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Objective:To investigate the effects of Juglone on the apoptosis of osteosarcoma(OS)cells(U2OS and MG63 cells)through the cysteinyl aspartate specific proteinase-3(Caspase-3)/gasdermin E(GSDME)-mediated pyroptosis pathway.Methods:The U2OS and MG63 cells were cultured in vitro and divided into control group,different concentrations(5,10 and 20 μmol·L-1)of Juglone groups and Caspase-3 inhibitor Z-DEVD-FMK group(10 μmol·L-1 Juglone+30 μmol·L-1 Z-DEVD-FMK).The survival rates of cells in various groups were assessed by cell counting kit-8(CCK-8)assay,and the apoptotic rates were detected by flow cytometry.Lactate dehydrogenase(LDH)release assay was used to measure the release rates of LDH from the cells.Western blotting method was used to detect the expression levels of apoptosis-related proteins including B-cell lymphoma-2(Bcl-2),Bcl-2-associated X protein(Bax),cleaved-Caspase-3 and poly(ADP-ribose)polymerase(PARP)and pyroptosis-related proteins including GSDME full form(GSDME-F)and GSDME N-terminal(GSDME-N).The levels of interleukin-1β(IL-1β)and interleukin-18(IL-18)in the cell supernataut in various groups were measured by enzyme-linked immunosorbent assay(ELISA)method.Results:Compared with control group,the survival rates of cells in 5,10,and 20 μmol·L-1Juglone groups were significantly decreased(P＜0.05 or P＜0.01),and the 50％inhibitory concentration(IC50)values of U2OS cells and MG63 cells were 8.4 and 10.2 μmol·L-1,respectively.Compared with control group,the apoptotic rates and LDH release rates of U2OS and MG63 cells in 5 and 10 μmol·L-1Juglone groups were significantly increased(P＜0.05 or P＜0.01).Compared with control group,the expression levels of Bax,cleaved-Caspase-3,and cleaved-PARP proteins in 5 and 10 μmol·L-1 Juglone groups were significantly increased(P＜0.01),while the expression levels of Bcl-2 protein were significantly decreased(P＜0.01).Compared with control group,the levels of IL-1β and IL-18 in cell supernatant in 5 and 10 μmol·L-1Juglone groups were increased(P＜0.01).Compared with control group,the expression levels of cleaved-Caspase-3 and GSDME-N proteins in 5 and 10 μmol·L-1 Juglone groups were significantly increased(P＜0.01),while there was no difference in the expression level of GSDME-F protein(P＞0.05).Compared with 10 μmol·L-1 Juglone group,the expression levels of cleaved-Caspase-3 and GSDME-N in Z-DEVD-FMK group were significantly decreased(P＜0.01),while there was no difference in the expression level of GSDME-F protein(P＞0.05).Conclusion:Juglone can induce the apoptosis of U2OS and MG63 cells and cause the Caspase-3/GSDME-mediated pyroptosis.

Objective:To observe the clinical effect of tracheal tube with an attached laryngeal pillow cushion(LPC)in the patients under general anesthesia,and to provide new methods for the preventing arytenoid dislocation during tracheal intubation.Methods:Forty-eight patients scheduled for elective oral tracheal intubation under general anesthesia and meeting the inclusion criteria were selected.Based on the head and neck positions,the patients were divided into supine without pillow(SWOP)group,supine with pillow(SWP)group,trendelenburg position(TP)group,and head side position(HSP)group,each group consisted of 12 patients.The patient in the following groups underwent two sequential treatments after tracheal intubation:intervention group(LPC-inflated)and control group(LPC uninflated,representing the current method of tracheal tube use).One patient in TP group and two patients in HSP group rminated the experiment,so a total of 45 patients were successfully included in this study.Electronic fiber laryngoscopy was used to observe and record the positional relationship between the endotracheal tube LPC and the posterior commissure arytenoid joint area under different head and neck positions after two treatments.The evaluation indicators were whether the tracheal tube was lifted from the posterior commissure arytenoid joint area and the degree of compression of the tracheal tube on the arytenoid joint.The incidence of tracheal tube lift-off and the percentage of compression degree on cricoarytenoid joint of the patients in various groups were calculated.Results:Within the same head and neck position group,compared with control group,the incidence of endotracheal tube lift-off of the patients in intervention group was significantly increased(P<0.05),and the percentage of compression degree of endotracheal tube on the arytenoid joint was significantly decreased(P<0.05).In control and intervention groups,there were no statistically significant differences in the incidence of endotracheal tube lift-off and the percentage of compression degree on arytenoid joint of the patients in various head and neck positions groups(P>0.05).Conclusion:Under the four head and neck positions,inflating the LPC of the tracheal tube can lift the tracheal tube from the posterior commissure arytenoid joint area,effectively relieving or reducing the compression and mechanical friction injuries to the arytenoid joint.

