Objective Based on the clinical data and imaging manifestations of patients with ischemic stroke to establish a simple clinical prediction model that is used for identifying intracranial atherosclerotic stenosis-acute large vessel occlusion(ICAS-LVO in posterior circulation before surgery.Methods The clinical data of patients with acute large vessel occlusion(LVO in the posterior circulation,who received endovascular intervention at the First Affiliated Hospital of Nanjing Medical University of China from January 2019 to September 2022,were retrospectively analyzed.According to the intraoperative angiographic findings,the patients were divided into ICAS-LVO group and non-ICAS-LVO group.Univariate analysis and multivariate logistic regression analysis were used to analyze the patient's demographic characteristics,clinical history,imaging findings,and laboratory results,based on which a clinical prediction model for ICAS-LVO was established,and according to the relevant parameters a nomogram prediction model was plotted.Results A total of 110 patients with LVO in the posterior circulation who received endovascular treatment were included in the final analysis.In 51 patients(49.6％)the cause of vascular occlusion was the atherosclerotic stenosis of the intracranial arteries.Compared with non-ICAS-LVO group,in ICAS-LVO group the patients were younger,the incidence of atrial fibrillation was lower,and the level of plasma D-dimer was lower.Three factors,including atrial fibrillation,occlusion site and collateral circulation status,were finally screened out to establish the prediction model for ICAS-LVO.This model demonstrated acceptable calibration(Hosmer-Lemeshow test,P=0.562)and good discrimination ability(AUC=0.956;95％CI:0.906-0.986).Conclusion The clinical prediction model for ICAS-LVO,which is established on the three predictive factors(absence of atrial fibrillation,occlusion located at the V4 segment of the vertebral artery or at the proximal to mid segment of the basilar artery,and a favorable collateral circulation),carries high sensitivity and accuracy.This model can help neurointervention physicians to make early identification of ICAS-LVO and to promptly formulate vascular recanalization treatment strategies.

Pulmonary hypertension(PH)is a serious cardiovascular condition that significantly impacts pa-tients'quality of life.Currently available clinical medications lack selectivity for pulmonary blood vessels,often produce substantial side effects,and are prohibitively expensive.Therefore,it is crucial to explore the mechanisms underlying the onset and progression of PH and to develop new,effective treatments.Ubiquitination is a key form of protein post-transla-tional modification in which specific E3 enzymes recognize substrate proteins and induce ubiquitination,leading to chang-es in their activity or stability.During the onset of PH,the activities of ubiquitin ligases and deubiquitinases undergo vari-ous changes,resulting in altered ubiquitination levels of different proteins.These variations primarily influence the degra-dation rates of substrate proteins within cells,thereby regulating essential physiological processes.Proteasomes play a vi-tal role in the degradation of ubiquitinated proteins,and inhibitors targeting these complexes have been developed,demon-strating therapeutic efficacy in experimental settings of PH.However,their low specificity presents significant challenges for practical applications.In this context,we summarize the relevant mechanisms of ubiquitination regulation in the onset of PH and highlight its practical significance for future therapeutic strategies.

Pulmonary hypertension(PH)is a serious cardiovascular condition that significantly impacts pa-tients'quality of life.Currently available clinical medications lack selectivity for pulmonary blood vessels,often produce substantial side effects,and are prohibitively expensive.Therefore,it is crucial to explore the mechanisms underlying the onset and progression of PH and to develop new,effective treatments.Ubiquitination is a key form of protein post-transla-tional modification in which specific E3 enzymes recognize substrate proteins and induce ubiquitination,leading to chang-es in their activity or stability.During the onset of PH,the activities of ubiquitin ligases and deubiquitinases undergo vari-ous changes,resulting in altered ubiquitination levels of different proteins.These variations primarily influence the degra-dation rates of substrate proteins within cells,thereby regulating essential physiological processes.Proteasomes play a vi-tal role in the degradation of ubiquitinated proteins,and inhibitors targeting these complexes have been developed,demon-strating therapeutic efficacy in experimental settings of PH.However,their low specificity presents significant challenges for practical applications.In this context,we summarize the relevant mechanisms of ubiquitination regulation in the onset of PH and highlight its practical significance for future therapeutic strategies.

