Objective:To investigate the influences of paeonol(PAE)on balance of Th17/Treg in autoimmune thyroiditis(AIT)rats by regulating high-mobility group box 1(HMGB1)/receptor for advanced glycation end product(RAGE)signal axis.Methods:Eighty-four rats were randomly divided into control group(NC group),Model group,low-dose PAE group(PAE-L group,8 mg/kg),medium-dose PAE group(PAE-M group,16 mg/kg),high-dose PAE group(PAE-H group,32 mg/kg),selenious yeast group(SY group,36 μg/kg)and PAE-H+rHMGB1(HMGB1 activator)group(32 mg/kg+8 μg/kg),with 12 rats in each group.Except for NC group,AIT models were established in other groups,and after successful modeling,rats were administered once a day for 6 weeks.ELISA was applied to detect the levels of thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TGAb),free triiodothyro-nine(FT3),free thyroxine(FT4),IL-17 and IL-10 in rat serum;flow cytometry was applied to detect ratios of Th17,Treg,Th17/Treg in peripheral blood of rats in each group;HE staining was applied to detect pathological changes of thyroid tissue in rats;qRT-PCR was applied to detect expression levels of retinoic acid-related orphan receptor γt(RORγt)and forkhead box protein P3(Foxp3)mRNA in rat thyroid tissue;Western blot was applied to detect expressions of HMGB1 and RAGE proteins in thyroid tissue of rats.Results:Compared with NC group,pathological damages of thyroid tissue in Model group were serious,TPOAb,TGAb,FT3,FT4,IL-17 levels,Th17 ratio,Th17/Treg,RORγt mRNA level,HMGB1 and RAGE protein expressions were increased,while IL-10 level,Treg ratio,and Foxp3 mRNA level were decreased(P<0.05);compared with Model group,pathological damages of thyroid tissue in PAE-L group,PAE-M group,PAE-H group and SY group were reduced,TPOAb,TGAb,FT3,FT4,IL-17 levels,Th17 ratio,Th17/Treg,RORγt mRNA level,HMGB1 and RAGE protein expressions were decreased,while IL-10 level,Treg ratio,and Foxp3 mRNA level were increased(P<0.05);rHMGB1 attenuated the promotion of high dose PAE on Th17/Treg balance in AIT rats.Conclusion:PAE may promote Th17/Treg balance in AIT rats by inhibiting HMGB1/RAGE pathway.

Objective:To investigate the influences of paeonol(PAE)on balance of Th17/Treg in autoimmune thyroiditis(AIT)rats by regulating high-mobility group box 1(HMGB1)/receptor for advanced glycation end product(RAGE)signal axis.Methods:Eighty-four rats were randomly divided into control group(NC group),Model group,low-dose PAE group(PAE-L group,8 mg/kg),medium-dose PAE group(PAE-M group,16 mg/kg),high-dose PAE group(PAE-H group,32 mg/kg),selenious yeast group(SY group,36 μg/kg)and PAE-H+rHMGB1(HMGB1 activator)group(32 mg/kg+8 μg/kg),with 12 rats in each group.Except for NC group,AIT models were established in other groups,and after successful modeling,rats were administered once a day for 6 weeks.ELISA was applied to detect the levels of thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TGAb),free triiodothyro-nine(FT3),free thyroxine(FT4),IL-17 and IL-10 in rat serum;flow cytometry was applied to detect ratios of Th17,Treg,Th17/Treg in peripheral blood of rats in each group;HE staining was applied to detect pathological changes of thyroid tissue in rats;qRT-PCR was applied to detect expression levels of retinoic acid-related orphan receptor γt(RORγt)and forkhead box protein P3(Foxp3)mRNA in rat thyroid tissue;Western blot was applied to detect expressions of HMGB1 and RAGE proteins in thyroid tissue of rats.Results:Compared with NC group,pathological damages of thyroid tissue in Model group were serious,TPOAb,TGAb,FT3,FT4,IL-17 levels,Th17 ratio,Th17/Treg,RORγt mRNA level,HMGB1 and RAGE protein expressions were increased,while IL-10 level,Treg ratio,and Foxp3 mRNA level were decreased(P<0.05);compared with Model group,pathological damages of thyroid tissue in PAE-L group,PAE-M group,PAE-H group and SY group were reduced,TPOAb,TGAb,FT3,FT4,IL-17 levels,Th17 ratio,Th17/Treg,RORγt mRNA level,HMGB1 and RAGE protein expressions were decreased,while IL-10 level,Treg ratio,and Foxp3 mRNA level were increased(P<0.05);rHMGB1 attenuated the promotion of high dose PAE on Th17/Treg balance in AIT rats.Conclusion:PAE may promote Th17/Treg balance in AIT rats by inhibiting HMGB1/RAGE pathway.