BACKGROUND:Unicompartmental knee arthroplasty can effectively treat severe unilateral knee osteoarthritis.It has been found that posterior tibial cortical fracture is prone to occur after unicompartmental knee arthroplasty.The fracture begins at the keel groove of tibial osteotomy.The tibial prosthesis riser length affects the biomechanical results of the knee joint after unicompartmental knee arthroplasty. OBJECTIVE:To investigate the effect of tibial prosthesis riser length on knee biomechanics in unicompartmental knee arthroplasty,and to find out the relationship between prosthesis riser length and anterior and posterior tibial diameters of patients. METHODS:Computed tomography image data and commonly used unicompartmental prostheses were selected from a 37-year-old healthy female with no history of knee disease.A natural knee joint model was established and a unicompartmental prosthesis model was built.Eight different lengths of tibial prosthesis risers were established,with a minimum length of 31 mm and a maximum length of 34.5 mm in 0.5 mm increments,for comparison with the commonly used hospital prosthesis riser length of 33.2 mm.The material of the femoral component and tibial disc was cobalt-chromium-molybdenum alloy,and the tibial spacer was ultra-high molecular weight polyethylene.The biomechanical changes of the knee joint were observed using finite element analysis software loaded with 1000 N over the femur. RESULTS AND CONCLUSION:(1)The tibial stress was minimal at a tibial prosthesis riser length of 33 mm;the anterior cruciate ligament stress was minimal;the lateral meniscus stress was minimal,and the femoral prosthesis stress was minimal.The remaining components were less stressful.(2)The subject's medial tibial plateau anterior-posterior diameter length was 53 mm,and by calculating the ratio,the optimal ratio of tibial prosthesis riser length to anterior-posterior tibial diameter should be about 62%.If it is lower than this value,aseptic loosening of the prosthesis may occur,and if it is higher than this value,fracture of the bone cortex at the anterior-posterior end of the tibia may occur.

Tetrandrine(TET),a natural bisbenzyl isoquinoline alkaloid extracted from Stephania tetrandra S.Moore,has diverse pharmacological effects.However,its effects on melanoma remain unclear.Cellular prolif-eration assays,multi-omics analyses,and xenograft models were used to determine the effect of TET on melanoma.The direct target of TET was identified using biotin-TET pull-down liquid chromatograph-mass spectrometry(LC-MS),cellular thermal shift assays,and isothermal titration calorimetry(ITC)analysis.Our findings revealed that TET treatment induced robust cellular autophagy depending on activating transcription factor 6(ATF6)-mediated endoplasmic reticulum(ER)stress.Simultaneously,it hindered autophagic flux by inducing cytoskeletal protein depolymerization in melanoma cells.TET treatment resulted in excessive accumulation of reactive oxygen species(ROS)and simultaneously triggered mitophagy.Sirtuin 5(SIRT5)was ultimately found to be a direct target of TET.Mechanistically,TET led to the degradation of SIRT5 via the ubiquitin(Ub)-26S proteasome system.SIRT5 knockdown induced ROS accumulation,whereas SIRT5 overexpression attenuated the TET-induced ROS accumula-tion and autophagy.Importantly,TET exhibited anti-cancer effects in xenograft models depending on SIRT5 expression.This study highlights the potential of TET as an antimelanoma agent that targets SIRT5.These findings provide a promising avenue for the use of TET in melanoma treatment and underscore its potential as a therapeutic candidate.