Objective:To explore the clinical effects of parallel combined flow-through perforator flaps in the treatment of circular hot crush injuries in limbs with blood supply disorder.Methods:The study was a retrospective observational study. From April 2016 to December 2022, 4 cases with circular hot crush injuries in limbs with blood supply disorder were admitted to the Department of Burns and Plastic Surgery of the 988 th Hospital of Joint Logistics Support Force of PLA, including 3 males and 1 female, aged from 24 to 48 years. Among them, 2 cases were injured in the calf and 2 cases were injured in the forearm. After emergency debridement, the area of skin and soft tissue defects was from 20 cm×20 cm to 44 cm×20 cm. The patients had defects in tibialis anterior and posterior tibial arteries with a length of 13 to 18 cm, and in ulnar and radial arteries with a length of 9 to 12 cm. Flaps were designed and cut, including a flow-through anterolateral thigh perforator flap with area of 20 cm×9 cm to 24 cm×21 cm carrying the descending branch of the lateral circumflex femoral artery and the accompanying veins of 8 to 18 cm in length; and a flow-through posterior tibial artery perforator flap with area of 21 cm×13 cm and 20 cm×14 cm carrying the posterior tibial artery, the accompanying veins with a length of 14 and 17 cm respectively, and the great saphenous vein with a length of 22 and 21 cm. The circular hot crush injury wounds in the calf with blood supply disorder were repaired by a parallel combination of flow-through posterior tibial artery perforator flap and flow-through anterolateral thigh perforator flap, and the circular hot crush injury wounds in the forearm with blood supply disorder were repaired by a parallel combination of bilateral flow-through anterolateral thigh perforator flap, and the injured main vessels were reconstructed. The donor site wounds of flap were closed directly or treated with split-thickness skin grafts from abdomen. After surgery, the blood supply and survival of the flap and distal affected limb, the healing of wounds in the donor and recipient sites, the survival of the skin graft in the flap donor site were observed. During follow-up, the condition of flaps, the appearance, blood supply, and function of affected limbs were observed. At the last follow-up, the foot and ankle functions were evaluated according to the scoring standards of American Orthopedic Foot and Ankle Association, and the wrist and hand function was evaluated according to the trial standard of replantation of amputated upper limb function assessment of the Hand Surgery of Chinese Medical Association. Results:The flaps and distal affected limbs of 4 patients had good blood circulation and successfully survived after surgery. The wounds of 3 cases successfully healed, while one patient with circular hot crush injury in the forearm experienced exudation in the recipient site in the later stage, and the wound healed after re-expansion and suturing. The donor site wounds healed smoothly, and the skin grafts successfully survived. During follow-up of 12 to 24 months after surgery, the flaps were slightly swollen, the limbs had good appearance, normal blood circulation, and fine functional recovery. At the last follow-up, the foot and ankle function of 2 patients with circular hot crush injuries in the calf was evaluated as good in 1 case and commonly in 1 case; the wrist and hand function of 2 patients with circular hot crush injuries in the forearm was evaluated as excellent in 1 case and good in 1 case.Conclusions:The parallel combined flow-through perforator flap can reconstruct the damaged main blood vessels and repair the wound at the same time. It can not only effectively save the limb, but also restore part of the function of the affected limb. It is one of the effective methods to treat the circular hot crush injuries in limbs with blood supply disorder.

Objective:To explore the potent effects of denatonium benzoate(DB)on Mas-related G protein-coupled receptor-B2(MrgprB2)-mediated rat mast cell degranulation.Methods:RBL-2H3 cells were treated with DB overnight,before challenged with MrgprB2 ligands substance P(SP).The release of β-hex from MrgprB2-activated RBL-2H3 was detected by substrate method.Detec-tion of LTC4,IL-6,TNF-α and cPLA2 activity were performed by ELISA.The Ca2+influx and the expression of RBL-2H3 MrgprB2 re-ceptors were measured by fluorescence assay.Results:The results showed 10 μmol/L,50 μmol/L,80 μmol/L,100 μmol/L DB treat-ments promoted β-hex and LTC4 releases from activated RBL-2H3,accompanied by increased Ca2+mobilization and cPLA2 activa-tion.DB treatments did not affect IL-6 and TNF-α LTC4 releases in MrgprB2-activated RBL-2H3,as well as the levels of MrgprB2 ex-pression in mast cells.Conclusion:Taken together,DB enhanced the MrgprB2-mediated RBL-2H3 degranulation in vitro,probably by up-regulating Ca2+mobilization in activated cells.

