10 was reduced in the model group(P＜0.05),and the expression of matrix metalloproteinase 13,interleukin 1β,and nuclear factor κB was elevated in the model group(P＜0.05).miR-27a overexpression or Tongan Decoction could differently reverse the changes in the above-mentioned indexes,while miR-27a inhibition weakened the effect of Tongan Decoction.Immunofluorescence staining results showed that CD86 protein expression in the model group was higher than that in the normal control group(P＜0.05),and CD206 protein expression was lower than that in the normal control group(P＜0.05);miR-27a overexpression group and Tongan Decoction had lower CD86 protein expression than that in the model group(P＜0.05),and higher CD206 protein expression than that in the model group(P＜0.05);in the Tongan Decoction+miR-27a inhibition group,CD86 protein expression was higher(P＜0.05)and CD206 protein expression was lower than that in the Tongan Decoction group(P＜0.05).Tongan Decoction mitigates knee osteoarthritis by upregulating miR-27a expression and suppressing nuclear factor κB activity,which improves knee joint function and further treats knee osteoarthritis.

OBJECTIVE To explore the association of postoperative biliary tract infection with expressions of soluble cluster of differentiation 14 subtype(sCD14-ST),procalcitonin(PCT),Toll-like receptor(TLR)4 and TLR2 in malignant obstructive jaundice(MOJ)patients undergoing percutaneous transhepatic cholangial drainage(PTCD).METHODS A total of 105 MOJ patients who underwent PTCD in Shengjing Hospital Affiliated to China Medical University form Nov.2021 to Nov.2023 were enrolled in the study and were divided into the infection group with 31 cases and the non-infection group with 74 cases according to the status of postoperative biliary tract infection.The etiological characteristics and drug resistance rates of the infection group were statistically analyzed.The levels of peripheral blood sCD14-ST,PCT,TLR4 and TLR2 were compared between the two groups,and the values of sCD14-ST,PCT,TLR4 and TLR2 in diagnosis of postoperative biliary tract infection in the MOJ patients under-going PTCD wee analyzed.RESULTS Totally 53 strains of pathogens were isolated from 31 patients of the infec-tion group,among which gram-negative bacteria were dominant.Escherichia coli and Enterococcus faecalis were respectively the major species of the gram-negative and gram-positive bacteria.The E.coli was mainly resistant to ampicillin and sensitive to imipenem;the E.faecalis was mainly resistant to ciprofloxacin,tetracycline,erythro-mycin and was sensitive to vancomycin.There were significant differences in the levels of sCD14-ST,PCT,TLR4 and TLR2 between the two groups(P＜0.05);the sCD14-ST level of the infection group was(41.12±13.14)ng/ml,higher than(29.35±9.17)ng/ml of the non-infection group(t=5.248,P＜0.001).The area under the curve(AUC)value of the joint detection of sCD14-ST,PCT,TLR4 and TLR2 was higher than that of the single detec-tion in diagnosis of postoperative biliary tract infection in the MOJ patients undergoing PTCD(P＜0.05).CONCLUSIONS The gram-negative bacteria are the major pathogens isolated from the MOJ patients with postop-erative biliary tract infection.Imipenem and vancomycin are recommended for treatment of the E.coli and E.fae-calis infections.The patients show abnormal expressions of sCD14-ST,PCT,TLR4 and TLR2.The joint detec-tion of the four indexes has high diagnostic value.

Head and neck squamous cell carcinoma(HNSCC)is a highly prevalent malignancy with poor prognosis.Treatment strategies to date have achieved limited success in significantly improving overall survival rates.γδ T cells,a unique subset of immune cells in the tumor microenvironment,can link adaptive and innate immune functions.While γδ T cells can effectively recognize and eliminate HNSCC tumor cells,certain subsets of these cells can secrete interleukin-17,contributing to tumor progression.Nevertheless,due to their remarkable cyto-toxic activity,γδ T cells have been identified as promising candidates for antitumor immunotherapy.This article reviews the biological back-ground of γδ T cells,their role in tumor immunity in HNSCC,and recent advances in γδ T cell immunotherapy,aiming to provide new in-sights into HNSCC diagnosis and treatment.