Objective:To explore the efficacy and safety of treating advanced esophageal cancer by implanting the common stent and the radioactive 125I particle stent with endoscope. Methods:The clinical data of patients with advanced esophageal cancer admitted to Jingbian County People's Hospital of Shaanxi Province, the First Affiliated Hospital of Xi'an Medical University, Xijing Hospital of Digestive Diseases of Air Force Medical University and the First Hospital of Yulin of Shaanxi Province from December 2014 to December 2020 were retrospectively analyzed. Patients were divided into common stent group ( n=66) and radioactive particle stent group ( n=34) according to different stent types. The postoperative complications, Karnofsky performance status (KPS) score, dysphagia score, restenosis rate and quality of life were compared between the two groups. Results:The incidences of postoperative retrosternal pain in the common stent group and the radioactive particle stent group were 65.2% (43/66) and 47.1% (16/34) respectively. The incidences of pharyngeal pain and hoarseness were 12.1% (8/66) and 5.9% (2/34) . The incidences of abdominal pain were 9.1% (6/66) and 2.9% (1/34) . The incidences of errhysis were 3.0% (2/66) and 2.9% (1/34) . The incidences of vomiting and nausea were 7.6% (5/66) and 5.9% (2/34) respectively. There were no statistically significant differences between the two groups ( χ2=3.04, P=0.081; χ2=0.40, P=0.527; χ2=0.53, P=0.467; χ2<0.01, P>0.999; χ2<0.01, P>0.999) . In the two groups, KPS scores in the first, second, third and sixth month after operation were higher than those before operation (all P<0.05) . KPS scores of the radioactive particle stent group in the second, third and sixth month were significantly higher than those of the common stent group [ (89.73±7.84) points vs. (82.37±7.42) points, t=4.62, P<0.001; (93.63±8.13) points vs. (88.33±7.28) points, t=3.74, P<0.001; (92.78±6.26) points vs. (87.28±8.73) points, t=3.77, P<0.001]. The dysphagia scores of patients in the two groups in the first, second, third and sixth month were lower than those before operation (all P<0.05) . The dysphagia scores of the radioactive particle stent group in the third and sixth month after operation were significantly lower than those of the common stent group [ (0.68±0.12) points vs. (2.33±0.32) points, t=26.20, P<0.001; (0.82±0.22) points vs. (2.67±0.24) points, t=36.92, P<0.001]. In the third month after operation, the restenosis rate of the radioactive particle stent group was significantly lower than that of the common stent group [5.88% (2/34) vs. 42.4% (28/66) , χ2 =14.27, P<0.001]. The scores of QLQ-C30 and OES-18 scales in the first, second, third and sixth month after operation were lower than those before operation (all P<0.05) . The scores of QLQ-30 scale in the radioactive particle stent group in the second, third and sixth month were significantly lower than those in the common stent group [ (19.12±3.02) points vs. (21.22±2.87) points, t=3.39, P=0.001; (15.04±1.68) points vs. (20.43±2.23) points, t=12.39, P<0.001; (14.38±2.18) points vs. (19.77±3.67) points, t=9.20, P<0.001]. The scores of OES-18 scale in the radioactive particle stent group were also significantly lower than those in the common stent group [ (17.13±2.07) points vs. (20.64±2.11) points, t=7.95, P<0.001; (15.22±1.88) points vs. (19.24±1.76) points, t=10.62, P<0.001; (14.74±2.36) points vs. (18.53±3.27) points, t=6.01, P<0.001]. Conclusion:The radioactive particle stent can improve the quality of life of patients with advanced esophageal cancer with esophageal stenosis, so as to improve dysphagia and reduce the restenosis rate after operation. However, whether it is obviously superior to common stent in prolonging survival time and reducing complications needs to be further confirmed by a multicenter, prospective, large-sample randomized controlled study.