Objective To evaluate the clinical value of optic nerve sheath diameter(ONSD)measured on thin-slice CT scan in the diagnosis and prognostic assessment of cerebral venous sinus thrombosis(CVST).Methods The clinical data of patients with CVST,who were admitted to the First Affiliated Hospital of Nanjing Medical University of China to receive treatment from January 1,2016 to December 31,2022,were retrospectively analyzed.The difference in ONSD was compared between CVST patients and normal population,the postoperative changes in ONSD was analyzed.Results A total of 49 patients with CVST(CVST group)and 49 normal persons having no brain disorders(control group)were enrolled in this study.In CVST group,the preoperative ONSD was(5.33±0.50)mm,which was significantly higher than(4.40±0.40)mm in control group(P＜0.001),the postoperative ONSD remarkably decreased to(4.98±0.59)mm(P＜0.01).The difference value between postoperative ONSD and preoperative ONSD in the patients receiving pure anticoagulation treatment was not statistically significant different from that in the patients receiving endovascular treatment[(-0.43±0.22)mm vs.(-0.40±0.42)mm,P=0.84].The preoperative ONSD in the patients having intracranial hemorrhage and in the patients having no intracranial hemorrhage was(5.26±0.51)mm and(5.41±0.49)mm respectively(P=0.31),and the difference value between postoperative ONSD and preoperative ONSD was(-0.39±0.40)mm and(-0.45±0.25)mm respectively(P=0.66).At the three-month follow-up visit,the difference in ONSD between the patients having a good prognosis(mRS score being 0-2 points)and the patients having a poor prognosis was not statistically significant(P＞0.05).Conclusion ONSD that is measured on plain head CT scan can be used as a response indicator of elevated intracranial pressure in CVST patients,which can be used to monitor the changes in intracranial pressure before and after treatment,but its value in assessing the curative efficacy of different therapeutic methods needs to be further explored.

Objective To provide reference for the formulation of public health policies through exploring the disease burden of aortic aneurysm (AA) in Chinese young adults. Methods We analyzed sex-specific mortality rates and years of life lost (YLLs) among Chinese young adults with AA in Global Burden of Disease (GBD) from 1990 to 2019, and compared with global and young adult AA data stratified by sociodemographic index (SDI). Joinpoint was used to analyze the time trend of AA burden among young males and females in China. The attributable risk factors for AA burden in young adults and its characteristics were analyzed. Results Among young adults (15-39 years old) in China, the total of AA deaths in 2019 was 657 (95%UI 549-791), with an increase of 16.90% compared with 1990. The mortality rate in 2019 was 0.13 per 100 000 (95%UI 0.11-0.16), with an increase of 30.00% compared with 1990. In 2019, a total of 36921 YLLs (95%UI 30 865-44 445) were produced by young adults in China, with an increase of 13.21% compared with 1990. The YLLs rate in 2019 was 7.42 per 100 000 (95%UI 6.20-8.93), with an increase of 24.92% compared with 1990. The male YLLs rate was 11.49 per 100 000 (95%UI 9.22-14.28), with an increase of 35.18%. The female YLLs rate was 3.11 per 100 000 (95%UI 2.36-3.98), with a decrease of 3.12%. Both the AA mortality rate and YLLs rate in male young adults were higher than those in female young adults, and the growth rate from 1990 to 2019 was significantly higher than that in females. Conclusion The disease burden of AA among young adults in China increases significantly from 1990 to 2019, mainly among males. The time trend of male and female AA YLLs in Chinese young adults is obviously inconsistent. The AA YLLs of Chinese male young adults are positively correlated with economic development and the progress of medical technology, and are in the process of gradual increase. The AA YLLs of Chinese female young adults are much lower than the average level, which is closely related to the low smoking rate.