Objectives:To propose a classification method of intervertebral disc annulus fibrosus injury and explore its guiding values for annulus fibrosus repair and reconstruction in lumbar spine.Methods:Based on the degree and location of annulus fibrosus injury observed during endoscopic surgery,injuries were classified into types Ⅰ-Ⅳ.Type Ⅰ,no full-thickness tear in the annulus fibrosus,requiring artificial transverse inci-sion during nucleus pulposus removal surgery;Type Ⅱ,longitudinal tear in the annulus fibrosus without de-fect,and which was further subdivided into ⅡA(≤1cm),Ⅱ B(1-1.5cm),and Ⅱ C(≥ 1.5cm)based on the tear length;Type Ⅲ,central tear in the annulus fibrosus with defect,and which was subdivided into ⅢA(≤1cm)and ⅢB(＞1cm)based on the longest diameter of the defect;Type Ⅳ,tear in the annulus fibrosus near the endplate with defect,which was subdivided into ⅣA(≤1cm)and ⅣB(＞1cm)based on the longest diameter of the defect.A retrospective analysis was conducted on 136 patients with single-segment lumbar intervertebral disc protrusion in our hospital.There were 75 male cases and 61 female cases,with an age of 36.5±10.3 years.According to the classification method,out of the 136 patients,11 cases were classified as type Ⅰ,underwent conventional single-line linear suturing;Type Ⅱ cases were treated with near-endplate bone tunnel method for suturing,with type ⅡA 26 cases using linear suturing,type ⅡB 13 cases using triangular sutur-ing,and type ⅡC 3 cases were abandoned suturing;For type ⅢA,3 cases used triangular suturing and 3 used cross suturing,while 2 type ⅢB cases were abandoned suturing;Type Ⅳ cases also used the near-endplate bone tunnel method for suturing,with 52 type ⅣA cases using triangular suturing,15 using parallel line suturing,4 cases were failed in suturing,and 4 type Ⅳ B cases were abandoned suturing.The visual analogue scale(VAS)was used to assess the pain of the patients,and the Oswestry disability index(ODI)was used to assess the lumbar function of the patients before operation,at postoperative 3 months and final fol-low-up.At final follow-up,MRI was reexamined to observe the healing of the annulus fibrosus and compare the changes from the preoperative intervertebral;The MacNab criteria were used to assess the therapeutic ef-fect.Results:All the patients successfully underwent nucleus pulposus removal and nerve root decompression surgery.There were no intraoperative complications such as nerve root injury,dural sac tear,or pseudospinal hypertension syndrome.The operation time ranged from 36min to 50min,with an average of 44.50(36.25,50.00)min.Overall,according to the classification of annulus fibrosus injury,suturing was performed in 127 cases,with a suturing rate of 93.38％,and among which 123 cases successfully completed suturing,with a success rate of 96.85％.All 136 patients were followed up for 9-24 months,averaged 13.2 months.At final follow-up,there were 6 recurrences,including 1 type ⅡC(not sutured),1 type Ⅲ A(sutured),and 4 type ⅣA(3 sutured,1 suturing failure),with a recurrence rate of 4.412％.The intervertebral space height measured at final follow-up showed no significant change compared to the preoperative height(P＞0.05),while the VAS scores for low back pain and leg pain,and ODI at 3 months postoperatively and at final follow-up were sig-nificantly improved compared to the preoperative levels(P＜0.05).According to the MacNab criteria,there were 108 excellent,14 good,8 fair,and 6 poor in outcomes,with an excellent and good rate of 89.71％.Conclu-sions:The classification of lumbar disc annulus fibrosus injury is simple and clear;Adopting corresponding annulus fibrosus suturing repair surgery that is suitable for such classification can yield a high success rate of suturing and avoid unnecessary suturing,which has certain values in guiding clinical practice.