Objective The efficacy of Zang Bi Formula(ZBF)in cardiac complications of rheumatoid arthritis(RA)was observed through animal experiments.Ultra-high performance liquid chromatography tandem time-of-flight mass spectrometry(UHPLC-TOF-MS)and network pharmacology was used to analyze the active ingredients,targets,and pathways of ZBF for the treatment of cardiac hypertrophy,and molecular docking was applied to verify the binding ability of the ingredients to pathway-related proteins.Methods TNF transgenic(TNF-Tg)mice were used as RA and RA-complexed cardiac hypertrophy models,and the left ventricular hypertrophy of mice was observed by echocardiography after 8 weeks of continuous gavage with ZBF,and WGA staining,HE staining,and Masson staining were used to observe and analyze the pathological changes of cardiac tissues.The chemical composition of ZBF was identified by UHPLC-TOF-MS technique.The public database was then used to screen the active ingredients and component targets and disease targets,construct interaction networks,and analyze the bioconcentration data as well as the docking ability of the active ingredients and proteins.Results In animal experiments,ZBF reduced cardiac weight index and cardiac weight tibia length ratio in TNF-Tg mice(P＜0.05,P＜0.01),attenuated cardiac hypertrophy(P＜0.001)and cardiomyocyte hypertrophy(P＜0.01),and alleviated inflammatory infiltration and fibrosis in the heart(P＜0.0001).A total of 24 compounds were identified from ZBF by UHPLC-TOF-MS.A total of 105 active ingredients of ZBF were screened by network pharmacological analysis,and 187 potential targets of ZBF for cardiac hypertrophy were constructed,and the enriched pathways with significance included PI3K-AKT signaling pathway,TNF signaling pathway,and MAPK signaling pathway.Conclusion ZBF attenuated myocardial hypertrophy and cardiomyocyte hypertrophy in TNF-Tg mice and alleviated inflammatory infiltration and fibrosis in the heart,and ZBF may be a potential drug for the treatment of RA and its cardiac complications in the clinic.

Objective The efficacy of Zang Bi Formula(ZBF)in cardiac complications of rheumatoid arthritis(RA)was observed through animal experiments.Ultra-high performance liquid chromatography tandem time-of-flight mass spectrometry(UHPLC-TOF-MS)and network pharmacology was used to analyze the active ingredients,targets,and pathways of ZBF for the treatment of cardiac hypertrophy,and molecular docking was applied to verify the binding ability of the ingredients to pathway-related proteins.Methods TNF transgenic(TNF-Tg)mice were used as RA and RA-complexed cardiac hypertrophy models,and the left ventricular hypertrophy of mice was observed by echocardiography after 8 weeks of continuous gavage with ZBF,and WGA staining,HE staining,and Masson staining were used to observe and analyze the pathological changes of cardiac tissues.The chemical composition of ZBF was identified by UHPLC-TOF-MS technique.The public database was then used to screen the active ingredients and component targets and disease targets,construct interaction networks,and analyze the bioconcentration data as well as the docking ability of the active ingredients and proteins.Results In animal experiments,ZBF reduced cardiac weight index and cardiac weight tibia length ratio in TNF-Tg mice(P＜0.05,P＜0.01),attenuated cardiac hypertrophy(P＜0.001)and cardiomyocyte hypertrophy(P＜0.01),and alleviated inflammatory infiltration and fibrosis in the heart(P＜0.0001).A total of 24 compounds were identified from ZBF by UHPLC-TOF-MS.A total of 105 active ingredients of ZBF were screened by network pharmacological analysis,and 187 potential targets of ZBF for cardiac hypertrophy were constructed,and the enriched pathways with significance included PI3K-AKT signaling pathway,TNF signaling pathway,and MAPK signaling pathway.Conclusion ZBF attenuated myocardial hypertrophy and cardiomyocyte hypertrophy in TNF-Tg mice and alleviated inflammatory infiltration and fibrosis in the heart,and ZBF may be a potential drug for the treatment of RA and its cardiac complications in the clinic.