Objective    To systematically evaluate the risk factors for postoperative pulmonary infection in patients with esophageal cancer. Methods    CNKI, Wangfang Data, VIP, CBM, PubMed, EMbase, The Cochrane Library were searched from inception to January 2021 to collect case-control studies, cohort studies and cross-sectional studies about risk factors for postoperative pulmonary infection in patients with esophageal cancer. Two researchers independently conducted literature screening, data extraction and quality assessment. RevMan 5.3 software and Stata 15.0 software were used for meta-analysis. Results    A total of 20 articles were included, covering 5 409 patients of esophageal cancer. The quality score of included studies was 6-8 points. Meta-analysis results showed that age (MD=1.99, 95%CI 0.10 to 3.88, P=0.04), age≥60 years (OR=2.68, 95%CI 1.46 to 4.91, P=0.001), smoking history (OR=2.41, 95%CI 1.77 to 3.28, P<0.001), diabetes (OR=2.30, 95%CI 1.90 to 2.77, P<0.001), chronic obstructive pulmonary disease (OR=3.69, 95%CI 2.09 to 6.52, P<0.001), pulmonary disease (OR=2.22, 95%CI 1.16 to 4.26, P=0.02), thoracotomy (OR=1.77, 95%CI 1.32 to 2.37, P<0.001), operation time (MD=14.08, 95%CI 9.64 to 18.52, P<0.001), operation time>4 h (OR=3.09, 95%CI 1.46 to 6.55, P=0.003), single lung ventilation (OR=3.46, 95%CI 1.61 to 7.44, P=0.001), recurrent laryngeal nerve injury (OR=5.66, 95%CI 1.63 to 19.71, P=0.006), and no use of patient-controlled epidural analgesia (PCEA) (OR=2.81, 95%CI 1.71 to 4.61, P<0.001) were risk factors for postoperative pulmonary infection in patients with esophageal cancer. Conclusion    The existing evidence shows that age, age≥60 years, smoking history, diabetes, chronic obstructive pulmonary disease, pulmonary disease, thoracotomy, operation time, operation time>4 h, single lung ventilation, recurrent laryngeal nerve injury, and no use of PCEA are risk factors for postoperative pulmonary infection in patients with esophageal cancer. Due to the limitation of the quantity and quality of included literature, the conclusion of this study still needs to be confirmed by more high-quality studies.

In unicompartmental replacement surgery, there are a wide variety of commercially available unicompartmental prostheses, and the consistency of the contact surface between the common liner and the femoral prosthesis could impact the stress distribution in the knee after replacement in different ways. Medial tibial plateau fracture and liner dislocation are two common forms of failure after unicompartmental replacement. One of the reasons is the mismatch in the mounting position of the unicompartmental prosthesis in the knee joint, which may lead to failure. Therefore, this paper focuses on the influence of the shape of the contact surface between the liner and the femoral prosthesis and the mounting position of the unicompartmental prosthesis on the stress distribution in the knee joint after replacement. Firstly, a finite element model of the normal human knee joint was established, and the validity of the model was verified by both stress and displacement. Secondly, two different shapes of padded knee prosthesis models (type A and type B) were developed to simulate and analyze the stress distribution in the knee joint under single-leg stance with five internal or external rotation mounting positions of the two pads. The results showed that under a 1 kN axial load, the peak contact pressure of the liner, the peak ACL equivalent force, and the peak contact pressure of the lateral meniscus were smaller for type A than for type B. The liner displacement, peak contact pressure of the liner, peak tibial equivalent force, and peak ACL equivalent force were the smallest for type A at 3° of internal rotation in all five internal or external rotation mounting positions. For unicompartmental replacement, it is recommended that the choice of type A or type B liner for prosthetic internal rotation up to 6° should be combined with other factors of the patient for comprehensive analysis. In conclusion, the results of this paper may reduce the risk of liner dislocation and medial tibial plateau fracture after unicompartmental replacement, providing a biomechanical reference for unicompartmental prosthesis design.