Objectives:To propose a classification method of intervertebral disc annulus fibrosus injury and explore its guiding values for annulus fibrosus repair and reconstruction in lumbar spine.Methods:Based on the degree and location of annulus fibrosus injury observed during endoscopic surgery,injuries were classified into types Ⅰ-Ⅳ.Type Ⅰ,no full-thickness tear in the annulus fibrosus,requiring artificial transverse inci-sion during nucleus pulposus removal surgery;Type Ⅱ,longitudinal tear in the annulus fibrosus without de-fect,and which was further subdivided into ⅡA(≤1cm),Ⅱ B(1-1.5cm),and Ⅱ C(≥ 1.5cm)based on the tear length;Type Ⅲ,central tear in the annulus fibrosus with defect,and which was subdivided into ⅢA(≤1cm)and ⅢB(＞1cm)based on the longest diameter of the defect;Type Ⅳ,tear in the annulus fibrosus near the endplate with defect,which was subdivided into ⅣA(≤1cm)and ⅣB(＞1cm)based on the longest diameter of the defect.A retrospective analysis was conducted on 136 patients with single-segment lumbar intervertebral disc protrusion in our hospital.There were 75 male cases and 61 female cases,with an age of 36.5±10.3 years.According to the classification method,out of the 136 patients,11 cases were classified as type Ⅰ,underwent conventional single-line linear suturing;Type Ⅱ cases were treated with near-endplate bone tunnel method for suturing,with type ⅡA 26 cases using linear suturing,type ⅡB 13 cases using triangular sutur-ing,and type ⅡC 3 cases were abandoned suturing;For type ⅢA,3 cases used triangular suturing and 3 used cross suturing,while 2 type ⅢB cases were abandoned suturing;Type Ⅳ cases also used the near-endplate bone tunnel method for suturing,with 52 type ⅣA cases using triangular suturing,15 using parallel line suturing,4 cases were failed in suturing,and 4 type Ⅳ B cases were abandoned suturing.The visual analogue scale(VAS)was used to assess the pain of the patients,and the Oswestry disability index(ODI)was used to assess the lumbar function of the patients before operation,at postoperative 3 months and final fol-low-up.At final follow-up,MRI was reexamined to observe the healing of the annulus fibrosus and compare the changes from the preoperative intervertebral;The MacNab criteria were used to assess the therapeutic ef-fect.Results:All the patients successfully underwent nucleus pulposus removal and nerve root decompression surgery.There were no intraoperative complications such as nerve root injury,dural sac tear,or pseudospinal hypertension syndrome.The operation time ranged from 36min to 50min,with an average of 44.50(36.25,50.00)min.Overall,according to the classification of annulus fibrosus injury,suturing was performed in 127 cases,with a suturing rate of 93.38％,and among which 123 cases successfully completed suturing,with a success rate of 96.85％.All 136 patients were followed up for 9-24 months,averaged 13.2 months.At final follow-up,there were 6 recurrences,including 1 type ⅡC(not sutured),1 type Ⅲ A(sutured),and 4 type ⅣA(3 sutured,1 suturing failure),with a recurrence rate of 4.412％.The intervertebral space height measured at final follow-up showed no significant change compared to the preoperative height(P＞0.05),while the VAS scores for low back pain and leg pain,and ODI at 3 months postoperatively and at final follow-up were sig-nificantly improved compared to the preoperative levels(P＜0.05).According to the MacNab criteria,there were 108 excellent,14 good,8 fair,and 6 poor in outcomes,with an excellent and good rate of 89.71％.Conclu-sions:The classification of lumbar disc annulus fibrosus injury is simple and clear;Adopting corresponding annulus fibrosus suturing repair surgery that is suitable for such classification can yield a high success rate of suturing and avoid unnecessary suturing,which has certain values in guiding clinical practice.

Function-preserving surgery for gastric cancer is a treatment strategy aimed at improving postoperative function while ensuring oncological safety. By preserving important anatomical structures such as the cardia, pylorus, and vagus nerve, as well as key functions like digestion, secretion, emptying, and anti-reflux, this approach aims to minimize the negative impact on patients' postoperative quality of life. With the widespread application of neoadjuvant treatment and the continuous improvement in the efficacy of anti-tumor drugs, the application and indications for functional-preserving surgery may further expand. This article reviews the current status and future prospects of function-preserving surgery for gastric cancer, focusing on its main types, applications after neoadjuvant therapy, and the exploration of new technologies.