Objective:To explore the effect of distal veins on the survival of a dorsal four-territory perforator flap in rats.Methods:A total of 32 SD rats were randomly divided into the control group and the experimental group, with 16 rats in each group. The multi-territory perforator flap including the bilateral iliolumbar and bilateral posterior intercostal angiosomes was cut from the back of each rat, with the size of 6 cm×7 cm. The right iliolumbar artery and vein were preserved in the control group, while the right iliolumbar artery and the right posterior intercostal vein were preserved in the experimental group. In both groups, incisions were made between the right iliolumbar angiosome and the right posterior intercostal angiosome. Finally, the flap was sutured back to their orthotopic site. At 6 hours and 1, 3, 5, 7 days after surgery, the blood perfusion at the bilateral iliolumbar and the left posterior intercostal vascular territories were measured. On the seventh day after surgery, the percentage of the survived area of the flaps were evaluated, arteriography was performed to observe the dilation of arteries within the flap, the intraluminal diameter of the choke artery in the choke 2 area was measured using hematoxylin and eosin staining, and the relative expression of endothelial nitric oxide synthase (eNOS) was detected by Western blotting. SPSS 28.0 was used for statistical analysis, and measurement data were presented as Mean±SD. Independent sample t-test was used to compare data across two groups. P<0.05 was considered statistically significant. Results:(1) At 6 hours and 1, 3, 5, 7 days after surgery, the experimental group displayed higher blood perfusion than the control group at the bilateral iliolumbar and the left posterior intercostal vascular territories (all P<0.01). (2) On the 7th day after surgery, the artery dilation of the experimental group was more obvious than that of the control group; the percentage of the survived flap area in the experimental group was higher than that in the control group [(87.6±3.2)% vs. (65.3±3.0)%, P<0.01]; the intraluminal diameter of the choke artery was greater in the experimental group than that in the control group[(49.3±3.1) μm vs. (35.1±2.3) μm, P<0.01]; and the relative expression of eNOS in the experimental group was higher than that in the control group (0.87±0.07 vs. 0.50±0.05, P<0.01). Conclusion:The distal vein (right posterior intercostal vein) of dorsal four-territory perforator flap of SD rats directly guided the pedicle artery blood supply to promote the expression of eNOS, dilated the arteries in each zone of the flap, increased the blood supply to the distal artery of the flap, and ultimately enhanced the flap survival area.

【Objective】 To explore the relationship between the storage time of leukodepleted red blood cells and transfusion adverse reactions by analyzing the occurrence of transfusion adverse reactions of patients after leukodepleted red blood cells transfusion from four hospitals. 【Methods】 By using the electronic medical record management system, the collection and transfusion dates of leukodepleted red blood cells from four hospitals in Enshi Prefecture from 2018 to 2022, as well as the information on transfusion adverse reactions, were retrieved. 【Results】 From 2018 to 2022, a total of 697 61 bags of leukodepleted red blood cells were transfused in four hospitals, resulting in 166 cases of transfusion adverse reactions, among which 93 were allergic reactions, 63 were non hemolytic febrile reactions, and 10 were others, with a total incidence rate of transfusion adverse reactions at 0.24%. The average storage time of leukodepleted red blood cells with and without transfusion adverse reactions was (20.25±6.31) and (19.88±5.50) days, respectively. With a storage time of 7 days as the threshold, the incidence of transfusion adverse reactions was the lowest for a storage time of 15~21 days. The incidence of transfusion adverse reactions of leukodepleted red blood cells in two groups (with storage days ≤21 days and >21 days) was not statistically significant(P>0.05). 【Conclusion】 Allergic reactions were the main type of transfusion adverse reaction caused by leukodepleted red blood cells, and the incidence of transfusion adverse reactions decreased and then increased with the prolongation of the storage time of leukodepleted red blood cells. There was no significant difference in the incidence of transfusion adverse reactions with leukodepleted red blood cells stored for ≤ 21 days and >21 days.