Arthroplasty, Replacement, Knee/methods* ; Biomechanical Phenomena ; Finite Element Analysis ; Humans ; Knee Joint/surgery* ; Knee Prosthesis ; Tibia/surgery*

Objective:To observe the influence of methylprednisolone in the respiratory mechanical parameters in the elderly patients undergoing major surgeries with general anesthesia intubation after mechanical ventilation,and to investigate whether methylprednisolone can improve the respiratory system degenerative diseases and benefit the mechanical ventilation. Methods:Sixty patients undergoing elective line laparotomy were divided into experimental group and conrol group (n=30) according to their wishes.The patients in experimental group receieved intravenous injection of methylprednisolone 1 mL (40 mg) after endotracheal intubation,and the patients in control group receieved 1 mL intravenous saline water injection.The airway peak pressure (Ppeak), airway platform (Pplat), lung compliance (Compl), and airway resistance (Raw) of the patients in two groups were recorded at the time of immediately before administration and 10,20,30,40 min after administration.The arterial blood oxygen partial pressure(PaO2),arterial blood CO2 partial pressure(PaCO2),CO2 partial pressure at the end of breathe out(PetCO2) of the patients were detected at the time of immediately before administration and 20 min after administration.Results:Compared with before administration, the respiratory mechanics parameters of the patients in control group 10,20,30,40 min after administration had no statistically significant differences (P>0.05);the Comple of the patients in experimental group was singnificantly increased (P<0.05), and the Ppeak, Pplat,and Raw were significantly decreased (P<0.05).Compared with control group, the Compl of the patients in experiment group 10,20,30,and 40 min after administration were significantly increased (P<0.05),and the Ppeak, Pplat, and Raw were decreased (P<0.05).Compared with before administration,the PaO2,PaCO2,and PetCO2 of the patients in control group 20 min after administration had no significant differences(P>0.05);the PaCO2 and PetCO2 of the patients in experimental group 20 min after administration were decreased(P<0.05),and the PaO2 was increased(P<0.05).Compared with control group,the PaCO2 and PetCO2 of the patients in experimental group 20 min after administration were decreased(P<0.05),and the PaO2 was increased(P<0.05).Conclusion:Methylprednisolone can obviously reduce PaCO2,Peak, and Pplat and increase PaO2 and Compl;methylprednisolone has possibility in improving the adverse effects of degenerative disease of respiratory system on general anesthesia in the elderly patients.

Objective To evaluate the measurement uncertainty of the detecting procedure of amino acids and carnitines by the Waters ACQUITY TQD tandem mass spectrometer and PerkinElmer NeoBaseTM non‐derivatized MSMS kit ,and to discuss the meaning of evaluation .Methods According to the method provided by the Medical Laboratories‐Evaluation and Expression of Measurement Uncertainty ,the internal quality control was detected by using two different batch codes of kit for 20 d ,once before and after the routine sample detection on each working day ,the detector were randomly changed ,and then the measurement uncer‐tainty introduced by measurement reproducibility was calculated;the amino acid external assessment quality control data in 20 times of neonatal hereditary metabolic disease tandem mass spectrometry screening provided by the National Center for Clinical Laborato‐ry in 2014 and 2015 ,and the same and 16 times of carnitines external assessment quality control data were performed the statistics , and then the measurement uncertainty introduced by bias was calculated .Next the relative standard uncertainty and the relative ex‐panded uncertainty according to the measurement uncertainty introduced by bias and measurement reproducibility were calculated . The allowed total error indicators of amino acid and carnitines external quality assessment in the neonatal hereditary metabolic dis‐ease tandem mass spectrometry screening by the National Center for Clinical Laboratory were used as the target expanded uncer‐tainty .Results The relative expanded uncertainties of citrulline ,methionine ,phenylalanine ,propionyl carnitine ,octanoyl carnitine , dodecanoyl carnitine ,palmitoyl carnitine and octadecanoyl carnitine were 19 .1% -26 .1% (k=2) ,which were smaller than the tar‐get uncertainty .The relative expanded uncertainties of leucine ,tyrosine ,valine ,free carnitine were 31 .0% -43 .3% (k=2) ,which were greater than the target uncertainty .The uncertainty of isovaleryl carnitine needed to be estimated separately .Conclusion As‐sessing the measurement uncertainty of the detecting procedure of amino acids and carnitines by the non‐derivatized tandem mass spectrometer method can not only provide an opportunity for continuously improving the detection quality ,but also can help the ex‐perimental technique staffs to interpret the test data correctly and the clinician to use the detection reports correctly .