BACKGROUND:Developed by the esteemed Chinese medicine master Wei Guikang,Tongan Decoction has proven highly effective in treating knee osteoarthritis.However,the mechanism of action is yet unclear.OBJECTIVE:To elucidate how Tongan Decoction modulates synovial macrophage polarization as a therapeutic strategy for knee osteoarthritis in a rat model.METHODS:(1)We employed high-throughput microRNA sequencing and polymerase chain reaction to analyze the differentially expressed miRNA in synovial macrophages of normal and knee osteoarthritis rats.Predicted target genes of miR-27a were identified using bioinformatics databases,with subsequent validation through luciferase assays.A total of 68 Sprague-Dawley rats were randomly divided into normal control group(n=16),model group(n=16),miR-27a overexpression group(n=12),Tongan Decoction group(n=12),and Tongan Decoction+miR-27a inhibition group(n=12).The miR-27a overexpression group and the Tongan Decoction+miR-27a inhibition group were injected with miR-27a mimic and miR-27a inhibitor in the right knee joint cavity,respectively,once daily for 5 continuous days.On the 15th day after modeling,the Tongan Decoction group and the Tongan Decoction+miR-27a inhibition group were given Tongan Decoction by gastric lavage,and the other three groups were given saline by gastric lavage,once daily for 14 continuous days.After administration,behavioral tests,X-rays,hematoxylin-eosin staining of synovial and cartilage tissues of the knee joint and immunofluorescence staining of synovial tissues of the knee joint,RT-PCR,and Western blot were performed.RESULTS AND CONCLUSION:High-throughput sequencing of miRNA showed low expression of miR-27a in synovial tissues of rats with knee osteoarthritis.The target gene of miR-27a was nuclear factor κB,and luciferase assay showed that the two could bind to each other.Behavioral assays showed that miR-27a overexpression or Tongan Decoction alleviated joint dysfunction in rats with knee osteoarthritis,and miR-27a inhibition antagonized the effect of Tongan Decoction.X-ray films and hematoxylin-eosin staining showed that miR-27a overexpression or Tongan Decoction reduced the degree of knee osteoarthritis and miR-27a inhibition weakened the therapeutic effect of Tongan Decoction.The results of RT-PCR and western blot assay showed that compared with the normal control group,the expression of interleukin 10 was reduced in the model group(P＜0.05),and the expression of matrix metalloproteinase 13,interleukin 1β,and nuclear factor κB was elevated in the model group(P＜0.05).miR-27a overexpression or Tongan Decoction could differently reverse the changes in the above-mentioned indexes,while miR-27a inhibition weakened the effect of Tongan Decoction.Immunofluorescence staining results showed that CD86 protein expression in the model group was higher than that in the normal control group(P＜0.05),and CD206 protein expression was lower than that in the normal control group(P＜0.05);miR-27a overexpression group and Tongan Decoction had lower CD86 protein expression than that in the model group(P＜0.05),and higher CD206 protein expression than that in the model group(P＜0.05);in the Tongan Decoction+miR-27a inhibition group,CD86 protein expression was higher(P＜0.05)and CD206 protein expression was lower than that in the Tongan Decoction group(P＜0.05).Tongan Decoction mitigates knee osteoarthritis by upregulating miR-27a expression and suppressing nuclear factor κB activity,which improves knee joint function and further treats knee osteoarthritis.