Objective:To investigate the prevention and risk factors of deep vein thrombosis (DVT) in the lower extremity after medial open wedge high tibial osteotomy (HTO).Methods:A total of 128 patients who underwent medial open wedge HTO in the Third Hospital of Hebei Medical University from January 2020 to October 2022 were retrospectively analyzed, including 45 males and 83 females, aged 59.3±6.8 years (range, 44-87 years). Postoperative anticoagulation with enoxaparin sodium was applied at a randomized dose of 4,000 AXaIU/d or 6,000 AXaIU/d. Gender, age, history of chronic diseases (hypertension, diabetes), smoking history, body mass index, and body fat percentage were collected. On admission, the risk of DVT was assessed using the Caprini scale and calf circumference was measured. Hemoglobin, D-dimer, antithrombin III, activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen (FIB), fibrinogen degradation products (FDP), glutathione, glutathione, urea, creatinine, uric acid were recorded. Patients were divided into DVT group and non-DVT group according to whether DVT occurred after operation. Binary logistic regression was used to analyze the independent risk factors of DVT after HTO. The receiver operating characteristic (ROC) curve was plotted, and the area under curve (AUC) was calculated to analyze the predictive value of the postoperative Caprini scale in the occurrence of DVT after HTO.Results:A total of 128 patients were enrolled, 83 patients were treated with enoxaparin sodium 4 000 AXaIU/d and 45 patients were treated with enoxaparin sodium 6 000 AXaIU/d. According to the results of color Doppler examination of bilateral lower extremity veins on the third day after operation, DVT occurred in 39% (50/128) of patients, including 39 cases of calf intermuscular thrombosis, 6 cases of peroneal vein thrombosis, 4 cases of posterior tibial vein thrombosis, and 1 case of popliteal vein thrombosis. DVT occurred in 36% (30/83) of patients receiving 4 000 AXaIU/d enoxaparin sodium and 44% (20/45) of patients receiving 6 000 AXaIU/d enoxaparin sodium, with no statistically significant difference (χ 2=0.84, P=0.358). Univariate analysis showed that smoking history, postoperative Caprini scale≥8, and female may be associated with the development of DVT after HTO ( P<0.05). They were included in the binary logistic regression, and the results showed that postoperative Caprini scale≥8 was an independent risk factor for DVT after HTO. The ROC curve of postoperative Caprini scale for predicting DVT after HTO was drawn, and the AUC was 0.847 (95% CI: 0.73, 0.96), the optimal cut-off value was 8, and the sensitivity and specificity were 84.2% and 77.6%, respectively. Conclusion:Caprini scale≥8 is an independent risk factor for DVT after medial open wedge HTO. Caprini scale has a good value in predicting the occurrence of DVT after HTO. The recommended dose of enoxaparin sodium is 4 000 AXaIU/d for the prevention of postoperative DVT, and increasing the dose is not associated with a decreased risk of DVT.

Objective:To explore the effect of distal veins on the survival of a dorsal four-territory perforator flap in rats.Methods:A total of 32 SD rats were randomly divided into the control group and the experimental group, with 16 rats in each group. The multi-territory perforator flap including the bilateral iliolumbar and bilateral posterior intercostal angiosomes was cut from the back of each rat, with the size of 6 cm×7 cm. The right iliolumbar artery and vein were preserved in the control group, while the right iliolumbar artery and the right posterior intercostal vein were preserved in the experimental group. In both groups, incisions were made between the right iliolumbar angiosome and the right posterior intercostal angiosome. Finally, the flap was sutured back to their orthotopic site. At 6 hours and 1, 3, 5, 7 days after surgery, the blood perfusion at the bilateral iliolumbar and the left posterior intercostal vascular territories were measured. On the seventh day after surgery, the percentage of the survived area of the flaps were evaluated, arteriography was performed to observe the dilation of arteries within the flap, the intraluminal diameter of the choke artery in the choke 2 area was measured using hematoxylin and eosin staining, and the relative expression of endothelial nitric oxide synthase (eNOS) was detected by Western blotting. SPSS 28.0 was used for statistical analysis, and measurement data were presented as Mean±SD. Independent sample t-test was used to compare data across two groups. P<0.05 was considered statistically significant. Results:(1) At 6 hours and 1, 3, 5, 7 days after surgery, the experimental group displayed higher blood perfusion than the control group at the bilateral iliolumbar and the left posterior intercostal vascular territories (all P<0.01). (2) On the 7th day after surgery, the artery dilation of the experimental group was more obvious than that of the control group; the percentage of the survived flap area in the experimental group was higher than that in the control group [(87.6±3.2)% vs. (65.3±3.0)%, P<0.01]; the intraluminal diameter of the choke artery was greater in the experimental group than that in the control group[(49.3±3.1) μm vs. (35.1±2.3) μm, P<0.01]; and the relative expression of eNOS in the experimental group was higher than that in the control group (0.87±0.07 vs. 0.50±0.05, P<0.01). Conclusion:The distal vein (right posterior intercostal vein) of dorsal four-territory perforator flap of SD rats directly guided the pedicle artery blood supply to promote the expression of eNOS, dilated the arteries in each zone of the flap, increased the blood supply to the distal artery of the flap, and ultimately enhanced the flap survival area.