AIM:To investigate the effect and mechanism of the exogenous hydrogen sulfide donor GYY4137 on hypoxia-induced proliferation of rat pulmonary artery smooth muscle cells(PASMCs).METHODS:Rat PASMCs in optimal growth condition were used.Once the cell density reached 60%～70%,the cells were serum starved for 24 h.The cells were then randomly divided into four groups:normal group,normal+GYY4137 group,hypoxia group,and hypoxia+GYY4137 group.A CCK-8 assay was used to determine the safe concentration range of GYY4137 that exerted no adverse effects on normal cells,and the optimal concentration of GYY4137 to inhibit hypoxia-induced proliferation of PASMCs was identified.EdU staining was employed to assess PASMCs proliferation in each group.Western blot analysis was conducted to evaluate the expression of proliferating cell nuclear antigen(PCNA)and proteins related to glycolysis and pyroptosis in PASMCs.Lactic acid content was quantified using a lactic acid assay kit.Immunofluorescence was used to detect the pro-tein expression of hexokinase 2(HK2)and nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)in PASMCs,and the levels of interleukin-1β(IL-1β)and IL-18 in PASMCs were measured using ELISA.RESULTS:The effective concentration of GYY4137 in inhibiting hypoxia-induced viability of PAMSCs was 100 μmol/L(P＜0.05).Com-pared with the hypoxia group,the hypoxia+GYY4137 group showed a significant decrease in PCNA protein expression(P＜0.05),reduced PAMSCs proliferation(P＜0.01),decreased HK2 and pyruvate kinase isozyme type M2(PKM2)protein expression(P＜0.05,P＜0.01),increased pyruvate dehydrogenase(PDH)protein expression(P＜0.05),and reduced lac-tic acid content(P＜0.01).Additionally,the expression of pyroptosis-related proteins was significantly decreased(P＜0.015,P＜0.01),and immunofluorescence revealed a significant decrease in HK2 and NLRP3 expression(P＜0.01).ELISA results showed that IL-1β and IL-18 protein levels were significantly decreased(P＜0.05,P＜0.01).CONCLU-SION:GYY4137 inhibits hypoxia-induced proliferation of rat PASMCs by regulating glycolysis and pyroptosis.

AIM:To investigate the effect and mechanism of the exogenous hydrogen sulfide donor GYY4137 on hypoxia-induced proliferation of rat pulmonary artery smooth muscle cells(PASMCs).METHODS:Rat PASMCs in optimal growth condition were used.Once the cell density reached 60%～70%,the cells were serum starved for 24 h.The cells were then randomly divided into four groups:normal group,normal+GYY4137 group,hypoxia group,and hypoxia+GYY4137 group.A CCK-8 assay was used to determine the safe concentration range of GYY4137 that exerted no adverse effects on normal cells,and the optimal concentration of GYY4137 to inhibit hypoxia-induced proliferation of PASMCs was identified.EdU staining was employed to assess PASMCs proliferation in each group.Western blot analysis was conducted to evaluate the expression of proliferating cell nuclear antigen(PCNA)and proteins related to glycolysis and pyroptosis in PASMCs.Lactic acid content was quantified using a lactic acid assay kit.Immunofluorescence was used to detect the pro-tein expression of hexokinase 2(HK2)and nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)in PASMCs,and the levels of interleukin-1β(IL-1β)and IL-18 in PASMCs were measured using ELISA.RESULTS:The effective concentration of GYY4137 in inhibiting hypoxia-induced viability of PAMSCs was 100 μmol/L(P＜0.05).Com-pared with the hypoxia group,the hypoxia+GYY4137 group showed a significant decrease in PCNA protein expression(P＜0.05),reduced PAMSCs proliferation(P＜0.01),decreased HK2 and pyruvate kinase isozyme type M2(PKM2)protein expression(P＜0.05,P＜0.01),increased pyruvate dehydrogenase(PDH)protein expression(P＜0.05),and reduced lac-tic acid content(P＜0.01).Additionally,the expression of pyroptosis-related proteins was significantly decreased(P＜0.015,P＜0.01),and immunofluorescence revealed a significant decrease in HK2 and NLRP3 expression(P＜0.01).ELISA results showed that IL-1β and IL-18 protein levels were significantly decreased(P＜0.05,P＜0.01).CONCLU-SION:GYY4137 inhibits hypoxia-induced proliferation of rat PASMCs by regulating glycolysis and pyroptosis.

Adipose-derived mesenchymal stem cells (ASCs) are pluripotent adult mesenchymal stem cells that are expected to be ideal seed cells for bone tissue engineering(BTE) due to their biosecurity, abundance, and easy access. However, in comparison with bone marrow mesenchymal stem cells, ASCs possess a relatively limited osteogenic capacity and often require further induction. Advances on strategies for promoting osteogenic differentiation of ASCs are reviewed from following aspects: optimization of scaffolds, addition of bioactive factors or drugs, non-coding RNA regulation, and physical stimulation, so as to provide references for the use of ASCs in BTE.