Periodontal homeostasis is regulated by the complex interplay between the gingival epithelial barrier, the extracellular matrix of soft tissues, the bone coupling system, and immune responses within the periodontal region. Gingival epithelial cells are primarily composed of keratinocytes and a small proportion of non-keratinocytes, and they are integral to the formation of the gingival epithelial barrier. This epithelial barrier plays a fundamental role in defending against pathogens, exogenous substances, and mechanical stress. This study aims to explore the intrinsic connections between gingival epithelial cells and periodontal homeostasis. Research has shown that gingival epithelial cells participate in maintaining periodontal homeostasis through multiple pathways: ① gingival epithelial cells respond to the inflammatory environment by undergoing proliferation, migration, epithelial-mesenchymal transition, and forming apoptosis-mediated neutrophil extracellular traps; ② when gingival inflammation damages the epithelial barrier, lipopolysaccharides cannot be easily removed, and gingival epithelial cells play a defensive role by activating innate immune responses; ③ the interactions of gingival epithelial cells with oral microbiota and immune cells are essential for maintaining periodontal homeostasis. Thus, gingival epithelial cells are closely associated with periodontal homeostasis. However, the crucial role and mechanisms of gingival epithelial cells in the maintenance of periodontal homeostasis are not clear, which provides novel insights for the research of periodontal homeostatic medicine.

BACKGROUND:Fixed-point rotation manipulation of cervical spine is a mechanical operation with high technical requirements,but the biomechanics of fixed-point manipulation of cervical spine still lacks relevant quantitative data.Moreover,the research on the influencing factors of cervical fixed-point rotation manipulation includes many parameters and there are differences,so it is necessary to further analyze its influencing factors to improve its related data. OBJECTIVE:To quantify the biomechanical parameters of cervical spine fixed-point rotation manipulation,explore the correlation between different biomechanical parameters,and the influence of individual characteristics of the subjects on the biomechanical parameters of cervical spine fixed-point rotation manipulation. METHODS:Totally 35 cases of cervical spondylosis were Outpatients from Orthopedic Department of Renai Branch of the First Affiliated Hospital of Guangxi University of Chinese Medicine and selected as the subjects investigated.Wearable mechanical measuring gloves were used to collect biomechanical parameters of cervical spine fixed-point rotation manipulation,including:thumb preload,thumb maximum thrust,palm preload,palm wrench force,and palm wrench maximum force.Personal characteristic parameters were collected,including age,height,weight,and neck circumference.The key biomechanical parameters in the process of cervical spine fixed-point rotation manipulation were analyzed and different individual characteristics were quantified.The results of biomechanical parameters were analyzed using Spearman correlation analysis.The possible effects of different individual characteristic parameters on biomechanics were analyzed. RESULTS AND CONCLUSION:(1)Compared with bilateral mechanical parameters,there was no significant difference between left manipulation and right manipulation(P>0.05).(2)The average of thumb preload force was(7.21±1.19)N;the average of thumb maximum thrust was(28.40±4.48)N;the average of palm preload was(5.67±2.49)N;the average of palm wrench force was(10.90±5.11)N,and the average of palm wrench maximum force was(16.00±7.27)N.(3)There was a significant positive correlation between palm preload and palm wrench force(Rs=0.812,P<0.01).There was a significant positive correlation between palm preload and palm wrench maximum force(Rs=0.773,P<0.01).There was a significant positive correlation between palm wrench force and palm wrench maximum force(Rs=0.939,P<0.01).(4)The weight was positively correlated with thumb preload,palm preload,palm wrench force and palm wrench maximum force(P<0.05).(5)These findings confirm that there is a certain biomechanical standard value in the operation of cervical spine fixed-point rotation manipulation to treat cervical spondylosis.There is no significant difference between the left and right manipulations,which indicates that the manipulation has good consistency and repeatability.There is consistency and coordination among palm preload force,palm wrench force,and palm wrench maximum force.Their contributions to the therapeutic effect are similar.Body weight is an important factor affecting cervical spine fixed-point rotation manipulation.

Function-preserving surgery for gastric cancer is a treatment strategy aimed at improving postoperative function while ensuring oncological safety. By preserving important anatomical structures such as the cardia, pylorus, and vagus nerve, as well as key functions like digestion, secretion, emptying, and anti-reflux, this approach aims to minimize the negative impact on patients' postoperative quality of life. With the widespread application of neoadjuvant treatment and the continuous improvement in the efficacy of anti-tumor drugs, the application and indications for functional-preserving surgery may further expand. This article reviews the current status and future prospects of function-preserving surgery for gastric cancer, focusing on its main types, applications after neoadjuvant therapy, and the exploration of new technologies.