Objective:To explore the risk factors of fatty liver occurrence in postoperative breast cancer patients after endocrine therapy, and establish a risk prediction model.Methods:A total of 120 breast cancer patients who received endocrine therapy after surgery in Huanggang Central Hospital from June 2014 to June 2016 were retrospectively selected, and another 120 breast cancer patients who did not receive endocrine therapy after surgery in the same period were selected as the control group. The difference of prognosis between patients treated with endocrine therapy or not was compared. According to the occurrence of fatty liver after endocrine therapy, the patients were divided into fatty liver group (63 cases) and non-fatty liver group (57 cases). Multivariate logistic regression was used to analyze the risk factors of fatty liver occurrence after endocrine therapy. Based on the risk factors, R 3.3.2 software was used to establish a nomogram prediction model. The Harrell consistency index and receiver operating characteristic (ROC) curve (with imageological diagnosis as the "gold standard") were used to analyze the effect of the model on predicting the occurrence of fatty liver, and the calibration curve was used to evaluate the consistency between the model prediction and the actual situation.Results:The recurrence and metastasis rate and mortality rate of patients with endocrine therapy were lower than those of patients without endocrine therapy, and the 3-year and 5-year disease-free survival rates and overall survival rates were higher than those of patients without endocrine therapy (all P < 0.05). Compared with the non-fatty liver group, the levels of alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBIL), total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and body mass index (BMI) in the fatty liver group increased (all P < 0.05), while the level of high-density lipoprotein cholesterol (HDL-C) decreased ( P < 0.05). Multivariate logistic regression analysis showed that increased ALT [ OR = 4.680 (95% CI 3.621-5.738)], AST [ OR = 4.862 (95% CI 3.809-5.914)], TBIL [ OR = 3.808 (95 % CI 2.754-4.861)], TC [ OR = 4.294 (95% CI 3.320-5.267)], TG [ OR = 3.401 (95% CI 2.442-4.359)], LDL-C [ OR = 2.976 (95% CI 2.037-3.916)], BMI [ OR = 4.082 (95% CI 3.118-5.045)] and decreased HDL-C [ OR = 0.930 (95% CI 0.876-0.983)] were independent risk factors for fatty liver occurrence after endocrine therapy (all P < 0.05). The consistency index of the nomogram model was 0.792 (95% CI 0.721-0.863), and the area under the ROC curve (AUC) of the nomogram model to judge the occurrence of fatty liver was 0.810 (95% CI 0.734-0.886), indicating that the model had a good discrimination between fatty liver and non-fatty liver. The evaluation of calibration curve showed that the nomogram model for prediction of fatty liver had a good consistency with the actual occurrence of fatty liver. Conclusions:Increased ALT, AST, TBIL, TC, TG, LDL-C, BMI and decreased HDL-C are risk factors for fatty liver occurrence after endocrine therapy in postoperative breast cancer patients. The nomogram model based on risk factors has a good effect on predicting the occurrence of fatty liver.

Objective: To analyze the causes of local necrosis and hemodynamics after pedicle peroneal perforator flap and try to find out prevention strategies. Methods: Retrospective 17 tissue defect cases admitted by Plastic and Reconstructive Surgery of Ningbo First Hospital, which treated by pedicle perforator flap with kinds of complications. 3 of 17 were naked the perforators to reduce reverse pressure. Patients involved 12 male, 5 female, ages from 22 to 46, with defected area from 5.0 cm×11.0 cm to 8.0 cm×14.0 cm, located in lateral ankle. Results: 3 to 5 days postoperative 12 cases with distal local necrosis, all of which were designed interregional, one with performator naked, turned back after drainage and wound dressing, 3 cases were gradually swelling and purple postoperative, two of them were perforator naked. 1 weeks later, the distal skin of flap necrosis and were gradually turning black scab appeared.With scab cutting and fascia survived, no bony tissues exposure, after 0.5% povidone iodine wet dressing regularly, endothelial cells crawled to cover. 2 cases with larger ranger of swelling and purple, not be better even pedicale releasing was conducted, 2 weeks later most part of the flap necrosis and the distal turned black eschar. After debridement and skin grafting, wounds healed later.All patients were followed up for 3 months with no flap transplantation required. Conclusions Coaxial homology, within 2 choke vessel areas, perforator skeletonization, kick out the small saphenous vein, might be the ways to reduce the complication of the cross area designing trans pedicled peroneal perforator flap.